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California Hazardousteerrials Inventory Form - Chemical w- <br /> (1) ❑ADD ❑DELETE ❑ EVI <br /> RSE I 2005 PAGE(2) = OF(3)� <br /> BUSINESS NAME (4) CIECENEU <br /> G 7 FODd iV / <br /> CHEMICAL LOCATION(S)(5) / / <br /> <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) e J TRADE SECRET(11) ❑Y ON <br /> COMMON NAME (9) <br /> *EHS (12) ❑Y ON <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 �!�/7 N (16) <br /> PHYSICAL STATE(17) ❑SOLID ®LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) 0 ME ❑REACTIVE [:]PRESSURE RELEASE ❑ ACUTE HEALTH [-] CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) E3eAL ❑CU FT MAX DAILY AMT(23) <br /> 1E]LBS ❑TONS <br /> CODE ON-SITE I 20, O� <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 20, 490:0:1 � <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 Ila <br /> STORAGE (28) M.AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 30 HAZARDOUS COMPONENT 3 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> FE-1Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)L_L_,= <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: ❑ C ❑ R ❑ S SJC 12/03 <br />