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California Hazardous Mateitials Inventory Form <br />(1) I ® ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME (4)r <br />((RIPON FARM SERVICE <br />CHEMICAL LOCATION(S) <br />5) <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 />LIQUID POLYPHOSPHATE <br />10-34-0 <br />7783-78-0 <br />LEAVE BLANK <br />Chemical Desription <br />PAGE (2) = <br />OF (3) 116 <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) ❑ PURE ® MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ YES ® NO (16) N/A <br />PHYSICAL STATE (17) ❑ SOLID ® LIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES (18)10FIRE ❑ REACTIVE ❑ PRESSURE RELEASE H ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) UNITS* (22) ® GAL ❑ LBS <br />CODE N/A ❑ CU FT ❑ TONS MAX DAILY AMT (23) 20,000 <br />ON SITE <br />DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 7,500 <br />ON SITE <br />LARGEST (21) 20000 ANNUAL WASTE AMT (25) N/A <br />CONTAINER <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 />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ 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 <br />(28) <br />® AMBIENT []ABOVE AMBIENT <br />[]BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) %WT <br />(30) HAZARDOUS COMPONENT <br />(31) EHS <br />(32) CAS# <br />57.00 AMMONIUM POLYPHOSPHATE ❑YES ®N 7783-78-0 <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 REC'D: 12/14/01 For Official Use Only: ® C ❑ R ❑ S SIC 12/99 <br />