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California Hazardous M 'als Inventory Form - Chemical Des tion <br /> PAGE(2) OF(3) <br /> BUSINESS NAME <br /> (4)UNIFIRST CORPORATION <br /> CHEMICAL LOCATIONS)(5)WASTE WATER ROOM <br /> MAP#(6)/ GRID#(7) 1/A4 NA INA� NA NA <br /> CHEMICAL NAME (8) CATIONIC POLYMER TRADE SECRET(11) 10 YES ®N0-1 <br /> COMMON NAME (9) POLYMER *EHS(12) JEIYES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 112042-91-0 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE `(14) ❑PURE ®MIXTURE ❑WASTE RADIOACTIVE(15) ❑YES ®NO (16) N/A <br /> PHYSICAL STATE:(17) ❑SOLID H LIQUID ❑GAS CURIES <br /> FED HAZARD ® <br /> CATEGORIES FIRE El REACTIVE ❑PRESSURE RELEASE [I ACUTE HEALTH ❑CHRONIC HEALTH <br /> (18) <br /> STATE WASTE (19) UNITS*(22) ❑GAL ®LBS MAX DAILY AMT(23)700 <br /> CODE NA ❑CU FT [ITONS <br /> ON SITE <br /> DAYS ON SITE (20) ®'- *If EHS,amounts must be in lbs AVG DAILY AMT(24) <br /> 365 ON SITE 700 <br /> LARGEST (21 55 GAL ANNUAL WASTE AMT(25) N/A <br /> CONTAINER <br /> STORAGE .(26) ❑ABOVE GROUND TANK []CAN ❑BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑OTHER <br /> ❑STEEL DRUM ®FIBER DRUM ❑PLASTIC BOTTLE ❑Other... <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑TOTE BIN <br /> STORAGE (27) ®AMBIENT []ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT []ABOVE AMBIENT []BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> 50 ALUMINUM SOLUABLE SALTS ❑YES ®N 12042-91-0 <br /> ❑YES ❑N F — — --� <br /> IF ❑YES ❑N �— <br /> ❑YES ❑N <br /> ❑YES ❑N F <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N/A <br /> (34)WHAT IS MATERIAL WATE WATER TREATMENT <br /> USED FOR? <br /> DATE REC'D: 1/8/04 For Official Use Only: 0 C ❑R ❑S SJC 12/99 <br />