Cal. Code Regs. Tit. 27, div. 1, 4, ch. 1, pt. II, art. 10, app B
I hereby certify the following:
1. I have read and understand Sections 15130 and 15150(e)(9), (14) and (15) of Article 3, Chapter 1, Subdivision 4, Division 1, Title 27 of the California Code of Regulations (CCR).
2. The administrative procedures of the proposed Unified Program, as implemented by my agency, will meet the standards described in Section of Title 2715180 of Title 27, CCR.
3. The Unified Program, as implemented by my agency, will meet the reporting requirements as described in Article 6 of Title 27, CCR.
4. All responsible agencies involved in the implementation of the Unified Program, as proposed by this application, have adequate resources to carry out the Unified Program.
5. If I am a non-county entity, I have notified the county of my intent to apply to administer the Unified Program within my jurisdiction.
6. I agree to use state certified laboratories for analysis required under the Hazardous Waste Generator Program by Health and Safety Code Chapter 6.5 (refer to Health and Safety Code Section 25198)
7. The information provided within this application is true to the best of my knowledge.
8. I understand that this certification is an integral part of the formal application for certification as a Certified Unified Program Agency, and that any false statement may be grounds for denial or revocation of the Unified Program authorization by the Secretary of the California Environmental Protection Agency.
| ___________________________ | ___________________________ | |
| Signature of Elected Official or Authorized Representative | Date | |
| ___________________________ | ||
| Title | ||
| ___________________________ | ||
| Jurisdiction | ||
| (CalEPA 1/17) |
Jurisdiction ______________________________ | ||||
Table 1: ENUMERATIONS/DEMOGRAPHIC INFORMATION | ||||
| PROGRAM/ACTIVITIES | # OF BUSINESSES OR # USTs | MANDATED INSPECTION FREQUENCY | APPLICANT INSPECTION FREQUENCY | AGENCY TO INSPECT |
| Total # of all regulated businesses | ||||
| UST facilities | At least once every year | |||
| Total # of USTs | ||||
| APSA | At least once every 3 years for tank facilities with 10,000 gallons or more of petroleum | |||
| HMMP* | ||||
| HMRRP | At least once every 3 years | |||
| HWG | No mandated frequency** | |||
| PBR | Initial inspection within 2 years of notification and every 3 years thereafter | |||
| CA | Initial inspection within 2 years of notification and every 3 years thereafter | |||
| CE | Initial inspection within 2 years of notification and every 3 years thereafter | |||
| CalARP | At least once every 3 years | |||
| * If the HMMP is fully covered by the HMRRP, leave this row blank. | ||||
| ** Although the Hazardous Waste Generator Program (HWG) has no mandated inspection frequency, HWG inspections are to be incorporated as part of the Unified Program, and coordinated with the inspection frequencies of other Unified Program elements. | ||||
| Regulatory Citations | CCR, Title 27, Sections 15150(e)(4) and (16) | |
| CCR, Title 27, Sections 15200(a), (b), and (f) | ||
| CCR, Title 27, Section 15210(b) | ||
| (CalEPA T01 1/17) |
Instructions for Table 1
Fill in the Jurisdiction name that is the reporting applicant agency or CUPA.
Fill out the blank and unshaded boxes.
# OF BUSINESSES - Number of businesses regulated under each of the programs listed.
MANDATED INSPECTION FREQUENCY - Lists the statutorily required minimum inspection frequency.
APPLICANT INSPECTION FREQUENCY - The inspection frequency established by the applicant agency in the Inspection and Enforcement Program Plan.
AGENCY TO INSPECT - Which internal CUPA department, office, or agency will inspect or which external local government (participating agency) will inspect.
Total # of all regulated businesses - Total number of all businesses within all regulated programs. Do not double count businesses for this total. Example: A business that stores hazardous waste in two underground tanks for use in an onsite PBR treatment process.
This business would count as one (1) regulated business for the "Total # of all regulated businesses" block of the chart. This same business would count as one (1) regulated business in the UST Program with a total of two UST's, one (1) regulated business in the HMRRP, one (1) regulated business in the HWG Program, and one (1) regulated business in the PBR Onsite Hazardous Waste Treatment Program.
UST Program - Underground Storage Tank Program
Total # of USTs - Total number of underground storage tanks that the business has onsite.
SPCC - Spill Prevention Control and Countermeasure Plan.
HMMP - Hazardous Material Management Plan.
HMRRP - Hazardous Materials Release Response Plan and Inventory Program.
PBR - Permit-By-Rule Onsite Hazardous Waste Treatment Program.
CA - Conditionally Authorized Onsite Hazardous Waste Treatment Program.
CE - Conditionally Exempt Onsite Hazardous Waste Treatment Program.
CalARP - California Accidental Release Prevention Program.
HW - Hazardous Waste Generator Program.
(CalEPA T01 Inst 1/17)
Instructions for Table 2
Fill in the Jurisdiction name that is the reporting applicant agency or CUPA.
Fill in the fiscal year that the Table is used for.
Fill out the blank and unshaded boxes.
See instructions for Table 1 for definitions of program abbreviations.
PROGRAM HISTORY:
PROGRAM IN PLACE IN ABOVE FISCAL YR? (Y/N) - Insert yes or no as appropriate.
ESTIMATED BUDGET FOR THIS PROGRAM DURING THE FISCAL YR ABOVE (IF PROGRAM WAS IN PLACE) - Give the dollar amount of the estimated budget or the actual budget of the fiscal year reported.
INSPECTIONS:
# OF ROUTINE PLANNED - Number of routine inspections planned in the fiscal year reported.
# OF ROUTINE COMPLETED - Number of routine inspections completed in the fiscal year reported.
# OF COMPLAINT COMPLETED - Number of complaint inspections completed in the fiscal year reported.
# OF MINOR VIOLS - Number of minor violations in the fiscal year reported.
# OF MAJOR VIOL - Number of major violations in the fiscal year reported.
ENFORCEMENT ACTIONS TAKEN:
INFORMAL ACTION/RETURNED TO COMPLIANCE - The number of informal enforcement actions or return to compliance actions taken during the fiscal year reported.
ADMIN - The number of administrative enforcement actions taken during the fiscal year reported.
CIVIL - The number of civil enforcement actions taken during the fiscal year reported.
CRIMINAL - The number of criminal enforcement actions taken during the fiscal year reported.
TOTAL PENALTIES ASSESSED - The total dollar amount of penalties assessed in the fiscal year reported.
TOTAL PENALTIES COLLECTED - The total dollar amount of penalties collected in the fiscal year reported.
The following are guidelines/definitions to be used in determining time allocations:
1. Inspection: inspections travel, research, analysis of findings, documentation, warnings and notices
2. Enforcement: includes warnings, notices, meetings, hearings, legal proceedings and documentation
3. Permit activities: includes application review, modification, revision and evaluation
4. Training: includes field, meeting, seminars, workshops, courses and literature reviews
5. Management: includes day-to-day scheduling and supervision
| Regulatory Citations | CCR, Title 27, Section 15170 |
| CCR, Title 27, Section 15150(e)(13) |
(CalEPA T03 1/17)
Jurisdiction ______________________________
TABLE 4
TRAINING AND EXPERTISE
| Please indicate the number of staff with experience related to any/all program elements: | ||||
| Job Title | 0 - 2 years | 3 - 5 years | 6 - 9 years | 10+ years |
It is suggested that all job titles in the first column of the table be provided in the following format for each applicable program element:
Program element, staff level.
Example: UST, Supervisor(s)
Generator, Field Staff
| See instructions for Table 1 for program abbreviations. | (CalEPA T04 11/95) |
Cal. Code Regs. Tit. 27, div. 1, 4, ch. 1, pt. II, art. 10, app B