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
Emergency Response Plan
 

 

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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

 

 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)

 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)

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

 

 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 Packetself-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

 

 Underground Storage Tanks

UST Installation/Modification Forms:

 

Change of Ownership Forms:

 

UST Repair Modifications Packet :

 

UST Permanent Removal Packet:

 

UST Abandonment in Place Packet:

 

UST Temporary Abandonment Packet:

 

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Additional Underground Storage Tank Forms

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