Solid: mg, g, kg; oz, lb. Numeric; From client inventory
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1 Client Name INVENTORY INPUT SAMPLE JENSEN HUGHES CHI Team Building Name Sample Internal ID / Record # Chemical Name Mixture? (Multiple CAS) Components of Mixture Percent of Mixture Concentration (Single CAS) Physical State CAS # Manufacturer Container Size Size Units Container Material Container Relief Container State Container Quantity Inventory Owner Data Source Expiration Date MSDS Available Location Solid: mg, g, kg; oz, lb Numeric; From client inventory Liquid/aerosol: ml, L; fl oz, pint, quart, gallon Glass, Plastic, Metal, References program, if applicable Text Y/N Y/N Optional; Comma-delimited 0-100% Solid, liquid, gas, aerosol (2-6 digits)-##-#; w or w/o dashes Text Numeric Gas: L@NTP; SCF Fiber, Composite, Other Y/N Full, Empty, Waste Numeric Username Text Date: DD-MM-YYYY Y/N Location 1-BUTANOL N Liquid gallon BUTANOL N Liquid gallon BUTANOL N Liquid gallon PROPANOL N Liquid gallon PROPANOL N Liquid gallon PROPANOL N Liquid gallon 23 3 Acetic acid N Liquid fl oz 5 1 Acetone N Liquid fl oz 9 1 Benzoyl Peroxide N Solid 500 mg 12 1 Butane (gaseous) N Gas SCF 40 1 CALCIUM HYPOCHLORITE N Solid g 16 1 Chloroform N Liquid fl oz 3 2 Chloroform N Liquid gallon 2 3 Copper(II) Sulfate N Solid kg 3 2 Ethyl Acetate N Liquid gallon 1 2 Ethyl Acetate N Liquid gallon 8 1 Formic acid N Liquid gallon 10 1 Hexanes N Liquid gallon 4 1 Hydrochloric Acid 35-37% N 37 Liquid fl oz 2 1 Hydrochloric Acid 35-37% N 37 Liquid pint 3 2 Hydrogen N Gas SCF 3 2 HYDROGEN PEROXIDE 30% N 30 Liquid quart 5 3 MAGNESIUM SULFATE, 7-HYDRATE N Solid oz 5 2 Methyl Ethyl Ketone N Liquid gallon 1 1 Nitric Acid % N 90 Liquid gallon 10 1 ORTHOPHOSPHORIC ACID N Liquid gallon 2 2 Polyethylene Glycol N Liquid gallon 3 1 POTASSIUM BROMIDE N Solid lb 2 3 POTASSIUM FERRICYANIDE N Solid lb 6 1 Sodium Nitrate N Solid lb 7 3 SODIUM PHOSPHATE, MONOBASIC, MONOHYDRATE N Solid kg 3 2 SODIUM THIOSULFATE 0.025N N 0.62 Liquid gallon 1 1 SODIUM THIOSULFATE, 5-HYDRATE N Solid oz 10 1 SULFURIC ACID 98% N 98 Liquid gallon 3 2 Toluene N Liquid gallon 5 3 WD-40 Y Liquid 5 gallon 3 1 Zinc Standard Solution N Liquid 1 gallon 2 1
2 INVENTORY INPUT SAMPLE Client Name JENSEN HUGHES CHI Team Building Name Sample Sample Sample
3 INVENTORY INPUT SAMPLE Client Name Building Name JENSEN HUGHES CHI Team Sample Sample Y Y 1
4 CONTROL AREA 1 REPORT Physical Hazards Health Hazards Client Name Building Name Floor # Report Generated Reviewed By JENSEN HUGHES CHI Team Sample 1 10/30/2018 3:42 PM Jeremy Lebowitz Solid Liquid Gas Material Class Inventory Amount Regulatory Limit Inventory Amount Regulatory Limit Inventory Amount Regulatory Limit Combustible Liquid II 3.91 gal gal. IIIA 0.00 gal. 1, gal. IIIB gal. NL gal. Combustible Fiber Loose 0.00 cu. ft cu. ft. Baled 0.00 cu. ft. 4, cu. ft. Cryogenics Flammable 0.00 gal gal. Oxidizing 0.00 gal gal. Inert 0.00 gal. NL Explosives lb lb lb lb lb lb lb lb lb lb lb lb lb lb lb lb. 1.4G 0.00 lb lb. lb lb lb lb lb lb lb. lb. Flammable Gas Gaseous 4, cu. ft. 4, cu. ft. Liquified 0.00 lb lb. Flammable Liquid IA 0.00 gal gal. IB & IC gal gal. Combination IA, IB, IC gal gal. Flammable Solid 0.00 lb lb. Organic Peroxide U 0.00 lb lb lb lb. I 0.00 lb lb lb lb. II 0.01 lb lb lb lb. III 0.00 lb lb lb lb. IV 0.00 lb. NL 0.00 lb. NL V 0.00 lb. NL 0.00 lb. NL Oxidizer lb lb lb lb lb lb. 100 lb lb lb. 1, lb lb. 1, lb lb. NL lb lb. NL lb. Oxidizer - Gas Gaseous 0.00 cu. ft. 6, cu. ft. Liquified 0.00 lb lb. Pyrophoric 0.00 lb lb lb lb cu. ft cu. ft. Unstable Reactive lb lb lb lb cu. ft cu. ft lb lb lb lb cu. ft cu. ft lb lb lb lb cu. ft. 3, cu. ft lb. NL 0.00 lb. NL 0.00 cu. ft. NL Water Reactive lb lb lb lb lb lb lb lb lb. NL 0.00 lb. NL Corrosive 0.00 lb. 20, lb gal. 2, gal cu. ft. 3, cu. ft. Corrosive - Liq. Gas 0.00 lb lb. Highly Toxic 0.00 lb lb. 100 lb lb cu. ft cu. ft. Highly Toxic - Liq. Gas 0.00 lb lb. Toxic 0.00 lb. 2, lb lb. 2, lb cu. ft. 3, cu. ft. Toxic - Liq. Gas 0.00 lb lb. Permitted only in buildings equipped throughout with an automatic sprinkler system The permitted quantities are not limited in a building equipped throughout with an automatic sprinkler system Permitted only when stored in approved exhausted gas cabinets, exhausted enclosures or fume hoods
5 CONTROL AREA 2 REPORT Physical Hazards Health Hazards Client Name Building Name Floor # Report Generated Reviewed By JENSEN HUGHES CHI Team Sample 2 10/30/2018 3:42 PM Jeremy Lebowitz Solid Liquid Gas Material Class Inventory Amount Regulatory Limit Inventory Amount Regulatory Limit Inventory Amount Regulatory Limit Combustible Liquid II 0.00 gal gal. IIIA 0.00 gal gal. IIIB 0.00 gal. NL gal. Combustible Fiber Loose 0.00 cu. ft cu. ft. Baled 0.00 cu. ft. 3, cu. ft. Cryogenics Flammable 0.00 gal gal. Oxidizing 0.00 gal gal. Inert 0.00 gal. NL Explosives lb lb lb lb lb lb lb lb lb lb lb lb lb lb lb lb. 1.4G 0.00 lb lb. lb lb lb lb lb lb lb. lb. Flammable Gas Gaseous 3, cu. ft. 3, cu. ft. Liquified 0.00 lb lb. Flammable Liquid IA 0.00 gal gal. IB & IC gal gal. Combination IA, IB, IC gal gal. Flammable Solid 0.00 lb lb. Organic Peroxide U 0.00 lb lb lb lb. I 0.00 lb lb lb lb. II 0.00 lb lb lb lb. III 0.00 lb lb lb lb. IV 0.00 lb. NL 0.00 lb. NL V 0.00 lb. NL 0.00 lb. NL Oxidizer lb lb lb lb lb lb lb lb lb lb lb lb lb. NL lb lb. NL lb. Oxidizer - Gas Gaseous 0.00 cu. ft. 4, cu. ft. Liquified 0.00 lb lb. Pyrophoric 0.00 lb lb lb lb cu. ft cu. ft. Unstable Reactive lb lb lb lb cu. ft cu. ft lb lb lb lb cu. ft cu. ft lb lb lb lb cu. ft. 2, cu. ft lb. NL 0.00 lb. NL 0.00 cu. ft. NL Water Reactive lb lb lb lb lb lb lb lb lb. NL 0.00 lb. NL Corrosive 0.00 lb. 15, lb gal. 1, gal cu. ft. 2, cu. ft. Corrosive - Liq. Gas 0.00 lb lb. Highly Toxic 0.00 lb lb lb lb cu. ft cu. ft. Highly Toxic - Liq. Gas 0.00 lb lb. Toxic lb. 1, lb lb. 1, lb cu. ft. 2, cu. ft. Toxic - Liq. Gas 0.00 lb lb. Permitted only in buildings equipped throughout with an automatic sprinkler system The permitted quantities are not limited in a building equipped throughout with an automatic sprinkler system Permitted only when stored in approved exhausted gas cabinets, exhausted enclosures or fume hoods
6 CONTROL AREA 3 REPORT Physical Hazards Health Hazards Client Name Building Name Floor # Report Generated Reviewed By JENSEN HUGHES CHI Team Sample 3 10/30/2018 3:42 PM Jeremy Lebowitz Solid Liquid Gas Material Class Inventory Amount Regulatory Limit Inventory Amount Regulatory Limit Inventory Amount Regulatory Limit Combustible Liquid II 0.00 gal gal. IIIA 0.00 gal gal. IIIB 0.00 gal. NL gal. Combustible Fiber Loose 0.00 cu. ft cu. ft. Baled 0.00 cu. ft. 2, cu. ft. Cryogenics Flammable 0.00 gal gal. Oxidizing 0.00 gal gal. Inert 0.00 gal. NL Explosives lb lb lb lb lb lb lb lb lb lb lb lb lb lb lb lb. 1.4G 0.00 lb lb. lb lb lb lb lb lb lb. lb. Flammable Gas Gaseous 0.00 cu. ft. 2, cu. ft. Liquified 0.00 lb lb. Flammable Liquid IA 0.00 gal gal. IB & IC gal gal. Combination IA, IB, IC gal gal. Flammable Solid 0.00 lb lb. Organic Peroxide U 0.00 lb lb lb lb. I 0.00 lb lb lb lb. II 0.00 lb lb lb lb. III 0.00 lb lb lb lb. IV 0.00 lb. NL 0.00 lb. NL V 0.00 lb. NL 0.00 lb. NL Oxidizer lb lb lb lb lb lb lb lb lb lb lb lb lb. NL lb lb. NL lb. Oxidizer - Gas Gaseous 0.00 cu. ft. 3, cu. ft. Liquified 0.00 lb lb. Pyrophoric 0.00 lb lb lb lb cu. ft cu. ft. Unstable Reactive lb lb lb lb cu. ft cu. ft lb lb lb lb cu. ft cu. ft lb lb lb lb cu. ft. 1, cu. ft lb. NL 0.00 lb. NL 0.00 cu. ft. NL Water Reactive lb lb lb lb lb lb lb lb lb. NL 0.00 lb. NL Corrosive 0.00 lb. 10, lb gal. 1, gal cu. ft. 1, cu. ft. Corrosive - Liq. Gas 0.00 lb lb. Highly Toxic 0.00 lb lb lb lb cu. ft cu. ft. Highly Toxic - Liq. Gas 0.00 lb lb. Toxic 0.00 lb. 1, lb lb. 1, lb cu. ft. 1, cu. ft. Toxic - Liq. Gas 0.00 lb lb. Permitted only in buildings equipped throughout with an automatic sprinkler system The permitted quantities are not limited in a building equipped throughout with an automatic sprinkler system Permitted only when stored in approved exhausted gas cabinets, exhausted enclosures or fume hoods
7 HMIS SAMPLE Client Name JENSEN HUGHES CHI Team Building Name Sample Owner Control Area Chemical Name CAS State Container Size Number of Containers Total Quantity Unit Density Normalized Quantity Manufacturer Customer ID Yes/No I II III II IIIA IIIB Dust 1 1-BUTANOL Li id Gallon 20 gal Unknown JENSEN HUGHES CHI Team Yes BUTANOL Liquid Gallon 30 gal Unknown JENSEN HUGHES CHI Team Yes BUTANOL Liquid Gallon 5 gal Unknown JENSEN HUGHES CHI Team Yes PROPANOL Li id Gallon 3 gal Unknown JENSEN HUGHES CHI Team Yes PROPANOL Li id Gallon 10 gal Unknown JENSEN HUGHES CHI Team Yes PROPANOL Liquid Gallon 23 gal Unknown JENSEN HUGHES CHI Team Yes 23 NON-HAZ Aerosol (lbs) COMB. LIQ. (gals) COMB. Solid (lbs) CRYOGENICS (gal) FLAMMABLE LIQ. (gal) EXPLOSIVES SOLID (lbs) EXPLOSIVES LIQUID (lbs) FLAM. SOLID (lbs) FLAM. GAS ORG. PEROX SOLID (lbs) ORG. PEROX LIQUID (lbs) OX. GAS OXIDIZER SOLID (lbs) OXIDIZER LIQUID (lbs) PYROPHORIC UNSTABLE SOLID (lbs) UNSTABLE LIQUID (lbs) UNSTABLE GAS (cu ft) W ATER REACT SOLID (lbs) W ATER REACT LIQUID (lbs) CORROSIVE SOLID (lbs) CORROSIVE LIQUID (gal) CORROSIVE GAS (cu ft) CORROSIVE AEROSOL (lbs) HIGHLY TOXIC SOLID (lbs) HIGHLY TOXIC LIQUID (lbs) Fiber - Loose Fiber - Baled Flammable Oxidizing Inert IA IB IC G Y/N Gaseous (cu ft) LG (lbs) UD I II III IV V UD I II III IV V Gaseous (cu ft) LG (lbs) Solid (lbs) Liquid (lbs) Gas (cu ft) Acetic acid Li id FluidOunce 3.9 gal Unknown JENSEN HUGHES CHI Team Yes Acetone Li id FluidOunce 35 gal Unknown JENSEN HUGHES CHI Team Yes 35 1 Benzoyl Peroxide Solid Milligram lbs Unknown JENSEN HUGHES CHI Team Yes Yes Butane (gaseous) Gas Scf 4000 cu ft Unknown JENSEN HUGHES CHI Team Yes CALCIUM HYPOCHLORITE Solid Gram 3.5 lbs Unknown JENSEN HUGHES CHI Team Yes No Chloroform Liquid FluidOunce 0.38 gal Unknown JENSEN HUGHES CHI Team Yes 3 Chloroform Li id Gallon 20 gal Unknown JENSEN HUGHES CHI Team Yes 2 Copper(II) Sulfate Solid Kilogram 26 lbs Unknown JENSEN HUGHES CHI Team Yes No 2 Ethyl Acetate Liquid Gallon 1 gal Unknown JENSEN HUGHES CHI Team Yes 1 1 Ethyl Acetate Li id Gallon 8 gal Unknown JENSEN HUGHES CHI Team Yes 8 1 Formic acid Li id Gallon 50 gal Unknown JENSEN HUGHES CHI Team Yes 50 1 HEXANES Liquid Gallon 40 gal Unknown JENSEN HUGHES CHI Team Yes 40 1 Hydrochloric Acid 35-37% Li id FluidOunce 1.6 gal Unknown JENSEN HUGHES CHI Team Yes Hydrochloric Acid 35-37% Li id Pint 1.5 gal Unknown JENSEN HUGHES CHI Team Yes Hydrogen Gas Scf 3000 cu ft Unknown JENSEN HUGHES CHI Team Yes HYDROGEN PEROXIDE 30% Li id Quart 2.5 gal Unknown JENSEN HUGHES CHI Team Yes MAGNESIUM SULFATE, 7-HYDRATE Solid Ounce 3.8 lbs Unknown JENSEN HUGHES CHI Team No 1 Methyl Ethyl Ketone Liquid Gallon 1 gal Unknown JENSEN HUGHES CHI Team Yes 1 1 Nitric Acid % Li id Gallon 1480 kg/m^3 10 gal Unknown JENSEN HUGHES CHI Team Yes ORTHOPHOSPHORIC ACID Li id Gallon 10 gal Unknown JENSEN HUGHES CHI Team Yes 10 1 Polyethylene Glycol Liquid Gallon 1130 kg/m^3 15 gal Unknown JENSEN HUGHES CHI Team Yes 15 3 POTASSIUM BROMIDE Solid Pound 2 lbs Unknown JENSEN HUGHES CHI Team Yes 1 POTASSIUM FERRICYANIDE Solid Pound 30 lbs Unknown JENSEN HUGHES CHI Team No 3 Sodium Nitrate Solid Pound 350 lbs Unknown JENSEN HUGHES CHI Team Yes No SODIUM PHOSPHATE, MONOBASIC, MONOHYDRATE Solid Kilogram 66 lbs Unknown JENSEN HUGHES CHI Team Yes 1 SODIUM THIOSULFATE 0.025N Li id Gallon 5 gal Unknown JENSEN HUGHES CHI Team No 1 SODIUM THIOSULFATE, 5-HYDRATE Solid Ounce 40 lbs Unknown JENSEN HUGHES CHI Team No 2 SULFURIC ACID 98% Li id Gallon 1840 kg/m^3 3 gal Unknown JENSEN HUGHES CHI Team Yes Toluene Liquid Gallon 870 kg/m^3 5 gal Unknown JENSEN HUGHES CHI Team Yes 5 1 WD-40 Liquid Gallon 15 gal Unknown JENSEN HUGHES CHI Team Yes 1 Zinc Standard Solution Liquid Gallon 2 gal Unknown JENSEN HUGHES CHI Team Yes
8 HIGHLY TOXIC GAS (cu ft) HIGHLY TOXIC AERSOL (lbs) TOXIC SOLID (lbs) TOXIC LIQUID (lbs) TOXIC GAS (cu ft) TOXIC AERSOL (cu ft) REQUEST ADDITIONAL INFORMATION 26 46
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