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California Hazardous Matals Inventory Form - Chemical DeZ'ription <br />(1) H ADD ❑ DELETE ❑ REVISE PAGE (2) = <br />OF (3) 116 <br />BUSINESS NAME (4) RIPON FARM SERVICE <br />CHEMICAL LOCATION(S) (5) <br /> <br />CHEMICAL NAME (8) ETHEPHON TRADE SECRET (11) ❑ YES H NO <br />COMMON NAME (9) ETHREL *EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />CAS # (10) 16672-87-0 ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE (13) <br />HAZARD LEAVE BLANK <br />CATEGORIES <br />TYPE (14) ❑ PURE ®MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ yES ®NO (16) N/A <br />PHYSICAL STATE (17) ❑ SOLID ®LIQUID ❑ GAS CURIES <br />PED HAZARD <br />CATEGORIES (IS)❑ FIRE ®REACTIVE []PRESSURE RELEASE ® ACUTE HEALTH H CHRONIC HEALTH <br />STATE WASTE (19) <br />CODE <br />DAYS ON SITE (20) <br />N/A <br />365 <br />LARGEST (21)� <br />❑BOX <br />❑ <br />CONTAINER <br />2.5 GAL <br />UNITS* (22) ® GAL ❑ LBS <br />MAX DAILY AMT (23) <br />❑ CU FT ❑ TONS 200 <br />ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 7 5 <br />ON SITE <br />ANNUAL WASTE AMT (25) N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />[]CAN <br />❑BOX <br />❑ <br />CONTAINER <br />❑ UNDER GROUND TANK <br />❑ CARBOY <br />❑ CYLINDER <br />❑ <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />H PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />❑ BAG <br />❑ TOTE BIN <br />STORAGE <br />(27) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) ® AMBIENT []ABOVE AMBIENT [:]BELOW AMBIENT []CRYOGENIC <br />TEMPERATURE <br />(29) %WT (30) HAZARDOUS COMPONENT (3 1) EHS <br />(32) CAS# <br />21.70 ETHEPHON ❑YES ON <br />16672-87-0 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 3265 <br />(34) WHAT IS MATERIAL RETAIL SALES <br />USED FOR? <br />DATE RECD: 12/14/01 For Official Use Only: ® C ❑ R ❑ S SIC 12/99 <br />