DIVISION OF LABOR
IOWA EMERGENCY RESPONSE COMMISSION
1000 EAST GRAND AVENUE
DES MOINES, IOWA 50319-0209
IMPORTANT
TIER TWO
EMERGENCY AND HAZARDOUS
CHEMICAL INVENTORY FORM
ENCLOSED
(DO NOT DISCARD)
* If you do electronic submission disregard this form.
PLEASE READ
IMPORTANT INFORMATION
Tier Two Facility Coordinator:
Enclosed is the 2001 Reporting Year Tier Two form. The Form is dueMarch 1 of 2002. Do not
submit form until AFTER January 1, 2002 - (this helps our electronic processing). Please
note some changes to the form.
On the reverse side of the Tier Two form you will find a peel off mailing label. Please affix the label to
the designated area on the Tier Two form. Please correct any errors that occur on the label.
We also provide a box to check if all the chemical information is identical to all the chemical
information submitted last year. If all the chemical information remains the same you still need
to fill out the form.
The Iowa Emergency Response Commission is providing computer software which allows facilities to
prepare Tier Two forms on a Personal Computer (PC) or 100% IBM compatible computer. The
software is available free of charge. To obtain the software facilities should contact the Iowa
Emergency Response Commission (515) 281-6175.
Facilities choosing to use the computer software should submit a magnetic disk of the The Tier Two
information and the magnetic submission certification statement, supplied for you with your computer
software. We do not need a print out of the Tier Two Form, when you send a magnetic submission
certification statement.
The Iowa Emergency Response Commission will only accept the Iowa computer generated or Iowa
Tier Two forms. All incomplete or other forms will be returned. If you have any questions, please
contact Anne Jackson or Ellen Hester at (515) 281-6175.
Your Tier II report will be returned to you if you do not include the following:
North American Industrial Classification System (NAICS)
To obtain your facility's NAICS, please call (515) 281-8178
Emergency Contact Information
TIER TWO INSTRUCTIONS
GENERAL INFORMATION
If you submit Tier One rather than Tier Two, you may still be required to
Submission of this Tier Two form (when requested) is required by Title III
submit Tier Two information upon request.
of the Superfund Amendments and Reauthorization Act of 1986. Section
312. Public Law 99-499. codified at 42 U.S.C. Section 11022. The
WHAT CHEMICALS ARE EXCLUDED
purpose of this Tier Two form is to provide State and local officials and the
Section 311(e) of Title III excludes the following substances:
public with specific information on hazardous chemicals present at your
(I) Any food, food additive, color additive, drug, or cosmetic regulated by
facility during the past year.
the Food and Drug Administration;
(II) Any substance present as a solid in any manufactured item to the
CERTIFICATION
extent exposure to the substance does not occur under normal conditions
The owner or operator or the officially designated representative of the
of use;
owner or operator must certify that all information included in the Tier Two
(III) Any substance to the extent it is used for personal, family, or
submission is true, accurate, and complete. On the first page of the Tier
household purposes, or is present in the same form and concentration as
Two report, enter your full name and official title. Sign your name and
a product packaged for distribution and use by the general public;
enter the current date. Also, enter the total number of pages included in
(IV) Any substance to the extent it is used in a research laboratory or a
the Confidential and Non-Confidential information Sheets as well as all
hospital or other medical facility under the direct supervision of a techni颅
attachments. An original signature is required on at least the first page of
cally qualified individual;
the submission. Submissions to the SERC, LEPC, and fire department
(V) Any substance to the extent it is used in routine agricultural operations
must each contain an original signature on at least the first page. Subse颅
or is a fertilizer held for sale by a retailer to the ultimate customer.
quent pages must contain either an original signature, a photocopy of the
original signature, or a signature stamp. Each page must contain the date
OSHA regulations, Section 1910.1200(b), stipulate exemptions from the
on which the original signature was affixed to the first page of the
requirement to prepare or have available an MSDS.
submission and the total number of pages in the submission.
REPORTING THRESHOLDS
YOU MUST PROVIDE ALL INFORMATION REQUESTED ON THIS
Minimum thresholds have been established for Tier One/Tier Two
FORM TO FULFILL TIER TWO REPORTING REQUIREMENTS.
reporting under Title III, Section 312. These thresholds are as follows:
This form may be submitted in place of the Tier One form.
For Extremely Hazardous Substances (EHSs) designated under section
302 of Title III, the reporting threshold is 500 pounds (or 227 kg.) or the
WHO MUST SUBMIT THIS FORM
threshold planning quantity (TPQ), whichever is lower:
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
For retail gasoline stations the reporting threshold is 75,000
commission, a local emergency planning committee, or a fire department
gallons for gasoline and 100,000 gallons for diesel.
with jurisdiction over the facility.
For all other hazardous chemicals for which facilities are required to have
This request may apply to the owner or operator of any facility that is
or prepare an MSDS, the minimum reporting threshold is 10,000 pounds
required, under regulations implementing the Occupational Safety and
(or 4.540 kg.).
Health Act of 1970, to prepare or have available a Material Safety Data
Sheet (MSDS) for a hazardous chemical present at the facility. MSDS
You need to report hazardous chemicals that were present at your facility
requirements are specified in the Occupational Safety and Health
at any time during the previous calendar year at levels that equal or
Administration (OSHA) Hazard Communication Standard, found in Title 29
exceed these thresholds. For instructions on threshold determinations for
of the Code of Federal Regulations at 搂 1910.1200.
components of mixtures, see 鈥淲hat About Mixtures?鈥? on page 2 of these
Iowa Administrative Codes (IAC) 605-104.1(1) and 605-104.3(2)
instructions.
require facilities to use a Tier Two form to comply with both
sections 302 and 312 of Title III.
A requesting official may limit the responses required under Tier Two by
This form does not have to be submitted if all of the chemicals located at
specifying particular chemicals or groups of chemicals. Such requests
your facility are excluded under Section 311(e) of Title III.
apply to hazardous chemicals regardless of established thresholds.
WHAT CHEMICALS ARE INCLUDED
INSTRUCTIONS
You must report the required information on this Tier Two form for each
Please read these instructions carefully, Print or type all responses.
hazardous chemical present at your facility in quantities equal to or greater
than established threshold amounts (discussed below), unless the
WHEN TO SUBMIT THIS FORM
chemicals are excluded under Section 311(e) of Title III. Hazardous
Owners or operators of facilities that have hazardous chemicals on hand
chemicals are any substance for which your facility must maintain an
in quantities equal to or greater than set threshold levels must submit Tier
MSDS under OSHA鈥檚 Hazard Communication Standard.
Two forms by March 1.
Facilities in Iowa that are subject to the requirements of Section 302 of Title
III shall use a Tier Two form to report covered extremely hazardous
substances.
1
If you choose to submit Tier One, rather than Tier Two, be aware that you
IDENTICAL INFORMATION
may have to submit Tier Two information later, upon request of an
Check the individual box in each chemical area, if the chemical information
authorized official. You must submit the Tier Two form within 30 days of
submitted is the same information submitted last year.
receipt of a written request.
Chemical descriptions, hazards, amounts, and locations must be provided
in this year鈥檚 form, even if the information is identical to that submitted last
WHERE TO SUBMIT THIS FORM
year.
Send either a completed Tier One form or Tier Two form(s) to each of the
following organizations:
CHEMICAL INFORMATION:
1. Your State Emergency Response Commission. (Address on Cover)
Description, Hazards, Amounts, and Locations
2. Your Local Emergency Planning Committee.
3. The fire department with jurisdiction over your facility. The main section of the Tier Two form requires specific information on
amounts and locations of hazardous chemicals, as defined in the OSHA
If a Tier Two form is submitted in response to a request, send the Hazard Communication Standard.
completed form to the requesting agency.
If you choose to indicate that all of the information on a specific hazardous
PENALTIES chemical is identical to that submitted last year, check the appropriate
Any owner or operator who violates any Tier Two reporting requirements individual box provided in each individual chemical area. Chemical
shall be liable to the United States for a civil penalty of up to $25,000 for descriptions, hazards, amounts, and locations must be provided even if
each such violation. Each day a violation continues shall constitute a the information is identical to that submitted last year.
separate violation.
鈥hat units should I use?
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. Calculate all amounts as weight in pounds. To convert gas or liquid
volume to weight in pounds, multiply by an appropriate density factor.
REPORTING PERIOD
Enter the appropriate calendar year, beginning January 1 and ending 鈥? What about mixtures?
December 31.
If a chemical is part of a mixture, you have the option of reporting
FACILITY IDENTIFICATION either the weight of the entire mixture or only the portion of the
Enter the full name of your facility (and company identifier where appropri颅 mixture that is a particular hazardous chemical (e.g., if a hazardous
ate). solution weighs 100 lbs. but is composed of only 5% of a particular
hazardous chemical, you can indicate either 100 lbs. of the mixture or 5
Enter the full street address or state road, if a street address is not lbs. of the chemical).
available, enter other appropriate identifiers that describe the physical
location of your facility (e.g., longitude and latitude). Include city, county, The option used for each mixture must be consistent with the option
state, and zip code. used in your Section 311 reporting.
Enter the primary Standard Industrial Classification (SIC) code and the Because EHSs are important to Section 303 planning, EHSs have
Dun & Bradstreet number for your facility. The financial officer of your lower thresholds. The amount of an EHS at a facility (both pure EHS
facility should be able to provide the Dun & Bradstreet number. If your firm substances and EHSs in mixtures) must be aggregated for purposes
does not have this information, contact the State or regional office of Dun & of threshold determination. It is suggested that the aggregation calcu
Bradstreet to obtain your facility number or have one assigned. lation 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
OWNER/OPERATOR
Enter the owner鈥檚 or operator鈥檚 full name, mailing address, and phone facility, or the weight of each mixture containing the EHS.
number.
EMERGENCY CONTACT (MUST BE INCLUDED)
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 emergency informa颅
tion will be available 24 hours a day, every day. This requirement is
mandatory. The facility must make some arrangement to ensure that a 24
hour contact is available.
2
CHEMICAL DESCRIPTION
MAXIMUM AMOUNT
1. Enter the Chemical Abstract Service registry number (CAS). For
1. For each hazardous chemical, estimate the greatest amount present
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 at your facility on any single day during the reporting period.
2. Find the appropriate range value code in Table I.
that has no CAS number, leave this item blank or report the CAS
numbers of as many constituent chemicals as possible.
3. Enter this range value as the Maximum Amount..
If you are withholding the name of a chemical in accordance with
TABLE I REPORTING RANGES
criteria specified in Title III, Section 322, enter the generic class or
Range Weight Range in Pounds
category that is structurally descriptive of the chemical (e.g., list
Value From . . . . To . . . .
toulene diisocyanate as organic isocyanate) and check the box
01 0 99
marked Trade Secret. Trade secret information should be submitted
02 100 999
to EPA and must include a substantiation. Please refer to EPA鈥檚 final
regulation on trade secrecy (53 FR 28772, July 29, 1988) for 03 1,000 9,999
04 10,000 99,999
detailed information on how to submit trade secrecy claims.
05 100,000 999,999
06 1,000,000 9,999,999
2. Enter the chemical name or common name of each hazardous
07 10,000,000 49,999,999
chemical.
08 50,000,000 99,999,999
09 100,000,000 499,999,999
3. Check box for all applicable descriptors: pure or mixture: and solid,
10 500,000,000 999,999,999
liquid, or gas; and whether the chemical is or contains an EHS.
11 1 billion higher than 1 billion
4. If the chemical is a mixture containing an EHS, enter the chemical
If you are using this form as a worksheet for completing Tier One, enter the
name of each EHS in the mixture.
actual weight in pounds in the shaded space below the response blocks.
Do this for both Maximum Amount and Average Daily Amount.
EXAMPLE:
You have pure chlorine gas on hand, as well as two mixtures that contain
EXAMPLE:
liquid chlorine. You write 鈥渃hlorine鈥? and enter the CAS number. Then you
check 鈥減ure鈥? and 鈥渕ix鈥? 鈥? as well as 鈥渓iquid鈥? and 鈥済as鈥?.
You received one large shipment of a solvent mixture last year. The
shipment filled five 5,000 gallon storage tanks. You know that the solvent
PHYSICAL AND HEALTH HAZARDS
contains 10% benzene, which is a hazardous chemical.
For each chemical you have listed, check all the physical and health
hazard boxes that apply. These hazard categories are defined in 40 CFR
You figure that 10% of 25,000 gallons is 2,500 gallons. You also know
370.2. The two health hazard categories and three physical hazard
that the density of benzene is 7.29 pounds per gallon, so you multiply
categories are a consolidation of the 23 hazard categories defined in the
2,500 gallons by 7.29 pounds per gallon to get a weight of 18,225
OSHA Hazard Communication Standard, 29 CFR 1910.1200.
pounds.
Then you look at Table I and find that the range value 04 corresponds to
Hazard Category Comparison For Reporting
18,225. You enter 04 as the Maximum Amount.
Under Sections 311 and 312
(If you are using the form as a worksheet for completing a Tier One form,
EPA鈥檚 OSH鈥檚
Hazard Categories Hazard Categories
you should write 18,255 in the shaded area.)
Fire Hazard Flammable
Combustion Liquid
Pyrophoric
Oxidizer
Sudden Release Explosive
of Pressure Compressed Gas
Reactive Unstable Reactive
Organic Peroxide
Water Reactive
Immediate (Acute) Highly Toxic Other hazardous
Health Hazards Toxic Chemicals with an
Irritant adverse effect with
Sensitizer short term exposure
Corrosive
Delayed (Chronic) Carcinogens
Health Hazard
3
Table II - STORAGE TYPES
AVERAGE DAILY AMOUNT
CODES Types of Storage
1. For each hazardous chemical, estimate the average weight in
pounds that was present at your facility during the year.
A Above ground tank
B Below ground tank
To do this, total all daily weights and divide by the number of days
C Tank inside building
the chemical was present on the site.
D Steel drum
E Plastic or non-metallic drum
2. Find the appropriate range value in Table I.
F Can
G Carboy
3. Enter this range value as the Average Daily Amount.
H Silo
I Fiber drum
J Bag
EXAMPLE:
K Box
L Cylinder
The 25,000-gallon shipment of solvent you received last year
M Glass bottles or jugs
was gradually used up and completely gone in 315 days. The
N Plastic bottles or jugs
sum of the daily volume levels in the tank is 4,536,000 gallons.
O Tote bin
By dividing 4, 536,000 gallons by 315 days on-site, you
P Tank wagon
calculate an average daily amount of 14,400 gallons.
Q Rail car
R Other
You already know that the solvent contains 10% benzene,
which is a hazardous chemical. Since 10% of 14,400 is 1,440,
Table III - TEMPERATURE
you figure that you had an average of 1,440 gallons of benzene.
AND PRESSURE CONDITIONS
You also know that the density of benzene is 7.29 pounds per
CODES Storage Conditions
gallon, so you multiply 1,440 by 7.29 to get a weight of 10,500
(PRESSURE)
pounds.
1 Ambient pressure
2 Greater than ambient pressure
Then you look at Table I and find that the range value 04
3 Less than ambient pressure
corresponds to 10,500. You enter 04 as the Average Daily
Amount.
(TEMPERATURE)
4 Ambient temperature
(If you are using the form as a worksheet for completing a
5 Greater than ambient temperature
Tier One form, you should write 10,500 in the shaded area.)
6 Less than ambient temperature
but not cryogenic
NUMBER OF DAYS ON-SITE
7 Cryogenic conditions
Enter the number of days that the hazardous chemical was found on-site.
EXAMPLE:
EXAMPLE:
The benzene in the main building is kept in a tank inside the
The solvent composed of 10% benzene was present for
building, at ambient pressure and less than ambient temperature.
315 days at your facility. Enter 315 in the space provided.
Table II shows you that the code for a tank inside a building is C.
Table III shows you that the code for ambient pressures is 1,
STORAGE CODES AND STORAGE LOCATIONS and the code for less than ambient temperature is 6.
List all non-confidential chemical locations in this column, along with
storage types/conditions associated with each location. Please note that a
particular chemical may be located in several places around the facility.
CONTAINER TYPE
Each row of boxes followed by a line represents a unique location for the
TEMPERATURE
SAMPLE
same chemical.
PRESSURE
Storage Codes: indicate the types and conditions of storage present:
C 1 6
a. Look at Table II. For each location, find the appropriate storage type
and enter the corresponding code in the first box.
b. Look at Table III. For each location, find the appropriate storage types
for pressure and temperature conditions. Enter the applicable pressure
code in the second box. Enter the applicable temperature code in the third
box.
4
Storage Locations:
Provide a brief description of the precise location of the chemical, so that
emergency responders can locate the area easily. You may find it
advantageous to provide the optional site plan or site coordinates as
explained below.
For each chemical, indicate at a minimum the building or lot. Additionally,
where 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
chemical 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 build
ings, lots, areas, etc. throughout your facility.
c. A description of dikes and other safeguard measures for storage
locations throughout your facility.
EXAMPLE:
You have benzene in the main room of the main building, and in
tank 2 in tank field 10. You attach a site plan with coordinates as
follows: main building = G-2. tank field 10 = B-6. Fill in the
Storage Location as follows:
B-6 ( Tank 2 ) G-2 ( Main Room )
CONFIDENTIAL INFORMATION
Under Title III. Section 324, you may elect to withhold location information
on a specific chemical from disclosure to the public, If you choose to do so:
鈥nter the word 鈥渃onfidential鈥? in the Non-Confidential Location section
of the Tier Two form on the first line of the storage locations.
鈥? 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.
鈥? Enter the appropriate location and storage information, as described
above for non-confidential locations.
鈥? Attach the Tier Two Confidential Location Information Sheet to the
Tier Two form. This separates confidential locations from other
information that will be disclosed to the public.
CERTIFICATION
Instructions for this section are included on page one of these instructions.
5
IOWA LEPC CHAIRPERSONS . . . 鉂? Regionalized Planning Districts and Addresses located at lower right. (9-01)
Fayette County Sharon Gerot, Coordinator
Adair County Lynn Eddy, Coordinator Cerro Gordo Co. North Central Regional Planning Dist.
鉂?
563-422-3614 PO Box 267 Courthouse
641-743-6141 Emergency Mgmt. Agency
West Union, Iowa 52715
204 SE Kent Cherokee Co. Region 4 Emergency
鉂?
Greenfield, Iowa 50849-1411 Planning District
Floyd County North Central Regional
鉂?
Emergency Planning District
Adams County Brian Kannas, Coordinator
641-322-4444 Emergency Mgmt. Agency
Franklin County North Central Regional
1007 - 7th Street Chickasaw Co. Ken Rasing, LEPC Chair 鉂?
Emergency Planning District
PO Box 407 641-394-2406 Emergency Mgmt. Agency
Corning, Iowa 50841 116 N Chestnut
Fremont County Keith Hickey
New Hampton, Iowa 50659
712-374-2415 Board of Supervisors
Allamakee Co. Neil E. Becker, LEPC Chair
Courthouse
319-568-4521 Sheriff鈥檚 Office Clarke County Allan Mathias, LEPC Chair
Sidney, Iowa 51652
County Courthouse 641-342-6654 Courthouse
PO Box 289 100 South Main Street
Greene County Region 5 Emergency
Waukon, Iowa 51272 Osceola, Iowa 50213 鉂?
Planning District
Appanoose Co. Pete Hall, Coordinator Clay County Region 3 Emergency
鉂?
Grundy County D. Sheridan Roberts
641-647-2699 Emergency Mgmt. Agency Planning District
319-814-6933 Coordinator, EMA
16479 Hwy J29
705 - 8th Street
Centerville, Iowa 52544
Grundy Center, Iowa 50638
Audubon County Lester Larsen, LEPC Contact Clayton Co. Carol Kuehl, LEPC Chair
Guthrie County Steve Patterson, Coordinator
712-563-3385 Audubon Emergency Mgmt. 563-964-2366 Emergency Mgmt. Agency
641-747-8320 EMA, Courthouse
606 South Division St. 115 W 13th Street
200 N. 5th Street
Audubon, Iowa 50025 Garnavillo, Iowa 52049
Guthrie Center, Iowa 50115
Benton County LEPC Contact Clinton County Wally Henry, Coordinator
Hamilton County Region 5 Emergency
319-472-4519 Emergency Mgmt. Agency 563-242-5712 Box 2957 鉂?
Planning District
PO Box 398 241 7th Avenue N
Vinton, Iowa 52349 Clinton, Iowa 52733-2957
Hancock County North Central Regional
Emergency Planning District
Black Hawk Co. Larry Tisor, Coordinator Crawford Co. John Lawler
319-291-4373 Black Hawk County LEPC 712-263-3340 Board of Supervisors
Hardin County Lyle Jeske, LEPC Chair
City Hall, 1925 Newell Street Courthouse, 1202 Broadway
641-858-3822 2006-12th Ave., #22
Waterloo, Iowa 50707 Denison, Iowa 51442
Eldora, Iowa 50627
Boone County Clay North Coordinator Dallas County Barry Halling, LEPC Chair
Harrison County Jim Unruh, Coordinator
515-433-0592 909 W Maimie Eisenhower 515-993-4506 Emergency Mgmt. Agency
712-644-2353 Emergency Mgmt. Agency
Boone, Iowa 50036 512 South 8th
116 North 2nd Ave.
Adel, Iowa 50003
Logan, Iowa 51546
Bremer County Scott LaRue, Coordinator
319-352-0332 Emergency Mgmt. Agency Davis County Craig Scott, Coordinator
Henry County Ed Farley, Coordinator
Courthouse, 415 East Bremer 641-664-3055 Emergency Mgmt. Agency
319-385-1479 Emergency Mgmt. Agency
Waverly, Iowa 50677 P.O. Box 184
220 West Monroe Street
Bloomfield, Iowa 52537
Mt. Pleasant, Iowa 52641
Buchanan Co. Rick Wulfekuhle, Coordinator
319-334-6411 Emergency Management Decatur County Rich Erke, LEPC Chair
Howard County James Kovarik, LEPC Chair
Courthouse - 210 5th Ave NE 641-446-7307 RR1 Box 97A
319-547-2636 Emergency Mgmt. Agency
Independence, Iowa 50644-0317 Leon, Iowa 50144
Courthouse, 205 E 2nd Street
Cresco, Iowa 52136
Buena Vista Co. Region 3 Emergency
鉂?
Planning District Delaware Co. Bob Clemen, LEPC Chairperson
Humboldt County Region 5 Emergency
563-927-2515 301 E Main 鉂?
Planning District
Manchester, Iowa 52057
Butler County Timothy Junker, Chair
Ida County Region 4 Emergency
319-267-2410 Emergency Mgmt. Agency 鉂?
Planning District
428 6th Street Des Moines Co. Gina Hardin, Coordinator
Allison, Iowa 50602 319-753-8206 Emergency Management
512 N. Main Street
Calhoun County Region 5 Emergency Burlington, Iowa 52601
鉂?
Iowa County Alan Husband, Coordinator
Planning District
319-642-3151 Emergency Mgmt. Agency
Dickinson Co. Region 3 Emergency
鉂?
132 W. Marion Street
Carroll County Region 5 Emergency Planning District
鉂?
Marengo, Iowa 51301
Planning District
Jackson County Buddy Olson, Coordinator
Cass County Rob Koppert, LEPC Chair
563-686-4267 Emergency Mgmt. Agency
712-243-1500 5 West 7th Street Dubuque County John Hutchcroft, LEPC Chair
Courthouse
Atlantic, Iowa 50022-1492 563-589-4172 Central Fire Headquarters
Maquoketa, IA 52060
11 West 9th Street
Cedar County Jill Randolph, LEPC Chair Dubuque, Iowa 52001 Jasper County John Schermerhorm, Coordinator
319-886-2121 Courthouse 515-792-7555 Emergency Mgmt. Agency
810 1/2 Walnut Emmet County North Central Regional County Annex Building
鉂?
Tipton, Iowa 52772 Emergency Planning District 115 N 2nd Avenue East
Newton, Iowa 50208
6
Jefferson County Jerry Calnon, Coordinator Montgomery Co. Rick Askey, LEPC Chair Story County Lori Morrissey, Coordinator
641-472-4146 1200 W Grimes 712-623-5127 Red Oak Fire Dept. 515-382-7315 Emergency Mgmt. Agency
Fairfield, Iowa 52556 1800 Broadway 900 6th Street
Red Oak, Iowa 51566 Nevada, Iowa 50201
Johnson County Kerry Fitzpatrick LEPC Chair
Muscatine Co. Norman Smith, LEPC Chair Tama County Scott Burns, Coordinator
319-626-3990 Stanley Consultants, Inc.
319-757-4305 Biotek Associates 641-476-2804 Sheriff's Office
ext. 112 2656 Crosspark Rd
1110 Robin Road
Coralville, Iowa 52241 P.O. Box 34 - 100 N. Main
Muscatine, IA 52761 Toledo, Iowa 52342
Jones County Dianna Desotel, Coordinator
319-462-2735 Emergency Mgmt. Agency O鈥橞rien County Region 3 Emergency Taylor County Michael Ware, LEPC Chair
鉂?
Courthouse Planning District 712-523-2846 Emergency Mgmt. Agency
Anamosa, Iowa 52205
1104 Dodge Street
Bedford, Iowa 50833
Keokuk County Larry Smith, Director
641-622-2528 Emergency Mgmt. Agency
PO Box 273 Osceola County Region 3 Emergency Union County Dan Truckenmiller, Chair
鉂?
Sigourney, Iowa 52591 Planning District 641-782-1912 Po Box 329
302 N. Pine
Kossuth County North Central Regional
鉂?
Creston, Iowa 50801
Emergency Planning District
Page County Raymond Bryant, Coordinator
712-246-4254 Box 569 815 W Thomas. Van Buren Co. Donald Pool, Coordinator
Lee County Frank Mohrfeld, Coordinator
Shenandoah, Iowa 51601 319-293-3663 Emergency Mgmt. Agency
319-372-4124 Emergency Mgmt. Agency
City Hall, PO Box 240 Courthouse
Fort Madison, IA 52627 Keosauqua, Iowa 52565
Palo Alto County North Central Regional
鉂?
Linn County Walter "Ned" Wright, Coordinator Emergency Planning District Wapello County Rhea Huddleston
319-363-2671 2nd Ave Bridge
641-683-4630 Board of Supervisors
Cedar Rapids, IA 52401 Plymouth County Keith Lostroh, Coordinator Wapello Bldg., 102 E. Main St.
712-533-6251 Emergency Mgmt. Agency Ottumwa, Iowa 52501
Louisa County Tom Colthurst, Coordinator
17131 Granite Avenue
319-658-3851 2873 Louisa-Washington Rd
Lemars, Iowa 50574
Columbus Junction, Iowa 52738 Warren County Mahala Cox, Coordinator
515-961-1105 Emergency Mgmt. Agency
Pocahontas County Region 5 Emergency PO Box 237
鉂?
Lucas County Ed Elam, City Manager Planning District Indianola, Iowa 50125
641-774-5083 Law Ctr, Lucas Co., Sheriff's Ofc
1023 Linden
Polk County Robert Goldhammer, Coordinator Washington Co. Owen White, Coordinator
Chariton, IA 50049
515-286-2107 Polk Co. Office Bldg. 319-657-2762 624 - 7th Street
111 Court Avenue Ainsworth, IA 52201
Lyon County Region 3 Emergency
鉂?
Des Moines, Iowa 50309
Planning District
Wayne County Tim Erich
Pottawattamie Terry Hummel, Coordinator 641-872-2025 County Engineer's Office
319-328-5777 Emergency Mgmt. Agency PO Box 463
Madison County Todd Brown, Coordinator Courthouse, 227 S. 6th Corydon, Iowa 50060
515-462-1496 616 W North
Council Bluffs, Iowa 51501
Winterset, Iowa 50273
Webster County Region 5 Emergency
鉂?
Poweshiek County Harold Mc Naul, Chair Planning District
Mahaska County R D Keep, Coordinator 641-623-5723 PO Box 57
641-672-1209 214 High Ave E Montezuma, Iowa 50171 Winnebago Co. North Central Regional
鉂?
Oskaloosa, IA 52577 Emergency Planning District
Ringgold County Merle Walter
641-464-2548 307 N Webster Winneshiek Co. Bruce Goetsch, Coordinator
Marion County Ray Stone, Coordinator
Mount Ayr, Iowa 50854 563-387-4095 Emergency Mgmt. Agency
641-828-2220 Courthouse 214 E Main
400 Claibone Dr
Knoxville, Iowa 50138
Decorah, Iowa 52101
Marshall County Deanna Neldeberg, Coordinator Sac County Region 5 Emergency
鉂?
641-754-6385 Emergency Mgmt. Agency Planning District Woodbury County Region 4 Emergency
鉂?
24 N. Center St. City Hall Planning District
Marshalltown, IA 50158 Scott County Ross Bergen, Coordinator
319-326-8663 Emergency Mgmt. Courthouse
Mills County Larry Hurst, Coordinator
416 W. 4th Street
712-527-3846 RR 3 Box 263
Davenport, Iowa 52801 Worth County North Central Regional
Glenwood, IA 51534 鉂?
Emergency Planning District
Mitchell County North Central Regional Shelby County Robert Seivert, LEPC Chair
鉂?
Planning Dist. 712-755-5160 612 Court Street Wright County Region 5 Emergency
鉂?
Harlan, Iowa 51537 Planning District
Monona County Region 4 Emergency
鉂?
Planning District
North Central Regional Emergency Planning District
鉂?
Sioux County Region 3 Emergency (Cerro Gordo, Emmet, Floyd, Franklin, Hancock,
鉂?
Planning District Kossuth, Mitchell, Palo Alto, Winnebago, Worth Counties)
Monroe County Dennis Ryan, LEPC Chair
641-421-3665 Steve O'Neil, Coordinator
641-932-5212 Auditors Office, Courthouse
Emergency Management Agency
Albia, Iowa 52531
78 S Georgia Street
Mason City, Iowa 50401
7 SEE BACKSIDE FOR REGION 3 THROUGH 5
Region 3 Emergency Planning District
鉂?
(Buena Vista, Clay, Dickinson, Lyon, O'Brien,
Osceola, and Sioux Counties)
712-262-7665 Aaron Steele
ext. 138 Box 1493
Spencer, IA 50301
Region 4 Emergency Planning District
鉂?
( Cherokee, Ida, Monona, Plymouth and Woodbury
Counties)
712-876-2212 Gary Brown
121 Deer Run Trail
Climbing Hill, IA 51015
Region 5 Emergency Planning District
鉂?
(Calhoun, Carroll, Greene, Hamilton, Humboldt,
Pocahontas, Sac, Webster, and Wright Counties)
515-573-2871 Peggy Fishel
1515 Central Avenue
Fort Dodge, Iowa 50501
8
2001 Tier Two Emergency and Hazardous Chemical Inventory - DUE MARCH 1, 2002
Due to Electronic Processing Your form will be returned unless each item is completed!
Page ____________ of ___________
68-0689 (10-01)
Place Label Here
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
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CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
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Facility ID #__________________________________________ Tier Two Continuation Form
Page ____________ of ___________
Facility Name ________________________________________
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
1
2
3
4
5
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
1
2
3
4
5
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
1
2
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5
Make Additional Copies of this form if more space is needed
68-0689 (10-01) Tier Two Continuation Sheet
2001 CONFIDENTIAL LOCATION INFORMATION SHEET (DUE MARCH 1, 2002)
Complete Only if storage code and location of chemical(s) is to remain Confidential Page ____________ of ___________
This is not to be used in place of the Tier Two Form - REFER TO INSTRUCTIONS ON PAGE 5
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
68-0689 (10-01) - Confidential location Sheet
CONFIDENTIAL LOCATION CONTINUATION SHEET Page ____________ of ___________
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
CHECK IF CHEMICAL INFORMATION LISTED IN THIS AREA IS IDENTICAL TO THE
INFORMATION LISTED LAST YEAR. (Please Complete Form From Prior copy)
Make additional copies of this form if more space is needed
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