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SARA Title III Release Report

  1. Is Chemical on 302 List?
  2. Is this a reportable release?
  3. Has the NRC been notified?
  4. Was any private contractor contacted to handle the release?
  5. Attach the following to the report: Any known or expected acute or chronic health risks associated with the release and advice regarding medical attention for exposed individuals

  6. CERTIFICATION: I CERTIFY UNDER THE PENALTY OF LAW, THAT I HAVE PERSONALLY EXAMINED AND AM FAMILIAR WITH THE INFORMATION SUBMITTED AND BELIEVE THE SUBMITTED INFORMATION IS TRUE, ACCURATE, AND COMPLETE.

  7. Leave This Blank:

  8. This field is not part of the form submission.