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Home My WebLink About88 Nutmeg Road - Tier II Reports - Fire (2) ,. Connecticut Department of Energy and Environmental Protection Commission Emergency Planning and Community Right-to-Know Tier2 Submit Chemical Inventory Report Certification Page Facility/Municipality Information [Reporting ame: Siemens Industry hone: 860-528-6512 ext. 20 Fax: 860-289-5028 Email Address who submitted the electronic Tier2 Submit form: stephen.depaima@siemens.com ddress: 88 Nutmeg Road South : South Windsor State: CT Zip Code: 06074 e: 860-291-8715 year consists of January 1 through December 31, 2012 "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." Si �ture of Preparer. Title Date r / Signature of Own r Br Operator of Facility Title or the Officially Designated Date 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,4t`Floor Hartford,CT 06106-5127 ❑Check if information below is identical to the information submitted last year. Reporting Period:January 1 to December 31,2012 • HazardousEmergency and Specific • • by Facility Identification Name Maximum No.of Occupants: l]Manned ❑Unmanned Siemens Industry Inc.-Customer Services 0 N/A Street County City State Zip 88 Nutmeg Road South Tolland South Windsor CT 6,074 Latitude Longitude NAICS Code Phone Number(optional) 41 49'N 72 36'W 325211 (860) 291-8715 Dun&Bradstreet Number TRI Facility ID: RMP Facility ID: 15-079-5342 ❑+ N/A [a N/A Subject to Emergency Planning under Section 302 of EPCRA(40 CFR part 355)? ❑Yes No Subject to Chemical Accident Prevention under Section 112(r)of CAA(40 CFR part 68,Risk Management Program)? ❑Yes t]No Owner or Operator Information Parent Company Information(optional) Name Name Dun&Bradstreet Number: Siemens Industry Inc-Customer Services Div Address Address 88 Nutmeg Road South,S Windsor CT 06024 Phone Number Email Phone Number Email (860) 291-8715 stephan.depalma@siemens.com ( ) Facility Emergency Coordinator(if applicable) Tier II Information Contact Name Title Name Title Drew Bolyard EHS Regional Mgr Email Address Email Address willard.bolyard@siemens.com Phone Number 24-hour Phone Phone Number ( ) ( ) (443) 846-7863 Emergency Contacts Name Name Stephan Depalma Drew Bolyard Title Title Branch Manager EHS Regional Mgr Phone Number 24-hour Phone Phone Number 24-hour Phone 860) 291-8715 (860) 883-3129 (443) 846-7863 ( ) same Email Address Email Address stephtln.depalma@siemens.com willard.bolyard@siemens.com Certification(Read and sign after completing all sections) Reporting Ranges Weight Range in pounds Range Code From To I certify under penalty of law that I have personally examined and 01 _ 0 99 am familiar with the information submitted in pages one through 02 100 499 and that based on my inquiry of those individuals responsible for 03 500 999 obtaining the information,I believe that the submitted information is 04 1,000 4,999 true,accurate and complete. 05 5,000 9,999 e- p � 06 10,000 24,999 07 25,000 49,999 Name and official title of owner/operator OR owner/operator's 08 50,000 74,999 authorized representative 09 75,000 99,999 10 100,000 499,999 Q% � 11 500,000 999,999 Signat V,e Date Signed 12 1,000,000 9,999,999 13 10,000,000 Greater than 10 million The public reporting and recordkeeping burden for this collection of information is estimated to range from 6 to 120 hours per response. Send comments on the Agency's need for this information,the accuracy of the provided burden estimates,and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director,Collection Strategies Division,U.S.Environmental Protection Agency(2822T), 1200 Pennsylvania Ave.,NW,Washington,D.C.20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form No. 8700-30 0111113 Control No.2050-0072 Page 1 of 10 EPA Form No. 8700-30 OMB Control No.2050-0072. Page 2 of 10 Physical and Storage Additional Chemical Description Health Inventory Type of . ..- Reporting Temperature) Hazards Storage (Pressure, Locations Information (Optional) Maximum Amount C 1,4 ❑Check if information below is identical to the information submitted ❑ Fire 1 1,4 Confidential: ❑ Below last year. Range Code: L 1,4 ❑Yes El No Reporting El Sudden Sudden Thresholds Release of (optional) Chemical Nam :Carbon Pressure CAS No.00744 -44 0 Average Daily ❑ Reactive Amount " Range Code: El State or Local EHS: Yes No El El Immediate 3 Requirements (Acute) El Solid ❑Li uid ❑Gas ❑Trade Secret 2 Delayed (Chronic) No.of days on site: 365 ❑Check if info mation below is identical to the information submitted ❑. Fire Maximum Amount Confidential: ❑ Below last year. (Total Mixture) ❑Yes ❑ No Reporting Range Code: Thresholds Mixture or Product Name: El Sudden Release of (optional) Pressure Average Daily CAS No. ❑Not Available Amount(Total ❑Solid ❑Liquid ❑Gas ❑Trade Secret ❑ Reactive Mixture) ❑State or Local Range Code: Requirements EHS: Yes No ❑ Immediate (Acute) EHS(s)Name(if applicable): ❑ Delayed No.of days on site: (Chronic) CAS No. Maximum Amount of Non-EHS(s)Na Tie(optional): each EHS in the Mixture Range Code: Optional Attac meets: ❑ I have attached a site plan ❑ I have attached a list of site coordinate abbreviations ❑ I have attached a description of dikes and other safeguard measures EPA Form No. 8700-30 OMB Control No.2050-0072 Page 3 of 10 StoragePhysical and Storage Additional Chemical Description Health Inventory Type of Conditions Reporting Storage Hazards Temperature) (Optional) ✓ Maximum Amount E 1,4 ❑Check if info mation below is identical to the information submitted ❑ Fire Confidential: ❑ Below last year. 3Range Code: El Yes El No Reporting ❑ sudden Thresholds Release of (optional) Chemical Name:Calcium Chloride Pressure CAS No.01004 -52-4 Average Daily ❑ Reactive Amount Range Code: ❑ State or Local EHS: Yes ❑ No 0 El Immediate 3 Requirements (Acute) ✓❑Solid ❑Li uid ❑Gas ❑Trade Secret ❑ Delayed (Chronic) No.of days on site: 365 ❑Check if information below is identical to the information submitted ❑ Fire Maximum Amount Confidential: ❑ Below last year. (Total Mixture) ❑El Sudden Yes ❑ No Reporting Range Code: Thresholds Mixture or Product Name: Release of (optional) CAS No. ❑Not Available Pressure Average DailyAmount(Total El Solid ElLiquid ❑Gas ❑Trade Secret ❑ Reactive Mixture) ❑State or Local Range Code: Requirements EHS: Yes ❑ No ❑ ❑ Immediate (Acute) EHS(s)Name(i applicable): ❑ Delayed No.of days on site: (Chronic) CAS No. Maximum Amount of Non-EHS(s)Na a(optional): each EHS in the Mixture Range Code: Optional Attact ments: ❑ I have attached a site plan ❑ I have attached a list of site•coordinate abbreviations 13 I have attached a description of dikes and other safeguard measures EPA Form No. 8700-30 OMB Control No.2050-0072 Page 4 of 10 TPhysical and Ste Additional Chemical Description Health Inventory Type of Conditions Ste Reporting . .. . .. z. T fol Hazards to rage •. . ID Check if information below is identical to the information submitted ❑ Fire Maximum Amount A 1,4 last year. Confidential: y Range Code: ❑Yes ❑ No ❑ Below El Sudden 4 Reporting Release of Thresholds Chemical Name:Hydrochloric Acid Pressure (optional) CAS No.7647 1-0 Average Dail El Reactive A g y Amount EHS: Yes El No 0 Range Code: ❑State or Local El Immediate 3 Requirements (Acute) ❑Solid 0 Liquid ❑Gas ❑Trade Secret ❑✓ Delayed (Chronic) No.of days on site: 365 ❑Check if info mation below is identical to the information submitted ❑ Fire Maximum Amount last year. (Total Mixture) Confidential: ❑ Below Range Code: ❑Yes ❑ No Reporting Mixture or Product Name: ❑ Sudden Thresholds Release of (optional) CAS No. ❑Not Available Pressure Average Daily Amount(Total ❑Solid ❑Li uid ❑Gas ❑Trade Secret ❑ Reactive Mixture) ❑State or Local Range Code: Requirements EHS: Yes ❑ No ❑ ❑ Immediate (Acute) EHS(s)Name(ii applicable): El Delayed No.of days on site: (Chronic) CAS No. Maximum Amount of Non-EHS(s)Name(optional): each EHS in the Mixture Range Code: Optional Attach ents: ❑ I have attached a site plan ❑ I have attached a I ist of site coordinate abbreviations 13 I have attached a description of dikes and other safeguard measures EPA Form No. 8700-30 OMB Control No.2050-0072 Page 5 of 10 StorageChemical Description Health Inventory Type of Conditions Hazards Storage (Optional) ❑� Check if information below is identical to the information submitted ❑ Fire Maximum Amount C 1,4 last year. Range Code: I 1,4 Confidential: ❑ Below ❑ 1,4 ❑Yes El No Sudden 4 L 14 Reporting Release of Thresholds Chemical Name:Ion Exchange Resin Pressure (optional) CAS No.6901 -18-3 Average Daily M Reactive Amount EHS: Yes No M Range Code: ❑State or Local 0 Immediate 4 Requirements (Acute) Solid ❑ iquid ❑Gas ❑Trade Secret ❑ Delayed (Chronic) No.of days on site: 365 ❑Check if infc rmation below is identical to the information submitted ❑ Fire Maximum Amount last year. (Total Mixture) Confidential: ❑ Below Range Code: ❑Yes ❑ No Reporting Mixture or Pro uct Name: ❑ Sudden Thresholds Release of (optional) CAS No. ❑Not Available Pressure Average Daily Amount(Total ❑Solid ❑Liquid ❑Gas ❑Trade Secret ❑ Reactive Mixture) ❑State or Local Range Code: Requirements EHS: Yes No ❑ ❑ Immediate (Acute) EHS(s)Name(if applicable): ❑ Delayed No.of days on site: (Chronic) CAS No. Maximum Amount of Non-EHS(s)Na a(optional): each EHS in the Mixture Range Code: Optional Attach ments: ❑ I have attached a site plan ❑ I have attached a list of site coordinate abbreviations 13 I have attached a description of dikes and other safeguard measures EPA Form No. 8700-30 OMB Control No.2050-0072 Page 6 of 10 Physical and Storage Type of Conditions Storage Reporting Chemical Description Health Inventory Storage (Pressure, Locations Information Hazards Temperature) (Optional) Maximum Amount C 1,4 ❑✓ Check if information below is identical to the information submitted ❑ Fire I 1,4 Confidential: ❑ Below last year. Range Code: 1,4 ❑Yes 121 No Reporting ❑ Sudden 4 L 1,4 Thresholds Release of (optional) ChemicalName:Ion Exchange Resin Pressure CAS No.0 901-22-9 Average Daily ❑ Reactive Amount Range Code: ❑ State or Local EHS: Yes ❑ No El ID Immediate 4 Requirements (Acute) Solid 13 Liquid ❑Gas ❑Trade Secret ID Delayed (Chronic) No.of days on site: 365 ❑Check if information below is identical to the information submitted ❑ Fire Maximum Amount Confidential: ❑ Below last year. (Total Mixture) ❑Yes ❑ No Reporting ❑ Sudden Range Code: Thresholds Mixture or Product Name: Release of (optional) Pressure Average Daily CAS No. ❑Not Available Amount(Total ❑ Reactive Mixture) ❑State or Local ❑Solid 13 Liquid ❑Gas ❑Trade Secret Range Code: Requirements EHS: Yes No ❑ ❑ Immediate (Acute) EHS(s)Name(if applicable): ❑ Delayed No.of days on site: (Chronic) CAS No. Maximum Amount of Non-EHS(s)Name(optional): each EHS in the Mixture Range Code: Optional A ttachments: ❑ I have attached a site plan ❑ I have attached a list of site coordinate abbreviations 13 I have attached a description of dikes and other safeguard measures EPA Form No. 8700-30 OMB Control No.2050-0072 Page ?of 10 Storage Physical and Type of Conditions Storage Reporting Chemical Description Health Inventory Information stora.. (Pressure, Locations Hazards (Optional) t C 1,4 �Check if i formation below is identical to the information submitted. El Fire Amount Confidential: ❑ Below last year. Range Code: [I Yes El No Reporting ❑ Sudden 4 Thresholds Release of (optional) Chemical Name:Sulfuric Acid Pressure Average Daily CAS No.766 93-9 El Reactive Amount ❑ State or Local Range Code: Requirements EHS: Yes ElNo ❑✓ � Immediate 3 (Acute) []Solid Q Liquid ❑Gas ❑Trade Secret Delayed No.of days on site: (Chronic) 365 ❑Check if i formation below is identical to the information submitted Maximum Amount Confidential: ❑ Below ❑ Fire (Total Mixture) ❑Yes ❑ No Reporting last year. Range Code: Thresholds Mixture or El Sudden (optional)Product Name: Release of Pressure Average Daily CAS No. ❑Not Available Amount(Total ❑ Reactive Mixture) [I State or Local ❑Solid El Liquid ❑Gas ❑Trade Secret Range Code: Requirements EHS: Yes ❑ No ❑ ❑ Immediate (Acute) EHS(s)Nam (if applicable): ❑ Delayed No.of days on site: (Chronic) CAS No. Maximum Amount of each EHS in the Non-EHS(s)Name(optional): Mixture Range Code: Optional Alachments: ❑ I have attached a site plan ❑ I have attached a list of site coordinate abbreviations ❑ I have attached a description of dikes and other safeguard measures EPA Form No. 8700-30 OMB Control No.2050-U072 -TI -- Page 8 of 10 DescriptionChemical Physical T Storage Health Inventory • of • • Additional Storage Hazards Reporting Storage (Pressure, Locations Information Tem • • • - Check f information below is identical to the information submitted last year. ❑ Fire Maximum Amount Range Code: Confidential: ❑Below❑ Sudden 4 Chemical ame:Sodium Hydroxide Release of ❑Yes 0 NoReporting CAS No. 1 10-73-2 Pressure Thresholds 0 Reactive Average Daily (optional) EHS: Yes ❑ No Amount Immediate Range Code: 3 El State or Local ❑Solid ED Liquid ❑Gas El Trade Secret (Acute) Requirements 0 Delayed (Chronic) No.of days on site: 365 ❑Check if i Iformation below is identical to the information submitted last year. ❑ Fire Maximum Amount (Total Mixture) Confidential: ❑ Below Mixture or Product Name: ❑ Sudden Range Code: ❑Yes ❑No Reporting CAS No. Release of . Thresholds ❑Not Available Pressure Average Daily (optional) ❑Solid ❑Liquid ❑Gas ❑Trade Secret Amount(Total ❑ Reactive Mixture) EHS: Yes No ❑ Range Code: ElState or Local ❑ Immediate Requirements EHS(s)Name pp(�if applicable): (Acute) ❑ Delayed No.of days on site: (Chronic) CAS No. Non-EHS(s)Name(optional): Maximum Amount of each EHS in the Mixture Range Code: Optional Attac ments: ❑ I have attached a site plan ❑ I have attached a description of dikes and ter safeguardattached a list me measures site coordinate abbreviations i EPA Fonn No. 8700-30 OMB Control No.2050-0072 Page 9 of 10 Physical and Storage Additional Chemical Description Health Inventory Type of Conditions Storage Reporting Hazards S (Pressure, Locations Information •. . Check if nformation below is identical to the information submitted ❑ Fire Maximum Amount E 1,4 last year. Range Code: C 1,4 Confidential: ❑ Below ❑ Sudden 3 ❑Yes 0 No Reporting Chemical Name:Magnesium Chloride Release of Thresholds Pressure (optional) CAS No.77 1-18-6 Average Daily ❑ Reactive Amount EHS: Yes ❑ No E1 Range Code: ❑State or Local El Immediate 2 q (Acute) Requirements ID Solid Liquid ❑Gas ❑Trade Secret ❑p Delayed (Chronic) No.of days on site: 365 ❑Check if i formation below is identical to the information submitted Maximum Amount last year. ❑ Fire Confidential: ❑ Below (Total Mixture) Range Code: ❑Yes ❑ No Reporting Mixture or P oduct Name: ❑ Sudden Thresholds Release of o Thresholds CAS No. ❑Not Available Pressure Average Daily (optional) Amount(Total ❑Solid ❑ -iquid ❑Gas ❑Trade Secret ❑ Reactive Mixture) Range Code: ❑State or Local EHS: Yes No ❑ Requirements ❑ Immediate (Acute) EHS(s)Name(if applicable): ❑ Delayed No.of days on site: (Chronic) CAS No. Maximum Amount of Non-EHS(s)N ame(optional): each EHS in the Mixture Range Code: Optional Atta hments: ❑ I have attached a site plan ❑ I have attached a list of site coordinate abbreviations ❑ I have attached a description of dikes and other safeguard measures EPA Form No. 8700-30 OMB Control No.2050-0072 Page 10 of 10 Chemical Description Physical Physical Hazards • ..- Health Inventory Type of Conditions Storage Reporting Hazards Health e of Storage (Pressure, Locations Information �. . one if in ormation below is identical to the information submitted ❑ Fire LAvera m Amount C 1,4 last year. J 1 4 Confidential: Code: ❑Below ❑ Sudden ❑Yes 0 No Reporting Chemical Na e:Sodium Chloride Release ofThresholds PressureCAS No.7647 14-5 (optional) Reactive Daily EHS: Yes M No 0 AmountRange Code: El Immediate 3 ❑State or Local (Acute) Requirements 0 Solid ❑Liquid ❑Gas ❑Trade Secret ❑ Delayed (Chronic) No.of days on site: 365 ❑Check if information below is identical to the information submitted last year. ❑ Fire Maximum Amount (Total Mixture) Confidential: ❑ Below Mixture or Product Name: ❑ Sudden Range Code: ❑Yes ❑ No Reporting Release of Thresholds CAS No. ❑Not Available Pressure Average Daily (optional) Amount(Total ❑Solid ❑Liquid ❑Gas ❑Trade Secret ❑ Reactive Mixture) Range Code: ❑State or Local EHS: Yes ❑ No ❑ Requirements ❑ Immediate (Acute) EHS(s)Name(if applicable): ❑ Delayed No.of days on site: (Chronic) CAS No. Non-EHS(s)Name(optional): Maximum Amount of each EHS in the Mixture Range Code: Optional Attach ents: ❑ I have attached a site plan P ❑ I have attached a list of site coordinate abbreviations • ❑ I have attached a description of dikes and other safeguard measures