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Attachment H STATEMENT OF DETERMINATION Facility Name Physical Address ( Street only) City County LEPC District I have determined that this facility is / is not subject to the following section ( s ) of EPCRA , Title III , for the reporting year( s ) indicated ( circle all applicable ) : SECTION 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 302 / 303 Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N 311 / 312 Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N 313 Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N If " No " was indicated on any of the above , please check appropriate box(s ) why : Sections Extremely Hazardous Substances ( EHSs ) are / were present only in amounts less than 302/ 303 established Threshold Planning Quantities TPQs . No EHSs are Present . No EHSs were present on - site during the year . Sections Hazardous chemicals/ EHSs are/were present only in amounts below established reporting 311 / 312 thresholds . No hazardous chemicals/EHSs are/were present . No hazardous chemicals were present on -site during the year . 7t: Section Not within covered SIC Codes . 313 Within covered SIC Codes , but less than ten ( 10 ) employees . Within covered SIC Codes , but no Section 313 chemicals were present or were below Section 313 reporting thresholds . Other Closed facility Chemicals removedTthreshold/TPQ hemics reduced below Date Effective : YES / NO YES / NO YES / NO New Facility . Date chemicals brought on site meeting / exceeding TPQ : Further explanation if necessary : CERTIleh : I undee requirements of the law ( s ) circled above . I also understand that ultimate compliance responwith me and failure to comply , if required , can result in civil and criminal penalties under federal and sta Name perators authorized representative ( printed ) : Officialted ) :SignatDate signed : 27