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Tier Two <br />Emergoncy arid Hazardous Chemical Jnventory <br />Specific Information by Chemical <br />ATTACHMENT 1 <br />Reporting Period: January 1 to December 31, 2012 <br />Page 1 <br />Printed: January 3, 2013 <br />Facility Name: <br />** <br />THIS REPORT HAS NOT PASEDAVALI00ONCHEC0 <br />kvl <br />^ <br />FACILITY IDENTIFICATION: <br />. USA <br />County: <br />Number of employees: <br />IDENTIFICATION NUMBERS: <br />NAICS: <br />CONTACT INFORMATION: <br />No Coritacts data available. <br />CHEMICAL DESCRIPTIONS: <br />[] All chemicals in inventory are dentcaI to Iastyear's submission <br />No Chemicadata available <br />FACILITY STATE FIELDS: <br />No Facilities State Fied data available. <br />STATE / LOCAL FEES: None. <br />[ ] 1 have attached a site plan <br />[ ] have attached a list of site coordinate abbreviations <br />[] 1 have attached a description of dikes and ther safeguard measures <br />Certification (Readand sign after completing alt sections) <br />[certify under penalty ef law'that 1 have personalty examlned and am familiarwth the informatlon submitted In pagesane through 1 <br />and that base"""yinquiry ofthose individuals responsible for obtaining this information, / believe that the submitted Information /° true, accurate, and complete. <br />Name and official title of owner/operator <br />OR owner/operator's authorized representative <br />Signature Date signed <br />