FORMS & DOCUMENTS

Environmental Compliance Division

CUPA Regulatory Compliance (Hazardous Materials) Forms

• Hazardous Materials Business Plan Forms
• Business Plan Assistance Workshop Schedule
• Request for Specific Material Exemption from Hazardous Materials PreRelease Response Plans & Inventory Requirements
• Area Plan for Emergency Response to Hazardous Materials Incidents in Sacramento County
• Guidelines for Generators of Hazardous Waste
• Hazardous Materials (CUPA) Inspection and Enforcement Plan
• Unified Program Fee Dispute Resolution Procedure
• CUPA Checklists and Return to Compliance Statements
• Meth Lab Cleanup Forms
• CAL-ARP Program
• Master Hazardous Materials Facility List
• Toxic Site Clean-Up List

Underground Storage Tank (UST) Forms

• Application Forms for Permit to Install, Upgrade or Repair UST(s)
• Application Forms for Permit to Remove UST(s)
• Application to Temporarily Close UST(s)
• Biodiesel Forms
• Underground Storage Tank (UST) Information Documents

Aboveground Storage Tank (AST) Forms

• Aboveground Petroleum Storage Tank Facility Statement
• Aboveground Storage Tank (AST) Information Documents

Solid Waste Program Forms & Documents

• Medical Waste Forms
• Business Recycling Program Information
• Waste Tire Program Information

Cross Connection Control (Backflow Prevention) Forms & Documents

• Certified Backflow Prevention Assembly Tester Application Form
• Certified Backflow Prevention Assembly Tester List
• Approved Backflow Prevention Assembly Lists
• Sacramento County Cross Connection Ordinance

Onsite Sewage Disposal (Septic System) Forms & Documents

• Septic Permit Application Form
• Onsite Sewage Disposal System Consultation Service Request Form
• Onsite Service Provider Lists
• Onsite Sewage Disposal Systems: Sacramento County Rules & General Information

Small Public Water Systems Forms & Documents

• Public Water System Repair Permit Form
• Small Water Systems Certified Operators List
• Well Water Testing Laboratories List
• Other Small Water Forms

Stormwater Compliance Forms & Documents

• General Industrial Stormwater Permit Notice of Intent (NOI) form
• StormWater Inspection Checklists
• Stormwater Program Compliance Guidelines and Brochures

Wells Program Forms & Documents

• Wells Program Contact List
• Sacramento County Well Ordinance & Enforcement Policy
• Well Application and Permit Forms
• Well Driller's List
• Well Water Testing Laboratories List
• Well Information Documents

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CUPA Forms and Information Documents

CUPA Regulatory Compliance (Hazardous Materials) Forms

• Hazardous Materials Business Plan Forms
• Schedule for Free Hazardous Materials Business Plan Assistance Workshops Updated 06/09/2009
  Call (916) 875-8550 to register to attend this free Workshop. You MUST register at least 24 hours before the class. Workshops will be canceled if no one is registered.
• Request for Specific Material Exemption from Hazardous Materials Release Response Plans and Inventory Requirements - Microsoft Word Updated 11/12/2009
• Request for Specific Material Exemption from Hazardous Materials Release Response Plans and Inventory Requirements - Adobe Acrobat Updated 11/12/2009     

CUPA Regulatory Compliance (Hazardous Materials) Information Documents

• Hazardous Materials (CUPA) Inspection and Enforcement Plan Updated 06/02/2008
• Area Plan for Emergency Response to Hazardous Materials Incidents in Sacramento County Updated 09/15/2007
• Guidelines for Generators of Hazardous Waste Updated 06/01/2008
• Unified Program Fee Dispute Resolution Procedure Updated 07/11/2006

CUPA Inspection Checklists

• Checklist Summary of Violations for Business Plan / Hazardous Materials / Above Ground Storage Tanks Updated 05/05/2009
• Return to Compliance Statement for BP/HM/AST Checklist Updated 05/05/2009

• Checklist Summary of Violations for Hazardous Waste Updated 05/05/2009
• Return to Compliance Statement for Hazardous Waste Checklist Updated 05/05/2009
• LQG Checklist Summary of Violations for Hazardous Waste (Page 3) Updated 05/05/2009

• Checklist Summary of Violations for Tiered Permitting Updated 05/05/2009
• Return to Compliance Statement for Tiered Permitting Checklist Updated 05/05/2009

• Checklist Summary of Violations for Underground Storage Tanks (UST) - For All Tank & Piping Systems Updated 05/05/2009
• Corrective Actions Certification (Return to Compliance) Statement for UST Checklist Updated 05/05/2009

• Checklist Summary of Violations for Underground Storage Tanks (UST) - Addendum for Emergency Generator, Single-Walled or Vaulted Systems Updated 05/05/2009
• Corrective Actions Certification (Return to Compliance) Statement for UST Checklist Addendum Updated 05/05/2009

• Checklist Summary of Violations for Cal-ARP Program General Requirements Updated 05/05/2009
• Return to Compliance Statement for Cal-ARP Program General Requirements Updated 05/05/2009

• Checklist Summary of Violations for Cal-ARP Program Level 2 Updated 05/05/2009
• Return to Compliance Statement for Cal-ARP Program Level 2 Updated 05/05/2009

• Checklist Summary of Violations for Cal-ARP Program Level 3 Updated 05/05/2009
• Return to Compliance Statement for Cal-ARP Program Level 3 (Page 1)
• Return to Compliance Statement for Cal-ARP Program Level 3 (Page 2)
• Return to Compliance Statement for Cal-ARP Program Level 3 (Page 3)
• Return to Compliance Statement for Cal-ARP Program Level 3 (Page 4)
• Return to Compliance Statement for Cal-ARP Program Level 3 (Page 5) Updated 05/05/2009

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Methamphetamine Laboratory Contamination Guidelines and Documents

Updated 05/05/2009

• 01-Plan for the Assessment and Remediation of Properties Contaminated by Meth Laboratory Activities
• 02-Meth Lab Field Worksheet
• 03-Meth Lab Posted Warning for Contaminated Property
• 04-Meth Lab Clean-Up Checklist
• 05-Notice of Order (Enforcement Letter) Template for Property Contaminated by Meth Lab Activities
• 06-Notice of Lien Template for Meth Lab Contaminated Property
• 07-Release of Lien Template for Meth Lab Contaminated Property
• 08-No Further Action (NFA) Determination Template for Meth Lab Contaminated Property
• 09-Meth Lab Preliminary Site Assessment (PSA) Report Approval Template
• 10-Meth Lab Preliminary Site Assessment (PSA) Work Plan Approval Template
• 11-Meth Lab Preliminary Site Assessment (PSA) Work Plan Denial Template
• ALL Meth Lab Remediation documents above (11) in one file

• Criteria for the Assessment and Remediation of Clandestine Methamphetamine Laboratories (.pdf) Updated 05/01/2003

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Underground Storage Tank (UST) Forms

Application Forms for Permit to Install, Upgrade or Repair UST(s)

Updated 05/06/2009

• Install, Upgrade or Repair Cover Letter
• UST Application Form
• Unified Program Consolidated Form (State of California)  
• Drawings & Parts List Requirements Checklist
• Legal UST Owner's Authorization Letter (used if Application not filled out by Owner)
• Sampling Protocol for UST Removals, Upgrades and Repairs
• ALL UST documents above (6) in one file

• Underground Storage Tank (UST) Construction Permit Fee Summary Updated 07/01/2009

• UST Owner Statement of Compliance & Identification of Designated Operator - County of Sacramento
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)
  Updated 05/07/2009
• UST Owner Statement of Compliance & Identification of Designated Operator - State of California
  Adobe Acrobat (.pdf) Updated 09/01/2004

Application Forms for Permit to Remove UST(s)

Updated 05/06/2009

• Removal Application Form
• Legal UST Owner's Authorization Letter (used if Application not filled out by Owner)
• Unified Program Consolidated Form (State of California)
• Sampling Protocol for UST Removals, Upgrades and Repairs
• ALL UST Removal documents above (4) in one file

• Underground Storage Tank (UST) Permit Fee Summary  Updated 07/01/2009

Application to Temporarily Close UST(s)

• Application to Temporarily Close Underground Storage Tanks Updated 05/06/2009
• Unified Program Consolidated Form - Facility Information (State of California)

Biodiesel

• Notice of Intent to Store Biodiesel
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)
  Updated 10/06/2009
• Testament of Compatibility
• Leak Detection Functionality

Underground Storage Tank (UST) Information Documents

• Demonstration of Financial Responsibility Guidelines for Owners and Operators of Petroleum Underground Storage Tanks (USTs)
• Demonstration of Financial Responsibility Guidelines for Owners and Operators of Petroleum Underground Storage Tanks (USTs)
• Certification of Financial Responsibility for USTs  Updated 11/2008
  Includes Instructions, Sample and blank form, plus Chief Financial Officer sample and blank letter.

• Requirements for Hazardous Waste Tank Systems (from Cal-CUPA Forum)

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Aboveground Storage Tank (UST) Forms

• Aboveground Petroleum Storage Tank Facility Statement Form  Updated 08/28/2009
• Aboveground Storage Tank (AST) Information Brochure  Updated 05/29/2009

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CAL-ARP Program Registration Form

Updated 05/07/2009

• Sacramento County CAL-ARP Registration Form - Microsoft Word
• Sacramento County CAL-ARP Registration Form - Adobe Acrobat

Master Hazardous Materials Facility List Updated 11/12/2009
Master List of Facilities within Sacramento County with potentially hazardous materials. List is sorted by Site Address.

Site Assessment and Mitigation Forms & Information Documents

• UST Corrective Action Enforcement Plan  Updated 09/28/2009

Toxic Site Clean-Up List Updated 11/12/2009
List of sites where unauthorized releases of potentially hazardous materials have occurred. List is sorted by Site Address

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Solid Waste Program Forms

Medical Waste

Updated 05/07/2009

• Medical Waste Generator Application
  Adobe Acrobat (.pdf)  Microsoft Word (.doc) 
• Medical Waste Generator - Hauling Exemption Application Updated May 22, 2009
  Adobe Acrobat (.pdf)  Microsoft Word (.doc)  
• Medical Waste Management Plan Form
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)  

• Medical Waste Management Plan Checklist

• Safe Disposal of Syringes and Sharps (Home Generated) Updated January, 2008

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Waste Tire Program Information

• Used and Waste Tire Enforcement Program Brochure

Business Recycling

• Business Recycling Ordinance Handbook
• Sacramento Regional Solid Waste Authority (SWA) web site

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Water Protection Forms and Information Documents

Small Public Water Systems

• Complete SSP (Sample Siting Plan) Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)   
• Lead Notification Form  Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)   
• Public Water System Repair Permit Form Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)   
• Request for Reclassification & Certification Form Updated 04/27/2009
  Adobe Acrobat (.pdf)  Microsoft Word (.doc)  
• Domestic Water Supply Permit Application Updated 10/30/2009
  Adobe Acrobat (.pdf)  Microsoft Word (.doc)  
• Emergency Notification Plan Form for Small Water Systems Updated 10/30/2009
  Adobe Acrobat (.pdf)  Microsoft Word (.doc)  
• Public Notification Tier 2 Template Updated 02/02/2007
  Adobe Acrobat (.pdf)  Microsoft Word (.doc)  
• Historical Assessment of Radionuclide Monitoring Data Form Updated 02/02/2007
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)

• Small Water Systems Certified Operator List Updated 04/27/2009
  Adobe Acrobat (.pdf)
• Well Water Testing Laboratories List  Updated 09/11/2009
  Adobe Acrobat (.pdf)

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Wells Program

• EMD Well Program Contact List   Updated 04/27/2009
• Sacramento County Well Ordinance
  Final, adopted by the Sacramento County Board of Supervisors on July 22, 2003
• Well Ordinance Enforcement Plan Updated 05/27/2009
• Destruction of Supply Wells and Exploratory Holes (Borings) Requirements Updated 05/06/2003

• Well Application and Permit Form  Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)  
• Well Site Plan Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)  
• Well Destruction Supplement Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)  
• Well Driller's Authorization Letter Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)  
• Property Owner's Authorization Letter  Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)  
  

• Well Driller's List   Updated 01/17/2008
• Well Water Testing Laboratories List  Updated 09/11/2009
  Adobe Acrobat (.pdf)

• 2009-2010 Well Fee Summary   Updated 07/01/2009
• Compliance Bulletin: Ready Mix Sand and Cement for Water Well Seals Updated 04/27/2009
• Water Well Disinfection Stages I and II Updated 04/27/2009
• Permit Requirements for Pump Repair or Replacement Updated 04/27/2009

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Cross Connection Control Program

• Certified Backflow Prevention Assembly Tester Application Form Updated 11/09/2009
  Adobe Acrobat (.pdf)   
• Backflow Assembly Test Report Form  Updated 04/27/2009
  Adobe Acrobat (.pdf)  
• Cross Connection Survey Form Updated 04/27/2009
  Adobe Acrobat (.pdf)  

• Certified Backflow Prevention Assembly Tester List   Updated 10/14/2009
• Cross Connection Water Purveyor Roster Sheet Updated 09/29/2009

Cross Connection Approved Backflow Prevention Assembly Lists

• Atmospheric Vacuum Breakers   Updated 10/29/2008
• Double Check Detector Assembly   Updated 10/26/2009
• Double Check Valve Assembly   Updated 09/21/2009
• Pressure Vacuum Breaker   Updated 03/06/2009
• Reduced Pressure Detector Assemblies    Updated 07/28/2009
• Reduced Pressure Principle Assemblies   Updated 10/26/2009
• Spillproof Vacuum Breaker   Updated 06/20/2008
• Orientation Key for Backflow Device Installation   Updated 04/27/2009

• Sacramento County Cross Connection Ordinance

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Onsite Sewage Disposal (Septic System) Program

• Septic System Permit Process Information
• Septic Permit Application Form  Updated 06/30/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)  
• Registration Application for Septic Tank, Chemical Toilet & Grease Trap Cleaners  Updated 04/27/2009
  Adobe Acrobat (.pdf)   Microsoft Word (.doc)
• Liquid Waste Request for Service Form   Updated 06/30/2009
  Adobe Acrobat (.pdf)  Microsoft Word (.doc)  
• Onsite Wastewater System Design Consultant List (formerly Percolation Testing List) Updated 07/15/2009

• Septic Tanks, Chemical Toilet, Sewage Pumpers and Grease Trap Cleaners List    Updated March, 2008
• Septic System Installation Contractors List   Updated 09/04/2009

• Sewage Disposal Systems: Sacramento County Rules, Regulations & Minimum Requirements
• Septic Tank Abandonment/Destruction Procedure   Updated 04/27/2009
• Flood Recovery Information
• Flooding and Sewage Spills Information Sheet   Updated 01/23/2006
• Septic System Setback Distance Requirements Summary  Updated 10/21/2004

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Stormwater Inspection Program

• General Industrial Stormwater Permit Notice of Intent (NOI) form
• Stormwater Inspection Checklist for Food Facilities (Restaurants) Updated 04/27/2009
• Stormwater Inspection Checklist for Non-Food Facilities Updated 04/27/2009
• Sacramento County National Pollutant Discharge Elimination System (NPDES) Municipal Stormwater Permit (adopted December 2002)

Stormwater Program Compliance Guidelines

• Sacramento Industrial Best Management Practices (BMP) for Industrial Stormwater Control Manual
• Stormwater Best Management Practice (BMP) Resource List (BERC) Updated January, 2007
• Auto Body and Painting stormwater compliance brochure
• Auto Repair stormwater compliance brochure
• Commercial Auto Washing and Detailing stormwater compliance brochure
• Vehicle Wash Water Discharge Policy
• Restaurant and Food Preparation Facility stormwater compliance brochure
• Stormwater Compliance Fact Sheet for Nurseries
• Concrete and Creeks Don't Mix
• Painting without Polluting
• Pressure Washer Best Management Practices (BMP) Booklet   Updated December, 2008
• Pressure Washer Service Provider List   Updated November, 2008

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