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California Hazardous Materials Inventory Form - Chemical Defription <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2)F, <br />2)105 OF (3) 116 <br />BUSINESS NAME (4)IRIPON FARM SERVICE <br />CHEMICAL LOCATION(S) (5) <br />MAP # (6) / GRID # (7) <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />STRYCHNINE ALKALOID <br />GOPHER GETTER BAIT <br />57249 <br />FIRE CODE (13) <br />HAZARD LEAVE BLANK <br />CATEGORIES <br />TRADE SECRET (I1) ❑YES ®NO <br />*EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />TYPE (14)EI <br />PURE ®MIXTURE ❑WASTE RADIOACTIVE (15) ❑YES ®NO(16)N/A <br />PHYSICAL STATE (17) IN SOLID ❑ LIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES (18)❑ FIRE ❑ REACTIVE ElPRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) UNITS* (22) ❑ GAL ® LBS <br />CODE N/A ❑ CU FT ❑ TONS MAX DAILY AMT (23) 2,500 <br />ON SITE <br />DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 1,000 <br />ON SITE <br />LARGEST (21) 25 LBS ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />®CAN <br />❑ BOX ❑ TAN <br />CONTAINER <br />❑ UNDER GROUND TANK <br />❑ CARBOY <br />❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />❑ BAG <br />[:]TOTE BIN <br />STORAGE <br />(27) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />STORAGE <br />(28) <br />® AMBIENT ❑ ABOVE AMBIENT <br />[]BELOW AMBIENT []CRYOGENIC <br />TEMPERATURE <br />110) rnurr <br />ram TiAOARTIOTts romp0>vs;_w <br />(31) EHS <br />(32) CAS# <br />1.50 STRYCHNINE ALKALOIDE ❑YES ®N 57249 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES 11 <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 0 S SIC 12199 <br />