The Checklist CalARP Summary of Violations - Program Level 3 Facilities is a Sacramento County Environmental Management Department (EMD) checklist of common violations under the California Accidental Release Prevention (CalARP) program, paired with a two-page Return to Compliance Statement. Facilities inspected by EMD use the statement to certify that the violations on the Official Inspection Report have been corrected. On FillingPDF you can fill out the form online and download or print the completed PDF; the original is published by EMD at emd.saccounty.gov.
Last updated
What is Checklist CalARP Summary of Violations - Program Level 3 Facilities – Sacramento County, CA?
Checklist CalARP Summary of Violations - Program Level 3 Facilities is a Sacramento County Environmental Management Department (EMD) checklist of common violations of federal, state and local laws and regulations under the California Accidental Release Prevention (CalARP) program, followed by a Return to Compliance Statement.
The checklist is an inspection element checklist. It does not replace your Official Inspection Report, which holds the specifics of your own inspection. Each row gives a violation number, the legal authority (for example 19 CCR 2, HSC 6.95 or SCC 6.96.030) and a description of the failure. The rows are grouped under:
- General: the active CalARP permit, applicability, coordination with the UPA and the management system.
- Risk Management Plan (RMP) components and submission, including certification, updates, corrections and registration.
- Hazard Assessment.
- Other Requirements, such as recordkeeping.
- Emergency Response Program.
- Program 3 Prevention Program: process safety information, process hazard analysis, operating procedures, training, mechanical integrity, management of change, pre-startup safety review, compliance audits, incident investigations, employee participation, hot work permits and contractors.
The last two pages are the Return to Compliance Statement. The facility certifies that the violations on the Official Inspection Report have been corrected, marks the evidence it submits for each violation number (Photo, Paperwork or Statement) and adds a corrective action statement.
EMD lists a separate checklist for Program Level 1 Facilities. This document is not a permit application: its first item, 5015, only checks that the facility has an active permit for CalARP covered process(es).
Who needs to file Checklist CalARP Summary of Violations - Program Level 3 Facilities – Sacramento County, CA?
Owners and operators of CalARP Program Level 3 facilities inspected by the Sacramento County Environmental Management Department use this document. The checklist shows the types of violations an inspection can cite. The Return to Compliance Statement is for a facility that received violations on its Official Inspection Report and must certify that they have been corrected.
- Facilities with violations: complete the statement and return it to EMD.
- Facilities preparing for an inspection: the checklist lists, by violation number, the requirements that inspectors check.
- Program Level 1 facilities: EMD publishes a separate checklist, Checklist CalARP Summary of Violations - Program Level 1 Facilities, so this Level 3 checklist is not the one for them.
The statement is signed by a person who gives a printed name and a position or title; the form does not say which positions may sign. The signer certifies under penalty of perjury and confirms having personally examined any attached proof of compliance.
When to file Checklist CalARP Summary of Violations - Program Level 3 Facilities – Sacramento County, CA
The Return to Compliance Statement must be returned to EMD within 19 days of your facility's inspection for Priority Corrective Action violations, and within 35 days for all other violations, unless the Official Inspection Report notes otherwise. Check the report for any different date before you count the days.
The checklist itself is a reference list and has no filing date. Its descriptions, however, carry the time frames that apply to each requirement. For example, the RMP must be revised, updated and submitted at least once every five years from its initial submission or most recent update, and the Process Hazard Analysis must be updated and revalidated at least every five years.
Documents you need
- Photos showing the violation was corrected, when you choose to submit them as proof of compliance.
- Copies of manifests, disposal records or receipts, when they show the violation was corrected.
- Other original paperwork that serves as proof of compliance, copied for submission with the statement.
How to fill out Checklist CalARP Summary of Violations - Program Level 3 Facilities – Sacramento County, CA
Read your Official Inspection Report
Find the violation numbers cited at your facility and any different return date the report notes. The checklist only lists common violations, so the report governs.
Match cited violations to the checklist
Look up each violation number in the checklist to read its authority and description, for example 5010069 for the initial Process Hazard Analysis.
Enter facility name and ID
Under Compliance Certification, write the Facility Name and the Facility ID# (FA) shown for your facility.
Complete the Executed at line
Enter the place where you sign, followed by California, and the Date.
Mark evidence for each violation
In the Summary of Violation Compliance Action table, find each cited violation number and check Photo, Paperwork or Statement for the type of evidence you submit.
Write the corrective action statement
In the Corrective Action Statement area, explain how each violation was corrected, in the manner the certification refers to.
Gather copies of proof of compliance
Collect photos, copies of manifests, disposal records or receipts, or other original paperwork that show the corrections.
Sign and print your name
Complete Signature, Printed Name and Position/Title. By signing you certify the corrections and declare under penalty of perjury that the certification is true and correct.
Review and download the completed PDF
Check the facility details, the evidence boxes and the statement against your Official Inspection Report. Download or print the completed PDF from FillingPDF and return it to EMD as described under How to submit.
How to submit Checklist CalARP Summary of Violations - Program Level 3 Facilities – Sacramento County, CA
The Return to Compliance Statement is returned to EMD. The form names no specific channel, such as a portal or mailbox, so use the contact details printed on its letterhead:
- Address: County of Sacramento, Environmental Management Department, Environmental Compliance Division, 11080 White Road, Ste. 200, Rancho Cordova, CA 95670.
- Phone: Voice (8am – 5pm) 916/875-8550.
- Fax: 916/875-8513.
- Website: http://www.emd.saccounty.gov
The checklist pages print 11080 White Rock Rd. Suite 200 and voice 916/875-8400 instead. Send copies of any proof of compliance documents with the statement, and return it within the 19-day or 35-day period described under When to file. Call EMD to confirm how it accepts the statement. FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Returning the statement after 19 days when the violations are Priority Corrective Action, or after 35 days for other violations, unless the Official Inspection Report gives a different date.
- Sending the statement without copies of proof of compliance, such as photos, manifests, disposal records, receipts or other paperwork.
- Using the checklist as your list of cited violations instead of the Official Inspection Report, which holds the specifics of your inspection.
- Signing the certification without personally examining the attached proof of compliance documents.
- Submitting information that is not true, accurate and complete; the statement warns of significant penalties for false information and for non-compliance.
- Leaving a violation number without a check in the Photo, Paperwork or Statement column when you submit evidence for it.
- Returning the statement unsigned or without the Facility Name and Facility ID# (FA).
- Using this Level 3 checklist for a Program Level 1 facility, for which EMD lists a separate checklist.
Frequently asked questions
What is the CalARP Summary of Violations checklist for Program Level 3 Facilities?
It is an EMD checklist of common violations of federal, state and local laws and regulations that apply to CalARP Program Level 3 facilities. Each row gives a violation number, its authority and a description. Your Official Inspection Report holds the specifics of your own inspection.
Is this form a Sacramento County business license?
No. It is an inspection checklist with a Return to Compliance Statement, not an application for a license or permit. The checklist's first item, 5015, only checks that a facility has an active permit for CalARP covered process(es) under SCC 6.96.030.
How long do I have to return the Return to Compliance Statement?
Return it to EMD within 19 days of your facility's inspection for Priority Corrective Action violations, and within 35 days for all other violations. The Official Inspection Report can note a different period, so check it first.
What do I send with the Return to Compliance Statement?
Send copies of any proof of compliance documents, such as photos, copies of manifests, disposal records or receipts, or other original paperwork. On the statement you mark the evidence type for each violation number: Photo, Paperwork or Statement.
Where do I send the Return to Compliance Statement?
Return it to EMD. The statement's letterhead lists the Environmental Compliance Division at 11080 White Road, Ste. 200, Rancho Cordova, CA 95670, voice 916/875-8550 and fax 916/875-8513. The form names no specific channel, so confirm with EMD how it accepts the statement.
Can I fill out the CalARP Level 3 checklist and statement online?
You can complete the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not connected to Sacramento County, and does not submit the statement; you return it to EMD yourself.
What is the difference between the Level 3 and Level 1 CalARP checklists?
EMD lists a separate checklist for Program Level 1 Facilities. This one is titled for Program Level 3 Facilities and includes the Program 3 Prevention Program items, such as process hazard analysis, management of change and compliance audits.
What am I certifying when I sign the Return to Compliance Statement?
You certify that the violations on the Official Inspection Report have been corrected as indicated, that you personally examined any attached proof of compliance, and that you are aware of significant penalties for false information or non-compliance. You declare this under penalty of perjury.
Ready to fill out Checklist CalARP Summary of Violations - Program Level 3 Facilities – Sacramento County, CA?
Fill out Checklist CalARP Summary of Violations - Program Level 3 Facilities – Sacramento County, CA now