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California Hazardous Oterials Inventory Form - Chem icalocription DEC 1 <br /> PAGE (2) OF(3) <br /> BUSINESS NAME (4) <br /> JIFFY LUBE #598 <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> CHEMICAL NAME (8) WASTE OIL FILTERS TRADE SECRET(11) ❑yE5 ®NO <br /> COMMON NAME (9) WASTE OIL FILTERS *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) N/A ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <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 H LBS <br /> CODE 221 ❑CU FT ❑TONS MAX DAII Y AMT(23)1,200 <br /> ON SITE <br /> DAYS ON SITE (20) *If EHS, amounts must be in lbs AVG Y AMT(24) <br /> 365 <br /> ON SITE <br /> 450 <br /> LARGEST (21)� ANNUAL WASTE AMT(25) <br /> CONTAINER 400 LBS. 4500 <br /> STORAGE (26)❑ABOVE GROUND TANK ❑CAN ❑BOX ❑TAN <br /> CONTAINER [:]UNDER GROUND TANK ❑CARBOY ❑CYLINDER ❑RAIL <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑ OTII <br /> ®STEEL DRUM ❑FIBER DRUM ❑PLASTIC BOTTLE ❑Other <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑TOTE BIN <br /> STORAGE (27)119 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 ❑N <br /> JOY ON <br /> ❑YES ON <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1270/1142 <br /> (34)WHAT IS MATERIAL REMOVED FROM VEHICLES DURING SERVICE. <br /> USED FOR? <br /> DATE REC'D: 12/19/03 For Official Use Only: ®C 0 R ❑S SIC 12/99 <br />