HomeMy WebLinkAbout1010 OrcuttSite Visit Packet
Permit No 60-0339
Facility Number:
Facility Information
Operator:
MICHAEL KAPLAN
Facility Name:
MIKE KAPLAN CYCLES
Address Number:
1010
Address:
ORCUTT ROAD
Suite:
City:
SAN LUIS OBISPO
Zip:
93401-
CrossStreet:
LAUREL LANE
Parcel No:
Phone No:
(805) 541-8351
Facility Type:
Individual
Property Owner
Name:
Address:
City:
State: CA
Zip:
Phone:
Underground Storage Tank
Property Owner Name:
Phone:
Mailing/Street Address
City:
State
Zip:
Owner Type:
Emergency Contacts
_Primary Days Last Name
n ® KAPLAN
First Name Title
MICHAEL OWNER
Status:
Permit Expiration Date:
10/23/02
Mailing Address
Name:
MIKE KAPLAN CYCLES
Address:
1010 ORCUTT ROAD
Care Off Address:
C/O MICHAEL KAPLAN
City:
SAN LUIS OBISPO
State:
CA
Zip:
93401-
Phone:
(805)541-8351
Business Owner
Name:
Address:
City:
State:
CA
Zip:
Phone:
Environmental Contact
Name:
Address:
City:
State:
CA
Zip:
Phone:
Miscellaneous
SIC Code
Dun Bradstreet
Business License
Guarantor Number
CAL000257681
Current Balance: $0.00
Business 24 Hr
Phone Phone Pager
(805)541-8351 ( 1 77
Hazardous Materials Business Plan - List of Chemicals
Permit No 60-0339 1 Faciffty:j MIKE KAPLAN CYCLES
---F-
Address.-I 1010 ORCUTT ROAD, SAN LUIS OBISPO
Maximum Physical Largest
Common Name FChemical Name Daily Amt I Units State I Container {Grid No
WASTE OIL JPETROLEUM HYDROCARBON 55 GAL Liquid 55
ASTE OIL FILTERS
ASTE PARTS WASHER
)LVENT
(WASTE OIL)
WASTE OIL FILTERS 55 GAL Liquid 55
WASTE STODDARD SOLVENT 5 GAL Liquid 15
Wednesday, October 23, 2002 1 1Page 1 of
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FORM S - SAN LUIy OBISPO COUNTY CERTIFIED UNIFIED I-jL%JGRAM AGENCY
BUSINESS OWNER/OPERATOR IDENTIFICATION ..
I. IDENTIFICATION 3�
FACILITY ID#S 1 1 BEGINNING DATE too ENDING DATE 101
0(_ o(- OL ( -31 - 02-
BUSINESNAME (same as F CIL" NA E or DB — Doing Business As) 3 LBUSINESS PHONE 102
' r
BUSINESS SITE ;kDMESS 103
o
CITY 10a ZIP CODE 105
z,.,; (�%�J5 CA
COUNTYL 108
e �
J
BUSINESS OPERATOR N � 109 1 BUSINESS OPERATOR PHONE 110
H. BUSINESS OWNER
OWNER NAME 111 OWNER PHONE 112
OWNER MAILING ADDRESS 113
to/D or
CITY tta STATE 115 ZIP CODE 116
C- C 3
III. ENVIRONMENTAL CONTACT
CONTACT NAME 117 CONTACT PHONE 118
ml-c rt� & la� �Us Sd 3s /
CONTACT MAILING ADDRESS 1119
lotU otj e.6
CITY 120 1 STATE 121 ZIP CODE 122
Sc1,n LI,i S 0,b%5 a CA 9 34 O
_PRIMARY_ IV. EMERGENCY CONTACTS-SF.cnNDARV-
NAME �� pp 123
NAME 128
TITLE 124
TITLE 129
BUSINESS PHONE 125
BUSINESS PHONE 130
s4
24-HOUR PHONE 126
24-HOUR PHONE 131
�d S
PAGER # / CELL PHONE # 127
PAGER # / CELL PHONE # 132
lob S-
ADDITIONAL LOCALLY COLLECTED INFORMATION:
133
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of Yaw that I have personally examined and
am familiar with the information submitted and believe the information is true, accurate, and complete.
SIG ry TURF Q QWh1 RJpP ATO OR DESIGNATED REPRESENTATIVE DATE 13a NAME OF DOCUMENT PREPARER 135
f g—zo—�2 1�693 rC5)-JP—
N M OF S GNER Ip 136 TITLE OF SIGNER 137
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O:IDOCUMENT\Jeffp1FORMS1Business Plan FormslFRM-S.DOC 09/17/01
FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
CHEMICAL INVENTORY
(one page per material per building or area)
'SADD [-]DELETE ❑REVISE 2W Page —of —
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3
rqI aeQ 6,P l� C1 c�le 5 Iv(O 0v�� I� i s(,0
CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202
E
D PCRA
S�I7 ❑YES ®NO
f 1� 1 I MAP# (optional) 203 GRIDN (optional)204
FACILTI'Y H)1J ��'t
II. CHEMICAL INFORMATION
CHEMICAL NAME 205 TRADE SECRET ❑ Yes ® No 206
PETROLEUM HYDROCARBON If Subjec(to EPCRA, refer to instructions
2—Foi
COMMON NAME1
EHS* ❑Yes ®No
WASTE OIL/OIL FILTERS
209
CASay *If EHS is "Yes", all amounts below must be in lbs.
N/A 210
FIRE CODE HAZARD CLASSES (Complete it required by CUPA)
211 212 213
HAZARDOUS MATERIAL TYPE ❑ a. PURE ® b. MIXTURE ® c. WASTE RADIOACTIVE ❑ Yes El No CURIES
(Check one item only)
214 215
PHYSICAL STATE ❑ a. SOLID ® b. LIQUID ❑ c. GAS
LARGEST CONTAINER
5
(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 zt8
ANNUAL WASTE AMOUNT
219 STATE WASTE CODE
220
��'
221
UNITS* ® a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS
❑ d. TONS
221
DAYS ON SITE:
�T
(P
272
(Check one item My) *If EHS, amount must be in potmds.
STORAGE ❑ a. ABOVE GROUND TANK 0e. PUISTICJNONMETALLIC DRUM
❑ l_ FIBER DRUM
m. GLASS BOTTLE
❑ r. OTHER
223
CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN
❑ J. BAG
❑ k. BOX
❑ n. PLASTIC BOTTLE
❑ o. TOTE BIN ❑ q• RAIL CAR
❑ c. TANK INSIDE BUILDING 0 g. CARBOY
❑ d. STEEL DRUM ❑ h. SILO
❑ 1. CYLINDER
❑ p. TANK WAGON
224
STORAGE PRESSURE ID 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 _
I 100
227
PETROLEUM HYDROCARBON
❑ Yes ® No
221
z29
231
❑ Yes [:]No
232
233
2
— 235
❑ Yes [I No
236
_
217
234
3
239
❑ Yes [I No
240
241
238
4
242
243
❑ Yes ❑ No
244
245
5
tf more hu rdwa eompooeals
art present al Rater than t% by wdgbt tf nm-cz�, or fl.t% b7 weight I[ urdnoxeoiri attach additbnat sheets of paper up[urtng the required iaormaliou.
24t
ADDITIONAL LOCALLY COLLECTED INFORMATION
A:\WASTOIL.DOC 11-Feb-00
FORM I — SAN LOS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
CHEMICAL INVENTORY
(one pa ge m r material per buiildbi g or area)
®ADD ❑DELETE ❑REVISE 2W
Page _ of —
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) i
0iL�,_ fC- (ate Cj 6,Le01u ov-ckk-N-�� Sl_C)
CHEMICAL LOCATION 201
CHEMICAL LOCATION CONFIDENTIAL a02
EPCRA
YES NO
MAP# (optional) 709
GRID# (optional) 2�m
FACILITY ID #
T
E1
1
II. CHEMICAL INFORMATION
CHEMICAL NAME 205 TRADE SECRET ❑ Yes El No 206
I
WASTE SOLVENT —If Subject to EPCRA, refer to instructions
COMMON NAME ?A7 zos
EHS"` ❑Yes ®No
WASTE SOLVENT
CAS# 295E
*If EHS is "Yes", all amounts below must be in lbs.
NIA
x19:
FIRE CODE HAZARD CLASSES (Complete if required by CUPA)
211
212
213
HAZARDOUS MATERIAL TYPE ❑ a. PURE ® b. MIXTURE ❑ c. WASTE
RADIOACTIVE ❑ Yes ® No
CURIES
(Check one item only)
214
215
PHYSICAL STATE ❑ a. SOLID ® b. LIQUID ❑ c. GAS
LARGEST CONTAINER 5
(Check one item only)
2E6
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
L
7 1 9W 5
UNITS* ® a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222
(Check one item only) *If EHS, amount must be in pounds.
STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTICINONME FALLIC DRUM i. FIBER DRUM m. GLASS BOTTLE 223
CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ It. PLASTIC BOTTLE ❑ r. OTHER
❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ q. RAIL CAR
'Rd. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON
22•t
STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT
2zs
STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC
%WT
HAZARDOUS COMPONENT (For mixture or waste only)
EHS
CAS #
1 90 226
WASTE SOLVENT 227
❑ Yes ® No 228
N/A 229
230
2 10
231
PETROLEUM HYDROCARBON
232
❑ Yes ® No
233
N/A
234
235
236
❑ Yes ❑ No
237
3
218
239
249
❑ Yes ElNo
241
4
242
243
244
❑Yes [:1No
245
5
if more lurarduuc components are present at greater (ban 1% by wdgbt if non -carcinogenic, or 0.1% by weight if carcia"cuic, attach additional sheets of paper capturing the required information.
246
ADDITIONAL LOCALLY COLLECTED INFORMATION
f EPCRA Please Sim Here
A:\WASTESOL.DOC 11-Feb-00
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San Luis Obi o County Certified Unified Program. ,ency
FORM M - MAP GRID (see instruction page iv) Map #
A+ B r C D -F E, F I G, H I J K L I M N
Mcp No+ To S c ci IQ
6�oray—
Rao
oil
Spill
OJZiL¢,
Z, k 0,0 y o b vwx
S j
3 3
N
A B C I D E I F I G I H I I I J I K L M N
Scale: 1 inch = Feet
Business Name: r4, Date: S- 20 -a 2
Address: /0/0 01-ctt tf" %Zovj- blis c� cl-3 40 r
Number of Employees in Facility Depicted Above - Day = Night = 0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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0AD0CUMENT1Jeffp1F0RMS1Business Plan FormsTRM-M.DOC 09/17/01
FORM E
SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMERGENCY RESPONSE PLAN
Or Hazardous Waste Contingency Plan
(see instruction page vi) Date: 8 — 2' --02
SECTION I -A: BUSINESS IDENTIFICATION DATA
BUSINESS NAME
SITE ADDRESS CITY ZIP CODE
FACILITY UNIT TELEPHONE NUMBER
5'7C�_ 01)C_
BUSINESS MAILING ADDRESS CITY ZIP CODE
Ifyour business has a license or permit fro irr 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 # CA (_ DDO Z S 7 (o g l & Permit # F1ve <_4c, f i o , 07 3
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 r ( 4 Telephone # �bc) —] + 3 — 5 DUO
Gas Service 11,k Gn_-, C o r, 17 c ,,,% Telephone # s�w 42-7 — Z Z cc)
Sanitation n t.w15 &101 ✓ 6CLIn� Telephone
- -
Water District Telephone
SECTION I-B: OWNER CERTIFICATION OF DATA (Certify either 1 or 2)
1. This is aiEW 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 Certified 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.
—20 —OZ
PRINT NAME OF OWNER GR OPERATOR SIGNATURE DATE
M b ✓al� ) 9— 20 — O2
DOCUMENTS kEPARED BY
010A
DATE
5
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SECTION H MERGENCY RESPONSE PLANS AND OCEDURES
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 Certified 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:
( V. Gi 1,7 161.v\_
NAME C b- P, f- . y L6 Vonw..v_ v(4 l µPq ft,_ POSITION
Individual responsible for calling San Luis Obispo Coup C rti d nified Pro am A en d the State Office of Emergency Services:
(Normally the Emergency Coordinator of your business.) -755 L S 5�f
Im � 6'('� ICE } l w� - �W i-p_/�
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.
r7 i Qy VIC- U1,51 f_0 1 O Vn (Jb (f ) -"�05 — 5 q 600
NAME ADDRESS Cn'Y PHONE
NAME ADDRESS MY PHONE
C. List the Emergency Coordinator(s) at your facility.
Primary: Iyr icc� (w� Owe t� goy - 5 4 I - 35
NAME TITLE BUSINESS PHONE 24 HR PHONE PAGER #
Secondary:
NAME TnLE BUSINESS PHONE 24 HR PHONE PAGER #
D. Does your business have an on -site emergency response team? ❑Yes ERNo Describe procedures your business will follow in the
event of a release or threatened release of hazardous materials.
C2n40- 11fOSor12.ew+ VI-M e4'ic r6-- i [baq
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6
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0:1DOCUMENT'deffpT0RMS1Business Plan FormsTRM-E.DOC 09/17/01
E. If you have acutely hazardous mats-.els above threshold planning quantities, list (b, aame 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.
N ohe [�, ✓eSe"-t-,
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.
i �� WtiS Di v1, ltit c:.c5in�,f Lbw ,,,1,,+1,4
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
S�V✓IC, t
i ap V �kO11 b
j�p
�; ✓5 f Ai A K,6
K h oy SiAkvi f(,
1-�l e u4-v;cat N,,vl.e 1
I e*,, is l,,e,e-& e l,
3. Evacuation — Describe how you will immediately evacuate your facility. What communications or alarms are used? How will you
operate these during power failure?
Ye 9 —
iI{ r�+;+V�.� C� i Cat f — l
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4. Shutdown — Describe the shutdown for each site or facility.
a-(f (;') C'S -+ zo—E i L O(X— V`2� i ✓�
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: ' .r�AA V 5 1C% w(4-t" 4�p
I J-1 cal 1-
Explosion: F ✓r- C -, oX'e- G' ,_ I I d- i "--� f CAA 1� - 1 - I
Spill: �� + 5 wua✓i��J l 1 �S _ �J i j �t �lpSy✓l� IMGI:F L'l'e .
Earthquake: ic_
Major Power Failure: 10 , P t ,
Flood: 5�2_ ep,y e f
b. Is this facility located on a 100-year flood plain? Dyes ONo
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.
6. Clean -Up - How do you handle the complete process of cleaning up and disposing of hazardous material releases at your facility?
Note: Notify the Certified Unified Program Agency when clean up is complete.
01A.4c-2� CJS Lam.
�1 I al C -791 5 S 4- -r 9 - / - I
G. Location — Your business is required to keep a copy of the Business Plan and related Material Safety Data Sheets (MSDS) on -site.
Describe where this information is located.
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FORM T
SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMPLOYEE TRAINING PROGRAM Date:'?, -Zc'--D Z-
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.
2
2. Summarize training specific to those employees that would respond to a release or threatened release of hazardous materials or
hazardous waste.
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Indicate frequency and duration of training for employees that work with or come into contact with hazardous materials/hazardous
waste.
N/4�
4. Describe how your employees access training materials. (E.g., bulletin board, employee newsletter, staff meetings, etc.)
N / A-
B. List person(s) in charge of training and indicate their qualifications to conduct the training.
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 of instructor/trainer.)
Iv ��
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