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California Hazardous A&rials Inventory Form - Chemical Oription <br /> (I) ❑ADD ❑DELETE ❑REVISE PAGE(2) = OF(3)� <br /> BUSINESS NAME (4) j A\k A?T <br /> CHEMICAL LOCATION(S)(5) <br /> (Within facility,not street address <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) rZ C TRADE SECRET(11) ❑Y <br /> ❑Y ❑N <br /> COMMON NAME (9) *EHS(12)'p QoQ�r,L <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FUZE CODE (13) <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE ®MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y (I6)� <br /> PHYSICAL STATE(17)1 []SOLID QLIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) G'IRE E]REACTIVE ©NOSURERELEASE ❑ ACUTE HEALTH [] CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) QQAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE 1[:]LBS ❑TONS ON-SITE <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 <br /> STORAGE (26) S-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 /> ❑PLASTICINONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27)JE] AMBIENT ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) nAMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑1 ❑N <br /> ❑Y—E]N] <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL pp--cp p'lE <br /> USED FOR. <br /> For Official Use Only: E] C ❑ R S SJC 12/03 <br />