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Home My WebLink AboutSLOUNIFLOW_FS1 Admin iRC3926i Color_0172_001FORM S _ SAN LUIS OBIS COUNTY CERTIFIED UNIFIED PROGR AGENCY BUSINESS OWNER/OPERATOR IDENTTFICATION CONTACTNAME 2 \\Caolysvr0392\pe-server\Environmental\Business Plans\SLO\SLO 2010\FRM-S1 201 0-doc AZ}il1A ( L IDENTIFICATION l0lENDINGDATE 201 1 FACILITY ID# tffi tffi I t00BEGINNINGDATE February 2010 544-7184 102BUSINESS NAME (same a TACLITY NAME orDBA-Doing Bdsiness As) United Parcel Service 3 BUSINESS SNE ADDRESS 3601 Sacramento Drive 105ZIP CODE 93401San Luis Obispo 104CITY CA 107(4 4789 DUN & BRADSTREET 00-686-5927 106 s44-7184 COIJNTY San Luis BUSINESS OPERATORNAME Mark il. BUSINESS OWNER lll 612-1890 OWNER I OWNER United Parcel Service OWNER MAILING ADDRESS Blvd1201 West 15 ll5STATE CA ll4 Los IIL ENVIRONMENTALCONTACT 2-1890t MAILINCADDRESS Blvd1201West 90015 zpt2tSTATE CA 120cnY .Los IV. EMERGENCY CONTACTS -SECONDARY-.PRIMARY. Klotonya Hamilton 128NAME Richard Cortez t2JNAME TITLE Supervisor 129 Center BUSINESS PHONE (818) 947-4831 130t25BUSINESS PHONE 544-7t84 PAGER# / CELLPHONE # N/A PAGEn* i C'ELL PHONE # N/A l2'I am familiar with 0re information submitted and believe the information is ttue, accurate, and complete. that I have personally examined andcertify underBased on my of those individuals responsible DOCUMENT 2/02/2010 TITLE OF SIGNER District Plant NAME OF SIGNER Nick Moldovan Page- of- iirq{is'#'ifi,',Hil'}$iilrHrdffi*ftl;Hil,;*tii,*l!lf*:;t[*liihl{i;1ff'J?$],i". Jitttl',.*.u Descrp,.nthis page must be signei bv fte appropllfisilj;;;i:''""ory submrssions. For the inveniory to u. ronriorij'Jrpr.t" (Note: the numberiig or the inttnitt-iJn;rio;;;t dttr clement numbers that are on the upcF (Unified program consolidated Form) pages. These data element numbers are used: for electronic submission and are the same as the numberingrrsed in-?7 .9c\, {pq.ndix c, the Business section of the unified program Data Dictionary.) Please number all pages of vour submittal' iil;htil;; Department "ir"-it'i'"[ri*".r-cont.or tdiiiiii."i,i" i*,her the submittar is complete and if any pages are separated. ir" ii!Lfrltr'?ilH?1t;,i:ili,H.l'*.T;:'fr:ilJ:,:"gned bv DrSC. rhis is the unique number which identines your rac'ity.100' BEGINNINC DATE - Enrer the begiini"t t * -i'0.,e of the report. (yyyyMMDD)l0l . ENDING DATE _ Enter the emirel.; *i d".; the report. (yyyn'IMDD)102' BUSINES' pHoNE -'nterrh. prr"i'. "r-i.i i.u ,oo. first, and any cxtension. ::: :::TA: nT#rffi;"1*:,ff;":i,:fJi"" *t"" 't'' r"iri,v i, r'*iiio. *o oon omce box numbers are arowed. rhis inrormation must provide alnr n*-' - .- |rv'' vrr r -Enrerrhecrfuor.unincorporatedareainwhichbusinesssite.isrocated. 105' zlp coDE - Enter tle zip code of busi".* ,r,..'m. "xtra 4-digit zip may also be added.106' DUN & BRAD.TREET - entt' tt't D;n; s;c';t nu,ou., ior,r,i iu"irirv.-ii. oun & Bradstreet number may be obtained by calring (610) 882-?248 or by Intemet.ttt t" ""!ilt-;ti*T$;r:t'** *dard Industrial classification code number for primary business activity. NorE: If code is more than 4 digits, report108. couNTy - Enter the co,nty in which trre business site is located.I09. BUSINESS opERAToR NAME _ i"*.,r,. "r_. if th" burin.r, operator. iii' iS',wFTL:l',I:H;*::',:Hfi,T,H;;#l*fffi;fr:,01;T;::,u"'businessphone,areacodenrst,and anyextensionI 12' owNER PH.NE - Enter tht u*int"o*n"r' it # nurnu", iroin *"i t""ii*iness phone, area code firs! and any cxtension.I 13' owNER MAILING ADDRESs ' E".itt. "*I"r:, ruiling "aur.r, iiiinir.nii"jn' uurin.* site address.I14. owNER CITy _ Enter the n.1". "i f,. "i,y i".in. o*".a, mailing address.115' owNERSTATE-Enterthcz-charactersiatJai'ti""viationto.rheowner,smailingaddress. r r 6. owNER zn cone -11i91,h" il;;;; ;;;1i,1",,, "dd;: *ilildfit zip may arso be added. ::: ::5$ffi*:;:X*lffi;l**";;;rl3:'::"ffirl#.illtrrom*renusin.,,-olun..o.operator,whoreceivesarenvironmentar : :: :::iil,lf;fNE - Enter tt't pi""' i"ilt'' iiii*""t #,n owner or operaror, at which the environmental contact can be contacted, area code firs! and any li;: 3$St'J.ffi:il:fi,i"Tdtr;?liT,fffil|j;"fllffi,ffiffilironmentar contactcorrespondenceshourdbesen! irdifferentrromrhesite address.l2l' srATE - Enter the 2'charactet J;.bb;.;:;;l;;;. environmentar intact;s ma'ing address. 'vr'rw'v'r'u.r 122' zP coDE ' Enter the zip codt r"t *tt t""lt""*."L contact's r.'i"g .ai.rrr. r'tre exna +{igit zip may also be added.123' PRIMARY EMERGENcY'coNrecr r'reve- iili' qrt".1*";i;;;rd;,u" *u,.* u.i"i,ioJir*"*l or* r,n"rr.n.y invorving hazardous materiars ^, ,_, *tff.H:*ess site' The contact shall;; F;ir- ru"ilirv o.r.rr;;il#*rv, *o ""*Jryi".Jr'fr"r,"", "r the business regarding incident124.- TITLE - Enter the title of the primary emergency contact.125' BUSINESS pHoive - Enter tire busintt#;; ilil;rimary emergency conract, ruu.ou. tr.t, and any e:rrensions.126' 24-HouR PHoNE - Enter a 24-hour phone nuttt' ro' *'t nltury "r'ffi.i #nt .t. -rn. ze-no", pt *J""*ier musr be one which is answered 24 hours a 11r. l19^r.{ffil1 $i{:il:1:#ffji:ffi**., ** *,. ,.*i., .i,*J,r.,, ,,," pr,"". ;,;;;;;;;;,il,,1"0,u,.,, "ontact the individuar stated above.r28' SEC.NDAR' Eva[ceNcy'caN';;NAJ;-t'ilfl.:T'#:.?":Jj:;:-r:#]i:::T,,", *.,.*, o" ****ffi*'**. o**.,",r.",,,"" -,-, ii.f;;lllot *uiluutt' The contact shall have FULL ft"ilry .r**lri* i#,,,*,rr, il "",rr";tb;;;;decisions for rhe business regarding incidenr129. TITLE - Enter the title ofthe secondary emergency contact.130' BUSINESS PH.NE -Enter the busin;t i;6;;;:;;mber for the secondary emergency contact, area code firsr, and any extension.I 3 I ' 24-HouR PHoNE - Enter a 24-hour phone numi.r try ,;*"i;;;;;ffitact. The 24 r,ou, pr,o* nurber must be one which is answered 24 hours af? l*{llii,fi;'#:ffi:ffi:f,T*T"JIii:t*l*ru;"mJ*",,Xi:"*o.ab,etoimmediarerycontactrrrei,ai",a*i**ot" * fr::*h1r#*"'""f*h?*i.ff.tffiItfi|rfl:f#,#":ffittlli".j:.orect any additionar inrormation necessary to meet rher34. DArE-Enrerthed.*y,^,p19.1l"";;;;isne"a':(yyynuMDD) _, 11: NAME oF DOCUMENT PREPARER _ E"*r,i" fur136. NAME or srcNen]inter rhe tu1 prinred name or*lTi lf tt person who prepared the inventory submittal infonnation. ^- -lT:aono.,ignJr,in!!i.voitr,o,.inffi*:J,iffrJri?f1'"il"'"ril.'Ii:ilfl',',,Txrr';:;rilN'ru;,*T;o'l.1il:.;::,:,:lffiini[flslGNAruRE on owNpll opanaron on iliiltNoieo ninii;*;iffi: rhe Business o;;;/il;r, or ofticiary designared representarive of rhe owner/operdtor' shall sign in trtt tpu"t pt*dJ, trt.,, rtil;;;;;, *ur"*" rr*.r,, r.r'i. *i,rrlt.*inro*ution rubmitted and thai based on the signer's inquiry of those individuarl *ti""rr''il. r"r "u"i"i'g *,. irr"*oi"iiii, ,rr. ,i*.r,, i"rlarri", ,r,, submitted information is truq accurate and cpmplete. 137. TITLE OF SIGNER _ Enter the title of rtre person signing the page. Plans\sLo\sLo ro, otr*Ll,-a , 201 0.doc r-ru)!'l1o'otu'0392\pe-server\Environmental\Business (1)REVISE San Luis Obispo County Hazar. )s FORM I Material Inventory Form - Chemir bescription Page PAGE (2)oF (3) BUSINESS NAME: United Parcel Service cHEMTCAL LOCATTON (4) MAP # (5)GRrD # (6)l5 CHEMICAL LOCATION IS CONFIDENTIAL AND NOT SUBJECT TO PUBLIC DISCLOSURE 1 cHEMTCAL NAME (7) coMMoN NAME (8) cAs # (9) TYPE (12) PHYSTCAL STATE (13) HAZARD CATEGORTES (16) STATEWASTE CODE (17) DAYS ON S|TE (18) LARGEST CONTAINER (19) sToMGE CONTATNER (24) SToMGE PRESSURE (25) sToMGE TEMPERATURE (26) ETHYLENE GLYCOL + OTHER GLYCOLS WASTE ANTIFREEZE TRADE SECRET (10) EHS (11) N/A N/A 107211 f-lpune l--lurxrunp Xwnsre RADTOACTTVE (14)(1 5) RE RELEASE HEALTH HEALTH uNrTs (20) Xcru Ecu rr DLes EroNs 365 lf EHS amounts must be in lb. 55 oal ENT [-]Y XN MAX DAILYAMT (21) AVG DAILYAMT (22) ANNUALWASTE AMT (23) IF EHS BOX IS'Y' ALLAMOUNTS MUST BE IN LBS pCURIES 55 20 55 oal 1 2 3 4 5 EHS llv XN l-lv [] ru l-lv Ett l-lv Eru l-lv I]l BELOWGROUNDTANK DRUM Xsreel onuu GROUND TANK INSIDE BUILDING BOX DRUM RAILCAR WAGON PLASTIC BOTTLE BOTTLE 50 ETHYLENE GLYCOL 107211 (31 ) ADDITIONAL LOCALLY COLLECTED INFORMATION Adapted from OES Form 2730 02102110 O :\document\jpoel\forms\wastanti.doc San Luis Obispo County Hazaru, -ls FORM T Material Inventory Form - Chemie.- bescription Page (1)Dnoo Xoelere [] Revrse PAGE (2)oF (3) United Parcel ServiceBUSINESS NAME: cHEMTCAL LOCATTON (4) MAP # (5)GRID # (6)l5 CHEMICAL LOCATION IS CONFIDENTIAL AND NOT SUBJECT TO PUBLIC nrsct osURE 1 CHEMTCAL NAME (7) coMMoN NAME (8) cAS # (e) TYPE (12) PHYSTCAL STATE (13) HAZARD CATEGORTES (16) STATEWASTE CODE (17) DAYS ON SITE (18) TARGEST CONTAINER (19) SToMGE CONTATNER (24) SToRAGE'PRESSURE (25) STORAGE TEMPERATURE (26) zt 90 10 o/oWT WASTE SOLVENT WASTE SOLVENT [-]pune Xurxrune Xwasre LIQUID UNrTS (20) TRADE SECRE"I(10) EHS (11) N/A N/A (15) REACTIVE HEALTH 213 365 lf EHS amounts must be in lb. 30 BIENT AMBIENT AMBIENT XRMereHr l-lRsove RvrsreNr neeLow AMBTENT [-]cnvooerutc HAZARDOUS COMPONENT EHS RADTOACTTVE (14)flv Xru MAX DAILY ANTT (21) AVG DAILY AMT (22) ANNUALWASTE AMT (23) IF EHS BOX IS'Y' ALLAMOUNTS MUST BE IN LBS pCURIES 30 12 30 CAS NUMBER 1 2 3 4 5 CU FT TONS GROUND TANK WAGON EeeLow onouND rANK nrnHr txsroe BUTLDTNG EcvuHoER nelnss BorrLE Dnntcnn flsrlo STEEL DRUM DRUM BOTTLE BIN WASTE P HYDROCARBON []v Xtt [v Xru Iv Ett Ev Et't []v [tt N/A N/A (31 ) ADDITIONAL LOCALLY COLLECTED INFORMATION \\Caolysvr0392\pe_server\Environmental\Business Plans\SLO\SLO 201O\WASTESOL 20'10.doc 2-Feb-10 FORM I ,,.., San Luis Obispo County Hazaru-.ls Material Inventory Form - Chemic.-.'Description Page (1)DELETE PAGE (2)oF (3) United Parcel ServiceBUSINESS NAME: oHEMTCAL LOCATTON (4) MAP # (5)GRID # (6) CHEMICAL LOCATION IS CONFIDENTIAL AND NOT SUBJECT TO PUBLIC DISCLOSURE I l5 Y NETHYLENE GLYCOL + OTHER GLYCOLSCHEMTCAL NAME (7) coMMoN NAME (S) cAs # (s) TYPE (12) PHYSTCALSTATE (13) HAZARD CATEGORTES (16) STATEWASTE CODE (17) DAYS ON S|TE (18) LARGEST CONTAINER (19) SToRAGE CONTATNER (24) SToRAGE PRESSURE (2s) SToMGETEMPEMTURE (26) zt 94o/o 1% 3% 2o/o %WT ANTIFREEZE/COOLANT 107-21-1 PURE LIQUID RADTOACTTVE (14)Ev EIH (1 5) FIRE REACTIVE HEALTH UN|TS (20) 365 lf EHS amounts must be in lb. 55 qal MAX DAILY AMT (21) AVG DAILYAMT (22) ANNUAL WASTE AMT (23) TRADE SECRET(10) EHS (11)[v XH IF EHS BOX IS'Y' ALLAMOUNTS MUST BE IN LBS pCURIES 60 qal 35 oal 0 qal ENT AMBIENT tc COMPONENT CAS NUMBER 1 2 3 4 5 CU FT GROUND TANK WAGON [eELow onouND TANK Ernnx rrusroe BuTLDTNG Xsreel oRuu [nnrucnn Esuo [rrsen onuu GLASS BOTTLE flpusrrc BorrLE' BIN ETHYLENE GLYCOL DIETHYLENE GLYCOL ADDITIVES DIPOTASSIUM PHOSPHATE f-lv X N TY ElN l-lv Xtt flY Xr.t flv Xh.r 107-21-1 11146-6 PROPRIETARY 7758-114 (31 ) ADDITIONAL LOCALLY COLLECTED INFORMATION \\Caolysvr0392\pe_server\Environmental\Business Plans\SLO\SLO 2010\ANTFREEZ 2010.doc 2-Feb-10 ^-\ San Luis Obispo County llazaru- is FORM I ,. Material Inventory Form - Chemir-.- Description Page (1)PAGE (2)oF (3) United Parcel ServiceBUSINESS I'IAME: cHEMTCAL LOCATTON (4) MAP # (5)GR|D # (6)t5 CHEMICAL LOCATION IS CONFIDENTIAL AND NOT SUBJECT TO PUBLIC DISCLOSURE 1 CHEM|CAL NAME (7) coMMoN NAME (8) cAs # (e) TYPE (12) PHYSTCAL STATE (13) HAZARD CATEGORTES (16) STATEWASTE CODE (17) DAYS ON S|TE (18) LARGEST CONTATNER (19) SToRAGE CONTATNER (24) SToRAGE TEMPERATURE (26) PETROLEUM HYDROCARBON WASTE OIUOIL FILTERS N/A flpune XurxruRe Xwnsre []soln Xuouro Fces uNrTs (20) TRADE SECRDT (10) EHS (11) N/A N/A l lY Xlr MAX DAILYAMT(21) AVG DAILY AMT (22) ANNUALWASTEAMT (23) IF EHS BOX IS'Y" ALLAMOUNTS MUST BE IN LBS pCURIES 110 55 1500 RADTOACTTVE (14)(1 5) RELEASE HEALTH 221 365 lf EHS amounts must be in lb. 110 AMBIENT ELOW AMBIENT BELOW HAZARDOUS COMPONENT CAS 1 2 3 4 5 GAL FT GROUND TANK GROUNDTANK CAN WAGON flceneov Icvt-tHoen Dnnrcen INSIDE BUILDING BOTTLE DRUM FIBER DRUM BAG PTASTIC BOTTLE DRUM BIN 100 PETROLEUM HYDROCARBON flv Xru []v Itt ;|v Er.r nv lru [v EN (31 ) ADDTTTONAL LOCALLY COLLECTED TNFORMATTON Adapted from OES Form 2730 02102110 O:\document\i poelVorms\wastanti. doc Hazardous Matt )1. Burin.rs Plan Reporting Requirer' 'ts For San Luis Obispo county certified unified Program Agency (cuPA) 55 Gallons 200 Cubic Feet 500 Pounds ANY Reportable Levels of Hazardous Materials: Hf}'f},1':Jffffil:ffit1}, except ror propane, which is reporred in garons Solids are reported in pounds. Hazardous Waste N - P - K Fertilizer ExemPtion if less that 1N-P-K fertilizers are TOTAL.otto include ammonium Medical Exemption and nitrous oxide are exempt if the total quantity of each gas on-site is less than or equal to 1,000 cubic dentists andfeet and is used Oxygen, nitrogen transmission, gearbox, differential, or hydraulic system other machinery powered by an internal combustion or TOTALLubricating oil intendedLubricating electric Lu oit Exemption notdoesaathandledoilfacilityvolumeofsingleareoilsifalllubricatingtheoftypesexempt crankcase,combustion1ninternalasforusean725oildefinedISexceedanygallons. orequipment,lane,heavyanofautomotruck,vessel,bile,bus,p wastenotincludedoesThisexemptionengme.powered o waste solvent or other hazardous materials/hazardous wastes does notvolume of fuel is thisthanata Facility, However,Business TankFuelralAboveUand ExemptionndergroundAgricultu fromfacilitiesareatexemptorandattanksI1lessagricultural00vehicleMotorabovecapacrtyfuelgallonsundergroundifTOTALthesubmitted.and site has beenonceuirementsthethePlanmapinventoryreportingreq Fertilizer following application, fertilizer/fertilizerindicating ApplicationLiquid thetimes4morenothanfertilizeryearperr$theunder conditions appliedarefertilizersLiquidexempt 1S lessoffertilizertheeachfornotdoes7exceedquantttyconsecutiveanddaysstorageperiodapplication mixturethelabelfertilizerthehasaIthan90Iatoneandcontainertime,gallons any to the California Fire Code. inventory kerosene),inert (diesel,liquids (propane) Warning SiteRemote Exemption andsecured1SThearea.facilityanlnremoteA1Ssiteasunstaffedanlocatedpopulatedsparselyisolated,defined facility cubic500lessthanlsorto1SsiteifhazardoustheequalmaterialaccessnottoibletheremoteAexemptpublic. 200fuelsourcetueloil,combustibleof used aas500offeetgasesgallonscompressed of1and,200500ofand gallonsfluids,of ln closed containers,lubricating hydraulicgallonsgallonselectrolytes PlanBusinessMaterialsone-a timeThesubmit HazardousmustflammableASusedfuelasourcefacilrtygas materialshazardousformaintainedandformmustbeRemoteSiteaandslgnspostedExemptioncomplete Retail Exemption Hazardous materials packaged for retail sale are exempt if hazardous materiats are contained solely in a consumer product foi Aireci distribution to, and use by, the general public (unless the administering agency determines that a Business Plan is needed ior a specific business, due to public health, safety or environmental concerns San Luis Local Please submit all forms to one of the following: Within San Luis Obispo citv limits: For agricultural businesses: City Fire Department San Luis Obispo County 2160 Santa Barbara Avenue Department of Agriculture San Luis Obispo, CA9340l-5240 2156 Siena Way, Suite A (805) 781-7380 San Luis Obispo, CA 93401 (805) 781-s910 All other citigs or unincorporated areas: San Luis Obispo CountY Division of Environmental Health PO Box 1489,2156 Siena WaY San Luis Obispo, CA 93406 (8os) 781-5s44 \\caolysvro392\pe_server\Environmental\Business Plans\sLo\B P Reporting Requirements.doc 02102/10 KLOTONYA HRI'IILTON818 947-4957 UPS - VAN NUYS 15@@@ nRItINTn ST VNN NUYS CA 91406 SHIP TO: CITY FIRE DEPRRTI'IENT 2160 SRNTA BRRBRRR RVE SAN LUIS OBISPO 0,0 LBS LTR 1 oF 1 cR 93401 -5240 cfl 93{ 0-28 ililililtIilililtililIil]t UPS NEXT DHY HIR TRfiCKING H: lZ 778 5tl0 @1 9l3O 7762 BILLING: P/P I cs 12.o.26 t|xPtE60 03.oA a4l2410 TM ffi\? ITFLEII UNIF'IED PROGRAM CONSO LIDATED F'ORM F'ACILITY INFORMATION BUSINESS A CTIVITIES I. F'ACILITYIDENTIF'ICATION (Agency Use Only) ID#F A 0 0 0 4 8 1 0 ID #Waste 98CAD 664022BUSINESSas Facility NameAME Business SITE IS OBISSITE CITY 104 CA 1 r05ZIPII.ACTIVITIES IfOTE:N u check toYESyo thisofpartany list, bmitsu the Busin ess r Identification Does faci IfY of the UPCFthese A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal thieshold 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 to l0 CFR Parts 40 or 70?ls E] YES HAZARDOUS MATERIALS INVENTORY * CHEMICAL DESCRIPTION Have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental Release B. REGULATED SUBSTANCES Program fl ves Coordinate with your local agency responsible for CalARP. STORAGE TANKS (USTs) Own or operate underground storage tanks? C. UNDERGROUND fives UST FACILITY (Formerly SWRCB Form A) UST TANK lone page per rbk) (Fomerly Fom B)D. ABOVE GROT]ND PETROLEUM STORAGE Own or operate ASTs above these thresholds: Store greater than 1,320 gallons ofpeholeum products (new or used) in aboveground tanks or containers.I ves NO FORM REQUTRED TO CUpAs Treatment subject to financial assurance requirements (for permit bv Rule and Conditional Authorization)? Consolidate hazardous waste generated at a remote site? E. HAZARDOUS WASTE Generate hazardous waste? Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? Treat hazardous waste on-site? Need to report the closure/removal of a tank that was classified &S hazardous waste and cleaned on-site? Generate in any single calendar month 1,000 kilograms (kg) e,200 pounds) or more of federal RCRA hazardous waste, or generate in any single calendar' month, or accumulate at any time, I kg (2.2 pounds) of RCRA acute hazardous waste; or generate or accumulate at any time more than 100 kg (220 pounds) of spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (FIHW) Collection site? E YES fl ves [] ves I ves I ves flyEs ! ves ! vns EPA ID NUMBER - provide at the top of this page RECYCLABLE MATERIALS REPORT (one per recycler) ON-SITE HAZARDOUS WASTE TREATMENT_ FACILITY ON.SITE HAZARDOUS WASTE TREATMENT - IINIT (one page per unit) CERTIFICATION OF FINANCIAL ASSURANCE REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Obtain federal EPA ID Number, file Biennial Report (EPA Form 8700- 13AlB), and satisfu requirements for RCRA Large Quantity Generator. See CUPA for required forms. F. LOCALREQUIREMENTS (You may also be required to provide additional infomation by your CUpA or local agency.) t5 UPCF Rev. (1212007) F'ORM S - SAN LUIS OBISPO COUNTY CERTIF'IED UNIF'IED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) UNITED PARCEL SERVICE BUSINESS PHONE 8055447184 BUSINESS SITE ADDRESS 3601 SACRAMENTO DR SAN LUIS OBISPO CITY CA ZIP CODE 93401 San I.uis Obisno COUNTY 0HftBEF"o'"tBt5Lo#iUS'" BUSINESS OPERATOR PHONE 8055447184 II. BUSINESS OWNER UNITED PARCEL SERVICE OWNERNAME OWNERPHONE 5594422925 OWNER MAILING ADDRESS 1601 W. McKinley Ave CITY Fresno STATE CA ZIP CODE 93728 III. ENVIRONMENTAL CONTACT CONTACTNAME Anthony Delgadillo CONTACTPHONE 6268146269 CONTACT MAILING ADDRESS 1100 N. Baldwin Park Blvd CITY Baldwin Park STATE CA ZIP CODE 91706 IV. EMERGENCY CONTACTS -SECONDARY--PRIMARY- NAME Cortez, Richard NAME Barksdale, Maurice CENTER MANAGER TITLE TITLE SUPERVISOR BUSINESS PHONE 8055447184 BUSINESS PHONE 5594422925 PAGER # / CELL PHONE # 24.HOIJR PHONE , ^uBR # / CELL PHONE # 24-HOUR PHONE Rnr'^ - ADDITIONAL LOCALLY COLLECTED INFORMATION Certification: Basedonmyinquiryofthoseindividualsresponsibleforobtainingtheinformation,Icertifuunderpenaltyoflawthatlhavepersonallyexaminedand arn familiar with the inforrnation submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE Submitted via Public Portal 01t07t2010 DATE NAME OF DOCTJMENT PREPARER Klotonya Hamilton NAME OF SIGNER furint) Noel Massie District Manager TITLE OF SIGNER FORM I _ SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL II\'VENTORY EADD !DELETE I.FACILITY INF'ORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business A0 U N ITED PARCEL SERVICE -.-. t CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA E YES fl No FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INF'ORMATION .HEMI.ALNA" Lu bricant oi I TRADESECRET !Yes ENo IfSubject to EPCRA, refer to instructions coMMoN NAME Lubricant Oil EHS*E Yes EI No CAS#*If BHS is "Yes", all amounts below must be in lbs, FIRE CODE HAZARD CLASSES (complete if required by CUPA) Combustible Liquid, Class lll-B HAZARDOUS MATERIAL TYPE E a. PURE EI b. MIXTURE E c. WASTE (Check one item only)RADIOACTIVE EYes ENo CURIES PHYSICAL STATE E A. SOLID E b. LIQUID EI C, GAS (Check one item only) LARGESTCoNTAINER 1 1 0.0 FED HAZARD CATEGORIES E A. FIRE E b. REACTIVE ! C. PRESSURE RELEASE fI d. ACUTE HEALTH E e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT 55.0 MAXIMUM DAILY AMOIJNT 110.0 ANNUAL WASTE AMOUNT 1500.0 STATE WASTE CODE 221 UNITS* (Check one item only) Sa. GALLONS Iu. cuucrneT E c. POUNDS *If EHS, amount must be in pounds. [f d. roNS DAYS oNrttu,365.0 STORAGE-___- EIA. ABOVE GROUND TANK CONTAINER Eb,UNDERGROUNDTANK E C. TANK INSIDE BUILDING E d. srEEL DRUM E e. PLASTICNONMETALLIC DRUM E i. FIBER DRUM EJ. BAG E k. Box E I. CYLINDER E m. GLASS BOTTLE f CAN g. CARBOY h. SILO trtr n. PLASTIC BOTTLE o. TOTE BIN trtr q. RAIL CAR r. OTHER I p. TANK WAGON STORAGE PRESSURE E A, AMBIENT E b. ABOVE AMBIENT E c, BELOW AMBIENT STORAGE TEMPERATURE E A. AMBIENT E b. ABOVEAMBIENT E c. BELOW AMBIENT E d. cRYocENtc o/oWT I{AZARDOUS COMPONENT (For mixture or waste only)EHS cAs # t 9o.o Lubricating Base Oil fives [No 2 5.0 Distillates, Hydrotreated E Yes E tto 3 5.0 Solvent Eves DNo 4 Eves ENo 5 lves [No If more haznrdous comDonents are present at greater than 17. by weight if non-c{rainogenic' or 0.1 7o by weight ifcarcinogenic, attach additional sheets ofpaper capturing the required informltion. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA, Ple ase Siqn Here FORM I - SAN LUIS OBISPO COUNTY CERTIFIED UNIF'IED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY material NADD !osI-BIE I. FACILITY INFORMATION BUSINESSNAME(SameasFACILITYNAMEoTDBA-DoingBusinessAs) UNITED PARCEL SERVICE CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES IJNO CHEMICAL LOCATION FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INF'ORMATION CHEMICALNA'" ETHYLE N E G LYCOL TRADESECRIT IYes ENo IfSubiect to EPCRA, refer to instructions EHS*!Yes ENo COMMONNAME ANTIFREEZE *If EHS is "Yes", all amounts below must be in lbs' cAS# 107_21-1 FIRE CODE HAZARD CLASSES (completeif requiredbyCUPA) lrritant (lrr) RADIOACTIVE Elves ENo CURIESHAZARDOUS MATERIAL TYPE (Check one item only)E a. PURE E b. MIXTURE E c. WASTE LARGESTcoNTAt*u* 55.0PHYSICAL STATE (Check one itern only)E a. SOLID E b. LIQUID E c. GAS FED HAZARD CATEGORIES (Check all that apply)E A. FIRE E b. REACTIVE E C, PRESSURE RELEASE E d. ACUTE HEALTH E s. CHRONIC HEALTH ANNUAL WASTE AMOUNT 275.0 STATE WASTE CODE 134 AVERAGE DAILY AMOUNT 35.0 MAXIMUM DAILY AMOUNT 55.0 DAYSoNtttu 365.0TJNITS* (Check one itern only) Iu. cuarcrner E c. PoUNDS *If f,HS, amount must be in pounds. [la. GALLONS E d. roNs b. UNDERGROUND TANK c. TANK INSIDE BUILDING d, STEEL DRUM E e. PLASTIC/NONMET EtcarI g. CARBOY E h. sILo tr trtrtr j k, l. n. PLASTIC BOTTLE o. TOTE BIN p. TANK WAGONCYLINDER DRUME a. ABOVE GROIIND TANKSTORAGE CONTAINER E q. RAIL CAR E r. OTHER i. FIBERDRUM E M. GLASS BOTTLE BAG BOX EI A. AMBIENT E b, ABOVE AMBIENT D c. BELOW AMBIENTSTORAGE PRESSURE STORAGETEMPERATURE [I A. AMBIENT EI b, ABOVEAMBIENT I c. BELOW AMBIENT E d, CRYOGENIC EHS CAS #%wr HAZARDOUS COMPONENT (For mixture or waste only) 107-21-1Ethylene Glycol Eves ENot gs.o E Yes ll No 7732-18-55.0 2 Water 3 EI ves E No ! ves I t.to 4 5 lves flNo ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sisn Here FORM I - SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY material bu or !nno EDELETE I. FACILITY INFORMATION BUSINESSNAME(SameasFACILITYNAMEoTDBA-DoingBusinessA9 UNITED PARCEL SERVICE CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES DNO FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INFORMATION CHEMICALNA*' PETROLE U M HYDROCARBON TRADESECRET IYes ENo IfSubject to EPCRA, refer to instructions COMMONNAME DIESEL FUEL EHS*EYes ENo cAS# 68476_34_6 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD (Complete ifrequired by CLIPA) Combustible Liquid, Class ll (1.1 ll), Flammable Liquid, Class l-A (3.3 l-A), lrritant (lrr) HAZARDOUS MATERIAL TYPE E A. PURE E b. MIXTURE E C. WASTE(Check one itern only) RADI0ACTIVE EIYes ENo CURIES PHYSICAL STATE E a. SOLID E U. I-iQUIO E c, GAS (Check ono itern only) LARGESTCONTATNER 1 2000.0 FED HAZARD CATEGORIES E A. FIRE E b, REACTIVE E C. PRESSURERELEASE E d, ACUTEHEALTH E e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT 550.0 MAXIMUM DAILY AMOUNT 10800.0 ANNUAL WASTE AMOUNT STATE WASTE CODE 213 TJNITS*[la. GALLONS !u. cunrc nenr E c. PouNDs *If EHS, amount must be in pounds. E d. roNS (Check one itern only) DAYS oN tttt' 365.0 STORAGE CONTAINER E a. ABOVE GROUND TANK E e. PLASTICNONMETALLIC DRUM EtcaNI g. CARBOY E h. srl-o u i. l ltsLiR DRUM tr tr E]tr rn. GLASS BOTTLE n, PLASTIC BOTTLE o. TOTE BIN p. TANK WAGON trtrtr b, UNDERGROUND TANK c. TANK INSIDE BUILDING d. STEEL DRUM El j. BAc E k. Box E l. CYLINDER fl q. RAIL CAR I r. OTHER STORAGE PRESSURE @A.AMBIENT Eb,ABOVEAMBIENT E c, BELOW AMBIENT STORAGETEMPERATURE E A. AMBIENT E b. ABOVEAMBIENT E c. BELOW AMBIENT E d, CRYOGENIC %wr HAZARDOUS COMPONENT (For mixture or waste only)EHS CAS # t 99.s DIESEL FUEL Eves DNo 68476-34-6 2 0.5 NAPHTHALENE EYes ENo 91-20-3 3 Eves ENo 4 EYes ENo 5 lves [No componen{s are present than 17' by weight or attach additional sheets paper ADDITIONAL LOCALLY COLLECTED INFORMATION If F.PCRA Pleqse Siqn lfere F'ORM I - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY mrterifll or f]ADD EoeI-Btg E I. F'ACIT,ITY INFORMATION BUSINESSNAME(SameasFACILITYNAMEoTDBA-DoingBusinessAs) UNITED PARCEL SERVICE 1 CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES flNo FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INFORMATION CHEMICALNA*' S P E NT ANTI- F RE EZE TRADESECRET IYes ENo If Subjcct to EPCRA, refer to instructions COMMON NAME SPENT ANTI-FRE EZE EHS+lYes ENo cAs# 107_21_1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Irritant (lrr) HAZARDOUS MATERIAL TYPE (Check one item only)E A, PURE E b. MIXTURN E C. WASTE RADI0ACTIVE Eves ENo CURIES PHYSICAL STATE (Check one item only)E A, SOLID E b. LIQUID E C, GAS LARGESTcoNTA'tt* 55.0 FED HAZARD CATEGORIES (Check all that apply)E A. FIRE E U. NSACTIVP D C. PRESSURERELEASE E d. ACUTEHEALTH E e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 20.0 MAXIMUM DAILY AMOUNT 55.0 ANNUAL WASTE AMOUNT 275.0 STATE WASTE CODE 134 UNITS* (Check one item only) fia. GALLONS ! u. cuerc neer E c, POUNDS *IfEHS, amount must be in pounds. E d. TONS DAYS oNtttt'365.0 STORAGE CONTAINER trtrtr EI a. ABOVE GROUND TANK b. IJNDERGROIJND TANK c. TANK INSIDE BUILDING d. STEEL DRUM EI e. PLASTIC/NONMETALLIC DRUM E i, FIBERDRUM Elj. BAG E k. Box E I, CYLINDER E m, GLASS BOTTLE E n. PLASTIC BOTTLE E o. TOTE BIN I p. TANK WAGON f. CAN g. CARBOY h. SILO q. RAIL CAR r. OTHER STORAGE PRESSURE @ a, AMBTENT E U. aSOVpaVeInNr fl c. BELOW AMBIENT STORAGETEMPERATURE EI A. AMBIENT E b. ABOVEAMBIENT fl c. BELOW AMBIENT E d. CRYOGENIC ohwr IIAZARDOUS COMPONENT (For mixture or waste only)EHS cAs # t t oo.o SPENT ANTI-FREEZE Eves DNo 2 lves [No 3 EYes ENo 4 [Yes [No 5 lves [No If more hazardous comltonents are present at greater than 17. by weight if non-carcinogenic, or 0.1yo by ifc{rcinogenic, attach addifional sheets ofpnper capturitrg the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sisn Here F'ORM I - SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY material or REVISEEADDIDELETE I. F'ACILITY INF'ORMATION BUSINESSNAME(sameasFACILIrYNAMEorDBA-DoingBusinessAs) UNITED PARCEL SERVICE -l CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES ENo CHEMICAL LOCATION MAP#GRID#FACILITY ID # (Agency use only) FA0004810 II. CHEMICAL INFORMATION TRADESECRET IYes ENo IfSubject to EPCRA, refer to instructions CHEMICAL NAME - - Toxic Solids EHS*EYes ENo coMMoNNAME Lab Pack _ Package Generated Waste *If EHS is "Yes", all amounts below must be in lbs. cAS# N/A FIRE CODE HAZARD Toxic (Tox) (Complere ifrequired by CIJPA) CURIESRADIoAcrtvE Eves flttoE a. PURE I] b. MIXTURE E c. WASTEHAZARDOUS MATERIAL TYPE (Check one itern only) L.ARGESrcoNrAt*t* 55. 0El a. S0LID E b. LIQUID E c. GASPHYSICAL STATE (Check one item only) E A. FIRE E b. REACTIVE ! C, PRESSURERELEASE E d. ACUTEHEALTHFED HAZARD CATEGORIES E e. CHRONIC HEALTH (Check all that apply) STATE WASTE CODE 213,352 ANNUAL WASTE AMOUNT 1 10.0 AVERAGE DAILY AMOUNT 55.0 MAXIMUMDAILY AMOUNT 55.0 DAYS oN tttu' 365.0UNITS* (Check one itern only) !t. cuntc nEer tr c. POUNDS *If EHS, amount must be in pounds. E o, roNsfr a. GALLONS C/NONMETALLICDRUM T] i. FIBERDRUM E m. GLASS BOTTLE E n, PLASTIC BOTTLE E o. TOTE BIN I p. TANK WAGON b. IJNDERGROUND TANK c. TANK INSIDE BUILDING d- STEEL DRUM EtcauI g. cARBoY E h. SILO J. BAG K. BOX I. CYLINDER CONTAINER q. RAIL CAR r. OTHER E A. AMBIENT E b. ABOVE AMBIENT E c. BELOW AMBIENTSTORAGE PRESSURE STORAGE TEMPERATURE @ A. AMBIENT E U. ABOVP AMSIBNIT E c. BELOW AMBIENT E d. cRYocENIc EHS CAS #IIAZARDOUS COMPONENT (For mixture or waste only)o/oWT flves [Not t oo.o Toxic Solids EYes ENo2 E ves El NoJ Eves ENo4 lves []No5 Foehma"dosmmpo'"nt""."p""/ob'weightifcarcinogenic,{ttachadditionalsheetsofpflpefcapturingtherequiIedinformation. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA, Please Siqn Hqe FORM I _ SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY r mrterial or NADD floelprr I. F'ACILITY INFORMATION BUSINESSNAME(sameasFACILIrYNAMEorDBA-DoingBusinessA') UNITED PARCEL SERVICE CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES fJNo FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INFORMATION CHEMICAL NAME \"""'" Corrosive Liquids TRADESECRET flYes ENo IfSubject to EPCRA, refer to instructions coMMoNNAME Lab Pack _ Package Generated Waste EHS*EYes ENo cAS# N/A *If EHS is "Yes", all amounts below must be in lbs, FIRE CODE HAZARD CLASSES (Complete if required by cuPA) Corrosive (CORR) HAZARDOIJS MATERIAL TYPE E a. PURE E b. MIXTURE E c. WASTE(Check one item only)RADIoAcrtvE EYes ENo CURIES PHYSICAL STATE E a. SOLID E b. LIQUID E c. GAS(Check one itern only) LARGESTCoNTAt*E* 55.0 FED HAZARD CATEGORIES E A. FIRE E b. REACTIVE fl C. PRESSURERELEASE E d, ACUTEHEALTH E e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT 55.0 MAXIMUM DAILY AMOUNT 55.0 ANNUAL WASTE AMOUNT 55.0 STATE WASTE CODE UNITS*@a. GALLONS !u. cunrc nerr E c. POUNDS *If EHS, amount must be in pounds, E d, roNS (Check one item only) DAYS oN tttu' 365.0 STORAGE CONTAINER E a. ABOVE GROUND TANK E e, PLASTICNONMETALLIC DRUM E i. FIBERDRUM E m. GLASS BOTTLE E n. PLASTIC BOTTLE E o. TOTE BIN I p. TANKWAGON b. UNDERGROUND TANK c. TANK INSIDE BUILDINC d- STEEL DRUM ErcaN I g. CARBOY E n. str,o trtrtr J. BAG K- BOX I. CYLINDER q. RAIL CAR r. OTHER STORAGE PRESSURE EI A. AMBIENT E b. ABOVE AMBIENT I c. BELOW AMBIENT STORAGE TEMPERATURE SI A. AMBIENT E b. ABOVE AMBIENT E c. BELOW AMBIENT E d. cRYocENIC %wr HAZARDOUS COMPONENT (For mixture or waste only)EHS CAS # t t oo.o Corrosive Liquids lves [No 2 ! ves fl No 3 E ves E tto 4 EYes ENo 5 lves [No tr.oet'aia"owo-po'u't.a""p"@oi0.l%byweightifcarcinogenic,attachaddition{lsheetsofpapercaptuIingtherequiredinformation. ADDITIONAL LOCALLY COLLECTED INFORMATION lf I'.PaR A Plpqcc Sion ff ere i F'ORM I - SAN LUIS OBISPO COUNTY CERTIFIED UNIF'IED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY or !ADD EDELETE I. FACTLITY INF'ORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) U N ITED PARCEL S ERVICE CONFIDENTIAL EPCRACHEMICAL EYES ENO CHEMICAL LOCATION FA0004810FACILITY ]D # (Agency use only) II. CHEMICAL INF'ORMATION IfSubject to EPCRA, refer to instructions SECRET Yes Corrosive SolidsCHEMICAL EHS*El Yes E NoLab Pack - Package Generated WasteCOMMON *If EHS is "Yes", all rmounts below must be in lbs'N/A (Complete ifrequired by CIJPA)FIRE CODE HAZARD Corrosive (CORR) CURIESRADIoACTIVE E Yes ENoHAZARDOUS MATERIAL TYPE (Check one itern only)E a. PURE E b. MIXTURE E c. WASTE LARGESTCoNTAI*"* 55.0E a. SOLID E b. LIQUID E c. GASPHYSICAL STATE (Check one itern only) EI A. FIRE E b. REACTIVE E C. PRESSURERELEASE fI d. ACUTE HEALTHFED HAZARD CATEGORIES E e. CHRONIC HEALTH (Check all that apply) STATE WASTE 181 WASTE AMOUNT 110.0 AMOUNT 55.0 AVERAGE DAILY 30.0 365.0DA UNITS* (Check one itern flr. cuetcreer ! c. PoUNDS [f d. roNS[la. GALLONS *IfEHS, amount must be in E b. UNDERGROUND TANK tl c. TANK INSIDE BUILDING B d. srEEL DRUM ErcaN E g. CARBOY E h. srlo E j. BAc E k. Box E I. CYLINDER trtrtr n. PLASTIC BOTTLE o. TOTE BIN p. TANK WAGON e,i. FIBERDRUM m.BOTTLEa.GROUND TANKSTORAGE CONTAINER q. RAIL CAR r. OTHER B A. AMBIENT E b. ABOVE AMBIENT E o. BELOW AMBIENTSTORAGE PRESSURE STORAGETEMPERATURE EA.AMBIENT Eb.ABOVEAMBIENT E d. cRYocENICE c, BELOW AMBIENT CAS #EHSF{AZARDOUS COMPONENT (For mixture or waste only)OAWT E ves E ttoCorrosive Solidst t oo.o Eves ENo2 Eves ENo3 [Yes [No4 flves [No5 components are present at greater or papercarcrnogenrc,more ADDITIONAL LOCALLY COLLECTED INFORMATION l FORM I _ SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY material or !ADD IDELETE I. F'ACILITY INFORMATION BUSINESSNAME(sameasFACILIrYNAMEorDBA-DoingBusinessAs) UNITED PARCEL SERVICE CHEMICAL CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES flNo FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INF'ORMATION .HEMICAL"^*' Flammable Liq u ids TRADESECRET EYes ENo IfSubject to EPCRA, refer to instructions coMMoNNAME Lab pack _ package Generated waste EHS*DYes ENo cAS# N/A *If EHS is((Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete if required bv CUPA) Flammable Liquid, Class I-A (3.3 l-A) HAZARDOIJS MATERIAL TYPE E a. PURE E b. MIXTURE E c, WASTE(Check one itern only)RADIoACTIVE Elves ENo CURIES PHYSICAL STATE E a. soLID E U. r.rQUIp E c. GAS(Check one itern only) LARGESrcoNrot*"* 55.0 FED HAZARD CATEGORIES E A. FIRE E b. REACTIVE E C, PRESSURE RELEASE E d. ACUTE HEALTH I e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT 50.0 MAXIMUM DAILY AMOUNT 55.0 ANNUAL WASTE AMOUNI' 1 10.0 STATE WASTE CODE 212,213 UNITS*S a. GALLONS Iu. cuarc nerr E c. POUNDS *If EHS, amount must be in pounds. E a. roNs (Check one item only) DAYSoNtttu'365.0 ;.plAsrlc,lxoNrraETALLIcDRUMEi'FIBERDRUM[m.GLASSBoTTLE CONTAINER trtrtr b. UNDERGROUND TANK c. TANK INSIDE BUILDING d. STEEL DRUM EtcaNI g. CARBOY E h. srl-o trtrtr j. BAG K. BOX I. CYLINDER trtrtr n, PLASTIC BOTTLE o. TOTE BIN p. TANK WAGON I q. RAIL CAR E r. OTHER STORAGE PRESSURE EI A. AMBIENT E b. ABOVE AMBIENT I c. BELOW AMBIENT STORAGE TEMPERATURE @ A, AMBIENT E b. ABOVE AMBIENT I c. BELOW AMBIENT E d. CRYoGENIC o/oWT IIAZARDOUS COMPONENT (For mixture or waste only)EHS CAS # t t oo.o Flammable Liquids flves [No 2 Eves ENo 3 EYes ENo 4 lves [No 5 EYes ENo * If more hazardous components are greator than l7' by weight if non-carcinogenic, or 0.1 7o by weight if crrcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sisn Here I F'ORM I - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY material nelo EDELETE REVISE I. F'ACILITY INF'ORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) UN ITED PARCEL SERVICE CHEMICAL LOCATIONa.t CHEMICAL LOCATION EYES flNo FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INF'ORMATION .HEMICALNA*' Flammable Sol ids TRADESECRET fIYes ENo IfSubject to EPCRA, refer to instructions coMMoNNAME Lab Pack _ Package Generated Waste EHS*El ves E tlo cAS# N/A *If EHS is'iYes", all amounts below must be in lbs' FIRE CODE HAZARD (Complete ifrequired by CIJPA) Flammable Solid (3.1) HAZARDOIJS MATERIAL TYPE EA,PURE Eb.MIXTURE EC,WASTE(Check one itern only) RADIOACTIVE Eves ENo CURIES PHYSICAL STATE E a. SOLID E b. LIQUID E c. GAS(Check one item only) LARGESTcoNTAt*t* 55.0 FED HAZARD CATEGORIES EI A. FIRE E b. REACTIVE E C. PRESSURERELEASE E d. ACUTEHEALTH E e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT 50.0 MAXIMUM DAILY AMOUNT 55.0 ANNUAL WASTE AMOUNT 165.0 STATE WASTE CODE 212,213,272 LINITS+ (Check one itern only) fia. GALLONS !t. cunrc naEr E c. POUNDS *IfEHS, amount must be in pounds. E d. TONS DAYS oN t'tt' 36s.0 fficnouNoreNrCONTAINER Eb.UNDERGROUNDTANK E c, TANK INSIDE BUILDING E a. srPpl onuv E e. PLASTICNONMETALLIC DRUM E i. FIBER DRUM tr j. BAc E k. Box E I, CYLINDER E m. GLASS BOTTLE trtrtr f. CAN g. CARBOY h. srl-o n. PLASTIC BOTTLE o. TOTE BIN p. TANK WACON E q. RAIL CAR E r. OTHER STORAGE PRESSURE @ A. AMBIENT E b. ABOVE AMBIENT E c. BELOW AMBIENT STORAGETEMPERATURE E A. AMBIENT E b. ABOVEAMBIENT I c. BELOW AMBIENT E d. cRYocENIc %wr HAZARDOUS COMPONENT (For mixture or waste only)EHS CAS # t t oo.o Flammable Solids EYes DNo 2 fives lxo 3 Eves ENo 4 E Yes E trto 5 I ves I t'to are Jrresent at greater than l9lo required information,OI attoch p{per ADDITIONAL LOCALLY COLLECTED INFORMATION If F'.PCRA- Please Siqn Here F'ORM I _ SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY mflterial or Eeoo EDELETE E I. FACILITY INF'ORMATION BUSINESSNAME(SameasFACILITYNAMEoTDBA-DoingBusinessAs) UNITED PARCEL SERVICE CHEMICAL LOCA CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES f]No FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INFORMATION CHEMICALNAME- Other Regulated Substances, Liquid TRADESECRET IYes ENo IfSubject to EPCRA, refer to instructions coMMoNNAME Lab pack _ package Generated waste EHS*! Yes D tlo CAS#*If EHS is "Yes", all amounts below must be in lbs' FIRE CODE HAZARD CLASSES (complete if required by cuPA) HAZARDOUS MATERIAL TYPE E a. PURE EI b. MIXTURE EI c. WASTE(Check one itern only)RADIOACTIVE EYes ENo CURIES PHYSICAL STATE E a. SOLID E b, LIQUID E c, GAS(Check one itern only) LARGESrcoNrott.* 55.0 FED HAZARD CATEGORIES (Check all that apply)E A. FIRE E b. REACTIVE ! C. PRESSURERELEASE E d. ACUTEHEALTH ! e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 27.0 MAXIMUM DAILY AMOUNT 55.0 ANNUAL WASTE AMOUNT 1 10.0 STATE WASTE CODE 343 IINITS* (Check one item only) fi a. GALLONS Iu. cuntc rerr E c. POUNDS *If EHS, amount nust be in pounds, E d. roNS DAYSoNtttu'365.0 DRUM E m. GLASS BOTTLE E n, PLASTIC BOTTLE E o. TOTE BIN El p, rANK WAGoN CONTAINER E b. UNDERGROUND TANK E c. TANK INSIDE BUILDING E d. STEEL DRUM f. CAN g. CARBOY h. SILO EIj. BAc E k. Box E I. CYLINDER E q, RAIL CAR E r. OTHER STORAGE PRESSURE fi A. AMBIENT E b, ABOVE AMBIENT ! c. BELOW AMBIENT STORAGETEMPERATURE @ A. AMBIENT E b. ASOVE AVEIENT ! c. BELOW AMBIENT E d. CRYOGENIC o/oWT IIAZARDOUS COMPONENT (For mixture or waste only)EHS CAS # t t oo.o Other Regulated Substances, contaminated liquid Eves ENo 2 flves flNo J fives [No 4 fl ves fl tlo 5 fives [No eightifcarcinogenic,attachadditionsIsheetsofpapeIcapfuringtherequiredinformation' ADDITIONAL LOCALLY COLLECTED INFORMATION If F.P(.R A- Plecse Sion Here FORM I _ SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per buildi EREVISEIADDEoslnrs FACILITY INFORMATIONI. BUSINESSNAME(sameasFACILIrYNAMEorDBA-DoingBusinessAs) UNITED PARCEL SERVICE ir CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES fJNo CHEMICAL LOCA GRID#FA000481 0 MAP#FACILITY ID # (Agency use only) il. CHEMICAL INFORMATION TRADESECRET !Yes ENo IfSubject to EPCRA, refer to instructions CHEMICAL NAME -'Toxic Liquids EHS*IYes ENo coMMoNNAME Lab pack _ package Generated waste *If EHS is "Yes", rll amounts below must be in lbs' cAS# N/A FIRE CODE HAZARD CLASSES (Complete if required by CtrPA) Toxic (Tox) CURIESRADIOACTIVE EYes ENoHAZARDOUS MATERIAL TYPE (Check one item only)E A. PURE E b. MIXTURE E C. WASTE LARGESrcoNrAt"t* 55.0PHYSICAL STATE (Check one item only)E A. SOLID E U. I-IQUIO E C. GAS FED HAZARD CATEGORIES (Chock all that apply)E A, FIRE E b. REACTIVE I C. PRESSURE RELEASE E d. ACUTE HEALTH fl e, CHRONIC HEALTH STATE WASTE CODE 211 ANNI]AL WASTE AMOUNT 1 10.0 AVERAGE DAILY AMOUNT 50.0 MAXIMUM DAILY AMOUNT 55.0 DAYS oNtttu' 365.0UNITS+ (Check one item only) ! u. cuelc rneT E ", POUNDS *If EHS, amount must be in pounds, E a. roi'.tsfia, GALLONS rrcnouvBralllc DRUM E i. FIBER DRUM E m. GLASS BOTTLE E n, PLASTIC BOTTLE E o. TOTE BIN I p. TANK WAGON trtr E b. UNDERGROUNDTANK E T. CAN c. TANK INSIDE BUILDING E g. CARBOY d. STEELDRUM E h. stlo J. BAG K. BOX I- CYLINDER CONTAINER q. RAIL CAR r. OTHER s a. AMBTENT El b. esoVp evstpNr ! c. BELOW AMBIENTSTORAGE PRESSURE STORAGETEMPERATURE E A, AMBIENT N b. ABOVEAMBIENT ! c. BELOW AMBIENT E d. CRYOGENIC CAS #EHSo/oWT HAZARDOUS COMPONENT (For mixture or waste only) E ves El NoToxic Liquidst t oo.o lves [No1 E yes E tto3 Eves ENo4 lves [No5 Ifmore hazardous components are present at greater than 19lo by if non-carcinogenic, or 0.lyo by weight if carcinogenic, attach additional sheets of Jtaper caDturing the requir€d inlbrm{tion. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA, Please Siqn Here FORM I - SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY material NADD NDELETE I.F'ACILITY INFORMATION BUSINESSNAME(SameasFACILITYNAMEoTDBA-DoingBusinessAs) UNITED PARCEL SERVICE CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES T]No FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INFORMATION CHEM]CALNAME Other Regulated Substances, Solid TRADESECRET IYes ENo If Subject to EPCRA, refer to instructions coMMoNNAME Lab Pack - Package Generated Waste EHS*! Yes E tto cAS# N/A *If EHS is "Yes", all amounts below must be in lbs, FIRE CODE HAZARD CLASSES (complete if required by cl;PA) HAZARDOI]S MATERIAL TYPE EA.PURE Eb.MIXTURE EC.WASTE(Check one item only)RADIOACTIVE EYes Etto CIJRIES PHYSICAL STATE EI A. SOLID E b. LIQUID E C. GAS(Check one item only) LARGESrcoNrAttu* 55.0 FED HAZARD CATEGORIES (Check all that apply)E A. FIRE E b. REACTIVE E C. PRESSURERELEASE N d. ACUTEHEALTH E e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 50.0 MAXIMUM DAILY AMOUNT 55.0 ANNUAL WASTE AMOUNT 1 10.0 STATE WASTE CODE 352,561,221 UNITS+ (Check one item only) Sa. GALLONS Iu, cualc neer E c; PoUNDS *If EHS, amount must be in pounds, E d. TONS DAYS oN tttt' 365.0 UM E i. FIBERDRUM E M. GLASSBOTTLE CONTAINER b. UNDERGROUND TANK c, TANK INSIDE BUILDING d, STEEL DRUM trtrtr f. CAN g. CARBOY h. SILO EJ, BAG E k. Box E I. CYLINDER n. PLASTIC BOTTLE o. TOTE BIN p. TANK WAGON I q. RAIL CAR E r. OTHER STORAGE PRESSURE EJ a. AMBTENT E b, aSOVp al\4ereNr E c. BELOW AMBIENT STORAGETEMPERATURE @ A. AMBIENT E b. ABOVEAMBIENT I c. BELOW AMBIENT E d, CRYOGENIC YoWT HAZARDOUS COMPONENT (For mixture or waste only)EHS CAS # t t oo.o Other Regulated Substances, contaminated material Eves DNo 2 E ves Ef No J Eves ENo 4 I ves I tto 5 lves [No Iiightifnon-cnrcinogenic,or0.19/obyweightifc8'tinogenic,attachndditionalsheetsofpaperc{ptuIingtherequiredinform0tion. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA, Plearc $ier lere F'ORM I - SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY material or !ADD EDELETE F'ACILITY INF'ORMATIONI. BUSINESSNAME(SameasFACILITYNAMEoTDBA-DoingBusinessAs) UNITED PARCEL SERVICE CHEMICAL LOCATION CONFIDENTIAL EPCRA EYES rlNo CHEMICAL LOCA GRID#MAP#FACILITY ID # (Agency use only) FA0004810 II. CHEMICAL INFORMATION TRADESECRET !ves ENo IfSubject to EPCRA, refer to instructions .HEMICALNA*' oxid izing Liq u id EHS*IYes Etlo coMMoNNAME Lab Pack _ Package Generated Waste *If EHS is "Yes", all amounts below must be in lbs' cAS# N/A FIRE CODE HAZARD CLASSES (complete if required by cuPA) Oxidizer, Class 1 (4.3-1) CURIESRADIoACTIVE tlves ENoHAZARDOUS MATERIAL TYPE (Check one item only)E A. PURE E b. MIXTURE EI C. WASTE LARGESrcoNrAttt* 55.0PHYSICAL STATE (Check one itern only)E a. SOLID El b. LIQUID E c. GAS FED HAZARD CATEGORIES (Check all that apply)EI A, FIRE E b, REACTIVE E C, PRESSURE RELEASE EI d, ACUTE HEALTH E e. CHRONIC HEALTH STATE WASTE CODE 181 ANNUAL WASTE AMOUNT 110.0 MAXIMUM DAILY AMOUNT 55.0 AVERAGE DAILY AMOUNT 27.0 DAYS oN tttt' 365.0UNITS* (Check one itern only) !u.cunrcnorr Ec.POUNDS *If EHS, amount must be in pounds' D a. roNsSa. GALLONS E a. ABOVE GROUND TANK E b. UNDERGROUND TANK E c. TANK INSIDE BUILDING E d. STEEL DRUM f. CAN g. CARBOY h. SILO J. BAG K. BOX I. CYLINDER E m. GLASS BOTTLE E n. PLASTIC BOTTLE E o. TOTE BIN E p. TANKWAGON LI e. PLASTIC/NONML''I.STORAGE CONTAINER q. RAIL CAR r. OTHER ALLICDRUM E i. FIBERDRUM EA.AMBIENT EIb.ABOVEAMBIENT I c. BELOW AMBIENTSTORAGE PRESSURE STORAGETEMPERATURE S A. AMBIENT E b. ABOVEAMBIENT I c. BELOW AMBIENT E d. cRYocENIc CAS #EHS%wT HAZARDOUS COMPONENT (For mixture or waste only) Eves ENo' t oo.o Oxidizing Liquid I ves fl No ) El ves D Not lves [No4 flves [No5 oginii,attachadditionalsh€etsofpapercapfuringtherequiredinformation. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA, Please Siqn Here F'ORM I - SAN LUIS OBISPO COUNTY CERTIF'IED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY NADD DDELETE I.FACILITY INFORMATION BUSINESSNAME(SameasFACILITYNAMEoTDBA*DoingBusinessAs) UNITED PARCEL SERVICE CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA E YES [J NO FACILITY ID # (Agency use only) FA0004810 MAP#GRID# II. CHEMICAL INF'ORMATION cHEMIcAL*o" oxidizing solid, N.o.S.TRADESECRET !Yes ENo IfSubject to EPCRA, refer to instructions coMMoNNAME Lab pack _ Package Generated Waste EHS*!ves ENo cAS# N/A *If EHS is "Yes", all amounts below must be in lbs' FIRE CODE HAZARD CLASSES (complete if required by GIJPA) Oxidizer, Class I (4.3-1) HAZARDOUS MATERIAL TYPE (Check one item only)E A. PURE E b. MIXTURE E C. WASTE RADIOACTIVE EIYes ENo CURIES PHYSICAL STATE (Check one item only)E a. SOLID E b. LIQUID E c. GAS LARGESrcoNrAtt"* 55.0 FED HAZARD CATEGORIES (Check all that apply)EI A. FIRE E b. REACTIVE EI C. PRESSURE RELEASE EI d. ACUTE HEALTH E e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 50.0 MAXIMUM DAILY AMOUNT 55.0 ANNUAL WASTE AMOUNT 110.0 STATE WASTE CODE 181 UNITS* (Check one item only) fia. GALLONS Iu. cuntcruer E c. POUNDS *If EHS, amount must be in pounds. E d. roNS DAYS oN tttu' 365.0 iC PNUV Ef i, FIBERDRUM E M. GLASS BOTTLE CONTAINER E b. UNDERGROUND TANK EI c. TANK INSIDE BUILDING E d, STEEL DRUM f CAN g. CARBOY h. SILO trtr j. k. BAG BOX trtrtr n, PLASTIC BOTTLE o. TOTE BIN p, TANK WAGON E q, RAIL CAR E r. OTHER E I. CYLINDER STORAGE PRESSURE El a. AMBIENT E O. aSOVpaN{sleNt E c. BELOW AMBIENT STORACETEMPERATURE [I A. AMBIENT E b, ABOVEAMBIENT ! c. BELOW AMBIENT E d. CRYOGENIC %wr HAZARDOUS COMPONENT (For mixture or waste only)EHS CAS # I 100.0 Oxidizing Solid, N.O.S fives [No 2 fives lNo J E Yes tl No 4 lves [No 5 EYes ENo Ifmore hazsrdous conrDonents are Dresent at greater than l% by weight ifnon-cat.cinogenic, or 0.19lo by weight ifcarcinogenic, attach additional sheets ofpeper captuilng (he required informatron. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sisn Here