Loading...
HomeMy WebLinkAbout648 Sullivan - Tier II Reports - Fire Ma �1 Check if information below is identic al to the information submitted last year. Reporting Period:January 1 to pecember 31,20 / Facility Identification , T11 v tv1 n I Maximum No.o/Occupants: Street L vi L 0 N/A Manned ❑Unmanned SU`�C.i V!"rN , Cou ty _.._. ...._ l l�i� City Latitude - ------ ----- -- --------- t`I(-�J � - State Zip fir L. r t r Longitude L bi.)''t'�, sv �'.r{' U 7 NAILS Code Phone Number(optional) Dun&Bradstreet Number _— —W 71� A r rz` ( 3"7 n H S4 ( �_ 5tr I 3 + TRI Facility ID. (�bG "�f - C21 i rj XN/A RMP Facility ID: Subject to Emergency Planning under Section 302 of EPCRA(40 CFR part 355)7 �N/A Subject to Chemical Occident Prevention under Section 112(r)of GAA(40 CFR part 68,Risk Management Program)? Yes 1 No Owner or Operator Information Yes I�No Parent Company Information Y (optional) � - -- Name t Dun&Bradstreet Number: Address 1 �.V(.t:i VNn/ !��`�, 1 r Address.. �LI{NPJt�ptn :Phone Plumber •i� Email. v _1�U -�. Phone Number Email Facility.Emergency Coordinator(if.applicable) -Name Tier,11 Info.rmationContact Title Name ... - Title Email Address (�Ll i brill ��O�,y, VP Email Addrrress T'l� Phone Number . f IM -- �K1 24-hour Phone t�rr_- Phone:Number (� •��i ( G I f 5 Name Emergency Contacts ' Name S 1 Ti Lw ' Title - - V hil� r Tine Phone Number i_ 24-hour Phone Phone Number es(CrC( i. 24-hour Phone E ail Address P �P"( 1 0 1 r 5 ; 7 E Y �^ II GCi?p "✓'� eC).Juc%t�✓ w EmailAddress Certification(Read and sir;n Jell, plem w all sections l i6w0Ai �r� I✓t1 _ rti✓I{3[ _U%L—of e_Lr`yl Ile Reportin Ranges; �i ei fit Ran a inpounds Liedily under 1 enalty of laNv'Thal I have persounliv examined and Range Code From tuu lanuliar ith tlta inlixmation vubmitteil m poses one Ihrnuglt 0I. fo and That Lased odnty-inquiry of!thosc individuals responsible far 0` 0 nhlaimng file infoiinaui99 on I believe that the submilwd information is 0' 100 99 titic,-iCwralc and complete. 0`I .500 999 f 1 05 1,000 999- �LQ�G)!/ ( 5,000 4,999 06 10.000 9.999 \';cme and official title ul c��uer,operator OR ottnn 'Operator's 07 24,999 ti d repiesen 08 25.000 tatice 50.000 49,999 ' 09 . �--_�7— 1 I 75 74.999. 10 -U ( 9y999L000 499.999 I)tle iandi / SUU.UOp ` 12 I,000.000 999.999 I.i 10,000:000 9,999,99())T he porting uui recordkee in burden for.thls coffee inn of.inftirmahun is estimated to range from G to 12(1 hours er Greater than 10 million eed for this Information,the accui tc v glt the use'ofautoinated collection t<hnitlues tooled biede�e��me�tioondrat ys Uivislo p response. Send commentsnn vania Avice.,NW Washtnghnt,U.C.204CO3 Include the OMB control number in any ronespondence�tUo�tottsend al Prb.respondent burden, n,U.S.F"m�h'onmental Protection Agency(28'l2'T), EPA Form No. 8700-30 a completed form to this OMB ControLNo.2050-0072 - Page 1 of EP A Form No. 870030 OMB Control No.2050-0072 page =2_of chbelcal �- - Add- itional -Health Type of C"Oridiji ns,� Storage- _,H Storage Reporting Locations Inf rmation irature) •,. ❑/Check if information below is identical to the information submitted last year. I Fire Maximum Amount i Range Code: Confidential: ❑Below i ❑ Sudden j ! El Yes IE No Reporting Chemical Name: - — I Release of j L, Pressure Thresholds u f�-rt4G•-s CAS No. c��L�;? _ y Average Daily � ) (optional) ❑ Reactive Amount EHS: Yes ❑ No 1-7I Range Code:Immediate �• Elf /� State or Local ! � (Acute) � Requirements ❑Solid I%Liquid El Gas ❑Trade Secret I 114 tj ❑ Delayed I (Chronic) No.of days on site: r_ Chrenformation below is identical to the information submitted, (� Fire Maximum Amount (Total Mixture) Confidential: ❑ Below roduct Name �t'-�tlaty Sudden Range Code f/� Z [ ❑Yes N No Reporting.. Release of �� A ! _7 Thresholds CAS No. Pressure_ _ ❑ Not Available Average Daily � ,.� � (optional) Amount(Total ) i �0, ❑Solid ®Liquid ❑Gas El Trade Secret I ❑..Reactive Mixture)Range - Range Code: 1I1l•'"'-( El State or Local EHS: Yes El No (�-�j t Immediate Requirements C�9 EHS(s)Name(if applicable): (Acute) ❑ Delayed No,of days on site: (Chronic) 7 CAS No. Non-EHS(s)Name(optional): Maximum Amount of each EHS in the Mixture Range Code: Optional Attachments: LrJ I have attached a site plan P . ❑ 1 have attached a list of site coordinate abbreviation, ❑ I have attached a description of dikes and ether safeLuard measures Page j of " pages Facility Identification Form Approved OMB No.2050-0072 Name if L Owner/Operator Name Tier Two —�NL Street Name - — ?; �l��)1 Phone' 0 S EMERGENCY City s v''t'I`� v t t�; v County /L State Mail Address v V � UL AND C.•i- zp HAZARDOUS act 'GrL O7 NAICS Dun&Brad Number Emergency Cont Code O (p�•� �'-]/ CHEMICAL INVENTORY Name �(�( ivy Title V FOR ID# Phone � O[1 24 Hr.Phone (O(l Specific OFFICIAL Information USE Date Received Name by Chemical ONLY Phone ( ) Title 24 Hr.Phone ( ) Important: Read all instructions before completing form Reporting Period From January 1 to December 31,20 [) Check if information below is identical to the information submitted last•year Physical 3 Chemical Description Inventory 7 m Storage Codes and Locations m P and Health Hazards y a =a E (Non-Confidential) s (check all that apply) � a `L PA YJ v r' al 9 a, CAS l7 .-3 2_ Trade 0 Secret Storage LOCatians Chem.Name 7 11;Z cs l t Fire . Max.Daily [] Sudden Release .. Amount.(code) Check al! [) [[ [j of Pressure I Reactivity l r that apply Pure Mix Solid Liquid Gas EHS Immediate(acute) ®Avg.Daily Amount EHS Name [I Delayed(chronic) code _ Tito w✓N- No.of Days CAS ?� �(8_ Trade On-site(days) . Secret [(� Fire . Chem.Name ytiE Sudden Release Max-Daily tl Check all of Pressure ®Amount(code) 9- I< , [] I l [] [l [1 [1 [I Reactivity that apply Pure Ma solid Liquid Gas EHS (� Immediate(acute)Avg.Daily Amount EHS Name code [I Delayed(chronic) No.of Days Trade On-site(days) CAS Secret [J Fire Chem.Name Max.Daily [] Sudden Release Q�Amount(code) Check all of Pressure [] [l [l [] [1 [] [I Reactivity that apply Pure Mix Solid Liquid Gas EHS Avg.Daily Amount EHS Name [] Immediate(acute) code [I Delayed(chronic) No.of Days Certification (Read and sign after completing all sections) On-Site(days) [I I certify under penalty of law that I have personally examined and am familiar with the informatio submitted i ages a throw h Optional Attachments on my inquiry of those indivi uaI responsible for obtaining the information,I be ve that r g and that based ,' 10 l have attached a site plan �t/1 t-l�i IOrWY ©Yy � nf a i true,accurate;and m lete. [j I have attached a fist of site coordinate abbreviations Name and official title of ownerloperator OR owner operator's �i nature authorized representative g Dat sig ed [I I have attached a description of dikes and other safeguards measures c o7 I (ZE D