Tier II Emergency and Hazardous Chemical Inventory Form Specific Information By Chemical

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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 II
State ID#:
Emergency and Hazardous Chemical Inventory Form
Date Received:
Specific Information by Chemical
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

Email Address
Phone Number

Title

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

OMB Control No. 2050-0072 Expiration Date: 00/00/0000

Information on this page is identical to the information submitted last year: ☐
Section 1: Chemical, Mixture, or Product Identification
Substance Name:
Substance Type: ☐ Pure Chemical (Skip Section 2)
CAS No.(s):
EPCRA EHS: ☐ Yes (See Section 4)

☐ Liquid
Physical State: ☐ Solid
Trade Secret: ☐ Yes (See Note *a)
Section 2: Mixture or Product Contents
EPCRA EHS Name(s):

☐ Mixture or Product (Complete Section 2)
☐ Not Available
☐ No

☐ Gas

Non-EHS Name(s):
(Optional)
Max. Amt. of each EHS in the mixture – Range Code: - Select Range Code - Or - Manuall Enter Values Section 3: Inventory Information
Maximum Amount - Range Code: - Select Range Code - Or - Manually Enter Values Average Daily Amount - Range Code: - Select Range Code - Or - Manually Enter Values Number of Days On-Site:
Type of Storage:
Storage Conditions:
(Pressure, Temperature, etc.)
Storage Location Confidential: ☐ Yes (See Note *b) ☐ No
Storage Location(s):
Section 4: Additional Reporting Information (Optional)
Below Reporting Thresholds: ☐
State or Local Requirements: ☐
Attachments: ☐ Description of dikes and other safeguard measures
☐ List of site coordinate abbreviations ☐ Site plan
☐ Tier II - Confidential Location Form ☐ Other
Section 5: Hazard Identification
Health Hazards:

Physical Hazards:

OMB Control No. 2050-0072 Expiration Date: 00/00/0000

Notes:
*a – Trade secret claims may be made for the specific chemical identities, as described in 40 CFR part 350. If you are
making a trade secret claim for chemicals reported, you are required to submit a substantiation to the US EPA to justify
the trade secrecy claim. Trade secrecy claims should be sent to: EPCRA Trade Secrets, c/o CGI Federal, Inc., 12601 Fair
Lakes Circle, Fairfax, VA 22038. Instructions and forms can be downloaded at:
https://www.epa.gov/epcra/epcra-trade-secret-forms-and-instructions.
*b –Storage Location(s) may be withheld from the Tier II Form, to withhold the locations from public disclosure. If you
choose to withhold the location information from disclosure to the public, you must complete the Confidential Location
Information Sheet and attach it to the non-confidential Tier II Form when submitting the information to the SERC, LEPC,
and the fire department with jurisdiction over your facility. If your facility is on Tribal Lands, verify with your Tribe which
SERC and LEPC to send your inventory forms to. Note that a Tribal Emergency Response Commission (TERC) is a form of
a SERC and a Tribal Emergency Planning Committee (TEPC) is a form of a LEPC.
Range Codes:
Reporting Ranges
weight ranges in pounds (lbs)

Range Code
01
02
03
04
05
06
07
08
09
10
11
12
13

From
0
100
500
1,000
5,000
10,000
25,000
50,000
75,000
100,000
500,000
1,000,000
10,000,000

To
99
499
999
4,999
9,999
24,999
49,999
74,999
99,999
499,999
999,999
9,999,999
> 10,000,000