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California Hazardous 1Yterials Inventory Form - Chemkl*Description <br /> (1) F]ADD ODFLETE REVISE 2001 PAGE(2) 1:2:1 OF (3) <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) / <br /> MAP#(6)/ GRID#(7) E:::= E= 1= c,, SA r AUUIm GW V7V .-s <br /> CHEMICAL NAME (8) TRADE SECRET(I l) ❑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 /> HAZATYPE RD CLASS (14) ❑PURE ❑MIXTURE ❑WASTE ❑Y ❑ N <br /> RADIOACTIVE(i5) (16) <br /> PHYSICAL STATE(17)1 ❑SOLID F]LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) []FIRE ❑ REACTIVE ❑PRESSURE RELEASE ❑ ACUrE HEALTH [:] CHRONIC HEALTH <br /> STATE WASTE (19)�� UNITS* (22)F]LBS <br /> GAL [:]CU FT MAX DAILY AMT(23)r� <br /> CODE Illy_ <br /> [:]TONS AVG DAILY AMT(24)� <br /> DAYS ON SITE (20) <br /> *[f EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 /QO ANNUAL WASTE AMT(25) TODD <br /> CONTAINER <br /> STORAGE (26) ❑ABOVEGROUNDTANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑RAIL CAR <br /> TANK INSIDE BUILDING ❑ SILO ❑GLASS BOTTLE 0-------------------- <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 AMB[ENT ❑BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> (29)%aWT (30)HAZARDOUS COMPONENT (31) EHS (32)CAS# <br /> ❑Y ❑N <br /> �Y QN <br /> ❑Y ❑N <br /> ❑Y [N FF <br /> YEJ❑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 � R � S SIC 12/00 <br />