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California Hazardous MAWS Inventory Form - Chemical De1ription <br />❑ ADD ❑ DELETE ® REVISE PAGE(2)F187 OF(3)F7116 <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br />5) <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />CAPTAN <br />CAPTAN <br />133-06-2 <br />LEAVE 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)®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 ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) UNITS* (22) ❑ GAL ® LBS <br />CODE N/A ❑ CU FT ❑ TONS MAX DAILY AMT (23) 30,000 <br />ON SITE <br />DAYS ON SITE (20) 120 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 3,000 <br />ON SITE <br />LARGEST (21� ANNUAL WASTE AMT (25) N/A <br />CONTAINER 30 LBS <br />STORAGE (26) <br />❑ ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />❑ <br />CONTAINER <br />❑ UNDER GROUND TANK <br />❑ CARBOY <br />❑ CYLINDER <br />❑ <br />❑YES ❑N <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <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) HA7ARD01iS COMPONENT (3 1) EHS (32) CAS# <br />50 <br />CAPTAN IF] YES ®N <br />133-06-2 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 9188 <br />(34) WHAT IS MATERIAL Agricultural fungicide 1 <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: 0 C ❑ R ❑ S SIC 12/99 <br />