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California Hazard& Materials Inventory Form - Ct cal Description <br /> (1) ❑ADD ❑DELETE REVISE 2001 PAGE(2) © OF(3)F47_ <br /> BUSINESS NAME (4) ILLS Ho <br /> CHEMICAL LOCATION(S)(5) 1 I <br /> NCUUNTY <br /> MAP#(6)/ GRID#(7) <br /> CHEMICALNAME (8) U�Cl41Fl�p 1�{Jn� � Cj TRADE SECRET(11) ❑Y <br /> COMMON NAME (9) *EHS(12) ❑Y ❑'f 1 <br /> 1 t lv *IF EHS BOX IS"Y•• <br /> CAS # (10) �G�,qQj �I p ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE IXTURE [:]WASTE RADIOACTIVE(I5) ❑y (16)� <br /> PHYSICAL STATE(17)1 [:]SOLIDIQUID ❑GAS CURIES <br /> FED HAZARDCATEGORIES <br /> FIRE ❑REACTIVE PRESSURERELEASE ACUIEHEALTH ❑ CHROMIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS* (22) E2 AL ❑CU FT J MAX DAILY AMT(23) <br /> CODE ON-SITE S�C� <br /> IEJ LBS ❑TONS <br /> DAYS ON SITE (20)� AVG DAILY AMT('24) �0 <br /> *If EHS, amounts mus[ be in lbs ON-SITE <br /> LARGEST (21) M ANNUAL WASTE AMT(25) <br /> CONTAINER CbG <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 BOTTLEEl STEEL DRUM ❑ DltablL_ ____ <br /> eyc(r'12eG( <br /> ❑ FIBER DRUM ❑ BOTTLE <br /> PLASTIC/NONMETALLIC DRUM ❑ BAGTOTE BIN ��;nders <br /> STORAGE (27)JE] 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 /x(32)CAS# <br /> 6IS- 106 P [� ❑Y N l �' 17/� <br /> Gam. S 'U <br /> FPO� F�/1 +� ❑Y N ?�r-���/�� <br /> Fz y ��1� ��e� f ❑Y N <br /> �-50 ✓Y1 { r� ISI Q 6TI V ❑Y N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONSID#(DOT) /978 <br /> (34)WHAT IS MATERIALNp Pp�e� <br /> USED FOR? <br /> For Official Use Only: C ❑ R ❑ S SJC 12/00 <br />