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California Hazardou iacerials Inventory Form - Chemi uescription <br /> I <br /> (1} 13 ADD p DELETE ❑REVISE PAGE (2) OF (3) <br /> BUSINESS NAME <br /> (4) <br /> EVEN ELEVEN#20632 <br /> CHEMICAL LOCATION(S) (5) <br /> <br /> = �— <br /> CHEMICAL NAME (8)ICARBON DIOXIDE <br /> TRADE SECRET(1 1) O <br /> COMMON NAME (9) CARBON DIOXIDE *EHS (12) <br /> "IF EHS BOX IS"Y S" <br /> CAS# (10) I24-38-9 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD CLASS LEAVE BLANK <br /> TYPE (14) ®PURE ❑ IXTURE p WASTE ADIOACTIVE (15) ❑ YES ® 16) N1A j <br /> PHYSICAL STATE(17) C3 [31 <br /> FED HAZARD <br /> LIQUID ■UAS <br /> CATEGORIES (18) 113 p <br /> D <br /> STATE WASTE (19) UNITS*(22) ❑ �TONS <br /> AX DAILY AMT(23) <br /> CODE ❑CU FTN SITE 00 <br /> DAYS ON SITE (20) -If EHS, amoun s muAVG DAILY AMT(24) <br /> 65 ON SITE 00 <br /> LARGEST (21) ANNUAL WASTE AMT(25) <br /> CONTAINER 0 <br /> STORAGE (26) 13 ABOVE GROUND TXNK 13 CAN 13130X O <br /> TANK WAGON <br /> CONTAINER [103 <br /> UNDER GROUND TANK p CARBOY ®CYLINDER p RAIL CAR <br /> TANK INSIDE BUILDING p SILO p GLASS BOTTLE p Other... <br /> STEEL DRUM p FIBER DRUM p PLASTIC BOTTLE <br /> PLASTIC/NONMETALLIC DRUM p BAG p TOTE BIN <br /> STORAGE (27) C)AMBIENT ®ABOVE AMBIENT ❑ <br /> PRESSURE <br /> STORAGE (28) 9 AMBIENT. E3 ABOVE AM131ENT L3 BELOW AM131ENT (3 CRYOGENIC <br /> TEMPERATURE <br /> (29) %WT (30) H7�2AROOCIS COMPONENT (31) tH6 (32) CAS# <br /> ❑YES a 7_]E__ <br /> ©YES ❑ <br /> ❑YES ❑NO 1: 1 <br /> IP YES 13147F <br /> v YFS ❑ <br /> LUT-UL .. __ j,5j) uN1It:IJNAIIUNbIIJ?F(IJU1) L1013 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? a machine <br /> For Official use only: XC — R —S SJC 112001 <br />