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California Hazardous Materials Inventory Form - Chemical Description <br /> (l) ADD DELETE DRUVISE 2001 PAGE(2) OF(3) <br /> 4 <br /> BUSINESS NAME (4) <br /> J.S.G. Trucking <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> CHEMICAL NAME (8) TRADE SECRET I IJ N <br /> Anti Freeze ( > ❑Y ❑ <br /> COMMON NAME (9) Anti Freeze *EHS(12) ❑Y ❑N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) <br /> 107-21-1 ALL AMOUNT'S MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE ❑MIXTURE ❑WASTE RADIOAC-I'IVE(15) ❑Y ❑N (16)� <br /> PHYSICAL STATE(17)1 ❑SOLID ❑x LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (1$)I ®FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ ACMEHEALTH ® CHRONIC HEALTH <br /> STATE WASTE (19)�� UNITS* (22) QGAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE [:]LBS ON-SITE 110 <br /> LBS ❑ <br /> DAYS ON SITE (20)= AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE 55 <br /> LARGEST (21� <br /> CONTAINER ANNUAL WASTE AMT(25)� <br /> 55 <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 /> x❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) x❑ AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) Q AMBIENT [:]ABOVEAMBIENT [:]BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT 30)HAZARDOUS COMPONENT332 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ED r_1 XT <br /> ADDITIONAL LOCALLY COLLECTED INFORMA'T'ION: (33)UNITED NATIONS ID#(DOT) 1142 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? 1&H1C CE IVIql.vi�iJq�/ -r <br /> For Official Use Only: C L R S SIC 12/00 <br />