Laserfiche WebLink
California Hazardous IN orials Inventory Form - Chemical r ription OI <br /> '4AGE(2) <br /> BUSINESS NAME (4) VALLEY FORKLIFT <br /> r <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> CHEMICAL NAME (8) ANTIFREEZE TRADE SECRET(11) ❑YES ®NO <br /> *EHS (12) ❑YES ®NO <br /> COMMON NAME (9) ANTIFREEZE <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) N/A ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE ®MIXTURE ❑ NvASTE RADIOACTIVE(15) ❑yES ®NO (16) <br /> PHYSICAL STATE(17) ❑SOLID ®LIQUID []GASCURIES <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE []REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑LBSMAX DAILY AMT(23)100 <br /> CODE N/ ❑CU FT ❑TONS ON SITE <br /> DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT(24) 7 5 <br /> ON SITE <br /> LARGEST (21)100 ANNUAL WASTE AMT(25) 500 <br /> CONTAINER <br /> STORAGE (26)❑ABOVE GROUND TANK ❑CAN ❑BOX ❑TAN <br /> CONTAINER []UNDER GROUND TANK []CARBOY ❑ CYLINDER ❑RAIL <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑OTH <br /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE ❑Other <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 (31)EHS 32 CAS# <br /> ❑YES ❑N <br /> ❑YF,S ❑N <br /> ❑YES ❑N <br /> ❑YES ❑N <br /> ❑YES [I 7N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N/A <br /> (34)WHAT IS MATERIAL FORKLIFTS <br /> USED FOR? <br /> DATE REC'D: 4/28/08 For Official Use Only: ®C ❑R 0 S SJC 12199 <br />