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Home My WebLink AboutSLOUNIFLOW_FS1 Admin iRC5235 Color_1466_001_RedactedData run: S/2W01S 1:07:43PM COUNTY OF SAN LUIS OBISPO Repose: MFR1 Run by: kbcyk Page Facility Information as of 5/20/2016 Record Selection Clibtle: Facalo IO: FAD0067M Date: r[:� J-0VE19" Requested by: jI V/I�[ . ] NEW FACILITY RECORD [ ] INFORMATION CHANGE I'� [ ]OWNERSHIP CHANGE: [ I Business [ I Property [ I Tank [ ] UPDATE UST INFO (s _ Li CLOSE FACILITY AS OF: Date: _al„O 11Wk ] UPDATE BILLING INFORMATION OWNER FILE INFORMATION Owner ID: OW0006839 New Owner ID: Owner Name: MARKOFF, BONNIE F New Name: Owner DBA I New DBA: Owner Address: New Address: Home Phone: New Home Phone: Work Phone: $05-545-0212 New Work Phone: Mailing Address: 162 CROSS ST New Mailing Address: SAN LUIS OBISPO, CA 93401 Care of: New Care of: FACILITY FILE INFORMATION Facility ID: FAOD06736 New ID: Facility Name: ANIMAL CARE CLINIC New Name: 162 CROSS ST New Site Address: SAN LUIS OBISPO, CA 93101 Phone: 805.545-8212 New Phone: Mailing Address: 162 CROSS ST New Mailing Address: SAN LUIS OBISPO, CA 93401 Care of HAZARDOUS MATERIALS COMPLIANCE New Care of: CERS ID: 10437487 GIS: ACCOUNTS RECEIVABLE FILE INFORMATION Accountl0. AR0014027 New Account ID. Mail Invoices to Account Mail Invoices to: Owner / Facility / Account Account Name: MARKOFF, BONNIE F (CinJe One) Account Balance as of WO/2016: $0.00 1 Prcgremleemem and Deecnpdon RecoN ID Employee to and Name Status GST(s) Pregram to Linked _ (Circe One) A awlnaclvat 1175-SLO CITY -WASTE GENERATOR(pmt or mealra0 PM010100 EEM00510-KERRY WYLE ael Y N A f I [ ] CREATE NEW FILE FOLDER ( ] UPDATE EXISTING FILE FOLDER LABEL UPDATE NEXT INSPECTION DATE: Date: I/_ Copy to: File Other: Update Nish Portal? Y N (If yes, forward to portal administrator for HAZARDOUS MATERIALS SPEC�IFFIC: /N PE Number of Materials _ Number of Waste Simmons ,L Number of Tanks (list 7 l HAZARDOUS MNI ERIALS BUSINESS PLAN CERTIFICATION FORM For Use by Umdocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Health and Safety Code§25503.3(c); 19 CCR§2729.5(c) To: Agency Name: CUPA for San Luis Obispo County and Ci Agency Mailing Address: PO Box 1489 San Luis Obispo, 943406 FAX 805-781-4211 Pursuant to Section 25503.3(c) of California Health and Safety Code (HSQ, the Hazardous Materials Business Plan (HMBP) certification described below is hereby submitted for the following facility: Facility Facility Date of Current I certify that: (Check the appropriate box.) I have personally reviewed the Hazardous Materials Business Plan currently on file with your agency and certify that the HMBP is complete and accurate. (See bottom ofpage for details) If this facility is subject to Federal Emergency Planning and Community Right to Know Act (EPCRA) reporting requirements, I have submitted the following documents with this Certification Form: Unified Program Consolidated Form (UPCF) Business Activities page; UPCF Business Owner/Operator Identification page with current signature and date; Hazardous Materials Inventory Statement page(s) with an original signature, photocopy of an original signature, or signature stamp on each page for all Extremely Hazardous Substances (EHS) handled at or above their Federal Threshold Planning Quantity (TPQ) or 500 pounds, whichever is less. or ❑ Revisions to the Hazardous Materials Business Plan are necessary. The HMBP as revised is complete and accurate and is being implemented. A copy of the revisions has been electronically submitted or is and UPCF Business Activities page if the HMBP revision include changes to the Hazardous Materials Inventory Statement. OWNER/OPERATOR CERTIFICATION: I hereby certify under penalty of law that, based upon my inquiry of those individuals responsible for obtaining the information reported above, I believe that the submitted information is true, accurate, and complete. I understand that a revised HMBP must be submitted within 30 days of any change in this facility's storage or handling of hazardous materials that would require updating of the HMBP. Phoneday—_ upper box on this form, you are certifying that: Date: '? 7 • The information contained in the HMBP most recently submitted is complete, accurate, and up-to-date; and • There has been no change in the quantity of any hazardous material as reported in the most recently submitted He aeduus Materials Inventory forms; and • The facility has not begun handling any hazardous material in a HMBP reportable quantity that is not currently listed in the Hazardous Materials Inventory; and • The most recently submitted HMBP contains the information required by Section 11022 of Title 42 of the United States Code; and • There have been no substantial changes in the facility's operations that would require revision of the current HMBP. uu-039- 1/1 www.unidoes.ors Rev. sdrostm i County of San Luis Obispo • Public Health Department Environmental Health Services Division 2156 Sierra Way • P.O. Box 1489 San Luis Obispo, California 93406 IUD 805-781-5544 - FAX 805-781-4211 Jeff Hamm Health Agency Director Penny Borenstem, M.D., M.P.H. County Health Officer Public Health Department Director Curtis A. Batson, R.E.H.S. Director of Environmental Health Annual Hazardous Materials Inventory/Business Plan Certification due 2-26.2010 Who is required to provide the Certification Form on the back of this pane? • Businesses who have not been inspected by the Certified Unified Program Agency (CUPA) in 2009. The CUPA is comprised of San Luis Obispo County Environmental Health Services and the San Luis Obispo City Fire Department. • Businesses who have not provided a new complete or updated Hazardous Materials Business Plan to the CUPA in 2009. How do I proceed if my Hazardous Materials inventory or Business Plan has not changed? • Check the first box on the Certification Form. Fill out the Farm. Mail, fax or e-mail the Form to us and you're done. Keep a copy on site. How do I proceed if my Hazardous Materials inventory or Business Plan has changed? • Check the second box on the Certification Form. Fill out the Form. • Provide updated hazardous materials business plan forms (Identification Page, Inventory, Site plan) and the Certification Form. Mall, fax or e-mail the Forms to us. Keep a copy on site. How do I obtain Hazardous Materials inventory or Business Plan forms? • Download the forms online at http://www.slocounty.ca.govlhealthipublichealth/ehs/HazMat.htm • Request a hazardous materials business plan packet to be mailed to you: o Call 805-781-5544 for facilities within the County. o Call 805-783-7774 for facilities within the City of San Luis Obispo. Where do I send the required fors? • All Forms can be e-mailed to cratligan@co.slo.ca.us, faxed to 805-781-4211, or mailed with invoice payment to P.O. Box 1489 San Luis Obispo, CA 93406 When are fors due? February 26, 2010 Who can I call with questions regarding Form completion? • The Hazardous Materials Inspector for your facility within the County. Call 805-781-5544. • The Hazardous Materials Inspector for your facility within the City of San Luis Obispo. Call 805-781-7383. j\/\ � � m� )) / to > !- > § \ . »)!))/ (( §§§■ f� f\ $ �} ; k kf ƒ \ 10 ! &f +!) • [\ )\f { 4 !!! ! \E / :! §00 (\ � /§ B u ) ANIMAL CARE QtLy LZC uality Medicine With A Gentle Touch 4/28/15 City of San Luis Obispo Certified Unified Program Agency Attn: Kerry Boyle Dear Kerry, Bonnie F. Markoff, DVM, ABVP DIPIM le, Anttrican Hoard of Veterinary Practitioners specializing in Canine & Feline Practice Jennifer Evans, DVM Richard Tao, DVM Marissa Greenberg, DVM Allis Bisson, DVM Per our conversation on the phone today, this letter is to inform you our clinic no longer produces silver waste from x-ray machines as we are now all digital. We also only store 400 cubic feet of compressed gas (all oxygen) at any given time. My understanding is this exempts us from your program but please let me ]mow if you have any questions or for some reason we are still required to be in this program. Thank you, Cate Morris Administrator Animal Care Clinic 805-540-2300 cmorfis@animalcareclinicslo.com ty 7 2615 162 Cross Street San Luis Obispo, CA 93401 (805) 545-8212 1W ` - G Ot of san tuts Obispo FIFE DEPARTMENT fl60 Santa 8f rban Avarua •San Luis Obispo, CA 97401-5240 • 805�:781-77r0 "Courtes��&Ser7/ice" 0 4/13/2015 MARKOFF, BONNIE F RE: ANIMAL CARE CLINIC 162 CROSS ST 162 CROSS ST, SAN LUIS OBISPO SAN LUIS OBISPO, CA, 93401 Conditionally Exempt Small Quantity Generator Self -Certification Form Facilities that generate less than 27 gallons per month of hazardous waste (e.gused oil, waste antifreeze, solvent, spent photographic chemicals, etc.) are required to provide the enclosed Certification Form and copies of waste disposal records for the previous year to this office. Please complete the Conditionally Exempt Small Quantity Generator (CESQG) Annual Self -Certification Form, attach copies of your waste disposal records for the previous year and provide to this office within 30 days. This Agency is required to verity that hazardous wastes are properly managed and disposed of or recycled. This Agency will conduct a billable inspection at the subject facility to verify compliance if the Self -Certification Form and disposal records are not received. If you have questions, please contact this office at (805) 781-7383. Kerry Boyle Hazardous Materials Coordinator Certified Unified Program Agency (CUPA) b,twv� � k/241 L Te Chy of San Luis Obispo is commdted to include the disabled an all of its services. programs and echoes. — elecemmumcaticn_ Ce:9ce fcrthe ceefi$CE;781-7G10. County of San Luis Obispo CUPA Hazardous Waste Small Quantity Generator Annual Self Certification This form is for facilities that generate less than 27 gallons of hazardous waste per month (e.g. used oil, waste antifreeze, etc.). If your facility qualifies to use this form, you will be exempt from an annual physical inspection and will be charged a reduced fee. Failure to complete and return this form along with copies of disposal or recycling documentation will result in an inspection being conducted and an increased fee. Facility Name: Date: Facility Address: Contact Person: Title/Position: Type of Facility: Phone Number: Date of Disposal Contractor or Type of Waste Quantity Service Collection Facility (in gallons) Attach copies of all disposal and recycling records from the previous calend year. Retain original receipts for your records. Mail form to: San Luis Obispo County Certified Unified Program Agency P.O. Box 1489 San Luis Obispo, CA 93406 Questions? Call (805) 781-5544 I certify, under penalty of perjury, that all hazardous wastes have been collected for recycling or disposal by the contractor(s) or at the collection facilities listed above and th; the above information is true and accurate. Name. Signature: