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California Hazardous Materials Inventory Form - Chemical Detription <br />(1) I ® ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME (4)I <br />RIPON FARM SERVICE <br />CHEMICALLOCATION(S)(5) <br /> <br />PAGE (2) F9 6 OF (3) F116 <br />CHEMICAL NAME (8) POTASSIUM NITRATE I TRADE SECRET (11) ❑YES ®NO <br />TYPE <br />(14) <br />❑ PURE ®MIXTURE <br />❑WASTE <br />*EHS (12) ❑YES ®NO <br />COMMON NAME <br />(9) <br />POTASSIUM NITRATE <br />❑ GAS <br />FED HAZARD <br />*IF EHS BOX IS "Y" <br />(18)®FIRE ❑ REACTIVE <br />CAS # <br />(10) <br />7757-79-1 <br />ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE <br />(13) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />HAZARD <br />4,000 <br />ON SITE <br />LEAVE BLANK <br />(21) <br />CATEGORIES <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br />TYPE <br />(14) <br />❑ PURE ®MIXTURE <br />❑WASTE <br />RADIOACTIVE (15) ❑ yE5 ®NO (16) N/A <br />PHYSICAL STATE (17) <br />CURIES <br />IN SOLID ❑ LIQUID <br />❑ GAS <br />FED HAZARD <br />CATEGORIES <br />(18)®FIRE ❑ REACTIVE <br />❑ PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE <br />CODE <br />(19) <br />UNITS* (22) ❑ GAL ®LBS <br />N/A ❑ CU FT ❑ TONS MAX Y AMT (23)10,000 <br />ON SITE <br />DAYS ON SITE <br />(20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) <br />365 <br />4,000 <br />ON SITE <br />LARGEST <br />(21) <br />ANNUAL WASTE AMT (25) <br />CONTAINER <br />50# <br />N/A <br />STORAGE <br />(26) <br />❑ ABOVE GROUND <br />TANK ❑ CAN ❑ BOX ❑ TAN <br />CONTAINER <br />❑ UNDER GROUND <br />TANK ❑ CARBOY ❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />STORAGE (27) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI <br />PRESSURE <br />STORAGE (28) IN AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />29 %WT 30 HAZARDOUS COMPONENT (3 1) EHS 32 CAS# <br />4.5 POTASSIUM ❑YES ON <br />7757-79-1 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES El <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 Usc Only: 0 C ❑ R ❑ S SIC 12/99 <br />