Yuba County
Certified Unified Program Agency
I. FACILITY IDENTIFICATION
EMERGENCY RESPONSE AND CONTINGENCY PLAN
Hazardous Materials Programs
FACILITY NAME:
FACILITY ID#: HM
FACILITY SITE ADDRESS:
DATE:
CITY/ZIP:
WORK PHONE:
FACILITY/PROPERTY OWNER NAME:
ELEMENTS COVERED BY THIS PLAN
Underground Storage Tanks (HSC 6.7)
PRINCIPAL BUSINESS ACTIVITY:
HOME PHONE:
Hazardous Materials (HSC6.95/CCR Title 19)
Hazardous Waste (CCR Title 22)
Aboveground Storage Tank
Other:
DESCRIPTION OF
DAYS/HOURS OF OPERATION:
OPERATIONS:
NUMBER OF SHIFTS:
NUMBER OF EMPLOYEES:
HAZARDS/EVENTS COVERED BY PLAN (i.e., chemical spills, fire, earthquake, etc.)
II. EMERGENCY COORDINATOR, EMERGENCY RESPONDERS, and TECHNICAL ADVISORS
Primary Emergency
Name/Position:
Coordinator (EC)
EC has the expertise to classify the
Address:
release determine appropriate
response and the authority to make
management decisions &
Phone #’s
Business:
Responsible
for:
spill prevention
emergency assessment/management
initiating alarms
agency notification
other.(Specify)
.
Alternate EC
24-Hour:
Name/Position
Address
City/Zip
Day/Eve Phone
Name:
Name:
Available to provide site-specific
technical advice to local emergency
responders.
Expertise:
Expertise:
Emergency Response
Team (ERT) Personnel
Team Members
(name/position)
ERT available on-site
Team Members, level of
training, and roles and
responsibilities are listed.
Outside Contractor(s)
Will be contacted for spill
clean-up.
1.
2.
3.
4.
Technical Advisors
Level of Training
Role/Responsibilities:
Call Local Emergency Responders--911
Name:
Emergency Communications
EXTERNAL: Notification of neighbors who
may be affected by a spill/release will occur
via:
CUPA04
Position:
personal contact
telephone
alarm system:
Automatic
personal contact
telephone
alarm system: Automatic
.
Role/Responsibilities
Company Name:
Address:
24-hr. Phone#(s):
Individual(s) named is responsible to notify
INTERNAL: Verbal communications or
evacuation notifications will occur via:
contacting facility responders
authorizing spill response work
interfacing with emergency responders
proper disposal of hazardous waste
Manual
Manual
Name:
Position:
public address/intercom system
pagers
portable radio
public address/intercom system
pagers
portable radio
Page 1 of 6
Yuba County
Certified Unified Program Agency
EMERGENCY RESPONSE AND CONTINGENCY PLAN
Hazardous Materials Programs
FACILITY IDENTIFICATION:
HM#
III. EMERGENCY COMMUNICATIONS AND NOTIFICATIONS
Emergency Notifications
Ambulance, Fire, Sheriff
911
Emergency Phone Numbers
To be contacted for any hazardous
Materials release
Yuba County CUPA
Yuba County Sheriff
CA Office of Emergency Services
Warning Center
(530) 749-5450 8-5 p.m.
(530) 749-7777 (24-hour)
1-800-852-7550
Nearest medical facility:
Name/Address: Rideout Hospital
426 4th Street Marysville, CA 95901
Phone: 749-4300
Designated medical facility,
urgent care facility, or occupational health care provider:
Agency Notification List
Name/Address: Sutter North Occupational
Health 886 Plumas Ave. Yuba City
Phone: 751-9675
National Response Center
1-800-424-8802
The following agencies will be contacted
as needed.
CA Central Valley RWQCB
US EPA
CA Dept. of Toxics Substances Control
CA Dept. of Fish and Game
US Coast Guard (Spill Response)
Cal OSHA
State Fire Marshal
Feather River Air Quality Mgmt. District
Yuba Co. Ag Commissioners Office
(916) 255-3000
(415)744-1500
(916)324-1824
(916) 445-0045
(510)437-3073
(916) 263-2800
(916) 445-8200
(530) 741-6484
(530) 749-5400
Other Important Numbers
Poison Control Center
1-800-342-9293
Notification of Adjacent Properties/Businesses (adjacent to facility)
Orientation: North of Facility.
Orientation: South of Facility.
Business Name:
Business Name:
Address:
Address:
Phone #
Phone #
Contact Name:
Contact Name:
Orientation: East of Facility.
Orientation: West of Facility
Business Name:
Business Name:
Address:
Address:
Phone #
Phone #
Contact Name:
Contact Name:
CUPA04
Page 2 of 6
Yuba County
Certified Unified Program Agency
EMERGENCY RESPONSE AND CONTINGENCY PLAN
Hazardous Materials Programs
FACILITY IDENTIFICATION:
HM#
IV. HAZARDOUS MATERIALS EMERGENCY PLANNING AND RESPONSE
Methods for Prevention, Containment, and Clean-Up of a Release
Preventing spill and release
Daily visual inspection
Weekly visual inspection
Monthly visual inspection.
Containers/raw materials inspected
prior to acceptance
Monitor for leaks, ruptures,
pressure build-up, etc .
Waste discharge points monitored
Automatic shutoffs
Tank monitoring/testing
Storm water sampling
Air monitoring device
Liquid monitoring device
Routine preventative maintenance
Other (Specify)
Containing spills, releases, fires or
explosions
Provide structural, physical barrier and
secondary containment.
Cover or block floor /storm drains
Built-in berms in storage area(s)
Provide absorbent physical barrier
Shut-off water, gas, and electrical
utilities as appropriate.
Automatic/electronic equipment shutdown system
Automatic fire suppression system
Secondary containment of tanks/drums
Mitigating associated harm to persons,
property and the environment.
Stop processes/operations
Eliminate ignition sources
Remove/isolate containers/area as needed.
Call 911 for emergency assistance and
medical aid
Notify and evacuate persons in all
threatened areas
Provide protective equipment for on-site
response team
Account for evacuated persons immediately
after evacuation call.
Other (Specify)
Other (Specify)
Clean-up Procedures
HAZWOPER Trained
Personnel:
Number of Personnel
Trained to HAZWOPER –
Awareness Level:
Operations Level:
Technician Level:
Incident Commander:
Use absorbent materials for spills and properly label,
store and dispose of hazardous waste.
Small Spill
Large Spill
Suction using shop vacuum with subsequent proper
storage, labeling, and hazardous waste disposal as
appropriate
Wash/decontaminate equipment and dispose of effluent/
rinsate as hazardous waste
Provide safe temporary storage of emergency-generated
wastes.
Hire licensed hazardous waste contractor
Other (Specify)
Small Spill
Large Spill
Small Spill
Large Spill
Small Spill
Large Spill
Small Spill
Large Spill
Emergency Evacuations
Evacuation Coordinator will initiate
evacuations and account for all
employees and site visitors after an
evacuation
Emergency Assembly Area
Name/Position:
Location where Evacuation
Procedures/Routes posted
Posting:
Evacuation Procedures
Procedures:
Location:
Arrangements with local emergency service providers
Advance arrangements have been made with local fire and police departments, hospitals and/or contractors for emergency services
to familiarize them with this facility.
Special arrangements:
CUPA04
Page 3 of 6
Yuba County
Certified Unified Program Agency
EMERGENCY RESPONSE AND CONTINGENCY PLAN
Hazardous Materials Programs
FACILITY IDENTIFICATION:
HM #
Emergency Equipment
√ Indicates equipment available on site for response to chemical leaks, spills, or fires.
Use Category
Equipment Available
Location
Capability/Description
Examples:
Portable fire extinguisher
Chemical protective gloves
center of N wall/shop
spill response kit
rated as “5A,10BC”
One-use, oil/solvent resistant
Safety and First
Aid Equipment
chemical protective suits, aprons or vests
chemical protective gloves
boots
safety glasses
goggles
shields
hard hats
shields
cartridge respirator
SCBA
first aid kits/ stations
emergency eye-wash
plumbed
portable
emergency shower
other
Fire
Extinguishing
portable fire extinguishers
fixed fire prot.systems
sprinklers
Equipment
fire alarm boxes or stations
other
Spill Control
and Clean-up
Equipment
absorbent material
container for used absorbent
berming/diking equipment
broom
shovel
shop vacuum
exhaust hood
emergency sump/holding tank
chemical neutralizers
gas cylinder leak repair kits
spill overpack drums
other
Communication
& Alarm
System
Equipment
telephones, including cellular
intercom/PA System
portable radios
automatic alarm w/monitoring equipment
UST monitoring system operations manual
list of notification phone numbers
other
fire hoses
CO2
fire hydrant
Areas of Earthquake Vulnerability
Areas /systems vulnerable to
releases / spills due to
earthquake related motion
The areas identified may require
immediate isolation and inspection.
CUPA04
hazardous materials/waste storage area
process lines/ piping
laboratory
waste treatment area
shelves, cabinets, & racks
other:
tanks (emergency shutoff)
portable gas cylinders
emergency shutoff/utility valves
sprinkler systems
stationary pressurized containers
other:
Page 4 of 6
Yuba County
Certified Unified Program Agency
EMERGENCY RESPONSE AND CONTINGENCY PLAN
Hazardous Materials Programs
FACILITY IDENTIFICATION:
V. EMPLOYEE TRAINING PROGRAM
HM#
Training Plan
Training Requirements: Training is required for all employees handling hazardous materials or hazardous wastes as
part of routine job duties and day-to-day operations or who may be exposed in the event of a spill or emergency release.
Training Subject Areas: Training subject areas vary according to the assigned duties of the employees. Topics
includes the following::
All Personnel:
Chemical Handlers:
Special Assignments:
Hazard Communication/MSDSs
safety policies and procedures
notification procedures
evacuation /re-entry procedures
location/contents of emergency
response plans
spill reporting requirements
Injury and Illness Prevention
Program
personal protective clothing/
equipment issued -
safe handling of hazardous substances
fire hazards associated with materials
and processes
conditions likely to worsen in an
emergency
coordination of emergency response
proper use of chemical protective
clothing and equipment
use of emergency response equipment
communications and alarm systems
decontamination procedures
control and containment procedures
Other
UST monitoring equipment and procedures (if
applicable)
hazardous waste management procedures (if
applicable)
fire brigade/fire suppression
hazardous chemical spill clean-up and large spill
clean-up
CPR/First Aid
Hearing Conservation
Respiratory Protection
Welding and Cutting
Forklift Safety
Ladder Safety
Spill Prevention, Control and Countermeasures
(SPCC) Plan requirements
Other
Other
Formats
TRAINING TOPICS
are listed under each
format or as follows:
Classroom
Study guides
Safety/tail-gate meetings
Videos
Manuals
OTHER:
Frequency
Employee training is
provided as indicated
by .
prior to any work with or around hazardous materials or hazardous wastes
as necessary prior to change in process or work assignment
upon modification to emergency response/ contingency plan
periodically to maintain awareness, competency and performance standard (i.e. Do employees know the
hazards of the materials they work with and how to work safely? What PPE to use and when?)
annually as required by HAZWOPER, HazWaste, and
Training frequency is, at a minimum, as described above.
Training frequency is, at a minimum, as follows:
Documentation
Training records are
kept for a minimum of
3 years.
Written records of employee training include:
Date and hours of training
Employee name
Brief job description (for hazardous waste workers)
Job Title
Training outline, agenda, or list of topics covered
Trainers name and qualifications
OTHER:
Employee training is provided, at a minimum, as described above.
A separate written Employee Training Plan is attached.
Employee training records are maintained in the following location _
_
Employee training records are maintained in the following manner:_
CUPA04
_
Page 5 of 6
Yuba County
Certified Unified Program Agency
FACILITY IDENTIFICATION:
VI. RECORDKEEPING REQUIREMENTS
EMERGENCY RESPONSE AND CONTINGENCY PLAN
Hazardous Materials Programs
HM#
The following records are maintained at this facility: ( * Required, if applicable)
Current employees training records to be retained until closure of this facility.*
Former employees training records to be retained at least 3 years after termination of employment.*
Training program (written description of initial and continuing training).*
Current copy of the Hazardous Materials Emergency Response and Contingency Plan.*
Record of hazardous materials/waste releases in Facility Log.*
Monitoring and daily/weekly/monthly visual inspection records.*
Documentation and description of facility emergency response drills.
Uniform Hazardous Waste (HW) Manifests are kept for minimum of 3 years after shipment.*
Record of all HW disposals, including manifests, recycling receipts, bills of lading are kept a minimum of 3 years.*
Record of all UST alarm logs and responses are kept for 3 years.*
Record of all AGT inspections and removals from secondary containment are kept for 3 years.*
Other: specify
VII. SIGNATURE AND CERTIFICATION
I certify under penalty of perjury of law that I have personally examined and am familiar with the
information submitted and believe the information is true, accurate, and complete to the best of my
knowledge, and that a copy of this plan is available on-site.
Signature
Date of completion
Print Name
Title/Position
VIII. LIST OF ATTATCHMENTS:
The following documents are attached to this plan.
Site/facility map
Evacuation Plan
CUPA04
Training plan
Inspection forms
UST Monitoring Plan
Other:
Aboveground Tank Storage Statement
SPCC
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