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California Hazardous Materials Inventory Form - Chemical Description. <br /> (1) ❑ADD I:LETE ❑RI?VIS1: 2000 PAGE(2) OF(3)� <br /> BUSINESS NAME (4)1�A <br /> � <br /> CHEMICAL LOCATIONS)(5)[ � <br /> MAP#(6)/ GRID#(7) <br /> a <br /> CHEMICAL NAME (ti) `^ O L' TRADE SECRET(1 1) ❑Y N <br /> COMMON NAME (1)1 v �� t *EHS(12) ❑Y N <br /> ✓✓✓ *IF EHS BOX IS "Y" <br /> CAS # (10) -3$ t[�- ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK Y <br /> HAZARD CLASS <br /> TYPE (14)1 1 RPURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16) <br /> PHYSICAL STATE(17) ❑SOLID XLLIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (1 g) [:]FIRE ❑REACTIVE N PRESSURE RELEASE ACUTE HEALTFI aCHRONICHEALIH <br /> STATE WASTE (19) UNITS* (22) ❑GAI_ ❑CU FI' MAX DAILY AMT(23) <br /> CODE 1 7 ON-SITE 1 <br /> LBS ❑ TONS <br /> DAYS ON SITE (2O) ,� AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 � ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑"TANK WAGON <br /> CONTAINER ❑ UNDER GROUND TANK ❑CARBOY K 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 ❑BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3 1)EHS (32)CAS# <br /> ❑Y N Z - 3 -- <br /> ❑Y NI L <br /> ❑Y [:]NIF <br /> 11 ❑Y ❑N 1E <br /> = I ❑Y ❑N 1E <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) I ILI " <br /> (34)WHAT IS MATERIAL <br /> USED FOR? "64 1 1 /1 h 15.-S <br /> For Offi Wal Use Only: F1 C II <br />