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0 0 <br />California Hazardous Materials Inventory Form - Chemical <br />(1)I [::]ADD [—]DELETE <br />BUSINESS NAME (4)j - <br />CHEMICAL LOCATION(S) <br />❑REVISE I 2001 <br />i�CnS 4ul-D jcvv Le <br />Description <br />PAGE (2) = OF (3)� <br />� <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) I U SOLID ,LIQUID I__I GAS <br />FED HAZARD <br />CATEGORIES <br />STATE WASTE <br />CODE <br />DAYS ON SITE <br />LARGEST <br />CONTAINER <br />I r,qfIRE n REACTIVE n PRESSURERELEASE I I ACUMHEALTH [_]CHRONIC HEALTH <br />(20) <br />(21 Z5 D <br />STORAGE (26) <br />CONTAINER <br />STORAGE <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />(29) %WT <br />UNITS* (22) QGAL ❑ CU FT MAX DAILY AMT (23) �� <br />ON-SITE <br />❑LBS ❑TONS <br />AVG DAILY AMT (24) ( <br />*If EHS, amounts must be in lbs ON-SITE ZIIJJ 0-1 <br />ANNUAL WASTE AMT (25) IMO <br />ABOVE GROUND TANK I__I CAN L_I BOX <br />ANK <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 />(27) AMBIENT ❑ ABOVE AMBIENT ❑BELOW AMBIENT <br />(28) 119AMBIENT ❑ ABOVE AMBIENT []BELOWAMBIENT ❑ CRYOGENIC <br />001 HA7ARtNl1iC('()MPnNANT (3 11 EHS <br />(32) CAS# <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) <br />(34) WHAT IS MATERIAL <br />USED FOR? <br />For Official Use Only: C ❑ R ❑ S <br />SJC 12/00 <br />FE-1Y❑N <br />❑ Y ❑ N—� <br />❑Y ❑N <br />I <br />❑Y ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) <br />(34) WHAT IS MATERIAL <br />USED FOR? <br />For Official Use Only: C ❑ R ❑ S <br />SJC 12/00 <br />