Hazardous Materials Inventory Statement EXAMPLE DOCUMENT ONLY by AprilY


									                               HAZARDOUS MATERIALS INVENTORY STATEMENT
                                      “EXAMPLE DOCUMENT ONLY”
  Note: All submittals must utilize the format shown within this example when submitting for any hazardous materials inventory review.

Business Name:                                                            Qualified
Business Owner
Telephone:                           Fax:

The following information shall be submitted for determination of occupancy group classification. A change of occupancy may occur
based on the type and amount of materials being stored within the structure. Please indicate individual class i.e., I, II, II, IV, V, 1, 2, 3, 4
using the detailed listing of the both the physical and health hazards regulated by the International Fire Code at the bottom of this table.)

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