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California Hazardous "I-,erials Inventory Form - Chemical r�.i ription <br /> PAGE(2) = OF(3) <br /> BUSINESS NAME (4) <br /> VALLEY FORKLIFT <br /> CHEMICAL LOCATION(S)(5) <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) PETROLEUM HYDROCARBON TRADE SECRET (11) 10YES ® NO <br /> COMMON NAME (9) MOTOR OIL *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) PROPRIETARY 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 ®LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE ❑REACTIVE []PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) N/A QTS*(22) H GAL ❑LBS MAX DAILY AMT(23)110 <br /> CODE <br /> [ICU FT ❑TONS <br /> ON SITE <br /> DAYS ON SITE (20) *If EHS, amounts must be in ]bs AVG DAILY AMT(24) <br /> 365 ONSITE 55 <br /> LARGEST (21)5 5 ANNUAL WASTE AMT(25) 00 <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 (3 1)EHS 32 CAS# <br /> ❑YES ❑N <br /> ❑YES ❑N I <br /> ❑YES ❑ N <br /> ❑YES ❑N <br /> ❑YES ❑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: ®C ❑R ❑S SIC 12/99 <br />