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Instructions For Completing CERS Codated Emergency Response/Contingency Plaage 2 of 2 Rev. 06/27/11 C2. NOTIFICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFECTED BY AN OFF-SITE RELEASE WILL OCCUR BY - Check one or more of the boxes to indicate how neighboring facilities will be notified of off-site releases. C3. LOCAL UNIFIED PROGRAM AGENCY PHONE - Enter the phone number of the local UPA that implements the Hazardous Materials Business Plan (HMBP) and hazardous waste generator Unified program elements. If there is more than one UPA, identify the second agency in C4. C4. OTHER AGENCY NAME - If applicable, use this space to enter the name of another emergency response agency. C5. OTHER AGENCY PHONE - If applicable, enter the phone number of the agency named in C4. C6. NEAREST MEDICAL FACILITY / HOSPITAL NAME - Enter the name of the hospital or emergency medical facility closest to your facility. C7. NEAREST MEDICAL FACILITY / HOSPITAL PHONE - Enter the phone number of the hospital or emergency medical facility named in C6. C8. REGIONAL WATER QUALITY CONTROL BOARD PHONE - Enter the phone number of the local RWQCB. C9. OTHER AGENCY NAME - If applicable, use this space to enter the name of another agency requiring notification. C10. OTHER AGENCY PHONE - If applicable, enter the phone number of the agency named in C9. C1 I. OTHER AGENCY NAME - If applicable, use this space to enter the name of another agency requiring notification. C12. OTHER AGENCY PHONE - If applicable, enter the phone number of the agency named in C 11. Dl. SPILL PREVENTION, CONTAINMENT, AND CLEANUP PROCEDURES - Check all applicable boxes to identify procedures used by your facility. D2. SPECIFY - Briefly specify other spill prevention, containment, and cleanup procedures if you checked Box D1-21. El. THE FOLLOWING ALARM SIGNAL(S) WILL BE USED TO BEGIN EVACUATION OF THE FACILITY - Check all applicable boxes to indicate how facility evacuation will be communicated. E2. SPECIFY - Briefly specify other evacuation signals if you checked Box E1-4. E3. THE FOLLOWING LOCATION(S) IS/ARE EVACUEE ASSEMBLY AREA(S) - Briefly identify or describe the assembly area(s). E4. EVACUATION ROUTE MAP(S) POSTED AS REQUIRED - Check the box to indicate that the evacuation routes have been posted as required. Fl ADVANCE ARRANGEMENTS FOR LOCAL EMERGENCY SERVICES - Check the box to indicate if advance arrangements have been made or they have been determined not to be necessary. F2. SPECIFY - If you checked Box F1-2, briefly describe the advance arrangements. G 1. EQUIPMENT AVAILABLE - Check all applicable boxes in the second column of the table to identify emergency equipment available at your facility. G2. LOCATION - Briefly describe the location(s) where the emergency equipment is kept. (Repeat for other rows in table.) G3. CAPABILITY - Where applicable, briefly describe the capability of the emergency equipment. (Repeat for other rows in table.) H1. VULNERABLE AREAS - Check all applicable boxes to identify areas at risk of hazardous materials releases or spills due to earthquakes. H2. LOCATIONS - If you checked Box HI -1, briefly describe the location. (Repeat for H3 through H5, if applicable). H6. VULNERABLE SYSTEMS - Check all applicable boxes to identify areas at risk of mechanical systems vulnerable to hazardous materials releases or spills due to earthquakes. H7. LOCATIONS - If you checked Box H6-1, briefly describe the location. (Repeat for H7 through H 12, if applicable). I1. INDICATE HOW EMPLOYEE TRAINING PROGRAM IS ADMINISTERED - Check all applicable boxes to identify how your employee training program is administered. 12. SPECIFY - If you checked Box I1-4, list the titles of the study guides or manuals. I3. SPECIFY - If you checked Box I1-5, briefly describe the other ways training is administered. J]. ATTACHMENTS - Check one of the boxes to indicate whether or not additional pages/documents are attached as part of this Emergency Response/Contingency Plan. J2. SPECIFY - If you checked Box J1-2, list the attachments in the section. K1. DATE SIGNED - Enter the date that the certification section was signed by the owner/operator or authorized representative. K2. NAME OF SIGNER - Type or print the full name of the person signing/certifying the plan. K3. TITLE OF SIGNER - Enter the title of the person signing/certifying the plan.