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California Hazardous Materials Inventory Form - Chemical Det,iption <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) EJ <br />OF (3) 116 <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) (5) <br />FARM SERVICE <br /> <br /> <br /> <br />❑YES ❑N 1 <br />❑YES ❑N <br />❑YES 0 <br />❑YES ❑N <br />CHEMICAL NAME <br />(8) <br />ESFENVALERATE <br />TRADE SECRET (11) ❑ YES ®NO <br />COMMON NAME <br />(9) <br />ASANA XL <br />*EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />CAS # <br />(10) <br />66230-04-4 <br />ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE <br />(13) <br />HAZARD <br />LEAVE BLANK <br />CATEGORIES <br />TYPE <br />(14)❑PURE <br />®MIXTURE ❑WASTE <br />RADIOACTIVE (15) ®NO(16)N/A <br />PHYSICAL STATE <br />(17) <br />❑ SOLID ® LIQUID ❑ GAS <br />CURIES <br />FED HAZARD <br />CATEGORIES <br />(18)® <br />FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH H CHRONIC HEALTH <br />UNITS* (22) ® GAL ❑LBS <br />STATE WASTE (19) <br />CODE <br />N/A ❑ CU <br />FT ❑ TONS MAX DAILY AMT (23) 200 <br />ON SITE <br />DAYS ON SITE <br />(20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />365 <br />2 0 <br />ON SITE <br />LARGEST <br />(21) <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br />GAL <br />N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />❑ CAN ❑ 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 />(29) %WT <br />(301 HAZARDOUS COMPONRNT <br />(31) EHS (171 CAS# <br />IB� ESFENVALERATE <br />❑YES ®N 66230-04-4 <br />❑YES ❑N 1 <br />❑YES ❑N <br />❑YES 0 <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATE RECD: 12/14/01 For Official Use Only: 19 C 0 R 0 S SJC 12/99 <br />