Hazardous Materials Business Plan And Inventory Certification Form - Riverside Country Department Of Environmental Health Page 2
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1
2Instructions for Completing the
HAZARDOUS MATERIALS BUSINESS PLAN AND INVENTORY CERTIFICATION FORM
Pursuant to California Health & Safety Code (H&SC) Section 25505 (d), a business handling hazardous materials shall review and
update their hazardous materials inventory annually. After initial submittal, if a change in your inventory has occurred you may
comply with the annual inventory reporting requirements by submitting this certification form and an updated Hazardous Materials
Inventory – Chemical Description Page. These forms can be downloaded from
Additionally, pursuant to H&SC Section 25505 (c), a handler shall review the business emergency plan at least once every three years
after the initial submittal. A copy of any changes to the plan, along with this certification form, shall be submitted to this
department. The business emergency plan can also be downloaded from the above website.
*Pursuant to H&SC 25270.6 (a)(1) & (2), each owner or operator of a tank facility subject to the Aboveground Petroleum Storage Act
shall annually file a tank facility statement that shall identify the name and address of the tank facility, a contact person for the tank
facility, the total storage capacity of the tank facility, and the location, size, age, and contents of each storage tank that exceeds
10,000 gallons in capacity and that holds a substance containing at least 5 percent of petroleum.
An owner or operator of a tank facility that submits a fully-compliant business plan to this department, satisfies the requirement to
file an annual tank facility statement.
SECTION 1 (completed annually):
Complete the business name, address, and owner information at the top. The facility # can be found on the upper right hand corner
of your permit, starting with “FA00.”
Indicate whether a change in your chemical inventory has occurred. Check the first box if there is no change. If a change has
occurred, check the second box, and submit the updated Hazardous Materials Inventory – Chemical Description Page(s) found in
your business emergency plan.
Print name, title, sign and date at the bottom of this section to certify under penalty of law that the information submitted is true,
accurate, and complete to the best of your knowledge.
SECTION 2 (completed every 3 years):
Complete the business name, address, and owner information at the top. The facility # can be found on the upper right hand corner
of your permit, starting with “FA00.”
Indicate whether a change in your business emergency plan has occurred. Check the first box if there is no change. Write the date
when the plan was last certified in the space provided. The certification date can be found on the bottom of the Business
Owner/Operator Identification Page of your business emergency plan, space #134.
If a change has occurred, check the second box, and the applicable updated sections. Submit this certification form along with the
updated page(s) to this department.
Print name, title, sign and date at the bottom of this section to certify under penalty of law that the information submitted is true,
accurate, and complete to the best of your knowledge.
Rev 4/2012
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