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California Hazardous Materials Inventory Reporting Form - Chemical Description Page <br /> (1) ❑ADD ❑DELETE ❑REVISE 1999 PAGE(2) OF(3) <br /> BUSINESS NAME (4) / / <br /> <br /> <br /> <br /> CHEMICAL NAME (8) /� r [ 1�O TRADE SECRET(11) ❑Y X❑N <br /> C` w *EHS (12) ❑Y ©N <br /> COMMON NAME (9) C- O <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ( 2 4 - 3 8 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ®PURE ❑MIXTURE ❑WASTE RADIOACTIVE(l5) ❑Y I�I N (16) <br /> PHYSICAL STATE(17)1 ❑SOLID QLIQUID ©GAS lC� CURIES <br /> FED HAZARD ❑ <br /> CATEGORIES (18) FIRE ❑REACTIVE ©PRESSURE RELEASE ❑ UI <br /> ACEHEALTH ❑ A <br /> CHRONICI- TH <br /> STATE WASTE (19) UNITS* (22) ❑GAL ❑CU FT MAX DAILY AMT(23) 6 81 <br /> CODE ©LBS [-] TONS ON-SITE �t70 <br /> DAYS ON SITE (20)� AVG DAILY AMT(24)� <br /> 3 � s *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 0 L Sj ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑w CYLINDER [:]RAIL CAR <br /> ®TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE 1:1-------------------- <br /> EI 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) ❑AMBIENT ❑ABOVE AMBIENT ©BELOW AMBIENT ®CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> to PSI be++- 7>rOIt . xe ❑Y ❑N / 2- V ' 3 8 4 <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y N11 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> ,'.o <br /> s/it S O T T <br /> USED FOR? <br /> For Official Use Only: L] C ❑ R S SIC 12/98 <br />