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SAN JOAQUIN COUNTY HAZARDOUS MATERIALS PROGRAM <br />This survey form is intended to identify businesses, which need to comply with the hazardous materials emergency planning and <br />reporting requirements of Chapter 6.95 of the California Health and Safety Code. This statute requires businesses, which handle <br />hazardous materials to prepare emergency plans for their employees' use in an emergency. Businesses must submit a copy of this <br />plan, along with annual inventory of their hazardous materials, to public agencies for use in protecting emergency responders and <br />the public. In San Joaquin County, the Office of Emergency Services (OES) has been designated to administer this program. <br />Should you have any questions on this program or this form, please call that office at (209) 468-3969. <br />Please consider the following guidelines when completing the questions on the front of this form. <br />Question 1 <br />The law defines "hazardous material" for purposes of this program as any material that, because of its quantity, concentration, or <br />physical or chemical characteristics, poses a significant present or potential hazard to human health and safety or to the environment <br />if released into the work place or the environment This includes, but is limited to, fuels, petroleum products, paints, propane, <br />oxygen, ammonia, chlorine, pesticides, fertilizers, and hazardous wastes. Answer "Yes" if you use a material that meets that <br />definition in any quantity at least once in the year. If you are unsure, contact our office at (209) 468-3969 for assistance. If you <br />answer "No" and at a later date your business, or a tenant on your property, begins handling hazardous materials, you must inform <br />the Office of Emergency Services within 30 days. <br />Question 2: <br />If you answer "Yes," you must meet the requirements of Chapter 6.95 of the California Health and Safety Code. Our office will be <br />contacting you to provide assistance. These requirements must be met prior to issuance of a certificate of occupancy. <br />U you answer "No," our office may conduct an inspection after you begin operations to verify your exemption. <br />The statutes establish some modified requirements or program exemptions for certain uses of hazardous materials. If you answered <br />"Yes" to questions 1 and 2, determine whether your business meets one of the following conditions. Then mark the appropriate <br />boxes on the front of this form. Our office will contact you to make a final determination of these exemptions. <br />A. Retail Exemption: Products packaged for direct distribution to the general public are exempt from the program. This <br />exemption may not apply if 1) the quantity handled creates an unacceptable public hazard; 2) the material is being used <br />directly by the business as part of its operations in addition to being sold to the general public; or 3) the general public does <br />not have ready access to the product as it is stored by the business, e.g., in a warehouse. <br />B. Medical Exemption: Medical offices which use only oxygen and/or nitrous oxide in quantities less than 1,000 cubic feet are <br />required to meet modified requirements. <br />C. Farm Exemption: Farms, as defined in the question, must meet modified program requirements. The definition of farm in <br />the law does not include businesses providing commercial pest control services, fertilizer application services, product <br />processing services, or packing shed services for farmers. Farms qualifying for exemption are still required to submit an <br />annual chemical inventory and fee to the County Agricultural Commissioner's Department along with other requirements. <br />Please contact the County Agricultural Commissioner's Department for further information. Businesses operating a <br />commercial business in addition to a farm as defined must comply with the HMMP program for those materials associated <br />with the commercial business. <br />Question 3 <br />The Federal and State governments have defined approximately 366 chemicals as "Acutely Hazardous Materials" (AHM). The <br />most common "AHMs" used in the County include chlorine, ammonia, sulfuric acid, methyl bromide, acrolein, sulfur dioxide, <br />formaldehyde, nitric acid, vinyl acetate monomer, hydrogen peroxide, and many types of pesticides. Answer "Yes" if you use any <br />of these specific chemicals in any quantity at any one time of the year. Call our office for assistance if you are unsure. <br />Question 4: <br />Answer "Yes" if the boundary of your property or facility will be within 1,000 feet of the boundary of a school (K thru 12). <br />F.'Tevsys'Planning Application Farms Page 2 of 2 <br />Hazardous Materials Disclosure Survey (Revised 8-25-03) <br />