SARA Title III

COMMUNITY RIGHT-TO-KNOW DATA TABLE
INFORMATION FORM

Print & fill out the form. Mail or fax CEPAC.
TO FAX: (614) 645-7342
TO MAIL: CEPAC, 240 Parsons Ave., Columbus, OH 43215
E-MAIL as an attachment to: jerryp@columbus.gov
For questions call : (614) 645-6275

Name of Facility: ____________________________

Address: ____________________________________

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Information Needed

_____ List of chemicals at this site defined as Extremely Hazardous.

_____ List of hazardous chemicals at this site.

Are there other questions about this company's chemicals that you would like to have answered?

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The CEPAC Public Information Office will not charge a fee for the first 20 pages. There will be a 5 cent charge for each page thereafter.