TER TWO INSTRUCTIONS
GENERAL INFORMATION
Submission of this tier Two form .(when requested) Is required by Till* III of the Superfund Amendments
and Reauthorizatlon Act of 1988, Section 312, Public Law 99-499, codified at 42 U.S.C. Section 11022. The
purpose of this Tier Two form la to provide State and local officials and the public with specific Informa-
tion on hazardous chemicals present at your facility during the past year.
CERTIFICATION . -
The owner or operator or the officially designated representative of th« owner or opecator must certify that all infor-
mation Included in the Tier Two submission is true, accurate, and complete. On the first page of the Tier Two report.
enter your fuH name and official title. Sign your name and enter the current date. Also, enter the total numoer 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 pag.e of the submission. Submissions to the SERC, LEPC. and fira deoarr-
ment 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 trw Tier One form or may be submitted
In place of the Tier On* form.
WHO MUST SUBMIT THIS FORM
Section 312 of Title III requires that the owner or opera-
tor 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 Hearth Act of 1970. to pre-
pare or have available a Material Safety Data Sheet
(MSDS) for a hazardous chemical present at the facility.
MSDS requirements are specified In the Occupational
Safety and Health Administration (OSHA) Hazard Com-
munication 'Standard, found In Title 29 of the Code of
Federal Regulations at §1910.1200.
This form doee not have to be submitted If all of the
chemicals located at your facility are excluded under
Section 311 (e) of THte III.
WHAT CHEMICALS ARE INCLUDED
If you are submitting Tier Two forme m Heu 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 thresh-
old 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 sub-
stances:
(i) Any food, food additive, .color additive, drug, or
cosmetic regulated by the Food and Drug Admini-
stration;
(II) Any substance present as a solid In any manu-
factured item to the extent exposure to the sub-
stance doee not occur under normal conditions of
use;
(IU) Any substance to the extent It Is used for per-
sonal, family, or household purposes, or is present in
the same form and concentration as a product pack-
aged for distribution and use by the general 'public :
(Iv) Any substance to the extent It Is used in a re-
search laboratory or a hospital or other medical facil-
ity under the direct supervision of a technically quali-
fied 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. Section I910.l200(b|. stipulate ex-
emptions from the requirement to prepare or have avail-
able 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:
For Extremely Hazardous Substances (EHSs) desig-
nated under section 302 of Title ill, the reporting thresh-
old Is 500 pounds (or 227 kg.) or the threshold planning
quantity (TPQ), whichever is lower:
For aN other hazardous chemicals for which facilities are
required to have or prepare an MSDS. the minimum re-
porting threshold I* 10,000 pounds (or 4,540 kg.).
You need to report hazardoue chemicals that were pre-
sent at your facility at any time during the previous cal-
endar year at levels that equal or exceed these thresh-
olds. For Instructions on threshold determinations for
components of mixture*, see/What About Mixtures?1
on page 2 of these Instructions.
A requesting official may limit the responses required un-
der Tier Two by specifying particular chemicals or
group* of chemicals. Such requests apply to hazardous
chemicals regardless of established thresholds.
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INSTRUCTIONS
Please read these instructions carefully. Print or type all responses.
WHEN TO SUBMIT THIS FORM
Owners or operator* 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 Informa-
tion 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 report -
* ing 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 shaU 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 Identi-
fier where appropriate).
Enter the full street 'address or state road. If a street
address is not available, enter other appropriate Identifi-
ers that describe the physical location of your faculty
{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 facHtty should be able to pro-
vide the Dun & Bradstreet number. If your firm does not
have this Information, contact the State or regional of-
fice of Dun & Bradetreet to obtain your facility number or
have one assigned.
OWNER/OPERATOR
Enter the owner's or operator's fu» name, mailing ad-
dress, and phone number.
EMERGENCY CONTACT
Enter the name, title, and work phone number of 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 emer-
gency information will be available 24 hours a day, every
day. This requirement is mandatory. 'Tho facility must,
make some arrangement to ensure that a 24 hour con-
tact is available.
IDENTICAL INFORMATION
Check the box Indicating Identical Information, located
below the emergency contacts on the Tier Two form, if
>the current chemical information'being reported is identi-
cal 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,
Hazards, Amounts, and Locations,
The main section of the Tier Two form requires sceciflc
information on amounts and locations of hazardous
chemicals, as defined In the OSHA Hazard Communica-
tion 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 in-
formation 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 fac-
tor.
• What about mixtures'?
If a chemical Is part of a mixture, you nave the
option of reporting either the weight of the en-
tire mixture or only the portion of the mixture
that Is a particular hazardous chemical (e.g..
If a hazardous solution weighs 100 Ibs. but is
composed of only 5% of a particular hazardous
chemical, you can Indicate either 100 Ibs. of
the mixture or S Ibe. 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 Suction 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 for purposes of threshold determi-
nation. It le suggested that the aggregation
calculation be done as a first step in making
the threshold determination. Once you deter-
mine whether a threshold for an EHS has been
reached, you should report either the total
weight of tne EHS at your facility, or the
weight of each mixture containing the EHS. _
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CHEMICAL DESCRIPTION
1. Enter the Chemical Abstract Service registry number
(CAS), For mixtures, enter the CAS number of the
mixture, a« a whoto If It has been assigned a number
. distinct from it« constituents. For a mixture that has
no CAS number, leave this Itam blank or report the
CAS number* of as many constituent chemicals as
possible. - '
If- you are withholding the name of a chemfcaf In ac-
cordance 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 diisocyahate as organic isocyanate) and check
the box marked Trade Secret. Trade secret
information should be submitted to EPA and must
include a substantiation. Ptease refer to EPA'3 final
regulation on trade secrecy (53 FR 28772. July 29,
1988) for detailed Information on how to submit
trade secrecy claims.
Hazard Category Comparison
For Reporting Under Sections 311 and 312
EPA's
Hazard Categories
Fire Hazard
Sudden Release of
Pressure
Reactive
Immediate (Acute)
Health Hazards
Delayed (Chronic)
Health Hazard
2. Enter the chemical name or common name of each
hazardous chemical.
OSHA's
Hazard Categories
Flammable
Combustion Liquid
Pyrophoric
OxJdizer
Explosive
Compressed Gas
Unstable Reactive
' Organic-Peroxide
Water Reactive
Highly Toxic
Toxic
Irritant
Sensitizer
Corrosive
Other hazardous
chemicals with an
adverse effect with
short term exposure
Carcinogens
Other hazardous
chemicals with an
adverse effect with
long term exposure
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.
MAXIMUM AMOUNT
1. For each hazardous chemical, ^estimate the greatest
amount present at your facility on any single day dur-
ing the reporting period.
2. Find the appropriate range value code In Table I.
3. Enter this range value as the Maximum Amount.
EXAMPLE:
You have pure chlorine gas on hand, ae
we« as two mixtures that contain liquid
chlorine. You write 'chlorine" and enter the
CAS number. Then you check 'pure' and
•mix" ~ as wen as -liquid' and -gas'.
Table) I REPORTING RANGES
Range Weight Range in Pounds
Value From... To...
PHYSICAL AND HEALTH HAZARDS
or
02
03
04
OS
06
07
08
09
10
11
0
100
1.000
10.000
100.000
1.000.000
1 0.000. 000
50.000,000
100.000.000
500.000.000
1 billion
99
999
9.999
99.999
999.999
9,999.999
49.999.999
99.999.999
499.999.999
999.999.999
higher than 1
billion
For each chemical you have listed, check aN the physical
and health hazard boxes that apply. These hazard cate-
gories are defined In 40 CFR 370.2. The two health haz-
ard 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.
If you are using this form as a.worksheet for com-
pleting Tier One, enter the actual weight in pounds
in the shaded spec* below the response blocks. Do
thl« for both Maximum Amount and Average
Daily Amount.
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EXAMPLE:
You received one large shipment of a solvent
mixture last year. The shipment filled five S 000 -
gallon storage tank*. You know that the solvent
contains 10% benzene, which la a hazardous
chemical.
You figure that 10% of 25,000 gallons Is 2.500
gallons. You also know that the 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 rand 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 dur-
ing the year.
To do this, total all dally weights and divide by the
number of days the chemical wa* 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 re-
ceived 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 le 7.29 pounds •;
• per gallon, so you multiply 1,440 by 7.29 to get
a weight of 10.500 pound*. l :
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 trie form as a worksheet for
completing a Tier On* form, you should write
10,500 in trw shaded area.)
STORAGE CODES AND STORAGE LOCATIONS
List all non-confidential chemical locations In this column
along with storage types/conditions associated with eacn
location. Please note that a particluar chemical may e>e
located In several places around the facility. Each row of
boxes followed by a line represents a unique location for
the same chemical.
Storage Codes: Indicate the types and conditions of
storage present.
a. Look at Table II. For each location, find the
appropriate storage type and enter the cor-
responding code in the first box.
b. Look at Table HI. For each location, find
the appropriate storage types for pressure
and temperature conditions. Enter the appli- "
cable pressure code in the second box. En-
ter the applicable temperature code in the
third box.
Table) II - STORAGE TYPES .
CODES Types of Storage
A Above ground tank
B Below ground tank
C Tank inside building
D Steel drum
E Plastic or non-metallic drum
F Can
Q Carboy
H Silo
I Fiber drum
J Bag
K Box
L Cylinder
M Glass bottles or jugs
N Plastic bottles or jugs
O Tote bin
P Tank wagon
Q Rail car
H Other
Tabl« ill - PRESSURE AND TEMPERATURE
CONDITIONS
CODES Storage Conditions'
(PRESSURE)
1 Ambient pressure*
2 Greater than ambient pressure
3 Lese than ambient pressure
(TEMPERATURE)
4 Ambient temperature
5 Greater than ambient temperature
6 Lees than ambient temperature
but not cryogenic
7 Cryogenic conditions
NUMBER OP DAYS ON-SITE
Enter the number of day* that the hazardous chemical
was found on-slte.
EXAMPLE:
The solvent composed of 10% benzene was
present for 315 daye at your faculty. Enter 315
In the space provided.
EXAMPLE:
The benzene In the main building Is kept In a
tank Inside the building, at ambient pressure
and less than ambient temperature.
Table II showe you that the code for a tank
inside a building le C. Table III shows you that
the code for ambient pressure la 1. and the code
for lese than ambient temperature la 6.
You enter: ICI1 I6I
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Storage Locations:
Provide a brief description of the precis* location of the
chemical, so that emergency responders can locate the
area ea«»y. You may find It advantageous to provide the
optional site plan or site coordinate* as explained below.
For each chemical. Indicate at a minimum the building or
lot. Additionally. *nere practical, the room or area may
be indicated. You may respond In narrative form with
appropriate site coordinates or abbreviations.
If the chemical Is present In more than one building, lot.
or area location, continue your responses down the page
as needed. If the chemical exists everywhere at the
plant site simultaneously, you may report that the chemi-
cal is ubiquitous at the site,
Optional attachments: If you'Choose -to attach one of the
following, check the appropriate Attachments box at the
bottom of the Tier Two form.
a. A site plan with site coordinates indicated for
buildings, lots, areas, etc. throughout your
facility.
b. A list of site coordinate abbreviations that
correspond to buildings, lots, areas, etc. '
throughout your facility.
c. A description of dixe's and other safeguard
measures for storage locations throughout
your facility.
EXAMPLE:
You have benzene in the main room of tho
main building, and In tank 2 In tank field 10.
You attach a site plan with coordinates as
follows: main building = Q-2, tank field 10
5-6. Fill in the Storage Location as follows:
B-6 [ Tank 2 J Q-2 [Main Room]
CONFIDENTIAL INFORMATION
Under Title III. Section 324. you may elect to withhold
location information on a specific chemical from disclo-
sure to the public. If you choose to do so:
• Enter the word "confidential' In the Non-Con-
fidential Location section of the Tier Two form
on the first line'of the storage locations..
• On a separate Tier Two Confidential Location
Information Sheet, enter 'the name and CAS
number of each chemical for which you are
• keeping the location confidential.
« Enter the appropriate location and storage in-
formation „ as described above for non-confi-
dential locations.
• Attach the Tier Two Confidential Location In-.
formation Sheet to the Ti«r Two form. This
separates confidential locations from other in-
formation that will be disclosed to the public.
CERTIFICATION
Instructions for this section are included on page one of
these Instruction*.
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Page ol
Tier Two
EMERGENCY
AND
HAZARDOUS
CHEMICAL
INVENTORY
Specific
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