HomeMy WebLinkAboutSLOUNIFLOW_FS1 Admin iRC3926i Color_2482_001Division of Environni ^ '[Hea!!!
(80s) 781-ss44
P.O. Box 1489 ,
2156 Sierra Way .San Luis Obispo, CA 93406
Department of Agriculture/Measurement
Standards (sos) 7s1-s9ro
2156 Sierra Way Suite A oSan Luis Obispo, CA 93401
FireDepartn'805)781-7380
2160 Santa Burara Avenue
Snn Luis Ohisno CA 93401-5240
Utilities Departmsnl r (805) 781-1215
879 Morro Street o San Luis Obispo, CA 93401
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CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM EFW data
entry by:WDate:
Time
YES NOfrTTTT
N/A
BUSINESS PLAN
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 layouUfacility maps are accurate (HSC $25504, Title 19 CCRS 2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR 52732 & 22 CCR 566265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR $2732 &
22 CCR $6626s.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 525504, Title 19 CCR
$2731 & 22 CCR $6626s.s3/s4)
Facility is operated and maintained to prevenVminimize/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)
BPOl
BPO2
BPO3
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FACILITY ID NO:
FACILITY NAME:
FIRE
u{rr,rrrss
DEH
AG DEPT
CITY
CITY
Routine
Reinspection
lh|.il/Other
PHONE:0'- /
! Business Plan E ttw Generator {usr ! ncr E Tiered PJ"-itti.rgPROGRAMS INSPECTED:
REINSPECTION REQUIRED :NNONYES f] BusinessPlan E,nlv Generator,i n usr nlcr ! Tiered Permitting
t/
PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining
rompliance with adopted codes. GRANTED BY (NAMEiTITLE):
COMMENTS:
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^r{A:\CUPA i I peetion forms.doe 19-Sep-02
t Division of Environn. .tal Health
(80s) 781-5s44
P.O. Box 1489
2156 Sierra Way rSan Luis Obispo' CA 93406
Denartment of Asriculture/Measurement
Standards (8os) 781-s9ro
of San Luis O
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
Utitities Department r (805) 781'7215
879 Morro Street r San Luis Obispo, CA 93401
!i-
"'r**Way Suite A rSan Luis Obispo' CA 93401
CERTIFIED UNIT'TED PROGRAM AGENCY (CUPA)
Date:
Time
COMMENTS:
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TRO2
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HAZAR s MATERIALS INSPECJION FORM
BUSINESS PLAN
Business plan is complete, currenl & available during inspection (HSC 25503.5' Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504' Title 19 CCR2729)
Site layouUfacitity maps are accurate ([ISC 25504' Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR 2732 &22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR2/3? & 22
ccR 6626s.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504' Title 19 CCR
2731 & 22 CCR $ 6626s.53/s4)
tr'acility 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)
EF'W.\
entty
data
by:
,up)
FACILITY ID NO:
FACILITY NAME:
ADDRESS: L+\ES
'OU(}'I
Ih t6r*tzt 57.
Routine
Reinspection
Complaint
Other
AGENCYn lrn
! IcDEPTn grrv rInB
Vcrcv uTILITIES
PHONE:
flusr fllct I TieredPermittingffHwc"r*ruto"Pland*inu*PROGRAMS INSPECTED:
fl usr ! lcr fl Tiered Permittingn Hw Generatorgfrto fl YEs n BusinessPlanREINSPECTION REQUIRED:
PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance
with adopted codes. GRANTED BY (NAME/TITLE):
INSPECTOR:FACILITY REP
Repro 1001 rev 1 O:\DOCUMENT\Jeifp\FORMS\lnspection forms\CUPA inspection forms.doc 't 0-Sep-01
DATE:
HAZARDOUS WASTE GENERATOR
I.\NSPECTOR:FACILITY NAME:
Lbs
EPA II)
NUMBER:
Tiered Permit:
L]0 a?Total
Waste oil:
Antifreeze:
Solvents:
Treatment EquiPment:
EPA ID NO/PERMITS
Generator has an EpA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR66262.L2) If Not, Call (800) 618-6942
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title22 CCR 66262'11)
F7ownknowtedge lanalYsis ilother
fi"ardous wastl analysis/test iecords are kept for at teast 3 years (Title22 CCR 66262.40.(c))
DISPOSAL/TRANSPORTATION
YES" NO N/AAEE--
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n
vIoL. #
GTOI
GTO3
GTO4
GTO5
GTO6
GTOT
GTO8
GTO9
GTlO
GTl1
GTI2
GTI3
GTI4
GT15
GTI6
GTIT
GTl8
GT19
GT2O
GT2I
authorization from
!milkrun service
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Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or
66262.r2\DTSC (HSC 25189.5, Title 22 CCR
Iother
un
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
66263.42t 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERSITANKS
Hazardous wastes are accumulated on site as follows (Title22 CCR 66262.34)
D go aays ifwaste generated per month is greater than or equal to 100 kg (220 lbs.)
n ttO days ifwaste generated per month is less than 100 kg (see note)
ZZIO 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(13200 lbs.)and no
acutely/extremely hazardous waste over I kg (2.2|bs.) is held on site for over 90 days'
Hazaidous waste,.satellite" coltection is managed properly (complete labeling/accumulation time/55-gal
or l-qt limit) (Title 22 CCR66262.34(c))
tgnitaute or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
6626s.176)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTE,, waste composition/physical state, hazardous properties, name/address of generator) (Title22
ccR66262.34)
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or
reaction (T itle 22 CCR 66265. I 7 I l.l9 l, 66265.17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (Tille 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
(T itle 22 CCR 66265.17 4)
iaily 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 (Title22 CCR 66261'7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
252s0.4)
Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed
rainproofcontainer, labeled "drained used oil filters," and transferred for metal reclamation) (Title22
ccR 66266.130)
Spent lead-acid batteries are transferred offsite under manifest or bill oflading for recycling' reuse' or
reclamation (Title 22 CCR 66266'81)
Solvents/other recyctable materials are managed as hazardous wastes until recycled (Title 22 CCR
66266.3',)
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SUMMARY OR OBSERVATIONS/VIOLATIONS
No violations of underground tank, hazardous materials, inventory, and hazardous waste laws' regulations, and requirements 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. Ifyou disagree with any ofthe violations or proposed action, please inform us in writing.
ALL YIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be i"TorieA in writing certifying
that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law jrhd punishable by a line
ofnotlessthan$2,000ormorethan$25,000foreachviolation. Yourfacilitymaybereinspectedanytimeduringhormalbusinesshours.
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.
NUMBER
VIOLATIONS
MINOR MAJOR CORRECTIVE ACTION REQUIRED
6+W
CoMMENTS: Atl l^n t;y€'i>tffi lHFe Pr6*{/Y fnyd rn lo'b"e,le)"
Inspected
Date:
Facility Rep
Signature:
N
Diyision of Environme'^"al Ilealth
(80s) 781-ss44
P.O. Box 1489
2156 Sierra Way rSan Luis Obistrro, CA 93406
Department of A griculture/M easurement
Standards (8os) 781-s910
2156 Sierra Way Suite A oSan Luis Obispo, CA93407
of San Luis Obis
F'ire Department (S05) 781-73g0 I
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
Utilities Department r (805) 7g1-7215
879 Morro Street r San Luis Obispo, CA 93401
I
EFW data. ,
entry by: \thl]
-'i t o
CERTIFIEID UNIFIED PROGRAM AGENCY (CUPA)
HAZARDO US MATERIALS INSPECTION FORM
nut", ll , ol , lg-
Time:
YES NO
u
COMMENTS:
INSPECTOR:
Facility is operated
hazardous waste to
including analarm
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BPO3
TROl
TRO2
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BUSINESS PLAN
Business plan is complete, current, & available during inspection (Hsc 25503.5, Title 1g ccR2729)
Inventory of hazardous materials is complete (Hsc 2s504, Title 19 ccL2Tzg)
Site layouVfacility maps are accurate (HSC 25504, Tide 19 CCF.ZT2g)
TRAINING PLAN
Facility has appropriate training program (Tifle 19 ccF.2732 & 22 ccR 6626s.r6)
Training documentation is maintained on site for current personnel (Tifle 1g ccR 2732 & 22ccR 66265.16)
)
EMERGENCY RESPONSE PLAN
contingency plan is complete, updated, and maintained on site (HSC 25504, Title 1g ccR2731 & 22 CCR S 66265.53/54)
and maintained to prevent/minimize/mitigate fire, explosion, or release ofthe environment. Maintains all required o. appropriate equipmentand communications system (Titre 19 ccF.27]tr &22 CCR iezes.st-.a11
FACILITY 6
at
FACILITY ID NO:
FACILITY NAME:
PHONE:
AG DEPT
CITY UTILITIES
FIRE
@ILl npu Routine
Reinspection
)
PROGRAMS I Business plan n HW Generator UST n acr Tiered
/x"n YESREINSPECTION REQUIRED:n Business Plan n Hw Generator tu,,fl acr n Tiered Permitting
obtaining photographs, reviewing and copying records, and determining compliance
INSPECT:ln volveTOmayInspections
BYRANTEDcodes.G
flepla 1001 rev 1 Q:\DOCUMI-NT\Jeffp\FoRMs\inspoctie.rn forms\cr.JpA inspecticn forms.rJoc i 0-$en-01
Division of Environme-.al Health
(80s) 781-ss44
P,O. Box 1489
2156 Sierra Way.San Luis Obispo, CA 93406
Department of Asriculture/Measurement
Standards (8os) 781-s910
2156 Sierra Way Suite A rSan Luis Obispo' CA 93401
-.it of San Luis Obispo
Fire Department (805) 781-7380
21 60 San{a Barbara Avenue
San Luis Obispo CA 93401,-5240
Utilities Department o (805) 781-7215
879 Morro Street r San Luis Obispo, CA 93401
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HMARDOUS MATERIALS INSPECTION FORM
nut"' ll ro) r r,A-'
EFW data
entry by:V,G
Time:
I
FACILITY ID NO:
FACILITY NAME:
4^RESS:
! Reinspection
TYPE
Routine
n Complaint
AGENCY[] rnH
E nc DEPr
Wctrv rtnnI crrv urrLrrIES
v
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-(-\
PHONE:"U
n Tiered Permitting! BusinessPlan n Hw Generator f, usr n EcrPROGRAMS INSPECTED:
! Tiered Permittingn Business Plan E Hw Generator /u,,n.tcrn No /unsREINSPECTION REQUIRED
PERMISSION TO INSPECT: Inspections may invotve obtaining photographs, reviewing and copying records, and determining compliance
rvith adopted codes. GRANTED BY (NAME/IfTLE):
N/Az
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nn
YES!nn
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BPOl
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BPO3
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BUSINESS PLAN
Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR2729)
Site layout/facility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facitity has appropriate training program (Title 19 CCR2732 & 22 CCR 66265,16)
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22
ccR 6626s.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR
2731 &22 CCR S 66265.53/s4)
Facility is operated and maintained to prevenUminimize/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 CCR273I & 22 CCR 66265,31143)
COMMENTS:
d
INSPECTOR:
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Division of Environn'
(80$ 78r-5s44
P.O. Box 1489
2156 Sierra Way e$41.' [,uis Obispo, CA 93406
De p a,rt nrqal st 3.e$s&eA4-egs u-{e!ry rd
StanrlardE (gos) 781-s9lo
2156 Sierra Way Suite A oSan l,,uis Obispo' {:A934AI
)..L t-of Sarr Luis
File 1)epartnrcrrt (805) 781-7380
2160 Santa Earbara Avenue
San f-uis {}trispo C:! 9340l-5240
Utilifies Department o (805) 781-7?.15
8'79 lf'{orro Street o San Luis Obispo, C:\ 93401
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n
cERTIFmn {JN{FIH,D PR.OGKAVI AGENilY (CUF.A)
I{AZARMO{.J$ MATHRIAI.$ Ih{SPE{:T!ON FORIU
Date:
Time
UA .(o +o 1o
EFW data
entry by:
liauce with
NO NIAnnnn
ll
TO INSPEC'I': [nspections rnay in"zolve ri:taiming photograph,s, ri::i iewiug anrl eopying record-q, a*d air:{.ertmiilirrtr_:
GR-AISTED tsV
EUSNNASS FLAF{
iltn nwnn
YESz
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Epor
EPO2
BPOS
TR.OI
T'R02
EROl
EI{02
Business plan is coimp.lete, current, & availalile *uring insprettion {iHSC 255t}3.5"'i'itl* d9 {.{R 2729't
lnventoly of hazardtiias rnaterials is coniplete {l{$C 2:{$04,'fitle tr9 C{-i{, X729)
Site layuut/{lrcilitl' nr:rps are acf,rrrate (I{Sdl 25f;C4. Title n9 CCfe 2729)
TR,A,TI\IF{G PI,AN
Facility has appropriate training program (Title i9 (iCR 273? & 22 CCR 66jt65.I6'i
Training docum*ntation is tnaitttained on site lbr eurrenf p*n'sonnel (T'itle 19 CCR ??3? &
22 CCR 66265. {6)
E I\4ARGE i\i CY REi$Fil'NSE Ptr,AN
Contingetrcy plan is colnplet*, uprlated, and snarrrt;rined fix site (F{[iC 235t],;,'[i{i;19 CCi4
?,731 'ti.22 CCI{ $ 66255.$3/54i
Facllity is cperated aftr.l maintftined to prevr:n!-/rriinirmi:relrlritigirte {ire, exp$osir'6s, 1iv lsiefi$tr
01-hnzardous lF,,asfe !.$ t{re ellvironnremt. Maintrrins a!l requirtd cr;rpprcpriaft) ii(lslrptn*it'i
inclurling an ai:rnrn;iirid comurunir:ations s;:r:iierut {I'lile 19 C{-ln }'731 8L 2l? djCri 562{r:i.31"
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{:FAC{LITY NAME:it
e
FACIT,ITY ID NO:
A,DDRESS:
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INSPECTION TYPtrffi--
f] Fteinspection
f,] Complaint
fl TiereO Permittingif acl
ff tlther
PROGR.AMS INSPKCTEU:
f] nusiness Plan ["J uw r;esrcri]tur f-.Jusr lf eer l]] Tiered PermittingREII{SPECT'ION [TEQUIR},!D:ffi*f YES
UNDERGROUND STORAGE TANK (UST)
Permit No.
# PERMITTED TAI\KS
# UNPERMITTED TANKS
Owner & operator as indicated on permit: I ySS nNO
If no, new owner name & address
new owner name & address
MOMTORING CODES
l. No monitoring
2. Standard Inventory Control
3. Modified Inventory Control
4. Statistical Inventory Rec.
5. Automatic tank gauge (list type)
6, Continuous monitoring in tank annular
space/secondary containment
7. Visual monitoring
8. Manual monitoring annular space
9. Temporarily abandoned under permit
10. Another method
YES NO
u
No, ofTanks:
Total Volume:
VIOI,. #
UTOOl
UTOO2
UTOO3
UTOO4
UTO05
UTOO6
UTOOT
UTOOS
UTOO9
UTOIO
UTO1l
NIAnItrn
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PER.MITTING
Site has a permit to operate (HSC 25284)
Permit is kept on the premises
Change ofownership is reported to the permitting agency within 30 days (HSC 25284(c))
All US'f(s) are properly permitted to operate or properly closed (HSC 25298)
MONITORING
UST(s) monitored using method specified on the permit or approved by the permitting agency (HSC 25293) (Write
monitoring code(s) observed _, _, )
Monitoring records are provided to regulatory agency upon request
Automatic line leak detection system is installed & kept operational for all pressurized piping (HSC 25292)
An annual report is submitted to regulatory agency
Tank tightness test and/or piping test is being performed as required (fitle 23 CCR)
Written Monitoring Plan submitted for electronically monitored tank system (Iitle 23 CCR2632134)
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 ACT
7'7{r4 b gals
Products Stored:
SPCC Plan is prepared and certified by a registered engineer within last 3 yrs.
SPCC Plan is maintained on site or nearest field office.
w{^" duonn" {r,**",
Wotn"rt A1F
Note: SPCC required for tanks with total storage capacity of > 10,000 gallons; for farms, nurseries, construction sites individual storage capacity of
>20,000 gal or total storage capacity of>100,000 gallons.
YESz
@rd
NO N/A VIOL. #
ATOOI
ATOO2
Tf
FAC:LITY NAME:DATH:
TIAZARDOUS WASTE GENER.ATOII.
' \spgcron:
EPA ID
NUMBER:
Tiered Permit:
Treatment Equipment
Total generated/month :
Waste oil: V-+
Antifreeze:
i\7d,Lbs or gals
(average)
YES./ NO N/A@E-E-
d
Tf
f
vrol. #
GTOl
GT03
GTO4
GTO5
GT06
GTOT
GTO8
GTO9
GTIO
GTIl
GT12
GTI3
GTI4
GT15
GT16
GT'7
GTIS
GTI9
Gr'20
G'{2\
CA Solvents:
Others:
EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR66262.12) If Not, Call (800) 618-6942
HAZARDOUS WASTE DETERMINATION
HazxAous u'aste deternrination conducted (Tltle 22 CCR 66262. I I )
6nn knowledge flanalysis ntin".
Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR 66262.40"(c))
tl
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DISPOSA I,/TRANSPORTATIORI
Hazardous wastes were transported and/or disposed to
aut}rdrizatian, from D'I'SC (HSC 251S9'5, Title 22 CCR
dmilkrun service nother
a facility with an EPA ID NO. amd permit or
66262.12)
Hazardous \qvastes are shipped with manifest (Title 22 CCR 662,62'20)
Manifests am<!/or receipts are properly conrpleted/retained by generator for 3 years (T'itle 22 CCR
66263.42t 66262.23)
STORJI.G E AND MANAGEM EN T' OF CONTAI NERSN.-ANKS
Hazardous rryastes are accunrulated on site as follows ("title 22 CCR 66262.34)
fJ gO Oays if waste generated per momth is greater than or equal to 100 kg (220 lbs.)
f] ttO days [fwaste generated per month is less than 100 kg (see note)
fJZIO days if waste generated per momth is less than 100 kg and tnansported more than 200 miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13200 frhs.)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 (cormplete labeling/accumulation time/55-gal
or tr-qt limit) (Title 22 CCR6626234@))
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
6626s.t76)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
W.{STE," waste composition/physical state, hazardous properties, name/address of generator) (Title22
ccR 66262"34)
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or
reaction (T itle 22 CCR 66265. I 7 | l.l9 l' 66265.11 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR 66265.172)
Containers storing hazardous wastes are closed/sealed (Title22 CCR 66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted
(T itle 22 CCR. 66265. I 74)
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 (0)
TTECYCLABI-E WASTE
[Jsed oil is rnanaged as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
zszsa.4)
Used oil filters for recycling are rnanaged properly (drained of free flowing liquid, stored in closed
rainproofcontainer, labeled "'tlrained used oil filters," and transferred for metal reclamation) (Title22
ccR 66256.130)
Spent lead-acid tratteries are transferred offsite under manifest on bill of lading f,or recycling, reuse' or
reclamation ("title 22 CCR 66266.81)
Solvents/othen recyclable matenials are managed as hazardous wastes until recycled (Title 22 CCR
66266.3)
SUMMARY OR OBSERVATXONS/VIOLATIONS
No violations of underground tank, hazardous rnaterials, inventory, and hazardous waste laws, regulations, and requirements were
discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility.
f Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each
violation. Ifyou disagree with any ofthe violations or proposed action, please inform us in writing.
ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be infornned 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 {ine
of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours.
You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective actions. The
issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the
violations noted or that have not been corrected within the time specified.
NUMBBR
VIOLATIQNS
MINOR M.AJOR CORRECTTVE ACTION REQUIRED
COMMENTS:
Date
0:\lf OCUMIt'iT\.]effp\FOl:ilvl$\lnspectialr forms\Cl.JPA ins;:et:tiarr fi:nn.s dnc 'i f]"Sr:p.01
-t't[nspected By:Facility R.ep Name:-:'ti
Signa{ure:
Division of Environmental Health
(80s) 78r-ss44
P.O. Box 1489
2156 Sierra Way.San Luis Obispo, CA 93406
Department of Agriculture/lVleasurement
Standards (805) 781-5910
2156 Sierra Way Suite AoSan Luis Obispo, CA 93401
Fire Department (80s) 78r-7380 ill I lll ]ll I llllll ll I il t I tl
311'"Tl3fiillTii#1j',,0 @-J rJ
&?"rt^ l,;, ort f" ffi
Utilities Departmentr (805) 781-7215
879 Morro Streeto San Luis Obispo, CA 93401
t0/til
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
EFW data
entry byDate:
Time ,dJ
YES NO N/A
COMMENTS:
BPOl
BPO2
BPO3
TROI
TRO2
EROI
ERO2
BUSINESS PLAN
Business ptan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR2729\
Inventory of hazardous materials is complete (HSC 25504' Title 19 CCR2729)
Site layouVfacility maps are accurate (HSC 25504' Title l9 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title l9 CCR2732 &
22 CCR66265.t6)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504' Title 19 CCR
2731 & 22 CCR S 6626s.53/s4)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release
of hazardous waste to the environmeht. Maintains all required or appropriate equipment
including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-
.43)
r
FACILITY ID NO:
FACILITY NAME:
ADDRESS: L
TYPE
Reinspection
Other
AGENCY
CITY UTILITIES
FIRE
DEH
AG DEPT
PHONE
ffis,ffi nc$! ttw Generatorl-l Business PlanPROGRAMS INSPECTED:
IacrI rm Generator lz(nl-l Business PlannYESREINSPECTION REQUIRED:
PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining
compliance with adopted codes. GRANTED BY
INSPECTOR:FACILITY REP:
PAvL k^MLk)vfr
''l3J.s [, l+iyna,M,v uNDERGRoUND sroRAGE TAI\K (usr)
Permit No
# PERMITTED TANKS A
# UNPERMITTED TANKS
Owner & operator as indicated on permit:YES ENO
If no, new owner name & address
new owner name & address
MONITORING CODES
1. No monitoring
2. Standard Inventory Control
3. Modified Inventory Control
4, Statistical Inventory Rec.
5. Automatic tank gauge (list type)
6. Continuous monitoring in tank annular
space/secondary containment
7. Visual monitoring
8. Manual monitoring annular space
9. Temporarily abandoned under permit
10. Another method
YES NO N/Ann!nnnnnn!!n
nttrunnnrntrntrtrTtrtrInnnn
vIoL. #
UTOOl
UTOO2
UTO03
UTOO4
UTOO5
UTOO6
UTOOT
UTOO8
UTOO9
UTOlO
UTO1l
PERMITTING
Site has a permit to operate (HSC 25284)
Permit is kept on the premises
Change of ownership is reported to the permitting agency within 30 days (HSC 25284(c))
All UST(s) are properly permitted to operate or properly closed (HSC 25298)
MONITORING
UST(s) monitored using method specified on the permit or approved by the permitting agency (HSC 25293) (Write
monitoringcode(s)observed- .
Monitoring records are provided to regulatory agency upon request
Automatic line leak detection system is installed & kept operational for all pressurized piping (HSC 25292)
An annual report is submitted to regulatory agency
Tank tightness test and/or piping test is being performed as required (Title 23 CCR)
Written Monitoring Plan submitted for electronically monitored tank system (Iitle 23 CCR2632134)
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 ACT
gals
Products Stored:nn Diesel f]Gasoline lCrude oilNo. of Tanks:
Total Volume:
Note: SPCC required for tanks with total storage capacity of > 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/Atr!ntr!n
VIOL. #
ATOOI
ATOO2
SPCC Plan is prepared and certilied by a registered engineer within last 3 yrs'
SPCC Plan is maintained on site or nearest field office,
rtlfy*f;', fitfud Al47*o^ /,^^ /A!rrtlt!4\u,t( lV^4
Auw^f,ffi| 0l<, (r(trAtd
^r,/W ,W + l/m,t alA,v',,!nl /r44
q Ar;w,Xufud ^qfl M/At/+ (/.tUOlAf
A I
a/yrol w\
FACILITY NAME:A
as^4,
D
S OBSERVATIONSn/IOLATIONS
No violations ofunderground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requirements 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 viotation. Ifyou disagree with any oftheviolations 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 line of not tess than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during
normal business hours.
You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective actions- The
issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the
violations noted or that have not been corrected within the time specified.
NUMBER
VIOLATIONS
MINOR MAJOR CORRECTIVE ACTION REQUIRED
BP
TR
ER
GT
UT
AT
\I
COMMENTS:
{
Inspected By:Facility Rep Name: 6.fl'<V
Signature:Date:
0;\DOCUMINT\Jeffp\F0Rlvl$\ln*p*ction forrr"rs\cuPA inspection forms.doc 2-Ja:n-01
Division of Environmental Health
(80s) 78r-ss44
P.O. Box 14E9
2156 Sierra WayXSrn Luis Obispo, CA 93406
Department of Agriculture/Measurement
Standards (Eos)7Er-59r0
2156 Sierra Way Suite AXSan Luis Obispo, CA 93401
,'\
_AL!_,_wCitv of San Luis oblspo ffi
Utilities Departmento (805) 7El-72f 5
955 Morro "'""T";;;"#w
Start Time:
cA 93401
CERTIFIED UNIF'IED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM 7Date:r/tr
YES
w.VV
d-nwtr
dn{n
NO N/A
BUSINESS PLAN
Business plan is complete, current, & available during inspection (HSC 25503.5' Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504' Title 19 CCR2729)
Site layout/frcility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 &22 CCR66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
6626s.t6)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR273I &22
ccR $ 6626s.s3ts4)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release of
hazardous materials/waste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title 19 CCR 2731 &22 CCR66265.31-
.43)
BPOl
BPO2
BPO3
TROT
TRO2
EROl
ERO2
Action Activity Violation CodeP/T Service ResultRecord ID
INSPECTION TYPE
Routine
Reinspection'WwwAG DEPT
PHONE:
ID
INSPECTORNAME:
FACILITY
FACILITY
ADDRESS:
ffusr I acr! Business Plan I ttw GeneratorPROGRAMS INSPECTED:
! ttw Generator flusr ! lcrfl YEswKo ! BusinessPlanREINSPECTION REQUIRED:
PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining
compliance with adopted codes. GRANTED BY (NAME/TITLE):
\\3000B\VOL1\HOME\JPOEt-ff-ORMS\OFFIC[97\lnspection forns\CUPA inspection forns.doc 4-Aug-00
UNDERGROUND STORAGE TANK (UST)
Permit No,
# PERMITTED TANKS
#TINPERMITTED TANKS
Owner & operator as indicated on permit:d*"!no
If no, new owner name & address
new owner name & address
MONITORING CODES
1. No monitoring
2. Standard Inventory Control
3. Modified Inventory Control
4, Statistical Inventory Rec.
5. Automatic tank gauge (list type)
6, Continuous monitoring in tank annular
space/secondary containment
7. Visual monitoring
8. Manual monitoring annular space
9. Temporarily abandoned under permit
10. Another method
N/Ann-wn
n
trWn
YES NOVtrwnn!wn
w
No. of Tanks:
Total Volume:
vIoL. #
UTOOl
UTOO2
UTOO3
UTOO4
UTOO5
UTOO6
UTOOT
UTOO8
UTOO9
UTOlO
UTO11
n
trtrrnnn
PERMITTING
Site has a permit to operate (HSC 25284)
Permit is kept on the premises
Change ofownership is reported to the permitting agency within 30 days (HSC 25284(c))
Alt UST(s) are properly permitted to operate or properly closed (HSC 25298)
MOi\rITORING
UST(s) monitored using method specified on the permit or approved by the permitting agency (HSC 25293) (Write
monitoring code(s) observed
- -
Monitoring records are provided to regulatory agency upon request
Automatic line leak detection system is installed & kept operational for all pressurized piping (HSC 25292)
An annual r€port is submiffed to regulatory agency
Tank tightness test and/or piping test is being performed as required (Iitle 23 CCR)
Written Monitoring Plan submitted for electronically monitored tank system (fitle 23 CCR2632134)
Facility maintains evidence of Financial Responsibility for corrective action and for compensating third
partiei for bodily injury/property damage caused by a release from the tank system (HSC 25292)
ABOVEGROUND PETROLEUM STORAGE TANK ACT
Products Stored:oila
gals
Note: SpCC required for tanks with total storage capacity of > 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
-d, nw!
N/A VIOL. #
ATOOl
ATOO2
SPCC Plan is prepared and certified by a registered engineer within last 3 yrs.
SPCC Plan is maintained on site or nearest field office.
I
FAGILITY NAME:TE
SUMMARY OR OBSERVATIONS/VIOLATIONS
tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requirements were
CUPA greatty appreciates your efforts to comply with all the laws and regulations applicable to your facility
n 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 line of not less
than $2,000 or more than $25,000 for each viotation. 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 CORRECWEACTIONREQUIRED
"Y, \{NlloLPnW\,flrtL \
'tus'e"'on'
BP
TR
ER
GT
UT
AT
I
\
COMMENTS:
(
Inspected By:Facility Rep:
Title:SpzryfturrDate:
\\3000BWOL't\HOME\JPOEL\FORMS\OFFIC[97\lnspection fornts\CUPA inspection forms.doc 4-Aug-00