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Home My WebLink About88 Nutmeg Road - Tier II Reports - Fire s2 �� Connecticut Department of Energy and Environmental Protection State Emergency Response Commission Emergency Planning and Community Right-to-K Tier2 Submit Chemical Inventory Report Certification Page Facility/Municipality Information Facility Name: Siemens Industry Facility Phone: 860-528-6512 ext. 20 Fax: 860-289-5028 Person's Email Address who submitted the electronic Tier2 Submit form: stephen.depalma@siemens.com Facility Address: 88 Nutmeg Road South City/Town: South Windsor State: CT Zip Code: 06074 Telephone: 860-291-8715 Reporting year consists of January 1 through December 31, 2011 "I have personally examined and am familiar with the information submitted in this document and all attachments thereto,and I certify that based on reasonable investigation,including my inquiry of those individuals responsible for obtaining the information, the submitted information is true,accurate and complete to the best of my knowledge and belief.I understand that a false statement in the submitted information may be punishable as a criminal offense,in accordance with Section 22a-6 of the General Statutes, pursuant to Section 53a-157b of the General Statutes,and in accordance with any other applicable statute." Signature of Preparer Title Date ZA cP`e•ss SignatAod Owner or Operator of Facility Title Date or the Officially Designated Representative of the Owner/Operator Persons who or municipalities that submit a Tier2 Submit Chemical Inventory form by e-mail,must also submit a signed Certification Page to the State Emergency Response Commission at the following address: State Emergency Response Commission c/o Department of Energy and Environmental Protection Bureau of Materials Management&Compliance Assurance Emergency Response and Spill Prevention Division 79 Elm Street,4`"Floor Hartford,CT 06106-5127 Page 1 of 3 pages Form Apt proved OMB No.2050-0072 Facility Identification Owner/Operator Name Name Siemens Industry Name Stephen DePalma Phone (860-291-8715 Tier Two Street C/O Stephen DePalma 88 Nutmeg Road South Mail Address 88 Nutmeg Road South South Windsor CT 06704 EMERGENCY City South Windsor County Tolland State CT Zip 06074 AND Emergency Contact HAZARDOUS NAICS 3087 Dun&Brad Number 15-079-5342 Code CHEMICAL Name Jack Masella Title Director-Saftey INVENTORY Phone (832 )541-9891 24 Hr.Phone ( ) FOR ID# Specific OFFICIAL Name Stephen DePalma Title Plant Manager Information USE Date Received Phone 860-291-8715 24 Hr.Phone 860-883-3129 by Chemical ONLY Important: Read all instructions before completing form Reporting Period From January 1 to December 31,20 11 [] Check if information below is identical to the information submitted last year. m Physical Storage Codes and Locations Chemical Description and Health Inventory (Non-Confidential) ° 0 y a Hazards A (check all that a l U~ a ~ Stora a Locations O Trade CAS 007440-44-0 Secret [] Fire Max Daily C 1 4 Soak Tanks(2)Backwash tanks Chem. Name Carbon [] Sudden Release 0 4 Amount(code) J 1 4 Storage area of Pressure L 1 4 Customer Exchange Tanks Check all [x [] [x] [] [] 0 3 Avg.Daily Amount that apply Pure Mix Solid Liquid Gas EHS [x] Immediate(acute) code EHS Name [x] Delayed(chronic) F-3—F 6 1 5 1 No.of Days [] On-site(days) Trade CAS 010043-52-4 Secret [] Fire Max.Daily E14 1 4 Inside building southeast side bay Chem.Name Calcium Chloride [] Sudden Release 0 3 Amount(code) of Pressure Check all [] [] [x] [] [] [] [x] Reactivity 0 1 3 Avg.Daily Amount that apply Pure Mix Solid Liquid Gas EHS [x] Immediate(acute) code EHS Name [] Delayed(chronic) 3 1 6 1 5 1 No.of Days [] On-site(days) Trade CAS 7647-01-0 Secret [j Fire Max.Daily A 1 4 Storage tank closest to North wall Chem.Name Hydrochloric Acid [] Sudden Release 0 4 Amount(code) of Pressure Check all [] [x] [] [x] [] [] [x] Reactivity 1 0 3 Avg. Daily Amount that apply Pure Mix Solid Liquid Gas EHS [x] Immediate(acute) code EHS Name [x] Delayed(chronic) 1 3 6 1 5 No.of Days [] On-site(days) Certification (Read and sign after completing all sections) Optional Attachments I certify under penalty of law that I have personally examined and am familiar with the information submitted in pages one through and that based [] I have attached a site plan on my inquiry of those individuals responsible for obtaining the information,I b 'avee that the submitt c ae,accurate,and complete. [] I have attached a list of site coordinate abbreviations Stephen A DePalma Plant Manager �`�,I1 �'�,,��j s al i�A]1,2 [] I have attached a description of dikes and other Name and official title of owner/operator OR owner/operator's Signatures Date sign d safeguards measures authorized representative Page 3 of 3 pages Form Approved OMB No.2050-0072 Facility Identification Owner/Operator Name Name Siemens Industry Name Stephen DePalma Phone (860-291-8715 Tier Two Street C/O Stephen DePalma 88 Nutmeg Road South Mail Address 88 Nutmeg Road South South Windsor CT 06704 EMERGENCY City South Windsor County Tolland State CT Zip 06074 AND Emergency Contact HAZARDOUS NAICS 3087 Dun&Brad Number 15-079-5342 Code CHEMICAL Name Jack Masella Title Director-Saftey INVENTORY Phone (832 )541-9891 24 Hr.Phone ( ) FOR ID# Specific OFFICIAL Name Stephen DePalma Title Plant Manager Information USE Date Received Phone 860-291-8715 24 Hr.Phone 860-883-3129 by Chemical ONLY Important: Read all instructions before completing form Reporting Period From January 1 to December 31,20 11 [] Check if information below is identical to the information submitted last year. m Physical 3 Storage Codes and Locations Chemical Description and Health Inventory = Q U (Non-Confidential) 2 Hazards 0g� 1 o 0. check all that a 1 Storage Locations Trade CAS 1310-73-2 Secret [] Fire Max Daily C 1 4 In building N.side 2"d tank from wall Chem. Name Sodium Hydroxide [] Sudden Release 0 4 Amount(code) of Pressure Check all [] [x] [] [x] [] [] [x] Reactivity 1 0 1 —37 Avg. Daily Amount that apply Pure Mix Solid Liquid Gas EHS [X] Immediate(acute) code) EHS Name [x] Delayed(chronic) 3 6 1 5-1 No.of Days [] On-site(days) Trade CAS 7791-18-6 Secret [] Fire Max.Daily E 1 4 Southeast side bay eastern most Chem. Name Magnesium Chloride [] Sudden Release 0 3 Amount(code) C 1 4 Mixing tank of Pressure Check all [] [x] x] [] [) [] [x] Reactivity 1 0 1 27 Avg.Daily Amount that apply Pure Mix Solid Liquid Gas EHS [X] Immediate(acute) code EHS Name [x] Delayed(chronic) 1 3 1 6 1 5 No.of Days [] On-site(days) Trade CAS 7647-14-5 Secret [] Fire Max.Daily C 1 4 Tank in North side center Chem.Name Sodium Chloride [] Sudden Release 0 4 Amount(code) J 1 4 Dock or Storage areas of Pressure Check all x [] [x] [] [] [] [x] Reactivity 0 3 Avg.Daily Amount that apply Pure Mix Solid Liquid Gas EHS [x] Immediate(acute) code EHS Name [] Delayed(chronic) 3 6 1 5 1 No.of Days [] On-site(days) Certification (Read and sign after completing all sections) Optional Attachments I certify under penalty of law that I have personally examined and am familiar with the information submitted in pages one through and that based [] I have attached a site plan on my inquiry of those individuals responsible for obtaining the information,I bel' a that the submitte o accurate,and complete. [] I have attached a list of site coordinate abbreviations Stephen A DePalma Plant Manager � — � [] I have attached a description of dikes and other Name and official title of owner/operator OR owner/operator's Signatur Date signed, safeguards measures authorized representative