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California Hazardous Materials Inventory Form - Chemica�Description <br /> (1)1 P71 ADD EIDELETE REVISE 2001 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) <br /> MAP#(6)/ GRID#(7) = � ,u <br /> , S <br /> CHEMICAL NAME (8) TRADE SECRET(I 1) ❑Y N <br /> COMMON NAME (9) � <br /> *EHS(12) ❑Y N <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) PURE ❑MIXTURE []WASTE RADIOACTIVE(15) ❑Y N (16)� - <br /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22)[]LBS <br /> GAL f�qCU FT MAX DAILY AMT(23) <br /> CODE ON-SITE SDO <br /> E]TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24)� <br /> *If EHS, amounts must be in lbs 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 ACYLINDER [—]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 JKABOVEAMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ❑AMBIENT E:]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 /> ❑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 Official Use Only: ❑ C ❑ R ❑ S SIC 12/00 <br />