HMD Forms

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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.


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 Application Form (English) HMF-1000 (Replaces old CERS Access Form)                                                  CERS Application Form (Spanish) HMF-1000  NEW!
          Corrective Action Form to Document Return to Compliance HM-926
          Hazardous Materials Questionnaire  (Please utilize the Online Hazardous Materials                                          Questionnaire during this time)
          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)
          Disclosure of Hazardous Materials Information Bulletin HM-9243
          (HM-9243 includes Carcinogen & Reproductive Toxin Report and Highly Toxic Gases)
          Remote Site Notification Form HM-9283
Complete form and upload in CERS in the Emergency Response and Training Plans sections:
          Consolidated Emergency Response/Contingency Plan

More information about the Hazardous Materials Business 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) Registration/ Work Plan HM-9240

For more information, go to the HMD’s CalARP Program page. For CalARP-related guidance documents, go to the HMD’s Publications and Guidance Documents page. 

 Hazardous Waste Forms
Non-RCRA and/or RCRA-Exempt Hazardous Waste Storage Extension Notification Form -  Due to Covid-19 emergency, HMD is temporarily accepting electronic submittals of this notification in addition to your certified mail (with return receipt) request.
          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
          Hazardous Waste Tank Closure Notification
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 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
          - Conditionally Authorized
          - Conditionally Exempt - Limited
          - Conditionally Exempt - Small Quantity Treatment
          - Conditionally Exempt - Specified Waste Streams
          - Permit By Rule
          Certification of Financial Assurance
          Plot Plan/Map
          Prior Enforcement History
          Tank and Container Certification
          Local Agency Notification
          Property Owner Notification
          Estimate of Closure Costs 
          Financial Assurance Closure Mechanism
Complete and maintain on site (do not submit in CERS)
          Waste Analysis Plan
          Closure Plan
          Phase 1 Assessment

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
          Statement of Understanding and Compliance (NEW)
          Designated Underground Storage Operator Identification Form (NEW)
Complete form and send to HMD (mail, email or fax):
          Spill Bucket Testing Report Form (UPDATED) 
          Overfill Prevention Equipment Inspection report Form (NEW) 
          Tank Integrity Test Report HM-965  
          UST Claim of Exemption Form HM-978  
          Temporary Closure of UST - Procedures & Application HM-9119  
          Unauthorized Release Forms and Instructions (UST Leak Reporting Form)
          UST Monitoring System Certification (UPDATED)
          UST Secondary Containment Testing Certification (UPDATED)
          Affirmative Statement of UST Compatibility
          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 Visual Inspection Form (NEW) 
          Facility Employee Certificate (NEW) 

More information about the UST Program
 Underground Storage Tank Plan Check Application Forms
Complete in CERS in the Underground Storage Tanks section:
          UST Certificate of Installation / Modification
Complete form and send to HMD via email to
          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

          Special Projects Assistance Program - Application HM-9170
          UST Compatibility with Hazardous Substance for New Installations HMF-2020


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


 Aboveground Petroleum Storage Act Forms

Complete and implement the appropriate form:
           Tier I Facility Spill Prevention Control and Countermeasure (SPCC) Plan
           Tier II Facility Spill Prevention Control and Countermeasure (SPCC) Plan
           Certification of the Applicability of the Substantial Harm Criteria (Required at all APSA facilities)

For guidance on selecting the correct SPCC Plan for your facility and for more information about APSA, please visit our  Aboveground Petroleum Storage Program  page.

Submit a completed Tank Facility Statement to the Aboveground Petroleum Storage Act Documentation link in the APSA section in CERS:

           Tank Facility Statement (APSA) 
           (This form is optional if you have a Certified Hazardous Materials Business Plan in CERS)

APSA Checklists          

STI SP001 AST Record
STI SP001 Monthly AST Inspection Checklist
STI SP001 Annual AST Inspection Checklist
Monthly Visual (OSFM) Inspection Checklist for TIUGAs at Facilities with Less than 1,320 gallons
Sample Monthly Aboveground Tank/Container Inspection Form

Monthly Checklist for TIUGA Facility with Less than 1,320 Gallons of Petroleum ( Word | PDF )

 Medical Waste Forms
Complete form and upload in CERS in the Hazardous Materials Inventory section under
Locally-Required Documentation:
          Medical Waste Management Plan HMF-8005 
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  
          Limited Quantity Hauling Exemption -Effective January 1, 2015, This form is no longer required. If you are a small or large quantity generator of medical waste, visit the CDPH Medical Waste Generators website for additional information.

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