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1 4 01 9 <br />California Hazardous Material Inventory Form/Addendum- Chemical Description Page <br />(1) 1 WDD F-1 DELETE ❑REVISE PAGE (2) OF (3) <br />BUSINESS NAME (4)�`�,cN (��� �L� 15�" o(\M` S i <br />CHEMICAL LOCATION (5) <br />MAP# (6) , <br /> <br />CHEMICAL NAME (8) Gas o L N TRADE SECRET (11) 1 El Q N <br />COMMON NAME (9) Gca,So L ,.� *EHS/AHM (12) ❑ Y Q -N] <br />CAS# (10)*IF EHS/AHM BOX IS "Y" <br />M ` X C $�� b b 9 ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE (13) <br />HAZARD <br />CLASSESO <br />C: -r-S S 3 <br />OCOMPLETE BLOCK (13) IF REQUESTED BY LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS <br />TYPE (14) ❑PURE [3MIIXTURE ❑WASTE RADIOACTIVE (15) ❑Y R N (16)� <br />PHYSICAL STATE (17)10 SOLID RLIQUID ❑GAS I CURIES <br />FED HAZARD (18) [2FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br />CATAGORIES <br />STATE WASTE (19) UNITS (22) ®GAL ❑CU FT MAX DAILY AMT (23)1 <br />CODE ❑LBS ❑TONS <br />DAYS ON SITE (20) Ikon "1F EHS/AHM AMOUNTS AVG DAILY AMT <br />LARGEST MUST BE IN LBS <br />CONTAINER (21) 1Z ��' "S ANNUAL WASTE AMT (25) L <br />STORAGE <br />CONTAINER (26) <br />❑ABOVE GROUND TANK <br />❑CAN <br />El BOX I <br />❑TANK WAGON <br />)ANDER GROUND TANK <br />❑CARBOY <br />❑CYLINDER <br />[-]RAILCAR <br />❑TANK INSIDE BUILDING <br />[-]SILO <br />[:I GLASS BOTTLE <br />❑ <br />❑STEEL DRUM ' <br />F-1 FIBER DRUM <br />❑PLASTIC BOTTLE <br />❑OTHER... <br />❑PLASTIC/NONMETALLIC DRUM <br />[:]BAG <br />[:]TOTE BIN <br />PRESSURE (27) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br />STORAGE <br />STORAGE (28) ❑ AMBIENT ❑ ABOVE AMBIENT --79PELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %BY WT (30) HAZARDOUS COMPONENT (31) EHS/AHM (32) CAS # <br />1 1 1 1 1 1 El ❑ N L <br />2 ❑ Y ❑ N <br />3 ❑Y ❑ N <br />F-- <br />41 1 IE1Y ❑ N <br />51 1 ❑Y ❑ N <br />I_1 �7 X111 U1► I_\ �■ R\Ifl_1 � �1'L�1�1�_�3ri 1 �I �l 1►17�1:�1�� /_\ 1 [�l ►i <br />DOT # 2 �'3 HOW IS MATERIAL USED Cvaso� e N �Z OES USE ONLY <br />INITIAL <br />S E <br />