Document x5JRDqvjdBJoGXLDxx3YQaGry
Tier Two / Emergency and Hazardous Chemical Inventory
Facility Identification...
Nmaa THE DOW CHEMICAL COMPANY - BRINE PROOF
Street ROUTE 1. BOX 200H
Nail ROUTE 1. BOX 200H
BELLE ROSE LA 70391-
Citv BELLE ROSE
Stats LA ZlD 70391-
Parish/Countv ASSUMPTION
SIC Coda
2869 Dm l Brad Nmber 001381^1
Official Usa...
ID Number
003967
`
Data Received
Page___ 1 of___ 8
Owner / Operator Name... Name THE DOW CHEMICAL CO.. LOUISIANA DIVISION Phone (504)353-8888 Address P.O. BOX 150
PLAQUEMINE. LA 70765-0150
Emergency Contacts... Name M. A. LOTT Phone (504)353-8384 Name STEVE MIMS Phone (504)353-5795
Title FACILITY COORDINATOR 24Hr Phone (504)353-8888
Title PLANT SUPERINTENDENT 24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if information below is identical to the information submitted last year:
Chemical Description
Physical and Health Hazards
Inventory
CAS 7486-2
Trade Secret NO
Cham. Name ACETYLENE
State Code 00655 I_ _ Y Pure Mix Solid Liquid Gas EHS Name
EHS
Storage Code L24
OPTIONAL: _
Location (NON-CONFIDENTIAL) PLANTSITE
Y Fire
Y Reactivity Y Imaediate (Acute) _ Delayed (Chronic)
Max. Daily Amt. Code 22 Avg. Daily Amt. Code 03
# of Days On-Site
365
CAS 7727-37-9 Trade Secret NO Chem. Name AIR COMP
State Code 01625
Y __
Y
Pure Mix Solid Liquid Gas
EHS Nmaa
EHS
Storage Code L24
OPTIONAL: _
Location (NON-CONFIDENTIAL) PLANTSITE
Fire Y Sudden Pressure Release
Reactivity
Imaediate (Acute) _ Delayed (Chronic)
UO lMO
Max. Daily Amt. Coda
Avg. Daily Amt. Code
# of Days On-Sita
m
CAS 106-97-8 Trade Secret NO Chem. Name BUTANE. COMMERCIAL
State Code 01216
Pure Mix EHS Name
Solid Liquid Gas
EHS
Storage Code R24
OPTIONAL:
Location (NON-CONFIDENTIAL) DOW WELL #12
Y Fire Y Sudden Pressure Release
Reactivity Immediate (Acute) _ Delayed (Chronic)
Max. Daily Amt. Code 07
Avg. Daily Amt. Code 07
# of Days On-Site
365
Certification: I certify wder penalty of (aw that I have with the information submitted in pages one through 8, of those individuals responsible for obtaining the information is true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL MAN. Name and official title of owner/operator ON owner/operator's authorized representative
tonally examined and am familiar that based on my inquiry
n, I/believe that the submitted
Date signed
Site Plan Attached
Site Coordinates Attache Dikes l Safeguards
Do A 057936
confidential
Tier Two / Emergency and Kazardoue Chemical Inwantory
Page___ J of ___ S
Facility Idantificatlon...
Naa THE DOW CHEMICAL COMPANY BRINE PROP.
Stract ROUTE 1. BOX 200H
til ROUTE 1. BOX 200H
BELLE ROSE LA 70391-
City BELLE ROSE Stata ^A Zip 70391-
Parish/Couity ASSUMPTION
SIC Coda
2869 Dir t Brad Number 001381581
Official Uaa...
ID Number
003967
Date Received
Ownar / Operator Naan...
Nana
THE DOW CHEMICAL CO.. LOUISIANA Division
Phone (504)353-8888
Addreea P.O. BOX 150
PLAQUEMINE. LA 70765-0150
Emergency Contacts...
Nana M. A. LOTT___________
Title FACILITY COORDINATOR
Phone (504)353-8384
24Hr Phone (504)353-8888
Nana STEVE MIMS___________
Title PLANT SUPERINTENDENT
Phone (504)353-5795
24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if infomation below ia identical to the information submitted last year: Jt
Chemical Description
Physical and Health Hazards
Inventory
CAS 7782-50-5 Trade Secret NO
Chen. Nnse CHLORINE Y Sudden Pressure _ Y Reactivity
State Code 0146$ Y_ _ Y Y Pure Mix Solid Liquid Gas EHS Nana
Y EHS
Storage Code A24
OPTIONAL: _
Location (NON-CONFIDENTIAL) PLANTS1TE____________________
.Fire
Release
Y Immediate (Acute) Y Delayed (Chronic)
Max. Daily Ant. Code 03
Avg. Daily Ant. Code 0J
# of Days On-Site
365
CAS 68334-30- Trade Secret NQ_ Chan. Name DIESEL FUEL 2 Y
State Code 01908
Y_
Y
ure Mix Solid Liquid Gas
EHS Nana
EHS
Storage Code A14
OPTIONAL: _
Location (NON-CONFIDENTIAL) PLANTSITE____________________
I Fire Sudden Pressure Release
________________________________________________
I Immediate (Acute) I Delayed (Chronic)
Max. Daily Ant. Code 03 Avg. Daily Ant. Code 03
" Reactivity
CAS __________ Trade Secret HQ Chan. Naan ETHANE/PROPANE MIX
State Code 02148
Y_
Y
Y
Pure Mix Solid Liquid Gas
EHS Nana
EHS
Storage Code A25
OPTIONAL:
Location (NON-CONFIDENTtAL) DOU WELL 810_________________
Y Fire Y Sudden Pressure Release " Reactivity Y Imaedlate (Acute) ~ Delayed (Chronic)
Max. Daily Ant. Code 07
Avg. Daily Ant. Code 07
# of Days On-Site
365
Certification: l certify inter penalty of law that with the information submitted in pages one through of those individuals responsible for obtaining the information is true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL MAN.______________ Name and official title of owner/operator OR iwner/operator's authorized representative
Site Plan Attached Site Coordinates Attached Dikes t Safeguards
DO A 057937 CONFIDFNTTAL
Tier Two / Emergency and Hazardous Chemical Inventory
Pag*
of___ S
Facility Idantification...
Nam THE DOW CHEN I CAL COMPANY BRINE PBCD.
'treet ROUTE 1. BOX 200H
ill ROUTE 1. BOX 200H
BELLE ROSE LA 70391'
City BELLE ROSE Stat* A> Zip 70391-
Pariah/County ASSUMPTION
SIC Cod*
2869 Dun t Brad Number 001381581
Official Uaa...
ID Nuaber 003967
Date Received
Owner / Operator Nam... Nam THE DOW CHEMICAL CO.. LOUISIANA DIVISION Phone (504)353-8888 Address P.O. BOX 150_______________________________
PLAQUEHINE. LA 70765-0150
Emergency Contacts...
Nam N. A. LOTT___________
Title FACILITY COORDINATOR
Phone (504)353-8384
24Hr Phone (504)353-8888
Nam STEVE MIMS___________
Titla PLANT SUPERINTENDENT
Phone 15M)153-S7ft
24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if information below is identical to the information aubmittad last year: _X
Chemical Description
Physical and Health Kazarda
Inventory
CAS 74851
Trade Secret Mg_
Chm. Nam ETHYLENE Y Sudden Pressure Release
_ 7 Reactivity
State Code02298
I_ Pure Nix EHS Nam
_II Solid Liquid Gas
EHS
Storage Cod* Location (NON-CONFIDENTIAL) R24 DOW WELL *8
OPTIONAL:
1
Y Fire
7 Immediate (Acute)
7 Delayed(Chronic)
Max. Daily Amt. Coda 09
Avg. Daily Amt. Coda 0
of Days On-Sit*
365
CAS 107062
Trad* Secret NO
Chm. Nam ETHYLENE DICHLORIDE
State Cod* 02271 Y
ure Nix Solid Liquid Gas EHS Nam
EHS
Storage Code R24
OPTIONAL:
Location (NON-CONFIDENTIAL) DOW WELL *5__________________
Y Fir* 2 Sudden Pressure Release ~ Reactivity
2 Immediate (Acuta) 7 Delayed (Chronic)
Nax. Daily Amt. Cod* 05
Avg. Daily Amt. Cod* 05
# of Days On-Site
365
CAS 68476-346 Trade Secret MO Chm. Nam FUEL OIL - (IN TANKS)
State Code 02417
Y_
_Y
Pure Nix Solid Liquid Gas
EHS Nam
EHS
Storage Cod* A14
OPTIONAL:
Location (NON-CONFIDENTIAL) PLANTSITE_____________________
2Y Fir* Sudden Pressure Release ~ Reactivity
7 Immediate (Acute) 7 Delayed (Chronic)
Nax. Daily Amt. Coda 05
Avg. Daily Amt. Code 05
# of Days On-Sit*
365
Certification: I certify under penalty of law that with the information submitted in peges one through of those individuals responsible for obtaining the information is true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL NAN, Nam end official title of owner/operator Oil iwner/operator's authorized representative
m fmi liar
inquiry the siixaitted
Site Plan Attached Site Coordinates Attached Dikes t Safeguards
DO ^ r\
Tier Two / Emergency and Hazardous Chemical Invantory
Page____4 of
Facility Identification...
Naae THE DOM CHEMICAL COMPANY - 881 HE PROP,
"treat ROUTE 1, BOH 200N
11 ROUTE 1. BOX 200H BELLE HOSE LA 70391-
City BELLE ROSE State LA Zip 70391-
Parish/Cointy ASSUMPTION
SIC Coda
2869 Dun l Brad NLabor 001381581
Official Use...
ID Nuber
003967
Date Received
Owner / Operator Haae... Nana THE DOW CHEMICAL CO.. LOUISIANA DIVISION Phone (504)353-8888 Address P.0. BOX 150
PLAOUEH1NE. LA 70765-0150
Emergency Contacts...
Name M. A. LOTT___________
Title FACILITY COORDINATOR
Phone (504)353-8384
24Hr Phone (504)353-8888
Heme STEVE MIMS___________
Title PLANT SUPER 1MTEHPEMT
Phone (504)353-5795
24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if inforaation below is identical to the inforaation submittad laat year: _X
Chaaical Description
Physical and Health Hazarda
Inventory
as 68476-346 Trade Secret NO. Chea. Naae FUEL OIL (IN WELLS)
State Code 02417
Y_
_I
Pure Mix Solid Liquid Gas
EHS Naaa
EHS
Storage Code R24
OPTIONAL:
Location (NON-CONFIOENTIAL) PROCESS WELLS________________
Y Fire Sudden Pressure Release Reactivity
Y Inmediate (Acute) Y Delayed (Chronic)
Max. Daily Aat. Code 06
Avg. Daily Aat. Coda 06
# of Days On-Sita
365
CAS 8006-61-9 Trade Secret MO chea. Naae GASOLINE____________
State Coda 02464 Y
.ire Mix Solid Liquid Gas EHS
EHS Naaa
Storage Code A14
OPTIONAL:
Location (NON-CONFIDENTIAL) PLANTS1TE____________________
Y Fire _ Sudden Pressure Release ~ Reactivity Y Iimwdiata (Acuta) Y Delayed (Chronic)
Max. Daily Aat. Coda 04
Avg. Daily Aat. Coda 04
# of Days On-Sita
365
CAS 8002059 Trade Secret NO Chea. Naae GEAR OIL______________
State Code 03790
Y__
Y
Pure Mix Solid Liquid Gas
EHS Naae
EHS
Storage Code A14
OPTIONAL:
Location (N0N-C0NFIDENT1AL) PLANTS1TE____________________
Y Fire ~ Sudden Pressure Release ~ Reactivity ~ Inmediate (Acute) " Delayed (Chronic)
Max. Daily Aat. Coda 03
Avg. Daily Aat. Coda 03
# of Days On-Site
365
Certification: I certify under penalty of law that with the information submitted in pages one through of those individuals responsible for obtaining the inforaation is true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL MAM. vaae and official title of owner/operator OR
wner/operator's authorized representative
Site Plan Attached Site Coordinates Attached Dikes l Safeguards
DO A 057939
CONF TDFMrrA(
Tier Two / Emergency and Hazardous Chemical Invantory
Facility Identification...
Nana THE DOW CHEMICAL COMPANY BRINE PROD.
Street ROUTE 1. BOX 200H
'il ROUTE 1. BOX 200H
BELLE ROSE LA 70391-
Citv BELLE ROSE
State LA Zip 70391-
Parish/Countv ASSUMPTION
SIC Coda
2869 Dun l Brad Ninfcer 001381581
Official Use...
ID Ninter 003967
Data Received
i____ of ___ a
Owner / Operator Name... Name THE DOW CHEMICAL CO.. LOUISIANA DIVISION Phone (504)353-8888 Address P.0. BOX 150
PLAOUEMINE. LA 70764-0150
Emergency Contacts... Name M. A. LOTT Phone (504)353-8384 Name STEVE MIMS Phone (504)353-5795
Title FACILITY COORDINATOR 24Hr Phone (504)353-8888
Title PLANT SUPERINTENDENT 24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if information below is identical to the information submitted last year: _X
Chemical Description
Physical and Health Hazards
Inventory
CAS 64742650 Trada Sacrat NO_ Cham.Mama GEOTEX LA 40
____________ StataCoda 01767
I Pura Mix EHS Name
_1 Solid Liquid Gas
EHS
Storage Code D14
OPTIONAL:
Location (MON-CONFIDENTIAL) PLANTS1TE____________________
Y Fira _ Suddan Praaaura Ralaaaa _ ~ Immediate (Acuta) ~ Dalayad (Chronic)
Max. Daily AM. Coda 0J Avg. Daily At. Coda 0J
Raactivity
CAS 64742376 Trada Secret MO Chen. Name INHIBITED INSULATING OIL
Stata Coda 06099
jra Mix cHS Name
Solid Liquid Gas
EHS
Storage Cods A14
OPTIONAL:
Location (MON-CONFIDENTIAL) TRANSFORMERS_________________
Y Fira ~ Sudden Pressure Release " Reactivity
Inaadiata (Acuta) ~ Delayed (Chronic)
Max. Daily Ant. Code 0J
Avg. Daily Ant. Code 0J
# of Days On-Site
365
CAS 75285
Trada Secret NO
Chan. Nana ISOBUTANE____________
State Code
Pure Mix EHS Nana
Solid Liquid Gas
EHS
Storage Code R24
OPTIONAL:
Location (NON-CONFIDENTIAL) PR0M1X WELL 1.
Fire Sudden Pressure Release Reactivity
Imnediate (Acute) Delayed (Chronic)
Max. Daily Ant. Coda 08
Avg. Daily Ant. Coda 08
* of Days On-Site
365
Certification: I certify mder penalty of law that with the information submitted in pages one through of those individuals responsible for obtaining the inforawtion is true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL MAM.______________ Name and official title of owner/operator OR
wner/operator's authorized representative
Site Plan Attached Site Coordinates Attached Dikes l Safeguards
DO A 057940 CONFIDENTIAL
Tier Two / Emergency and Hazardous Chemical Inventory
Pago___ $ of___ 5
Facility Identification...
Name THE DOW CHEMICAL COMPANY B8IHE PROP,
straat ROUTE 1. BOX 200H
(11 ROUTE 1. BOX 200H
BELLE ROSE LA 70391-
City BELLE ROSE Stata Zip 70391-
Parish/County ASSUMPTION
SIC Coda
2869 Dun l Brad Number 001381581
Official Uaa...
ID Number
003967
Data Reeaivad
Owner / Operator Name... Name THE DOW CHEMICAL CO.. LOUISIANA DIVISION
Phone (504)353-8888 Address P.O. BOX 150
PLA0UEM1HE. LA 70765-0150
Emergency Contacts...
Nama M. A. LOTT___________
Title FACILITY COORDINATOR
Phone (504)353-8384
24Hr Phone (504)353-8888
Name STEVE MIMS___________
Title PLANT SUPERINTENDENT
Phone (504)353-5795
24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if Information below is Identical to the Information submitted last year: _X
Chemical Description
Physical and Health Hazards
Inventory
CAS 8030306 Trade Secret NO Cham. Name NAPHTHA_______________
Stata Coda 03798 Y_ _ Y Pure Mix Solid Liquid Gas
EHS Name
EHS
Storage Code R24
OPTIONAL: _
Location (NON-CONFIDENTIAL) DOW WELL 16_________________
Y Fire
7 Sudden Pressure Release
~ Reactivity
7 Immediate (Acuta)
7 Delayed (Chronic)
Max. Daily Amt. Coda 09
Avg. Daily Amt. Coda 08
# of Days On-Site
365
CAS 7727-37-9 TradeSecret NO_
Cham.Nama NITROGEN
Y
StateCode 03496
jre Nix cHS Name
Solid Liquid Gas
EHS
Storage Code L24
OPTIONAL: _
Location (NON-CONFIDENTIAL) PLANTS1TE______________________
_ Fire
Sudden Pressure Release I Reactivity
~ 7 Immediate (Acute)
I Delayed (Chronic)
Max. Daily Amt. Coda 03
Avg. Daily Amt. Coda 03
# of Days On-Site
365
CAS 7782-447 Trade Secret NO_ Cham. Name OXYGEN
______
State Code 03663 Y__ _ Y Pure Mix Solid Liquid Gas
EHS Name
EHS
Storage Coda L24
OPTIONAL:
Location (DON-CONFIDENTIAL) PLANTS ITE_____________________
_ Fire Y Sudden PressureRelease
7 Reactivity
~ Inaadiate (Acute) I Delayed (Chronic)
Max. Daily Amt. Code 03
Avg. Daily Amt. Code 03
of Days On-Site
365
Certification: I certify under penalty of law that t have with the inforswtion submitted in pages one through 8, of those individuals responsible for obtaining the information is true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL MAN. Name and official title of owner/operator OR wner/operator's authorized representative
am familiar inquiry the submitted
Date signed
Site Plan Attached Site Coordinates Attached Dikes t Safeguards
A 057941
CONFIDFNT TA!
Tier Two / Emergency and Hazardoua Chemical Invantory
Pag*___ 7 of
8
Facility Identification...
Maaa THE DOW CHEMICAL COMPANY - 8RIME PROP.
Street ROUTE 1. BOX 20QH
ill ROUTE 1. BOX 200H
BELLE ROSE LA 70391-
City BELLE ROSE Stata ^A Zip 70391-
Parlah/Couity ASSUMPTION
SIC Coda
2869 Dun 8 Brad Nimber 001381581
Official Usa...
ID Nimber
003967
Data Racalvad
Ownar / Operator Naaw... Maaa THE DOW CHEMICAL CO.. LOUISIANA DIVISION Phone (504)353-8888 Addraaa P.0. BOX 150
PLA0UEH1ME. LA 70765-0150
Emergency Contacts...
Name H. A. LOTT___________
Title FACILITY COORDINATOR
Phone (504)353-8384
24Hr Phone (504)353-8888
Name STEVE M1HS___________
Title PLANT SUPERINTENDENT
Phone (504)353-5795
24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if information below is identical to the information submitted last year: _X
Chemical Description
Physical and Health Hazards
Inventory
CAS 74986
Trade Secret N2_
Cham. Name PROPANE Y
StateCode 04052
I_ _ Y Pure Mix Solid Liquid Gas EHS Name
EHS
Storage Code Location (NON-CONFIDENTIAL) R24 DOW NELL #9
OPTIONAL:
Y Fire Sudden Pressure Release
~
Y ~ Delayed (Chronic)
Max. Dally Amt. Code 09 Avg. Dally Amt.Code 09
Reactivity
Immediate (Acuta)
CAS 115071
Trade Secret NO
Cham. Na PROPYLENE
State Code 04108
ure Nix EHS Name
Solid Liquid Gas
EHS
Storage Code R24
OPTIONAL:
Location (NON-CONFIDENTIAL) DOW WELL 83
Fire Sudden Pressure Release Reactivity Imnediate (Acute) Delayed (Chronic)
Max. Dally Amt. Coda 07
Avg. Daily Amt. Code 07
# of Days On-Site
365
CAS 64742650 Trade Secret NO Cham. Name REGAL OIL (32.150)
State Code 01767
Pure Mix EHS Name
Solid Liquid Gas
EHS
Storage Code D14
OPTIONAL:
Location (NON-CONFIDENTIAL) PLAMTS1TE______________
Y Fire _ Sudden Pressure Release ~ Reactivity
Imaadiate (Acute) _ Delayed (Chronic)
Max. Daily Amt. Coda 03
Avg. Daily Amt. Code 03
# of Days On-Site
365
Certification: I certify under penalty of law that I with the information submitted in pages one through of those individuals responsible for obtaining the information la true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL MAN.______________ Name and official title of owner/operator OR iwner/operator's authorized representative
am familiar nquiry the submitted
Date signed
Site Plan Attached Site Coordinates Attached Dikes t Safeguards
DO A 05794? CONFTDFNTTAL
Tier Two / Eaorgoncy and Hazardous Chemical lnvantory
facility Identification...
Name THE DOW CHEMICAL COMPANY BRINE PROD.
Street ROUTE 1. BOX 200H_________________ ________
iil ROUTE 1. BOX 2Q0H
BELLE ROSE LA 70391-
City BELLE ROSE Stata JjA Zip 70391-
Pariah/County ASSUMPTION
SIC Coda
2869 Dm A Brad Nimfeer 001381581
Official Uaa...
ID Nuafcer 003967
Data Racaivod
Page___ S of
Owner / Operator Naaw... Naaw THE DOW CHEMICAL CO.. LOUISiAHA DIVISIOM Phono (504)353-8888 Addresa P.O. BOX 150
PLAOUEMIHE. LA 70765-0150
Emergency Contacta...
Name M. A. LOTT___________
Title FACILITY COORDINATOR
Phone (504)353-8384
24Hr Phone (504)353-8888
Name STEVE MIMS___________
Title PLANT SUPERINTENDENT
Phone (504)353-5795
24Hr Phone (504)353-1612
Reporting Period: Jan. 1 to Dec. 31, 1994
Check if information below ia identical to the information aubmitted laat year: _X
Chemical Deacription
Phyaical and Health Hazarda
Inventory
CAS 7732-18-5 Trade Secret Ng_ Chem. Name S001UM CHLORIDE BRINE 25X
State Code 04975
Y_ _ Y
Pure
Mix Solid Liquid Caa
EHS Name
EHS
Storage Code A14 R24
OPTIONAL:
Location (NON-CONFIDENTIAL) PLANTSITE STORAGETANK PLANTSITE STORAGE WELLS
_ Fire _ Sudden Preaaure Releaae _ 7 lamediate (Acute) 7 Delayed (Chronic)
Max. Daily Amt. Code H Avg. Dally Amt. coda 11
Reactivity
CAS 27176870 Trade Secret NO_ Cham. Naaw SULFATE SOLUBLE INHIBITOR _
State Code 06103
Y
Pure Mix EHS Name
Solid Liquid Gaa
EHS
Storage Code A14
OPTIONAL:
Location (NON-CONFIDENTIAL) PLANTSITE
_ Fire Sudden Preaaure Releaae
Y 7 I mediate (Acute) ~ Delayed (Chronic)
Max. Daily Amt. Code 04 Avg. Daily Amt. Code 04
Reactivity
CAS 8052413 Trade Secret NO_ Chem. Name VARSOL SOLVENT _
State Coda 03790
Pure Mix EHS Name
Solid Liquid Caa
EHS
Storage Code E14
OPTIONAL:
Location (NON-CONFIDENTIAL) PLANTSITE___________________
Y Fire Sudden Preaaure Releaae
Reactivity Y Immediate (Acuta)
Delayed (Chronic)
Max. Daily Amt. Code Og
Avg. Daily Amt. Code 02
of Daya On-Site
365
Certification: 1 certify under penalty of law that with the information submitted in pages one through of those individuals responsible for obtaining the information ia true, accurate, and complete.
DOYLE A. HANEY. ENVIRONMENTAL MAN. Name and official title of owner/operator OR
wner/operator'a authorized representative
Site Plan Attached Site Coordinates Attached Dikes t Safeguards
D0 A 057943 CONFIDENTIAL