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HomeMy WebLinkAboutSLO Motorsports Inspection ReportsCounty of San Luis Obispo My Of L r�nv oen al Health Services SAY) WI S OBIS 00!0 �71 P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Lois Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data r'9t HAZARDOUS MATERIALS INSPECTION FORM entry by: Date:\ ' e j Time: 1 1.•i �7 d�V FACILITY NAME: , ,..' AGENCY [IEHS ❑ AG DEPT CITY FIRE INSPECTION TYPE f, Routine ❑ Complaint Result Code: _70 Action Code: _32 ❑ Reinspe� to ❑ Other fits _80 _90 �37 _33 _31 ADDRESS: r -All r] , i PHbNE ') PROGRAMS INSPECTED: P-Susiness Plan [ !iW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: �PINO ❑ YES ❑ Business Plan MWQar ❑ UST ❑ AGT ❑CALARP PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and etermining com liance with adopted codes. GRANTED BY NAMEJTITLE : BUSINESS PLAN YES NO ❑ COS ❑ N/A ❑ BPOI Business plan is complete, current, &available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) n ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) `� ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR b 66265.16) EMERGENCY RESPONSE PLAN ® ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 li CCR § 66265.53/54) ❑ ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of 1/ hazardous materials/waste constituents to the environment. Maintains all required or appropriate, equipment including -an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) COMMENTS do to hy/ ABOVEGROUND PETROLEUM STORAGE TANK ACT AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) _materials.htm, to obtain fanns to comply with BPOI-BP03, "IRO) and EROI FACILITY REP": FACILITY NAME. A ADDRESS: HAZARDOUS WASTE GENER�TOR EPA ID I w Lbs or gals NUMBER: n > — Total generated/month: (average) Tiered Permit: CESW CESQT CA ❑PBR Waste oil: Solvents: Treatanent Equipment: Antifreeze: '_ Others: YES NO COS N VIOL. # EPA ID NO/PERMITS LJ LJ] GTOl Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ GT03 Hazardous waste determinadon•'conducted (Title 22 CCR §66262.11) ❑own knowledge []analysis ❑other GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorisation from DTSC (HSC §25189.5, Title 22 CCR §66262.12) ❑milkrun ]other IQ` ❑ ❑ GT06 Hazardous wastes are shipped with manifest (;Title 22 CCR §66262.20) GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS r� GTOS Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days If waste generated per month is greater than or equal to 100 kg (220 lbs.) 180 days If waste generated per month is less than 109 kg (see note) ❑ 270 days If waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only If hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 jr days. GT09 Hazardous waste "satellite" collection Is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, nametaddress of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are In good condition handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted ❑ (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE P'. ❑ GT18 Used oil is managed as hazardous waste until recycled (includes properlabeling, storage, etc) (HSC §25250.4) GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) / (Title 22 CCR§ 66266.130) GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) / GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating>12,000 kg./yr. of hazardous waste on site. ❑ ❑ E GT22 Generator Is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ ❑ er GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and Implementation schedule of selected source reduction measures. (HSC §25244.19) Environmental Health Services city Of 4.p' (805) 781-5644 sa P.O. Box 1489 n US OBISPO 2156 Sierra Way San Luis Obispo, CA 93406 Firs Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: �-� �� EFW data Time: �f%s.iF� �I.►.�� entry by: ■ FACILITY NAME: ,, AGENCY ❑ EHS CITY FIRE INSPECTION TYPE t0 Routine ElRelnspectiort ❑ Complain ❑ Other ADDRESS: PHONE: PROGRAMS INSPECTED: 0Business Plan 0HW Gen or ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: j�'NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP Y S NO N/A t] ❑ ❑ BPOI r ❑ ❑ BP02 r ❑ ❑ BP03 E ❑ ❑ ID ❑ ❑ AJ ❑ ❑ COMMENTS BUSINESS PLAN Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) Site layouttfacility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 .CCR 66265.16) EMERGENCY RESPONSE PLAN ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53154) ER02 Facility is operated and maintained to prevent/ndnimizelmitigate fire, explosion, or release of hazardous materialstwaste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) to hap.111yww.slopublichealth.orWenvimnnxnrathealthlbarardous_materials.htm, to obtain for ms to comply with BPOI-BPO3, T1t01 and E1101 GPS Coordinates: Latitude: deg min decimal min Longitude: deg___ mlP _-deeirrral min INSPECTOR: JJV V FACILITY REP C:WCUMQ71\Repro\LOCALS--1\Temp\c.lotus. notes-data\1_Inspection Form Page 1.doc 24-Jan-06 FACILITY NAME:, ADDRESS: � HAZARDOUS WASTE GENERA��R Lbs or gals EPA ID NUMBER: 'Total generated/month: (average) Tiered Permit: ❑CESW ❑CESQT CA ❑PBR Waste oil: t/ Solvents: Treatment j Equipment: Antifreeze: Others: d� a - NO N/A VIOL. ❑ ❑ GT01 V0 ❑ ❑ GTO3 ' ❑ ❑ GT04 ❑ ❑ GTOS ❑ ❑ GTO6 ❑ ❑ GTO7 ❑ [] GTO8 ❑ 0 GTO9 ❑ ❑ GT10 El GT11 0 ❑ ❑ GT12 Q ❑ ❑ GT13 ,E]. ❑ ❑ GT14 E] ❑ ❑ GT15 f ❑ ❑ GT16 ❑ ❑ GT17 El GT18 V` El ❑ GT19 12/ ❑ ❑ GT20 P ❑ ❑ GT21 ❑ ❑ y� GT22 ❑ ❑ GT23 # EPA ID NO/PERMITS Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge [-]analysis ❑other Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §251895, Title 22 CCR §66262.12) ❑milkrun ❑other Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. Hazardous waste "satellite" collection is managed properly (complete labeling/accumuladon time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Titre 22 CCR §66265.176) Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste compositiontphysicai state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Titre 22 CCR §66265.171/.191, 66265.177(c)) Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) Solventstother recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) `.' C:\DOCUME-1\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 � C, ` Environmental Health Services (805)781-5544 P.O. Box 1489 2156 Sierra Way San Luis Obispo, CA 93406 city sAn Luis owpo i. Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) !!NN 1/ HAZARDOUS MATERIALS INSPECTION FORM EFW data Date! 9 entry by. Time: -- IV Ax , , FACILITY NAME: AGENCY EHS CITY FIRE NSPEGTION TYPE f Routine Reinspection ElCompl n ElOther /7 A DRES : { r 44 PHONE: PROGRAMS INSPECTED: Business Plan HW Generator ❑ UST ❑AGT ❑CALARP REINSPECTION REQUIRED: � NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YE NO N/A ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ' ❑ ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22,CCR 66265.16) EMERGENCY RESPONSE PLAN © ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ V AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) :OMMENTS Go to http://www.slopublichealth.org/environmentalhealMazardous_materials.htm, to obtain forms to comply with BP01-BP03, TRO l and ER01 IJ GPS Coordinates: Latitude: deg min decimal min deg Inin decimal min Page 1.doc 24-Jan-06 f4t, _ITY NAME:AADDRESS:— (.0 - HAZARDOUS WASTE GENERA A EPA ID NUMBER: Tiered Permit: Treatment Equipment: Ly/�{ ? Total generaled/utputh: CESW QT CICA ❑PBR Waste oil: —�Z Solvents: Antifreeze: 41 Others: Lbs or gals (average) r11.-Z111A NO NIA VIOL. # EPA ED NO/PERMITS ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge []analysis ❑other ❑ ❑ GTO4 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ GTOS Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §251895, Title 22 CCR §66262.12) ❑mflkrun ❑other ❑ ❑ GTO6 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GTO7 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42166262.23) STORAGE AND MANAGEMENT OF CONTAMERS/TANKS © ❑ ❑ GTOS Hazardous wastes are accumulated on site as follows (Titre 22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) to li(l days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no ❑ ❑ acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. GTO9 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Titre 22 CCR §66265.176) D/ ❑ ❑ GTll Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, nameladdress of generator) (Title 22 CCR §6626231, 66262.34) ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) j� ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) LI��J-1r ❑ ❑ GT14 Containers storing hazardous wastes are dosed/sealed (Title 22 CCR §66265.173) ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Titre 22 CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) [] ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §662663) SOURCE REDUCTION: For facilities generating >12,000 kg✓yr. of hazardous waste on site. �] ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) n ❑ i GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUME-1\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 - °-• . '� Environmental Health Services city Of 81 P.O. Box 14 9 L� � � WI A �1� P.O. Box 1489 �� ! a ENGS 2156 Sierra Way San Luis Obispo, CA 93406 Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM ' EFW data 64 Date!' ' / 'J Time: _ entry by: FACILITY NAME ' ill' �. j AGENCY ❑ EHS CITY FIRE INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complpint ❑Other ADDRESS: L, :r PHONE: 1-�l ���j PROGRAMS INSPECTED: , ❑ Business Plan ❑ HW Generator ❑ UST ❑AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A �P ❑- ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BPO2 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ BPO3 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN . ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) f ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 C. 66265.16) EMERGENCY RESPONSE PLAN P ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 6626553/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimizelmitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS, Go to http://www.slopublichealth.org/environimntalheWth/hazardous_materials.htm, to obtain forms to compiy with BP01-BP03,,TR01 and E1101 GPS Coordinates: Latitude: deg --inin_ decimal min Longitude:_ decimal min INSPECTOR: h FACILITY REP: C:\DOCUME-1\Repro\LOCALS--1\Temp\c.lotus.notes. data\i Inspection Form Page 1.doc 24-Jan-06 M. FACILITY NAME: /bll ADDRESS: IIAZARDOUS WASTE GENERATOR �) 1 r, Lbs or gals EPA ID V NUMBER: l/ L D ' (� 'Total generated/month: / (average) Tiered Permit: ❑CESW CESQT ❑CA ❑PBR Waste nil: Solvents: G� Treatment Equipment: Antifreeze: Others: LA14 YES NO N/A VIOL. # EPA ID NO/PERMITS ❑ GTOI Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) []own knowledge ❑analysis ❑other ❑ ❑ GTO4 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSALnPRANSPORTATION ❑ ❑ GTOS Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) ❑milkrun ❑other ❑ ❑ GTO6 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GTO8 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) 12 270 days if waste generated per mouth is less than 100 kg and transported more than 200 miles (see ono ) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no I acutely/extremely hazardous. waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ `71�j'{ GTO9 Hazardous waste "satellite" collection is managed properly (complete labeling(accumulation time155-gal or 1-qt limit) (Title 22 CCR §6626234(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) ❑ ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §6626231, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) E] ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are storedis conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE j�j`7'j ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §252 oi 4) Used ❑ ❑ GT19 Useded oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Titre 22 CCR §66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Titre 22 CCR §662663) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ ❑ GT22 Generator its subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) CMOCUME—i\Repro\LOCALS—i\Temp\c.lotus. notes.data\2_Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 ue4;: Environmental Health Services city q •,•�� 605)781-5544 �� ��� ^�� P.O. Box 1489 o 2156 Sierra Way Rf �_• San Luis Obispo, CA 93406 Fire Department (805) 781-7380 d 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 l CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) IAJ HAZARDOUS MATERIALS INSPECTION FORM 1 Date: 9lir/�I Time: %- FACILITY NAME: _7",' � 1 ADDRESS: 1_v PHONE: PROGRAMS INSPECTED: REINSPECTION REQUIRED: ❑ NO ❑ YES AGENCY ❑ EHS CITY FIRE 4fll ❑ Business Plan (� HW Generator Business Plan EFW data entry by: INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint ❑ Other ❑ UST I ❑ AGT I ❑CALARP [�'HW Generator I ❑ UST, ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ BP03 Site layouttfacility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN �� ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ Da/' AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ Wes, AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/hazardous_materials.htm, to obtain forms to comply with BPO1-BP03, TRO1 and ER01 r '� T- GPS Coordinates: Latitude: deg �/4 imal min Longitude: deg_ min decimal min 1 \Temp\c. lotus. notes. data\1_Inspection Form Page 1.doc 24-Jan-06 ...'�1.Ii•N'niil�" .� Environmental Health Services city or Q _ t P.O. )Box 489 SAn Luis oBis 2156 Sierra Way - San Luis Obispo, CA 93406 Fire Department (805) 781-7380 --f 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) / HAZARDOUS MATERIALS INSPECTION FORM EFW data Date: // entry by: Time: F - _ FACILITY NAME: AGENCY INSPECTION TYPE ❑ EH5 [ Routine ADDRESS: ' 'CITY FIRE Reinspection ❑ Complaint ❑ Other !!I 122fL, PHONE: PROGRAMS INSPECTED: []/eusiness Plan [I HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST Fo AGT ❑CALARP BUSINESS PLAN YES NO N/A ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ {X ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑�� ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to hitp://www,slopublichealth.oWenviranmentalltealth/hazardous_materials.btm, to obtain forms tocomply with BPO1-BPO3, TRO1 and ERO1 t , , 4/N1 A/A1.4 11I /i n 4 /!ram .ril�/r�:�Jilt/J s�IjL1.r�I��T�1�,���I1I►'�11I��1�f�.�J�id.Ii�.I�E�►/�J�►� + 1 ► �.w 1 I -I Jis7 111� INSPECTOR: _ `,/ 'f ` FACILITY REP:�������� C:\DOC E-1\Re ro\LOCALS-1\Temp\c.lotus.notes.data\1—Inspection Form Page 1.doc 24-Jan-06 ri FACILITY NAME:—. ' �;i�`.�� �1 ADDRESS:_ HAZARDOUS WASTE GENERATOR Lbs or gals EPA ID NUMBER ' / / i/ (average) Total generated/month: (avera ) Tiered Permit: ❑CESW ❑CESQT LJCA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS ❑ ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) , gmilkrun nether pX•fl�' ®/ ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.26) ❑ ❑ GTO7 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42166262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ®� ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is loss than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ® GT09 Hazardous waste "satellite" collection is managed properly (complete labelingtaccumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ® ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR ❑ [ ❑ GT11 §66265.176) Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or - reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are dosed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC ❑ ❑ GT19 §25250.4) Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ GT21 Solventstother recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) G\DOCUME—i\Repro\LOCALS-1\Temp\c.lotus. notes. data\2 Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 .."�".`�i";;..-�.,_-.�:T'+.-.r�'�--^:�F !', ., �r.?";'-.�-._..-..,,."....,...�-�.-....-ry....w�,;Rn.,_,,,.,..�r,r.,rxr-a�.v'3•"'rn.^.-...rmr...,�J++e+a++.vr..e>..r.F,..,.a„r,.�.,.-�.^.r--�».+.�r,.-....w'-..�... n�,-. 1 Environmental Health Services `•L (805) 781-5544 P.O. Box 1489 / 2156 Sierra Way sCa►�i Luis ompo �. San Luis Obispo, CA 93406 Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM EFW data Date: ����� i/ i entry by: Time: ; ?; 44— FACILITY NAME: ,, / !n/I / .sue 77 AGENCY INSPECTION TYPE_ ❑ EHS ADDRESS: It',1,y y'+ CITY FIRE r t PHONE: PROGRAMS INSPECTED: REINSPECTION REQUIRED: [ENO ❑ YES YES NO N/A ❑ ❑ ❑ BP01 ❑ ❑ ❑ BP02 ❑ ❑ ❑ BP03 ElR/ ❑ TROI ❑ I� ❑ TR02 ❑ ❑ ❑ ER01 ❑ ❑ ❑ ER02 BUSINESS PLAN Routine ❑ Reinspection ❑ Complaint ❑ Other ❑Business Plan [ /HW Generator ❑ UST ❑ AGT ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP ❑CALARP Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) Facility is operated and maintained to prevent/minimize/mitigate tire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑., AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMJyENNTS��, Go tohttttp://ww/w..ssllopubliche�atlth...00rrg//eeen+}vironmentalhealth/hazardous_materials.ht�jm,,, to obtain forms to comply with BPOl-BPO3,tTRO1 and ER01 1 'r} IL...iL��1J�fT .• i IrIiIC/[f� 1 r � GPS Coordinates: Latitude: _deg min decimal min Longitude: deg min decimal min INSPECTOR: i FACILITY REP: v C:\DOCWE-_" ` •Ri'..rr,)J CJGAL'S, -1\Temp\c.lotus, notes. data\1_Inspection Form Page 1.doc 24-Jan-06 FACILITY NAME: ` `"� ADDRESS: r1 HAZARDOUS WASTE GENERA40R ) 1 • ? ; Lbs or gals EPA ID NUMBER: h /I (% j / i i % Total generatedlmunth: 7 (average) Tiered Permit: CESW CESQT ❑CA ❑PBR Was#sail: i,f Solvents: Treatment Equipment: Antifreeze: Others: �' r YES NO N/A VIOL. # EPA ID NO/PERMITS ® ❑ ❑ GT01 . Generator has an EPA -ID number to treat, store, dispose, transport or transfer hazardous waste; Mde 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION �`'! ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other Oj ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION �� ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) ❑milkrun ❑other 0• - ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ®� ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) © 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6600 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR _ �'r ❑ ❑ GTH §66265.176) j Containers of hazardous waste are properly labeled (includes,�ppropriate date, "HAZARDOUS WASTE," waste coin posit! on/physical state, hazardous properties,.'natneladdress of generator) (Title 22 CCR §66262.31, 66262,34) ' ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ® ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored .or transferred (Title 22 CCR§66265.172) ❑ 0' ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ,, ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑� ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ©� ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ®' ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ i✓ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ �f� IVJ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) r ME-1\Repro\LOCAL5-11Temp\c. lotus. notes.data\�Hazardous Waste Generator.doo 20®Juf 04 20JuIm04 Environmental Health Services ►J^� (805) 781-5544 P.O. Box 1489 - 2156 Sierra Way •San Luis Obispo, CA 93406 SAn Wis om spo Department of AsriculturelMeasurcrncnt Standards (805) 781-5910 Fire Department (805) 781-7380 2156 Sierra Way Suite A •San Luis Obispo, CA 93401 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM EFW data -� Date: 7 `9 t O'f'�entry by:? Time: 150V — iw[-70[j V,6 41e� FACILITY NAME: (/t2©i-aYS AGENCY INSPECTION TYPE ❑ EHS Routine ❑ G DEPT ❑ Reinspection ADDRESS: [-i' rrc� CITY FIRE ❑ Complaint ❑ Other PHONE: PROGRAMS INSPECTED: aBusinessPlan W Generator ❑ UST ❑AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO SYES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP 'ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and btermining compliance with adopted codes. GRANTED BY (NAMEITITLE): BUSINESS PLAN YE NO N/A ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN �f ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ 0_ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ABOVEGROUND PETROLEUM STORAGE TANK ACT AT01 SPCC Plan is prepared and certified by a registered engineer within last 3 yrs. (HSC 25270) ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS GPS Coordinates: Latitude: deg min decimal min Longitude:_ deg_min_decimal min INSPECTOR: r�u t YrJ77�L—� FACILITY REP: O:�ot r7ion1DOCUMENT\JeffpIFORMSilrispc:ctirm forrnsllnspection Form Page 1.doc 21-Apr-04 FACILITY NAME: $— DATE: V Q' ISPECTOR: ewb 1E;� L0 HAZARDOUS WASTE GENERATOR EPA ID (✓ C%C)C D �7 ( 0 `� I % Lbs or gals NUMBER: / Total generated/month: �ljma(average) Tiered Permit: ❑CESW ❑CESQT CA PBR Waste oil: ?, C-))ci , } Solvents: Treatment Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR 66262.12) If Not, Call (800) 618-6942 HAZARDOUS WASTE DETERMINATION 0 ❑ GT03 Hazardous waste determination conducted (Title 22 CCR 66262.11) 05o`wn knowledge ❑analysis ❑other ❑ ❑ 0 GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR 66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or autho ization from DTSC (HSC 25189.5, Title 22 CCR 66262.12) Lt,ffmi service ��� ❑other 2' ❑ ❑ GT06 Hazardous wastes are shi ped with manifest (Title 22 CCR 66262.20) Q— ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR 66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR 66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) 0"T 80 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13200 Ibs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ra"' GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR 66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR 66265.176) ❑ 0 ❑ GTH Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR 66265.171/.191, 66265.177(c)) _ ❑ ' ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR 66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR 66265.173) ❑' ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR 66265.174) ❑ ❑ ❑' GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR 66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR 66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC 25250.4) ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR 66266.130) ❑ i.% ❑ GT20 Spent lead -acid batteries are transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR 66266.81) [Z ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR 66266.3) 0:iDOCUMENT1JeffpIFORMS1lnspection formslCUPA inspection forms.doc 10-Sep-01 FACILITY NAME: 5 i- l S La SUMMARY OR OBSERVATIONSNIOLATIONS 0 No violations of underground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requirements were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or proposed action, please inform us in writing. ALL MINOR VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing certifying that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective actions. The issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the violations noted or that have not been corrected within the time specified. VIOLATIONS NUMBER MINOR MAJOR BP TR r deliT 11 ✓ GAT 14: ✓ AT COMMENTS: CORRECTIVE ACTION REQUIRED tyry.it v 41 -. . 11 ..f, ...wd 1_., uPn.at \ «: A,-- ..►.e l_- LC L. _a —.h ;i : Ll-A kYGi/:��1.' : Pi Gt•C3Y•ct¢ c��YP L '� t,c i�e�Lti�IG� `^JLL.I.Ch? i• -�or.n �'7F.C..L7_ CK�� i•� r c cQ.✓ww-5 wti w t% I.>��k�.•1 �rf^ �� [� y ;. C��i �1r�s b.'a� �'�E'_ r�.:S�:�C i�1 ..� Lt1 .'7�l � ie � t � F� `4��� �+z_� ��U'.1'c �' ��T>arftt 1 ':1 ���i..�3c • t n �LG.'� T�� S -'�1�' Inspected By: Vv�l �Gz+/� _ Facility Rep Name: 3 Date: -7 r _ C) Signature: -7 1 <5CvU O:\©OCUMENT\JeffpiFORMS`Einspection farrns\CUPA inspection forms.doc 2-Jan-01 Environmental Healt "ervices (805)781-5544 P.O. Box 1489 41.4 r 2156 Sierra Way •San Luis Obispo, CA 93406 Dcllartment of Agriculture/Measurement Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 7ity of San Luis Obispo Fire Department (805) 781-7380 I{II1111111 I jilt 2160 Santa Barbara Avenue San 1Lnis Ohisno CA 93401-5240 t'� I Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) ee r HAZARDOUS MATERIALS INSPECTION FORM EFW data Date: 7 / [D / 0 3 entry by: Time: WL 3 a FACILITY ID NO: AGENCY INSPECTION TYPE FACILITY NAME: 5aAl be4`-5 ❑ DEH ❑ Routine ADDRESS: El AG DEPT ElReinspection ❑ My FIRE ❑ Complaint t., S L U JKCITY UTILITIES ❑ Other PHONE: 01 PROGRAMS INSPECTED: Business Plan VW Generator ❑ Cal ARP ❑ UST ❑ AGT ❑ Tiered Permitting REINS NO YES El Business Plan ❑ HW Generator ❑ Cal ARP [:JUST [-IAGT[-ITieredPermitting VION REQUIRED: ;PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YNO ' N I1a ❑ ❑ BPOl Business plan is complete, current, &available during inspection (HSC §25503.5, Title 19 CCR §2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) ❑ ❑ BP03 Site layouttfacility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR §2732 & 22 CCR §66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR ❑ ❑ §2731 & 22 CCR §66265.53/54) ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- .43) COMMENTS: GPS Coordinates: Latitude: _deg min_decimal min Longitude:degmindecimal min ,"-k Inspector: Facility Representative: A:\CUPA inspection forms 2.doc 20-Mar-03 FACILITY NAME: DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA ID NUMBER: G%% L o CAD O / I D J L( s o Dais Total generated! onth. � ave e Tiered Permit: ❑CESW ❑CESQT ❑CA ❑PBR Waste ail: Solvents: Treatment (� Equipment: Antifreeze: Others: YW NO N/A VIOL. # EPA ID NO/PERMITS UJ ❑❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION �� ❑ GT03 Ha-z ous waste determination conducted (Title 22 CCR §66262.11) wn knowledge ❑analysis ❑other ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GTO5 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or Jlkrun rization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) ❑other ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labelinglaccumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) El ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) n/ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §252 Used oil ❑ n GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) �IW/I ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of / lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ [V GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5)rdays. (HSC §25244.19, 25244.21) ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) A:\CUPA inspection forms.doc 19-Sep-02 FACILITY NAME: ADDRESS: SUMMARY OF OBSERVATIONSNIOLATIONS Ve"'No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates ymir efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. VIOLATIONS NUMBER MINOR MAJOR COMMENTS: CORRECTIVE ACTION REQUIRED d Y ' t Inspectedl3ti: Facility [pep N tie: Date: Signature: Sign the certification below and mail this form to the CUPA inspector after all corrective ad (have been completed. Retain a copy for your records. Certification: I certify under penalty of perjury that this facility has compli d4vith the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: A:\CUPA inspection forms.doc 19-Sep-02 Division of Environmental Health "• P.O. Box 1489 11k 1 it 2156 Sierra Way -San Luis Obispo, CA 93406 i 3 De artment of A riculture Measurement City of San Luis Obispo il Standards (8O5) 10 Utilities Department • (805) 781-7215 2156 Sierra Way Suite te A A -San Luis Obispo, CA 93401 955 Morro Street • San Luis Obispo, CA 93401 f �l CERTIFIED UNIFIED PROGRAM AGENCY Da te: j HAZARDOUS MATERIALS Time In: INSPECTION FORM Record ID Prog/Ele Svc Result Action Insp Min. Facility Violation ENVISION FACILITY ID NO.: TYPE OF INSP.: outine ❑ Re-insp. ❑Complaint FACILITY NAME: S 7U LL4-[e, 14,4,Jel _ FACILITY LOCATION: lo 14 16 a-e-Z.rJ I`'ET INSPECTING AGEN Y: NO.(DAY): ❑ DEH ITY UTILITIES ❑ AG (24 (24 HR) PROGRAMS INSPECTED: Business Plan eRw Generator ❑ UST ❑ AGT REINSPECTION REQUIRED: ❑ NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT CONSENT: Consent to conduct inspection which may involve obtaining photographs, review and copying of records, and determination of compliance with UST, AGT, and hazardous materials/waste handling requirements. Granted Refused By (Name/Title): Reason (if refused): GENERAL REQUIREMENTS YS NO 0Ej _ N/A VIOL. # TROT TRAINING Faculty has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) CONTINGENCY/EMERGENCY PLAN oo" ❑ EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR & 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) BUSINESS PLAN NO N/A VIOL. # ❑ BPOl Business plan is current &available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ BP03 Site layout/facility laps are accurate (HSC 25504, Title 19 CCR 2729) HAZARDOUS WASTE GENERATOR EPA ID NO: o U 00 % 10 Tiered Permit:_ CESW _ CESQT _ CA _ PBR Treatment Equipment: Total generated/mo: Ibs or gals Waste Oil: Solvents: Anti -freeze: Others: V NO N/A VIOL. # EPA ID NO/PERMITS ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR 9 u 66262,12) GT02 Generator has a permit or authorization to conduct on -site waste treatment (Title 22 CCR 66270.1) HAZARDOUS WASTE DETERMINATION GT03 Hazaraous waste determination conducted (Title 22 CCR 66262.11) tz:fJown knowledge ❑analysis ❑other GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR 66262.40.(c)) GT05 GT06 GT07 GT08 GT09 ❑ ❑ � CT10 ❑ � ❑ GTH ❑ ❑ GT12 ❑ ❑ ❑ - GT13 GT14 ❑� GT15 ❑ ❑ GT16 ❑ ❑ GT17 DISPO SAL/TRANPORTATION Hazardous wastes were offered to transporter and/or disposed to a facility with an EPA ID No. and permit or au orization from DTSC (IISC 25189.5, Title 22 CCR 66262.12) milkrun service ❑other Hazardous wastes are shipped with manifest ('Title 22 CCR 66262.20) Manifests are properly completed/retained by generator for 3 years (Title 22 CCR 66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS Hazar ous wastes are accumulated on site as follows (Title 22 CCR 66262.34) <90 days if waste generated per month is �! 100 kg (2201bs.) ❑s 180 days if waste generator per month is less than 1000 kg (See Note) ❑s 270 days If waste generator per month is ._ less than 1000 kg and transported more than 200 miles (See Note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg and no acutely/extremely hazardous waste over 1 kg is held on site for over 90 days. Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR 66262.34(c)) Ignitable or reactive wastes are located 15 m (501) from facility's property line (Title 22 CCR 66265.176) Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE.," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR 66262.34) Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR 66265.17I/.19I, 66265.177(c)) Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR 66265.172) Containers storing hazardous wastes are closed/scaled (Title 22 CCR 66265.173) Weekly inspection of areas where haz. waste containers are stored is conducted/documented (Title 22 CCR 66265.174) Daily inspection of all tank systems is conducted and documented (Title 22 CCR 66265.195) Kurlity containers or inner liners > 5 gal has date when emptied and managed properly within one year of date emptied (Title 2 CCR 66261.7 (0) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC 25250.4) ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof ❑ ❑ container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR 66266.130) GT20 Spent lead -acid batteries are transferred offsite under manifestation for recycling, reuse, or reclamation (Title 22 CCR 66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR 66266.3) SUMMARY OR OBERVATIONSNIOLATIONS ❑ No violations of underground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requirements were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or proposed action, please inform us in writing. All minor violations must be corrected within 30 days or as specified. CUPA must be informed in writing certifying that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected at any time. You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective actions. The issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the violations noted or that have not been corrected within the time specified. VIOLATIONS. NO. MINOR MAJOR f✓ TRO a ERO CORRECIVE ACTION REQUIRED BPO GTOAWjQ !;'1jLiLeATApNe S L l n ," P WDO UTO ATO COMMENT: Insp. Agency Rep; ^ Facility Rep: J Date: Title: 11 Environmental Healtx Services (805) 781-5544 I P.O. Box 1489 2156 Sierra Way •San Luis Obispo, CA 93406 yr. Department of AariculturelMeasurement Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 Date: / (0/ 0 3 Time: Q 13 f FACILITY ID NO: _ FACILITY NAME: SaAl ADDRESS: PHONE: PROGRAMS INSPECTED: NO ❑ YES City of San Luis Obispo Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Lnis Ohisno CA 93401-5240 Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM AGENCY _ ❑ DEH ❑ AG DEPT F] CITY FIRE lid' CITY UTILITIES EFW data entry by: INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint ❑ Other Business Plan I [L I Generator I ❑ Cal ARP I ❑ UST I ❑ AGT I ❑ Tiered Permitting ❑ Business Plan I ❑ HW Generator I ❑ Cal ARP I ❑ UST I ❑ AGT I ❑ Tiered Permitting PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN Y114 �f ❑ ❑ BPOl Business plan is complete, current, &available during inspection (HSC §25503.5, Title 19 CCR §2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR §2732 & 22 CCR §66265.16) EMERGENCY RESPONSE PLAN ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR §2731 & 22 CCR §66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- .43) COMMENTS: GPS Coordinates: Latitude: _deg mindecimal min Longitude:degmindecimal min Inspector: Facility Representative: A:\CUPA inspection forms 2.doc 20-Mar-03 FACILITY NAME: DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA ID NUMBER: Tiered Permit: Treatment Equipment: adZ,0e900~71®3 / CESW ❑CESQT ❑CA ❑PBR Total generated/ onth. Waste oil: 3- Solvents: Antifreeze: ig Others: Lbs o a#s (ave e YEfi NO N/A VIOL. # EPA ID NO/PERMITS ❑❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION El GT03 Hadous waste determination conducted (Title 22 CCR §66262.11) _ wn knowledge ❑analysis [:]other ❑ �� GT04 oHazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or autk6rization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) mtlkrun ❑other ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) ❑ ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted ❑ ❑ (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ E GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ F] GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5)-days. (HSC §25244.19, 25244.21) El❑ GT23 Source Reduction Evaluation and Plan contains the following live elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) A:\CUPA inspection forms.doc 19-Sep-02 FACILITY NAME; — ADDRESS: SUMMARY OF OBSERVATIONSNIOLATIONS 2/"'NNo violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. VIOLATIONS NUMBER MINOR MAJOR CORRECTIVE ACTION REQUIRED COMMENTS: �lHaa —L-T l 7+ -57 lI-W L4 A f, 5 Inspected lly: Date: a Facility Rt Signature: a(CAW Sign the certification below and mail this form to the CUPA inspector after all corrective ac�11ns ave been completed. Retain a copy for your records. Certification: I certify under penalty of perjury that this facility has compli44ith the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: A:\CUPA inspection forms.doc 19-Sep-02 Division of Envirori A Health (805)781.5544 P.O. Box 1489 2156 Sierra Way *San Luis Obispo, CA 93406 Departmelit of Agrictllture/Measuremelit. Stalidards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 1'+ Date: f / 1 Time: 60 ._ity of San Luis Obi Po I Fire Department (805) 781-7380 I 2160 Santa Barbara Avenue !� San Luis Obispo CA 93401-5240 tN . utIll Utilities Department . (805) 781-7215 879 Morro Street a San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM FACILITY ID NO: FACILITY NAME: �r - ���r�• ADDRESS: (.3 1�iii'ti►� err C'T PHONE: 0 AGENCY ❑ DEH ❑ AG DEPT ❑ CITY FIRE 'CITY UTILITIES EFW data entry by: PJ INSPECTION 'TYPE ❑, I utine einspection ❑ Complaint ❑ Other PROGRAMS INSPECTED: 9 Business Plan I KKHW Generator I ❑ UST FO AGT ❑ Tiered Permitting REINSPECTION REQUIRED: JONO ❑ YES ❑ Business Plan ❑ HW Generator 1 ❑ UST ❑ AGT ❑ Tiered Permitting ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance rith adopted codes. GRANTED BY (NAMFJF1T11i BUSINESS PLAN 111EY NO N/A BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) & ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) 0 BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) COM NT;S: Z�ct� INSPECTOR: FACILITY REP: ,h�q%b Division of Enviranm -ittal I•Iealth (805) 781-5544 P.O. Box 1489 d 2156 Sierra Way *San Luis Obispo, CA 93406 I]Fe artment of A riculturelMeasurenient Standards (805) 781-5910 2156 Sierra Way Suite A •San Luis Obispo, CA 93401 ity of San Luis Obis Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 qq 1 - Pti Utilities Department • (805) 781-7215 879 Morro Street . San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: ') / 15 / U Time: 30 1 ?, 0 EFW data entry by: _Pat 1 0 Pa 03 0 FACILITY ID NO: AGENCY El DEH ❑ AG DEPT PITY FIRE CITY UTILITIES INSPECTION TYPE outine ❑ Reinspection El Complaint ❑ Other ❑AGT El Tiered Permitting FACILITY NAME: ADDRESS: S I✓Q PHONE: PROGRAMS INSPECTED] �Wnms Plan HIY Generator El UST REINSPECTION REQUIRED: ❑ NO VIYES Business Plan ❑ HW Generator ❑UST ❑AGT [I Tiered Permitting PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with ado ted codes. GRANTED BY NAMEPPITLE): BUSINESS PLAN YES NO N/A ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 hiventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ LLi ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) COMMENTS: to V7 �00Z INSPECTOR: FACILITY REP: I001 rr+. I .I Ir , -A I.13 0nl. ..--r`i�l. FACILITY NAME: DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA ID NUMBER: _ Lbs or gals [%00 Q � Total generated/month: (average) Tiered Permit: ❑CESW ❑CE5QT ❑CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YEV NO N/A VIOL. # EPA ID NO/PERMITS GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR 66262.12) If Not, Call (800) 618-6942 HAZARDOUS WASTE DETERMINATION ❑ ❑ GT03 Ha zrdous waste determination conducted (Title 22 CCR 66262.11) Pown knowledge []analysis ❑other ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR 66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GTO5 Hazardous wastes were transported and/or disposed to a facility with an EPA 1D NO. and permit or sut rization from DTSC (HSC 25189.5, Title 22 CCR 66262.12) &fmilkrun service ❑other ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR 66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR 66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 ous wastes are accumulated on site as follows (Title 22 CCR 66262.34) r9oays if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13200 Ibs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR 66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR 66265.176) ❑ ❑ GT1I Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR 66262.34) d ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR 66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR 66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR 66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR 66265.174) ❑ CT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR 66265.195) ❑ ❑ I „{' GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR 66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC ❑ ❑ GT19 25250.4) Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR 66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR 66266.3) repro 1183 SUMMARY OR OBSERVATIONSNIOLATIONS No violations of underground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requirements were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or proposed action, please inform us in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing certifying that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law acid punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility maybe reinspected anytime during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective actions. The issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the violations noted or that have not been corrected within the time specified. VIOLATIONS NUMBER MINOR MAJOR r' COMMENTS: CORRECTIVE ACTION REQUIRED M rA-e r w >,A'Pc' 3 Al r d 5z Alec5' 4 ' -ram h1 4 Inspected By: Facility Rep Name: Date: S �j Signature: repro 1127 rev 1 O:\DOCUMENT\Jeffp\FORMS\Inspection forins\CUPA inspection forms doc 10-Sep-01