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Attachment D <br /> HAZARDS ANALYME CONTRACT CHECKL19T AND CAMEO GUIDE <br /> F,4 TT TTY INFORMATION <br /> Facility Name {per Attachment C) ( Facility page) <br /> Facility Physical address ( Facility page) <br /> SERC Code identification number {per Attachment C , i . e . SERC#XXXXX) (Department Field on Facility page) <br /> Latitude & Longitude in degrees/ minutes/seconds {i . e . 30 . 1917 - 84 . 36211 ( Map Data tab on Facility page) <br /> Facility Emergency Coordinator name , title , phone # {including 24 hr. number) (Contact tab on Facility page) <br /> Transportation Route(s ) (from county line to the facility) ( Notes tab on Facility page) <br /> Evacuation Route(s ) to exit the vulnerable zone ( Notes tab on Facility page) <br /> Historical Accident Record ( If none , please note) ( Notes tab on Facility page) <br /> HAZARD IDENTIFMIZ ATION (for each Extremely Hazardous Substance on site) <br /> Proper chemical name(s ) (Chemical in Inventory page(s)) <br /> Chemical Abstract Service (CAS ) number (Chemical in Inventory page(s)) <br /> Natural physical state { i . e . mixture , pure , liquid , solid , gas) ( Chemical in Inventory page(s), Physical State and Quantity tab <br />) <br /> Maximum quantity on-site in pounds ( Chemical in Inventory page(s), Physical State and Quantity tab ) <br /> Amount in largest container or interconnected containers (Chemical in Inventory page(s), Physical State and Quantity tab ) <br /> Type and design of storage container(s ) {i . e . cylinder, steel drum , carboy etc.) (Chemical in Inventory page(s), Location tab) <br /> Nature of the hazard (i . e . , acute , chronic, fire , pressure etc. ) ( Chemical in Inventory page(s ), Physical State and Quantity tab <br />) <br /> VULNERABILITY ANALYM (for each Extremely Hazardous Substance on site) <br /> Estimate vulnerable zone (threat zone) radius ( bottom of Scenario page(s)) <br /> Facility Population {unmanned facilities minimum of one is required for maintenance personnel) ( ID Codes tab on Facility page) <br /> Critical Facilities {name of facilities and max occupancy for each) (if none , please note) ( Notes tab on Scenario page(s)) <br /> Estimate Total Exposed Population (s ) {facility + general population + critical facilities) ( Notes tab on Scenario page(s)) <br /> (for each Extremely Hazardous Substance on site) ( Scenario page(s)) <br /> The three ratios Risk Assessment at the bottom of the SCENARIO PAGES will meet the four requirements below <br /> Rate probability of release {i . e . , low, medium or high) <br /> Rate severity of consequences of human injury ( i . e . , low, medium or high) <br /> Rate severity of consequences of damage to property {i . e . , low , medium or high) <br /> Rate severity of consequences of environmental exposure {i . e . , low, medium or high) <br /> ON-SITE VIgM (within the contract period) <br /> Completed hazards analysis site visit certification form (submitted electronically or hard copy) <br /> Site plan map (submitted electronically) for each facility, with SERC code number and with sufficient detail to identify: <br /> Location of major building (s ) <br /> Location of container(s ) of Extremely Hazardous Substance(s ) <br /> Location of major street(s ) and entrance(s ) <br /> North arrow <br /> The data in the Facility Information , Hazard Identification , Vulnerability Analysis and Risk Analysis sections noted above shall be <br /> submitted electronically in a CAMEOfm zip file format, <br /> 20 <br />