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California Hazardous MALerials Inventory Form - Chemical Dription <br /> (1) [::]ADD DELETE ORE GGE(2) O OF(3)O <br /> BUSINESS NAME (4) <br /> CBMICAL LOCATION(S)(5) <br /> <br /> MAP#(6)/ GRID#(7) = E= E <br /> ;HEMICAL NAME (8) �\Q� TRADE SECRET(I1) ❑Y ❑N <br /> cam, *EHS(12) OY ON <br /> �OMMON NAME (9) .11�, �, <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE�IIXTURE ❑WASTE RADIOACTIVE(15) O Y ❑N (16) <br /> ?HYSICAL STATE(17) []SOLID ®LIQUID ❑GAS CURIES <br /> 7ED HAZARD <br /> CATEGORIES (18) gFIRE ❑REACTIVE []PRESSURE RELEASE ❑ ACUTEHEALTH O CHRONICHEALTH <br /> iTATE WASTE (19) UNITS*(22) 12GAL OCU FT MAX DAILY AMT(23)� <br /> 7ODEON-SITE <br /> ❑LBS E]TONS <br /> >AYS ON SITE (20)� AVG DAILY AMT(24)� <br /> c *If EHS, amounts mus[be in lbs ON-SPIE <br /> AST <br /> ' AINER (21) ��J O0� ANNUAL WASTE AMT(25) <br /> ONTiTORAGE (26) aABOVF GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> �ONTAINER ❑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 /> iTORAGE (27) ®-ANMIENT [:]ABOVE AMBIENT ❑BELOW AMBIENT <br /> 'RESSURE <br /> iTORAGE (28)IMAMBIENT O ABOVE AMBIENT BELOW AMBIENT O CRYOGENIC <br /> CEMPERATURE <br /> (29)%WT 30)HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y ^❑��N <br /> ❑Y LJN <br /> OY ON <br /> ❑Y ❑N �� <br /> OYON -� <br /> ONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> T IS MATERIAL <br /> D FOR? <br /> For Official Use Only: ❑ C El R ❑ S SIC 12/03 <br />