Program
Hazardous Materials
Greg Smith
Manager
(805) 654-2815

Click here to email Greg Smith

Environmental Health
Division
800 South Victoria Ave.
Ventura, CA 93009-1730
(805) 654-2813
Fax: (805) 654-2480


Household Hazardous Waste- click here

Electronic Reporting- click here

Biodiesel

Hazardous Materials CUPA Program Forms
► General Forms
► Hazardous Materials and Hazardous Waste 
► Underground Storage Tanks  (UST)
► Aboveground Petroleum Storage (APSA)/SPCC
► Onsite Hazardous Waste Treatment
► California Accidental Release Prevention Plan (CALARP)
 
General Forms (Required for All Programs)
► Business Owner/Operator Identification Form This form provides the CUPA with facility, environmental contact, and emergency contact information.
Word Word File PDF PDF File
► Business Activities Form This form identifies the CUPA programs for your facility
Word Word File PDF PDF File
Hazardous Materials Business Plan (HMBP) and Hazardous Waste Forms
► NEW FACILITY PACKET

This packet includes: Hazardous Materials Business Plan Fact Sheet, Business Owner/Operator Identification Form, Business Activities Form, Chemical Description Form, Site Map, and Emergency Response/Contingency Plan. 

(Individual forms found below)
  PDF PDF File
► Chemical Description Form This form is used to report chemical information.  Complete this form for each hazardous material and hazardous waste.
Word Word File PDF PDF File
► Site Map Use this form to provide a scaled map of your facility.
Word Word File PDF PDF File
► Emergency Response Contingency Plan Form This form is used to develop plans and procedures in the event of a spill or emergency response involving hazardous materials or hazardous waste.
Word Word File PDF PDF File
► Remote Facility Exemption Request Form This form is used for an unstaffed HMBP remote facility.
Word Word File PDF PDF File
► California Hazardous Waste ID Number
(EPA ID)		 Hazardous waste generators must complete and submit this form to Cal. Dept. of Toxic Substances Control to obtain, reactivate or make corrections of an EPA ID number.
Word Word File PDF PDF File
Underground Storage Tanks (UST)
► UST Permit Application for Installation This form must be completed for the installation of a UST system. Click here for Installation Permit Guidelines.
Word Word File PDF PDF File
► UST Permit Application for Permanent Closure A Permanent Closure Permit must be completed for each UST removal or in place closure.
Word Word File PDF PDF File
► UST Permit Application for Modification or Repair This form must be completed for the modification or repair of a UST system. Click here for Modification or Repair Permit Guidelines.
Word Word File PDF PDF File
► UST Facility Form Complete this form for each Underground Storage Tank (UST) facility.
Word Word File PDF PDF File
► UST Tank Form Complete this form for each UST system.
Word Word File PDF PDF File
► UST Installation/Modification Certification Form This form must be completed for each tank system after any UST modification or installation.
Word Word File PDF PDF File
► UST Monitoring Plan A Monitoring Plan must be submitted to and approved by the regulatory agency. Copies must be kept on-site and available to employees and inspectors.
Word Word File PDF PDF File
► UST Response Plan A Response Plan must be submitted to and approved by the regulatory agency. Copies must be kept on-site and available to employees and inspectors.
Word Word File PDF PDF File
► Certification of Financial Responsibility Financial responsibility entails providing proof that money will be available to meet costs associated with a leak from a UST. Click here for Certification of Financial Responsibility Guidelines.
Word Word File PDF PDF File
► UST Electronic Leak Detection System Certification Electronic leak detection systems for a UST system must be certified annually. This form must be completed at time of certification, and submitted to the regulatory agency within 30 days.
Word Word File PDF PDF File
► UST Secondary Containment Testing Report Form Use this form to report results of any Underground Storage Tank (UST) secondary containment or annual spill containment testing. This form must be completed at time of certification, and submitted to the regulatory agency within 30 days.
Word Word File PDF PDF File
► UST Compliance and Designated Operator Form By January 1, 2005, this form must be completed and submitted to Ventura County EHD. Along with the completed form please include a copy of the International Code Council California UST Operator Certification for each listed Designated UST Operator.
Word Word File PDF PDF File
► Designated UST Operator Monthly Inspection Checklist Use this checklist to conduct monthly Designated UST Operator reporting. At least 12 months of reporting must be available onsite for EHD inspection and review.
Word Word File PDF PDF File
► UST Unauthorized Release Report Use this form to report an unauthorized release from an Underground Storage Tank (UST) system. This form must be completed and submitted to the regulatory agency within 5 days of unauthorized release discovery.
Word Word File PDF PDF File
Aboveground Petroleum Storage Tanks (APSA)/SPCC
► SPCC Tier I Template Tier I facilities are those:
• with no more than 10,000 gallons of oil, and
• with no single container exceeding 5,000 gallons, and
• which has had no single discharge to navigable waters exceeding 1,000 gallons and no two discharges each exceeding 42 gallons within any 12 month period in the prior 3 years

On-line training for completion of the SPCC Tier I templates is available here
Word Word File PDF PDF File
► SPCC Tier II Template

Tier II facilities are those:
• with no more than 10,000 gallons of oil, and
• Have a single container greater than 5,000 gallons, and
• which has had no single discharge to navigable waters exceeding 1,000 gallons and no two discharges each exceeding 42 gallons within any 12 month period in the prior 3 years
Word Word File PDF PDF File
Onsite Hazardous Waste Treatment/Tiered Permit
► Onsite Treatment Notification Form Required to be submitted for all tiers.
Word Word File PDF PDF File
► Unit Page Required to be submitted for each treatment unit for all tiers.
Word Word File PDF PDF File
► Permit By Rule Page Required to be submitted for operation under Permit By Rule for each unit.
Word Word File PDF PDF File
► Conditionally Authorized Page Required to be submitted for operation under Conditional Authorization for each unit.
Word Word File PDF PDF File
► Conditionally Exempt-Limited Page Required to be submitted for operation under Conditionally Exempt-Limited for each unit.
Word Word File PDF PDF File
► Conditionally Exempt-Small Quantity Treatment Page Required to be submitted for operation under Conditionally Exempt- Small Quantity Treatment for each unit.
Word Word File PDF PDF File
► Conditionally Exempt-Specified Wastestream Required to be submitted for operation under Conditionally Exempt-Specified Wastestream for each unit.
Word Word File PDF PDF File
► Certification of Financial Assurance Form Required to be submitted for operation under Permit By Rule and Conditional Authorization
Word Word File PDF PDF File
California Accidental Release Prevention Plan (CALARP)
► Registration Required to be submitted for all facilities with a regulated substance at or above the threshold quantity
Word Word File PDF PDF File