Undated Critical & Haz Mat List: Diesel Fuel/Oil #2 rICAL AND HAZARDOUS MATIOALS LIST
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'lease fill out the following list as per instructions on the reverse, return to the Department of Buildings, and retain
copy at your place ofl1business. Feeel free to make
copies, attach additional pages, and/or add explanatory notes, if
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'RODUCT 1 (
Product and/or Chemical Name: � e.S e( fu 2\ O t I •
Maximum Quantity (Gals, Lbs, Cu,Ft): i!.✓ _ I "
Material Classification(UBC Table 9-A, 9-B):
MSDS Shoot etc.: c. - -1- ( a ;+
Area Stored and/or Used: u ' -e.. Jou ' S' - v c..-
rn�K� �7� ec � '- v nrn�
Proposed Method of Storage: a, •p v 2 �vD 0,-14 ��O v.Q�e c./ � � CoCo.1. Ck. eKr
?RODUCT2 Gt•tilkvi0Inl'utnTiosoIf4+C
Product and/or Chemical Natno: (''�p cX C�, R P - �� � �y'a �S oc�1+V."t^ "tc.-
Maximum Quantity (Gals, Lbs, Cu.Ft):
Material Classification (UBC Table 9-A, 9-B):
MSDS Sheet etc.: o ; (e- llos,•'.•l
Area Stored and/or Used: Si„.‘, Iv, (6 v o. kiA e ,
Pro.osed Method of Storage: c fid wit CA i u .
?RODUCT 3
Product and/dr Chemical Name: Roao.411‹ k\4 O ��,. ....)041.1U14". w� $ ,S U ,'- Seri' i'1 Su lc;fe
Maximum Quantity (Gals, Lbs, Cu.Ft): ,5 �‘ki S
Material Classification (UBC Table 9-A,.9-B);
MSDS Sheet etc.: p • FsL.
Area Stored and/or Used: .� R q.� _ i 4t p p t e .•
Proposed Method of Storage: bv�jSo c V i • i h u -
PRODUCT 4
Product and/or Chemical Name:
Maximum Quantity (Gals, Lbs, Cu.Ft):
Material Classification (UBC Table 9-A, 9-B):
MSDS Sheet etc.:
Area Stored and/or Used:
Proposed Method of Storage: _
PRODUCT S
Product and/or Chemical Name: I ' _
Maximum Quantity (Gals, Lbs, diti.Ft�:
Material Classification (UBC Table 9-A, 9-B):
MSDS Sheet etc.:
Area Stored and/or Used:
Pro..sed Method of Stora:o: .-..
The above is a true and correct accounting of the chemicals intended to be used and/or stored at the referenced facilities,
ligned by: Date:
Owner or Authorized Representative
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