F110.01

Appropriation Request Review Checklist

ENVIRONMENTAL, SAFETY AND HEALTH

APPROPRIATION REQUEST REVIEW CHECKLIST

Does this involve adding new equipment, duct work or piping, change in a process, addition of a new chemical (e.g. calibration, solvent, touch up paint, new lubricant or refrigerant), new procedure or modification in an existing procedure, software, and maintenance, management or training program?

  • Yes – Proceed with completing this checklist
  • No - Done

Are the changes identical or replacement in kind?

  • Yes - Done
  • No - Proceed with completing this checklist

This is a chemical (pure or as a component in an article) that will pass though the equipment or piping or ductwork or process?

  • Yes - Has the MSDS for this chemical (or component in an article) been obtained and reviewed?
  • Is it available for personnel? YesProceed with completing this checklist
  • No - Stop - obtain the MSDS before continuing this review.

Is the chemical or component an Extremely Hazardous Substance?

See 40 CFR 355 Appendix A

  • Yes – Will we exceed the TPQ or 500 whichever is less on an annual basis?
  • Report to LEPC and SERC in 60 days the name of the chemical.
  • Report to LEPC and SERC in 90 days name and hazard category.
  • No - It is a hazardous substance.
  • Proceed with completing this checklist

Will the inventory of above chemical at any time be greater that the thresholds listed above or greater than 10,000 pounds?

  • Yes - Report to LEPC, SERC and FD by March 1 of the next year.
  • Proceed with completing this checklist

Is the chemical a Toxic Release Inventory Chemical?

  • Yes - Will the plant manufacture or process 25,000 pounds annually of the material or otherwise use 10,000 pounds of this chemical Proceed with completing this checklist
  • Yes – Report on TRI Form by July 1 Proceed with completing this checklist , Proceed with completing this checklist
  • No – Proceed with completing this checklist

Is chemical or product regulated or does it require licensing by DEA, BATF, FDA, NRC, TSCA?

  • Yes or don’t know - Call Regulatory Affairs
  • No – Proceed with completing this checklist

Is the product to be imported or exported?

  • Is it to be transported by Fisher?
  • Does it require special
  • Packaging?
  • Storage?
  • PPE?
  • Yes – Call Regulatory Affairs
  • No – Proceed with completing this checklist

Will this chemical enter the environment (water, air, land)?

  • Air - Yes?
  • Is the chemical a volatile organic chemical or a hazardous air pollutant?
  • Volatile Organic Compound
  • Hazardous Air Pollutant
  • Particulate matter
  • Other air contaminant
  • Will the chemical exit though a duct, pipe hole in a wall, or emission stack to the outside or inside air?
  • Yes - does an existing air permit cover this source?
  • Yes - If this chemical is not on the permit, the existing permit must be modified prior to using this chemical.
  • No - A permit to construct is required unless exempted by agency. A letter to agency requesting their agreement to the exemption will be required. Must receive written notification that the agency agrees with the exemption.
  • An industrial hygiene evaluation needs to be made before the exhaust can be vented in work place environment.
  • Water - Yes?
  • Yes - Sanitary Sewer?
  • Prepare letter to inform sewer authority the amount of chemical that will be discharged to them and a copy of the MSDS for their acceptance.
  • Yes - Storm Water? Stop Process discharges are not permitted in the storm water.
  • No - Proceed with completing this checklist
  • Solid Waste
  • Industrial (Special Waste)
  • Hazardous Waste
  • Universal Waste
  • Waste oil
  • Document the results of the analysis or by using knowledge on a Waste Determination Sheet.
  • Land - Yes?
  • Proceed with completing this checklist

What is the appropriate technology to dispose of the material?

Where will the material be disposed?

What is the cost to dispose of the material?

  1. Checklist completed by facility manager/ plant engineer:

Date:

Signed:

  1. Reviewed by on-site Regulatory Affairs/ Regional ESH Manager:

Date:

Signed:

  1. Reviewed by Site Controller:

Date:

Signed:

  1. Reviewed by Corporate Regulatory Affairs (required for AR’s >= $100K):

Date:

Signed:

  1. Reviewed by VP Finance:

Date:

Signed:

Rev. # Mandatory Discretionary 

Effective Date: August 2004Page 1 of 3