Drift logs roll in surf. Unusually high waves and sneaker waves. Beware of incoming tides. High waves sweep over rocks, jetties, and headlands

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1 A few words from J.R. Beaver The Oregon coast is a great place to visit. Whether you are looking for seashells, playing in the waves, or exploring tide pools, the beach can be a lot of fun. Remember that the beach is not like a swimming pool. The ocean has waves, logs, rocks and cliffs. All these things can be a lot of fun, but they can also be dangerous. Enjoy your visit and make sure you talk to your family and friends about how to play safe at the beach. Play safe, J.R. Beaver Know the Signs Drift logs roll in surf Unusually high waves and sneaker waves Beware of incoming tides High waves sweep over rocks, jetties, and headlands High, steep cliffs Overhanging cliffs and falling rocks Deep water and strong outgoing currents Beach Safety Tips for Kids Explanation for Plain Language Examples: Uses simple language Use of graphics helps to clarify points and market Oregon parks and recreation sites Oregon Parks and Recreation Department 725 Summer Street NE, Suite C, Salem, OR Phone: beach.safety@state.or.us Printed on Recycled Paper This publication is available in alternative formats on request. Write to: OPRD, 725 Summer St. NE, Suite C, Salem, OR Or call (503) or for the hearing impaired (3/05) Plain Language Example

2 Beach Safety Rules Beware of Rip Currents Rip currents are strong currents of water that rush out to sea. They are stronger than even the best swimmer. Rip currents can form on any beach that has breaking waves. If you look closely you can see a rip current. It will have dark muddy water and be very choppy. You might see foam and other debris floating out to sea. If you see a rip current, stay away! They are very dangerous. If you are ever caught in a rip current, don t panic. Relax and swim parallel to the beach. Don t try to fight it. If you have trouble swimming, tread water and call for help. Parents! Keep your kids nearby when they re playing in the ocean water. Don t Climb on Drift Logs Logs on wet sand or in the water are especially dangerous. The ocean is strong enough to pick up even the biggest log and plop it down on top of you. If you see a log in the surf or on wet sand, stay off it. Beware of Incoming Tides Tide pools can be so interesting, you might lose track of time. Make sure you know when the tide is coming in so you don t end up stranded. Get a free tide table at state park offices, information centers and many shops and motels. Be Careful on Cliffs and Rocks Ocean spray and heavy rains can make rocks and trails slippery and unsafe. Stay behind fences. They are there for your safety. When hiking, make sure you are wearing the right shoes and stay on marked trails. Stay away from cliff edges. They may not support your weight. And, don t stand under overhanging cliffs. Don t Turn Your Back on the Ocean Watch out for sneaker waves. Sneaker waves are unpredictable and appear suddenly. They can rush high up on the shore with enough force to knock you down and drag you out to sea. Make sure you always swim with a friend and keep one eye on the ocean. Respect the Beach

3 Pet Safety Don t leave pets unattended for long periods of time. Don t lock pets in a car, camper, or trailer without food, water and proper ventilation. Temperatures inside a closed vehicle in the summer can kill your pet very quickly. Don t tie your pet where a child or an unsuspecting visitor, not knowing the animal s disposition, may be bitten or injured. You are liable in these cases, not the park. Always leave fresh water out for your pet. Walk your pets in designated areas whenever such areas are provided. Otherwise, use isolated areas away from the campgrounds, picnic and play areas. top ten ways your uncontrolled pet can wreck your stay 10. They might dig, roll or fall into some thing dangerous or very, very dirty! 9. They might harass wildlife. 8. They might ransack garbage. 7. They might wander into others campsites. 6. They might get into fights with other people s pets. 5. You could get costly citations. 4. They might scare children or other visitors. 3. They might get hit by a car. 2. They might bite someone. 1. They might get lost. Pets in the Parks Oregon Parks and Recreation Department 725 Summer St. NE, Suite C Salem, OR Printed on Recycled Paper This publication is available in alternative formats upon request. Write to: OPRD, 725 Summer St. NE, Suite C, Salem, OR You may also call or (Oregon Relay for the hearing impaired) (8/07) Plain Language Example

4 Thank you for picking up this brochure! Oregon State Parks welcomes responsible pet owners and their pets. We know that your pet is important to you, and we want to make your stay fun and safe for both you and your four-legged friend. Our parks are popular, and safety for our visitors is paramount. Please cooperate with your neighbor and with park staff. The rules below are designed to reduce the risk of injury or property damage, and to keep the peace within the park. All types of pets must be kept on a leash (maximum 6 feet long), or in a vehicle or tent. The pet must be under physical control at all times, meaning you must be holding your pet, holding onto its collar, or be controlling its leash. Your roaming pet can scare, hurt or kill wildlife, frighten or bite other visitors, or get into a fight. Your pet is in an unusual situation, and may not react the way you think he will. Problems may turn into serious liability to you and your pocketbook. Bring bags! You must clean up after your dog, and dispose of wastes into the garbage. This is a health and sanitation issue, and we take it seriously. You are responsible for your pet s behavior. Barking dogs (or other noisy animals) can wreak havoc on a peaceful campground, and create ill will among campers. Please do not leave your pet unattended in a vehicle or a tent at your campsite. No animals, except for designated service animals, are allowed in any building or structure. Unfortunately, many people suffer from allergies, so we cannot allow pets in such structures as yurts, cabins and tepees. Exercise pens are to be moved daily to maintain the best possible conditions for the grounds. Pets must be properly licensed and inoculated. An identification tag is a smart idea. The tag should include a number where somebody can be reached when you are away from home. Animals found loose may be seized and subjected to laws pertaining to stray animals. Should your animal become lost, immediately call the local authorities to find the locations of the nearest stray holding facilities. Most, but not all, state parks allow dogs on their trails. Check with park staff if you are not sure. P e n a l t i e s Failure to follow these rules may result in a citation ($97 fine) and your removal from the park. If you use a retractable lead, (above) remember, you must keep it to 6 feet. Off- lead Areas The following parks have designated off-lead areas: Champoeg State Heritage Area (7 miles east of Newberg) Farewell Bend State Park (1 mile north of I-84 exit 353) Milo McIver State Park (4 miles west of Estacada) Rooster Rock State Park (I-84, 22 miles east of Portland) Molalla River State Park (2 miles north of Canby) The Cove Palisades State Park (15 miles southwest of Madras) Silver Falls State Park (26 miles east of Salem) Willamette Mission State Park (8 miles north of Salem)

5 Oregon Department of State Police Plain Language Plan December 3, 2008 The Oregon State Police is a diverse organization responsible for duties related to the mission of supporting public safety. OSP divisions are responsible for statewide law and regulatory enforcement. The agency creates forms, letters, guides, job descriptions, administrative rules, educational material and other written communication for public use. The overall goal for the OSP PL plan is clear, concise and effective communication with the public. The OSP PL plan includes the following objectives, training and integrity check. Objective #1: Conduct a department wide inventory identifying all written communications provided to the public. Complete inventory by April 1, Objective #2: Identify divisions for select projects from the inventory for plain language analysis and implementation. Divisions already identified. Projects due by March Objective #3: All divisions review their applicable web page(s) from the Oregon State Police website and update to PL specifications. Ongoing process through September Objective #4: All divisions implement PL initiative when developing new forms and form letters. Ongoing process. Projects Complete department wide inventory of written communications with public Ensure web pages comply with Plain Language Initiative Sex Offender Registration Unit Project(s)-Relief web pages, Conditions of Use web page-public website, registration requirement documents CJIS Project- Copy of Own Record and Open Records associated documents Fire Marshal Project(s)-State Mobilization Plan, key form letters Training Send personnel identified for targeted plain language projects to the DAS sponsored Plain Language Training in Develop an Oregon State Police internal training program and offer to staff responsible for regular written communication with the public and staff Integrity Check Divisions/sections revising documents with PL standards applied, will have another division/section (of a different discipline) review and comment on PL changes prior to release to the public.

6 Oregon State Police Plain Language Coordinator: Cynthia Kok, Captain, Research and Development Telephone: Oregon State Police Communications Council Representative: Gregg Hastings, Lieutenant, PIO Telephone: ex: 247

7 The Department of Oregon State Police Mission Statement Plain Language Improvements: Prior to Plain Language 2007 Simplified so people could remember and articulate is to statements provide protection to the people, The mission of the Department of Oregon State Police property and natural resources of the state and to contribute to the state s safety and livability by providing critical and essential public safety services in cooperation with our criminal justice partners. Newly stated Mission Statement The mission of the Department of Oregon State Police to enhance livability and safety by protecting the people, property and natural resources of the state. Prior to Plain Language 2007 Vision Statement Through leadership, planning, coordinated partnering and action, the Department of Oregon State Police strives to continually position the organization to meet current and future service requirements of our public safety partners, stakeholders, constituents and citizens. Newly stated Vision Statement Premier Public Safety Services Prior to Plain Language 2007 Goals and Values Service - We value our statewide mission of public safety and the protection of our citizens and natural resources through courteous and professional services for all people. Workforce - We value our people and their families and recognize that without their unique individuality and creativity, the organization cannot be successful. Partnering - We value our stakeholders, clients, constituents and partners and strive to promote unity of purpose to the end that our services are delivered in a manner that provides the greatest benefit and measurable value to Oregon communities. Accountability We value our tradition of high ethical standards, professionalism and dedicated service, and the accountability to those that we serve. Newly stated goals Be there whenever the citizens of Oregon need our services.

8 Partnering - We value our stakeholders, clients, constituents and partners and strive to promote unity of purpose to the end that our services are delivered in a manner that provides the greatest benefit and measurable value to Oregon communities. Accountability We value our tradition of high ethical standards, professionalism and dedicated service, and the accountability to those that we serve. Newly stated goals Be there whenever the citizens of Oregon need our services. Prevent harm by providing direct enforcement, resources and education. Support local communities by providing services in and specialized assistance to communities throughout Oregon. Newly stated Values Pride in our professionalism, the courage and initiative of our worforce, and the high quality of service we provide. Loyalty to the agency s public safety mission and the citizens we serve, demonstrated by our unwavering commitment to integrity, accountability, respect and responsibility. Dedication to each other, the citizens and communities we serve, our partners and our mission of public safety.

9 Department of State Police OFFICE OF STATE FIRE MARSHAL Community Right to Know Unit Hazardous Substance Information Survey Instruction Booklet Revised January 2008 Mailing Address: Office of State Fire Marshal CR2K Unit 4760 Portland Rd NE Salem OR Hazardous Substance Information Hotline: Monday thru Friday 8:00am-12:00pm and 1:00pm-5:00pm PST (503) TDD (503) Web Site: Before

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11 Table Of Contents Introduction... 1 The Oregon Community Right to Know and Protection Act... 1 How the Information Is Used... 1 The Instruction Booklet... 1 Receiving Assistance... 1 Important Reporting Requirements... 2 Requesting a Survey for Unreported Sites... 3 Quick Steps To Completing the Survey... 4 Information Required To Be Completed On the Survey... 4 Hazardous Substance Definition and Minimum Reportable Quantities... 5 Sections A, B and C Instructions and Definitions Tables for Completing the Survey... 8 Sections D and E Instructions and Definitions Storage Location Instructions Reporting Gases Reporting Lead Acid Batteries Frequently Asked Questions Extremely Hazardous Substance (EHS) and 112R Clean Air Act Information OSHA Process Safety Management Information List of Extremely Hazardous Substances (EHS) List of Clean Air Act (CAA), Section 112(r) Substances List of Process Safety Management Substances (PSM).23

12 1 Introduction The Oregon Community Right to Know and Protection Act ORS In 1985 the Oregon Legislature passed the Community Right to Know and Protection Act. This law requires the Office of State Fire Marshal to conduct an annual Hazardous Substance Information Survey of Oregon facilities. The administration and enforcement of the survey is conducted by the Community Right to Know Unit (CR2K). Facilities in Oregon with reportable quantities of hazardous substances are required to annually report those substances on the survey. In addition, facilities that receive the survey for the first time are also required to complete and submit the survey. Facilities failing to complete and submit the survey as required are subject civil penalties. A hazardous substance possession fee may be assessed based on the information provided. How The Information Is Used The information collected on the survey serves many purposes. It allows the general public to determine what hazards are present in their communities so they can better protect themselves. It also serves as the foundation for preplanning activities conducted by emergency responders as well as a resource during an emergency. In addition, the information is a key component for the State Fire Marshal s Planning and Training Assistance program for local fire departments and communities. The Instruction Booklet Because some reporting requirements may have changed, it is strongly recommended that the instruction booklet be reviewed before completing the survey. The booklet is arranged to reflect the different sections of the survey in chronological order. Additional information and tables have been provided for completing sections of the survey involving the reporting of storage locations, liquefied gases, batteries, Extremely Hazardous Substances, 112r Clean Air Act and Process Safety Management Substances. There is also a section titled Frequently Asked Questions (FAQ) that may be of further assistance. Receiving Assistance If after reviewing the instruction booklet, you still have questions or need assistance completing the survey, help is available by calling our Hazardous Substance Information Hotline at (503) or for TDD (503) Monday through Friday, 8:00am to 12:00pm and 1:00pm to 5:00pm. Other resources are available on our web site at Some of the resources available are: Applicable ORS and OAR s MSDS s Sections D and E of the survey Conversion charts for gases and refrigerants Searchable Databases Survey Request Form for Unreported Sites Hazardous Substance Information Request form

13 2 Important Reporting Requirements Oregon Law requires the survey to be completed correctly and returned by the due date indicated on the survey or it will be returned for correction and will not be considered received by the OSFM. A copy of the survey is required to be kept at the site address listed on the survey for three (3) years. Exception: Records for facilities and/or remote sites, where the covered employer, owner or operator is not set up to maintain such records, may be maintained at another of their facilities within the state. Facilities are required to maintain complete and accurate records of each hazardous substance they manufacture, generate, use, store, possess, or dispose of. A separate survey must be submitted for each site address in Oregon (OAR ) unless otherwise notified by the Office of State Fire Marshal. If you have a site address that is not already receiving a survey, complete and return to OSFM the Request Form for Unreported Sites included in this booklet. If a substantive change occurs at the facility during the current survey period, notification to the OSFM is required within 30 days of its occurrence. Substantive changes are: o A change of site address or mailing address. o A change of the emergency contact person. o A change of any phone numbers. o A change of ownership or business name. o Introduction of new substances to the site in reportable quantities which were not previously reported. o An increase of a substance already reported that increases the Maximum Amount code. o An already reported substance that is moved to another building, to another floor level, or 300 feet from its reported location. To report a substantive change, update the facility s copy of the survey and write update at the top. Make a new copy for the facility s records and mail the updated survey to the Office of State Fire Marshal. If the facility has been sold, return the survey to our office with a letter that includes the date it was sold and as much contact information for the new owner as possible, or call the Hazardous Substance Information Hotline at (503) TDD (503) If the facility is no longer doing business in the state of Oregon, write a letter to us identifying when the facility ceased operations. Please include the facility ID number, your name, and a contact phone number. Under-reporting substance amounts or failing to report could subject your facility to citation and monetary penalties.

14 3 REQUESTING A SURVEY FOR UNREPORTED SITES Unless otherwise notified by our office, a separate survey is required to be submitted for each site address in Oregon. A specific facility ID number is assigned to each site. Do not photocopy an existing survey to use for an unreported site. If you have a site address that is not already receiving a survey, complete and return the form below. Complete a separate request form for each unreported site. Office of State Fire Marshal Request Form for Unreported Sites PHOTOCOPY THIS FORM AS NEEDED BUSINESS NAME: OFFICE USE ONLY FACILITY ID #: DEPT/DIVISION: SITE LOCATION: (STREET, CITY, STATE, ZIP CODE) LOCATION COUNTY: MAILING ADDRESS: (STREET OR PO BOX, CITY, STATE, ZIP CODE) MAILING ADDRESS COUNTY: ADDRESS: NORTH AMERICAN INDUSTRIAL CLASSIFICATION SYSTEM (NAICS) CODE BUSINESS ACTIVITY: RESPONSIBLE FIRE DEPT: OWNER/CEO/ REGISTERED AGENT: SEND TO THE ATTN OF: BUSINESS PHONE NUMBER: SIGNATURE DATE

15 4 Quick Steps To Completing The Survey If this is the first time you are completing the survey for this site address and you determine there were no hazardous substances in a reportable quantity during the previous twelve months, complete sections A, B, and C. See pages 6 & 7 for instructions on completing sections A, B, and C. If this is the first time you are completing the survey for this site address and you determine that there was a hazardous substance at the site in a reportable quantity during the previous twelve months, complete sections A, B, C and D. Complete section E as needed. See pages 9 through 11 for instructions on completing sections D and E. If this is not the first time a survey has been completed for this site address, all sections of the survey must be reviewed, completed, and updated as needed. See pages 6 thru 11 for instructions on completing sections A thru E. Once you have completed the survey, keep a copy at the site address for three years. Information Required To Be Completed On The Survey The following fields are required to be completed on the survey or it will be returned for correction and will not be considered received by the Office of State Fire Marshal. Section A: Question number 1 Section B: Question number 1, 3, 4, 6, 8, 9, 10, 11, 13, 14, 15, and 16 Section C: Number 1 and 2 Section D: Common Name/Trade Name Physical State Unit of Measure Average Amount code Max Amount code Amount In code Amount Out code Number of Days on Site Storage code Storage Location(s) and Loc Max code Mail the completed survey to: Office of State Fire Marshal CR2K Unit 4760 Portland Road NE Salem, Oregon

16 5 WHAT IS A HAZARDOUS SUBSTANCE? Any substance that OR-OSHA requires the manufacturer to produce a Material Safety Data Sheet (MSDS) for is considered a hazardous substance by the Office of State Fire Marshal. This includes substances produced at your site, waste substances, solutions, certain food ingredients, and refrigeration system gases. WHAT ARE THE REPORTABLE QUANTITIES? If the maximum amount of a hazardous substance that was on site at any time during the survey period (the previous twelve months) was in an amount that meets or exceeds the reportable quantities listed below, it must be reported. LIQUIDS: 50 GALLONS OR MORE (E.g. gasoline, diesel, oils, acetone, paint, cleaners, solutions etc.) SOLIDS: 500 POUNDS OR MORE (E.g. lime, metal ingots, fertilizer, caustic soda, GASES: 200 CUBIC FEET OR MORE (At atmospheric pressure and temperature) POISONS AND EXPLOSIVES LIQUIDS: 5 GALLONS OR MORE SOLIDS: 10 POUNDS OR MORE GASES: 20 CUBIC FEET OR MORE (E.g. cyanide, strychnine, dynamite, black powder, etc.) RADIOACTIVE SUBSTANCES bulk food ingredients, wastes, etc.) (E.g. acetylene, oxygen, propane, liquid oxygen, sulfur dioxide, Freon, etc.) Any quantity of radioactive substance including radioactive wastes. EXCEPTION: Sealed source radioactive materials, as defined by OAR (118). EXTREMELY HAZARDOUS SUBSTANCES Extremely Hazardous Substances (EHS) that meet or exceed their Threshold Planning Quantity (TPQ) are required to be reported at the TPQ or the amounts listed on this page, whichever is lower. For more information, see the EHS list and the TPQ s in this booklet or call the Hazardous Substance Information Hotline. REPORTING EXCEPTION FOR GASES Gases intended for human/animal ingestion and/or inhalation either directly or added to a product are exempt from reporting, if ALL of the following apply: 1) The gas is present at the site where human/animal ingestion and/or inhalation occur. 2) The gas is not being used in a manufacturing process. 3) The gas is not a cryogenic. 4) The gas is not being stored at the site in excess of 1,000 cubic feet. SUBSTANCES THAT ARE CURRENTLY NOT REPORTABLE ABS Pipe Metal Sheets Polyurethane - foam finished products Acrylic Sheets Plastic Pipe PVC Pipe Alcoholic Beverages Plastic Tubing Tires Metal Pipe Polyethylene Products (finished form) Transformers Metal Rods Polystyrene - filler material Vinyl - film and sheeting

17 INSTRUCTIONS AND DEFINITIONS 6 This survey is required to be completed correctly and accurately for the survey period or it will be returned for correction and will not considered received. The survey period is the 12 months prior to the receipt of this survey. If updates need to be made to the survey, cross out the information that is no longer correct and provide the updated information in the gray shaded area. If you have other sites in Oregon that are not receiving a survey and you have not already notified our office, complete the request form for Unreported Sites on page 3 of this booklet. ALL PORTIONS OF THE SURVEY MUST BE TYPED OR PRINTED IN BLACK OR BLUE INK SECTION A HAZARDOUS SUBSTANCE PRESENCE 1. Check Yes or No depending upon whether or not your facility had hazardous substances in reportable quantities during the survey period. A hazardous substance is any substance for which OR-OSHA requires the manufacturer to produce a Material Safety Data Sheet (MSDS). If you answer Yes, a section D sheet must be completed. Substances will NOT be deleted from the survey unless the NO LONGER REPORTABLE box in Section D is checked. 2. Check Yes or No depending upon whether or not an Extremely Hazardous Substance (EHS) was present at this site at or above its Threshold Planning Quantity (TPQ) during the survey period. Refer to the section in this booklet on EHS. 3. Check Yes or No depending upon whether or not the facility is subject to the reporting requirements of Section 112(r) of the Clean Air Act. Refer to the section in this booklet on the Clean Air Act, Section 112(r). 4. Check Yes or No depending upon whether or not the facility is subject to the notification requirements of OR-OSHA s Process Safety Management (PSM) Program for substances. Refer to the section in this booklet on OR-OSHA s PSM program. SECTION B DEMOGRAPHIC DATA 1. NAICS Code 1 (North American Industry Classification System Code) - List the six-digit number that corresponds to the business activity at the site. If you are unsure of your code, you can obtain information at 2. NAICS Code 2 - List the six-digit number that corresponds to any other type of business activity at your facility, if applicable. 3. Business Activity - Describe the type of business occurring at the site address identified in #9. Is it Logging, Landscaping, Silicon Chip Manufacturing, Sawmill, Welding Shop, Automotive Repair Shop, Gas Station, Office, etc. If the site is a home office, indicate the type of business the office is for. E.g., Home office for excavation business. 4. Business Name - Name that the business is known by, operates under or doing business as (DBA). 5. Dept. or Div. - Department or Division of the facility if applicable. 6. Owner/CEO/Reg Agent - Enter the name of the person who is the highest ranking official for the entity. E.g, Owner, Chief Executive Officer, Registered Agent, Director, or President.

18 7 INSTRUCTIONS AND DEFINITIONS (continued) 7. Send to Attention of - This person will receive all correspondence regarding the HSIS. 8. Address - address of the person at the site who should receive the survey. If there is no e- mail address, enter NONE. Do not enter web sites. By providing an for the facility, you will have the option to complete an electronic version of the survey in the future. 9. Site Address - A facility s business location in Oregon, including street number and name, city, county, and zip code. A facility may have more than one site. Each site is separate if it has a different address. A separate survey must be completed for each site. 10. Mailing Address - The address that all correspondence from OSFM will be sent to regarding the HSIS. 11. Business Phone - Telephone number that can be used to contact your facility during business hours. 12. Dun & Bradstreet # - Enter this number if your company has a Dun & Bradstreet number. 13. Number of Employees at this Site - Number of persons employed by your business at this site only. 14. Emergency Assistance Contact Person - Person qualified to give on-site information concerning hazardous substances used at this site. This is required under both state and federal statutes. 15. Emergency Contact Phones - Daytime and nighttime phone numbers for the emergency contact person. 16. Responsible Fire Department - Name of the fire department that would respond to an emergency at this site. 17. Written Emergency Plan - Check Yes or No depending upon whether or not your facility has a WRITTEN emergency plan. If yes, enter where the plan is kept. 18. Automatic Fire Suppression - Check Yes or No depending upon whether or not your building has an automatic sprinkler system or other automatic fire suppression system. 19. Are Buildings/Tanks/Areas Placarded According to NFPA 704? - Check Yes or No if any storage buildings, tanks or areas at the site are placarded according to NFPA 704. If you have any questions, contact your local fire department or the Office of State Fire Marshal. NFPA Other Placarding - Check Yes or No if labeling or placarding is used at the site other than NFPA 704. SECTION C PERSON COMPLETING FORM 1. Print Name - Printed name of the person completing the survey. 2. Signature - Signature of the person completing the survey. 3. Date - Enter the date the survey was completed. Phone Number - Enter the phone number (and extension if applicable) of the person completing the survey.

19 TABLES FOR COMPLETING THE SURVEY 8 Note: A hazardous substance possession fee may be assessed based on the information provided. It is important that you take particular care in accurately reporting the "Hazardous Ingredient" and the "Maximum Amount" of each hazardous substance possessed. Over-reporting may result in a higher than required fee while under-reporting or failing to report could subject your facility to citation and monetary penalties. TABLE I PHYSICAL STATE 1 SOLID 2 LIQUID 3 GAS TABLE II QUANTITY UNITS 1 POUNDS 2 GALLONS 3 CUBIC FEET 4 MILLICURIES TABLE III - REPORTING QUANTITIES (AMOUNTS) AND CODES CODE FROM TO , , , , , , , , , , , , , , , , ,000, ,499, ,500, ,999, ,000, ,499, ,500, ,999, ,000, ,999, ,000, ,999, ,000, ,999, ,000, ,999, ,000, ,999, ,000, ,999, ,000, ,999, ,000, ,999, BILLION HIGHER THAN 1 BILLION TABLE IV - STORAGE CODES Code Type of Storage A...Aboveground tank B...Underground tank C...Tank inside building D...Steel drum E...Plastic or non-metallic drum F...Can G...Carboy H...Silo I...Fiber drum J...Bag K...Box L...Cylinder M...Glass bottles, jugs or buckets N...Plastic bottles, jugs or buckets O...Totebin P...Tank wagon Q...Railcar R...Other S...Dewar TABLE V TEMPERATURE AND PRESSURE CONDITIONS AND STORAGE CODES Codes Storage Conditions (PRESSURE) Normal pressure Greater than normal pressure Less than normal pressure (TEMPERATURE) Normal temperature Greater than normal temperature Less than normal temperature but not cryogenic Cryogenic conditions EXAMPLE: Marksman Herbicide in the main building is kept in a tank inside the building, at normal pressure and normal temperature. Table IV shows you that the code for a tank inside a building is C. Table V shows you that the code for normal pressure is 1 and the code for normal temperature is 4. You enter: C 1 4 TABLE VI HAZARD CLASSIFICATION CODES Code Class Code Class (1.1) Class A Explosives (4.3) Dangerous When Wet (1.2) Class B Explosives (4.4) Reactive Materials (1.3) Class C Explosives (4.5) Combustible Materials (1.4) Blasting Agents (5.1) Oxidizers (1.5) Insensitive Explosives (5.2) Organic Peroxides (2.1) Flammable Gases (6.1) Poisonous Materials (2.2) Nonflammable Gases (6.2) Etiologic Materials (2.3) Poison Gases (6.3) Acute Health Hazard (3.1) Flammable Liq. (FP less than 0 o F) (6.4) Chronic Health Hazard (3.2) Flammable Liq. (FP between 0 o F & 73 o F) (6.5) Pesticide (3.3) Flammable Liq. (FP between 73 o F & 141 o F) (7.3) Radioactive Materials (4.1) Flammable Solids (8.0) Corrosives (4.2) Spontaneously Combustible Materials (9.0) Misc. Hazardous Materials No Longer Reportable 112 (r) EHS PSM SECTION D 1-Pure 2-Mixture [2] Location EXAMPLE Common Name or Trade Name: [ Marksman Herbicide ] Hazardous Ingredient: [ Atrazine ] Physical State Use Table I 2 [ ] Unit of Measure Use Table II 2 [ ] Avg Amt Code Use Table III 10 [ ] Max Amt Code Use Table III 11 [ ] Amt In Code Use Table III 20 [ ] Amt Out Code Use Table III 20 [ ] No. Days on Site 3 digits 365 [ ] Storage Code Use Table IV & V C 1 4 A 1 4 [ ] [ ] [ ] [ ] [ ] [ ] Hazard Classes Use Table VI [ ] [ ] UN/NA if known 3082 [ ] EPA Pesticide Registration No [ ] CAS No if known [ ] In/Out Building Floor Area Room Quadrant Loc Max Use Table III Delete [ I ] [ Main ] [ 1 ] [ NA ] [ Storage ] [ NE ] [ 10 ] Delete [ O] [ Warehouse ] [ ] [ Parking Lot ] [ NA ] [ SW ] [ 04 ] Delete [ I ] [ Various ] [ 1 ] [ NA ] [ NA ] [ V ] [ 04 ]

20 9 INSTRUCTIONS AND DEFINITIONS (continued) SECTION D SUBSTANCE INFORMATION This section is completed only if you have reportable quantities. Common/Trade Name - Enter the name of the hazardous substance in the space provided. The name of the hazardous substance is on the Material Safety Data Sheet (MSDS), container, package, or tank that the substance came in. A substance name is to be reported only once on the survey even if it is stored in several different locations at the facility. The HSIS will be returned if duplicate entries of substance names are entered. Hazardous Ingredient - Enter the name of the chemical, other than water, present in the substance in highest concentration. See the Material Safety Data Sheet or contact your supplier. No Longer Reportable - Check this box if the substance is no longer reportable. A substance can not be removed from the survey unless it has been present in an amount less than a reportable quantity for 12 complete months. Extremely Hazardous Substance (EHS) - If this product is or contains an EHS, place an X in this box. A list of EHS substances is provided in this instruction booklet. 112(r) - If this product is or contains a 112(r) substance, place an X in this box. A list of 112(r) substances is provided in this instruction booklet. Process Safety Management (PSM) - If this product is or contains a PSM substance, place an X in this box. A list of PSM substances is provided in this instruction booklet. Pure or Mixture - Enter a 1 or 2 in the brackets. Pure substances have only one component; e.g., oxygen or acetone. Mixtures contain two or more different components mixed together; e.g., paint or gasoline. See the Material Safety Data Sheet or contact your supplier for assistance. Physical State - Enter the code number that represents the physical state of the substance as it would be if released into the atmosphere. (Use Table I for code values.) Unit of Measure - Enter the code number that represents the applicable unit of measure for this substance. (Use Table II for code values). Report solids in pounds, liquids in gallons, gases in cubic feet, radioactives in millicuries, and liquefied and cryogenic gases in gallons. Average Amount - Enter the two-digit code for the average amount possessed during the previous 12 months. (Use Table III. Also see FAQ section on how to calculate). This amount cannot be greater than the maximum amount code. Maximum Amount - Enter the two-digit code for the maximum amount possessed at one time during the previous 12 months. (Use Table III). The Max Amt code must be equal to, or larger than, the Avg Amt code, and the Loc Max code. The maximum amount code must be reviewed and provided for each reportable substance. Amount In - Enter the two-digit code for the amount of the substance transported to the facility during the previous 12 months (Use Table III). NOTE: If no amounts were transported to the facility, place 00 in the box.

21 10 INSTRUCTIONS AND DEFINITIONS (continued) Amount Out - Enter the two-digit code for the amount of the substance transported off the site in its original form during the previous 12 months (Use Table III). NOTE: If no amounts were transported from the facility, place 00 in the box. (This does not include accidental and/or intentional releases of the fuel, gas, oil, etc., used in the facility vehicles or other substances consumed at the site). Number of Days on Site - Enter the number of days the substance was on site during the previous 12 months. Storage Codes - Enter the code(s) that describe the type(s) of storage containers and conditions of storage for this substance; e.g., C 1 4. (Use Tables IV & V) Review the example located on the tables page for assistance. NOTE: More than one storage code may apply. Hazard Classes - Enter all applicable hazard classes that apply to this substance (use Table VI). Department of Transportation guides or Material Safety Data Sheets can be used for reference. More than one hazard class may apply. CAS NUMBER - Enter the Chemical Abstract Service number (if known) for the ingredient listed in highest concentration. Material Safety Data Sheets can be used for reference. UN/NA NUMBER - Enter the United Nations/North America 4 digit classification number (if known). Material Safety Data Sheets can be used for reference. EPA Pesticide Registration Number - If the substance reported is a pesticide, enter the EPA Pesticide Registration Number that is located on the pesticide label. Storage Locations - Report or update the locations using the format indicated below. All locations containing a minimum reportable quantity of a substance must be reported in the location field of Section D, along with the Loc Max code for that location. Do not list the same location more than once. Loc Max codes cannot be greater than the Max Amt Code. If there are more locations with reportable quantities than space allows, enter the additional locations on the Section E form provided. If the facility does not have a reportable quantity in a single location, but the accumulative amount throughout the facility reaches the OSFM minimum reportable quantity, enter various on the first location line in the Building column, a V in the quadrant column, and enter the Loc Max code for the amount of substance located throughout the facility. At least one location must be entered for each substance name reported. See Storage Locations page for more detailed instructions. If a storage location is no longer applicable, check the delete box next to the location to be removed. If the substance has been gone longer than twelve months, check the No Longer Reportable box immediately to the left of the Physical State Box. In/Out Building Floor Area Room Quadrant Loc Max UseTable III Delete [ I ] [ Main ] [ 1 ] [ NA ] [ Repair ] [ NE ] [ 10 ] Delete [ O] [ Warehouse ] [ ] [ Parking Lot ] [ NA ] [ SW ] [ 04 ] Delete [ I ] [ Various ] [ 1 ] [ NA ] [ NA ] [ V ] [ 04 ] SECTION E Enter all fields that apply ADDITIONAL LOCATION SHEET Complete this section for additional substance locations. Location - If additional space is needed to report substance locations than is available under Section D, complete Section E, including all required information as instructed under Section D Storage Locations.

22 11 STORAGE LOCATIONS All location fields MUST be completed unless otherwise noted in these instructions, or the survey will be returned. If the individual field does not apply to the substance being reported, enter NA in that field. In/Out Building INSIDE REPORTING SUBSTANCES INSIDE OF A BUILDING Enter an I to indicate the substance is located inside a building. NA is not acceptable. Enter the building name, number, or any other identifier used to describe the building that the substance is located in (not a site address). If there is only one building at the site, enter Main. EXAMPLES: Building 1, Building A, Warehouse, Fuel Shed, Equipment Shed, or Main Floor Enter the floor number on which the substance is located. If the building is a single story, enter 1. If the substance is located in a basement, enter BSMT. Area Room Quadrant Loc Max Enter the area of the building where the substance is located. If no designation has been made, enter NA. EXAMPLES: Shipping Dock, Welding Area, Framing Area, Receiving Area, or NA Enter the room the substance is located in. If the building has only one room, enter NA. EXAMPLES: Room 3, Parts Room, Storage Room, Tool Room, or NA NA is not acceptable. Enter the quadrant for the last field specified i.e., building, area, or room. OPTIONS: N, S, E, W, NE, NW, SE, SW, C (center), V (various) Enter this location s maximum amount for the substance being reported. Refer to Table III in the Instruction Booklet. This will be the maximum amount at this storage location. The Loc Max code cannot be greater than the Max Amt code. OUTSIDE REPORTING SUBSTANCES OUTSIDE OF A BUILDING In/Out Building Floor Area Room Quadrant Loc Max Enter an O to indicate the substance is located outside. Enter the building name, number, or any other identifier used to describe the building that the substance is located closest to (not a site address). If there are no buildings at the site, enter NA. EXAMPLES: Building 1, Building A, Fuel Shed, or NA Leave Blank. Enter the area where the substance is located. If no designation has been made, enter NA. EXAMPLES: Fueling, Drum Storage, Fenced Yard, Parking Lot, or NA Enter NA NA is not acceptable. Enter the quadrant for the last field specified; i.e., building or area. OPTIONS: N, S, E, W, NE, NW, SE, SW, C (center), V (various) Enter this location s maximum amount for the substance being reported. Refer to Table III in the Instruction Booklet. This will be the maximum amount at this storage location. The Loc Max code cannot be greater than the Max Amt code.

23 12 REPORTING GASES REPORTABLE QUANTITIES The reportable quantity for gases both liquefied and vapor is 200 cubic feet or more at atmospheric pressure and temperature. EXCEPTION Gases intended for human/animal ingestion and/or inhalation either directly or added to a product are exempt from reporting if ALL of the following apply: The gas is present at the site where human/animal ingestion and/or inhalation occurs. The gas is not being used in a manufacturing process. The gas is not a cryogenic. The gas is not being stored at the site in excess of 1,000 cubic feet. Examples: Carbon Dioxide used at a restaurant to carbonate soft drinks. Nitrous Oxide used at a dentist office. LIQUEFIED AND CRYOGENIC GASES Liquefied and cryogenic gases are defined as those gases that are received and maintained as liquids through the use of pressure and/or cryogenic conditions. 1. Liquefied gases and cryogenic gases are to be reported in gallons. If unsure of the conversion, call your gas supplier for assistance. 2. Some examples of liquefied gases and cryogenic gases include: Ammonia, Anhydrous Argon, cryogenic Apache (Propylene Mixture) Butane Carbon Dioxide Chlorine Fluorine Freon Helium, cryogenic Hydrogen, cryogenic Methane, cryogenic Methyl Bromide Neon, cryogenic Nitrous Oxide Nitrogen, cryogenic Oxygen, cryogenic Propane Sulfur Dioxide 3. Mark the physical state box on the survey as a 3 for gas. 4. Mark the unit of measure box on the survey as a 2 for gallons. 5. If you are not sure how to complete the survey, please call the hotline at OXYGEN Oxygen should be reported as Oxygen, Oxygen Liquid or Oxygen Medical. Oxygen Oxygen stored in a compressed state, used mostly for welding purposes, etc. Oxygen Liquid Oxygen stored in a liquefied state due to cryogenic conditions. Oxygen Medical Oxygen used by hospitals, ambulances, etc., for medical purposes. (This does not include liquid oxygen.) NOTE: If reporting a Self Contained Breathing Apparatus (SCBA) report the substance name as Breathing Air. ANHYDROUS AMMONIA When reporting Anhydrous Ammonia, the contents of the entire distribution system, as well as any tanks on site, must be included. (e.g. Piping System, Holding Tanks, Storage Tanks, etc.)

24 13 REPORTING LEAD ACID BATTERIES 1. The Common Name/Trade Name for lead acid batteries will be reported in one of the following categories: Lead Acid Batteries Dry Dry lead acid batteries are to be reported as Lead Acid Batteries Dry (for batteries without liquid electrolyte added). Dry batteries are those that are newly made and have not been filled with electrolyte (usually a sulfuric acid solution). If the batteries are shipped off site dry, report them as Lead Acid Batteries dry. Lead Acid Batteries Wet Wet lead acid batteries are to be reported as Lead Acid Batteries-Wet (for batteries filled with electrolyte). Wet lead acid batteries are those that have been filled with electrolyte and are ready for use. If batteries are shipped off site wet, report them as Lead Acid Batteries Wet. Lead Acid Batteries Gel Gel lead acid batteries are to be reported as Lead Acid Batteries-Gel. Gel batteries are a type of sealed lead acid battery. Used Lead Acid Batteries Used lead acid batteries are to be reported as Used Lead Acid Batteries-Wet. Used lead acid batteries are those that are dead, but can be recharged and/or sold as used batteries. Waste Lead Acid Batteries Waste lead acid batteries are to be reported as Waste Lead Acid Batteries. Waste lead acid gel batteries are to be reported as Waste Lead Acid Batteries-Gel. Waste Lead Acid Batteries are those that are dead and will no longer hold a charge. 2. The Hazardous Ingredient in Highest Concentration (HIHC) will be reported as follows: For Lead Acid Batteries Dry HIHC will be Lead For Lead Acid Batteries Wet HIHC will be Sulfuric Acid For Lead Acid Batteries Gel HIHC will be Sulfuric Acid For Lead Acid Batteries Used and Waste HIHC will be Sulfuric Acid 3. The Physical State of lead acid batteries will be reported as a solid. 4. The Unit of Measure of lead acid batteries will be reported in pounds. DETERMINING REPORTABLE QUANTITIES OF BATTERIES The reportable quantity for each category of lead acid batteries (Dry, Wet, Gel, Used & Waste) will be determined by using the total weight of the batteries, including the electrolyte if applicable, and will be subject to the minimal reporting quantity of 500 pounds. NOTE: Batteries in electric powered fork lift trucks must also be reported. Batteries in use on over the road motor vehicles are not reportable. Dry cell batteries, like those used in flashlights, portable radios, cell phones and pagers are not reportable.

25 14 FREQUENTLY ASKED QUESTIONS (FAQ) 1. How do I make corrections to the pre-printed information on the survey? When making a change or correction to the pre-printed information on the survey, cross out the incorrect information and enter the correct information in the gray shaded area. IF YOU HAVE A PRE- PRINTED SURVEY WITH INFORMATION FROM THE PREVIOUS YEAR - REVIEW CAREFULLY. FACILITIES ARE RESPONSIBLE TO UPDATE OR CORRECT DISCREPANCIES. 2. Must I report a hazardous substance that is on site for less than 24 hours? The reporting of a hazardous substance on site for any length of time is recommended. However, you are only required to report substances present at the site in a reportable quantity for 24 hours or more. Note: If a substance is regularly arriving and leaving in a reportable quantity, it must be reported even if on site less than 24 hours. 3. Do I have to complete the survey if I am operating from a residence? Yes, you will still need to complete the survey. If the residential site is only an office, indicate this in section B #3 by stating that it is an office for the type of business. E.g. Home office for trucking business. 4. How do I report if I have more than one site location? You must fill out a separate survey for each site address. Complete the Request Form for Unreported Sites, found in this booklet. 5. What do I do if my facility goes out of business? If the facility is out of business and does not have any other sites in Oregon, write a letter that includes the Facility I.D. number, a contact name and phone number, a narrative explaining that the facility is out of business, the effective date, and does not have any other reportable sites. Or call the hazardous substance information hotline. If there is another site in Oregon that is not reporting, update the survey for that site. If additional surveys are needed for other unreported sites, use the survey request form provided in this book. 6. How do I report my retail operation? Retail operations are not required to report those substances that are located on the retail sales floor. HOWEVER, substances stored or maintained in a back room or warehouse area MUST be reported if they meet the reportable quantities. DEFINITION Retail Sales Floor: The area within the facility where monetary transactions are handled. 7. How do I report a substance that is located throughout the facility in different quantities? A substance name is to be reported only once on the survey even if it is stored in several different locations at the facility. Duplicate entries of substance names will be returned to the facility to be corrected. All locations containing a reportable quantity of a substance must be included in the location fields of Section D. If there are more locations with reportable quantities than space allows, enter the additional locations on the Section E form provided. If the facility does not have a reportable quantity in a single location but the accumulative amount throughout the facility reaches the reportable quantity, enter various on the first location line in the Building column; enter a V in the quadrant column, and enter the Loc. Max code for the amount of substance throughout the facility. At least one location must be entered for each substance name reported. For more information, see Instructions and Definitions for Section D and Storage Locations.

26 15 FREQUENTLY ASKED QUESTIONS (FAQ) (continued) 8. How do I calculate the average amount? The average amount of each reportable hazardous substance may be measured daily, weekly or monthly as appropriate to your type of operation. Total these numbers and divide by the number of days, weeks or months the substance is on-site. Enter the appropriate two-digit code from Table III for the "average amount in the block provided in Section D of the survey for each reportable hazardous substance. Amount divided by Time = Average Amount. 9. How do I determine the maximum amount? You must consider the amount of each reportable hazardous substance possessed at your facility at one time. The amount may vary as shipments increase your inventory and regular use depletes it. The "maximum amount is the highest quantity of a substance that was at the facility at any time during the survey period. Enter the appropriate two-digit code from Table III in the block provided in Section D of the survey for each reportable hazardous substance. 10. How is the total amount in and amount out calculated? Amount In is the total amount of the substance transported to the facility during the previous 12 months. Amount Out is the total amount of the substance in it s original form transported off the site during the previous 12 months in shipments, sales, etc. (This does not include amounts transported from the facility due to accidental or intentional releases, the fuel, gas, oil, etc., used in the facility s vehicles or other substances consumed at the site.) 11. What do the storage codes normal pressure, normal temperature and cryogenic conditions mean? Normal Pressure means normal atmospheric pressure. Any gases stored in high-pressure containers are reported as being greater than normal pressure. Normal Temperature means the substance is stored in the same temperature range as that of the surrounding area. Cryogenic Conditions means substances are stored at a very low temperature (-130 degrees Fahrenheit or lower). For assistance in determining a substance s storage conditions, contact your supplier or your local trade association. 12. What if I no longer have a substance at the facility that I reported previously? The survey period is the 12 months prior to the receipt of this survey. Your responses should reflect the substances that were present in reportable quantities during the survey period as follows: If the substance was present at the site in reportable quantities during any part of the survey period, it must be reported. If a previously reported (pre-printed) substance was NOT present at the site in reportable quantities during any part of the survey period, check the box next to the substance titled No Longer Reportable. NOTE: A previously reported (pre-printed) substance must be absent from the facility or below reportable quantities for the entire survey period, before it may be identified as No Longer Reportable in Section D of the survey. 13. Do I have to report all the different colors of paint separately? No. Paint should be reported in two broad categories. The two categories are paints-water based and paintsoil based. Note: This does not apply to two component or highly toxic paints, which must be reported separately.

27 16 FREQUENTLY ASKED QUESTIONS (FAQ) (continued) 14. Do I have to report all types of motor oil separately? No. Motor oils should be combined if the only major difference is viscosity (weight). Waste Motor Oil and Used Motor Oil are different substances and should be reported separately. 15. What is considered a waste product and how are they to be reported? Waste products are those that are considered spent material, sludge, scrap, or otherwise designated as such by the Department of Environmental Quality. To report these products, begin the name with the word waste, and then the common name of the substance; e.g., Waste Acetone, Waste Motor Oil, Waste Solvent 350B, Waste 1,1,1-trichloroethane. 16. How do I report ammunition and fireworks? The powder content of the ammunition and the accelerant portion of the fireworks are REPORTABLE. (Ten pounds of powder or accelerant is a reportable quantity.) The lead projectile, brass casing, paper, cardboard, wood, plastic and metal portions are NOT REPORTABLE. DEFINITION - Explosives: A hazardous substance that has been classified as an explosive (class A, B or C) by the U.S. Department of Transportation. 17. Do I have to report the fuel and batteries that are in my vehicles? No. Fuel, engine lubricant, engine coolants and batteries contained within motorized vehicles are not reportable. 18. How do I request Trade Secret protection? A request for trade secret protection must be made at the time the survey is submitted to the Office of State Fire Marshal. Only the name of the hazardous substance may be protected. If you request Trade Secret protection, instead of entering the name of the hazardous substance, enter its hazardous classification code. For example: for ACETONE enter 3.1, which is the code for flammable liquids. You will also need to separately request in writing Trade Secret protection for the substance. If you do not, Trade Secret protection will not be granted. 19. How do I report substations? If you operate substations that are of the same type (e.g. Electrical Relay, Sewage/Storm Pump Station, Telephone Relay, etc.), you may report all of them on a single combined survey instead of reporting each location separately. If you choose to report your substations on a single combined survey, specific requirements must be met. For more information, call the Hazardous Substance Information Hotline at and request the information packet for reporting substations on a single combined survey. NOTE: Source generation sites must be reported separately. A source generation site is a facility that generates what is relayed, pumped or stored by substations. (Examples: A facility that generates electricity or a wastewater treatment plant). 20. May I create and use my own survey form if it looks like the Office of State Fire Marshal s form? No. You must use the forms issued by the Office of State Fire Marshal. Using forms created by the facility creates data entry problems and will result in the survey being sent back to the facility.

28 17 EHS, 112R, and PSM HAZARDOUS SUBSTANCE QUESTIONS The following are three lists of hazardous substances that are intended to help you complete the Oregon Hazardous Substance Information Survey (HSIS). Under Sections A & D of the HSIS are boxes that refer to these lists. Please read each description below and check all applicable boxes on the HSIS. These lists are not intended to be complete lists of substances subject to reporting on the HSIS. To determine if a substance is reportable, refer to the Reportable Quantities section in this booklet. EXTREMELY HAZARDOUS SUBSTANCES (EHS) are regulated by the Environmental Protection Agency (EPA). EHS substances are calculated based on the accumulative amount at the facility at any one time. Survey Section A, Question # 2: If your facility has a substance on the EHS list in an amount that meets or exceeds the Threshold Planning Quantity (TPQ) indicated on the list, your facility is subject to EPA s Emergency Planning Requirements and the Yes Box on the survey must be marked. Example: If the EHS was present in a mixture, calculate only the EHS portion of the substance. For example, if a mixture of gases contains 50% phosgene and that 50% is equal to or greater than 10 pounds (the TPQ for phosgene), the facility is subject to SARA Title III planning requirements, and must identify itself as an EHS facility under Section A. The substance must also be reported in section D of the survey. Survey Section D: If the substance you are reporting is an EHS or contains an EHS, you will need to mark the EHS box. References: If you have questions about EHS reporting requirements: contact EPA s RCRA, Superfund and EPCRA Hotline (800) , Monday through Friday 10 AM to 3 PM, Eastern Time or visit the CEPPO home page at The EHS list is at CLEAN AIR ACT (CAA), SECTION 112(r) is regulated by the EPA. Survey Section A, Question # 3: If your facility has a substance on the 112(r) list in an amount that meets or exceeds the TQ (Threshold Quantity), your facility is subject to the EPA s Risk Management Plan (RMP) rule of the CAA 112(r) and the Yes box on the survey will need to be marked. Special Note: There are certain exemptions given to this requirement, please review the specific CAA 112(r) requirements for further information. Examples: Facility A has acetylene at their site at one time in a maximum amount of 150,000 cu ft. When checking the TQ Cubic Feet column they determine their maximum amount is greater than that listed (147,000 cu ft.). They are subject to the requirements and the Yes box must be marked. Facility B has a mixture containing Hydrazine. They determine the maximum amount of the entire mixture is 10,000 gallons. The mixture contains 15% Hydrazine. To find the total amount of Hydrazine contained in the mixture, they multiply 10,000 by.15, which equals 1,500 gallons. When checking the TQ Gallons column, they determine their maximum quantity of Hydrazine is less than the TQ of 1,800 gallons. They are not subject to the 112(r) requirements. Survey Section D: If the substance you are reporting is a 112(r) substance or contains a 112(r) substance, you will need to mark the 112(r) box. References: If you have questions about specific 112(r) reporting requirements: contact EPA s RCRA, Superfund and EPCRA Hotline (800) , Monday through Friday 9 AM to 6 PM, Eastern Time, or Lisa McArthur, EPA, (206) or visit the CEPPO home page in the World Wide Web at The 112(r) list is at

29 18 PROCESS SAFETY MANAGEMENT (PSM) Regulated by the Oregon Department of Consumer and Business Services, Occupational Safety and Health Division. Survey Section A, Question # 4: If your facility has a substance on the Process Safety Management (PSM) list in an amount that meets or exceeds the Threshold Quantity (TQ) or your facility uses a flammable liquid or gas in a quantity of 10,000 pounds, or more, you are subject to the PSM requirements and should mark this box accordingly. Special Note: There are certain exemptions given to this requirement. Please review the specific PSM requirements for further information. Example: The facility has allyl chloride, which they use in a process in the amount of 1,050 pounds. This facility would be subject to the PSM requirements. Survey Section D: If the substance you are reporting is a PSM substance or contains a PSM substance, you will need to mark the PSM box. References: If you have questions about PSM reporting requirements: contact Penny Wolf-McCormick, Health Enforcement Manager at or find information on the Oregon OSHA web page at

30 19 EXTREMELY HAZARDOUS SUBSTANCES (EHS) TPQ (Threshold Planning Quantity) - This amount triggers notification that the facility is subject to SARA Title III planning requirements. For substances with two TPQ s listed in pounds; e.g., 500/1,000, the lower quantity would apply for solids in powder form with a particle size less than 100 microns and substances in solution or molten form. The higher number is for all other forms. CAS numbers for EHS substances are listed on the EPA web-site at: Chemical Name TPQ Pounds TPQ TPQ Cubic Ft Gallons Acetone cyanohydrin 1, Acetone thiosemicarbazide 1,000/10,000 Acrolein Acrylamide 1,000/10,000 Acrylonitrile 10,000 1,497 Acrylyl chloride Adiponitrile 1, Aldicarb 100/10,000 Aldrin 500/10,000 Allyl alcohol 1, Allylamine Aluminum phosphide 500 Aminopterin 500/10,000 Amiton oxalate 100/10,000 Amiton 500 Ammonia 500 4, Amphetamine 1, Aniline 1, Aniline, 2,4,6-trimethyl Antimony pentafluoride Antimycin A 1,000/10,000 Antu 500/10,000 Arsenic pentoxide 100/10,000 Arsenous oxide 100/10,000 Arsenous trichloride Arsine 100 3,550 Azinphos-ethyl 100/10,000 Azinphos-methyl 10/10,000 Benzal chloride Benzenamine, 3-(trifluoromethyl) Benzene, 1-(chloromethyl)-4-nitro- 500/10,000 Benzenearsonic acid 10/10,000 Benzimidazole, 4,5-dichloro-2-500/10,000 (trifluoromethyl)- Benzotrichloride Benzyl chloride Benzyl cyanide beta-propiolactone Bicyclo[2.2.1]heptane-2-carbonitrile, 5-500/10,000 chloro-6-((((methylamino) carbonyl)oxy) imino)-,(1-alpha,2-beta,4-alpha,5- alpha,6e))- Bis(chloromethyl) ketone 10/10,000 Bitoscanate 500/10,000 Boron trifluoride compound with methyl 1, ether (1:1) Boron trichloride Boron trifluoride ,015 Bromadiolone 100/10,000 Bromine Cadmium stearate 1,000/10,000 Cadmium oxide 100/10,000 Calcium arsenate 500/10,000 Camphechlor 500/10,000 Cantharidin 100/10,000 Carbachol chloride 500/10,000 Carbamic acid, methyl-, O-(((2,4-dimethyl- 100/10,000 1,3-dithiolan-2-yl)methylene)amino)- Carbofuran 10/10,000 Chemical Name TPQ Pounds TPQ TPQ Cubic Ft Gallons Carbon disulfide 10, Carbophenothion Chlordane 1, Chlorfenvinfos Chlorine 100 3, Chlormephos Chlormequat chloride 100/10,000 Chloroacetic acid 100/10,000 Chloroethanol Chloroethyl chloroformate 1, Chloroform 10, Chloromethyl methyl ether Chloromethyl ether Chlorophacinone 100/10,000 Chloroxuron 500/10,000 Chlorthiophos Chromic chloride 1/10,000 Cobalt carbonyl 10/10,000 Cobalt, ((2,2'-(1,2-100/10,000 ethanediylbis(nitrilomethylidyne))bis(6- fluorophenylato))(2-)-n,n',o,o')- Colchicine 10/10,000 Coumaphos 100/10,000 Coumatetralyl 500/10,000 Crimidine 100/10,000 Crotonaldehyde 1, Crotonaldehyde, (E)- 1, Cyanogen bromide 500/10,000 Cyanogen iodide 1,000/10,000 Cyanophos 1, Cyanuric fluoride 100 Cycloheximide 100/10,000 Cyclohexylamine 10,000 1,386 Decaborane(14) 500/10,000 Demeton Demeton-S-methyl Dialifor 100/10,000 Diborane 100 1, Dichloroethyl ether 10, Dichloromethylphenylsilane 1, Dichlorvos 1, Dicrotophos Diepoxybutane Diethyl chlorophosphate Digitoxin 100/10,000 Diglycidyl ether 1, Digoxin 10/10,000 Dimefox Dimethoate 500/10,000 Dimethyl phosphoro- chloridothioate Dimethyl sulfate Dimethyl-p-phenylenediamine 10/10,000 Dimethyldichlorosilane Dimethylhydrazine 1, Dimetilan 500/10,000 Dinitrocresol 10/10,000 Dinoseb 100/10,000 Dinoterb 500/10,000 Dioxathion Diphacinone 10/10,000

31 Chemical Name TPQ Pounds TPQ TPQ Cubic Ft Gallons Diphosphoramide, octamethyl Disulfoton Dithiazanine iodide 500/10,000 Dithiobiuret 100/10,000 Emetine, dihydrochloride 100/10,000 Endosulfan 10/10,000 Endothion 500/10,000 Endrin 500/10,000 Epichlorohydrin 1, EPN 100/10,000 Ergocalciferol 1,000/10,000 Ergotamine tartrate 500/10,000 Ethanesulfonyl chloride, 2-chloro Ethanol, 1,2-dichloro-, acetate 1, Ethion 1, Ethoprophos 1, Ethylbis(2-chloroethyl) amine Ethylene fluorohydrin Ethylene oxide 1,000 19, Ethylenediamine 10,000 1,334 Ethyleneimine Ethylthiocyanate 10,000 1,190 Fenamiphos 10/10,000 Fensulfothion Fluenetil 100/10,000 Fluorine 500 5, Fluoroacetamide 100/10,000 Fluoroacetic acid 10/10,000 Fluoroacetyl chloride 10 Fluorouracil 500/10,000 Fonofos Formaldehyde cyanohydrin 1, Formaldehyde 500 7, Formetanate hydrochloride 500/10,000 Formothion Formparanate 100/10,000 Fosthietan Fuberidazole 100/10,000 Furan Gallium trichloride 500/10,000 Hexachlorocyclopentadiene Hexamethylenediamine, N,N'-dibutyl- 500 Hydrazine 1, Hydrocyanic acid 100 1, Hydrogen chloride (gas only) 500 8,461 Hydrogen selenide Hydrogen fluoride Hydrogen peroxide (Conc.> 52%) 1, Hydrogen sulfide 500 7,941 Hydroquinone 500/10,000 Iron, pentacarbonyl Isobenzan 100/10,000 Isobutyronitrile 1, Isocyanic acid, 3,4-dichlorophenyl ester 500/10,000 Isodrin 100/10,000 Isofluorphate Isophorone diisocyanate 500 Isopropyl chloroformate 1, Isopropylmethylpyrazolyl dimethylcarbamate Lactonitrile 1, Leptophos 500/10,000 Chemical Name TPQ Pounds 20 TPQ TPQ Cubic Ft Gallons Lewisite Lindane 1,000/10,000 Lithium hydride 100 Malononitrile 500/10,000 Manganese, tricarbonyl methylcyclopentadienyl Mechlorethamine Mephosfolan 500 Mercuric acetate 500/10,000 Mercuric oxide 500/10,000 Mercuric chloride 500/10,000 Methacrolein diacetate 1,000 Methacrylic anhydride 500 Methacrylonitrile Methacryloyl chloride Methacryloyloxyethyl isocyanate 100 Methamidophos 100/10,000 Methanesulfonyl fluoride 1,000 Methidathion 500/10,000 Methiocarb 500/10,000 Methomyl 500/10,000 Methoxyethylmercuric acetate 500/10,000 Methyl vinyl ketone Methyl hydrazine Methyl thiocyanate 10,000 1,122 Methyl isothiocyanate 500 Methyl chloroformate Methyl phenkapton 500 Methyl mercaptan Methyl 2-chloroacrylate Methyl phosphonic dichloride 100 Methyl bromide 1,000 43, Methyl isocyanate Methylmercuric dicyanamide 500/10,000 Methyltrichlorosilane Metolcarb 100/10,000 Mevinphos Mexacarbate 500/10,000 Mitomycin C 500/10,000 Monocrotophos 10/10,000 Muscimol 500/10,000 Mustard gas , Nickel carbonyl Nicotine sulfate 100/10,000 Nicotine Nitric acid 1, Nitric oxide 100 1,388 Nitrobenzene 10, Nitrocyclohexane Nitrogen dioxide 100 2, Nitrosodimethylamine 1, Norbormide 100/10,000 o-cresol 1,000/10,000 Organorhodium Complex (PMN ) 10/10,000 Ouabain 100/10,000 Oxamyl 100/10,000 Oxetane, 3,3-bis(chloromethyl) Oxydisulfoton 500 Ozone 100 2, Paraquat methosulfate 10/10,000 Paraquat dichloride 10/10,000 Parathion Parathion-methyl 100/10,000

32 21 Chemical Name TPQ Pounds TPQ TPQ Cubic Ft Gallons Paris green 500/10,000 Pentaborane Pentadecylamine 100/10,000 Peracetic acid Perchloromethyl mercaptan Phenol 500/10,000 Phenol, 3-(1-methylethyl)-, methylcarbamate 500/10,000 Phenol, 2,2'-thiobis[4-chloro-6-methyl- 100/10,000 Phenoxarsine, 10,10'-oxydi- 500/10,000 Phenyl dichloroarsine Phenylhydrazine hydrochloride 1,000/10,000 Phenylmercury acetate 500/10,000 Phenylsilatrane 100/10,000 Phenylthiourea 100/10,000 Phorate Phosacetim 100/10,000 Phosfolan 100/10,000 Phosgene Phosphamidon Phosphine 500 7, Phosphonothioic acid, methyl-, O-ethyl O- 500 (4-(methylthio)phenyl) ester Phosphonothioic acid, methyl-, S-(2-(bis( methylethyl)amino)ethyl) O-ethyl ester Phosphonothioic acid, methyl-, O-(4-500 nitrophenyl) O-phenyl ester Phosphoric acid, dimethyl 4-(methylthio) phenyl ester Phosphorothioic acid, O,O-dimethyl-5-( (methylthio)ethyl)ester Phosphorus oxychloride Phosphorus pentachloride 500 Phosphorus trichloride 1, Phosphorus 100 Physostigmine 100/10,000 Physostigmine, salicylate (1:1) 100/10,000 Picrotoxin 500/10,000 Piperidine 1, Pirimifos-ethyl 1, Potassium cyanide 100 Potassium arsenite 500/10,000 Potassium silver cyanide 500 Promecarb 500/10,000 Propargyl bromide Propionitrile Propionitrile, 3-chloro- 1, Propiophenone, 4'-amino 100/10,000 Propyl chloroformate Propylene oxide 10,000 1,395 Propyleneimine 10,000 1,490 Prothoate 100/10,000 Pyrene 1,000/10,000 Pyridine, 4-amino- 500/10,000 Pyridine, 2-methyl-5-vinyl Pyridine, 4-nitro-, 1-oxide 500/10,000 Pyriminil 100/10,000 Salcomine 500/10,000 Sarin Selenious acid 1,000/10,000 Selenium oxychloride Semicarbazide hydrochloride 1,000/10,000 Silane, (4-aminobutyl) diethoxymethyl- 1,000 Sodium selenate 100/10,000 Sodium arsenite 500/10,000 Chemical Name TPQ Pounds TPQ TPQ Cubic Ft Gallons Sodium fluoroacetate 10/10,000 Sodium cacodylate 100/10,000 Sodium cyanide (Na(CN)) 100 Sodium arsenate 1,000/10,000 Sodium selenite 100/10,000 Sodium azide (Na(N3)) 500 Sodium tellurite 500/10,000 Stannane, acetoxytriphenyl- 500/10,000 Strychnine 100/10,000 Strychnine, sulfate 100/10,000 Sulfotep Sulfoxide, 3-chloropropyl octyl 500 Sulfur trioxide 100 Sulfur dioxide , Sulfur tetrafluoride 100 4,711 6 Sulfuric acid 1, Tabun Tellurium hexafluoride Tepp Terbufos Tetraethyl lead Tetraethyltin Tetramethyllead Tetranitromethane Thallium sulfate 100/10,000 Thallous malonate 100/10,000 Thallous carbonate 100/10,000 Thallous chloride 100/10,000 Thallous sulfate 100/10,000 Thiocarbazide 1,000/10,000 Thiofanox 100/10,000 Thionazin 500 Thiophenol Thiosemicarbazide 100/10,000 Thiourea, (2-chlorophenyl)- 100/10,000 Thiourea, (2-methylphenyl)- 500/10,000 Titanium tetrachloride Toluene-2,6-diisocyanate Toluene-2,4-diisocyanate trans-1,4-dichlorobutene Triamiphos 500/10,000 Triazofos Trichloro(chloromethyl) silane 100 Trichloro(dichlorophenyl)silane Trichloroacetyl chloride Trichloroethylsilane Trichloronate Trichlorophenylsilane Triethoxysilane Trimethylchlorosilane 1, Trimethylolpropane phosphite 100/10,000 Trimethyltin chloride 500/10,000 Triphenyltin chloride 500/10,000 Tris(2-chloroethyl)amine Valinomycin 1,000/10,000 Vanadium pentoxide 100/10,000 Vinyl acetate monomer 1, Warfarin sodium 100/10,000 Warfarin 500/10,000 Xylylene dichloride 100/10,000 Zinc phosphide 500 Zinc, dichloro(4,4-dimethyl- 5((((methylamino)carbonyl)oxy)imino)pent anenitrile)-, (T-4)- 100/10,000

33 CLEAN AIR ACT (CAA) SECTION 112(r) SUBSTANCES 22 Chemical Name TQ Pounds TQ TQ Cubic Ft Gallons 1,1 Dichloroethylene 10, Butenal 20,000 6,849 Acetaldehyde 10,000 1,545 Acetylene 10, ,000 1,950 Acrolein 5, Acrylonitrile 20,000 3,012 Acrylylchloride 5,000 Allyl alcohol 15,000 2,126 Allylamine 10,000 1,798 Ammonia (anhydrous) 10, ,800 1,943 Ammonia (aqueous) Conc. >=20% 20,000 3,912 Arsenous trichloride 15, Arsine 1,000 5, Bis(chloromethyl)ether 1, Boron Trichloride 5,000 16, Boron Trifluoride 5,000 28, Boron Trifluoride w/methyl ether(1:1) 15,000 1,238 Bromine 10, Bromotrifluoroethylene 10,000 Butadiene (1,3-) 10,000 69,000 1,854 Butane 10,000 63,356 2,008 Butene 10,000 Butene (1-) 10,000 65, Butene (2-) 10,000 Butene-cis (2-) 10,000 65, Butene-trans (2-) 10,000 65, Carbon Disulfide 20,000 1,854 Carbon Oxysulfide (Carbonylsulfide) 10, , Chlorine 2,500 13, Chlorine Dioxide 1,000 4, Chlorine Monoxide 10,000 Chloroform 20,000 1,618 Chloromethyl ether 5, Chloropropylene (1-) 10,000 1,279 Chloropropylene (2-) 10,000 1,279 Crotonaldehyde 20,000 2,935 Crotonaldehyde, (E)- 20,000 2,802 Cyanogen 10, ,082 Cyanogen chloride 10, ,266 1,004 Cyclohexylamine 15,000 2,077 Cyclopropane 10, ,762 1,673 Diborane 2,500 35,125 Dichlorosilane 10, ,441 Difluoroethane 10,000 57, Dimethylamine 10,000 86,000 1,772 Dimethyldichlorosilane 5, Dimethylhydrazine (1,1-) 15,000 2,285 Dimethylpropane (2,2-) 10,000 78,875 Epichlorohydrin 20,000 2,037 Ethane 10, ,151 2,677 Ethyl acetylene 10,000 72,000 1,792 Ethylamine 10,000 1,754 Ethyl chloride 10,000 44,042 1,310 Ethyl ether 10,000 1,697 Ethyl mercaptan 10,000 1,431 Ethyl nitrate 10,000 1,268 Ethyl nitrite 10,000 1,333 Ethylene 10, ,000 2,114 Ethylenediamine 20,000 2,677 Ethyleneimine 10,000 1,448 Ethylene oxide 10,000 87,800 1,385 Explosives ( DOT 49 CFR ) 5,000 Fluorine 1,000 10, Formaldehyde (solution) 15,000 2,217 Furan 5, Hydrazine 15,000 1,800 Hydrochloric acid (soln.conc. >=37%) 15,000 1,689 Hydrocyanic acid (Hydrogen cyanide) 2, Hydrogen 10,000 1,920,000 16,886 Hydrogen chloride 5,000 53, Hydrogen fluoride/hydrofluoric acid 1,000 19, (conc.>=50%) Hydrogen selenide Chemical Name TQ Pounds TQ TQ Cubic Ft Gallons Hydrogen sulfide 10, ,920 1,017 Iron, Pentacarbonyl- 2, Isobutane 10,000 63,355 2,077 Isobutyronitrile 20,000 3,171 Isopentane 10,000 1,943 Isoprene 10,000 1,769 Isopropylamine 10,000 1,746 Isopropyl chloride 10,000 1,398 Isopropyl chloroformate 15,000 Methacrylonitrile 10,000 1,506 Methane 10, ,113 2,175 Methylamine 10, ,000 1,336 Methyl-1-butene (2-) 10,000 Methyl-1-butene (3-) 10,000 83, Methyl chloride 10,000 75,000 1,310 Methyl chloroformate 5, Methyl ether 10,000 88,217 1,823 Methyl formate 10,000 1,229 Methyl hydrazine 15,000 2,068 Methyl isocyanate 10,000 1,255 Methyl mercaptan 10, ,110 1,385 Methyl propene (2-) 10,000 80,076 2,000 Methyl thiocyanate 20,000 Methyl trichlorosilane 5, Nickel carbonyl 1, Nitric acid (Conc. EPA >=80%, OSHA >= 15,000 1, %) Nitric oxide 10, , Oleum (OSHA Conc.5 80%) 10,000 Pentadiene (1,3-) 10,000 1,828 Pentane 10,000 1,923 Pentene (1-) 10,000 1,883 Pentene (2-) (E)- 10,000 1,883 Pentene (2-) (Z)- 10,000 1,883 Peracetic acid/ Peroxyacetic acid (OSHA 10,000 1,048 Conc. >60% Acetic acid) Perchloromethyl-mercaptan 10, Phosgene 500 1, Phosphine 5,000 79, Phosphorus oxychloride (phosphoryl chloride) 5, Phosphorous trichloride 15,000 1,143 Piperidine 15,000 2,097 Propadiene 10,000 Propane 10,000 84,515 2,358 Propionitrile 10,000 1,545 Propyl chloroformate 15,000 Propylene 10,000 88,750 2,362 Propylene oxide 10,000 1,403 Propyleneimine (2-methyl aziridine) 10,000 1,506 Propyne 10,000 97,000 Silane 10, ,000 1,772 Sulfur dioxide (anhydrous) 5,000 29, Sulfur tetrafluoride 2,500 Sulfur trioxide (sulfuric anhydride) 10, Tetrafluoroethylene 10,000 Tetramethyllead 10, Tetramethylsilane 10,000 1,859 Tetranitromethane 10, Titanium tetrachloride 2, Toluene 2,4-diisocyanate 10, Toluene-2,6-diisocyanate 10, Toluene diisocyanate 10, Trichlorosilane 10,000 1,012 Trifluorochloroethylene 10, , Trimethylamine 10,000 64,000 1,812 Trimethylchlorosilane 10,000 1,401 Vinyl acetate monomer 15,000 1,407 Vinyl acetylene 10,000 91,647 1,939 Vinyl chloride 10,000 62,500 1,316 Vinyl ethyl ether 10,000 1,321 Vinyl fluoride 10,000 1,557 Vinyl methyl ether 10, ,095 1,600 Vinylidene fluoride 10,000 82,345 1,946

34 23 PROCESS SAFETY MANAGEMENT (PSM) SUBSTANCES hid 23 Chemical Name TQ TQ Pounds Cu. Ft. TQ Gallons acetaldehyde acrolein (2-propenal) acrylyl chloride 250 allyl chloride allylamine alkylaluminums 5000 ammonia, anhydrous ammonia solutions (>44%) ammonium perchlorate ammonium permanganate 7500 arsine (arsenic hydride) bis(chloromethyl) ether boron trichloride boron trifluoride bromine bromine chloride 1500 bromine pentafluoride bromine trifluoride bromopropyne (propargyl bromide) butyl hydroperoxide butyl perbenzoate, tertiary carbonyl chloride (phosgene) carbonyl fluoride cellulose nitrate (<12.6% nitrogen) 2500 chlorine chlorine dioxide chlorine pentafluoride 1000 chlorine trifluoride chlorodiethylaluminum (diethylaluminum chloro-2,4-dinitrobenzene chloromethyl methyl ether chloropicrin chloropicrin & methyl bromide mixture 1500 chloropicrin & methyl chloride mixture 1500 cumene hydroperoxide cyanogen cyanogen chloride cyanuric fluoride 100 diacetyl peroxide (>70%) 5000 diazomethane dibenzoyl peroxide diborane dibutyl peroxide, tertiary dichloro acetylene dichlorosilane diethylzinc diisopropyl peroxydicarbonate 7500 dilauroyl peroxide dimethyldichlorosilane ,1-dimethylhydrazine dimethylamine, anhydrous ,4-dinitroaniline ethyl methyl ketone peroxide (>60%) ethyl nitrite ethylamine ethylene fluorohydrin 100 ethylene oxide ethyleneimine fluorine formaldehyde (formalin) furan hexafluoracetone hydrochloric acid, anhydrous hydrofluoric acid, anhydrous hydrogen bromide hydrogen chloride hydrogen cyanide, anhydrous hydrogen fluoride Chemical Name TQ TQ Pounds Cu. Ft. TQ Gallons hydrogen peroxide, >52% by weight hydrogen selenide hydrogen sulfide hydroxylamine iron, pentacarbonyl isopropylamine ketene methacrylamide methacryloyl chloride 150 methacryloyloxyethyl isocyanate 100 methyl acrylonitrile methylamine, anhydrous methyl bromide methyl chloride methyl chloroformate methyl ethyl ketone peroxide, >60% methyl fluoroacetate 100 methyl fluorosulfate 100 methyl hydrazine methyl iodide methyl isocyanate methyl mercaptan methyl vinyl ketone methyltrichlorosilane nickel carbonyl (nickel tetracarbonyl) nitric acid, 94.5% nitric oxide nitroaniline (para-nitroaniline) nitromethane nitrogen dioxide nitrogen dioxides (NO, NO2, N2O4, N2O3) nitrogen tetroxide (nitrogen peroxide) nitrogen trifluoride nitrogen trioxide 250 oleum, 65% to 80% by weight (fuming osmium tetroxide oxygen difluoride (fluorine monoxide) ozone pentaborane peracetic acid, >60% acetic acid perchloric acid, >60% by weight perchloromethyl mercaptan perchloryl fluoride peroxyacetic acid, >60% acetic acid 1000 phosgene (carbonyl chloride) phosphine (hydrogen phosphide) phosphorus oxychloride (phosphoryl phosphorus trichloride propargyl bromide 100 propyl nitrate sarin selenium hexafluoride stibine (antimony hydride) sulfur dioxide (liquid) sulfur pentafluoride sulfur tetrafluoride sulfur trioxide (sulfuric anhydride) sulfuric anhydride (sulfur trioxide) 1000 tellurium hexafluoride tetrafluoroethylene 5000 tetrafluorohydrazine 5000 tetramethyl lead thionyl chloride trichloro (chloromethyl) silane trichloro (dichlorophenyl) silane 2500 trichlorosilane trifluorochloroethylene trimethoxysilane

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37 OREGON COMMUNITY RIGHT TO KNOW AND PROTECTION ACT Plain Language Improvements: Input from stakeholders helped to shape revisions White space added to make document easier to read Removed repetitious instructions and vague wording How to Identify and Report Hazardous Substances on the Hazardous Substance Information Survey Revised October 20, 2008 Mailing Address: Office of State Fire Marshal Community Right to Know Unit 4760 Portland Rd NE Salem, OR Website: For assistance call the Hazardous Substance Information Hotline (503) Toll Free (800) TDD (503) Monday Friday 8AM 12PM and 1PM 5PM After

38 Visit our website for more information: These documents are currently available from our website: Blank Section D Chemical Form Blank Section E Additional Storage Location Form Survey Request Form Gas Conversion Chart Survey Mailing Schedule

39 TABLE OF CONTENTS Introduction.. 1 Quick Steps to Complete the Survey. 1 Reporting Requirements... 2 What is a Hazardous Substance?... 3 What is a Reportable Quantity?.3 Reporting Compressed Gases.. 4 Liquefied and Cryogenic Gases... 4 Reporting Lead Acid Batteries.. 5 Tables for Completing the Survey... 6 Instructions and Definitions. 7 Reporting Storage Locations..11 Frequently Asked Questions.. 13 EHS, 112r, PSM Questions 14 EHS List (r) List...18 PSM List...19 Request Form for Unreported Sites...20

40 INTRODUCTION The Oregon Community Right to Know and Protection Act ORS In 1985, the Oregon Legislature passed the Community Right to Know and Protection Act. This law makes information about hazardous materials in Oregon available to emergency service personnel, emergency planners, health officials, and the general public. This law requires the Office of State Fire Marshal to annually conduct an annual Hazardous Substance Information Survey of Oregon facilities with the potential to possess hazardous substances. The Community Right to Know Unit administers and enforces the survey. Facilities in Oregon with reportable quantities of hazardous substances are required to annually report those substances on the survey. In addition, facilities that receive the survey for the first time are also required to complete and submit the survey. Facilities failing to complete and submit the survey as required are subject to civil penalties. A Hazardous Substance Possession Fee may be assessed based on the information provided. Thank You! The information you provide on the Hazardous Substance Information Survey is a very important part of our effort to enhance the safety of Oregonians from fire and hazardous materials. The information serves many purposes, including: Community protection Emergency pre-planning Response tool Responder safety Environmental health Quick Steps to Complete the Survey If this is the first time you are completing the survey for this site address and you determine there were no hazardous substances in a reportable quantity during the previous twelve months, complete sections A, B, and C. See pages 7 through 9 for instructions on completing sections A, B, and C. If this is the first time you are completing the survey for this site address and you determine that there was a hazardous substance at the site in a reportable quantity during the previous twelve months, complete sections A, B, C and D. Complete section E as needed. See pages 9 through 12 for instructions on completing sections D and E. If this is not the first time a survey has been completed for this site address, review all sections of the survey and update it as needed. See pages 7 thru 12 for instructions on completing sections A thru E. Return the completed and signed survey to the Office of State Fire Marshal and keep a copy at the site address for three years

41 REPORTING REQUIREMENTS 1. The survey must be completed correctly and submitted by the due date or it will be returned for correction and will not be considered received by OSFM. 2. A copy of the survey must be kept at the site address listed on the survey for three (3) years. Exception: Records for facilities and/or remote sites, where the covered employer, owner or operator is not set up to maintain such records, may be maintained at another facility within the state. 3. Facilities must maintain complete and accurate records of each hazardous substance they manufacture, generate, use, store, possess, or dispose of. 4. A separate survey must be submitted for each site address in Oregon unless otherwise notified by the Office of State Fire Marshal. If you have a site address that is not already receiving a survey, complete and return the Request Form for Unreported Sites included in the back of this booklet. 5. If the facility has been sold, return the survey to our office with a letter that includes the date it was sold and the contact information for the new owner. 6. If the facility is no longer doing business in Oregon, send a letter identifying when the facility ceased operations. Include the facility ID number, a contact name and phone number. 7. Under-reporting substance amounts, or failing to report, could subject your facility to citation and monetary penalties. Reporting Substantive Changes If a substantive change occurs at the facility during the year, you must notify OSFM within 30 days. Substantive changes include: 1. A change of site address or mailing address. 2. A change of the emergency contact person. 3. A change of any phone number. 4. A change of ownership or business name. 5. Introduction of new substances to the site in reportable quantities not previously reported. 6. An increase of a substance already reported that changes the Maximum Amount code. 7. A previously reported substance that is moved to another building, another floor level, or 300 feet or more from its originally reported location. To report a substantive change, update the facility s copy of the survey and write update at the top. Make a new copy for the facility s records and mail the updated survey to the Office of State Fire Marshal

42 What is a Hazardous Substance? REPORTING REQUIREMENTS A substance is considered hazardous by the Office of State Fire Marshal if the manufacturer is required by Oregon-OSHA to produce a Material Safety Data Sheet. This includes substances shipped to the site, produced at the site, waste substances, and solutions. What is a Reportable Quantity? If the maximum amount of a hazardous substance at the site meets or exceeds the reportable quantities listed below at any time during the survey period (the previous twelve months), it must be reported. Liquids: 50 gallons or more Solids: 500 pounds or more Gases: 200 cubic feet or more (at atmospheric pressure and temperature) Poisons and Explosives Liquids: 5 gallons or more Solids: 10 pounds or more Gases: 20 cubic feet or more As defined by the U.S. Department of Transportation in 49 CFR Part 173. (e.g. gasoline, oils, acetone, paint, cleaners, solutions, etc.) (e.g. batteries, metal ingots, fertilizer, etc.) (e.g. acetylene, oxygen, propane, etc.) Exceptions to the General Reportable Quantities: EPA Extremely Hazardous Substances Currently Not Reportable (not all-inclusive) ABS Pipe Acrylic Sheets Alcoholic Beverages Metal Pipe Metal Rods Metal Sheets Plastic Pipe Plastic Tubing Polyethylene Products (finished form) Polystyrene Filler Material Polyurethane (foamfinished products) PVC Pipe Tires Transformers Vinyl Film and Sheeting Radioactive Substances Any quantity of a radioactive substance or radioactive waste must be reported. Exception: Sealed source radioactive materials as defined by OAR (118) are not required to be reported. Extremely Hazardous Substances (EHS) that meet or exceed their Threshold Planning Quantity (TPQ) must be reported at the TPQ listed on page 17, or the amounts listed on this page, whichever is lower. For more information, see the EHS list and the TPQ s on page 17, or call the Hazardous Substance Information Hotline

43 REPORTING REQUIREMENTS Reporting Compressed Gases The reportable quantity for gases, in either liquid or vapor state is 200 cubic feet or more at atmospheric pressure and temperature. Liquefied and Cryogenic Gases Liquefied and cryogenic gases are gases received and maintained as liquids through the use of pressure and/or temperature. Liquefied and cryogenic gases are in a reportable quantity if they are present at 200 cubic feet or more. If a reportable quantity is reached, liquefied and cryogenic gases must be reported in gallons. If unsure of the conversion, call your gas supplier for assistance. Some examples of liquefied gases and cryogenic gases include, but are not limited to: Anhydrous Ammonia Carbon Dioxide Chlorine Refrigeration gases Nitrogen, cryogenic Propane Reporting Oxygen Oxygen should be reported in one of the following ways: Oxygen: stored in a compressed vapor state, used mostly for welding purposes Oxygen Liquid: stored in a liquefied state in cryogenic conditions Oxygen Medical: used for medical purposes (does not include liquid oxygen) Note: Report Self-Contained Breathing Apparatus (SCBA) as Breathing Air. Anhydrous Ammonia When reporting Anhydrous Ammonia, the contents of the entire distribution system must be considered. This includes the piping system and all holding tanks or storage tanks. Reporting Exception for Gases Gases intended for human/animal ingestion or direct inhalation, or added to a product, are exempt from reporting if ALL of the following apply: The gas is present at the site where human/animal ingestion or inhalation occurs. The gas is not being used in a manufacturing process. The gas is not cryogenic. The gas is not being stored at the site in excess of 1,000 cubic feet

44 Reporting Lead Acid Batteries REPORTING REQUIREMENTS The reportable quantity of lead acid batteries is determined by the total weight of the batteries, including the electrolyte if applicable. They are subject to the general reporting quantity of 500 pounds. NOTE: Batteries in electric-powered forklift trucks must be reported. Batteries used in over-the-road motor vehicles are not reportable. Dry cell batteries, such as those used in flashlights, portable radios, cell phones and pagers are not reportable. 1. The Common Name/Trade Name for lead acid batteries should be reported in one of the following categories: Lead Acid Batteries Dry Dry lead acid batteries must be reported as Lead Acid Batteries Dry. Dry batteries are those that are newly made and have not been filled with electrolyte (usually a sulfuric acid solution). If the batteries are shipped off site dry, report them as Lead Acid Batteries dry. Lead Acid Batteries Wet Wet lead acid batteries must be reported as Lead Acid Batteries-Wet. Wet lead acid batteries are those that have been filled with electrolyte and are ready for use. If batteries are shipped off site wet, report them as Lead Acid Batteries Wet. Lead Acid Batteries Gel Gel lead acid batteries must be reported as Lead Acid Batteries-Gel. Gel batteries are a type of sealed lead acid battery. Used Lead Acid Batteries Used lead acid batteries must be reported as Used Lead Acid Batteries-Wet. Used lead acid batteries are those that are dead, but can be recharged and/or sold as used batteries. Waste Lead Acid Batteries Waste lead acid batteries must be reported as Waste Lead Acid Batteries. Waste lead acid gel batteries must be reported as Waste Lead Acid Batteries-Gel. Waste lead acid batteries are those that are dead and will no longer hold a charge. 2. The Hazardous Ingredient in Highest Concentration (HIHC) will be reported as follows: For Lead Acid Batteries Dry HIHC will be Lead For Lead Acid Batteries Wet HIHC will be Sulfuric Acid For Lead Acid Batteries Gel HIHC will be Sulfuric Acid For Lead Acid Batteries Used and Waste HIHC will be Sulfuric Acid 3. The Physical State of lead acid batteries will be reported as a solid. 4. The Unit of Measure of lead acid batteries will be reported in pounds

45 TABLES FOR COMPLETING THE SURVEY A Hazardous Substance Possession Fee may be assessed based on information provided on the survey. It is important that you accurately report the Hazardous Ingredientand the Maximum Amount of each hazardous substance possessed. Over-reporting may result in a higher than required fee. Under-reporting or failing to report may result in a citation and monetary penalties. TABLE I PHYSICAL STATE TABLE III REPORTING QUANTITIES AND CODES Code From To ,000 4, ,000 9, ,000 49, ,000 99, , , , , , , , , ,000,000 2,499, ,500,000 4,999, ,000,000 7,499, ,5000,000 9,999, ,000,000 24,999, ,000,000 49,999, ,000,000 74,999, ,000,000 99,999, ,000, ,999, ,000, ,999, ,000, ,999, ,000, ,999, Billion TABLE II UNIT OF MEASURE Code State Code Units 1 Solid 1 Pounds 2 Liquid 2 Gallons 3 Gas 3 Cubic Feet 4 Millicuries Higher than 1 Billion TABLE IV STORAGE CODES Code Type of Storage Code Type of Storage A Aboveground tank K Box B Underground tank L Cylinder C Tank inside building M Glass bottles, jugs or buckets D Steel Drum N Plastic bottles, jugs or buckets E Plastic or non-metallic drum O Totebin F Can P Tank wagon G Carboy Q Railcar H Silo R Other I Fiber drum S Dewar J Bag IMPORTANT! Solids must be reported in pounds Liquids must be reported in gallons Gases must be reported in cubic feet, except liquefied gases which must be reported in gallons Radioactive substances must be reported in millicuries OAR (3) TABLE V STORAGE CONDITION CODES Code Storage Condition PRESSURE 1 Normal pressure 2 Greater than normal pressure 3 Less than normal pressure 4 Normal temperature TEMPERATURE 5 Greater than normal temperature 6 Less than normal temperature, not cryogenic 7 Cryogenic conditions TABLE VI HAZARD CLASSIFICATION CODES Code Class Code Class 1.1 Class A Explosives 4.3 Dangerous When Wet 1.2 Class B Explosives 4.4 Reactive Materials 1.3 Class C Explosives 4.5 Combustible 1.4 Blasting Agents 5.1 Oxidizers 1.5 Insensitive Explosives 5.2 Organic Peroxides 2.1 Flammable Gases 6.1 Poisonous Materials 2.2 Nonflammable Gases 6.2 Etiologic Materials 2.3 Poison Gases 6.3 Acute Health Hazard 3.1 Flammable Liq. (FP less than 0 o F) 6.4 Chronic Health Hazard 3.2 Flammable Liq. (FP between 0 o F & 73 o F) 6.5 Pesticide 3.3 Flammable Liq. (FP between 73 o F & 7.3 Radioactive Materials 4.1 Flammable Solids 8.0 Corrosives 4.2 Spontaneously Combustible Materials 9.0 Misc. Hazardous Materials - 6 -

46 General Instructions INSTRUCTIONS AND DEFINITIONS 1. All portions of the survey must be typed or printed in black or blue ink. 2. Only official survey forms provided by the Office of State Fire Marshal will be accepted. 3. Surveys must be complete and accurate or they will be returned for correction and not considered received. 4. Review each field for accuracy and provide updated information as necessary. For updates, cross out incorrect information and enter the correct information in the gray shaded area. 5. If you have other sites in Oregon that are not receiving a survey and you have not notified our office, complete the Request Form for Unreported Sites on page 20 of this booklet. The following instructions are organized by survey section and numbered to match the survey questions. Section A Instructions 1. Reportable Quantities Present? Indicate whether or not your facility had hazardous substances in reportable quantities during the survey period. A hazardous substance is any substance for which OR- OSHA requires the manufacturer to produce a Material Safety Data Sheet (MSDS). If you answer Yes, Section D must be completed. To remove previously reported substances that are no longer reportable, check the No Longer Reportable box in Section D. 2. Extremely Hazardous Substance Requirements? Indicate whether or not the facility was subject to the Extremely Hazardous Substance (EHS) requirements of the Emergency Planning and Community Right to Know Act (EPCRA) during the survey period. A facility is subject to EHS requirements if it has a substance found on the EHS list, or it has a substance with an ingredient that is found on the EHS list, and the total amount of the EHS at the site meets or exceeds the Threshold Planning Quantity (TPQ) indicated on the list. 3. Clean Air Act 112(r ) Requirements? Indicate whether or not the facility was subject to the requirements of Section 112(r) of the Clean Air Act (CAA). A facility is subject to the 112(r ) requirements if it has a substance found on the 112(r ) list, or it has a substance with an ingredient found on the list, and the total amount of the substance meets or exceeds the Threshold Quantity (TQ) indicated on the list. NOTE: There are certain exemptions. Review the CAA 112(r) section for more information. 4. Process Safety Management Requirements? Indicate whether or not the facility was subject to the notification requirements of OR-OSHA s Process Safety Management (PSM) Program. Refer to the section on the PSM program. If the facility (1) has a substance on the PSM list or a substance that contains an ingredient on the PSM list, and the total amount of the substance meets or exceeds the Threshold Quantity (TQ), or (2) the facility uses a flammable liquid or gas in a quantity of 10,000 pounds or more, it is subject to the PSM requirements. NOTE: There are certain exemptions. Review the PSM section for more information

47 Section B Instructions INSTRUCTIONS AND DEFINITIONS 1. NAICS Code 1 - (North American Industry Classification System Code) - List the six-digit number that corresponds to the business activity at the site. If you are unsure of your code, you can obtain information at 2. NAICS Code 2 - List the six-digit number that corresponds to any other type of business activity at your facility, if applicable. 3. Business Activity - Describe the type of business occurring at the site address (e.g., logging, landscaping, silicon chip manufacturing, sawmill, welding shop, automotive repair shop, gas station, office, etc). If the site is a home office, indicate the type of business the office is for (e.g., home office for excavation business). 4. Business Name The name the business is known by, operates as, or is doing business as (DBA). 5. Dept. or Div. - Department or Division if applicable. This field may also be used to list a parent company, if applicable. 6. Owner/CEO/Reg Agent - The name of the person who is the highest ranking official for the entity (e.g., owner, chief executive officer, registered agent, director, or president). 7. Send to Attention of - The name or position title the survey and related information should be sent to. 8. Address The address of the person at the site who should receive the survey. If there is no address, enter NONE. Do not enter web sites. 9. Site Address - The facility s business location in Oregon, including street number, street name, city, county, and zip code. A facility may have more than one site. Each site is separate if it has a different address. A separate survey must be completed for each site. 10. Mailing Address The address to where all survey-related correspondence from OSFM will be sent. 11. Business Phone The telephone number used to contact the site location during business hours. 12. Dun & Bradstreet # - A nine-digit number acquired by registering with the Dun & Bradstreet Corporation. The number provides a way to identify and track businesses. 13. Number of Employees at this Site - Number of persons employed by your business at this site only. 14. Emergency Assistance Contact Person The person able to provide information to emergency responders concerning hazardous substances at this site. 15. Emergency Contact Phones The day and night phone numbers for the emergency assistance contact person. 16. Responsible Fire Department - Name of the fire department that would respond to an emergency at the site. 17. Written Emergency Plan? - Indicate whether the facility has a written emergency plan. If so, enter the location of the plan

48 INSTRUCTIONS AND DEFINITIONS 18. Automatic Fire Suppression? - Indicate whether the facility has an automatic sprinkler system or other automatic fire suppression system. 19. Are Buildings/Tanks/Areas Placarded According to NFPA 704? Indicate whether any storage buildings, tanks or areas at the site are placarded according to NFPA 704. If you have questions, contact your local fire department or the Office of State Fire Marshal. 20. Other Placarding? Indicate whether labels or placards (other than NFPA 704) are used to identify hazardous substances at the site. Section C Instructions NFPA Placard 1. Print Name The printed name of the person completing the survey. 2. Signature The signature of the person completing the survey. 3. Date - The date the survey was completed. 4. Phone Number - Enter the area code and phone number of the person completing the survey. Section D Instructions Common Name/Trade Name - Enter the name of the hazardous substance listed on the Material Safety Data Sheet (MSDS), container, package, or tank that the substance came in. NOTE: Report a substance name only once on the survey even if it is stored in several different locations at the facility. The survey will be returned if duplicate entries of substance names are entered. Hazardous Ingredient - Enter the name of the ingredient, other than water, present in the substance in highest concentration. See the Material Safety Data Sheet or contact your supplier for assistance. No Longer Reportable - Check this box if the substance is no longer reportable. A substance cannot be removed from the survey unless it has been present in an amount less than a reportable quantity for more than 12 months. Extremely Hazardous Substance (EHS) - If the substance is on the EHS list, or contains an ingredient on the EHS list, mark this box. The EHS list is provided on page 15 of the instruction booklet. 112(r) - If the substance is on the 112(r) list, or contains an ingredient on the 112(r) list, mark this box. A list of 112(r) substances is provided on page 18 of this instruction booklet. Process Safety Management (PSM) - If the substance is on the PSM list, or contains an ingredient on the PSM list, mark this box. A list of PSM substances is provided on page 19 of this instruction booklet. Pure or Mixture Determine whether the substance is pure or a mixture. Pure substances have only one component; e.g., oxygen or acetone. Mixtures contain two or more different components mixed together; e.g., paint or gasoline. Enter 1 for a pure substance or 2 for a mixture. See the Material Safety Data Sheet or contact your supplier for assistance. Physical State - Enter the code number that represents the physical state of the substance as it would be if released into the atmosphere (see Table I on page 6 for code values)

49 INSTRUCTIONS AND DEFINITIONS Unit of Measure - Enter the code number that represents the applicable unit of measure for this substance (see Table II on page 6 for code values). NOTE: Report solids in pounds, liquids in gallons, gases in cubic feet, radioactives in millicuries, and liquefied and cryogenic gases in gallons. Average Amount - Enter the two-digit code for the average amount possessed during the previous 12 months (see Table III on page 6 for code values). This amount cannot be greater than the maximum amount code. Maximum Amount - Enter the two-digit code for the maximum amount possessed at one time during the previous 12 months (see Table III on page 6 for code values). The Max Amt code must be equal to, or larger than, the Avg Amt code, and the Loc Max code. The Max Amt code must be reviewed and provided for each reportable substance. Amount In - Enter the two-digit code for the total amount of the substance transported to the facility during the previous 12 months (see Table III on page 6 for code values). NOTE: If no amounts were transported to the facility, place 00 in the box. Amount Out - Enter the two-digit code for the amount of the substance transported off the site in its original form during the previous 12 months (see Table III on page 6 for code values). NOTE: If no amounts were transported from the facility, place 00 in the box. (Amount Out does not include accidental and/or intentional releases of the fuel, gas, oil, etc., used in the facility vehicles or other substances consumed at the site). Number of Days on Site - Enter the actual number of days the substance was on site during the previous 12 months. Storage Codes - Enter the code that describes the type of storage container and conditions of storage for the substance (e.g., C 1 4). NOTE: More than one storage code may apply (see Table IV and V on page 6 for code values). Hazard Classes - Enter all applicable hazard classes that apply to this substance (see Table VI on page 6 for code values). Use U.S. Department of Transportation Emergency Response Guides or Material Safety Data Sheets for reference. More than one hazard class may apply. CAS NUMBER - Enter the Chemical Abstract Service (CAS) number (if known) for the ingredient in highest concentration. Material Safety Data Sheets can be used for reference. UN/NA NUMBER - Enter the United Nations/North America 4 digit classification number (if known). Material Safety Data Sheets can be used for reference. EPA Pesticide Registration Number - If the substance reported is a pesticide, enter the EPA Pesticide Registration Number located on the pesticide label. Storage Locations - All storage locations with a reportable quantity of a substance must be reported in a location field on Section D, along with the Loc Max code for that location. Section D allows up to three individual storage locations for each substance listed. Use Section E to report additional storage locations. See the section titled Reporting Storage Locations for detailed instruction. Section E Instructions If more space is needed to report substance locations than is available under Section D, complete Section E, including all required information as instructed under Section D Storage Locations

50 Important Points REPORTING STORAGE LOCATIONS Storage locations for substances are reported on Section D, and if applicable, Section E of the survey. Each location at the facility where the substance is stored in a reportable quantity must be listed as a separate storage location on Section D of the survey. If the facility does not have a reportable quantity in a single location, but the total amount stored throughout the facility equals a reportable quantity, the storage location should be entered with Various in the Building field, V in the Quadrant field, and the correct Loc Max code number (see Table III on page 6) for the amount of the substance stored throughout the facility. At least one location must be entered for each substance reported in Section D. Do not list the same location more than once, even if the substance is in various containers. All required storage location fields must be completed or the survey will be returned. Loc Max codes cannot be greater than the Max Amt Code. If there are more locations with reportable quantities than space allows, enter the additional locations on the Section E form provided in the survey packet. If a pre-printed storage location is no longer applicable, check the delete box next to the location to be removed. NOTE: This will not remove the substance from the survey. To remove a substance from the survey that has been below a reportable quantity for more than twelve months, check the No Longer Reportable box immediately to the left of the Physical State Box for that substance. Reporting Substances Stored Inside a Building In/Out Building Floor Area Room Quadrant Loc Max Enter I to indicate the substance is located inside a building. NA is not acceptable. Enter the building name, number, or other identifier (except a site address) used to describe the building where the substance is stored. If there is only one building at the site, enter Main. Examples: Building 1, Building A, Warehouse, Fuel Shed, Equipment Shed, or Main. Enter the floor number on which the substance is located. If the building is a single story, enter 1. If the substance is located in a basement, enter BSMT. Enter the area of the building where the substance is located. If no area designation can been made, enter NA. Examples: Shipping Dock, Welding Area, Framing Area, Receiving Area. Enter the room the substance is located in. If the building has only one room, enter NA. Examples: Room 3, Parts Room, Storage Room, Tool Room. NA is not acceptable. Enter the quadrant of the last field specified (building, area, or room) where the substance is stored. Options: N, S, E, W, NE, NW, SE, SW, C (center), V (various) Enter the code number for the maximum amount of the substance stored at this location. Refer to Table III to obtain the Loc Max code. Reminder: The Loc Max code cannot be greater than the Max Amt code

51 REPORTING STORAGE LOCATIONS Reporting Substances Stored Outside a Building In/Out Building Floor Area Room Quadrant Loc Max Enter O to indicate the substance is stored outside. Enter the building name, number, or other identifier (except site address) to describe the building closest to where the substance is stored. If there are no buildings at the site, enter NA. Examples: Building 1, Building A, Fuel Shed. Leave Blank. Enter the area where the substance is located. If no area designation can be made, enter NA. Examples: Fueling, Drum Storage, Fenced Yard, Parking Lot. Enter NA. NA is not acceptable. Enter the quadrant for the last field specified (building or area) where the substance is stored. Options: N, S, E, W, NE, NW, SE, SW, C (center), V (various) Enter the code number for the maximum amount of the substance stored at this location. Refer to Table III to obtain the Loc Max code. Reminder: The Loc Max code cannot be greater than the Max Amt code. Section D Example A facility has a 500 gallon aboveground tank they fill with unleaded gasoline nine times a year. The tank is located outside of Building A next to the north wall. The facility also has a supply of unleaded gasoline stored in 10 five-gallon cans located in the southwest corner of a room labeled Flammables in the Parts area of the machine shop. The gasoline is used to fuel machinery located at the facility. Gasoline Unleaded Petroleum Hydrocarbons A 1 4 F O Building A N/A N/A N/A N 11 I Machine Shop 1 Parts Flammables SW

52 FREQUENTLY ASKED QUESTIONS 1. How do I report hazardous substances stored at my retail operation? Retail operations are not required to report substances located in the retail sales area. This is generally defined as an area freely accessible to the public. Items stored there are intended to be handled and purchased by customers. However, substances stored or maintained in a back room or warehouse area are not considered to be in a retail area and must be reported if the total amount is in a reportable quantity. 2. Do I have to report all the different colors of paint separately? No. Paint should be reported in two categories, paints-water based and paints-oil based. Note: This does not apply to two-component or highly toxic paints, which must be reported separately. 3. Do I have to report all types of motor oil separately? No. Motor oils should be combined if the only major difference is viscosity (weight). Waste Motor Oil and Used Motor Oil are different and should be reported separately. 4. What is considered a waste product and how are they to be reported? Waste products are those considered to be spent material, sludge, scrap, or otherwise designated as such by the Department of Environmental Quality. To report these products, begin the name with the word waste, and then the common name of the substance; e.g., Waste Acetone, Waste Motor Oil, Waste Solvent 350B, Waste 1,1,1-trichloroethane. 5. How do I report ammunition and fireworks? The powder content of the ammunition and the accelerant portion of the fireworks are reportable. (Ten pounds of powder or accelerant is a reportable quantity.) The lead projectile, brass casing, paper, cardboard, wood, plastic and metal portions are not reportable. Explosives Definition: A hazardous substance classified as an explosive (class A, B or C) by the U.S. Department of Transportation. 6. Do I have to report the fuel and batteries that are in my vehicles? No. Fuel, engine lubricant, engine coolants and batteries in motorized vehicles are not reportable. 7. How do I request trade secret protection? A request for trade secret protection must be made when the survey is submitted to the Office of State Fire Marshal. Only the name of the hazardous substance may be protected. If you request trade secret protection, instead of entering the name of the hazardous substance, enter its hazardous classification code. Example: For ACETONE enter 3.1, which is the code for flammable liquids. You must separately request, in writing, trade secret protection for the substance, otherwise protection will not be granted. 8. How do I report substations? If you operate substations that are of the same type (e.g. Electrical Relay, Sewage/Storm Pump Station, Telephone Relay, etc.), you may report all of them on a single combined survey instead of reporting each location separately. However if you do this, specific requirements must be met. For more information, call the Hazardous Substance Information Hotline at and request the information packet for reporting substations on a single combined survey. NOTE: Source generation sites must be reported separately. A source generation site is a facility that generates what is relayed, pumped, or stored by substations. Examples include a facility that generates electricity, or a wastewater treatment plant

53 EHS, 112R, PSM QUESTIONS The following three lists are intended to help facilities complete the Oregon Hazardous Substance Information Survey. Sections A & D of the survey have questions that refer to these lists. Use information on the lists to correctly answer questions on the survey. IMPORTANT: These lists are not intended to represent a complete list of substances subject to reporting on the survey. They are a reference to assist with answering certain questions on the survey. To determine if a substance is reportable, refer to the Reporting Requirements section in this booklet. Extremely Hazardous Substances (EHS) These substances are regulated by the Environmental Protection Agency (EPA) under the Emergency Planning and Community Right to Know Act (EPCRA). Facilities that possess a Threshold Planning Quantity (TPQ) of an EHS are subject to federal emergency planning requirements. TPQ s are calculated based on the total amount at the facility at one time. In Section A - Question 2 of the Hazardous Substance Information Survey, facilities are asked to identify whether or not they are subject to these requirements (i.e., they possess a TPQ of an EHS). In Section D, facilities are asked to identify whether a reported substance is, or contains an ingredient that is, on the EHS list. For More Info: EPA RCRA/Superfund/EPCRA Hotline: (800) (M F, 10 a.m. 3 p.m. ET) EPA s EPCRA website: Clean Air Act (CAA) Section 112r This section of the Clean Air Act requires facilities that produce, handle, process, distribute, or store certain chemicals to develop a Risk Management Program, prepare a Risk Management Plan (RMP), and submit the RMP to the EPA. Facilities are subject to this requirement if they possess a Threshold Quantity (TQ) of a substance found on the 112r list. In Section A Question 3 of the Hazardous Substance Information Survey, facilities are asked to identify if they are subject to these requirements. For More Info: EPA RCRA/Superfund/EPCRA Hotline: (800) (M F, 10 a.m. 3 p.m. ET) EPA s EPCRA website: Process Safety Management (PSM) Oregon OSHA administers and enforces OAR , Process Safety Management (PSM). This standard applies to facilities using certain listed chemicals at or above a given quantity. Facilities are subject to the PSM requirements if they (1) use a flammable liquid or gas in a quantity of 10,000 pounds or more, or (2) have a substance on site that meets or exceeds the Threshold Quantity (TQ) on the PSM list. In Section A Question 4 of the Hazardous Substance Information Survey, facilities are asked to identify if they are subject to these requirements. For More Info: OR-OSHA Technical Section: (503) or (800) Oregon OSHA web page: Federal OSHA web page:

54 EXTREMELY HAZARDOUS SUBSTANCE LIST Chemical Name TPQ TPQ TPQ Pounds Cubic Ft Gallons Acetone cyanohydrin 1, Acetone thiosemicarbazide 1,000/10,000 Acrolein Acrylamide 1,000/10,000 Acrylonitrile 10,000 1,497 Acrylyl chloride Adiponitrile 1, Aldicarb 100/10,000 Aldrin 500/10,000 Allyl alcohol 1, Allylamine Aluminum phosphide 500 Aminopterin 500/10,000 Amiton oxalate 100/10,000 Amiton 500 Ammonia 500 4, Amphetamine 1, Aniline 1, Aniline, 2,4,6-trimethyl Antimony pentafluoride Antimycin A 1,000/10,000 Antu 500/10,000 Arsenic pentoxide 100/10,000 Arsenous oxide 100/10,000 Arsenous trichloride Arsine 100 3,550 Azinphos-ethyl 100/10,000 Azinphos-methyl 10/10,000 Benzal chloride Benzenamine, 3-(trifluoromethyl) Benzene, 1-(chloromethyl)-4-nitro- 500/10,000 Benzenearsonic acid 10/10,000 Benzimidazole, 4,5-dichloro-2-500/10,000 (trifluoromethyl)- Benzotrichloride Benzyl chloride Benzyl cyanide beta-propiolactone Bicyclo[2.2.1]heptane-2-carbonitrile, 5-500/10,000 chloro-6-((((methylamino) carbonyl)oxy) imino)-,(1-alpha,2-beta,4-alpha,5- alpha,6e))- Bis(chloromethyl) ketone 10/10,000 Bitoscanate 500/10,000 Boron trifluoride compound with methyl 1, ether (1:1) Boron trichloride Boron trifluoride ,015 Bromadiolone 100/10,000 Bromine Cadmium stearate 1,000/10,000 Cadmium oxide 100/10,000 Calcium arsenate 500/10,000 Camphechlor 500/10,000 Cantharidin 100/10,000 Carbachol chloride 500/10,000 Carbamic acid, methyl-, O-(((2,4-dimethyl- 1,3-dithiolan-2-yl)methylene)amino)- 100/10,000 Carbofuran 10/10,000 Carbon disulfide 10, Carbophenothion Chlordane 1, Chlorfenvinfos Chemical Name TPQ TPQ TPQ Pounds Cubic Ft Gallons Chlorine 100 3, Chlormephos Chlormequat chloride 100/10,000 Chloroacetic acid 100/10,000 Chloroethanol Chloroethyl chloroformate 1, Chloroform 10, Chloromethyl methyl ether Chloromethyl ether Chlorophacinone 100/10,000 Chloroxuron 500/10,000 Chlorthiophos Chromic chloride 1/10,000 Cobalt carbonyl 10/10,000 Cobalt, ((2,2'-(1,2-100/10,000 ethanediylbis(nitrilomethylidyne))bis(6- fluorophenylato))(2-)-n,n',o,o')- Colchicine 10/10,000 Coumaphos 100/10,000 Coumatetralyl 500/10,000 Crimidine 100/10,000 Crotonaldehyde 1, Crotonaldehyde, (E)- 1, Cyanogen bromide 500/10,000 Cyanogen iodide 1,000/10,000 Cyanophos 1, Cyanuric fluoride 100 Cycloheximide 100/10,000 Cyclohexylamine 10,000 1,386 Decaborane(14) 500/10,000 Demeton Demeton-S-methyl Dialifor 100/10,000 Diborane 100 1, Dichloroethyl ether 10, Dichloromethylphenylsilane 1, Dichlorvos 1, Dicrotophos Diepoxybutane Diethyl chlorophosphate Digitoxin 100/10,000 Diglycidyl ether 1, Digoxin 10/10,000 Dimefox Dimethoate 500/10,000 Dimethyl phosphoro- chloridothioate Dimethyl sulfate Dimethyl-p-phenylenediamine 10/10,000 Dimethyldichlorosilane Dimethylhydrazine 1, Dimetilan 500/10,000 Dinitrocresol 10/10,000 Dinoseb 100/10,000 Dinoterb 500/10,000 Dioxathion Diphacinone 10/10,000 Diphosphoramide, octamethyl Disulfoton Dithiazanine iodide 500/10,000 Dithiobiuret 100/10,000 Emetine, dihydrochloride 100/10,000 Endosulfan 10/10,000 Endothion 500/10,000 Endrin 500/10,000

55 EXTREMELY HAZARDOUS SUBSTANCE LIST Chemical Name TPQ TPQ TPQ Pounds Cubic Ft Gallons Epichlorohydrin 1, EPN 100/10,000 Ergocalciferol 1,000/10,000 Ergotamine tartrate 500/10,000 Ethanesulfonyl chloride, 2-chloro Ethanol, 1,2-dichloro-, acetate 1, Ethion 1, Ethoprophos 1, Ethylbis(2-chloroethyl) amine Ethylene fluorohydrin Ethylene oxide 1,000 19, Ethylenediamine 10,000 1,334 Ethyleneimine Ethylthiocyanate 10,000 1,190 Fenamiphos 10/10,000 Fensulfothion Fluenetil 100/10,000 Fluorine 500 5, Fluoroacetamide 100/10,000 Fluoroacetic acid 10/10,000 Fluoroacetyl chloride 10 Fluorouracil 500/10,000 Fonofos Formaldehyde cyanohydrin 1, Formaldehyde 500 7, Formetanate hydrochloride 500/10,000 Formothion Formparanate 100/10,000 Fosthietan Fuberidazole 100/10,000 Furan Gallium trichloride 500/10,000 Hexachlorocyclopentadiene Hexamethylenediamine, N,N'-dibutyl- 500 Hydrazine 1, Hydrocyanic acid 100 1, Hydrogen chloride (gas only) 500 8,461 Hydrogen selenide Hydrogen fluoride Hydrogen peroxide (Conc.> 52%) 1, Hydrogen sulfide 500 7,941 Hydroquinone 500/10,000 Iron, pentacarbonyl Isobenzan 100/10,000 Isobutyronitrile 1, Isocyanic acid, 3,4-dichlorophenyl ester 500/10,000 Isodrin 100/10,000 Isofluorphate Isophorone diisocyanate 500 Isopropyl chloroformate 1, Isopropylmethylpyrazolyl dimethylcarbamate Lactonitrile 1, Leptophos 500/10,000 Lewisite Lindane 1,000/10,000 Lithium hydride 100 Malononitrile 500/10,000 Manganese, tricarbonyl methylcyclopentadienyl Mechlorethamine Mephosfolan 500 Chemical Name TPQ TPQ TPQ Pounds Cubic Ft Gallons Mercuric acetate 500/10,000 Mercuric oxide 500/10,000 Mercuric chloride 500/10,000 Methacrolein diacetate 1,000 Methacrylic anhydride 500 Methacrylonitrile Methacryloyl chloride Methacryloyloxyethyl isocyanate 100 Methamidophos 100/10,000 Methanesulfonyl fluoride 1,000 Methidathion 500/10,000 Methiocarb 500/10,000 Methomyl 500/10,000 Methoxyethylmercuric acetate 500/10,000 Methyl vinyl ketone Methyl hydrazine Methyl thiocyanate 10,000 1,122 Methyl isothiocyanate 500 Methyl chloroformate Methyl phenkapton 500 Methyl mercaptan Methyl 2-chloroacrylate Methyl phosphonic dichloride 100 Methyl bromide 1,000 43, Methyl isocyanate Methylmercuric dicyanamide 500/10,000 Methyltrichlorosilane Metolcarb 100/10,000 Mevinphos Mexacarbate 500/10,000 Mitomycin C 500/10,000 Monocrotophos 10/10,000 Muscimol 500/10,000 Mustard gas , Nickel carbonyl Nicotine sulfate 100/10,000 Nicotine Nitric acid 1, Nitric oxide 100 1,388 Nitrobenzene 10, Nitrocyclohexane Nitrogen dioxide 100 2, Nitrosodimethylamine 1, Norbormide 100/10,000 o-cresol 1,000/10,000 Organorhodium Complex (PMN ) 10/10,000 Ouabain 100/10,000 Oxamyl 100/10,000 Oxetane, 3,3-bis(chloromethyl) Oxydisulfoton 500 Ozone 100 2, Paraquat methosulfate 10/10,000 Paraquat dichloride 10/10,000 Parathion Parathion-methyl 100/10,000 Paris green 500/10,000 Pentaborane Pentadecylamine 100/10,000 Peracetic acid Perchloromethyl mercaptan Phenol 500/10,

56 EXTREMELY HAZARDOUS SUBSTANCE LIST Chemical Name Phenol, 3-(1-methylethyl)-, methylcarbamate TPQ Pounds 500/10,000 TPQ TPQ Cubic Ft Gallons Phenol, 2,2'-thiobis[4-chloro-6-methyl- 100/10,000 Phenoxarsine, 10,10'-oxydi- 500/10,000 Phenyl dichloroarsine Phenylhydrazine hydrochloride 1,000/10,000 Phenylmercury acetate 500/10,000 Phenylsilatrane 100/10,000 Phenylthiourea 100/10,000 Phorate Phosacetim 100/10,000 Phosfolan 100/10,000 Phosgene Phosphamidon Phosphine 500 7, Phosphonothioic acid, methyl-, O-ethyl O- 500 (4-(methylthio)phenyl) ester Phosphonothioic acid, methyl-, S-(2-(bis( methylethyl)amino)ethyl) O-ethyl ester Phosphonothioic acid, methyl-, O-(4-500 nitrophenyl) O-phenyl ester Phosphoric acid, dimethyl 4-(methylthio) phenyl ester Phosphorothioic acid, O,O-dimethyl-5-( (methylthio)ethyl)ester Phosphorus oxychloride Phosphorus pentachloride 500 Phosphorus trichloride 1, Phosphorus 100 Physostigmine 100/10,000 Physostigmine, salicylate (1:1) 100/10,000 Picrotoxin 500/10,000 Piperidine 1, Pirimifos-ethyl 1, Potassium cyanide 100 Potassium arsenite 500/10,000 Potassium silver cyanide 500 Promecarb 500/10,000 Propargyl bromide Propionitrile Propionitrile, 3-chloro- 1, Propiophenone, 4'-amino 100/10,000 Propyl chloroformate Propylene oxide 10,000 1,395 Propyleneimine 10,000 1,490 Prothoate 100/10,000 Pyrene 1,000/10,000 Pyridine, 4-amino- 500/10,000 Pyridine, 2-methyl-5-vinyl Pyridine, 4-nitro-, 1-oxide 500/10,000 Pyriminil 100/10,000 Salcomine 500/10,000 Sarin Selenious acid 1,000/10,000 Selenium oxychloride Semicarbazide hydrochloride 1,000/10,000 Silane, (4-aminobutyl) diethoxymethyl- 1,000 Sodium selenate 100/10,000 Sodium arsenite 500/10,000 Sodium fluoroacetate 10/10,000 Sodium cacodylate 100/10,000 Sodium cyanide (Na(CN)) 100 Sodium arsenate 1,000/10, Chemical Name TPQ TPQ TPQ Pounds Cubic Ft Gallons Sodium selenite 100/10,000 Sodium azide (Na(N3)) 500 Sodium tellurite 500/10,000 Stannane, acetoxytriphenyl- 500/10,000 Strychnine 100/10,000 Strychnine, sulfate 100/10,000 Sulfotep Sulfoxide, 3-chloropropyl octyl 500 Sulfur trioxide 100 Sulfur dioxide , Sulfur tetrafluoride 100 4,711 6 Sulfuric acid 1, Tabun Tellurium hexafluoride Tepp Terbufos Tetraethyl lead Tetraethyltin Tetramethyllead Tetranitromethane Thallium sulfate 100/10,000 Thallous malonate 100/10,000 Thallous carbonate 100/10,000 Thallous chloride 100/10,000 Thallous sulfate 100/10,000 Thiocarbazide 1,000/10,000 Thiofanox 100/10,000 Thionazin 500 Thiophenol Thiosemicarbazide 100/10,000 Thiourea, (2-chlorophenyl)- 100/10,000 Thiourea, (2-methylphenyl)- 500/10,000 Titanium tetrachloride Toluene-2,6-diisocyanate Toluene-2,4-diisocyanate trans-1,4-dichlorobutene Triamiphos 500/10,000 Triazofos Trichloro(chloromethyl) silane 100 Trichloro(dichlorophenyl)silane Trichloroacetyl chloride Trichloroethylsilane Trichloronate Trichlorophenylsilane Triethoxysilane Trimethylchlorosilane 1, Trimethylolpropane phosphite 100/10,000 Trimethyltin chloride 500/10,000 Triphenyltin chloride 500/10,000 Tris(2-chloroethyl)amine Valinomycin 1,000/10,000 Vanadium pentoxide 100/10,000 Vinyl acetate monomer 1, Warfarin sodium 100/10,000 Warfarin 500/10,000 Xylylene dichloride 100/10,000 Zinc phosphide 500 Zinc, dichloro(4,4-dimethyl- 5((((methylamino)carbonyl)oxy)imino)pent anenitrile)-, (T-4)- 100/10,000

57 Chemical Name TQ Pounds TQ Cubic Ft TQ Gallons 1,1 Dichloroethylene 10, Butenal 20,000 6,849 Acetaldehyde 10,000 1,545 Acetylene 10, ,000 1,950 Acrolein 5, Acrylonitrile 20,000 3,012 Acrylylchloride 5,000 Allyl alcohol 15,000 2,126 Allylamine 10,000 1,798 Ammonia (anhydrous) 10, ,800 1,943 Ammonia (aqueous) Conc. >=20% 20,000 3,912 Arsenous trichloride 15, Arsine 1,000 5, Bis(chloromethyl)ether 1, Boron Trichloride 5,000 16, Boron Trifluoride 5,000 28, Boron Trifluoride w/methyl ether(1:1) 15,000 1,238 Bromine 10, Bromotrifluoroethylene 10,000 Butadiene (1,3-) 10,000 69,000 1,854 Butane 10,000 63,356 2,008 Butene 10,000 Butene (1-) 10,000 65, Butene (2-) 10,000 Butene-cis (2-) 10,000 65, Butene-trans (2-) 10,000 65, Carbon Disulfide 20,000 1,854 Carbon Oxysulfide (Carbonylsulfide) 10, , Chlorine 2,500 13, Chlorine Dioxide 1,000 4, Chlorine Monoxide 10,000 Chloroform 20,000 1,618 Chloromethyl ether 5, Chloropropylene (1-) 10,000 1,279 Chloropropylene (2-) 10,000 1,279 Crotonaldehyde 20,000 2,935 Crotonaldehyde, (E)- 20,000 2,802 Cyanogen 10, ,082 Cyanogen chloride 10, ,266 1,004 Cyclohexylamine 15,000 2,077 Cyclopropane 10, ,762 1,673 Diborane 2,500 35,125 Dichlorosilane 10, ,441 Difluoroethane 10,000 57, Dimethylamine 10,000 86,000 1,772 Dimethyldichlorosilane 5, Dimethylhydrazine (1,1-) 15,000 2,285 Dimethylpropane (2,2-) 10,000 78,875 Epichlorohydrin 20,000 2,037 Ethane 10, ,151 2,677 Ethyl acetylene 10,000 72,000 1,792 Ethylamine 10,000 1,754 Ethyl chloride 10,000 44,042 1,310 Ethyl ether 10,000 1,697 Ethyl mercaptan 10,000 1,431 Ethyl nitrate 10,000 1,268 Ethyl nitrite 10,000 1,333 Ethylene 10, ,000 2,114 Ethylenediamine 20,000 2,677 Ethyleneimine 10,000 1,448 Ethylene oxide 10,000 87,800 1,385 Explosives ( DOT 49 CFR ) 5,000 Fluorine 1,000 10, Formaldehyde (solution) 15,000 2,217 Furan 5, Hydrazine 15,000 1,800 Hydrochloric acid (soln.conc. >=37%) 15,000 1,689 Hydrocyanic acid (Hydrogen cyanide) 2, Hydrogen 10,000 1,920,000 16,886 Hydrogen chloride 5,000 53, Hydrogen fluoride/hydrofluoric acid 1,000 19, (conc.>=50%) Hydrogen selenide CLEAN AIR ACT 112R LIST Chemical Name TQ Pounds TQ Cubic Ft TQ Gallons Hydrogen sulfide 10, ,920 1,017 Iron, Pentacarbonyl- 2, Isobutane 10,000 63,355 2,077 Isobutyronitrile 20,000 3,171 Isopentane 10,000 1,943 Isoprene 10,000 1,769 Isopropylamine 10,000 1,746 Isopropyl chloride 10,000 1,398 Isopropyl chloroformate 15,000 Methacrylonitrile 10,000 1,506 Methane 10, ,113 2,175 Methylamine 10, ,000 1,336 Methyl-1-butene (2-) 10,000 Methyl-1-butene (3-) 10,000 83, Methyl chloride 10,000 75,000 1,310 Methyl chloroformate 5, Methyl ether 10,000 88,217 1,823 Methyl formate 10,000 1,229 Methyl hydrazine 15,000 2,068 Methyl isocyanate 10,000 1,255 Methyl mercaptan 10, ,110 1,385 Methyl propene (2-) 10,000 80,076 2,000 Methyl thiocyanate 20,000 Methyl trichlorosilane 5, Nickel carbonyl 1, Nitric acid (Conc. EPA >=80%, OSHA >= 15,000 1, %) Nitric oxide 10, , Oleum (OSHA Conc.5 80%) 10,000 Pentadiene (1,3-) 10,000 1,828 Pentane 10,000 1,923 Pentene (1-) 10,000 1,883 Pentene (2-) (E)- 10,000 1,883 Pentene (2-) (Z)- 10,000 1,883 Peracetic acid/ Peroxyacetic acid (OSHA 10,000 1,048 Perchloromethyl-mercaptan 10, Phosgene 500 1, Phosphine 5,000 79, Phosphorus oxychloride (phosphoryl chloride) 5, Phosphorous trichloride 15,000 1,143 Piperidine 15,000 2,097 Propadiene 10,000 Propane 10,000 84,515 2,358 Propionitrile 10,000 1,545 Propyl chloroformate 15,000 Propylene 10,000 88,750 2,362 Propylene oxide 10,000 1,403 Propyleneimine (2-methyl aziridine) 10,000 1,506 Propyne 10,000 97,000 Silane 10, ,000 1,772 Sulfur dioxide (anhydrous) 5,000 29, Sulfur tetrafluoride 2,500 Sulfur trioxide (sulfuric anhydride) 10, Tetrafluoroethylene 10,000 Tetramethyllead 10, Tetramethylsilane 10,000 1,859 Tetranitromethane 10, Titanium tetrachloride 2, Toluene 2,4-diisocyanate 10, Toluene-2,6-diisocyanate 10, Toluene diisocyanate 10, Trichlorosilane 10,000 1,012 Trifluorochloroethylene 10, , Trimethylamine 10,000 64,000 1,812 Trimethylchlorosilane 10,000 1,401 Vinyl acetate monomer 15,000 1,407 Vinyl acetylene 10,000 91,647 1,939 Vinyl chloride 10,000 62,500 1,316 Vinyl ethyl ether 10,000 1,321 Vinyl fluoride 10,000 1,557 Vinyl methyl ether 10, ,095 1,600 Vinylidene fluoride 10,000 82,345 1,946

58 PROCESS SAFETY MANAGEMENT (PSM) LIST Chemical TQ TQ TQ Name Pounds Cu. Ft. Gallons acetaldehyde acrolein (2-propenal) acrylyl chloride 250 allyl chloride allylamine alkylaluminums 5000 ammonia, anhydrous ammonia solutions (>44%) ammonium perchlorate ammonium permanganate 7500 arsine (arsenic hydride) bis(chloromethyl) ether boron trichloride boron trifluoride bromine bromine chloride 1500 bromine pentafluoride bromine trifluoride bromopropyne (propargyl bromide) butyl hydroperoxide butyl perbenzoate, tertiary carbonyl chloride (phosgene) carbonyl fluoride cellulose nitrate (<12.6% nitrogen) 2500 chlorine chlorine dioxide chlorine pentafluoride 1000 chlorine trifluoride chlorodiethylaluminum (diethylaluminum chloro-2,4-dinitrobenzene chloromethyl methyl ether chloropicrin chloropicrin & methyl bromide mixture 1500 chloropicrin & methyl chloride mixture 1500 cumene hydroperoxide cyanogen cyanogen chloride cyanuric fluoride 100 diacetyl peroxide (>70%) 5000 diazomethane dibenzoyl peroxide diborane dibutyl peroxide, tertiary dichloro acetylene dichlorosilane diethylzinc diisopropyl peroxydicarbonate 7500 dilauroyl peroxide dimethyldichlorosilane ,1-dimethylhydrazine dimethylamine, anhydrous ,4-dinitroaniline ethyl methyl ketone peroxide (>60%) ethyl nitrite ethylamine ethylene fluorohydrin 100 ethylene oxide ethyleneimine fluorine formaldehyde (formalin) furan hexafluoracetone hydrochloric acid, anhydrous hydrofluoric acid, anhydrous hydrogen bromide hydrogen chloride hydrogen cyanide, anhydrous hydrogen fluoride hydrogen peroxide, >52% by weight hydrogen selenide hydrogen sulfide Chemical TQ TQ TQ Name Pounds Cu. Ft. Gallons hydroxylamine iron, pentacarbonyl isopropylamine ketene methacrylamide methacryloyl chloride 150 methacryloyloxyethyl isocyanate 100 methyl acrylonitrile methylamine, anhydrous methyl bromide methyl chloride methyl chloroformate methyl ethyl ketone peroxide, >60% methyl fluoroacetate 100 methyl fluorosulfate 100 methyl hydrazine methyl iodide methyl isocyanate methyl mercaptan methyl vinyl ketone methyltrichlorosilane nickel carbonyl (nickel tetracarbonyl) nitric acid, 94.5% nitric oxide nitroaniline (para-nitroaniline) nitromethane nitrogen dioxide nitrogen dioxides (NO, NO2, N2O4, N2O3) nitrogen tetroxide (nitrogen peroxide) nitrogen trifluoride nitrogen trioxide 250 oleum, 65% to 80% by weight (fuming osmium tetroxide oxygen difluoride (fluorine monoxide) ozone pentaborane peracetic acid, >60% acetic acid perchloric acid, >60% by weight perchloromethyl mercaptan perchloryl fluoride peroxyacetic acid, >60% acetic acid 1000 phosgene (carbonyl chloride) phosphine (hydrogen phosphide) phosphorus oxychloride (phosphoryl phosphorus trichloride propargyl bromide 100 propyl nitrate sarin selenium hexafluoride stibine (antimony hydride) sulfur dioxide (liquid) sulfur pentafluoride sulfur tetrafluoride sulfur trioxide (sulfuric anhydride) sulfuric anhydride (sulfur trioxide) 1000 tellurium hexafluoride tetrafluoroethylene 5000 tetrafluorohydrazine 5000 tetramethyl lead thionyl chloride trichloro (chloromethyl) silane trichloro (dichlorophenyl) silane 2500 trichlorosilane trifluorochloroethylene trimethoxysilane

59 UNREPORTED SITES A separate survey is required to be submitted for each site address in Oregon that possesses a Reportable Quantity (see page 3 of this booklet), unless otherwise notified by our office. A specific Facility ID Number is assigned to each site. Do not photocopy an existing survey to use for an unreported site. Complete a separate request form for each unreported site. Office of State Fire Marshal Request Form for Unreported Sites PHOTOCOPY THIS FORM AS NEEDED BUSINESS NAME: OFFICE USE ONLY FACILITY ID #: DEPT/DIVISION: SITE LOCATION (STREET, CITY, STATE, ZIP CODE): LOCATION COUNTY: MAILING ADDRESS (STREET OR PO BOX, CITY, STATE, ZIP CODE): ADDRESS: NORTH AMERICAN INDUSTRIAL CLASSIFICATION SYSTEM (NAICS) CODE: BUSINESS ACTIVITY: RESPONSIBLE FIRE DEPT: OWNER/CEO/ REGISTERED AGENT: SEND TO THE ATTN OF: BUSINESS PHONE NUMBER: SIGNATURE: DATE:

60

61 date Name Company Name Address Enclosed is your license application for the renewal of your nonretail facility license. Your current license expires on Federal law requires that all licensing agencies obtain the social security number of individual company owners. The social security number is used for child support enforcement purposes only. We are not allowed to issue a license to an individual owner without this information. If your business is identified as a corporation, your social security number is not required. Oregon Revised Statutes require that a copy of your current written agreement for commercial fuel dispensing be submitted with your renewal application. This is required even though you may have submitted it in the past. Please include a (blank) copy of your written agreement with your license renewal application. In addition, we require a copy of your current safety training brochure to ensure all elements are being covered as outlined in the Oregon Fire Code. Please submit your payment, application, written agreement, and a copy of the safety training to the address indicated on the enclosed application and listed below. They may be sent together in the same envelope. To allow time for processing, the application and attachments must be postmarked. If you have any questions, please call me at Sincerely, Anita Phillips, Manager License and Permit Services 10/14/08 Before

62 date Plain Language Improvements: Cut unnecessary information Used short, simple sentences Name Company Name Address Enclosed are your nonretail facility license renewal application forms, and a checklist to assist you with completion of your license requirements. In the center of the application is a block that requires your action. We cannot issue a license to an individual owner without your social security number as required under federal child support laws. If your business is a corporation, your social security number is not required. Your current license expires on To allow time for processing, the application and attachments must be postmarked by. If you have any questions, please call me at Sincerely, License and Permit Services After

63 Public Employees Retirement System (PERS) Plain Language Implementation Plan ( ) PERS continues to simplify language in written documents and provide easier access to information on its website. Key projects We completed phase 1 of a project to update the Tier One/Tier Two Pre-Retirement Guide and retirement application in Our goal was to simplify language and make the information easier to understand. Our Retiree Focus Group provided input on ways to make the Tier One/Tier Two retirement application more user friendly. Phase 2 is scheduled for We intend to decrease the page count and amount of information in the Tier One/Tier Two Pre-Retirement Guide and retirement application (currently 54 pages total) without sacrificing critical information needed to make an informed retirement decision. We also streamlined the Oregon Public Service Retirement Plan (OPSRP) Pension Program Pre-Retirement Guide and retirement application in We used simpler language and reduced total page count from 38 to 13. PERS conducts Retirement Application Assistance Sessions (RAAS) with members to help them understand benefit options and complete their retirement application(s). The RAAS counselors will gauge the effectiveness of the new Tier One/Tier Two and OPSRP Pre- Retirement Guides and retirement applications with those retiring members. They will determine if there are fewer errors on the applications as a result of simplification. To provide easier access to information on the PERS website, we continue to convert various program guides to A-Z listings by searchable topic. We created A-Z listings for Tier One/Tier Two, OPSRP Pension Program, and the Individual Account Program (IAP) in In 2008, we created A-Z listings for the Oregon Savings Growth Plan and the Electronic Data Exchange reporting system used by PERS employers. Feedback from members, retirees, and employers show that the A-Z listings by topic are comprehensive and easy to use. Contact information Plain Language Coordinator: David Crosley PERS Communications Officer david.crosley@state.or.us