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HAZARDOUS WASTE CONTINGENCY PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 22, California Code of Regulations(CCR)§66265.52 as referenced by§66262.34(a)(4)or 67450.3(c)(9)(C) Facilities that generate 1,000 kilograms or more of hazardous waste per month, or accumulate more than 6,000 kilograms of hazardous waste on-site at any one time, must prepare a Contingency Plan. Facilities that generate in any month more than 1 kilogram of acutely hazardous waste (AHW), or more than 100 kilograms of debris resulting from the spill of an AHW, or which treat hazardous waste onsite under the Permit by Rule (PBR) onsite treatment tier must also prepare a Contingency Plan. Many facilities that are required to prepare a Contingency Plan are already subject to Hazardous Materials Business Plan(HMBP) reporting requirements due to the quantities of hazardous materials/wastes they have onsite. If you have already prepared a Unidocs HMBP, or already have a plan which is equivalent in content to the Emergency Response/Contingences module of the Unidocs HMBP, you have satisfied the Contingency Plan requirements, and are not required to complete the blank plan, below. This site-specific Contingency Plan is the facility's plan for dealing with emergencies and shall be implemented immediately whenever there is an imminent or actual fire, explosion, or release of hazardous waste or a hazardous waste constituent which could threaten human health and/or the environment. At least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. A copy of the plan and any revisions must be provided to any contractor, hospital, or agency with whom special (i.e., contractual) emergency services arrangements have been made (see Section E, below). A. Facility Information: BUSINESS NAME BUSINESS PHONE. SITE ADDRESS CITY _ ZIP CODE B. Emergency Coordinators: All personnel qualified to act as the facility's Emergency Coordinator must be listed in this plan. (Note: Emergency Coordinator responsibilities are described in Section F, below) If more than two people are qualified, list the names, titles, business and 24-hour telephone numbers, and pager numbers of the additional qualified individuals on an attached page in the order in which they will assume responsibility as alternates, then check the box beneath the Emergency Coordinator information table, below, and indicate the list's page number in the space provided. Primary Emergency Coordinator Secondary Emergency Coordinator NAME NAMEa -1 TITLE TITLE 11)4 19 BUSINESS PHONE BUSINESS PHONE otl 9Ijf_ Zleoe-, ate/ 9JP3 - yeov 24-HOUR PHONE 24-HOUR PHONE (1;?-,i � 1Y 7C _ 73 (2 PAGER-+ G t=1L. PAGER# ( ) - a3vy ( ) ❑ (Check box only if applicable)Additional Emergency Coordinators are listed on page of this plan. C. Evacuation Plan: 1. The following alarm signal(s)will be used to begin evacuation of the facility(check all that apply): ❑Bells; ❑Horns/Sirens; ❑Verbal(i.e.,shouting); © Other(specify V i546h� V"A)li OG",e4 5415 UN-017 www.unidocs.org 1/6-Rev.12/14/10