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Jan 19 07 09: 39a James Paulk (209) 948-2446 p. 8 <br /> 40 0 <br /> California Hazardous Materials inventor Form- ��iE��E® <br /> . y Chemical Description <br /> p} ❑ ❑ ❑ " POAGE(2) A(3} wTa <br /> ADD DELETE REVISE2007 <br /> °I;UL;N 1 Y <br /> BUSINESS NAME (4) ' ur ER NCY SERMES <br /> s �- <br /> CHEMICAL LOCATION(S)(5) <br /> (Within facility,not street address <br /> MAP#(6)/ GRID 4(7) <br /> CHEMICAL NAME (8) TRADE-SECRET(11) 1 ❑X ❑N . <br /> COMMON NAME (9) *EHS(12) ❑Y D <br /> *IF EHS BOX IS"Y" <br /> CAS# (10) ALL AMOUNTS MUST BE 1N LBS <br /> FIRE CODE (13) <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE aMIXTURE WASTE RADIOACTIVE-(15) LEI gN (16) <br /> PHYSICAL STATE(17) E]SOLID XQUID ❑CTAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIIt); ❑REACTIVE E[PKESSLFWMZASE ❑ACUTCEHEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNIT'S"(22)WAL_ ❑.CU-FT MAX-DAILY.AMT.(23) <br /> CODE [_]LBS ❑F]TONS ON-SITE �Q <br /> DAYS ON SITE (20) AVCrDAlLY-AM`F(24) , <br /> If EHS, amounts must be in lbs ON-SITE /e)0 <br /> LAROEST <br /> CONTAINER (21 ANNUAL WAS-1-r-AMT(25) . <br /> STORAGE (26) ❑ABOVE GROUND TANKCAN ❑ BOX ❑TANK WAGON <br /> CONTAIN ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER ❑RAIZ,CAR <br /> ❑TANK INSIDE SU11:,I JNG ❑SIZE} El-GLASS BOTTLE El--------------------- <br /> ❑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-AMRIENI' []-CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (3Q HAZARDOUS COMPONENT 3! EHS 32 CAS# <br /> ❑Y ❑N <br /> �Y 17 <br /> ❑Y ON <br /> ❑Y ❑N <br /> ❑Y 0 I F <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) /;z <br /> (34)WHAT IS MATERIALv <br /> USED FOR? <br /> For Official Use Only: C [:] R [] S SIC 12103 <br />