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SA N sJ O A Q U I N Enyir onrnental Health Depnrnn¢nt --COUNTY San Joaquin County Environmental Health Department HAZARDOUS MATERIALS PROGRAM This s vey form Is Intended to Identlry businesses which ossa to comply with Ina Hazardous materials a ergency planning entl reporting requirements of the Galifornla Health entl Safety Cotler (HSC) Chapter 6.95. This Chapter requires businesses which hantlla M1azardOus matarlals to prepare emergency plans for[hatr employees to use in an emergency. Businesses mus[submit this information, along wish an annual Inventory of their hazardous matarlals,Online to tna California Environmental Reporting Sysiam (GERS) found at c caleoa c v for u e In protecting a argancy raspontlars entl tM1e general public. In San Joaquin Counfy, the Environmental�Heal[h Daparfman< (EHD) has bean authorizetl to atlminls[er tM1is program as the Certified Uniflatl Program Agency Or CUPA. SM1ould you have any quastlons about the CUPA program or tots brm, please contact EHD at(209)466-3420. Plaasa consitler the following guitlellnes when complafing the quastlons on page t Quasflon 1: Tna(HSC)section 2550'1(p)tlaflne6 a"Hazardous Materiel"as any matarlal Shat,because of its quantity,concantratlon.or physical or chemical characteristics, poses a slgnlllcant present or pofantlal Hazartl to human Health and safety or to the ¢ ronmeni if ralaasatl Into the workplace or tM1e environment. "Hazardous Materials" Include but era not Ilmitatl to, HazartlOusnsubstancas. hazartlous waste,entl any material tM1at a M1andler or the adminiataring agency has a reasonable basis(Or believing that it woultl ba Inludous to tna Health and safety of parsons or Harmful to the environment If released Into the workplace or the environment This Includes, but Is not limited to, fuels, petroleum protlucts. paints, propane. oxygen, a onia, chlorine, pasticitles, fertilizers, entl setl oil. If a businasa generates env amount of hazardous este they must enroll in the EHO Hazardous Wastes Generator Program. Answer"Yes" if you u material that maeta the definition above in any quantity at least o a in the year. It you a confacf the EHD at(209)468-3420 for assistance. If you answer"No"and el a later data your business,or a tenant on your property, begins Handling hazartlous materials,you must Inform the EHD within 30 days. Question 2: If you answer"Vas",you muai meat IM1e raqulrements of HSC Chapter 6.95. Ther EHD will ba contacting you to provide assistance. These requirements must ba mat prior to Is6uance oT a certificate of occupancy. If you anawar"No'", our office may conduct an Inspactlon attar you begin operations to verity your exempflOn. The HSC as[abllahas soma modified requirements Or program exemptions Tor certain uses of hazartlous matarlals. If you answered "Vas" to quastlons 1 entl 2, a tlatarminatlon mus[ b¢ matla If your business meets one of thea mpflons Ilstatl. Chock the appropriate boxes on page 1 and submit the hazartlous materiels informafion onllna a[cars cai¢oa Please contact the EHD t0 tleterm lne iT your business mee<s thea mptions. However,e n It a mptlon is mat for the Business Plan program, you may still be a hazartlous waste generator and will need to report Inyc caleoa a hazardous waste generator. A. Ra[all Examotlon-Protluds paokagatl Tor tliract tllstrlbutiOn to[he ganerel public are exempt from[he program. This exemptlOn may not apply if any of the following contlitlons axisb l.Tha quantity handled crestas an unacceptable public hazartl 2.The matarlal Is being used tliracfly by the business as part of Its Operation In atltlltlon to being sold t0 [ha ganerel public 3.THa 9aneral public tloasnY nava ready access to the product as storatl by Sha business(e.g. In a warehouse). B. Motllflad Farm Examotlon-Ferme,as statetl in Guestlon 26 on pa0a t, u t a f modified t . TM1e dafinidon of a farm In the law doesn't include businesses providing commerolal pest control services. fertilizer applications rvices, protluct processing services. or packing shatl s rvlces for Tarm¢rs. Farms quell(yin9 for the exemption a still required to submit a annual chemical Inventoryesite map. entl other requirements onllna to calaoa v entl pay a tea to the San JOaquln Courtly Environmental Haaltn Department(EHD). Please contact theSEHD at (209) 468-3420 for assistance. Businaseas operating a commerolal business In atltlifion fo a farm a tlafinad must comply with[he requirements of Sha Hazardous Materials Program for those matarlals assoclatetl with the crommamial business. �uesfion 3: Ther Federal and Sfa[a governments have definetl approximately 366 chemicals as an"Acutely Hazardous Material"(AHM). The most common AHM used In the county Include: CHlorine, Ammonia, Sulfuric Acid, Methyl Bromltla, Acrolain, Sulfur Dioxide, Formaldahytla,Nitric Acid,Vinyl Acata[a Monomer, Hytlrogen Paroxitla,and many types of Pesticides. Answer'•Yes" If you use any of these specific cnamicals In any quantity a[any one lime of Sha year. Contac[the EHD If you're Un6Ure for a861StanCe. Quasflon 4: Answer"Vas"if the boundary of your proparry or facility Is or will be within 1,000 feet of the bountlary of a scnool. (x-t2)