HomeMy WebLinkAboutSLOUNIFLOW_FS1 Admin iRC3926i Color_0147_001d.
r--cArrDJ utDe)(TH,<.gl1e{t
AD DRESS:\S.OO
S.(q- 7 tt
DATE R E ['1A.R KS )
z-ze-1(Pm t.xLz&, o^ fo.r OSf L.,*'.-"' Trrs"4€.*i
3 - //-?B /*r,"",!1"./ ()sT svrh)^ -l-l'i< .1-*n', ,tl/rt uta/o'y't.a^* ,/,r^l-J -77-s ,)*-
t*uy* t>-/.22./aa ,?n-a 2o,*. z:,t:/1'l,t\ /r't-n k t/- L"/ ,,/'n-ttt ,Ltt"a/nJ-oz"
7-/7.qe t z/z.z/4 s 'C:n-h'fr'.o-4r* e- lae.r A*-;J'J' lLu ./ no./o ,V9.
\|
/
I
I
j
i
r$
Date:
Time:
10
t-l 7'-cn
BUSINESSPLAN
EFW data
entry by:t ed Parce I LSe l.v C e
360r Sacr;rmen to EHS
ctw
la \t
tr
X{]FIRE
INSPECTED:PROGRATIIS
XE
trntr
Rouilne
Reinspecfion
Gomptatnt
Other
Xtr Buslners plan HW Generalor UST E acr Elcnr-nnp
REINSPECTION REOUIFED:No tr YEs E Buriness ptan E trw Gsnenrtor flacr Ecaunp
BFOr
BFO2
BPO3
TROr
TRO2
D aRor
D ERo2
T0r
Tl02
COMMENTS Co to http://www
Latitude:
N/AItrD
trtr
c,,nWA
NO
DtrD
YESffi,
W-W
dV
{
ry''
EtrDtr
tr
tr
/\
I
to obtain forms to comply with Bp0l-8p03,TROI andER0t
mifi
FACILITYREP
INSPECTOR:
C;\DOC
\Temp\c.lotus.notes.data\1 Page l.doc 24-Jtan-O6
min
FACILIWNAME.LI';i'r*i.i r''rr:cr''i-r' ii"'r ' 'r',i
-
ADDRESs: r-iiitli li:ic-:r,.;ru,r,
hAZARDOUS WASTE GEIYERATOR
EPAIDITIUMBER:
fiercdPermit:
Treatment
Equipment:
Antifreeze: t ,/' Others:
Lbs or safe
(average)
,$ dff; c:\DocUME-1\Repro\LocALS-1\Temp\c'lotus.notes-data\2-Hazardous
waste Generator.do c za-Jur.4 2o-Jul-o4
I
2156 Siera way
San Luis Obispo, CA 93406
@
P.O. Box 1489 39,?,fro'spo
ilf,??,'ilB:si::?"1'"'"-3."uan Luia oblsPo cA 93.01_5240
r&
0/19/2.C0q
CERTIFIED UNIF'IED PROGRAM AGENCY (cuPA)HAZAR DOUS MATE RIALS I NSPECTION FORMi
L {l a".rn" * li:30 il . rn.
N/Atrn!
!n
u
!
YES -af'
W
VW'
@'
{
NO BUSINESS PLAN
BPOT
BPO2
BPO3
i"TjffiJ51il:;o*'"' curr€nt' & availabre daring inspecrion (Hsc 2ss03.s, riue re cc]R 272s)
site rayouurac*;;;;,T:iffffi?ffii:r!tr,""fiT;::{?,;",,"*-, - - -l
TRAINING PLAN
Facility has appropriate trainrng program (Titre 19 CcR 2732 &22 ccR 66265.16)m:ff o**entation is mainrainJ;;:;;;;".rent personner (rire re ccR273z& 22ccR
TROI
TR02
EFW data
entry by:
CAS;in l,u.i r; tlir l.s xE clTY HRE
fl ens
Routine
Reinspection
Complaint!ri]-l Ce rri :i. .l-c;,1{: icr
XE
nu
OtheruringPROGRAMSINSPECTED:XEI Bustness ptan rtrI HW Generator ffi usr Elacr EceunpREINSPECTION REQUIRED:tr No DYES E Businees plan O nw Generator E usr Eacr [caune
tr
n
EROT
ERO2
trD {W
Co to
A
A
T0r
T02
COMMENTS
to obtain forms to BPOI.BPO3, TROI and ER0l
GPS Coordinates:Latitude:
min
INSPECTOR:
F'ACILITY REP:Flaaa gi
deg
1\Temp\c.lotus.
Page t.doc 24-Jan-O6
min
.\
I
FACILITY NAME:
NO i N/A
tr'
DATE:INSPECTOR
UNDERGROUND STORAGE TANK INSPECTION
REOUIREMENT cHsc
UT13 Site has a permit to operate.25284
Permit is kept on the premises.
UT15 Change of ownership is reported to the permitting agency within
30 days.25284{c)
Oontractor trained properly. Contractor has class A,C-
10,C34,C36, or C61 license?
UST system leak response plan
Facility maintains evidence of Financial Responsibility
UST System information forms (Form A&B) are on file, accurate
and entered into database.
ccR
TITLE 23
2712
25284.1(aX5XD)2637(bXlXB)
' 2632
25292
25286
Chapter 6.7 2637
263s(b)(1)
2635(bX1XC)
2631(dX4),
2634
2632(c)(2)(B),
2636(rX1)
25284.1(aXsXc)
2636(0(1) &
(g)
2636
2632
2632
UT19
F.
UT2O Facility has BOE number. lf not call 916'324-2166 to obtain.
Testing as required.containment
Certification.ELD
UT22 Overspill ners pass liquid lightness test, with no leak
drain valve. Containers without are tested
Overspill Container drain functional or alternative available.
L UT24 !
Secondary containment & overspill containers are liquid/ debris
free.
Console has proper leak detection and overfill
tr UT25 notification programming. Continuous alarm history is
maintained.
UT26 Audible and visual alarms functioning properly
Under Dispenser Containment (UDC) present.
UT28 i
UDC has approved operational leak detection equipped with
pump shut down.
UT29
UTSO
F'"
F/"
Fr'
tr
tr
Leak detection sensors are properly secured at lowest point in
sumps and tank annular spaces, at time of inspection.2641(al
Pumping system shuts otf when leak is detected or when the
monitor is disconnected or fails.
2636(fX4)
Line leak detectordetects 3.0 gph and is certified annually 2s284.1(a)(4)(C)2630(d),
UT33 Overfill prevention system installed and operational.2635
UT32
Emergency Shut Off switch (ESO) is functioning properly.
No liquid leaks visible.
UT36 Shear Valves are in place and functioni
UT37 Secondary Piping is open at the turbine and transition sumps.
tr tr UT38 i Fuelfilters managed properly
tr"UT39 : Monitoring system checked daily (Emergency generators only)
2632
2632
I zogo
25189.5(a)
2636(sxs)
YES
tr uE"
UT14
I F'
u tr
@"*
tr"-u fI
UT16
UT17
UT18
8"""n tr
UT21@"'utr
u
UT23
F"I tr UT27
F'tr
F tr tr
n @"-
i, Annual piping integrity test detects 0.1 gph. NA if yes on UT 18 iUT31
,{u tr
E''"tr;tr
w'EN UT34
Fn'.tr tr UT35
FI,
tr u F'
1
UT4O Monitoring Wells are maintained properly. CA Well Standards;
County Well Ordinance
'Title22
: 66262.23
: 66263.42
' 2632
tr tr : ur+t""iE'Documentation of hazardous and restricted waste disposal
A:\UST lnspection Report.doc 5-Feb-04
I
A.
(CopiesofMonitoringSystemCertificationformand.*it,:l'fl;f,',,o.,,.navailableat@,l
MONITORING SYSTEM CERTIFICATION
Authoritv ctted: chapter 6.r, H":i[f::Jglffi3':f"!{,i,:l;:;i3,"'r",1'l:;:{r,}u* u, carirornia code orRegulations
This form must be used to document testing and servicing of monitorrng equipment. A separate ce(ificatron or report must be prepared foreach monitoring svstem control panel ui in"- i.;r"iJian wlro performs ti" iu.,?r, A copy of t-r..,li iJi,ii .rrt be provided to the iani sysremowner/operator' The owner/op"tito' t'lt i;il';';py ot tnii torm to $,"-ro.ii'ug"n"y regurating usr systems within 30 days of t€st date.General lnformation
Facilily Name;Up,q
Blds.
Site Address:3601
City:San I lris
Facllity Contact person
Contact Fhone No.: i 818 ) 942:48g1.
Make/Model of Monitoring System:Tt s
B. lnventory of Equipment Testedlcertifiect
Dateof Testinglserviclng: .10 I 1g I 10
Eon
Plping Sump / Trench
Fill Sump Sensor(s).
Mechanicat Line Leak
Probe.Gauging
Sensor
X Senso(s).
Detector
Detector
Model:
2nF,
x ln-Tankx Annular Space or Vault
Eleclronic Line Leak
Tank Overfiil i High-Level Sensor.
Tank lD:
Model:
Model:
Model:
Model:
Model:
Eon
Fill Sump Sensor(s).
Mechanical Line Leak
ln-
Space Model:
Modeh
Detec{or Model;
Detector,Model:
Model:Other
Gauging Probe.: Annular or Vau[ Sensor
/ TrenchPiping Sump S€nsor(s). Model:
Eleclronic Line Leakl; Tank Ovedill /Hlgh-Lovel Sensor.
and model in
Tank lDl
Model:
Model:
Model:
Model:
Model:
Model:
Mod6l:
. ln-Tank
... Annular Space or Vault Sensor.
Piping Sump / Trench
Fill Sump Sensor(s).
Mechanical Line Leak
Sensor(s).
Detector
LineEleclronic Leak Delector
Tank Qverfill Hlgh-Level Sensot
Tank lD:
Model:
Model:
Model:
Model:
Model:
Model:
in
Probe.; ln-Tank
Tank lD:
Model:
oo1X Shear Valve(s).
and
Dbpenser lD:
l Shear Valve(s).
t.i Conlainmenl
; I Dlspenser
and
Shear Valve(s)
Ll
Shear Valve(s).
Dispenser lO:
: r Dispenser
:; Shear Valve(s).
Dl6penser lD:
Dispenser
Model:ContainmentDispenser Sensor(s)
Shear Valve(s).
Dlsponsor lD;
Cerrification No,
Tesling Company Name:
No.:902034
Testing Company Addressi
Phone No,:(,80S ) 929-8944
PaOe 1 of4
I
12t07
Monltodng System Csrtification
s Rr,l 9JAAN Date ofTesting/Seruicing: 10/18/10
2/21/07
)
D. Fesults ol Teating/Serviclng
Sofiware Version lnstalled: 325.02 .,. ,
tln
)
o No".JT Yes
No"
)r Yes t:r No'
( Yes No*
N/A
j,,t/ Yes No'
N/A
l..i
it
toa
nolso
equipmenlare
u
Qheokdetecls a fails lo
the lurbine
dlsconn6oted?ssnsolswhichorlseleculcallyyes:
moniioring slation,
shul-down due lo leaks 4gl sensor,,GumdTrenoh Sensors;
For
rt Dlspenser Conlalnmont Sensors. Did you conlirm
ll so,what percentis the
no
ls
tankassystem
th6atvisiblealarmaudibleand iank fill polnt(s) and operaling
Ll Yes
f Nt^
t_r No.
"rY No sensors, probes, or
atl that
.yes
0as
to set
l l Yes-
Li Yes*€iNo
,Jd- Yes l-r No:
ffi |oer rhanufdclulgis,sh€blf icatlons?
E. Commentsr
Page 2 of 4
2
Monitorlng system cdrtlllcallon 1U07
2l2r/07
F. ln-Tank Gauging / SIH Equipment: ri Ch€ck this box il tank gauging is used only for invenlory conlrol'
::li Check thls box if no tank gauging or SIR equlpment ls installed'
This section must be completed lt in.lank gauging equipment ls used to perform leak deteotion monltorlng,
r ln H;
G. Line Leak Detectors (LLD):
n
H, Comments
wele Wlllbe
n check this box if LLDs are not installed.
werg or
fatermilestingir Yes ii No*Hds all inputlwirin
I,: NO'W€re alltanhgaugirrt.: Yes
i.l Yes ll No-Wgs accgracy of sys
l. i Yes L] NO"Was aocurac system
n No-Were all protl Yes
i W-gr:e, Fll' t!ems,9n,!llE Yes E NO-
rYe;s !l No"
'.r N/A
or certiflcatlon, was a veiify ILD
that apply)leak g.P.h,; ,.r 0.1 g'P.h; l-l 0'2g'P,h,
-V Yes ii No'd and accurate
prop6ily.F Yes i. i No'
(Yes li
rl
No-
NiA
mechanibal product a
, does the turblne LLD detects al- I Yos n No'
fT N/An Yes n No-
r"Ef- N/A
lly shut any monitoring or
disoonnedted?
I Yos n No'
.(d- N/A
tho turbine any portton 0r
falls a test?
g Y€s E NO'
.tr/ N/A
all
"f Ygc t'l No'
Page 3 of 4
3
M onltorlng System Certitication 1UO7
2/2U07
)
UST SitP Plot
G #p{.h'rnlfie
Ei
EW
. .b'
,fu@t erl
q. lS,
,ffi: :
Vcx,.Mn AlIn000
)
Spill Bucket Testing Report Form
I'his form is inrended
'or
use by.contractors perlbrming.annuar resting of usrlrom tests (if applicablc), shoui<l be pro"id;i;';;'fu.,,,,,'wner/operator
for
spill containment structures, The cornpleted fornr and printoutssubmittal to the local regularory agcncy.
F,,I
2. TESTING CONTRACTOR TNFORMATION
3.
i lVacuum I lOther
Tcst Method Used:
l'est Uscd:
Equipment RcsolutionldentifySpilBucketTctnk(By I Diesel ,
3 4
Buckct Installation .lype:X Direct llury
Contained in
i Direct Bury
in Su ln
Direct Bury
llucket Diameter;
. lDirect Bury*l
lnI t"
Bucket Depth:t2"
timc bctwcen applying
l5 minutes
l'est Start Time (Tr):SEI]
(Rr):Initial Reading
Tcst End Time (Tr):INCON
(RF)l:inal Reading
(TrTestDuration Tr):RESULTS
tnChalge Reading (Rr Rr):-t-/-,002
Pass/Fail 'l'hreshold or Criteria:+/-.002
Tesf Result:lE Pass E Fail tr Pass tr Fell E Pass E Fail 0 Pass E I'ail
Facil Nanre:UPS
Date of t0/t8/10Faciliry Address 360r San Luis Obispo, CAFacility Conlact:David Ayala
8 I 8-947-483 IPhonc:
ta/]t/t0
Date Locnl wa.sAgency Notified of Tesling
Keny Boyle
(tf presentNamcofLocalInAgencyspector during testing):
Name:TB&Service Station Contractor
Aaron Shultz
Technician 'l'est:
Credentialsr:x CSLB Contractor
SWRCB Tank Tesrer ; lorher
x ICC Service 'l'ech.
9A2$4License Nu mber(s):
Com ments -on repairs nade lo and
I state laws
be more stri
and regulations clo not curently require testing to be performed by a quaritied conffactor. However, local requirerne'rs may
ngent.
5
2/21/07
CERTIFICATION OF TECI{NICIATV RESPONSTBLE FOR CONDUCEING THIS TESTTNG
r hereby-;;iEifi En;E'a:i -Clte iiiirnacion conEained in this report js true, aecutate,
in fuLl" conpl-ianee wiEh Tegal- reguiremenEs.
and
Technician's S
6 2/21/07
ea et rA,a -rF\-, \../ tlr olr
Site UPS
San Luis
aJ 60 1 Service B &T ceServi Station
Date:0/I 8/0
Technician Aaron Shultz Tech ber:Num 667#s2 95 UT
OF LEAK D E
Owner/Operator
TEST INFORMATION
n XLD 1 6-03 n 1FX D II 6-0s 4-sDnLD6-0 -57 I FX2BF LDitFX26-046-5N BFLD Mode I 6-039-5 FX-:l VI 6-s6-0s[l FX2D 1I 8-56-04tlBFLDII6-0 I FX2V I I 6-05nFX1DVI156-05 5DXLP6-03 5-5 il FX I DV II 6-0s 8-5NiI536-0 5nPLDII6-030-5 I FX2DV I 6-0s 9-5;1 FXIBF LDN FXI 116-047-s I FXI V I 6-051-sit
'l FX2V 1 6-052
Product Serial
Number
Openlng
Time
Metering
PSI/kPe Elcmcnt
Ilolding
PS/kPe
Test Leak
RttG
ML/Min
Prsg/Fail
Test Leek
Rate
ML/IIIn
Pump
PSI/kPr
Pressure
Diese.l t64A 3 sec 25 PSI I2 PSI 3 GPH Pass 28 PSI
(Signature)
(Date)
['559117 1p5
3'i0 t .$ACRAf,IENI0
SAI\I LUIS I}BIST,I]
805-544_7184
10/ 1812010 t2;d? Fft
SUrtP LE,,lji lE$I p,t?0Rt
IlstFlLl_
llsi. IiIARIfiD
IFST SIARIIII
BEtjIN I.TUEt. ENO IIflE
ENIJ OAIE
EtrtD LE/[t.
LFAK Iil^'ES'HOLt
IESI RF.$UII
1P":2i i.'y1
1()/18/2r0rc
5,946? lit
12i/l2 PH
t0/ls/2010
5,9458 tri
0,002 IN
i'ASSI[l
lii59d7 tJi,r-
JIiOI SAI.RAIIEIIItJ
SAr{ LUll} tJBI)-i..n
605-544,7i0"4
10/ jt,i?tlt i;j: p6 iri4
,SUI'IP LE'iEI" RfiPURi
SullP ljtirFlii. 5, g4ij lti
251i9$| p;5
3601 SAIIRAI,IFNTO
SAN IIJIS I]BISPO
805-g{4-7164
luilS/?010 12:57 py1
strlP i.tAt( ILSI fijiPtrRl
DSLFILL
Ifisr giARlt-u
TIST .STARIEIJ
8E0irJ t FrtL
ENO IifiE
6ND IIATI
FNO TTUEL
i.EAl( IilREsflril0
iTSi P,ESUL I
lti4A i.Tl'to/1U/20rc
5, s45g iil
12:57 py
t0/18/20\c
5,9457 iN
0, 'lc2 /lJ
PASSEO
A.
Appendix Vl
(Copies o{ Monitoring System Certification form and UST Monitorlng Plot Plan available at http://www.waterboAI]S..ca.gov,)
MONITORING SYSTEM CERTIFICATION
For lJse By Ail Jutisdlctions Wlthln {he Sfat€ of Calilornia
Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Dlvision 3, Title 23, Calilornia Code of
Hegulations
This lorm must be used to documenl testing and sorvicing ot monitoting equipment. A separate certltication or report must be prepared lor
each monitoring syslem control pansl by the technician who perlorms the work. A copy ol this lorm must be provided to the tank system
owner/operaiorl Tire ownerioperator mult submil a copy of this fgrm to the local ageney r€gulating UST systems within 30 days of t€st date.
General lnlormalion
Facility Name:
Site Address:3BO1 Sacramenlo
UPS Bldg. No.:_
copy of the rcporli rcheck all that aPply)'- ? $ystem
Technician Name (prinl): . Tino Ba.mirez Signatur€
(lertilrcilli0u No.:tl0{}9rr25 t I'f
Cltyr Qan I rric Ohieno
No.0al?r]1d
Phono Nojl-$!_l-- e?gq!!
Page 'l of 4
Ap:
Facllity Conlact Person:- ,.... Klelonve. Conlact Phone No.:( 2131
Maks/Model of Monitoring Syslernl TLS DateofTesting/Servicing: -J0 / 19 / Og
-
B.Equipm ent TestediGortilied
to indicat€
"lf the conlains mote or pensers, copy lhis information for every and disponser at the
C. Gertification ' I certity that lhe equipment identllied in thls document wa$ inspected/sorulced ln accordance tYlth the manutactulers'
guldellnes.Attached to this Certilicatlon is lnformation (e's.that lhis intormation is correcl
and a Plot Plan showing the lsyout ol monitoring equipment'reports, I have also attached a
set-u
Tesling Company Namo: ,
'f6sling Oompany Address 63r} S Fronlaoe Rd.
B&T Slalion
12JD7
1
r.l ln-Tank Gauging Probe.
l r Annular Spaoe or Vault Sensor.
., Piping SumplTrench Sensor(s).
., Fill Sump Senso(s).; Mechanical Line Leak Detector.. Electronic Line Leak D€lector.
Model:
Model:
Model:
Model:
Model:
Model:
Tank Ovedill / High-Level Sensor. Model: .....-_--
Other (specify equipment type and modeli@
Fill Sump Sensor(s),
Mechanical Line Leak Deleclor.
Electronic Line Leak Deleclor.
Tank Ovcriill / High-Level Sensor
enl and model Section E on
Tank lD:
ln-Tank Gauging P
Annular Spaco or Vaull Sensor
I Piping Sump/Tronch Senso(s).
Other
Model:
Mod€l:
Modol:
Modol:
| ' AnnularSpace or Vault Sensor. Model:
r I Piping $ump/ Tronch Sonso(s). Model;
: Fill Sump Sonsor(s). Model:
Mechanaeal Llne Lsak Detector. Model: -------.
Tank Overfill / High"Level Sensor, Model: -----.. other (specilv equipment tvpe and model in $ectior-r.E on Page 2).
Tank lD
Model:
Eloctronic Line Leak Deloctor,Model:
..' ln-Tank Gauging Prob€'ln-Tank Gauging Probe.
Annular Space or Vaull Sensor.
Piping Sump / Trench Senso(s)
Fill Sump Senso(s).
Mechanical Line Leak Deteclor.
Eleclronic Llne Lsak Detector,
Model:
Modell
Model:
Model:
Model:
Tank over{ill / High-Lovol Sensor. ModBl; -----.Other (soecilv eouiprnent tvpe and model in Section E on Pago 2).
Tank lD:
ConlainmonlSenso(s), Mod6l:=--*...-
r, ShearValve(s).
r.i Disponser Containment Floal(s) and Chain(s).
Dispenser lD:
i I DispensorX Dispenser Conlainment Senso(s)' Model:
X Sheat Valve(s)-, Dispenser Containment Floa!(s) and Chain(s).
Dispenser lD:
Disponsor Containment Senso(s).
Shear Valve(s),
Disoensor Conlainment Float(s) and Chain(s),
Dlspenser lD:
Model: .. _.,-DispenserContainmenlSenso(s), Model:
Shear Valvc(s),
and
Disponser lD
Containmont
i Disponser Containmcnl Senso(s).
:. j Shoar ValvB(s).
r r Dispenser Containment Float(s) and Ch.C!!GL-
Dlsponser lD:
Model: .--.------- .. - -DispenssrContainmentSenso(s). Model:
, , Shear Valve(s)., Disoenser Containment Float(s) and Chain(s)'
Dispenser lD: .
Monitorlng system Certitication
C^ A3444 Date ol Teslingiservicing: 10/ 19 / 2009 ... .
2t21107
It
D. Results of Testlng/9erviclng
Software Verslon lnstalled: 325'02 -
the
below, d and en lvere or wlll be
alarmr/ Yos No'
1t Yes No'
I Yes No'
./l Yas ii No'
i Yos
.t
No"
N/A
No'
N/A
testod
andatpoinl
commLln
device no
in
ensure
opsrational
and operaling properly? ll so, at what Perconl
itlals positivo shut'down?
posilive shut-down dus
syslemsocondary
all applv)(Cheekadetoclsleak,to leaks sonsorandSum
aslhe primarysyst0msystems ,ilvisibloaudibleandlheallankisovelhorfialarmtsvalvewalnrnginstall€d),
bolow.
are relayed to a romolo stalion,
and list theorequipment re
sensols I
alarm
senS0rs
t.l No.
%doesol
Sensors,Was yes,
belowallnamo and
as drysysl€msWasany
./ Yes
, No'
./ NtA
Yes
Yes'./ No
Yes"/No
{ Yeg No'
No'/ Yes
E. Comments:
Page 2 of 4
2
Monitoring System Gertltlcatlon 1?/07
?121107
)
F, ln-Tank Gauging / SIR Equipment:
This section must be completed if in-tank gauging equipment is used to
/ Check this box if tank qauging.is used only for inventory conkol.check this box lf no tanr< giuling oi6tn;,il;ffilis insraued.
psrform leak detection monitoring.
the
H,describe
G, Line Leak Detectors (LLD):
ln
were ot
the
Check this box if LLDs are not instailed,
wgre or be
the how
H. Comments:
lj Yes -1 No' -
/ No-
all input properinspected
ults?
/ No.
all probes visgaug
age
Yes / No--accuracy of syst€m
Yes / No'-roadingsWasaccuracy
Yes / No.
Were p r€t
on the eqW€re
/. Yes No-
N/A
/ Yes No'
to all
equlpment orstart-up annua eq uipm€nlthatSimulatodapply)rate:leak 3 g,p.h
was a leak
0.1 9.p.h; ,. 0.2s.p.h.
7 Yes No*
Wore
Was apparatus2 Yes No"
NiA a l€ak?product
Yes No,./ NlA
e
ofl
Yes Noi
N/A
doos lhe any portione
system ordisoonn6cted?
eleotronic
Yes No-
/ t'ttg shul any portionlails a test'i
the
system or
Yes No,
"/ Yes No'
all accessibleFor
on lheall
Page 3 of 4
J
Monitoring System Certlf lcation
12/07
2/21/A7
USf Site PIot
Wu'
:G ffipftnn,rl\q,f:
'F.J
Ver. Datc 8/l14000
I
Spill Buckct Tcsting Report Form
'l'his lbrm is intendecl for use by contractors pertbrrning annual testing ofUSTfrorn rcsls (il' applicabte),should be pro vided ro rhc laci I ity owncr/opcr.ator l.or
spill containment struclur.es. Thc conrpletcd lbrm and printoutssubrnittal to thc local rcgularory agoncy.
INFORMAT'IQN
3.RUCKE'I'
include mude lo and
bc mole stlingcnl.
I
Tr
5
l:acil Namc:UPS
l0t2t/08Date ol''l'csringFaciliry Addrcss 360t mento san Lu
Facility Conracr Klctonya l.larnilton Phone: 213-507-i769
l0/t/09ifiedDatAI-ocal Wusgen Notcy ol''fcst ng
Kerry Boylc
N alnc ol'Loctl lnAgency (spcctor pt'(senltt during lesring
Co Nnnrc;u&'t'Service Station Contlacto
'l'ino Ratnircz #8009625 tJT.
'l'cchnician Cr.rnduor ing'l'csl
Crcclent ialsl x CSl-ll Conrractor x ICC Service I'cch.SWRCB 'l'ank 'fester Qther (SpeciJy)License Numbcr(s):902034
'lbst Equiprncnr LJsed
ly I llrrckcr (/1.1,I Dicsel 2Pel(:.
EquiprnenI Resolution:
3 4
Bucker lnsrallarion .l ypc:
IJucke( Diamercr
13ucket Depth:
X l)irecr Bury
Contained in Sumfi
Dirccr Bury
Contained in Su tnp
l)irrct Bury
Contained in Sump
l)ircct Bur.y
Contained in
w arl lilnc bct rvcen app yt ng
vacuu rnlwatcr trntl start ol lesl:
Test Srart Tirnc (l'r);
Initial Reading (ll):
Tcst End Tinrc ('lj,)
Final ll.cading (R1,):
Tcsr Duration ('lj. -'ll)
Change in Rcadi nB (Rr- Ilr):
I'ass/F:ril'lhlcstrolcl or Cliter.ia:
I'est Rcsult:Fail Pnss Fall Pass FtiI Pass Fail
wswvaa ,luLIuylt-Ll
2/21/07
CERIIFICATION OF TECHNICIAI{ RESPONSIBLE FOR CONDUCTING THIS TEST]NG
I hereby certj.fy tltaE alf the informa|ion confained in this report is VTue, accutate, and
rance w.:ith l"egal requiremenl:sin ful..l. compl.
Technician's Signntule:.
/
6 7/2t/07
etectonea
Service CompanY: B&T Service Station
contractors
Site Location: UPS
3601 Sacramento San Luis
Date: I 19109
Tech Number: #8009625-UTTechnician: Tino Ramirez
TYPES OF LEAK DETECTORS TESTED
TEST INFORMATION
Owner/Operator
I l xLD (l 16-036-5)I FXID (l 16-054-5 :.,IFX2BFLD
IDLD (l l6-017-5 .lFXz (ll 6-046-5 r-J FX-IV (l 16-056-l)_
] BFLD Modet I l6-039-5 ,l ll
i I BFLD r 16-01 I I FXIDV r 1 6-055-s ,.IFXlDV 11 -5
.I XLP il6-035-5 ,s)r FX2DV (l I iFX2DV r l6-059-5
tPLD (l i6-030-5 TFXIBFLD ; IFXIV l t6-051-s
: rFXl (116-047-5 I I FX2V (11
Product Serial
Number
Opening
Time
Metering
PSVkPa
F\nctional
Elcmenl
Holding
PVkPa
Appror{nrute
I'est Leuk
Rate
ML/Min
GPII
PrsdFail
Tcsl Ltsk
Rat€
MUMin
GPH
Pump
PSVkPU
Pressure
0rc6o1 ''1,gco
25
16t
/6P8l 36ftl Pass fF,
(Signature)(Date)
:-:E,BEL,\1\RE
25971 Tawne Centre Drive, Faathill Ranch, CA 92610
TeL (949) 4s0-520A Fax. (949) 460-5214
To
TRANSMITTAL
Date:3t2512008
Kerry Boyle
San Luis Obispo CitY Fire
2160 Santa Barbara Avenue
San Luis Obispo, CA 93401-5240
Shawna Chambers
UPS Ground
1 2F834R60390709344
Secondary Containment Test
UPS. SAN LUIS OBISPO
3601 Sacramento Dr
San Luis Obispo, CA 93401
The following test report(s) are included:
Secondary Containment Test performed on 312012008
Comments:
please do not hesitate to call me at (949) 460-5200 if you have any questions or concerns regarding this work.
From:
Sent Via:
Tracking #:
Re:
Jim Brown
Project Manager
fze
)
SWRpB, January2002 Page
--
of
Secondary Containment Testing Report Form
This form is intendedfor use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate
pages of this form to report results for all components tested. The completedform, written test procedures, and printouts from tests
(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. F'ACILITYINFORMATION
Facility Name: UPS - San Luis Obispo Facilfty Date of Testins: 1/Z-O/O Y"
Facility Address:3601 Sacramento Drive, CA 93401 S
Facility Contact:Phone:
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector (if present during testing)58989 3 Year Test
2. TESTING CONTRACTOR INFORMATION
Company Name: Belshire Environmental Services, Inc.
Technician Conducting Test:
Credentials: X CSLB Licensed Contractor tr SWRCB Licensed Tank Tester
License Type:A - General Engineering Contractor License Number: 808313
Manufacturer Training
Manufacturer Component(s)Date Trainins Expires
Available upon request
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
Tank Annulars (t)tr tr (n we+!D !I
!n D tr !n D I
Secondary Pipe 0t d !D I !n !!
n I !n n !!n
Turbine Sump u)d L_l !!!!tr !
!I !n !!!D
UDC 0)d !!!!l tr !
n n !!I !tr n
Fill Sump (ol n !!!n !n n
!!I !!!!!
Spill Bucket (a)d I !!D n !!
n !!n !!n tr
If hydrostatic testing was performed,describe what was done with the water after completion of tests:
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
Tothebestofmv o"o*rtor",Wnor"ot"rw"ro r"rr""*r,r"r*)r[r)J"frt
n,Technician's Signature:.
SWRCB, Ianuary2002
Page -- of_
4. TANK TESTING
[l Industry Standard D Professional Engiheer
Test Method Developed By:tr Tank Manufactur6r
E other
Test Method Used:
EIVacuum flHydrostatic
Used: Test
DNo fl No fl No
Test
Is Tank Exempt From Testing?r
D other (Specify)
venturi pu and Resolution 0.50h of span
D
ENo
Tank #
D Yes
Tank #
D YesTank Capacity:
D Pressure
Tank #
fl Yes
Tank #
D Yes
FRP Steel Other FRP Steel OtherOther FRP Steet OtherTank Manufacturer:
Tank Material:
Product Stored:
pressure/vacuum,/water and
Waittime between applying
test:
87 89 9l D Other
10 minutes
87 89 91 D Other
10 minutes
87 89 9l D Other
l0 minutes
87 89 9f D Other
l0 minutes
Final Reading (Rp)
Initial Reading (R1)
Change in Reading (Rp-R):
Test End Time:
Test Duration
No Detectable Loss
D Pass tr Fail
n Yes fl1r16
nYes DNo NA
Pass/Fail Threshold or Criteria:
Was sensor removed for testing?
properly
verified
Was sensor replaced and
ftnctional after
Test Result:
No Detectable Loss
tr Pass tr Fail
flYes DNo tr1r14
DYes trNo !Na
No Detectable Loss
E Pass tr Fail
flYes DNoDrue
flYes !NotrNa
No Detectable Loss
D Pass D Fail
IYes trNo DNA
!Yes DNo trP4
Comments -on made to and recommended
monitors both the primary and secondary
vacuum, are exempt from periodic containment
tl Piping Manufacturer
E Other (Speeifu)
I Industry Standard E Professional EngineerTest Method Developed By:
E Pressure
E Other (Spectfu)
E Vacuum ! HydrostaticTest Method Used:
Resolution: 0.5Vo of
Piping Run #Piping Run #
Test Equipment Used: Test reducer boots, air
Piping Run #Piping Run #
and gauges
T:h.6ra c sPiping Material:
z7 Asm;{nPiping Manufacturer:
<.1Piping Diameter:
/o'Length of Piping Run:
87 89 91 D Other87 89 91 D Other87 89 91 D Other87 89 g{ n ,bttrerProduct Stored:
Reducer
Boots/Fittings Reducer Boots/FittingsReducer Boots/FittingsReducer Boots/FittingsMethod and location of
isolation:
10 minutes10 minutes1.0 minutesl0 minutes
Wait time between applying
pressure/vacuum./water and
starting test:
// ioO ,tt''tr 'Test Start Time s#s.rInitial Reading (ft):
/ 7:oo 2 n,Test End Time:
S PJ.TFinal Reading (Rr):
f Aou^Test Duration:oChange in Reading (Rr-&):
No detectable LossNo detectable LossNo detectable LossNo detectable LossPass/Fail Threshold or
Criteria:
D Pass ! FailI Pass ! Fail! Pass I Failf nuss I FailTest Result:
FWRCBT January2002
Comments
Page _ of
on
5. SECONDARY PIPE TESTING
made to and
SWRCB, Ianuary 2002
Page --.- of_6. PIPING SUMP TESTIN GTest Method Developed By:E Industry Standard E Professional Engineer
Manufacturerfl Sump
flOther
Test Method Used:
E Vacuum Xl Hydrostatic
I Pressure
D Other
Test Eq Used: Incon S Tester
Resolution: +/- 0.002
Sum ##Sump #Sump#Sump Diameter:
Sump Depth ttI
Sump Material:
Penetration;
fromHeight Tank to ofTopTop tl
fromHeight Tank T to Lowestop
Electrical QuofConditiontosumppflortesting:
Portion of TestedSump ,trg 9orl-{,,p
sump sensor detects
Does turbine shut down when
liquid (both
and
flYes tr No 51p4 D Yes D No fi1114 EYesDNoXNa D Yes tr No [1114TurbineshutdowntimeresponseN/A N/A N/A N/AIs system
shutdown
p*rogrammed for fail-safe DYesDNo [1Na flYes tr No 61Ua flYes D No XNA D Yes D No [try4Was fail-safe verified to be DYestrNo XNA D Yes tr No 51Na EIYes D No 61Na D Yes tr No [t1.{4
30 minutes 30 minutes 30 minutes 30 minutes
Test Start Time:,?Initial Reading (R's
Test End Time:/2:Z (
Final Reading (Rp):
Test Duration:l5 min.l5 min.15 min.15 min.15 min.l5 min.l5 min.l5 min.mChange Reading (R.&):
Pass/Fail Threshold or Criteria:+/- 0.002,,+/- 0.002,,+/- 0.002f +/- 0.002Test Result:tr Fail D Pass D Fait D Pass tr Fail I Pass tr Failaswsensorremovedfortesting?es D No flNA EYestrNo DWa lYestrNoDNa D Yes D No DNaWassensorlyproperandreplaced
verified functional after es tr No DNe ! Yes f] No trP4 ElYes D No DNA D Yes flNo !1114
Comments (include information on repairs made prior to testing,and recomm ended for failed tests)
S ensor functio nality was not confirmed.This proced ure is not pa rt of the Contain ment Testing scope of work.
I If the entire
asterisk (*) is
depth of the sump is not tested' specifu how much was tested. If the answer to any of the questions indicated with"NO" or "NA,', the entire sump must be tested. (See SWRCB LG_I60)
D UDC Manufacturer X Industry Standard E Professional EngineerTest Method Developed By:
E Other
E Pressure
E Other (Specfy)
E Vacuum fi HydrostaticTest Method Used:
Resolution: +l- 0.002"
UDC #UDC #
Test Equipment Used: Incon Sump Tester
UDC#UDC #
UDC Manufacturer:
((A s-4/c IUDC Material:
lfUDC
B"#tr*tHeight from UDC Bottom to ToP
of Penetration:
Bofr-Height from UDC Bottom to
Lowest Electrical Penetration:
G-"*lCondition of UDC prior to
testing:
11Portion of UDC Tested'
E Yes D No trNAE Yes flNo EINAflYes tr No XNAEYesDNo XNA
Does turbine shut down when
UDC sensor detects liquid (both
product and water)?t
N/AN/AN/AN/ATurbine shutdown response time
I Yes E No t]NAnYeslNo trNAE Yes tr No trNAE Yes n No /NnIs system programmed for fail-
safe shutdown?
EYesDNo trNAnYeslNo trNAn Yes tr NJFNA EYesENo trNAWas fail-safe verified to be
operational?'
30 minutes30 minutes30 minutes30 minutes
Wait time between applying
pressure/vacuum/water and
starting test
I t:2.Y//:oqTest Start Time:Ssnb93?bqInitial
I l'.2t 1 lt:LtoTest End Time:
3.qy*l s,316 [/Final Reading (Rr):
15 min.15 min.15 min.15 min.15 min.15 min.15 min.l5 min.Test Duration:
N\nrn.4.ru]N'ln
+t- 0.002"+t- 0.002,,+l- 0.002,'' '- 'il: o.o[2,'-Pass/Fail Threshold or Criteria:! Pass ! FailI Pass D Fail! Pass ! FailPass E FailTest Result:
E Yes tr No trNAflYesnNo trNAes n No DNA E Yes tr No DNAWas sensor removed for testing?
flYeslNo trNAI Yes tr No trNAE Yes D No trNA'ft"rtr No I NAproperly replaced andWas sensor
verified functional after testing?
$WRCB, January2002
7 UNDER-DISPENSER CONTAINMENT TESTING
Comments - (include informati on repairs made prior to testing, and recommended follow-up for failed tests)
Page of
Sensor functionalitY was not confirmed This pnccedure is not part of the Seco ndary Containment Testing scope of work
t If the entire depth of the UDC is not tested, speci8 how much was tested. If the answer to any of the questions indicated with an
asterisk ('r.) is ,,No" or "NA", the entire UDC must be tested. (See SWRCB LG-160)
l
)
,SWRCB, Ianuary2002 Page _ of_
8. FILL RISER CONTAINMENT SUMP TESTING
With Fill Riser Containment tris Not
are Present, but were Not Tested IFill Riser Containment
fl Sump Manufacturer
flOther (SpecifY)
I Industry Standard E Professional EngineerTest Method Developed BY:
E Pressure
flOther (Spectfu)
fl Vacuum ffi HydrostaticTest Method Used:
Equipment Resolution: +l- 0.002"Test Equipment Used: Incon Sump Tester
F\-Fill Sump #FillFill Sump O --
Sump Diameter:
Sump Depth:
\Height from Tank ToP to ToP of
Hiehest Piping Penetration: ^t
Height from Tank ToP to
Electrical Penetration:/Condition of sumP Prior to
Portion of
]Material
30 minutes30 minutes30 minutes
/
30 minutesand
Wait time between
test:
Test Start Time 7,/Initial {\Test End Time:
Final
15 min.15 min.15 min.15 min.15 min. -/ls mip1.\5 min.15 min.Test Duration:
1n
+l- 0.002",/ +t- o.oo2"),+l-,,PasslFail Threshold or
tr Pass ! Failn Pass tr FailtrI PassTest Result:fl Yes D No fl Yes E NoE Yes NoE Yes ENoIs there a sensor in the sumP?
DYestrNoENAIYesDNoXNAE Yes tr No XINAlYesEDoes the sensor alarm when
either product or water is
detected?EYesDNotrNA C Yes tr No trNAEYestrNo trNAE Yes E No trNAWas sensor removed for testing?
D Yes tr No trNAEYestrNotrNAD Yes tr No trNAEYestrNo ENAWas sensor properlY rePlaced and
verified functional after testing?
Comments - (include information on repairs made to testing,and recommended follow-up for failed tests)
Sensor functionalitY was not confirmed This procedure is not part of the Secondary Containment Testing scope of work.
'\
a, \
))
, . SWRCB, January 2002
9. SPIL/OVERFILL CONTAINMENT BOXES
Comments - (include information on repatrs made prior to testing, and recommended follow-up for failed tests)
Page of_
is Not with Containment Boxes E
Sp ilVOverfill Containment Boxes are Present, but were Not Tested E
I Spill Bucket Manufacturer
E Other (Specfy)
X Industry Standard E Professional F.ngineerTest Method Developed BY:
D Pressure
D Other (Specrfu)
E Vacuum fi HydrostaticTest Method Used:
Equipment Resolution: + /-0.002"
Box #Box #
Used: InconTest
Box #Box #
Tester
r)D
/L'/lL',lBucket Diameter:
tL'lIL'IBucket Depth:
30 minutes30 minutes30 minutes30 minutes
Wait time between applYing
pressure/vacuum/water and
starting test:lt:z,rII'.LSITest Start Time
2.tt z.v 7b)\.)kvJrInitial Reading (R1):
{ r"1*Ll lr'-V c)t l'-\rtt tiLLlTest End Time:
I.Vlt"92.1'(l 7.1uWFinal Reading (Rn):
15 min15 min l5 min15 min 15 min15 min 15 min15 minTest Duration:
)fl.D0tv4\.0 0D [.t- 0r
()
)\,0 x)'0Change in Reading (Rp-R): ,
+l- 0.002"+l- 0.002,'+t- 0.002,'+/- 0.002"PasslFail Threshold or
Criteria:
D Pass tr FailPass ! Fail tr Pass ! FailPass tr FailTest Result:
I
(
cftyo[
san Urs
Environmental Health Services
(E05) 781-5544
P.O. Bor 1'189
2156 Sierra Way
San Luis Obispo, CA 93406
rll
Flre Department (805) 781-7380
2160 Santa Barbara Avenue
San Luls Obispo CA 931101.5240
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS SPECTION FORM
.lfl
EFW data
entry by:Date:
Time:
N/Annn
n!
n
!
w'.,W
NOTun
trr
n
n
nf
c'
W
F/'
ry,
trn
Bml
Bm2
Bm3
TROI
TRO2
EROI
ERO2
ATOl
ATO2
BUSINESS PLAN
Business plan is complete, curren! & available during inspection (HSC 25503.5, Title 19 CCR2729\
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR2729)
Site layouUfacility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate fraining program (Title 19 CCR2732 & 22 CCR 66265.161
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
66265.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22
ccR $ 66265.s3/54)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release of
hazardous materialVwaste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43'l
ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs, (40 CFR 1f2.5(b))
SPCC Plan is maintained on site or nearest field oflice. (HSC 25270')
COMMENTS Co to http://www.slopublichealth.org/environmentalhealth/hazardous-materials.htm. to obtain forms to comply with BPOl-8P03. TROl and ERO|
FACILITY NAME
PHONE:
AGENCY
F
,yx?Ar7
I exs
CITY FIRE
INSPECTION TYPE
Routine
Reinspection
[-l Comolaint /
4P otr,"l tuTw'{-e{
PROGRAMS INSPECTED:Bueiness Plan ,ff t* cenerator UST fl rcr Ecnunp
RErNspEciloN REQutneo: [p r,ro tr YES I Eusiness Plan I xw Generator E usr E ncr flcar-rnp
,./
GPS deg mln
INSPECTOR:
C:\D E-1 1 \Temp\c. lotus.notes.data\.1 _l onF Page 1.doc 24-Jan-06
mm
FACILITY REP:
FACILIry NAME:DATE:INSPECTOR
UNDERGROUND STORAGE TANK INSPECTION
N/A REOUIREMENT
UT13 Site has a permit to operate.
UT14 Permit is kept on the premises.
permitting agency within
Contraclor trained properly. Contractor has class A,C-
10,C34,C36, or C61 license?
UST system leak response plan.
Facility maintains evidence of Financial Responsibility.
UST System information forms (Form A&B) are on file, accurate
and entered into database.
Facility has BOE number. lf not call 9'16-324-2166 to obtain. I
UT21 Testing as required. f]Secondary containment
nual Certification ELD
UT22 Overspill pass liquid tightness test, with no leak
drain valve. Gontainers without are tested
Overspill Container drain functional or alternative available.
UT29 Leak detection sensors are properly secured at lowest point in
sumps and tank annular spaces, at time of
Annual piping integrity test detects 0.1 gph. NA if yes on UT 18
CHSC ccR
TITLE 23
25284
25284(c\
25284.1(a)(5)(D)2637(bX1XB)
2632
25292
25286
Chapter 6.7 2637
263s(bx1)
2635(bX1XC)
2634
2636(rX1) &
2636
F
F
n.'
:UT16 .
E,
tr
n
tr."'
(g)
2641 (a)
E-'
tr i 2636(f)(4)
2712
YES NO
E
tr UT17
tr tr UT18
UT19
UT2Otrin
tr tr
tr"
tr"'u !UT23
2631(dX4),
tr 2632(c)(2)(B),
2636(fX1)
Secondary containment & overspill containers are liquid/ debris
lree.
Leak Monitoring Console has proper leak detection and overfill
notification programming. Continuous alarm history is
UT26 I Audible and visual alarms functioning properly
25284.1(aX5XC)
UT24
UT25
'maintained.
tr UT27 Under Dispenser Containment (UDC) present.
UDC has approved operalional leak detection equipped with
pump shut down.UT28
UTsO Pumping system shuts off when leak is detected or when the
monitor is disconnected or fails.
n tr"
trtr
UT31
UT32
tr"'tr !UT33
E]
u tr
tr Line leak detector detects 3.0 gph and is certified annually 2s284.1(a)(4XC)2630(d),
Overfill prevention system installed and operational.2635
UT34 Emergency Shut Off switch (ESO) is lunctioning properly 2632
UT35 No liquid leaks visible.2632
E UT36 ; Shear Valves are in place and functioning.2632E'tr
u'tr
tr'
UT37 Secondary Piping is open al the turbine and transition sumps.
UT38 , Fuelfilters managed properly.
: Monitoring system checked daily (Emergency generators only)
: Monitoring Wells are maintained
: County Well Ordinance
properly. CA Well Standards;
25189.5(a)
2636
. 2636(gxs)
, 2692tr":
:_ .-_ '...- _'i
tr:
n UT4O
:
' Tille 22
tr UT41 Documentation of hazardous and restricted waste disposal
A:\UST lnspection Report.doc 5-Feb-04
FACILITY NAME
EPA IDI{UMBER:
Tiered Permit:
Treatment
Equipment:
ADDRESS: ", ," ,r
,
HAZARDOUS WASTE GENERATOR
i, ,i..,',' il ,'., ,. ,,.i. i.. ,r, :
,.
ncBsw "Eirsor nci flpnn
Total generated/month:
Waste oil: t;" solvents:
Antifreeze:Others:
Lbs or gals
(average)
'J.l ,r'i,.,
I j .
YES NO N/AE'tr' [--
n
n
nn
tr'
E''
E
tr"tr
E
vrol.#
GTOl
GTO3
GTI}4
GTO5
GT06
GTOT
GTOS
GTO9
GTlO
GT11
GTI2
GT13
GT14
GTI5
GT16
GTIT
GT18
GT19
GT2O
GT21
GT22
GT23
EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR 966262.12') If Not, Call (800) 618-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title XZ CCR $66262.11)
flown knowledge flanalysis Eother
Hazardous waste analysiVtest records are kept for at least 3 years (Title22 CCR $66262.40.(c))
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or
authorization from DTSC (HSC $25189.5, Title 22 CCRS66?62.12), i ., ;!
[milkrun fllother ii,,'!t l)i!:i i.:',,.,i 'i"
Hazardous wastes "t" rhilffiiilt'Eiffil-( Tifie 22 CC
n
n
n
n
Tutr
Tu
n
n
u
tr
tr
tr
u
n
n
nnn
nu
T
n
tr'
tr'
tr
E"
fl"'trE"
E'
E"
tr,"
E
E
n
n
Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR
966263.4U 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title22 CCR $66262.34)
lg[90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.)
n tgO aays if waste generated per month is less than lfi1 kg (see note)
fl 2ZO Aays it waste generated per month is less than 100 kg and transported more than 2(X) miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6fiX) kg(13,2fi) lbs.)and no
acutely/extremely hazardous waste over lU,C@.2lbs.) is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/S5-gal
or l-qt limit) (Title22 CCR $66262.34(c))
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title ?;2 CCR
$6626s.176)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTE,t'waste composition/physical state, hazardous properties, name/address of generator) (Title22
ccR $66262.31, 66262.34)
Contoinersy'tanks containing hazardous wastes are in good condition/handled to minimize release or ,
reaction(Title22CCR$66265.17U.191,66265.177(c))
Containers/tankMiners are compatible with waste stored or transferred (Title22 CCR$66265.172)
Containers storing hazardous wastes are closed/sealed (Title22 CCR 566265.173)
\{eekly inspection ofareas where hazardous waste containers are stored is conducted
(T itle 22 CCR$66265. 174)
Daily inspection of all tank systems is conducted and documented (Title 22 CCx. $66265.195),
Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly
within one year of date emptied (Title 22 CCR $66261.7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
$2s2s0.4)
Used oil filters for recycling ar€ managed properly (drained of free llowing liquid, stored in closed
rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title22
ccR$ 66266.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (Title22 CCR S66266.81)
Solventry'other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR
$66266.3)
SOURCE REDUCTION: For facitities generating >12,000 kg"/yr. of hazardous waste on site.
Generator is subject to SB14 and has prepared and retained current source reduction documents or is
able make them available to the inspector within (5) days. (HSC 82524.19,2524.21)
Source Reduction Evaluation and Plan contains the following live elements:
certification, amounts of wastes generated, process description, block diagrams, and implementation
schedule of selected source reduction measures. (HSC 5252,44.19)
EI'
tr
n
. l ,l
li ) ,C:\DOCUME-1\Bepro\LOCALS-1\Temp\c.lotus.notes.data\Z_Hazardous Waste Generator.doc 2A-Jul-O4 2A-Jul-O4
(
.,,
Environmental Health Servicesffi
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
ctyo[
san lul rls oBtspo
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
Date: s/Art/rry EFW data
entry by:
Time:
YES NO N/A
BPO3
TROl
TRO2
EROl
ERO2
n n Aroln ! Aro2
nn
n
n
. BUSINESS PLAN
Brrsiness plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR272L)
Site layouUfacility maps are accurate (HSC 25504, Title 19 CCF.2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCF_2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR
66265.16\
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCP.273l & 22
F"""fitr-ti:t"fi:if;'"* maintained to prevent/minimize/mitigate fire, exptosion, or tetease of
hazardous materials/waste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43\
ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR f 12.5(b))
SPCC Plan is maintained on site or nearest field ofTice. (IISC 25270)
COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/}azardous_materials.htm; to obtain forms to comply with BP01-8P03, TROl and EROl
FACILITY
PH
l-il2 crrY nRe
4
AGENCY
n ens
INSPECTION TYPE
n Routine
n Reinspection
fr?,#fw-
PROGRAMS INSPECTED E Business Plan E HW Generator fi UST flear flcf,rhnp
REINSPECTION REQUIRED:F
/no: tr YES n Business Plan fl HW Generator usr I rcr ncaunp
{
GPS Latitude mtn
FACILITY RE?:INSPECTOR:
C:\DO
deq
CALS-1 \Temp\c.lotus.notes.data\'l _lnspection Form Page 1 .doc 24-Jan-06
mrn
r.2/86/2607 r..t::{.1_\ sERVrcE =r:\":\ 'AGE az
MOI., T IoRING SYSTEM CERTIFIC.^,IIoN
A,trhoriry citEd: chapter t ,. [::'yi::i li!;'Atj:!tf"{;'! i'ou;,j'.,:,"t.7',','tl3'|ro,,rornia eey'a 6r Npsurat,oa.r
Tlis forn must bc uscd to doclcncnt rcsdng and scrvicing of monitoring,c4uipmcnt A sFsaratc cerrificstion or rcoon musr bc nraEcg!.
fnr cach-molilqriag-svglcln conkol oenel by thc tcch,rriciEn who performs thc work. ,t copy of Oie forrn mucrr bc providcd to thc Lrnk
eycram owner/opcrator. The owncrlopemtof r.rust submit a copy of thin fonn to the local ogcncy rcgutating UST systcms witlin 3O
days ofttstdatc.
on ?-lf qal
Bldg. No.:-
Sitc Addnss:CiVt ,4zYt Lv,3 AhB*''lzqe I
Frcility Caotsct Pcrson:t+t c Contret Phone Ns,7tg q
MskeA,fodcl of Monitoring Systcm: 7?-< 3-di(2 - - - Datc qf Tcstiirg/Scrvicing;
B, InvcnOory of Equipment Tested/Certified
.If thc frcilitj conlrirs nslg trnks or dispcnrcn. copy this fono. Iaclutlc hforoetion for cvcry rnd dispcnrcr rl thc frciliV
C. CgttifiCatiQU - I ccrtll! thrt thc,cqulpuent (deutificd in th'u docuruco.t w*l lnspt*cted/rerviced lq tccordalcc with thc rarauflcmrrrr'
guidclhcr Atlacbed
comrd end r Plot Ph
rmctc{ r copy of lhc
Technicirn Ndnrc (print) :
to thk CcrtlflcottoD Is uocerrry to vcrify thrt thk iufornrdoD ir
n rhoving ttc hyout of of gclcrrttng tuch rcportg' I lrvt rlro
Sigrratr^ac:
Catificrtion No.:Liccnsc. No
Tcsting &rnpany Namc:erone xo.:(€9E-) ? z? - Ft v t -
Site Addrers:o Data of Tcsring/Scr"icinsi I!-W q
.d General
Facility Nrmc:
fl{?"{
filt,,t
.r L1i
',. 'f'''j
alI
Q ln.Tart ftugi.ng Probc.
d ,1(muJrsprcc or Vrult Sentor,
VP;pinssump I Trcnch scnsor(r).
O Fill S.rmp Scolo(s). Mo'deh
O Mcclraniql Linc trrk Dcrector. 'Modcl:
O Slcotronic Lioc Lcrk Dctcctor. - 'Modcl:
O Trnk Over{ill / High^Lcvcl,Scn#}, Modct:
O Othcr (rpccify aQuioocnt nrue rndlnodcl in
TrnklD:Or E<tl
Scction E on Prra 2)-
Modcl:
Model:
Modcl:
Trnk lD: ' __ - .tr tn.TmtOruging Probc.
D Annular Sprcc.o! Vlul{ Senror.
O PipLng Sump / Tnnch Senso(s).
F Pitl Sunp Scnto{s).
O Mcchzrlul Linc Lark Dalactor.
O Elcrtronic Linr l-cek Dctcc(or,
O -TrntOvcrtilt / t{lgh.t cvcl Scntor.
Modal:
Mo&l:
Modcl:
Mo&l:
Modcl:
Modcl:
Model:
B Olhcr (sgcci$ c{ulpornl lype rnd 1nqdq!.tn Scction E on Prgc l).
El AnnuluSprca or Vrult Scnsoc, Modcl:
Cl PipingSuog / Treach Scrsor(r]. . Modcl:
O Fill Sursp Scncor(r). Mo&l:
O McchailcalLincl'akDetcctor, Modcl:
B Etcslrlhti Linc Lci! Detector. Modct:
A Tu* G^{fin / Hfuh.l-crycl Sco:oc Modal:
El Cliher (rreifveouiomcnr tale lld fitodcl it S*lion B on Parc 2).
O ln-Trnt Oluging Pmbc.
, Tenk lDr
O In-TmkOauging.Probc.
O Arurular Spacc or Vrult Sensor,
O tipingSuAp /Tcnch Scrsodr).
tr Fitl Srrnp Scnro(r).
El Mcelirnigl Lhc l*rk Detcctqr. Modcl:
O El.ctmnic-&ra Lcrlc Daloctor,
O Te* Ovcr{l[ / High-trvcl Scrr*or.
Et O0rcr frocci& cauiomot twc ud nodcl io Sccrion E on lari 2'l:
Modch
?rtrlc lD;
Ms&l: - -- .
Modlll
Modcl:
Modcl:
tr ShcrrVdr{9.
Q Dimdsg Conlrinrert Float(r) rnd Chrin(rl.
Sclrro(r). . Modcl:
O Dirnqr*r Conninracnr Flort(s) urd C&rh(r).
DbSrarcclD: -j +2- - .-:0r6hp"*
gf,hanV**t1r),
O Shcrr Vrlw{r}.
O Dispara Contriruacnt Flort(r) rnd Chrin(c)
Senrodr). Modcl:
Dhpcs*ID:
0 Dhpenrcr Contalnnknt Scnro(:). l,,lodcl
9 ShcrrVrlvc(r).
O Dispenrcr Containroent Flotl(r) rnd Chsir(l).
O Disgoscr Contahncni Surso(s).
O ShcerVrlvc(l),
El DirNorerContsinrucnt Rorlf6) rrld Chrin{tl.
Dirpper III:
O Dirpenr< Conlainracnl Senro(s), Modcl:
O SlcrrVd"c6r),
ODitfnrc Conhiruacnt Rort(d ard Cbein(.).
.Dtrpcuct ID:
t .{.t abt zu6 / I 2: 1 S g659298948 B&T SERVICE STATION PAGE 83
I'liill
Aq{-(
iu ri.ng Sysrem Cer:ti Ji,6, 1;u,"
/: Results of Tcsting/Servicing
5o0wnrc Vcrsion lnbultcj
Sectiqn E belotv,dcscr[be how.rnd.!'hgn.
0. Cornmentsl
I'rg: I lf .l
defi eIencies rvere or.rillt be
glE-O No-
Q No.
-V Ycs _O No'
1'cs o No'Wsrc
nol
senso13 .inBtdl lcd at lox,clt tn(Fo scconda cory n[airulcnt and go (hrt lhcr,0 sil.lFnlcnlqq!rI0rcatantrst00rchyi:d rcr!t olc ntonitoring rSsrarion,IIa g0mntunica(t0nt cq uiptnant (c.8.rnodcrn)
tr Ycs
Ycs
tr
N/A
No'
N/A
'tank
Ftir nk tha(syslelrrg Ihc n10 atsyl(crn thcmcchniicaOvcrfiprAvenrlg6ecvalrsrnSldlled),thct3'firt
t0nk !rgrn 9idctng cc (i:e.nolormvisibldend.,tleudible hc bnkYcs'
aqulP[lenl Nlrloccd
0ny
thc I
lt't
cqulpnrent rcploced?r !c5'c;'rccilic scngon. probcs, gr
No
o
rn eptl)l
8ny crin(aisccondary nrncnt systcnls as dry syclenls? (Check alt
t Is
12/s6/2987 12: L5 8059298948
',,\'-.f
F. tn-Tank Gauging / SIR Equiprnent:
B&T SERVICE STATION PAGE g4
-)
I !l'."1. tfris lor if trnk geu5ing is uscd only for invcntory conuol.u chcek this bor if no tarrk gaugi.ng orSIRe4uipnrcnt is in$aflad.
t
This sestion must be completed if in-ank gauging equipment is used ro pedorrn leak detcction monitonng
thc Sectlon E,below,descrlbc horv and when these dclicienclcs *erc or wlll be coffccted.
G. Line resk Deteetors (LLD): e chcck this box if LLDs arc nor insurtcd.
'In thc II, belorv, discrtbe how rad when thesc de(ictencies wcre or wlll bc corrcctad.
I
\,tk4H,
Q Ycs tr No'becn inspcctcd forHne elt snd tcrminrtion fotincludhg faults?tasting Founda Ycs Cl No.Wcre rI rank Ssui DrobcrQ Ycs O No-rccuacy of tbstd?tr Ycs El Nor Wrs rectcrcy ofr reskd?level
A TE-Q No.Wcre r,ll pmbce rci
B Ycs Q No-dl itcms on rhe s rraintcrrenac
a
EI N/to wri$ LLD gcrfonnrnca?Fur,cguigrmant
a;ll that(Clzeck tr 0.2 ,h.9.9
and scourate withinconfirmcd
El Nor
tho LLD product flowif itForLLDs,a
Q Yes For elcckonic docs thc autoinatieally ehut ofr
Yes tho tlrIbine shut efrif qy puti6.Etonitoring syst'm
or disconnccled?
LLDs,
Ycs tr docs tho tr.rbine antoneticaJly shrn portiria of tha raonjiorhg Eyr&qr
faits r tcst?
clcfionic
accissible wirhg connetioss b6lFor ctcctmic [lLDs, havc
Ycro all itmsonfic
L2/86/2667 12:15 885s238948 B&T SERVICE STATION
,'"\ --)
PAGE 65
-)
UST Site PIot
: ',O:hnrwl\4(: : :: ,
' ' ' " 'l
cj
p
s*..:
il:S:.\..,,.
'€,. .
''i
t
Va-Dar glt2000
12/66/266r-V 12:15 8859298948lrr-lrJ.-r\,,.a\._
FXT
rrP s
)
-ts VALUATION
LeaK uetecror ,'4,--)
Cl-lART
Servioe ComPanY Ea-
B&T SERVICE STATION
rfL
PAGE 66
Site Location
.+/ a t5b9 I 9n-- -.,^ 11 3 LO
Date
Technician Performing Test
rEOli Number n Zy gZq
TYPES O,F LEAK DETECTORS TESTED
tr
tr
tr
tr
tr
tr
tr
tr
trf,
tr
trf
xLD (1 16-036-5)
.
DLD (116-017-s)
EFLD (XL Model) (116-039-5)
BFLD (11S-012-5)
xLP (1f 6-035-5)
PLD (116-030-5)
FXr (1 16-047-5)
Owner/Operator
FXI D (1 16-054-5)
FX2 (116-046-s)
FX2D (116-049'5)
FXlDV {116-055-5}
FX2DV (1 16,053-5)
.''.
FX1BFLD ' '
tr FX2BFLD
f rxtv (118-o5e-E)
tr t;zv 1t to'osz's1
{r*rou (11s-obs-s)
f..lxeoy (118'ose'5)
[-I rxiv (11,G-051-5)|l ,l
f ixzv (110-o5z-s)
TEST INFORMATION
9;ex-\
(Signature)(Date)
H Meiley PurP
I 0nltd Dol?rliiln tong.nt
7101 W. 'l 2E st, . 0verland Pert, KS 66?1 3 ' 91 3-498'5700
Mrdey Putnt t080fvrs lhe llqhl r0 raake deslgn lmprovsmlnls and
prlcln0 rnodllicatlon8 r$ fie0e39ary rnd vrllhoul noti0e,
btssl Mraay Pum I Prlntrd in IJSA
rG
PrDdusl
Serl6l
Nuribar
Oprnlno
Tllne
ilet.dn0
PSl,LFr
.FunctlarnEl.
Elemonl ' .
Holdhe PS,hh
I L.rf Rtt!
'Prslrfall
T.rt L.rk Rrtt
ML,llln
OFH
Pomp
PSI/tPs
PLtultl
t
2 l[,9o 4*r e9?st inBl 77 f5,
q I
4
5 i, Lt, ":'
E
7
I
I"/A6/2887 L2: L5 8859298948 B&T SERVICE STATION
,"\..- -.
)swRcB,Imuary 2gg5
Spill Bucket Testing Report Form
This forn is intended for use by corttraclors performlng annual testing of LIST spill containment stnrcture$- T!rc complazd form ond
prinlovts from tes$ (if spplicable), should be .prwided to the{actltty owner/operator lor submittal to the lscal regulatory agenclt.
3.BUCKET TION
PAGE A7
Fecility Na6e: llP<Date of Tertingt ll- i,A$>
Address:
Coutactl ga I Phoue:
Date Local Agency Was Notified of Testing
Nsmo of Local
Name:I
Tschnician Test:
Credentials O CSlBCofractor O ICC Service Tech, tr SWRCB Tester tr Other
License
Test Mcthod Used:D Olher
Resolution:
1,.,Id€nn} Spill Bucket (By tnh
Tcst Used:
Bucket Iaatallation Tlpc:Ctdirect Bury
O Conained in Sumo
E DirectBury
O Comained in Sumo
0 Direct BDry
O Contaiued in Suup
O Direct Bury
B Contaiosd in Sumo
BuclotDiaustsr:ll"
BucketDeptb:12"
Wsit tinc bctwecn applying
vacuum/water and gfart cf test:
Tcat Strrt Tiruc {T):
Initial ReaCiqg (Rt):
Test Eud Time (Tr):
Final Rcsdijng Gr):
TestDrstim (T3-T;):
Cbange in R€adin8 (&-&),
Pass/Fail Tbreshold or
Critcia:
o Pasr E FeiI E Prsr trFrllTref 'Rerd&Vfues O Fell tll Prrr tl Dall
Commcntg-on lo and
CERTIF'ICATION OF TECHMCIAN RNSPONSIELE FOR CONDUCTING TTIIS TESTING
I hcreby cctltly thal oII lhc lnfonutlon Inkls rqod it lne, awiltc, nnd ie filI o;gatne vhh kgil teqlubalwab.
7
Tccbnician's Sipanue:a^t", //-RA -67
I Starc laws aod regulnions do uot orrr€nuy require terting to be
aorr ha nno oir.iranlt
by a qwli.tied contraaor. Howevor, tocal requiremoB
Appendix Vl
(copies of Monitoring system certification form and usT Monitoring Plot Plan available at http://www.waterboards'-qa.qo:4.)
MONITORING SYSTEM CERTIFICATION
For IJse By All Jurisdictions Within fhe Sfate of California
Authority Cited: Chapter 6.7, Heatth ancl laterty Code; Chapter 16, Division 3, Titte 23, Calilornia Code of
Flegulations
This lorm must be used to document testing and servicing of monltoring equipment. A separate cenification.or report must be prepared.fot
each monitoring system .o"rcf prn"r [y-in"e tecrrnician *-no plrrorru tie wort<. A copy bt this form mu:t b: provided lo the tank system
owner/operator. The owner/operator must submit a copy of thii form to the local ageney'regulatlng UST systems within 30 days ol test date'
A,General Intormalion
Facilily Name: UPS .
/ Rn6\
Bldg, No.:.-------._.'--
site Address: 3601 Sacrgnento -
city: .san Luis obispo -. ".. zlp:
-
Facility Gonlact Person:Hewitt Contacl Phone No.
Make/Model ol Monhoring SYstem:TI-S Date ol Tesling/Servicing:10/31 /o8
B, lnvenlL 'i Equipment Tested/Certilied cedlto
Ccrtil'ical.ron No':I-iccnse. No.:
TeslingcompanyName:B&TServiceslatio4contlaqtors-Phon€
Testing Company Address: E3O S' Fronlaoe Bd' NiDomo' Ca 93444 "Date ol Tesling/Servioing:
Page 1 ol 4 1AO7
1
2)
ln-Tank Gauging Probe.
Annular SDace or Vault Sensor-
fiping Sump / Trench Sensor(s).
Fill Sump Sensor(s).
Mechanical Line Leak Deteclor.
/ High-Level Sensot
Eon
Tank lD:
model in
; Electronlc Deteclor
Model:
Mod€l:
Model:
Model:
Model:
Model:
Mod€l:
r.j
lt
il
:_
t..i
t.t
ln-Tank Gauging Probe.
Annular Spaoe or Vault Sensor.
Piping Sump / Trench Senso(s)'
Flll Sump Sonsor(s).
Mechanical Line Leak Delector.
Eleclronic Line Leak Det€ctor,
Tank Overlill / High'Level Sensor
Model:
Model:
Model:
Model:
Model:
Model:
Model:
Tlnk lD:
EonandOther
i.i DispenserContainm€nl
. I ShearValve(s)'
ModelSenso(s).
and
Disp€n36r lO:
Conlainmentand
and
Dlsponser lD:$enso(s). Model:X DlspenserContainmenl
X Shear Valve(s).
Shear Valve(s),
Di6p€nser lD:' Dispenser Containmentsenso(s). Model
and
Senso(s). Model:
Model:
andl"i
Sensor(s)Dlspenser lD:
--.-----: r bispenser Containmenl senso(s), Model:
---: I shearValve(s).
. Disponset Conlainment Floal(s) and Chain(s)' -...._
Monitoring Syslem Certilicatlon
1o1 31 l 2no8
?lzU07
D. Results ol Tettingy'Servicing
Software Verslon lnslalled: 325'02 ,.,, -. ',.
the tol checkllst:
these were or corrected,
ls lhe alarmU
andsensots
at lowest withnolsoequipmentsensorssecondary
, . -}lo"are relayed lo a remole communicalions pm s.
N/A lliate posilive shut-down?
posilive shul-down due
all appty)(Check
5€nsor10leaksand
No.
syst6meYes
N/A
no{i,e,
whalal percentItso,and oPerating properly?
tankmasthalsystem
audibleand theat tankvisiblealarmovedlllisvalveinslalwafnrngtheisled),
ol k thedoes
, or other
mod6l fot
r€placedSensors,any
inmanulacturer
No
No a9conlainmentlound inside any
in Section
reporls,to ensule
persmonltorlng
E. Comments:
,rl,
':.-,rr,::,
Page 2ol 4
?
M onltoring System Certilication 1AO7
2/21107
,/
F. In-Tank Gauging / slR EqUipment: Lrlchecx ttris box if tank gauglng is used only for invenlory control
t r Check this box if no tank gauging or SIR equipment is lnslallod'
This section musl be completed if intank gauging €quipment is used lo perform leak detection monitoring'
lhe followl chockll6li
H, below,
G. Line Leak Detectors (LLD)r
wero or wlll be
| : Check this box i{ LLDs are not installed.
ln how
tho
H. Comments
checkllst:
H, belolv,how were or qorrectedln
wiring for proper enlry for ?inclallYesNo*
i. No'probes lor damage up?all tank,, Yes
Was accuracy readingsNo'Yes
accuracy of system water readingsI Yes No"
probes properly?l: Yes
checklistsonYesit No'
y'Yes No'
N/A
For equipm
that apply)
ent start-up ol annual
Simulated leak rate:
equjprn ent cerlil ication,
t/s.p.h.t 0'1 g.P.h ;
was a leak simulated to veflly LLU pbdormance? (Check all
0.2 g.p.h,
'V Fs ti No'
VXes ri No'
li/ Yes No'
N/A
Yes ;r ,!lfr{ NA,
;l Yes il Do't.r/NlA
fi Yes Lr -Dl-o''1wa
Yes rr /{o"./ N/A
'{ Yes No'
Page 3 ot 4
3
MonilorlnE System Certlf lcatlon 12107
2t2U07
Monitoring System Certif ication
UST Monitoring $ite Plan
G
Site Address:
Date map was drawn: --J--.*J-.
lnstructionq
ll you already have a diagram that shows all required information, you may include it, rather than this pags, with your Moniloring system
certilicalion. on your site ptan, show the general tayour oiianxs ani piplng.' clearly identily locaiions of ih.e lollowing equipmenl, iJ installed;
monitoring system control pin"Gi ."nro[ monitoring tank annular ipaoEs, sumps, dispenser pans, spill containers' or other s€condary
containment areas; mechanioal or electronic line leak ii,i".to"; and in-tank liquii level probes (il used lor leak deteclion)' ln the space
provided, note the date thls Site Plan was prepared'
Monllorlng System Cortlllcatlon Pago 4 ol 4 12Jo7
4 22U47
l
SPill Buckct Tcsting RePort Form
This lorm is intenclccl lbr use by contfactors Ferforming annual testing of usr spill containment structures, The completed ltlrm and printouts
i*rn r"rt, (if applicablc), shouicl b" provided to the facility owner/operator for strbmittal to the local regulatory agcncy'
Iz
]. FACIUW INFORMATION
la and recotrunendedon
lo -11-Datc ol'Tcsting:
3601 Sacramcnto San Luis ObisPo'Facility Address:
Was Notified of 'l'estingDate l-ocal AgencY
Kerry BoYleName ofLocal AgencY I ( if present during teitin g)i
B&T Service Station ContractorCompany Name
Mike GutierrczTcchn ician Conducting Test:
x CSLB Contractor x ICC Service Tech.SWRCB'l'ankTestcr Qther(Specify)Credcntialsl
License Numbcr(s)902034
Tcst Method Used Vacuum Other
'l'est Equipment Used:Equipment Resolution:
Idcntily Spill (By Tank I Diesel
Stored
.,3 4
Bucket lnstallation TYPe
X Dircct Bury
Contained in
Direct Bury
Contained in SuntP
Direct Bury
Contained in SutnP
Dircct Bttry
Contained in Srr
Buckel Diarneter:ll*
Bucket DePth:12"
limc between aPPlYing
vacuum/water and slart of lest
1'est Start Time (T1):
lnitial Reading (R)
Tcst End Tirne (Tr):
Finat Reading (Rp):
Test Duration (Tp - Tr):
Changc in Reading (Rp - R):
Pass/Fail Threshold or Criteria;
Test ResulJ:@1, noit
t renffiae
Pass Fail Prss Fail Pass f,'all
I State laws ancl regulations do not currently require testing to be performed by a qualified contractor However, local requirements may
5
be more stringent'
2t21107
CERTIFICATION
I hereby certify that
in fuJl compliance wi a7
'l'echniciatr's Si gnature:
oFTECHNICIANRESPoNSIBIJEFoRcoNDUcTINGTHISTESTINGiil- *, infornatiii co,ntainea jn this report ie true, accurate, and
ls
Date t*
6 2/2U47
))
etectorea
Service Company: B&TSite Location: UPS
3601 Sacramento San Luis Obi
Date: 10131/08
Tech Number:Technician: Mike Gutienez
TYPES OF LEAK DETECTORS TESTED
TEST INFORMATION
Owner/Operator
(Date)
I xLD (u6-036-5)IFXrD (l l6-054-5 I FX2BFLD
, I DLD (l 16-017-5 I FX2 (l r6-046-5 lFXrv (l l6-os6-5)
I BFLD (XL Model ll6-039-5 : I FX2D (l16-048-5)tFX}V (ll6-057-5)
I BFLD I l6-012-5 IFXrDV (n6-055-5)q4xtnv (ll6-os8-5
i]XLP I l6-035-5 I FX2DV (l l6-053-5)r I FX2DV (l 16-059-5
I I PLD (l l6-030-5 i ]FXIBFLD I FX lV ( I l6-05 l-5
I FXI (l l6-047-s il i I FX2V (l16-052-5)
Product Serial
Numbcr
Opening
Time
Metering
PSVkPa
Fr\rncllonal
Element
Holding
PS/kPa
Approximute
Test Ltuk
Rute
MI,/]VIIN
GPH
Pass/Fail
T$t Lesk
Rete
IvJI^/Min
GPH
PumP
PSVkPa
Pressure
ibt(c)t-1ec Trtst l3 l>r 19{ rr11"
t v}l rnl
(hss'a E9\+3e#l
(Signature)
255967 UPS
3601 SACRAI'IENTO
SA{ LUIS OBTSPO
E05s44?184
10/31/2008 10:34 Al'l
SUI'IP LEAI TEST NTPONT
DSL FIL
TEST STARTEO 10:19 At,I
TEST STARTED 10/31/2008
BEGIN LEVEL 3' 5?80 IN
ENo TIt'lE 10134 Al'l
END oAlE 1o/31/200E
ENO LEVEL 3.5782 IN
LEAK THRE$HOLD O' OO2 IN
TEST RESULT PAS8EO
255967 UPS
3601 SACRAIIENIO
SAN LUIS OEISPO
E05544?184
10/31/2008 10150 All
SUI'IP LEAK TEST REPORT
OSL FIL
TEST STARTEB ,10:35
At'l
rEsT STARTED 10/311200E
BEGIN LEVEL 3.5?81 IN
END TII'IE 10!50 Al'l
ENo DATE 10/31/200s
END LEVEL 3,5782 IN
LEAK THRESIOLO O, OO2 IN
TEST RESULT PASSED
\
q
Environmental Health Services
(805) 781-5s44
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
oI
lur s oBtspo
sty
san L!
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
FACILITY NAME:AGENCY
n ens
E crrY F|RE
EFW data
entry by:
INSPECTION TYPE
trnf,
Routine
Reinspection
Complaintf
ADDRESS
PHONE
PROGRAMS INSPECTED r Business Plan E nw Generator fl usr I acr ncamnp
REINSPECTION REQUIRED:nNo trYES I Business Plan ! nw Generator I usr n acr !crune
Date: l"l 'i'1!' ''
Time
n
tr
n
tr
NOnn!
TT
tr
n
YESuntr
trtr
tr
tr
Tu
N/An
BUSINESS PLAN
Business plan is complete, current, & available during inspection (HSC 25503.5, Title L9 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR2729)
Site fayouVfacility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR
66265.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR273I & 22
ccR s 6626s.s3ls4)
Facility is operated and maintained to prevenVminimize/mitigate fire, explosion, or release of
hazardous materials/waste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43'l
ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 25270)
BPOl
BPO2
BPO3
TROl
TRO2
EROl
ERO2
ATOl
AT02
COMMENTS Go to http://www.slopublichealth.org/environmentalhealth./hazardous-materials,htm, to obtain forms to comply with BPO1-BP03, TRO1 and EROl
ij.t.:1'
GPS Coordinates: Latitude:
-deg
min-decimal min Longitude: deg-min-decimal min
FACILITY REP:INSPECTOR:
C:\DOCUME-1\Repro\LOCALS-1\Temp\c.lotus.notes.data\1_lnspeclion Form Page 1.doc 24-Jan-06
FACILITY NAME ADDRESS: 1:'1 ..
HAZARDOUS WASTE GENERATOR .
'/]rl ll', 't'1'li I i,,i'r i ',1 .',i ,. l,:
Lbs or gals
(average)EPAIDI\UMBER:
Tiered Permit:
Treatment
Equipment:
Epnn
Antifreeze:Others:
YES NO N/AE.T N
n
Tn
n
n
tr
tr
trntr
trn
n
n
x
tr'
tr
n
n
u
n
u
tr
n
nnn
trI]
tr
u
E'"
4."'
El'
tr
Er'
Qt
El'
m'
E/'
E"'
trtr'a'
u'tr'
tr
EI
tr'
n
u
vrol.#
GTOl
GTO3
GT04
GT05
GTO6
GTOT
GTOS
GTO9
GTlO
GTl1
GT12
GT13
GT14
GTI5
GT16
GT17
GT18
GT19
GT2O
GT21
GT22
GT23
EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous wiste (Title
22CCRg662f2.12) If Not, Call (S00) 618-6942 to obtain your CAL EPA ID number. i. ir'
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title 22 CCR966262.11)
Fbwn knowledge lanalysis Eother
Hazardous waste analysisftest records are kept for at least 3 years (Title 22 CCR $66262.40.(c))
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or
/
Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR
5ffi263.42t 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title22CCR $66262.34)
E'lO a.y, if waste generated per month is greater than or equal to f00 kg (220 lbs.)'E
f tO days if waste generated per month is less than lfi) kg (see note)
flZl0 days if .vaste generated per month is less than 100 kg and transported more than 2fi) miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 60fi| kg(13,20 lbs.)and no
acutely/extremely hazardous waste over lkg(2.21bs.) is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/S5-gal
or l-qt limit) (Title 22CCR$66262.34(c))
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title ?2 CCR
$6626s.176)
Containers of hazardous waste are properly labeled (includes appropriate date, "IIAZARDOUS
WASTE," waste composition/physical state, hazardous properties, narne/address of generator) (TitleXL
ccR $66262. 31, 66262.34)
ContainerVtanks containing hazardous wastes are in good condition/handled to minimize release or ,
reaction(Title22CCR$66265.1711.191,66265.177(c))
Containers/tankMiners are compatible with waste stored or transferred (Title 22 CCRS66265.172)
Containers storing hazardous wastes are closed/-sealed (Title22 CCR $66265.173)
Weekly inspection of areas where hazardous waste containers,are stored is conducted
(Title 22 CCR$66265.1 74)
Daily inspection of all tank systems is conducted and documented (Title 22 CCR $66265.195),
Empty containers or inner liners greater than 5 gat has date when emptied and are managed properly
within one year of date emptied (Title 22 CCR $66261.7 (f))
RECYCLABLE WASTE
Used oil is managed ", t """rdoo, waste until recycled (includes proper labeling, storage, etc) (HSC
$2s2s0.4)
Used oil filters for recycling are managed property (drained of free flowing liquid, stored in closed
rainproof containet, labeled "drained used oil filters," and transferred for metal reclamation) (Title22
ccR$ 66266.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bilt of
lading for recycling, reuse, or reclamation (Titlezz CCR $66266.81)
SolventVother recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR
$66266.3)
SOURCE REDUCTION: For facilities generating >12,fi)0 kg./yr. of hazardous waste on site.
Generator is subject to SB14 and has prepared and retained current source reduction documents or is
able make them available to the inspector within (5) days. (HSC 82524.19'2524.21)
Source Reduction Evaluation and Plan contains the following five elements:
certification, arnounts of wastes generated, process description, block diagrams, and implementation
schedule of selected source reduction measures. (HSC $25244.19)
C:\DOCUME-1\Flepro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator.doc 2A-Jul-04 20-Jul-04
S)
8501 N. MoPac Expressway, Suite 400
Austin, Texas 78759
Phone: (512) 451-6334
Fax: (512)459-1459 Date Printed and Mailed: 0512212007
SAN LUIS OBISPO FIRE DEPT.
KERRY BOYLE
2160 SANTA BARBARAAVE
sAN LUIS OBISPO, CA.93401-5240
Test Date: 0412412007
Order Number: 2249393
Dear Regulator,
Enclosed are the results of recent testing performed at the following facility:
UPS - SLO
3601 SACRAMENTO DRIVE
SAN LUIS OBISPO, CA.93401
Testing performed:
Secondary Containment-Spill Container
Tank Tests
Sincerely,
bo"^ K"hI^Y^
Dawn Kohlmeyer
Manager, Field Reporting
*d&jTanknology'
Site Name & lD #: UPS - SLO
Address:3601 SACRAMENTO DRIVE
City, State, Zip:SAN LUIS OBISPO cA 93401
Phone #:(949) 452-
WO#: 2249393 Testdate: 0412412007
Site lnformation
Subcontracted Services
SubcontractorName: PRAXAIR
Address 3755 N. BUSINESS CEN
City, State, Zip TUCSON, M.85705
Phone #:800-394-9929
Tanknology Contact: MARK
Tank#Tank#Tank#Tank#Tank#Tank#Tank#Tank#
Product
Tank Size
Tank Tightness Test P
Tank lnterstitial
Line Tightness Test
Line lnterstital
Leak Detector Test
Static Torque
Drop Tube lntegrity
Spill Bucket Leak Test P
989 Turbine Sump Test
Tank Cathodic Protection
Line Cathodic Protection
lmpact Valve
Flex Cathodic Protection
60 Day lnspection
ATG Certification
Pressure Decay
A/L
Liquid Removal
Dry DBP
Wet DBP
989 Disp. Sump Test
AZ Leak Test
Section 52 lnsp.
lntersticial lnsp
Rule 461 lnsp.
Pressure Vent Cap
Vapor Tie
10 Gallon / Min
6-Click Test
Rhode lsland Mon Well
RESULT ENTRY CODES
P = PASS
F = FAIL
l= INGONGLUSIVE
R=REPAIR&RETEST
* IF BLANK NOT TESTED
Printed: 0512212007
8501 N. MoPac Expressway, Suite 400, Austin, TX 78759 Phone: (800) 800-4633
www.tanknology.com
Fax: (512) 451-6344
sPl LL BUCKET REPORT
f PasEffiFfi
Pas!, Fall
(0=Pa63.
>FFall)
Change ln
readings
(cml
1;00 0
Time bet{ren
Measurementg
lhr)
-
Flnal
Readlng
Tlme
Flnal
Reading
(cm1
Mark Shaw
.8921
'13:30?2.25 22.25
lnitial
rradlng
{cml
12:30
12'.XO
T€t
St rt
Tlme
30.5
Bucket
Depth
tcml
30.5
Bucket
Diamstel
tcml
RGmotG Fill
Bucket
Other
teat
Senn
06-1723
uPs
Signaturs: ar-
aDate:
06-1723*:.
kno,Yledge.myofbestthetoaccurateandtruetsreporthistncontainedinformationallthatceilifybyher€
dsl
dsl
T.nk
38822EL.WPFinal-logbook
PAGEI of1
o\
F*
ooF-
a(g
X(.)F
a
oo+
o
a
h
Fao
0)ka,x
rq
o(n
a
2
tn
oo
d
boo
J1tr
<dF
an
6(n
o.l
\t{
ol
oit
!
ko
-v
F
Work Order: 2249393
*!-*
:iti#f,PnAxArR
Praxah 9eryicgr, lnc'
r'zEi'B eutintss center Drivo
Tucson, AZ 85706
Tel: (E001 394'992SPraxair Services' Inc'
rN sERvrct t*Hsi"#8[r DETECTIoN (lsELD)
LTS
I doct t€ undor goneltY ol Pcrluu ihat I am a licertrad tank t€st€r 'nd
lhat the lnlormafon contalnod in thl! repott
;ffiil;;io tm best ot mY knotf,lods€
Stato Llc.f: 06-1723
Teeter:
slgnatulsr
Naythan Senn
Date:4124//20072-z'
-
38822EL.WPFinal-logbook
1 ot2
UPS
TX 78?59
0{l21l07
TanknologY
#400ExpresswaYN.llopac
Sacramento Dr'
Luis cA 93401
trsilgtslr
Tank BottomGroilnd Wlt3r
Product Lavel
Pa88
7
H2()
UnderDlsPenser
contalnment
Tank ToP011-
---T1-- dsl
Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759
' work order: 2249393
;:;%PRAXA'F
Praxair Services, fnc.
PrilrlrSalYlcr, lnc.
3765 tl. Budn .r Cont r Drivc
Tucron, AZ 85705
Trl: (8001 30C0e20
Frr:2gt-t308
Ittti:, ..:, i;;: J;-=.;;i", il;:'Datlil 0rDAloz lSit*lnilf :1..,=iiohJlix.is
Tanknology
E50t N. tlopac Exprocswey #4{t0
Aurdn, TX 78750
Secremonto Dr.
Lule Oblrpo, CA 93401
luPs
lgeor
ls"n
lN SERVTCE EilHANCED LEAK DETECTTON (tSELDl
TEST RESULTS
li*:
,..:.'i:
QA/QC: A[ lleld tlrle rnd rempb enelFh hrr b..n rwlcwrd rnd confirmcd to br complob. All
Enhrncod Lcet Ddcc{fun pmc.dul! rnd proiocob hevc bcro nrot
Afiachcd Flcld Documrntrtbn:
Splll Buckct tlydro T..t Clrt
Slb tlrp
Ploochdru Loe
Lnl Log
Revlarcd By:
Slgnatule:
Mark
2ol'2 38622EL.WPFlnal-'logbook.xls
Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas78759
Work Order: 2249393
PRAXAIR JOB I
Sita Hrm:
CALulr
slt AddFs
cttY. strt . Ao
I nrtill
I)rb
ln trllld
pa? Wort
Plln
(Y'Nl
Brctllll
(Pm
Gtavol,
Ssnd, Sqil)
P?oba
Corfruction
(3r4 or t'
F /c)
G.drd
Cover
Tbbrn.lr
(in)
Voluma oa
Brcmll
Rrnw"d
(q/Ft) o.l0
@fVg.l)
Gloalnd
Cont
(srcBta,
$phalt)
cornpLt d
OaDdl
(in)Probe i
412912007mr dlavcl vI6Concrele12.l 0.51
a,23noo76rnruwlcffid€60-51202
at23t200fmaq6wlt6CorcEtar200.53
1t23t2007vFg orsvslI60.2 Concrete381
Lnu2007me otav€lI6o2Conwtr385
423nOO7Dea oflvcl vI6Coflctate12.)0.5B
1t2312007oes oraYtlI60-5 Concr€la't207
412312007oea orawl v10non91200.56
1t23t2007vD€a qEvcl1nong0o.230I
112312007Ea craval10o2non€38't0
1l
1t23120D7o€s oiivcl16coH6t€o6
aF
ENHANCED LEAK DETECTION PROBE INSTALI.ATION LOG
rEad:
Srnn ConFnt:Prusir lnc
lnrt lled By:lllythln
Prg. 1 o{ I
:t8822EL.W?Fiml'loebook rlE
Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759
#>nnn'poov
8501 N MOPAC EXPRESSWAY, SUITE 4OO
AUSTIN, TEXAS 78759
(512) 451-6334
FAX (512) 459-1459
TESTDATE:O4/24/07
CLIENT:UPS
WORK ORDER NUMBER2 49393
SITE:UPS - SLO
COMMENTS
SUBBED ONE TAI{K AND TWO SPILL BUCKETS. ALL PASSED
PARTS REPLACED
HELTUM PTNPOINT TEST RESULTS (lF APPLICABLE)
P rinted 05 I 221 2007 08:42 ACRAM E R
:iilD*rxM,
PraELr Sewlces, Ihc
11
6 LS.7
Tank 1
10,0oo gal
Biesel
Tlacer [w]
2 1.
Bulldlng
38a22EL-O O O O
EXPI,ANATION
.1 sanpting Probe tocatl-on
ApProxiffice PiPcline l.eation
rzs trctk ai[ulation Probr
/
T-A.NKNOLOGY
United Parcel service
360 ! 5^CRAXANTq DrlVE
saN !uta o!rsFo. cA!rPotNra
N
o 5 10
l#LJ SAXTLINO LOCATIONS
{Gel
Figure I
I
I
I
@ @''
9
OtI
10
e)
lre
EF
LJ4a(D
i1
N
N
Alo
UJ
\o(,
Fl
F)
,t
D
o
0c
I
@(no
7
F'o
ldx
4(Dqq{
FJS
v)
(D
5
q
*lo
X
F)q{
oo\](^\o
:i{f#ffigPNAXATR
':\
)
Praxair Services, lnc.
3755 N. Business Genter Drive
Tucson, 4285705
Tel: (800) 394-9929
Fax: (520) 293-1306FraxaEn Senvfrcesu Xrrc-
Date: 5103120007
To:City of San Luis Obispo
Attn: City Fire Department - Kerry Boyle
2160 Santa Barbra Ave
San Louis Obispo, CA 93401-5240
80s-781-7380
Inspector Boyle,
Please find the attached Enhanced Leak Detection Test Certification.
For:
SITE United
Address: 360
City: San
City/County: San Luis
Client Contact: Klotonya Hamilton
Contact Phone #: 310-625-3256
Tank Tester : Sergio Nunez / Nathan Senn
CA License #: CA# 06-1727 / 06-1723
Our Job No: 38822EL
If you have any questions or require any additional information, please give me a call.
Mark Caldon
ELD Project Manager
Praxair Services, lnc.
3755 N. Business Genter Drive
Tucson, 4285705
Tel: (800) 394-9929 -x248
Cell: (520) 2714540
Fax: (520) 293-130
INFORMATION CONTAINED WITHIN IS CONSIDERED CONFIDENTIAL, PROPNETARY INFORMATION OF
PRAXAIR SERVICES, INC.
;h\+j $,
::i:itffiPnLxMn
I
',',:ef.ffiK"&ffiffi,S6'F Praxair Services, lnc.
3755 t{: Business Center Drive
Tueson, AZ 85705
Tel: {8S0} 394-9929$-3s-{*.:<ez az^ ffit;::a*'; Kt":t}l* u i- * r:
Fax:2S3-1306
Client Date:04!2410v
ology
8501 N" MoPac ExPresswaY #400
Austin, TX 78759
UPS
3601 Sacramento ilr.
, cA 93401San l*uisreUS-assi Fa
Product / SYstem Size Tank ProductPrimary (Primary)
Vent
{Primary}
dsl Pass Pass ;r Fass
Under'OisPenser
Containment 1 Pass
tN SERVICE ENHANCHD LEAK DETECTION (ISELD)
TEST RTSULTS
Site lnfo: Job No 388228L
GROIJND WATER ANS PRO DUCT INFO
I declare under penalty of perjury that I am a licenoed tank tester and that the information contained in this report
is true and correct to the best of my knowledge
Tester:Nayth an $enn $taie Lic. #: 0S-17?3
Signature Date: 412412007
Product I $yst*m IN_TANK ll?0 (lni Product Level (tni
Grqund Water
{in}
Tank Bottsm
tinl
Tanh ToP
{in)
dsl 0 ot >1 20"4 AE
1at2 38822EL WPFinal-logbook
-J
rN SERVICE ENHANCED LEAK DETECTION (|SELD)
TEST RESULTS
38822EL
CIA/QC: All field data and sample analysis has been reviewed and confirmed to be complete. All
Enhanced Leak Detection procedures and protocols have been met.
Attached Field Documentation:
Spill Bucket Hydro Test Cert
Site Map
Probe lnstall Log
Leak Log
Reviewed By:
Signature:
Mark
;':i:€ffif,PRAXATR Praxair Seruices, lnc.
3755 N. Business Center Drive
Tucson, P.Z85708
Tel: (800) 394-9929Flraxair Services, fnc,
Fax:293-1306
lSite info: J;04t24t07
Dr.
cA 93401
nknology
I N. Mopac Expressway #400
TX 78759
PS
3601 Sacramento
San Luis
2of 2 38822EL.WPFinal-logbook. xls
SPILL BUCKET TEST REPORT
Resolution;1mm
Facility Contact:
Facilitv: City, State, ZIP:
Facility Address
Facilitv Name:
Facility lnformation
Mark $haw
San Luis Obispo, CA 93401
3601 Sacramento 0r
uPs
Phone:
Date of Testinq
s{G.997.8921
4t23/2il47
License Number:
Name of Tester:
Company Name:
Testi n g Contractor lnformation
06-17?3
Naythan Senn
PRAXAIR $ERVICES, INC
dsl
dsi
Tank
Test Esuipment Used
Test Method Used: Circle
Remote Fiil
Fiil
Bucket
16
Bucket
Diameter
{cm}
1"{vdrq}sts?ia
2n 4
JU-3
Bucket
Depth
{crri
II.JU
Test
$tart
Tinre
NIA - Lake test
22 25
zJ.c
Initial
reading
{cm}
Vacuum
22.2a
Final
Reading
tcm)
Equi
al.aa
Final
Reading
Time
1:00
1:00
Time between
Measurements
(hr)
Other
0
Change in
readings
{cm}
Comments
Spill Bucket Testing lnfsrmation
I here by certify that all information contained in ihis repori is true and accurate to the best of my knowledge.
s 6Technician's Signature
CERTI RESPON$IBLE FOR
Bate:
#:06-17?3
0
Pass
Pass I $ait
i*;Pa$$,
>Q*$at?l
38822EL.WPFinal-logbook PAGE 1 of 1
|ETPMXATR
Praxair services, Inc
EX
Building
PLANATION
Sampling Probe l-ocation
Approximate Pipeline Location
Leak Simulatsion Probe
United Parc
TANKN
38a22EL-OOOO
LOGY
l- Service
NTO DRIVE
, CALTFORNIA
o
e
1
.LS
N
5o
35O1 SACRAME
SAN LUI S OB T S PO10
ft SA!{PLING ],OCATIONS
Figure 1
feet
t
I6
O
I
I
I
11
L,5"7
Tank 1
10, 000 gal
DieseI
'l racer twl
123
9o
TI
l_oo
-A.TG
5
4 @@
File:34422-Ol
Dace: 04-25-O?
1 ')t )
ENHANCED LEAK DETECTION PROBE INSTALLATION LOG
This needs to be com for all sam installed for ELD
Naythan Senn corp"ny,@lnstalled By:
38822ELPRAXAIR JOB #
UPSSite Name:
3601 Sacramento DrSite Address
City, State, Zip San Luis Obibpo, CA 93401
lnstall
Date
Ground
Cover
(concrete,
asphalt)
Ground
Cover
Thickness
(in)
Probe
Construction
(314 ot 1"
PVC)
Backfill
(Pea
Gravel,
Sand, Soil)
per Work
lnstalled
Plan
(Y/N)Probe #
Completed
Depth
(in)
Volume of
Backfill
Removed
(cu/Ft) e.48
cu fU gal)
4t23t200711200.5 Concrete o pea gravel
oea oravel 4t23t200721200.5 Concrete 6 1
oea oravel 4t23t20071200.5 Concrete 6 1
Dea oravel 4t23t20074360.2 Concrete 6 1
Dea oravel 4t23t20075JO0.2 Concrete 6 I
oea oravel 4t231200761200.5 Concrete b 1
Dea oravel 4t231200771200.5 Concrete b 1
oea oravel 41231200781200.5 none 0 1
oea oravel 412312007o5b0.2 none 0 1
1 oea oravel 4123120071036o.2 none 0
1 oea oravel 41231200711o0Concrete6
38822E L.WP Final-log book.xls Page 1 of 1
NO SWO
Mark Shaw
9't 6.997.8921
locate leak at nipple into face-seal adapter in bucket. Contractor present.
contractor finishes repair. Re-pressurize tank. Spot check looks. Continue
oreliminary check on tank top fittinqs for qross leaks.
locate audible leak on vent riser pipe: holes in pipe behind the fire-extinguisher
box that is mounted to the vent. And contractor beqins reDair
contractor finishes repair: taps and plugs holes.
detect tracer P from ATG grommet. Confirm with soapy water. Contractor
present to beqin reoair
detect tracer P in spill bucket. Locate leak with s oapy water from drain plug.
oontractor tiqhtens q rommet.
contractor cleans and re-builds drain plug. Re-apply pressure to system, but
drain oluo is still leakino.
contractor flnishes repair. Apply pressure to tank and spot check looks good.
Blow out and cover sumps for 'l hr button up test
Dass button uo
pass button up
t hr test - Pass
swo #388228L
Client Contact
Contact #
Sdmpl€ lD
note
note
note
note
note
nole
note
note
note
note
note
note
Tanknology
San Luis Obispo, CA 93401
Tested
fill bucket
vapor bucket
1
vent
ATG
vapor bucket
ATG
vapor bucket
vapor bucket
ATG
vapor bucket
ATG MW
Job#
Naythan Senn
Test
BU
BU
BU
BU
BU
BU
BU
BU
BU
BU
BU
Final
Client:
3601 Sacramento Dr
ITEIA
fill bucket
DSLTK
vent
DSLTK
DSLTK
DSLTK
DSLTK
DSLTK
DSLTK
DSLTK
DSLTK
DSLIK
UPS
Time
9:00
9:20
9:35
10:00
1 0:'1 0
10:13
1O:2Q
10:3C
11:0C
12:OC
12:OC
14:4c
Site Address:
Loq Completed By
LeaUPass
1a
2a
1b
2b
1c
1d
2c
2d
2d
3c
3a, 3d
3c
Site
Date:
04123107
o4l23l07
o4l23l07
o4123l07
o4l23l07
04123107
o4l23lo7
o4t23to7
o4l23l07
04123107
04t23t07
04123107
Description {How collected, Volume Collected,Complete Notes)
1 =Leak 2=Repair 3=RetestPass
Environmental Health Services
(805) 781-s544
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
oBtspo rl
,-l
cltvoL
san lrirs
Flre Department (805) 781-7380
2160 Santa Balbara Avenue
San Luis Obispo CA 93401-5240
CERTTFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
Date: //4q /f'T
EFW data
entry by:
Time:
YES NO N/A
COMMENTS Goto
nntr
n!
BPOl
BPO2
BPO3
TROl
TRO2
EROl
ERO2
ATOl
AT02
BUSINESS PLAN
Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR2729)
Site layouUfacility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
6626s.16)
3HrT"i"t".)r"rlH|r3H,Eor"t:1il ""0 maintained on site (HSC 25504, ritre re ccR 2731 &22
ccR $ 6626s.s3/s4)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release of
hazardous materials/waste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title 19 CCR273l & 22 CCR 66265.31-.43)
ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 25270)
to obtain forms to comply with 1-BP03,TROI andER0l
n!
nT
n
n
Tu
T
T
tr
D
I
FACILITY NAME:
S:
AGENCY
fl EHs
! crrY F|RE
t
INSPECTION TYPE
trn
H
Reinspection
n Routine
PHONE;"1"'
E Business Plan E ttw Generator UST ! acr Ecar-anpPROGRAMS INSPECTED:
n Business Plan I ttw cenerator usT E rcr IcnmnnREINSPECTION REQUIRED:n No IYES
'GPS Coordinates: Latitude:
-deg
min Longitude: deg min-decimal min
FACILITYINSPECTOR:
C:\DOC 1 \Temp\c. lotus. notes. data\1 _l Form Page 1.doc 24-Jan-06
styofsan luls oBtspo
Re:
FIRE DEPARTMENT
2160 Santa Barbara Avenue. San Luis Obispo, CA 93401-5240.805t81-7380
"Courrtesy & Service"
December 12,2006
Ms. Barbara Bolivar, Plant Engineering Supervisor
United Parcel Service
1201 W. Olympic Blvd.
Los Angeles, CA 90015-3905
3601 Sacramento, San Luis Obispo, CA. Rescind Notice of Yiolation Issued
10118/2006 for Failure to Conduct Enhanced Leak Detection Testing on
Underground Storage Tanks.
Dear Ms. Bolivar:
Due to a misunderstanding with San Luis Obispo County Environmental Health I agreed to allow
them to draft a Notice of Violation for United Parcel Service's failure to conduct Enhanced Leak
Detection testing of the diesel tank in a timely manner. I worked closely with one of their
inspectors and issued the NOV on City letterhead based on his input without confirming the need
to issue it. Please accept my apologies for the mistake as this should never have been mailed out
without confirming that the State Water Resources Control Board had indeed sent you notice to
conduct testing at your San Luis Obispo facility.
I spoke with Ms. Marci Christofferson, Environmental Scientist with the UST Leak Prevention
Regulatory Unit of the SWRCB. Her telephone number is (916) 341-5594. She checked her
files and verified that you had not been sent a formal notification or deadline to conduct
Enhanced Leak Detection testing due to proximity to a public drinking water supply well. You
have since received notice to conduct testing and have an 18 month window to complete the
testing. Please be sure to notify me of the contractor and test date (both site preparation for tank
inoculation and sample collection), so that I may be on site to witness the process. If you have
further questions please contact me at (805) 781-7383.
Sincerely,
)r,fuW
B
Hazardous Materials Coordinator
The City of San Luis Obispo is committed to include the disabled in all of ils services, programs and activities.
Telecommunications Device for the Deaf (805) 781-7410.flp
Cify of San Luis Obispo
Fire Department
John Callahan, Fire Chief
2160 Szurta Barbara Ave.
San Luis Obispo, CA 93401
Phone: (805) 7Bl-7380FAX: (805) s43-8019
FAX COVER SIfiET
TO: UNITED eARCEL SERVTCE Arrn: Kloronya llamilton
D'
a
F'AX:r?l ?) 6 12-1710
From: san Luis obispo city F'ire Department
Kerry Boyle (80s) 7Br-7383(Sender's Name)
Date:nanaml. ^r o ?nn6
You should have received 04 pages (including this cover sheet).
If you do not receive all of the pages, or any of the pages are illegible, then please contact the
sender at (505) 7AI-7380, or FAX (80J) 543_S0Ig.
COMI4TENTS: Tonya: As per your request here are the citations in the calif. code
of Regulations regarding the need to install overspill buckets wit.h a capacity of 5
gallons to replace Lhe ones on sj-te that failed the most recent test. Additionally, as
we discussed the deadline for completing the work has been extended to Feb . 28, 2OO7 .
Please call if you have any questions. Lr n /1WW
Cal. Code Regs. Title 23, Division 3, Chapter 16, Underground Tank Regulations
stringent requirement ofthe manufacturers' specifications or the special inspector
Authority: Sections 25299.3 and25299.7, Health and Safety Code.
Reference: Sections 25292 and25292.1, Health and Safety Code; 40 CFR 280.21,280.32(d) and 281.33.
$ 2665. Spill and Overfill Prevention Equipment Upgrade Requirements.
By December 22, 1998, all underground storage tank systems shall be retrofitted with an overfill prevention system and a spill
container which meet the requirements of section 2635(b). The local agency may waive the requirements for overfill prevention
equipment if the conditions specified in section 2635(bX3) are met.
Authority: Sections 25299.3 and25299.7, Health and Safety Code.
Reference: Sections 25292 and25292.1, Health and Safety Code; 40 CFR 280.21
$ 2666. Requirements for Upgrading Underground Piping.
(a) By December 22, 1998, all underground piping containing hazardous substances other than motor vehicle fuel shall be
retrofitted with secondary containment meeting the requirements of section 2636.
(b) By December 22,1998, all underground piping containing motor vehicle fuel and connected to an existing tank shall be
retrofitted with secondary containment unless the owner or operator demonstrates to the local agency that the piping is
constructed of fiberglass reinforced plastic, cathodically protected steel, or other materials compatible with stored products and
resistant to conosion. The secondary containment system shall meet the construction, installation, and monitoring requirements
of section 2636.
(c) By December 22, 1998, all iutomatic line leak detectors for underground pressurized piping which is not secondarily
contained shall be capable of shutting off the pump when a release occurs. In addition, the pumping system shall shut down
automatically if the automatic line leak detector fails or is disconnected. In lieu of the above, for underground storage tank
emergency generator systems, the leak detector must be connected to an audible and visible alarm to indicate a release
malfunction of the system.
(d) All underground piping and secondary containment shall be tested for tightness after installation in accordance with section
2636(e).
(e) By December 31, 2003, all existing underground storage tanks shall be retrofitted with under-dispenser containment, or an
under-dispenser spill containment or control system. The under-dispenser containment or under-dispenser spill containment or
control system shall meet, where applicable, the requirements of 2636(hX2), or 2636(hX3).
Authority: Sections 25299.3 and25299.7, Health and Safety Code.
Reference: Sections 25284.1,25292 and25292.1, Health and Safety Code; 40 CFR 280.21
49
Cal. Code Regs. Title 23, Division 3, Chapter 16, Underground Tank Regulations
$ 2635. Installation and Testing Requirements for All New Underground Storage Tanks.
(a) Primary and secondary conrainment systems shall be designed, constructed, tested, and certified to comply, as applicable,
with all of the following requirements:
(1) All underground storage tanks shall be tested at the factory before being transported. The tests shall determine whether
the tanks were constructed in accordance with the applicable sections of the industry code or engineering standard under
which they were built.
(2) The outer surface of underground storage tanks constructed of steel shall be protected from corrosion as follows, except
that primary containment systems installed in a secondary containment system and not backfilled do not need cathodic
protection:
(A) Field-installed cathodic protection systems shall be designed and certified as adequate by a corrosion specialist.
The cathodic protection systems shall be tested by a cathodic protection tester within six months of installation and at
least every three years thereafter. The criteria that are used to determine that cathodic protection is adequate as required
by this section shall be in accordance with a code of practice developed in accordance with voluntary consensus
standards. Impressed-current cathodic protection systems shall also be inspected no less than every 60 calendar days to
ensure that they are in proper working order.
(B) Underground storage tanks protected with fiberglass-reinforced plastic coatings, composites, or equivalent
non-metallic exterior coatings or coverings, including coating/sacrificial anode systems, shall be tested at the
installation site using an electric resistance holiday detector. Alt holidays detected shall be repaired and checked by a
factory authorized repair service before installation. During and after installation, care shall be taken to prevent damage
to the protective coating or cladding. Preengineered corrosion protection systems with sacrificial anodes shall be
checked once every three years in accordance with the manufacturer's instructions.
(3) Before installation, the tank shall be tested for tightness at the installation site in accordance with the manufacturer's
written guidelines. If there are no guidelines, the primary and secondary containment shall be tested for tightness with air
pressure at not less than 3 pounds per square-inch (20.68 k Pa) and not more than 5 pounds per square-inch(34.48 k Pa)' In
lieu of the above, an equivalent differential pressure test, expressed in inches of mercury vacuum, in the interstitial space of
the secondary containment, is acceptable. The pressure (or vacuum in the interstitial space) shall be maintained for a
minimum of 30 minutes to determine if the tank is tight. If a tank fails the tightness test, as evidenced by soap bubbles, or
water droplets, installation shall be suspended until the tank is replaced or repaired by a factory authorized repair service.
Following repair or replacement, the tank shall pass a tightness test.
(4) All secondary containment systems shall pass a post- installation test which meets the approval of the local agency.
(5) After installation, but before the underground storage tank is placed in service, a tank integrity test shall be conducted to
ensure that no damage occurred during installation. The tank integrity test is not required if the tank is equipped with an
interstitial monitor certified by a third-party evaluator to meet the performance standards of a "tank integrity test" as defined
in section 261L, or if the tank is tested using another method deemed by the State Water Resources Control Board to be
equivalent.
(6) All underground storage tanks shall be installed according to a code ofpractice developed in accordance with voluntary
consensus standards and the manufacturer's written installation instructions. The owner or operator shall certify that the
underground storage tank was installed in accordance with the above requirements as required by subsection (d) of this
section.
(7) Alt underground storage tanks subject to flotation shall be anchored using methods specified by the manufacturer or, if
none exist, shall be anchored according to the best engineeringjudgment.
(b) All underground storage tanks shall be equipped with a spill container and an overfill prevention system as follows
(1) The spill container shall collect any hazardous substances spilled during product delivery operations to prevent the
hazardous substance from entering the subsurface environment. The spill container shall meet the following requirements:
(A) If it is made of metal, the exterior wall shall be protected from galvanic corrosion.
(B) It shall have a minimum capacity of five gallons (19 liters).
I6
Cal. Code Regs. Title 23, Division 3, Chapter 16, Underground Tank Regu
(C) It shall have a drain valve which allows drainage of the collected spill into the primary container or provide a
means to keep the spill container empty.
(2) The overfill prevention system shall not allow for manual override and shall meet one of the following requirements
(A) Alert the transfer operator when the tank is 90 percent full by restricting the flow into the tank or triggering an
audible and visual alarm; or
(B) Restrict delivery of flow to the tank at least 30 minutes before the tank overfills, provided the restriction occurs
when the tank is filled to no more than 95 percent of capacity; and activate an audible alarm at least five minutes before
the tank overfills; or
(C) Provide positive shut-off of flow to the tank when the tank is filled to no more than 95 percent of capacity; or,
(D) Provide positive shut-off of flow to the tank so that none of the fittings located on the top of the tank are exposed
to product due to overfilling.
(3) The local agency may waive the requirement for overfill prevention equipment where the tank inlet exists in an
observable area, the spill container is adequate to collect any overfill, and the tank system is filled by transfers of no more
than 25 gallons at one time.
(c) Secondary containment systems including leak interception and detection systems installed pursuant to section 2633 shall
comply with all of the following:
(1) The secondary containment system shall encompass the area within the system of vertical planes surrounding the exterior
of the primary containment system. If backfill is placed between the primary and secondary containment systems, an
evaluation shall be made of the maximum lateral spread of a point leak from the primary containment system over the
vertical distance between the primary and secondary containment systems. The secondary containment system shall extend
an additional distance beyond the vertical planes described above equal to the radius of the lateral spread plus one foot.
(2) The secondary containment system shall be capable of preventing the inflow of the highest ground water anticipated into
the interstitial space during the life of the tank.
(3) If the interstitial space is backfilled, the backfill material shall not prevent the vertical movement of leakage from any
part of the primary containment system.
(4) The secondary containment system with backfill material shall be designed and constructed to promote gravity drainage
of an unauthorized release of hazardous substances from any part of the primary containment system to the monitoring
location(s).
(5) Two or more primary containment systems shall not use the same secondary containment system if the primary
containment systems store materials that in combination may cause a fire or explosion, or the production of a flammable,
toxic, or poisonous gas, or the deterioration of any part of the primary or secondary containment system.
(6) Drainage of liquid from within a secondary containment system shall be controlled in a manner approved by the local
agency to prevent hazardous materials from being discharged into the environment. The liquid shall be analyzed to
determine the presence of any of the hazardous substance(s) stored in the primary containment system prior to initial
removal, and monthly thereafter, for any continuous discharge (removal) to determine the appropriate method for final
disposal. The liquid shall be sampled and analyzed immediately upon any indication of an unauthorized release from the
primary containment system.
(7) For primary containment systems installed completely beneath the ground surface, the original excavation for the
secondary containment system shall have a water-tight cover which extends at least one foot beyond each boundary of the
original excavation. This cover shall be asphalt, reinforced concrete, or equivalent material which is sloped to drainways
leading away from the excavation. Access openings shall be constructed as water-tight as practical. Primary containment
systems with integral secondary containment and open vaults are exempt from the requirements of this subsection.
(8) The actual location and orientation of the tanks and appurtenant piping systems shall be indicated on as-built drawings
ofthe facility. Copies ofall drawings, photographs, and plans shall be submitted to the local agency for approval.
I1
L
I
Environmental Health Services
(805) 781-ss44
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
oBrspo -!l
/'--\
I
Gq/o[
san luls
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
CERTTFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
ilh
EFW data
entry by:
uTn
nn
n
n
w,B'
dw
ad
Date:
Time
YES NO N/A
nn ca'
tr
n
GPS Coordinates:
BPOl
BPO2
BPO3
TROl
TRO2
EROl
ERO2
ATOl
AT02
BUSINESS PLAN
Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR2729)
Site layouUfacility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
66265,16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCF-273l & 22
ccR $ 6626s.s3/s4)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release of
hazardous materials/waste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title t9 CCR273I &22 CCR66265.31-.43\
ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer witNn last 5 yrs. (40 CFR f 12.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 25270)
COMMENTS Co to http://www.slopublichealth.org/environmentalhealth/hazardous-materials.htm, to obtain forms to comply with BP01-BP03, TR0l and ER0l
t,-
: deg min Longitude: deg-min-decimal min
FACILITY REP:,.{." i". l
FACI NAME:
l/y/\
PHONE:
AGENCY
4
E ens
CITY FIRE
Routine
Reinspection
TYPE
n otner
! Complaint
PROGRAMS INSPECTED:Business Plan ffiw cenerator UST fl ecr Icnunp
REINSPECTION REQUIRED:u No IYES ! Business Plan I Hw Generator
I
E usr I rcr ncaunp
INSPECTOR:
C:\DO 1\Repro\LOCALS-1\Temp\c.lotus.notes.data\1_lnspection Form Page 1.doc 24-Jan-06
FACILITY NAME
EPA ID NUMBER:
Tiered Permit:
Treatment
Equipment:
ADDRESS
HAZARDOUS WASTE GENERATO
frJA ?ti/i,fi?p ilfr
E]CES4' ' "'!cndoi -" lcr Epnn
Total generat"orrrlorrtt, ry$&b, r**4
Waste oil: Solvents:
{r"
Lbs or gals
(average)
Antifreeze: Others:
tr
Bl,
@n
tr
@':w
@/
Vl
@''
ffi
d"Ww'
aa
B',
El
@/
ET
YES" NO N/AW E E-.
ttM
YtoL.#
GTOl
GT03
GTO4
GTO5
GTO6
GTOT
GT08
GTO9
GTlO
GTl1
GT12
GT13
GT14
GT15
GT16
GT17
GTl8
GT19
GT2O
GT2I
GT22
GT23
authorization
!milkrun
22CCR
E6it'".
EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR566262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title 22 CCR $66262.11)
f]own knowledge lanalysis Eother
. Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR S66262.40.(c))
DISPOSAL/TRA NSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or
from DTSC (HSC $25189.5, Title s66262.r2),
@/i
T
T
T
ITn
Itr
T
T
8'
w''
u
nTtr
TT
T
T
,n
tr
T
I
Hazardous wastes are shipped with manifest (Title 22
Manifests and,/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR
566263.42t 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERSITANKS
HaSgrdous wastes are accumulated on site as follows (Title 22 CCR $66262.34)
W9O days if waste generated per month is greater than or equal to 100 kg (220 lbs.)
n ftO days if waste generated per month is less than 100 kg (see note)
Z nO days if waste generated per month is less than 100 kg and transported more than 200 miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13'200 lbs.)and no
acutely/extremely hazardous waste over lkg (2.2lbs;) is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/S5-gal
or l-qt fimit) (Title 22 CCRS662623a@D
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
$6626s.176)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTE," waste composition/physicat state, hazardous properties, name/address of generator) (Title22
ccR s66262. 31, 66262.34)
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or '
reaction (T itle 22 C CR S66265. 1 7 t I .19 l, 66265.17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR$66265.172)
Containers storing hazardous wastes are closed/sealed (Title 22 CCR $66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted
(Titte 22 CCR$66265. 174)
Daily inspection of all tank systems is conducted and documented (Title 22 CCR $66265.195) ,
Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly
within one year of date emptied ("Iitle 22 CCR $66261.7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
s2s2s0.4)
Used oil filters for recycling are managed properly (drained of free flowing liquid' stored in closed
rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22
ccR$ 66266.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recydling, reuse, or reclamation (Title 22 CCR $66266.81)
Solvents/other recyclable materials are managed as hazar{ous wastes until recycled (Title 22 CCR
$66266.3)
SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site.
Generator is subject to 58L4 and has prepared and retained current source reduction documents or is
able make them available to the inspector within (5) days. (HSC 525244.19,25244.21)
Source Reduction Evaluation and Plan contains the following five elements:
ceitification, amounts of wastes generated, process description, block diagrams, and implementation
schedule of selected source reduction measures. (HSC $25244.19)
C:\DOCUME-1\tlepro\LOCALS-1\Temp\c.lotus.notes.data\2--Haeardous Waste Generator.doc 20-Jul-04 20-Jul-04
I ti j',r t
iJX| ".{) .l*
b4x/{\wn //Md'( FAC|L|TY NAME:DATE:INSPECTOR:
UNDERGROUND STORAGE TANK (UST)
Permit No.
#PERMITTED TANKS
# UNPERMITTED TANKS
Owner & operator as indicated on permit:
If no, new owner name & address:
fl vrs ENo
MONITORING CODES
1. No monitoring
2. Standard Inventory Control
3. Modilied Inventory Control
4. Statistical Inventory Rec.
5. Automatic tank gauge (list type)
6. Continuous monitoring in tank annular
space/secondary contain ment
7. Visual monitoring
8. Manual monitoring annular space
9. Temporarily abandoned under permit
10. Another methdd
YES NO N/A PERMITTING
Site has a permit to operate (HSC 25284)
Permit is kept on the premises
Change of ownership is reported to the permitting agency within 30 days (HSC 25284(c))
All UST(s) are properly permitted to operate or properly closed (HSC 25298)
MONITORING
UST(s) monitored using method specified on,the permit or approved by the permitting agency (HSC
25293\ (Write monitoring code(s) observed {-2 , .
Monitoring records are provided to regulatory agency upon request
Automatic line leak detection system is installed & kept operational for all pressurized piping (HSC
2s292)
An annual report is submitted to regulatory agency
Tank tightness test and/or piping test is being performed as required (Title 23 CCR)
Written Monitoring Plan submitted for electronically monitored tank system (Title 23 CCR 2632134)
Facility maintains evidence of Financial Responsibility for corrective action and for compensating third
parties for bodily injury/property damage caused by a release from the tank system (HSC25292')
nn
@'n
!
nn
@-
nn
w''
a"a-
trn,
@'E*
@',
UTOl
UT02
UTO3
UT04
UTO5
UTO6
UTOT
UTO8
UTO9
UTlO
UTlI
UTl2 Equipment is maintained in a satisfactory
1v+t],N
SPCC Plan is prepared and certified by a registered engineer within last 3 yrs.
SPCC Plan is maintained on site or nearest lield office.
/i
YES
1., L/i)i i-l\ i .r
NO N/Atld,trE ATOI
ATO2
' "i"'1-/l'(
ABOVEGROUND s ET
Total Volume:_ gals
Note: SPCC required for single tank
(including 55 gallon drums); for farms,
storage capacity ofgreater than or
No. ofTanks:Products
capacity ofgreater than or equal to 660 gallons or cumulative capacity of 1,320 gallons
construction sites individual storage capacity ofgreater than or equal to 20,000 gal or total
nn flGasoline f]Crude oil
gallons.
Diesel
Others
\\3000S\VCI11\HCIMH\JPO[:l-\FORM$\OFFlCff97\lnspsction forn'rs\CUPA inspection forms.doc 4-Aug-00
11/21/2665 21:24 8859298948 B&T SERVIEE STATION PAGE b2
MONTTOPJNG S YSTEM CERTIFIC.ATION
Far Use Bv All Jurisdictions Within the Statc of California
luthoriry eited: Chaptcr 6.7, Health oni Solety eode; Chapler )6, Division I, fn[" Zl, Calihrnic Code ol Rcgulariort
This fo ru muet bc uscd {o documcnt tcsting errd fc*ic.;g of monibring cquipmcnr, A rcoatg(c ccRisceticn or rcport must bc prc$4
fo. crchtgdlodng-flft$-."aru9l atsct by tha tcclurician who per$rrinr tlre ,rvork. A copy of tbir fomr must lc Brovidcd 1p thq trnk
syctclrr owna/opsrator. The owrct/opctator must submit r copy of rhis form to thc locrl sgency rcgulating UST systcrns withifl l0
days oftstdrtc.
A. Gencral I nformationIJP''Facility lfrmc:Blds. No.:-
sitcAddrcss: -?-bO-l F^zror*enta ciry:s{nl,,}r 6,bl?p . zse:-
E'railiru fmtort D.*^----f--. bL^-- rr- . I !a? \ C .r U -?.t *'lLUil ELr r OUr rE r i s. . trg,!g.l*J &,J_-:!___-.-7t--
M*e/Model of MonitorinE Syttcm:Datc of Tcsting/Scricing: L,eJ n-L
B, Inveutory of Eq Tested/Certified
.lffhc flcilg conhins morc tanlcs or dispcnrcrs, copy lhis foma. lncludc infocoation for evdy tilrk lld dlspcnscr rt thc facilltv.
C. Ccrtificaticd - I ccrttfy thtr ttra qrrlpornt ldestifiad in ihir docnocl'1rvrr in:pectcd,/srrvicrd lrr ercordrnce with (he mraulecturtrs'
gtri&Jiaea Allrc&ed ro rhla Cer(ificetlol ls inforortioa (cg, nimrifesftiftsr ucccrtrry io verify ft$ ilit hfo nfon is
torriA lnd r Plot Plin rhowlag 6c lryout of mslllorlng cquigr(ent. For ruy
rttrclcd r copy o( thr rcpo d; (check all rhu appllt)z Efystem sct-up
TcchnicianNrnro lprur$ ffriY/-- . Gi+iAIeL:- sign:ture:
crgeblc of gcEerlting fudl rep€rt5, I heve rlsof
Cesrificatisn No,; F Z'/S Z?- -- Liccrrsc.No.qz3
t
TcstingComprny Ntmc:
Site
O Other fscccifr couiorocnl *Ei nnd rcorlct in Sacrion E or. Pare 2)
O Fill Swp Scnso(_r). Mode!:
tr Mcctieniel Lbc l.crk Dctcctor. Modcl:
O Electrqric Linc hlk Dctcctor. Mo<lcl:
Il Teak Orrf li/ i{igir-Level Scnsor. Modcl:
ID:
Fiobc.
Sprccor Viulr5enror
P ipingSuop / Trcach Scruot{e).
M6dcI:
Modcl:Q Affiutaf Spsc{ or Vrult Sancor. Mo&l: -B PipingSumpiTnnelrScnsor(s). Model:..*-
tr FillSurpSecsodr).
O M€chrni&l Linc Leak Dclcctor
O P,tcclrronie Linc Lak Delector.
tr Tuk0vcrfilll Higi'{.+vct Scnsor. Mrdcl:
D O0rel {rpceifi €qtip osnt lyDc lnd nodel in See'tion E on 9enc 1).
D ln-TrnkGruging Probe.
Trnk lD:
Mcdcl
Modcl:
Mnrlpt'
Modclr
-
Ta:rk ID:- .
D h-Tar&GeugingProbc, Modcl:
O fuinulu Specc qr Vrult Scnror. Modcl:
fl PipingStraptT*nchSensor(r), Modtt:
Cl Fill SumpSasor{ri. Modrl:
trMccfiardec!LiltcLclkDct*!cr. Modcl:
Cl Elcctruic Unc L€d( Dcicctor. Modcl:
O Tink0vcrlill ltligh-Lrvct Scnsor. Modcl;
G Othcr{roccify*sionot tnoc rnd rwdcl in Scction E on ?rer 2).
D la-Tank0rughgProbc.
D Arurutar Sprqc or Vrull Se.nsor.
tr Fiplrg Sump /Trenclr Scnla(s),
tr FillSurnpScnrc(s).
O Mceharrici! Lifie ilak Dctcctor.
O Blcslronic Line krJr' Dctcctor,
U TrrI( Ovcrfill i Higfi-trrcl Scnroa
Modcl:
Modcl:
Modcl:
Modrl:
Modc{:
Modcl:
fl O{rcrfrpcritr cquitrlqrttpc ud Eodel h$aclion E 6n Plrc 2).
TrnkIS:
Scnso(r). MqdcLrfR Og I
O DispancrConaiiruat! Flor(s) rnd C&sia(4.
rD: I +l-
O ShcarYrh(r).
lDhpcnrcr lD;
O DirparuConhinnrnrsenio(s). Modrt_
El Steervlllt(s)-
C Dbtarf{ Conlnilltwnt Flor(rl lrut Clrir(r)-
Dirpcucr lD:
-
o Dispcnsrconlrioregil scnsodr). Mo&h-
tr ShcarVrlw(r).
I DiscsccrContriru*nt Floar(rl and Chainfr).
Dkorscr lD:
tr Dirpenrer Cookinnrn! $eiuor{r). Modclj
Q Shcar Vrlw(s),
E Dispenru Cotrtrinncnt Flortfr) and Chain(r].
DlspcnrltlD: . ..
O DispanscrConirinrunt Scnsor(s). Model:
tr Stcarvrlw{s).
ClDispenrc Contrinrcnt Floal(s) ud Cleia(s).
DirprarulD: _ : _
Q DispcnscrContriqncnt Scnsods), Modcl:
-
D Shear ltalrirlr;.
D Dirpcncct Cortri$nent Flort(r) and Ciein(s).
11121/2885 21i24 6853298948 B&T SERVICE STATION
t'agt t rrf .1
',.-!-.r (r,rr^- t'.'-.:E- -.'r.rr r!rF rrJ.rsr.r Lrlrttlrxtton.
-': Rcs{rlfi cf Tcsring/Servier'Eg
Soflwan: Vcrsion tn5ralle&3x{.oL
chrc
'ld E belbrv. desrrlbe horv snd t'hen thesc dctlcicncics rr.ecc orr rvlll bc corr€clc
E. Commenfs:
PAGE 83
fi lr01
EflYc'O No-
EI.//ct Cl Nor Is ihe visual'ehrm opcirtiono[?
€llYcs G No'w
U Yrr 0 No.so that.othcr cguipnrcnt willsl forvcst pOint Of conl,simtcn(Wbre oll sensont
intcrfcrc vritl
U TCg El/No.d Nt,t
nrodcnr)lf ilrcalnnrts to rcnrstc0 toriltront s{ation.Its C6rn!l'lull nicationsrclaycdng cquiprrrant {c.g
E[ Ycs u
n No'
N/A rngniiorirrg ststerii dEaEets I
positivc shur"dcw<r? {C&acl
For tlrcdocs turbinc do\.rnshul rhcifp.rcssurirsd systeflri.oiping rntllcrlc(rnl{lauronrericrllysccondrry
sEffiOtrqhich llllllttt
Scnsors.inncnl
linnegn tr rtu
E Ycs flrNo'd Nla
t
onk lizc(br(!he to!!'!ot!r thctt t.l!-systcrnt systenltnu fiodevice{Vatning.
ovcrfimcchniricol vcval 3I insrol rhirS ovcrfipravention'rrrdihlavisibld.and tit halcd),lrAL
nll I0 Yer'tl"No
I sfrci.fic. $ensoG. probcs. or cqvrpnlcnt r.cp laccdWas!nv cqu r|)lrcnt ycs'
namc and nrodcl all rts in Scction
U Yesit,
'J
ElNo any sccondary cdnt0intncnt systenrs as dry systcnu? (Check all that opltl.r)Dlbund in
Itroductl 0
Was
iA Ycs E.Noa iflo ctrsurc
E! Ycs ls n ll rionitorinp .q uip$"ri opa$tiotn I pcr nrrauitcturcr's
II/21/2685 2I124 8659298948 B&T SERVICE STATION
checldist:
r In thc Seetion En belorv, dercribe ho rv gnd lyhcn these deficicaclce wrre or wlt! be correetcd,
G. Line r*rkDetectors (LLD): D ctrccr.thisboxifLLDcErcnori$sb[ed.
'[n the Section H, bclor, dcscrlbe rnd rvhen thesc dehciencles were or witl bc cottoctcd.
H. Commenls:
PAGE 64
/
F. fn-Tank Geaging I SIR. Equipment:E Chcck this box if tenk gruging ir uscd only for invcntory control.
C Cheek this trox if no tu*, gauging or SIR cquipmcnt is Lrnetlcrl.
This sectioa must bc completed if in-unk gaugrng equipment is used to perfom leak detection moniroring.
thc
E ir. -a/r I Gf u rl(,"-Iies ui input wiring bcen inspccted for crrtT and tcrminutioq indudhg taeting for grorsrd faulrs?
6 ]t*tJ l\tO'
t{/\Ar ii i{or Was rccrrrcy of slttrur preduct lovel rcadiagr tened?
El /fe"E Nol
Wana rll
V/rs wttcr
rcinstalhddlY.,tf No.
El Yes O No'\lrcce dl itcrru the cquipnont maintcnraccooEcturar'manu E
tl Ycs
L
No'
wA
o
{1
slut 3
orFor rnnual8Ud.up Fequipmcntw8s Icak {asigrulatcd LLD-r-iR,pcrfcmtenoc?
dlt(Cll.r'tft fiiat Sirnulatcd latCilcak tr 0.dFPlv)t D 0.2c.p.h.g,p.h c.P.h.
8li conliancd accula1erndopcrational
Wes thctenin6 spprlrtut
F-or elcctrOnic LLDI, docs thc tsbine
if it dctectr a lak?
if rhc
For mechenical docs tlrc LLD rcstiict pioduct
4lYrs iJ NO'
9/rrs O Noi
€I Yes o
tri
Nor
lilA
G Ycs lJlllc'
a/lye
f-l Ir- rq tlu
dr.ve.
6c rubinc ehrrt offif ury of the monitoring system is
or disccnnacted?
crccroDlc LLIjlsr
l-l trt-a
dN/e LLDs, docs &c automadcr,ily shut off of thc rnalfi,nctionssysornmonitoring
or failE u tecJ
Fsr
"r cl;hr
C tva wiritg cou*tiour bcca risually inspectcd?lavedi
dYcs 0 Nor raangftdtra't roinfutoca
l- l-lul u JB&T SERVICE STATION
rL+.qu16ttlRcnt
885923834877/21/2885 21r24
i /O.bv J vL v ,- .)
)
U te PIot
-s'."'-\r.
. : :q)
7-
s:
:f,..':gl'v
\.P.::.
,,1011r , .i; 'si 4r., , -,;,'' ,j{ r,i,}rlilr.r-i,B-. ' !:-tri. ,Dde UIln000
Nt
t1,/2r/2685 2r;24 8659298948 B&T SERVTCE STATT0N
/-\
@FEDJACKET ) ,="k Deiector
FXT EVALUATION CHART
service cornpanv .Fd frla:^+a'lc-e
PAGE O6
Site Locatlon
360 r eazraA^tr+e <.r A
Date -e-0- o
Te chn i cia n Pe rf o rm i n g Te st-{rA: K€- 6.J i-i€ffe?- -
TECH Number
TYPES OE LEAK DETECTORS TESTED
[] xlo i11e-036-si
t] DLD (118-017-s)
tt BFLD (XL Mociel) (116-039-5i
n (116-012.5)
1 16-035-5)xLP (
I PLB (i1,o-oso-s)
I Fx1 {11o-o4z-5)
FXlD (116-054-5)
FX2 (116-046-5)
FXzD (ii6-048-5)
FXlDV (116-0ss"5)
FX2DV (116-Os3-5)
FXlBFLD "
TEST INFORMATION
l-l rxeeruo
-f rxtv t11o-os5-5)
fl rxev (11c-os?-5)
f.;rxrov (118-o5B-5)
E .TtuY i1i€'oss€i
p rxtv (i1c-os1-5)
f rxev (116-os2-s)
tr
tr
*uuil
{-.|*.,-. I'!,,r.(+tb I
Owner/Operator .i,
(Signeture)
7401 W. 129 St..0varland Part. KS 60213 r 9l-3'lgE-57:00
Mrrlay Pump tegofvls the (loht lo makr deslgn lmptovemcntg lnd
Dr{Dlno nodtttcrfioni la n0cessary lnd wllhout notlcl
btrsl m.*oy Runng ?rir'iEd in U$A
16
(oate)
m ftlatlsy Puttt
l tjrni ooolnbl elt'lnY
ProduEl
Scihl
flumbat
Op.filhg
llmr
il€t rlhg
?3lllt?r
Funcuonol.
Elcnlaot .
fi6ldh0PS&ti
&prormatc
Tnrt Llok RltG'Fl-ttllo
GPI{
: ProerFlll
T.itLrlkRct
iilJiltnoPfi
Pumg'Fgtilh
It !6ufo
t AAr a\ALI \{ )6- qL(r -?at I-f \ Y>t -r^ rlz r'f [, T,f I Wa.F*trh>\ tdat I 2,h*l
2
3
4 t
5
A
t
7
I
Gtyo[san luls oBtspo
FIRE DEPARTMENT
2160 Santa Barbara Avenue. San Luis Obispo, CA 93401-5240.8051/81-7380
"Courtesy & Service"
October 20,2006
Ms. Klotonya Hamilton
United Parcel Service
Plant Engineering
1201 West Olympic Blvd.
Los Angeles, CA 90015-3905
Re: 3601 Sacramento Dr., San Luis Obispo, CA. Rescind Notice of Violation Issued
10/18/2006 for Failure to Conduct Enhanced Leak Detection Testing on
Underground Storage Tanks.
Dear Ms. Hamilton:
Due to a misunderstanding with San Luis Obispo County Environmental Health I agreed to allow
them to draft a Notice of Violation for United Parcel Service's failure to conduct Enhanced Leak
Detection in a timely manner. I worked closely with one of their inspectors and issued the NOV
on City letterhead based on his input without confirming the need to issue it. Please accept my
apologies for the mistake as this should never have been mailed out without confirming that the
SWRCB had indeed sent you notice to conduct testing at your San Luis Obispo facility.
I spoke with Ms. Marci Christofferson, Environmental Scientist with the UST Leak Prevention
Regulatory Unit of the SWRCB. Her telephone number is (916) 34I-5594. She checked her
files and verified that you had not been sent a formal notification or deadline to conduct
Enhanced Leak Detection testing due to proximity to a public drinking water supply well. An
exemption from testing may be granted if you complete a "Request for Reconsideration" and
send it to the SWRCB. Based on further analysis by their staff you may be exempt from these
requirements if your fuel tank is more than 1,000 feet away from a public drinking water supply
well. If you have further questions please contact me at (805) 781-7383.
Sincerely,
\0
D. Kerry Boyle
Hazardous Materials Coordinator
The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities.
Telecommunications Device for the Deaf (805) 781-7410.
t
f,p
ilttr$lillttftllll
.'\
cltyo[sanhls onlspo
F]RE DEPAFITMENI
;i'ils#;;ruara,qvonre . san Lurs oblspo, GA garr$l-Fa{r} . g05J78l-raa0
"(TntrmrS df -\ctt'tcr"
VIA OVERNIGHT SERVICE, SIGNATURE REQUIRED
101171200e
UNITED PARCEL SERVICE
UNITED PARCEL SERVICE
16000 ARMENTA ST
VAN NUYS, CA 91406
FacilitY Address:3601 Sacramento Dr.
San Luis ObisPo, CA 93401
NOTICE OF VIOLATION
our records indicate that you have failed to correct the listed violations by the assigned
deadline date. You must take appropriate action as directed, not later than 11101/2006' to
avoid further enforcement action. dnforcement action includes, but is not limited to' a
chargeable reinspect.ron, administrative entorcement, and civil or criminal prosecution' within
20 days of the oate of this letter, initial each violation below that you have corrected' sign the
statement certifying comptiance, anO return the signed copy to SLOFD with any requested
supporting documentation.
lf the listed violations have not been corrected, and you have not returned this form with any
requested suPPorting documentation bY the deadline, You will be scheduled for an Office
Hearing at CitY Fire Station #1, 2160 Santa Barbara Aven ue, San Luis ObisPo, CA on
Dec. L2, 2006 at 3 P.M. to discuss required corrective actions , timetables for comPletion,
and potential Penatties.lf you have corrected the listed violations and retumed this letter,
please call me at (805) 781 -7383 to cancelthis hearing. lf you do not send in the certification
and yo u do not appear as scheduled,you may be assessed a fine or referred to the Office of
the District Attorney for Prosecution.
Date of Violation
9/15/06
violation code: uT21 PE: 0351 Original comply By Date: 10/15/06
vioration Text: sECoNDARy CONTAINMENT, ANNUAL CERTIFICATION, AND/ORELD TESTINGS Nor
PERFORMED AS REQIIIRED
([ISC CHAPTER6.7, TITLE 23 CCF.2637)
GOMMENTS: 1. SUBMIT AN ELD WORKPLAN WITHIN 2 WEEKS USING A SWRCB LICENSED TESTING
COMPANY.
2. COMPLETE TESTING BY T2-4.2006,
UST OWNERHAS NOT COMPLETED ELD TESTING. THE UST SYSTEM IS WITHIN I'OOO FEET OF A
PT]BLIC WATER SUPPLY WELL.
ViOIAtiON COTTECTiON TCXt: IMMEDIATELY BEGIN ARRANGEMENTS TO XIYINECESSARY TESTING
PERFORMED BY A QUALIFIED TESTER AT THE EARLIEST POSSIBLE DATE' FOR ENHANCED LEAK
DETECTION, YOU TNTUST PROVTDE A TESTING WORKPLAN TO TIIE CIJPA WTTITN TI{E TIMEFRAME
SPECIFIED TNTHIS LETTER. FAILURETO CORRECTTHIS VIOLATIONBYTHEDATE SPECIFIED IN
THIS REPORT MAY RESULT IN CIVIL PENALTIES OF $5OO TO $5,OOO PER DAY' PER TANK'
AFTER CORRECTION, CONTACT INSPECTORFOR A REINSPECTION TO VERIFY COMPLIANCE'
UNITED PARCEL SERVICE
NOTICE OF VIOLATION
lf you have questions reg arding this notice, please contact me at (805) 781-7383'
\$,
101171200e
PAGE 2
a,
D. Kerry Boyle, Hazardous Materials Coordinator
City of San Luis Obispo Fire-Department
FrJ:g;m'
- slo ctrY - RENEWAL - usr ANNUAL PERMIT FEE
I hereby certify, under penalty of law, that the initialed violations, listed above' have been
conected. I understand tnat d chargeable reinspection may be conducted to verify compliance.
Title DateSignature Report 9602
I