Cupa Form Hm 907 PDF Details

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QuestionAnswer
Form NameCupa Form Hm 907
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names cers accessid request form

Form Preview Example

COUNTY OF SAN DIEGO CUPA

DEPARTMENT OF ENVIRONMENTAL HEALTH

HAZARDOUS MATERIALS DIVISION

P.O. BOX 129261, SAN DIEGO, CA 92112-9261

PHONE: (858) 505-6700; FAX: (858) 505-6848; Email: hmdutyeh@sdcounty.ca.gov

CERS ACCESS/I.D. REQUEST FORM

All Certified Unified Program Agency (CUPA) regulated businesses are required by law (Assembly Bill 2286) to submit business information electronically through the California Environmental Reporting System (CERS). This includes information related to your:

Unified Program Facility Permit

Remote Waste Consolidation

Hazardous Materials Business Plan

Recyclable Materials Reports

Hazardous Waste

Underground Storage Tanks

Hazardous Waste Onsite Treatment

Aboveground petroleum storage over 1,320 gallons

Hazardous Waste Tank Closures

Medical Waste**

A CERS I.D. is required in order to obtain or maintain a valid Unified Program Facility Permit. Please send your completed form to the County of San Diego Hazardous Materials Division (address above). When your CERS account is established, your designated lead users will receive an email with directions to begin electronic reporting.

** In San Diego County, Medical Waste Generators are required to report in CERS in order to receive a valid permit.

I. IDENTIFICATION

Change of Owner: a business is sold to a new owner.

 

 

 

PERMIT/RECORD NUMBER

Relocation: a business moves to a new address and owner remains the same.

 

 

New Business: a business opens in a vacant or newly constructed building.

 

CERS ID NUMBER

CERS Assistance Requested: none of the above are applicable. I need access to my CERS account.

 

 

BUSINESS NAME (Same as FACILITY NAME or DBA – Doing Business As)*

 

 

 

BUSINESS PHONE*

 

 

 

 

 

SITE ADDRESS*

 

 

 

SUITE NUMBER*

 

 

 

 

 

CITY*

 

CA

 

ZIP CODE*

 

 

 

 

 

 

 

 

 

BUSINESS OWNER FIRST AND LAST NAME or CORPORATE NAME*

 

 

 

BUSINESS OWNER PHONE

 

 

 

 

II. PREVIOUS ADDRESS (IF APPLICABLE)

 

 

PREVIOUS SITE ADDRESS

 

 

 

PREVIOUS PERMIT/RECORD NUMBER

 

 

 

 

 

PREVIOUS CITY

 

CA

 

PREVIOUS ZIP CODE

 

 

 

 

 

 

 

 

III. CERS LEAD USERS

 

 

–PRIMARY–

 

 

–SECONDARY–

NAME*

NAME

 

 

 

 

 

 

TITLE*

TITLE

 

 

 

 

 

 

BUSINESS PHONE

BUSINESS PHONE

 

 

 

 

 

 

E-MAIL:*

E-MAIL:

 

 

*Required

I authorize the Hazardous Materials Division to create my CERS ID. I understand that I am responsible for completing and maintaining my facility information in CERS as required by law. I certify under penalty of law that I have personally examined and am familiar with the information submitted on this form and believe the information is true, accurate, and complete.

SIGNATURE OF OWNER OR OPERATOR*

DATE*

 

 

NAME OF SIGNER (print)*

TITLE OF SIGNER*

 

OFFICE USE

 

Transfer past submittals? no yes

HUPFP #:_______________________________

 

 

 

 

 

ONLY

 

PLAN CHECK: no yes

HHMBP #:______________________________

 

 

 

 

 

 

 

 

County of San Diego CUPA

Department of Environmental Health - Hazardous Materials Division

HM-907 (01/14)

1

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Part # 1 in filling out Cupa Form Hm 907

2. Just after this part is filled out, go to enter the suitable details in these - NAME TITLE BUSINESS PHONE EMAIL, NAME TITLE BUSINESS PHONE EMAIL, DATE TITLE OF SIGNER, OFFICE USE, ONLY, Transfer past submittals no PLAN, yes, yes, HUPFP HHMBP, Department of Environmental Health, and County of San Diego CUPA.

Completing part 2 in Cupa Form Hm 907

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