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California Hazardous Materials Inventory Form - ChemicaDescription <br /> (I) ADD DELETE REVISE 2001 PAGE(2) = OF(3) <br /> BUSINESS NAME (4) y/' RECEIVED <br /> CHEMICAL LOCATION(S)(5) (/ IilA 1 tj 200' <br /> MAP#(6)/ GRID#(7) � = 2 ftcE I>FPM ENCYSERVICES <br /> CHEMICAL NAME (8) TRADE SECRET(I I) ❑Y N <br /> COMMON NAME (9) � � *EHS(I2) ❑Y KfN <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK to <br /> HAZARD CLASS <br /> TYPE (14)F[:]PURE [:]MIXTURE [:]WASTE RADIOACTIVE(15) ❑l, N (16)� <br /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID [:]GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE ❑ REACTIVE [:]PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHROiNIC HEALTH <br /> STATE WASTE (19) UNITS*(22) GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE BOO <br /> ❑LBS ❑ TONS <br /> DAYS ONSITE (20)� AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER O <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 ❑ABOVE AMBIENT [_]BELOWAMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N71 <br /> ❑Y 0 <br /> I F_ ❑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 fficial Use Only: C FR ❑ S SJC 12/00 <br />