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REG <br />HAZARDOUS WASTE CONTINGENCY PLA 12008 <br />For use by Unidocs Member Agencies or where approved by your Local Jurisdictiosglv <br />Authority Cited: Title 22, California Code of Regulations (CCR) §66265.52 as referenced by §66262.34(a)(4) or <br />p,P, RT elv <br />Facilities that generate 1,000 kilograms or more of hazardous waste per month, or accumulate more than K000 <br />kilograms of hazardous waste on-site at any one time, must prepare a Contingency Plan. Facilities that generate <br />in any month more than 1 kilogram of acutely hazardous waste (AHW), or more than 100 kilograms of debris <br />resulting from the spill of an AHW, or which treat hazardous waste onsite under the Permit by Rule (PBR) <br />onsite treatment tier must also prepare a Contingency Plan. Many facilities that are required to prepare a <br />Contingency Plan are already subject to Hazardous Materials Business Plan (HMBP) reporting requirements <br />due to the quantities of hazardous materials/wastes they have onsite. If you have already prepared a Unidocs <br />HMBP, or already have a plan which is equivalent in content to the Emergency Response/Contingency Plan <br />module of the Unidocs HMBP, you have satisfied the Contingency Plan requirements, and are not required to <br />complete the blank plan, below. <br />This site-specific Contingency Plan is the facility's plan for dealing with emergencies and shall be implemented <br />immediately whenever there is an imminent or actual fire, explosion, or release of hazardous waste or a <br />hazardous waste constituent which could threaten human health and/or the environment. At least one copy of <br />the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the <br />local agency. A copy of the plan and any revisions must be provided to any contractor, hospital, or agency <br />with whom special (i.e. contractual) emergency services arrangements have been made (see Section E, below). <br />A. Facility Information: <br />BUSINESS NAME I BUSINESS PHONE. <br />ACM <br />SITE ADDRESS t CITY ZIP CODE <br />i f) / 9 4- i n �f Q �, UX llo/L, W A.'I S ke- /C fats , t '� 5-20 c - <br />B. Emergency Coordinators: <br />All personnel qualified to act as the facility's Emergency Coordinator must be listed in this plan. (Note: <br />Emergency Coordinator responsibilities are described in Section F, below.) If more than two people are <br />qualified, list the names, titles, business and 24-hour telephone numbers, and pager numbers of the additional <br />qualified individuals on an attached page in the order in which they will assume responsibility as alternates, <br />then check the box beneath the Emergency Coordinator information table, below, and indicate the list's page <br />number in the space provided. <br />Priniarl <br />Emergencl <br />Coordinator <br />Secondary Emergenel Coordinator <br />NAME <br />' <br />NAME !�fl <br />® <br />TITLE <br />TITLE F` <br />�$ <br />p) <br />BUSINESS PHONE <br />Lt b 6 - <br />ca°'2_ 1 <br />BUSINESS PHONE <br />�� Y66- ?oZ! <br />24-HOUR PHONE <br />24-HOUR PHONE <br />7 <br />PAGER# <br />PAGER# <br />❑ (Check box only if applicable) Additional Emergency Coordinators are listed on page of this plan. <br />C. Evacuation Plan: <br />1. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): <br />❑ Bells; ❑ Horns/Sirens; Verbal (i.e., shouting); YOther (sped Altx k / � �5 <br />UN -017 -1/6 www.unidocs.org Rev. 03/27/08 <br />