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UNMED PROGRAM CONSOLIDATED FORM <br />HA IIS MATULIALS <br />HAZARDOUS MATERIALS INVENTORY -- CHEMICAL DESCRIPTION <br />asomkl . <br />19 ADD ❑ Da= ❑ REVM zea Page <br />L FACILrrY INFORMATION <br />BUSH,TM NAME (Same as FACILrrY NAME or DBA - Doing Business As) 3. <br />�,® <br />CHOWCAL LOCATION 201. <br />CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br />❑ YFS ®, NO <br />FACII.rrY ID #2 <br />F <br />1 <br />MAP # <br />G12ID # 2" <br />( 88-7 U� Only) <br />.! <br />IL CHEMICAL INFORMATION <br />CHEMICAL NAME ms• <br />TRADE SECRET Yes 06. <br />No 2 <br />/ <br />f 1 EA N � t� V � V. J L ` � <br />If3u*d 4o MCRA, afm is metsaAim <br />COMMON NAME 2m. <br />sees <br />01 l G► 56 L-t FJ C <br />EHSa ® Yes ❑ No <br />CAS# 209. <br />srooco® (.0 1 <br />alf EELS is "Yes," all amounts below must be in ]ba. <br />FIRE CODE HAZARD CLASSES (Cousphleffrequosel by Isom Wady) 210. <br />r L pf C Lt w <br />HAZARDOUS MATERIAL <br />TYPE (Check cm item only) ❑ a PURE tB b. MIXTURE ❑ c. WASTE 211. <br />RADIOACTIVE ❑ Ya VNo 212 <br />213. <br />CURIES <br />PHYSICAL STATE <br />215. <br />(Clack one item only) ❑ a. SOLID b. LIQUID ❑ c. OAS 21a. <br />LARGEST CONTAINER <br />FED HAZARD CATBOORIES 216. <br />(Check all that apply) iB a FIRE job. REACTIVE ❑ c. PRESSURE RELEASE IC&ACUTEHBALTH e. CHRONIC HEALTH <br />AVERAGE DAILY AMOUNT 217. <br />MA7ffivItJM DAILY AMOUNT 21& <br />ANNUAL WASTE AMOUNT 219. <br />STATE WASTE CODE 220. <br />s <br />'2. 1 <br />UNTTS•&raLGALLONS ❑ b. CUBIC FEST ❑ c. POUNDS ❑ d TONS 221. <br />DAYS ON SITE 222 <br />Clack atm it. Ski• If EHS amass mist be in <br />STORAGE <br />CONTAINER ❑ a. ABOVEGROUND TANK ❑ a. PLASTICNONMETALLIC DRUM ❑ i FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAIL CAR <br />b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ a PLASTIC BOTTLE ❑ r. OTHER <br />❑ a TANK INSIDE BUILDING ❑ S. CARBOY ❑ k. BOX ❑ o. TOTE BIN <br />❑ d STEEL DRUM ❑ h SILO ❑ 1 CYLINDER ❑ p. TANK WAGON 223. <br />STORAGE PRESSURE ❑ a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224. <br />STORAGE TEMPERATURE ❑ a AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d CRYOGENIC 225. <br />% WT <br />HAZARDOUS COMPONENT (For mixture or waste only) <br />EHS <br />CAS # <br />1. 226. <br />°7 �� L 227. <br />n <br />0 Yes 13 No 228. <br />--� t t,( ?J ®� 229. <br />G` <br />2 ( 19 230 <br />/ 231. <br />[8 Yes ❑ NO 232.er <br />233. <br />Q V <br />3. 234. <br />235. <br />❑ Yes ❑ No 236. <br />237. <br />4. 238. <br />239. <br />❑ Yes ❑ No 240. <br />241. <br />5. 242 <br />243. <br />❑Yee ❑ No 244. <br />zest. <br />H mare batardooe ampaamb aro protest at tatertkas 1% bywejht H c, or a.1%by welg6t HeaMsageek, atta* eMdonai sheets atpow' capturing the ngakw heloreanum <br />ADDITIONAL LOCALLY COLLECTED INFORMATION 246. <br />DOT Hazard Class: C t1 IN 1203) <br />If EPCRA, Please Sign Here <br />UN-020UPCF - 7115 www.tmittomerg Rev. 01AfiW <br />