Tier II Inventory Form Checklist

Reporting Year 2017

• The calendar year for the reporting period.
• An indication whether the information being reported on page one of the form is identical to that submitted last year.
• The complete name and address of the location of your facility (include the full street address or state road, city, county, state and zip code), latitude and longitude.
• An indication if the location of your facility is manned or unmanned.
• An estimate of the maximum number of occupants present at any one time.  If the location of your facility is unmanned, check the box marked N/A, not applicable.
• The North American Industry Classification System (NAICS) code for your facility.
• The Dun & Bradstreet number of your facility.
• Facility identification numbers assigned under the Toxic Release Inventory (TRI) and Risk Management Program.  If you facility has not been assigned an id number under these programs or if your facility is not subject to reporting under these programs, check the box marked N/A, not applicable.
• An indication whether your facility is subject to the chemical accident prevention requirements under section 112(r) of the Clean Air Act (CAA), codified in 40 CFR part 68, Chemical Accident Prevention Provisions, also known as the Risk Management Program.
• The name, mailing address, phone number and email address of the owner or operator of the facility.
• The name, mailing address, phone number, Dun & Bradstreet number and email address of the facility's parent company. These are optional data elements.
• The name, title, phone number, 24-hour phone number and email address of the facility emergency coordinator, if applicable.
• The name, title, phone number and email address of the person to contact regarding information contained in the Tier II form.
• The name, title, phone number and email address of at least one local individual that can act as a referral if emergency responders need assistance in responding to a chemical accident at your facility.  You must also provide an emergency phone number which will be available 24 hours a day, every day.
• An indication whether the information being reported on page two of the form is identical to that submitted last year.
• An indication whether you are including any attachments (optional).
• Certification - The owner or operator or the officially designated representative of the owner or operator must certify that all information included in the "Tier2 Submit" submission is true, accurate and complete on a Connecticut Tier2 Submit Certification (PDF, Word). 

1. Pure Chemical: Provide the chemical name (or the common name of the chemical) as provided on the Material Safety Data Sheet (MSDS) and provide the Chemical Abstract Service (CAS) registry number of the chemical provided on the MSDS.
2. Indicate whether the chemical is a solid, liquid, or gas; and whether the chemical is an Extremely Hazardous Substance (EHS).
3. Mixture: If you are reporting a mixture, enter the mixture name, product name or trade name as provided on the MSDS and provide the CAS registry number of the mixture provide do the MSDS.  If there is no CAS number provided or it is not known, check the box "Not Available".
4. If the mixture you are reporting contains EHS(s), provide the name(s) of each EHS in the mixture.  As provided in the federal regulations in 40 CFR §370.14(a), you also have an option to report the non-EHS hazardous components in the mixture.
5. Pure Chemical or Mixture:  Indicate which hazard categories apply to the chemical or the mixture.  The five hazard categories are defined in the federal regulations in 40 CFR §370.66.
6. Provide an estimate (in ranges) of the maximum amount of the hazardous chemical present at your facility on any single day during the preceding calendar year. If you are reporting a mixture, provide an estimate of the total amount of the mixture present at your facility on any single day during the preceding calendar year. If the mixture contains any EHS, provide the total amount of each EHS in that mixture. You must use the codes that correspond to different ranges.  The amounts and associated range codes are in the federal regulations in 40 CFR §370.43.
7. Provide an estimate (in ranges) of the average daily amount of the hazardous chemical present at your facility during the preceding calendar year.  If you are reporting a mixture, provide an estimate of the average daily amount of the mixture. You must use the codes that correspond to different ranges.  The amounts and associated range codes are in the federal regulations in 40 CFR §370.43 .
8. Provide the maximum number of days that the hazardous chemical or mixture was present at your facility during the preceding calendar year.
9. Provide the type of storage for the hazardous chemical or the mixture containing the hazardous chemical at your facility.  Examples for types of storage:  above-ground tank, plastic or non-metallic drum, steel drum, cylinder, rail car, etc.
10. Provide the storage conditions for the hazardous chemical at your facility.  Examples for types of storage conditions:  Ambient pressure, ambient temperature, less than ambient temperature/pressure, cryogenic conditions, etc.
11. Provide a brief description of the precise location(s) of the hazardous chemical(s) or the mixture(s) at your facility.  You may also attach one of the following with your Tier II inventory form:  (the SERC does not require such a submittal, however; the local Fire Department and/or LEPC may require such a submission.)
    (i) A site plan with site coordinates indicated for buildings, lots, areas, etc. through your facility. 
    (ii) A list of site coordinate abbreviations that correspond to buildings, lots, areas, etc., throughout your facility. 
    (iii) A description of dikes and other safeguard measures for storage locations throughout your facility.  
12. Under EPCRA Section 324, you may choose to withhold from disclosure to the public the location information for a specific chemical.  If you choose to withhold the location from disclosure to the public, you must clearly indicate that the information is "confidential."  You must provide the confidential location information on a separate sheet from the other Tier II information (which will be disclosed to the public), and attach the Confidential Location Information Sheet to the other Tier II information.  Indicate any attachments you are including.
13. You may provide additional reporting.  For example, if your state or local agencies require you to provide inventory information on additional chemicals or if you wish to report any hazardous chemical below the reporting thresholds specified in the federal regulations in 40 CFR §370.10, check the appropriate box.

Tier II Reporting FAQs  |  2012 Amendments to EPCRA