San Bernardino County Fire Department
Hazardous Materials Division
620 South "E" Street
San Bernardino, CA 92415-0153
Phone:  909.386.8401
Fax:  909.386.8460

Please call to obtain any forms that are not currently available online or if you have any difficulty downloading these forms. Most forms require Adobe Acrobat Reader, unless otherwise noted.


 Note that saving changes to Adobe pdf files requires full Adobe Acrobat or Acrobat Approval.

Waste Collection Facility Publications (Household Hazardous Waste & CESQG)

• Household Hazardous Waste Flyer
• CESQG Brochure
• Free Recycled Latex Paint Flyer

All CUPAs and regulated facilities are required to file CUPA forms electronically beginning Jan 1, 2013. For more information, refer to our Electronic Reporting (CERS) page.

Hazardous Materials Emergency Response Plans and Inventory (Business Plan)

• Business Emergency/Contingency Plan Forms and Guidelines [MS Word Format]
• Agency Notification Form only [MS Word Format]
• Example Business Emergency/Contingency Plan
• E-Reporting Authorization [MS Word Format]
• Permit Exemption Request Form
  [MS Word Format]
• EPCRA Equivalency Letter
• EPCRA Fact Sheet
• Release Notification Guidance from OES
• Release Reporting Form from Title 19 [MS Word Format]

California Accidental Release Prevention Program (CalARP)

• CalARP 5 Year Recertification Update Checklist – California Only [MS Word Format]
• San Bernardino County CUPA CalARP Stationary Source Registration Form [MS Word Format]
• San Bernardino County CUPA CalARP Submission Process
• EPA Checklist for Resubmitting RMP's
• Accident Prevention Program Deregistration
• De-registration Form
• San Bernardino County CUPA California Accidental Release Prevention Program Registration Form[MS Word Format]
• Flammable Fuels Exemption Form
• Basic RMP Work Plan[MS Word Format]
• CalARP Statute - CA Health and Safety Code 25531-25543
• CalARP Regulations from CCR Title 19
• EPA Guidance documents (link to EPA download site)
• EPA Guidance for Offsite Consequence Analysis
• EPA Clean Air Act General Duty Clause
• Sample Seismic Walkdown Forms [MS Word Format]

Underground Storage Tank (UST)

UST System Required Documents
The following documents must be submitted by the UST owner/operator to the UST Compliance Program of the Hazardous Materials Division and updated within 30 days of a change in information. They also must be kept on site available for inspection. The State Water Resource Control Board forms are available in current versions and may have additional electronic format options at: http://www.waterboards.ca.gov/cwphome/ust/forms/index.html

• 1 UST Facility Form[MS Word Format]
• 1 UST Tank Form (2 pages) Per Tank or Compartment of a Tank
  [MS Word Format]
• UST Certificate of Financial Responsibility 
  • Sample Chief Financial Officer Letter
• Leak Detection/Monitoring Plan [MS Word Format]
• Response Plan [MS Word Format]
• Designated Operator Statement [MS Word Format]
• UST Monthly Designated Operator Statement [MS Word Format]
• Business Emergency/Contingency Plan Forms and Guidelines
  [MS Word Format]

UST System Construction and Testing

• Installation, Modification & Monitoring Requirements for New and Existing Underground Storage Tanks
• UST Installation Certificate of Compliance [MS Word Format]
• Verifying UST Contractor Licensing & Certifications [MS Word Format]
• Expectations for UST Inspections
• UST January 2003 Upgrade Requirements
• Healy ISD Requirements
• Veeder Root Carbon Canister Guidelines
• OSFM Statewide Fire Dept VST nozzle Safety Alert - 8/25/2010
• UST Monitoring System Certification Form [MS Word Format]
• UST Monitoring System Certification Form Addendum for Vacuum/Pressure Interstitial Sensors [MS Word Format]
• UST Secondary Containment Testing Report Form [MS Word Format]
• UST Spill Bucket Testing Form [MS Word Format]

UST System Closure

• UST Removal/Closure Procedures
• UST Hazardous Waste Tank Closure Certification Form [MS Word Format]
• UST Unauthorized Release Form
• UST Temporary Closure Eligibility and Application

Aboveground Petroleum Storage Act (APSA)/Spill Prevention, Control, and Countermeasure (SPCC) Plan

For more information about APSA and SPCC Plans, refer to our APSA/SPCC page.

• Aboveground Petroleum Storage Tank Facility Statement [MS Word Format]
• Tier I Qualified Facility SPCC Plan Template
• APSA Frequently Asked Questions
• APSA Fact Sheet
• APSA Scope of CUPA Implementation
• Spill Prevention, Control, and Countermeasure (SPCC) Rule
• Oil Pollution Prevention Regulation Overview
• Spill Prevention Control and Countermeasure (SPCC) Plan Requirements
• APSA statute - CA Health and Safety Code Chapter 6.67 Section 25270-25270.13
• SPCC statute – 40 CFR 112

Hazardous Wastes

• Hazardous Waste Storage Weekly Inspection Checklist [MS Word Format]
• Hazardous Waste AST Daily Inspection Checklist [MS Word Format]
• Hazardous Waste AST Daily Inspection Checklist - Monthly View [MS Word Format]
• Hazardous Waste Training Requirements
• Hazardous Waste Employee Training Record Example Form [MS Word Format]
• DTSC EPA ID Number Determination
• DTSC Fact Sheet – Accumulating Hazardous Waste
• DTSC Fact Sheet – EPA ID Number
• California ID Number Application Form - DTSC 1358
• Recyclable Materials Reporting Form [MS Word Format]
• Remote Waste Consolidation Notification Form [MS Word Format]

Universal Waste

For more information about Universal Waste, refer to our Universal Waste Program page.

• DTSC Universal Waste Fact Sheet
• DTSC Universal Waste Page
• DTSC Electronic Hazardous Waste
• Summary Table of Universal Waste Requirements
• Best Management Practices for Managing Spent Fluorescent Lamps - Jan 2005
• Fluorescent Light Tube Fact Sheet - Jan 2005

Tiered Permitting Forms

• Tiered Onsite Treatment Notification - Facility [MS Word Format]
• Tiered Onsite Treatment Notification - Unit [MS Word Format]
• Tiered Process Form - CA [MS Word Format]
• Tiered Process Form - CEL [MS Word Format]
• Tiered Process Form - CESQT [MS Word Format]
• Tiered Process Form - CESW [MS Word Format]
• Tiered Process Form - PBR [MS Word Format]
• Tiered Permitting Certificate of Financial Assurance [MS Word Format]

General Resources

• Compliance Made Easy / La Conformidad Es Fácil
• Customer Service Survey [MS Word Format]
• Fee Schedule
• Fee Ordinance
• Carbon Dioxide and Helium Exemption Ordinance
• Request for Certified Hazardous Materials Record Search Findings
• Procedures for Certified Hazardous Materials Record Search Findings
  Request
• File Review Request
• NFPA 704 Placarding Requirements for County Fire Jurisdiction Areas
• Dept of Toxic Substances Control Hazardous Waste Hauler List

The Hazardous Materials Division maintains lists of consultants who provide various services. Please call (909) 386-8401 to obtain an appropriate list.

Disaster-Related Hazardous Waste Information

• American Red Cross – Recover After a Disaster
• Ash and Debris Cleanup Guidance
• Hazardous Waste Fire Assistance
• Residential Fire Victims Special Notice Fire Damaged Household Hazardous Waste / Noticia Especial a las Victimas del Incendio
• FEMA Disaster Information
• US EPA Flood Cleanup Information
• Flood Safety Checklist
• US EPA Mold Information