LOCAL EMERGENCY PLANNING COMMITTEE State Fiscal Year 2016 LEPC Funding Application General Information LEPC Name Address City State Zip LEPC Project Manager Phone Number Fax Number Email Address Membership Current LEPC membership list is attached. YES NO (**Please use the standard LEPC Membership Roster form located at ) Hazardous/ Extremely Hazardous Substances Information Total number of facilities in LEPD reporting one or more Hazardous Substances Date of last review of number of Hazardous Substances reporting facilities Total number of facilities in LEPD reporting one or more Extremely Hazardous Substances (EHS) Date of last review of number of EHS reporting facilities Estimated volume of hazardous substances and EHS transported through LEPD Date of last review of estimated volume of hazardous substances or of EHS transported in LEPD Performance of Baseline Requirements in Previous Year Has LEPC membership been maintained? YES NO Have rules or bylaws been established and maintained to: YES NO Provide for public notification of LEPC meetings and activities? Conduct meetings to discuss Emergency Operations Plan with the public? Provide for public distribution of the Emergency Operations Plan? Have procedures for receiving and processing requests from the public for YES NO Material Safety Data Sheets (MSDS) and Tier II information been established and maintained? Has the LEPC evaluated the need for resources to develop, implement, and YES NO exercise the EOP? Did your LEPC act as an advisory committee to the political subdivisions YES NO within the LEPD? Did your LEPC attend the scheduled LEPCA workshops and/or SERC YES NO meetings? Did your LEPC submit timely quarterly reports to DHS&EM in accordance YES NO with Grant Award documents? Did your LEPC maintain a current list of all facilities within the LEPD which YES NO are required to complete a Tier II report? For any “No” answers, please explain below Projected baseline allocation for this LEPC (See Table A)
LOCAL EMERGENCY PLANNING COMMITTEE State Fiscal Year 2016 LEPC Funding Application General Information LEPC Name Address City State Zip LEPC Project Manager Phone Number Fax Number Email Address Membership Current LEPC membership list is attached. (**Please use the standard LEPC Membership Roster form located at ) YES NO Hazardous/ Extremely Hazardous Substances Information Total number of facilities in LEPD reporting one or more Hazardous Substances Date of last review of number of Hazardous Substances reporting facilities Total number of facilities in LEPD reporting one or more Extremely Hazardous Substances (EHS) Date of last review of number of EHS reporting facilities Estimated volume of hazardous substances and EHS transported through LEPD Date of last review of estimated volume of hazardous substances or of EHS transported in LEPD Performance of Baseline Requirements in Previous Year Has LEPC membership been maintained? YES NO Have rules or bylaws been established and maintained to: Provide for public notification of LEPC meetings and activities? Conduct meetings to discuss Emergency Operations Plan with the public? Provide for public distribution of the Emergency Operations Plan? YES NO Have procedures for receiving and processing requests from the public for Material Safety Data Sheets (MSDS) and Tier II information been established and maintained? YES NO Has the LEPC evaluated the need for resources to develop, implement, and exercise the EOP? YES NO Did your LEPC act as an advisory committee to the political subdivisions within the LEPD? YES NO Did your LEPC attend the scheduled LEPCA workshops and/or SERC meetings? YES NO Did your LEPC submit timely quarterly reports to DHS&EM in accordance with Grant Award documents? YES NO Did your LEPC maintain a current list of all facilities within the LEPD which are required to complete a Tier II report? YES NO For any “No” answers, please explain below Projected baseline allocation for this LEPC (See Table A)