Roseville Fire Department

Roseville Fire Department General Fire Code Requirements Within Commercial Tenant Spaces October 27, 2008 CONTRACTOR S DOCUMENT - RETAIN AT JOB SITE FOR REFERENCE Our Mission Protect and enhance the safety and well being of residents, businesses, customers and partners. We will accomplish this by Delivering exceptional service and compassionate solutions as a cohesive team with dedication, pride and vigilance.

CONTENTS Title... Page 3 Scope... Page 3 Codes and Standards... Page 3 Permits Required... Page 3 Premises Identification... Page 3 Portable Fire Extinguishers... Page 4 Fire Sprinkler System Modifications... Page 5 Fire Extinguishing System Alarms Modifications...Page 5 Combustible Storage in Buildings... Page 6 Use of Combustible Decorative Materials... Page 6 Maintenance of Fire-Resistive Construction...Page 6 Maintenance of Emergency Exits... Page 6 Compressed Gas Storage... Page 7 Flammable Liquids... Page 7 Hazardous Materials... Page 8 Fire Safety During Construction... Page 8 Fire Department Construction Inspection... Page 9 Attachments 1. Plan Submittal Application 2. CUPA Business Activities 3. Construction Inspection Request. Page 2

Title General Fire Code Requirements within Commercial Tenant Spaces. Scope: This handout is designed to assist owners, architects, contractors and others in understanding and complying with the applicable fire safety standards for office and mercantile tenant spaces within the City of Roseville. This handout clarifies the general requirements found within the Fire Code for such uses. This handout is not intended to address specific site issues related to individual projects. Codes and Standards: (as currently adopted) 1. 2007 California Fire Code with City of Roseville amendments 2. 2006 International Fire Code 3. 2007 California Building Code 4. California Mechanical Code 5. 2002 NFPA Standard No. 13- Fire Sprinkler Installation 6. 2002 NFPA Standard No. 72 - Fire Alarm Code 7. Roseville Fire Department Standard on Fire Sprinkler System Installations 8. Roseville Fire Department Standard on Smoke Control Within Buildings Plans: Plans shall be submitted to the Roseville Fire Department for review and approval prior to installation and/or modification of any fire protection systems. Permits Required: The Roseville Fire Department requires a wide variety of permits. Below you will find a brief list of the most common T.I. related permits. Consultation with the fire department to determine which permits apply specifically to your project is not required, but highly recommended. Refer to the current fee schedule that is located at: http://www.roseville.ca.us/fire/fire_prevention/fees_and_permits.asp 1. Fire Sprinkler Tenant Improvement Plan Review 1 to 50 heads Fire Sprinkler Tenant Improvement Plan Review - 51 or more heads 2. Fire Alarm System TI 3. Hood & Duct Fire Suppression System Plan Review 4. Compressed Medical Gas System Plan Review Page 3

5. Hazardous Materials Plan Review Premises Identification: 1. Approved address numbers shall be placed on all new and existing buildings and tenant spaces in accordance with Section 505 of the California Fire Code. Building address numbers shall be plainly visible and legible from the street or road fronting the building. Numbers shall contrast with their background. 2. Building address numbers shall be either internally or externally illuminated so as to be seen from the street or road fronting the building. 3. Building address number heights shall be sized in accordance with the table noted below. The number stroke shall be 1-inch or larger. Distance from Road Address No. Size 0-50 feet 6-inch 50-100 feet 8-inch 100-150 feet 10-inch 150 + feet 12-inch 4. Tenant spaces shall be provided with approved unit numbers as assigned by the City of Roseville Public Works Department - Engineering Division. The assigned tenant space number shall be placed above or directly adjacent to the main entry door into the area served. 5. Tenant space unit numbers shall have a height of 3-inches or larger. The number stroke shall be ½ inch or larger. All unit numbers shall contrast in color with their background. 6. Tenant spaces that are provided with additional exterior access doors shall be provided with unit numbers conforming to the above criteria. Portable Fire Extinguishers: 1. Portable fire extinguishers shall be installed in all businesses and locations as set forth in Section 906 of the California Fire Code. 2. Portable fire extinguishers located in general office and mercantile areas shall be provided with a multiple-purpose dry chemical agent that provides a minimum rating classification of 2A-10B:C. 3. The maximum travel distance to a portable fire extinguishers within general office and mercantile areas shall not exceed 75-feet. Extinguishers shall be located adjacent to emergency exits where possible. 4. A minimum of one (1) K Type portable fire extinguisher shall be located within 30- feet of commercial hood and duct fire suppression system locations. 5. Portable fire extinguishers shall be installed on the hangers provided or within an approved storage cabinets. Cabinets housing extinguishers shall not be locked unless they are provided with a means of emergency access. Page 4

6. Portable fire extinguishers shall be installed so that the top of the extinguisher is no more than 5 feet, and no less than 3 feet above the floor. Portable fire extinguishers having a gross weight greater than 40 pounds shall be so installed that the top of the extinguisher is not more than 3-feet, 6-inches from the floor. 7. Portable fire extinguishers mounted in cabinets or on brackets shall be placed in such a manner such that the extinguisher operating instructions face outward. 8. Portable fire extinguishers shall not be obstructed or obscured from view. In large rooms, and in certain locations where visual obstruction cannot completely be avoided, an approved sign, which states FIRE EXTINGUISHER, shall be located above the extinguisher. 9. Portable fire extinguishers installed shall have a service tag, and internal maintenance tag affixed to them from a California State Fire Marshal registered fire extinguisher concern prior to final occupancy approval by the fire department. Fire extinguishers shall be serviced on an annual basis in accordance with California Code of Regulations, Title 19. Fire-Sprinkler System Modifications: 1. Automatic fire sprinkler systems shall be installed and maintained in accordance with Section 903 of the California Fire Code. Automatic fire sprinkler systems shall be extended, altered or augmented as necessary to maintain and continue protection whenever the building is altered, remodeled or increased in size. 2. Automatic fire sprinkler system modifications shall be designed and installed in accordance with NFPA 13 - Fire Sprinkler Installation, and Fire Department standards. All necessary work to an automatic fire sprinkler system shall be reviewed and approved by the Fire Department prior to final occupancy of the project. 3. All work associated with modification to an existing automatic fire sprinkler system shall be performed by a State of California Licensed C-16 (Fire Protection) contractor. 4. A fire department plan review fee shall be paid prior to submittal of plans and specifications for all changes to the system. 5. Existing automatic fire sprinkler systems that have been modified with the addition or replacement of system risers, mains, branch lines and other equipment, except for fire sprinkler drops into tenant spaces, shall be hydrostatically tested at 150 PSI for a 2 hour test period. No loss of pressure or water leakage is permitted in the system. Fire Extinguishing System Alarm Modifications: 1. Fire extinguishing system alarms shall be installed and maintained in accordance with NFPA 72 and Sections 901 and 907 of the California Fire Code. Fire extinguishing system alarms shall be extended, altered or augmented as necessary to maintain and continue protection whenever the building is altered, remodeled or increased in size. 2. Fire extinguishing system alarms shall be designed, installed and maintained in accordance with the protective premises fire alarm system requirements found within Chapter 4 of NFPA 72 - National Fire Alarm Code, and Fire Department standards. All necessary work to a fire extinguishing system alarm shall be reviewed and approved by the Fire Department prior to final occupancy of the project. Page 5

3. All buildings provided with an automatic fire extinguishing system constructed after March 7, 1995, shall be provided with approved audible and visual evacuation warning appliances located in a constantly attended area, in accordance with Section 903.4.2 of the California Fire Code. These devices shall be provided in accordance with the Notification Appliance for Fire Alarm System provisions found within Chapter 7 of NFPA 72. 4. All work associated with modification to an existing fire extinguishing system alarms shall be performed by a State of California Licensed C-10 (Electrical) contractor. 5. A fire department plan review fee shall be paid prior to submittal of plans and specifications for all changes to the system. HVAC System Fire Alarm Modifications: 1. A single HVAC system, or a combination of units that are capable of moving 2000 CFM s and serve one tenant space, shall be equipped with a smoke duct detector. Multiple HVAC units that combined move 2000 CFM s or more and serve multiple tenant spaces that are not separated by full height walls shall also be equipped with a smoke duct detector. 2. Smoke duct detectors shall be monitored by the fire alarm control panel. Exception: Not required if fire alarm system only monitors water flow and valve supervision of fire sprinkler systems. 3. Smoke duct detectors; when activated, shall report to the fire alarm panel as a supervisory signal. 4. Smoke duct detectors shall be tested for HVAC shutdown and notification at the fire alarm panel. Shutdown for the smoke detector may be demonstrated with the use of a magnet or application of canned smoke. Flow through the detector shall be measured with a Magnehelic or Manometer device, provided by an HVAC technician or the general contractor. 5. All work associated with modification to an existing fire alarm system shall be performed by a State of California Licensed C-10 (Electrical) contractor. 6. A fire department plan review fee shall be paid prior to the submittal of plans and specifications for all changes to the system. Knox Access The building containing your tenant improvement project may have a Knox key box located on the exterior of the building for fire department access in the event of an emergency. It may be necessary to place a key(s) related to your project within the Knox box. Please consult your fire inspector to determine if keys to your project are necessary within the Knox box. Combustible Storage in Buildings: 1. Storage in buildings shall be maintained 2-feet or more below the ceiling in non-fire sprinklered areas of buildings. Page 6

2. Storage shall be maintained 18-inches or more below sprinkler head deflectors in fire sprinklered areas of buildings. 3. Combustible material shall not be stored in exits or exit enclosures. 4. Combustible materials shall not be stored in boiler rooms, mechanical rooms or electrical equipment rooms. Use of Combustible Decorative Materials: 1. Combustible decorative materials, including drapes, curtains, textile and film materials, wood materials less than ¼-inch, and foam plastics, used in Group A, and Group M wholesale and retail stores shall be flame resistant in accordance with the requirements of Section 807 of the California Fire Code. 2. All flame resistant treatment materials used to render materials flame resistant shall be listed by the California Fire Marshal, and shall be renewed as often as necessary to maintain the materials flame resistance. Maintenance of Fire-Resistive Construction: 1. Required fire-resistive construction, including occupancy separations, area separation walls, exit corridors, draft-stop partitions and roof coverings shall be maintained as specified in the California Building Code. 2. When required fire-rated gypsum walls or ceilings are penetrated to the extent that openings exist, the damaged wallboard shall be replaced or returned to the required level of fire resistance using a listed repair system or using materials equivalent to the original construction. 3. Required fire assemblies, including fire-rated doors and window openings, shall be maintained as specified by the California Building Code and the installation manufacturer. The fire rated assembly shall bear an approved label or other identification showing the rating thereof, and shall be properly repaired, restored or replaced when damaged, altered, penetrated, removed or improperly installed. Maintenance of Emergency Exits: 1. All exits in buildings and structures used or intended to be used for human occupancy shall comply with the provisions of Chapter 10 of the California Fire Code. 2. Aisles leading to required exits must be provided from all portions of buildings and tenant spaces. 3. In areas serving employees only, the minimum aisle width shall be 24-inches minimum, but not less than the width required by the number of employees served. 4. In public areas of office and mercantile occupancies, the minimum clear aisle width shall be 36-inches where tables, counters, chairs, furnishings, merchandise and other similar obstructions are placed on one side of the aisle only. Where such materials are placed on both sides of the aisle, a minimum aisle width of 44-inches shall be maintained at all times. Page 7

5. Obstructions, including storage, shall not be placed in the required width of an exit. Exits shall not be obstructed in any manner and shall remain free of any material or matter where its presence would obstruct or render an exit hazardous. 6. Exit doors shall be maintained in an operable condition in accordance with Section 1008 of the California Fire Code. 7. Doors leading from the tenant space into fire-rated exit corridors shall not be obstructed in any manner, including wedges, to prevent the door from closing and latching against the doorframe as required by 1028.2 of the California Fire Code. 8. Exit doors must be operable from the inside without the use of a key or any special knowledge or effort except as noted in Section 1008.1.8 of the California Fire Code. 9. In office and mercantile tenant spaces, key locking hardware may be used on the main exit only if there is a durable sign on or adjacent to the door which reads THIS DOOR TO REMAIN UNLOCKED DURING BUSINESS HOURS. The sign must be in letters not less than 1-inch high on a contrasting background. When unlocked, the door must be free to swing without operation of any latching device. Compressed Gas Storage: 1. Storage, use and handling of compressed gases in containers, tanks and systems shall be in accordance with Chapter 30 of the California Fire Code. 2. Compressed gas containers, tanks and systems shall be marked in accordance with Sections 3003.4.1 through 3003.4.3 of the California Fire Code. Markings shall be visible from any direction. Markings used for piping systems shall consist of the content s name and include a direction of flow arrow. 3. Compressed gas containers, cylinders and systems, which could be exposed to physical damage shall be protected. 4. Compressed gas containers, cylinders and tanks shall be secured to prevent falling due to contact, vibration or seismic activity. Secure all gas containers, cylinders and tanks by an approved hook and chain device located 2/3 of the way up from the floor. 5. Compressed medical gas storage shall be located in areas dedicated to the storage of such gases without other storage or uses. When containers of medical gases in quantities greater than the permit amount are located inside buildings, they shall be in a 1-hour exterior room, or a 1-hour interior room, or a gas cabinet in accordance with Section 3006.2.3 of the California Fire Code. A fee for the plan review and inspection of such a system will be applied and is payable upon submittal of said plans. 6. Medical facilities storing less than 1,000 cubic feet of compressed gas are exempt from the business plan requirement pursuant to the H&SC 6.95. When quantities exceed this amount at a medical facility, a business plan must be submitted. Guidance literature and a questionnaire can be obtained from the fire department s website at www.roseville.ca.us/fire/. Flammable Liquids: 1. The storage and use of flammable liquids in excess of ten (10) gallons within office and mercantile tenant spaces shall be in accordance with Chapter 34 of the California Fire Code. Page 8

2. Quantities of flammable and combustible liquids permitted within an office or mercantile tenant space shall not exceed the provisions listed within Section 3404.3.4 and Table 3404.3.4.1 of the California Fire Code. 3. Contact the fire department regarding a permit when the quantity of flammable liquids exceeds 25 gallons (flash point < 100 degrees), or when combustible liquids (including motor oil and used oil combined) exceeds 110 gallons. 4. A business plan is required if the quantity of flammable liquids exceeds 55 gallons. Hazardous Materials: 1. The storage and use of hazardous materials within office and mercantile tenant spaces shall be in accordance with Chapter 27 of the California Fire Code. 2. Permits are required to store, dispense, use or handle hazardous materials in excess of the quantities specified in Section 105, Permit h.1 of the California Fire Code. 3. When required by the Fire Department, a Hazardous Materials Business Plan (HMBP) shall be prepared for the facility in accordance with Chapter 6.95 of the California Health & Safety Code. 4. Contact this office for applicable permit and fee information. Fire Safety During Construction, Alteration or Demolition: 1. Buildings and tenant spaces under construction, alteration or demolition shall be provided with approved safety measures as required by Chapter 14 of the California Fire Code. 2. A minimum of one (1) portable fire extinguisher with a rating of 2A-10B:C shall be provided within the construction area. Said fire extinguisher shall be located in an area that is readily accessible by all workers, and shall remain unobstructed at all times. Said fire extinguisher shall have been serviced within the last 1 year by a CSFM licensed fire extinguisher concern. 3. Combustible debris shall not be accumulated within buildings or tenant spaces. Combustible debris, rubbish and waste material shall be removed from buildings prior to the end of daily construction work. 4. Temporary heating devices, including dry-wall heaters, shall be of an approved type. Said heating device shall be located away from combustible materials in accordance with the manufacturer-supplied specifications. 5. Temporary heating devices, including dry-wall heaters, shall not be left in operation after construction hours unless an approved fire-watch is provided on an hourly basis. A Fire Department Permit to Operate shall be obtained prior to the use of such heating appliances after hours. 6. Smoking is prohibited within the construction area. A suitable number of NO SMOKING signs shall be posted in the construction area to warn all occupants. Page 9

7. When a building is protected by an automatic fire-sprinkler system, such systems shall be maintained operational at all times during construction or alterations to the building or tenant space. When alterations to the building or tenant space involve the automatic fire sprinkler system, a fire watch shall be kept on site until the system is returned to service. 8. Operations involving the removal of asbestos or asbestos-containing materials from buildings shall be in accordance with regulations established by the State Department of Toxic Substances Control when the waste contains more than 1% friable asbestos. A call to inquire about state regulations should be made to the DTSC Duty Officer 800-72-TOXICS (86942). Additionally, owners and/or contractors shall refer to 25917 of the Health and Safety Code prior to commencing asbestos removal. The Fire Department shall be notified 24-hours prior to the commencement and closure of asbestos-removal operations. 9. Temporary construction barriers, including plastic film sheeting and plywood, shall not obstruct exits from the building. Where required by the Fire Department, such materials shall be flame resistant. Fire Department Construction Inspection Process: 1. Construction or work for which fire department approval is required shall be subject to inspection by a Fire Inspector, and such construction or work shall remain accessible and exposed for inspection purposes until approved. 2. It shall be the duty of the person doing the work authorized by a permit to notify the fire department that such work is ready for inspection. A request for inspection shall provide a minimum of 48-hours advance notice to the Fire Department. 3. All requests for inspection shall be made directly to the Fire Department. by sending an Inspection Request Form via FAX to (916) 774-5810. Please refer to the attached Inspection Request FAX Form for additional information. 4. A complete set of City of Roseville Building Inspection Division approved construction drawings shall be available at the project site for review by the Fire Inspector. 5. The City of Roseville Building Construction Permit Sign-off Card, and the Fire Department Permit Card shall be available on-site for use by the Fire Inspector. Revision History Rev Description of Change Issue Date Approved Date: 01 Initial Release 02/18/99 02/18/99 02 Revision 08/08/02 08/08/02 03 Revision 06/05/06 06/05/06 04 Revision 07/25/06 07/25/06 05 Revision 10/03/08 10/27/08 Page 10

City of Roseville Fire Department Construction Inspection Request Form Step 1: Please complete the following information. A minimum of 48-hours advance notice is required before inspection requests will be performed by the Fire Department. Note: Due to scheduling conflicts, all inspection start times are estimated time frames only. Note: The Fire Department requires approved plans prior to any inspection. Date Form Submitted: BD# Project Address: Project Name: Person / Company Requesting Inspection: Your Phone No Your Fax No. Date of Requested Inspection: AM PM Step 2: Please check the appropriate inspection request boxes. Underground Fire Service Water Mains: Field inspection of approximately feet of fire service water line 75030 Witness hydrostatic pressure test of the fire service water line installation 75040 Acceptance test of the system flush of the fire service water line installation 75050 Perform fire-flow test from the fire service water main system 75060 Fire Sprinkler System Installation: Field inspection of approx. sections of welded fire sprinkler pipes 75110 Field inspection of fire sprinkler piping, hanger and bracing installation 75120 Witness hydrostatic pressure test for the fire sprinkler system(s) 75130 / 40 Final inspection of the fire sprinkler system installed in the building 75190 / 95 Fire Alarm System Installation: Field inspection of fire alarm system devices installed 75230 Acceptance test of the 24-hour fire alarm standby power test 75280 Field inspection of the central station alarm monitoring system 75295 Miscellaneous Inspections: Acceptance test of hood & duct fire suppression system(s) 75320 Acceptance test of medical gas / compressed gas system(s) 75380 Other inspection type: Final acceptance of shell building construction permit work for the project 75710 Final inspection of tenant improvement permit work for the project 75720 Step 3: FAX the completed form to the Roseville Fire Department at (916) 774-5810. This form will be faxed back to you with a scheduled inspection date and estimated time. See below. Please note that whenever a requestor fails to cancel a requested inspection prior to the scheduled time of inspection, the standard inspection fee shall be charged, based on a one (1) hour minimum rate. To cancel an inspection, please call (916) 774-5800. FIRE DEPARTMENT USE ONLY Assigned Fire Inspector: Date / Time of Inspection: ( ) AM ( ) PM Comments: Page 11

Date: Roseville Fire Department Fire Prevention Bureau Plan Submittal Application 401 Oak Street, #402 Roseville, CA 95678 Phone (916) 774-5800 Fax (916) 774-5810 BD Number: Project Name: Project Address New Construction Commercial Tenant Improvement Residential A P P Name: Day Phone L I C Address Fax: A N T City Zip Pager C O I N N S F T O R R U M C A T T I I O O N N Company Name: Contractor: Phone Fax Address: City: Zip Arch/Engineer: Phone: Fax Address: City: Zip Owner/Lessee: Page 12 Phone Address: City: Zip Construction/Building Code Classification Building Construction Type: Occupancy Type: Code Edition Used: UBC UFC: Civil Improvement Other Civil Improvement Compressed Gas System Number of Hydrants Haz Mat Medical Reinspections (2nd and Subsequent) New Commercial Fire Sprinkler System Postage Fee(s)/Mailing/Handling 1-99 Sprinkler Heads Special Fire Plan Review Request 100-199 Sprinkler Heads Hood System 200 or more Sprinkler heads Spray Booth Total Number Heads Fire Pump After Hour Inspection Tenant Improvement/Fire Sprinkler System Fire Department Access (Knox) Number of Devices 1-50 Sprinkler Heads Halon & Other Special Extinguishing System(s) 51 or more Sprinkler Heads Standpipe Plan Check Total Number Heads Total Number of Risers Lot Splits/Subdivisions Fire Flow Test 1-4 Lots Smoke Management 5-24 Lots 25 or more Lots Alarm Systems Total Number of Lots Fire Alarm System Resubmittal Total Number of Initiating Devices Ist 2nd More Flow and Tamper Alarm Plan Check ALL APPLICABLE FEES MUST BE PAID AT TIME OF PLAN SUBMITTAL. BD NUMBER AND PROJECT STREET ADDRESS REQUIRED FOR ALL SUBMITTALS AND INQUIRIES.

Licensed Contractor s Declaration I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class: License Number: License Expiration Date: City Business License Number: Contractor s Signature: Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-insure for workers compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers compensation insurance as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers compensation insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is for one hundred dollars ($100.00) or less) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers compensation laws of California, and agree that if I should become subject to workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant s Signature: WARNING: Failure to secure worker s compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest, and attorney s fee. Page 13

ROSEVILLE FIRE DEPARTMENT UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES I. FACILITY IDENTIFICATION FACILITY ID # 1 3 1 0 1 5 EPA ID # (Hazardous Waste Only) BUSINESS NAME/ADDRESS (Same as Facility Name of DBA-Doing Business As) 3 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility If Yes, please complete these pages of the UPCF. A. HAZARDOUS MATERIALS YES NO 4 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (OES 2731) Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? YES NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? YES NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? YES NO 7 UST TANK (closure portion one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or YES NO 8 NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? YES NO 9 EPA ID NUMBER provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted YES NO 10 RECYCLABLE MATERIALS REPORT (one per recycler) recyclable materials (per HSC 25143.2)? 3. Treat hazardous waste on site? YES NO 11 ONSITE HAZARDOUS WASTE TREATMENT FACILITY (Formerly DTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for YES NO 12 CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Form 1232) Permit by Rule and Conditional Authorization)? 5. Consolidate hazardous waste generated at a remote site? YES NO 13 REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? Page 14 YES NO 14 HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS 15 1. Refrigeration unit and system installations having a refrigerant circuit containing more than 220 pounds of group A or 30 YES NO pounds of any other group of refrigerant. 2. Storage use and handling of toxic gases in amounts exceeding 10 cubic feet per control area YES NO 3. Storage, use and handling of toxic gases in excess of 20 cubic feet per control area. YES NO 4. Storage, use or handling of any amount of highly toxic compressed gases. YES NO

Signature: Date: Page 15

Business Activities Please submit the Business Activities page, the Business Owner/Operator Identification page (OES Form 2730), and Hazardous Materials Inventory - Chemical Description pages (OES Form 2731) for all submissions. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER - Leave this blank. This number is assigned by the Certified Unified Program Agency (CUPA) or Administering Agency (AA). This is the unique number which identifies your facility. 2. EPA ID NUMBER - If you generate, recycle, or treat hazardous waste, enter your facility's 12-character U.S. Environmental Protection Agency (U.S. EPA) or California Identification number. For facilities in California, the number usually starts with the letters ΑCA. If you do not have a number, contact the Department of Toxic Substances Control (DTSC) Telephone Information Center at (916) 324-1781, (800) - 61-TOXIC or (800) 61-86942, to obtain one. 3. BUSINESS NAME - Enter the full legal name of the business. This is the same as the terms ΑFacility Name or ΑDBA - Doing Business As that might have been used in the past. 4. HAZARDOUS MATERIALS ONSITE - Check the box to indicate whether you have a hazardous material onsite. You have a hazardous material onsite if: - It is handled in quantities equal to or greater than 500 pounds, 55 gallons, or 200 cubic feet of gas (calculated at standard temperature and pressure), - It is handled in quantities equal to or greater than the applicable federal threshold planning quantity for an extremely hazardous substance listed in 40 CFR Part 355, Appendix A, - Radioactive materials are handled in quantities for which an emergency plan is required to be adopted pursuant to Part 30, Part 40, or Part 70 of Chapter 10 of 10 CFR, or pursuant to any regulations adopted by the state in accordance with these regulations. If you have a hazardous material onsite, then you must complete the Business Owner/Operator Identification page (OES Form 2730) and the Hazardous Materials Inventory - Chemical Description page (OES Form 2731), as well as an Emergency Response Plan and Training Plan. Do not answer ΑYES to this question if you exceed only a local threshold, but do not exceed the state threshold. 5. OWN OR OPERATE UNDERGROUND STORAGE TANK (UST) - Check the appropriate box to indicate whether you own or operate USTs containing hazardous substances as defined in Health and Safety Code (HSC) 25316. If YES, then you must complete one UST Facility page and UST Tank pages for each tank. You must also submit a plot plan and a monitoring program plan. 6. UPGRADE/INSTALL UST - Check the appropriate box to indicate whether you intend to install or upgrade USTs containing hazardous substances as defined in HSC 25316. If YES, then you must complete the UST Installation - Certificate of Compliance page in addition to UST Facility and Tank pages, plot plan and monitoring program plan. 7. UST CLOSURE - Check the appropriate box if you are closing an UST and complete the closure portion of the UST Tank pages for each tank. (CUPAs may require additional information.) 8. OWN OR OPERATE ABOVEGROUND PETROLEUM STORAGE TANK (AST) - Check the appropriate box to indicate whether there are ASTs onsite which exceed the regulatory thresholds. (There is no UPCF page for ASTs.) This program applies to all facilities storing petroleum in aboveground tanks. Petroleum means crude oil, or any fraction thereof, which is liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure (HSC 25270.2 (g)). The facility must have a single tank greater than 660 gallons, or cumulative storage capacity greater than 1,320 gallons for all ASTs. NOT Subject to the Act (exemptions): An aboveground petroleum storage tank (AST) facility with one or more of the following (see HSC 25270.2 (k)) is not subject to this act and is exempt: - A pressure vessel or boiler which is subject to Division 5 of the Labor Code, - A storage tank containing hazardous waste if a hazardous waste facility permit has been issued for the storage tank by DTSC, - An aboveground oil production tank which is regulated by the Division of Oil and Gas, - Certain oil-filled electrical equipment including but not limited to transformers, circuit breakers, or capacitors. 9. HAZARDOUS WASTE GENERATOR - Check the appropriate box to indicate whether your facility generates hazardous waste. A generator is the person or business whose acts or processes produce a hazardous waste or who causes a hazardous substance or waste to become subject to State hazardous waste law. If your facility generates hazardous waste, you must obtain and use an EPA Identification number (ID) in order to properly transport and dispose of it. Report your EPA ID number in #2. Hazardous waste means a waste that meets any of the criteria for the identification of a hazardous waste adopted by DTSC pursuant to HSC 25141. "Hazardous waste" includes, but is not limited to, federally regulated hazardous waste. Federal hazardous waste law is known as the Resource Conservation and Recovery Act (RCRA). Unless explicitly stated otherwise, the term "hazardous waste" also includes extremely hazardous waste and acutely hazardous waste. 10. RECYCLE - Check the appropriate box to indicate whether your facility recycles more than 100 kilograms per month of recyclable material under a claim that the material is excluded or exempt per HSC 25143.2. Check YES and complete the Recyclable Materials Report pages, if you either recycled onsite or recycled excluded recyclable materials which were generated offsite. Check NO if you only send recyclable materials to an offsite recycler. You do not need to report. 11. ONSITE HAZARDOUS WASTE TREATMENT - Check the appropriate box to indicate whether your facility engages in onsite treatment of hazardous waste. "Treatment" means any method, technique, or process which is designed to change the physical, chemical, or biological character or composition of any hazardous waste or any material contained therein, or removes or reduces its harmful properties or characteristics for any purpose. "Treatment" does not include the removal of residues from manufacturing process equipment for the purposes of cleaning that equipment. Amendments (effective 1/1/99) add exemptions from the definition of treatment for certain processes under specific, limited conditions. Refer to HSC 25123.5 (b) for these specific exemptions. Treatment of certain laboratory hazardous wastes do not require authorization. Refer to HSC 25200.3.1 for specific information. Please contact your CUPA to determine if any exemptions apply to your facility. If your facility engages in onsite treatment of hazardous waste then complete the Onsite Hazardous Waste Treatment Notification - Facility page and one set of Onsite Hazardous Waste Treatment Notification - Unit pages with waste and treatment process information for each unit. 12. FINANCIAL ASSURANCE - Check the appropriate box to indicate whether your facility is subject to financial assurance requirements for closure of an onsite treatment unit. Unless they are exempt, Permit by Rule (PBR) and Conditionally Authorized (CA) operations are required to provide financial assurance for closure costs (per 22 CCR 67450.13 (b) and HSC 25245.4). If your facility is subject to financial assurance requirements or claiming an exemption, then complete the Certification of Financial Assurance page. 13. REMOTE WASTE CONSOLIDATION SITE - Check the appropriate box to indicate whether your facility consolidates hazardous waste generated at a remote site. Answer YES if you are a hazardous waste generator that collects hazardous waste initially at remote sites and subsequently transports the hazardous waste to a consolidation site you also operate. You must be eligible pursuant to the conditions in HSC 25110.10. If your facility consolidates hazardous waste generated at a remote site, then complete the Remote Waste Consolidation Site Annual Notification page. Page 16

14. HAZARDOUS WASTE TANK CLOSURE - Check the appropriate box to indicate whether the tank being closed would be classified as hazardous waste after its contents are removed. Classification could be based on: - Your knowledge of the tank and its contents - The mixture rule - Testing of the tank - The listed wastes in 40 CFR 261.31 or 40 CFR 261.32. - Inability to remove hazardous materials stored in the tank. If the tank being closed would be classified as hazardous waste after its contents are removed, then you must complete the Hazardous Waste Tank Closure Certification page. 15. LOCAL REQUIREMENTS - Some CUPAs or AAs may require additional information. Check with your CUPA before submitting the UPCF to determine if any supplemental information is required. Page 17