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0 RECEINiED <br />CALIFORNIA ENVIRONMENTAL REPORTING SYSTEM (CERS) FEB 01 2017 <br />CONSOLIDATED EMERGENCY RESPONSE / CONTINGENCY PLAN <br />Prior to completing this Plan, please refer to the INSTRUCTIONS FOR COMPLETING A CONSOLIDATED CONTINGENC PLAN <br />A. FACILITY IDENTIFICATION AND OPERATIONS OVER <br />FACILITY ID # CERS ID AI. DATE OF PLAN PREPA ION <br />BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3. <br />a <br />BUSINESS 1ITE ADDRESS 103 <br />1 <br />BUSI ESS SITE CITY 104. <br />ZIP CODE 105 <br />CA <br />TYPE O BUS SS (e.g., Painting C ntractor) A3. <br />INCIDENTAL OPERATIONS (e.g., FleetMaintenance) A4. <br />C^ <br />THIS PLAN COVERS CHEMICAL SPILLS, FIRES, AND EARTHQUAKES INVOLVING: (Check all that apply) A5. <br />® 1. HAZARDOUS MATERIALS, K2. HAZARDOUS WASTES <br />B. INTERNAL RESPONSE <br />INTERNAL FACILITY EMERGENCY RESPONSE WILL OCCUR VIA: (Check all that apply) B1. <br />Z 1. CALLING PUBLIC EMERGENCY RESPONDERS (i.e., 9-1-1) <br />2. CALLING HAZARDOUS WASTE CONTRACTOR <br />3. ACTIVATING IN-HOUSE EMERGENCY RESPONSE TEAM <br />C. EMERGENCY COMMUNICATIONS, PHONE NUMBERS AND NOTIFICATIONS <br />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 <br />Emergency Coordinator is on call) shall: <br />1. Activate internal facility alarms or communications systems, where applicable, to notify all facility personnel. <br />2. Notify appropriate local authorities (i.e., call 9-1-1). <br />3. Notify the California Emergency Management Agency at (800) 852-7550. <br />Before facility operations are resumed in areas of the facility affected by the incident, the emergency coordinator shall notify the California Department of Toxic <br />Substances Control (DTSC), the local Unified Program Agency (UPA), and the local fire department's hazardous materials program that the facility is in compliance <br />with requirements to: <br />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 <br />the facility; and <br />2. Ensure that no material that is incompatible with the released material is transferred, stored, or disposed of in areas' oT the facility affected by the incident until <br />cleanup procedures are completed. <br />INTERNAL FACILITY EMERGENCY COMMUNICATIONS OR ALARM NOTIFICATION WILL OCCUR VIA: (Check all that apply) CI. <br />�.1. VERBAL WARNINGS; ❑ 2. PUBLIC ADDRESSOR INTERCOM SYSTEM; TELEPHONE; <br />PAGERS; 1�f5. ALARM SYSTEM; 6. PORTABLE RADIO <br />NOTIFICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFECTED BY AN OFF-SITE RELEASE WILL OCCUR BY: (Check all that apply) C2. <br />J?1.1. VERBAL WARNINGS; ❑ 2. PUBLIC ADDRESS OR INTERCOM SYSTEM; X3. TELEPHONE; <br />J�,4. PAGERS; 5. ALARM SYSTEM; 6. PORTABLE RADIO <br />EMERGENCY RESPONSE AMBULANCE, FIRE, POLICE AND CHP .............................................. 9-1-1 <br />PHONE NUMBERS: 800 852-7550 <br />CALIFORNIA EMERGENCY MANAGEMENT AGENCY (CAL/EMA) ...................... ( ) <br />NATIONAL RESPONSE CENTER (NRC) .............................................. (800) 424-8802 <br />POISON CONTROL CENTER........................................................ (800) 222-1222 <br />LOCAL UNIFIED PROGRAM AGENCY (UPA/CUPA)...................................�- <br />C4. C5. <br />OTHER (Specify): I _ <br />....... .............._.................._........_-._...` .......__.......-_.___.._..-... <br />` C6. c <br />NEAREST MEDICAL FACILITY / HOSPITAL NAME: �.Y_ I � 09) O 2 ^ 7 <br />AGENCY NOTIFICATION PHONE NUMBERS: CALIFORNIA DEPT. OF TOXIC SUBS�CONTROL (DTSC) .... (916) 255-3545 <br />cs <br />REGIONAL WATER QUALITY CONTROL BOARD .................. I <br />U.S. ENVIRONMENTAL PROTECTION AGENCY (US EPA) ........... (800) 300-2193 <br />CALIFORNIA DEPT OF FISH AND GAME (DFG) .................... (916) 358-2900 <br />U.S. COAST GUARD ............................................. (202) 267-2180 <br />CAL/OSHA..................................................... (916) 263-2800 <br />STATE FIRE MARSHAL ......................................... (916) 445-8200 <br />C9. ... _. _.-..... CIO. <br />OTHER (Specify): <br />CII. c1z. <br />OTHER (Specify): <br />Rev. 06/27/11 <br />LTH <br />