Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Hazardous Materials Program General Information
HMBP
Required
New
Consolidated
Forms
Using this
booklet
Booklet
topics
It has been determined that your facility must complete and submit the enclosed
Hazardous Materials Business Plan (HMBP) packet. You must complete a separate
plan for each non-contiguous location where you conduct business if hazardous
materials are handled that meet reporting criteria.
This packet incorporates statewide consolidated forms. In addition, we have created
a site map and emergency response & contingency plan for your use. The forms
allow you to address many paperwork regulatory requirements of these programs
using one streamlined HMBP. These forms conform to the minimum requirements
of the law.
This packet provides you with:
 instructions and guidelines for properly completing your forms,
 assistance in determining which forms you must complete, and
 basic program information.
Here is what you’ll find in this packet:
Topic
Applies To Forms…
Find Topic
on page…
Introduction to Hazardous Materials
Business Plan
(HMBP)Requirements
all
2
Rules To Know Before You Begin
all
4
Recognizing Hazardous Materials
all
6
all
8
The Emergency Response
and Contingency Plan
10
Completing the Paperwork-General
Overview
About The Emergency Response
and Contingency Plan
Guidelines for Making Key
Business Plan Decisions
Instructions for Completing The
Emergency Response and
Contingency Plan
Completing Your Facility Site Map
Basic Program Implementation
Information
If you need
more help
CUPA04
Page 1
The Emergency Response
and Contingency Plan
11
The Emergency Response
and Contingency Plan
14
Site Map
18
all
19
If you need more help in completing your HMBP, you can:
 call one of our Hazardous Materials Specialists at 530-749-5450,
 request an appointment for further consultation or assistance.
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Introduction to Hazardous Materials Business Plan Requirements
Page 2
HMBP
Required
Hazardous Materials Business Plans (HMBPs) are required for all businesses handling
hazardous materials (in reportable quantity), hazardous waste (in any quantity) and / or
underground storage tanks.
What’s a
HMBP?
An HMBP is simply a management plan for hazardous materials, hazardous wastes and
underground storage tanks having the mandated components as listed below.
Required
forms
You are required to complete and submit your original completed forms shown below.
The consolidated HMBP integrates minimum regulatory requirements for hazardous materials,
hazardous waste and underground storage tanks as shown here:
These forms meet reporting requirements under the California Health and Safety Code, and the
Federal Community Right-to-Know requirements.
Who
Submits
What
Your facility status determines which forms you must submit as summarized here:
Facility type
all facilities (handling reportable
quantities of hazardous materials, any
amount of hazardous waste &/or
underground storage tanks)
Forms Required





Business Activities Form
Business Owner / Operator Identification For
Facility Site Map
Emergency Response and Contingency Plan
Hazardous Waste Generator Statement
handles reportable quantities
of  Hazardous Materials Inventory Form(s) (one
hazardous materials, (or mixtures
per material and/or waste)
containing hazardous materials) OR
Definition of Handle: to use, generate,
hazardous waste
process, produce, treat, store, emit, discharge, or
dispose of a hazardous material in any fashion.
(Reportable quantities are 55 gallons, 500 pounds
or 200 cubic feet at standard temperature and
pressure—see Basic Rules .



Underground Storage Tanks Facility Form
Underground Storage Tank Form(s)
Underground Storage Tank Written Monitoring
Plan Supplement

submit storage statement to State if total
storage is 1320 gallons or single tank is 1320
gallons.
engages in on-site hazardous waste 
treatment activities

Onsite Hazardous Waste Treatment
Notification Facility Form
Onsite Hazardous Waste Treatment
Notification Unit Form
Specific treatment activity page (based on the
categorization of your treatment activities as
Conditionally Exempt, Conditionally
Authorized, Permit By Rule, etc)
Certification of Financial Assurance Form (for
Permit By Rule and Conditionally Authorized)
has underground storage tanks
has aboveground storage tanks
containing petroleum products.


CUPA04
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Introduction to Hazardous Materials Business Plan Requirements
Page 3
What you
must do





Complete forms, sign and date.
Submit forms by due date.
Pay program fees.
Remember to keep copies of your submitted information at your facility!!!
Update information annually as required.
Obtaining
tank and
treatment
forms
The enclosed HMBP does not include all required forms / paperwork for facilities with
underground storage tanks, aboveground storage tanks, or engaging in on-site
treatment. You may obtain additionally required paperwork by calling us at 530/ 7495450.
Other
Programs
Cal-ARP: If you handle certain quantities of extremely (acutely) hazardous materials
(EHM, AHM), you will be required to comply with this program. If you handle EHM’s,
contact this office to determine if you need to comply with this program. Examples of
EHM’s: chlorine, ammonia, methyl bromide.
CUPA04
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Rules To Know Before You Begin
Basic rules
Page 4
This table explains the basic rules you must know to accurately complete your HMBP:
Rules
Explanations
Definition:
“any material which because of its quantity, concentration or
physical or chemical characteristics, poses a significant present or potential risk to
human health and safety or the environment…”
Recognizing
hazardous
materials
Indicators:
 Manufacturer is required to prepare a Material Safety Data Sheet (MSDS) for product
 Label has specific hazard warning words, graphics or phrases (e.g. caution, danger,
irritant, toxic)
 Material is on a state or federal hazardous material list
 Material falls in a US Department of Transportation “Hazard Class”
Recommendation: Use guideline handout titled Recognizing Hazardous Materials
together with product’s Material Safety Data Sheet to make proper determination.
Reportable
Quantities
You must report all hazardous materials, mixtures containing hazardous materials, and
hazardous wastes handled at your facility, that are handled at any one time during the
reporting year that are at or above these threshold reportable quantities—this includes
applied materials present during the course of application:
 55 gallons
 500 pounds
 200 cubic feet (at standard temperature and pressure)


above amounts of a material containing any amount of perchlorate
extremely hazardous materials at or above the threshold planning quantity.*
* The reportable quantities for radioactive materials and extremely or acutely hazardous
Determining
Quantities
materials (EHM or AHM) and/or wastes may be less. Contact the CUPA at 530-7495450 for a list if you think you handle any of these materials.
To determine quantities of hazardous materials:
 Report total quantities for similar categories of materials such as lacquer thinners,
latex paints, oil based paints and motor oils ignoring brand name or minor
ingredient differences, and
 Add together all containers of the same category of material to get your total quantity.
Recommendation:
See quantity calculation examples (next page).
Engine lubricating oils are exempt from the hazardous material disclosure requirements if
you have:
  55 gallons of any one type of lubricating oil, and
 not more than 5 different types of lubricating oils for a combined total of  275
gallons.
Lubricating
You are not exempt from the disclosure requirements if your lubricating oil storage
oil exemption exceeds either of these limitations.
Cautions: Types of lubricating oils include crankcase, transmission, gearbox, differential
and hydraulic system oils. Do not distinguish motor oil by weight — it must be counted
together as one type.
Waste oil is not a lubricating oil and must be reported as a
hazardous waste.
Mixtures
CUPA04
Many hazardous materials are mixtures, and composed of one or more hazardous
materials. When reporting mixtures, be sure to determine the most hazardous components
of the mixture and report each one at the bottom of the inventory page.
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Rules To Know Before You Begin, continued
Calculating
reportable
quantities
Page 5
Here are some examples of correct quantity calculations:
Scenario:
Example
1
A paint contractor handles both latex and oil
based paints in several brands and colors of paints with minor
proprietary formula differences.
Solution:
The contractor should report total
quantity of “latex paint” and total quantity of “oil based
paint” separately, without regard to color or brand
differences.
Scenario:
Example
2
An auto repair shop stores 45 gallons of 30
weight motor oil, 45 gallons of 40 weight motor oil and 30
gallons of gear oil.
Solution:
The shop reports “motor oil” with a
total quantity of 90 gallons, but does not need to report the
gear oil.
Scenario:
Example
3
A construction company has a repair shop
with 55 gallons of motor oil, 55 gallons of hydraulic fluid, 55
gallons of transmission fluid, 55 gallons of solvent and a 10,000
gallon diesel tank.
Solution:
The company reports solvent and diesel
only. The oil storage meets the lubricating oil exemption
criteria.
Scenario:
Example
4
A farmer has a 1000 gal diesel
aboveground tank, 55 gallons of used oil, and applies 5 gal. of a
pesticide during the year, mixed with water and applied in a 500
gallon mix tank/spray rig.
Solution:
The farmer must report all of the
materials. The quantity for the pesticide should be reported
as 500 gallons. This would be considered the largest
container.
Scenario:
Example
5
CUPA04
A small welding shop has 2 cylinders of
oxygen, each containing 220 cubic feet (cf) and 1 cylinder of
acetylene, containing 184 cf. They also have a small portable
welding unit on their service truck which contains 84 cf of
acetylene, and 120 cf of oxygen.
Solution:
The owner reports 560 cf of oxygen and
268 cf of acetylene.
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Recognizing Hazardous Materials
Introduction
“Official”
definition
Page 6
This handout will help you determine whether any of the materials you use at your
facility should be classified as hazardous. If in doubt, call us at 530/749-7520.
The laws which require businesses to report the use and storage of hazardous
materials define a hazardous material as:
"any material which because of its quantity, concentration, or physical or
chemical characteristics, poses a significant present or potential hazard to
human health and safety or to the environment..." {California Health &
Safety Code, Chapter 6.95, Section 25501(n)}
The terms hazardous materials and hazardous substances mean the same thing for
reporting purposes.
What this means
to business
owners?
You must submit information on the use and storage of hazardous materials at
your facility. However, it is not always clear which materials are hazardous and
which are not.
For example, sulfuric acid is obviously hazardous because of its corrosiveness.
The hazard of a compressed inert gas, however, is not so obvious; it lies in the
potential for violent rupture of cylinders under pressure.
Hazardous waste
How to recognize
hazardous
materials
Hazardous waste, such as beadblasting dust, used oil, spent solvents and paint
filters, are also considered hazardous materials.
There are at least four indicators that should alert you that a material is
hazardous:


A Material Safety Data Sheet (MSDS) is prepared and distributed by the
manufacturer.
The label contains specific hazard warning words, graphics, or phrases.

The physical characteristics of the material place it within one of the U.S.
Department of Transportation's "Hazard Classes."

The material is found on one of several state and federal lists of hazardous
materials.
Indicators
Indicator 1: MSDS
Indicator 2: Label
Warnings
Manufacturers are required by law to provide a Material Safety Data Sheet with
hazardous materials/substances. This document provides safety information and
physical/chemical data on the product.
The labels on hazardous material/substance packaging may contain certain
graphic hazard symbols such as skull & crossbones or flames, National Fire
Protection Institute diamonds, or terms such as:
danger  caution  warning  flammable
 sensitizer  combustible  irritant
reactive  corrosive  hazard  carcinogen  poison  toxic  oxidizer
radioactive  avoid contact (with skin or eyes)  do not store or use near heat
use with adequate ventilation  wear protective equipment
Indicator 3:
DOT Hazard
Classes
CUPA04
Hazardous materials cannot be transported unless placarded or labeled according
to the Department of Transportation's (DOT) Hazard Class Requirements. A few
examples of Hazard Classes:
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Recognizing Hazardous Materials continued
Page 7
General Hazard Properties
Hazard Class
Hazard
Examples
Explosive
dynamite, TNT, ammunition
explosive; exposure to heat,
shock or contamination can
result in thermal & mechanical
hazards
Flammable gas,
nonflammable gas &
poisonous gas
propane, acetylene, carbon
dioxide, anhydrous ammonia
under pressure, container
may rupture violently; may be
flammable, corrosive,
poisonous or an oxidizer
Corrosive material
hydrochloric acid, sulfuric
acid, sodium hydroxide
disintegrates contacted
tissues; may fume; water
reactive
Classes
Indicator 4:
Specifically listed
References
A number of government agencies have published lists of hazardous
materials:

Code of Federal Regulations Title 40 (hazardous substances and reportable
quantities) and Title 49 (transport of hazardous materials).

California Code of Regulations Title 8 (Cal OSHA Hazardous Substances
List) and Title 22 (hazardous waste).
The California Chamber of Commerce (916/444-6670) has published several
manuals to assist businesses in complying with hazardous material regulatory
requirements:






CUPA04
California Environmental Compliance Handbook
Community Right to Know
Proposition 65 Compliance
Cal OSHA Handbook
Hazard Communication Handbook
SB 198 Handbook (Injury and Illness Prevention Plan)
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Completing the Paperwork-General Overview
Business
Activities Form
Line by line
instructions on back
of form.
Facility ID#
This will be assigned to you by the CUPA.
EPA ID#
If you generate a hazardous waste in any amount you must have an
EPA ID#. Call 1-800-618-6942 to obtain one, if you do not already
have one.
Business
etc.
Business
Owner/Operator
Identification
Name, Fill in Business name, address, type of business (rice farm, auto
repair, public utility, etc.), contact, phone.
Balance of Form
Answer YES or NO to each question as it pertains to your business.
Signature/Date
Form must be signed and dated.
Identification
Section
Complete information about your business. If there is no physical
address for the business location give as much information as
possible: closest street, cross streets, physical description, etc. The
Dun and Bradstreet info may be left blank if you do not have a rating.
The SIC code is the Standard Industrial Code which identifies the
type of business you are. If you do not know what your code is you
may look it up on the internet, or contact this office for the SIC Code.
Business Owner
Complete information on the owner of the business.
Environmental
Contact
Complete information on who would handle any environmental
reporting, problems, etc. for your business.
Emergency
Contacts
Complete information on who to call in case of an emergency. These
people should be familiar with the facility and who have the authority
to make important decisions in an emergency.
Signature/Date
Form must be signed and dated.
Facility
Information
Provide business name and chemical location (i.e. shop, flammable
liquids cabinet, NW corner of driveway, etc.) Indicate location on site
map according to grid, or map, if desired.
Chemical
Information
Use MSDS sheets to help complete this information. This is
important information; be as thorough as possible.
Line by line
instructions on back
of form.
Hazardous
Materials
Inventory
Page 8
Line by line
instructions on back
of form.
CAS #: This is the Chemical Abstract Number. Look on the MSDS
for this number. If it is not available, leave it blank.
Average Daily Amount: Report the amount that you generally have
on-site on a day-to-day basis. (Not the amount you use daily.)
Maximum Daily Amount: Report the maximum amount that would
ever be on-site at one time.
Mixtures: If this material is a mixture, be sure to provide information
on the most hazardous components at the bottom of the page. If you
need help call the CUPA office at 749-5450.
CUPA04
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Completing the Paperwork-General Overview continued
Page 9
Facility Site Map
See additional
instructions
Complete map showing location of facility in relationship to
surrounding areas, and where all materials are located.
Business
Emergency
Response and
Contingency Plan
See additional
guidance and
instructions
This plan is meant to outline procedures to follow in case of a
hazardous materials emergency at your facility. It needs to be
specific as possible and meet all component criteria. Your
employees must be familiar with the contents of the plan. Keep
plan on site accessible to employees.
Hazardous Waste
Generator
Statement
Facility Information
Complete basic information. If you generate a hazardous
waste and do not have an EPA# call 1-800-618-6942 to obtain
one.
Waste Generated
Mark the appropriate box. If you generate a hazardous waste,
mark the box showing that a waste is generated. If you do not-mark the box with the declaration that you do not generate a
waste.
Identification of
Waste
List each different waste that you generate; designate if it is a
liquid or solid. State amount generated per month and year.
Use your disposal records to determine the amounts
generated. Describe how you dispose of the waste.
Largest Container
Indicate the largest hazardous waste container you have for
that particular waste.
Sign and Date
Be sure to sign and date the form.
You have been
provided with
general hazardous
waste information.
Review this carefully
before completing
this form.
CUPA04
Yuba County Certified Unified Program Agency
About the Emergency Response & Contingency Plan
What to do
Consolidated
format
Complete the
form
If you already
have a plan
Caution
Emergency
Response and
Contingency
Plan
Requirements
Owner /
operator
responsibilities
CUPA04
Hazardous Materials Programs
Page 10
Complete the emergency response / contingency plan, making any additions
necessary to adjust for your facility size, facility operations or emergency procedures.
Submit the original to the CUPA; keep a copy on site.
Conforming to the statewide effort to consolidate forms and lessen paperwork
redundancy, we have created an Emergency Response and Contingency Plan form
which unifies the emergency response / contingency plan requirements for hazardous
materials, hazardous waste and underground storage tanks (our three most common
regulatory programs). It also meets Emergency Action Plan requirements.
The Emergency Response and Contingency Plan form aids you in creating a better
emergency response plan in a more comprehensive and streamlined format. It aids
us in ensuring that all regulated businesses in the County have met relevant
emergency response / contingency plan requirements.
Your facility may have its own internal proprietary emergency response document
(not our version). You should verify that it provides the same information as the plan
included here. If so, submit your document to the CUPA in lieu of the enclosed plan.
You may also choose to revise your document to incorporate any missing information
so that it meets our plan requirements.
Our emergency response / contingency plan provides the minimum information
necessary to meet emergency planning requirements. You may attach additional
information or addendums for specific hazard response, if needed.
It is advised that you do not neglect or omit any portion of the plan without careful
evaluation of that item.
An Emergency Response and Contingency Plan is required of all facilities having
hazardous materials, hazardous wastes or underground storage tanks to ensure
proper action during emergencies by:

describing specific actions to be taken in an emergency or accident involving
hazardous materials, hazardous wastes or underground storage tanks,
 providing procedures for immediate and appropriate emergency response,
 requiring owners and operators to have response procedures developed in
advance to facilitate implementation during emergencies, and
 minimizing hazards to people, property and the environment.
An owner / operator is required to:
 keep a copy of the plan,
 train employees on its use
 submit copies to emergency response agencies, and
 revise the plan if it fails in an emergency, its components change, or if
regulations change.
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Guidelines for Making Key Response Plan Decisions
Purpose
It is important that your emergency response / contingency plan serves your facility
and our community as a functional emergency planning and management tool. Here
you will find guidelines for creating an effective emergency plan covering:




Emergency
Coordinator
guidelines
Emergency
assessment
guidelines
Page 11
making emergency coordinator decisions,
hazard assessment and assessing emergencies,
emergency preparedness considerations, and
making agency notifications
Your designated Emergency Coordinator must:

have sufficient knowledge of facility chemicals and processes, and be able to
assess hazards


be able to communicate such to others, and
have the necessary authority to independently initiate and coordinate
emergency response activities
You must know how to properly assess and react to potential emergency situations.
Use this table to assist you in classifying emergencies and determining appropriate
responses:
Emergency Assessment Guidelines
Classify as
a…
And Call…
Potential
Emergency
Condition
Poses no immediate threat to life, property
or the environment
Any emergency incident or threat of
release posing a greater hazard or
involving a large area
May require a limited evacuation of
surrounding area
No one beyond
internal
response team- unless
situation
escalates or
you’re unsure
Limited
Emergency
Condition
911
Poses a potential threat to life, property or
the environment
Any emergency incident or threat of
release posing a severe hazard or
involving a large area
Requires large scale evacuation of area
Poses an extreme threat to life, property
and the environment
Full
Emergency
Condition
911
Characteristics











CUPA04
Any emergency incident or threat of
release that can be controlled by the onsite first responder
Does not require evacuation
Emergency is confined to small on-site
area
Requires expertise or resources of city,
county, state, federal or other external
agencies / organizations
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Guidelines for Making Key Response Plan Decisions, continued
Emergency
preparedness
guidelines
Page 12
Follow the guidelines presented in this table to maximize your emergency
preparedness:
Emergency
preparedness
considerations for…
Personnel
Equipment
Facility
CUPA04
Ensure that…

you schedule employee (hazardous materials,
hazardous waste and emergency response)
training programs at least annually

you have enough trained personnel to respond
as indicated in your response/contingency plan

you have chemical technical resource personnel
available for response assistance

you know your facility’s personnel and resource
limitations

you’ve tested your procedures for getting public
emergency responder assistance when needed .

you know what equipment is required to respond
as indicated in your emergency response and
contingency plan

you have available sufficient amounts of each
type of equipment you rely on for emergency
response

equipment lists are updated and distributed to onsite response team upon any modifications

you know where & how to obtain emergency
equipment on short term notice (24 hours or less)

adequate
communications
maintained on-site

emergency equipment is regularly maintained &
logs are kept of such

you have sufficient dedicated space for cleaning
& storing response equipment

you know how to properly dispose of hazardous
waste generated by a release or incident

you can provide necessary immediate medical
treatment to persons exposed chemicals at your
facility.

you have identified an adequate relocation area
for evacuated persons
equipment
is
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Guidelines for Making Key Response Plan Decisions, continued
Agency
notification
guidelines
Your call to 911 may result in emergency response by local, state and federal
agencies dependent upon the health, safety and environmental risk posed by the
emergency, release or threatened release (see assessment guidelines on prior page)
as shown here:
This agency will be
involved…
If your emergency…


DTSC

California Dept. of Fish & Game

Cal OSHA

threatens human health, or
threatens or impacts the environment
(soil, air or water), storm drain or
sewer system
poses threat to either human health or
the environment off premises
involves large releases of hazardous
wastes
involves a release impacting wildlife in
creeks, streams or rivers
impacts worker safety and / or health
US Coast Guard
Regional Water Quality Control
Board

impacts a river

impacts surface water quality

is large enough to require Federal
government
intervention
and
resources
impacts the public infra-structure
(sewer, storm water, roads, etc)
Local Fire department and
Yuba County CUPA
State Office of Emergency
Services

US EPA
County Public Works
Department
Checklist for
making
notifications
If OES is
notified
CUPA04
Page 13

You must provide this information when making required notifications to agencies:
 your name & phone number
 facility name and address
 date and time of incident
 nature (e.g. fire, release) & cause of incident
 name & quantity of hazardous materials involved
 current status of facility / incident
 description of any injuries
 description of hazards to people or the environment off-site
If the CUPA is notified as a result of your emergency, you must submit a written
report to the CUPA within 15 days confirming or revising the initial notification. Your
report must include the amount and disposition of any recovered waste. Obtain forms
from the CUPA: 749-5450.
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Instructions for Completing the Emergency Response & Contingency Plan
Page 14
Introduction
The Emergency Response / Contingency Plan:




unifies emergency planning requirements for hazardous materials, hazardous
waste and underground storage tanks (see next section for supplemental UST
written monitoring plan requirement),
provides for basic contingency planning for an average small to mid-size
facility in Yuba Count
outlines specific responses to specific types of hazards
may require an additional supplement or amendment (or an equivalent
substituting document) for facilities of exceptional size or having exceptional
operations or processes that warrant additional contingency planning.
Examples of operations that may warrant additional contingency planning are:
 unusual hazardous waste treatment processes (e.g neutralization),
 large-scale manufacturing processes (e.g. household cleaning product
manufacturing), or
 elaborately plumbed above-ground storage tank systems (chemical feed /
distribution systems).
 facilities handling threshold quantities of extremely hazardous materials.
What you’ll
find here
We hope you find that the Emergency Response /Contingency Plan requires little
instruction to complete. However, we have included here three resources to assist
you in its completion as shown in this table:
Resource
General
instructions
How it helps you

gives you general rules of thumb to
use in completing the plan
page 15

gives specific instructions for
sections of the plan and
addresses
commonly
made
mistakes or frequently asked
questions
page 15
Specific line item

instructions
CUPA04
Where to find it
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Instructions for Completing the Emergency Response & Contingency Plan
continued
Page 15
Follow these general rules in completing your Emergency Response / Contingency
Plan:
 Remember that this plan applies to your hazardous material, hazardous waste
and underground storage tank processes—keep them all in mind as you address
each plan section
 Mark sections that don’t apply to your facility with “N/A” for not applicable
 Be as specific as possible.
 Review the specific line item instructions before completing your plan to avoid
common errors.
 Attach hazard specific response procedures that are not addressed in this plan.
General
instructions
Specific line
item
instructions
Most portions of the Emergency Response / Contingency Plan require no advance
explanation to complete. However, this table instructs you in areas where errors are
commonly made.
Page
Section
#
1
1
1
1
1
1
1
Heading
Instructions
Facility Identification
Facility ID#
Your facility ID# is a number assigned by us.
It will be designated XXXX.
1
Facility Identification
Principal
Business
Activity
Identify what the main business activity is:
auto repair, rice farm, meat processing plant,
etc.
2
Primary / Alternate
Emergency
Coordinator
2
2
2
Technical Advisors
Identification of
Response Personnel
Emergency
Communications
3
2
3
CUPA04
Requested
information
Emergency Phone
Numbers /
Notification Lists
Name,
Address, etc.
Names
Identify who
would be
called to
respond to an
emergency.
Name of
person
responsible for
notifications.
Nearest
medical facility
/ hospital
Your medical
facility /
hospital
Identify your primary and alternate
emergency coordinators by name.
Identify who can give specific technical
information to emergency responders about
the facility and hazardous materials handled
and what their expertise is.
Indicate whether an internal response team,
an outside contractor, or public responders
will be requested to respond to an emergency
at your facility. Indicate names and numbers
if internal or contracted responders.
Identify who is responsible to make on and
off-site notifications, and indicate how they
are to be made.
Enter the name & phone # of the nearest
medical facility.
Enter the name & phone # of your designated
medical facility or hospital for insurance
purposes.
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Instructions for Completing the Emergency Response & Contingency Plan
continued
Page
2
3
3
Page 16
Section
#
3
4
4
Heading
Notification of
Adjacent Properties
Methods for
Prevention,
Containment, and
Clean-up of a
Release
Evacuation
Coordinator…
4
4
Emergency
Equipment
5
4
Earthquake
Vulnerability
CUPA04
Requested
information
Instructions
Names and
information of
adjacent
businesses.
Provide names, addresses, phone numbers,
and contacts of the adjacent property owners/
businesses adjacent to your facility.
Identification of
procedures to
prevent,
contain,
mitigate and
cleanup a
release of
hazardous
materials.
Evacuation
information
Identification of
materials and
equipment on
hand to use in
an emergency.
Identification of
areas in the
facility that
may be
vulnerable
during an
earthquake.
Identify methods, equipment, procedures,
etc. on how you intend to prevent a release
from occurring, how you would contain a
release, and how you would prevent harm to
persons, property and the environment.
Indicate how you intend to cleanup large and
small spills. Identify number of trained
personnel for each level, if you have them.
Attach more specific information as needed.
(NOTE: this is general in nature and may
not fully address responses to
flammables, toxins, corrosives, etc.
Provide hazard specific response
procedures in a supplemental
attachment.)
If an evacuation of your facility is needed,
indicate who will be responsible for all
evacuees, where the assembly area will be,
where procedures and routes are posted, and
what the procedures are.
Check those items that you have on hand for
use in emergency situations. Identify the
location and it’s capability. Attach additional
information, if necessary.
Check those areas within your facility that
may be affected if an earthquake were to
occur.
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Instructions for Completing the Emergency Response & Contingency Plan
continued
Page
5
Page 17
Section
#
5
Heading
Training Plan
Requested
information
Identification of
training.
Instructions
Identify training topics, formats,
frequency and documentation
procedures for training that is provided
to your employees.
Sample: Employee Training Record
Wild Wild West Company Monthly Training Meeting Held August 1, 1997
Trainer: HazMat Hal Hours of training: 2-4 p.m.
Topics Discussed:
 Reviewed MSDS (Material Safety Data Sheet) for new item—parts washer solvent
 Reviewed proper disposal of oil containers and waste paint cans
 Covered spill containment guidelines, spill response crew members & evacuation
route
 Identified fire extinguisher & first aid locations & use
Employees Attending:
Name: Yosemite Sam
Job Title: Outlaw Signature: Yosemite Sam
6
6
Recordkeeping
6
7
Signature /
Certification
6
CUPA04
8
List of Attachments
Identification of
records kept at
facility.
Signature of
Business
Owner
Indicate other
documents
Indicate which records are kept at the facility.
Sign and date plan.
Indicate any other documents you are
submitting with this plan.
Attach your hazard specific response
instructions on the materials you handle.
(i.e. chemical specific actions needed to
respond to flammables, corrosives, toxins,
etc.)
Yuba County Certified Unified Program Agency
Hazardous Materials Programs
Completing the Facility Site Map
Introduction
How to
complete
your map
Page 18
All facilities handling hazardous wastes or reportable quantities of hazardous
materials must complete a facility site map.
Follow these steps to complete your map.
Step
Action
1
Indicate your map direction and scale.
2
Choose and list your map legend. Use map symbols if desired, or use Site
Map template provided.
3
Draw your building outline.
Using your legend symbols, indicate general building information such as:
4
 fire hydrants/sprinklers
 knox boxes
 parking lots and internal roads
 sumps, storm and sewer drains
 UST dispenser island
 loading areas
Using your legend, indicate the locations of:
5
6
Show locations of emergency shut-off switches for:
 natural gas
 water
 electrical
7
Show locations of emergency equipment such as:
 fire extinguishers
 first aid & protective equipment
 monitoring alarm boxes
 mitigation & clean-up equipment
8
9
CUPA04
 hazardous material and hazardous waste storage / handling areas
 above ground and / or underground storage tanks (w/content) and
monitoring equipment (sensors, probes, monitors, leak detectors, sumps,
dispensers, etc)
 fuel / hazardous material piping systems and secondary containment
areas
 fuel
Show locations of:
 Material Safety Data Sheets
 Evacuation assembly area
 Hazardous Materials / Contingency Plan
Show locations of adjacent streets and identifying neighboring properties.
 If businesses / neighbors are present, indicate location by name.
 If residential neighbors are present, indicate by name.
Yuba County Certified Unified Program Agency
Basic Program Implementation Information
Paperwork
Submittal
Fees
Hazardous Materials Programs
Page 19
When you have completed the business plan forms, fill out the “Billing Information”
form, and the “Compliance Checklist and Certification” form and submit with the
business plan. Send completed materials to :
Yuba County
Certified Unified Program Agency
915 8th Street, Suite 123
Marysville, CA 95901
Once this completed packet is submitted, it will be reviewed for completeness and
accuracy. Any deficiencies will be noted and you will be notified to correct the
deficiencies.
You have been provided with a fee schedule and fee category information. You will be
billed according to which fee category you fall into. You may submit fees with the
paperwork packet, or wait to be billed by this office. Applied materials are not used to
determine fee category, except for the handling of acutely hazardous materials (AHM),
which affect the lowest business and farm categories. If you submit fees with this
packet and they are found to be incorrect, you will be billed for the difference.
Fees are set by the Board of Supervisors to cover the cost of program operation, and
reviewed periodically.
Annual Submittals
Annual Permit
Statement
Inspections
Enforcement
Annual Seminars
CUPA04
Surcharge: The State of California charges a surcharge fee (currently $24.00) for all
businesses that are part of any hazardous material program. Underground tank
surcharge fees are currently $15 per tank per year.
Each year, in December, you will receive a packet of materials and an invoice for
program fees. The packet of materials includes updated program information, an
inventory certification, a hazardous waste generator statement, and a response
plan/site map update certification, The certifications and generator statement must be
completed, signed, and returned, with payment of fees, for your facility to be in
compliance. If you have additional inventory or changes to your response plan, etc. you
need to submit the updates.
After you have submitted all annual paperwork, you will be sent a Permit Statement
showing the programs you are required to comply with. This does not ascertain that you
are in operational compliance. You are to keep this at your facility.
You are required to be inspected every three years, or annually if you are a UST
facility. Please contact this office for an inspection by calling (530) 749-5450. Our goal
in conducting inspections is to educate you in what your responsibilities are for program
compliance. We have available self-audit checklists that can help you prepare for an
inspection. During an inspection, violations will be noted as Minor, or Major. You will
generally be given 30 days to correct any violations. For minor violations, you may be
allowed to self-certify that they have been corrected, or may be required to provide a
written explanation of the correction. A re-inspection may be made to verify correction.
Major violations will require written explanation of the correction, or a re-inspection.
Any major violations may be pursued using formal enforcement procedures.
We are required by law to have enforcement procedures. Our enforcement procedures
consist of informal and formal enforcement. If you receive a Notice to Comply or a
Notice of Violation, you will know that informal enforcement procedures have been
initiated. If violations are not corrected within specific time frames, or if you have
chronic or major violations, etc. the enforcement action will escalate to formal
enforcement. Formal enforcement includes administrative enforcement orders and
referral to the District Attorney. Formal enforcement requires penalty assessment,
which may result in as much as $5000 to $25,000 per day of violation for each violation.
We conduct annual seminars, which provides valuable information for your business
regarding the hazardous materials programs. If you would like a particular topic
discussed in the seminar, let us know.
Yuba County Certified Unified Program Agency
CUPA04
Hazardous Materials Programs