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Non-Waste Hazardous Materials Inventory Statement <br /> Date: — For use by Unidocs Member Agencies or where approved S pp by your Local Jurisdiction <br /> Business Name: <br /> (Same as Facllitpivame) d~ ® Type of Report on This Page: page,.of <br /> ❑Add <br /> Chemical Location: EPCRA Confidential Location? Yes• > ❑Delete; Revise (One page per building or area) <br /> (Bu)IdingtStorage Area) ❑ r ❑NO Facility ID# <br /> Trade Secret Information? ❑Yes; ❑No (Agent?,use onbl <br /> 1. 2. 3, <br /> 4. 5. 6 <br /> 7. 8. 9. <br /> Map and Hazardous Components Type Grid or (For mi dares only) and Quantities Storage Codes <br /> Haz Location Chemical % Physical Max. Average Largest <br /> Class Code Common Name Name Wt EHS CAS No. State Dail Dail g C rat. Units Pressure Tem Storage Storage CHe <br /> ❑ ❑1niAt11<e Ilons - bigot ambient ate <br /> L_1 Peds (,J>amb. •(J>arab. U reactive <br /> �'Fi ❑ ❑solid Curies: Days On Storage ❑eM feet ❑<amb. ❑<amb. ❑pressure Mime <br /> CAS No: ❑EHS d fifradiaacti.), _Site: Container:' ❑tons <br /> ❑ 4at ❑cryogenic ❑acute health <br /> } ® LI$as c health <br /> �/ /?� ❑ ❑p� ❑radoacfi- <br /> _ ❑ ❑Mixture ambient p bieat ❑tee <br /> lids ❑>amb. ❑>amb. reactive <br /> "-� ❑ ❑solid Curies: Daus On Storage ❑cu.feet ❑<amb. ❑<amb. ❑pressure rele <br /> CTAS No.: ❑EHS ® +>v:lwz_.�d (lfmdiaae6ve) Lite: Container." ❑tons ❑cyogevic [ acute health <br /> '._ ,' ❑ •0❑gas `❑ttrunic health <br /> i €. <br /> ® ❑p= radioactive <br /> _ - Ions - _ bient -ambient �Qta <br /> t ❑ ❑mutate pounds ❑>amb. ❑>amb. active <br /> 1 $a r <br /> ❑ ❑solid Caries: Days On Stors ❑ ❑<amb. ❑<arab. ❑pressure release <br /> CAS No.: ❑En3d Qnadioavve) Site: Container.* ❑tons <br /> ❑ ,�4m — ❑ cm@cutehealth <br /> ® <br /> 'El gas cryogeni <br /> _ •� / ,.chronic health <br /> ® ❑pl J ❑radioact ve <br /> ❑ ❑ �� ons ambient _ bimt <br /> y ' as <br /> +�"7 - Pis ❑>amb. ❑> <br /> ® ❑t ❑ mb, <br /> rac <br /> solid Curies: Days On StorEl gut ❑<amb. ere m. p ' <br /> ase <br /> CAS No: ❑ n$ fi d (lfndotise) Site: Containeteas <br /> cryogenic .-t. <br /> ' ® ❑gas ❑chronic health <br /> MA, ❑ ❑p� ❑radioactive <br /> ❑ ❑Mixture -gallons �'��mbietrt �-ambiem ❑fm <br /> _ Iroumds ❑>amb. ❑>aurb. Q:ftactive <br /> ❑ [3 solid Cables: Deva On Sto. rage ❑ <br /> OU.- ❑<emb. ❑<amb. pressure mime <br /> CAS No.: ❑EHS ® �yj��-f�.;uquid (tt,ad;oaetiv) Site: Contain ❑tons ❑cryogenic ❑acute health <br /> ® LJ gas cfiionichealth <br /> 1 ❑ ❑radioactive <br /> s <br /> pure ons f biem --• _ambient <br /> ❑ El Mixture ❑Pmmds ❑>arab. ❑>arab. :reactive <br /> � `,�'r' ❑ <br /> solid <br /> Curies: Dans On SforagE ❑cu.feet ❑<a�il. ❑<amb. j Pressure release <br /> CAS No.. ❑Ens ® '[4quid Orradioactivo Site: Contain er:• ❑tons ❑cryogenic ❑acute health <br /> ® ]gas � =efuanic health <br /> # o e Storage vve Coe Storage Tvoe Coe toraee Tvoe '°' u ❑radioactive <br /> Code Storage Tvve Coe Storage Tvve o e torage ave <br /> A Aboveeronvd Tank D Steel Drum G Carboy J Bag M Glass Bottle or Jug P Tank V/a on If EPCRA ei ¢loS$_t�_' <br /> B Belawgrouad Tank E Plastic/Non-metallicm B Drum SROg ` <br /> K Hax N Plastic Bottle or Jug Q Rai]Car <br /> C Tank Inside Building F Can I Fiber Dtum L CylinderO Tote Bin R Other <br /> ^r <br /> TJN-oto-7/17 www.nnidors.org Rev.07/24/06 <br />