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9 <br />0 <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY — CHEMICAL <br />10 <br />®ADD ❑DELETE []REVISE <br />I. FACILITY INFORMATION <br />as rnuu s 2 <br />it # 0707 <br /> <br />HI-rr. "M Mw ... .._. <br />HAZARD CLASS OR DIVISION #---- 2.2_ <br />If EPCRA. Please Sign Here <br />Revised (5/03) <br />UMVIOUN <br />U. CHEMICAL INFORMATION <br />C,'T <br />Irubjeclto EI'CRti Mar to lcmn6om <br />EHS, ❑ Yes N No <br />*If EHS is "Yes', all amounts below most be in Ibs. <br />JPA) <br />211 RADIOACTIVE ❑ Yes N No 212 1 CURIES <br />RE ❑ c. WASTE <br />214LARGEST CONTAINER 50lbs/213 euible feel <br />lD N c. GAS <br />IVF. ®a PRESSURE RELEASE ® d. ACUTE HEALTH ❑ c. CHRONIC HEALTH <br />lbs / 426 cubic feet I NIA 11'^ <br />221 DAYS ON SITE <br />)BIC FEET ❑ c. POUNDS ❑ d. TONS 365 <br />amount ust tk moo ds <br />'LASTTCINONMETALLIC DRUM j. ❑Cir. FIBER DROUa. M PLASTIC OTTLt1 ❑E r. O IF RAILCAR <br />N <br />ABOY ❑ k. BOX ❑ o. TOTE BIN <br />❑ 1. CYLINDER ❑ P. TANK WAGON <br />__ .. _..,..... I _ nv nm nRMIFNr <br />1 It. ABOVE AMBIENT D c. BELOW AMBIENT ❑d. CRYOGENIC <br />WENT (For mixture or waste only) SHS <br />222 ❑ Yes ❑ No 229 <br />231 ❑ Yes ❑ No 252 <br />zss ❑ Yes [I No xlfi <br />259 ❑ Yes ❑ No 240 <br />M3 ❑ Yes ❑ No 2N <br />UN#_1046 <br />CAS# <br />225 <br />224 <br />225 <br />229 <br />253 <br />252 <br />241 <br />245 <br />FACILITY ID # <br />CHEMICAL NAME <br />Helium <br />COMMON NAME <br />Helium <br />CAs# 7440-59-7 <br />FIRE CODE HAZARD CLASSES (ComplelelrequiredbyC <br />HAZARDOUS MATERIAL <br />TYPE (Check one item only) s a. PURE ❑ b. MIXTL <br />PHYSICAL STATE <br />(Check one item only) ❑ a. SOLID 0 b. LIQU <br />FFD HAZARD CATEGORIES <br />(Check all that apply) ❑ a FIRE ❑ b. REAC' <br />AVERAGE DAILY AMOUNT 217 <br />MAXI <br />45 cubic feet <br />1100 <br />UNITS, ❑ es. GALLONS ®b. CI <br />Check one item onl • If EH: <br />STORAGE <br />CONTAINER [I a ABOVE GROUND TANK 130J <br />[3 b. UNDERGROUND TANK ❑ F. CA <br />® c. TANK INSIDE BUILDING ❑ a. C/ <br />❑ d. STEEL DRUM ❑ h. SIL( <br />STORAGE PRESSURE ❑ a. AMBIENT 1 <br />STORAGE TEMPERATURE ®a. AMBIENT I <br />o/at,VTEpmsen <br />MP( <br />) <br />2 <br />3 <br />4 <br />5 <br />mofe a291 oan l°IT <br />HI-rr. "M Mw ... .._. <br />HAZARD CLASS OR DIVISION #---- 2.2_ <br />If EPCRA. Please Sign Here <br />Revised (5/03) <br />UMVIOUN <br />U. CHEMICAL INFORMATION <br />C,'T <br />Irubjeclto EI'CRti Mar to lcmn6om <br />EHS, ❑ Yes N No <br />*If EHS is "Yes', all amounts below most be in Ibs. <br />JPA) <br />211 RADIOACTIVE ❑ Yes N No 212 1 CURIES <br />RE ❑ c. WASTE <br />214LARGEST CONTAINER 50lbs/213 euible feel <br />lD N c. GAS <br />IVF. ®a PRESSURE RELEASE ® d. ACUTE HEALTH ❑ c. CHRONIC HEALTH <br />lbs / 426 cubic feet I NIA 11'^ <br />221 DAYS ON SITE <br />)BIC FEET ❑ c. POUNDS ❑ d. TONS 365 <br />amount ust tk moo ds <br />'LASTTCINONMETALLIC DRUM j. ❑Cir. FIBER DROUa. M PLASTIC OTTLt1 ❑E r. O IF RAILCAR <br />N <br />ABOY ❑ k. BOX ❑ o. TOTE BIN <br />❑ 1. CYLINDER ❑ P. TANK WAGON <br />__ .. _..,..... I _ nv nm nRMIFNr <br />1 It. ABOVE AMBIENT D c. BELOW AMBIENT ❑d. CRYOGENIC <br />WENT (For mixture or waste only) SHS <br />222 ❑ Yes ❑ No 229 <br />231 ❑ Yes ❑ No 252 <br />zss ❑ Yes [I No xlfi <br />259 ❑ Yes ❑ No 240 <br />M3 ❑ Yes ❑ No 2N <br />UN#_1046 <br />CAS# <br />225 <br />224 <br />225 <br />229 <br />253 <br />252 <br />241 <br />245 <br />