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LOUISIANA DEPARTMENT OF PUBLIC SAFETY OFFICE OF STATE POLICE
HAZARDOUS MATERIALS UNIT P.O. BOX 66614
BATON ROUGE, LOUISIANA 70896
TOXIC SUBSTANCES EMERGENCY PLAN
This form is pursuant to Act 642 of the 1979 and Act 364 of the 1980 regular session of the Louisiana Legislature. This form shall be filed with the Secretary of Public Safety no later than January 31 of each year.
1. Facility Name, Location, and Mailing Address:
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2. Classification: [X] Refinery and/or Chemical Manufacturer
[ ] Repackager
[ ] Wholesale storage and distribution
3. Name and/or title of person who will notify authorities:
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4. 24-Hour Telephone Number where authorities can make contact in case of emer
gency:
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5. Principal product(s) or chemical(s) which is maintained, stored or manufactur
ed and meets the definition of Toxic Substance (Attachment if Needed):
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6. List organizations and authorities who will be notified in the event of a toxic
release: [X] Hazardous Material Hotline 24-Hour(collect) (504)925-6595
(LRS 40:1299.100)
W( State Police Troop D [ Sheriff's Office
[ ] Mutual Aid
[ ] Fire Department
[v*( Municipal Police
[V"f Civil Emergency Office
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[ ] other Sju> jkuAjj.vJU
DPSSP 4014 <R 3/81)
SL 048747
7. The notification to the proper public safety authorities will include th type
of gas or mixed gases, direction of travel of gas, severity and expected duration
of gas emission to the atmosphere, and suggested actions.
8. Releases that will escape beyond the plant perimeter shall be reported.
9. Notification will be made by telephone #
, radio(freq.)
, or other (list)
REMARKS: Jhns CM*
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When this form has been completed, in its entirety, please mail to the address listed at the top of the page.
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Date Submitted: h<C !'$ 1 By Whom: ^QG,tfL ^OfcLc'i Date Approved:
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SL 048748