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California Hazardous leerials Inventory Form - Chemical,cription DEC 19 20W <br />PAGE (2) = OF (3) = <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br />5) <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />COPPER SULPHATE PENTAHYDRATE <br />BLUESTONE, CUPROFIX <br />7758.99-8 <br />LEAVE BLANK <br />TRADE SECRET (11) ❑YES ®NO Tra <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) IN SOLID ❑ LIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES (18)❑ FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ® CHRONIC HEALTH <br />STATE WASTE (19)UNITS* (22) ❑ GAL ® LBS <br />CODE N/`� [:ICU FT ❑TONS MAX DAILY AMT (23) 40,000 <br />ON SITE <br />DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 6,000 <br />ON SITE <br />LARGEST (21) 50 LB ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />STORAGE <br />(26) ❑ ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />❑ TANi <br />CONTAINER <br />❑ UNDER GROUND TANK <br />❑ CARBOY <br />❑ CYLINDER <br />❑ RAIL <br />❑YES ❑N <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ OTHI <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <br />❑ Other <br />❑ PLASTIC/NONMETALLIC DRUM <br />® BAG <br />❑ TOTE BIN <br />STORAGE <br />(27) ®AMBIENT []ABOVE AMBIENT <br />[]BELOW AMBIENT <br />PRESSURE <br />STORAGE <br />(28) ® AMBIENT []ABOVE AMBIENT <br />[]BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29)%WT <br />(10) 14A7Aunnric rnmpr)NTPNT <br />rlli Fus <br />z) rAQ� <br />99.00 <br />COPPER SULPHATE PENTAHYDRATE <br />❑YES ®N <br />7758-99-8 <br />❑YES ❑N <br />❑YES ❑N <br />JOY ON11 <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />(34) WHAT IS MATERIAL RETAB SALE <br />USED FOR? <br />DATE REC'D:: DEC 2 2M4 For Official Use Only: M C ❑ R ❑ S <br />SIC 12/99 <br />