Laserfiche WebLink
alifornia HazardouS'Platerials Inventory Form - Che6o►"lt�esc"Ftion <br /> (0ADD ❑DELETE ❑REVISE 2001 �UNP�WAI j� OF(3) <br /> BUSINESS NAME (4) �� EEgF(IUYSERYIGC <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> tJ S <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y N <br /> -EHS(12) ❑Y N <br /> COMMON NAME (9) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)11-_]PURE [-]MIX RADIOACTIVE(15) ❑ Y Pq N (16)� <br /> PHYSICAL STATE(17)1 ❑SOLID IQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACI7VE [:]PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) ffGAL ❑CU FT MAX DAILY AMT[:]LBS TO (23) � I� <br /> CODE �Z ON-SITE ti <br /> ❑ U <br /> DAYS ON SITE (20) AVG DAILY AMT(24) ,¢ <br /> 3 *If EHS, amounts must be in lbs ON-SITE (J <br /> LARGEST (21 /oo ANNUAL WASTE AMT(25) /®�O <br /> CONTAINER <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 /> ❑PLA TIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27)jAMBIENT [:]ABOVE AMBIENT []BELOW AMBIENT] <br /> PRESSURE lL <br /> STORAGE (28) �AMBEENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT 31)EHS 32 CAS# <br /> ❑Y ❑N �� _� <br /> ❑Y ❑N <br /> ❑Y ❑N �—� <br /> F ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For tfricial Use Only: C R ❑ S SIC 12/00 <br />