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California Hazardous Oerials Inventory Form - Chemical4acription DEC A 0 m4 <br />PAGE (2) = OF (3) = <br />BUSINESS NAME <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 />FARM SERVICE <br />(5) <br /> <br />ORGANOPHOSPHATE <br />VAPONA, VAPOCIDE <br />62-73-7 <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 (14) ❑ PURE ®MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ YES ®NO (16) <br />PHYSICAL STATE (17) ❑ SOLID H LIQUID ❑ GAS CURIES <br />FED HAZARD <br />CATEGORIES (,,)®FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) <br />CODE <br />DAYS ON SITE (20) <br />N/A <br />365 <br />LARGEST (21)� <br />CONTAINER <br />UNITS* (22) H GAL ❑ LBS <br />MAX DAILY AMT (23) <br />❑ CU FT ❑ TONS 15 <br />ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />ON SITE <br />ANNUAL WASTE AMT (25) N/A <br />STORAGE (26) ❑ ABOVE GROUND TANK <br />CONTAINER ❑ UNDER GROUND TANK <br />❑ TANK INSIDE BUILDING <br />❑STEEL DRUM <br />❑ PLASTIC/NONMETALLIC DRUM <br />❑ CARBOY <br />❑ SILO <br />❑ FIBER DRUM <br />❑ BAG <br />❑ CYLINDER ❑ RAIL <br />❑ GLASS BOTTLE ❑ OTHI <br />❑ PLASTIC BOTTLE ❑ Othec <br />❑ TOTE BIN <br />STORAGE (27) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT <br />PRESSURE <br />STORAGE (28)®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br />TEMPERATURE <br />(29) %WT (30) HAZARDOUS COMPONENT (31) EHS (32) CAS# <br />7.44 ORGANOPHOSPHATE ❑YES ®N 62-73-7 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) <br />(34) WHAT IS MATERIAL I TMQPrTrrrnF <br />USED FOR? <br />DATE REC'D: 12/30/04 For Official Use Only: 0 C 0 R 0 S SIC 12/99 <br />Tra <br />