Form 8700-29 Tier One Emergency and Hazardous Chemical Inventory

Revisions to the Emergency and Hazardous Chemical Inventory Forms (Tier I and Tier II), Section 312 of the Emergency Planning and Community Right-to-Know Act (EPCRA) (Proposed Rule)

2436supp01 - Tier I Inventory Form PROPOSED 04 28 11

Private Facilities

OMB: 2050-0206

Document [doc]
Download: doc | pdf

Check if information below is identical to the information submitted last year.

Tier One

Emergency and Hazardous Chemical Inventory

Aggregate Information by Hazard Type


Reporting Period: January 1 to December 31, 20____

Facility Identification

Name

TRI Facility ID

RMP ID




Street

County

City

State

Zip

Phone Number






( )

Latitude

Longitude

NAICS Code




Dun & Brad Number

FTE





Owner or Operator

Parent Company

Name

Name

Dun & Brad Number




Address

Address



Phone Number

Email

Phone Number

Email

( )


( )


Facility Emergency Coordinator

Tier II Information Contact

Name

Title

Name

Title





Email Address

Email Address



Phone Number

24-hour Phone

Phone Number

( )

( )

( )

Emergency Contacts

Name

Name



Title

Title



Phone Number

24-hour Phone

Phone Number

24-hour Phone

( )

( )

( )

( )

Email Address

Email Address



Subject to Emergency Planning under Section 302 of EPCRA?

Yes

No

Subject to Chemical Accident Prevention under Section 112(r) of CAA (40 CFR part 68, Risk Management Program)?

Yes

No

Certification: (Read and sign after completing all sections)

I certify under penalty of law that I have personally examined and am familiar with the information submitted in pages 1 through , and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate and complete.








Name and official title of owner/ operator OR owner/operator’s authorized representative


Signature


Date signed

Optional Attachments

I have attached a site plan

I have attached a list of site coordinate abbreviations



I have attached a description of dikes and other safeguards measures




EPA Form No. 8700-29

OMB Control No. 2050-0072

Page 1 of ----








Hazard Type

Max Amount

Average Daily Amount

Number of Days On-Site

General Location

Physical Hazard

Fire





Sudden Release of Pressure





Reactivity





Health Hazard

Immediate (acute)





Delayed (acute)







REPORTING RANGES



WEIGHT RANGE IN POUNDS

Range Codes

From

To

01

0

99

02

100

499

03

500

999

04

1,000

4,999

05

5,000

9,999

06

10,000

24,999

07

25,000

49,999

08

50,000

74,999

09

75,000

99,999

10

100,000

499,999

11

500,000

999,999

12

1,000,000

9,999,999

13

10,000,000

Greater than 10 million

EPA Form No. 8700-29

OMB Control No. 2050-0072

Page


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File Typeapplication/msword
AuthorMelissa Romero
Last Modified ByEPA
File Modified2011-05-27
File Created2011-05-27

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