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SANJ O A Q U I N Environmental Health Department COUNTY— Registration OUNTY—Registration Information Instructions This form is to be completed for a Stationary Source that handles a Regulated Substance (RS) in a process at or above the threshold quantity. Regulated Substances (including Federal and State Listed Regulated Substances) must be registered for the purpose of complying with the California Accidental Release Prevention (CaIARP) program. The owner or operator shall provide information for each Regulated Substance per process in the spaces provided. The definition of a "Stationary source" means any buildings, structures, equipment, installations, or substance emitting stationary activities which belong to the same industrial group, which are located on one or more contiguous properties,which are under the control of the same person (or persons under common control),and from which an accidental release may occur. The term stationary source does not apply to transportation, including storage incident to transportation, of any regulated substance or any other extremely hazardous substance under the provisions of this chapter. A stationary source includes transportation containers used for storage not incident to transportation and transportation containers connected to equipment at a stationary source for loading or unloading.Transportation includes, but is not limited to,transportation subject to oversight or regulations under Part 192, 193, or 195 of Title 49 of CFR, or a state natural gas or hazardous liquid program for which the state has in effect a certification to DOT under Section 60105 of Title 49 of USC.A stationary source does not include naturally occurring hydrocarbon reservoirs. Properties shall not be considered contiguous solely because of a railroad or pipeline right-of-way. (1) Facility/Stationary Source Name, street, city, county, state, zip code: Enter the full legal name of the facility and/or stationary source and the current information. Latitude and longitude: Enter the degrees of latitude and longitude where the chemical process is located.The position of your facility can be determined in several ways, including through the use of U.S. Geological Survey(USGS),global positioning system(GPS)receivers,and web-based siting tools. Latitude is the degrees north or south of the equator. Longitude is the degrees west or east of the prime meridian. Both are measured in degrees, minutes, and seconds. Method for obtaining latitude and longitude: Source of latitude and longitude information. Description of location that latitude and longitude represent: Describe what the location represents(i.e., Storage vessel, building, etc.) (2) The stationary source Dun and Bradstreet number: Enter the Dun and Bradstreet number of the Principal Company or entity which owns at least 50 percent of the voting stock. The Dun and Bradstreet number allows your business to be cross-referenced to various business information. You may be able to obtain this number from your finance department. If your business does not have this information, contact Dun and Bradstreet at (610) 882-7748 or via the internet at www.dnb.com. (3) Name and Dun and Bradstreet number of the corporate parent company: See number 2 above. (4) The name, telephone number, and mailing address of the owner or operator: Enter the current information. 7 of 22 Doc ID:6a6ea4fac281501cd30efa4128b75fd8a1870d1a