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California Hazardous Materials Inventory Reporting Form - Chemical Description Page <br /> (1) ADD ❑DELETE ❑REVISE 1999 PAGE(2) 1OF(3) <br /> t <br /> BUSINESS NAME (4) <br /> Auo <br /> CHEMICAL LOCATION(S)(5) 3 <br /> aw.0 t36 2 - INSICt SoVT11EAv WAl-L OF 15T <br /> MAP#(6)/ GRID#(7) I �� OFFICE CF E,�-_? ENCY SERVICES <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y �N <br /> (al`�kROL 123- �2pPA1�E'rRIOL <br /> COMMON NAME (9) G WGE�I fJE *EHS(12) ❑Y D?N <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) �Irj ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14)[E]PURE DMIXTURE ❑WASTE RADIOACTIVE(15) ❑Y ®'N (16)� <br /> PHYSICAL STATE(17)1 [:]SOLID ®LIQUID ❑GAS Id CURIES <br /> FED HAZARD ❑ <br /> CATEGORIES (18) FIRE ❑REACTIVE []PRESSURE RELEASE [:] ACUTE HEALTH [:] CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) SGAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE ON-SITE <br /> [:]LBS ❑ TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> 3�5 DAlS *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25)D <br /> CONTAINER <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 1:1--------------------- <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)119AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT (31 EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> FET Y ❑N <br /> ❑Y ❑N � <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: ❑ C R ❑ S SJC 12/98 <br />