Manufacture¡¯s                                           Emergency
Name                                                  Telephone No.: 
Address                                                Other
.                                                      Information Calls: 
Signature of Person                                       Date
Responsible for Preparation                                 Prepared

SECTION 1. IDENTITY

Common Name: (used on label)                               Order No.:
(Trade Name & Synonyms)                                  Cas No.
Chemical                                                 Chemicals
Name                                                    Family
Formula: 

SECTION 2. HAZARDOUS INGREDIRENTS

Principal Hazardous  Component(s)   (chemical & common name(s))   Threshold Limit value(units)

SECTION 3. PHYSICA & CHEMICAL CHARACTERISTICS (Fire & Explosion Data)

Boiling                            Specific                            Vapor
Point                                                                Pressure (mm 780 Hg)
Percent Volatile                      Vapor                              Evaporation Rate
By Volume (%)                       Density (Air=1)   1                 (       )=1
Solubility                                               Reactive
in Water   SOLUBILITY IN WATER                        in Water    UNACTIVE IN WATER
Appearance
And odor

Flash            Flammable Limits         Lower      Upper     Extinguisher       Auto
Point            in air % by Volume                              Media           Temperature
Special Fire
Fighting Procedure

(page: 2/3)
Unusual Fire and
Explosion Hazards

SECTION 4. PHYSICAL HAZARDS

Stability        Solubility          Conditions 
                  to Avoid
Decomposition product
(Materials to Avoid)
Hazardous
Decomposition Products
Hazardous                                Conditions
Polymerization                             to Avoid

SECTION 5. HEALTH HAZARDS

Threshold
Limit value
Skin and              1. Acute
headache,
Symptoms of Exposure    Overexposure
2. Chronic
  Overexposure
Medical Conditions Generally
Aggravated by exposures

Chemical Listed as Carcinogen   National Toxicology  Yes ¡õ I.A.R.C.   Yes ¡õ   OSHA    Yes ¡õ
Or potential Carcinogen     program            No ¡õ Monographs   No ¡õ          No ¡õ
OSHA Permissible                   ACGHI Threshold              Other Exposure
Exposure Limit                     Limit value                  Limit Used
Emergency and
First Aid procedures
1. Inhalation:
2. Eyes: Wash eyes immediately with large amount of water.
3. Skin:
4. Ingestion:

SECTION 6  SPECIAL PROTECTION INFORMATION

Respiratory protection                    
(specify type)
Ventilation

Protective                                            Eyes
Gloves                                              protection

SECTION 7 SPECIAL PRECAUTION AND SPILL/LEAK PROCEDURES
(page: 3/3)
Other
Precautions
Step to be Taken in case
Material is Released or spilled
Waste Disposal
Methods


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