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ATTACHMENT 1 <br />Tier Two Reporting Period: January 1toDecember 31.2O12 <br />Emergency and Hazardous Chemica lnventory Page 1 <br />Specific Informatiori by Chemical <br />• Printed: January 3, 2013 <br />Facility Name: <br />~^^^^^"^^ THIS REPORT HAS NOT PASSED AVALIDATION CHECK! <br />^ <br />FACILITY IDENTIFICATION: <br />Dept <br />. USA <br />County: <br />Number of employees: <br />IDENTIFICATION NUMBERS: <br />NAICS: <br />CONTACT INFORMATION: <br />No Contacts data avaiIabe. <br />CHEMICAL DESCRIPTIONS: <br />{] AH chemica!s in inventory are identical to iast years submssion <br />No Chemica! data available. <br />FACILITY STATE FIELDS: <br />No Facflities State FieId data available. <br />STATE / LOCAL FEES: None. <br />[ ] have attached a site plan <br />[ ] 1 have attached a llst of site coordinate abbreviations <br />1 ] 1 have attached a description of dikes and 6ther safeguard measures <br />Certification (Read and sign after competing all sections) <br />/ certify under penalty ofuWth"/have personally examined and "mfamiliar with the information submitted mpages one through ,. <br />and that based on myinquiry mthose individuals responsible for obtaining this information, /believe that the submitted information is true, asourate and complete. <br />Name and official title of owner/operator <br />DR ownerloperators authorized representative <br />Signature Date signed <br />