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DISCLAIMER:

These guidelines were developed under contract using generally accepted secondary sources. The protocol used by the contractor for surveying these data sources was developed by the National Institute for Occupational Safety and Health (NIOSH), the Occupational Safety and Health Administration (OSHA), and the Department of Energy (DOE). The information contained in these guidelines is intended for reference purposes only. None of the agencies have conducted a comprehensive check of the information and data contained in these sources. It provides a summary of information about chemicals that workers may be exposed to in their workplaces. The secondary sources used for supplements III and IV were published before 1992 and 1993, respectively, and for the remainder of the guidelines the secondary sources used were published before September 1996. This information may be superseded by new developments in the field of industrial hygiene. Therefore readers are advised to determine whether new information is available.

Introduction | Recognition | Evaluation | Controls | References

Introduction

This guideline summarizes pertinent information about calcium chromate for workers and employers as well as for physicians, industrial hygienists, and other occupational safety and health professionals who may need such information to conduct effective occupational safety and health programs. Recommendations may be superseded by new developments in these fields; readers are therefore advised to regard these recommendations as general guidelines and to determine whether new information is available.

Recognition

SUBSTANCE IDENTIFICATION

* Formula
CrO(4)Ca

* Structure
(For Structure, see paper copy)

* Synonyms
Calcium chromate (VI), calcium monochromate, Calcium Chrome Yellow, C. I. Pigment Yellow 33, Gelbin, Yellow Ultramarine

* Identifiers
  1. CAS No.: 13765-19-0
  2. RTECS No.: GB2750000
  3. DOT NA: 9096 (calcium chromate is not listed in the 1993 DOT guidebook)
  4. Specific DOT label: None.
* Appearance and odor

Calcium chromate is a bright yellow powder, monoclinic, or rhombic crystals. It normally occurs as a dihydrate compound which loses water at 200 degrees C (392 degrees F).

CHEMICAL AND PHYSICAL PROPERTIES

* Physical data

  1. Molecular weight: 156.08
  2. Boiling point: Data not available.
  3. Specific gravity (water = 1): 2.89 at 20 degrees C (68 degrees F)
  4. Vapor density: Data not available.
  5. Melting/Freezing point/Decomposition Temperature: Data not available.
  6. Vapor pressure: Data not available.
  7. Solubility: Soluble in dilute acids; practically insoluble in alcohol; slightly soluble in water.
  8. Evaporation rate: Not applicable.
* Reactivity
  1. Conditions contributing to instability: None reported.
  2. Incompatibilities: Contact of calcium chromate with organic matter or reducing agents (paper, wood, aluminum, plastics, or sulfur) may cause reaction forming chromium III, acids and ethanol cause slow reactions, hydrazine causes explosive reactions, and if mixed with boron and ignited, calcium chromate will burn violently.
  3. Hazardous decomposition products: None reported.
  4. Special precautions: None reported.
* Flammability

Calcium chromate is not combustible. The National Fire Protection Association has not assigned a flammability rating to calcium chromate.
  1. Flash point: Not applicable.
  2. Autoignition temperature: Not applicable.
  3. Flammable limits in air: Not applicable.
  4. Extinguishant: Use an extinguishant that is suitable for the materials involved in the surrounding fire.
Fires involving calcium chromate should be fought upwind from the maximum distance possible. Isolate the hazard area and deny access to unnecessary personnel. Firefighters should wear a full set of protective clothing and self-contained breathing apparatus when fighting fires involving calcium chromate.

EXPOSURE LIMITS

* OSHA PEL

The current Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) for calcium chromate is 0.1 milligram per cubic meter (mg/m(3)) of air as a ceiling limit (for chromic acid and chromates). A worker's exposure to calcium chromate shall at no time exceed this ceiling level [29 CFR 1910.1000, Table Z-2].

* NIOSH REL

The National Institute for Occupational Safety and Health (NIOSH) has established a recommended exposure limit (REL) for calcium chromate of 0.001 mg/m(3) as a TWA for up to a 10-hour workday and a 40-hour workweek. NIOSH also lists calcium chromate as a potential human carcinogen [NIOSH 1992].

* ACGIH TLV

The American Conference of Governmental Industrial Hygienists (ACGIH) has assigned calcium chromate a threshold limit value (TLV) of 0.001 mg/m(3) as a TWA for a normal 8-hour workday and a 40-hour workweek. The ACGIH also lists calcium chromate as an A2 substance (suspected human carcinogen) [ACGIH 1994, p. 15].

* Rationale for Limits

The NIOSH limit is based on the risk of lung cancer [NIOSH 1992]. The ACGIH limit is based on the risk of cancer [ACGIH 1994, p. 15].

Evaluation

HEALTH HAZARD INFORMATION

* Routes of Exposure

Exposure to calcium chromate can occur through inhalation, ingestion, and eye or skin contact.

* Summary of toxicology

  1. Effects on Animals: Calcium chromate can affect the lungs, liver, spleen, gastrointestinal system and reproductive system in experimental animals; it is also an experimental mutagen and carcinogen [NLM 1993; NIOSH 1994a]. The oral LD(50) in rats is 327 mg/kg [NLM 1993]. Mice exposed to 13 mg/m(3) calcium chromate for 5 hours/day, on 5 days/week over their lifespan did not have a significantly elevated incidence of cancer, although marked changes in the bronchial epithelium (necrosis, atrophy, and hyperplasia) were observed. In addition, atrophy of the spleen and liver was noted, and ulcerations in the stomach and intestinal mucosa were also observed [NLM 1993]. Rats administered more than 0.125 percent chromium (VI) in their feed had impaired reproductive function and sterility; stunted growth and roughness of fur were also noted in young rats [NLM 1993]. Calcium chromate was mutagenic in experimental test systems [NLM 1993]. Calcium chromate was carcinogenic when administered to rats by intratracheal injection [NIOSH 1994a; NLM 1993].
  2. Effects on Humans: Calcium chromate is a skin and eye irritant; it can also affect the respiratory tract, immune system, liver, and kidney; calcium chromate is considered a human carcinogen. Eye contact with chromate compounds may cause conjunctivitis with lacrimation and a dark red band on the cornea [NLM 1993]. Exposure to chromium compounds by skin contact or inhalation can result in a sensitization reaction resulting in dermatitis or asthma [Hathaway et al. 1991; NLM 1993]. Large doses of chromates can cause kidney damage characterized by albuminuria, desquamated cells, hyperemia, fatty degeneration and necrosis [NLM 1993]. Calcium chromate can also cause hepatitis [NLM 1993]. Calcium chromate is a water insoluble hexavalent chromium compound; these chemicals are considered human carcinogens [Hathaway et al. 1991; NLM 1993]. Inhalation can cause breakdown of nasal tissue [Sittig 1991].
* Signs and symptoms of exposure
  1. Acute exposure: Acute exposure can cause irritation of nose and throat, disintegration of nasal tissue, coughing, wheezing, headache, painful breathing, and fever. Skin contact may cause irritation. Calcium chromate also causes severe chemical burns to the eyes. Ingestion causes severe sore throat and irritation of the stomach and intestine which can develop into tissue damage [Sittig 1991].
  2. Chronic exposure: Repeated skin contact leads to incapacitating eczematous dermatitis with edema, and ulceration that heals slowly [NLM 1993]. Inhalation of calcium chromate over long periods causes painless ulceration, bleeding and perforation of nasal septum accompanied by foul nasal discharge [NLM 1993; Sittig 1991]. Chronic exposure can also result in conjunctivitis, lacrimation, and acute hepatitis with jaundice. Symptoms associated with hepatitis include nausea, vomiting, loss of appetite, and enlarged, tender liver [NLM 1993].
EMERGENCY MEDICAL PROCEDURES

* Emergency medical procedures: [NIOSH to supply]

Rescue: Remove an incapacitated worker from further exposure and implement appropriate emergency procedures (e.g., those listed on the Material Safety Data Sheet required by OSHA's Hazard Communication Standard [29 CFR 1910.1200]). All workers should be familiar with emergency procedures, the location and proper use of emergency equipment, and methods of protecting themselves during rescue operations.

EXPOSURE SOURCES AND CONTROL METHODS

The following operations may involve calcium chromate and lead to worker exposures to this substance:
  • The manufacture and transportation of calcium chromate
  • Use as a pigment and corrosion inhibitor
  • Use in the manufacture of chromium, in oxidizing reactions, and in battery depolarization
  • Use in the electroplating industry
  • Use in photochemical processing and industrial waste treatment
Methods that are effective in controlling worker exposures to calcium chromate, depending on the feasibility of implementation, are as follows:
  • Process enclosure
  • Local exhaust ventilation
  • General dilution ventilation
  • Personal protective equipment
Workers responding to a release or potential release of a hazardous substance must be protected as required by paragraph (q) of OSHA's Hazardous Waste Operations and Emergency Response Standard [29 CFR 1910.120].

Good sources of information about control methods are as follows:
  1. ACGIH [1992]. Industrial ventilation--a manual of recommended practice. 21st ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.
  2. Burton DJ [1986]. Industrial ventilation--a self study companion. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.
  3. Alden JL, Kane JM [1982]. Design of industrial ventilation systems. New York, NY: Industrial Press, Inc.
  4. Wadden RA, Scheff PA [1987]. Engineering design for control of workplace hazards. New York, NY: McGraw-Hill.
  5. Plog BA [1988]. Fundamentals of industrial hygiene. Chicago, IL: National Safety Council.
MEDICAL SURVEILLANCE

OSHA is currently developing requirements for medical surveillance. When these requirements are promulgated, readers should refer to them for additional information and to determine whether employers whose employees are exposed to calcium chromate are required to implement medical surveillance procedures.

Medical Screening:

Workers who may be exposed to chemical hazards should be monitored in a systematic program of medical surveillance that is intended to prevent occupational injury and disease. The program should include education of employers and workers about work-related hazards, early detection of adverse health effects, and referral of workers for diagnosis and treatment. The occurrence of disease or other work-related adverse health effects should prompt immediate evaluation of primary preventive measures (e.g., industrial hygiene monitoring, engineering controls, and personal protective equipment). A medical surveillance program is intended to supplement, not replace, such measures. To detect and control work-related health effects, medical evaluations should be performed (1) before job placement, (2) periodically during the term of employment, and (3) at the time of job transfer or termination.

* Pre-placement medical evaluation

Before a worker is placed in a job with a potential for exposure to calcium chromate, a licensed health care professional should evaluate and document the worker's baseline health status with thorough medical, environmental, and occupational histories, a physical examination, and physiologic and laboratory tests appropriate for the anticipated occupational risks. These should concentrate on the function and integrity of the eyes, skin, gastro-intestinal system, blood, and respiratory system. Medical surveillance for respiratory disease should be conducted using the principles and methods recommended by the American Thoracic Society.

A pre-placement medical evaluation is recommended to assess medical conditions that may be aggravated or may result in increased risk when a worker is exposed to calcium chromate at or below the prescribed exposure limit. The health care professional should consider the probable frequency, intensity, and duration of exposure as well as the nature and degree of any applicable medical condition. Such conditions (which should not be regarded as absolute contraindications to job placement) include a history and other findings consistent with diseases of the eyes, skin, gastro-intestinal system, blood, or respiratory system.

* Periodic medical evaluations

Occupational health interviews and physical examinations should be performed at regular intervals during the employment period, as mandated by any applicable Federal, State, or local standard. Where no standard exists and the hazard is minimal, evaluations should be conducted every 3 to 5 years or as frequently as recommended by an experienced occupational health physician. Additional examinations may be necessary if a worker develops symptoms attributable to calcium chromate exposure. The interviews, examinations, and medical screening tests should focus on identifying the adverse effects of calcium chromate on the eyes, skin, gastro-intestinal system, blood, or respiratory system. Current health status should be compared with the baseline health status of the individual worker or with expected values for a suitable reference population.

* Termination medical evaluations

The medical, environmental, and occupational history interviews, the physical examination, and selected physiologic or laboratory tests that were conducted at the time of placement should be repeated at the time of job transfer or termination to determine the worker's medical status at the end of his or her employment. Any changes in the worker's health status should be compared with those expected for a suitable reference population. Because occupational exposure to calcium chromate may cause diseases with prolonged latent periods, the need for medical surveillance may extend well beyond the termination of employment.

* Biological monitoring

Biological monitoring involves sampling and analyzing body tissues or fluids to provide an index of exposure to a toxic substance or metabolite. No biological monitoring test acceptable for routine use has yet been developed for calcium chromate.

WORKPLACE MONITORING AND MEASUREMENT

OSHA's method for the determination of a worker's exposure to airborne calcium chromate is made using a low ash polyvinyl chloride (LAPVC) filter (5 microns). Samples are collected at a maximum flow rate of 2 liters/minute (ceiling) until a maximum collection volume of 960 liters is reached. The sample is then treated with a carbonate/bicarbonate buffer. Analysis is conducted by polarographic analysis. This method (OSHA method ID-103) is described in the OSHA Computerized Information System [OSHA 1994] and is fully validated.

NIOSH has two published methods for the determination of a worker's exposure to calcium chromate both of which require sample collection on polyvinyl chloride filters (5 microns). The samples for both methods are collected at flow rates of 1 to 4 liters/minute. Method No. 7600 lists a minimum collection volume of 8 liters and a maximum collection volume of 400 liters. For this method, samples are analyzed by visible absorption spectrophotometry. Method No. 7604 lists a minimum collection volume of 100 liters and a maximum collection volume of 1000 liters. For this method, samples are analyzed by ion chromatography using a conductivity detection system [NIOSH 1994c].


Controls

PERSONAL HYGIENE PROCEDURES

If calcium chromate contacts the skin, workers should immediately wash the affected areas with large amounts of soap and water.

Clothing contaminated with calcium chromate should be removed immediately, and provisions should be made for the safe removal of the chemical from the clothing. Persons laundering the clothes should be informed of the hazardous properties of calcium chromate.

A worker who handles calcium chromate should thoroughly wash hands, forearms, and face with soap and water before eating, using tobacco products, using toilet facilities, applying cosmetics, or taking medication.

Workers should not eat, drink, use tobacco products, apply cosmetics, or take medication in areas where calcium chromate is handled, processed, or stored.

STORAGE

Calcium chromate should be stored in a cool, dry, well-ventilated area in tightly sealed containers that are labeled in accordance with OSHA's Hazard Communication Standard [29 CFR 1910.1200]. Containers of calcium chromate should be protected from physical damage and should be stored separately from organic matter, reducing agents, paper, wood, aluminum, plastics, sulfur, acids, ethanol, hydrazine, and boron.

SPILLS AND LEAKS

In the event of a spill or leak involving calcium chromate, persons not wearing protective equipment and clothing should be restricted from contaminated areas until cleanup has been completed. The following steps should be undertaken following a spill or leak:
  1. Do not touch the spilled material; stop the leak if it is possible to do so without risk.
  2. Notify safety personnel.
  3. Ventilate the area of the spill or leak.
  4. For small dry spills, use a clean shovel and place the material into a clean, dry container; cover and remove the container from the spill area. Use damp mop or vacuum with the appropriate filter to minimize dust generation.
  5. For small liquid spills, take up with sand or other noncombustible absorbent material and place into closed containers for later disposal.
  6. For large liquid spills, build dikes far ahead of the spill to contain the calcium chromate for later reclamation or disposal.
SPECIAL REQUIREMENTS

U.S. Environmental Protection Agency (EPA) requirements for emergency planning, reportable quantities of hazardous releases, community right-to-know, and hazardous waste management may change over time. Users are therefore advised to determine periodically whether new information is available.

* Emergency planning requirements

Calcium chromate is not subject to EPA emergency planning requirements under the Superfund Amendments and Reauthorization Act (SARA) ( Title III) in 42 USC 11022.

* Reportable quantity requirements for hazardous releases

A hazardous substance release is defined by EPA as any spilling, leaking, pumping, pouring, emitting, emptying, discharging, injecting, escaping, leaching, dumping, or disposing into the environment (including the abandonment or discarding of contaminated containers) of hazardous substances. In the event of a release that is above the reportable quantity for that chemical, employers are required to notify the proper Federal, State, and local authorities [40 CFR 355.40].

The reportable quantity of calcium chromate is 10 pounds. If an amount equal to or greater than this quantity is released within a 24-hour period in a manner that will expose persons outside the facility, employers are required to do the following:

- Notify the National Response Center immediately at (800) 424-8802 or at (202) 426-2675 in Washington, D.C. [40 CFR 302.6].

* Community right-to-know requirements

Employers who own or operate facilities in SIC codes 20 to 39 that employ 10 or more workers and that manufacture 25,000 pounds or more of calcium chromate per calendar year or otherwise use 10,000 pounds or more of calcium chromate per calendar year are required by EPA [40 CFR Part 372.30], as a chromium compound, to submit a Toxic Chemical Release Inventory form (Form R) to EPA reporting the amount of calcium chromate emitted or released from their facility annually.

* Hazardous waste management requirements

EPA considers a waste to be hazardous if it exhibits any of the following characteristics: ignitability, corrosivity, reactivity, or toxicity as defined in 40 CFR 261.21-261.24. Under the Resource Conservation and Recovery Act (RCRA) [40 USC 6901 et seq.], EPA has specifically listed many chemical wastes as hazardous. Calcium chromate is listed as a hazardous waste under RCRA and has been assigned EPA Hazardous Waste No. U032. This substance has been banned from land disposal.

Providing detailed information about the removal and disposal of specific chemicals is beyond the scope of this guideline. The U.S. Department of Transportation, EPA, and State and local regulations should be followed to ensure that removal, transport, and disposal of this substance are conducted in accordance with existing regulations. To be certain that chemical waste disposal meets EPA regulatory requirements, employers should address any questions to the RCRA hotline at (703) 412-9810 (in the Washington, D.C. area) or toll-free at (800) 424-9346 (outside Washington, D.C.). In addition, relevant State and local authorities should be contacted for information on any requirements they may have for the waste removal and disposal of this substance.

RESPIRATORY PROTECTION

* Conditions for respirator use

Good industrial hygiene practice requires that engineering controls be used where feasible to reduce workplace concentrations of hazardous materials to the prescribed exposure limit. However, some situations may require the use of respirators to control exposure. Respirators must be worn if the ambient concentration of calcium chromate exceeds prescribed exposure limits. Respirators may be used (1) before engineering controls have been installed, (2) during work operations such as maintenance or repair activities that involve unknown exposures, (3) during operations that require entry into tanks or closed vessels, and (4) during emergencies. Workers should only use respirators that have been approved by NIOSH and the Mine Safety and Health Administration (MSHA).

* Respiratory protection program

Employers should institute a complete respiratory protection program that, at a minimum, complies with the requirements of OSHA's Respiratory Protection Standard [29 CFR 1910.134]. Such a program must include respirator selection, an evaluation of the worker's ability to perform the work while wearing a respirator, the regular training of personnel, respirator fit testing, periodic workplace monitoring, and regular respirator maintenance, inspection, and cleaning. The implementation of an adequate respiratory protection program (including selection of the correct respirator) requires that a knowledgeable person be in charge of the program and that the program be evaluated regularly. For additional information on the selection and use of respirators and on the medical screening of respirator users, consult the latest edition of the NIOSH Respirator Decision Logic [NIOSH 1987b] and the NIOSH Guide to Industrial Respiratory Protection [NIOSH 1987a].

PERSONAL PROTECTIVE EQUIPMENT

Workers should use appropriate personal protective clothing and equipment that must be carefully selected, used, and maintained to be effective in preventing skin contact with calcium chromate. The selection of the appropriate personal protective equipment (PPE) (e.g., gloves, sleeves, encapsulating suits) should be based on the extent of the worker's potential exposure to calcium chromate. There are no published reports on the resistance of various materials to permeation by calcium chromate.

To evaluate the use of PPE materials with calcium chromate, users should consult the best available performance data and manufacturers' recommendations. Significant differences have been demonstrated in the chemical resistance of generically similar PPE materials (e.g., butyl) produced by different manufacturers. In addition, the chemical resistance of a mixture may be significantly different from that of any of its neat components.

Any chemical-resistant clothing that is used should be periodically evaluated to determine its effectiveness in preventing dermal contact. Safety showers and eye wash stations should be located close to operations that involve calcium chromate.

Splash-proof chemical safety goggles or face shields (20 to 30 cm long, minimum) should be worn during any operation in which a solvent, caustic, or other toxic substance may be splashed into the eyes.

In addition to the possible need for wearing protective outer apparel (e.g., aprons, encapsulating suits), workers should wear work uniforms, coveralls, or similar full-body coverings that are laundered each day. Employers should provide lockers or other closed areas to store work and street clothing separately. Employers should collect work clothing at the end of each work shift and provide for its laundering. Laundry personnel should be informed about the potential hazards of handling contaminated clothing and instructed about measures to minimize their health risk.

Protective clothing should be kept free of oil and grease and should be inspected and maintained regularly to preserve its effectiveness.

Protective clothing may interfere with the body's heat dissipation, especially during hot weather or during work in hot or poorly ventilated work environments.


References

ACGIH [1994]. 1994-1995 Threshold limit values for chemical substances and physical agents and biological exposure indices. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.

ATS [1987]. Standardization of spirometry -- 1987 update. American Thoracic Society. Am Rev Respir Dis 136:1285-1296.

CFR. Code of Federal regulations. Washington, DC: U.S. Government Printing Office, Office of the Federal Register.

DOT [1987]. 1987 Emergency response guidebook, guide 31. Washington, DC: U.S. Department of Transportation, Office of Hazardous Materials Transportation, Research and Special Programs Administration.

Genium [1992]. Material safety data sheet No. 818. Schenectady, NY: Genium Publishing Corporation.

Hathaway GJ, Proctor NH, Hughes JP, and Fischman ML [1991]. Proctor and Hughes' chemical hazards of the workplace. 3rd ed. New York, NY: Van Nostrand Reinhold.

Lewis RJ, ed. [1993]. Hawley's condensed chemical dictionary. 12th ed. New York, NY: Van Nostrand Reinhold Company.

Mickelsen RL, Hall RC [1987]. A breakthrough time comparison of nitrile and neoprene glove materials produced by different glove manufacturers. Am Ind Hyg Assoc J 48(11): 941-947.

Mickelsen RL, Hall RC, Chern RT, Myers JR [1991]. Evaluation of a simple weight-loss method for determining the permeation of organic liquids through rubber films. Am Ind Hyg Assoc J 52(10): 445-447.

NIOSH [1987a]. NIOSH guide to industrial respiratory protection. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 87-116.

NIOSH [1987b]. NIOSH respirator decision logic. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 87-108.

NIOSH [1992]. Recommendations for occupational safety and health: Compendium of policy documents and statements. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 92-100.

NIOSH [1994a]. Registry of toxic effects of chemical substances: Calcium chromate. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, Division of Standards Development and Technology Transfer, Technical Information Branch.

NIOSH [1994b]. NIOSH pocket guide to chemical hazards. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 94-116.

NIOSH [1994c]. NIOSH manual of analytical methods. 4th ed. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 94-113.

NLM [1993]. Hazardous substances data bank: Calcium chromate. Bethesda, MD: National Library of Medicine.

OSHA [1994]. Computerized information system. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration.

Sax NI, Lewis RJ [1989]. Dangerous properties of industrial materials. 7th ed. New York, NY: Van Nostrand Reinhold Company.

Sittig M [1991]. Handbook of toxic and hazardous chemicals. 3rd ed. Park Ridge, NJ: Noyes Publications.

USC. United States code. Washington. DC: U.S. Government Printing Office.

Windholz M, ed. [1983]. Merck Index 10th ed. Rahway, NJ: Merck & Company.


Introduction | Recognition | Evaluation | Controls | References