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Version 1.0 1

CSAT Agriculture Survey

Questions Guide July 2010 Version 1.0

CSAT Agriculture Survey Questions Guide

U.S. Department of Homeland Security i

Table of Contents 1. General.................................................................................................................. 1 2. Facility Screening Information ................................................................................ 2 3. Agricultural Facility Customers .............................................................................. 3 4. COI Identification ................................................................................................... 7 5. COI-Containing Pesticide Products ...................................................................... 32 6. COI-Containing Fertilizer Products ...................................................................... 42 7. Other COI-Containing Products ........................................................................... 52 8. Finish ................................................................................................................... 62


U.S. Department of Homeland Security 1

1. General • The Agriculture Survey will collect information from the facilities being surveyed

about Chemicals of Interest (COI) and COI-containing products provided to their agricultural production customers as well as certain information, where available, about those customers’ use and handling of COI-containing products.

• Where information is requested for COI listed in Appendix A to 6 CFR Part 27, or for COI-containing product mixtures or blends (hereafter "COI-containing products"), please provide information for all COI or COI-containing products that meet or exceed the lowest applicable minimum concentration level established for that COI in Appendix A--whether or not the amount(s) of the COI(s) possessed by the facility exceed the applicable Screening Threshold Quantity(ies) in Appendix A--and that the facility sells, transfers, or commercially applies to agricultural facilities for agricultural activities. Facilities should not include COI or COI-containing products which are used exclusively as fuels in answering this questionnaire.

• For the purpose of this questionnaire:

o Agricultural activities means (1) preparation for the treatment of crops, feed, land, livestock (including poultry), or other areas of an agricultural facility; or (2) application to or treatment of crops, feed, land, livestock (including poultry), or other areas of an agricultural facility.

o Agricultural facility includes farms (e.g., crop, fruit, nut, and vegetable); ranches and rangeland; poultry, dairy, and equine facilities; turfgrass growers; golf courses; nurseries; floricultural operations; and public and private parks.



2. Facility Screening Information Does your facility sell, transfer, or commercially apply COI-containing products directly for use by an agricultural facility in the preparation for the treatment of crops, feed, land, livestock (including poultry) or other areas of an agricultural facility? [Q:1.0-23756]

Yes No

Does your facility sell, transfer, or commercially apply COI-containing products directly for use by an agricultural facility during application to or treatment of crops, feed, land, livestock (including poultry) or other areas of an agricultural facility? [Q:1.0-23757]

Yes No



3. Agricultural Facility Customers

NAICS Codes Using the U.S. Census Bureau's North American Industry Classification System (NAICS) codes, identify all of your agricultural facility customers - specifically, your agricultural facility customers (other than chemical distribution facilities or commercial chemical application services) to whom you sell, transfer or commercially apply COI for use in agricultural activities:

• In preparation for the treatment of crops, feed, land, livestock (including poultry) or other areas of an agricultural production facility; or

• During application to or treatment of crops, feed, land, livestock (including poultry) or other areas of an agricultural production facility.

Such customers may include farms (e.g., crop, fruit, nut and vegetable); ranches and rangeland; poultry, dairy and equine facilities; turfgrass growers; golf courses; nurseries; floricultural operations; and public and private parks.

Below are the NAICS codes that DHS believes relate to agricultural activities. You may have others. Each NAICS code title links to the definition of the specific code at the NAICS website.

NAICS Code

Customer Type Does this NAICS code describe your agricultural facility customers? [Q:2.0-23861]

1111 Oilseed and Grain Farming Yes No

1112 Vegetable and Melon Farming Yes No

1113 Fruit and Tree Nut Farming Yes No

1114 Greenhouse, Nursery, and Floriculture Production

Yes No

1119 Other Crop Farming Yes No

112111 Beef Cattle Ranching and Farming Yes No

112112 Cattle Feedlots Yes No

112120 Dairy Cattle and Milk Production Yes No

112130 Dual-Purpose Cattle Ranching and Farming

Yes No

112210 Hog and Pig Farming Yes No

1123 Poultry and Egg Production Yes No

1124 Sheep and Goat Farming Yes No

11251 Aquaculture Yes No



NAICS Code

Customer Type Does this NAICS code describe your agricultural facility customers? [Q:2.0-23861]

1129 Other Animal Production Yes No

113110 Timber Tract Operations Yes No

113210 Forest Nurseries and Gathering of Forest Products

Yes No

11511 Support Activities for Crop Production (includes Soil Preparation, Planting, & Cultivation)

Yes No

11521 Support Activities for Animal Production

Yes No

11531 Support Activities for Forestry Yes No

53131 Real Estate Property Managers Yes No

54171 Research and Development in the Physical, Engineering, and Life Sciences

Yes No

611 Educational Services Yes No

711310 Promoters of Performing Arts, Sports, and Similar Events with Facilities

Yes No

712130 Zoos and Botanical Gardens Yes No

712190 Nature Parks and Other Similar Institutions

Yes No

712120 Historical Sites Yes No

713110 Amusement and Theme Parks Yes No

713910 Golf Courses and Country Clubs Yes No

Add other NAICS codes not listed above.

If you have agricultural facility customers that do not fit one of the descriptions/definitions in the above section, please click here which will take you to the NAICS website where you can identify the appropriate NAICS code(s) to list in the text field below. After typing in each NAICS code, click the "Add" button to add it to the list of additional NAICS codes describing your customers.

NAICS Code [Q:2.0-24819] NAICS Code Description [Q:2.0-23864]

Have you listed all NAICS codes that describe your agricultural facility customers? [Q:2.0-23858]

Add



Yes No

Facility/Customer Relations Does your facility transfer possession of any COI-containing product(s) to any of your agricultural facility customers (e.g., the COI-containing product leaves your facility with a customer and there is no delivery or commercial application by your facility)? [Q:2.1-24423]

Yes No

Does your facility commercially apply any COI-containing product(s) to any of your agricultural facility customers? [Q:2.1-24424]

Yes No

Does your facility deliver any COI-containing product(s) to any of your agricultural facility customers? [Q:2.1-24426]

Yes No

Does your facility place security-related conditions or restrictions (e.g., voluntary company, association, or industry customer and/or purchaser verification programs) on the sale of any of the COI-containing product(s) to any of your agricultural facility customers? [Q:2.1-24427]

Yes No

Are any of the COI-containing product(s) that you commercially apply stored at your agricultural facility customers' facilities before, during, or after commercial application? [Q:2.2-24822]

Yes No



Customer Activities To the best of your knowledge, do any of your agricultural facility customers ship any COI-containing product(s)? [Q:2.3-24400]

Yes No Don’t Know

To the best of your knowledge, do any of your agricultural facility customers resell any COI-containing product(s)? [Q:2.3-24401]

Yes No Don’t Know

To the best of your knowledge, do any of your agricultural facility customers implement security measures for any COI-containing product(s)? [Q:2.3-24402]

Yes No Don’t Know

To the best of your knowledge, do any of your agricultural facility customers participate in any mandatory or voluntary security programs (e.g., voluntary company, association, or industry programs or state or territorial programs) for any COI-containing product(s)? [Q:2.3-24403]

Yes No Don’t Know



4. COI Identification

Chemicals of Interest Identify each COI in COI-containing products at or above the lowest Appendix A minimum concentration, regardless of the screening threshold quantity, that you sell, transfer or commercially apply to agricultural facilities.

The COI that your facility identified in its Top-Screen are listed in the table below. The minimum concentration provided is the lowest from Appendix A and may be lower than those applicable to your facility's Top-Screen. For each COI in column 1 that you sell, transfer, or commercially apply to agricultural facilities, indicate whether the COI functions as:

• a pesticide (including active ingredients, fumigants, sterilants and COI used in food preparation/preservation);

• a fertilizer (including as a fertilizer ingredient); or

• any other agriculture-related purpose.

If a COI performs different functions in different products, click all that apply (e.g., a COI that functions as a pesticide in one product but a fertilizer in another).

Chemical of Interest

CAS# Min. Conc.

Pesticide [Q:2.5-24039]

Fertilizer [Q:2.5-24033]

Other [Q:2.5-24034]

Chemical X XXX-X XXX% Yes No Yes No Yes No

Do you possess any other COI-containing products at or above the lowest Appendix A minimum concentration - regardless of the Appendix A screening threshold quantity - that you sell, transfer or commercially apply to agricultural facilities? [Q:2.5-24048]

Yes No

The remaining Appendix A COI are listed in the table below. For each of COI in column 1 that you sell, transfer, or commercially apply to agricultural facilities indicate whether the COI functions as:

• a pesticide (including active ingredients, fumigants, sterilants and COI used in food preparation/preservation);

• a fertilizer (including as a fertilizer ingredient); or

• any other agriculture-related purpose.

If a COI performs different functions in different products, click all that apply (e.g., a COI that functions as a pesticide in one product but a fertilizer in another).



Chemical of Interest CAS# Min. Conc. Pesticide [Q:2.6-24053]


Other [Q:2.6-24055]

Acetaldehyde 75-07-0 1.00% Yes No Yes No Yes No

Acetone cyanohydrin, stabilized 75-86-5 ACG Yes No Yes No Yes No

Acetyl bromide 506-96-7 ACG Yes No Yes No Yes No

Acetyl chloride 75-36-5 ACG Yes No Yes No Yes No

Acetyl iodide 507-02-8 ACG Yes No Yes No Yes No

Acetylene [Ethyne] 74-86-2 1.00% Yes No Yes No Yes No

Acrolein [2-Propenal or Acrylaldehyde] 107-02-8 1.00% Yes No Yes No Yes No

Acrylonitrile [2-Propenenitrile] 107-13-1 1.00% Yes No Yes No Yes No

Acrylyl chloride [2-Propenoyl chloride] 814-68-6 1.00% Yes No Yes No Yes No

Allyl alcohol [2-Propen-1-ol] 107-18-6 1.00% Yes No Yes No Yes No

Allylamine [2-Propen-1-amine] 107-11-9 1.00% Yes No Yes No Yes No

Allyltrichlorosilane, stabilized 107-37-9 ACG Yes No Yes No Yes No

Aluminum (powder) 7429-90-5 ACG Yes No Yes No Yes No

Aluminum bromide, anhydrous 7727-15-3 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

Aluminum chloride, anhydrous 7446-70-0 ACG Yes No Yes No Yes No

Aluminum phosphide 20859-73-8 ACG Yes No Yes No Yes No

Ammonia (anhydrous) 7664-41-7 1.00% Yes No Yes No Yes No

Ammonia (conc. 20% or greater) 7664-41-7 20.00% Yes No Yes No Yes No

Ammonium nitrate, [with more than 0.2 percent combustible substances, including any organic substance calculated as carbon, to the exclusion of any other added substance]

6484-52-2 ACG Yes No Yes No Yes No

Ammonium nitrate, solid [nitrogen concentration of 23% nitrogen or greater]

6484-52-2 33.00% Yes No Yes No Yes No

Ammonium perchlorate 7790-98-9 ACG Yes No Yes No Yes No

Ammonium picrate 131-74-8 ACG Yes No Yes No Yes No

Amyltrichlorosilane 107-72-2 ACG Yes No Yes No Yes No

Antimony pentafluoride 7783-70-2 ACG Yes No Yes No Yes No

Arsenic trichloride [Arsenous trichloride] 7784-34-1 1.00% Yes No Yes No Yes No

Arsine 7784-42-1 1.00% Yes No Yes No Yes No

Barium azide 18810-58-7 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

1,4-Bis(2-chloroethylthio)-n-butane 142868-93-7 Yes No Yes No Yes No

Bis(2-chloroethylthio)methane 63869-13-6 Yes No Yes No Yes No

Bis(2-chloroethylthiomethyl)ether 63918-90-1 Yes No Yes No Yes No

1,5-Bis(2-chloroethylthio)-n-pentane 142868-94-8 Yes No Yes No Yes No

1,3-Bis(2-chloroethylthio)-n-propane 63905-10-2 Yes No Yes No Yes No

Boron tribromide 10294-33-4 ACG Yes No Yes No Yes No

Boron trichloride [Borane, trichloro] 10294-34-5 1.00% Yes No Yes No Yes No

Boron trifluoride [Borane, trifluoro] 7637-07-2 1.00% Yes No Yes No Yes No

Boron trifluoride compound with methyl ether (1:1) Yes No Yes No Yes No

[Boron, trifluoro [oxybis (methane)]-,T-4-] 353-42-4 1.00% Yes No Yes No Yes No

Bromine 7726-95-6 1.00% Yes No Yes No Yes No

Bromine chloride 13863-41-7 9.67% Yes No Yes No Yes No

Bromine pentafluoride 7789-30-2 ACG Yes No Yes No Yes No

Bromine trifluoride 7787-71-5 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

Bromotrifluorethylene [Ethene, bromotrifluoro-] 598-73-2 1.00% Yes No Yes No Yes No

1,3-Butadiene 106-99-0 1.00% Yes No Yes No Yes No

Butane 106-97-8 1.00% Yes No Yes No Yes No

Butene 25167-67-3 1.00% Yes No Yes No Yes No

1-Butene 106-98-9 1.00% Yes No Yes No Yes No

2-Butene 107-01-7 1.00% Yes No Yes No Yes No

2-Butene-cis 590-18-1 1.00% Yes No Yes No Yes No

2-Butene-trans [2-Butene, (E)] 624-64-6 1.00% Yes No Yes No Yes No

Butyltrichlorosilane 7521-80-4 ACG Yes No Yes No Yes No

Calcium hydrosulfite [Calcium dithionite] 15512-36-4 ACG Yes No Yes No Yes No

Calcium phosphide 1305-99-3 ACG Yes No Yes No Yes No

Carbon disulfide 75-15-0 1.00% Yes No Yes No Yes No

Carbon oxysulfide [Carbon oxide sulfide (COS); carbonyl sulfide]


Carbonyl fluoride 353-50-4 12.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Carbonyl sulfide 463-58-1 56.67% Yes No Yes No Yes No

Chlorine 7782-50-5 1.00% Yes No Yes No Yes No

Chlorine dioxide [Chlorine oxide, (ClO2)] 10049-04-4 ACG Yes No Yes No Yes No

Chlorine monoxide [Chlorine oxide] 7791-21-1 1.00% Yes No Yes No Yes No

Chlorine pentafluoride 13637-63-3 4.07% Yes No Yes No Yes No

Chlorine trifluoride 7790-91-2 9.97% Yes No Yes No Yes No

Chloroacetyl chloride 79-04-9 ACG Yes No Yes No Yes No

2-Chloroethylchloro-methylsulfide 2625-76-5 Yes No Yes No Yes No

Chloroform [Methane, trichloro-] 67-66-3 1.00% Yes No Yes No Yes No

Chloromethyl ether [Methane, oxybis(chloro-)] 542-88-1 1.00% Yes No Yes No Yes No

Chloromethyl methyl ether [Methane, chloromethoxy-]


1-Chloropropylene [1-Propene, 1-chloro-] 590-21-6 1.00% Yes No Yes No Yes No

2-Chloropropylene [1-Propene, 2-chloro-] 557-98-2 1.00% Yes No Yes No Yes No

Chlorosulfonic acid 7790-94-5 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

Chromium oxychloride 14977-61-8 ACG Yes No Yes No Yes No

Crotonaldehyde [2-Butenal] 4170-30-3 1.00% Yes No Yes No Yes No

Crotonaldehyde, (E)- [2-Butenal], (E)-] 123-73-9 1.00% Yes No Yes No Yes No

Cyanogen [Ethanedinitrile] 460-19-5 1.00% Yes No Yes No Yes No

Cyanogen chloride 506-77-4 1.00% Yes No Yes No Yes No

Cyclohexylamine [Cyclohexanamine] 108-91-8 1.00% Yes No Yes No Yes No

Cyclohexyltrichlorosilane 98-12-4 ACG Yes No Yes No Yes No

Cyclopropane 75-19-4 1.00% Yes No Yes No Yes No

DF [Methyl phosphonyl difluoride] 676-99-3 Yes No Yes No Yes No

Diazodinitrophenol 87-31-0 ACG Yes No Yes No Yes No

Diborane 19287-45-7 1.00% Yes No Yes No Yes No

Dichlorosilane [Silane, dichloro-] 4109-96-0 1.00% Yes No Yes No Yes No

N,N-(2-diethylamino)ethanethiol 100-38-9 30.00% Yes No Yes No Yes No

o,o-Diethyl S-[2-(diethylamino)ethyl] phosphorothiolate






Other [Q:2.6-24055]

Diethyl methylphosphonite 15715-41-0 30.00% Yes No Yes No Yes No

N,N-Diethyl phosphoramidic dichloride 1498-54-0 30.00% Yes No Yes No Yes No

Diethyldichlorosilane 1719-53-5 ACG Yes No Yes No Yes No

Diethyleneglycol dinitrate 693-21-0 ACG Yes No Yes No Yes No

Difluoroethane [Ethane, 1,1-difluoro-] 75-37-6 1.00% Yes No Yes No Yes No

Dimethylamine [Methanamine, N-methyl-] 124-40-3 1.00% Yes No Yes No Yes No

N,N-(2-diisopropylamino)ethanethiol [N,N-diisopropyl-β-aminoethane thiol]


N,N-Diisopropyl phosphoramidic dichloride 23306-80-1 30.00% Yes No Yes No Yes No

N,N-(2-dimethylamino)ethanethiol 108-02-1 30.00% Yes No Yes No Yes No

N,N-Dimethyl phosphoramidic dichloride [Dimethylphosphoramido-dichloridate]


N,N-(2-dipropylamino)ethanethiol 5842-06-8 30.00% Yes No Yes No Yes No

N,N-Dipropyl phosphoramidic dichloride 40881-98-9 30.00% Yes No Yes No Yes No

Dimethyldichlorosilane [Silane, dichlorodimethyl-] 75-78-5 ACG Yes No Yes No Yes No

1,1-Dimethylhydrazine [Hydrazine, 1, 1-dimethyl-] 57-14-7 1.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

2,2-Dimethylpropane [Propane, 2,2-dimethyl-] 463-82-1 1.00% Yes No Yes No Yes No

Dingu [Dinitroglycoluril] 55510-04-8 ACG Yes No Yes No Yes No

Dinitrogen tetroxide 10544-72-6 3.80% Yes No Yes No Yes No

Dinitrophenol 25550-58-7 ACG Yes No Yes No Yes No

Dinitroresorcinol 519-44-8 ACG Yes No Yes No Yes No

Diphenyldichlorosilane 80-10-4 ACG Yes No Yes No Yes No

Dipicryl sulfide 2217-06-3 ACG Yes No Yes No Yes No

Dipicrylamine [or] Hexyl [Hexanitrodiphenylamine] 131-73-7 ACG Yes No Yes No Yes No

Dodecyltrichlorosilane 4484-72-4 ACG Yes No Yes No Yes No

Epichlorohydrin [Oxirane, (chloromethyl)-] 106-89-8 1.00% Yes No Yes No Yes No

Ethane 74-84-0 1.00% Yes No Yes No Yes No

Ethyl acetylene [1-Butyne] 107-00-6 1.00% Yes No Yes No Yes No

Ethyl chloride [Ethane, chloro-] 75-00-3 1.00% Yes No Yes No Yes No

Ethyl ether [Ethane, 1,1-oxybis-] 60-29-7 1.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Ethyl mercaptan [Ethanethiol] 75-08-1 1.00% Yes No Yes No Yes No

Ethyl nitrite [Nitrous acid, ethyl ester] 109-95-5 1.00% Yes No Yes No Yes No

Ethyl phosphonyl difluoride 753-98-0 Yes No Yes No Yes No

Ethylamine [Ethanamine] 75-04-7 1.00% Yes No Yes No Yes No

Ethyldiethanolamine 139-87-7 80.00% Yes No Yes No Yes No

Ethylene [Ethene] 74-85-1 1.00% Yes No Yes No Yes No

Ethylene oxide [Oxirane] 75-21-8 1.00% Yes No Yes No Yes No

Ethylenediamine [1,2-Ethanediamine] 107-15-3 1.00% Yes No Yes No Yes No

Ethyleneimine [Aziridine] 151-56-4 1.00% Yes No Yes No Yes No

Ethylphosphonothioic dichloride 993-43-1 30.00% Yes No Yes No Yes No

Ethyltrichlorosilane 115-21-9 ACG Yes No Yes No Yes No

Fluorine 7782-41-4 1.00% Yes No Yes No Yes No

Fluorosulfonic acid 7789-21-1 ACG Yes No Yes No Yes No

Formaldehyde (solution) 50-00-0 1.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Furan 110-00-9 1.00% Yes No Yes No Yes No

Germane 7782-65-2 20.73% Yes No Yes No Yes No

Germanium tetrafluoride 7783-58-6 2.11% Yes No Yes No Yes No

Guanyl nitrosaminoguanylidene hydrazine ACG Yes No Yes No Yes No

Hexaethyl tetraphosphate and compressed gas mixtures


Hexafluoroacetone 684-16-2 15.67% Yes No Yes No Yes No

Hexanitrostilbene 20062-22-0 ACG Yes No Yes No Yes No

Hexolite [Hexotol] 121-82-4 ACG Yes No Yes No Yes No

Hexyltrichlorosilane 928-65-4 ACG Yes No Yes No Yes No

HMX [Cyclotetramethylenetetranitramine] 2691-41-0 ACG Yes No Yes No Yes No

HN1 (Nitrogen Mustard-1) [Bis(2-chloroethyl)ethylamine]

538-07-8 Yes No Yes No Yes No

HN2 (Nitrogen Mustard-2) [Bis(2-chloroethyl)methylamine]


HN3 (Nitrogen Mustard-3) [Tris(2-chloroethyl)amine] 555-77-1 Yes No Yes No Yes No





Other [Q:2.6-24055]

Hydrazine 302-01-2 1.00% Yes No Yes No Yes No

Hydrochloric acid (conc. 37% or greater) 7647-01-0 37.00% Yes No Yes No Yes No

Hydrocyanic acid 74-90-8 1.00% Yes No Yes No Yes No

Hydrofluoric acid (conc. 50% or greater) 7664-39-3 50.00% Yes No Yes No Yes No

Hydrogen 1333-74-0 1.00% Yes No Yes No Yes No

Hydrogen bromide (anhydrous) 10035-10-6 95.33% Yes No Yes No Yes No

Hydrogen chloride (anhydrous) 7647-01-0 ACG Yes No Yes No Yes No

Hydrogen cyanide [Hydrocyanic acid] 74-90-8 4.67% Yes No Yes No Yes No

Hydrogen fluoride (anhydrous) 7664-39-3 1.00% Yes No Yes No Yes No

Hydrogen iodide, anhydrous 10034-85-2 95.33% Yes No Yes No Yes No

Hydrogen peroxide (concentration of at least 35%) 7722-84-1 35.00% Yes No Yes No Yes No

Hydrogen selenide 7783-07-5 0.07% Yes No Yes No Yes No

Hydrogen sulfide 7783-06-4 1.00% Yes No Yes No Yes No

Iodine pentafluoride 7783-66-6 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

Iron, pentacarbonyl- [Iron carbonyl (Fe(CO)5), (TB5-11)-]


Isobutane [Propane, 2-methyl] 75-28-5 1.00% Yes No Yes No Yes No

Isobutyronitrile [Propanenitrile, 2-methyl-] 78-82-0 1.00% Yes No Yes No Yes No

Isopentane [Butane, 2-methyl-] 78-78-4 1.00% Yes No Yes No Yes No

Isoprene [1,3-Butadiene, 2-methyl-] 78-79-5 1.00% Yes No Yes No Yes No

Isopropyl chloride [Propane, 2-chloro-] 75-29-6 1.00% Yes No Yes No Yes No

Isopropyl chloroformate [Carbonochloridic acid, 1-methylethyl ester]


Isopropylamine [2-Propanamine] 75-31-0 1.00% Yes No Yes No Yes No

Isopropylphosphonothioic dichloride 1498-60-8 30.00% Yes No Yes No Yes No

Isopropylphosphonyl difluoride 677-42-9 Yes No Yes No Yes No

Lead azide 13424-46-9 ACG Yes No Yes No Yes No

Lead styphnate [Lead trinitroresorcinate] 15245-44-0 ACG Yes No Yes No Yes No

Lewisite 1 [2-chlorovinyldichloroarsine] 541-25-3 Yes No Yes No Yes No

Lewisite 2 [Bis(2-chlorovinyl)chloroarsine] 40334-69-8 Yes No Yes No Yes No





Other [Q:2.6-24055]

Lewisite 3 [Tris(2-chlorovinyl)arsine] 40334-70-1 Yes No Yes No Yes No

Lithium amide 7782-89-0 ACG Yes No Yes No Yes No

Lithium nitride 26134-62-3 ACG Yes No Yes No Yes No

Magnesium (powder) 7439-95-4 ACG Yes No Yes No Yes No

Magnesium diamide 7803-54-5 ACG Yes No Yes No Yes No

Magnesium phosphide 12057-74-8 ACG Yes No Yes No Yes No

MDEA [Methyldiethanolamine] 105-59-9 80.00% Yes No Yes No Yes No

Mercury fulminate 628-86-4 ACG Yes No Yes No Yes No

Methacrylonitrile [2-Propenenitrile, 2-methyl-] 126-98-7 1.00% Yes No Yes No Yes No

Methane 74-82-8 1.00% Yes No Yes No Yes No

2-Methyl-1-butene 563-46-2 1.00% Yes No Yes No Yes No

3-Methyl-1-butene 563-45-1 1.00% Yes No Yes No Yes No

Methyl chloride [Methane, chloro-] 74-87-3 1.00% Yes No Yes No Yes No

Methyl chloroformate [Carbonochloridic acid, methyl ester]






Other [Q:2.6-24055]

Methyl ether [Methane, oxybis-] 115-10-6 1.00% Yes No Yes No Yes No

Methyl formate [Formic acid Methyl ester] 107-31-3 1.00% Yes No Yes No Yes No

Methyl hydrazine [Hydrazine, methyl-] 60-34-4 1.00% Yes No Yes No Yes No

Methyl isocyanate [Methane, isocyanato-] 624-83-9 1.00% Yes No Yes No Yes No

Methyl mercaptan [Methanethiol] 74-93-1 1.00% Yes No Yes No Yes No

Methyl thiocyanate [Thiocyanic acid, methyl ester] 556-64-9 1.00% Yes No Yes No Yes No

Methylamine [Methanamine] 74-89-5 1.00% Yes No Yes No Yes No

Methylchlorosilane 993-00-0 20.00% Yes No Yes No Yes No

Methyldichlorosilane 75-54-7 ACG Yes No Yes No Yes No

Methylphenyldichlorosilane 149-74-6 ACG Yes No Yes No Yes No

Methylphosphonothioic dichloride 676-98-2 30.00% Yes No Yes No Yes No

2-Methylpropene [1-Propene, 2-methyl-] 115-11-7 1.00% Yes No Yes No Yes No

Methyltrichlorosilane [Silane, trichloromethyl-] 75-79-6 ACG Yes No Yes No Yes No

O-Mustard (T) [Bis(2-chloroethylthioethyl)ether] 63918-89-8 Yes No Yes No Yes No





Other [Q:2.6-24055]

Nickel Carbonyl 13463-39-3 1.00% Yes No Yes No Yes No

Nitric acid 7697-37-2 68.00% Yes No Yes No Yes No

Nitric oxide [Nitrogen oxide (NO)] 10102-43-9 1.00% Yes No Yes No Yes No

Nitrobenzene 98-95-3 ACG Yes No Yes No Yes No

5-Nitrobenzotriazol 2338-12-7 ACG Yes No Yes No Yes No

Nitrocellulose 9004-70-0 ACG Yes No Yes No Yes No

Nitrogen mustard hydrochloride [Bis(2-chloroethyl)methylamine hydrochloride]


Nitrogen trioxide 10544-73-7 3.83% Yes No Yes No Yes No

Nitroglycerine 55-63-0 ACG Yes No Yes No Yes No

Nitromannite [Mannitol hexanitrate, wetted] 15825-70-4 ACG Yes No Yes No Yes No

Nitromethane 75-52-5 ACG Yes No Yes No Yes No

Nitrostarch 9056-38-6 ACG Yes No Yes No Yes No

Nitrosyl chloride 2696-92-6 1.17% Yes No Yes No Yes No

Nitrotriazolone 932-64-9 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

Nonyltrichlorosilane 5283-67-0 ACG Yes No Yes No Yes No

Octadecyltrichlorosilane 112-04-9 ACG Yes No Yes No Yes No

Octolite 57607-37-1 ACG Yes No Yes No Yes No

Octonal 78413-87-3 ACG Yes No Yes No Yes No

Octyltrichlorosilane 5283-66-9 ACG Yes No Yes No Yes No

Oleum (Fuming Sulfuric acid) [Sulfuric acid, mixture with sulfur trioxide]


Oxygen difluoride 7783-41-7 0.09% Yes No Yes No Yes No

1,3-Pentadiene 504-60-9 1.00% Yes No Yes No Yes No

Pentane 109-66-0 1.00% Yes No Yes No Yes No

1-Pentene 109-67-1 1.00% Yes No Yes No Yes No

2-Pentene, (E)- 646-04-8 1.00% Yes No Yes No Yes No

2-Pentene, (Z)- 627-20-3 1.00% Yes No Yes No Yes No

Pentolite 8066-33-9 ACG Yes No Yes No Yes No

Peracetic acid [Ethaneperoxic acid] 79-21-0 1.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Perchloromethylmercaptan [Methanesulfenyl chloride, trichloro-]


Perchloryl fluoride 7616-94-6 25.67% Yes No Yes No Yes No

PETN [Pentaerythritol tetranitrate] 78-11-5 ACG Yes No Yes No Yes No

Phenyltrichlorosilane 98-13-5 ACG Yes No Yes No Yes No

Phosgene [Carbonic dichloride] or [carbonyl dichloride]


Phosphine 7803-51-2 0.67% Yes No Yes No Yes No

Phosphorus 7723-14-0 ACG Yes No Yes No Yes No

Phosphorus oxychloride [Phosphoryl chloride] 10025-87-3 ACG Yes No Yes No Yes No

Phosphorus pentabromide 7789-69-7 ACG Yes No Yes No Yes No

Phosphorus pentachloride 10026-13-8 ACG Yes No Yes No Yes No

Phosphorus pentasulfide 1314-80-3 ACG Yes No Yes No Yes No

Phosphorus trichloride 7719-12-2 ACG Yes No Yes No Yes No

Picrite [Nitroguanidine] 556-88-7 ACG Yes No Yes No Yes No

Piperidine 110-89-4 1.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Potassium chlorate 3811-04-9 ACG Yes No Yes No Yes No

Potassium cyanide 151-50-8 ACG Yes No Yes No Yes No

Potassium nitrate 7757-79-1 ACG Yes No Yes No Yes No

Potassium perchlorate 7778-74-7 ACG Yes No Yes No Yes No

Potassium permanganate 7722-64-7 ACG Yes No Yes No Yes No

Potassium phosphide 20770-41-6 ACG Yes No Yes No Yes No

Propadiene [1,2-Propadiene] 463-49-0 1.00% Yes No Yes No Yes No

Propane 74-98-6 1.00% Yes No Yes No Yes No

Propionitrile [Propanenitrile] 107-12-0 1.00% Yes No Yes No Yes No

Propyl chloroformate [Carbonchloridic acid, propylester]


Propylene [1-Propene] 115-07-1 1.00% Yes No Yes No Yes No

Propylene oxide [Oxirane, methyl-] 75-56-9 1.00% Yes No Yes No Yes No

Propyleneimine [Aziridine, 2-methyl-] 75-55-8 1.00% Yes No Yes No Yes No

Propylphosphonothioic dichloride 2524-01-8 30.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Propylphosphonyl difluoride 690-14-2 Yes No Yes No Yes No

Propyltrichlorosilane 141-57-1 ACG Yes No Yes No Yes No

Propyne [1-Propyne] 74-99-7 1.00% Yes No Yes No Yes No

QL [o-Ethyl-o-2-diisopropylaminoethyl methylphosphonite]


RDX [Cyclotrimethylenetrinitramine] 121-82-4 ACG Yes No Yes No Yes No

RDX and HMX mixtures 121-82-4 ACG Yes No Yes No Yes No

Sarin [o-Isopropyl methylphosphonofluoridate] 107-44-8 Yes No Yes No Yes No

Selenium hexafluoride 7783-79-1 1.67% Yes No Yes No Yes No

Sesquimustard [1,2-Bis(2-chloroethylthio)ethane] 3563-36-8 Yes No Yes No Yes No

Silane 7803-62-5 1.00% Yes No Yes No Yes No

Silicon tetrachloride 10026-04-7 ACG Yes No Yes No Yes No

Silicon tetrafluoride 7783-61-1 15.00% Yes No Yes No Yes No

Sodium azide 26628-22-8 ACG Yes No Yes No Yes No

Sodium chlorate 7775-09-9 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

Sodium cyanide 143-33-9 ACG Yes No Yes No Yes No

Sodium hydrosulfite [Sodium dithionite] 7775-14-6 ACG Yes No Yes No Yes No

Sodium nitrate 7631-99-4 ACG Yes No Yes No Yes No

Sodium phosphide 12058-85-4 ACG Yes No Yes No Yes No

Soman [o-Pinacolyl methylphosphonofluoridate] 96-64-0 Yes No Yes No Yes No

Stibine 7803-52-3 0.67% Yes No Yes No Yes No

Strontium phosphide 12504-16-4 ACG Yes No Yes No Yes No

Sulfur dioxide (anhydrous) 7446-09-5 1.00% Yes No Yes No Yes No

Sulfur Mustard (Mustard gas (H)) [Bis(2-chloroethyl)sulfide]


Sulfur tetrafluoride [Sulfur fluoride (SF4), (T-4)-] 7783-60-0 1.00% Yes No Yes No Yes No

Sulfur trioxide 7446-11-9 1.00% Yes No Yes No Yes No

Sulfuryl chloride 7791-25-5 ACG Yes No Yes No Yes No

Tabun [o-Ethyl-N,N-dimethylphosphoramido-cyanidate]


Tellurium hexafluoride 7783-80-4 0.83% Yes No Yes No Yes No





Other [Q:2.6-24055]

Tetrafluoroethylene [Ethene, tetrafluoro-] 116-14-3 1.00% Yes No Yes No Yes No

Tetramethyllead [Plumbane, tetramethyl-] 75-74-1 1.00% Yes No Yes No Yes No

Tetramethylsilane [Silane, tetramethyl-] 75-76-3 1.00% Yes No Yes No Yes No

Tetranitroaniline 53014-37-2 ACG Yes No Yes No Yes No

Tetranitromethane [Methane, tetranitro-] 509-14-8 1.00% Yes No Yes No Yes No

Tetrazene [Guanyl nitrosaminoguanyltetrazene] 109-27-3 ACG Yes No Yes No Yes No

1H-Tetrazole 288-94-8 ACG Yes No Yes No Yes No

Thiodiglycol [Bis(2-hydroxyethyl)sulfide] 111-48-8 30.00% Yes No Yes No Yes No

Thionyl chloride 7719-09-7 ACG Yes No Yes No Yes No

Titanium tetrachloride [Titanium chloride (TiCl4) (T-4)-]

7550-45-0 ACG Yes No Yes No Yes No

TNT [Trinitrotoluene] 118-96-7 ACG Yes No Yes No Yes No

Torpex [Hexotonal] 67713-16-0 ACG Yes No Yes No Yes No

Trichlorosilane [Silane, trichloro-] 10025-78-2 ACG Yes No Yes No Yes No

Triethanolamine 102-71-6 80.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Triethanolamine hydrochloride 637-39-8 80.00% Yes No Yes No Yes No

Triethyl phosphite 122-52-1 80.00% Yes No Yes No Yes No

Trifluoroacetyl chloride 354-32-5 6.93% Yes No Yes No Yes No

Trifluorochloroethylene [Ethene, chlorotrifluoro] 79-38-9 1.00% Yes No Yes No Yes No

Trimethyl phosphite 121-45-9 80.00% Yes No Yes No Yes No

Trimethylamine [Methanamine, N,N-dimethyl-] 75-50-3 1.00% Yes No Yes No Yes No

Trimethylchlorosilane [Silane, chlorotrimethyl-] 75-77-4 ACG Yes No Yes No Yes No

Trinitroaniline 26952-42-1 ACG Yes No Yes No Yes No

Trinitroanisole 606-35-9 ACG Yes No Yes No Yes No

Trinitrobenzene 99-35-4 ACG Yes No Yes No Yes No

Trinitrobenzenesulfonic acid 2508-19-2 ACG Yes No Yes No Yes No

Trinitrobenzoic acid 129-66-8 ACG Yes No Yes No Yes No

Trinitrochlorobenzene 88-88-0 ACG Yes No Yes No Yes No

Trinitrofluorenone 129-79-3 ACG Yes No Yes No Yes No





Other [Q:2.6-24055]

Trinitro-meta-cresol 602-99-3 ACG Yes No Yes No Yes No

Trinitronaphthalene 55810-17-8 ACG Yes No Yes No Yes No

Trinitrophenetole 4732-14-3 ACG Yes No Yes No Yes No

Trinitrophenol 88-89-1 ACG Yes No Yes No Yes No

Trinitroresorcinol 82-71-3 ACG Yes No Yes No Yes No

Tritonal 54413-15-9 ACG Yes No Yes No Yes No

Tungsten hexafluoride 7783-82-6 7.10% Yes No Yes No Yes No

Vinyl acetate monomer [Acetic acid ethenyl ester] 108-05-4 1.00% Yes No Yes No Yes No

Vinyl acteylene [1-Buten-3-yne] 689-97-4 1.00% Yes No Yes No Yes No

Vinyl chloride [Ethene, chloro-] 75-01-4 1.00% Yes No Yes No Yes No

Vinyl ethyl ether [Ethene, ethoxy-] 109-92-2 1.00% Yes No Yes No Yes No

Vinyl fluoride [Ethene, fluoro-] 75-02-5 1.00% Yes No Yes No Yes No

Vinyl methyl ether [Ethene, methoxy-] 107-25-5 1.00% Yes No Yes No Yes No

Vinylidene chloride [Ethene, 1,1-dichloro-] 75-35-4 1.00% Yes No Yes No Yes No





Other [Q:2.6-24055]

Vinylidene fluoride [Ethene, 1,1-difluoro-] 75-38-7 1.00% Yes No Yes No Yes No

Vinyltrichlorosilane 75-94-5 ACG Yes No Yes No Yes No

VX [o-Ethyl-S-2-diisopropylaminoethyl methyl phosphonothiolate]


Zinc hydrosulfite [Zinc dithionite] 7779-86-4 ACG Yes No Yes No Yes No



5. COI-Containing Pesticide Products

Identify Pesticide Products For each COI that you identified previously as a pesticide, identify each pesticide product that you sell, transfer or commercially apply to agricultural facilities.

In responding to this question, include all COI-containing pesticide products that your facility has sold, transferred or commercially applied in the past year and all that your facility anticipates selling, transferring, or commercially applying in the coming year. Do not include pesticides that are no longer available in commerce (e.g., pesticides without an active registration).

If the pesticide product is shown in the table below, select the EPA Pesticide Registration Number and corresponding product name which appear on the pesticide label. If your product's name is not shown in this table, you will need to add the EPA registration number and the different product name in the section farther down on this page.

In the text fields below, enter in the EPA Registration Number and pesticide product name of any other pesticide products which are not listed in the previous table. Provide only the numbers on each side of the first hyphen of the EPA Registration Number (e.g., 123-456-798). Click "Add" to add the pesticide product to the list.

EPA Registration Number

[Q:3.0-24183] Pesticide Product

[Q:3.0-23881]

Have you listed all COI-containing pesticide products that you sell, transfer, or commercially apply to agricultural facilities? [Q:3.0-23870]

Yes No

All Pesticide Products Click "Describe" to provide the requested information for each pesticide product.

EPA Registration Number – Product Name [Q:3.1-23898]

XXX-XXX-XXX – Product X

Add

Describe: XXX-XXX-XXX – Product X



Have you described all pesticide products listed above? [Q:3.1-24268]

Yes No

Pesticide Product Ingredients Indicate the percent by weight of all COI present in XXX-XXX-XXX - Product X

Confirm Appendix A COI present in the pesticide product at or above the lowest Appendix A minimum concentration by clicking Yes if the percent by weight provided is correct for the COI listed on the pesticide label. If the COI is correct and the percent by weight is wrong, click "Yes" and correct the percent by weight. Click "Yes" and add the percent by weight for any additional COI in the pesticide product at or above the lowest Appendix A minimum concentration. (The percent by weight of active ingredients is listed on the pesticide product label.) If percent by weight must be rounded, enter values that are rounded to two decimal places.

Chemical of Interest CAS# Min. Conc.

COI present in Pesticide? [Q:3.2-24041]

Percent by Weight [Q:3.2-24042]

Chemical X XXX-X XXX% Yes No

Pesticide Product Containers Add an entry for each type of container that you sell, transfer, or commercially apply of XXX-XXX-XXX – Product X, using the net weight or net content listed on the pesticide label. Express the net weight in the Amount column as the largest applicable unit, rounding, if necessary, to two decimal places (i.e., express 5 pounds, 4 ounces as 5.25 pounds). Click "Add" to add the container type to the list.

Container [Q:3.25-23944]

Amount [Q:3.25-23945]

Unit [Q:3.25-23946]

Add



Customer Types for COI-Containing Pesticide Products Identify the customer type(s) to whom you sell, transfer, or for whom you commercially apply XXX-XXX-XXX – Product X.

Customer Types [Q:3.3-23942]

Do you sell, transfer, or commercially apply the pesticide to this customer type? [Q:3.3-23943]

Customer Type X Yes No

Customers for COI-Containing Pesticide Products Click "Provide" to provide the requested information for each customer type with regards to XXX-XXX-XXX – Product X.


Customer Type X

Have you answered the questions for all customer types associated with this pesticide? [Q:3.4-23949]

Yes No

Facility/Customer Relations for Pesticide/Customer Pairs In the Facility Information section, you answered a number of questions about your facility and customer relations. Based on those responses, you will be directed to answer specific questions about each COI-containing product and customer combination. Click Next to continue.

Do you transfer possession of XXX-XXX-XXX – Product X to Customer Type X customers (e.g., the COI-containing product leaves your facility with a customer and there is no delivery or commercial application by your facility)? [Q:3.41-24942]

Yes No

Provide Customer Type X Detail Information



Do you commercially apply XXX-XXX-XXX – Product X to Customer Type X customers and the product is stored at the customer facilities before, during or after commercial application? [Q:3.41-24943]

Yes No

Do you deliver XXX-XXX-XXX – Product X to Customer Type X customers? [Q:3.41-24944]

Yes No

Pesticide Products Transferred to Agricultural Facility Customers If you transfer possession of XXX-XXX-XXX – Product X consistently throughout the year, enter the number of containers you typically transfer each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If you transfer possession of XXX-XXX-XXX – Product X on an as needed basis, leave the text box blank.

Container Types [Q:3.6-23976]

Amount [Q:3.6-23992]

Units [Q:3.6-23994]

Year Round [Q:3.6-23941]

Container X XX XX

If the number of containers you transfer is not consistent throughout the year, enter the number of containers you typically transfer each month for each container type in the column corresponding to each month below. If you do not typically transfer possession of XXX-XXX-XXX – Product X during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If you transfer possession of XXX-XXX-XXX – Product X on an as needed basis, leave the text box blank.

Container Types

[Q:3.6-23996]

Amount

[Q:3.6-23997]

Units

[Q:3.6-23998]

January

[Q:3.6-24000]

February

[Q:3.6-24001]

March

[Q:3.6-24002]

April

[Q:3.6-24003]

May

[Q:3.6-24004]

June

[Q:3.6-24005]

Container X XX XX



Container Types

[Q:3.6-23991]

Amount

[Q:3.6-23993]

Units

[Q:3.6-23995]

July

[Q:3.6-

23970]

August

[Q:3.6-23971]

September

[Q:3.6-23972]

October

[Q:3.6-23973]

November

[Q:3.6-23974]

December

[Q:3.6-23975]

Container X XX XX

Pesticide Products Commercially Applied and Stored for Agricultural Facility Customers If you commercially apply XXX-XXX-XXX – Product X consistently throughout the year, enter the number of containers you typically store at the customer's site each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If XXX-XXX-XXX – Product X is stored at the customer’s site on an as needed basis, leave the text box blank.


Amount [Q:3.7-24199]

Units [Q:3.7-24200]


Container X XX XX

If the number of containers you store at the customer's site is not consistent throughout the year, enter the number of containers you typically store each month for each container type in the column corresponding to each month below. If you do not typically store XXX-XXX-XXX – Product X at the customer's site during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If XXX-XXX-XXX – Product X is stored at the customer’s site on an as needed basis, leave the text box blank.

Container Types

[Q:3.7-24202]

Amount

[Q:3.7-24203]

Units

[Q:3.7-24204]

January

[Q:3.7-24205]

February

[Q:3.7-24206]

March

[Q:3.7-24207]

April

[Q:3.7-24208]

May

[Q:3.7-24209]

June

[Q:3.7-24210]

Container X XX XX



Container Types

[Q:3.7-24211]

Amount

[Q:3.7-24212]

Units

[Q:3.7-24213]

July

[Q:3.7-

24214]

August

[Q:3.7-24215]

September

[Q:3.7-24216]

October

[Q:3.7-24217]

November

[Q:3.7-24218]

December

[Q:3.7-24219]

Container X XX XX

Pesticide Products Delivered to Agricultural Facility Customers If you deliver XXX-XXX-XXX – Product X consistently throughout the year, enter the number of containers you typically deliver each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If XXX-XXX-XXX – Product X is delivered on an as needed basis, leave the text box blank.


Amount [Q:3.8-24224]

Units [Q:3.8-24225]


Container X XX XX

If the number of containers you deliver is not consistent throughout the year, enter the number of containers you typically deliver each month in the column corresponding to each month below. If you do not typically deliver the product during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If XXX-XXX-XXX – Product X is delivered on an as needed basis, leave the text box blank.

Container Types

[Q:3.8-24227]

Amount

[Q:3.8-24228]

Units

[Q:3.8-24229]

January

[Q:3.8-24230]

February

[Q:3.8-24231]

March

[Q:3.8-24232]

April

[Q:3.8-24233]

May

[Q:3.8-24234]

June

[Q:3.8-24235]

Container X XX XX

Container Types

[Q:3.8-24236]

Amount

[Q:3.8-24237]

Units

[Q:3.8-24238]

July

[Q:3.8-

24239]

August

[Q:3.8-24240]

September

[Q:3.8-24241]

October

[Q:3.8-24242]

November

[Q:3.8-24243]

December

[Q:3.8-24244]

Container X XX XX



Security Restrictions Placed on Sale of Pesticide Products Do you place any security-related conditions or restrictions on the sale of this product to these customers? [Q:3.91-24496]

Yes No

Do you follow a company or facility policy/program? [Q:3.92-24478]

Yes No

Do you follow an industry/association program? [Q:3.92-24479]

Yes No

If Yes, please enter the association and program name. [Q:3.92-24480]

Do you follow a state security regulatory program? [Q:3.92-24481]

Yes No

If Yes, please identify the state of the regulatory program (select all that apply). [Q:3.92-24482]

If you place any other condition or restriction that is not listed above, please describe the security-related condition or restriction in this text field. [Q:3.92-24483]

Add



Pesticide Customer Activities To the best of your knowledge, do any of these customers ship this product? [Q:3.925-24502]

Yes No Don’t Know

To the best of your knowledge, do any of these customers resell this product? [Q:3.925-24508]

Yes No Don’t Know

To the best of your knowledge, do any of these customers implement security measures for this product? [Q:3.925-24514]

Yes No Don’t Know

To the best of your knowledge, do any of these customers participate in any mandatory or voluntary security programs for this product? [Q:3.925-24520]

Yes No Don’t Know

Customer Security Measures Do you believe that any of these customers have access control measures in place? [Q:3.93-23952]

Yes No Don’t Know

Do you believe that any of these customers have physical security measures in place (e.g., locked or fenced storage enclosures, lighted storage areas, valve locks, motion detector lights, or alarms)? [Q:3.93-23953]

Yes No Don’t Know



Do you believe that any of these customers have inventory control measures in place? [Q:3.93-23954]

Yes No Don’t Know

Do you believe that any of these customers have security procedures in place (e.g., regular security inspection of storage area and security measures, transaction records/logs, procedures for reporting tampering or loss)? [Q:3.93-23955]

Yes No Don’t Know

Do you believe that any of these customers have security awareness measures in place (e.g., procedures for identifying and reporting suspicious behavior)? [Q:3.93-23956]

Yes No Don’t Know

Do you believe these customers have other security measures in place? If so, please describe the customer's security measures in this text field. [Q:3.93-23957]

Customer Security Programs Do you believe that any of these customers have a company or facility policy/program in place? [Q:3.94-23959]

Yes No Don’t Know

Do you believe that any of these customers follow an industry/association program? [Q:3.94-23965]

Yes No Don’t Know




Do you believe that any of these customers follow a state security regulatory program? [Q:3.94-23967]

Yes No Don’t Know


If you believe an agriculture facility customer follows some other security program not listed above, please describe the customer's security programs in this text field. [Q:3.94-23968]

Add



6. COI-Containing Fertilizer Products

Identify Fertilizer Products For each COI that you identified previously as a fertilizer, identify each fertilizer product that you sell, transfer, or commercially apply to agricultural facilities.

In responding to this question, include all COI-containing fertilizer products that your facility has sold, transferred, or commercially applied in the past year and all that your facility anticipates selling, transferring, or commercially applying in the coming year.

List of COI Used in Fertilizers

The following list shows all COI that you have indicated are used as a fertilizer.


Chemical Y YYY-Y YYY%

In the text fields below, enter a unique product name for each fertilizer product that you sell, transfer, or commercially apply to agricultural facilities. Click "Add" to add the fertilizer product to the list and then click "Describe" to provide the requested information for each fertilizer product.

Fertilizer Name

[Q:4.0-23978]

Product Y

Have you described all COI-containing fertilizers that you sell, transfer, or commercially apply to agricultural facilities? [Q:4.0-24395]

Yes No

Describe: Product Y

Add

Delete



Fertilizer Product Ingredients Indicate the percent by weight of all COI present in Product Y

Identify all Appendix A COI present in Product Y in an amount at or above the lowest Appendix A minimum concentration. (The percent by weight of active ingredients is available from the product label or MSDS.) Enter values that are rounded to two decimal places.


COI present in Fertilizer? [Q:4.2-24493]


Chemical Y YYY-Y YYY% Yes No

Fertilizer Product Containers Add an entry for each size container that you sell, transfer, or commercially apply of Product Y, using the drop down box selections below. If you select "Flexible Intermediate Bulk Container (pounds)" or "Other Bulk Container (pounds)" enter the number of pounds in the "Additional Information" column. If you select ">55 gallons","Tank Truck (gallons)," or "Rail Car (gallons)" enter the number of gallons in the "Additional Information" column. Otherwise, leave the "Additional Information" column blank. Click "Add" to add the container size to the list.

Container Size [Q:4.25-24174]

Additional Information [Q:4.25-24175]

Customer Types for COI-Containing Fertilizer Products Identify the customer type(s) to whom you sell, transfer, or for whom you commercially apply Product Y.


Do you sell, transfer, or commercially apply the fertilizer to this customer type? [Q:4.3-24261]

Customer Type Y Yes No

Add



Customers for COI-Containing Fertilizer Products Click "Provide" to provide the requested information for each customer type with regards to Product Y.


Customer Type Y

Have you answered the questions for all customer types associated with this fertilizer? [Q:4.4-24265]

Yes No

Facility/Customer Relations In the Facility Information section, you answered a number of questions about your facility and customer relations. Based on those responses, you will be directed to answer specific questions about each COI-containing product and customer combination. Click Next to continue.

Do you transfer possession of Product Y to Customer Type Y customers (e.g., the COI-containing product leaves your facility with a customer and there is no delivery or commercial application by your facility)? [Q:4.41-24956]

Yes No

Do you commercially apply Product Y to Customer Type Y customers and the product is stored at the customer facilities before, during or after commercial application? [Q:4.41-24957]

Yes No

Do you deliver Product Y to Customer Type Y customers? [Q:4.41-24958]

Yes No

Provide Customer Type Y Detail Information



Fertilizer Products Transferred to Agricultural Facility Customers If you transfer possession of Product Y consistently throughout the year, enter the number of containers you typically transfer each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If you transfer possession of Product Y on an as needed basis, leave the text box blank.


Additional Weight Information [Q:4.6-24538]


Container Y YY

If the number of containers you transfer is not consistent throughout the year, enter the number of containers you typically transfer each month for each container type in the column corresponding to each month below. If you do not typically transfer possession of Product Y during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If you transfer possession of Product Y on an as needed basis, leave the text box blank.

Container Types

[Q:4.6-24541]

Additional Weight Information

[Q:4.6-24542]

January

[Q:4.6-24543]

February

[Q:4.6-24544]

March

[Q:4.6-24545]

April

[Q:4.6-24546]

May

[Q:4.6-24547]

June

[Q:4.6-24548]

Container Y YY

Container Types

[Q:4.6-24550]


[Q:4.6-24551]

July

[Q:4.6-

24552]

August

[Q:4.6-24553]

September

[Q:4.6-24554]

October

[Q:4.6-24555]

November

[Q:4.6-24556]

December

[Q:4.6-24557]

Container Y YY



Fertilizer Products Commercially Applied and Stored for Agricultural Facility Customers If you commercially apply Product Y consistently throughout the year, enter the number of containers you typically store at the customer's site each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If Product Y is stored at the customer’s site on an as needed basis, leave the text box blank.




Container Y YY

If the number of containers you store at the customer's site is not consistent throughout the year, enter the number of containers you typically store each month for each container type in the column corresponding to each month below. If you do not typically store Product Y at the customer's site during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If Product Y is stored at the customer’s site on an as needed basis, leave the text box blank.

Container Types

[Q:4.7-24565]


[Q:4.7-24566]

January

[Q:4.7-24567]

February

[Q:4.7-24568]

March

[Q:4.7-24569]

April

[Q:4.7-24570]

May

[Q:4.7-24571]

June

[Q:4.7-24572]

Container Y YY

Container Types

[Q:4.7-24574]


[Q:4.7-24575]

July

[Q:4.7-

24576]

August

[Q:4.7-24577]

September

[Q:4.7-24578]

October

[Q:4.7-24579]

November

[Q:4.7-24580]

December

[Q:4.7-24581]

Container Y YY



Fertilizer Products Delivered to Agricultural Facility Customers If you deliver Product Y consistently throughout the year, enter the number of containers you typically deliver each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If Product Y is delivered to the customer’s site on an as needed basis, leave the text box blank.




Container Y YY

If the number of containers you deliver is not consistent throughout the year, enter the number of containers you typically deliver each month in the column corresponding to each month below. If you do not typically deliver Product Y during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If Product Y is delivered to the customer’s site on an as needed basis, leave the text box blank.

Container Types

[Q:4.8-24589]


[Q:4.8-24590]

January

[Q:4.8-24591]

February

[Q:4.8-24592]

March

[Q:4.8-24593]

April

[Q:4.8-24594]

May

[Q:4.8-24595]

June

[Q:4.8-24596]

Container Y YY

Container Types

[Q:4.8-24598]


[Q:4.8-24599]

July

[Q:4.8-

24600]

August

[Q:4.8-24601]

September

[Q:4.8-24602]

October

[Q:4.8-24603]

November

[Q:4.8-24604]

December

[Q:4.8-24605]

Container Y YY



Security Restrictions Placed on Sale of Fertilizer Products Do you place any security-related conditions or restrictions on the sale of this product to these customers? [Q:4.91-24613]

Yes No


Yes No


Yes No



Yes No



Add



Fertilizer Customer Activities To the best of your knowledge, do any of these customers ship this product? [Q:4.925-24614]

Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know




Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know



Yes No Don’t Know


Yes No Don’t Know





Yes No Don’t Know


Add




7. Other COI-Containing Products

Identify Other Products For each COI that you identified previously as used for some purpose other than as a pesticide or fertilizer, identify each product that you sell, transfer, or commercially apply to agricultural facilities.

In responding to this question, include all COI-containing products (other than pesticides or fertilizers) that your facility has sold, transferred, or commercially applied in the past year and all that your facility anticipates selling, transferring, or commercially applying in the coming year.

List of COI Used in Other Products

The following list shows all COI that you have indicated are used as other products.


Chemical Z ZZZ-Z ZZZ%

In the text fields below, enter a unique name for each product (other than pesticides or fertilizers) that you sell, transfer, or commercially apply to agricultural facilities. Click "Add" to add the product to the list and then click "Describe" to provide the requested information for each product.

Product Name

[Q:5.0-24439]

Product Z

Have you described all COI-containing products (

Add

other than pesticides or fertilizers) that you sell, transfer, or commercially apply to agricultural facilities? [Q:5.0-24441]

Yes No

Describe: Product Z Delete



Other Product Ingredients Describe the use of the product. [Q:5.2-24485]

Indicate the percent by weight of all COI present in Product Z

Identify all Appendix A COI present in Product Z in an amount at or above the lowest Appendix A minimum concentration. (The percent by weight of active ingredients may be available from the product label or MSDS.) Enter values that are rounded to two decimal places.


COI present in Product?

[Q:5.2-24468]


Chemical Z ZZZ-Z ZZZ% Yes No

Other Product Containers Add an entry for each size container that you sell, transfer, or commercially apply of Product Z, using the drop down box selections below. If you select "Flexible Intermediate Bulk Container (pounds)" or "Other Bulk Container (pounds)" enter the number of pounds in the "Additional Information" column. If you select ">55 gallons","Tank Truck (gallons)," or "Rail Car (gallons)" enter the number of gallons in the "Additional Information" column. Otherwise, leave the "Additional Information" column blank. Click "Add" to add the container size to the list.

Container Size [Q:5.25-24452]

Additional Information [Q:5.25-24453]

Add



Customer Types for Other COI-Containing Products Identify the customer type(s) to whom you sell, transfer, or for whom you commercially apply Product Z.


Do you sell, transfer, or commercially apply the fertilizer to this customer type? [Q:5.3-24457]

Customer Type Z Yes No

Customers for Other COI-Containing Products Click "Provide" to provide the requested information for each customer type with regards to Product Z.


Customer Type Z

Have you answered the questions for all customer types associated with this product? [Q:5.4-24461]

Yes No

Other Product Use by Customers In the Facility Information section, you answered a number of questions about your facility and customer relations. Based on those responses, you will be directed to answer specific questions about each COI-containing product and customer combination. Click Next to continue.

Do you transfer possession of Product Z to Customer Type Z customers (e.g., the COI-containing product leaves your facility with a customer and there is no delivery or commercial application by your facility)? [Q:5.41-24964]

Yes No

Provide Customer Type Z Detail Information



Do you commercially apply Product Z to Customer Type Z customers and the product is stored at the customer facilities before, during or after commercial application? [Q:5.41-24965]

Yes No

Do you deliver Product Z to Customer Type Z customers? [Q:5.41-24966]

Yes No

Other Products Transferred to Agricultural Facility Customers If you transfer possession of Product Z consistently throughout the year, enter the number of containers you typically transfer each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If you transfer possession of Product Z on an as needed basis, leave the text box blank.




Container Z ZZ

If the number of containers you transfer is not consistent throughout the year, enter the number of containers you typically transfer each month for each container type in the column corresponding to each month below. If you do not typically transfer possession of Product Z during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If you transfer possession of Product Z on an as needed basis, leave the text box blank.

Container Types

[Q:5.6-24657]


[Q:5.6-24658]

January

[Q:5.6-24659]

February

[Q:5.6-24660]

March

[Q:5.6-24661]

April

[Q:5.6-24662]

May

[Q:5.6-24663]

June

[Q:5.6-24664]

Container Z ZZ



Container Types

[Q:5.6-24666]


[Q:5.6-24667]

July

[Q:5.6-

24668]

August

[Q:5.6-24669]

September

[Q:5.6-24670]

October

[Q:5.6-24671]

November

[Q:5.6-24672]

December

[Q:5.6-24673]

Container Z ZZ

Other Products Commercially Applied and Stored for Agricultural Facility Customers If you commercially apply Product Z consistently throughout the year, enter the number of containers you typically store at the customer's site each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If Product Z is stored at the customer’s site on an as needed basis, leave the text box blank.




Container Z ZZ

If the number of containers you store at the customer's site is not consistent throughout the year, enter the number of containers you typically store each month for each container type in the column corresponding to each month below. If you do not typically store Product Z at the customer's site during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If Product Z is stored at the customer’s site on an as needed basis, leave the text box blank.

Container Types

[Q:5.7-24681]


[Q:5.7-24682]

January

[Q:5.7-24683]

February

[Q:5.7-24684]

March

[Q:5.7-24685]

April

[Q:5.7-24686]

May

[Q:5.7-24687]

June

[Q:5.7-24688]

Container Z ZZ



Container Types

[Q:5.7-24690]


[Q:5.7-24691]

July

[Q:5.7-

24692]

August

[Q:5.7-24693]

September

[Q:5.7-24694]

October

[Q:5.7-24695]

November

[Q:5.7-24696]

December

[Q:5.7-24697]

Container Z ZZ

Other Products Delivered to Agricultural Facility Customers If you deliver Product Z consistently throughout the year, enter the number of containers you typically deliver each month for each container type in the column marked "Year Round". Enter a value that has been rounded to the closest whole number. If Product Z is delivered to the customer’s site on an as needed basis, leave the text box blank.




Container Z ZZ

If the number of containers you deliver is not consistent throughout the year, enter the number of containers you typically deliver each month in the column corresponding to each month below. If you do not typically deliver Product Z during a particular month or for a particular container type, leave that field blank. Enter values that have been rounded to the closest whole number. If Product Z is delivered to the customer’s site on an as needed basis, leave the text box blank.

Container Types

[Q:5.8-24705]


[Q:5.8-24706]

January

[Q:5.8-24707]

February

[Q:5.8-24708]

March

[Q:5.8-24709]

April

[Q:5.8-24710]

May

[Q:5.8-24711]

June

[Q:5.8-24712]

Container Z ZZ

Container Types

[Q:5.8-24714]


[Q:5.8-24715]

July

[Q:5.8-

24716]

August

[Q:5.8-24717]

September

[Q:5.8-24718]

October

[Q:5.8-24719]

November

[Q:5.8-24720]

December

[Q:5.8-24721]

Container Z ZZ



Security Restrictions Placed on Sale of Other Products Do you place any security-related conditions or restrictions on the sale of this product to these customers? [Q:5.91-24729]

Yes No


Yes No


Yes No



Yes No



Add



Describe Customer Use To the best of your knowledge, do any of these customers ship this product? [Q:5.925-24730]

Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know




Yes No Don’t Know


Yes No Don’t Know


Yes No Don’t Know



Yes No Don’t Know


Yes No Don’t Know





Yes No Don’t Know



Add



8. Finish

DHS Communications A letter acknowledging receipt of the Agriculture Survey will be sent to the Submitter.

Preparer Copy Do you want a copy of the letter acknowledging receipt of the Agriculture Survey to be sent to the Preparer in addition to the Submitter? [Q:9.9-24387]

Yes No

Submission Statement My statements in this submission are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both. (See section 1001 of title 18, United States Code).

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