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California Hazardous tviaterials Inventory Form - Chemical Description, <br /> (T) ❑ADD ` DELETE REVISE' 2000 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> ". I <br /> CHEMICAL LOCATION(S)(S) <br /> -Putt <br /> ( <br /> MAP# (6) / GRID#(7) <br /> CHEMICAL NAME (K) �/' �` TRADE SECRET (1 1) ❑Y N <br /> *EHS (12) ❑Y <br /> COMMON NAME (9) ( VP✓ ,� �i� N <br /> IF EHS BOX IS "Y" <br /> CAS # (1O) ��ll( -3 ALL AMOUNTS MUSTBE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) 'URE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑ Y N (16) <br /> PHYSICAL STATE(17) ❑SOLID aLIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (1 K) ❑ FIRE ❑ REACTIVE TfPRESSURE RELEASE ACU-11---I IEALTI1 CI IRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ❑GAL ❑CU FT MAX DAILY AMT(23) )� <br /> CODE LBS E] TONS_ ON-SITE P Z 0 <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> *If EHS, amounts must be in Ibs ON-SITE L <br /> LARGEST (21) ANNUAL WASTE: AMT(25) <br /> CONTAINER (A . <br /> STORAGE (26) ❑ ABOV13 GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑ UNDER GROUND TANK ❑CARBOYCYLINDER [:]RAIL CAR <br /> ❑'TANK INSIDE BUILDING ❑ SILO ❑LASS BOA 1'LE ❑-------------------- <br /> El <br /> - -- -- <br /> ❑STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) 0,,AMBIENT ❑A130VE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (2S) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> (29)-/,WT (_ )) HAZARDOUS COMPONENT (3 1) F HS (32) CAS# <br /> ❑ 1' - N i _I <br /> ❑Y ❑ N <br /> ' ❑Y ❑N <br /> ❑Y [:JNIE <br /> ❑Y ❑ N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL- <br /> USED <br /> ATERIALUSED FOR? <br /> For Official Use -Only: I C '�-� R I- I S SJC 12/99 <br />