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California Hazardous Materials Inventory Form - Chemical D <br />(1) ❑ADD ❑DELETE ❑REVISE 2001 P 3)= <br />BUSINESS NAME (4) 8ANd0A011111000WIM <br />2 _ `�'i <br />/VI. QV`. !J ( l ��"r �/ � MM/M/��www-tiiww.0 -� <br />CHEMICAL LOCATIONS) (5) <br /> <br /> <br /> <br />CHEMICAL NAME (8) TRADE SECRET(11) ❑ Y N <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE <br />(13) <br />HAZARD CLASS <br />TYPE <br />(14) <br />PHYSICAL STATE (17) <br />FED HAZARD <br />RADIOACTIVE(15) ❑P N (16)� <br />CURIES <br />CATEGORIES <br />(18) <br />STATE WASTE <br />(19) <br />CODE <br />❑ABOVEGROUNDTANK CAN <br />❑ UNDERGROUND TANK ❑ CARBOY <br />❑ TANK INSIDE BUILDING ❑ SILO <br />❑ STEEL DRUM ❑ FIBER DRUM <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BAG <br />DAYS ON SITE <br />(20. <br />LARGEST (21 <br />CONTAINER <br />STORAGE (26; <br />CONTAINER <br />STORAGE (27, <br />PRESSURE <br />STORAGE (28 <br />TEMPERATURE <br />/� � 2— <br />*EHS (12) ❑Y N <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />LEAVE BLANK <br />RADIOACTIVE(15) ❑P N (16)� <br />CURIES <br />❑PURE 2DMIXTURE ❑WASTE <br />❑SOLID IQUID ®GAS <br />❑ FIRE [:]REACTIVE PRESSURE RELEASE ❑ ACUTE HEALTH [:]CHRONIC HEALTH <br />UNITS* (22) ❑GAL ❑ CU FT MAX DAILY AMT (23)® <br />ON-SITE <br />LBS ❑TONS <br />AVG DAILY AMT (24)� <br />,*If EHS, amounts must be in lbs ON-SITE <br />ANNUAL WASTE AMT (25) <br />❑ABOVEGROUNDTANK CAN <br />❑ UNDERGROUND TANK ❑ CARBOY <br />❑ TANK INSIDE BUILDING ❑ SILO <br />❑ STEEL DRUM ❑ FIBER DRUM <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BAG <br />[:1 BOX ❑TANK WAGON <br />CYLINDER ❑ RAIL CAR <br />❑ GLASS BOTTLE ❑-------------------- <br />❑ PLASTIC BOTTLE <br />❑ TOTE BIN <br />❑ AMBIENT gABOVE AMBIENT ❑BELOW AMBIENT <br />❑ AMBIENT ❑ ABOVE AMBIENT BELOW AMBIENT YLCRYOGENIC <br />02) CAS# <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) / I <br />(34) WHAT IS MATERIAL So DA NnAcQ )iJ� <br />USED FOR? <br />For Official Use Only: ❑ C R S SJC 12/00 <br />