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RECEIVED
<br />MAY 0
<br />E� RM�Nr�t H
<br />�r'SEaV FA( rH
<br />San Joaquin County Environmental Health Department CFS
<br />HAZARDOUS MATERIALS PROGRAM
<br />This survey form is intended to identify businesses which need to comply with the hazardous materials emergency planning
<br />and reporting requirements of the California Health and Safety Code (HSC) Chapter 6.95. This Chapter requires businesses
<br />which handle hazardous materials to prepare emergency plans for their employees to use in an emergency. Businesses must
<br />submit a copy of this plan, along with an annual inventory of their hazardous materials, to public safety agencies for use in
<br />protecting emergency responders and the general public. In San Joaquin County, the Environmental Health Department
<br />(EHD) has been authorized to administer this program as the Certified Unified Program Agency or CUPA Should you have
<br />any questions about the CUPA program or this form, please contact EHD at (209) 468-3420.
<br />Please consider the following guidelines when completing the questions on page 1:
<br />Question :
<br />The (HSC) section 25501(p) defines a 'Hazardous Material" as any material that, because of its quantity, concentration, or
<br />physical or chemical characteristics, poses a significant present or potential hazard to human health and safety or to the
<br />environment K released into the workplace or the environment "Hazardous Materials include but are not limited to,
<br />hazardous substances, hazardous waste, and any material that a handler or the administering agency has a reasonable basis
<br />for believing that it would be injurious to the health and safety of persons or harmful to the environment if released into the
<br />workplace or the environment This includes, but is not limited to, fuels, petroleum products, paints, propane, oxygen,
<br />ammonia, chlorine, pesticides, fertilizers, and useci.y .4f.q btsmess,,Wtleuates ,, �n�� �t gf.t ar of ste they must
<br />m
<br />enroll in the EHD Hazardous Waste Generator Progra' "Answer "Yes' if yo use a material Mat mieets•lfie de irf tiun above in
<br />any quantity at least once in the year. If you are unsure, contact the EHD at (209) 458-3420 for assistance. If you answer
<br />"No" and at a later date your business, or a tenant on your property, begins hanLnah az d:material �yjtkrpust inform the
<br />END within 30 days
<br />Question 2:
<br />t`'S� v1!a► .Z}Id1��Wa��}t 1 t:A.12lh.,A
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<br />If you answer "Yes", you must meet the requirements of HSC Chapter 6.95. The EHD will be contacting you to provide
<br />assistance. These requirements must be met prior to issuance of a certificate of occupancy. If you answer "No', our office
<br />may conduct an inspection after you begin operations to verify your exemption.
<br />The HSC establishes some modified requirements or program exemptions for certain uses of hazardous materials. If you
<br />answered "Yes" to questions 1 and 2, a determination must be made if your business meets one of the exemptions listed.
<br />Check the appropriate boxes on page 1. The EHD will contact you to make a final determination if your business meets the
<br />exemptions.
<br />A Retail Exemption — Products packaged for direct distribution to the general public are exempt from the program.
<br />This exemption may not apply if any of the following conditions exist:
<br />1. The quantity handled creates an unacceptable public hazard
<br />2. The material is being used directly by the business as part of its operation in addition to being sold to
<br />the general public
<br />3. The general public doesn't have ready access to the product as stored by the business (e.g. in a
<br />warehouse).
<br />B Modified Farm Exemption — Farms, as stated in Question 26 on page 1, must meet modified grogram
<br />requirements The definition of a farm in the law doesn't include businesses providing commercial pest control
<br />services, fertilizer application services, product processing services, or packing shed services for farmers.
<br />Farms qualifying for the exemption are still required to submit an annual chemical inventory and fee to the San
<br />Joaquin County Office of the Agricultural Commissioner (OAC) along with other requirements. Please contact
<br />the OAC for further information at (209) 953-6000. Businesses operating a commercial business in addition to a
<br />farm as defined must comply with the requirements of the Hazardous Materials Program for those materials
<br />associated with the commercial business.
<br />Question :
<br />The Federal and State governments have defined approximately 366 chemicals as an "Acutely Hazardous Material" (AHM).
<br />The most common AHM used in the county include: Chlorine, Ammonia, Sulfuric Acid, Methyl Bromide, Acrolein, Sulfur
<br />Dioxide, Formaldehyde, Nitric Acid, Vinyl Acetate Monomer, Hydrogen Peroxide, and many types of Pesticides.
<br />Answer "Yes" if you use any of these specific chemicals in any quantity at any one time of the year. Contact the EHD if you're
<br />unsure for assistance.
<br />Question 4:
<br />Answer "Yes' if the boundary of your property or facility is or will be within 1,000 feet of the boundary of a school. (Grades K - 12)
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