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California Hazardous Materials Inventory Form - Chemical DA <br />ption <br />(1) HADD []DELETE ❑ REVISE PAGE (2) = <br />OF (3) 116 <br />BUSINESS NAME (4) <br />RIPON FARM SERVICE <br />CHEMICAL LOCATION(S) (5) <br />MAP # (6) / GRID # (7) <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />MYCLOBUTANIL <br />RALLY <br />88671-89-0 <br />LEAVE BLANK <br />TRADE SECRET (11) ❑YES ®NO <br />*EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />TYPE (14) ❑PURE ®MIXTURE ❑WASTE RADIOACTIVE (15) ❑yES ®NO (16) N/A <br />PHYSICAL STATE (17) IN SOLID ❑ LIQUID []GAS CURIES <br />FED HAZARD <br />CATEGORIES (18) ❑ FIRE ❑ REACTIVE ElPRESSURE RELEASE ® ACUTE HEALTH ® CHRONIC HEALTH <br />STATE WASTE (19) UNITS* (22) ❑ GAL ® LBS <br />CODE N/A ❑ CU FT ElTONS MAX DAILY AMT (23)1,000 <br />ONSITE <br />DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 100 <br />ON SITE <br />LARGEST (21)1 LB ANNUAL WASTE AMT (25)N/A <br />CONTAINER <br />STORAGE (26) <br />CONTAINER <br />❑ ABOVE GROUND TANK []CAN ❑ BOX ❑ TAN <br />❑ UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑ RAI] <br />❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Oth( <br />❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM ®BAG ❑ TOTE BIN <br />STORAGE (27) IN AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) IN AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />091 0/1WT (30) HA7AR1N1Ti.4 ('OMPONRNT (31)EHS (32) CAS4- <br />42 <br />MYCLOBUTANIL ❑YES ®N <br />88671-89-0 <br />60 <br />SILICA AMORPHOUS I ❑YES ®N <br />7631-86-9 <br />❑YES ❑N <br />❑YES ON <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: ®C ❑ R ❑ S SIC 12/99 <br />