Chemical Classification Form - Completed Sample

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					                                                                   Chemical Classification Form – Completed Sample
                                                                                  MATERIAL                                                    TOTAL
                                                                       1                                                                2             2
            COMMON NAME                 CHEMICAL                CAS#            FORM; solid,       QUANTITY            QUANTITY IN USE      QUANTITY        LOCATION(S)         FIRE CODE HAZARD CLASSES;
                                                                                                          1
                                       NAME and %                               liquid, or gas     STORED               (Open vs. Closed)   (Storage &     (Storage & Use)         Physical & Health Hazards
                                       composition                                                                                             Use)
            Acetic Acid             Acetic Acid,            64-19-7            Liquid             15 gal              5 gal, Open System    20 gal        Stor: Flam Cab     Class II Combustible/Corrosive
                                    Glacial – 100%                                                                                                        Use: Wet
                                                                                                                                                          Process
            Acetone                 2-propanone             67-64-1            Liquid             55 gal              10 gal, Open System   65 gal        Stor: Exter Stor   Class I-B Flammable
                                                                                                                                                          Use: H-2 Room

            Acetylene,              Acetylene –             74-86-2            Gas                200 cf              200 cf, Closed        400 cf        Stor: Weld         Flammable Gas/Class 1 Unstable
            Compressed              100%                                                                              System                              Shop, Use:Weld     Reactive
                                                                                                                                                          Shop
            Benzene                 Benzene                 74-13-2            Liquid             5 gal               1 gal, Open System    6 gal         Stor: Flam Cab     Class I-B Flammable
                                                                                                                                                          Use: Lab

            Formaldehyde            Formaldehyde            50-00-0            Liquid             110 gal             55 gal, Open System   165 gal       Stor: Exter Stor   Class II Combustible/Toxic
            with Methanol           37%, Methanol           67-56-1                                                                                       Use: H2 Room
                                    15%, Water
                                    52%
            Hydrochloric            Hydrochloric            7647-01-0          Liquid             300 gal             55 gal, Closed        355 gal       Stor: Corr Stor    Corrosive
            Acid                    Acid – 100%                                                                       System                              Use: Wet
                                                                                                                                                          Process
            Isopropanol             Isopropyl               67-63-0            Liquid             15 gal              3 gal, Open System    18 gal        Stor: Flam Cab     Class I-B Flammable
                                    Alcohol –                                                                                                             Use: Lab
                                    100%
            Nitric Acid             Nitric Acid             7697-37-2          Liquid             55 gal              10 gal, Open System   65 gal        Stor: Corr Stor,   Class 1 Oxidizer/Corrosive
                                    10%                                                                                                                   Use: Wet
                                    Water 90%                                                                                                             Process
            Sodium                  Sodium                  10588-01-9         Solid              50 lb               10 lb, Open System    60 lb         Stor: H-7 Room     Corrosive / Highly Toxic /Class 1
            Dichromate              dichromate,                                                                                                           Use: H-7 Room      Oxidizer
                                    anhydrous




1
    % of concentration per CAS #, from MSDS sheets
1
    Quantities of products shall be represented in pounds for solids, gallons for liquids, and cubic feet for gases



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Chemical Classification Form – Completed Examples