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Attachment E <br /> HAZARDEANALY919 CONTRACTCHFC.KLICTAND CAMEO QUID <br /> FACILITY INFORMATION <br /> Facility Name (per Attachment C) ( Facility page) <br /> Facility Physical address (Facility page) <br /> SERC Code identification number (i.e. SERC#XXXXX) (Department Field on Facility page) <br /> Latitude & Longitude in decimal degrees (i.e. 30. 1917 - 84.3621) (Map Data tab on Facility page) <br /> Facility Emergency Coordinator name, title, phone # (including daytime & 24 hr. number) (Contact tab on Facility page) <br /> Transportation Route(s) (from county line to the facility) ( Notes tab on Facility page) <br /> Evacuation Route(s) to exit the vulnerable zone (Notes tab on Facility page) <br /> Historical Accident Record (If none, please note} ( Notes tab on Facility page) <br /> HAZARD IDENTIFICATION (for each Extremely Hazardous Substance on site) <br /> Proper chemical names) (Chemical in Inventory page(s)) <br /> Chemical Abstract Service (CAS) # (Chemical in Inventory page(s)) <br /> Natural physical state (i.e. mixture, pure, liquid, solid, gas) (Chemical in Inventory page(s), Physical State and Quantity tab) <br /> Maximum quantity on-site in pounds (Chemical in Inventory pages), Physical State and Quantity tab) <br /> Amount in largest container or interconnected containers (Chemical in Inventory page(s), Physical State and Quantity tab) <br /> Type and design of storage container(s ) (i.e. cylinder, steel drum, carboy etc.) (Chemical in Inventory page{s), Location tab) <br /> Nature of the hazard {i. e. , acute, chronic, fire , pressure etc.} (Chemical in Inventory page(s), Physical State and Quantity tab) <br /> V(JLNEMB LDYAN T Yc'f (for each Extremely Hazardous Substance on site) <br /> Estimate vulnerable zone (threat zone} radius (Bottom of Scenario page{s)) <br /> Facility Population (unmanned facilities minimum of one is required for maintenance personnel} (ID Codes tab on Facility page ) <br /> Critical Facilities (name of school(s ), hospital(s ) etc.} and max occupancy for each [if none, please note] (Notes tab on Scenario <br /> page(s)) <br /> Estimate Total Exposed Population (facility + general population + critical facilities) (Notes tab on Scenario page(s)) <br /> (for each Extremely Hazardous Substance on site) (Scenario page{s}) <br /> The three ratings {Risk Assessment) at the bottom of the SCENARIO PAGE(S) will meet the four requirements below <br /> _ Rate probability of release {i.e., low, medium or high} <br /> Rate severity of consequences of human injury (i.e. , low, medium or high) <br /> Rate severity of consequences of damage to property {i.e. , low, medium or high) <br /> Rate severity of consequences of environmental exposure {i.e. , low, medium or high} <br /> ON-SITE VISITS (within the contract period) <br /> Completed hazards analysis site visit certification form <br /> Site plan map with SERC code identification number for each facility and with sufficient detail to identify: <br /> Location of major building(s ) <br /> Location of container(s ) of Extremely Hazardous Substance(s ) <br /> Location of major street(s ) and entrance(s ) <br /> North arrow <br /> 23 <br />