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California Hazardo*aterials Inventory Form - Chemic*scription <br /> PAGE(2) OF(3) <br /> 13IJSINESS NAME (4) <br /> RACY BP SERVICE CENTER <br /> CHEMICAL LOCATION(S) (5) <br /> IA /A /A /A <br /> CHEMICAL NAME (8) USED ANTI/FREEZE TRADE SECRET(11) JO YES ®NO <br /> COMMON NAME (9) USED ANTUFREEZE *EHS (12) JEIYES. ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 1107-21-1 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD <br /> CATEGORIES LEAVE BLANK <br /> "1TYP1- (14) ❑PURE ❑MIXTURE ®WASTE RADIOACTIVE(15) ❑YES ®NO (16) <br /> I'll YSICAI-STATE(17) ❑SOLID ®LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ® FIRE ❑REACTIVE ❑PRESSURE RELEASE ®ACUTE HEALTH H CHRONIC HEALTH ❑ <br /> STATE WASTE (19) UNITS* (22) ®GAL El LBS MAX DAILY AMT(23) <br /> CODE 43 ❑CU FT ❑TONS 5 <br /> ON SITE <br /> DAYS ON SITE (20) *If EHS,amounts must be in lbs AVG DAILY AMT(24) <br /> 65 ON SITE 5 <br /> LARGEST (21) ANNUAL WASTE AMT (25) <br /> CONTAINER 5 1110 <br /> STORAGE (26) p ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER ❑ UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG ❑TANK WAGON <br /> ®PLASTIC/NONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ID CAN 0 CYLINDER 0 OTHER <br /> STORAGE (27) ®AMBIENT ❑BELOW AMBIENT <br /> PRESSURE 10 ABOVE AMBIENT <br /> STORAGE, (28) ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29) %oWT (30) HAZARDOUS COMPONENT (3 1) EHS (32) CAS# <br /> 94 ETHYLENE GLYCOL ❑YES ®NO 107-21-1 <br /> 1 <br /> EETHYLENE GLYCOL ❑YES ®NO 111-46-6 <br /> IO WATER <br /> 10 YES ®NO 732-18-5 <br /> 2 DIPOTASSIUM PHOSPHATE ❑YES ®NO 758-11-4 <br /> ❑YES ❑NO <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT)11142 <br /> (34) WHAT IS MATERIAL WASTE <br /> USED FOR? <br /> DATE REC'D: 3125/07 For Official Use Only: ® C ❑R ❑S S]C 12/99 <br />