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(3) timely notification of the affected public, including release of messages prepared pursuant to subsections (c) and (d) of this section;
(4) properties of hazardous materials, such as quantity, concentration, vapor pressure, density, and potential health effects;
(5) possible release scenarios;
(6) facility characteristics, topography, meteorology, and demography of potentially affected areas;
(7) ingress and egress routes and alternatives;
(8) location of medical resources trained and equipped for hazardous material response;
(9) mass-care facilities, reception areas, and sheltering; and
(10) procedures for post-emergency period population recovery.
(New section filed 7-30-86, operative 8-29-86; Register 86, No. 31).
Note: Authority cited: Sections 25503 and 25517.5, Health and Safety Code. Reference: Section 25503, Health and Safety Code.
s 2727. Supplies and Equipment.
(a) Area plans shall contain a listing and description of available emergency response supplies and equipment specifically designated for the potential emergencies presented by the hazardous materials which are handled within the jurisdiction of the administering agency. This information shall be presented to reflect response capability.
(b) Area plans shall outline the provisions for regular testing, if applicable, and proper maintenance of emergency response equipment under the direct control of the county or city, as the case may be.
Note: Authority cited: Section 25503, Health and Safety Code. Reference: Section 25503, Health and Safety Code.
s 2728. Incident Critique and Follow-Up.
Area plans shall describe provisions for the critique and follow-up of major incidents of a release or threatened release of hazardous material. The critique shall include an interagency meeting to evaluate the response, to improve future response, and to determine if any area plan revisions are required.
Note: Authority cited: Section 25503, Health and Safety Code. Reference: Section 25503, Health and Safety Code.
The provisions of this subchapter are intended to be implemented in
coordination with existing local hazardous materials planning efforts.
s 2729. Purpose.
(a) This article provides minimum standards for the hazardous materials business plan. A hazardous materials business plan includes the following:
(1) Hazardous material inventory in accordance with Section 2729.2-2729.7;
(2) Emergency response plans and procedures in accordance with Section 2731; and
(3) Training program information in accordance with Section 2732.
Note: Authority cited: Section 25503, Health and Safety Code. Reference: Section 25504, Health and Safety Code.
s 2729.1. Business Plan General Requirements.
(a) A business that handles a hazardous material or a mixture containing a hazardous material shall establish and implement a business plan if the hazardous material is handled in quantities:
(1) equal to or greater than 500 pounds, 55 gallons, or 200 cubic feet of gas (gas calculated at standard temperature and pressure), or
(2) equal to or greater than the applicable federal threshold planning quantity (TPQ) for an extremely hazardous substance (EHS) listed in Appendix A, Part 355, Title 40, of the Code of Federal Regulations.
(3) radioactive materials that are handled in quantities for which an emergency plan is required to be adopted pursuant to Part 30 (commencing with Section 30.1), Part 40 (commencing with Section 40.1), or Part 70 (commencing with Section 70.1), of Chapter 10 of Title 10 of the Code of Federal Regulations (54 Federal Register 14051), or pursuant to any regulations adopted by the state in accordance with those regulations.
(b) If a business handles a hazardous material pursuant to (a)(2) above, the business is subject to the Federal Emergency Planning and Community Right-to-Know Act (EPCRA) and shall also comply with Section 2729.6 of this article.
Note: Authority cited: Sections 25503, Health and Safety Code. Reference: Sections 25503.5(a) and 25503.8(a), Health and Safety Code.
s 2729.2. Hazardous Materials Inventory Reporting Requirements.
(a) A business subject to the requirements of Section 2729.1 shall complete and submit to the Certified Unified Program Agency (CUPA) or Administering Agency (AA) the following to satisfy the inventory reporting requirement:
(1) The Business Activities page of the Unified Program Consolidated Form as required by California Code of Regulations (CCR) Title 27, Section 15600(a); and Business Owner/Operator Identification page (Appendix A, OES Form 2730 (1/99)); and
(2) The Hazardous Materials-Chemical Description Page (Appendix A, OES Form 2731 (1/99)); and
(3) An Annotated Site Map if required by the CUPA or AA. An optional Annotated Site Map (Appendix A, OES Form 732 (map)(04/96)) is provided. CUPA's or AA's may modify the optional Annotated Site Map.
(b) Forms described in (a) of this section and their completion instructions are in Appendices A and B of this article.
(c) Hazardous materials considered to be trade secrets shall be clearly marked as such on the Chemical Description Page and are bound by Health and Safety Code, Section 25511.
(d) Businesses shall report mixtures that are hazardous materials by their common name (the common name or trade name of the mixture as a whole). Hazardous components in the mixture shall be identified by chemical name, percent weight, and Chemical Abstract Service (CAS) numbers (refer to Material Safety Data Sheet (MSDS) or, in case of trade secrets, refer to manufacturer).
(e) Public availability of the hazardous materials inventory required by this section is subject to Section 25506(a) of the Health and Safety Code.
Note: Authority cited: Sections 25503, 25503.1, 25503.3 and 25503.9, Health and Safety Code. Reference: Sections 25503.3, 25503.9, 25504, 25505(d), 25509, 25511 and 25533(b), Health and Safety Code.
s 2729.3. Alternative Hazardous Materials Inventory Requirements.
(a) A CUPA or AA may create alternative versions of the hazardous materials inventory forms for local purposes.
(b) Alternative versions shall:
(1) Be developed in consultation with all agencies within the CUPA's or AA's jurisdiction that are responsible for fire protection, emergency response and environmental health; and
(2) Meet the requirements of 27 CCR, Section 15400.3(c).
(c) The CUPA or AA shall accept the inventory as shown in the appendices from any regulated business that chooses to use it, even if the CUPA or AA adopts one or more alternative versions.
Note: Authority cited: Section 25503, Health and Safety Code. Reference: Sections 25404(b), (c), (d) and (e), 25404.6(c) and 25503.3, Health and Safety Code.
s 2729.4. Hazardous Materials Inventory Submittal.
(a) A business shall submit a hazardous materials inventory to the appropriate CUPA or AA and local fire agency.
(b) The hazardous materials inventory shall be submitted annually on or before March 1.
(c) Businesses may choose to submit an inventory utilizing the forms specified in Section 2729.2 of this article or an alternate version developed by the CUPA or AA for their jurisdiction.
(d) Businesses shall submit an amendment to the inventory within 30 days of the following events:
(1) A 100 percent or more increase in the quantity of a previously disclosed material.
(2) Any handling of a previously undisclosed hazardous material subject to the inventory requirements of this chapter.
(3) Change of business address.
(4) Change of business ownership.
(5) Change of business name.
Note: Authority cited: Sections 25503, Health and Safety Code. Reference: Sections 25505(a) and (d) and 25510 Health and Safety Code.
s 2729.5. Hazardous Material Inventory Submission Options.
(a) If no change in an inventory has occurred, a business subject to the hazardous materials reporting requirements may comply with the annual inventory reporting requirements of Section 2729.4 by submitting a certification statement to the CUPA or AA if all the following apply:
(1) The business has previously filed the hazardous materials inventory pursuant to Section 2729.2 and 2729.3 requirements.
(2) The business owner or officially designated representative signs and attests to these statements:
(A) The information contained in the hazardous materials inventory most recently submitted to the CUPA or AA is complete, accurate, and up to date.
(B) There has been no change in the quantity of hazardous materials reported in the most recently submitted inventory.
(C) No hazardous materials subject to inventory requirements are being handled that are not listed on the most recently submitted inventory.
(3) The business is not utilizing the submission of this certification to meet the annual inventory submission requirements of EPCRA (Section 11022 of Title 42, United States Code).
(b) If a change in the hazardous materials inventory has occurred, a business subject to the hazardous materials reporting requirements may comply with the annual inventory reporting requirements by submitting the following:
(1) Signed Business Owner/Operator page for the current reporting year.
(2) Updated Chemical Description pages showing additions, deletions, or revisions to previously submitted hazardous materials inventory.
(c) Notwithstanding Section 2729.5 (a) and (b) facilities subject to EPCRA must, annually submit the following, whether a change has occurred or not:
(1) Business Activities page of the Unified Program Consolidated Form.
(2) Signed Business Owner/Operator page for the current reporting year.
(3) Chemical Description page for each federally listed Extremely Hazardous Substance (EHS) handled in quantities equal to or greater than applicable Federal Threshold Planning Quantities or 500 pounds, whichever is less.
s 2729.6. Emergency Planning and Community Right to Know Act Compliance Requirements.
(a) Submittal of the inventory required in 2729.2 shall meet EPCRA if the following additional requirements are met.
(1) Business Activities page of the Unified Program Consolidated Form.
(2) All businesses which are subject to EPCRA and wish to claim trade secrecy must comply with the requirements of Code of Federal Regulations (CFR) Title 40 Part 350 and submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to the United States Environmental Protection Agency (USEPA).
(3) If the hazardous material being reported is an EHS as identified in 40 CFR Part 355, Appendix A, the Chemical Description page, for that material, must contain an original signature, a photocopy of the original signature, or a signature stamp. This signature may be placed in the box for locally collected information.
Note: Authority cited: Sections 25503, 25503.8, 25509(d) and (e), Health and Safety Code. Reference: Section 25506, Health and Safety Code.
s 2729.7. Uniform Fire Code Compliance Requirements.
(a) The requirement of Section 25503.9 of the Health and Safety Code to obligate administering agencies to require businesses to submit an addendum with the inventory of hazardous materials when complying with Sections 13143.9(b) and (c) and Section 25509(b) of the Health and Safety Code shall be met by complying with the requirements of Section 2729.2.
(1) If the local fire chief requires submittal of a Hazardous Materials Inventory Statement (HMIS) as stated in the Uniform Fire Code Section 80.103 subdivision (c) (1991), then the fire code hazard classes shall be identified on the chemical description page.
(2) The hazardous material inventory specified in section 2729.2 shall be submitted in lieu of an HMIS.
Note: Authority cited: Sections 25503, 25503.9, 25509(b), and 25509.2(a), (b), and (c), Health and Safety Code. Reference: Sections 25509(b), and 25509.2(d) and (e), Health and Safety Code
Appendix A
Article 4 -Minimum Standards for Business Plans Hazardous Materials Inventory - Forms
I. Unified Program Consolidated Form-Business Activities Page
II. Business Owner/Operator Identification Page
III. Hazardous Materials -Chemical Description Page
IV. Annotated Site Map
Appendix B
Article 4 -Minimum Standards for Business Plans Hazardous Materials Inventory - Instructions
I. Unified Program Consolidated Form -Business Activities
II. Business Owner/Operator Identification
III. Hazardous Materials -Chemical Description
IV. Annotated Site Map
I. The Unified Program Consolidated Form -Activities Instructions
Please submit the Business Activity page, the Business Owner/Operator Identification page, and the Chemical Description page for all hazardous materials inventory submissions. (Note: the numbering of the instructions follows the data element numbers that are on the form pages. These data element numbers are used for electronic submission and is the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.)
Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated.
ID ELEMENT INFORMATION DESCRIPTION
1. Facility ID Leave this blank. This number is assigned by the Certified
Number Unified Program Agency (CUPA)
or Administering Agency (AA). This is the unique number
which identifies your facility.
2. EPA ID Number If you generate, recycle, or treat hazardous waste, enter
your facility's 12-character U.S.
Environmental Protection Agency (U.S. EPA) or California
Identification number. For
facilities in California, the number usually starts with the
letters "CA". If you do not have a
number, contact the Department of Toxic Substances Control
(DTSC), Telephone
Information Center at (916) 324-1781, (800) 61-TOXIC or
(800) 61-86942, to obtain one.
3. Business Name Enter the full legal name of the business. This is the same
as the terms "Facility Name" or
"DBA-Doing Business As" that might have been used in the
past.
4. Hazardous Check the appropriate box to indicate whether you have a
Materials hazardous material onsite. You have
Onsite
a hazardous material onsite if:
•It is handled in quantities equal to or greater than 500
pounds, 55 gallons, or 200 cubic feet of gas (calculated
at standard temperature and pressure),
•It is handled in quantities equal to or greater than the
applicable federal threshold planning quantity for an
extremely hazardous substance listed in 40 CFR Part 355,
Appendix A,
•Radioactive materials are handled in quantities for which
an emergency plan is required to be adopted pursuant to
Part 30, Part 40, or Part 70 of Chapter 10 of 10 CFR, or
pursuant to any regulations adopted by the state in
accordance with these regulations.
If you have a hazardous material onsite, then you must
complete the Business Owner/Operator Identification (OES
Form 2730) and the Hazardous Materials Inventory-Chemical
Description page (OES Form 2731), as well as an Emergency
Response Plan and Training Plan.
Do not answer "YES" to this question if you exceed only a
local threshold, but do not exceed the state threshold.
5. Own or Operate Check the appropriate box to indicate whether you own or
Underground operate USTs containing hazardous
Storage Tank substances (HS) as defined in Health and Safety Code (HSC)
(UST) s25316. If "YES", then you must
complete one UST Facility page (formerly State Water
Resources Control Board (SWRCB)
Form A) and UST Tank pages (formerly SWRCB Form B) for each
tank.
6. Check the appropriate box to indicate whether you intend to
Upgrade/Install install or upgrade UST's containing hazardous substances
UST as defined in HSC s25316. If "YES", then you must complete
the UST Installation-Certificate of Compliance page
(formerly SWRCB Form C) in addition to UST Facility and
Tank pages.
7. UST Closure Check the appropriate box if you are closing an UST and
complete the closure portion of the UST Tank pages
(formerly SWRCB Form B) for each tank. (CUPAs may require
additional information.)
8. Own or Operate Check the appropriate box to indicate whether there are
Aboveground AST's onsite which exceed the
Petroleum regulatory thresholds. (There is no state AST form.)
Storage Tank
(AST)
This program applies to all facilities storing petroleum in
aboveground tanks. Petroleum means crude oil, or any
fraction thereof, which is liquid at 60 degrees Fahrenheit
temperature and 14.7 pounds per square inch absolute
pressure (HSC s25270.2(g)). The facility must have a
single tank greater than 660 gallons, or cumulative
storage capacity greater than 1,320 gallons for all AST's.
NOT Subject to the Act (exemptions):
An aboveground petroleum storage tank (AST) facility with
one or more of the following (see HSC s25270.2(k)) is not
subject to this act and is exempt:
•A pressure vessel or boiler which is subject to Division 5
of the Labor Code.
•A storage tank containing hazardous waste if a hazardous
waste facility permit has been issued for the storage tank
by the Department of Toxic Substances Control.
•An aboveground oil production tank which is regulated by
the Division of Oil and Gas.
•Certain oil-filled electrical equipment including but not
limited to, transformers, circuit breakers, or capacitors.
9. Hazardous Check the appropriate box to indicate whether your facility
Waste Generator generates hazardous waste (HW). A generator is the person
or business whose acts or processes produce a HW or who
causes a hazardous substance or waste to become subject to
state HW law. If your facility generates HW, you must
obtain and use an EPA Identification number (ID) in order
to properly transport and dispose of it. Report your EPA
ID number in #2.
Hazardous waste means a waste that meets any of the criteria
for the identification of a hazardous waste adopted by
DTSC pursuant to HSC s 25141. "Hazardous waste" includes,
but is not limited to, federally regulated hazardous
waste. Federal hazardous waste law is known as the
Resource Conservation and Recovery Act (RCRA) Unless
explicitly stated otherwise, the term "hazardous waste"
also includes extremely hazardous waste and acutely
hazardous waste.
10. Recycle Check the appropriate box to indicate whether your facility
recycles more than 100 kilograms per month of recyclable
material under a claim that the material is excluded or
exempt per HSC s 25143.2. Check "YES" and complete the
Recyclable Materials Report pages, if you either recycled
onsite or recycled excluded recyclable materials which
were generated offsite. Check "NO" if you only send
recyclable materials to an offsite recycler. You do not
need to report.
11. Onsite Check the appropriate box to indicate whether your facility
Hazardous Waste engages in onsite treatment of
Treatment hazardous waste. "Treatment" means any method, technique, or
process which is designed to change the physical,
chemical, or biological character or composition of any
hazardous waste or any material contained therein, or
removes or reduces its harmful properties or
characteristics for any purpose. "Treatment" does not
include the removal of residues from manufacturing process
equipment for the purposes of cleaning that equipment.
Amendments (effective 1/1/99) add exemptions from the
definition of "treatment" for certain processes under
specific, limited conditions. Refer to HSC section
25123.5(b) for these specific exemptions.
Treatment of certain laboratory hazardous wastes do not
require authorization. Refer to HSC section 25200.3.1 for
specific information.
Please contact your CUPA to determine if any exemptions
apply to your facility. Triggers requirement for onsite
hazardous waste treatment data elements.
If your facility engages in onsite treatment of hazardous
waste then complete the Onsite Hazardous Waste Treatment
Notification-Facility page (formerly DTSC Form 1772) and
one set of Onsite Hazardous Waste Treatment
Notification-Unit pages (formerly DTSC Forms 1772A, B, C,
D, E, and L) with waste and treatment process information
for each unit.
12. Financial Check the appropriate box to indicate whether your facility
Assurance is subject to Financial Assurance requirements for closure
of an onsite treatment unit. Unless they are exempt,
Permit by Rule (PBR) and Conditionally Authorized (CA)
operations are required to provide financial assurance for
closure costs (per 22 CCR s67450.13(b) and HSC s25245.4).
If your facility is subject to Financial Assurance
requirements or claiming an exemption, then complete the
Certification of Financial Assurance page (formerly DTSC
Form 1232).
13. Remote Waste Check the appropriate box to indicate whether your facility
Consolidation consolidates hazardous waste generated at a remote site.
Site
Answer "YES" if you are a hazardous waste generator that
collects hazardous waste initially at remote site and
subsequently transports the hazardous waste to a
consolidation site you also operate. You must be eligible
pursuant to the conditions in HSC s25110.10.
If your facility consolidates hazardous waste generated at a
remote site, then complete the Remote Waste Consolidation
Site Annual Notification page (formerly DTSC Form 1196).
14. Hazardous Check the appropriate box to indicate whether the tank being
Waste Tank closed would be classified as hazardous waste after its
Closure contents are removed. Classification could be based on:
•Your knowledge of the tank and its contents
•Testing of the tank
•Inability to remove hazardous materials stored in the tank
•The mixture rule
•The listed wastes in 40 CFR 261.31 or 40 CFR 261.32
If the tank being closed would be classified as hazardous
waste after its contents are removed, then you must
complete the Hazardous Waste Tank Closure Certification
page (formerly DTSC Form 1249).
15. Local Some CUPA's or AA's may require additional information.
Requirements Check with your CUPA before submitting the UPCF to
determine if any supplemental information is required.
II. Business Owner/Operator Identification -Instructions
Please submit the Business Owner/Operator Identification page, the Business Activity page, and the Chemical Description page for all hazardous materials inventory submissions. For the inventory to be considered complete this page must be signed by the appropriate individual. (Note: the numbering of the instructions follows the data element numbers that are on the form pages. These data element numbers are used for electronic submission and is the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.)
Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated.
ID ELEMENT INFORMATION DESCRIPTION
1. Facility ID Number This number is assigned by the Certified Unified
Program Agency (CUPA) or Administering Agency (AA).
This is the unique number which identifies your
facility.
3. Business Name Enter the full legal name of the business. This is the
same as the terms "Facility Name" or
"DBA-Doing Business As" that might have been used in
the past.
100. Beginning Date Enter the beginning year and date of the report.
(YYYYMMDD)
101. Ending Date Enter the ending year and date of the report.
(YYYYMMDD)
102. Business Phone Enter the phone number, area code first, and any
extension.
103. Business Site Enter the street address where the facility is located.
Address No post office box numbers are allowed.
This information must provide a means to geographically
locate the facility.
104. City Enter the city or unincorporated area in which business
site is located.
105. Zip Code Enter the zip code of business site. The extra 4 digit
zip may also be added.
106. Dun & Bradstreet Enter the Dun & Bradstreet number for the facility. The
Dun & Bradstreet number may be
obtained by calling (610) 882-7748 or by Internet.(610)
882-7748 or by Internet.
107. SIC Code Enter the primary Standard Industrial Classification
Code number for primary business
activity. NOTE : If code is more than 4 digits, report
only the first four.
108. County Enter the county in which the business site is located.
109. Business Operator Enter the name of the business operator.
Name
110. Business Operator Enter business operator phone number, if different from
Phone business phone (area code first) and
any extension.
111. Owner Name Enter name of business owner, if different from
business operator.
112. Owner Phone Enter the business owner's phone number if different
from business phone (area code first)
and any extension.
113. Owner Mailing Enter the owner's mailing address if different from
Address business site address.
114. Owner City Enter the name of the city for the owner's mailing
address.
115. Owner State Enter the 2 character state abbreviation for the
owner's mailing address.
116. Owner Zip Code Enter the zip code for the owner's address. The extra 4
digit zip may also be added.
117. Environmental Enter the name of the person, if different from the
Contact Name Business Owner or Operator, who receives all
environmental correspondence and will respond to
enforcement activity.
118. Contact Phone Enter the phone number, if different from Owner or
perator, at which the environmental contact can be
contacted, area code first, and any extension.
119. Mailing Address Enter the mailing address where all environmental
contact correspondence should be sent, if different
from the site address.
120. City Enter the name of the city for the environmental
contact's mailing address.
121. State Enter the 2 character state abbreviation for the
environmental contact's mailing address.
122. Zip Code Enter the zip code for the environmental contact's
mailing address. The extra 4 digit zip may also be
added.
123. Primary Emergency Enter the name of a representative that can be
Contact Name contacted in case of an emergency involving hazardous
materials at the business site. The contact shall
have FULL facility access, site familiarity, and
authority to make decisions for the business
regarding incident mitigation.
124. Title Enter the title of the primary emergency contact.
125. Business Phone Enter the business number for the primary emergency
contact (area code first) and any extensions.
126. 24-Hour Phone Enter a 24-hour phone number for the primary emergency
contact. The 24-hour phone number must be one which
is answered 24 hours a day. If it is not the
contact's home phone number, then the service
answering the phone must be able to immediately
contact the individual, stated above.
127. Pager Number Enter the pager number for the primary emergency
contact, if available.
128. Secondary Enter the name of a secondary representative that can
Emergency Contact be contacted in the event that the primary
Name emergency contact is not available. The contact shall
have FULL facility access, site familiarity, and
authority to make decisions for the business
regarding incident mitigation.
129. Title Enter the title of the secondary emergency contact.
130. Business Phone Enter the business telephone number for the secondary
emergency contact (area code first) and any
extension.
131. 24-Hour Phone Enter a 24-hour phone number for the secondary
emergency contact. The 24 hour phone number must be
one which is answered 24 hours a day. If it is not
the contact's home phone number, then the service
answering the phone must be able to immediately
contact the individual stated above.
132. Pager Number Enter the pager number for the secondary emergency
contact, if available.
133. Additional This space may be used for CUPA's or AA's to collect
Locally Collected any additional information necessary
Information to meet the requirements of their individual programs.
Contact your local agency for guidance.
134. Date Enter the date that the form was signed. (YYYYMMDD)
135. Name Document Enter the full name of the person who prepared the
Preparer inventory submittal information.
136. Name of Signer Enter the full printed name of the person signing the
form. The signer certifies to a familiarity with the
information submitted and that based on their inquiry
of those individuals responsible for obtaining the
information, all the information submitted is true,
accurate and complete.
Signature of The Business Owner/Operator, or officially designated
representative of the Owner/Operator,
Owner/Operator shall sig n in the space privided. This signature
or certifies that the signer is familiar with the
Designated information submitted and that based on their inquiry
Representative of those individuals responsible for obtaining the
information it is the signer's belief that the
submitted information is true, accurate and complete.
137. Title of Signer Enter the title of the person signing the form.
III. Hazardous Materials Inventory -Chemical Description Instructions
You must complete a separate Chemical Description page for each hazardous material (hazardous substances and hazardous waste) that you handle at your facility in aggregate quantities equal to or greater than 500 pounds, 55 gallons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the federal threshold planning quality for Extremely Hazardous Substances, whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantities of hazardous materials at your facility, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state, storage temperature and storage pressure. (Note: the numbering of the instructions follows the data element numbers that are on the form pages. These data element numbers are used for electronic submission and is the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.)
Please number all pages of your submittal. This helps your Certified Unified Program Agency (CUPA) or Administering Agency (AA) identify whether the submittal is complete and if any pages are separated.
ID ELEMENT INFORMATION DESCRIPTION
1. Facility ID Number The number is assigned by the CUPA or AA. This is
the unique number which identifies your facility.
3. Business Name Enter the full legal name of the business as entered
on the Business Owner/Operator identification
page.
200. Add/Delete/Revise Indicate if the material is being added to the
inventory, deleted from the inventory, or if the
information previously submitted is being revised.
NOTE : You may choose to leave this blank if you
resubmit your entire inventory annually.
201. Chemical Location Enter the building or outside/adjacent area where
the hazardous material is handled. A chemical that
is stored at the same pressure and temperature, in
multiple locations within a building, can be
reported on a single page. NOTE: This information
is not subject to public disclosure pursuant to
Section 25506 of the Health and Safety Code.
202. Chemical Location All businesses which are subject to the Emergency
Planning and Community Right to Know
Confidential-EPCRA Act (EPRCA) must check "Y" to keep chemical location
information confidential. If the business does not
wish to keep chemical location information
confidential check "N".
203. Map Number If a map is included, enter the number of the map on
which the location of the hazardous material is
shown.
204. Grid Number If grid coordinates are used, enter the grid
coordinates of the map that correspond to the
location of the hazardous material. If applicable,
multiple grid coordinates can be listed.
205. Chemical Name Enter the proper chemical name associated to the
Chemical Abstract Service (CAS) number of the
hazardous material. This should be the
International Union of Pure and Applied Chemistry
(IUPAC) name found on the Material Safety Data
Sheet (MSDS). NOTE: If the chemical is a mixture,
do not complete this field; complete the "common
name" field instead.
206. Trade Secret Check "Y" for yes if the information in this section
is declared a trade secret, or "N" for no, if it
is not.
State requirement: If yes, and business is not
subject to EPCRA, disclosure of the designated
trade secret information is bound by Health and
Safety Code. Section 25511.
Federal Requirement: If yes, and business is subject
to EPCRA, disclosure of the designated Trade
Secret information is bound by Title 40 Code of
Federal Regulations (CFR) and the business must
submit a "Substantiation to Accompany Claims of
Trade Secrecy" form (40 CFR 350.27) to USEPA.
207. Common Name Enter the common name or trade name of the hazardous
material or mixture containing a hazardous
material.
208. EHS Check "Y" for yes if the hazardous material is an
Extremely Hazardous Substance (EHS), as defined in
40 CFR, Part 355, Appendix A. If the material is a
mixture containing an EHS, leave this section
blank and complete the section on hazardous
components below.
209. CAS # Enter the Chemical Abstract Service (CAS) number for
the hazardous material. For mixtures, enter the
CAS number of the mixture if it has been assigned
a number distinct from its components. If the
mixture has no CAS number, leave this column blank
and report the CAS numbers of the individual
hazardous components in the appropriate section
below.
210. Fire Code Fire Code Hazard Classes describe to first
responders the type and level of hazardous
Hazard Classes materials which a business handles. This information
shall only be provided if the local fire chief
deems it necessary and requests the CUPA or AA to
collect it. A list of the hazard classes and
instructions on how to determine which class a
material falls under are included in the
appendices of Article 80 of the Uniform Fire Code.
If a material has more than one applicable hazard
class, include all. Contact the CUPA or AA for
guidance.
211. Hazardous Material Check the one box that best describes the type of
Type hazardous material: pure, mixture or waste. If
waste material, check only that box. If mixture or
waste, complete hazardous components section.
212. Radioactive Check "Y" for yes if the hazardous material is
radioactive or "N" for no, if it is not.
213. Curies If the hazardous material is radioactive, use this
area to report the activity in curies. You may use
up to nine digits with a floating decimal point to
report activity in curies.
214. Physical State Check the one box that best describes the state in
which the hazardous material is handled: solid,
liquid or gas.
215. Largest Container Enter the total capacity of the largest container in
which the material is stored.
216. Federal Hazard Check all categories that describe the physical and
Categories health hazards associated with the hazardous
material.
PHYSICAL HAZARDS
Fire: Flammable Liquids and Solids, Combustible
Liquids, Pyrophorics, Oxidizers
Reactive: Unstable Reactive, Organic Peroxides,
Water Reactive, Radioactive
Pressure Release: Explosives, Compressed Gases,
Blasting Agents
HEALTH HAZARDS
Acute Health (Immediate): Highly Toxic, Toxic,
Irritants, Sensitizers, Corrosives, other
hazardous chemicals with an adverse effect with
short term exposure.
Chronic Health (Delayed):Carcinogens, other
hazardous chemicals with an adverse effect with
long term exposure.
217. Average Daily Amount Calculate the average daily amount of the hazardous
material or mixture containing a hazardous
material, in each building or adjacent/outside
area. Calculations shall be based on the previous
year's inventory of material reported on this
page. Total all daily amounts and divide by the
number of days the chemical will be on site. If
this is a material that has not previously been
present at this location, the amount shall be the
average daily amount you project to be on hand
during the course of the year. This amount should
be consistent with the units reported in box 221
and should not exceed that of maximum daily
amount.
218. Maximum Daily Amount Enter the maximum amount of each hazardous material
or mixture containing a hazardous material, which
is handled in a building or adjacent/outside area
at any one time over the course of the year. This
amount must contain at a minimum last year's
inventory of the material reported on this page,
with the reflection of additions, deletions, or
revisions projected for the current year. This
amount should be consistent with the units
reported in box 221.
219. Annual Waste Amount If the hazardous material being inventoried is a
waste, provide an estimate of the annual amount
handled.
220. State Waste Code If the hazardous material is a waste, enter the
appropriate California 3-digit hazardous waste
code as listed on the back of the Uniform
Hazardous Waste Manifest.
221. Units Check the unit of measure that is most appropriate
for the material being reported on this page:
gallons, pounds, cubic feet or tons. NOTE: If the
material is a federally defined Extremely
Hazardous Substance (EHS), all amounts must be
reported in pounds. If material is a mixture
containing an EHS, report the units that the
material is stored in (gallons, pounds, cubic
feet, or tons).
222. Days on Site List the total number of days during the year that
the material is on site.
223. Storage Container Check all boxes that describe the type of storage
containers in which the hazardous material is
stored. NOTE: If appropriate, you may choose more
than one.
224. Storage Pressure Check the one box that best describes the pressure
at which the hazardous material is stored.
225. Storage Temperature Check the box that best describes the temperature at
which the hazardous material is stored.
226, Hazardous Component Enter the percentage weight of the hazardous
1-5 component in a mixture. If a range of
230, (% by weight) percentages is available, report the highest
percentage in that range.
234,
238,
242
227, Hazardous Component When reporting a hazardous material that is a
1-5 mixture, list up to five chemical names of
231, Name hazardous components in a mixture by percent weight
(refer to MSDS or, in the case of trade
235, secrets, refer to manufacturer). All hazardous
components in the mixture present at greater
239, than 1% by weight if non-carcinogenic, or 0.1% by
weight if carcinogenic, should be reported.
243 IF more than five hazardous components are present
above these percentages, you may attach
an additional sheet of paper to capture the required
information. When reporting waste
mixtures, mineral and chemical composition should be
listed.
228, Hazardous Component Check "Y" for yes if the component of the mixture is (continued)