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5.A+ 4E)AfL`Lti Cf3t tTt 1I2F{1A(1€'S 4LA'I ERI.cL 5 PROGIR&M
<br /> swvev form is intmded w identify bu-sisesses,',e hich need to comply with the hazardous materials emergency planning and
<br /> repardag requirements of Charles 6.95 ofthe Ca:i O iia Bealth and Safety Code. 'ibis stanne requires businesses,which handle
<br /> aazandMis materials to pr--pare calc''gen 'plans for then'employees, use in ani7a1Cr�E uGY. Bil-sinesses nails€ submit a copy of ills
<br /> plan.alansz y}iti annual inventory of their hazardous materials,to on,lie agencies t ,use in noir a tiIIP emergency responders Antl
<br /> :LPe ptitHic. In San joaquin i o'Snty,the Of"ice Of Emergency Ser rices tOEI has been desigrdteµto adnnn€ster this tx'Ggrcr-
<br /> A.
<br /> Sl culd.,, bare riY u v;ons on tins progrsin or t:t=:s f�a.,please nail;hat vffize at C2091 468-3969.
<br /> Please Consider the following.guidelines when complefing the questions ori the ti oat of lhis forn'.
<br /> .tEesC€a3A I:
<br /> Tile law defines-hazardous material"R r purposes of this prt:grac,as any n aierir..i teat.because,,:"is qualmy,CencautT tion;
<br /> ar p }reical or e nical Characteris cs,noses a ca t>ca n present or pr;<a tial:^,<a.rd:o hu+x an Ilea I ry x d safe v o to time
<br /> eriviroyxmcnt if released into ase v=ertr ileo or the=ice torment. i hisis in:vted io Is_ penoicam products,px'„t;,
<br /> ctu-�a se,oxygen,ar.«oc.A,eiilo,-:nne.pesticides,Tenillzers.2uv?hazardoussaa..e-z. s's<.nsw "Yea i you use a material fret:aecls
<br /> that de?riinon in any quantity at leasr onve in the ve ar. If you:re unsum coracct our ofKce az(209)4S3-3%9 for assistance. if
<br /> you ansu C--"Iia"and at a.laieidate your business,or a"count au your pra?en' ,1Tegius bemc'ding hazard&us:materials,you:racist
<br /> oiforta he Of'fi'ce of ctnerLeacy Senicees wiia':m a{I dacre.
<br /> uEsti�s 2:
<br /> ff yell ansv-er"t'e;,'}roe snusi^aces€€be rcquss'ensents oz Chapter 6.�5 Of tae Caufamis Herst'n and Safety Cdde. C3ur af3iC::will
<br /> be contacting you to pro;'ole assistance. TtiEss.reynirem;attc must be rz:-t p r,r;z�iss€:ance of a eery :auc of occcpz:;c _
<br /> if you answer"Nrj,'our office luny,conduct au wsp�tiou after you begun operations to vie Crow exeinp€tan. y
<br /> 'fhe statutes establish some modified requirements or program exemptions for certain uses of hazardous ma€:erials. if}'cu
<br /> answered"Yes."to cnesdons 1 and- dete.-:nme wilLillor your bRaincs rnt�s one of the fallowing-auditions. Thea:nark the
<br /> appropriate boxes on the front of this font-. Dur o!Tlce wi11 cron£act You to retake E liaal detemi.;r-_tiara of these exeriptions.
<br /> :A. Retail E eerindoll:Piodoe+s pace agel,far cire-et di9Lion tion to the gen=I public are n-at fmm tae program. This
<br /> exemption may not apply if i t the quarry handled create as,unacceptable public hazard:2)the material is being used
<br /> directly by the buviness as part of i€s upwatioraa in addition to&eng,sold to the general pubic r=)the ecais�ral.IrsbtiC does
<br /> ant have ready ecus toills product,as it is,sozeri by the bestows_,e.g.,is A�;•arc;i;atse. _.
<br /> B. Medical 1"x.e}no2 tion.:Medical oi'5ces which use Mty oxygen snclor:nitrous Oxide in c€=can ities'.ess ffian I.(O cubic feet x.
<br /> required to meet modi5ed rz:;iziremens.
<br /> C. Feankxei�ti2p:gams,as defined is the ques€itv-t,must meet monified program req e teals. Hie,definition at arm in
<br /> the taw dyes not.include busasesnes pr1,iding Ccvnrtercisl pest control services.ferolizer application st nicer„product
<br /> processing seuvices,or packing sated sere-ices flay farm as. F irons casalitm.—for exen'aption as stilt requinxi to submit an
<br /> aruaual cI en iCal im-emary and fen to the Ca tnfo;lgx cultural Co-unnission s Department along with ahEr requimeris.
<br /> Please contact the Coun€y Agricul?uref Cannnisskmer's Depailmem Zor fir Cher information. Bu :ncKscs opc�aiing x
<br /> commercial business in atddirion to a faun as defined must comply with the HIVI?IP Irof-m .for*those materials associated
<br /> ;with the commety al business.
<br /> -Queytia_a 33
<br /> Tine Federal and;state goyeltonents have de£ned approximately=366 chemicals es"Acutel;.I azat'd sus v1a noels"i AHM,i. The
<br /> most common':AM4s"used in the Coun€y include chlorine,a m?cnia,sulf�vie acid,rnudyl bromide acrolcin.,sslnir dioxide,
<br /> `ormi0dehyde,nitric acid,lir;y't aaxxaie mottomer,hydrogen peroxide,and many,,pas of - sticicias. Answer"Yes"if you use
<br /> Any of these specific chemicals ri any quantity at asst'one tints of the year. Cali ac a;:c for assistance if'You are an r,-
<br /> �esrion 4:
<br /> Answer"`.lets"if the boundary off your property or facility will be-s'idsin 1 A00 fcu of the boundary of e school(IC thru 12).
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