Section H4 — MAINTENANCE OF RECORDS

H4.1 Hazardous materials inventory statements and hazardous materials management plans shall be maintained by the permittee for a period of not less than three years after submittal of updated or revised versions. Such records shall be made available to the fire chief upon request.

FIGURE A-H-1 — SAMPLE FORMAT HAZARDOUS MATERIALS MANAGEMENT PLAN (HMMP) INSTRUCTIONS

SECTION I—FACILITY DESCRIPTION

1.1 Part A

1. Fill out Items 1 through 11 and sign the declaration. 2. Only Part A of this section is required to be updated and submitted annually, or within 30 days of a change.

1. 2 Part B—General Facility Description (Site Plan) 1. Provide a site plan on 8 [1] / 2 -by 11-inch (215 mm by 279 mm) paper, using letters on the top and bottom margins and numbers on the right and left side margins, showing the location of all buildings, structures, chemical loading areas, parking lots, internal roads, storm and sanitary sewers, wells, and adjacent property uses. Indicate the approximate scale, northern direction and date the drawing was completed. 2 List all special land uses within 1 mile (1.609 km).

1.3 Part C—Facility Storage Map (Confidential Information) 1. Provide a floor plan of each building on 8 [1] / 2 by 11-inch (215 mm by 279 mm) paper, using letters on the top and bottom margins and numbers on the right and left side margins, with approximate scale and northern direction, showing the location of each storage area. Mark map clearly “Confidential—Do not disclose” for trade-secret information as specified by federal, state and local laws.

2. Identify each storage area with an identification number, letter, name or symbol. 3. Show the following: 3.1. Accesses to each storage area. 3.2. Location of emergency equipment. 3.3. The general purpose of other areas within the facility. 3.4. Location of all aboveground and underground tanks to include sumps, vaults, below-grade treatment systems, piping, etc.

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

4. Map key. Provide the following on the map or in a map key or legend for each storage area: 4.1. A list of hazardous materials, including wastes.

4.2. Hazard class of each hazardous waste.

4.3. The maximum quantity for hazardous materials. 4.4. Include the contents and capacity limit of all tanks at each area and indicate whether they are above or below ground. 4.5. List separately any radioactives, cryogens and compressed gases for each facility. 4.6. Trade-secret information shall be listed as specified by federal, state and local laws.

SECTION II—HAZARDOUS MATERIALS INVENTORY STATEMENT (HMIS)

2.1 Part A—Declaration

Fill out all appropriate information.

2.2 Part B—Inventory Statement

1. You must complete a separate inventory statement for all waste and nonwaste hazardous materials. List all hazardous mate- rials in alphabetical order by hazard class.

2. Inventory Statement Instructions:

Column Information Required

1. Provide hazard class for each material.

2. Nonwaste. Provide the common or trade name of the regulated material. Waste. In lieu of trade names, you may provide the waste category. 3. Provide the chemical name and major constituents and concentrations, if a mixture. 4. Enter the chemical abstract service number (CAS number) found in 29 C.F.R. For mixtures, enter the CAS number of the mixture as a whole if it has been assigned a number distinct from its constituents. For a mixture that has no CAS number, leave this item blank or report the CAS numbers of as many constituent chemicals as possible. 5. Enter the following descriptive codes as they apply to each material. You may list more than one code, if applicable.

P = Pure

M = Mixture

S = Solid

L = Liquid

G = Gas

6. Provide the maximum aggregate quantity of each material handled at any one time by the business. For underground tanks, list the maximum volume [in gallons (liters)] of the tank. 6.1. Enter the estimated average daily amount on site during the past year.

7. Enter the units used in Column 6 as:

LB = Pounds

GA = Gallons

CF = Cubic Feet

8. Enter the number of days that the material was present on site (during the last year). 9. Enter the storage codes below for type, temperature and pressure.

Type A = Aboveground Tank B = Belowground Tank C = Tank inside Building D = Steel Drum

E = Plastic or Nonmetallic Drum

F = Can

G = Carbon

H = Silo

I = Fiber Drum

J = Bag

K = Box

L = Cylinder M = Glass Bottle or Jug N = Plastic Bottles or Jugs

O = Tote Bin

P = Tank Wagon

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

Q = Rail Car

R = Other

Temperature

4 = Ambient

5 = Greater than Ambient

6 = Less than Ambient, but not Cryogenic [less than -150°F (-101.1°C)] 7 = Cryogenic conditions [less than -150°F (-101.1°C)]

Pressure

1 = Ambient (Atmospheric) 2 = Greater than Ambient (Atmospheric) 3 = Less than Ambient (Atmospheric) 10. For each material listed, provide the Superfund Amendments and Reauthorization Act (SARA) hazard class as listed below. You may list more than one class. These categories are defined in 40 C.F.R. 370.3.

Physical Hazards

F = Fire

P = Sudden Release of Pressure

R = Reactivity

Health Hazards

I = Immediate (Acute) D = Delayed (Chronic) 11. Waste Only. For each waste, provide the total estimated amount of hazardous waste handled throughout the course of the

year.

SECTION III—SEPARATION AND MONITORING

3.1 Part A—Aboveground

Fill out Items 1 through 6, or provide similar information for each storage area shown on the facility map. Use additional sheets as

necessary.

3.2 Part B—Underground 1. Complete a separate page for each underground tank, sump, vault, below-grade treatment system, etc. 2. Check the type of tank and method(s) that applies to your tank(s) and piping, and answer the appropriate questions. Provide any additional information in the space provided or on a separate sheet.

SECTION IV—WASTE DISPOSAL

Check all that apply and list the associated wastes for each method checked.

SECTION V—RECORDING KEEPING

Include a brief description of your inspection procedures. You are also required to keep an inspection log and recordable discharge log, which are designed to be used in conjunction with routine inspections for all storage facilities or areas. Place a check in each box that describes your forms. If you do not use the sample forms, provide copies of your forms for review and approval.

SECTION VI—EMERGENCY-RESPONSE PLAN

1. This plan should describe the personnel, procedures and equipment available for responding to a release or threatened release of hazardous materials that are stored, handled or used on site.

2. A check or a response under each item indicates that a specific procedure is followed at the facility, or that the equipment spec- ified is maintained on site.

3. If the facility maintains a more detailed emergency-response plan on site, indicate this in Item 5. This plan shall be made avail- able for review by the inspecting jurisdiction.

SECTION VII—EMERGENCY RESPONSE TRAINING PLAN

1. This plan should describe the basic training plan used at the facility. 2. A check in the appropriate box indicates the training is provided or the records are maintained. 3. If the facility maintains a more detailed emergency-response training plan, indicate this in Item 4. This plan shall be made available for review by the inspecting jurisdiction.

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

FIGURE A-H-1 — HAZARDOUS MATERIALS MANAGEMENT PLAN

SECTION I: FACILITY DESCRIPTION

PART A—GENERAL INFORMATION

1. Business Name: __________________________________________________________ Phone:_____________________

_Address: ____________________________________________________________________________________________

2. Person Responsible for the Business Name: Title: Phone:

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3. Emergency Contacts:

Name: Title: Home Number: Work Number:

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4. Person Responsible for the Application/Principal Contact: Name: Title: Phone:

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5. Property Owner: Name: Address: Phone:

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6. Principal Business Activity:____________________________________________________________________________

7. Number of Employees:________________________________________________________________________________

8. Number of Shifts:____________________________________________________________________________________

_9. Hours of Operation: __________________________________________________________________________________

_10. SIC Code: __________________________________________________________________________________________

_11. Dunn and Bradstreet Number: __________________________________________________________________________

12. Declaration________________________________________________________________________________________

I certify that the information above and on the following parts is true and correct to the best of my knowledge.

_Signature: _________________________________________________Date: ______________________________________

Print Name: _______________________________________________Title:

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(Must be signed by owner/operator or designated representative)

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

PART B—GENERAL FACILITY DESCRIPTION/SITE PLAN

(Use grid format on next page.) Special land uses within 1 mile (1.609 km):______________

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PART C—FACILITY MAP

(Use grid format below.)

SECTION II: HAZARDOUS MATERIALS INVENTORY STATEMENT

PART A—DECLARATION

_1. Business Name: ___________________________________________________________ _2. Address: _________________________________________________________________

3. Declaration:

Under penalty of perjury, I declare the above and subsequent information, provided as part of the hazardous materials inventory statement, is true and correct. Signature: _________________________________________________Date:

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Print Name: _______________________________________________Title:

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(Must be signed by owner/operator or designated representative)

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

FIGURE A-II-E-1—(Continued) PART B—HAZARDOUS MATERIALS INVENTORY STATEMENT

SECTION III: SEPARATION, SECONDARY CONTAINMENT AND MONITORING

PART A—ABOVEGROUND STORAGE AREAS

Storage Area Identification (as shown on facility map):_____________________________________

1. Storage Type:

____________ Original Containers_ ____________ Safety Cans_

____________ Inside Machinery_ ____________ Bulk Tank_

____________ 55-gallon (208.2 L)_ ____________ Outside Barrels_

Drums or Storage Shed

____________ Pressurized Vessel_

____________ Other: ______________________________________________________________________________________

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______________________________________________________________________________________________________2.

Storage Location:

____________ Inside Building_ ____________ Outside Building_

____________ Secured_

3. Separation:

____________ All Materials_ ____________ One-hour Separation_

____________ Compatible Wall/Partition_

____________ Separated by 20 Feet (6096 mm) ___________ Approved Cabinets_

____________ Other: ______________________________________________________________________________________

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______________________________________________________________________________________________________4.

Secondary Containment:

____________ Approved Cabinet_ ____________ Secondary Drums_

____________ Tray_ ____________ Bermed, Coated Floor_

____________ Vaulted Tank_ ____________ Double-wall Tank_

____________ Other: ______________________________________________________________________________________

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______________________________________________________________________________________________________5.

Monitoring:

____________ Visual_ ____________ Continuous_

____________Other: ______________________________________________________________________________________

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______________________________________________________________________________________________________Att

ach specifications if necessary

6. Monitoring Frequency:

____________ Daily ___________ Weekly_

____________ Other: ____________________________________________________________________

Attach specifications if necessary

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

APPENDIX H

FIGURE A-II-E-1—(Continued)

SECTION III: SEPARATION, CONTAINMENT AND MONITORING

PART B—UNDERGROUND

S INGLE-WALL TANKS AND PIPING

_Tank Area Identification (as shown on facility map): ____________________________________________

1. _____ Backfill Vapor Wells

Model and Manufacturer:

______________________________________________________________________________________________________Co

_ntinuous or Monthly Testing: _____________________________________________________________________________

2. _____ Groundwater Monitoring Wells

3. _____ Monthly Precision Tank Test

4. _____ Piping—

_Monitoring Method: ______________________________________________________________________________________

_Frequency: _____________________________________________________________________________________________

_5. _____ Other: __________________________________________________________________________________________

DOUBLE-WALL TANKS AND PIPING

Tank Area Identification (as shown on facility map):_____________________________________________________________ 1. Method of monitoring the annular space: ____________________________________________________________________ 2. Frequency: __________ Continuous _________ Daily _________ Weekly __________ Other: ________________________________________________________________________________________ _3. List the type of secondary containment for piping: _____________________________________________________________

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4. List the method of monitoring the secondary containment for piping: ______________________________________________ 5. Are there incompatible materials within the same vault? ________ Yes _______ No If yes, how is separate secondary containment provided?_________________________________________________________

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Note: If you have continuous monitoring equipment, you shall maintain copies of all service and maintenance work. Such reports shall be made available for review on site, and shall be submitted to the fire prevention bureau upon request. Attach additional sheets as necessary.

SECTION IV: WASTE DISPOSAL

______ Discharge to the Sanitary ____________ Pretreatment—_

_Sewer—Wastes: _________________ Wastes: ____________________________________________________________

______________________________________________________________________________________________________Li

_censed Waste Hauler _________________Recycle __________________

_Wastes: _________________________Wastes: _________________________________________________________________

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___________ Other—_

_Describe Method: ________________________________________________________________________________________

_Wastes: _________________________

__________ No Waste_

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

APPENDIX H

FIGURE A-II-E-1—(Continued)

SECTION IV: WASTE DISPOSAL—continued

B. Spill Containment:

______ Absorbents _____ Other: _______________________________________

C. Spill Control and Treatment:

______ Vapor Scrubber ______ Mechanical Ventilation_

______ Pumps/vacuums ______ Secondary Containment_

______ Neutralizer ______ Other: _________________________________________________________

4. Evacuation:

______ Immediate area evacuation routes posted_

______ Entire building evacuation procedures developed_

______ Assembly areas preplanned_

______ Evacuation maps posted_

______ Other: ____________________________________________________________________________________________

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5. Supplemental hazardous materials emergency response plan on site.

Location:______________________________________________________________________________________________

_Responsible Person: ______________________________________________________________________________________

Phone:________________________________________________________________________________________________

SECTION V: RECORD KEEPING

_Description of our inspection program: _______________________________________________________________________

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______ We will use the attached sample forms in our inspection program._

______ We will not use the sample forms. We have attached a copy of our own forms._

SECTION VI: EMERGENCY RESPONSE PLAN

1. In the event of an emergency, the following shall be notified:

A. On-site Responders:

Name: Title: Home Number:

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B. Method of Notification to Responder:

______ Automatic Alarm _____ Phone_

______ Manual Alarm _____ Verbal_

______ Other: ____________________________________________________________________________________________

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APPENDIX H — HAZARDOUS MATERIALS MANAGEMENT PLANS AND HAZARDOUS MATERIALS INVENTORY STATEMENTS (SEE SECTIONS 5001.5.1 AND 5001.5.2)

C. Agency: Phone Number: Fire Department: California Emergency Management Agency (Cal EMA): Other:

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2. Designated Local Emergency Medical Facility:

Name: Address: Phone (24 hours):

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3. Mitigation Equipment: A. Monitoring Devices: _______ Toxic or flammable gas detection_ _______ Fluid detection_ _______ Other:___________________________________________________________________________________________

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SECTION VII: EMERGENCY-RESPONSE TRAINING PLAN

1. Person responsible for the emergency-response training plan: Name: Title: Phone:

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2. Training Requirements: A. All employees trained in the following as indicated: ______ Procedures for internal alarm/notification_ ______ Procedures for notification of external emergency-response organization_ ______ Location and content of the emergency-response plan_ B. Chemical handlers are trained in the following as indicated: ______ Safe methods for handling and storage of hazardous materials_ ______ Proper use of personal protective equipment_ ______ Locations and proper use of fire- and spill-control equipment_ ______ Specific hazards of each chemical to which they may be exposed_ C. Emergency-response team members are trained in the following: ______ Procedures for shutdown of operations_ ______ Procedures for using, maintaining and replacing facility emergency and monitoring equipment_ 3. The following records are maintained for all employees: ______ Verification that training was completed by the employee_ ______ Description of the type and amount of introductory and continuing training_ ______ Documentation on and description of emergency-response drills conducted at the facility_

4. A more comprehensive and detailed emergency-response training plan is maintained on site.

_Location: _______________________________________________________________________________________________

_Responsible Person: ______________________________________________________________________________________

_Phone: _________________________________________________________________________________________________

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CALIFORNIA FIRE CODE – MATRIX ADOPTION TABLE

APPENDIX I – FIRE PROTECTION SYSTEMS—NONCOMPLIANT CONDITIONS

(Matrix Adoption Tables are nonregulatory, intended only as an aid to the code user. See Chapter 1 for state agency authority and building applications.)

(Not adopted by the State Fire Marshal)

• The California Code of Regulations (CCR), Title 19, Division 1 provisions that are found in the California Fire Code are a reprint from the current CCR, Title 19, Division 1 text for the code user’s convenience only. The scope, applicability and appeals procedures of CCR, Title 19, Division I remain the same.

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APPENDIX I-2 2025 CALIFORNIA FIRE CODE

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