HomeMy WebLinkAbout4120 Horizon Docst--*
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ENVISION INPUT/UPDATE FORM ..
Master File Record Information aN-fr,nlulI
-t--} CREATE NEW RECORD*il FILE il LABEL
FACILITY NUM BER FA# ooo#rn q6 I
I I CHANGE OF OWNERSHIP
[] TANK OWNER il BUSTNESS OWNER
PROGRAM NUMBER ppg 00i5004 lUrlzz
fxk UPDATE BILLING INFO PROGMM ELEMENT PE#ltLb
I I PERMANENTLY TNACTTVATE
FACILITY AS OF:
I I TEMPORARTLY TNACTTVE
FACILITY AS OF:
DATE OF NEXT SCHEDULED
INSPECTION: November 6. 2014
RETURN TO INSPEGTOR:
Ktr0lYES I INO
DESCRIPTION OF CHANGES! Faetlity wtll be movt-ng ro Counry jur1sdlctlon effecrt_ve
Tanrrorrz ?fll I trloal +^ +vano€a* ^^e*{ +- and lnspection responsl-b {1{tv- Nerv address
._) I
BILLING INFORMATION:kx Please send out 2014 btll to current address.
Number of Materials:
Number of Waste Streams: 1-5
Number of Tanks (capacity/compartment): N/A
Facility Name:
rgH[F,""",
Cloud Companyr Inc.
4120 HOrizon Lane, //A San Luls Obispo, CA 93401
(ctry, STATE, ZIP CODE)
Facility phone Number: 549-8093 Attn:Brad Erlckson
Owner Name:C/O Brad Erickson
PostalAddress:4120 Horizon Lane, tlA San Lills Obispo, CA 9340L
(ctw, STATE, zlP coDE)
Requested By:
Entered By:
D- Kerrv Bov Date Requested:Nnrromlrar 1Z.- )l?
3 n/t-,o. 4(aru r r^ Date Entered:({
f ',T,ffi 5qd settinss\kbovre\Locar Settings\Temporary lntetnet Files\Content:OutlookUW6l HlOH\MFR HAZMAT (2).DOC 16-Jan-13
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Page I of2
From:
To:
<alvinsolis@ups.com >
< bhansen@co.slo.ca. us >
)
Date:
Subject:
History:
Thursday, November 14, 20L3 04:4BPM
RE: SLO County CUPA billing address update
*this message has been forwarded.
Hi Briana,
I apologize if I conveyed the wrong number. My correct phone number is 510-633-3960. For our San Luis
Obispo facility, l'd like to change the billing address to:
UPS - Oakland Hub
Attn: Plant Engineering
8400 Pardee Drive
fi'11
\|
Oakland, CA94621
For inquiries or any environmental-related correspondence, the contact person (also residing in the address
above) will be:
Jason Schoon
Phone #: 510-633-4035
Fax #: 51 0-633-3997
E-mail: ischoon@ups.com
Thank yotr,
Alvin P. Solis
North California District Plant Engineering
http:i/eagle.wings.co.slo.ca.us/mail5/bhansen .nsfl(%24Inbox)174D110985E4EE86DA0F... lll15l20l3
r\
l
Environmental Health Services
(80$ 7815544
P.O.Box 1489
2156 Sierra Way
San Luis Obispo. CA 93406
-1gtyol-
sAll l.l,tls ffitspo
Fire Deoaitment (80$ 7817380
2160 Santa Barbara Avenue
San Luis Obispo CA 934015240
Date: 1110612013
cERTtFtED UNTFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIAL INSPECTION FORM
Time:
lnsoection Tvoe
trRoutine
trReinspection
trChargeable Reinspection
trChange of Ownership
trComplaint
trSecondary Containment Testing
trChargeable Secondary Containment T
Serial Number: DA1176864
Facility Name: CLOUD COMPANY, INC
Phone: (805)549-8093
trEHS
trCITY FIRE
Site Address: 4120 HORIZON LN #A
SAN LUIS OBISPO, CA 93401
trCalARP trTPEtrHazmatEIHWGeneratortrUSTtrAGTPROGRAMS INSPEGTED:
trCa|ARP trTPEtrHazmattrHWGeneratortrUSTtrAGTREINSPECTION REQUIRED:
PERMISSION TO INSPEGT: lnspections may involve obtaining photographs, reviewing and
copying records, and determining compliance with adopted codes.
YES N9 N/A BUSINESS PLAN
tr tr tr BP01 Business plan is complete, current, available during inspection (HSG 25503.5, Title 19 CCR 2729)
tr tr tr BP02 lnventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729)
g tr tr BP03 Site layouUfacility maps are accurate (HSC 25504, Title 19 CCR 2729)
TRAINING PLAN
tl tr tr TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16)
tr tr tr TR02 Training documentation is maintained on site for current personnel (Title l9 CCR 2732 &22CCR|
66265.16
EMERGENCY RESPONSE PLAN
tr tr tr EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title l9 CCR2731 &22
ccR s 66265.53/54)
El tr tr ER02 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 CCR 66265.31-.37'
66267.34 (dX2),40CFR 1 265.31)
tr tr tr ERO3 Secondary containment is installed and sufficiently impervious to discharges. ICHSC
2527 0.4.5; 40 cFR I 1 2.8(cX2)l
GENERAL EH VIOLATIONS
tr tr tr FE01 Environmental Health fees paid. ICBPC 17200, Local Ordinance]
GPS Goordinates: Latitude: GPS Coordinates: Longtitude:
INSPEGTOR: KERRY BOYLE FACILITY REP: Brad Erickson
FACILITY NAME: CLOUD dI,NU", ,AIC
EPA ID
NUMBER:
4120 HORIZON LN #A
SAN LUIS OBISPO, CA 93401
HAZARDOUS WASTE GENERATOR
Total generated/month: Lbs or gals (average)
ADDRi. )
Waste Oil:_
Antifreeze:
Solvents:
Others:_
YES NO N/Atrtrtr VIOL. # EPA ID NO/PERMITS
GT01 Generator has an EPA lD number to treat, store, dispose, transport or transfer hazardous
waste (Title 22CCRS66262.12) lf not, Call (800) 618-6942 to obtain your GAL EPA lD number
HAZARDOUS WASTE DETERM INATION
GT03 Hazardous waste determination conducted (Title 22 CCR S66262.f 1)
trown knowledge tranalysis trother
GT04 Hazardous waste analysis/test records are kept for at least 3 years(Title 22 CGR $66262.40.(c))
DI S POSALff RAN S PO RTATIO N
GT05 Hazardous wastes disposed of at an authorized location (HSC 5251 89.5 , Title 22 CCR $66262.12)GT06 Facility utilizes a registered hazardous waste transporter, and hazardous wastes shipped with
a manifest (Title 22 CGR 566262.20, HSC 525160/25163(a))Emilkrun trother
GT0TManif esffiorrryleted/reta
CCR 566263.421 66262.23, 66262.40 {a))
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
GT08 Hazardous wastes are accumulated on site as follows (Title 22 GCR 566262.34)
tr90 days if waste generated per month is greater than or equal to 100 kg. (220 lbs.)
tr1 80 days if waste generated per month is less than 100 kg (see note)
tr270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6000k9({3,200 lbs) and no
GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation
time/5S-gal or 1-qt limit) (fitle22 CCR S66262.34(c))
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
E
E
tr
tr
E
B
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr GT1O
tr GT1l
E] GT12
tr GT13
tr GT14
tr GT15
tr GT{6
tr GT'17
tr GT18
tr GT19
lgnitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
s66265.1 76)
Containers of hazardous waste are properly labeled (includes appropriate date,"HAZARDOUS
WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Iitle
22 CCR 566262.31, 66262.34)
Containers/tanks containing hazardous wastes are in good conditiory'handled to minimize the
release or reaction (Title 22 CCR 566262.34 (dX2), 66265.171-.191,66265.{77(c))
Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCRS
s66262.34 {dX2), 66265.172)
Containers storing hazardous wastes are closed/sealed (Title 22 CCR 5566262.34 (dX2), 66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CGR$
s66262.34 (dX2), 66265.r74)
Daily inspection of all tank systems is conducted and documented (Title 22 CCR 5566262.34 (dX2),
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 566261 .7 (f))
RECYGLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (Title
22 CCRS 66266.13, HSCS25250.4)
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) fiitle 22
ccRs 66266.13)
Spent lead-acid bafteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (Title 22 CCR 566266.81)
Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR
s66266.3)
SOURCE REDUCTION:For facilities generating >12,000 kg./yr. of hazardous waste on
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 525244.19 , 25244.2'll
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, 07100.8, HSC 525244.19)
tr GT2O
tr GT21
trtrtrGT22
trtrtrGT23
-\
SUMM. IY OF OBSERVATIONSruIOL,. flONS
tr 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.
tr Violations were observed/discovered as listed below. All violations must be corrected by implementing the
corrective action listed by each violation. lf 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. GUPA must be informed in writing
wlth 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: CLOUD COMPANY, INC ADDRESS: 4120 HORIZON LN #A
SAN LUIS OBISPO, CA 93401
VIOLATIONS
VIOL. NO CORRECTIVE ACTION REOUIRED
INSPECTION COMMENTS:
Annual inspection - shop in good order. Good record keeping. Facility will be relocating to new address in
the County jurisdiction near the SLO Airport in Jan.2014 - Morabito Street.
Hazardous waste properly stored and managed. No violations noted.
INSPECTED BY: KERRY BOYLE
DATE: 11t06t2013
NAME OF FACILITY REP: Brad Erickson
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.
Signatu re of Owner/Operator:_ Title:_ Date
"-)
Gounty of San Luis Obispo res
lrfis s6poEnvironmental Health Services
(805) 781-5544
P.O. Box 1489
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 INSPEGTION FORM
Date. 1:L/6 /ZttL3
EFW data
entry by:
Time:
NO COSn!NDNT
YESnntr
nn
N/A
BUSINESS PLAII
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 layoutifacility 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, updatedo and maintained on site (HSC 25504' Title 19 CCR273I &22
ccR $ 6626s.s31s4)
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 (Titte 19 CCR273I & 22 CCR 66265.31'
.43)
ABOVEGROUND PETROLEUM STORAGE TA]\IK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 25270)
n
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BPO2
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mcrny iiAi,iE' ctoub'fioltt''afit, lt'tc.
ADDRESS: 4120 Horlson Lane dlA
San LuLs Obl"spor g* CA
Reinspection
Other Annual-
Result Code: _70 _80 _90
Action Gode: _32 _37
-33 -31
! Gomplaint
Routine
AGENCY
-
LI EHS
E ac DEPT
Km clTY FIRE
PHONE:
!cnlnnpKE Hw Generator ! usr ! acrI Business PlanPROGRAMS INSPEGTED:
4,EXnTVtfjll'! rcr Icrenen Business Plan n usrREINSPECTION REQUIRED:tr NO IYES
INSPEGT: lnspections may involve obtaini copying records, andng
codes. GRANTED BY
ERMISSION
COMMENTS Go to http://www.slopublichealth.orglenvironmentalhealthlhazardous_materials.htm, to obtain forms to with BP01-8P03, TR01 and
J
GPS Coordinates: Latitude:
-deg -min-decimalINSPECTOR:
mrn
FACILITY
mln mtn
FACtLtTyp46g. CL0UD C0I"IPANf' INC.4120 t{ori.uon Lane, #A
HAZARDOUS WASTE GENERATOR
fl,/] I " fi//)LI+a'I/,Total generrted/month:
Tiered Pernrttt f]ccsuf '/Dcd66f *Dte i 'IIPBR Waste oil: - XX Sotvents:
Trerffirent Eouloment: Antifreeze: Others:
EPA II)
NUMFER:
Lbs or gals
(average)
YES
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fi
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wt/
n
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GTOS
GTO4
GTO5
GTO6
GTOT
GTOS
GTO9
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GTl1
GTI3
GTI4
GTI5
GTI6
GT17
GTIE
GT19
GT2O
GTzT
GT22
GT23
EPA ID NO/PERMITS
Generator hrs en EPA ID number to trea! store, dhpose, traneport or tranrfer hazerdous w&ste
(Tltle 22CC-R, $ff,262,121 If Not, Call (S00) 6l&6942 to obtain your CAL EPA ID number.
IIAZARDOUS WASTE DETERMINATION
Hazordous wrste determinetioniconducted Gitle i2 CCR S66262.11)
Eown knowledge flanalysls, fJother
Ifazrrdous warte enelysls/test records are kept for at leart 3 yearr (TtOe 22 CCR $66262.40.(c))
DISPOSAI,/TRANSPORTATTON
Hazardous wastec were trrmported rnd/or dlsposed to e faclltty wlth en EPA ID NO. and permit
or authodzrtlon ftom DTSC (HSC $251E9.5, Tltle 22 CCR $66262.12)
Elminnun Dother
Hrzsrdous wectes rre shipped with menlfest (Title 22 CCR 966262.20,
Menifeck end/or receipts rre properly completed/retalned by generetor for 3 yean (fftle 22 CCR
966,263.421 66262.23'
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Ifrzardouc wsstes sre accumulated on rlte as follows (Tltle 22 CCR $6625234)
! 9l deyr lf wrste gencrated per month is grcrter than or equel to f00 kg (220 lbs.)
,filf,lOdays tf waste generated per month is less then 100 kg (see note)
E 270 dsp lfwaste generated per month ls tess than 100 kg rnd trenrported npre than 200 rniles
(cee note)
Note: Applier only if hazardous wrste accumulrted on site never exceedo 6000 kg(13,200
Ibs.)and no acutely/extremely hrzerdous waste ovcr I kg(2,21bs.) is held on slte for over 90
H"lraoo, wagte "srtelllte' collection ls managed prop.rty (complete labeling/accumulatlon
time,/S5-gal or lqt ltmlt) (Tltle 22 CCR $66262.34(cD
Ignltable or resctlve wastes are located t5 m (50 feet) from faclllty's property line (fitle 22 CCR
$6626s.176)
Contalnersof hazardour waste are properly laboled (lncludes rppropriate date,*HAZARDOUS
WASTE," waste comporition/physical state, hazardous properties, name./addrest of gcnerator)
(Title 22 CCR $66262.31,6626234,
Containers/tsnkr contalning hazardous wastes ere ln good condltlott/handled to mlnintze relerse
or reactlon (Tltle 22 CCR $66265.1711,191,66265.177(c)
Contalnerg/tanks4lners are compalible with waste storrd or tmnsferrcd (TlOe 22 CCR$66265.172)
Contdners storing hazardous wrsles sre closed/sealed Clttle 22 CCR $66265.173)
Weekly lnspectlon of rreas where hazardous w.ste contriners are storcd ls conducted
(Tltle 22 CCR$66265.174)
Daily inspection of rll tank syslems is conducted end documented (fitle 22 CCR $66265.f95)
Empty contriners or inner llners greeler lhan 5 gal has date when emptled rnd are managed
properly withln one year oldale emplicd (Title 22 CCR $6626t.7 (f))
RECYCLABLEWASTE
Used oil is managed rs hazardous wssle untll rrrycled (includes properlabellng storrge etc) (HSC
$252s0.4)
Used oll ltlters for recycling rre managed properly (dnlned of free llowing liquid stoltd in clo*d
rainproofcontainer, labeled *drained used oil lllters,'and transfencd for metal reclamation)
(Tltle 22 CCRS 66266.130)
Spent leed-acld bstteri€s are being properly sto.ed cnd transferred offslte under manlfest or blll of
leding for recycllng, reuse, or reclamatlon (fitle 22 CCR $66266.E1)
Solvents/other recyclrble materials ore manrged ar hazardous westee until recycled (Title 22 CCI
$662663)
SOURCE REDUCTION: For frclllties generoting >l2,lXl0 kg./yr. of hezerdous warte on slte.
Generrtor lg subJect to SBl4 and hac prepered and retalned current rource reductlon documents
or ir rble meko thcm evallrble to the lnspector wlthin (5) dayg. (IISC $25244.f 9,2524/,.21,
Source Reductlon Evclurtion rnd Plsn contslns the followlng [ve elementr:
cerdficetion, rrqounls of wrstes generate4 procer dercrlptlon, block dlagramr, and
lmpbmentrdon rehedule of celected cource reducdon ne.suret. (HSC $252,(.f9)
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Gounty of San Luis Obispo
Environmental Health Services
(805) 781-5544
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo GA 93401-5240
ef.cffyol-wlluls ffiIry
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
EFW data
entry by:
i i lr"
Time:
cos N/A
n!
MENTS Go to
GPS Coordinates:
nT
YES NOnntrnnn
ntrnn
!BPOI
BPO2
BPO3
TROl
TRO2
EROl
ERO2
ATOI
ATO2
BUSINESS PLAN
Business plan is completeo 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 CCId.2729\
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 CCR
66265.16',)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR273I &22
ccR $ 6626s.s31s4)
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
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 25270)
to obtain forms to BPOI , TR0l and ER0l
decimalmin Longitude:_
nnnn
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FACILITY E:
I
fu
AGENCYtr EHS
AG DEPT
CITY FIRE
nj,ar
INSPEGTION TYPE
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Reinsoection ,tomeiffifi4g
Result Gode: _70 _80 _90
Action Code:32 37, 33 31PHOM: -
Generator n usr n ncr ncamnpPROGRAMS INSPECTED:fl Business Plan
n acr IcnlnnenF*o tr YES I Business Plan ll-;l'Hw Generatort:t'n usrREINSPECTION REQUIRED
PERMISSION TO INSPECT: lnspections may involve obtaining photographs,rlgviewinq3;5[ggOVi
determininq compliance with adopted codes. GRANTED BY (NAME/TITLE): NN f//) I
^l/UV
j
ng records, and
INSPECTOR:-deg
nun
FACILITY
mrn decimal min
FACILITY NAM
EPA ID
NT]MBER:
ADDRESS
US WASTE GENERATOR
*A t- fr## /#:,"7]-*Total generatedfnonth:
Waste oil: V"
Antifreeze:
-
Lbs or gals
(average)
Tiered Permit:ncusw ncnser [cn
Treatment Equipment:
Irnn Solvents:
Others:
YES NO COS N/A,E'nrn vIoL. #
GTOl
GTO3
GTO4
GTO5
GTO6
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GTO9
GTlO
GTl1
GTl2
GT13
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GTl5
GTI6
GTIT
or authorization
,.Ef-intun
EPA ID NO/PERMITS
Generator has an EPA ID number to treatn store, disposeo transport or transfer hazardous waste '
(Title 22CCR 966262.12) If Not, Call (S00) 618-6942 to obtain your CAL EPA ID numbdr.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determinafioniconducted (Titte 22 CCR S66262.1f )
Eown knowledge flanalysis [other
Hazardous waste analysis/test records are kept for at least 3 years (Tifle 22 CCR $66262.a0.(c))
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID N0. and permit
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fromDTSC (HSC
Hazardous wastes are shipped with manifest (Title 22 CCR
Manifests and/or receipts are properly completed/retained by generator for 3 years (fitle 22 CCR
s66263.421 66262.23\
STORAGE AND MANAGEMENT OF CONTAINERS/TAI\IKS
Hazardous w&stes are accumulated on site as follows (Title 22 CCR $66262.34)
-n-lt}days if waste generated per month is grdater then or equal to 100 kg (220 lbs.)
fl f SO days if waste generated per month is less than 100 kg (see note)
JZIO days if waste generated per month is less than 100 kg and transported more than 200 nriles
(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 I kSQ.2lbs.) is held on site for over 90
days.
Ilazardous waste "satellite" collection is managed properly (complete labeling/accumulation
time/55-gal or l-qt limit) (Title 22 CCR $66262.34(c))
Ignitable or reactive wastes are located I 5 m (50 feet) from facility's property line (Title 22 CCR
$6626s.176)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTET' waste composition/physical state, hazardous properties, name/addreif,of generator)
(Title 22 CCR $66262.31,66262.341
Containers/tanks containing hazardous wastes are in good condition/handled to minimize relerse
or reection (Title 22 CCR $66265. I 7 I l.l9 l, 66265.17 7 (c\\
Containers/tanks/liners are compatible u'ith waste stored or transfer.ed'ltitte ZZ CCRS66265.172)
Containers storing hazardous wastes are closed/sealed (Titte 22 CCR 566265.173)
Weekly inspection of areas where hazardous woste containers are stored is conducted
(Title 22 CCR$66265.174)
Daily inspection of all tank systems is conducted and documented (Title 22 CCR $66265.f 95)
EmpB containers or inner liners grealer than 5 gal has date when emptied and are managed
properly within one year of date emptied (Title 22 CCR S66261.7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storagq etc) (HSC
s2s2s0.4)
Used oil lilters for recycling are managed properly (drained offree flowing liquid, stored in closed
rainproof container, labeled "drained used oil filters,tt and transfened for metal reclamation)
(Title 22 CCR$ 66266.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling reuse, or reclamation (Title 22 CCR $66266.81)
' Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR
s66266.3)
SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site.
Generator is subject to SBl4 and has prepared and retained current source reduction documents
or is able make them available to the inspector within (5) days. (HSC 525244.19,25244.21,
Source Reduction Evaluation and Plan contains the following five elements:
certification, ampunts of wastes generated, process description, block diagrams, and
implementation schedule ofselected source reduction measures. (IISC $25244.19)
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County of San Luis Obispo
Environmental Health Services
(805) 781-5544
Gty.of
$an u.fis oH$rc
P.O. Box 1489
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
entry by:,/l /;,r"si i
Date:/ tl,! !{i"i i i
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FACILITY NAME:
ADDRESS
AGENCY
tr' EHSn ec DEPT
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Complaint n Otner
Result Gode: _70 _80 _90
Action Gode: 32 37 33 31
Routine Reinspection
PHONE
n usr E rcr flcnmnppr'eusiness elan FA* GeneratorPROGRAMS INSPEGTED:
! Business Plan ! Hw Generator ! usr n rcr IcnnnpREINSPECTION REQUIRED N YES
TO INSPECT: tnspections may involve obtaining photographs, reviewing and copying records, andtsst
iance with codes.BY
Time:,{
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BUSINESS PLAN ,\.
' Business plan is completd, current, & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCF.272[
Site layout/facility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265,16)
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
66265.16',)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updatedo and maintained on site (HSC 25504, Title 19 CCR273I &22
ccR s 6626s.ssts4)
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
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 25270)
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FACILITY
{.tlfMFACILITY NAME
EPA ID
NUMBER:
Tiered Permit:
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EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste
(Title 22CCR 566262,12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title22 CCR $66262.11)
flown knowledge [analysis f]other
Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR $66262.40.(c))
DISPO SAL/TRAN SPORTATION
A ID NO. and permit
Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR
966263.42t 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title 22 CCR 566262.34)
! 90 days ifwaste generated per month is greater than or equal to f00 kg (220 lbs.)
yflTtO days if waste generated per month is less than 100 kg (see note)
Z ZIO days if waste generated per month is Iess than 100 kg and transported more than 200 miles
(see note)
Note: Applies only ifhazardous waste accumulated on site never exceeds 6000 kg(13,200
lbs.)and no acutely/extremely hazardous waste over I kg (2.2 lbs.) is held on site for over 90
days.
Hazardous waste 'osatellite" collection is managed properly (complete labeling/accumulation
timei5S-gal or l-qt limit) (Title 22 CCR $6626234(c))
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
s6626s.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')
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release
or reaction (T itle 22 CCR S66265. 17 1 1 .191, 66265,17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR$66265.172)
Containers storing hazardous wastes are closed/sealed (Title 22 CCR $66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted
(T itle 22 CCRS662 65. 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 (Title22 CCR $66261.7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
$2s2s0.4)
Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed
rainproof container, labeled "drained used oil filters," and transferred for metal reclamation)
(T itre 22 CCR$ 66266.130)
Spent Iead-acid batteries are being properly stored and transferred offsite under manifest or bill oT,
lading for recycling, reuse, or reclamation (Title 22 CCR $66266.81)
Solventsiother 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 SBl4 and has prepared and retained current source reduction documents
or is able make them available to the inspector within (5) days. (HSC S25244,19,25244.21')
Source Reduction Evaluation and Plan contains the following five elements:
certification, amounts of wastes generated, process description, block diagrams, and
implementation schedule ofselected source reduction nreasures. (HSC S25244.19)
YES NO COS N/AwE E E
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Environmentsl llealth Services
(805) 7E1€s44
P.O. Bor 1489
2155 Sierrr Wey
Sen Luis Obispo, CA 934116
GwO[
safi lrils ffiispo -ri
EFW data
entry by:
Ftlr Ospanmont (8O5) 781-7380
San Lulr Oblrpo CA 93'101-524O
CERTIT'IED T,JNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORMi
t; l""lq't i4',)
DateJ j /U",'r '
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BUSINESS PLAN
Bnsiness plan is complete, current & avallable during inspcction (HSC 25503.5, Title 19 CCR 2729,
Inventory of hazardous materials is complete (HSC 2551X, Title 19 CCR2729)
Site layouUfacility mape arr accurete (HSC 25504, Title 19 CCR'2729)
TRAINING PLAN
Facillty has approprlate training program (Title 19 CCIf-lii/3L& 22 CCR 66265.f6)
Training docunrentation is maintained on site for current pcrsonnel (Title 19 CCR2732 & 22 CCR
ffi255.151
EMERGENCY RESPIONSE PLAN
Contingency plen is complete, updated, and maintained on site (HSC 25504' Title 19 CCR n3l & 22
ccR $ 6626s.s3/54)
Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or relesse of
hazardous materlalVwrste consdtuents to the environmenL Malntains dl requircd or appropriate
equipment including an alerm and communications system (Title 19 CCR 273f & 22 CCR6626531-.43)
ABOVEGROT]IID PETROLEUM STORAGE TANK ACT \
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR f f2.5(b))
SPCC Plan is maintained on silebr nearrcst lield ofrice. (IISC 25270)
IPfrdrt#
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CITY FIRE
AGENCY
E EHS
INSPECTION TYPE
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Reinspectlon
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Bugincgg Plan ,Sxwco","ro,Elusr fl rcr EcnuapPROGRAMS INSPECTED:
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\
COMMENTS Goro to obtain forms to comply with BP0I-8P03, TROI and ER0l
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{,t ,ir'u.FACILITYINSPECTOR:
\Temp\c.lotus.notes.data\1 *lnspection Form Page 1.doc 24-Jan-O6
fi
,FACILITY
EFAIDITUMBER:
Tlercd Permit:
Treahent
Equipment:
HAZARDOUS WASTE GENERATOR\
ftLt
Lbs or gnls
(average)Total eeneratod/mofth. ^
wastc-oir: t/ s"l"""E t/
Antifreeze: Othen:
YES --NO N/AW E Er
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GTO4
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EPA IDNO/PERMITS
Generator has an EPA ID number to hcat, store, dispose, transport or transferhazardous waste (fitle
2:2CCR9ffi2ff2.12) If No! CaIl (E00) 61E-6942ta obtaln your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
nnzardous waste detemination conducted (Tltlet2 CCR $66262.11)
ffo.ohowledge Eanalysf Eother
ftbzaraous waste analysigt€st rccords are kept for at least 3 years (litlitZ CCR $56262.40.(c))
DISFOSAI,/IR,ANSPORTATION
Ifazardous wastes were transportcd and/or disposed to a facility with an EPA ID NO. and pemit or
Msnifests and/or receipts are properly completed/retained by g€nerator for 3 yean (Title 22 CCR
96f'263.{U ffit62.23)
STORAGE AND MANAGNMENT OT CONTAINERS/TAI\KS
Hazardous wastcs are accumulated on site as follows (TllleXL CCR $6625234)
4s0 days if waste generated per month is greater than or equal to l00 kg (220 lbt")
E fm Aays if waste generated per month is less than llXl kg (see noie)
E ZZO aays if waste generated per month is less than llXl kg and transported more than 2(X) miles (sce
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13t00 lbs.)and no
acutely/extrcmely hazardous waste over 1 kg (22 lbs.) is held on site for over 90 days.
rrnznrdons wsste 'tatellite" collection is managed properly (complete labeling/accumuladon timc/ss-gat
or l-qt limtt) (fitle 22 CCR $662.623(c))
Ignitabte or reactive wastes are located 15 m (50 feet) from facllity's property line (Title /2 CCR
9ffi265.176'
Containers of hazardous waste are properly labeled (includes appropriate dste' 'IIAZARDOUS
\ilASIts 'waste compooition/physical state, hazardous properties, name/address ofgenerator) (Tide 22
ccR $6625231,ffi262.9)
Containerr/tanks containing hazardous wastes are in good condition/handled (p ninimizt release or
reaction (Tltle 22 CCR $66255.17U.191, 6C265.177 (c))
Containerdtankdliners arte compatible with waste storcd or transferred (TltleX2 CCR$66265.172)
Containers storlng hazardous wastes are dosed/sealed (fitte 22 CCR $66255.173)
lVeekly inspedioh ofareas where hazardous waste containers are storpd is conducted
(fitle X2 CCR$66265.174)
Daity tnspection of all tank systems is conducted and documented (TitIeI2 CCR $66265.195),
Empty containers or inner linen greater than 5 ggl has date when empded and are managed properly
within one year of ilate emptied (Title Zl CCR $66261.7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling storage' etc) (HSC
$2:r2s0.4)
Used oil fllters for recycling are managed properly (drained offree flowing liquid. stored in ctosed
rainproof containerr labcled "drained used oil filtersrtt and transferred for metal redamation) (Tltle?.i2
ccR$ 66266.il11))
Spent lead-acid battcries are being properly stored and transferrcd ofrsite under manlfet or bill of
lading for recycling, reuse, or reclaqration (TilleZ2 CCR $66256.8f)
Solventdother recyclable materials are managed as hazardous wastes until rccycled (Title 22 CCR
$662663)
SO(IRCE REDUCTION: For facllities generating >12,0fi) kgJyr. of hazardous waste on site.
Generator is subject to SB14 and hns preparcd and retained current source reduction documents or is
able make them available to the inspector within (5) days" (HSC $25244.19,?,52.44'21)
Source Reduction Evaluation and Plan contains the following ffve elements:
cerdficadon, amounts of wastes generated, proces descripdon, block diagramsr and implementation
schedule of selected source reduction mealures. (HSC S25244.19)
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1\Repro\LOCALS-'l\Temp\c.lotus.notes.data\2*Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04
Environmental Health Services
(805) 781-s544
P.O. Box 1t189
2156 Sierra Way
Sen Luls Obispo, CA 934116
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sanuls
Flre Deparlment (805) 781-7380
2160 Santa Barbara Avenue
San Luls Obispo CA 93tt{11-5240
.r.,..,ri. , ir',
Date:....i -..i., ,''
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
, HAZARDOUS MATERTALS TNSPECTTON FORM
' .':EFW data
entry by:
Time:
YES NO N/Annlnnrtrn!
!n
BPOl
BPO2
Bm3
TROI
TRO2
EROl
ERO2
ATOl
ATO2
BUSINESS PLAN
Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR2729)
Site layouUfacility maps are accurate (HSC 25504, Title 19 CCR272I,
TRAINING PLAN ] i
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR (fi265.16)
Training docurnentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
66265.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR1,,731 & 22
ccR $ 6626s.s3/s4)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release of
hazardous materialVwaste constituents to the environment. Maintalns all required or appropriate
equipment including an alarm and communications system (Title 19 CCR 2731 &22CCR66265.31-.43)
ABOVEGROTJND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 1f2.5(b))
SPCC Plan is maintained on site or nearest field oflice. (HSC 25n0)
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TYPE
PROGRAMS INSPECTED:S Business Plan ffxw Generator E usr El acr Ecat.enp
REINSPECTION REQUIRED:tr'NO I YES E Business Plan E xw Gsnerator E usr E ncr Ecer-nnp
COMMENTS .htm. to obtain forms to comply with BF01 TR01 and ER0l
GPS Latitude: deg mrnmln
FACILITY REP:INSPECTOR:
C:\DOCUM inepro\t-ocntS-'I \Temp\c. lotus.notes *lnspection Form Page 1.doc 24-Jan-06
FACILITY
EPAIDNUMBER:
Tiered Permit:
Treatment
Equipment:
ADDRESS
HAZARDOUS WASTE GENERATOR
'l
Lbs or gals
(average)Total generated/month :
Waste oil:Solvents:
Antifreeze:Others:
YES NO N/Ann n vrol.#
GTOl
GTO3
GTO4
GTO5
GT06
GTOT
GTOS
GTO9
GTlO
GTl1
GT12
GT13
GT14
GT15
GT16
GT17
GT18
GT19
GT2O
GT2I
GT22
GT23
EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR566262.12) If Not, Calt (800) 618-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title 22 CCR 966262.11)
nown knowledge [analysis Eother
Hazardous waste analysis/test records are kept for at least 3 years (Title22 CCR $66262.40.(c))
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and,/or disposed to a facility with an EPA ID NO. and permit or
authorization from DTSC (HSC $25189.5, Title ?2CCR966262.12)
Emittrun lother
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
s66263.421 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title22 CCR $66262.34)
n 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.)
E fSO days if waste generated per month is less than Ifi| kg (see note)
fln0 days if waste generated per month is less than 100 kg and trarsported more than 200 miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6ffi0 kg(13,200 lbs.)and no
acutely/extremely hazardous waste over lkg(@,2lbs.) is held on site for over 90 days.
Hazardous waste "satellitet' collection is managed properly (complete labeling/accumulation time/S5-gal
or l-qt limit) (Title 22 CCR &66?,,62.34(c\l
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
$6626s.176)
Containers of hazardous waste are properly labeled (includes appropriate llate, "HAZLRDOUS
WASTE,''waste composition/physical state, hazardous properties, name/address of generator) (fitle 22
ccR $66262.31, 66262.34)
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or ,
reaction (T itle 22 CCR $ 66265. 17 I l.l9l, 66265.17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (TitleZ2 CCR$66265.|72)
Containers storing hazardous wastes are closed/sealed (Title 22 CCx- $66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted
(T itle 22 CCR$66265. 174)
Daily inspection of all tank systems is conducted and documented (Title 22 CCx. $66265.195),
Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly
within one year of date emptied (Title 22 CCR $66261.7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
$2s2s0.4)
Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed
rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title22
ccR$ 66266.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (Title22 CCR 566266.81)
SolventVother recyclable materials are managed as hazardous wastes until recycled (Titte 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 92524.19,252U.21)
Source Reduction Evaluation and Plan contains the following live elements:
certification, amounts of wastes generated, process description, block diagrams, and implementation
schedule ofselected source reduction measures. (HSC 525244.19)
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C:\DOCUME-1\Repro\LOCALS-'1\Temp\c.lotus.notes.data\2_,Hazardous Waste Generator.doc 2Q-JulO4 2A-Jul-04
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