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California Hazardous Materials Inventory Form - Chetal Description <br /> (1) <br /> ELETE REVISE 2001 PAGE(2) ® OF(3)� <br /> ADD D <br /> BUSINESS NAME (4) A <br /> CHEMICAL LOCATION(S)(5)F <br /> MAP#(6)/ GRID#(7) E= E� � <br /> !fir <br /> CHEMICAL NAME (8) u:i „ .... . .,c <br /> TRADE SECRET(I 1) ❑Y N <br /> (��—MF,NT LICa'�UI� �}DffES/✓E <br /> *EHS 02) ❑Y N <br /> COMMON NAME (9) GLUT <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) AA \XW RE ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) rjPURE MIXTURE ❑WASTE RADIOACTIVE(IS) ❑Y N (IF>�� <br /> CURIES <br /> PHYSICAL STATE(17)1 [:]SOLIDUID SOLID LIQ ❑GAS <br /> FED HAZARD FIRE REACTIVE PRESSURE RELEASE E] ACUTE HEALTH ® CHRONIC HEALTH <br /> CATEGORIES (18) 1:1 FIRE I ❑ <br /> STATE WASTE (19)�� UNITS* (22)FOLBS <br /> GAL HCUNS FT MAX DAILY AMT(23) <br /> CODEON-SITE <br /> TO <br /> DAVG DAILY AMT(24) <br /> DAYS ON SITE (20) � <br /> *If EHS, amounts must be in lbs ON-SITE r o—�L—(ASSES <br /> LARGEST (21) ! ANNUAL WASTE AMT(25) <br /> CONTAINER C /fC GAL. <br /> STORAGE (26) ❑ABOVEGROUNDTANK CAN IMBOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER [:I 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 (27) AMBIENT ❑ ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT E]ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29 %WT (30)HAZARDOUS COMPONENT (3 1)EHS (32)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y [–]N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)I <br /> (34)WHAT IS MATERIAL Re-SALE <br /> USED FOR? <br /> For Official Use Only: n C E] R= SJC 12/00 <br />