HomeMy WebLinkAboutBUSINESS PLAN O!1 OF ENVIRONMENTAL VICES 1715 Chester Ave., CA 93301 (661) 326-3979
HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
W (one fo/Tn per material per building or area)
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" I. FACILITY II, FORMATION
BUSINESS I',fAME (Same as FACILITY NAMJ5 ~; D~"~'Doing ~us{~,~'S ~,~i- ............... 3
CHEMICAL LOCATION O~,~.~l~.. ~ ~j~ ~ p,~.*,~l'~ ~'~,~l~'T'~ 201CONFIDENTIALCHEMICALLOCATION(EPCRA) E~Yes FIND 202
FACILITY ID # ?!?]J~t -~--~--'l~?'i~;~ r ',[--i' ;'-'i ...... ¥ MA~'~ ('o~i~'6 ..... 20'3 ; ~RID #(op~/)- 204
· .... ' II. CHEMICAL INFORMATION
205 TRADE SECRET [] Yes I'-'t-t-t-t-t-t-t-t~ 206
CHEMICAL NAME ~,,.~..~ ~ e~, ~J,~,~ I, Subject to EPCRA. refer to instru~'~s
..................................... ~'b7 ......
COMMON NAME EHS° [] Yes ,~No 208
CAS # 209 *If EHS i$~Yes,' aU amounts below must be ia lbs.
FIRE CODE HAZARD CLASSES (Complete if requested by I¥c~-f~re'-chie0~
210
TYPE [] p PURE [] m MIXTURE ~ WASTE 2': i R-,fblOACTIVE [] Yes ~O 212 i CURIES 213
PHYSICAL STATE [] S SOLID ~i..LlOUlO [] g GAS 214 ' LARGEST CONTAINER E~C' 215
FED HAZARD CATEGORIES
(Check all that apply) ~ FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 AC. UTE HEALTH ~ CHRONIC HEALTH 216
ANNUAL WASTE ~ ~ 217 M,&XIMUM ~-'-,.~" 218 i AVERAGE ~ ,.'"~. 219 STATE WASTE CODE 220
AMOUNT 5 _~__. _ ......... i! DAILY AMOUNT ........................... ._.'..~ _"~ .......... L' DAILY AMOUNT .............................
UNITS* 'lF~a GAL [] cf CU FT [] lb LBS I--] tn TONS 221
DAYS
ON
SITE
222
* If EHS. amount must be in lbs.
STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTrLE [] q RAIL CAR 223
(Check all that apply)
[] b UNDERGROUND TANK [] f CAN L.~ J BAG [] n PLASTIC BO'I-rLE [] r OTHER
[] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN
,~ STEEL DRUM h SILO I CYLINDER p TANK WAGON
STORAGE PRESSURE ~.a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224
STORAGE TEMPERATURE ~ AMBIENT [] aa ABOVE AMBIENT [] b3 BELOW AMBIENT [] c CRYOGENIC 225
'~/:' ¥~'.,,'~; ;.:;;:' :' ~,t',' .:::,!~:~,';~'j~,~I/~;:~,::":§!'~i::' , ~'-
:,::r,:;:C: %WT: ??: ;-.:" ,"' ~' HAZARDOUs COMPONENT. _ ............................. .E__FtL~_S __ C~
i i
1 226 { 227 [] Yes [] No 228 I
/ I
2 230 ', 231 EYes []No 232I 233
[ 235 237
3 234I .................................
4 238 239 i [] Yes [] No 240 241
242 243 [[]yes []No 244 245
~, "' ;,: i ;'.' ~i:. ,,~' .' .'i.::' ,',:
· ' ' :~!:.: III. SIGNATURE
PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2
UPCf (7/99) S:\CUPAFORMS\OES2731 .'l'V4.wpd