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California Hazardous maials Inventory Form- Chemical Des tion <br /> PAGE(2) OF(3) <br /> BUSINESS NAME (4)UNIFIRST CORPORATION <br /> CHEMICAL LOCATION(S)(5)IWASH ROOM <br /> MAP#(6)/ GRID#(7) MAP 1 C 1 INA INA N A <br /> CHEMICAL NAME (8) FLOROSILICIC ACID TRADE SECRET(11) ❑YES ®NO� <br /> COMMON NAME (9) SOUR/HYDROFLUOROSILIC ACID *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 16961-83-4 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD <br /> CATEGORIES LEAVE BLANK <br /> TYPE ,(14) ❑PURE - MIXTURE ❑WASTE RADIOACTIVE(15) ❑YES ®NO (16) 0 <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) NA UNITS*(22)119 GAL ❑LBS <br /> CODE ❑CU FT ❑TONS MAX DAILY AMT(23110 <br /> ON SITE 1 7 <br /> ')AYS ON SITE (20) *If EHS,amounts must be in lbs AVG DAILY AMT(24)C <br /> 3 6 5 ON SITE 5 5 <br /> LARGEST (21 5 5 ANNUAL WASTE AMT(25)INA <br /> CONTAINER <br /> STORAGE (26)10 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 °SWT 30 HAZARDOUS COMPONENT (3 1)EHS3( 2)CAS# <br /> NA HYDROFLUOROSILIC ACID ❑YES ®Nq 11,6961-83-4 <br /> WATER ❑YES 0 9 7732-18-5 <br /> ❑YES ❑N <br /> ❑YES ❑N <br /> ❑YES ❑N I <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 11778.1 <br /> (34)WHAT IS MATERIAL USED FOR? INDUSTRIAL LAUNDRY PROCESSING <br /> DATE REC'D: 1/8/04 For Official .Use Only: 0 C ❑R ❑S SJC 12/99 <br />