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SA LI ��o��7(T��7t1 Environmental Health Department C O lJ N TVY1� I v San Joaquin County Environmental Health UepaRment HAZARDOUS MATERIALS PROGRAM This SUrvOy fOr'm i9 Intentl0tl t0 itlantify bu wM1icM1 n ed to c mply wilF tM1e M1azardous maforials a ergs cy pia ng and reporting requirements of the California Health and Safa[y Cotle (HSC) CM1apter 6.95. TM1is CM1apter requires businesses wM1icM1 hantll0 Fta ardo atBnals to prepafa a ergency pia s for tM1e mploye s to u ergency. Bu st submit tM1is information, along with a ual in antory of their hazardous materials.online to tM1eaCaiifornia Environmental Reporting System (CERS)fountl at cers.caleoa v for use in protecting a ergency responders and[M1e general public. In San Joaquin County, the Environmental Haelth DBpertment (EHD) has been authortzetl to etlminister tF is program as [M1a CartlFlad UNfiad Program Agency or CU PA. Should you have any questions about[he CU PA program or this form. please contact EHD at(209)468-3420. , Please consider the following guidelines when completing the questions on page t: Quastlon t' The(HSC)sactlon 25501(p)daflnas a"Hazardous Material"as any matarlal ihaq because of its quantity,concentratloq or physical chamlcal characteristics, poses a signiflcan[ present or potan[ial hazard to human health and safety or to the environment if roalaased into Yha workplace or the environment. "Hazardous Matarlals" include but a not limited [o, hazardous substances, hazardous waste,and any material that a hantllar or the administering agency has a reasonable basis for believing that i[would ba injurious[o the health and safety of persona or harmful fo the anvlronman[if released Into the workplace or the environment. This includes, but is not Iimliatl id, fuels. petroleum products, paints, propane, oxygen, ammonia, chlorins, pesticides, fartllizere, and sad oil. If a business generates env am uni of hazardous aster they mus[enroll In the EHD Hazardous Waste Generator Program. Answer"Yes" if you u matarlal chat meaffi the daFlnition alwva in any quan[Ity a[ leas[o a in [ha year. If you a contact the EHD at(2U9)468-3420 for asalstanca. If you answer"No'and at a later data your business,or a tenant on your property, begins handling hazardous materials.you must inform the EHD within 30 days. Quastlon 2' If you a r"Yes",you mus[meat the raqulrements of HSC Chapter 6.95. Tha EHD will ba contacting you to provitla assistance. These requirements must ba ma[prior to is of a oertiflce[a of occupancy. If you answer"No",our offices may contluct an ' inspection after you begin operations[o verify your exemption. Ther HSC astablishas soma motliflad requirements or program axamptlons for certain uses of hazardous materials. If you answeratl "Yes' to quasilons t and 2, a tlatarnlna[lon must ba made If your business meats o of the a mptlons Iistetl. Chock Na appropriate boxes on pa9a t and submit the hazardous materials information online at cars celaoa Please contact the EHD to tla[arnine if your business meats[ha a mptlons. However, a n If an a mption is mat for[ha Business Plan program,you may s[III ba a hazardous waste generator and will need to report Invc celaoa a hazardous waste generator. A. Ratall Examo[lon—Products packaged for disc[distribu[lon to the 9aneral public ora exempt from[he program. This axamption may not apply if any of the following contlitipns axisY t.The quantity handled creates an u ccap[able public hazard 2.Tha matarlal is being used tlirecfly by the business as part of Its opare[lon in adtli[lon[o being sold to [he general public 3.Tha 9anerel public doesn't have ready access to the product as stored by the business(a.g.in a warehouse). B. Mod'£Bd Farm ExemoEo —Ferns,a statatl In question 2B on pa9a t, n[ . Ther def ninon of a farm in the law�Include businesses providing c rolal pas[controls s, fertilizer application services, prgtluct processing services. or pecking shetl services for farmers. Fares q alifying for Ma mption still required to submit an annual chemical inventory, site map, antl other requkemen[s online to celaoa and pay a fes[o[ha San Joaquin County Environmental Health Department(EHD). Please contact thasEHD at (209)v468-3420 fora sistanca. Businesses operating a ial business in etldi[ion to a Farm as daFlnad must comply with the requireman[s of[ha Hazardous MafarlalsoProgram for[hose materials assoGa[ad with the commeroial business. QuesYon 3: i Tha Fatlaral and State govarnmanis have daFlnad approximately 366 chemicals as an"Acutely Hazardous Material"(AHM). Tha osi common AHM used in the county Include: Chllorina, Ammonia, Sulfuric Acid, Methyl Bromlda, Acrolein, Sulfur Dioxide, Formaldehyde,Nitric Acid,Vinyl Acetate Monomer, Hydrogen Peroxide,and many HPes of Pas[icitles. Answer"Yes' if you u any of these speciFc chemicals in any quanflty ai any ono rima of[ha year. Contac[[ha EHD If you're '� unsure for assistancasa Question 4: Answer"Yes'If[ha boundary of your property or facility Is or will ba within 1,000 feat of the boundary of a school.(rc-T2)