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California Hazardous0aterials Inventory Form (1) ❑ADD ❑DELETE ❑REVISE 2001 BUSINESS NAME (4) f��/�\ CHEMICAL LOCATION(S) (5) MAP # (6) / GRID # (7) CHEMICAL NAME (8) COMMON NAME (9) CAS # (10) FIRE CODE (13) HAZARD CLASS �2C7�✓� J� TYPE (14) PHYSICAL STATE (17) FED HAZARD CATEGORIES (18) STATE WASTE (19) CODE DAYS ON SITE (20) LARGEST (21, CONTAINER STORAGE (26) CONTAINER STORAGE (27) PRESSURE STORAGE (28) TEMPERATURE Chemical Description PAGE (2) = OF (3)� ,►., LP [NT 31 EHS (32) CAS# Y N ❑Y ❑N ❑Y ❑N ❑Y ❑N ❑Y ❑N ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) �— (34) WHAT IS MATERIAL1 G `� USED FOR? For Official Use Only: II/J C ❑ R U s SIC 12/00 (3t TRADESECRET(II) ❑Y RN *EHS(12) ❑Y RN *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS �2C7�✓� J� (O LEAVE BLANK RADIOACTIVE (15) FI ---]Y [SN (16) CURIES is PURE [:]MIXTURE [:]WASTE ❑SOLID ❑LIQUID GAS CHRONIC REACVE []PRESSURE RELEASE ❑ ACUIE HEALTH ❑CHRONIC HEALTH ❑ FIRE ❑TI UNITS* (22)GAL ❑ CU FT MAX DAILY AMT (23) � ON-SITE F]LBS ❑ TONS AVG DAILY AMT (24) 3 (p5 *If EHS, amounts must be in lbs ON-SITE ANNUAL WASTE AMT (25) 17v58 �L b0 0b�0 0 [J P� ABOVE GROUND TANK ❑ CAN ❑ UNDER GROUND TANK [:]CARBOY ❑ TANK INSIDE BUILDING ❑ SILO ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ BOX [–]TANK WAGON [gCYLINDER [:]RAIL CAR ❑ CLASS BOTTLE ❑-------------------- ❑ PLASTIC BOTTLE ❑ TOTE BIN ❑ AMBIENT ® ABOVE AMBIENT ❑BELOW AMBIENT AMBIENT ❑ ABOVE AMBIENT ❑BELOW AMBIENT ❑ CRYOGENIC [NT 31 EHS (32) CAS# Y N ❑Y ❑N ❑Y ❑N ❑Y ❑N ❑Y ❑N ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) �— (34) WHAT IS MATERIAL1 G `� USED FOR? For Official Use Only: II/J C ❑ R U s SIC 12/00