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Instructions for Completing the CERS Consolidated Emergency Response/Contingency Plan CL LOCAL UNIFIED PROGRAM AGENCY PHONE - Enter the phone number of the local UPA that implements the Hazardous Materials Business Plan (HMBP) and hazardous waste generator program elements . If there is more than one UPA, identify the second agency in C5 . C2 . OTHER AGENCY NAME - If applicable, enter the name of another UPA or emergency response agency . C3 . OTHER AGENCY PHONE - If applicable, enter the phone number of the agency named in C2 . C4 . NEAREST MEDICAL FACILITY or HOSPITAL NAME - Enter the name of the nearest hospital or medical facility. C5 . NEAREST MEDICAL FACILITY or HOSPITAL PHONE - Enter the phone number of the nearest hospital or medical facility named in C4 . C6 . REGIONAL WATER QUALITY CONTROL BOARD PHONE - Enter the phone number of the local RWQCB . CT OTHER AGENCY NAME - If applicable, enter the name of another agency requiring notification (e . g . , Regional or local agencies not otherwise included) . C8 . OTHER AGENCY PHONE - If applicable, enter the phone number of the agency named in C7 . C9 . OTHER AGENCY NAME - If applicable, enter the name of another agency requiring notification (e .g. , Regional or local agencies not otherwise included) . C10 . OTHER AGENCY PHONE - If applicable, enter the phone number of the agency named in C9 . C11 . INTERNAL FACILITY EMERGENCY COMMUNICATIONS OR ALARM NOTIFICATION WILL OCCUR VIA - Check one or more of the boxes to indicate how internal emergency communication and/or alarm notification will occur. C12 . NOTIFICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFECTED BY AN OFF - SITE RELEASE WILL OCCUR BY - Check one or more of the boxes to indicate how neighboring facilities will be notified of actual or threatened off-site releases . C13 , C13 . EMERGENCY COORDINATOR CONTACT INFORMATION - Provide appropriate contact information for large quantity hazardous waste generators . D1 . EMERGENCY CONTAINMENT AND CLEANUP PROCEDURES - Check all applicable boxes to identify procedures and resources used by your facility to contain, prevent, and/or mitigate a release or emergency. D2 . OTHER (SPECIFY) - Briefly specify other spill prevention, containment, and cleanup procedures if you checked Box 21 . E1 . THE FOLLOWING ALARM SIGNAL( S) WILL BE USED TO BEGIN EVACUATION OF THE FACILITY - Check all applicable boxes to indicate how facility evacuation will be communicated . E2 . OTHER (SPECIFY) - Briefly specify other evacuation signals if you checked Box 4. E3 . THE FOLLOWING LOCATION( S) WILL BE USED FOR AN EMERGENCY ASSEMBLY AREA( S) - Briefly describe the evacuation assembly area(s) . E4 . EVACUATION ROUTES AND ALTERNATE EVACUATION ROUTES ARE DESCRIBED AS FOLLOWS : - Check the applicable box or boxes to indicate how evacuation routes are described . E5 . OTHER ( SPECIFY) - Briefly specify other options for describing evacuation routes if you checked Box 3 . F1 . ADVANCE ARRANGEMENTS FOR LOCAL EMERGENCY SERVICES - Check the appropriate box to indicate if advance arrangements have been made or if they have been determined not to be necessary. F2 . ADVANCE ARRANGEMENTS (SPECIFY) - If you checked Box 2, briefly describe the advance arrangements . G1 . EQUIPMENT AVAILABLE - Check all applicable boxes in the second column of the table to identify emergency equipment available at your facility. G2 . LOCATION - Briefly describe the location(s) where the emergency equipment is kept. Repeat for other rows in table . G3 . CAPABILITY -If applicable, briefly describe the capability of the emergency equipment. Repeat for other rows in table . H1 . VULNERABLE AREAS - Check all applicable boxes to identify areas at risk for hazardous materials releases or spills due to earthquakes . H2 . LOCATIONS - If you checked Box 14, briefly describe the location in the corresponding row. Repeat for each row, if applicable . H3 . VULNERABLE SYSTEMS AND/OR EQUIPMENT - Check all applicable boxes to identify systems and/or equipment vulnerable to hazardous materials releases or spills due to earthquakes . H4 . LOCATIONS - If you checked Box 1 -6 , briefly describe the location in the corresponding row. Repeat for each row, if applicable. Il . INDICATE HOW EMPLOYEE TRAINING PROGRAM IS ADMINISTERED - Check all applicable boxes to identify how your employee training program is administered . 12 . OTHER (SPECIFY) - If you checked Box 5 , briefly describe the other ways training is administered. 13 . Check this box if a separate employee training plan is used and uploaded to CERS as a PDF document . 14 . Check this box if an employee training plan is maintained onsite in addition to the above referenced training plan content. JI . ATTACHMENTS - Check this box to indicate that no additional pages and/or documents are attached . J2 . DOCUMENTS ATTACHED ( SPECIFY) - Check this box to indicate that attachments are provided and list the attachments in the section . Rev. 03/07/17 Page 2 of 2