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California Hazardoqu lmaterials Inventory Form - CherdTcal Description <br /> (1) r71ADD ❑DELETE ❑REVISE 2001 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y Dj�N <br /> COMMON NAME (9) *EHS(12) ❑Y IQ N <br /> ao <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)1 OPURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) Fu N (16)� <br /> PHYSICAL STATE (17)1 ❑SOLID RtIQUID OGAS CURIES <br /> FED HAZARD <br /> CATEGORIES (Ig)r0FIRE ❑REACTIVE ZPRESSURERFLEASE ACUTEHEALTH E] CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE <br /> BS ❑ TONS $ Ob <br /> ❑L <br /> DAYS ON SITE (20) AVG DALLY AMT(24)� <br /> *If EHS, amounts must be in lbs ON-SITE ZSa <br /> LARGEST (21)� ANNUAL WASTE AMT(25)D <br /> CONTAINER 00 <br /> STORAGE (26) ABOVEGROUNDTANK E] CAN ] BOX []TANK WAGON <br /> CONTAINER UNDERGROUND 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 <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> 11 QN11 <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) f J D S <br /> (34)WHAT IS MATERIAL <br /> USED FOR? I X, <br /> For Official Use Only: E C R S SIC 12/00 <br />