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California Hazards Materials Inventory Form - Che cal Description <br /> (U ADD DELETEREVISE 2001 PAGE(2) OF(3)� <br /> BUSINESS NAME (4) <br /> GJ <br /> CHEMICAL LOCATION(S)(5) / <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) `o / �M c TRADE SECRET(11) ED]—YON <br /> *EHS (12) ❑Y ❑N <br /> COMMON NAME (9) Gotic /Hf j �GhCL <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 13 O _ _ � ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) E]PURE MIXTURE ❑WASTE RADIOACTIVE(15) ❑1 N (16)� <br /> PHYSICAL STATE(17)1 []SOLID LIQUID [:]GASCURIES <br /> FED HAZARD <br /> CATEGORIES (18) [:]FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ ACUIE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22)XGAL ❑CU FT MAX DAILY AMT(23) <br /> CODE D ON-SITE �r <br /> ❑LBS ❑TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> 3GS *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21) ANNUAL WASTE AMT(25)� <br /> CONTAINER SS <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 ❑ABOVE AMBIENT ❑ LOW AM <br /> BEBIENT <br /> PRESSURE Im <br /> STORAGE (28) AMBIENT []ABOVEAMBIENT ❑BELOW AMBIENT ❑CRYOGENICTEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (31 EHS (32 CAS# <br /> �a SD�i!/fin /7 GOX/d ❑Y [P}N 0 _ Z. <br /> a o J ❑Y N — ,>/� <br /> ❑Y ❑N <br /> ❑YE]N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) (/ p <br /> (34)WHAT IS MATERIAL <br /> USED FOR? G <br /> For Official Use Only: Ffl C ❑ R ❑ S SIC 12100 <br />