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California Hazardous Mai>rrials Inventory Form - Chemical Dfription <br />(1) I R ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />MAP # (6) / GRID # (7) <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />FARM SERVICE <br />(5) <br />COPPER <br />TENN-COP <br />61789-22-8 <br />VE BLANK <br />PAGE (2) F2 9 OF (3) F116 <br />TRADE SECRET (11) ❑YES R NO <br />*EHS (12) ❑YES R NO <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />TYPE (14)❑PURE ®MIXTURE ❑WASTE RADIOACTIVE(15) ❑yES RNO(16)N/A <br />PHYSICAL STATE (17) ❑ SOLID R LIQUID ❑ GAS CURIES <br />FED HAZARD <br />CATEGORIES (18)R FIRE ❑ REACTIVE []PRESSURE RELEASE R ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) N/A <br />CODE <br />DAYS ON SITE (20) 365 <br />LARGEST <br />(21 <br />CONTAINER 2.5 GAL <br />UNITS* (22) R GAL ❑ LBS MAX DAILY AMT (23) 400 <br />[ICU FT ❑ TONS ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 100 <br />ON SITE <br />ANNUAL WASTE AMT (25) N/A <br />STORAGE <br />(26) <br />[:]ABOVE GROUND TANK <br />[]CAN <br />❑ BOX <br />❑ <br />CONTAINER <br />25551-13.7 <br />❑ UNDER GROUND TANK <br />[]CARBOY <br />❑ CYLINDER <br />❑ <br />❑YES <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ <br />❑N <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />R PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />[]BAG <br />❑ TOTE BIN <br />STORAGE <br />(27) <br />R AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) R AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT (30) HAZARDOUS COMPONENT (3 1) EHS <br />(32) CAS# <br />58.00 COPPER <br />❑YES <br />ON <br />61789-22-8 <br />42.00 XYLENE <br />❑YES <br />RN <br />25551-13.7 <br />❑YES <br />❑N <br />❑YES <br />❑N <br />❑YES <br />❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 1307 <br />(34) WHAT IS MATERIAL RETAIL SALE - <br />USED FOR? -- <br />DATE REC'D: 12/14/01 For Official Use Only: 0 C ❑ R ❑ S SIC 12/99 <br />