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Attachment K <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 <br /> reporting ears indicated(circle all applicable <br /> SECTION 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 <br /> 302 / 303 Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N <br /> 311 / 312 Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N <br /> 313 Y / N Y / N Y / N 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) why: <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 /> 311/312 <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 /> CERTIFICATION: <br /> I understand the requirements of the law(s) circled above. I also understand that ultimate <br /> compliance responsibility lies with me and failure to comply, if required, can result in civil and <br /> criminal penalties under federal and state laws. <br /> Name of owner/ operator's authorized representative (printed) <br /> Official Title (printed) <br /> Signature JDate signed <br /> 34 <br />