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California Hazardous Materials Inventory Form - Chemical Description <br /> (U ADD ❑DELETE ❑REVISE 2001 PAGE(2) OF(3)� <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> = <br /> CHEMICAL NAME (8) TRADE SECRET(1 1) ❑Y N <br /> ❑Y N <br /> COMMON NAME (9) *EHS(12)- � <br /> .IF EHS BOX IS "Y" <br /> CAS # (10) O _ Z _ ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)1 XPURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16)� <br /> PHYSICAL STATE(17) []SOLID LIQUID [:]GASCURIES <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE [:]REACTIVE ❑PRESSURE RELEASE ❑ ACUTEHEALTH CHRONICHEALTH <br /> STATE WASTE (19) UNITS*(22) GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE �5—O <br /> LBS ❑TONS <br /> DAYS ON SITE (20)� AVG DAILY AMT(24)� <br /> 3�S *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21� ANNUAL WASTE AMT(25)� <br /> CONTAINER .Sy <br /> STORAGE (26) grABOVE 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 101 <br /> STORAGE (28) AMBIENT ❑ABOVEAMBIENT []BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3 (32)CAS# <br /> IDYE]NIF- <br /> FE—IY [:]N' <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N/�r <br /> (34)WHAT IS MATERIAL / <br /> USED FOR? 6,�, % / <br /> For Official Use Only: C& C R ❑ S SJC 12/00 <br />