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California Hazardous Materials Inventory Form - Chemical Description <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) 6 3 OF (3) 116 <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />FARM SERVICE <br />5) <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />IPRODIONE <br />ROVRAL <br />36734-19-7 <br />LEAVE 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 <br />(14) <br />❑ PURE ®MIXTURE ❑ WASTE <br />RADIOACTIVE (15) ❑ yES ®NO (16) <br />N/A <br />PHYSICAL STATE (17) <br />CONTAINER <br />CURIES <br />IN SOLID ❑ LIQUID <br />❑ GAS <br />FED HAZARD <br />CATEGORIES <br />(,8)10 <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />FIRE ❑ REACTIVE <br />❑ PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE <br />CODE <br />(19) <br />N/A <br />UNITS* (22) <br />❑ GAL ®LBS <br />MAX DAILY AMT (23) 4,000 <br />❑ PLASTIC/NONMETALLIC DRUM <br />® BAG <br />❑ TOTE BIN <br />❑ CU FT ❑TONS <br />STORAGE <br />(27) <br />IN AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />ONSITE <br />DAYS ON SITE <br />(20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />(28) <br />® AMBIENT ❑ ABOVE AMBIENT <br />365 <br />ON SITE 200 <br />LARGEST <br />(21) <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br />(29) %WT <br />5 LBS <br />N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />❑ TAN <br />CONTAINER <br />❑ UNDER GROUND TANK <br />[]CARBOY <br />❑ CYLINDER <br />❑ RAI <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ Othe <br />❑YES ❑N <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM <br />® BAG <br />❑ TOTE BIN <br />STORAGE <br />(27) <br />IN AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />PRESSURE <br />STORAGE <br />(28) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT <br />(30) HA7ARnous CnMP(INFNT <br />(31) EHS <br />(32) CAS# <br />50.00 <br />IPRODIONE <br />❑YES ®N <br />36734-19-7 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />(34) WHAT IS MATERIAL RETAIL SALE <br />USED FOR? <br />DATE RECD: 12/14/01 For Official Use Only: 9 C ❑ R ❑ S SIC 12/99 <br />