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HomeMy WebLinkAboutFile 1����u�1�Ne1�1111� �1�������► 11 I I city osAn luis oBispo FIRE DEPARTMENT 2160 Santa Barbara Avenue * San Luis Obispo, CA 93401-5240 * 805/781-7380 "Courtesy & Service" HAZARDOUS MATERIALS BUSINESS PLAN UPDATE FORM YEAR 2003 FACILITY NAME:ECONO LUBE N' TUNE #107 ADDRESS: 286 HIGUERA STREET, SAN LUIS OBISPO, CA 93401 - 4215 CONTACT PERSON: �1O11 Mi C410ASov- TELEPHONE: Annual Inventory Update (due each year) ® No significant changes in inventory have occurred since the last Business Plan or inventory was submitted. ❑ New inventory forms are attached, ❑ Replace previous inventory with attached inventory. ❑ Replace only designated pages of inventory. Additional Comments: Yearly Review and Recertification ® I certify that the Business Plan has been reviewed and the information contained in the Business Plan is accurate and complete as of this date. Other Updates ❑ Please incorporate the following information into the Business Plan for this facility: I declare, under penalty , of perjury, that the information provided herein is true and correct to the best o/f y knowledge. Signature: C d Date:_ A-V 1,2 10 Printed Name:, Nn (hIBC ha U lso -- Please Return to: Molly Brown, Hazardous Materials Section City Fire Department 2160 Santa Barbara Avenue San Luis Obispo, CA 93401-5240 H;/BUSINESS PLAN UPDATE FORM MOLLY ❑The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecommunications Device for the Deaf (805) 781-7410. 0 Site Visit Packet Permit No 60-0034 Facility Number: Facility Information Operator: JIM WILMORE Facility Name: ECONO LUBE AND TUNE Address Number: 286 Address: HIGUERA ST Suite: City: SAN LUIS OBISPO Zip: 93401- CrossStreet: HIGH ST Parcel No: 002-482-024 Phone No: (805) 544-2976 Facility Type: Corporation Property Owner Name: Address: City: State: Zip: Phone: Underground Storage Tank Property Owner Name: ECONO LUBE AND TUNE Phone: 8055442976 Mailing/Street Address 286 HIGUERA ST City: SAN LUIS OBISPO State CA Zip: 93401 Owner Type: Emergency Contacts Primary Days Last Name I F.-I F1 \A/II MnRF First Name JIM VILMORE PATRICIA Status: Permit Expiration Date: 2/13/02 Mailing Address Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: JIM WILMORE City: SAN LUIS OBISPO State: CA Zip: 93401- Phone: (805) 544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Current Balance Title MANAGER/OWNER WIFE OF OWNER Business Phone (805) 544-2976 (805) 544-2976 1 4. 0 24 Hr Phone Pager )) 000-0000 Hazardous Materials Business Plan - List of Chemicals Permit No 60-0034 Common Name Facility: ECONO LUBE AND TUNE Address: 286 HIGUERA ST, SAN LUIS OBISPO Maximum Physical Largest Chemical Name Daily Amt Units State Container Grid No ATF PETROLEUM HYDROCARBON (ATF) 120 GAL Liquid 120 1135 MOTOR OIL PETROLEUM HYDROCARBON (MOTOR OIL) 775 GAL Liquid 120 JE7, G4, H4 WASTE ANTIFREEZE ETHYLENE GLYCOL (WASTE) 165 GAL Liquid 55 B-4 WASTE MOTOR OIL PETROLEUM HYDROCARBON (WASTE OIL) 520 GAL I Liquid 1 550 JB5 WASTE SAFETY KLEEN SOLVENT WASTE SOLVENT 55 GAL I Liquid 55 JE Wednesday, February 13, 2002 Page 1 of 1 Site Visit Packet Permit No 60-0034 Facility Number: Facility Information Facility Name: ECONO LUBE AND TUNE Operator: JIM WILMORE Address Number: 286 Address: HIGUERA ST Suite: City: SAN LUIS OBISPO Zip: 93401- CrossStreet: HIGH ST Parcel No: 002-482-024 Phone No: (805) 544-2976 Facility Type: Corporation Property Owner Name: Address: City: State: Zip: Phone: Underground Storage Tank Property Owner Name: ECONO LUBE AND TUNE Phone: 8055442976 Mailing/Street Address 286 HIGUERA ST City: SAN LUIS OBISPO State CA Zip: 93401 Owner Type: Emergency Contacts Primary Days Last Name First Name Q ❑� WILMORE JIM WILMORE PATRICIA Title Status: Permit Expiration Date: 3/9/01 Mailing Address Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: JIM WILMORE City: SAN LUIS OBISPO State: CA Zip: 93401- Phone: (805)544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Current Balance: $194.00 MANAGER/OWNER WIFE OF OWNER Business Phone (805) 544-2976 24 Hr Phone Pager .000)000-0000 (805)544-2976 )7 (000)000-0000 Hazardous Materials Business Plan - List of Chemicals Permit No: 60-0034 Facility: ECONO LUBE AND TUNE Address: 286 HIGUERA ST, SAN LUIS OBISPO Maximum Physical Largest Common Name Chemical Name Daily Amt Units State Container Grid No AUTOMATIC TRANSMISSION FLUID PETROLEUM HYDROCARBON (ATF) 120 GAL I Liquid 1 120 JB5 MOTOR OIL PETROLEUM HYDROCARBON (MOTOR OIL) 775 GAL Liquid 720 JE7, G4, H4 WASTE ANTIFREEZE ETHYLENE GLYCOL (WASTE) 165 GAL I Liquid 55 B-4 WASTE MOTOR OIL PETROLEUM HYDROCARBON (WASTE OIL) 520 GAL I Liquid 1 550 JB5 WASTE STODDARD SOLVENT STODDARD SOLVENT(WASTE) 55 GAL I Liquid 1 55 E-3, F-6 Friday, March 09, 2001 Page 1 of I Site Visit Packet Permit No 60-0034 Facility Number: Facility Facility Name: ECONO LUBE AND TUNE Operator: GREG PIPKIN M Address Number: 286 Address: HIGUERA ST Suite: City: SAN LUIS OBISPO Zip: 93401 CrossStreet: HIGH ST Parcel No: 002-482-024 Phone No: (805) 544-2976 Facility Type: Individual Operator Name: GREG PIPKIN M Address: City: State: Zip: Phone: 805/773-0571 Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Emergency Contacts Primary Days Last Name First Name WILMORE JIM Status: Permit Expiration Date: 12/6/99 Property Owner Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: City: SAN LUIS OBISPO State: CA Zip: 93401 Phone: (805) 544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Current Balance: S19400 Business 24 Hr Title Phone Phone Pager MANAGER/OWNER (805) 544-2976 O w H U ZQ U) CL m � m wp J 0 (n O = J Z W N U) N n U O Z zl A T d Crm E. w a a a � L g = H V .0 c a� C O d E O U R c C O a E U m O N m M O O O ca O Z E m a MINIMININ w H Q J J_ F- 0 w J O w a U F- Q x a_ J Q 0 O O Cn 0) X. w N n X_ w g Do MINIMININ EZ E Z E ,tea, ~ ,teaL ~ Z Q > Z Q > E 0)E 0) Q U U MINNIN J_ O Z w N O Q CO Q -J a C7 z 0 z - 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I=@@ _ 0 $ E k \ j E £ » t CO % ) E / E ) \ / ) E £ b \ E Hazardous Materials Business Plan - List of Chemicals Permit No: 60-0034 Facility: ECONO LUBE AND TUNE Address: 286 HIGUERA ST, SAN LUIS OBISPO Maximum Physical Largest ChemiCal Mid%, Anrt Units Stale (,ontainer Grid No PETROLEUM HYDROCARBON 880 GAL Liquid 120 D-7, G-4, H-4, I-4 PETROLEUM HYDROCARBON MIXTURE 12D GAL Liquid 120 C-6 WASTE HYDROCARBON SOLVENT 55 GAL Liquid 55 E3, F3 WASTE PETROLEUM HYDROCARBON 520 GAL Liquid 550 E3 Tuesday, September 28, 1999 Page I of I �1ill IIIIIII illll Illlillf��� � �Ilhl III I� Cl Or SM MIS OBIS f� FIRE DEPARTMENT ' 2160 Santa Barbara Avenue • San Luis Obispo, CA 93401-5240. 805/781-7380 E LA-) "Courtesy & Service" P l&v-,, BUSINESS PLAN UPDATE FORM ECONO LUBE N' TUNE #107 286 HIGUERA FACILITY NAME:BAN yj II, OBISPO CA 93401 (805) 544-2976 ADDRESS: BAR # AH2O1056 A�, Ab 0000G8W6- CONTACT PERSON: -X% w, W . 1 +Iw a rL TELEPHONE: 2544 - 24'7L Annual Inventory Update (due every year by January 1) [� No significant changes in inventory have occurred since the last Business Plan or inventory was submitted. [ ] New inventory forms are attached. [ ] Replace previous inventory with attached inventory. [ ] Replace only designated pages of inventory. Additional Comments: Yearly Review and Recertification [✓11" I certify that the Business Plan has been reviewed and the information contained in the Business Plan is accurate and complete as of this date. Other Updates [ ] Please incorporate the following information into the Business Plan for this facility: I declare, under penalty of perjury, that the information provided herein is true and correct to the best of my knowledge. Signature: Date: 3l7 Printed Name: �'N •M� s �• W . IPA orb Please Return to: Molly Brown, Hazardous Materials Section City Fire Department 2160 Santa Barbara Avenue San Luis Obispo, CA 93401-5240 H:/BUSINESS PLAN UPDATE FORM MOLLY OThe City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecommunications Device for the Deaf (805) 781-7410. PAGE NO. 1 Administrative Report - Disclosure Packet For Business: [2594] ECONO LUBE N' TUNE #107 BID Range: [2594] To [2594] Business ID...: 2594 Business Name.: ECONO LUBE N' TUNE #107 Number......... 286 SLreeL........: HIGUERA Suite.......... Building......: City..........: SAN LUIS OBISPO State.........: CA Zip Code......: 93401 Mailing Name..: Attention...... Street......... City/State/Zip: Owner.........: GREGORY PIPKIN Business Phone: (805) 544-2976 Shift Hours Name 8-6 M-F GREG PIPKIN 8-6 M-F GREG PIPKIN 8-6 M-F GREGORY PIPKIN — 0-6 ?1 F ED 6A'YIP6R— B u s i n e s s Address M a i l i n g A d d r e s s Business Hours Contact Title MANAGER/OWNER A f t e r B u s i n e s a H o u r s C o n t a c t s MANAGER/OWNER OWNER EMPLOYEE- H a z a r d o u s Material Emergency Contacts 8-6 M-F GREG PIPKIN OWNER/MANAGER General and Building Information Doing Business As: ECON LUBE N' TUNE Business License.: 342 Dun & BradStreet.: 18-799-8612 EPA ID...........: CAL 000 008 725 Operation Desc...: AUTOMOTIVE LUBRICATING & ENGINE TUNE-UP SERVICE Shift Hoursl.....: 8-6 M-F Number of Employeesl: 7 Shift Hours2.....: 9-5 SAT Number of Employees2: 7 obi -Ft Emp1%,-1, 0 Sic ..............: 7549 UBC1.............: 22. UBC2.............: UNKNOWN/UNDEFINED Non -Profit.......: NO Lot Size.........: 14560 Number of Floors.: 1 Reporting Status.: C 7 06/03/98 Phone (805) 544-2976 (8 1 BUSINESS(ES) LISTED PAGE NO. 1 Chemical Inventories Report 06/03/98 All Chemicals (In Maximum Quantity Per Day Order) BID Range: [2594] To [2594] Trade Name HazClass Tw DOT# MaxPerDay Un Haz Rate Location Chemical Names/Components CAS # EC % MaxPerDay --------------- ---------------•------- -------------------------------------------- Business: [02594] ECONO LUBE N' TUNE #107-------------------------------- ---- -- -- MOTOR OIL 2 9 1267 Compl: VARIOUS LUBRICATING BASE OILS 6474XXXX 85 Comp2: ADDITIVE PACKAGE 15 Comp3: ZINC ALKYLDITHIOPHOSPATE 68649423 C 2 WASTE OIL 2 19 1270 Compl: VARIOUS LUBRICATING BASE OILS 6474XXXX 85 Comp2: ADDITIVE PACKAGE, INCLUDING: MIXTURE 15 Comp3: ZINC ALKYLDITHIOPHOSPHATE 68649423 2 AUTOMATIC TRANSMISSION FLUID 2 9 1270 Compl: ALIPHATIC HYDROCARBONS 64742898 85 Comp2: AD 50760 C 15 Comp3: TERT-AMYL PEROXY-2-ETHYLHEXANOATE, TECHN 686317 2 WASTE PARTS WASHING SOLVENT ? 2 19 1270 Compl: ALIPHATIC HYDROCARBONS 64742898 85 Comp2: XYLENE, LIQUID 1330207 1 Comp3: ETHYLBENZENE, LIQUID 100414 5 960.0 GA 230 SO WALL OF BRAKE BAY; BY RESTROOM; S WAL 816.0 144.0 19.2 �•OO GA 220 UNDERGROUND STORAGE TANK W OF WORK BAY 382.5 67.5 9.0 110.0 GA 230 WEST WALL OF WORK BAY 93.5 16.5 2.2 55.0 GA 220 NO WALL OF BRAKE BAYS SE COR SO WALL OF 46.8 0.6 2.8 4 CHEMICAL(S) LISTED 1 BUSINESS(ES) LISTED i ED PROGRAM CONSOLIDATED FOF FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of I. FACILITY IDENTIFICATION FACILITY ID # IF FAI 0 10 10 151111161 1 1 1 1 EPA ID # (Hazardous Waste Only) 2 ICAL000387770 (Agency Use Only) BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) LUBE_N_GO 3 BUSINESS SITE ADDRESS 286 HIGUERA aST tos BUSINESS SITE CITY SAN LUIS OBISPO 104 CA ZIP CODE 93401 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/ O erator Identification page. Does your facility... If Yes, please com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed © YES INVENTORY — CHEMICAL gases (include liquids in ASTs and USTs); or the applicable Federal threshold DESCRIPTION quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency Ian is required pursuant to 10 CFR Parts 30, 40 or 70? B. REGULATED SUBSTANCES Have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental Release ❑ YES Coordinate with your local agency prevention Program (CalARP)? responsible for CalARP. C. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB Form A) Own or operate underground storage tanks? ❑ YES UST TANK (one page per tank) (Formerly Form B) D. ABOVE GROUND PETROLEUM STORAGE You may need to submit an Own or operate ASTs above these thresholds: ABOVEGROUND PETROLEUM Store greater than 1,320 gallons of petroleum products (new or used) in ❑ YES STORAGE TANK FACILITY aboveground tanks or containers. STATEMENT. Click for details E. HAZARDOUS WASTE Generate hazardous waste? © YES EPA ID NUMBER— provide at the top of this page Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES RECYCLABLE MATERIALS REPORT (one per recycler) Treat hazardous waste on -site? ❑ YES ON -SITE HAZARDOUS WASTE TREATMENT— FACILITY ON -SITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? ❑ YES CERTIFICATION OF FINANCIAL ASSURANCE Consolidate hazardous waste generated at a remote site? ❑ YES REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? ❑YES HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or edsr"PA-IB NumbeF, . l e. more of federal RCRA hazarous waste, or generate to any singe calendar YES Biennial Report (EPA Form 700- month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous 1 and satisfy requiremeentsnts for waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA RCRA Large Quantity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? Y,ESS,/J See CUPA for required forms. `❑ F. LOCAL REQUIREMENTS`� lJ Gz/ is (You may also be required to provide additional information by your CUPA or local agency ) UPCF Rev (12/2007) FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY nne 1a ,c mr nrttcrial ,cr builJin ur area ❑ADD ❑DELETE F1REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION Ir'.,,.__ 4y CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # (Agency FA0005116 MAP# O1 GRID# use only) f,J—O`'F II. CHEMICAL INFORMATION CHEMICAL NAME TRADE SECRET ❑ Yes ❑ No AUTOMATIC TRANSMISSION FLUID If Subject to EPCRA, refer to instructions COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes []No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete irrequired by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ 0 (Check one item only) a. PURE 0 b. MIXTURE c. WASTE RADIOACTIVE ❑Yes []No CURIES PHYSICAL STATE 0 a. SOLID b. LIQUID c. GAS LARGEST CONTAINER O. O (Check one item only) FED HAZARD CATEGORIES (Check all that apply) a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 60.0 1 240.0 UNITS* Q a GALLONS O b. CUBIC FEET ❑ c. POUNDS ❑ d TONS DAYS ON SITE: 365.0 � O (Check one itein ubly) 'if EHS, amount must be in pounds. . STORAGE ❑ a ABOVE GROUND TANK ❑ e. PLASTICINONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b UNDERGROUND TANK ❑ f. CAN ❑ j BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR 0 c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h SILO [11. CYLINDER ❑ p TANK WAGON STORAGE PRESSURE W a AMBIENT ❑ b. ABOVE AMBIENT c. BELOW AMBIENT STORAGE TEMPERATURE ❑� a. AMBIENT ❑ b- ABOVE AMBIENT ❑ c. BELOW AMBIENT d CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # l 95.0 hydrocarbons ❑ Yes ® No 2 5.0 BTEX ❑ Yes ® No 3 ❑ Yes ❑ No 4 El Yes n No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sin Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one page per material per buildinp or areal ❑ADD []DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) LU BE-N-GO Cl IEMICAL LOCATION t —y CHEMICAL LOCATION CONFIDENTIAL EPCRA __[FA0005116 ❑ YES ❑ NO FACILITY ID # MAP# O 1 GRID# �— / O II (Agency use only) II. CHEMICAL INFORMATION CFIEMICAI. NAME WASTE ANTIFREEZE TRADE SECRET ❑Yes 0 No If Subject to EPCRA, refer to instructions COMMONNAME WASTE ANTIFREEZE EHS* [I Yes ❑ No CAS# 107-21-1 *ITEHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE 0 (Check one item only) a. PURE 0 b. MIXTURE M c. WASTE RADIOACTIVE [3 Yes []No CURIES PHYSICAL STATE [3 a. SOLID 0. b. LIQUID 0 c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES (Check all that apply) ❑ a. FIRE [3b. REACTIVE ❑ c. PRESSURE RELEASE d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 1 165.0 1 675.0 UNITS* Qi a. GALLONS a b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: A 5. O (Check one item only) "If EHS, amount must be In pounds b STORAGE ❑ a. ABOVE GROUND TANK e. PLASTIGNONMETALLIC DRUM ❑ i FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN 13 r. OTHER ❑ d. STEEL DRUM ❑ It. SILO ❑ 1 CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT c. BELOW AMBIENT STORAGE TEMPERATURE Q a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT [3 d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 50.0 antifreeze ❑ Yes ® No z 50.0 water ❑ Yes ® No 3 ❑ Yes ❑ No a rl Yes rl N 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight it carcinogenic. attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please S112n Ilere FORM S - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME Same as FACILITY NAME or DBA— Doing Business As) BUSINESS PHONE 18057864056 LUBE-N-GO BUSINESS SITE ADDRESS 286 HIGUERA ST CITY C`°'J93401 ZIP CODE SAN LUIS OBISPO COUNTY n Luis Obispo BUSINESS OPERATOR PHONE y6ggf:4)C1�VIE6) 6nNNAME �� 18054235921 II. BUSINESS OWNER OWNERNAME OWNERPHONE SIMCAT ENTERPRISES 18057864056 OWNER MAILING ADDRESS 286 HIGUERA CITY STATE ZIP CODE SAN LUIS OBISPO CA 193401 III. ENVIRONMENTAL CONTACT CONTACT NAME CONTACT PHONE JOSEPH SIMONIN 18052389301 CONTACT MAILING ADDRESS 2505 THEATRE DRIVE CITY STATE ZIP CODE PASO ROBLES CA �93446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NAME JOSEPH SIMONIN LARRY KNIGHT TITLE TITLE OWNER / OPERATOR LUBE TECHNICIAN BUSINESS PHONE BUSINESS PHONE 8052389301 18057864056 24-HOIJR PHONE 244HOUR PHONE PAGER # / CELL PHONE # PAGER N / CELL PHONE # ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATUREOF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE NAME OF DOCUMENT PREPARER Submitted via Public Portal 10/17/2013 CAMILLE SUNDAHL NAME OF SIGNER (print) TITLE OF SIGNER CAMILLE SUNDAHL OFFICE MANAGER I Vv, f,) Af, uQ -t � Hazardous Materials U'1p 1� Management Plan HMMP AND Hazardous Materials Disclosure Forms For: ECONO LUBE N, TUNE N107 rE-�� 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to CERTIFIED UNIFIED PROGRAM AGENCY San Luis Obispo City Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 ATTN: Molly Brown ;W16roli,. .� TCific Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 -1510 FAX (559) 251 - 5534 FORM S - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME (same as FACILITY NAME orDBA-Doing Business LU B E-N-GO As) BUSINESS PHONE 18057864056 BUSINESS SITE ADDRESS 286 HIGUERA ST CITY SAN LUIS OBISPO CA ZIP CODE 93401 COUNTY San Luis Obispo �] � S6J9 ')'&WmhNAME 18054235921 BUSINESS OPERATOR PHONE II. BUSINESS OWNER OWNER NAME SIMCAT ENTERPRISES 18057864056 OWNER PHONE OWNER MAILING ADDRESS 286 HIGUERA CITY SAN LUIS OBISPO STATE CA ZIP CODE �93401 III. ENVIRONMENTAL CONTACT CONTACT NAME JOSEPH SIMONIN �8052389301 CONTACT PHONE CONTACT MAILING ADDRESS 2505 THEATRE DRIVE CITY PASO ROBLES STATE CA 193446 ZIP CODE -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME JOSEPH SIMONIN NAME OMAR GODINEZ TITLE OWNER / OPERATOR TITLE MANAGER BUSINESS PHONE 8052389301 BUSINESS PHONE 8057864056 24-HOUR PHONE 24-HOUR PHONE PAGER # / CELL PHONE # PAGER # / CELL PHONE # ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE Submitted via Public Portal DATE 02/10/2017 NAME OF DOCUMENT PREPARER CAMILLE SUNDAHL NAME OF SIGNER (print) CAMILLE SUNDAHL TITLE OF SIGNER OFFICE MANAGER FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one page pier material per buildingor area ❑ADD ❑DELETE ❑REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) LU BE-N-GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O1 GRID#-O` F (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET ❑Yes []No If Subject to EPCRA, refer to instructions COMMONNAME MOTOR OIL EHS* ❑Yes []No CAs# 64742-54-7 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE a. PURE • b. MIXTURE (Check one item only) ❑ ❑ ❑ c. WASTE RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID 0 b. LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES a. FIRE (Check all that apply) ❑ b, REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 388.0 775.0 UNITS* Q a. GALLONS O b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: ^ ^ 36 0 (Check one item only) *If EHS, amount must be in pounds. . STORAGE 0 a. ABOVE GROUND TANK e. PLASTICINONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE CONTAINER ❑ b UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR 0 c. TANK INSIDE BUILDING ❑ g CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h SILO [11. CYLINDER ❑ p TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ® No z 5.0 BTEX ❑ Yes ® No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No Ir more hazardous components are present at greater than 1 % by weight it non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sign Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY nuc page per material nv building or area) ❑ADD ❑DELETE ❑REVISpage I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) LOBE-N-GO CHEMICAL LOCATION '-• •:1.J:ngs CHEMICAL LOCATION CONFIDENTIAL EPCRA - ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 01 GRID# (Agency use only) C-O9 II. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET Yes No If Subject to EPCRA, refer to instructions COMMON NAME WASTE OIL EHS* [I Yes []No CAS' 8002-05-9 *[f EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ ❑ ❑' (Check one item only) a. PURE b MIXTURE c WASTE RADIOACTIVE ❑Yes [INo TCURIES PHYSICAL STATE ❑ a. SOLID 0 b. LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES (Check all that apply) a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e CHRONIC HEALTH AVERAGE DAILY AMOUNT AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 260.0 7777DAILY 520.0 1 4800.0 221 UNITS* Q a. GALLONS O b CUBIC FEET ❑ c POUNDS ❑ d. TONS DAYS ON SITE: ^ 5. 0 (Check one item only) *If EHS, amount must be in pounds. b STORAGE a ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM 0 i. FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n PLASTIC BOTTLE ❑ q RAILCAR ❑ c TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 11 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ® No 2 5.0 BTEX ❑ Yes ® No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sion Here UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of I. FACILITY IDENTIFICATION FACILITY ID # TF A 0 0 0 5 1 1 6 EPA ID # (Hazardous Waste Only) Z (Agency Use Only) CAL000387770 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) LUBE-N-GO ' BUSINESS SITE ADDRESS 286 HIGUERA ST 103 BUSINESS SITE CITY SAN LUIS OBISPO 104 CA IZIP CODE 93401 tos II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/O perator Identification page. Does your facility... If Yes, PIC= com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed YES INVENTORY — CHEMICAL gases (include liquids in ASTs and USTs); or the applicable Federal threshold DESCRIPTION quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency lan is required pursuant to 10 CFR Parts 30, 40 or 70? B. REGULATED SUBSTANCES Have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental Release ❑ YES Coordinate with your local agency prevention Program (CalARP)? responsible for CaIARP. C. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly swacB Form A) Own or operate underground storage tanks? ❑ YES UST TANK (one page per tank) (Formerly Form B) D. ABOVE GROUND PETROLEUM STORAGE Own or operate ASTs above these thresholds: Store greater than 1,320 gallons of petroleum products (new or used) in ❑ YES NO FORM REQUIRED TO CUPAs aboveground tanks or containers. E. HAZARDOUS WASTE (; ncr;ric hazardous waste? X Y ❑fS " NUM[3FRTnmvjdeaL t 1np... this page Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑YES RECYCLABLE MATERIALS REPORT (one per recycler) Treat hazardous waste on -site? ❑ YES ON -SITE HAZARDOUS WASTE TREATMENT — FACILITY ON -SITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? ❑ YES CERTIFICATION OF FINANCIAL ASSURANCE Consolidate hazardous waste generated at a remote site? ❑ YES REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as ❑ YES HAZARDOUS WASTE TANK hazardous waste and cleaned on -site? CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or Obtain federal EPA ID Number, file Biennial Report (EPA Form month, or accumulate at any time, I kg (2.2 pounds) of RCRA acute hazardous 13A/B), and satisfy requirements for ents waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? ❑ YES See CUPA for required forms. % F. LOCAL REQUIREMENTS 411 I 15 (You may also be required to provide additional information by your CUPA or local agency.) UPCF Rev. (12/2007) FORM S - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME Same as FACILITY NAME or DBA —Doing Business As) BUSINESS PHONE LUBE-N-GO 18057864056 BUSINESS SITE ADDRESS 286 HIGUERA ST CITY ZIP CODE SAN LUIS OBISPO C�` 93401 COUNTY San Luis Obispo BUSINESS OPERATOR PHONE S6�gV41 %ffl6n�NAME �� '`�' 18054235921 II. BUSINESS OWNER OWNER NAME I OWNER PHONE SIMCAT ENTERPRISES 18057864056 OWNER MAILING ADDRESS 286 HIGUERA CITY STATE ZIP CODE SAN LUIS OBISPO CA 193401 III. ENVIRONMENTAL CONTACT CONTACT NAME CONTACT PHONE JOSEPH SIMONIN 18052389301 CONTACT MAILING ADDRESS 2505 THEATRE DRIVE CITY STATE ZIP CODE PASO ROBLES ICA 193446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NAME JOSEPH SIMONIN OMAR GODINEZ TITLE TITLE OWNER / OPERATOR LUBE TECHNICIAN BUSINESS PHONE BUSINESS PHONE 8052389301 8057864056 24-HOUR PHONE 24-HOUR PHONE PAGER N /CEL I- PHONE li PAGER # / CELL PHONE # ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE NAME OF DOCUMENT PREPARER Submitted via Public Portal 02/11/2016 CAMILLE SUNDAHL NAME OF SIGNER (print) TITLE OF SIGNER CAMILLE SUNDAHL OFFICE MANAGER FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one � �c 1cr material ter builtiin r or Wren) ❑ADD ❑DELETE REVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU B E-N-GO CHEMICAL LOCATIC" CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O GRID# b-04 (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME TRADE SECRET 0 Yes 0 No AUTOMATIC TRANSMISSION FLUID If SubjecttoEPCRA,refertoinstructions COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes []No CASH — — — *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete i£required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a, PURE Elb. MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID ><❑ b. LIQUID ❑ c. GAS LARGEST CONTAINER 120 O (Check one item only) FED HAZARD CATEGORIES ❑x a, FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑X d. ACUTE HEALTH ❑x e, CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 60.0 1 240.0 UNITS* Na. GALLONS ❑ It. CUBIC FEET ❑ c. POUNDS ❑ d, TONS DAYS ON SITE: (Uh"k RIN! item rus yr .11F viv.s. Amnlln Intl{ patin {. STORAGE a. ABOVE GROUND TANK e. PLASTIC/NONMFTALLIC DRUM i. FIBER DRUM 0 m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ® c. TANK INSIDE BUILDING Q g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER Q d. STEEL DRUM ❑ It. SILO [11. CYLINDER [3 p. TANK WAGON STORAGE PRESSURE ❑x a. AMBIENT ❑ It ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 21. AMBIENT ❑ It. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ❑ No 5.0 BTEX ❑ Yes ❑ No ❑ Yes ❑ No a ❑ Yes ❑ No S ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sin I Iere FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one a !c per matcria ter buildin or area) ❑ADD ❑ULLL'L LJRFVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE—N—GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES []NO FACILITY ID # FA0005116 MAP# 0 1 II GRID# �_O� (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET Yes No If Subject to EPCRA, refer to instructions COMMONNAME MOTOR OIL EHS* [I Yes ❑ No CAs# 64742-54-7 *[f EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ❑x b. MIXTURE ❑ c WASTE RADIOACTIVE ❑ Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID El b LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES x a. FIRE x x e. ❑ ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑ d. ACUTE HEALTH ❑ CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 388.0 1 775.0 UNITS* ❑X a. GALLONS ❑b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE 0 a. ABOVE GROUND TANK e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM ❑ m GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK Q f. CAN ❑ j. BAG 0 n. PLASTIC BOTTLE ❑ q. RAIL CAR ® c. TANK INSIDE BUILDING ❑ g CARBOY ❑ k. BOX Q o TOTE BIN ❑ r OTHER 0 d. STEEL DRUM ❑ It SILO ❑ I. CYLINDER Q p. TANK WAGON STORAGE PRESSURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Si n Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one nage per material per building or area) []ADD ❑DELETE LJREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION iI CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # 7-FM005116 MAPY O GRIDk d -10 (Agency use only) H. CHEMICAL INFORMATION CHEMICAL NAME WASTE ANTIFREEZE TRADE SECRET Yes No IfSubject to EPCRA, refer to instructions COMMONNAME WASTE ANTIFREEZE EHS* [I Yes ❑ No CAS# 107-21-1 *If EFIS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete irrequired by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a, PURE ❑ b MIXTURE ❑x c WASTE (Check one item only) RADIOACTIVE ❑ Yes ❑ No CI: M S PHYSICAL STATE ❑ a. SOLID ❑x b. LIQUID ❑ c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES ❑ a. FIRE (Check all that apply) ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d. ACUTE HEALTH ❑% e. CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 165.0 675.0 UNITS* X❑ a. GALLONS ❑ b, CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: OII �I �J mOYN:-0IINi STORAGE 13 a. ABOVE GROUND TANK e. PLASTIC/NONMETALLIC DRUM i. F]BER DRUM in. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f CAN ❑ j, BAG ❑ n. PLASTIC BOTTLE ❑ q RAILCAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r OTHER ❑ d. STEEL DRUM ❑ h. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE a. AMBIENT ❑ b ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE ❑x a. AMBIENT ❑ b ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 50.0 antifreeze ❑ Yes ❑ No 50.0 water ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No i ❑ Yes ❑ No If mar hatardom components are present at grealer than 1% by weight irnon—minogenir, cr 0.1% by weight if carcinogmir, attach addilimrnl %heels orpaper capturing the required informntion. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sian Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one page per material per buildin- or arca) []ADD []DELETE LJRF.VISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE—N-GO CHEMICAL LOCATION a llil S g CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY # FA 005116 MAP# 0 J I' GRID# (Agency use onlyy)) C-09 II. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET []Yes❑ No If Subject to EPCRA, refer to instructions COMMON NAME WASTE OIL EHS* ❑Yes ❑ No CAs# 8002-05-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a. PURE ❑ b. MIXTURE ❑x c. WASTE RADIOACTIVE ❑ Yes [3N. CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID 0 b. LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES El a. FIRE ❑ b. REACTIVE ❑ c PRESSURE RELEASE Q d. ACUTE HEALTH 0 e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 260.0 1 520.0 1 4800.0 221 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: n �+ 5.0 (Check one item only) *If EHS, amount must be in pounds. 3 V STORAGE 0a. ABOVE GROUND TANK E3 e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM m, GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ Is. BOX ❑ o. TOTE BIN ❑ r OTHER ❑ d. STEEL DRUM ❑ It. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑x a AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ❑ No z 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight irnon•carcinogenic, or O.l % by weight if carcinogenic, attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Si n Here UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of I. FACILITY IDENTIFICATION FACILITY ID 4 F A 0 0 0 5 1 l 6 I EPA ID # (Hazardous Waste Only) 2 (Agency Use Only) CAL000387770 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) LU BE-N- O 3 BUSINESS SITE ADDRESS 286 HIGUERA ST IOl BUSINESS SITE CITY SAN LU I S O B I S PO 104 I CA ZIP CODE 93401 ... 1I. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/O perator Identification page. Does your facility... If Yes, please com lete these Daiies of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed Q YES INVENTORY — CHEMICAL gases (include liquids in ASTs and USTs); or the applicable Federal threshold DESCRIPTION quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency lan is required pursuant to 10 CFR Parts 30.40 or 70? B. REGULATED SUBSTANCES Have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental Release ❑ YES Coordinate with your local agency prevention Program (CaIARP)? responsible for CalARP. C. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly sWRCB Form A) Own or operate underground storage tanks? ❑YES UST TANK (one page per tank) (Formerly Form B) D. ABOVE GROUND PETROLEUM STORAGE Own or operate ASTs above these thresholds: Store greater than 1,320 gallons of petroleum products (new or used) in ❑ YES NO FORM REQUIRED TO CUPAs aboveground tanks or containers. E. HAZARDOUS WASTE Generate hazardous waste? YES EPA ID NUMBER— pi ovide at the top of this page Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES RECYCLABLE MATERIALS REPORT (one per recycler) Treat hazardous waste on -site? ❑ YES ON -SITE HAZARDOUS WASTE TREATMENT — FACILITY ON -SITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? ❑ YES CERTIFICATION OF FINANCIAL ASSURANCE Consolidate hazardous waste generated at a remote site? ❑ YES REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as YES HAZARDOUS WASTE TANK hazardous waste and cleaned on -site? CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or tle— more of fiederalhazardous waste, or generate in any singe ca en ar LJ YES Biennial Report (EPA Form 8700- month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous 13A/B), and satisfy requirements for waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? ❑ YES See CUPA for required forms. F. LOCAL REQUIREMENTS is (You may also be required to provide additional information by your CUPA or local agency.) UPCF Rev. (1212007) FORM S - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) BUSINESS PHONE LUBE-N-GO 18057864056 BUSINESS SITE ADDRESS 286 HIGUERA ST ('I II' ZIP CODE SAN LUIS OBISPO CA I 93401 COUNTY San Luis Obispo BUSINESS OPERATOR PHONE 9N EBQP.ATVIV�IV NAME ��M 18054235921 II. BUSINESS OWNER OWNER NAME OWNER PHONE SIMCAT ENTERPRISES 18057864056 OWNER MAILING ADDRESS 286 HIGUERA CIT. cTATE 1 ?ip rnnF SAN LUIS OBISPO CA 93401 III. ENVIRONMENTAL CONTACT CONIACFNAME CONTACTPHONE JOSEPH SIMONIN 18052389301 CONTACT MAILING ADDRESS 2505 THEATRE DRIVE CITY STATE ZIP CODE PASO ROBLES CA 193446 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME NAME JOSEPH SIMONIN OMAR GODINEZ TITLE TITLE OWNER / OPERATOR LUBE TECHNICIAN BUSINESS PHONE BUSINESS PHONE 8052389301 18057864056 24-HOUR PI ION I: 24-HOUR PHONE PAGER # / CELL PHONE q PAGER # / CELL PHONE # ADDITIONAL LOCALLY COLLECTED INFORMATION Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE NAME OF DOCUMENT PRF:PARER Submitted via Pub[ icPortal 03/11/2015 CAMILLE SUNDAHL NAME OF SIGNER (prim) TITLE OF SIGNER CAMILLE SUNDAHL OFFICE MANAGER FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one pm-,cu•r ucttcrial per building ur arcnl ❑ADD []DELETE REVISE 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION , CHEMICAL LOCATION CONFIDENTIAL EPCRA --fFA0005116 ❑ YES ❑ NO FACILITY ID # MAP# O 1 GRID4-04 (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME TRADE SECRET ❑ Yes ❑ No AUTOMATIC TRANSMISSION FLUID If Subject toEPCRA,refer toinstructions COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes ❑ No CAS# *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE (Checkoneone item only) a. PURE M b MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ❑ No CURIES PHYSICAL STATE [:]a . SOLID ❑x b. LIQUID ❑ a GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES a. FIRE [I(Check all that apply) ❑ b REACTIVE [I c. PRESSURE RELEASE (] d. ACUTE HEALTH Me CHRONIC HEALTH AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 60.0 1 240.0 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: ^ 0 (Check one item only) *If EHS, amount must be in pounds. b . STORAGE E3 a. ABOVE GROUND TANK 0 e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER Q b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR IN c. TANK INSIDE BUILDING Q g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM Q h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE (] a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE a. AMBIENT ❑ b. ABOVE AMBIENT [3c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No 11 more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Si n Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (onc Iagc per material perbuildia or area []ADD ❑DELETE RF.VIS1: 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA —Doing Business As) LU BE-N-GO CHEMICAL LOCATION ay CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O GRID#-O` (Agency use only) F II. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET ❑Yes ❑ No instructions If Subject to EPCRA, refer to COMMONNAME MOTOR OIL EHS* ❑Yes ❑ No CAS# 64742-54-7 *if EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Tnvin /Tnvl HAZARDOUS MATERIAL TYPE ❑ a PURE ❑x b MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ❑ No CURIES (Check one item only) PHYSICAL STATE LARGEST CONTAINER 120.0 ❑ a SOLID 0 b LIQUID ❑ c. GAS (Check one item only) FED HAZARD CATEGORIES 0 a FIRE ❑ b. REACTIVE ❑ c PRESSURE RELEASE 0 d. ACUTE HEALTH 0 e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 388.0 1 775.0 UNITS* Z a GALLONS ❑b. CUBIC FEET ❑ c POUNDS ❑ d. TONS DAYS ON SITE: 365. 0 (Check one item only) *If EHS, amount must be in pounds. STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM 0 in. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ cl. RAIL CAR ® c. TANK INSIDE BUILDING ❑ p. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r, OTHER ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT [3. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more huardous components are present at erealer than 1% by weight if non -carcinogenic, or 0.1% by weight it carcinogenic, attach additional sheets or paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA. Please Sign Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one page per material per buildingor area []ADD ❑I)I I I I[-,.RIiV1SE 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) LU BE-N-GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # (Agency FA0005116 MAP# O 1 GRID# �— J O -I use only) II. CHEMICAL INFORMATION CHEMICAL NAME WASTE ANTIFREEZE TRADE SECRET ❑Yes El No If Subject to EPCRA, refer to instructions COMMONNAME WASTE ANTIFREEZE EHS* ❑Yes ❑ No CAS# 107-21-1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE 0 c. WASTE RADIOACTIVE ❑ Yes ❑ No CURIES PHYSICAL STATE ❑ a. SOLID 0 b. LIQUID ❑ c, GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE 0 d. ACUTE HEALTH 0 e CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 1 165.0 1 675.0 UNITS* [@a GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: ^ 0 (Check one item only) *If EHS, amount must be in pounds. b . STORAGE ❑ a ABOVE GROUND TANK _M e PLASTIC/NONMETALLIC DRUM 0 i. FIBER DRUM m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j, BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ It. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 50.0 antifreeze ❑ Yes ❑ No 2 50.0 water ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sign Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (ouc pa-ge per material per buildiit g or at []ADD ❑DELETE ElIzImsv I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CIIEMICAL LOCAT'— ' CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 0 GRID# C_0^ y (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET ❑Yes [:]No instructions If Subject to EPCRA, refer to COMMON NAME WASTE O I L EHS* ❑Yes ❑ No CAs# 8002-05-9 *If FHS is "Yes", all amounts below must he in Ihs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Tnvin /Tnv\ I vnJ HAZARDOUS MATERIAL TYPE ❑ a. PURE ❑ b. MIXTURE 0 c WASTE RADIOACTIVE ❑ Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a SOLID 0 b. LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES a FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE 0 d. ACUTE HEALTH e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 260.0 520.0 4800.0 221 UNITS* 0 a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE • a. ABOVE: GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n PLASTIC BOTTLE ❑ q RAILCAR ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k BOX ❑ o. TOTE BIN ❑ r. OTHER ❑ d. STEEL DRUM ❑ h. SILO [11. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a, AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are piesent at greater than 1 % by weight if non -carcinogenic, ar 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the mquiivd information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sien Here UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page I of 1. FACILITY IDENTIFICATION FACILITY ID # Use Only) IFIAIOIOI0151111161 I I I I I EPA ID # (Hazardous Waste Only) 2 I (Agency CAL000387770 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) _N_ 0 3 BUSINESS SITE ADDRESS 286 HIGUERA ST 103 BUSINESS SITE CITY SAN LUIS OBISPO 704 CA ZIP CODE 93401 los II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page. Does your facility... If Yes, please com fete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed ❑X YES HAZARDOUS MATERIALS INVENTORY— CHEMICAL gases (include liquids in ASTs and USTs); or the applicable Federal threshold DESCRIPTION quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency Ian is required pursuant to 10 CFR Parts 30, 40 or 70? B. REGULATED SUBSTANCES Have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental Release ❑ YES Coordinate with your local agency prevention Program (CalARP)? responsible for CalARP. C. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly sWRCB Form A) Own or operate underground storage tanks? ❑ YES UST TANK (one page per tank) (Formerly Form B) D. ABOVE GROUND PETROLEUM STORAGE Own or operate ASTs above these thresholds: Store greater than 1,320 gallons of petroleum products (new or used) in ❑ YES NO FORM REQUIRED TO CUPAs aboveground tanks or containers. E. HAZARDOUS WASTE Generate hazardous waste? ❑X YES EPA ID NUMBER — provide at the top of this page Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES RECYCLABLE MATERIALS REPORT (one per recycler) Treat hazardous waste on -site? ❑ YES ON -SITE HAZARDOUS WASTE TREATMENT— FACILITY ON -SITE HAZARDOUS WASTE TREATMENT — UNIT (one page per unit) Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? ❑ YES CERTIFICATION OF FINANCIAL ASSURANCE Consolidate hazardous waste generated at a remote site? ❑ YES REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as ❑ YES HAZARDOUS hazardous waste and cleaned on -site? WASTE TANK CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or more of federal RCRA hazardous waste, or generate in any single calendar ❑ YES Obtain federal EPA ID Number, file month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous Biennial Report (EPA Form 8700- waste; or generate or accumulate at any time more than 100 kg (220 pounds) of 13A/B), and satisfy requirements for spill cleanup materials contaminated with RCRA acute hazardous waste. RCRA Large Quantity Generator. Household Hazardous Waste (HHW) Collection site? ❑ YES See CUPA for required forms. F. LOCAL REQUIREMENTS 15 (You may also be required to provide additional information by your CUPA or local agency.) UPCF Rev. (12/2007) r It: FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one Page per material ner building or area [—]ADD ❑DELETE ❑IZEVISI: I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU B E_N_GO CHEMICAL LOCATION ; CHEMICAL LOCATION CONFIDENTIAL F.PCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 01 GRID# b-04 (Agency use only) II. CHEMICAL INFORMATION CHEMICAL NAME AUTOMATIC TRANSMISSION FLUID TRADE SECRET El Yes ❑ No EPCRA, to instructions If Subject to refer COMMONNAME AUTOMATIC TRANSMISSION FLUID EHS* ❑Yes ❑No CAS# *IfEHS is "Yes", all amounts below must be in lbs. 71RE CODE HAZARD CLASSES (Comple(e if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a PURE x❑ b MIXTURE ❑ c WASTE RADIOACTIVE ❑ Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a SOLID ❑x b. LIQUID ❑ c. GAS LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES R a FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE 0 d. ACUTE HEALTH 0 e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT' STATE WASTE CODF 60.0 240.0 DAYS ON STI F 365.0 UNITS* ❑X a. GALLONS ❑ b, CUBIC FEET ❑ c POUNDS ❑ d To (Check one item only) *If EIIS, amount must be in pounds. STORAGE U a ABOVE GROUND TANK 0 e PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE BOTTLE ❑ RAIL CAR CONTAINER ❑ b UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ it PLASTIC q. ❑ k. BOX ❑ o. TOTE BIN ❑ l'. OTHER 51 c. TANK INSIDE BUILDING ❑ g CARBOY ❑ d. STEEL DRUM ❑ h SILO ❑ I CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a AMBIENT ❑ b. ABOVE AMBIENT ❑ c BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes [INo 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If morc it pint door components are present at greater than I % by weight if non•rnrcinogeoir, or 0.1 % by rreishl if carcinogenic, attach additional sheets of pnlmr ca pto ring the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sign Here FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY Out paze per material .rr building or a rca) ❑ADD ❑ DELETE OREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA—Doing Business As) LOBE-N-GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# O GRID#-O` (Agency use only) F H. CHEMICAL INFORMATION CHEMICAL NAME MOTOR OIL TRADE SECRET Yes No instructions If Subject to EPCRA, refer to COMMON NAME MOTOR OIL EHS* ❑Yes ❑ No CAS' 64742-54-7 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE IWARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a. PURE ❑x b, MIXTURE ❑ c. WASTE RADIOACTIVE ❑Yes ❑No CURIES (Check one item only) PHYSICAL STATE a, SOLID ❑x b. LIQUID c. GAS ❑ ❑ LARGEST CONTAINER 120.0 (Check one item only) FED HAZARD CATEGORIES ❑x a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE d. ACUTE HEALTH 0 e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 388.0 775.0 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) "If EHS, amount must be in pountb STORAGE U a. ABOVE GROUND TANK e. PLASTICINON METALLIC DRUM i. FIBER DRUM in. GLASS BOTTLE CONTAINER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR ❑ k. BOX ❑ o. TOTE BIN ❑ r. OTHER ❑x c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE 0 a, AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # l 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No ❑ Yes ❑ No ,I ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hnxnrdous cmnponenlf are present nt gieater than 1% by welglllif notreltrelacivait. or 0.1 % by weight if carcinugerdc, allach additional sheets or paper rapludng the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sign Ilerc FORM I - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one page per material per buildin or area ❑ADD ❑DELETE OREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATIOb CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES ❑ NO FACILITY ID # FA0005116 MAP# 01 GRID# _ 0 (Agency use only) H. CHEMICAL INFORMATION CHEMICAL NAME WASTE ANTIFREEZE TRADE SECRET Yes ❑No If Subject to EPCRA, refer to instructions COMMON NAME WASTE ANTIFREEZE EHS* ❑Yes ❑ No CAS# 107-21-1 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a. PURE [I b, MIXTURE ❑x c. WASTE RADIOACTIVE [I Yes ❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a. SOLID ❑x b. LIQUID ❑ c. GAS LARGEST CONTAINER 55.0 (Check one item only) FED HAZARD CATEGORIES ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d. ACUTE HEALTH ❑x e. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 83.0 1 165.0 1 675.0 UNITS* Z a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds. STORAGE ❑ a. ABOVE GROUND TANK ❑x e PLASTICINONMETALLIC DRUM i FIBER DRUM ❑ m. GLASS BOTTLE CONTAINER ❑ b UNDERGROUND TANK ❑ f. CAN ❑ j BAG ❑ n, PLASTIC BOTTLE [3 q. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g CARBOY ❑ k. BOX ❑ o, TOTE BIN 0 r. OTHER ❑ d. STEEL DRUM ❑ h. SILO ❑ 1 CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑x a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c, BELOW AMBIENT STORAGE TEMPERATURE 0 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 50.0 antifreeze ❑ Yes ❑ No 2 50.0 water ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non-em cinogenic, or 0.1% by weight if earcinogenic, attach additional sheets of paper capturing The required information. ADDITIONAL LOCALLY" COLLECTED INFORMATION If EPCRA Please Si en I lore FORM I — SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY one pate per material er buiWin or arrU (—]ADD [—]DELETE DREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) LU BE-N-GO CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL EPCRA ❑ YES NO FACILITY ID # FA0005116 MAP# O GRID# C-O9 (Agency use only) H. CHEMICAL INFORMATION CHEMICAL NAME WASTE OIL TRADE SECRET Yes No If Subject to EPCRA, refer to instructions COMMONNAME WASTE OIL EHS* ❑Yes ❑ No CAS# 8002-05-9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requited by CUPA) Toxic (Tox) HAZARDOUS MATERIAL TYPE ❑ a, PURE ❑ b. MIXTURE ❑x c. WASTE RADIOACTIVE []Yes❑ No CURIES (Check one item only) PHYSICAL STATE ❑ a, SOLID I7 b. LIQUID ❑ c. GAS LARGEST CONTAINER 550.0 (Check one item only) FED HAZARD CATEGORIES ❑x a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ❑x d, ACUTE HEALTH ❑x c. CHRONIC HEALTH (Check all that apply) AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT STATE WASTE CODE 260.0 1 520.0 1 4800.0 1 221 UNITS* ❑X a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 365.0 (Check one item only) *If EHS, amount must be in pounds, STORAGE ❑x a. ABOVE GROUND TANK ❑ e PLASTIC/NONMETALLIC DRUM i. FIBER DRUM 0 in. GLASS BOTTLE CONTAINER Q b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ q. RAIL CAR Q c. TANK INSIDE BUILDING ❑ g CARBOY ❑ k. BOX ❑ o, TOTE BIN ❑ r. OTHER Q d. STEEL DRUM ❑ In SILO [11, CYLINDER ❑ p. TANK WAGON STORAGE PRESSURE ❑x a AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT STORAGE TEMPERATURE a AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 95.0 hydrocarbons ❑ Yes ❑ No 2 5.0 BTEX ❑ Yes ❑ No 3 ❑ Yes ❑ No 4 ❑ Yes ❑ No 5 ❑ Yes ❑ No If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCRA Please Sign Here UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES FACILITY ID # I I I I I I I I I I I I I I 1 ICEPA AL 1 000 008ou725aste Only) BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) 3 ECONO LUBE N' TUNE #107 IL ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility I If Yes, olcase complete these naves of the UPCF_ _ A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CFR Part - CHEMICAL DESCRIPTION (OES 2731) 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SwRCBForm A) I . Own or operate underground storage tanks? 11YES NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? ❑ YES NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? ❑ YES ® NO 7 UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: --"any tank capacity is greater than 660 gallons, or ❑ YES ® NO 8 NO FORM REQUIRED TO CUPAs --- the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1, Generate hazardous waste? ® YES [:]NO 9 EPA ID NUMBER - provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? ❑ YES ® NO 10 perrecycler) 3. Treat hazardous waste on site? []YES ONSITE HAZARDOUS WASTE ®NO 11 TREATMENT - FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) 4. Treatment subject to financial assurance requirements (for []YES ® NO 12 (Formerly DISC Forms 1772 A,B,C,D and Q CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? []YES ® NO 13 REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ❑YES ®NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) UPCF (1/99) 165 FORM S - SAN LUI, 1ISPO COUNTY CERTIFIED UNIFIED i FTRA2 BUSINESS OWNER/OPERATOR IDENTIFICAT. I. IDENTIFICATION FACILITY ID# FA 1 BEGINNING DATE 100 BUSINESS NAME (Sane as FACILITY NAME or DBA — Doing Business As) 95C,�"1.10 L 3 BUSINESS PHONE 102 (., BUSINESS SITE ADDRESS 2- t3(, c v e ✓� ,q 5-1-, 103 CITY C) lot CA ZIP CODE 105 COUNTY S ups � � r Sr�a 109 BUSINESS OPERATOR NAME ILI ESS OPERATOR PHONE Ito II. BUSINESS OWNER OVRqER NAME 111 OWNER PHONE f c 7 (chi1LLLjLPtKr< v_O S. OWNER MAILING ADDRESS ��(o � � uex+� S-� • 113 CITY lla STATE 115 ZIP CODE 116 III. ENVIRONMENTAL CONTACT CONT CT NAME 117 CONTACT PHONE CONTACT MAILING ADDRESS 119 CITY Sr '1 120 STATE 121 ZIP CODE I2, 19 7 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME ,may i}:S ,>/ 123 NAMEM� ) tex TITLE 124 TITLE 129 BUSINESS PHONE 125 BUSINESS PHONE 130 24-HOUR PHONE 126 24 HOUR PHO 131 JUG 4- PAGER # / CELL PHONE # PAG /CELL PHONE # 132 c� v 1 ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 Certification: Based on my inquiry of those individ s respo le f obtaining the ormation, I certify under penalty of law that I have personally examined and am familiar with ft information submitted SM'SIGNER ER/OPERATOR OR DESIGNATE REPR TIV DATE 134 NAME OF DOCUMENT PREPARE135 Nint) 136 E OF SIGNER137 - N 8+� MA4N�L _. Page Of 2 N C:1DOCUMENTWeffp1FORMS1Business Plan ForrnMFRM-S.DOC 09/17/01 - ~ ^ ' r� Permit No 60-0034 Facility Number: Facility Information Operator: Facility Name: Address Number: Address: Suite: City: Zip: CrossStreet: Parcel No: Phone No: Facility Type: Property Owner Name: Address: City: State: Zip: Phone: JIM WILMORE ECONO LUBE AND TUNE 286 HIGUERA ST SAN LUIS OBISPO 93401- HIGH ST 002-482-024 (805) 544-2976 Corporation Site Visit Packet Underground Storage Tank Property Owner Name: ECONO LUBE AND TUNE PI tune: 8055442976 Mailing/Street Address 286 HIGUERA ST City: SAN LUIS OBISPO State CA Zip: 93401 Owner Type: Emergency Contacts Primary Days Last Name WILMORE 0 WILMORE First Name JIM PATRICIA Title OWNER WIFE OF OWNER Status: Permit Expiration Date: 7/9/02 Mailing Address Name: ECONO LUBE AND TUNE Address: 286 HIGUERA ST Care Off Address: JIM WILMORE City: SAN LUIS OBISPO State: CA Zip: 93401- Phone: (805) 544-2976 Business Owner Name: Address: City: State: Zip: Phone: Environmental Contact Name: Address: City: State: Zip: Phone: Miscellaneous SIC Code 7549 Dun Bradstreet 18-799-8612 Business License 342 Guarantor Number Current Balance: $194.00 Business _ Phone (805)544-2976 (805) 544-2976 (f 24 Hr Phone Pager _ (805)441-3457 (000)000-0000 Hazardous Materials Business Plan - List of Chemicals Permit No',60-0034 Facility: ECONO LUBE AND TUNE Address: 286 HIGUERA ST, SAN LUIS OBISPO Common Name Chemical Name Maximum Daily Amt I Units Physical State l Largest Container Grid No ATF PETROLEUM HYDROCARBON (ATF) 120 GAL Liquid 120 D-9 MOTOR OIL PETROLEUM HYDROCARBON MOTOR OIL) 775 GAL Liquid 120 D-9, H-12, J- 8, K-8 WASTE ANTIFREEZE ETHYLENE GLYCOL (WASTE) 165 GAL Liquid 55 D-8 WASTE MOTOR OIL PETROLEUM HYDROCARBON WASTE OIL 520 GAL Liquid 550 B5 WASTE SAFETY KLEEN SOLVENT IWASTE SOLVENT I GAL I Liquid Z— 1-1-6 i --1 Page 1 of APR 2 3 2-002 2002 COPYA Hazardous Materials Management Plan HMMP AND Hazardous Disclosure For: Materials Forms rE7�� ECONO LUBE N, TUNE #107 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO CITY FIRE DEPARTMENT Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 ATTN: Molly Brown Prepared by: aclfic Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 �'Up/q- Emu(5 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page I of 1 I. FACILITY IDENTIFICATION FACILITS ID n 1.7 I EPAIII #(Hazardous Waste Only) 1 CAL 000 008 725 BUSINESS NAME (Same as Facility Name of DBA•Doing Business As) ECONO LUBE N' TUNE #107 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility If Yes, please com lete these pages of the UPCF _ A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CPR Part CHEMICAL DESCRIPTION of ( S 2731) 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CPR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB form A) I . Own or operate underground storage tanks? N YES ❑ NO 5 UST TANK (one page per tank) (Formerly form B) 2. Intend to upgrade existing or install new USTs? ❑ YES N NO 6 UST FACILITY , UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form 3. Need to report closing a UST? ❑ YES N NO 7 C) UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (AS*Fs) Own or operate ASTs above these thresholds: -"any tank capacity is greater than 660 gallons, or ❑ YES N NO 8 NO FORM REQUIRED TO CUPAs --- the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE I. Generate hazardous waste? ® YES ❑ NO 9 EPA ID NUMBER - provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES N NO 10 RECYCLABLE MATERIALS REPORT (one 3. Treat hazardous waste on site? ❑ YES N NO 1 1 perrecycler) ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) 4. Treatment subject to financial assurance requirements (for [-]YES N NO 12 (Formerly DISC Forms 1772 A,B,C,D and Q CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION []YES N NO 13 SITE ANNUAL NOTIFICATION (Formerly 6. Need to report the closure/removal of a tank that was classified as YES NO 14 DISC Form 1196) HAZARDOUS WASTE TANK CLOSURE 9ste-eton id eleenee} sitc ERT-Ifie TIO (Formerly 13 ISC li-xinOT— E. LOCAL REQUIREMENT is (You may also be required to provide additional information by ),our CUPA or local agency.) UPCF (1/99) 165 FORM S - SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION FACILITY ID# I BEGINNING DATE 100 ENDING DATE 101 04/27/01 104/26/02 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE 102 ECONO LUBE N' TUNE 4107 1 (805) 544-2976 BUSINESS SITE ADDRESS 286 HIGUERA STREET CITY 104 ZIP CODE 105 SAN LUIS OBISPO CA 93401 - 4215 DUN & BRADSTREET 106 SIC CODE (4 digit 4) 107 18 - 799 - 8612 7549 COUNTY 10s SAN LUIS OBISPO BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 JIM WILMORE 1(805)544-2976 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 1112 JIM WILMORE 1(805) 544-2976 OWNER MAILING ADDRESS 113 286 HIGUERA STREET CITY 114 STATE 115 ZIP CODE 116 SAN LUIS OBISPO ICA 193401 - 4215 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 JIM WILMORE 1(805) 544-2976 CONTACT MAILING ADDRESS 119 286 HIGUERA STREET CITY 120 STATE 121 ZIP CODE 122 SAN LUIS OBISPO ICA 193401 - 4215 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 129 JIM WILMORE PATRICIA WILMORE TITLE 124 TITLE 129 OWNER WIFE OF OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (805) 544-2976 (805) 544-2976 24-HOUR PHONE 126 24-1-IOUR PRONE 131 ( PAGER A / CELL PHONE N 127 PAGER k / CELL PHONE M 132 ( ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based oil my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATUR&OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 04 / 26 / 02 IPACIFIC MANAGEMENT SVCS. NAME OF SIG E (print) 136 TITLE PIRE OF SIGNER 137 JIM A OWNER Page 1 Of 16 C:IWINDOWSITEMPIFRM-S.DOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LURE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 WORK BAY, ADJACENT WEST WALL 1 ❑ E YE YES 0 NO FACILITY ID # MAP# (optional) 203 GRID# (optional) 204 ID 2 of 3 - 9 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes No 206 PETROLEUM HYDROCARBON MIXTURE If Subject to EPCRA, refer to instructions COMMON NAME 207 208 AUTOMATIC TRANSMISSION FLUID EHS* ❑ Yes ® No CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 MATERIAL 211 TYPE (Check TYPE (Check one item only) ❑ a. PURE ®b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes ® No 212 213 CURIES N/A PHYSICAL STATE 215 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS 214 LARGEST CONTAINER 120 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ In. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 60 120 1 1 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE. 222 (Check one itent nn1 * If FHS, amnunt mnet he.. in pmmdc 365 NI URAU1 -- CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE ❑ q. OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ® c. TANK INSIDE BUILDING ❑ g,CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c, BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 85 - 100 226 227 ❑ Yes ® No 228 229 64742-65-0 2 230 231 ❑ Yes ❑ No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 243 If more hazardous components am present at greater than 1% by weight if non carcinogenic, or 0 1% by weight if carcinogenic, attach additional sheets of paper capturing the required information ADDITIONAL LOCALLY COLLECTED INFORMATION z4a Page 2 Of 16 C:IWINDOWSITEMPIFRM-I.DOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA I WORK BAY, ADJACENT SOUTH WALL ❑ YES [D NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 2 of 3 114-12 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes No 206 PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMONNAME 207 EHS* 208 Yes ®No MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complele if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE 211 RADIOACTIVE ❑ Yes ®No 212 213 CURIES PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 211 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 28 55 1 1 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 Cltooh one item uulvt * If EI1S, a nount must bo in pounds. 365 STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in, GLASS BOTTLE ❑ q. OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ J. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ h SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 > 85 226 Various Lubricating Base Oils 227 ❑ Yes ® No 228 6474X-XX-X 229 2 < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 :5:9 234 �lAG—/al d7t�laA lies last 235 ❑ Yes ® No 236 237 4 238 239 ❑ Yes ❑ N0 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information ADDITIONAL LOCALLY COLLECTED INFORMATION 246 l/ If FprRA- PIP -age Sion Here Page 3 Of 16 C:IWINDOWSITEMPIFRM-I.DOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FCONO LLIBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA BRAKE BAY, 1) ADJECENT WEST WALL; 2) NEAR RESTROOM YES 0 NO FACILITY ID # MAP# (optional) 203 GRID# (optional) 204 ID-9; 3 of 3 J-8; K-8 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes N No 206 PETROLEUM HYDROCARBON If subject to EPCRA, refer to instructions COMMON NAME 207 208 MOTOR OIL EHS* ❑ Yes ® No CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) [Ia. PURE ® b MIXTURE ❑ c. WASTE RADIOACTIVE Yes 213 ❑ ® No 212 CURIES PHYSICAL STATE 215 (Check one item only) ❑ a. SOLID ®b LIQUID ❑ c. GAS 214 LARGEST CONTAINER 120 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zzo 360 720 1 UNITS* ®a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 heck one item nnl • • Tf FHS, ammnrt mist he in pounds. 365 S7'URAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ In. GLASS BOTTLE ❑ q. OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ® c. TANK INSIDE BUILDING ❑ g,CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ P. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I > 85 226 Various —Lubricating Base Oils 227 ❑ Yes ® No 228 6474X-XX-X 229 Z < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 233 Mixture 3 < 2 234 ine r dill ^ te 235 LLllllil! ❑ Yes ® No 236 _3 237 4 238 239 ❑ Yes ❑ N0 240 241 5 242 243 ❑ Yes ❑ No 244 245 If to ore hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0 I% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 t% Page 4 Of 16 C:MINDOWSITEMPTRM-LDOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) —]ADD [:]DELETE ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BRAKE BAY; ADJACENT WEST WALL EPCRA YES 0 NO FACILITY ID # MAP# (optional) 203 GRID# (optional) 204 3 of 3 D - 8 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes 0 No 206 WASTE ETHYLENE GLYCOL MIXTURE If Subject to EPCRA. refer to instructions COMMON NAME 207 Zoe WASTE ANTIFREEZE / COOLANT EFTS* El Yes ®No CAS# 20s Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE 1L4DIOACTIVE Yes ❑ Z No 212 213 CURIES N/A PHYSICAL STATE 215 Check one item only) a. SOLID 214 ( Y) ❑ ®b. LIQUID ❑ c. GAS LARGEST CONTAINER 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE Z d. ACUTE HEALTH ❑ e. CHRONIC HEALTH A VERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 83 165 1675 134 UNITS* Z a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 1365 Check one item on * if FNC, amount must be in pounds. STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i, FIBER DRUM ❑ in. GLASS BOTTLE ❑ q. OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ❑ c, TANK INSIDE BUILDING ❑ g,CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ TANK WAGON P. 223 STORAGE PRESSURE Z a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE Z a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 84 - 94 226 Ethylene Glycol 227 ❑ Yes Z No 228 107-21-1 229 2 0 - 10 230 Dieth lene Glycol 231 ❑ Yes Z No 232 233 111-46-6 _4 234 3 2-4 Witter 235 ❑ Yes Z No 236 �732-18— 237 4 231 239 ❑ Yes ❑ No zoo 241 5 242 243 1 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than I% by weight if nen•earcinogenie, or 0 I% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 Page 5 Of 16 C:\WINDOWS\TEMP\FRM-I.DOC 04/04/02 FORM 1— SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE 200 1. FACILITY INFORMATION BUSINESS NAME (Saute as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 UST, WEST OF WORK BAY EPCRA 1 ❑ YES ® NO FACILITY [D #H MAP# (optional) 203 GRID# (optional) 204 IC-9 2 of 3 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes N No 206 WASTE PETROLEUM HYDROCARBON If Subject to EPCRA, rotor to instrualons COMMON NAME 207 208 WASTE MOTOR OIL EHS* Yes Z No ❑ CAS# 20s Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete it required by CUPA) 210 HAZARDOUS MATERIAL TYPE Check one item only) a. PURE 211 ( Y) ❑ ❑ b. MIXTURE Z c. WASTE RADIOACTIVE ❑ Yes Z No 212 213 CURIES N/A PHYSICAL STATE 215 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c, GAS 214 LARGEST CONTAINER $50 FED HAZARD CATEGORIES 216 (Clieck all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE Z d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 211520 MAXIMUM DAILY AMOUNT 2I8 ANNUAL WASTE AMOUNT zry STATE WASTE CODE 220 260 14,800 1221 UNITS* ❑ a.GALLONS ❑ b. CUBIC FEET Elc. POUNDS Eld TONS 221 DAYS ON SITE: 222 Check one item (Check * t-ittustlx.iu-pounds` tJs STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE ❑ q. OTHER ® b. UNDERGROUND TANK ❑ f. CAN ❑ i. BAG ❑ it. PLASTIC BOTTLE ❑ r. RAIL CAR ❑ c. TANK INSIDE BUILDING ❑ g,CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1 CYLINDER ❑ TANK WAGON P. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOi iS COMPONENT (For mixture or waste only) EHS CAS # I > 85 226 Various Lubricating Base Oils 227 [--]Yes ® No zzs 6474X-XX-X 229 Z < 15 230 Additive Package, including: 23 ❑ Yes Z No 232 233 Mixture 3 2 23a 235 Zinc Alky1dithiol2hosphat ❑ Yes Z No 236 Z 237 4 238 239 ❑ Yes ❑ No zoo 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0 1% by weight if carcinogenic, attach additional sheets of paper capturing the required information ADDITIONAL LOCALLY COLLECTED INFORMATION 246 Page 6 Of 16 C:IWINDOWSITEMPIFRM-I.DOC 04/04/02 FORM 1- SAN LUIS OBISPO COUNTY CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) CHEMICAL INVENTORY (one page per material per building or area) ❑ADD ❑DELETE ®REVISE zoo 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BRAKE BAYS, ADJACENT NORTH WALL; EPCRA 1 El YES ® NO FACILITY ID # MAP# (optional) 203 GRID# (optional) 204 114-6 3 of 3 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET U Yes IN No 206 WASTE HYDROCARBON SOLVENT If Subject to EPCRA, refer to instructions COMMONNAME 207 208 WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT EHS* El Yes ®No CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ❑ b MIXTURE ®c. WASTE RADIOACTIVE ❑ Yes ® No 212 213211 CURIES PHYSICAL STATE (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS 214 216 LARGEST CONTAINER 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ® e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 2 13 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zza 28 55 110 1212 UNITS* 221 ® a.GALLONS ❑ b. CUBIC FEET ❑ ..POUNDS ❑ d. TONS DAYS ON SITE: 222 w " amowL4uus1 lean pounds 3615 STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e, PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ in. GLASS BOTTLE ❑ q. OTHER ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. RAILCAR ❑ c. TANK INSIDE BUILDING ❑ g,CARBOY ❑ k. BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p, 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 85 226 C-9 to C-13 Saturated Hydrocarbon 227 ❑ Yes ® No 228 64741-41-9 229 2 1.0 230 X lene 231 ❑ Yes ® No 232 1330-20-7 233 3 0.5 234 Ethyl _Belll7erie 235 ❑ Yes ® No 236 4237 4 236 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If MICRA Menge, Page 7 Of 16 C:1WIND0WSITEMPIFRM-LD0C 04/04/02 C c��� 2001 Hazardous Materials ' Management Plan HMMP AND Hazardous Materials Disclosure Forms For: NOV 14 20ol J v ECONO LURE N, TUNE aio7 E 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 , Prepared by: '�ific Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 L "'f4 ✓ J �— ✓L e Aral i i,• �I • city osAn tuis omspo FIRE DEPARTMENT 2160 Santa Barbara Avenue* San Luis Obispo, CA 93401-5240 * 805/781-7380 "Courtesy & Service" HAZARDOUS MATERIALS BUSINESS PLAN UPDATE FORM YEAR 2001 FACILITY NAME: ECONO LUBE N' TUNE #107 ADDRESS: 286 HIGUERA STREET, SAN LUIS OBISPO, CA 93401 - 4215 CONTACT PERSON: Jim WILMORE TELEPHONE: (805) 544-2976 Annual Inventory Update (due each year) ❑ No significant changes in inventory have occurred since the last Business Plan or inventory was submitted. ❑ New inventory forms are attached, ❑ Replace previous inventory with attached inventory. ❑ Replace only designated pages of inventory. Additional Comments: Yearly Review and Recertification ® I certify that the Business Plan has been reviewed and the information contained in the Business Plan is accurate and complete as of this date. Other Updates ❑ Please incorporate the following information into the Business Plan for this facility: I declare, under penalty of perjury, that the information provided herein is true and correct to the best of my knowledge. Signature: INC— w- Date: 11 / 15 / 01 Printed Name: JINS,XILMORE Please Return to: Molly Brown, Hazardous Materials Section City Fire Department 2160 Santa Barbara Avenue San Luis Obispo, CA 93401-5240 H:BUSINESS PLAN UPDATE FORM MOLLY ❑The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecommunications Device for the Deaf (805) 781-7410. 19 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of 8 I. FACILITY IDENTIFICATION FACILITY ID # 1 EPA ID # (Hazardous Waste Only) CAL 000 008 725 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) 3 ECONO LUBE N' TUNE #107 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility if Yes, please com lete these pages of the UPCF_ _ A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold E YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CFR Part - CHEMICAL DESCRIPTION (OES 2731) 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB Form A) I . Own or operate underground storage tanks? EYES ❑ NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? ❑ YES E NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? ❑ YES ENO 7 UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: -"any tank capacity is greater than 660 gallons, or ❑ YES E NO 8 NO FORM REQUIRED TO CUPAs --- the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? E YES [:]NO 9 EPA ID NUMBER - provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? [:]YES E NO 10 perrecycler) 3. Treat hazardous waste on site? ❑ E ONSITE HAZARDOUS WASTE YES NO 11 TREATMENT - FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) 4. Treatment subject to financial assurance requirements (for - YES NO 12 (Formerly DISC Forms 1772 A,B,C,D and Q CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION ❑ YES E NO 13 SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ❑ YES E NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DISC Forn 1249) E. LOCAL REQUIREMENTS 1s (You may also be required to provide additional infonnation by yOUr CUPA or local agency.) UPCF (1/99) 165 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Pace 2 r 8 I. IDENTIFICATION FACILITY ID# t BEGINNING DATE 100 ENDING DATE 101 110/15/01 10/16/00 BUSINESS NAME (Same is FACILITY NAME or DBA • Doing Business As) 3 BUSINESS PHONE 102 ECONO LUBE N' TUNE #1071(805)544-2976 BUSINESS SITE ADDRESS 103 286 HIGUERA STREET CITY 104 CA ZIP CODE 105 SAN LUIS OBISPO 93401 -4215 DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 18 - 799 - 8612 7549 108 COUNTY AN LUIS OBISPO BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE ' 10 JIM WILMORE1(805) 544-2976 II. BUSINESS OWNER OWNER NAME III 1(805)544-2976 OWNER PHONE 112 IM WILMORE OWNER MAILING ADDRESS 286 HIGUERA STREET CITY 4 STATE its 193401 ZIP CODE 16 SAN LUIS OBISPO ICA - 4215 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 1(805) CONTACT PHONE 118 JIM WILMORE 544-2976 119 CONTACT MAILING ADDRESS 286 HIGUERA STREET CITY 120 STATE 121 193401 ZIP CODE SAN LUIS OBISPO ICA - 4215 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 129 JIM WILMORE PATRICIA WILMORE TITLE 124 TITLE 29 OWNER WIFE OF OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 805 544-2976 (805) 544-2976 24-HOUR PI-IONP 126 24-1{OUR PHONE " v v / •PAGER PAGER# 132 127 # ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATUI : OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 1 NAME OF DOCUMENT PREPARER 135 11 / 15 / 01 PACIFIC MANAGEMENT SVCS. 137 NAME OF SIG Ei (print) 136 TITLE OF SIGNER JIM WILMORE OWNER UPCF ( 1/99 revised) 167 OES FORM 2730 (1/99) UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION lone Rage per material Der building or area) ❑ADD ❑DELETE ®REVISE 200 Page of S I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 WORK BAY, ADJACENT WEST WALL EPCRA YES 0 NO FACILITY ID # MAP# (optional) 203 GRID# (optional) 204 2 of 3 B - 5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes N No 206 PETROLEUM HYDROCARBON MIXTURE If Subject to EPCRA, refer to instructions COMMON NAME 267 Zoe AUTOMATIC TRANSMISSION FLUID EHS* El Yes Z No CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE Check one item only) a. PURE 211 ( y) ❑ ®b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes Z No 212 213 CURIES N/A PHYSICAL STATE 215 (Check one item only) Ela. SOLID ®b. LIQUID [I c. c. GAS LARGEST CONTAINER 120 FED HAZARD CATEGORIES 716 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH Ele. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 219 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 55 1 120 UNITS* Z a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 1365 Check one item an)v * If EHS, amount must be in pounds. STORAGE a ABOVE GROUND TANK ❑ PLASTICINONMETALLIC DRUM CONTAINER ❑ e. ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAIL CAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ® c. TANK INSIDE BUILDING ❑ g_CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 123 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I e _ 100 226 Aliphatic Petroleum Distillates 227 ❑ Yes ® No zzs 64742-65-0 229 2 230 231 El Yes No 232 233 3 234 235 ❑ Yes ❑ No 236 237 4 238 239 ❑ Yes [__1 No zao zal 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than ] % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 Si-n Here UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (one paoe per malerlal per bu inq or areal ❑ADD ❑DELETE ®REVISE 200 Page of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA WORK BAY, ADJACENT SOUTH WALL YES 0 NO MAP# (optional) 203 GRID# (optional) zoa FACILITY ID # 2 of 3 IE-7 H. CHEMICAL INFORMATION CHEMICALNAME 205 TRADE SECRET 0 Yes No 206 PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMONNAME 207 EHS* Zoe ❑ Yes ® No MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ®b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes ® No 212 213 CURIES N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 20 AXIMUM DAILY AMOUNT eta ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 28 r55 221 UNITS* a.GALLONS ® ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 222 (Check one item only * If EHS, amount must be in pounds. 365 STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM m. GLASS BOTTLE CONTAINER ❑ ❑ q. RAILCAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGE PRESSURE ® a. AM BIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HA-Z'ARDOUS`tCQMPONENT (For mixture or waste only) EHS CAS # I 226 > 5 227 ric Various L batin Base Oils ❑ Yes ® No 22s 6474X-XX-X 229 2 < 15 230' dditive\ Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 < 2 234 Zinc AlkYldithio hos hate 235 ❑ Yes ® No 236 68649-42-3 237 4 238 239 ❑ Yes ❑ No zao 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than I % by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA. q io n Here UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one ome Per malerial tier buildino or area ❑ADD ❑DELETE ®REVISE 200 Pave of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 BRAKE BAY, NEAR RESTROOM ��� — c4 �ct�i" 5bv41 o.- �X EPC RA YES 0 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1-1-77 3 of 3 1 G-4, H-4 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes W No 206 PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS* 208 El Yes. ®No MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE 211 RADIOACTIVE ❑ Yes ® No 212 213 CURIES N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 120 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 1 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS [:1 d. TONS 7365 DAYS ON SITE: zzz Check one ilcm only * If EHS, amount must be in pounds. STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q, RAILCAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r, OTHER ® c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 []Yes ®No zzs 229 > 5 Various Lubricatine Base Oils 6474X-XX-X 2 < 15 230 Additive Package, including: 231 g , �� El Yes ED NO 232 Mixture 233 3 < 2 234 Zinc Alkvldithio hos hate 235 ❑ Yes ® No 236 68649-42-3 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 zas If more hazardous components am present at greater than ] % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION z4ry v If fPleaceSien Here UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION lone naae ner material per buildinct or areal ❑ADD ❑DELETE ®REVISE 200 Page 6 of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 E BRAKE BAY, ADJACENT WEST WALL ❑ YE YES ® NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 IC-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET 0 Yes IN No 206 WASTE ETHYLENE GLYCOL MIXTURE If Subject to EPCR4, refer to instructions COMMONNAME 207 EHS* 208 ❑ Yes ® No WASTE ANTIFREEZE / COOLANT CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE RADIOACTIVE ❑ Yes ® No 212 CURIES 213 N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT eta ANNUAL WASTE AMOUNT 219 WASTE CODE 220 83 1 165 1 675 JSTATE 134 UNITS* ®a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: --- (Check one item only) If EHS, amount must be in pounds. 365 STORAGE ❑ a. ABOVE GROUND TANK ®e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM m. GLASS BOTTLE RAIL CAR CONTAINER ❑ ❑ q. ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 ❑ Yes ® No 228 229 84-94 Ethylene Glycol 107-21-1 2 0 - 10 230 ithylene Glycol 231 ❑ Yes ® No 232 111-46-6 233 3 2-4 234 Water 235 ❑ Yes ® No 236 7732-18-5 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 if more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION ll 24K UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM I-IAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one oa a oer material rer buildino or area) ❑ADD ❑DELETE ®REVISE 200 Pave 7 of 8 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA UST, WEST OF WORK BAY ❑ YES ® NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 2 of 3 1 B - 5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes 0 No 206 WASTE PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMON NAME 207 Zoe EHS* ❑ Yes ® No WASTE MOTOR OIL CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE RADIOACTIVE ❑ Yes ®No 212 CURIES 213 N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 550 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 1 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 260 520 4,800 1221 UNITS* ®a.GALLONS Elb. CUBIC FEET [Ic. POUNDS [Id. TONS 221 1 DAYS ON SITE: 222 Check one item only * If EHS, amount must be in pounds. 365 STORAGE ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ m. GLASS BOTTLE i. FIBER DRUM RAIL CAR ❑ ❑ CONTAINER q. ® b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 zz7 [:]Yes No z28 zz9 > 95 Various Lubricating Base Oils 6474X-XX-X 2 < 15 230Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 < 2 234 Zinc Alkvldithio hos hate 235 ❑ Yes ® No 236 68649-42-3 237 4 238 239 ❑ Yes ❑ NO zoo 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA_ Please Si-n Here UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION (one page Der material per buildinq or area ❑ADD ❑DELETE ®REVISE 200 Page of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONNOCC��IILL�UpB�E TUNE #107 TN' 1�H13KAKl✓L 13AY�N ADJACENT NORTH WALL; 201 CHEMICAL LOCATION CONFIDENTIAL 202 R 2) BAKE BAYS, S/E CORNER OF SOUTH WALL EPCRA ❑ YES [0 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 IE-3; F-6 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes 0 No 206 WASTE HYDROCARBON SOLVENT If Subject to EPCR4, refer to instructions COMMON NAME 207 EHS* 208 ❑Yes ®No WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT CAS# zos Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE Elb. MIXTURE ® c. WASTE 211 RADIOACTIVE ❑ Yes ® No 2172 213 CURIES N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER 55 FED HAZARD CATEGOKIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 21 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 28 155 110 1212 UNITS* ® a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 1 DAYS ON SITE: 222 (Check one item only * If EHS, amount must be in pounds. 365 STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. PIBER DRUM ❑ m. GLASS BOTTLE Elq, RAILCAR ❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 []Yes ® No 228 229 S -9 to C-13 Saturated Hvdrocarbon 64741-41-9 2 1.0 230 ylene 231 ❑ Yes ® No 232 1330-20-7 233 3 0.5 234 thvl Benzene 235 ❑ Yes ® No 236 100-41-4 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ NO 244 245 If more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required info mittion. ADDITIONAL LOCALLY COLLECTED INFORMATION 6 If EPCRA. c UPCF (1/99) 169 OES Form 2731 (".. 14 FEB 2 1 2001 OQ� III Hazardous Materials Management Plan HMMP AND Hazardous Materials Disclosure Forms For: UPI. -1 ECONO LUBE N, TUNE #107 7��* 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 Prepared by: Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 F'Imsib-' 60A DK-) V� r1j WL(S p ' UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES Page] of 8 I. FACILITY IDENTIFICATION FACILITY ID q 77I 1 EPA ID # (Hazardous Waste Only) CAL 000 008 725 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) ECONO LUBE N' TUNE ##107 II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility If Yes, please coin lete these pages of the UPCF..... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold ® YES ❑ NO 4 HAZARDOUS MATERIALS INVENTORY quantity for an extremely hazardous substance specified in 40 CFR Part - CHEMICAL DESCRIPTION (OES 2731) 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY(Formerly SWRCB Form A) I . Own or operate underground storage tanks? EYES ❑ NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new LISTS? ❑ YES ® NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per lank) (Formerly Form 3. Need to report closing a UST? [:]YES ® NO 7 C) UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: -"any tank capacity is greater than 660 gallons, or ❑ YES ® NO 8 NO FORM REQUIRED TO CUPAs -- the total capacity for the facility is greater than 1,320 gallons? J1 F1ATLU W-A l . Generate hazardous waste? ® YES ❑ NO 9 EPA ID NUMBER - provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES ® NO 10 RECYCLABLE MATERIALS REPORT (one per recycler) 3. Treat hazardous waste on site? ❑ YES ® NO ONSITE HAZARDOUS WASTE 1 1 TREATMENT - FACILITY (Formerly DISC Fortes 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) 4. Treatment subject to financial assurance requirements (for ❑ YES ® NO 12 (Formerly DISC Forms 1772 A,B,C,D and Q CERTIFICATION OF FINANCIAL Permit b Rule and Conditional Authorization)? Y ) ASSURANCE (Formerly DTSC Forte 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION ❑ YES ® NO 13 SITE ANNUAL NOTIFICATION (Formerly 6. Need to report the closure/removal of a tank that was classified as YES NO 14 DTSC Form 1 ] 96) HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite7 CERTIFICATION (Formerly DTSC Form 1249) s (You may also be required to provide additional information by your CUPA or local agency ) UPCF (1/99) 165 IFIED PROGRAM CONSOLIDATED FO' FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION FACILITY IDIt I BEGINNING DATE 100 ENDING DATE 101 01/01/00 12/31/00 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE 102 ECONO LUBE N' TLJNE #107 (805) 544-2976 BUSINESS SITE ADDRESS lea 286 HIGUERA STREET CITY 104 CA ZIP CODE 105 SAN LUIS OBISPO 93401 - 4215 DUN & BRADSTREET 106 SIC CODE (4 digit #) 101 18 - 799 - 8612 7549 COUNTY 106 AN LUIS OBISPO BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 JIM WILMORE (805) 544-2976 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 112 JIM WILMORE 1(805) 544-2976 OWNER MAILING ADDRESS 113 286 HIGUERA STREET CITY 114 STATE 115 ZIP CODE 116 SAN LUIS OBISPO ICA 193401 - 4215 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 11s JIM WILMORE 1(805) 544-2976 CONTACT MAILING ADDRESS 119 286 HIGUERA STREET CITY 120 STATE 121 ZIP CODE 122 SAN T.UIS=OBISPO ICA - 4215 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 129 JIM WILMORE PATRICIA WILMORE TITLE 124 TITLE 129 OWNER WIFE OF OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (805) 544-2976 (805) 544-2976 24-HOUR PHONE 126 24-HOUR PHONE I31 PAGER # 127 I PAGER# t32 Y COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined ani am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OWNER/OPERATOR OR DOrWAJEDREPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 W ' 01 / 29 / O1 PACIFIC MANAGEMENT SVCS. NAME OF SIGN rint) 136 TITLE OF SIGNER 137 IM WILMORE OWNER UPCF ( 1/99 revised) 167 OES FORM 2730 (1/99) .e, , 'r . UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one pane per material per building or area ❑ADD ❑I)ha.l? l }: 01avISE 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 WORK BAY, ADJACENT WEST WALL EPCRA YES 0 No FACILITY ID # MAP# (optional) 203 1 GRID# (optional) 204 2 of 3 B - 5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes N No 200 PETROLEUM HYDROCARBON MIXTURE 11 Subject to EPCRA. refer to instruclions COMMON NAME 207 208 AUTOMATIC TRANSMISSION FLUID EHS* ❑ Yes ® No CAS# 200 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete it required by CUPA) :+o HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE RADIOACTIVE ❑ Yes ® N o 212 CURIES N/A PHYSICAL STATE (Check one item only) ❑ a. SOLID ®b. LIQUID ❑ c. GAS 214 11`' LARGEST CONTAINER 120 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zza 55 1 120 UNITS* ® GALLONS a 221 ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS DAYS ON SITE: 222 Cheek one item only) • If EHS. amount must be in pounds. 365 STORA ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM rn. GLASS BOTTLE ❑b-h1DERGR0MUTANK ❑Y-CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE U r. OTHER ® c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGEPRESSURE ®a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ®a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 226 Aliphatic Petroleum Distillates 227 ❑ Yes ® No 228 64742-65-0 229 2 210 231 ❑ Yes No 232 233 3 234 231 ❑ Yes ❑ No 236 237 4 238 239 S 242 743 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if Carcinogenic, attach additional sheets of poper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If FPCRA Please S UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one Pace Def material per building or area ❑ADD 01)I•:I.h'1'k; MR]: VISE 200 Page 4 of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE # 107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL. 202 EPCRA 1 WORK BAY, ADJA ENT SOUTH WALL YES 0 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # \ T-F I I I I I I 1 1 2 of 3 IE-7 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Ll Yes N No Zoe PETROLEUM HYDROCARBON\ If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS* z0e ❑ Yes ® No MOTOR OIL CAS# 200 Mlxturc *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required byCUPA) 210 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE RADIOACTIVE [I Yes ® N o 212 CURIES 213 N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑.,c. GAS LARGEST CONTAINER 215 55 FED HAZARD CATEGORIES ] I o (Check all that apply) ®a. FIRE ❑ b. REACTIVE ❑ c. F'Ri SSURE RELEASE ®d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT = t x ANNUAL WASTE AMOUNT 219 STATE WASTE CODE zzo 28 55 , UNITS* ® a. GALLONS ❑b. CUBIC FEET ❑ c. PO S ❑d. TONS 221 DAYS ON SITE: 222 (Check one item only) If EHS, amount must be in ounds. 365 STORAGE —CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM ❑ m. GLASS BOTTLE 0 Q. RAILCAR ❑ b. UNDERGROUND TANK❑ f. CAN j.BAi, ❑ n. PiA3"�IC�� 1°❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ giCARBO Y ❑ BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ h. SILO ❑ 1. YLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELO AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW A IENT ❑ d. CRYOGENIC 225 %W T HAZARDOUS COMPONENT Mixture or waste only) H S CAS # I 226 227 ❑Yes ® 0 228 229 > arious Lbbricatirla Base is 6474X-XX-X 2 < 15 230 dditivo Package, in lu n : 231 ❑ Yes ® No ��232 Mixture 233 3 < 2 234 Zinc A ld' uo Lolwi 235 ❑ Yes ® No 236 649-42-3 237 4 238 C 239 rl Yes rj No 240 241 r 5 2 243 ❑ Yes ❑ No 244 245 If more hazardous omponents am present at greater than 1% by weight if non -carcinogenic, or 0.1% by weight if carcinogenic. attach additional sheets of paper capturing the roquired information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 l If FPCRA Please S;Pn Here UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY —CHEMICAL DESCRIPTION (one PaQe Per material per building or area —]ADD ❑DI{1.}:"I'I: ®Ith\'ISIi 200 Page of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA 1 BRAKE BAY, NEAR RESTROOM YES NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # F1 I I I I I I I I I I 1 1 3 of 3 IG-4; H-4 H. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Ll Yes N No 20o PETROLEUM HYDROCARBON If Subject to EPCRA, refer to instructions COMMON NAME 207 EHS* 20t1 Yes ®No MOTOR OIL CAS# tog Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete if required by CUPA) 216 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE ❑ c. WASTE RADIOACTIVE [IYes ® No 212 213 CURIES PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 720 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE N d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT eta ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 360 + L $ ' = _0 5 720 f S 5 ; -7 i , 1 UNITS* a. GALLONS 221 ® ❑ b. CUHIC FEET ❑ e. POUNDS ❑ d. TONS DAYS ON SITE: 222 Check one item only) • If EHS. amount must be in pounds. 365 STORAGE (D TA IN R R ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ RAIL CAR Ob. IDIDERGROUNDTANK ❑f.-CAN— - - O j. 13AU -- [:1n. PLASTIC BOTTLE U r. OTHER ® c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 223 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I>95 226 Various Lubricating Base Oils 227 ❑ Yes ® No 228 6474X-XX-X 229 2 < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 < 2 234 Zinc Alky1dithiophosphate 235 ❑ Yes ® No 236 68649-42-3 237 4 236 4 5 242 243 ❑ Yes [:1 No 244 243 If more hazardous components am present at greater than ] % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 L UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION (one Pace oer material Der buildmg or area ❑ADD ❑DELETE ®ltI;Vlsl'. 200 Page A of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ECONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA BRAKE BAY, ADJACENT WEST WALL El YES N NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 3 of 3 IC-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET LJ Yes D9 No 206 WASTE ETHYLENE GLYCOL MIXTURE If Subject to EPCRA, rater to instructions COMMON NAME 202 EHS* 200 ❑ Yes ® No WASTE ANTIFREEZE / COOLANT CAS# 209 Mixture *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete if required by CUPA) a0 HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE 211 RADIOACTIVE ❑ Yes ® N o 212 ' t } C GP.'.!':> N/:1 PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 215 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE N d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 DAILY AMOUNT eta ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 83 JMAXIMUM 165 1675 1134 UNITS* a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 Check one item only)• If EHS, amount must be in pounds. 365 STORAGE -CONTAINER ❑ a. ABOVE GROUND TANK ® e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ 4 RAID CAR ❑ b7UNDERGROUND-TANK ❑ f CAN ❑ j. BAG [3n. PLASTIC BOTTLE Ur. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBO Y ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ TANK WAGON p. 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 ❑ Yes ® No 221 229 94-94 Ethylene Glycol 107-21-1 Z 0 - 10 230 ieth lene Glycol 231 ❑ Yes ® No 232 111-46-6 233 -4 234 3 2-4 Water 235 ❑ Yes ® No 236 7732-18-5 237 4 231 239 11 Yes rl No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1% by weight if non•careinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 , If EPCRA. Please Si UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one paqa per material per building or area ❑ADD ❑I ELETE ®REVISE 200 Pagc —1 of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CONO LUBE N' TUNE #107 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA 1 UST, WEST OF WORK BAY 0 YES 19 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 2 of 3 IB-5 II. CHEMICAL INFORMATION CHEMICALNAME 205 TRADE SECRET Lj Yes D9 No 206 WASTE PETROLEUM HYDROCARBON 11 Subject to EPCRA, refer to instructions COMMON NAME 207 EHS* Zoe El Yes ®No WASTE MOTOR OIL CAS# 209 'rIf EHS is "Yes", all amounts below must be in lbs. Mixture FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 2t0 HAZARDOUS MATERIAL TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE 211 RADIOACTIVE [I Yes ®N o 212 TCURIES 2u PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS 215 LARGEST CONTAINER 550 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE N d. ACUTE HEALTH ❑ e. CHRONIC HEALTH AVERAGE DAILY A1,1017t. T 217 MAXIMUM DAILY AMOUNT 215 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 260 1520 1 4,800 1221 UNITS. ®a.GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS 221 DAYS ON SITE: 222 1365 Check one item only) • If EHS, amount must be in pounds. STORAGE [1NTlfi#1RR a. ABOVE GROUND ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM 0 m. GLASS BOTTLE _TANK_ ® b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG [In. PLASTIC BOTTLE ❑ r OTHER ❑ c. TANK INSIDE BUILDING ❑ g,CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 ❑ Yes ® No 228 229 > Various Lubricating Base Oils 6474X-XX-X 2 < 15 230 Additive Package, including: 231 ❑ Yes ® No 232 Mixture 233 3 < 2 234 Zinc Alky1diflijophosphate 235 ❑ Yes ® No 236 68649-42-3 237 238 239 Yes No 240 241 5 242 243 1 [—]Yes ❑ No 244 245 If more hazardous components am present at greater than 1 % by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If SS. UPCF (1/99) 169 OES Form 2731 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY -CHEMICAL DESCRIPTION l one v,,ac vcr material perbulldin or area ❑Ann ❑DEl,F TE 0m:v1S1? 200 Page _ of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CONO LUBE N' TUNE #107 115HM1�L1WAV?N ADJACENT NORTH WALL; 201 CHEMICAL LOCATION CONFIDENTIAL 202 2) BRAKE BAYS, S/E CORNER OF SOUTH WALL EPCRA 1 YES 9 NO MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1.3 of 3 IE-3-, F-6 H. CHEMICAL INFORMATION CHEMICAL NAME .10 TRADE SECRET U Yes No 208 WASTE HYDROCARBON SOLVENT If Subject to EPCRA, refer to instructions COMMON NAME 207 :os EHS* ❑ yes ®No WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT CAS# tog *If EHS is "Yes", all amounts below must be in lbs. Mixture FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 2io HAZARDOUS MATERIAL 211 TYPE (Check one item only) ❑ a. PURE ❑ b. MIXTURE ® c. WASTE RADIOACTIVE El Yes ®N o 212 CURIES N/A PHYSICAL STATE 214 (Check one item only) ❑ a. SOLID ® b. LIQUID ❑ c. GAS LARGEST CONTAINER 55 FED HAZARD CATEGORIES 216 (Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT era ANNUAL WASTE AMOUNT 2t9 STATE WASTE CODE 220 28 55 110 212 U N ITS • ® a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d TONS 221 DAYS ON SITE: 222 Check one item only) * If EHS, amount must be in pounds. 365 STORAGE ❑ ❑ ❑ ❑ q. RAIL CAR a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM i. FIBER DRUM m. GLASS BOTTLE El b. UNDERGROUNDTANK Lj t CAN ❑ j. BAG On. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g.CARBOY ❑ k BOX ❑ o. TOTE BIN ® d. STEEL DRUM ❑ In. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 %W T HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 ❑ Yes ® No 228 229 95 -9 to C-13 Saturated Hydrocarbon 64741-41-9 Z 1.0 230 lene 231 ❑ Yes ® No 232 1330-20-7 233 3 0.5 231 Ethyl Benzene 233 ❑ Yes ® No 236 100-41-4 237 4 238 239 ❑ Yes ❑ No 240 241 5 242 243 ❑ Yes ❑ No 244 245 If more hazardous components am present at greater than 1% by weight if non -carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing tho requited information ADDITIONAL LOCALLY COLLECTED INFORMATION 246 UPCF (1/99) 169 OES Form 2731 VI / DEC 2 9 LI-) )G1. ?yt Clip 1999 �Fp1, C40 Hazardous Materials p� Management Plan HMMP AND Hazardous Materials Disclosure Forms For: ECONO LUBE N, TUNE aim E 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401 - 5240 (805) 781 - 7383 -4051cific Management Services Environmental Compliance Specialists 1923 North Fine, Suite 101 (559) 251 - 4060 Fresno, California 93727 - 1510 FAX (559) 251 - 5534 10 ckfywA 4+-Lz,c b CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX A California Hazardous Materials Inventory Reporting Form - Business Owner/Operator Identification Page CALENDAR YEAR BEGINNING (1) 11 / 01 / 98 ENDING (2) 10 / 31 / 99 (3) PAGE 1 OF 6 BUSINESS NAME (4) ECONO LUBE N' TUNE #107 BUSINESS PHONE (5) (805) 544-2976 SITE ADDRESS (6) 286 HIGUERA STREET CITY (7) STATE (8) CA ZIP (9) 93401 - 4215 SAN LUIS OBISPO DUN & (10) SIC CODE (4 DIGIT) (11) 7549 18 - 799 - 8612 BRADSTREET OPERATOR (12) JIM WILMORE OPERATOR PHONE (13) (805) 544-2976 NAME OWNER INFORMATION OWNER NAME (14) 1 JIM WILMORE OWNER PHONE (15) 1 (805) 544-2976 OWNER MAILING ADDRESS (16) 286 HIGUERA STREET CITY (17) SAN LUIS OBISPO STATE (18) Cq ZIP (19) 93401 - 4215 ENVIRONMENTAL CONTACT CONTACT NAME (20) JIM WILMORE CONTACT PHONE (21) (805) 544-2976 MAILING ADDRESS (22) 286 HIGUERA STREET CITY (23) SAN LUIS OBISPO STATE (24) CA ZIP (25) 93401 - 4215 Primary NAME (26) JIM WILMORE TITLE (27) OWNER BUSINESS PHONE (28) (805) 544-2976 24-HOUR PHONE (29) PAGER # (30) (805) 801-8429 EMERGENCY CONTACTS HAZA Secondary NAME (31) PATRICIA WILMORE TITLE (32) WIFE OF OWNER BUSINESS PHONE (33) (805) 544-2976 24-HOUR PHONE (34) r PAGER # (35) 805) 801-8428 S MATERIALS (AHM) ON SITE AHM (36) ❑Yes X No If yes, and above Threshold Planning Quantities, attach a sheet of paper with a general description of the process and principal equipment. ADDITIONAL LOCALLY COLLECTED INFORMATION Certification: I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. Print Name of Document Preparer (38) Pacific Management Services / 1923 North Fine, Suite #101 / Fresno, CA 93727 / (559) 251-4060 Signature of Owner/Operator (39) Date (40) 11 / 29 / 99 OES Form 2730(04/96) .. , .,� e . � f ..' ,. CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) El ADD ❑ DELETE X REVISE PAGE (2) OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) ADJACENT WEST WALL OF WORK BAY MAPS (6) 2 of 3 GRID # (7) 1 C - 5 CHEMICAL NAME (8) PETROLEUM HYDROCARBON MIXTURE TRADE SECRET (11) ❑ Y X N COMMON NAME (9) AUTOMATIC TRANSMISSION FLUID *EHS (12) ❑ Y X N CAS (10) Mixture 'IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES' COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS TYPE (14) ❑ PURE X MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ Y X N (16) N/A PHYSICAL STATE (17) ❑ SOLID Xi LIQUID ❑ GAS CURIES FED HAZARD CATEGORIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH STATE WASTE (19) UNITS" (22) IX GAL ❑ CU FT MAX DAILY AMT (23) 110 CODE Cl LBS ❑ TONS DAYS ON SITE (20) 365 'If EHS, amounts must be in lbs. AVG DAILY AMT (24) 55 LARGEST (21) 120 CONTAINER STORAGE (26) ❑ ABOVE GROUND TANK CONTAINER ❑ UNDER GROUND TANK X TANK INSIDE BUILDING ❑ STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM ❑ CAN ❑ CARBOY ❑ SILO ❑ FIBER DRUM ❑ BAG ANNUAL WASTE AMT (25) ❑ BOX ❑ TANK WAGON ❑ CYLINDER ❑ RAIL CAR ❑ GLASS BOTTLE ❑ ❑ PLASTIC BOTTLE ❑ TOTE BIN STORAGE PRESSURE (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT STORAGE TEMPERATURE (28) X AMBIENT I]ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC (29 %b lrf HAZARDOUS P 31 EHS A # 1 85 100 Aliphatic Petroleum Distillates ❑ Y X N 64742-65-0 2 ❑Y ❑N 3 ❑Y ❑N 4 ❑Y ❑N 5 ❑Y ❑N i SEE APPENDIXES A & B / CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page _ (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) V OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) 1) ADJACENT SOUTH WALL OF WORK BAYS; 12) ADJACENT SOUTH WALL OF BRAKE BAY, NEAR RESTROOM MAPS (6) 2 of 3; 3 of 3 GRID # (7) Map 2 Map 3 E -7 G-4, H-4, 1-4 CHEMICAL NAME (8) PETROLEUM HYDROCARBON TRADE SECRET (11) ❑Y XJN COMMON NAME (9) MOTOR OIL *EHS (12) ❑ Y X N CAS (10) Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE ❑ WASTE] RADIOACTIVE (15) ❑ Y X N (16) N/A (17) ❑ SOLID X LIQUID ❑ GAS I CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) UNITS* (22) FF1_1 I GAL ❑ CU FT ILBS ❑ TONS (20) 365 *If EHS, amounts must be in lbs. LARGEST (21) 120 CONTAINER STORAGE (26) ❑ ABOVE GROUND TANK CONTAINER ❑ UNDER GROUND TANK TANK INSIDE BUILDING ❑ STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM STORAGE PRESSURE (27) X AMBIENT ❑ ABOVE AMBIENT STORAGE TEMPERATURE (28) X AMBIENT ❑ ABOVE AMBIENT MAX DAILY AMT (23) 880 AVG DAILY AMT (24) 440 ANNUAL WASTE AMT (25) ❑ CAN ❑ BOX ❑ TANK WAGON ❑ CARBOY ❑ CYLINDER ❑ RAIL CAR ❑ SILO ❑ GLASS BOTTLE ❑ ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ BAG ❑ TOTE BIN ❑ BELOW AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC (29) %WT 30) HAZARDOUS COMP T 31 EHS 1 > 85 Various Lubricating Base Oils ❑ Y X N 6474X-XX-X 2 < 15 Additive Package, including: ❑ Y X N Mixture 3 < 2 Zinc Alkyldithiophosphate ❑ Y SIN 68649-42-3 4 ❑Y ON 5 ❑Y ON () ADDITIONAL LOCALLY I SEE APPENDIXES A & B )ES form 2731 (04196) CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) ADJACENT WEST WALL OF BRAKE BAY BUILDING MAPS (6) 3 of 3 GRID # (7) B - 4 CHEMICAL NAME COMMON NAME CAS FIRE CODE HAZARD CLASSES* TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE (8) WASTE ETHYLENE GLYCOL MIXTURE (RECYCLED) TRADE SECRET (11) O Y =N (9) ANTIFREEZE / COOLANT (RECYCLED) *EHS (12) ❑ Y 1N N WASTE (10) Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS J -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE X WASTE I RADIOACTIVE (15) ❑ Y X N (16) N/A (17) ❑ SOLID X LIQUID ❑ GAS I CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) 134 (20) 365 UNITS* (22) XI GAL ❑ CU FT rCI LBS ❑ TONS *If EHS, amounts must be in Ibs LARGEST (21) 55 @ @ Recycled in-house CONTAINER MAX DAILY AMT (23) 165 @ AVG DAILY AMT (24) 83 e° ANNUAL WASTE AMT (25) 675 @ STORAGE (26) ❑ ABOVE GROUND TANK ❑ CAN ❑ BOX CONTAINER ❑ UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE X_ PLASTIC / NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN STORAGE PRESSURE (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT STORAGE TEMPERATURE (28) FX AMBIENT ❑ ABOVE AMBIENT [IBELOW AMBIENT ❑ CRYOGENIC ❑ TANK WAGON ❑ RAIL CAR (29) %WT S COMP 31 EHS # 1 84 - 94 Ethylene Glycol ❑ Y X N 107-21-1 2 1 0- 10 1 1 Diethylene Glycol 3 2 - 4 Water 4 5 ❑Y XN ❑Y XN ❑Y ❑N 0Y 0N 111-46-6 7732-18-5 CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) O ADD ❑ DELETE X REVISE PAGE (2) OF (3) F BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) UST WEST OF WORK BAY MAPS (6) 2 of 3 GRID # (7) CI 5 CHEMICAL NAME (8) WASTE PETROLEUM HYDROCARBON TRADE SECRET (11) ❑ Y X N COMMON NAME (9) WASTE MOTOR OIL *EHS (12) ❑ Y X N CAS (10) Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE LARGEST CONTAINER -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE X WASTE RADIOACTIVE (15) Ely X N (16) N/A (17) ❑ SOLID X LIQUID ❑ GAS I CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) 221 (20) 365 (21) 550 UNITS* (22) X GAL ElCU FT CI LBS ❑ TONS *If EHS, amounts must be in lbs. STORAGE (26) ❑ ABOVE GROUND TANK ❑ CAN CONTAINER X UNDER GROUND TANK ❑ CARBOY ❑ TANK INSIDE BUILDING ❑ SILO ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC / NONMETALLIC DRUM ❑ BAG STORAGE PRESSURE STORAGE TEMPERATURE (29) ° 1 > 85 2 1 <15 3 <2 4 5 MAX DAILY AMT (23) 520 AVG DAILY AMT (24) 260 ANNUAL WASTE AMT (25) 4,800 ❑ BOX ❑ CYLINDER ❑ GLASS BOTTLE ❑ PLASTIC BOTTLE ❑ TOTE BIN (27) X AMBIENT ❑ ABOVE AMBIENT _❑ BELOW AMBIENT (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC ❑ TANK WAGON ❑ RAIL CAR HAZARDOUS COMPQNENT31 EHS # Various Lubricating Base Oils ❑ Y ?9 N I 6474X XX-X Additive Package, including: Zinc Alkyldithiophosphate — ❑ Y X N I I Mixture Y Y� XI N �O❑ 68649-42-3 ❑Y ❑N ❑Y ON LOCALLY A SEE APPENDIXES A & B )ES Form 2731 (04196) / CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) � 6 OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) 1) ADJACENT NORTH WALL OF BRAKE BAYS; 2) SOUTHEAST CORNER OF SOUTH WALL OF BRAKE BAYS MAPS (6) 3 of 3 GRID # (7) E - 2, F - 5 CHEMICAL NAME (8) WASTE HYDROCARBON SOLVENT TRADE SECRET (11) ❑Y N71 COMMON NAME (9) WASTE SAFETY'- KLEEN 105 PARTS WASHING SOLVENT *EHS (12) ❑ Y X N CAS (10) Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE LARGEST CJNTAINER STORAGE CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE 'COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE X WASTE I RADIOACTIVE (15) ❑ Y X N (16) 1 N/A (17) ❑ SOLID XI LIQUID ❑ GAS —1 CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH X CHRONIC HEALTH (19) 212 (20) 365 UNITS* (22) 1E0�1 I GAL El TONS FT LBS TONS *If EHS, amounts must be in Ibs. (21) 55 (26) ❑ ABOVE GROUND TANK ❑ CAN ❑ UNDER GROUND TANK ❑ CARBOY ❑ TANK INSIDE BUILDING ❑ SILO X STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC / NONMETALLIC DRUM ❑ BAG MAX DAILY AMT (23) 55 AVG DAILY AMT (24) 28 ANNUAL WASTE AMT (25) 110 ❑ BOX ❑ TANK WAGON ❑ CYLINDER ❑ RAIL CAR ❑ GLASS BOTTLE ❑ ❑ PLASTIC BOTTLE ❑ TOTE BIN (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) X' AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC (2T850— WT HAZARDOUS 31 EHS 1 C-9 to C13 Saturated Hydrocarbon ❑ Y X N 64741-41-9 2 11.0 Xylene 10Y SIN I 1330-20-7 3 0.5 Ethyl Benzene ❑ Y X N 100-41-4 4 ❑Y ❑N 5 ❑Y ❑N (33)ADDITIONAL LOCALLY L INFORMATION SEE APPENDIXES A & B 1 )ES Form 2731 (041%) ` / 1 G&N 1998 �p�pr. G Hazardous Materials 4 1 Management Plan ! n,% a Era jai] HMMP AND v ti Hazardous Materials�1 • 99p`' otss� Disclosure Forms For: rE* ECONO LUBE N, TUNE #107 286 HIGUERA • SAN LUIS OBISPO, CA 93401-4215 • (805) 544-2976 Presented to: CERTIFIED UNIFIED PROGRAM AGENCY SAN LUIS OBISPO COUNTY San Luis Obispo Fire Department Hazardous Materials Division 2160 Santa Barbara Street San Luis Obispo, CA 93401-5240 9 1999 (805) 781 - 7383 AEG Prepared by: '4�Iflc Management Services Environmental Compliance Specialists D 1923 North Fine, Suite 101 9 (559) 251 - 4060 Fresno, California 93727 "✓ FAX (559) 251 - 5534 CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX A California Hazardous Materials Inventory Reporting Form - Business Owner/Operator Identification Page CALENDAR YEAR BEGINNING (1) 11 / 01 / 97 ENDING (2) 10 / 31 / 98 1 (3) PAGE 1 OF 1 5 BUSINESS NAME (4) ECONO LUBE N' TUNE #107 BUSINESS PHONE (5) (805) 544-2976 SITE ADDRESS (6) 286 HIGUERA STREET CITY (7) STATE (8) CA ZIP (9) 93401 - 4215 SAN LUIS OBISPO DUN & (10) SIC CODE (4 DIGIT) (11) 7549 18 - 799 - 861277 BRADSTREET OPERATOR (12) JIM WILMORE OPERATOR PHONE (13) (805) 544-2976 NAME OWNER INFORMATION OWNER NAME (14) JIM WILMORE OWNER PHONE (15) 1 (805) 544-2976 OWNER MAILING ADDRESS (16) 286 HIGUERA STREET CITY (17) SAN LUIS OBISPO STATE (18) Cq ZIP (19) 93401 - 4215 ENVIRONMENTAL CONTACT CONTACT NAME (20) JIM WILMORE CONTACT PHONE (21) (805) 544-2976 MAILING ADDRESS (22) 286 HIGUERA STREET CITY (23) SAN LUIS OBISPO STATE (24) CA ZIP (25) 93401 - 4215 Primary EMERGENCY CONTACTS Secondary NAME (26) JIM WILMORE NAME (31) TITLE (27) OWNER TITLE (32) BUSINESS PHONE (28) (805) 544-2976 BUSINESS PHONE (33) 24-HOUR PHONE (29) 24-HOUR PHONE (34) PAGER # (30) PAGER # (35) ACUTELY HAZARDOUS MATERIALS (AHM) ON SITE AHM (36) ❑ Yes N :�o If yes, and above Threshold Planning Quantities, attach a sheet of paper with a general description of the process and principal equipment. ADDITIONAL LOCALLY COLLECTED INFORMATION (37) Certification: I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. Print Name of Document Preparer (38) 1 Pacific Management Services LyT North Fine, Suite #101 / Fresno, CA 93727 / (559) 251-4060 Signature of Owner/Operator (39) OES Form 2730 (04/96) Date (40) 11 / 24 / 9g CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD O DELETE X REVISE PAGE (2) OF (3) U BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) ADJACENT WEST WALL OF WORK BAY MAPS (6) 2 of 3 GRID # (7) 1C - 6 CHEMICAL NAME COMMON NAME CAS FIRE CODE HAZARD CLASSES" TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE LARGEST CONTAINER (8) I PETROLEUM HYDROCARBON MIXTURE (9) AUTOMATIC TRANSMISSION FLUID (10) [ Mixture (13) TRADE SECRET (11) ❑ Y X N "EHS (12) O Y MN 'IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ Y X N (16) N/A (17) ❑ SOLID X LIQUID ❑ GAS CURIES (18) X FIRE DREACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) UNITS" (22) f )<I GAL ❑ CU FT MAX DAILY AMT (23) 110 ❑ LBS ❑ TONS (20) 365 "If EHS, amounts must be in Ibs. AVG DAILY AMT (24) 55 (21) 120 ANNUAL WASTE AMT (25) STORAGE (26) ❑ABOVE GROUND TANK CONTAINER ❑ UNDER GROUND TANK X TANK INSIDE BUILDING ❑ STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM STORAGE PRESSURE STORAGE TEMPERATURE (29 °WT 1 85 - 100 2 3 I 4 5 ❑ CAN O CARBOY ❑ SILO ❑ FIBER DRUM ❑ BAG (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ BOX ❑ CYLINDER O GLASS BOTTLE ❑ PLASTIC BOTTLE ❑ TOTE BIN (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT O CRYOGENIC HAZARDOUS MP N Aliphatic Petroleum Distillates I ❑ TANK WAGON ❑ RAIL CAR O 31 EHS 32ZCA1S# ❑ Y MIN 64742-65-0 ❑Y El ❑Y ❑N ❑Y ❑N ❑Y NJ F77 (33) ADDITIONAL LOCALLY LL INFORMATION SEE APPENDIXES A & B )ES Farm 2731 104196) CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE LARGEST CONTAINER California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) F771 OF (3) 5 BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) 1) ADJACENT SOUTH WALL OF 12) ADJACENT SOUTH WALL OF WORK BAYS; BRAKE BAY, NEAR RESTROOM MAPS (6) 2 of 3; 3 of 3 GRID # (7) 1 Map D -7 2 Map 3 G-4, H-4, 1-4 CHEMICAL NAME (8) I PETROLEUM HYDROCARBON _I TRADE SECRET (11) ❑ Y X N COMMON NAME (9) MOTOR OIL *EHS (12) ❑ Y X N CAS (10) Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ Y X N (16) 1 N/A (17) ❑ SOLID X LIQUID ❑ GAS CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) (20) 365 (21) 120 STORAGE (26) CONTAINER STORAGE PRESSURE STORAGE TEMPERATURE (29 `001T 1 I > 85 2 <15 3 <2 4 5 UNITS* (22) XI GAL ❑ CU FT CI LBS ❑ TONS *If EHS, amounts must be in Ibs. MAX DAILY AMT (23) AVG DAILY AMT (24) ANNUAL WASTE AMT (25) 880 L440 ❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑ TANK WAGON ❑ UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ❑ RAIL CAR X TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑ ❑ STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ PLASTIC / NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN (27) 1 X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC (�-Q) HA7— AR(701-5 C(OMPQNENT Various Lubricating Base Oils Additive Package, including: Zinc Alkyldithiophosphate SEE APPENDIXES A & B )ES Form 2731 (94M) 31 EH 2 A i ❑ Y X N 6474X-XX-X ❑ Y X N Mixture ❑ Y MN I 68649-42-3 ❑Y ON ❑Y ❑N CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) = OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 CHEMICAL LOCATION (5) UST WEST OF WORK BAY MAPS (6) 1 of 3 GRID # (7) 1 E - 3 CHEMICAL NAME (8) WASTE PETROLEUM HYDROCARBON TRADE SECRET (11) ❑ Y x N COMMON NAME (9) 1 WASTE MOTOR OIL *EHS (12) ❑ Y X N CAS (10) I Mixture *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS FIRE CODE (13) HAZARD CLASSES* TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE LARGEST CONTAINER -COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE X MIXTURE X WASTE RADIOACTIVE (15) ❑ Y X N (16) N/A (17) ❑ SOLID X LIQUID ❑ GAS CURIES (18) X FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH ❑ CHRONIC HEALTH (19) 221 (20) 365 (21) 550 UNITS* (22) X GAL ❑ CU FT ❑ LBS ❑ TONS *If EHS, amounts must be in Ibs. STORAGE (26) ❑ ABOVE GROUND TANK CONTAINER X UNDER GROUND TANK ❑ TANK INSIDE BUILDING ❑ STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM STORAGE PRESSURE STORAGE TEMPERATURE (29) %WT 1 > 85 2 <15 3 <2 4 5 MAX DAILY AMT (23) AVG DAILY AMT (24) ANNUAL WASTE AMT (25) 520 260 4,800 ❑ CAN ❑ BOX ❑ TANK WAGON ❑ CARBOY ❑ CYLINDER ❑ RAIL CAR ❑ SILO ❑ GLASS BOTTLE ❑ ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ BAG ❑ TOTE BIN (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 0 HAZARDOUS COMPONENT Various Lubricating Base Oils Additive Package, including: Zinc Alkyldithiophosphate 31 EHS 32 CA # ❑ Y X N 6474X-XX-X ❑ Y X N Mixture ❑ Y X N 68649-42-3 ❑Y ON ❑Y ❑N (33) ADDITIONAL LOCALLY COLLECTED INFORMATION SEE APPENDIXES A & B 3ES Form 2731 (04/961 CALIFORNIA CODE OF REGULATIONS TITLE 19 CHAPTER 2 SUBCHAPTER 3. APPENDIX C TYPE PHYSICAL STATE FED HAZARD CATEGORIES STATE WASTE CODE DAYS ON SITE California Hazardous Materials Inventory Reporting Form - Chemical Description Page (1) ❑ ADD ❑ DELETE X REVISE PAGE (2) IF -]OF (3) BUSINESS NAME (4) ECONO LUBE N' TUNE #107 1 CHEMICAL LOCATION (5) 1) ADJACENT NORTH WALL OF BRAKE BAYS; 2) SOUTHEAST CORNER OF SOUTH WALL OF BRAKE BAYS MAPS (6) 3 of 3 GRID # (7) E - 3, F - 6 771 CHEMICAL NAME (8) WASTE HYDROCARBON SOLVENT TRADE SECRET (11) ❑ Y N COMMON NAME (9) WASTE SAFETY - KLEEN 105 PARTS WASHING SOLVENT *EHS (12) ❑ Y N N CAS (10) I Mixture FIRE CODE (13) HAZARD CLASSES* 'COMPLETE BLOCK (13) IF REQUESTED BY THE LOCAL FIRE CHIEF - REFER TO INSTRUCTIONS (14) ❑ PURE N MIXTURE X WASTE RADIOACTIVE (15) ❑ Y 'X N (16) I N/A (17) ❑ SOLID X LIQUID ❑ GAS CURIES (18) N FIRE ❑ REACTIVE ❑ PRESSURE RELEASE X ACUTE HEALTH X CHRONIC HEALTH *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS (19) 212 (20) 365 LARGEST (21) 55 CONTAINER UNITS* (22) X GAL ❑ CU FT ❑ LBS ❑ TONS *If EHS, amounts must be in Ibs. STORAGE (26) ❑ ABOVE GROUND TANK CONTAINER ❑ UNDER GROUND TANK ❑ TANK INSIDE BUILDING X STEEL DRUM ❑ PLASTIC / NONMETALLIC DRUM STORAGE PRESSURE STORAGE TEMPERATURE (2J `/OVV 1 �I 85 2 � 1.0 3 0.5 4 5 MAX DAILY AMT (23) 55 AVG DAILY AMT (24) 28 ANNUAL WASTE AMT (25) 110 ❑ CAN ❑ BOX ❑ TANK WAGON ❑ CARBOY ❑ CYLINDER ❑ RAIL CAR ❑ SILO ❑ GLASS BOTTLE ❑ ❑ FIBER DRUM ❑ PLASTIC BOTTLE ❑ BAG ❑ TOTE BIN (27) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT (28) X AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC HAZARDOUSP N C-9 to C13 Saturated Hydrocarbon Xylene Ethyl Benzene 31 EHS ❑ Y X N 64741 41-9 ❑ Y N N 11330-20-7 ❑ Y X N 100-41-4 ❑Y ❑N ❑Y El (33)ADDITION L LOCALLY COLLECTED INFORMATION SEE APPENDIXES A & B DES Foam 2731 (04f96) 0 00 M r 00 0 0 in �o den �( �d +� U C* czO A cn PLO � � C N V1 a z 0 i o� z z Ho�a A wa 00 W wo C W O W n � o o, o V f F t2 a O o 0 c � W F F 14 0 00 � p w N U O = O � C � o o Ucdbk o °' �•� (DU 0 61) o Cq �+ cc U o is c Y^ (� N 2 cd U N cC _ N N U cn b rz o a� Q o d w 34 d •' V a '� 'CS �p � � c w WV•� C." a"'j G c . u5 O N o cd vi U c o U A UaY' O cd > Gn el 04 °' fi U " "" as H h � ° a) o C U cd U L O V y G, C z (U • Cd U L _ Cd � O �� L i+ B ��� ca ca 3 OL ebo L_. o o�D E•y O � Fri V N � L •y � '� ,� •N G1. 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V1 �O Date: 02/10/2016 Envi-mmental Health Services (805) 7815544 P.0.13ox1489 2156 Sierra Way San Luis ObIS00 CA 93406 CA..9 smubS oSpo Fire DeQartment (805) 781-7380 2160 Santa Barbara Avenue San Luis Qbi-sA4 CA-aRM2-40 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Time: Facility Name: LUBE-N-GO Agency Inspection Type ❑EHS (]Routine OCITY FIRE ❑Reinspection Site Address: 286 HIGUERA ST SAN LUIS OBISPO, CA 93401-4215 ❑Chargeable Reinspection ❑Change of Ownership Phone: (805)786-4056 ❑Complaint ❑Secondary Containment Testing Facility ID: FA0005116 ❑Chargeable Secondary Containment Testinc Serial Number: DALYJ07TN PROGRAMS INSPECTED: OHazmat 9HW Generator DUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): Name: Omar Godinez Title: Manager YES NO N/A 19 ©�El BP01 ❑x ❑ ❑ BP02 0 ❑ ❑ BP03 BUSINESS PLAN Business plan4s-complete, swren"va0able-durang4nspestiGn4HSC--266036,-T4tle49-CCR-2729) Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) Site layouttfacility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑x ❑ ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑x ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66265.16 EMERGENCY RESPONSE PLAN ® ❑ ❑ ER01 Emergency response/contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑x ❑ ❑ ER02 Facility is operated and maintained to preventlminimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 273% 22 CCR 66265.31-.37, 66267.34 (d)(2), 40CFR 1 265.31) 191 ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. �o)(2)T GENERAL EH VIOLATIONS 19 ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724600000 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: KERRY BOYLE FACILITY REP: Omar Godinez FACILITY NAME: LUBE. 30 ADI :SS: 286 HIGUERA ST HAZARDOUS WASTE GENERATOR 934 LUIS OBISPO, CA 3401-4215 EPA ID CAL000387770 Total generated/month: Lbs or gals (average) NUMBER: Waste Oil: Solvents: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS iX; ❑ ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR§66262.12) If not, Call (800) 618-6942 to obtain your CAL EPA ID number HAZARDOUS WASTE DETERMINATION ❑X ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) Oown knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years(Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑X ❑ ❑ GT05 Hazardous wastes disposed of at an authorized location (HSC §25189.5, Title 22 CCR §66262.12) ❑ ❑ ❑O GT06 Facility utilizes a registered hazardous waste transporter, and hazardous wastes shiDDed with a manifest (Title 22 CCR 566262.20. HSC 525160/25163(a)) Emilkrun ❑other ❑x ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23, 66262.40 (a)) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑x ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 1990 days if waste generated per month is greater than or equal to 100 kg. (220 lbs.) 0180 days if waste generated per month is less than 100 kg (see note) 0270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) 1Xl ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ix] ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) [xl ❑ ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date,"HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize the release or reaction (Title 22 CCR §66262.34 (d)(2), O ❑ ❑ GT13 ContainersttanWiiner.s imsQmpatible_with-waste-store"r-transferred(Title 22CCR§. §66262.34 (d)(2), 66265.172) ❑x ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §§66262.34 (d)(2), 66265.1 ❑O ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§§66262.34 (d)(2), 66265.174) ❑x ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §§66262.34 (d)(2), 66265.195) ❑x ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE 19 ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (Title 22 CCR§ 66266.13, HSC §25250.4) ❑x ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.13) ❑x ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) 0 ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR 466266.3) SOURCE REDUCTION:For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑x ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (67100.7, 67100.8, HSC ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementationschedule of selected source reduction measures. (67100.7. 67100.8. HSC 625244.19) Cx] ❑ ❑ GT24 Hazwaste Contingency Plan prepared, current, submitted to the CUPA, maintained onsite. (Title 22 CCR §66265.51-.54) SUM 4RY OF OBSERVATIONS/VI _ATIONS ❑x No violations of underground storage tank, hazardous materials, or hazardous waste lawstregulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to you facility. El Violations were observed/discovered as listed below. All violations must be corrected by implementing the correcti% action listed by each violation. If you disagree with any of the violations or corrective actions required, please infon the CUPA in writina. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing wi certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: LUBE-N-GO VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED ADDRESS: 286 HIGUERA ST SAN LUIS OBISPO, CA 93401-4215 INSPECTION COMMENTS: Cammille to complete Hazardous Materials Business Plan (230,9301) within two weeks of today's date. All else ok. Area near dumpster needs to have floor sweep used to pick up small area of waste oil. Empty small drum of water/motor oil and turn empty containers over to prevent further problems. INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Omar Godinez DATE: 02/10/2016 SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: Environmental Health Services (805)781-5544 ;,� —■ P.O.Box 1489 2156 Sierra Way r San LUIS Obispo (A 93406 city ou SAt1 LiIIS OLiISO Fire Depa inent (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 03/06/2015 Time: Facility Name: LUBE-N-GO Agency Inspection Type ❑EHS [@Routine Site Address: 286 HIGUERA ST OCITY FIRE ❑Reinspection❑Chargeable SAN LUIS OBISPO, CA 934014215 Reinspection ❑Change of Ownership ❑Complaint Phone: (805)786-4056 ❑Secondary Containment Testing Facility ID: FA0005116 ❑Chargeable Secondary Containment Testinc Serial Number: DAFWOOZNI PROGRAMS INSPECTED: ®Hazmat OHW Generator DUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): Name: Omar Godinez Title: Manager 0Z� YES NO N/A BUSINESS PLAN 0 ❑ ❑ BP01 Business plan is complete, current, available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑O ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑x ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN 0 ❑ ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) 0 ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66265.16 EMERGENCY RESPONSE PLAN 0 ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑x ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 273% 22 CCR 66265.31-.37, 66267.34 (d)(2), 40CFR 1265.31) I] ❑ ❑ ER03 Secondary containment is installed and sufficiently -impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c)(2)] GENERAL EH VIOLATIONS 0 ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724600000 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: KERRY BOYLE FACILITY REP: Omar Godinez SUMMARY OF OBSERVATIONSAMO.ATIONS ❑x No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: LUBE-N-GO VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED ADDRESS: 286 HIGUERA ST SAN LUIS OBISPO, CA 934014215 INSPECTION COMMENTS: Annual inspection. A new state requirement is now in effect - please submit an updated Hazardous Materials Business Plan during the First Quarter of each calendar year. If you haven't yet done so, please complete this requirement before the end of March 2015. Make sure empty drums are completely empty before storing outside near dumpster - keep drums covered so as to keep rain water out of them prior to recycling the drums. Facility well run, no problems noted. INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Omar Godinez DATE: 03/06/2015 SIGNATURE OF FACILITY REP: STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator:_ Title: Date: Environm— al Health Services cI v1- t * (805) 781-5544 P.O.Box 1489 sAn Luis oBis o 2156 Sierra Wav Fire Depa r ment (805) 781738 0 \r✓ San Luis Obispo CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 02/13/2014 Time: Facility Name: LUBE-N-GO Agency Inspection Type ❑EHS I]Routine Site Address: 286 HIGUERA ST OCITY FIRE ❑Reinspection SAN LUIS OBISPO, CA 934014215 ❑Complaint ❑Secondary Containment Testing Phone: (805)239-9301 Facility ID: FA0005116 Serial Number: DAMPFVOXD PROGRAMS INSPECTED: ❑O Hazmat I9HW Generator OUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator OUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): Name: Larry Knight Title: Lube Technician YES NO N/A BUSINESS PLAN ❑O ❑ ❑ BP01 Business plan is complete, current, available during in ecp tion (HSC 25503.6, Title 19 CCR 2729) x❑ ❑ ❑ 131*02 Inventory of hazardous materials Is complete (HSC 25504, Title 19 CCR 2729) ❑x ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑x ❑ ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑x ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66265.16 EMERGENCY RESPONSE PLAN © ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑x ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 273% 22 CCR 66265.31-.37, 66267.34 (d)(2), 40CFR 1265.31) ❑x ❑ ❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5140 CFR 112_11(c)(2)1 GENERAL EH VIOLATIONS ❑x ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2724600000 GPS Coordinates: Longtitude:-120.6701500000 INSPECTOR: KERRY BOYLE FACILITY REP: Larry Knight FACILITY NAME: LUBE-N- ADDR' 286 HIGUERA ST SAN LUIS OBISPO, CA HAZARDOUS WASTE GENERATOR 934014215 EPA ID CAL000387770 Total generated/month: Lbs or gals (average) NUMBER: Waste Oil: Solvents: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS ❑x ❑ p GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR§66262.12) If not, Call (800) 618-6942 to obtain your CAL EPA ID number HAZARDOUS WASTE DETERMINATION ❑x ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) Downknowledge ❑analysis ❑other ❑O ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years(Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ x❑ GT05 Hazardous wastes disposed of at an authorized location (HSC §25189.5, Title 22 CCR §66262.12) ❑p ❑ ❑ GT06 Facility utilizes a registered hazardous waste transporter, and hazardous wastes shipped with a manifest (Title 22 CCR §66262.20, HSC §25160/25163(a)) ❑milkrun ❑other ❑p ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23, 66262.40 (a)) STORAGE AND MANAGEMENT OF CONTAIN ERSITANKS 0 ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 090 days if waste generated per month is greater than or equal to 100 kg. (220 lbs.) 0180 days if waste generated per month is less than 100 kg (see note) 0270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000kg(13,200 Ibs) and no ❑x ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling(accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) p ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) p ❑ ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date,"HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑x ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize the release or reaction (Title 22 CCR §66262.34 (d)(2), 66265.171-.191,66265.177(c)) ❑x ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§ §66262.34 (d)(2), 66265.172) ❑p ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §§66262.34 (d)(2), 66265.173) ❑x ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§ §66262.34 (d)(2), 66265.174) ❑x ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §§66262.34 (d)(2), 66265.195) ❑p ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑x ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (Title 22 CCR§ 66266.13, HSC §25250.4) ❑x ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.13) ❑p ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) x❑ ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION:For facilities generating >12,000 kg./yr. of hazardous waste on ❑p ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (67100.7, 67100.8, HSC §25244.19, 25244.21) ❑p ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements:certification, amounts of wastes generated, process description, block diagrams, and implementationschedule of selected source reduction measures. (67100.7, 67100.8, HSC §25244.19) SUMM. X OF OBSERVATIONS/VIOi TIONS ❑x No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings andlor the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: LUBE-N-GO VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED INSPECTION COMMENTS: INSPECTED BY: KERRY BOYLE DATE: 02/13/2014 ADDRESS: 286 HIGUERA ST SAN LUIS OBISPO, CA 934014215 NAME OF FACILITY REP: Larry Kniqht SIGNATURE OF FACILITY REP: ldu&�VA)u-1 STATEMENT OF COMPLIANCE Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: County Luis of San Obispo a Environmental Health Services � (805) 781.5544 � P.O. Box 1489 C ] h �'� v San Sierra Way '�'��/ C��/1 . San Luis Obispo, CA 93406 FI a71L_Jl�'"1 Date: /q, FACILITY NAME: A'D P1-40 re Department (805) 781-7380 2160 Santa Barbara A,-n.. San Luis Obispo CA 93401 5240 CERTIFIED UNIFIED PROGRAM HAZARDOUS MATERIALS INSPECTION FORM 'r1 FORM PROGRAMS INSP INSPECTED REINSPECTION REQUIRED: AG— E ❑ EHS ❑ AG DEPT CITY FIRE [:E;:: Routine ❑Reins Complaint pe�tion , . ❑ Other`; Result Code: —70 _80 —90 Action Code: g0 Business Plan — —37 _33 —31 HW Generator ❑UST NO ❑ YES ❑ AGT IgSION TO INSPECT: Ins Business Plan ❑ HW Generator Inspections may involve obtainin ❑ UST ❑ AGT Inin com Hance with adopted codes. GRANTED gy g photographs, reviewing and copying records, and YES NO COS N/A Q Cl ❑ ❑ 0 ❑ ❑ ❑ 0 ❑ ❑CALARP ❑CALARP BUSINESS PLAN BPOl Business Ian is com p plete, current BP02 Inventory of hazardous materials is omailable during inspection BP03 Site layout/facili plete (HSC 25504 (HSC 25503.5, Title 19 CCR 2729) b maps are accurate Title 19 CCR 2729) (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TROT Facility has appropriate ppropriate training program (Title 19 CCR 2732 Training documentation is maintained on site for current personnel (Title 19 66265.16) 66265.16) CCR 2732 .e. „..,,.. r--7 ❑ ❑ ❑ EROI EMERGENCY RESPONSE PLAN v Contingency plan is complete, updated, and maintained on site (HSC 25504 7 CCR § 66265.53/54) Facility is operated and maintained to the 19 CCR 2731 & 22 hazardous materials/►vaste constituents to the environment. ,Maintains all required or prevent/minimize/mitigate tire, explosion, or release of equipment including an alarm and communications system (Title 19 .43) CCR 2731 & 22 CCR 662riate ABOVEGROUND P CCR 66265.31_ SPCC Plan is reviewed and RcO died b a registered STORAGE TANK ACT SPCC Plan is maintained on site or nearest Held office engineer within last 5 rs. (40 CFR 112.5(b)) Go to http://www•stopubiichcalth.org/environmentalhcait (HSC 25270) li%i� �•i! i:'G it ., . , a hlazardous_tnatcrials.htm. to nhf�;- -BP03, TRO1 and ER01 Longitude: de�_min decimal min FACILITY NAME. •r ADDRESS: r2! 14� HAZARDOUS WASTE GENERATOR EPA ID ,� J r Lbs or gals NUMBER: I Total generated/month: (average) Tiered Permit: CESW CESQI' []CA PBR Waste oil: ;�• Solvents: Treatment Equipment: Antifreeze: . ' Others: YES NO COS N/A VIOL. # EPA ID NO/PERMITS n' ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste �►� (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION �❑ ❑ ❑ ❑ GT03 Hazardous waste determination -,conducted (Title 22 CCR §66262.11) ❑own knowledge []analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) �"�❑ DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO, and permit or "thorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) Elmflkrun []other ❑ ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERSITANKS ❑ ❑ ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) n- n n n I Container"f-hazardous-waste-are-properly-labeled (includes appropriate date, -"HAZARDOUS WASTE," waste composition/physical state, hazardous properties, nameladdress of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release a❑ or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ;,� ❑ ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) �9 ❑ ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper )abeling, storage, etc) (HSC §25250.4) ❑ ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed �❑ rainproof container, labeled "drained used oil filters," and transferred for metal reclamatioip) (Title 22 CCR§ 66266.130) _ ❑ U U GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) 0 ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, ampunts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25144.19) =� County of San Luis Obispo C!ty or Environmental Health Services C cln Luis OBISPO r (805) 781-5544 19.f P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data HAZARDOUS MATERIALS INSPECTION FORM entry by: Date: �'/ /� Time: ''/1. `� �✓1 01 r FACILITY NAME: j AGENCY ❑ EHS ❑ AG DEPT ❑ CITY FIRE INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint ❑ Other Result Code: _70 _80 _90 Action Code: �32 �37 _33 �31 d (71 ADDRESS: /Y'"1 - i?/� PHONE. 1 ' v . PROGRAMS INSPECTED: ❑ Business Plan HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: P NO ❑ YES ❑ Business Plan fffcl H " e�e t� ❑ UST ❑ AGT ❑CALARP PERMISSION TO INSPECT: inspections may involve obtaining photographs, reviewing and copying records, and etermining compliance with adopted codes. GRANTED BY (NAMEITITLE): BUSINESS PLAN YES N COS N/A El ❑ ❑ BP01 Business plan is complete, current, &available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ X1 ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ +❑ ❑ ❑ BP03 Site layout1facility maps are accurate (HSC 2.5504, Title 19 CCR 2729) TRAINING PLAN ❑ V ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ✓❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ABOVEGROUND PETROLEUM STORAGE TANK ACT AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ rf I AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to htip:".slopublichealth.orglcnvirunmctualhcalth/harnrdoiu_matcrials.htm, to obtain forms to comply with BP01-BP03, TRO] and ERUI r11 MINN. 11T. AM, /1/L91411T/arNl�lr�Iir'I 122PRA141eevArrr ' rim,0"TIN • 1. d (' v-r - r fi61 '� n o e• FACILITY REP: 77171 A, ;,�► 1.4�d� FACILITY NAME. .� . bra J _ v,� " � � ADDRESS: y ,••- HAZARDOUS WASTE GENERATO� EPA ID J�; Lbs or gals NUMBER: j' � �M' / /�!l �� ��"��'�ota! generated/month: (average) Tiered Permit: CESW CES(2T CA PBR Waste oil: Solvents: V Treatment Equipment: Antifreeze: fe- Others: O COS VIOL. # EPA ID NO/PERMITS GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste �����""" -1Z�)17i 6 (Title 22CCR §66262,12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION GT03 Hazardous waste determination "conducted (Title 22 CCR §66262.11) Clown knowledge ❑analysis ❑other J2 ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO, and permit or authorization from DTSC (HSC §25189.5, •title 22 CCR §66262.12) ❑milkrun ❑other ❑ ❑ ❑ GT06 Ilazardous wastes are shipped with manifest (Title 22 CCR §66262.20) GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Titre 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) r 0 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (sea note) ❑ 270 days if waste generated per month Is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. GT09 Hazardous waste "satellite" collection Is managed properly (complete labeling/accumulation time/55-gal or I-qt limit) (Title 22 CCR §66262.34(c)) ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) . ontainers-orhar.ardo»s wasteweTrolierly lid) -tied (includes approprtAtc-dat(,,-"HAT.A PODS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) t4••^ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) r GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑. GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed !� properly within one year of date emptied (Title 22 CCR §66261.7 (1)) RECYCLABLE WASTE r GT18 Used oil is managed as hazardous waste until recycled (includes properlabeling, storage, etc) (HSC §25250.4) p` GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating>12,000 kgJyr. of hazardous waste on site. ❑ ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the Inspector within (5) days. (HSC §25244.19, 25244.21) GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and Implementation schedule of selected source reduction measures, (HSC §25244.19) � Avli�, /�� Environmental Health Services (805) 781-5544 P.O. Box 1489 • 2156 Sierra Way Date: Time: City of san leis osispo San Luis Obispo, CA 93406 Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM EFW data entry by:4—f FACILITY NAME: AGENCY ❑ EHS rr ❑ CITY FIRE %\� _ U, ^ INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint Other 1-14 ADDRESS: L! r PHONE: PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator ❑ UST ❑ T ❑CALARP REINSPECTION REQUIRED: ❑ NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A ❑ ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BPO2 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ ❑ BPO3 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ ❑ COMMENTS ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) Go to http://www.slopublichealth.org/environmentalhealth/hazardous_materials.htm, to obtain forms to comply with BPOI -131`03, TR01 and ER01 0 17 wfiffi��;n GPS Coordinates: Latitude: deg min decimal min Longitude: deg. —nun decimal min INSPECTOR: FACILITY REP: C:\DOCUME-1\Repro\LOCALS-•1\Temp\c.lotus. notes. data\1 Inspection Form Page 1.doc 24-Jan-06 FACILITY NAME: ADDRESS: EPA ID NUMBER: Tiered Permit: Treatment Equipment: HAZARDOUS WASTE GENERATOR Lbs or gals Total generated/month: (average) [CESW ❑CESQT ❑CA ❑PBR Waste oil: Solvents: Antifreeze: Others: �� YES NO N/A VIOL. # EPA ID NO/PERMITS ❑' ❑ ❑ GTOI Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) N Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis []other ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GTOS Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §251895, Title 22 CCR §66262.12) ❑milkrun ❑other ; ❑ ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42166262.23) STORAGE AND MANAGEMENT OF CONTAINERSMANKS ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days N waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ❑ GTO9 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) F ❑❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GTH Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) /❑ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) . ❑' ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) a. ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) r_. ❑ ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Titre 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly " within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 ❑ ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ,jE] ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUME—i\Repro\LOCALS-1\Temp\c.lotus.notes.data\2 Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 County of San Luis Obispo My Lit - Environmental= ti Health Services c' n W I ` owpo � �'� •` �'�' (805 781-5544 a7A1 , a7 rl"x") L whad P.O. Box1489 "'•-�f� 2156 Sierraa Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data HAZARDOUS MATERIALS INSPECTION FORM entry by. Date: Time: FACILITY NAME:M&ff AGENCY ❑ EHS ❑ AG DEPT ❑ CITY FIRE I SPECTION TYPE Routine ❑ Reinspection Complaint ❑ Other Result Code: _70 _80 _90 Action Code: _32 _37 _33 _31 ADJDRESS: d� i PHONE: ' PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator ❑ HW Generator ❑ UST ❑ UST ❑ AGT ❑ AGT ❑CALARP ❑CALARP REINSPECTION REQUIRED: NO ❑ YES ❑ Business Plan PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY NAME/TITLE ,- BUSINESS PLAN YES N COS N/A ❑ ❑ BPO1 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) Fj El ❑ ❑ COMMENTS r Go to EMERGENCY RESPONSE PLAN ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate tire, 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) GPS Coordinates: Latitude: INSPECTOR: 'Q + ABOVEGROUND PETROLEUM STORAGE TANK ACT AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) iclicalih.org/environmentallicalth/hay.ardt)tts mawrials.hdn. to obtain fionns� to comply with BPO1-BP03, TRO] and ERO1 Longitude:- M47- 4 11 MOM u WV- imm !41 min decimal min , decimal I W FACILITY NAME: i lr ADDRESS: HAZARDOUS WASTE GENERATOR )R EPA ID NUMBER: Zr v / Tiered Permit: OCESW CESQT CA ❑PBR Treatment Equipment: YES, NO COS N/A VIOL. # o ❑ F cTo1 " ❑ ❑ ❑ GT03 `❑-- ❑ ❑ ❑ GT04 'a' ❑ ❑ ❑ GT05 i ] r ❑ ❑ ❑ GT06 �❑- ❑ ❑ ❑ GT07 ❑ ❑ ❑ GT08 ❑ ❑ ❑ 0" GT09 0' ❑ ❑ ❑ GT10 ❑ ❑ ❑ GTH ❑ Ll GTl2 ❑ ❑ ❑ GT13 ❑ ❑ ❑ GTl4 ❑ ❑ ❑ GT15 ❑ ❑ ❑ GTl6 ❑ ❑ ❑ GT17 �j ❑ ❑ ❑ GT18 jo- ❑ ❑ ❑ GT19 ❑ ❑ ❑ GT20 ❑ ❑ ❑ ❑ GT21 ❑ ❑ ❑ ❑ GT22 ❑ ❑ �,❑ ❑ GT23 Lbs or gals Total generated/month: (average) Waste oil: Solvents: Antifreeze: _ Others: j -!774 A EPA ID NO/PERMITS Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION Hazardous waste determination conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis Mother Hazardous waste analysis/test 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 authorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) 9milkrun ❑other Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) Pe90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) t `nntainrrs/tank�rnntnirrfn fraz rrrf hsmtth*tfii o or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 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 (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) 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 1 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) Environmental Health Services City 4 r .. '. (805) 781-5544 S � �1 �� P.O. Box 1489 a7AI aIS a 2156 Sierra Way San Luis Obispo, CA 93406 Fire Department (805) 781-7380 —� 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM EFW data Date. �J/i� entry by: Time: '? Min , 4 Vir, FACILITY NAME: AGENCY ❑ EHS CITY FIRE v INSPECTION IE ❑ ❑ TYPE Routine Reinspection Complal t Other '��� ADDRESS: �% / PHONE: PROGRAMS INSPECTED: Busi ess Plan 011 W Generator I ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO /YES ❑ Business Plan /❑ HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) [:J O BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN 0 0 TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 .CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ n ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materialstwaste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/hazardous_materials.htm, to obtain forms to comply with BP01-BP03, TR01 and ER01 GPS INSPECTOR: FACILITY REV- 1 \Temp\c. lotus. notes.dat6�1 -_I nspec I i o n Form Page 1.doc 24-Jan-06 %f% l FACILITY NAME: t�_/J)Z% � 144" ADDRESS: / T� HAZARDOUS WASTE GENERATOR Lbs or gals EPA ID NUMBER: L 01,7 PUqT Total generated/ onth: (average) Tlered Permit: CESW CESQT CA ❑1'fIR Waste oil: Solvents: V Treatment — Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) [Down knowledge ❑analysis ❑other Fj GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GTOS Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DT?SC (HSC §25;895, Title 22 CCR §66262.12) Qmilkrun ('(1t1�[1 'i �Y��(M,(i , ❑other ❑ GTO6 Hazardous wastes are shipped with manifest (Title 22 CCR 466262. GTO7 Manifests and/or receipts are properly completed/retained by generator for 3 years (Titre 22 CCR §66263.42166262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. 0�,� GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) GT10 Ignitable or reactive wastes are located 15 in (50 feet) from facility's property line (Title 22 CCR §66265.176) © n GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of 22 CCR §66262.31, 66262.34) Uel i/ =.Or 2— ❑❑GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) E ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ►� GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ®� ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266:130)— ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) GT21 Solventstother recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §662663) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) G723 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) l /� : C:\DOCUME—i\Repro\LOCALS-1\Temp\c.lotus.notes.data\2 Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 Date: Time: FACILITY NAME: �rl J ADDRESS:'/ PHONE: PROGRAMS INSPECTED: REINSPECTION REQUIRED: 41NO ❑ YES Environmental Health Services (805) 781-55" 4 - P.O. Box 1489 2156 Sierra Way city q san Luis osispo �. San Luis Obispo, CA 93406 Fire Department (805) 781-7380 - - 1 2 80 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) r HAZARDOUS MATERIALS INSPECTION FORM EFW data` entry by: ��) AGENCY ❑ EHS CITY FIRE Plan i HW Generator I ❑ INSPECTION TYPE [j Routine ❑ Reinspection ❑ Complalr)t... _ , Other AGT I ❑CALARP ❑ Business Plan I ❑ HW Generator I ❑ UST I ❑ AGT I ❑CALARP BUSINESS PLAN YES NO N/A ❑ ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ ❑ BP03 Site layouttfacility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EM-ERGENC Y-RR.SPONSE-PLA-N - ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materialstwaste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopubiichealth.org/environmentalhealMazardous_materials.htm, to obtain forms to comply with BPOI-BPO3, TR01 and ERO1 GPS Coordinates: Latitude: deg min decimal min I C:\DOCUM11E-1\Repro`LOCALS--1\Temp\c.lotus. notes data\1_In(speol J ion Form Page 1.doc 24-Jan-06 FACILITY NAME ADDRESS: HAZARDOUS WASTE GENERATOR Lbs or gals EPA ID NUMBER: _ Total generated/month: (average) Tiered Permit: ❑CESW ❑CESQT ❑CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ED NO/PERMITS F17,1' ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ GTO5 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) ❑milkrun ❑other 7 ❑ GTO6 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GTO7 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) L E 190 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. • ❑ ❑ 0 GTO9 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR —I §66265.176) n I n GTII Containers of hazardous waste are properly labeled (includes appropriate bate, "HA'LARI)OUS WASTE," waste composition/physical state, hazardous properties, nameladdress of generator) (Title 22 CCR §66262.31, 66262.34) ❑' ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑'f ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑`. ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) .. ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers -are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , _ ❑'` ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ ❑ 0' GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.199 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUME—i\Repro\LOCALS-1\Temp\c.lotus.notes.data\2 Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 r Environmental Health Services city q P.O. Box 1489 JA` Us owpo "`_ •J 2156 Sierra Way San Luis Obispo, CA 93406 Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) Date: HAZARDOUS MATERIALS INSPECTION FORM EFW data ��� 1� entry by: Time: FACILITY NAME: AGENCY INSPECTION TYPE ❑ EHSE Routine ADDRE S• / CITY FIRE Reinspection ❑ Complaint PHONE:r `, El Other PROGRAMS INSPECTED: 9Business Plan HW Generator ❑ UST ❑ ❑CALARP REINSPECTION REQUIRED: NO ❑ YES ❑ Business Plan ,( HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A ❑ 2 ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) �' ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ©' ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ n EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) �- -�/ Eb ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.43) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ie AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/hazardous_materials.htm. to obtain forms to comply with BPOI-BPO3, TRO1 and ER01 iI 'I'll Lill GPS Coordinates: Latitude: deg min decimal min Longitude: —deg—min decimal min INSPECTOR: FACILITY REP: C:\DOCUME--1\Repro\LOCALS-1\Temp\c.Iotus.notes.data\1_Inspection Form Page 1.doc 24-Jan-06 II FACILITY NAME: f V g, � tit1A ADDRESS: HAZARDOUS WASTE GENERATOR i ff Lbs or gals �" t=' 'J�0 G� `� EPA ID NUMBER: 1 9 ,I Total generated/month: (average) Tiered Permit: ❑CESW ❑CESQT ❑CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: ✓ Others: YES NO N/A VIOL. # EPA ID NO/PERMITS ❑ ❑ ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste,(I Itie 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑' ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other ' ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑, ' ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §25189.5, Title;2 CCR §6¢262.12), [-]ndikrun 1 4� a ❑ ❑ ,�iij"other �. GT06 Hazardous wastes are shipped with manifest ( it a 22 CCR §66262.20)t ' © ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) V 90 days if waste generated per month is greater�than or equal to 100 kg (220 lbs.) 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no .. acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ®� GT09 Hazardous waste "satellite" collection is managed properly (complete labelinglaccumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) �,•' ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) -" ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or - reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) !. , ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑- ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑'� ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , ®', ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ��� ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) �' ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 66266.130) ❑ ❑ 2'- GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ l ' ,- GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) , SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ 0 GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.199 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) ±.` U . C:\DOCUME-1\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_,Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 Environmental Health S (805) 781-5544 ervices P.O. Box 1489 2156 Sierra Way San 1,145 Obispo, CA 93406 Date: A `1 Time: , . Q Q TR01 Q Q TR02 citYOf U""Sowsm Fire 0 apartment2160 Santa Barbara q Avenue CERTIFIED 7sao UNIFIED PRD San Luis Obispo po CA 93401-5240 MATERIALS INSPECNCY TION FORM nl BUSINESS PLAN Business � plan is complete, current, .4: available clurin Inventory of hazardous in, is corn Site la o 9 inspection (HSC 25503. y layout/facility maps are accurate (HSC to (HSC Title 19 Title 19 CCR 5+ Title 19 CCR 27 25504, Title 19 CCR 2729) 2729) TRAINING PLAN Facility has appropriate training Training documentation is mAi „Program (Title 19 CCR 27i� 6626s ,a, o On site of current 6265.16) EMERGE perS°nnel ('title 19 CCR 2732 8,22 CC ERo1 1VCY RESPONSE PLAN R CCR plan is complete # 66265.53/S4) , updated Q ER02 Facilityis updated, and maintained operated and on site (HSC 255 hazardous maintained to prevent/minimiz+ Title 19 CCR 2731 & 22 equipment including Haste co e ui nstituents tot Jtuitigate fire 43) alarm and commun, ationt snment. , explosion or release of Maintains all required or appropriate ysten, (Title 19 CCR 2731 ABOVEGROUND PET `� 22 CCR 66265.31. ATOl SPCC Plan is reviewed and OLEUA4 STO i 0 AT02 SPCC Plan is maintained on sitetrcd b RAGE ngin e ACT a Y a registered or nearest field otliCe, (HSC 2S �,0)last 5,vrs. (40 CFR 112.5(b)) Go to http:/hvww.slopublichcaith.o COMMENTS 11 /environmentalheahh/lio?ardous_ n l i , matcrials.htm. to obtain for ,TRUt and ER01 7 U�/ i'.,. /l /I�r ��itiP/..►,,_ ��.. i �,�J:�" ice. •1 ,. 7 i i 4 , oordinates: Latitude: ode g GPS C Amin —decimal ' min longitude: CTOR= �de�,nin�deci INSPE FACILITY REp mill min C: \DOCUME-11heProlLOCALS_l liemplc.lotus.notes.da# a11_ Inspection Form pan , � F,ICIIIIY NAME:_ ,�,y:i I 1 6 ���� ADDRESS: c�,�b i �.GN,i 1. HAZARDOUS WASTE GENERATOR EPA IDNUMBER: IA ❑���� 1 / Total generated/month: TJereArmit: CESW CESQT CA PBR tmrol ❑ Waste oil: ; , Solvents: Tres _ E�luiPmrot �% liti !,�,QLi Antifreeze: _trtW Others: 0� ©- a ❑ ©� a ❑ p 0 ❑ 1 0` EJ 0 Lbs or gals (average) VIOL. # EPA ID NO/PERMITS GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or a thorization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) [fmilkrun ❑other GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if waste generated per month is greater than or equal to 100 kg (2201bs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,2001bs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is field on site for over 90 days. ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ GT10 Ignitable or reactive wastes are located 15 in (50 feet) from facility's property line (Title 22 CCR §66265.176) Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/add ress of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or ❑� ❑ reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) GT13 Containers/tanksAiners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑❑✓ ❑ GT14 Containers storin hEl d ❑ ❑ ©' ❑ 12/ ❑ g azar ous wastes are closed/sealed (Title 22 CCR §66265.173) GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC ❑ §25250.4) GT19 Used oil filters for recycling are managed properly (drained of free flowing u....:a W,,red in closed x ed "drained used oil filters," and transferred for metal reclamation) (Title 222 CCR§ 66266.130) ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ® GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUME-1\Repro\LOCALS-1\Temp\c.lotus.notes.data\2_Hazardous Waste Generator rtr,r 7_RAnY_nc -7 RA-- — Environmental Health Services (805)781-5544 r P.O. Box 1489 2156 Sierra Way San Luis Obispo, CA 93406 Sdtl LWS OBISpO Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) Date: HAZARDOUS MATERIALS INSPECTION FORM ��`'� Time: 11'1 9 FACILITY NAME: FAa+n I _m N? 1 /.l i f AGENCY ADDRESS: PHONE: ❑ EHS ❑ AG DEPT A CITY FIRE EFW data entry by: INSPECTION TYPE Routine Reinspection ❑ Complaint ❑ Other PROGRAMS INSPECTED:I A Business Plan IA, HW Generator I ❑ UST I AGT I ❑CALARP REINSPECTION REQUIRED: I ❑ NO ❑ YES I ❑ Business Plan I ❑ HW Generator I ❑ UST I ❑ AGT I ❑CALARP 'ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and etermining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YE NO N/A ❑ U BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ 1] BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN �� ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) U TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265_ 161 EMERGENCY RESPONSE PLAN ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) ❑ Eld AT01 ABOVEGROUND PETROLEUM STORAGE TANK ACT SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS I411'/11/4 ` % r; GPS Coordinates: Latitude: deg _min decimal min l.ongitude:deg 1indecimal min INSPECTOR: h t\ �j 0A&-,, lt Q FACILITY REP: = > C:\DOCIUME-1bAepro\LOCALS-1\Temp\c.lotus.notes.data\1__Inspection Form Page 1.doc 20-Jul-04 r I FACILITY NAME:C�A4 L ,tf A? _ _ ADDRESS: a i ' L-A ' i HAZARDOUS WASTE GENERATOR Lbs or EPA ID NUMBER: O f L e ` Total generated/month: (average) Tiered Permit: ❑CESW ❑CESQT CA ❑PBR Waste oil: _ Solvents: Treatment Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS �r ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GT03 Ka.'..'ardous ardous waste determination conducted (Title 22 CCR §66262.11) wn knowledge [:]analysis❑other GT04 waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) D^ DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from UTSC (HSC §25189.5,'Iitle 7 t,2 CCR §¢6262.12 10milkrun ]other _ Ll' ❑ ❑ GT06 azardous wastes are shipped with manifest (Title 22 CCR §6624MOi y ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS 0 ❑ GT08 kla?;ardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GTI I Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 Daily inspection of all lank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC fKZ' ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed Aiiilii of)f cisltiaiiier,jal3tied dralneil Usetl olt inter , aiiiltmiisserrei3iornieinireciamation)(iii]eLz CCR§ 66266.130) El ❑ GT20 Spent Iead-acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ u GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days.. (HSC §25244.19, 25244.21) ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) Y A:1UST, AGT, Hazardous waste generator inspection. forms.doc 3-Nov-03 Environmental Health Services / O� (805)781-5544 c'li y • P.O. Box 1489 !;An n Us OBi C po 2156 Sierra Way *San Luis Obispo, CA 93406 [�1 a7 Department of Agriculture/Measurement Standards (805) 781-5910 Fire Department (805) 781-7380 2156 Sierra Way Suite A •San Luis Obispo, CA 93401 2160 Santa Barbara Avenue Date: 0; Time: Z(%' FACILITY NAME: j San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM t,/e- n - -fv,7 F-, ADDRESS: 286 /j,•g , e,/-4 PHONE: f'OS' - -!!;w- Z y 7(" PROGRAMS INSPECTED: AGENCY ❑ EHS ❑ AG DEPT (� CITY FIRE Business Plan I f EFW data entry by: INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint ❑ Other HW Generator I ❑ UST I ❑ )(GT I V❑CALARP REINSPECTION REQUIRED: I ❑ NO ❑ YES I ❑ Business Plan ❑ HW Generator I ❑ UST I ❑ AGT I— ❑CALARP 'ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and letermining compliance with adopted codes. GRANTED BY (NAME/TITLE): YES NO 11 N/A LYJ ❑ ❑ ❑ ❑ COMMENTS BUSINESS PLAN BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TRO1 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR EMERGENCY RESPONSE PLAN ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) AT01 AT02 ABOVEGROUND PETROLEUM STORAGE TANK ACT SPCC Plan is prepared and certified by a registered engineer within last 3 yrs. (HSC 25270) SP,CC Plan is maintained on site or nearest field office. (HSC 25270) GPS Coordinates: Latitude: _deg _min decimal min Longitude:_deg_mindecimal min INSPECTOR: J-'., . 1 � tIAW I 1,V7'A V FACILITY REP: 0:\(ffomryion\D6CUMENT\JeffpIFORMS11r)spection formsllnspectjon Form Page 1.doc 21-Apr-04 Environmental fie. ,ervices uoe (805) 781-5544 P.O. Box 1489 2156 Sierra Way •San Luis Obispo, CA 93406 Department of Aericulture/Measurement Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 -'ity of Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Lnis Ohisnn CA 93401-5240 San Luis Obi o w!.�ia..t ldt i•l4CIli1�lLI �. �-1�a�i Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: � /r�- /Q � EFW data Time: G O entry by: FACILITY ID NO: AGENCY INSPE ION TYPE FACILITY NAME: j, t -7' ❑ DEH Wioutine �-f ❑ AG DEPT ❑ Reinspection A ADDRESS: ITY FIRE Complaint VCCITY❑ UTILITIES ❑ Other PHONE: PROGRAMS INSPECTED: ❑ Business Plan 5F24 Generator ❑ Cal ARP ❑ UST ❑ AGT ❑ Tiered Permitting REINSPEC ON REQUIRED: Tn r, vz+o ❑ Business Plan ❑ HW Generator ❑ Cal ARP ❑ UST ❑ AGT ❑ Tiered Permitting ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YE NO N/A ❑ ❑ ❑ ❑ ❑ ❑ BP01 BP02 BP03 Business plan is complete, current, & available during inspection (HSC §25503.5, Title 19 CCR §2729) Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) Site layouttfacility maps are accurate (HSC §25504, Title 19 CCR§ 2729) ❑ ❑ TROT TRAINING PLAN Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) I I n TR02 Training documentation is maintained on site for current personnel (Title 19 CCR §2732 & 22 CCR §66265.16) ❑ ❑ ER01 EMERGENCY RESPONSE PLAN Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR ❑ ❑ ER02 §2731 & 22 CCR §66265.53/54) Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- .43) COMMENTS: GPS Coordinates: Latitude: _deg min decimal min Longitude:degmindecimal min Inspector: Facility Representative: A:\CUPA inspection forms 2.doc 20-Mar-03 FAC:; ITY NAME: DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA H) NUMBER: r L OO OO oZ �{ a Lbs o al !�� _� 8 7 Total generated/in alit yr' (average) Tiered Permit: _ ❑(I SW ❑CESQT ❑CA ❑PBR Waste oil: y,_ 5 Solvents: Treatment Equipment: _ Antifreeze: 0 0L Others: YES _ NO N/A ❑ VIOL. # EPA ID NO/PERMITS GTO1 Generator has QX❑ an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GT03 Haza ous waste determination conducted (Title 22 CCR §66262.11) ❑ ❑ vn knowledge ❑analysis ❑other GT04 Tlazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GT05 IlazardOtis %tastes «cre transported and/or disposed to a facility with an EPA ID NO. and permit or autl rization from U1:SC (HSC §25189.5, Title 22 CCR §66262.12) ❑ ❑ nilkrun ❑other GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ ous wastes are accumulated on site as folkms (Title 22 CCR §66262.34) GT08 =ays if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no ❑ ❑ acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. GT09 Hazardous "satellite" waste collection is managed properly (complete labelinglaccumulation time/55-gal ❑ or 1-qt limit) (Title 22 CCR §66262.34(c)) GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GT 11 Containers of hazardous waste arc properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or ❑ reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted ❑ ❑ (Title 22 CCR§66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ 52" GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC d ❑ ❑ §25250.4) GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed —rninprnnf-cn=tnPr t-aheted **dralnell used oil filters,"andtransferred or metal reclamation) (Tille 22 ❑ CCR§ 66266.130) GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is ❑ able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) A:\CUPA inspection forms.doc 19-Sep 1 FAC.'LITY NAME: ADDRESS: SUMMARY OF OBSERVATIONSNIOLATIONS o violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. �N SLO ('11PA greatly appreciates your efforts to compl.y with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. VIOLATIONS NUMBER MINOR MAJOR COMMENTS: CORRECTIVE ACTION REQUIRED Inspected By: Facility Rep Name: '�` ri 1 Date: Signature: Sign the certification below and mail this form to the CUPA inspector after all corrective actions have beenlaa*leted. Retain a copy for your Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: A:\CUPA inspection forms.doc 19-5ep-02 Environmental Heal ,,ervices "ity of San Luis Obi �r (805 781-5544 P.O )Box 1489 Fire Department (805) 781-7380 I III I IIIII il� %r� 2156 Sierra Way •San Luis Obispo, CA 93406 2160 Santa Barbara Avenue i Department of Aariculture/Measurement San Luis Ohisno CA 93401-5240 Standards (805) 781-5910 Utilities Department • (805) 781-7215 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: 50 l o 3 Time: G70/ 30 FACILITY ID NO: FACILITY NAME: ADDRESS: " .96 A AGENCY .�� ❑ DEH ❑ AG DEPT ❑ CITY FIRE CITY UTILITIES EFW data entry by: INSPECTION TYPE Routine ❑ Reinspection ❑ Complaint ❑ Other PHONE: PROGRAMS INSPECTED: Business Plan HW Generator ❑ Cal ARP ❑ UST ❑ AGT ❑ Tiered Permitting REINSPECTION UI D: El Business Plan ❑ HW Generator ❑ Cal ARP ❑ UST [-IAGT❑ Tiered Permitting NO ES 'ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining ompliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO N/A ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC §25503.5, Title 19 CCR §2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) 22 CCR §66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR §2731 & 22 CCR §66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- .43) COMMENTS: GPS Coordinates: Latitude: _deg _min decimal min Longitude:_deg_mindecimal min Inspector: Facility Representative: A:\CUPA inspection forms 2.doc 20-Mar-03 FACILITY NAME: - DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR ID NUMBER: _ eLbs or a oco og (average)EPA :;cnertun Tiered Permit: ❑CESW ❑CESQT ❑C.A ❑PBR 3 Solvents: Treatment Equipment: G� Antifreeze: �� Others: nn — J 0 YES N/A VIOL. # EPA ID NO/PERMITS GTOI Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. ❑ GT03 HAZARDOUS WASTE DETERMINATION I lazardous ❑ waste determination conducted (Title 22 CCR §66262.11) n knowledge ❑analysis ❑other Ki'('11:rdous ❑ ❑ GT04 waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or a �orization from DTSC (HSC §25189.5. Title 22 CCR §66262.12) ❑ ❑ GT06 milkrun ❑other Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ GT08 I1. • lous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 911 clays if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 to (50 feet) from facility's property line (Title 22 CCR §66265.176) GTll Containers of hazardous waste are properly labeled (Includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22 CCR §66262.31, 66262.34) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) '© GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed ralnproor container, labeled "drainedused oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ❑ ❑ GT20 Spent lead -acid batteries are being properly stored and transferred offsite under manifest or bill of lading for recycling, reuse, or reclamation (Title 22 CCR §66266.81) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §66266.3) SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site. ❑ ❑ GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) El El GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) A:\CUPA inspection forms.doc 19-Sep-02 FACILITY NAME: ADDRESS: SUMMARY OF OBSERVATIONSNIOLATIONS No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the (11PA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. VIOLATIONS MINOR MAJOR rN^'UMBER COMMENTS: " i CORRECTIVE ACTION REQUIRED Inspected By: Facility Rep Name: Date: 0 Signature:�- Sign the certification below and mail this form to the CUPA inspector after all corrective actions have been completed. Retain a copy for vour records. Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: AACUPA inspection forms.doc 19-5ep-02 P. Division of Environn +al Health (805)781-5544 r P.O. Box 1489 2156 Sierra Way -San Luis Obispo, CA 93406 Department of AuriculturelMeasurement Standards (805) 781-5910 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 Date: `/ Time: C>r FACILITY ID NO: FACILITY NAME: ADDRESS: J .Vi PHONE: Fire Depart (805) 781-7380 2160 Santa i_ Gara Avenue San Luis nhisnn CA 91401-5240 Utilities Department • (805) 781-7215 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM J AGENCY ❑ DEH ❑ AG DEPT CITY FIRE ❑ CITY UTILITIES EFW data entry by: INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ ►tnplaint f Other PROGRAMS INSPECTED ❑ Business Plan I ❑ HW Generator I LZ UST I ❑ AGT I ❑ Tiered Permitting REINSPECTION REQUIRED: ❑ NO MES ❑ Business Plan ❑ HW Generator I Qf UST ❑ AGT ❑ Tiered Permitting ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO N/A usiness plan is compiele, current, 29 ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TRAINING PLAN ❑ ❑ ❑ TROI Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR §2732 & 22 CCR §66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR §2731 & 22 CCR §66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR §2731 & 22 CCR §66265.31- IA. i M13 fP�.p.c:� :wv✓Ie �0 411e 1101� ,wl'A� AII'Ainspeetitr orrns.cioc 'i97-O? 'Opot_ Division of Envirom tal Health 'ity of San Luis Obispo (805) 781-5544 P.O. Box 1489 Zaire Department (805) 781-7380 II"Illl f I Ilill�l Iq 2156 Sierra Way •San Luis Obispo, CA 93406 2160 Santa Barbara Avenue Department of Aericulture/Measurement San Luis Obispo CA 93401-5240 Standards (805) 781-5910 ��. 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 Utilities Department • (805) 781-7215 879 Morro Street •San Luis Obispo, CA 9340I CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) P/ HAZARDOUS MATERIALS INSPECTION FORM Date: Time: FACILITY ID NO: AGENCY FACILITY NAME: El DEH ❑ AG DEPT ADDRESS: CITY FIRE CITY UTILITIES EFW data entry by: INSFACTION TYPE Routine Reinspection ❑ Corn0al'n��,^ ❑ Other PHONE: PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator UST ❑ AGT ❑ Tiered P mitting REINSPECTION REQUIRED: KNO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT L] Tiered Permitting MISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining liance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO N/ a jyj/ BPOI Business plan is complete, current, axe avauapte during inspection inns za3v.1.�, BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) / EMERGENCY RESPONSE PLAN ymU( EROl Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ER02 Facility is operated and maintained to prevent/minimize/mitigate fire-, explosion, or release of hazardous waste to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- 44 COMMENTS:01%A` / INSPECTOR: FACILTI'Y 00CUMENT\Jeffp\F0RMS\Inspection forms\CUPA inspection for mos. doc 10-Sep-01 Few a UZ flil�) Division of Environmental Health IIIIIII II III II� (805) 781-5544 P.O. Box 1489 2156 Sierra WayXSan Luis Obispo, CA 93406 City of San Luis Obispo Department of Agriculture/Measurement Utilities Department• (805) 781 7215 Standards (805) 781-5910 955 Morro Street• San Luis Obispo, CA 93401 2156 Sierra Way Suite AXSan Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) Date: /a �7�1 GO Start Time: HAZARDOUS MATERIALS INSPECTION FORM 0�V l Record ID P/E Service Result Action Activity Violation Code INSPECTOR NAME: FACILITY ID NO: FACILITY NAME: E&WO �bAe� AJ IWNe ADDRESS: 11 AGENCY 11DEII CITY AG DEPT INSPECTION TYPE Routine FIReinspection Complaint / -71'V1fi miil► f� vrf f" PHONE: ✓ PROGRAMS INSPECTED: E] Business Plan Ej HW Generator P<ST ❑ AGT REINSPECTION REQUIRED: NO YES ❑ Business Plan HW Generator UST E3AGT PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO N/A ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) BP03 Site layouttfacility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) n n n ER02 Facility is operated and maintained to prevent/minimize/mitigate-fire. explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) g-/o 1\3000B\VOL1IHOME\JPOE I-TO12M5\OFFICE9711nspection forms\CUPA inspection forms.doc 4-Aug-00 . Division of Environmental Health (805) 781-5544 �.r P.O. Box 1489 2156 Sierra WayXSan Luis Obispo, CA 93406 Department of Agriculture/Measurement Standards (805) 781-5910 2156 Sierra Way Suite AXSan Luis Obispo, CA 93401 City of San Luis ObispoI, Utilities Department• (805) 781-7215 955 Morro Street* San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: /%� / � / Qi . Start Time: Record ID P/E Service Result Action Activity Violation Code INSPECTOR NAME: FACILITY ID NO: FACILITY NAME: ADDRESS: d� AGENCY Ej DE 1 ITV AG DEPT INSPECTION TYPE ❑ Routine EIReinspection Complaint PHONE: `"6(9 tk PROGRAMS INSPECTED: V - Business Plan HW Generator [8 UST AGT REINSPECTION REQUIRED: ❑ NO gMS Business Plan HW Generator 2<S"T ❑ AGT PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO N/A BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BPO2 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) L+1 TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ER01 EMERGENCY RESPONSE PLAN Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 ER02 CCR § 66265.53/54) Facility is and maintained to fire. or operated prevent/minumuzelmetipate explosoon. release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) w�e & 0 �) ial-�6rp \\3000B\VOI.1\HOME\JPOEL\FORMS\OFt ICE97Unspection forms\CUPA inspection forms.doc 4-Aug-00 UNDERGROUND STORAGE TANK (UST) MONITORING CODES 1. No monitoring Permit No. 2. Standard Inventory Control # PERMITTED TANKS 0 3. Modified Inventory Control # UNPERMITTED TANKS P 4. Statistical Inventory Rec. A 5. Automatic tank gauge (list type) Owner & operator as indicated on permit: ErYES [—]NO6. Continuous monitoring in tank annularNO space/secondary containment If no, new owner name &address 7. Visual monitoring 8. Manual monitoring annular space new owner name &address 9. Temporarily abandoned under permit 10. Another method YES NO N/A VIOL. # PERMITTING UT001 Site has a permit to operate (HSC 25284) Fa ❑ ❑ UT002 Permit is kept on the premises UT003 Change of ownership is reported to the permitting agency within 30 days (HSC 25284(c)) ❑ ❑ UT004 All UST(s) are properly permitted to operate or properly closed (HSC 25298) MONITORING iY❑ UT005 UST(s) monitored using method specified on the permit or approved by the permitting agency (HSC 25293) (Write monitoring code(s) observed , n UT006 Monitoring records are provided to regulatory agency upon request IlrrrJJj/ UT007 Automatic line leak detection system is installed & kept operational for all pressurized piping (HSC 25292) ❑ ❑ UT008 An annual report is submitted to regulatory agency UT009 Tank tightness test and/or piping test is being performed as required ('Title 23 CCR) ❑ UT010 Written Monitoring Plan submitted for electronically monitored tank system (Title 23 CCR 2632/34) ❑ ❑ UT011 Facility maintains evidence of Financial Responsibility for corrective action and for compensating third parties for bodily injury/property damage caused by a release from the tank system (HSC 25292) ABOVEGROUND -PETROLEUM STORAGE TANK ET No. of Tanks: 4AProducts Stored: ❑ Diesel AGPaoie ❑Crude oil Total Volume: gals �thers Note: SPCC required for tanks with total storage capacity of z 10,000 gallons; for farms, nurseries, construction sites individual storage capacity of >20,000 gal or total storage capacity of>100,000 gallons. YES NO N/A VIOL. # ❑ ❑ AT001 ❑ ❑ AT002 SPCC Plan is prepared and certified by a registered engineer within last 3 yrs. SPCC Plan is maintained on site or nearest field office. FACILITY NAME: ,j f ,%1�j /� �e DATE: waINSPECTOR:`Aepl* SUMMARY OR OBSERVATIONS/VIOLATIONS 5►'' "" 0l No violations of underground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requirement. weYe discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or proposed action, please inform us in writing. All minor violations must be corrected within 30 days or as specified. CUPA must be informed in writing certifying that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective actions. The issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the violations noted or that have not been corrected within the time specified. VIOLATIONS NUMBER MINOR MAJOR CORRECIVE ACTION REQUIRED BP TR - ER - GT UT AT l >n�s�or�rsri����><iuL►>sai �rir. �,,# V - v V \ Inspected By:eIAMI Facility Rep: Date: Title: ©. _ w �-v� 7/c0 1l3000BIVOL1iHOME1JPOEL\FORMSIOFFICE071Inspection forrns\CUPA inspection forms.doc 4-Aug-00 6, IS OBISPO HEALTH DEPARTMENT Routine Inspection If Environmental Health Reinspection No San Luis Obispo, CA 93406 Complaint Investigation ;ROUND STORAGE TANK/WASTE GENERATOR PORT/NOTICE OF VIOLATION 1 Z--- Date- --` O — Contact Perso o I Title/Position: �v- W µ �l H t` t` W 0 00w `T H H >i � 4*� Ei M M WWa 4 � U 4 Ei Ei x a UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div. 20, Chap. 6.7) ATL. # _ GENERAL Viol 20. Permit to operate Com I Viol 21. Inventory reconciliation 22. Precision tank test 23. Leak detectors _ TANK CLOSURE 24. Permit approved 25. Temporary closure 26. Removal/in place abandonment a) Tanks purged b Tanks rinsed c Soil samples taken _ WASTE GENERATORS COMP #_ 27. EPA identification number 28. Variances and/or exemptions .. 29. Manifests 30. Waste oil receipt 31. Training program/records 32. Contingency Ian 33. Material stored in proper containers & labeled - 34. Incompatibles not stored together _ 35. Storage - 90 days 36. Fire extin uishers 37. Spill containment QQo P4 z z E-1 rn a lifornia Health & Safety Code and the California Code of W W W � O MmzW - �D �DWpC1 aao�H H p 000xa � ai A v ooN0z UUNco9 - - WWNNVI El Inspector's Signature. 1 f� -�-X Owner/Operator Signature a C'�. Page of NOTE: Signature indicates receipt of this document only and not an admission of the facts. /81-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection Division of Environmental Health Reinspection No P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION Facility Name: ,. / �7 _ ���o tj�.. Date -- -WI59 c� Facility Address: B(. v� _ _ Contact Perso // �r%Lat� `�--�L-cs Title/Position- HAZARDOUS MATERIALS (2185) (COMP # ) �0 �� (CA H&S Code, Div. 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div 20, Chap 6.7) BUSINESS I.D. FORM ATL # _ _ GENERAL 1. Complete com I Viol 20. Permit to op erate Com I Viol 2. Verify emergency hone,number 1 21. Inventory reconciliation 3. Location of utilities 22. Precision tank test INVENTOFIY 23. Leak detectors 4. Hazardous material & amounts ' ted TANK CLOSURE 5. Material stored in proper containers & labeled �. 24 Permit a proved _ 25. Temporary closure 6. Incompatibles not stored together 26 Removal/in place abandonment 7. Spill containment provided a Tanks urged RL91 PLAN b Tanks rinsed 8. Plot plan submitted c Soil samples taken 9. Verify streets & adjacent buildln s WASTE GENERATORS COMP #_ 10. Location of hazardous materials 27. EPA identification number 11. Fire extinguishers/water source 28. Variances and/or exemptions r. 12, Emergency shut-off switches 29. Manifests .r 13. Location & verification of MSDS 30. Waste oil receipt 14. Sewers stem and/or storm drains 31 Training program/records 15. Staging area 32. Contingency Ian 16. Changes/modifications in previous year 33. Material stored in proper containers & labeled EMERGENCY RESPONSE PLAN 1T Adequate emergency response procedures 34. Incompatibles not stored together 18. Adequate evacuation procedures _ 35. Storage - 90 days 19. TRAINING PROCEDURES _ 36. Fire extinguishers _ 37. Spill containment The above marked items represent violations of the California Health & Safety Code and the California Code of Regulations and must be corrected. COMMENTS 196mrrr;�l Inspector's Signature Owner/Operator Signature Page of NOTE: Signature indicates receipt of this document only and not an admission of the facts. 805-781-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection Division of Environmental Health Reinspection No. P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION . 11��1ys Facility Name: ��L_L,L...vr� � b.r.o, r� � /li / Date; i v� Facility Address: 2,o Contact Person: � 4- 46 Title/Position:- "'M (4-, HAZARDOUS MATERIALS (2185) (COMP # ) (CA H&S Code, Div. 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div. 20, Chap. 6.7) BUSINESS I.D. FORM ATL. # GENERAL 1. Complete Com I Viol 20. Permit to operate Com I Viol 2. Verify emergency hone number 21. inventory reconciliation 3. Location of utilities 22. Precision tank test 23. Leak detectors TANK CLOSURE INVENTORY 4 Hazardous material & amounts listed 5 Material stored in proper containers & labeled 24. Permit approved Aj 25. Temporary closure 6. Incompatibles not stored together 26. Removal/in place abandonment 7. Spill containment provided a Tanks purged PLOT PLAN b) Tanks rinsed 8. Plot plan submitted c Soil samples taken 9. Verify streets & adjacent buildings WASTE GENERATORS COMP # 10. Location of hazardous materials 27. EPA identification number " �. i _ .r.'„^: ;`. t b 11. Fire extinguishers/water source \ 28. Variances and/or exemptions 12. Emergency shut-off switches 29. Manifests 13. Location & verification of MSDS 30. Waste oil receipt 14. Sewer system and/or storm drains 31. Training program/records - 15. Staging area 32. Contin e cy plan 16. Changes/modifications in previous year 33. Material stored in proper containers & labeled EMERGENCY RESPONSE PLAN 17. Adequate emergency response procedures 34. Incompatibles not stored together 18. Adequate evacuation procedures 35. Storage - 90 days 19. TRAINING PROCEDURES 36. Fire extinguishers 37. Sill containment <. 1i The above marked items represent violations of the California Health & Safety Code and the California Code of Regulations and must be corrected. /r /J Inspector's Signature Owner/Operator Signature Page of NOTE: Signature indicates receipt of this document only and not an admission of the facts. 805-781-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection Division of Environmental Health Reinspection No. P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION Facility Name: F CGr-r..r, �- QiA,10 - -t- / /ynf,) JI /n Facility Address:_ (D � -LI A.�c_p aq ..�f Daterc / 2 1 Contact Person: Title/Position: HAZARDOUS MATERIALS (2185) (COMP # ) (CA H&S Code, Div. 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div. 20, Chap. 6.7) BUSINESS I.D. FORM ATL. # GENERAL 1. Complete Com I Viol 20. Permit tooperate Com I Viol 2. Verity emergency hone number 21. Inventory reconciliation ,+ 3. Location of utilities 22. Precision tank test / INVENTORY `, 23. Leak detectors 4. Hazardous material & amounts listed TANK CLOSURE 5. Material stored in proper containers & labeled 6. Incompatibles not stored tog -ether �` 24. Permit approved 25. Temporary closure \ 26. Removal/in place abandonment 7. Spill containment provided a Tanks purged PLOT PLAN b Tanks rinsed 8. Plot plan submitted %c Soil samples taken 9. Verity streets & adjacent buildings WASTE GENERATORS COMP # 10. Location of hazardous materials 27. EPA identification number CA (_ 000 11. Fire extinguishers/water source 28. Variances and/or exemptions 12. Emergency shut-off switches 29. Manifests 13. Location & verification of MSDS 30. Waste oil receipt 14. Sewer system and/or storm drains 31. Training program/records 15. Staging area 32. Contingency lan ' 16. Changes/mod if icat ions in previous year 33. Material stored in proper containers & labeled / EMERGENCY RESPONSE PLAN 17. Adequate emergency response procedures 34. Incompatibles not stored together 18. Adequate evacuation procedures 35. Storage - 90 days 19. TRAINING PROCEDURES 36. Fire extinguishers 37. Spill containment The above marked items represent violations of the California Health & Safety Code and the California Code of Regulations and must be corrected. COM rector's Signature - ��t' ZK*!',' r/Operator Signature Page / of� mature indicates receipt of this document only and not an admission of the facts. 90.3 6' 805-549-5544 COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Division of Environmental Health P.O. Box 1489, San Luis Obispo, CA 93406 Routine Inspection Reinspection No. _ Complaint Investigation _ HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GENERATOR INSPECTION REPORT/NOTICE OF VIOLATION Facility Name: - t' /' to Date: Facility Address: `• i !- I Contact Person: c_ - Title/Position: HAZARDOUS MATERIALS (2185) (COMP # ) (CA H&S Code, Div. 20, Chap. 6.95) UNDERGROUND STORAGE TANKS (COMP # ) (CA H&S Code, Div. 20, Chap. 6.7) BUSINESS I.D. FORM ATL. # GENERAL 1. Complete Com I Viol 20. Permit to operate Com I Viol 2. Verity emergency hone number 21. Inventory reconciliation 3. Location of utilities 22. Precision tank test INVENTORY 23. Leak detectors 4. Hazardous material & amounts listed TANK CLOSURE 5. Material stored in proper containers & labeled 24. Permit approved 25. Temporary closure 6. Incompatibles not stored together 26. Removal/in place abandonment 7. Spill containment provided a Tanks purged PLOT PLAN b Tanks rinsed 8. Plot plan submitted c Soil samples taken 9. Verify streets & adjacent buildings WASTE GENERATORS COMP # ' 10. Location of hazardous materials 27. EPA identification number 11. Fire extinguishers/water source 28. Variances and/or exemptions 12. Emergency shut-off switches 29. Manifests 13. Location & verification of MSDS 30. Waste oil receipt _ 14. Sewer Wstem and/or storm drains 31. Training program/records 15. Staging area 32. Contingency Ian 16. Chan estmodifications in previous year 33. Material stored in proper containers & labeled EMERGENCY RESPONSE PLAN 17. Adequate emergency response procedures 34. Incompatibles not stored together 18. Adequate evacuation procedures 35. Storage - 90 days 19. TRAINING PROCEDURES 36. Fire extinguishers 37. Spill containment The above marked items represent violations of the California Health & Safety Code and the California Code of Regulations and must be corrected. COMMENTS Inspector's Signature-,.. Owner/Operator Signature NOTE: Signature indicates receipt this document only a d not an admission of the facts. Page of curacy of ge • to the o[llceo at one Aundnd (100) of Nlgwn ttr.ac n Lana. becreen Northetly along ' thence ■t right englog Obtapol thence he Northruurly o! seld lot of I. end the point of o Nary ILlas by deed web.r, 191O, In the ■ ObLapo, CelLtarata one hundred end ila Ns@terly lls@ .1 Lute Obispo Toro running thence Northerly ,.nce at right galls@. Obispo, thence tha Nruu"' ,Sth dry orthof November, i the P Narly Lin. Icnet oLat of •) =;kAr7s. a. o t*N IN-" Nwgll- A+No u.w.va. r9^ftwK4V /i' "Hr M1G4t." 11 TMIL r--w or t+(c r-U-CP pw... �? .u. �+wl�ldrj7 I IN4 ++K-447 &V MINIH64't IDrla t'w mvC.H.ly 1 *k* A. d4t411.lO U,t *vm#044tl µof- 11JRPtipme" 6j 101116 M"ftIqy NNE, I�•,�st9sj►T'� it+v IWIL'on"L(b, I*TM ►"(1,01 /'ND rrafbwt ldml� *t+Ut pN Imm "4 -me. PALvwv4 O,mu- Kt< H.00p tar-rer a•I 10 I fear Armur- RLti' 1 CLI! to, E I ►or b bt..11.l�llkt IatG 1�}anerr{1Nh "Oil tbf/ 1. ►11N� I Vw of Wo It-,H40 W L ?►. M11 L, 1 'L ��+'4 5r ce'j 3,g71 �y 7701 fit! 1,7,W latt'ir J� U)", H�JUi-lii �t u,It Tom) 1� ^ t►� 0 w 1r�-a�wH r- v ----�— ►xr�t► --� , q�r,► + I j- °�� WTI► i�l j LL 7 1 F�fii n rS'A r � ar�'tTIN4 0EIES'' r-�J is t a-ZI lye(y aP W "rW &&J.at ID Pe Prww Ho rMH4 -.. -- Gh1. I LAW- Q llAa[�.e�rriCt..lo� Il1lj�6 0� � �C7-i AC&Agwe -0,64Y4/ 14194-01 ►.--qlaN — ItJW L+..111L 'IHe IJE� IFY �►tCo IN `.4pm z. D I— Z wv UJ O m Wv) -J ¢ O W Z� O -CD Z W Nw