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California Hazardous .`,vials Inventory Rep(�rkilt�g ort, ,_chemical Description Page <br /> (1) ❑ADD ❑DELETE ❑REVISE 1998 ' PAGE(2) OF(3) <br /> BUSINESS NAME (4) NODI 1 7 W <br /> 14 G0 73e / <br /> CHEMICAL LOCATION(S)(5) ( <br /> <br /> = <br /> CHEMICAL NAME (8) C QON Z.To TRADE SECRET(11) ❑Y N <br /> COMMON NAME (9) O Q/v �i Q X: L) 1:--7 *EHS(12) ❑Y N <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) I [1 _ 3 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)1 OPURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y f'DfN (16)� <br /> PHYSICAL STATE(17) [_]SOLID ®LIQUID GAS lld� CURIES <br /> FED HAZARD ERE ❑ ® ACUTE HEALTH E] CHROMC HEALTH <br /> CATEGORIES (18) ❑ �� PRESSURE RELEASE <br /> STATE WASTE (19) UNITS* (22) []GAL <br /> MAX DAILY AMT(23) / <br /> CODE ON-SITE QO SS <br /> DAYS ON SITE (20) LBS [] TONS <br /> � AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <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 [KABOVEAMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ^'AMBIENT ❑ABOVEAMBIENT OBELOWAMBIENT CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT (31 EHS 32)CAS# <br /> ❑Y ❑N <br /> ❑Y 7[:]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 SJC 12/97 <br />