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California Hazardous Materials Inventory Form - Chemical Descriptioq, <br /> (1) ❑ADD ❑DELETE ❑REVISE 2001 PAGE(2) OF(3) <br /> f- � <br /> BUSINESS NAME (4) P P e b e e s I� i �j 1c) r <br /> p�/ I�00� C��1�� '+ Qr1/ <br /> CHEMICAL LOCATION(S)(5) ° ,` / <br /> MAP#(6)/ GRID#(7) ��',� <br /> CHEMICAL NAME (8) U" 7C:)'1 0 X 1 D e TRADE SECRET(11) FE-1Y MN ✓S <br /> �.� *EHS(12) ❑Y N PS <br /> COMMON NAME (9) <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) t Z '1 _ _ C1 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ®PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y MN (16)I <br /> ;/ N <br /> PHYSICAL STATE(17) ❑SOLID ❑LIQUID ®GA� CURIES <br /> FED HAZARD [:] FIRE ❑REACnVE ®PRESSURE RELEASE E] ACUTE HEALTH [_ CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS* (22) ❑GAL ❑CU FT MAX DAILY AMT(23)� <br /> CODELBS [—] TONS ON-SITE <br /> DAYS ON SITE (20) AVG 'AMT(24)� <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER �DO <br /> STORAGE (26) ABOVE GROUND TANK ❑ CAN —] BOX <br /> 1I ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ® CYLINDER [—]RAIL CAR <br /> ®TANK INSIDE BUILDING ❑ SILO ❑GLASS BOTTLE El-------------------- <br /> [:1 STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ AMBIENT Z ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ❑AMBIENT ❑ABOVE AMBIENT ®BELOW AMBIENT [-]CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT Q 32 CAS# <br /> 11 ❑Y ❑N <br /> FE]Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) Q I <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: 11 C SJC 12/00 <br />