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HomeMy WebLinkAboutPRR23223 Cavanaugh - 1850 1800 Calle JoaquinWerizon Wireless Hwy 101 Los Osos Valley Road L800 Calle Joaquin Fian Luis Obispo, CA 93405 submittal Status 4iubmitted on 6/9/2020 by Samantha Marie pellerin of Verizon Wireless [Northern California] (Folsom, CA) �;ubmittal was Accepted; Processed on 6/15/2020 by Kerry Boyle for San Luis Obispo County Environmental Health dentificatfon erizon Wireless Beginning Date Ending Date perator Phone Business Phone Business Fax 866) 694-2415 (866) 694-2415 (916) 357-2508 Dun & Bradstreet SIC Code 884638305 4812 Facility/Site Mailing Address rlmary Emergency Contact Z95 Parkshore Drive 4etwork Operations Control Center =olsom, CA 95630 Itle OCC usiness Phone 24-Hoer 06-- 800)264-6620 3wner Secondary Emergency Contact ✓erizon Wireless Network Operations Control Center 866) 694-2415 Title t95 Parkshore Drive NOCC =olsom, CA 95630 Business Phone 24•Hour Phone 800) 264-6620 CERS ID 10143617 Primary NAICS 517212 Pager Number Pager Number 3illing Contact nVironmental Contact :nvironmental Compliance nvironmentai Compliance 866) 694-2415 Armand.Delgado@VerizonWireless.Com 866) 694-2415 Armand. Delgado @VerizonWireless.Com �95 Parkshore Drive 95 Parkshore Drive =olsom, CA 95630 alsom, CA 95630 Name of Signer Signer Title Document Preparer rmand delgado environmental compliance mgr Steve Skanderson j Additional Information )Locally -collected Fields dome or all of the following fields may be required by your local regulator(s). Assessor Parcel Number (AR Number of Employees 0 Facility ID Printed on 6/15/2020 11:48 AM 2 o o_ Z 0 u N� O w � Y � C _ l0 > 3 C 0 O. 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'X GJ Y GJ y Y Gl m 'K ii VO_ O c S to 2 0 2 GJ O S 0 2 i U L U i i d'e �i Oi C U; �e a` 3 a 3€ T C S 01 alb a 1O a E v E 0 oi¢ Hi¢ J C u 0�0 s N Li d Ln `m ko g C rn o V) d m c � i O M N uJN O N o 0 N C w O 7 V 7 a)Y Mm a X M 7 VI J HT' O c d 10 > ` JA o N O O J�rJ N 01 C 0 CL L 0O m 0 GJ m O '° E Z J m 'u m vNi vFAi `^ ° Q rn 0 4! a► c E m Z i a u° J 8 � 33o o v C C m MV N N V � ` L O > W cu 00 V rl N u z 0 = ^ v m o a N L z E U a Z a m u °° o r a 72 pF p a 00 a --I 0 N O N Ln l\O c O -v aJ c a Ir JFIED PROGRAM CONSOLIDATED F(C I Q FACILITY INFORMATION BUSINESS ACTIVITIES %' Pale I of I. FACILITY IDENTIFICATION FACILITY ID # I EPA ID # (Hazardous Waste Only) 2 (Agency Use Only) IFIA1010J018J710121 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) S R NT N E TE 45X O9 a BUSINESS SITE. ADDRESS 1800 CALL Q Q IN loa BUSINESS SITE CITY SAN LUIS OBISPO 104 I CA ZIP CODE 934 551os II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page. Does your facility... I If Yes, please complete these Daces 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 emergeny plan is required pursuant to 10 CFR Parts 3.O 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 Own or operate ASTs above these thresholds: Store greater than 1,320 gallons of petroleum products (new or used) in ❑ YES NO FORM REQUIRED TO CUPAs aboveground tanks or containers. 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 subject to financial assurance requirements (for Permit by Rule and TREATMENT —UNIT (one page per unit) 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 2s hazardous waste and cleaned on -site? ❑ YES HAZARDOUS WASTE TANK CLOSURE CERTIFICATION —+ JM3QtL ,rr piry alAJZ; k; cn,c,tun, I[L01RII u,vvv xulograms txg) te,Luv 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 (HHW) Collection site? ❑ YES See CUPA for required forms. F. LOCAL REQUIREMENTS 15 (You may also be required to provide additional information 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 FACILITY NAME or DBA— Doing Business As) SPRINT/NEXTEL (SN45XC092) 19252792300 BUSINESS PHONE BUSINESS SITE ADDRESS 1800 CALLE JOAQUIN CITY SAN LUIS OBISPO CA ZIP CODE 93405 COUNTY San Luis Obispo BUSINESS OPERATOR NAME BUSINESS OPERATOR PHONE II. BUSINESS OWNER OWNER NAME SPRINT/NEXTEL COMMUNICATIONS OWNER PHONE OWNER MAILING ADDRESS PO BOX 7994 CITY SHAWNEE MISSION STATE IKS ZIP CODE 166207 III. ENVIRONMENTAL CONTACT CONTACT NAME CONTACT PHONE CONTACT MAILING ADDRESS CITY STATE ZIP CODE -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NAME TITLE TITLE BUSINESS PHONE BUSINESS PHONE 24-HOUR PHONE 24-HOUR PHONE 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 Submitted via Public Portal DATE NAME OF DOCUMENT PREPARER NAME OF SIGNER (print) TITLE OF SIGNER Environmental He 'Services D- 6k ,a1r• (805) 781-5544 city ol- san luis owspo actth `r.P.O.Box 1489 FIRE DEPARTMENT++s2160 Santa Barbara Avenue' San Luis Obispo, CA 93401-5240' (805) 781-7380IL 7156 Sierra WaySte. B "Cotirtes y & Service" San Luis Obispo, CA 93406 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 08/10/2022 Time: Facility Name: Verizon Wireless Hwy 101 Los Osos Agency Inspection Tyne Valley Road ❑EHS ORoutine Site Address: 1800 Calle Joaquin ❑x CITY FIRE ❑Reinspection San Luis Obispo, CA 93405 ❑Chargeable Reinspection ❑Change of Ownership Phone: (866)694-2415 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0006923 CERS ID: 10143617 ❑Chargeable Secondary Containment Testinc Serial Number: DADOUNVYI PROGRAMS INSPECTED: IgHazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. YES NQ N/A VIOL. # BUSINESS PLAN ❑x ❑ ❑ BP01 Business plan complete, current, available during inspection and submitted electronically (HSC 25505, 25508(a)(1); 19 CCR 2651) ❑x ❑ ❑ BP02 Inventory of hazardous materials is complete and submitted electronically (HSC 25505(a)(1), 25506, 25508(a)(1), 19 CCR 2652, 2654) x❑ ❑ ❑ BP03 Site layout/ facility maps are accurate and submitted electronically (HSC 25505(a)(2), 25508(a)(1), 19 CCR 2652) TRAINING PLAN 0 ❑ ❑ TR01 Facility has appropriate training program, submitted electronically (HSC 25505(a)(4), 25508(a)(1), 19CCR 2659, 22CCR66265.16) ❑ ❑ ❑x TR02 Training documentation is maintained on site for current personnel (HSC 25505(a)(4), 22CCR66265.16) EMERGENCY RESPONSE PLAN 0 ❑ ❑ ER01 Emergency response/contingency plan complete, current, submitted electronically, maintained onsite (HSC 25505(a)(3), 25508(a)(1), 19CCR 2658, 22CCR 66265.52-.54) ❑ ❑ ❑x ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c)(2)] GENERAL EH VIOLATIONS ❑ ❑ ❑x FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 0.0000000000 GPS Coordinates: Longtitude: 0.0000000000 INSPECTOR: MATHESON BLISS FACILITY REP: Unstaffed Facility SUMMARY OF OBSERVATIONSVIOLATIONS ❑p No violations of undergrOL \storage tank, hazardous materials, or hazar( ') waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform th CUPA in writing ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: Verizon Wireless Hwy 101 Los Osos Valley ADDRESS: 1800 Calle Joaquin Road San Luis Obispo, CA 93405 VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED INSPECTION COMMENTS: INSPECTED BY: MATHESON BLISS DATE: 08/10/2022 NAME OF FACILITY REP: Unstaffed Facility SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: Environmental Health vices COUNTY8Q5) 7�1&544 � o city of san Luis omspo ° ` •° ; P.O.BoJC 1489 ; { FIRE DEPARTMENT • ' • 2-1-66Sierra way Ste. B 2160 Santa Barbara Avenue' San Luis Obispo, CA 93401-5240 • (805) 781-7380 San Luis Obiwo CA 93406 "Courtesy & Service" I" CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 11 /24/2021 Time: Facility Name: Verizon Wireless Hwy 101 Los Osos Agency Inspection Tyne Valley Road ❑EHS [@Routine Site Address: 1800 Calle Joaquin ❑X CITY FIRE ❑Reinspection San Luis Obispo, CA 93405 ❑Chargeable Reinspection ❑Change of Ownership Phone: (866)694-2415 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0006923 ❑Chargeable Secondary Containment Serial Number: DAB40ZNGE Testing PROGRAMS INSPECTED: OHazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. YES NO N/A VIOL. # BUSINESS PLAN ❑x ❑ ❑ BP01 Business plan complete, current, available during inspection and submitted electronically (HSC 25505, 25508(a) (1); 19 CCR 2651) IN ❑ ❑ BP02 Inventory of hazardous materials is complete and submitted electronically (HSC 25505(a)(1), 25506, 25508(a)(1), 19 CCR 2652, 2654) 0 ❑ ❑ BP03 Site layout/ facility maps are accurate and submitted electronically (HSC 25505(a)(2), 25508(a)(1), 19 CCR 2652) TRAINING PLAN ❑x ❑ ❑ TR01 Facility has appropriate training program, submitted electronically (HSC 25505(a)(4), 25508(a)(1), 19CCR 2659, 22CCR66265.16) ❑ ❑ 1@ TR02 Training documentation is maintained on site for current personnel (HSC 25505(a)(4), 22CCR66265.16) EMERGENCY RESPONSE PLAN ❑x ❑ ❑ ER01 Emergency response/contingency plan complete, current, submitted electronically, maintained onsite (HSC 25505(a)(3), 25508(a)(1), 19CCR 2658, 22CCR 66265.52-.54) ❑ ❑ 1] ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c) (2)l GENERAL EH VIOLATIONS ❑x ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 0.0000000000 GPS Coordinates: Longtitude: 0.0000000000 INSPECTOR: MATHESON BLISS FACILITY REP: Unstaffed Facilitv SUMMA�Y OF OBSERVATIONSVIOLATIONS p No violations of underground : age tank, hazardous materials, or hazardoi aste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: Verizon Wireless Hwy 101 Los Osos Valley ADDRESS: 1800 Calle Joaquin Road San Luis Obispo, CA 93405 VIOLATIONS VIOL, NO CORRECTIVE ACTION REQUIRED INSPECTION COMMENTS: Items marked N/A not reviewed during inspection. INSPECTED BY: MATHESON BLISS DATE: 1 V24/2021 NAME OF FACILITY REP: Unstaffed Facilitv SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: Environmental Health dices ��j�;•,, • P.O.Box 1489(805) 781-5544 � ��,. city �� San Luis �B�S�iO ' ' i'• FIRE DEPARTMENT • ' • 2156 Sierra Way Ste. B 2160 Santa Barbara Avenue' San Luis Obispo, CA 93401-5240' (805) 781-7380fi7S'}p. San Luis Obispo. CA 93406 "Courtesy & Service" }?Y CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 11 /14/2019 Time: Facility Name: Verizon Wireless Hwy 101 Los Osos Agency Inspection Type Vallev Road ❑EHS IFIRoutine Site Address: 1800 Calle Joaquin OCITY FIRE ❑Reinspection San Luis Obispo, CA 93405 ❑Chargeable Reinspection ❑Change of Ownership Phone: (866)694-2415 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0006923 ❑Chargeable Secondary Containment Serial Number: DAQSATDST Testing PROGRAMS INSPECTED: gHazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): Name: Senior Cell Tech. Title: YES NO N/A VIOL. # BUSINESS PLAN x❑ ❑ ❑ BP01 Business plan complete, current, available during inspection and submitted electronically (HSC 25505, 25508(a) (1); 19 CCR 2651) ❑x ❑ ❑ BP02 Inventory of hazardous materials is complete and submitted electronically (HSC 25505(a)(1), 25506, 25508(a)(1), 19 CCR 2652, 2654) ❑x ❑ ❑ BP03 Site layout/ facility maps are accurate and submitted electronically (HSC 25505(a)(2), 25508(a)(1), 19 CCR 2652) TRAINING PLAN ❑x ❑ ❑ TR01 Facility has appropriate training program, submitted electronically (HSC 25505(a)(4), 25508(a)(1), 19CCR 2659, 22CCR66265.16) 17 ❑ ❑ TR02 Training documentation is maintained on site for current personnel (HSC 25505(a)(4), 22CCR66265.16) EMERGENCY RESPONSE PLAN ❑x ❑ ❑ ER01 Emergency response/contingency plan complete, current, submitted electronically, maintained onsite (HSC 25505(a)(3), 25508(a)(1), 19CCR 2658, 22CCR 66265.52-.54) ❑x ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c) (2)l GEN EH—VL01AI1QN5 19 ❑ ❑ FE01 .EAI_ Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 0.0000000000 GPS Coordinates: Longtitude: 0.0000000000 INSPECTOR: KERRY BOYLE FACILITY REP: Senior Cell Tech. SUMMARY OF OBSERVATIONSVIOLATIONS x❑ No violations of underground,. .ge tank, hazardous materials, or hazardou iste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observedldiscovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: Verizon Wireless Hwy 101 Los Osos Valley ADDRESS: 1800 Calle Joaquin Road San Luis Obispo, CA 93405 VIOLATIONS VIOL. NO CORRECTIVE .ACTION REQUIRED INSPECTION COMMENTS: HMBP has been updated and submitted for CY 2019. INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Senior Cell Tech. DATE: 1V14/2019 SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: County of San Luis Obispo C;Ity of 1r � Environmental Health Services L� ]� Lr n �+ : � r'� (805) 781-5544 �7i�i a S V ISPO �ti P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data r HAZARDOUS MATERIALS INSPECTION FORM entry,by: Date: FACILITY NAME: AGENCY INSPECTION TYPE i7 F❑ EHS P Routine ❑ Reinspection ❑ AG DEPT ❑ Complaint ❑ Other ADDR S: / ❑ CITY FIRE Result Code: 7080 _90 PHOISE Action Code: _32 _37 _33 _31 PROGRAMS INSPECTED: Y`f Business Plan ❑ HW Generator ❑ UST ❑ AGT I ❑CALARP REINSPECTION REQUIRED: ❑ NO ❑ YES T Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP PERMISSION TO INSPECT: inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YE NO COS N/A k f ❑ ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) G ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TRO1 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) O[� ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN �,� ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) Q❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ` ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ ❑ ATO1 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ 'n AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) CW71 M NTS Po to hht`tp'://www.slopub[ichealtli.org/cnyironinentailt Itihazardous niaterials.lnnz, to obtain forms to comply with BPO1-BP03, TRO1 and ER01 7 � � j GPS Coordinates: Latitude: deg min decimal min Longitude: deg _min decimal min INSPECTOR: FACILITY REP: Environmental Health atryia§ _ f�a;��J ,o•. city of san Luis osispo � f8051781-5544 Q. Box 1489 r rDEPART P• a FIRE MENT a 2156 Sierra ,•yy y %g, B 2160 Santa Barbara Avenue' San Luis Obispo, CA 93401-5240 4 (005) 781-7350 "Courtes & Service" San. Luis flbisoo. CA 93406 y CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 12/13/2018 Time: Facility Name: Verizon Wireless Hwy 101 Los Osos Agency Inspection Tyne Vallev Road ❑EHS ZRoutine Site Address: 1800 Calle Joaquin OCITY FIRE ❑Reinspection❑Chargeable San Luis Obispo, CA 93405 Reinspection ❑Change of Ownership Phone: (866)694-2415 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0006923 ❑Chargeable Secondary Containment Serial Number: DARICIGUP Testing PROGRAMS INSPECTED: OHazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): Name: Larry Hatchett Title: Sr. Cell Tech. YES NO N/A VIOL. # BUSINESS PLAN 0 ❑ ❑ BP01 Business plan complete, current, available during inspection and submitted electronically (HSC 25505, 25508(a) (1); 19 CCR 2651) ❑x ❑ ❑ BP02 Inventory of hazardous materials is complete and submitted electronically (HSC 25505(a)(1), 25506, 25508(a)(1), 19 CCR 2652, 2664) ❑x ❑ ❑ BP03 Site layout/ facility maps are accurate and submitted electronically (HSC 25505(a)(2), 25508(a)(1), 19 CCR 2652) TRAINING PLAN 19 ❑ ❑ TR01 Facility has appropriate training program, submitted electronically (HSC 25505(a)(4), 25508(a)(1), 19CCR 2659, 22CCR66265.16) ❑x ❑ ❑ TR02 Training documentation is maintained on site for current personnel (HSC 25505(a)(4), 22CCR66265.16) EMERGENCY RESPONSE PLAN ❑x ❑ ❑ ER01 Emergency response/contingency plan complete, current, submitted electronically, maintained onsite (HSC 25505(a)(3), 25508(a)(1), 19CCR 2658, 22CCR 66265.52-.54) ❑x ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c) (2)l GENERAL EH VIOLATIONS ❑x ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 0.0000000000 GPS Coordinates: Longtitude: 0.0000000000 INSPECTOR: KERRY BOYLE FACILITY REP: Larry Hatchett SUMMARY OF OBSERVATIONSVIOLATIONS p No violations of underground s age tank, hazardous materials, or hazardou, aste lawslregulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: Verizon Wireless Hwy 101 Los Osos Valley ADDRESS: 1800 Calle Joaquin Road San Luis Obispo, CA 93405 VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED INSPECTION COMMENTS: HMBP has been updated electronically for CY 2018. No violations noted. INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Larry Hatchett DATE: 12113/2018 SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: -�;:aY1 County of San Luis Obispo CA C�� rr Environmental Health Services �* San Wis ompo �r �r� ;• (805) 781-5544 P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data Date: HAZARDOUS MATERIALS INSPECTION FORM entry by: /%�;�y' Times• 4 r FACILITY NAME: jjgAf AGENCY INSPECTION TYPE ❑ EHS ❑ Routine ❑ Reinspection ADDRESS: e ❑ AG DEPT ❑ Complaint El Other ❑ CITY FIRE ' < ,- - Result Code: 70 80 _90 ?Z� N, �� Action Code: 32 37 33 31 PHONE: — — — PROGRAMS INSPECTED: , Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: �XNO ❑ YES Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP PERMISSION TP INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and idetermining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN VFS NO COS N/A ❑ ❑ ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) 1,E] ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729 , TRAINING PLAN ❑ ❑ ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ ' TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ n ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of V— C— hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ 1,0 AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http:Ihvwqv"slopublichcahhiiviroiimenTUiealllilliaaardotis_materials.htm, to obtain farm to cop p1 with BPO1-BP03, TRO1 and EROI iki r Julle +' .j GPS Coordinates: Latitude: __deg min decimal min Longitude: . deg _min decimal min INSPECTOR: L 1 d4414 k //,2 FACILITY REP: r YLUIS I n iro_pmentatHeallh QerntiCes (805) 781-5544 P.O. Box 1489 2156 Sierra Way Ste. B San Lyik Obi5po, CA 93406 city of san tins osispo _ , FIRE DEPARTMENT d 2160 Santa Barbara Avenue' San Luis Obispo, CA 93401-5240' (805) 781-7380 �tfL'i• "Courtesy & Service" CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 12/14/2017 Time: Facility Name: Verizon Wireless Hwy 101 Los Osos Agency Inspection Type Valley Road ❑EHS ZRoutine Site Address: 1800 Calle Joaquin ❑x CITY FIRE ❑Reinspection❑Chargeable San Luis Obispo, CA 93405 Reinspection ❑Change of Ownership Phone: (866)694-2415 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0006923 ❑Chargeable Secondary Containment Testirn Serial Number: DA7CDDC9T PROGRAMS INSPECTED: OHazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. YES NO N/A BUSINESS PLAN ❑x ❑ ❑ BP01 Business plan is complete, current, available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑x ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑x ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑x ❑ ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) 0 ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66265.16 EMERGENCY RESPONSE PLAN ❑x ❑ ❑ ER01 Emergency response/contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑x ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 273% 22 CCR 66265.31-.37, 40CFR 1 265.31) 9 ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. (CRS-CB2WX.-6-, 4(f'C 1'12:$Ze](2}�. GENERAL EH VIOLATIONS ❑x ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 0.0000000000 GPS Coordinates: Longtitude: 0.0000000000 INSPECTOR: KERRY BOYLE FACILITY REP: Larry Hatchett SUMMARY OF OBSERVATIONSMOL 4TIONS ❑O No violations of underg, �d storage tank, hazardous materials, or ha ;ous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with ail the laws and regulations applicable to yoi facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writina. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing w certification that compliance has been achieved. A false statement that compliance has been achieved is a violatior of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: Verizon Wireless Hwy 101 Los Osos Valley ADDRESS: 1800 Calle Joaquin Road San Luis Obispo, CA 93405 VIQLAJIONS VIOL. NO COR9F.QJIYE ACTION REQUIRED INSPECTION COMMENTS: HMBP has been updated and suubmitted electronically via CERS database INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Larry Hatchett DATE: 12/14/2017 SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: AO County of San Luis Obispo Oty O� ?~ c Environmental Health Services �l �' `� L+s �J n� (805) 781-5544 A i J P.O. Box 1489 r! 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data 1 HAZARDOUS MATERIALS INSPECTION FORM entry by: Date: Time. FACILITY NAME: r/ ;/ AGENCY ❑ EHS ❑ AG DEPT CITY FIRE INSPECTION TYPE Routine ❑ Complaint Result Code: _70 Action Code: _32 ❑ Reinspection ❑ Other _80 _90 _37 _33 _31 AD RE . PHONE: V'1v PROGRAMS INSPECTED: Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED:FP/NO ❑ YES 'Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP (PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YE5 NO COS N/A Z ❑ ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) P ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑/ ❑ ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) n ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR P— 66265.16) EMERGENCY RESPONSE PLAN ❑ U ❑ EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of ,E] hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ f J AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ Y AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to httpJ/%vcvw,slopublichealtli.orgleiivironmemalhea�lioiazaf-dotis materials.htm, to obtain forms to comply,with BP01-BP03, TRO1 and ERO1 GPS Coordinates: Latitude: deg min decimal min Longitude: deg _min decimal min INSPECTOR: FACILITY REP: /j Date: 09/01 /2016 Environmental Hea.,,.,. $ervi (805) 781-5544 P,O.Sox 1489 2156 Sierra Way Ste- B ui bi5 0 cmyuf fon US OB1SPO Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis ObiSno CA 93401r62 0. CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Time: Facility Name: Verizon Wireless Hwy 101 Los Osos Agency Inspection Type ❑EHS ORoutine Vpilgy Road pCITY FIRE ❑Reinspection Site Address: 1800 Calle Joaquin ❑Chargeable Reinspection San Luis Obispo, CA 93405 []Change of Ownership Phone: (866)694-2415 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0006923 ❑Chargeable Secondary Containment Testirn Serial Number: DAYCKQIGQ PROGRAMS INSPECTED: 91-lazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: I ❑Hazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): Name: Larry Hattchet Title: Site Technician YES NO N/A BUSINESS PLAN ❑x ❑ ❑ BP01 Business plan is complete, current, available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑x ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑x ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN * ❑ ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) * ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66265.16 EMERGENCY RESPONSE PLAN 0 ❑ ❑ ER01 Emergency response/contingency plan is complete, updated, and maintained on site (HSC 26504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) 0 ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 273% 22 CCR 66265.31-.37, 66267.34 (d)(2), 40CFR 1 265.31) ❑x ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. —ICRS=270.4.6'; 40-CFR-I''I MC)('2)1 gaENERAL EH VIOLATIONS 19 ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 0.0000000000 GPS Coordinates: Longtitude: 0.0000000000 INSPECTOR: KERRY BOYLE FACILITY REP: Larry Hattchet SUMMA.Y OF OSSERVATIONS/V101-4TIONS ❑x No violations of underg, id storage tank, hazardous materials, or ha Ydous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to yoi facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writina. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing w certification that compliance has been achieved. A false statement that compliance has been achieved is a violatior of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: Verizon Wireless Hwy 101 Los Osos Valley ADDRESS: 1800 Calle Joaquin Road San Luis Obispo, CA 93405 VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED INSPECTION COMMENTS: Hazardous Materials Business Plan is current and has been submitted recently via CERS electronic data base. No changes to chemical inventory or emergency contact staff. Facility in good order and no violations noted during facility inspection. INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Larry Hattchet DATE: 09/01/2016 SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of OwnerlOperator: Title: Date: =x• County of San Luis Obispo City O� �' Environmental Health Services �+ (805) 781-5544 � US OBI SPO 111111111126 P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data HAZARDOUS MATERIALS INSPECTION FORM entry by: DatgV 11 ' Time:.r>' Ali FACILITY NAME:14AML11 AGENCY ❑ EHS ❑ AG DEPT ❑ CITY FIRE I PECTION TYPE kE Routine ❑ Complaint Result Code: _70 Action Code: _32 ❑ Reinspection. ❑ Other��� _80 _90 _37 _33 _31 ADDRESS: // '10A% ) Ph'i;iNE: j PROGRAMS INSPECTED: Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO ❑ YES] Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP ]PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO COS N/A ❑ ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) 47]❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ,❑ ❑ ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ��" ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ 0 ATOI SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ y❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to Ikillp://www.siol)ublieheakili.c)rglpnvimnmentaihealllilbazardaus_materials.htm, to 01kim forms to comply with BPO1-BPO3, TROI and EROI OF rr ✓ 1 , / • E f J GPS Coordinates: Latitude: `_deg min decimal min Longitude: deg _min decimal min INSPECTOR: FACILITY REP: SPRINT/NEXTEL (SN45XCO92) (CERSID: 10436713) f,Y/;/) M01 Facility Information Not Applicable Apr 18, 2016 Submitted on 2/24/2016 7:47:41 AM by Andrea Salazar of Sprint United Management Co. (Overland Par KS) Submittal was Not Applicable on 4/18/2016 12:13:49 PM by Kerry Boyle • Business Activities • Business Owner/Operator Identification Hazardous Materials Inventory Not Applicable Apr 18, 2016 Submitted on 2/24/2016 7:47:41 AM by Andrea Salazar of Sprint United Management Co. (Overland Park, KS) Submittal was Not Applicable on 4/18/2016 12:13:49 PM by Kerry Boyle • Hazardous Material Inventory (1) • Site Map (Official Use Only) Annotated Site Map (Official Use Only) (Adobe PDF, 118KB) Emergency Response and Training Plans Not Applicable Apr 18, 2016 Submitted on 2/24/2016 7:47:41 AM by Andrea Salazar of Sprint United Management Co. (Overland Park, KS) Submittal was Not Applicable on 4/18/2016 12:13:50 PM by Kerry Boyle • Emergency Response/Contingency Plan Emergency Response and Employee Training Plan (Adobe PDF, 228KB) • Employee Training Plan Emergency Response and Employee Training Plan (Adobe PDF, 228KB) Printed on 4/18/2016 12:13 PM Identification JNT/NEXTEL(SN45XC092) I CALLE JOAQU IN LUIS OBISPO, CA 93405 Luis Obispo submittal Status submitted on 2/24/2016 by Andrea Salazar of Sprint United Management Co. (Overland Park, KS) submittal was Not Applicable; Processed on 4/18/2016 by Kerry Boyle for San Luis Obispo County Environmental Health CERSID 10436713 EPA ID Number fazardous 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 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 1 or S; or handle radiological materials in quantities for which an emergency plan IS required pursuant to 10 CFR Parts 30, 40 or 70? Jnderground Storage Tank(s) (UST) )oes your facility own or operate underground storage tanks? NO Hazardous Waste s your facility a Hazardous Waste Generator? No Does your facility treat hazardous waste on -site? NO Is 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 rore 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 Toes 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. oes your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental NO ditional Information additional comments provided. Printed on 4/18/2016 12:13 PM California Environmental Reporting System (CERS) Business Owner Operator �acility/Site SPRINT/NEXTEL(SN45XC092) 11800 CALLE JOAQU IN lSAN LUIS OBISPO, CA 93405 Status CERS ID 10436713 bmitted on 2/24/2016 by Andrea Salazar of Sprint United Management Co. (Overland Park, KS) bmittaI was Not Applicable; Processed on 4/18/2016 by Kerry Boyle for San Luis Obispo County Environmental Health Identification ;print )perator Phone Business Phone 3773474457011 87734744570PT4 Beginning Date Ending Date Business Fax (913) 523-2040 Dun & Bradstreet SIC Code Primary NAICS 006942395 4812 517210 Facility/Site Mailing Address Primary Emergency Contact P.O. Box 7994 HS Help Line Shawnee Mission, KS 66207 Itle HS Help Line usiness Phone 24-Hour Phone Pager Number 7734-144S7opt4 +Dwner Sprint ,37734744570pt4 130 BOX 7994 SHAWNEE MISSION, KS 66207 !Billing Contact Sprint Environmental, Health and Safety 3773474457opt4 ehscompliance@sprint.com PO BOX 7994 SHAWNEE MISSION, KS 66207 4[game of Signer >ete Wang tdditionalInformation condary Emergency . uuvto�% ETWORK MANAGEMENT CENTER itfe ETWORK ENGINEER usiness Phone 24-Hour Phone Pager Number 64005040OPT8 nvironmental Contact HS Territory Manager 7734744570pt4 ehscompliance@sprint.com . O. Box 7994 hawnee Mission, KS 66207 Signer Title Sprint West EHS Territory Manager ,Locally -collected Fields Some or all of the following fields may be required by your local regulator(s). Property Owner hone ailing Address Printed on 4/18/2016 12:13 PM Assessor Pai Number of E Facility ID 42008701 Document Preparer Pete Wang easiness/Org. Sprint United Management Co. Hazardous. Wastes InventoryReport Chemical Location CERS ID 10436713 oe ty Name SPRINT/NEXTEL (SN45XC092) Battery Cabinet Facility ID 42008701 1800 CALLE JOAQUIN, SAN LUIS OBISPO 93405 Sutua Suhmltied on 20*2015 7:47 AM Annual Hazardous Components Quantities Waste Federal Hazard For mixture and DGT Cod$/Flre Haz. Class Common Name Unit Max. Daki larpelt Cent Avg. Daily Amount Cat.g.des Comyanwit Name % Wt EHS CAS No. Lead Acid Batteries (Electrolyte) Gallons 12.96 2.16 12.96 - Fire CAS No State Storage Container p_ressue Waste Code - Reactive )ther Health Hazard, Carcinogen — Liquid Other Ambient 181 - Pressure TypeRelease Mixture Mixture Days on Site: 365 AmbienTempmt Wn5lent Acute Health - Chronic health Printed on 4/18/2016 12:13 PM Page 1 of 1 California Environmental Reporting System (CERS) Business Activities Site Identification SPRINT/NEXTEL (SN45XC092) CERS ID 1800 CALLE JOAQUIN 10436713 SAN LUIS OBISPO, CA 93405 EPA ID Number County San Luis Obispo Submittal Status Submitted on 11/4/2014 by Pete Wang of Sprint United Management Co. (Overland Park, KS) Submittal was Accepted; Processed on 11/24/2014 by Kerry Boyle for San Luis Obispo County Environmental Health Hazardous 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 :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 1 or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? Jnderground Storage Tank(s)(UST) )oes your facility own or operate underground storage tanks? No Hazardous Waste Is your facility a Hazardous Waste Generator? No )oes 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 more 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 boveground tanks or containers. oes your facility have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental No ,kdditional Information Vo additional comments provided. Y Printed on 11/24/2014 8:57 AM SPRINT/NEXTEL (SN45XC092) (CERSID: 10436713) Submitted on 11/4/2014 3:57:10 PM by Pete Wang of Sprint United Management Co. (Overland Park, KS) Submittal was Accepted on 11/24/2014 8:57:36 AM by Kerry Boyle • Business Activities • Business Owner/Operator Identification Printed on 11/24/2014 8:57 AM pFacility/Site SPRINT/NEXTEL (SN45XC092) CERS ID 13 L800 CALLE JOAQUIN ;AN LUIS OBISPO, CA 93405 ubmittal Status uhmitted on 11/4/2014 by Pete Wong of Sprint United Management Co. (Overland Park, KS) ubmittal was Accepted; Processed on 11/24/2014 by Kerry Boyle for San Luis Obispo County Environmental Health Identification Sprint Beginning Date Ending Date 3peratorPhone Business Phone Business Fax 1/1/2014 1/1/2015 37734744570pt4 8773474457OPT4 (913) 523-2040 Dun & Bradstreet SIC Code Primary NAICS 006942395 4812 517210 Facility/Site Mailing Address rlmary Emergency Contact P.O. Box 7994 HS Help Line Shawnee Mission, KS 66207 itic HS Help Line uslness Phone 1 -u-r ohnne Pager Number 7734744570pt4 Dwner econdary Emergency Contact Sprint 4ETWORK MANAGEMENT CENTER 37734744570pt4 Itis PO BOX 7994 4ETWORK ENGINEER SHAWNEE MISSION, KS 66207 usiness Phone 24-Hour Phone Pager Number 664006040OPT8 Billing Contact rivironmental Conta— Sprint Environmental, Health and Safety HS Territory Manager 3773474457opt4 ehscompliance@sprint.com 37734744570pt4 ehscompliance@sprint.com '0 BOX 7994 1. 0. Box 7994 -HAWNEE MISSION, KS 66207 hawnee Mission, KS 66207 of Signer Wang ional Information Signer Title Document Preparer Sprint West EHS Territory Manager Pete Wang Ily-collected Fields or all of the following fields may be required by your local regulator(s). Owner Address Assessor Parcel Number (APN) Number of Employees Facility ID 42008701 Printed on 11/24/2014 8:57 AM UNIDOCS FACILITY INFORMATION BUSINESS ACTIVITIES PAGE Page 1 of I. FACILITY IDENTIFICATION FACILITY ID # 1• EPA ID # (Hazardous Waste Only) 2 (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3 Sprint Cell Site SN45XCO92 BUSINESS SITE ADDRESS 1800 Calle Joaquin 103 BUSINESS SITE CITY San Luis Obispo 104. CA ZIP CODE 93405 105_ 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 complete these pagges of the UPCF... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable ®YES ❑ NO a. HAZARDOUS MATERIALS INVENTORY — Federal threshold quantity for an extremely hazardous substance specified in CHEMICAL DESCRIPTION 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. REGULATED SUBSTANCES Have Regulated Substances stored onsite in quantities greater than the ❑ YES ® NO aa. Coordinate with your local agency responsible for threshold quantities established by the California Accidental Release CaIARP. Prevention Program (CalARP)? C. UNDERGROUND STORAGE TANKS (USTs) UST OPERATING PERMIT APPLICATION — Own or operate underground storage tanks? ❑ YES ® NO s. FACILITY INFORMATION UST OPERATING PERMIT APPLICATION — TANK INFORMATION D. ABOVE GROUND PETROLEUM STORAGE Own or operate ASTs above these thresholds: DYES ®NO s. No form required to CUPAs Store greater than 1,320 gallons of petroleum products (new or used) in aboveground tanks or containers? E. HAZARDOUS WASTE Generate hazardous waste? ❑ YES ® NO 9. EPA ID NUMBER — provide at top of this page Recycle more than 100 kg/month of excluded or exempted recyclable ❑ YES ® NO to. RECYCLABLE MATERIALS REPORT materials (per HSC §25143.2)? (one per recycler) Treat hazardous waste onsite? [-]YES ® NO 11. ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION — FACILITY PAGE ONSITE HAZARDOUS WASTE TREATMENT NOTIFICATION —UNIT PAGE (one page per unit) Perform treatment subject to financial assurance requirements (for Permit by ❑ YES ® NO 11 CERTIFICATION OF FINANCIAL ASSURANCE Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? ❑ YES ® NO l3. REMOTE WASTE CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as hazardous ❑ YES ® NO ia. HAZARDOUS WASTE TANK CLOSURE waste and cleaned onsite? CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 ❑ YES ® NO laa. Obtain federal EPA ID Number, file Biennial pounds) or more of federal RCRA hazardous waste, or generate in Report (EPA Form 8700-13A/B), and satisfy any single calendar month, or accumulate at any time, 1 kg (2.2 requirements for RCRA Large Quantity Generator. pounds) of RCRA acute hazardous waste; of generate or accumulate at any time more then 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste? Serve as a Household Hazardous Waste HHW) Collection site? ❑ YES ® NO lab, See CUPA for required forms. F. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) 15 FORM S — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION FACILITY ID# I BEGINNING DATE 100 ENDING DATE 101 3/3/2010 1 3/3/2013 BUSINESS NAME (Same as FACILITY NAM: or DBA — Doing Business As) BUSINESS PHONE 102 Sprint Cell Site SN45XCO92 $77 347- 4457 0ot.4 BUSINESS SITE ADDRESS 1111 1800 Calle Joaquin CITY too ZIP CODE 105 San Luis Obispo CA 93405 DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 00-694-2395 4812 COUNTY 108 San Luis Obispo BUSINESS OPERATOR NAME 419 BUSINESS OPERATOR PHONE 1111 Sprint United Management Co. $ 7 347- 4457 O t.4 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 11-1 Sprint United Management Co. $77 347- 4457 O i.4 OWNER MAILIN(: ADDRESS 113 PO BOX 7994 CITY 114 STATE 115 ZIP CODE 116 Shawnee Mission I KS 66207 1 III. ENVIRONMENTAL CONTACT CONTACT NAME t17 CONTACT PHONE 118 California EHS Specialist 877 347- 4457 O t.4 CONTACT MAILING ADDRESS 1 9 PO BOX 7994 CITY 120 STATE 721 ZIP CODE 122 Shawnee Mission KS 66207 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY. NAME 1=3 NAME 129 Network Mana emen Center E r rrtal Health & Safety He# line TITLE 17.1 TITLE 12R Network En ineer Environmental Health & Safety Helipline BUSINESS PHONE 130 BUSINESS PHONE 125 866 400-6040 Opt. 221 1 or 2 877 347- 4457 126 24-HOUR PHONE 131 ....,,,.. ,r 'CL- , rnV1VC 1F 127 E # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION. 147 Certification: Based on my inquiry of those individuals responsible for obtaining the information. I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 3-3-2010 1 Pete Wan NAME OF SIGNER (prim) 136 TITLE OF SIGNER 137 Pete Wang EHS Specialist II C:1Doaunents and Settings11bj630606\My Docoments`JIMBP\County CUPAs\San Luis Obispo COunlyU-IBMP March 2010\Business Activities and Owner\San Luis Obispo Business Owner Forn1,DOC 3-Mar 10 FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY tone we per nlaterial per building or area) ❑ADD []DELETE ❑REVISE 200 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 Cell Site SN45XCO92 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 ❑ YES ® NO 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY Ill # II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes ® No 206 Lead Acid Batteries If Subject to EPCRA, refer to instructions COMMON NAME 207 208 LEAD ACID BATTERY EHS* ❑ Yes ❑ No CAS# 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 Other health hazard material Class 2 water -reactive corrosive HAZARDOUS MATERIAL TYPE 211 (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE 212 RADIOACTIVE ❑ Yes ® No 213 CURIES PHYSICAL STATE 214 (Check one item only) ® a. SOLID ❑ b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER 100 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 220 600 600 1 N/A 1 N/A UNITS* ❑ a. GALLONS ❑ b. CUBIC FEET ® c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 (Check one item only) *If EHS, amount must be in pounds. 1 365 STORAGE a. ABOVE GROUND TANK e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE 223 CONTAINER ❑ b. UNDERGROUND TANK ❑ f CAN © j. BAG ❑ n. PLASTIC BOTTLE ® r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ q. RAILCAR ❑ d. STEEL DRUM ❑ II. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a AMBIENT ❑ It. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 226 227 229 229 1 75% Lead ❑ Yes ® No 7439-92-1 230 231 232 233 2 24% Sulfuric Acid [I Yes El No 7664-93-9 234 235 236 237 3 ❑ Yes ❑ No 238 239 240 241 4 ❑ Yes ❑ No '2•Ix 243 2.w 24s 5 ❑ Yes ❑ No If more hazardous rontpmcltis are present at greater ataa 1 % by xright it uon•rarrbtogeoir, or 0.1 % by weight if[an9ntrgenie, nllarls addflirnud %hems or poper raploring the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA, Please Sign Here