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Tier I_Emergency and Hazardous Chemical Inventory Form_Aggregate Information by Hazard Type
ICR 202607-2050-001 · OMB 2050-0072 · Object 170728600.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | Tier I_Emergency and Hazardous Chemical Inventory Form_Aggregate Information by Hazard Type |
| Subject | Hazardous Chemical Inventory Reporting [40 CFR part 370] |
| Author | Jennifer Barre U.S. EPA |
| Last Modified By | Acrobat PDFMaker 25 for Word |
| File Modified | 2025-07-21 |
| File Created | 2025-07-21 |
| Conversion State | complete |
Extracted Text
OMB Control No. 2050-0072 Expiration Date: 00/00/0000 Information on this page is identical to the information submitted last year:☐ Reporting Period: January 1 to December 31, 2026 For Official Use Only Tier I State ID#: Emergency and Hazardous Chemical Inventory Form Date Received: Aggregate Information by Hazard Type Facility Identification Name Phone Number (optional) Street County City State Latitude Longitude ☐ Manned Dun & Bradstreet Number NAICS Code RMP Facility ID: ☐ Unmanned ☐ N/A Zip Maximum No. of Occupants: ☐ N/A TRI Facility ID: ☐ N/A ☐ Yes ☐ No Subject to Emergency Planning under Section 302 of EPCRA [40 CFR part 355] Subject to Chemical Accident Prevention under Section 112(r) of CAA [40 CFR part 68, Risk Management Program] ☐ Yes ☐ No Owner or Operator Information Name Parent Company Information (optional) Name Dun & Bradstreet Number: Address Address Phone Number Email Address Facility Emergency Coordinator (if applicable) Name Title Tier II Information Contact Name Title Email Address Email Address Phone Number Email Address Phone Number 24-hour Phone Number Name Title Phone Number Emergency Contacts Name Email Address Phone Number Title Email Address 24-hour Phone Number Phone Number 24-hour Phone Number 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 one 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 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]. 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 6 to 120 hours per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to Director, Information Engagement 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 Page of Information on this page is identical to the information submitted last year: ☐ Maximum Amount (Range Code) Health Hazard Categories Acute Toxicity, Oral – Category 1 Acute Toxicity, Oral – Category 2 Acute Toxicity, Oral – Category 3 Acute Toxicity, Oral – Category 4 Acute Toxicity, Dermal – Category 1 Acute Toxicity, Dermal – Category 2 Acute Toxicity, Dermal – Category 3 Acute Toxicity, Dermal – Category 4 Acute Toxicity, Inhalation – Category 1 Acute Toxicity, Inhalation – Category 2 Acute Toxicity, Inhalation – Category 3 Acute Toxicity, Inhalation – Category 4 Aspiration Hazard – Category 1 Carcinogenicity – Category 1 Carcinogenicity – Sub-Category 1A Carcinogenicity – Sub-Category 1B Carcinogenicity – Category 2 Germ Cell Mutagenicity – Category 1 Germ Cell Mutagenicity – Sub-Category 1A Germ Cell Mutagenicity – Sub-Category 1B Germ Cell Mutagenicity – Category 2 Reproductive Toxicity – Category 1 Reproductive Toxicity – Sub-Category 1A Reproductive Toxicity – Sub-Category 1B Reproductive Toxicity – Category 2 Reproductive Toxicity - Effects on or via lactation Respiratory Sensitizer - Category 1 Respiratory Sensitizer – Sub-Category 1A Respiratory Sensitizer – Sub-Category 1B Skin Sensitizer – Category 1 Skin Sensitizer – Sub-Category 1A Skin Sensitizer – Sub-Category 1B Serious Eye Damage – Category 1 Eye Irritation – Category 2 Eye Irritation – Sub-Category 2A Eye Irritation – Sub-Category 2B Simple Asphyxiant Skin Corrosion – Category 1 Skin Corrosion – Sub-Category 1A Skin Corrosion – Sub-Category 1B Skin Corrosion – Sub-Category 1C Skin Irritation – Category 2 Specific Target Organ Toxicity Single Exposure – Category 1 Specific Target Organ Toxicity Single Exposure – Category 2 Specific Target Organ Toxicity Single Exposure – Category 3 Specific Target Organ Toxicity Repeated or Prolonged Exposure – Category 1 Specific Target Organ Toxicity Repeated or Prolonged Exposure – Category 2 Hazard Not Otherwise Classified (HNOC) Average Daily Amount (Range Code) - Select Range Code - - Select Range Code - - Select Range Code - 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- Select Range Code - Number of Days On-Site General Location Space is intentionally blank EPA Form No. 8700-29 Page 2 of 3 Information on this page is identical to the information submitted last year: ☐ Physical Hazard Categories Aerosols – Category 1 Aerosols – Category 2 Aerosols – Category 3 Chemicals Under Pressure – Category 1 Chemicals Under Pressure – Category 2 Chemicals Under Pressure – Category 3 Flammable Gases – Category 1A Flammable Gases – Category 1B Flammable Gases – Category 2 Flammable Gases – Chemically Unstable Gas – Category 1A/A Flammable Gases – Chemically Unstable Gas – Category 1A/B Flammable Gases – Pyrophoric Gas – Category 1A Flammable Liquids – Category 1 Flammable Liquids – Category 2 Flammable Liquids – Category 3 Flammable Liquids – Category 4 Flammable Solids – Category 1 Flammable Solids – Category 2 Combustible Dust Corrosive to Metal – Category 1 Desensitized Explosives – Category 1 Desensitized Explosives – Category 2 Desensitized Explosives – Category 3 Desensitized Explosives – Category 4 Explosives – Unstable Explosives – Division 1.1 Explosives – Division 1.2 Explosives – Division 1.3 Explosives – Division 1.4 Explosives – Division 1.5 Explosives – Division 1.6 Gas Under Pressure – Compressed Gas Gas Under Pressure – Dissolved Gas Gas Under Pressure – Liquefied Gas Gas Under Pressure – Refrigerated liquefied gas In Contact With Water Emits Flammable Gases – Category 1 In Contact With Water Emits Flammable Gases – Category 2 In Contact With Water Emits Flammable Gases – Category 3 Organic Peroxides – Type A Organic Peroxides – Type B Organic Peroxides – Type C Organic Peroxides – Type D Organic Peroxides – Type E Organic Peroxides – Type F Organic Peroxides – Type G Oxidizing Gases Oxidizing Liquids – Category 1 Oxidizing Liquids – Category 2 Oxidizing Liquids – Category 3 Oxidizing Solids – Category 1 Oxidizing Solids – Category 2 Oxidizing Solids – Category 3 Pyrophoric Liquids – Category 1 Pyrophoric Solids – Category 1 Self-Heating Chemicals – Category 1 Self-Heating Chemicals – Category 2 Self-Reactive Chemicals – Type A Self-Reactive Chemicals – Type B Self-Reactive Chemicals – Type C Self-Reactive Chemicals – Type D Self-Reactive Chemicals – Type E Self-Reactive Chemicals – Type F Self-Reactive Chemicals – Type G Hazard Not Otherwise Classified (HNOC) Maximum Amount (Range Code) Average Daily Amount (Range Code) - 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