Chemical Inventory Form Page 2
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1
2
3Joel Klein
Chancell
PRINT OR TYPE ALL INFORMATION
Page ___1__ of ___1___
School/Division
Name
P.S 118 /Region 5
Jane Smith
Address
Title
123-45 Court Street, Brooklyn 11245
Teacher
Department
Room
Work Phone
Date
Industrial Arts
126
(718) 123-4567
11/30/00
1 Product Trade
2 Manufacturer’s Name &
3 Exact Storage
4 Warnings on Label
5 Other Identifying
6
7
8
9
10
11
12
Name
Address
Location
Information
Beacon Ammonia
Q-Pac Corporation
Second shelf in large
Irritation to eyes, skin and
CAS # 1336-21-6
P
2
N
1 G
2
S
√
2145 Ave. C, Newark NJ
metal cabinet
mucous membranes
L
07104
Cosco Powder
Cosco Enterprises
Under sink
Irritation of open cuts
White powder in box
S
1
K
16 oz
5
N
N/A
No Address
CAS # N/A
M
Tel. (718) 383-4488
N/A
N/A
Top shelf in large
N/A
Clear liquid in glass
L
1
M
8 fl
2
N
N/A
metal cabinet
bottle
CAS # N/A
Fleet Latex Paint
Long Island Paint
On floor in storage
Harmful if swallowed
Titanium Dioxide
L
3
F
1 G
5
S
N/A
1 Continental Hill
closet
CAS #
M
Glencove, NY 11542
N/A
Ricon Company Ltd.
Cabinet under copy
High vapor concentration –
Carbon black, Acrylic
L
4
N
16 oz
8
O
√
136 Nakamagome, Ota-ku
machine
irritating to eyes and
resin, Naphtha
M
Toyko, Japan
respiratory tract
CAS # N/A
Acetylene
Airweld Industries
Chained to south wall
Flammable vapors may
G
1
L
C
10
O
N/A
No Address
cause dizziness
CAS # 74-86-2
P
Physical State – Item 6
Container Type – Item 8
Units of Measure – Item 9
Frequency of Use – Item 11
S – Solid or Powder
A – Above ground tank
F – Can
M – Glass bottles or Jugs
C – Cubic feet for gas
S – Sometimes
L – Liquid
B – Below ground tank
I – Fiber drum
N – Plastic bottles or Jugs
lb – Pounds for solids
O – Often
G – Gas
C – Tank inside building
J – Bag
O – Tote Bin
oz – Ounces for solids
N - Never
P – Pure
D – Steel drum
K – Box
R - Other
G – Gallons for liquid
M - Mixture
E – Plastic or non-metallic
L – Cylinder
fl – Fluid ounces for liquid
drum
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