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California Hazardous Matials Inventory Form - Chemical Aription <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2)2 0 OF (3) 116 <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br />5) <br />MAP # (6) / GRID # (7) <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />CARBARYL <br />SEVIN XLR <br />63-25-2 <br />FIRE CODE (13) <br />HAZARD LEAVE BLANK <br />CATEGORIES <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 <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 [I MAX <br />CODE N/A ❑ GA FT ❑ TONS MAX DAILY AMT (23 400 <br />ON SITE <br />DAYS ON SITE (20) *If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />365 <br />ON SITE 60 <br />LARGEST (21) 2.5 GAL ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />STORAGE <br />(26) <br />❑ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />❑ TAN <br />CONTAINER <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 <br />(27) ® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />STORAGE <br />(28) IN AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(IM %WT <br />ram uazaunnlls CrnMP(1NFNT <br />(3 1) EHS <br />(32) CAS# <br />41 CARBARYL OYES ®N <br />63-25-2 <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 RETAH, SALE <br />USED FOR? <br />DATE RECD: 12/14/01 For Official Use Only: ® C 0 R 0 S SIC 12/99 <br />