DTSC Form 1444 "One-Time Notification for Perchlorate Materials" - California

What Is DTSC Form 1444?

This is a legal form that was released by the California Department of Toxic Substances Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 18, 2007;
  • The latest edition provided by the California Department of Toxic Substances Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DTSC Form 1444 by clicking the link below or browse more documents and templates provided by the California Department of Toxic Substances Control.

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Download DTSC Form 1444 "One-Time Notification for Perchlorate Materials" - California

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State of California-California Environmental Protection Agency
Department of Toxic Substances Control
One-Time Notification for Perchlorate Materials Instructions
Business Name: Enter the full name of the business. Please do not use acronyms.
Site Address: Enter the location address of the company. Enter the city, state and zip code of the company’s location on the following line. The
address should be where the perchlorate materials will be managed in the course of its operations.
Mailing Address: Enter the mailing address of the company if it is different from the location address (e.g., P.O. Box numbers). Enter the city,
state and zip code of the company’s mail address on the following line. The mailing address should be the location that collects and distributes
mail for the company.
EPA ID Number: If applicable enter the business twelve-digit EPA Identification Number.
Business NAICS Number or SIC Code: Enter the business’ North American Industry Classification System code or the Standard Industrial
Classification Code. To obtain your business’ NAICS code, go to the U.S. Census Bureau 2002 NAICS web page at
http://www.census.gov/epcd/naics02/naicod02.htm. To obtain your business’ SIC code, go to the U.S. Department of Labor, OSHA web page
at http://www.osha.gov/pls/imis/sicsearch.html.
Contact Name: Enter the name of the person that is responsible for establishing, implementing and reporting the site’s best management
practices for perchlorate.
Contact Address: Enter the mailing address of the contact if his/her address is different from the site or mailing address, (e.g., P.O. Box
numbers). If it is not different, enter “Same as Site” or “Same as Mailing.”
Contact Title: Enter the title of the contact person.
Contact Phone: Enter the telephone number of the contact person.
Nature of the Business: Enter the type of business that is being conducted at the site address. This should be the same as the NAICS
classification or more specific.
Email Address: Enter the contact’s email address.
Lists of Perchlorate Materials Handled: 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 concentration of perchlorate.
Business Plan: Select “Yes” or “No” if your business has implemented a plan that complies with the California Health and Safety Code, Section
25504.1. For more information on Business Plan, see
http://www.calcupa.net/programs/related/consolidated/guidancedoc.pdf
How Much Perchlorate Materials…: Select the “Less than 500 lbs....” or “Greater than 500 lbs…” box per each question if you manufacture,
store, sale, generate as waste, recycle, treat, or discharge any perchlorate materials at your facility. If the “Less than 500 lbs…” or “Greater than
500 lbs…” categories do not apply then select “None.” To calculate the poundage of perchlorate materials, use the total weight of the material
which contains the perchlorate. However, for a product that has one or more perchlorate-containing devices, use only the weight of the
perchlorate-containing devices to determine the total weight that is to be reported. To see some examples of perchlorate materials and products
review our web site at http://www.dtsc.ca.gov/HazardousWaste/Perchlorate/upload/Perchlorate_products.pdf.
Submit: The form can be submitted electronically to the Department. You can do so by saving the file (e.g., using Adobe® Standard), then fill-in
the fields and email the completed form as an attachment to perch_bmp@dtsc.ca.gov. Note the underscore in perch_bmp. If you do not wish to
or are unable to submit the completed notification electronically, complete the required information fields then print the form and mail it to:
Department of Toxic Substances Control
Hazardous Waste Management Program
Regulatory and Program Development Division
P.O. Box 806
Sacramento, CA 95812-0806
Attention: Perchlorate Best Management Practices
Also, you may fax the form to:
Department of Toxic Substances Control
Regulatory and Program Development Division
Attention: Perchlorate Best Management Practices
(916) 322-1005
If any part of the information that the company is submitting could be considered confidential then the company may contact the Department of
Toxic Substances Control and request business confidentiality. This will allow that company to request that part or all of the information on the
notification be withheld from public disclosure. Any questions and further information can be obtained by contacting the Department at 1-800-72-
TOXIC (1-800-728-6942) or (916) 324-0064. Additional perchlorate information is available at:
http://www.dtsc.ca.gov/HazardousWaste/Perchlorate/.
DTSC 1444 1/18/07
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State of California-California Environmental Protection Agency
Department of Toxic Substances Control
One-Time Notification for Perchlorate Materials Instructions
Business Name: Enter the full name of the business. Please do not use acronyms.
Site Address: Enter the location address of the company. Enter the city, state and zip code of the company’s location on the following line. The
address should be where the perchlorate materials will be managed in the course of its operations.
Mailing Address: Enter the mailing address of the company if it is different from the location address (e.g., P.O. Box numbers). Enter the city,
state and zip code of the company’s mail address on the following line. The mailing address should be the location that collects and distributes
mail for the company.
EPA ID Number: If applicable enter the business twelve-digit EPA Identification Number.
Business NAICS Number or SIC Code: Enter the business’ North American Industry Classification System code or the Standard Industrial
Classification Code. To obtain your business’ NAICS code, go to the U.S. Census Bureau 2002 NAICS web page at
http://www.census.gov/epcd/naics02/naicod02.htm. To obtain your business’ SIC code, go to the U.S. Department of Labor, OSHA web page
at http://www.osha.gov/pls/imis/sicsearch.html.
Contact Name: Enter the name of the person that is responsible for establishing, implementing and reporting the site’s best management
practices for perchlorate.
Contact Address: Enter the mailing address of the contact if his/her address is different from the site or mailing address, (e.g., P.O. Box
numbers). If it is not different, enter “Same as Site” or “Same as Mailing.”
Contact Title: Enter the title of the contact person.
Contact Phone: Enter the telephone number of the contact person.
Nature of the Business: Enter the type of business that is being conducted at the site address. This should be the same as the NAICS
classification or more specific.
Email Address: Enter the contact’s email address.
Lists of Perchlorate Materials Handled: 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 concentration of perchlorate.
Business Plan: Select “Yes” or “No” if your business has implemented a plan that complies with the California Health and Safety Code, Section
25504.1. For more information on Business Plan, see
http://www.calcupa.net/programs/related/consolidated/guidancedoc.pdf
How Much Perchlorate Materials…: Select the “Less than 500 lbs....” or “Greater than 500 lbs…” box per each question if you manufacture,
store, sale, generate as waste, recycle, treat, or discharge any perchlorate materials at your facility. If the “Less than 500 lbs…” or “Greater than
500 lbs…” categories do not apply then select “None.” To calculate the poundage of perchlorate materials, use the total weight of the material
which contains the perchlorate. However, for a product that has one or more perchlorate-containing devices, use only the weight of the
perchlorate-containing devices to determine the total weight that is to be reported. To see some examples of perchlorate materials and products
review our web site at http://www.dtsc.ca.gov/HazardousWaste/Perchlorate/upload/Perchlorate_products.pdf.
Submit: The form can be submitted electronically to the Department. You can do so by saving the file (e.g., using Adobe® Standard), then fill-in
the fields and email the completed form as an attachment to perch_bmp@dtsc.ca.gov. Note the underscore in perch_bmp. If you do not wish to
or are unable to submit the completed notification electronically, complete the required information fields then print the form and mail it to:
Department of Toxic Substances Control
Hazardous Waste Management Program
Regulatory and Program Development Division
P.O. Box 806
Sacramento, CA 95812-0806
Attention: Perchlorate Best Management Practices
Also, you may fax the form to:
Department of Toxic Substances Control
Regulatory and Program Development Division
Attention: Perchlorate Best Management Practices
(916) 322-1005
If any part of the information that the company is submitting could be considered confidential then the company may contact the Department of
Toxic Substances Control and request business confidentiality. This will allow that company to request that part or all of the information on the
notification be withheld from public disclosure. Any questions and further information can be obtained by contacting the Department at 1-800-72-
TOXIC (1-800-728-6942) or (916) 324-0064. Additional perchlorate information is available at:
http://www.dtsc.ca.gov/HazardousWaste/Perchlorate/.
DTSC 1444 1/18/07
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State of California-California Environmental Protection Agency
Department of Toxic Substances Control
One-Time Notification for Perchlorate Materials Form
California Code of Regulations Title 22 Section 67384.7
“On or before September 1, 2007 a business managing perchlorate materials in the course of its operations in an amount
greater than 500 pounds of solid or 55 gallons of liquids, at any one time, shall submit to the Department a one-time
notification regarding perchlorate materials. The notification shall cover activities occurring between July 1, 2006 and June
30, 2007 and shall include the following:”
Business Name:
Site Address:
City, State:
Zip:
Is the Site Address the same as the Mailing Address?
Yes
No
Mailing Address:
City, State:
Zip:
Contact Name:
Contact Title:
Contact Address:
Contact Phone:
Ext:
City, State:
Zip:
Business EPA ID #:
Email:
(optional)
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 concentration.
List of Perchlorate
Materials Handled:
RESET FORM
RESET BOXES
DTSC 1444 1/18/07
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State of California-California Environmental Protection Agency
Department of Toxic Substances Control
One-Time Notification for Perchlorate Materials Form
Has the business plan been updated to include perchlorate-containing
materials pursuant to the Health & Safety Code Section 25504.1?
Yes
No
How much perchlorate materials….
None
Less than or equal to 500 lbs
Greater that 500 lbs of
solids or 55 gallons of
or 55 gallons of
liquid per year
liquid per year
does your business manufacture or process?
does your business use to manufacture
or produce a product?
are used or combusted?
are stored?
are offered for sale or procurement?
are generated as waste?
are treated or recycled onsite?
are treated or recycled offsite?
are discharged under a permit or waiver
issued by the SWRCB or a RWRCB?
are sent for offsite disposal?
RESET FORM
RESET BOXES
DTSC 1444 1/18/07
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