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HomeMy WebLinkAboutFile 1city or san,: ul, OBISPO FIRE DEPARTMENT 2160 Santa Barbara Avenue * San Luis Obispo, CA 93401-5240 * 805/781-7380 "Courtesy & Service" HAZARDOUS MATERIALS BUSINESS PLAN UPDATE FORM YEAR 2003 FACILITY NAME:ECONO LUBE N' TUNE #107 ADDRESS: 286 HIGUERA STREET, SAN LUIS OBISPO, CA 93401 - 4215 CONTACT PERSON:. D011 �Mi CI1tt�P�So►� TELEPHONE: Annual Inventory Update (due each year) ® No significant changes in inventory have occurred since the last Business Plan or inventory was submitted. ❑ New inventory forms are attached, ❑ Replace previous inventory with attached inventory. ❑ Replace only designated pages of inventory. Additional Comments: Yearly Review and Recertification ® I certify that the Business Plan has been reviewed and the information contained in the Business Plan is accurate and complete as of this date. Other Updates ❑ Please incorporate the following information into the Business Plan for this facility: I declare, under penalt of perjury, that the information provided herein is true and correct to the best f y knowledge. f Signature: -i d D ate: AV Printed Name:, ( )cm f n t is o t3o -- Please Return to: Molly Brown, Hazardous Materials Section City Fire Department 2160 Santa Barbara Avenue San Luis Obispo, CA 93401-5240 H;/BUSINESS PLAN UPDATE FORM MOLLY ❑The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecommunications Device for the Deaf (805) 781-7410. 19 Site Visit Packet Permit No 60-0034 Facility Number: Facility Information Operator: JIM WILMORE Facility Name: ECONO LUBE AND TUNE Address Number: 286 Address: HIGUERA ST Suite: City: SAN LUIS OBISPO Zip: 93401- CrossStreet: HIGH ST Parcel No: 002-482-024 Phone No: (805) 544-2976 Facility Type: Corporation Property Owner Name: Address: City: State: Zip: Phone: Underground Storage Tank Property Owner Name: ECONO LUBE AND TUNE Phone: 8055442976 Mailing/Street Address 286 HIGUERA ST City: SAN LUIS OBISPO State CA Zip: 93401 Owner Type: Status: Permit Expiration Date: 2/13/02 Mailing Address Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: JIM WILMORE City: SAN LUIS OBISPO State: CA Zip: 93401- Phone: (805) 544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Current Balance: $194.00 Emergency Contacts Primary Days Last Name First Name Title 0 0 WILMORE JIM MANAGER/OWNER 0 WILMORE PATRICIA WIFE OF OWNER Business 24 Hr Phone Phone Pager (805) 544-2976 )) 000-0000 (805) 544-2976 Hazardous Materials Business Plan - List of Chemicals Permit Noy 66-0034 j Facility: ECONO LUBE AND TUNE ��ddress: 286 HIGUERA ST, SAN LUIS OBISPO Common Name Chemical Name �tailymumi Amt Units Physical State Largest Container Grid No ATF PETROLEUM HYDROCARBON (ATF) 120 GAL Liquid 120 B5 MOTOR OIL PETROLEUM HYDROCARBON (MOTOR OIL) 775 GAL I Liquid 1 120 JE7, G4, H4 WASTE ANTIFREEZE ETHYLENE GLYCOL (WASTE) 165 GAL I Liquid 1 55 13-4 WASTE MOTOR OIL PETROLEUM HYDROCARBON (WASTE OiL) 520 GAL I Liquid 1 550 1135 WASTE SAFETY KLEEN SOLVENT IWASTE SOLVENT 55 1 GAL I Liquid 55 1 E-3, F-6 Wednesday, February 13, 2002 Page 1 of 1 Site Visit Packet Permit No 60-0034 Facility Number: Facility Information Facility Name: ECONO LUBE AND TUNE Operator: JIM WILMORE Address Number: 286 Address: HIGUERA ST Suite: City: SAN LUIS OBISPO Zip: 93401- CrossStreet: HIGH ST Parcel No: 002-482-024 Phone No: (805) 544-2976 Facility Type: Corporation Property Owner Name: Address: City: State: Zip: Phone: Underground Storage Tank Property Owner Name: ECONO LUBE AND TUNE Phone: 8055442976 Mailing/Street Address 286 HIGUERA ST City: SAN LUIS OBISPO State CA Zip: 93401 Owner Type: Status: Permit Expiration Date: 3/9/01 Mailing Address Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: JIM WILMORE City: SAN LUIS OBISPO State: CA Zip: 93401- Phone: (805)544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Current Balance: 1194.00 mergency Contacts Business 24 Hr Primary Days Last Name First Name Title Phone Phone Pager WILMORE JIM MANAGER/OWNER (805) 544-2976 000) 000-0000 0 F,/] WILMORE PATRICIA WIFE OF OWNER (805) 544-2976 �O - )7 (000) 000-0000 Hazardous Materials Business Plan - List of Chemicals Permit No: 60-0034 Facility: ECONO LUBE AND TUNE Address: 286 HIGUERA ST, SAN LUIS OBISPO Maximum Physical Largest Common Name Chemical Name Daily Amt Units State Container Grid No AUTOMATIC TRANSMISSION FLUID PETROLEUM HYDROCARBON (ATF) 120 F GAL I Liquid 1 120 JB5 MOTOR OIL PETROLEUM HYDROCARBON (MOTOR OIL) 775 GAL Liquid 1 720 JE7, G4, H4 WASTE ANTIFREEZE ETHYLENE GLYCOL (WASTE) 165 GAL Liquid 55 3-4 WASTE MOTOR OIL PETROLEUM HYDROCARBON WASTE OIL 520 GAL Liquid 550 JB5 WASTE STODDARD SOLVENT STODDARD SOLVENT(WASTE) 55 GAL Liquid t 55 E-3, F-6 Friday, March 09, 2001 Page 1 of I Site Visit Packet Permit No 60-0034 Facility Number: Facility Facility Name: ECONO LUBE AND TUNE Operator: GREG PIPKIN M Address Number: 286 Address: HIGUERA ST Suite: City: SAN LUIS OBISPO Zip: 93401 CrossStreet: HIGH ST Parcel No: 002-482-024 Phone No: (805) 544-2976 Facility Type: Individual Operator Name: GREG PIPKIN M Address: City: State: Zip: Phone: 805/773-0571 Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Status: 3ermit Expiration Date: 12/6/99 Property Owner Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: City: SAN LUIS OBISPO State: CA Zip: 93401 Phone: (805) 544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Current Balance: $194.00 Emergency Contacts Primary Days Last Name First Name Title Q 0 WILMORE JIM MANAGER/OWNER Business 24 Hr _ Phone _Phone Pager (805) 544-2976 O w H U ZQ U) CL m O� m w p J 0 (n O = J Z W N U) MINIMININ X. w N n X_ m m MINIMININ cn J O z W m U IL 2 Z ? 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[ ] New inventory forms are attached. [ ] Replace previous inventory with attached inventory. [ ] Replace only designated pages of inventory. Additional Comments: Yearly Review and Recertification P1 I certify that the Business Plan has been reviewed and the information contained in the Business Plan is accurate and complete as of this date. Other Updates [ ] Please incorporate the following information into the Business Plan for this facility:. I declare, under penalty of perjury, that the information provided herein is true and correct to the best of my knowledge. Signature: Date: Printed Name:'Uj• tM^ orb Please Return to: Molly Brown, Hazardous Materials Section City Fire Department 2160 Santa Barbara Avenue San Luis Obispo, CA 93401-5240 H:/BUSINESS PLAN UPDATE FORM MOLLY OThe City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecommunications Device for the Deaf (805) 781-7410. PAGE NO. 1 Administrative Report - Disclosure Packet For Business; [2594] ECONO LUBE N' TUNE #107 BID Range: [2594] To [2594] Business ID...: 2594 Business Name.: ECONO LUBE N' TUNE #107 Bus i n e s s Address Number........: 286 SLreeL...,....: HIGUERA Suite......... Building...... City..........: SAN LUIS OBISPO State........... CA Zip Code ...... 93401 M a i l i n g A d d r e s s Mailing Name.. - Attention. . _ . ! Street......... City/State/Zip: Owner.........: GREGORY PIPKIN Business Phone: (805) 544-2976 Business Hours Contact Shift Hours Name Title 8-6 M-F GREG PIPKIN MANAGER/OWNER A f t e r B u s i n e s a H o u r s C o n t a c t s 8-6 M-F GREG PIPKIN MANAGER/OWNER 8-6 M-F GREGORY PIPKIN OWNER EL SA LER + H a z a r d o u s M a t e r i a l E m e r g e n c y C o n t a c t s 8-6 M-F GREG PIPKIN OWNER/MANAGER General and Building Information Doing Business As: ECON LUBE N' TUNE Business License.: 342 Dun & BradStreet.: 18-799-8612 EPA ID...........: CAL 000 008 725 Operation Desc...: AUTOMOTIVE LUBRICATING & ENGINE TUNE-UP SERVICE Shift Hoursl.... 8-6 M-F Number of Employeesl: 7 Shift Hours2.....: 9-5 SAT Number of Employees2: 7 wut�ex--0E i �ca3 Sic ..............: 7549 UBC1.............: 22. UBC2.............: UNKNOWN/UNDEFINED Non -Profit....... NO Lot Size.........: 14560 Number of Floors.. 1 Reporting Status.: C 06/03/98 C � 00 1 Phone (805) 544-2976 (8 f- 1 BUSINESS(ES) LISTED i PAGE NO. 1 Chemical Inventories Report All Chemicals (In Maximum Quantity Per Day Order) BID Range: [2594] To [2594] Trade Name HazClass Tw DOT# MaxPerDay Un Haz Rate Location Chemical Names/Components CAS # EC % MaxPerDay 06/03/98 --------------- --------------------- Business: [02594] ECONO LUBE N' TUNE #107--------------------------------------------- MOTOR OIL 2 9 1267 Compl: VARIOUS LUBRICATING BASE OILS 6474XXXX 85 Comp2: ADDITIVE PACKAGE 15 Comp3: ZINC ALKYLDITHIOPHOSPATE 68649423 C 2 WASTE OIL 2 19 1270 Compl: VARIOUS LUBRICATING BASE OILS 6474XXXX 85 Comp2: ADDITIVE PACKAGE, INCLUDING: MIXTURE 15 Comp3: ZINC ALKYLDITHIOPHOSPHATE 68649423 2 AUTOMATIC TRANSMISSION FLUID 2 9 1270 Compl: ALIPHATIC HYDROCARBONS 64742898 85 Comp2: AD 50760 C 15 Comp3: TERT-AMYL PEROXY-2-ETHYLHEXANOATE, TECHN 686317 2 WASTE PARTS WASHING SOLVENT ? 2 19 1270 Compl: ALIPHATIC HYDROCARBONS 64742898 85 Comp2: XYLENE, LIQUID 1330207 1 Comp3: ETHYLBENZENE, LIQUID 100414 5 960.0 GA 230 SO WALL OF BRAKE BAY; BY RESTROOM; S WAL 816.0 144.0 19.2 �VWGA 220 UNDERGROUND STORAGE TANK W OF WORK BAY 382.5 67.5 9.0 110.0 GA 230 WEST WALL OF WORK BAY 93.5 16.5 2.2 55.0 GA 220 NO WALL OF BRAKE BAYS SE COR SO WALL OF 46.8 0.6 2.8 4 CHEMICAL(S) LISTED 1 BUSINESS(ES) LISTED I PIED PROGRAM CONSOLIDATED FOF ' FACILITY INFORMATION BUSINESS ACTIVITIES Paize 1 of I. FACILITY IDENTIFICATION FACILITY ID # IF o 0 0151111161CAL000387770 I EPA ID # (Hazardous Waste Only) 2 (Agency Use Only) BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) LUBE-N-GO 3 BUSINESS SITE ADDRESS 286 HIGUERA ST tos BUSINESS SITE CITY SAN LU IS OBISP❑ 104 CA ZIP CODE 9340 1 '0' II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, Tease submit the Business Owner/ Q 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 cme!&ency 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 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 Ohluain-f g4cn"PAr4B 1u Wr f4I more of fccleralhazardous waste, or generate in any singe 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? See CUPA for required forms. �❑%YES 7- F. LOCAL REQUIREMENTS /l/�T is (You may also be required to provide additional information by your CUPA or local agency.) UPCF Rev. (12/2007) FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material er buildingurarea) [:]ADD ❑DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) LU BE-N-GO CHEMICAL LOCATION Ir'.,,.__ 4y CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # (Agency FA0005116 MAP# O1 GRID# use only) f,J—O`'F II. CHEMICAL INFORMATION CHEMICAL NAME TRADE SECRET ❑ Yes ❑ No AUTOMATIC TRANSMISSION FLUID If Subject to EPCRA, refer to instructions COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes []No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete irrequired by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ 0 (Check one item only) a. PURE 0 b, MIXTURE c. WASTE RADIOACTIVE ❑Yes []No CURIES PHYSICAL STATE ❑ a SOLID b. LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD REACTIVE FIRE b CATEGORIES JJ a. . c. PRESSURE RELEASE (Check all that apply) ❑ ❑ d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 60.0 1 240.0 7 UNITS* Q a. GALLONS O b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 � O (Check one itein ubly) 'if EHS, amount must be in pounds. . 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 ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE W a. AMBIENT ❑ b. ABOVE AMBIENT c. BELOW AMBIENT STORAGE TEMPERATURE ❑� a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c, BELOW AMBIENT d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # l 95.0 hydrocarbons ❑ Yes ® No 2 5.0 BTEX ❑ Yes ® No 3 ❑ Yes ❑ No 4 Yes rl 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 Sin Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one e r material r buiillfin or area ❑ADD ❑DELETE REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) LU BE-N-GO CHEMICAL LOCATION r- —y CHEMICAL LOCATION CONFIDENTIAL EPC PA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O1 GRID# �— II / O (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME WASTEANTIFREEZE TRADE SECRET ❑ Yes MW IfSubject to EPCRA, refer to iostroetions COMMONNAME WASTE ANTIFREEZE EHS* [I Yes ❑ No CAS# 107-21-1 *ITEHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE 0 (Check one item only) a. PURE 0 b. MIXTURE M c. WASTE RADIOACTIVE ❑Yes []No CURIES PHYSICAL STATE [3 a. SOLID M b. LIQUID 0 0. 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 A VERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 1 165.0 1 675.0 UNITS* Qi a. GALLONS a b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: A 5. O (Check one item only) "If EHS, amount must be In ppanda b STORAGE ❑ a. ABOVE GROUND TANK N 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 ❑ It. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT c. BELOW AMBIENT STORAGE TEMPERATURE Q a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 17 d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 50.0 antifreeze ❑ Yes ® No z 50.0 water ❑ Yes ® No 3 ❑ Yes ❑ No 4 rl Yes rl N 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight it carcinogenic. nsmch addilional sheet, or paper ropturing the regoirnl inrornin ion, ADDITIONAL LOCALLY COLLECTED INFORMATION IFEIRCRA Please Si n here 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) LUBE-N-GO BUSINESS SITE ADDRESS 286 HIGUERA ST CITY SAN LUIS OBISPO COUNTY San Luis Obisw BJ.j�II�II;SS ClP.E> 6nNNAME JvJtF'11 �IIVI II. BUSINESS OWNER OWNERNAME SIMCAT ENTERPRISES OWNER MAILING ADDRESS 286 HIGUERA CITY SAN LUIS OBISPO CONTACT NAME JOSEPH SIMONIN CONTACT MAILING ADDRES 2505 THEATRE DRIVE CITY PASO ROBLES -PRIMARY- NAME JOSEPH SIMONIN TITLE OWNER / OPERATOR BUSINESS PHONE' 8052389301 24-HOIJR 111IONE PAGER # / CELL PHONE # BUSINESS PI3C 8057864056 CA 193401 BUSINESS OPERATOR 8054235921 OWNER PHONE 8057864056 STATE ZIP CODE CA 193401 III. ENVIRONMENTAL CONTACT CONTACTPHONE 8052389301 STATE ZIP CC1L} CA 193446 IV. EMERGENCY CONTACTS -SECONDARY- NAME ADDITIONAL LOCALLY COLLECTED INFORMATION: LARRY KNIGHT TITLE LUBE TECHNICIAN BUSINESS PHONE 8057864056 24-11OUR PHONE PAGER N/CELL PHONEI1 Certification: Based.on my inquiry ofillose individuals responsib[v 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 Or OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE NAME OF DOCUMENT pRL"PARER Submitted via Public Portal 10/17/2013 CAMILLE SUNDAHL NAME OF SIGNER (print) T-ITLC Or SIGNER CAMILLE SUNDAHL OFFICE MANAGER ) l I L" i °> 2003 2003 1U Hazardous Materials op Management Plan HMMP AND Hazardous Materials Disclosure Forms For: r 0� ECONO LUBE N, TUNE N107 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY San Luis Obispo City Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 ATTN: Molly Brown --Prparud--by; acific Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 -1510 FAX (559) 251 - 5534 FORM S - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME (same as FACILITY NAME orDBA-Doing Business LU B E-N-GO As) 18057864056 BUSINESS PHONE BUSINESS SITE ADDRESS 286 HIGUERA ST CITY SAN LUIS OBISPO CA ZIP CODE 93401 COUNTY San Luis Obispo �] � S6J9 ') 90PIM64h ME BUSINESS OPERATOR PHONE 18054235921 II. BUSINESS OWNER OWNER NAME SIMCAT ENTERPRISES OWNER PHONE 18057864056 OWNER MAILING ADDRESS 286 HIGUERA CITY SAN LUIS OBISPO STATE CA ZIP CODE 193401 III. ENVIRONMENTAL CONTACT CONTACT NAME JOSEPH SIMONIN CONTACT PHONE 18052389301 CONTACT MAILING ADDRESS 2505 THEATRE DRIVE CITY PASO ROBLES STATE ZIP CODE CA 193446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME JOSEPH SIMONIN NAME OMAR GODINEZ TITLE OWNER / OPERATOR TITLE MANAGER BUSINESS PHONE 8052389301 BUSINESS PHONE 8057864056 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 02/10/2017 CAMILLE SUNDAHL NAME OF SIGNER (print) CAMILLE SUNDAHL TITLE OF SIGNER OFFICE MANAGER FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one are per material per building or area) ❑ADD ❑DELETE REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) LU BE-N-GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O1 GRID#-O` F (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET Yes []No If Subject to EPCRA, refer to instructions COMMONNAME MOTOR OIL EHS* ❑Yes []No CAs# 64742-54-7 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE a. PURE b. MIXTURE ❑ c. WASTE (Check one item only) ❑ ❑ RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE ❑ a, SOLID 0 b, LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (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 388.0 1 775.0 UNITS* Q a. GALLONS O b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: ^ ^ 36 0 (Check one item only) *If EHS, amount must be in pounds. . STORAGE 0 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 M 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 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 95.0 hydrocarbons ❑ Yes ® No z 5.0 BTEX ❑ Yes ® No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No Ir more hazardous components are present at greater than 1 % by weight it 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 tsn@ page er material to lrui[tiiu � oraren) ❑ADD ❑DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) LOBE-N-GO CHEMICAL LOCATION r ' :1 a:ngs CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 01 GRID# (Agency use only) C-O9 II. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET ❑Yes No If Subject to EPCRA, refer to instructions COMMON NAME WASTE OIL EHS* [I Yes []No CAS' 8002-05-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ ❑ b, ❑' (Check one item only) a. PURE MIXTURE c WASTE RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID 0 b, LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES JO (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 260.0 1 520.0 1 4800.0 221 UNITS* Q a_ GALLONS O b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: ^ 5. 0 (Check one item only) *if EHS, amount must be in pounds. b 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 RAILCAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r OTHER ❑ d. STEEL DRUM ❑ h, SILO ❑ 1. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 11 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ® No 2 5.0 BTEX ❑ 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 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of 1. FACILITY IDENTIFICATION FACILITY ID # F A o 0 0 5 11 I EPA ID # (Hazardous Waste Only) Y (Agency Use Only) CAL000387770 BUSINESS NAME (Same as Facility Name of DRA-Doing Business As) L BE— — 3 BUSINESS SETS ADDRE55 286 H IGU ERA ST 103 BUSINESS SITE CITY SAN LUIS OBISPO to I CA ZIP CODE 93401 t°s II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/O perator Identification page - Does your Facility... If Yes, please cam [etc 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 lan 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 (CaIAI;P).q responsible for CaIARP. C. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly swacB 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 —Ciencratehazardous-was te? LP lD_ N11Wir[� gm ideas fhe.. - - -nf .-. - 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 ❑ YES HAZARDOUS WASTE TANK hazardous waste and cleaned on -site? CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or Obtain federal EPA ID Number, file ens -waste, rnirr-rmy-sirtgte-calun Biennial Report (EPA Form $700- month, or accumulate at any time, I 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) BUSINESS PHONE LUBE-N-GO 18057864056 BUSINESS SITE ADDRESS 286 HIGUERA ST CITY ZIP CODE SAN LUIS OBISPO C�` 93401 COUNTY San Luis Obispo BUSINESS OPERATOR PHONE S6�gV41 %ffl6n�NAME �� '`�' 18054235921 II. BUSINESS OWNER OWNER NAME OWNER PHONE SIMCAT ENTERPRISES 18057864056 OWNER MAILING ADDRESS 286 HIGUERA CITY STATE ZIP CODE SAN LUIS OBISPO CA 93401 III. ENVIRONMENTAL CONTACT CONTACT NAME CONTACT PHONE JOSEPH SIMONIN 18052389301 CONTACT MAILING ADDRESS 2505 THEATRE DRIVE CITY STATE ZIP CODE PASO ROBLES CA 193446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NAME JOSEPH SIMONIN OMAR GODINEZ TITLE TITLE OWNER / OPERATOR LUBE TECHNICIAN BUSINESS PHONE BUSINESS PHONE 8052389301 8057864056 24-HOUR PHONE 24-HOUR PHONE PAGER#/CELL PHONE 4 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 02/11/2016 CAMILLE SUNDAHL NAME OF SIGNER (Print) TITLE OF SIGNER CAMILLE SUNDAHL OFFICE MANAGER FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one page r per material per building or area ❑ADD []DELETEREV15] I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU B E-N-GO CHEMICAL LOCATIC— CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 0 GRID# b-04 (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME rRnnEs1;CRET ❑Yes No AUTOMATIC TRANSMISSION FLUID If Subject to EPCRA, refer to instructions COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes []No CASH *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete i£required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a. PURE El b, MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes [IN. [CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID ><❑ b. LIQUID ❑ c GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES ❑x a, FIRE ❑ b, REACTIVE ❑ c. PRESSURE RELEASE ❑X d. ACUTE HEALTH ❑x e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 60.0 240.0 UNITS* X❑ a. GALLONS ❑ It, CUBIC FEET ❑ c. POUNDS ❑ d. TONS HAYS ON SITE. n 65 m ms. — - rum i n rm Y �rfF ; amattn -ml[ti n e corm — — — - . STORAGE El a. ABOVE GROUND TANK e. PLASTICINONMPTALLIC DRUM i. FIBER DRUM El m. GLASS BOTTLE CONTAINER ❑ It. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ® c. TANK INSIDE BUILDING 0 g, CARBOY ❑ k. BOX 13 o. TOTE BIN ❑ L OTHER ❑ d. STEEL DRUM ❑ It, SILO [11. CYLINDER 13 p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ It. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ It. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d, CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No d ❑ 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 Siizn IIere FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (a PieP.m, Per malrrial rr huildiPig ornren ❑ADU ❑Di:1.Ei'li R{ V[S[. I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE—N—GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES []NO FACILITY ID # FA0005116 MAP# 0 1 II GRID# �_O� (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET ❑Yes No If Subject to EPCRA, refer to instructions COMMON NAME MOTOR OIL EHS* [I Yes ❑ No CAs# 64742-54-7 *[f EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a PURE ❑x b MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes ❑ No CURIES PHYSICAL STATE ❑ a SOLID x❑ b LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES x a. FIRE x x e, ❑ ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ❑ CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 388.0 1 775.0 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 7 DAYS ON SITE: 365.0 6 O (Check one item only) *If EHS, amount must be in pounds. . STORAGE 0 a ABOVE GROUND TANK t3 e. PLASTIC/NONMETALLIC DRUM 0 i. FIBER DRUM ❑ m GLASS BOTTLE CONTAINER ❑ b UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n PLASTIC BOTTLE }3 q, RAIL CAR c TANK INSIDE BUILDING 0 g. CARBOY ❑ k. BOX ❑ o TOTE BIN r. OTHER © d STEEL DRUM 0 h. SILO ❑ I. CYLINDER ❑ p TANK WAGON STORAGE PRESSURE Q 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 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ 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 vac gape !i• material Ire Iruild'us or areal []ADD ❑DELETEOREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) LU BE-N-GO CHEMICAL LOCATION it � CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY 1D # FA0005116 MAP# 01 GRIDA d-10 (Agency use only) H. CHEMICAL INFORMATION CHEMICAL NAME WASTE ANTIFREEZE TRADE SECRET ❑Yes r3 No [f Subject to EPCRA, refer to instructions COMMONNAME WASTE ANTIFREEZE EHS* ❑Yes ❑ No CAS# 107-21-1 *If EFIS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE a. PURE ❑ b. MIXTURE ❑ c. WASTE ❑ >< RADIOACTIVE ❑ Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID ❑x b. LIQUID ❑ c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d. ACUTE HEALTH ❑% e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIN[UM DAILY AMOIINT ANNUAL. WASTE ANIOUNT STATE WASTE CODE 83.0 1 165.0 1 675.0 UNITS* X❑ a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: [sr ucm.ors }�.l'�tl-k.rt�,.rinw�n�my�Fl>e-in�pu STORAGE a. ABOVE GROUND TANK e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM E3 in. 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 ❑ It SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE ❑x a- AMBIENT ❑ b- ABOVE AMBIENT ❑ o_ BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 50.0 antifreeze ❑ Yes ❑ No 7 50.0 water ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No [f urore hx nrdous romponenn me preunt as Rreoter iban 1 % by woght if nnn•rdrrtnokrnit. Dr Q.15G. by weilhi irrareinnrruic. anMrb addfiioual ntwoy the requimd infnrmarien. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Si u here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material ter hui#din„ or arc:l) []ADD []DELETE REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION a' illl S CHEMICAL LOCATION CONFIDENTIAL EPCRA g ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 01 GRID# (Agency use only) C-O9 II. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET []Yes No If Subject to EPCRA, refer to instructions COMMON NAME WASTE OIL EHS* ❑Yes ❑ No CAs# 8002-05-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a. PURE ❑ b. MIXTURE ❑x c. WASTE RADIOACTIVE ❑ Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID ❑x b LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES ❑x a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d. ACUTE HEALTH ❑x e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 260.0 520.0 1 4800.0 221 UNITS* Ea. GALLONS ❑b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE- 0 (Check one item only) *If EHS, amount must be in pounds. (Check STORAGE >< a. ABOVE GROUND TANK 0 e. PLASTIC/NONMETALLIC DRUM E3 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 ❑ Is. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑% a, AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE ❑x a. AMBIENT ❑ b, ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ❑ No z 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight irnon•carcinogenic, or O.l % by weight if carcinogenic, attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Si n Here UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of I. FACILITY IDENTIFICATION FACILITY ID 4 IFIAIOIOI0151111161 I EPA ID # (Hazardous Waste Only) 2 (Agency Use Only) CAL000387770 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) LU BE-N-GO 3 BUSINESS SITE ADDRESS 286 HIGUERA ST 103 BUSINESS SITE CITY SAN LU I S O B I S PO 104 CA ZIP CODE 93401 ... 1I. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/O perator 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 Q 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 lan 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 (CaIARP)? 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 — pi ovide 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 YES HAZARDOUS WASTE TANK hazardous waste and cleaned on -site? CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or _Jubtaiu_fedrzxal..EPA in Blum more ol leacralhazardous waste, or generate in any singe ca en ar LJ 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 is (You may also be required to provide additional information by your CUPA or local agency.) UPCF Rev. (1212007) 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) BUSINESS PHONE LUBE-N-GO 18057864056 BUSINESS SITE ADDRESS 286 HIGUERA ST CITY ZIP CODE SAN LUIS OBISPO CA I 93401 COUNTY San Luis Obispo BUSINESS OPERATOR PHONE FlM T NAME QIV 9NVIV� � 18054235921 II. BUSINESS OWNER OWNER NAME OWNER PHONE SIMCAT ENTERPRISES 18057864056 OWNER MAILING ADDRESS 286 HIGUERA CIT. cTA-M I ?ip rnnF SAN LUIS OBISPO CA 93401 III. ENVIRONMENTAL CONTACT CONIACI'NAME CONTACTPHONE JOSEPH SIMONIN 18052389301 CONTACT MAILING ADDRESS 2505 THEATRE DRIVE CITY STATE ZIP CODE PASO ROBLES CA 193446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NAME JOSEPH SIMONIN OMAR GODINEZ TITLE TITLE OWNER / OPERATOR LUBE TECHNICIAN BUSINESS PHONE BUSINESS PHONE 8052389301 8057864056 24-HOUR PHONE: 24-HOUR PHONE I PAGER # / CELL PHONE: 9 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 PRF.PARER Submitted via Pub[ icPortal 03/11/2015 CAMILLE SUNDAHL NAME OF SIGNER (prim) TITLE OF SIGNER CAMILLE SUNDAHL OFFICE MANAGER FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (ultr pAgc ]cr utatcrial per buiklin' ur arial ❑ADD ❑DELETE IiI VISI: 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION , CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O1 GRID#—O� (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME TRADE SECRET ❑ Yes ❑ No AUTOMATIC TRANSMISSION FLUID If Subject toEPC",refer toinstructions COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes ❑ No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE (Checkoneone item only) a 0PURE b, MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE [:]a SOLID ❑x b. LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES (Check all that apply) ❑ a. FIRE ❑ b. REACTIVE ❑ c, PRESSURE RELEASE ❑x d. ACUTE HEALTH ❑x e CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 60.0 1 240.0 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d TONS DAYS ON SITE: ^ 0 (Check one item only) *If EHS, amount must be in pounds. b . STORAGE a. ABOVE GROUND TANK 0 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 ❑ r. OTHER (3 d. STEEL DRUM © h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE El a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c, BELOW AMBIENT ❑ d, CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 Yes ❑ No 5 ❑ Yes ❑ No lr 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 F,PCRA. Please Si n Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY .on a e per material rrr buildin = w ar(a) []ADD ❑DELETE REV ISi, 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION ay CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O GRID#-O` (Agency use only) F II. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET ❑Yes ❑ No instructions If Subject to EPCRA, refer to COMMONNAME MOTOR OIL EHS* ❑Yes ❑ No CAS# 64742-54-7 *if EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) i Tax n /Tnvl 1 VAV HAZARDOUS MATERIAL TYPE ❑ a PURE ❑>< b MIXTURE ❑ c. WASTE RADIOACTIVE [:]Yes❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a SOLID x❑ b, LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES ❑x a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d, ACUTE HEALTH ❑x e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 388.0 1 775.0 UNITS* Z a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 36 5. 0 (Check one item only) *If EHS, amount must be in pounds. STORAGE ❑ a. ABOVE GROUND TANK 0 e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM 0 in. GLASS BOTTLE CONTAINER Q b. UNDERGROUND TANK ❑ f. CAN 0 j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ® c. TANK INSIDE BUILDING ❑ p. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER Q d. STEEL DRUM ❑ It. SILO Q 1. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 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 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at Treater than 1% by weight if non-cai-cinogenic, or 0.1% by weight ircarcinogenic, attach additional sheets or 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 InuC DAVC .ri" material per huildio p or arca []ADD ❑DEIZTE ❑ ld _VISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # (Agency FA0005116 MAP# O 1 GRID# _ J O -I use only) II. CHEMICAL INFORMATION CHEMICAL NAME WASTE ANTIFREEZE TRADE SECRET ❑Yes No If Subject to EPCRA, refer to instructions COMMONNAME WASTE ANTIFREEZE EHS* ❑Yes ❑ No CAS# 107-21-1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE 0 c. WASTE RADIOACTIVE ❑ Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID 0 b. LIQUID ❑ c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES (Check all that apply) ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE 0 d. ACUTE HEALTH 0 e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 1 165.0 1 675.0 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d, TONS DAYS ON SITE: ^ 0 (Check one item only) *If EHS, amount must be in pounds. b . STORAGE 0 a. ABOVE GROUND TANK Me. PLASTIC/NONMETALLIC DRUM t3 i. FIBER DRUM EI m. GLASS BOTTLE CONTAINER 0 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 0 d. STEEL DRUM ❑ It. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ a 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 50.0 antifreeze ❑ Yes ❑ No 2 50.0 water ❑ 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 (CUP: FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one to c per ntalcrial bnildin or arra []ADD [-]DELETE RFVIS1: I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) LU BE-N-GO CIIEMICAL LOCAT'— • CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 0 TG C_0 RID# 9 (Agency use only) H. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET Yes No instructions If Subject to EPCRA, refer to COMMON NAME WASTE O I L EHS* ❑Yes ❑ No CAs# 8002-05-9 *If FHS is "Yes", all amounts below must he in Ihs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Tnvin /Tnv\ I vnJ HAZARDOUS MATERIAL TYPE ❑ a PURE ❑ b. MIXTURE ❑x c WASTE RADIOACTIVE ❑Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID x❑ b. LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES a. FIRE ❑ b, REACTIVE ❑ c PRESSURE RELEASE ❑x d. ACUTE HEALTH x❑ e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 260.0 1 520.0 1 4800.0 1 221 UNITS* Z a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: ^ (Check one item only) *If EHS, amount must be in pounds. 365.0 STORAGE IN it. ABOVE 4ROUND TANK ❑ e, PLASTIC/NONMETALLIC DRUM ❑ i, FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑!• BAG 0 n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX 0 o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h, SILO [11. CYLINDER G] p. TANK WAGON STORAGE PRESSURE 0 a, AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE a_ AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If moire hazardous components are piesent at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the mquiivd information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sign Here UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page I of 1. FACILITY IDENTIFICATION FACILITY ID # Use Only) I F I AJ 0 1 0..J 0 151111161CAL000387770 I EPA ID # (Hazardous Waste Only) 2 (Agency BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) LLJIBE-N-GO 3 BUSINESS SITE ADDRESS 286 HIGUERA ST 103 BUSINESS SITECPry SAN LUIS OBISPO 104 1 CA ZIP CODE 93401 l05 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page. Does your facilit .. If Yes, please com fete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed ❑X YES HAZARDOUS MATERIALS 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 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? ❑X 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 ❑ YES HAZARDOUS hazardous waste and cleaned on -site? WASTE TANK CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate in any single calendar ❑ YES Obtain federal EPA ID Number, file month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous Biennial Report (EPA Form 8700- waste; or generate or accumulate at any time more than 100 kg (220 pounds) of 13A/B), and satisfy requirements for spill cleanup materials contaminated with RCRA acute hazardous waste. RCRA Large Quantity Generator. 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) RX FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (unr late livi, imiterial rer building ur at•ra ❑ADD ❑DELETE ❑RI.1 I S 1: I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU B E_N_GO CHEMICAL LOCATION i FACILITY ID # FA0005116 (Agency use only) CHEMICAL LOCATR A CONFIDENTIAL El'CRA ❑ YES ❑ NO MAP# 01 CiNDili b_04 II. CHEMICAL INFORMATION CHEMICAL NAME '[RADII SECRET Yes ❑ No AUTOMATIC TRANSMISSION FLUID If Subject to EPCRA, refer to instructions COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes ❑No CAS# i'1RE CODE HAZARD Toxic (Tox) (Comple(e if required by CUPA) *If EHS is "Yes", all amounts below must be in lbs. HAZARDOUS MATERIAL TYPE ❑ a. PURE x❑ b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes [I No CURIES (Check one item only) PHYSICAL STATE [I a. SOLID ❑x b. LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES Q a FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d. ACUTE HEALTH ❑% e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY Aki(JUN'I ANNUAL WASTE AhI0U1lT STATE WASTE CODE 60.0 240.0 UNITS* ❑X a. GALLONS ❑ b, CUBIC FEET ❑ c. POUNDS ❑ d. TONS N Sl'fG: 365.0 (Check one item only) *If EIIS, amount must be in pounds. STOPAGi a. ABOVE GROUND TANK e. PLAS-nCINONMTTAL1_IC DRUM ❑ i, FIBER DRUM m. GLASS r30TI'l.E ❑ j. BAG ❑ It PLASTIC BOTTLE ❑ q. RAIL CAR CONTAINER ❑ b. UNDERGROUND TANK 51 c. TANK INSIDE BUILDING ❑ f. CAN ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r, OTHER ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c, BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No ❑ Yes ❑ No 5 ❑ Yes ❑ No If more IINYardtlag components are present at greatertlu $ t % by weight ifnon•tarcinuKeuir, or o.t % by weight if rartinoRenir, attach addioutsol sheets of pnper capturing the requirrd information. ADDITIONAL LOCALLY COLLECTED INFORMATION FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one r material 1cr building or rn•ea] t ❑ADD ❑DELETE []REVISEa I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA—Doing Business As) LOBE—N—GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O GRID#—O` (Agency use only) F H. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET YesNo instructions If Subject to EPCRA, refer to COMMON NAME MOTOR OIL EHS* ❑Yes ❑ No CASH 64742-54-7 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a, PURE ❑x b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes [:]No CURIES (Check one item only) PHYSICAL STATE a. SOLID ❑x b. LIQUID ❑ a.GAS ❑ LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES ❑x a, FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE d. ACUTE HEALTH 0 e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOU91' MAXIMUM DAILY AMOUNT ANNUAL WASTi. AMOUNT STATE WASTE CODE 388.0 1 775.0 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) "If EHS, amount must be in hounds. STOP,AGE L3 a. ABOVE GROUND TANK E3 e, PLASTICINONMETr LIA' DRUM ff7FIBER DRUM m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n, PLASTIC BOTTLE ❑ q. RAIL CAR ❑ k. BOX ❑ o, TOTE BIN ❑ r. OTHER ❑x c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ d. STEEL DRUM ❑ h, SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑x 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 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No lrmore hnxardonstoptipogegq are present at greater than 1 k by Weight it numrm•rinogenir, or 0.1 % by ncight if Parrinugeni4 RIIACh additional sheets of papercmpluringshr required information. ADDITIONAL LOCALLY COLLECTED INFORMATION IfFPCRA Please Si �n licrc FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material lier building or area ❑ADD [—]DELETE REVISIT I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATIOb CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O1 GRID# _ 0 (Agency use only) H. CHEMICAL INFORMATION CHEMICAL NAME WASTE ANTIFREEZE TRADE SECRET Yes No If Subject to EPCRA, refer to instructions COMMON NAME WASTE ANTIFREEZE EHS* ❑Yes ❑ No CAS# 107-21-1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a [I❑x PURE b. MIXTURE c. WASTE RADIOACTIVE [I Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID [0 b. LIQUID ❑ c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE 0 d. ACUTE HEALTH 0 e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 1 165.0 1 675.0 UNITS* Q a, GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 1. DAYS ON SITE: 365. 0 (Check one item only) *If EHS, amount must be in pounds. STORAGE ❑ a. ABOVE GROUND TANK El e PLASTICINONMETALLIC DRUM a FIBER DRUM m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK (3 f. CAN ❑ j. BAG ❑ n, PLASTIC BOTTLE 0 q. RAIL CAR ❑ c. TANK INSIDE BUILDING 0 g. CARBOY ❑ k. BOX ❑ o, TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM (3 h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c, BELOW AMBIENT STORAGE TEMPERATURE ❑>< a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 50.0 antifreeze ❑ Yes ❑ No 2 50.0 water ❑ 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-em cinogenic, m, 0.1% by weight if carcinogenic, attach additional sheets of paper capturing The required information. ADDITIONAL LOCALLY" COLLECTED INFORMATION If EPCRA Please Sip n here FORM LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) :—SAN CHEMICAL INVENTORY (one pstat per material mr buildin • or urea (—]ADD ❑DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY 1D # FA0005116 MAP# 0 GRID# C-O9 (Agency use only) H. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET Yes No If Subject to EPCRA, refer to instructions COMMONNAME WASTE OIL EHS* ❑Yes ❑ No CAs# 8002-05-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requited by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a. PURE ❑ b. MIXTURE ❑x c. WASTE RADIOACTIVE []Yes❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a SOLID b, LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 m (Check one iteonly) FED HAZARD CATEGORIES ❑x FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d. ACUTE HEALTH ❑x c. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 260.0 1 520.0 4800.0 1 221 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds, STORAGE ❑x a. ABOVE GROUND TANK El e. PLASTIC/NONMETALLIC DRUM 0 i. FIBER DRUM 0 in 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 ❑ In. SILO [11, CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 hydrocarbons ❑ Yes ❑ No z 5.0 BTEX ❑ 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 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of 1 F FACILITY lit 9 I I I I I I I I ! I I I I I I ICEPA AL I OOORa008 au72 ante Only) SS NAME (Same as Facility Name of DBA-Doing Business As) LUBE N' TUNE #107 H. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification paSe (OES Form 2730). Does your facility I If Yes, nlcasc comnlete these oaees 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 ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CFR Part - CHEMICAL DESCRIPTION (OES 2731) 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. UNDERGROUND STORAGE TANKS USTs UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? 11YES 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_ 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 [:]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 perrecycler) 3. Treat hazardous waste on site? []YES ONSITE HAZARDOUS WASTE ®NO 11 TREATMENT - FACILITY (Formerly DISC Forms1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) 4. Treatment subject to financial assurance requirements (for []YES ® NO 12 (Formerly DISC Forms 1772 A,B,C,D and Q CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? []YES ® NO 13 REMOTE WASTE / CONSOLIDATION 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. LOCA_L_RE!2LIIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) UPCF (1/99) 165 FORM S — SAN LUI, 1ISPO COUNTY CERTIFIED UNIFIED., FTRA2 BUSINESS OWNER/OPERATOR IDENTIFICAT.�� I. IDENTIFICATION FACILITY ID# eA I 1 BEGINNING DATE Too BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 BUSINESS PHONE 102 BUSINESS SITE ADDRESS 103 CITY Sri L�r�S �fo��s oCA a l 105 ZIP CODE 93�a/ COUNTY loe BUSINESS OPERATOR NAME ESS OPERATOR PHONE t tv II. BUSINESS OWNER O NAME NAME 111 OWNER PHONE 7 OWNER MAILING ADDRESS i t3 CITY 114 STATE 115 ZIP CODE 116 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE � CONTACT MAILING ADDRESS 119 CITY r '1 120 ST TE 121 ZIP CODE 121 �.iv y &V -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME TITLE r7 123 1 NAME 1W*&AWr— 128 !7124 TITLE . 129 BUSINESS PHONEBUSINESS 130 PHONE 24-HOUR PHONE 126 24-HO R. PHO 131 PAGER # /CELL PHONE # k27 PAG / CELL PHONE # 132 c� v 1 ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 Certification: Based on my inquiry of those individu s respo ' le f obtaining the orination, I certify under penalty of law that I have personally examined and am familiar with 0it information submitted SICNA it WNERIOPERATOR OR DESIGNATE REPR DATE 134 NAME OF DOCUMENT PREPARER 135 o ,. -Caw ern NAME SIGNER (print) 136 E OF SIGNER 137 Page Of 2 C:1DOCUMENTWeffp1FORMS1Business Plan FOrmMFRM-S.DOC 09/17/01 Site Visit Packet Permit No 60-0034 Facility Number: Facility Information Operator: JIM WILMORE Facility Name: ECONO LUBE AND TUNE Address Number: 286 Address: HIGUERA ST Suite: City: SAN LUIS OBISPO Zip: 93401- CrossStreet: HIGH ST Parcel No: 002-482-024 Phone No: (805) 544-2976 Facility Type: Corporation Property Owner Name: Address: City: State: Zip: Phone: Underground Storage Tank Property Owner Name: ECONO LUBE AND TUNE PI lone: 8055442976 Mailing/Street Address 286 HIGUERA ST City: SAN LUIS OBISPO State CA Zip: 93401 Owner Type: Emergency Contacts PrimaryDays Last Name First Name Title WILMORE JIM OWNER 0 WILMORE PATRICIA WIFE OF OWNER Status: Permit Expiration Date: 7/9/02 Mailing Address Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: JIM WILMORE City: SAN LUIS OBISPO State: CA Zip: 93401- Phone: (805) 544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Current Balance: $194.00 Business 24 Hr Phone Phone Pager (805)544-2976 (805)441-3457 (805)544-2976 (f __ (000)000-0000 Hazardous Materials Business Plan - List of Chemical Permit No 6�-0034 Facility. jECONO LUBE AND TUNE Address:11286 HIGUERA ST, SAN LUIS OBISPO Common Name ;Chemical Name Maximum I Daily Amt Units Physical State Largest I Container Grid No ATF PETROLEUM HYDROCARBON (ATF) 120 GAL Liquid 120 D-9 MOTOR OIL PETROLEUM HYDROCARBON MOTOR OIL 775 GAL Liquid 120 D-9, H-12, J- U. K-8 WASTE ANTIFREEZE ETHYLENE GLYCOL (WASTE) 165 GAL Liquid 55 D-8 WASTE MOTOR OIL PETROLEUM HYDROCARBON WASTE OIL 520 GAL I Liquid 550 B5 WASTE SAFETY KLEEN 'WASTE SOLVENT 1 GAL I Liquid 5 — H-6 r 15' 55 C �� Tuesday, July 09, 2002 [5 Page 1 of 2002 Hazardous Materials Management Plan HMMP AND Hazardous Disclosure For: Materials Forms APR 2 3 2-002 CUPA COPY ECONO LUBE N, TUNE #107 rE�� 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO CITY FIRE DEPARTMENT Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, ,CA 93401 - 5240 (805) 781 - 7383 ATTN: Molly Brown Prepared by: acific Management 5ervices Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 Emu(5 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page Iof 1 I. FACILITY IDENTIFICATION FACILITY Ili # I CPA ID h (Hazardous Waste Only) 1 CAL 000 008 725 BUSINESS NAME (Saine as Facility Name of DBA•Doi11g Business As) 3 ECONO LUBE N' TUNE #107 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility If YCS, lease cam 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 (include liquids in ASTs and USTs); or the applicable Federal threshold ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CPR Part - CHEMICAL DESCRIPTION of ( S 2731) 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CPR Parts 30, 40 or 70? B- UNDERGROUND STORAGE TANKS USTs UST FACILITY (Formerly SWRCB form A) I . Own or operate underground storage tanks? N YES ❑ NO 5 UST TANK (one page per tank) (Formerly form B) 2. Intend to upgrade existing or install new USTs? ❑ YES N NO 6 UST FACILITY. UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form 3. Need to report closing a UST? [:]YES N NO 7 C) UST TANK (closure portion -one page per tank) AB VE PETROIEUM ST A (Aus) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ❑ YES N NO 8 NO FORM REQUIRED TO CUPAs --- the total capacity for the facility is greater than 1,320 gallons? P. HAZARDOUS WASTC I. 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 (per HSC 25143.2)? ❑ YES N NO 10 RECYCLABLE MATERIALS REPORT (one 3. Treat hazardous waste on site? ❑ YES N NO 1 1 perrecycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) 4. Treatment subject to financial assurance requirements (for [-]YES. N NO 12 (Formerly DISC Forms 1772 A,B,C,D and Q 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 N NO 13 SITE ANNUAL NOTIFICATION (Formerly 6. Need to report the closure/removal of a tank that was classified as r-t .,,., ,, , ,, , , DISC Form 1196) HAZARDOUS WASTE TANK CLOSURE E. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) IN UPCF (1/99) 165 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 III L111 I 04/27/01 104/26/02 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE 102 ECONO LUBE N' TUNE 4107 1 (805) 544-2976 BUSINESS SITE ADDRESS 63 286 HIGUERA STREET CITY 104 ZIP CODE 105 SAN LUIS OBISPO C A 93401 - 4215 DUN & BRADSTREET 106 SIC CODE (4 digit 4) 107 18 - 799 - 8612 7549 COUNTY 10s ;SAN LUIS OBISPO BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 JIM WILMORE 805' 544-2976 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 112 JIM WILMORE 1(805) 544-2976 OWNER MAILING ADDRESS 113 :286 HIGUERA STREET CITY 114 STATE Its ZIP CODE 116 SAN LUIS OBISPO ICA 193401 - 4215 III. ENVIRONMENTAL CONTACT CONTACT NAME 1 1 7 CONTACT PHONE Ire JIM WILMORE (805) 544-2976 CONTACT MAILING ADDRESS 119 .286 HIGUERA STREET CITY 120 STATE 121 ZIP CODE 122 SAN LUIS OBISPO ICA 1-93401 - 4215 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 129 JIM WILMORE PATRICIA WILMORE TITLE 124 TITLE 129 OWNER WIFE OF OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 �(805) 544-2976 (805) 544-2976 2441OURPHONG 126 24-HOUR PI [ONE PAGER 4 J CELL PHONE q rs7 PAGER # ! CELL PHONE R Ii3 ( ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based oil 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. SIGNATURF•S01T OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 04 / 26 / 02 PACIFIC MANAGEMENT SVCS. 1 NAME OF SIG E (print) 136 TITLE OF SIGNER 137 JIM WILM'CFRE OWNER 2 Page 1 Of 16 C:IWINDOWSITEMPIFRM-S,DOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) []ADD ❑DEI.F-rG ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CONO LURE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 WORK BAY, ADJACENT WEST WALL EPCRA 1 YES 0 NO FACILITY ID # MAP# (optional) 203 GRID# (optional) 204 2 of 3 D-9 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes No 200 PETROLEUM HYDROCARBON MIXTURE If Subject to EPCRA, refer to instructions COMMON NAME 207 208 AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes ®No CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 TYPE (DOMATERIAL 211 TYPE (Checkck one item only) ❑ a. PURE ®b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes ®No 212 213 CURIES NSA PHYSICAL STATE 215 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS 214 LARGEST CONTAINER 120 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 DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 160 JMAXIMUM 120 1 1 UNITS* ® a.GALLONS ❑ b, CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 C11CG and itma nnl * If EHS, amount mnet he.. in priurnift. 365 Yl URAU1 CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE ❑ q, OTHER ❑ b, UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ® c. TANK INSIDE BUILDING ❑ g,CARBOY ❑ k, BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ TANK WAGON p, 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 85 - 100 226 '--=7 ❑ Yes ® No 228 229 64742-65-0 ? 23.0 231 ❑ Yes ❑ No 232 253 3 234 235 ❑ Yes ❑ No 236 111 `i 234 239 ❑ Yes ❑ No 240 NI 5 242 243 ❑ Yes ❑ No 244 2a5 If more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach addjlionpl sheets of paper capturing the required infatmation ADDITIONAL LOCALLY COLLECTED INFORMATION 3i6 Page 2 Of 16 C:IWINDOWSITEMPIFRM-LDOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 20I CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA WORK BAY, ADJACENT SOUTH WALL YES NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 _Ld H L 1. 1 1 1 1 1 2 of 3 H-12 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes No 206 PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMONNAME 207 EHS* 208 Yes ®No MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complele if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE 211 RADIOACTIVE ❑ Yes ®No 212 213 CURIES PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a, FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 211 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 28 .55 1 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 Cllool[ one item and * If EI15, a nount must bo in pounds. 365 STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in, GLASS BOTTLE ❑ q, OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ❑ o- TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ® d, STEEL DRUM ❑ it. 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 ❑ e. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I > 85 226 Various Lubricating Base Oils 227 ❑ Yes ® No 228 6474X-XX-X 229 2 < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 234 235 ditl�ie 1}c►s ]Iatro ❑ Yes ® No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 - 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1% by weight if eetcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 3 6 l�� Page 3 Of 16 C:IWINDOWSITEMPIFRM-I,DOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE 200 1. FACILITY INFORMATION -BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 PCONO LUBE N' TUNE # 107 CHEMICAL LOCATION 201 1 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA BRAKE BAY, 1 ADJECENT WEST \VALL: 2) NEAR RESTROOM YES ® NO FACILITY ID # I M"11 I HT7FTTLI tv,3 MAP# (optional) 203 GRID# (opiional) I 204 of 3 D-5; J-8: K-8 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes No 206 PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMON NAME 207 208 MOTOR OIL EHS* ❑ Yes ® No CAS# gas Mixture *If EHS is "Yes", all amounts below must be in lbs. 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 Yes213 ❑ ®No::2712CURIES NIA PHYSICAL STATE 215 Check one item only) a. SOLID ( Y) ❑ ®b. LIQUID ❑ c, GAS 214 LARGEST CONTAINER ' 120 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 zzo 360 1720 1 UNITS* ® a,GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 1365 222 hlaek rnte itcm nnl 9 TfF.HS, ammnrt nmct he in petaj& S'1'URAUE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ In. GLASS BOTTLE ❑ q. OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ® c. TANK INSIDE BUILDING ❑ g-CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ TANK WAGON P. 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 > 85 226 Various LubricatinE Base Oils 227 ❑ Yes ® No 228 6474X-XX-X 229 Z < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 <2 234 Zhic r 235 ❑ Yes ® No 236 7 y 237 - 4 238 239 ❑ Yes ❑ N0 240 241 5 242 243 ❑ Yes ❑ No 244 245 If to ore hazardous components am present Opt greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required larnrmation. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 t% 1 3 Page 4 Of 16 C:MINDOWSITEMPTRM-LDOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑D> LETE ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LURE N' TUNE #I07 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BRAKE BAY; ADJACENT WEST WALL EPCRA YES Z NO FACILITY ID #7TT13 MAP# (optional) 203TD RID# (optional) 204 of 3 8 II. CHEMICAL INFORMATION CHEMICAL NAME 245 TRADE SECRET U Yes 29 No 206 WASTE ETHYLENE GLYCOL MIXTURE If Subject to EPCRA. refer to instructions COMMON NAME 207 xoa WASTE ANTIFREEZE / COOLANT EFTS* ❑Yes ®No CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a, PURE ❑ b. MIXTURE ® c. WASTE 1L4DIOACTIVE Yes ❑ Z No 212 213 CURIES N/A PHYSICAL STATE 215 Check one item only) a. SOLID 214 ( Y) ❑ ®b. LIQUID ❑ c. GAS LARGEST CONTAINER 55 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 "I MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 83 165 1675 1 134 UNITS* Z a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 one. item mil * if14IS, amount must be in 12un& {5 S'F El a. ABOVE GROUND TANK ® e, PLASTIC/NONMETALLIC DRUM ❑ i, FIBER DRUM CONTAINER ❑ in, GLASS BOTTLE ❑ q, OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ i. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ❑ c, TANK INSIDE BUILDING ❑ g,CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ TANK WAGON P. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 2z4 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 84 - 94 226 Ethylene Glycol 227 ❑ Yes Z No 228 107-21-1 229 2 0 - 10 230 Dieth lene Glycol 231 ❑ Yes ® No 232 233 111-46-6 3 2-4 234 235 ❑ Yes Z No 236 237 4 231 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 24$ Ir more hazardous components am present at greater than 1% by weight if non-earcinaganie, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 Page 5 Of 16 C:\WINDOWS\TEMP\FRM-I.DOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) []A D D —]DELETE MREVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Saute as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UST, WEST OF WORK BAY EPCRA Ej YES 0 NO FACILITY ID # f (optional) 203 GRID# (optional) 2 8 _ILMAP# of 3 C - 9 II. CHEMICAL INFORMATION CHEMICAL NAME NS TRADE SECRET LJ Ycs No 206 WASTE PETROLEUM HYDROCARBON II Suhjeel Io EPCRA, refer to instruct Ions COMMON NAME 207 208 WASTE MOTOR OIL EHS* Yes M No ❑ CAS# 20s tiliNtllre *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete it required by CUPA) 210 HAZARDOUS MATERIAL TYPE Cheek one item only) a. PURE ( Y) ❑ ❑ b. MIXTURE ®c. WASTE 211 RADIOACTIVE El Yes ®No 212 CURIES 213 N'. PHYSICAL STATE 215 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS 214 LARGEST CONTAINER $$0 FED HAZARD CATEGORIES Nil (Clieck all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 21T MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zzu 260 20 800 221 UNITS* ❑ a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 Cheek one ite nonly) * IrEFIS, a ugLhrjn.pnun STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE ❑ q. OTHER ® In. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ It. PLASTIC BOTTLE ❑ r. RAILCAR ❑ 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 HAZARDOi iS COMPONENT (For mixture or waste only) EHS CAS # I > 85 226 Various Lubricating Base Oils 227 ❑ Yes ® No zzs 6474X-XX-X zzv Z . < 15 230 Additive Package, includinv 231 ❑ Yes ® No 232 Mixture 233 3. <2 134 Zinc A1k ldithio 2.5 ❑ Yes M No 236 237 4 238 23% ❑ Yes ❑ No 240 y;l 5 142 —[— sat ❑Yes ❑ No zaa 14s If more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing 1be required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 3 Page 6 Of 16 C:IWINDOWSITEMPIFRM-I.D00 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE 2110 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BRAKE BAYS, ADJACENT NORTH WALL; EPCRA Ej YE5 0 NO FACILITY ID # 1 MAP# (optional) 203 GRID# (optional) 204 IH-6 3 of 3 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET U Yes 29 No 206 WASTE HYDROCARBON SOLVENT If subject to EPCRA, refer to instructions COMMONNAME 207 208 WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT EHS* El Yes ®No CAS# 201. Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) El a. PURE ❑ b MIXTURE ® c. WASTE 213 RADIOACTIVE ❑ Yes ® No 212 —] CURIES I PHYSICAL STATE (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS 214 215 LARGEST CONTAINER 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b, REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ® e. CHRONIC HEALTH AVERAGE DAILY AMOUNT TES MAXIMUM DAILY AMOUNT 2 i s ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zza 28 55 110 212 UNITS* 221 ® a.GALLONS ❑ b. CUBIC FEET ❑ ..POUNDS ❑ d. TONS DAYS ON SITE: 222 ppe iron onlu * If EHSa=0aULjUu9Jw_m+Puads_ }} J365 STORAGE CONTAINER ❑ a, ABOVE GROUND TANK ❑ e, PLASTIC/NONMETALLIC DRUM ❑ i, FIBER DRUM Elm. GLASS BOTTLE ❑ q. OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n, PLASTIC BOTTLE ❑ r. RAILCAR ❑ c. TANK INSIDE BUILDING ❑ g•CARBOY ❑ k. BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ h. SILO ❑ 1, CYLINDER ❑ TANK WAGON p, 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 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # i 35 226 C-9 to C-13 Saturated Hydrocarbon 227 ❑ Yes ® No 228 64741-41-9 229 230 2 1.0 lene 231 ❑ Yes ® No 232 1330-20-7 233 3 0.5 234 235 ❑ Yes ® No 236 1-4 237 4 239 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 20 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by w6Sht if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 . Page — 7 Of 16 C:IWINDOWSITEMPIFRM-LDOC 04/04/02 r"-y � 2001 Hazardous Materials ' Management Plan HMMP AND Hazardous Materials Disclosure Forms For: 1P NOV 14 2001 I&A" ECONO LUBE N' TUNE a107 K�E 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 Prepared by: 40 ific Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 L "'f4 ✓ J �- hrli C.- tiCity Of SAn IJAIS OBISPO MEMO FIRE DEPARTMENT 2160 Santa Barbara Avenue* San Luis Obispo, CA 93401-5240 * 805/781-7380 "Courtesy & Service" HAZARDOUS MATERIALS BUSINESS PLAN UPDATE FORM YEAR 2001 FACILITY NAME: ECONO LUBE Iv' TUNE #107 ADDRESS: 286 HIGUERA STREET, SAN LUIS OBISPO, CA 93401 - 4215 CONTACT PERSON: Jim WILMORE TELEPHONE: (805) 544-2976 Annual Inventory Update (due each year) ❑ No significant changes in inventory have occurred since the last Business Plan or inventory was submitted. ❑ New inventory forms are attached, ❑ Replace previous inventory with attached inventory. ❑ Replace only designated pages of inventory. Additional Comments: Yearly Review and Recertification ® I certify that the Business Plan has been reviewed and the information contained in the Business Plan is accurate and complete as of this date. Other Updates ❑ Please incorporate the following information into the Business Plan for this facility: I declare, under penalty of perjury, that the information provided herein is true and correct to the best of my knowledge. Signature: INw--_..__ Date: 11 / 15 / 01 Printed Name: JI ILMORE Please Return to: Molly Brown, Hazardous Materials Section City Fire Department 2160 Santa Barbara Avenue San Luis Obispo, CA 93401-5240 H:BUSINESS PLAN UPDATE FORM MOLLY ❑The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecommunications Device for the Deaf (805) 781-7410. 0 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Paee 1 of 8 I. FACILITY IDENTIFICATION FACILITY ID # 1 1 EPA ID # (Hazardous Waste Only) I I 1. 1 1 1 CAL 000 008 725 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) 3 ECONO LUBE N' TUNE #107 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification 2aae (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 (include liquids in ASTs and USTs); or the applicable Federal threshold ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CFR Part - CHEMICAL DESCRIPTION (OES 2731) 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. UNDERGROUND STORAGE TANKS USTs • UST FACILITY (Formerly SwRCB Form A) I . Own or operate underground storage tanks? EYES ❑ 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. 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 [:]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 perrecycler) 3. Treat hazardous waste on site? ❑ ® ONSITE HAZARDOUS WASTE YES NO 1 1 TREATMENT - FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) 4. Treatment subject to financial assurance requirements (for []YES ®NO 12 (Formerly DISC Forms 1772 A,B,C,D and Q 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 DISC Forn 1249) E. LOCAL REQUIREMENTS IS (You may also be required to provide additional infonnation by Your CUPA or local agency.) UPCF (1/99) 165 t . UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Paec 7.- 8 I. IDENTIFICATION FACILITY ID# I BEGINNING DATE 10D ENDING DATE 10/16/00 10/15/01 BUSINESS NAME (Same is FACILITY NAME or DBA � Doing Business As) 3 1 BUSINESS PHONE 102 ECONO LUBE. N' TUNE #107 805 544-2976 BUSINESS SITE ADDRESS 103 286 HIGUERA STREET CITY 104 ZIP CODE CA 105 SAN LUIS OBISPO '93401 -4215 DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 18 - 799 - 8612 7549 COUNTY 108 SAN LUIS OBISPO BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE do JIM WILMORE 805) 544-2976 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 112 JIM WILMORE 1(805) 544-2976 OWNER MAILING ADDRESS 113 286 HIGUERA STREET CITY 114 STATE 115 ZIP CODE I 193401 6 SAN LUIS OBISPO -CA - 4215 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 119 JIM WILMORE 1(805) 544-2976 CONTACT MAILING ADDRESS 119 ;286 HIGUERA STREET CITY 120 STATE 121 ZIP CODE ICA 193401 .SAN LUIS OBISPO - 4215 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 129 .JIM WILMORE PATRICIA WILMORE TITLE 124 TITLE 29 OWNER WIFE OF OWNER BUSINESS PHONE 12s BUSINESS PHONE 130 (805) 544-2976 (805 544-2976 24-HOUR PI-IONP Iz6 24-HOUR PHONE 131 PAGER # 127 PAGER# 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry ofthosc 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. SIGNATU • OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE I DATE 134 NAME OF DOCUMENT PREPARER 135 11 / 15 / 01 PACIFIC MANAGEMENT SVCS. 1 NAME OF 51G E (print) 136 TITLE OF SIGNER 137 JIM WILMORE OWNER UPCF ( 1/99 revised) 167 OES FORM 2730 (1/99) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one me Per malerial Der bifildirm or area) ❑ADD ❑DELETE ®REVISE 200 Page _of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA WORK BAY, ADJACENT WEST WALL rl YES 0 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # ? of 3 B - 5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes ET No 206 PETROLEUM HYDROCARBON MIXTURE If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* El Yes Z No AUTOMATIC TRANSMISSION FLUID CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE Check one item only) a. PURE ( y) ❑ ®b. MIXTURE ❑ c. WASTE 21t RADIOACTIVE ❑Yes ®No 212 CURIES 213 N/A PHYSICAL STATE 215 (Check one item only) Ela. SOLID ®b. LIQUID [I c. c. GAS LARGEST CONTAINER 120 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 21s ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 55 120 1 UNITS* Z a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 Check one item only * 1f EM. amount must be inpounds. 365 STORAGE a ABOVE GROUND TANK ❑ PLASTICINONMETALLIC DRUM CONTAINER ❑ e. ❑ i. FIBER DRUM ❑ in. GLASS 80TT[.E ❑ 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 ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 123 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 Aliphatic Petroleum Distillates 227 ❑ Yes ® No zzs 64742-65-0 229 2 230 231 Yes No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No zao 241 5 242 243 ❑ Yes ❑ NO 244 zas - —.,p...,c,,.e a„, p.cao„, a, g—a,o..." , - uy —gn, ,r nun -carcinogenic, or u, t io oy weight It carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one paqe per malerial ver buildine er area ❑ADD ❑DELETE ®REVISE zoo Page of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 IECONO LUBE N' TUNE #107 CHEMICAL LOCATION a"1 CHEMICAL LOCATION CONFIDENTIAL EPCRA WORK BAY, ADJACENT SOUTH WALL Q YES 0 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # [A JJ I of 3 IF-7 H. CHEMICAL INFORMATION CHEMICALNAME 205 TRADE SECRET LJ Yes N No 206 PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMONNAME 207 EHS* 20e ❑ Yes ® No :MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE RADIOA213 CTIVE ❑Yes ®No 212 CURIES NIA PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER 55 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 28 55 1 UNITS* ® a.GALLONS 221 ❑ b: CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 272 Ch¢ok ona item onlyl If EHS, amount must be in potinds. 365 STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM m. GLASS BOTTLE CONTAINER ❑ ❑ q. RAILCAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE 13UILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ®::. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HA-LARD0US1C MPONENT (For mixture or waste only) EHS CAS # 1 226 > 5Various �([��; 227 � tiricatin Base Oils ❑ Yes ® No 228 229 6474X-XX-X 2 < 15 230' dd O Package, including: 231 El Yes ®No z3z Mixture 233 3 < 2 239 Zinc AlkYldithio hos hate 235 ❑ Yes ®No 236 68649-42-3 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing rlrc required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If P . ase_Sian1%_m UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one we r malerial par build Inq or areal ❑A,DD []DELETE ®REVISE 200 Pave _ of 8 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ; CONO LUBE N' TUNE #107 CHEMICAL LOCATIONS CHEMICAL LOCATION CONFIDENTIAL =0z RA BRAKE BAY, NEAR RESTROOM .1. wovk � � ctci �Cti 5ov a I r OCv s ® NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 G-4, H-4 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes DQ No 206 PETROLEUM HYDROCARBON If Subject to EPCR4, refer to instructions COMMON NAME 207 EHS* 208 ❑ Yes. ® No MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. 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 ❑ Yes ® No 212 21 d CURIES N/A PHYSICAL STATE 214 LARGEST CONTAINER 215 (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS 120 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT 211 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 1 1 UNITS* ® a.GALLONS 13b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 Check one item oniv * If EHS, amount must be in pounds. 365 STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTI E ❑ 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 ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 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 > 5 226 Various Lubricating Base Oils 227 []Yes ® No 228 6474X-XX-X 229 2 < 15 230 Additive Package, including: 231 g , g� El Yes NO 232 Mixture 233 3 < 2 234 Zinc Alkyldithiophosphate 235 ❑ Yes ® No 236 68649-42-3 237 4 238 239 ❑ Yes [--1 No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than ] % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. i ADDITIONAL LOCALLY COLLECTED INFORMATION 24 If FPCRA. Mease Sian Here UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one Daae Per material per buildina or area ❑ADD ❑DELETE ®REVISE 200 Page 6 of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 E 1 BRAKE BAY, ADJACENT WEST WALL ❑ YE YES ® NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 IC-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes N No 206 WASTE ETHYLENE GLYCOL MIXTURE If Subject to EPCR4, refer to instructions COMMONNAME 207 'WASTE 203 EHS* ❑ Yes ON. ANTIFREEZE / COOLANT CAS# 209 :Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE RADIOACTIVE ❑ Yes ® No 212 CURIES 213 N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 55 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 eta ANNUAL WASTE AMOUNT 27134 STATE WASTE CODE 220 83 165 1 675 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 !Cheek one item oniv * iFEHS, amount must be in poutidi 365 STORAGE ❑ a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM m. GLASS BOTTLE RAIL CAR CONTAINER ❑ ❑ q. ❑ 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 ❑ TANK WAGON p. 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 # j 226 227 ❑ Yes ® No 229 229 R - Q Eth lene Glycol 107-21-1 2 0 - 10 230 :)iethylene Glycol 231 ❑ Yes ® No 232 111-46-6 233 3 2-4 234 Water 235 ❑ Yes ® No 236 7732-18-5 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 if more hazardous components am 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 241 Plea" UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one oa a oer material par bulfdl or area ❑ADD ❑DELETE ®REVISE 200 Page of 8 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA 1 UST, WEST OF WORK BAY YES 10 NO MAP# (optional) .203 GRID# (optional) 204 FACILITY ID # ? of 3 B - 5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes 0 No 206 WASTE PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS* Zoe Yes ®No WASTE MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE RADIOACTIVE 213 ❑Yes ®No 212 CURIES N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 550 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 NUAL WASTE AMOUNT 219 STATE WASTE CODE 220 T4A,8 :260 1520 0 221 UNITS* ®a.GALLONS Elb. CUBIC FEET ❑ c. POUNDS [Id. TONS 221 1 DAYS ON SITE: 222 Check one item only * If EHS, amount must be in pounds. 365 STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ L FIBER DRUM m. GLASS BOTTLE RAILCAR ❑ ❑ CONTAINER q. ® 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 ❑ 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 zz7 []Yes ® No 229 229 5 Various LubricatingBase Oils 6474X-XX-X 2 < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 < 2 234 Zinc Alkyldithiophosphate 235 ❑ Yes ® No 236 68649-42-3 237 4 238 239 ❑ Yes ❑ NO zoo 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am 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 2-t6 PleaseIf FPCR.A- Sign LjCi:C UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION [one me or material Per buildrna or area []ADD ❑DELFTE ®;REVISE 200 Page of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONNOCC��IILL�UpB�E TUNE #107 TN' I�HI3K )& 13AY�N ADJACENT NORTH WALL; 201 CHEMICAL LOCATION CONFIDENTIAL 202 2 BRAKE BAYS, S/E CORNER OF SOUTH WALL EPCRA El YES 0 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 IE-3; F-6 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Lj Yes N No 206 'WASTE HYDROCARBON SOLVENT If Subject to EPCR4, refer to instructions COMMON NAME 207 EHS* 208 ❑Yes ®No WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT CAS# zos .Mixture *If EHS is "Yes", all amounts below must be in lbs. 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 212 213 CURIES /A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 'i' MAXIMUM DAILY AMOUNT 216 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 28 55 1 110 1212 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 JDAYS ON SITE: 222 Cb=k one item only * If EHS, amount must be in pounds. 365 STORAGE ❑ ❑ q• CONTAINER a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE 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 95 ✓-9 to C-13 Saturated Hvdrocarbon 64741-41-9 2 1.0 230 xylene 231 ❑Yes No 232 1330-20-7 233 3 0.5 234 3thvl Benzene 235 ❑ Yes ® No 236 100-41-4 237 4 238 239 ❑ Yes ❑ No zoo 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capluting the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 6 UPCF (1/99) 169 OES Form 2731 F E B 2 1 2001 P cvQ.� roe 5 A0 r,A 2000 Hazardous Materials Management Plan HMMP AND Hazardous Materials Disclosure Forms For: ECONO LUBE N, TUNE #107 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 Prepared by: 40 CIBIc Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 F'Ims iati V116 '3 I—Ok 6vufA DK-) WMb 5 9 -01 fI " UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES I of 8 I. FACILITY IDENTIFICATION FACILITY ID ar 1 1 1 1 1 1 1 1 1 1 1 1 1 , 000 008 725 ame as Fas;iiity ]Name LU13E N' TUNE ##107 II, ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification pal4c [DES Form 2730 3 Does your facility If Yes, lease cam 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 (include liquids in ASTs and USTs); or the applicable Federal threshold ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CFR Part - CHEMICAL DESCRIPTION (OES 2731) 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. UNDERGROUND STORAGE TANKS USTS UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? EYES ❑ NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new LISTS? ❑ YES ® NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per lank) (Formerly Form 3. Need to report closing a UST? ❑ YES ® NO 7 C) UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STO. AGE LANK(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? 1. Generate hazardous waste? 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? 3. Treat hazardous waste on site? 4. Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? 5. Consolidate hazardous waste generated at a remote site? 6. Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite? ® YES ❑ NO 9 EPA Ili NUMBER - provide at the top of this page ❑YES ® NO 10 RECYCLABLE MATERIALS REPORT (one perrecycler) ❑ YES ® NO 11 ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DISC Fortes 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly DISC Forms 1772 A,B,C,D and Q [—]YES ® NO 12 CERTIFICATION OF FINANCIAL ASSURANCE (Formerly DTSC Form 1232) []YES ® NO 13 REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DISC Form 1196) ❑ YES ® NO 14 HAZARDOUS WASTE TANK CLOSURE CERTIFICATION (Formerly DISC Form 1249) LE (You may also be required to provide additional information by your CUPA or local agency.) UPCF (1/99) 165 IFIED PROGRAM CONSOLIDATED FO' FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION pa4r or I. IDENTIFICATION FACILITY 1D# IJ BEGINNING DATE 10 ENDING DATE 101 I I O1/01/00 112/31/00 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE 1N ECONO LUBE N' TUNE #107 805. 544-2976 BUSINESS SITE ADDRESS W1 286 HIGUERA STREET CITY 104 CA ZIP CODE 105 SAN LUIS OBISPO 93401 - 4215 DUN & BRADSTREET 196 SIC CODE (4 digit #) 107 18 - 799 - 8612 7549 COUNTY 10s AN LUIS OBISPO BUSINESS OPERATOR NAME l097BUSINESS OPERATOR PHONE 110 JIM WILMORE 544-2976 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 11.1 J I M WILMORE 10305) 544-2976 OWNER MAILING ADDRESS 11 3 286 HIGUERA STREET CITY 114 STATE 115 ZIP CODE 116 SAN LUIS OBISPO ICA 193401 - 4215 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 11 s JIM WILMORE 1(91)5) 544-2976 CONTACT MAILING ADDRESS 11 286 HIGUERA STREET CITY 120 STATE 121 193401 ZIP CODE Itt _ CA. -4215 IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME I I M WILMORE PATRICIA WILMORE TITLE 124 TITLE 129 OWNER WIFE OF OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (805) 544-2976 (805) 544-2976 24-HOUR PHONE 126 1 24-HOUR PHONE I I1 PAGER# 127 IP-AGER# 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry ofthose 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. S[ONATURE OWNER/OPERATOR OR DE DATE 134 NAME OF DOCUMENT PREPARER 135 �-DREPRESENTATIVE (,j ~ LA.A 01 / 29 / O1 PACIFIC MANAGEMENT SVCS. NAME OF SIGN riot) 136 TITLE OF SIGNER 137 JIM WILMORE OWNER UPCF ( 1/99 revised) 167 OES FORM 2730 (1/99) , o. UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one pae por material per building or area ]ADD ❑DELETE N10-VISE 200 A4ge __ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) y CONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL. IOCATION CONFiI)ENTIAL 202 WORK BAY, ADJACENT WEST WALL EPCRA YES 0 NO FACILITY ID # MAP# (optional) 203 1 GRID# (optional) 204 2 of 3 B - 5 II. CHEMICAL INFORMATION CHEMICAL NAME gas TRADE SECRET L1 Yes 19 No 20e PETROLEUM HYDROCARBON MIXTURE II $ub)ect to EPCRA, rater to in slruclions COMMON NAME 207 208 AUTOMATIC TRANSMISSION FLUID EHS* ❑ Yes ® No CAS# 200 Mixture *If EHS is "Yes", all amounts below must be in lbs, FIRE CODE HAZARD CLASSES (Complete it required byCUPA) 210 HAZARDOUS MATERIAL TYPE Check one item only) a. PURE 211 ( Y) ❑ ®b. MIXTURE ❑ c. WASTE 213 RADIOACTIVE ❑ Yes ® N o 212 CURIES NIA PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS 216 LARGEST CONTAINER 120 FED HAZARD CATEGORIES 21 d a. FIRE (Check all that apply) ® ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 117 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zza 55 120 UNITS* ®a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 Cheek one itcm onl * If EHS. amount must be in ottods. 365 STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM m. GLASS BOTTLE ❑Ti. UNDEitGR'OUND-TANK ' LJ f -CALM ❑ j- VK0 ❑ n. PLASTIC BOTTLE Lj r. OTHER ® c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ c. TOTE BIN ❑ d. STEEL DRUM [Ih. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGEPRESSURE ® 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 li hatic Petroleum Distillates 27 ❑ Yes ® No 228 64742-65-0 229 2 210 :31 ❑ Yes ❑ No 232 211 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 r7 20 741 5 242 243 ❑ Yes ❑ No 244 245 if more hazardous componants am present as greater than 1%by weight if non-carrinogcnic, m p-M by wctghl ircarcinogenic, nitach eMdonal sheets orpaper capturing the required information - ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA—Please So UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one a per malarial per Wilding or area ❑ADD) ❑DELETE MREVISE 200 Page _ of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE # 107 CHEMICAL LOCATION, 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA 1 WORK BAY, ADJACENT SOUTH WALL ❑ YES ® NO MAP# (optional) GRID# (optional) 204 FACILITY ID # 2 of 3 IE-7 H. CHEMICAL INFORMATION CHEMICALNAME 205 TRADE SECRET LJ Yes N No 206 PETROLEUM HYDROCARBO If Subject to EPCRA, refer to instructions COMMON NAME 207 208 El Yes ®No MOTOR OIL CAS# Zoe Mixture *If EHS is "Yes", all amounts below must be in Ibs. FIRE CODE HAZARD CLASSES (Complete if required by'�-UPA) 210 HAZATYPE (Check oUS neitem n) ❑ a. PURE ® b. !MIXTURE-\ ❑ c. WASTE f DIOACTIVE [I Yes ®N o 212 213 CURIES N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ lc. GAS LARGEST CONTAINER 215 55 FE13 HAZARD CATEGORIES 21" (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. P SSURE RELEASE N d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMQ 219 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zzo .28 55 , UNITS* a. GALLONS ❑ b. CUBIC FEET Elc. PO S ❑ d. TONS 221 1 DAYS ON SITE. Check one item onl If EHS, amount must be in pounds. 365 STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLA$ IC/NaNh1ETALLIC DRUM i. FIBER DRUM ❑ m. GLASS BOTTLE RAIL f ] 6��PLiTi{T�fi�O"I "i^%I y n. A r. OTHER ❑ c. TANK INSIDE BUILDING ❑ &:CARBOY ❑ 8DX [I o. TOTE BIN ® d. STEEL DRUM ❑ h. SILO ❑ I, YLINDER ❑ P. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. 8ELt7. AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b ABOVE AMBIENT ❑ c. BELOW A TENT ❑ d. CRYOGENIC 225 %W T HAZARDO,U� COMPONENT (F mixture or waste only) HS CAS # 1 22n 227 Various Lubricating,Base s ❑ Yes ® a 226 229 6474X-XX-X 2 < 15 230 dditivt Package, iri lu n : 231 ❑ Yes ® No '32 Mixture 233 3 < 2 214 Zinc -AHldW IIo ❑ 1 235 ❑ Yes ® No 236 649-42-3 237 4 238 239 0 Yes rl No 240 241 5 1j4 243 ❑ Yes ❑ No 244 245 If more hazardous2omponcnts am present at &realer than t I uy weight Knon-csreinogenie, or Q-1%by weight ifearcinogenic, attach additional shoal of paper capturing the required infarmafion. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 L Please UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION one Pa Oe Der material DeF buildin a or area ❑ADD ❑DEI.iTL MRL•VISE 200 Page _of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) i CONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BRAKE BAY, NEAR RESTROOM EPCRA YES NO FACILITY ID # MAP# (optional) 203 GRID# (optional) 204 IG-4, 3 of 3 H-4 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes 9 No 206 PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS' 208 El ®No MOTOR OIL CAS# 20a Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ®N o 212 213 CURIES NIA PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 720 FED HAZARD CATEGORIES 2 t 6 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE N d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT z17 MAXIMUM DAILY AMOUNT 113 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 360 720 r S5 1 -I � , 1 UNITS � a.GALLONS 22 ® ❑ b. CU131C FEET ❑ c. POUNDS ❑ d TONS ' DAYS ON SITE: 222 1365 Check one item only)• If EHS, amount must be in pounds. STORAGE n Csl ❑ a. ABOVE GROUND TANK ❑ e PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE — — 01i.77NDERGRO'UND'TANK ❑ f-CAN ❑`j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER Be. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ In. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 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 P27 Various Lubricadn Base Oils Yes No 2za 6474X-XX-X ?2s 2 < 15 230 Additive Packa e, including: 2a1 ❑ Yes ® No 232 Mixture 73) 3 <2 734 Zinc Alk-y1dithiopAjosphate 23S ❑ Yes ® No 236 68649-42-3 237 4 238 1� _ 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am pmgent al greeter then 1% by weight ifnon-carcinogenic, m 0.1% by weight ircareinogenic, attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 IfEPCRA- Please Sipri ere UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one Pa n it p a material per building or aroa ❑A DT) ❑DELETE mium 51i 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION tot CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA BRAKE BAY, ADJACENT WEST WALL YES 0 NO -T MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 IC-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Lj Yes N No 20a WASTE ETHYLENE GLYCOL MIXTURE If Subjeel to EPCRA, raforto inslrOclions COMMON NAME 207 EHS* 200 ❑ Yes ® No WASTE ANTIFREEZE / COOLANT CAS# 200 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE RADIOACTIVE ❑ Yes ® N o 212 CURIES 213 PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 S5 FED 1iAZARD CATEGORIES Id (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2i7 MAXIMUM DAILY AMOUNT=16 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 2.20 83 165 675 134 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS zztnds. DAYS ON SITE: 222 Check one item on1 • IFEHS, amount mustbe in ou 365 STORAGE CONTAIN-E ❑ a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM m. GLASS BOTTLE RAIL cAg Q li'_ UNDER'aRoUND�T-ANK ❑ f CAN' 0 BAG ❑ n. PLASTIC BOTTLE ❑ .r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBO Y ❑ 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 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 ❑ Yes ®No 228 229 _ tII lane Glycol 107-21-1 2 0 - 10 230 iet11 lene Glycol 231 ❑ Yes ® No 232 11146-6 233 -4 234 3 2-4 Ater 235 ❑ Yes ® No 236 7732-18-5 237 4 2311 230 240 241 5 242 243 ❑ Yes ❑ No 244 243 If more hazardous components am present at greater than I% by weighs if non -carcinogenic, or 0.1%by weight if carcinogenic, attach eddilional slxels of paper capturing She required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA. Please Sien Iierc UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one page per material per bu Ilding or area []ADD ❑1)i 1.l:TE ®REVISE 200 Page 7 ar 8 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA UST, WEST OF WORK BAY Ej YES N NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 2 of 3 113 - 5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes N No 200 WASTE PETROLEUM HYDROCARBON It Subject to EPCRA, refer to inorucllons COMMON NAME 202 EHS* Zoe El Yes ®No WASTE MOTOR OIL CAS# 209 'rIf EHS is "Yes", all amounts below must be in lbs. Mixture FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 2ttr HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE RADIOACTIVE ❑Yes ®N o 212 213 CURIES NZA PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 550 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE N d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT eta ANNUAL WASTE AMOUNT 219 STATE WASTECODE 220 260 1 520 4,800 221 IJN ITS ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 Check one item only)o If EHS, amount must be in ourtds. 3{}5 STORAGE a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM m. GLASS BOTTLE PAIL CAP IN -RR ® b. UNDERGROUND TANK LjfCAN 0 ]- BAG �❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ L CYLINDER ❑ p. TANK WAGON 2.23 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 2''-7 ❑Yes ® NO 228 227 - Various Lubricating Base Oils 6474X-XX-X 2 < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 <2 234 Zinc Alky1dithiophosehate 23% ❑Yes ® No 236 68649-42-3 237 4 ;?s 239 Yes No 2e0 1 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am 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 FPCRA. Me= am �z UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION (one oacte Permaterial petbulldin or area ❑ADD ❑DELETE NREVISE 20° Page _-d 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CONO LUBE N' TUNE #107 li L ATT11 N 201 I � AY�. ADJACENT NORTH WALL; CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA 2) BRAKE BAYS, S/E CORNER OF SOUTH WALL El YES 0 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 IE-31 F-6 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes D9 No 206 WASTE HYDROCARBON SOLVENT If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS* :oa ❑Yes N No WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT CAS# 209 *If EHS is "Yes", all amounts below must be in lbs. Mixture 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 ®N o 212 213 CURIES NIA PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 55 FED HAZARD CATEGORIES 216 a. FIRE b. REACTIVE (Check all that apply) ® ❑ ❑ 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 28 55 1110 1 212 UNITS* N a.GALLONS ❑ h. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 222 Chtcic one item onl " If EHS, amount must he inpounds- 365 STORAGE ❑ ❑ ❑ ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM m. GLASS BOTTLE CO q, RAILCAR El b. UNDERCROUND TANK — 'f-. CAN LJ j. SAO ❑n. PLASTIC'noTTLE' [j r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ In. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE N a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE N a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 22' ❑ Yes ® No 228 229 81 -9 to C-13 Saturated —Hydrocarbon 64741-41-9 2 1.0 230 lene 231 ❑ Yes ® No 232 1330-20-7 233 3 0.5 234 di 1 Benzene 233 ❑ Yes ® No 236 100-41-4 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight i f eaMnogeniv, atlach additiona3 sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If r_PCRA_ Please Smsm Here UPCF (1/99) 169 OES Form 27 DEC 2 9 C%JPN r-A s �i� 1999 COPY Hazardous Materials Management Plan HMMP AND Hazardous Materials Disclosure Forms For: 40 ECONO LURE N, TUNE aim ler#E 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 �4^fk Management Services vj Environmental Compliance Specialists I' 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 4+-lz,ob CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX A California Hazardous Materials Inventory Reporting Form - Business Owner/Operator Identification Page CALENDAR YEAR BEGINNING (1) 11 / 01 / 98 ENDING (2) 10 / 31 / 99 (3) PAGE 1 OF 6 BUSINESS NAME (4) ECONO LUBE N' TUNE #107 BUSINESS PHONE (5) (805) 544-2976 SITE ADDRESS (6) 286 HIGUERA STREET CITY (7) TSAN STATE (8) CA ZIP (9) 93401 -4215 LUIS OBISPO DUN & (10) SIC CODE (4 DIGIT) (11) 7549 18 - 799 - 8612 BRADSTREET OPERATOR (12) JIM WILMORE OPERATOR PHONE (13) (805) 544-2976 NAME OWNER INFORMATION OWNER NAME (14) 1 JIM WILMORE OWNER PHONE (15) 1 (805) 544-2976 OWNER MAILING ADDRESS (16) 286 HIGUERA STREET . CITY (17) SAN LUIS OBISPO STATE (18) Cq ZIP (19) 93401 - 4215 ENVIRONMENTAL CONTACT CONTACT NAME (20) JIM WILMORE CONTACT PHONE (21) (805) 544-2976 MAILING ADDRESS (22) 286 HIGUERA STREET CITY (23) FAN LUIS OBISPO STATE (24) CA ZIP (25) 93401 - 4215 Primary EMERGENCY CONTACTS Secondary NAME (26) JIM WILMORE NAME (31) PATRICIA WILMORE TITLE (27) OWNER TITLE (32) WIFE OF OWNER BUSINESS PHONE (28) (805) 544-2976 BUSINESS PHONE (33) (805) 544-2976 24-HOUR PHONE (29) i 24-HOUR PHONE (34) PAGER # (30) (805) 801-8429 PAGER # (35) 1 805) 801-8428 ACUTELY HAZARDOUS MATERIALS (AHM) ON SITE AHM (36) ❑ Yes X No If yes, and above Threshold Planning Quantities, attach a sheet of paper with a general description of the process and principal equipment. OCALLY COLLECTED INFORMATION Certification: I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. Print Name of Document Preparer (38) FFacific Management Services / 1923 North Fine, Suite #101 / Fresno, CA 93727 / (559) 251-4060 Signature of Owner/Operator (39) OES Form 2730 (04/96) Date (40) 11 / 29 / 99 .. , .,� e . � f...' ,. CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) El ADD ❑ DELETE X REVISE PAGE (2) OF (3) h.�J BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) ADJACENT WEST WALL OF WORK BAY MAPS (6) 2 of 3 GRID # (7) C - 5 CHEMICAL NAME (8) PETROLEUM HYDROCARBON MIXTURE TRADE SECRET (11) ❑ Y RJ N COMMON NAME (9) AUTOMATIC TRANSMISSION FLUID *EHS (12) ❑ Y X N CAS (10) Mixture 'IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) — HAZARD CLASSES' _ 'COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS TYPE (14) ❑ PURE X MIXTURE ❑ WASTE� RADIOACTIVE (15) ❑ Y x N (16) N/A PHYSICAL STATE (17) ❑ SOLID Xi LIQUID ❑ GAS CURIES FED HAZARD CATEGORIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH STATE WASTE (19) UNITS" (22) IX GAL ❑ CU FT MAX DAILY AMT (23) 110 CODE Cl LBS ❑ TONS DAYS ON SITE (20) 365 'If EHS, amounts must be in lbs. AVG DAILY AMT (24) 55 LARGEST (21) 120 CONTAINER III STORAGE CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE (26) ❑ ABOVE GROUND TANK ❑ UNDER GROUND TANK X TANK INSIDE BUILDING ❑ STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM (27) X AMBIENT ❑ ABOVE AMBIENT (28) I X AMBIENT ❑ ABOVE AMBIENT ❑ CAN ❑ CARBOY ❑ SILO ❑ FIBER DRUM ❑ BAG ❑ BELOW AMBIENT ANNUAL WASTE AMT (25) C� ❑ BOX ❑ CYLINDER ❑ GLASS BOTTLE ❑ PLASTIC BOTTLE ❑ TOTE BIN ❑ BELOW AMBIENT ❑ CRYOGENIC ❑ TANK WAGON ❑ RAIL CAR (29) /AVr (19) KAZARDOUS COMPONENT31 ENS A # 85 - 100 Aliphatic Petroleum Distillates ❑ Y X N 64742-65-0 2 ❑Y El 3 ❑Y ❑N 4 ❑Y ❑N I - 5 ❑Y ❑N 3 ADD I NAL LOCALLY SEE APPENDIXES A & B L DES Form 2731 (04M) i CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) 1= OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) 1) ADJACENT SOUTH WALL OF WORK BAYS; 2) ADJACENT SOUTH WALL OF BRAKE BAY, NEAR RESTROOM MAPS (6) 2 of 3; 3 of 3 GRID # (7) Map 2 Map 3 E -7 G-4, H-4, 1-4 CHEMICAL NAME (8) PETROLEUM HYDROCARBON TRADE SECRET (11) ❑ Y X N COMMON NAME (9) MOTOR OIL *EHS (12) ❑ Y X N CAS (10) Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS TYPE (14) ❑ PURE X MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ Y X N (16) 1 N/A PHYSICAL STATE (17) ❑ SOLID X LIQUID ❑ GAS CURIES FED HAZARD (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH CATEGORIES STATE WASTE (19) UNITS* (22) XI GAL ❑ CU FT.1 MAX DAILY AMT (23) 880 CODE CI LBS ❑ TONS DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs. AVG DAILY AMT 440 (24) LARGEST CONTAINER (21) 120 ANNUAL WASTE AMT (25) STORAGE (26) ❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TANK WAGON CONTAINER ❑ UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑ RAIL CAR X TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ PLASTIC / NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN STORAGE PRESSURE (27) 1 X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT STORAGE X' TEMPERATURE (28) AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC (29 ° WT R COMPONENT 31 EHS 1 > 85 Various Lubricating Base Oils ❑ Y X N 6474X-XX-X 2 < 15 Additive Package, including: ❑ Y X N Mixture 3 < 2 Zinc Alkyldithiophosphate ❑ Y X N 68649-42-3 4 ❑Y ❑N 5 ❑Y ❑N (33) ADDITIONAL LOCALLY COLLECTED INFORMATION SEE APPENDIXES A & B 7E$ Fars2731 (04M) CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Descri tion Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) 4 OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) ADJACENT WEST WALL OF BRAKE BAY BUILDING 1 MAPS (6) 3 of 3 GRID # (7) B - 4 CHEMICAL NAME (8) WASTE ETHYLENE GLYCOL MIXTURE (RECYCLED) TRADE SECRET (11) ❑ Y X N COMMON NAME (9) WASTE ANTIFREEZE / COOLANT (RECYCLED) *EHS (12) ❑ Y ® N CAS (10) Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE X WASTE l RADIOACTIVE (15) ❑ Y X N (16) (17) ❑ SOLID X LIQUID ❑ GAS I CURIES J (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) 134 UNITS* (22) XI GAL ❑ CU FT CI LBS ❑ TONS (20) 365 *If EHS, amounts must be in Ibs LARGEST (21) 55 @ @ Recycled in-house CONTAINER STORAGE (26) ❑ ABOVE GROUND TANK ❑ CAN CONTAINER ❑ UNDER GROUND TANK ❑ CARBOY ❑ TANK INSIDE BUILDING ❑ SILO ❑ STEEL DRUM ❑ FIBER DRUM X_ PLASTIC / NONMETALLIC DRUM ❑ BAG STORAGE PRESSURE STORAGE TEMPERATURE (2g) %WT 1 84-94 (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT MAX DAILY AMT (23) AVG DAILY AMT (24) ANNUAL WASTE AMT (25) ❑ BOX ❑ CYLINDER ❑ GLASS BOTTLE ❑ PLASTIC BOTTLE ❑ TOTE BIN (28) 1 X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 165 @ 83 @ 675 @ ❑ TANK WAGON ❑ RAIL CAR 0DIRAZARDOUSOMP N NT (311 EH5 2 A # Ethylene Glycol ❑ Y X N 107-21-1 2 1 0- 10 1 1 Diethylene Glycol ❑ Y X N 1 1 111-46-6 3 2-4 Water ❑ Y X N 7732-18-5 E 4 ❑Y ❑N 5 ❑Y ❑N SEE APPENDIXES A & B CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) O ADD ❑ DELETE X REVISE PAGE (2) OF (3) E BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) UST WEST OF WORK BAY MAPS (6) 2 of 3 GRID # (7) IC-5 CHEMICAL NAME (8) WASTE PETROLEUM HYDROCARBON TRADE SECRET COMMON NAME (9) ! WASTE MOTOR OIL CAS (10) Mixture FIRE CODE (13) HAZARD CLASSES* TYPE (14) PHYSICAL STATE (17) FED HAZARD (18) CATEGORIES (11) ❑Y XN *EHS (12) ❑ Y X N *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS ❑ PURE X MIXTURE X WASTE RADIOACTIVE (15) Ely X N (16) N/A ❑ SOLID X LIQUID ❑ GAS I CURIES X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH []CHRONIC HEALTH STATE WASTE (19) 221 UNITS* (22) X GAL ❑ CU FT MAX DAILY AMT (23) 520 CODE CI LBS ❑TONS DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs. AVG DAILY AMT (24) 260 LARGEST (21) 550 ANNUAL WASTE AMT (25) 4,800 CONTAINER STORAGE (26) FEOABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TANK WAGON CONTAINER v, I InlnFp npnl Mir) Te AIL! n reocnv n rv� i�in�o r, on.. rno STORAGE -- --- PRESSURE (27) X: AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT STORAGE TEMPERATURE (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑CRYOGENIC (29 %WT HAZARDOUS C MP N N 31 EHS C S# 1 > 85 Various Lubricating Base Oils ❑ Y ?X N 6474X-XX-X 2 < 15 AdditiveePackage, including: ❑ Y X N I Mixture 3 < 2 Zinc Alkyldithiophosphate ❑ Y X N 68649-42-3 4 ❑Y ON 5 ❑Y ❑N 03)ADDITIONAL LOCALLY COLLECTED INFORMATION SEE APPENDIXES A & B 3E5 Form 2731 {04M) V CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) 1) ADJACENT NORTH WALL OF BRAKE BAYS; 2) SOUTHEAST CORNER OF SOUTH WALL OF BRAKE BAYS MAPS (6) 3 of 3 GRID # (7) E - 2, F - 5 CHEMICAL NAME (8) WASTE HYDROCARBON SOLVENT TRADE SECRET (11) ❑Y SIN COMMON NAME (9) WASTE SAFETY'- KLEEN 105 PARTS WASHING SOLVENT "EHS (12) ❑ Y X N CAS (10) Mixture 'IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES" TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE LARGEST STORAGE CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE 'COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS. (14) ❑ PURE X MIXTURE X WAST�] RADIOACTIVE (15) ❑ Y N (16) N/A (17) ❑ SOLID XI LIQUID ❑ GAS I CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH 5X CHRONIC HEALTH (19) ff 212 (20) I365 —I (21) 55 UNITS* (22) X GAL ❑ CU FT CI LBS ❑ TONS "If EHS, amounts must be in Ibs. (26) ❑ABOVE GROUND TANK ❑ UNDER GROUND TANK ❑ TANK INSIDE BUILDING X STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM ❑ CAN ❑ CARBOY ❑ SILO ❑ FIBER DRUM ❑ BAG MAX DAILY AMT (23) 55 AVG DAILY AMT (24) 28 ANNUAL WASTE AMT (25) 110 O BOX ❑ CYLINDER ❑ GLASS BOTTLE ❑ PLASTIC BOTTLE ❑ TOTE BIN (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT�� (28) AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT El X' ❑ TANK WAGON ❑ RAIL CAR (29) ° WT HAZARDOUS MPQNEN-T --] 1111 EHS 2 CAS# 1 85 C-9 to C13 Saturated Hydrocarbon ❑ Y X N 64741-41-9 2 11.0 1 1 Xvlene I 1❑ Y X N 1 1 1330-20-7 3 0.5 Ethyl Benzene ❑ Y X N I100-41-4 4 ❑Y ❑N 5 ❑Y ❑N ADDITIONAL LOCALLY L INFORMATION SEE APPENDIXES A & B )ES Farm 2731 (041961 p F� 1998 �Op�pr Hazardous Materials Management Plan 'w ! 9 Q HMMP C107� AND �r Hazardous Materials totast� Disclosure Forms For: ECONO LUBE N, TUNE #107 rE 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401-5240 9 1999 (805) 781 - 7383 AEG Prepared by: tlfk Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 I (559) 251 - 4060 Fresno, California 93727 "✓ FAX (559) 251 - 5534 tl 0!i' q t aa A � ���� CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX A California Hazardous Materials Inventory Reporting Form - Business Owner/Operator Identification Page CALENDAR YEAR BEGINNING (1) 11 / 01 / 97 ENDING (2) 10 / 31 / 98 (3) PAGE 1 OF 5 BUSINESS NAME (4) ECONO LUBE N' TUNE #107 BUSINESS PHONE (5) 1 (805) 544-2976 SITE ADDRESS (6) 286 HIGUERA STREET CITY (7) STATE (8) CA ZIP (9) 93401 - 4215 SAN LUIS OBISPO DUN & (10) SIC CODE (4 DIGIT) (11) 7549 18 - 799 - 8612 BRADSTREET OPERATOR (12) JIM WILMORE OPERATOR PHONE (13) (805) 544-2976 NAME .- ... OWNER INFORMATION OWNER NAME (14) JIM WILMORE OWNER PHONE (15) (805) 544-2976 OWNER MAILING ADDRESS (16) 286 HIGUERA STREET CITY (17) I SAN LUIS OBISPO STATE (18) Cq ZIP (19) 93401 - 4215 ENVIRONMENTAL CONTACT CONTACT NAME (20) JIM WILMORE CONTACT PHONE (21) (805) 544-2976 MAILING ADDRESS (22) 286 HIGUERA STREET CITY (23) FAN LUIS OBISPO ZIP (25) STATE (24) [CA7771 93401 - 4215 Primary EMERGENCY CONTACTS Secondary NAME (26) JIM WILMORE NAME (31) TITLE (27) f OWNER TITLE (32) BUSINESS PHONE (28) (805) 544-2976 BUSINESS PHONE (33) 24-HOUR PHONE (29) 24-HOUR PHONE (34) PAGER # (30) PAGER # (35) ACUTELY HAZARDOUS MATERIALS (AHM) ON SITE AHM (36) Yes N No If yes, and above Threshold Planning Quantities, attach a sheet of paper with a general `❑ description of the process and principal equipment. ADDITIONAL LOCALLY COLLECTED INFORMATION (37) Certification: I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. Print Name of Document Preparer (38) 1 Pacific Management Services ! 923 North Fine, Suite #101 / Fresno, CA 93727 / (559) 251-4060 Signature of Owner/Operator (39) OES Form 2730 (04/96) Date (40) 11 / 24 / 98 1 CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD O DELETE X REVISE PAGE (2) OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) ADJACENT WEST WALL OF WORK BAY MAPS (6) 2 of 3 GRID # (7) C - 6 CHEMICAL NAME (8) PETROLEUM HYDROCARBON MIXTURE TRADE SECRET (11) ❑ Y X N COMMON NAME (9) AUTOMATIC TRANSMISSION FLUID "EHS (12) O Y MN CAS (10) Mixture 'IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES" _ -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS TYPE (14) ❑ PURE X MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ Y X N (16) N/A PHYSICAL STATE (17) ❑ SOLID X LIQUID ❑ GAS CURIES FED HAZARD (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH CATEGORIES STATE WASTE (19) UNITS" (22) X GAL ❑ CU FT MAX DAILY AMT (23) 110 CODE ❑ LBS ❑ TONS DAYS ON SITE (20) 365 "If EHS, amounts must be in Ibs. AVG DAILY AMT (24) 55 LARGEST (21) 120 ANNUAL WASTE AMT (25) CONTAINER STORAGE (26) CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE (29) %WT 1 85 - 100 2 3 4 5 ❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TANK WAGON ❑ UNDER GROUND TANK O CARBOY ❑ CYLINDER ❑ RAIL CAR X TANK INSIDE BUILDING ❑ SILO O GLASS BOTTLE O ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ PLASTIC / NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT O CRYOGENIC 0 HA RD MP NEN Aliphatic Petroleum Distillates LOCALLY(33) ADDITIONAL A SEE APPENDIXES A & B DES Farm 2731 [04M) 31 EHS 32 # ❑ Y X N 64742-65-0 ❑Y ❑N ❑Y ❑N ❑Y El ❑Y El CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) 1) ADJACENT SOUTH WALL OF WORK BAYS; 2) ADJACENT SOUTH WALL OF BRAKE BAY, NEAR RESTROOM MAPS (6) 2 of 3; 3 of 3 CHEMICAL NAME (8) 1 PETROLEUM HYDROCARBON COMMON NAME (9) MOTOR OIL i CAS (10) Mixture FIRE CODE (13) HAZARD CLASSES* TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE LARGEST CONTAINER GRID # (7) ' Map 2 D -7 Map 3 G-4, H-4, 1-4 TRADE SECRET (11) *EHS (12) ❑Y !N ❑Y XN *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ Y N N (16) N/A (17) ❑ SOLID X LIQUID ❑ GAS CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) (20) 365 (21) 120 STORAGE (26) CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE (29) ° WT 1 1 > 85 2 <15 3 <2 4 5 UNITS* (22) XI GAL ❑ CU FT Cl LBS ❑ TONS *If EHS, amounts must be in Ibs. MAX DAILY AMT (23) AVG DAILY AMT (24) ANNUAL WASTE AMT (25) ❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TANK WAGON ❑ UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑ RAIL CAR X TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ PLASTIC / NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN (27) 1 X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) N AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 00) HA R P N Various Lubricating Base Oils Additive Package, including: Zinc Alkyldithiophosphate SEE APPENDIXES A & B D�Es Form 2731 M4M) 31 EHS /32)-CAS# ❑ Y X N 6474X-XX-X ❑ Y X N Mixture ❑ Y X N E8649-42-3 ❑Y ❑N ❑Y ❑N CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) 1= OF (3) 5 BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) I UST WEST OF WORK BAY MAPS (6) 1 of 3 GRID # (7) E - 3 CHEMICAL NAME (8) WASTE PETROLEUM HYDROCARBON j TRADE SECRET (11) ❑ Y X N COMMON NAME (9) WASTE MOTOR OIL *EHS (12) ❑ Y X N J CAS (10) Mixture *IF EHS BOX IS "Y" �— - ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS TYPE (14) ❑ PURE X MIXTURE X WASTE RADIOACTIVE (15) ❑ Y X N (16) N/A PHYSICAL STATE (17) ❑ SOLID X LIQUID ❑ GAS CURIES FED HAZARD (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH CATEGORIES - -- STATE WASTE (19) 221 UNITS* (22) X GAL ❑ CU_ffj MAX DAILY AMT (23) 520 CODE ❑ LBS ❑ TONS DAYS ON SITE (20) 365 *If EHS, amounts must be in Ibs. AVG DAILY AMT (24) 260 LARGEST (21) 550 ANNUAL WASTE AMT (25) 4,800 CONTAINER STORAGE (26) ❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TANK WAGON CONTAINER X UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER []RAIL CAR ❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ PLASTIC / NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN STORAGE PRESSURE STORAGE TEMPERATURE (29) %WT 1 > 85 2 <15 3 <2 4 5 (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC HAZAROOUS COMPONENT Various Lubricating Base Oils Additive Package, including- Zinc Alkyldithiophosphate 31 EHS 32 A # ❑ Y X N 6474X-XX-X ❑ Y X N Mixture ❑ Y X N 68649-42-3 ❑Y ❑N El ID (33)ADDITIONAL LOCALLY A SEE APPENDIXES A & B OES Form 2731 (04/96) CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C TYPE PHYSICAL STATE FED HAZARD CATEGORIES California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ElADD ❑ DELETE X REVISE PAGE (2) 1= OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 I CHEMICAL LOCATION (5) 1) ADJACENT NORTH WALL OF BRAKE BAYS; 2) SOUTHEAST CORNER OF SOUTH WALL OF BRAKE BAYS MAPS (6) 3 of 3 GRID # (7) E - 3, F - 6 CHEMICAL NAME (8) WASTE HYDROCARBON SOLVENT TRADE SECRET (11) ❑ Y X N COMMON NAME (9) WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT *EHS (12) ❑ Y N N CAS (10) I Mixture FIRE CODE (13) HAZARD CLASSES* 'COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE N MIXTURE X WASTE RADIOACTIVE (15) ❑ Y N (16) N!A (17) ❑ SOLID X LIQUID ❑ GAS CURIES (18) N FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH X CHRONIC HEALTH *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS STATE WASTE (19) 212 UNITS* (22) X GAL ❑ CU FT CODE ❑ LBS ❑ TONS DAYS ON SITE (20) 365 *If EHS, amounts must be in Ibs. LARGEST (21) 55 CONTAINER STORAGE CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE (29) °oWT 1 85 2 1.0 3 0.5 4 5 (26) ❑ ABOVE GROUND TANK ❑ UNDER GROUND TANK ❑ TANK INSIDE BUILDING X STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM ❑ CAN ❑ CARBOY ❑ SILO ❑ FIBER DRUM ❑ BAG MAX DAILY AMT (23) 55 AVG DAILY AMT (24) 28 ANNUAL WASTE AMT (25) 110 ❑ BOX ❑ CYLINDER ❑ GLASS BOTTLE ❑ PLASTIC BOTTLE ❑ TOTE BIN (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC (301 HAZARDQQS COMPONENT C-9 to C13 Saturated Hydrocarbon Xylene Ethyl Benzene [COLLECTED SEE APPENDIXES A & B )ES Form 2731 (04196) ❑ TANK WAGON ❑ RAIL CAR 3T EHS CA5# ❑ Y X N 64741-41-9 ❑ Y N N 1330-20-7 ❑ Y X N 100-41-4 ❑Y ❑N ❑Y El 0 00 M r 00 0 0 14 in �o den � ° cd +� 1. 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V1 �O Envi:onmental Health Services UVZ1 myof (8.17x 1489 smusomspo P.O.Box 14892156 Sierra WavFire Department (805) 781-7380 San Luis Qi)ispo, CA 9340 2160 Santa Barbara Avenue San Luis Obisno CAg34Q1-,5240[ CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 02/10/2016 Time: Facility Name: LUBE-N-GO Agency Inspection Type ❑EHS IFIRoutine OCITY FIRE ❑Reinspection Site Address: 286 HIGUERA ST SAN LUIS OBISPO, CA 93401-4215 ❑Chargeable Reinspection ❑Change of Ownership Phone: (805)786-4056 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0005116 ❑Chargeable Secondary Containment Testinc Serial Number: DALYJ07TN PROGRAMS INSPECTED: OHazmat ❑x HW Generator DUST ❑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. GRANTED BY (NAME/TITLE): Name: Omar Godinez Title: Manager YES NO N/A BUSINESS PLAN --9 B Ej 131304-- -13usiness-plan4s-Gampte rren"vaftbi"u-r4og4nspestlan4HSC-29603 6,-Tifia-49-CGW2729) ❑x ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑x ❑ ❑ 13P03 Site layouttfacility 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) ❑x ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66265.16 EMERGENCY RESPONSE PLAN ! ❑ ❑ ER01 Emergency response/contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) IN] ❑ ❑ ER02 Facility is operated and maintained to preventlminimize/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) ❑% ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. c GENERAL EH VIOLATIONS ❑x ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724600000 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: KERRY BOYLE FACILITY REP: Omar Godinez FACILITY NAME: LUBE 30 ADI :SS: 286 HIGUERA ST HAZARDOUS WASTE GENERATOR 934 LUIS OBISPO, CA 3401-4215 EPA ID CAL00038777Q Total generated/month: Lbs or gals (average) NUMBER: Waste Oil: Solvents: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS lx ❑ ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR§66262.12) If not, Call (800) 618-6942 to obtain your CAL EPA ID number HAZARDOUS WASTE DETERMINATION ❑x ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) Oown knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years(Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑x ❑ ❑ GT05 Hazardous wastes disposed of at an authorized location (HSC §25189.5, Title 22 CCR §66262.12) ❑ ❑ ❑O GT06 Facility utilizes a registered hazardous waste transporter, and hazardous wastes shiDDed with a manifest (Title 22 CCR 566262.20. HSC 525160/25163(a)) Emilkrun ❑other ❑x ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23, 66262.40 (a)) STORAGE AND MANAGEMENT OF CONTAIN ERSITANKS ❑x ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 1990 days if waste generated per month is greater than or equal to 100 kg. (220 lbs.) 0180 days if waste generated per month is less than 100 kg (see note) 0270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Ix] ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) �f ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) Cl ❑ ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date,"HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) r1x ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize the release or reaction (Title 22 CCR §66262.34 (d)(2), flx ❑ © GT13 Containers/tanksllinm are comoatibls-with write stored or transferred_(ICR(- §66262.34 (d)(2), 66265.172) ❑x ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §§66262.34 (d)(2), 66265.1 ❑O ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§§66262.34 (d)(2), 66265.174) ❑x ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §§66262.34 (d)(2), 66265.195) ❑x ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE 19 ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (Title 22 CCR§ 66266.13, HSC §25250.4) ❑x ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.13) ❑x ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑x ❑ ❑ GT21 Solvents/othor recyclabie materials are manacled as hazardous wastes until recycled (Title 22 CCR 466266.3) SOURCE REDUCTION:For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑x ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (67100.7, 67100.8, HSC ❑x ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementationschedule of selected source reduction measures. (67100.7. 67100.8. HSC 625244.19) ❑ ❑ GT24 Hazwaste Contingency Plan prepared, current, submitted to the CUPA, maintained onsite. (Title 22 CCR §66265.51-.54) SUM 4RY OF OBSERVATIONS/VI _ATIONS ❑x No violations of underground storage tank, hazardous materials, or hazardous waste lawstregulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to you facility. El Violations were observed/discovered as listed below. All violations must be corrected by implementing the correcti% action listed by each violation. If you disagree with any of the violations or corrective actions required, please infon the CUPA in writina. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing wi 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: LUBE-N-GO VIOLATIONS ADDRESS: 286 HIGUERA ST SAN LUIS OBISPO, CA 93401-4215 INSPECTION COMMENTS: Cammille to complete Hazardous Materials Business Plan (230,9301) within two weeks of today's date. All else ok. Area near dumpster needs to have floor sweep used to pick up small area of waste oil. Empty small drum of water/motor oil and turn empty containers over to prevent further problems. INSPECTED BY: KERRY BOYLE DATE: 02/10/2016 NAME OF FACILITY REP: Omar Godinez 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 Services (805)781-5544 .V.. 2156 Si 1489 sm Us OW R 156 Serra Way 3Fire Depa merit (805) 781-7380 San Luis Obispo, CA 9 40Q 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 03/06/2015 Time: Facility Name: LUBE-N-GO Agency Inspection Type ❑EHS [@Routine Site Address: 286 HIGUERA ST OCITY FIRE ❑Reinspection❑Chargeable SAN LUIS OBISPO, CA 934014215 Reinspection ❑Change of Ownership ❑Complaint Phone: (805)786-4056 ❑Secondary Containment Testing Facility ID: FA0005116 ❑Chargeable Secondary Containment Testinc Serial Number: DAFWOOZNI PROGRAMS INSPECTED: ®Hazmat INHW Generator DUST ❑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. GRANTED BY (NAME/TITLE): Name: Omar Godinez Title: Manager YES NO N/A BUSINESS PLAN x❑ ❑ ❑ BP01 Business plan is complete, current, available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑O ❑ ❑ 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 0 ❑ ❑ 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 0 ❑ ❑ ER01 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, 66267.34 (d)(2), 40CFR 1265.31) ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c)(2)] GENERAL EH VIOLATIONS 0 ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724600000 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: KERRY BOYLE FACILITY REP: Omar Godinez SUMMARY OF OBSERVATIONSAMO.ATIONS ❑x No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: LUBE-N-GO VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED ADDRESS: 286 HIGUERA ST SAN LUIS OBISPO, CA 934014215 INSPECTION COMMENTS: Annual inspection. A new state requirement is now in effect - please submit an updated Hazardous Materials Business Plan during the First Quarter of each calendar year. If you haven't yet done so, please complete this requirement before the end of March 2015. Make sure empty drums are completely empty before storing outside near dumpster - keep drums covered so as to keep rain water out of them prior to recycling the drums. Facility well run, no problems noted. INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Omar Godinez DATE: 03/06/2015 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: i Environm—Kcal Health Services (805) 781-5544 Clq ` Vt- { P.O.Box 1489 sm ors mism 2156 Sierra Way Fire Depa ment 005) 781-7380 San Luis_ObispQ._CA 934QE 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 02/13/2014 Time: Facility Name: LUBE-N-GO Agency Inspection Type ❑EHS I]Routine Site Address: 286 HIGUERA ST OCITY FIRE ❑Reinspection SAN LUIS OBISPO, CA 934014215 ❑Complaint ❑Secondary Containment Testing Phone: (805)239-9301 Facility ID: FA0005116 Serial Number: DAMPFVOXD PROGRAMS INSPECTED: 17Hazmat 17HW 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 Knight Title: Lube Technician i YES NO N/A BUSINESS PLAN 9 ❑ ❑ 13P01 Business plan is complete, current, available during inspection (HSC 25503.5, Title 19 CCR 2729) x❑ ❑ ❑ 131*02 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) ❑x ❑ ❑ 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) 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 1265.31) ❑x ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 252Z4.4-5* 4 CfL FR 112-g(GX2)j— GENERAL EH VIOLATIONS ❑x ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724600000 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: KERRY BOYLE FACILITY REP: Larry Knight FACILITY NAME: LUBE-N- ADDR' 286 HIGUERA ST SAN LUIS OBISPO, CA HAZARDOUS WASTE GENERATOR 934014215 EPA ID CAL000387770 Total generated/month: Lbs or gals (average) NUMBER: Waste Oil: Solvents: Antifreeze: Others: YES NO N/A VIOL. # EPA I❑ NO/PERMITS p ❑ p GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR§66262.12) If not, Call (800) 618-6942 to obtain your CAL EPA ID number HAZARDOUS WASTE DETERMINATION p ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) Downknowledge ❑analysis ❑other O ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years(Title 22 CCR §66262.40.(c)) DI S POSALITRANS PO RTATION ❑ ❑ x❑ GT05 Hazardous wastes disposed of at an authorized location (HSC §25189.5, Title 22 CCR §66262.12) 19 ❑ ❑ GT06 Facility utilizes a registered hazardous waste transporter, and hazardous wastes shipped with a manifest (Title 22 CCR §66262.20, HSC §25160/25163(a)) ❑milkrun ❑other p ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23, 66262.40 (a)) STORAGE AND MANAGEMENT OF CONTAINEWTANKS 0 ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 090 days if waste generated per month is greater than or equal to 100 kg. (220 lbs.) 0180 days if waste generated per month is less than 100 kg (see note) 0270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000kg(13,200 Ibs) and no ❑x ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling(accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) 0 ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) p ❑ ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date,"HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑x ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize the release or reaction (Title 22 CCR §66262.34 (d)(2), 66265.171-.191,66265.177(c)) ❑x ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§ §66262.34 (d)(2), 66265.172) ❑p ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §§66262.34 (d)(2), 66265.173) ❑x ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§ §66262.34 (d)(2), 66265.174) ❑x ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §§66262.34 (d)(2), 66265.195) ❑p ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑x ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (Title 22 CCR§ 66266.13, HSC §25250.4) ❑x ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.13) ❑p ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) x❑ ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION:For facilities generating >12,000 kg./yr. of hazardous waste on ❑p ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (67100.7, 67100.8, HSC §25244.19, 25244.21) ❑p ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements:certification, amounts of wastes generated, process description, block diagrams, and implementationschedule of selected source reduction measures. (67100.7, 67100.8, HSC §25244.19) SUMM. X OF OBSERVATIONS/VIOi TIONS ❑x No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings andlor the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: LUBE-N-GO VIOLATIONS INSPECTION COMMENTS: INSPECTED BY: KERRY BOYLE DATE: 02/13/2014 ADDRESS: 286 HIGUERA ST SAN LUIS OBISPO, CA 934014215 NAME OF FACILITY REP: Larry Kniqht SIGNATURE OF FACILITY REP: &'"04"w "zi, STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: ' =rcCounty Of San Luis pbi a Environmental Health Ser►�ice- Sp0 �r� {8051781.5544 P.O. Box 1489 � n �ls ccjspo San LuiSies O Way C>t/ San Luis Obispo, CA 93406 Fi �A,CiLITY NAME: A pH re Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM HAZARDOUS MATER ALS INSPECTION FORM FORM i-l1. AG1 E ❑ EHS ❑ AG DEPT ❑ CITY FIRE PROGRAMS INSPECTED: E►�NO DYES NgPECTION REQUIRED: ❑—Business Plan R ❑ B------ EEFW data entry INSPECTION TYPE ❑ ROutine 0 Reinsp n ❑ Complaint ❑ Other!��a Result Code: —70 _80 —g0 I��G Action Code: —32 37 33 I-1 —31 n�J HW Generator ❑UST ❑ AGT SION TO INusmess Plan ❑ HW Generator ❑UST ❑AGT �RM►SSPECT; inspections may involve obtainin �xer�irtin com liance with ado ted codes. GRANTED BY 9 photographs, reviewin NAMEITITLE : 9 and copying records, and JyG$ NO ❑ ❑ COS ❑ N/A ❑ '' ❑ ❑ ❑ E N ❑ ❑ ❑ 1 ON 01 ❑CALARP ❑CALARP BUSINESS PLAN BPOl Business Ian is com p plete, current BP02 Inventory of hazardous materials is omailable during inspection BP03 Site layout/facili plete (HSC 25504 (HSC 25503.5, Title 19 CCR 2729) layout/facility maps are accurate Title 19 CCR 2729) (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TROT Facility has appropriate ppropriate training program (Title 19 CCR 2732 Training documentation is maintained on site for current personnel (Title 19 66265.16) 66265.R CCR 2732 Rf 77 rr-r, MERGENcY RESPONSE PLAN v El El EROl Contingency plan Is complete, updated, and maintains CCR § 66265.53/54) d on site (HSC 25504 ❑ ❑ ❑ ER02 Facility is Operated and maintained to preventlttrfnimi Tttle I9 CCR 2731 & 22 equipment including is g an ale Conrmand to to the environment. Maintains fire, all aeJntiti$ate tire, explosion, Or release of equipment including an alarm and to a ins system 43}required1&or appropriate {'Title 19 CCR Z73I & 22 CCR 6626 COMMENTS ABOVEGROUND P 5.31- ❑❑ 'LJ ATOl SPCC Plan is reviewed ET certif M STORAGE TANK ACT /❑' AT02 SPCC Plan is maintained d rcrtified by a registered engineer within last 5 on site or nearest field office. yrs. (40 CFR 1I2.5 b Go to http://www.sloputsliehtpllit.or,�lvuvir°nttierr.alht:altitl��?�rdniis mA�eriais.hrm. to obtain formC 5270} (j} ° "TuPiY with BPOI _BP03, T RO1 and EROl �S:.�i .f ._ _ 1 � / L � • r � '� L� . � •J� ..Pl : f.a:.l rflj ,.'� . ... J, GPs Coordinates: Latitude: —deg __min INSPECTOR decimal min Longltede: �de�mfn decimal min ;,7 j FACILITY FACILITY NAME: L; t' f ADDRESS: ) 1114"(wor' HAZARDOUS WASTE GENERATOR EPA ID Lbs or gals NUMBER: 4 Total generated/month: (average) Tiered Permit: CI;SW EICESQT CA MPBR Waste oil: 'V' Solvents: 4V, r Treatment Equipment: Antifreeze: � � Others: YES NO COS N/A VIOL. # EPA ID NO/PERMITS n' ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste �►� (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION �❑ ❑ ❑ ❑ GT03 Hazardous waste determination -,conducted (Title 22 CCR §66262.11) ❑own knowledge []analysis ❑other ❑ ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO, and permit ,).Q or "thorization from ❑TSC (HSC §25189.5, Title 22 CCR §66262.12) Elmflkrun []other ❑ ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERSITANKS ❑ ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 Ibs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) ners-of-haaar ut aal"rapr-oper-iy-labeled-(includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, nameladdress of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release a❑ or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) �9 ❑ ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ ❑ GTl 8 Used oil is managed as hazardous waste until recycled (includes proper )abeling, storage, etc) (HSC §25250.4) ❑ ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed �❑ rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) {Title 22 CCR§ 66266.130) ❑ ❑ ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) 0 ❑ ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, ampunts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25144.19) County of San Luis Obispo My or •� 'Environmental 781-554 Health Services SM i.>l. IS OBIS O Zr. (805) 781-5544 7 x7 .'9� � 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 j fr. HAZARDOUS MATERIALS INSPECTION FORM entry by: Date: 'r �! J .� Time: FACILITY NAME• 4 ' 'GENCY [] EHS AG DEPT ❑ CITY FIRE INSPECTION TYPE ❑ Routine ❑ Reinspection Complaint Other tri p Result Code: _70 _80 _90 Action Code: �32 �37 _33 �31 a r ADPRESS: '� PHONE: ) v PROGRAMS INSPECTED: []'Business Plan HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: VNO ❑ YES ❑ Business Plan H e a It ❑ UST ❑ AGT ❑CALARP PERMISSION TO INSPECT: inspections may involve obtaining photographs, reviewing and copying records, and Hetermining compliance with adopted codes. GRANTED BY NAMEITITLE : BUSINESS PLAN YES N COS N/A El ❑ ❑ BP01 Business plan is complete, current, &available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ X1 ❑ ❑ BPO2 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ +❑ ❑ ❑ BPO3 Site layout1facility maps are accurate (HSC 2.5504, Title 19 CCR 2729) TRAINING PLAN ❑ V ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ❑ ❑ ❑ i. AT01 ❑ ❑ ❑ ,"LJ AT02 r-nmPAF.NTR Go to hlto://www.slon CPS Coordinates: Latitude: INSPECTOR: 1 ABOVEGROUND PETROLEUM STORAGE TANK ACT SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) SPCC Plan is maintained on site or nearest field office. (HSC 25270) deciTal min ials.htm, to obtain forms to comply with BPOI -BP03, TROT and ay. AM 44 ngftifile, Vega n` Mh&l min FACILITY REP: a FACILITY NAME. ' ADDRESS: , HAZARDOUS WASTE GENERATO EPA ID "/] f r I� - / Lbs or gals NUMBER: 5 I _�,; %"Sf G�• �_. I�:� . Af ' Totul generated/month: (average) Tiered Permit: �CESW CESQT CA' PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: fry Others: - 4 YE NO COS A VIOL. # EPA ID NO/PERMITS GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262,12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION GT03 Hazardous waste determination "conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO, and permit or authorization from DTSC (HSC §251893, Title 22 CCR §6626L12) nd1krun El ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66162.10) GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Tide 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) r 0 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month Is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or I-qt limit) (Title 22 CCR §66262.34(c)) ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) tintti;ttatliarardn11,; wastereperlytai�elt(itfttutles apprar iarriate-"H�t7 AltlitlL►, WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.317 66262.34) ^ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) r GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑. GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed !� properly within one year of date emptied (Title 22 CCR §66261.7 (1)) RECYCLABLE WASTE r GTl8 Used oil is managed as hazardous waste until recycled (includes properlabeling, storage, etc) (HSC §25250.4) p` GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) - 4Tltle-22-CCR§ 662&&130) GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of ❑ lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating>12,000 kg./yr. of hazardous waste on site. ❑ ❑ ❑ �GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the Inspector within (5) days. (HSC §25244.19, 25244.21) ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and Implementation schedule of selected source reduction measures. (HSC §25244.19) It •%,-% Environmental Health Services (805) 781-5544 P.O. Box 1489 2156 Sierra Way san0 Luis omspo San Luis Obispo, CA 93406 Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: Time- EFW data entry by:WL FACILITY NAME: AGENCY ❑ EHS ❑ CITY FIRE IsKr❑ _ �, L i c� INSPECTION TYPE ❑ Routine Reinspection ❑ Complaint ❑ .�'_�_Other� ADDRESS: PHONE. PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator ❑ UST ❑ T ❑CALARP REINSPECTION REQUIRED: ❑ NO ❑ YES ❑ Business Plan ❑ HW Generator ❑UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A ❑ ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BPO2 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ ❑ BPO3 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EME GENC"MSFONSE PLAN ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/hazardous_materials.htm, to obtain forms to comply with BPOI -BPO3, TROI and ER01 ,� .�,n f ^r ,*p)r,,�� �n �' � �r�J�� I r�� 1 �'.�i1i'J � -"•7 .�.r� r' ��,�i�i /r)171 "6f� d•,. GPS Coordinates: Latitude: deg min decimal min Longitude: deg. —nun decimal min INSPECTOR: ; ' V FACILITY REP: J CADOCUME-1\Repro\LOCALS—i\Temp\c.lotus. notes. data\1 Inspection Form Page 1.doc 24-Jan-06 ,• FACILITY NAME: ADDRESS: HAZARDOUS WASTE GENERATOR .-1 ,4 - -, .,j _ f I -. - - EPA ID NUMBER: Total generaterl/month: Tiered Permit: Elcitsw ❑CESQT CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: /.'yU A Lbs or gals (average) YES NO N/A VIOL. # EPA ID NO/PERMITS ❑' ❑ ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) N Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GTOS Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §251895, Title 22 CCR §66262.12) ❑milkrun ❑other ❑ ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42166262.23) STORAGE AND MANAGEMENT OF CONTAINERSMANKS ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days N waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GTO9 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) F ❑❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) /❑ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) . ❑' ❑ ❑ GT13 Containers/tanksAiners are compatible with waste stored or transferred (Title 22 CCR§66265.172) a. ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) r_. ❑ ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly " within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 ----CCR§`66 G6-.M ❑ ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ,jE] ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) ' C:\DOCUME—i\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 � County of San Luis Obispo G! f ii �`i=°'= �` `" L ~ Environmental Health Services (805) 781-5544 SN]� E 1 kils OLMSPO M ' 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: Date: Time: FACILITY NAME: AGENCY I SPECTION TYPE ❑ EHS r Routine ❑ Reinspection ❑ AG DEPT 0 CITY FIRE Complaint El Other AD,pRESS: d� - i ` Result Code: _70 _80 ,)I PHONE: ' _90 Action Code: _32 _37 _33 _31 PROGRAMS INSPECTED: Business Planl ❑ 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) ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ❑ EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) �� ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous 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)) ❑ ❑ ❑ a❑i AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to htlp:Nwww.sfo17ublichcahlt.orgjcnvironmcntalheailltlhnzardi)us mutUWIS,blm. to obtain form t o'omply with BP01-BP03, TR01 and ER01 f — --� /►7lY JS /i 1,A -& r w ..rf.f _ %I Ai �tOf .. .� A.e10 a GPS Coordinates: Latitude: d]� min decimal min Longitude: deg _min decimal min INSPECTOR: 3 1 FACILITY REP: 1 FACILITY NAME: !� ADDRESS: f 4r . t HAZARDOUS WASTE GENERAT R EPA ID � � H� / Lbs or gals NUMBER: 4 l�r Total generated/month: (average) Tiered Permit: CESW CESQT !❑CA LJPBR Waste oil: �� Solvents: Treatment Equipment: Antifreeze: a.� Others: r YES, NO COS N/A VIOL. # EPA ID NO/PERMITS GTOI Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION .�" GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis Mother El F7 FI GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) gmflkrun ❑other `LJ r ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) �- ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) Pe90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 GT09 days. Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or l-qt limit) (Title 22 CCR §66262.34(c)) ❑F1GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GTl l Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) " .. releav ❑ ❑ ❑ GT13 or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ ❑ GTl4 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) iF ❑ ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE �f GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) . ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ElEl El GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of rg-fuFeeeye3i+Feen+otieft+R2C-04*&M6, ❑ ❑ D GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. 7 El k ❑ GT22 Generator is subject to SBl4 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ ;rLJ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) }: �i--` `�-• i •• `� Environmental Health Services city ■#■■■ P.O. Box 14 9 L1 �] � WI S OBI i ��, P.O. Box 1489 a7A1 e a a 2156 Sierra Way ■■ _ . San Luis Obispo, CA 93406 Fire Department (805) 781-7380 —� 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)i�N �k HAZARDOUS MATERIALS INSPECTION FORM FdataDate: �jr 1�by: Time: 1 ,f� lKirl FACILITY NAME: /f AGENCY ❑ EHS CITY FIRE INSPECTION ❑ ❑ TYPE Routine Reinspection Complaint Other ADDRESS: PHON : PROGRAMS INSPECTED: Busi ess Plan [liW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO IYES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A g ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) Ej Ej BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) [:J BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 .CCR 66265.16) EMERGENCY RESPONSE PLAN �T ❑ ❑ 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 materialstwaste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) El�ATOl D AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/hazardous_materials.htm, to obtain forms to comply with BP01-BP03, TRO1 and ER01 1 f��� � � .� � � . 1 �l J ,�1►!/fl.l�►�/!5I r � . J .1 J!►�7�IIf�/��'1/1�/'/ �C/ GPS C6ordiates: Lati&,de: t deg ------ in decimalf min Longitude:---�—deg_ _ _nUn. L decirVl main INSPECTOR: FACILITY REP: C:\DOCLUMG-I�Rel)ro,.l_OCALS-•1\Temp\c.lotus. notes data\1- Inspeclion Form Page 1.doc 24-Jan-06 V FACILITY NAME: r--{'� �I ���';' ADDRESS: HAZARDOUS WASTE GENERATOR f �] Lbs or gals EPA IDNUMBER: 'Total generated/month: (average) Tiered Permit: CESW CES�T CA ❑PI3Ii Waste oil: Solvents: V Treatment Equipment: Antifreeze: _ Others: YES NO NO N/A VIOL. # EPA ID NO/PERMITS GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) [Down knowledge ❑analysis ❑other Fj GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GTOS Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from D(HSC §25 5, Title 22 CCR §66 2.1Z �imlwmn ('( 1lYk Dottier MW ❑ GTO6 Hazardous wastes are shipped with manifest (TlUe 22 CCR §66262.20 GTO7 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42166262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS oGT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 0 9tl days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. 0 El 0�,� GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) GT10 Ignitable or reactive wastes are located 15 in (50 feet) from facility's property line (Title 22 CCR §66265.176) Q ��] GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste uow"ido pb sdkal stile, hazardous p eJ �o[g�et�j�f T��� CCR §6626231, 66262.34) �+:�� . • flit' n ,/' E— ❑ rel GT12 Containers/tanks containing rdous wastes are in good condition/handled to minimize ease or reaction (Title 22 CCR §66265.17V.191, 66265.177(c)) ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) E GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ►� GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ®� GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 —CCRTM266:1 GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) GT21 Solventstother recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §662663) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ n GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) G723 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUME—i\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 " 3 Environmental Health Services (805) 781-55" P.O. Box 1489 `. 2156 Sierra Way sCar�i Uuis osispo �:. San Luis Obispo, CA 93406 Fire Department (805) 781-7380 1 Date: Time: FACILITY _NAME:. vr�l J PHONE: 2 80 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM EFW data entry by: .z{�J AGENCY ❑ EHS CITY FIRE PROGRAMS INSPECTED: REINSPECTION REQUIRED: *NO ❑ YES Plan I [ZHW Generator I ❑ INSPECTION TYPE [l Routine ❑ Reinspection ❑ Complalrlt.... , i ,l Other AGT ❑CALARP ❑ Business Plan I ❑ HW Generator I ❑ UST I ❑ AGT + ❑CALARP BUSINESS PLAN YES NO N/A ❑ ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ ❑ BP03 Site layouttfacility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) MERGED - ❑ ❑ 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 materialstwaste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopubiichealth.org/environmentalhealMazardous_materials.htm, to obtain forms to comply with BPOI-BPO3, TR01 and ER01 GPS Coordinates: Latitude: deg min decimal min min INSPECTOR: N FACILITY REP: E-1\ReproaLCCALS--1\Temp\c.lotus, notes data\1 Incipec;lion Fr,)rr:l Page 1.doc 24-Jan-06 FACILITY NAME: � , ADDRESS: HAZARDOUS WASTE GENERATOR t Lbs or gals EPA ED NUMBER: Total generated/month: (average) Tiered Permit: ❑CESW ❑CESQT CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: L' Others: YES NO N/A VIOL. # EPA ED NO/PERMITS F17,1' ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ GTO5 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §25189.5. Title 22 CCR §66262.12) ❑milkrmr ❑other d7 ❑ ❑ GTO6 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ F ] GTO7 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) L E 190 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) i Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.21bs.) is held on site for over 90 days. • ❑ ❑ D GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑" GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) JGTIl Containers"f_bazardous--wastr__are-property-labeled--(includes-appropriate-date.-` HAZARDAUS- WASTE," waste composition/physical state, hazardous properties, nameladdress of generator) (Title 22 CCR §66262.31, 66262.34) ❑' ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑'/ ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑`. ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) .. ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers -are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , '` ❑ ❑ _ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) FJ ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ ❑' GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.199 25244.21) ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUME-i\Repro\LOCALS-1\Temp\c.lotus.notes.data\2 Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 i•.,_--.-:'r'<-"s•.;i-.Y.. a:a:a=- �K.�... .e, ��r—. ....��._.....�--q...--.,..rw.e.-s-..rm.,..�asw:•�.-vim•. .cm-,�+a f,.-r�sP;=/'..�rC'F'!"'''-.�"."'e'er*.f v,sr.-9. .—V��. ".'-�'-"-'ter".^-.^ I f •.--iS,LLf[f ty Y Environmental Health Services P.O. ox 14 9 JAn tuiS ow P.O. Box 1489 LJpo 2156 Sierra Way ,_. San Luis Obispo, CA 93406 Fire Department (805) 781-7380 ��— 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) llate:1�1�1�/qHAZARDOUS MATERIALS INSPECTION FORM EFW data entry by: Time: �'/h - Ir' FACILITY NAME: AGENCY INSPECTION TYPE ❑ EHS Routine ADDRESS:CITY FIRE Reinspection El Complaint ❑ Other PHONE: PROGRAMS INSPECTED: 'PrBusiness Plan HW Generator I.Af ❑ UST ElAdT ❑CALARP REINSPECTION REQUIRED: ANO ElYES Business Plan11P HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A 2 ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ©' ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) �- -�/ Eb ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ � AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ [V AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopnbiicheailh.org/Cnvironmentaihca]Mazardous_matcrials.htm. to obtain forms to comply ith BPOI-BP03, TRO1 and ERO1 r � / ii�) I r / 7.1 ��'. :f. •-_• �7 ., ��ry ram- --r�. _ � ;'lN f� /y �'! %� � _-' 1 GPS Coordinates: Latitude: _deg min decimal min Longitude: deg min decimal min INSPECTOR: FACILITY REP: C:\DOCUME_1\Repro\LCCALS-1\Temp\c.Iotus.notes.data\1_Inspection Form Page 1.doc 24-Jan-06 ~ 1 1 FACILITY NAME: 1 V 91 i� t ADDRESS: 'I •_; HAZARDOUS WASTE GENERATOR /.. EPA ID NUMBER: L��i'yl `I �V 9 G� `� Total generated/month: Tiered Permit: ❑CESW ❑CESQT ❑CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: Lbs or gals (average) YES NO N/A VIOL. # EPA ID NO/PERMITS ❑ ❑ ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous ► p.* k[ e 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑� ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other ' ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑, ' ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization From DISC (HSC §25189.5, Title �2 CCR M621,121 �]otherf 4� a ❑ ❑ GT06 axardous wastes are shipped with manifest ('f5t4e 22 C R 066 62.90) © ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) V 90 days if waste generated per month is greater�than or equal to 100 kg (220 lbs.) 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ®� GT09 Hazardous waste "satellite" collection is managed properly (complete labelinglaccumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) �,•' ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ," ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or - reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑- ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑'� ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ®' ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE F�.],' ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 66266.130) ❑ ❑ 2'- GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) EJ❑ l ' ,- GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ 0 , GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.199 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) ! C:\DOCUME-1\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 YES Environmental Ilealth $ [805} i81-5544 Ct ViCZ'S �� LJr p.D. Sox 1489 #0. 2136 Sierra Way y r San Luis Oblspa, CA 93486 1S 0j;1S Fire p epartrnent (805 781-7380 2160 Santa Barbara Avenue CERTIFIEp UNIFIED San Luis Cbisp❑ CA 93401-5240 HAZARDOUS PROGRAM AGE Dale: its.' , '.3 • fi. MATERIALS ski NCY (CUPgI 'Tine: ED TR01 1 TR02 tJ SANCTION FORM ilw BUSINESS PLAN Business plan is tom -_ Inventor plete, current, & available Burin Y of hazardous rnaterFals is complete Site sayout/racilit g Inspection (We 25503.5 Y maps are accur MSC 25504, Title I9 , Title 19 CCR 27 ate C 25504, Title 19 CCR 2729) TRAINING PLAN CCR 2729) Facility has appropriate trairdn ation is 8 prngrant {Title I9 66265_IeGti CCR 273� .9. Training docurnent�..._ _ sr a ar Utirrent 66265.16) personnel (Title 19 CCR 2732 8,22 CCR EMERGENCY RE EROl Contingent SPONSE PLAN e CCR Y plan is complete, updates ER02 T''acils # 66265.53154) ,and maintained on site [IiSC hazardnusopeteri al and maintainers to matcriaislwaste pYent/nrinirn; 2SSO4, Titre 19 CCR 2731 & 22 equipment including an nsfituents tot zelmitigate Rre 43) alarm and communications sys ein(Maintain,, �pl0.sian or all re retease of Title 19 CCR y73 required or appropriate �-� AT01 ABOVEGROUND PET 1 & 22 CCR 66265,31- r� SPCC Plan RaLEUM STORAGE AT02 SPCC Plan is IRtaed ano t�site fed TAgi � ACT Y a registered en Go to http:llsvwW.$)npubiirheaitlr.o °r nearest field 2527n seat S �iYTS >�enviroumenralh atfice' {BSC 25270) �'� {� CFR 122.5(b}} Z{.'OM � � � rr calZhlfrar.�pas /... �. 1 - nfatenals.btrn. to obtain to rrn, tocnru �R0 i and E ordinates: Latfftrsde: ode GPS C g——Min�decimas min Long �deg�nrin INSPECTOR FACILITY �derarnal min C: \DOCU REP: � � 1lfiepFO�LOCALS-f liem plc.lofus•notesAatall-fnspeCtion Form Pan rrr �j�CIIIIY NAME: , - . I -lit % ADDRESS: ��b F r� �G6 HAZARDOUS WASTE GENERATOR I EYE IDNUMBER: i f Total generated month: T'ieredhrmit: ❑CESW ❑CESQT CA Treataror ❑I'BR Waste oil: �' Solvents: ---ter= iPmrot: � � EQ u t Antifreeze: r rn Others: Lbs or gals (average) LN/A VIOL. # EPA ID NO/PERMITS GTO1 Generator has �.. an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Cali (SOU) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ©' Q ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other ©� Q ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) Q DISPOSAL/TRANSPORTATION 0 ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DT5C (HSC §25189.5, Title 22 CCR §66262.12) ninilkrun ❑other - EJ ❑ ❑ GT06 Hazardous wastes shipped with manifest (Title 22 CCR §66262.20) GT07 ❑ Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) �� ❑ STORAGE AND MANAGEMENT OF CONTAINERS/TANKS GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) G 90 days if waste generated per month is greater than or equal to 100 kg (2201bs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated month is less per than 100 kg and transported more than 200 miles (see note) ❑ Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,2001bs.)and no acutely/extremely hazardous waste over I kg (2.2 MS.) is held on site for over 90 days. GT09 Hazardous waste "satellite" collectionis managed properly (complete labelinglaccuntulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ GT10 Ignitable or reactive wastes are located 15 in (50 feet) from facility's property line (Title 22 CCR §66265.176) El EJr Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste comlxrsition/physical state, hazardous properties, name/address of Lin ❑ ❑ CCR §66262.31, 66262,34) generator) (Title 22 GT12 Containers/tanics containing hazardous wastes are in good condition/handled to minimize release ❑ ❑� ❑ or reaction (Title 22 CCR 466265.1711.191, 66265.177(c)) GT13 Containers/tanks/liners are compatible with ❑ 0 ❑ waste stored or transferred ('(Title 22 CCR§66265;172) GT14 Containers storm h d ❑ El©� ❑ El ❑ ❑ g azar wastes are closedlsealed (Title 22 CCR §66265.173) GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) GT19 Used oil filters for recycling are managed properly (drained of Free iln►vin _ 10'nPlOorcunTafttel . labelea -drainedused oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For Facilities generating >12,000 kg./yr. of hazardous waste on site. GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is GT23 able make them available to the inspector within (5) days, (HSC §25244.19, 25244.21) Source Reduction Evaluation and Plan contains the following five elements: Certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected ,source reduction measures, (HSC §25244.19) C:\DOCUME-1\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator rtr,r 7_RAnY_nc -7 RA-- — Environmental Health Services (805)781-5544 P.O. Box 1489 2156 Sierra Way San Luis Obispo, CA 93406 S� LWS C)BI.SpO Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) Date: HAZARDOUS MATERIALS INSPECTION FORM Time: j �������� 4•T FACILITY NAME:: F.n.t+n. � I'jilk' T I1 , f I AGENCY ADDRESS: r- r . PHONE: ❑ EHS ❑ AG DEPT A CITY FIRE EFW data entry by: II,1~9Jx6ICehlii'J0 Routine Reinspection ❑ Complaint ❑ Other PROGRAMS INSPECTED: Business Plan HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO El YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP 'ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and etermining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YE NO N/A ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN El TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR EMERGENCY RESPONSE PLAN { ❑ El 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 El El AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS 4 r t GPS Coordinates: Latitude: deg —min, _decimal min Longitude:_deg ..decimal min INSPECTOR: it A /,V, . (4, 41 FACILITY REP: V 'Itlhp-pro\LOCALS-1\Temp\c.lotus.notes.data\1__Inspection Form Page 1.doc 20-Jul-04 FACILITY NAME:F�' ,,n A ! ADDRESS: HAZARDOUS WASTE GENERATOR Lbs or gals EPA ID NUMBER: CAL � � ` � Total generated/month: (average) ) Tiered Permit: ❑CESW ❑CESQT CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS ❑ ❑ GTOI Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GT03 11,4zardous waste determination conducted (Title 22 CCR §66262.11) wn knowledge [:]analysis ❑other ❑ kardous ❑ GT04 waste analysisltest records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION Q/ ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DT3C (HSC $251895, Title 7CCR § 1 62,12 jmilkrun other E '❑ ❑ GT06 Itiazardous wastes are shipped with manifest ( de 22 CCR §66 24 ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAI S ❑ NER /TANKS ❑ GT08 Jia,*ardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if waste generated per ntnnth is greater than or equal to 100 kg (220 lbs.) I80 days if waste generated per month is Iess than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GTII Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all lank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed t e :s, au eaus erne ur me a rec ama on e CCR§ 66266.130) ❑ ❑ GT20 Spent Iead-acid batteries are being properly stored and transferred offsite under manifest or bill of / lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days.. (HSC §25244.19, 25244.21) ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation r• schedule of selected source reduction measures. (HSC §25244.19) ���� A:1UST, AGT, Hazardous waste generator inspection. forms.doc 3-Nov-03 Environmental Health Services city it J of (805)781-5544 1 y P.O. Box 1489 r7 San U OBISPO rar 2156 Sierra Way •San Luis Obispo, CA 93406 Department of Ariculture/Measurement Standards (805) 781-5910 Fire Department (805) 781-7380 2156 Sierra Way Suite A •San Luis Obispo, CA 93401 2160 Santa Barbara Avenue Date: SDI) Time: W' FACILITY NAME: P San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM s L t1GL tv,7 e-, ADDRESS: 286 v e-11-4 p 94,7L(� i C" CD bl•S U c•4 • r, PHONE: Z y �� PROGRAMS INSPECTED AGENCY ❑ EHS ❑ AG DEPT CITY FIRE EFW data entry by: INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint ❑ Other Business Plan I JA HW Generator I ❑ UST I ❑ )(GT I V❑CALARP REINSPECTION REQUIRED: I ❑ NO ❑ YES I ❑ Business Plan ❑ HW Generator 1 ❑ UST I ❑ AGT I ❑CALARP 'ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and eterrnining compliance with adopted codes. GRANTED BY (NAMEfTITLE): BUSINESS PLAN YES NO N/A BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) LO ❑ ❑I BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN LlJ ❑ ❑ TRO1 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 ❑ ❑ ❑ ❑ ❑ ❑ COMMENTS ❑ ❑ r Vr ER01 ER02 .: AT01 AT02 EMERGENCY RESPONSE PLAN Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) Facility is operated and maintained to prevent/minimize/mitigate 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 SPCC Plan is prepared and certified by a registered engineer within last 3 yrs. (HSC 25270) SPCC Plan is maintained on site or nearest field office. (HSC 25270) Ir GPS Coordinates: Latitude: "deg _min decimal min Longitude:_deg_mindecimal min INSPECTOR: FACILITY REP: C UMENT1JeffpIF0RMS11nspection formsWispecflbri Form Page 1.doc 21-Apr-04 Environmental He. services ' i ty of San Luis Ob (805) 781-5544 ] I ff P.O. Box 1489 Fire D epartment 80 - aJ 2156 Sierra Way •San Luis Obispo, CA 93406 2160 Santa Barbarara Avenue p vyr Department of Aerieulture/Measurement San Lnis Ohisnn (A 93401-5240 Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: � /r�- /Q � EFW data Time: & O entry by: FACILITY ID NO: AGENCY INSPE ION TYPE FACILITY NAME: L t -7Z4 ❑ DEH outine ❑ AG DEPT ❑ Reinspection ADDRESS: o�ITY FIRE Complaint VEl El UTILITIES ❑ Other PHONE: PROGRAMS INSPECTED: ❑ Business Plan IW Generator ❑ Cal ARP ❑ UST ❑ AGT ❑ Tiered Permitting RE UIRl7]: -- � ❑ ❑ YCS Business Plan ❑ ❑❑❑❑ HW Generator Cal ARP UST AGT � Tiered Permitting PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining -ompliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES► No N/A J ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC §25503.5, Title 19 CCR §2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) ❑ ❑ BP03 Site layouttfacility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TROT TR02 TRAINING PLAN Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) Training documentation 22 CCR §66265.16) EMERGENCY RESPONSE PLAN ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR §2731 & 22 CCR §66265.53/54) ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- .43) COMMENTS: GPS Coordinates: Latitude: _deg min decimal min Longitude:degmindecimal min wt 7 Inspector: Facility Representative: A:\CUPA inspection forms 2.doc 20-Mar-03 FAC:; ITY NAME: DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA H) NUMBER: %� t 0tJ d f7 7 A 13 Total generated/m Lbs oal ut iY (average ) Tiered Permit: ❑C1:51i' ❑CESQT ❑c :i pBR Waste nil: �J Solvents: Treatment Equipment: Antifreeze: 0 0L Others: 41—F —5 d YES _ NO N/A ❑ VIOL. # EPA ID NO/PERMITS GTO1 Generator has QX❑ an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GT03 HazaSdous waste determination conducted (Title 22 CCR §66262.11) ❑ ❑ vn knowledge ❑analysis ❑other GT04 i azardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes ,svre transported and/or disposed to a facility with an EPA ID NO. and permit or autl riration fro,ra D :5C (HSC §25189.5, Title 22 CCR §66262.12) ❑ ❑ m 1krin3 ❑other GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ll�((,��-77rJ ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08H87 ous wastes are accumulated on site as follows (Title 22 CCR §66262.34) EA days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no ❑ ❑ L�r acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. GT09 Hazardous "satellite" waste collection is managed properly (complete labelinglaccumulation time/55-gal ❑ ❑ or 1-qt limit) (Title 22 CCR §66262.34(c)) GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) on amers of agar ous waste arc properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or ❑ ❑ reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted ❑ ❑ ❑ (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC d ❑ ❑ §25250.4) GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed tuillpliuuf cuts! stg oil fitters,"and transferredor metal reclamation) ('Title 22 CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of ❑ ❑ lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is ❑ ❑ able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) A:\CUPA inspection forms.doc 19-Sep 1 FAC.'LITY NAME: ADDRESS: SUMMARY OF OBSERVATIONSNIOLATIONS o violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. �N SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. VIOLATIONS NUMBER MINOR MAJOR COMMENTS: CORRECTIVE ACTION REQUIRED Inspected By: Facility Rep Name:` 1 Date: Signature: �+u Sign the certification below and mail this form to the CUPA inspector after all corrective actions have been feted. Retain a copy for your recur . 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: A:\CUPA inspection forms.doc 19-5ep-02 Environmental Heal 7ervices (805) 781-5544 `kA P.O. Box 1489 r �„ei •+��� 2156 Sierra Way •San Luis Obispo, CA 93406 Department of Agriculture/Measurement Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 Date: 5 / ] / o 3 Time: CIO1 ,30 FACILITY ID NO: ?ity of San Luis Obi Fire Department (805) 781-7380 III I f l �I{ !` 2160 Santa Barbara Avenue San Luis Ohisno CA 93401-5240 Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM FACILITY NAME: 6eolyo ADDRESS: �g(p i-�iirc8� PHONE: PROGRAMS INSPECTED: EFW data entry by: AGENCY INSPECTION TYPE V �� ❑ DEH Routine '87r ❑ AG DEPT ❑ Reinspection ❑ TY FIRE ❑ Complaint [�] CITY UTILITIES ❑ Other � Business Plan f HW Generator ❑Cal ARP ❑ UST ❑AGT ❑Tiered Permitting NO M4S ' ❑ Business Plan I ❑ HW Generator f ❑ Cal ARP I —❑ UST ❑ AGT ❑ Tiered Permitting PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES' NO N/A ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC §25503.5, Title 19 CCR §2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) 22 CCR §66265.16) EMERGENCY RESPONSE PLAN ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR §2731 & 22 CCR §66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- .43) COMMENTS: GPS Coordinates: Latitude: _deg _.min decimal min Longitude:_deg_mindecimal min Olt Inspector: Facility Representative: A:\CUPA inspection forms 2.doc 20-Mar-03 FACILITY NAME: DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA ID NUMBER: Z j Tiered Permit: ❑CESW Treatment Equipment: a oopa g Total rener ted/ ,ni L(a a als .. €� �j � (average) ❑CESQT ❑CA PBR Waste oil: `i3 Solvents: Antifreeze: �� Others: — J YES N/A VIOL. # EPA ID NO/PERMITS El�GTOI Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. V❑ GT03 HAZARDOUS WASTE DETERMINATION Hazardous ❑ waste determination conducted (Title 22 CCR §66262.11) own knowledge []analysis❑other 'hazardous ❑ ❑ GT04 waste analysistiest records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or From DTSC (HSC §25189.5, Title 22 CCR §66262.12) ❑ ❑ GT06 Xaorization miIkrun ❑other Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 llazr sous wastes are accumulated on site as follows (Title 22 CCR §66262.34) X90 days if waste generated per month is greater than or equal to 100 kg (2201bs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) f ,T11 Containers of hazardous waste are properly labeled (Includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ F�r ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems Is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly /va� within one year of date emptied (Title 22 CCR §66261.7 (f)) Jr RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC ❑ ❑ GT19 §25250.4) Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ M' GT22 Generator is subject to SB14 and has prepared and ietained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) El El GT23 Source Reduction Evaluation and Plan contains the following rive elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) A;\CUPA inspection forms.doc 19-Sep-02 FACILITY NAME: ADDRESS: SUMMARY OF OBSERVATIONSNIOLATIONS No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. VIOLATIONS MINOR MAJOR rN^'UMBER CORRECTIVE ACTION REQUIRED ffn COMMENTS: T wii I 13 e4w-spee N '5 e i 5 Inspected By: Facility Rep Name: Date: � r Signature: Sign the certification below and mail this form to the CUPA inspector after all corrective actions have been completed. Retain a copy for vour records. 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: AACUPA inspection forms.doc 19-5ep-02 Division of Environn +al Health t (805)781-5544 P.O. Box 1489 2156 Sierra Way -San Luis Obispo, CA 93406 Department of Agriculture/Measurenlent Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 Date: `/ Time: C7 -- /J ;"-qp Fire Depart L): (805) 781-7380 2160 Santa i_ r:ara Avenue San Luis nhisnn CA 91401-5240 ■..-_ _. � ol. Swi. L.+•:� DG;.�a ...-..-.��..-..... �-..-_:i-l' Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM 1J11 EFW data entry by: k FACILITY ID NO: AGENCY INSPECTION TYPE FACILITY NAME: ❑ DEH ❑ Routine ❑ AG DEPT ElReinspection ADD E5S: L❑-161TY FIRE ❑ mplaint ❑ CITY UTILITIES Other sA PHONE: PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator UST ❑ AGT ❑ Tiered Permitting REINSPECTION REQUIRED: ❑ NO EYES El Business Plan ❑ HW Generator Qf UST El AGT ❑ Tiered Permitting ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining ,ompliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO N/A Business plan is complete, currei • • ... , ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR §2732 & 22 CCR §66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR §2731 & 22 CCR §66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- F", f ' 1 1�6 "-q�lt'AW4 '/� /11V? zovy� lwl'A� f-, JjPA inspection orrns.cioc 'i 9-Sop-02 Ate- Division of Environ, tat Health m (805) 781-5544 P.O. Box 1489 ii 2156 Sierra Way •San Luis Obispo, CA 93406 . Department of Agricttlture/Measurement Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 7ity of San Luis Obispo Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 - Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) P/ HAZARDOUS MATERIALS INSPECTION FORM Date: Time: a [ — _1 FACILITY ID NO: AGENCY FACILITY NAME: ❑ DEH ❑ AG DEPT ADDRESS: krCITY FIRE Lj CITY UTILITIES EFW data entry by: INSPECTION TYPE Routine Lj Reinspection ❑ commalpt f ❑ Other 440,07 PHONE: I Zr_r l: �e PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator UST ❑ AGT ❑ Tiered P initting REINSPECTION REQUIRED: NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT L] Tiered Permitting MISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining liance with adopted codes. GRANTED BY(YNAME/TITLE : �_•• BUSINESS PLAN YES NO N a IY1 J BP01 Business plan is complete, current, ■xr. available during Ingpeclfon (ifn% caaua.: BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) LA BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ER02 Facility is operated and maintained to prevent/minimize/mitigate fire-, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) COMMENTS: AT bV4V-,.,A INSPECTOR: A FACILITY I 1z/z8le l III 00CUMENT\Jeffp\F0RMS\Inspection forms\CUPA inspection for mos. doc 10-Sep-01 Few a b� qi�r Division of Environmental Health IIIIIIII III III 1111� (805) 781-5544 P.O. Box 1489 2156 Sierra WayXSan Luis Obispo, CA 93406 i I 3 €� Department of Agriculture/Measurement City of San Luis Obispo ' ; Utilities Department• (805) 781-7215 Standards (805) 781-5910 955 Morro Street• San Luis Obispo, CA 93401 2156 Sierra Way Suite AXSan Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) Date: d$l GO Start Time: HAZARDOUS MATERIALS INSPECTION FORM 0�V /� 1 Record ID P/E Service Result Action Activity Violation Code INSPECTOR NAME: FACILITY ID NO: FACILITY NAME: d ADDRESS: AGENCY ❑ Opt CITY ❑ AG DEPT INSPECTION TYPE Routine Reinspection Complaint / -rVSfi mot)��brf lye` PHONE: / PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator ST ❑ AGT REINSPECTION REQUIRED: NO YES ❑ Business Plan ❑ HW Generator UST AGT 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 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) E] BP03 Site layouttfacility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) n n n ER02 Facility is operated and maintained Ju nreventlminimizelmitigate fire, ex lo, sion, 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) — PWX, ffKfA A 4ew 1\3000B\VOL1IHOME\JPOE I-TO12M5\OFFICE9711nspection forms\CUPA inspection forms.doc 4-Aug-00 Division of Environmental Health (805) 781-5544 P.O. Box 1489 4 2156 Sierra WayXSan Luis Obispo, CA 93406 Departntent of Agriculture/Measurement Standards (805) 781-5910 2156 Sierra Way Suite AXSan Luis Obispo, CA 93401 Citp oi' San Luis Obispo ma.. i Utilities Department• (805) 781-7215 955 Morro Street* San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) ��$ D p/A ate:. HAZARDOUS MATERIALS INSPECTION FORM / / Qi . Start Time: Record ID P/E Service Result Action Activity Violation Code INSPECTOR NAME: FACILITY ID NO: FACILITY NAME: ADDRESS: 141Zwovia AGENCY ❑ DE 1 Y 0 AG DEPT INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Compisint i t 9 PHONE: PROGRAMS INSPECTED: V Business Plan HW Generator [8 UST AGT REINSPECTION REQUIRED: ❑ NO gMS Business Plan HW Generator 2<S"T ❑ AGT 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 N/A BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BPO2 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) u ❑ 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) L+1 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 n ER02 Facility is operated and maintained to preventlminimizelmiti,Pj9te fire. ex iop sion, 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) w�e a / �'Itv \\3000B\VOI.1\HOME\JPOEL\FORMS\OFt ICE97Unspection forms\CUPA inspection forms.doc 4-Aug-00 UNDERGROUND STORAGE TANK (UST) MONITORING CODES 1. No monitoring Permit No. 2. Standard Inventory Control # PERMITTED TANKS 3. Modified Inventory Control # UNPERMITTED TANKS 4. Statistical Inventory Rec. 5. Automatic tank gauge (list type) Owner & operator as indicated on permit: ErYES [—]NO6. Continuous monitoring in tank annularNO If no, new owner name &address space/secondary containment 7. Visual monitoring 8. Manual monitoring annular space new owner name &address 9. Temporarily abandoned under permit 10. Another method YES NO N/A VIOL. # PERMITTING UT001 Site has a permit to operate (HSC 25284) Fa ❑ ❑ UT002 Permit is kept on the premises UT003 Change of ownership is reported to the permitting agency within 30 days (HSC 25284(c)) ❑ ❑ UT004 All UST(s) are properly permitted to operate or properly closed (HSC 25298) MONITORING iY❑ UT005 UST(s) monitored using method specified on the permit or approved by the permitting agency (HSC 25293) (Write n UT006 monitoring code(s) observed , Monitoring records are provided to regulatory agency upon request 0 Ilrr "' UT007 Automatic line leak detection system is installed & kept operational for all pressurized piping (HSC 25292) ❑ ❑ [0- UT008 An annual report is submitted to regulatory agency n [Poo UT009 Tank tightness test and/or piping test is being performed as required ('Title 23 CCR) L�✓J/ tj ❑ UT010 Written Monitoring Plan submitted for electronically monitored tank system (Title 23 CCR 2632/34) ❑ ❑ UT011 Facility maintains evidence of Financial Responsibility for corrective action and for compensating third parties for bodily injury/property damage caused by a release from the tank system (HSC 25292) No. of Tanks: Products Stored: ❑ Diesel Ga o ' e ❑Crude oil Total Volume: gals �Tlthers 41 Note: SPCC required for tanks with total storage capacity of z 10,000 gallons; for farms, nurseries, construction sites individual storage capacity of >20,000 gal or total storage capacity of>100,000 gallons. YES NO N/A VIOL. # ❑ ❑ AT001 ❑ ❑ AT002 SPCC Plan is prepared and certified by a registered engineer within last 3 yrs. SPCC Plan is maintained on site or nearest field office. FACILITY NAME: ,j /i�AqDATE: `��iti INSPECTOR: SUMMARY OR OBSERVATIONSIVIOLATIONS 5/W W No violations I� too at�ons of underground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requiremen 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 he corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or proposed action, please inform us in writing. All minor violations must be corrected within 30 days or as specified. CUPA must be informed in writing certifying that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective actions. The issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the violations noted or that have not been corrected within the time specified. 3 OL— ATIONS NUMBER MINOR MAJOR CORRECIVE ACTION REQUIRED BP TR ER GT UT AT 1. ■ [A Y y V C � Inspected By: Facility Rep: _ W Date: Title: © W 7/p(-.) 1l3000BIVOL1iHOME1JPOEL\FORMSIOFFICE071fnspection forms\CUPA inspection forms.doc 4-Aug-00 I N N O z 6, w u 90 a z a z µ �l H t` t` W 0 00w 'T HH>4 M � 4*� E-I M wwa 4 IS OBISPO HEALTH DEPARTMENT if Environmental Health San Luis Obispo, CA 93406 Routine Inspection ✓ ` Reinspection No, Complaint Investigation ;ROUND STORAGE TANK/WASTE GENERATOR PORT/NOTICE OF VIOLATION �/�9'7 __ .. ❑ate'__...--_ �? Contact Perso 4 llplee4 — Title/Position: UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div. 20, Chap. 6-7) ATL. # -- GENERAL Viol 20. Permit to operate Com I Viol 21. Inventory reconciliation 22. Precision tank test _ _ 23. Leak detectors 4 TANK CLOSURE 24, Permit approved 25. Temporary closure 26. Removal/in pWce abandonment ti a) Tanks purged b Tanks rinsed c Soil samples taken _ WASTE GENERATORS COMP #_ 27. EPA identification number 28. Variances and/or exemptions 29. Manifests 30. Waste oil receipt 31. Training ro ramirecords 32. Contingency Ian 1 33. Material stored in proper containers & labeled 34. Incompatibles not stored together 35. Storage - 90 days 36. Fire extinguishers 37. Spill containment — QQo P4 z z Ei to a lifornia Health & Safety Code and the California Code of W W W � O mmzw �D �DWpv1 H - 000z1.4 vx 8 -- ooNlflz 1 UUNco9 — - WWNNVI C Page of NOTE: Signature indicates receipt of this document only and not an admission of the facts. /81-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection Division of Environmental Health Reinspection No P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION a'i r� �o �71 c Facility Name: _-.--- _ _ - _ _ [- �t - -__--_- Facility Address: �� ___-.. _ _ . _ Contact Person // yy�� )e `�--��"� 014 Title/Position: VCAJN� HAZARDOUS MATERIALS (2185) (COMP # ) 0 (CA H&S Code, Div. 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div. 20, Chap. 6.7) BUSINESS I.D. FORM ATL- #_- _ _ GENERAL 1. Complete Com I Viol 120. Permit to operate Com I Viol 2. Verity emergency hone.number 21, Inventory reconciliation 3. Location of utilities _ 22, Precision tank test INVENTORY 23. Leak detectors _ 4. Hazardous material & amounts i ted TANK CLOSURE 5. Material stored in proper containers,1111 & labeled. 24, Permit approved 25. Temporary closure 6. Incompatibles not stored together 26, Removal/in place abandonment 7. S 'ill containment provided a Tanks purged R1Z PLAN b Tanks rinsed 8. Plot plan submitted c Soil samples taken 9. Verify streets & adjacent builaings WASTE GENERATORS COMP #_ 10. Location of hazardous materials 27. EPA identification number +� 11. Fire extinguishers/water source 28. Variances and/or exemptions .. 12. Emergency shut-off switches 29. Manifests 13. Location & verification of MSDS '� 30. Waste oil receivil) 14. Sewer system and/or storm drains 31. Training program/records 15. Staging area 32. Conlingency plan 16. Changes/modifications in previous year 3a Material stored in proper containers & labeled EMERGENCY RESPONSE PLAN 17. Adequate emergency response erocedures 34. Incompatibles not stored together 18. Adequate evacuation procedures 35. Storage - 90 days 19. TRAINING PROCEDURES 36. Fire extinguishers 37. Spill containment The above marked items represent violations of the California Health & Safety Code and the California Code of Regulations and must be corrected. COMMENTS A -- _------__-- -!' Inspector's Signature_ NOTE: Signature indicates receipt of this only and not an admission of the facts. Page of f 805-781-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection Division of Environmental Health Reinspection No. P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION 7 L,� Facility Name: ' �� � Date: � � • � � 1 ,!� Facility Address. -�_nL�. Contact Person:- {..� r Title/Position: .. .. r HAZARDOUS MATERIALS (2185) (COMP # ] (CA H&S Code, Div, 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div. 20, Chap. 6.7) BUSINESS I.D. FORM ATL. # GENERAL 1. Com late Com I Viol 20. Permit to o erate Com I Viol 2. Verity emergency hone number 21. Inventory reconciliation 3. Location of utilities 22. Precision tank test INVENTORY 23. Leak detectors 4. Hazardous material & amounts listed TANK CLOSURE 5 Material stored in proper containers & labeled 24. Permit approved 25- Temporary closure 6. Incompatibles not stored together 26. Removal/in place abandonment 7. Spill containment provided a Tanks purged PLOT PLAN b) Tanks rinsed 8. Plot plan submitted 1 / `• c Soil samples taken 9, Verify streets & adjacent buildings- l WASTE GENERATORS COMP # 10. Location of hazardous materials 27. EPA identification number 11. Fire extin uisherslwater source 28. Variances and/or exemptions 12. Emergency shut-off switches �, 29. Manifests 13. Location & verification of MSDS 30. Waste oil receipt 14, Sewer system and/or storm drains 31. Training program/records -�-- 15. Staging area 32. Contingency Ian 16, Change s1mod MCM ions in previous year 33. Material stored in proper containers & labeled f EMERGENCY RESPONSE PLAN 17. Adequate emergenCy response procedures 34. Incompatibles not stored together 18. Adequate evacuation procedures 35. Stora e - 90 days 19. TRAINING PROCEDURES 36. Fire extinguishers 37. Spill containment ' The above marked items represent violations of the California Health & Safety Code and the California Code of f1 � Inspector's Signature Owner/Operator Signature -- NOTE: Signature indicates receipt of this document only and not an admission of the facts. 1 ' Page of 805-781-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection Division of Environmental Health Reinspection No. P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION r / Facility Blame: y. L 4-- "a 7' / Lf►zo- Date: Facility Address: _ t • Contact Person: ' �rtr n � L• -/) Title/Position- HAZARDOUS MATERIALS (2185) (COMP # f (CA H&S Code, Div. 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # j (CA H&S Code, Div. 20, Chap. 6.7) BUSINESS I.D. FORM ATL. # GENERAL 1. Complete Com I Viol 20. Permit tooperate Com I Viol 2. Verify erw9ency phone number 21. Invento reconciliation 3. Location of utilities 22. Precision tank test INVENTORY `, 23. Leak detectors 4. Hazardous material & amounts listed t� TANK CLOSURE 24. Permit approved 5. Material stored in proper containers & labeled 25. Temporary closure 26. Removal/in place abandonment a Tanks purged 6. Incompatibles not stored together 7. Spill containment provided PLOT PLAN t] Tanks rinsed 8. Plot plan submitted c Soil samples taken 9. Verify streets & adjacent buildings / WASTE GENERATORS COMP li 10. Location of hazardous materials 27. EPA identification number L 0 0 11. Fire extin uisherViNater source , 28. Variances and/or exemptions 12. Emergency shut-off switches 29. Mantfests 13. Location & verification of MSDS 30. Waste oil receipt 14. Sewers stem and/or.storm drains 31. Training ro ramlrecords 15. Staging area 32. Contingency Ian 16. Changes/modifications in previous year 33. Material stored in proper containers & labeled EMERGENCY RESPONSE PLAN 17. Adequate emeTency response procedures 34. Incom atibles not stored together 16. Adequate evacuation procedures 35. Siora e - 90 days 19. TRAINING PROCEDURES 36. Fire extinguishers 37. Spill containment The above marked items represent violations of the California Health & Safety Code and the California Code of Regulations and must be corrected. f� rector's Siclnature�fr _ r/Operator Signature r{� Page / of� mature indicates receipt of this document only and not an admission of the facts. 90.3 6' 805-549-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection Division of Environmental Health Reinspection No. P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION Facility Name:__ ! _-. ___-_- .� p _� Date: Facility Address: Contact Person: c_ Title/Position: HAZARDOUS MATERIALS (2185) (COMP # ) (CA H&S Code, Div. 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # } (CA H&S Code, Div. 20, Chap. 6.7) BUSINESS I.D. FORM ATL. # GENERAL 1. Complete Com I Viol 20. Permit to operate ComPL Viol 2. Verity emergency hone number 21. Inventory reconciliation 3. Location of utilities 22. Precision tank test INVENTORY 2a Leak detectors 4. Hazardous material & amounts listed TANK CLOSURE 5. Material stored in proper containers & labeled 24. Permit approved 25. Temporary closure 6. Incompatibles- not stored together 26. Removal/in place abandonment 7. Spill containment provided a Tanks pur,qed / PLOT PLAN b Tanks rinsed 8. Plot plan submitted c Soil samples taken 9. Verify streets & ad acent buildings WASTE GENERATORS COMP # -' 10. Location of hazardous materials 27. EPA identification number 11. Fire extinguishers/water source 28. Variances and/or exemptions ram; 12. Emergency shut-off switches 29. Manifests 13. Location & verification of MSDS 30. Waste oil recei t 14. Sewer system and/or storm drains 31. Training program/records la Staging area 32. Contingency Ian 16. Changes/Modifications in previous year 33. Material stored in proper containers & labeled EMERGENCY RESPONSE PLAN 17, Adequate emergency response prodedures 34. Incompatibles not stored together 18. Adequate evacuation pmoedures 35. Storage - 90 days 19, TRAINING PROCEDURES 36. Fire extinguishers 37. Spill containment The above marked items represent violations of the California Health & Safety Code and the California Code of Regulations and must be corrected. 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