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California Hazardous MaI."rials Inventory Form - Chemical Dt�ription <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) <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 /> <br />ABAMECTIN <br />AGRI-MEK <br />71751-41-2 <br />VE BLANK <br />fiv ylfl01 <br />OF (3) 116 <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)® FIRE ❑ 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 <br />❑BOX <br />❑ <br />CONTAINER <br />GAL <br />UNITS* (22) ® GAL ❑ LBS <br />❑ CU FT ❑ TONS MAX DAILY AMT (23)100 <br />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 />STORAGE <br />(26) <br />❑ABOVE GROUND TANK <br />❑CAN <br />❑BOX <br />❑ <br />CONTAINER <br />❑YES ❑N <br />❑ UNDER GROUND TANK <br />[]CARBOY <br />❑ CYLINDER <br />❑ <br />FTTT 11 Ng <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />® PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />[]BAG <br />❑ TOTE BIN <br />STORAGE <br />(27) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT (30) HAZARDOUS COMPONENT (31) EHS <br />(32) CAS# <br />1.9 ABAMECTIN <br />❑YES ®N <br />71751-41-2 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />FTTT 11 Ng <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATE RECD: 12/14/01 For Official Use Only: 19 C ❑ R ❑ S SJC 12/99 <br />