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California Hazardous Moials Inventory Form - Chemical Doiption <br /> PAGE(2) = OF(3) <br /> BUSINESS NAME (4) TED'S WELDING & REPAIR <br /> CHEMICALLOCATION(S) (5) <br /> <br /> CHEMICAL NAME (8) WASTE ANTIFREEZE TRADE SECRET(11) ❑yES ®NO <br /> COMMON NAME (9) WASTE ANTIFREEZE *EHS (12) ❑YES ®NO <br /> IF EHS BOX IS"Y" <br /> CAS # (10) MIXTURE ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE ❑MIXTURE ®WASTE RADIOACTIVE(15) ❑YES ®NO (16) N/A <br /> PHYSICAL STATE(17) ❑SOLID ®LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) RE❑FIRE ❑ ACTIVE [:1PRESSURE RELEASE ®ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑LBS <br /> CODE 134 ❑CU FT ❑TONS] MAX ON SITTEE Y AMT(23)5 5 <br /> DAYS ON SITE (20) 36 5 *If EHS, amounts must be in lbs AVG DAILY AMT(24) 3 0 <br /> ON SITE <br /> LARGEST (21 5 5 ANNUAL WASTE AMT(25) 5 5 <br /> CONTAINER <br /> STORAGE (26)[:]ABOVE GROUND TANK ❑CAN ❑BOX ❑TAN <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑CYLINDER ElRAIL <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑OTH <br /> ❑STEEL DRUM ❑FIBER DRUM ❑PLASTIC BOTTLE ❑Other <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 (3 1)EHS 32 CAS# <br /> ❑YES E]NqF- <br /> L <br /> OYES ❑N <br /> ❑YES ❑N <br /> ❑YES ON <br /> ❑YES ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1142 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> DATE REC'D: 9/22/06 For Official Use Only: 19 C 0 R ❑S SIC 12/99 <br />