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California Hazardous Mal6als Inventory Reporting Form Aemical Description Page <br /> (1)E4 <br /> ADD ®DELETE ❑REVISE 1998 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(S) <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) TRADE SECRET(11) 1 ❑Y UN <br /> COMMON NAME (9) C�410L�r•¢ / �G�J�®✓ U�1��p(��� *EHS (12) ❑Y N <br /> s ALL AMOUNTS <br /> EHS BOX IS "Y" <br /> CAS # <br /> (10) �U b 6�— f MOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ®PUREd�MLYZ'URE ®WAS RADIOACTIVE(15) ®I, N (16) <br /> PHYSICAL STATE(17) ®SOLID LIQUID ®GAS CURIES <br /> FED HAZARD <br /> ❑ <br /> CATEGORIES (18) F1RE REACTIVE ❑PRESSURE RELEASE ACUTE HEALTH HEALTH <br /> CHRONIC <br /> STATE WASTE (19) UNITS*(22) GAL ®CU FT ON-SITE <br /> Y AMT(23) ®DD <br /> CODE <br /> ®LBS ® TONS _ <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> 363 *If EHS, amounts must be in lbs ON-SITE �©0 v <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER /Z� Uv:0:] 1 —1 <br /> STORAGE (26) ®ABOVE GROUND TANK ❑ CAN ® BOX ❑TANK WAGON <br /> CONTAINER UNDER GROUND TANK ®CARBOY ® CYLINDER []RAIL CAR <br /> ❑TANK INSIDE BUILDING ® SILO ® GLASS BOTTLE 7--------------------- <br /> El STEEL DRUM ®FIBER DRUM ❑ PLASTIC BOTTLE <br /> ®PLASTIC/NONMETALLIC DRUM ® BAG ❑ TOTE BIN <br /> STORAGE (27)12 AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT ®CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> /0 g5-:- 114 449 Z- ❑Y N F dY-17- s- <br /> Y [3 N L 171— vy Z <br /> [� Y E]N] <br /> 11 ❑Y ®N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)I 12,OT� <br /> (34)WHAT IS MATERIAL v J M O /L 6- <br /> USED FOR? <br /> For Official Use Only: ❑ C ❑ R ❑ S SJC 12/97 <br />