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ENVISION INPUT/UPDATE FORM Master File Record Information xV) CREATE NEW RECORD [ ] FILE [ ] LABEL FACILITY NUMBER FA# Existing FA=_FA0005116 xk ] CHANGE OF OWNERSHIP [ } TANK OWNERXJ] BUSINESS OWNER PROGRAM NUMBER PR# ] UPDATE BILLING INFO. PROGRAM ELEMENT PE# [ ] PERMANENTLY INACTIVATE FACILITY AS OF: [ ] TEMPORARILY INACTIVE FACILITY AS OF: DATE OF NEXT SCHEDULED INSPECTION: March 19, 2014 RETURN TO INSPECTOR: xk ] YES [ ] NO DESCRIPTION OF CHANGES: 1) Change of ownership; 2) Change of Business Name Note: Program Elements to remain the same. BILLING INFORMATION: PLEASE SEND OUT PRO -RATED INVOICE FOR BALANCE OF THE YEAR. Number of Materials: 1-4 Number of Waste Streams: 1-5 Number of Tanks (capacity/compartment): N/A Facility Name: MEINEKE SUPER CENTER SAN LUIS OBISPO Site Address: 286 HIGUERA STREET, SAN LUIS OBISPO, CA 93401 (CITY, STATE, ZIP CODE) Facility Phone Number: (805) 541-0898 Owner Name: Ryan Keller Postal Address: Same as Above (CITY, STATE, ZIP CODE) Requested By: Kerry Boyle Entered By: Date Requested: March 21, 2013 Date Entered: 6 n t. U ul CADocuments and Settings\kboyle\Local Settings\Temporary 10119 IC slinpk.J�! 4W 1MFR HA7_MAT �2y,ppC 18 Jan-13 i An COWNTY OF SAN LUIS OBISPO ENVIRONMENTAL HEALTH SERVE..tS DIVISION 2156 SIERRA WAY PO BOX 1489 SAN LUIS OBISPO, CA 93406 805-781-5544 PUBLIC HEALTH DEPARTMENT INVOICE - FIRST NOTICE TO KELLER, RYAN 286 HIGUERA ST SAN LUIS OBISPO, CA 93401 ATTN RE: MEINEKE SUPER CENTER SAN LUIS OBISPO 286 HIGUERA ST SAN LUIS OBISPO, CA 93401-4215 Invoice ID Date IN0085273 3/21/2013 jj Facility JD_ Due Date FA0005116 4/8/2013 ENIIna Period 1/1/2013 THRU 12/31/2013 PLEASE RETURN INVOICE NOTICE WITH PAYMENT Program/ Date Element Description Amount 03/21/13 0762 SLO CITY -HAZARDOUS MATERIALS HANDLER 1-4 $ 198.00 03/21/13 1176 SLO CITY- WASTE GENERATOR (1-5 waste streams) $ 198.00 03/21/13 0755 SLO CITY- STATE SITE SURCHARGE $ 35.00 03/21/13 DISC GENERAL DISCOUNT $ -77 00 Total Due For This Invoice: $354.00 We now accept VISA, MasterCard and Discover over the phone and at our office. PAYMENTS RECEIVED AFTER THE DUE DATE ARE SUBJECT TO PENALTIES. PENALTY OF 25% WILL BE ADDED TO THE INITIAL FEE FOR LATE PAYMENT OR NON-PAYMENT AFTER FIRST NOTICE DUE DATE PENALTY OF 50% WILL BE ADDED TO THE INITIAL FEE FOR LATE PAYMENT OR NON-PAYMENT AFTER SECOND NOTICE DUE DATE 100% PENALTY FOR FAILURE TO OBTAIN INITIAL PERMITS WILL BE CHARGED UNPAID ACCOUNTS AFTER THE LAST NOTICE DUE DATE WILL BE REFERRED TO A COLLECTION AGENCY AND MAY BE SUBJECT TO PERMIT SUSPENSION 5301.rp1 1.0.1.03.00 i Aa ?//0 ATn esi m&t r A State of CalifOrrlla State Water Resources Control Board tail .4 Poiy Adwtq Uat 040 FILE COP CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAt'3E TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the required amounts as specified in Section 2807, Chapter 18. Div. 3, Title 23. CCR: a500,000 dollars per occurrence O t million dollars annual aprepte or AND or t million dollars per occurrence �2 million dollars annual a�re8ate B. ' il�-Y� hereby certifies that it is in compliance with the requirements of Section 2807, (Nome orTaak Owns or operawr) Article 3, Chapter f a, Division 3, rd/s 23, California Code of Regulations. The mechanisms used to demonstrate financial res nslbil as required b Section 2807are as follows: C. Mechanism T Narne and Addmm of Utler ltl Number Covaiage Arnount Coverage Period CormctK* Action Third Party Comp, Note: if you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that u are in cam lance with a# conditions fbrpqrticl tian in the Fund. D. FadlityName FaatyAddrass Fadll tyNsme Fadltl ' eA E FaduiyNama FtrLity ea FadlfryKsate FadLityAddrese Fadliity Name Ftrcility Addreq ,�/ •L�L ff _ 4C�� L 4 Si ererNoury Doe Nsa+eorNRtn Notary cmowl) /009, FILM ori*W - Local Aemry Copies - FadGty/5ite(s) CERTIFICATION OF FINANCIAL R>RSPONSISILITY FORM Please type or print clearly all information on Certification of Financial Responsibility form. All UST facilities and/or sites owned or operated may be listed an one form; therefore a seperate certificate is not required for each cite. DOCUMENT INFORMATION A. Am unt Required - Check the appropriate boxes. B. Name of Tank Omer - Full name of either the tank owner or the operator. or Operator C. Necheniem Type - Indicate which Stntc approved mechenism(s) are being used to show financial responsibility either as contained in the federal regulations, 40 CFR, Part 280, Subpart H, sections 280.90 through 280.103 (See Financisl Rponeibility Guide, for more information), or Section 2808.1, Chapter 18, Division 3, Title 23, CCR. Naar of Issuer - List all names and addresses of companies and/or individuals issuing coverage. Nechenfm Number - List identifying number for each mechanism used. Example: insurance policy number or file number as Indicated on bond or document. (If using State Cleanup Fund (State Fund) leave blank.) Coverage Amount - Indicate smount of coverage for each type of mechanism(s). If more than one mechanism is indicated, total must equal 100% of financial responsibility for each facility. Coverage Period - Indicate the effective date(s) of all financial mechanism(s). (State Fund coverage would be continuous as Long as you maintain compliance and remain eligible to continue participation in the Fund.) Corrective Action - Indicate yes or no. Does the specified financial mechanism provide coverage for corrective action? (If using State Fund, indicate "yes".) Third Party - Indicate yes or no. Does the specified financial mechanism provide coverage for Compensation third party compensation? (If using State Fund, indicate "yes".) D. Facility - Provide ell facility and/or site names and addresses. Information E. Signature Block - Provide signature and date signed by tank owner or operator; printed or typed name and title of tank owner or operator; signature of witness or notary and date signed; and printed or typed name of witness or notary (if notary signs as witness, please place notary seal next to notary's signature). e e to ft it art J f I cat Please send original to your local agency (agency who issues your UST permits). Keep a copy of the certification at each facility or site listed on the form. Questions: If you have questions on financial responsibility requirements or on the Certification of Financial Responsibility Form, please contact the State UST Cleanup Fund at (916) 227-4307. Note: Penalties for Fai lure to coyly with Financial ResponsibiII ty R irements: Failure to comply may result in: (1) jeopardizing claimant eligibility for the State UST Cleanup Fund, and (2) liability for civil penalties of up to $10,000 dollars per day, per underground storage tank, for each day of violation as stated in Article 7, Section 25299.76(a) of the California Health and Safety Code. ACORD CERTIFIC. PRODUCER THORSON AND ASSOCIATES INSURANCE SERVICES 21700 E. COPLEY DRIVE, #100 DIAMOND BAR, CA 91765- 909-860-1143 DVBURED ECONO LURE N' TUNE CORPORATE ATTN: JEFFREY A. STEWART 4911 BIRCH STREET NEWPORT BEACH, CA 92660 E OF INSURANCE CsR PL ISSUE DATE ,YY, 10/27/90/27/93 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE LETTER A AMERICAN INT'L SPECIALTY LINES COMPANY LETTER B COMPANY LETTER C COMPAIIY LETTER D COMPANY LETTER E COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO, TYPE Of E%URANCR POLICY NUMBER POLICY EFFECTIVE: POLICY EXPIRATION DATE(MM/DD/YY) DATE (MbUDD/I Y) LIMITS GENERAL LIABILITY GENERAL AGGREGATE f COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGO, f CLAIMS MADE OCCUR. PMMNAL A ADV. INJURY f OWNER'S A CONTRACTOR'S PROT. EACH OCCURR04C E f FIRE DAMAGE (Amy one lim) f MID. EXPENSE (Azw am Pusan) : f AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT f BODILY INJURY f (T- panao) BODILY INJURY f (Ibr wowed) PROPERTY DAMAGE f EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE f OTHER THAN UMBRELLA FORM I WOR"R'S COMPENSATION STATUTORY LIMITS !1 �� EACH ACCIDENT f EMI'LOYSRS'LIABILITY D14EASE—POIICYLIMIT f j DISEASE —EACH EMPLOYEE S I OTHER A POLLUTION LIABILITY UST 7730702 07/20/93 07/20/94 1,000,000 EACH LOSS 2,000,000 AGGREGATE DESCRIPTION OF OPERATIONS/LOCATION&TRIHCLES/SPECIAL ITEMS LIMITS OF INSURANCE: $1,000,000 PER POLLUTION INCIDENT/$2,000,000 ANNUAL AGGREGATE S 500,000 DEFENSE COSTS LIMIT I HE EVEN 1 F -KONPA IME -7ICLSUPERCEOE: - - - - — - - — PROOF PROVIDED FOR: SITE #107-286 HIGUERA, SAN LUIS OBISPO, CA 93401 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEIIID BEFORE THE EXPIRATION DATE THERBOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAID - 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE JAMES P. JONES TRUSTEE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 717 MARSH STREET LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. SAN LUIS OBISPO CA 93401 UTI10R6ED REFRESH ATIVE , ' 1 25-S (7190) ACORD CORPORATION 19" �7�sIiI�,N�N city of sans an IUIS OBISPOFire1 � Luis Obispo, Ca. 93401 6 781 Permit 748Rrcarallwared e 7 ECONO LUBE AND TUNE 286 HIGUERA DATE: 10/07/93 SAN LUIS OBISPO, CA 93401 IS REQUIRED TO OBTAIN A PERMIT TO MAINTAIN, STORE, USE OR HANDLE MATERIALS, OR TO CONDUCT PROCESSES, OR TO INSTALL EQUIPMENT AS DESCRIBED BELOW: 1) STORE/HANDLE/USE CLASS III FLAM. LIQUIDS $ 45 2) U.G. STORAGE TANK PER ORD 999 - NEW $175 3) HAZ MAT INVENTORY/BUSINESS PLAN - ORD 1075 $270 THE PERMIT MAY BE OBTAINED FROM THE FINANCE DEPARTMENT AT 990 PALM ST - OBISPO, CA 93401 OR BY RETURNING THE ENCLOSED ENVELOPE WITH A CHECK TO THE CITY OF SAN LUIS OBISPO IN THE AMOUNT OF: 11-01-94 490 00 PERMIT .WILL BE VALID UNTIL 2594 I.L. NO. w Payable within 30 days FIRE IvIAh SHAL RECEIVED APR 2 21994 CLEAN UP FUND PROGRAM Ui,iFIED PROGRAM CONSOLIDATED FORAM TANKS F E B 2 6 ��(�� UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page 1 of 1 TYPE OF ACTION ®5.CHANGE OF INFORMA`jQ _ER ❑ 7. PERMANENTLY CLOSED SITE ].NEW SITE PERMIT 3. RENEWAL PERMIT local W N (Check one item only) specify change use only V ❑4. AMENDED PERMIT 6.TEMPORARY SITE CLOSURE ❑ g. TANK REMOVED 400 I. FACILITY / SITE INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID# �LU]CALAGE ECONO LUBE N' TUNE #107 lsW I4-, ,,0 , LQ4 NEAREST CROSS STREET 401 FACILITY OWNER TYPE C S RI 'T* ❑ 1. CORPORATION ❑ 5. COUNTY AGENCY* ® 2. INDIVIDUAL ❑ 6. STATE AGENCY* BUSINESS Lj 1. GAS STATION Lj 3. FARM M 5. COMMERCIAL TYPE ❑ 2. DISTRIBUTOR ❑ 4. PROCESSOR 6. OTHER 403 ❑ 3. PARTNERSHIP ❑ 7. FEDERAL AGENCY* 402 TOTAL NUMBER OF TANKS s facility on Indian Reservation or If owner of UST is a public agency: name of supervisor of divis1on, section or o ice whicli REMAINING AT SITE trustlands? operates the UST (This is the contact person for the tank records.) 1 404 Yes ® No 405 406 IL PROPERTY OWNER INFORMATION PROPERTY OWNER NAME PHONE 408 JAMES P. JONES, TRUSTEE (805) 543-9643 MAILING OR STREET ADDRESS 409 3820 SEQUOIA DRIVE CITY STATE A11 ZIP CODE SAN LUIS OBISPO ICA 193401 PROPERTY OWNER TYPF Lj 1,CORPOZATION N 2. INDIVIDUAL Lj 4.LOCAL AGENCY /DISTRICT Lj 6. STATE AGENCY ❑ 3. PARTNERSHIP 5. COUNTY AGENCY 7. FEDERAL AGENCY 413 III. TANK OWNER INFORMATION TANK OWNER NAME 414 PHONE JAMES & PATRICIA WILMORE 805 541-6007 MAILING OR STREET ADDRESS 416 REST CITY 417 SIAII; ala Z{'C DE 419 SAN LUIS OBISPO CA 193401 TANK OWNLR TYPE Lj 1, CORPORA I ION N 2, IN 01VIDUAL U 4- LOCAL AGENCY 1 DISTRICTS' Lj 6, STATE AGENCY 420 3. PARTNERSHIP 05.COUNTYAGENCY 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - 1 1 1 1 1 1 1 Callif uestions arise 421 V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) ❑ I. SELF -INSURED 4. SURETY BOND ❑ 7. STATE FUND ❑ 10. LOCAL GOVT MECHANISM 2. GUARANTEE ❑ 5. LETTER OF CREDIT ❑ 8. STATE FUND & CFO LEVIER ❑ 99. OTHER: ® 3. INSURANCE ❑ 6. EXEMPTION ❑ 9. STATE FUND & CD 422 VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate whlrlt address should be used for legal noti lcations and mailing. VII. APPLICANT SIGNATURE Certification -1 certify that the information provided herein is true and accurate to the best of my knowledge. S1GNA1 E OF API'i.ICr1N [ rl ►I �- DATE 4� PFIONI: -` �J --�- 01 / 15 / 021(805)544-2976 NAME OF ICANT (print) 4 6 TITLE GI' APPLICANTJIM VP WIRE OWNER STATE UST FACILITY NUMBER (For local use only) 4213 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 429 UPCF (1/99 revised) 171 Formerly SWRCB Form A 6� YR STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD W �, UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A ct,rp Kx+. COMPLETE THIS FORM FOR EACH FACILITY/SITE MARK ONLY L� 1 NEW PERMIT C 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION D 7 PERMANENTLY CLOSED SITE ONE ITEM [:] 2 INTERIM PERMIT �4 AMENDED PERMIT 6 TEMPORARY SITE CLOSURE 1. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR FACILITY NAME NA,%OF OPERATOR i ADDRESS ' NCAnCOT CnOOO OTRCCT PARCEL M (OPT NAL) r n f /f"�� �T CITY NAME STATE ZIP CODE 517E P ON WITH AREA CODE o CA i, ✓ BOX f TO INDICATE C617RATION 5< INDIVIDUAL PARTNERSHIP 0 LOCAL -AGENCY COUNTY -AGENCY F-1 FATE -AGENCY (] FEDERAL -AGENCY DISTRICTS r TYPE OF BUSINESS 1 STATION 0 2 DISTRIBUTOR ✓ IF INDIAN n OF TANKS AT SITE E. P. A. I, D. # (optional) Q 3 FARI�\ C 4 PROCESSOR X 5 OTHER RESERVATION OR TRUST LANDS / zea-,tn/ /fir EMERGENCY COkACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional DAYS: NAST, FIST)� PHONE TH - � AYS: NAME (LAST�� NIGHTS: N GIL FIRST) % HONE WITS AREA CODE NIGHTS: NAME(LAS , IRST) II. PROPERTY OWNER INFORMATION ='(MUST BE COMPLETEDI NAME CARE OFADfl $$ INFORMATION MAILING OR STREET ADDRESS ✓ b0% to,Wbo INDIVIDUAL LOCAL -AGENCY STATE -AGENCY Q"C KPORATION PARTNERSHIP COUNTY -AGENCY 0 FEDERAL -AGENCY NAME STA ZIP CODE PHONE # WITH AREA CODE III. TANK OWNER INFORMATION - fMUST BE COMPLETED) NAME OF OWNER CARE OF ADDRESS INFORMATION / CORPORATION 0 PARTNERSHIP COUNTY -AGENCY 0 FEDERAL -AGENCY /J" "/a � T CITY NAME t 8jATG ZI DE PHONE # WITH AREA OWE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 323-9555 if questions arise, TY (TK) HQ [4[4]- -- I , 1=r ; f V. PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BE COMPLETED) — IDENTIFY THE METHOD(S) USED ✓ box 10IrrdlraI0 Lj i SELF-IN5IIREA 2 GUAR ANTEt 3 INSURANCE 4 SURFTY RONn CI 5 LETTEROFCREDIT J 6 EXEMPTION 99 OTHER VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing wil a sent to the tank owner unless box I or II is checked, CHECK ONE BOX INDICATING WHICH AHOVC ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLI I. El II. n III. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY,KNOWLEDGE. IS TRUE AND CORRECT 'r LOCAL AGENCY USE ONLY ` 1 COUNTY # I �- 1(I LOCATION CODE - OPTIONAL CENSUS TRACT # - OPTIONAL JURISDICTION # ITY # SUPVISOR - DISTRICT CODE - OPTIONAL; THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FORM A (5-91) FOR0033A-5 f LOCAL AGENCY USE ONLY ` 1 COUNTY # I �- 1(I LOCATION CODE - OPTIONAL CENSUS TRACT # - OPTIONAL JURISDICTION # ITY # SUPVISOR - DISTRICT CODE - OPTIONAL; THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FORM A (5-91) FOR0033A-5 f ll�NI•lt[ CH: ri•:.`i I c';� i'uM1;1.1,i IN(i 101l ".1 1W GENERAL WSl RUC11()W 3 I31t� i - WM 'r%" • 11,11! 61: 1',1,,'ll _:t1 I. ,- 1111 N I i W 1'1 f UM I i , l'I!vNII I [I FA it:+ _i esr :Isl} I°ACI11I'Vpa 1-11 IN11011 iv7.'111ON 01AN(,i:I'- 3 tit JJWI1 ON1,Y Oil: 1;, (1) 3 t.1 [iht 'r%' fut• .1 1 .:cl ll; !'';• o% (4;- h:y: nI 1. [1, nnn11 r a,f lanln 1,m11tr1 it[ ,i,:: Mle i. IiNm ri,tilt r,il,lullt le.: •ar 11i F,',l•+.1 he. ..CpkIt: r It I, 1'l:{t.',ICI AI Yf I(JV41' 111' Ills 1.0CA1. A(iI?NCY UNI11--Rt:l(t1t,:\f3 1- VIC "u;t_ litl•' of ;1:1111 I:1" iI']': :11 1-;11. -:'il j 1Ire ,, I... 11) I,G111t 5+f i11t,1t 3 11 t' I-tk1 ;11%1 111- I,llikkkil: r)I1R".�. 'IY)f' (fir I-()WNC W AAh i)/,*qI- ()N;; I lI:1,' Ma n :1I7 f}•i) III I i I C IDk:A I1.=1t II. 11I� iI-CM Ihat bind I tlGCl'1IFI• 11.(. MISC511 III; k1irr5 C. 1)1-i11f: rIIIIIPIC1kid L.-t,A(.:Il ftY/Sfl]! FNI'()ItM1M1+►'1T()N AI3i7R"."* (I,+IO' fT1-' ('[,;111'1 III I Jl) I. 1'ccuisl rrrsns�- ,u1r1 .urrlu•:-� {php�ar.,l i,�.•stiul1l ,t[ [h,• r„1.:,�rri:•nun[I 1su]�isl. 1l7 I E Ail1]1 .7 +i) ]n I' hscir II 1 i Id 1111Y.xir II II • ;rtilln ill0kitli„g city, %Mlle, m1a fII, [o.lf, 1Nt.)Mill;PS tilts. N(YF AUCTIPIi W f'- Iti•:tbsie_• nr.lrccl 1;,1,4- .trrr:1 111,d luuttr_ of tlsr op1•,r11II 1. 2- 111 t5it t- II I. I I I I:1r'f In II•a hri!4 4111 4141 a ;1.N, 1-- IP C, I mvItl nd In ll Dolt i, 1a.. % 1 t IItt WI ill '4ji?till." in 15ft 11)4,%r JkW II WLIl 3. (:hPrk Isle nitfl,11f1r1atr I, IN. f+)1 'I VIII. `)i' lii,MN!.,;s I.)W 'l W 1IIV ttx [:1,11kVC) RA, I1(i;ti, t`_I)IVII)U 1k •k, ('Reek the 1tilttixrpxiatc iK1x for 'I YN i)i- IzI i:-'li1I ti S. if 1WAlity/Slle it IdrAled tvilhin lilt Indian ir;r-ntatiull <rr CIM111, l:,lii:llk bust tnndx, check: tile. b,.Ix malk"'cl "Y1',5", It, Eirt vow the i tf 1MBF11 ui TANKS :it lni, SI 11-1 7. Rcmd tlsc I:.I'A 11) # or w-ilc "•:r1y'i'" it, rile ,]5akti. llrovidvd, 11. 1'1Zi3MAKI'Y OWNEX iM'0KMAI[70N & -1`lU KJi5z-; (t US -I' BE COM1'1J:i11)) Complete all ilemn in thin sersinn, 1rtt1c all 11r'tn. IT,: tilt 4:tinr, ns S14 ION 1: il' the "LIM, wrile •SAME. A-S %'(Illy' 111 nR+s Ihis union. IIc lout to check PROPiUZTY 0 'iii.161111' IT IT, IIox, i1I. TANK OYlN]M Fiti9F(YRMM1ON A A011M PISS (hII),';1' 1-111. L;i)!i(f'l.l111F11) campfatc All deals in IrSiri "clkut, usslc+s tli il�rsu� )Ileihr stmc I;!; Si CHIN 1; if Ilia Nmtte, wr11t: ""W61F. AS ;hill" : tltti 111k xwcsiron, Jk sm to to check: 'I'AKK t)V1r11fTi[tS) I TY PI S I,ns, iV. ii[}AR1) Oil l:[iiiMJZA'IION US1'' I'OR.Ai?K ITI:7 A(YY0lJNI' NliJMBM (MU;iI' 19! i.OMPIAt 11ti)) F am, yttinr Rtinrd of F.qualixsltion (SOU) l+"Sf xlnmV fcc m1count stmnInr whirls Fs mquired lxfom yam permit Ispplitatirka c�+a�'�n �b,re pmu-culcd, Rcgissrulisfn with the HIM; will enUurt that 5o1 will me6m 1t qunrierly stot:sge fcc st:Inrn in rispsss�iing Cite _ru.(NYF (6 mills) per gallon fec .dut: oxi. thr. numb" of gfltlonr; [Ilom.d in ys+s,r"111t; 13f3I? will cxsllr PelSnn5 1;;cen11'1 limit prying the atorap fee lip rmuctus w91i1 ltoi bv xt-m, If ynu da am have urt accuunt number wish ,he B01: of If y1,u 11a+•k nns tltitmi [nts rcIpirding tin: rea or exempliom., 1,]r;ssr. vall. she 11M.11 `91&321.9555 In wrist to the 130V al itic foll0winl; addtlss: Ward of ?!'1laulinUnn, I'nvisrrrlmcfiml ]Fr5. lh,il, P.O. RaA `1 }?.M, 5a,r lamesnn, CA 94? 79-(K)()l. V. f 15i M)iMM iJSC FWANC'fA)- RF-SP0N'q Ii.rfY (MUST' fill. COMPT,101--7) identify the melhod(x) sxsz(1 by tile ❑wnCr and/or qx-rmol in mcelinp fill_ 1'ellcral and S1ntn lmauri,I rc.14mimUilily rcqulrrmcnlx USis O+Vmcd lay 3rky 1Ft-t:t,:d (tr Su Ic agprncy are cl:empt rsxnu this tr[Iairefnelsl.. VJ. 1EGAI., NCY11VICAI'ItMN AND 13111IMi AI1;)R1_S.; Chary; DNH 11C)Y lrir lhs_ nddrr�•: Ihat will be, utird for 110111 LlikIAL ANY) IHUJNG NCYI10CW1l0N& ATrF'I..TCAKr hftmr q(,,LN Ain i).VrE TIM PORM AS VNIMi N11-1), INSFIt[1 NION FOR'1111; 1.0C.M. A(iFA IFN The munly and jurisr1klian uumher' are prl:dctermincd and ran Ire ot*ibled by calling the Stall: Ilkwild (9t(r)'t39-2d21. The (nf.ilily nt1I1tE5Cr nmv fcc 11--tiislted 11v Ihr It•r:11 ycrs.y; ht-mv.'er, the: number must be mnucrival :Ind 0111ml mrimin any alph:llmliral. !I' the lilval a ;e„ry f 4resx tlsl: Simi 13ril,ctl io ,mvign tlic facility number• picasc leave h bInnk. !'i' Is'mv: u-'sromali ire (it-ml! 1, WA.y. Aiit_IN(.'Y'11IA'T' Irk?+€r IXNISIll It PAC 3111Y'11C) VIa IFV'171E AIVURACY 01; '11 IF li1f+C)IRM IIuM -IIIIS AlTI3('11•IIIIN CJINNiLT V fill 11ROCUSSM) 111'I'IIII FK)Ji A(MUM I' NIIMF3i'.R IS tV YV I.11 ].1!I) IN. 11W l.[ CAL AGIF ICY iti R1r5PON-SLIME MR -11M cCyl'GfPLf?I7C N oil nu., ' OCAl.. AC,I'Ti(W MV ONLY' fivNrRi1AA31:01; IKA ANi) F(M FFORWARDINC. ONE it(]RM W' AND A&1X 3ATFD MRM `FY(x) TO 'flif? VO LO WINE; AT) RF-'-'M- SI'A'IT? I1it C.'rUI`0RNIA 4t 11'FL1 R1A'i'i :it RV.S01-IF -Vi CONi[iOI. BOARD C:JC] �.W.lifiT'.S 1?A'1'A 3'1i(7C'ECtitiEf�Li C:} s1fi•f?IL P.O. BOX sal PARAMOUNT, CA 'XMI ss u STATE OF CAUFORMA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM MARK ONLY I 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED ON SITE ONE ITEM 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY TANK CLOSURE I_i 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # I B. MANUFACTURED BY: C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: . II. TANK CONTENTS IF A-1 IS MARKED. COMPLETE ITEM C. ❑ 1 MOTOR VEHICLE FUEL B. C. UNLEADED ❑ TBREGULAR jI-. ,�, 3 DIESEL ❑ 6 AVIATION GAS A ❑ 2 PETROLEUM ❑ 80 EMPTY ❑ 1 PRODUCT ❑ 1bPREMIUM u 4 GASAHOL {_ 7 METHANOL UNLEADED ❑ 5 JET FUEL 1 ❑ 3 CHEMICAL PRODUCT ❑ 95 UNKNOWN ❑ 2 WASTE ❑ 2 LEADED ❑ 99 OTHER (DESCRIBE IN ITEM D. BELOW D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE, STORED C. A. S. # III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. AND C, AND ALL THAT APPLIES IN BOX D A. TYPE OF Q 1 DOUBLE WALL ❑ 3 SINGLE WALL WITH EXTERIOR LINER ❑ 95 UNKNOWN SYSTEM ❑ 2 SINGLE WALL ❑ 4 SECONDARY CONTAINMENT (VAULTED TANK) ❑ 99 OTHER ❑ 1 BARE STEEL ❑ 2 STAINLESS STEEL ❑ 3 FIBERGLASS 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL ❑ 5 CONCRETE n 6 POLYVINYL CHLORIDE n 7 ALUMINUM ❑ 8 1009/6 METHANOL COMPATIBLE W/FRP (Primary Tank) ❑ 9 BRONZE LI 10 GALVANIZED STEEL ❑ 95 UNKNOWN ❑ 99 OTHER — n- 1 RUBBER LINED ❑ 2 ALKYD LINING ❑ 3 EPDXY LINING ❑ 4 PHENOLIC LINING 'NTERIOR ❑ 5 GLASS LINING ❑ 6 UNLINED ❑ 95 UNKNOWN J ❑ 99 OTHER rL �!' "t � r LINING IS LINING MATERIAL COMPATIBLE WITH 1009/6 METHANOL? YES_ NO— D. CORROSION ❑ 1 POLYETHYLENE WRAP ❑ 2 COATING ❑ 3 VINYL WRAP lg� 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ❑ 5 CATHODIC PROTECTION ❑ 91 NONE ❑ 95 UNKNOWN ❑ 99 OTHER IV. PIPING INFORMATION CIRCLE A IFAROVEGROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE B. CONSTRUCTION (A'-,U 1 ( SINGLE WALL &nU 2 DOUBLE WALL , A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U A U A, U ❑ 1 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A,/U- 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U AUTOMATIC LINE LEAK DETECTOR ❑ 2 LINE TIGHTNESS TESTING ❑ 3 A10HRORI 4 4 FIBERGLASS PIPE 8 10016 METHANOL COMPATIBLE W/FRP 99 OTHER ❑ 99 OTHER V. TANK LEAK DETECTION 1 VISUAL CHECK I 2 INVENTORY RECOftM*TION ;` 3 VAPOR MONITORING ��] 4 AUTOMATIC TANK GAUGING ❑ 5 GROUND WATER MONITORING 6 TANK TESTING I 7 INTERSTITIAL MONITORING ;—� 91 NONE 95 UNKNOWN` ❑ 99 OTHER VI. TANK CLOSURE INFORMATION t 1. ESTIMATED DATE LAST USED (MO/DAY/YR) i 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES ❑ NO ❑ f SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT (PRINTED $ SIGNATURE) LOCAL AGENCY USE ONLY THE STATE lb. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW STATE I.D.# PERMIT NUMBER CrrOUNTY # JURISDICTION # IT-1 PERMIT APPROVED BY/DATE EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. F01100346-114 iNS`TRUC1IONS FOR COMPLETING FORM "13" GENERAL INSI'RU('IIONS- 1. One FORiv1 "13" shall be completed for each tank for all NEW PE?RM1TS, PHRMLr CHANGES, RI+NOVALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the Pi?RMIT APPLICANT' or the I O;'Al, AGENCY UNDERGROUND'TANK INSPEC FOR. 3. Please type or print clearly all requested information. 4. Use a hard point writing instrument, you are making 3 copies. TOP OF FORM. "MARK ONLY ONE r11+,M" 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. indicate The DBA or Facility name where the tank is installed. L TANK DINCRIPIION - COMPl IUE ALi, 1`11rWIS - iF UNKNOWN - SO SPECIFY A. Indicate owners took 11) # - Ir thcrc is a tank number that is used by the owner to identify the tank (ex. AB70789). 13. Indicate the more of the company (flat rttamtfruturc4 the tank (ex. ACMP TANK MFG.). C. indicate the year tht: tank xis itminllcd (ex. 1987). D. Indicate the tank capacity in pillons (cx. 2-S,t1M or 10.(M etc.). If. TANK CONIENIS A. L if MOTOR VI-MICLE I'VE3L, check box 1 and complete items B & C. 2. If not 110-1 OR VEHICLE FUEL, check the appropriate box in section A and complete items 13 & D. 11. Check the appropriate box. C. Check the type of MOTOR VEHICLE FU1:7L (if box I is checked in A). 1). Print the chemical name of the haaardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number), if box 1 is NOT chftkcd in A. III. "TANK CONSTRUCTION -- MARK ONE mm ONLY IN BOX A, i3, C & D 1. Check only one item in TYPE? OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION PROTF:C,TION, 2. If OT111'R, print in the space provided. IV. PIPING; INFORMATION 1. CievIc A if ahavc ground, circle UK underground. and circle both if applicable. 2. If IJNKNOWN, 6rcte; or if O'TI Ij;v, print in space. provided. 3. Indical,: the I-FAK DF-11'CTION syntem(s) used to mmply with the monitoring requirement for the piping, V. TANK 1.17AK DI i17 CTIION I. Indicate the LEAK DETECI ]ON system(s) used to comply with the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSVD IN PLACE I. I--S 11MA1L;D DA'11 IAS"I' USED - MONTII/YEAR (January, 1988 or 01/88). 2 ESTIMA'ITD QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Cheek 'Ycs' or 'NO'. APPI.ECANr MUST SIGN AND DATE T1I1ffl, FORM AS INDICATED. 1NSTRUCIION FOR 7111110(AL AGENCIPS The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers nre predetermined and can be obtained by calling the `,late Board (916)739-2421. The facility number must Ire the same as shown in form "A". TI1e tank numher nmy be assigned by the local agency; hrrwrvcr, this cumber must be numerical and cannot contain an alphabet, If the local agency prefers the State Board (o assign the tank number, please leave it blank. rr IS '11IE RKSPONSIB1I11'Y OF 11IE LOCAL AGENCY 13IA1.7 INSPECTS TI iE FAC7L1'TY TO VERIFY 111E ACCURACY OF 11IF? I[NI7ORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR TIIE COMPLU17ON OF THE *LOCAL AGENCY USE ONLY, INFORMATION BOX AND FOR FORWARDING ONE FORM "A" AND ASSOCIA117M FORM "B"(s) IX) '11It! FOII,OWING ADDRFSS. S TNI1? OF CALIFORNIA 9FNIL WA17-?R RESOURCES CONMOL BOARD C/O S.W.11E= P s. DATA PROCESSING CENIIIR P.O. BOX 527 PARAMOUNT', CA, 90M 04-21-03 09.22AM FROM KERN CONSTRUCTION P02 11NIFIFD PROGRAM CONSOJ JDATED FORM TANKS UNDERGROUND STORAGE TANKS - FACILITY (onage per site) Page of-4— RPNEWALPERMIT S.CHAIeOEOPnvF Pg FORMATION 7-1RMAt NTLYCLUSBDSIT6 TYPE OF ACT tUN 1, tleW SITE PERMIT�- a local use only A. TANK REMOVED (Cloak one sbm only) ❑ 4 AMENDED PERMIT %p%c11y harp � +sro ❑ 6 TEMPORARY SITE CLOSURE I. FACILITY I SITE INFORMATION 9UStNESS NAME (9.,n. r FnC1LrrY N^Me m bBA - Doha Brrinsea Aq 3 FACILITY IDn I py►"+ ��� IN r !A ml F LiTY 0►I+NER TYPP. 4, LOCA AGENCYIDISTRICT' NB 097 CROSS STREET i. CORPORATION ❑ S. COUNTY AGENCY* h 6. STATE AGENCY' 8U6i 9 I. GAS STATION 3. PARM s- COMMS CIAL ❑ 2, INDIVIDUAL ❑ 7. PBDBRAL AGENCY• +oa TYPE ❑ 2. DISTRIBUTOR ❑ 4. PROCESSOR [] 6. OTHER 4U ❑ 3. PARTNERSHIP ❑ •If o-- of US %a pub50 WM-. was of s %Ncr W r of dldi. on, a%ouan mnTrlae uhlxh T TAi. NUMBER OF TANKS h �� nd q n Indian RolervRtiws or Q�Has ft UST {TAI+ 4 Ike COMO parlor far sho wtr noords.l REMAINING AT SiTY 40 06 0 dN Q Ycs id No II. PROPERTY OWNER INFORMATION ao% aor PHONE PROPBRTY OWN R NAMb i j yy 7,19-7 (a . � . I — . U-0 409 MAILINO OR STREET ADDRESS ala STAT all ZIP CODE ats CITY _ y3Y01 • iS 06 Z. INDIVIDUAL 4- LOCAL AGENCY ► DISTRICT 6- TATB AGENCY PROPER? OWNERTYP I. CORPORATION all 3- PARTNERSHIP ❑ S. COUNTY AgIiNCY ❑ 7. FEDERAL AGENCY III. TANK OWNER INFORMATION u+ PHONE as TANKOWNER NAME VH- Z V 76 +ta 1FAor4L MAl 0 OR STREET ADS Sg Z,96 •V 1"'m Or ass ZIP CODE el9 CITY a1y STATE giYa1 �• L4. LOCAL AO NCY ! 321STR)CT 6.6TATE A CY +M TANKOWNB 7.F 3, PARTr`1ERSHIP S. COUNTY AEIENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER 421 I % V. PETROLEUM UST FINANCIAL RESPONSIBILITY ❑ 10.40CAL GOVT MECHANISM INDICATE METHOD(%) ❑ 1, SELF -INSURED ❑ 4. SURbTY BOND [) 7, STATE FUND 99. OTHER: ❑ 2. OUwRANTER ❑ S, LETTER OF CREDIT D S. STATE FUND A CPO LETTER ❑ +s� ❑ 3, INSURANCE E] 6. EXEMPTION ❑ 9. STATE PUND & CD VI. LEGAL NOTIFICATION AND MAILING ADDRESS C& nmWoulen' and m a+ws -14 aanondll* u+dl owncr uniaa%box os 2 �m t FAGILIFY ❑ 2. PRpPEl1TY 4ER ❑ 3. TANK OW!lEE �7 VII, APPLICANT SIGNATURE PHONE the bell a Gs4llusGrn — k unrly thu she iefom)aelen gmrld%d ht[eln II+rW and %alarm bellof mY nP. � AT� ■ . � r r ...... as or�h k�s dR (For loaf uu only) UPCF (1199 revised) 8 (Par loud ore Only) Formerly SWRCB Form A 04-21-03 09:22AM FROM KERN r^NSTRUCTION PO4 UNIFIED PROGRAM CONSOLIDA'1-I,D rt myi TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 2 Pew L e1 V 1. PIPLNG C TI�Kmk AROVE(3A4LND PIPING HI tt o7tfNA8fit3R0UN17 PlPINO ❑ 2. SUCTION 3.ORAVITYado ❑ 2, SUCTION 3. GRAVITY 419 SYSTEM TYPR [I 1. PReSSUAE 1. SINGLE WALL ❑ 3. LINED TRENCH ❑ 99. OTHER SINGLE WALL ❑ 9! UNKNOWN [3 CdNg7RucnoN MANUFACTURER 2, DOUBLE WALL 0 97. UNKNOWN 2, DOUBLE WALL ❑ 99.OTHER ed3 MANUFACTURER MANUFACTURER ❑ 1, BARE a61 STRRL p 6, FRP COMPATIBLE WA00%METHANOL ❑ 1. BARB STEEL 0 6, FRP COMPATIBLE w/100R METHANOL STEEL K7- GALVANIZED STEEL p Unknown l�f 7, O�„V A.�iflBi] STEEL ❑ 2, STAINLESS STEEL l` ❑ 99. OTHER ❑ 2 STAINLESS ❑ 99. Odra ❑ 3. PLASTIC COMPATIBLE W/ CONTENTS ❑ B. PLERIBLR (HDPR) ❑ ). PLASTIC COMPATIBLE W f CONTENTS p 4, FIBERGLASS ❑ 9. CATHODIC PROTECTION ❑ 4 FIBERGLASS ❑ S. FLEXIBLE (HDPE) 0 9. CATHODIC PROTECTION ©!. STEEL WICOATINO p 95UNXN fN e46 0 3. BT@EL WICOATING V7. IN A[Dld hnsadann re Vg11 10414 e [Ane5 aahe DP1PBpG- tTti no DUND PIPING 444 SINGLE WALL PIPING 461 SINGLIE WALL PIPING PRx8SURl7k0 PIPING (Ct«koil twgvly) PRESSURIZED PIPING (cheek '"IeoelrlAL LINE LEAK DETECTOR 3.0 GPH TEST ]Y3 3 RUTO PUMP SHUT 0 MP ❑ I • SHHUT OFF FOR LEALEAK ysTtm FAILURE, ND SYSTDISCONNECTION ❑ 1- ELECTRONIC Opp FOR LBAK,SY8TEMFAILVAR, AND SYSTEM DISCONNECTION AUDIBLE ANO VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. p 2, MONTHLY 9 2 GPM TEST ❑ 2. MONTHLY 0.2 GPH TEST ❑ 3, ANNUAL INTEGRITY TEST (O.IOPH) p 3. ANNUAL INTEGRITY TEST (0.1OPH) O,4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all the' ePPly) COW ENTIONAL SUCTION SYSTEMS ❑ S. DAILY VISUAL MONITORING OF P'UV4PINO SYSTEM +TRIENNIAL P1PIN0 ❑ ! DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0,1 OPH) SAffi SUCTION SYSTEMS (NO VALUES IN 9ELOW GROUNDPIPINOI: 6. TR;F,.NjAL INTEGRITY TEST (0 1 OPH) T O SY EM$ (NO VALVE 8IN BELOW GROUND PIPING): ❑ 7, SELF MONITORING S FE SV p 7. SELF MONI70RINA GRAVITY FLOW GRAVITY PLOW (Check all tMt apply)' Q 9, BIENNIAL INTEGRITY TEST (0.1 GPH) p S, DAILY VISUAL MONITORING ❑ 9. BIENNIAL INTEGRITY TEST (0.1 GPM BLCONDARILV CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING Wi wlo ell "m eppiy) PRESSURIZED PIPING (Check d11 thu apply) SUMP SENSOR b' W AUDIBLE AND VISUAL I0_ CO iT1�fUOU3 TURIITHE SUMP 9P.`I80R W= AUDIBLE AND VISUAL 10- CONIINTfOUS TURBINE ALARMS AND (Check ene) ALARMS AND (check one) a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS 0. A p p. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ❑ E oIAl' Co. ECTIDN DISCONNECTION ❑e NO AUTO PUMP SHUT OFF Qc. NO AUTO PUMP SHUT OR F LINE LEAK DETECTOR (3.0 GPM TEST) Y1ulii PLOW BRUT p 11. AUTOMATIC LEAK DETECTOR ❑ 11. AUTOMATIC OFF OR RESTRICTION p 12. ANNUAL INTEGRITY TEST (0.1 OPH) ❑ 12. ANNUALINTEGRITY TEST (0.1OPH) SUCTION+ORAV=SYSTEM SUCTIONIORAVITY SYSTEM SENSOR. AUDIBLE AND VISUAL ALARI-MS VISUAL ALARMS ❑ 13. CONTINUOUSlIM [313. CONTINUOUS SUMP RGS,yCY OLN[lATORf ONLY�([r"keEtislw+pplr) I gIRGLNCY ORNKRATORS GNLY (Check ell °hµapPly) • ' 0 14, CONTINUOUS SUMP SENSOR wlTH AUTO PUMt BRUT OFF © 14. CONTINUOUS SUMP SP.N&OR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AIfl7)BLE AND VISUAL ALARMS 015, AUTOMATIC LINE LEAK DETECTOR (3.0 OPH TEST) WIM14 FLOW ❑ 15. AUTOMATIC LINE LEAK DFTRCTOR (3,0 OPH TEST) SHUT OFF OR RESTRICTION ANNUAL INTEGRITY TEST (0.1 GPH) (' 16 ANNUAL INTEGRITY TEST (0,1 GPM) LEO3 DAILY VISUAL CHECK 17 DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT AL CHECK DISPENSER CONTAINMENT DATE INSTALLED add I ca111y+hm r L `+ 1!h JeA4NIl J (P0l looel My) d (. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑ 2. CONTINUOUS DISPENSER PAN SENSOR - AUDIBLE AND VISUAL ALARMS ❑ 3. CONTINUOUS DISPENSER PAN SENSOR WffH AUTO SHUT OFF FOR ...wwnvoen � &i mlAt-7 AND VISUAL ALAWA Ix. C) W I hctav a no and eaotete w the boo of mY 00ledge. 3 ❑ 4 DAILY YIBU ❑ !, TRENCH LINER / MONITORING ❑ 6, NON$ Lru UPCF (12/99 revised) 12 FoLmerly SWRCB Form B ACORD CERTT1 ATE OF INCS R Pt MUE DATE aa+/DDIYY) 10/27/93 PROM" THORSON AND ASSOCIATES INSURANCE SERVICES 21700 E. COPLEY DRIVE, #100 DIAMOND BAR, CA 91765- 909-860-1143 ..................... f... ............ ECONO LURE N' TUNE CORPORATE ATTN: JEFFREY A. STEWART 4911 BIRCH STREET NEWPORT BEACH, CA 92660 THIS ClbRTMCATE IS ISSUED -AS A MATTER OF DIFORMATiog ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ]EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, COMPANIES AFFORDING COVERAGE UrrIx A AMERICAN lNTIL SPECIALTY LI COMPANY B LErrElt ........ .......�..... . w»...__»....w_. _...._...».._..........�.._ ..... _ COMPANY C UnTER ............. ....... ........,........... .,..... ....... .......................... . ............................... . COIPANY D LsrrE R ..................... l. ............................ MANY E`ti' COMAGES. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BRIM ISUEwro THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDINO ANY RFQtnRMWWT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOLT]MI NT WLIH RESPECT TO WHICH '!HIS Cyr wrmrATF Mo v I- tonurri 1 nv MAY P"- TAK 11-M IW'0JP ►u(m AFonnnvM !!Y Tr= r-Zv -= ,.�C,�.+..:..,.,,,.,.:5 9LB .Z--: m A_vr EXCLUSIONS AND ODNDITLONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN I EMO ) BY PAID CLAIMS. ............. .............. ....•- ........ ... .... ... , .. .... ... I........ ................................ ,................................... LTX TY]PR OF AMURANCE ]POLICY NUMBER FOLI`Y SFFECrIVE . rOLWY REPWATION Lnum ...... . DAT90AMIDWM VA" V4mA kYY) = GRNERAL LIASIIdrV GENERAL AOGRFAATE i COMMERCW. GENERAL LLABBlI Y PRODUCT3COMP/OP A00. ....::............ . ', .......................... CLAS#SMAnE OCCUR.: PERSONAL & AM. DOURY n. ..... . _................ t .. ............................ OWNERS A CONTRAmrs FRor, ' EACH ......................... s ................................. ......... ....... .. ..I....................... �..» ..�....... FBLE nAMAGE (A� ®ems) .. .......... ................ ............. ... I : WM. EXPEM (AM cm pftwW ................ . $ AVrOMOBILR LIAKUff CohoIN®SRgLB ANY AUTO I _ .......... AIL OWNED AUTOS ... ... BODILY BOURY _ I C%EDtf= AUTOS 0%c Pa-Q .... i1BtIDAUTOe .......................... i.............................. .... BODILY DGURY i S NOWOWNED Atn'W (h -') :............I.... »».. .....a......._............ ........ ' GARAGE LIA11MM PROPERTY DAMAGE _ EICEBB LIABHlrf EACH OCCURREN(M : I .................. .............. ........:.............. ............ .... .... UMBRELLA FORM AGGREGATE OTHER THAN ISIBREUA FOAM WORLER7COMPR RATION SPATUrORYLDAM . DM Ate --POLICY LBW EMPLOYESB'LIASILrrY------------------ ------ _. DISEASE -EACH EMPLOYEE S OT=R A POLLUTION UST M0702 07/20/93 07/20/94 1,000,000 EACH LOSS LIABILITY 2,000,000 AGGREGATE DBBCRIrr;ON of OPEI<ATIONwLOCATLOP6IV nwLp61BpscL4L flBMB LIMITS OF INSURANCE: $1,0001000 PER POLLUTION INCIDENT/S2,000,000 ANNUAL AGGREGATE $ 500,000 DEFENSE COSTS LIMIT PROOF PROVIDED FOR: SITE #107-286 IGUERA, SAY LU1S OBISPO, CA 93401 CERTFICATE HOLDER CANCELi:ATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ED BEFORE THE ECPMATION DATE THEREOF, THB ISSUING COMPANY WILL ENDEAVOR TO MAH- 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE JAMES P. JONES TRUSTEE LEFT BUT FAILURE TO MALL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 717 MARSH STREET LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. SAN LUIS OBISPO CA 93401 LTWK = RUROWATM ►CORD as-s ('.•'.. .. .1190] _ • ACORD CORPORATION 1990 A'1 �INN R l T P city of sAn Luis oBispoFire 1 Department 748 require Pismo St. 0 San Luis Ca. 93401 0d'3e ECONO LUBE AND TUNE 286 HIGUERA DATE:. 10/07/93 SAN LUIS OBISPO, CA 93401 IS REQUIRED TO OBTAIN A PERMIT TO MAINTAIN, STORE, USE OR HANDLE MATERIALS, OR TO CONDUCT PROCESSES, OR TO INSTALL EQUIPMENT AS DESCRIBED BELOW: 1) STORE/HANDLE/USE CLASS III FLAM. LIQUIDS $ 45 2) U.G. STORAGE TANK PER ORD 999 - NEW $175 3) HAZ MAT INVENTORY/BUSINESS PLAN - ORD 1075 $270 THE PERMIT MAY BE OBTAINED FROM THE FINANCE DEPARTMENT AT 990 PALM ST. SAN LUIS OBISPO, CA 93401 OR BY RETURNING THE ENCLOSED ENVELOPE WITH A CHECK TO THE CITY OF SAN LUIS OBISPO IN THE AMOUNT OF: 11-01-94 $ 490.00Payable within 30 days PERMIT WILL BE VALID UNTIL 2594 1 I �]^ FiRE MARSHAL D. NO. _� BY: _l a y A I ECONO LURE N'TUNE nlE Steve Pipkin 286 HIGUERA, SAN LUIS OBISPO, CA 93401 • (805) 544-2976 Date run: 10/11/2022 3:27:29PM COUNTY OF SAN LUIS OBISPO Report #: MFRt Facility Information as of 10/11/2022 Page#: 1 Facility ID:FA0005116 Date: 10/11/2022 Requested by: _s [ ] NEW FACILITY RECORD [ ] OWNERSHIP CHANGE: [ ] Business [ ] Property [ ] Tank I[� INFORMATION CHANGE '[ [ ] UPDATE BILLING INFORMATION ] CLOSE FACILITY AS OF: Date: 1 / [ ] UPDATE UST INFO (sys, type, capacity, etc.) OWNER FILE INFORMATION Owner ID: OW0006190 New Owner ID: _ Owner Name: SIMCAT ENTERPRISES New Name: Owner DBA: New DBA: Owner Address: 2505 THEATRE DR #A New Address: PASO ROBLES, CA 93446 Home Phone: New Home Phone: Work Phone: 805-423-5921 New Work Phone: Mailing Address: 2505 THEATRE DR #A New Mailing Address: PASO ROBLES, CA 93446 Care of: JOE SIMONIN New Care of: FACILITY FILE INFORMATION Facility ID: FA0005116 New ID: v Facility Name: LUBE-N-GO New Name: 286 HIGUERAST New Site Address: SAN LUIS OBISPO, CA 93401-4215 Phone: 805-786-4056 New Phone: Mailing Address: 286 HIGUERA ST New Mailing Address: SAN LUIS OBISPO, CA 93401-4215 Care of: JOSEPH SIMONIN New Care of: CERS ID: 10437337 New CERS ID: GIS: 35.27246-120.67015 New GIS: ACCOUNTS RECEIVABLE FILE INFORMATION - PRIMARY FOR ALL BILLING AND PERMITTING CORRESPONDEN11 Account ID: AR0020508 New Account ID: Account Name: Camille New Account Name: Mailing Address: 286 HIGUERA ST New Mailing Address: SAN LUIS OBISPO, CA 934014215 Cam of- JOE SIMONIN .New -Care. of - Account Balance as of 10/11/2022: $0.00 Mail Invoices to: Account Discount Code: Discount Invoices?: Y LINKED PROGRAMS Transfer (Circle One) UST(s) Program to Activate/Change Linked New Owner? llnactvate 0762 - SLO CITY -HAZARDOUS MATERIALS HANDLER 1-4 PR0007504 EE0000517 - MATHESON BLISS Active Y N A C I Last Activity: 08/24/2022 - REGULAR INSPECTION 1176 - SLO CITY- WASTE GENERATOR (1-5 waste streams) PR0007505 EE0000517 - MATHESON BLISS Active Y N A C I Last Activity: 09/08/2022 - REINSPECTION 0351 - SLO CITY - RENEWAL - LIST ANNUAL PERMIT FEE PR0007506 Inactive 1 Y N A C I Last Activity: 04/21/2004 - CONSTRUCTION / EQUIPMENT INSPECTION 0755 - SLO CITY- STATE SITE SURCHARGE PR0007507 Inactive Y N A C I Last Activity: No Previous Activity 1251 - SLO CITY -AGTANNUAL PERMIT PR0009762 EE0000517 - MATHESON BLISS Inactive 1 Y N / A/ C I Last Activity: 02/01/2012 -REGULAR INSPECTION �./ 4506 - SERVICE STATION PROO17378 EE0000152 - LUCAS WILLIS Inactive Y N A C I Last Activity: 10/16/2018 - REGULAR INSPECTION Date run: 1011V2022 3-27:29PM COUNTY OF SAN LUIS OBISPO Report#: MFR1 Facility Information as of 10/11/2022 Page# 2 [ ] CREATE NEW FILE FOLDER HAZARDOUS MATERIALS SPECIFIC: [ ] UPDATE EXISTING FILE FOLDER LABEL Number of Materials UPDATE NEXT INSPECTION DATE: Date: / / Number of Waste Streams Copy to: File Other: _ Number of Tanks (list Update CERS/HazMat Portal? Yof yes, forward to CERS/portal admin for update) capacity/compartment) Comments: jI le.11,(x j71. (rLG�7`I` '? E I1. S{ . '[1. IIt1 $ Entered by:[xW Date:/,� �Z UNIFIED PROGRAM CONSOLIDATED "' �IZM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page _ of I. IDENTIFICATION FACILITY ID# M�0�0�0�%�1�6� 1 BEGINNING DATE 100 ENDING DATE 101 BUSINESS NAME Same as FACILITY NAME or DBA — Doing Businesg As) 3 BUSINESS PHONE 102 LUBE-N-GO 8057864056 BUSINESS SITE ADDRESS 103 BUSINESS FAX 1o2a 286 H I G U E RA ST 8057864057 BUSINESS SITE CITY 10+ ZIP CODE 105 COUNTY lob SAN LUIS OBISPO cA 93401 DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a BUSINESS MAILING ADDRESS 108a 286 HIGUERA ST BUSINESS MAILING CITY i08b STATE 10Nr ZIP CODE i0aa SAN LUIS OBISPO CA 93401 BUSINESS OPERATOR NAME I09 BUSINESS OPERATOR PHONE 1 JOSEPH SIMONIN 8054235921 II. BUSINESS OWNER OWNER NAME 111I OWNER PHONE SIMCAT ENTERPRISES 18057864056 OWNER MAILING ADDRESS 113 286 HIGUERA OWNER MAILING CITY i i+ STATE its ZIP CODE 11h SAN LUIS OBISPO CA 93401 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 JOSEPH SIMONIN 8052399301 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a ppE����++����ETT CONTACT MAILING CITY 120 STATE 121 1 ZIP CODE 122 PASO ROBLES CA 193446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 12s JOSEPH SIMONIN OMAR MORALES TITLE 129 TITLE 124 OWNER / OPERATOR MANAGER BUSINESS PIIONE 125 BUSINESS PIIONI; 130 8052399301 8057864056 24-HOUR PHONE _1 i3i 24-HOUR PHONR 126 ___, ? 8054235921 Y CELL / PAGER # 132 CELL, I PAGER # 127 RNECL EMAIL ADDITIONAL LOCALLY COLLECTED INFORMATION: V Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 02/28/2022 1 CAMILLE SUNDAHL NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 CAMILLE SUNDAHL OFFICE MANAGER UPCF (Rev. 12/2007) a Go N N N ■ PP :I• �o G E 2 c E o a o o a C o ui ui o 0 E 40 L H C o o o o 0 C O C C O G -4 -4 -4 J V Ln .N-i Qn C 3O L C ql U (i7 C O Ile c O C .0 Q ai ai 10 w .0 w ce m m u •E rn? w L- I N W w N > v v V c c 0 J LL z r,Z) [17 m �� N N WLU E Q- N C LlJ Z a o w a E o � £ .. O c°� 3 a 3 a o a o 0 0 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one Page per material or buildina or area ❑ADD ❑DELETE ❑REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 LUBE-N-GO CHEMICAL LOCATION =oi CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 ❑ YES MAP# (optional) F GRID# (optional) 204 FACILITY ID # F A 0 0 0 5 1 1 6 01 b-04 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Lj Yes 206 AUTOMATIC TRANSMISSION FLUID If Subject to EPCPA, refer to instructions COMMON NAME 207 208 AUTOMATIC TRANSMISSION FLUID EHS* ❑ Yes CAS# 209 *If EHS is "Yes", all amounts below must be in lbs- FIRE CODE HAZARD CLASSES (Complete irrequired by CUPA) 210 Toxic (Tox) HAZARDOUS MATERIAL 213 TYPE (Check one item only) Oa. PURE Ob. MIXTURE Oc. WASTE 211 RADIOACTIVE ❑Yes 212 CURIES PHYSICAL STATE 215 214 LARGEST CONTAINER (Check one item only) O a SOLID Ob, LIQUID O c. GAS 120.0 FED HAZARD CATEGORIES - PHYSICAL FLAMMABLE 0 GAS UNDER PRESSURE ❑ EXPLaSIV SEI.F HEATING (check all that apply) ❑ PYROPHORIC ❑OXIDIZER ❑ ORGANIC PEROXIDE ❑SELF REACTIVE ❑PYROHORIC GAS ❑CORROSIVE TO METAL ❑ CONTACT WATER EMITS FLAMMABLE GAS ❑COMBUSTABLE TO DUST ❑ HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: ❑CARCIGONECITY ❑K ACUTE TOXICITY ❑ REPRODUCTIVE TOXICITY ❑ SKIN CORROSION OR IRRITATION (check all that apply) ❑ RESPIRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE IRRIATIION ❑ SPECIFIC TAGET ORGAN TOXICITY ❑ ASPIRATION HAZARD ❑ GERM CELL MUTAGENICITY ❑ SIMPLE ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVERAGE DAILY AMOUNT 2I K tut DAILY AMOUNT 21S ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 60.0 240 0 UNITS* Qa 221 DAYS ON SITE: 222 GALLONS O b CUBIC FEET O c, POUNDS Od. TONS 365.0 Check one item onl) * If EHS, amount must be in pounds. STORAGE CONTAINER ❑a, ABOVE GROUND TANK ❑e. PLASTIC/NONMETALLIC DRUM[:]i. FIBER DRUM ❑m. GLASS BOTTLE ❑q. RAILCAR ❑b. UNDERGROUND TANK f. CAN ❑j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER �c. TANK INSIDE BUILDING g. CARBOY ❑ k. BOX ❑ a TOTE BIN ❑d. STEEL DRUM ❑h. SILO 1:11. CYLINDER ❑p. TANK WAGON 223 STORAGE PRESSURE O a AMBIENT O b. ABOVE AMBIENT O c, BELOW AMBIENT 224 STORAGE TEMPERATURE O a AMBIENT O b. ABOVE AMBIENT O c. BELOW AMBIENT Od, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) I EHS I CAS # 1 95.0 226 hydrocarbons 227 ❑Yes 228 229 2 5,0 230 BTEX 231 ❑Yes 232 233 3 234 235 1-3 236 237 4 238 239 7Yes 240 241 5 242 243 7Yes 244 245 If more hazardous components are present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. 246 ADDITIONAL LOCALLY COLLECTED INFORMATION UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION onr pW per mateiiod per burldin • or area []ADD ❑DELETE []REVISE 200 Page _of_ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 LU BE-N-GO CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 YES 1 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # F A 0 0 0 5 1 1 6 01 b-04 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes 206 MOTOR OIL If Subject to EPCRA, refer to instructions COMMON NAME 207 * 208 EHS Yes MOTOR OIL CAS# 209 64742-54-7 *If EHS is "Yes", a]I amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete If required by CUPA) 210 Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) Oa. PURE Ob MIXTURE Oc. WASTE 211 RADIOACTIVE Yes 212 213 CURIES PHYSICAL STATE 214 (Check one item only) O a. SOLID Ob. LIQUID O c. GAS 215 LARGESTCONTAINIR 1 _ FED HAZARD CATEGORIES - PHYSICAL K FLAMMABLE GAS UNDER PRESSURE EXPLOSIVE :LF HEATING (check all that apply) PYROPHORIC OXIDIZER []ORGANIC PEROXIDE SELF REACTIVE []PYROHORIC GAS CORROSIVE TO METAL CONTACT WATER EMITS FLAMMABLE GAS 1:1COMBUSTABLE TO DUST HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: E]CARCIGONECITY ❑X ACUTE TOXICITY []REPRODUCTIVE TOXICITY []SKIN CORROSION OR IRRITATION (check all that apply) RESPIRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE IRRIATTON ❑ SPECIFIC TAGET ORGAN TOXICITY ASPIRATION HAZARD ❑ GERM C LI, MIITAGENI('1TY ❑ SIMPI,E ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVCRAOC DAILY AMOUNT 2t7 1 M DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 388.0 75.p UNITS* Oa GALLONS O b. CUBIC FEET O ..POUNDS Od. TONS 221 1 DAYS ON SITE: zzz365.0 (Check one item only) * If EHS, amount must be in pounds. STORAGE CONTAINER Fla. ABOVE GROUND TANK [:]e. PLASTIC/NONMETALLIC DRUM[] i, FIBER DRUM [:]m. GLASS BOTTLE �q. RAILCAR Mb. UNDERGROUND TANK []f. CAN [:], BAG �n. PLASTIC BOTTLE T. OTHER Mc TANK INSIDE BUILDING g. CARBOY ❑ k. BOX o. TOTE BIN Eld. STEEL DRUM h. SILO 1:11. CYLINDER Ejp. TANK WAGON 223 STORAGE PRESSURE O a. AMBIENT O b. ABOVE AMBIENT O c. BELOW AMBIENT 224 STORAGE TEMPERATURE Oa AMBIENT Ob, ABOVEAMBIENT Oc, BELOW AMBIENT Od, CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 226 hydrocarbons 227 Yes 228 229 2 5.0 230 BTEX 231 Yes 232 233 3 234 235 ❑ 236 237 4 238 239 Yes 240 241 5 242 243 Yes 244 245 Ir more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one page per material per buildiniz or area ❑ADD ❑DELETE ❑REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 LUBE-N-GO CHEMICAL LOCATION ml CHEMICAL LOCATION CONFIDEN-DAL EPCRA 2402 ❑ YES I MAP# (optional) 207 GRID# (optional) 204 FACILITY ID # F A 0 0 0 5 1 1 6 01 d-10 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes 206 WASTE ANTIFREEZE If Subject to EPCRA, refer to instructions COMMON NAME 207 208 WASTE ANTIFREEZE EHS* ❑ Yes CAS# 209 107-21-1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 Toxic (Tox) HAZARDOUS MATERIAL 2l3 TYPE (Check one item only) On. PURE Ob, MIXTURE Oc. WASTE 211 RADIOACTIVE ❑Yes 212 CURIES PHYSICAL STATE 215 (Check one item only) 0 a. SOLID Ob. LIQUID 0.. GAS 214 LARGEST CONTAINER t5CJ 11 J`J FED HAZARD CATEGORIES - PHYSICAL FLAMMABLE GAS UNDER PRESSURE EXPLOSIVE SELF HEATING (check all that apply) ❑ PYROPHORIC [-]OXIDIZER []ORGANIC PEROXIDE [:]SELFREACTIVE ❑ PYROHORIC GAS ❑ CORROSIVE TO METAL ❑ CONTACT WATER EMITS FLAMMABLE GAS ❑COMBUSTABLE TO DUST ❑X HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: ❑CARCIGONECITY ❑X ACUTE TOXICITY ❑ REPRODUCTIVE TOXICITY [-]SKIN CORROSION OR IRRITATION (check all that apply) ❑ RESPIRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE IRRIATTION ❑ SPECIFIC TAGET ORGAN TOXICITY ❑ ASPIRATION HAZARD CELL MUTAGENICITY ❑ SIMPLE ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVERAGE DAILY AMOUNT I17 k-NMXfMfiM DAILY AMOUNT 218 1 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zzo 83.0 1 165 675,0 zzl 1 DAYS ON SITE: zzz UNITS* Oa GALLONS O b. CUBIC FEET O c. POUNDS Od, TONS 365.0 Check one item only) * If EHS, amount must be in ounds. STORAGE CONTAINER ❑a, ABOVE GROUND TANK �e. PLASTIC/NONMETALLIC DRUM❑ i. FIBER DRUM ❑tn. GLASS BOTTLE ❑q. RAIL CAR ❑b, UNDERGROUND TANK ❑ f. CAN J. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑c. TANK INSIDE BUILDING ❑ g. CARBOY k. BOX ❑ o. TOTE BIN ❑d. STEEL DRUM ❑ h. SILO 1. CYLINDER ❑p. TANK WAGON 223 STORAGE PRESSURE O a; AMBIENT O b. ABOVE AMBIENT O c. BELOW AMBIENT 224 STORAGE TEMPERATURE Oa AMBIENT O b. ABOVE AMBIENT O c. BELOW AMBIENT Od. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) I EHS I CAS # 1 50.0 226 1antifreeze 227 ❑Yes 228 229 2 50.0 230 water 231 ❑Yes 232 233 3 234 — — 235 ❑ 236 237 4 238 239 ❑Yes 240 241 5 242 243 ❑Yes 244 245 If more hazardous components are present at greater than I % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION twit PW per molonal pot hj]&jK or mcal ❑ ADD ❑DELETE ❑REVISE Page _ oP_ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 LU B E-N-GO CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 YES 1 FACILITY ID # F A 0 0 0 5 1 1 6 101 MAP# (optional) 203 GRID# (optional) 20'1 C-09 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Lj Yes 206 WASTE OIL If Subject to EPCRA, refer to instructions COMMON NAME 207 208 WASTE OIL EHS* ❑ Yes CAS# 209 8002-05-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete irieyuiied by CIIPA) 210 Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) Oa. PURE Ob, MIXTURE O211 c. WASTE RADIOACTIVE []Ye. 212 213 CURIES PHYSICAL STATE (Check one item only) 0.. SOLID Ob. LIQUID O c. GAS 214 215 LARGEST CONTAINER � FED HAZARD CATEGORIES - PHYSICAL ❑ FLAMMABLE GAS UNDER PRESSURE EXPLOSIVE SELF HEATING (check all that apply) ❑ PYROPHORIC ❑OXIDIZER ❑ORGANIC PEROXIDE ❑SELFREACTIVE ❑PYROHORICGAS []CORROSIVE TO METAL ❑ CONTACT WATER EMITS FLAMMABLE GAS EICOMBUSTABLE TO DUST ❑ HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: ❑CARCIGONECITY ❑ ACUTE TOXICITY ❑ REPRODUCTIVE TOXICITY []SKIN CORROSION OR IRRITATION (check all that apply) ❑ RESPiRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE IRRIATIION ❑ SPECIFIC TAGET ORGAN TOXICITY ❑ ASPIRATION HAZARD ❑ GERM CELL MUTAGENICITY ❑ SIMPLE ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVERAGE DAILY AMOUNT 217 IMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 260.0 20.0 1 4800.0 221 1 221 UNITS* Oa. GALLONS O b. CUBIC FEET O c. POUNDS Od, TONS 1 DAYS ON SITE; 222 (Check one item only) * If EHS, amount must be in 2ounds. 365.0 STORAGE CONTAINER [_)CIa, ABOVE GROUND TANK ❑e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM ❑m. GLASS BOTTLE ❑q. RAIL CAR ❑b. UNDERGROUND TANK ❑ f CAN ❑I BAG ❑n. PLASTIC BOTTLE ❑ r. OTHER ❑e. TANK INSIDE BUILDING ❑ g, CARBOY k, BOX ❑ o. TOTE BIN ❑d- STEEL DRUM It. SILO ❑I. CYLINDER ❑p. TANK WAGON 223 STORAGE PRESSURE O a. AMBIENT O b. ABOVE AMBIENT 4 c. BELOW AMBIENT 224 STORAGE TEMPERATURE O a. AMBIENT O b, ABOVE AMBIENT O c, BELOW AMBIENT Od. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 226 hydrocarbons 227 ❑Yes 228 229 2 5.0 230 BTEX 231 Yes 232 233 3 234 235 ❑ 236 237 4 238 239 Yes 240 241 5 242 243 Yes 244 245 Itmore hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of I. FACILITY IDENTIFICATION FACILITY ID # F J.A 10 10 10 151111161 1 1 J I EPA ID # (Hazardous Waste Only) 2 ICAL000387770 (Agency Use Only) 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 LUIS OBISPO 104 CA ZIP CODE 93401 70S I1. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/ O erator Identification page. Does your facility.., if Yes, please com lete these vaszes 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 (CalARP)? responsible for CaIARP. 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? REMOTE WASTE / CONSOLIDATION ❑ YES SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? ❑ YES HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or Obtain federal EPA 1D Number, file more of federal RCRA hazardous waste, or generate in any single calendar ❑ YES Biennial Report (EPA Form 8700- month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous 13A/B), and satisfy requirements for waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? ❑YES See CUPA for required forms. F. LOCAL REQUIREMENTS 1`is (You may also be rega d to pro dd aaddiiimial in rtnation by your CUPA or local agency.) UPCF Rev. (12/2007) UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of_ I. IDENTIFICATION FACILITY ID# M�01,0101511�1161 BEGINNING DATE 100 1 ENDING DATE IOj BUSINESS NAME (Same as FACILITY NAME or DBA—Doing Business As) 3 BUSINESS PHONE 102 LUBE-N-GO 8057864056 BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a 286 HIGUERA ST 8057864057 BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY I08 SAN LUIS OBISPO CA 93401 DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a BUSINESS MAILING ADDRESS 108a 286 HIGUERA ST BUSINESS MAILING CITY 10ft STATE 109c ZIP CODE toad SAN LUIS OBISPO CA I 93401 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE do JOSEPH SIMONIN 8054235921 II. BUSINESS OWNER OWNER NAME 13I OWNER PHONE 112. SIMCAT ENTERPRISES 8057864056 OWNER MAILING ADDRESS 1111 286 HIGUERA OWNER MAILING CITY Ito STATE 1 1 5 ZIP CODE 116 SAN LUIS OBISPO CA 1 93401 III. ENVIRONMENTAL CONTACT CONTACT NAME 1 1 7 CONTACT PHONE 1 I a JOSEPH SIMONIN 8052389301 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 2505 THEATRE DRIVE CAMILLE LUBENGO.NET CONTACT MAILING CITY 120 STATE 121 1 ZIP CODE 122 PASO ROBLES CA 193446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME IZ3 NAME 128 JOSEPH SIMONIN OMAR GODINEZ TITLE 124 TITLE 129 OWNER / OPERATOR MANAGER BUSINESS PHONE 125 BUSINESS PHONE 130 8052389301 8057864056 24-HOUR PHONE 126 1 24-HOUR PHONE 111 CELL / PAGER # 127 CELL / PAGER # 132 EMAIL EMAIL — ADDITIONAL LOCALLY COLLECTED INFORMATION: ITS Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 01/25/2019 CAMILLE SUNDAHL NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 CAMILLE SUNDAHL OFFICE MANAGER UPCF (Rev. [2/2007) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (one page per material per building or area ❑ADD ❑DELETE ❑REVISE 200 Page of_ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 LUBE-N-GO CHEMICAL LOCATION mt CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 ❑ YES FACILITY ID # 1 F A 0 0 0 5 1 1 6 MAP# (optional) 203 GRID# (optional) 204 01 b-04 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Lj Yes 206 AUTOMATIC TRANSMISSION FLUID 1f Subject to EPCRA, referto instructions COMMON NAME 207 208 EHS* ❑ Yes AUTOMATIC TRANSMISSION FLUID CAS# 209 If EHS is "Yes", all amounts below must be in Ibs, FIRE CODE HAZARD CLASSES (Complete irrequired by CUPA) 210 Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) Oa. PURE Ob, MIXTURE Oc. WASTE 211 RADIOACTIVE [:]Yes 212 TURIES 213 PHYSICAL STATE (Check one item only) O a. SOLID Ob_ LIQUID O c. GAS 214 LARGEST CONTAINER120.0 215 FED HAZARD CATEGORIES -PHYSICAL 2FLAMMABLE GAS UNDER PRESSURE EXPLOSIVE ❑ SELF HEATING (check all that apply) ❑ PYROPHORIC ❑OXIDIZER [—]ORGANIC PEROXIDE ❑SELF REACTIVE ❑ PYROHOR[C GAS []CORROSIVE TO METAL ❑ CONTACT WATER EMITS FLAMMABLE GAS ❑COMBUSTABLE TO DUST ❑ HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: ❑CARCIGONECITY ❑K ACUTE TOXICITY ❑ REPRODUCTIVE TOXICITY ❑ SKIN CORROSION OR IRRITATION (check all that apply) ❑ RESPIRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE [RRIATIION ❑ SPECIFIC TAGET ORGAN TOXICITY ❑ ASPIRATION HAZARD ❑ ACUTE TOXICITY ❑ SIMPLE ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 60.0 1 240.0 1 UNITS* Oa, GALLONS O b. CUBIC FEET O c. POUNDS Od. TONS 221 DAYS ON SITE: 222365.0 Check one itetn onl * If EHS, amount must be in pounds. STORAGE CONTAINER ❑a, ABOVE GROUND TANK ❑e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑tn, GLASS BOTTLE ❑q, RAILCAR ❑b. UNDERGROUND TANK ❑ f. CAN ], BAG El n. PLASTIC BOTTLE ❑ r, OTHER File. TANK INSIDE BUILDING ❑ g. CARBOY ek. BOX El o, TOTE BIN ❑d. STEEL DRUM ❑ h. SILO ❑I, CYLINDER p. TANK WAGON 223 STORAGE PRESSURE O a, AMBIENT O b, ABOVE AMBIENT Q c. BELOW AMBIENT 224 STORAGE TEMPERATURE Oa. AMBIENT Ob. ABOVE AMBIENT Oc. BELOW AMBIENT Od. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 226 hydrocarbons 227 ❑Yes 228 229 2 5.0 230 BTEX 231 ❑Yes 232 233 3 234 235 ❑Yes 236 237 4 238 239 []Yes 240 241 5 242 243 ❑Yes 244 245 If mme hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if earcinagenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one a er material per buiIding or area ❑ADD ❑DELETE []REVISE 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 LUBE-N-GO CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 ❑ YES 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY 1D # F A 0 0 0 5 1 1 6 01 1 b-04 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes 206 MOTOR OIL If Subject to EPCRA, refer to instructions COMMON NAME 207 209 EHS* Yes MOTOR OIL CAS# 209 64742-54-7 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete if required by CUPA) 210 Toxic (Tox) HAZ.ARnni IA MATERIAL i11 TYPE (Check one item only) Oa. PURE Ob, MIXTURE 0,.WASTE r--t.. [(AV1GHl 11 VE Ores 2i2 213 CUniES PHYSICAL STATE 214 (Check one item only) O a, SOLID Ob. LIQUID O c, GAS 215 LARGEST CONTAINER 120.0 FED HAZARD CATEGORIES - PHYSICAL i❑X FLAMMABLE GAS UNDER PRESSURE ❑ EXPLOSIVE SELF HEATING (check all that apply) ❑ PYROPHORIC ❑OXIDIZER ❑ ORGANIC PEROXIDE []SELFREACTIVE ❑ PYROHORIC GAS ❑CORROSIVE TO METAL ❑ CONTACT WATER EMITS FLAMMABLE GAS ❑COMBUSTABLE TO DUST ❑ HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: ❑CARCIGONECITY ❑X ACUTE TOXICITY []REPRODUCTIVE TOXICITY ❑ SKIN CORROSION OR IRRITATION (check all that apply) ❑ RESPIRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE IRRIATTON ❑ SPECIFIC TAGET ORGAN TOXICITY ❑ ASPIRATION HAZARD ❑ ACUTE TOXICITY ❑ SIMPLE ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 2I8 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 388.0 775.0 221 UNITS* Oa, GALLONS Q b. CUBIC FEET Q c. POUNDS Od. TONS DAYS ON SITE: zzz 365.0 Check one item only)* If EHS, amount must be in pounds. STORAGE CONTAINER ❑a, ABOVE GROUND TANK ❑e. PLASTIC/NONMETALLIC DRUM[]i. FIBER DRUM ❑m. GLASS BOTTLE ❑q. RAIL CAR ❑b. UNDERGROUND TANK ❑ f CAN ❑j. BAG ❑ ts. PLASTIC BOTTLE ❑ r. OTHER Fc. TANK INSIDE BUILDING ❑ g. CARBOY ❑k. BOX ❑ o. TOTE BIN ❑d. STEEL DRUM ❑ h. SILO ❑I, CYLINDER ❑p. TANK WAGON 223 STORAGE PRESSURE 0 a, AMBIENT O b. ABOVE AMBIENT 0.. BELOW AMBIENT 224 STORAGE TEMPERATURE Oa. AMBIENT Ob, ABOVE AMBIENT Oc. BELOW AMBIENT Od. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 226 hydrocarbons 227 ❑Yes 228 229 2 5.0 230 BTEX 231 []Yes 232 731 3 234 235 [—]Yes 236 237 4 238 239 1:1Yes 240 241 5 242 243 ❑Yes 244 245 If more hazardous components are present at grealer than 1 % by weight if non-cnrcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. 246 ADDITIONAL LOCALLY COLLECTED INFORMATION UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one Pape Per material er buildin or area) ❑ADD ❑DELETE ❑REVISE 200 Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 LU B E-N-GO CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 YES 1 I FACILITY ID # F A 0 0 0 5 1 1 6 MAP# (optional) 203 GRID# (optional) 204 01 d-10 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Lj Yes 206 WASTE ANTIFREEZE If Subject to EPCRA, refer to instructions COMMON NAME 207 208 WASTE ANTIFREEZE EHS* Yes CAS# 209 107-21-1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) Oa, PURE Ob. MIXTURE Oc. WASTE 211 RADIOACTIVE Yes 212 213 CURIES PHYSICAL STATE 214 (Check one item only) O a, SOLID Ob, LIQUID O c. GAS 215 LARGEST CONTAINER 55.0 FED HAZARD CATEGORIES - PHYSICAL FLAMMABLE GAS UNDER PRESSURE LJEXPLOSIVF SELF HEATING (check all that apply) ❑ PYROPHORIC ❑ OXIDIZER [—]ORGANIC PEROXIDE SELF REACTIVE ❑ PYROHORIC GAS ❑ CORROSIVE TO METAL CONTACT WATER EMITS FLAMMABLE GAS �COMBUSTABLE TO DUST ❑X HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: []CARCIGONECITY ❑X ACUTE TOXICITY REPRODUCTIVE TOXICITY ❑ SKIN CORROSION OR IRRITATION (check all that apply) ❑ RESPIRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE 1RRIATHON ❑ SPECIFIC TAGET ORGAN TOXICITY ❑ ASPIRATION HAZARD ❑ ACUTE TOXICITY ❑ SIMPLE ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 83,0 165.0 1 675.0 UNITS" Oa, GALLONS O b. CUBIC FEET O c, POUNDS Oct.2t TONS DAYS ON SITE. 222, Check one item only) * If EHS, amount must be in pounds, 365.0 STORAGE ❑ ❑ �q,RAILCAR CONTAINER a, ABOVE GROUND TANK >< e, PLASTIC/NONMETALLIC DRUM i. FIBER DRUM tn, GLASS BOTTLE �b. UNDERGROUND TANK �f. CAN E:]j. BAG Eln. PLASTIC BOTTLE ❑ r, OTHER ❑e. TANK INSIDE BUILDING g. CARBOY 1:1k. BOX ❑ o. TOTE BIN ❑d- STEEL DRUM [1h. SILO El 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE O a AMBIENT O b, ABOVE AMBIENT O c. BELOW AMBIENT 224 STORAGE TEMPERATURE O a. AMBIENT O b, ABOVE AMBIENT O c. BELOW AMBIENT Od. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 229 1 50.0 226 antifreeze 227 Yes 228 2 50.0 230 water 231 Yes 232 233 3 234 235 Yes 236 237 4 238 239 Yes 240 241 5 242 243 Yes 244 245 if more hazardous components are present at greater than 1% by weight if non -carcinogenic, o• 0.l % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION nne all nmtarinl Iff Inn ldin or arra []ADD ❑DELETE ❑REVISE 20o Page _ or- 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 LUBE-N-GO CHEMICAL IOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 ❑ YES 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # F A 0 0 0 5 1 1 6 01 C-09 11. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes 206 WASTE OIL If Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS* Yes WASTE OIL CAS# 209 CAS# 5-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complele if required by CUPA) 210 Toxic (Tox) T-lA7ARfl(II LC MATFRIAI. TYPE (Check one item only) Oa. PURE Ob. MIXTURE Oc. WASTE ui 213 r�-. KAUIVAI TI V E LJ r es 2III CURIES 215 PHYSICAL STATE 214 (Check one item only) O a. SOLID Ob, LIQUID O c. GAS LARGEST CONTAINER 550.0 FED HAZARD CATEGORIES - PHYSICAL ❑X FLAMMABLE GAS UNDER PRESSURE EXPLOSIVE SELF HEATING (check all that apply) ❑ PYROPHORIC ❑OXIDIZER ❑ ORGANIC PEROXIDE ❑SELF REACTIVE ❑ PYROHORIC GAS ❑CORROSIVE TO METAL ❑ CONTACT WATER EMITS FLAMMABLE GAS ❑COMBUSTABLE TO DUST ❑ HAZARD NOT OTHERWISE CLASSIFIED FED HAZARD CATEGORIES - HEALTH: ❑CARCIGONECITY ❑X ACUTE TOXICITY [—]REPRODUCTIVE TOXICITY ❑ SKIN CORROSION OR IRRITATION (check all that apply) ❑ RESPIRATIORY OR SKIN SENSITIZATION ❑ SERIOUS EYE DAMAGE OR EYE IRRIATTON ❑ SPECIFIC TAGET ORGAN TOXICITY ❑ ASPIRATION HAZARD ❑ ACUTE TOXICITY ❑ SIMPLE ASPHYXIANT ❑ HAZARD NOT OTHERWISE CLASSIFIED AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 260.0 1 520.0 1 4800.0 221 1 zzl UNITS* Oa. GALLONS Q b. CUBIC FEET Q c. POUNDS Od. TONS DAYS ON SITE: 222 365.0 Check one item only) * If EHS amount must be in pounds. STORAGE CONTAINER na ABOVE GROUND TANK ❑e. PLASTIC/NONMETALLIC DRUM❑ i. FIBER DRUM ❑1n. GLASS BOTTLE ❑q. RAILCAR Flb. UNDERGROUND TANK f.CAN ❑j. BAG ❑n. PLASTIC BOTTLE ❑ r. OTHER ❑c. TANK INSIDE BUILDING B g. CARBOY �k..BOX ❑ o. TOTE BIN �d. STEEL DRUM h, SILO �1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE Q a. AMBIENT O b. ABOVE AMBIENT O c, BELOW AMBIENT 224 STORAGE TEMPERATURE O a. AMBIENT O b. ABOVE AMBIENT O c. BELOW AMBIENT Od. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 226 hydrocarbons 227 Yes 228 229 2 5.0 230 BTEX 231 ❑Yes 232 233 3 234 235 ❑Yes 236 237 4 238 239 Yes 240 241 5 242 243 ❑Yes 244 245 If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. 246 ADDITIONAL LOCALLY COLLECTED INFORMATION UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of I. FACILITY IDENTIFICATION FACILITY ID # FAD O 151111161 I EPA ID # (Hazardous Waste Only) (Agency Use Only) CAL000387770 BUSINESS NAME (Some as Facility Name of DBA-Doing Business As) LUBE_N_GO BUSINESS SITE ADDRESS 286 HIGUERA ST 103 BUSINESS SITE CITY SAN LU I5 OBISPO CA ZIP CODE 93401 tos II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, (ease submit the Business Owner/ perator Identification page. Does your faciIi If Yes, please com [etc these Mes 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 enieWncy 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 (CaIARP)? responsible for CaIARP. 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 Forrn 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? 171 VTPZ EPA ID NUMBER —provide at the top of is page Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MATERIALS REPORT materials (per HSC 25143.2)? ❑ YES (one per recycler) Treat hazardous waste on -site? ❑ YES HAZARDO LI WASTE TREATMENT— 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? REMOTE WASTE / CONSOLIDATION ❑ YES SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? ❑ YES HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or Obtain federal EPA ID Number, file more ol'fuderalwaste, or Uncratu in au single 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? EpYES See CUPA for required forms, rs F. LOCAL REQUIREMENTS �� ur (You may also be required to provide addit al infamra n by 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 SAN LUIS OBISPO C °` ZIP CODE 93401 COUNTY San Luis Obispo �� ��PI�IV�NAME IVI BUSINESS OPERATOR PHONE 8054235921 II. BUSINESS OWNER OWNER NAME I OWNER PHONE SIMCAT ENTERPRISES 18057864056 OWNER MAILING ADDRESS 286 HIGUERA CITY STATE ZIP CODE SAN LUIS OBISPO I CA 193401 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 MANAGER BUSINESS PHONE BUSINESS PHONE 8052389301 8057864056 24-HOUR PHOINP 24-HOUR PHONE PAGER # / CELL PHONE # PAGER N 1 CELL PHONE 4 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 O WNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE NAME OF DOCUMENT PREPARER Submitted via Public Portal 02/13/2018 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 per material per building or area ❑ADD ❑DELETE ❑ICI VISi 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 GRIDU (Agency use only) f,/-OAF II. CHEMICAL INFORMATION CHEMICAL NAME Yes ❑ TRADE SECRET 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 if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE 0 a. PURE 0 b. MIXTURE ❑ c, WASTE RADIOACTIVE Yes ❑ No CURIES (Check one item only) PHYSICAL STATE 0 a. SOLID 0 b. LIQUID 0 c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES 0 a. FIRE ❑ b. REACTIVE ❑ c, PRESSURE RELEASE 0 d, ACUTE HEALTH ® e. CHRONIC HEALTH (Check all that apply) AVERAGE DAUN AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTL• CODE 60.0 1 240.0 UNITS* Q a. GALLONS O b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 5 0 (Chock one item only) , amount mull be in pouR f. STORAGE Ll a. ABOVE GROUND TANK 0 e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUNI ❑ m. GLASS BOTTLE CONTAINER ❑ b, UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR 0 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 0 a. AMBIENT 0 b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 0 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 1f mare hnrardaus cnmpancnts nre present nt amuter Ihno I % by weigh) if non•cartipoeenic. or n.1% by weight if carcinogenic, Munch additiadtl sheets of paper cnluuring the required infurmtHon. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please SiEn Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one Pue per makrioltmr buildine or area ❑ADD []DELETE UREVISE 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 (Agency use only) MAP# O1 GRID#-04 If. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRAD E 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 (Check one item only) ❑ a. PURE M b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes [3 No CURIES PHYSICAL STATE [3 a. SOLID b. LIQUID [3 c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES a FIRE [Ib_ REACTIVE c. PRESSURE RELEASE (Check all that apply) ❑ d. ACUTE HEALTH a CHRONIC HEALTH 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: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE 13 a. ABOVE GROUND TANK 0 e. PLASTICNONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m, GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN [3j. BAG ❑ n. PLASTIC BOTTLE 0 q RAILCAR 0 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 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE M a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 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 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 tune page per material per buildia or array []ADD ❑DELETE LIRLVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-G0 CHEMICAL LOCATIC— CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # Ll!! 5116 MAP# 0 1 GRID# d-10 (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME WASTE ANTIFREEZE TRADE SECRET ❑Yes ❑ No If Subject to EPCRA, refer to instructions COMMONNAME WASTE ANTIFREEZE EHS* [I 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. PURE ❑ b. MIXTURE M c. WASTE RADIOACTIVE ❑ Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID b. LIQUID ❑ G GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES ❑ a. FIRE ❑ b. REACTIVE ❑ c, PRESSURE RELEASE 10 d. ACUTE HEALTH ® e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY ANIOUNT DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 165.0 675.0 UNITS* Q a GALLONS 0 b. CUBIC FEET ❑ c. POUNDS [3 d. TONS DAYS ON SITE-: au n (ChLck one item on y) A]r EIIS, amount must be in pounds STORAGE a. A13OVE GR()UNDTANK e. PLAS-11CINONMETALLIC DRUM 0 i. FIBL'R 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 [11. 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 # I 50.0 antifreeze ❑ Yes ® No z 50.0 water ❑ Yes ®No ❑ Yes ❑ No 4 ❑ Yes ❑ No S ❑ Yes ❑ No Ef moir 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 Sig n IIere FORM I - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one page per material per buildingor areal [:]ADD ❑DELETEOREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LLIBE-N-GO CHEMICAL LOCATION a' ngs CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 01 GRID# C—O�J (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't ❑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) TnYir. lTnYl HAZARDOUS MATERIAL TYPE a. PURE 0 b. MIXTURE c. WASTE (Check one item only) RADIOACTIVE ❑ Yes []No CURIES PHYSICAL STATE ❑ a. SOLID 0' b, LIQUID 0 c, GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES M 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 260.0 520.0 4800.0 221 UNITS* Qi a. GALLONS Q b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: ^ 5.0 (Check one item only) *If EHS, amount must be in pounds. 3 STORAGE a, ABOVE GROUND TANK e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG © it. PLASTIC BOTTLE ❑ % RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k BOX ❑ o. TOTE BIN ja r. OTHER ❑ d. STEEL DRUM ❑ h. SILO © I. CYLINDER Q p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT [3c. BELOW AMBIENT Q 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 CI-Ly Of SAn tLA6 OBISPO Fire Department * 748 Pismo St. 0 San Luis Obispo, Ga. 93401 0 549-7380 permit 000002 20 2274 11--04--88 MISC. 1 490.00 005001.5045070 DAPPE: CASH ? TOTAL 1: 490.00 SAN LUIS OBISPO, CA 93401 HAS PERMISSION TO MAINTAIN, STORE, USE OR, HANDLE MATERIALS, OR TO CONDUCT PROCESSES, OR TO INSTALL EQUIPMENT AS DESCRIBED BELOW: ALL REQUIREMENTS SHALL BE PER THE UNIFORM FIRE CODE AND ITS STANDARD. THIS PERMIT IS NON -TRANSFERABLE. IT SHALL BE POSTED IN PUBLIC VIEW AND SHALL NOT BE REMOVED - BY ORDER OF THE FIRE CHIEF. I I I • AMOUNT PAID• $ EXPIRA700N DATE I.D. NO. 1 W FIRE MARSHAL I `"-"° °1 Fire Department • 748 Pismo Ste San Luis Obispo,Ca. 93401 • 1permlt ADDRESS: Higuera - Econo Lube N' Tune DATE: -September 30, 1987 B & B Contractors HAS PERMISSION TO MAINTAIN, STORE, USE OR HANDLE MATERIALS, OR TO CONDUCT PROCESSES, OR TO INSTALL EQUIPMENT AS DESCRIBED BELOW: To install 1-5 0 gallon waste oil tank in accordance with Article 79, Uniform Fire Code. ALL REOU I REMENTS S HALL B E PER THE UN I FORM F I RE COD E AND I TS STAND ARD - THIS PERMIT IS NON TRANSFERABLE. IT SHALL BE POSTED IN PUBLIC VIEW AND SHALL NOT BE REMOVED - BY ORDER OF THE FIRE CHIEF• October 15, 1987 AMOUNT OF PERMIT: $ 40.OL I Paid with check #16?65 EXPIRATION DATE T_ Tl_ Nn. -- r-o weirs Triinnd1l i Firs NA', , 1 J CITY OF SAN LUIS OBISPO - FIRE DEPARTMENT 748 PISMO STREET SAN LUIS OBISPO, CA 9 ,-}O1 805/549-7380 POST CARD AT JMITE 0 FACILITY PERMIT # UAMM ADDRESS ADDRESS EIx•iJ e_ Lt �! __- CITY %LIP, CITY PHONE NO. PHONE NO. I INSTRUCTIONS: Please call for an inspector only when each group of inspections with the sane number are ready. They will run in consecutive order beginning with number 1. DO NOT cover work for any numbered group until all items in that group are signed off by the Permitting Authority. Following these instructions will reduce the number of required inspection visits and therefore prevent assessment of additional fees. INSPECTION DATE INSPRL"MR Backfill of Tank(s) — Spark Test Certification W?ap Cathodic Protection of Tank(s) /1.,14 - PIPING SYSTEM - piping & Racewayw Co lection Sump �� Protection o Piping, Joints, Fill Pipe _Corosion E ec isolation o Piping From Tank(s) Cathodic Protection System -Piping A- L JAln1 - SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECT Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Cam table Sealer Level Gauges or Sensors, Float Vent Valves _ Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s) for Annular Space-D.W. Tank(s) Monitoring Wells) Sumps) Leak Detection Device(s) For Vadose Groundwater - FINAL - Monitoring Wells, Caps & Locks Fill Box Lock Monitoring R irements oZ CONTRACTOR `e •L SGz� - ,...... _ l ~ LICENSE. # CONTACT / PH Construct New Tank Operate New Tank SAN LUIS OBISPO CIVY APPLICATION FOR PERMIT TO CONSTRUCT UNDERGROUND HAZARDOUS MATERIALS STORAGE TANK 0 Modify Existing Tank [] Transfer of Ownership In or on the premises at �e?(o PART I OWNER: Company: Contact: LC�,+t Mailing { Address: t�� To_ Klewmif .Q(',k) , `Tel . (71q)L5� 5q OPERATOR: G2.V5S Company: 1()+ ..._L' li Contact : 1 LOA Mailing Address: R,_MX- nnil Z4.7u��^�..f'7.� _k Ij n Tel CONSTRUCTION: (Complete on if application to construct or modify tank) Company: r.{� rG1�� Contact: Mailing Address _(L�l��� ,�1 �� _Tel: State Contractor License No.: Construction Start Date: Attach a Plot Plan Showing: (for new construction and modification only) Location of all tanks and piping and j( Leak Detection System their secondary containment Overfill Protection System Scale � Property Line North Arrow Nearest Intersection or Road JG'nii;mm�nfCmmarti }� SCC' If this is an P4�mb n LA. application o P()-1 orat-off _X New am. t� transfer ownership or operation of tank, tquipmen complete Previous Owner: n „� . _� ^Contact: Address: Previous Operator: Address: Start Up Date: 1q1-' ** 24 Hour Emergency Telephone Plan Approved X Plan Disapproved Contact: Date Installed: (for existing tanks following: Tel : ( ) Tel: ( ) .Je('le lopl el-) T scant .7 -- Date of Approval/Disapproval If V Date.of_Const-ruction -Completion.-- Return this copy to San Luis Obispo Fire ®epl. o f FDP 268 92�� Authorizing Agent Signature % j SAN LUIS OBISPO CITY APPLICATION FOR PERMIT TO CONSTRUCT UNDERGROUND HAZARDOUS MATERIALS STORAGE TANK PART II DIRECTIONS: Complete one form for each tank being installed/modified. PROPOSED USE OF TANK: YYtiA_ C�kal 40J4 I i MATERIAL(s) TO BE STORED I TANK: �!c u_)i-_ i-'. It )be di ! u a VOLUME OF TANK IN GALLONS: MANUFACTURER OF TANK:, n L� IF TANK USED PREVIOUSLY: Past Use of Tank: 1) _F[X ' Materials) Stored in Tank: TYPE OF CONTAINMENT: ]] Concrete D Fiberglass F—j Other Car bon S e-e- I U.L. NUMBER efF. LjoL 5 Thickness of Primary Containment: aclI TYPE OF SECONDARY CONTAINMENT OR DRIP -PAN AS APPLICABLE:' Fiberglass Coated Steel (� Concrete Fiberglass Coated Steel Fiberglass Other Thickne,.>s of Secondary Containi.ient or Drip -Pan as applicable:t L �_ t I L PIPING MATERIALS OF CONSTRUCTION: 59 Steel [K Fiberglass LZI Other lboube WaA-ecd C pf MOLry 5CCond�O_V-c ) p p e, Describe the leak detection system you plan to use for tank pressure lines a{) s)n r) eC-W_CL-) tT-) 6-n 0J.A t i b l e 1 v t5c, a( P- c a_.r M scribe the overfill protection system you pan to use:/dr�. hat,is the approximate depth of groundwater? 5 tf m Attach a certification from the manufacturer, or his authorized representative, of the tank and piping materials as to the capability of the tank and piping material with the proposed stored materials. (This applies onl -tom-N n-Motor Fuel Products) . 2 Of O���po Fire Dept. FDP 268 ;. r .. . .., .. - - CITY OF SAN LUIS OBISPO - FIRE DEPARTMENT 748,PISMO STREET SPA'• LUIS OBISPO, CA 934ul INSPWrION MKX)M 805/549-7380 INSTRUCTIONS: Please call for an inspector only when each group of inspections with the sane number are ready. They will run in consecutive order beginning with number 1. DO NOT cover work for any numbered group until all items in that group are signed off by the Peamittirg Authority. Following these instructions will reduce the number of required inspection visits and therefore prevent assessment of additional fees. - TANKS & BACKFILL - INSPECTION DATE INSPECTOR - PIPIN(, SYSTEM - Pi i & Raceway w C❑ lection Sump _ Corrosion Protection of Piping, Joints, Fill Pipe Electrical Isolation ot Piping From Tank(s) Cathodic Protection Sstvm-Piping - 5U)UNDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION - Liner Installation - Tank(s) Liner Installation - Pil2iN Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s) for Annular Space-D.W. Tank(s) Monitoring Wells) Sumps) Leak Detection Device(s) For Vadose Groundwater - FINAL - Monitoring Wells, Caps & Locks Fill Box Lock Monitoring R irements CONTRACTOR_ CONTACT LICENSE PH # -PRELIMINARY -SOILS .ENGINEERING INVESTIGkTION OF ECONO LUBE N '. TUBE, -SITEj...286 I JERA STREETo SANLUI .',,. CAI, I FORN IA. I PACIFIC GEOSCIENCE, INC. Geotechnical Research and Engineering Materials Testing Laboratory 396 BUCKLEY RD. (805) $"-3276 SAN LUIS OBISPO, CA 93401 September 15, 1986 Econo Lube N' Tune Attn: Mr. Larry Bell 4911 Birch Street Newport Beach, CA 92660 SUBJECT: PRELIMINARY SOILS ENGINEERING INVESTIGATION OF ECONO LUBE N' TUNE SITE, 286 HIGUERA STREET, SAN LUIS OBISPO, CALIFORNIA. G2492 INTRODUCTION This report presents the findings of a Preliminary Soils Engineering Investigation performed by this firm at the above referenced site. It is our understanding that a single story structure with block walls up to 18 feet in height and a slab -on -grade are proposed. The building will encompass 2556 square feet and 9 parking spaces will be provided. A lube pit extending 7 feet below finish floor elevation is planned. SCOPE OF WORK. The Preliminary Soils Engineering Investigation was based on a preliminary site plan provided by the client in August, 1986. The report and recommendations are intended to comply with the considerations of Subsection c of Section 2905, Chapter 29, Subsection e of Section 7006, Chapter 70, Uniform Bi ilding, Codc, 1985 edition, and standard soils engineering practice. Recommendations for site preparation, earthwork, foundations, slabs, and pavement sections are presented to ' guide the development of project plans and specifications. It is requested that final plans be reviewed by this office to ensure conformNficc with The intent of this report, Ir changes in project plans become necessary, or if conditions are encountered that differ significantly from those anticipated, the soils engineer shall be consulted prior to construction. Analyses of erosion potential, erosion mitigation, potential for flooding, and the corrosive potential PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 2 September 15, 1986 of soils upon underground utilities are beyond the scope of this investigation. SITE DESCRIPTION The 256 x 56 foot rectangular shaped site is located on the west side of Higuera Street in the City of San Luis Obispo, California. The property is relatively level and partially paved. It is our understanding that a building which occupied the site was demolished and removed prior to this investigation. The adjoining lot to the north is developed with an older building, Bianchi Lane is to the south and San Luis Creek lies immediately to the west. A block retaining wall extends along the north property line. The wall, which retains soil on the subject lot, varies in height from 1 foot near the center of the lot to 5 feet at the northwest corner. An evaluation of the structural integrity of the wall is beyond the scope of this report. The majority of the site is presently paved with A.C. The site is free of vegetation with the exception of two pine trees on the north property line and vegetation on the creek bank. Some minor amounts of fill have been placed at the top of the creek bank. The creek bank is estimated to be 15 feet in height with slopes up t❑ 50%. A 5 foot diameter concrete storm drain discharges into the creek near the southwest corner of the lot. The drain appears to cross the property in a northeast direction, beneath the proposed parking area. Location of the culvert was not indicated on plans provided by the client. FIELD_ AND LABORATORY INVESTIQATIQ On September 2, 1986, three borings were drilled on the site in the locations shown on the attached site map, Appendix A. A Mobile B53 drill with an 8 inch diameter continuous flight auger was employed to explore subsurface conditions to a maximum depth o eet. Soils encountered were visually classified and logged in accordance with the Unified Soils Classification System; please refer to Appendix B for copies of the Boring Logs. As the site was drilled, Shelby thin tubes lined with a low shear strength, microcrystalline wax were employed to retrieve four undisturbed soil samples. Locations PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 3 September 15, 1986 and depths of the samples are noted in the left column of the boring logs. Representative surface soil samples were also collected at this time. In all 3 borings, Standard Penetration tests were performed at various depths. The Standard Penetration test is performed using a 2 inch (outside diameter) by 2 foot long split -spoon sampler attached to a 140 pound drop hammer. The hammer is repeatedly dropped from a specified height, driving the sampler into undisturbed soil. The number of blows, by the hammer, required to drive the sampler (in 6 inch increments) is recorded and used in empirically assessing a variety of soil and rock parameters. Standard penetration data is recorded in the second column from the left on the boring logs. To assess the bearing capacity of the soil, three of the undisturbed soil samples were tested for consolidation under normal loads in accordance with ASTM D2435-80. The results of these tests are presented as void ratio vs, pressure diagrams in Appendix C. An expansion index test was conducted on a representative sample of material. A description of the test and the test results can be found in Appendix D. Due to the cohesive nature of the soils encountered, an R-Value test did not appear warranted. GENERAL SOIL PROFILE The subsurface profiles at the locations drilled were somewhat variable near the surface, becoming more uniform with depth. In Borings 2 and 3, 2.5 inches of A.C. were encountered above 4.5 to 6 inches of gravel base material. In Boring 1, a gravelly, rubble fill with a sandy clay matrix was encountered to a depth of 3 feet. In Boring 2, a somewhat cleaner gravel fill with occasional cobbles up to 6 inches in diameter was encountered to a depth of 2.5 feet. In Boring 3, a mottled sandy clay fill was encountered to a depth or 2.5 feet. Below t e i , con jtions were relatively uniform in all 3 borings. Native sandy silt and clayey silt was encountered from the base of the fill to a maximum depth of 9 feet where a transition to a dark brown to black sandy clay occurred. The sandy clay became brown in color and increasingly sandy with depth. Sandy soils PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 4 September 15, 1986 predominated the profile in Boring 1 from 16 feet to the termination of the boring at 31.5 feet, and were encountered in Boring 3 from 15 feet to the termination of the Boring at 16.5 feet. The fill material was in a varied state of compaction. The native sandy and clayey silts were moderately stiff, the sandy clay stiff to very stiff, and the deeper sandy soils loose to moderately compact. The moisture content generally increased with depth. Subsurface free water was encountered in Boring 1 at depths of 18 feet and 23.5 feet and in Boring 3 to a depth of 16 feet. A piezometer was installed -in Boring 1 to a depth of 34 feet. No subsurface water was encountered in Boring 2. No bedrock was encountered in any of the borings. CONCLUSTONS The site is suitable for the proposed commercial building provided that site development is in accordance with the recommendations presented herein. The exploratory borings revealed 2-3 feet of sandy clay and gravel fill material overlying cohesive native soils with sands predominating below a depth of 15 feet. No bedrock was encountered. The fill was in a varied state of compaction while the silts were moderately stiff, the clays stiff, and the sands loose to moderately compact. Free subsurface water was encountered below the depth of the proposed development. The field and laboratory test data indicate variable materials and conditions near the surface with some soft zones at depth. The primary concerns from a geotechnical standpoint will be to obtain uniform conditions within the fill and to accommodate the expansive nature of the soil. This can be accomplished with an earthwork program which will be outlined in t i following section. The expansion index sample was taken from the sandy clay fill soil encountered in Boring 3 from a depth of 9 inches to 2.5 feet. The expansion index test yielded a value of 46, which is indicative of a soil with a low to moderate tendency toward expansion. PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 5 September 15, 1986 Expansive soils tend to swell with seasonal increases in soil moisture and subsequently shrink as soil moisture is reduced during the drier months. As such seasonal volume changes in the soil can stress and damage slabs and foundations it will be necessary to incorporate precautionary measures into the construction process. Current engineering practice is to provide a deep perimeter foundation that extends below the expansive soil zone, and to protect slabs either by presaturation of sub -slab soils or by placement of a layer of non -expansive material beneath the slab. No R-Value (resistance to deformation under repeated loads) was performed due to the clayey nature of the soils. As even a moderate amount of fine particles within a soil render the R-value low, pavement sections have been developed using an estimated R-value of 10. They are presented in a later section of this report. The existing paving appears to be relatively intact and may be overlain in accordance with the recommendations presented in the following section. In view of the variable soil types and states of compaction within the upper several feet of strata at this site, two sets of recommendations will be provided. The first will be for re -working the on -site soils which are considered cohesive and somewhat expansive. The second for imported non -cohesive, non -expansive fill. RECOMMENDATIONS - COHESIVE SOILS Site Pre aration: The site shall be stripped of all organic and deleterious materials as described in Appendix G. Any voids resulting from the removal of tree roots, stumps, or other subsurface items shall be promptly backfilled and compacted to a minimum of 90% relative compaction. Immediatc-�backfilling is recommended to avoid losing the precise void location. Any utilities present on the site that will not be serving the new structures shall be removed or relocated outside of the proposed building areas. Portions of the existing block retaining wall which lie within the building footprint shall be removed. PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 6 September 15, 1986 It is recommended that the exact location of the storm drain culvert be determined prior to commencement of earthwork. Earthwork: The entire area within and extending a minimum of 5 feet beyond the foundation envelope shall be excavated to a depth of 18 inches below finish slab excavation. The excavated material shall be stockpiled. All deleterious material which doe not meet the earthwork material; requirements set forth in the appendices shall be removed. Excavations shall not extend onto the adjoining property to the north. The entire cut area shall be scarified to a depth of 12 inches and recompacted .to a minimum 90% relative compaction. The on -site, stockpiled materials or if imported cohesive soils will be used as fill they shall be placed in lifts not exceeding 8 inches and recompacted to a minimum 90% relative compaction. If imported granular fill soils are used, they shall be placed in lifts not exceeding 12 inches and compacted to a minimum of 95% relative compaction. This program shall apply to soils within and extending a minimum of 5 feet beyond the foundation envelope. Compaction requirements for soils beneath paved areas may differ and are presented under Pavement Sections later in this report. To facilitate compaction, it is suggested that soil moisture be adjusted to within 3% of optimum prior to receiving compactive effort. Soil moisture should be uniform throughout soils to be compacted. The contractor shall be aware that obtaining compaction in this type of soil may be difficult if earthwork is attempted when soil moisture is high, particularly during or following the wet season. Please see Appendices H through J for additional criteria for cohesive soils earthwork. expansive soil condition, all perimeter footings and interior spread footings shall extend a minimum of 21 inches below lowest adjacent grade; interior continuous footings may be per U.B.C. requirements. Minimum reinforcement shall consist of #4 bars top and bottom or PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 7 September 15, 1986 as directed by the structural engineer. Foundation design shall be based upon maximum soil bearing values of 1000 psf dead load and 1500 psf dead plus live. The bottoms of the footings shall be horizontal and stepped as necessary to accommodate the slope. The foundation along the northern property line shall function as a low retaining wall. - lab • Slabs shall have a minimum thickness of 4 full inches and shall be reinforced with #3 bars placed 18 inches on center each way. Slabs shall be tied to the interior and exterior footings by the use of dowels spaced 18 inches on center each way. The dowels shall hook over the outside of the upper stemwall horizontal rebar, extending vertically to 3 inches above the bottom of the footing, and a minimum of 3 feet horizontally into the slab. Rebar is recommended for slab reinforcement rather than wire mesh due to the expansive soil condition. Please note that these are minimum requirements only and may be superseded by the structural engineer. Presaturation of sub -slab soils is one method that may be used to protect against prior to construction of the slab; the casting of the slab then seals the moisture in, thus breaking the swell -shrink cycle. The procedure is performed after the foundation is cast, but prior to the casting of the slab. Moisture content shall be adjusted to 130 percent of optimum to a depth of 27 inches below lowest adjacent grade and tested by the soils engineer. Once adequate saturation has been achieved, the moisture content shall be maintained until the slab is cast. With presaturation, a better work surface can be obtained by using clean -gravel (such as floatrock or 3/4 x #4) as capillary break material. A minimum. 6 inch thickness of clean gravel beneath the slab will provide a stable work surface and will act as a barrier against infiltration of subsurface moisture. If preferred, four inches of clean sand with a vapor barrier sandwiched in the center can be substituted for the gravel. PACIFIC GEOSCIEN CE, INC. Lube N' Tune, G2492 8 September 15, 1986 As an alternative to presaturation, 18 inches of non -expansive material can be placed beneath slabs. The non -expansive import is defined as a granular material exhibiting an expansion index of 20 or less and shall be placed in horizontal lifts having a maximum depth of 12 inches. A minimum of 95% relative compaction shall be obtained. If this alternative is preferred, provisions to allow for the 18 inches of import must be incorporated into the grading plan. The upper portion of the non -expansive material shall be 4 inches of ]c can sand, with a vapor barrier at the mid -section, or 6 inches of clean gravel. To protect patios, walkways, etc., from damage due to expansive soils, a minimum 8 inch thickness of non -expansive material placed beneath such flatwork is recommended. A third option is the use of post -tensioned slabs method is desired, please contact this office. RECOMMENDATIONS - NON -COHESIVE SOILS Site Prel2protion: Same as for cohesive soils. If further discussion of this Earthwork: The entire area within the building envelope and 5 feet beyond (except along north nranerty line] shall be excavated a minimum of 18 inches below finish slab elevation. All excavated cohesive and deleterious materials shall be removed from the site. The entire cut area shall be scarified to a depth of 12 inches and recompacted to a minimum of 90% relative compaction. The excavation shall be, filled with non -cohesive, non -expansive import placed in 12 inch lifts compacted to a minimum 95% relative compaction. Compaction requirements for soils beneath paved areas may differ and are presented under Pavement Sections later in this report. To facilitate compaction, it is suggested that soil moisture be adjusted to within 3% of optimum prior to receiving compac ive effort. Soll moisture shou uniform trir i u a compacted. Please see Appendices K through M for additional earthwork criteria for non - cohesive soils. F un[inionS. Continuous and spread footing foundations may be used for the proposed PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 9 September 15, 1986 buildings. Continuous footings and column pads shall have a depth of 18 inches below lowest adjacent grade. Minimum reinforcement shall consist of #4 bars top and bottom; the structural engineer may supersede this as necessary. Fov -in design shall be based upon maximum allowable soil bearing values of 1200 psf e 9,00 psf dead plus live loads. Along the northern property line the f o� Y `�4 if 21 inches below lowest adjacent grade. The foundatic Slabs: Slabs shall have a minimum thic' normal U.B.C. requirements. The slr granular cushion material, i.e., a c' the sand is recommended to moisture. Care shall be taken to pl utilities, and to protect it from damage . ` all. � aa�,� 0 be reinforced per 1��.Ot3 Cif '.mum of 4 inches of ,ed at the midsection of infiltration of subsurface preferred, six inches of clean gravel capillary bi, , barrier, particularly around ,ossible during construction. If material can be substituted for the ote that these are minimum requirements only and that addition slab thickness and reinforcement may be required by the structural engineer. Drainage: The sites shall be graded to direct surface runoff away from foundations at a minimum 2% grade for a minimum distance of 5 feet. Runoff from roof gutters, downspouts, etc., shall discharge in a non -erosive manner away from foundations and other improvements in accordance with the requirements of the City of San Luis Obispo. Under no circumstances shall uncontrolled runoff be allowed to discharge over the face of the creek bank. Stabilization of disturbed soils by vegetation or other means during and ollowing construction recommended. ncrcte Paving, Design For concrete paving over reworked, cohesive soils, an estimated modulus of subgrade reaction of 150 pounds per cubic inch may be used for design purposes. For concrete paving over imported, non -cohesive soils, an estimated modulus of PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 10 September 15, 1986 subgrade reaction of 250 pounds per cubic inch may be used for design purposes. A 6 inch thick reinforced concrete slab overlying 6 inches of compacted Class III Base as per San Luis Obispo Parking and Driveway Standard 2110 may be used in lieu of an actual concrete paving design. s fi;�1 ncret PavementSections: The following pavement sections are based on an estimated R-value of 10 for the native cohesive soils. The sections calculated are for Traffic Indices (T.I.) of 4.0 and 5.5. If heavy vehicles such as garbage collection trucks will be using certain areas, it is recommended that pavement in these areas be designed using the higher T.I. or that concrete aprons be provided. Additional sections based on different traffic indices or different proportions of asphalt and base are available and can be furnished upon request. R-value TrBfriC Index A.C. 10 4.0 2" 10 4.0 2" Class If Banc Class III Base 8" - 9TI 10 5.5 2" 13" - 10 5.5 3" - 1211 Native soils shall be compacted to a minimum depth of 24 inches below the too of pavement in areas having a T.I. of 4.0. or to 30 inches in areas utilizing the higher T.I. A minimum of 90% relative compaction shall be obtained. Base material shall be compacted to a minimum relative compaction of 95%. Compaction testing shall be conducted in accordance with ASTM D1557 and ASTM 2922-78 or other methods acceptable to the soils engineer. , In addition, the pavement shall comply with the recommendations presented in Appendix N. Pavement, curbs, and gutters shall be constructed in accordance with the City of San Luis Obispo Standards. To provide maximum stability for curbs, fills shall be extended to.a minimum of 2 feet beyond the edge of the curb. PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 11 September 15, 1986 Pavement longevity will be enhanced if the surface grade drains away from the edges of the pavement. Ponding of surface water against the upslope sides of curbs is undesirable and should be avoided by proper grading of swales in areas where no sidewalks are planned. The existing pavement appears to be relatively intact and a reasonable lifespan may be assumed with a 2 inch A.C. overlay. If significant damage occurs during construction, it may be necessary to replace the entire section. The soils engineer shall verify the pavement condition prior to an overlay. Lube Pit Retaining Wa11: The footing for the lube pit retaining wall shall extend a minimum of 21 inches below lowest adjacent grade. The retaining wall shall be designed using the following values: Maximum toe pressure: 2000 psf Active pressure: 60 pcf Passive pressure: 240 pcf Coefficient of Sliding friction: 0.25 All pressures presented assume a horizontal retained surface with a native cohesive soil backfill and no surcharge. If a non -cohesive granular backfill, extending at a 1:1 (horizontal to vertical) slope from the base of the wall is used, an active pressure of 35 pcf and an at rest pressure of 50 pcf will apply. If the above criteria does not meet the design parameters, the soils engineer shall be contacted. Please note that no factor of safety has been incorporated into the above soil pressures. Although no subsurface water was encountered in the exploratory boring drilled in the area of the lube pit, installation of a sump and a sump pump is recommended for dewatering purposes. It must be recognized that the recommendations contained in this report are based PACIFIC GEOSCIENCE, INC. Lube N' Tune, G2492 12 September 15, 1986 on a limited number of borings and rely on continuity of the subsurface conditions encountered. The soils engineer shall therefore be retained to interpret this report during construction and to provide construction monitoring in the form of testing and inspection. If the soils engineer is not retained to provide such testing and inspection the recommendations contained herein shall be null and void. Furthermore, it is the responsibility of the owner, contractor, or project manager to contact the building official to determine what, if any, certification shall be required and to contact this firm so that the inspection program may be discussed and key inspection items outlined. The above must be accomplished prior to beginning earthwork. This report is valid for conditions as they exist at -this time for the type of development described herein. If changes with respect to building type or location become necessary, or if items not addressed in this report are incorporated into plans, the soils engineer shall be notified for modifications to this report. This report shall be used in its entirety, with no individual sections reproduced or used out of context. The client shall be aware that this report was prepared prior to city approval of a grading plan or specific building plans and as such may be subject to modification. Please note that the program presented herein is one of several possible approaches to development of the property. If discussion of alternate concepts or modification of recommendations is desired, please feel free to contact this office at your convenience. Thank- you for this opportunity to have been of service. PACIFIC GEOSCIENCE, INC. REVIEWED BY: �O"01ESz$�O.y�f BA No. 33563 x Rob Mohle, Staff Geologist Sims, P.E. E,F 6., 0.90 JMS/RM:mm 1,.SI�;L��ti��/ LUBETUNE.SEI PACIFIC GEOSCIENCE, INC. Appendix A _ J N, SA^ +5 C�2��� 5 G�L.J�R'r I'll �GpNO L_ufiC- N� TUNS Cr-2�`12 H-I rZA ZO & 0oflr1,j6T LO A7-1oN5 Lo cam,-no,J OF r3o+%-D,raL- r7r2-" + o uS L. Y fzE-MoJE4. L•1M k N f clr-u�- f�A 5` - -EXiyl'i-jC- riLo(-k�- W ALL i , I+, (,g C?20Do5en F3vl L-D i N [r LAc,^,n o N PACIFIC GEOSCIENCE, INC. Geotechilicul Resenrcll and Engineering Mittvriuls 1`esiing Laboratory Jl� BUCXLEY RD• (WS) 544-3276 LOGGED BY: R.M. SAN LUIS OBISPO, CA 93401 DRILL: B-53 Appendix B DIAMETER: 8" BORING NO. 1 Depthi I SAMPLES STANDARD PEN [MOISTURE 1 2 3 4 1 11 12 13 14 Moist Very Moist Slightly Damp SPT r t4,5,7 r _ _. TUBE 19" SPT 5,9,7 Very Moist Slightly Damp SPT 4,9,9 16 Damp 17 18 ----- - -- - wet ECONO LUBE N' TUBE SOIL DESCRIPTION FILE: GW 2792 DATE: 9-2-86 Moderately compact, brown GRAVtLSi,bw) siignzi 4; cohesive, slightly plastic with SANDY CLAY o matrix; asphalt concrete and concrete o ° fragments to 6" diameter (FILL) Moderately stiff, gray -brown SANDY SILT(ML) moderately cohesive, slightly plastic (NATIVE) Moderately stiff, gray -brown CLAY SILT(ML) -moderately—cohesive, moderately plastic Stiff Very stiff, black SANDY CLAY(CH) highly cohesive, highly plastic Brown moderately cohesive, moderately plastic increasing in sand content Moderately compact, brown SILTY SAND(SM) slightly cohesive, non -plastic, very fine to course graned with occasional gravels to 1/2" diameter 19 2Q LOGGED BY: R.M.-- PACIFIC GEOSCIENCE. INC. DRILL: B-53 DIAMETER : 8" BORING NO. 1 (cont.) ECONO.LUBE N' TUBE °i}M' Samples Moisture SOIL DESCRIPTION +GRAB Sl ightly 21Damp 22 23 24Wet 2 26 z7 3 GRAB 31 32 33, 34 35 37_ 3a 39 40 FILE: G#2792 DATE: 9-2-86 Very stiff, brown SANDY CLAY(CH) highly cohesive, highly plastic Moderately compact, brown CLAY SAND(SC) slightly cohesive, non -plastic with gravels to 1" diameter ------------- Loose, increasing in sand content END OF BORING @ 31.5' Subsurface water encountered @ 18' & 23.5'. Piezometer installed to 34'. NOTE: This log of subsurface conditions is a simplification of actual conditions encountered. It applies at the location and time of this excavation. Subsurface conditions may differ at other locations and times. LOGGED BY: R.M. DRILL: B-53 DIAMETER: 8" PACIFIC GYEOSCIENCE. INC. Geol►-chili► it 12c search and Engineering Miderials 1'esling La6oralory 39t. BUCKL12Y RD• (KK) S44.3776 CAN LUIS OBISPO, CA 93401 BORING NO. 2 Depth SAMPLES JSTANDARD MOISTURE PEN 1 Very Moist 2 3 Very TUBE 14 Moist 4 SPT 1,3,3 6 7 8 9 10. 11 12 13 14 16 17 1B 19 20 - 1 Slightly Damp Very Moist SPT 1 4,8,11 Damp SPT 3,5,6 FILE: GW 2792 DATE: 9-2-86 ECONO.LUBE N' TUBE SOIL DESCRIPTION 2.5" Asphalt Concrete with 4.5" ravel base IModerately Compact, gray and brown GRAVELS(GW) slightly cohesive, non -plastic with occasional cobbles to 6" diameter (FILL) stiff, gray -brown SANDY SILT(ML) moderately cohesive, slightly plastic (NATIVE) Moderately stiff, gray -brown CLAY SILT(ML) moderately cohesive, moderately plastic Very stiff, gray -brown SANDY CLAY(CL)highly cohesive, moderately plastic ~ Stiff,brown, moderately cohesive, moderately plastic, increasing in sand content END OF BORING @ 16.5' No subsurface water encountered. PACIFIC: GEOSCIENCE, INS.. Geoiecl►nicul Research and Engineering Materials 1'esting Laboratory 3% 13UCKLEY RD• (905) 344'3276 LOGGED BY: R.M. SAN LUIS OBISPO, CA 93401 FILE: Get 2792 DRILL: B-53 DATE: 9-2-86 DIAMETER: 8" BORING NO. 3 ECONO LUBE N' TUBE Depth SAMPLES STAPNDnARD MOISTURE SOIL DESCRIPTION U halt Concrete over 7" base 1 Veryark brown SANDY CLAY(CL) moderately Moist, moderately plastic with gravels to meter (FILIL) 2 TUBE 8" 3 4 1 Very Moist 5 — — —— -- — --- Very — TUBE 13' Moist s SPT 2,3,5 7 Very Moist t3 SPT 1 4,6,8 11 12 Slightly 13 Damp 14 _ 15 16 SPT 5,3,2 Damp y - -- - -- Wet = 17 18 19 20 Moderately stiff, brown SANDY SILT(ML) slightly cohesive, slightly plastic with occasional gravels to 1" diameter(NATIVE) Moderately stiff, gray -brown CLAY SILT(ML) moderately cohesive, moderately plastic with occasional gravels to I" diameter Stiff, dark brown SANDY CLAY(CL) highly cohesive, moderately plastic Brown, moderately cohesive, moderately plastic, increasing in sand content non -plastic, very fine to very course grained with occasional gravels to 1/2" diameter END OF BORING @ 16.5' Subsurface water encountered @ 16'. PACIFIC GEOSCIENCE. INC. Appendix C VOID RATIO VS. PRESSURE DIAGRAMS Void ratio vs. pressure diagrams depict the consolidation characteristics of the examined samples to normally applied loads. For this test, a specimen is carved from an undisturbed sample at the 2.8 inch Shelby tube diameter to a 2,5 inch diameter by one inch thick test sample. Tne test sample is placed in a consolidometer where it is loaded normally and restrained horizontally. Its consolidation is measured to within 0.0001 inch. Each sample is loaded past the point of precompression, if any, to establish the virgin compression curve. The apparatus procedure and report format of each consolidation test follows the ASTM Standard 02435-80, with the exception. of certain procedures modified for the specific project requirements. The results are presented in graphic form on the succeeding void ratio vs, pressure diagrams. vole RArIo 1.35 A 1.30 1.25 1.20 1. 15 1.10 1.05 VOID RATIOVS. NO144kl.MESSUREC(2M1 _DIA r_T PItOJ ECP: ECIXVo LURE M' 'RNE Dp rr.. 9-15-86 mkIN0 NO.: 2 ea2.5-3.5' SO I L : CWM 13ROW SANDY CLAY my LOlSITY: 70.9 PCF wrr DCAf51'l7: 85.3 PCF h1� 1 SIWE pp riNf : 10. 2"G V0113 RATIO VS. 14ORK-AL PRESSURE D1AG MI PROJECT: ECONO LURE N' TUNE DATE: 9-15-86 BORING NO.: 3 02-3' SOIL: DARK BROIVN SANDY CLAY DRY DENSITY: 102.4 PCF ` WET DENSITY: 117.0 PCF mD j STURE CONTENT: 14. 2% VOID RATIO .65 0. 60 0. 55 0.50 0.45 1000 10.000 100,000 (20 5 ).. -1,717m.I.. 2 2 NOI NAL PRESSURE--KG/M (LB/FT ) (SEMI -LOGAR MHO 1 C SCALE) VOID RATIO VS. NORMAL PRL'SSURL•' 0IP.GRMI ----------------------------- P1LOJ CCI': GCONO LUM' N' 'l'UI1L 9- 15-86 11ORING NO.: 3 05-6' SOIL: DARK fl13U N SAN171' CLAY DRY MNSI Y: 92.5 PC- WL•-i' DINS 1 TY: 1 13. 9 PCf M? 1 S,I lK - c)WrE9I' : 2 3. 2"v VOID RATIO ,8 0.75 0, 70 0.65 0.60 REBOUND 0.55 6.50 + + .+ 1000 10,000 100.000 (205) (2050) (20,500) 2 2 NO NAL PRESSURE--KG/M (LB/FT ) (SM-LOGARITWIC SCALE) PACIFIC GEOSCIENCE, INC. Appendix D EXPANSION INDEX The expansion index value for a given soil is determined in accordance with the procedure of Uniform -=Building Code Standard No. 29-2. The numeri- cal value relates to tree soi s characteristic of rapid volume change upon saturation with water. The higher the index value, the more the soil will swell with increased moisture content. The referenced procedure begins with a soil sample at 50 percent satura- tion (assuming a specific gravity of 2.70), which is loaded with a surcharge of 145 pounds per square foot. The sample is allowed to absorb water for about 24 hours, at which point the change in volume is determined. Sample Depth 1-2' Expansion Index 46 PACIFIC GEOSCIENCE, INC. Appendix RECOMMENDATION SCOPE Recommendations contained herein are considered minimum guidelines to allow for the preparation of the development of plans in accordance with stan- dard soils engineering practices. The owner, architect, engineer, and/or governing governmental agencies may have other requirements. If these addi- tional requirements have the effect of lessening or negating the intent of the recommendations contained herein, the soils engineer small be consulted for modification of this report so that its overall integrity is maintained. Conclusions and recommendations contained within this report are profes- sional opinions made in accordance with accepted soil and foundation engineer- ing practices. These opinions have been developed using the observed soil pro- files in test borings and laboratory test results of the acquired soil samples at the buses of formation. Similarity of soil type and engineering character- istics has been supposed. Soil, engineering solutions other than those discussed within this report may be possible for problems peculiar to this site. Discussion of such con- cepts is encouraged. The use of locally obtained materials, construction equipment, and construction techniques is usually a primary objective in order to minimize improvement costs. The proposed grading and foundation plans shall be reviewed prior to cL fn,- hiri anrilnr ronstruction to verify that the intent of these recom- mendations have been incorporated. Prior to construction, there shall be an on -site conference between the grading plan engineer, foundation design engineer, owner, general contractor, earthwork subcontractor, soils inspector, and soils engineer for the purpose of reviewing the intent of construction documents with respect to the planned earthwork program. PACIFIC GEOSCIENCE, INC. Appendix F QUALITY CONTROL 1.00 Toe grading operation shall be completed with the knowledge of the soils engineer. To reduce the potential for misunderstandings, the earthwork contractor and soils engineer shall review the grading plan, recommendations of the soils report, and the intended grading approach prior to commencing work. The soils engineer shall perform a site inspection after stripping and before compaction. If unusual conditions are exposed during the initial earthwork, direction for treatment will be given at that time. 2.00 The soils engineer shall provide sufficient inspection and tests during the grading operation to verify that a uniform and acceptable condition exists when work is completed. 3.00 Unless otherwise designated, the inspections shall -be at random times and when requested by the contractor or owner. 4.00 'Compaction tests shall be obtained in each material, with a minimum of one test per soil type. The degree of compaction in scarified soils shall be determined prior to placing more than one foot of additional fill material. Engineered fills or backflls shall have a minimum of one compaction test per 18 inch additional thickness, or one compaction test per 1,000 cubic yards, whichever results in the greatest number of Inrier)pndent of the previous statement, at least three compaction tests shall be obtained at any one visitation. 5.00 Compaction results shall be obtained prior to placing more than three or five feet of clay or sand material, respectively, in any given location although increased testing may be desired at the contractor's option to decrease potential earthwork resulting from poor compaction values. PACIFIC GEOSCIENCE. INC. Appendix G SITE PREPARATION 1.00 Procedure: 1.01 All fill areas shall have existing organic material removed. Orq_ an i c materi al may be either surf ace or subsurf ace. This m fiat eri - al shall not be used iii any engineered fill. Other deleterious substances, foundations, etc., shall be removed from the applica- ble areas. Those items leaving a large void shall be promptly backfilled with compacted on -site material at the time of removal. Prompt backfilling of such areas is essential so that the precise location of the void is not lost. 1.02 Existing underground utility lines which are not going to serve the the proposed structure shall either be relocated outside the build- ing area or abandoned. Abandonment of such lines shall require that the lines be removed from the building area and capped off at a minimum of ten feet outside the building area in such a manner that the lines are not capable of transmitting water or other potentially harmful materials to the soil beneath the building. Such abandonment shall be completed with the knowledge and in accordance with the recommendations from the represented utility company. While no evidence of old septic tanks, abandoned wells, or other such subsurface features were apparent, it is possioie Lnai Lney may be present and discovered during the earthwork operation. If found, they shall be brought to the attention of the soils engi- neer so that recommendations may be given concerning their dispos- al in order that no future hazards remain. 2.00 Definitions: 2.01 A fill area is defined as that horizontal surface area to receive fill and extending a minimum of five horizontal feet beyond the limits thereof where soil, gravel, aggregate base, and/or other materials are/is to be placed with the objective of raising the subgrade elevation to the desired level from the bottom of an excavation or from the existing surface. Where the fill is to be FIQUCV IJkdUIFj36 U IL�U414-..�J . i I, WV 1 . V .r.v...,-.... I.-1 rigid boundary, the limits of the fill area shall be defined by such boundaries. 2.02 Organic material is considered to include grasses, bushes, trees, tree stumps, tree roots over three inches in diameter, or similar deleterious materials. COHESIVE MATERIAL APPENDICES H, I, J PACIFIC GEOSCIENCE, INC. Appendix H EARTHWORK MATERIALS 1.00 All fill material shall be approved by the soils engineer. Qualities of proposed fill material shall include, but not be limited to, the capa- bility of being compacted in a uniform manner. Unsuitable material shall include such materials which are excessively wet, excessively dry, or containing deleterious substances which would be deemed unsuitable by the soils engineer. The on -site soils are considered suitable as fill material, although the moisture content may have to be adjusted. 2.00 Select, non -expansive material shall be approved by the soils engineer. Qualities of such material shall include having a granular nature, con- taining no organic matter, having the majority of the material exhibit a maximum particle dimension of three inches after being compacted, and an expansion index of 20 or less as determined by the procedures outlined by Uniform Euildinq Code Standard 29-2. There• shall be sufficient binder present to maintain vertical sidewalls while trenching for foot- ings and the like. 3.00 Capillary break material�is also considered non -expansive and shall com- prise the upper four to six inches of material directly beneath the building slab on grade. It shall have less than 4 percent passinq the #200 sieve and a maximum particle size of one inch. Typical materials that conform to this requirement include concrete, sand, pea gravel, concretewatzha,i fill sand, arse aggregate, and lightweight shale rock locally termed "floatrock." The use of moisture membrane placed about mid -depth of the capillary break material would be considered good prac- tice when the finer capillary break materials are utilized. When the coarser rock or gravel materials are utilized, considerable penetration aqd tearing of the membrane usually occurs. 4.00 Utility trenches within the building area shall be backfilled with a clean sand capable of being readily compacted with minimum effort. The following specifications usually define such a material. Sieve Size Percent Passing 1/211 100 # 2 0 0 0-7 PACIFIC GEOSCIENCE, INC. Appendix I EARTHWORK EQUIPMENT 1.00 To ensure uniformity of compaction throughout the site, all site work shall be compacted by the use of a compactor conforming to one of the following descriptions. 1.01 A vibrating compactor having a drum diameter of not less than three feet. The roller shall consist of a single drum with at least one tamping foot per5 100 square inches of drum surface. The area of each tamping foot shall be at least six square inches and less than ten square inches. The face of each tamping foot shall be at least four inches and no more than eight inches from the drum sur- face. The entire compactor shall weigh at least 3,000 pounds. Equipment meeting this recommendation is locally termed "vibrating sheepsfoot." A vibrating sheepsfoot shall riot be used within 5' of existina buildings. 1.02 An approved, self-propelled, segmented foot compactor. 1.03 Aggregate base material shall be compacted with a steel -wheeled flat roller or flat vibrating plate having sufficient weight to adequately compact the material uniformly and to the specified density. 1.04 Earthworking equipment such as bulldozers or front-end loaders on rubber tires or steel tracks may be used on fills not exceeding 3' in depth. PACIFIC GEOSCIENCE, INC. Appendix J EARTHWORK PROCEDURE 1.00 All fill, fill material, scarified soils, and import material shall be compacted to a minimum of 90 percent relative compaction, unless other- wise noted as determined by ASTM D1557-78, method C; D2922-78 and D3017- 78. 2.00 Miaterial receiving compactive effort shall have a moisture content that is within 3 percent of optimum moisture, unless otherwise noted in the conclusions. If drying or wetting is necessary to achieve the proper moisture content, it shall be done prior to the compactive effort. The soil shall be thoroughly mixed to obtain a uniform moisture content. 3.00 All fill slopes shall be constructed on a 2:1 (horizontal to vertical) or flatter ratio. Cut slopes in soil material shall be constructed on a 2:1 or flatter ratio. 4.00 Materials designated'to be scarified shall be ripped by parallel shanks extending below the original surface ten inches (plus or minus two inches). Such ripping shall be completed in two perpendicular direc- tions. 5.00 For trench depths below five feet, provide suitable shoring and/or slop- ing sidewalls prior to personnel entering such trenches to meet require- ments of Title 8, California Administration Code. 6.00 Flooding, jetting, and/or other means of water settling utility trench backfill material is prohibited within the building area. Outside the building area, the material may be water settled, if adequate compaction around the pipelines is obtained and a firm, stable, compacted backfill mass is obtained prior to the placement of additional backfill. The depth of water settled lifts shall be limited to four feet. A concrete vibrator, applied to the saturated soils at regular intervals may be necessary to facilitate compaction. 7.00 Compact general fill materials in lifts not to exceed eight inches, except where approval for deeper lifts is obtained from the soils engineer. NON -COHESIVE MATERIAL APPENDICES K, L, M PACIFIC GEOSCIENCE, INC. Appendix K EARTHWORK MATERIALS 1.00 All fill material shall be approved by the soils engineer. Qualities of proposed fill material shall include, but not be limited to, the capa- bility of being compacted in a uniform manner. Unsuitable material shall include such materials w�rich are excessively wet, excessively dry, or containing deleterious substances which would be deemed unsuitable by the soils engineer. The on -site soils are considered suitable as fill material, although the moisture content may have to be adjusted. 2.00 Select, non -expansive material shall be approved by the soils engineer. Qualities of such material shall include having a granular nature, con- taining no organic matter, having the majority of the material exhibit a maximum particle dimension of three inches after being compacted, and an expansion index of 20 or less as determined by the procedures outlined by Uniform Building Code Standard 29-2. There- shall be sufficient binder present to maintain vertical sidewalls while trenching for foot- ings and the like. 3.00 Capillary break material is also considered non -expansive and shall com- prise the upper four to six inches of material directly beneath the building slab on grade. It shall have less than 4 percent passing the #200 sieve and a maximum particle size of one inch. Typical materials that conform to this requirement include concrete, sand, pea gravel, washed fill sand, concrete coarse a greoate and lightweight shale rock locally termed "floatrock." The use of moisture membrane placed about mid -depth of the capillary break material would be considered good prac- tice when the finer capillary break materials are utilized. When the coarser rock or gravel materials are utilized, considerable penetration and tearing of the membrane usually occurs. 4.00 Utility trenches within the building area shall be backfilled with a clean sand capable of being readily compacted with minimum effort. The following specifications usually define such a material. Sieve Size Percent Passing 1,1211 100 -"200 0-7 l 1 PACIFIC GEOSCIENCE, lN%,:. Appendix L EARTHWORK EQUIPMENT 1.00 To ensure uniformity of compaction throughout the site, all site work shall be compacted by the use of a compactor conforming to one of the following descriptions. 1.01 A vibrating compactor having a drum diameter of not less than three feet. The roller shall consist of a single drum with at least one tamping foot per 100 square inches of drum surface. The area of each tamping foot shall be at least six square inches and _ less than ten square inches. The face of each tamping foot shall be at least four inches and no more than eight inches from the drum surface. The entire compactor shall weigh at least 3,000 pounds. Equipment meeting tl,iis recommendation is locally termed "vibrating sheepsfoot." 1.02 Aggregate base material shall be compacted with a steel -wheeled flat roller or flat vibrating plate having sufficient weight to adequately compact the material uniformly and to the specified density. PACIFIC GEOSCIENCE, INC. Appendix M EARTHWORK PROCEDURE 1.00 All fill, fill material, scarified soils, and import material shall be compacted to an average of 95 percent relative compaction, unless other- wise noted as determined by ASTMI D1557-78, method C; D2922-78 and D3017- 78. 2.00 material receiving compactive effort shall have a moisture content that is within 3 percent of optimum moisture, unless otherwise noted in the conclusions. If drying or wetting is necessary to achieve the proper moisture content, it shall be done prior to the compactive effort. The soil shall be thoroughly mixed to obtain a uniform moisture content. 3.00 All fill slopes shall be constructed on a 2.5:1 (horizontal to vertical) or flatter ratio. Cut slopes in soil material shall be constructed on a 2.5:1 or flatter ratio. 4.00 Materials designated to be scarified shall be ripped by parallel shanks extending belo�-., the original surface ten inches (plus or minus two inches). Such ripping shall be completed in two perpendicular direc- tions. 5.00 For trench depths belo6i five feet, provide suitable shoring and/or slop- ing sidewalls prior to personnel entering such trenches to meet require- ments of Title 8, California Administration Code. 6.00 Flooding, jetting, and/or other means of water settling utility trench backfill material is acceptable within the building area and outside the building area. Adequate compaction around the pipelines shall be obtained and a firm, stable, compacted backfill mass obtained prior to the placement of additional backfill. The depth of water settled lifts shall be limited to four feet. A concrete vibrator, applied to the saturated soils at regular intervals may be necessary to facilitate compaction. 7.00 Compact general fill materials in lifts not to exceed one foot, except where approval for deeper lifts is obtained from the soils engineer. PACIFIC GEOSCIENCE, INC. Appendix N ASPHALT CONCRETE STRUCTURAL SECTION 1.00 Structural sections recommended in this report have been developed in accordance with the oncept of the California Design Method as presented in the publication Soil Engineering and Asphalt Pavement Design, by Harry R. Cedargren, and w. R. Lovering, The Ins itu e of Transportation and Traffic Engineer, University of California. 2.00 The Standard Specifications referred to hereafter is the latest pub- lished edition produced y the Department of Transportation, Business and Transportation Agency, State of California, entitled Standard Speci- fications. 3.00 All aggregate base and subbase materials shall be compacted to a minimum of 95 percent relative compaction. Native soils within the defined structural section shall be compacted to a minimum of 90 percent relative compaction, unless otherwise noted. In situ bedrock is considered to have 100 percent relative compaction. 4.00 Class -II aggregate base.,,material shall conform to, be mixed, spread, and compacted to the requirements of Section 26 of the Standard Specifica- tions. 5.00 Class III Aggregate Base The percentage composition by weight of aggregate base snail conTorm the following grading when determined by Test Method No. Calif. 202. Sieve Sizes Percentage Passing 1 1/2" i00 No. 4 40-60 No. 200 0-15 The aggregate base shall also conform to the requirements: Test Resistance (R-value)* Sand Equivalent Durability Test Method ivo. Calif. 1,07— 217 following quality Requirements 25 *The R-value requirement may be waived provided the aggregate base has a sand equivalent of 30 or more. The work of furnishing, spreading and compacting the aggregate base shall, be done in acordance with these specifications, the special provisions and Section 26 of the State of California Standard Specifications. PACIFIC GEOSCIENCE, INC. Appendix 0 GLOSSARY Clean: Denotes a lack of fines in a granular soil. Damp: Moisture content sliahtly wetter than optimum moisture. Dense: Usually rock material or a very highly consolidated material backhoe will skip with no penetration. Firm: A material that has undergone previous consolidation to some degree. Will hand shovel with difficulty. In situ: In the natural or original position. Moist: Moisture contest slightly drier than optimum moisture. Optimum Density: The maximum obtainable soil density, dry weight basis, expressed in lbs. per cu. ft., using a standard procedure. Standard Specifications: Publications entitled STANDARD SPECIFICATIONS, State of California, Business and Transportation Agency, Department of Transportation, January 1979. Soft: A material with very little resistance to penetration. 01 ! S tngineer: _,old I 1 111t:0rI L I I C lIIV I V 4UU0 1 1 CZrJV Ila Iv i w' r, . . ?t .. ,.• ..r - .- tion included herein. Construction and/or other inspections called for to be completed by the soils engineer, regarding the project, may be completed by others only with the express written consent of,the soils engineer. Soil Fractions: When assigning description names to soils, grain size is the determinate. Sand: Grain size between 2 mm. and 0.05 mm. Silt: Grain size between 0.05 mm. and 0.005 mm. Clay: Grain size less that) 0.005 mm. When comtining sizes, the greater fraction is mentioned last and the lesser fraction first. Stiff: Description of a clay,soil having a relatively high density. Very Damp: Soil moisture content over optimum, but less than wet. Very Dense: Usually reserved for unweathered rock units. Will require jack- hammer or powder. Very Firm:- A material that has undergone considerable consolidation. Great difficulty will be encountered trying to shovel, but a backhoe will easily excavate. Wet: Moisture showing on exterior of sample when gently shaken. *0 4) ENGINEERING & ASSOCIATES INC. CONSULTING ENGINEERS 14730 BEACH BLVD. SUITE 207 • LA MIRADA • CA 90638 (714) 522.3220 (714) 522.3221 TO San Luie Obispo Fire Dept. 748 Pismo (BUT URUSUIDUML DATE 6-22-8 JOB NO ATTENTION Mr. Randy Millpa RE ECONO L ' TUNE SAN LUIS OBISPO CA GENTLEMEN: WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via_ the following Items: ❑ Shop drawings ❑ Prints ❑ Plans: ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ No exceptions taken ❑ For your use ❑ Make corrections noted ❑ As requested ❑ Revise and resubmit ❑ F view and comment El ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints or rs � - ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS __Please review and if any questions call. -Thank you. hz COPY TO SIGNED: If enclosures are not as noted, kindly notify u at anee�" ECONO LUBEN'TUNE, ., April 2, 1987 Mr. Bahl Kavthekar B.S.K. Engineering 14730 Beach Boulevard, Suite 207 La Mirada, California 90638 RE: UNDERGROUND WASTE OIL TANK LEAK DETECTION SYSTEM ALTERNATE Dear Mr. Kavthekar: Attached please find an equipment description and catalog cuts for the API/Ronan Model X765-(2 thru 4)-RLW Leak/Level Detection System with (2) to (4) Model I_S-3 sensor probes (number of probes as required per local governing agencies such as the local Environmental Health or Fire Prevention Department). We have determined the above systems to be equal to, or better than, the Universal Leak Alert System currently specified in our engineering drawings. As such, effective immediately, please show both systems in our equipment specifications, with the API/Ronan System listed first as we consider it a more cost effective unit with superior sales/installation/maintenance service. arry Be I I Development Manager LB/lh Attachment cc: Mr. Ray Williams Shamrock Control & Equipment 5731 Sierra Cielo Irvine, CA 92715 714/854-4911 4911 BIRCH STREET STE. 100 . P. O. BOX 2470 . NEWPORT BEACH, CA 92660 • (714) a51-2259 BSK ENGINEERING & API/RONAN SPECIFICATIONS ASSOCIATES, INC. 14730 Beac,h Blvd. Attention: Bhal Kavthekar Suite 207 Attention: LaMirada, CA 90638 Page 2 API/RONAN MODEL WILL-X76S-3 LEAK/LEVEL DETECTION SYSTEM, CONSISTING OF... Electronics for operation on 115V AC, 60 Hz. in a wall mounted NEMA-1 enclosure (9"W X 9-1/2"H X 4-1/2"D) complete with door mounted display window, annunciator horn, system test button, and acknowledge button. (2) X53 intrinsically safe field sensor interface module. (1) Intrinsically safe power supply. (3) Probe alarm module with LED status indicators and SPDT relay contacts rated 2 amps @ 110VAC for auxiliary control/alarm/pump shut down, etc. All of the above components .are Factory Mutual approved. (3) Model LS-3 UL listed sensor of type 304 stainless steel/polysulfone construction with 18' 2-wire 20 AWG jacketed cable. 6 ECTION 8281EM, CONSISTING OF... Electronics for operation on 115V AC, 60 Hz. in a wall mounted NEMA-1 enclosure (9"W X-9-1/211H X 4-1/2"D) complete with door mounted display window, annunciator horn, system test button, and acknowledge button. (2) X53 intrinsically safe field sensor interface module. (1) Intrinsically safe power supply. (4) Probe alarm module with LED status indicators and auxiliary control/alarm/pump shut down, etc. All of the above components are Factory Mutual approved. (4) Model LS-3 UL listed sensor of type 304 stainless steel/polysulfone construction with 18' 2-wire 20 AWG jacketed cable. BSK ENGINEERING & API/RONAN SPECIFIC'ATI+ONS ASSOCIATES, INC. 14730 Beach Blvd. Attention: Bhal Kavthekar Suite 207 Attention: LaMirada, CA '90638 Page 1 ************************************************************** API/RONAN MODEL X76S-1-RLW LEAK/LEVEL DETECTION SYSTEM, CONSISTING OF... Electronics for operation on 115V AC, 60 Hz. in a wall mounted NEMA-1 enclosure (9"W X 9-1/2"H X 4-1/2"D) complete with door mounted display window, annunciator horn, system test button, and acknowledge button. (1) X53 intrinsically safe field sensor interface module. (1) Intrinsically safe power supply. (1) Probe alarm module with LED status indicators and SPDT relay contacts rated 2 amps @ 110VAC for auxiliary control/alarm/pump shut down, etc. All of the above components are Factory Mutual approved. (1) Model LS-3 UL listed sensor of type 304 stainless API/RONAN MODEL WILL—X76S-2 LEAK/LEVEL DETECTION SYSTEM, CONSISTING OF... Electro.ies for operationI 60 liz. in a wall mounted NEMA-1 enclosure ON X 9-1/2"H X 4-1/2"D) complete with door mounted display window, annunciator horn, system test button, and acknowledge button. (1) X53 intrinsically safe field sensor interface module. (1) Intrinsically safe power supply. (2) Probe alarm module with LED status indicators and SPDT relay contacts rated 2-amps @ 110VAC for auxiliary control/alarm/pump shut down, etc. All of eve t Fae 1 �-�ic�cr�v-r��9-�ivisu iz-�cr"re—r-orc�-ezy—��ca-i�-� approved. (2) Model LS-3 UL listed sensor of type 304 stainless steel/polysulfone construction with 18' 2-wire 20 AWG jacketed cable. CONTROL; �r 1R EC1��� Cl `O Series X76S ii��ii`?F, CA J27�.5 (./14) 8�,4-4911-(714) 854-97x�', Vapor/Liquid Detector- System TJ RDIMAPJ Features ❑ Up to 4 Alarm Modules with LED Indicators ❑ intrinsically Safe Interface to Sensor. Fµ Approved ❑ Field -Proven Circuit Design f 1 Rorlear-- i 17 n- Q,,n ;c Rv ❑ Alarm Contact Output per Sensor for Remote indication or Telemetering he Model X76S Vapor and Liquid Detector System installations for leakage of gasoline, diesel oil, waste oil and other hydrocarbons. Two types of Liquid Level Sensors are horizontally or vertically positioned in the normally dry annular space of double -walled tanks. A reservoir level type is also available where the annular space is water -filled and the loss of water is detected. Vapor Sensors monitor well holes, drilled around the perimeter of single -wall tanks, or the annular space of double -wall tanks. individual alarm modules via FM approved intrinsically safe barriers. This allows installation of the sensors in Class 1, Division 1, Groups B, C, or D areas as defined in the National Electrical Code, without using costly conduits, conduit seals and explosion proof junction boxes. The X76S provides up to four level or vapor sensor alarms. X7.6S Vapor/Liquid Detector System Viewing Window The Sensors Model LS-3 Tank Level Sensor The Model LS-3 is most suitable for positioned vertically on the bottom of the carbon liquids, providing long, trouble -free performance. U� Listed E86797 Aboft Intrinsically Safe Power Supply Sensor Alarm Modules Intrinsically Safe Barriers Field Wiring Compartment Power Input Terminals Model LS 10 Tank Level Sensor The Model LS-10 consists of a reservoir mounted on an Owens -Coming fiberglass tank (''P" style) annulus riser and an integral level sensor. The reservoir and the annulus are filled with water to at least one foot above the tank. _ I^� Any loss of water clue to a 4 i 11{� The Model HV Vapor Sensor is designed for industrial and commercial applications with exposure to hydrocarbons over long periods of time. The solid -state - type sensor provides long trouble -flee performance and will not deteriorate due to continuous exposure to residual vapor, inherently present in double -wall tanks, dry wells and sumps. U& Listed E100826 Typical Installation • 12.00" (30.48 cm) Manhole Caper Existing " Liquid :� Concrete Sensor }Vapor Sensor == 2" or 4" Dia. ' Threaded PVC Cap •� •:•• , ''= .75" (1.91 cm) Rigid Conduit i .•'?'•,:: Red White Dry Well Black Vapor Sensor Model HV Bentonite Vapor Sensor Model HV — No. 3 Mesh Sand j� Bottom Cap y 7 Wiring Information 6 OT 0 ACK Internal Wiring 0 V+ By Ronan @ V_ Al iF Spare NO-i r-------- — _--- .. _ _ _� iA7ta tsically Safe Wiring Only j 48 I A - I C AUX4 NC NO C AUX3 NCJ I 36 I I A I NOJ C AUX2 aR NC A I NO _ H AUK] IA i NCJ G I I Fri FC2 FC3 FCC•4 NO C NC �NQ C NC, ,rNO C NC, Nip C NG H N G c ` Sensor #1 — #2— #3 #4 W `� AUX4 AUX3 AUX2 AUXI 115 VAC Intrinsically Safe Field Contact Input Alarm Auxiliary Output (Safe Area) Input Power Mechanical Dimensions 9.00 in. (228.60 m .75 in. 7.50 in. (19.05 mm) (190.50 mm) .22 In Dta. Mounting Hole (5.54 mm) .75 in. (19.05 mm) t—.— mm) f i f I.S. AuxilMary AC Field Outguls Power Inputs (1[ Used) Input Specifications System, Model X76S Power: 115 VAC, 60Hz. Power Consumption: 100 VA Operating Temperature: 32 to 1650F (0 to 75°C) Dimensions: 9x9.5x4.2 in. (22.86x24.13x 10.67 cm) Mounting: General purpose area; wall mount FM Approved: File J.I. 2N4ALAX Annunciator Module Field Sensor: Dry contact Field Sensor Voltage: 115 VAC (supplied by X76S) Number of inputs: One per module <FM> Approved: File J.I. 2N4ALAX Intrinsically Safe Field Sensor Interface Module X53 Number of Inputs: Two per module Sensors Voltage: 24 VDC, current limited Sensors: Dry contact Output Interface to Alarm Module: Relay contact; normally open/normally closed; selectable Power Consumption: 750 mW per input Supply Voltage: 24 VDC from IS power supply FM Approved: File J.1. 2N4A1. AX Power Supply IS (Intrinsically Safe) Power Input: 115 VAC Output Voltage: 24 VDC FM Approved, File J.I. 2N4A1.AX Operating Temperatui, ) to 2250F (-18 to 107°C) Pressure: 50 psi maximum Leads: 22 AWG M Approved: File E86797 Tank Leak Sensor, Model LS-7 For fiberglass tank Housing Material: ABS Mounting: %:'t NPT with 5/811 THD and lock nut Pressure: 150 psig at 70OF (21 °C) maximum Liquid SpG:.70 minimum Switch: Type: Single pole, single throw N.C. Rating: 10 VA, 110 to 240 VAC Leads: 22 AWG Uo Approved: File E86797 Reservoir Type Tank Leak Sensor, Model LS-10 Reservoir: - Volume: Two gallons (7.57 liters) Dimensions (he(ghtxwrdthxdepth): 13x ll x ll inches (33.02x27.94x27.94 cm) Material.• Polyethylene plastic Switch: Type: Single pole, single throw Rating., 10 VA, 110 to 240 VAC Stem and float material.• Polysulfone Operating Temperature: 0 to 225 OF (-18 to 107°C) Pressure: 50 psi maximum Leads: 22 AWG 90 Approved: File E86797 Vapor Sensor, Model HV ordering Information Detection Method: Solid-state diffusion type The Ronan Model X76S Leak Detector Monitor System Detectable Gases: Hydrocarbons, gasoline, solvents, can be configured to meet the different local and state carbon monoxide, methane, ammonia, sulfur dioxide, codes for underground storage by proper selection of hydrogen sulfide sensors and monitor modules. For example, a particular DetectMe g�1 local code and/or type of facility may require leak detection Accuracy: t5% of a tank annulus. The monitor system would consist of the Response Time: Less than 15 sec. to 90% full scale following items: Sensitivity. 5 ppm Model X76S-( ) Sensor Life: 5 years minimum t— No. of alarm inputs (1 thru 4) max-4 Zero Drift: Less than 5% per year Accessories Operating Temperature: —400 to 1650F (-400 to 75°C) Qty, Type Electrical Classification: Class I, Division 1, Groups B, C LS-3 (Vertical liquid level sensing probe) and D; hazardous atmosphere Cable Length: 25 feet; 3-conductor, number 2b AWG LS-7 (Horizontal liquid level sensing probe) shielded; max. length 3,000 feet LS 10 (Reservoir liquid level system) WApproved: File E100826 HV Vapor Sensor (Specify. product being monitored) Tank Leak Sensor, Model LS-3 Housing. 304 stainless steel Warranty: Ronan warrants equipment of its own manufacture to be g free from defects in material and workmanship under normal conditions Type: Single pole, single throw N.C. defective, on its return, transportation charges prepaid, within one year Ratin 10 VA, 110 to 240 VAC of its original purchase. This warranty carries no liability, either expressed or implied, beyond our obligation to replace the unit which Stem and float material. Fuel -proof polysulfone carries the warranty. 01 RONAN ROMAN ENGINEERING COMPANY P.O. Box 1275 21200 Oxnard Street Woodland Hills, Calil'ornia 91367 U.S.A. (818) 883-5211 0 Telex 698-490 FAX (818) 992-6435 X76S/1286 RONAN ENGINEERING LTD. U.K. 1 Tilley Road Crowther District 3 Washington, Tyne and Wear United Kingdom, NE38-OEA (091) 416-1689 0 Tblex 537-746 FAX (091) 416-5856 RONAN ENGINEERING LIMITED 32 Bermondsey Road Toronto, Ontario Canada MIBIZ5 (416) 752-0310 0 Telex 63662 FAX (416) 752-8072 RONAN ENGINEERING (AUST.) PTY. LTD, Unit 10. 8 Leighton Place Hornsby, N.S.W. 2077 Australia (02) 477-7344 0 Telex 73467 FAX (02) 477-6151 Printed In U.S.A Advanced Techno%gy- LE - WA 0 Working today - fortheFuture...' A The OOWC3CNc:7 WA CCU tarp r It was a formidable challenge. In 1971, our missioh was to design an advanced type of durable storage tank — one which would withstand a wide range of adverse conditions. The industry needed a tank for permanent and safe containment of hazardous and flammable materials; a tank of superior structural characteristics to withstand any punishment inflicted by unstable soil conditions and high stress loads. The tank had to be impervious to corrosion, even in rigorous conditions such as salt flats, tidelands, or coastal areas. Joor Manufacturing, Inc. met this challenge with a new concept in tank design — the PLASTEEL° tank. By bonding the corrosion resistance of fiberglass to the strength of steel, we manufactured a tank with unmatched durability and reliability. PLASTEEL°—SETTING NE_W PERFORMAIIIICE STANDARDS We created new standards of performance with the PLAS- TEEL® tank. Tanks made only of steel or plastic are subject to the inherent weaknesses of these materials. However, bonded together into PLASTER", steel and fiberglass form a strong deterrent to the assault of external forces in underground installations. PLASTEEL® tanks are thus impervious to all except the most violent sources of dam- age; their development was a major advance in storage technology of hazardous materials. Since 1971, we've continually improved the PLASTEELQD tank through constant refinement of manufacturing tech- niques and quality control. Our system of quality checks and, balances through each step of manufacture plays an inte- gral role in maintaining the high performance asspcigted with every Joor tank. The high standards adhered to in the manufacture are evident in the fact that there has never been a documented in-service failure of a PLASTEEL® tank. - __-------JOORIPLA3FEEt Automatic submerged arc welding ensures a uniform quality weld. Tank cross section showing PLASTEEL® Composite external secondary container. internal sunnort ribs. OUR TANKS RATE '1UL LISTING -COMPOSITE" FOR ADVANCED TECHNOLOGY In 1980, after testing by Underwriter's Laboratories (UL], we introduced the technically advanced PLASTEEL® composite tank... Virtually trouble -free, the composite tank is UL Listed for corrosion resistance and meets all federal (EPA), state, local, military, fire and environmental codes. The PLASTEELO composite JgL U8CE-WALL, tank is the least complicated and most forgiving system that can be installed. Joor PLASTEELO composite tanks surpass traditional UL standards and are recognized for their innovative tech- nology by the "UL Listing -Composite" designation, the first underground storage tank manufactured to earn this label. PLASTEELO COMPOSITE j DOUBLE -WALL TANK: UNIDUE SELF-SUPPORTING DESIGN In 1983, to comply with California's new regulations (A.B. 1362), Jcor Manufacturing, Inc. constructed a unirye new tank configuration --the PLASTEELO composite f f}01aBLE-V11AI.1 tank. The exterior structure is made of fiberglass -reinforced -polyester: resit (FRR) permanently bonded to a welded steel vessel; this outer form houses an inner steel tank which is totally supported by 8 system of interlocking ribs. The double -wall design offers unsurpassed strength and reliability, and eliminates the possibility of a structural failure under normal use. It is completely self-supporting and requires no external r . The design is a true complete 360° [DU UBLE_WALL; tank including pipe fitting penetrations. CUSTOMIZED FITTINGS PLASTEELO composite DOUBLE-WAI..L tanks are crafted to meet specific installation requirements. Cus- tomized fittings can be of any size, at any specified location; standard anchoring designs are available for pipe and trench secondary containment systems. The smooth outer surface, with flush pipe fittings and handling hooks on tank ends, simplify placement of a top -pan secondary cpptoiner liner. COMPOSITE--- Da� ]&A L tanks. d Inner and outer tanks assembled. Note the true 360' DOUBLE -WALL configuration. EASY -ACCESS MONITORING PI,ASTEEL® tanks are compatible with all monitoring sys- tems: electrical, mebhanical, or manual. Two 11/2 inch NPT fittings are provided for direct monitoring of the annulus between the tank walls. For additional stability, the annulus may be sealed after monitor installation. FAIL-SAFE AGAINST UNDETECTED DAMAGE The finished tank is virtually indestructible. If the exterior is impacted during installation, it is immediately apparent --- the struck area turns white. Repairs, if ever required, can be made quickly on site, using the resin kit which is supplied to seal the fittings and lifting lugs after installation. Even minor in -ground damage represents no threat with PLAS- TEEL®, due to the "self -healing" characteristics of the com- posite structure. 1 11 A final 35,000 volt holiday test is performed and recorded just prior to shipment i°UL LISTED" CORROSION RESISTANCE PLASTEEL° Composite [_D0_U1 LE-WQLLI tanks are com- pletely corrosion resistant, and require no additional corrosion protection. The FRR exterior is impervious to all stray electrical currents and soil contaminants, eliminating the need for dielectric bushings or cathodic protection sys- tems. The FRR structure is tested by UL for strength, stability and liquid permeability. The UL Listed Composite IOaUBLE-WA L tank is recognized and certified by UL to have corrosion resistance and protection meeting the requirements of UL 1316. QUALITY ASSURANCE TESTING Through each step of manufacture, materials and product are subjected to comprehensive testing procedures by a stringent and detailed door quality control program which is monitored by Underwriter's Laboratories. A holiday detec- tor operated at 35,000 volts insures that no pinholes, holidays, or other flaws are present in the finished product. These quality control measures are carefully recorded, and retained as part of the manufacturing history on every container shipped from our plant. After preparing steel surface by sandblast- ing, expert application of highest quality UL Listed PLASTEEL© material guarantees permanent bonding with no weak spots. W •- - FAST INSTALLATION One of the many benefits of a PLASTEEL® composite b6 8LE WA tank is the simple installation. The design th of e tank [flush fittings, no external ribbing, large diame- ter with shorter overall length, and flat heads] minimizes excavation size: These tanks require no special backfills, tamping, tank excavation liners, or vaults. The entire installation is com- pleted quickly and effectively, without the need for certified installers. The average installation cost of a Joor PLASTEELP tank is documented to be a minimum of 15 % less than other underground tank installations. i ■ni`t i,ABT• COi,��IH.iTe � 4!O - JOOR TRUCKS FOR ON -TIME DELIVERY The cost effectiveness of the Joor PLASTEEL® composite (COUl3LE-W LLI tank is continued through delivery by our own trucks direct to your site. Meeting your installation schedule, on time —every time —is a vital part of our com- mitment to customer satisfaction and product quality. Used for over a decade by major oil companies, industrial concerns, municipalities, and the U.S. government, PLAS- TEEL9 storage tanks have demonstrated their effective- ness in safely containing stored materials. They are ideal for storage of combustible and flammable liquids in hostile soil conditions. Even under extreme temperatures, the iso- phthalic-polyester resin preserves its integrity and provides good insulation. All PLASTEEL® composite tanks meet, and in fact exceed, UL standards and Uniform Fire Code specifications. No PLASTEELO tank has ever been replaced or removed for any type of in-service failure. The UL Listing label on every Joor PLASTEEL° tank is your guarantee of a superior product. PLASTEE01 Composite DOUBLE -WALL tanks arrive on time and are expeditiously set in tank excavation, Note the minimum excavation size required, handling hook placement and smooth, flush, top surface of PLASTEEL° tank. SPECIFICATIONS Tanks shall be UL'Listed as composite underground tanks for the storage of flammable liquids. Tanks shall be built of mild steel plate, all welded construction, 100% f17�i17i'f in -AM construction, self supporting, with no external ribs- Tank fittings shall be of true 10QUIRLS WALLl construction, attached to both the inner and outer tanks, and pressure tested for leak tightness. Monitor fittings shall penetrate the outer tank only. The outer surface shall be certified corrosion resistant using UL Listed fiberglass reinforced polyester resin. The annulus shall be UL Listed to be sealed (non -vented). The tanks shall be UL Listed for all motor fuels including, but not limited to, unleaded gasoline, leaded gasoline, gasohol in any alcohol blend per- centage,100% methanol, 100%ethanol, jet fuel, and diesel fuel. Following fabrication and leak testing of the steel assembly, the entire exterior surface shall be prepared per UL Listing requirements for the spray application of glass -fiber reinforced isophthalic polyester resin to a sufficient thickness to show no holidays when using a Tinker & Rasor Model AP-W holiday detector set at 35,000 volts. Tank supplier shall supply installation instructions and a kit of materials and resin for sealing all exposed metal after tank installation. Tank to be installed per NFPA-30, applicable local codes and manufacturers instructions. Product Trade Name: PLASTEEL°Composite (US .E Ef Tank. Manufacturer: Joor Manufacturing, Inc. 1189 Industrial Avenue Escondido, California 92025 Telephone: 619/745-0971 WARRANTY As our final assurance of a superior product, PLASTEELO composite IDO BL E-MA1 I I tanks are warranted against internal and external corrosion for 30 years when storing all motor fuels including but not limited to leaded and unleaded gasoline, gasohol In any alcohol blen percentage, 100% methanol, 100% ethanol, jet fuel and diesel fuel. Workmanship and materials are warranted against defects for 5 years. Full warranty available on request. UUNDERWRITERS I L LABORATORIES LISTED INC TYPE II' SECONDARY CONTAINMENT COMPOSITE UNDERGROUND TANK FOR FLAMMABLE LIQUIDS 360 CIRCUMFERENTIAL DEGREES NO. CONSULT LOCAL AUTHORITIES BEFORE COVERING THIS TANK JOOR MFG., INC. ESCONDIDO, CA 92025 STANDARD TANK SIZES CAPACITY GALLONS SIZE OUTSIDE OVERALL DIAMETER x LENGTH WEIG"T LBS. (APPROX.) 500 481/4 "x 6'0" 1,100 1,000 661/4"x 67" 2,200 2,000 951/2"x 67' 4,400 3,000 951/2"x 916" 5,600 4,000 951/2"x 12'6" 6,800 5,000 951/2"x 15'5" 8,000 6,000 951/2"x 18'5" 01100 8,000 114"x 17'0" 11,200 10,000 114"x 21'0" 13,700 12,000 114"x 25'3" 15,700 15,000 114"x31'5" 21,000 20,000 114"x 41'9" 30.500 NOTES: 1) All standard fittings are 4" N.P.T. 2) Other fitting sizes & locations as required. 4) Lift Lugs provided at both ends of all tanks. 5) Manway is optional extra- 6) Custom/special dimensions and larger capacities available. Consult manufacturer for details, MANUFACTURING, INC. LA Joor Manufacturing, Inc.,1189 Industrial Avenue, Escondido, California 92025 Telephone 6191745-0971 .4 el "M A 7 iz TE'4_71 U Q le-;- t\-Ti c 1 Ro 0 i� is 14 At 'D" 7- Ver. 1 -E-dl�C.1-i8-�Q Tier Qualified Facility SPCC Plan This template constitutes the SPCC Plan for the facility, when completed and signed by the owner or op facility that meets the applicability criteria in §112.3(g)(1). This template addresses the requirements of 40 CFR Maintain a complete copy of the Plan at the facility if the facility is normally attended at least Four hours per d facility attended fewer than four hours per day. at the nearest field office. When making operational changes that are necessary to comply with the rule requirements, the ownerloperator should follow state and local req (such as for permitting, design and construction) and obtain professional assistance, as appropriate. rator of a part 112, , or fora m a facility irements Facility Description Facility Name aimeckivy Facility Address city o State cor ZIP 3LJOI County 5QorJy ► ]o Tel. Number I Owner or Operator Name s� Owner or Operator Address -v4— City ?"D State C Zip 93YYL County SCrt. LJiS boo syl0 Tel_ Number - 1. Self -Certification Statement (§112.6(a)(1)) The owner or operator of a facility certifies that each of the following is true in order to utilize this tempi at with the SPCC requirements: to comply GSA certify that the foliowing is accurate: 1. l am famifiarwith the applicable requirements of 40 CFR part 112: 2. 1 have visited and examined the facility-, • ,QII Wr U V0VM41LU I F I tlUt:uwnnL;t-- witri acceptea ano sounri industry practices a n a standards: 4. Procedures for required inspections and testing have been established in accordance with industry i spection and testing standards or recommended practices: 5. 1 will fully implement the Plan: 6. This facility meets the following qualification criteria (under §112.3(g)(1)): a. The aggregate aboveground oil storage capacity of thefacility is 10,000 U.S- gallons or less: and b. The facility has had no single discharge as described in §112.1(b) exceeding 1,000 U-S, gallons and no two discharges as described in §112.1(b) each exceeding 42 U.S. gallons within any twelve m nth period in the three years priorto the SPCC Plan setf-certif!cation date, orsince becoming subject to 40 CFR part 112 if the facility has been in operation for less than three years (not including oil discharges a described in §112.1(b) that are the result of natural disasters, acts of war, or terrorism): and c. There is no individual oil storage container at the facility with an aboveground capacity greater than 5,000 U.S. gallons- T. This Plan does not deviate from any requirement of 40 CFP, part 112 as allowed by §112.7(a)(2) (en ironmental equivalence) and §112.7(d) (impracticability of secondary containment) or include any measures pu uant to §112.9(c)(6) forproduced water containers and any associated piping; have committed the necessary resources to fully implement this Plan. FaciliiyName: ' ��1,� Page 1 T:er I QualifiedFaC My SPCC Plan Ver.-i~doo3-1800 i also understand my other obligations relating to the storage of oil at this facility, including, among others: 1. To report any oil discharge to navigable waters or adjoining shorelines to the appropriate authorities Notification information is included in this Plan. 2. To review and amend this Plan whenever there is a material change at the Facility that affects the pc tential for an oil discharge, and at least once every five years. Reviews and amendments are recorded in an attached log [See Five Year Review Log and Technical Amendment Log in Attachments 1.1 and 1.2.] I Optional use of a contingency plan. A contingency plan: a. May be used in lieu of secondary containment forqualified oll-filled operational equipment, in accordance with the requirements under §I12.7(k), and; b. Must be prepared forflowlines and/o r intra -facility gathering lines which do not have seconds containment at an oil production facility, and; c. Must include an established and documented inspection or monitoring program: must f o I lo w tI te provisions of 40 CFR part 109; and must include a written commitment of manpower, equipment and ma erials to expeditiously remove any quantity of oil discharged that may be harmful. If applicable, a copy of the contingency plan and any additional documentation will be attached to this Plan as Attachmerf 2. 1 certify that I have satisfied the trement to prepare and implement a Plan under §112.3 and all of the req irements under §112.G(a)_ I certify tha he infdrmation contained in this Plan is true_ 16 Signature 'f Title: Name , � Gj I PA&A, Date: 10 / 1 / 9 2D11 II. Record of Plan Review and Amendments Five Year Review (§112.5(b)): Complete a review and evaluation of Iris SPCC Plan at least once every five years. As a result of the review, amen [his Plan within six manthstoinclude morceffectivoprevention and control measuresforthefacility,ifappiitable.hnpiantnr,tally PCCPI ty, amendmentassoon aspossible, but nolater than six months following Plan amendment Document complelionofthe r8 ietvand evaluation, and complete the Five Year Review Login Attachm ant 1.1. If the facility no longer meets Ter I qualified farlit eligibil"Ily, the owner or operator must revise the Plan to meet Tier 11 qualified facility requirements. or com plete a full PE certified Plan. Table G-1 Technical Amendments 112.5(a). c) and 112.E(a 2) This SPCC Plan will be amended when them is a change in the facility design. construction, operation, or maintenance that materially affects the potential fora dischargeto navigable waters oradjoining shorelines. Examples include adding or removing containers. reconstruction, replacement, or installation of piping systems, changes to secondary containment systems, changes in product stored at this facility, or revisionsilio standard operating procedures - Any technical amendments to this Plan will be re -certified in accordance with Section I of this Plan template. 112.6a 2} ee Technical Amendment Log in Attachment 1. Facility Name: Gr r> L o Page 2 Tier I Qualified Fa Ni ' SPCC Pan I Ili, Plan Requirements I. Oil Storage Containers (§112.7(a)(3)(i)): yer. 1-E-doc-3-18--,0 aote vri stora a Containers and Capacities This tabic includes a complete list o' all nil storage containers (aboveground containersaand cornpletaly bulled tanks°) with capacity of 55 U,S. gallons or more, unless otherwise exempt from the rule. For mobilelportai7le containers, an estimated number of containers, types of oil, and anticipated capacities are provided. Oil Storage Container Iindicate whether abovearounoi ' or completel buried B) Type of Oil Shell Capacity (gallons) �L D 1 0 t 0 5 SL3 3D - - O `.� �� S Total Aboveground Storage Capacity c gallons Total Completely Buried Storage Capacity allgallons Facility Total Oil Storage Capacity lip gallons Aboveground storage containers that mustbe included when calculating total facility oil storage capacity include: tanks and mobile or portable containers, oil -filled operational equipment (e.g. transformers). other oil -filled equipment, such as flow -through process equipment Exempt containers thatare not included in the capacity Calculation include- anv contamerwith a Woraoe caoacity of less than 55 galtonsof oil, containers used exciusiveiy forwastewatermeatment: permanently closed containers: motive power containers hoc mix asphalttAntainers; nearing oil containers used solely at a single-family residence, and pesticide application equipment or related mix containers. `' Although the criteria to determine eligibility for qualified facilities focuses on the aboveground oil storage containers at the facility. the corn pletely buried tanks at a qualified facility are still subjectto the rule requirements and m ust be addressed in the template: however, they are not counted toward the qualified facility applicability threshold. Counts toward qualified facility applicability threshold. 2. Secondary Containment and Oil Spill Control (§§112_6(a)(3)(i) and (ii), 112.7(c) and 112.9(c)(2)): Table O-3 Secondary Containment and Oil Spill Control Appropriate secondary containment andior diversionary structures orequipmenta is provided forall oil handling containers, equipment, and transfer areas to prevent a dischargeto navigable waters or adjoining shorelines. The entire secondary containment system, including walls and floor, is capable of containing oil and is constructed so that any discharge from a primary containment system. such as a tank arpipe, will not escape the containment system before cleanup occurs. ; impervtouu to contain oil; (2) Curbing-, (3) CulveMng, gutters, or other drainage systems: (4) Weirs, booms, or other barriers: (5),3011 diversion ponds; (6) Retention ponds: or (7) Sorbentmaterials. Facility Name, 'm if C--., 1,0_ Pa903 Tierl QuaFfied Facility SPCC Plan Q W r� ca E C � C O j` m C C U U cn In m E c io 0 U �a O L to E yam'. U L 7 SC Q C N _ w r E O E m m m U — 0 !n n- A m �_ 9 f6 m s to c � O :I} L C La m al Q Gi 1 w Co ro 3 C m C QZ CC Q U � o V � Q � ❑ f6 w.. a C U c � c U m � m a m :o m � m r� O1 � G � m � C S U m O N vJ � f�rJ ti i6 � O L Cd �m E 1 c II � +^ U y m U O y T N � O m v. o 8 a E N T d j C O CL — m m CLI V m C E � C � a o m � W m 0 0 m c � c � L C i C � C c a Q G5 � o a N T Y � j m C a � c a -� ✓4 L � a 2 a 0 0i1 o — � y N 9 0 T 0 Z 0 -` 3. ver. 1.�oc;,3-,s-10 Inspections, Testing, Recordkeeping and Personnel Training (§§112.7(e) and (f), 112.8(c)(6) and (d)(4), 112.9(c)(3), 112.12(c)(6) and (d)(4)): An inspection and/or testing program is implemented for all aboveground bulk storage containers and pip in at this facility. 1126 c 6 and d {4 112. c 3. 112. f2 ❑f G and 4W The following is a description of the inspection and for testing program (e.g. reference to industry standard u ihZed, scope, frequency, method of inspection ortest, and person conducting theinspection)for all aboveground ulk storage containers and piping at this facility: e 1; X51 el I Inspections, tests, and records are conducted in accordance with written procedures developed for the facilijy. ®. Records of inspections and tests kept under usual and customary business practices will suffice for purposes of this paragraph. [§112.7(e)] A record of the inspections and tests are kept at the f act ity or with the SPCC Plan for a period of three yea d 12T(g)[See Inspection Log and Schedule in Attachment 3.1 Inspections and tests are signed by the appropriate supervisor or inspector. [§112.7(e)] �- I Personnel, training, and discharge proventlon procedures 112.7 g Oil -handling personnel are trained in the operation and maintenance of equipment to prevent discharges; discharge procedure protocols; applicable pollution control laws, rules. and regulations; general facility operations; and, the contents of the Facility SPCC Plan. 1§1127(t�f A person who reports to f agility [§112.7(ol Name/Title, �u S Discharge prevention briefings are conducted foroil -handling personnel annually to assure adequate I understgnding of the SPCC Plan for that facility. Such briefings highlight and describe past reportable discharges or failures. malfunctioning comporents.. and any recently developed precautionary measures. See 011-handl ing Personnel TraInIng and Briefin g Log in Attachment 3.4] aciliiyNama: �/`- v ?age 5 ?ter I Cuallfied PasyiSty SPCC Plan Ver. 1-E-doc 3-18-1© 4. Security (excluding oil production fadlities) §1127(g): Table G=G. im Ilernentaltion. and Description of SecurE Measures Security measures are implemented at this facility to prevent unauthorized access to oil handling, processin and storage area. The following is a description of howyou secure and control access to the oil handling, processing and stom 3e areas; secure master flow and drain valves; prevent unauthorized access to starter controls on oil pumps; secure o -d-of- service and loading/unloading connections of oil pipelines: address the appropriateness of security lighting t¢r both prevent acts of vandalism and assist in the discovery of oil discharges: S. Emergency Procedures and Notifications (§112.7(a)(3)(iv) and 112.7(a)(5)): Table G 7 Description of ErnergenCy Procedures and NoUtications The following is a description of the immediate actions to be taken by facility personnel in the event of a disgiarge to navigable waters or adjoining shorelines (§112.7(a)(3)(►v) and 112.7(a)(5)1: A i Grt Fj 1� Facility Name: tJ1V \T tjV page 6 Tier r Qualified F 1Nry SPCC Pran 6. Contact List (§112.7(a)(3)(vi)): Contacl Organization 1 Person National Response Center (NRC) Cleanup Contractor(s) Table O-8 Contact List Telephone Number 1-800-424-8$ 02 Key FacHity Personnel Designated Person Accountable for Discharge Prevention: Office: 0\0A \, v 1 Emergency: Office: nbC 4 `& Emergency_ Office: SEmergency: Office: Emergency: State Oil Peflution Control Agencies Other State. Federal. and Local Aae Local Fire Department Local Police Department Hospital Other Contact References (e.g., downstream water intakes or neighboring facilities) 1 - Soo - ver_ E-doc-3.18-1f7 acidtMome: 1 t)k L-L 0 oaaa 7 Tiarl Q,.ghfied F—ility E-PCC Pl— I Ver. E-doo-3-18-to 7. N RC Notification Procedure (§112.7(a)(4) and (a)(5)): Table. G-9 NRC' NotMcauon Procecture In the event of a discharge of oil to navigable waters or adjoining shorelines, the following -information identi led in Attachment 4 will be provided to the National Response Center immediately following identification of a discharge to navigable waters or adjoining shorelines [See Discharge Notification Form in Attachment 4 (G 7 ?2. 7(a)f4)1 • The exact address or location and phone number of the facility; • Date and time of the discharge; • Type of material discharged; • Estimate of the total quantity discharged; • Estimate of the quantity discharged to navigable waters: Source of the discharge; • Description of, all affected media; • Cause of the discharge; • Any damages or injuries caused by the dis harge: • Actions being used to stop, remove, and m tigate the effects of the discharge; • Whether an evacuation may be needed: aro Names of individuals and/or organizations ho have also been contacted. 8. SPCC Spill Reporting Requirements (Report within 60 days) (§112.4): Submit information to the EPA Regional Administrator (RA) and the appropriate agency or agencies in c-harg of oil pollution control activities in the State in which the facility is located within 60 days from one of the following schar events A single discharge of more than 1,000 U.S. gallons of oil to navigable waters oradjoining shorelines or Two discharges to navigable waters oradjoining shorelines each more than 4.2 U.S. gallons of oil occur any twelve month period (1) Name of the facility; (2) Your name; (3) Location of thefaciiity_ (4) Maximum storage orhandling capacity of thefacility and normal daily throughput; (5) Corrective action and countermeasures you have taken, including a description of equipment repairs and replacements; (6) An adequate description of the facility, including maps, flow diagrams, and topographical maps, as necessary; (7) The cause of the reportable discharge, including a failure analysis of the system or subsystem in which the failure occurred: and (8) Additional preventive measures you have taken or contemplated to minimize the possibility of recurrence (9) Such other information as the Regional Administrator may reasonably require pertinent to the Plan or discharge NOTE: Complete one of the fbilowing sections (A, B or C) as appropriate for the facility type. within Facility Marne: L Rage e T!er I Qualified Pacllity SPCC Plan �^ Ver,-L-ri:r.3-18-10 A. Onshore Facilities (excluding production) {§§1f2.8(b) through (d)T 112.12(b) through (d)) The owner or operator must meet the ganeraI rule requirements as we as requirements under this section. Note that not it provisions may be applicable to all awnersloperaiors. Far example, S facility may not maintain completely buried metallic storage tars installed after January 10, 1974, and thus would not have to ablcle by requirements in %112.8(c)(4) and 112.12(c)(4), listed below! In cases where a provision is not applicable, write "N!A". f Table G-10 General Rtde Requirements for Ons1f6nffjf iiitFees ' NIA I Drainage from diked storage areas is restrained by valves to prevent a discharge into the drainage system or facility ❑ i effluent treatment system, except where facility systems are designed to control such discharge. Diked areas may be emptied by pumps or ejectors that be JJJ must manually activated after inspecting the condition of the accumulation to ensure no oil will be discharged. f§§112.8(b)(1) and 112.12 b 1 Valves of manual, open -and -closed design are used for the drainage of diked areas. (§§712.8fb)(2) and 112.12 b z ❑ The containers at the facility are compatible with ma#erials stored and conditions of storage such as ressure and tarnrinraturn. 112.8 c 1 and 112. 12C 1 Secondary containment for the bulk storage containers (including mobilelportable oil storage containers) holds the capacity of the largest container plus additional capacity to contain precipitation. Mobile or ❑ portable oil storage containers are positioned to prevent a discharge as described in §112.1(b). 112. fi a 3 it If uncontaminated rainwater from diked areas drains into a storm drain or open watercourse the following procedures will be implemented at the facility: &§112.8(c)(3) and 112.12(c)(3)J • Bypass valve is normally sealed closed • Retained rainwater is inspected to f ❑ ensure that its presence will not cause a discharge to navigable waters or adjoining shorelines ❑ • Bypass valve is opened and resealed under responsible supervision ❑ 1 • Adequate records of drainage are kept [See Dike Drainage Log in Attachment 3.3) ❑ For completely buried metallic tank and 112.12(c)(4)p s insta€led on or after January 10, 1974 at this facility (§§112.8(c)(4) I • Tanks have corrosion protection with coatings or cathodic protection compatible with local soil ❑ conditions_ • Regular leak testing is conducted. ❑ For partially buried or bunkered metallic tanks [§112.8ec)(5) and 9 1 12.12(c)(5)1_ • Tanks have corrosion protection with coatings or cathodic protection compatible with local soil conditions. Each aboveground bulk container is tested or inspected for integrity on a regular schedule and whenever material repairs are made. Scope and frequency of the inspections and inspector qualifications are in accordance with industry standards. Container supports and foundations are regularly inspected_ [See Inspection Log and Schedule and Bulk Storage Container Inspection Schedule in Attachments 3.1 and 3.2 112.8(c)(fi and §1 12.12 c 6 i Outsides of bulk storage containers are frequently Inspected for signs of deterioration, discharges. or — accumulation of oil inside diked areas. [See Inspection Log and Schedule in Attachment 3.11 112.sc i5 and 112.12(c)(6 For bulk storage containers that are subject to 21 GFR part 110 which are shop -fabricated, constructed of austenitic stainless steel. elevated and have no external insulation, formal visual inspection is conducted on a regular schedule. Appropriate qualifications for personnel performing tests and inspections are documented. [See Inspection Log and Schedule and Bulk Storage Container Inspection Schedule — RK..�v..-_�a� .a _ . w w. r.... .._. ...._ Facility Name: L-t+V �T 7yy -. Page 9 0 , LEI Ter t Qualified Fadljty SPCC Ptar ver. �-L-WC-' -1 a• 10 1 Table.C—i.fi Genelta _B21mRe u":rernetsta for C3n5hona FaGtlifies _f 1 MA Each container is provided with a system or documented procedure to prevent overfills for the container. Describe: O 1 ❑ Liquid level sensing devices are regularly tested to ensure proper operation [See Inspection Log and ❑ ❑ Schedule in Attachment 3.11. 112.6(a (3)(ii Visible discharges which result in a loss of oil from the container. including but not limited to seams, ❑ ❑ gaskets, piping, pumps, valves, rivets, and bolts are promptly corrected and oil in diked areas is promptly removed_ 0 112.8 c 10 an_d 112.1?[oJf1O)j Aboveground valves, piping, and appurtenances such as flange joints, expansion joints, valve glands and ❑ ❑ bodies, catch pans, pipeline supports, locking of valves, and metal surfaces are inspected regularly. [See Inspection Log and Schedule in Attachment 3.111al 12.8 d 4 and i 12.12 d 4 i integrity and leak testing are conducted on buried piping at the time of installation, modification, I El construction, relocation, or replacement. [See Inspection Log and Schedule in Attachment 3.1] I_ JffL1Zq(d)(4) and 11Z.12(d)(4)1 aclily Name: � � T! Page 10 Tier I Qualified F 1p SPGG Plan 2 ver. 13. Onshore Oil Production; Facilities (excluding drilling and work6ver facilities) (t112.9(b), }, and (d)}:Ic The owner or operator must meet the general rule requirements as well as the requirements under this section. Note that lot all provisions may be applicable to all ownerstoperators. In cases where a provision is not applicable, write "NIA". At tank batteries, separation and treating areas, drainage is closed and sealed except when draining - - uncontaminated rainwater. Accumulated oil on the rainwater is returned to storage or disposed of in ❑ ❑ i accordance with legally approved methods. ff 112.9 b 1 Prior to drainage, diked areas are Inspected and (§112.9(b)(T)J: • Retained rainwater is inspected to ensure that its presence will not cause a discharge to ❑ C El waters • Bypass valve is opened and resealed under responsible supervision ❑ ❑ • Adequate records of drains a are kept tSee Dike lamina e Log in Attachment 3.3 ❑ ❑ Field drainage systems and oil traps, sumps, or skimmers are inspected at regularly scheduled intervals for oil, and accumulations of oil are promptly removed [See inspection Log and Schedule in ❑ ❑ Attachment 3.11 alIL-9LbA2J] The containers used at this facility are compatible with materials stored and conditions of storage. 112.9 c 1 ❑ ❑ All tank battery, separation, and treating facility installations (except for flow -through process vessels) are constructed with a capacity to hold the largest single container plus additional capacity to contain rainfall. ❑ ❑ Drainage from undiked areas is safely confined In a catchment basin or hold'm nd. (§112.9 c 2 Except for flow -through process vessels, containers that are on or above the surface of the ground. including foundations and supports, are visually inspected for deterioration and maintenance needs on a ❑ ❑ regular schedule. See inspection Log and Schedule in Attachment 3.17 X112.9ic)(3)1 New and old tank batteries at this facility are engineered/updated in accordance with good engineering ❑ El to prevent discharges including at least one of the following: i. adequate container capacity to prevent overfill if regular pumping/gauging is delayed; I[. overflow equalizing lines between containers so that a full container can overflow to an adjacent container, iv. high level sensors to generate and transmit an alarm to the computer where the Facility is subject to a corn uter eroduction controls stem_ 112.9 c 4 Flow -through process vessels and associated components are: Or Are constructed with a capacity to hold the largest single container plus additional capacity to contain rainfall. Drainage from undiked areas is safely confined in a catchment basin or holding pond; f§112.9(c)(2)] and • That are on or above the surface of the ground, including foundations and supports, are visually inspected for deterioration and maintenance needs on a regular schedule. [gee Inspection Log and Schedule in Attachment 3.11 1§112.9(c)(3)] • Visually inspected and/or tested periodically and on a regular schedule for leaks, corrosion, or other conditions that could lead to a discharge to navigable wafers; and Corrective action or repairs are applied to flow through process vessels and any associated components as indicated by regularly scheduled visual inspections, tests, or evidence of an oil discharge; and Is Any accumulations of oil discharges associated with finw-thrm inh nrnr-cacc vaa-cz lk are nreimnt{i • Flow -through process vessels are provided with a secondary means of containment for the entire capacity of the largest single container and sufficient freeboard to contain precipitation within six El 11 months of a discharge from flow -through process vessels of more than 1,000 U.S. gallons of oil in a single discharge as described in §112.1(b), or a discharge more than 42 U.S. gallons of oil in each of two discharges as described in §112.1(b) within any twelve month period. (§112.9(c)(5)1 (Leave blank until such lime that km provision is applicabie-1 Facility Name; 11 Li _ Page 11 Tier I Qualified • ;cilrry SPCC Plan �IA- Ver- 3'l-L-doC-3-18-10 Fable G-11 General Rule -rements for Onshore tail F�comes I WA All aboveground valves and piping associated with transfer operations are inspected periodically and a regular schedule. The general condition of flange joints, valve glands and bodies, drip pans, pipe ❑ El supports, pumping well polish rod stuffing boxes, bleeder and gauge valves, and other such items are included in the ins clion. See ins ection Log and Schedule in Attachment 3.1 112.9(d)(1)] An oil spill contingency plan and written commitment of resources are provided foriiowlines and Intra- ❑ ❑ facility gathering tines [See Oil Spill Contingency Plan and Checklist in Attachment 2 and inspection Log and Schedule in Attachment 3.1](§1129(a)(3)1 or Appropriate secondary containment and/or diversionary structures or equipment is provided for flowlines ❑ ❑ and intra-facility gathering lines to prevent a discharge to navigable waters or adjoining shorelines. The entire secondary containment system, including walls and floor, is capable of containing oil and is constructed so that any discharge from the pipe, will not escape the containment system before cleanup occurs. A flowlinellntrafaciliiy gathering line maintenance program to prevent discharges from each Howrline has ❑ ❑ been established at this facility. The maintenance program addresses each of the following: • Flowlines and intra facility gathering lines and associated valves and equipment are compatible ❑ with the type of production fluids, their potential corrosivity, volume, and pressure, and other conditions expected in the operational environment; • Flowlines, intra-facility gathering lines and associated appurtenances are visually inspected ❑ ❑ and/or tested on a periodic and regular schedule for leaks. oil discharges. corrosion. or other conditions that could lead to a discharge as described in §112-1(b). The frequency and type of testing allows for the implementation of a contingency plan as described under part 109 of this chapter. l • Corrective action and repairs to any flowlines and intra-facility gathering lines and associated El appurtenances as indicated by regularly scheduled visual inspections, tests, ar evidence of a discharge_ Accumulations of oil discharges associated with flowlines, intra facility gathering lines, and ❑ ❑ associated a purtenanees are rout Ei removed. 112.9 d 4 The following is a description of the flowline/intra-facility gathering line maintenance program implemented a this facility-G. Onshore Oil Drilling and Workover Facilities (§112.1fltb), (c) and (d)): The owner or operator must meet the general rule requirements as well as the requirements under this section. Table G-12 General? Rule Requirements for Onshore Oil Drilling and Workover Facilities Mobile drilling or worker equipment is positioned or located to prevent discharge as described in §112.1(b). ❑ 112.10 b = Catchment basins or diversion structures are provided to intercept and contain discharges of fuel, crude oil, or I❑ oily drill lin fluids. 112.10(c A blowout prevention (BOP) assembly and well control system was installed before drilling befog any cas stri[nq or during workover operations_ J§ 112.10(d) J The 80P assembly and well control system is capable of 6i trolling any well -head pressure that may be encountered while the BOP asSembly and well control system are on the well. j§ 112.1 Ui'dlj ;ablity Name! U, 1_ � V V — __ Page 12 Tier i Qualified SPl+C Plar. I `Jgr, 1�L�c-3-1$-10 ATTACHMENT 1 — Five Year Review and Technical Amendment Logs I have completed a review and evaluation of the SPCC Plan for this facility, and wiflfmll not amend this Plan as a result. �ir- Review Date Plan Amendment flame and signature of parson authorized to nevi this Will Amend Will Not Amend flan ❑ I ❑ I I � ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ f Cl ❑ ❑ ❑ (Insert Facility Name Here) Page 13 Tier I Qualified Foolity SPCC Plan Any technical amendments to this Plan will be r®-certified in accordance with Section I of fhis Plan template. _ ��fl�aAEGe ' �nica�Ariaeridait!`- .__� Review Description of Technical Amendment Name and signature of person cerffyin Date technical amendment this _ i i l I j I `f Facility Name: Page 14 Tier I Qualified iiy SPCC Pfar. Ver. -1,dcc-3-18-10 ATTACHMENT 2 — Oil Spill Contingency Plan and Phecklist An oil spill contingency plan and written commitment of resources is required for. • Flowtines and inch-faatity gathering lines at oil production facilities and • Quaallfted oil -filled operational equipment which has no secondary containment. An oil spill contingency plan meeting the provisions of 40 CFR part 109, as described below, and a written ❑ commitment of manpower, equipment and materials required to expeditiously control and remove any quanti ,y of oil discharged that may be harmful is attached to this Plan. Complete the checklist below to verify that the necessary operations outlined in 40 CFR part 109 - Criteria for State. Local and Regional Oil Removal Contingency Plans - have been included. (a) Definition of the authorities, responsibFities and duties of all persons, organizations or agencies which to be involved in planning or directing oll removal operations. (b) Establishment of notification procedures for the purpose of early detection and timely notification of an re ❑ 1 it discharge including: (1) The identification of critical water use areas to facilitate the reporting of and response to oil dischar F ❑ (2) A current list of names, telephone numbers and addresses of the responsible persons (with altemat ) j 1771 and organizations to be notified when an oil discharge is discovered. 1 (3) Provisions for access to a reliable communications system for timely notification of an oil discharge, ❑ I and the capability of interconnection with the communications systems established under related oil removal contingency plans, particularly State and National plans (e.g., NCP). (4) An established, prearranged procedure for requesting assistance during a major disaster or when t ❑ 7 situation exceeds the response capability of the State, local or regional authority. (c) Provisions to assure that full resource capability is known and can be committed during an oil discharg situation including: (1) The identification and inventory of applicable equipment, materials and supplies which are availab 0 focally and regionally. 2 An estimate of the a ui m nt materials and supplies which would be required to remove the maxi um: oil discharge to be anticipated. (3) Development of agreements and arrangements in advance of an oil discharge for the acquisition ofl ❑ equipment, materials and supplies to be used in responding to such a discharge. (d) Provisions for well defined and specific actions to be taken after discovery and notification of an oil discharge including: (1) Specification of an oil discharge response operating team consisting of trained, prepared and availa Die ❑ operating personnel. (2) Predesignation of a properly qualified oil discharge response coordinator who is charged with the ❑ responsibility and delegated commensurate authority for directing and coordinating response operai ion, and who knows how to request assistance from Federal authorities operating under eAsting natlon and regional contingency plans- (3) A preplanned location for an oil discharge response operations center and a reliable communicatio s ❑ system for directing the coordinated overall response operations. (4) Provisions for varying degrees of response effort depending on the severity of the oil discharge. ❑ than one water use may be adversely affected as a result of an oil discharge and where response - operations may not be adequate to protect all uses. (6) Specific and well defined procedures to facilitate recovery of damages and enforcement measures is ❑ provided for by State and local statutes and ordinances- The contingency plan must be consistent with all applicable state and local plans, Area Contingency Plans, and the Nadi rwt Contingency Plan (NCP) Facility Name: Lor- SVf 0 - Page 15 Tier I Qualified Fa iIhy SPCC Ptan M F Z W C3 a Q I i 2M to E m c O i f y I t0 Z � m m 0 m �4d W C O m I o= co 0 a E z LL LL Vec To comply with integrity inspection requirement for bulk storage containers, inspecUtest each shop -built aboveground bulk container on a regular schedule in accordance with a recognized container inspection standard based on the minimum req the Following table. Container Size and Design Specification Rortable containers (including drums, totes, and intermodal bulk containers (IBC)) 55 to 1,100 gallons with sized secondary containment 1.101 to 5,000 gallons with sized secondary containment and a means of leak detection" 1,101 to 5,000 gallons with sized secondary containment and no method of leak detection' Inspection requirement ff.11S111 Usually inspect monthly for signs of dete )ration, discharges or accumulation of oil inside diked areas in Visually inspect monthly for signs of deter4wation, discharges or accumulation of oil inside diii.ed areas plus any annual inspection elements per industry in ct on standards Visually inspect monthly for signs of deteri�nation, discharges or accumulation of oil inside di ed areas, plus any annual inspection elements and t)ther specific integrity tests that may be requirer?i per industry inspection standards a Examples of leak detection include, but are not limited to, double -walled tanks and elevated containers where a leak can be visually identified. Facility Name: Lloe r? I O Page 17 Tier I auaffied SPGG Plan C I UL DateDesciliptivn l Scope Facility Narne: _L&CC✓o Ver 1 }I_-dao-3-18-10 Ait ndew v Page 19 Tier I QualAved I 4 Plan. /er. IFL-d--3.78-10 In the event of a discharge of oll to navigable waters or adjoining Shorelines, the foilmving informatian will be provided to th National Response Center [also see the notification Information provided in Section T of ft Plan}: Cate Name Time Facility Location (Addresskat- LongfSection Township Range) Name of reporting individual Telephone # Type of material discharged Estimated total quantity Gallons/Barrels discharged Source of the discharge Media affected ❑ Soil ❑ Water (spec y) J Actions taken Damage or contacted ❑ other ❑ No ❑ Yes (specify) I Evacuation needed? I ❑ No ❑ Yes individuals ❑ National Response Center 800-424-8802 Time ❑ Cleanup contractor (Specify) Time ❑ Facility personnel (Specify) Time ❑ State Agency (Specify) Time ❑ Other (Specify) Time Facility Name: —wk��L� Q Page 20 Tier I Qualified Fa ility SPCC Plan Division ofEnvironm lealth " 7 (845;781-5544 ro Y of San Luis Obispo :� P.O. Box 1489 1 ��� 2156 Sierra Way *San Luis Obispo, CA 93406 Fire Department (805) 781-7380 N DC artnlent of A riculturelMellsurement 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 Standards (805) 781-5910 1 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: � / �/ � EFW data Time: /,�, -- ,� PMentry by: FACILITY ID NO: AGENCY FACILITY NAME: ❑ DEH ADD ESg: ❑ AG DEPT CITY FIRE CITY UTILITIES PHONE: INSPECTION TYPE ❑ Routine ❑ Reinspection Complain Other PROGRAMS INS ❑ Business Plan ❑ HI Generator UST ❑ AGT ❑ Tiered Permitting REINSPECTION REQ...PECTED, ❑ YES ❑Business Plan ❑ HW Generator ❑UST ❑AGT ❑ Tiered Permitting 'ERNISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance ,ith adopted codes. GRA14TED BY (NAME/TM.F1! BUSINESS PLAN A[/ + " `� ,I e YES NO N/ T ❑ BPOl Business plan is complete, urr";' i p p av i ble urines g ins ti ni (HSC 2 .503S, ifiie 1 CCR 272 ❑ 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 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) I COMMENTS: - AV r � • ��Yyy ri 7 /� jU�' %SPECTOR: , FACHYry REP: ,3ro 1001 rev 1 0:\f0OCl1MENT\Jeffp\FORMS\Inspection forms\CUPA inspoction forms.doc 10-Sep-01 1 -A -'�. i ( . h ile of Cali fornio—Environmental Protection Agency Im Approved OMB No. 205"039 (Expires 9.30.99) See Instructions on back Of aae 6. lease print or type. Form designed lot use on elite F t 2-pitch) 1'- P - Department of Toxic Substances Conlro' Sacramento, California UNIFORM HAZARDOUS alor's US EPA ID No. f r e ; Manifest Document 1 2. Page 1 Information in the shaded areas WASTE MANIFEST is not required by Federal law. [ClA7�lO1Of41 010 $'� Z 5 0 0 0 0 a �af1 3. Generator's Name and Mailing Address A. State Manifest Document Number Attn : J zM wI1,M0>�E 23376506 26F5 HfIGUERA ST_ SilN LUIS OBI:ip% CA 93401 B. State Generator's ID a�___ 805 ,544-297b 5- Transporter 1 Company Name sCV Off' ADAMS SERVICES, INC 0 7. Transporter 2 Company Name jo _op J_ 0 Q • V �j � �gil Site Address Q► Q 2000 N . ALMfECIA STREET COMPTON, CA 9022.2 6. US EPA ID Number y 21 2 8- US EPA ID Number 10. US EPA ID Number {�O T 0 LL- VV 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) Z a. {OIL �& WATER] t- G E o b• N co coo E v R v A o T c- � 0 R rY us d. t- Z W V W O7� Adt�sJ�af},µplrp;s fale[�gl Listed Above 0 v+��GRR ice•" V) W Q Z C. State Transporter's ID ]Reserved-] ] D, Transporter's Phone _ GL E. State Transporter's ID [Resarved.] F. Transporter's Phone G. Slate Facility$ ID � T 1 1 1 3 3 H. Facility's Phone 310 537 7100 12. Conlainers 13. Total 14. Unit No, Type Quantity Wt/Vol I. Waste Number State 241 1 T T f�' EPA/Other Slate EPA/Other State EPA/Other State EPA/Other K. Handling Codes For Wastes Listed Above a. b i d. I O 15. Special Handling Instructions and Additional Information r,azlh t a AVOID CY1i OQIITAGT £r VMBR RUENCR GIDVES ECONOL---2$O...-Oiga.L Z - - 9an Lug s Oba.spo_ , CA = COnt� "0tcm- Hawn County Conctznction, Ino. 93401 t- 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this eonsi nment are fully and aceurolel described above by proper shipping name and ore camified, packed, V marked, and labeled, and are in all respects in proper condition For transport by highway according to applicable international and national government ro r@ lions, IF I am a large quantity generator, I carlify that I have a program in place to reduce the volume and toxicity of waste generated to the degree t have determined to be economically N practicable and that I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, I have mode a good faith fort to minimize my waste genuroiion and select fhe best waste management melbod that is available to me and that I con afford. f O 9 VPrinted/Typed Name Si nnrur `� Mont p[sy�/�Year w f ..> 0 Ur T 17. Tron rler 1 Acknow ement OF Receipt of Materials R WS Pri yped Name Signature o ay seer W P J OR 1 B. Trans ortpr 2 Acknawled ement a Recai t of Melerials 6101 W Printed/Typed Name Signature Month Day Year rn R (a) 19. Discrepancy Indication_Space Z F A C I L f 20. Facility Owner or Operator Cerlificafion of receipt of hazardous materials covered b this manifest exce t as noted in Item f 9, T Printed/Typed Name Signature �, g Month Day Year DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 .J o E p X y c e e Z h a O ~ .y 0 sir t;. ❑ v �w N � c ca m CL:: c E ca E a)c c ❑ Z tn rn a U 0 lob in a U o 0 a f7� � � N N � mN Mc ,It OR o. Ul `Dn 5` m m c E rn rn c Ln LO x' a d, o°'e ir, a` U o oe �n a ci o w 00 a a c x x o c O � ❑ Z � T� 7 � a 01 y oY1 a m 0-0 uj ° "_ o ❑❑❑❑ CD o ° �• yC 1 � 'V (� '� � •m •� y 'm N + Co U a m ' NCy a v o w 0 9 7 D- E E44 a 43 D E �Q £ ul ii U U 5 m p Z'd ESSO-sirs(SOB) odstg0 sink ueS -jooaS di0:E0 -�,0 SO qa=l Feb 05 04 03:01p Secor- San Luis Obispo (805)546-0583 p.3 8 �7 f la�e-N`�7^une L, d Ots Ilrak 5v3 Id t7 �a H alppr-cam I � 6 �J n 04-21-03 09:22AM FROM KERN CONSTRUCTION I P05 1 a� W LL ,w w r - 7 ..� c-r �,.. L L -� p¢ ❑ ? LJJ Wr-- te � u r LCv w ,� ❑ x Li II i I n I I d i � I ' I i e _ yy � L GG44 l i, u a O a `A r o +! `�! by "' y pWa� N� T y6� M1 �lZir yLL �l�a � .♦ 3 � e L' U y �. = V1 J it !lh Q n yy�� z e^ W �.,� J do �❑ mz 6Z� X u ��u`m rpm ry Z�u lL pGrppc� aM7��L 7,LQ g� Y , O w Glq ru6c 1J I -•- - - --- - - -- I� z . ICI �:3q , Y �r1 �+ N 4 v `i- W � W ad zZ 0 1WW Q u_ i L7 Z u 4 GI ❑ aaZz--zlzz a-a.�a zzz -- , 1,ax� f I,,,. �.�L L CU CU rU 411 51 2 (TI i I I 9 UiNN 01 RS 9L 1?1,0•!'007- 7. 10 >- D60d of city o r ; sari WIS oB I Sr O Ann S#aeBui g & Safety Division • 990 Palm Street • San Luis Obispo, CA 93401-3249 • (805) 781-7180 r ,f L 64.J Fire Date Routed 04/17/03 Application Number 030407 Application Date 04/17/03 Project Address 286 HIGUERA Assessor's Parcel Number002-482-024 Zoning C-R-MU Project Description REMOVE WASTE OIL TANK/INSTALL NEW TANK Print/Type Name KERRY BOYLE Department Phone Number(805) 781-7380 Property Owner JONES PATRICK T THE ETAL Mailing Address 3162 ROSE AVE City/State/Zip SLO CA, 93401-5905 Contractor's NameKERN COUNTY CONST INC Phone Number 661-634-9950 Fax Number 661-634-9233 Project Manager JOSH SIMMONS Phone Number 661-203-3094 Fire REC'D 3 SETS OF PLANS. ROUTED TO BLDG, PLNG, & KERRY BOYLE AT FIRE. BLDG APPROVED OTC. SB W>Ic'.'i GtVt d� A�u�.. dam. dWA/I Date APRIL 21, 2003 Status OK Our department will conduct a final inspection on this project Yes ) XX No — � •• x - � i; +• � - s ,yam � 1 �� Kern County Construction, Inc. P.O. Box 6096, Bakersfield, CA 93386 Contractors License # 481053 (661) 634-9950 Fax (661) 634-9233 March 18, 2003 Attn: Jim Wilmore Econo Lube N' Tune & Brakes 286 Higuera St. San Luis Obispo, Ca From: Josh Simmons Re: Waste oil tank removal and installation of new above ground tank and piping. Scope of Work 1. Sawcut, remove, and dispose of concrete around waste oil tank. 2. Excavate tank and piping and remove. 3. Triple rinse and dispose of existing tank and piping. 4. Provide soils samples in area of existing tank and piping. 5. Backfill excavation and replace concrete paving to match existing. 6. Pour concrete pad in location of new tank. 7. Provide new above ground double wall steel tank and piping. 8. Provide permit to be issued by San Luis Obispo City Fire Department. Equipment list: 1- Modern Welding 500 gallon UL 2085 storage tank 1-Kreugar H-2 style guage 1 -7 '/2 gallon spill bowl with drain and lid 1 -6" emergency vent 1 -opw 23 vent cap 1 -decal kit 1- Warren Rupp S1FB1AHWANS000 1" diaphragm I Exclusions td AL1�7 (1eI i sm NVS 'AA CLIAA,3IAM ba rIVUna Nor LNgAjS l aa13 M31AHN Calms 0.L.LDdf£if1S'1VA0Nddb` 1. Price excludes any soils remediation. 2. Price does not include any additional regulatory requirements after March 18, 2003. 3. Price is good up to thirty days after Marchl 8, 2003. Price to perform the above stated work is: $14,840.00 rJ UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS WASTE HAZARDOUS WASTE TANK CLOSURE CERTIFICATION 1 of 1 I. FACELI TY IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID# 1 ECONO LUBE 'N TUNE 1 TANK OWNER NAME 740 JIM WILMORE TANK OWNER ADDRESS 741 286 HIGUERA ST. TANKOWNERCITY SAN LUIS OBISPO 742 .STATE CALIF. 743 ZIP CODE 93401 7a4 II. TANK CLOSURE INFORMATION Tank ID # (Attach additional copies Concentration of Flammable Vapor Concentration of Oxygen of dus page for morethan TANK t1treetanh) Top Center Bottom Top Center Bottom INTERIOR ATMOSPHERE I 745 01 746a 0% 746b 0% 746c 0% 20.4% 747a 747b 20.4% 747c 20.4% READINGS 2 N/A 748 749a —W_--- 749b 749c 750a 750b 750c 3 __,_m 752b N/A 751 752a 752c ^— 753a —_--- 753b — — — 753c III. CERTIFICATION On examination of the tank, I certify the tank is visually free from product, sludge, scale (thin, flaky residual of tank contents), rinseate and debris. I further certify u L WU susvis"UULI Psuvlueu ncrem rs sue am accurate to the best of my knowledge. SIGNATURE OF CERTIFIER NAME OF CERTIF�ER (Prim) [ � D. Kerry Boyle �J TITLE OF CERTIFIER Hazardous Materials Coordinator Santa Barbara Ave. CITY San Luis Obispo PHONE (805) 781-7383 DATE 759 CERTIFICATION T]ME 2/5/04 1:00 P.M. STATUS OR AFFILIATION OF CERTIFYING PERSON Certifier is a representative of the CUPA, authorized agency, or LIA: 760 7sa XK3 Yes ❑ No Name of CUPA, authorized agency, or LIA: 761 755 San Luis Obispo City Fire .Department If certifier is other than CUPA / LIA check appropriate box below: 762 756 , ❑ a. Certified Industrial Hygienist.(4CIH) ❑ b. Certified Safety Professional (CSP) 757 ❑ c. Certified Marine Chemist (CMC) ❑ d. Registered Environmental Health Specialist (REHS) 753 ❑ e. Professional Engineer (PE) ❑ f. Class H Registered Environmental Assessor ❑ g. Contractors' State License Board licensed contractor (with hazardous substance removal certification) TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS (If yes, the tank interior atmosphere shall be redKcked with a combmubie ps indicator prior to work being condwW on the nude.) Xja Yes ❑ No CERTMER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSAL FACILITY. ETC: No flammable vapors evident. Tank has been triple rinsed with a caustic cleaning agent n then visually inspected. Tank may be recycled as scrap metal. Tank held waste oil only. oopY of tbEs txriifteate ihalE acooaspany The tank to the rocy clu,� 1 dtspocai ficlltty and be Ptorided to CsG C(JPA. If there is oo CUPA, topics sW be talbujuad to the UA ant! UPCF (1/99) 201 Formerly DISC 1249 (6/98) 0 N 00 02 F I> w Nr Q k oz uZ, 0 > U. 0� Qw a l L, G/ SECOR February 24, 2004 Mr. Josh Simmons Kern Construction Post Office Box 6096 Bakersfield, California 93386 Subject: Waste Oil Tank Removal Soil Sample Results Econo Lube N' Tune 286 Higuera Street San Luis Obispo, California Dear Mr. Simmons: SECOR www.secorcom INTERNATIONAL INCORPORATED SECOR Job No. IOOT.05971 SECOR International Incorporated (SECOR) is pleased to present this letter -report documenting the results of soil sampling activities conducted during the removal of an underground waste oil tank and associated piping at the above referenced site (Figure 1). The scope of work included the following: • Collection of soil samples from the boundaries of the tank excavation; • I ahoratory analvsis or soi ■ Preparation of this letter -report. Project Location and Current Use The subject property is located on the west side of Higuera Street, at the intersection with High Street, in the City of San Luis Obispo, California (Figure 1). The property is currently developed with an automobile servicing facility. Soil Samplin>; akersfield, California conducted the excavation and tank removal activities. On February 5, 2004, three soil samples were collected (two from the bottom of the tank excavation and one from the trench associated with the removed piping) for laboratory analysis as directed by a San Luis Obispo Fire Department (SLOFD) inspector (Figure 2 depicts soil sample locations). 3437 Empresa Drive, SuiteA, ;an Leis Obispo, California 93401 Tel: (805) 546-0455, Fax: (805) 546-0583 Mr. Josh Simmons February 24, 2004 Page 2 Soil samples were collected from the teeth of the backhoe bucket and placed into laboratory -supplied glass sample jars. The sample jars were immediately sealed with Teflon -lined screw lids, labeled and placed on ice for transport to a California certified laboratory. Analytical Methods The soil samples were delivered to ZymaX Envirotechnology in San Luis Obispo, California, a State of California Department of Health Services certified laboratory, and analyzed for Total Petroleum Hydrocarbons (TPH) characterized against a motor oil standard (TPHo), volatile organic compounds (VOCs) including benzene, toluene, ethylbenzene, and total xylenes (BTEX), and CA LUFT metals by Environmental Protection Agency (EPA) Test Methods 8260, 6020 and California LUFT GC/MS Combination. Copies of certified analytical reports, quality assurance documents, and minimum detection limits for the soil analytical results are attached. Soil Sample Results TPHo and VOCs (including BTEX) were not detected in any of the samples analyzed. LUFT metals, including cadmium, chromium, lead, nickel and zinc were either not detected or detected in the samples at concentrations below the Total Threshold Limit Concentration (TTLC). Thank you for the opportunity to provide environmental services for this project. If you should have any questions regarding the information contained herein, please do not hesitate to contact the undersigned at (805) 546-0455. SECOR International Inci Chris Prevost, P.E. Associate Engineer Attachments Figure 1 — V Figure 2 — Site Plan Soil AnalyticalLaboratory Reports and Cain of Custody Documentation Cc: Mr. Kerry Boyle, San Luis Obispo Fire Department, 2160 Santa Barbara Avenue, San Luis Obispo, California 93401 X:\Letters\SLO Econo Lube N Tune\Soil Sample Results FIGURES f+ ,a �:•�,: -i ---- rvaera x• --aR .'==�:,... 1r,,:, is oo, � ,r �� �. o. x t C @a Sly -I.. `"'!' ..5 •ua • sla .�.Y��''k .. tA x�.. era Ap 0-1 Lp 28 -r� ] . '� • - J �' ���4 ,�. `� I• �� - s't • � `'ter;' ` ri " j i �- r •'� .,1 _ - .. �.: 1 -..lank ` ,:�-' 'a 4rn f • ae. i • 7. +• 1.._ '••�`tir �, =:--::.��-ry �i {, ��r1- .l� I�,j 6S{4l fl.0 C•,gs[['�dr' ALL age y [di f~• 4 A'! 245 S 4r y `� � �, p" 1 � _ � � yeti 1 � . • Y.`'k � � u ( [aaye �. . \_ / � � ��� S ' r • � '�s � � - - } fir. •; i �� r ' S(IJ � .i' •' <p `•� % [� _ .R9 •w R � Ali -.� � .ti - 1 '< � } � ,' S ;• ti •r i • ,ir +. ti •�y ` • ` nclIt i t �+ tnu ia4:� a r l .-.,W.�•-%�' .•� �-'lr' Orr . `•,, '� l ;;eat j E;" ,S4Urt� .. __- 9! �_ ,..., �z.l.�.- f. ��� =�- �: •�.�� � �.� � . � �^=�� ��' SITE ,. t3, 1• .. •.^=ti'ti;:�=� nr=• Y _ ^•1 y�°�� <Y:�45. ,1� ''�ti_Ihj rtk' •`i' -• -_ . { - . •� • ��} - u �` % •' ' ;� .ar�jy; i+�rh1 ... ;� i ` -' r �r�. � [i.-Y R] � .�1`r -. .� ,s�fi.liv...� } .•,�- .'{,, - �lam; i, a� 'y'. ,! 0.. � _ �`[ � ', �i:'. .��!;li:• r' may.. �, e{SAP Cv �4.k 1r 34r7 '; ;' • oo IR•j l3 1 •; i"4 e. � ..�'� `��h t �,heaterl • 'L�1. upl•F•:I ' a, � ���'-,r • � r !(i'/t .•!.• ti= (i. y3 !s[11C�: - r* �tar.nk...;... `1 4 J +11 1• i e ] { ,`,L r• .:ti p g 4:r�r. �-'•-,.rrlsa •'��, • ram. R 'Well +ry � �; 7+8sposal {:• l � r .. ,,jlal . -- �., : � ' �'r' �., ti Well {.JobiWfi40mB (Scale In Feet) ^Crave r. : Parr. I—Purnping "~ m&f.Ie 0 2,000 +�` j wStation ParTANK rARM k ••q VICINITY MAP 10 ECONO LUBE-N-TUBE S E C Q R 286 HIGUEPA ST/'� 3437 Empresa Drive, Suite A, San Luis Obispo, CA93401 SAN LUIS OBISPO, CA FILE NAME: PROJECT NUMBER: DRAWING DATE: FIGURE: X:\CAD\PHASE 1DRAFr1NG\26BHIGUERA-VM-sM 100T.05971.001 17 FEB 04 1 r� SOUTH HIGUERA ST LUBE BAYS I Ix ICONC� I� /A.C. PAVING LUBE BAYS NOT TO SCALE LEGEND ® SOIL SAMPLE LOCATIONS ed S E=OR 3437 Empresa Drive, Suite A, San Luis Obispo, CA 93401 FORMER PIPING RUN 51 PIPING RUN (APPROX. 5' B.G.) S3-SOUTH PIT BOTTOM (APPROX. 10' B.G.) S2-NORTH PIT BOTTOM (APPROX. 10' B.G.) EDGE OF ASPHALT/CONCRETE CUT SITE MAP ECONO LUBE-N-TUBE 286 HIGUERA ST SAN LUIS OBISPO, CA I FILE .NAD\PHASE 1_DRAFrING\286HIGUERA-vM-SM PROJECT 100T.0 987ER001 DRAWING DATE17 FEB 04 FIGURE: 2 SOIL ANALYTICAL LABORATORY REPORTS AND CHAIN OF CUSTODY DOCUMENTATION -r w G 0 V M. Z I V �+ Cli U1 Lq O O co 00 X x O c N V) �J • • . ©EN MENEM ■ENE■■ MENE■ ■■■■■■■■■■■■� !� NONE ■■M■E��; A � i 1 � EEEEEEEEE�■�7EEEEEEEEEEEEEEIEEEEEEEEEEEEEEIEEEEEEEEEEEEEEIEEEEEEEEEEEEEEIEEEEEEEEEEEEEE�aEEEEEEEEEEEEEE�EEEEEEEEEEEEEE�EEEEEEEEEEEEEE�EEEEEEEEEEEEEE#EEEE� ■ 1 ■ 1 e i i 1 i l 1 i E V i x N N N .� C CL .� C a)V V 31 in a U 0 01 in a U o �1 i kn J m C Z > C a_ CC C c- E = icn a U) U 0 C n a Uce Ca �f 1 O VV h . c AN �. m a m n m 0 a Q CL } ❑❑❑❑ V �' tJ O U U a U� ti ca 2 Co V{i L U .0 N O U � �• � '� N Q N U N 'O U d O N nr E_ cn E= in fn U U w�r SPORT OF ANALYTICAL RESULTS Page 1 of 3 Client: Chris Prevost Lab Number: 34678-1 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S1-Piping Run Project Number: 10OT.05971.00.0001 Analyzed: 02/06/04 Collected i)y. Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT* * mg/kg mg/kg VOLATILE ORGANIC COMPOUNDS Benzene 0.005 ND Bromobenzene 0.005 ND Bromochloromethane 0.005 ND Bromodichloromethane 0.005 ND Bromoform 0.005 ND Bromomethane 0.005 ND n-Butylbenzene 0.005 ND sec-Butylbenzene 0.005 ND tert-Butyl benzene 0.005 ND Carbon Tetrachloride 0.005 ND Chlorobenzene 0.005 ND Chloroethane 0.005 ND 2-Chloroethylvinyl ether 0.010 ND Chloroform 0.005 ND Chloromethane 0.005 ND 2-Chlorotoluene 0.005 ND 4 GhIeFo`tel -0-O r 1,2-Dibromo-3-Chloropropane 0.010 ND Dibromochloromethane 0.005 ND Dibromomethane 0.005 ND 1,2-Dichlorobenzene 0.005 ND 1,3-Dichlorobenzene 0.005 ND 1,4-Dichlorobenzene 0.005 ND Dichlorodifluoromethane 0.005 ND 1, 1 -Dichloroethane 0.005 ND 1,2-Dichloroethane (EDC) 0.005 ND 1,1-Dichloroethene 0.005 ND ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit 1 *14__..lt_3isted as NE) aid have-been-repoited if piesunt at crap uyu the! fisted 1301t. MSD #2 34678-1.xls JMM/ash/pv/ra 805.544.4696 i r � -PORT OF ANALYTICAL RESULTS ZYM47X Page 2 of 3 Client: Chris Prevost Lab Number: 34678-1 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S1-Piping Run Project Number: 100T.05971.00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT** mg/kg mg/kg VOLATILE ORGANIC COMPOUNDS cis-1 ,2-Dichloroethene 0.005 ND trans- 1,2-Dichloroethene 0.005 ND 1, 2-Dichloropropane 0.005 ND 1,3-Dichloropropane 0.005 ND 2,2-Dichloropropane 0.005 ND 1,1-Dichloropropene 0.005 ND cis-1 ,3-Dichloropropene 0.005 ND trans-1,3-Dichloropropene 0.005 ND Dichlorotrifluoroethane 0.005 ND Ethylbenzene 0.005 ND Ethylene Dibromide (EDB) 0.005 ND Hexachlorobutadiene 0.005 ND Isopropyl benzene 0.005 ND 4-Isopropyltoluene 0.005 ND Methylene Chloride 0.005 ND Naphthalene 0.005 ND Styrene 0.005 ND 1,1,1,2-Tetrachloroethane 0.005 ND 1,1,2,2-Tetrachloroethane 0.005 ND Tetrachloroethene (PCE) 0.005 ND Toluene 0.005 ND 1,2,3-Trichlorobenzene 0.010 ND 1,2,4-Trichlorobenzene 0.010 ND 1,1,1-Trichloroethane (TCA) 0.005 ND 1,1,2-Trichloroethane 0.005 ND Trichloroethene (TCE) 0.005 ND ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit IsTed as MU wou Id Piave been reported it present at or above the rs e . MSD #2 34678-1.xls JMM/ash/pv/ra �1. ^FPORT OF ANALYTICAL RESULTS ZY Page 3 of 3 Client: Chris Prevost Lab Number: 34678-1 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S1-Piping Run Project Number: 100T.05971.00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT*' mg/kg mg/kg VOLATILE ORGANIC COMPOUNDS Trichlorofluoromethane (freon 11) 0.005 ND 1,2,3-Trichloropropane 0.005 ND 1,1,2-Trichlorotrifluoroethane (Freon 113) 0.005 ND 1,2,4-Trimethylbenzene 0.005 ND 1,3,5-Trimethylbenzene 0.005 ND Vinyl Chloride 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 93 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. VS20206 MSD #2 34678-1.xls JMM/ash/pv/ra Submitted by, ZymaX envirotechnology, inc. J❑ n MacMurphey Laboratory Director 805.544.4696 r'� :PORT OF ANALYTICAL RESULTS Client: Chris Prevost Lab Number: 34678-1 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S1-Piping Run Project Number: 10OT.05971.00.0001 Analyzed: 02/09/04 Collected by: Rich Besco Method: See Below CONSTITUENT PQL* RESULT* * mg/kg mg/kg TOTAL PETROLEUM HYDROCARBONS Total Petroleum Hydrocarbons 10. ND Percent Surrogate Recovery 83 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 02/06/04. Note: Analytical range is C8-C40. Note: TPH quantitated against motor oil. MSD #5 34678-1 t.xls JMM/ash/kg/yl/sd/kd Submitted by, ZymaX ennviirotechnology, inc. A J MacMurphey Laboratory Director 805.544.4696 zym..a;K 'PORT OF ANALYTICAL RESULTS Client: Chris Prevost Lab Number: 34678-1 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S1-Piping Run Project Number: 10OT.05971.00.0001 Analyzed: 02/10/04 Collected by: Rich Besco Method: EPA 6020 CONSTITUENT PQL* RESULT* * mg/kg mg/kg TOTAL METALS Cadmium 1.0 ND Chromium 1.0 120. Lead 1.0 6.2 Nickel 1.0 210. Zinc 1.0 62. ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. ICPMS #1 34678-1 m.xls JMM/sks/mm/ba/am Submitted by, ZymaX envirotechnology, inc. TJn =urphey Laboratory Director 805.544,4696 `'SPORT OF ANALYTICAL RESULTS ZY�11 1? , Page 1 of 3 Client: Chris Prevost Lab Number: 34678-2 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S2-North Pit Bottom Project Number: 100T.05971 .00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT** mg/kg mglkg VOLATILE ORGANIC COMPOUNDS Benzene 0.005 ND Bromobenzene 0.005 ND Bromochloromethane 0.005 ND Bromodichloromethane 0.005 ND Bromoform 0.005 ND Bromomethane 0.005 ND n-Butylbenzene 0.005 ND sec -Butyl benzene 0.005 ND tert-Butylbenzene 0.005 ND Carbon Tetrachloride 0.005 ND Chlorobenzene 0.005 ND Chloroethane 0.005 ND 2-Chloroethylvinyl ether 0.010 ND Chloroform 0.005 ND Chloromethane 0.005 ND 2-Chlorotoluene 0.005 ND 1,2-Dibromo-3-Chloropropane 0.010 ND Dibromochloromethane 0.005 ND Dibromomethane 0.005 ND 1,2-Dichlorobenzene 0.005 ND 1,3-Dichlorobenzene 0.005 ND 1,4-Dichlorobenzene 0.005 ND Dichlorodifluoromethane 0.005 ND 1,1-Dichloroethane 0.005 ND 1,2-Dichloroethane (EDC) 0.005 ND 1, 1 -Dichloroethene 0.005 ND ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit MSD #2 34678-2.xls JMM/ash/pv/ra 805.544.4696 IyTwo� Au --'SPORT OF ANALYTICAL RESULTS Page 2 of 3 Client: Chris Prevost Lab Number: 34678-2 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S2-North Pit Bottom Project Number: 10OT.05971.00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT* * mg/kg mg/kg VOLATILE ORGANIC COMPOUNDS cis-1,2-Dichloroethene 0.005 ND trans-1,2-Dichloroethene 0.005 ND 1,2-Dichloropropane 0.005 ND 1,3-Dichloropropane 0.005 ND 2,2-Dichloropropane 0.005 ND 1,1-Dichloropropene 0.005 ND cis- 1,3-Dichloropropene 0.005 ND trans-1,3-Dichloropropene 0.005 ND Dichlorotrifluoroethane 0.005 ND Ethylbenzene 0,005 ND Ethylene Dibromide (EDB) 0.005 ND Hexachlorobutadiene 0.005 ND Isopropylbenzene 0.005 ND 4-Isopropyltoluene 0.005 ND Methylene Chloride 0.005 ND Naphthalene 0.005 ND Styrene 0.005 ND 1,1,1,2-Tetrachloroethane 0.005 ND 1,1,2,2-Tetrachloroethane 0.005 ND Tetrachloroethene (PCE) 0.005 ND Toluene 0.005 ND 1,2,3-Trichlorobenzene 0.010 ND 1,2,4-Trichlorobenzene 0.010 ND 1,1,1-Trichloroethane (TCA) 0.005 ND 1,1,2-Trichloroethane 0.005 ND Trichloroethene (TCE) 0.005 ND ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit MSD #2 34678-2.xls JMM/ash/pv/ra 805.544.4696 W ,.il�A11)1111tlll� `SPORT OF ANALYTICAL RESULTS Page 3 of 3 Client: Chris Prevost Lab Number: 34678-2 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S2-North Pit Bottom Project Number: 10OT.05971.00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT* mg/kg mg/kg VOLATILE ORGANIC COMPOUNDS Trichlorofluoromethane (freon 1 1) 0.005 ND 1,2,3-Trichloropropane 0.005 ND 1,1,2-Trichlorotrifluoroethane (Freon 113) 0.005 ND 1,2,4-Trimethylbenzene 0.005 ND 1, 3, 5-Trimethylbenzene 0.005 ND Vinyl Chloride 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 93 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. VS20206 MSD #2 34678-2.xis JMM/ash/pv/ra Submitted by, ZymaX envirotechnology, inc. In MacMurphey Laboratory Director 805.544.4696 _PORT OF ANALYTICAL RESULTS Client: Chris Prevost Lab Number: 34678-2 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S2-North Pit Bottom Project Number: 100T.05971 .00.0001 Analyzed: 02/10/04 Collected by: Rich Besco Method: See Below CONSTITUENT PQL* RESULT** mg/kg mg/kg TOTAL PETROLEUM HYDROCARBONS Total Petroleum Hydrocarbons 10, ND Percent Surrogate Recovery 66 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 02/06104. Note: Analytical range is C8-C40. Note: TPH quantitated against motor oil. MSD #5 34678-2t.xls JMM/ash/kg/yl/sd/kd Submitted by, ZymaX eenvviirotechnology, inc. Join MacMurphey Laboratory Director 805.544.4696 zPORT OF ANALYTICAL RESULTS Client: Chris Prevost SECOR International Inc. 3437 Empresa Dr., Ste. A San Luis Obispo, CA 93401 Lab Number: 34678-2 Collected: 02/05/04 Received: 02/05/04 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S2-North Pit Bottom Project Number: 10OT.05971.00.0001 Analyzed: 02/10/04 Collected by: Rich Besco Method: EPA 6020 r ONSTITUENT PQL* RESULT** 1 rng/kg nlg/kg TOTAL METALS Cadmium 1.0 1.3 Chromium 1.0 140. Lead 1.0 12. Nickel 1.0 220. Zinc 1.0 79. ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. ICPMS #1 34678-2m.xls JMM/sks/mm/ba/am Submitted by, ZymaX e/nnviir_oottechnology, inc. Jon MacMurphey, Laboratory Director 805.544.4696 -SPORT OF ANALYTICAL RESULTS ZYulillitil� I :;j Page 1 of 3 Client: Chris Prevost Lab Number: 34678-3 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S3-South Pit Bottom Project Number: 10OT.05971.00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT* rng/kg mglkg VOLATILE ORGANIC COMPOUNDS Benzene 0.005 ND Bromobenzene 0.005 ND Bromochloromethane 0.005 ND Bromodichloromethane 0.005 ND Bromoform 0.005 ND Bromomethane 0.005 ND n-Butylbenzene 0.005 ND sec-Butylbenzene 0.005 ND tert-Butyl benzene 0.005 ND Carbon Tetrachloride 0.005 ND Chlorobenzene 0.005 ND Chloroethane 0.005 ND 2-Chloroethylvinyl ether 0.010 ND Chloroform 0.005 ND Chloromethane 0.005 ND 2-Chlorotoluene 0.005 ND 4-Ghlerot-oluen 0 00-3 1,2-Dibromo-3-Chloropropane 0.010 ND Dibromochloromethane 0.005 ND Dibromomethane 0.005 ND 1,2-Dichlorobenzene 0.005 ND 1,3-Dichlorobenzene 0.005 ND 1,4-Dichlorobenzene 0.005 ND Dichlorodifluoromethane 0.005 ND 1,1-Dichloroethane 0.005 ND 1,2-Dichloroethane (EDC) 0.005 ND 1,1-Dichloroethene 0.005 ND ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit MSD #2 34678-3.xls JMM/ash/pv/ra 805.544.4696 r zy!;'�, ,SPORT OF ANALYTICAL RESULTS Page 2 of 3 � To ,�" Client: Chris Prevost Lab Number: 34678-3 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S3-South Pit Bottom Project Number: 10OT.05971.00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 I CONSTITUENT PQL* RESULT** n}gilig mg/kg VOLATILE ORGANIC COMPOUNDS cis- 1,2-Dichloroethene 0.005 ND trans-1,2-Dichloroethene 0.005 ND 1,2-Dichloropropane 0.005 ND 1,3-Dichloropropane 0.005 ND 2,2-Dichloropropane 0.005 ND 1,1-Dichloropropene 0.005 ND cis- 1,3-Dichloropropene 0.005 ND trans-1,3-Dichloropropene 0.005 ND Dichlorotrifluoroethane 0.005 ND Ethylbenzene 0.005 ND Ethylene Dibromide (EDB) 0.005 ND Hexachlorobutadiene 0.005 ND Isopropylbenzene 0.005 ND 4-Isopropyltoluene 0.005 ND Methylene Chloride 0.005 ND Naphthalene 0.005 ND TI- Prcpyl ITen7lU nC 0-005 ND Styrene 0.005 ND 1,1,1, 2-Tetrachloroethane 0.005 ND 1,1,2,2-Tetrachloroethane 0.005 ND Tetrachloroethene (PCE) 0.005 ND Toluene 0.005 ND 1,2,3-Trichi orobenzene 0.010 ND 1,2,4-Trichlorobenzene 0.010 ND 1,1,1-Trichloroethane (TCA) 0.005 ND 1,1,2-Trichloroethane 0.005 ND Trichloroethene (TCE) 0.005 ND ZymaX envirotechnology, Inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit MSD #2 34678-3.xls JMM/ash/pv/ra 805.544.4696 =PORT OF ANALYTICAL RESULTS ZY1�e Page 3 of 3 Client: Chris Prevost Lab Number: 34678-3 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S3-South Pit Bottom Project Number: 10OT.05971.00.0001 Analyzed: 02/06/04 Collected by: Rich Besco Method: EPA 8260 CONSTITUENT PQL* RESULT* mg/kg mg/kg VOLATILE ORGANIC COMPOUNDS Trichlorofluoromethane (freon 1 1) 0.005 ND 1,2,3-Trichloropropane 0.005 ND 1,1,2-Trichlorotrifluoroethane (Freon 113) 0.005 ND 1,2,4-Trimethylbenzene 0.005 ND 1,3,5-Trimethylbenzene 0.005 ND Vinyl Chloride 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 91 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. VS20206 MSD #2 34678-3.xls JMM/ash/pv/ra Submitted by, ZymaX envirotechnology, inc. Jk MacMurphey Laboratory Director ZYMV( :PORT OF ANALYTICAL RESULTS Client: Chris Prevost Lab Number: 34678-3 SECOR International Inc. Collected: 02/05/04 3437 Empresa Dr., Ste. A Received: 02/05/04 San Luis Obispo, CA 93401 Matrix: Soil Project: Econo Lube-n-Tune Sample Description. S3-South Pit Bottom Project Number: 100T.05971.00.0001 Analyzed: 02/10/04 Collected by: Rich Besco Method: See Below CONSTITUENT PQL* RESULT* * mg/kg mg/kg TOTAL PETROLEUM HYDROCARBONS Total Petroleum Hydrocarbons 10. ND Percent Surrogate Recovery 55 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 02/06/04. Note: Analytical range is C8-C40. Note: TPH quantitated against motor oil. MSD #5 34678-3t.xls JMM/ash/kg/yl/sd/kd Submitted by, ZymaX envirotechnology, inc. John MacMurphey Laboratory Director 805.544.4696 ZYMA .cPORT OF ANALYTICAL RESULTS Client: Chris Prevost SECOR International Inc. 3437 Empresa Dr., Ste. A San Luis Obispo, CA 93401 Lab Number: 34678-3 Collected: 02/05/04 Received: 02/05/04 Matrix: Soil Project: Econo Lube-n-Tune Sample Description: S3-South Pit Bottom Project Number: 10OT.05971.00.0001 Analyzed: 02/10/04 Collected by: Rich Besco Method: EPA 6020 CONSTITUENT PQL* RESULT*' * rig/kg mg/kg TOTAL METALS Cadmium 1.0 1.5 Chromium 1.0 130. Lead 1.0 8.8 Nickel 1.0 220. Zinc 1.0 80. ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. ICPMS #1 34678-3m.xls JMM/sks/mm/ba/am Submitted by, ZymaX ennviirrottechnology, inc. Jo�,n MacMurphey Laboratory Director 805.544.4696 QUALITY ASSURANCE REPORT Zymanvif"I'Xim, SPIKE RESULTS Client: Lab Number: QS VS20206 ZymaX envirotechnology, Inc. Collected: 71 Zaca Lane, Suite 110 Received: San Luis Obispo, CA 93401 Matrix: Soil Project: Sample Description: Quality Assurance Spike Project Number: Analyzed: 02/06/04 Collected by: Method: See Below CONSTITUENT Amount Spiked Amount Recovered Percent mg/kg wq,'kg Recovery VOLATILE ORGANIC COMPOUNDS Benzene 0.033 0.028 85 Chlorobenzene 0.033 0.029 88 1, 1 -Dichloroethene 0.033 0.031 94 Toluene 0.033 0.027 82 Trichloroethene (TCE) 0.033 0.027 82 Percent Surrogate Recovery 96 ZymaX envirotechnology, Inc. is certified by CA Department of Health Services: Laboratory #1717 Note: Analyzed by EPA 8260 and GC/MS Combination. VS20206 MSD #2 VS20206q.xls JMM/ash/pv/sm Submitted by, ZymaX envirotechnology, inc. John MacMurphey Laboratory Director 805.544.4696 ��a QUALITY ASSURANCE REPORT yV� I"` lil'upixlo SPIKE DUPLICATE RESULTS Client: f Lab Number: QSD VS20206 ZymaX envirotechnology, inc. Collected: 71 Zaca Lane, Suite 110 Received: San Luis Obispo, CA 93401 Matrix: Soil Project: Sample Description: Quality Assurance Spike Duplicate Project Number: Analyzed: 02/06/04 Collected by: Method: See Below CONSTITUENT Amount Spiked Amount Recovered Percent Relative Percent mglkg mg/kg Recovery Difference VOLATILE ORGANIC COMPOUNDS Benzene 0.033 0.029 88 4 Chlorobenzene 0.033 0.030 91 3 1,1-Dichloroethene 0.033 0.031 94 0 Toluene 0.033 0.028 85 4 Trichloroethene (TCE) 0.033 0.028 85 4 Percent Surrogate Recovery 95 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *Relative Percent Difference of the spike and spike duplicate Note: Analyzed by EPA 8260 and GC/MS Combination. VS20206 MSD #2 VS20206q.xls JMM/ash/pv/sm Submitted by, ZymaX envirotechnology, inc. Jot MacMurphey Laboratory Director 805.544.4696 QUALITY ASF 'ANCE REPORT - BLANK RESULTS Page 1 of 3 Client: ZymaX envirotechnology, inc. 71 Zaca Lane, Suite 110 San Luis Obispo, CA 93401 Lab Number: Collected: Received: Matrix: BLK VS20206 Soil Project: Sample Description: Method Blank Project Number: Analyzed: 02/06/04 Collected by: Method: See Below CONSTITUENT PQL* RESULT* * :I-19/kg mg/kg VOLATILE ORGANIC COMPOUNDS Benzene 0.005 ND Bromobenzene 0.005 ND Bromochloromethane 0.005 ND Bromodichloromethane 0.005 ND Bromoform 0.005 ND Bromomethane 0.005 ND n-Butylbenzene 0.005 ND sec -Butyl benzene 0.005 ND tert-Butyl benzene 0.005 ND Carbon Tetrachloride 0.005 ND Chlorobenzene 0.005 ND Chloroethane 0.005 ND 2-Chloroethylvinyl ether 0.010 ND Chloroform 0.005 ND Chloromethane 0.005 ND 2-Chlorotoluene 0.005 ND 1,2-Dibromo-3-Chloropropane 0.010 ND Dibromochloromethane 0.005 ND Dibromomethane 0.005 ND 1,2-Dichlorobenzene 0.005 ND 1,3-Dichlorobenzene 0.005 ND 1,4-Dichlorobenzene 0.005 ND Dichlorodifluoromethane 0.005 ND 1,1-Dichloroethane 0.005 ND 1,2-Dichloroethane (EDC) 0.005 ND 1, 1 -Dichloroethene 0.005 ND ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit suf present or above The listed MSD #2 VS20206b.xls JM M/ash/pv/ra 805,544.4696 0 11 'Zyrwa�( QUALITY ASF 'ANCE REPORT - BLANK RESULTS Page 2 of 3 Client: Lab Number: BLK VS20206 ZymaX envirotechnology, inc. Collected: 71 Zaca Lane, Suite 110 Received: San Luis Obispo, CA 93401 Matrix: Soil Project: Sample Description: Method Blank Project Number: Analyzed: 02/06/04 Collected by: Method: See Below CONSTITUENT PQL* RESULT* * nzg/kg mg/kg VOLATILE ORGANIC COMPOUNDS cis-1 ,2-Dichloroethene 0.005 ND trans- 1,2-Dichloroethene 0.005 ND 1,2-Dichloropropane 0.005 ND 1,3-Dichloropropane 0.005 ND 2,2-Dichloropropane 0.005 ND 1,1-Dichloropropene 0.005 ND cis-1,3-Dichloropropene 0.005 ND trans-1,3-Dichloropropene 0.005 ND Dichlorotrifluoroethane 0.005 ND Ethylbenzene 0.005 ND Ethylene dibromide (EDB) 0.005 ND Hexachlorobutadiene 0.005 ND Isopropylbenzene 0.005 ND 4-Isopropyltoluene 0.005 ND Methylene Chloride 0.005 ND Naphthalene 0.005 ND 0.-00 -ND Styrene 0.005 ND 1,1,1,2-Tetrachloroethane 0.005 ND 1,1,2,2-Tetrachloroethane 0.005 ND Tetrachloroethene (PCE) 0.005 ND Toluene 0.005 ND 1,2,3-Trichlorobenzene 0.010 ND 1,2,4-Trichlorobenzene 0.010 ND 1,1,1-Trichloroethane (TCA) 0.005 ND 1,1 ,2-Trichloroethane 0.005 ND Trichloroethene (TCE) 0.005 ND ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit would have Been reported present at or above the is e . MSD #2 VS20206b.xls JM M/ash/pv/ra 805.544.4696 t-. zymaQUALITY ASSI ,NCE REPORT -BLANK RESULTS A' , Page 3 of 3 Client: Lab Number: BLK VS20206 ZymaX envirotechnology, inc. Collected: 71 Zaca Lane, Suite 110 Received: San Luis Obispo, CA 93401 Matrix: Soil Project: Sample Description: Method Blank Project Number: Analyzed: 02/06/04 Collected by: Method: See Below CONSTITUENT PQL* RESULT** mglkg mg/kg VOLATILE ORGANIC COMPOUNDS Trichlorofluoromethane (freon 1 1) 0.005 ND 1,2,3-TrichIoropropane 0.005 ND 1,1,2-Trichlorotrifluoromethane (Freon 113) 0.005 ND 1 ,2,4-Trimethylbenzene 0.005 ND 1 ,3,5-Trimethylbenzene 0.005 ND Vinyl Chloride 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 96 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. VS20206 MSD #2 VS20206b.xls JMM/ash/pv/ra Submitted by, ZymaX envirotechnology, inc. (4hn MacMurphey Laboratory Director 805.544.4696 Feb 12 04 08:16a Secor- San Luis Obispo (805)546-0583 p.1 G//// SECOR f a x fax no: 5 iri Zj — 1 attention: vW company: date/time: Z�f zlC y from: G� '-15 number of pages (including cover): 17 SECOR JN.ERNATIONAL INCORPORATED 3437 Empresa Drive, Suite A www,secor.com San Luis Obispo, CA 93401 805-546-0455 TEL / 805-546-0583 FAX x as Rc?stJ 1 s o Lt�1� e AliJ-.e ��, �, L Q . Disclaimer: The information transmitted herein is intended only far the person or entity to which it is addressed and may contain confidential and/or privileged material. If you are not the intended recipient of this message, you are hereby notified that any use, review, retransmission, dissemination, distribution, reproduction or any action taken in reliance upon this message is prohibited. If you received this communication in error, please notify the sender immediately and delete the on inal message and all attachments from vour electronic files. Feb 12 04 08:16a Secor- San Luis Obispo FEB 11 2004 16:21 HP LRSERJET 3200 (805)546-0583 p.2 p.2 aOn LP O z r.+rurinl�c+a �v ■ V - M c �Lin iA d Y y F . J 44? 4� N ip J71 4 n 8 P i N ►�y LLL c QlN I K r*M I Feb 12 04 08:17a Secor- San Luis Obispo [805)546-0583 p.3 FEB 11 2004 16:22 HP LHSERJET 3200 p.3 Client: Chris Prevost SECOR International Inc. 3437 Etnprese Dr., Sts. A San Luis Obispo, CA 93401 Project: Econo Lulbe-n-Tune Project "LA, r: 100T.05971.00.0001 Collected by. Rich Besoo REPORT OF ANALYTICAL RESULTS Page 1 of 3 Lob Number: 34676-1 Collected: 02/05/04 RwAlved: 02/05/04 Matrk: Soil Sampls Description: S1-Piping Run Analyaad: 02/06/04 Method: EPA 8260 CONSTITLIEW Pt1LD' RESULT' ~ rrtigmo TqLk VOLATILE ORGANIC COMPOUNDS Benzene 0.005 ND Bromobanzene 0.005 NO Bromochloromethans 0.005 ND Bromodichloromethane 0.005 ND Bromoform 0.005 ND Bromomethane 0.005 ND n-Butyibenzene 0.005 ND sec-Butylbenzene 0.005 ND tart-Butylbenzene 0.005 ND Carbon Tetrachloride 0.005 ND Chlorobenzene 0.005 ND Chloroethane 0.005 NO 2-Chloroethylvinyl ether 0.010 ND Chloroform 0.005 ND Chloromethane 0.005 ND 2-Chlorotoluene 0.005 ND 4-Chlorotoluene 0.005 ND 1.2-Dibromo-3-Chloropropane 0.010 ND Dibromochloromethane 0.005 ND -Dibromom-ethsno — G.G0.5 ND 1,2-Dichlorobenzens 0.005 NO 1,3-Dichlorobenzene 0.005 ND 1,4-Dichlorobenzens 0.005 NO Dichlorodifluoromethans 0.005 ND 1,1-Dichloroethane 0.005 NO 1,2-Dichloroethans IEDC} 0.005 NO 1,1-Dichloroethene 0.005 NO ZymsX envirotadmology, inc. is certified by CA Department of Health Services_ Laboratory #1717 •PGL - Practical Ounntiiation Limit "Results Hated as NO would have been reported If present at or above the listed POL. MSD 02 3497g-1 _Yts JMM/ash/pv/ra o Lane 805.544.4696 71 z9 Son Luis Obispo CA 340101 www.zymaXusa.com Fax 805.544.8226 Feb 12 04 06:17a Secor- San Luis Obispo (805)546-0583 p.4 FEB 11 2004 16:22 HP LASERJET 3200 p.4 +r1r 1 � � • I►' Client: Chris Provost SECOR International Inc. 3437 Empress Dr., Sts. A San Luis O ' o, CA 93401 Project: Econo Lube-n-Tune Project Number: 100T.05971.00.0001 Collected by. Rich Bosco VOLATILE ORGANIC COMPOUNDS REPORT OF ANALYTICAL RESULTS Page 2 of 3 Lab Number: 34678-1 Collected: 02/05/04 Received: 02/05/04 Matrix: Sob Sample Description: St -Piping Run Analyzed: 021DW04 method: EPA 8260 cis-1, 2-D ichloroethene 0.005 NO trans-1,2-Dichloroethene 0.005 NO 1, 2-Dichloropropene 0.005 N D 1,3-Dichloropropene 0.005 ND 2, 2-Dichloropropene 0.005 NO 1,1-Dichloropropene 0.005 NO cis- 1,3-Dichloropropene 0.005 NO trans- 1,3-Dichloropropene 0.005 NO Dichlorotrlfluoroethane 0.005 NO Ethylbenzene 0.005 NO Ethylene Dibromide (EDB) 0.005 NO Hexachlorobutadiene 0.006 ND I sopropylbenzene 0.005 NO 4-Isopropyltoluene, 0.006 NO Methylene Chloride 0.005 NO Naphthalene 0.005 ND n-Propylbenzene 0.005 NO Styrene 0.005 NO 1,1,1,2 Tetrachloroethane 0.005 NO 1,1,7,2 Tatrachloroeviane -- -- — _0:005 —AID Tetrachloroethene IKE) 0.005 NO Toluene 0.005 NO 1, 2, 346chlorobenzens 0.010 NO 1, 2,4-Trichlorobenzene 0.010 NO 1.1.1-Trichloroethane (TCA) 0.005 NO 1,1, 2-Trlchloroethane 0.005 N D Trichlorosthens (TCE) 0.005 NO ZymaX envirotechnology, Inc. is certified by CA Department of Health Services: Laboratory #1717 6POL - Precticsl Ouenthation Limit "Results Gated as ND would have been roporied if present at or above the listed POL. MSD #2 34676-1-.xis JMM/ashlpvlre 71 zeta Lone 805.544.4696 Son Luis Obispo G4 93401 wwwZymaXusEi.com fox 605-544.8226 Feb 12 04 08:17a Secor- San Luis Obispo (805)546-0583 p.5 FEB 11 2004 16:22 HP LRSERJET 3200 p-5 Client: Chds Prevost SECOR International Inc. 3437 Emprean Dr., Ste, A San Lub Obispo, CA 93401 Project: Econo Lubs-t-Tune Project Number: 100T.05971.00.0001 Colheted b : Rich Bosco VOLATILE ORGANIC COMPOUNDS REPORT OF ANALYTICAL RESULTS Page 3 of 3 Lab Number: 34678-1 Coleeted. 02/06/04 Received: 02/05/04 MaMx: Soil Sample Description: SI-Plong Run Anatyrad: 02/06/04 Method: EPA 8260 Trichloroffuoromethane (feon 11) 0.005 NO 1.2,3-Trichloropropane 0.005 NO 1,1,2-Trlchlorotriflucroethene (Freon 113) 0.006 NO 1,2,4-Trimethylbenzene 0.006 NO 1,3,5-Trimethylbenzene 0.006 NO Vinyl Chloride 0.005 ND Xyienes 0.005 NO Percent Surrogate Recovery 93 ZymaX enviretechnology, Inc. is certified by CA Department of Health Services: Laboratory #►1717 'PO,L - Practical Ousntitedon Limit "•Results listed as NO would have been reported if present at or abova the listed PQL- submitted by, Zym of envlratechnology, Inc. VS20206 MSD #►2 34678-1.xia J MeelYturphey JM M/ashlpvira Laboratory Director 805.544.4696 www.ZyrnaXuse.com 71 Zow lam Son Wis Obspo CA 93401 fmc805.544.8226 Feb 12 04 08:17a Secor- San Luis Obispo (805)546-0583 p.6 FEB 11 2004 16:22 HP LRSERJET 3200 P.6 ZYMO REPORT OF ANALYTICAL RESULTS 34678-1 Client: Chris Prevost Lab Number: SECOR International Inc. Collected: 02/05104 3437 Emprese Dr.. Ste. A Reoaved: 02 OS104 San Luis Obispo. CA 93401 Matrix: Soil Sampla i7escriptlon: Project: Econo Lulu-n-Tune S7-Piping Run Project Number: 100T.05971.00.0001 Analyzed: 02JO9104 Coleactad b Ridgy Basco Method-' See Below POI.« TOTAL PETROLEUM HYDROCARBONS RESULTO " Total Petroleum Hydrocarbons 10. NO Percent Surrogate Recovery 83 ZymaX envirotechnology, Inc. is cardfied by CA Doper tment of Heelth Services: Laboratory #1717 "POL - Prscdesl Ow ntitedon Limit " ° Results listed as NO would have been reported if present at or above the Ilsted'PC L. Note: Analyzed by GC/MS Corntrtnation. Note: Extracted by EPA 3550 on 02106104. Note: Analytical range in C8-C40. Note: TPH quantitated ag4inst motor of. MSD #5 34678-1t.xts JMM/ashlkg/yl/adlkd rbmltted-by. ZymeX aAAnvirotechnology, tine. 1W! J MaoMurphoy Laboratory Director w Lane 805,544.4696 Son Lois Jbispo CP. 934Gi 71 �A 9 40-1 wwwzy axusa-com fax 905.544 8226 Feb 12 04 08:17a Secor- San Luis Obispo FEB 11 2004 16:22 HP LRSERJET 3200 (805)546-0583 p.7 p.7 Crent.Chft Prevost SECOR Inteimu tonal Inc. 3437 Empress Dr.. Sta. A Son Luis Obispo. CA 93401 REPORT OF ANALYTICAL RESULTS Lau Number: 34678-1 Co"ected: 02/O6104 Received: 02/05104 Matrix: Soil Project: Econo Luba-n-Tune Sample Dascription: S14hping Run Project Ntornber: 100T.05971.00.0001 Analyzed: 02/10/04 CoNwed by-. Rich fteco Method: EPA 6020 :ONSTITOFNT PQL" I SULT** mg/kg mglkg TOTAL METALS Cadmium 1.0 ND Chromium 1.0 120. Lead 1.0 6.2 Nickel 1.0 210. Zinc 1.0 62. ZymaX envirotechnology. inc. In oartlf ed by CA Departruent of Health S"ces: Laboratory #r1717 p PaL - Practical Quentitation Limit *;Results listed as ND would have been reported if present at or above the listed POL. Submitted by, ZymaX onvirotechnology, inc. ICPMS 1 - - - 34678-1m.xis J mlad rphey JMM/aks/mm/ba/snn Labwaiory Director zai Lon.805.544.4696 Son fuze Obispo CA 93401 www.ZymaXusa.corn fox 805.544.8226 Feb 12 04 08:18a Secor- San Luis Obispo (805)546-0583 p.8 FEB 11 2004 16.22 HP LASERJET 3200 P.8 COeM: Chris Provost SECOR International Inc. 3437 Empress Dr., Ste. A San Luis Obispo, CA 93401 Project: Econo Luba-n-Tuns Project Number: 100T.05971.00.0001 Colfecled by-. INch Besco VOLATILE ORGANIC COMPOUNDS Benzene Bromobenzene Bromochloromethane Brom odichloro methane Bromoform Bromomethane n-Butylbenzene sec-Butylbenzene tort Butylbenzene Carbon Tetrachloride Chlorobenzene Chloroethane 2-Chioroethylvinyl ether Chloroform Chloromethane 2-Chlorotoluens 4-Chlorotoluens 1,2-Dibromo-3-Chloropropans Dibro mochlo ro methane —Dilsramornethane- 1,2-Dichlorobenzene 1,3-Dichlorobenzene 1,4-Dichloroberizene DicNorodifluoromethane 1, 1 -Dichloroethane 1,2-Dichloroethans iEDCI• 1,1-Dichloroethene REPORT OF ANALYTICAL RESULTS Page 1 of 3 Lab Number: 34678-2 Collected; 02/05/04 Received: 02/06104 Matrix. SON Semple Descripdon: S2-North Pit Bottom Analyzed: 02106/04 Method: EPA 8260 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.010 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.010 ND 0.005 ND 0:006 N D- 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND ZymeX envirotaehnology, Inc. is earMed by CA Department of Haa th Services: Laboratory $1717 'PQL - Prwlcol Quawitetion Limit •'Results Nsted as N D -would have been reported if present at or above the listed PQL. MSO d2 �4�78=2_x1a J M M/ashfpvlre 805.544,4696 7 i Zow Iona Son Luis Obispo CA 93401 www.ZymaXusa.com fax SC5.544.6226 Feb 12 04 08:18a Secor- San Luis Obispo (805)546-0583 p.9 FEB 11 2004 16:22 HP LRSERJET 3200 p.9 '+ ! ''i► +' ICI Giant: Chris PMV08t SECOR International Inc. 3437 Empreso Dr., Ste. A San Lull Obispo. CA 9W1 Project: Econo Luke-n-Tuns Project Number: 10OTM971.00.0001 Collected by. Rich Bosco VOLATILE ORGANIC COMPOUNDS cis-1, 2- Di ch I oroethens trans-1,2-Dichloroethene 1, 2-Dichloro propene 1,3-Dichloropropane- 2, 2-Dichloropropene 1,1-Dichloropropene cis-1,3-Dichloropropene trans-1,3-01chloropropene Dichlorotrifluoroethane Ethylbenzene Ethylene Dibromide (EDB) Hexachlorobutadiene Isopropylbenzene 4-Isopropyltoluene Methylene Chloride Naphthalene n-Propylbenzene Styrene 1,1,1,2-Tetrachloroethene 1 Telrachlomezhane Tetrachloroethene (PCE) Toluene 1, 2, 3-Trichlorobenzens 1, 2,4-Trichlorobenzene 1,1,1-Trichioroethane (TCA) 1,1,2-Trichloroethans Trichlorcethene (TCE) REPORT OF ANALYTICAL RESULTS Page 2 of 3 Lab Numbest: 34678-2 Collected: 02/05/04 i;ecdwed: 02/05/04 Matrix: Shc Satripla Description: S2-North Pit Bottom Analyzed: 02/06104 Method: EPA 8260 PUL° RESULT" era/ka ►n91k9 0.005 NO 0,005 ND 0.005 NO 0.005 NO 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 NO 0.005 NO 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0,005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.010 ND 0.010 ND O.OD6 ND 0.005 ND 0.005 NO ZymaX envirotechnoloOY, inc. is oertified by CA Department of Ho*th Services: Laboratory 01717 `POL - Practical Quentitation Umit "Flesults listed as NO would have been reported If present at or above the listed PQL. MSD #2 344#B-2.,,iela JMIMi/ashlpvlra 805,544.4696 www.ZymaXusa.com 71 Zoco Lone 5an Luis Ob0z CA 93401 foot 805 54*8226 Feb 12 04 08:18a Secor- San Luis Obispo (805)546-0583 p.10 FEB 11 2004 16:22 HP LRSERJET 3200 p.10 +Ci.nt: Chris Prevost SECOR International Inc. 3437 Empress Dr., Sim. A San Luis Obispo, CA 93401 Project: Econo Lube-n-Tune Project Number: 100T.05971.00.0001 Collected by: Rich Bosco VOLATILE ORGANIC COMPOUNDS Trichlorofluoromethane (freon 11) 1,2,3-Trichloropropane 1,1,2-Trichlorotrifluoroethene (Freon 113) 1,2,4-Trimethylbenzene 1,3,5-Trimethyibenzens Vinyl Chloride xylenes Percent Surrogate Recovery REPORT OF ANALYTICAL RESULTS Page 3 of 3 Lab Number: 34678-2 Collected: 02/05/04 Receiv0d: 02105/04 Matrix: Soil Description: ESncpple 82-North Pit Botwm Analyzed: 02/06/04 Method: EPA $260 PaL* RESULT" 0.005 ND 0.005 ND 0.005 ND 0.005 ND 0.005 NO 0.005 ND 0.005 ND ZyatsX envirotechnology, inc. is certified by CA Department of Heath Services: Laboratory 41717 ' POIL - Prac dvel Ouantitation Limit "•Results Bated as ND would have been reported if present at or above the listed PCLL. Submitted by, ZymsX envirotechnology, Inc. VS20206 MSD 42� 34678-2.xls J n Mec1 urphey JMMhsh/pv/ra Laboratory Director 805.544.4696 www.ZymaXusa.com 93 11 zoom LDM Son Luis Obispo CA 93401 faK 805.544 8226 Feb 12 04 08:18a Secor- San Luis Obispo (805)546-0583 p.11 FEB 11 2004 16:22 Hp LRSERJET 3200 P.11 Client: Chris Prevost SECOR International Inc. 3437 Empress Dr., Ste. A Son Luis Obispo. CA SM07 Project: Econo Lubin -Tune Project Number: 100T.06871.00.0001 Collected by: Rich Bosco TOTAL PETROLEUM HYL)ROCARSONS Total Petroleum Hydrocarbons Percent Surrogate Recovery REPORT OF ANALYTICAL RESULTS Lab Number: 34678-2 Collected-. 02/05/04 Raeeived: 02/05/04 matrix: Solt Sernple Desctiptiart: 62-North Pit Bottom Analyzed, 02110/04 Method: See EWow 10. ZymaX envirotechnology, inc. is certified by CA D*pertOwnt of Health Services: Laboratory #1717 •PI,L - Practical Guanfi'tation Limit ••Result listed as ND would have been reported if present at or above the listed PQL. Not*: Analyzed by GC/MS Combination, Note: Extracted by EPA 3550 on 82106/04. Note: Analytical range Is C8-C40. Note: TPH quantitated against motor ob. MSD as 34678-2t:xls JMM/ash/kg/yl/ldlkd 805.544.4696 www.ZymaXusa.cor-n �nrnnessx>�v� ZymaX envirooschnology, inc. � ,io— n 4MLxphey► Laboratory Director ND 66 71 Zacc Lone Son Luis Obispo CA 9340'. fox SU5.544 8226 Feb 12 04 08:19a Secor- San Luis Obispo (805)546-0583 p.12 FEB 11 2004 16:22 HP LRSERJET 3200 P.12 REPORT OF ANALYTICAL RESULTS awn. Chia Provost Lair Number: 34678-2 SECOR international Inc. Collected: 02/05/04 3437 Empress Dr., Ste. A Ree, 1, a 02f05104 Son Luis Obispo, CA 93401 Matrix: Soil Project: Econo tub*`n-Tune Sarnpte Description: S2-North Pit Bottom Prgact Number: 100T.05971.00.0001 Analyzed: 02/10104 Collocted Rich Basco Method: EPA 6020 CONSTITUENT PUL18 RESULT•' mglkg mglkg TOTAL METALS Cadmium 1.0 1.3 Chromium 1.0 140. Lead 1.0 12. Nickel 1.0 220. Zinc 1.0 79. ZymaX envirotechnology, Inc. W owti led by CA Department of Hadth Services: Laboratory #1717 *POL - Practical Qivantitation Limit "Results listed as No would have been reported If present at or above "listed POL. ICPMS 81 34678-2nn.xb JMM1eks/mm/b&/am 805.544.4696 wWW.ZyrnaxuS8.00M Submitted by, ZymaX enviratechnology, Inc. Jelin MacMurphey Laboratory Director i i torn wnc Svn Leis Obispo CA 93401 hix 805 544 0226 Feb 12 04 08:19a Secor- San Luis Obispo (805)546-0583 p.13 FEB 11 2004 16:22 HP LRSERJET 3200 p.13 Crent: Chris Provuat SECOR Intemationd Inc. 3437 Empreae Dr.. Ste. A San Luis Obi , CA 93401 Project: Econo Luba-n-Tune Project Number: 100T.05971.00.0001 Colectad Ruff Beaco REPORT OF ANALYTICAL RESULTS Page 1 of 3 Lab Number: 34678-3 Collected: 02/05/04 Received: 02/06/04 Matrix: Soil Semple D"CrIpdon: S3-Souk Pit Bottom Analyzed: 02/06fO4 method. EPA 8260 CONSTMENT POL• RESULT•" mg1ka Milks VOLATILE ORGANIC COMPOUNDS Benzene 0.005 NO Brcmobenzene 0.005 NO Brcmochloromethane 0.005 NO Bromodichloromethane 0.005 ND Bromoform 0.005 ND Bromomethane 0.005 ND n-Butylbenzene 0,005 NO sec-Butylbenzene 0.005 ND tart-Butylbenzene 0.005 NO Cerbon Tetrachloride 0.005 NO Chlorobenzene 0.005 NO Chloroethane 0.005 NO 2-Chloroethylvinyl ether 0.010 ND Chloroform 0.005 ND Chloromethane 0.005 ND 2-Chlorotoluens 0.005 NO 4-Chlorotoluene 0.005 NO 1, 2-Dibromo-3-Chloropropane 0.010 NO Dibromochloromethane 0.005 NO 0.006 D- r ona 1,2-Dichlorobenzene 0.005 NO 1, 3-Dichlorobenzene 0.005 NO 1,4-Dichlorobenzene 0.006 NO Dichlorodif luoromethens 0.005 NO 1,1-Dichloroathene 0.005 NO 1,2-Dichloroethane (EDC) 0.005 ND 1,1-Dichloroathene 0.005 ND ZymeX envirotechnology. Inc. is certified by CA Department of Health Services: Laboratory #1717 VOL - Practical QarsirdtWnn Limit *,*Results listed as ND would have been reported if present at or above the Rated POL. MSD #2 •34678-3.xls JMM/ash/pv/ra z W5.544.4696 San Luis Obispo CAA 9340101 www.ZymaXusa.com (ax BC3.541.8226 Feb 12 04 08:19a Secor- San Luis Obispo (805)546-0583 p.14 FEB 11 2004 16:23 HP LRSERJET 3200 p.14 C18ent: "a Prevost SECOR Intsmetiaw Inc. 3437 Empreee Dr.. Ste, A San Luis ()bljipo, CA 93401 Pit; Econo Lubrn Tune Projecl Number: 1 DOT.05971.00.0001 CoNected Rich Beeco VOLATILE ORGANIC COMPOUNDS REPORT OF ANALYTICAL RESU. Page 2 of 3 Leh Ne>n*w: 3`%470 Collected: 02/05/04 gecdvw: 02105/04 Now1c: Sail Sample Deeedpdow S3South Pit Bottom Anetyzed: 02106104 Method: EPA B2S❑ cis-1,2-Diddoroethene 0.005 NO NO trans-1,2-Dlchloroethene 0.005 NO 1,2-Dichloropropans 0.005 ND 1,3-Dlohloropropene 0.005 ND 2,2-Dichlompropans 0.005 NO 1,1-D ichlofopropene 0.005 0.005 ND cis-1,3-Oichloropropens 0.005 ND trans-1,3-Dichloropropene 0.005 ND Dlchlorotrllluoroethans 0,006 ND Ethylbonzene 0.005 ND Ethylene Dibromlda (EDB) NO Hexachlorobutadiens 0.005 NO Isopropylbenzene 0.005 0.005 ND 4-190propyholuene 0.005 ND Methylene Chloride 0.005 ND Naphthalene 0.005 ND n-Propylbenzene 0.005 ND Styrene 0.005 ND 1,1,1,2-Tetrechloroethanc NO 1,1;2,2-Tecrachloroethane 0.005 ND Tetra&loroethene (PCE) 0.005 NO Toluene D.005 ND 1,2,3-Trichlorobenzene 0.010 ND 1,2,4 Trichtorobenzene 0.070 ND 1,1,1-Tdcrioroethene (TCA) 0.005 ND 1,1,2-Trichloroathane 0.005 ND Trichloroethene (TCE) 0.005 Zjmlax envirotncl+rrobgY• inc. is Card(!ed by CA Depuartent all H"th sermon: Laboratory #1717 •pOL - prwMaal OuamltWon Limit if at or above the Wad POL. ••Recuks bead as ND would have been reported present MSD 82 34678-3.xb imulash/pvlre 805.544.4696 WwW zymexusa'COn1 --•-__ .._..... � ..- .. -..... .�.r .....-... �.-.,.. .. �r.rrr+.� Y. r, r�..-.r w.r MYNA . �. Submitted by, xyninX envirotechnology. Inc. S MO82S1) lt 34678-3 xte J n MnelMurphey dMM1"11/pv/ra Laboratory Dil 71 Za Lure San Luis Obispo CA 93401 fo 605.544.8226 e&T SERVICE STATION CONTRACTORS (e05) 4el-0412 12/09/02 01:33P P.002 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited.- Chapter 6.7 Health and Safety Code,, Chapter 16, Division 3, Title 23, California Code of Regulation's' xitis form rntw be used to document testing and servicing of monitoring equipment Ae t rti n rt a ed !'or etch rno jinrisst sv�tslm_conlrt)�sanel by die technician who perfomu the work. A copy of this form must be ptavided to the tank symcm ownettopemor. Tile ownerloperatot must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. Gencral Information r- Bldg. No,; aeility Name: — Site Address: c , . 0- 0- a City: Sal WN ; pro �,-R Zip: ? ALf o / gac.0hy Contact Pcrson: Contact Phone No.;- Make/Model of Monitoring System: /ys r7 Date ofTcsting/Servicing: JL g. Inventory of Equipment Tcsted/Certified Glrerk the artpropriate bauet Co Indicate ■ eelfic ut rnent !ns etedlserricei Tttnk ID: tiy_r1-, ILL a ;; l c3 Its Trask Gauging Probe. Model: _ fiW Annular Space or Vault Sensor. Model: -1C17 d. C] Piping Sump / Trench Scnsor(s). Model: Q Fill Sump Sensor(s). Model- C3 Mechanical Line Lcok Detector. Model: O Electronic Line Leak Detector. Model: O Tank Overfill / High-Lr.vel Sensor. Model: E2tNhsricnerifv r•nummrnf wnc and Model in Section L on Pepe 2). Tank ll): , _ O In -'tank Gauging Probe. ❑ Angular Space or Vault SCnenr_ O PipinrZump/ Trench Sensor(s). Cl fill Sump Scasot(s). C3 Mechanical Line Leak Detector. O Electronic Line Leak Detector. C3 Tank OvcdiB / liio-Lcvcl Sensor ❑ Qlher (speciN equiprocnt typt And pispenser tD: ❑ Dispenser Containment Sensors ❑ Shcarvalve(s). O DISDCAsa Conlauuncnt Flaat(s) pispenser ID: O Dispenser Containment Srnsor(s Cl Shear Valvc(s). ❑ Dispenser Containment ROnsa and Model: Model: . Model; Model: Model: Model: Model: Todd in Section E on Model: Chains . Model; and Cha inft)- pispenser M.- O DispmwContainnsentSensor(s). Model: ❑ Shearvalve(s). t❑Din neA set Con lsirumnI Floats . nd Chain i Tank ID; d In -'rank Gauging Probe. Model: ❑ Annular Space or Vault Senior. Model: O Piping Sump / Trench Sensor(s)_ Model: O Fill Sump Sensor(s). Model: ❑ Mechanical Line Leak Detector. Model; ❑ Electronic Line Leak Detector, Model: 0 TankOveriill / High-Ltvel Sensor. Model: - O Other (specify(spccify a ui inrnt typc and model in Section E on FaFlc 2 Tank ID' - p to -Tank Ganging Probe. Model: ❑ Annular Space or Vault Sensor. Model: ❑ Piping Sump I Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model. ❑ Mechanical Line Leak Detector. Model: ❑ Sloctronie Line Leak Deteclor. Model; _ • Tank Overfill / High -Level Sensor. Model: O other (sp frify equipment typ a and model in Ste inn Eon Pa e Z). Dispenser ID; ❑ DispenscrConta• un=1 Sensor(s). Model: ShearValveiNY ❑ Disocnscr Containnaenl Floa► s and Chains . Dispenser ID: ❑ Dispenser Containment Scnsor(s). ❑ Shear Valve($), O 1)isnenserContainmenl Float(s) and Dispenser ID: p DispesscrConlainmcni Scnsor(s). I] Shear Valve(&). ❑ DisvenserContainroent FIoaI(s)pnd Model: Model: .If the facility contains nsor+e tanks or dispensers• copy this form. Include information for every tank and dispenser at the facility- C. Certification -I certify that the equipment Identified in this documcnt was rttspecrcd/serviced In accordance with the manufacturers' guidelines. Attached to this Certification is information (e g. maitufsetumus' cheeidists) necessary to verify that this information is tanxm and a Plot Plan showing Like layout of tnorijwring equipnknt. For any equipment eepirbie of geoeratittg such reports* 1 have also attached a cape of (Ise repoati (cheek all that apply): a System set-up ❑ Alamo history report Technician Name (print), -__ Signature: Cali(icauon N o License. No.: Testing CompanyNamc: _ — Phone No., Site Address; G7 i'a k a ►^ U ' Sn ' Date of Tcstine/Servicing: 2_L_I?_4J?_2- city Of SAn tuts OBISPO FIRE DEPARTMENT 2160 Santa Barbara Avenue • San Luis Obispo, CA 93401-5240 • 805/781-7380 "Courtesy & Service" GENERAL MONITORING INSPECTION CHECKLIST IN ACCORDANCE WITH THE STATE OF CALIFORNIA HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7, SECTION 25280 et. seq., AN INSPECTION OF EVERY UNDERGROUND STORAGE FACILITY SHALL BE CONDUCTED TO DETERMINE WHETHER THE TANK SYSTEM(s) COMPLIES WITH THE APPLICABLE REQUIREMENTS AND REGULATIONS AND TO DETERMINE WHETHER THE TANK SYSTEM(s) IS IN A SAFE OPERATING CONDITION. I%t i FACILITY NAME: _ ic—c- ,Ld�ZL) #t 6 % FAC[LIT•Y ID NUTABER; �I U 0 2. i FACILITY ADDRESS: e INSPECTION DATE: FACILITY PHONE NUMBER: y— -2 V 16 _ INSPECTION TYPE: RO INZ- ✓ FOLLOW-UP: f�n(� BID: TIME IN: _ Z/) 1 1n TIME OUT: r C) Upgrade Deadlines 01-01-84 O Cutoff date for new and existing USTs. 07-01-85 O Existing USTs must install monitoring system (H&SC 25292 (a)). 07-01-87 O Secondary containment required for piping connected to tanks installed after this date (exceptions) (CCR 2636 (a)). 10-26-90 O Evidence of responsibiity for UST system by owner/operator for corrective action release (H&SC 25292.2 (a)). 12-22-90 O Existing pressurized piping equipped with automatic leak line detector (H&SC 25292 (e), (CCR 2666 (b)). 01-01-91 O Operative date for violations; civil/criminal penalties (HRSC 25299 (g)). nA n._.__:... : tnrnnn n ... �. - ........... ........... ...,...Z..J ,,.... -..��I- 07-01-91 O Independent approval for primary containment construction and design of UST components (CCR 2631 (b)). 01-01-92 O Independent approval for primary containment construction and design of UST piping components (CCR 2631 (b)). 08-09-92 O Tank lining material and process listed/certified by and independent testing organization (CCR 2663 (e)). 01-01-93 O Manual inventory reconciliation allowable only when the underlying groundwater is at a depth greater than 20 feet below the bottom of the UST (CCR 2646 (b)). 01-01-95 O Automatic tank gauge systems installed after this date are to generate a hard copy of the calculated leak rate and leak threshold (CCR 2643 (b)(1)). 12-22-98 O Existing UST(s) replaced or upgraded to prevent releases due to corrosion, spills, and overfills (H&SC 25292 (d), CCR 2665). O All single wall tanks (steel) are retrofitted with secondary containment or by one of the following options (CCR 2662 (b)): 2. Bladder system, interior lining, and cathodic protection O Existing pressurized piping is retrofitted with secondary containment (CCR 2666 (b)).. o Audible/visual alarm attached to pressurized piping (CCR 2666 (c)). O Manual tank gauging no longer an acceptable method of non -visual monitoring for -UST systems having a capacity of 1,000 gallons or greater (CCR 2645 (e)). O Manual inventory reconciliation is no longer acceptable (CCR 2646 (b)) O Striker plate installed under all openings used for manual dipstieking (drop tube -mounted bottom protector is acceptable) (CCR 2662 (d)) 16VIThe 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. COMMENTS: NOTE: VIOLATIONS NEED TO BE CORRECTED WITHIN 30 DAYS OF DATE SIGNED BELOW RE -INSPECTION RECEIVED BY: INSPECTOR: _ TELEPHONE NUMBER: H&SC = CHAPTER 6.7, HEALTH AND AFETY CODE CCR = TITLE 23, DIVISION 3, CHAPTER 16, CALIFORNIA CODE OF REGULATIONS (MAY 5, 1994) UFC = UNIFORM FIRE CODE (1994 UNLESS NOTED) commcx✓pmc nl/µp/p1U. fn GENERAL MONITORING INSPECTION CHECKLIST If the facility has more then 4 tenke, plaue photocopy Iha chickrtsl before completion. H&SC - CHAPTER 0.7. CALIFORNIA HEALTH & SAFETY CODE CCR - TITLE 23, OVASION 3, CHAPTER 10. CALIFORNIA CODE OF REGULATIONS (1994) FCR - TITLE 40, FEDERAL CODE OF REGULATIONS UFC - UNIFORM FIRE CODE 11904 unless noted) REQUIREMENTS PRE -INSPECTION DOCUMENT REVIEW Permit Ap Ip ications and Fees to Operate: ,Y. Forms A&B submitted (H&SC 25286(a), CCR 2711, UFC 7901.3.1(1)', l}), -14erm C submitted (CCR 2635(06),(d}). X. Operating fees paid [H&SC 25287(a), CCR _2711(c))- State surcharge paid (H&SC 25287(b), CCR 271l(c)L Current Permits, Records, and Plans Facility lot plan submitted (CCR 2711(all. Previous violations corrected within 30 days (H&SC 25288(b), CCR 2712(f)), ,8' Business Ian to mitigate a release ors ill on file. Statement of financial responsibility submitted (H&SC 25292.2(a), UFC SU01.5.2.51. Written contract exists between ovinerfo erator (H&SC 25293(b), CCR 2620(b)). Approved written routine monitoring plan submitted (CCR 2632(b), (d)(1), 2641()). Unauthorized release reported within 24 hours (H&SC 25295(a)(1), CCR 2652(b)). Unauth. release response plan submitted (CCR 2632(d)(2), 2634), UFC 8001.5.2.3). �hxn a in ownership teported within 30 days (H&SC 25.284(b), CCR 2712(d)), fratPges to opera tinglmonitoring procedures of UST system reported within 30 days (H&SC 25286(d), CCR 2711(b), UFC 7901.3.1(5), 7902.1.2). -4-�dicprotection inspection recorded. . - Corr ctive Action 1. C rections specified in the previous inspection implemented within 30 days of rce 'ving the inspection report (CCR 2712(f)). 2. Vlork an submitted (CCR 2722(c)). (CCR 27N (a1). 4. Corrective (ion complies with policies for water quality control plans (CCR 2721(I (0). 5. Corrective acts R includes at least one of the following phases: (CCR 2722(a)) Preliminar site ssessmertt. Soil and water in.. sti ation. Corrective action plk implementation. Verification monitorin base. 6. Interim remedial plan and lion initiated (CCR 2722(b)). Nlonjtoring Methods and Reports Approved monitoring system installed and operating under permit conditions M&SC 25291(b), 25292(a), 25293(a), CCR 2632(b], 2641(a), UFC 7901.8.4.4.1). - Integrity Testing 1. Tank test in last 12 months (H&SC 25292(b)(1), UFC 7901.8.4.4.21. _ueti fiCRT ss test in last 3 years (CCR 2643(d)). k 4. Gravity pipe test in last 2 years (CCR 2643(e)). S. Test results submitted within 30 days (CCR 2643( ), UFC 7902.6.16.3). .- Annual maintenance and/or calibration performed on line leak detection equip. '����' focal agent contacted 48 hours prior to a tanklpipe integrity test (CCR 26-13( )). Cathodic Protection u ant to., 7fad g 1 1=Co, I. er'. I. C.. w, TANK 1 1 TANK 2 1 TANK 3 1 TANK 4 provided for secondary containment of tank and for UST piping (CCR 2631(d), 2636(h), UFC 7901.11.3, 7902.6.15.1). -T-�oznc-Pi**etiaa_Lasled within 6 months of installation and every 3 years thereafter (CCR 2635(a)(2)(A)). properly. ---3— 4ak " "a ----'ameiri ante system tests indicate that the system is functioning _ REQUIREMENTS TANK 1 TANK 2 TANK 3 TANK 4 piping . rA; 1. Conlinuous monitoring of piping is pefformed (CCR 2636(f)(1), 2643(c)(1)). _2-+arras-monito-rin al suction piodictpiping-performed daill (CCR 2643(d)). Reconciliation (void after 12.22.98)< with an annual tank li htness test (CCR 2646(d)). Nntor ceeding the allowable variation is reported to local agency vritftirt(CCR 2646(e)(1)). art submitted verifying that data on monthly reports didn't exceed ' its, or a list of dates and times of releases exceeding the allowable I(CCR 2 )). Statists al Inya Me ry Reconciliation y 1. Pert med with biennial tank tightness test (CCR 2646(c), ()). 2. Annu 1 SIR report submitted (CCR 2646.1(•)1. 3. Freq nt or 2 or more inconclusive inventories reported (CCR 2646.1(d)). 4. Tank i htness test perlomed for inconclusive results (CCR 2.646.1(h)). • htonuaI nk Gauging 1. Annua tank integrity test p erformed [CCR 2645(b)). Automatic Tank Gauging 4. OR 1. Monthl automatic tank gauging results submitted (CCR 28431b)(1)). Upgrades s d Repairs its, 1. Any unau orized releases) has been reported to the local agency prior to re airs(C R 2661(a)). 2. Non-metal p ing and tanks tightness tested within 30 days of repairs (CCR 2661(f] 3. Repaired cath is protection systems have been tested within 6 months of repairs (CCR 26 0(n)). Ta4 Closure 1,A lication for tank closure submitted within 90 days of the cessation of the sto ge of hazardous substances (CCR 2670(e)). 2. Prop of of compliance with tank closure regulations submitted within 30 days of osure (CCR 2670(f)). Ni container and monitored pursuarst to Article and 4 until actual 3. UST Sysi completion osure (CCR MOW). Detection of Leak or Unauthorized Release election of an unauthorized release and/or sudden loss of product has leen reported to the local agency within 24 hours (CCR 2652(b)). 2. AIVIfwritten repo r s been submitted by the ownerloperator to the local f agenc within 5 : ing days of detecting on unauthorized release (CCR 2 2( 3. Update •ep its ubmitted to the local agency quarterly, or more frequently, to pro ' e updat re ardin cleanup and initial abatement actions (CCR 2652(d)). ON -SITE DOCUMENT REVIEW '"' Cur,pent Perinits, Records, and Plans :• :•..: Valid operating permit on -site (H&SC 25286, CCR 2712(i), UFC 7901.3.1). . V/ritten records maintained on -site (H&SC 25293(a), CCR 2630(d), 2641(), 2712(b)). flunrnonry racnnncn nlan nn cifolnnaratnr ran varhally descrihP features a the clan. - �Cathocl;e roteeti -- ecor kept for 6.5 years (CCR 2712 (b)). 6a-ie�f.$r+tar e�faims for release detection systems kept for 5 years (CCR 2712 M). and upgrade records kept on -site for the life of the UST (CCR 2712(b)). Safely and trl�inin records on file. MoRjtoring Methods and Reports X. Monitorin !maintenance records kept for 3 years (CCR 2712 (b)). InterstitiaP hlonitorin Tank monitored visually at required frequency MSC 25292(h), CCR 2632 (c)(1), 26.11(d), 2642(a), UFC 7901.8.4.4.1) or Continuous non -visual interstitial monitoring for double -walled tanks ►H&SC 2529IM, CCR 2632(c)(2)(A), 2641(1)). 1 _ '-r.ec.orded at the time of inspection (CCR 2632(c) REQUIREMENTS TANK 1 TA'IK 2 TANK 3 TANK 4 thodic Protection 1, m ressed currents stems) is inspected ever 60 calendar days (CCR 2635(a)(2)Wl. Dis ser Meters 1. Disp ser meters inspected by department of weights and measures (proper stickers esent) (CCR 264661L 2. Dis ens ters calibrated annually {CCR 2646.1(k)). 3. Dispenser ane ressurized and suction piping, and sums do not show visual si ns that a se mayhave occured. �� _• ya Pi in cl Continuousmonitorin of i in is performed (CCR 2636(i)(1), 2643(c)(11), Visual monitoria of suction roduct i in erformed -ail {CCR 2643{d)I. Ian Ilnventor Reconciliation 1. Nia ual Inventor Recondiliation each month (CCR 2646(d)). 2.. uS uantity measurements based on liquid elevation measurement re uir ell (CCR 2643.1, 2646(c)(1)(C), (D)). ,} Sta 'stical Inventor Reconciliation 1. 5 tistical inventor reconciliation performed each month (CCR 2646.1(c). (}i. se or 2 or more inconclusive inventories reported (CCR 2646.1(d)), 2. Fre tor 3. Tank htness test erfomed for inconclusive results (CCR 2646.1IN). { 'gin,' n Gau in /-F y��>!'•rr•h'. t2f+"N^•+ tank into rit test erformed (CCR2645(b)). tank au in erformed week)Gal. or Less) (CCR 2645(d)). ken out of service 48.72 hours, and at least 12 hours before gauging NTankken CR 2645(a)). Ia gauping measurements exceed the v►eekly or monthly limits seau a tests and a tank integrity test has been performed within 72 hours (CM645(d)(3)). tomatic Tank Gauging 1, lonthl automatic tank au in results submitted (CCR 2643(b)(])). Tank Insure .77' 1. US stem contained and monitored pursuant to Article 3 and 4 until actual cam let q c asure e "r• FACILITY WALKTHROUGH 7 Interstitial Monitoring Nr Interstitial monitoring checklist completed. C ho plot Im re current system installed and op eratin (CCR 2635(a)(2)(A]). 7 ispe Meters ep t t of iei. I Measures inspection stickers resent and current (C 646(i)). tz,; 'tire:>•��,* Pi r1n P-- Continuous rnonitorin of piping is performed ICCR 2636(1111), 2643(c)(]))• Secondar r containment of pi in is present (CCR 2636(a), UFC 1902.6.111. . hlanitorin of i in is nPrIllme- in sumps (CCR 2636(g)(1)). Automatic line leak detection equipment installed (H&SC 25291(f), 25292 75992(11 CCR 2636(f)(2), UFC 7902.6.12). G 5. Leak detection checklist for piping completed. Gro dvvme monitor"n fti onitvr'n w�l s checklist completed. Up ndes and Rem airs 1. A proved UST system up r.ad"es andfor repairs made (H&SC 25292.1(c), 25 98, CCR 2660-2 ). 2. Inter or linin oft tank replaced no more than once (CCR 2661(c)), 3. Holes roperl u ed (CCR 26661(d)). ^. Nietal ipi , fittings, and tank fittings that have released product have been replace' CCR 2661(e)). 5, Va,t or round rater monitoring system installed to continuously monitor II sra ra;rai ed by lining if no secondary containment exists (CCR 26611 11. REQUIREMENTS TANK 1 TANK 2 TANK 3 TANK 4 • U rades and Re airs (coot.) �^�:��=` ,F ' containment rovided (OCR 2662(b), UFC 7902.6.11,8001.4.5.1.2). V.'SSecondary prevention equipment installed (H&SC 25291(c), CCR 2665, 2635(b), 02.6.5.3). ntainment provided (H&SC 25291(c), 25292(d), 25292.2(a), CCR 2665, ), UFC 7901.8.1, 7902.6.5.2). Audible and visual alarms are connected to the continuous monitoring system (CCR 2632(c)(2)(R), UFC 7901.8.4.4.1). iiL shut-off capability (CCR 2636( )(3)(4)1. .WxPi e'oints are liquid light (UFC 7901.11.8). §hear valves provided at dispenser base (UFC 79.904(e)(2) '91 UFC CODES). 7 nk osure `" r; . 'F I. S erl closed (H&SC 25298(c), CCR 2670.72, UFC 7902.1.7.2, 8001.11). he LUBE TNUNE.,m FILE COR n1E Steve Pipkln ECTION SYSTEM CERTIFICA' 286 HIGUERA, SAN LUIS OBISPO, CA 93401 • (805) 544-2976 ------------------ FCC Y)o e SERVICE COMPANY: ---------------- ---------------- TECHNICIAN PERFORMING TEST/CERTIFICATION: TECHNICIAN NUMBER: # LEAK DETECTION -SYSTEM MANUFACTURER: �'4�� e1/� LEAK DETECTION SYSTEM MODEL: # PRODUCT LINE TYPE: MONITOR NON -EXISTING OPERATIONAL PRODUCT TANK TYPE: MONITOR NON -EXISTING - OPERATIONAL F A;O WASTE OIL TANK/ TYPE: MONITOR NON -EXISTING t OPERATIONAL NON -OP- NUN -OP lvON-ur DEAR SIRS; This is to certify that, the annual monitoring system test was perfdrmed at'the;� ab '' referenced- facil-ity, the. method used. to test the monitoring system. is approved by, and ARROYDGRANI) r. exceeds the specifications- according to the system': P.O. Box2':' manufacturer. 4Arroyo Grande, CA 9342 05) 481 SINCERELY, FAX (805) 01-011 _ VENTVR 11.0. 24D Ventura, CA 9300 TECHNICIAN SIGNATURE, DATE � (B0641-y. FAX (805) j 641=14? Please forward copies to facility and appropriate agencieal ANTABARBAR.'- P.O. Boat 449 7 Santa Barbara, CA 9314D419 (805) 962-571 Ventura. ('A ia, 1! Service Station Contractors Maintenance and Construction License No.623923 A, B,C-61/D-40, Hazmat Certification FILE 1COR LEAK DETECTION SYSTEM CERTIFICA1 FACILITY.LOCATION: ------------------ �e��o ue, S� SERVICE COMPANY: ---------------- TECHNICIAN PERFORMING TEST/CERTIFICATION: TECHNICIAN NUMBER: # LEAK DETECTION " SYSTEM MANUFACTURER: JC fA. ( e t/7f-- ,PEI YR: _LL LEAK DETECTION SYSTEM MODEL: # D Z PRODUCT LINE PRODUCT TANK WASTE OIL TANK/ TYPE: TYPE: TYPE: MONITOR MONITOR MONITOR NON -EXISTING NON -EXISTING- NON -EXISTING OPERATIONAL OPERATIONAL OPERATIONAL NON -OP., NON -OP NON-ur DEAR SIRS; This 'is to certify .that- the annual monitoring system test was performed ' at'the:-above: referenced facility, the..: method used. to test. the 'monitoring system. is approved by, and' ARROYOGRAW exceeds the specif ieations according to the- system P.O. Boxy?: manufacturer". Arroyo Grande, CA 9342 FAX (865) 481.011 _ SINCERELY, TECHNICIAN SIGNATURE DATE VENTVR P.O.2429 vtntura, CA9300 (805) 641-93; FAX (805) 641442 Please forward copies to facility and appropriate agencieSPANTASAR13AR.' 1 Santa Barbara, CA 93140.449 (805) 962-571 ventura, CA ° !� FI 6 C' 1995 itoring Procedures for t1,rft'&& erground Storage Tanks For: nE ECONO LURE N'T u V 1\L Tr 286 HIGUERA • SAN LUIS OBISPO, CA 93401 • (805) 544-2976 F SAN LUIS OBISPO FIRE DEPARTMENT Spencer Meyer, Hazardous Materials Coordinator 748 Pismo Street San Luis Obispo, CA 93401 (805) 781 - 7380 Prepared by: Environmental Compliance Specialists 1923 North Fine, Suite 101 Fresno, California 93727 (209) 251- 4060 FAX (209) 251 - 5534 This report is based on available information and may have some incomplete answers. For further information please contact Steve or Gregory Pipkin at Econo Lube N' Tune (805) 544-2976. ROUTINE MONITORING PROCEDURES FOR NEW UNDERGROUND STORAGE TANKS Facility Name: Facility Address: UST Installed: Piping Installed: Monitoring System: A. Frequency of Monitoring B. Econo Lube N' Tune #107 286 Higuera Street San Luis Obispo, CA 93401 Date - January, 1988 Type - Double Wall —Primary Steel and Secondary Fiberglass Type - Single Piping with Fiberglass Gravi Monitoring is performed on the: Double wall UST and its sumps: Continuously Product yiping: Not available The methods and equipment used to perform monitoring are: Monitoring system used: Universal Sensor Devices Inc. --Leak Alert Model LA-02 In -tank detection used: Interstitial space Line leak detection used: Liquid and vapgr sensors in interstitial space Sensors are used in the: UST interstial Vace overflow and between limn s of tank UST interstitial space Fill sump Turbine/piping sump Dispenser pan These sensors differentiate between hydrocarbons and other liquids (water). C. Locations where monitoring is performed: Continuous monitoring and leak detection audible & visual are performed in the: Interstitial space Interstitial space of the double -wall UST Primary tank Fill sump Turbine/piping sump Pressurized primary supply line D. Monitoring Personnel: The Facility Supervisor, Steve Pipkin, is responsible for performing: Operational monitoring On -site record keeping The reporing of any discrepancies and alarms with the monitoring system, UST, piping and/or associated hardware. Econo Lube N' Tune, #107 is responsible for all maintenance and repairs to the UST monitoring system, UST, piping and associated hardware. E. Reporting Format: Weekly reports are generated by Leak Alert LA-02 for on -site documentation and record keeping. Econo Lube N' Tune, #107 does not use a computer programmed for accessing/polling all facilities with Leak Alert LA-02 of all inventory, alarms, warnings, and in -tank leak detection. F. Preventative maintenance, calibration, certification to manufacturer's specification and repair of the UST monitoring system and associated hardware shall be performed at lease annually. Steve Gregory directs, manages, and schedules all maintenance and repairs for Econo Lube N' Tune, #107's USTs, piping, associated hardware, and the UST monitoring systems' preventative maintenance, calibration, certification and repairs. Currently, Econo Lube N' Tune, #107 does not have an annual contract with Universal Sensors and Divices, Inc. 9205 Alabama Avenue, Unit C, Chatsworth, Calfornia 91311. To contact them to perform field services, their number is (818) 998-7172. G. Training: Econo Lube N' Tune, #107's Written Practice/Procedures, Petroleum Storage Tank's Maintenance, Monitoring and Record Keeping describe the procedures company employees follow for underground storage tank and monitoring systems. This document outlines the maintenance, monitoring, testing, calibration/certification, record keeping requirements, and responsibilities for underground storage tanks owned and operated by Econo Lube N Tune, #107. Operating instructions for the UST and the LA-02 monitoring system used are on -site. On -site training is performed on initial start-up of the UST monitoring system and refresher training is performed on an as -needed basis or at least annually. If you have any questions or need additional information, please contact Econo Lube N Tune, #107 at (805) 544-2976. Gregory Pipkin Owner NEW USE RESPONSE PLAN Facility Name: Econo Lube N' Tune, #107 Facility Address: 286 Higuera Street San Luis Obispo, CA 93401 UST Installed: Date - January, 1988 Type - Double -Wall Steel 550 Gallons for Waste Oil Piping Installed: Type - Single Piping with Fiberglass Monitoring System: Leak Alert System LA-02 A. An unauthorized release of any hazardous substance and/or water from the interstitial space, fill sump, piping sump and/or dispenser pan will be removed by one of two methods: 1) hand/electrical pump for small quantities or 2) vacuum truck for large quantities. Small quantities of any hazardous substance will be placed into steel drums. Large quantities will be placed into a vacuum truck tank. Removal, disposal, or in the event of catastrophic failure and/or if an emergency response is required, the vendor listed below will respond or (another agency -approved vendor): Black Gold 527 North Rice Avenue Oxnard, CA 93030 Phone: (805) 981-4616 lrrr_ardour waste-Nv rH-be-recordcd o possible. B. Steve Gregory is responsible for authorizing any work necessary under this Response Plan and can be reached a (805) 544-2976. Gregory Pipking Owner Econo Lube N' Tune, #107 city of sAn luis oBim)o ,€ . FIRE DEPARTMENT 748 Pismo Street • San Luis Obispo, CA 93401 805/781-7380 GENERAL MONITORING INSPECTION CHECKLIST IN ACCORDANCE WITH THE STATE OF CALIFORNIA HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7, SECTION 25280 et. seq., AN INSPECTION OF EVERY UNDERGROUND STORAGE FACILITY SHALL BE CONDUCTED TO DETERMINE WHETHER THE TANK SYSTEM(s) COMPLIES WITH THE APPLICABLE REQUIREMENTS AND REGULATIONS AND TO DETERMINE WHETHER THE TANK SYSTEM(s) IS IN A SAFE OPERATING CONDITION. FACILITY NAME: Lu ' FACILITY ID NUMBER: YO 0Z3 a,gs--o - FACturY ADDRESS: INSPECTION DATE: o- 4 - q i FACILITY PHONE NUMBER: 5 y4y- j_47b INSPECTION TYPE: ROUTINE: X FOLLOW-UP: BID: Z 5rg TIME IN: 7 : 5 v TIME OUT: 7', 3 Upgrade Deadlines 01-01-84 O Cutoff date for new and existing USTs. 07-01-85 O Existing USTs must install monitoring system (H&SC 25292 (a)). 07-01-87 O Secondary containment required for piping connected to tanks installed after this date (exceptions) (CCR 2636 (a)). 10-26-90 O Evidence of responsibiity for UST system by owner/operator for corrective action release (H&SC 25292.2 (a)). 12-22-90 O Existing pressurized piping equipped with automatic leak line detector (H&SC 25292 (e), (CCR 2666 (b)). 01-01-91 o Operative date for violations; civil/criminal penalties (H&SC 25299 (g)). 01-01-91 o Permits issued shall comply with H&SC 25299.3. 07-01-91 O Independent approval for primary containment construction and design of UST components (CCR 2631 (b)). 01-01-92 O Independent approval for primary containment construction and design of UST piping components (CCR 2631 (b)). 08-09-92 O Tank lining material and process listed/certified by and independent testing organization (CCR 2663 (e)). 01-01-93 O Manual inventory reconciliation allowable only when the underlying groundwater is at a depth greater than 20 feet below the bottom of the UST (CCR 2646 (b)). 01-01-95 o Automatic tank gauge systems installed after this date are to generate a hard copy of the calculated leak rate and leak threshold (CCR 2643 (b)(1)). 12-22-98 O Existing UST(s) replaced or upgraded to prevent releases due to corrosion, spills, and overfills (H&SC 25292 (d), CCR 2665). O All single wall tanks (steel) are retrofitted with secondary containment or by one of the following options (CCR 2662 (b)): 1. Interior lining and cathodic protection 2. Bladder system, interior lining, and cathodic protection o Existing pressurized piping is retrofitted with secondary containment (CCR 2666 (b)). AUdLble/V[SUal alarm attached o pressure piping c. O Manual tank gauging no longer an acceptable method of non -visual monitoring for UST systems having a capacity of 1,000 gallons or greater (CCR 2645 (c)). O Manual inventory reconciliation is no longer acceptable (CCR 2646 (b)) O Striker plate installed under all openings used for manual dipsticking (drop tube -mounted bottom protector is acceptable) (CCR 2662 (d)) vrruT�mipre• av, +.u; r 1iJ. I rtlS Sar: cur Obispo is commil[C-d to inewde rt,e rllsabled ;n a1! cits s2r;ic s, crocr�ma and aCtiVities. �e�aronm_ini::aucn,, Dunce for the Deaf (805) 78'I-7:1 COMMENTS: NOTE: VIOLATIONS NEED TO BE CORRECTED WITHIN 30 DAYS OF DATE SIGNED BELOW INSPECTOR: TELEPHONE NUMBER: H&SC = CHAPTER 6.7, HEALTH AND SAFETY CODE CCR = TITLE 23, DIVISION 3, CHAPTER 16, CALIFORNIA CODE OF REGULATIONS (MAY 5, 1994) UFC = UNIFORM FIRE CODE (1994 UNLESS NOTED) crnnmcxilpr-(,wplpol3.f— GENERAL MONITORING INSPECTION CHECKLIST If this facility has more then 4links, please photocopy this checklist befoca completion. H&SC - CHAPTER 8.7, CALIFORNIA HEALTH & SAFETY CODE CCR - TITLE 23, DIVISION 3, CHAPTER 18. CALIFORNIA CODE OF REGULATIONS (1994) FCR - TITLE 40, FEDERAL CODE OF REGULATIONS UFC - UNIFORM FIRE CODE (1994 unless noted) REQUIREMENTS PRE -INSPECTION DOCUMENT REVIEW Permit Applications and Fees to Operate: Farms A&B submitted (H&SC 25286(a), CCR 2711, UFC 7901.3.101101). A. Form C submitted (CCR 2635(a)(6),(d)1. ,T Operating fees paid (H&SC 252871a), CCR 2711(c)). *.. State surcharge paid (H&SC 25287(b), CCR 2711(c)). Current Permits, Records, and Plans 1. Facility lot plan submitted (CCR 2711(a)). ,V Previous violations corrected within 3.0 days (H&SC 25288(b), CCR 2712(f)). -3' Business plan to mitigate a release ors ill on file. IA'Statement at financial res ❑nsibilt submitted (H&SC 25292,2(a), UFC 8001.5.2.5). 4'Iritten contract exists between ownerfo erator (H&SC 25293(b), CCR 2620(b)l. Approved written routine monitoring Ian submitted (CCR 2632(b). (d)(1). 2641( )). Unauthorized release reported within 24 hours (H&SC 25295(a)(1), CCR 2652(b)). Unauth. release response plan submitted (CCR 2632(d)(2), 2634). UFC 8001.5.2.3). . Chan a in wnership reported within 30 days JH&SC 25284(b), CCR 2712(d)). Changes to operating/monitoring procedures of UST system reported within 30 days (H&SC 25286(d), CCR 2711(b), UFC 7901.3.1(5), 7902.1.2). Cathodic protection inspection recorded. Cor n 1. Corrections specified in the previous inspection implemented within 30 days of receivin.g the inspection report (CCR 2712(f)). 2. Workplan submitted (CCR 2722(c)). 3. Corrective action process initiated for reported unauthorized release (CCR 2721(a)). 4. Corrective action complies with policies for water quality control pi arts {CCR 2721(b.), (0. 5. Corrective action includes at least one of the followinphases: (CCR 2722(a)) Preliminary site assessment. Soil and water investigation. Corrective action plan implementation. Verification monitoring phase. 6. Interim remedial plan and action initiated (CCR 2722(h)). Monitoriny Methods and Reports �'° • 1, Approved monitoring system installed and operating under permit conditions (H&SC 25291(b), 25292(a), 25293(a), CCR 2632(h), 2641(a), UFC 7901.8.4.4.1). Integrity Testing ,14"Tank test in last 12 months (H&SC 25292(b)(1), UFC 7901.8.4.4.2). Pressurized pipe test in last 12 months (CCR 26431c)(31, H&SC 25291(f)). Suction pipe tightness test in last 3 years (CCR 2643(d)). *-Gravity pI a test to ast 2 years 2 43(e)). Test results submitted within 30 days (CCR 2643(), UFC 7902,6.16.3). Annual maintenance and!or calibration.performed on line leak detection equip. Local agency contacted 46 hours prior to a tank! ipe inte rit test (CCR 2643( )). Cathod' on 1. Cathodic protection provided for secondary containment of tank and for UST piping (CCR 2631(d), 2636(b), UFC 7901.11.3, 7902.6.15.1). Cathodic Protacton tasted within 6 months of installation and every 3 years kiff"i KCM 7EN .,rer U,� •rr.� r,...i n,rse �nl e.0 ly^ .L 6wr J.L 60. i L or. �. Soo s�. sw TANK TANK 2 TANK 3 1 TANK 4 REQUIREMENTS TANK 1 TANK 21 TANK 3 TANK 4 Piping:. :.. 1. Continuous monitoring of piping is performed (CCR 2636(f)(1), 2643(c)(1)). 2. Visual monitorin2 of suction product Eiping performed daily (CCR 2643(d)). Manual Inventor Reconciliation (void after 12.22.90) :E 1. Periormed with an annual tank lightness test (CCR 2648(d)). 2. MIR(s) exceeding the allowable variation is reported to local agency within 24 hours (CCR 2646(e)(1)). 3. Annual report submitted verifying that data on monthly reports didn't exceed allowable limits, or a list of dates and times of releases exceeding the allowable limits (CCR 2646( )). Statistical Inventory Reconciliation r { kP 1. Performed with biennial tank ti htness test (CCR 2646(c), ()). 2. Annual SIR report submitted (CCR 2646.1(•)), 3. Frequent or 2 or more inconclusive inventories reported [CCR 2646..1(d)). 4. Tank tightness test perlomed for inconclusive results (CCR 2646.1(h)). Manual Tank Gauging 1. Annual tank integrity test Performed (CCR 2645(b)). Automatic Tank Gau in - wpm 1. Month) y automatic tank gau in results submitted (CCR 2643(b)(1)). Upgrades and Repairs 1. Any unauthorized releasa(s) has been reported to the local agency prior to re airs(CCR2661(a)). 2. Nan -metal piping and tanks tightness tested within 30 days of repairs (CCR 2661(f)). 3. Repaired cathodic protection systems have been tested within 6 months of repairs (CCR 2660(n)). . Tank Closure 1. Application for tank closure submitted within 90 days of the cessation of the storage of hazardous substances (CCR 2670(e)). 2. Proposal of compliance with tank closure regulations submitted within 30 days of closure (CCR 2670(f)). 3, UST system contained and monitored pursuant to Article 3 and 4 until actual completion closure (CCR 2670(e)), Detection of leak or Unauthorized Release 1. Detection of an unauthorized release andfor sudden loss of product has been reported to the local agency within 24 hours (CCR 2652(b)). 2. A full written report has been submitted by the ownerloperator to the local agency within 5 working days of detecting an unauthorized release (CCR 2652(c)). 3. Update reports submitted to the local agency quarterly, or more frequently, to provide updates re_garding cleanup and initial abatement actions [CCR 2652(d)). ON -SITE DOCUMENT REVIEW Current Permits, Records, and Plans Valid o eratin permit on -site (H&SC 25286, CCR 2712(i), UFC 7901.3.1). Written records maintained on -site (H&SC 25293(a), CCR 2630(d), 2641(•), 2712(b l mer enc response plan on siteloperator can verbally describe features of the pla Cathodic protection records kept for 6.5 aars (CCR 2712 (b)). 5. Performance claims for release detection systpms kpnt fnr fs vanrc tf'r'R ?719 W1 R..epair, lining. and up g rade records kept on -site for the life of the UST {CCR 2712(bll- .---r Safety and t4ining records on file. Monitoring Methods and Reports 1. !blonitorin ;maintenance records ke t for 3 years (CCR 2712 (b)). Interstitial Monitorin r - Tank monitored visually at required frequency (H&SC 25292(b), CCR 2632 (c!!11, 26 rl;d 26:2(a). UFC 7901.6.4.4.1) or mOn"'Cr!-j for da'llcle-ilalled tail'-:S „SadCtlan rR 26�2,r- REQUIREMENTS TANK 1 TANK 2 TANK 3 TANK 4 Catho rOre rtian 1. Impressed current system(s) is inspected every 60 calendar days (CCR 2635(02)(A)). Dispenser meters inspected by department of weights and measures (proper stickers resent) (CCR 264661). Dispenser meters calibrated annually (CCR 2646.1(k)). dispenser panels, pressurized and suction piping, and sumps do not show visual sians that a release may have occured. 1. Continuous monitoring of piping is performed (CCR 2636(f)(1).2643(c)(1)). 2. Visual monitoring of suction product piping performed daily (CCR 2643(d)). Manual Inventor Leanciliation 1_ua Inv;'ntory Reconciliation each month (.CCR 2646(d)). 2. UST quantity measurements based an liquid elevation measurement requirements (CCR 2643.1, 2646(c)(1)(C), (D)). 5t allnventor Reconciliation =w.-- 1. Statistical inventor K reconciliation performed each month (CCR 2646.1(c), (l). 2. Frequent or 2 or more inconclusive in entorie treported (CCR 2646.1(d)). 3. Tank tightness test perfomed for inconclusive'results (CCR 2646.1(h]). Manual Tank Gauging 1—Annbal lank inte rit test perfarmed (CCR2645(b)). 2. Manual tank gauging performed weekly (2,000 Gal. or less] [CCR 2645(d)). 3. Tank taken out of service 48.72 hours, and at least 12 hours before gauging be `ris (CCR 2645(a)). 4. Manual tank gauging measurements exceed the weekly or monthly limits in 2 consecutive tests and a tank integrity test has been performed within 72 hours (CCR 2645(d)(3)). Automa • ank Gauging A. M on thly automatic tank pauging results submitted (CCR 2643(b)(1)). surer 1. UST system contained anal monitored pursuant to Article 3 and 4 until actual completion closure (CCR 2670(e)). Interstitial Monitoring Y. Interstitial monitorin checklist completed. 'Cathodic Protection 1 1m ressed current system installed and operating (CCR 2635(a)(2)(A)). _ispenser Meters 1, Cepartment of Weights and Measures inspection stickers present and current (CCR 26460)). Piping --1-,Continuous monitoring of piping is performed (CCR 2636(f)(11, 2643(c)[1)). -Secondary containment of piping is present (CCR 2636(a), UFC 7902.6.11).T _--3'Monito_ring of pipiniq is performed in sumps (CCR 2635(g)(1)), utomatic line leak detection a ui ment installed (H&SC 25291(f), 25292 (b)(4)(C), 25292(e)(1), CCR 2636(f)(2), UFC 7902.6.12). rr` Leak detection checklist for piping completed. 1, Monitoring wells checklist completed. Upj�a# and RTairs —1. Approved UST system upgrades andlor repairs made (H&SC 25292.1(c), 25298, CCR 2660 2666). Interior lining of the tank replaced no more than once (CCR 2661(c)). Holes properly plugged (CCR 26661(d)). Fetal piping, fittings and tank fittings that have released product have been 17� _j connuously manit_ e;s!> (CCR 2661 "C: REQUIREMENTS TANK 1 TANK 2 TANK 3 TANK 4 Upgrades and Repairs (cont.) 6. Secondary containment provided (CCR 2662(b), UFC 7902.6.11, 8001.4.5.1.2). . verfill prevention equipment instal d (H&SC 25291(c), CCR 2665, 2635(b), X UFC7902.6.5.3). 1,--- - o, cr pill containment provided (H&SC 25291(c), 25292(d), 25292.2(a), CCR 2665, 2635(b), UFC 7901.8.1, 7902.6.5.21. . udible and visual alarms are connected to the continuous monitoring system (CCR 2632(c)(2)(B), UFC 7901.8.4.4.1). �tl^Automatic pump shut-off capability (CCR 2636()(3)(4)). Pie joints are liquid tight (U FC 7901.11.8). _-12-Emergency shear valves provided at dispenser base (UFC 79.904(e)(2) -'91 UFC COOES). Tank Closure 1. UST PFORetly Closed (H&SC 25298(c), CCR 2670.72, UFC 7902.1.7.2, 8001.11). Other JU g & T RFl%ff ,0: P.O. Bog 220, Arroyo Grande, CA 93421 INVOICE c Z 5 6 Service Station ❑ ARROYO GRANDE ❑ VENTURA ❑ SANTA BARBARA Contractors P.O. Box 220, Arroyo Grande P.O. Bog 24294, Ventim ' (805) 962-5716 CA 93421 CA 93002 License # 623923 (805) 481-2552 (805) 641-9316 FAX: (805) 481-0412 - To: Ee,00-0 - .&,,k@ 2. g 6 *t6u e�ZDate: :. I. , ,C P.O. No. =/ �r r- 2 aL O LL lT W o_ a � �— Y II c O 3 JOB COMPLETE YES ❑ NO ❑ DESCRIPTION 0 W to J OUAN PRICE AMOUNT I NAME ARRIVAL DEPARTURE LABOR TRAVEL TOTAL I HOURLY AMOUNT 0 TIME TIME HOURS HOURS HOURS RATE LL O r'r W Ir W H Attorney's Fees: Should the services of an attorney be required to enforce any part of the credit fflSn t" a ULVIrtt74 ] guarantor, it is agreed that the debtor will pay reasonable costs of collection including a reasonable attorney's fee. TERMS: A SERVICE CHARGE OF 1 1/2% PER MONTH (ANNUAL RATE OF 1 B%) WILL BE CHARGED ON PAST DUE BALANCES OVER 30 DAYS coTHIS IS TO CERTIFY THAT r / WORK WAS SATISFACTORILY COMPLETED IN INDICATED J + TIME MATERIAL LABOR COST EQUIPMENT MILEAGE CHARGE OUTSIDE SERVICES i TAX TOTAL INVOICE $ q, µ %e 1� � F ; e x e b x E .mry C 29 m C 0 Fr 5' b f0 c 5 A i CO b �. p� ;; ? o o .e a `� °_ o �°l o �^ ter'° rr o iii " �• °. S H y n f�=ogg N_6 �o • ■ Y!� •< g .. ° N ry N u. a y ° o m O + y O o t i g Z■ .. Q p, 7 N N "' N G. m O N O .G - N f� a° N "� zz N ry� 'O N ,e n =• a N O °- a O rV ■ y i O •^� xO �„vpi cN.. a° A�bOo AS a� eye rn� o = rno Zi °`�� �� S w 7 Wa S 2. '?,7 i w tTjAZ CI A w mm G' � gm ti° o o 3° c� m c mo• _c•. °' c c. a. n a • ° oo►+00 a° p vo 'd xV tib 'rl A o' ',� ■ i r. 6 � b � E IJ �, � o. c3 p � E �. 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I I I •1 IAA �yo m 4lIO 1M� �� L�1S ��15��lI� FIRE DEPARTMENT 748 Pism• Street • San Luis Obispo, California 93401 a 805/549-7380 M.- TO l' DATES FROM l� SUBJECT - A I _ r It �/ CG/�- THE PRYNTERS . 543.5939 MEMORANDUM Date 03/23/89 ID:NUMBER 2594 STREET HIGUERA ADDRESS 286 BUSINESS ECONO LUBE AND TUNE GRID H13 BUS:PHONE 544-2976 EMER:PHONE: 805/544-1508 ASSIGNMENT: 4A RESP:PARTY: GREG PIPKIN LASTCLEAR : 01-06-89 AREA 2880 OCC:LOAD : 20 OCCUPANCY : B1 FIREFLOW : 1000 CONST:TYPE: 5-N STORIES : 1 PROTECTION: F REMOTE : F LOCBOX : F FREQUENCY : 1 MANHOURS : 0.4 SPRINKLERS: 00-00-00 HOOD INSP 64 PROP:OWNER: ECONO LUBE AND TUNE MAILTO : 286 HIGUERA CITY SLO STATE : CA ZIP 93401 VIOL:ALRMS: rvl PREPLN:HAZ: 1-250 WASTE OIL TANK U.G. 2- WASTE OIL TANKS ABOVE GROUND. NOTES F.L., HAZ MAT 11/89 PERMIT:HAZ: ART 4-18, 22 PERMIT_MON: 11 PERMIT_AMT: 490.00 PERMEXDATE: 11-01-89 PERMIT_INF: 1) STORE/HANDLE/USE CLASS I FLAM. 2) U.G. STORAGE TANK PER ORD 999 - 3) HAZ MAT INVENTORY/BUSINESS PLAN LIQUIDS $ 45 NEW $175 - ORD 1075 $270 ADDRESS: £Lu6, N robe 7-86 14,�%--� sf. S�c�C �ink�n �LILt'7G� 6 ;DATE _� REMARKS IFS- � ��-�.�1� � "+5 � � �.... �� r �i • D 4 , � � � cart' /7� f gz L I I Environmental Her_— ,rvices s_a , . &Q5) 781-5544 city off. san Luis om spo N�' Y r+i h FIRE DEPARTMENT��, �p_._Box 14139 ���,� I%k 2160 Santa Barbara Avenue' San Luis Obispo, CA 93401-5240' (005) 731-7350 Zan Luisrra Way Ste. B ^Courtesy & Service" �.:.;.. San Luis Obispo. CA 93d06 �` CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 10/14/2022 Time: Facility Name: LUBE-N-GO Agency Inspection Tyg_e ❑EHS ORoutine Site Address: 286 HIGUERA ST OCITY FIRE ❑Reinspection❑Chargeable SAN LUIS OBISPO, CA 93401�215 Reinspection ❑Change of Ownership Phone: (805)786-4056 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0005116 CERS ID: 10437337 ❑Chargeable Secondary Containment Testin( Serial Number: DADBSULOG PROGRAMS INSPECTED: ❑Hazmat ❑HWGenerator OUST ❑xAGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. YES NQ NIA VIOL. # BUSINESS PLAN ❑ ❑ 0 BP01 Business plan complete, current, available during inspection and submitted electronically (HSC 25505, '25508(a)(1); 19 CCR 2651) ❑ ❑ 0 BP02 Inventory of hazardous materials is complete and submitted electronically (HSC 25505(a)(1), 26506, 25508(a)(1), 19 CCR 2652, 2654) ❑ ❑ 0 BP03 Site layout/ facility maps are accurate and submitted electronically (HSC 25505(a)(2), 25508(a)(1), 19 CCR 2652) TRAINING PLAN ❑ ❑ 0 TR01 Facility has appropriate training program, submitted electronically (HSC 25505(a)(4), 25508(a)(1), 19CCR 2659, 22CCR66265.16) ❑ ❑ 0 TR02 Training documentation is maintained on site for current personnel (HSC 25505(a)(4), 22CCR66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ 0 ER01 Emergency response/contingency plan complete, current, submitted electronically, maintained onsite (HSC 25505(a)(3), 25508(a)(1), 19CCR 2658, 22CCR 66265.52-.54) ❑ ❑ 0 ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 26270.4.5; 40 CFR 112.8(c)(2)] GENERAL EH VIOLATIONS �❑ ❑ 0 FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724599999 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: MATHESON BLISS FACILITY REP: FACILITY NAME: LUBE-^'-GO ADDRESS: 286 HIGUERAST AoOVEGROUND STORAGE TANK (t„j f) SAN LUIS OBISPO, CA 93401-4215 YES NO N/A VIOL. # x❑ ❑ ❑ AT01 A Prevention control and countermeasure (spcc) plan has been prepared and implemented at facility (Note: An SPCC Plan is required for single tanks 1,320 gallons or greater or tanks/containers with a cumulative capacity of greater than 1,320 gallons of oil products; for farms, nurseries, construction sites: single tanks greater than 20,000 gallons or tanks with a cumulative capacity of greater than 100,000 gallons. (HSC 25270.4.5/REF. 40 CFR 112.1, 112.3(d), 112.6) 91 ❑ ❑ AT20 SPCC plan has been reviewed and/or evaluated within the last 5 years and completion of the review has been documented (HSC 25270.4.5(a)/REF. 40 CFR 112.5(b)) 0 ❑ ❑ AT21 SPCC plan has been amended for changes (HSC 25270.4.5(a)/REF. 40 CFR 112.5(a)) ❑x ❑ ❑ AT02 The Spill Prevention Control and Countermeasure Plan is maintained on site or at the nearest field office. (HSC 25270.4.5/REF. 40 CFR 112.3(e )(1)) ❑ ❑ ❑x AT03 Secondary containment for the entire contents of the largest single tank, plus sufficient freeboard to allow for precipitation, has been installed and is sufficiently impervious to contain discharges. (HSC 25270.4.5/REF. 40 CFR 112.7(c ), 112.8(c)(2)) ❑ ❑ 0 AT22 Secondary containment drainage restrained by valves/positive means and normally kept closed (HSC 25270.4.5/REF. 40 CFR 112.8(b)(2), 112.8(c)(3)) ❑ ❑ ❑x AT06 Drainage of any uncontaminated rainwater from secondary containment is documented and recorded. (HSC 25270.4.5; 40 CFR 112.8(c)(3)(iv)) ❑ ❑ ❑x AT07 Liquid level sensing device is present and tested regularly. (HSC 25270.4.5/REF.40 CFR 112.8(c)(8)(v)) ❑ ❑ ❑x AT08 The master flow valve that will prevent direct outward flow of the tank's content to the environment is securely locked in the closed position when in non -operating or non -standby status. (HSC 25270.4.5/REF.40 CFR 112.7(g)) ❑ ❑ ❑x AT09 The master flow valve (i.e. gate valve, solenoid valve, etc.) and Emergency Shut-off switch are inspected and tested regularly, documented, and records are maintained for three years. (HSC 25270.4.5/REF.40 CFR 112.8(d)(4)) ❑ ❑ ❑x AT10 Each aboveground tank is tested for integrity (if applicable) on a regular schedule and whenever material repairs are made. (HSC 25270.4.5/REF.40 CFR 112.8(c)(6)) ❑ ❑ x❑ AT11 Appropriate warning signs are posted at the loading/unloading rack and at the fuel island to prevent vehicular departure before complete disconnect of flexible or fixed transfer lines. (HSC 25270.4.51REF.40 CFR 112.7(h)(2),MIS (d S )_ ❑ ❑ 0 AT12 Guard posts or other approved means are being provided to protect storage tanks and connected piping, valves, fittings, and dispensers from vehicular damage. (HSC 25270.4.5/REF.40 CFR 112.7(a)(1), 112.70); CA FIRE CODE 5704.2.9.7.4) ❑ ❑ 0 AT13 Visual inspections of tanks, valves, piping, and appurtenances storing petroleum products are being conducted and documented regularly, and maintained for three years. (HSC 25270.4.5/REF.40 CFR 112.7( e), 112.8(d)(4)) ❑ ❑ ❑x AT14 There are no visible leaks at tanks, pumps, master flow valve or aboveground piping. (HSC 25270.4.5/REF.40 CFR 112.8(c)(10)) ❑ ❑ 0 AT15 Facility lighting is commensurate with the type and location of the facility, giving consideration to the discovery of spills occurring during hours of darkness both by operating personnel and non -operating personnel (i.e. general public, local police/fire) (HSC 25270.4.5/REF.40 CFR 112.7(g)) ❑ ❑ ❑x AT16 FFacility is fully fenced and locked when facility is unattended. (HSC 25270.4.5/REF.40 CFR 112.7(g)) Li Lj Inas i Has aocumenteci spill History a no corrective actions EaKen. . . x❑ ❑ ❑ AT18 Spill prevention briefings for operating personnel covering the SPCC Plan are conducted and documented annually to assure adequate understanding of the SPCC Plan. (HSC 25270.4.5/REF.40 CFR 112.7(f)) 0 0 ❑x AT19 Spill control equipment is maintained on site. (HSC 25270.4.5/REF.40 CFR 112.7(c)) SUMM 'RY OF OBSERVATIONSVIO► '-TIONS ❑x No violations of underground storage tank, hazardous materials, or hazardous Haste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform th CUPA in writina 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 INSPECTION COMMENTS: SPCC Plan review. INSPECTED BY: MATHESON BLISS DATE: 10/14/2022 ADDRESS: 286 HIGUERA ST SAN LUIS OBISPO, CA 93401-4215 NAME OF FACILITY REP: SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: COUNTY o SAN LUIS OBISPO Environmental Hey ervices (805) 781-5544 P.O. Box 1489 !K aig—Wgy Ste B San Luis Qbisoo- CA 93406 a.t city oi- san luis oBlspo FIRE DEPARTMENTl+ 7 2160 Sanla Barbara Avenue' $an Luis Obispo, CA 93401-5240' (805) 781-7380 "CoTrrtesy & Service" CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 09/08/2022 Time: Facility Name: LUBE-N-GO Agency Inspection Type ❑EHS ❑Routine Site Address: 286 HIGUERA ST ❑xCITY FIRE pReinspection SAN LUIS OBISPO, CA 934014215 ❑Chargeable Reinspection ❑Change of Ownership Phone: (805)786-4056 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0005116 CERS ID: 10437337 ❑Chargeable Secondary Containment Testin( Serial Number: DAFQOPNCZ PROGRAMS INSPECTED: ❑Hazmat ❑x HW Generator OUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. YES NQ N/A VIOL. # BUSINESS PLAN ❑ ❑ 2) BP01 Business plan complete, current, available during inspection and submitted electronically (HSC 25505, 25508(a)(1); 19 CCR 2651) ❑ ❑ ❑x BP02 Inventory of hazardous materials is complete and submitted electronically (HSC 25505(a)(1), 25506, 25508(a)(1), 19 CCR 2652, 2654) ❑ ❑ ❑x BP03 Site layout/ facility maps are accurate and submitted electronically (HSC 25505(a)(2), 25508(a)(1), 19 CCR 2652) TRAINING PLAN ❑ ❑ 191 TR01 Facility has appropriate training program, submitted electronically (HSC 25505(a)(4), 25508(a)(1), 19CCR 2659, 22CCR66265.16) ❑ ❑ 9 TR02 Training documentation is maintained on site for current personnel (HSC 25505(a)(4), 22CCR66265.16) EMERGENCY RESPONSE PLAN 0 ❑ 0 ER01 Emergency response/contingency plan complete, current, submitted electronically, maintained onsite (HSC 25505(a)(3), 25508(a)(1), 19CCR 2658, 22CCR 66265.52-.54) ❑ ❑ 0 ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c)(2)] GENERAL EH VIOLATIONS ❑ ❑ ❑x FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724599999 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: MATHESON BLISS FACILITY REP: Omar Morales