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California Hazardous",Vlaterials Inventory Form - Cheml=al Description <br /> (1) ADD DELETE REVISE 2001 PAGE(2) OF(3) �O <br /> BUSINESS NAME (4) RECEIVE <br /> • r <br /> CHEMICAL LOCATION(S)(5) *" " 5 2001 <br /> $pNJUPuui <br /> MAP#(6)/ GRID#(7) ! _ E= rmmwv,- <br /> FNCVS <br /> CHEMICAL NAME (8) TRADE SECRET(1 I) ❑Y' N <br /> �, n �i *EHS(12) ❑Y RrN <br /> COMMON NAME (9) (3 GGG� <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE B/LANK <br /> HAZARD CLASS <br /> TYPE (14) RE ❑MIXTURE [:]WASTE RADIOACCIVE05) ❑Y N (16)� <br /> PHYSICAL STATE(17)1 ❑SOLID MLIQUID []GAS I <br /> CURIES <br /> FED HAZARD �p( <br /> CATEGORIES (18) X FIRE ❑REACTIVE Ld PRESSURE RELEASE —] ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE <br /> [:]LBS ❑ TONS ON-SITE SOO <br /> DAYS ON SITE (20) ! AVG 'AMT(24) �sD <br /> l� *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER SO©SSS 0 <br /> STORAGE (26) OABOVE 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) ❑ AMBIENT 'ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT [:]ABOVEAMBIENT I—IBELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 '%WT (30)HAZARDOUS COMPONENT 31)EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For ARicial Use Only: >Q C ❑ R ❑ S SJC 12/00 <br />