California Code of Regulations › Title 19 - Public Safety › Division 5 - California Environment Protection Agency › Chapter 1 - Hazardous Material Inventory and Response Plans › Article 3 - Minimum Standards for Business Plans › Appendix B

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Article 3 -- 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
Business Activities
Please submit the Business Activities page, the Business
					 Owner/Operator Identification page, and Hazardous Materials Inventory --
					 Chemical Description pages for all submissions. (Note: the numbering of the
					 instructions follows the data element numbers that are on the Unified Program
					 Consolidated Form (UPCF) pages. These data element numbers are used for
					 electronic submission and are the same as the numbering used in Division 3,
					 Electronic Submittal of Information). 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.
1. FACILITY ID NUMBER -- Leave this blank. This number is
					 assigned by the Certified 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.
103. BUSINESS SITE ADDRESS -- Enter the street address
					 where the facility is located. No post office box numbers are allowed. This
					 information must provide a means to geographically locate the facility.
104. BUSINESS SITE 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.
4. HAZARDOUS MATERIALS --
Check the box to indicate whether you have a hazardous
					 material onsite. You have a hazardous material onsite if:
- It is handled in quantities equal to or greater than 500
					 pounds, 55 gallons, or 200 cubic feet of compressed 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 page and the Hazardous
					 Materials Inventory -- Chemical Description page, 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.
4a. REGULATED SUBSTANCES -- Refer to
					 19 CCR
					 5130.6 for regulated substances. Check the
					 box to indicate whether your facility has CalARP regulated substances stored
					 onsite.
5. OWN OR OPERATE UNDERGROUND STORAGE TANK (UST) -- Check
					 the appropriate box to indicate whether you own or operate USTs containing
					 hazardous substances as defined in Health and Safety Code (HSC) 25316. If
					 []YES[], then you must complete one UST Facility page and UST Tank pages for
					 each tank. You must also submit a plot plan and a monitoring program
					 plan.
8. OWN OR OPERATE ABOVEGROUND PETROLEUM STORAGE TANK OR
					 CONTAINER -- Check the appropriate box to indicate whether there are ASTs
					 onsite which exceed the regulatory thresholds. (There is no UPCF page for
					 ASTs.) 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 25270.2 (g)). The facility must have a cumulative storage
					 capacity greater than 1,320 gallons for all ASTs. NOT Subject to the Act
					 (exemptions):
An aboveground petroleum storage tank (AST) facility with
					 one or more of the following (see HSC 25270.2 (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 DTSC,
- 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 WASTE GENERATOR -- Check the appropriate box
					 to indicate whether your facility generates hazardous waste. A generator is the
					 person or business whose acts or processes produce a hazardous waste or who
					 causes a hazardous substance or waste to become subject to State hazardous
					 waste law. If your facility generates hazardous waste, 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 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 you recycle more than 100 kilograms per month of recyclable material
					 under a claim that the material is excluded or exempt per HSC 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 HAZARDOUS WASTE TREATMENT -- Check the
					 appropriate box to indicate whether your facility engages in onsite treatment
					 of 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 25123.5 (b) for
					 these specific exemptions. Treatment of certain laboratory hazardous wastes do
					 not require authorization. Refer to HSC 25200.3.1 for specific information.
					 Please contact your CUPA to determine if any exemptions apply to your facility.
					 If your facility engages in onsite treatment of hazardous waste then complete
					 the Onsite Hazardous Waste Treatment Notification -- Facility page and one set
					 of Onsite Hazardous Waste Treatment Notification -- Unit pages with waste and
					 treatment process information for each unit.
12. FINANCIAL ASSURANCE -- Check the appropriate box to
					 indicate whether your facility 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. 67450.13 (b) and HSC
					 25245.4). If your facility is subject to financial assurance requirements or
					 claiming an exemption, then complete the Certification of Financial Assurance
					 page.
13. REMOTE WASTE CONSOLIDATION SITE -- Check the
					 appropriate box to indicate whether your facility consolidates hazardous waste
					 generated at a remote site. Answer []YES[] if you are a hazardous waste
					 generator that collects hazardous waste initially at remote sites and
					 subsequently transports the hazardous waste to a consolidation site you also
					 operate. You must be eligible pursuant to the conditions in HSC 25110.10. If
					 your facility consolidates hazardous waste generated at a remote site, then
					 complete the Remote Waste Consolidation Site Annual Notification page.
14. HAZARDOUS WASTE TANK CLOSURE -- Check the appropriate
					 box to indicate whether the tank being closed would be classified as hazardous
					 waste after its contents are removed. Classification could be based on:
- Your knowledge of the tank and its contents
- The mixture rule
- Testing of the tank
- The listed wastes in
							 40 CFR
							 261.31 or
							 40 CFR
							 261.32.
- Inability to remove hazardous materials stored in the
							 tank.
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.
14a. RCRA LQG -- Check the appropriate box to indicate
					 whether your facility is a Large Quantity Generator. If YES, you must have or
					 obtain a US EPA ID Number.
14b. HOUSEHOLD HAZARDOUS WASTE COLLECTION -- Check the
					 appropriate box to indicate whether your facility is a HHW Collection
					 site.
15. LOCAL REQUIREMENTS -- Some CUPAs or AAs may require
					 additional information. Check with your CUPA before submitting the UPCF to
					 determine if any supplemental information is required.
UPCF Rev. (12/2007)
Business Owner/Operator Identification
Please submit the Business Activities page, the Business
					 Owner/Operator Identification page, and Hazardous Materials Inventory --
					 Chemical Description pages 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 Unified Program Consolidated Form (UPCF)
					 pages. These data element numbers are used for electronic submission and are
					 the same as the numbering used in Division 3, Electronic Submittal of
					 Information.) Please number all pages of your submittal. This helps Unified
					 Program Agency (UPA) identify whether the submittal is complete and if any
					 pages are separated.
1. FACILITY ID NUMBER -- Leave this blank. This number is
					 assigned by the UPA. This is the unique number which identifies your
					 facility.
3. BUSINESS NAME -- Enter the doing business as
					 name.
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.
102a. BUSINESS FAX -- Enter the business fax number, area
					 code first.
103. BUSINESS SITE ADDRESS -- Enter the street address
					 where the facility is located. No post office box numbers are allowed. This
					 information must provide a means to geographically locate the facility.
104. BUSINESS SITE 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 -- If subject to EPCRA, enter the
					 Dun & Bradstreet number for the facility. The Dun & Bradstreet number
					 may be obtained by calling (610) 882-7748 or on the web at
www.dnb.com
.
107. SIC NUMBER -- Enter the primary Standard Industrial
					 Classification System Number. Required for EPCRA.
107a. NAICS NUMBER -- Enter the primary North American
					 Industrial Classification System Number.
108. COUNTY -- Enter the county in which the business site
					 is located.
108a. BUSINESS MAILING ADDRESS -- Enter the mailing address
					 to be used for all official business correspondence. This mailing address must
					 be filled in.
108b. BUSINESS MAILING CITY -- Enter the name of the city
					 for the business mailing address.
108c. STATE -- Enter the two character abbreviation of the
					 state for the business mailing address.
108d. ZIP CODE -- Enter the zip code for the business
					 mailing address. The extra 4 digit zip may also be added.
109. BUSINESS OPERATOR NAME -- Enter the name of the
					 business operator.
110. BUSINESS OPERATOR PHONE -- Enter business operator
					 phone number, if different from business phone, area code first, and any
					 extension.
111. BUSINESS OWNER NAME -- Enter name of business owner,
					 if different from business operator.
112. BUSINESS OWNER PHONE -- Enter the business owner's
					 phone number if different from business phone, area code first, and any
					 extension.
113. BUSINESS OWNER MAILING ADDRESS -- Enter the owner's
					 mailing address, if different from business mailing address.
114. BUSINESS OWNER CITY -- Enter the name of the city for
					 the owner's mailing address, if different from business mailing address.
115. BUSINESS OWNER STATE -- Enter the 2 character state
					 abbreviation for the owner's mailing address, if different from business
					 mailing address.
116. BUSINESS OWNER ZIP CODE -- Enter the zip code for the
					 owner's address, if different from business mailing address. The extra 4 digit
					 zip may also be added.
117. ENVIRONMENTAL CONTACT NAME -- Enter the name of the
					 person, who receives all environmental correspondence.
118. CONTACT PHONE -- Enter the phone number, if different
					 from Owner or Operator, for the environmental contact, area code first, and any
					 extension.
119. CONTACT MAILING ADDRESS -- Enter the mailing address
					 where all environmental contact correspondence should be sent.
119a CONTACT EMAIL -- Enter the email address of the
					 environmental contact in 117, if the contact has one.
120. CONTACT MAILING 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 CONTACT NAME -- Enter the name of a
					 representative to be contacted in case there is 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 EMERGENCY CONTACT NAME -- Enter the name of
					 a secondary representative that can be contacted in the event that the primary
					 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 LOCALLY COLLECTED INFORMATION -- This space
					 may be used for UPA to collect any additional information necessary to meet the
					 requirements of their individual programs. Contact UPA for guidance.
134. DATE -- Enter the date that the document was signed.
					 (YYYYMMDD)
135. NAME OF DOCUMENT PREPARER -- Enter the full name of
					 the person who prepared the inventory submittal information.
136. NAME OF SIGNER -- Enter the full printed name of the
					 person signing the page. The signer certifies to a familiarity with the
					 information submitted and that based on the signer's inquiry of those
					 individuals responsible for obtaining the information, all the information
					 submitted is true, accurate and complete.
SIGNATURE OF OWNER/ OPERATOR OR DESIGNATED REPRESENTATIVE
					 -- The Business Owner/Operator, or officially designated representative of the
					 Owner/Operator, shall sign in the space provided. This signature certifies that
					 the signer is familiar with the information submitted and that based on the
					 signer's inquiry 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 page.
UPCF Rev. (12/2007)
Hazardous Materials Inventory -- Chemical
					 Description
You must complete a separate Hazardous Materials Inventory
					 -- 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 quantity 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 Unified Program Consolidated Form (UPCF) pages. These data element numbers
					 are used for electronic submission and are the same as the numbering used in
					 Division 3, Electronic Submittal of Information.) 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.
1. FACILITY ID NUMBER -- This 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.
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 HSC §
										25506.
202. CHEMICAL LOCATION CONFIDENTIAL -- EPCRA -- All
					 businesses which are subject to the Emergency Planning and Community Right to
					 Know Act (EPCRA) must check "Yes" to keep chemical location information
					 confidential. If the business does not wish to keep chemical location
					 information confidential check "No".
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 with 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 "Yes" if the information in this
					 section is declared a trade secret, or "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 HSC §
										25511. Federal requirement: If
					 yes, and business is subject to EPCRA, disclosure of the designated Trade
					 Secret information is bound by 40 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 "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.
211. HAZARDOUS MATERIAL TYPE -- Check the one box that best
					 describes the type of hazardous material: pure, mixture or waste. If waste
					 material, check only that box. If mixture or waste, complete hazardous
					 components section.
212. RADIOACTIVE -- Check "Yes" if the hazardous material
					 is radioactive or "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 CATEGORIES -- Check all categories that
					 describe the physical and health hazards associated with the hazardous
					 material.
PHYSICAL HAZARDS
HEALTH HAZARDS
Fire:
Flammable Liquids and Solids,
							 Combustible Liquids, Pyrophorics, Oxidizers
Acute Health (Immediate):
Highly Toxic,
							 Toxic, Irritants, Sensitizers, Corrosives,
Reactive:
Unstable Reactive, Organic
							 Peroxides, Water Reactive, Radioactive
other hazardous chemicals with an adverse effect with
							 short term exposure
Pressure Release:
Explosives, Compressed
							 Gases, Blasting Agents
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 one box that best
					 describes the temperature at which the hazardous material is stored.
226. HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) -- Enter the
					 percentage weight of the hazardous component in a mixture. If a range of
					 percentages is available, report the highest percentage in that range. (Report
					 for components 2 through 5 in 230, 234, 238, and 242.)
227. HAZARDOUS COMPONENTS 1-5 NAME -- When reporting a
					 hazardous material that is a mixture, list up to five chemical names of
					 hazardous components in that mixture by percent weight (refer to MSDS or, in
					 the case of trade secrets, refer to manufacturer). All hazardous components in
					 the mixture present at greater than 1% by weight if non-carcinogenic, or 0.1%
					 by weight if carcinogenic, should be reported. 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. (Report for
					 components 2 through 5 in 231, 235, 239, and 243.)
228. HAZARDOUS COMPONENTS 1-5 EHS -- Check "Yes" if the
					 component of the mixture Is considered an Extremely Hazardous Substance as
					 defined in 40 CFR, Part 355, or "No" if it is not. (Report for components 2
					 through 5 in 232, 236, 240, and 244.)
229. HAZARDOUS COMPONENTS 1-5 CAS -- List the Chemical
					 Abstract Service (CAS) numbers as related to the hazardous components in the
					 mixture. (Repeat for 2-5.)
246. LOCALLY COLLECTED INFORMATION -- This space may be
					 used by the CUPA or AA to collect any additional information necessary to meet
					 the requirements of their individual programs. Contact the CUPA or AA for
					 guidance.
UPCF Rev. (12/2007)
IV.
California Annotated Site
					 Map--Instructions
Attach a map of the facility using the standard grid. As a
					 minimum, the map should show the following:
1. Site Layout
* Scale of map
* Site Orientation (north, south, etc.)
* Loading areas
* Parking lots
* Internal roads
* Storm and sewer drains
* Adjacent property use
* Locations and names of adjacent streets and alleys
* Access and egress points and roads
2. Facility
* Location of each storage area
* Location of each hazardous material handling area
* Location of emergency response equipment. For example,
					 equipment for fire suppression, approach and mitigation, protective clothing,
					 medical response, etc.