HomeMy WebLinkAbout648 Sullivan Avenue - Tier II Reports - (4) /Check if information below is identical to the information submitted last year. Reporting Period:January 1 to December 31,20_
Tier •
Emergency . Hazardous
InformationSpecific by Chemical
Facility Identification
Name Maximum No.of Occupants: % Manned ❑Unmanned
QC—, ❑ N/A
i
(-ot1"%X'dtaL L• CyC ', C`a
Street +� Coup�ty City State Zip
�s�L 1 Vi�ty AV—
PA E. f i i� �D 5c u.Ut SC rL C'..-f' 04XC 7*—U _
Latitude Longitude NAICS Code Phone Number(optional)
PQ L- z _! ' (! 1 Sr6 l: W��� .. �"� I�3`7 It Lf 54 311
Dun&Bradstreet Number TRI Facility,ID: RMP Facility ID:
5q I %,N/A Z,1 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 XNo
Owner or Operator Information Parent Company Information(optional)
Name 1, Name Dun&Bradstreet Number:
LO
Address 1 Address
�H �VL A—i va s AWL
Phone Number j Email Phone Number Email
Facility Emergency Coordinator(if applicable) Tier It Information Contact
Name Title Name r Title
W LLi form L�Uv'N V.,1t
Email Address Email Address y �n
- V.,) Vt"•f?��i;S.�+�`�iL�� t(� '.'.1 c. it�L'C'Je L G(� �U j'Yt
Phone Number 24-hour Phone Phone Number
—� Emergency Contacts
Nape Name v
37 R
Title Title
Phone Number 24-hour Phone Phone Number i 24-hour Phone
t , ) 2 L(I oo � Aw 'Z-cl I 1� t Eat �c,
E ail Address I Email Address
i}•�,�laj•J.•.%t'1L� �' t`'h q etv.i+al LoC7i L �.: L..G� 1A�J'��`a:�rL i� .. GYLi t'?rL.-tTfL C.C:) i:�ri•`dt
Certification(Read and sign a ter completing all sections) ReportinIg Ranges
Weight Range in pounds
Range(_ode From To
l certify under penalty of lase that I have personally examined and 01 0 99
am familiar Frith the information submitted in pages one through 02 100 499
and that based ono my inquiry of those individuals regpousible for 0-, 500 999
obtaining the information,I hc•hes"e that the submitted infomtation is 04 1,000 4,999
true,accurate and complete. 05 5,000 9,999
\ ' j 06 10.000 24.999
i L I i W V►^ V ti�✓>P.i �Ir-� 07 25.000 49,999
Name and official title ifrncnel--operator(1R owner=operators 08 50.000 74.999
a � f it ur inn%pi ..cnt nse 09 00.000 99.999
10 100.(100 499.999
11500,000 999,999
Signature [)ate Signed 12 1,000.000 9.999,999
13 10,000.000 Greaten 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.i:rtvironmental 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 OMB Control No,2050-0072 Page 1 off
EPA Form No. 8700.30 OMB Control No.2050-0072 Page _Zof
storage
Additional
Physical and Type of Con " " ns Reporting
Chemical Description
Hazards
•'
I a Check if information below is identical to the information submitted i 1 Fire Maximum Amount Confidential ❑Below
last year. i Range Code: ❑Yes Z No Reporting
❑ Sudden C74 �✓ 1 Thresholds
Release of j� ►2i;G is (optional)
Chemical Name: - °� •, -" i Pressure -17 o Average Daily
CASNo. Reactive
Amount �7
Range Code: ❑State or Local
EHS: Yes ❑ No I Immediate Requirements
I
(Acute) `-� 1 114
❑Solid 1%Liquid ❑Gas ❑Trade Secret ❑ Delayed
(Chronic) No.of days on site:
Ig Fire Maximum Amount ❑Below
Check it information below is identical to the information submitted Confidential:
last year. (Total Mixture) ❑Yes N No Reporting
Range Code-
Sudden �� Thresholds
Mixture or Product Name: �1'c:�fa�t � Release of �I' U�51 (optional)
Pressure Average Daily
CAS No. ❑ Not Available Amount(Total
❑ Reactive Mixture) El❑State or Local
❑Solid iA Liquid ❑Gas ❑Trade Secret Range Code: I Requirements
EHS: Yes ❑ No Immediate i �.3
• l�
(Acute)
EHS(s)Name(if applicable): I ❑ 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.Attachments: Lei l have attached a site plan ❑ 1 have attached a list of site coordinate abbreviations-
0 1 have attached a description ofdikes and other safeguard measures
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