Laserfiche WebLink
• •PAGE(2) = OF(3) <br /> BUSINESS NAME (4) �r- <br /> �MICAL LOCATION(S)(5) _ <br /> <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑yES ❑NO <br /> ❑YES ❑NO <br /> COMMON NAME (9) *EHS(12) <br /> \ � a *IF EHS BOX IS B <br /> CAS # (10) E J1 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE IXTURE ❑WASTE RADIOACTNE(15) ❑yES O (16) <br /> PHYSICAL STATE(17) ❑SOLID QUID ❑GAS CURIES <br /> FED HAZARD ❑FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> CATEGORIES (18) M06 <br /> j <br /> STATE WASTE (19) UNITS*(22) AL ❑LBS MAX DAILY AMT(23) 1 <br /> CODE ❑CU FT ❑TONS ON STTE <br /> •fS ON SITE (20)�� *If EHS, amounts must be in lbs AVG DAILY AMT(24) <br /> ON SITE <br /> LARGEST (21) l ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26)❑ABOVE GROUND TANK ❑CAN ❑BOX ❑TAN <br /> CONTAINER UNDER GROUND TANK ❑CARBOY ❑CYLINDER ❑RAIL <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) MBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) MBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%aWT (30)HAZARDOUS COMPONENT (31)EHS (32) CAS# <br /> OYES ON <br /> OYES ON <br /> C� 0E ON <br /> ❑YES ❑N <br /> ❑YES ❑N <br /> WITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) . <br /> WHAT IS MATERIAL <br /> USED FOR? <br /> DATE REC'D: For Official Use Only: 0 C ❑R ❑S SIC 12/99 <br />