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California Hazardous MatFrials Inventory Form <br />(1) 1 ® ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <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 />FARM SERVICE <br /> <br /> <br />CARBOFURAN <br />FURADAN 4 <br />1563-66-2 <br />VE BLANK <br />Chemical DSription <br />PAGE (2)2 2 OF (3)116 <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 t uxtr <br />FED HAZARD <br />CATEGORIES (18)❑ FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ® ONIC HE <br />CHRALTH <br />STATE WASTE (19) UNITS* (22) []-GAL ® LBS MAX DAILY AMT (23)1,000 <br />CODE N/A ❑ CU FT ❑ TONS ON SITE <br />DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 7 5 <br />ON SITE <br />LARGEST (21) 90GAL ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />STORAGE (26) ❑ ABOVE GROUND TANK <br />CONTAINER ❑ UNDER GROUND TANK <br />[]TANK INSIDE BUILDING <br />I[] STEEL DRUM <br />❑CAN [I BOX ❑T <br />❑ CARBOY ❑ CYLINDER ❑ R <br />❑ SILO ❑ GLASS BOTTLE ❑ 0 <br />❑ FIBER DRUM ® PLASTIC BOTTLE <br />�❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN I <br />STORAGE (27) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />1101 V/ urr rtm RA7ARDOIN rOMPON- NT (3 1) EHS (32) CAS# <br />44 <br />CARBOFURAN <br />®YES ❑N <br />1563-66-2 <br />PROPYLENE GLYCOL <br />[]YES ®N <br />57-55-6 <br />❑YES ❑N <br />❑YES ❑�' <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 2757 <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: ® C ❑ R ❑ S SJC 12/99 <br />