Form 8700-29 Tier One Emergency and Hazardous Chemical Inventory

 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			of