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Home My WebLink AboutHAZARDOUS WASTE Appropriate pe~t on h~d ',: .." ? :':~..-."-~,:?Fr-;,'-:~:?: -, :~" ;.aq.~-~ .': ::,; :-?~ ~ ',:.';; ';:~:: :~,,~;~':";r'~i;;5};~. ,~. ~,':-., - ",~:~.;.' '"a~':~'a~z,:¢.~'~,a'%:4~' '.' Bus~ness plan conmc~)nfomat~on accmte ,.:..,.~ .: Visible a'.'. ess, ~;~ .i.4~.:.: ~,;?;~¥. :~..~ :.:.~ ~:,¥~, :~, . :.~ ~_. . . .,. ...... . ..... .... . ........ ......., ..~ ... ,~;a~x~,x;. ~;~: :~:~ ~;: ..... ?'"';?' '"" ~'"'~;':'~' :'" :'~':'~ -- . .:-,':'"~" ..... '~' "~'"?~' ".'"":..;~,:,.~:~?-"~ '"" ' .....~} "" :~"~,~ ":' ~-":.':'~":~ ~';"::"' ;..:4. 'y->~?~::¢~:~;y: V~:;:(~/:~ ?~ :; ..,,: .,.-~ *,z .., -~.. ~,~.,~ ~ . nro-~ se~e~aqon o~ ma.ena, H~IblPPLA~ MAP SITE DIAGRAM (ZZ] FACILITY DIAGRAM L_ THE WAX SHOP :] _ Ncr-~h ,'lame ~f ar~_a:5441~ A~drin Building I and See Attached .. 7-kV$ IM£U¥ 7-~1£ ~ I,'VC. 5441 HMb"IPPLAN MAP ' SITE DIAGRAM CZ) FACILITY DIAGRAM U_ ,'fame: THE WAX SHOP No.--~h Name o~ A~a: Building l,'Section A Fire / Emergency Evacuation Routes Business Name: The Wax Shop Name of Area: BiJ(LD(NG 1 SECT(ON A NC)RI'H WALK IN~CONDARY poor I S~CON~ARY RECEIVABLE GARAGE 7 T ~ (]OR , o ENTRY O TO Pt. AAFF CLOSET( GENERAL OFFICE PU~C~JNO ~RT ROOM DEPARTMENT I ~ ~ t°ooR ~ o ~ ::o DOOR Z o EXECUTKVE OFF~CE -.~-----~DOOR [ i MARKETING ·RECEPTIONAREA 0 OSETUBR. ARY~ DEPARTMENT P~IMAR¥ F_XIT PRIMARY EXIT SECONDARY EXIT(S) 12/98 HMb'IP P LAN SITE DIAGRAM (ZZ] FACILITY DIAGFJ. ANI Fire / Emergency Evacuation Routes Business Name: The Wax Shop RAW CHEMICALS ~ ) DOOR ) DOOR 2 SECONDARY EXIT REs~Roo~ ,~OLL u~ CONFERENCE ROOM EQUIPMENT STORAGE OVERHEAD STORAGE PRINtAR'f ETJ~r DOOR 1 WALK IN SECONI3ARY EXiT I DOOR I ~ ROLL ~JP DOOR ~ PRIMARY EXIT ~ SECONDARY EXIT(S) 12/98 ,, SITE DIAGRAM L-U_' FACIL. I. TY DIAGR'A/Vt ~ THE WAX SHOP Fire / Emergency Evacuation Routes Business Name: The Wax Shop Name of Area: E~UfLDING 1 SECTION C NORTH DOOR 4 SECONDARY EXIT PAINT ROOM BOX STORAGE F~H,I, StAEID PROOUCTS SHIPPING DEPARTMENT DOOR, MAINTENANCE AREA J LAt~EL ROOM ~s"moc,~ "~ DOOR PRIMARY ROLL UP DOOR · PRIMARY EXIT SECONDARY EXIT(S) 12/98 · ' H~IblPPLAN MAP SITE DIAGRAM CI FACILITY DIAGRAM Bus Lness ,'lame: THE WAX SHOP 0 H~r~h Hame o~ Area: Building I, Section O Fire / Emergency Evacuation Routes Business Name: The Wax Shop AreaMap # ,/~ of//~ Name of Area: BUILDING 1 SECTfON 0 NORTH RAW CHEMICALS SECONDAK',Y/,NOT ~N EX~') ~ESTROOIV OFFICES LAB '--~ooo~. ---- g m ----t Door I l TM08 LAB OFFICES C) MIXER -'- CHEMICAL AND RAW _ PRODUCT STORAGE DOOR ~DOOR ~_..,~ SECONDARY EXIT ' I ROLL UP DOOR e PRIMARY EXiT ~ SECONDARY EXIT(S) 12/98 ~(~' E:~ERGE:NCY REPORTING OF 'A RELEASE OR A THREATENED IRELE-~SE EMERGENCY RESPONSE AGENCY 911 OFFICE OF EMERGENCY SERVICES 1-800-852-7550 1-916-427' 4341 1. The exact location of the release or threatened release. 2. The name of the person r'eporting the release or. threatened release. 3. The hazardous material,s'involved in the release or threatened release. 4, An estimate of the quantity of hazardous materials involved. If known, the potential hazards presented by the hazardous material involved in the release or threatened release. Emergency Response Assistance 1. The members of the emergency response team will s~and by to assist thc emergency agency attd offer the benefit of their special knowledge of th~ facility and its contents. 2. The following members of the production management will stand by to offer technical adv/c¢ to the emergency response agency personae/ffaccessary: A. ,less R. Winters B. Brenda Bynum C. ,lohn Satterlee D. D/mae Resales Medical Assistance I. Ail employees affected by exposure to the hazardous mater/als released during the spill/release or injured from the fire should be transported to the hospital, which ~s the most appropriate fac'fftty for the treatment of chemical-related injuries. A copy of the appropriate MSDS should accomp~y the affected person(s) to the hospital. A. Diane Resales B. ~/ames Baldwim ,fft~ --'~~~ ~-~ ~ ~-~ i ~ President/Founder EO. Box 10226 Bakersfield, California 93389-0226 ~1-800/323-9192 ~ 805/397-5274 ~ 805/397-6817 HAZARDOUS MATERIALS INVENTORY Page~ ! of Bus'ness Name THE WAX,,gHOP A~ 5441 ALDRIN CT. \ CHEMICAL DESCRIPTION ~ ) INVENTORY STA'~OS: New [ ] Addition [ ] Revision [ ~etion [ ] Ch~k if chemical is a NON Trade 8~:re~ [ ] Trade ~ [ ] 4) Physical & Health PHYSICAL I-IEALTH Hazard Categories Fire[~]Reactive[ ]S~dd_~nReleaseof _Pressure[ ] lmmediateHealth(Acute)[ ]DelayedHealth(Chmmic)[~(] 5) WASTE CLASSIYICATION (3-digit code from DHS Form 8022) USE CODE '/- ~ 6) PHYSICAL STATE Solid [ ] Liquid [~] Gas [ ] Pure [/~] Mixture [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FACILITY_ , ,, UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ~/5~'/-~'~ Lbs [ ] Gal [~'] fl3 [ ] a) Containe~. Average Daily Amount Curies [ ] b) Pressure: Annual Amount ~ ~/~7 ~- c) Temperature Largest Size Container b/Et(~ # Days on Site *...~(~-- Circle Which Months: All Year, $, F, ~ A, 1~ $, $, A, S, O, lq, D 9) MIXTURE: List COMPONENT Cas// % WT AHM thc three most hazardous 1) [ ] chanical components or 2) [ ] any AHM components 3) [ ] IO)LOCATION O~$..~ ~ O~ INVENTORY STATUS: New [ ] Addition [ ] Revision [ I-]q~on [ ] Check if chemical is a NON Trade Secret [ ] Trade Sec~t [ ] 4) Physical & Health PHYSICAL HEALTH H_azardCategories Fire,[/~]Reactive[ ]S-~en_ Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [/~] 5) WASTE CLASSn~ICATION (3-digit cod~ f~om DHS Form 8022) USE CODE / ~ 6) PHYSICAL STATE Solid [ ] Liquid [~ ] Gas [ ] Pure [~] Mixture [ ] Waste [ ] Radioactive [ ] ?) AMourcr AND AT u rrs s) STORAGE CODES Maximum Daily Amount '~ I~/~ Lbs [ ] Gal [~] ft3 [ ] a) Contain~ Average Daily Amount Curies [ ] b) Pressure: Annual Amount ~D ~ ~ ~ c) Temperature Largest Size Container f~._ # Days on Site _ Ci~le Which Montl~: All Year, $, F, ~ A, M, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most b,,.~,xlous 1) [ ] chemical components or 2) [ ] any AI-IM components 3) [ ] ! certify under pmmlty of law, that I have personally emm~in~l and am familiar with the infonnation on ~his and all attached documonts. I believe the submitted information is tn~, accumt~ and cornple~. INVENTORY HAZARDOUS MATE~ ~ C~~ DES~ON I)~ORYSTA~S:N~[ ]A~[ ]Re~~le~[ ] C~~~hNONT~~[ ]T~~[ ] 1 4 ) Ph~i~ · H~ P~SIC~ ~ ~) w~ C~S~CAUON (~t ~ ~ Dm F~ ~=) USE CODE 6) P~S[C~STA~ ~Ud[ ] nq~d[~] ~[ ] ~,~] ~[~] W~[ ] ~.[ ] 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ S) STO~E COD~ ~m ~y ~t ~OO ~ L~ [ ] ~ [~ ~ [ ] a) c~ ~m ~ 2) [ ] ~y ~ ~n~m 3) [ ] ~) ~T J (~) 5) W~ C~CA~ON (3~t ~ ~ D~ F~ ~) USE CODE 6) P~SIC~STA~ ~d[ ] Liq~d[~ ~[ ] ~[~ ~[ ~ W~[ ] ~~[ ] 7) ~o~ ~ ~ AT ~AC~ ~ O~ ~~ S) S~O~a~ COD~ Av~e ~ly ~o~t ~ C~ [ ] b) ~: / ~e ~ mo~ ~ 1) [ ] ch~ ~m~ ~ 2) [ ] P~ N~e & Title ofAu~ C~y R~~ve ~ Si~] HAZARDOUS MATERIALS INVENTORY Page~ '-~ of :~6. Business Name THE WAX SHOP Address 5441 ALDRIN CT. ~O CHEMICAL DESCRIPTION I ) ~VENTOR¥ STATUS: New [ ] Addition [ ] Revision [~]~l~etion [ ] Check ifchemic~ is a NON Trade Secret [ ] Trade Sea'et [ 4) Physical & Health PHYSICAL HEALTH Hazard Catesories Fire [ ] Reactive [ ] S-a_d,~ Release of Pressure [ ] Immediate Health (,acute) [~ ] Delayed Health (Chronic) 5) WASTE CL~SS[aCATIO~ (3-~Sit ~t~ ~=n Dm ~o,m S022) US~- CODE-- / ~ 6) PHYSICAL STATE Solid[ ] Liquid[/k2] Gas[ ] Pure[ ] Mixture[)~] Waste[ ] Radioactive[ ] ?) ~ou~,rr .~D r~ AT ~^c..rrv. ~ O~ ~.~SU~ S) STO~E COD~ Maximmn Daily ^mount --' ~ ~'0 c~ Lbs [ ] Gal WI fl3 [ ] a) Container: Average Daily.~a~ount Curies [ ] 'b) P~e: ^unu~ Amount 3 ~ O ~) ?~mpor~t~ Largest Size Contsiaer ~P_.,C4 # Days on Site ~(,,_~"' CL'cle Which Months: All Year, 3, F, M, A, M, 3, 3, A, S, O, N, D the three most ho?Ardous 1) ~ ~ '~ ! ~'- ~' ~ [ ] chemical components or 2) ? ~/~ ~- ~,.~- <~ .~ / [ ) any AHM components 3) ~J [ ] ;0)LOCAT~O~ 0/XT"~ ~ 1) ORYSTATUS:lqe~v[ ]Addition[ ]Revi~ionl.~.-l~tien[ ] Ch~:kifoh~micali~aNONTmd~[ ]Tmd~[ ] 2) Common Name: ~~~ ~ )~/07 3) DOT # (optional) 4) Fhysical & Health PHYSICAL HEALTH HazardCategofies Fire[ ]Reactive[ ]SuddenReleaseofPressure[ ] Immediate Health (Acute} [ ] Delayed Health (Chronic} L~'] 5) WASTE CLASSIFICATION (3-dj/it code from DHS Form $022) USE CODE 6> PHYSICAL STATE Solid [ ] Liquid,~ ] Gas [ ] Pure [ ] Mixture.~ Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY. UNITS OF MEAS~ ~) STORAGE CODES Maximtun Daily Amount t/~-'~ ~ Lbs [ ] Gal]/~] fl3 [ ] a) Container:. 7 Average Daily Amount Cu/'ies [ ] b) Pressure: ,Amnua] Amount ~-?~ c) TemperBture T.~rsest S~ Container # Days on Site ~(~S Circle Which Months: All Year, $, F, M, A, M, $, $, A, 8, O, N, D 9) MIXTURE: List /~ , COMPONENT /~_ S.~ ~CAS [ l chemical components or 2) j~~~ ~ / / / ,,z_/Z - '~ ~_~ [ ] any AHlVl components 3) [ ] ! certify under penalty of law, that I have personally examined and am familiar with the information on this and all attached documents. I believe the submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Representative ~// Signature ' / Da~ ' HAZARDOUS MATERIALS INVENTORY Pase _.~=...of Business Name THE WAX SHOP ' .' Address 544'1 Al r)RIN'C~' · ~ CI~MICAL DESCRIPTION ~) n~-NTOR¥ STATUS: New [ ] Addition [ ] Revisi°n ~'l~emm [ ] Check ~che~mcal is ~ NON Trad~ 4) Physical & Health PHYSICAL ~TH ~) w~ CU,,SSn~CATIO~ (~iSit ~ ~.,~ V~ ~o~ SO=) USE COD~ 6) PHYSICAL STATE Solid [ ] Liquid [/~] Cas [ ] Pure [ ] Mixture [~] Waste [ ] Radioactive [ ] 7) ~v~out, rr ~ Tnvm ^T ~^cn. rry tn,rrm o~ ~ s) S~OP. AaE COD~ tv~n~yAmenn~ '~ ~ Ub~[ ]C-,tt[)~lOZ[ ] ,,)C~. Averse Daily Amou~~-'T) Curi~ [ ] b) ~ Annual Amount ~T~ .~~ # Days on Site ~_~G~_q Cixcle Which Months: All Year, J, F A, M, J, $, A, S, O, N, D the three most hazardous 1) J~- ~ -~,O ,~-/'~.0Z./~. ~. ~TZ ~ [ any AHM components 3) [ ~0)~OCA~O~ ~ ~La ~ 4) Physical & Health PHYSICAL ~ LTH Hazard Categories Fire [ ] Rencfive [ ] $~d_~ Release ofPr~ssu~ [ ] t.~.~n~ Health 0 tcute) [ ] Delayed I-Ienlth (Chronic)~ S) WASTE CLASSIFICATION O-digit code from DHS Form g022) USE CODE 6) PHYSICAL STATE Solid~] Liquid[ ] Gas[ ] Pure[] Mixture[ Waste[ ] Radioactive[ ] 7) AMOUNT AND TIME AT FACILn~ UNITS OF MEASURE 8) STORAGE CODES Maximum Daffy Amount ! ~'~ ~ Lbs [/~I Gal [ I fi3 [ ], a) Container:. A~,~-D,i~XA~o,--~ ~.0~ C~i.[ ] b)_~,~: f Annual Amount ~-900 c) T~mpemtwe Largem Size Cenmi~r ~ ~ # Day~ o~ Site ~ Ci~le Which Montlm: All Year, $, F, ~M, A, M, $, $, A, S, O, N, D chemical components or 2) ~x'! - i~-~o~-~'~ -? ~ny AH~ components 3) w [. ] 10)LOCATION ~ ~.~ __~ [ c~rfify under penal0/oflaw, ~ha~ I I~ve pe~omflly ~ and am familiar w~th th~ infommtien on ~ and all at~ac~h~l da~um~m. I belie~'~-'~_~ ye the subng ~ tted ~l.j!inf°nnati°n is,~7.d:::~ true,,,~/Z~ accurate/~ and complete. ~ ~~''l/-/ PRINT Name & Title otAuthorized Company Representative (./ $igmlture HAZARDOUS MATERIALS INVENTORY Page ,:9 of 35 Bus~¢ss Name THE WAX SHOP ,.: ...... Address 5441 ALDRIN CT. · .. ' D .scmmo. I ) INVENTORY STATUS: N~.w [ ] Addition [ l Re,isien [~q~on [ ] Check if~h~mical is a lqON Trade 2) Common Name: ~/L0~_~/.t4~ ~ ~"~ ] t '~ 3) DOT # (optional) 4) Physical & Health PHYSICAL HEALTH Hazard Catesories Fire [ ~g] Reactive [ ] S,_,dd~ Release of Pressure [ ] ~m,~ediate Health (,acute) p(] Delayed Health (Chronic) [ ] ~) WASTE CIASSIHCATION (3-disit code from DHS Form S0Z~) USE CODE ~) Pt-r~s[c,~ ST^fa Solid [ ! Liquid ~1 C_,as [ ] ~ [X] ~tixture [ ] Was~ [ tn, a'rs o~ ~m~s~ s) STORAOE CODES ?) ~v~OOm' ~ ~m ^T ~^ctu'r'/,,, ~ Maximum Daily Amount '-t~' Lb~ [ ] C~ [~ fO [ ] a) Co,,tain~, Average Daily Amount Curi~s [ ] b) Pressure: .ual Amount ~ ~.~ c) Temperature Largest Size Container # Days on Site -..~(,,_.~" Circle Which Months: All Year, $, F, M, A, M, $, I, A, S, O, N, D 9) MIXTURE: List COMPOlqElqT CAS# % WT AHM the three most b~,7~,dous l) [ ] chemical components or 2) [ ] any AHM components 3) [ ] I)~--r'roR¥STATU$:N~v[ ]Addition[ IRcvi~ion[M'~ledon[ ] Ch~:kifch~nicalisaNON'Tmd¢.~a'~t[ 2) Common Narne: ~~ (~) ///~ 3) DOT # (optional) / Chemical Nam,: AH1VI [ ] CAS# ~ 4) Physical & Health PHYSICAL HE. ALTH H~rdCategories Fire[ ]Reactive[ ]SuddenReleaseofPressum[ ] Immediate Health (Acute) [ lDelayedHealth(Chwni¢),[,A~ 5) WAST~ CLASS~C^T~O14 (3ai~it ~ from Dm Form S022) US~ CODE ~)?HYS~cALsr^T~ sona£~] Liquia[ ] C-a~[ ] Pu~[] Mixt~] Waste[ 7) AMOUNT AND ~ AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Dai~y Amount /~g)O~ Lb~ikqC~[ ]f~[ ] a)Contain~ Average Daily Amount Curies [ ] b) Pressure: Lartest Size Container # Days on Site ~- Circle Which Months: All Year, I, F, M, A, M, I, I, A, S, O, I4, D 9) MIXTURE: List ~c~O ~MP~4~._~.~ //./Z/,~_//Z_ / %/~ AHM the three most hazardous 1) [ chemical components or 2) ~./.c'o._/.~ 'i ,~,~/~ .?,z/'~'~(~. ~)--'/ ..~ [ ] uny AI-IM components 3) [ 10)LOCATION ~,~ ['¥~C ~ ! certify under penalty of law, that I have personally examined ami am familiar with the.information on this and all aRached documents. I believe the submitted information is true, accurate md complete. PI?Jl~ Name & Title of Authorized Company Representative . Signature HAZARDOUS MATERIALS INVENTORY ; Page A.of3s Business Name THE WAX SHOP' CHEMICAL DESCRIFrlON ~)~,a"a'NTORYST^TUS:New[ ]A, ddition[ ]Rc~isi~[~rDeleU~[ ] Chcck~~i-,il'~ONTra~Secm[ ]Trad~S~cr~[ ] ~) DOT # (optional) 4) Physical & Health PHYSICAL ~TH HazardCate~ori~s Fire[ ]Rea~ive[ ]Sudd~R~e~seofPr~.sur~[ ] h~m~ist~-Health(Acute)[ ]DelayedHealth(Clmmi¢)[ i) WASTE CLASSIFICATION (3-disit cod~ 6) PHYSICAL STATE Solid ~,] Liquid [ 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES M .imum Dail Amour P 51C, al[ ^verag~ Daily Ataou~ Curi~s [] b) 1~r~ssure: / Annual Amount _~'~0 c) T m~rature Largest Size Contahm'-~-01~ / # Days on Site ~'~ Circle Which Montim: All Y~ar, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) chemical components or 2) [ ] any ARM componen~ 3) 0 OCATIO . LO _C 4) Physical & Health PHYSICAL HEALTH Hazard Categories F~[ ]R~'tiv~[ ]SuddonReleaseofPr~ssure[ ] i,.-.~,~s~Health(Aonte)[ ]Delay~dHealth(Clmmi¢)[ ] f) wASTE CLASS CATIOa 6) PHYSICAL STATE Solidi ] Liquid~] Gas[ ] Pure[ ] Mixtureq] Waste[ ] Radioa~ve[ ] 7) AMOUNT AND TIME AT FACILITY ,~ ~ ~ ~/ ~a,, ,, UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amoont ~('}' ~l~'fgLbs[ IOal~]ft3[ ] a)C~ntain~. '7 Amount .., i - Ctm'es [ ] b)_P~: Average Daily Annual Amount ~ E.%Go tt Days on Site ~::i/~ ¢Ci~rJe Which Months: All Year, ~, F, iM, A, M, $, ~, A, 8, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AI-IM the thr~ most hazardous 1) , , t , , ~ ~ / - ~ ] [ ] any AI-IM components 3) [ ' ] I certify under penalty of law, that I have personally examined and am familiar with ~ informati~"'on ~ and all attar, ged ~ta. I PRINT Name & Title of Authom~l Company Represm~ive HAZARDOUS MATERIALS INVENTORY Page ~ of ~' THE WAX SHOP 5441 ALDRIN CT. , Busi~ess Name Address I ) INVENTORY STATUS: New [ ] Addition [ i Re~i~ion ~'~I~letion [ ] Ch~: if~h~dc~l i$ · NON Tmd~ ~ [ ] Tr~l~ ~ [ ] Ch~ ~: am~ [ I cas # 4) Physical & Health PHYSICAL HEALTH Ha?ardCategories Fire[ ]Reactive[ ]SuddenR¢leaseofPressm'e[ ] lmmediateHealth(Acute)[ ]DelayedHealth(Cln-oni¢)[ ] s) WASTE CLASSmCAT~O~ Oa~it ~,~ ~. Dm Fo.. ~0~2) ; USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [~'] C-as [ ] Pure [/~ Mixture [ ] Waste [ 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum D~y Amount -- ~.5'! t~ Ubs ! ~ C-~ grl fU ~ I .) Cun~.i~. Average El~ily Amount Curies [ ] b) Pre~-ure: / Annual Amount .c~ .,~_. ¢) Temperatm'e largest Size Container # Days on Site ~,~'"~ Circle Which Months: All Year, J, F, M, A, M, J, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous I) [ ] chemical components or 2) [ ] any AI-IM components 3) [ ] o) ocAuo b0}¢3¢ 0 1) ~'~Y STATUS: New [ ]Addition[ ]Rcvi~ion[~fi~[ ] Ch~:kifoh~mic~li~.lqON'Tmd~:r~t[ ]Tr~l~'~'t[ ] 4) Physical & Health PHYSICAL HEALTH I4a~ardCategories Fire[/~]Reactive[ ]SuddenR¢leaseofPressure[ ] lmmediateHealth(Acute)[ ] Delayed Health (Chroni¢) Dc] 5) WASTE CLASSIFICATION (34tigit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ~'] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ?) AMOUNT AND Tn~ AT FACtLrrY uNrrs OF MEAStmE S) STORAaF. CODES/;. MaximumDsilyAmount----g~'O d,L Lbs[ ]C~W]~[ ] a)Containe=. ~, /~.~ Average Daily Amount Curies [ ] b) Pressure: Annual Amount J ~ 9 5- Co t_ ¢) Temperature Largest Size Container ~ # Days on Site ~ ~,5'~ Circle Wlgch Months: All Year, 1, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WI' AI-IM the three most hazardous 1) [ ] chemical compomm~s or 2) [ any AHM components 3) [ ] 10)LOCATION 0 ~ ~ff'~ ~ ~ [ certify under penalty oflaw, tl~t I have personally examined and am f~miliar with the information on thi~ md all attached docum~ts. I believe the submitted information i~ ~ a~cumte and complete. PRINT Name & Title of Authorized Company Representative ~ Signature ' / Da~e HAZARDOUS MATERIALS INVENTORY '" t Page X'°f a6 Business Name THE WAX SHOP' Address 5441 ALDRIN ~'. ' CltEMICAL DESCRIPTION ~VENTOR¥ST^TUS~N~v[ lAddition[ ]Revision[~g'~leti~n[ ] Checkifchamic~isaNONTmdcSec~t[ 2) Common Nam¢: ~ ~-~L'~"-~-'~ ..~ ~/-~-~ 1)DOT (optional) 4) Physical & Health / PHYSICAL HE LTH I-Ia,*rd Categories Fire [t~Reactive [ ] S,,~,t,,n Release ofPressu~ [ ] lmm,.dl**~ Health ~,¢ute) [ ] Delayed Health (Chronic) ['t.~ 5) WASTE CLASSIFICATION O-digit cod~ 1~,~ DHS Form S022) USE CODE / 6) PHYSlCAL STATE Solid[ I Liquid[/~] Gas[ ] Pore[y] Mixtu~[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AND ~ AT FAC~ UNITS OF MEASURE 8) S~ORAGE CODF. S Maximum Daily Amount i4~OCJ'~ Lbs[ ]Gal[~'lfl3[ ] a)Cbntain~. Averase Daily Amount Cmies [ ] b) Pi-essore: ,/' Annual Amount '~0 t~ c) T .~'ature ~ ' Largest Size Contsiner ~ Year, $, F, M, A. M, 1, J, A, S, O, N, D # Days on Site Ci/cle Which Months: All 9) MIXTLrRE: List COMPONENT CAS~ % WT AHM the three moa tmT~rdous 1) I [ ] chemical components or 2) ] [ ] any ~ components 3) I [ ] 10 OCAT ON0 a77_f ,/ ~)I~ORYST^mS:lq'~[ l.a. adi~[ lR~'i~ion~[ I Cl~if~ani~i~lq'ON'Tr~[ lTr~~[ ] DOT# 4) Physical & Health PHYSICAL HEALTH HazardCatesories Fire[ ]Reactive[ ]S,~,~ReleaseofPressure[ ] ImmedlateHealth(~,te)[ ] Delayed Health (Chronic) [/~'] 5) WASTE CLASS~C^'nON O-digit ~ r,,~ DHS Form S022) USE 6) PHYSICAL STATE Solidi I Liquid~] Gas[ ] Pure[ ] Mixture[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AND 'rIME AT FACILrl~ UNITS OF lVlEASURE S) STORAGE CODES Maximum Daily Amount ~0 Lbs [ ] Gal [/~1 ft3 [ ] Average Daily Amount Cm'ies [ ] b) Pre~ssure: / Ann Amount I U6 ¢) ,7/ Lamest Siz~ Container # Days on Site .~G~-- Circle Which Months: All Year, $, F, ~ A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS#I % WT AHM the three most ~,,,-,,ntous l) / [ ] chemical components or 2) [ ] any AI-IM comlxments 3) / [ 10)LOCATION ~ ~'~S~ 0 I ceftin/tmd~r l~mlt~ of la~, tl~t I have l~r~mally mmmin~l and ~m fiunilim' with the i~ffomu~tion on tl~ ~! ~11 aU~aed ~ts. I believe the submitted information is true, ac cut ate and complete. PRI1VT Name & Title of Authorized Company Representative ~/ Signathre BAZARDOUS MATERIALS INVENTORY Page ~ of 3~ Busi~ness Name THE WAX SHOP . ~, Addtms 5441 ALDRIN CT.' 'CHEMICAL DESCRIlV~ON I)IIkIVENTORYSTATUS:New[ ]Addition[ ]Revision[~i~fi'~[ ] CheckffchemicalisaNONTradeSec~t[ ]TradeSec~[ ] 2) Common Name: ~.~-],t/--~E'M~, ~ ~ I )~/'~"~/ 3) DOT # (optional) 4) Physica~ & Heahh ?H~$[CAL Haz~rdCateSod~s Rre[ ]Eeactive[ |$,_~c~Eeleaseot'Pr~ss~r~[ ] r-~-~fiateHealth(^cate)[ 5) WASTE CLASS]I~ICATION (3-disit code from Dm Form 8022) USE CODE / 6) PHYS[C~ ST^~ Solid [/~] Liqmd [ ] C-~ [ ] ~ [~ ~ [ ] W~ [ ] m,mo~,~. [ ] 7) AMOUNT AND T[N~ AT FAciLr~Y UNITS OF MEASURE 8) STORAGE CODES Av~'ase Daily Amount Curies [ ] b) Pressure: / .~maal Amount / 0OO C~ c) Tempemtm~ Larsest Siz~ Container ~ # Days on Site ~ Circle Whi~ Months: All Year, $, F, ~ A, lV[, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM me mr~ most lmzardous 1) [ ] ch~cal components or 2) [ ] my AHM components 3) [ ] 10)LOCATION ~0 ~.j[ 5~ ~ 2) Common Name: Xt~ C_~n_~ ~~ ~'~/ ~/4. 3)DOT # (optional) 4) Physical & Health PHYSICAL HEALTH Haz~dCatesori~s Fire[~,~]Reactive[ ]SudmmR¢leas~ofPressu~[ ] ImmediateHeslth(^onte)[;¥]Dctay~He. alth(Clmmic)[At--]' ~) w~s~ cr.~ssn~c^rrON O-msit ~ ~ DHS ~o,m son) use CODE / ~)PHYS[C~ ST^~ So~id [ ] Liquia ~/~] C-~ [ ] Pu~ [ ] ~ .D<] W..~ [ ] mmioactiw [ ] 7) AMOUNT AND 'lIME AT FACILITY..i(o.~.,- I UNITS OF MEASURE 8) STORAGE CODES ~-.~ D~i~y Amount 51 '-~[ ] c~ [~ ~U [ ] a) Average Daily Amount '~J curies [ ] b) Pressure: Annual Amount ~q } ¢) Temperature Largest Size Container # Days on Site ~,_%'- Circle Which Months: All Year, ~, F, M, A, M, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AttM the three most hazardous 1) [ ] chemical components or 2) [ ] any AHM components 3) [ ] I certify under l~'nalty of l~w, that I l~v~ l~r~on~lly ~m~n~l ~d ~'~ f~fili~r with thc infom~tion un thi~ ~d ~11 ~tt~h~t ¢lo~amen~. I believe the submitted inforr~tion is true, ~:mate ~nd complete. PRINT N~ne & Titl~ of^uthor/2od COml~ny R~pr~atetive ItAZARDOUS MATERIALS INVENTORY Pa~e ~.of.~L Bus/ness Name THE WAX SHOP~ ' ' ,:~' Addrms 544,1 A! I')R~ ~T ~ '~ ' / ~,5 CIi~M~CAL DES CRII~rloN~ I)INVENTORYSTATUS:New[ ]Addition[ ]Rcvision[~l'etiml[ ] Check if chcmical is a NON Trade Sccret [ ]TradeS.n-et[ ] 2) Common Name: ~-" -.~ '-/ (~ / c/? 3) DOT # (optiomd) Am[ . , 4 ) Physical & Health PHYSICAL HE ALTH Hazard Categories Fire [ ] Reactive [ ] Sudden Re~ea~ ofPressu~ [ ] tm~.~!at~ Health (Acute) [ ] Delayed H~lth (Chronic) 5) WASTE CLASSIFICATION (3-disit code f~um DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid,[~] Liquid[ ] C~s[ ] Pure[~'~ Mixtu~[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AND TI/viE AT FACILITY UN'ITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount /0(...30 Lb~,[~C~[ ]f13[ ] a)Containec. Average Daily Amount Curies [ ] b) ,P~sure: / Ann~ Amount ~OOCO ~) T~eznt~at~ Largest Size Container~ All Year, J, F! M, A, M, J, J, A, S, O, N, D # Days on Site ~,~u Circle Which Montl~: 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) [ ] chemical componems ~ 2) [ ] any AI-IM compon~ ~) [ ] 10)LOCATION ~ ~ ~- O 1) RYSTATUS:New[ ]Addition[ ]Revisiont~[~on[ ] Claeckif~cali~a~NONTradeSec~[ ]Trad~[ ] 4) Physical & H~lth PHYSICAL HEALTH ~,,,,,,xi Categories Fi~ [ ] Reactive [ ] Sudd~ Rele~e ofPr~s~ [ ] ~ Health (~cute) [ ] De~y~d Health (Chemic) [ ] ~) WASTE CLASSIFICATION (3-digit ~ f~om DHS Form 1~22) USE ~ODE / 6)~HYs~c~s~^~ soua[ ] ~.i~a[)(] c~[] ~ur~[~ ~,~ixtur~[ ] w..~[ ] 7) AMOUNT AND TIME AT FACIL~v,.~ ~ ~, UNITS OF MEASURE 8) ST~ORAGE CODES M~at~a Daily Amomt ~ruu,,~o Lb~ [ ] G~ [~(1 tt3 [ ] a) Cont,~u~. Average Daily Amount Curies [ ] b) Pressure: Annual Amount ¥ ~rOC~ c) T= aperatu~ # Days on Site ~(~-~- Circle Wh/ch Month~: All Year, $, F, ! & A, M, $, I, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS// % Wi AIiM the three most hazardous I) [ ] chem/cal components or 2) [ ] any AHM components 3) [ ' ] I certify under penalty of law, that I have l~rSonally examin~l and am familiar with the infatuation on ~ and all att~a~l docum~ta. I believe the submitted information is.tru~ accurate and complete.<~_~ ~ //~//'~/7'O~,~ - ,~/~ ~ ,/~ ~ ,/~/,~Z,~'"'. PRINT Name & Tide of Authorized Company Repres~tative 6/ Signa ,thre ! HAZARDOUS MATERIALS INVENTORY '- Page Bus~ess Name THE WA~ SHOP Address 5441 ALDRIN CT. I ) INVENTORY STAT~S: New [ ] Addition [ ] R~ision [~qi'$h [ ] Ch~:k if~h~aical is ~ NON Tmd~ S~a'~t [ ] Tmdo ~ [ ] 2) Common Name:/,'k- liZ~0~ ~C)~/' ('~ / L'/9 3) DOT # (optional) 4) Physical & Health PHYSICAL HF..ALTH Hazard Categories Fire [ ] Reactive [ ] S,_,,!_,!_~ Release ofPressur~ [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) wAs~ CLASS~C^TION (3.,iisit ~ ~ DltS Fo~m S0Z~) USE CODE / 6) PHYSICAL STATE Solid [~ Liquid [ ] ~ [ ] ~ [ ~ ]v~'e [ ] Waste [ ] ?,adioactive [ ] ?) ~ou'~r ~ ~ AT F^c~rr¥ tn, a'rs oF ~,~_.~scrl~s) STO~OE COD~ · ~aximum I:~i~y ^mount --:.5'~'O ~'j L~ IAI C, al[ ] e,3 [ ]a) Con,,~ / ^verase Daily Amount Curi~s [ ] b) Pressure: / ,~mnual Amount ~ ¢) Temperature Largest Size Container # Days on Site Circle Which Months: All Year, .l, F, M, A, M, .l, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) [ ] chemical components or 2) [ ] any AHIVl components 3) [ ] 1)rmr~,rr%¥sT^rUS:N~[ l.~.adition[ l~e~i~ionl~un[ I C~:~if~emi~isaNON'rr~:t~S.:~[ lTr~S~a~t[ 1 2) Common Name: ~/f--/L ~ ~C.)/~ ~/--Y'O 3) DOT # (optional) / 4) Physical & Health PHYSICAL HEALTH ' Hazard Categories Fire [ ] Reactive [ ] Sudden Release ofPressuxe [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION O-digit code fxom DHS Form 8022) USE CODE ~) PHYSICAL ST^TE SoUd [/~] Liquid [ ] Sas [ ] Pure [~4 Mixture [ ] Waste [ ] Radioactive [ 7) AMOLrNT AND TIME AT FACILITY _ UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount I (~ ~/~c- ~ Lbs [~] Cral [ ] ft3 [ ] a) Containec. Average Daily Amount Curies [ ] b) Pressure: Annual Amount / 0 ~?'t.4~ c) Temperature Largea Size Container ~ # Days on Site ~ ~ 5'" Circle Which Months: All Year, J, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) [ ] chemical components or 2) [ ] any AHM components 3) [ ] 10)LOCATION ~ ~j...~ ~.~ j~ . ~ certify under penalty oflaw, that I have personally examined and am familiar with the information on this and all attached documents. I believe the submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Representative , /~7 Signature RAZARDOUS MATER/ALS INVENTORY Page ~of as Business Name THE WAX SHOP -, , . , ~ 5441 ALDRIN CT,. ' , CltEMICAL DESCRIPTION 1 ) l~q~rTOR¥ ST^TU$: New [ ] Addition [ ] Revision [~ Chcc~ ii'chemical is ~ NON Trade Secret [ ] Trad~ Sccr~ Clmmcal N~tme: AHM [ /] CAS # 4) Physical & Health PHYSICAL i.k~HEAL~ut~ 5) WASTE CLASSIlrlCATION . (3-digit codg ,",~ Dm Form 8022) USE CODE 6) Pm. smAL STA'm Soad [ ] · liquid [X'] C.. [ ] P"~ [ I mixt.~ [ ~(/ W~ [ ] Pauli~ [ l / 7) AMOUNT AND TIME AT FAClLrrY uNrrs OF ME~, LTRE 8) STORAGE CODES ~.mmumDa~yAmoum /10 Lbs[ lC-.ral[/~]tt3[ ] a)~,o~. Average Daffy ^mourn Curies [ ] b) ~ Annua~ Amount /_~ c/O ¢) T~ l_am~t Size Container AP..( t ty~ # Days on Site ~{.a~ C/r~le Which Montlm: AIl Y~r, $, F! M, A, M, f, J, A, S, O, N, D 9) IVlIXTURE: List ~ , CO~ . CAS# . ~-. % WT · .y AH~ com~aonr~ 3) FM~a.wh, ~t,o.-,~ gd~,aZ4 g / 7 f ~.~ 77-,g / O [ ] / 1) INVENTORY STATUS: New [ ]Addition[ ]Revi6on~l~l'~T] Ch~ckitd~mi~ NONTnd~[ ]Tn~[ 4) Physical & H{adth PHYSICAL HEALTH Hazard Cau~ories F~ [ ] R,~tive [ ] Suddm 1~ ofl'r~.~.~ [ ] Innn~li~t~ H~lth (~h.'.~) [ ] l~hy~l I-I~lth wAs'm CLASSn CAT ON O-al,it coa t.,,... Dm Form 8O22) USE/COD - 6) PHYSICAL STATE Solid [ ] Liquid [~1 ~ [ I Pm~ [~'] Mixtm~ [ ] Wastg [ I Radio~m-fiw [ ] 7) AMOLrNT AND TIME AT FACILITY^..-~- UNTrS OF MEAS~ 8) STORAGE CODES Avm'~e I:~ly Panount - Curi~ [ ] b) ~: / ...o. ' .... Lars.~t $iz~ Container /M it I~y~o~ Sim .'~{,.~" ¢~le Wlfich Montln: All Year, J. F! M, A. M. J, J. A. S. O, N. D 9) MIXTURE: List COMPONENT CAS# % WT AI. tlvl the thr~ most hmmto~ 1) [ ] chemical compon~t~ or 2) [ ] a~y ABM coml:x~ms :~) [ ' [ certify under penalty of law, that ! have pea,sonally examined and am familiar with the information onl this and all attached dec--ts. ! believe thc suborned information is true, accurate and complete, I,~/~...._,,/' PRJlq'r Name & Tide of Authorized Company Representative (-/ Sisn~tum ' RAZARDOUS MATERIALS INVENTORY . Page~_..0.0.of 36 Business Name THE WAX SHOP Address 544,1 ALDRIN aT ' · I)[NVENTORYSTATUS:New[ ]Add/tion[ ]Rcvis/on[~letion[ ] Check/fchem/calLsaNONTradeSecret[ ]TradeSecr~[ ] C~,mi~,~,e: ~ [ ] CAS # 4) Physical & Health/ PHYSICAL HEALTH HazardCategones Firc[v"]Reactive[ ]SuddonP~esseofPressure[ ] Immediate~th(^cute)[ ]DclayedHealth(Chmm¢)[l,,,~ s) w~TE cn~ssn~c^uolq O-~sit ~ a~,, Dm Form SO=) USE CODE / 6) PHYSICAL STATE Solid [ ] Liquid [)('] Gas [ ] Pure [ ] Mixture [/k'j Waste [ ] Radioactive [ ] ?) AMou~ ~ ~ Ar F^CnaW u-~rrs oF ~.~.su~ s) sroRAaE CODES ~im~mD~y,~ ~lO ~ Lbs[ ]~[X'1~[ ] .)co~. /~ ^vcrase Daily Amount Curies [ ] b) Pressu~ Annual Amount ~.? g~. c) Temperatum · Larsest Size Container # Days on Site -~ ~ ' ' Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, lq, D (~ COMPO C # % WT I)INVENTORYSTATUS:New[ ]Addition[ ]Revision~on[ ] CheckifchcmicalisaNONTradeSccrct[ ]TradeSecmt[ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive[ ]$-n,~P~leaseofPrcsa~[ ] ~-,,,,,.,~*teHealth(Aonte)[ ]DelayedHealth(Chmnic)[ ] ~) WASTE CL~SSn~C^TfON (3-disit mode fi,,~ Dm Form SO=) USE CODE 6) PHYSICAL STATE Solld[ ] Liquid[ ] Gas[ ] Pure[ ] Mixture[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AND TIME AT FACff,rrY UNITS OF MEASURE 8) STORAGE CODES MaximumDaHyAmonnt Lbs[ lC-ali ]~[ ] a)Contain~. Average Daily Amount Curies [ ] b) Pressure: Annual Amount c) Temperature Largest Size Container # Days on Site CE, cie Which Months: All Year, J, F, M, A, M, J, L A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the ~hree most hazardous 1) [ ] chemical components or 2) [ ] any AI-IM components 3) [: ] 10)LOCATION [ certify under penalty of law, that I have personally examined and am familiar with the information on this and aH attached domnnents. believe thc submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Representative ~/ Signature HAZARDOUS MATERIALS INVENTORY ?age Bus~ess Name ~ THE WAX SHOP , Addt~s 544~ ALDR~N~ ': "/ ',' CHEMICAL DESCRIPTION ! ) INVENTORY STRATUS: New [ ] [ ] Revision [ ] Deletion~J Check ifchemicai is a NON Trade Secret [ ] Trade Sec~-t 2) Common Name: ~ ['/~Z 3) DOT # ioptional) ame: AHM [ ] CAS # I 4) Physical & Health HEALTH H.:,~rd Categories Fire [ ~/]/Reactive [ ] ] Immediate Health (Acute) [ ] Delayed Health (Chronic) 5) WASTE CLASSIFICATION (3-digit code from Dm USE ~ODE 6) PHYSICAL STATE Solid [ ] Liquid [/~] Gas [ ] Mixture [ ] Waste 7) AMOUNT AND TIME AT FACILITY __ UNITS OF IV[EASUI~ 8) S'I ORAGE CODF_,S Maximum Daffy Amount c~ ~--~_~ Lbs [ ] Gal ~X~ ] ft3 [ ] , Co atainen. Average Daily Amount Curies [ ] i Pressure: Annual Amount T,~ nperature # Days on Site ~'~_~ Circle Which Months: All Y .~A,M, J, $, A, S, O,N,D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most b~lous 1) [ chemical components or 2) [ any AHM components 3) .. [ 10)LOCATION 0 (.~ ~'..~ / ~ 4) Physical & Health PHYSICAL HEA~TH Hazard Categories Fire[~]Reactive[ ]Su__,~Je~ReleaseofPressure[ ] ImmediateHealth(A,~.'ute)[ ]DelayedHealth(Chruni¢)[L~/ s> WAST CLASSn CAT O t3 iSit f om DHS S022> USE COD ./ 6) PHYSICAL STAT~ So~id [ ] Liquid IN] C-as [ ] Pure [ ]Mixtu~ [~l Waste [ ] lhdioactive [ ] 7) AMOUNT AND ~ AT FACILITY .~ UN1TS OF MEASURE 8) SI )RAGE CODES Maximum Daily Amount tff~.OCO Lbs[ ]Gall ]ft3[ ] a)Cottain~ Average Daily Amount Curies [ ] b) Pressure: Annual Amount / 5'O~ c) T~ nperatu~ Lm'~est Size Container ~ # Days on Site ,.~._~'--- Circle Wkich ~onths: Ali Yenr, $, F, ~ A, ~, $, $, A, $, O, N, D the three most hazardous 1) I~'] 77¢ chemical components or 2) [ any AHM components 3) [ certify und~ penait~ oflaw, tl~t ! l~ve l~ZSen~ly ~.~in~l ~ ~m [mnili~' with the in~em~tien o~ this ~d ~11 att~h~l de~n,~t~. I believe the submitted information is true, accurate andcomplete.~_.~::~ ~ ~/~ _J/~/'~/'-- ~--~/~ ~ /'/~//~D~~. PRiiqT Name & Title of Authorized Company Representative ~/ Signature ~.~ HAZARDOUS MATERIALS INVENTORY Page~) of 36 Business Name THE WAX SHOP ' , ~ Address 5441 ALORIN CT. " CHEMICAL DESCRIFFION 1) INVE17rORY STATUS: New [ ] ^dd/~on [ ] Rev/sion [~l~tion [ ] Check if~hem/cal is a NON Trade Secre~ [ ] Trade Secret [ ] ~) Co.mo. ~am~:~.~ ~ e_ /0 ~ - I ~) ~OT # (op~o~) Ch~m~ ~ame: ama[ I CAS # 4) Physical & Health PHYSICAL HEALTH HaTard Categories Fire [ v'] Reactive [ ] Sua_d_,-n Release ofPressam [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASS~C^TION (3-disit code from DHS Form 8022) USE CODE 6)PHYS[Ca£ST^TE Solid[ ] Liquid[/y] C-as[ ] h~[ ] Mixtu~[~] Waste[ 7) AMOUNT AND TIME AT FACILrrY UNITS OF MEASUR~ 8) STORAGE CODES Maximum Daily Amount ~ ~ ~ Lbs [ ] Gal [X ] fi3 [ ] a) Contein~' ^veraSe Daily Amount Curies [ ] b) Pressure: Annual Amount :2 1 ~ ¢) T~anl~ratur~ ' Larse~t Siz~ ConUtiner ~ '~ T # Days on Site 2~ ('q ~' Cimle Which Months: Ail Year, J,. F, IvI, A, M, J, J, A, S, O, N, D 9) MIXTURE: List ~ COMPONENT , .~,~S~ # ~/~ % ~'T~ AHM chemic~ components or 2) ~ ~.~.~ %~j.,~--'_ ~ o~'-~. ,-//-.~ ~ [ ] =y AH~ components~) ..%-~.- , 0~,.o~'~-~ /'-/'-/4 ¥-¥4-/ / [ ] I) ~ Y ST^TU$: lq~w [ ] Addition [ 1 R¢~siun [~,la.~uon [ ] Ch~k il'da~m.i~l is · lqON Tr~l~ ~ [ ] Tr~l~ ~ [ ] 2) Common N~une: ~.j~0~ ~0-~."'~' ~-t~..- 3)DOT#(optiorud) Chcmim ~am~: ~[ I CAS # 4) Physical & He~th PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive[ ]$uctd_~mR¢lea.~of~¢[ ] lmmedi~teHealth(^~te)[ ]DehyedH~lth(Clmmi¢)[~.~'j 5) WASTE CLASSIFICATION (~-disit ~ from DI-~ Form 8022) USE CODE 6) PHYSICAL STATE Solidi I Liquid[X'l G~[ ] Pum[ ] Mixtu~[~] Waste[ ] Radio~fiw[ ] 7) AMOUNT AND TIME AT F^ClLITY UNITS OF ME~URE 8) STORAGE CODES Maximum Daily Amount 2 FO Lbs [ ] Gal [,X ] ft3 [ ] a) Containec Average Daily Amount Curies [ ] b) Pressure: Annual Amount ~ 0~ c) Temperature Largest S/ze Container # Days on Site %/~ ~'~ CLrcle V~aich Months: All Year, I, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List ~.ASJ °~V AHM the three most hazardous I) '~, ~~_NEI~.~.~ ~ ~/~,/ ~'~ [ ] chem/cal components or 2) ..~b/2c~._., %,.-~/-~ / ~,tt~,~C. ~t~_ ( ~o [ ] any AH2vf components 3) [ ] [ certify under penalty of law, that I have personally exam/ned and am familiar w/th the/nformation on tiffs and all attached documents. I believe the subm/tted information is true, accurate and complete. PRINT lqam~ & Title of ^uthofi2J~d ¢oml~ny Repr~:nmtiv¢ ~/ Signature itAZARDOUS MATERIALS II~/ENTORY Business Name THE WAX SHOP " . Address 5441 ALDRIN C . ~0~Y Clt]gMICAL DESCRIPTION 4) ~i~ & H~ P~SIC~ ~ L~ ~) w~ C~S~CA~O~ (~t ~ ~ Dm r~ ~) US~ COD~ 6) P~SIC~ STA~ ~ [ ] Li~d [~] ~ [ ] ~ [ ] ~ [~ W~ [ ] ~ve [ ] 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) S~0~GE COD~ ~m~y~t ~ L~[ l~]~[ ] a)C~ /~ /3 - Av~e ~y ~o~ ~ [ ] b) ~ ~ ~ m Si~ ~ ~ C~le ~ ~: ~ Y~, J, F,q ~ & ~ J, ~, & S, O, N, D 9) ~: Li~ CO ~ ' C ~y ~ ~~ 3) ~ [ ] ] ] 3)~T ~ (~fi~) 4) Ph~i~ & H~ ~IC~ ~Ca~ F~[ 1~[ ]S~l~of~[ ] l~a~(A~)[ 5) W~ C~CA~ON (3~t ~ a~a D~ F~ ~) ~E CODE 6) P~SlC~STA~ ~d[ I Liqad[-~] ~[ I ~[ ] ~[~] W~[ ] ~~[ ] 7) ~0~ ~ ~ AT FAC~ ~ ~ OF ~~ 8) STOOGE COD~ ] Av~e D~I~ ~o~t C~ [ ] b) ~: ~ ~ ~ Si~ ._ C~le ~ M~: ~ Y~, L F, ~ & ~ J, L & S, O, N, D 9) ~: L~ ~ CO~~ ch~ ~a ~ 2) ' ~ ., ~ , [ ] ~y ~ ~~ 3) [ ] I ~ m~ ~ of law, ~t I ~ve ~y ~ ~ ~ ~ ~a ~ ~fi~ ~ ~ ~ ~ a~ ~, I P~ N~e ~ Title ofAu~ C~y R~~ve -~ Si~ BAZARDOUS MATERIALS INVENTORY Page~'~ of Business Na~e THE WAX SHOP ' Address 5441 ALDRIN CT,' :" ~,~" ~) / CHEMICAL DESCRIPTION I)INVENTORYSTATUS:New[ ]Addition[ ]Revision~]Deletien[ ] Check if chemical is a NON Trade Secret [ ]TradeSeeret[ 3) DOT #(optionai) c~ni~ ~.m~: AH~ [ ] CAS # 4) Physical &Heaith PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] St~_den Release of Pre. ute [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) 5) WAST~ CL~.SSn~CAT~ON (3-aigit c.x~ from DHS Vo~m S022) USS CODS 6) PHYSICAL STATE Solid [ ]. Liquid If5 ] Gas [ ] Pure [ ] Mixture iX] waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILIT~.~_ UNITS OF MEAS~ 8) STORAGE CODES ~ [X] ~ a) Container /(~t / 3 Maximum Daily Amount ~ o Lbs [ ] [ ] Average Daily Amount Curi~ [ ] b) Pressure: t Annual Amount t ~7 0~ c) Tempemtm'e Largest Size Container # Days on Site ~-e~/_~'~ Ch-cie Which Months: All Ye&r. $, F, M, A, M, $, $, A. $, O, N, D chemical components or 2) ~.~) ~~ /t-/'~'~7,/~'! ?/ [ any AHM components 3) [ 10)LOCATION ~)(a~ ~ ~ 1) OR¥$T^TU$:New[ ]Addition[ ]Revision [ ] Ch~:kifc, h~ai~lisaNONTrt~[ ]Tmd~[ 2) Common Name: ~.~'c~ P~ l/t-~:-~, 3) DOT # (optional) ] cas# 4) Physical & Health PHYSICAL I-IE~TH Hazard Catesories Fire ['~j Reactive [ ] S~dde~ Release ofPressu~ [ ] immediate Health (Acute) [ ] Delayed Health (Ctu'oaic) [ 5) WASTE CLASSIFICATION (3-digit code from DI-IS Fo~m S022) US~ COD£ ~) PHYsicAL STATE Sold [ ] ~.iquid [~j C-~ [ ]~ [ ] ~ [~'] Wa.~ [ ] ~o~tive [ ] ?) AMou~rr A~D T[~a~ AT v^c~rrY, u~Trs OV ~V[EASU'P,~ S) STORAG£ CODES Maximum Daily Amount ~O Lbs [ ] C-ai [ ~ ] fi3 [ ] a) Contai~e~. Average Daily Amount Curies [ ] b) Pressure: A~oal Amount ~ ~o c) Tempe~at~e Largest Size Container '~ # Days on Site ~ ~ ~' Circle Which Month~: All Year, J, F, M, A, M, $, $, A, $, O, N, D the three most hazardo~ I) ~ - ? [ any AI-IM components 3) . -- j ~ [ lO)LOCATION' I certi£y ~de~ pe~lty of law, I1~t I l~ve pe~maily exam~ed a~l am f~mlia~ with the i~formation on lhi-. a~d ail a~ d~'~me~t~. I PR/NT Name & Title of Authorized Company Reprmentative Signature HAZARDOUS MATERIALS INVENTORY Bus/ness Name THE WAX SHOP'"' :,'. ~ "- A~ 5441 ALDRIN'CT., ' '.' CHEMICAL DESCRIPTION 4) Physical & Health PHYSICAL H~TH Hazard Cat~'iori~s Fire [ ] Remiw [ ] $, _~,._ l~l~ase ofl~su~ [ ] ~ Health (~ute) [ ] / 5) WASTE CLASSIFICATION (3-d/8/t cod~ from DHS Form 8022) USE CODE 6) PHYSICAL STATE Sol/d [ ] Liquid [ ~] Oas [ ] Pure [ ] IViixIure [J~] Waste 7) AMOUNT AND TUViE AT FACK/TY UNITS OF MEASURE 8) STORAGE CODES Maximum Dafly Amount ~ Lbs[ ]Gal[/T]fl3[ ] a)C~a~. Av=~e D~y .~nount Curi= [ ] b) ~ / # Days on Site .'A Circle Wa/ch Monfl~: All Year, .r, F, M, A, M, J, J, A, S, O, N, D [ ] 1)~NrI~OR¥$TATU$:N'ew[ ]Additi~l[ ]Re~ion[~on[ ] Cl~l~,ifch~mi~ali~NONTmd~:a'~t[ ]Tn~[ Chemical N~n¢: AHM [ CAS # ~/~-" 4) Physical & Health PHYSICAL HEALTH ~) WASTE CLASSn~ICATION (3-d/~it code from DHS Form 8022) USE]iCODE 6) ~HYs~CAL STATE Solid [ ] Liq. ia [/X'] C~ i ] P~ [ ] Mixture [)~I W~ [ ] 7) AMOUNT AND ~ AT FACILITY UNlq'S OF MHAS~ 8) STIORAGE CODES Maximum Daily Amount z/',~'~o Lbs [ ] Gal [)t'] fO [ ] a) C0ntainec. Average Daily Amount Curie~ [ ] b) ~: # Days on Site Circle Which Months: All Year, $, F, ~M, A, M, l, $, A, S, O, N, D certify under pen~t~ oFl,,w, that ! h~ve persomflly exaufined mud mm familflu' with th~ information on th/m ~d ail am~hed docummtm. I PRll~I' Name & Title of Authorized Company Represeulative ~/ $i~ua~re / D~- HAZARDOUS MATERIALS INVENTORY Pag~,'~'~ of 36 Busi-~ess Nar~e THE WAX SHOP ' ~ ~ ~ Addrms 5441 ALORIN CT. ~ ' . \ l~ CHEMICAL DESCRIFIION~ I) INVENTORY STATUS: New [ ] Addition [ ] Revision [,,,]"]~i~letion [J Check ifchemical is a NON Trade Secret [ ] Trade Soc~t [ ] 2)Com onN,me: 3) OT#(optio. ) 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] St~den Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code fi-om DHS Fonn 8022) USE CODE 6) PHYSICAL STATE Solidi ] Liquid[ ] Gas[ ] Pure[ ] Mixture[~] Waste[ ] Radioactive[ ] 7) AMOUNT AND TllV[E AT FACILITY UNITS OF MEAS~ 8) STORAGE CODES Maximum Daily Amount Lbs[ ]C-al[~]l~3[ ] a)ConUfinec. Average Daily Amount Curi~s [ ] b) Pressure: Annual Amount c) Temperature Largest Size Container # Days on Site Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List ch~i~ components or ~) ~ ~ £f.5~--o'V-? ¥ .. [ ] any AHM components 3) [ ] /- 1) INVENTORY STATUS: New [ ] Addition [ - ] Revision [t~?]~Seletion [ ] Check if chemical is a NON Trade Socret [ ] Trade Secr~ [ ] 2) Common Name: Z~ /~Ur~ ~ {X3S-/X 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] Sodd_~ Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [/~'] 5) WASTE CLASSIFICATION (3-digit co~ fl'om DHS Fon~ S022) USE CODE ~) PHYSICAL STATE Sona [ ] Liquia [fi/] C-~ [ ] mu~ [ ] ~ bY] waste [ ] m~uo~tive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ~ Lbs [ ] Oal IX ] ft3 [ ] a) container. 7/- / ~ - Ave~mge Daily Amount Curies [ ] b) Pressure: Amount Largest Size Container ~ ~/C # Days on Site ]1 ~ Circle Which Months: All Year, $, F. M, A, M. $, $, A. S. O. N. D 9) MIXTURE: List COMPONENT CAS# % grr AHM chemical components or 2) ~.~-~.a..'q~.~ ~ ~ ~ ~3- ~/2-~ ~/ [ ] 10)LOCATION b ~-~t~/ ! certi£y under penally o£law, that I ha~e personally examined and am familiar with the information on this and all at~.,hed do¢~nenls. I believe thc submit~t information is true, accurate and compl~-~. PRINT Name & Title of Authorized Co~pany Represemativ¢ ~/ Signature tiAZARDOUS MATERIALS INVENTORY Page.k_~.ot' Business N~..~ THE WAX sHOp '. ..... , Address 5441 ALDRIN CT. ,,, / I)D, fVENTORYSTA'I-tJS:New[ JAddifion[ ]Revisi~oa,[ { Checkifcl~/NONT~~[ ITradeSecret[ ~) ¢o,,~on ~: '~,~ P_~L~ ~ { ~~) DOT ~ Ch~ ~=,: ami cas # /V//t- 4 ) Physical & Health PHYSICAL HE~ ~LTH Hazard Categmes Fire [ ] Re~iv~ [ { Sudden R~i~as~ ot'Pr~ssu~ [ ] ~ H~alth. ~ate) [ ] De'xed H~alth (Cluuui¢) 5) WASTE CLASSIFICATION (:t.digit ~ .%,~ DHS Form 8022) USE CODE v5 6) PHYSICAL STATE SoUd [ ] Liquid [/~] Oas [ ] Pure [ ] Mixt~ D/~] Was~ [ ] aadioa~,e [ ] / ?) AMOUNT AND TIIvlE .AT F^CIIZI'Y' ~ OF lVlEasUR~ 8) s~rORAOE CODES Maximum Daily Amotmt ~0 Lt~[ loal[;<liU[ ] a)c,outai,~. Average Daily Amount Curies ( ] b) Ph~m~ , / Am,,., Amouat / ~ ~) T~mx~at~ ~-/ # Days on Site ,.?'g...c' Civic Whi~ Months: All Year, $, F, lVl, A, M, $, J, A, S, O, IV, D 9) MIXTURE: List COMPO · ' [ l ch~mic~ compou,,,t~ or 2) C4Le. o~d /¥~ ed~ .. ~ / 2.- [ l lO)LOCATION 6/,,t,"~.~ 1 ~Y~ ' I)~'~RYSTATUS:New[ ]Additi~m[ ]RevisionL~~[ ] Checkifchemic~isaINONTnld~Secret[ ]Trad~Seo-et[ ] Ch~ ~,m,: am ~ cas # 4) Physical & H~alth PHYSICAL ~ LTH I-tazardCatesories F~[ lR~'tiw[ ]Sudd~l~l~as~ofPre~u~[ ] Imm~liateHcalth(J~cut~)[ ]Delay~dI-kalth(Chrouio)[ ] 5) wasTE CLASSUUCATIO~ O-digit co~ eom DHS Form 8O22) US~ CODE --~ 6) PHYSICAL STATE Solid [ I Liquid IX]' Cas [ ] Pure [ I Mixtu~ ~'] Waste [ I Radio~w [ l 7) AMOUNT AlVD TIME AT F^ClLITV , ~' UNn~ OF MEAS~ 8) STORAOE CODES Maximum Dafly Amount 2 c/5 Lbs[ ]~['x-]tu[ ] ,)c~,~,~. , 7-/d-/ Avia'age Daily Amount Curi~s [ ] b) Pressure: ~u~ Amora .2 .r09 ~) T.~,~tm~ Largest Size Couufin~r ~ c/3 Yc~r, J, F, M, A, M, $, J, A, # Days on Site '~ 6,-~' Circle Which Mouths: All 8, O, iV, D 9) MIXTURE: List COMPONENT · Cas~ % w'r chemical compon~uts or 2) . .~ / [ ] any AHlVi componmts 3) [: J lO)LOCATION O~"~/ PRINT ~m~ & Tifl~ of^-tho~d COml~ny Rq~r~v~ (~' Siam,' tm~ / HAZARDOUS MATERIALS INVENTORY Bushiness Name, THE WAX SHOP ' Address 5441 ALDRIN (~ CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New [ ] Addition [ ] Revision f~]~l~tion [ ] Check if chemical is a NON Trade Secret [ ] Trade Sec~ [ ] :) Common Name: 3) DOT # (option) 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive[ ]$,_,dd,mReleaseofPressure[ ] lmmediateHealth(Acute)[ ]DelayedHeaith(Chroaic)[/xf] 5) w^sTE CLASS~C^~ZON (3~it coa~ eom DF.S Form SO=) USE CODE 3-O 6) PHYSICAL STATE Solid [ ] Liquid [~ ] Gas [ ] Pure [ ] Mixture [~ ] Waste [ ] Radioactive [ ] 7) ~OUNT AND ~v[S ^Z ~^czrrv uNrrs oF NEAS~ S) STO]U~aE COD~ ~dmua Dm]y Amount ~ Lbs [ ] C-~ [~ ] ~ [ ] a) Conmm~ Average Daily Amount Curies [ ] b) Pressure: / Annual Amount ~/0-~ ¢) Temperature , Largest Size Container ~ # Days on Site ~).~ Circle Which Months: All Year, I, F, M, A, M, $, $, A. S, O, N, D 9) MIXTURE: List .COMPO~ ~ ,/ ~,A~ ./,., % WT AHM I)]3~'~]'?'-(~RYSTATUS:New[ ]Addition[ ]RevisJoa~[ ] Check ifchemical is a NON Trade Secret [ ]TraaeSecret[ ] 2) Common Name: ~a~0-~~ /.d ~ ."z'~.- 3) DOT # (optional) 4) Physical & H~lth PHYSICAL Haza~dCategories Fire[ ]Reactive[ ]SuddeaReleaseofPressur¢[ ] lmmed~ateHeaith(Acute)[ ]DelayedH~lth(Ct~aic)[~,] 5) WASTE CLASS[~CAT[ON (3-di~t code Eo~ DHS Form 8022) USE CODE -~) 6) PHYSICAL STATE Sotid [ ] Liquid IX] C-as [ ] Pt~-e [ ] Mixtu~ [ ~ Waste [ ] ]~.~tioactive [ ] 7) A~v[ouz, r~ AND ~ AT FACEt'P/ m OF M~.S~ 8) STOI~,OE CODES Maxi=ua Daily Amount 2 ~ O Lbs [ ] C.~ [ X] m [ ] a) Contains-. Average Daily Amount Curies [ ] b) Pressure: / A~tal Amount ]~ 0-O c) Temi:~-atu~ z/_ Largest Size Container g c~ ~' # Days on Site ~ ~ ~f' Cimle V~ich ~onths: All Year, $, F, ~ A, M, $, $, A, S, O, N, D the three most hazardous l) / 1 '~ ~ [ ] chem~c~ components or 2)' ' '~ c~_~u.~-_~ ./~y/-~'3- ~" any AH]vi components 3) [ ] [ certify under penalty of law, that I lave personally examined .ad am fami_liar with the information on this and ail attached documents. believe the submitted information is true, accurate and complete. PRINT Name & Title of Authorized (~ompany Representative ~/ S{gnaturc ' HAZARDOUS MATERIALS TO " ~ Pago'~.~_. of Bus/ness Name THE WAX SHOP · -,, '. ~ Addxcss 5441 ALORIN C . . ' I)INVENTORY~'STATUS:N~w[ ]Addition[ ]Revision~]~tien[ ] CheckifchemicalishNONTradeSecmt[ ]TradeSecr~[ ] Chem/cai Name: __ 4) Physical & Health PHYSICAL HEAL~ Hazard Categories Fire [ ] Reactive [ ] Sudden Re. lea.~ ofPressu~ [ ] lmmed/ate Health (Acute) [ ] Delayed Health (Chrome) [ ] 5) WASTE CLASSIFICATION (3-d/8/t code fi,~ DHS Form S022) USE CODE 6) PHYSICAL STATE Solid [ ] Liqu/d [~ ] Gas [ ] Pure [ ] Mixture [~Y] Waste [ ] Rad/oact/ve [ ] 7) AMOUNT AND TIME AT FACILITY ,.~ UNITS OF MEAS~ 8) S~TORAGE CODES MaximumDafly~t ~f'~ Lbs[ ]Cml[ Iff3[ ] ~)Contain~. 7-" Average Daffy Amount Curies [ ] b), Pm~n~: / Annual Amount ¢) T~mlxaature Largest Size Container # Days on Site Circle Which Months: All Year, $, F, M, A, M. I, I, A, S, O, N, D the three most hazardous l) ff~- g ~ [ ] chemical components or 2) ~ ~ ..~o- ~f- ~f ~ [ ] any AHM components 3) ~ ~ [ ] 10)LOCATION 6 ~'~'"X I ~ 1) STATU$:N'~,[ ].addition[ ]Rm4si Cl~.kif~calis~,~ON'Trad~,~a~[ ]Trad~[ ] Chem/cal Name: -- AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH HazardCategofies Fire[~]React/ve[ ]S~4d~ReleaseofPressure[ ] Imm"ai,teHenlth(Aicute)[ ]DelayedHealth(Chroni¢)[~,] 5) WASTE CLASSIFICATION (3-dig/t code fio,,~ DHS Form 8022) USE{~ODE .~ 6) PHYSICAL STATE Solid[ ] Liquid[~] Cas[ ] Pure[] Mixtu~[~ Waste[ ] Radioact/ve[ ] ! 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) ST~ORAGE CODES Maximum Dafly Amount -..~O Lbs[ ]C_ral~.~]f~[ ] a)Co~niner:. 7 Average Daily Amount Curies [ ] b) ~: ! ~nual Amount % d-O c) T~e~ Largest Size Container -5'-~~ # Days on Site ~ b~' Circle Which Montbs: All Year, $, F, ~M, A, M, $, $, A, S, O, N, D the thr~ most hazardous 1) ~,, ~p,.~ ~ l /9'' WT chemicalcomponentsor 2) ~0~c~ C'c/~c-. /I/- ~2 (~ 4 'x- [ ] [ any AHM components 3) ~ u [ · ] 10)LOCATION 6 ~{-7'"~ ~ I certify under penalty ofl~w, that I hay, pa'~mally examined and am familiar with the information on ~ and all ,,Rach~ docum~ts. I PRINT Name & Title of Authorized Company Represmtative ~/ Signa[hre HAZARDOUS MATERIALS INVENTORY' , Page Bus~]ess Name THE WAX SHOP Address 5441 ALORIN CT. o~RY S~A CHEMICAL DESCRIPTION I)IN,~NT TUS:New[ ]Addition[ ]Revisiun~[ ] Check if chemical is a NON Trade Sccret [ ]TradeSecret[ ] Chcmi~Name:~ ~ AH~[ I CAS# 4) Physical & Health PHYSICAL HEALTH I-IazardCategories Fire[ ]Reactive[ ]Sudd~nReleaseofPressure[ ] Immediate Health (Acute) [ ]DelayedHeaith(Chroni¢)[/y] 5) WASTE CLASSIHCATION (3-digit code from DHS Form 8022) USE CODE S) PHYSICAL STATE SolidI ] Liquidl/X] Gas[ ] Pum[ ]Mixture[>(] Waste[ ] Radioautiv~[ ] ?) A~OUh-r Ah~ TnVm Aa' F^cmrrv m oF zvmAso'~ 8) SXORAeE CODm Maximum Daily Amount / 3 ~ Lbs [ ] Gal D( ] ft3 [ ] a) Contain~ Average Daily Amount Curies [ ] b) Pressure: / Annual Axnount ~ ¢) Teanl~ature Largest Size Container ~ # Days on Site ~ ~ ~ Circle Which Months: All Year, $, F, M, A, M, J, $, A, S, O, N, D 9) MIXTURE: List ~ COlVIPO~ , A~#..C # % wr.~ AHM chemical components or 2) ~'~. ~.~.~~ '~J.4at~rl~ (o r~z/eq, qT.[( .~ /,O [ ] any AHlVl components 3) /~¢~01 r~. - - go~/a-~/7--~' 10)LOCATION 0~"/~ l ~ 1)INVENT~ STATUS:No, vi ]Addition[ ]Rcvisionl~,~lX~,~¢uont ]~' ~ Check if chemical is a NON Trade Secret [ ]TradeSecret[ 2) Common Name: (J2)~~_ ~/C'~ , / ~ ~J~ 3)DOT#(optionai) c~¢.~ ~am¢: ~ [ ] cas # 4) Physical & Health PHYSICAL HEALTH I4a~ardCategories Fire[ ]Reactive[ ]S~_~d_~mR¢lea~ofPressure[ ] lmmediateHeaith(Acute)[ ]De]ayedHealth(Chroaic)[/~] 5) WASTE CLASS]I*ICATION (3-disit cod~ from DHS Form 8022) USE CODE 6) PHYsicAL STATE Solid [ ] Liquid IX] c-~ [ ] Pu~ [ ] Mixt~ [~t Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY uNrr$ OF MEASURE 8) STORAGE CODES Average Daily Amount Curi~s [ ] b) Pressure: / Annual Amount / 0~90 c) Temperature Largest Size Cuntain~ 3 c/5~ # Days on Site 2 to ~ Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D th¢~r,,mos, h,,=,~o,, l) ~ ~, a, ~ /5/3' O,-? / ~ [ ] chemical components or 2) ~:~t_a~ '~__~[/~'~-~t_,t. /t_/~/~z/- ~. / / ~ [ ] anyAI-IMcomponents 3) '~', (P.~,2~-'~~~,~:~ ' ~_ p/ 7~2' ~'~- ~' ' {:> [ ] lO)LOCATION 0 LA-~'--.~ / I certify under penalty of law, that I have personally examined and am familiar with the information on this and all atta~ed documents. I believe the submitted information is true, accurate and complete. PI~qT Name & Title of Authoiqzad company Representetive ~/ Signature · / Da~ HAZARDOUS MATERIALS INVENTO Y ' Business Name THE WaX SHOP, ..... _' ^aam~ s44~ aLOm. C~;, 1) STATUS:New[ ]Additio~[']l~vi~ion~ea[ ] CheckffchemicalishNONrradesoc~[ ]TradeSecmt[ ] 4 ) Physical & Health PHYSICAL ~TH Ia,,,,,-d Camsori~ Fire [ ] R~'~i~ [ ] Sudan l~Jea~ ofPmm~ [ ] Imm~iam I-I~ iAcum) [ ] D~ Hml~ (Clmmio) [,¥] S) WASTE CLASS~CATtON (~[i~it ~ a,~ Dm Form ~022) USE CODE 6) ?HYSICAL STATE Solid [ ] Liquid~ ] C~ [ ] Pu~ [ ] ~ [ ~] Wasm [ ] P.~tioamive [ ] 7) AMotm-r A~rD Tram AT FAC~'Y [mrm OF ~mSU~ S) STO~AG~ CODES Av~e ~y ~o~ ~ [ ] b) ~ 4) Ph~i~ & H~ ~IC~ w~ C~CA~O~ O~t ~ ~ D~ F~ ~) US~ ~OD~ 5) ~)P~S~C~STA~ ~d[ ] Li~[~] ~[ ] ~[ ] ~[~ W~[ ] ~~[ ] 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) 8~ O~OE COD~ Av~e ~ly ~omt C~m [ ] b) ~: / RAZARDOUS MATERIALS INVENTORY Business Name THE WAX SHOP Address 5441 ALORIN CT. ' 1) ORY STATUS: New [. ] Addition [ ! Revision~]_~. Deletion [ ] Check ifd~emical is a NON Trade Secret [ ] Trade ~ Chemical Name~ ' AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] S,_,dd_,~_l Release ofPressum [ ] l-~mediate Health (Acute) [ ] Delayed Health (Chronic) 5) wASTE CLASS~C^TiON (3~sit com~ from DI-m Form SOn) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [~(] Gas [ ] Pure [ ] Mixture [/~] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACE/fY UNITS OF MEASURE 8) STORAGE CODES Maximum Dmly ,X, nount /5'0 Lbs[ ]C-albOlt3[ ] a)Co~t.i-~. 7-/6--/~ Ava'age Daily Panount Curies [ ] b) Pressure: ! Annual Amount 60-~ c) Temperature # Days on Site ~6~'~ Circle Which Months: All Year, $, F, M, A, M, 5, I, A, S, O, N, D 9) MIXTURE: List CO,~I~...~,"-~-,-~'~% ~'~- . CAS, _ %~,.., AHM chemical componeats or 2) :~a-~ D./~ , 304/~2- z/7- .C /~ [ any AI-iM components 3) (_J.~fl.-exL,.~& ~ ~_.f~.~, /o~_'-//3~,"/,~- ~- ~ [ 10) OCA ON /)CcT'S I>~E~~ATUS:New[ }Addition[ ]Rcvision~J~~] Che~k if chemical is a NON Trade Secr~ [ ]TradeSecmt[ ] Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH HazardCategor/es Fire[ ]Reactive[ ]SuddonReleaseofPressure[ ] Immediate Health (Acute) [ ]DelayedHealth(Chron/c)[~] ~) WASTE C[~,SS~C^TiON O~it ~ eom D~ Form SOn) USE CODE ~) PHYS[C~ Sr^T£ SoUa [ ] Liquid [~q C~ [ ] m~re [ ] ~ ~] Waae [ ] m~tio~tive [ ] 7) AMOUNT AND TIME AT FACEATY UNITS OF MEASURE ~) STORAGE CODES Maximum Daily Amount ~ ~ Lbs [ ] Oal[k ] fl3 [ ] a) Containe~. Average Daily Amount Cudes [ ] b) Pressure: Annual Amount ~ ~ c) Temperature Largest Size Container _~'-/~" # Days on Site 2~-%' Circle Which Months: AIl Year, 1, F, M, A, M, J, J, A, S, O, N, D chemical components or 2) ~7~ ~.. {~,f.~/~ $~ ~/~.%./~ ~ ~,. c.f [ any AHIVl components 3) t~ ,-~ ~t.i~tTt~t.4, fo:5 P-/X-~2- c~ 7 [ lO)LOCATION /~)~7="a t /~ ~ I certify under penalty oflaw, tim I have personally emlmined and am familiar with the information on ~his and all av, a~hed doamonts. I believe the submit~d/nformation is true, accurate and complete. PRINT Name & Title of Authorized Company Representative. /~- Signature ' / Dat~ HAZARDOUS MATERIALS INVENTORY Business Name THE WAX SHOP ~ 5441 ALORIN C!. , ' G~ CHEbilCAL DESC1/IPTION I)~/ENTORYST^TU$:N~v[ ]^d~it~on[,]Revi~ion~] Ch~itchemical~NONTradeS~t[ Ch N me: AH t ] CAS# 4) Physical & Health PHYSICAL HEALTH Haz~Cat~ode~ Fiji ]R~i~[ ]Su~aR~a~ofPr~a~[ ] lmm~l~Health(~ont~)[ ]Delay~dHealth(Ch-~¢)[~,] 5) WASTE CLASSIFICATION (3-disit code fi~u DHS Form ~T22) USE CODE ~-~ 6) Pm'StCAL sr^TE solia [ ] U~uia [ ~ c.~ [ ! ~r~ [ I Mixture IAi1 W~ [ ?) ~ou-~ ~rD m~ Ar F^Cn.rTy tmTm O~ MF.~tn~ S) sro~aE COD~ Maximum Daily Amount ~SZ) Lbs [ ] Gal [?fl it3 [ ] a) C~mtain~. Average Daily Amount Curies [ ] b) ~ tamual Amount ~o e) T,m~m'atur~ Largest Siz~ Contaiu~ &qS~ AIl Year, $, F, M, A, M, $, # Days on Site ~ ~'x" Cin:le Which Mouths: $, A, S, O, N, D 9) MIXTURE: List ..,__ COMPONENT . CAS, chemical componeuts or 2) _~'~gC'a,t~ ,a-u.,~c4~4~ '1~ q_e/7.~- t g-a- .2_ [ ] q~v/(,-¢~'Nq' [ ] 10)LOCATION 0 (7~'['~ ! )INVENTORYS~ATUS:New[ ]Addition[ ]Revision CheckifchemicalisaNONTradeSecrct[ ]TradeS~[ ] Chemical lq~me: ~ [ 4) Physical & I-L~llth PH~ICAL I-tE~TI-'I ~C~t~ori~ Fiji llt~v~[ ]$mtd~l~l~.~of~[ I lmm~I-I~th(~)[ ]l~hy~lH~th(Ch~mi¢)[)t 5) WASTE CLASSIFICATION (34igit eod~ from DHS Form ~22) USEr, ODE 6) PHYSICAL STATE Solid [ ] Liquid [/~] Cfm [ ] Pure [ ] Mixture [/~] Waste [ ] Radioa~ive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) ST~ORAGE CODES Maximum Daily Amouat '.~Q~' Lbs[ ]C-~I[~R3[ ] a)Co~tainer:. · Average Daily Amount - ' Curies [ ] b) ~: / Annm Amount , ~ ~o ~) T~ '-/ Lwg~ Sm Conmuer .3 '-/U' # Days on Site ~"0 Circle Which Mouths: All Year, $, F, iM, A, M, $, $, A, $, O, N, D 9) MIXTURE: List COMPONENT chemical compononts or 2), (~F_c-~ ~6~69C 0~--{ / ,~'- [ { [ any AHIVi componeum~) { 10)LOCATION (-~ (-~ I ~ I certif~ under p~alty of law, that I have personally examined ami am familiar with the iaformafion on ~ ami all attached doonmeats. I PRINT Name & Title of Authorized Company Rcprcscutative ~ Signa,U~re I~Z~RDOUS MATERIALS INVENTORY THE WAX SHOP 5441 ALDR~N CT. PaseJ_~.of.~ Business Name " Address CI~MICAL DESCRIPTION I~ [ ]Addition[ ]Revision[ ]Delch~nl Chcck~chemicalisaNONTrac~Scoret[ ]Trad~Secret[ ] 4) Physical & Healt~ ttF. ALT[-[ HazardCateSorie~ Fiji ]Rea~iv~[ ] [ ] ;~Ua~a~h(^c~te)[~Daay~H~h(Chr~i¢)[~l 5) WASTE CLAS$I~CATfON · fi,,~., DZ-[S Fona 8022) USE CODE 6) PHYSICAL, STATE So[id [ ] Liq~d [ ~ Gas [ ] Pm'e [~j~ Mbc~m'e [ ] Waste [ ] Radioactive [ ] 7) AMOU]~ A~D TIME AT FAC]ZJTY UNH'S OF 8) STORAGE CODES Maximum Daily Amount Lbs [ ] a) ContaLnec. Average Da~ly Amount Cta'ie~ [] b) Pressta'e: Annual Amount ¢) Temperature ~,~ Largest Size Contsk~r ' # Days on Site Cix~le Wifich ?,~atbs: ALI Year, $, $, A, S, O, N, D 9) MDCCu'R~: List COMPONENT CAS# % WT ~he three most hazardous 1) [ ] chemical components or 2) [ ] any ~ components 3) [ lO)LOCATION '/~ ~I)~OR¥$T^TU$:New[ ]Addition[ ]Revision [ ] Ch~kifd~ficali~NONTr~l~8~a~'t[ ]Tr~l~8~'t[ ] Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive[ ]SuddenRelea.~ofPressure[ ] ),~,~,.~-)~H~th(Acu~)[~/]Det~y~lHealth(ClnmiO[ ] ~> W~STE Ct.~SIHC^TtON O-,ligit ~, ~ ~m ~o~m so=} USE CODE 6) PHYSICAL STATE So[id [ ] Liquid ~ ] Gas [ ] Pure [ ] Mixture [)(] Waste [ ] Radioactive [ ] ?) ~,~oum' A)O TXME ^T ~^cnsry tr~rns o~ M~.AS~ S) STORAO~. CODES M.,dmumDai~yAmou-,t .+CoOCL~ nbs[ ]C~[y]~[ ] a)Contain~. Average Daily Amount Cutie~ [ ] b) Pressure: / Aunuai Amount c/O c/~ c) Tempo'atu~ Largest Siz~ Container / # Days on Site ~ (~'~ ' Civic Which Months: All Year, $, F, l~ A, 84, $, $, A, $, O, N, D 9) IVffXTURE: List ~, / COMPONENT CAS# AHM the three most hazardous1) C~~-~,~n /~h<~7-c~7-c) any AHM components 3) 0 c~ c~ (/ - [. ] IO)LOCATION 0 ~.'~ ] 0C I cert/fiy under pe~lty of law, that ! have personally exam/ned and am faro/l/ar w/th tl~/nformat/on on ~ and all attached decuments. believe the sub~tted/nformat/on/s true, accurate and complete. HAZARDOUS MATERIALS INVENTOR~ Pa~e [ ~ of $6 Busi~ncss Name THE WAX. SHOP Address 5441 ALDRIN CT. CHEMICAL DESCRIPTION ~)INVENTORYSTATUS:New[ ].Addition[ ]Revision[M4~l~'ff&[ ] Check ifchemical is ~ NON Trade Secret { ]TradeSec~[ ] 2) ¢ommon Name: ~ ~ ,¢/'~-&" 3)DOT I (optioml) 4) Physical & Health PHYSICAL HF. ALTH Hazard Categories Fire [ ] Reactive [ ] Sudd~ Release ofPressm'e [ ] Immediate Health (~eute) [ ] Delayed Health (Chronic) [..~]' 5) WASTE CLASSIFICATION (34git code fix~m DHS Form 8022) US! CODE 6) ?W~SICAL ST^TS So~ia [ ] Liquid ~1 C,~ [ ] Pure [)(] lVnxture [ ] W~ste [ ] R~Uo~ti~ [ ] 7) A~OVm' ANY Tnvm ^T FACnZry uNrrs OF ~.gstms S) S roRAoE covss ~u~mum n~ily Amount ~-O t~ Lbs [ ] C,~ .DC] ea[ ] a) c Average Daffy Amount Curies [ ] b) P ~ssure: ~amual Amount ~ c) T. ~perature Largest Size Container ~ # Days on Site ~.'.~ t,a~ Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) [ ] chemical components or 2) [ ] any AHM components 3) [ ] IO)LOCATION 1)INVENTORYSTA~S:N~[ ]Addition[ ]Revision[ ]Deletion~'~-- Check if ehemieal is a NON Trade Secret [ ]TradeSec~[ ] 2) Common Nal~.~_~ ~~--.'~.-~ 0'~ / S'-? 3) DOT # {optional) Hazard Categories FireJ)(']Reactive[ ]S,_,8~.~Pressum[ ] Immediate Health (Acute) [ ]l)el,,yedHeslth(Chronie)[~ s) wtaw c~a~,ssn~c^TIo~. ~. 04git c,~ fro~o~.~ s022) uss CODE _ / 6) FW£S~C~ sa^rs Son,, [ ] LiquiU D('] cas [ ] l'u~~Mumtre [ ] Waste [ ] RaUio~ve [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE ~.8) STORAGE CODES Maximum Daily Amount Lbs [ ] Cml [~ ] fi3 [ ] a~tainer: Average Daily Amount __ Curies [ ] b) Pr~ ~: / Aun~ Amount __ c) T ,~4mp~'m~ Largest Size Container I,i...,~, # Days on Site ~ Ci~le Which Month~: Ail Year, $, F, ~ A, M, $, $, ~S, O, N, D 9} MIXTURE: List COMPONENT CAS# % WT AHM the ~ree most hazardous 1 ) [ ] chemical components or 2) [ ] any AI-[M compone~t~ 3) [ ] 0(AT-Z I certify under t~'mlty of law, tl~t I h~v~ l~a'~ndly ~xantin~l ~md um f~mili~r with th~ inferm~tion on ~l~hi~ and ail ~tt~r.h~ do~ma~t~. I PRINT Name & Title of ~Utherized Company R~tative Si~mlture ~OUS MATERIALS INVENTORY Page, of 36 Business Name THE WAX SHOP Address 5441 ALDRtN CT. '[)I2~/ENTORYST^TUS:New[ ]Addition[ ]Revimon[~.,],~lction[ ] Ch~.kifche~ic~.~aNONTradeSeoret[ ]TradeSecret[ ] 4) Physical & Health PHYSICAL HEALTH ~ Categories Fire [ ] Reactive [ ] Sudden Release ofPressure [ ] {m,,,,'~!,,te Health (Acute) [ ] Delayed Health (Clu~¢) [.~'] 5) WASTE CLASSIFICATION ?) ~ot.u, rr ~ r~s ^~ ~cnn~q~ K~? uNrrs o~ l~..~tma ~) s~o~oE CODES Maximum Daily Amouat ^vera~e Daily Amouat Cu~ [ ] b) ~ / Annual Amouat qJ~ '1507C~ c) Temperature /.~ ' # Days o- Sit~ ~o5" ~ ~P--~ie Which Moa,,,: All ¥~a~. $. F. iVi. A. ~. J'. ]. A. S. O. N. D 9) MIXTURE: List CON[PO~ CAS# % WT AHM the thrc~ most h*-~,xtons I) [ ] chemical components or 2) [ ] any AHM compon~ts 3) [ ] I \c4, bo 2) Common Nam.: ,/~/~ ~ (~ "~ 3, DOT # (optional) 4) Physical & Health PI-IYSIC~ HEALTH I-I~ardCatcgorie~ Fire[HRealctive[ ]$~d0_,gaRcleaacof~[ ] lmm~_'ateI'Iealth(Acut~)[ ]DclayedI'Ioilth(~c)D('] 5) WASTE CLASSIFICATION (a-digit code fium DHS Form 8022) USE CODE /t~/ 6) PHYSICAL STATE Solid [ I Liquid [?ql G~ [ I Pt~ [~] Mixtu~ [ ] W~ [ I Radi~ [ 7) AMOUNT AND TIME ^T F.a.¢II~ ~ t_. Gaiu~[.~[ it3 a) IViaxim,,m Daily Amo--~ ~cr~ ~ Lbs [ ] [ ] CouU~m~. AveraSe Daily Amotmt C ] b) Pressure: La. est Size ConuKu~ # Days on Site ~,~-- Cin:le '~uich Moufl~s: AIl Yea~, $, F, M, A. M, $, $. A, S, O, N. D 9) IVilXTURE: L~ COIViPONENT CAS# % ~ AHlvi the ~ree most hazantous !) [ ] chemical cemlxmeuts or 2) [ ] any AH~ com{xmeuts lO)LOCATION [ cortffy uacl~r penalty ot'law, that ! lave perso~ly examined a~l am fi~iliar wi~ ti~ i~'omation on tl~ and all ,,t~J:~! documeats. ! believe the subdued i~'onaatioa is Uae, accurate a~d complete. PPJ~rT Name & Title of^uthorized HAZARDOUS MATERIALS INVENTOR~f Page I__.~ of 36 Business Name "~--,.,THE WAX SHOP .... Address 5441 ALDRIN CF. CHEMICAL DESCRIPTION I)INVENTORYSTATU~S:New[ ]Additien'~Revision[ ]Del~tion~~] Check ifchemical is i NON Trade Secret[ ]Tradesoc~[ ] 4) Physical & Health PHYSICAL ~ I-~kLTH Hazard Categories Fir~ [ ] Reactive [ ] S~utd~ Rel~a.~ of [ ] Immediate Health (~¢ute) [ ] D~lay~ Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3 ) USE CODE /~/ 6) PHYSICAL STATE Solid [ ] Liquid [//~ ,~,, [ J ~ /] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILrrY UIqlTS OF MEASURE xX 8) STORAGE CODES Maximmn Daily Amount . Lbs [ ] _Gal .[~ ! ft3_ [ ] '~ a) Container:. ^v~-qe mily Amount - - c~i~ ~1 ',~) ~h,=.~: Annual Amount ' c~xTmlxaatm'e L~est Size Container . ~ # Days on Site Circle Which Months: AIl Year, ,, Fi ~lVl, J, J, A, S, O, Iq, D 9) MIXTURE: List .__p COMPUNEt._, CAS' ~.. o/~rff the three most hazardous 1) ~v-c~ ~ ~ chemical components or 2) ~ ~ ~ .-%'~- (~ t-h-' 7-~ [ any AI-IM components 3) ~ U [ ] 10)LOCATION Y STATUS Iqew [ ] Addition [ ] Revisiun [ ] Check ffchemical is a!NOiq Trade Secret [ ] Trade Soca~t [ 2) Common Name: ~i~C. O-,~ '~' ~/~'~ 3) DOT # (optional) C # 7 4) Physical & Health PHYSICAL HEALTH Ha?ardCategories Fire[ ]Reactive[ ]SuddenReleassofPressure[ ] lmmediateHealth(,~cute)[ ]DelayedHealth(Clmmic)D~] 5) w^sTE CLASSn~C^rION (3-digit ced~ from Dm Form 8O22) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [~/] C~s [ ] Pure [~] Mixture [ Waste [ ] Radio~tive [ ] 7) AMOUNT AND TIME AT FACILITYz(-<~- UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ,a..~ Lbs[ ]GalD(']ff3[ ] a).cdntain~ Average Daily Amount Curies [ ] b) Pressure: 2.~(a..~ Circle Which Months: All Year, J, F, A, M, J, J, A, S, O, lq, D # Days on Site i1VI, 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) [ ] chemical components or 2) [ ] any AHM components 3) [ . ] o> .OC^noiq O CCT-6 t I certify under penalty of law, that I have personally examined and am familiar with the information on flhis and all attached documonts. I believe the sutnnitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Representative : Signature ' HAZARDOUS MATERIALS INVENTORY page ]~/b of~ Business Name THE WAX SHOP "' CHEMICAL DESCRIPTION I)I2~VENTORYSTATUS:New[ ]Addition[ ]Rcvision~'~Delcti~m[ ] Checkifchemicali.saNONTradeSec~t[ ]TradeSecret[ ] 4) Physical & Health PHYSICAL HEALTH I-]~,=~,,'dCategories F/r~[v/]Reacfive[ ]SuddenReleaseof~[ ] Y,,,,,,~!~,t--Health(Acute)[ ]DehyedHealth(Chmni¢)[~ 5) WASTE CLAS$IFiC^TION - (3-digit cod~ F.,~ DHS Form N022) USE COD£ 6) PHYSICAL STATE Solid [ ] Liquid ?> , aotn, rr azqu TnU AT F^cu.rFy. _. ]v~,,,,, n~iiy A, noun{ h~0C~ c~ Lbs [ l C,~.pr ] n3 [ ] a) Containe=. Averse Unily dmouat Cmies [ ] b) Pr~ / ,a. nn~ ,~anoun~ .-~ 0D t.~5 ¢) Tem~=atm'e # Days on Site .Rt._c;'- Circle Which Months: AH Year, $. F, M, 4 M, l, $, 4 S, O, N, U 9).MIXI'URE: List COMPONENT CAS// % WT AHM the three most hazardous 1) [ chemical components or 2) [ any AHM components I)INVENTORYSTATUS:New[ ]Addition[ ]RevisionS[ ] CheckifchemicalisaNONTrndeSec~[ ]Trad~Secaxst[ ] 4) ?h~ical & Health PHYSICAL HEALTH HazardCate~orie~ Fire[~q/Re~ve[ lSudd~l~of~[ 6) ?HYSlCAI, STATE Solid [ I Liquid [~l C-~ [, ] Pure [ I Mixture [ ~] Waste [ ] R~o~dve [ ] 7) AMOUNT AND TIME AT FACILITY . UNITS OF MEASURE 8) STORAGE CODES anount -qS'0 Average Daily Amount Curies [ ] b) Pressu~: # Days on Site ..B'6~_,~ Circle Which Months: All Yenr, J, F, M, A, fYI, $, J, A, S, O, N, U the three most hezardou~ 1) ~L~ , [ ] any AI./M components 3) U [ ] I certify under pea~lty of law, that I have perso~flly examined and ~n f~nili~r with tim information on ~ and all auached docume~t~. I believe the sulamtted mformat/~ i~ true,, ~-urat~ and complete. HAZARDOUS MATERIALS INVENTOR! Bus~ess Name THE WAX SHOP ~; Address 5441 ALDRIN (~'[",' · ', · '~ CHEMICAL DESCRIFrlON 4) Physical & Health PHYSICAL HEALTH HaZard Categories Fire[ ]Reactive[ ]SoddenRele~seofPressure[ ] Irnmediat~Health(Acut~)[ ]I)elayedHeal~(Chn:~ic) 5) WASTE CLASSIFICATION ..... (3-digit cod~ fi-om DHS Form 8022) USE CODE / 6) PHYsicAL STAT~ Sond ~] Liqui,l[ ] C-~ [ ] Pu~ [~ Mixtu~ [ ] W~-t~ [ ] R,,,iio~ti,~ [ ] 7) AMOUXr A~D ~ ^T F^cn.n~ ~.a,,) u'~n's oF MEASUP,~ S) STO~.~,aS CODF, S Maximum Daily Amoont '~',"-' Lb~[/yJC-~I[ Irt3[ ] a)C~nU~in~ / Annual Amount c]CYO ¢) T~porature ,/~ n~ge~ s~ conumer # Days on Site ~(~" Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D ~) MIXTURE: List COMPO~ CAS# % WT AHM the ~aee most hazardous 1) [ ] chemical components or 2) any AHM components 3) [ ] 10)LOCATION ~) ~--~ .~ 1) INVENTORY STATUS: New [ ]Addition[ ]Revision[g,~e~on[ ] Check if ehemical is a NON Trad~ Secret [ ]TradeSec~t[ ] 2) Common Name: '~ ~~rx~_ ~'~ ) 7~'~ 3) DOT # ioptional) 4) Physical & Health / PHYSICAL HEALTH Ha~rd Categories Fire [ ~J'Reactiv¢ [ ] Sudden Rele.~s~ ofPressur~ [ ] Immediate Health (~cute) [ ] l)~layed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit cod~ from OHS Form ~022) usuicoD~.. 6)PHYS[CALSTAT£ So~i~t[ ] Liquidly] C-~[ ] P,~[~ Mixtu~[ I] W~,~[ ] ~io~tive[ ] ,) ~o~ ~D ~ ^~ ~^c=~=~ ~. ^ ~-r~s o~ M~S~ ,) S~O~. COD~.S M~m.mD~,ly~o,~t . -~-O~O ~-"[ ]~I~=[ '] ~)C~= 7 Average Daily Amount Cur~ ] b) ~: / Annual Amount ' 9 ~'~'-~- c) T~p,~rat'um # Days on Site ._~ (o.b'- Circle Which Months: All Year, J, F, iM, A, M, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % w'r AHM the thr~ most h~.~-dous 1) [ cho~ical components or 2) ' [ ] any AI-IM components 3) [ ] ! certify undo' penalt~ of law, that I l~w p~n~mally ~r~nin~d and ~m £~nilim' ruth the information on .~is and all att~hed documents. I PI?J]~ Name & Title ofAuthofized Conyany Representative ~/ . SilFulmre ' / D~'te BAZARDOUS MATERIALS INVENTORY Page~ of 3S Bus~'ness Name THE WAX SHOP Address 5441 ALDRIN CT. 1) INVENTORY STATUS: N~w [ ] Addition [ l Re~i~ion ~l~¢tion [ ] Ch~k if chemical i~ a NON Tr~i~ ~ [ ] Tr~l~ ~ [ ] Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEAL~ HazardCategofies Fire[~]Reactive[ ]Sudd_,mReleaseofPressum[ ] Immediate Health (Acute) [ ] Delayed Health (Chron/c) [¥-] $) WASTE CLASSIFICATION (3-disit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid[ ] Liquidity] Gas[ ] Pure[ ] Mixture[/~ Waste[ ] Radioactive[ ] 7) AMOUNT AND ~ AT FACILITy. UNTTS OF MEASURE 8) STORAGE CODES Max/mum Daily Amount ]{~O Lbs[ ]C-al[)~]fl3[ ] a)Containec. Average Daffy Amount Curies [ ] b) Pressure: / Annual Amount ~ c) Temperature Larsest Size Container # Days on Site ~ (~ 2' Circle Which Months: All Year, $, F, M, A, M, $, I, A, S, O, N, D the t~-ee most b---~tous 1) .~ 7- /3 [ ] chemical components or 2) /u~/c~t~U,.~._ ~ 0,~ ..7/- ?~- 3 / [ ] any AHM components 3) / ~J ~ {/ [ ] 1)Im~{~ST^~S:N~w[ ]^daition[ ]R~vi~ioni~~l~[ ] Ch~:kit'~emi~i~alqOlq'Trad~S~a~t[ ]Tr~~[ Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Ha?~rdCatcgofies Fire[ ]Reactive[ ]SuddenReleaseofPresswe[ ] Immediate Health (Acute) [ ]DelayedHealth(Chwnic)[1..~ 5) WASTE CIASS]FICATION (3-disit code ~ DHS Form $022) USE CODE .~"~ 6) Pm~'s[c,,a. STATE So[ia [ ] Liquid [~ ] C-as [ ] Pure [ ] ~ [~ ] Wa~e [ ] ~,adioactive [ ] 7) AMOUNT AND T[lV[E AT FACILIT~ UNITS OF MF_.ASLrRE $) STORAGE CODES Maximum Daffy Amount ~,._.~O Lbs [ ] C.~ [~ ] fl3 [ ] a) Contame~. Averase Daily Amount Curies [ ] b) Pressure: Annual Amount ~ ~--O ~ c) Temperature Largest Size Container ~"/~ # Days on Site '~ (~ g Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D the three most b,,-,,,do~s 1) ..~, (~.~ CO , any AHM components 3) i ~3 ~' 4t' 6l-¥ ~'7 [ ] io> oc^TIo O l,47-S l [ certify under penalt~ of law, that I have personally examined and am familiar with the informat/un on lkis ~nd all attached documents. I believe fire subm/lted/nfomml/on is true, accurate ~nd complete. Pl~irr Name &-'/~tle of Authorized Company Representative , ~ - Si/~ature · HAZARDOUS MATERIALS INVENTORY Business Name THE WAX SHOP ~ '~ Addrms 5441 ALDRIN CI{]~lViI~,~CRIFrlON I ) INVENTORY STATUS: New 0~] Addition[ ]Rcvision~)elctiou[ ] CheckifchemicalisaNONTrad~Secret[ ]TradzSec~[ ] ~co~o~: ~--~ ,~c~ ~o~-~/ (opUoual) Ch~ ~: 4 ) Physical & Health PHYSICAL HE ~LTH Hazard Camo~es F~ [ ] Re~dv~ [ I Sudd~ P.d~ ofPr~au~ [ ] ~uu~U~e H~dth (Acute) [ ] r~ayed H-*,th (Chr~i¢) [~/~ ~) wasr~ C~SSU~CAT~O~t O-cU~t cod~ a~ Dm Form 80=) US~- COD£ [ ] LiquidD(] Oas[ { Pure[ I ~[~q Waste[ ] Radioactive[ ] 6) PHYSICAL STATE Solid ?) ~d~omrr A~U rU~ ^~ racuzrv umus oF ~.ASU~ 8) S~O~.AO~. COU~S ~mummayAmouut ~ Lb~[ ]c~Pcled[ ] a)comh~. AveraSe Daily Amount Curi~ [ ] b) Annual Amount ~t) 0-O Large~ Siz~ Contain~ .gV~' # Days on Site ~J (o _% Circle Which Mouths: All Yea~, J, F! M, A, M, J, $, A, S, O, N, D any AHM componmts 3) ~ ~,~,~ ~3-/ /~.~ [ ] 10)LOCATION ~ ~f'~ l ~ chm~ ~: Am 4) Physical & H~dth PHYSICAL HEALTH ~Cat~ohes F~[ ]R~miv~[ ]Sudd~l~l~as~of~[ ] lnun~lia~Heaith(A~)[ WASTE CLASSIFICATION (3-disit cod~ f~,au DI~ Form 8022) USE ~ODE 5) 6) PHYSICAL STATE Solid [ ] Liquid [7 ] Gas [ ] Pu~ [ ] Mixtu~ [71 Wast~ [ I Radioa~dw [ l 7) ~omer A~rU m~ AT rACUZnf tnvrrs or ~.~.ASU~ 8) s~oaao£ CODm Maximum Daily Amouat /~ Lbs[ ]Gal[X"]ft3[ ] a)Couta~. Average Daily Amount Curies [ ] b) P~: Annual Amount ,5-0-0 c) # Days ou Site ~ ~, b'~ Circle Which Mouths: All Ye~, J, F, {1VI, A, IVl, $, J, A, S, O, N, D th~ three most hazardous 1) I certify under penalty of law, fi~t I have pemmally examined and am familiar with tl~ information on ~ and all aUar. h~ d~'um~ta I believe the submitted informatiun is true., ~t~ ~md complete. (/~_ PRIN:r N~uu~ & Titl~ of Authorized Company Repr~ntativ~ ~/~"~ $is~athm - HAZARDOUS MATERIALS INVENTORY THE WA~Y. SHOP 5441 ALDRIN CT. Page ~_~..~. Business Name " Address ':' I)[NVENTORYSTATU$:New[ lAdd/t/on[ ]Rcvis/on~l¢~ion[ ] Chcckifchemical/saNONTradeSeoret[ ]Trade~[ [ ] CAS # 4) Physic.~l & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] Sudd~ Release ofPr~sore [ ] rmm,~!At,~ Health (Acute) [ ] Delayed Health (Clmmi¢) 5) WASTE CLASSIFICATION (3-disit ~ fi~u DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [~] C-~ [ ] Pu~ [ ] Mixture [/~J Waste [ ] Radioactive 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Ms mumD yAmunt ] a)Comi . AverSe Daily Amouat Curies [ ] b) ~ Aunual Amount ~' ~n::~ ¢) Tm~-atur~ Largot Size Container ~ g- # Days on Site ~ Circle Which Months: All Yeer, $, F, M, A, M, $, $, A, S, O, N, D the three most hazardons I) ~'~r)v/JOdLo~ /d.,~ dbmS. i~. ~ chemical components or 2) / any AI-IM compoamts 10)LOCATION ~.~ !{j~ ~ O[NVI!2CrORYSTATUS:N/~w[ ]Addition[ ]Rm, ision[ ]De~on[ ] Checkirchen~calisaNONTrad~Secret[ ]Trad~[ 2) Common Nme: ', _ [ '"' :"/' 3) DOT # (optional) Chemical Name: AHlVl [ ] CAS # 4) Physical & Health PHYSICAL HEALTH I-IazardCategories Fire[ ]Reactive[ ]S,_,,~_a__-,nReles~ofI're~mu~[ ] ~,,,,,,~li~teI-Iealth(Acu~e)[ ]Del~yeclHealth(Chronic)[ 5) WASTE CLASSIFICATION (3-digit code r, um DI-IS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] C-~ [ ] Pu~ [ ] Mixtu~ [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FACILITY UNT~ OF MEASURE 8) STORAGE CODES Maximum Daily Amount Lb~ [ ] Gal [ ] fl3 [ ] a) Container:. Averase Daily Amount Curies [ ] b) Pressu~: Annual Amount c) Temperature l.~sest Size Coutaiu~r # Day~ on Sim Circle Which Months: All Yea', ./, F, lVl, A, M, .~, ./, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT the three most tumudous 1) chemical components or 2) any AHM components :~) 10)LOCATION I certify under penalty of law, that I have personally examined ami am f~miliar with the information on ~ and all auached believe the submit, ed iafommtiun is m~ ac, curate and complete. PRII~T Name & Title of A~ihoriz~t Company R~l~."ntative ~j' $i~natur~ HAZARDOUS MATERIALS INVENTOR~ · ... Page Busi'~ess Name THE WAX SHOP Address 5441 ALDRIN CT. CHEMICAL DESCRIPTION I ) INVENTORY STATUS: New [ ] Addition [ ] Revision [ Check if chemical is ~ NON Trade Secret [ ] Trade Secret [ ] Chemical Name: kd ~"/ - AHM [ ] CAS # /~/1~- 4) Physical & Health PHYSICAL HEAL'I~ H~rd Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (~cute) [ ] Delayed Health (Chronic) [/~-] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [~] Gas [ ] Pure [ ] Mixture [~] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY / UNTrS OF MEASURE 8) S~'O. RAOE CODES Maximam Daily Amount ~ ./a Lb~ [ ] ;-al~ [ ] C-al ] ft3 a) C0utain~ Average Daily Amount Cur~es [ ] b) 1~: / Annual Amount ..~ ~--0'O c) T~mp~'atur~ .... Largest Size Container 3 # Days on Site -~ ~ 2~' Circle Which Months: All Year, $, F,I M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT . C, AS# _ ~ % WI' AI-IM the three most hazardous l) .~. ~.~' ~ .~-[Oz~/-I chemical components or 2) ~(2~d//-~~ 0,.. ,~-~'{o 0~-)qZ- c~ 0' ~- [ ] any AHM components 3) · [ ] [ ]Addition~,Rcvision [ ] Check ifchemicai is alNON Trade Secret[ ]TradeSecr~t[ ] chum [ I cAS # 4) Physical & Health PHYSICAL I-IF.~TH I4~ntCate~ori~ F~[ ]Restive[ ]Suda__~R¢l~of~[ ] Imm~li~teHealth(X~ute)[/~/]DelaycdHealth(¢lnmi¢)[__ ] 5) WASTE CLASSlFIC^TION (3-disit ~ fi'om DI-I8 Folm 8022) uSEICoDE ~ 6) PHYSICAL STATE Solidi ] Liquidly] C~[ ] Pur~[ ] Mixtm~[~l] W~[ ] Radio~tive[ ] 7) AMOUNT AND TIME AT FACILITbYb__~/ UN1TS OF MEASURE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] C~ [Z"] ft3 [ ] a) CSntain~. Average Daily Amount Curies [ ] b) Pressure: Annual Amount / / ~ c) Tc ~perature Largest Size Container # Days on Site ~ [~ ~' Circle Which Months: All Year, J, F, '.VI, A, M, $, J, A, S, O, N, D thc three most hazardous 1) ~ ~ /~/~)- [ ] chemical components or 2) ~ '~- ~.X. a~_~ ~ ~ b/ - ~2- O '--/ [ ] any AHM components 3} ~' ' '~v '3"~'~T ~ q'q 7~' f~l-/~ ~ [ ] I certify under penalty of law, that I have personally exmnined and am familiar with the information on ibis and all attached documents. I believe the submitted infonmtion is true, accurate and complete. PRINT Name &,'Title'ofAuthorized Company Representative. ~' Signature r Da~