Hazardous Materials Inventory Declaration
Facility Information
Facility Name:
Address:
City:
State/Province:
Zip/Postal Code:
Contact Name:
Phone:
Email:
Hazardous Materials Inventory
Material Name
Chemical Abstracts Service (CAS) Number
Quantity
Unit
Physical State
Storage Location
Hazard Classification
Additional Information
Notes / Special Instructions:
Prepared By:
Date: