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California Hazardous Ma'�ials Inventory Form <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 /> <br /> <br /> <br /> <br /> <br />FIRE CODE (13) <br />HAZARD LEAVE BLANK <br />CATEGORIES <br />Chemical D0ription <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) N/A <br />PHYSICAL STATE (17) ❑ SOLID H LIQUID ❑ GAS CURIES <br />FED HAZARD <br />CATEGORIES (18)❑ FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) UNITS* (22) ® GAL ❑ LBS <br />N/A MAX DAILY AMT (23 <br />CODE 2,500 <br />❑ CU FT ❑TONS ON SITE <br />DAYS ON SITE (20) 36 5 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 100 <br />ON SITE <br />LARGEST (21)2.5 GAL ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />STORAGE (26) <br />CONTAINER <br />❑ ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />[I TAN <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 (27) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT (30) HA7.ARD011S COMPONENT (31)EHS (32) CAS# <br />6 CALCIUM NITRATE IP <br />YES ®N <br />79-14-1 <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 RECD: 12/14/01 For Official Use Only: ® C ❑ R ❑ S SIC 12/99 <br />