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CALIFORNIA ACCIDENTAL REL \SE PREVENTION J
<br /> PROGRAM REGISTRATION
<br /> OES 2735.6(NEW 6197)(REVERSE)
<br /> PLEASE READ CAREFULLY BEFORE COMPLETING FORM
<br /> GENERAL INFORMATION
<br /> This registration form is to be completed by an owner or operator of a stationary source that handles one or more regulated
<br /> substances in a process in excess of the threshold quantity(see definition below). To complete this form, the registrant should
<br /> refer to the California Accidental Release Prevention(CaIARP)program regulations. The regulations are codified in the
<br /> California Code of Regulations(CCR),Title 19, Division 2,Chapter 4.5, Sections 2735.1 through 2785.1. The list of regulated
<br /> substances and thresholds are in Section 2770.5. Information on the CaIARP program and the regulations are located on the
<br /> Governor's Office of Emergency Service's(OES) internet home page at http://www.oes.ca.gov. The completed registration form
<br /> must be submitted to the registrant's local Certified Unified Program Agency(CUPA)or administering agency(AA).
<br /> The following definitions of specific terms are included to assist the registrant in completing this form.
<br /> "Process" means any activity involving a regulated substance including any use, storage, manufacturing, handling, or on-site
<br /> movement of such substances, or combination of these activities. For the purpose of this definition, any group of vessels that are
<br /> interconnected, or separate vessels that are located such that a regulated substance could be involved in a potential release, shall
<br /> be considered a single process.
<br /> "Regulated substance" means any substance,unless otherwise indicated, listed in CCR, Title 19, Section 2770.5.
<br /> "Stationary source" means any buildings, structures, equipment, installations, or substance emitting stationary activities which
<br /> belong to the same industrial group,which are located on one or more contiguous properties, which are under the control of the
<br /> same person(or persons under common control), and from which an accidental release may occur. A stationary source includes
<br /> transportation containers that are no longer under active shipping papers and transportation containers that are connected to
<br /> equipment at the stationary source for the purposes of temporary storage, loading,or unloading. The term stationary source does
<br /> not apply to transportation, including storage incident to transportation, of any regulated substance or any other extremely
<br /> hazardous substance under the provisions of CCR, Title 19, Chapter 4.5. Transportation includes, but is not limited to,
<br /> transportation subject to oversight or regulations under Title 49 of the Code of Federal Regulations, Parts 192, 193, or 195.
<br /> Properties shall not be considered contiguous solely because of a railroad or gas pipeline right-of-way. A stationary source does
<br /> not include naturally occurring hydrocarbon reservoirs.
<br /> "Threshold quantity" means the quantity specified for a regulated substance pursuant to CCR,Title 19, Section 2770.5 and
<br /> determined to be present at a stationary source as specified in Section 2770.2.
<br /> INSTRUCTION FOR COMPLETING THE CalARP PROGRAM REGISTRATION FORM
<br /> Please indicate the number of pages to be submitted in the upper right comer of each form completed. Use additional pages, if
<br /> the number of regulated substances handled exceeds the space available on one page. Indicate if this is a "new" registration or a
<br /> registration "update" by checking the appropriate box. If this form updates a previously submitted registration indicate the type
<br /> of update as follows: check "add" if a regulated substance is being added; check "delete" if a regulated substance is being
<br /> deleted; check "revise" if any other information is being revised.
<br /> I. Business Owner/Operator Information: Complete business name, address(number and street), city, county, state,and zip
<br /> code; and owner or operator name and phone number.
<br /> U. Regulated Substance List: A.Name of Each Regulated Substance- Provide the chemical name and Chemical Abstracts
<br /> Service(CAS)number for each regulated substance held above the threshold quantity in a process, and the maximum
<br /> quantity of each regulated substance in the process(in pounds),to two significant digits(refer to CCR,Title 19, Section
<br /> 2770.2 and 2770.5); B.Name of Each Regulated Substance in a Mixture- Provide the chemical name and CAS number for
<br /> each regulated substance in the mixture held above the threshold quantity in a process, the percent weight of the regulated
<br /> substance in the mixture, and the maximum quantity of each regulated substance in the process(in pounds),to two
<br /> significant digits(refer to CCR, Title 19, Sections 2770.2 and 2770.5). (Note: Specifically identify any information on this
<br /> form which is classified information or trade secret.)
<br /> III. Certification: Read the certification statement and provide the owner or operator name, signature, and date when executed.
<br /> If you have any questions regarding the completion of this form, please contact the local CUPA or AA.
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