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California Hazardous Oterials Inventory Form - Chemical Wription -DEC 19 2004 <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 />SIMAZINE <br />PRINCEP 4L, SIMTROL <br />122-34-9 <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 (18)10FIRE ❑ 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)2 <br />CONTAINER <br />5 <br />UNITS* (22) ® GAL ❑ LBS <br />ID CU FT ❑TONS SITE MAXAMT (23) <br />ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 240 <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 <br />❑CAN <br />❑ CARBOY <br />❑ SILO <br />❑ FIBER DRUM <br />❑ BOX ❑ T <br />❑ CYLINDER ❑ R <br />❑ GLASS BOTTLE ❑ O <br />® PLASTIC BOTTLE ❑ O <br />STORAGE (27) IN 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 />41.9 <br />SIMAZINE <br />110YES ®N 122-34-9 <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 upuuym,, <br />USED FO�y f� <br />DATE RECD: "bE'L 2 9,2004 IFor Official Use Only: JKC [IR ❑ S SIC 12/99 <br />Tra <br />