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SAN JOJVIN COUNTY HAZARDOUS MATERIALS PROGRAM This survey form is intended to identify businesses,which need to comply with the hazardous materials ernergency.planning and reporting°requirements of Chapter 6.95 of the California Healthattd Safety Code. This statute requires businesses, which handle hazardous materials to prepare erhergericy plans for their employees' use in an emergency Businesses must submit a copy of this plan along with annual inventory:of their hazardous matenaEs to public agencies for use in pratectmg' emergency responders and the,public in.San•Joaqutn.:County; the Office of Emer-jency Services(GES}has been tlesignated to administer this program Should you hare:any questions on this program or this ftirm please call That office at ,1209)'4:18 3g$ Please consider the fallciwirig guidelines when.cothpletino�the-questions on the front of this form: 'The law defines `hazardous rnaterial"for purposes of this,program as any material that, because of its,quantity, concentration 'or physical orcherhical characteristics, poses a significantpresent`or potential hazard:to humari�health and safety:or to`the e-nviconnient if released into the workplace or:the"environment. ?his includes,but is=limited to fuels; petroleum products paints, propane, oxygen,ammonia, chlorine, pesticides .fer#ilizers, and.hazardous wastes. Answer "yes"if you use a material that meets that definition in any quantity at least once in the year. If you are unsure;coritactour... office at(209)468-3969 for assistance. If you answer"No"and at a later'date your business, or a tenant on yaur°prop6rty,. begins handling hazardous materials,.you must inform the Office of Emergency Services within 30 days. Question 2: Ifyou answer"Yes,"you must meet the requirements of Chapter 6.95 of the California Health and Safety Code. Our office will be contacting you to provide assistance. These requirements must be met prior to issuance of a certificate of occupancy. If you answer"No,"our office may conduct an inspection after you begin operations to verify your exemption. The statutes establish some modified requirements or program exemptions for certain uses of hazardous materials. If you answered"Yes"to questions 1 and 2, determine whether your business meets one of the following conditions. Then mark the appropriate boxes on the front of this form. Our office will contact you to make a final determination of these exemptions. A. Retail Exemption: Products packaged for direct distribution to the general public are exempt from the program. This exemption may not apply if 1)the quantity handled creates an unacceptable public hazard;2)the material is being used directly by the business as part of its operations in addition to being sold to the general public;or 3)the general public does not have ready access to the product as it is stored by the business, e.g., in a warehouse. B. Medical Exemption: Medical offices which use only oxygen and/or nitrous oxide in quantities less than 1,000 cubic feet are required to meet modified requirements. C. Farm Exemption: Farms, as defined in the question, must meet modified program requirements. The definition of farm in the law does not include businesses providing commercial pest control services, fertilizer application services, product processing services, or packing shed services for farmers. Farms qualifying for exemption are still required to submit an annual chemical inventory and fee to the County Agricultural Commissioner's Department along with other requirements. Please contact the County Agricultural Commissioner's Department for further information. Businesses operating a commercial business in addition to a farm as defined must comply with the HMMP program for those materials associated with the commercial business. Question 3` The Federal and State governments have defined approximately 366 chemicals as"Acutely Hazardous Materials" (AHM). The most common"AHMs"used in the County include chlorine, ammonia,sulfuric acid, methyl bromide, acrolein, sulfur dioxide,formaldehyde, nitric acid, vinyl acetate monomer, hydrogen peroxide, and many types of pesticides. Answer"Yes"if you use any of these specific chemicals in any quantity at any one time of the year. Call our office for assistance if you are unsure. Question 4: 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). F:VEVSVMPlanning Application Forms\Site Approval.(Revised 1-3-03) Page 7 of 9