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California Hazardouomaterials Inventory Form - Chetcal Description <br /> (1) ADD ❑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 N <br /> o vi <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) to U <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) ❑PURE UMIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16) <br /> PHYSICAL STATE(17)1 ❑SOLIDLIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE Sb <br /> ❑ ❑ <br /> DAYS ON SITE (20) LBS TONSAVG DAILY AMT(24)� <br /> 3�s *If EHS, amounts must be in lbs ON-SITE �$—p <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER iso <br /> STORAGE (26) 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 /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIENT E]ABOVE AMBIENT []BELOW <br /> AMBIENT <br /> PRESSURE 10 <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> 11 E]NIF- <br /> I <br /> ❑Y ❑N <br /> YE]Njj <br /> ❑Y ❑N <br /> F01_y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? U l <br /> For Official Use Only: C R S SJC 12/00 <br />