8 CAR pt. 100, Appendix A
NAME OF EMPLOYER: ____________
CONTACT PERSON: _______ PHONE: _____
WORKPLACE LOCATION: ____________
MAILING ADDRESS: ____________
CITY AND ZIP CODE: ____________
List below each hazardous chemical used, generated, or stored in the workplace in an amount equal to or greater than fifty-five (55) gallons or five hundred (500) pounds. Fill in the appropriate information in each of the listed columns. If you have any questions contact the Arkansas Department of Labor at 682-4522.
| Chemical Name or Common Name Used on the MSDS or the Container Label | CAS Number (if on the MSDS) | Location of the Chemical in the Workplace | Amount Present |
|---|---|---|---|
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10.
(If more space is needed use an additional form.)
Return the completed list to:
Mike Watson Division of Labor Arkansas Dept of Labor and Licensing Public Employee Right to Know 900 West Capitol Avenue, Suite 400 Little Rock, Arkansas 72201