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NOTICE TO TOXICS BOARD OF TRADE SECRET REPORTS <br />FILED WITH THE OFFICE OF THE FIRE MARSHAL' <br />Company: <br />Tax Identification Number: <br />Reporting Year: <br />Note: This report to the Toxics Board must he updated by April I each year only if there are <br />changes to the report last filed with the Toxics Board. <br />Code Number of Substance <br />Category: Hazardous <br />substance (HS), extremely <br />hazardous substance (EHS) <br />Date Filed With <br />Fire Marshal's <br />Office <br />Signature <br />Print name <br />Title <br />' Eugene Charter Amendment IV, Section 5.2(A)(2) <br />Date <br />The reporting year is the year previous to the April I reporting date. For instance, a report filed by <br />April 1, 2012 would cover the reporting year of January I - December 31, 2011. <br />3 'Trade Secret Chemical Code Number is the facility's 9 -digit Tax Identification Number followed by a hyphen <br />followed by a whole number (1, 2, 3 ... n) which uniquely identifies each trade secret chemical. A <br />company with two trade secret chemicals would have Code Numbers for those two chemicals of: <br />Tax Identification Number -1 (xx-xxxxxxx-I) <br />Tax Identification Number -2 (xx-xxxxxxx-2) <br />This form is to be filed with the Eugene Toxics Program Staff c/o Eugene Toxics Board <br />(1320 Willamette Street, Eugene OR 97401) when the previous form (Substantiation to <br />Accompany Claims of Trade Secrecy) is filed with the City's Fire Marshal for one or more <br />substances. <br />-52- <br />