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California Hazardous Materials Inventory Reporti ojnS �Ahemical Description Page <br /> (1) ADD =DELETE El REVISE <br /> 1999 PAGE(2) = OF(3)� <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATIONS)(5) <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) / Pr / / TRADE SECRET(11) ❑Y N <br /> fp Gt *EHS(12) ❑Y N <br /> COMMON NAME (9) S0 /h <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS _ <br /> TYPE (14) []PUREMIXTURE ❑WAI RADIOACTIVE(15) ❑Y N (16)E= <br /> CURIES <br /> PHYSICAL STATE(17) ❑SOLID LIQUID ❑GAS <br /> FED HAZARD ❑RFACI7VE ❑PRESSURE RE[.EASE ACUTE Hf?.I-TH CHROMC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS*(22) GAL ❑CU FT OMS Y AMT(23) 3 S 000 <br /> CODE [[:]LBS E] TONS <br /> DAYS ON SITE (20) 3 b S AVG DAILY AMT(24) <br /> * <br /> If EHS, amounts must be in lbs ON-SITE / <br /> LARGEST (21� ANNUAL WASTE AMT(25)�� <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❑-------------------- <br /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) IENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> PS- 1 c Fl yr � / �� tS ❑Y N <br /> y. 9 P ❑Y N — <br /> � // ❑Y P006- �/- <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> FU <br /> or Official se Only: C ❑ R S SJC 12197 <br /> Fi <br />