Forms & Applications Page

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Consumer Protection Programs
Food Protection General Food Forms & Applications Mobile Food Facilities Community Event Organizer Temporary Food Facilities Cottage Food Operations Forms	Recreational Health Public Pools & Spas Body Art Tattoos
Land Use & Environmental Protection Programs
Biosolids Program Land Use Review Program Onsite Wastewater Treatment Systems Program	Solid Waste Disposal Program Small Public Water Systems Program Water Well Program
Hazardous Material Programs
Aboveground Storage Tanks (*AST) California Accidental Release Prevention (CalARP) California Environmental Reporting System (CERS) Hazardous Materials/Hazardous Waste Monitoring wells & Soil Borings Well/Septic Systems On-site Hazardous Waste & Treatment Underground Storage Tanks (UST*) Additional UST Forms

Miscellaneous Forms
Complaint (*Non-Housing*)	Housing Complaints (*within city limits*)
Substandard Housing Complaint (*Unincorporated areas of Yolo County*)	Request for Service- Land Use Request for Service- Consumer Protection

CONSUMER PROTECTION PROGRAMS

Food Protection Program
Permit Application (Food Service Establishments)	Veteran's Fee Exemption Form
Plan Check Review Application (Retail Food Facilities)	Non-Profit Exemption Form
Plan Review Checklist (Retail Food Facilities)	Hot Holding Temperature Log
Mobile Food Facility
Application Packet (English)	Application Packet (Spanish)
Commissary Agreement (English)	Commissary Agreement (Spanish)
Restroom Agreement (English)	Restroom Agreement (Spanish)
Food Cart Operations Information	Mobile Food Truck Checklist / Information
Community Event Organizer
Community Event Forms & Application Package	Non-Profit Exemption Form
Temporary Food Facility
Temporary Food Forms & Application Package	Non-Profit Exemption Form
Cottage Food Operations Forms
Registration Permit Form (Class A and B)	Self-Certification Form (Class A only)

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Recreational Health
Pool/Spa Health Permit Application	CCDEH Guidelines for Water Parks
Recreational Health Facility Plan Review Guide	CCDEH Guidelines for Spraygrounds
California Pool Code	CCDEH Guidelines for Water Slides
Pool & Spa Inspection Checklist	Pool/Spa Daily Maintenance Log
California Department of Public Health AB1020 Compliance Form

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Body Art
Perform Tattooing, Body Piercing, or Permanent Cosmetics
Practitioner Registration Application	Facility Permit Application
Infection Prevention and Control Plan Guideline	Hepatitis B Declination Statement
Approved Bloodborne Pathogen Training Course	Sharps Mail Back List

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LAND USE & ENVIRONMENTAL PROTECTION PROGRAMS

Biosolids Program
Biosolids Permit	Biosolids Checklist

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Onsite Wastewater Treatment System Program
Septic System Installation Permit Application Septic Abandonment Permit Application
Typical Process for Designing and Installing a New Septic System	Septic System Contractors
Site Evaluation/Soil Profile Request Form	Septic System Variance Application
Septic System Setbacks	Septic System Designers/Qualified Professionals
Septic Pumper Truck Registration Form	Septic Tank Pumper List

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Solid Waste Disposal Program
Enforcement Agency Notification (CIWNB Form 169) Word File PDF File	Registration Permit Application (CIWMB Form 83) Word File PDF File
Solid Waste Facility Permit Application (CIWMB Form E-1-77) Excel File PDF File	Directions for Completion of Form E-1-77 Word File PDF File
Standardized Permit Application (CIWMB Form 92) Word File PDF File

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Small Public Water Systems Program
Domestic Water Supply Permit Application	Domestic Water Supply Permit Amendment Application
CalCode/Cottage Food Operation Water System Application	Water System Determination Form
Water System Permit Application Instruction	Operation Plan Form
Technical Report Guide	CEQA Application Information form
Drinking Water Source Assessment Form	Service Request Form for PWS
TMF Assessment Requirement	Water Quality Emergency Notification Plan
Cross-Connection Control Survey for CWS	Cross-Connection Control Survey for Non Community Water Systems

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Water Well Program

Water Well Permit Application

Well Abandonment Application

Example of Water Well Permit Application

Petition for Variance Form

Well Plot Plan

Property Owner's Authorization Letter

Well Driller's Authorization Letter

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HAZARDOUS MATERIAL PROGRAMS

Aboveground Storage Tank

Daily Inspection Log for Tank Systems

Tier I Qualified Facility SPCC Plan Template

Tier II Qualified Facility SPCC Plan Template

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California Accidental Release Prevention
Please visit the CERS webpage to upload/update all forms online
Annual Renewal Certification	Consolidated Contingency Plan
Instructions for all of the CUPA forms	Site Map (Excel)/(PDF)

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Hazardous Materials Business Plan and Inventory

Please visit the CERS webpage to update all forms online

Consolidated Contingency Plan	Site Map (Excel)/(PDF)
Financial Responsibility & CFO Letter

Annual Renewal Certification	Training Documentation Form (used to log employee training)
Ag Facility Exemption (Farm Exemption Application)	Ag Cover Letter (Farm Exemption Cover Letter )
All CUPA Instructional Forms	Site Map (Excel)/(PDF)
All CUPA Instructional Forms	Consolidated Contingency Plan

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Monitoring Wells and Soil Borings

Monitoring Wells & Soil Borings
Permit Application
For projects on multiple parcels a separate permit application is required for each parcel.

***ADDITIONAL requirements for a Monitoring well and/or Soil Boring Permit***
The additional documents in the link above MUST be attached to the permit application upon submission or else the application will be rejected.

General Permit Conditions for Monitoring Well & Soil Borings
Monitoring Well & Soil Boring Permit Conditions

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Onsite Hazardous Waste Treatment

On-site Hazardous Waste Treatment Unit Forms . For each treatment unit, submit the first page and one of the additional pages depending on the type of treatment unit. The treatment types are: Waste Treatment Unit

Conditionally Exempt - Small Quantity Treatment (CESQT)
Conditionally Exempt - Specified Wastestream (CESW)

Conditionally Authorized (CA)
Permit By Rule (PBR)
Conditionally Exempt - Limited (CEL)

Download the Hazardous Materials Business Plan Packet: self-executable zip.
Recyclable Materials Report (only facilities that recycle more than 100 kg/month of excluded or exempted recyclable materials)	On-site Hazardous Waste Treatment Facility Form (one form per facility and the Waste Treatment Unit Forms below)
Certification of Financial Assurance	Remote Waste Consolidation Site Annual Notification
Haz Waste Tank Closure Certification	CUPA Forms Instructions
Consolidated Contingency Plan Manual (Click Read-Only* to view the manual*)	Business Activities Page
Business Owner/Operator Identification	Consolidated Contingency Plan (click "yes" when asked to view file as read only)
Hazardous Material Inventory Report Form	Annual Renewal Certification

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Underground Storage Tanks

UST Installation/Modification Forms:
New Install Cover Letter New Install Application Contingency Plan Financial Responsibiltiy & CFO Letter	UST Designated Operator Response Plan Site Map Repair Classifications

Change of Ownership Forms:
Contingency Plan Financial Responsibility & CFO Letter UST Designated Operator Statement	Response Plan Site Map

UST Repair Modifications Packet :
Repair Classifications Description of Repair Work Completed

UST Permanent Removal Packet:
Cutting and Cleaning Disclaimer UST Removal Cover Letter UST Removal Application UST Removal Inspection Report	Site Map Tank Closure Form A Form B

UST Abandonment in Place Packet:
Abandonment In Place Requirements Authority to Abandon UST Abandonment Cover Letter UST Abandonment Application	Cutting and Cleaning Disclaimer HW Tank Closure Certification Site Map Plan Check Guidance

UST Temporary Abandonment Packet:
Temp. Abandonment Cover Letter Temp. Abandonment Application Temp. Abandonment Requirements	Cutting and Cleaning Disclaimer HW Tank Closure Certification Site Map Plan Check Guidance