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California Hazardous Maflals Inventory Form - Chemical Dtription (1) 1 ❑ ADD ❑ DELETE ® REVISE BUSINESS NAME CHEMICAL LOCATION(S) MAP # (6) / GRID # (7) FARM SERVICE (5) PAGE (2) = OF (3) FE6 CHEMICAL NAME (8) PHOSMET IN SOLID ❑ LIQUID ❑GAS TRADE SECRET (11) ❑YES ®NO FIRE []REACTIVE ❑ PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH STATE WASTE CODE DAYS ON SITE LARGEST CONTAINER STORAGE CONTAINER (19) (20) (21)30 (26) N/A *EHS (12) ®YES ❑ NO ❑YES ❑N 4,000 COMMON NAME (9) IMIDAN ❑ ABOVE GROUND TANK []CAN ❑ BOX ❑ TAN ❑ UNDER GROUND TANK ❑ CARBOY [ICYLINDER ❑ RAI ❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE *IF EHS BOX IS "Y" CAS# (10) 732-11-6 ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD LEAVE BLANK CATEGORIES TYPE (14) PHYSICAL STATE (17) FED HAZARD CATEGORIES (18)❑ ®PURE ❑MIXTURE ❑WASTE RADIOACTIVE (15) ❑yES ®NO (16) N/A CURIES IN SOLID ❑ LIQUID ❑GAS ❑YES ❑N FIRE []REACTIVE ❑ PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH STATE WASTE CODE DAYS ON SITE LARGEST CONTAINER STORAGE CONTAINER (19) (20) (21)30 (26) N/A UNITS* (22) ❑ GAL ® LBS ❑ CU FT ❑ TONS MAX DAILY AMT (23 ON SITE *If EHS, amounts must be in lbs AVG DAILY AMT (24) ON SITE ANNUAL WASTE AMT (25)N/A ❑YES ❑N 4,000 120 5 00 ❑ ABOVE GROUND TANK []CAN ❑ BOX ❑ TAN ❑ UNDER GROUND TANK ❑ CARBOY [ICYLINDER ❑ RAI ❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE STORAGE (27) ❑ AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI PRESSURE STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT []CRYOGENIC TEMPERATURE (29) %WT (30) HAZARDOUS COMPONENT (3 1) EHS (32) CAS# 70 PHOSMET ®YES ❑N 732-11-6 ❑YES ❑N ❑YES ❑N ❑YES ❑N ❑YES 0 N ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) NONE (34) WHAT IS MATERIAL AGRICULTURAL INSECTICIDE USED FOR? DATE REC'D: 12/14/01 For Official Use Only: 0 C ❑ R 0 S SIC 12/99