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i • <br />California Hazardous Materials Inventory Form - Chemical Description <br />(1) E]ADD =DELETE =REVISE 2001 PAGE (2) =OF(3)� <br />BUSINESS NAME (4) <br />1�DnS /auto je,vvic-eJ <br />CHEMICAL LOCATION(S)(5) <br /> _ <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD CLASS <br />TYPE (14) <br />PHYSICAL STATE (17) <br />FED HAZARD <br />TRADE SECRET(11) ❑Y �,N <br />*EHS(12) ❑Y M <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />CATEGORIES <br />(18) <br />STATE WASTE <br />(19) <br />CODE <br />DAYS ON SITE <br />(20 <br />LARGEST (21 <br />CONTAINER <br />STORAGE (26; <br />CONTAINER <br />STORAGE (27 <br />PRESSURE <br />STORAGE (28 <br />TEMPERATURE <br />oy/� tn <br />TRADE SECRET(11) ❑Y �,N <br />*EHS(12) ❑Y M <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />LEAVE BLANK <br />RADIOACTIVE(l5)❑Y N (16)� <br />CURIES <br />URE [—]MIXTURE ❑WASTE <br />❑SOLID ❑LIQUID2GAS <br />❑ FIRE <br />�EAcnvE <br />RESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />GAL F1CU FT MAX DAILY AMT (23) Z S <br />D UNITS* (22)F]LBS❑ TONS ON-SITE <br />3�AVG DAILY AMT (24)� <br />*If EHS, amounts must be in lbs ON-SITE <br />Z QO ANNUAL WASTE AMT (25) <br />❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br />❑ 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 />❑ AMBIENT TSABOVE AMBIENT ❑BELOW AMBIENT <br />AMBIENT [-]ABOVE AMBIENT ❑BELOW AMBIENT <br />❑ CRYOGENIC <br />ADDITIONAL LOCALLY COLLECTED INFORMATION <br />(34) WHAT IS MATERIAL <br />USED FOR? Uy -�-- <br />N�3 1) EHS <br />❑Y❑N C <br />❑Y ❑N C <br />❑Y❑NI C <br />❑Y ❑N <br />❑Y❑N C <br />(33) UNITED NATIONS ID # (DOT) <br />For Official Use Only: ] C ❑ R F] S I SIC 12/00 <br />