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California Hazardous* 777 aterials Inventory Form - ChemTLlafl Description <br /> (1) ADD DDELETE REVISE2001 PAGE(2) OF(3) <br /> BUSINESS NAME (4) . <br /> CHEMICAL LOCATION(S)(5) Cut <br /> MAP#(6)/ GRID#(7) _ � <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y N <br /> l� ! ❑Y N <br /> COMMON NAME (9) *EHS(12) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) L/_ gG Z ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)10 PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y (16)� <br /> PHYSICAL STATE(l7) ❑SOLID ❑LIQUIDGAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) t4FIRE ❑REACTIVE OPRESSURE RELEASE ❑ ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22)ELBS <br /> GAL CU F I OMAX N-SIDAILY AMT(23) <br /> CODE <br /> TO <br /> DAYS ON SITE (20) 2 AVG DAILY AMT(24)� <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 r ANNUAL WASTE AMT(25) <br /> CONTAINER a S <br /> STORAGE (26) ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER 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)JE] AMBIENT MABOVEAMBIENT []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 <br /> ❑Y ❑N <br /> F0 ❑N <br /> ❑ Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) /DD <br /> (34)WHAT IS MATERIAL <br /> USED FOR? r� <br /> For Wricial Use Only: C R u S SJC 12/00 <br />