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ATTACHMENT 5 Hawaii Emergency Planning and Community Right -To -Know Act (IIEPCRA) Hawaii Chemical Inventory Form/Tier II (HCII) - INSTRUCTIONS FACILITY INFORMATION Enter the full name of your facility. Enter the full street address or state road. If a street address is not available, enter other appropriate identifiers that describe the physical location of your facility. Include city, state, zip code, island and latitude and longitude in decimal degrees. Enter the primary Standard Industrial Classification (SIC) code, the North American Industry Classification System (NAICS) and the Dun and Bradstreet number for your facility. The fmancial officer of your facility should be able to provide the Dun & Bradstreet number. If your firm does not have this information, visit http://fedgov.dnb.com/webform/displayHomePage.do, to obtain your facility number or have one assigned. FACILITY REPRESENTATIVE Under Section 303 a facility representative shall be reported to the HSERC/HEER OFFICE. Enter the facility representative's full name, mailing address, phone number and e-mail address. OWNER/OPERATOR Enter the owner or operator's full name, mailing address and phone number. Any changes or sale shall be reported to the HEER Office stating the new owner and the effective date of the transfer. EMERGENCY CONTACT Enter the name, title and work phone number of at least one local person or office who can act as a referral if emergency personnel need assistance in responding to a chemical accident at a facility Provide an emergency phone number where emergency information will be available 24 hours a day, every day. This requirement is mandatory. The facility must make some arrangement to ensure that a 24-hour contact is available. CHEMICAL INFORMATION The main section of the Hawaii Chemical Inventory Form requires specific information on amounts and locations of hazardous chemicals, as defined in the OSHA Hazard Communication Standard. CHEMICAL DESCRIPTION Enter the chemical name or common name of each hazardous chemical Enter the Chemical Abstract Service registry number (CAS). For mixtures, enter the CAS number of the mixture as a whole, it has been assigned a number distinct from its constituents. For a mixture that has no CAS number, leave this item blank or report the CAS number of as many constituent chemicals as possible. Check whether the chemical is or contains an Extremely Hazardous Substance (EHS). If the chemical is a mixture containing an EHS, enter the chemical name of each EHS in the mixture. Check box for all applicable descriptors: pure or mixture and solid, liquid or gas. PHYSICAL AND HEALTH HAZARDS For each chemical you have listed, check all the physical and health hazard boxes that apply. These hazard categories are defined in 40 CFR 370.2. The two health hazard categories and three physical categories are a consolidation of the 23 hazard categories defined in the OSHA Hazard Communication Standard 29 CFR 1910.120.