HomeMy WebLinkAboutSTATETIERII PACKET2012NEIL ABERCROMBIE
GOVERNOR OF HAWAII
STATE OF HAWAII
DEPARTMENT OF HEALTH
P. 0. BOX 3378
HONOLULU, HI 96801-3378
January 7, 2013
TO: State Agencies Facility Operators
FROM: Keith E. Kawaoka, D.Env., Program Manager
Hazard Evaluation and Emergency Response Office
LORETTA J. FUDDY, A.C.S.W., M.P.H.
DIRECTOR OF HEALTH
SUBJECT: Hawaii Emergency Planning and Community Right -to -Know Act (HEPCRA),
Section 128E-6, Hawaii Administrative Rules (HAR), Chapter 11-453-25,
Filing for the 2012 Reporting Year
In reply, please refer to:
File:
13-006 SL
The 1993 Hawaii Emergency Planning and Community Right -to -Know Act (HEPCRA) requires an annual
submission of chemical inventories by covered facilities.
The Environmental Protection Agency (EPA) and the National Oceanographic and Atmospheric
Administration (NOAA) have developed a software package, Tier2Submit, which facilities may use to submit
their HEPCRA inventories. This program is free and available at:
http://www.epa.2ov/emergencies/content/epera/tier2.htm . The Department of Health (DOH), Hazard
Evaluation and Emergency Response (HEER), Office encourages facilities operators to use the Tier2Submit
and provide the HEER Office with an electronic version of their data. Information for the HEER Office is
available at our website: http://hawaii.gov/health/environmentalthazard/index.html.
Please include an e-mail address with your contact information. In the future, BEER Office would like to send
these reminders by e-mail. If your facility does not have access to an e-mail account, we will continue to
provide a hardcopy.
The provision of information on the Longitude and Latitude, in decimal degrees, of your facility is very
important for emergency response personnel, in the event of any incident. There are numerous websites
available on the internet to help you find the correct Longitude and Latitude for your facility.
We request that you notify us by fax, mail, or e-mail if your facility is no longer operating or is no longer a
reportable facility.
If you have questions regarding HEPCRA, please contact Curtis Martin or Sharon Leonida with the DOH
Hazard Evaluation and Emergency Response (BEER) Office at (808) 586-4249, fax (808) 586-7537.
Attachments:
1) Tier2Submit 2012 (preprinted form) EXAMPLE EPA PROGRAM FORM
2) HEER Hazardous Substance Inventory Guideline
3) Options for Tier2Submit
4) Additional Notes and Amendments for Filing Hawaii Chemical Inventory Form
5) Hawaii Chemical Inventory Form, HCIF (blank) and Instructions
6) Addresses of BEER Office and Local Emergency Planning Committee (LEPCs)
7) Sample Journal Vouchers
ATTACHMENT 1
Tier Two Reporting Period: January 1toDecember 31.2O12
Emergency and Hazardous Chemica lnventory Page 1
Specific Informatiori by Chemical
• Printed: January 3, 2013
Facility Name:
~^^^^^"^^ THIS REPORT HAS NOT PASSED AVALIDATION CHECK!
^
FACILITY IDENTIFICATION:
Dept
. USA
County:
Number of employees:
IDENTIFICATION NUMBERS:
NAICS:
CONTACT INFORMATION:
No Contacts data avaiIabe.
CHEMICAL DESCRIPTIONS:
{] AH chemica!s in inventory are identical to iast years submssion
No Chemica! data available.
FACILITY STATE FIELDS:
No Facflities State FieId data available.
STATE / LOCAL FEES: None.
[ ] have attached a site plan
[ ] 1 have attached a llst of site coordinate abbreviations
1 ] 1 have attached a description of dikes and 6ther safeguard measures
Certification (Read and sign after competing all sections)
/ certify under penalty ofuWth"/have personally examined and "mfamiliar with the information submitted mpages one through ,.
and that based on myinquiry mthose individuals responsible for obtaining this information, /believe that the submitted information is true, asourate and complete.
Name and official title of owner/operator
DR ownerloperators authorized representative
Signature Date signed
ATTACHMENT 2
Hawaii State Department of Health
Hazard Evaluation and Emergency Response Office (NEER)
Hazardous Substance Inventory Guideline
WHO MUST SUBMIT AN INVENTORY FORM
You need to report hazardous substances that were present at your facility at any time during the previous calendar year at levels that
equal or exceed reporting thresholds established for Hawaii Chemical Inventory Form/Tier II (HCIF) reporting under the Hawaii
Emergency Planning and Community Right -to -Know Act (HEPCRA). These thresholds are as follows:
For Extremely Hazardous Substances (EHS) designated under section 302 of The Emergency Planning and Community Right -to -Know
Act (EPCRA), the reporting threshold is 500 pounds (or 227 kg) or the Threshold Planning Quantity (TPQ) whichever is lower.
For all other hazardous chemicals for which facilities are required to have or prepare a Material Safety Data Sheet (MSDS), the
reporting threshold is 10,000 pounds or (4,540 kg).
WHAT CHEMICALS ARE EXCLUDED
1) Any food additive, color additive, drug or cosmetic regulated by the Food and Drug Administration:
2) Any substance present as a solid in any manufactured item to the extent exposure to the substance does not occur under normal
conditions of use:
3) Any substance to the extent it is used for personal, family, or household purposes, or is present in the same form and concentration
as a product packaged for distribution and use by the general public:
4) Any substance to the extent it is used in research laboratory or a hospital or other medical facility under the direct supervision of a
technically qualified individual:
5) Any substance to the extent it is used in routine agricultural operations or is a fertilizer held for sale by a retailer to the ultimate
customer.
In 1999, Federal EPCRA Section 311-312 threshold planning quantities increased to 75,000 gallons for gasoline and 100,000 gallons
for diesel for Retail Gasoline Stations that are in full compliance with underground storage tank regulations for the year.
WHEN TO SUBMIT THE HCIF
The HCIF must be submitted by March 1 for the previous reporting year. HCIFs for the reporting year January 1, 2012 through
December 31, 2012 must be submitted by March 1, 2013.
WHERE TO SUBMIT THE HCIF
Send completed Hawaii Chemical Inventory/Tier II Forms to each of the following organizations:
1) The Hawaii State Emergency Response Commission (HSERC)/HEER Office (586-4249)
2) Your Local Emergency Planning Committee (LEPC)
3) The fire depai latent with jurisdiction over your facility
FILING FEE
Under Hawaii Revised Statutes Section 128E-9 and Hawaii Administrative Rules 11-453-32, a $100.00 filing fee must be submitted
for each facility covered under HEPCRA. Please make checks or money orders payable to the State of Hawaii, Hazard Evaluation
and Emergency Response Office, or State of Hawaii, HEER Office. No Purchase Orders will be accepted. Enclose payment
with the HCIF(s) that you mail to the HEER Office.
PENALTIES
Any owner or operator who violates any HCIF reporting requirements shall be liable to the State of Hawaii for a civil penalty of up to
$25,000 for each such violation. Each day of a violation constitutes a separate violation.
ATTACHMENT 2
NEER Hazardous Substance Release. Notification and Inventory Guideline - Summary Implementation Table
Statute or
Regulation Section
Number
List of Lists(7/1/93)
Column Heading
Who must Provide Information
Information to
Provide
To Whom
Information Goes
When to Submit Information
§302
Sec. 302 (EHS) TPQ
All who store in excess of the TPQ.
Letter stating that
HSERC,
Information due within 60 days of
§128E-6
you are regulated.
LEPC .
receipt of Extremely Hazardous
Substance at a facility.
§304
EHS RQ
Those who release above the RQ in a
Release Notification
HSERC,
Release Notification due
§ 128E-7
CERCLA RQ
24 hour period.
and
LEPC
immediately.
§11-45I-7
and
Written Follow-up.
§103
10 pound RQ for
TCP
and
Written follow-up due as soon as
possible within 30 days.
Oil under the listed
circumstances. *
§ 103
CERCLA RQ
Those who release above the RQ.
Release Notification
NRC
Immediately.
§311
Sec. 302 (EHS) TPQ
Those who store above the 1PQ.
List of MSDS
HSERC,
Due annually by March 1 for
§ 128E -6(2)(A)
and
10,000 pound TPQ
for OSHA Hazardous
Chemicals and
Hazard Categories
for Each.
LEPC,
Fire Department
preceding calendar year inventory.
Chemicals.
§312
Sec. 302 (EHS) TPQ
Those who store above the TPQ.
Hawaii Chemical
HSERC,
Due annually by March 1 for
§128E-6(2)(B)&(C)
and
10,000 pound TPQ
for OSHA Hazardous
Inventory Folin
(Tier II) and Site
Map.
LEPC,
Fire Department
preceding calendar year inventory.
Chemicals.
§ 128E-9
Those who submit an HCIF.
Filing Fee - $100 per
facility.
HSERC
Due annually with HCIF.
§313
Sec 313
Manufacturing facilities in specified
SIC Codes, with more than 10
employees, that manufacture or
process more than 25,000 pounds or
otherwise use more than 10,000
pounds of the listed chemicals.
TRI Form R
Due annually by July 1 for
preceding calendar year inventory.
*(A) Any amount of oil which when released into the environment causes a sheen to appear on surface water, or any navigable water of the State;
(B) Any free product that appears on ground water;
(C) Any amount of oil released to the environment greater than 25 gallons; and
(D) Any amount of oil released to the environment which is less than 25 gallons, but which is not contained and remediated within 72 hours.
ATTACHMENT 3
Options For Tier2Submit
Option 1: Tier2Submit
Download the software from the CEPPO website,
http://www.epa.gov/emergencies/content/epera/tier2.htin . Enter the inventory
information into Tier2Submit. Generate a hardcopy and a diskette from the Tier2Submit
software. Send a diskette or e-mail the electronic file, from the website, to
sharon.leonida@doh.hawaii.gov. Please submit only the Word or PDF versions of the
forms. Sign the hardcopy and submit it and the diskette with facility maps indicating
chemical locations, and a $100.00 filing fee per facility.
Option 2: Hardcopy Only
Hardcopy submissions will be accepted as in the past. If a hardcopy only is submitted,
the HEER Office will enter the information from those forms into Tier2Submit. Also
include facility maps indicating chemical storage locations and a $100 filing fee per
facility. Additional maps are submitted only after changes are made to facility.
The HEER Office is using Tier2Submit for two reasons. One is to allow electronic
submission in a form already in use by the EPA. The other is to gain compatibility with
the CAMEO/ALOHA/MARPLOT software in use by emergency planners. Maintaining
Tier II information in CAMEO will increase the usefulness of the HEPCRA inventories
to response agencies.
The deadline for filing is March 1, 2013, for inventories complied during the 2012
calendar year. Please submit completed forms as follows to the following agencies:
Agency
Form and Updated Map
Filing Fee
Hawaii State Emergency
Response Commission
(HSERC) (1- see below)
Form with Original
Signature; optional diskette,
or e-mail and map
Check/money order for total
Filing Fee payable to: State
of Hawaii HEER Office.
($100.00 per facility)
Your County Local
Emergency Planning
Committee (LEPC) (1- see
below)
Form with Original Signature
and map
No check/money order
Your County Fire Dept.
(1 -see below)
Form with Original Signature
and map
No check/money order
Filing Fees
As a result of Act 260/97, the filing fees are deposited to an account within the
Environmental Response Revolving. Fund for further disbursement to the Local
Emergency Planning Committee (LEPC) accounts
( 1 ) Current addresses for HSERC and LEPCs are located in Attachment 6 in this
packet. For state department facilities, a sample of a journal voucher is included for
your convenience, (Attachment 7).
ATTACHMENT 4
Additional Notes and Amendments for Filing Hawaii Chemical Inventory Form
Preprinted Hawaii Chemical Inventory Foiut (HCIF)
If you are not using Tier2Submit program, please use the preprinted foim, with the information printed
from the previous year, generated by Tier2submit 2012. Fill in any missing information and make small
changes directly on the form. The date of the reporting period and the date signed will need updating.
Initial all updates and changes. Then make three copies, sign and date each form. Send each one of the
signed forms to the three appropriate agencies. Only include an updated map for each agency if there are
changes. Use the blank form for major corrections,(attachments 5), Chemical Inventory Form .
Note that if you used Tier2Submit 2011, you may import to Tier2Submit 2012 and make changes.
Material Safety Data Sheet (MSDS) Handling
The HEER Office ask that facilities not submit MSDSs with their forms due to space constraints, the
facility is required to maintain current MSDSs for its hazardous substances and to have them available
upon request.
Retail Gasoline Stations
For Retail Gasoline Stations that are in full compliance with Underground Storage Tank requirements, the
threshold planning quantities (TPQ) are increased to 75,000 gallons for gasoline and 100,000 gallons for
diesel. This is due to the 1999 changes in Federal EPCRA Section 311-312. For those Retail Gasoline
Stations that have violations documented during a compliance inspection, the TPQ reverts to 10,000
pounds for the reporting year following the year in which the violation occurred. Call the EPA hotline at
1 (800) 424-9346 or the HEER Office or check http://www.epa.gov/ceppo/ for information.
Rules For Hawaii Revised Statutes (HRS) 128-E
The Office of Hazard Evaluation and Emergency Response and the Local Emergency Planning
Committees have written rules for HRS 128-E, http://www.capitol.hawaii.gov/hrscurrent/vo103 chOl21-
0200D/HRS0128E . Effective date for "Chapter 453 of Title 11, Hawaii Administrative Rules" is
November 5, 2010, http://gen.doh.hawaii.gov/sites/har /AdmRulesl/11-453.pdf . For more information
contact sharon.leonida@doh.hawaii.gov, or call 586-4249.
Amendments to EPCRA
Tier I and Tier II forms and instructions have been removed from the Code of Federal Regulations
(CFR). They are located on EPA's Website: www.epa.gov/emergencies.
Facilities are now required to report their North American Industry Classification System (NAICS)
code on Tier I or Tier II form.
Chemical or common name of the chemical as provided on the Material Safety Data Sheet must be
provided on Tier II form.
Hazardous Chemical Inventory Reporting Chemicals in Mixtures
When determining whether the threshold quantity of an extremely hazardous substance (EHS) has been
met, facilities must include the total quantity of the EHS present in the pure fowl as well as in any
mixture, even if any mixture including the EHS is also being reported as a hazardous chemical.
For hazardous chemicals that are mixtures and do not contain any EHS, facilities have an option when
determining whether the threshold quantity is present: (1) add together the quantity present in its pure
form and as a component in all mixtures (even if the mixture is also being reported as a hazardous
chemical), or (2) consider the total quantity of each mixture separately.
Read All Instructions Before Competing
Remit $100;00 Filin1 Fee,per ynclllty
STATE OF HAWAII
CHEMICAL INVENTORY FARM [71E_• R 11) W
AT.TAC'1 E,NT 5
Page
or
• Facility identification -`
Nnmo
Strout
t
City County Slate Zip
Latitude Longitude) Country USA
Owner/Operator Name ,
Nama Phone
Mall
Addrasa
city.
Stain Zip Country .
Mailing Address (if different from facility address)
. • Siraut
City • ' Stale Zip Country
Emergency Contact .
Nnmo Title
Phvno 24 Hr. Phono
SIC Code Dun & Hrad Number NA 1 CS
• •
Name Title
• •
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Chemical Description
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- - - ' -
Physical and
Heath Hazards
❑ Piro
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h a E
err
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1
It'
Storage Codes and Locations
(Non -Confidential)
•
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Max. Dally
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1 codify under penalty al Saw that I hove personally examined and am familiar with the Information eubmltted In papas one Ihrough'I.
and that basod on my Inquiryof Ewan Individuals rosponslblo for obtaining this Idformallon,1 hollow) that the submitted Intonation Is truth =undo, and oampioto,
optional Attchments
0 I have attoohod a alto plan .
0I have attached a Het of silo caardlnala abbrovialions
Nemn and official (Ilia of awnudopatator
DR owndopuratoes authorized reprnsontailva 6lpnaturo Data slenod
t!'!'!
• 1 hovs attached a doscdption of dikes and other
safeguards measures
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_ ' - - - - - - - - - - - - - - - - - -
CAS Trado Sacral - ®
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Nemo
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Physical and
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,--
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Avg. Daily
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No, of Days
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Storage Codes and Locations
(Non-Confidential)
•
❑Chock If all of Iho information for Ihls:chamtcal Is
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- - --- -- ----
CAS Trada Sacra
Cham.
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❑ Sudden Ratanso
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- - - - - - - - - - - - - - - - - - - - -
CAS Trade Sacral ®
Cham.
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- - - - - - - - - - - - - - - - - - - - -
CAS Trade Sacral D
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•
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No, of Days
(days)
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-
•
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Idonllcal lq Iho Informallon suhmlllad Iasi your
- - - - - - - .. - - - - - - - - - - -
CAS Trade Sacral ®
Cham.
Namo
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Apply Pura • Mk Sand Liquid Gas EHS
Certification (Read and slgn after completing all sections)
I codify undorpenally of law that I hove personally oxamined and am familiar with Iha Information submitted In papas ono through 1,
and that hosed an my Inquiry of those Individuals rosponalble for obtaining this Information, I believe that the submitted Information Is Iran ncouralo,
end complain.
Dalo signed •
.
Optional Attchments
❑ I have allochod a slip plan
❑ I have attached o list of alto coordlnaln.nhhrevlollonc
❑ I have aordshmaasutos d a r4)1ton of dikes and other
'
Nemo and official Illlo of ownarlopornlar9lgnalure
OR owner/oporolor•s aulhodsad representative •
ATTACHMENT 5
Hawaii Emergency Planning and Community Right -To -Know Act (HEPCRA)
Hawaii Chemical Inventory Form/Tier II (HCIF) - 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 financial 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 HSERCIHEER OFFICE. Enter the facility representative's full
name, mailing address, phone number and e-mail address.
OWNER/OPERATOR
Enter the owner or operator's fall name, mailing address and phone number. Any changes or sale shall be reported to the NEER 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.
ATTACHMENT 5
MAXIMUM AMOUNTS
For each hazardous chemical, estimate the greatest amount in pounds present at your facility on any single day during the reporting
period.
Find the appropriate range value code under Reporting Ranges.
Enter this range value code as the maximum amount.
AVERAGE DAILY AMOUNT
For each hazardous chemical, estimate the average weight in pounds that was present at your facility during the year.
To do this, total all daily weights and divide by the number of days the chemical was present on the site.
Find the appropriate range value under Reporting Ranges.
Enter this range value as the Average Daily Amount.
NUMBER OF DAYS ON-SITE
Enter the number of days that the hazardous chemical was found on-site.
STORAGE CODES AND LOCATIONS
List all non -confidential chemical locations in this column along with storage types/conditions associated with each location. You may
list several locations for a particular chemical. Each column of boxes indicates a type of storage container (for example: an
underground storage tank at ambient pressure and temperature (B 14) or a compressed gas cylinder at ambient temperature (L24)) and
the corresponding line represents a location for that container.
STORAGE CODES
Indicate the code for the container types and the pressure and temperature conditions for that storage container.
STORAGE LOCATIONS
Provide a brief description of the precise location of the chemical so that, emergency responders can locate the area easily. These
descriptions must correspond to the site plan that you provide.
CERTIFICATION
The owner, operator or the officially designated representative of the owner or operator must certify that all infoi„iation included in the
HCIF submission is true, accurate and complete. On the first page of the report enter your full name and official title. Sign your name
and enter the current date. Also, enter the total number of pages included in the Confidential and Non -confidential information sheets
as well as all attachments. An original signature is required on at least the first page of the submission. Submissions to the HSERC,
LEPC and Fire department must each contain an original signature on at least the first page. Subsequent pages must contain either an
original signature, a photocopy of the original signature or a signature stamp. Each page must contain the date on which the original
signature was affixed to the first page of the submission and the total number of pages in the submission.
Range Value
01
02
03
04
05
06
07
08
09
10
11
Storage Codes for Container Type
A Above ground tank
B Below ground 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 or jugs
N Plastic bottles or jugs
O Tote bin
P Tank Wagon
Q Rail car
R Other
Reporting Ranges
From (Pounds'
0
100
1,000
10,000
100,000
1,000,000
10,000,000
50,000,000
100,000,000
500,000,000
1 billion
ATTACHMENTS 5
To (Pounds)
99
999
9,999
99,999
999,999
9,999,999
49,999,999
99,999,999
499,999,999
999,999,999
Greater than 1 billion
Storage Codes for Pressure and Temperature
1
2
3
Ambient Pressure
Greater than ambient pressure
Less than ambient pressure
4 Ambient temperature
5 Greater than ambient temperature
6 Less than ambient temperature but not cryogenic
7 Cryogenic conditions
Hawaii State Department of Health Hazard Evaluation and Emergency Response Office (NEER)
Addresses of NEER Office and Local Emergency Planning Committee (LEPCs)
Emergency Planning and Community Right to Know Act of 1986 §302, §304, §311, §312 and §313
Hawaii Emergency Planning and Community Right to Know Act §128E-6, §128E-7, §128E-9 and Title 11 Chapter 453 Hawaii Administrative Rules § 11-453
The State Contingency Plan, Title 11 Chapter 451 Hawaii Administrative Rules §11-451-7
Comprehensive Environmental Response Compensation and Liability Act §103
The Hawaii State Emergency Response Commission (HSERC), the Local Emergency Planning Committee (LEPC), local Fire Department and the National Response Center (NRC)
must receive the appropriate notification upon a covered chemical release and/or for routine inventories at the addresses and phone numbers listed in the table below.
County
HSERC
LEPC
Fire Depai tnrent
NRC
C & C of Honolulu
Hawaii State Department of Health
919 Ala Moana Blvd., Room 206
Honolulu, Hawaii 96814-4912
Attn: EPCRA Data Manager
Phone (808) 586-4249 Fax (808) 586-7537
After Hours (808) 247-2191
sharon.leonida@doh.hawaii.gov
Honolulu LEPC
Department Of Emergency
Management
650 South Icing St.
Honolulu, Hawaii 96813
Phone (808) 723-8960
After Hours 911
Fax 524-3439, LEPC 723-8960
Fire Chief
Honolulu Fire Dept.
636 South Street
Honolulu, Hawaii 96813-5007
Phone Fire Chief 723-7101
After Hours 911 Fax 723-7179
Fire Prevention 723-7162
1(800)424-8802
Hawaii
Hawaii State Department of Health
Same address and phone numbers
statewide.
Henry Silva
Hawaii County LEPC
Hawaii State District Health Office
1582 Kamehameha Avenue
Hilo, Hawaii 96720
Phone (808) 895-7318
Darren Rosario, Fire Chief
Hawaii Fire Department
25 Aupuni St., Suite 2501
Hilo, Hawaii 96720
Phone (808) 932-2903
After Hours 961-8336
Same number
nationwide.
Kauai
Hawaii State Department of Health
Same address and phone numbers
statewide.
Albert Kaui
Kauai Fire DepaitLuent
3083 Akahi Street, Suite 101
Lihue, Hawaii 96766
Phone 241-6515
After Hours 241-1711
Fax 241-6508
Robert Westerman, Chief
Kauai Fire Department
3083 Akahi Street, Suite 101
Lihue, Hawaii 96766
Phone 241-4975
After Hours 241-1711
Same number
nationwide.
Maui
Hawaii State Department of Health
Same address and phone numbers
statewide.
Scott Kelcuewa
Maui Fire Depaitinent
200 Dairy Road
Kahului, Hawaii 96732
Phone 270-7911
After Hours 911
Fax 270-7917
Jeff Murray, Chief
Maui Fire Dept.
200 Dairy Rd.
Kahului, Hawaii 96732
Phone 270-7561
After Hours 270-7911
Fax 270-7919
Same number
nationwide.
STATE OF HAWAII
DOH
(HEER) HAZARDOUS EVALUATION AND EMERGENCY RESPONSE OFFICE
JOURNAL VOUCHER REMITTANCE FOR HEPCRA FEE:
Please use the numbers below for the TIER II PAYMENT
SFX
TC
F
YR
APP
D
ALLOT
CAT
SOURCE/
OBJECT
COST
CENTER
PROJ. NO DEPT
G/L
ACCT
SIL
ACCT
REFERENCE DOC
AMOUNT
NUMBER
PH ACT
NUMBER
SFX
XX
XXX
X
XX
XXX
XX
XX
XXXX
XXXX
XXXXXX
XX XXX
XXX
C(XXX>
XXXXXXXX
XX
XXXXX
XX
01
805
S
342
H
1115
000338
00 371
100
00
SAMPLE JOURNAL VOUCHER
For State Agencies Only
NAME OF FACILITY SHOULD BE INCLUDED IN EXPLANATION BOX.
Questions can be directed to: sharon.leonida@doh.hawaii.com