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California Hazardous Materials Inventory <br />(1) M ADD ❑ DELETE ❑ REVISE <br />BUSINESS NAME <br />CHEMICAL LOCATION(S) <br />MAP # (6) / GRID # (7) <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />FARM SERVICE <br /> <br /> <br />DRY FERTILIZER <br />DRY FERTILIZER <br />N/A <br />LEAVE BLANK <br />Form - Chemical De3"ription <br />PAGE (2) 51 OF (3)116 <br />TRADE SECRET (11) ❑YES M NO <br />*EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />TYPE <br />(14)❑PURE <br />❑MIXTURE ❑WASTE <br />RADIOACTIVE (15) ❑yES MNO(16) N/A <br />PHYSICAL STATE (17) <br />CURIES <br />M SOLID ❑ LIQUID ❑GAS <br />FED HAZARD <br />CATEGORIES <br />(18)I <br />❑ FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE <br />CODE <br />(19) <br />N/A <br />UNITS* (22) ❑ GAL M LBS <br />❑ CU FT ❑ TONS]MAX DAILY AMT (23) 600,000 <br />ON SITE <br />DAYS ON SITE (20) <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 250,000 <br />365 <br />ON SITE <br />LARGEST <br />CONTAINER <br />(21) <br />ANNUAL WASTE AMT (25) N/A <br />bulk <br />STORAGE <br />(26) <br />❑ ABOVE GROUND TANK <br />[]CAN ❑ BOX []TAN <br />CONTAINER <br />[]UNDER GROUND TANK <br />[]CARBOY ❑ CYLINDER ❑ RAI <br />❑ TANK INSIDE BUILDING <br />❑ SILO ❑ GLASS BOTTLE M Othe <br />❑ STEEL DRUM <br />❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM []BAG ❑ TOTE BIN <br />❑ AMBIENT ❑ ABOVE AMBIENT <br />❑ BELOW AMBI <br />STORAGE (27) <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />(28) <br />M AMBIENT []ABOVE AMBIENT <br />[]BELOW AMBIENT ❑ CRYOGENIC <br />(29) %WT <br />(30) HA7.ARDOUS COMPONENT <br />(3 1) EHS (32) CAS# <br />AMMONIUM NITRATE ❑ YES ZNq <br />6484-52-2 <br />CALCIUM PHOSPHATE ❑YES MN <br />7757-93-9 <br />DIAMONMONIUM PHOSPHATES ❑YES MN <br />7783-28-0 <br />POTTASIUM SULFATE ❑YES ❑N <br />7778-80-5 <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS H)# (DOT) <br />(34) WHAT IS MATERIAL RETAIL SALES <br />USED FOR? <br />DATE REC'D: 12/14/01 For Official Use Only: Mc ❑ R ❑ S SIC 12/99 <br />