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Renton Hazardous Materials Inventory Statement Application

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Renton Hazardous Materials Inventory Statement Application Powered By Docstoc
					              1055 S. Grady Way
              Renton, WA 98057           Fire & Emergency Services Department                                                                                       Date

              425-430-7000 (Phone)
              425-430-7044 (Fax)     Hazardous Materials Inventory Statement (HMIS)                                                                    Page                of

Business
Name:

Contact
Person:                                                                                              Telephone:

Operation                                                                                            City, State,
Address:                                                                                             Zip:

Mailing                                                                                              City, State,
Address:                                                                                             Zip:
              1                  2                3                  4           5         6         7          8        9        10   11     12      13                   14
                                                                Chemical                                                                                          IFC 2703.5/




                                                                                                                     Container
                                              Chemical                                            Maximum                        Site Site




                                                                              Physical




                                                                                                                                                      Outdoor
                                                                                                                                             Indoor
            Hazard        Common Trade                          Abstract                                                                                        NFPA 704 Rating




                                                                                         Purity
                                                                               State




                                                                                                                       Type
No.                                         Components                                            Quantity    Unit               Map Map
             Class           Name                                Service
                                           & Concentration                                        on Hand                        Page Grid                      H    F     R    XXX
                                                               Registry No.




                                                       If needed, please print additional copies.

Form: CRR-HMIS                                                        Print Form                                                                                     Revised 01/25/2009
     1055 S. Grady Way                                                                                   425-430-7000 (Phone)
     Renton, WA 98057                    Fire & Emergency Services Department                              425-430-7044 (Fax)

                                                    Abbreviations for HMIS

                 Column 1 - Hazard Class                Column 5 - Physical State       Column 8 - Container Type

     BLA             Blasting Agenda                S     =       Solid             A    =     Aboveground Tank
     COM IIIA        Class III-A Combustible        L     =       Liquid            B    =     Belowground Tank
     COM IIIB        Class III-B Combustible        G     =       Gas               C    =     Tank Inside Building
     COR             Corrosive                                                      D    =     Steel Drum
     CRY             Cryogenic                                                      E    =     Plastic or Non-Metal Drum
     EXP             Explosive                                Column 6 - Purity     F    =     Metal Can
     FLAG            Flammable Compressed Gas                                       G    =     Carboy
     FLA IA          Class I-A Flammable            P     =       Pure              H    =     Silo
     FLA IB          Class I-B Flammable            M     =       Mixture           I    =     Fiberdrum
     FLA IC          Class I-C Flammable            W     =       Waste             J    =     Bag
     COM II          Class II Combustible                                           K    =     Box
     FLS             Flammable Solid                                                L    =     Compressed Gas Cylinder
     HTX             Highly Toxic                             Column 7 - Units      M    =     Glass Bottle
     INT             Inert Compressed Gas                                           N    =     Plastic Container
     LPG             Liquified Petroleum Gas        G     =       Gallons           O    =     Tote Bin
     OXYG            Oxidizing Compressed Gas       L     =       Liters            P    =     Tank Wagon
     OXY 4           Class 4 Oxidizer               F     =       Fluid Ounces      Q    =     Rail Car
     OXY 3           Class 3 Oxidizer               Q     =       Quarts            R    =     Other
     OXY 2           Class 2 Oxidizer               P     =       Pounds
     OXY 1           Class 1 Oxidizer               K     =       Kilograms
     NFL             Non-Flammable Compressed Gas   M     =       Grams
     ORG IV          Class IV Organic Peroxide      N     =       Pints
     ORG III         Class III Organic Peroxide     T     =       Milliliters
     ORG II          Class II Organic Peroxide      I     =       Milligrams
     ORG I           Class I Organic Peroxide       O     =       Troy Ounces
     OHH             Other Health Hazard            C     =       Cubic Feet
     PYR             Pyrophoric                     R     =       Curie
     RAD             Radioactive                    U     =       Microcurie
     TOX             Toxic
     URE 4           Class 4 Unstable (Reactive)
     URE 3           Class 3 Unstable (Reactive)
     URE 2           Class 2 Unstable (Reactive)
     URE 1           Class 1 Unstable (Reactive)
     WRE 3           Class 3 Water Reactive
     WRE 2           Class 2 Water Reactive
     WRE 1           Class 1 Water Reactive

Form: CRR-HMIS                                                                                                 Revised 01/25/2009

				
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