 Check if information below is identical to the information submitted last year. Reporting Period: January 1 to December 31, 20 Tier One Date Received: Emergency and Hazardous Chemical Inventory Aggregate Information by Hazard Type Facility Identification For Official Use Only State ID #: 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 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. Name and official title of owner/ operator OR owner/operator’s Signature Date signed authorized representative 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, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 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 1 of Expiration Date: 03/31/2016
 Check if information below is identical to the information submitted last year. Reporting Period: January 1 to December 31, 20 Facility Identification Tier One Emergency and Hazardous Chemical Inventory Aggregate Information by Hazard Type For Official Use Only 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 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. Name and official title of owner/ operator OR owner/operator’s authorized representative Signature Date signed 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, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 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 1 of Expiration Date: 03/31/2016
t1-form2012-1_1.docx