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California Hazardous 11terials Inventory Form - Chemif Description <br /> (I) ADD RE <br /> DELETE VISE 2001 PAGE(2) <br /> BUSINESS NAME (4) ULU 14 <br /> i cin <br /> CHEMICAL LOCATION(S)(5) OFHOEOP EW N CES <br /> <br /> = <br /> CHEMICAL NAME (8) TRADE SECRET(1 1) ❑Y ON <br /> *EHS (12) ❑Y N <br /> COMMON NAME (9) <br /> *IF E•HS BOX IS"Y" <br /> CAS # 00) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE MIXTURE ❑WASTE RADIOACTIVE(IS) ❑Y fGl N (16) <br /> PHYSICAL STATE(17) ❑SOLID �L[QUID [:]GA=S �I CURIES <br /> FED HAZARD <br /> CATEGORIES (I821 ❑ E.4FIRE RCTI VE [-]PRESSURE ❑RELEASE ACUTE HEALTH CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (12) MAX[(GAL ❑CU FT ON-S DAM' .AMT('-3) <br /> CODE ON-SITE ZS v <br /> DAYS ONSITE (20) [:]LBS ❑ TONS AVG DAILY AMT(24) <br /> �S *ll EHS. amounts must be in lbs ON-SITE �.Sv <br /> LARGEST (21) ANNUAL WASTE AMT(25) <br /> CONTAINER Zrp <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) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT [:]CRYOGEN <br /> IC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (3 1YON (32)CAS# <br /> E]NII <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 FORT � w %Ga <br /> For Official Use Only: L] L] R ❑C S SJC 12/00 <br />