California Code of Regulations › Title 19 - Public Safety › Division 2 - California Governor's Office of Emergency Services › Chapter 4 - Hazardous Material Release Reporting, Inventory, and Response Plans › Article 2 - Reporting Requirements › Section 2632 - Written Reporting of Emergency Releases

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  If required to submit a written emergency release follow-up notice pursuant to
				  42 U.S.C. section
				  11004(c) (1989), or as that
				  section may be subsequently amended, a business shall prepare the written
				  emergency release follow-up notice using the form specified in subsection (c)
				  of this section.
(b) A written
				  emergency release follow-up notice prepared pursuant to subsection (a) shall be
				  sent to the Chemical Emergency Planning and Response Commission (CEPRC) at 3650
				  Schriever Avenue, Mather, CA 95655. This written report shall be sent as soon
				  as practicable following a release, but no later than 30 days from the date of
				  the release.
(c) The following
				  reporting form (with instructions), the 'Emergency Release Follow-up Notice
				  Reporting Form,' shall be used for filing the written emergency release
				  follow-up notice required by subsection (a) of this section. This form may be
				  reproduced, as needed.
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GENERAL INFORMATION:
Chapter 6.95 of Division 20 of the California Health and
					 Safety Code requires that written emergency release follow-up notices prepared
					 pursuant to 42 U.S.C. §
												11004, be submitted using this reporting
					 form. Non-permitted releases of reportable quantities of Extremely Hazardous
					 Substances (listed in 40 CFR
					 355, appendix A) or of chemicals that require
					 release reporting under section
					 103(a) of the
					 Comprehensive Environmental Response, Compensation, and Liability Act of 1980
					 [42 U.S.C. §
												9603(a)] must be reported on
					 the form, as soon as practicable, but no later than 30 days, following a
					 release. The written follow-up report is required in addition to the verbal
					 notification.
BASIC INSTRUCTIONS:
. The form, when filled out, reports follow-up information
					 required by 42 U.S.C §
												11004. Ensure that all information requested
					 by the form is provided as completely as possible.
. If the incident involves reportable releases of more than
					 one chemical, prepare one report form for each chemical released.
. If the incident involves a series of separate releases of
					 chemical(s) at different times, the releases should be reported on separate
					 reporting forms.
SPECIFIC INSTRUCTIONS:
Block A:
Enter the name of the business and
					 the name and phone number of a contact person who can provide detailed facility
					 information concerning the release.
Block B:
Enter the date of the incident and
					 the time that verbal notification was made to Cal EMA. The Cal EMA control
					 number is provided to the caller by Cal EMA at the time verbal notification is
					 made. Enter this control number in the space provided.
Block C:
Provide information pertaining to the
					 location where the release occurred. Include the street address, the city or
					 community, the county and the zip code.
Block D:
Provide information concerning the
					 specific chemical that was released. Include the chemical or trade name and the
					 Chemical Abstract Service (CAS) number. Check all categories that apply.
					 Provide best available information on quantity, time and duration of the
					 release.
Block E:
Indicate all actions taken to respond
					 to and contain the release as specified in
					 42 U.S.C. §
												11004(c).
Block F:
Check the categories that apply to
					 the health effects that occurred or could result from the release. Provide an
					 explanation or description of the effects in the space provided. Use Block H
					 for additional comments/information if necessary to meet requirements specified
					 in 42 U.S.C. §
												11004(c).
Block G:
Include information on the type of
					 medical attention required for exposure to the chemical released. Indicate when
					 and how this information was made available to individuals exposed and to
					 medical personnel, if appropriate for the incident, as specified in
					 42 U.S.C. §
												11004(c).
Block H:
List any additional pertinent
					 information.
Block I:
Print or type the name of the
					 facility representative submitting the report. Include the official signature
					 and the date that the form was prepared.
MAIL THE COMPLETED REPORT TO:
Chemical Emergency Planning and Response Commission
					 (CEPRC)
Local Emergency Planning Committee
					 (LEPC)
Attn: Section
					 304 Reports
3650 Schriever Avenue
Mather, CA 95655
1. Change
					 without regulatory effect renumbering section
					 2705 to new section
					 2632 filed 5-11-2016 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 2016, No. 20).
Note: Authority cited: Section
						8585,
						Government Code; and Sections
						25503,
						25503.1
						and
						25507.1,
						Health and Safety Code. Reference: Section
						8585,
						Government Code; and Sections
						25503(b)(4),
						25503.1,
						25507.1,
						25518
						and
						25520,
						Health and Safety Code.