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California Hazardof Materials Inventory Form - Chellical Description <br /> (1) ADD [—]DELETE ❑REVISE 2001 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> G lit L/ <br /> CHEMICAL LOCATION(S)(5) / <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y N <br /> COMMON NAME (9) �J� o` <br /> *EHS 02) ❑Y �N <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 ❑MIXTURE WASTE RADIOACTIVE(15) ❑Y N (16) <br /> PHYSICAL STATE(17)1 ❑SOLID IQUID ❑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 ZLBS TONS ON-SITE Z o <br /> ljo ❑ <br /> DAYS ONSITE (20) AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ZSv ANNUAL WASTE AMT(25)� <br /> CONTAINER <br /> STORAGE (26) ABOVE GROUND TANK E] CAN [:1BOX [-]TANK WAGON <br /> CONTAINER EUNDER 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)1 ZMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (31 E) HS (32)CAS# <br /> 11 ❑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: 0 C ❑ R ❑ S SJC 12/00 <br />