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Perchlorate Materials One-Time Notification

CCR, Title 22, Section 67384.7

Business Name:

Site Address 1:

Site Address 2:

City:

State:

Zip Code:

Mailing Address

Mailing Address 1:

Mailing Address 2:

City:

State:

Zip Code:

Contact

First Name:

Last Name:

Title:

Contact Address 1:

Contact Address 2:

City:

State:

Zip Code:

Email:

EPA ID Number:

(if available)

Business NAICS or SIC Code:

Nature of Business:

Enter the perchlorate materials that are used in the course of its operations. If it is available, enter the material's product market name along with its perchlorate concentration.

List of Perchlorate Materials Handled:

Business Plan Updated:

Yes

No

Has the business plan been updated to include perchlorate-containing materials pursuant to the Health & Safety Code Section 25504.1?

How much perchlorate material does your business...

manufacture or process:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

use to manufacture or produce a product:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

use or combust:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

store:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

offer for sale or procurement:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

generate as waste:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

treat or recycle onsite:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

treat or recycle offsite:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

discharge under permit or waiver:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

(Permit or waiver issued by the SWRCB or RWQCB)

send for offsite disposal:

None

<= 500 lbs of solids or 55 gallons of liquids

>= 500 lbs of solids or 55 gallons of liquids

A confirmation that DTSC has received your notification will be sent to the e-mail address entered.

If you have questions regarding the One -Time Notification for Perchlorate Materials, please contact Matthew Mulinax at (916) 324-0064 or send an e-mail to perch_bmp@dtsc.ca.gov.

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