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California Hazardous Materials Inventory Form <br />(1)I ® ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME (4) RIPON FARM SERVICE <br />CHEMICAL LOCATION(S) <br />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 />Chemical De3'Cription <br />PAGE (2)F, <br />2)115 OF (3) F116 <br />ZINC,MANGANESE,IRON,CALCIUM,METALOS <br />ATES <br />SAME <br />N/A <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) N/A <br />PHYSICAL STATE (17) ❑ SOLID ®LIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES (18)2FIRE ❑ 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) 800 <br />ON SITE <br />LARGEST (21) GAL ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />STORAGE (26)❑ABOVE <br />GROUND TANK <br />❑CAN <br />❑BOX <br />❑ <br />CONTAINER <br />❑ UNDER GROUND TANK <br />❑ CARBOY <br />❑ CYLINDER <br />❑ <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ <br />❑ STEEL DRUM <br />[I FIBER DRUM <br />® PLASTIC BOTTLE <br />M PLASTIC/NONMETALLIC DRUM <br />M BAG <br />r] TOTE BIN <br />STORAGE (27) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(291 %nWT (30) HA7ARDOTTS COMPONENT (31) EHS (32) CAS# <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: ® C 0 R ❑ S SIC 12/99 <br />❑YES ❑N <br />❑YES ❑N <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 REC'D: 12/14/01 For Official Use Only: ® C 0 R ❑ S SIC 12/99 <br />