Laserfiche WebLink
California Hazardous iterials Inventory Form - Chemica"./scription <br /> U ❑ADD [::]DELETE 2005 PAGE(2) OF(3)F <br /> BUSINESS NAME (4) o <br /> CHEMICAL LOCATION(S)(5) SAiv JOACUIN COUNT• <br /> (Within facility,not street address :E Cf EMERGEN <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) % TRADE SECRET(11) ❑Y [DN <br /> COMMON NAME (9) �e �� �. w *EHS(12) ❑Y �N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ! ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16) <br /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE [:]REACTIVE ❑PRESSURE RELEASE [ZACUI'EHEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19)O UNITS*(22) ®GAL ❑CU FT MAX DAILY AMT(23)� <br /> CODEON-SITE <br /> ( ) *If EHS, r�p <br /> DAYS ON SITE 20 D ❑LBS ❑TONS AVGrFE Y AMT(24)� <br /> amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER <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 BOTTLE ❑-------------------- <br /> 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)% 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> 11 ❑Y ❑N IF <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1 7 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? AVEI e <br /> For Official Use Only: C R S SIC 12/03 <br />