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California Hazardous Matals Inventory (1) SMD ❑ DELETE ❑ REVISE BUSINESS NAME CHEMICAL LOCATIONS) MAP # (6) / GRID # (7) CHEMICAL NAME (8) COMMON NAME (9) CAS # (10) FIRE CODE (13) HAZARD CATEGORIES FARM SERVICE (5) Form - Chemical Acription CALCIUM AMMONIUM NITRATE SOLUTION CAN - 17 10124-37-5 & 6484-52-2 LEAVE BLANK PAGE (2) = OF (3) 116 TRADE SECRET (11) ❑YES B NO *EHS (12) *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS TYPE (14)❑PURE ®MIXTURE ❑WASTE RADIOACTIVE(15) ❑YES BN0(16) N/A PHYSICAL STATE (17) CURIES ❑ SOLID B LIQUID ❑GAS FED HAZARD CATEGORIES (18) ❑YES ❑N ❑ FIRE ❑ REACTIVE [IPRESSURE RELEASE B ACUTE HEALTH ❑ CHRONIC HEALTH STATE WASTE CODE (19) N/A UNITS* (22) B GAL ❑ LBS ❑ CU FT ❑ TONS MAX DAILY AMT (23)15,000 ON SITE DAYS ON SITE (20) *If EHS, amounts must be in lbs AVG DAILY AMT (24) 365 8,000 ON SITE LARGEST CONTAINER (21 ANNUAL WASTE AMT (25) N/A 20000 STORAGE (26) B ABOVE GROUND TANK ❑ CAN []BOX ❑ TAN CONTAINER []UNDER GROUND TANK []CARBOY ❑ CYLINDER ❑ RAI ❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ Othe ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE STORAGE (27) B AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBI PRESSURE STORAGE (28) B AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT []CRYOGENIC TEMPERATURE 29 %WT 30 HAZARDOUS COMPONENT (31) EHS 32 CAS# 36.50 CALCIUM NITRATE ❑YES BN 10124-37-5 30.90 AMMONIUM NITRATE ❑ YES B N 6484-52-2 ❑YES ❑N ❑YES ❑N ❑YES ❑N ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) (34) WHAT IS MATERIAL RETAIL SALE USED FOR? DATE REC'D: 12/14/01 For Official Use Only: B C 0 R ❑ S SIC 12/99