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California Hazardous Matgiials Inventory Form - Chemical Delpription <br />(1) I ® ADD ❑ DELETE ❑ REVISE <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 /> <br /> <br /> <br /> <br /> <br />LEAVE BLANK <br />PAGE (2) = <br />OF (3) F116 <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 />N/A <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 <br />CODE <br />DAYS ON SITE <br />LARGEST <br />CONTAINER <br />STORAGE <br />CONTAINER <br />STORAGE <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />(29) %WT <br />(19) N/A <br />(20) 365 <br />(21)50 LBS <br />(26) ❑ ABOVE GRO <br />UNITS* (22) ❑ GAL ® LBS <br />❑ CU FT ❑ TONS MAX DAILY AMT (23 25,000 <br />ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />ON SITE 7,000 <br />ANNUAL WASTE AMT (25) N/A <br />TANK <br />UNDER GROUND TANK <br />TANK INSIDE BUILDING <br />STEEL DRUM <br />❑ CAN <br />❑ CARBOY <br />❑ SILO <br />❑ FIBER DRUM <br />DRUM ®BAG <br />LJ BOX ❑ <br />❑ CYLINDER ❑ <br />❑ GLASS BOTTLE ❑ <br />❑ PLASTIC BOTTLE <br />❑ TOTE BIN <br />(27) <br />® AMBIENT <br />❑ ABOVE <br />AMBIENT <br />❑ BELOW AMBI <br />❑YES ❑N <br />(28) <br />❑YES ❑N <br />❑YES ❑N <br />® AMBIENT <br />❑ ABOVE <br />AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />(30) HAZARDOUS COMPONENT (31) EHS (32) CAS# <br />99.00 BORON 110YES <br />®N 12280-03-4 <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 RETAH, SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: H C 0 R 0 S SIC 12/99 <br />