Form 8700-29 Tier I Form

Community Right-to-Know Reporting Requirements Under Sections 311 and 312 of the Emergency Planning and Community Right-to-Know Act (EPCRA) (Renewal)

Tier I Form Ver. 3-2019

Community Right-to-Know Reporting Requirements Under Sections 311 and 312 of EPCRA - Private Sector

OMB: 2050-0072

Document [docx]
Download: docx | pdf
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Check if information below is identical to the information submitted last year. Reporting Period: January 1 to December 31, 20

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Facility Identification

Tier One

Emergency and Hazardous Chemical Inventory

Aggregate Information by Hazard Type


For Official Use Only

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State ID #:

Date Received:

Name Maximum No. of Occupants: Manned


N/A Unmanned

Street County City State Zip


Latitude Longitude NAICS Code Phone Number (optional)

( )

Dun & Bradstreet Number TRI Facility ID: RMP Facility ID:

N/A N/A

Subject to Emergency Planning under Section 302 of EPCRA? Yes No


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

Program)? Yes No

Owner or Operator Information Parent Company Information (optional)

Name Name Dun & Bradstreet Number



Address Address


Phone Number Email Phone Number Email

( ) ( )

Facility Emergency Coordinator (if applicable) Tier I 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


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.

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Name and official title of owner/ operator OR owner/operators authorized representative



Signature Date signed


This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2050-0072). Responses to this collection of information are mandatory (40 CFR 370.41). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to range from 10 to 120 hours per response. Send comments on the Agency’s need this formation, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden including through the use of automated collection techniques to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.  Include the OMB control number in any correspondence.  Do not send the completed form to this address.



EPA Form No. 8700-29 OMB Control No. 2050-0072 Page of

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


Hazard
Types

Max Amount
(Range Code)

Average Daily
Amount
(Range Code)

Number of Days
On-Site

General Location

Physical Hazard

Explosive





Flammable (gases, aerosols, liquids, or solids)





Oxidizer (liquid, solid or gas)





Self-reactive





Pyrophoric (liquid or solid)





Pyrophoric Gas





Self-heating





Organic peroxide





Corrosive to metal





Gas under pressure (compressed gas)





In contact with water emits flammable gas





Combustible Dust





Hazard Not Otherwise Classified





Health Hazard

Acute toxicity (any route of exposure)





Skin corrosion or irritation





Serious eye damage or eye irritation





Respiratory or skin sensitization





Germ cell mutagenicity





Carcinogenicity





Reproductive toxicity





Specific target organ toxicity(single or repeated exposure)





Aspiration hazard





Simple Asphyxiant






Hazard Not Otherwise Classified





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


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 safeguard measures

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleTier I Inventory Form
SubjectEmergency Planning
AuthorUS EPA, OSWER, Office of Emergency Management
File Modified0000-00-00
File Created2022-01-28

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