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
Hazardous Materials Questionnaire HM-9171 (04-07) PDF | WORD
Unified Program Facility Permit (formerly Health Permit) Application 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
Tenant improvement and new business forms and information
Top
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 Publications
Top
Hazardous Waste Forms
Hazardous Waste Tank Closure Certification HM-9704 (07-02) PDF | WORD
Hazardous Waste Tank System Daily Inspection Log HM-9321 (10-03) PDF
Recyclable Materials Report HM-9713 (07-02) PDF | WORD
Remote Waste Consolidation Site Annual - Notification HM-9714 (07-02) PDF | WORD
Photographic Waste Only - Notification HM-9281 (07-07) PDF | WORD
Aerosol Can Processing - Notification HM-9284 (06-03) PDF | WORD
AST Certification & Engineering Assessment Exemption - Notification HM-9271(01-01) PDF
More information about HMD's Hazardous Waste Inspection Program
Hazardous Waste Publications
Top
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 (07-02) PDF | WORD
Tiered Permitting Publications
Top
Underground Storage Tank (UST) Forms
Spill Bucket Testing Report Form HM-9010 (04-07) PDF
Tank Integrity Test Report HM-965 (12-06) PDF
Designated Operator Training Description and Documentation HM-9177 (12-06) PDF
Certification of Financial Responsibility
Certification of Financial Responsibility Sample CFO Letter WORD | PDF
Underground Storage Tank Unauthorized Release Forms and Instructions (Leak Reporting Form)
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
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 (03-08) PDF | WORD
UST Emergency Response Plan HM-9222B (03-08) PDF | WORD
UST Monitoring System Plot Plan HM-9222C (09-02) PDF | WORD
More information about HMD's UST Program
Top
UST Permit Application
Operating Permit Application - Facility Information HM-9715 (03-08) PDF | WORD
UST Certificate of Installation / Modification HM-9716 (03-08) PDF | WORD
Operating Permit Application -Tank Page HM-9717 (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
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
Top
Medical Waste Forms
Application for a Limited Quantity Hauling Exemption HM-9156 (08-05) PDF
Medical Waste Management Plan HM-9213 (05-08) PDF | WORD
Application for Onsite Medical Waste Treatment Permit HM-9188 (05-05) PDF | WORD
More information about HMD's Medical Waste Inspection Program
Medical Waste Publications
Top
|
