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San Joaquin County Environmental Health Department HAZARDOUS MATERIALS PROGRAM This survey form is intended to identify businesses which need to comply with the hazardous materials emergency planning and reporting requirements of the California Health and Safely Code(HSC) Chapter 6.95. This Chapter requires businesses which handle hazardous materials to prepare emergency plans for their employees to use in an emergency. Businesses must submit a copy of this plan, along with an annual inventory of their hazardous materials, to public safety agencies for use In protecting emergency responders and the general public. In San Joaquin County, the Environmental Health Department (EHD) has been authorized to administer this program as the Certified Unified Program Agency or CUPA Should you have any questions about the CUPA program or this form,please contact EHD at(209)468-3420. Please consider the following guidelines when completing the questions on page 1. Question 1 The (HSC) section 25501(p) defines a "Hazardous Material- as any material that, because of its quantity, concentration, or physical or chemical characteristics, poses a significant present or potential hazard to human health and safety or to the environment if released into the workplace or the environment. "Hazardous Materials' include but are not limited to, hazardous substances, hazardous waste, and any material that a handler or the administering agency has a reasonable basis for believing that it would be injurious to the health and safely of persons or harmful to the environment if released into the workplace or the environment. This includes, but is not limited to, fuels, petroleum products. Paints, propane, oxygen, ammonia, chlorine, pesticides, fertilizers, and used oil. If a business generates any amount of hazardous waste they must enroll in the EHD Hazardous Waste Generator Program. Answer"Yes'if you use a material that meets the definition above in any quantity at least once In the year. If you are unsure, contact the EHD at(209) 468-3420 for assistance. If you answer 'No'and at a later date your business,or a tenant on your property.begins handling hazardous materials, you must inform the EHD within 30 days. Question 2: If you answer 'Yes", you must meet the requirements of HSC Chapter 6.95. The EHD 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 HSC establishes some modified requirements or program exemptions for certain uses of hazardous materials. If you answered 'Yes' to questions 1 and 2, a determination must be made if your business meets one of the exemptions listed. Check the appropriate boxes on page 1. The EHD will contact you to make a final determination if your business meets the exemptions. A. Retail Exemption—Products packaged for direct distribution to the general public are exempt from the program. This exemption may not apply if any of the following conditions exist: 1.The quantity handled creates an unacceptable public hazard 2. The material is being used diroclly by the business as part of its operation in addition to being sold to the general public 3. The general public doesn't have ready access to the product as stored by the business (e.gin a warehouse). B. Modified Farm Exemption — Farms, as stated in Question 2B on page 1, must meet modified program requirements. The definition of a farm in the law o n't include businesses providing commercial pest control services, fertilizer application services. product processing services, or packing shed services for farmers, Farms qualifying for the exemption are still required to submit an annual chemical inventory and fee to the San Joaquin County Office of the Agricultural Commissioner(OAC) along with other requirements. Please contact the OAC for further information at(209)953-6000. Businesses operating a commercial business in addition to a farm as defined must comply with the requirements of the Hazardous Materials Program for those materials associated with the commercial business. Question 3. The Federal and Slate governments have defined approximately 366 chemicals as an 'Acutely Hazardous Material" (AHM), The most common AHM 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. Contact the EHD if you're unsure for assistance. Question 4: Answer'Yes'if the boundary of your property or facility is or will be within 1,000 feel of the boundary of a school.(dredee x-u) 2 R+.wea l MM.,