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California Hazardous MatEFials Inventory Form - Chemical De�ription <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) = <br />OF (3) 116 <br />BUSINESS NAME (4) RIPON FARM SERVICE <br />CHEMICAL LOCATION(S) <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 />:5) <br /> <br /> <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 <br />(14)❑PURE <br />®MIXTURE <br />❑WASTE <br />RADIOACTIVE (15)❑VES ®NO(16)N/A <br />PHYSICAL STATE (17) <br />CURIES <br />❑ SOLID H LIQUID <br />❑ GAS <br />FED HAZARD <br />CATEGORIES <br />(18)10 <br />FIRE ❑ REACTIVE <br />❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />UNITS* <br />N/A <br />(22) ® GAL ❑ LBS <br />❑ CU FT ❑ TONS MAX DAILY AMT (23) 200 <br />ON SITE <br />STATE WASTE (19) <br />CODE <br />DAYS ON SITE <br />(20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 100 <br />365 <br />ON SITE <br />LARGEST <br />(21) <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br />GAL <br />N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND <br />TANK []CAN ❑ BOX ❑ TAN <br />CONTAINER <br />❑ UNDER GROUND <br />TANK ❑ CARBOY [I CYLINDER ❑ RAI <br />El TANK INSIDE BUILDING ❑ SILO [I 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 (3 1) EHS 32 CAS# <br />50.00 <br /> <br />❑YES ®N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />1. <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATEREC'D: 12/14/01 For Official Use Only: 0 C 0 R 0 S S1C 12/99 <br />