HMD Forms

doing_formsapps124
 

Starting January 1, 2013 all Certified Unified Program Agency (CUPA) regulated businesses are required by law (Assembly Bill 2286) to submit business information electronically through the California Environmental Reporting System (CERS). This includes information related to your:

Many of the forms previously available through the Hazardous Materials Division (HMD) are now required to be completed and/or uploaded in CERS. The form list is now organized by subject and submission requirement. Locate the form you need to complete and refer to the subheading for submittal directions.  

All forms required to be submitted to HMD should sent to:                                                                                       Hazardous Materials Division                                                                                                                                    P.O. Box 129261                                                                                                                                                          San Diego, CA 92131

Ask your Specialist for the best FAX number or e-mail address to use.If you do not know who your Specialist is, contact the HMD Duty Desk at (858) 505-6880. 


***PLEASE BE ADVISED***

A copy of all completed forms should be kept onsite for inspection review.

For more details on completing CERS, please refer to our CERS Information Page.

 

 General Business Forms for All Facilities
Complete in CERS in the Facility Information section:
          Business Activities
          Business Owner/Operator Identification (Certification Statement is included)
Complete form and send to HMD (mail, email or fax):
          CERS Access/I.D. Request Form HM-907
          Corrective Action Form to Document Return to Compliance HM-926
          Hazardous Materials Questionnaire HM-9171

          Tenant improvement and new business forms and information

 

 Hazardous Materials Forms including Business Plan
          Hazardous Materials Business Plan (HMBP) Instructions and Templates HM-952
Complete in CERS in the Hazardous Materials Inventory section
          Hazardous Materials Inventory - Chemical Description
Complete form and upload in CERS in the Hazardous Materials Inventory section:
          Sitemap Multi-page site maps should be uploaded as a single document (Microsoft Word Version)
          Remote Site Notification HM-9283
          Disclosure of Hazardous Materials Information Bulletin HM-9243
          (HM-9243 includes Carcinogen & Reproductive Toxin Report and Highly Toxic Gases)
Complete form and upload in CERS in the Emergency Response and Training Plans sections:

          Consolidated Emergency Response/Contingency Plan

 

 CalARP Forms
Complete form and send to HMD (mail, email or fax):
          CalARP Screening, Disclaimer and Deregistraion Guide HM-9220
          CalARP Screening, Disclaimer and Deregistration Form HM-9221
          How to Determine TQs & TPQs HM-9181
          CalARP Screening Worksheet HM-9223
          Risk Management Plan (RMP) Work Plan HM-9240

More information about the CalARP Program and Hazardous Materials Guidance Documents

 

 Hazardous Waste Forms
Complete in CERS in the Remote Waste Consolidation Site Annual Notification section:
          Remote Waste Consolidation Site Annual Notification Form HM-9714
Complete form and upload in CERS in the Hazardous Waste Tank Closure Certification section:
          Hazardous Waste Tank Closure Certificate
Complete form and upload in CERS in the Recyclable Materials Report Documentation section:
          Recyclable Materials Report
Complete form and send to HMD (mail, email or fax):
          Photographic Waste Only - Notification HM-9281
          Aerosol Can Processing - Notification HM-9284
          AST Certification & Engineering Assessment Exemption - Notification HM-9271
Complete form and keep onsite for inspection review:
          Hazardous Waste Container Weekly Inspection Log HM-9322
          Hazardous Waste Tank System Daily Inspection Log HM-9321

More information about Hazardous Waste and additional Hazardous Waste Guidance Documents

 

 Onsite Hazardous Waste Treatment - Tiered Permitting Forms
Complete in CERS in the Tiered Permitting section:
          Hazardous Waste Treatment Notification-Facility Page
          Hazardous Waste Treatment Notification-Unit Page
          Certification of Financial Assurance
          Conditionally Authorized
          Conditionally Exempt - Limited
          Conditionally Exempt - Small Quantity Treatment
          Conditionally Exempt - Specified Waste Streams
          Permit By Rule
          Plot Plan/Map
          Prior Enforcement History
          Tank and Container Certification
          Local Agency Notification
          Property Owner Notification
          Closure Plan
          Estimate of Closure Costs
          Financial Assurance Closure Mechanism
          Waste Analysis Plan

Additional Hazardous Waste Treatment Guidance Documents

 

 Underground Storage Tank (UST) Forms
Complete in CERS in the Underground Storage Tanks section:
          Operating Permit Application - Facility Information          
          Operating Permit Application -Tank Page          
          UST Monitoring System Plan
Complete form and upload in CERS in the Underground Storage Tanks section:
          UST Monitoring System Emergency Response Plan HM-9222B 
          UST Monitoring System Plot (Site) Plan HM-9222C  
          Certification of Financial Responsibility
          Sample Letter from the Chief Financial Officer
          Designation of UST Operator & Owner Statement
Complete form and send to HMD (mail, email or fax):
          Spill Bucket Testing Report Form HM-9010  
          Tank Integrity Test Report HM-965  
          Temporary Closure of UST - Procedures & Application HM-9119  
          Unauthorized Release Forms and Instructions (UST Leak Reporting Form)
          UST Monitoring System Certification HM-9301  
          UST Secondary Containment Testing Certification HM-9169 
          Affirmative Statement of UST Compatibility HM-9325
          UST Leak Detection Functionality HM-9326
Complete form and keep onsite for inspection review:
          Designated Operator Training Description and Documentation HM-9177  
          Designated UST Operator Monthly Visual Inspection Checklist HM-9175  

More information about the UST Program

 

 Underground Storage Tank Plan Check Application Forms
Complete form and upload in CERS in the Underground Storage Tanks section:
          UST Certificate of Installation / Modification HM-9716
Complete form and send to HMD (mail, email or fax):
          Part I General project information HM-9311
          Part II Construct a UST facility HM-9312
          Part III Close a UST system HM-9313
          Part IV Modify existing UST site HM-9314
          Part V Interior coating/lining/repair UST HM-9315
          Part VI Construct vaulted UST facility HM-9316
          Part VII Install a UST bladder HM-9317
          Special Projects Assistance Program - Application HM-9170

More information about the UST Plan Check Program and UST Lining Inspection Requirements

 

 Aboveground Petroleum Storage Act Forms
Complete form and upload in CERS in the Aboveground Petroleum Storage Act section:
          Tank Facility Statement (APSA) HM-9501
Complete form and keep onsite for inspection review:
           Tier I Facility Spill Prevention Control and Countermeasure (SPCC) Plan
           Tier II Facility Spill Prevention Control and Countermeasure (SPCC) Plan

More information about the Aboveground Petroleum Storage Program

 

 Medical Waste Forms
Complete form and upload in CERS in the Hazardous Materials Inventory section under
Locally-Required Documentation:
          Medical Waste Management Plan HM-9213  
Complete form and send to HMD (mail, email or fax):
          Application for Home-Generated Sharps Consolidation Point HM-9158 
          Application for Onsite Medical Waste Treatment Permit HM-9188  

More information about the Medical Waste Program and Medical Waste Guidance Documents