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California Hazardousloaterials Inventory Form - Chem* Description <br /> (I) ®ADD DELETE REVISE 2001 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> 1ti C . <br /> ULC 1 4 200n <br /> CHEMICAL LOCATIONS)( <br /> <br /> <br /> CHEMICAL NAME (8) TRADE SECRET(I 1) ❑ ® N <br /> QialG� <br /> COMMON NAME (91 *EHS (12) ❑t © N <br /> G U <br /> *IF EHS BOX IS"l"" <br /> CAS # (1()) 407 4/ el ALL AMOUNTS MUST BE W LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE �bIIXTURE ❑WASTE RAD[O.ACTNE(IS) ❑ Y ON 116) <br /> PHYS[CALSTATE(17) [:]SOLIDLIQUID ❑GAS 1�1 CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ ACUTE HEALTH [3CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) 12rGAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE IL ON-SITE Za o6� <br /> ❑LBS ❑TONS <br /> DAYS ON SITE (20) .AVG DAILY AMT(24) <br /> 36s *If EHS, amounts must be in lbs ON-SITE O pyo <br /> LARGEST (21) ANNUAL WASTE AMT(25)� <br /> CONTAINER <br /> STORAGE (26) ABOVE GROUND TANK CAN ❑ BOX ❑TANKNVAGOY <br /> CONTAINER ❑ UNDER GROUND TANK [:]CARBOY ❑ CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING SILO ❑ GLASS BOTTLE ❑-------------------- <br /> ❑STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (2 7) 21 AMBIENT [:]ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ® AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGEMC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (3 1)EHS (321 CAS# <br /> FE-1Y ❑N <br /> ❑Y ❑ N <br /> ❑Y ❑ N <br /> ❑ y ❑ N <br /> 11 ❑Y ❑ N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT)=: � <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use only: ❑ C ❑ R LIE SJC 12/00 <br />