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California Hazardous Materials Inventory Form - Chemical Description <br />(nI HADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br />`5) <br /> <br /> <br /> <br />❑YES ®N <br />15299-99-7 <br />71 <br />CHLOROBENZENE <br />❑YES ®N <br />108-90-7 <br />CHEMICAL NAME <br />(8) <br />NN -DIETHYL -2 <br />TRADE SECRET (11) ❑YES ®NO <br />❑YES ❑N <br />*EHS (12) ❑YES ®NO <br />COMMON NAME <br />(9) <br />DEVRINOL 2-E <br />*IF EHS BOX IS "Y" <br />CAS # <br />(10) <br />15299-99-7 <br />ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE <br />(13) <br />HAZARD <br />LEAVE BLANK <br />CATEGORIES <br />TYPE <br />(14)❑PURE <br />®MIXTURE ❑WASTE <br />RADIOACTIVE(15) ❑YES ®NO(16) N/A <br />PHYSICAL STATE <br />(17) <br />❑ SOLID H LIQUID ❑ GAS <br />CURIES <br />FED HAZARD <br />CATEGORIES <br />(IS)® <br />FIRE ❑ REACTIVE L1PRESSURE RELEASE H ACUTE HEALTH ❑ CHRONIC HEALTH <br />UNITS* (22) ® GAL ❑ LBS <br />N/A MAX DAILY AMT (23)180 <br />STATE WASTE (19) <br />CODE <br />[ICU FT ❑TONS <br />ON SITE <br />DAYS ON SITE <br />(20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />365 <br />30 <br />ON SITE <br />LARGEST <br />(21) <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br />5 GAL <br />N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK ® CAN ❑ BOX ❑ TAN <br />CONTAINER <br />[]UNDER GROUND TANK []CARBOY ❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING <br />❑ SILO ❑ GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />STORAGE (27) ® AMBIENT ❑ ABOVE AMBIENT ❑BELOW AMBI <br />PRESSURE <br />STORAGE (28) IN AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />29 %WT 30 HAZARDOUS COMPONENT (31) EHS 32 CAS# <br />21.5 <br />N,N DIETHYL -2 <br />❑YES ®N <br />15299-99-7 <br />71 <br />CHLOROBENZENE <br />❑YES ®N <br />108-90-7 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 1993 <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 Far Official Use Only: 0 C 0 R ❑ S SIC 12/99 <br />