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California Hazardous .. _terials Inventory Form - Chemi Description <br /> �1) ❑ADD DELETE REVISE 2000 PAGE(2) OF(3)� <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) t <br /> MAP#(6) / GRID#(7) <br /> CHEMICAL NAME (8) l TRADE SECRET(1 1) ❑Yb, <br /> N <br /> ❑ � <br /> COMMON NAME (9) *EHS(12) Y N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) �I ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> URE [:]MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y [:]N (16) <br /> TYPE (141 <br /> PHYSICAL STATE(17) ❑SOLID MLIQUID []GASCURIES <br /> FED HAZARD <br /> CATEGORIES (1 g) ❑FIRE ❑REACTIVE PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22)) [:]GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE ) '1 <br /> ' LBS ❑ TONS - <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> !1 *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 t ANNUAL WASTE AMT(25) <br /> F, <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 /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIENT ❑ABOVE AMBIENT [—]BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) MAMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT ( 0)HAZARDOUS COMPONENT (3 1)EHS d32) CAS# <br /> LEI Y - .N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> El ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> /. i <br /> (34)WHAT IS MATERIAL / 7i <br /> USED FOR'? <br /> For Official Use Only: �� C R S SJC 12/99 <br />