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California Hazardous Materials Inventory Form - Chemical DeS:'ription <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) = <br />OF (3) F116 <br />FARM SERVICE <br />CHEMICAL LOCATION(S) (5) <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />MONOCARBAMIDE DIHYDROGENSULFATE <br />N-PHURIC 15-0.0-49 <br />21351-39-3 <br />FIRE CODE (13) <br />HAZARD LEAVE BLANK <br />CATEGORIES <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 H LIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES (18)❑ FIRE ®REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ®CHRONIC HEALTH <br />STATE WASTE (19) UNITS* (22) ® GAL ❑ LBS <br />CODE N/A ❑ CU FT ❑TONS MAX DAILY AMT (23) 6,500 <br />ON SITE <br />DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 4,500 <br />ON SITE <br />LARGEST (21) 6500 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 />❑YES ❑N <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 />0Q1 %WT <br />(301 14A7AR1)(lfiS C0MP(PMNT <br />(3 1) EHS <br />(32) CAS# <br />79 <br />MONOCARBAMIDE DIHYDROGEN ❑YES ®N 21351-39-3 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) <br />(34) WHAT IS MATERIAL RETAIL SALES <br />USED FOR; <br />DATE REC'D: 12/14/01 For Official Use Only: ®C ❑ R [IS SIC 12/99 <br />