Consolidated Contingency Plan by wjkcA4yb

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									Butte County                                                                              Consolidated Contingency Plan
Environmental Health Division (CUPA)                                                          For Hazardous Materials, Hazardous Waste & Underground Storage Tanks

        Submit completed document to Butte County Environmental Health @ 202 Mira Loma Dr., Oroville, CA 95965

    FACILITY IDENTIFICATION / OPERATIONS OVERVIEW
    1    BUSINESS NAME                                                                                          FACILITY ID #                                  DATE


    2    BUSINESS ADDRESS


    3    Check elements covered by this consolidated plan:
                                                                   Hazardous Materials                    Hazardous Waste                 Underground Storage Tanks
    4    Supplemental elements submitted:                                                                                                UST Written Monitoring Plan
    5    TYPE OF BUSINESS (e.g. painting contractor)                                          INCIDENTAL OPERATIONS (e.g. fleet maintenance)


    6    HAZARDS / EVENTS COVERED BY PLAN (e.g. chemical spills, fire, earthquake, etc)



    EMERGENCY COORDINATOR & ON-SITE TECH ADVISORS / INTERNAL RESPONSE
    7                                              Identify your Emergency Coordinator & On-site Technical Advisors:
    8    \
                                                                   Name / Position:

                                                                          Address:
                  Emergency Coordinator:

                                                                         Phone #s:     Day:                                        After hours:
             Must have the authority to classify the
         release, make management decisions, &                     Responsible for:       spill prevention                            contacting facility responders
                determine appropriate response                                                                                        authorizing spill response work
                                                                                          emergency assessment /
                                                              (check all that apply)     management
          Person is:          on-site or           on-call
                                                                                                                                      interfacing with public emergency
                                                                                          initiating alarms                        responders
                                                                                          agency notification                         other:
    9                                                                                              Alternate # 1                                   Alternate # 2
                                                                   Name / Position:

                                                                          Address:

         Alternate Emergency Coordinators:                                     City:

                  List In order of responsibility.                              Zip:

                                                                       Day phone:

                                                               After hours phone:

                                                                         Person is:               on-site or    on-call                           on-site or       on-call
    10
                On-Site Technical Advisors
                                                              Owner:                                                      Supervisor:
         (Available to provide site-specific technical
          advice to off-site emergency responders)            Manager:                                                    Other:
    11                                                                Identify type of internal response:
    12                                                                   Team Members (name or position):                                      Responsibilities:
                            Internal facility
                                                              1.
                            response team
         Option         (attach additional pages if needed:   2.
         s:
                       indicate an attachment by checking
                                                              3.
                                   this box    )
          (check                                              4.

    13
             one or
                                                              Name:                                                                   Describe role / responsibilities:
             more)
                                                              address:
                            Contractor
                                                              phone #:




Page: BP-1
Butte County                                                                    Consolidated Contingency Plan
Environmental Health Division (CUPA)                                              For Hazardous Materials, Hazardous Waste & Underground Storage Tanks
                                                    BUSINESS NAME                                                        FACILITY NUMBER
FACILITY IDENTIFICATION

EMERGENCY COMMUNICATIONS / PHONE NUMBERS / NOTIFICATIONS
14
                                                   Internal & External Emergency Communications
15
      Individual responsible for on-site and off-site emergency                      Name / Position:
      alarm notifications / communications:
16                                                                                                                  check all that apply:
                                                                                           verbal warnings                    public address or intercom system
        INTERNAL facility emergency communications or alarm
                           notification will occur via:                                    telephone                          pagers
                                                                                           alarm system                       portable radio
17                                                                                                                  check all that apply:
       EXTERNAL notifications / communications to neighboring                              verbal warnings                    public address or intercom system
         facilities that may be affected by an off-site release will
                                                                                           telephone                          pagers
                                 occur by:
                                                                                           alarm system                       portable radio
18
                                                    Emergency Phone Numbers / Notification Lists
19                                                                Ambulance, Fire, Sheriff & CHP – use for all
                                                                  emergencies                                                      911
            Emergency response phone numbers                                                                                       530-538-7281 (8 am – 5 pm)
                                                                  Butte County Environmental Health
                                                                                                                                   911 (24 hour emergency number)
                                                                  Poison Control Center                                            1-800-342-9293
20
            Nearest medical facility / hospital                   Name:                                                            Phone #:
21
            Your medical facility / hospital                      Name:                                                            Phone #:
22                                                                CA Dept of Toxic Substances Control                              916 324-1824

                                                                  CA Office of Emergency Services                                  1-800-852-7550

                                                                  CA Water Quality Control Board, Central Valley Region            916 255-3000
                                                                  US Environmental Protection Agency (US EPA)                      1-415-744-1500

            Agency Notification Phone List                        National Response Center                                         1-800-424-8802
                                                                  CA Dept of Fish & Game                                           916 445-0045
                                                                  US Coast Guard (spill response)                                  1-510-437-3073
                                                                  Cal OSHA                                                         916 263-2800
                                                                  State Fire Marshall                                              916 445-8200
23
            Other Important Numbers
26
                                                                     Neighbor Notification List
27                                               List all businesses / structures bordering &/or adjacent to your facility:

28    at facility’s   Business name:                                                    at facility’s   Business name:
      northern                                                                          southern
      border:         address:                                                          border:         address:

                      phone #:                                                                          phone #:

                      contact name / position:                                                          contact name / position:

29    at facility’s   Business name:                                                    at facility’s   Business name:
      eastern                                                                           western
      border:         address:                                                          border:         address:

                      phone #:                                                                          phone #:

30
                      contact name / position:                                                          contact name / position:



Page: BP-2
Butte County                                                           Consolidated Contingency Plan
Environmental Health Division (CUPA)                                     For Hazardous Materials, Hazardous Waste & Underground Storage Tanks


FACILITY IDENTIFICATION
31     BUSINESS NAME                                                                       FACILITY ID #                              DATE



EMERGENCY CONTAINMENT & CLEAN-UP PROCEDURES
32
                                                Containment, Prevention & Clean-Up
33                                                                                     check all that apply:
      Indicate your procedures for:
                                               provide structural physical barrier(e.g. portable     monitor for leaks, ruptures, pressure build-up, etc
                                               spill containment walls)
        1. containing spills, releases,
           fires or explosions, &              provide absorbent physical barrier                    cover or block floor &/ or storm drains
        2. preventing and mitigating           built-in berm in work / storage area                  automatic fire suppression system
           associated harm to persons,
                                               stop processes &/or operations                        automatic / electronic equipment shut-off system
           property & the environment:
                                               shut-off water, gas, electrical utilities as          call 911 for public emergency responder
                                               appropriate                                                 assistance / medical aid

                                               provide protective equipment for on-site              eliminate sources of ignition for flammable
                                               response team                                         hazards (e.g. fuel, propane)
                                               notify & evacuate persons in all threatened           remove     or   isolate   containers    /   area   as
                                               areas                                                 appropriate

                                               account for evacuated persons immediately
                                               after evacuation call

                                               other (specify):




34                                                                                     check all that apply:
      Indicate your clean-up procedures:
                                               hire licensed hazardous waste contractor

                                               use absorbent material for spills with subsequent proper labeling, storage and hazardous waste
                                               disposal as appropriate
                                               suction using shop vacuum with subsequent proper labeling, storage and hazardous waste disposal as
                                               appropriate
                                               wash / decontaminate equipment w/ containment & disposal of effluent / rinsate as hazardous waste

                                               provide safe temporary storage of emergency-generated wastes

                                               other (specify):




35
                                              Evacuation Coordinator & Assembly Area
36                                         Name:
      Provide name / position of
      evacuation coordinator who will
      account for all on-site employees
      and / or site visitors after
      evacuation:
37                                         Specify:
      Identify / describe emergency
      assembly area for evacuees:



      Identify the location where your     Specify:
      evacuation route / map is posted:
      Other     facility      evacuation   Specify:
      procedures:



Page: BP-3
Butte County                                                                        Consolidated Contingency Plan
Environmental Health Division (CUPA)                                                For Hazardous Materials, Hazardous Waste & Underground Storage Tanks


FACILITY IDENTIFICATION
38     BUSINESS NAME                                                                                    FACILITY ID #               DATE



EMERGENCY EQUIPMENT
39
                                                           List of available emergency equipment
                                                                      (check all that apply)
40                                            Equipment Available                                  Location                     Capability (as applicable)
41                                                    Example:

                                  portable fire extinguishers                             center of each wall in shop                   rated as “C”
          Use Category            chemical protective gloves                                  spill response kit          one-time use; oil & solvent resistant only

42                                   chemical protective suits, aprons or
      Safety & First Aid
                                     vests
      Equipment
                                     chemical protective gloves
                                     chemical protective boots
                                     safety glasses / goggles / shields
                                     hard hats
                                     cartridge respirator
                                     self-contained breathing apparatus
                                     first aid kits / stations
                                     plumbed eyewash fountain / shower
                                     portable eyewash kits

                                     other:

43                                   portable fire extinguishers
      Fire Extinguishing
                                     fixed fire systems / sprinklers / fire hoses
      Equipment
                                     fire alarm boxes or stations

                                     other:

44                                   absorbent material
      Spill Control & Clean-
                                     container for used absorbent
      Up Equipment
                                     berming / diking equipment
                                     broom
                                     shovel
                                     shop vac
                                     exhaust hood
                                     emergency sump / holding tank
                                     chemical neutralizers
                                     gas cylinder leak repair kits
                                     spill overpack drums
                                     other:
45                                   telephones (includes cellular)
      Communications &
                                     intercom / PA system
      Alarm System
                                     portable radios
      Equipment
                                     automatic alarm chemical monitoring
                                     equipment
                                     UST monitoring system operations
                                     manual
                                     list of notification phone numbers

                                     other:


Page: BP-4
Butte County                                                                   Consolidated Contingency Plan
Environmental Health Division (CUPA)                                             For Hazardous Materials, Hazardous Waste & Underground Storage Tanks




FACILITY IDENTIFICATION
46     BUSINESS NAME                                                                                  FACILITY ID #                                  DATE



EARTHQUAKE VULNERABILITY
47
                                                           Areas of earthquake vulnerability
48                                                                     check all that apply:                         Location (e.g. shop, outdoor shed, forensic lab):
      Identify areas of facility vulnerable to
      releases / spills due to earthquake                    hazardous materials / waste storage area
      related motion:                                        process lines / piping
       (require immediate isolation and inspection)          laboratory
                                                             waste treatment area
49                                                                     check all that apply:                                      Affected locations:
      Identify mechanical systems vulnerable
      to releases / spills due to earthquake                 shelves, cabinets & racks
      related motion:                                        tanks (emergency shutoff)
                                                             portable gas cylinders
       (require immediate isolation and inspection)
                                                             emergency shutoff &/or utility valves
                                                             sprinkler systems
                                                             stationery pressurized containers (e.g.
                                                             tank for dispensing propane)

ARRANGEMENTS FOR EMERGENCY SERVICES
50                                                    Advance arrangements with local fire & police departments, hospitals and /or contractors for emergency
      Explanation of Requirement
                                                      services should be made as appropriate for your facility; you may determine that advance arrangements
                                                                                         are not necessary for your facility.
51    Describe any advance                              Determined not necessary
      arrangements made for local
      emergency services:                               Specify:




EMPLOYEE TRAINING CONTENT & FORMAT
52
                                                          Employee Training Content & Format
53                                               Employee training is required for all employees handling hazardous materials / hazardous wastes in day to
      Explanation of Requirement
                                                 day or clean-up operations including volunteers &/or contractors.
                                                 Required content for employee training includes all of the following:
54
                                                                                                                           communication & alarm systems
                                                        Material Safety Data Sheets
                                                                                                                          personal protective equipment
                                                         hazard communication related to health & safety
                                                                                                                          use of emergency response equipment
                                                         methods for safe handling of hazardous substances
                                                                                                                           (e.g. fire extinguishers, respirators, etc)
                                                        fire hazards of materials / processes
                                                                                                                           decontamination procedures
                                                        conditions likely to worsen emergencies
                                                                                                                           evacuation procedures
                                                        coordination of emergency response
                                                                                                                           control & containment procedures
                                                        notification procedures
                                                                                                                           UST monitoring system equipment &
                                                        applicable laws & regulations
                                                                                                                            procedures (if applicable)
55                                                                                                check all that apply:
      Indicate how employee training
      program (with required content) is                Formal classroom                       Video(s) (specify):
      administered:
                                                        Safety / tail-gate meetings            Other (specify):

                                                        Study Guides / Manuals (specify):




Page: BP-5
Butte County                                                                   Consolidated Contingency Plan
Environmental Health Division (CUPA)                                              For Hazardous Materials, Hazardous Waste & Underground Storage Tanks


FACILITY IDENTIFICATION
56     BUSINESS NAME                                                                                    FACILITY ID #                        DATE



EMPLOYEE TRAINING FREQUENCY & DOCUMENTATION
57
                                                             Required frequency of training
58                                                   Employee training must be:
      Explanation of Requirement
                                                         provided within 6 months for new hires,

                                                         amended as necessary prior to change in process or work assignment,

                                                         given upon modification to emergency response / contingency plan, and

                                                         updated / refreshed annually for ALL employees.
59
      Certify that the facility’s employee
      training program meets minimum                     Employee training is provided, at a minimum, as described above.
      frequency requirements:
60
                                                                     Record of training
61                                                   Written documentation of employee training sessions must be kept which include:
      Explanation of Requirement
                                                         training outline / agenda                      date of training session

                                                         employee names & job titles                    brief job description for hazardous waste generator
                                                                                                          facilities

62
      Certify that the facility’s training
      documentation meets minimum                        Employee training documentation is provided, at a minimum, as described above.
      record keeping requirements:
63
      Training program description or                    Employee training program outline is attached.
      outline attached:
                                                         Employee training program is described here:




LIST OF ATTACHMENTS
62     List all attachments to this document here:




SIGNATURE / CERTIFICATION
63    Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am
      familiar with the information submitted and believe the information is true, accurate and complete and that a copy is available on-site.
      Signature                                                                                              Date of completion



      Print Name                                                                                             Title / Position




Page: BP-6

								
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