FORMS, DOCUMENTS, REPORTS and PRESENTATIONS

Posted below are forms and documents that customers of EMD may require or find useful.  If there are additional forms and documentation that would be useful to you or your business, please let us know by sending a message to emdinfo@saccounty.net. 

Hazardous Materials Forms (Business Plan forms, CUPA Checklists, Registration Forms, Meth Lab Cleanup Forms, Medical Waste Generator & Management Plan Forms, etc)

Hazardous Materials Information Documents (Guidance documents, Master HazMat facility list, HazMat Enforcement Plan, etc.) 

Environmental Health Forms (Food and Pool Plan Review forms, Food Facility applications, Temporary Food event applications, etc. )

Environmental Health Information Documents (Environmental Health Food Safety in the Home, Consumer Guidelines, list of Approved and Accredited Food Safety Certification Exam providers, etc.)

Water Protection Forms  (Hauling Exemption Application, Well Application & Permit form, inspection checklists, Certified Backflow Prevention Assembly Tester Application, etc.)

Water Protection Information Documents  (Cross-Connection Program Reference Lists, Well Ordinance Information, Toxic Site Clean-up List, Water Well Testing Lab list, Pressure Washer BMP booklet, etc.)

Reports (EMD Monthly Updates, HazMat Bulletins)

Presentations (PowerPoint presentations for various subjects, viewable directly on the Web)

FORMS    

  Hazardous Materials Forms

• Hazardous Materials Business Plan Forms
   
• Request for Specific Material Exemption from Hazardous Materials Release Response Plans and Inventory Requirements
    (Updated 03/24/2008)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)
   

• Application Form for Permit to Install, Upgrade or Repair Underground Storage Tank(s) (USTs) for Hazardous Substances
    (Updated 07/26/2007)
    -Install, Upgrade or Repair Cover Letter
    -Application Form (County)
    -Unified Program Consolidated Form (State)  
    -Drawings & Parts List Requirements Checklist
     -Legal UST Owner's Authorization Letter (used if Application not filled out by Owner)
  
    -ALL documents above (5) in one file
      (Updated 07/26/2007)
     -Underground Storage Tank (UST) Construction Permit Fee Summary
   

• UST (Underground Storage Tank) Removal Application Form
     (Updated 07/26/2007)
    -Microsoft Word format
    -Adobe Acrobat format
     -Legal UST Owner's Authorization Letter (used if Application not filled out by Owner)
     -Underground Storage Tank (UST) Construction Permit Fee Summary
   
• Sampling Protocol for Routine Underground Storage Tank (UST) Removals
     (Updated March, 2007

• Methamphetamine Laboratory Contamination Guidelines and Documents
     (Updated 04/27/2006)
    -Plan for the Assessment and Remediation of Properties Contaminated
     by Methamphetamine Laboratory Activities
  
    -Clandestine Laboratory Field Worksheet
    -Clandestine Lab Posted Warning for Contaminated Property
    -Clandestine Lab Clean-Up Checklist
    -Notice of Order (Enforcement Letter) Template for Property Contaminated by
     Methamphetamine Lab Activities
    -Notice of Lien Template for Methamphetamine Contaminated Property
     (Updated 04/08/2008)
    -Release of Lien Template for Methamphetamine Contaminated Property
     (Updated 04/08/2008)
    -No Further Action (NFA) Determination Template for
     Methamphetamine Contaminated Property
    -Preliminary Site Assessment (PSA) Work Plan Approval Template
    -Preliminary Site Assessment (PSA) Work Plan Denial Template
  
    -ALL documents above (10 Documents) in one file
     (Updated 04/08/2008)
   
• CAL-ARP Program Registration Form
    -Microsoft Word format
    -Adobe Acrobat format
   
• UST Owner Statement of Compliance & Identification of Designated Operator Forms
    -Microsoft Word format (Sacramento County)  
    -Adobe Acrobat format  (Sacramento County) -Adobe Acrobat format  (State)
   
• CUPA Inspection Checklists:

• -Checklist Summary of Violations for Business Plan / Hazardous Materials /  Above Ground Storage Tanks (Updated 09/06/2004)

• -Return To Compliance Statement for BP/HM Checklist (Updated 09/08/2004)
   

• -Checklist Summary of Violations for Hazardous Waste

• -Return to Compliance Statement for Hazardous Waste Checklist
   

• -Checklist Summary of Violations for Tiered Permitting

• -Return to Compliance Statement for Tiered Permitting Checklist
   

• -Checklist Summary of Violations for Underground Storage Tanks (UST) - General Permit Provisions (Form 1)

• -Return to Compliance Statement for UST - General Permit Provisions checklist
   

• -Checklist Summary of Violations for Underground Storage Tanks (UST) -Tanks (Form 2)

• -Return to Compliance Statement for UST - Tanks checklist
   

• -Checklist Summary of Violations for Underground Storage Tanks (UST) -Piping (Form 3)

• -Return to Compliance Statement for UST - Piping checklist
   

• -Checklist Summary of Violations for Cal-ARP Program General Requirements

• -Return to Compliance Statement for Cal-ARP Program General Requirements
   

• -Checklist Summary of Violations for Cal-ARP Program Level 2

• -Return to Compliance Statement for Cal-ARP Program Level 2
   

• -Checklist Summary of Violations for Cal-ARP Program Level 3

• -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)

• Medical Waste Forms:

• Medical Waste Generator Application
     (Updated 02/06/2007)
    -Microsoft Word format
    -Adobe Acrobat format

• Medical Waste Management Plan Form
     (Updated 01/31/2007)
    -Microsoft Word format
    -Adobe Acrobat format

• Medical Waste Management Plan Checklist
     (Updated 02/16/2007)
    -Adobe Acrobat format

• Hauling Exemption Application for Medical Waste Generators
     (Updated 02/06/2007)
    -Microsoft Word format
    -Adobe Acrobat format

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  Environmental Health Forms

Food Facilities

Public Pools and Spas (Recreational Health)

Medical Waste (now under Hazardous Materials)

• Application for Food Facility Plan Review
  (Updated 07/03/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Preview Checklist for Food Establishment Plan Review
  (Updated 09/25/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• How to Obtain Plan Approval and Health Permit for a Food Facility
  (Updated 04/01/2008)
    -Adobe Acrobat format (.pdf)

• How to Obtain Plan Approval and Health Permit for a Mobile Food Facility
  (Updated 07/26/2007)
    -Adobe Acrobat format (.pdf)

• Verification of Mobile Food Facility and Mobile Food Prep Unit/Commissary
  (Updated 07/31/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Application for Permit to Operate (used for Food Facilities, Mobile Food Facilities
  & Public Pools and Spas)
  (Updated 03/31/2008)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Application for Permit to Operate: Community Event  (used for Community Events and Temporary Food Facilities)
  (Updated 06/29/2007
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Community Event Organizer Packet (used for Community Events and Temporary Food Facilities)
  (Updated 07/17/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Temporary Food Facility (TFF) Operator's Packet
  (Updated 07/30/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Temporary Food Facility (TFF) Annual Permit (Multi-Event) Application Packet
  (Updated 03/14/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Catering Operation Application Packet
  (Updated 03/14/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)
   

• Application for Recreational Health (Pool/Spa) Plan Review
  (Updated 07/01/2007)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

• Recreational Health Minor Remodeling Application form
  (Updated 10/10/2006)
    -Microsoft Word format (.doc)
    -Adobe Acrobat format (.pdf)

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  Water Protection Forms

• Certified Backflow Prevention Assembly Tester Application Form
  (Updated 09/28/2007)
    -Microsoft Word format
    -Adobe Acrobat format
   

• Food Facility (Restaurant) Stormwater Inspection Checklist
  (Updated 03/05/2005)

• Stormwater Inspection Checklist for Non-Food Facilities
  (Updated 07/01/2004)

• Registration Application for Septic Tank, Chemical Toilet & Grease Trap Cleaners
  (Updated 11/30/2007)

• Well Application and Permit Form

• Well Driller's Authorization Letter 
  Property Owner's Authorization Letter 
   

• General Industrial Stormwater Permit Notice of Intent (NOI) form
   

• Onsite Sewage Disposal System Consultation Service Request form
  (Updated March, 2008)

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INFORMATION DOCUMENTS

  Hazardous Materials Documents

• Master HazMat Facility List
  Master List of Facilities within Sacramento County with potentially hazardous materials
  List is sorted by Site Address
  (Updated 02/11/2008)
   

• Toxic Site Clean-Up List
  List of sites where unauthorized releases of potentially hazardous materials have occurred.
  List is sorted by Site Address
  (Updated 02/11/2008)
   

• Hazardous Materials Inspection and Enforcement Plan
  (Updated 11/01/2005)
   
• Area Plan for Emergency Response to Hazardous Materials Incidents in Sacramento County (.pdf) 
  (260 page report, 10 MB to download)
  (Updated September, 2007)
   
• Criteria for the Assessment and Remediation of Clandestine Methamphetamine Laboratories (.pdf)
   
• Compliance Assistance Bulletins
   
• Safe Disposal of Syringes and Sharps (Home Generated) (Updated January, 2008)
   
• Demonstration of Financial Responsibility for Owners and Operators of Petroleum Underground Storage Tanks (USTs)
    -Adobe Acrobat format (.pdf)
   
• Certification of Financial Responsibility for USTs
  (Instructions, sample and blank form, plus Chief Financial Officer sample and blank letter.)
    -Adobe Acrobat format (.pdf)
    -Microsoft Word 2000 template (.dot)
   
• Requirements for Hazardous Waste Tank Systems (from Cal-CUPA Forum)

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  Environmental Health Documents

• List of Approved and Accredited Food Safety Certification Examination Providers
  (Updated March 20, 2008)

• Proposed Draft Permit Revision for Elder Creek Landfill
   
• Compliance Assistance Bulletins
   

• California Retail Food Code (CalCode)  
  (Effective July 1, 2007)

• CalCode Field Guide for Sacramento County  
  (Updated 11/28/2007)

• California Uniform Retail Food Facilities Law (CURFFL) 
  (Superseded by CalCode effective July 1, 2007)

• Floor Materials for  Retail Food Facilities
  (Updated 03/16/2007)

• Floor Materials Reference Sheet
   

• How to Obtain Plan Approval and Health Permit for a Food Facility
  (Updated 04/01/2008)
    -Adobe Acrobat format (.pdf)
   

• How to Obtain Plan Approval and Health Permit for a Mobile Food Facility
  (Updated 07/26/2007)
    -Adobe Acrobat format (.pdf)
   

• Public Swimming Pools: Design, Construction, Operation and Maintenance (.pdf)
   
• Public Swimming Pools: Replaster or Resurface Requirements
  (Updated 03/07/2007)
• Swimming Pool & Spa Daily Maintenance Log
  (Updated 08/20/2007)
   
• Power Outages and Food Service
• Power Outages and Public Pools

   Food Safety In Your Home

• The Big Thaw - Safe Defrosting Methods for Consumers (Updated February, 2007)

• Be Smart - Keep Foods Apart.  Avoiding Cross-Contamination (Updated February, 2007)

• Freezing and Food Safety (Updated February, 2007)

• Cutting Boards and Food Safety (Updated February, 2007)

• Food Safety While Boating  (Updated June, 2005)

• Food Safety While Camping  (Updated June, 2005)

• Food Safety While Hiking  (Updated July, 2005)

• Summer Food Safety: Outdoor Grilling  (Updated June, 2005)

• Seven Super Steps for Safe Food in the Summertime  (Updated June, 2005)
   

• Common Questions & Answers about Eggs (Updated March, 2006)

• Egg Safety for Egg Hunts (Updated March, 2006)

• Egg Safety While on the Road (Updated March, 2006)

• Spring... A Great Time for Eggs! (Updated March, 2006)
   

• Holiday Food Safety Strategies  (Updated November, 2004)

• Preparing Turkey for the Holidays  (Updated November, 2004)

• Traveling with the Turkey Dinner (Updated November, 2004)

• Tasty Holiday Gifts: Keep Them Safe, Send them Safely (Updated November, 2004)
   

• Preparando la comida de fiesta con seguridad  (Updated November, 2005)

• Preparando el pavo durante las fiestas (Updated November, 2005)

• Viajando con el pavo para la cena  (Updated November, 2005)
   

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Water Protection Documents

• Toxic Site Clean-Up List
  List of sites where unauthorized releases of potentially hazardous materials have occurred.
  List is sorted by Site Address
  (Updated 02/11/2008)
   

• Master HazMat Facility List
  Master List of Facilities within Sacramento County with potentially hazardous materials
  List is sorted by Site Address
  (Updated 02/11/2008)
   

• Flood Recovery Information

• Flooding and Sewage Spills Information Sheet
  (Updated January 23, 2006)

• Water Well Testing Laboratories  
  (Updated May 30, 2007)
   

• Percolation Testing List  
  (Updated April 10, 2008)

• Septic System Installation Contractors List  
  (Updated April 16, 2008)

• Septic Tanks, Chemical Toilet, Sewage Pumpers and Grease Trap Cleaners List  
  (Updated March, 2008)
   

• Compliance Assistance Bulletins

• Pressure Washer Best Management Practices (BMP) Booklet
  (Updated June 2004)

• Vehicle Wash Water Discharge Policy

• Stormwater Compliance Fact Sheet for Nurseries

• Sacramento Industrial BMP Manual

• Commercial Auto Washing and Detailing stormwater compliance brochure

• Auto Repair stormwater compliance brochure

• Auto body and painting stormwater compliance brochure

• Restaurant and food prep facility stormwater compliance brochure

• Sacramento's new National Pollutant Discharge Elimination System (NPDES) Municipal Stormwater Permit (adopted December 2002)

• Painting without Polluting

• Concrete and Creeks Don't Mix

• Pressure Washer Service Provider List
  Updated January, 2007

• Stormwater Best Management Practice (BMP) Resource List (BERC)
  Updated January, 2007

• Septic Tank Abandonment/Destruction Procedure
  Updated October, 2004March, 2007

• Water Well Disinfection Stages I and II
  Updated October 25, 2004

• Destruction of Supply Wells and Exploratory Holes (Borings)
  Updated May 3, 2003

• Permit Requirements for Pump Repair or Replacement
  Updated January 15, 2008

• Well Ordinance: Staff Report
• Well Ordinance
   (Final, adopted by the Sacramento County Board of Supervisors on 04/16/02)
• Well Ordinance Affidavit of Posting

• Well Ordinance Enforcement Policy
  Updated October 27, 2003

• Sewage Disposal Systems: Rules, Regulations & Minimum Requirements

Cross Connection Program Reference Lists

• Certified Backflow Prevention Assembly Tester list  
  (Updated April 18, 2008)

• Cross Connection Water Purveyor Roster Sheet  
  (Updated April, 2008)

• Approved Backflow Prevention Assembly Lists:

  • Atmospheric Vacuum Breakers  
    (Updated May 26, 2006)

  • Double Check Detector Assembly  
    (Updated March 31, 2008)

  • Double Check Valve Assembly  
    (Updated March 31, 2008)

  • Pressure Vacuum Breaker  
    (Updated May 26, 2006)

  • Reduced Pressure Detector Assemblies  
    (Updated May 26, 2006)

  • Reduced Pressure Principle Assemblies  
    (Updated March 31, 2008)

  • Spillproof Vacuum Breaker  
    (Updated May 26, 2006)

• Cross Connection Ordinance

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REPORTS

EMD Updates

• EMD April 2008 Update Report  

• EMD March 2008 Update Report  

• EMD February 2008 Update Report  

• EMD January 2008 Update Report  

• EMD December 2007 Update Report  

• EMD November 2007 Update Report  

• EMD October 2007 Update Report  

• EMD September 2007 Update Report  

• EMD August 2007 Update Report  

• EMD July 2007 Update Report 

• EMD June 2007 Update Report  

• EMD May 2007 Update Report  

• EMD April 2007 Update Report  

• EMD March 2007 Update Report  

• EMD February 2007 Update Report  

• EMD January 2007 Update Report  

• EMD December 2006 Update Report  

• EMD November 2006 Update Report  

• EMD October 2006 Update Report 

• EMD September 2006 Update Report 

• EMD August 2006 Update Report 

• EMD July 2006 Update Report 

• EMD June 2006 Update Report 

• EMD May 2006 Update Report 

• EMD April 2006 Update Report 

• EMD March 2006 Update Report 

• EMD February 2006 Update Report  

• EMD January 2006 Update Report 

• EMD December 2005 Update Report 

• EMD November 2005 Update Report 

• EMD October 2005 Update Report 

• EMD September 2005 Update Report 

• EMD August 2005 Update Report 

• EMD July 2005 Update Report

• EMD July 2004-June 2005 Summary

• EMD June 2005 Update Report

• EMD May 2005 Update Report

• EMD April 2005 Update Report

• EMD March 2005 Update Report

• EMD February 2005 Update Report

• EMD January 2005 Update Report

• EMD Summary for 2004

• EMD December 2004 Update Report

• EMD November 2004 Update Report

• EMD October 2004 Update Report

• EMD September 2004 Update Report

• EMD August 2004 Update Report

• EMD July 2004 Update Report (.pdf)

• EMD June 2004 Update Report (.pdf)

• EMD May 2004 Update Report (.pdf)

• EMD April 2004 Update Report (.pdf)

• EMD March 2004 Update Report (.pdf)

• EMD January 2004 Update Report (.pdf)  (Includes Summary for 2003)

• EMD FY 2002-2003 Annual Report (.pdf,  619k)

HazMat Bulletins

• HazMat Bulletin February 2008

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PRESENTATIONS

• Environmental Health Specialist Recruitment Presentation (October 2007)
    -View on Web (.html) (Works best with IE 5 or higher)
    -Download PowerPoint File (.ppt) 
    -View Adobe Acrobat document of presentation slides (.pdf)
    

• Pool Maintenance Workshop Presentation (May 2007): 
    -View on Web (.html) (Works best with IE 5 or higher)
    -Download PowerPoint File (.ppt) 
    -View Adobe Acrobat document of presentation slides (.pdf)
   

• Preparing a Site Conceptual Model (January 2003): 
    -View on Web (.html) (Works best with IE 5 or higher)
    -Download PowerPoint File (.ppt) 
   

• Approved Swimming Pool Drain & Cover Presentation: 
    -View on