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California Hazardous Materials Inventory Form - Chemit Description <br /> (1) MADDDELETE E—]REVISE 2001 PAGE(2) O1(3) <br /> EI <br /> BUSINESS NAME (4) <br /> DEC 14 2000 <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> CHEMICAL NAME (3) TRADE SECRET(1 I) ❑Y MN <br /> COMMON NAME (9) l(�A *EHS(12) ❑Y �N` <br /> 1 i��i i �v tGZG' <br /> *IF EHS BOX IS <br /> CAS # (IOi , 2 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) [:]SOLID LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (1$) ❑ FIRE []REACTIVE ❑PRESSURE RELEASE ❑ ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) f171GAL ❑CU FT MAXN-S DAILY AMT(23)� <br /> CODE Iwo+ ON-SITE <br /> LBS ❑TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> .S *If EHS, amounts must be in lbs ON-SITE -- II <br /> LARGEST (21) ANNUAL WASTE AMT(25)C- I <br /> CONTAINER SS J <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 ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) O AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (3 1)EHS 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 E17S SJC 12/00 <br />