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HomeMy WebLinkAbout3877 Long St Env Recordsn Luis Sourdough F7 Long St I Luis Obispo, CA 9340 bmittal Status CERS iD 10411510 by Kevin N r of San Luis Sourdough (Horsham, PA) bysubmitter.only-c nges from last submittal were to contacts. Thank you dentification limbo Bakeries USA, Inc. peratorPhone Business Phone 055447687x11S (323)893-9237 L_ acility/Site Mailing Address 877 Long St n Luis Obispo, CA 93401 Business Fax N/A limbo Bakeries USA, Inc.- 5) 957 4416 Z5 i55 Business Center Dr. C Horsham, PA 19044 B1Bing Contact Mason Klein 055447687x115 jason.klein@grupobimbo.com 877 Long St an Luis Obispo, CA 93401 Beginning Date Ending Date Dun & Bradstreet SIC Code Primary NAICS 2051 31182 Primary Emergency Contact �ason Klein ETI? Production Manager .Buwiess Phone lumber 8055447687x115 [le dary Emergency Contact Hathaway enance Manager ss Phone Z4-Hour PhonePager Number 47687xf15� nvironmental Contact l r ustin Hathaway \ 916) 695-0198 justin.hathaway@grupobimbo.com 877 Long St n l an Luis Obispo, CA 93401 qX ie of Signer Signer Title in Yavari 4ir� Region Environmental Manager itional Information 7fl �1 :ally -collected Fields ��@. ie or all of the following fields maybe r quired by your local regulator(s). 1 � � � . �JC Property Owner l�Imbo Bakeries USA, Inc. ng Address Business Center Dr. ,ham, PA 19044 Printed on 7/19/2021 11:04 AM J Document Preparer Kevin Yavari Assessor Parcel Number (APN) Number of Employees �n Facility ID O E m C c c c O O O p O Lo Lo O 00 LO O O O O O O O O O O N c O O m L O m L c O c O c O c O O co U c o o ca c m c m c m C cn O O cn cn cn cn I` N N T- 6 Ln M to cD O LO A ti M ti 00 4 00 4 Cfl Q ti ti O O 4 O_ O_ N N U W ao t� co co r V1 _p i- CIO CD LO Liz O "Iv � U LL_ � < �Q rl law =� U 4?7' Q W_ LO I - LO LL � Ln I Q J Irr r� a3i v � a3i a3i a�'i v H L, San Luis Sourdough (CERSID: 10411510) Facility information Accepted. Feb 18, 2020 Submitted on 1/30/2020 9:43:50 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 2/18/2020 11:08:39 AM by Kerry Boyle • Business Activities • Business Owner/Operator Identification Hazardous Materials Inventory Accepted Feb 18, 2020 Submitted on 1/30/2020 9:43:50 AM by Kevin Yavari of San Luis Sourdough (Horsham. PA) Comments by Submitter: Updated facility map and updated locations in Inventory. No new materials added to inventory for this submission. Thanks! Submittal was Accepted on 2/18/2020 11:08:55 AM by Kerry Boyle • Hazardous Material Inventory (7) • Site Map (Official Use Only) Annotated Site Map (Official Use Only) (Adobe PDF, 708KB) Emergency Response and Training Plans Accepted Feb 18, 2020 Submitted on 1/30/2020 9:43:50 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 2/18/2020 11:09:13 AM by Kerry Boyle • Emergency Response/Contingency Plan Emergency Response/Contingency Plan (Adobe PDF, 369KB) • Employee Training Plan • New Hire Employee Training Plan (MS PowerPoint, 13686KB) • Hazardous Materials and Emergency Response Training (MS PowerPoint, 1033KB) Printed on 2/18/2020 11:36 AM 151te Identification San Luis Sourdough CERS ID 877 Long St 10411510 Safi Luis Obispo, CA 93401 EPA ID Number os�nty CAL000350061 Sari Luis Obispo ISubmIttal Status omitted on 1/30/2020 by Kevin Yavori of San Luis Sourdough (Horsham, PA) ubm4ttal was Accepted; Processed on 2/18/2020 by Kerry Boyle for San Luis Obispo County Environmental Health azardous Materials does your facility have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 Yes ublc feet for compressed gases (include liquids in ASTs and USTs); or is regulated under more restrictive inventory local reporting requirements shown below if present); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix or 8; or handle radiological materials in quantifies for which an emergency plan Is required pursuant to 10 CFR Parts 30, 40 or 70? _ nderground Storage Tank(s)(UST) es your facility own or operate underground storage tanks? No Hazardous Waste Is your facility a Hazardous Waste Generator? Yes Does your facility treat hazardous waste on -site? No s your facility's treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? No oes your facility consolidate hazardous waste generated at a remote site? NO oes your facility need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? No Does your facility generate'in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate n any single calendar month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous waste; or generate or accumulate at any time are than 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste. No s your facility a Household Hazardous Waste (HHW) Collection site? _ NO ided and/or Exempted Materials your facility recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? No roe s your facility own or operate ASTs above these thresholds? Store greater than 1,320 gallons of petroleum products (new or used) in No veground tanks or containers. s your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities estabiished by the California Accidental No ditfonal Information additional comments a Printed on 2/18/202011:36 AM California Environmental Reporting System (CERS) Business Owner Operator in Luis Sourdough 77 Long St n Luis Obispo. CA 93401 bmittal Status bmitted on 1/30/2020 by Kevin Yovari of San Luis Sourdough (Horsham, PA) bmittal was Accepted; Processed on 2/18/2020 by Kerry Boyle for San Luis Obispo County Environmental Health CERS ID 10411510 �denmblwIi �imbo Bakeries USA, Inc. Beginning Date Ending Date Operator Phone Business Phone Business Fax tt� 7x115 (323) 893-9237 N/A Dun & Bradstreet SIC Code Primary NAICS 2051 31182 Facility/Site Mailing Address 31rimary Emergency Contact 3877 Long St anon Klein San Luis Obispo, CA 93401 itle reduction Manager usiness Phone Pager Number 055447687x115 ner ec4Emergency Contact limbo Bakeries USA, Inc. ason Klein 215) 957-4416 Ale 5 Business Center Dr, reduction Manager orsham, PA 19044 Susiness Phone Pager Number 055447687x145 filling Contact lEnvironmental Contact aeon Klein Francisco Gutsavo Cruz F son.klein@grupobimbo.com 805) 215-5543 francisco.gordillo@grupobimbo.com 877 Long St . " . uwspo, CA 93401 San Luis Obispo, CA 93401 Orne of Signer Signer Title Document Preparer Levin Yavari Regional Environmental Manager Kevin Yavari Wditiooal Information Local IV -coil Fields Some or all of the following fields may be required by your local regulator(s). roperty Owner Assessor Parcel Number (APN) Imbo Bakeries USA, Inc. Number of Employees .mmng Naaress Facility ID 55 Business Center Dr. orsham, PA 19044 Printed on 2/18/2020 11:36 AM cn w 0 � 0 6 maoL�) O " o a v a a N a 00 o 0) 00 m m i m o m z 7 N b, a O V N W m C _ C C O 0 6 ❑ e v E d o a E v E x I a v E m ui E a v a v o E v E a r Q 0. n t- F N o f0 � V 10 M C 'F u Y1 N Ln m a d r c a c 6 O O « x Ln u Ln u m w-OD o O o T n H a+ n u YI C � � LL _ m l7 0 00 a c m a m d L00 O z 0 n ba 3 7 •"' 0 0 � c E C rn zl-, fa o T z o E 3 7 vi u C u 0000 H H N (A 0 tW J J JO c C 6 Vf VI m o` = E 6 E W v E �, m 1O C A L LL z N o t� m Z 1-4 r n G E: rt E Q LD m O O N W N O 01 c a N Q O ~ O1 lfl rn V in R N N N 00 M N O N N 00 rn o N la./ OO � l!n " '0 w m Un n In 00 N Ln '^-1 -D m Ln n O � � = w m � � y O O o. a o Ln v) in Ln Ln in m N W W O = u ? ? O a 3 9 Z)E . - E E E E O Z z z a1 r — •C E O J w C c Z Z O E Z = p Z> J a z O E y a F o w > > E E E u u n E E v? v t x = 0 u w w E E Cm c o o o r w w O w Ci w O J Y 0 Q m L m u v E L' � O > O E O ER > Y U O W O E j U° w o o o b pn ¢ u 0¢ o u D u C of N Y 0 w O p N O O C v1 N C O1 Y 3> Y >? p w W 'n F > 01 na Y L .O w CO O H c C N Y OJ 00 i— Y O O p0 _ V� L 0 0 L N L E C m> O p C p m LA m C m> N O C O m N m C O N E u L E ` N im+ (6 l6 'a N fo O L N 0 O) j, O m m Y p O Y C f0 O N m .Q H ,M ? 0 am+ [mod O N �a N •F 91 a ,n rt LL u° =u°=_¢v01ixw ail auO y xcO� x u x i a `o x `o z v c= in w _ u� u- zin w yi o m y 3 p o = I 0 0 O u v; of u; a` 3 E 3 E lo mLn r v BID v v Ln v d 3 a E a E w� E a E E E E o a` Q H Q a` i Q F Q a Q ri Q m 0 0. � � O 3 3 •"' O O � � c 7 7 vmi Cn H N v,IAm J J C c n CA ul m u tkO m V G7 3 i a E 14 ti M N 2 c Ln 00 E 0 Z 4 C U. l0J Q U 1000 Q m u � A � O ka O � u y W A u r n 0 s C) .4 p a c J O O 0 u E 00 m 0 0 cu 00 R Z> a W rn r-i O N N 00 N c O a ar C d 2 N Q O n Oi m Z o n � u o � � o'^ = 14 C CO a o e Om ,Ofl 14 E m LM u � v E O a o m Y O = O u ^ E o 0 z a 0 o 0 0 o L, V - Y 7 w Y 3 W v V N C O C VI C Z- la a) lY/1 C O •F+ LN V7 C O F � .� .uf — +L+ O aLL+ aL+ N D V Y O Y aL•+ N q°e} o amo'�ma•�-mom>EmoO oaf 00 a �s ,� a, ai ,n c ar v +� L E w m c v m a a `o a x o x a a x> o x `o x ar a x> li V U U— LL' VI i W— LL V— LL' VI W a of 0 7j O Of U U; � « � O aa+ O r O ' Ln a`3a 3 3 d a O V1 C C C C 0➢ Gj A a 9 Ln� i i] d C m E a E m E aE, E a Q F Q CL i Q Q c 0 u Ln oaa Ln E � o T d E C LX C 0 V Z m U O f0 in a C C m 1.2 rl O m C) > > O O O - c 3 3 Ln H N Cn EA IA as 7 7 0 J J � C c n V1 {n m LM Ln E 0 u a v c E O ° C .-i o o ,4 u z d U N N p f0 � a c v O a ad+ a X f0 Q Q lD m O N O 0\0 c O cc a CERS Consolidated Emergency Response / C gency Plan INTERNAL FACILITY EMERGENCY COMMUNICATIONS OR ALARM NOTIFICATION WILL OCCUR BY (Check all that apply): C11. 1. VERBAL WARNINGS; [j] 2. PUBLIC ADDRESS OR INTERCOM SYSTEM; 0 3. TELEPHONE; ❑ 4. PAGERS; ❑ 5. ALARM SYSTEM; 6. PORTABLE RADIO NOTIFICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFECTED BY AN OFF -SITE RELEASE WILL OCCUR BY (Check all that apply): Cie 1. VERBAL WARNINGS; ❑ 2. PUBLIC ADDRESS OR INTERCOM SYSTEM; 0 3. TELEPHONE; ❑ 4. PAGERS; ❑ 5. ALARM SYSTEM; ❑ 6. PORTABLE RADIO EMERGENCY COORDINATOR C3NTACT INFORMATION: C13. PRIMARY EMERGENCY COORDINATOR NAME: Chris Sesto PHONE NO.: (805) 544-7687 PHONE NO. n ALTERNATE EMERGENCY COORDINATOR NAME: Jason Klein PHONE NO.: (805) 544-7687 PHONE NO ❑ Check if additional Emergency Coordinator contact and address information is available onsite or by calling PHONE NO Note: If more than one alternate emergency coordinator is designated, attach a list in order of'responsibility. D. EMERGENCY CONTAINMENT AND CLEANUP PROCEDURES Check the applicabIc boxes to indicate your facility's procedures for containin s ills and prCVCnLirkg and mitigatingmitigpting releases fires anchor explosions. 0 1. MONITOR FOR LEAKS, RUPTURES, PRESSURE BUILD-UP, ETC,; n�. ❑ 2. PROVIDE STRUCTURAL PHYSICAL BARRIERS (e.g., Portable spill containment walls, built-in berms); 0 3. PROVIDE ABSORBENT PHYSICAL BARRIERS (e.g., Pads, spill pigs, spill pillows); 4. COVER OR BLOCK FLOOR AND/OR STORM DRAINS; ❑ 5. LINED TRENCH DRAINS AND/OR SUMPS; 0 6. AUTOMATIC FIRE SUPPRESSION SYSTEM; ❑ 7. ELIMINATE SOURCES OF IGNITION FOR FLAMMABLE HAZARDS; 8. STOP PROCESSES AND/OR OPERATIONS; 0 9. AUTOMATIC / ELECTRONIC EQUIPMENT SHUT-OFF SYSTEM; 10. SHUT OFF WATER, GAS, ELECTRICAL UTILITIES; 11. CALL 9-1-1 FOR PUBLIC EMERGENCY RESPONDER ASSISTANCE AND/OR MEDICAL AID; 12_NOTIFY AND EVACUATE PERSONS IN ALL THREATENED AND/OR IMPACTED AREAS; 0 13. ACCOUNT FOR EVACUATED PERSONS IMMEDIATELY AFTER EVACUATION; ❑ 14. PROVIDE PROTECTIVE EQUIPMENT FOR ON -SITE EMERGENCY RESPONSE TEAM; ❑ 15. REMOVE CONTAINERS AND/OR ISOLATE AREAS; El 16. HIRE LICENSED HAZARDOUS WASTE CONTRACTOR; 0 17. USE ABSORBENT MATERIAL FOR SPILL CONTAINMENT; 18. VACUUM SUCTION USING APPROPRIATE VACUUM (e.g., Intrinsically safe) FOR SPILL CONTROL AND/OR CLEANUP; ❑ 19. DECONTAMINATE PERSONNEL AND EQUIPMENT WITHIN DESIGNATED AREA AND DISPOSE OF WASTEWATER AS HAZARDOUS WASTE; ❑ 20. PROVIDE SAFE TEMPORARY STORAGE OF HAZARDOUS WASTE GENERATED DURING EMERGENCY ACTIONS; ❑ 21, OTHER (Specify): Dz E. FACILITY EVACUATION THE FOLLOWING ALARM SIGNAL(S) WILL BE USED TO BEGIN EVACUATION OF THE FACILITY (Check all that apply): E1 ❑ 1, BELLS; E2 2. HORNS/SIRENS; 0 3. VERBAL (i.e., Shouting); ❑ 4. OTHER (Specify): THE FOLLOWING LOCATION(S) WILL BE USED FOR AN EMERGENCY ASSEMBLY AREA(S) (e.g., Parking lot, street comer): E3 Corner of Long & Hind Street Note: The Emergency Coordinator must account for all onsite employees and visitors after evacuation. EVACUATION ROUTE S AND ALTERNATE EVACUATION ROUTES ARE DESCRIBED AS FOLLOWS: 0 1. WRITTEN PROCEDURES DESCRIBING ROUTES, EXITS, AND ASSEMBLY AREAS; El 2. EVACUATION MAP(S) DEPICTING ROUTES, EXITS, AND ASSEMBLY AREAS; ❑ 3. OTHER (Specify): Es Note: Evacuation procedures and/or maps should be posted in visible facility locations and must be included in the Contingency Plan, F. ARRANGEMENTS FOR EMERGENCY SERVICES ADVANCE ARRANGEMENTS FOR LOCAL EMERGENCY SERVICES (Check one of the following): F1 0 1. HAVE BEEN DETERMINED NOT NECESSARY; ❑ 2. THE FOLLOWING ARRANGEMENTS HAVE BEEN MADE (Specify): Fz Note: Advance arrangements with local fire and police departments, hospitals, state and local emergency response teams, and/or emergency services contractors should be made for your facility, if necessary, Large Quantity Generators must describe arrangements in the Contingency Plan. Rev. 03/07/17 Page 2 of 4 CERS Consolidated Emergency Responsc ntingency Plan G. EMERGENCY EQUIPMENT Check the applicable boxes to list emergency response equipment available at the facility, identify the location(s) where the equipment is kept, and indicate the equipment's capability, if applicable. TYPE EQUIPMENT AVAILABLE Gi. LOCATION G2 CAPABILITY G3 EXAMPLE ® CHEMICAL PROTECTIVE GLOVES SPILL RESPONSE KIT SINGLE USE, OIL RESISTANT ONLY Safety 1. B CHEMICAL PROTECTIVE SUITS, APRONS, Sanitation Room Chemical Resistant, multi -use AND/OR VESTS .and First Aid 2. El CHEMICAL PROTECTIVE GLOVES Sanitation Room Chemical Resistant, multi -use 37 51 CHEMICAL PROTECTIVE BOOTS Individually Issued Chemical Resistant, multi -use 4. ■1 SAFETY GLASSES, GOGGLES, AND FACE Supply Room Multi -use SHIELDS 5 ❑ HARD HATS 6 ❑ AIR -PURIFYING RESPIRATORS 7 ❑ SELF-CONTAINED BREATHING APPARATUS SCBA 8. ■ FIRST AID KITS Office Area Basic first aid and Blood Borne Pathogen ,9. ■ PLUMBED EYEWASH FOUNTAIN AND/OR Shop, Chemical Storage Area, Supply Plumbed dLIQWER 10.0 PORTABLE EYEWASH KITS AND/OR Forklift Charging Station 10 minutes STATION It. OTHER Fire Fighting 12. PORTABLE FIRE EXTINGUISHERS Throughout Facility A B C 5lbs 13. 0 FIXED FIRE SUPPRESSION SYSTEMS AND/ Throughout Facility Plumbed OR SPRINKLERS 14. FIRE ALARM BOXES Manufacturing Exit Doors Pull Box 15. OTHER Spill 16 ❑ ALL -IN -ONE SPILL KIT Control and 17. ABSORBENT MATERIAL Manufacturing Shop Kit Contents Clean -Up 18 0 CONTAINER FOR USED ABSORBENT Spill Kit Container 20 g 19 ❑ BERM AND/OR DIKING EQUIPMENT 20. BROOM Spill Kit 1 21. 0 SHOVEL Spill Kit 1 22. ■ VACUUM Supply Rooms Multiple 23.0 EXHAUST HOOD 24. SUMP AND/OR HOLDING TANK 25. ❑ CHEMICAL NEUTRALIZERS 26. ❑ GAS CYLINDER LEAK REPAIR KIT 27. 0 SPILL OVERPACK DRUMS Manufacturing 55g 28. ❑ OTHER Communi- 29. 0 TELEPHONES (e.g., Cellular) Offices, Shop, Production Multiple cations .and 30, INTERCOM AND/OR PA SYSTEM Offices, Shop, Production All phones Alarm Systems 31. PORTABLE RADIOS Leads &Engineers 14 32 ❑ AUTOMATIC ALARM CHEMICAL MONITORING T Other 33 ❑ OTHER 34. ❑ OTHER Rev. 03/07/17 Page 3 of 4 CERS Consolidated Emergency Response / C gency Plan H. EARTHQUAKE VULNERABILITY Identify areas.ofthe faci ft that are vulnerable to hazardous materials relmws due to seismic motion. These areas requim immediate isolation and ins Lion. VULNERABLE AREAS (Check all that apply): xi. LOCATIONS (e.g., Shop, outdoor shed, lab): Ha 0 1, HAZARDOUS MATERIALS AND/OR WASTE STORAGE AREAS Chemical Storage Room El 2. PROCESS LINES AND PIPING Oil Tote Storage Rack ❑ 3. LABORATORY ❑ 4. WASTE TREATMENT AREA Identify mechanical systems vulnerable to releases I spills due to earthquake -related motion. Theses stems require immediate isolation and inspection. VULNERABLE SYSTEMS AN DIOR EQUIPMENT (Check all that apply): LOCATIONS: H4 0 L SHELVES, CABINETS AND/OR RACKS Manufacturing (Pallet Racks) ❑ 2. TANKS AND SHUT-OFF VALVES Shop 3. PORTABLE GAS CYLINDERS Gas behind ovens, Electrical Room, water out front ❑ 4. EMERGENCY SHUT-OFF AND/OR UTILITY VALVES Entire Facility 0 5. SPRINKLER SYSTEMS + Compressed Air- Outside back door 6. STATIONARY PRESSURIZED CONTAINERS (e.g., Propane tank) I. EMPLOYEE TRAINING Employee training is required for all employees and/or contractors handling hazardous materials and/or hazardous wastes during normal and/or emergency operations. Most facilities will need to submit a separate Training Plan, However, your CUPA may accept this section as the Training Plan for some small facilities. Employee training plans may include the following content: • Applicable laws and regulations; • Communication and alarm systems; • Emergency response plans and procedures; ! Personal protective equipment; • Safety Data Sheets; • Use and maintenance of emergency response equipment and supplies • Hazard communication related to health and safety; (e.g. Fire extinguishers, respirators, spill control materials); • Methods for safe handling of hazardous substances; • Decontamination procedures; • Hazards of materials and processes (e.g„ fire, explosion, asphyxiation); • Evacuation procedures and evacuation staging locations; • Hazard mitigation, prevention and abatement procedures; • Identification of facility areas, equipment, and systems vulnerable to • Coordination of emergency response actions; earthquakes and other natural disasters. • Notification procedures for local emergency responders, CUPA, • OTHER (Specify): Cal OES, and onsite personnel; Check the applicable boxes below to indicate how the employee training program is administered. 0 1, FORMAL CLASSROOM 0 2. VIDEOS El 3. SAFETY MEETINGS [14. STUDY GUIDES / MANUALS ❑ 5. OTHER (Specify): 12 ❑ 6. NOT APPLICABLE SINCE FACILITY HAS NO EMPLOYEES [17. CHECK IF A SEPARATE EMPLOYEE TRAINING PLAN IS USED AND UPLOADED TO CERS AS A PDF DOCUMENT 13. 0 8. CHECK IF EMPLOYEE: TRAINING IS COVERED BY THE A13OVE REFERENCED CONTENT AND OTHER DOCUMENTS ONSITE 14 EMPLOYEE TRAINING FREQUENCY AND RECORDKEEPING TRAINING MUST BE: • Provided initially for new employees as soon as possible following the date of hire. New employees should not work in an unsupervised position that involves hazardous materials handling and/or hazardous waste management without proper training; • Provided within six months from the date of hire for new employees at a large quantity generator; • Ongoing and provided at least annually; • Amended prior to a change in process or work assignment; • Given upon modification to the Emergency Response/Contingency Plan. Large Quantity Generator Training: Large quantity generators (1,000 kg or more) must retain written plan and documentation of employee training which includes: • A written description of the type and amount of both initial and ongoing training that will be given to persons filling each job position having responsibility for hazardous waste management and/or emergency response. • The name, job title and job description for each position at the facility related to hazardous waste management. • Current employee training records must be retained until closure of the facility and former employee training records must be retained for at least three years after termination of employment. Small Quantity Generator Training: Small quantity generators (less than 1,000 kg) must include basic hazardous waste management and emergency response procedures but a written employee training plan and training records are not required. In order to show that the facility has met the small quantity generator employee training requirement, an employee training plan and training records may be made available, Hazardous Materials Business Plan Training: Businesses must provide initial and annual employee training that includes the content referenced above. The training may be based on the job position and training records must be made available for a period of at least three years. J. LIST OF ATTACHMENTS Check one of the following: n. 0 1- NO ATTACHMENTS ARE REQUIRED; or ❑ 2- THE FOLLOWING DOCUMENTS ARE ATTACHED: 32. Rev. 03/07/17 Page 4 of 4 San Luis Sourdough (CERSID: 10411510) Facility information Accepted Nov 6, 2019 Submitted on 10/31/2019 10:02:20 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 11/6/2019 7:54:19 AM by Kerry Boyle • Business Activities • Business Owner/Operator Identification Hazardous Materials Inventory Accepted Nov 6, 2019 Submitted on 10/31/2019 10:02:20 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 11/6/2019 7:53:18 AM by Kerry Boyle • Hazardous Material Inventory (8) • Site Map (Official Use Only) Oil Storage Map (Adobe PDF, 29KB) Annotated Site Map (Official Use Only) (Adobe PDF, 289KB) Emergency Response and Training Plans Accepted Nov 6, 2019 Submitted on 10/31/2019 10:02:20 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Comments by Submitter: Updated both Contingency Plan and Employees Emergency Response Training sections based on Inspector comments on October 8, 2019. Submittal was Accepted on 11/6/2019 7:55:29 AM by Kerry Boyle • Emergency Response/Contingency Plan Emergency Response/Contingency Plan (Adobe PDF, 369KB) • Employee Training Plan • New Hire Employee Training Plan (MS PowerPoint, 13686KB) • Hazardous Materials and Emergency Response Training (MS PowerPoint, 1033KB) Printed on 11/6/2019 8:01 AM California Environmental .. Site Identification San Luis Sourdough CERS ID 10411510 877 Long St San Luis Obispo, CA 93401 EPA ID Number County CAL000350061 an Luis Obispo ubmittal Status ubmitted on 10/31/2019 by Kevin Yavari of San Luis Sourdough (Horsham, PA) ubmittal was Accepted; Processed on 11/6/2019 by Kerry Boyle for San Luis Obispo County Environmental Health Hazardous Materials Does your facility have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 Yes cubic feet for compressed gases (include liquids in ASTs and USTs); or is regulated under more restrictive inventory local reporting requirements (shown below if present); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or 8; or handle radlola ical materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 34 40 or 70? Storage Tank(s) (UST) your facility own or operate underground storage tanks? No Hazardous Waste s your facility a Hazardous Waste Generator? Yes Does your facility treat hazardous waste on -site? No s your facility's treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? No Does your facility consolidate hazardous waste generated at a remote site? No Does your facility need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? No Does your facility generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate n any single calendar month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous waste; or generate or accumulate at any time more than 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste. No Is your facility a Household Hazardous Waste (HHW) Collection site? No Ided and/or Exempted Materials your facility recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? No Does your facility own or operate ASTs above these thresholds? Store greater than 1,320 gallons of petroleum products (new or used) in No 3bovesround tanks or containers. your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental se prevention Program (CaIARP)? ditional Information additional comments No Printed on 11/6/2019 8:01 AM FCalifornia Environmental Reporting System (CERS) Business Owner Operator in Luis Sourdough 77 Long St n Luis Obispo, CA 93401 Status ubmitted on 10/31/2019 by Kevin Yavari of San Luis Sourdough (Horsham, PA) ubmittal was Accepted; Processed on 11/6/2019 by Kerry Boyle for San Luis Obispo County Environmental Health mbo Bakeries USA, Inc. I Beginning Date Ending Date aerator Phone Business Phone Business Fax i55447687x115 (323) 893-9237 N/A Dun & Bradstreet CERS ID 10411510 SIC Code Primary NAICS 2051 31182 Facility/Site Mailing Address rP mary Emergency Contact 877 Long St ason Klein San Luis Obispo, CA 93401 Itle roduction Manager usiness Phone Pager Number 055447687415 Owner imho Bakeries USA, Inc. 215) 957-4416 255 Business Center Dr. Horsham, PA 19044 econdary Emergency Contact ason Klein tle Productfon Manager usiness Phone Pager Number 5447687x145 Illing Contact nvironmental Contact hris Rawitzer Francisco Gutsavo Cruz 323) 893-9237 CRawitzer@bbumail.com 805) 215-5543 francisco.gordillo@grupobimbo.com 877 Long St 3877 Long St an Luis Obispo, CA 93401 San Luis Obispo, CA 93401 Name of Signer Signer Title Document Preparer Kevin Yavari Regional Environmental Manager Kevin Yavari Additional Information ocally-collected Fields ome or all of the following fields may be required by your local regulator(s). riDpeM Owner 9imbo Bakeries USA, Inc. ailing Address 5 Business Center Dr. Horsham, PA 19044 Assessor Parcel Number (APN) Number of Employees Facility ID Printed on 11/6/2019 8:01 AM � ( 69 § Zm k�k « / x° \r\§\ 22{ jEQ Ln 00m0) LM f�) kE kE _ 2s �4A Oc } k |f U \ §« �2 rE �z � ) \} )} }7)�\00 �)\t"O p«E0 (u Ef±gm�22>®Ql « ,2-§;-2g 2 Q)46 I!%=f3\fJ\fz{fz3 ;.Io § §� o\ ' kk\ m \ _ \ f m • 2 ll •i § ) - °{\ 6E °tA § . u . E / §) _ \ )� )\ \ }\ LA l 2fral _ - CL ;:J § �e \ � ( / \ k d / A \ . % ) � � LA d § 0tio % E 2 5 5 k | § o Ln x£a«)\ § )R a/§ \ / 2I $ /!|S§ / 2W) a on % % 2 «_ km0 en 3 I -_ E 0 E kr- a $r. . §{ � % ƒ > < § \ � k CL J � o « � G \ § 2 = \In � r a - 5 j E �§k � k`` 2 &_ B y q / a �)\/ �] //\\ -§Ga£0;E§2�/#Ee2m=2E kE - ka-2G-3g'->. `�-2« ±e2L�2»»2o�=Em2 ))%�\a£f)\fz\t=3)tfccLnw v'a76�� oi ' kkk )� I ! / < ;'f kLn JE ^ )\ k \ \ \ § 2 . 0 k§p Ln ) £ r4 em ■ a E a o M o a: x Ln : G ].� £ / - ; A:0 \ \ d ) d / \ / ) . 0 & a IA § 0 CL m 0 �tok f� ~ 003 |2 §z\\ r2 2 3) u k k�00 / d (A 2 > v).7 ca j % 2 - - = - \ � \ m\ g _m - - - - - - O \k/ \\ 4 }J 22ƒ k 2) \ 0 co M� 4 2 § \ G 0 § 0 0 { § \ � § / 0 } oo \ \ \ �° -o{ § # 2 a a a # j E ° Ln § o | I } o \ 0 2� / g� E £ § g f 2 ( ( f - § § ± § -E E E \ k(k\§f{/\2 E:3E a)o»«) - a 4 e� a G& o u 7 - -� \ /rs\ };`_\�\/ ----\\»)£%3§ƒ)5«)k«rx ]«3k ))=u t\f))�){�ccv)w wLo ƒ o:]!k° ° ' ) k k k� k: \Ln j2 (2 2/Ln §°/}&)\\!f o \ } m 2 § �-J = k/ EE m k k \ k k'Z m &/ k�) $ _ •% $ % \ d \ 0 9 \ \ ) 2 ƒ � m co § k \ L \ � oo x x 5 5 n 2 8 ) ■ Sak, 0zo 22) uo uT/ «?§} 0 0 ° ° / _ _ tko % � \ \ \ kkk \ �\ \ \ \ §§ \f ) 2\ }oa \ o k (\ k) G§] b � < § \ / < \ aj bD § zk \ m u \ Ln Mn / j� In oo C ; a # # 2 o 0 !2 « � w 1-12 » V�B g 2 2 k F i)f z k g©� ()< < - ;o \ 2 = § = |/ auw e - k� §§2�§/2/2 \ E§0§§2)/\ 7 <u0<0uou 72 \\\§ � � �k\) -D ;�_� =eS)% 2)E3))e`§ _-_- �ktk«k «3a\omo T cLm 2 )§/))\){\ƒ\\}{/)k\){\ƒv) !!§o § § \k\ � ,� _ I� !{ �k® ° ma/ .� ° I § \ ƒ . ! . § 2 \§ G | G )_j q J/ 0 0 �j k E ) § § o o �81z q)/ �2 m§ \j )£ k ` k � \ � \ m � _ E e � 2 cr k § » a 5�� �� L x 803 Eu ii oJ(\ 2 2 m | L - , u ° _ � u«§2� «?-§ V) / LA En OD .LM 2oo \ - c c % - \ (A V) c - - g tj - LO 0 - k■ \) _ \ k ~ z - 0// ) 2 ){ k // , 0RA ca (D L M C CU O —0 4— U N 'O cB O L L a) CL a) cu C 4- m .S; C Cl) O a O C O C � 0 L cu cn N O O A0 M L L O O CO) N I 0i San Luis Sourdough (CERSID: 10411510) Facility Information Accepted Apr 17, 2019 Submitted on 3/21/2019 8:17:39 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 4/17/2019 8:33:40 AM by Kerry Boyle • Business Activities • Business Owner/Operator Identification Hazardous Materials Inventory Accepted Apr 17, 2019 Submitted on 3/21/2019 8:17:39 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Comments by Submitter: Based on regulator comments selected "Hazard Not Otherwise Classified" under the Federal Hazard Categories for the compressed gas cylinder (mark it as a "YES"). Submittal was Accepted on 4/17/2019 8:34:04 AM by Kerry Boyle • Hazardous Material Inventory (8) • Site Map (Official Use Only) • Annotated Site Map (Official Use Only) (Adobe PDF, 289KB) • Oil Storage Map (Adobe PDF, 29KB) Printed on 4/17/2019 8:34 AM 3rnia Environmental Renr ate Identification an Luis Sourdough CERS ID 877 Long St 10411510 an Luis Obispo, CA 93401 EPA ID Number aunty CAL000350061 an Luis Obispo uhmittal Status ubmitted on 3/21/2019 by Kevin Yavari of San Luis Sourdough (Horsham, PA) ubmittal was Accepted; Processed on 4/17/2019 by Kerry Boyle for San Luis Obispo County Environmental Health azardous Materials oes your facility have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 Yes obit feet for compressed gases (include liquids in ASTs and USTs); or is regulated under more restrictive inventory local reporting requirements shown below if present); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix or 9; or handle radiological materials in quantities for which an emergency San Is required pursuant to 30 CFR Parts 30, 40 or 70? �ndorground Storage Tank(s)(UST) your facility own or operate underground storage tanks? No J Hazardous Waste Is your facility a Hazardous Waste Generator? Yes Does your facility treat hazardous waste on -site? No s your facility's treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? NO Does your facility consolidate hazardous waste generated at a remote site? No Does your facility need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? NO Does your facility generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate NO n any single calendar month, or accumulate at any time, 11 (2.2 pounds) of RCRA acute hazardous waste; or generate or accumulate at any time norel than 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste. i s your facility a Household Hazardous Waste (HHW) Collection site? No °xcluded and/or Exempted Materials )oes your facility recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? NO )oes your facility own or operate ASTs above these thresholds? Store greater than 1,320 gallons of petroleum products (new or used) in No aboveground tanks or containers. Does your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental No Release prevention Program (CalARP)? 4ddittonal Information Vo additional comments provided. Printed on 4/17/2019 8:34 AM -qw NW California Environmental Reporting System (CERS) Business Owner Operator an Luis Sourdough CERS ID 877 Long St 10411510 an Luis Obispo, CA 93401 ubmittal Status ubmitted on 3/21/2019 by Kevin Yavari of San Luis Sourdough (Horsham, PA) ubmittal was Accepted; Processed on 4/17/2019 by Kerry Boyle for San Luis Obispo County Environmental Health den"catian imbo Bakeries USA, Inc. Beginning Date Ending Date peratar Phone Business Phone Business Fax 055447687.115 (323) 893-9237 N/A Dun & Bradstreet SIC Code Primary NAICS 2051 31182 acility/Site Mailing Address rlmary Emergency Contact 877 Long St ason Klein San Luis Obispo, CA 93401 ritle roduction Manager usfness Phone Pager Number 0SS447687x115 ner econdary Emergency Contact imbo Bakeripc i icA Inc. ason Klein life r, raduction Manager orsham, PA 19044 lustness. Phone Pager Number — 055447687x145 Billing Contact [SM77 ronmental Contact cisco Gutsavo Cruz CRawitzer@bbumail.com ) 215-5543 Francisco.gordillo@gruppbimbo.cgm A l n rn 77 Long St Long St Luis Obispo, CA 93401 Luis Obispo,CA 93401 r 1 Name of Signer Signer Title Document Preparer Kevin Yavari Regional Environmental Manager Kevin Yavari ddltioiiat Information ocally•collected Fields Some or all of the following fields may be required by your local regulator(s). roperty Owner Imbo Bakeries USA, Inc. �MoinnO �ririracc Assessor Parcel Number (APN) Number of Employees Facility ID Printed on 4/17/2019 8:34 AM -ti n �O1d, m ao Ln 6 T v v v a N a 00 rn rn N N ri VI m W C q in ao rn ti 0 N n '-I \V C m a c a a n DO 01 rl O N !_J N N C r w m � C °a O ° E Lno u E o a 01 LA H o_ m N u n a N N v LL C m a3 ti cn m O a N 7 7 O O O � e AA IA LY In La N 0A J J C C n IAA IA m 14 LA N M LJ1 Z v n to m Ln M pN4 u l0 �..i N N m 00 Lmn . ii Ln n 2 W 3 a' ae a'. ae aE 2R Ln Ln Ln Ln Ln z z w w E _E _E v o ' Z Z E o Z Z E w E E E ? w? w L I I o,cM cv w Z Z- L E `o E o E_ d C j 0 V C w C a"O Q u L: u V� E O O Y O V 0, 4u � L u W .••I O rl O D V c w ? 7 W O c Ln C w w Ln C O G Ln m N N i°° O Y L N IO 01 L y a Y w o c a w �ui� u E=1=Ln Lu ui '0i u° 0 I O to E m a 3 v: a d Ln 01 y m y Ln �'" € A s E Q a Q 91< X Ln w v_ 0 Lc C to C N ? 7 W O c C 0 a)L bm 0) 1n c O P Ln O N N t ° F Y L'N Y w m m 'a 2 Lo 0 L w w Y w Ln C w w o_ o` x o '� x w w x U U — o Ln W mi vi o€ ut o N! m 3' Ln w i c c Ln a m w y l a E E ai Q F Q Ln Ln E 2 0 u Y `Lo w E O M T4 O � rl VOIZO NF u N N p � f0 Vfi O_ N C w O «•' f0 mI r 9D W m m M cc u H C1 Re N ^L Lnm co O n J u Z, d a U. c� rn c N J O 0 0 M w m a a ,n 00 01 N O N n 1'•I c O w c a` a • j ! 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A �) \ | ._ )I\ ) / $ s ' E rk} LM E Ln E u� o o k! k ± E E : o + . - - _; § - ul< _o _' § - UIZ k ,� $ 2 m g \ \ \ } � _ E � 7 L. § > a CL | � C C 0 f§ §« M ,2\ ■ 0 0 0= | ■'§ u; 6 22k �a§.7£ ji a ° i2§ in U) « 0 kW)k k |\ \ ƒk Bm a? ) � z d{ u} $ �$ j bm \o6in o w - % m 0- ,b0/ZO 000"6050 LO 1S 6uo-j yN-Wad 90OZ P; IA000Z eJes\jefuawuwlnu3\:N b 10 a6ed S = NBIN 99 = Aeo - anogy paaoida(j Al!l!oej ui saaAoldw3 jo jagwnN Wb£6 dO 'odsigp sinj ueS 'IS 61JoI LLg£ :ssaJppy Ol/b/Z :a)eQ dnaE) Aja�eg eel eaeS;o uoisiniQ a gBnopmoS sin-1 ueS :aweN ssauisn8 yow 6 :aIeog - N W 1 l m I r i H J d 3 a 8 d b6 £6 ZL L� OL 6 8 FA £ 101 ALdW3 �y l s, ON O� Z 101 A.L IV#3 N3dVdtiM]N-WIVIINJ WVN91111 N l w )I r H J 3 a 3 a V IS bUolol # dew (n 96ed uoilona>.sui aas) (31HO dVW _ W WHOA AOua6d we.JBOJd palmun paippoo Ajuno3 odsigo sin-1 ueS r 1 I cd aD L � o a a`) a > L C G C N O 0 10 4- C O m C L O C ccO cm 2 Lo m ti N N N C +' O C) L O O v N a I �T San Luis Sourdough (CERSID: 10411510) Facility Information Accepted Mar 1, 2018 Submitted on 2/23/2018 7:51:01 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 3/1/2018 2:44:29 PM by Kerry Boyle • Business Activities • Business Owner/Operator Identification Hazardous Materials Inventory Accepted Mar 1, 2018 Submitted on 2/23/2018 7:51:01 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 3/1/2018 2:44:38 PM by Kerry Boyle • Hazardous Material Inventory (8) • Site Map (Official Use Only) Annotated Site Map (Official Use Only) (Adobe PDF, 289KB) o Oil Storage Map (Adobe PDF, 29KB) Emergency ;Response and ft Plus Accepted Mar 1, 2018 Submitted on 2/23/2018 7:51:01 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 3/1/2018 2:44:51 PM by Kerry Boyle • Emergency Response/Contingency Plan o Emergency Response/Contingency Plan (Adobe PDF, 2043KB) • Employee Training Plan Employee Training Plan (MS PowerPoint, 2012KB) Printed on 3/1/2018 3:17 PM to Identification In Luis Sourdough 77 Long St n Luis Obispo, CA 93401 n Luis Obispo !submittal Status Submitted on 2/23/2018 by Kevin Yovari of San Luis Sourdough (Horsham, PA) ;submittal was Accepted; Processed on 3/1/2018 by Kerry Boyle for San Luis Obispo County Environmental Health Materials CERSID 10411510 EPA ID Number CAL000350061 )oes your facility have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 ubic feet for compressed gases (include liquids in ASTs and USTs); or is regulated under more restrictive inventory local reporting requirements shown below if present); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix k or B; or handle radiological materials inquantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? Underground Storage Tank(s) (UST) Roes your facility own or operate underground storage tanks? Yes No �4azardous Waste s your facility a Hazardous Waste Generator? Yes Does your facility treat hazardous waste on -site? No s your facility's treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? No Does your facility consolidate hazardous waste generated at a remote site? No Does your facility need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? No )oes your facility generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate n any single calendar month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous waste; or generate or accumulate at any time pore than 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste. No s your facility a Household Hazardous Waste (HHW) Collection site? No :xcluded and/or Exempted Materials does your facility recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? No does your facility own or operate ASTs above these thresholds? Store greater than 1,320 gallons of petroleum products (new or used) in aboveground tanks or containers. No does your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental telease prevention Program CalARP ? No Additional Information No additional comments provided. Printed on 3/1/2018 3:17 PM Facility/Site ian Luis Sourdough CERS ID 3877 Long St 10411510 Sian Luis Obispo, CA 93401 ubmittal Status Abmitted on 2/23/2018 by Kevin Yovori of San Luis Sourdough (Horsham, PA) 3bmittal was Accepted; Processed on 3/1/2018 by Kerry Boyle for San Luis Obispo County Environmental Health IBimbo Bakeries USA, Inc. Beginning Date Ending Date Operator Phone Business Phone Business Fax 3055447687x115 (323) 893-9237 N/A Dun & Bradstreet SIC Code Primary NAICS 2051 31182 Facility/Site Mailing Address Primary Emergency Contact 3877 Long St Chris Rawitzer San Luis Obispo, CA 93401 Ifle cant Manager sssiness Phone Pager Number 55447687x115 caner -Secondary Emergency Contact t Inc. hris Sesto title Dr. Dperations Supervisor orsham, PA 19044 3usiness Phone Pager Number 055447687x145 filling Contact ironmental Contact tnvis Sesto CRawitzer@bbumail.com chris.sesto@bbumail.com o► r tong x fi Luis Obispo, CA 93401 n Luis Obispo, CA 93401 ame of Signer Signer Title Document Preparer evin Yavari Regional Environmental Manager Kevin Yavari dditional Information Locally -collected Fields Some or all of the following fields may be required by your local regulator(s). �FIroperty Owner Isimbo Bakeries USA. Inc. Mailing Address 55 Business Center Dr. orsha m, PA 19044 Printed on 3/1/2018 3:17 PM Assessor Parcel Number (APN) Number of Employees Facility ID ERS8u.h,—j0,,6. San Luis Sourdough Chemical Location CERS ID 10411510 srnev roam. San Luis Sourdough EF 516 Facility ID 3877 Long St, San Luis Obispo 93401 status Submitted on 2f 23/2018 7:51 AM Annual Hazardous Components Quantities Waste Federal Hazard Fw mIwtu... Code/Fire Haz. Class Common Name Unit Max. DaNy Lvil-%Cant. AYE. t7aily Amount Caullwin Component Name %Wt EHS CAS No. 3 - Flammable and AFCO Wyandotte Sanifect 17117 Gallons 110 .5S 55 0 - Physical Isopropyl alcohol 50 % 67-63-0 mbVob$a Liquids (AFCO 5503) state storage contains Press---- Flammable Liquid Plastic/Non-metalic Drum -_ Ambient Waste Code - Health Skin Nnmabte Liquid, Class I -A CAS No Corrosion 67-63-0 Type Temperature Irritation Map: EF 5/6 Mixture Ambient - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye r; 2,1 • Flammable Gases Tri-Gas Shielding Gas Cu. Feet 580 125 500 0 •Physical Argon 8% 7440.37-1 CAS No state Storage Container Pressue _ Waste Code Flammable Carbon Dioxide 3 % 124-38-9 lammable Gas 7440-59-7 Gas Cylinder > Ambient Helium 90 % 7440-59-7 Map: EF 5/6 Type Temperature Printed on 3/1/2018 3:17 PM Page 1 of 4 ERR a„tlnaWOrr. San Luis Sourdough Hazardous Materials And Wastes inventory rnemuaL teration Matrix Repar-t Ccgs In 10411510 adlny Nomr San Luis Sourdough J9 Facility m 3877 Long St, San Luis Obispo 93401 51a1ur Submitted on 2(23/2016 7:51 AM Annual Hazardous Components Qn.nnt ec Waste Federal Hazard For mixture onl i�oT Codeflite Haz. Class Common Yamn unit Max. [zany taryiest Cont. Ayp.l Ally Amount Qlwit Aet Corrgmnant Name % Wt EHS CAS No. OT:3-Flammabin and Divider Oil Gallons 550 275 275 a-Physkal Combustible Liquids CAS No State Sto r.tn Centa finer L+auua Flammab3e 8017-95-1 Liquid Tote Bin _ Amhlartt Wutc code - Health Skin bustlhle Liquid, Class II Map; J9 Type EuTt."t„re Corrosion Pure Ambient Urilattan - Heath Resoratory Skin Sensitization - Health Serious Eye Damage bye Irritation T: 3- Flammable and Colony Sun Release Pan Oil Gallons 550 275 275 0 -Physical mhusable Liquids State Srpnge Conuiner Pressue Flammable CAS No Liquid Tote Bin Ambient watte Code - Health Skin 6001-21-2 Combustible Liquid, Class III-B Corrostan Ma J9 p' Type Temperature IrNtatiort Pure Ambient -Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye l"itau" Printed On 3/1/701 g 3:17 PM Page 2 of 4 ERS Business/org. San Luis Sourdough WName San Luis Sourdough 3877 Li+nr, St, San Luls ❑hispo 93401 Ot Cadf/F6 Haz. Class Common Name HazardousReport Unit Max. Mlly Chemical Location L7/8 t?,—Tw LarRess Cont. Ayr, Dazly Annual Waste Federal Hazard Amount Caugctlf. CERS ID 10411510 Facility ID status Submitted on 2/23/2918 7:51 AM Hazardous Components IF. mk.t-e.s CemIaMent Name % Wt EHS CAS No. )OT:8- Corrosives (Liquids and AFCO 5212 Scrubber Magic Gallons 110 55 55 0 -Physical Quaternary ammonium 5 % 68424-85-1 Solids) CAS No State Storage Container r Pressue Corrosive To compounds Liquid Plastic/Non-metalic Drum Ambient Waste code Metal Ethyl Alcohol 5 % -5 _orrosive -Health Skin 1-Decanaminium, N,N-dime[hyl-N- S % 32426-11-2 3242 Map: L7/8 Map: L 7/8 Type T m eture Corrosion octyl-,chloride Mixture Mixture Ambient Irritation 1-Octanaminium, N,N-dimethyl-N- 5 % 5538-94-3 - Health octyl, chloride Respiratory Skin Didecyldimethylammonium 5 % 7173-51-5 Sensitization chloride - Health Serious Eye Damage Eye Irritation DOT: 8 - Corrosives (Liquids and AFCO 5249 SCRUBBIE Gallons 110 55 55 0 - Physical Sodium hydroxide 5 % 1310-73-2 Solids) CAS No State Storage Container Pressue Corrosive To Liquid Plastic/Non-metalic Drum Ambient Waste code Metal Corrosive 1310-73-2 - Health Skin Map: L 7/8 Tvpe Temperature Corrosion Mixture Ambient Irritation - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye Irritation Printed on 3/1/2018 3:17 PM Page 3 of 4 RSeuslness/Org. San Luis Sourdough Hazardous Materials And Wastes Inventory Chemical Location Matrix Report CERS ID 10411510 e RAV Name San Luis Sourdough 1.7/8 Facility ID 3877 Long St, San Luis Obispo 93401 status Submitted on 2/23/2018 7:51 AM Annual Hazardous Components Quantities Waste Federal Hazard IFor mixtufCan i Ced401re Haz, Class Common Name Unit Max. Daily Largest Conl Avg..OaRy Amount Categw ss Camponrtm Name % Wt EHS CAS No. OT:8- Corrosives (Liquldsand AFCO 4312 VIGILQUAT Gallons 110 55 55 0 -Physical ALKYL DIMETHYL AMMONIUM 3% 68424-85-1 Iids) state Storage Container Pressue Corrosive To CHLORIDE CAS No Liquid Plastic/Non-metalic Drum — — _ -- " Ambient Waste _Code Metal OCTYL DECYL DIMETHYL 2 % 32426-11-2 rroslye 68424-85-1 -Health Skin AMMONIUM CHLORIDE Map: L7/8 Type Mixture Temperature, Ambient Corrosion DIOCTYL DIMETHYL AMMONIUM 1% 5538-94-3 Irritation CHLORIDE -Health DIDECYL DIMETHYL AMMONIUM 1% 7173-51-5 Respiratory Skin CHLORIDE Sensitization - Health Serious Eye Damage Eye Irritation T• 8 -Corrosives (Liquids and AFCO 5316 Power Foam HD Gallons 110 55 55 0 - Physical Sodium hydroxide 30 % 1310-73-2 acids) CAS No Slate Storage Container Pressue Corrosive To 1310-73-2 Liquid Plastic/Non-metalic Drum Ambient Waste Code Metal rroslve Ma L7 8 p' / Type Temperature - Health Skin Mixture Ambient Corrosion Irritation - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye Irritation Printed on 3/1/2018 3:17 PM Page 4 of 4 Ib0/ZO 004'60SOL01S 6uo1 n-Wad SOOZ P-_!A9N1800Z eJeSMelu8wua1nu3\:1N b 10 a6ed 9 = 1146iN 99 = Aea - anogy paaoidaQ Appoea ui saaAoldw3 )o jagwnN WK6 dO 'odsigp sml ueS IS 6uol LL8£ :ssajppd ONb/z :Ole(] dnag AisMeg eel ejeS jo uoisinip a g6nopinog sink ueS :aweN ssouisng youl 6 :01e0S N w r i H 1f 3 a e v b4 £6 woo Z 01911 lv°n1nuluov 71tlVd 1vItl15nON, L� 1 o� i dt x Z 8 0 � n z m L 9 9 b z o-1 7 .-i. ."-i'1.��.i....•.o_ '•�� •I ",�rjf�:4i� �.r.�....:..�1�Jl..�i 1 _ i _ , , � `L I 1Nr101lIJ Wvi19'I171 J • N^••a V wf -i131l rl i lHJE)L_=i1.3Ia��l9�d IS 6-1 # dew (n 96ed uoiaoni;su. aas) aND di -VW - W WHO -A AouaBV wEJ BOJd paimun paippoo Ajunoo odsigp sink ueS b6 9 5 b z I A' • I I ULU RUJU I i .,. 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VERBAL WARNINGS; 0 2 PUBLIC ADDRESS OR INTERCOM SYSTEM; 0 3. TELEPHONE; ❑ 4. PAGERS; ❑ 5. ALARM SYSTEM; El 6. PORTABLE RADIO NOTIFICATIONS TO NEIGHBORING FACILITIES THAT MAY BE AFFECTED BY AN OFF -SITE RELEASE WILL OCCUR BY (Check all that apply): Cie E I. VERBAL WARNINGS; [12. PUBLIC ADDRESS OR INTERCOM SYSTEM; 0 3. TELEPHONE; ❑ 4. PAGERS; ❑ 5. ALARM SYSTEM; ❑ 6. PORTABLE RADIO EMERGENCY COORDINATOR CONTACT INFORMATION: (713 PRIMARY EMERGENCY COORDINATOR NAME: PHONE NO.: (805) 544-7687 PHONE NO.: ALTERNATE EMERGENCY COORDINATOR NAME PHONE NO.: (805) 544-7687 PHONE NO.: ❑ Check if additional Emergency Coordinator contact and address information is available onsite or by calling PHONE NO.: Note: If more than one alternate emergency coordinator is designated, attach a list in order of fesponsibil ity. D. EMERGENCY CONTAINMENT AND CLEANUP PROCEDURES Check the applicable boxes to indicate your facility's procedures for containing spills and preventin ang d mitigating releases, fires and/or explosions. _ 1. MONITOR FOR LEAKS, RUPTURES, PRESSURE BUILD-UP, ETC.; DI. ❑ 2. PROVIDE STRUCTURAL PHYSICAL BARRIERS (e.g., Portable spill containment walls, built-in berms); 0 3. PROVIDE ABSORBENT PHYSICAL BARRIERS (e.g., Pads, spill pigs, spill pillows); 0 4. COVER OR BLOCK FLOOR AND/OR STORM DRAINS; ❑ 5. LINED TRENCH DRAINS AND/OR SUMPS; 6. AUTOMATIC FIRE SUPPRESSION SYSTEM: ❑ 7. ELIMINATE SOURCES OF IGNITION FOR FLAMMABLE HAZARDS; 0 8. STOP PROCESSES AND/OR OPERATIONS; 29. AUTOMATIC / ELECTRONIC EQUIPMENT SHUT-OFF SYSTEM; 0 10. SHUT OFF WATER, GAS, ELECTRICAL UTILITIES; 0 11. CALL 9-1-1 FOR PUBLIC EMERGENCY RESPONDER ASSISTANCE AND/OR MEDICAL AID; 0 12. NOTIFY AND EVACUATE PERSONS IN ALL THREATENED AND/OR IMPACTED AREAS; 13. ACCOUNT FOR EVACUATED PERSONS IMMEDIATELY AFTER EVACUATION; ❑ 14. PROVIDE PROTECTIVE EQUIPMENT FOR ON -SITE EMERGENCY RESPONSE TEAM; ❑ 15. REMOVE CONTAINERS AND/OR ISOLATE AREAS; 0 16. HIRE LICENSED HAZARDOUS WASTE CONTRACTOR; 0 17. USE ABSORBENT MATERIAL FOR SPILL CONTAINMENT; 18. VACUUM SUCTION USING APPROPRIATE VACUUM (c,g., Intrinsically safe) FOR SPILL CONTROL AND/OR CLEANUP; ❑ 19. DECONTAMINATE PERSONNEL AND EQUIPMENT WITHIN DESIGNATED AREA AND DISPOSE OF WASTEWATER AS HAZARDOUS WASTE; ❑ 20. PROVIDE SAFE TEMPORARY STORAGE OF HAZARDOUS WASTE GENERATED DURING EMERGENCY ACTIONS; ❑ 21. OTHER (Specify): D2. E. FACILITY EVACUATION THE FOLLOWING ALARM SIGNAL(S) WILL BE USED TO BEGIN EVACUATION OF THE FACILITY (Check all that apply): El ❑ 1 BELLS; E2 0 2. HORNS/SIRENS; �] 3. VERBAL (i.e., Shouting); ❑ 4. OTHER (Specify): THE FOLLOWING LOCATION(S) WILL BE USED FOR AN EMERGENCY ASSEMBLY AREA(S) (e.g., Parking lot, street comer): E3 Comer of Long & Hind Street Note: The Emergency Coordinator must account for all onsite employees and visitors after evacuation. EVACUATION ROUTE S AND ALTERNATE EVACUATION ROUTES ARE DESCRIBED AS FOLLOWS: E4 0 1. WRITTEN PROCEDURES DESCRIBING ROUTES, EXITS, AND ASSEMBLY AREAS; 0 2. EVACUATION MAP(S) DEPICTING ROUTES, EXITS, AND ASSEMBLY AREAS; ❑ 3. OTHER (Specify): E5. Nolc: Evacuation procedures and/or maps should be posted in visible facility localiuns and must be included in the Contingency Plan. F. ARRANGEMENTS FOR EMERGENCY SERVICES ADVANCE ARRANGEMENTS FOR LOCAL EMERGENCY SERVICES (Check one of the following): FI. 0 1. HAVE BEEN DETERMINED NOT NECESSARY; ❑ 2. THE FOLLOWING ARRANGEMENTS HAVE BEEN MADE (Specify): Fx Note: Advance arrangements with local fire and police departments, hospitals, state and local emergency response teams, and/or emergency services contractors should be made for your facility, if necessary. Large Quantity Generators must describe arrangements in the Contingency Plan. Rev. 03/07/17 Page 2 of 4 CERS Consolidated Emergency Response / Contingency Plan G. EMERGENCY EQUIPMENT Check the applicable boxes to list emergency response equipment available at the facility, identify the location(s) where the equipment is kept, and indicate the equipment's capability, if applicable. TYPE EQUIPMENT AVAILABLE Gi LOCATION G2 CAPABILITY G3. EXAMPLE ® CHEMICAL PROTECTIVE CLOVES SPILL RESPONSE KIT SINGLE USE, OIL RESISTANT ONLY Safety :and I. 0 CHEMICAL PROTECTIVE SUITS, APRONS, AND/OR VESTS Sanitation Room Chemical resistant, multi -use First Aid 2. CHEMICAL PROTECTIVE GLOVES Sanitation Room Chemical resistant, multi -use 3. ■ CHEMICAL PROTECTIVE BOOTS Individually Issued Chemical resistant, multi -use 4. SAFETY GLASSES, GOGGLES, AND FACE SHIELD Supply Room Multi -use 5. Ll HARD HATS ,6. AIR -PURIFYING RESPIRATORS 7. ❑ SELF-CONTAINED BREATHING APPARATUS SCRA 8. 0 FIRST AID KITS Office Area Basic first aid and Blood Bome Pathogen 19. PLUMBED EYEWASH FOUNTAIN AND/OR SHOWER Shop, Chemical Storage Area, Supply Plumbed 10. 0 PORTABLE EYEWASH KITS AND/OR STATION Forklift Charging Statlon 10 minutes 1L ❑ OTHER Fire Fighting 12. PORTABLE FIRE EXTINGUISHERS Throughout Facility A B C 5lbs 13. FIXED FIRE SUPPRESSION SYSTEMS AND/ OR SPRINKLERS Throughout Facility Plumbed 14. 0 FIRE ALARM BOXES Manufacturing Exit Doors Pull Box 15. ❑ OTHER Spill Control 16 ❑ ALL -IN -ONE SPILL KIT and 17 [] ABSORBENT MATERIAL Manufacturing , Shop Kit Contents Clean -Up 18 CONTAINER FOR USED ABSORBENT Spill Kit Container 20g 19. ❑ BERM AND/OR DIKING EQUIPMENT 20. BROOM Spill Kit 1 21. ® SHOVEL Spill Kit 1 22. ® VACUUM Supply Rooms Multiple 23. EXHAUST HOOD 24.0 SUMP AND/OR HOLDING TANK 25. ❑ CHEMICAL NEUTRALIZERS 26. ❑ GAS CYLINDER LEAK REPAIR KIT 27. 0 SPILL OVERPACK DRUMS Manufacturing 55g 28. OTHER Communi- cations 29. TELEPHONES (e.g., Cellular) Offices, Shop, Production Multiple and 30. INTERCOM AND/OR PA SYSTEM Offices, Shop, Production All phones Alarm Systems 31, PORTABLE RADIOS Leads & Engineers 14 32. ❑ AUTOMATIC ALARM CHEMICAL MONITORJNQ EOUIPMENT Other 33. ❑ OTHER 34. ❑ OTHER Rev. 03/07/17 Page 3 of 4 CERS Consolidated Emergency Response / Contingency Plan H. EARTHQUAKE VULNERABILITY Went areas of the the itit y that are vulnerable to hazardous materials releases due to seismic motion. Thesc areas re uirc immediate isolation and inspection VULNERABLE AREAS (Check all Ihat apply); H1. LOCATIONS (e.g„ Shop, outdoor shed, lab): rtz [HI 1. HAZARDOUS MATERIALS AND/OR WASTE STORAGE AREAS Chemical Storage Room F1 2. PROCESS LINES AND PIPING Oil Tote Storage Rack ❑ 3. LABORATORY ❑ 4. WASTE TREATMENT AREA Identify mechanical systems vulnerable to releases / spills due to earth uakc-related motion. These systems require immediate isolation and inspection, VULNERABLE SYSTEMS AND/OR EQUIPMENT (Check all that apply): H3. LOCATIONS: H4 1. SHELVES, CABINETS AND/OR RACKS Manufacturing (Pallet Racks) ❑ 2. TANKS AND SHUT-OFF VALVES 1 0 3. PORTABLE GAS CYLINDERS Shop ❑ 4. EMERGENCY SHUT-OFF AND/OR UTILITY VALVES Gas behind ovens, Electrical Room, Water out front 0 5, SPRINKLER SYSTEMS Entire Facility 0 6. STATIONARY PRESSURIZED CONTAINERS (e.g., Propane tank) Compressed Air -Outside back door I. EMPLOYEE TRAINING Employee training is required for all employees and/or contractors handling hazardous materials and/or hazardous wastes during normal and/or emergency operations. Most facilities will need to submit a separate Training Plan. However, your CUPA may accept this section as the Training Plan for some small facilities. Employee training plans may include the following content: • Applicable laws and regulations; • Communication and alarm systems; • Emergency response plans and procedures; • Personal protective equipment; • Safety Data Sheets; Use and maintenance of emergency response equipment and supplies • Hazard communication related to health and safety; (e.g. Fire extinguishers, respirators, spill control materials); • Methods for safe handling of hazardous substances; • Decontamination procedures; • Hazards of materials and processes (e.g., fire, explosion, asphyxiation); • Evacuation procedures and evacuation staging locations; + Hazard mitigation, prevention and abatement procedures; + Identification of facility areas, equipment, and systems vulnerable to • Coordination of emergency response actions; earthquakes and other natural disasters • Notification procedures for local emergency responders, CUPA, . OTHER (Specify): Cal OES, and onsite personnel; Check the applicable boxes below to indicate how the employee training program is administered. I. FORMAL CLASSROOM 2. VIDEOS 3. SAFETY MEETINGS ❑ 4. STUDY GUIDES / MANUALS 11 ❑ 5. OTHER (Specify): 12 ❑ 6. NOT APPLICABLE SINCE FACILITY HAS NO EMPLOYEES ❑ 7. CHECK IF A SEPARATE EMPLOYEE TRAINING PLAN IS USED AND UPLOADED TO CERS AS A PDF DOCUMENT 13 0 8. CHECK IF EMPLOYEE TRAINING IS COVERED BY THE ABOVE REFERENCED CONTENT AND OTHER DOCUMENTS ONSITE 14 EMPLOYEE TRAINING FREQUENCY AND RECORDKEEPING TRAINING MUST BE: • Provided initially for new employees as soon as possible following the date of hire. New employees should not work in an unsupervised position that involves hazardous materials handling and/or hazardous waste management without proper training; • Provided within six months from the date of hire for new employees at a large quantity generator; • Ongoing and provided at least annually; • Amended prior to a change in process or work assignment; • Given upon modification to the Emergency Response/Contingency Plan. Large Quantity Generator Training: Large quantity generators (1,000 kg or more) must retain written plan and documentation of employee training which includes: • A written description of the type and amount of both initial and ongoing training that will be given 10 persons filling eachjob position having responsibility for hazardous waste management and/or emergency response. • The name, job title and job description for each position at the facility related to hazardous waste management. • Current employee training records must be retained until closure of the facility and former employee training records must be retained for at least three years after termination of employment. Small Quantity Generator Training: Small quantity generators (less than 1,000 kg) must include basic hazardous waste management and emergency response procedures but a written employee training plan and training records are not required. In order to show that the facility has met the small quantity generator employee training requirement, an employee training plan and training records may he made available. Hazardous Materials Business Plan Training: Businesses must provide initial and annual employee training that includes the content referenced above The training may be based on the job position and training records must be made available for a period of at least three years. J. LIST OF ATTACHMENTS Check one of the following: 7• ❑ 1. NO ATTACHMENTS ARE REQUIRED; or ❑ 2. THE FOLLOWING DOCUMENTS ARE ATTACHED: rz 1 Rev. 03l07/17 Page 4 of 4 ' 21-Z7-j1,Y San Luis Sourdough (CERSID: 10411510) Facility information Accepted Apr 19, 2018 Submitted on 2/23/2018 7:51:01 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 4/19/2018 8:42:20 AM by Kerry Boyle • Business Activities • Business Owner/Operator Identification Hazardous Materials Inventory Accepted Apr 19, 2018 Submitted on 2/23/2018 7:51:01 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 4/19/2018 8:41:46 AM by Kerry Boyle • Hazardous Material Inventory (8) • Site Map (Official Use Only) • Annotated Site Map (Official Use Only) (Adobe PDF, 289KB) • Oil Storage Map (Adobe PDF, 29KB) Emergency Response and Training Plans Accepted Apr 19, 2018 Submitted on 2/23/2018 7:51:01 AM by Kevin Yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted on 4/19/2018 8:42:11 AM by Kerry Boyle • Emergency Response/Contingency Plan Emergency Response/Contingency Plan (Adobe PDF, 2043KB) • Employee Training Plan Employee Training Plan (MS PowerPoint, 2012KB) Printed on 4/19/2018 8:58 AM Site Identification !San Luis Sourdough CERS ID 3877 Long St 10411510 San Luis Obispo, CA 93401 EPA ID Number County CAL000350061 San Luis Obispo Submittal Status I Submitted on 2/23/2018 by Kevin yavari of San Luis Sourdough (Horsham, PA) Submittal was Accepted; Processed on 4/19/2018 by Kerry Boyle for San Luis Obispo County Environmental Health Hazardous Materials does your facility have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 Yes :ubic feet for compressed gases (include liquids in ASTs and USTs); or is regulated under more restrictive inventory local reporting requirements shown below if present); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix % or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? Underground Storage Tank(s) (UST) does your facility own or operate underground storage tanks? No Hazardous Waste s your facility a Hazardous Waste Generator? Yes Does your facility treat hazardous waste on -site? No s your facility's treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? NO does your facility consolidate hazardous waste generated at a remote site? No Does your facility need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? NO Does your facility generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate n any single calendar month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous waste; or generate or accumulate at any time pore than 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste. No s your facility a Household Hazardous Waste (HHW) Collection site? No Excluded and/or Exempted Materials Does your facility recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? NO does your facility own or operate ASTs above these thresholds? Store greater than 1,320 gallons of petroleum products (new or used) in NO Iboveground tanks or containers. )oes your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental NO telease prevention Program (CalARP)? kdditional Information Vo additional comments provided, Printed on 4/19/2018 8:58 AM an Luis Sourdough 877 Long St an Luis Obispo. CA 93401 CERSID 10411510 bmittai Status bmitted on 2/23/2018 by Kevin Yavari of San Luis Sourdough (Horsham, PA) bmittal was Accepted; Processed on 4/19/2018 by Kerry Boyle for San Luis Obispo County Environmental Health mbo Bakeries USA, Inc. aerator Phone Business Phone Business Fax 155447687x115 (323) 893-9237 N/A Ending Date SIC Code Primary NAICS 2051 31182 acilfty/Site Mailing Address rimary Emergency Contact 877 Long St hris Rawitzer San Luis Obispo, CA 93401 ritle lant Manager sines Phone Pager Number 55447687xi15 Owner Secondary Emergency Contact Bimbo Bakeries USA, Inc. hris Sesto :215) 957-4416 ritle 255 Business Center Dr. Operations Supervisor 4orsham, PA 19044 Business Phone Pager Number �8055447687.145 Beginning Date Dun & Bradstreet ling Contact Environmental Contact CRawitzer@bbumail.com chris.sesto@bbumail.com 1 Luis Obispo, CA 93401 t-2 n Luis Obispo, CA 93401 Name of Signer Kevin Yavari Additional Information Signer Title Document Preparer Regional Environmental Manager Kevin Yavari Ily-collected Fields or all of the following fields may be required by your local regulator(s). G"rty Owner ilnbo Bakeries USA, Inc. iaumg Haaress S. Business Center Dr. Horsham; PA 19044 IAssessor Parcel Number (APN) Number of Employees Facility ID Printed on 4/19/2018 8:58 AM Business/Org. San Luis Sourdough ly Name San Luis Sourdough 3877 Long St, San Luis Obispo 93401 Chemical Location EF 5/6 Annual Quantities Waste Federal Hazard OTCode/Fire Haz. Class Common Name Unit Max. Daily Largest Cont. Avg. Daily Amount Categories Component P DOT, 3 - Flammable and AFCO Wyandotte Sanifect D2 Gallons 110 55 55 0 - Physical Isopropyl al Combustible Liquids (AFCO 5503) State Storage Container Pressue Flammable Liquid Plastic/Non-metalic Drum Ambient Waste Code - Health Skin Flammable Liquid, Class I -A CAS No Type Temperature Corrosion 67-63-0 Mixture Ambient Irritation Map: EF 5/6 - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye Irritation DOT- 2.1- Flammable Gases Tri-Gas Shielding Gas Cu. Feet 580 125 500 0 - Physical Argon CAS No State Storage Container Pressue Waste Code Flammable Carbon Dio: ........................... .........._ _. — Flammable Gas 7440-59-7 Gas Cylinder > Ambient Helium Map: EF 5/6 T..yk..e_ Temperature Mixture Ambient Printed on 4/19/2018 8:58 AM CERS Business/Org. San Luis Sourdough Chemical Location Facility Name San Luis Sourdough J9 3877 Long St, San Luis Obispo 93401 Annual Quantities Waste Federal Hazard DOT Code/Flra Haz. Class Common Name Unit Max. Daliy Largest Cont. Avg. Dalxy Amount Categories Component P DOT: 3 - Flammable and Divider Oil Gallons 550 275 275 0 - Physical Combustible Liquids CAS No State --- Storage Container Pressue Flammable 8017-95-1 Liquid Tote Bin Ambient Waste Code - Health Skin 'omhastible Liquid, Class II Corrosion Map: J9 Type Temperature Pure Ambient Irritation - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye Irritation )CIT. 3 - Flammable and Colony Sun Release Pan Oil Gallons 550 275 275 0 - Physical -ombustible Liquids CAS State Li Storage Container Pressue Flammable 8001- 21-2 Liquid Tote Bin Ambient Waste Code - Health Skin .ombustible Liquid, Class III-B Corrosion Map: J9 Type_ Temperature Pure Ambient Irritation - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye Irritation Printed on 4/19/2018 8:58 AM Business/org. San Luis Sourdough [y Name San Luis Sourdough 3877 Long St, San Luis Obispo 93401 Chemical Location L 7/8 Annual Quantities Waste Federal Hazard ❑T Code/Fire Haz. Class Common Name Unit Max. Daily Largest Cont. Aug. pally Amount Categories Component DOT: 8 - Corrosives (Liquids and AFCO 5212 Scrubber Magic Gallons 110 55 55 0 - Physical Quaternary Solids) CAS No State Storage Container Pressue Corrosive To compounds Liquid Plastic/Non-metalic Drum Ambient Waste Code Metal Ethyl Alcoh, Corrosive 68424-85-1 - Health Skin 1-Decanam Map: L 7/8 Type Temperature Corrosion octyl-,chlor Mixture Ambient Irritation 1-Octanami - Health octyl, chlori Respiratory Skin Didecyldim, Sensitization chloride - Health Serious Eye Damage Eye _ Irritation OT: 8 - Corrosives (Liquids and AFCO 5249 SCRUBBIE Gallons 110 55 55 0 - Physical Sodium hyc Solids) CAS No State Storage Container Pressue Corrosive To 1310-73-2 Liquid Plastic/Non metalic Drum Ambient Waste Code Metal Corrosive Map: L 7/8 Type Temperature - Health Skin Mixture Ambient Corrosion Irritation - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye Irritation Printed on 4/19/2018 8:58 AM Business/org. San Luis Sourdough ;y Name San Luis Sourdough 3877 Long St, San Luis Obispo 93401 Chemical Location U/8 Annual Quantities Waste Federal Hazard DOT Code/Fire Haz. Class Common Name Unit Max. Daily Largest Cont. Avg. Dally Amount Categories Component P T: 8 - Corrosives (Liquids and AFCO 4312 VIGILQUAT Gallons 110 55 55 0 - Physical ALKYL DIME Solids) CAS No State — — Storage Container — Pressue Corrosive To CHLORIDE 68424-85-1 Liquid Plastic/Non-metalic Drum Ambient Waste Code Metal -- -....... OCTYL DEC` Corrosive Map: 1-7/8 Type Temperature -Health Skin AMMONIUI Mixture Ambient Corrosion DIOCTYL DI Irritation CHLORIDE - Health DIDECYL DII Respiratory Skin CHLORIDE Sensitization - Health Serious Eye Damage Eye Irritation U01 : 8 - Corrosives (Liquids and AFCO 5316 Power Foam HD Gallons 110 55 55 0 - Physical Sodium hyc olidsy CAS No State Storage Container Pressue Corrosive To 1310-73-2 Liquid Plastic/Non-metalic Drum Ambient Waste Code Metal �orrosive Map: 1-7/8 Type Temperature - Health Skin Mixture Ambient Corrosion Irritation - Health Respiratory Skin Sensitization - Health Serious Eye Damage Eye Irritation Printed on 4/19/2018 8:58 AM t'b01Z0 000'60901.0IS 6uo-I W-yya=l 90OZ PT "a\900Z PJeS\I8IUGwuwinu31:y4 b ;p abed 9 = ILAN 99 = Au(] - anogy pajoldap Alllloe.1 ul se@Aoldw3 jo jagwnN WK6 VO 'odslgp sin-1 ueS IS 6uol LLB£ :ssaippy 0L/17/Z :ale(] dnojp Ajiq�eg 99-1 ejeS;o uolslnlp a g6nopmoS sin-1 ueS :aweN ssaulsng }aaj = youl :aleoS N I W 1 l H I r 1 H J q 1 3 d sa V tiL £L Z L _ 13 31runsn�rmoa .« m vd lviwu11aril ,..... ..,._... .. LL 1 6 T cl r: I F r T-.. f _ 1 101A1dW3 `yl s 0H 0� Z L 101 A1d"3 N3dtldSM7N IMIdIIU WVN97i71 N w l 1 H r 1 H 0 j A I 3 jS 656-1 # deW (n 96ed uopnilsul aas) QRiO dVW ' W WNO=l AauaBV wej6oJd palmun paigpao Ajunoo odsigp sink ueS K £L ZL LL 0L 6 9 L 9 s b £ 2 L 'NIFIED PROGRAM CONSOLIDATED F M FACILITY INFORMATION BUSINESS ACTIVITIES Page I of I. FACILITY IDENTIFICATION FACILITY ID # 2 17] 1 (Agency Use Only) BUSINESS NAME (Same as Facility Name ofDBA-Doing Business As) SAN LUIS SOUkuVuum 3 BUSINESS SITE ADDRESS 3877 LONG ST 103 BUSINESS SITE CITY SAN LUIS OBISPO 104 CA I ZIP CODE 93401 Ios II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/ O erator Identification page. Does your facility... If Yes, please com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed © YES INVENTORY — CHEMICAL gases (include liquids in ASTs and USTs); or the applicable Federal threshold DESCRIPTION quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency Ian is required pursuant to 10 CFR Parts 30, 40 or 70? B. REGULATED SUBSTANCES Have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental Release ❑ YES Coordinate with your local agency prevention Program (CalARP)? responsible for CalARP. C. UNDERGROUND STORAGE TANKS (USTS) UST FACILITY (Formerly SWRCB Form A) Own or operate underground storage tanks? ❑ YES UST TANK (one page per tank) (Formerly Form B) D. ABOVE GROUND PETROLEUM STORAGE You may need to submit an Own or operate ASTs above these thresholds: ABOVEGROUND PETROLEUM Store greater than 1,320 gallons of petroleum products (new or used) in ❑ YES STORAGE TANK FACILITY aboveground tanks or containers. STATEMENT. Click for details E. HAZARDOUS WASTE Generate hazardous waste? © YES EPA ID NUMBER —provide at the top of this page Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES RECYCLABLE MATERIALS REPORT (one per recycler) Treat hazardous waste on -site? ❑ YES ON -SITE HAZARDOUS WASTE TREATMENT — FACILITY ON -SITE HAZARDOUS WASTE TREATMENT— UNIT (one page per unit) Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? ❑ YES CERTIFICATION OF FINANCIAL ASSURANCE Consolidate hazardous waste generated at a remote site? ❑ YES REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? ❑ YES HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or Obtain federal EPA ID Number, file more of federal RCRA hazardous waste, or generate in any single calendar ❑ YES Biennial Report (EPA Form 8700- month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous 13A/B), and satisfy requirements for waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HH W) Collection site? ❑ YES See CUPA for required forms. F. LOCAL REQUIREMENTS 1 �Jl is (You may also be required to pravid addi oral infbrrnalion by your CUPA or local agency ) UPCF Rev. (12/2007) FORM S — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME (Same as FACL UTY NAME. or DBA- Doing Business As) BUSINESS PHONE SAN LUIS SOURDOUGH 18055447687 BUSINESS SITE ADDRESS 3877 LONG ST CITY ZIP CODE SAN LUIS OBISPO CA 93401 COUNTY San Luis i PHONE �EU�MC 911"I'll06 i r. II. BUSINESS OWNER OWNER NAME BIMBO BAKERIES USA, INC OWNER MAILING ADDRESS CITY STATE ZIP CODE SAN LUIS OBISPO CA 93401 III. ENVIRONMENTAL CONTACT CONTACT NAME Dwayne Brown CONTACT MAILING ADDRESS 3877 Long Street CITY STATE ZIP CODE San Luis Obispo CA 93401 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NAME Dwayne Brown Amy Marks TITLE TITLE Engineering Manager QFS Manager BUSINESS PHONE BUSINESS PHONE 8055447687 18055447687 PAGER # / CELL PHONE # PAGER # / CELL PHONE # ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE NAME OF DOCUMENT PREPARER Submitted via Public Portal 03/13/2017 Dwayne Brown NAME OF SIGNER (print) TITLE OF SIGNER Dwayne Brown Engineering Manager FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY auc mwe rr• material Der buildin r or area ❑ADD [:]DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) SAN LUIS SOURDOUGH CHEMICAL LOCATION Throughout facility CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES NO FACILITY ID # MAP# GRID# (Agency use only) O II. CHEMICAL INFORMATION CHEMICAL NAME sulfuric acid TRADE SECRET ❑ Yes No If Subject to EPCRA, refer to instructions COMMON NAME battery acid EHS* ❑Yes ❑ No CAS# *IPEHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Corrosive (CORR) HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ❑. b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID 0 b. LIQUID ❑ c GAS LARGEST CONTAINER 107.0 (Check one item only) FED HAZARD CATEGORIES ❑ (Check all that apply) a, FIRE ®b. REACTIVE ❑ c. PRESSURE RELEASE d. ACUTE HEALTH ❑ e, CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 107.0 163.0 UNITS* Qi a. GALLONS O b. CUBIC FEET ❑ a POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j, BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN I{ r, OTHER ❑ d. STEEL DRUM ❑ It. SILO [] 1. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE M a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE El a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 40.0 sulfuric acid ❑ Yes ® No 2 60.0 water ❑ Yes ®No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No ❑ Yes ❑ No 5 If more hazardous components are present at greater than t% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sin Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per bit ildin M or:uros ❑ADD []DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) SAN LU IS SOURDOUGH CHEMICAL LOCATION Production area CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # MAP# GRID# (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME K— I be TRADE SECRET ❑ Yes ❑ No u If Subject to EPCRA, refer to instructions COMMON NAME Food grade mineral oil EHS* ❑Yes ❑ No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete i£required by CUPA) Combustible Liquid, Class III-B HAZARDOUS MATERIAL TYPE 0 a PURE ❑ b. MIXTURE ❑ c, WASTE RADIOACTIVE ❑Yes []No CURIES (Check one item only) PHYSICAL STATE LARGEST CONTAINER ❑ a. SOLID 0 b. LIQUID ❑ c. GAS o (Check one item only) . FED HAZARD CATEGORIES 0 a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ❑ e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 275.0 1 550.0 UNITS* @) a GALLONS 0 b. CUBIC FEET ❑ c, POUNDS ❑ d. TONS DAYS ON SITE: ^ 6 ^ 0 (Check one item only) *If EHS, amount must be in pounds. �{vh . STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTICINONMETALLIC DRUM ❑ i, FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k, BOX M o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE M a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE Q a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 ❑ Yes ® No 2 ❑ Yes ® No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sign Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one Page trr material per buildin or wren) []ADD ❑DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) SAN LU IS SOURDOUGH CHEMICAL LOCATION Washroom CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # MAP# GRID# (Agency use only) O1 II. CHEMICAL INFORMATION CHEMICAL NAME AFCO5316 Power Foam HD TRADE SECRET ❑ Yes No If Subject to EPCRA, refer to instructions COMMON NAME Power Foam EHS* ❑Yes ❑ No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Corrosive (CORR) HAZARDOUS MATERIAL TYPE MIXTURE ❑ c. WASTE ❑ a. PURE M b. M RADIOACTIVE ❑Yes No ❑ CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID b. LIQUID ❑ c, GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES ❑ [I❑ (Check all that apply) a. FIRE b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 55.0 1 110.0 UNITS* @ a. GALLONS 0 b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE 0 a. ABOVE GROUND TANK Ia e, PLASTIC/NONMETALLIC DRUM El i. FIBER DRUM 0 m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ F. CAN ❑ j. BAG © n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g, CARBOY (3 k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE M a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 30.0 sodium hydroxide ❑ Yes ® No z 70.0 water ❑ Yes ® No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than t % by weight if non -carcinogenic, or O.t % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sin Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY nne smac per nntterial per building, or area) ❑ADD []DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) SAN LU IS SOURDOUGH CHEMICAL LOCATION Washroom CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES NO FACILITY ID # MAP# GRID# (Agency use only) 0 II. CHEMICAL INFORMATION CHEMICAL NAME A F C O 5212 Scrubber magic TRADE SECRET ❑Yes ❑ No If Subject to EPCRA, refer to instructions COMMONNAME Scrubber magic EHS* ❑Yes []No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Corrosive (CORR) HAZARDOUS MATERIAL TYPE (Check one item only) a. PURE M b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE ❑ a SOL1D b. LIQUID 0 c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES a_ FIRE ❑ b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH (Check all that apply) ❑ ❑ ii{ ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 55.0 110.0 UNITS* a. GALLONS Q b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE ❑ a. ABOVE GROUND TANK 0 e. PLASTICINONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p, TANK WAGON STORAGE PRESSURE W a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMB[ENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT [3 d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 15.0 Quarternary ammonium compounds ❑ Yes ® No z 5.0 ethyl alcohol ❑ Yes ® No 3 80.0 water ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0. t % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sign Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building orare:t ❑ADD ❑DELETE EIREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) SAN LU IS SOURDOUGH CHEMICAL LOCATION Washroom CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # MAP# O1 GRID# (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME A F C O 524 9 S c r u b b i e TRADE SECRET Yes No [f Subject to EPCRA, refer to instructions COMMON NAME Scrubbie EHS* ❑Yes []No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Corrosive (CORR) HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a, PURE 0 b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID b. LIQUID 0 c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES (Check all that apply) ❑ a, FIRE ❑ b REACTIVE ❑ c, PRESSURE RELEASE d. ACUTE HEALTH ❑ e, CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 55.0 1 110.0 UNITS* @ a. GALLONS O b. CUBIC FEET ❑ c_ POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE 0 a. ABOVE GROUND TANK M e, PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM El m, GLASS BOTTLE CONTAINER © b, UNDERGROUND TANK ❑ F. CAN ❑ j, BAG ❑ n, PLASTIC BOTTLE ❑ q, RAIL CAR © c, TANK INSIDE BUILDING ❑ g, CARBOY ❑ k, BOX ❑ o, TOTE BIN ❑ r, OTHER ❑ d, STEEL DRUM ❑ h. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE El a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 5.0 sodium hydroxide ❑ Yes ® No 2 95.0 water ❑ Yes ®No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No Ir more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight it carcinogenic, attach additional sheets of paper capturing the required inrormation. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sian Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (urge toga scr material per buildis: g or area) ❑ADD ❑DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) SAN LU IS SOURDOUGH CHEMICAL LOCATION Production area CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES [] NO FACILITY l(3 # MAP# O / II GRID# jAypncy ru4 eniyJ II. CHEMICAL INFORMATION CHEMICAL NAME Colony Sun Release Pan Oil TRADE SECRET Yes No If Subject to EPCRA, refer to instructions COMMON NAME Sunflower oil EHS* ❑Yes ❑ No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Combustible Liquid, Class III-13 HAZARDOUS MATERIAL TYPE (Check one item only) M a PURE ❑ b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes []No CURIES PHYSICAL STATE ❑ a. SOLID b. LIQUID ❑ c. GAS LARGEST CONTAINER 275.0 (Check one item only) FED HAZARD CATEGORIES (Check all that apply) NJa FIRE ❑ b. REACTIVE ❑ c PRESSURE RELEASE ❑ d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 275.0 1 550.0 UNITS* @ a. GALLONS 0 K CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE 0 a_ ABOVE GROUND TANK 0 e. PLASTIC/NONMETALLIC DRUM 0 i. FIBER DRUM 0 m. GLASS BOTTLE CONTAINER ❑ b, UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR © c, TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX 0 o. TOTE BIN ❑ r. OTHER ❑ d, STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE M a AMBIENT ❑ b. ABOVE AMBIENT ❑ c BELOW AMBIENT STORAGE TEMPERATURE M a_ AMBIENT ❑ b_ ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 ❑ Yes ® No 2 ❑ Yes ® No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION IfEPCRA Please Sin Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one poge permaterial perbuildin or area) ❑ADD ❑DELETE OREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) SAN LU IS SOURDOUGH CHEMICAL LOCATION Shop CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY 1D # MAP# GRID# (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME Tri Gas TRADE SECRET ❑ Yes No If Subject to EPCRA, refer to instructions COMMONNAME Welding Shielding gas EHS* ❑Yes ❑ No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete irrequired by CUPA) Compressed Gas (CGas) HAZARDOUS MATERIAL TYPE ❑ a. PURE M b. MIXTURE ❑ c. WASTE RADIOACTIVE [I Yes ❑ No CURIES (Check one item only) PHYSICAL STATE [I a. SOLID ❑ b. LIQUID c. GAS LARGEST CONTAINER 125.0 (Check one item only) FED HAZARD CATEGORIES ❑ a FIRE ❑ b. REACTIVE ®c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ❑ e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 500.0 1 580.0 UNITS* Q a. GALLONS Q b. CUBIC FEET ❑ C. POUNDS ❑ d. TONS DAYS ON SITE: ^ O (Check one item only) *If EHS, amount must be in pounds. b . STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTICINONMETALLIC DRUM ❑ i. FIBER DRUM 1] m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG ❑ n_ PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ li. SILO I{ 1. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑ a. AMBIENT b ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 7.5 Argon ❑ Yes ® No 2 2.5 Carbon Dioxide ❑ Yes ® No 3 90.0 Helium ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Si n Here FORM E SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EMERGENCY RESPONSE PLAN Or Hazardous Waste Contingency Plan Date: 03/03/2017 SECTION I -A: BUSINESS IDENTIFICATION DATA BUSINESS NAME SAN LUIS SOURDOUGH SITE ADDRESS CITY ZIP CODE 3877 LONG ST SAN LUIS OBISPO 93401 FACILITY UNIT TELEPHONE NUMBER BUSINESS MAILING ADDRESS CITY ZIP CODE lfyour business has a license or permit from any of thefollowing agencies, please indicate the document number. 1. Hazardous Materials 3. Air Pollution Control Underground Storage # District # 2. Hazardous Waste 4. Responding Fire Dept Generator # & Permit # Please provide the following information as it pertains to your business and its location. You are not required to notify these companies in the event of an em ergency. Thi s i nformation i s provi ded for y our reference and t o assi st ern ergency response personnel i n respondi ng t o a hazardous materials emergency at your facility. List the name and phone number of the utility company. Electrical Service PG&E Telephone # Gas Service The Gas Company Telephone # Sanitation Telephone # San Luis Garbage Water District Telephone # SLO City Utilities SECTION I-B: OWNER CERTIFICATION OF DATA (Certify either 1 or 2) 1. This is a JRNEW 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 remainder 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. PRINT NAME OF OWNER OR OPERATOR SIGNATURE — ' -- Bimbo Bakeries USA, Inc. Submitted via Portal 03/03/2017 DOCUMENTS PREPARED BY SIGNATURE DATE Dwayne Brown Submitted Via Portal 03/03/2017 1 SECTIF ,II: EMERGENCY RESPONSE PLANS / I PROCEDURES Note: Complete all sections ofthis Emergency Response Procedure below. Use ofterms 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 California Emergency Management Agency (CAL EMA) - (800) 852-7550. 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: NAME POSITION Chris Rawitzer Plant Manager Individual responsible for calling San Luis Obispo County Certified Unified Program Agency and CAL EMA: (Normally the Emergency Coordinator of your business). NAME POSITION Dwayne Brown Engineering Manager 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. NAME ADDRESS CITY PHONE Med Plus 283 Madonna Road San Luis Obispo 8055498880 NAME ADDRESS CITY PHONE Sierra Vista Regional Medic 1010 Murray Road San Luis Obispo 8055467600 C. List the Emergency Coordinator(s) at your facility: PRIMARY COORDINATOR'S NAME TITLE BUSINESS PHONE 24HRPHnuG PAGER# Dwayne Brown Engineering Manager 8055447687 ex SECONDARY COORDINATOR'S NAME TITLE BUSINESS PHONE 24 FIR PHONE PAGER # Amy Marks Quality Food Safety Mal 8055447687 ex. D. Does your business have an on -site emergency response team? Oyes I)No Describe procedures your business will follow in the event of a release or threatened release of hazardous materials. E. If you have acutely hazardous meter above threshold planning quantities, list (by ae and address) adjacent neighboring businesses and residences, schools, hospitals, etc. Include sensitive facilities (schools, hospitals and rest homes) within 1,000 feet (straight-line distance from your property line). List telephone numbers for all businesses; for apartment buildings, list manager's phone. Do not list telephone numbers for private residences. F. Briefly describe your standard operating procedures in the event of a release or threatened release of hazardous materials. Emergency response procedures must comply with all federal, state and local regulations. Existing emergency response procedures may be referenced and attached to this document. 1. Prevention -- Describe the accident potentials associated with the hazardous materials present at your facility. What actions would your business take to reduce accident potentials? Include description of safety, storage, and containment procedures. Any release (spill) or threatened release of a hazardous material of sufficient quantity that might escape the premises and impact the environment or the community will be immediately reported to SLO county Environmental Health at (805) 781-5544, to the State Office of Emergency Services at (800) 852-7550 and to the local fire agency by calling 911. 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 Sprinklers Fire Suppression Throughout facility Annual inspection; 5 year inspection Fire Extinguishers Fire Suppression Throughout facility Monthly checks; annual inspection and recharge Spill Kit Oil/Chemical Spills Shop, production roll up door Monthly inspection First Aid Kit First aid Office area Monthly inspection 3. Evacuation -- Describe how you will immediately evacuate your facility. Where are the designated meeting locations? What communications or alarms are used? How will you operate these during powT-7 failure? If a large release of hazardous materials occurs, management will take immediate action to have all employees and customers leave the facility and meet at our designated location for roll call. All employees will be accounted for at the corner of Long Street and Hind Street. We have fire alarms, an intercom system and bullhorn to notify employees to evacuate the facility. 4. Shutdown -- Describe the procedures to shutdown the facility in case of an emergency. If accessible and with proper personal protective equipment, unplug forklift and/or scissor lift from charging station and make sure key is off. Personal protective equipment is acid resistant aprons, boots, rubber gloves and a face shield. Any spills of hazardous liquid would be prevented from entering the floor drains or storm drains utilizing spill response equipment. Shut down main electrical service located in main electrical room near office entrance. 5a. Response -- Describe what is done to lessen or mitigate the harm or damage done to person(s), property, or the environment, and to prevent the event from getting worse or spreading. What is your immediate response to: Fire: Dial 911. Evacuate if safe. Explosion: Dial 911. Evacuate if safe. Spill- Staff can handle spills. Earthquake: Shut off utilities and evacuate if safe. Major Power Failure: Notify PG&E and shut down main breaker. Flood: It sate, evacuate. b. Is this facility located on a 100-year flood plain? ®Yes SNo 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. Safety assessment the building. Evacuate if safe. Monitor or shut off utilities. Check forklift and scissor lifts to ensure they are in the upright position and check for chemical spills. 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. Follow cleanup procedures and notify necessary agencies. 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. P SIDS binder is located by the employee ume clocks at eh entry to the break room. , he business plan is kept in the engineering office located on the SW side of the facility. the Business Plan is saved electronically on a shared drive at the facility as well. 5 r UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of 1 I. FACILITY IDENTIFICATION FACILITY ID # 1 EPA ID # (Hazardous Waste Only) 2 CAL000350061 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) 3 Bimbo Bakeries USA, Inc. 3877 Long St, San Luis Obispo, CA 93401 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility... If Yes, please com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY (include liquids in ASTs and USTs); or the applicable Federal threshold — CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emer encv plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS.(USTs] UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? ❑ YES ® NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? ❑ YES ® NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? ❑ YES ® NO 7 UST TANK (closure portion —one page per tank) C. ABO'VE MDUND_PE_TROLEUM STORAGE 'TANKS (ASTO Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ❑ YES ® NO 8 NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? EYES ❑ NO 9 EPA ID NUMBER — provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? ❑ YES ONO 10 per recycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE [:]YES ® NO 11 TREATMENT — FACILITY (Formerly DTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for El YES ®NO 12 CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION ❑ YES ® NO 13 SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ❑ YES ® NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS 15 (You may also be required to provide additional information by your CUPA or local agency.) UPCF (1/99) FORM E SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EMERGENCY RESPONSE PLAN Or Hazardous Waste Contingency Plan (see instruction page vii) Date•8/26/14 SECTION I -A: BUSINESS IDENTIFICATION DATA Bimbo Bakeries USA, Inc. BUSINESS NAME 3877 Long St San Luis Obispo 93401 SITE ADDRESS CITY ZIP CODE 805-544-7687 FACILITY UNIT TELEPHONE NUMBER 3877 Long St San Luis Obispo 93401 BUSINESS MAILING ADDRESS CITY ZIP CODE If your business has a license or permit from any of the following agencies, please indicate the document number. 1. Hazardous Materials 3. Air Pollution Control Underground Storage # N/A District # 528-2 2. Hazardous Waste 4. Responding Fire Dept Generator # CAL000350061 & Pen -nit # SL002592 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 PG&E Telephone # 800-743-5000 Gas Service the Gas Company Telephone # a(q-427-2000 Sanitation Eco Solutions Telephone #&5-481-9111 Water District SLO City Utilities Department Telephone # $05-781-7215 SECTION I-B: OWNER CERTIFICATION OF DATA (Certify either 1 or 2) 1. This is a ❑NEW Plan ®UPDATED Existing Plan. I have personally examined the information it contains and am familiar with the operation of the plan. (If you check either of the above two options, continue to complete the remained of the Emergency Response / Contingency Plan). 2. ❑ This plan requires no change and is on file with San Luis Obispo County Hazardous Materials Unified Program Agency and does not need any change. (If you check this section, please proceed directly to Form T, the Training Program.) I certify under penalty of law that the above information is true and accurate. Joe Dangelmaier PRINT NAME OF OWNER OR OPERATOR SlG�l ' A11K. DATE Dwayne Brown DOCUMENTS PREPARED BY SIGNATURE DATE 5 Page Of M:\Environmental\SARA 2014\Revised 2014 FRM-E Long St.doc 09/25/14 1 SECTIOI\ EMERGENCY RESPONSE PLANS AND )CEDURES Note: Complete all sections of this Emergency Response Procedure below. Use of terms such as "N/A" (Not Applicable) will not be accepted. A. FIRE, SPILL OR RELEASE: The fire code requires immediate notification through dialing 911, by whoever first sights the incident. In the event of release or spill of hazardous materials, you must also notify: 1. San Luis Obispo County Hazardous Materials Unified Program Agency during business hours @ 805-781-5544. After business hours dial 911. 2. The State Office of Emergency Services - (800) 852-7550 or (916) 262-1621. List the individuals responsible for verifying that these calls have been made and also indicate their position in your company. FOR VERIFYING THE DIALING OF 911: Dwayne Brown Engineering Supervisor NAME POSITION Individual responsible for calling San Luis Obispo County Hazardous Materials Unified Program Agency and the State Office of Emergency Services: (Normally the Emergency Coordinator of your business.) Dwayne Brown Engineering Supervisor 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. Med Plus 877 Oak Park Blvd Pismo Beach 805-474-8450 NAME ADDRESS CITY PHONE Sierra Vista Regional Medical Center 1010 Murray Ave San Luis Obispo 805-546-7600 NAME ADDRESS CITY PHONE C. List the Emergency Coordinator(s) at your facility. Primary: Dwayne Brown Engineering Supervisor 805-544-7687 ext 114 NAME TITLE BUSINESS PHONE 24 HR PHONE PAGER # Secondary: Amy Marks QA Manager 805-544-7687 ext 130 NAME TITLE BUSINESS PHONE 24 HR PHONE PAGER # D. Does your business have an on -site emergency response team? ❑Yes ®No Describe procedures your business will follow in the event of a release or threatened release of hazardous materials. Any release (spill) or threatened release of a hazardous material of sufficient quantity that might escape the premises and impact the environment or the community will be immediately reported to SLO Co Environmental Health at (805) 781-5544, to the State Office of Emergency Services at (800) 852-7550 and to the local fire agency by calling 911. 6 Page Of M:\Environmental\SARA 2014\Revised 2014 FRM-E Long St.doc 09/25/14 E. If you have acutely hazardous materials above threshold planning quantities, list (by name and address) adjacent neighboring businesses and residences, schools, hospitals, etc. Include sensitive facilities (schools, hospitals and rest homes) within 1,000 feet (straight-line distance from your property line). List telephone numbers for all businesses; for apartment buildings, list manager's phone. Do not list telephone numbers for private residences. We have sulfuric acid in our lead/acid batteries. 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. Designated engineer responsible for monitoring and maintaining forklift and scissor lift batteries in the facility. Engineer is required to wear personal protective equipment and follow all safety procedures at all times while working in the battery compartments. Replacement batteries are not stored by the facility and an outside contractor would be called for major repair or battery replacement. Forklift and scissor lift driver training is conducted and only certified employees are authorized to operate this equipment. 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 Sprinklers Fire Suppression Throughout Facility Annual inspection; 5-year inspection Fire Extinguishers Fire Suppression Throughout Facility Monthly checks; annual inspection and recharge Spill Kit Oil/Chemical Spills Engineering shop, production roll up door Monthly inspection 3. Evacuation -- Describe how you will immediately evacuate your facility. What communications or alarms are used? How will you operate these during power failure? If a large release of hazardous materials occurs, management will take immediate action to have all employees and customers leave the facility and meet at our designated location for roll call. All employees will be accounted for at the corner of Long Street and Hind Street. We have fire alarms, an intercom system and a bullhorn to notify employees to evacuate the facility. In the event of power failure, the bullhorn will be used to evacuate employees from the facility, Page Of MAEnvironmental\SARA 2014\Revised 2014 FRM-E Long St.doc 09/25/14 4. Shutdown -- Describe the shutdown for each site or facility. If accessible and with proper personal protective equipment, unplug forklift and/or scissor lift from charging station and make sure key is off. Personal protective equipment would include acid resistant aprons, boots, rubber gloves and a face shield. 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: Control localized fires using hand-held chemical extinguishers and/or call 911, evacuate employees, shut off power to electrical equipment, exhaust and make-up fans and shut off the main natural gas valve. Explosion: Call 911 and evacuate employees to designated location for roll call. Spill: Stop and contain spill, isolate hazard area and deny entry. Neutralize battery acid spill with sodium bicarbonate. Dispose of contaminated materials in accordance with local, state and federal regulations. Contact 911, CUPA, SERC, OES if spill exceeds reporting limits or reaches the environment. Earthquake: Check forklift and sissorlift to ensure they are in upright position and that no battery acid has leaked. If leak (spill) is identified, follow spill clean-up procedures and notify necessary agencies. Major Power Failure: Unplug forklift and sissorlift from battery charging stations. Flood: Check the condition of the facility, forklift and scissor lift if accessible. Wait for flood waters to subside, contact outside contractor to assess/repair damage and report on extent of release. Report release amounts to CUPA, OES and local fire dept. b. Is this facility located on a 100-year flood plain? ❑Yes ®No c. Earthquake - Identify facility areas and list mechanical or other systems that require immediate inspection or isolation because of their vulnerability to earthquake related ground motion. Visual inspection of the forklift and scissor lift to insure equipment is upright and that no battery acid has leaked. 6. Clean -Up (Remove the Hazard) -- How do you handle the complete process of cleaning up, and disposing of related materials at your facility? Note: Notify the Hazardous Materials Unified Program Agency when clean up is complete. Stop release, if possible. Avoid contact with any spilled material. Contain spill, isolate hazard area, and deny entry. Limit site access to emergency responders. Neutralize with sodium bicarbonate. Place battery in suitable container for disposal. Dispose of contaminated material in accordance with applicable local, state and federal regulations. Sodium bicarbonate or other neutralizing agents should be kept on site for spill remediation. G. Location -- Your business is required to keep a copy of the Business Plan and related MSDS sheets on -site. Describe where this information is located. MSDS binder is located by the employee time clocks at the entry way to the break room. The Business Plan is kept in the engineering office located on the SW side of the building. Page Of M:\Environmental\SARA 2014\Revised 2014 FRM-E Long St.doc 09/25/14 UNIFIED PROGRAM CONSOLIDATED FORM F. HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one page per material per building or area ❑ADD ❑DELETE ®REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 Bimbo Bakeries USA, Inc. CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 3877 Long St, San Luis Obispo, CA 93401 ❑ YES ® NO 1 (optional) 203 GRID# (optional) 204 FACILITY ID # F]7API 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ❑ Yes 10 No 206 Sulfuric Acid If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* ® Yes El No Sulfuric Acid in Lead Acid Batteries CAS# 209 *If EHS is "Yes", all amounts below must be in lbs. 7664-93-9 1 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) Ela. PURE ® b. MIXTURE ❑ c. WASTE 211 213 RADIOACTIVE El Yes ® No 212 CURIES PHYSICAL STATE (Check one item only) ❑ a. SOLID ® b. LIQUID El c. GAS 21a 215 LARGEST CONTAINER 2916 ]b battery FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a. FIRE Z b. REACTIVE ❑ c. PRESSURE RELEASE ® d, ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 807.36 1 807.36 1 0 DAYS ON SITE: 222 UNITS* Ela. GALLONS ❑ b. CUBIC FEET ®c. POUNDS El d. d. TONS 365 Check one item only)" If EHS, amount must be in pounds. STORAGE CONTAINER ❑ a, ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i, FIBER DRUM ❑ m, GLASS BOTTLE ❑ q. RAIL CAR ❑ b, UNDERGROUND TANK ❑ f. CAN ❑ j_ BAG ❑ n, PLASTIC BOTTLE ® r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ I, CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a, AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 ❑ Yes ❑ No 228 229 2 230 231 235 ❑ Yes ❑ No 232 233 3 234 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components are present at greater than 1 % by weight irnon-carcinogenic, or 0.1 % by weight it carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here UPCF (1/99) 6 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one r material per building or arcs! ❑ADD ❑DELETE ®REVISE Page ___ or. I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) 3 Bimbo Bakeries USA, Inc. CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 3877 Long St, San Luis Obispo, CA 93401 ❑ YES M NO 1 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 D6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET 0 Yes 0 No 206 Lead If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* ❑ Yes ® No Lead CAS# 209 *If EHS is "Yes", all amounts below must be in lbs, 7439-92-1 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) M a, PURE ❑ b, MIXTURE ❑ c. WASTE RADIOACTIVE [:1Yes M No 212 213 CURIES PHYSICAL STATE 214 (Check one item only) M a. SOLID El29161b b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER battery FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a, FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ® e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 3114.6 1 3114.6 0 DAYS ON SITE: 222 UNITS• Ela. GALLONS Elb, CUBIC FEET M c. POUNDS El22l d. TONS 365 Check one item only)* If EHS amount must be inpounds- STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m, GLASS BOTTLE ❑ q. RAIL CAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE M r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE M a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE M a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 227 ❑ Yes ❑ No 228 229 2 230 231 ❑ Yes ❑ No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA, Please Sign Here UPCF (1/99) 6 OES Form 2731 2 3 4 5 6 7 8 9 10 11 12 13 14 San Luis Obispo Coui,.y Certified Unified Program Agency FORM M - MAP GRID (see instruction page v) Map # Long St A I B I C D E F G H I! J I K I L M N W DUSTRUIL PARK TELEDFAM TROVWe IRWSPA,PER ASRICUTU..l NEW 1 2 3 4 5 6 7 8 9 10 11 12 13 14 A B C D E F 1__ G I H - -� .�_ J I K I L ._._l.. M I N I 1 Sc_a_ I_e_ : 1 in ch = Feet Business Name: Bimbo Bakeries USA, Inc Date: 8/26/14 Address: 3877 Long St, San Luis Obispo, CA 93401 Number of Employees in Facility Depicted Above - Day = 80 Night = 5 4 Page Of MAEnvironmentahSARA 2014\Revised 2014 FRM-M Long St.doc 09/28/14 EPCRA Tier I/Tier II Reporting Obligations for Calendar Year 2014 Inventory for San Luis Sourdough, 3877 Long St, San Luis Obispo, CA 93401 Scissor lift 1 - Trojan T-105 battery, 4 batteries containing 3.87 lbs of sulfuric acid each = 15.48 lbs Scissor lift 2 - Trojan T-125 battery, 4 batteries containing 3.58 lbs of sulfuric acid each = 14.32 lbs Forklift - Model B491 battery, total battery weight of 2916 lbs at 9%* sulfuric acid = 262.44 lbs Floor Scrubber 1 Trojan L16H battery, 4 batteries containing 6.29 lbs of sulfuric acid each = 25.16 lbs Floor Scrubber 2 Trojan L16H battery, 3 batteries containing 6.291bs of sulfuric acid each = 25.16 lbs Cart Pusher 1 AC Delco Model M30HMFbattery, 3 batteries containing 8.93 lbs of sulfuric acid each = 26.79 Cart Pusher 2 AC Delco Model M30HMFbattery, 3 batteries containing 8.93 lbs of sulfuric acid each = 26.79 Cart Pusher 3 AC Delco Model M30HMFbattery, 3 batteries containing 8.93 lbs of sulfuric acid each = 26.79 Cart Pusher 4 AC Delco Model M30HMFbattery, 3 batteries containing 8.93 lbs of sulfuric acid each = 26.79 Stack Pusher Trojan model T-605 6 battery, 4 batteries containing 3.58 lbs of sulfuric acid each = 14.32 lbs. Total Sulfuric Acid inventory of 464.04 lbs Scissor lift 1- 49.6 lbs lead per battery X 4 batteries = 198.40 lbs Scissor lift 2- 52.8 lbs Lead X 4 batteries = 211.20 lbs Forklift - 2916 X 60% Lead = 1749.60 lbs Floor Scrubber - 96.8 lbs lead per battery X 4 batteries = 387.20lbs Cart Pusher 1- 29.75 lbs lead per battery X 3 batteries = 89.25lbs Cart Pusher 2 - 29.75 lbs lead per battery X 3 batteries = 89.25lbs Cart Pusher 3 - 29.75 lbs lead per battery X 3 batteries = 89.25lbs Cart Pusher 3 - 29.75 lbs lead per battery X 3 batteries = 89.25lbs Stack Pusher Trojan model T-605 6V battery, 4 batteries containing 52.8 lbs of lead each = 211.2 lbs. Total Lead inventory of 3114.6 IN SIC CODE = 2051 Bread & Other Bakery Products Facility only uses toxic chemicals in the form of articles and does not manufacture or process or use these chemicals other than in the article purchased in. Lead Acid Batteries are purchased in whole and are not altered in any way during use. Facility is exempt from EPRCA 312 Tier I/II reporting. Facility does not manufacture, process or use ammonia in any system. 2011 annual natural gas fuel consumption was 18.60 mm cf/yr. The threshold is 3.21 X 1010 cf. *Called forklift battery manufacturer (Enersys) to get sulfuric acid percentage of battery (model B491) on 4/27/07. Was told to take 30% of battery weight for electrolyte, and then to take 30% of electrolyte weight for sulfuric acid weight in battery, resulting in 9% battery weight. UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION FACILITY 1DN I BEGINNING DATE i°+ ENDING DATE tut I 2010/1/1 2010/12/31 BUSINESS NAME (Same as FACILITY NAMFor or DBA - Doing Business As) BUSINESS PHONE 1°'- San Luis SOUrdou h 805-544-7687 BUSINESS SITE ADDRESS 103 3877 LA)ng St CITY 104 ZIP CODE 105 CA San Luis Obispo 93401 DUN & BRADSTREET 106 SIC CODE (4 digit N) 107 00-906-2998(Sara Lee Bakery Grog) 2051 COUNTY 108 San Luis Obispo BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Chuck Linthicum 805-544-7687 ext 115 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 1tz Sara Lee OWNER MAILING ADDRESS 11j 3500 Lacey Road CITY 114 STATE 115 ZIP CODE t 16 Downers Grove 1 IL 1 60515 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT Its Amy Foley 1�v CONTACT MAILING ADDRESS 119 3877 Long St CITY 120 STATE 121 ZIP CODE 122 San Luis Obispo CA 93401 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 Amy Foley Dwayne Brown TITLE 124 TITLE 129 Compliance Supervisor Engineering Supervisor BUSINESS PHONE 125 BUSINESS PHONE 130 805-544-7687 ext 130 805-544-7697 4 24-HOUR ___----— 126 24-HOU 131 PAGER N I" PAGER N — 13-' ADDITIONAL LOCALLY COLLECTED INFORMATION. 133 Cenificaliun: Based on my inquiry of those individuals responsible For ohr<linin the information, I certify under penalty of law that I have Personally examined and am himill;u %ciil e i ft luon hmiued and hellc\c the 1nformauun is true, acc ualc. and nmpkl SIGNATURI R T)I'SIf-iNA-rFD REPRESENTATIVE DATE 3d NAME OF DOCUMENT PREPARER 135 Amy Fol w ��u:1x 511,�I-Ii ,,r..„. Chuck Linthicum M rrn I OF s1GNl_R Plant Manager "-' UI'CT ( 1 99 revised) 4 OES 1`01W 2730 (1,199) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEM ICAL DESCRIPTION pna a c W material per building or area) ❑ADD [—]DELETE ®REVISE 7200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business A s) 3 San Luis Sourdough CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 3877 Long St, San Luis Obispo, CA 93401 EPCRA ❑ YES ® NO 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ❑ Yes ® No 206 Sulfuric Acid If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* ® Yes ElNo Sulfuric Acid in Lead Acid Batteries CAS# 209 *If EHS is "Yes", all amounts below must be in lbs_ 7664-93-9 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) Ela. PURE Z b_ MIXTURE [I c. WASTE �11 RADIOACTIVE ❑Yes Z No T2.2CURIES 213 PHYSICAL STATE (Check one item only) ❑ a. SOLID Z b. LIQUID ❑ c. GAS 214 215 LARGEST CONTAINER FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a. FIRE ® b. REACTIVE ❑ c, PRESSURE RELEASE Z d. ACUTE HEALTH ❑ e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 2I' ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 317.40 317.40 0 1 221 DAYS ON SITE: 222 UNITS* ❑ a. GALLONS ❑ b. CUBIC FEET Z c. POUNDS ❑ d. TONS 365 1 Check one item only) * If EHS, amount must be in pounds. STORAGE CONTAINER ❑ a. ABOVE GROUND TANK Z e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAILCAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ i. BAG ❑ n. PLASTIC BOTTLE Z r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g, CARBOY ❑ k. BOX Z o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p, TANK WAGON 223 STORAGE PRESSURE Z a. AMBIENT ❑ b, ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE Z a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 227 ❑ Yes ❑ No 228 229 2 230 231 ❑ Yes ❑ No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components are present at greater than 1% by nvcight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here UPCF (1/99) 6 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEM ICAL DESCRIPTION (otte a c cr matcrtal par Wildit or nrca) ❑ADD ❑DELETE ®REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business A s) 3 San Luis Sourdough CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 3877 Long St, San Luis Obispo, CA 93401 EPCRA ❑ YES ® NO FACILITY ID # 1 MAP# (optional) 203 1 GRID# (optional) ® 204 CD II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes No 206 Lead If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* ElYes ® No Lead CAS# 209 *If EHS is "Yes", all amounts below must be in lbs. 7439-92-1 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ® a. PURE Elb. MIXTURE ❑ c. WASTE 211 RADIOACTIVE El Yes ®No 212 CURIES 213 PHYSICAL STATE 214 (Check one item only) ® a. SOLID Elb. LIQUID ❑ c. GAS LARGEST CONTAINER 29161b battery 215 FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑ d_ ACUTE HEALTH ® e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 2635.7 2635.7 1 1 0 221 DAYS ON SITE: 222 UNITS* ❑ a. GALLONS ❑ b. CUBIC FEET ® c. POUNDS ❑ d. TONS 1 365 Check one item only) * If EHS amount must be in pounds. STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAILCAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG [In. PLASTIC BOTTLE ®r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ® o. TOTE BIN ❑ d. STEEL DRUM Cl h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 227 ❑ Yes ❑ No 228 229 2 230 231 ❑ Yes ❑ No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components are present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA. Please Sign Here UPCF (1/99) 6 OES Form 2731 2 3 4 5 z a _J 7 6 f C, 7 8 9 10 11 12 13 14 San Luis Obispo Cou, Certified Unified Program Agency FORM M - MAP GRID (see instruction page v) Map # Long St A B C D EFF G f H I 1 J I K I L I M _F N EMPTY LOT TELEGRAM TRIBUNE NEWSPAPER II INDUSTRIAL PARK <0H c sT R AFT CMPTYLOT �I a E� .-- 0 AG ICUTURALFIELD w z CC J O z x A_J B I C LD E I F I G I H I I I J I K I L I M I N Scale- 1 inch = FPPt Business Name: San Luis Sourdough a Division of Sara Lee Bakery Group Date: 2/15/11 Address: 3877 Long St, San Luis Obispo, CA 93401 Number of Employees in Facility Depicted Above - Day = 65 Night = 5 1 `: 3 4 5 6 7 8 9 13 14 FORM V, SAN IJT' (MISN)C'OUNIY (TAT1111,.1) 11N11=ILD 1' NIFalGENCY FiESPONSF PLAN Or I hzlu-&Us �k astC Clorttittgcncy Phil (see insnuctiun pate vii) Date:2i 15/2011 SEC"TION I -A: BUSINESS IDENTIFICATION DATA San Luis 5ourdous)h it Divisllon of the Sara Lee Bakery Group ttt "NI ti.1., \Air 38'! 7 lung Si San Luis Obispo 93401 I i :A00I{1•SS I �0S-�'t4-7fa$7 t,4Cdr n r t it a.l i'nONb NUMIALK 3877 Long, tit � � � Sall I mis Ohispl) � 9.3401 01 MNFSS MAIL [Nki lilt �!{l-tip ! 1I N Ill, ODF I f Your f usinevs lim a ni%l 1 e Or 1mrati1 from arts' of Pile. allowing !Y('.•ewiev, pleme it" icau, the durament number. I t uardows Ml1ltmils .1. Ajf Pollution CUIIlrol Underground Stores 4 NIA l)islricl k �28-2 L R.�.stxtnding Fire Dept '. I Iz, G,:, 1'emlil N StI))2592 l'lertsc provide the fnllovvinit information as it pemains to your business ilrid its location. You are not rt.quired to notify these companies it) the event of an emergency. This information is provided for your reterenee and to assist emcrgency rerpon.se personnel in responding to a hazardous materials emergency at your facility. List the name and phone number of the utility company. 131ecl,ricStavii;cr 1'G�&f:�: •Telephone ll 800-743-5000 ()is servikc _�I1lt-.(ii15_ Util�]i11iY - Telephone tl 800427-1000 swliY3lior"P Fuo Solutions Water District SLO (.,ity Utilities Dcp"Mment Telephone A 8U,481�2 L "Telephone 4 805-781-7' 15 SECTION 1-11: OWNER OF DATA (Certify either I or 2) I. This is a C__]INEW flan �]U1'f)ATI;l7 [5xisfing Plan. 1 have personally examined the information it contains and ,.uir fitnliliar with the I)pOM11011 cat the p ill), dt' %OU check cuher of the above (wo alrtiown , continue lu cconlplete the, reim'Iutcd oi'the 1'111crgenev Response ('ontint�enc� Platt). �J l III Iilll,l r�•(joirc.s nu change itmt i,; im iile with Sant Ohisp(o County 1Iaiardous Millcuuls 1 :niliCkl Pro"dram <!gel-Ic" and flocs not need aliv chan}..',e. (If you check this section_ please proc.ccvl directly to Form T. the T aining Prol;ranl.) s ■ ceriliy under p('nally o kov that the above intormatk)n is Chuck I wihi(lirll UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page IofI I. FACILITY IDENTIFICATION FACILITY [D # I I I I = 1 I EPA ID # (Hazardous Waste Only) 2 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) 3 San Luis Sourdough 3877 Long St, San Luis Obispo, CA 93401 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility... If Yes, please coat fete these paEcs of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold EYES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency lan is required pursuant to 10 CFR Parts 30, 40 or 70? 13. LINDERGROUND STORAGE TANKS LIST UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? ❑ YES ® NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? ❑ YES ONO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? ❑ YES ® NO 7 UST TANK (closure portion —one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (AST . Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or [--]YES ® NO 8 NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? ❑ YES ® NO 9 EPA ID NUMBER — provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? ❑ YES ® NO 10 per recycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE ❑ YES ® NO 11 TREATMENT — FACILITY (Formerly DTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for []YES ®NO 12 CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION ❑ YES ® NO 13 SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as [:]YES ONO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIRE:ME?NTS 15 (You may also be required to provide additional information by your CUPA or local agency.) UPCF (1/99) J UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (one page per material tier buildimt at eras] ❑ADD []DELETE ®REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 San Luis Sourdough CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 3877 Long St, San Luis Obis o, CA 93401 ❑ YES ® NO FACILITY ID # 1 MAP# (optional) 203 GRID# (optional) 204 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ❑ Yes ®No 206 Lead If Subject to EPCR A, RA, refer to instructions COMMON NAME 207 208 Lead EHS* ❑ Yes ® No CAS# 209 7439-92-1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 213 TYPE (Check one item only) ®a. PURE Elb. MIXTURE ❑ c. WASTE 211 RADIOACTIVE El Yes ® No 212 CURIES PHYSICAL STATE 215 (Check one item only) ®a. SOLID ❑ b. LIQUID ❑ c. GAS 214 LARGEST CONTAINER 141.56 lb battery FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ® e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 213 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 2546.4 1 2546.4 1 0 1 UNITS* ❑ a. GALLONS El b. b. CUBIC FEET ®c. POUNDS ❑ d. TONS DAYS ON SITE: 222 Cheek one llem aul * If EHS, amount must be in pounds. 365 STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m, GLASS BOTTLE ❑ q. RAIL CAR ❑ b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG [In. PLASTIC BOTTLE ®r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX Z o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE Z a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 227 ❑ Yes ❑ No 228 229 2 230 231 ❑ Yes ❑ No 232 ❑ Yes ❑ No 236 233 237 3 234 235 4 233 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 n ntat a 11-1aan3 —11Punetns are Presets at greater umn . io uy wetgnt a non -carcinogenic, or o.t 70 oy wergnt a carcinogenic, attach additional sheets at paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA, Please Sign Here UPCF (1/99) 6 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION lonelmgc permatcrinl rmrbuild ins or tuna ❑ADD ❑DELETE ®REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 San Luis Sourdough CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 3877 Long St, San Luis Obispo, CA 93401 ❑ YES E NO FACILITY ID # 1 1 1 1 1 1 1 MAP# (optional) 203 1 GRID# (optional) 204 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET 0 Yes E No 206 Sulfuric Acid If Subject to EPCRA, refer to instructions COMMON NAME 207 208 Sulfuric Acid in Lead Acid Batteries EHS* ® Yes ElNo CAS# 209 7664-93-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 213 TYPE (Check one item only) ❑ a. PURE E b. MIXTURE ❑ c. WASTE 211 RADIOACTIVE ❑ Yes E No 212 CURIES PHYSICAL STATE 215 (Check one item only) ❑ a. SOLID E b. LIQUID ❑ c. GAS 214 LARGEST CONTAINER 2916 lb battery FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a, FIRE E b. REACTIVE ❑ c. PRESSURE RELEASE E d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 317.40 1 317.40 1 0 1 UNITS* DAYS ON SITE: Ela. GALLONS Elb. CUBIC FEET E c. POUNDS El d. d. TONS 222 Check ojw item only)• If EHS, amount must be in pounds. 365 STORAGE CONTAINER [Ia. ABOVE GROUND TANK E e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE ❑ q. RAIL CAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG [In. PLASTIC BOTTLE E r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX E o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ I. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE E a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE E a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 227 ❑ Yes [I No 228 229 2 230 231 ❑ Yes ❑ NO 232 233 3 234 235 ❑ Yes ❑ NO 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 ,,,..,.r,........ — t,..—..... . �, — ...,... , — ..r was........,..-c„.cu.vgcmc, 11 uy we.gnr r, carunugemc, Htt—] aumuunai sneers of paper capturing the regmrea mtormauon. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UPCF (1/99) 6 OES Form 2731 San Luis Obispo County, -0'grtified Unified Program Agency FORM M - MAP GRID (see instruction page v) Map# Long St A I B I C D T—ET—F T G T-H -F-,-F-j-FK FL—F—m7N TLLEGRM6 rRICIONI NLWSPAPC; EMPTY L OT 11 3 4 3 EMPTY Lar 5 1 L F= IL 6 6 LII - . 7 7 8 8 F1 ';0 9 9 fA ZZI, 10 10 12 12 INDUSTRIAL PARK AGRICUTURAL FIELD 13 13 14 14 A B f C l D E IF G H i J K L M N Scale: I inch= Feet Business Name: San Luis Sourdough a Division of Sara Lee Bakery Group 1/5/09 Address: 3877 Long St, San Luis Obispo, CA 93401 Number of Employees in Facility Depicted Above - Day = 60 Night = 4 4 NI:Tnvironmentaksara 2008\Rev is ed 2008 FRM-M Long St 0101,""'%"? D-"" f EPCRA Tier I/Tier II Reporting Obligations for Calendar Year 2008 Inventory for San Luis Sourdough, 3877 Long St, San Luis Obispo, CA 93401 Sissorlift 1 - Trojan T-105 battery, 4 batteries containing 3.87 lbs of sulfuric acid each = 15.48 lbs Sissorlift 2 - Trojan T-125 battery, 4 batteries containing 3.58 lbs of sulfuric acid each = 14.32 lbs Forklift — Model B491 battery, total battery weight of 2916 lbs at 9%* sulfuric acid = 262.44 lbs Floor Scrubber Trojan L16H battery, 4 batteries containing 6.29 lbs of sulfuric acid each = 25.16 lbs Total Sulfuric Acid inventory of 317.41bs Sissorlift 1- 49.6 lbs lead per battery X 4 batteries = 198.40 lbs Sissorlift 2- 52.8 lbs Lead X 4 batteries = 211.20 lbs Forklift — 2916 X 60% Lead = 1749.601bs Floor Scrubber — 96.8 lbs lead per battery X 4 batteries = 387.20 Total Lead inventory of 2546.4 lbs SIC CODE = 2051 Bread & Other Bakery Products Facility only uses toxic chemicals in the form of articles and does not manufacture or process or use these chemicals other than in the article purchased in. Lead Acid Batteries are purchased in whole and are not altered in any way during use. Facility is exempt from EPRCA 313 Form R reporting. Facility does not manufacture, process or use ammonia in any system. 2007 annual natural gas fuel consumption was 15.09 mm cf/yr. The threshold is 3.21 X 1010 cf. *Called forklift battery manufacturer (Enersys) to get sulfuric acid percentage of battery (model B491) on 4/27/07. Was told to take 30% of battery weight for electrolyte, and then to take 30% of electrolyte weight for sulfuric acid weight in battery, resulting in 9% battery weight. D UNIFIED PROGRAM CONSOLIDATED FORM E: #ACI LITY INFORMAT N BUSINESS ACTIVITIES MAR 1 7 2006 Page 1 of 1 I. FACILITY IDENTIFICATION ENVIRPAI FACILITY ID # t 1 EPA ID TdJuadefgNTAt nn 3 n 2006 3 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) MAR 1111ii 1 1l San Luis Sourdough — Long St Facility % g U� t S�' , I,�(� 0 IL ACTIVITIES DECLARATION I c+v C �"o NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility... If Yes, lease com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases EYES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY (include liquids in ASTs and USTs); or the applicable Federal threshold —CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emer,gency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs ] UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? ❑ YES ® NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? ❑ YES ONO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? ❑ YES ® NO 7 UST TANK (closure portion —one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS ASTs Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ❑ YES ® NO 8 NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? []YES ONO 9 EPA ID NUMBER — provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? ❑ YES ®NO 10 per recycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE ❑ YES ® NO 11 TREATMENT — FACILITY (Formerly DTSC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) (Formerly DTSC Forms 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for [:]YES ®NO 12 CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization). ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION [:]YES ®NO 13 SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ❑ YES ® NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) F. LOCAI. RE UIREMENTS 15 (You may also be required to provide additional information by your CUPA or local agency.) UPCF (1 /99) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (one vmt per malerlal buildins nr area ❑ADD ❑DELETE ®REVISE 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business A s) 3 San Luis Sourdough CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 3877 Long St, San Luis Obispo, CA 93401 EPCRA 1 ❑ YES 0 NO 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes ® No 206 Sulfuric Acid If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* ® Yes ElNo Sulfuric Acid in Lead Acid Batteries CAS# 209 *If EHS is "Yes", all amounts below must be in lbs. 7664-93-9 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) Ela. PURE ® b. MIXTURE ❑ c WASTE 211 RADIOACTIVE El Yes ®No 212 213 CURIES PHYSICAL STATE (Check one item only) El a. SOLID ® b. LIQUID El c. GAS 214 215 LARGEST CONTAINER 141.56 lb battery FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a. FIRE E b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e_ CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 497.88 1 497.88 1 0 ON SITE: 222 UNITS" ❑ a. GALLONS ❑ b. CUBIC FEET ® c, POUNDS [-Id.DAYS d. TONS 365 (Check one item only) " If EHS, amount must be in pounds, STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ no. GLASS BOTTLE ❑ q. RAILCAR ❑ b_ UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n_ PLASTIC BOTTLE ® r. OTHER ❑ c, TANK INSIDE BUILDING ❑ g, CARBOY ❑ k, BOX ® o, TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1, CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # i 226 227 ❑ Yes ❑ No 228 229 2 230 231 ❑ Yes ❑ No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components are present at greater than 1% by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here UPCF (1/99) 6 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION tune)agc Per material pirr buildin or array ❑ADD ❑DELETE ®REVISE 200 Page _ of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business A s) 3 San Luis Sourdough CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 3877 - A Long St, San Luis Obispo, CA 93401 EPCRA ❑ YES ® NO 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET El Yes 0 No 206 Lead If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* El ® No Lead 1 CAS# 209 *If EHS is "Yes", all amounts below must be in lbs. 7439-92-1 1 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ® a. PURE ❑ b. MIXTURE ❑ c. WASTE 211 RADIOACTIVE El Yes ®No 212 213 CURIES PHYSICAL STATE 214 (Check one item only) ® a. SOLID ❑ b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER 141.56 lb battery FED HAZARD CATEGORIES 216 (Check all that apply) ❑ a. FIRE ❑ b, REACTIVE ❑ c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ® e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 1860 1860 0 221 DAYS ON SITE; 222 UNITS* ❑ a, GALLONS ❑ b, CUBIC FEET ® c. POUNDS ❑ d, TONS 365 (Check one item onlyl If EHS amount must be in pounds. STORAGE CONTAINER [-]a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m, GLASS BOTTLE ❑ q, RAILCAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j, BAG [--In. PLASTIC BOTTLE ® r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ® o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 227 ❑ Yes ❑ No 228 229 2 230 231 ❑ Yes ❑ No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 It more hazardous components are present at greater than 10/c by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets or paper capturing the required inrormation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here UPCF (1/99) 6 OES Form 2731