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California Hazardous aterials Inventory Form - Chemica !scription JAN 2 3 2004 PAGE (2) = OF (3) BUSINESS NAME (4 i-r1EMICAL LOCATIONS) ( CHEMICAL NAME (8) MAGNESIUM CHLORIDE TRADE SECRET (11) JO YES H NO COMMON NAME (9) ICE MELT *EHS (12) 10 YES ®NO *IF EHS BOX IS "Y" CAS # (10) 17786-30-3 ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CATEGORIES LEAVE BLANK TYPE (14)IS PURE ❑ MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ YES 19 (16) PHYSICAL STATE (17) IS SOLID ❑ LIQUID ❑ GAS CURIES FED HAZARD ❑ FIRE ElREACTIVE ❑ PRESSURE RELEASE ElACUTE HEALTH [:1CHRONIC HEALTH CATEGORIES (18) STATE WASTE (19) NA r')DE _ . YS ON SITE (20) 1365 LARGEST (21) 50 CONTAINER STORAGE (26) CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE UNITS* (22) ❑ GAL ® LBS MAX DAILY AMT (23) 3 5 0 ❑ CU FT ❑ TONS ON SITE *If EHS, amounts must be in lbs AVG DAILY AMT (24) 125 ON SITE ANNUAL WASTE AMT (25) INA []ABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TANP ❑ UNDER GROUND TANK [:]CARBOY ❑ CYLINDER ❑ RAIL ❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ OTHI ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ Other ❑ PLASTIC/NONMETALLIC DRUM ® BAG ❑ TOTE BIN (27) ®AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT [:]CRYOGENIC (30) HAZARDOUS COMPONENT (3 1) EHS (32) CAS# R4) DITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) NA WHAT IS MATERIAL FOR SALE USED FOR? DATE REC'D: iFor Official Use Only: IC ❑ R RS SJC 12/99 Tra OYES ON ❑YES ON ❑YES El ❑YES ON ❑YES El R4) DITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) NA WHAT IS MATERIAL FOR SALE USED FOR? DATE REC'D: iFor Official Use Only: IC ❑ R RS SJC 12/99 Tra