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California Hazardous Materials Inventory Form - Chemical Description <br /> (I)I uADD DDELETE REVISE 2001 PAGE(2) _ OF(3)� <br /> BUSINESS NAME (4) <br /> �L Tt bm t <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> CHEMICAL NAME (8) I� � L 1� TRADE SECRET(11) ❑Y EI N <br /> COMMON NAME (9) <br /> *EHS (12) ❑Y ERN <br /> �e Ej 1 T� ` <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (1 ) LEAVE BLANK <br /> HAZA <br /> TYPE RD CLASS (14) PURE [-]MIXTURE ❑WASTEEDY ©N C-� <br /> RADIOACTIVE(IS) (16) <br /> PHYSICAL STATE (17)1 ❑SOLID ❑LIQUID ®GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ©FIRE REACTIVE PRESSURERELEASE ❑ ACUTEHEALTH ❑ CHRONICHEALTH <br /> ❑ <br /> STATE WASTE (19)� UNITS* (22)ELBS <br /> GAL ❑CU FT MAX DAILY AMT(23) a�G <br /> CODE E]TONS <br /> DAVG DAILY AMT(24) <br /> DAYS ON SITE (20) <br /> �7 *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21) ANNUAL WASTE AMT(25)� <br /> CONTAINER 3�P <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 ABOVEAMBIENT ❑BELOWAMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT [:]ABOVE AMBIENT [:]BELOWAMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29 %WT (30)HAZARDOUS COMPONENT (3 (32 CAS# <br /> ❑Y ❑N <br /> F — — - — <br /> roY E]NJ <br /> []Y ❑N <br /> ❑Y ❑N <br /> -- � ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) d.l IAN1 loot <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For fficial Use Only: C [] R [] S SJC 12/00 <br />