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Hazardous Chemical Survey

Novi Fire Department
Hazardous Chemical Survey

This survey is requested to determine the quantity of specific chemical groups used, produced or stored in your facility. The Novi Fire Department is required to collect chemical data under the Michigan Occupational Safety and Health Act (MIOSHA), P.A. 154 of 1974, as amended, and the Fire Prevention Code, P.A. 207 of 1974, as amended.

COMPLIANCE WITH THIS SURVEY IS MANDATORY

Business/Project Name
Address/Location
Suite
Mailing Address
Telephone Number
Email
Name of Manager or Owner
Type of Business

IDENTIFY THE TYPE OF HAZARDOUS CHEMICAL USER YOUR FACILITY IS:

This site is: (You Must Check One)



IDENTIFY YOUR HAZARDOUS MATERIALS BY TYPE AND REPORTABLE QUANTITY

 2. Indicate the reportable quantity category for each chemical type on your site based on the maximum quantity at any time.

CHEMICAL TYPE FD HAZARD
CLASS SYMBOL
REPORTABLE
QTY
 
Aerosols Type 2 or 3: AER 500 lbs


Carcinogens (Known Human): CAR Any Quantity


Combustible Fiber
    Loose: CFL 100 cu ft


    Baled: CFB 1,000 cu ft


Combustible Liquids
    Class II: CLII 120 gal.


    Class III-A: CLIIIA 330 gal.


    Class III-B: CLIIIB 10,000 gal.


Compressed Gases
    Toxic: CGT Any quantity


    Corrosive: CGC 810 cu ft.


    Flammable: CGF 810 cu ft.


    Liquefied Flammable: CGLF 30 gal.


    Liquefied Oxidizing: CGLO 15 gal.


    Liquefied Petroleum Gas: LPG 30 gal. individual


Corrisives
    Liquids: CORR 500 gal.


    Solids: CORR 500 lbs.


Cryogenic Liquid
    Flammable: CRYF 45 gal.


    Oxydizer: CRYOX 45 gal.


Explosives & Blasting Agents:
   (Not including Class "C" Explosives)
EXP Any quantity


Flammable Liquds
    Class 1-A: FL1A 30 gal.


    Class 1-B: FL1B 60 gal.


    Class1-C: FL1C 90 gal.


    Combination of Classes: FLCOMB 120 gal.


Flammable Solids: FS 125 lbs.


Highly Toxic & Toxic Materials
    Highly Toxic: HTOX 10 lbs / 20 cf


    Toxic - Solids: TOX 500 lbs / 810 cf


Irritating Materials
    Liquids: IRR 1,000 gal.


    Solids: IRR 500 lbs.


Organic Peroxides
    Class 1: OP1 5 lbs.


    Class 2: OP2 50 lbs.


    Class 3: OP3 125 lbs.


Oxidizer
    Class 1: OXY1 4,000 lbs.


    Class 2: OXY2 250 lbs.


    Class 3: OXY3 10 lbs.


    Class 4: OXY4 Any quantity


Poisonous Gas: POIS Any quantity


Pyrophoric Materials: PYRO 4 lbs.


Radioactive Material: RAD Any quantity


Unstable (Reactive) Material
    Class 2: URM2 50 lbs.


    Class 3: URM3 5 lbs.


    Class 4: URM4 1 lbs.


Water Reactive Material
    Class 2 (Solid): WRM2 50 lbs.


    Class 3: WRM3 5 lbs.


When substantial changes occur in the quantity or type of chemical use, manufacture or related storage, a revised survey must be submitted to the Fire Department. This survey may be followed up with a request for more detailed information. This may include a request for Material Safety Data Sheets, chemical inventory, site plan, and a hazardous materials management plan. The undersigned has read the foregoing hazardous chemical survey and states that all of the facts and information contained are true to the best of his/her/their knowledge.

By checking the box below and entering my name, I attest that I have read the foregoing hazardous chemical survey and states that all of the facts and information contained are true to the best of my knowledge.

  Author's Name

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