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California Hazardous VAN�.terials Inventory Form - Chemical ' #,cription <br /> PAGE(2) =OF(3) <br /> BUSINESS NAME (4) <br /> AND R AUTO REPAIR <br /> CHEMICAL LOCATION(S)(5) AST END OF SHOP <br /> MAP#(6)/ GRID#(7) 1/FS NA VA <br /> CHEMICAL NAME (8) WASTE OIL LL TRADE SECRET(11) ❑yES ®NO <br /> COMMON NAME (9) WASTE OIL *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS "Y" <br /> 'CAS# (10) MIXTURE 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) <br /> /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 21 ❑CU FT ❑TONSMAX DAILY AMT(23)155 <br /> ON SITE <br /> DAYS ON SITE (20) *If EHS,amounts must be in lbs AVG DAILY AMT(24) <br /> 65 ON SITE 100 <br /> LARGEST (21) O ANNUAL WASTE AMT(25) <br /> CONTAINER 5 00 <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER ❑UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ®STEEL DRUM ❑BAG ❑TANK WAGON <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> 171 CAN 173 CYLINDER DOTHER <br /> STORAGE (27) ®AMBIENT ❑BELOW AMBIENT <br /> PRESSURE 10 ABOVE AMBIENT <br /> STORAGE (28) ® AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (3 1) EHS (32)CAS# <br /> ❑YES ❑NO <br /> ❑YES ❑NO <br /> ❑YES ❑NO <br /> ❑YES ❑NO �� <br /> ❑YES ❑NO <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1270 <br /> (34)WHAT IS MATERIAL waste oil <br /> USED FOR? <br /> DATE REC'D: 5/28/08 or Official Use Only: HC ❑R [IS SIC 12/99 <br />