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CALIFORNIA ENVIRONMENTAL REPORTING SYSTEM (CERS) CONSOLIDATED EMERGENCY RESPONSE / CONTINGENCY PLAN Prior to completing this Plan, please refer to the INSTRUCTIONS FOR COMPLETING A CONSOLIDATED CONTINGENCY PLAN A. FACILITY IDENTIFICATION AND OPERATIONS OVERVIEW FACILITY [D # CERS ID A DATE OF PLAN PREPARATION/REVISION AZ BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3 - BUSINESS SITE ADDRESS BUSINESS SITE CITY 104. 1 1 ZIP CODE 103. CA TYPE OF BUSINESS (e g., Painting Contractor) A3 INCIDENTAL OPERATIONS (e.g., Fleet Maintenance) A4 THIS PLAN COVERS CHEMICAL SPILLS, FIRES, AND EARTHQUAKES INVOLVING: (Check all that apply) As- ® 1. HAZARDOUS MATERIALS, ❑ 2. HAZARDOUS WASTES B. INTERNAL RESPONSE INTERNAL FACILITY EMERGENCY RESPONSE WILL OCCUR VIA: (Check all that apply) BI- ❑ 1. CALLING PUBLIC EMERGENCY RESPONDERS (i.e., 9-1-1) ❑ 2. CALLING HAZARDOUS WASTE CONTRACTOR ❑ 3. ACTIVATING IN-HOUSE EMERGENCY RESPONSE TEAM C. EMERGENCY COMMUNICATIONS, PHONE NUMBERS AND NOTIFICATIONS Whenever there is an imminent or actual emergency situation such as an explosion, fire, or release, the Emergency Coordinator (or his/her designee when the Emergency Coordinator is on call) shall: 1. Activate internal facility alarms or communications systems, where applicable, to notify all facility personnel 2. Notify appropriate local authorities (i.e., call 9-1-1). 3. Notify the California Emergency Management Agency at (800) 852-7550. Before facility operations are resumed in areas of the facility affected by the incident, the emergency coordinator shall notify the California Department of Toxic Substances Control (DTSC), the, local Unified Program Agency (UPA), and the local fire department's hazardous materials program that the facility is in compliance with requirements to: 1. Provide for proper storage and disposal of recovered waste, contaminated soil or surface water, or any other material that results from an explosion, fire, or release at the facility; and 2. Ensure that no material that is incompatible with the released material is transferred, stored, or disposed of in areas of the facility affected by the incident until cleanup procedures are completed. INTERNAL FACILITY EMERGENCY COMMUNICATIONS OR ALARM NOTIFICATION WILL OCCUR VIA: (Check all that apply) C1 [:11. VERBAL WARNINGS; ❑ 2. PUBLIC ADDRESS OR INTERCOM SYSTEM, ❑ 3. TELEPHONE, ❑ 4. PAGERS, ❑ 5. ALARM SYSTEM, ❑ 6. PORTABLE RADIO NOTIFICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFECTED BY AN OFF-SITE RELEASE WILL OCCUR BY: (Check all that apply) C2 ❑ I VERBAL WARNINGS, ❑ 2. PUBLIC ADDRESS OR INTERCOM SYSTEM: ❑ 3. TELEPHONE; ❑ 4. PAGERS; ❑ S. ALARM SYSTEM, ❑ 6. PORTABLE RADIO EMERGENCY RESPONSE AMBULANCE, FIRE, POLICE AND CHP.. ........ . ...... . . . . ................ 9-1-1 PHONE NUMBERS: CALIFORNIA EMERGENCY MANAGEMENT AGENCY (CAL/EMA) .. . . ................ (800) 852-7550 NATIONAL"RESPONSE CENTER (NRC) ....... ... . ........ .......... ...... ...... (800) 424-8802 POISON CONTROL CENTER ...................... . . . .............. ... ............ (800) 222-1222 LOCAL UNIFIED PROGRAM AGENCY (UPA/CUPA) ....... ..... ( ) C3. OTHER (Specify) C4 cs . ( ) NEAREST MEDICAL FACILITY /HOSPITAL NAME C6C7r AGENCY NOTIFICATION PHONE NUMBERS: CALIFORNIA DEPT. OF TOXIC SUBSTANCES CONTROL (D"I'SC) .... (916) 255-3545 C8 REGIONAL WATER Q11A1,1"CY CONTROL, BOARD.. U.S. ENVIRONMENTAL PROTECTION AGENCY (US EPA) ... - - - ... (800) 300-2193 CALIFORNIA DEPT OF FISH AND GAME (DFG) ..... ... (916) 358-2900 U S. COAST GUARD (202) 267-2180 CAL/OSHA .. (916) 263-2800 STATE FIRE MARSHAL . - (916) 445-8200 - ----------- OTHER (Specify): Ca ( clo OTHER (Specify): j Cil M) Rev. 06/27/11