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Company Name: <br />Representative name and phone no.}: <br />Location of reported EHS materials street address} <br />Please provide the following information for each of the Extremely Hazardous <br />Substances designated by SARA Title III, Section 302 X40 CFR 355; see Appendix <br />VI-A, Part IV} that you have in your possession. List only those chemicals <br />which you possess in greater than Threshhold Planning Quantities ~TPQ}; use <br />add~t~onal sheets ~f necessary. <br />Chemical Name: <br />CAS No.: <br />Density liquids; lbs/gal}: <br />Average Quantity on-hand ~l bs} <br />Maximum Quantity on-hand ~1bs}: <br />Quantity in largest single containers tlbs}: <br />Transportation routes: list all roads or railroad <br />the material is carried either from the city limits <br />or from your facility tv the city limits. <br />Maximum amount transported at one time albs}: <br />SECTION III: SEPARATION OF MATERIALS <br />segments that <br />to your facility, <br />1, For each storage facility describe the method used to separate and <br />protect non-compatible materials hex: 20 feet distance, one-hour separation, <br />approved storage cabinets, etc.}. This listing may be clarified with a <br />simple diagram where appropriate. See specific requirements in Article 80, <br />Division III. <br />2. list the materials used for the primary and secondary containment <br />of any stared chemicals hex: teflon for corrosives}. Verify that they are <br />adequate and impervious to the chemicals stored by attaching chemical <br />resistance charts and/or other technical data. <br />SECTION IV: MONITORING PROGRAM <br />I. Provide a copy of your written procedures fvr reporting discharges. <br />this is to include your internal notification plan and decision-making cri- <br />teri a. <br />NOTE: The Chief should be notified of all reportable discharge <br />occurrences immediately, in accordance with 80.I04~c}. <br />~. For each storage facility provide the following: <br />a. Describe the location preference facility map i f appropri ate} . <br />b. Describe monitoring methods used to detect leaks or spills. <br />c. Type and manufacturer of any monitoring equipment. <br />d. Monitoring frequency for that storage facility. <br />e. Maintenance frequency of monitoring equipment. <br />Ordinance - 83 <br />