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California Hazardous Mat rials Inventory Form <br />- Chemical DeSFription <br />TRADE SECRET (11) ❑ YES ®NO <br />(1) <br />® ADD ❑ DELETE ❑ REVISE <br />PAGE (2) <br />F2 5 <br />OF (3) F116 <br />BUSINESS NAME (4)IRIPON FARM SERVICE <br />CHEMICAL LOCATION(S)(5) <br /> <br />CHEMICAL NAME <br />(8) CHLORPYRIFOS <br />TRADE SECRET (11) ❑ YES ®NO <br />*EHS (12) ❑YES ®NO <br />COMMON NAME <br />(9) LORSBAN 50W <br />❑YES ❑N <br />*IF EHS BOX IS "Y" <br />CAS # <br />(10) 2921-88-2 <br />ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE <br />(13) <br />HAZARD <br />LEAVE BLANK <br />CATEGORIES <br />TYPE <br />(14)®PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑YES ®NO(16) N/A <br />PHYSICAL STATE <br />(17) IN SOLID []LIQUID ❑ GAS <br />CURIES <br />FED HAZARD <br />❑ FIRE ❑REACTIVE El PRESSURE RELEASE ®ACUTE HEALTH ❑ CHRONIC HEALTH <br />CATEGORIES <br />(18) <br />STATE WASTE <br />(19) UNITS* (22) ❑ GAL ® LBS MAX DAILY AMT (23) 2,580 <br />N/A <br />CODE <br />[ICU <br />FT ❑ TONS ON SITE <br />DAYS ON SITE <br />(20) *If EHS, amounts must be in lbs AVG DAILY AMT (24) 720 <br />210 <br />ON SITE <br />LARGEST <br />(21) <br />ANNUAL WASTE AMT (25) N/A <br />CONTAINER <br />50 LBS <br />STORAGE <br />(26)❑ABOVE GROUND TANK <br />CAN [I BOX ❑TAN <br />CONTAINER <br />[]UNDER GROUND TANK <br />[]CARBOY ❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING <br />❑ SILO ❑ GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />® BAG ❑ TOTE BIN <br />STORAGE <br />(27) ❑ AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />STORAGE <br />(28) ® AMBIENT []ABOVE AMBIENT <br />❑ BELOW AMBIENT []CRYOGENIC <br />TEMPERATURE <br />(901 q WT <br />(70) T4A7ARDOITS COMPONENT <br />(31) EHS (32) CAS# <br />50 <br />CHLORPHYRIFOS <br />❑YES ®N 2921-88-2 <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 INSECTICIDE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: 0 C ❑ R ❑ S SIC 12/99 <br />