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RECEIVED <br /> California Hazardous Materials Inventory Form - Chemical Description � c!o <br /> (1) ADD DELETE REVISE 2001 PAGE(2) (3) <br /> IN COON <br /> BUSINESS NAME (4) <br /> r!? R AE.e/A[ �.t/TFit�PiP/S�1NL'- D,r3,e S.CN .X�Qu/iL' /9��2 <br /> CHEMICAL LOCATION(S)(5) �6�u/�U7 C6E Tj9Nr= , tsysr &e9x^),!v-o <br /> MAP#(6)/ GRID#(7) ® �� <br /> CHEMICAL NAME (R) /DQ L A(f!!1T!ON (g.4 o1iNE TRADE SECRET(11) ❑Y EYN <br /> COMMON NAME (9) <br /> �V gqS *EHS(12) ❑Y N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y ®N (16)� <br /> PHYSICAL STATE(17)1 []SOLID aIQUID [-]GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (1 g) ®FIRE [:]REACTIVE ❑PRESSURE RELEASE , - ACUTE HEALTH ®CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) ®GAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE ON-SITE <br /> 1E]LBS ❑ 'IONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) a f/OD <br /> *If EHS, amounts must be in lbs ON-SITE � <br /> LARGEST (21 ANNUAL WASTE AMT(25)� <br /> CONTAINER SO�e /✓O/✓� <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ®UNDER GROUND TANK ❑CARBOY ❑ CYLINDER WAGON-1 CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑-------------------- <br /> ❑STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ® AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®'AMBIENIT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3 1)EHS (32)CAS# <br /> FED Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑ N <br /> ❑Y ❑ N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) r <br /> (34)WHAT IS MATERIAL `uE4 C;P,,e 4 ,5 R12C,0Af7 5 (No-r For- ,EESA�c <br /> USED FOR'? <br /> For Official Use Only: C �� R F] S SIC 12/00 <br />