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California Hazardous MaiEFials Inventory Form - Chemical Deription (1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) 8 4 OF (3) 116 BUSINESS NAME (4) RIPON FARM SERVICE CHEMICAL LOCATION(S) (5) CHEMICAL NAME (8) TRADE SECRET (11) F[]—'FES ® NO OXYFLOURFEN COMMON NAME (9) *EHS (12) ❑YES ®NO GOAL 2XL *IF EHS BOX IS "Y" CAS# (10) 42874-03-3 ALL AMOUNTS MUST BEINLBS FIRE CODE (13) HAZARD LEAVE BLANK CATEGORIES TYPE (14) ❑ PURE ®MIXTURE [1W RADIOACTIVE (15) ❑ YES ®NO (16) N/A PHYSICAL STATE (17) ❑ SOLID ®LIQUID ❑ GAS CURIES FED HAZARD CATEGORIES (18)® FIRE ❑ REACTIVE ElPRESSURE RELEASE ® ACUTE HEALTH H CHRONIC HEALTH STATE WASTE (19) UNITS* (22) ® GAL ❑ LBS N/A MAX DAILY AMT (23)1,000 CODE [ICU FT ❑TONS ON SITE DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) ON SITE 100 LARGEST (21) 30 GAL ANNUAL WASTE AMT (25) N/A CONTAINER STORAGE (26) ❑ ABOVE GROUND TANK []CAN ❑ BOX []TAN CONTAINER [:]UNDER GROUND TANK []CARBOY ❑ CYLINDER ❑ RAI ❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe ❑ STEEL DRUM ❑ FIBER DRUM ® PLASTIC BOTTLE ❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN STORAGE (27) ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBI PRESSURE STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT []BELOW AMBIENT [:]CRYOGENIC TEMPERATURE (29) %W T (30) HAZARDOUS COMPONFNT (3 D EHS Ma CAsx 122 —1 OXYFLUORFEN ❑YES ®N 42874-03-3 ❑YES ❑N ❑YES ❑N ❑YES ❑N 1 ❑YES ❑N ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A (34) WHAT IS MATERIAL RETAII. SALE J USED FOR? DATE REC'D: 12/14/01 For Official Use Only: H C 0 R [IS SIC 12/99