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California Hazardous MatZi`ials Inventory Form - Chemical <br />(1) 1 ® ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />4) RIPON FARM SERVICE <br />,5) <br /> <br /> <br /> <br /> <br /> <br /> <br />AMBIENT <br />❑ BELOW AMBI <br />(28) <br />❑YES ❑N <br />CHEMICAL NAME <br />COMMON NAME <br />CAS# <br />(8) <br />(9) <br />(10) <br />AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <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 />BROMOXYNIL OCTANOATE <br />BUCTRIL <br />1689-99-2 <br />FIRE CODE <br />HAZARD <br />CATEGORIES <br />(13) <br />LEAVE BLANK <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 [IREACTIVE [IPRESSURE 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 UNITS* (22) ® GAL ❑ LBSMAX DAILY AMT (23) 200 <br />❑ CU FT ❑ TONS ON SITE <br />(20) *If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />365 ONSITE 50 <br />(21) 2.5 GAL ANNUAL WASTE AMT (25) N/A <br />(26) ❑ 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 />(27) <br />® AMBIENT <br />❑ ABOVE <br />AMBIENT <br />❑ BELOW AMBI <br />(28) <br />❑YES ❑N <br />® AMBIENT <br />❑ ABOVE <br />AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />(30) HAZARDOUS COMPONENT (3 1) EHS (32) CAS# <br />33.40 <br />BROMOXYNIL OCTANOATE <br />❑ YES ®N <br />1689-99-2 <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 RETAIL SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: 0 C ❑ R ❑ S SIC 12/99 <br />