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CERS Consolidated Emergency Response / Contingency Plat RNAL FACILITY EMERGENCY COMMUNICATIONS 01 , ALAR vi NOTIFICATION WILL OCCUR BY (Check all that apply): C I L 1 . VERBAL WARNINGS; [32. PUBLIC ADD SS OR INTERCOM SYSTEM; ❑ 3 . TELEPHONE; ❑ 4. PAGERS; ❑ 5. ALARM SYS ❑ 6. PORTABLE RADIO NQflIFICATIONS TO NEIGHBORING FACILITIES THAT MAI BE AF FECTED BY AN OFF-SITE RELEASE WILL OCCUR BY (Check all that apply): C12. 1 . VERBAL WARNINGS; ❑ 2. PUBLIC ADDR 3SS OR INTERCOM SYSTEM; ❑ 3. TELEPHONE; ❑ 4. PAGERS; ❑ 5 . ALARM SYS ❑ 6. PORTABLE RADIO EMERGENCY COORDINATOR CONTACT INFORMATION: c13. PRIMARY EMERGENCY COORDINATOR NAME:bt)O LA PHONE NO.: 1 � PHONE NO.::' 71 ALTERNATE EMERGENCY COORDINATOR NAME: )4&k C PHONE NO -4Z j� 3 PHONE NO 20 'BIZ "31 Check if additional Emergency Coordinator contact and address orma on is available onsite or by calling PHONE NO.: Note: If more than one alternate emergency coordinator is designat xi, attac a list in order of responsibility. IL Do EMERGENCY CON NT AND CLEANUP PROCEDURES ' Check theapplicable boxes to indicate our facility's procedures fo con s ills and preventing, and miti aM releases, fires and/or explosions. I . MONITOR FOR LEAKS, RUPTURES, PRESSURE BUIL UP, ET .; Dl. ®"2. PROVIDE STRUCTURAL PHYSICAL BARRIERS (e.g., rtable spill containment walls, built-in berms); gPROVIDE ABSORBENT PHYSICAL BARRIERS (e.g., Pw s, spill I ligs, spill pillows); 4. COVER OR BLOCK FLOOR AND/OR STORM DRAINS; ❑ 5. LINED TRENCH DRAINS AND/OR SUMPS; V'6. AUTOMATIC FIRE SUPPRESSION SYSTEM; ❑ 7. ELIMINATE SOURCES OF IGNITION FOR FLAMMAB S; V8. STOP PROCESSES AND/OR OPERATIONS; �9. AUTOMATIC / ELECTRONIC EQUIPMENT SHUT-OFF I YSTEM ; FRr10. SHUT OFF WATER, GAS, ELECTRICAL UTILITIES; 1 . CALL 944 FOR PUBLIC EMERGENCY RESPONDER A fSISTA1 ICE AND/OR MEDICAL AID; . NOTIFY AND EVACUATE PERSONS IN ALL THREATS qED D/OR IMPACTED AREAS; 13. ACCOUNT FOR EVACUATED PERSONS IMMEDIATEL AFTE EVACUATION; ❑ 14. PROVIDE PROTECTIVE EQUIPMENT FOR ON-SITE EM 3RGENRESPONSE TEAM; REMOVE CONTAINERS AND/OR ISOLATE AREAS; L�'11�6. HIRE LICENSED HAZARDOUS WASTE CONTRACTOR 17. USE ABSORBENT MATERIAL FOR SPILL CONTAINME u; ❑ 18. VACUUM SUCTION USING APPROPRIATE VACUUM ( g.,In ically safe) FOR SPILL CONTROL AND/OR CLEANUP; j �9. DECONTAMINATE PERSONNEL AND EQUIPMENT WI D IGNATED AREA AND DISPOSE OF WASTEWATER AS HAZARDOUS WASTE; [�20. PROVIDE SAFE TEMPORARY STORAGE OF HAZ S WA TE GENERATED DURING EMERGENCY ACTIONS; ❑ 21 . OTHER (Specify): D2 E. FA MILLI Y EVACUATION THE FOLLOWING ALARM SIGNAL(S) WILL BE USED TO BE IN EV14 CUATION OF THE FACILITY (Check all that apply): Et . ❑ 1 . BELLS; E2. Cj 2A HORNS/SIRENS; 93. VERBAL (i.e., Shouting); ❑ 4. OTHER (Specify): j THE FOLLOWING LOCATION(S) WILL BE USED FOR ANE GEN ASSEMBLY AREA(S) (e.g., Parking lot, street comer): E3. ii Note: The Emergency Coordinator must account for all onsite em to s and risitors after evacuation. EVACUATION ROUTE S AND ALTERNATE EVACUATION RO JTES A RE DESCRIBED AS FOLLOWS: E4. I ❑,l . WRITTEN PROCEDURES DESCRIBING ROUTES, EXITS, A. EMBLY AREAS; 4 2. EVACUATION MAP( ) D PI G ROUTES,Ste, IXITS, A ASS Y AREAS; E3 . OTHER (Specify): OLtA-t t 0 (1 PA �} Es. Note: Evacuation procedures and/or maps should be posted in visible acility 1 tions and must be included in the Contingency Plan. F. ARRANGEMENTS f OR EMERGENCY SERVICES ADD CE ARRANGEMENTS FOR LOCAL EMERGENCY SERI ICES (( beck one of the following): Fl. L/J 1 . HAVE BEEN DETERMINED NOT NECESSARY; ❑ 2. THE FOLLOWING ARRANGEMENTS HAVE BEEN MAD (Specify): F2. Note: Advance arrangements with local fire and police departments, spitals, state and local emergency response teams, and/or emergency services contractors should be made for your facility, if necessary. Large Quai tity Gen rators must describe arrangements in the Contingency Plan. Rev. 03/07/17 Pagre 2 of 4