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California Hazardous Mattials Inventory Form - Chemical De�ription <br />® ADD ❑ DELETE ❑ REVISE PAGE (2)3 0 OF (3) F116 <br />BUSINESS NAME (4) rRIPON FARM SERVICE <br />CHEMICAL LOCATION(S) (5) <br /> <br />CHEMICAL NAME (8) COPPER HYDROXIDE TRADE SECRET (11) ❑ YES H NO <br />COMMON NAME (9) CHAMP II *EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />CAS # (10) 20427-59-2 ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE (13) <br />HAZARD LEAVE BLANK <br />CATEGORIES <br />TYPE <br />(14) <br />❑ PURE ®MIXTURE ❑WASTE <br />RADIOACTIVE (15) <br />❑ yES ®NO (16) <br />OYES ❑N <br />N/A <br />PHYSICAL STATE (17) <br />CURIES <br />❑ SOLID H LIQUID ❑GAS <br />FED HAZARD <br />CATEGORIES <br />(18)10 <br />FIRE []REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE <br />(19) <br />UNITS* (22) <br />® GAL ❑ LBS <br />CODE <br />N/A <br />❑ CU FT ❑ TONS <br />MAX DAILY AMT (23 <br />400 <br />ON SITE <br />DAYS ON SITE <br />(20) <br />365 <br />*If EHS, amounts must be in 16s AVG DAILY AMT O <br />ONSITE 75 <br />LARGEST <br />(21) <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br />2 5 GAL N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK []CAN ❑ BOX []TAN <br />CONTAINER <br />[]UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM ❑ FIBER DRUM ® PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br />STORAGE <br />(27) <br />H AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE <br />(28) <br />® AMBIENT []ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT <br />(30) HAZARDOUS COMPONENT (3 1) EHS <br />137.50 I (COPPER HYDROXIDE <br />❑YES ®N 20427-59-2 <br />❑YES ❑N <br />OYES ❑N <br />❑YES N11 <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 REC'D: 12/14/01 For Official Use Only: H C ❑ R ❑ S SIC 12/99 <br />