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California Hazardous Materials Inventory Form - Chemical Deskiption <br />(1) I HADD ❑ DELETE ❑ REVISE <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 />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />UREA <br />UREA <br />57-13-6 <br />LEAVE BLANK <br />PAGE (2)113 OF(3)F116] <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) ®NO(16)N/A <br />PHYSICAL STATE (17) IN SOLID ❑ LIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES (18) ❑ FIRE ❑ REACTIVE [:3PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <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 />(29) %WT <br />(19) N/A <br />(20) 365 <br />(21) BULK <br />(26) ❑ ABS <br />UNITS* (22) ❑ GAL ❑ LBS MAX DAILY AMT (23) 3 0 <br />❑ CU FT ® TONS ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 2 0 <br />ON SITE <br />ANNUAL WASTE AMT (25) N/A <br />UNDER GROUND TANK <br />TANK INSIDE BUILDING <br />STEEL DRUM <br />LJ CAN <br />LJ BOX ❑ <br />❑ CARBOY <br />❑ CYLINDER ❑ <br />H SILO <br />❑ GLASS BOTTLE ❑ <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <br />❑ BAG <br />❑ TOTE BIN <br />(27) <br />® AMBIENT <br />❑ ABOVE <br />AMBIENT <br />❑ BELOW AMBI <br />(28) <br />❑ —YE S ON <br />❑YES ❑N <br />® AMBIENT <br />❑ ABOVE <br />AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />(30) HAZARDOUS COMPONENT (31) EHS (32) CAS# <br />46.00UREA <br />❑YES ®N 57.13-6 <br />OYES ON <br />❑YES ❑N <br />❑ —YE S ON <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) <br />(34) WHAT IS MATERIAL RETAIL SALE _..._— <br />USED FOR? <br />DATE RECD: 12/14/01 Pur OIY'1.11 Csc ()[III: ®C ❑ R ❑ S SIC 12/99 <br />