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California Hazardous Materials Inventory Form - Chemit Description <br /> (1) al ADD ❑DELETE [-]REVISE 2001 PAGE(2) <br /> FR ED <br /> BUSINESS NAME (4) DEC 14 ZUUU <br /> vG <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> := F: <br /> CHEMICAL NAME (S) / 1 / I TRADE SECRET(I I 1 ❑Y ON] <br /> *EHS (12) ❑Y N <br /> COMMON NAME (9) r V I <br /> *IF EHS BOX IS"l"' <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE ❑MIXTUREpWASTfi RADIOACTIVE(15) ❑Y ®N (16)� <br /> PHYSICAL STATE (17) ❑SOLID ❑LIQUID []GAS ldl CURIES <br /> CATHAZARD <br /> (18) FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ ACUTEHEALTH ® CHRONICHEALTH <br /> STATE WASTE (19) UNITS* (22) RGAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE Z 2 F] ON-SITE 2 0 <br /> ❑LBS ❑ TONS <br /> DAVG DAILY AMT(24i <br /> DAYS ON SITE (201 � <br /> *If EHS, amounts must be in lbs ON-SITE (j <br /> LARGEST (21) ANNUAL WASTE AMT(25)C <br /> CONTAINER <br /> STORAGE (26) 1A I ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER UNDER GROUND TANK ❑CARBOY ❑ CYLINDER []RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE El-------------------- <br /> [-I 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 (2S) [MAMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (31) EHS (32)CAS# <br /> 0 ❑ N <br /> ❑Y ❑ N <br /> ❑ Y ON <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 ❑ S SIC 12/00 <br />