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California Hazardous Oerials Inventory Form - Chemical lecription <br />PAGE (2) <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) (5) <br />FARM SERVICE <br /> <br /> <br /> <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />GLYPHOSATE <br />ROUNDUP,WEATHERMAX,GLYPHOS <br />38641.94-0 <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 <br />(14) <br />® PURE ❑ MIXTURE ❑WASTE <br />RADIOACTIVE (15) ❑ yES ®NO (16) <br />PHYSICAL STATE (17) <br />CURIES <br />❑ SOLID ®LIQUID OGAS <br />FED HAZARD <br />CATEGORIES <br />(18)❑ <br />FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />UNITS* (22) IN GAL ❑ LBS <br />N/ MAX DAILY AMT (23) 2,000 <br />STATE WASTE (19) <br />CODE <br />❑ CU <br />FT ❑ TONS <br />ON SITE <br />DAYS ON SITE <br />(20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 960 <br />365 <br />ON SITE <br />LARGEST <br />(21 <br />100 GAL <br />ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />❑ CAN []BOX ❑ TANI' <br />CONTAINER <br />[]UNDER GROUND TANK <br />❑ CARBOY ❑ CYLINDER ❑ RAIL <br />❑ TANK INSIDE BUILDING <br />❑ SILO ❑ GLASS BOTTLE ❑ OTHI <br />❑ STEEL DRUM <br />❑ FIBER DRUM ® PLASTIC BOTTLE ❑ Other <br />® PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ 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 />(30) HAZARDOUS COMPONENT <br />(3 1) EHS (32) CAS# <br />48.8 <br />GLYPHOSATE <br />❑ YES ®N 38641-94-0 . <br />❑YES ❑N <br />❑YES ❑N <br />PVT S ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />(34) WHAT IS MATERIAL AGRICULTURAL HERBICIDE <br />USED FOR? <br />DATE REC'D: 12/29/04 For Official Use Only: ® C 0 R ❑ S SIC 12/99 <br />Tra <br />