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California Hazardous Materials Inventory Form - Chemical Description <br /> (1) ®ADD DELETE REVISE 2001 PAGE(2) Lj]_OF(3)= <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) <br /> ��JQAQUIYCQQ <br /> MAP# (6) / GRID#(7) <br /> CHEMICAL NAME (8) UTDSL ALL TRADE SECRET(11) ❑Y ®N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) <br /> O *IF EHS BOX IS"Y" <br /> CAS # (10) 1 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)� URE ❑WASTE RADIOACTIVE(15) ❑Y ®N (16)� <br /> PHYSICAL STATE(17)1 ❑SOLIDLIQUID ❑GAS CURIES <br /> FED HAZARD FIRE REACTIVE PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH <br /> CATEGORIES (18) � ❑ ❑ <br /> STATE WASTE (19)�� UNITS* (22) ❑GAL <br /> LBS ❑TO❑CU <br /> FT MAX DAILY AMT(23) _7 <br /> CODE ON-SITE /C <br /> - <br /> DAYS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25)�� <br /> CONTAINER oO <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 11--------------------- <br /> R]STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27)110 AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT []CRYOGEN <br /> 17C <br /> TEMPERATURE <br /> (29) %WT (30)HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL Q\L, KDY2_ -7N-c_- —L`C, <br /> USED FOR? <br /> For Official Use Only: C ❑ It El S SJC 12100 <br />