Forms
All Forms / Brochures included below are in an Adobe Acrobat PDF format: PDF
All of the CUPA Forms and most of the other forms are also available in Word-Interactive format: Word
Please note that there is currently no option to submit the Word-Interactive forms online. They must be printed and mailed or faxed to the HMD. For instructions on how to complete these forms, click here.
General and Business Forms
Application - Unified Program Facility Permit HM-906 (05-08) PDF | WORD
Business Activities HM-9701 (05-08) PDF | WORD
Business Owner/Operator Identification HM-9702 (03-08) PDF | WORD
Corrective Action Form to Document Return to Compliance HM-926 (07-07) PDF | WORD
Hazardous Materials Questionnaire HM-9171 (04-07) PDF | WORD
Tenant improvement and new business forms and information
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Hazardous Material Forms
Business Plan HM-952 (03-07)
Business Plan Certification Statement HM-953 (05-06) PDF | WORD
Hazardous Materials Inventory - Chemical Description HM-9703 (03-08) PDF | WORD
Disclosure of Hazardous Materials Information Bulletin HM-9243 (01-03) PDF | WORD
HM-9243 For reporting Multiple Pages of carcinogens & reproductive toxins PDF | WORD
CalARP Screening, Disclaimer and Deregistration HM-9220 (05-05) PDF | WORD
Risk Management Plan (RMP) Work Plan HM-9240 (02-08) PDF | WORD
More information about HMD's CalARP Program
Hazardous Materials Guidance Documents
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Hazardous Waste Forms
Aerosol Can Processing - Notification HM-9284 (06-03) PDF | WORD
AST Certification & Engineering Assessment Exemption - Notification HM-9271(01-01) PDF
Hazardous Waste Tank Closure Certification HM-9704 (07-02) PDF | WORD
Hazardous Waste Tank System Daily Inspection Log HM-9321 (10-03) PDF
Photographic Waste Only - Notification HM-9281 (07-07) PDF | WORD
Recyclable Materials Report HM-9713 (07-02) PDF | WORD
Remote Waste Consolidation Site Annual - Notification HM-9714 (07-02) PDF | WORD
More information about HMD's Hazardous Waste Inspection Program
Hazardous Waste Guidance Documents
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On Site Treatment - Tiered Permitting Forms
Hazardous Waste Treatment Notification-Facility Page HM-9705 (07-02) PDF | WORD
Hazardous Waste Treatment Notification-Unit Page HM-9706 (07-02) PDF | WORD
Certification of Financial Assurance HM-9707 (07-02) PDF | WORD
Conditionally Authorized HM-9708 (07-02) PDF | WORD
Conditionally Exempt - Limited HM-9709 (07-02) PDF | WORD
Conditionally Exempt - Small Quantity Treatment HM-9710 (07-02) PDF | WORD
Conditionally Exempt - Specified Waste Streams HM-9711 (07-02) PDF | WORD
Permit By Rule HM-9712 (08-08) PDF | WORD
Tiered Permitting Guidance Documents
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Underground Storage Tank (UST) Forms
Certification of Financial Responsibility
Certification of Financial Responsibility Sample CFO Letter WORD | PDF
Designated Operator Training Description and Documentation HM-9177 (12-06) PDF
Designation of UST Operator & UST Owner Statement of Compliance with UST Requirements HM-9174 (11-04) PDF | WORD
Designated UST Operator Monthly Visual Inspection Checklist HM-9175 (11-04) PDF
Spill Bucket Testing Report Form HM-9010 (04-07) PDF
Tank Integrity Test Report HM-965 (12-06) PDF
Underground Storage Tank Unauthorized Release Forms and Instructions (Leak Reporting Form)
UST Monitoring System Certification HM-9301 (03-08) PDF | WORD
UST Secondary Containment Testing Certification HM-9169 (03-06) PDF | WORD
UST Monitoring Plan - Cover Letter HM-9222 Cover (03-08) PDF
UST Monitoring Plan HM-9222A (08-08) PDF | WORD
UST Emergency Response Plan HM-9222B (08-08) PDF | WORD
UST Monitoring System Plot Plan HM-9222C (09-02) PDF | WORD
More information about HMD's UST Program
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UST Permit Application
Operating Permit Application - Facility Information HM-9715 (08-08) PDF | WORD
Operating Permit Application -Tank Page HM-9717 (08-08) PDF | WORD
UST Certificate of Installation / Modification HM-9716 (03-08) PDF | WORD
Part I General project information HM-9311 (06-08) PDF | WORD
Part II Construct a UST facility HM-9312 (06-08) PDF | WORD
Part III Close a UST system HM-9313 (06-08) PDF | WORD
Part IV Modify existing UST site HM-9314 (06-08) PDF | WORD
Part V Interior coating/lining/repair UST HM-9315 (07-07) PDF | WORD
UST Lining Inspection Requirements
Part VI Construct vaulted UST facility HM-9316 (01-03) PDF
Part VII Install a UST bladder HM-9317 (01-03) PDF
More information about HMD's UST Plan Check Program
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Medical Waste Forms
Application for a Limited Quantity Hauling Exemption HM-9156 (08-05) PDF
Application for Home-Generated Sharps Consolidation Point HM-9158 (08-08) PDF | WORD
Application for Onsite Medical Waste Treatment Permit HM-9188 (05-05) PDF | WORD
Medical Waste Management Plan HM-9213 (05-08) PDF | WORD
More information about HMD's Medical Waste Inspection Program
Medical Waste Guidance Documents
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