Chp Form 361E – Fill Out and Use This PDF

APPLICATION PROCEDURES

Enclosed you will find the following forms:

1.Application for Hazardous Materials Transportation License (CHP 361M).

2.Motor Carrier Profile (CHP 362).

Complete all applicable entries on the Application for Hazardous Materials Transportation License form (CHP 361M). Applicants who do not have a California Carrier Identification number (CA number) must also complete the enclosed Motor Carrier Profile form

(CHP 362). Print legibly or use a typewriter to complete the form(s). Make copies for your file. Mail the completed application, Motor Carrier Profile (if required) and appropriate fee to:

California Highway Patrol

Accounting Section (HM Licensing Program)

P.O. Box 942902

Sacramento, CA 94298-2902

DO NOT SEND CASH OR COMBINE WITH ANY OTHER

APPLICATION OR FEE.

APPLICATION LINE ITEM INSTRUCTIONS

Complete all entries.

REASON FOR APPLICATION: Check the appropriate box corresponding to the reason for submitting the application.

APPLICANT NAME: Company name. This name must be the same as the name listed for your California Carrier Identification Number (CA Number).

FEDERAL EMPLOYER I.D. NUMBER (EIN): Enter your federal EIN assigned by the IRS. This unique number ensures your records are not duplicated. Individuals with no employees may not have this number; in that case no entry is required. Do not use a Social Security number.

OWNERSHIP INFORMATION: Check the appropriate box corresponding to the ownership type of the applicant. If the applicant is an individual with no federal EIN, a valid driver’s license number and the state of issue are required. All requested information is necessary to prevent duplication of records.

NAME CHANGE: If your company previously held a CHP hazardous materials transportation license under a different name, enter that name.

TELEPHONE NUMBER: Enter the phone number for the applicant.

DOING BUSINESS AS: List additional registered, legal names the applicant is doing business as other than the APPLICANT’S NAME.

MAIL LICENSE ATTENTION: If the license is to be mailed to a specific company individual enter that person’s name, otherwise leave blank.

MAIN OFFICE STREET ADDRESS, CITY, STATE, and ZIP CODE: Enter the complete address for the company headquarters.

MAILING ADDRESS, CITY, STATE, and ZIP CODE: Enter the complete mailing address where the license is to be sent.

CALIFORNIA CARRIER IDENTIFICATION NUMBER: Enter your CA number.

CHP HAZARDOUS MATERIALS TRANSPORTATION LICENSE NUMBER and EXPIRATION DATE: Enter current CHP license number and expiration date.

FEDERAL OPERATING AUTHORITY NUMBER: Circle MC or MX and enter authority number if applicable.

US DOT NUMBER: Enter federal US DOT number if applicable.

CALIFORNIA CORPORATION NUMBER: Enter the corporation’s identification number if applicable.

PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION (PHMSA): Enter PHMSA registration number and expiration date.

FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION (FMCSA) HAZARDOUS MATERIALS SAFETY PERMIT (HMSP): Enter FMCSA HMSP number and expiration date if applicable.

SPECIALIZED HIGHWAY ROUTING REQUIREMENT INFORMATION: Check the appropriate boxes which correspond to your type of operation (For additional information see SPECIAL REQUIREMENTS). If you do not transport any materials identified, check the “None of the above” box.

APPLICANT BACKGROUND: Provide an explanation in the space below for each response marked “yes”. Attach an additional sheet if necessary.

CARRIER IDENTIFICATION OF TERMINALS: Enter the complete address, contact person, and phone number of all California terminals from which hazardous materials transport vehicles are operated.

AUTHORIZED CERTIFIER’S SIGNATURE: Authorized corporate officer or authorized representative of the company must certify the application and print or type their name, title, and date.

TEMPORARY LICENSE

Applicants who have submitted an application and the appropriate license fee may carry in the vehicle, for not more than sixty days, either of the following for use as a temporary license:

•A copy of the applicant’s completed “Application for Hazardous Materials Transportation License” form and a copy of the check or money order indicating payment of fee.

•A telegraphic money order receipt (i.e., Western Union Money Transfer) or copy thereof, made payable to the California Highway Patrol, indicating payment of fee for a license to transport hazardous materials.

INCOMPLETE APPLICATION FORMS OR INSUFFICIENT FUNDS

Incomplete application forms will be returned to the applicant for completion. Copies of incomplete applications are not valid temporary licenses. The correct fee, in U.S. funds, must be submitted with the application. Failure to submit a completed application or insufficient fee will delay issuance of the license.

STATUTORY REQUIREMENTS FOR LICENSE

A valid Hazardous Materials Transportation License is required by the laws and regulations of the State of California (Vehicle Code Section 32000.5) for the transportation of either:

1)Hazardous materials shipments for which the display of placards is required; or

2)Hazardous materials shipments of more than 500 pounds (being transported for a fee), which would require placards if shipped in greater amounts in the same manner.

General requirements regarding the transportation of hazardous materials are governed by Vehicle Code Sections 31300-34510 (Divisions 13 through 14.8). A copy of the Vehicle Code may be purchased at any California Department of Motor Vehicles office.

SPECIAL REQUIREMENTS

Laws and regulations governing the transportation of explosives, inhalation hazards and radioactive materials are more restrictive than those concerning the transportation of hazardous materials in general. The specific requirements for transportation of these materials are identified below.

EXPLOSIVES

Shipments of explosive materials that meet the definitions outlined in Division 14 of the Vehicle Code must follow additional rules and regulations for routing, safe stopping places and inspection stops designated by the California Highway Patrol in Title 13, California Code of Regulations, Chapter 6, Article 1 (Sections 1150-1152.10). These additional requirements are effective if transporting:

• An amount in excess of 1,000 pounds of any class 1.1, 1.2, or

1.3(formerly class A or B) explosives, or

•A combined load in excess of 1,000 pounds of any

class 1.1, 1.2, or 1.3 (formerly class A or B) explosives and blasting agent,

or

•Any amount of class 1.1, 1.2, or 1.3 (formerly class A or B) when the transportation is rendered as a delivery service or for hire.

(NOTE: These regulations do not include special fireworks transported by carriers licensed by the State Fire Marshal or any other class of explosives.)

INHALATION HAZARDS

Shipments of inhalation hazards that meet the definitions outlined in Division 14.3 of the Vehicle Code must follow additional rules and regulations for routing, safe stopping places and inspection stops designated by the California Highway Patrol in Title 13, California Code of Regulations, Chapter 6, Article 2.5 (Sections

1157-1157.18). These additional requirements are effective if:

•It is a material meeting the defining criteria in Section 173.115

(c) of Title 49 Code of Federal Regulations or for which a “Poison-Inhalation Hazard” or “Inhalation Hazard” shipping paper description is required pursuant to Section 172.203 of Title 49 Code of Federal Regulations, AND;

•It is being transported in bulk packaging except when that packaging contains only residue.

This would include, but not necessarily be limited to, hazardous materials that are poisonous by inhalation (liquid or gaseous) in Hazard Zones A, B, C, or D.

RADIOACTIVE MATERIALS

Shipments of radioactive materials meeting the definition for highway route controlled quantity found in Section 174.403, Title 49 Code of Federal Regulations must follow the routes designated by the California Highway Patrol in Title 13, California Code of Regulations, Chapter 6, Article 2.7 (Sections 1158-1159).

SPECIALIZED HIGHWAY ROUTING AND ASSOCIATED REQUIREMENTS INFORMATION

Applicants who check one, or more, of the specialized routing (“HMX,” “HMPIH,” “HRCQ”) boxes will be placed on the appropriate mailing list(s) to receive special highway routing requirements. Those on the HMX and HMPIH mailing lists will also receive safe stopping place and in route inspection stop information. Applicants not already on a particular list will receive a free current copy of the appropriate designated routes and related requirements. Applicants currently on one, or more, of these mailing lists will continue to receive published revisions to the designated routes and related requirements. This information may be reproduced locally, or additional copies may be purchased from the California Highway Patrol. Questions concerning the specialized highway routing requirements or how to obtain additional copies of these requirements should be directed to the Commercial Vehicle Section, Routing Coordinator at (916) 327-3310.

QUESTIONS/ADDITIONAL FORMS

If you have questions regarding the application process or required fee, or if you need additional forms, contact the California Highway Patrol, Commercial Vehicle Section, P.O. Box 942898, Sacramento, CA 94298-0001 or by telephone at (916) 327-5039. Questions regarding the Motor Carrier Profile form should be directed to the California Highway Patrol, Commercial Records Unit at

(916) 375-2810.