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California Hazardous Ma ials Inventory Form - Chemical Deetription <br />(1) I ® ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME (4) RIPON FARM SERVICE <br />CHEMICAL LOCATION(S) (5) <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />ACEPHATE <br />ORTHENE <br />30560-19-1 <br />VE BLANK <br />PAGE (2) = OF (3) E1161 - <br />MAP # (6) / <br />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 <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) <br />CODE <br />DAYS ON SITE (20) <br />N/A <br />365 <br />LARGEST (21 <br />❑ BOX <br />❑ TAN <br />CONTAINER <br />5 # <br />UNITS* (22) ❑GAL ®LBS <br />MAX DAILY AMT (23) <br />❑ CU FT [I TONS1,000 <br />ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 7 5 <br />ON SITE <br />ANNUAL WASTE AMT (25) N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />❑ TAN <br />CONTAINER <br />❑ UNDER GROUND TANK <br />[]CARBOY <br />❑ CYLINDER <br />❑ RAI <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ Othe <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 <br />(28) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT <br />(30) HAZARDOUS COMPONENT <br />(31) EHS <br />(32) CAS# <br />75 <br />ACEPHATE 110YES <br />❑N 30560-19-1 <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 RETAIL SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 iFor Official Use Only: ® C ❑ R ❑ S SIC 12/99 <br />