Form ECY070-305 "Washington State Emergency Response Commission Section 302 & 303 Emergency Planning & Community Right-To-Know (Epcra)" - Washington

Form ECY070-305 is a Washington State Department of Ecology form also known as the "Washington State Emergency Response Commission Section 302 & 303 Emergency Planning & Community Right-to-know (epcra)". The latest edition of the form was released in October 1, 2008 and is available for digital filing.

Download a PDF version of the Form ECY070-305 down below or find it on Washington State Department of Ecology Forms website.

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Download Form ECY070-305 "Washington State Emergency Response Commission Section 302 & 303 Emergency Planning & Community Right-To-Know (Epcra)" - Washington

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WASHINGTON STATE EMERGENCY RESPONSE COMMISSION
Section 302 - Emergency Planning Notification
Section 303 - Facility Representative Designation
EMERGENCY PLANNING & COMMUNITY RIGHT-TO-KNOW
ACT OF 1986
This is a notification that the facility has an Extremely Hazardous Substance at or above the
Threshold Planning Quantity.
A chemical that subjects this facility to Section 302 is:
CAS Number
CHEMICAL NAME
The maximum amount present at one time is:
pounds
Washington Community Right-to-Know Number: ______________________________________
Name of Owner:
Name of Operator:
Name of Business:
SIC Code/Primary Business Activity: ________________
Dates of Notification: SERC:
LEPC:
Fire Dept:
Physical Address:
Mailing Address:
(if different from physical address)
Use a separate form for each facility
Latitude
Longitude
Facility Representative:
Telephone Number:
Name of Person Making Notification:
Title:
Signature:
Date:
SUBMIT TO:
Community Right-to-Know Unit
Department of Ecology
PO Box 47659
Olympia WA 98504-7659
(800) 633-7585 or (360) 407-6178
If you need this form in an alternate format, please contact the Hazardous Substance Information Office at 1-800-633-7585 (voice,
press 2 at the greeting), or1-800-833-6388 (TTY).
ECY 070-305 (09/08)
Print Form
WASHINGTON STATE EMERGENCY RESPONSE COMMISSION
Section 302 - Emergency Planning Notification
Section 303 - Facility Representative Designation
EMERGENCY PLANNING & COMMUNITY RIGHT-TO-KNOW
ACT OF 1986
This is a notification that the facility has an Extremely Hazardous Substance at or above the
Threshold Planning Quantity.
A chemical that subjects this facility to Section 302 is:
CAS Number
CHEMICAL NAME
The maximum amount present at one time is:
pounds
Washington Community Right-to-Know Number: ______________________________________
Name of Owner:
Name of Operator:
Name of Business:
SIC Code/Primary Business Activity: ________________
Dates of Notification: SERC:
LEPC:
Fire Dept:
Physical Address:
Mailing Address:
(if different from physical address)
Use a separate form for each facility
Latitude
Longitude
Facility Representative:
Telephone Number:
Name of Person Making Notification:
Title:
Signature:
Date:
SUBMIT TO:
Community Right-to-Know Unit
Department of Ecology
PO Box 47659
Olympia WA 98504-7659
(800) 633-7585 or (360) 407-6178
If you need this form in an alternate format, please contact the Hazardous Substance Information Office at 1-800-633-7585 (voice,
press 2 at the greeting), or1-800-833-6388 (TTY).
ECY 070-305 (09/08)
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