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California Hazardous Materials Inventory Form - Chemical DeZrription <br />(1) 1 ®ADD ❑ DELETE ❑ REVISE <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 />'4) RIPON FARM SERVICE <br />(5) <br /> <br />IMIDAZOLE <br />PROCURE <br />68694-11-1 <br />VE BLANK <br />PAGE (2) = <br />OF (3) F116 <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 <br />(14) <br />❑ PURE ®MIXTURE <br />❑ R'ASTE <br />RADIOACTIVE (15) ❑ yE S ® NO (16) N/A <br />PHYSICAL STATE (17) <br />CURIES <br />IN SOLID ❑ LIQUID <br />❑GAS <br />FED HAZARD <br />CATEGORIES <br />(,,)IO <br />❑YES ❑N <br />FIRE ❑ REACTIVE <br />❑ PRESSURE RELEASE ® ACUTE HEALTH ®CHRONIC HEALTH <br />UNITS* (22) ❑ GAL ® LBS <br />N/A ❑ CU FT ❑ TONS MAX DAILY AMT (23)1,200 <br />ON SITE <br />STATE WASTE (19) <br />CODE <br />DAYS ON SITE <br />(20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />365 <br />5 011 <br />ON SITE <br />LARGEST <br />(21)1 <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br /># <br />N/A <br />STORAGE <br />(26) <br />1:-] ABOVE GROUND <br />TANK ❑ CAN [I BOX ❑ TAN <br />CONTAINER <br />❑ UNDER GROUND <br />TANK ❑ CARBOY [I CYLINDER 1:1 RAI <br />❑ TANK INSIDE BUILDING [I SILO [I GLASS BOTTLE [:1Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />STORAGE (27) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) IN AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT (30) HAZARDOUS COMPONENT (31) EHS (32) CAS# <br />50 <br />IMIDAZOLE 110YES ®N <br />68694-11-1 <br />[:]YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) <br />(34) WHAT IS MATERIAL RETAIL SALES <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Onlp: ® C 0 R 0 S SIC 12/99 <br />