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California Hazardous Materials Inventory Form - Chemical Description <br />(I) I HADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br />(5) <br /> <br /> <br />(14)0PURE <br />®MIXTURE <br />❑WASTE <br />RADIOACTIVE (15) ❑yES ®NO(16)N/A <br />PHYSICAL STATE (17) <br />CURIES <br />❑ SOLID H LIQUID <br />CHEMICAL NAME (8) <br />PHOSPHORIC ACID/ PROPYLONEGLYCOL <br />TRADE SECRET (11) ❑YES ®NO <br />COMMON NAME (9) <br />BUFER <br />*EHS (12) ❑YES ®NO <br />FIRE ❑ REACTIVE <br />❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />*IF EHS BOX IS "Y" <br />CAS # (10) <br />7664-38-2 <br />ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE (13) <br />STATE WASTE <br />CODE <br />(19) <br />N/ <br />HAZARD <br />CATEGORIES <br />LEAVE BLANK <br />TYPE <br />(14)0PURE <br />®MIXTURE <br />❑WASTE <br />RADIOACTIVE (15) ❑yES ®NO(16)N/A <br />PHYSICAL STATE (17) <br />CURIES <br />❑ SOLID H LIQUID <br />❑ GAS <br />FED HAZARD <br />CATEGORIES <br />(18)❑ <br />❑YES ❑N <br />FIRE ❑ REACTIVE <br />❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE <br />CODE <br />(19) <br />N/ <br />UNITS* (22) ®GAL ❑LBS <br />[ICU GA FT ❑ TONS MAX DAILY AMT (23) 600 <br />ON SITE <br />DAYS ON SITE (20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />365 <br />100 <br />ON SITE <br />LARGEST <br />CONTAINER <br />(21 <br />ANNUAL WASTE AMT (25) N/A <br />5 GAL <br />STORAGE <br />(26) <br />❑ ABOVE GROUND <br />TANK ❑ CAN ❑ BOX ❑ TAN <br />CONTAINER <br />[]UNDER GROUND <br />TANK []CARBOY [ICYLINDER ElRAII <br />❑ TANK INSIDE BUILDING ❑ SILO ® GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />STORAGE (27) IN AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) IN AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) SWT (30) HAZARDOUS COMPONENT (31) EHS (32) CAS# <br />17.55 <br />PHOSPHORIC ACID <br />❑YES ®N 7664-38-2 <br />❑YES El <br />❑YES ❑N <br />❑YES ❑N <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 RECD: 12/14/01 For Official Use Only: ®C ❑ R ❑ S SIC 12/99 <br />