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Califo-nia Hazardous Materials Inventory Reporting Form Chemical Description Page <br /> (11 EIADD E:]DELETE REVISE 1999 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) <br /> h <br /> MAP# (6)/ GRID#(7) <br /> CHEMICAL NAME (8) TRADE SECRET (11) <br /> COMMON NAME (9) *EHS (12) [:]Y EN <br /> CAS # (10) *IF EHS BOX IS "Y" <br /> ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS I <br /> TYPE (14)IWPURE [:]MIXTURE ®WASTE RADIOACTIVE(15) (16) <br /> PHYSICAL STATE(17)1 [-]SOLID [ZLIQUID ®GAS CURIES <br /> FED HAZARD — -] <br /> CATEGORIES (18)12 FIRE REACTIVE PRESSURE[_ RELEASE [KACUIEIIEALTH [] CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) GAL CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE <br /> DAYS ON SITE (20) [:]LBS TONS AVG DAILY AMT(24) <br /> LARGEST (21 Nr----------------- *If EHS, amounts must be in lbs ON-SITE <br /> CONTAINER /< ANNUAL WASTE AMT(25) <br /> STORAGE (26) ABOVE GROUND TANK CAN <br /> ® BOX BOX [:]TANK WAGON <br /> UNDER GROUND TANK CARBOY CYLINDER [:]RAIL CAR <br /> El TANK INSIDE BUILDING SILO GLASS BOTTLED-------------------- <br /> ®STEEL DRUM FIBER DRUM PLASTIC BOTTLE <br /> []PLASTIC/NONMETALLIC DRUM BAG TOTE BIN <br /> STORAGE (27) [q AMBIENT [:]ABOVE AMBIENT [:]BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT [:] [:]BELOW AMBIENT MBIENT <br /> TEMPERATURE — [:]CRY <br /> (29)%WT (30)HAZARDOUS COMPONENT <br /> (3 1)EHS (32)CAS# <br /> =E]YUNI <br /> Y NJ <br /> E== ❑Y N F� <br /> 77 <br /> E 7 ❑Y 1:1 N <br /> L== F <br /> ®Y <br /> N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: C R El S SJC 12/98 <br />