TIER TWO INSTRUCTIONS Reauthorization Act of 1986, Section (when requested) is required by Title III of the Superfund Amendments and Submission of this Tier Two form General Information ing the past year. chemicals present at your facility durspecific information and local officials and the public with this Tier Two form is to provide State U.S.C. Section 11022. The purpose of 312, Public Law 99-499, codified at 42 hazardous on and that bared load and sign after completing all sections) Icarly under penalty of law that I have personally examined and am familiar with the information submitted in pages one through. en my inquiry of these individuals responsible ler obtaining the information, I believe that the submitted information le trus, accurate, and complete. Name and official title of enanoperator OR emer/operator's authorized representative Signature Temperature Pressure 24 Hr. Phone 24 Hr. Phone Check & information | you Storage Codes and Locations (Confidential) Storage Locations Dale signed Optional Certification The owner or operator or the officially designated representative of the owner or operator must certify that all information included in the Tier Two submission is true, accurate, and complete. On the first page of the Tier Two report, enter your full name and official title. Sign your name and enter the current date. Also, enter the total number of pages included in the Confidential and Non-Confidential Information Sheets as well as all attachments. An original signature is required on at least the first page of the submission. Submissions to the SERC, LEPC, and fire department must each contain an original signature on at least the first page. Subsequent pages must contain either an original signature, a photocopy of the original signature, or a signature stamp. Each page must contain the date on which the original signature was affixed to the first page of the submission and the total number of pages in the submission. You Must Provide All Information Requested on This Form to Fulfill Tier Two Reporting Requirements This form may also be used as a worksheet for completing the Tier One form or may be submitted in place of the Tier One form. Who Must Submit This Form Section 312 of Title III requires that the owner or operator of a facility submit this Tier Two form if so requested by a State emergency response commission, a local emergency planning committee, or a fire department with jurisdiction over the facility. This request may apply to the owner or operator of any facility that is required, under regulations implementing the Occupational Safety and Health Act of 1970, to prepare or have available a Material Safety Data Sheet (MSDS) for hazardous a chemical present at the facility. MSDS requirements are specified in the Occupational Safety and Health Administration (OSHA) Hazard Communication Standard, found in Title 29 of the Code of Federal Regulations at § 1910.1200. This form does not have to be submitted if all of the chemicals located at your facility are excluded under Section 311(e) of Title III. What Chemicals are Included If you are submitting Tier Two forms in lieu of Tier One, you must report the required information on this Tier Two form for each hazardous chemical present at your facility in quantities equal to or greater than established threshold amounts (discussed below), unless the chemicals are excluded under Section 311(e) of Title III. Hazardous chemicals are any substance for which your facility must maintain an MSDS under OSHA's Hazard Communication Standard. If you elect to submit Tier One rather than Tier Two, you may still be required to submit Tier Two information upon request. What Chemicals are Excluded Section 311(e) of Title III excludes the following substances: (i) Any food, food additive, color additive, drug, or cosmetic regulated by the Food and Drug Administration; (ii) Any substance present as a solid in any manufactured item to the extent exposure to the substance does not occur under normal conditions of use; (iii) Any substance to the extent it is used for personal, family, or household purposes, or is present in the same form and concentration as a product packaged for distribution and use by the general public; (iv) Any substance to the extent it is used in a research laboratory or a hospital or other medical facility under the direct supervision of a technically qualified individual; (v) Any substance to the extent it is used in routine agricultural operations or is a fertilizer held for sale by a retailer to the ultimate customer. OSHA regulations, § 1910.1200(b), stipulate exemptions from the requirement to prepare or have available an MSDS. Reporting Thresholds Minimum thresholds have been established for Tier One/Tier Two reporting under Title III, Section 312. These thresholds are as follows: 194-160 D-01--16 For Extremely Hazardous Substances (EHSS) designated under section 302 of Title III, the reporting threshold is 500 pounds (or 227 kg.) or the threshold planning quantity (TPQ), whichever is lower; For all other hazardous chemicals for which facilities are required to have or prepare an MSDS, the minimum reporting threshold is 10,000 pounds (or 4,540 kg.). You need to report hazardous chemicals that were present at your facility at any time during the previous calendar year at levels that equal or exceed these thresholds. For instructions on threshold determinations for components of mixtures, see "What About Mixtures?" on page 2 of these instructions. A requesting official may limit the responses required under Tier Two by specifying particular chemicals or groups of chemicals. Such requests apply to hazardous chemicals regardless of established thresholds. INSTRUCTIONS Please read these instructions carefully. Print or Type all Responses When to Submit This Form Owners or operators of facilities that have hazardous chemicals on hand in quantities equal to or greater than set threshold levels must submit either Tier One or Tier Two forms by March 1. If you choose to submit Tier One, rather than Tier Two, be aware that you may have to submit Tier Two information later, upon request of an authorized official. You must submit the Tier Two form within 30 days of receipt of a written request. Where to Submit This Form Send either a completed Tier One form or Tier Two form(s) to each of the following organizations: 1. Your State Emergency Response Commission. 2. Your Local Emergency Planning Committee. 3. The fire department with jurisdiction over your facility. If a Tier Two form is submitted in response to a request, send the completed form to the requesting agency. Penalties Any owner or operator who violates any Tier Two reporting requirements shall be liable to the United States for a civil penalty of up to $25,000 for each such violation. Each day a violation continues shall constitute a separate violation. If your Tier Two responses require more than one page use additional forms and fill in the page number at the top of the form. Reporting Period Enter the appropriate calendar year, beginning January 1 and ending December 31. Facility Identification Enter the full name of your facility (and company identifier where appropriate). Enter the full street address or state road. If a street address is not available, enter other appropriate identifiers that describe the physical location of your facility (e.g., longitude and latitude). Include city, county, state, and zip code. Enter the primary Standard Industrial Classification (SIC) code and the Dun & Bradstreet number for your facility. The financial officer of your facility should be able to provide the Dun & Bradstreet number. If your firm does not have this information, contact the State or regional office of Dun & Bradstreet to obtain your facility number or have one assigned. Owner/Operator Enter the owner's or operator's full name, mailing address, and phone number. Emergency Contact Enter the name, title, and work phone number at least one local person or office who can act as a referral if emergency responders need assistance in responding to a chemical accident at the facility. Provide an emergency phone number where such emergency information will be available 24 hours a day, every day. The requirement is mandatory. The facility must make some arrangement to ensure a 24 hour contact is available. Identical Information Check the box indicating indentical information, located below the emergency contacts on the Tier Two form, if the current chemical information being reported is identical to that submitted last year. Chemical descriptions, hazards, amounts, and locations must be provided in this year's form, even if the information is identical to that submitted last year. Chemical Information: Description, The main section of the Tier Two form requires specific information on amounts and locations of hazardous chemicals, as defined in the OSHA Hazard Communication Standard. If you choose to indicate that all of the information on a specific hazardous chemical is identical to that submitted last year, check the appropriate optional box provided at the right side of the storage codes and locations on the Tier Two form. Chemical descriptions, hazards, amounts, and locations must be provided even if the information is identical to that submitted last year. • What units should I use? Calculate all amounts as weight in pounds. To convert gas or liquid volume to weight in pounds, multiply by an appropriate density factor. • What about mixtures? If a chemical is part of a mixture, you have the option of reporting either the weight of the entire mixture or only the portion of the mixuture that is a particular hazardous chemical (e.g., if a hazardous solution weights 100 lbs. but is composed of only 5% of a particular hazardous chemical, you can indicate either 100 lbs. of the mixture or 5 lbs. of the chemical). The option used for each mixture must be consistent with the option used in your Section 311 reporting. Because EHSS are important to Section 303 planning, EHSs have lower thresholds. The amount of an EHS at a facility (both pure EHS substances and EHSS in mixtures) must be aggregated and purposes of threshold determination. It is suggested that the aggrega tion calculation be done as a first step in making the threshold determination. Once you determine whether a threshold for an EHS has been reached, you should report either the total weight of the EHS at your facility, or the weight of each mixture containing the EHS. Chemical Description 1. Enter the Chemical Abstract Service registry number (CAS). For mixtures, enter the CAS number of the mixture as a whole if it has been assigned a number distinct from its constituents. For a mixture that has no CAS number, leave this item blank or report the CAS numbers of as many constituent chemicals as possible. If you are withholding the name of a chemical in accordance with criteria specified in Title III, Section 322, enter the generic class or category that is structurally descriptive of the chemical (e.g., list toulene diisocyanate as organic isocyanate) and check the box marked Trade Secret. Trade secret information should be submitted to EPA and must include a substantiation. Please refer to EPA's final regulation on trade secrecy (53 FR 28772, July 29, 1988) for detailed information on how to submit trade secrecy claims. 2. Enter the chemical name or common name of each hazardous chemical. 3. Check box for ALL applicable descriptors: pure or mixture; and solid, liquid, or gas; and whether the chemical is or contains an EHS. 4. If the chemical is a mixture containing an EHS, enter the chemical name of each EHS in the mixture. Example: You have pure chlorine as on hand, as well as two mixtures that contain liquid chlorine. You write "chlorine" and enter the CAS number. Then you check "pure" and "mix”—as well as "liquid" and "gas". Physical and Health Hazards For each chemical you have listed, check all the physical and health hazard boxes that apply. These hazard categories are defined in 40 CFR 370.2. The two health hazard categories and three physical hazard categories are a consolidation of the 23 hazard categories defined in the OSHA Hazard Communication Standard, 29 CFR 1910.1200. density of benzene is 7.29 pounds per gallon, so you multiply 2,500 gallons by 7.29 pounds per gallon to get a weight of 18,225 pounds. Then you look at table I and find that the range value 04 corresponds to 18,225. You enter 04 as the Maximum Amount. (If you are using the form as a worksheet for completing a Tier One form, you should write 18,255 in the shaded area.) Average Daily Amount 1. For each hazardous chemical, estimate the average weight in pounds that was present at your facility during the year. To do this, total all daily weights and divide by the number of days the chemical was present on the site. 2. Find the appropriate range value in table I. 3. Enter this range value as the Average Daily Amount. Example: The 25,000-gallon shipment of solvent you received last year was gradually used up and completely gone in 315 days. The sum of the daily volume levels in the tank is 4,536,000 gallons. By dividing 4,536,000 gallons by 315 days on-site, you calculate an average daily amount of 14,400 gallons. You already know that the solvent contains 10% benzene, which is a hazardous chemical. Since 10% of 14,400 is 1,440, you figure that you had an average of 1,440 gallons of benzene. You also know that the density of benzene is 7.29 pounds per gallon, so you multiply 1,440 by 7.29 to get a weight of 10,500 pounds. Then you look at table I and find that the range value 04 corresponds to 10,500. You enter 04 as the Average Daily Amount. (If you are using the form as a worksheet for completing a Tier One form, you should write 10,500 in the shaded area.) Number of Days On-Site Enter the number of days that the hazardous chemical was found on-site. Example: The solvent composed of 10% benzene was present for 315 days at your facility. Enter 315 in the space provided. |