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California Hazardous [v7aterials Inventory Form - Chemical Description <br /> (1) HADD DDELET'E REVISE 2001 PAGE('_') OF(3) <br /> BUSINESS NAME (4) <br /> c h <br /> CHEMICAL LOCATION(S)(5) bAN J0aaUIN COUMY <br /> OFRCE OF EMERGENCY SERV ES <br /> MAP#(6)/ GRID#(7) = <br /> CHEM[CAI, NAME (S) —� TRADE SECRET O 1) ❑Y [B N <br /> COMMON NANIE (9) *EHS (I-1) ❑Y 0L�y( <br /> N <br /> �-O kHC <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) SS8 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) Z PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y [RN (l6) <br /> PHYSICAL STATE(17)1 [:]SOLID ❑LIQUIDOGAS [R <br /> CURIES <br /> FED HAZARD �q- <br /> CATEGORIES (IS) [ FIRE []REACTIVE PRESSURE RELEASE [RACUTE HE-\LTH CHRONIC HEALTH <br /> STATE WASTE (.19)D UNITS* (22) OGAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE ON-SITE SJ1� <br /> 10LBS []TO AVG DAILY AMT(24) <br /> DAYS ON SITE 1_0) <br /> S *If EHS, amounts must be in lbs ON-SITE 25a <br /> LARGEST (21� ANNUAL WASTE AMT(25)� <br /> CONTAINER ,s�o <br /> STORAGE (26) OABOVEGROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑ UNDER GROUND TANK ❑CARBOY ❑ CYLINDER [-]RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE 1:1-------------------- <br /> 0 STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27)12f AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)12 AMBIENT E]ABOVE AMBIENT [:]BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%oWT (30) HAZARDOUS COMPONENT (3 1)EHS (32)CAS# <br /> YE]NII <br /> N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑ N <br /> ❑Y E-1 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 />