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California Hazardous Malials Inventory Form - Chemical Deeiption <br />(1) ® ADD ❑ DELETE ❑ REVISE PAGE (2) = OF (3) F116 <br />BUSINESS NAME (4) RIPON FARM SERVICE <br />CHEMICALLOCATION(S)(5) <br /> <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />AMMONIUM NITRATE <br />AMMONIUM NITRATE <br />6484-52-2 <br />FIRE CODE (13) <br />HAZARD LEAVE BLANK <br />CATEGORIES <br />TRADE SECRET (I1) ❑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) IN SOLID ❑ LIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES (18) IN FIRE ❑ REACTIVE ElPRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE (19) UNITS* (22) ❑ GAL ® LBS <br />CODE N/ ❑ CU FT ❑ TONS MAX DAILY AMT (23)120,000 <br />ON SITE <br />DAYS ON SITE (20)AVG DAILY AMT (24) 365 *If EHS, amounts must be in lbs 60,000 <br />D ON SITE <br />LARGEST (21� ANNUAL WASTE AMT (25) N/A <br />CONTAINER 50# bag <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 />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />STORAGE (27) <br />PRESSURE <br />STORAGE <br />(28) <br />® AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(291 %WT <br />(401 HA7ARnnrrs CnMPONFNT <br />(3 1) EHS <br />(32) CAS# <br />33.5 AMMONIUM NITRATE <br />❑YES ®N 6484-52-2 <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 2067 <br />(34) WHAT IS MATERIAL RETAIL SALES <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Onlv: ®C ❑ R ❑ S SJC 12/99 <br />