SD Information Bulletin 116

THE CITY OF SAN DIEGO FORM Hazardous Materials and Processes Reporting Form DS-165 January 2024 All non-residential projects (except retaining walls, fences, and similar projects) and/or multiple dwelling units (MDU) projects must have a completed Hazardous Materials Reporting Form at the time of project submittal. This information is used to determine the occupancy classification of the proposed structure(s) along with the fire and life safety protection systems and procedures required. For information regarding the completion of this form, see Information Bulletin 116. SECTION I: General Information Project Name: Tenant Name: Job Address: Building/Unit/Suite Number: Project Contact Name: Contact Phone Number: SECTION II: Hazardous Materials Summary Will this project include the use, storage, or dispensing of any hazardous materials listed below? No Yes If the answer above is “Yes,” check off the applicable hazardous materials classifications and complete Table 1: Chemical Classification on Page 2 and Summary Sheets per Section IV below.

Aerosols Corrosive Materials Flammable Solids Pyrophoric Materials Combustible/Flammable Liquids Cryogenics (inert or oxidizing) Organic Peroxides Toxic / Highly Toxic Materials Combustible Fibers Fireworks/Explosives Oxidizers Unstable Reactive Materials Compressed Gases Flammable Gases Oxidizing Gases Water Reactive Materials SECTION III: Hazardous Process Summary Will this business perform any of the hazardous processes listed below? No Yes If the answer above is “Yes,” check off the applicable hazardous materials processes below and complete Table 2: Energy Storage Systems, Table 3: Lithium-ion and Lithium Metal Battery Storage and/or Table 4: Refrigeration Systems on Page 3, as applicable. A technical report may be required for complex projects at the direction of the hazardous materials plan reviewer. Battery/Energy Storage Dry Cleaning Organic/Powder Coatings Semiconductor Fabrication Brewery/Distillery Dust-Producing Operations Plant Processing/Extraction Spray Finishing Dipping Operations Metal Plating Refrigeration Systems Welding/Cutting

SECTION IV: Hazardous Materials Classification The classification of all chemicals stored and in use for this project is required to determine the requirements in the California Fire Code. Attached is Table 1, a sample Chemical Classification Table. The hazardous materials submittal must include an inventory of all chemicals along with a summary sheet detailing the total amounts for each hazardous classification. Each building or control area must have a separate summary sheet. SECTION V: Declaration I declare under penalty of perjury that, to the best of my knowledge, the responses made herein are true and correct. Name of owner/ occupant/ authorized agent (select one) Signature Date Visit our web site: sandiego.gov/dsd. Upon request, this information is available in alternative formats for persons with disabilities. DS-165 (01-24) CLEAR FORM

THE CITY OF SAN DIEGO a Table 1: Chemical Classification Quantity Quantity in Use Stored (specify Location CFC Common Chemical % Material State (gallons/ open/closed CAS # (storage & Hazardous Name Name Concentration (liquid/solid/gas) pounds/ use and gallons use) Classifications cubic / pounds / feet) cubic feet) aFor traditional Hazardous Materials, as shown in Section II, please refer to the General Definitions in CFC Section 202. Visit our web site: sandiego.gov/dsd. Upon request, this information is available in alternative formats for persons with disabilities. DS-165 (01-24)

THE CITY OF SAN DIEGO a Table 2: Energy Storage Systems (ESS) Battery Technology Number of Total Energy Capacity Location / Enclosure Type Batteries (kWh) (Inside or Outside / Walk-in or Reach-in) Capacitor ESS b Flow Batteries c Lead-Acid Batteries (all types) Lithium-ion Batteries Nickel Metal Hydride (Ni-MH) Nickel-Cadmium Batteries (Ni-Cd) Other Battery Technologies Other Electrochemical ESS Technologies aFor energy storage systems, please report the total energy capacity of all batteries (per battery technology type) in kWh per CFC Table 1207.1.1. Energy capacity is the total energy capable of being stored (nameplate rating), not the usable energy rating. For units rated in amp-hours, kWh shall equal rated voltage times amp-hour rating divided by 1,000. For batteries rated in watts per cell, kWh = the nameplate watts per cell x the number of cells divided by 1,000 and multiplied by the nameplate minutes rating / 60. (This calculation method is shown in the 2023 Edition of NFPA 855 and is proposed for the 2024 IFC / 2025 CFC).

b Shall include vanadium, zinc-bromine, polysulfide-bromide and other flowing electrolyte-type technologies. c Fifty gallons of lead-acid battery electrolyte shall be considered equivalent to 70 kWh. a Table 3: Lithium-ion and Lithium Metal Battery Storage Length Width Height Total Volume of Storage (feet) (feet) (feet) (cu. ft.) aFor storage of lithium-ion and lithium metal batteries, please report the total cubic feet of lithium-ion and lithium metal batteries in storage per CFC Section 322. a Table 4: Refrigerants Mechanical System ID Refrigerant System Charge Capacity CMC Safety Group a Common Name (pounds) Classification aFor refrigerants, please use Safety Group Classification per CMC Table 1102.3. Visit our web site: sandiego.gov/dsd. Upon request, this information is available in alternative formats for persons with disabilities. DS-165 (01-24)