hazardous materials business plan requirements · 11022 (c))) a hazardous chemical subject to the...

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Hazardous Materials Business Plan RequirementsStudent Resource Packet

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Hazardous Materials Business Plan Requirements

Table of Contents

Presentation ............................................................................................................... 1 Applicability........................................................................................................... 1 HMBP Overview ................................................................................................... 2 HMBP Submittals ................................................................................................. 3 Employee Training Requirements ........................................................................ 8 Spill Reporting ...................................................................................................... 9

Hazardous Materials Business Plan FAQ ................................................................ 11 Hazardous Materials Business Plan Info Sheet ....................................................... 23


NES g l o b a l . n e t

Hazardous Materials Business Plan RequirementsPresented by Nicholas R. Armstrong

Download Presentation Here:www.nesglobal.net/webinar-downloads

Outline

Hazardous Materials Business Plan (HMBP) Requirements• Applicability• HMBP Overview• HMBP Submittals• Employee Training Requirements• Spill Reporting

Applicability

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Applicability

A business shall establish and implement an HMBP if it meets any of the following conditions:

• It handles a hazardous material (including mixtures containing hazardous materials) equal to or greater than reporting thresholds:

– 55 gallons for liquids

– 500 pounds for solids

– 200 cubic feet for compressed gases

HSC 25507

Applicability

A business shall establish and implement an HMBP if

it meets any of the following conditions (cont.):

• It handles 5,000 pounds of solids or 550 gallons of

liquids that are solely classified as irritants or

sensitizers

HSC 25507

HMBP Overview

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HMBP Overview

• HMBP program established in 1986

• Goal is to prevent potential damage to public health or the environment from the release of hazardous materials

• Requirements outlined in the California Health and Safety Code (HSC) Division 20, Chapter 6.95, Article 1

HMBP Overview

• Statutes enforced by the Certified Unified Program Agency (CUPA)

• Facilitates the requirements of the Federal Emergency Planning and Community Right-to-Know Act (EPCRA)

HMBP Submittals

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HMBP Submittals

Business owner/operator• Facility information

• Business owner information

• Environmental contact

• Emergency contacts

HSC 25505

HMBP Submittals

Business activities• Hazardous materials

• Underground storage tanks

• Aboveground petroleum storage tanks

• Hazardous waste

HSC 25505

HMBP Submittals

Site map• North orientation

• Hazardous materials storage locations

• Gas/water/power shutoffs

• Storm drains

• Streets bordering facility

• Evacuation routes and assembly areas

HSC 25505

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HMBP Submittals

Contingency Plan• Emergency contacts

• Containment and cleanup procedures

• Evacuation procedures

• Emergency equipment

• Earthquake vulnerability

HSC 25505

HMBP Submittals

Training plan• Employees trained on

emergency response and evacuation procedures

HSC 25505

HMBP Submittals

Chemical inventory• Chemical name

• Common name

• Physical state

• Hazard category/categories

• Average daily amount

• Maximum daily amount

• Days on-site

• Largest / type of containers

• Storage location

HSC 25505

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EPA Hazard Categories

Physical• Flammable (gases, aerosols, liquids, or solids)

• Gas under pressure

• Explosive

• Self-heating

• Pyrophoric (liquid or solid)

• Pyrophoric gas

• Oxidizer (liquid, solid, or gas)

• Organic peroxide

• Self-reactive

• In contact with water emits flammable gas

• Combustible dust

• Corrosive to metal

• Hazard not otherwise classified (HNOC)

Health• Carcinogenicity

• Acute toxicity (any route of exposure)

• Reproductive toxicity

• Skin corrosion or irritation

• Respiratory or skin sensitization

• Serious eye damage or eye irritation

• Specific target organ toxicity (single or repeated exposure)

• Aspiration hazard

• Germ cell mutagenicity

• Simple asphyxiant

• Hazard not otherwise classified (HNOC)

HMBP Submittals

California Environmental Reporting System (CERS)Electronic submissions – https://cersbusiness.calepa.ca.gov

HSC 25508

HMBP Submittals

• Annual renewal of HMBP required by March 1st or

locally enforceable renewal date

• HMBPs must be updated within 30 days for

significant changes

HSC 25508.1

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HMBP Submittals

HMBPs must be updated within 30 days for the

following:

• 100% increase in quantity for a previously disclosed

hazardous material

• Handling of any previously undisclosed hazardous

material that equals or exceeds reporting thresholds

HSC 25508.1

HMBP Submittals


following (cont.):

• Change of business or facility address

• Change of business ownership

• Change of business name

HSC 25508.1

HMBP Submittals


following (cont.):

• Any substantial change in the handler’s operations

that would require modifications to the HMBP

– A substantial change is a change that would inhibit

immediate response during an emergency

HSC 25508.1

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Employee Training Requirements

Employee Training

All employees must be trained on:• Safety procedures in the event of a release or

threatened release of a hazardous material

• Notification contacts

• Procedures for mitigation of a release or threatened release of a hazardous material to minimize harm to people, property, or the environment

• Evacuation procedures

HSC 25505(a)(4)

Employee Training

• Training can take into consideration the position of each employee

• Training must be documented

• Training documentation must be made available for a minimum of three years

HSC 25505(a)(4)

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Employee Training Plan

To satisfy HMBP training requirements, program elements are to include:

• Hazardous materials handling and safety procedures

• Response agency coordination procedures

• Emergency response plans and procedures

• Procedures for immediate notification of emergency response agencies, CUPA, Cal EMA, and on-site emergency personnel

• Identification of local emergency medical assistance resources

• Hazard mitigation, prevention, and abatement procedures

• Notification and evacuation procedures

• Identification of facility areas, equipment, and systems vulnerable to earthquakes

• Use and maintenance of emergency response equipment and supplies

HSC 25505(a)(4)

Spill Reporting

Spill Reporting

Upon discovery, any hazardous material release or threatened release must be immediately reported

• Local CUPA or AA

• Cal OES

– 800-852-7550

HSC 25510

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Spill Reporting

When reporting, provide:• Name of caller

• Location, date, and time of release

• Potential for impact to waterways or storm drains

• Hazardous material and amount released

HSC 25510

Thank You

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Hazardous Material Business Plan FAQ

The following information is provided to assist with understanding the Hazardous Material Business Plan program. This information is not to be relied upon as legal advice or interpretation by the California Governor’s Office of Emergency Services (CalOES) or the State of California. It does not create any rights, obligations, or establish any new standards. Local governments often have requirements that are more stringent than state and should be contacted for advice about this program in their area.

Most Frequently Asked Hazardous Material Business Plan Questions

1) What is a Hazardous Material?

State: "Hazardous material" means any material that, because of its quantity, concentration, or physical orchemical characteristics, poses a significant present or potential hazard to human health and safety or to theenvironment if released into the workplace or the environment. "Hazardous materials" include, but are notlimited to, hazardous substances, hazardous waste, and any material that a handler or the unified programagency has a reasonable basis for believing that it would be injurious to the health and safety of persons orharmful to the environment if released into the workplace or the environment (Health and Safety Codesection (Health & Saf. Code sec) 25501 (m)).

State Laws & Regulations: Health and Saf. Code § 25501 (m)

Federal: The federal government defines (Section 11022 (c) of Title 42 of the United States Code (42 USC 11022 (c))) a hazardous chemical subject to the requirements of Title 42 Section 11022 as any hazardous chemical for which a material safety data sheet or a listing is required under 42 USC 11021.

The federal government defines (40 Code of Federal Regulations (CFR) Section 370.66) hazardous chemical as any hazardous chemical as defined under 29 CFR Section 1910.1200 (c), any chemical which is a physical hazard or a health hazard. Except that it does not include the following substances:

• Any food, food additive, color additive, drug, or cosmetic regulated by the Food and DrugAdministration

• Any substance present as a solid in any manufactured item to the extent exposure to the substancedoes not occur under normal conditions of use

• Any substance to the extent it is used for personal, family, or household purposes, or is present in thesame form and concentration as a product packaged for distribution and use by the general public

• Any substance to the extent it is used in a research laboratory or a hospital or other medical facilityunder the direct supervision of a technically qualified individual

• Any substance to the extent it is used in routine agricultural operations or is a fertilizer held for saleby a retailer to the ultimate customer.

The federal government defines (40 CFR Section 370.66) extremely hazardous substance as a substance listed in the appendices to 40 CFR part 355, Emergency Planning and Notification.

Page 1 California Governor’s Office of Emergency Services 3650 Schriever Ave Mather, CA 95655 Feb 2014

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http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC&sectionNum=25501.



Federal Laws & Regulations: 42 USC 11021

42 USC 11022 (c) 40 CFR § 370.66 29 CFR § 1910.1200 (c)

2) What is a Hazardous Materials Business Plan (HMBP)?

A Hazardous Material Business Plan (HMBP) is a document containing detailed information on the:

• Inventory of hazardous materials at a facility • Emergency response plans and procedures in the event of a reportable release or threatened release

of a hazardous material • Training for all new employees and annual training, including refresher courses, for all employees in

safety procedures in the event of a release or threatened release of a hazardous material. • A site map that contains north orientation, loading areas, internal roads, adjacent streets, storm and

sewer drains, access and exit points, emergency shutoffs, evacuation staging areas, hazardous material handling and storage areas, and emergency response equipment.

State Laws & Regulations: Health and Saf. Code § 25505

3) What is the purpose of the HMBP? The intent of the HMBP is to:

• Provide basic information necessary for use by first responders in order to prevent or mitigate damage to the public health and safety and to the environment from a release or threatened release of a hazardous material

• Satisfy federal and state Community Right-To-Know laws.

4) Who must complete and submit a HMBP? State: The State of California requires an owner or operator of a facility to complete and submit a HMBP if the facility handles a hazardous material or mixture containing a hazardous material that has a quantity at any one time during the reporting year equal to or greater than:

• 55 gallons (liquids), 500 pounds (solids), or 200 cubic feet for a compressed gas • The business is required to submit chemical inventory information pursuant to Section 11022 of Title

42 of the United States Code • The business handles at any one time during the reporting year an amount of hazardous material that

is equal to, or greater than the threshold planning quantity, under both of the following conditions:


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http://frwebgate.access.gpo.gov/cgi-bin/usc.cgi?ACTION=RETRIEVE&FILE=$$xa$$busc42.pt2.wais&start=17838306&SIZE=6808&TYPE=TEXT


http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=870e570da1445f607786a8a367a211f8&tpl=/ecfrbrowse/Title40/40cfr370_main_02.tpl

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10099




o The hazardous material is an extremely hazardous substance, as defined in Section 355.61 of Title 40 of the Code of Federal Regulations

o The threshold planning quantity for that extremely hazardous substance listed in Appendices A and B of Part 355 (commencing with Section 355.1) of Subchapter J of Chapter I of Title 40 of the Code of Federal Regulations is less than 500 pounds.

• A total weight of 5,000 pounds for solids or a total volume of 550 gallons for liquids, if the hazardous material is a solid or liquid substance that is classified as a hazard for purposes of Section 5194 of Title 8 of the California Code of Regulations solely as an irritant or sensitizer, unless the unified program agency finds, and provides notice to the business handling the product, that the handling of lesser quantities of that hazardous material requires the submission of a business plan, or any portion of a business plan, in response to public health, safety, or environmental concerns.

• A total of 1,000 cubic feet, if the hazardous material is a compressed gas and is classified as a hazard for the purposes of Section 5194 of Title 8 of the California Code of Regulations solely as a compressed gas, unless the unified program agency finds, and provides notice to the business handling the product, that the handling of lesser quantities of that hazardous material requires the submission of a business plan, or any portion thereof, in response to public health, safety, or environmental concerns.

• Amounts of radioactive materials requiring an emergency plan pursuant to Parts 30, 40, or 70 of Chapter 1 of Title 10 of the Code of Federal Regulations.

• The business handles perchlorate material, as defined in subdivision (c) of Section 25210.5, in a quantity at any one time during the reporting year that is equal to, or greater than, the thresholds listed in paragraph (1).

Any business, not subject to the thresholds above, which is required to submit chemical inventory information pursuant to 42 USC 11022 shall establish and implement a HMBP in accordance with Health & Saf. Code sec 25507.

State Laws & Regulations: Health & Saf. Code § 25507

Title 19 § 2729.1 Title 19 § 2729.2

Federal: The federal government requires owners and operators of a facility to complete and submit an emergency and hazardous chemical inventory form annually, known as the Tier II form, if the facility has at a minimum or greater:

• 500 pounds (or 227 kilograms --- approximately 55 gallons) or applicable federal threshold quantities for extremely hazardous substances listed in 40 CFR Part 355, Appendix A and B and hazardous chemicals, whichever is lower

• 10,000 pounds of a hazardous chemical that is not an extremely hazardous substance • 75,000 gallons of gasoline • 100,000 gallons of diesel.


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http://government.westlaw.com/linkedslice/default.asp?Action=TOC&RS=GVT1.0&VR=2.0&SP=CCR-1000







Facilities provide their hazardous materials inventories on a Tier II form. Tier II forms require basic facility identification information (including their North American Industry Classification System (NAICS) code), employee contact information for both emergencies and non-emergencies, and information about chemicals stored or used at the facility:

• The chemical name or the common name as provided on the Material Safety Data Sheet (MSDS) and its Chemical Abstract Service (CAS) registry number.

• An indication of whether the chemical is: pure or mixture; solid, liquid, or gas; and whether the chemical is or contains an EHS

• An indication of the hazard categories that apply to the chemical • An estimate (in ranges) of the maximum amount of the chemical present at any time during the

preceding calendar year and the average daily amount • The maximum number of days that the chemical was present at your facility during the preceding

calendar year • A brief description of the manner of storage of the chemical • The location of the chemical at the facility • An indication of whether the owner of the facility elects to withhold location information from

disclosure to the public.

Federal Laws & Regulations: 42 USC 11022 (a) 42 USC 11022 (b) 42 USC 11022 (d) 40 CFR § 370.10 40 CFR § 370.42 40 CFR Part 355 Appx A & B

5) To whom do I submit my HMBP?

State: The State of California requires all HMBPs to be submitted electronically to the California Environmental Reporting System (CERS - http://cers.calepa.ca.gov [Health & Saf. Code sec 25508]). State Laws & Regulations: Health & Saf. Code § 25508

Health & Saf. Code § 25509 Title 19 § 2729.4

Federal: The Federal government requires all Tier II forms be submitted to the State Emergency Response Commission (SERC), the Local Emergency Planning Committee (LEPC), and the local fire department (40 CFR Section 370.32). In California, any person who submits an inventory to CERS under Health & Saf. Code sec 25506 shall be deemed to have filed the inventory form (Tier II form) required by subsection (a) of Section 11022 of Title 42 of the United States Code with the SERC and LEPC (Health & Saf. Code sec 25506 (c)). The


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http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title40/40cfr355_main_02.tpl

http://cers.calepa.ca.gov/







UPA shall, upon request, transmit the inventory information to the SERC and LEPC (Health & Saf. Code sec 25509 (c)).

Federal Laws & Regulations: 42 USC 11022 (a)

40 CFR § 370.32 * The State of California thresholds are more stringent than federal thresholds. If a business must submit a Tier II form then the business must submit a complete HMBP as well (Health & Saf. Code sec. 25506(c)).

6) How do I submit a HMBP? State: The State of California developed the California Environmental Reporting System (CERS) for businesses to use to submit their HMBP. By submitting the HMBP through CERS, businesses will fulfill the information requirements of the HMBP.

• Business Activities of the Unified Program Consolidated (Title 27, Section 15600 (a)) • Business Owner/Operator Identification • Hazardous Materials – Chemical Description. The CERS database will require all state and federally

required inventory information and will meet state and federal reporting requirements. There will also be a section for additional information that may be requested by the UPA. Contact your local UPA to determine what additional information, if any, is required.

• An Annotated Site Map.

Contact your local UPA to determine any specific requirements for submittal of the emergency response plans and procedures, training program information, and additional information.

* The UPA may have requirements in addition to the State of California HMBP requirements. Check with the local jurisdiction having authority to implement and enforce the HMBP Program to determine what those additional requirements, if any, are.

State Laws & Regulations: Health & Saf. Code § 25506

Title 19 § 2729.2 Title 27 § 15600 (a)

Local: A handler shall electronically submit its business plan to CERS (Health & Saf. Code sec 25506(c))

Federal: If a business chooses to use the federal Tier II form described in 40 CFR Section 370.42 to meet its inventory reporting requirements, it must also submit a state or local form. The federal Tier II form and its instructions can now be found on the Environmental Protection Agency (EPA) website. Submittal of the business plan to CERS will also meet state and federal reporting requirements in California.


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Federal Laws & Regulations: 42 USC 11022 (g)

40 CFR § 370.42 * The State of California thresholds are more stringent than federal thresholds. If a business must submit a Tier II form then the business must submit a complete HMBP as well (Health & Saf. Code sec 25506 (c)).

7) Are there exemptions for submitting a HMBP? Types of Hazardous Materials Exemptions: The State of California exempts the following hazardous materials from the HMBP requirements:

• Oxygen, nitrogen, and nitrous oxide handled by a physician, dentist, podiatrist, veterinarian, or pharmacist at their place of business in quantities of not more than 1,000 cubic feet of each material at any one time (Health & Saf. Code sec 25507(b))

• Lubricating oil for a single business facility, if the total volume of each type of lubricating oil handled at that facility does not exceed 55 gallons and the total volume of all types of lubricating oil handled at the facility does not exceed 275 gallons, at any one time (Health & Saf. Code sec 25507 (c)(1))

• Hazardous Material contained solely in a consumer product for direct distribution to, and use by, the general public, unless the UPA has found, and has provided notice to the business handling the product, that the handling of certain quantities of the product requires the submission of a HMBP, or any portion thereof, in response to public health, safety, or environmental concerns (Health & Saf. Code sec 25507 (e)).

• On-premise use, storage, or both, of propane in an amount not to exceed 500 gallons that is for the sole purpose of cooking, heating the employee working areas, unless the UPA has found, and provides notice to the business handling the propane, that the handling of the on-premise propane requires the submission of a HMBP, or any portion thereof, in response to public health, safety, or environmental concerns (Health & Saf. Code sec 25507 (2)(b)).

Types of Business Exemptions: The State of California exempts the following businesses from filing portions of the HMBP requirements if they meet specific requirements:

• Farms operating for the purpose of cultivating the soil or raising or harvesting any agricultural or horticultural commodity from filing the emergency response plans and procedures (Health & Saf. Code sec 25507.1(a)) if:

a. The farm handler provides the inventory of information required by Health & Saf. Code sec 25506 to the county agricultural commissioner before January 1 of each year

b. Each building in which hazardous materials subject to the HMBP requirements are stored is posted with signs that provide notice of the storage of any of the following:

i. Pesticides ii. Petroleum fuels and oil

iii. Types of fertilizers.


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• Unstaffed remote facilities located in an isolated sparsely populated area from filing the HMBP and inventory requirements if all of the following requirements are met (Health & Saf. Code sec25507.2(a)):

a. The types and quantities of materials onsite are limited to one or more of the following: i. One thousand standard cubic feet of compressed inert gases (asphyxiation and

pressure hazards only) ii. Five hundred gallons of combustible liquid used as a fuel source

iii. Two hundred gallons of corrosive liquids used as electrolytes in closed containers iv. Five hundred gallons of lubricating and hydraulic fluids v. One thousand two hundred gallons of flammable gas used as a fuel source

vi. Any quantity of mineral oil contained within electrical equipment if the spill prevention control and countermeasure plan has been prepared for quantities that meet or exceed 1,320 gallons.

b. The facility is secured and not accessible to the public c. Warning signs are posted and maintained for hazardous materials pursuant to the California

Fire Code d. A one-time notification and inventory is provided to the UPA along with a processing fee in

lieu of the existing fee. The fee shall not exceed the actual cost of processing the notification and inventory, including a verification inspection, if necessary.

e. If the information contained in the initial notification or inventory changes and the time period of the change is longer than 30 days, the notification or inventory shall be submitted within 30 days to the UPA to reflect the change, along with a processing fee, in lieu of the existing fee

f. The UPA may require an unstaffed remote facility to submit a HMBP and inventory in accordance with the HMBP requirements if the agency finds that special circumstances exist such that development and maintenance of the HMBP and inventory is necessary to protect public health and safety and the environment.

Types of Procedural Exemptions: The State of California allows the UPA to exempt any hazardous material, handler or a specific hazardous material handled by a business from HMBP requirements or any portion thereof under the following circumstances:

• The UPA may, in exceptional circumstances, following notice and public hearing, may exempt from the inventory provisions of Chapter 6.95 any hazardous substance if the UPA finds that the hazardous substance would not pose a present or potential danger to the environment or to human health and safety if the hazardous substance was released into the environment (Health & Saf. Code sec 25507(f))

• The UPA, upon application by a handler, may exempt the handler, under conditions that the UPA determines to be proper, from any portion of the HMBP, upon a written finding that the exemption would not pose a significant present or potential hazard to human health or safety or to the environment or affect the ability of the UPA and emergency rescue personnel to effectively respond to the release of a hazardous material, and that there are unusual circumstances justifying the exemption (Health & Saf. Code sec 25507(g))


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• The UPA, upon application by a handler, may exempt a hazardous material from the inventory provisions of Chapter 6.95 upon proof that the material does not pose a significant present or potential hazard to human health and safety or to the environment if released into the workplace or environment (Health & Saf. Code sec 25507(h))

• The UPA may adopt of amend existing regulations specifying the inventory information required. Additionally, if pursuant to federal law or regulation, the UPA may determine that the inventory information required by subdivisions (a) and (c) is substantially equivalent to the inventory information required under the Emergency Planning and Community Right-to-Know Act of 1986, the requirements of subdivision (a) and (c) shall not apply, (Health & Saf. Code sec 25506(c) and (d)).

State Laws & Regulations: Health & Saf. Code § 25504 (e) Health & Saf. Code § 25505 (e)

Health & Saf. Code § 25506 Health & Saf. Code § 25507

*The State of California exemptions are only applicable to businesses not subject to the requirements of applicable federal law.

8) When do I need to submit a HMBP to CERS? State/Federal: A business is required to submit an initial HMBP when it begins to handle hazardous materials at the applicable state and/or federal thresholds (See question #4 – Page 2).

9) How often do I need to update my Hazardous Material Inventory and HMBP in CERS? State: The State of California requires the hazardous materials inventory and the HMBP to be updated as follows: A business must update and submit their hazardous materials inventory annually on or before March 1, depending on your UPA’s individual requirements (Title 19 Section 2729.4 (b)). After initial submittal, if no changes in your inventory have occurred and your business is only regulated under the state program, you may submit a certification statement (Health & Saf. Code sec 25508.2 and Title 19 Section 2729.5 (a)). If a change in your inventory has occurred you may comply with the annual inventory reporting requirements by submitting an updated Business Owner/Operator Identification Page and Hazardous Materials – Chemical Description Page (Title 19 Section 2729.5 (b)). A business must review their HMBP at least once every three years after the initial submission of the HMBP, to determine if a revision is needed and shall certify to the UPA that the review was made and that any necessary changes were made to the plan. An electronic submittal to the statewide information management system (CERS) satisfies this requirement (Health & Saf. Code sec 25508 (b)).


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State Laws & Regulations Health & Saf. Code § 25508

Health & Saf. Code § 25508.2 Title 19 § 2729.4 (b) Title 19 § 2729.5 (a) Title 19 § 2729.5 (b) Title 19 § 2729.6

Federal: An inventory must be submitted annually on or before March 1, and annually thereafter (40 CFR Section 370.45 (a)). For those businesses that fall under the federal requirement to submit an annual inventory, a certification statement will not suffice. Submittal of the inventory shall meet the Emergency Planning & Community Right-to-Know Act (EPCRA) if the following are submitted with the inventory (Title 19 Section 2729.6):

• Business Activities page of the Unified Program Consolidated Form • “Substantiation to Accompany Claims of Trade Secrecy” Form (40 CFR Section 350.27) if the business

wishes to claim trade secrecy in accordance with 40 CFR Part 350, to USEPA. • Chemical Description Page(s), for each extremely hazardous substance, containing an original

signature, a photocopy of the original signature, or a signature stamp. This signature may be placed in the box for locally collected information.

Federal Laws & Regulations: 42 USC 11022 (a)

40 CFR § 370.45 (a) 40 CFR § 350.27

10) Am I subject to inspections by the local UPA?

State: The State of California provides the authority to any employee or authorized representative of a UPA to inspect the premises of a handler concerning hazardous materials, in addition to hazardous waste to determine if the business is in compliance with the HMBP requirements (Health & Saf. Code sec 25511). State Laws & Regulations: Health & Saf. Code § 25511

Federal: The federal government requires an owner/operator of a facility that has submitted an inventory form to allow the fire department having jurisdiction over the facility to conduct an on-site inspection of your facility as well as provide the fire department with information about specific locations of hazardous chemicals at the facility (40 CFR Section 370.65). In California, the UPA have jurisdiction over the facility. The UPA is either the fire department, public health, environmental health or other local department authorized to implement or enforce the HMBP requirements.


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Federal Laws & Regulations: 42 USC 11022 (f)

40 CFR § 370.65

11) What happens if I do not comply with the HMBP requirements? State: In California, any business that does not comply with the HMBP requirements is civilly liable to the administering county or city in an amount not more than two thousand dollars ($2,000) for each day in which the violation occurs. If the violation results in, or significantly contributes to, an emergency, including a fire, the business shall also be assessed the full cost of the county or city emergency response, as well as the cost of cleaning up and disposing of the hazardous materials (Health & Saf. Code sec 25515 (a)). If the business continues to be in violation after reasonable notice of violating the HMBP requirements, the business is civilly liable to the administering county or city in an amount not to exceed five thousand dollars ($5,000) for each day in which the violation occurs (Health & Saf. Code sec 25515 (b)). State Laws & Regulations: Health & Saf. Code § 25515

Federal: In the United States, any person other than a governmental entity who violates any requirement of 42 USC 11022 and 42 USC 11023 shall be liable for civil and administrative penalties of not more than $37,500 for each violation. Each day a violation continues shall constitute a separate violation (42 USC 11045 (c)(1)).The adjustment to civil monetary penalties for inflation can be found at 40 CFR Section 19.4.

Federal Laws & Regulations: 42 USC 11045 40 CFR § 19.4

12) Is my HMBP that is on file with the UPA subject to public inspections?

State: The State of California requires the UPA to make available for public inspection the HMBP and revisions during regular working hours of the UPA, except those portions of the HMBP specifying the precise location where the hazardous materials are stored and handled onsite, including maps of the site (Health & Saf. Code sec 25509 (a)). Upon receipt of a request for the release of information to the public which includes information which the business claimed as a trade secret, the UPA shall notify the business in writing of the request by certified mail. The UPA shall release the information to the public, but not earlier than 30 days after the date of mailing the notice of request for information, unless, prior to the expiration of the 30-day period, the business files an action in an appropriate court for a declaratory judgment that the information is subject to protection or for an injunction prohibiting disclosure of the information to the public and promptly notifies the UPA of that action (Health & Saf. Code sec 25512 (c)).


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http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?type=simple;c=ecfr;cc=ecfr;sid=53fcffc0c16ddf85c7f8d1b85bb36eff;idno=40;region=DIV1;q1=table;rgn=div5;view=text;node=40%3A1.0.1.1.18


Any information which is confidential shall not be disclosed to anyone except the following (Health & Saf. Code sec 25512 (d)):

• An officer or employee of the county, city, the state, or the United States, in connection with the official duties of that officer or employee under any law for the protection of health, or to contractors with the county or city and their employees if, in the opinion of the UPA, disclosure is necessary and required for the satisfactory performance of a contract, for the performance of work, or to protect the health and safety of the employees of the contractor

• Any physician where the physician certifies in writing to the UPA that the information is necessary to the medical treatment of the physician’s patient.

State Laws & Regulations: Health & Saf. Code § 25509 (a)

Health & Saf. Code § 25512 (c) Health & Saf. Code § 25512 (d)

Federal: The federal government requires the SERC, LEPC, and/or local fire department to make available for public inspection the hazardous materials inventory. The owner/operator may request to withhold from disclosure the location of any specific chemical identified in the Tier II form. The public can petition requesting disclosure of chemical identity claimed as a trade secret (40 CFR 350.15). In California, the UPA makes available the hazardous materials inventory.

Federal Laws & Regulations: 42 USC 11022 (e) 40 CFR § 350.15 40 CFR § 370.61 40 CFR § 370.63

13) Is my HMBP information shared with local emergency response personnel?

State: The UPA shall make the data elements and documents submitted pursuant to this article available to a requesting government agency that is authorized by law to access the information. (Health & Saf. Code sec 25509 (a)). In addition, emergency rescue personnel will have access to the statewide information management system (CERS) on a 24-hour basis (Health & Saf. Code sec 25509). State Laws & Regulations: Health & Saf. Code § 25509

Federal: The SERC, LEPC, or local fire department shall provide, upon request, Tier II information to a local official, acting in his or her official capacity. In California, the UPA makes the hazardous materials inventory available. Federal Laws & Regulations: 42 USC 11022 (e)

40 CFR 370.61


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http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=f349918c274ff870045b656aa3bbffe1&tpl=/ecfrbrowse/Title40/40cfr350_main_02.tpl







Who do I contact if I have further questions?

Contact your local UPA.

If you have any questions regarding HMBP Submittals, please call the Cal OES Hazardous Materials Section @ (916) 845-8798

Additional Resources can be found on the Internet at the following locations: www.caloes.ca.gov (California Governor’s Office of Emergency Services) www.calcupa.net (California Certified Unified Program Agencies) www.epa.gov (Environmental Protection Agency) www.leginfo.ca.gov (Official California Legislative Information) http://cers.calepa.ca.gov (California Environmental Reporting System)


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http://www.calcupa.net/

http://www.caloes.ca.gov/

http://www.calcupa.net/

http://www.epa.gov/

http://www.leginfo.ca.gov/

http://cers.calepa.ca.gov/

UN-020 - 1/17 www.unidocs.org Rev. 07/24/06

HAZARDOUS MATERIALS BUSINESS PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction

Authority Cited: Ch. 6.95 HSC; Title 19, Div. 2, CCR; Title 22, Div. 4.5, CCR All facilities that handle virgin or waste hazardous materials in quantities subject to the State Hazardous Materials Business Plan (HMBP) reporting requirements described below are required to prepare and submit a HMBP to the local Unified Program Agency that administers the HMBP Program. If that local agency does not routinely forward first-responder HMBP copies to the local first-responder fire agency, you must also submit a copy of the HMBP to the local fire agency (see www.unidocs.org for details). This Matrix Inventory Format Hazardous Materials Business Plan is the preferred format for HMBP reporting in Unidocs member agency jurisdictions. [This form was developed by the Certified Unified Program Agency (CUPA) as an alternative version of the Unified Program Consolidated Form (UPCF). Businesses have the option to use it or the UPCF adopted in state regulations. The CUPA or Participating Agency (PA) must accept the state UPCF and cannot require a business to use the alternative version developed by the CUPA. The CUPA and PA can require businesses to provide additional information on either the UPCF or a supplemental page to that document.] Adobe Acrobat (PDF) and Microsoft Word template versions of this HMBP and a HMBP which includes the standard UPCF One-Chemical-Per-Page inventory format are available at www.unidocs.org. You may complete your HMBP on-line using the Unidocs Online Hazardous Materials Inventory Database at www.unidocs.org. If you wish to use forms other than those included in this document or the Unidocs standard UPCF Hazardous Materials Business Plan, please contact your local agency for guidance. Depending upon the nature of storage/handling of hazardous materials at the facility and whether or not this is a first-time submittal, other documents may be required to be submitted in addition to the HMBP [e.g., UPCF Onsite Hazardous Waste Treatment Forms, UPCF Underground Storage Tank (UST) − Facility and UST − Tank pages, etc.]. What is a Hazardous Materials Business Plan? A HMBP is a document containing detailed information on the storage of hazardous materials at a facility. Chapter 6.95 of California Health and Safety Code (HSC) and Title 19, Division 2, of the California Code of Regulations (CCR) require that facilities which use or store such materials at or above reporting thresholds submit this information. What is the purpose of the Hazardous Materials Business Plan? The intent of the HMBP is to satisfy federal and state Community Right-To-Know laws and provide detailed information for use by emergency responders. All persons at the facility qualified to serve as emergency coordinators must be thoroughly familiar with the contents and use of the HMBP, with the operations and activities of the facility, and with the locations of hazardous materials records maintained by the facility. This HMBP has been developed to assist you in complying with the State requirements and to provide the fire department with adequate information about the type, quantity of—and management practices regarding—hazardous materials that are stored at your facility. It is intended to additionally satisfy some or all of the reporting requirements for the following programs: CalARP Program Registration; Hazardous Waste Generator Registration; and Hazardous Waste Contingency Plan. Who must complete a Hazardous Materials Business Plan? The owner/operator of a facility must complete and submit a HMBP for each site where any individual hazardous material or mixture containing a hazardous material is present at or above its reporting threshold at any time during the reporting year. Reporting thresholds are: 1. 500 pounds or more of any solid hazardous material. [HSC §25503.5(a)]

2. For liquid hazardous materials:

a. More than 55 gallons of any type or 275 gallons aggregate quantity on site for lubricating oils as defined by HSC §25503.5(b)(2)(B). [HSC §25503.5(b)(2)(A)]

b. 55 gallons or more of any other liquid, including waste oil. [HSC §25503.5(a)]

3. For hazardous material gases:

a. More than 1,000 cubic feet (at standard temperature and pressure) of Oxygen, Nitrogen, or Nitrous Oxide stored/handled at a physician, dentist, podiatrist, veterinarian, or pharmacist’s place of business. [HSC §25503.5(b)(1)]

b. More than 300 gallons of Propane used for the sole purpose of heating the employee working areas within the facility. [HSC §25503.5(d)]

c. 200 cubic feet or more of any other gas. [HSC §25503.5(a)]

4. Amounts of radioactive materials requiring an emergency plan under Parts 30, 40, or 70 of Title 10 Code of Federal Regulations or applicable quantities specified in items 1, 2, or 3, above, whichever amount is smaller. [HSC §25503.5(a)]

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Hazardous Materials Business Plan (continued) 5. Applicable federal threshold planning quantities for extremely hazardous substances listed in 40 CFR Part 355, Appendix A. Note: Retail (Consumer) Products packaged for direct distribution to, and use by, the general public are exempt from HMBP requirements except where the local agency determines otherwise pursuant to HSC §25503.5(c)(1). [Unidocs member agency interpretation is that materials qualify for this exemption only if the following requirements are met: (1) The product is not dispensed from containers at the storage facility; (2) The product is stored in a “retail display area” as defined by the 1994 California Fire Code (e.g., Quarts of oil sitting in a display area for sale at a service station are exempt, but oil used by a mechanic in the service bay is not exempt.); (3) containers are no larger than 5 gallons (liquids) or 100 pounds (solids); and (4) Handling of the product does not present unacceptable risk to public health, safety, or the environment.]

What if I don’t handle any hazardous materials in amounts requiring a HMBP? Facilities that are not required to complete a HMBP may still be required to register their hazardous materials with the local agency. See www.unidocs.org for details. (Note: The local agencies reserve the right to require a HMBP for any facility upon determination that the manner of use or storage of hazardous materials is such that additional information is necessary for emergency response purposes.)

What information is required to be submitted with the Hazardous Materials Business Plan? The HMBP must contain the following elements:

• Business Activities page (Form and instructions attached) • Business Owner/Operator Identification page (Form and instructions attached) • Hazardous Materials Inventory Statement page(s) (Forms and instructions attached) • Facility Map(s) (Sample form and instructions attached) • Emergency Response/Contingency Plan (Sample forms and instructions attached) • Employee Training Plan (Sample form and instructions attached)

How often do I have to update or recertify my Hazardous Materials Business Plan? Within 30 days of the occurrence of any of the following events, the HMBP must be revised and the revisions submitted to the local agency: (1) There is a 100% or more increase in the quantity of a previously disclosed material; (2) The facility begins handling a previously undisclosed material at or above HMBP reporting thresholds; (3) The facility changes address; (4) Ownership of the facility changes; or (5) There is a change of business name. [HSC §25510] Additionally, if the local agency determines that the HMBP is deficient in any way, the plan must be revised and the revisions submitted to the local agency within 30 days of the notice to submit a corrected plan. [HSC §25505(a)(2)] Without regard to the above events, the owner, operator, or designated representative of the facility must complete and submit to the local agency a Hazardous Materials Business Plan Certification Form [or a copy of the current hazardous materials inventory and an updated certification signature and date at the bottom of the Business Owner/Operator Identification page] annually on or before March 1. [HSC §25503.3(c) and 19 CCR §2729.4(b)] Facilities subject to Federal Emergency Planning and Community Right to Know Act (EPCRA) reporting requirements must submit the following to satisfy annual inventory certification requirements: A UPCF Business Activities page; UPCF Business Owner/Operator Identification page with current signature and date; and Hazardous Materials Inventory Statement page(s) with an original signature, photocopy of an original signature, or signature stamp on each page which lists an Extremely Hazardous Substance (EHS) handled at or above its Federal Threshold Planning Quantity (TPQ) or 500 pounds, whichever is less. [19 CCR §2729.5(c)] The entire HMBP must be reviewed every three years to determine whether revision is needed. The facility owner, operator, or designated representative must certify that the review was performed and any needed changes were made. This certification is accomplished by completing and submitting to the local agency a Hazardous Materials Business Plan Certification Form if no changes have been made to the HMBP, or a copy of the complete HMBP with an updated certification signature and date at the bottom of the Business Owner/Operator Identification page. [HSC §25505(c)] The Hazardous Materials Business Plan Certification Form is available at www.unidocs.org. If all of the following conditions are met, facilities with an approved HMBP on file with the local agency are exempt from the requirements for annual inventory certification/submittal and triennial review/certification unless required by federal law or local ordinance. The site must: be an unstaffed remote facility located in an isolated sparsely populated area; be secured and inaccessible to the public; be marked with warning signs in accordance with California Fire Code requirements; and handle no more than: [HSC §25503.5(c)(6)]

• 500 gallons of combustible liquid fuel (e.g., diesel); • 1,200 gallons of flammable gas fuel (e.g., propane); • 200 gallons of corrosive battery electrolytes (liquid- or gel-type); • 500 standard cubic feet of compressed inert gases (e.g., nitrogen); or • 500 gallons of lubricating and/or hydraulic fluids.

Who is my local agency? Unidocs member agency contact information is available on-line at www.unidocs.org/members.html.

24 of 39


UNIFIED PROGRAM CONSOLIDATED FORM

FACILITY INFORMATION BUSINESS ACTIVITIES

Page 1 of ___

I. FACILITY IDENTIFICATION FACILITY ID # (Agency Use Only) - -

1. EPA ID # (Hazardous Waste Only)

2.

BUSINESS NAME (Same as Facility Name) 3.

II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list,

please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility… If Yes, please complete these pages of the UPCF…

A. HAZARDOUS MATERIALS

Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70?

YES NO 4. HAZARDOUS MATERIALS INVENTORY – CHEMICAL DESCRIPTION (OES 2731)

B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? YES NO 5. UST TANK (one page per tank) (Formerly Form B)

YES NO 6. UST FACILITY

UST TANK (one per tank) 2. Intend to upgrade existing or install new USTs?

UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C)

3. Need to report closing a UST? YES NO 7. UST TANK (closure portion – one page per tank)

C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or YES NO 8. NO FORM REQUIRED TO CUPAs

---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? YES NO 9. EPA ID NUMBER – provide at the top of this

page 2. Recycle more than 100 kg/month of excluded or exempted recyclable

materials (per HSC §25143.2)? YES NO 10. RECYCLABLE MATERIALS REPORT (one per recycler)

3. Treat hazardous waste on site? YES NO 11.

ONSITE HAZARDOUS WASTE TREATMENT – FACILITY (Formerly DTSC Forms 1772)

ONSITE HAZARDOUS WASTE TREATMENT – UNIT (one page per unit) (Formerly DTSC Forms 1772 A, B, C, D, and L)

4. Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? YES NO 12.

CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Form 1232)

5. Consolidate hazardous waste generated at a remote site? YES NO 13.

REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196)

6. Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? YES NO 14.

HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Form 1249)

E. LOCAL REQUIREMENTS 15.

(You may also be required to provide additional information by your CUPA or local agency.)

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Business Activities Page Instructions You must submit the Business Activities page with all submittals. [Note: Numbering of these instructions follows the Unified Program Consolidated Form (UPCF) data element numbers on the Business Activities page. These data element numbers are used for electronic submittal and are the same as the numbering used in 27 CCR, Appendix C, the Unified Program Data Dictionary.] Please number all pages of your submittal. 1. FACILITY ID NUMBER - This number is for agency use only. Leave this space blank. 2. EPA ID NUMBER - If you generate, recycle, or treat hazardous waste, enter your facility's 12-character U.S. Environmental

Protection Agency (U.S. EPA) or California Identification number. For facilities in California, the number usually starts with the letters "CA." If you do not have an ID number, contact the Department of Toxic Substances Control (DTSC) at 1-800- 618-6942 to obtain one.

3. BUSINESS NAME - Enter the complete Facility Name. 4. HAZARDOUS MATERIALS ONSITE - Check the appropriate box to indicate whether you have any hazardous material on site

in a quantity subject to Hazardous Materials Business Plan reporting requirements (please refer to the above Hazardous Materials Business Plan Information Sheet).

5. OWN OR OPERATE UNDERGROUND STORAGE TANK (UST) - Check the appropriate box to indicate whether you own or operate USTs containing hazardous substances as defined in Health and Safety Code (HSC) §25316. If "YES", and you do not already have on file with your local agency a UST Facility page, UST Tank page for each tank, written UST Monitoring Plan, and UST Response Plan, then you must submit those documents. (There are no UPCF pages for the monitoring and response plans.)

6. UST INSTALLATION/UPGRADE - Check the appropriate box to indicate whether you have installed or upgraded USTs containing hazardous substances as defined in HSC §25316. If "YES," then you must submit to your local agency a UST Installation - Certificate of Compliance page for each tank in addition to the UST Facility and Tank pages.

7. UST CLOSURE - Check the appropriate box if you are closing a UST and complete the closure portion of the UST Tank page for each tank.

8. OWN/OPERATE ABOVEGROUND PETROLEUM STORAGE TANK (AST) - Check the appropriate box to indicate whether your facility stores petroleum aboveground in any tank greater than 660 gallons capacity or has aggregate aboveground petroleum storage greater than 1,320 gallons (count only petroleum stored in tanks and containers greater than or equal to 55 gallon capacity). (There is no UPCF page for ASTs.) The following are exempt from this requirement: • Pressure vessels or boilers subject to Division 5 of the Labor Code; • Tanks containing hazardous waste if a hazardous waste facility permit has been issued by DTSC; • Aboveground oil production tanks regulated by the Division of Oil and Gas; • Certain oil-filled electrical equipment, including, but not limited to, transformers, circuit breakers, and capacitors.

9. HAZARDOUS WASTE GENERATOR - Check the appropriate box to indicate whether your facility generates a waste that meets any of the hazardous waste criteria adopted pursuant to HSC §25141.

10. RECYCLE - Check the appropriate box to indicate whether your facility recycles more than 100 kilograms (approximately 220 pounds or 27 gallons) per month of recyclable material under a claim that the material is excluded or exempt per HSC §25143.2. If you check "YES," and you do not already have a current Recyclable Materials Report on file with your Certified Unified Program Agency (CUPA), then you must also submit that report to the CUPA. Check "NO" if you only send recyclable materials to an offsite recycler.

11. ONSITE HAZARDOUS WASTE TREATMENT - Check the appropriate box to indicate whether your facility engages in regulated onsite treatment of hazardous waste. If you check "YES," and you do not already have current Onsite Hazardous Waste Treatment Notification - Facility and Onsite Hazardous Waste Treatment Notification - Unit documents on file with your CUPA, then you must submit those forms to the CUPA.

12. FINANCIAL ASSURANCE - Check the appropriate box to indicate whether your facility has Permit by Rule (PBR) and/or Conditionally Authorized (CA) operations subject to financial assurance requirements for closure of an onsite treatment unit. If you check "YES," and you do not already have current "Certification of Financial Assurance" on file with your CUPA, then you must submit that form to the CUPA.

13. HAZARDOUS WASTE REMOTE CONSOLIDATION SITE - Check the appropriate box to indicate whether your facility consolidates hazardous waste generated at a remote site. By answering "YES," you are indicating that you are a hazardous waste generator that collects hazardous waste initially at remote sites and subsequently transports the hazardous waste to a consolidation site you also operate. If you check "YES," and you do not already have current "Remote Waste Consolidation Site Annual Notification" page on file with your CUPA, then you must submit that form to the CUPA.

14. HAZARDOUS WASTE TANK CLEANING - Check the appropriate box if any tank has been cleaned onsite to render it non-hazardous per Title 22, Div. 4.5, Ch. 32, CCR. If you check "YES," then you must submit a Hazardous Waste Tank Closure Certification to your local agency.

15. LOCAL REQUIREMENTS - Check with your local agency before submitting this document to determine if any supplemental information is required.

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UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION

BUSINESS OWNER/OPERATOR IDENTIFICATION Page 2 of

I. IDENTIFICATION BEGINNING DATE 100. ENDING DATE 101. FACILITY ID #

(Agency Use Only) - - 1.

BUSINESS NAME (Same as FACILITY NAME) 3. BUSINESS PHONE 102.

( ) BUSINESS SITE ADDRESS 103.

CITY 104. ZIP CODE 105.

CA

DUN & BRADSTREET 106. SIC CODE (4 digit #) 107.

COUNTY 108.

BUSINESS OPERATOR NAME 109. BUSINESS OPERATOR PHONE 110.

( ) ext.II. BUSINESS OWNER

OWNER NAME 111. OWNER PHONE 112.

( ) ext.OWNER MAILING ADDRESS 113.

CITY 114. STATE 115. ZIP CODE 116.

III. ENVIRONMENTAL CONTACT CONTACT NAME 117. CONTACT PHONE 118.

( ) ext.CONTACT MAILING ADDRESS 119.

CITY 120. STATE 121. ZIP CODE 122.

-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123. NAME 128.

TITLE 124. TITLE 129.

BUSINESS PHONE 125. BUSINESS PHONE 130.

( ) ext. ( ) ext. 24-HOUR PHONE* 126. 24-HOUR PHONE* 131.

( ) ext. ( ) ext. PAGER # 127. PAGER # 132.

ADDITIONAL LOCALLY COLLECTED INFORMATION: 133.

Billing Address:

Property Owner: Phone No.: ( )

Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete.

SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134. NAME OF DOCUMENT PREPARER 135.

NAME OF SIGNER (print) 136. TITLE OF SIGNER 137.

* See Instructions on next page.

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Business Owner/Operator Identification Page (OES Form 2730) Instructions Except when using the Hazardous Materials Business Plan Certification Form, you must submit the Business Activities page, the Business Owner/Operator Identification page, and Hazardous Materials - Chemical Description pages with all hazardous materials inventory submittals. (Note: Numbering of these instructions follows the UPCF data element numbers on the Owner/Operator page.) 1. FACILITY ID NUMBER - This number is for agency use only. Leave this space blank. 3. BUSINESS NAME - Enter the complete Facility Name. 100. BEGINNING DATE - Enter the beginning year and date of the report. 101. ENDING DATE - Enter the ending year and date of the report. 102. BUSINESS PHONE - Enter the phone number, including area code and any extension. 103. BUSINESS SITE ADDRESS - Enter the street address where the facility is located, including building number, if applicable.

Post office box numbers are not acceptable. This information must provide a means to locate the facility geographically. 104. CITY - Enter the city or unincorporated area in which the facility is located. 105. ZIP CODE - Enter the 5 or 9 digit zip code for the facility. 106. DUN & BRADSTREET - If the business has a D&B number, enter it here. 107. SIC CODE - Enter the 4 digit Standard Industrial Classification Code number for the facility's primary business activity. 108. COUNTY - Enter the name of the county in which the facility is located. 109. BUSINESS OPERATOR NAME - Enter the name of the facility operator. 110. BUSINESS OPERATOR PHONE - Enter the operator's phone number, including area code and any extension. 111. OWNER NAME - Enter the name of the facility owner, if different from the operator. 112. OWNER PHONE - Enter the owner's phone number, including area code and any extension. 113. OWNER MAILING ADDRESS - Enter the owner's street or P.O. box mailing address, if different from the site address. 114. OWNER CITY - Enter the name of the city for the owner's mailing address. 115. OWNER STATE - Enter the 2 character state abbreviation for the owner's mailing address. 116. OWNER ZIP CODE - Enter the 5 or 9 digit zip code for the owner's mailing address. 117. ENVIRONMENTAL CONTACT NAME - Enter the name of the person, if different from the Business Owner or Operator, who

will receive all environmental correspondence and will respond to enforcement activity. 118. CONTACT PHONE - Enter the environmental contact's phone number, including area code and any extension. 119. CONTACT MAILING ADDRESS - Enter the street or P.O. box mailing address where all environmental contact

correspondence should be sent, if different from the site address. 120. CITY - Enter the name of the city for the environmental contact's mailing address. 121. STATE - Enter the 2 character state abbreviation for the environmental contact's mailing address. 122. ZIP CODE - Enter the 5 or 9 digit zip code for the environmental contact's mailing address. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative (i.e., Emergency Coordinator) who can be

contacted in case of an emergency involving hazardous materials at the facility. This person shall have full facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation.

124. TITLE - Enter the title of the primary Emergency Coordinator. 125. BUSINESS PHONE - Enter primary Emergency Coordinator's business phone number, including area code and any extension. 126. 24-HOUR PHONE - Enter a phone number that will be answered 24 hours a day. If not the primary Emergency Coordinator's

home phone number, then the number of an answering service able to immediately contact the primary Emergency Coordinator must be provided. Please note that this is a public document, so any telephone number provided is available to the general public any time a review of your facility's records is conducted.

127. PAGER NUMBER - Enter the pager number for the primary Emergency Coordinator, if available. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary Emergency Coordinator who can be

contacted in the event that the primary Emergency Coordinator is not available. The contact shall have full facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation.

129. TITLE - Enter the title of the secondary Emergency Coordinator. 130. BUSINESS PHONE - Enter secondary Emergency Coordinator's business phone number, including area code and any

extension. 131. 24-HOUR PHONE - Enter a phone number for the secondary Emergency Coordinator. See instructions for item 123, above. 132. PAGER NUMBER - Enter the pager number for the secondary Emergency Coordinator, if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - Enter the complete mailing address to which bills for permit fees

should be sent, if different from items 119-122, above. Enter the name and phone number for the property owner. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially

designated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted, and that based on the signer's inquiry of those individuals responsible for obtaining the information, it is the signer's belief that the submitted information is true, accurate, and complete.

134. DATE - Enter the date that the document was signed. 135. NAME OF DOCUMENT PREPARER - Type or print the full name of the person who prepared the Business Plan information. 136. NAME OF SIGNER - Type or print the full name of the person signing this document. 137. TITLE OF SIGNER - Enter the title of the person signing this document.

28 of 39

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Typ

e of

Rep

ort o

n T

his P

age:

Add

; D

elet

e;

Rev

ise

(O

ne p

age

per

build

ing

or a

rea)

Che

mic

al L

ocat

ion:

(Bui

ldin

g/St

orag

e A

rea)

E

PCR

A C

onfid

entia

l Loc

atio

n?

Yes

; N

o T

rade

Sec

ret I

nfor

mat

ion?

Y

es;

No

Faci

lity

ID #

(A

genc

y U

se O

nly)

-

-

1.

Haz

. C

lass

2.

Map

and

G

rid

or

Loc

atio

n C

ode

3.

Com

mon

Nam

e

4.

Haz

ardo

us C

ompo

nent

s (F

or m

ixtu

res o

nly)

C

hem

ical

%

N

ame

Wt.

EH

S C

AS

No.

5.

Typ

e an

d Ph

ysic

al

Stat

e

6.

Qua

ntiti

es

Max

. A

vera

ge

Lar

gest

D

aily

D

aily

C

ont.

7.

Uni

ts

8.

Stor

age

Cod

es

Stor

age

Stor

age

Pres

sure

T

emp.

9.

H

azar

d C

ateg

orie

s

p

ure

mix

ture

C

AS

No.

:

E

HS

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

p

ure

mix

ture

C

AS

No.

:

E

HS

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

p

ure

mix

ture

C

AS

No.

:

E

HS

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

p

ure

mix

ture

C

AS

No.

:

E

HS

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

p

ure

mix

ture

C

AS

No.

:

E

HS

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

p

ure

mix

ture

C

AS

No.

:

E

HS

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e A

A

bove

grou

nd T

ank

D

Stee

l Dru

m

G

Car

boy

J B

ag

M

Gla

ss B

ottle

or J

ug

P Ta

nk W

agon

B

Bel

owgr

ound

Tan

k E

Pl

astic

/Non

-met

allic

Dru

m

H

Silo

K

B

ox

N

Plas

tic B

ottle

or J

ug

Q

Rai

l Car

*

C

Tank

Insi

de B

uild

ing

F C

an

I Fi

ber D

rum

L

C

ylin

der

O

Tote

Bin

R

O

ther

If E

PCR

A, s

ign

belo

w:

____

____

____

____

____

____

____

____

____

____

__

29 of 39


Non-Waste Hazardous Materials Inventory Statement Instructions (Modified UPCF Hazardous Materials Inventory - Chemical Description Page)

All non-waste hazardous materials stored at the facility must be listed on the Non-Waste Hazardous Materials Inventory Statement [or the Unified Program Consolidated Form (UPCF) Hazardous Materials Inventory - Chemical Description form (available on the Internet at www.unidocs.org/hazmat/business-plan/index.html)]. This form allows you to report up to six chemicals on a single page. Do not list hazardous wastes on this form. You must complete a separate inventory line for each individual hazardous material that you handle at your facility in an aggregate quantity subject to Hazardous Materials Business Plan reporting requirements (please refer to the Hazardous Materials Business Plan instructions). The completed inventory must reflect all HMBP-reportable materials at your facility, listed separately for each building or outside storage area, with separate inventory lines for unique occurrences of physical state, storage temperature, or storage pressure. Trade secret materials must be listed on separate pages. Make additional copies of this form if needed. Your local agency may require reporting of hazardous materials present in quantities below HMBP reporting thresholds. Contact your local agency for details. 1. DATE - In the space at the top left side of the form, enter the date this inventory statement page was prepared. 2. BUSINESS NAME - Enter the complete Facility Name. 3. TYPE OF REPORT ON THIS PAGE - Indicate whether the material is being added to the inventory, deleted from the inventory, or if the information previously

submitted is being revised. (Note: You may leave this blank if you resubmit your entire inventory annually.) 4. PAGE NUMBER - Number each page of the inventory appropriately. 5. CHEMICAL LOCATION - Enter the name of the building or outside area where the hazardous materials reported on this page are handled. A chemical stored at

the same pressure and temperature in multiple locations in one building or area can be reported on a single line. 6. EPCRA CONFIDENTIAL LOCATION - You must check "Yes" to keep chemical location information confidential. If you do not wish to keep chemical

location information confidential check "No." If "Yes," a signature is required on the line provided at the bottom of the form. 7. TRADE SECRET INFORMATION- Check "Yes" if the information in this section is declared a trade secret, "No" if it is not. If "Yes," and the business is subject

to EPCRA, disclosure of designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form to the United States Environmental Protection Agency.

8. FACILITY ID NUMBER - This number is for agency use only. Leave this space blank. 9. HAZARD CLASS - In Column 1 of the inventory table, provide the primary U.S. Department of Transportation (DOT) numerical hazard class for the material

being reported on each line. (Note: If your local agency requires reporting of Fire Code hazard classes rather than DOT classes, report the Fire Code class rather than the DOT class.)

10. MAP & GRID OR LOCATION CODE - In Column 2, enter the page number of the Storage Map where the location of the hazardous material is shown, along with the grid coordinates from your Storage Map that correspond to the location of the hazardous material. If applicable, multiple grid coordinates can be listed. If you do not use a grid system, enter the Location Code shown on your Storage Map. Report each bulk storage tank on a separate line as a distinct storage location.

11. COMMON NAME, CAS NUMBER, & EHS - In Column 3, enter the following information: • COMMON NAME - The Common Name or Trade Name of the hazardous material or mixture (e.g., Gasoline, Acme Super Solvent). • EHS - If the material is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, Appendix A, check the EHS box. • CAS NUMBER - Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has

been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section, below.

12. HAZARDOUS COMPONENTS - (Note: If the material is not a mixture, skip Column 4 and go directly to Column 5.) In column 4, enter the following information regarding Hazardous Components that make up the material listed in Column 3: • CHEMICAL NAME - If the Chemical Name is the same as the Common or Trade Name shown in Column 3, you may leave this space blank. If the material

is a mixture, list the chemical name of each hazardous component in the mixture ranked by percent weight (refer to the MSDS or manufacturer). All hazardous components present at greater than 1% by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, must be reported. If more than five hazardous components exceed these percentages, you may attach an additional sheet of paper to report the required information.

• % BY WEIGHT - Enter the percentage weight of each hazardous component. If a range of percentages is available, report the highest percentage in that range. • EHS - Check the box provided if the component of the mixture is considered an Extremely Hazardous Substance. • CAS NUMBER - List the Chemical Abstract Service (CAS) number for each hazardous component.

13. TYPE & PHYSICAL STATE - In column 5, identify the material type and physical state by checking the “pure” or “mixture box and the “solid”, “liquid”, or “gas” box.

14. QUANTITIES - In the appropriate spaces within column 6, list: • MAXIMUM DAILY AMOUNT* - Enter the maximum amount of the hazardous material or mixture handled in this building or outside area at any one time

over the course of the year. This amount must contain, at a minimum, last year's reported inventory with the reflection of additions, deletions, or revisions projected for the current year.

• AVERAGE DAILY AMOUNT* - Calculate the average daily amount of the hazardous material or mixture in this building or outside area. If this is a material that is new to this location, the amount should be the average daily amount you project to be on hand during the course of the year.

• LARGEST CONTAINER* - Enter the volume of the largest container in which the material is handled at the location. • CURIES - If the material is radioactive, use the space provided to report the activity in curies. • DAYS ON SITE - Enter the total number of days (e.g., 365) during the year that the material is on site. • STORAGE CONTAINER - Using the container codes listed at the bottom of the inventory statement, list every type of container in which the material is

stored/handled. * Except for Curies, units of measure must be the same as that indicated in Column 7.

15. UNITS - In column 7, check the appropriate unit of measure: gallons for liquids, pounds or tons for solids, and cubic feet for gases. If the material is a federally defined EHS at or above the Federal threshold planning quantity (TPQ) limit and is not a mixture, all amounts must be reported in pounds.

16. STORAGE CODES - In the appropriate spaces within Column 8, list: • STORAGE PRESSURE - Check the box that best describes the pressure at which the material is stored: ambient (standard), > amb. (greater than ambient), <

amb. (less than ambient), or cryogenic. • STORAGE TEMPERATURE - Check the box that best describes the temperature at which the material is stored.

17. HAZARD CATEGORIES - In column 9, check the box(es) to describe all physical, health, and radioactivity hazards associated with the hazardous material. PHYSICAL HAZARDS HEALTH HAZARDS Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics,

Oxidizers Reactive: Unstable Reactives, Organic Peroxides, Water Reactives,

Radioactives

Acute Health (Immediate): Toxics, Highly Toxics, Irritants, Sensitizers, Corrosives, other hazardous chemicals with an adverse effect with short-term exposure

Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other chemicals with an adverse effect with long-term exposure

Note: If this facility is subject to Federal Emergency Planning and Community Right to Know Act (EPCRA) reporting requirements, a signature is required on the line provided at the bottom of the form if the page lists any Extremely Hazardous Substance (EHS) handled at or above its Federal Threshold Planning Quantity (TPQ) or 500 pounds, whichever is less.

30 of 39

UN

-020

- 9/

17

ww

w.u

nido

cs.o

rg

Rev

. 07/

24/0

6

Dat

e:

H

azar

dous

Was

te In

vent

ory

Stat

emen

t Fo

r use

by

Uni

docs

Mem

ber A

genc

ies o

r whe

re a

ppro

ved

by y

our L

ocal

Jur

isdi

ctio

n

Pa

ge

of

B

usin

ess N

ame:

(Sam

e as

Fac

ility

Nam

e or

DB

A)

Typ

e of

Rep

ort o

n T

his P

age:

A

dd;

Del

ete;

R

evis

e

(One

pag

e pe

r bu

ildin

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are

a)

Che

mic

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ocat

ion:

(Bui

ldin

g/St

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e A

rea)

E

PCR

A C

onfid

entia

l Loc

atio

n?

Yes

; N

o T

rade

Sec

ret I

nfor

mat

ion?

Y

es;

No

Faci

lity

ID #

(A

genc

y U

se O

nly)

-

-

1.

Haz

. C

lass

2.

Map

and

G

rid

or

Loc

atio

n C

ode

3.

Was

te S

trea

m N

ame

4.

Haz

ardo

us C

ompo

nent

s C

hem

ical

%

N

ame

Wt.

EH

S C

AS

No.

5.

Typ

e an

d Ph

ysic

al

Stat

e

6.

Qua

ntiti

es

Max

. A

vera

ge

Lar

gest

D

aily

D

aily

C

ont.

7.

Ann

ual

Was

te

Am

ount

8.

Uni

ts

9.

Stor

age

Cod

es

Stor

age

Stor

age

Pres

sure

T

emp.

10.

H

azar

d C

ateg

orie

s

was

te

Man

agem

ent M

etho

d:

Shi

pped

Off

-site

R

ecyc

led

On-

site

T

reat

ed O

n-si

te

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

Stat

e W

aste

Cod

e :

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

was

te

Man

agem

ent M

etho

d:

Shi

pped

Off

-site

R

ecyc

led

On-

site

T

reat

ed O

n-si

te

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

Stat

e W

aste

Cod

e:

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

was

te

Man

agem

ent M

etho

d:

Shi

pped

Off

-site

R

ecyc

led

On-

site

T

reat

ed O

n-si

te

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

Stat

e W

aste

Cod

e :

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

was

te

Man

agem

ent M

etho

d:

Shi

pped

Off

-site

R

ecyc

led

On-

site

T

reat

ed O

n-si

te

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

Stat

e W

aste

Cod

e:

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

was

te

Man

agem

ent M

etho

d:

Shi

pped

Off

-site

R

ecyc

led

On-

site

T

reat

ed O

n-si

te

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

Stat

e W

aste

Cod

e:

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e

was

te

Man

agem

ent M

etho

d:

Shi

pped

Off

-site

R

ecyc

led

On-

site

T

reat

ed O

n-si

te

solid

li

quid

g

as

Cur

ies:

(I

f rad

ioac

tive)

Day

s On

S

ite:

Stor

age

Con

tain

er:*

Stat

e W

aste

Cod

e:

gallo

ns

poun

ds

cu. f

eet

tons

ambi

ent

> am

b.

< am

b.

ambi

ent

> am

b.

< am

b.

cryo

geni

c

fire

re

activ

e pr

essu

re re

leas

e ac

ute

heal

th

chro

nic h

ealth

ra

dioa

ctiv

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e C

ode

Stor

age

Typ

e A

A

bove

grou

nd T

ank

D

Stee

l Dru

m

G

Car

boy

J B

ag

M

Gla

ss B

ottle

or J

ug

P Ta

nk W

agon

B

Bel

owgr

ound

Tan

k E

Pl

astic

/Non

met

allic

Dru

m

H

Silo

K

B

ox

N

Plas

tic B

ottle

or J

ug

Q

Rai

l Car

*

C

Tank

Insi

de B

uild

ing

F C

an

I Fi

ber D

rum

L

C

ylin

der

O

Tote

Bin

R

O

ther

If E

PCR

A, s

ign

belo

w:

____

____

____

____

____

____

____

____

____

____

__

31 of 39


Hazardous Waste Inventory Statement Instructions (Modified UPCF Hazardous Materials Inventory - Chemical Description Page)

Each hazardous waste handled at the facility in an aggregate quantity subject to Hazardous Materials Business Plan reporting requirements must be listed on the Hazardous Waste Inventory Statement [or the Unified Program Consolidated Form (UPCF) Hazardous Materials Inventory - Chemical Description form (available on the Internet at www.unidocs.org/hazmat/business-plan/index.html)](please refer to the Hazardous Materials Business Plan instructions). This form allows you to report up to six wastes on a single page. Do not list non-waste hazardous materials on this form. You must complete a separate inventory line for each individual hazardous waste that you handle at your facility . The completed inventory must reflect all hazardous wastes at your facility, reported separately for each building or outside storage area, with separate inventory lines for unique occurrences of physical state, storage temperature, or storage pressure. Trade secret wastes must be listed on separate pages. Make additional copies of this form if needed. Your local agency may require reporting of hazardous materials present in quantities below HMBP reporting thresholds. Contact your local agency for details. 1. DATE - In the space at the top left side of the form, enter the date this inventory statement page was prepared. 2. BUSINESS NAME - Enter the complete Facility Name. 3. TYPE OF REPORT ON THIS PAGE - Indicate whether the waste is being added to the inventory, deleted from the inventory, or if the information previously

submitted is being revised. (Note: You may leave this blank if you resubmit your entire inventory annually.) 4. PAGE NUMBER - Number each page of the inventory appropriately. 5. CHEMICAL LOCATION - Enter the name of the building or outside area where the hazardous wastes reported on this page are handled. A waste stored at the

same pressure and temperature in multiple locations in one building or area can be reported on a single line. 6. EPCRA CONFIDENTIAL LOCATION - You must check "Yes" to keep chemical location information confidential. If you do not wish to keep chemical

location information confidential check "No." If "Yes," a signature is required on the line provided at the bottom of the form. 7. TRADE SECRET INFORMATION- Check "Yes" if the information in this section is declared a trade secret, "No" if it is not. If "Yes," and the business is subject

to EPCRA, disclosure of designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form to the United States Environmental Protection Agency.

8. FACILITY ID NUMBER - This number is for agency use only. Leave this space blank. 9. HAZARD CLASS - In Column 1 of the inventory table, provide the primary U.S. Department of Transportation (DOT) numerical hazard class for the waste being

reported on each line. (Note: If your local agency requires reporting of Fire Code hazard classes rather than DOT classes, report the Fire Code class rather than the DOT class.)

10. MAP & GRID OR LOCATION CODE - In Column 2, enter the page number of the Storage Map where the location of the hazardous waste is shown, along with the grid coordinates from your Storage Map that correspond to the location of the hazardous waste. If applicable, multiple grid coordinates can be listed. If you do not use a grid system, enter the Location Code shown on your Storage Map. Report each bulk storage tank on a separate line as a distinct storage location.

11. WASTE STREAM NAME & MANAGEMENT METHOD - In Column 3, enter the following information: • WASTE STREAM NAME - The Common Name of the hazardous waste (e.g., Used Oil, Spent Solvent). • MANAGEMENT METHOD - Check the appropriate box(es) to indicate how you manage the waste.

12. HAZARDOUS COMPONENTS - In column 4, enter the following information regarding Hazardous Components that make up the waste listed in Column 3: • CHEMICAL NAME - List the chemical name of each hazardous component in the mixture ranked by percent weight. All hazardous components present at

greater than 1% by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, must be reported. If more than five hazardous components exceed these percentages, you may attach an additional sheet of paper to report the required information.

• % BY WEIGHT - Enter the percentage weight of each hazardous component. If a range of percentages is available, report the highest percentage in that range. • EHS - Check the box provided if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, Appendix A. • CAS NUMBER - List the Chemical Abstract Service (CAS) number for each hazardous component.

13. TYPE & PHYSICAL STATE - In column 5, identify the physical state by checking the “solid”, “liquid”, or “gas” box. 14. QUANTITIES - In the appropriate spaces within column 6, list:

• MAXIMUM DAILY AMOUNT* - Enter the maximum amount of the hazardous waste handled in this building or outside area at any one time over the course of the year. This amount must contain, at a minimum, last year's reported inventory with the reflection of additions, deletions, or revisions projected for the current year.

• AVERAGE DAILY AMOUNT* - Calculate the average daily amount of the hazardous waste or mixture in this building or outside area. If this is a waste that is new to this location, the amount should be the average daily amount you project to be on hand during the course of the year.

• LARGEST CONTAINER* - Enter the volume of the largest container in which the waste is handled at the location. • CURIES - If the waste is radioactive, use the space provided to report the activity in curies. • DAYS ON SITE - Enter the total number of days (e.g., 365) during the year that the waste is on site. (Note: This does not refer to the accumulation time limit

for individual waste containers.) • STORAGE CONTAINER - Using the container codes listed at the bottom of the inventory statement, list every type of container in which the waste is

stored/handled. * Except for Curies, units of measure must be the same as that indicated in Column 8.

15. ANNUAL WASTE AMOUNT - Enter the total quantity of this waste generated annually. Use the same unit of measure as that indicated in Column 8. 16. UNITS - In column 8, check the appropriate unit of measure: gallons for liquids, pounds or tons for solids, and cubic feet for gases. If the waste is a federally

defined EHS at or above the Federal threshold planning quantity (TPQ) limit and is not a mixture, all amounts must be reported in pounds 17. STORAGE CODES - In the appropriate spaces within Column 9, list:

• STORAGE PRESSURE - Check the box that best describes the pressure at which the waste is stored: ambient (standard), > amb. (greater than ambient), < amb. (less than ambient), or cryogenic.

• STORAGE TEMPERATURE - Check the box that best describes the temperature at which the waste is stored. 18. HAZARD CATEGORIES - In column 10, check the box(es) to describe all physical, health, and radioactivity hazards associated with the hazardous waste.

PHYSICAL HAZARDS HEALTH HAZARDS Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics,

Oxidizers Reactive: Unstable Reactives, Organic Peroxides, Water Reactives,

Radioactives

Acute Health (Immediate): Toxics, Highly Toxics, Irritants, Sensitizers, Corrosives, other hazardous chemicals with an adverse effect with short-term exposure

Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other chemicals with an adverse effect with long-term exposure

Note: If this facility is subject to Federal Emergency Planning and Community Right to Know Act (EPCRA) reporting requirements, a signature is required on the line

provided at the bottom of the form if the page lists any Extremely Hazardous Substance (EHS) handled at or above its Federal Threshold Planning Quantity (TPQ) or 500 pounds, whichever is less.

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Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module)

Authority Cited: HSC§ 25504(b); 19 CCR §2731; 22 CCR §66262.34(a)(4) Page of All facilities that handle hazardous materials in HMBP quantities must have a written emergency response plan. In addition, facilities that generate 1,000 kilograms or more of hazardous waste (or more than 1 kilogram of acutely hazardous waste or 100 kilograms of debris resulting from the spill of an acutely hazardous waste) per month, or accumulate more than 6,000 kilograms of hazardous waste on-site at any one time, must prepare a hazardous waste contingency plan. Because the requirements are similar, they have been combined in a single document, provided below, for your convenience. This plan is a required module of the Hazardous Materials Business Plan (HMBP). If you already have a plan that meets these requirements, you should not complete the blank plan, below, but you must include a copy of your existing plan as part of your HMBP. This site-specific Emergency Response/Contingency Plan is the facility’s plan for dealing with emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials that could threaten human health and/or the environment. At least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. A copy of the plan and any revisions must be provided to any contractor, hospital, or agency with whom special (i.e., contractual) emergency services arrangements have been made (see section 3, below). 1. Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply):

Bells; Horns/Sirens; Verbal (i.e., shouting); Other (specify b. Evacuation map is prominently displayed throughout the facility. Note: A properly completed HMBP Site Plan satisfies contingency plan map requirements. This drawing (or any other drawing that

shows primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas) must be prominently posted throughout the facility in locations where it will be visible to employees and visitors.

2. a. Emergency Contacts*: Fire/Police/Ambulance Phone No.: 911

State Office of Emergency Services Phone No.: (800) 852-7550

b. Post-Incident Contacts*: Certified Unified Program Agency (CUPA) Phone No.: ( )

Fire Department Hazardous Materials Program Phone No.: ( )

California EPA Department of Toxic Substances Control Phone No.: ( )

Cal-OSHA Division of Occupational Safety and Health Phone No.: ( )

Air Quality Management District Phone No.: ( )

Regional Water Quality Control Board Phone No.: ( ) * Phone numbers for agencies in Unidocs’ Member Agency geographic jurisdictions are available at www.unidocs.org.

c. Emergency Resources: Poison Control Center* Phone No.: ( )

Nearest Hospital: Name: Phone No.: ( )

Address: City:

If you have made special (i.e., contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements below:

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Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) Page of 4. Emergency Procedures: Emergency Coordinator Responsibilities: a. Whenever there is an imminent or actual emergency situation such as a explosion, fire, or release, the emergency coordinator (or

his/her designee when the emergency coordinator is on call) shall: i. Identify the character, exact source, amount, and areal extent of any released hazardous materials. ii. Assess possible hazards to human health or the environment that may result from the explosion, fire, or release. This

assessment must consider both direct and indirect effects (e.g., the effects of any toxic, irritating, or asphyxiating gases that are generated, the effects of any hazardous surface water run-off from water or chemical agents used to control fire, etc.).

iii. Activate internal facility alarms or communications systems, where applicable, to notify all facility personnel. iv. Notify appropriate local authorities (i.e., call 911). v. Notify the State Office of Emergency Services at 1-800-852-7550. vi. Monitor for leaks, pressure build-up, gas generation, or ruptures in valves, pipes, or other equipment shut down in response to

the incident. vii. Take all reasonable measures necessary to ensure that fires, explosions, and releases do not occur, recur, or spread to other

hazardous materials at the facility.

b. Before facility operations are resumed in areas of the facility affected by the incident, the emergency coordinator shall: i. Provide for proper storage and disposal of recovered waste, contaminated soil or surface water, or any other material that

results from a explosion, fire, or release at the facility. ii. Ensure that no material that is incompatible with the released material is transferred, stored, or disposed of in areas of the

facility affected by the incident until cleanup procedures are completed. iii. Ensure that all emergency equipment is cleaned, fit for its intended use, and available for use. iv. Notify the California Environmental Protection Agency’s Department of Toxic Substances Control, the local CUPA, and the

local fire department’s hazardous materials program that the facility is in compliance with requirements b-i and b-ii, above. Responsibilities of Other Personnel: On a separate page, list any emergency response functions not covered in the “Emergency Coordinator Responsibilities” section, above. Next to each function, list the job title or name of each person responsible for performing the function. Number the page(s) appropriately. 5. Post-Incident Reporting/Recording: The time, date, and details of any hazardous materials incident that requires implementation of this plan shall be noted in the facility’s operating record. Within 15 days of any hazardous materials emergency incident or threatened hazardous materials emergency incident that triggers implementation of this plan, a written Emergency Incident Report, including, but not limited to a description of the incident and the facility’s response to the incident, must be submitted to the California Environmental Protection Agency’s Department of Toxic Substances Control, the local CUPA, and the local fire department’s hazardous materials program. The report shall include: a. Name, address, and telephone number of the facility’s owner/operator; b. Name, address, and telephone number of the facility; c. Date, time, and type of incident (e.g., fire, explosion, etc.); d. Name and quantity of material(s) involved; e. The extent of injuries, if any; f. An assessment of actual or potential hazards to human health or the environment, where this is applicable; g. Estimated quantity and disposition of recovered material that resulted from the incident; h. Cause(es) of the incident; i. Actions taken in response to the incident; j. Administrative or engineering controls designed to prevent such incidents in the future. 6. Earthquake Vulnerability: [19 CCR §2731(e)] As an attachment to this plan, you must identify any areas of the facility and mechanical or other systems that require immediate inspection or isolation because of their vulnerability to earthquake-related ground motion. 7. Hazard Mitigation/Prevention/Abatement [19 CCR §2731(e)] As an attachment to this plan, you must include procedures that provide for mitigation, prevention, or abatement of hazards to persons, property, or the environment. These procedures must be scaled appropriately for the size and nature of the business, the nature of the damage potential of the hazardous materials handled, and the proximity of the business to residential areas and other populations.

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Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) Page of 8. Emergency Equipment: 22 CCR §66265.52(e) [as referenced by 22 CCR §66262.34(a)(4)] requires that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement.

EMERGENCY EQUIPMENT INVENTORY TABLE

1. Equipment

2. Equipment

3.

4.

Category Type Locations * Description** Personal Cartridge Respirators Protective Chemical Monitoring Equipment (describe) Equipment, Chemical Protective Aprons/Coats Safety Chemical Protective Boots Equipment, Chemical Protective Gloves and Chemical Protective Suits (describe) First Aid Face Shields Equipment First Aid Kits/Stations (describe) Hard Hats Plumbed Eye Wash Stations Portable Eye Wash Kits (i.e., bottle type) Respirator Cartridges (describe) Safety Glasses/Splash Goggles Safety Showers Self-Contained Breathing Apparatuses (SCBA) Other (describe) Fire Automatic Fire Sprinkler Systems Extinguishing Fire Alarm Boxes/Stations Systems Fire Extinguisher Systems (describe) Fire Extinguishers (describe) Other (describe) Spill Absorbents (describe) Control Berms/Dikes (describe) Equipment Decontamination Equipment (describe) and Emergency Tanks (describe) Decontamination Exhaust Hoods Equipment Gas Cylinder Leak Repair Kits (describe) Neutralizers (describe) Overpack Drums Sumps (describe) Other (describe) Communications Chemical Alarms (describe) and Intercoms/ PA Systems Alarm Portable Radios Systems Telephones Tank Leak Detection Systems Other (describe) Additional Equipment (Use Additional Pages if Needed.)

* Use the map and grid numbers from the Storage Map prepared earlier for your HMBP. ** Describe the equipment and its capabilities. If applicable, specify any testing/maintenance procedures/intervals. Attach

additional pages, numbered appropriately, if needed.

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Employee Training Plan (Hazardous Materials Business Plan Module)

Authority Cited: HSC, Section 25504(c); 22 CCR §66262.34(a)(4) Page of All facilities that handle hazardous materials in HMBP quantities must have a written employee training plan. This plan is a required module of the Hazardous Materials Business Plan (HMBP). A blank plan has been provided below for you to complete and submit if you do not already have such a plan. If you already have a brief written description of your training program that addresses all subjects covered below, you are not required to complete the blank plan, below, but you must include a copy of your existing document as part of your HMBP. Check all boxes that apply. [Note: Items marked with an asterisk (*) are required.]: 1. Personnel are trained in the following procedures:

Internal alarm/notification * Evacuation/re-entry procedures & assembly point locations* Emergency incident reporting External emergency response organization notification Location(s) and contents of Emergency Response/Contingency Plan Facility evacuation drills, that are conducted at least (specify): (e.g., “Quarterly”, etc.)

2. Chemical Handlers are additionally trained in the following:

Safe methods for handling and storage of hazardous materials * Location(s) and proper use of fire and spill control equipment Spill procedures/emergency procedures Proper use of personal protective equipment * Specific hazard(s) of each chemical to which they may be exposed, including routes of exposure (i.e., inhalation, ingestion,

absorption) * Hazardous Waste Handlers/Managers are trained in all aspects of hazardous waste management specific to their job duties

(e.g., container accumulation time requirements, labeling requirements, storage area inspection requirements, manifesting requirements, etc.) *

3. Emergency Response Team Members are capable of and engaged in the following: Complete this section only if you have an in-house emergency response team

Personnel rescue procedures Shutdown of operations Liaison with responding agencies Use, maintenance, and replacement of emergency response equipment Refresher training, which is provided at least annually * Emergency response drills, which are conducted at least (specify): (e.g., “Quarterly”, etc.)

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Record Keeping (Hazardous Materials Business Plan Module) Page of

All facilities that handle hazardous materials must maintain records associated with their management. A summary of your record keeping procedures is a required module of the Unidocs Hazardous Materials Business Plan (HMBP). A blank summary has been provided below for you to complete and submit if you do not already have such a document. If you already have a brief written description of your hazardous materials record keeping systems that addresses all subjects covered below, you are not required to complete this page, but you must include a copy of your existing document as part of your HMBP. Check all boxes that apply. The following records are maintained at the facility. [Note: Items marked with an asterisk (*) are required.]:

Current employees’ training records (to be retained until closure of the facility) * Former employees’ training records (to be retained at least three years after termination of employment) * Training Program(s) (i.e., written description of introductory and continuing training) * Current copy of this Emergency Response/Contingency Plan * Record of recordable/reportable hazardous material/waste releases * Record of hazardous material/waste storage area inspections * Record of hazardous waste tank daily inspections * Description and documentation of facility emergency response drills

Note: The above list of records does not necessarily identify every type of record required to be maintained by the facility. Note: The following section applies where local agencies require facility owners/operators to perform and

document routine facility self-inspections: A copy of the Inspection Check Sheet(s) or Log(s) used in conjunction with required routine self-inspections of your facility must be submitted with your HMBP. [Exception: Unidocs provides a Hazardous Materials/Waste Storage Area Inspection Form that you may use if you do not already have your own form. If you use the Unidocs form (available at www.unidocs.org), you do not need to attach a copy.] Check the appropriate box:

We will use the Unidocs “Hazardous Materials/Waste Storage Area Inspection Form” to document inspections. We will use our own documents to record inspections. (A blank copy of each document used must be attached to this HMBP.)

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Facility Site Plan/Storage Map (Hazardous Materials Business Plan Module)

Site Address: Date Map Drawn: Map Scale: Page of

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

1

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10

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Instructions are printed on the following page.

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Facility Site Plan and Storage Map Instructions (Hazardous Materials Business Plan Module)

A Site Plan (public document) and Storage Map (confidential document) must be included with your HMBP. For relatively small facilities, these documents may be combined into one drawing. However, if combined, the combined Site Plan/Storage Map will become a public document. If you are concerned about displaying the storage locations of hazardous materials to the public, you must provide a separate facility Storage Map. Since these drawings are intended for use in emergency response situations, larger facilities (generally those with complex and/or multiple buildings) should provide an overall site plan and a separate storage map for each building/storage area. A blank Facility Site Plan/Storage Map sheet has been provided on the previous page. You may complete that page or attach any other drawing(s) that contain(s) the information required below: 1. Site Plan (public document): This drawing shall contain, at a minimum, the following information:

a. An indication of North Direction; b. Approximate scale (e.g., “1 inch = 10 feet”.); c. Date the map was drawn; d. All streets bordering the facility; e. Locations of all buildings and other structures; f. Parking lots and internal roads; g. Hazardous materials loading/unloading areas; h. Outside hazardous materials storage or use areas; i. Storm drain and sanitary sewer drain inlets; j. Wells for monitoring of underground tank systems; k. Primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas.

2. Storage Map (confidential): The map(s) shall contain, at a minimum, the following information:

a. General purpose of each section/area within each building (e.g., “Office Area”, “Manufacturing Area”, etc.);

b. Location of each hazardous material/waste storage, dispensing, use, or handling area (e.g., individual underground tanks, aboveground tanks, storage rooms, paint booths, etc.). Each area shall be identifiable by a Grid Number, to be used in item 204 on the Hazardous Materials Inventory - Chemical Description pages of the Business Plan;

c. For tanks, the capacity limit in gallons and common name of the hazardous material contained in each tank;

d. Entrances to and exits from each building and hazardous material/waste room/area; e. Location of each utility emergency shut-off point (i.e., gas, water, electric.); f. Location of each monitoring system control panel (e.g., underground tank monitoring, toxic gas

monitoring, etc.).

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hazardous materials business plan requirements · 11022 (c))) a hazardous chemical subject to the...

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