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r1 �t A— <br /> s-_ _Y', _ fi ^»"�+ - J ..'CL`�.,',,,}Y.s r r�'i`.�"4sr -�1 a«+.6� '+-• <br /> California Hazardous Mat is Inventory Repo m <br /> Reporting Form • eical Description Page <br /> A REIPAGE( )O ❑DEEE OF(3) 22 - <br /> f <br /> BUSINESS NAME (4) <br /> MIRK,W()v tis zle:h ce)�✓ <br /> CHEM UCAL LOCATION(S)(5) <br /> <br /> MAP#(6)/ GRID#(7) / /G S ® F = L <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y 0 N <br /> COMMON NAME (9) D *EHS (12) ®Y N <br /> /ese C �r/e 1 �' Z <br /> CAS ## ;, *IF EHS BOX IS "Y" <br /> (10) <br />_._ ,• ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) �BLANK <br /> HAZARD CLASS <br /> TYPE (14)LOPuRE MIXTURE ®WASTE RADIOACTIVE(15) ®Y - N (16 <br /> PHYSICAL STATE(17) ®SOLID RJLIQUID ®GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACTIVE ❑PRESSURE RELEASE [XACUTE HEALTH W CHRONIC HEALTH <br /> STATE WASTE (19) UMTS*(22) ®GAL ❑CU F.I. MAX DAILY ABMT(23) <br /> CODE ON-STI"E <br /> DAYS ON SITE (20) * ❑LBS ® TONS AVG DAILY AMT(24) <br /> 3 S If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER 2 UNDER GROUND TANK ®CARBOY ❑ CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑------------------- <br /> ❑STEEL DRUM ❑FIBER DRUM ® PLASTIC BOTTLE <br /> ®PLASTIC/NONMETALLIC DRUM ❑ BAG ® TOTE BIN <br /> STORAGE (27) ® AmmBIENT ®ABOVE A1titBIEV�I' ®BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®A�VIBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑ CRYOGEMC <br /> TEMPERATURE <br /> (29) %IN7 (30)HAZARDOUS COMPONENT (3 1)EHS (32) CAS# <br /> n-/°v Oe5e( c it/0- Z ❑Y ®N G7l_ 3y <br /> �P I*PAThaIc-ne, ❑Y RN <br /> ❑Y ❑N <br /> ❑Y ®N <br /> • , t_I =[] -- <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT)L 1937 <br /> (34)WHAT IS MATERLAL �l t7 d bi <br /> USED FOR? <br /> Foc Official Use Oa1y: ❑ C ❑ R ❑ S SIC 12/97 <br />