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California Hazardous Arials Inventory Form - Chemical Des ption <br /> PAGE(2) OF(3) <br /> BUSINESS NAME (4)UNIFIRST CORPORATION <br /> CHEMICAL LOCATIONS)(5) WASTE WATER ROOM <br /> MAP#(6)/ GRID#(7) MAP 1 A 3 NA NA EA <br /> CHEMICAL NAME. (8) ANIONIC POLYMER 672 TRADE SECRET(11) ❑YES ®NO� <br /> COMMON NAME (9) DWT-672 *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 064742-47-8 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE ®MIXTURE ❑WASTERADIOACTIVE(15) ❑YES ONO (16) N/A <br /> PHYSICAL STATE(17) ❑SOLID ®LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑LBS <br /> CODE N/A ❑CU FT ❑_TONS MAX DAILY AMT(23 110 <br /> ON SITE _ <br /> DAYS ON SITE (20) *If EHS;amounts must be in lbs AVG DAILY AMT(24) <br /> 365 ON SITE 110 <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 IN FIBER DRUM ❑PLASTIC BOTTLE ❑Other... <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑TOTE BIN <br /> STORAGE (27)110 AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT (3I)EHS 32 CAS# <br /> <40 PETROLEUM DISTILLATE 10 YES IN 064742-47-8 <br /> ❑YES ❑N <br /> ❑YES ❑NO I --� <br /> 10 YES ❑N�0 <br /> ---710 YES ❑N��s <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(�-DOIJT) N/A <br /> (34)WHAT IS MATERIAL WASTE WATER TREATMENT <br /> USED FOR? <br /> -)ATE REC'D: 1/8/04 For Official Use Only: 0 C ❑R ❑S SJC 12/99 <br />