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California Hazardous Materials Inventory Form <br />(1) I ® ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME (4) RIPON FARM SERVICE <br />CHEMICALLOCATION(S)(5) <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 />CARBARYL <br />SEVIN BAIT <br />63.25-2 <br />LEAVE BLANK <br />Chemical Daeription <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)0PURE ®MIXTURE El WASTE JRADIOACTIVF (15) ❑yE5 ®NO(16) N/A <br />PHYSICAL STATE (17) ® SOLID ❑ LIQUID ❑ GAS CURIES <br />FED HAZARD ❑ FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />CATEGORIES (18) <br />STATE WASTE (19) UNITS* (22) ❑ GAL H LBS <br />CODE N/A ❑ CU FT ❑ TONS MAX DAII Y AMT (23) 4,000 <br />ON SITE <br />DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 600 <br />ON SITE <br />LARGEST (21)SOLBS 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 />❑YES ❑N <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />® BAG <br />❑ TOTE BIN <br />STORAGE <br />(27) <br />®AMBIENT ❑ABOVE AMBIENT <br />❑BELOW AMBI <br />PRESSURE <br />STORAGE <br />(28) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />ism W -11r <br />izm U A 7 A nnnT TV rnn,ronXMXr <br />(711 FHS <br />(7)1 rA.C# <br />5 <br />CARBARYL <br />DYES ®N <br />63-25-2 <br />❑YES ❑N <br />❑YES ❑N <br />DYES ❑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 RECD: 12/14/01 For Official Use Only: ❑ C 0 R ❑ S SJC 12/99 <br />