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California Hazardous Materials Inventory Form - Chemical Description of(3) <br /> 2001 PAGE(2) <br /> (1) ADD DELETE REVISE r <br /> BUSINESS NAME (4) 14 2M1 <br /> CHEMICAL LOCATION(S)(5) �V nCEE <br /> ttc <br /> MAP#(6)/ GRID#(7) O �6 E= <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y ❑N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) O O 1,L- <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(IS) ❑—Y -0 N (l6) <br /> CURIESES <br /> PHYSICAL STATE(17) ❑SOLID ®LIQUID ❑GAS <br /> FED HAZARDFIRE ®.REACTIVE ❑PRESSURE RELEASE E) ACUTE HEALTH ❑ CHRONIC HEALTH <br /> CATEGORIES (18) 7[0—]LBS <br /> STATE WASTE (19) UNITS*(22) AL HCUNS <br /> FT MAX DAILY AMT(23) <br /> CODE ® ON-SITE <br /> TO <br /> DAYS ON SITE (20) AVG DAILY AMT(24) o0 <br /> 3 ,GS *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ( ANNUAL WASTE AMT(25) <br /> CONTAINER o O 00 o t� <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER M1 UNDER GROUND TANK ❑CARBOY ❑ CYLINDER [_]RAIL 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) ❑AMBIENT ❑ABOVE AMBIENT [—]BELOWAMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT332)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)E1 'Lo <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: ❑ C 0 R S SJC 12/00 <br />