Okaloosa County BOCC — November 18, 2014 — REVISED Okaloosa HA Agreement 2014-15 — reading text

Physical State and Quantity Tab) Vulnerability Analysis (CAMEOfm Scenarlo Page) (for éach Extremely Hazardous Substance on site)‘ Enter maximum amount in largest container or interconnected containers in the Amount Released field (Scenario Description tab) Enter the concentration percentage in the Concentration field {Scenario Description tab) Enter Release Duration (10 minutes for gases, solids in solution or powders; no entry for liquids is required) (Scenario Description tab) Determine the natural Physical State (specified in CAMEO Chemicals) and enter into the Physical State field (Scenario Description tab) Weather Information - Use the weather default settings or enter average wind speed {don’t enter a value In the Wind From fleld) and Urban or Forest Is recommended in the Ground Roughness field, (Scenario Description tab) Risk Assessment - Rate the Risk, Consequences and Overall Risk of a release occurring {based upon release history & malntenance etc.} (Scenario Description tab) Extent of Vulnerable Zone {CAMEO automatically calculates Threat Zone Radius when Edit button and Estimate Threat Zone Radius buttons are used} (Scenario Description tab) Enter estimate of Total Exposed Population (Notes Tab on Scenario Page{s}} Enter Critical Facilities {name of critical facility(s) and max occupancy for each; If none, state No Critical Facilities} (Notes Tab on Scenario Page{s}} On-Site Visits (for each Facility and within the Contract Period) -.:: Site Vislt Certification Form (Attached to Site Plan Tab on Facility Page) {file name must contain at minimum the SERC number if applicable and SV —if SERC number Is not available facility name and SV — additional Info allowed but not required,} Site Plan (Attached to Site Plan Tab on Facility Page) {flle name must contain at minimum the SERC number If applicable and SP — if SERC number is not available the facility name and SP — additional info allowed but not required.} Sufficient Detail to Identify: Location of Major Building(s) Name and Location of Extremely Hazardous Substance(s) {if extremely hazardous materials are co-located, noting EHS is acceptable) Name and Location of Street(s) Identify Pertinent Access and Egress Points Note Additional Features Pertinent to Hazardous Materials and Medical Response All data shall be submitted electronically via CAMEOfm version 3.0.1 in a .zip file format. 33 Attachment J °”. PLORIDA STATE EMERGENCY RESPONSE COMMISSION FORT HAZARDS ANALYSIS SITE-VISIT ‘CERTIFICATION FORM » Facility Name (Please print) Street Address, City & Zip Code (Please print) County (Please print) Name of Facility Representative (Please print) Facility Representative Signature Site Visit Date Site Visit Performed by (Please print) Signature - Site Visit Date The individuals signing above certify that a hazards analysis site visit was conducted on the above date. Notes: Ol Check if facility representative was informed about using E-Plan (httos://erplan.net/eplan/login.htm)} for EPCRA on-line filing 34 Attachment K STATEMENT OF DETERMINATION Facility Name Physical Address (Street only) City County LEPC District | have determined that this facility is / is not subject to the following section(s) of EPCRA, Title'Ill, for the reporting year(s) Indicated {circle all applicable): SECTION 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 302 / 303 Y/N_L Y/N LE Y/N | Y/N | Y/N | Y/N | Y/N | Y/N | Y/N | Y/N | Y/N 311/312 Y/N UL Y/N | Y/N | Y/N | Y/N | Y/N | Y/N | Y/N | Y/N [| Y/N [| Y/N 313 Y/N Y/N | Y/N | Y/N | Y/N [| Y/N | Y/N [| Y/N | Y/N | Y/N [| Y/N If “No” was indicated on any of the above, please check appropriate box(s) why: Sections Extremely Hazardous Substances (EHSs) are / were present only,in amounts less than established 302/303 Threshold Planning Quantities (TPQs), No EHSs are Present. No EHSs were present on-site during the year. Sections Hazardous chemicals/EHSs are/were present only in amounts below established reporting thresholds. 314/342 No hazardous chemicals/EHSs are/were present. No hazardous chemicals were present on-site during the year. Section Not within covered SIC Codes. 313 Within covered SIC Codes, but less than ten (10) employees. Within covered SIC Codes, but no Section 313 chemicals were present or were below Section 313 reporting thresholds. Other Closed facility Chemicals removed Chemicals reduced. below | Date Effective: YES/NO YES/NO threshold/TPQ YES/NO New Facility. Date chemicals brought on site meeting / exceeding TPQ: Further explanation if necessary: CERTIFICATION: | understand the requirements of the law(s) circled above. | also understand that ultimate compliance responsibility lies with me and failure to comply, if required, can result in civil and criminal penalties under federal land state laws. Name of owner / operator's authorized representative (printed): Official Title (printed): Signature: [Date signed: 35