Who needs to complete this survey?

Businesses in San Joaquin County should complete a separate survey for each business name and/or address. The form asks about hazardous materials, waste, and business details.

Do I need a notary for the Hazardous Materials Disclosure Survey?

No. The owner or authorized agent signs and dates a declaration under penalty of perjury; the survey does not require notarization.

How do I submit the Hazardous Materials Disclosure Survey?

If you answer No to both Question 1 items, print, sign, and date the form and return it to the address above. If you answer Yes to Question 2, submit hazardous materials information through CERS.

San Joaquin County, CA · San Joaquin County

No notary required

Hazardous Materials Disclosure Survey

San Joaquin County businesses use this survey to disclose hazardous materials and waste and determine whether they must meet hazardous materials program requirements.

At a glance

Issued by: City of San Joaquin County · San Joaquin County, San Joaquin County, California
Notarization: Not required: file this form without a notary.
Official source: sjgov.org
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

The San Joaquin County Environmental Health Department uses this survey to identify businesses that may need to comply with hazardous materials emergency planning and reporting requirements. Each business name and/or address requires a separate survey. The form asks about business and owner details, hazardous materials and waste, quantities handled, acutely hazardous materials, and proximity to a school. Businesses answering Yes to Question 2 are directed to submit hazardous materials information online through CERS.

Who needs it

A business in San Joaquin County should complete a separate survey for each business name and/or address to disclose its hazardous materials and waste handling.

How to submit it

If you answer No to both questions in Question 1, print, sign, and date the form and return it to the address above: 1868 E. Hazelton Avenue, Stockton, California 95205. If you answer Yes to Question 2, submit hazardous materials information online at cers.calepa.ca.gov.

About notarization

This survey does not require a notary; the owner or authorized agent signs and dates a declaration under penalty of perjury.

How to submit this form

1
Download the Survey
Download the Hazardous Materials Disclosure Survey for your business.
2
Complete the Business Details
Enter the business, owner, and site information, then answer the questions about hazardous materials, waste, and school proximity.
3
Review the Submission Instructions
If you answer Yes to Question 2, submit hazardous materials information online through CERS.
4
Sign and Submit
If you answer No to both items in Question 1, print, sign, and date the survey and return it to the address above.

Frequently asked questions

What is the Hazardous Materials Disclosure Survey for?: The San Joaquin County Environmental Health Department uses it to identify businesses that may need to comply with hazardous materials emergency planning and reporting requirements.
Who needs to complete this survey?: Businesses in San Joaquin County should complete a separate survey for each business name and/or address. The form asks about hazardous materials, waste, and business details.
Do I need a notary for the Hazardous Materials Disclosure Survey?: No. The owner or authorized agent signs and dates a declaration under penalty of perjury; the survey does not require notarization.
How do I submit the Hazardous Materials Disclosure Survey?: If you answer No to both Question 1 items, print, sign, and date the form and return it to the address above. If you answer Yes to Question 2, submit hazardous materials information through CERS.

Need something notarized?

This Hazardous Materials Disclosure Survey doesn’t need a notary, but if you have another San Joaquin County form that does, a commissioned online notary can help.