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Attachment I <br /> STATEMENT OF DETERMINATION <br /> Facility Name <br /> Physical Address ( Street only) <br /> City County LEPC District <br /> I have determined that this facility is / is not subject to the following section (s) of EPCRA , Title III , for the reporting <br /> year(s) indicated <br /> (circle all applicable) : <br /> SECTION 2004 2005 2006 2007 2008 IY / <br /> 9 2010 2011 2012 2013 2014 <br /> 302 / 303 Y / N Y / N Y / N Y / N Y / N N Y / NY / N Y / N Y / <br /> N Y / N <br /> 311 / 312 Y / N Y / N Y / N Y / N Y / N N Y / N Y / N Y / N Y <br /> / N Y / N <br /> 313 Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N <br /> If " No " was indicated on any of the above , please check appropriate box s wh <br /> Sections Extremely Hazardous Substances ( EHSs) are / were present only in amounts less than established Threshold <br /> 302/303 Planning Quantities (TPQs ) . <br /> No EHSs are Present . <br /> No EHSs were present on-site during the year. <br /> Sections Hazardous chemicals/EHSs are/were present only in amounts below established reporting thresholds . <br /> 3111312 <br /> No hazardous chemicals/EHSs are/were present . <br /> No hazardous chemicals were present on-site during the year. <br /> Section Not within covered SIC Codes . <br /> 313 <br /> Within covered SIC Codes , but less than ten ( 10 ) employees . <br /> Within covered SIC Codes, but no Section 313 chemicals were present or were below Section 313 reporting <br /> thresholds . <br /> Other Closed facility Chemicals removed Chemicals reduced below Date Effective : <br /> YES / NO YES / NO threshold/ TPQ YES / NO <br /> New Facility. Date chemicals brought on site meeting / exceeding TPQ : <br /> Further explanation if necessary : <br /> rrespo:nsibility <br /> RION :undthe requirements of the law(s) circled above . I also understand that ultimate compliancelies with me and failure to comply , if required <br />, can result in civil and criminal penalties under federald ss .Namner/operators authorized representative ( printed ) : <br /> Offic (printed ) :Si nDate signed : <br />