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California Hazardous MaPials Inventory Form - Chemical Deiption <br />® ADD ❑ DELETE ❑ REVISE PAGE (2) = OF (3) F116 <br />BUSINESS NAME (4) RIPON FARM SERVICE <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 />ACETYLENE <br />ACETYLENE <br />74-86-2 <br />VE 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) <br />PHYSICAL STATE (17) <br />FED HAZARD <br />® PURE []MIXTURE ❑WASTE <br />RADIOACTIVE (15) ❑ yES ®NO (16) N/A <br />CURIES <br />❑ SOLID []LIQUID ®GAS <br />❑YES ❑N <br />CATEGORIES (18)® <br />FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) <br />CODE <br />DAYS ON SITE (20)AVG <br />LARGEST (21)154 <br />CONTAINER <br />STORAGE (26) <br />CONTAINER <br />STORAGE (27) <br />PRESSURE <br />N/A <br />UNITS* (22) ❑ GAL ❑ LBS <br />®CU FT ❑TONS MAX DAILY AMT (23)600 <br />ON SITE <br />*If EHS, amounts must be in lbs DAILY AMT (24) <br />ON SITE <br />ANNUAL WASTE AMT (25) <br />❑YES ❑N <br />365 <br />D <br />❑YES ❑N <br />600 <br />D <br />N/A <br />❑ ABOVE GROUND TANK ❑ CAN ❑ BOX []TAN <br />[]UNDER GROUND TANK []CARBOY ® CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br />❑ AMBIENT H ABOVE AMBIENT ❑ BELOW AMBI <br />STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT []BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />29 %WT 30 HAZARDOUS COMPONENT (31) EHS 32 CAS# <br />99 ACETYLENE I <br />10YES ®N <br />74-86-2 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 1001 <br />(34) WHAT IS MATERIAL I SHOP USE <br />USED FOR? <br />DATE RECD: 12/14/01 For Official Use Only: H C ❑ R ❑ S SIC 12/99 <br />