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SAN JOAQUIN <br />COUNTY <br />❑ Other(explain): <br />Environmental Health Department <br />California Accidental Release Prevention Program <br />De -Registration Form <br />The <br />Hazardous Materials Business Plan <br />(HMBP) <br />was updated with <br />the changes and submitted in <br />the <br />California Environmental Reporting <br />System <br />(CERS) on: May 20, <br />2021 <br />11. EPA RMP De -registration Information: <br />According to Tile 19 CCR Section 2745.10 (c) If a stationary source is no longer subject to the <br />applicability requirements of Section 2735.4(a)(1), the owner or operator shall submit a de- <br />registration pursuant to Section 2740.1(a) to USEPA within six months indicating that the <br />stationary source is no longer covered. A copy of the de -registration shall also be submitted to <br />the UPA. <br />Is the stationary source covered by 40 CFR Part 68? ❑Yes ❑ No <br />If yes, provide a copy of the EPA RMP de -registration with this submittal. <br />The stationary source USEPA identifier: <br />12.Owner/Operator Certification: <br />certify the above stationary <br />source as of the <br />above effective date is <br />no longer <br />subject to <br />the CaIARP applicability <br />requirements of <br />section 2735.4(a)(2)1 <br />Signature of Owner or Operator <br />Official Title <br />Date <br />Page 3 of 3 <br />