Document 1Oop7j03dLkOe2Z9qxReMzz5
Haskell Number_
HASKELL LABORATORY FOE TOXICOLOGY AHD USDUSTRIAL MEDICIEE
Department/- /-*
SAMPLE SUBMITTED FOR TOXICITY BVAKIATIOH
Division
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Systematic Hame of Chemical:
Synonym, Product Hame and/or Designations:
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Formula;
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Sample: Code Ho,PH99/>-^/A3 Lot Ho.
-..... Amount . JL
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Grade
Color________ Form________ Mol. Wt._____ . '
Special Handling Requirements
//& a _____________ . __________
.
Is it explosive in air? '"'""'in oxygen?
If so, at what concentrations?
Active Ingredient SX/er/<uj /7:*e.ra. /
Composition, if a mixture (are percentages by weight or volume? )
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Impurities (identity and amountsj are percentages hy weight or volume?)
25C__ Properties: MP BP VP
Max. Process Temp.__
(Attach VP
curve if . available)
Sp.Gr. /, 'jrLg-yS._____ Vapor Density (air o 1)_______________________ _
Flash Point (Open cup)___________ .
____ (Closed cup)__________
Solubility (Quantitative, if possible) in water_____ ________ Acetone_______
EthanolVegetable oil Other Solvents _______ _
Proposed Use: .
Present Stage of Development.* Research
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Sales
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DUP040000425
Employee Exposure
1. Concentration of material in process.
2. Solvent and other chemicals present
3. Is exposure by inhalation ^skin abaorption^j-^,fl^her
h. Maximum temperature of material in process
5. Is the ^compound present in the atmosphere $n the form of vapor
mist
dust_______
r
6. Maximum concentration likely to be present in atmosphere______
7. What type of ventilation is in use? - .
8. What type of protective clothing is worn?_______ . .
9. Exposure is for '
hours
minutes per day
Consumer Exposure
By Another Mfgr.
By Public
What is possibility of; li Ingestion 2. Inhalation
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3. Shin contact 4.. Eye contact
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Experience to Pate
Have any clinical signs of toxicity such as headaches, difficulty in breathing, dizziness, nausea, skin or eye irritation, etc., been reported by persons who have been in contact with the chemical? If so, please list them and describe circum stances under which they occurred.
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HOTE:
Haskell Laboratory will retain the unused portion of stable, nonflammable, nonvolatile, low toxicity samples for 5 years 'unless requested to return to sender immediately after testing. After 5 years, the samples will be discarded or returned to the appropriate department. It is suggested that the sender also retain a suitably identified portion of the sample sent for toxicity evaluation for his own future reference.
Signature
Pate 3/><rAj2-
DUP040000426