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HAZABDOUS WASTE CONTINGENCE' PLAN <br /> ,For use 5y Unidocs Member Agencies or where approved by your Local Jurisdiction <br /> Authority Cited.- Title 22,California Code of Regulations(CCR)§66265.52 as referenced by§66262.34(a)(4)or 67450.3(c)(9)(C) <br /> Facilities that generate 1,000 kilograms or more of hazardous waste per month, or accumulate more than 6,000 <br /> kilograms of hazardous waste on-site at any one time,must prepare a Contingency Plan. Facilities that generate <br /> in any month more than 1 kilogram of acutely hazardous waste (AHW), or more than 100 kilograms of debris <br /> resulting from the spill of an AHW, or which treat hazardous waste onsite under the Permit by Rule (PBR) <br /> onsite treatment tier must also prepare a Contingency flan. Many facilities that are required to prepare a <br /> Contingency Plan are alreE dy subject to Hazardous Materials Business Plan (HMBP) repotting requirements <br /> due to the quantities of ha2 ardous materials/wastes they have onsite. If you have already prepared a Unidocs <br /> HMBP or al adv have a plan which is equivalent in content to the Emergency Response/Contingency Plan <br /> module of the Unidocs HN BPyou have satisfied the Contimzency Plan re uirements and are not required to <br /> complete the blank lan be ow. <br /> This site-specific Contingecy Plan is the facility's plan for dealing with emergencies and shall be implemented <br /> immediately whenever th e is an imminent or actual fire, explosion, or release of hazardous waste or a <br /> hazardous waste constituent which could threaten human health and/or the environment. At least one copy of <br /> the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the <br /> local agency. A. copy of the plan and any revisions must be provided to any contractor, hospital, or agency <br /> with whom special (i.e. contractual) emergency services arrangements have been made(see Section E below). <br /> A. Facility Information: <br /> BUSIS NAME BUSINESS PHONE. <br /> ES <br /> � rc��,nvr1 �� Zo L � r 9 o o 0 <br /> SITE L4 cep 5 ���r� .r CrrY �� �, ZIP CODE <br /> a o r <br /> B. Emergency Coordina rs: <br /> All personnel qualified to act as the facility's Emergency Coordinator must be listed in this plan. (Note; <br /> Emergency Coordinator re onsibilities are described in Section F below.) If more than two people are <br /> qualified, list the names, titles, business and 24-hour telephone numbers, and pager numbers of the additional <br /> qualified individuals on an attached page in the order in which they will assume responsibility as alternates, <br /> then check the box beneath the Emergency Coordinator information table, below, and indicate the list's page <br /> number in the space providol. <br /> Primary Fmerg6cy Coordinator Secondary Emergency Coordinator <br /> NAME ; � �z v !1 I AME_i S <br /> TITLE <br /> ry_ TITLE �� <br /> 1 <br /> PH01> l I liUo ESS PHONE <br /> (2^ � —1� 010 [ G� <br /> 24-HOUR PHONE r`,/� Cl q 24-HOUR PHONE <br /> 3 a 1 C1 <br /> PACER# PAGER# <br /> F� (Check box only if applicable)Additional Emergency Coordinators are listed on page of this plan. <br /> C. Evacuation Plan: �p/� �terQ�1. The following alarmsignsignal(s)will be used to begin evacuation of the facility(check all that apply):LMA 6pta <br /> Bells; ❑ Horns/Sirens; 7 Verbal (i.e., shouting); W Other(.specify <br /> UN-017-1/6 www.unidocs.org Rev.03/27/08 <br /> fl0 ooO 'A\I 'HNIZ ME HT1 Q.9f 6N IFS 9MT Hill 600 / NT <br />