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California Hazardous Materials Inventory Form - Chetcal Description <br /> (U 1 A IADD DELETEREVISE 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 <br /> COMMON NAME (9) � ._ <br /> *EHS(12) ❑Y 21N <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14)10 PURE MIXTURE WASTE I RADIOACTIVE(15) ❑Y N (16)� <br /> PHYSICAL STATE(17) ❑SOLID LIQUID [–]GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (I8) ❑FIRE RF ACTIVE ❑PRESSURE RELEASE ❑ ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) GAL ❑CU FT MAX DAILY AMT(23) <br /> LBS ❑ TONS <br /> � <br /> CODE f' ❑ ON-SITE S v <br /> DAYS ON SITE (20) /0 AVG DAILY AMT(24)� <br /> 365— *If EHS, amounts must be in lbs ON-SITE _Sv <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER s D 3 0 <br /> STORAGE (26) ABOVE GROUND TANK E] CAN ❑ BOX [:]TANK WAGON <br /> CONTAINER 191UNDER 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 <br /> STORAGE (28) TrAMBrENT [:]ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE fte <br /> (29)%WT (30)HAZARDOUS COMPONENT (3� (32)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <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 L] S SIC 12/00 <br />