Forms
All forms and brochures included below are in an Adobe Acrobat PDF format: PDF. All CUPA Forms and most 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 Word-Interactive forms, click here. All mail should be sent to the address on the DEH "Contact Us" page. Ask your Specialist for the best FAX number to use.
General and Business Forms
Application - Unified Program Facility Permit HM-906 PDF | WORD
Business Activities HM-9701 PDF | WORD
Business Owner/Operator Identification HM-9702 PDF | WORD
Corrective Action Form to Document Return to Compliance HM-926 PDF | WORD
Hazardous Materials Questionnaire HM-9171 PDF | WORD
Tenant improvement and new business forms and information
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Hazardous Materials Forms
Business Plan HM-952
Business Plan Certification Statement HM-953 PDF | WORD
Disclosure of Hazardous Materials Information Bulletin HM-9243 PDF | WORD
(HM-9243 includes Carcinogen & Reproductive Toxin Report and Highly Toxic Gases)
Hazardous Materials Inventory - Chemical Description HM-9703 PDF | WORD
Small Quantity Generator Emergency Response Plan HM-9099a PDF | WORD
Tank Facility Statement (APSA) HM-9501 PDF | WORD
Aboveground Petroleum Storage Program
CalARP Specific Forms
CalARP Screening, Disclaimer and Deregistration Guide HM-9220 PDF | WORD
CalARP Screening, Disclaimer and Deregistration Form HM-9221 PDF | WORD
How to Determine TQs & TPQs HM-9181 PDF
CalARP Screening Worksheet HM-9223 PDF | WORD
Risk Management Plan (RMP) Work Plan HM-9240 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 PDF | WORD
AST Certification & Engineering Assessment Exemption - Notification HM-9271 PDF
Hazardous Waste Container Weekly Inspection Log HM-9322PDF
Hazardous Waste Tank Closure Certification HM-9704 PDF | WORD
Hazardous Waste Tank System Daily Inspection Log HM-9321 PDF
Photographic Waste Only - Notification HM-9281 PDF | WORD
Recyclable Materials Report HM-9713 PDF | WORD
Remote Waste Consolidation Site Annual - Notification HM-9714 PDF | WORD
More information about HMD's Hazardous Waste Inspection Program
Hazardous Waste Guidance Documents
On Site Hazardous Waste Treatment - Tiered Permitting Forms
Hazardous Waste Treatment Notification-Facility Page HM-9705 PDF | WORD
Hazardous Waste Treatment Notification-Unit Page HM-9706 PDF | WORD
Certification of Financial Assurance HM-9707 PDF | WORD
Conditionally Authorized HM-9708 PDF | WORD
Conditionally Exempt - Limited HM-9709 PDF | WORD
Conditionally Exempt - Small Quantity Treatment HM-9710 PDF | WORD
Conditionally Exempt - Specified Waste Streams HM-9711 PDF | WORD
Permit By Rule HM-9712 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
CFO (fill-in) Docs on UNIDOCS
Claim of Exemption from UST Regulations & Law HM-978 PDF
Designated Operator Training Description and Documentation HM-9177 PDF
Designated UST Operator Monthly Visual Inspection Checklist HM-9175 PDF
Designation of UST Operator & UST Owner Statement of Compliance with UST Requirements HM-9174 PDF | WORD
Special Projects Assistance Program - Application HM-9170 PDF
Spill Bucket Testing Report Form HM-9010 PDF
Tank Integrity Test Report HM-965 PDF
Temporary Closure of UST - Application Cover Sheet & Procedures HM-9119 PDF
Temporary Closure of UST - Application HM-9119a PDF
Unauthorized Release Forms and Instructions (UST Leak Reporting Form)
UST Monitoring System Certification HM-9301 PDF | WORD
UST Secondary Containment Testing Certification HM-9169 PDF | WORD
UST Monitoring Plan - Cover Letter HM-9222 PDF
UST Monitoring Plan HM-9222A PDF | WORD
UST Emergency Response Plan HM-9222B PDF | WORD
UST Monitoring System Plot Plan HM-9222C PDF | WORD
UST Monitoring Plan, ER Plan & Plot Plan HM-9222 combo PDF | WORD
More information about HMD's UST Program
UST Permit Application
Operating Permit Application - Facility Information HM-9715 PDF | WORD
Operating Permit Application -Tank Page HM-9717 PDF | WORD
UST Certificate of Installation / Modification HM-9716 PDF | WORD
UST Certification of Installation HM-9009 PDF
Part I General project information HM-9311 PDF | WORD
Part II Construct a UST facility HM-9312 PDF | WORD
Part III Close a UST system HM-9313 PDF | WORD
Part IV Modify existing UST site HM-9314 PDF | WORD
Part V Interior coating/lining/repair UST HM-9315 PDF | WORD
UST Lining Inspection Requirements
Part VI Construct vaulted UST facility HM-9316 PDF
Part VII Install a UST bladder HM-9317 PDF
More information about HMD's UST Plan Check Program
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Medical Waste Forms
Application for Home-Generated Sharps Consolidation Point HM-9158 PDF | WORD
Application for a Limited Quantity Hauling Exemption HM-9156 PDF
Application for Onsite Medical Waste Treatment Permit HM-9188 PDF | WORD
Medical Waste Management Plan HM-9213 PDF | WORD
More information about HMD's Medical Waste Inspection Program
Medical Waste Guidance Documents
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