 Check if information below is identical to the information submitted last year. **Reporting Period:** January 1 to December 31, 20____ 

### Tier One **Emergency**

**and Hazardous Chemical Inventory**  Aggregate Information by Hazard Type **For Official Use Only State ID #:**  **Date Received: Facility**  **Identification** Name Maximum No. of Occupants:  Manned
 N/A  Unmanned Street County City State Zip

Latitude Longitude NAICS Code Phone Number (optional)

Dun & Brad

street Number TRI Facility ID RM P Facility ID:  N/A  N/A Subject to Emergency Planning under Section 302 of EPCRA?  Yes  No Subject to Chemical Accident Prevention under Section 112(r) of CAA (40 CFR part 68, Risk Management Program)?  Yes  No **Owner or Operator Information**  **Parent Company Information (optional)**  Name Name Dun & Brad street Number

Address Address

Phone Number Email Phone Number Email ( ) ( ) **Facility Emergenc**  **y Coordinator (if applicable)**  **Tier I Information Contact** Name Title Name Title

Email Address Email Address

Phone Number 24

- hour Phone Phone Number ( ) ( ) ( ) **Emergency**

**Contacts** Name Name

Title Title

Phone Number 24

- hour Phone Phone Number 24

- hour Phone ( ) ( ) ( ) ( ) Email Address Email Address
**Certification: ( Read and sign after completing all sections)**  I certify under penalty of law that I have personally examined and am familiar with the information submitted in pages 1 through , and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate and complete.
Name and official title of owner/ operator OR owner/operator’s authorized representative Signature Date signed

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	u se	of	automated	collection	techniques	to	the	Director,	Collection	Strategies	Division,	U.S. Environmental	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. **E PA Form No**  **. 8 700**  **- 29**  **OMB Control No. 2050 -**  **0072 Page**  **1 of ----** **EPA Form No. 8700 -**  **29 OMB Control No. 2050**  **- 0072**  **Page ----**  **of ----** 

 Check if information below is identical to the information submitted last year. Hazard Type Ma x Amount Average Daily Amount Number of Days

On

- Site General Location**P h** **y s** **i c** **a l** **H a** **z a** **r d**  Fire

Sudden Release of Pressure

Reactive**H e** **a l** **t h** **H a** **z a** **r d**  Immediate (acute)

Delayed (acute)

**REPORTING RANGES**

**WEIGHT RANGE IN POUNDS**  **Range Codes From**  **To** 01 0 99 02 100 499 03 500 999 04 1,000 4,999 05 5,000 9,999 06 10,000 24,999 07 25,000 49,999 08 50,000 74,999 09 75,000 99,999 10 100,000 499,999 11 500,000 999,999 12 1,000,000 9,999,999 13 10,000,000 Greater than 10 million

**Optional Attachments:**  I have attached a site plan  I have attached a list of site coordinate abbreviations  I have attached a description of dikes and other safeguard measures