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Emergency Response/Contingency Plan (Hazardous Materials Business Plan Module) Authority Cited: HSC, Section 25504(b); Title 22, Div. 4.5, Ch. 12, Art. 3 CCR Page _of _ All facilities that handle hazardous materials in specified quantities must have a written emergency response plan. In addition, 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. Because the requirements are similar, they have been combined in a single document, provided below, for your convenience. This plan is a required module of the Hazardous Materials Business Plan (HMBP). If you already have a plan that meets these requirements, you should not complete the blank plan, below, but you must include a copy of your existing plan as part of your HMBP. This site-specific Emergency Response/Contingency Plan is the facility's plan for dealing with emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials that 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. Within Santa Clara County, hospitals and police agencies have delegated receipt of these plans to the local agencies administering Hazardous Materials Business Plans, so additional copies need not be submitted. However, 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 3, below). 1. Evacuation Plan: a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply): ❑ Bells; ❑ Horns/Sirens; rf Verbal (i.e. shouting); ❑ Other (spec) b. ❑ Evacuation map is prominently displayed throughout the facility. Note: A properly completed HMBP Site Plan satisfies contingency plan map requirements. This drawing (or any other drawing that shows primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas) must be prominently posted throughout the facility in locations where it will be visible to employees and visitors. 2. a. Emergency Contacts*: Fire/Police/Ambulance...................................... State Office of Emergency Services .............................. b. Post -Incident Contacts*: Fire Department Hazardous Materials Program ................... Santa Clara County Hazardous Materials Compliance Division ...... California EPA Department of Toxic Substances Control ............ Cal -OSHA Division of Occupational Safety and Health .............. Air Quality Management District ........................ Phone No. 911 Phone No. (800) 852-7550 Phone No.: (2m Phone No. (408) 918-3400 Phone No. (510) 540-3739 Phone No. (408) 452-7288 Phone No. (415) 771-6000 Regional Water Quality Control Board ........................... Phone No. (510) 622-2300 * These telephone numbers are provided as a general aid to emergency notification. Be advised that additional agencies may be required to be notified c. Emergency Resources: Poison Control Center ....................................... Phone No. (800) 876-4766 Nearest Hospital: Name: U!O% R -S Address: 161J 21--- Alell6w �7- 3. Arrangements With Emergency Responders: OF/1UK *2V, PhoneNo.: J City: >��/�l✓C'�4 If you have made special (i.e. contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements below: UN -020 - 13/17 www.unidocs.org Rev. 01/16/02