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California Hazardous Ma kals Inventory Form - Chemical Dpription <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) 10 OF (3) F116 <br />BUSINESS NAME <br />FARM SERVICE <br />CHEMICAL LOCATION(S) (5) <br /> <br /> <br /> <br /> <br />❑YES ❑N <br />❑YES ❑N <br />CHEMICAL NAME <br />(8) <br />TRADE SECRET (11) F[] -YTS -CR NO <br />BORIC ACID <br />COMMON NAME <br />(9) <br />*EHS (12) ❑YES ®NO <br />BOROSOL <br />*IF EHS BOX IS "Y" <br />CAS# <br />(10) <br />26038-87-9 <br />ALL AMOUNTS MUST BEINLBS <br />FIRE CODE <br />(13) <br />HAZARD <br />CATEGORIES <br />LEAVE BLANK <br />TYPE <br />(14) <br />❑PURE ®MIXTURE ❑ WASTE <br />RADIOACTIVE (15) ❑yES ®NO (16) N/A <br />PHYSICAL STATE <br />(17) <br />❑ SOLID H LIQUID ❑GAS <br />CURIES <br />FED HAZARD <br />CATEGORIES <br />(18)1 <br />FIRE FIRE 1:1REACTIVE ElPRESSURE RELEASE ® ACUTE HEALTH ElCHRONIC HEALTH <br />STATE WASTE <br />CODE <br />(19) <br />N/`� <br />UNITS* (22) ®GAL ❑LBS <br />❑CU FT ❑TONS MAX DAII.YAMT (23 <br />ON SITE <br />200 <br />DAYS ON SITE <br />(20) <br />365 <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />ONSITE <br />7 5 <br />LARGEST <br />CONTAINER <br />(21) <br />5 GAL <br />ANNUAL WASTE AMT (25) <br />N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />❑ CAN ❑ BOX ❑ TAN <br />CONTAINER <br />[]UNDER GROUND TANK <br />[]CARBOY ❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING <br />❑ SILO []GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM IN PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />[]BAG ❑ TOTE BIN <br />AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />STORAGE (27) IN <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />(28) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />(30) HAZARDOUS COMPONENT <br />(31) EHS sn <br />(29) °SWT <br />110.00 I IBORIC ACID <br />❑YES ON <br />26038-87-9 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />(34) WHAT IS MATERIAL RETAII, SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: 0 C 0 R 0 S SIC 12/99 <br />