Ds 3163 Form San Diego PDF Details

Engaging with the DS 3163 form presents a critical step for any business in San Diego considering operations that involve hazardous materials. This document, integral to ensuring public safety and environmental protection, serves as a comprehensive questionnaire for businesses to disclose their use, storage, processing, or dispensing of hazardous substances. Detailed within its structure are sections mandating interaction with various regulatory bodies, including the San Diego Fire Department's Hazardous Materials Division for fire safety considerations, the San Diego County Department of Environmental Health for matters impacting public health, and the San Diego County Air Pollution Control District for air quality concerns. Businesses must meticulously report on the types and quantities of hazardous materials involved in their operations, alongside details pertinent to waste disposal and air contaminant emissions. This process not only helps in identifying the need for specific permits and reviews by regulatory agencies but also plays an essential role in the broader context of environmental risk management within the county. The form underscores the interconnectedness of public safety, environmental stewardship, and business operations, making it a crucial document for ensuring that businesses comply with local regulations designed to protect the community and the environment alike.

QuestionAnswer
Form NameDs 3163 Form San Diego
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesDEH, DS-3163, Roasters, Mfg

Form Preview Example

City of San Diego

1222 First Ave., MS-301

Development Services

San Diego, CA 92101

Information and Application Services

Appointments (619) 446-5300

 

Information (619) 446-5000

HAZARDOUS MATERIALS QUESTIONNAIRE

OFFICE USE ONLY

UPFP#:

HV:

BP DATE: _____/_____/____

Business Name

Business Contact

 

Telephone #

 

 

 

(

)

 

Project Address

City

State

Zip Code

 

APN#

 

 

 

 

 

 

Mailing Address

City

State

Zip Code

 

Plan File#

 

 

 

 

 

Project Contact

 

 

Telephone #

 

 

 

(

)

 

The following questions represent the facility’s activities, NOT the specific project description.

PART I: FIRE DEPARTMENT – HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Will your business use, process, store or dispense any of the following hazardous materials? Indicate by circling the item(s) that apply. If any of the items are circled (except item 15), a San Diego Fire Department Hazardous Materials Information Sheet (form FPB-500) must be submitted with your project review to: Planning & Development Review, Fire Hazardous Materials Plan Review, 1222 First Avenue, 4th Floor, San Diego, CA 92101 (619) 446-5438.

1.

Explosive or Blasting Agents

5.

Organic Peroxides

9.

Water Reactives

13.

Corrosives

2.

Compressed Gases

6.

Oxidizers

10.

Cryogenics

14.

Other Health Hazards

3.

Flammable/Combustible Liquids

7.

Pyrophorics

11.

Highly Toxic or Toxic Materials

15.

None of These.

4.

Flammable Solids

8.

Unstable Reactives

12.

Radioactives

 

 

PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH – HAZARDOUS MATERIALS DIVISIONS (HMD): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, 3rd floor, San Diego, CA 92101.

Call (619) 338-2222 prior to the issuance of a building permit.

FEES ARE REQUIRED.

Expected Date of Occupancy:

/

/

 

CalARP Exempt

 

 

/

YES

NO

 

 

 

 

 

 

 

 

 

 

 

Date

Initials

1.

Is your business listed on the reverse side of this form? (check all that apply).

 

 

 

 

 

 

 

 

2.

Will your business dispose of Hazardous Substances or Medical Waste in any amount?

 

 

 

CalARP Required

3.

Will your business store or handle Hazardous Substances in quantities equal to or greater than

 

 

 

/

 

55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity?

 

 

 

Date

Initials

4.

Will your business use an existing or install an underground storage tank?

 

 

 

 

 

5.

Will your business store or handle Regulated Substances (CalARP)?

 

 

 

CalARP Complete

 

 

 

 

/

6.

Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)?

 

 

 

 

 

 

 

Date

Initials

 

 

 

 

 

 

 

PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCD): If the answer to any of the questions below is yes, applicant must contact the Air Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition permit. Note: if the answer to questions 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information.

YES

NO

 

1.

Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the

 

APCD factsheet at http://www.sdapcd.org/info/facts/permits.pdf , and the list of typical equipment requiring an APCD permit on the reverse side

 

of this from. Contact APCD if you have any questions).

 

2.

(ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)?

 

(Public and private schools may be found after search of the California School Directory at http://www.cde.ca.gov/re/sd/; or contact the

 

appropriate school district).

 

3.

Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos?

4.

Will there be demolition involving the removal of a load supporting structural member?

 

 

Briefly describe business activities:

Briefly describe proposed project:

I declare under penalty of perjury that to the best of my knowledge and belief the responses made herein are true and correct.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

/

 

 

Name of owner or Authorized Agent

 

 

 

Signature of Owner or Authorized Agent

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR OFFICIAL USE ONLY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BY:

 

 

 

 

 

 

 

DATE:

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXEMPT OR NO FURTHER INFORMATION REQUIRED

 

RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY

 

RELEASED FOR OCCUPANCY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COUNTY-HMD

 

APCD

 

COUNTY-HMD

 

APCD

 

COUNTY-HMD

 

APCD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HM-9171-A (02/07)

DS-3163 (02/07)

County of San Diego – DEH – Hazardous Materials Division

LIST OF BUSINESSES THAT REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO

DEPARTMENT OF ENVIRONMENTAL HEALTH – HAZARDOUS MATERIALS DIVISION

Check all that apply:

AUTOMOTIVE

CHEMICAL HANDLING

OTHERS AND MISCELLANEOUS

Battery Manufacturing/Recycling

Photographic Processing

Asphalt Plant

Boat Yard

Pool Supplies/Maintenance

Biotechnology/Research

Car Wash

Printing/Blue Printing

Chiropractic Office

Dealership Maintenance/Painting

Road Coatings

Co-Generation Plant

Machine Shop

Swimming Pool

Dental Clinic/Office

Painting

Toxic Gas Handler

Dialysis Center

Radiator Shop

Toxic Gas Manufacturer

Emergency Generator

Rental Yard Equipment

 

Frozen Food Processing Facility

Repair/Preventive Maintenance

METAL WORKING

Hazardous Waste Hauler

Spray Booth

Anodizing

Hospital/Convalescent Home

Transportation Services

Laboratory/Biological Lab

Chemical Milling/Etching

Wrecking/Recycling

Medical Clinic/Office

Finish-Coating/Painting

 

Nitrous Oxide (NOx) Control System

 

Flame Spraying

CHEMICAL HANDLING

Pharmaceuticals

Foundry

Agricultural supplier/distributor

Machine Shop-Drilling/Lathes/Mills

Public Utility

Refrigeration System

Chemical Manufacturer

Metal Plating

Rock Quarry

Chemical Supplier/Distributor

Metal Prepping/Chemical Coating

Ship Repair/Construction

Coatings/Adhesive

Precious Metal Recovery

Telecommunications Cell Site

Compressed Gas Supplier/Distributor

Sand Blasting/Grinding

Veterinary Clinic/Hospital

Dry Cleaning

Steel Fabricator

Wood/Furniture Manufacturing/Refinishing

Fiberglass/Resin Application

Wrought Iron Manufacturing

 

Gas Station

 

 

Industrial Laundry

AEROSPACE

ELECTRONICS

Laboratory

Aerospace Industry

Electronic Assembly/Sub-Assembly

Laboratory Supplier/Distributor

Aircraft Maintenance

Electronic Components Manufacturing

Oil and Fuel Bulk Supply

Aircraft Manufacturing

Printed Circuit Board Manufacturing

Pesticide Operator/Distributor

 

 

NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES. ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES, USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE HAZARDOUS MATERIALS DIVISION (HMD) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (619) 338-2222.

LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES

Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District.

CHEMICAL

47 – Organic Gas Sterilizers

32 – Acid Chemical Milling

33 – Can & Coil Manufacturing

44 – Evaporators, Dryers & Stills Processing

Organic Materials

24 – Dry Chemical Mixing & Detergent Spray

Towers

35 – Bulk Dry Chemicals Storage

COMBUSTION

ROCK AND MINERAL

34

– Piston Internal – Combustion Engines

04

– Hot Asphalt Batch Plants

13

– Boilers & Heaters (1 million BTU/hr or larger)

05

– Rock Drills

14

– Incinerators & Crematories

06

– Screening Operations

15

– Burn Out Ovens

07

– Sand Rock & Aggregate Plants

16

– Core Ovens

08

– Concrete Batch, CTB, Concrete Mixers, Mixers

20

– Gas Turbines, and Turbine Test Cells & Stands

 

& Silos

48

– Landfill and/or Digester Gas Flares

10

– Brick Manufacturing

55 – Chrome Electroplating Tanks

COATINGS & ORGANIC SOLVENTS

27 – Coating & Painting

37 – Plasma Arc & Ceramic Deposition Spray

Booths

38 – Paint, Stain & Ink Mfg

27 – Printing

27 – Polyester Resin/Fiberglass Operations

METALS

18 – Metal Melting Devices

19 – Oil Quenching & Salt Baths

32 – Hot Dip Galvanizing

39 – Precious Metals Refining

ORGANIC COMPOUND MARKETING (GASOLINE, ETC)

25 – Gasoline & Alcohol Bulk Plants & Terminals

25 – Intermediate Refuelers

26 – Gasoline & Alcohol Fuel Dispensing

ELECTRONICS

29 – Automated Soldering

42 – Electronic Component Mfg

FOOD

12 – Fish Canneries

12 – Smoke Houses

50 – Coffee Roasters

35 – Bulk Flour & Powered Sugar Storage

SOLVENT USE

28 – Vapor & Cold Degreasing

30 – Solvent & Extract Driers

31 – Dry Cleaning

OTHER

01 – Abrasive Blasting Equipment

03 – Asphalt Roofing Kettles & Tankers

46 – Reverse Osmosis Membrane Mfg

51 – Aqueous Waste Neutralization

11 – Tire Buffers

17 – Brake Debonders

23 – Bulk Grain & Dry Chemical Transfer & Storage 45 – Rubber Mixers

21 – Waste Disposal & Reclamation Units

36 – Grinding Booths & Rooms

40 – Asphalt Pavement Heaters

43 – Ceramic Slip Casting

41 – Perlite Processing

40 – Cooling Towers – Registration Only

91 – Fumigation Operations

56 – WWTP (1 million gal/day or larger) & Pump Station

NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600.

HM-9171A (02/07)

DS-3163 (02/07)

County of San Diego – DEH – Hazardous Materials Division

How to Edit Ds 3163 Form San Diego Online for Free

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2. Once your current task is complete, take the next step – fill out all of these fields - PART III SAN DIEGO COUNTY AIR, Will the subject facility or, YES, Will there be renovation that, Briefly describe business, Briefly describe proposed project, I declare under penalty of perjury, Signature of Owner or Authorized, FOR OFFICIAL USE ONLY FIRE, Date, EXEMPT OR NO FURTHER INFORMATION, RELEASED FOR BUILDING PERMIT BUT, RELEASED FOR OCCUPANCY, COUNTYHMD, and APCD with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Mfg conclusion process detailed (stage 2)

People generally get some things wrong while filling in EXEMPT OR NO FURTHER INFORMATION in this area. Don't forget to double-check everything you type in here.

3. In this part, review AUTOMOTIVE cid Battery, CHEMICAL HANDLING cid Photographic, METAL WORKING cid Anodizing cid, OTHERS AND MISCELLANEOUS cid, ELECTRONICS cid Electronic, NOTE THE ABOVE LIST INCLUDES, and LIST OF AIR POLLUTION CONTROL. All of these are required to be completed with greatest accuracy.

Simple tips to complete Mfg portion 3

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