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California Hazardous Materials Inventory Form - Chemical DI ription <br />(1) r ❑ ADD ❑ DELETE ® REVISE PAGE (2) = <br />OF (3) Eil <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br /> <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />TYPE (14) <br />PHYSICAL STATE (17) <br />FED HAZARD <br />CATEGORIES <br />STATE WASTE <br />CODE <br />DAYS ON SITE <br />LARGEST <br />CONTAINER <br />STORAGE <br />CONTAINER <br />STORAGE <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />(18) ®FIItE []REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />(19) N/A UNITS* (22) ®GAL ❑LBS MAX DAILY AMT (23) 750 <br />❑ CU FT ❑TONSJ ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 100 <br />(20) 12 0 ON SITE <br />(21) 2.5 gal ANNUAL WASTE AMT (25) N/A <br />(26)I❑ABOVE GROUND TANK UCAN <br />❑ UNDER GROUND TANK ❑ CARBOY <br />❑ TANK INSIDE BUILDING ❑ SILO <br />❑ STEEL DRUM ❑ FIBER DRUM <br />(27) ❑ AMBIENT ❑ ABOVE AMBIENT ❑ BELOWAMBI <br />(28) 6a AMRIENT ❑ ABOVE AMBIENT ❑ BELOW <br />i1m u A 7 ART1nTiC rnMPnNFNT (31)EHS <br />❑ BOX UTA <br />❑ CYLINDER ❑ RA <br />❑ GLASS BOTTLE ❑ Otl <br />® PLASTIC BOTTLE <br />(32) CAS# <br />73 Y <br />PROPARGITE <br />EO YES HN 1312-35-8 <br />❑YES ON <br />OYES ON <br />OYES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) <br />(34) WHAT IS MATERIAL AGRICULTURAL MITICIDE <br />USED FOR? <br />DATE RECD: 12/14/01 For Official Use Only: ® C ❑ R ❑ S SJC 12/99 <br />