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Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) I � Authority Cited: HSC§ 25504(b); 19 CCR ¢2731; 22 CCR §66262.34(a)(4) Page L of -01 All facilities that handle hazardous materials in HMBP quantities must have a written emergency response plan. In addition, facilities that generate 1,000 kilograms or more of hazardous waste (or more than 1 kilogram of acutely hazardous waste or 100 kilograms of debris resulting from the spill of an acutely hazardous waste) per month, or accumulate more than 6,000 kilograms of hazardous waste on-site at any one time, must prepare a hazardous waste contingency plan. Because the requirements are similar, they have been combined in a single document, provided below, for your convenience. This plan is a required module of the Hazardous Materials Business Plan (HMBP). If you already have a plan that meets these requirements, you should not complete the blank plan, below, but you must include a copy of your existing plan as part of your HMBP. This site-specific Emergency Response/Contingency Plan is the facility's plan for dealing with emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials that could threaten human health and/or the environment. At least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. A copy of the plan and any revisions must be provided to any contractor, hospital, or agency with whom special (i.e., contractual) emergency services arrangements have been made (see section 3, below). Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): ❑ Bells; ® Horns/Sirens; ® Verbal (i.e., shouting); ❑ Other (specify ® Evacuation map is prominently displayed throughout the facility. Note: A properly completed HMBP Site Plan satisfies contingency plan map requirements. This drawing (or any other drawing that shows primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas) must be prominently posted throughout the facility in locations where it will be visible to employees and visitors. 2. a. Emergency Contacts:* Fire/Police/Ambulance Phone No.: 911 -------------------------------------------------------- California Emergency Management Agency --------------------------------- Phone No.: (800) 852-7550 b. Post -Incident Contacts:* Certified Unified Program Agency (CUPA) Phone No.: --------------------------- Local Hazardous Materials Program .................... Phone No.: ( ) California Department of Toxic Substances Control (DTSC) Phone No.: ( ) Cal/OSHA Division of Occupational Safety and Health Phone No.: ( ) Air Quality Management District Phone No.: ( ) •- --•------------ Regional Water Quality Control Board Phone No.: ( ) *Phone numbers for agencies in Unidocs Member Agency geographic jurisdictions are available at www.unidocs.org, c. Emergency Resources: Poison Control Center* --------------------------------------------------- Phone No.: (800) 876-4766 LOCATED ON PHYSICIAN'S Phone No.: Nearest Hospital: Name: PANEL IN BREAK ROOM Address: 3. Arrangements With Emergency Responders: City: If you have made special (i.e., contractual) arrangements with any police department, fire department, hospital, contractor, or Stats or local emergency response team to coordinate emergency services, describe those arrangements below: UN 1270 www.uni ocs.org -Rev—.127T47