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jt ' HAZARDOUS MATERIALROGRAM , SAN �QUIN COUNTY This survey form is intended t identify businesses,which need to comply with the hazardous materials emergency planning Businesses must submit a re uiements of Chapter 6.95 of the California Health and ogees'use iCodn ems bu gencyrequsin Businesses mus s bmit and reporting q lens far their p handle hazardous materials to prepare emergency p to copy of this plan,along with annual inventory of their he Office of Emerghazardous ency Servlices(OE as been protecting d to y lease call that office at(209)468"3969. responders and the public. 1n San u have tY administer this program. Should you have an questions on this program this form, front of his form. Please consider the following guidelines when completing the quests Que� scion 1: rial"for purposes of this program as any material that,because of its quantity, The law defines"hazardous mate man health and concentration,or physical or chemical characteristics, poses a or the env ronment Thispncludeshb t s limited t d t,fuels, petroleum safety or to the environment if renaammonia,chlorine,pesticides,fertilizers, and hazardous wastes. Answer"Yat e s"if 9)you products,paints, propane,oxyg quantity at least once in the year. if you are unsure, contact oubeffIns handling material that meets that definition in any q tY 3969 for assistance. If you manswer "No" and form the Office of Emeargency Services within 30 days.n your props hazardous materials,you Question 2: ipter 6.95 the l ety Code. our office if you answer"Yes,"you must mess the requi hese requiremets mustfbe mel California oto issuance of a(certificate of occupancy. will be contacting you to provide assistance. your If you answer"No,"our office may conduct an inspection after you begin operations to verify of hazardous materials. If you The statutes establish some modified requirements or program exemptions for certain uses followingmeets one of the conditions. Then mark answered"Yes"to questions 1 and 2, determine whether your business you t make a final determination oft these exemptions, the appropriate boxes on the front of this form. Our office will the A. Retail Exem tion: Products packaged for'directe quant ty hand edtribution to the general createspublic unac unacceptable public hazard;2) program. This exemption may not apply' ) sold to the material is being the public does not haverectly by the business as part of its ready accesstohe addition is stored by the e general public; or 3)the g p business, e.g., in a warehouse. B, Medical Exem tion: Medical offices which use b�oxygen and/or nitrous oxide in quantities less than 1,000 cubic feet are required to meet modified requirements. C. Farm Exempom inrms,as thelaw does include busines eed in the question, s t meet modified program requirements. The definition of farm providing commercial pest control services,fertilizer ng s.or packing shed ces for farmers. application services,tlrequired to submitanannual chemical inventory and fee to the County Agricultural raElying or exemption a q Agricultural Commissioner's Department along with other requirements. Please contact the County Ag Commissioner's Department for further information. Businesses operating a commercial business in addition to a farm as defined must comply with the HMMP program for those materials associated with the commercial business. Question 3: tely 366 ' Acutely The Federal and State governments hathe ve do include chlorine,efined rammonia, sulfur c acid,`methyl bromide,acroleids tn,rsulfur dioxide, he most common"AHMs" used formaldehyde, nitric acid,vinyl acetate monomer, hydrogen time the year. Call our office foroxide,and many types of lass stance f you are ucides. Answer"Yes" if ure.se any of these specific chemicals in any quantity any o Question 4: Answer"Yes" if the boundary of your property or facility will be within 1,000 feet of the boundary of a school(K thru 12).