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Attachment D <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 />F <br />FoA TT TTY INFORMAMN <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 IDE CATION (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 pages)) <br />Natural physical state {i.e. mixture, pure, liquid, solid, gas) (Chemical in Inventory page(s), Physical State and Quantity tab) <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 pages}, 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 />VULNERABILITY ILITY ANALYM (for each Extremely Hazardous Substance on site) <br />Estimate vulnerable zone (threat zone) radius (bottom of Scenario pages}) <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-STTE VISI'T'S (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 />F <br />