Document 86N7EXymMoVDxgOg1p7V1Ovd

ABD00022674 Georgia Guff ( orporon rn cuu! i(f,Uai^ ABFRDFF N PLANT CHEMICAL APPROVAL/HAZARD ASSFSSMFN F TORM REQUFST FOR USE __________________________________________ ___________ __________ ________________________ Product Name Manulacturer Status fNL What will the material be used tor7 at Cl d 6uf-f New $4- Revision What department(s) w ill use this material7 Drvduct.iJ Cflp-po UJjL_____________________________ Inventory Requirements o Less than 500 lbs 500-10,000 lbs Category (check appropriate category) Adhesives &. Sealants IT 1 uels - Gases or Liquids Catalysts & Initiators Heat Transfer f luids Compound - ( olorants (1 Industrial Gases - Pipeline or C> hnder ^-Compound - I illcrs <C Lubricants f! 1 aboratory Reagents or Chemicals Compound - Other Ingredients 111 andscaping/Pest Control Compound - Plasticizers IT 1 ubricants Compound Stabilizers /\ fl Miscellaneous - Not Otherwise Listed Requested by \JjLkX sjci/yuj (^Greater than 10,000 lbs U Paintings A Coatings Process Chemicals <_ Additives fl Raw Materials D Refrigerants U Solvents <_ Cleaners [J Water Treatment Chemicals LJ Filter Media/Aids or Absorbents Date tOlS/b/ Note PLEASE ATTACH Tfljfc MSDS T O THIS FORM AND FORWARD BOTH TO THE IH/SAFETY COORDINATOR SAFETY REVIEW (29 CFR 1910 1200) .. " ` .. , Ph>sical Hazards (check all appropriate) LI Combustible liquid Compressed gas flammable gas O Flammable liquid G Organic peroxide Oxidizer 11 Unstable Water-reactive n Explosive G flammable solid Pyrophoric i 1 Corrosive l) Health Hazards (check all appropnate) U Carcinogen Irritant Biomodes of Tntr> (check all appropriate) Cl Eye Skin Is training required tor this material7 (Check one) Comments IT Sensitizer Inhalation Yes No Ioxic O Ingestion Approved for use Date Not approved for use ENVIRONMENTAL REVIEW s - >, Would this chemical impact plant emissions7 (Check one) Would this chemical produce hazardous waste7 (Check one) If hazardous, it is due to (check all appropriate) G Ignitability 0 Corrosivity G Reactivity O Toxicity Reportable under SARA 3 13 under any quantity7 (Check one) G Yes Reportable under SARA 311/3 I27 (Check one) Yes Is the chemical listed under CTRCLA7 (Check one) 11 Yes No 11 Listed as a Hazardous Substance (40 CFR 302 4) () Listed as an Extremely Hazaidous Substance (40 CfR 355 20) [! 1 isted in 1 SCA Inventory' Is the chemical regulated under DOT (49C1 R 172) 7 11 Yes 11 No Comments Date LI Yes IT Yes No No U A listed waste No No RQ lbs Approved for use Not approved for use Entered into DMS bv Date Date Date Revision Date 5-7-01