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California Hazardous P erials Inventory Form - Chemical 1 ..,,pription <br /> PAGE(2) = OF(3) <br /> BUSINESS NAME (4) VALLEY FORKLIFT <br /> CHEMICAL LOCATION(S)(5) <br /> N/A <br /> CHEMICAL NAME (8) MERCON TRADE SECRET(11) ❑YES ®NO <br /> COMMON NAME (9) ATF FLUID *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) MIXTURE ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE ®MIXTURE ❑WASTE RADIOACTIVE(15) ❑yES ®NO (16) <br /> PHYSICAL STATE(17) ❑SOLID H LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE [:1REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑LBS <br /> CODE N/ ❑CU FT ❑TONS MAX DAILY AMT(23)110 <br /> ON SITE <br /> DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT(24) 5 5 <br /> ON SITE <br /> LARGEST (21 5 5 ANNUAL WASTE AMT(25)D <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 /> 19 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 /> OYES ON <br /> ❑ YES ❑N <br /> OYES ❑N <br /> ❑ YES ❑N <br /> ❑YF,S ❑N <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: 0 C 0 R ❑S SIC 12/99 <br />