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YHVCIGJ <br /> BUSINESS NAME (q) u u <br /> vIICAL LOCATION(S)( <br /> / <br /> MAP#(6) / GRID#(7) <br /> CHEMICAL NAME (8) I--J TRADE SECRET(11) ❑YES ❑NO <br /> *EHS(12) ❑YES ❑NO <br /> COMMON NAME (9) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) �1/� ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE IXTURE ❑WASTE RADIOACTIVE(15) ❑YES 0NO-106) <br /> CURIES <br /> PHYSICAL STATE(17) ❑SOLID QUID ❑GAS <br /> FED HAZARD ❑FIRE []REACTIVE ElPRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS*(22) ❑GAL ❑LBSMAX DAILY AMT(23) ' <br /> CODE C ❑CU FT ❑TOIN ON SITE 06 <br /> -alk <br /> .t S ON SITE (20)� *RS'amounts must be in Ibs Y AMT( ) , �� <br /> ON SITE <br /> ( l <br /> LARGEST <br /> (21 - � x� 1pCS��� ANNUAL WASTE AMT(25) <br /> CONTAINH? �4 <br /> STORAGE (26) OVE 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 IENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) IENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 1291 q T (30 HAZARDOUS COMPONENT YE EHS (32 CAS# <br /> CYES ❑N <br /> ❑YES ❑N <br /> YES ❑N <br /> I <br /> []YES ❑N <br /> ❑YES ❑N <br /> �DITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> `4)WHAT IS MATERIAL <br /> USED FOR? <br /> DATE REC'D: For Official Use Only: ❑C ❑R 0 S SIC 12/99 <br />