Local Emergency Planning Committee Chairpersons Contact Information Update Form

Notification of Change for Local Emergency Planning Committee Chairpersons' Contact Information

The following form should be submitted whenever there is a change in a town's Local Emergency Planning Committee Chairpersons' contact information.
Information submitted using this form will be available to the public unless otherwise noted in the comments section of the form.

Use the tab key to move between fields. Before submitting your request, please check your entries.
(** Identifies Required Field)

Local Emergency Planning Committee (LEPC) Information
Municipality**
Street Number/Name and/or PO Box
Town/City
State
Zip
Phone # (include area code)
Appointed LEPC Chairperson Information
Chairperson Name**
Chairperson Title (LEPC Chair, Fire Chief, Emergency Management Director, etc.)
Chairperson Mailing Address
Street Number/Name and/or PO Box
Town/City
State
Zip

Telephone (include area code)**
Alternative Telephone (include area code)
Fax # (include area code)
E-mail**	(If you do not have an e-mail address, please enter Not Available)
Comments
Do you collect Tier II Reports?	Yes No
Please check your entries before submitting form. NOTE: After submitting this form, the First Selectman, Town Manager or Town CEO must send an appointment letter to SERC indicating the official date and appointment of LEPC Chairperson.

If your browser is unable to process this form:

Email your updated contact information to: dep.ctepcra@ct.gov
Or, print this page, fill it out and mail it to:

SERC c/o
DEEP Emergency Response and Spill Prevention Division
79 Elm Street, 4th Floor
Hartford CT 06106-5127

Local Emergency Planning Committees