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HAZA OUS 'WASTE CONTINGENCY PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 22, Calffiornia Code of Regulations(CCR)§66265.52 as referenced by§665262.34(a)(4)or 67450.3(c)(9)(C) Facilities that generate 1,000 kilograms or more of hazardous waste per month, or accumulate more than 6,000 kilograms of hazardous waste on-site at any one time,must prepare a Contingency Plan. Facilities that generate in any month more than 1 kilogram of acutely hazardous waste (AHW), or more than 100 kilograms of debris resulting from the spill of an AHW, or which treat hazardous waste onsite under the Permit by Rule (PBR) onsite treatment tier must also prepare a Contingency Plan. Many facilities that are required to prepare a Contingency Plan are alre dy subject to Hazardous Materials Business Plan 'HMBP) reporting requirements due to the quantities of hw ardous materials/wastes they have onsite. If you 1:ave already prepared a Unidocs HMBP or already have a Dlan which is equivalent in content to the Emerge icy Response/Contingency Plan module of the Unidocs HN.BP, you have satisfied the Contingency Plan requirements, and are not required to complete the blank plan,be ow. This site-specific Continger cy Plan is the facility's plan for dealing with emergencies and shall be implemented immediately whenever there is an imminent or actual fire, explosion, or release of hazardous waste or a hazardous waste constituen which 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 trie plan and any revisions must be provided to any contractor, hospital, or agency with whom special(i.e. con ractual) emergency services arrangements have been made (see Section E, below). A. Facility Information: j C�3 ) L t` BUSINESS NAME WJSINESS PHONE. �ovmfpt � � � 1 vjo` k 19Iin Z_UvN7/�'7 GL L4)T � -f3 -1 SITE ADPRESS CIT " ZIP CODE I ! ° B. Emergency Coordinators: All personnel qualified to act as the facility's Emergency Coordinator must be listed in this plan. (Note: Etnergency Coordinator responsibilities are described in Section F, below.) If more than two people are qualified, list the names, titles, business and 24-hour telephone numbers, and pager numbers of the additional qualified individuals on an attached page in the order in which they will assume responsibility as alternates, then check the box beneath the Emergency Coordinator information table, beow, and indicate the list's page number in the space provided. Primary Emergency Coordinator SecondM Emergency Coordinator NAMENAME ^ TITLE TITLE BUSINESS PHONE , BUSINESS PHONE t 24-HOUR PHONE e 24-HOUR ONE �� 77777 ZJ PAGER# PAGER I ❑ (Check box only if applicable Additional Emergency Coordinators are listed on page _ of this plan. C. Evacuation Plan: 1. The following alarm signal(s)will be used to begin evacuation of the facility(check all that apply): ❑Bells; ❑ Homs/Sirens Verbal(i.e., shouting); ❑Other(specify UN-017- 1/0 www.unidoes.org Rev.03/27/08