Laserfiche WebLink
California Hazardous',daterials Inventory Form - Chemlxldl Description <br /> (1) OADD DDELETE REVISE 2001RE PAGFf2� OF(3) <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATIONS)(5) ` `f' <br /> MAP#(6)/ GRID#(7) _ <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y N <br /> ❑Y' N <br /> COMMON NAME (9) *EHS (12) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) F <br /> ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK I <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE [:]WASTE RADIOACTIVE(15) ❑Y N (16)r� <br /> PHYSICAL STATE(17)JE]SOLID ❑LIQUID OGA=S CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE [:]REACTIVE PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) []GAL CUFT MAX DAILY AMT(23) <br /> CODEON-SITE SDO <br /> 1[:]LBS [-] TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> �j *If EHS, amounts must be in Ibs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER 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 ❑ LASS BOTTLE❑-------------------- <br /> ❑STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ AMBIENT KABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)ItoAMBIENT [:]ABOVEAMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT (31 EHS (32)CAS# <br /> ❑Y ❑N <br /> Ely []NI <br /> ❑Y ❑N <br /> YE] NJ <br /> ❑1' ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL w l r�� © +>( <br /> USED FOR. <br /> For Official Use Only: C ❑ R S SJC 12/00 <br />