Laserfiche WebLink
California Hazardous Materials Inventory Form - Chemical Description <br /> (U ADD ❑DELETE ❑REVISE 2001 PAGE(2) = OF(3)� <br /> BUSINESS NAME (4) <br /> 17(ln er Tnt. �bct 1 –D CA )'I's 6rrM ". f <br /> CHEMICAL LOCATION(S)(5) S r cl + PCj � ,:; —E��CEIVED <br /> MAP#(6)/ GRID#(7) �t E= EE—^LN 2001 <br /> SANJ0 <br /> CHEMICAL NAME (8) /y ©� 1 X TRADE SECREPfde <br /> E <br /> l� *EHS(12) ❑Y N <br /> COMMON NAME (9) a <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) /a _J? _ C ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) pIN <br /> LIQU (16) <br /> ❑Y � <br /> PHYSICALSTATE(17) ❑SOLID ❑ ID EAGAS 1�N1 CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE ❑REACTIVE PRESSURE RELEASE (gACUTE HEALTH M CHRONIC HEALTH <br /> STATE WASTE (19)�� UNITS*(22) GAL ❑CU FT MAX Y AMT(23) �fl� <br /> CODE ON-SITE <br /> ®LBS ❑TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> bJ *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 /'�✓1 ANNUAL WASTE AMT(25)� <br /> CONTAINER "t vv <br /> STORAGE (26) ®ABOVE GROUND TANK ❑ CAN ❑ BOX []TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK [:]CARBOY ❑ CYLINDER [:]RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO ❑GLASS BOTTLE 0--------------------- <br /> [_1 STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ AMBIENT ®ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ❑AMBIENT ❑ABOVE AMBIENT ®BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT 32 CAS# <br /> ❑3� <br /> Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y El EN <br /> ]Y [_]NII <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) I O 3 <br /> (34)WHAT IS MATERIAL S (3 P rp► Sze <br /> USED FOR? <br /> For Official Use Only: X C ❑ R ❑ S SIC 12/00 <br />