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S A N F�O H a U I N Envlro. .[ental H¢alth Department
<br /> COUNTY
<br /> San Joaquin County Environmental Fleslth �apartmant
<br /> HAZARDOUS MATERIALS PROGRAM
<br /> TM1is survey Torm is intended to identify businesses wM1icM1 neatl to comply with the hazardous materiels emergency planning and
<br /> reporting requiremeMa of the California Health antl Safety Coda (HSC) Chapter 6.95. This Chapter requires businesses which
<br /> handle hazardous matadals to prepare emergency plans for their employees to use in en emergency. Bgsinessas must submit tM1is
<br /> Information, along with an annual invaMory oT their M1azardous materials. online to the California Environmental Reporting System
<br /> (GFRs)found at cars caleoa v for use in protecting emergency respondare antl the general public. In San Joaquin County,
<br /> the Environmental Health DapartmarH (EHD) M1as bean authorized to administer this progrem as the Certified Unified Program
<br /> Agency or CUPA. Should you have any questions about the CUPA program or this form, please comapt EHD at(209)468-3420.
<br /> Piaesa consider the following guidelines when completing the questions on page l
<br /> CueaYon l:
<br /> Tha(HSC)section 26601(p)defines a"Hazardous Material"as any malarial that,because oT its quantRy,concan[ratlon,or physical
<br /> or chemical characteristics, poses a slgniTlcant present or potential hazard to human hsaltM1 and safety or to the environment iT
<br /> released IMo lM1a worKplaca or the environmaM. "Hazardous Materials" include but are not limited to, M1azartlous substances,
<br /> M1azardous waste,and any malarial that a handler or tM1e administering agency has a reasonable basis for believing that It would ba
<br /> Injurious io the M1ealth and safety of parsons or harmful to the environment if released Into the workplace or the anvironmant. This
<br /> includes, but Is not limited To. fuels, petroleum products, paints, propane, oxygen, ammonia, chlorine, peshcidas, fertilizers, and
<br /> used oil. If a business generates env amount of hazardous waste they must enroll in the EHD Hazardous Warta Oanaretor Program.
<br /> Answer"Vas' if you use a material that meats the definition above in any quantity at least once in the year. If you are unsure,
<br /> contact the EHD at(209)468-3420 for assistance. It you answer"No"and a[a later tlata your business,or a tenant on your property,
<br /> begins handling hazardous materials,you must inform the EHD within 30 days.
<br /> Oues[ion 2:
<br /> H you answer"Yes",you must meat the requirements of HSC Chapter 6.96. TM1a EHD will be contacting you to provide assistance.
<br /> These requirements mus[be mat prior to Issuance of a certlflceta of occupancy. If you answer"No", our oTgce may conduct an
<br /> inspaMion after you begin operations to verity your exemption.
<br /> The HSC establishes soma modified requirements or program exemptions Tor certain uses of hazardous materials. IT you answered
<br /> "Vas" to questions 1 and 2, a determination must ba matla if your business meets one oT tM1a exemptions listed. Chock the
<br /> appropdata boxes on page t and submit the hazardous materials InTorma[ion online at cars-caleoa ca c v. Plaasa contact lM1e EHD
<br /> b determine If your business meso the exemptions. However, even IT an exemption is mat for the Business Pian program, you
<br /> may still be a M1azardous waste generator and will need to report in cars caleoa ca cov as a M1azardoua wast¢generator.
<br /> A. Retail Examotton-Products packaged Tor direct distribution to the general public era exempt from the program. TM1is
<br /> exemption may not apply it any of Tha following wnditions exist:
<br /> [.Tha quantity handled crestas an unacceptable public M1azartl
<br /> 2.TM1a material is being used directly by tM1a business as part of its operation In adtlitlon to being sold to the
<br /> ganarel public
<br /> 3.The general public doasnY have ready access to the prodpct as stored by 1M1a business(a.g. in a warehouse).
<br /> B. Modified Farm Exemption-Farms,as stated in CuesHon 2B on page 1, must meat modified program racuiremams.
<br /> THa daflnHlon oT a farm in the law g2aaLS include businesses providing commeroial pest control services, fertilizer
<br /> application services, product processing services, or packing shad services for farmers. Farms qualifying for the
<br /> exemption era still required to submit an annual chemical inventory, alta map, and otM1er requirements online to
<br /> cers.calapa ov and payataa to the San Joaquin County Environmental HaaltM1 Department(EHD). Pleas¢contact
<br /> the EHD at (209) 468-3420 for assistance. Businesses operating a commercial business in addition to a Tarm as
<br /> defined must comply wHM1 the requirements of the Hazardous Materials Program for those materials associated with
<br /> the wmmarclal business.
<br /> Question 3:
<br /> Tha Federal antl States governments M1ava defined approximalaly 366 chemicals as an"Acutely Hazardous Material"(AHM). The
<br /> moss common AHM used in tM1a coumy Include: Chlodna, Ammonia, Sulfuric Acttl, Methyl Bromltla, Acrolain, Suttur Dioxide,
<br /> FormaltlaM1yda, Nitric Acid,Vinyl Acetate Monomer,Hydrogen Peroxide,and many types oT Pesticides.
<br /> Answer"Vas" if you use any oT these specific chemicals in any quantity at any one time of the year. COMact tM1e EHD if you're
<br /> unsure for assistance.
<br /> Question 4:
<br /> Answer"Yes"IT tM1a boundary of your property or facility is or will be within 1,000 feet of the boundary of a school.(K-t2)
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