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HomeMy WebLinkAboutHMBPIFIED PROGRAM CONSOLIDATED F( FACILITY INFORMATION E: BUSINESS OWNER/OPERATOR IDENTIFICATION Page of I. IDENTIFICATION FACILITY ID# ��01010151110131 11 BEGINNING DATE 100 1 ENDING DATE 101 BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 BUSINESS PHONE 102 PAUL'S DRY CLEANERS 8055432250 BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a 214 HIGUERA ST BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108 SAN LUIS OBISPO cA 93401 DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a BUSINESS MAILING ADDRESS 108a 214 HIGUERA ST BUSINESS MAILING CITY 108b STATE 108o ZIP CODE I08d SAN LUIS OBISPO CA 1 93401 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Jim Morabito 8055432250 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 112 MORABITO, JAMES 8055432250 OWNER MAILING ADDRESS 113 214 HIGUERA OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 SAN LUIS OBISPO CA 1 93401 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 Jim Morabito 8055432250 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 214 Higuera Street CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122 San Luis Obispo I CA 93401 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 MORABITO, ROD MORABITO, JIM TITLE 124 TITLE 129 MANAGER Owner BUSINESS PHONE 125 BUSINESS PHONE 130 8055432250 8055432250 24-HOUR PHONE 126 24-HOUR PHONE 3 t C _ CELL / PAGER # 132 CELL / PAGER # 127 EMAIL EMAIL ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 09/26/20' 1 Rod Morabito NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 Jim Morabito Manager UPCF (Rev. 12/2007) I TIED PROGRAM CONSOLIDATED FOF FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of 1. FACILITY IDENTIFICATION FACILITY ID # IFIAIOIOIOISlllOI31 l EPA ID # (Hazardous Waste Only) 2 (Agency Use Only) CAD981666464 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) PAU L'S DRY CLEANERS 3 BUSINESS SITE ADDRESS 214 HIGUERA ST taj BUSINESS SITE CITY SAN LUIS OBISPO 104 CA ZIP CODE 93401 tos IL ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the -Business Owner" erator Identi±:cation page Does your facility... If Yes, please corn ]etc these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed © YES INVENTORY — CHEMICAL gases (include liquids in ASTs and USTs); or the applicable Federal threshold DESCRIPTION quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. REGULATED SUBSTANCES Have Regulated Substances stored onsite in quantities greater than the threshold quantities established by the California Accidental Release ❑ YES Coordinate with your local agency prevention Program (CalARP)? responsible for CalARP. C. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SWRCB Form A) Own or operate underground storage tanks? ❑ YES UST TANK (one page per tank) (Formerly Form B) D. ABOVE GROUND PETROLEUM STORAGE You may need to submit an Own or operate ASTs above these thresholds: ABOVEGROUND PETROLEUM Store greater than 1,320 gallons of petroleum products (new or used) in ❑ YES STORAGE TANK FACILITY aboveground tanks or containers. STATEMENT. Click for details E. HAZARDOUS WASTE Generate hazardous waste? © YES EPA ID NUMBER— provide at the top of this page Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ❑ YES RECYCLABLE MATERIALS REPORT (one per recycler) Treat hazardous waste on -site? ❑ YES HAZA DO L[ WASTE TOREATE ON -SITE HAZARDOUS WASTE TREATMENT —UNIT (one page per unit) Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)? ❑ YES CERTIFICATION OF FINANCIAL ASSURANCE Consolidate hazardous waste generated at a remote site? ❑ YES REMOTE WASTE / CONSOLIDATION SITE ANNUAL NOTIFICATION Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned on -site? ❑ YES HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or Obtain federal EPA ID Number, file more of federal RCRA hazardous waste, or generate in any single calendar ❑ YES Biennial Report (EPA Form 8700- month, or accumulate at any time, 1 kg (2.2 pounds) of RCRA acute hazardous 13A/B), and satisfy requirements for waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? ❑ YES See CUPA for required forms. F. LOCAL REQUIREMENTS (You may also be required to pr vide additiatal nformation by your CUPA or local agency.) UPCF Rev. (12/2007)