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California Hazardous Materials Inventory Reporting Form - Chemical Description Page <br /> (1) ❑ADD ❑DELETE ❑REVISE PAGE(2) OF(3)� <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) <br /> MAP#(6)/ GRID#(7) E= E= E= <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑yES ❑NO <br /> COMMON NAME (9) *EHS (12) ❑yES ❑NO <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) ❑yES ❑NO (16)� <br /> PHYSICAL STATE(17) ❑SOLID ❑LIQUID ❑GAS CURIES • <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ❑GAL ❑LBS MAX DAILY AMT(23� <br /> CODE ❑CU FT ❑TONS ONSITE <br /> DAYS ON SITE (20) *If EHS, amounts must be in lbs AVG DAILY AMT(24)�� <br /> ON SITE <br /> LARGEST (21� ANNUAL WASTE AMT(25)� <br /> CONTAINER <br /> STORAGE (26) [1ABOVE GROUND TANK ElCAN --D- <br /> STORAGE ❑TAN <br /> CONTAINER []UNDER GROUND TANK []CARBOY ❑CYLINDER ❑RAIL <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑Other <br /> ❑STEEL DRUM ❑FIBER DRUM ❑PLASIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑TOTE BIN <br /> STORAGE (27) ❑AMBIENT []ABOVE AMBIENT []BELOW AMBIENT . <br /> PRESSURE <br /> STORAGE (28) ❑AMBIENT []ABOVE AMBIENT []BELOW AMBIENT ❑CRYOGENIC • <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> ❑YES ❑N <br /> []YES ❑N <br /> ❑YES 0 <br /> ❑YES ❑N <br /> ❑YES ❑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 <br /> 1999 SIC 12/97 • <br />