HMPC Application 2008 Blankform-New Logom

PleasemailHMPCApplicationto:

Support Services

Administrative Coordinator

Metropolitan Sewer District 700 West Liberty Street Louisville, KY40203

For MSD Use Only

Company#PlanExemption

Inspector

Received Date Fee Amount Paid

PLAN APPLICATION

HAZARDOUS MATERIALS USE AND SPILLPREVENTION CONTROL(HMPC)PLAN

A.GENERALINFORMATION

A1.Business Name:

Street Address: City:

Telephone:()-

State:

Fax:()-

Zip:

Servicing Fire Department: A2.Corporate Name:

CorporateHeadquartersAddress: City:

State:

Zip:

Telephone:()-

Fax:()-

A3.Describe nature of businessatthissite:

Standard Industrial Classification(SIC)Code(s)(Ifknown):

North American Industry ClassificationSystem(NAICS)Code(s)(Ifknown): Days and Hours of Operation:

A4.Local Owners and Managers:

Name:Title: Email: Mailing Address:

City: Telephone:()-

State: Fax:()-

Zip:

Name:Title: Email: Mailing Address:

City: Telephone:()-

State: Fax:()-

Zip:

A5.Indicate Two or More PersonstoContactinanEmergency:

NameTitleBusiness PhoneEmergency PhonePager

B.HAZARDOUS MATERIALS LOCATIONANDDESCRIPTION

B1.Do you store, handle, or process anypetroleumproducts(gasoline,diesel fuel, oil, etc.) on site in excess of 55 gallons?

B2.Do you store, handle, or process any corrosive, explosive, ignitable, radioactive,orreactivehazardousmaterialsonsiteinquantitiesof100 pounds or greater?

B3.Do you store, handle, or process any materials listed in the enclosed Appendix A in excess ofthe listed reportable quantity?

DYesDNo

For assistance answering questionsB1,B2,orB3,pleasecontact your assigned Emergency Response PretreatmentInspector(ERPI).Refertothelastsentenceofyourcoverlettertofindoutwhoisyour ERPI.For assistance determining who your ERPIis, please contactMSD’sIndustrialWaste Department at 540-6939.

B4.If you answered“No”to questions B1, B2, and B3; you may qualify for an Exemption fromthe HMPC Program.Having an approved Exemption does not relieve your company from the HazardousmaterialsOrdinancereportingresponsibilities.IF YOU HAVEASPILL OF ANY HAZARDOUS MATERIAL TO THE ENVIRONMENT OR DRAIN, 911 MUST BE

NOTIFIED IMMEDIATELY. PleaseskiptosectionEonPage6.

B5.If you answered “YES” to any of questions B1,B2 or B3, you must fill out the entire HMPC plan and submit a fee accordingtothefollowingschedule.Thisisaonetimefeeonly.If you are submitting an updated plan and you paid the feewithyourinitialapplication, no fees are due at this time and please continue to B6.

1-4 employees / $25.00 / 5-9 employees / $50.00
10-24 employees / $75.00 / 25-49 employees / $100.00
50-99 employees / $150.00 / 100-499 employees / $250.00
500-999 employees / $500.00 / >999 employees / $750.00

If you are submitting a check, please make checks payable to Metropolitan Sewer District. If you prefer to pay with a credit card, MSD acceptsVisaandMastercard.Please call

(502)587-0603togiveyourcardinformation

Please continue with question B6.

Nonlistedmaterialsthatexhibitcharacteristichazards(corrosive,etc.)haveareportablequantity of 100 pounds. PleaseseeAppendixAlocatedonthelastpageofthispamphlet.

Please make copies ofthe Attachment A and fill out one sheet for each hazardous materials storage area.(Refertotheinstructionsforadefinitionofahazardousmaterials storage area).

B7. Required Maps (See instructionsforinformationaboutmaps).

Please mark each hazardous material storage location on the map provided to you by MSD.The map should be numbered consecutively starting withthe number 1 listing the hazardous materials storagelocationsonsite.Foreachnumberon themap,thereshouldbeacorrespondingHazardous Materials Inventory Data Entry Form (AttachmentA). Please see B7 on page 14 for more information.

C.EMERGENCYRESPONSETRAININGPROCEDURES

C1.Emergency ProceduresPosting

InaccordancewiththeHazardousMaterialOrdinance, you must post a simplified Emergency ResponseProcedure(AttachmentC).The Hazardous Materials Ordinance requires immediate notification to 911 in the event ofaReportableQuantity.Your AttachmentC must include procedures to notify 911.AnexampleisincludedintheSampleHMPCPlan. Pleaselistthelocationswherethisisposted atyour facility.(Example:time clock, storage locations, etc.) Please include a copyofAttachment C with your Plan submittal.

C2.Employee Training

TheHazardousMaterialOrdinancerequiresaninitial and on-going safetyand accident prevention training programfor allemployees.Describetrainingprovided to employees: (e.g. proper handling, spill response procedures, evacuation procedures, emergency procedures, first aid, spill cleanup, equipment handling, etc.)

HAZARDOUS MATERIAL SPILL PREVENTIONCONTROL MEASURES

D1.List Spill Response suppliesandequipmentatthefacilityandidentifylocation(e.g.fire fighting equipment, materials to neutralize chemicals,sorbentmaterials,sandbags,floor drain mats, or other materials for blocking surface drainage ditches, etc.).

D2.Describe the measures taken to ensure safeseparation and protection of material, measures to prevent spills (operational procedures, equipmentsafeguards,corrosionprotection,etc.),spill detectionmeasures(airmonitoringdevices,pHmeters,levelsensors andalarms, etc.), and containment and flow control measures (dikes,berms, valves, absorbent materials, etc.). Also,describemeasurestakentoinsuresafeseparation of stored materials fromfactors that may cause fire or explosions.

D3.Describesecuritymeasureswhenthefacility is not open for businesstoensureprotection fromhazardous materials releases (e.g. remote alarms, fire protection systems, security guard services,watchperson,etc.).

D4.Arehazardousmaterialsstoredinanyareasof your facility that are prone to flood?Please identifyand list these areas below.Describe measures taken to prevent a release in theevent of high water.

E.Owner/ManagerCertification

The attached HazardousMaterials Spill Prevention andControlPlan(HMPC)orExemptionRequest for this business, will beimplemented as herein described.IherebycertifythatIamresponsiblefor the operation of the above named facility and have described all hazardousmaterialskeptonsitein amountsgreaterthantheReportableQuantitiesspecifiedbyMSD/Federalregulations.

Owner/ Manager Name:

Company Name:

Title:

Owner/Manager Signature:Date:

NOT REQUIRED.IFYOURPLAN WAS FILLED OUTBYA PROFESSIONAL ENGINEER, PLEASE FILL OUTTHE FOLLOWING SECTION.

P. E. CERTIFICATION

I have examined the named facility and, to the bestofmyknowledgeandbelief,thisHazardous Materials Spill Prevention and Control (HMPC) Plan has been prepared in accordance with provisions oftheMSDHazardousMaterialsSpillPreventionregulations and in accordance with good engineering practices.

Printed Name of Registered Professional Engineer

Signature of RegisteredProfessional Engineer

(seal)

Registration NumberState

Date

Industrial Waste Information System

HazardousMaterialsInventory DataEntryForm

AttachmentA

Date Completed:

Company #:

Company Name:

Location#:

Description:

Containment Type:

Description:

Spill Remediation:

Materials:

MixtureName / CAS
# / StorageType / ContainerDescription / Maximum
Storage Quantity (Lbs.) / Material Components (See Example) / %
ofTotal Amount

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INSTRUCTIONS

Louisville Jefferson County Metropolitan Sewer District HazardousMaterialSpillPreventionControl (HMPC) Plan Application

INTRODUCTION

TheLouisvilleandJeffersonCountyhaveadoptedaHazardousMaterialsOrdinance(HMO) requiring that businesses which manufacture, use, or store hazardous materials on their business site submitaplantopreventspills.TheHazardousMaterialsUseandSpillPreventionControl(HMPC) Planmustbepreparedwhen minimumdesignated quantitiesofhazardous materials are regularly stored at the business site. The Louisville andJeffersonCountyMetropolitanSewerDistrict(MSD) serves as thelead agencyin the administration ofthe Ordinance. HMPC Plans which are submitted to MSD will be shared with the Department ofPublic Health and the FireDepartmenthaving jurisdictionoverthe facility.

Hazardousmaterialsmaybegenerallyconsidered to be substancesinaquantityandform,which,if released, can be harmfulto life,property,ortheenvironment.The range ofmaterials encompassed bythisdefinitionincludesexplosives,flammable and combustibleliquidsandsolids,poisonsand toxic substances, oxidizing or corrosive materials, and compressed gases.In recent years, hazardous material spills have caused or threatened to causeserious problems to the environment of Louisville and Jefferson County. New hazardous substances arecontinuouslybeingdevelopedandeachyear greater volumes are produced and/or transported through the community.The purpose of an HMPC Planistobecertainthatbusinessesarepreparedtocopewithspillswhichoccasionallyoccurandto abet the objective of protecting the community’shealthandenvironment.

WHO MUST PREPARE AN HMPC PLAN

Two questions must be asked to determine if an HMPC Plan will be necessary fromyour business:

1.Do you regularly have hazardous materials on your businesssite? Manybusinesses do, but take themfor granted because of unfamiliarity withthe hazards associated with some materials.

2.Doyouhavequantitiesofhazardousmaterialsatyourbusinesssitelarge enough to require preparationofanHMPCPlan? In the MSD regulations, whichhavebeenadopted,these minimumquantitiesaredesignatedas“ReportableQuantities.” The Reportable Quantities (RQs) varyfordifferentmaterialsaccordingtorelativehazard.

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SectionB in the instructions should be read closely to determine if your business must complete an HMPC Plan Application. QuestionsonspecificmaterialsandRQs should be directed to MSD. Unless a business facilityhas both a hazardous materialandtheregularoccurrenceofminimum ReportableQuantitiesonitsbusinesssite,the owner does not need to file an HMPC Plan Application. However, if a businesscontactedbyMSDbelievesanHMPCPlanisnotnecessary,a Request for Exemption fromthe HMPC filing requirementmustbefiled.Ifyouarerequestingan Exemption fromfiling an HMPC plan, please follow the directions on Page 2, Section B4.

SPECIFIC EXEMPTIONS BYORDINANCE/ REGULATION

Thefollowingpersonsorbusinessesareautomaticallyexemptbyordinancefromhavingtoprepare an HMPC Plan:

1.Personswhohandleagriculturalchemicals inthe ordinarycourse of agricultural operations otherthanwarehousingorbulkstorageofsuch chemicals for resale or commercial application.

2.Personswhohandlehazardousmaterialsotherwise regulated only at temporary construction sites.

3.Personswhohandlehazardousmaterialsonlyinconjunction with residential use ofproperty for non-commercial purposes.

4.Ingredients for consumer products and food stuffsdirectlypackagedfordistributiontoand intendedforusebythegeneralpublicwhichareregulatedbytheFederalFoodDrugand Cosmetic Act.

5.Retailsalesbusinesses,exceptaportionofthebusinessthatusesbulkstorageincontainers whose size exceeds the Reportable Quantity standard.

6.Liquor stores.

7.Persons who do not handle hazardous materials in quantities equaltoorgreaterthanthe reportable quantities unless the administering agency finds it necessary to require an HMPC plan to protect the health and safety.

Businesseswhichclaimanexemptionforanyofthe abovereasonsmustcompletePages1,2 & 6.The facilitywillbeinspectedbyanMSDinspectortoverifyapprovalofthesubmittedexemption.

SCHEDULE FOR HMPC PLANSUBMISSION

Businesses,whichforsomeunforeseenreasonareunabletomeetthescheduledsubmissiondate, may request a 30 day delay in submission. This request must be submitted prior to the due date and will only be allowedonce.

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SPECIFICINSTRUCTIONS

GENERALINFORMATION

A1.FACILITY BUSINESS NAME/ADDRESS

Please fill out Business Name and General Information for your facility.

A2. CORPORATE BUSINESS NAME/ADDRESS

If operation of your business is legally the responsibility ofa corporation, indicate the name of that corporation and the home office headquarters address of the corporation.If ownership is not with a national corporation, indicate NONE.

A3.NATURE OF BUSINESS

Describethetypeofbusinessoccurringatthissite and the days of the week and hours of operation.Examplesofbusinesstypearemanufacturing, wholesaling, retail sales, consulting, etc.Describe the type of goodsmanufactured,storedorsoldwith thisbusiness.Indicatethe Standard Industrial Classification (SIC) orNorth AmericanIndustry ClassificationSystem(NAICS) Code, if it is known. SIC codes maybefoundintheStandardIndustrial Classification Manual andNAICScodesmaybefoundintheNorthAmericanIndustryClassification SystemManual.Formoreinformationonthese codes, please visit the Internet at and

A4.LOCAL OWNERS AND MANAGERS

Complete the name, phone number, and addressofpersonswithlocalownershipor managementresponsibleforthebusiness.

A5.INDICATE TWO OR MORE PERSONS TO CONTACT IN AN EMERGENCY

The names of two or more personstocallinanemergencyshouldbeindicatedalongwiththeir emergencyphonenumbers(cellphone,pagers,etc.).Thesenumbersshouldbeusedforcontact after non-working hours. These persons are assumed to have decision making responsibilities in the event of a hazardous material release thatoccurs at site.They should be familiar with the operations at the site, know personnel availableto respond toa hazardous material release and beabletomakedecisionsintheeventofinquiriesbypolice,fire or emergency response teams.

B.HAZARDOUSMATERIALSLOCATION ANDDESCRIPTION

INTRODUCTION

Thissectionwilldetermineifyourfacilityisrequiredtoprepare an HMPC plan or if you may qualify for an Exemption fromthe HMPC plan filing requirement.Thedeterminingfactoriswhetherornotyou use,store,manufacture,orprocessaReportableQuantity(RQ)ofa hazardous material.A definition of hazardousmaterialandreportablequantitycanbefoundbelow.

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DETERMININGREPORTABLEQUANTITIES

To make this determination, you mustanswerquestionsB1,B2andB3.

B1.Pleasedetermineifyoustore,handleorprocess any petroleumproducts, such as gasoline, dieselfuel,heatingoil,wasteoil,etc.,onsiteinquantitiesof56gallonsorgreaterandcheckthe appropriateboxontheform.

B2.Pleasedetermineifyoustore,handleorprocessanyhazardousmaterialsonsiteinquantities equal to or greater than the listed Reportable Quantity for those materials greater andcheck the appropriateboxontheform.Pleaserefertothe AppendixA,locatedonthe last page of this pamphlet, to assist you in making this determination.

B3.Pleasedetermineifyoustore,handleorprocessanycorrosive, explosive, ignitable, radioactive, or reactive hazardous materials on site in quantitiesof100poundsorgreaterandcheckthe appropriateboxontheform.Forthisstep,youdonotneedtoconsidermaterialslistedin AppendixA.Doesthismaketheexamplesobsolete? Maybe too specific? Please refer to the accompanying definitions and list ofexamples below to assist you in making this determination.

DEFINITIONS

HAZARDOUS MATERIALS

A hazardous material is a substance,whichifreleased,canbeharmfultolife,propertyortothe environment. Some of the more common examples of Hazardous MaterialsarelistedonPage12. PleaseseeAppendixA,locatedonthelastpage, for a more comprehensive list of specific HazardousMaterials.

Please note that Appendix A is notacompletelistofallHazardous Materials.Any material that is not listed in AppendixA that exhibits the characteristic ofcorrosivity, explosivity, ignitability, radioactivityor reactivityshall be considereda Hazardous Material withaReportableQuantityof 100 pounds.

CORROSIVEMATERIALS

Corrosive materials and/or wastes are substances,which react chemically.They are generally water based with strong acid (pH less than 2.0) or base (pH greater than 12.5).

EXPLOSIVEMATERIALS

Includesexplosivematerialsthatdetonateinstantaneously (High Explosives), deflagrate (Low Explosives) and modified high explosives (Permitted Explosives). Explosive materials are generally considered to exhibit the characteristic hazard of reactivity.

IGNITABLEMATERIALS

Ignitablematerialsand/orwastesareliquidswithaflashpointoflessthan140degreesFahrenheit, or flammable gases, oxidizers, or substances which burn spontaneously.

RADIOACTIVEMATERIALS

Radioactivematerials (alpha,beta,andgammaemitters)andtheirisotopes.

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REACTIVEMATERIALS

Reactivematerialsand/orwastes; are substances which are unstableandmayspontaneouslyreact withairorwaterandexplode or generate toxic gases.

REPORTABLEQUANTITY

Materialsdeemedtobehazardousareassignedareportable quantity for the purpose ofrelease reporting requirements. The Louisville andJeffersonCountyHazardousMaterialsOrdinance (HMO)requiresthat 911 be immediately notified in the event of a release of a hazardous material inanamountequaltoorgreater thanthatmaterialsreportablequantity.The HMO also requires immediate notification to911 in the event of a release ofahazardousmaterialinanamountless thanthatmaterialsreportablequantity,ifthe release enters a sewer or stream.

HAZARDOUSMATERIALSSTORAGEAREA

AHazardousMaterialsStorageAreaisdefinedastheareamaterialsarestoredthatisisolatedfrom reaching an environmental receptor bygravity.The area may have one or many primary hazardous materials storage containers. Commonly, a hazardousmaterialsstorageareaissurroundedbya secondarycontainmentstructure.Intheeventthattheentirecontentsofaspilled vessel could not reach an environmental receptor by gravity, the hazardousmaterialsstorageareamaybeadequately protected without a secondarycontainmentstructure.

SECONDARYCONTAINMENTSTRUCTURES

SecondaryContainmentStructuresincludeconcretedikes,metalpans,doublewalltanks,earthen berms,containmentpits,etc.Therecommendedfree volume for a secondary containment structure is 110% of the volume of the largest primary storage container in that storage area.

PRIMARYSTORAGECONTAINERS

PrimaryStoragecontainersaretheactualvesselsin which the materials are stored.They include

tanks,drums,totes,etc.

ENVIRONMENTALRECEPTOR

For the purpose of the HMPC Plan, an environmentalreceptorshallbe consideredapointofentry foraspilledliquidmaterialto flow by gravity toa sewer orstormwater conveyance (catch basin, drainage ditch, stream, river, etc.)

TOXICITY

The ability of a substance to cause damage tolivingtissue,impairmentofthecentralnervous system,severeillness,ordeathwheningested, inhaled, or absorbed by the skin.

For assistance answering questions B1, B2 or B3,please contact your assigned ERPI. Refer to thelastsentenceofyourcoverlettertofindout who is your ERPI. For assistance determining whomyourERPIis,pleasecontactMSD’sIndustrialWasteDepartmentat(502)540-6939.

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COMMONEXAMPLESOFHAZARDOUSMATERIALS

IGNITABLESTOXICSACUTELY TOXIC

AcetyleneAcetoneAldrin

AcrylonitrileAmmoniaArsenicCompounds

GasolineBenzeneCyanide Compounds

KeroseneCreosoteEndrin

PaintFormaldehydeNicotine

PropaneFormicAcidPhenols

SolventsMercuryStrychnine and Salts

ThinnerMetals & CompoundsVanadiumOxide Liquid PetroleumGas (LPG)Toluene

VarnishXylene

CORROSIVESREACTIVESOTHERREG.MAT’LS

Acetic Acid Battery Wastes / Ammunition Blasting Caps / Motor Oil Waste Oil
Hydrochloric Acid / Explosives / Lube Oil
Nitric Acid / Cyanide Compounds / Hydraulic Oil
SodiumHydroxide / Isocyanate / PetroleumBased Products
SulfuricAcid / RadioactiveMaterials

B4.If you answered “NO” to questionsB1, B2andB3, you may qualify for anExemptionfrom the HMPC Program.EvenifyouareexemptfromfilingacompleteHMPCPlan,youmust still complete SectionsA,B andE of the plan application.Your ERPIwill inspect your facility to determine if your facilityqualifiesforanexemption fromthe HMPC Plan.Having an approvedExemption does not relieve you oftheHazardousMaterialsOrdinancereporting responsibilities.IF YOU HAVE A SPILL OF ANY HAZARDOUS MATERIAL TO THE ENVIRONMENT OR DRAIN, 911 MUSTBE NOTIFIED IMMEDIATELY.

B5.If you answered “YES” to any of questionsB1, B2 or B3, you must fill out the entire HMPC plan and submit a feeaccordingtothefollowingschedule.Thisisaonetimefeeonly.If you are submitting an updated plan and you paid thefeewithyourinitialapplication,nofeesare due at this time and please continue to B6.

If you are submitting a check, please make checks payable to Metropolitan Sewer District.Ifyouprefertopaywithacreditcard, MSD accepts Visa and Mastercard. Pleasecall587-0603togive your card information.

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B6.All hazardous materials stored in quantitiesgreater than the Reportable Quantities (RQ) defined in Appendix A of the Ordinance must be identified onthe attachedHazardous Materials Inventory Data Entry Form (AttachmentA).Non-listedmaterialsthatexhibit characteristic hazards have a reportable quantityof100pounds.Pleasemakecopiesofthe Attachment A and fill out one sheet foreachhazardousmaterialsstoragearea.

If hazardous materials are stored inanareathatisisolatedfromenvironmentalreceptors(floor drains, storm drains, stormcatch basins, ditches, creeks,etc.);youmaynotberequiredtohave asecondarycontainmentstructure.Uponinspectionofyourfacility,MSDwillmakethat determination.

For each specific hazardous materials storage area, please list the activities you will performto clean up spilled hazardous materials.This maydifferbetweenhazardousstorageareas.

B7.Uponrequest,MSDwillprovideyouwithamap(Attachment B) of your facility using data fromtheLouisvilleandJeffersonCounty Information Consortium(LOGIC) at You may substitute a copy of your building’s blueprint. Please mark each hazardous material storagelocationonthemap.Themapshouldbenumberedconsecutivelystartingwiththe number 1 listing the hazardous materials storagelocationsonsite.Foreachnumberonthe map, there should be a corresponding Hazardous Materials Inventory Data Entry Form (Attachment A).

C.EMERGENCYRESPONSETRAININGPROCEDURES

C1.You must post a simplified Emergency ResponseProcedure (Attachment C).An example is included in the Sample HMPC Plan.The Hazardous Materials Ordinance requires immediatenotificationto911intheeventof areportablerelease.YourAttachmentC must include procedures to notify 911.Pleaselistthelocations where this is posted at your facility. (Example: time clock, storage locations,etc.)PleaseincludeacopyofAttachmentC with your Plan submittal.

C2.TheHazardousMaterialOrdinancerequiresan initial and on-going safety and accident prevention training programfor all employees.Pleasedescribe trainingprovidedto employees:(e.g.properhandling,spillresponseprocedures,emergencyprocedures,firstaid, spillcleanup,equipmenthandling,etc.)Pleasefeelfree to use the Attachment C example with your company letterhead; however, you may want tocustomize this to fit the needs ofyour facility.

D.HAZARDOUSMATERIALSPILL PREVENTIONANDCONTROL MEASURES

D1.You must list spill responsesuppliesandequipmentatthe facilityandidentifylocation(e.g. firefightingequipment,materialstoneutralize chemicals, sorbent materials, sandbags, floor drain mats, or other materials for blocking surface drainage ditches, etc.).

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D2. You must describe the measures takentoensuresafeseparation and protection of material, measures to prevent spills (operational procedures,equipmentsafeguards,corrosionprotection, etc.), spill detection measures (air monitoringdevices,pHmeters,levelsensorsandalarms, etc.)andcontainmentandflowcontrolmeasures(dikes, berms, valves, absorbent materials, etc.).Also,describemeasures taken to insure safe separation ofstoredmaterialsfromfactors thatmaycausefireorexplosions.

D3. Many businesses will not have an employee atthe siteon a 24-hour basis.Describe any securitymeasureswhichthebusinesshastoinsure protection fromhazardous material releases that occur in non-business hours.These may include remote alarms, fire protection systems, and the presence of a watchman or a security service.

D4. Are hazardous materials storedinanyareasofyourfacilitythatare prone to flood? Please identifyand list these areas below.Describe measures taken to prevent a release in the event of high water.

E.OWNER/MANAGER CERTIFICATION

The Owner of each business or facility must certifythattheyareresponsibleforoperationoftheabove named facility and has described all hazardous materials which are kept on siteinamountsgreaterthan the reportable quantity specified by MSD regulations.It is requestedthat both the Owner’s signature andtheManager’ssignaturebeprovidedonthecertification.Forsmallbusinesses, the Owner’s signature is sufficient.

In some cases, businesses may have a Professional Engineer prepare their plan application. This is not arequirement in submitting an application.However, if a Professional Engineer prepares the application for the facility, please complete the P.E. Certification that is shown on the last page along with the Owners Certification.

CONFIDENTIAL INFORMATION

If you deem any of the information requested in this application as confidential, you must submit two versions of the application; one with all information included which will be locked in a file cabinet and not disclosed by MSD pursuant to the Kentucky Open Records Act and a second version with the information not included.

You must type the following language in the field(s) you deem confidential:

“Pursuant to KRS 61.878 (1) 2c, the following information has been classified as exempt from disclosure under the provisions of the Kentucky Open Records Act.”

You must submit in writing the reasons you deem the information to be classified as confidential and provide an explanation justifying that it constitutes a secret commercially valuable plans, appliances, formulae, or processes, which are used for the making, preparing, compounding, treating, or processing of articles or materials which are trade commodities as per KRS 61.878(1)2C. MSD will not consider your request without this information being submitted. MSD will review the information and notify you of the approval or denial of any or all of the information as confidential.