2015-131 - Laserfiche WebLink

Home Browse Search

Attachment K 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 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 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 "No" was indicated on any of the above, please check appropriate box(s) why: Sections 302/303 Extremely Hazardous Substances (EHSs) are / were present only in amounts less than established Threshold Planning Quantities (TPQs). Name of owner / operator's authorized representative (printed): No EHSs are Present. Official Title (printed): No EHSs were present on-site during the year. Sections 311/ 312 Hazardous chemicals/EHSs are/were present only in amounts below established reporting thresholds. No hazardous chemicals/EHSs are/were present. No hazardous chemicals were present on-site during the year. Section 313 Not within covered SIC Codes. Within covered SIC Codes, but Tess 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 YES / NO Chemicals removed YES / NO Chemicals reduced below threshold/TPQ YES / NO Date Effective: New Facility. Date chemicals brought on site meeting / exceeding TPQ: Further explanation if necessary: 31 CERTIFICATION: I understand the requirements of the law(s) circled above. I also understand that ultimate compliance responsibility lies with me and failure to comply, if required, can result in civil and criminal penalties under federal and state laws. Name of owner / operator's authorized representative (printed): Official Title (printed): Signature: Date signed: 31