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Attachment K STATEMENT OF DETERMINATION Facility Name 2009 Physical Address (Street only) 2011 City County LEPC District 2015 I have determined that this facility is / is not subject to the following section(s) of EPCRA, Title III, for the reporting ear(s) indicated (circle all applicable): SECTION 2009 2010 2011 2012 1 2013 2014 2015 2016 2017 2018 2019 3021303 Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/ Y/N 311/312 Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/ IJ Y/N 313 Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/ q 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 established 302/303 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 thresholds.. 311/312 No hazardous chemicals/EHSs are/were present. No hazardous chemicals were present on-site during the year. 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 13 reporting thresholds. Other Closed facility Chemicals removed Chemicals reduced below Date Effective YES / NO YES / NO threshold/TPQ YES 1 NO New Facility. Date chemicals brought on site meeting / exceeding TPQ: Further explanation if necessary: CERTIFICATION: I understand the requirements of the law(s) circled above. I also understand that ultimate ompliance responsibility lies with me and failure to comply, if required, can result in civil and criminal penalties ur der federal and state laws. Name of owner / operator's authorized representative (printed): Official Title (printed): Signature: JDate signed: 31 165