HomeMy WebLinkAbout4096 Horizon Docsl-
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I MNFORM-
CALEI{DAREARBEGINNING (I)
BUSINESS
NAME
ENDU{g.(2)DEC3J.,t99j (3)PAGE r OF
Ar f,nusqnir-<BUSINESS
PHONE (5)
JAli r,
srIE
ADDRESS
CITY
DtIN&
BRADSTREET
OPERATOR
NA}IE
(4)
(o
a
00)
02)
b
.1",.^ [-.r'. r- db""s: .o sf,ATE (8)CA n {e)
slc coDE(4DrCIT#) (11)
*+-*.-)n u-t2yS I oT*r oPERATORPT{ONE (t3)
I
ONNITER INFOR}TATION
OVN\TERPI{ONEO'oWNERNAI,IE (14)
OVAIERMAIIJNG
,IDDRESS
crTY 07)
(10
STATE08)Cl zP(19)?a{aa/
ENVIROIYMENTAL CONTACT
CoNTACTNAITE (20)CoNTACTPHONE(2r)- -
MAILTNGADDRESS (2'
CITY (23)/.-= STATE (24)b ?34t>re (6)
EII'IERGENCYCOITTTACTS
NAI4E' Aq f, r,^*lp Glt,NAIvtE (31)
Tmr Q2'Ptc{r=dcf ./ara E}L
BUSTNESSPHONE (28)542- 7930 BUSINESS PHONE (33)-f-/? - ?23 6
TTrLE e7)
24-HOURPHONE Q9)
PAGER# (30)
24.HOT.'RPHONE (34)
Dde (40)6-y'- fl
l-Jves lXlxo
PAGER# (3'
ACTITELY EAZARDOI'S MATERIAIS (AIIM)
If ycs, and abovc Thtcsbotd Planning Qrotitics, 'rtach a shcst
pocess and principal equipm€ntONSITEAIIM (3O
ADDMONAL LOCAIIY COLLECTED IMORMATION
Ccrtilieation: I certi$ under peudty of law ttat I have pcrsondly erarnined and em familiar wi& tbc
believc the informadon is tnre, accurate and completc.
PrintName ofDocumcot Prcpacr (38)
'r-o/'>
0 1999AUG
E
Sigarure of Ovmer/Opcraor
o:"n*xumenrs!,ipt'el''forms:'oflice9,Rlrns',i:tFs.dos {.n-1i9$
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to
FORII I - San Luis Obispo County Hazardous Material Unifred Program fnventory Form
Chemical Description Page
(see instnrction page 19
(1)PAGE (2)e
GRID#(6)
AND NOT SUBJECTTO PUBLIC DISCLOSURE
oF (3)
J-8
BUSINESS t,lAME
CHEMICALLOCATION (4)
- MAP#(s)/
CHEMICALIi|AME C/)
coMMoN ttlAME (8)
cAs#(si.
TYPE (12)
PHYSTCALSTATE (13)
FI,AZARD CATEGORIES (1 6)
Sf,ATEWASTE CODE (17)
DAYS ON S|TE (18)
T-ARGEST CONTA|NER (19)
SToRAGE CONTANER (24)
STORAGE PRESSURE (25)
STOPAGE TE!,TIFERATURE (2e)
CHEIIIICALLOCATION lS
l-lsouo l-luoulo .Elcas
uNrs e0)
3L{I EHS arnounts must be in lb.
/2{
F}AZARDOUS
Itl$( DAILYAMT(21)
AVG DAILYAMT (22)
ANNT,TALWASTEAMT (23)
IF EHS BOX lsNr
AIAMOUNTS MUSTBE IN LBS
pCURIES
3/6
/2y'
CAS NUMBER
IRADE SECRET (10)
EHS (11)
1-1v tr(h,r (15)MDTOACTTVE(14)
RELEAS'E HEALTH HEALTH
AfuIBIENT AMBIENT
.AIJEIENT AMEISNT
EHS
1
2
3
4
5
I
![, FT
rONS
DRUM
CAR
WAGON
BOTTLE
BOTTLE
DRUM
GROUND TANK
GROUNDTANK
INSIDE BU]LDING
DRUM
t06 NY RIN
l-lv [-ltt
[-]v Ex
l'-lv l''lu
l-fv l-ht
z{y'a - 3>- /
(31) ADDffiOMI LOCATLY COLLECTED INFORI\,IATION
1.+Ad4ted &on OES Form 2730 05114198 o:.docrnag1tt.1poel:Ji)rms''.ofi icairLi'omrs\ fi rn-I.doc *24,'98
FORM I - San Luis Obispo County Hazardous Material Unilied Program Inventory Form
Chemical Description Page
(see instructionp€e l9
(1)Iknoo l-lper-erE l--'lnEuse PAGE (2)oF (3)/z1
BUSINESS nlAME
CHEVIICALLOCAION (4)
. MAP#(5)GRID# (6)-/O
CHEMICAL LOCATION IS CONFIDENTLAL AND NOTSUB'ECTTO PUBUC DISCLOSURE
I
CHEMTCALMMET/)
coMMoN ltlAME (8)
cfs #(s)
TYPE (12)
PHYSTCALSTATE (13)
I'TAZARD CATEGORTES (16)
SIATEWASTE CODE (1A
DAY€ONSm(18)
TARGEST CO!{IA|NER (1 9)
SToRAGE CONTANER (24)
STORAGE PRESSURE (25)
STORAGE TETVIPERATI,JRE (26)
IRADESECRET(10)
EHS (11)
RADIOACTIVE (14)l'-]v llln (1s)
IF EHS BOX IS Y
ALLAMOUNTS MUSTBE IN L8S
pCURIES
uNtTs (20)//6Il,lA( DAILYAMT(21)
AVG DAILYAMT (22)
ANNUALWASIEAIVT E3)
EHS
9G{f EFIS arEmts must b€ ln lD"
//c
ToWTAI
,/n
COMPONENT CAS NUMBER
1
2
3
4
5
RELEASE HEALTH HEALTH
GROUNOTANK
GROUNDTANK
DRUM
INSIDEBUIU)ING
DRUM DRUM
CAR
WAGON
BIN
BOTTLE
BOTNE
AMBIENT ATI,IBIENT
AI,IBIEt{T AMts!ENT
Cr*r l-,^^ D,'n i)e Flr Pln
f-Tr l"l tt
l-llv tru
fv Ex
l'-Tr, l-ltt
/;241-38 -9
(31) ADDmOML LOCALLY COTTECTED TNFORMATION
4Adryted fiom OES Form 2730 0544/98 o:idocument'jpoetti)rms:'o{ice9ifomrs\ lrm J. doc'1124, 98
FORM I - San Luis Obispo County Eazardous Material Unified Program Inventory Forn
Chemical Description Page
(see instnrction page tD
i
(1)Pfnoo f-]ber-ere f-]Rer sE PAGE (2)oF (3)A/
BUSINESS l\l.AME
CHEMTCALLOCATTON (4)
.MAP#(O
\
GR|D#(6)Cc-?
CHEMICAL LOCATION IS CONFIDENTLqL NOTSUB'ECTTO PUBUC DISCLOSURE
U*LL
/
CHEMICAL I.IAME C4
coMMoN ttlAME (8)
cAs#(e)
. TYPE(lz)
PFTYSTCALS|TATE (13)
HAZARD CATEGORTES (16)
SI'ATEWASTE CODE (1?
DAYSON S|TE (18)
|-ARGEST CONIATNER (1 9)
SToRAGE CONTANER (24)
STORAGE PRESSURE (2O
STORAGE TEMPERAT!.JRE (26i
ToWT I.IAZARDOUS
[-'lsouo [']uouto Elens
3bs , trEHS arFunFfirustbeinlb"
963
TRADE SEQREf,(10)
f-'lv RIn
lilA)( DAILYAIIIT(21)
AVG DAILYAMT(22)
ATTINUALWASTEAMT (23)
EHS (11)
tF EHS BOX tS -r
AIAiNOUIITS MUST 8E IN tBS
pCURIES
,9L4
J83
NUMBER
RADTOACTTVE(14)(1s)
Mnne l-''lnencrve ElFnessunenELEAsE fhctmneru-n EcrnonrcuEeml
UNITS t20)
f"lnueuvr KReove nn rBtENT ElBELow AITIBIENT
AMBIE}.IT AMBIENT
EHS
2
3
4
5
Ct, FT
roNs
DRUM
CAR
WAGOt{
BIN
BOTTLE
BOTTLE
DRUM
GROUNDTANK
GROUNDTANK
INSIDE BUILDING
DRUM
loo ^RIv l-ln
l-lv l-l N
trlv tru
l-tv i-'ltt
l-lv l'lN
72a24"/?
(31) ADDmOML LOCATLY COLr ECTED TNFORMATTON
4Adaptcd frorn OES Form 2730 05114198 o:,doanaent'f poel'Jirrmsioilicegi.tbmu\&mJ.do c 1i24i98
unty --4 -hdous
APPENDIX C
Material Inventory Form - -.mical Description Page
(1)l.]noo l-loeure [-l nevise PAGE (2)tr oF (3)
BUSINESS MME:
CHEMTCAL LOCATTON (4)
" MAP # (5)GR|D # (6)r/4 - 9-
CHEMICAL LOCATION IS CONFIDENTIAL AND NOT SUBJECT TO PUBLIC DISCLOSURE
/r?,-
/
CHEMICAL NAME (7)
coMMoN MME (8)
cAs # (9)
wPE (12)
PHYSTCAL STATE (13)
HAZARD CATEGORIES (16)
STATE WASTE CODE (17)
DAYS ON S|TE (18)
LARGEST CONTAINER (19)
SToMGE CONTATNER (24)
STORAGE PRESSURE (25)
STORAGE TEMPEMTURE (26)
PETROLEUM HYDROCARBON
PROPANE
74-986
flpune Xlutxrune l-lwnsre
l-lsor-ro Xllouro [-'lces RADTOACTTVE (14)
uNrTs (20)
36{lf EHS amounts must be in lb.
t?*
TRADE SECRET (10),/,
[-"lv XlH
MAX DATLYAMT(21)
AVG DA|LY AMT (22)
ANNUAL WASTE AMT (23)
EHS (11)
IF EHS BOX IS "Y'
ALL AMOUNTS MUST BE IN LBS
pCURIES
/25L
/ ?J2-
74-98-6
7+U4
106-974
(1 5)
o/oW
AMBIENT AMBIENT
flRtrdsteNr l-lneove AMBI ENT XlgeLow eMsreNr ncRvocENrc
HAZARDOUS COMPONENTzt
/h
2
3
4
5
EHS
l-lv Xtt
l-lv X r.t
l-iY X1r.r
l-lY l-lt't
l-lv [lN
HEALTH NIC HEALTHFIRE
GROUNO TANK
GROUNO TANK
K INSIDE BUILDING
DRUM
DRUM BER ORUM
CAR
WAGON
NDER
BIN
BOTTLE
BOTTLE
PROPANE
ETHANE
BUTANE
(31) ADDMONAL LOCALLY COLLECTED INFORMATION
Adapted from OES Form2730 Mll7l98 O :\document\jpoelVorms\pro pane. doc
San Luis Obispo County Ha;'-'' -)rs
Materials Unified Program Age'- '*l
FORM M - MAP GRID (seeinstructionpasev)
Scale: 1 inch = p, Feet
lMap #
1
2
3
4
5
6
7
8
I
10
11
12
13
14
A
I
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t
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B c D E F G H J K L M N
1
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4 B*h-loT 2
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4 3
4
5
$
$
b\l
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6
7
8
I
10
11
12
e*b- I)oXiute-
Art4s^
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FMotqlr @ svil-l- A^e:*-vlf>6a
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D E F H K L M N
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Business Name:H I fitbrt Et>Date: b-€-?1
Address 401b JL^rr-, /,-..<'14^ (-
Number of Employees in Facility Depicted Above - Day = 5 Night = /Page L of r*
a.
- EQRM E
))
SAN LUIS OBISPO COUNry HHzT,xDOUS MATERIALS UNIFIED PROtrn 'rvl
AGENCY
EMERGENCY RESPONSE PLAN
Or Hazardous Waste Contingency Plan
(see instruction Page vii)
Page 7 o1 /&
Date: 6 - ./- ??
SECTION l-A: BUSINESS IDENTIFICATION DATA
4frrDd-s FA
BUSINESS MME
SITE ADDRESS CITY ZIP CODE
Qfs -.,-a
FACILITYUNIT TELEPHONE NUMBER
BUSINESS MAILING ADDRESS CITY zrP co0E
If.your busrness has a license or permit from any of the following agencies,,.please indicate ilte document number.
1. Hazardous Materials
Underground Storage #
2. Hazardous Waste
Generator #
3. Air Pollution Control
District #
4. Responding Fire Dept
& Permit #
Please provide the following information as it pertains to your business and its location. You are not required to notiff these
companies in the event of an emergency. This information is provided for your reference and to assist emergency response
personnel in responding to a hazardous materials emergency at your facility. List the name and phone number of the utility
company.
ElectricService Telephone#
Telephone#
Telephone#
Telephone#
?-A o- "c/3- Sffi
Gas Service 4, A*s z
78/-?3t>
Sanitation
Water District
SECTION l-B: OWNER CERTIFICATION OF DATA (Certify either 1 or 2l
1. This is a ftrueW Rnn IUeOATED Existing Plan. I have personally examined the information it contains and am
familiarwithihdoperationoftheplan. (lfyoucheckeitheroftheabovetwooptions,continuetocompletetheremainedofthe
Emergency Response/ Contingency Plan).
Z. X fnis plan requires no change and is on file with San Luis Obispo County Hazardous Materials Unified Program
Agency and does not need any change. (lf you check this section, please proceed directly to Form T, the Training Program.)
I certify under penalty of law that the above information is true accurate.
NAME OF O\^NER OR OPERATOR
SIGNATURE
DATE
- s-4
DOCUMENTS PREPARED BY DATE
--f- 7 1
SECTION ll: EMERGENCY RESPONSE PLANS AND PROGEDURES
of /2-
Note: Complete all sections of this Emergency Response Procedure below. Use of terms such as "N/A' (Not Applicable) will not be accepted.
A. FIRE, SPILL OR RELEASE: The fire code requires immediate notification through dialing 911, by whoeverfirst
sights the incident. ln the event of release or spill of hazardous materials,you must also notify:
1 . San Luis Obispo County Hazardous Materials Unified Program Agency during business hours @ 805-781-
5544. Afterbusiness hours dial911.
2. The State Office of Emergency Services - (800) 852-7550 or 19161262-1621.
List the individuals responsible for verifying that these calls have been made and also indicate their position in
yourcompany.
FORVERIFYINGTHE DIALING OF 911:
NAME POSTT|ON
lndividualresponsiblefor calling San Luis Obispo County Hazardous Materials Unified Program Agency and the State Office of
Emergency Services: (Normally the Emergency Coordinatorof your business.)
POSITTONNAI\4E
B. List the local emergency medical facilities that will be used by your business in the event of an accident or injury caused
by a release or threatened release of hazardous materials.
NAME ADDRESS CITY PHONE
MME AODRESS clry PHONE
C. List the Emergency Coordinator(s) at your facility.
Primary:
TTTLEMME BUSINESS PHONE 24 HR PHONE PAGER#
Secondary:*
TITLEMME BUSINESS PHONE 24 HR PHONE PAGER#
D. Does your business have an on-site emergency response team? [Ves ElNo lf yes, describe procedures your
business will follow to notiff your: on-site emergency response team in the event of a release or threatened release of
hazardous materials.
5
E. lf you have acutely hazardous materials above threshold planning quantities, list (by name and address) adjacent
neighboring businesses and residences, schools, hospitals, etc. lnclude sensitive facilities (schools, hospitals and
rest homes) within 1,000 feet (straightJinedistance from your property line). List telephone numbers for all
businesses; for apartment buildings, list manageds phone. Do not list telephone numbers for private residences.
F. Briefly describeyour standard operating procedures in the event of a release or threatened release of hazardous
materials. Emergency response procedures must comply with all Federal, State and local regulations. (Use additional
sheets if necessary. Use our format if computerized.)
1. Prevention -- Describe the accident potentials associated with the hazardous materials present at your facility. \Mtat
actions would your business take to reduce accident potentials? lnclude description of safety, storage and containment
procedures.
2. Equipment - List the emergency response equipment at your facility (e.9. fire extinguishing systems, spill control
equipment, decontamination equipment). lnclude summary of maintenance procedures.
Item Maintenance Procedure
rt.nz
3. Evacuation - Describe how you will immediately notiff and evacuate your facility. What communicationsor alarms are
Use Location
6,,to Crr.*l l^)all . J.<J^-.-
ilrl.^'., {irirr.D,*v
tlrf/zrrrrru.ir-
w
used? Howwill you operate these d rfailure?
G
Z,rr.
-!Page/O oJ /2-
4. Shutdown .- Describe the shutdown for each site or facility
5a. Response - Describe what is done to lessen or mitigate the harm or damage to person(s), property, or the environment,
and prevent the event from getting worse or spreading. What is your immediate response to:
Fire:.{
Spill:
Severe Ground Motion:
Major Power Failure:
Flood:
b. ls this located on a {O0-yearftood plain?. [Ves KNo
c. Ground Motion - ldentifo facility areas and list mechanicalor other systems that require immediate inspection or isolation
because of their vulnerability to earthquake related ground motion.
6. Clean-Up (Remove the Hazard) -- How do you handle the complete process of cleaning up, and disposing of related
at yourfaci Note:Notify the Hazardous Materials Unified ProgramAgency when clean up is
G. Location -- Your business is required to keep a copy of the Business Plan and related MSDS sheets on-site. Describe
where this information is located.
?
.t.
)
FORM T
SAN LUIS OBISPO COUNTY FIAZARDOUS MATERLALS UNIFIED
PROGRAMAGENCY:.: EMPLOYEE TRAINING PROGRAM
Page t/ ot e
Date:?>--?1
A - Descdbe the safety prccedure hining for all employees ln the event of a rctease or trreatened release ofhazardous materiats. Thb training strafl inctuds 6ut not ne fmrco to;th" brd;;gii.*iiiployee tnining,
ltnual training, periodic rEfrcsher soulBes' and hmiliarEafionwith Emergency Phris anC proceO:urpe of thiiBusiness Plan / Contingenry Phn.
' 1- Sumrnarize speciFc job descriptions for all posilions that work wih or come in conFct wi$ hazardous materbls/haardous tJuaste and indicate how hese specific positions are tained br theirjob responsibilitiesor hazards of
"r.po"ure(desoibe taining program). Designate whether employee ls working witt dzardous material (HM), haardous wasb(l{W}, orboth (B)- * r,.-
I
Z Summadze tiahing specific b smergency rcsponse personnel that deal wih eiher hzardous material or hazardous
waste release or threatened relese.
o:Hocnment\ipoel\fonnstof6ce97lfiormslfrrn-t @4/98 - 1 :47 pm
l!
'I
a
ol ,/a-
3' lndicate ftequenry and duration of baining for each type of employee noted above (a table may be used).
..-+
+
4. lndicab hor your business facilitabs employee access b tsaining matedals. (e.g., bulletin board, employee ne'arsleter,
staffmeetings, eb.)
B. Lltst the personnel in charge of training and indtcate quallfications of pesonnel conducting the t:aining.
C' lndicate where rccords are kept Rectrds must document taining including baining duration and completion dates,
names and positionsof employeesreceivingfaining, and he name(s) of insfr,rctors/bainer.
r-1 o:kocument\ipoef\fo rms\orff ce97\forms\frrn-t 4/24198 1 :47 prn
An<,-$-si l\$ $r1 '/\tD in:qrcA;sf ic,,,{ I \A1 [tttl
San Luis Obispo Gounty'Hazardous Materials Unirred Program Agency
FORl'l D - HAZARDOUS MATERIALS DISCLAIMER
for.CA Hea'lth & Safety Code, Chapter 6.95
A.t,,tBusiness Name:
Signatu re:
o l\4 Phone: (&dlt 5t l-Tlla
SiteAddress: tl\?[ lJ"rizr2,r Ln- 5'J.City:/-uiz 0 L,
MaitingAddress: L{A ? 6 lt".izra Lo^"9^t /*B Cirv:. 5n /*,t Ll,Vo
State: IJ- Zip Code: ct b Llo I ,*
coMpLETESECTIONSAAND B. lf noneof thenumbereditemsapply,youmustcomplete andsubmita HazardousMaterials
Disclosure Business Plan to: within San Luis Obispo city limits: all other cities and unincorporatedareas:
' City Fire Deparlment San Luis Obispo County UPA
attn: SpencerMeyer attn: ManuelNegrete
2160 Santa BarbaraAve. PO Box 1489,2156 Sierra Way
. San Luis Obispo, Ca. 93401-5240 San Luis Otiispo, CA. 93406
I
A. HPZ+RDOUS MATERIAU1ruASTE lCheck appropriate statement(s)] :
d t This business does not store, use, or handle any hazardous material or hazardous waste in any quantity. (lt is
YOUR RESPONSIBILITYto determine via the Califomia Health & Safety Code and/or the material supplierwhether
/ a given materiator waste should be classified as hazardous'),/
d Z. ff,i" business does not store, use, or handle any hazaidous material at any one time during a calendir year in
quantities equal to or greaterthan 55 gallons of a liquid, 500 pounds of a solid,.or 200 cubic feet of a compreqsed
. ,/ gas at standard temperatureand pressure. .
,/fl S. ff,i" business does not store, use, or handle any hazardous material in any quantity exceeding-the increased
threshold reporting levels as provided by either stite or local exemptions. Refer to the Business Plan Exemption
,, Reference Sheet for a list of hazdrdous materials in this category../
fl +. fnir business does not store, use, or handle any hazardous materials in any quhnti$ except materials packaged
-,/ solely for direct distributionas a consumerproducl to the general public.
fr s. This business does not store, use, or handte any hazardous material in any quantity excePt materials contbined in a
rail car, rail tank car, rail freight container, marine vessel, or marine freight containerfor no more than 30 days. We
/ will immediately notify the local fire agency of their anival. ' :
M O. This business does n9t store. use, or handle any hazardous materials except those under shipping orders while in
transit. We do not store these materials in a fixed facility for more than 30 days while in the course of transportation.
B. ACU_JFLY (EXTREMELY) HAZARDOUS MATERIAL (Check appropriate statement): 'i
dfnit business does not store, use, qr handle liqy acutely/extremelyhazardous materials or any mixture containing an
, acutely/extremely hazardous mate{al in g4y amount.
{rn "uusiness fl nas submitte adn *a*it^H acutety hazardous material registration form.
Under penal$ of law, I declare that the information is true and conect and
Hazardous Materials Unified Program Agency must be notified lf the operations
way to make apy of the above statements inaccurate.W C^J,/
understand that the
or p/ocedures of this
I
: I Date: 9
San Luis Obispo CountY
business change in such a
,7
?
Print or
type name:
P..
r"ol Jh+Phonq:&os-1 7- 1/3il
c-Title
\\30O0AWOL1\COMMON\WP\DOCUMENilJPOELIFORIVTS\OFFlCE97\DlSCl-AlM\FRM-D.DOC 20-Oct-98
Division of Envir: rental llea!!!l
(805) 781-5s44
P.O. Box 1489
2156 Sierra Way rSan Luis Obispo, CA 93406
Department of Aqriculture/lVleasurement
Standards (80s) 781-s910
2156 Sierra Way Suite A rSan Luis Obispo, CA 93401
cir of San Luis Obis
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
Utilities Department r (805) 781-7215
879 Morro Street r San Luis Obispo, CA 93401
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HMARDOUS MATERIALS INSPECTION FORM EFW data
entry by:Date: 71ll 1o;\
Time: A qeo
FACILITY ID NO:AGENCYffiEHn acDEPTn crrv nrnntr crrv UTILITIES
INSPECTION TYPE
E- R""tt""
-! Reinspection
n Complaintn otn"t
FACILITY NAME: Ar^1c
.T T
ADDRESS:4fSq{, l4r1 2..,,^ l*.,,.o .}fC,
(-
PHONE 5v c,'
PROGRAMS INSPECTEDI K Business Ptan n HWGenerator n usr I acr ! Tiered Permitting
REINSPECTION REQUIRED:! NO Kvns E Business Plan fl Hw cenerator E usr n ncr I Tiered Permitting
PERMISSION TO INSPECT: Inspections nury involve obtaining photographs, reviewing and copying records, and determining compliance
with adopted codes. GRANTED BY (NAME/TITLE)
TT
NO
XE
tr
E
tr
E
tr
YESnnn
tr
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 layouVfacility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265.16)
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 CCR
2731 &22 CCR S 66265.53/s4)
Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of
hazardous waste to the environment. Maintains all required or appropriate equipment
including an alarm and comrnunications system (Title 19 CCR273[ & 22 CCR 66265.31-,43)
#(
BPOl
BPO2
BPO3
TROl
TRO2
EROl
ERO2
Reprc 1001 rev 1
,.; l;r.:
0:\DCCUMENl-\Jeffp\F*Fttv{$\[nspeetion fotrns\CUl"A inspe*tion {orms'doc l0-$ep-l}1
COMMENTS:
'h'e;t,
INSPECTOR:FACILITY REP:
COUNfY OF SAN LUIS OBISPO HEALTH DEPAHT
Division of Environmental Health
P.O. Box 1489, San Luis Obispo, CA 93406
zor-t L*. # A
,"\ENT Routine lnspection
Reinspection No.
Complainl lnvestigation _
Contact Pe Ane.:fesoo
Title/Posilio n: OtJgiN'@<-
:-1
,/805-78 1 -5544
Facility
Facilily
HAZARDOUS MATERIAL/UNDERGROU ND STORAGE TANK/WASTE GENERATOR
ION REPORT/NOTICE OF VIOLATION\e>7 zdl q?L
q
SLO
HMARDOUS MATERIALS (21
(CA H&S Code, Div. 20, ChaP.
#UNDERGROUND STORAGE TANKS (COMP # )
H&S Code, Div. 20, Chap. 6.7)
BUSINESS I.D. FORM ATL. #GENERAL
9ppfiv€
number
3. Location of utilities
INVENTORY
4. Hazardous material &listed
Material stored in proper containers
& labeled
containment
PLOT PLAN
8. Plot submitted
9.
10. Localion of materials
11
12.switches
Location & verification of
14. Sewer storm drains
area
16.tn
17.
18.
TRAINING
The above marked items represent violations of the California Health & Safety Code and the California Code of
2.
E
5.
6.
7.
ComViol
20. Permit to
21. I
22. Precision tank lesl
23. Leak detectors
TANK
roved24. Permit
closure25.
abandonment26. Removal/innot stored
Tanks
Tanks rinsed
WASTE GENERATORS COMP #reets &bu
27. EPA identification number
28. Variances and/or
29.
30. Wasle oil
31
32
33. Material stored in proper conlainers
& labeledPLAN
not stored34. lncom
35.90
36. Fire
37.containment
Regulations and must be corrected
I+AL sf<vaLc
E€ Sl.fBH rr -r/{€ €gs'i*ls>Ird g
SdD ce-YB ts €srA%qsA
S, CoHr2/6:€5@ E]l^/c'
lnspector's Signatu
Owner/Operator Sign
NfiE: Signature indicates of this document only and not an admission of the facts.
p"s" [ ",-..1-
PUBLIC INFORMATION REQUEST
Cour -r) of San Luis Obispo .'^LOUc F{ealth Agency
Public Heakh Departrnent
Enyironmental Health Division
2156 Sierra Way . P.O. Box 1489
San Luis Obispo, Caffimie 93406
(805) 781-ss44. FAX: (80s) 781-4211
Gregory Thgmas, M.D,, M,P.E.
Coutrty Eeslth Officer
P ub Ii c Ee alth-Age ncy D i/e cto r
Curtis A. Batson,
^ifrf;**
SAN LUIS OBISPO COUNTY
ENVIRONMENTAL HEALTH SERVIGES
This form may be used to submit a written request for public information contained in
the Department's files. A reproduction charge may be assessed based on the amount
of material requested. Up to 10 working days may be required to locate and compile
the requested information.
DATE OF REQUEST:L8 o>
REQUESTOR'S NAME:/"(d,,il.--
FIRM NAME:ko*",
F;RMADDRE5Sl Lt4{ y'.,2* f/ ,-f",/^ t-z
CITY, STATE, ZIP:t - lu "E C6, r/to C/l /34./
FIRM PHONE /nr)737- o3a7
REASON FOR REQUEST:/4ff( f<eacz ,qver/r o
BUSINESS NAME FOR REVIEW:/-n. /,1 t T,/1 /^.,/u"/","t
BUSINESS ADDRESS FOR 4rr( //,,,.^ L-. e fta
SIGNATURE:
O:\DOCUrvIENT\FornS\GENERAIWUBINREQ.FRM iz-Ju -a2
CREATE NEW MFR RECORD (App. attached)
.CHANGE
CURRENT MFR RECORD
RELEASE PLAN CK TO PERMIT (App attached)
CHANGE OF OWNERSHIP (App. attached)
INACTIVATE MFR
CLOSE (DELETE) MFR
zrt
coMP. # 201
PROGRAM# ^I ELEM#-2U-
ASSTGN FEE CODE # /t O
CHANGE FEE CODE # _
CHANGE ELEM # _
CHANGE RISK CATEGORY
"t
MASTER F|LE RECORD (MFR} INPUT/UPDATE FOHM
SUP, DIST. # 303-+
I]
tI
I]
tI
I1
I1
t1
t1
t1
I1
t1
I1
CHANGE CURRENT MFR INFORMATION TO:i'r-il, qr n,
HAZARDOUS MATERIALS SPECIFIC:
Number of Materials 4
Number of Waste Streams
Number of Tanks
il New [ ] Corrected
#
4ogt-o6f zal5
KNOUD T-cD:r:{bcpszr;Ls
Fs *c Sco
LABEL INFO:
Color Code
Site Address:
Site Name:
Requested by
Date:
lnput Entered by:
Date:
Copy to:
e- 7 -?a
---14r{
File Other
Reviewed 6y tinitiaDl Tsupervisor l(1
\\30O0AVCLI\CCMMON\WF4DOCU&{ENTTFORMS\GENERAL''IdFRFILE DOC 3'Nov-98
California Environmental Repo {cERsl Business Owner Operator
CERS ID
10902964
LUIS cA 93401
REFRIGERATION
HORIZON LN
onAtJZleZZby Jason Sprinkle of A&J REFRIGERATION (SAN LUIS OBISPO, CA)
Status
Wighton Beginning Date
8/t7/2022
Dun & Bradstreet
Ending Date
8/16/2023
SIC Code
7623
Phone Business Phone Business Fax
748-6222 (8Os1748-6222 Primary NAICS
811310
:acility/Site Mailing Address
1096 Horizon Ln
ian Luis Obispo, CA 93401
Owner
Ihe Arcticom Group
ls2sl334-7222
1676 N California Blvd, 550
Walnut Creelt CA 94596
Billing Contact
loseph Wighton
1805t-748-6222 jwighton@ajrefrigeration.net
4096 Horizon Ln
San Luis Obispo, CA 93401
Pa8er NumberPhone
rector of Safety
2+Hour Phone
497-4745
Wayne Sprinkle
Emertency Contact
iecondary Emergency Contact
oseph Wighton
rltle
Jranch Manager
lusiness Phone 2+Hour Phone Pater Number
(8osl 748-6222
invironmental Contact
ason Sprinkle
7O7l 497-8145
1096 Horizon Ln
ian Luis Obispo, CA 93401
jsprinkle@arcticomgroup.com
Name of Signer
lason Sprinkle
Signer Title
Director of Safety
Document Preparer
Jason Sprinkle
Additional lnformation
Locally-collected Fields
iome or all of the following fields may be required by your local regulato(s).
Property Owner
)hone
Vlailing Address
Assessor Parcel Number (APNI A>)
- eeg_
\s<4 A
qo4 + euc'(^'
Number of Employees
Facillty lD
FAo015659
Printed on8/78/2022 3:05 PM
CALTFORNIA ENVTRONMENTAL REPORTING SYSTEM (CERS)
CONSOLIDATED EMERGENCY RESPONSE / CONTINGENCY PLAN
ro the INSTRUCTIONS FOR COMPLETNG A CONSOLIDATED CONTNGENCY PLANPrior lo compleling this PIan, please reler
A. FACILITY IDENTIFICATION AND OPERATIONS OVERVIEW
tt CERS ID
lolo
1l2.t qorl OF PLAN A3.
oU 2471/FACILITY ID#
SITB ADDRESS
q8BUSINESS NAMEt Nane or DBA - Doing Business
Ttop
CA 3YdSn.,r (ti,c t-3bir o,
46.SUSTNESS SITECITY
INCIDENTAL OPERATIONS (e.g., Fleet Maintenance)49.TYPE OF BUSINESS (-.g., Faifiting Corftractor)
i?ePrz-, aEnftrtai Grqan t6(L
48.
fnnrUqUlfes D'I/OLVING (Check all that applv):
E I, HMARDOUS MATERIALS; E 2.HMARDOUS WASTES
AIU.
B. INTERNAL RESPONSE
Htr
l. CALLING PUBLIC EMERGENCY RESPONDERS (e,g.,9-l-l)
2, CALLING HAZARDOUS WASTE CONTRACTOR
3. ACTIVATING IN-HOUSE EMERGENCY RESPONSE TEAM
Bl.INTERNAL FACILITY EMERGENCY RESPONSE WILL OCCUR BY (ChCCK all thal apply):
c. EMERGENCY COMMUNICATIONS, PHONE NUMBERS AI\D NOTIFICATIONS
In the eve,nt olan emergency involving hazardous materials and/or hazardous waste, all facilities must IMMEDIATELY:
l. Notiff facility personnel and evacurile if necessary in accordsnce with the Emergency Action Plan (Title 8 Califomia Code of Regulstions $3220);
2. Notifu local emergency responders by calling 9- l- l ;
3. Notiry the local Unified Program Agency (uPA) at the phone number below; and
4. Notiry lhe State Waming Center at (800) 852-7550.
Facilities that generate, treat, store or dispose of hazardous waste have addilional responsibilities to notiff and coordinate with other response agencies. Whenever lhere
is an imminenlor actual emergency situation such as an explosion, fire, or release, the Ernergency Coordinator must follow the appropriale requirements for the category
offacility and type ofrelease involved:
l. TitleL2 Califomia Code ofRegulations g66265.56. Emergency Procedures for generalors of 1,000 kilograms or more ofhazardous waste in any calendar month.
2. Tille 22 Calitomia Code of Regulations g 66265.196. Response to Leaks or Spills and Disposition of Leaking or Unfit-for-Use Tank Syslems.
3. Title40CodeofFederalReguiations$302,6.Notificationrequirementsforareleaseofahazardoussubsianceequaltoorgreaterthanthereportablequantity'
4.Title22Califomia Codc ofRegulations 966262.34(d)(2) and Title 40 Code ofFederal Regulations $262,34(dx5xiil for generators ofless than 1000 kilogroms of
hazardous waste in any calendar month,
Following notificgtion and before facility operations arc resumed in areas of the facility affected by lhe incident, the-Emergency Coordinator shall notiry the local UPA
and the local firc department's hazardous materials program, if necessary, thal the facili$ is in compliance with rcquirements to:
I . provide for propir storage and disposal of recovered waste, contaminated soil or surface waler, or any other material that results from an explosion, {ire, or releaso at
the facility; and
procedures are completed,
OUU
gos? 8 t g5,l("'
7b Lt?'l et+ec2,ve
EMERGENCY RESPONSE
PHONENUMBERS:
NEAREST MEDICAL FACILITY / HOSPITAL NAME:
AMBI.JLANCE, FIRE, POLICE AND CHP
CALIFORNIA STATE WARNING CENTER (CSWC)/CAL OES,
NATIONAL RESPONSE CENTER (NRC) ,
POISON CONTROL CENTER. , .
LOCAL I,JNIFIED
OTHER (Speci$):
flzaryt /bsP*Ju
9-1-1
(800) 852-7550
(800) 424-8802
222-1222
gas 5Vs 5353
c6.j86
cE.
ct0,
AGENCY NOTIFICATION PHONE NUMBERS: CALIFORMA DEPT. OF TOXIC SUBSTANCES CONTROL (DTSC)
RECIONAL WATERQUALITY CONTROL BOARD (RWQCB).
U.S, E).IVIRONMENTAL PROTECTION AGENCY (US EPA) . .
CALIFORNIA DEPT. OF FISH AND WILDLIFE (CDFW) . , . , . .
U.S. COAST GUARD (USCG)
CALOSHA
CAL FIRE OFFICE OF THE STATE FIRB MARSHAL (OSFM) .
255-35451
c9_
1 323-7390
(800) 300-21e3
(916) 358-2900
(202) 267-2180
(e16) 263-2800
oTHER (Specifu):
OTHER (Speci$):
Rev,03/07/l?Page I of4
CERS Consolidated Emergency Response /c- 'rpgencY Plan
tr( T.vSRBALWARNINGSI
E +, pncens;
E 2. PIIBLICADDRESS ORINTERCOM SYSTEM;
f] 5, ALARM SYSTEM;
[] 3. TELEPHoNE;
E 6, PORTABLE MDIO
TIONS OR ALARMNOTTFICA all that apply):INTERNAL FACILITY
Etr
EI 3. TELEPHONE;
[] o. ponrAgr.E MDIo
cl2.
4.
ORINC FACILITIES THAT BE
I. VERBAL WARNINGS;
AN OFF-SITE RELEASE WILL OCCUR BY
E 2, PUBLICADDRESS OR INTERCOM SYSTEM;
5. ALARM SYSTEM;
EMERGENCY COORDINATOR CONTACT INFORMATION' cr3'
PRIMARYEMERGENCY COORDINATORNAME:I!;i' WrcTN'il PHONE NO.: PHONE NO.:
ALTERNATE EMERGENCY COORDINATOR NAME:fi L?x t{ A 6+\ PHONE NO.: PHONE NO':
(! ChectifadditionalEnrergencyCoordinatorcontactandaddressinfonnationisavailableonsiteorbycalling PHONENO.:70? 4q) il45
Note: Ifrnorc than one alternato emergency coordinator is designated, attach a list in order ofresponsibility.
D. EMERGENCY CONTAINMENT AI\D CLEANT]P PROCEDT]RES
fires
E I. UoNTTON FOR LEAKS, RUPTURES, PRESSURE BUILD.IJP, ETC,;
E Z. pnOVioe STRUCTURAL pHySICAL BARRIERS (e.g., Portable spill containment walls, built-in berms);
fi r. rnovne ABSoRBENT PHYSICAL BARRIERS (e.g., Pads, spill pigs, spill pillows);
E l. covsn oR BLocK FLooR AND/oR sroRM DRAINS;
fI s. INEO TNTNCH DRAINS AND/OR SUMPS;
E o. AUTOUNTIC FIRE SIJPPRESSION SYSTEM;
E z. sLrMINnrE sor.JRcES oF IcNITIoN FoR FLAMMABLE UAZARDS;
E s. srop pRocEssEs AND/oR oPERATIoNS;
E 9. AUTOMATIC / ELECTRONIC EQUIPMENT SHUT-OFF SYSTEM;
E IO, SHUT OFF WATER, GAS, ELECTRICAL UTILITIES;
El I I.CALL 9-l-t FOR pUBLIc EMERGENCY RESPoNDER ASSISTANCE AND/OR MEDICAL AID;
El 12.NOTrFy AND EVACUATE PERsoNs IN ALL THREATENED AND/OR IMPACTED AREASI
I t r, nccouNT FoR EVAcUATED PERsoNs IMMEDLATELY AFTER EvACUATIoN;
E 14, PRoVIDE PROTECTIVE EQUIPMENT FOR ON-SITE EMERGENCY RESPONSE TEAM;
E] 15. REMOVE CONTAINERS AND/OR ISOLATE AREAS;
E 16. HIRE LICENSED HAZARDOUS WASTB CONTMCTOR;
Uil 17. UsE ABSORBENT MATERIAL FOR SPILL CONTAINMENTI
E 18. VACUUM SUCTION UsINc APPROPzuATE VACUUM (e.g,, Inhinsically safe) FOR SPILL CoNTROL AND/oR CLEANUP;
I t9. DECONTAMINATE PERSONNEL AND EQUIPMENT WITHIN DESIGNATED AREA AND DISPOSE OF WASTEWATER AS HAZARDOUS WASTE;
E 20. pRovrDE SAFE TEMPORARY STORAGE OF HAZARDOUS WASTE GENERATED DURING EMERGENCY ACTIONS;
E zt.orgrn (specify): D2'
DI
E. FACILITY EVACUATION
I. BELLS;
2. HORNS/SIRENS;
3. VERBAL (i.e,, Shonting);
4. OTHER (Specifu):
trtr
En
Et.
F2,
THE FOLLOWING ALARM SICNAL(S) WILL BE USED TO BEGIN EVACUATION OF THE FACILITY (Check all tltat apply):
L*t S+,e+ c<trJl *I;Kosil'e sida f**
FOR AN EMERGENCY ASSEMBLYTHE FOLLOWING LOCA
The
slreet1ot,corner):
must account for all onsite
E I. WRITTEN PROCEDURES DESCRIBING ROUTES, EXITS, AND ASSEMBLY AREAS;
E 2. EVACUATIoN MAp(s) DEPICTING RourEs, Exlrs, AND ASSEMBLY AREAS' - , lt ) , --frr orHunlspeciry), A't ;;'i;r!"'fr; ";*-;;:;'r"i*n;*n J*. oF tlatalqctvs'e- MIIvP doo(
Note: Evacuation procedures and/or maps should be posted in visible fncitity locations and must be included in the Contingency Plan'
EVACUATION ROUTE S AND ACUATION ROUTES ARE DESCRIBED
F" ARRANGEMENTS FOR EMERGENCY SERVICES
ADVANCE ARRANGEMENTS FOR LOCAL EMERGENCY SERVICES (Check one of the following);
E I, HAvE BEEN DETERMINED NOT NEbESSARY;
E 2. THB FOLLOWING ARRANGEMENTS HAVE BEEN MADE (SPCCi&):
Note: Advance anangements with local 6re and police departmenls, hospitals, state and local emcrgenoy response teams, and./or etnergency
contraclors should bJmade for your facility, iInecessary. Large Quantity Generators must describe arrangemenis in the Contingency Plan.
Ft.
F2,
servlces
Rev.03/0?/17 Page 2 of 4
CERS Consolidated Emergency Response / (' ''lngency Plan
G. EMERGENCY EQTIIPMENT
Check the appllcable boxes lo llst emergency response equlpment avoilable rt the faclllty'identlfy the locatlon(s) where the equipment ls kept, rnd lndlcate the
if
CAPABILITYTIONG2.AVAILABLETYPE
OIL RESISTANT ONLYSINGLESPILL RESPONSE KITEXAMPLECHEMICAL PROTECTII/E GLOVES
CHEMICAL APRONS,
PROTECTIVE3
paraho,.r,!?FACEGLASSES,
l'2d.r|.Val.u1,l arJ cF,5.
RESPIRATORS6.
BREATHING7
vfttrzWvLQ&,FIRSTAID
AINPLI.JMBED
PORTABLE EYEW AND/OR
Safety
snd
Aid
ll OTHER
l,llarg.hct"'-F,\zeTABLEFIRE
OR SPRINKLERS
FIRE ALARM
5 OTHER
ALL-IN-ONE SPILL KIT
I a.,d <cLo.6ata,C,errr rf wc^tel,cWS€MATERIALt7
CONTAINERFOR ABSORBENT
AND/ORDIKINCt9.
fe'l^ oF fuaxhr,20.
,t$21.
22.v
HOOD
AND/OR HOLDING TANK
NEUTRALIZERS
LEAK REPAIR KITGAS
SPILOVERP DRI'MS2'l
Spill
Up
28.OTHER
,r*-lafa"o om29.TELEPHONES Cellular)
SYSTEMINTERCOM
PORTABLE
ns
rm
AUTOMATIC2,
33
3
Rev.03/07117 Page 3 of4
CERS Consolidated Emergency Response / f - -'ingency Plan
H. EARTIIQ UAKE VULNERABILITY
immediate isolation andreleases due to seismic motion,losreas
LOCATIONS (e,g.,
lpttywteJ &reA-("t <,jEI- I. HAZARDOUS MATERIALS AND/OR WASTE STORACE AREAS
E] 2. PROCESS LINES AND PIPING
D 3,LABORATORY
AREAS
4. WASTE TREATMENT AREA
isolation andnrolion. Theseto releases /duemechanical
LOCATIONS:
Wc*ehou9 v'vlC)zzAnh?tq
tra
tr
tr
tr
SHELVES, CABINETS AND/OR RACKS
TANKS AND SHUT-OFF VAI-VES
PORTABLE GAS CYLINDERS
EMERGENCY SHUT.OFF AND/OR UTILITY VALVES
SPRINKLER SYSTEMS
STATIONARY PRESSURIZED CONTAINERS
l.
2.
3.
4.
5,
6.
all thatSYSTEMS
I. EMPLOYEE TRAINING
o Communication and alarm sYstems;
r Personal protective equipment;
. Use and maintenance ofemergency response equipnrent and supplies
(e.g. Fire exlinguishers, respirators, spill conhol ntaterials);
. Deconlaminationprocedures;
r Evacuation procedures and evacuation staging locations;
r ldentification of facility areas, equipment, and systems wlnerable to
earthquakes and other natural disnsters.
o OTHER (Specify):
Employee training plans may include the following content:
. Applicable laws and regulations;
. Emergency response plans and procedures;
. Safety Data Sheets;
e Hazard communication related to health and safety;
r Methods for safe handling ofhazardous substances;
. Hazards ofmalerials and processes (c.g,' fire, explosion, asphyxiation);
. Hazard mitigalion, prevention and abatemenl procedures;
r Coordination ofemergency response ections;
r Notification procedures for local emergency responders, CUPA,
Cal OES, and onsite Personnel;
wastes and/ornormal emergencyand/ormaterialsconlractorsand/orlstraining
forPlan smallsome hcilities.CI.JPA this assectiotr lheasubmitPlan.TrainingfacilitiesMostneedwillloTrainingHowever,your may accepts€parate
Check the applicable boxes below to indicate how the employee training program is administered.
TRAININC PLAN IS USED AND UPLOADED TO CERS AS A PDF DOCUMENT t3.
14.
ntr ONSITE
HAS6, NOT APPLICABLB SINCE
7. CHECK IF A SEPARATE EMPLOYEE
"El s. oruen (Speciry):
IS COVERED BY8. CHECKIF EMPLOYEE
il.
t2.E l. FoRMAL cLAssRooM [:l 2. vlDEos 43. SAFETYMEETINGS 84, SrUDYGUIDES/MANUALS
RECORDKEEPING TRAINING MUST BE:
as possibte following the date ofhire, New ernployees should not work in an unsupervised position that involves
waste maoagement without proper haining;
. provided within six months frorn the date of hire for new employees at a l8rge qtlantity getrerator;
o Ongoing and provided at least annually;
o Amendcd prior lo a change in process or work assignnent;
o Givenupon modification to the Emergency Response/Contingency Plan.
Lnrge euantlfy Generator Trrlnlng: Large quantity generators (1,000 kg or more) must retain written plan and documenlalion of employee training which includes:
waste management and/or em€rgency r€sponse'
. The name, job title and job description for each position at the facility related to hazardous waste manag€ment'
r Cunent employee training recor.ds must be retained until closure of the facility and former employee haining records must be retained for at least three years after
termination of employment,
Small euantity Generator Tralnlngl Small quantity generalors (less than I,000 kg) must include basic hazardous wasle management and emergency response
proceduies but a wrinen employee trai-ning plan and trainilg records-are noi required. In order to show that the facility has met the small quantity generator employee
iraining requirement, an employee training plan and training records may be mode nvailable.
Hazardous Materlals Buslness plan Trninlng: Businesses nrust provide initial and annual employee training that includes the contenl referenced above. The training
may be based on thejob position and training records must be made available for a period ofat lcast three years.
EMPLOYEE TRAINING FREQUENCY AND
. Provided initially for ncw employees as soon
hazardous rnaterials handling and/or hazardous
J. LIST OF ATTACHMENTS
trt.
,EL2.
t2.DOCI.'MENTS
A.l;.n ?lcn
ARE REQUIRED; OT
AREATTACHED:
one
THE FOLLOWTNC
Et+*
NOATT
Rev.03/07/17 Page 4 of 4
^,nr *sPEctloN REPoRT
FIRE-o1145-20t6 4096 Horizon A
053-258-079
Next !nspection s126lt99s
3R7/2076
Assignment Kerry Boyle
case P LOCC-I O5667'2OL4
last lnspection 5 / 26 | 1995
cycle Biannual
Total Unlts 0
BuildingArea 9,700.00
Storles 0
Construction Type
Responsible party MICHAEL WIGHTON
Phone 543-745-7458
Emergency Phone 543-745-7 458
Propertyowner WIGHTON MICHAEI G TRUST (TR 1)
CONTACTTYPE TENANT NAME
Tenant
COMPANY
OCCUPANCY
A & J Refrigeration
Mike Rosales
BUslNEss 805-440-249t
HOME
FIRE PERMITS
MOBITE
orHER 805-543-7458
Area 5,000.00
Load 50
Classes
STANDPIPES False SPRINKLERS
lnstalled
Details
FDC Location
ATARM False
Sprinklers?
last Certlflcatlon
Sprinkler Location
Sprinkler FDC Locatlon
CTEAN AGENT False
Alarm Date
Alalm Details
Clean Agent Date
Clean Agent Details
Mtsc
last Hood fest
Knox Box
Central Monitoring False
Fire Flow 2000
Fire Lateral lnstalled? False
cRtTtcAr rocATloNs ACCESS
MAIN ELEC. S.O. S-A OUTSIDE,
PRE-PIAN HAZARD TEGACY NOTES 3L77
WATER SUPPLY: 4 TANKS(APPROX 40K)CHECK FOR PERMITS
OF
*{4q
Hol tr $
A
("
,-fcqnrtr 6\'"5
lze , }'u..^'<'t
06/2012022 Page 1 of 1
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6tDG t n-named, srEA
4lto Floilmlsil Lub offipo, GASS401
Bldg Address
PRE6ISqITItIRSFORTS
BLOG T$l{lAll€d, STE D
4cffi lhflzon
san Lub otlspo, cA
Bklg Address
t nlsrotrr ocGupant
BLDG lrn-oard. sTE C
4,96 FlodEon
Sil Luis O0lESo, CASS4ll
Eldg Addt'ess
A & J REFRIGERATION
BLDG Un.named. STE A
4096 Horizon
San Luis 0bispo, CA 93401
'' - -GlrtAnuilfidBcilcE8 i rii]3g rLt dsg€dm i Bliss. Maitie I
f[\n <5 +^.!LLa '51\41-rP
fiAts Cv\A/\ &t ,
RIETKERKHEATINGANDArc Un{arEd ./
ELBG I'N.rlElltE{I. STE Btr'ffim-;;' (
-\-,
BkrgMdress l,lf2ffp.
C rqt I NV,S"^arn
9-E 1) Arnlt Ffe Rlsiless
hsoddt
ft-tryectqtbJbsesltor TYPq+
l)AmrC Fc BuiE fEF€dtM
E 1)Anrd Fie &$iness
rEpeelidr
E
i-- i-ir" _1I Blis Mdtia I
,.P \'*
L]
l_1
PRECISI0NMOTORSPORT9 Un-rlaned
Unlmor,n Occtpant Un-narFd
A & J REFRIGERATION Un{rafi'}ed
7t?ilL&n
Srlzms
7tit2024
(Autol
Aliss, M€ttie
Diepenbroch,Ar.lel_
1) Bi-Annuat Fire Business
lnspectsn
r- .. :_JI 48 C". 'a'nY I
COUNTY
"..: SAN LUIS
OBISPO
Environgantal H6.
($Aq 7U-5544
-Qerylges
?156 Sierra Wav Ste. B
San Lut's Obtsoo. O4 93401
ehs(dco.s/o.ca. us
slocountv.qov/ehs
\
l
Fire Department
?160 $arta BarbaraAvenue, $an Luis Obispo, eA 93401-5?dS
805.7S1 7380
lilofity {:r!,
CERTIFIED UNIFIED PROGRAM AGENCY (CUPAI
Regulated Facility lnspection Form
Facility Name: A&J REFRIGERATION Phone: (8OS) 748-6222
Site Address: 4096 Horizon Ln City: San Luis ObisPo 2ip93401
Facility lD: FA0015659 GERS lD: 10902964 Serial N umber: DA7 820837 Date 06/L9/2025
lnsnection Tvoe
tr Routine
fl Other tr Change of Ownership
O Reinspection
tr Chargeable
tr Complaint
B Secondary Conlainment Testing
Aqencv
trEHS trCity Fire
Programs lnspected EHazmal DHW Generator C]UST trAST SCalARP trTPE
Reinspection Required ElHazmat nHW Generator gUST CIAST IICaIARP ETPE
Permit Number:PR0021149 )R0021150
PERMTSSION IO TNSPFCT: lnspections may involve obtaining photographs, reviewing and copying records, and determinin
compliance with adopted codes.
GRANTED BY (NAME/TITLE): Name: Joe Wighton Title: Branch Manager
SUMMARY OF FINDINGS
A No violations of underground storage tank, hazardous materials, or hazardous waste lawslrcgulations were discovered.
SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility.
El Violatlons were observed/discovered as listed below. All violations must be corrected by implementing the corrective
action llsted by each violation. lf you dleagree wlth any of the vlolatlona or corrective actions reguired, please inform the
CUPA in writing.
o ALL VIetAl./ONS MUSr BE CORRECTED W|THIN 30 OAyS OR AS SPECIFIED. CUPA must be informed in writing with a
cerlification that compliance f,as been achieved. A fatse slatement that compliance has been achieved is a violation of lhe law and
punishable by a fine of up to $70,A00 far each vialation. Your facility may be reinsryCted \ny time duing normal buslness hours.
c You may rsquesf a meeting with the Program Manager to dlscuss the inspection frndings and/or the proposed conective acllons.
IDe lssuance of this Summary of Vbtations does not preclude the C,JPA from taking administratlve, civil, or criminal action.
hanaa*ar Gommants
Facility no longer generating used oil; will be removed from hazardous waste generator program.
HMBP certified during inspection. Thank you.
lnspected Matheson Bliss Name of Facility Rep:Joe Wighton
lnspection Date: 06/l-9/2025 Facility Rep Signature:
STATE M E N.T-gj: q oM P.IIAN c q
Gertification: t certify under penalty of perjury that this facility has complied with the corrective actions listed on
this inspection form.
Tltle:Signature of Owner/Operaior:Date
Page ! of !
Environmental Health Services
(805) 781-5544
'P.O.Box 1489
, 2156 Sierra Wav Ste. B
San Luis Obisoo, CA 93406
ctty o[ san Luls oBlspo
FIRE OEPARIflEilT
2'160 Sata Barbaa Avduo'Sil Luls Obbpo, CA 93401-5210'(805) 781-7380
"Courtesy & Service"
Date. 0813112023
GERTTFTED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIAL INSPECTION FORM
Time:
COUNTY.6 SAN LUIS
OBISPO
Facility Name: A&J REFRIGERATION
Aqencv
trEHS
trCITY FIRE
lnspection Tvpe
trRoutine
trReinspection
trChargeable Reinspection
trChange of Ownership
trComplaint
trSecondary Containment Testing
trChargeable Secondary Containment Testing
Site Address: 4096 HORIZON LN
SAN LUIS OBISPO, CA 93401
Phone: (805)748-6222
Facility lD: FA0015659 CERS lD: 10902964
SerialNumber: DAMFQZPEW
PROGRAMS INSPECTED:trHazmat trHW Generator trUST trAGT trCalARP trTPE
REINSPECTION REQUIRED:BHazmat EHW Generator trUST trAGT trCalARP trTPE
PERMISSION TO INSPEGT: lnspections may involve obtaining photographs, reviewing and copying records, and
determining compliance with adopted codes.
N/A
tr
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tr
tr
tr
tr
tr
NO
tr
tr
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tr
D
tr
tr
YES
tr
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tr
tr
tr
tr
BUSINESS PLAN
Business plan complete, current, available during inspection and submitted electronically (HSC 25505,
25508(aX1); 19 CCR 2651)
lnventory of hazardous materials is complete and submitted electronically (HSC 25505(aXl), 25506,
25508(aX1), 19 CcR 2652, 2654)
Site layoug facility maps are accurate and submitted electronically (HSC 25505(ax2l, 25508(axl), 19 CCR
26521
TRAINING PLAN
Facility has appropriate training program, submitted electronically (HSC 25505(aX4), 25508(aXl), 19CCR
2659,22CCR66265.16)
Training documentation is maintained on site for current personnel (HSC 25505(aX4),22CCR56265.16)
EMERGENCY RESPONSE PLAN
Emergency response/contingency plan complete, current, submitted electronically, maintained onsite
(HSC 25505(aX3), 25508(axl), 19CCR 2658, 22CCR 65265.52-.54)
Secondary containment is installed and sufficiently impervious to discharges. ICHSC 25270.4.5; 40 CFR
112.8(cX2)l
GENERAL EH VIOLATIONS
tr tr tr FEO1 Environmental Health fees paid. ICBPC 17200, Local Ordinancel
GPS Coordinates: Latitude: 0.0000000000 GPS Coordinates: Longtitude: 0.0000000000
vtol. #
BPOl
BPO2
BPO3
TROl
TRO2
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ERO3
INSPECTOR: MATHESONBLISS FACILITY REP: Joe Wighton
FACILITY NAME
'. \\\t
)
A&J REFRIUERATION ADDRESS:
HAZARDOUS WASTE GENERATOR
4096 HORTZON LN
SAN LUIS OBISPO, CA 93401
YES
tr
tr
tr
tr
tr
tr
tr
N/A
tr
NO
tr
vtol. #
GTOl
GTO3
GTO4
GTOS
GT06
GTOT
GTOS
GTO9
GTlO
GT11
GT12
EPA ID NO/PERMITS
Generator has an EPA lD number to treat, store, dispose, transport or transfer hazardous waste (22
CCR 56262.12) lf not, Call (800) 618-6942 to obtain your CAL EPA lD number
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (22 CCR 65262.11)
Eown knowledge Eanalysis Eother
Hazardous waste analysis/test records are kept for at least 3 years(22 CCR 66262.40.(c))
DISPOSAL/TRANS PORTATION
Hazardous wastes disposed of at an authorized location (Hsc 25189.5, 25201lal,22 CCR 66262.121
Facility utilizes a registered hazardous waste transporter, and hazardous wastes shipped with a
manifest (HSC 25160,25163(a): 22 CCR 66262.20. 66253.411
Emilkrun Elother SalfrlWMA
Manifests and/or receipts are properly completed/retained by generator for 3 years (22 CCR 66262.23,
66262.40(a))
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows: ( HSC 25123.3 (bX1l/(d)/(hX1); 22 CCR 66262.34(d))
tr90 days if waste generated per month is greater than or equal to 1000 kg. (2200 lbs.)
tr180 days ifwaste generated per month is less than 1000 kg (see note)
D27O days ifwaste generated per month is less than 1000 k9 and transported more than 200 miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6000k9(13,200 lbs) and no
acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal
or 1-qt limitl (22 CCR 56262.34(ell
tgnitabte or reactive wastes are located 15 m (50 feet) from facility's property line (22 CCR 66262.34(axl),
66265.176)
Containers of hazardous waste are properly labeled (includes appropriate date,"HAZARDOUS WASTE,"
waste composition/physical state, hazardous properties, name/address of generator) (22 CCR 66262.31,
66262.34(fl1
Containers/tanks containing hazardous wastes are in good condition/handled to minimize the release
or reaction (22 CCR 66262.34; 22 CCR 66265.171-.179, 66265.177(c))
Containers/tanks/liners are compatible with waste stored or transferred (22 CCR 66262'34,66265.1721
Containers storing hazardous wastes are closed/sealed (22 CCR 56252.34, 65265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted (22 CCR
66262.34,66265.1 74)
Daily inspection of all tank systems is conducted and documented (22 CCR 65262.34, 66265.195)
Empty containers or inner liners > 5 gal has date when emptied and are properly managed within one
yearofdate emptied (22 CCR 66261.7(fl)
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled {includes proper labeling, storage, etc) (HSC
2s250.41
Used oil filters for recycling are managed properly (drained offree flowing liquid, stored in closed
rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22
ccRs 65265.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (22 CCR 66256.81)
Solvents/other recyclable materials are managed as hazardous wastes until recycled (22 CCR 66266.2)
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
abte make them available to the inspector within (5) days. (HSC 252/14.19/.211.22; 22 CCR 67'100'7/.8)
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. IHSC 25244.'191.21 , 22 CCR 67100.5/7/.8)
Hazwaste Contingency Plan prepared, current, submifted to the CUPA, maintained
66262.34(aX4), 66255.51 -.s4)
Employees trained upon hire, annually; training records maintained at facility as required (22 CCR
66262.34(aX4l, 66255.16)
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 (22 CCR 56265.31-.37)
tr
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E
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D
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D
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D
tr
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EI
tr
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E
tr
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tr
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n
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tr
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D
n
tr
tr
tr
D
tr
tr
tr
tr
tr
tr
tr
tr
a
tr
tr
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D
tr
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GT13
GT14
GT15
GT15
GT17
GT18
GT19
GT2O
GT2'I
GT22
GT23
GT24
GT25
ERO2
onsite.(22CCR
':) ')
SUMMARY OF OBSERVATIONSruIOLATIONS
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.
El Violations were observed/discovered as listed below. AII violations must be corrected by implementing the corrective
actionlisted byeachviolation. lfyoudisagreewithanyoftheviolationsorcorrectiveactionsrequired,pleaseinformthe
CUPA in writino.
ALL VTOLATTONS MUST BE CORRECTED W|THIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a
certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of
the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be
reinspected any time during normal business hours.
you may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective
actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil' or
criminal action.
VIOL. NO
BPOl
FACILITY NAME: A&J REFRIGERATION ADDRESS: 4096 HORIZON LN
SAN LUIS OBISPO, CA 93401
VIOLATIONS
CORRECTIVE ACTION REQUIRED
IMMEDIATELY TAKE A/ECESSARY ACTION TO ENSURE THAT THE BUS/NESS PLAN /S COMPLETE,
jTJBMITTED ELECTRONTCALLr AND AVATLABLE (VIS|T CALIFORNIA ENVIRONMENTAL REPORTING
SYSIEM - 'CFRS'i httpsf/cers.catepa.ca.gov). IMPLEMENT A PROCEDURE fO ENSURE THAT THE PLAN lS
IJPDATED As REQU/RED BY HEALTH AND SAFETY CODE SECTIONS 25505, 25508(A)(1) AND CALIFORNIA
CODE OF REGIJLATIONS SECI/ON 2657. FAILURE TO CORRECT IHIS VIOLATION BY THE DATE
SPECIFIED /N IHIS REPORT MAY RESULT IN CIVIL AND/OR CRIMINAL PENALTIES OF UP TO $2,OOO PER
DAY PER VIOLATION, AND/OR THE PENALTIES DESCR/BED IN THE CA HEALTH & SAFETY CODE SECTION
25515.
Review/Certify Hazardous Materials Business Plan for the year through CERS by 10l1l23' Enter
Chemical lnventory (compressed and add facilitv site map.
INSPECTION COMMENTS:
Items marked N/A not reviewed during inspection
Discontinue practice of taking used oil into IWMA on Fridays/Saturdays. Used oil shall be taken into IWMA
by appointment on Wednesdays (or through licensed hazardous waste hauler). Maintain copies of all
receipts from IWMA to be reviewed during next compliance inspection.
INSPECTED BY: MATHESON BLISS
DATE:08/31/2023
NAME OF FACILITY REP: Joe Wighton
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.
of Owner/Operator:Tiflrr:Date:
COUNTY
b SAN IUIS
OBISPO
/"\,
l
crty o[ san Luls oBlspo
FIRE DEPARIMENT
2160 Santa Barban Avduo' sil Luir 0blspo, CA 9340'l-5240 .
{8G5) 78'l'7380
Date:0811812022
"Courtesy & Service"
GERTTFTED UNIFIED PROGRAM AGENGY (CUPA)
HAZARDOUS MATERIAL INSPECTION FORM
Time:
Facility Name: A&J REFRIGERATION Agencv lnspection TypetrEHS trRoutine
trClTY FIRE trReinspection
trChargeable ReinsPection
trChange of Ownership
trComplaint
trSecondary Containment Testing
trChargeable Secondary Containment Testinl
Site Address: 4096 HORIZON LN
SAN LUIS OBISPO, CA 93401
Phone: (805)543-7458
Facility lD: FA0015659 CERS lD: 10902964
Serial Number: DAIAAZ9CE
PROGRAMS INSPECTED:ElHazmat EHW Generator trUST trAGT trCa|ARP OTPE
REINSPECTION REQUIRED:trHazmat trHW Generator DUST trAGT trCa|ARP trTPE
PERMISSION TO INSPECT: lnspections may involve obtaining photographs, reviewing and copying records, and
determining compliance with adopted codes.
NO
tr
tr
tr
tr
tr
tr
tr
YES
tr
tr
tr
tr
u
tr
tr
tr
N/A VIOL. #
tr BPO1
u BP02
tr BPO3
TROl
TRO2
EROl
ERO3
tr tr FE01
GPS Coordinates: Latitude:
tr
tr
tr
tr
BUSINESS PLAN
Business plan complete, current, available during inspection and submitted electronically (HSC 25505,
25508(aXl); 19 CCR 2651)
lnventory of hazardous materials is complete and submitted electronically (HSC 25505(axl )' 25506,
25508(aX1), 19 CCR 2652,26541
Site layouu facility maps are accurate and submitted electronically (HSC 25505(aX2)' 25508(aX1), 19 CCR
26521
TRAINING PLAN
Facility has appropriate training program, submitted electronically (HSC 25505(aX4), 25508(aXl), l9CCR
2659, 22CCR66265.16)
Training documentation is maintained on site for current personnel (HSG 25505(aX4), 22CCR66265.16)
EMERGENCY RESPONSE PLAN
Emergency response/contingency plan complete, current, submitted electronically, maintained onsite
(HSc 25505(aX3), 25508(aXl), 19CCR 2658, 22CCR 66265.52-'54)
Secondary containment is installed and sufficiently impervious to discharges. ICHSC 25270'4'5;40 CFR
112.8(cX2)l
GENER,AL EH VIOLATIONS
Environmental Health fees paid. ICBPC 17200, Local Ordinance]
GPS Coordinates: Lonqtitude:
INSPEGTOR: MATHESON BLISS FACILITY REP: Joe Wighton
FACILITY NAME: A&J REFRIGF \TION ADDRESS; C96 HORIZON LN
oAN LUIS OBISPO, CA93401
HAZARDOUS WASTE GENERATOR
YES
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E
EI
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tr
tr
tr
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u
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NO
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n
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n
tr
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EI
EI
B
tr
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tr
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tr
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Nla vrol. #tr GTO1
GTO3
GTO4
GTO5
GTO6
GTOT
GTOS
GTO9
GTlO
GT11
GT12
EPA ID NO/PERMITS
Generator has an EPA lD number to treat, store, dispose, transport or transfer hazardous waste (22
CCR 66262.12) lf not, Call (800) 618-6942 to obtain your CAL EPA lD number
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (22 CCR 66262.111
trown knowledge uanalysis trother
Hazardous waste analysis/test records are kept for at least 3 years(22 CCR 66262.40.(c))
D IS P OSA UTRA N S P ORTATIO N
Hazardous wastes disposed of at an authorized location (HSC 251 89.5, 25201(al, 22 CCR 66262.121
Facility utilizes a registered hazardous waste transporter, and hazardous wastes shipped with a
manifest (HSC 25160. 25163(a): 22 CCR 66262.20.66263.41)
trmilkru trother lE9 Self to IWMA
Manifests and/or receipts are properly completed/retained by generator for 3 years (22 CCR 66262.23,
66262.40(a))
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows: ( HSC 25123.3 (bxly(dy(hx1); 22 CCR 66262.34(d))
tr90 days if waste generated per month is greater than or equal to 1000 kg. (2200 lbs.)
8180 days if waste generated per month is less than 1000 kg (see note)
tr270 days if waste generated per month is less than 1000 kg and transported more than 200 miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6000k9(13,200 lbs) and no
acutely/extremely hazardous waste over 1kg (2.2 lbs.) is held on site for over 90 days
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/S5-gal
or 1-qt limit) (22 CCR 66262.34(e))
lgnitable or reactive wastes are located 15 m (50 feet) from facility's property line (22 CCR 66262.34(aXl),
6626s.176)
Gontainers of hazardous waste are properly labeled (includes appropriate daIe,"HAZARDOUS WASTE,"
waste composition/physical state, hazardous properties, name/address of generator) (22 CCR 66262.31,
66262.34(f))
Containers/tanks containing hazardous wastes are in good conditiodhandled to minimize the release
or reaction (22 CCR 66262.34; 22CCR66265.171-.179, 66265.177(c))
Gontainers/tanks/liners are compatible with waste stored or transferred (22 CCR 66262.34,66265.1721
Containers storing hazardous wastes are closed/sealed (22 CCR 66262.34,66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted (22 CCR
66262.34,66265.1 74)
Daily inspection of all tank systems is conducted and documented (22 GCR 66262.34, 66265.195)
Empty containers or inner liners > 5 gal has date when emptied and are properly managed within one
year of date emptied (22 CCR 66261.7(D)
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
25250.41
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) (Tille22
ccRs 66266.130)
Spent leacl-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (22 CCR 66266.81)
Solvents/other recyclable materials are managed as hazardous wastes until recycled (22 CCR 66266.2)
SOURCE REDUCTION:For facilities generating >12,000 kg./yr. of hazardous waste on site.
Generator is subject to SB14 and has prepared and retained current source reduction documents or is
able make them available to the inspector within {5} days. (HSC 25244.191.21122; 22 CCR67100.7/A)
Source Reduction Evatuation and Plan contains the following five elements:certification, amounts of
wastes generated, process description, block diagrams, and implementationschedule of selected
source reduction measures. (HSC 25244.191 .21 , 22 CCR 67100.5/7/.8)
Hazrvaste Contingency Plan prepared, current, submitted to the GUPA, maintained onsite. (22CCR
66262.34(aX4), 66265.51 -.54)
Employees trained upon hire, annually; training records maintained at facility as required (22 CCR
66262.34(aX4), 66265.16)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release of
hazardous materials/waste constituents to the environmenf Maintains all required or appropriate
equipment including an alarm and communications system (22 CCR 66265.31-.37)
GT13
GT14
GT15
GT16
GT17
GT18
GT19
GTzO
GT2'I
GT22
GT23
GT24
GT25
ERO2
SUMM TY OF OBSERVATION9VIOI' .)TIONS
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 th
CUPA in writina
ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED CUPA must be informed in writing with a
certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of
the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be
reinspected any time during normal business hours.
You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective
actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or
criminal action.
FACILITY NAME: A&J REFRIGERATION ADDRESS: 4096 HORIZON LN
SAN LUIS OBISPO, CA 93401
VIOLATIONS
VIOL. NO CORRECTIVE ACTION REQUIRED
INSPECTION COMMENTS:
Site map completed and in process of being uploaded to CERS
INSPECTED BY: MATHESON BLISS
DATE:08fl82022
NAME OF FACILITY REP: JOE WiqhtON
SIGNATURE OF FACILITY REP:
STATEMENT OF COMPLIANCE
rtification: I certify under penalty of periury that this facility has complied with the corrective actions listed on
is inspection form.
nature of Owner/Operato Title:- Date
COUNTY
bSANLUIS
OBISPO
/'-\
)crty o;- srrl Luls oBlspo
flRE DEPART'IEIIT
2164 gfit^qaftaq Auduo * 80 Lub Obbpo, CA 9310r'52t0 ' l8ll5) 781-7300
"Cot.rtesy & Service"
Date:0612412022
GERTIFIED UNIFIED PROGR^AM AGENCY (CUPA)
HAZARDOUS MATERIAL INSPECTION FORM
Time:
Facility Name: A&J REFRIGERATION
Aqency lnspection TyoetrEHS trRoutine
trClTY FIRE trReinspection
trChargeable ReinsPection
trChange of OwnershiP
trComplaint
trSecondary Containment Testing
trChargeable Secondary Containment Testinl
Site Address: 4096 HORIZON LN
SAN LUIS OBISPO, CA 93401
Phone: (805)543-7458
Facility lD: FA0015659 CERS lD
Serial Number: DANPNAU45
PROGRAMS INSPECTED:EHazmat EHWGenerator trUST trAGT trCa|ARP trTPE
REINSPECTION REQUIRED:ElHazmat trHWGenerator trUST trAGT trCalARP trTPE
pERMISSION TO INSPECT: lnspections may involve obtaining photographs, reviewing and copying records, and
determining compliance with adopted codes.
YES N9 N/Atrtrtr vtol. #
BPOl
BPO2
BPO3
TRO{
TRO2
EROl
ERO3
E FE01
GPS Goordinates: Latitude:
BUSINESS PLAN
Business plan complete, current, available during inspection and submitted electronically (HSC 25505,
25508(aXl); 19 cCR 2651)
lnventory of hazardous materials is complete and submifted electronically (HSG 25505(axl), 25506,
25508(aXl), 19 CCR 2652,26541
Site layouU facility maps are accurate and submitted electronically (HSC 25505(aX2)' 25508(aX1), 19 CCR
26521
TRAINING PLAN
Facility has appropriate training program, submifted electronically (HSC 25505(aX4), 25508(aXl), 1gCCR
2659, 22CCR66265.16)
Training documentation is maintained on site for current perconnel (HSC 25505(aX4), 22CCR66265'16)
EMERGENCY RESPONSE PLAN
Emergency response/contingency plan complete, current, submitted electronically, maintained onsite
(HSC 25505(a)(3), 25508(a)(l), l9CCR 2658, 22CCR 66265.52-.54)
Secondary containment is installed and sufficiently impervious to discharges. ICHSC 25270.4.5;40 CFR
112.8(cx2)l
GENERAL EH VIOLATIONS
Environmental Health fees paid. ICBPC 17200, Local Ordinance]
tr
tr
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tr
tr
tr
tr
E
tr
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tr
tr
GPS Coordinates: Longtitude:
INSPEGTOR: MATHESON BLISS FACILITY REP: Alex Haga
FAGTLTTY NAME: A&J REFRTGtr-\ArroN ADDRESS' .6Xt^?111553$3,
"oe3401HAZARDOUS WASTE GENERATOR
YES
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u
D
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N9
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u
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u
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u
M
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tr
tr
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GTO3
GTO4
GTO5
GTO6
vtol. #
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EPA ID NO/PERMITS
Generator has an EPA lD number to treat, store, dispose, transport or transfer hazardous waste (22
CCR 66262.12) lf not, Call(800) 618-6942 to obtain your CAL EPA lD number
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (22 CCR 66262.11)
Eown knowledge tranalysis trother
Hazardous waste analysis/test records are kept for at least 3 years(22 CCR 66262.40.(c))
D IS P OSA UTRA N S P O RTATIO N
Hazardous wastes disposed of at an authorized location (HSC 25189.5, 25201(al,22 CCR 66262.121
Facility utilizes a registered hazardous waste transporter, and hazardous wastes shipped with a
man ifest (HSC 251 60. 251 63(a)i 22 CCR 66262.20. 66263.41 )
trmilkrun Bother
GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (22 CCR 66262.23,
GTOS
66262.a0(a))
STORAGE AND MANAGEMENT OF CONTAINERSffANKS
Hazardous wastes are accumulated on site as follows: ( HSC 25123.3 (bxly(dy(hxl); 22 CCR 66262.34(d))
tr90 days if waste generated per month is greater than or equal to 1000 kg. (2200 lbs.)
tr180 days if waste generated per month is less than 1000 kg (see note)
tr270 days if waste generated per month is less than 1000 kg and transported more than 200 miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6000k9(13,200 lbs) and no
acutely/extremely hazardous waste over 1kg(2.2!bs.) is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation tim€tss{al
or 1-qt limit) (22 CCR 66262.34(e))
lgnitable or reactive wastes are located 15 m (50 feet) from facility's property line (22 CCR 66262.34(a)(1)'
66265.176)
Gontainers of hazardous waste are properly labeled (includes appropriate daIe,"HAZARDOUS WASTE,"
waste composition/physical state, hazardous properties, name/address of generator) (22 CCR 66262.3'l,
66262.34(fl)
Gontainers/tanks containing hazardous wastes are in good conditiory'handled to minimize the release
or reaction (22 CCR 66262.34;22 CCR 66265.171-.179, 66265.177(c))
Gontainers/tanks/liners are compatible with waste stored or transferred (22 CCR 66262.34,66265.1721
Gontainers storing hazardous wastes are closed/sealed (22 CCR 66262'34,66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted (22 CCR
66262.34, 66265.174)
Daily inspection of all tank systems is conducted and documented (22 CCR 66262.34,66265.195)
Empty containers or inner liners > 5 gal has date when emptied and are properly managed within one
year of date emptied (22 CCR 66261.7(D)
RECYGLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC
25250.41
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) ffille 22
ccRs 66266.130)
Spent lea*acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (22 CCR 66266.81)
Solvents/other recyclable materials are managed as hazardous wastes until recycled (22 CCR 66266.2)
SOURCE REDUCTION:For facilities generating >12,000 kg.fyr. of hazardous waste on site.
Generator is subject to SB14 and has prepared and retained current source reduction documents or is
able make them available to the inspector within (5) days. (HSC 25244.191.211.22;22CCR 67100.7/.8)
Source Reduction Evaluation and Plan contains the following five elements:ceftification, amounts of
wastes generated, process description, block diagrams, and implementationschedule of selected
source reduction measures. (HSC 25244.'lIL21,22 CCR 67100'517/.8)
Haa,vaste Contingency Plan prepared, current, submifted to the CUPA, maintained onsite. (22CCR
66262.34(aX4), 66265.51 -.54)
Employees trained upon hire, annually; training records maintained at facility as required (22 CCR
66262.34(aX4), 66265.1 6)
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 (22 CCR 66265.31-.37)
GTO9
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GTlI
GT12
GT13
GT14
GT15
GTl6
GT17
GT18
GT19
GT2O
GT21
GT22
GT23
GT24
GT25
ERO2
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s u M l""\RY oF oBS E RVATIONSVIC"ATIONS
No violations of undergrouno -.J."g" tank, hazardous materials, or hazardc- . 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 th
CUPA in writincr
ALL VTOLATIONS MUST BE CORRECTED WtTHtN 30 DAYS OR AS SPECIFIED CUPA must be informed in writing with a
certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of
the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be
reinspected any time during normal business hours.
You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective
actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or
criminal action.
FACILITY NAME: A&J REFRIGERATION ADDRESS: 4096 HORIZON LN
SAN LUIS OBISPO, CA 93401
VIOLATIONS
VIOL. NO
BPOl
CORRECTIVE ACTION REOUIRED
IMMEDIATELY TAKE NECESSARY ACTION IO ENSURE THAT THE BUS/NESS PLAN /S COMPLETE,
SUBM\TTED ELECTRONTCALLy AND AVATLABLE (VlStT CALIFORNIA ENVTRONMENTAL REPORTING
SySIEM - "CERS'i hftpsl/cers.catepa.ca.gov). IMPLEMENT A PROCEDURE TO ENSURE THAT THE PLAN lS
UPDATED AS REQUIRED BY HEALTH AND SAFETY CODE SECI/OA/S 25505, 25508(AX1) AND CALIFORNIA
CODE OF REGULATIOAIS SECI/ON 2651. FAILURE TO CORRECT THIS VIOLATION BY THE DATE
SPECIFIED IN THIS REPORT MAY RESULT IN CIVIL AND/OR CRIMINAL PENALTIES OF UP TO $2,OOO PER
DAY PER VIOLATION, AND/OR THE PENALTIES DESCR'BED IN THE CA HEALTH & SAFETY CODE SECTION
25515.
Create and submit a Hazardous Materials Business Plan through CERS (cers.calepa.ca.gov) by
7t27t22. lnclude Business Activities (stores hazardous material; generates hazardous waste),
Business owner/operator information, Ghemical lnventory, Facility Site Map, and Emergency
Res olans.
FEOl
Pay permit fees by contacting (805)781-55'14 or visiting
https://sloonli ne.envisioncon nect.com/#/onlinePavments
GTOl
Apply for Cal EPA lD number. Visit https ://dtsc.ca.qov/perma nent-state-epa-id-n u m bers/
GT17
Properly dispose of or recycle empty plastic and metal 55-gal drums stored behind shop' Manage
emptv conta iners within I vear of beinq emptied.
GT18 IMMEDIATELY MANAGE USED OIL AS A HAZARDOUS WASTE UNTIL IT IS RECYCLED. IMPLEMENT A PLAN
IO EA/SURE THAT IJSED OILWLLCONTINUE TO BE MANAGED AS A HAZARDOUS WASTE. THE FINE FOR
THIS VIOLATIOIV /S AA/ INITIAL PENALW OF IJP TO $7O,OOO, AND THEN AI{ ADDITIONALTWO PERCENT OF
THE INITIAL PENALTY PER DAY THEREAFTER.
AFTER CORRECTION, CONTACT /NSPECIOR FOR A REINSPECTION TO VERIFY COMPLIANCE.
Properly dispose of waste oil stored behind shop. Observed several Sgal buckets with
deteriorating/missing lids and approximately 15-20 five-gallon buckets in total. Provide labeled
containers and secondary containment for waste oil storage. Remove and dispose of stained soil
in area as hazardous waste. Review with emplovees "qood housekeepi nq" Dractices.
INSPECTION COMMENTS:
Email copies of recent receipts for waste refrigerant recycling
FACIL;TY NAME: A&J RF,"qjGERAT|ON
INSPECTED BY: MATHESON BLISS
DATE: OG12412022
ADDp\SS: 4096 HORIZON LN,l
NAME oF FA'Lrry -J,^X'::it"oaBrsPo'
cAe3401
SIGNATURE OF FACILITY REP:
STATEMENT OF COMPLIANCE
n: I certify under penalty of perjury that this facility has complied with the corrective actions listed on
is inspection form.
nature of Title: Date:-
COUNTY OF SAN LUIS OBISPO
Faci lnformation as of 06/19/2025 Pa e#:1
t I NEW FACrLrry RECORD
trXl.rronvnroN cHANGE
f I clost FAcrLrw AS oF: Date:
t I OWNERSHIPCHANGE:[ ] Business [ ] Property [ ]Tank
[ ] UPDATE BILLING INFORMATION
[ ] UPDATE UST INFO (sys, type, capacity, etc.)
Date: 06/19/2025 Requested By: mb
OWNERFILE INFORMATION
Owner lD: OW00161 16
Owner Name: The Arcticom Group
San Luis Obispo, CA 93401
Home Phone: 8055437458
Busi ness Phone: 92533 47 222
Mailing Address: 1676 N California Blvd, 550
Walnut Creek, CA 94596
OwnerAddress: 4096 Horizon Ln
Owner DBA:
New Owner lD:
New Owner Name:
New Owner DBA:
New Owner Address:
New Home Phone:
New Business Phone:
New Mailing Address:
New Care of:
New Email:
Care of:
Email:
ESTABLISHMENT FIIE INFORMATION
Establishment lD: FA001 5659
CERS fD: 1090296/
Establishment Name: A&J REFRIGERATION
Site Address:Site Address: 4095 Horizon Ln
San Luis Obispo, CA 93401
Phone: 8057486222
Email:
New Establishment lD:
New CERS lD:
New Name:
Phone:
Email:
TINKED PROGRAMS
ctive
PR0021149 PA - Hazardous Materials Handler - 1 - 4 EE0000517 - Matheson Bliss
Hazardous Materials
LastActivity: 4/2/2024 12:00:00AM - Reinspection, Matheson Bliss
PR0021150 PA - Hazardous Waste Generator - Very Small EE0000517 - Matheson Bliss
Quantity Generator
8/31/2023 12:00:00 AM - Routine lnspection, Matheson Bliss
lActivate I Change I lnactive l
IActivatelChangell
Last
BI ttING CONTACT INFORMATION
Account lD: AR0029398
Account Name: Joseph Wighton
New Mailing Address:Mailing Address: 4096 Horizon Ln
San Luis Obispo, CA 93401
Discount Code:
Account Balance*: "asol 06/19/2025: $0.00
Discount Eligible? NO
Care of:
New Account lD:
New Account Name:
New Care of:
Discount Eligible?
CUPASECTION
Number of Materials: PE: Number of Waste Streams:
Update CERS? Yes No (if yes,forward to CERS admin)
Number of Tanks(lsitcapacity/Compartmentbelow):
PE:
PE:
I CREATE NEW FILE
I UPDATE EXtSTtNG FILE LABEL
t I UPDATE NEXT INSPECTION DATE: Date
[ ] RETURN F|LE TO:
Please 0r
UNIFORM HAZARDOUS
WASTE MANIFEST
Form 0MB No.2050-0039
1. Generator lD Number
BF
different than mailing
t-..i.j ,:1 i :iil "t'i
EPA lD Number6. Transporter
l' !!ic dialiJ:'r i':l,rr.l,ii
U.S, EPA lD Number7. Transporter
U.S. EPA lD NumberL Designated Name and Site Address
r,j. r. I J(if ti, .;i+ ;",
ia. I '.3'.' ,t .1r1{:t'i
i.aft.:
Name
Phone:
iii:.{.:11-- iri;,.,!ri , l';.-.i,in::::i.;ilil:,i :., . ..i.,... \.1 t.:
of 3. Emergency Response
r,,. l t".f:ri'''!f r'. 1. I'9i3t ,,.,t
r;*.'1.: I'i(:,ii!:tj'.r:,:; ; I f'l
":'.i,,i. i 1. t, it' . rlii,'; lr ;F !i..r ! .:J: {'.';:.'1 i'' i
!' ! 1,..4 1': *i,t.ii i..r ?:!i \-qht,r ! f: l:),t.tr. t't tt,;i r *
", i'i:i 1', iitifu<lrii:! | ti
f';:pi:;, ; f'r.q;rlf ;,{; j.i:j];tl i
10. Containers 12. Unlt
Wt.frlol.
13. Waste Codes
No.Type
11. Tolal
Quantity
9a.
HM
9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, lD Number,
and Packing Group (if any))
11
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4.
14. Special Handling lnstructions and Additional lnformation
!. J:!i .,.jj i :: I
i :; t , rlj.r;';;,:.,-{,i r ti':"'t!,-;fjii: !.rii 1 i
marked and labeled/placarded, and are in all respects in proper condition lor hansport according to applicable international and
Exporter, I certify thal the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent.
that the waste minimization statement identilied in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true.
areard classified,of thiscontents are and described above the name,packaged,CERTIFICATION:GEN ERATOR'S/OFFEROR'S thatdeclare the accurately by pr0per shipping5.1 hereby consignment fully
am theandnationalexport Primaryshipmentregulations.governmental
I certify
d.okd.ulz,ut()
Generator's/Offeror's Printed/Typed Name
' .,J .
"' !:.f:: ,i1,.^'..
Signature
!
Month Day Year
Ji-z,
16 lnternational shipments E rmport to u.s.Export from U,S.
Transporter signature (tor exports only):u.s.Date leaving
Port of entry/exit:
17. TransporlerAcknowledgment of Receipt of Materials
Month _ Day. Year
lli ,"1 i ". l;;:- -:*'"4
u
IJTFtoo-(t2
E.F I
MonthSignature Day Year
18. Discrepancy
l-l Residue
lvlanifest Reference Number:
18a. Discrepancy lndication Space Full RejeclionPartial Rejection trTypeQuantity
U.S. EPA lD Number18b. Alternate Facility (or Generator)
Facility's Phone:
Month Day Year18c. Signature ofAlternate Facility (or Generato0
19, Hazardous Waste Report Management l\.4ethod Codes (i.e., codes for hazardous waste trealment, disposal, and recycling systems)
4.1.
20. Designated Facility Owner or operator: Certification of receipt ol hazardous materials covered by the manifest except as nded in ltem 18a
F
=C)
f,
ctutF
z(9
at,r!o
Printed/Typed Name tllSignatureMonth Day Year
EPA Form 8700-22 (Rev. '12-17) Previous editions are obsolete.GEI'IERATOR'S INITIAL COPY
Date run:2:39:02PM
\
COUNTY OF SAN LUIS OBISPO Report #: MFRI
Page* 1
Dale:6124f2O22 Requested Oy: Q\;(<#
r( r
NEW FACILITY RECORD
INFORMATION CHANGE
I ] CLOSEFACILITYASOF:oarc: W tl4tLL
OWNER FILE INFORMATION
Owner lD:
Orner Name:
lnformation as of 6n4n022
t IO\NERSHIPCHANGE: [ ] Business [ ]Property [ ]Tank
I I UPDATE BILLING INFORMATION
[ ] UPDATE UST INFO (sys, type, capacity, etc.)
New Owner lD:
New Name:
New Home Phone:
NewWork Phone:
New Mailing Address:
Home Phone: Not SPecified
Work Phone: Not SPecified
Mailing Address:I,L ,/
Care of:New Care of:
FACILITY FILE INFORMATION
Faclllty lD:
Facility Name:
Phone:
Mailing Address:
Care of:
CERS ID:
Grs:\o1o zt b\
New lD:
New Name:
New Site Address:
New Phone:
New MailingAddress:
New Care of:
New CERS lD:
New GIS:
NTS RECEIVABLE FORMATION . PRIMARY BILLINGAND NG
Account lD:
Account Name:
Mailing Address:
Care of:
NewAccount lD:
NewAccount Name:
New Mailing Address:
New Care of:
Mail lnvoices to:DiscountCode: Discountlnvoices?:
LINKED PROGRAMS Transfer (Circle One)
UST(s) Programto Ac'tivate/Change
Linked New Owner? /lnactvate
I I CREATENEWFILEFOLDER
t I UPDATE EXTSTTNG F|LE FOLDER I-ABEL
UPDATE NEXT INSPECTION DATE: Date:
Copy lo: File Other:
HAZARDOUS MATERIALS SPECI FIC:
Number of Materials 1
Number of Vlhste Streams I
Number of Tanks (list
PE.A+VL
, I.q,LI
Update CERVHazMat Portal? O ru 1,ty"", forward to CERVportal for update)
Comments:
Entered by:Date:-9r1fu-&
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