Instructions for DTSC Form 1447 "Upa Model Application for Corrective Action Delegation" - California

This document contains official instructions for DTSC Form 1447, Upa Model Application for Corrective Action Delegation - a form released and collected by the California Department of Toxic Substances Control.

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Download Instructions for DTSC Form 1447 "Upa Model Application for Corrective Action Delegation" - California

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State of California – California Environmental Protection Agency
Department of Toxic Substances Control
INSTRUCTIONS FOR COMPLETING THE
UNIFIED PROGRAM AGENCY
MODEL APPLICATION FORM
FOR
CORRECTIVE ACTION DELEGATION
DTSC 1447 Instructions (1/17/2008)
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
INSTRUCTIONS FOR COMPLETING THE
UNIFIED PROGRAM AGENCY
MODEL APPLICATION FORM
FOR
CORRECTIVE ACTION DELEGATION
DTSC 1447 Instructions (1/17/2008)
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
INSTRUCTIONS FOR COMPLETING THE UNIFIED PROGRAM AGENCY
MODEL APPLICATION FORM FOR CORRECTIVE ACTION DELEGATION
General Instructions
General information
The Model Application Form includes the necessary forms to complete an application for either Tier 1 or Tier 2 delegation.
The Forms and Attachments Index and Checklist on page 2 of these instructions identifies the necessary forms needed to
complete an application for the appropriate level of delegation.
Required information
Information identified as “Required information” in the application forms is necessary to meet regulatory requirements and
must be submitted in the application for the application to be considered complete. Incomplete applications will result in
delays when processing the application to determine delegation approval.
Regulatory citations
Information in the application under “Regulatory citations” is provided for reference and describes the qualification criteria
required by the regulations. All information submitted in the application is subject to verification.
Submitting the application
The Department of Toxic Substances Control (Department) asks that applicant agencies submit two copies of their
application and supporting documents, one paper copy and one in a digital format on a CD using a file format compatible
with MS Office or as PDF documents. There is no deadline for submitting an application; the Department is prepared to
receive applications at the time an applicant agency is prepared to submit their application. Applications can be submitted
in person or by mail to:
Department of Toxic Substances Control
Tiered Permitting Corrective Action Branch
5796 Corporate Avenue, MS R4-5
Cypress, California 90630-4700
Attention: Raymond Campbell
Determination of qualification
The Department, within 60 days of receipt of the application, will inform the UPA, in writing, that either the application is
complete and accepted for determination of qualification, or that the application is deficient and identify the information
that is required to complete the application.
The Department shall complete the review of the application within 90 days from the receipt of a completed application to
determine whether the UPA is qualified to implement and enforce the requirements for environmental assessments and
corrective action portions of the Unified Program under Health and Safety Code section 25404.1(a)(3)(C).
The Department, upon completion of the review of the application, shall in writing either approve or disapprove the
application for qualification. Within 30 days of approving the application, the Department shall issue a letter of qualification
to the UPA (Notice of Approval). Within 45 days of disapproving the application, the Department shall issue a denial letter
identifying the areas of deficiency pursuant to this section (Notice of Denial).
Questions and information
Answers to questions and further information on the application and delegation process can be obtained by contacting
Violeta Mislang
Department of Toxic Substances Control
5796 Corporate Avenue
Cypress, California 90630
Phone: (714) 484-5387
Fax: (714) 484-5392
Email: VMislang@dtsc.ca.gov
DTSC 1447 Instructions (1/17/2008)
Page 1 of 15
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
INSTRUCTIONS FOR COMPLETING THE UNIFIED PROGRAM AGENCY
MODEL APPLICATION FORM FOR CORRECTIVE ACTION DELEGATION
Forms and Attachments
Index and Checklist
Forms
Forms
Required for
Required for
Form
Title
Documentation
Tier 1
Tier 2
Applicants
Applicants
UPA Applicant Identification and
DTSC 1447A
Tier Selection
UPA job specification
DTSC 1447B
Personnel Expertise (Option 1)
Training records
DTSC 1447C
Personnel Expertise (Option 2)
Training records
DTSC 1447D
Tier 2 Personnel Expertise
Training records
(accompanied by
DTSC 1447B/C)
Tier 2 UPA Personnel with
DTSC 1447E
Training records
(accompanied by
Specialized Geological Expertise
DTSC 1447B/C)
Tier 2 UPA Personnel with
DABT Certification
DTSC 1447F
(accompanied by
Specialized Toxicological Expertise
Training records
DTSC 1447B/C)
Tier 2 Specialist Contractor
DTSC 1447G
DABT Certification
Identification and Qualifications
Triennial review
DTSC 1447H
UPA Past Experience
Enforcement certification
3 Project summaries
DTSC 1447I
Tier 2 UPA Past Experience
2 Project summaries
Ability to Implement Environmental
DTSC 1447J
Process flow chart
Assessment and Corrective Action
DTSC 1447K
Adequacy of Staff Resources
Organizational chart
Recordingkeeping and Accounting
DTSC 1447L
Systems
Local Ordinance Authority to
DTSC 1447M
Local ordinance
Recover Costs
DTSC 1447 Instructions (1/17/2008)
Page 2 of 15
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
INSTRUCTIONS FOR COMPLETING THE UNIFIED PROGRAM AGENCY
MODEL APPLICATION FORM FOR CORRECTIVE ACTION DELEGATION
I. Form DTSC 1447A Applicant Identification and Tier Selection
Required information:
Lines 1 thru 7: Complete the required UPA agency identification and contact information.
Line 8: Enter the date the completed application is submitted.
Lines 9 & 10: Indicate the level of delegation for which the UPA is seeking qualification by checking the box for either Tier
1 or Tier 2.
Regulatory citation:
68400.15(a) An UPA shall indicate in its application the Tier for which it seeks qualification.
II. Form DTSC 1447B Personnel Expertise (Option 1)
A separate form (DTSC 1447B or DTSC 1447C) must be completed for each individual UPA technical staff
designated to perform duties for the Tier 1 AND Tier 2 Corrective Action Programs.
Required information:
Lines 11 & 12: Enter the name of the UPA staff and the official UPA position title.
Lines 13, 14 & 15: For qualification of personnel expertise based on knowledge and abilities that are equivalent to those
for the Hazardous Substances Scientist, Hazardous Substances Engineer, or Engineering Geologist Classes as defined
by the California State Personnel Board, indicate which classification series is equivalent to the UPA classification
identified on Line 12 by checking the appropriate box on Line 13, 14 or 15 and attach a copy of the official UPA job
classification specification to the application.
Lines 16 & 17: Provide a brief description of the areas of technical expertise for the staff identified on Line 11 and the
number of years of experience with this expertise.
Lines 18 thru 41: For training received in the required areas of proficiency indicated, enter the title of the training, name of
the training provider, and the date the training was completed.
Line 42: Attach copies of official training records and check the box to indicate the documents are included with the
application.
Regulatory citations:
68400.14(a) Tier 1 level of qualification criteria:
(1) Personnel Expertise Requirements.
(A) UPA personnel designated to perform the activities of Tier 1 as described in subsection 68400.13(a) and
section 68400.16 shall have educational background and technical expertise sufficient to perform the activities of
Tier 1 as described in subsection 68400.13(a) and section 68400.16 in accordance with all applicable state laws
and regulations, including the requirements of either subparagraph 1 or subparagraph 2, and subparagraph 3 and
subparagraph 4 below:
1. Educational background shall consist of a degree from a college or university with a minimum of 60
semester units in the following areas of study:
a. environmental, biological, chemical, physical, or soil science;
DTSC 1447 Instructions (1/17/2008)
Page 3 of 15
State of California – California Environmental Protection Agency
Department of Toxic Substances Control
INSTRUCTIONS FOR COMPLETING THE UNIFIED PROGRAM AGENCY
MODEL APPLICATION FORM FOR CORRECTIVE ACTION DELEGATION
b. environmental or public health;
c. environmental, civil or chemical engineering; or
d. directly related scientific field;
2. The requirements of subparagraph 1 above may be substituted by qualifications knowledge and
abilities that are equivalent to those for the Hazardous Substances Scientist, Hazardous Substances
Engineer, or Engineering Geologist Classes defined by the California State Personnel Board in the
following documents, incorporated herein by reference:
a. Hazardous Substances Scientist, Series Specification, established July 1, 1994;
b. Hazardous Substances Engineer, Series Specification, established June 21, 1994 and revised
January 19, 2000;
c. Engineering Geologist, Series Specification, established September 24, 2002.
3. Technical expertise shall include two consecutive years of experience in hazardous materials
management, regulation, analysis, or research, environmental research, monitoring, surveillance or
enforcement, or resource recovery.
4. Technical expertise shall also consist of documented training or proficiency in the fields of
hydrogeology, fate and transport, environmental chemistry, toxicology, preliminary endangerment
assessment, quality assurance and quality control for analytical results, and statistics. Additional training
in other technical disciplines related to site characterization and cleanup activities will be considered for
its applicability to this requirement. This training shall be sponsored by a credible program, including, but
not limited to a state or federal agency, university extension, community college, or qualified UPA.
(B) Documentation of UPA Personnel Expertise. An UPA shall submit with its application documentation
demonstrating that UPA personnel meet the educational and technical expertise requirements as described in
subsection (a)(1)(A).
III. Form DTSC 1447C Personnel Expertise (Option 2)
A separate form (DTSC 1447B or DTSC 1447C) must be completed for each individual UPA technical staff
designated to perform duties for the Tier 1 AND Tier 2 Corrective Action Programs.
Required information:
Lines 43 & 44: Enter the name of the UPA staff and the official UPA position title.
Lines 45 thru 53: Identify the college/university attended, the degree and major, and year the degree was conferred.
Lines 54 thru 56: For each area of study provide the number of semester units completed. For an other directly related
scientific field specify the field of study on Line 57.
Lines 59 & 60: Provide a description of the areas of technical expertise and the number of years of experience with this
expertise.
Lines 61 thru 84: For training received in the areas of proficiency indicated, enter the title of the training, name of the
training provider, and the date the training was completed.
Line 85: Attach copies of official training records and check the box to indicate the documents are included with the
application.
Regulatory citations:
68400.14(a) Tier 1 level of qualification criteria:
DTSC 1447 Instructions (1/17/2008)
Page 4 of 15