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California Hazardous Mat als Inventory Form - Chemical Deollription <br />(1) ❑ ADD ❑ DELETE ® REVISE PAGE (2) F58 I <br />OF(3)F7116 <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />MAP # (6) / GRID # (7) <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />FARM SERVICE <br />FENBUTATIN OXIDE <br />VENDEX SOW <br />13356-08-6 <br />VE BLANK <br />TRADE SECRET (11) ❑YES ®NO <br />*EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />TYPE (14)IMPURE <br />PHYSICAL STATE (17) <br />FED HAZARD <br />❑MIXTURE ❑WASTE <br />RADIOACTIVE (15) ❑yES ®NO(16) N/A <br />CURIES <br />® SOLID ❑ LIQUID ❑ GAS <br />❑YES ❑N <br />CATEGORIES <br />(18)® <br />FIRE [:]REACTIVE <br />❑ PRESSURE RELEASE ® ACUTE HEALTH []CHRONIC HEALTH <br />STATE WASTE <br />CODE <br />DAYS ON SITE <br />LARGEST <br />CONTAINER <br />(19) <br />(20) <br />(21)1 <br />N/`� <br />UNITS* (22) ❑ GAL ® LBS <br />❑CU FT ❑TONS MAX DAILY AMT (23)2,000 <br />ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />ON SITE <br />ANNUAL WASTE AMT (25) <br />120 <br />120 <br />lb <br />N/A <br />STORAGE <br />CONTAINER <br />(26) <br />❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TAN <br />❑ UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />STORAGE (27) ❑ AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT (30) HAZARDOUS COMPONENT (3 1) EHS (32) CAS# <br />150 FENBUTATIN OXIDE ❑YES ®N <br />13356-08-6 <br />77FT 0 <br />❑YES ❑N <br />❑YES ❑N <br />7VET 0 N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 2588 <br />(34) WHAT IS MATERIAL I AGRICULTURAL MITICIDE <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: ® C ❑ R ❑ S <br />SIC 12/99 <br />