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California Hazardousserials Inventory Form - Chemical-cription <br />PAGE (2) <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br />"DEC 3 f 'DD4 <br />= OF (3) = <br />MAP #(6)/ GRID #(7) <br /> <br /> <br /> <br /> <br /> <br />CHEMICAL NAME <br />(8) BIFENTHRIN <br />TRADE SECRET (11) ❑YES ®NO <br />❑YES ❑N <br />*EHS (12) ❑YES ®NO <br />COMMON NAME <br />(9) CAPTURE <br />*IF EHS BOX IS "Y" <br />CAS # <br />(10) 82657-04-3 <br />ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE <br />(13) <br />HAZARD <br />LEAVE BLANK <br />CATEGORIES <br />TYPE <br />(14) ❑ PURE IMMIXTURE ❑ WASTE RADIOACTIVE (15) ❑ YES ®NO (16) <br />PHYSICAL STATE (17) ❑ SOLID ® LIQUID ❑GAS <br />CURIES <br />FED HAZARD <br />INFIRE []REACTIVE ❑PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH <br />CATEGORIES <br />(18) <br />STATE WASTE <br />(19) UNITS* (22) ® GAL ❑ LBS MAX DAILY AMT (23)180 <br />N/ <br />CODE <br />❑ CU <br />FT ❑ TONS ONSITE <br />DAYS ON SITE <br />(20) *If EHS, amounts must be in lbs AVG DAILY AMT (24) 5 0 <br />365 <br />ON SITE <br />LARGEST <br />(21 <br />ANNUAL WASTE AMT (25)N/A <br />CONTAINER <br />GAL <br />STORAGE <br />(26) ❑ ABOVE GROUND TANK <br />[]CAN ❑BOX ❑ TAN <br />CONTAINER <br />❑ UNDER GROUND TANK <br />[]CARBOY ❑ CYLINDER ❑ RAIL <br />❑ TANK INSIDE BUILDING <br />❑ SILO ❑ GLASS BOTTLE ❑ OTH <br />❑ STEEL DRUM <br />❑ FIBER DRUM ® PLASTIC BOTTLE ❑ Other <br />❑ PLASTIC/NONMETALLIC DRUM <br />❑ BAG ❑ TO BIN <br />STORAGE <br />(27) 159 AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBIENT <br />PRESSURE <br />STORAGE <br />(28) ® AMBIENT []ABOVE AMBIENT <br />❑ BELOW AMBIENT []CRYOGENIC <br />TEMPERATURE <br />On) mart <br />(10) HA7ARDOIJS COMPONENT <br />(3 1) EHS (32) CAS# <br />25.1 <br />BIFENTHRIN <br />❑YES ®N 1 <br />82657-04.3 <br />❑YES ❑N <br />❑YES ❑N <br />DYES ❑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: 12/30/04 For Official Use Only: ®C ❑ R ❑ S SJC 12/99 <br />Tra <br />