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California Hazardous Materials Inventory Reporting Norm Chemical Description Page <br /> (I) ❑ADD ❑DELETEREVISE 1997 PAGE(2) OF(3)F-----1 <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) A'j %1->%- <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) ^ TRADESECRET(11) ❑Y N <br /> COMMON NAME (9) �00 *EHS(12) ❑Y ®N <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) F C <br /> HAZARD <br /> CATEGORIES <br /> TYPE (14) QPURE ❑MIXTURE ❑WASTF, RADIOACTIVE(15) ❑Y [RN] (16)� <br /> PHYSICAL STATE(17) [:]SOLID LIQUID [:]GASL7CURIES <br /> FED HAZARD <br /> CATEGORIES (18) L11I FIRE ©REACnVE ❑PRESSURE RELEASE ❑ACME HEALTH ❑CHRONIC HEALTH <br /> STATE <br /> CODE WASTE (19) UNITS*(22) R11[:]LBS [:] TONS GAL ❑CU FT MAX DAILY AMT(23) <br /> S <br /> DAYS ON SITE (20) /� AVG DAILY AMT(24) <br /> 36`� *If EHS, amounts must be in lbs <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX [—]TANK WAGON <br /> CONTAINER Kn 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 ❑ABOVEAMBIENT mBELOW AMBIENT [:]CRYOGEN <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT3( I]EHS 32 CAS# <br /> ❑Y ❑N❑N <br /> ❑Y ❑N <br /> El ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION(33): DOT# <br /> For Official Use Only: Lyj C Lj R [_] S SJC 12/96 <br />