• HAZARDOUS MATERIALS SURVEY & CERTIFICATION FORM

  • The purpose of this form is to obtain information regarding the use of hazardous materials* on Irvine Company Office Properties (“ICOP”) property.

    Prospective tenants should answer the questions in light of their proposed activities on the premises, and shall submit the completed Survey Form to the ICOP leasing representative prior to executing the lease.

    Current tenants should answer the questions as they relate to ongoing activities on the premises and should update any information previously submitted as soon as changes occur.

    Your cooperation in this matter is appreciated.

    *California law defines “Hazardous Material” as “any material that, because of its quantity, concentration, or physical, chemical characteristics, poses a significant present or potential hazard to human health and safety or to the environment if released into the workplace or the environment. Hazardous materials include, but are not limited to, hazardous substances, hazardous waste, and any material that a handler or the administering agency has a reasonable basis for believing that it would be injurious to the health and safety of persons or harmful to the environment if released into the workplace or the environment.” “Hazardous substance” means any substance or chemical product for which the manufacturer or producer is required to prepare a MSDS, is listed as radioactive in Appendix B of 10 CFR, is listed pursuant to Title 49 of the Code of Federal Regulations, or list listed in Section 6382(b) of the Labor Code. “Hazardous waste” means hazardous waste as defined by Sections 25115, 25117, and 25316 of the California Health & Safety Code. For purposes of this Hazardous Materials Survey, the term “hazardous material” shall include any per- and polyfluoroalkyl substances (PFAS) listed in 40 CFR 372.65(d) and (e) or otherwise designated as a hazardous material under any other state or federal statute or regulation.

  • 1. GENERAL INFORMATION

  • Your Relationship with Irvine Company Office Properties*
  • Format: (000) 000-0000.

  • Current Tenant

  • Prospective Tenant

  • 2. OPERATIONS ON THE PREMISES

  • Do or will your operations and activities on the leased premises include:*
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  • Do you perform any of the operations described below at your facility which may use PFAS chemicals?*
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  • 3. HAZARDOUS MATERIALS

    For the purposes of this form, the term “hazardous material” includes any hazardous material, hazardous substance, and hazardous waste. For details, see page 1 of this form. The term does not include wastes which are intended to be discarded. Hazardous materials may include very common substances such as isopropyl alcohol, propane, degreasers, UPS batteries and diesel fuel, among other chemicals and materials.
  • Will any hazardous materials or hazardous substances be used or stored on site?*
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  • List any hazardous materials to be used or stored, the quantities that will be on-site at any given time, and the location and method of storage (e.g., bottles in storage closets on the premises).
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  • Is any underground storage of hazardous materials or hazardous substances proposed or currently conducted on the premises?*
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  • 4. HAZARDOUS WASTE

    For the purposes of this form, the term “hazardous waste” means any waste (including biological, infectious or radioactive waste) considered hazardous under any state or federal law, and which is intended to be discarded.
  • Do your operations require a:*
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  • Click here for more information regarding the permit types above.

  • List any hazardous waste generated or to be generated on the premises, and indicate the quantity generated on a monthly basis.
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  • Describe the method(s) of disposal (including recycling) for each waste. Indicate where and how often disposal will take place.
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  • Is any treatment or processing of hazardous, infectious or radioactive wastes currently conducted or proposed to be conducted on the premises?*
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  • 5. SPILLS

  • During the past five years, have any spills or releases of hazardous materials or substances occurred on your current operating premises?*
  • Were any agencies notified in connection with such spills?*
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  • Were any clean-up actions undertaken in connection with the spills or releases?*
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  • 6. WASTEWATER TREATMENT & DISCHARGE

  • Do you discharge industrial wastewater to:*
  • Is your industrial wastewater treated before discharge?*
  • Do your operations require a permit for industrial wastewater discharge?*
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  • Do your operations require a permit for discharges to the sanitary sewer?*
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  • Do your operations discharge any substances to sink or floor drains?*

  • 7. AIR DISCHARGES

  • Do you have any air filtration systems, hoods or stacks that vent into the air?*
  • Do you operate any equipment that requires air emissions permits? (i.e. diesel or natural gas powered generator)*
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  • 8. HAZARDOUS MATERIALS DISCLOSURES

  • Does or will your company handle an aggregate of at least 500 pounds, 55 gallons or 200 cubic feet of hazardous material at any given time?*
  • Has your company prepared a Hazardous Materials Business Plan (HMBP), Hazardous Materials Inventory (HMI) or similar disclosure document pursuant to state or city and county requirements?*
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  • Has your company prepared a facility or hazardous materials Closure Plan pursuant to state or city and county requirements?*
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  • Is your company required to submit financial assurance documentation for the operations at the premises? *
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  • Has your company prepared a Hazardous Materials Business Plan (HMBP), Hazardous Materials Inventory (HMI), CalARP Risk Management Plan (RMP) or similar disclosure document pursuant to state or city and county requirements?*
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  • Are any of the chemicals used in your operations or that are or will be present or stored on the premises regulated under Proposition 65?*
  • Is your company subject to OSHA Hazard Communication Standard Requirements?*
  • Does your company have a recent report under the Toxic Release Inventory (TRI)?*
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  • 9. ANIMAL TESTING

  • Does your company bring or intend to bring live animals onto the premises for research or development purposes?*
  • Does your company bring or intend to bring animal body parts or bodily fluids onto the premises for research or development purposes?*
  • Does your company bring or intend to bring animal body parts or bodily fluids onto the premises for research or development purposes?*
  • Does your company use any genetically modified or transgenic organisms or microorganisms for research or development purposes?*

  • 10. ODORS, FUMES, VAPORS

  • Do you anticipate any odors, fumes, and/or vapors resulting from your operations?*

  • 11. ENFORCEMENT ACTIONS, COMPLAINTS

  • Has your company ever been subject to any agency enforcement actions, administrative orders, lawsuits, or consent orders/decrees regarding environmental compliance or health and safety?*
  • Has your company ever received any request for information, notice of violation, notice to comply, citation, or demand letter, complaint, or inquiry regarding environmental compliance or health and safety?*
  • Has an environmental audit ever been conducted which concerned operations or activities on premises occupied by you?*

  • TIC TENANT HAZARDOUS MATERIALS CERTIFICATION

  • The undersigned hereby certifies that all information provided in the above Hazardous Materials Survey Form is true and correct to the best of the undersigned’s knowledge. The undersigned hereby certifies that Tenant will promptly notify Irvine Company if any of the information or responses provided above to the Hazardous Materials Survey change or are anticipated to change due to changes in operations, materials, quantity of materials, processes, discovery of new information, or other circumstances. The undersigned hereby certifies that it is familiar with and has knowledge of the Tenant’s hazardous materials operations and is authorized to sign this certification on behalf of the Tenant.

  • ACKNOWLEDGED AND AGREED TO BY:

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: