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HomeMy WebLinkAbout4120 Horizon Docst--* ) 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 ,) 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 n nnnn nnnn nnnn BPOl BPO2 BPO3 TROl TRO2 EROI ERO2 ATOl ATO2 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 F fr F F fi ,F. wt/ n W w ac W ff, Wn n ! D un ! n n nn NOn tr tr nn n n n n GTl2 n cos N/ATT EI vIoI,. # GTOl GTOS GTO4 GTO5 GTO6 GTOT GTOS GTO9 GTTO 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) nntrn I I[]' ntrtr untrn unnntr tr E" D n ! trtr! ntr n W" { tr F ,a'hl t\f {,,, / ,,i tI I --) 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 ntrutr FACILITY E: I fu AGENCYtr EHS AG DEPT CITY FIRE nj,ar INSPEGTION TYPE 'E1-nffi"--nI Gomplaint tr 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 GTOT GTOs GTO9 GTlO GTl1 GTl2 GT13 GTl4 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 E F" tw jn {..8 i"Er n oE"' tZo' -El' E^a' ;tr Ld."E' l@'- tr n tr ntr n n d n T n nntr un tr tr tr u u!u trtr n tr n n u tr nnn nn 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) Jr- un tr F"J ! n crrs E} crre fr'*"erzo n cr2r tr n n n GT22 GT23 {fil, d '-\ 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 \ FACILITY NAME: ADDRESS AGENCY tr' EHSn ec DEPT . [7-crtv nRelr 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:,{ a'tr COS N/Anffin tn,nin YESnnn BPOl BPO2 BPO3 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) -iia rRor 1,7 TRo2!4 ,bl ERol I .1,' ER02ilre)v ATOl ATO2 COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/hazardous materials.htm,to obtain fonns to comply with BPOl -8P03, TROl and ER0l -4 , f..'i \...,, FACILITY {.tlfMFACILITY NAME EPA ID NUMBER: Tiered Permit: AD HAZARDOUS WASTE GENERATOR Icrsw ncaser nca npnn Total generated/month: rhftqik 1M'\ a7T (r Solu"n* Lbs or gals (average) Treatment Equipment:Antifreeze:Others: 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 ttr'' n tr T fn E 'E ae B, -E- p" I n nnn tT I Tn E- tr n tr T u T }ET* n ffi p" Du' ., E'_ w-" iw' El'* gE, W ra" tr n T n VIOL. # GTOI GTO3 GTO4 GTO5 GTO6 GTOT GTOs GTO9 GTlO GTlI GTI2 GTI3 GTl4 GT15 GT16 GT17 GTIS GT19 GT2O GT21 $4 GT22 M' cr23 4 , i,.1 h rf;l\,j'r.i d-r /JvAreh.la\ 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 ' Time: YES NO N/Aa, tr n4.. tr n@'un trtran. F' t' ..d,z nEtr n ntlrn d:,,,,'w BPOT Bm2 BPO3 TROI TRO2 EROl ERO2 ATOI AT02 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# 8' CITY FIRE AGENCY E EHS INSPECTION TYPE H"tr trtr Routlne Reinspectlon Other Bugincgg Plan ,Sxwco","ro,Elusr fl rcr EcnuapPROGRAMS INSPECTED: E nw Gansrator f E usr I lcr !cr-naeREINSPECTION REQUIHED:M no DYES{\fl Euriners Plan \ COMMENTS Goro to obtain forms to comply with BP0I-8P03, TROI and ER0l deg ll i'min mtnGPS {,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 dn r.V tr N C D n W N Tw n n V-n vIoL.# GTOl GTO3 GTO4 GTOs GTIb GTffi GTOS GTOII GTlO GT11 GT13 GT14 GT15 GT16 GT17 GTlE GT19 GT2O GT2I GT22 GT23 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) tr n GT12 nd { V n n tr n n ! trd {ad!trVa'ndraW! d tr 8,. TI 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 ffiispo -tr ,^) cftyo[ 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) ntr ! tr nT 'Go to un n tr nu nn ! FACILITY '-t:..." ADDRESS PHOdH U CITY FIRE AGENCY E exs Routine Reinspection ! Complalntn otner 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) !n n nu n tr n n n utrtr n n n nnn nn n n n n n n tr C:\DOCUME-1\Repro\LOCALS-'1\Temp\c.lotus.notes.data\2_,Hazardous Waste Generator.doc 2Q-JulO4 2A-Jul-04 n