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California Hazardous Materials Inventory Form - Chemical lription <br /> (1) ❑ADD ❑DELETE ❑RE aE I GE(2) OF(3) <br /> BUSINESS NAME (4) <br /> CWCAL LOCATION(S)(5) <br /> (Within facility,not street <br /> := <br /> -HEMICAL NAME (8) TRADE SECRET(I1) ❑Y [:]N <br /> COMMON NAME (9) � �m e *EHS(12) FE-1Y [:]N� B <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 KMIXTURE [:]WAS TE RADIOACTIVE(15) 1[:]Y ❑N (16) <br /> PHYSICAL STATE(17) 1 ❑SOLID LIQUID [:]GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) F41 FIRE E]REACTIVE ❑PRESSURERELEASE ❑ ACUI'EHEALTH ❑ CHRONICHEALTH <br /> STATE WASTE (19) UNITS*(22) AL ❑Cu FT MAX DAILY AMT(23) c <br /> CODE ON-SITE <br /> NS <br /> JAYS ON SITE (20) 1:1 LES ❑TO <br /> AVG DAILY AMT(24)� <br /> *If EHS, amounts must be in lbs ON-SITE <br /> .AST (21) ANNUAL WASTE AMT(25) <br /> 'ONTAINER SO E1 <br /> STORAGE (26) ABOVE GROUND TANK ❑CAN ❑ BOX !❑TANK WAGON <br /> _ONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER [:]RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑SILO ❑ GLASS BOTTLE El-------------------- <br /> El STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> iTORAGE (27) ErAMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> 'RESSURE <br /> iTORAGE (28) NAMBIENf ❑ABOVEAMBIENT ❑BELOWATvIBIENT ❑CRYOGENIC <br /> 'EMPERATURE <br /> (29)%WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> DONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> 34) T IS MATERIAL <br /> USED FOR.? <br /> For Official Use Only: ❑ C ❑ R S SIC 12/03 <br />