HomeMy WebLinkAboutRECORDS REQUEST - 955 MONTEREY - SPRINT CELL SITE FILE SN45XC086Printed on 4/18/2016 12:03 PM
[odl,1,jtV/S1te
T/NEXTEL (SN45XCO86/CA-6216)
CERS ID
ONTEREY ST
10436836
NL U IS OMPOr CA 93401
bmittal Status
ubmitted on 2/22/2016 by Pete Wang of Sprint United Management Co. (Overland Park, KS)
omments by submitter: This facility does not store any hazardous materials above the agency's reporting threshold, and therefore,
should be excluded from the
UPA program.
ubmittal was Not Applicable; Processed on 4/18/2016 by Kerry Boyle for San Luis Obispo County Environmental Health
dentificatlan
print Beginning Date Ending Date
perator Phone Business Phone Business Fax
7734744570.pt4 87734744570PT4 (913) 523-2040 Dun & Bradstreet SIC Code
Primary NAILS
006942395 4812
517210
Facility/Site Mailing Address Primary Emergency Contact
P.O. Box 7994 EHS Help Line
Shawnee Mission, KS 66207 ritle
�EHS Help Line
3usiness Phone 24-Hour Phone Pager Number
37734744570pt4 87734744570pt4
Owner secondary Emergency Contact
:sprint IVETWORK MANAGEMENT CENTER
87734744570pt4 ritle
PO BOX 7994 VETWORK ENGINEER
iHAWNEE MISSION, KS 66207 3usiness Phone 24-Hour Phone Pager Number
3664006040OPT8 86640060400pt8
F
ontactvironmental, Health and Safety
4570pt4 ehscompliance@sprint.com
)O BOX 7994
[:�
NEE MISSION, KS 66207
Name of Signer
Pete Wang
4 d d i tio n a l Information
Environmental Contact
EHS Territory Manager
37734744570pt4
3. O. Box 7994
Shawnee Mission, KS 66207
Signer Title
Sprint West EHS Territory Manager
L_
(Locally -collected Fields
`Tome or all of the following fields may be required by your local regulator(s).
(Property Owner
)hone
Mailing Address
Printed on 4/18/2016 12:03 PM
ehscompliance@sprint.com
Assessor Parcel Number (APN)
Number of Employees
Facility ID
42008701
Document Preparer
Pete Wang
SPRINT/NEXTEL (SN45XC086/CA-6216) (CERSID: 10436836)
Facility Information Accepted Nov 24, 2014
Submitted on 11/4/2014 3:59:30 PM by Pete Wang of Sprint United Management Co. (Overland Park, KS)
Submittal was Accepted on 11/24/2014 8:56:03 AM by Kerry Boyle
• Business Activities
• Business Owner/Operator Identification
Printed on 11/24/2014 8:56 AM
IINT/NEXTEL (SN4SXCO86/CA-6216)
MONTEREY ST
LUIS 063SPO, CA 93401
bmittal Status
bmitted on 11/4/2014 by Pete Wang of Sprint United Management Co. (Overland Park, KS)
bmittal was Accepted; Processed on 11/24/2014 by Kerry Boyle for San Luis Obispo County Environmental Health
Identification
CERSID
10436836
Sprint Beginning Date Ending Date
)perator Phone Business Phone Business Fax 1/1/2014 1/1/201S
37734744570pt4 8773474457OPT4 (913) 523-2040 Dun & Bradstreet SIC Code Primary NAILS
006942395 4812 517210
Facility/Site Mailing Address )rimary Emergency Contact
11.0. Box 7994 -HS Help Line
"Shawnee Mission, KS 66207 'itle
--H5 Help Line
iusiness Phone 24-Hour Phone Pager Number
37734744570 t4 87734744570 t4
Owner Secondary Emergency Contact
Sprint NETWORK MANAGEMENT CENTER
B7734744570pt4 ritle
PO BOX 7994 NETWORK ENGINEER
SHAWNEE MISSION, KS 66207 3usiness Phone 24-Hour Phone Pager Number
3664006040OPT8 86640060400pt8
Billing Contact °nvironmental Contact
Sprint Environmental, Health and Safety -HS Territory Manager
37734744570pt4 ehscompliance@sprint.com 37734744570pt4 ehscompliance@sprint.com
30 BOX 7994 1. 0. Box 7994
SHAWNEE MISSION, KS 66207 Shawnee Mission, KS 66207
of Signer Signer Title Document Preparer
Wang Sprint West EHS Territory Manager Pete Wang
ional Information
Locally -collected Fields
Some or all of the following fields may be required by your local regulator(s).
Property Owner
phone
Vlailing Address
Assessor Parcel Number (APN)
Number of Employees
I Facility ID
42008701
i
Printed on 11/24/2014 8:56 AM
SPRINT/NEXTEL (SN45XC086/CA-6216) (CERSID: 10436836)
Facility Information Accepted Oct 22, 2014
Submitted on 10/16/2014 2:47:56 PM by Pete Wang of Sprint United Management Co. (Overland Park, KS)
Submittal was Accepted on 10/22/2014 8:15:48 AM by Kerry Boyle
• Business Activities
• Business Owner/Operator Identification
Emergency Response and Training Plans Submitted Oct 16, 2014
Submitted on 10/16/2014 2:47:56 PM by Pete Wang of Sprint United Management Co. (Overland Park, KS)
• Emergency Response/Contingency Plan
Full HMBP (Adobe PDF, 161 KB)
• Employee Training Plan
Full HMBP (Adobe PDF, 161 KB)
Printed on 11/2/2014 12:35 PM
California Environmental Reporting System (CERS) Business Activities
�5ite Identification - - - -- - - — — --- - - — -- --- - - - — - - —_
II PRINT/NEXTEL (SN45XC086/CA-6216) CERS ID
55 MONTEREY ST 10436836
AN LUIS OBISPO, CA 93401 EPA ID Number
ounty
an Luis Obispo
submittal Status
submitted on 10/16/2014 by Pete Wang of Sprint United Management Co. (Overland Park, KS)
submittal was Accepted; Processed on 10/22/2014 by Kerry Boyle for San Luis Obispo County Environmental Health
r '
azardous Materials
des your facility have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200
cubic feet for compressed gases (include liquids in ASTs and USTs); or is regulated under more restrictive inventory local reporting requirements
shown below if present); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix
-or B;_ or handle radiological materials in -quantities for which an emergencIan is required pursuant to 10 CFR Parts 30, 40 or 70?
nderground Storage Tank(s) (UST)
oes your facility own or operate underground storage tanks?
Yes
m
Hazardous Waste
s your facility a Hazardous Waste Generator?
No
Does your facility treat hazardous waste on -site?
No
s your facility's treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)?
No
Does your facility consolidate hazardous waste generated at a remote site?
No
Does your facility need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site?
No
Does your facility generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate
n any single calendar month, or accumulate at any time, 1 kg (2,2 pounds) of RCRA acute hazardous waste; or generate or accumulate at any time
pore than 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste.
No
s your facility a Household Hazardous Waste (HHW) Collection site?
No
xcluded and/or Exempted Materials
)oes your facility recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? No
)oes your facility own or operate ASTs above these thresholds? Store greater than 1,320 gallons of petroleum products (new or used) in No
aboveground tanks or containers.
Does your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental No
teleasee revention Program CaIARP ?
Mditionai Information
No additional comments p
Printed on 11/2/2014 12:35 PM
adlity/5 i to
PRINT/NEXTEL(SN45XCO86/CA-6216)
55 MONTEREY ST
AN LUIS OBISPO, CA 93401
bmittal Status
bmitted on 10/16/2014 by Pete Wang of Sprint United Management Co. (Overland Park, KS)
bmittal was Accepted; Processed on 10/22/2014 by Kerry Boyle for San Luis Obispo County Environmental Health
dentification
,print
)perator Phone
:7734744570 pt4
Business Phone Business Fax
87734744570PT4 (913)523-2040
Beginning Date
Ending Date
Dun & Bradstreet
SIC Code
006942395
4812
CERS ID
10436836
Primary NAICS
517210
Facility/Site Mailing Address Primary Emergency Contact
P.O. Box 7994 -HS Help Line
Shawnee Mission, KS 66207 ritle
_HS Help Line
3u5iness Phone 24-Hour Phone Pager Number
7734744570pt4 87734744570pt4
Owner ecandary Emergency Contact
Sprint JETWORK MANAGEMENT CENTER
37734744570 pt4 I d e
30 BOX 7994 IlErWORK ENGINEER
SHAWNEE MISSION, KS 66207 uslaess Phone 24-Hour Phone Pa
664006040O.PT8 86640060400�it8 __
3illing Contact Environmental Contact
;print Environmental, Health and Safety -HS Territory Manager
7734744570pt4 ehscompliance@sprint.com 37734744570pt4 ehscompliance@sprint.com
)0 BOX 7994 1. 0. Box 7994
;HAWNEE MISSION, KS 66207 Shawnee Mission, KS 66207
Vame of Signer Signer Title Document Preparer
'ete Wang Sprint West EHS Territory Manager Pete Wang
4dditional Information
)Locally -collected Fields
Some or all of the following fields may be required by your local regulator(s).
Property Owner
Phone
Vlailing Address
Assessor Parcel Number (APN)
Number of Employees
Facility ID
42008701
ger Number
Printed on 11/2/2014 12:35 PM
UNIDOCS
FACILITY INFORMATION
BUSINESS ACTIVITIES PAGE
Pay 1 of
I. FACILITY IDENTIFICATION
FACILITY ID #
-
L
EPA ID # (Hazardous Waste Only) 2.
(Agency Use Only)
I
1
17
1
1
1-1
1
1
1
TT-T
I
BUSINESS NAME (Sarre as Facility Name or DBA - Doing Business As) 3•
Sprint Cell Site SN45XCO86
BUSINESS srrE ADDRESS 955 MONTEREY ST. 103.
BUSINESS SITE CITY San Luis Obispo 104,CA
IZIP CODE 93401 105
IL ACTIVITIES DECLARATION
NOTE: If you check YES to any part of this list,
lease submit the Business Owner/Operator Identification page.
Does your facility...
If Yes, lease complete these. pages of the UPCF...
A. HAZARDOUS MATERIALS
Have on site (for any purpose) at any one time, hazardous materials at or
above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for
compressed gases (include liquids in ASTs and USTs); or the applicable
® YES El NO a.
HAZARDOUS MATERIALS INVENTORY —
Federal threshold quantity for an extremely hazardous substance specified in
CHEMICAL DESCRIPTION
40 CFR Part 355, Appendix A or B; or handle radiological materials in
quantities for which an emergency plan is required pursuant to 10 CFR Parts
30, 40 or 70?
B. REGULATED SUBSTANCES
Have Regulated Substances ,stored onsite in quantities greater than the
El YES ®NO 4a.
Coordinate with your local agency responsible for
threshold quantities established by the California Accidental Release
CalARP.
Prevention Program CalARP ?
C. UNDERGROUND STORAGE TANKS (USTs)
UST OPERATING PERMIT APPLICATION —
Own or operate underground storage tanks?
❑ YES ® NO s.
FACILITY INFORMATION
UST OPERATING PERMIT APPLICATION —
TANK INFORMATION
D. ABOVE GROUND PETROLEUM STORAGE
Own or operate ASTs above these thresholds:
❑ YES ®NO x
No form required to CUPAs
Store greater than 1,320 gallons of petroleum products (new or used) in
above round tanks or containers?
E. HAZARDOUS WASTE
Generate hazardous waste?
[—]YES ® NO 9,
EPA ID NUMBER — provide at top of this page
Recycle more than 100 kg/month of excluded or exempted recyclable
❑YES ® NO nr.
RECYCLABLE MATERIALS REPORT
materials (per HSC §25143.2)?
(one pci fecyelef)
Treat hazardous waste onsite?
❑ YES ® NO 1 i.
ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION — FACILITY PAGE
ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION —UNIT PAGE (one page per unio
Perform treatment subject to financial assurance requirements (for Permit by
❑ YES ® NO 12.
CERTIFICATION OF FINANCIAL ASSURANCE
Rule and Conditional Authorization)?
Consolidate hazardous waste generated at a remote site?
[—]YES ® NO 13.
REMOTE WASTE CONSOLIDATION SITE
ANNUAL NOTIFICATION
Need to report the closure/removal of a tank that was classified as hazardous
[:]YES ® NO 14.
HAZARDOUS WASTE TANK CLOSURE
waste and cleaned onsite?
CERTIFICATION
Generate in any single calendar month 1,000 kilograms (kg) (2,200
❑ YES ® NO 14a
Obtain federal EPA ID Number, file Biennial
pounds) or more of federal RCRA hazardous waste, or generate in
Report (EPA Form 8700-13A/B), and satisfy
requirements for RCRA Large Quantity Generator.
any single calendar month, or accumulate at any time, 1 kg (2.2
pounds) of RCRA acute hazardous waste; or generate or accumulate
at any time more then 100 kg (220 pounds) of spill cleanup materials
contaminated with RCRA acute hazardous waste?
Serve as a Household Hazardous Waste (HHW) Collection site?
❑ YES ® NO 14h
See CUPA for required forms.
F. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) 13,
FORM S — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY
BUSINESS OWNER/OPERATOR IDENTIFICATION
I. IDENTIFICATION
FACILITY ID#
BEGINNING DATE t[Kl
ENDING DATE
$01
10/14/2014
0/14/2017
BUSINESS NAME (Sanne as FACIt.iTY NAMe of Dr3A - Doing Business As) 3
BUSINESS PHONE
102
Sprint Cell Site SN45XCO86
1 877 347- 4457 0 t.4
BUSINESS SITE ADDRESS
15
955 MONTEREY ST.
CITY
104
ZIP CODE
105
CA
San Luis Obispo
93401
DUN & BRADSTREET
nG
SIC CODE (4 digit #)
107
00-694-2395
4812
COUNTY
109
San Luis Obispo
BUSINESS OPERATOR NAME
10/
BUSINESS OPERATOR PHONE
110
Sprint United Management Co.
877 347- 4457 O t.4
II. BUSINESS OWNER
OWNER NAME
OWNER PHONE
112
Sprint United Management Co.
877 347- 4457 Oi2t.4
OWNER MAILING ADDRESS
PO BOX 7994
CITY
114
STATE 11S ZIP CODE
6
Shawnee Mission
1 KS 66207
III.
ENVIRONMENTAL CONTACT
CONTACT NAME
117
CONTACT PHONE
8
California EHS Specialist
1 877 347- 4457 O t.4
CONTACT MAILING ADDRESS
PO BOX 7994
CITY
120
STATE 121
ZIP CODE
122
Shawnee Mission
1 KS
66207
-PRIMARY- IV.
EMERGENCY CONTACTS -SECONDARY-
NAME
12"1
NAME
128
Network Management Center
Environmental Health & Safety Hel line
TITLE
174
TITLE
129
Network En-aineer
Environmental Health & Safety H l line
BUSINESS PHONE
125
BUSINESS PHONE
130
866 400-6040
877 347-4457
24-HOUR PHONE
126
24-HOUR PHONE
131
866 400-6040
877 347-4457
PAGER # / CELL PHONE #
127
PAGER # / CELL PHONE #
132
ADDITIONAL LOCALLY COLLECTED INFORMATION:
133
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and
am familiar with the information submitted and believe the information is true, accurate, and complete,
SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE
DATE
"I NAME OF DOCUMENT PREPARER
135
C- -
3-3-2010
I Pete Wan
NAME OF SIGNER (prim)
136 TITLE
OF SIGNER
37
Pete Wang
EHS Specialist
0:%,Docurnents and Sett1ngslbj630606\My
Doat3ments\I-IMBP\C0unty CIJPAsvSan Luis Obispo Cot,mty`.HBMP March 2010\Easiness Activities and Owner`,,San Luis Obispo BDS1ness Owner
Forrn.DOG 3-Mar-10
FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
CHEMICAL INVENTORY
(one gage per material per buildingor area)
❑ADD [-]DELETE 200
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3
Cell Site SN45XCO86
CHEMICAL LOCATION 201
CHEMICAL LOCATION CONFIDENTIAL EPCRA 211''
Within lead -acid batteries inside site shelter
❑ YES ® NO
I
MAP# (optinnap 211i
GRID# (opt innap 2t14
FACILITY ID #
I
T7L.1_1
LH
I
I
I I
II. CHEMICAL INFORMATION
CHEMICAL NAME 205
TRADE SECRET ❑ Yes ® No 206
Lead Acid Batteries
If Subject to EPCRA, refer to instructions
COMMON NAME 207
)m
EHS* ❑Yes ❑ No
LEAD ACID BATTERY
CAS# 209
*If EHS is "Yes", all amounts below must be in lbs.
FIRE CODE HAZARD CLASSES (Complcle if requited by C 311A) 210
Other health hazard material, Class 2 water -reactive corrosive
HAZARDOUS MATERIAL TYPE El. MEl
a, PURE ®bIXTURE c. WASTE
❑212
RADIOACTIVE Yes ®No
213
CURIES
(Check one item only)
214
PHYSICAL STATE
®a. SOLID [Ib. LIQUID El c. GAS
215
LARGEST CONTAINER 100
(Check one item only)
216
FED HAZARD CATEGORIES ❑ a FIRE ® b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ® e. CHRONIC HEALTH
(Check all that apply)
AVERAGE DAILY AMOUNT 217
MAXIMUM DAILY AMOUNT 218
ANNUAL WASTE AMOUNT 219
STATE WASTE CODE 220
600 1
600
1 N/A
I N/A
UNITS* ❑ a. GALLONS ❑ h, CUBIC FEET ® c. POUNDS ❑ d. TONS 221
DAYS ON SITE: 222
(Check one itein only) *If EHS, amount must be in pounds.
1 365
STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i, FIBER DRUM ❑ m, GLASS BOTTLE 223
CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ®r. OTHER
❑ c, TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ q. RAIL CAR
❑ d. STEEL DRUM ❑ h, SILO ❑ I, CYLINDER ❑ p. TANK WAGON
224
STORAGE PRESSURE ® a. AMBIENT ❑ b, ABOVE AMBIENT ❑ c. BELOW AMBIENT
225
STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC
%WT
HAZARDOUS COMPONENT (For mixture or waste only)
EHS
CAS #
226
227
228
229
1 75%
Lead
❑ Yes ® No
7439-92-1
230
231
232
233
2 24%
Sulfuric Acid
® Yes ❑ No
7664-93-9
234
23s
216
237
3
❑ Yes ❑ No
238
239
2411
241
4
❑ Yes ❑ No
242
243
244
245
5
❑ Yes ❑ No
If more IwArdous components are present al greater than 1 % by weight if non•carcinogenie, or 0.1% by weight if carcinogenic, attach additional sheets or paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246
If EPCRA Please Sin Here
FORM E
SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMERGENCY RESPONSE PLAN
Or Hazardous Waste Contingency Plan
(see instruction page vii) Date: 10/14/2014
SECTION I -A: BUSINESS IDENTIFICATION DATA
Cell Site SN45XCO86
BUSINESS NAME,
955 MONTEREY ST.
San Luis Obispo 93401
SITE ADDRESS
CITY ZIP CODE
877-347-4457
FACILITY UNIT
"TELEPHONE NUMBER
PO Box 7994
Shawnee Mission 66207
BUSINESS MAILING ADDRESS
CITY ZIP CODE
!f your business has a license or permit from any of the following agencies, please indicate the document number.
1. Hazardous Materials
3. Air Pollution Control
Underground Storage #
District #
2. Hazardous Waste
4. Responding Fire Dept
Generator #
& Permit #
Please provide the following information as it pertains to your business and its location. You are not required to notify these companies in the
event of an emergency.
This information is provided for your reference and to assist emergency response personnel in responding to a
hazardous materials emergency at your facility. List the name and phone number of the utility company.
Electric Service City
of San Luis Obispu Telephone # 805-781-7215
Gas Service City
of San Luis Obispo Telephone # 805-781-7215 _
Sanitation City of San Luis Obis ❑ Telephone # -7-115
City of San Luis Obispo
Water District Telephone # 805-781-7215
SECTION I-B: OWNER CERTIFICATION OF DATA (Certify either 1 or 2)
1. This is a ®NEW Plan ❑UPDATED Existing Plan. I have personally examined the information it contains and am familiar with the
operation of the plan. (If you check either of the above two options, continue to complete the remained of the Emergency Response /
Contingency Plan).
2, ❑ This plan requires no change and is on file with San Luis Obispo County Hazardous Materials Unified Program Agency and does
not need any change. (If you check this section, please proceed directly to Form T, the Training Program.)
I certify under penalty of law that the above information is true and accurate.
Pete Wang 3-5-10
PRINT NAME OF OWNER OR OPERATOR SIGNATURE DATE
Pete Wang 3-5-10
DOCUMENTS PREPARED BY SIGNATURE DATE
5
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IC `Documt nla and Settingsrbj630606+My DoctiinonlslHM[313".County CUEAs:San Luis Obispo Counly`•.HBW March 201t1�.Einergenry Response f lanlSan
Luis Obispo ERP Ternplale-City of San Luis Oblspo.DOC 03/08/10
SECTION II: EMERGENCY RESPONSE PLANS AND PROCEDURES
Note: Complete all seclions of this Emergency Response Procedure below. Use of lerms such as "N/A" (Not Applicable) will not be accepted.
A. FIRE, SPILL OR RELEASE: The fire code requires immediate notification through dialing 911, by whoever first sights the
incident. In the event of release or spill of hazardous materials, you must also notify:
1. San Luis Obispo County Hazardous Materials Unified Program Agency during business hours @ 805-781-5544. After
business hours dial 911.
2. The State Office of Emergency Services - (800) 852-7550 or (916) 262-1621.
List the individuals responsible for verifying that these calls have been made and also indicate their position in your company.
FOR VERIFYING THE DIALING OF 911:
Daniel J Jaimes Field Services Manager
NAME POSITION
Individual responsible for calling San Luis Obispo County Hazardous Materials Unified Program Agency and the State Office of
Emergency Services: (Normally the Emergency Coordinator of your business,)
Matt Fohlmeister EHS Specialist
NAME POSITION
B. List the local emergency medical facilities that will be used by your business in the event of an accident or injury caused by a release
or threatened release of hazardous materials.
Sierra Vista Regional Medical Center 1010 Murray Avenue, San Luis Obispo 805-546-7600
NAME ADDRESS CITY PHONE
French Hospital Medical Center 1911 Johnson Avenue, San Luis Obispo 805-543-5353
NAME ADDRESS CITY PHONE
C. List the Emergency Coordinator(s) at your facility.
Primary: Matt Fohlmeister EHS Specialist 913-762-6004 877-347-4457
NAME 'TITLE BUSINESS PHONE 24 HR PHONE PAGER Y
Secondary: Pete Wang EHS Specialist 650-375-2019 877-347-4457
NAME TITLE BUSINESS PHONE 24 1IR PI ]ONE PAGER N
D. Does your business have an on -site emergency response team? ❑Yes ®No Describe procedures your business will follow in
the event of a release or threatened release of hazardous materials.
A contract has been established with Hazmat Resltonse,Inc_(877-347-4457) which can deliver teams of skilled and -experienced fie Id
person n 1 and other technic p 1 ex perts to handle the ntiti ation and remediation of a significant releases ill leak etc. Employees will
contact 1jazMat Response. Inc. when they observe chemical release, spills and leak on -site.
6
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C:ADoct,nnenls and lMBP1C0u11y CUfAs\San Luis Obispo Counly%+lBMP March 2010\Cmorgency Response Plan\San
Luis Obispo CRP Template- City of San Luis Obispo,DOC 03/08/ 10
E. If you have acutely hazardous materials above threshold planning quantities, list (by name and address) adjacent neighboring
businesses and residences, schools, hospitals, etc. Include sensitive facilities (schools, hospitals and rest homes) within 1,000 feet
(straight-line distance from your property line). List telephone numbers for all businesses; for apartment buildings, list manager's
phone. Do not list telephone numbers for private residences.
F. Briefly describe your standard operating procedures in the event of a release or threatened release of hazardous materials.
Emergency response procedures must comply with all federal, state and local regulations. Existing emergency response procedures
may be referenced and attached to this document,
1. Prevention -- Describe the accident potentials associated with the hazardous materials present at your facility. What actions
would your business take to reduce accident potentials? Include description of safety, storage and containment procedures.
The facility is eguipped with sl2ill response procedures and a ui ment. In the event of a leak ors ill the spill may be contained b
surrounding the spilled acid with an approved absorbent. The substance will then be neutralized into a harmless material. Under
emergency res once conditions a contract has been established with Hazmat Response 877-147-4457 which can deliver teams of
skilled and ex erienced field personnel and other technical ex errs to handle the mitigation and remediadon of a significant release
sl2ifl, leak etc. The Corporate Environmental Health and Safety Department has developed a S ill Prevention RiWairt that
provides guidelines for l2ersonnei on the vrevention of accidental releases of hazardous substances into the environment and also
provides spi I response procedures.
The site has desi nalcd areas marked with signs and labels for storage of hazardous materials. Personnel are kept are aware of safer
issues regarding all hazardous materials lhrou h safety training meetings. Regularly scheduled ins eetions of batteries and fire
exIiit guishers are routine res ponsibilities of rite associated Field Technician. The Corporate Environmental Health and Safer
IDe amiie l has developed a 5 ]ill Prevention Program which provides guidelines -for aersonnel on the prevention of accidental release's
of hazardous substances into the environment. All ernl2loyees who come in contact with battery s stems and/or diesc] fuel in theirdaily
work res ponsibiliLies are trained on [lie sp iIl prevention iro g ram anti s )ill res xins£ 11rocedures.
2. Equipment -- List the emergency response equipment at your facility (e.g, fire extinguishing systems, spill control equipment,
decontamination equipment).
Item
Use
Location
Maintenance Procedure
Chemical
PPE for spill
Within field
Visually inspected by field technician
Protective
control
technicians vehicle
Gloves
First Aid Kits
First Aid
Within field
Visually inspected by field technician
technicians vehicle
Hard Hats
PPE
Within field
Visually inspected by field technician
technicians vehicle
Safety
PPE for spill
Within field
Visually inspected by field technician
Glasses/Splash
control
technicians vehicle
Goggles
Fire
Fire hazard
Within field
Annually inspected and serviced by qualified vendor/supplier
Extinguishers
technicians vehicle
7
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Nlobile I'hone. Communication Within field 'tested by field technician on a daily basis
technicians vehicle
3. Evacuation -- Describe how you will immediately evacuate your facility, What communications or alarms are used? How will
you operate these during power failure?
This is an unmanned eel sile Verbal cominunicalion i.e. S110 Ll I i 11R, is used for evacuation i f the associated f field technician a aeais on -site
during the event of a release or threatened release of hazardous materials.
4. Shutdown -- Describe the shutdown for each site or facility,
5a. Response -- Describe what is done to lessen or mitigate the harm or damage to person(s), property, or the environment, and
prevent the event from getting worse or spreading. What is your immediate response to:
Fire: Fire Department will be contacted in the event of fire.
Explosion: Employees will contact 911 in the event of an explosion,
Spill: Employees will contact HazMat Response, Inc. when they observe chemical release, spills and leak on -site.
Earthquake: If any property damage or personnel injuries are caused by the earthquake, the following staff members will be notified: Site
Manager, Production and Maintenance Managers, Safety Manager, Emergency Response Team and Electrician.
Major Power Failure: The following staff members will be notified: Site Manager, Production and Maintenance Managers, Safety
Manager, Emergency Response Team, and Electrician.
Flood: Notify the following staff members: Site Manager, Production and Maintenance Managers, Safety Manager, Emergency Response
Team, and Electrician.
b. Is this facility located on a 100-year flood plain? ❑Yes ®No
c. Earthquake - Identify facility areas and list mechanical or other systems that require immediate inspection or isolation because of
their vulnerability to earthquake related ground motion,
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6. Clean -Up (Remove the Hazard) -- How do you handle the complete process of cleaning up, and disposing of related materials at your
facility? Note: Notify the Hazardous Materials Unified Program Agency when clean up is complete.
Employees will contact HazMat Response, Inc. when they observe chemical release, spills and leak on -site.
G. Location -- Your business is required to keep a copy of the Business Plan and related MSDS sheets on -site. Describe where this
information is located.
Inside equipment shelter.
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FORM T
SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMPLOYEE TRAINING PROGRAM Date: 10/14/2014
A. Describe the safety training for all employees in the event of a release or threatened release of hazardous materials. This
training shall include, but not be limited to, the following: new employee training, annual training, periodic refresher courses,
and familiarization with Emergency Plans and Procedures of this Business Plan / Contingency Plan.
1. Summarize the training for all employees that work with or come in contact with hazardous materials/hazardous waste, Describe
how these employees are trained to avoid exposure.
Personnel who work with or come in contact with hazardous materials are required to be trained in the following recedures:
• Internal alarnttnotiftcation;
• Evacmion/re-enuy procedures and aSSCTnl)ly 00int Incations•
• Emery incident report.
Chemiu I Handlers are additional) [rained in Safc methods for hand lin and stona a or hazardous materials
• Locations and proper use of [ire ands ill control a ui ment•
• mill proceduredemergencyprocedures;
• Proper use oi' oersonal_prot_ective ouipmeent:
• Specific hazards of each chemical to which they may be ex rnsed including routes of cx osume i.e, inhalation in eslion
absorption].
2. Summarize training specific to those employees that would respond to a release or threatened release of hazardous materials or
hazardous waste.
Harmat Response, Inc. 877-347A457 is responsible for delivering teams of skilled and experienced field personnel and other technical
experts to handle the mitittatioa and remediation of a significant release, spi11,_1mk, etc.
Indicate frequency and duration of training for employees that work with or come into contact with hazardous materials/hazardous
waste.
Employees who work with or come into contact with hazardous materials are required to complete the initial training. Some specific
training courses are required to be renewed annually.
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4. Describe how your employees access training materials. (E,g., bulletin board, employee newsletter, staff meetings, etc.)
kiln In ees receive: their initial and renewal training via company's online training too]. Training to contractors and vendors are provided
by their companies.
B. List person(s) in charge of training and indicate their qualifications to conduct the training.
Sm to ces receive their initial and renewal " i n i ne via cam -rn 's online trainijig .tool. Trainin g to Contractors and vendors are provided
by their companies.
C. Indicate where training records are kept. (Records must document the type of training, duration, completion dates, names and
positions of employees receiving training and the name(s) of instructors / trainer.)
The following records are maintained at the l'acilit :
■ Cun•ent employees' trasining_record s 6o be retained Lint iI closure of the facility;
• Former cm ]c> ces' training records to be retained :rt ]cast three years after icnnination of cm ila ment
• Training Pro *rains i.e. written description of inn•oductot and cont inuing trainin'
■ Current copy ol'this Emergency Response/Contingency Plan:
• Record of record.tole/relxntah le_ltaua_rdous materiallwastC_releases:
• Record of hazardous maierial/waste storage area inspections
10
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UNIDOCS
FACILITY INFORMATION
BUSINESS ACTIVITIES PAGE
Page 1 of
I. FACILITY IDENTIFICATION
FACILITY ID #
t- EPA ID It (Hazardous Waste Only) 2
(Agency Use Only)
I I
ITFT
I
BUSINESS NAME (Same as facility Name or DBA - Doing Business As) 3
Sprint Cell Site SN45XCO86
BUSINESS SITE ADDRESS 103
955 MONTEREY ST.
BuslNEss SITE CITY San Luis Obispo loa
CA
ZIP CODE
93401 ws-
II. ACTIVITIES DECLARATION
NOTE: If you check YES to any part of this list,
lease submit the Business Owner/Operator Identification page.
Does your facility...
If Yes, please complete these pages of the UPCF...
A. HAZARDOUS MATERIALS
Have on site (for any put -pose) at any one time, hazardous materials at or
above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for
compressed gases (include liquids in ASTs and USTs); or the applicable
®YES ❑ NO a.
HAZARDOUS MATERIALS INVENTORY —
Federal threshold quantity for an extremely hazardous substance specil'ied in
CHEMICAL DESCRIPTION
40 CFR Part 355, Appendix A or B; or handle radiological materials in
quantities for which an emergency plan is required pursuant to 10 CFR Parts
30, 40 or 70?
B. REGULATED SUBSTANCES
Have Regulated Substances stored onsite in quantities greater than the
El YES ®NO aa.
Coordinate with your local agency responsible for
threshold quantities established by the California Accidental Release
CaIARP.
Prevention Program (CalARP)?
C. UNDERGROUND STORAGE TANKS (USTs)
UST OPERATING PERMIT APPLICATION —
Own or operate underground storage tanks?
[:]YES ® NO s,
FACILITY INFORMATION
UST OPERATING PERMIT APPLICATION —
TANK INFORMATION
D. ABOVE GROUND PETROLEUM STORAGE
Own or operate ASTs above these thresholds:
❑ YES NO a.
No form required to CUPAs
Store greater than 1,320 gallons of petroleum products (new or used) in
aboveground tanks or containers?
E. HAZARDOUS WASTE
Generate hazardous waste?
❑ YES ® NO 9.
EPA ID NUMBER — provide at top of this page
Recycle more than 100 kg/month of excluded or exempted recyclable
❑ YES ® NO io.
RECYCLABLE MATERIALS REPORT
materials (per HSC §25143.2)?
(one pCf 1CLyel01)
Treat hazardous waste onsite?
[:]YES ® NO n-
ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION — FACILITY PAGE
ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION — UNIT PAGE (one page per unit)
Perform treatment subject to financial assurance requirements (for Permit by
❑ YES ® NO 12.
CERTIFICATION OF FINANCIAL ASSURANCE
Rule and Conditional Authorization)?
Consolidate hazardous waste generated at a remote site?
❑ YES ® NO i3.
REMOTE WASTE CONSOLIDATION SITE
ANNUAL NOTIFICATION
Need to report the closure/removal of a tank that was classified as hazardous
❑ YES ® NO la.
HAZARDOUS WASTE TANK CLOSURE
waste and cleaned onsite?
CERTIFICATION
Generate in any single calendar month 1,000 kilograms (kg) (2,200
❑ YES ® NO 14a.
Obtain federal EPA ID Number, file Biennial
pounds) or more of federal RCRA hazardous waste, or generate in
Report (EPA Form 8700-13A/B), and satisfy
requirements for RCRA Large Quantity Generator.
any single calendar month, or accumulate at any lime, 1 kg (2.2
pounds) of RCRA acute hazardous waste; or generate or accumulate
at any time more then 100 kg (220 pounds) of spill cleanup materials
contaminated with RCRA acute hazardous waste?
Serve as a Household Hazardous Waste (HHW) Collection site?
❑ YES ® NO iab,
See CUPA for required forms.
F. LOCAL REQUIREMENTS (You niay also be required to provide additional information by your CUPA or local agency,) 15
FORM S — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY
BUSINESS OWNER/OPERATOR IDENTIFICATION
I. IDENTIFICATION
FACILITY ID#
I
BEGINNING DATE 100
ENDING DATE 101
10/14/2014
1 10/14/2017
BUSINESS NAME (sanleasFAC11.1TYNAMern-DnA— Doing Business As) 3
BUSINESS PHONE 102
Sprint Cell Site SN45XCO86
877 -347- 4457 01AA
BUSINESS SITE ADDRESS 103
955 MONTEREY ST.
CITY 104
ZIP CODE los
CA
San Luis Obispo
93401
DUN & BRADSTREET 106
SIC CODE (4 digit#) tU%
00-694-2395
4812
COUNTY 1UX
San Luis Obispo
BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 11U
Sprint United Management Co. 877 347- 4457 O t.4
II. BUSINESS OWNER
OWNER NAME III
OWNER PHONE 112
Sprint United Management Co.
877 347- 4457 O t.4
OWNER MAILING ADDRESS 13
PO BOX 7994
CITY 114
STATE 115
ZIP CODE 116
Shawnee Mission
1 KS 1
66207
III. ENVIRONMENTAL CONTACT
CONTACTNAME 7 CONTACT PHONE ns
California EHS Specialist 877 347- 4457 O t.4
CONTACT MAILING ADDRESS 119
PO BOX 7994
CITY 120
STATE }2t
ZIP CODE 122
Shawnee Mission
1 KS
66207
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-
NAME 123
NAME
Network Manawment Center
Environmental Health & Safety Hel line
TITLE 124
TITLE 129
Network En ineer
Environmental, Health & Safety Hel line
BUSINESS PHONE 125
BUSINESS PHONE 311
866 400-6040
877 347-4457
24-HOUR PHONE 12(1
24-HOUR PHONE 131
866 400-6040
877 347- 4457
PAGER # / CELL PHONE # 127
PAGER # / CELL PHONE # 132
ADDITIONAL LOCALLY COLLECTED INFORMATION: 133
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and
am familiar with the information submitted and believe the information is true, accurate, and complete.
SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE
134
NAME OF DOCUMENT PREPARER 135
3-3-2010
1 Pete Wan
NAME OF SIGNER (print) 136 TITLE
OF SIGNER 137
Pete Wang EHS
Specialist
II C:\Documonts and Settingslbj630606\My
Documents\HMBP\C%01-1i3[y GUPAs\San Luis Obispo Get10ty`1-]BMP March 2010\[3usine9s Activities and Owner\San Luis Obispo Business Owner
Form.DOC; 3-Mar 10
FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
CHEMICAL INVENTORY
(one gage per material per building or area)
❑ADD ❑DELETE ❑REVISE 2ii0
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3
Cell Site SN45XCO86
CHEMICAL LOCATION 20l
CHEMICAL LOCATION CONFIDENTIAL EPCRA 70'
Within lead -acid batteries inside site shelter
❑ YES ® NO
I
MAP# (optional) 203
GRID# (optional) 204
FACILITY ID #
II. CHEMICAL INFORMATION
CHEMICAL NAME 205
TRADE SECRET El Yes ® No 206
Lead Acid Batteries
If Subject to EPCRA, refer to instructions
COMMON NAME 207
1U8
EHS* ❑Yes ❑ No
LEAD ACID BATTERY
CAS# 209
*If EHS is "Yes", all amounts below must be in lbs.
FIRE CODE HAZARD CLASSES (Complete it required by CUPA) 21)
Other health hazard material Class 2 water -reactive, corrosive
2tI
212
213
HAZARDOUS MATERIAL TYPE
El a. PURL ®b. MIXTURE ❑ c. WASTE
RADIOACTIVE. El ® No
CURIES
(C heck one item only)
214
215
PHYSICAL STATE
® a. SOLID ❑ b. LIQUID ❑ c, GAS
LARGEST CONTAINER 100
(Check one item only)
216
FED HAZARD CATEGORIES ❑ o FIRE ® It. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH E e. CHRONIC HEALTH
(Check all that apply)
AVERAGE DAILY AMOUNT 217
MAXIMUM DAILY AMOUNT 219
ANNUAL WASTE AMOUNT 219
STATE WASTE CODG 220
600 1
600
1 N/A
1 N/A
UNITS* ❑ a_ GALLONS ❑ b. CUBIC FEET ® c. POUNDS ❑ d. TONS 221
DAYS ON SITE: 222
(Check one item only) *If EHS, amount must be in pounds.
365
STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE 223
CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ®r. OTHER
❑ c. TANK INSIDE BUILDING ❑ g, CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ q. RAIL CAR
❑ d. STEEL DRUM ❑ It, SILO ❑ I. CYLINDER ❑ p. TANK WAGON
224
STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT
225
STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC
%WT
HAZARDOUS COMPONENT (For mixture or waste only)
EHS
CAS #
226
227
221t
229
1 75%
Lead
❑ Yes ® No
7439-92-1
2:7o
231
232
233
2 24%
Sulfuric Acid
® Yes ❑ No
7664-93-9
234
235
236
237
3
❑ Yes ❑ No
238
239
240
241
4
❑ Yes ❑ No
242
243
244
245
5
❑ Yes ❑ No
ff more hazardous components are present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information,
ADDITIONAL LOCALLY COLLECTED INFORMATION 246
If EPCRA Please Sin Here
Facility Site Plan/Storage Map
(Hazardous Materials Business Plan Module)
Site Address: Cell Site SN45XC086, 955 MONTEREY ST.,San Luis Obispo
Date Map Drawn: 3-1-10 Map Scale:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Page` of
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
VICINITY MAP
Equipment Room
"'. 1
} 1
FORM E
SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMERGENCY RESPONSE PLAN
Or Hazardous Waste Contingency Plan
(see instruction page vii) Date: 10/14/2014
SECTION I -A: BUSINESS IDENTIFICATION DATA
Cell Site SN45XCO86
BUSINESS NAME
955 MONTEREY ST. San Luis Obispo 93401
SITE ADDRESS CITY ZIP CODE
877-347-4457
FACILITY UNIT TELEPHONE NUMBER
PO Box 7994 Shawnee Mission 66207
BUSINESS MAILING ADDRESS CITY ZIP CODE
Ifyour business has a license or permit from any of the fallowing agencies, please indicate the document number.
1. Hazardous Materials 3. Air Pollution Control
Underground Storage # District #
2. Hazardous Waste 4. Responding Fire Dept
Generator # & Permit #
Please provide the following information as it pertains to your business and its location, You are not required to notify these companies in the
event of an emergency. This information is provided for your reference and to assist emergency response personnel in responding to a
hazardous materials emergency at your facility. List the name and phone number of the utility company.
Electric Service City of San Luis Obispo Telephone # 805-781-7215
Gas Service City of San Luis Obispo Telephone # 805-781-7215
Sanitation City of San Luis Obispo Telephone # 34W 7st l -72 t 5_
City of San Luis Obispo
Water District Telephone # 805-781-7215
SECTION I-B: OWNER CERTIFICATION OF DATA (Certify either 1 or 2)
1. This is a ®NEW Plan ❑UPDATED Existing Plan. I have personally examined the information it contains and am familiar with the
operation of the plan. (If you check either of the above two options, continue to complete the remained of the Emergency Response /
Contingency Plan).
2. ❑ This plan requires no change and is on file with San Luis Obispo County Hazardous Materials Unified Program Agency and does
not need any change. (If you check this section, please proceed directly to Form T, the Training Program.)
I certify under penalty of law that the above information is true and accurate.
Pete Wang cam_ �a 3-5-10
PRINT NAME. OF OWNER OR OPERATOR SIGNATURE DATE
Pete Wang 3-5-10
DOCUMENTS PREPARED BY SIGNATURE DATE
5
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SECTION II: EMERGENCY RESPONSE PLANS AND PROCEDURES
Note: Complete all sections of this Emergency Response Procedure below. Use of terms such as "N/A" (Not Applicable) will not be accepted.
A. FIRE, SPILL OR RELEASE: The fire code requires immediate notification through dialing 911, by whoever first sights the
incident. In the event of release or spill of hazardous materials, you must also notify:
1. San Luis Obispo County Hazardous Materials Unified Program Agency during business hours @ 805-781-5544. After
business hours dial 911.
2. The State Office of Emergency Services - (800) 852-7551) or (916) 262-1621.
List the individuals responsible for verifying that these calls have been made and also indicate their position in your company.
FOR VERIFYING THE DIALING OF 911:
Daniel J Jaimes Field Services Manager
NAME POSITION
Individual responsible for calling San Luis Obispo County Hazardous Materials Unified Program Agency and the State Office of
Emergency Services: (Normally the Emergency Coordinator of your business.)
Matt Fohlmeister EHS Specialist
NAME POSITION
B. List the local emergency medical facilities that will be used by your business in the event of an accident or injury caused by a release
or threatened release of hazardous materials.
Sierra Vista Regional Medical Center 1010 Murray Avenue, San Luis Obispo 805-546-7600
NAME ADDRESS CITY PHONE
French Hospital Medical Center 1911 Johnson Avenue, San Luis Obispo 805-543-5353
NAME ADDRESS CITY PHONE
C. List the Emergency Coordinator(s) at your facility.
Primary: Matt Fohlmeister EHS Specialist 913-762-6004 877-347-4457
NAME TI"rLE BUSINESS PHONE 24 FIR PHONE PAGER #
Secondary: Pete Wang EHS Specialist 650-375-2019 877-347-4457
NAME TITLE BUSINESS PI [ONE 24 1IR PI IONE PAGER JI
D. Does your business have an on -site emergency response team? ❑Yes ®No Describe procedures your business will follow in
the event of a release or threatened release of hazardous materials.
A COII act has bs en established with Hazmat Res }onse Inc 877-347-4457 which can deliver teams of skilled and ex Verianced field
personnel and other technical experts to handle the mitigation and remediation of a significant releases ill leak etc. Employees will
contact Hw/Mat Response, Inc. when they observe chemical release, spills and leak on -site.
6
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E. If you have acutely hazardous materials above threshold planning quantities, list (by name and address) adjacent neighboring
businesses and residences, schools, hospitals, etc. Include sensitive facilities (schools, hospitals and rest homes) within 1,000 feet
(straight-line distance from your property line). List telephone numbers for all businesses; for apartment buildings, list manager's
phone. Do not list telephone numbers for private residences.
F. Briefly describe your standard operating procedures in the event of a release or threatened release of hazardous materials.
Emergency response procedures must comply with all federal, state and local regulations. Existing emergency response procedures
may be referenced and attached to this document.
1. Prevention -- Describe the accident potentials associated with the hazardous materials present at your facility. What actions
would your business take to reduce accident potentials? Include description of safety, storage and containment procedures.
The raciray iscLquipApLd with s ill response onse roceduregs and a ui ment. In the event of a leak or spill, the spill may be eontained b
surrounding the spilled acid with an a. roved ab: orbent.'rhe substance will then be neutralized into a harmless material. Under
p mergency res ponce cond i i io ns. a contract has been established with Ilit zinat Res ponse 877-347-4457) which can deliver te.uns of
skiiled and ex perianced ftelci Versonnel and other technical ex ertr to handle lire miti &ation and reniediation of a si gnillcant release
spill, leak. etc. The Corporate Environmental I-ie.alth and Safety De"rtnlent_has developed a Spill Prevention program that
provides guidelines for personnel on [lie prevention of accidental releases of hazardous substances into the environment and also
provides spill response procedures.
The site has designated rheas marked with signs and labels for storage ol'hazardous materials. Pcrsonncl are kept are aware of sales
issues regard i n g ail hazardous materials throw ah safes y I rai n i ng meetin s. ReptuIarl y scheduled ins ections of batteries and Eire
extinguishers are routine res onsibilities of the associated Field Technician. The Cot orate Environmental Health gild Safes
Department has developed a Spill Prevention Program which provides guidelines for ersonnel on the grevendon of accidental releases
of hazardous substances into the environnle_nt. All employees whocotne in contact with battery systems and/or diesel fuel in their d
work responsibilities are trained on the spill prevention program and spill response procedures.
2. Equipment -- List the emergency response equipment at your facility (e.g, fire extinguishing systems, spill control equipment,
decontamination equipment).
Item
Use
Location
Maintenance Procedure
Chemical
PPE for spill
Within field
Visually inspected by field technician
Protective
control
technicians vehicle
Gloves
First Aid Kits
First Aid
Within field
Visually inspected by field technician
technicians vehicle
Hard Hats
PPE
Within field
Visually inspected by field technician
technicians vehicle
Safety
PPE for spill
Within field
Visually inspected by field technician
Glasses/Splash
control
technicians vehicle
Goggles
Fire
Fire hazard
Within field
Annually inspected and serviced by qualified vendor/supplier
Extinguishers
technicians vehicle
7
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Mobile Phone C'mulnunication Within field Tested by field technician on a daily basis
technicians vehicle
3. Evacuation -- Describe how you will immediately evacuate your facility. What communications or alarms are used? How will
you operate these during power failure?
This is an unmanned cell site. Verbal communication i.e. shouting, is psod for evacuation if the associated field technician apagars on -site
during the event of a release or threatened release of hazardous materials.
4. Shutdown -- Describe the shutdown for each site or facility,
5a. Response -- Describe what is done to lessen or mitigate the harm or damage to person(s), property, or the environment, and
prevent the event from getting worse or spreading. What is your immediate response to:
Fire: Fire Department will be contacted in the event of fire.
Explosion: Employees will contact 911 in the event of an explosion,
Spill: Employees will contact HazMat Response, Inc. when they observe chemical release, spills and leak on -site.
Earthquake: If any property damage or personnel injuries are caused by the earthquake, the following staff members will be notified: Site
Manager, Production and Maintenance Managers, Safety Manager, Emergency Response Team and Electrician,
Major Power Failure: The following staff members will be notified: Site Manager, Production and Maintenance Managers, Safety
Manager, Emergency Response Team, and Electrician.
Flood: Notify the following staff members: Site Manager, Production and Maintenance Managers, Safety Manager, Emergency Response
Team, and Electrician.
b. Is this facility located on a 100-year flood plain? ❑Yes ®No
c. Earthquake - Identify facility areas and list mechanical or other systems that require immediate inspection or isolation because of
their vulnerability to earthquake related ground motion.
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6. Clean -Up (Remove the Hazard) -- How do you handle the complete process of cleaning up, and disposing of related materials at your
facility? Note: Notify the Hazardous Materials Unified Program Agency when clean up is complete.
Employees will contact HazMat Response, Inc, when they observe chemical release, spills and leak on -site.
G. Location -- Your business is required to keep a copy of the Business Plan and related MSDS sheets on -site. Describe where this
information is located.
Inside equipment shelter.
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Luis Obispo ERP Template- City of San Luis Obispo.DOC 03,108/10
FORM T
SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMPLOYEE TRAINING PROGRAM Date: 10/14/2014
A. Describe the safety training for all employees in the event of a release or threatened release of hazardous materials. This
training shall include, but not be limited to, the following: new employee training, annual training, periodic refresher courses,
and familiarization with Emergency Plans and Procedures of this Business Plan / Contingency Plan.
I. Summarize the training for all employees that work with or come in contact with hazardous materials/hazardous waste. Describe
how these employees are trained to avoid exposure.
Personnel who work with or come in contact with hazardous matatals are re uired to be trained in the foil owin rocedures:
• Internal alarni/notiCication;
• Rvac uat i on/t-L-ent a V rocedures and assemhI y i mint locations•
■ Emergency incident report.
Chemical Handlc:ls are additiopally trained in Safe methods for handling and storage of hazardous materials
• Locations zuid p=cr use of Fine ands ill control equipment,
• Spilt procedumslem_ergenc�+ procedures;
• Proper use of ygrsonal rotevtivv c ui inern,
■ S eciftc hazards of each chemical to which they may be exposed, including routes of ex osure i.e. inhalation in lion.
absotpt ion).
2. Summarize training specific to those employees that would respond to a release or threatened release of hazardous materials or
hazardous waste.
Hazunat Res once Inc. 877-347-4457 is res onsible for delivering teatns of skilled and ex etienced field personnel and other technical
eeVerts to handle the mitigation and rcmedia(ion of a significant release, spill. leak. etc.
3. Indicate frequency and duration of training for employees that work with or come into contact with hazardous materials/hazardous
waste.
Em Io ees who work with or come into contact with hazardous materials are required to complete the initial trainin . Some s ecifie
training courses are required to he renewed annually;
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4. Describe how your employees access training materials. (E.g., bulletin board, employee newsletter, staff meetings, etc,)
Em to ces receive their initial and renewal Iraininje via company's online training tool. T:ainin g to contractors and vendors are Provided
by their companies.
B. List person(s) in charge of training and indicate their qualifications to conduct the training.
Em la s receive their initial and renewal training via company's online training tool. Training to contractor and vendors we provided
by their companies;
C. Indicate where training records are kept. (Records must document the type of training, duration, completion dates, names and
positions of employees receiving training and the name(s) of instructors / trainer.)
The following rtAxwds aremainttingd at_thc Iiuility:
• Current employees' training records (to _he_retained _ until closure of the facility;
• Former employees' G'aininf* rccards (to he retained at leas[ three years after teriniriation of enrployinent '
• Training Programs) (i.e., written description of introd uctory_and cont inu'sng trainin
• Current copy of this Emergency Response/Contingency Plan;
■ Record of recordable/reportable hazardous matedid/waste releases;
• Rccord of hazardous material/waste storage area inspections
10
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PIawFrnpIoyee?raining torrn.DOC 0316/10
Facility Site Plan/Storage Map
(Hazardous Materials Business Plan Module)
Site Address: Cell Site SN45XC086, 955 MONTEREY ST.,San Luis Obispo
Date Map Drawn: 3-1-10 Map Scale: Page of
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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
VICINITY MAP
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Equipment Room
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UNIDOCS
FACILITY INFORMATION
BUSINESS ACTIVITIES PAGE
Page 1 of
I. FACILITY IDENTIFICATION
FACILITY ID #
1
EPA ID # (Hazardous Waste Only) 2
(Agenct, Use Only)
I
BUSINESS NAME (Sante as Facility Name or DBA - Doing Business As) 1•
Sprint Cell Site SN45XCO86
BUSINESSSITE ADDRBS 955 MONTEREY ST. 1U3.
BUSINESS SITE CITY San Luis Obispo oa CA ZIP CODE 93401 o5.
II. ACTIVITIES DECLARATION
NOTE: If you check YES to any part of this list,
lease submit the Business Owner/Operator Identification page.
Does your facility...
If Yes, lease complete these pages of the UPCF...
A. HAZARDOUS MATERIALS
Have on site (for any purpose) at any one time, hazardous materials at or
above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for
compressed gases (include liquids in ASTs and USTs); or the applicable
® YES ❑ NO a,
HAZARDOUS MATERIALS INVENTORY -
Federal threshold quantity for an extremely hazardous substance specified in
CHEMICAL DESCRIPTION
40 CFR Part 355, Appendix A or B; or handle radiological materials in
quantities for which an emergency plan is required pursuant to 10 CFR Parts
30, 40 or 70?
B. REGULATED SUBSTANCES
Have Regulated Substances stored onsite in quantities greater than the
❑ YES ® NO aa.
Coordinate with your local agency responsible for
threshold quantities established by the California Accidental Release
CalARP.
Prevention Program (CalARP)?
C. UNDERGROUND STORAGE TANKS (USTs)
UST OPERATING PERMIT APPLICATION -
Own or operate underground storage tanks?
[-]YES ® NO 5.
FACILITY INFORMATION
UST OPERATING PERMIT APPLICATION -
TANK INFORMATION
D. ABOVE GROUND PETROLEUM STORAGE
Own or operate ASTs above these thresholds:
❑YES ®NO s.
No form required to CUPAs
Store greater than 1,320 gallons of petroleum products (new or used) in
aboveground tanks or containers?
E. HAZARDOUS WASTE
Generate hazardous waste?
❑ YES ® NO 9.
EPA ID NUMBER - provide at top of this page
Recycle more than 100 kg/month of excluded or exempted recyclable
❑ YES ® NO to
RECYCLABLE MATERIALS REPORT
materials (per HSC §25143.2)?
(one per recycler)
Treat hazardous waste onsite?
❑ YES ® NO it.
ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION - FACILITY PAGE
ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION - UNIT PAGE (one page per unit)
Perform treatment subject to financial assurance requirements (for Permit by
❑ YES ® NO 12.
CERTIFICATION OF FINANCIAL ASSURANCE
Rule and Conditional Authorization)?
Consolidate hazardous waste generated at a remote site?
❑ YES ® NO 13
REMOTE WASTE CONSOLIDATION SITE
ANNUAL NOTIFICATION
Need to report the closure/removal of a tank that was classified as hazardous
[]YES ® NO ta,
HAZARDOUS WASTE TANK CLOSURE
waste and cleaned onsite?
CERTIFICATION
Generate in any single calendar month 1,000 kilograms (kg) (2,200
[:]YES ® NO taa
Obtain federal EPA ID Number, file Biennial
pounds) or more of federal RCRA hazardous waste, or generate in
Report (EPA Form 8700-13A/B), and satisfy
any single calendar month, or accumulate at any time, 1 kg (2.2
requirements for RCRA Large Quantity Generator.
pounds) of RCRA acute hazardous waste; or generate or accumulate
at any time more then 100 kg (220 pounds) of spill cleanup materials
contaminated with RCRA acute hazardous waste?
Serve as a Household Hazardous Waste (HHW) Collection site?
❑ YES ® NO iab.
See CUPA for required forms.
F. LOCAL REQUIREMENTS (You may also be required to provide additional information by your Ct1PA or local agency.) 15.
FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
CHEMICALINVENTORY
lane u c er material per building or area)
❑ADD [—]DELETE ❑REVISE 200
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3
Cell Site SN45XCO86
CHEMICAL LOCATION eat
CHEMICAL LOCATION CONFIDENTIAL EPCRA 202
Within lead -acid batteries inside site shelter
❑ YES M NO
I
MAP# (optional) 203
GRID# (optional) 204
FACILITY ID #
1
II. CHEMICAL INFORMATION
CHEMICAL NAME 205
TRADE SECRET LJ Yes Z No 206
Lead Acid Batteries
If Subject to EPCRA, refer to instructions
COMMON NAME 207
208
EHS* ❑ Yes ❑ No
LEAD ACID BATTERY
CAS# 209
*If EHS is "Yes", all amounts below must be in lbs.
FIRE CODE HAZARD CLASSES (complete if required by CUPA) 210
Other health hazard material Class 2 water -reactive corrosive
HAZARDOUS MATERIAL TYPE 211
❑ a. PURE M b. MIXTURE ❑ c, WASTE
212
RADIOACTIVE ❑ Yet M No
213
CURIES
(Check one item only)
PHYSICAL STATE 214
(Check one item only) ® a. SOLID ❑ b. LIQUID ❑ c. GAS
215
LARGEST CONTAINER 100
216
FED HAZARD CATEGORIES
❑ a. FIRE b. REACTIVE Elc. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH
®
(Check all that apply)
AVERAGE DAILY AMOUNT 217
MAXIMUM DAILY AMOUNT 218
ANNUAL WASTE AMOUNT 219
STATE WASTE CODE 220
600
600
1 N/A
1 N/A
UNITS* ❑ a. GALLONS ❑ b. CUBIC FEET M c. POUNDS ❑ d. TONS 221
DAYS ON SITE: 222
(Check one item only) *If EHS, amount must be in pounds.
1 365
STORAGE ❑ a. ABOVE GROUND TANK LI e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM Ll m. GLASS BOTTLE 223
CONTAINER ❑ b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE M r, OTHER
❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX Cl o. TOTE BIN ❑ q. RAIL CAR
❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON
STORAGE PRESSURE M a. AMBIENT ❑ b. ABOVE AMBIENT Elc. BELOW AMBIENT 224
STORAGE TEMPERATURE M a. AMBIENT Elb. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225
%WT
HAZARDOUS COMPONENT (For mixture or waste only)
EHS
CAS #
226
227
228
229
1 75%
Lead
❑ Yes M No
7439-92-1
230
231
232
233
2 24%
Sulfuric Acid
M Yes ❑ No
7664-93-9
234
235
236
237
3
❑ Yes ❑ No
238
239
240
241
4
❑ Yes ❑ No
242
243
244
245
5
❑ Yes ❑ No
If more hazardous components are present at grealer Than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheels of paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246
If EPCRA, Please Sign Here
SECTION II: EMERGENCY RESPONSE PLANS AND PROCEDURES
Note: Complete all sections of this Emergency Response Procedure below. Use of terms such as "N/A" (Not Applicable) will not be accepted.
A. FIRE, SPILL OR RELEASE: The fire code requires immediate notification through dialing 911, by whoever first sights the
incident. In the event of release or spill of hazardous materials, you must also notify:
1. San Luis Obispo County Hazardous Materials Unified Program Agency during business hours @ 805-781-5544. After
business hours dial 911.
2. The State Office of Emergency Services - (800) 852-7550 or (916) 262-1621.
List the individuals responsible for verifying that these calls have been made and also indicate their position in your company.
FOR VERIFYING THE DIALING OF 911:
Daniel J Jaimes Field Services Manager
NAME POSITION
Individual responsible for calling San Luis Obispo County Hazardous Materials Unified Program Agency and the State Office of
Emergency Services: (Normally the Emergency Coordinator of your business.)
Matt Fohlmeister EHS Specialist
NAME POSITION
B. List the local emergency medical facilities that will be used by your business in the event of an accident or injury caused by a release
or threatened release of hazardous materials.
Sierra Vista Regional Medical Center 1010 Murray Avenue, San Luis Obispo 805-546-7600
NAME ADDRESS CITY PHONE
French Hospital Medical Center 1911 Johnson Avenue, San Luis Obispo 805-543-5353
NAME ADDRESS CITY PHONE
C. List the Emergency Coordinator(s) at your facility.
Primary: Matt Fohlmeister EHS Specialist 913-762-6004 877-347-4457
NAME TITLE BUSINESS PHONE 24 HR PHONE PAGER #
Secondary: Pete Wang EHS Specialist 650-375-2019 877-347-4457
NAME TITLE BUSINESS PHONE 24 HR PHONE PAGER #
D. Does your business have an on -site emergency response team? ❑Yes ®No Describe procedures your business will follow in
the event of a release or threatened release of hazardous materials.
A contract has been established with Nazmat Response, Inc (877-347-4457) which can deliver teams of skilled and experienced field
personnel and other technical experts to handle (lie mitigation and remediation of a significant release, spill, leak, etc. Employees will
contact HazMat Response. Inc. when they observe chemical release, spills and leak on -she,
6
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Luis Obispo ERP Template- City of San Luis Obispo,DOC 03/08/l0
Mobile Phone Communication v, ithin field Tested by field technician t daily basis
technicians vehicle
3. Evacuation -- Describe how you will immediately evacuate your facility. What communications or alarms are used? How will
you operate these during power failure?
This is an unmanned cell site. Verbal communication i.e. shotuin * is used for evacuation if the associated field technician appears on -site
dude the event of a release or threatened release of hazardous materials.
4. Shutdown -- Describe the shutdown for each site or facility.
5a. Response -- Describe what is done to lessen or mitigate the harm or damage to person(s), property, or the environment, and
prevent the event from getting worse or spreading. What is your immediate response to:
Fire: Fire Department will be contacted in the event of fire.
Explosion: Employees will contact 911 in the event of an explosion.
Spill: Employees will contact HazMat Response, Inc. when they observe chemical release, spills and leak on -site.
Earthquake: If any property damage or personnel injuries are caused by the earthquake, the following staff members will be notified: Site
Manager, Production and Maintenance Managers, Safety Manager, Emergency Response Team and Electrician.
Major Power Failure: The following staff members will be notified: Site Manager, Production and Maintenance Managers, Safety
Manager, Emergency Response Team, and Electrician.
Flood: Notify the following staff members: Site Manager, Production and Maintenance Managers, Safety Manager, Emergency Response
Team, and Electrician.
b. Is this facility located on a 100-year flood plain? ❑Yes ®No
c. Earthquake - Identify facility areas and list mechanical or other systems that require immediate inspection or isolation because of
their vulnerability to earthquake related ground motion.
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C:\Documents and Settings\bj630606\My Documents\HMBP\County Cl1PAs\San Luis Obispo County\HBMP March 20101Emergency Response Plan\San
Luis Obispo FRP Template- City of San Luis Obispo.DOC 03/08/10
FORM T
SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMPLOYEE TRAINING PROGRAM Date: 3-5-10
A. Describe the safety training for all employees in the event of a release or threatened release of hazardous materials. This
training shall include, but not be limited to, the following: new employee training, annual training, periodic refresher courses,
and familiarization with Emergency Plans and Procedures of this Business Plan / Contingency Plan.
1. Summarize the training for all employees that work with or come in contact with hazardous materials/hazardous waste. Describe
how these employees are trained to avoid exposure.
Personnel who work with or come in contact with hazardous materials are required to be trained in the Following procedures:
■ Internal alarm/notification;
• Evacuationlre:gntryyrocedures. and assembly point locations,
• Emergency incident report.
Chemical Handlers are additionally trained in Safe methods for handling; and storage of hazardous materials:
• Location[s] and.proner use of fire and spill control eyuipment:
• Sill rocedureslemer encprocedures-,
• Pix1 per use of personal proLective et ui menu
■ S chic hazards of each chemical to which they may be exposed, including routes of ex sure i.e, inhalation in estion
absorption).
2. Summarize training specific to those employees that would respond to a release or threatened release of hazardous materials or
hazardous waste.
Hazmat Response, Inc. H 7-347-4457 is responsible for delivering teams of skilled and exiNrienced field personnel and other technical
exWrts to handle the mitieation and remediation of a significant release, spill, leak, etc.
3. Indicate frequency and duration of training for employees that work with or come into contact with hazardous materials/hazardous
waste.
Employees who work with or come into contact with hazardous materials are re wired to complete the initial training. Some specific
training courses are required to be renewed annually.
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C:\Docurnents and Settings,bj630606`,My Documents\HMBP\County CUPAs\San Luis Obispo CounlyiHBMP March 201MEmergency Response
Plan\Employee Training Fornl,DOG 03/16./10
Facility Site Plan/Storage Map
(Hazardous Materials Business Plan Module)
Site Address: Cell Site SN45XC086, 955 MONTEREY ST.,San Luis Obispo
Date Map Drawn: 3-1-10 Map Scale: Page of
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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Equipment Room
V f,
i
-�--`- - -
Instructions are printed on the following page.