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Home My WebLink AboutInspection Reports 3Environn —,al Health Services (805) 781-5544 P.O.Box 1489 2156 Sierra Way - San Luis Obispo, CA 93406 atV O1- sAn Us owspo Fire Depa ment (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 07/01/2014 Time: Facility Name: PAUL'S DRY CLEANERS Agency Inspection Tyne ❑EHS ❑Routine Site Address: 214 HIGUERA ST 2CITY FIRE RReinspection SAN LUIS OBISPO, CA 93401 ❑Chargeable Reinspection ❑Change of Ownership Phone: (805)543-2250 ❑Complaint❑Secondary Containment Testing Facility ID: FA0005103 ❑Chargeable Secondary Containment Testing Serial Number: DA1169505 PROGRAMS INSPECTED: OHazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ❑Hazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. YEAS M N/A BUSINESS PLAN ❑ ❑ ❑x BP01 Business plan is complete, current, available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ 0 BP02 Inventory of hazardous materials is complete (HSC 25604, Title 19 CCR 2729) ❑ ❑ © BP03 Site layout/facility maps are accurate (HSC 25604, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑x TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑x TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66266.16 EMERGENCY -RESPONSE PLAN- ❑ ❑ ❑x ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66266.53/64) ❑ ❑ Z ER02 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 273% 22 CCR 66265.31-.37, 66267.34 (d)(2), 40CFR 1265.31) ❑ ❑ x❑ ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c)(2)] GENERAL EH VIOLATIONS ❑ ❑ ❑x FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2960420000 GPS Coordinates: Longtitude:-120.9846750000 INSPECTOR: KERRY BOYLE FACILITY REP: Owner SUMP OY OF OBSERVATIONSMOLATIONS cl No violations of undergrOL. .3torage tank, hazardous materials, or haza is waste laws/regulations were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. i] Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. 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 andlor 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: PAUL'S DRY CLEANERS VIOLATIONS VIOL. NO CORRECTIVE ACTION REQUIRED INSPECTION COMMENTS: Documentation of training provided in writing. ADDRESS: 214 HIGUERA ST SAN LUIS OBISPO, CA 93401 INSPECTED BY: KERRY BOYLE NAME OF FACILITY REP: Owner DATE: 07/01/2014 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. Signature of Owner/Operator: Title: Date: County of San Luis Obispo C1S! u i Environmental Health Services C 1f1 US (1�Z�C� o 781-5544 7A1 ! .7 VL7/.7t✓t� (805) ~' P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data HAZARDOUS MATERIALS INSPECTION FORM entry by: �*' 0 Date.) Timeri . FACILITY j AGENCY INSPECTION TYPE i ElEHS El Routine ❑ Reinspection ' ❑ AG DEPT ❑ Complaint ❑ Other ADDRESS: nk �/ [ CITY FIRE ., Result Code: _70 _80 _90 PHONE: Action Code: _32 _37 _33 _31 PROGRAMS INSPECTED: -`Business Plan ❑ HW Generator [:]UST ❑ AGT ❑CALARP ❑CALARP REINSPECTION REQUIRED: FP NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and eterminina compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO COS N/A BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) l�J ( ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) 4E ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN 1-Fj ❑ ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) n ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN p ❑ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ❑ ER02 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 AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ ❑� AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go tolhit`tp://www.slopublichealth.org/environnientalhealth/hazardous materials.him, to obtain forms to comply with BPO1 BP03, TRO1 and ER01/ GPS Coordinates: Latitude: deg min ` decimal min deg _min r / decimal Jun 26 14 09:00a Paper Manage 'it Inc 80-�444388 p.1 PAUL'S DRY CLEANERS AND LAUNDRY INC. Our Motto: "Quality and Prompt Service" 214 HIGUERA STREET, SAN LUIS OBISPO, CA 93401 PHONE 805-543-2250 FAX 805-543-3408 June 26, 2014 UNION MACHINE HL 890 DRY CLEANING MACHINE INSTRUCTIONS TO FOLLOW IN CASE OF: 1. MINOR SPILL - PLACE CLEAN RAGS ON TOP OF MINOR SPILL, ONCE CLEANED UP PLACE RAGS BACK IN BARBELL -- 2. MAJOR SPILL - SAME AS ABOVE THEN CALL 911 IF NECESSARY 3. IN CASE OF FIRE: TURN OFF POWER SWITCHES AT OR ON ELECTRICAL PANEL, CALL 911. USE FIRE EXTINGUISER UNTIL FIRE DEPT ARRIVES. WE BELOW UNDERTAND ALL OF THESE PROCDUERS luhICCU 1*ktIVAV MIMI y : F � H4 Environn,,,.aal Health Services C (805) 781-5544 y (IPV 1489 2156 Sierra Way- SM US MIS Fire Depa ment (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 02/28/2014 Time: 1:30 am Facility Name: PAUL'S DRY CLEANERS Agency Inspection Type ❑EHS IgRoutine OCITY FIRE ❑Reinspection Site Address: 214 HIGUERA ST ❑Complaint SAN LUIS OBISPO, CA 93401 ❑Secondary Containment Testing Phone: (805)543-2250 Facility ID: FA0005103 Serial Number: DAOGBPSVO PROGRAMS INSPECTED: ©Hazmat I9HW Generator DUST ❑AGT ❑CaIARP ❑TPE REINSPECTION REQUIRED: ©Hazmat ❑HW Generator DUST ❑AGT ❑CaIARP ❑TPE PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. YES NO N/A BUSINESS PLAN ❑x ❑ ❑ BP01 Business plan is complete, current, available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑x ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑x ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑x ❑ TR01 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑x ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR) 66265.16 EMERGENCY RESPONSE I7 ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑x ❑ ❑ ER02 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-.37, 66267.34 (d)(2), 40CFR 1 265.31) ❑ ❑ Z ER03 Secondary containment is installed and sufficiently impervious to discharges. [CHSC 25270.4.5; 40 CFR 112.8(c)(2)] GENERAL EH VIOLATIONS x❑ ❑ ❑ FE01 Environmental Health fees paid. [CBPC 17200, Local Ordinance] GPS Coordinates: Latitude: 35.2960420000 GPS Coordinates: Longtitude:-120.9846750000 INSPECTOR: KERRY BOYLE FACILITY REP: Rod Morabito FACILITY NAME: PAUL'S C CLEANERS ADDRI; EPA ID NUMBER: HAZARDOUS WASTE GENERATOR Total generated/month: Waste Oil: Solvents: Antifreeze: Others: 214 HIGUERA ST SAN LUIS OBISPO, CA 93401 Lbs or gals (average) VIOL. # EPA ID NO/PERMITS GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR§66262.12) If not, Call (800) 618-6942 to obtain your CAL EPA ID number HAZARDOUS WASTE DETERMINATION GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other GT04 Hazardous waste analysis/test records are kept for at least 3 years(Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GT05 Hazardous wastes disposed of at an authorized location (HSC §25189.5, Title 22 CCR §66262.12) GT06 Facility utilizes a registered hazardous waste transporter, and hazardous wastes shipped with a manifest (Title 22 CCR §66262.20, HSC §25160/25163(a)) ❑milkrun ❑other GT07 Manifests andlor receipts are properly completed retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23, 66262.40 (a)) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 090 days if waste generated per month is greater than or equal to 100 kg. (220 lbs.) 0180 days if waste generated per month is less than 100 kg (see note) 0270 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 6000kg(13,200 Ibs) and no GT09 Hazardous waste "satellite" collection is managed properly (complete labelinglaccumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) GT11 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) GT12 Containers/tanks containing hazardous wastes are in good conditionfhandled to minimize the release or reaction (Title 22 CCR §66262.34 (d)(2), 66265.171-.191,66265.177(c)) GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§ §66262.34 (d)(2), 66265.172) GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §§66262.34 (d)(2), 66265.173) GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§ §66262.34 (d)(2), 66265.174) GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §§66262.34 (d)(2), 66265.195) GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year o a e emptied -(Title CCR R 66261.7 (f)) RECYCLABLE WASTE GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (Title 22 CCR§ 66266.13, HSC §25250.4) GT19 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) (Title 22 CCR§ 66266.13) GT20 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) GT21 0 ❑ ❑ GT22 © ❑ ❑ GT23 Solvents/other 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 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 §25244.19, 25244.21) 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, 67100.8, HSC §25244.19) County of San Luis Obispo Cluj! O. 'e ILA Environmental Health Services c'IC (805) 781-5544 7AI ` a7 P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data HAZARDOUS MATERIALS INSPECTION FORM entry by: Date: 0( %.-1 /� /�,y, Time: 'l�'f�'! ^ "I 11 // 1 ; A FACILITY NAME: AGENCY ❑ EHS ❑ AG DEPT ['CITY FIRE INSPECTION TYPE ❑ Routine ❑ Complaint Result Code: _70 Action Code: _32 ❑ Reinspertion ❑ Other_ f _80 _90 _37 _33 7 1 ' ADDRESS: rLY PHONE: PROGRAMS INSPECTED: .Q-gusiness Plan 2 HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: f NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAMEITITLE): BUSINESS PLAN YES NO COS N/A ❑ ❑ ❑ BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) �d ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) s TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) t riJ�i ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ iJ ❑ ❑ EMERGENCY RESPONSE PLAN ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ER02 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 6626531- .43) ❑° ❑❑ ❑ �' COMMENTS Go to hap:/h c1✓ GPS Coordinates: Latitude: INSPECTOR: Ar ABOVEGROUND PETROLEUM STORAGE TANK ACT AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) w.slopublichealth.org/environmentalhealth/hazardous_Matcrials.htto obtain forms to comply y ith BP0I,-BP03, TRO1 and ER01 (. deg min decimal min Longitude: d min decimal min % FACILITY REP: I (" ' V, V \ .1 -- M�kFACILITY NAME. l ADDRESS: /la YAda, A HAZARDOUS WASTE GENERAT J� - I " EPA ID NUMBER: Total generated/month: Tiered Permit: EJCESW CESQT CA [:]PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YES Lbs or gals (average) NO COS N/A VIOL. # EPA ID NO/PERMITS 7 GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste GT03 El El El GT04 r' I O ❑ O GTO5 del GT06 ❑ GT07 t EJ GT08 GT09 �® GT10 GTl l 0 GT12 GT13 GT14 `D GT15 ❑ ❑ GT16 Jo- ❑ GT17 ❑EJGT18 f �' GT19 GT20 GT21 GT22 GT23 r (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION Hazardous waste determination conducted ('Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSALITRANSPORTATION 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 22 CCR §66262.12) ❑milkrun , ,Elother Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(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 limit) (Title 22 CCR §66262.34(c)) Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, nameladdress of generator) (Title 22 CCR §66262.31, 66262.34) Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(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 or areas where hazardous waste containers are stored is conducted —4T4d#42-GCR§6626& l 74) Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE Used oil is managed as hazardous waste until recycled (includes proper )abeling, storage, etc) (HSC §25250.4) 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) (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 §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 §25244.19, 25244.21) Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) ' County of San Luis Obispo MY 0[ Environmental Health Services �� (805) 781-5544 SAn Itas t1 f�� 1spo P.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data f HAZARDOUS MATERIALS INSPECTION FORM entry by: Date: r� 1 kj '/Il Time:( � / -.- '• ". y .. FACILITY NAME: AGENCY INSPECTION TYPE t 0[IEHS Routine ❑ Reinspection ❑ AG DEPT ❑ Complaint ❑ Other ADDRESS: 1 -Gf �, / ❑CITY FIRE Result Code: 7080 _90 PHONE: pkaoI jr, Action Code: _32 _37 733 _31 PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Gener or ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED:NO ❑ YES ❑ Business Plan W ener ❑ UST ❑ AGT ❑CALARP PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN N U.S NO COS N/A ❑ ❑ ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ ❑ ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN I,❑ ❑ ❑ ❑ ERO1 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate lire, 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 ❑ ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to hnp:/lww w.>lupublichcalth.ur `cm ironmrnialhr;ihh/h;varduu. materials.htm, to obtain forms to comply with BPO1-BPO3, TRO1 and ERO1 GPS Coordinates: Latitude: deg mi decimal min Longitude: deg min decimal min � � 1 INSPECTOR:OAA FACILITY REP: n (f I I � FACILITY NAME. ADDRESS: 1 i HAZARDOUS WASTE GENERAT EPA ID I f Lbs or gals NUMBER: / V� Total generated/month: / (average) Tiered Permit: OCESW OCESQT CA PBR Waste oil: Solvents: ►/ Treatment Equipment: Antifreeze: Others: YES NO _CO17 OS_ VIOL. # EPA ID NO/PERMITS U LJ LJ GTOl Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ ❑ ❑ P°' o 0 P ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ gyp" ❑ O ❑ O ❑ O ❑ O ❑ ❑ L7RES 0 -�Mm GT03 Hazardous waste determination -conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION GT05 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 22 CCR §66262.12) ❑milkrun ❑other GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) GT07 Manifests and/or receipts are properly completed/retalned by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS GTOS GT09 GT10 GT11 GT12 GT13 GT14 GT15 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 090 days If waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(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 limit) (Title 22 CCR §66262.34(c)) Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, nametaddress of generator) (Title 22 CCR §66262.31, 66262.34) Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(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 U GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ GT17 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 P,� GT18 Used oil is managed as hazardous waste until recycled (includes properlabeling, storage, etc) (HSC §25250.4) P' GT19 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) (Title 22 CCR§ 66266.130) GT20 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) ❑ GT21 Solvents/other 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. GT22 Generator is subject to S1314 and has prepared and retained current source reduction documents or is able make them avaflable to the inspector within (5) days. (HSC §25244.19, 25244.21) GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, ampunts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) s Environmental Health Services (805) 781.55" P.O. Box 1489 2156 Sierra Way city of san Luis osispo i. San Luis Obispo, CA 93406 Fla Department (SOS) 781-7380 2160 Santa Barbera Avenue San Luis Obispo CA 93401.5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: f2 o f i, Time- 11 arli EFW data entry by: ;WA FACILITY NAME: pjj t i i; O r v C 7. �: a t. r, AGENCY ❑ EHS CITY FIRE INSPECTION X.,, ❑ ❑ ❑ TYPE Routine Reinspection Complaint Other ADDRESS: 0 lip 1"'I !"-- . Jb1-"ij)0, Cl, PHONE: PROGRAMS INSPECTED: ❑ Business Plan HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO ja-fES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YES NO N/A BP01 Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) BPO2 Inventory of hazardous materials is complete (HSC 25504,'Title 19 CCR 2729) ❑ ❑ BPO3 Site layout/facility maps are accurate (HSC 2554M, Title 19 CCR 2729) TRAINING PLAN 0 ❑ ❑ TRO1 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 .CCR 66265.16) EMERGENCY RESPONSE PLAN �/ ❑ ❑ EROI Contingency plan Is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR 166265SN54) ❑ ❑ ER02 Facility is operated and maintained to pmvent/minimizdnddgate 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- A3) ABOVEGROUND PETROLEUM STORAGE TANK ACT ❑ ❑ ❑ AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 ym (40 CFR 112.5(b)) ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to hup://www..5lopublichealth.orW vironmenWhea]th/hazardous_matena]s.htm. to obtain forms to comply with BPOI-BP03, TROI and ER01 Ala", yi :' 11MUNIAe, r \\ GPS Omrdinates: Latitude: deg min decimal min Longitude: deg min decitn>al min '/I Y n �n INSPECTOR: (1 FACILITY REP: ,q� � CADOCUME-1\Repro LOCALS--1\Temp\c.lotus.notes.data\1_Inspection Form Page 1.doc 24-Jan-06 FACILITY NAME. ADDRESS: HAZARDOUS WASTE GENERATOR EPA ID Lbs or gals NUMBER: Total generated/month: (average) Tiered Permit: LJCESW CESQT ❑CA PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YES NO COS N/A VIOL. # EPA ID NO/PERMITS ❑ ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12), If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION �' ~ ❑ ❑ GT03 Hazardous waste determination -conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other ❑ ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑F1GT05 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 22 CCR §66262.12) ❑mflkrun ❑other ❑ ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS p' ❑ ❑ ❑ GTO8 Hazardous wastes are accumulated on site as follows (Title,22 CCR §66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) 0180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over I kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ '40, GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) i ❑ ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) P[I El ❑ GTH 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) / ❑ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release d or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) [� ❑ ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) r-1 E] GT!S Meekly inspection of' areas where hazardouswastecontainers are stored is conducted (Title 22 CCR§66265.174) J ❑ ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) 4 ' ❑ ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly within one year or date emptied (Title 22 CCR §66261.7 (1)) RECYCLABLE WASTE ❑ ❑ ❑ Q . GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ ❑ GT19 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) ❑ ❑ GT20 (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) ❑ ❑ GT21 Solvents/other 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. ❑ ❑ ❑ GT22 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 §25244.19, 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) j 1. County of San Luis Obispo Gltj/ OEnvironmental o Health Services� 11 i' ''``� ((�� ``. `��ff(805)781-5544 sm Wis `,��ispoP.O. Box 1489 2156 Sierra Way Fire Department (805) 781-7380 San Luis Obispo, CA 93406 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) EFW data HAZARDOUS MATERIALS INSPECTION FORM entry by: Date: Time: - , FACILITY NAME: 4Q>4 JI AGENCY INSPECTION TYPE ❑ EHS Routine ❑ Reinspection ADDRESS: td ❑ AG DEPT El Complaint El CITY FIRE Other Result Code: _70 _80 _90 PHONE: Action Code: _32 _37 _33 _31 PROGRAMS INSPECTED: XBusiness Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: NO ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP 'ERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and etermining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YE* NO COS N/A t ❑ ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) 1 �❑ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) s. ❑ ❑ ❑ TROT TRAINING PLAN Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ❑ EROI Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ❑ ER02 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 ❑ ❑ ❑ , AT01 SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b)) ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.slopuplichealth.org/cnvirpnmcntalhcaltb/haza(dous _mates is .hlm. to obtain form, to comply with .BP01-I31103, TROI and 601 W A /7" http://www.slopuplichealili.org/c=iniciiialheiilt , GPS Coordinates: Latitude: deg iVin decimal min Longitude: deg _nun decimal INSPECTOR: I \ I i M N /4 1 ,14VI y FACILITY REP: ;; • (If" FACILITY NAME: t -! � ADDRESS: / �QA HAZARDOUS WASTE GENERATOR EPA ID / Lbs or gals NUMBER: ILLl L7 Total generated/month: (average) Tiered Permit: CE CES T CA PBIt Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YES NO COS N/A VIOL. # EPA ID NO/PERMITS i ❑ ❑ ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste " (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION 1E ❑ ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) • Down knowledge ❑analysis [:]other ❑ ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ ❑ GT05 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 22 CCR §66262.12) ❑milkrun ❑other ❑ ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) ❑ 90 days if waste generated per month is ;greater than or equal to 100 kg (220 lbs.) ❑ ISO days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 l<g and n-ansported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 I lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) ❑ ❑ ❑ ❑ GTH 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) ❑ ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/191, 66265.177(c)) ❑ ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265174) ` ❑ ❑ ❑ ❑ GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) Q�[� GT17 Empty containers or inner liners greater than 5 got has date Mien empaml and are manag d properly within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ ❑ `i►' GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) I❑ ❑ ❑ GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed rl rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ❑ ❑ ❑ n/' GT20 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) ❑ ❑ ❑ ❑ GT21 Solvents/other 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. ❑ ❑ ❑ �%� GT22 Generator is subject to SB14 and has prepared and retained current source reduction documents ❑ n/ or is able make them available to the inspector within (5) days. (HSC §25244.19, 25244.21) ❑ ❑ `i'` GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) I 1 �'i Yy it .�/.�, O f �••�- i � '�. Environmental Health Services City i�\�]/J P.O. ox 14 9 S 1„ Wis ��po 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 to Date: entry Time: by: FACILITY NAME: / AGENCY ❑ EHS CITY FIRE ��5 /,� INSPECTION 0 ❑ TYPE Routine Reinspection Complai t Other ADDRESS: CV PHbNE: % PROGRAMS INSPECTED: Business Plan 'HW Generator ❑ UST ❑ AGT ❑CALARP REINSPECTION REQUIRED: ❑ NO ❑YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN Y S NO N/A ❑ [--IBPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ BPO3 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ❑ TROI Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 .CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materialstwaste 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) COMMENTS ABOVEGROUND PETROLEUM STORAGE TANK ACT ATOI SPCC Plan is reviewed and crrtifivrt by a registered nnoineer within tact 5 .,Vs (40 CYR 1111.5(b)) AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) Go to http://www.slopubl GPS Coordinates: Latitude: deg min decimal min obtain forms to comply with BPOI-BPO3, TR01 and E1101 min LS -1\Temp\c.lotus. notes data\ I Inspection Form Page 1.doc 24-Jan-06 FACILITY NAME: �`�—'t�- ��J ADDRESS: f 1 4 !" HAZARDOUS WASTE GENERATOR Lbs or gals EPA ID NUMBER: r r f _ Total generated/month: / (average) Tiered Permit: ❑CESW CESQT CA PBR Waste oil: Solvents: ✓ Treatment Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ED NO/PERMITS ❑ ❑ GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title f 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) Down knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DLSPOSAU TRANSPORTATION ❑ ❑ GTOS Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or authorization from DTSC (HSC §251895, Title 22 CCR §66262.12) ❑miikrun ❑other > ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR 1 §66263.42166262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GTO8 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) yn90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days V waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GTO9 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time155-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) ❑ ❑ GT11 Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, nameladdress of generator) (Title 22 CCR §6626231, 66262.34) ❑ ❑ GT12 Containersitanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) Uli ❑ ❑ GT13 Containers/tanksAiners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are dosed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted (Title 22 CCR§66265.174) ❑ ❑ GT16 _wilyyIiwpe_c_ffo_n_oT all tank systems is conducted and documented (Title 22 CCR §66265.195), ❑ ❑ GT17 Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly r within one year of date emptied (Title 22 CCR §66261.7 (f)) RECYCLABLE WASTE ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC ❑ ❑ §25250.4) GT19 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) (Title 22 L , CCR§ 66266.130) ❑ ❑ `j�� GT20 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) ❑ ❑ GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR §662663) SOURCE REDUCTION: For facilities generating >12,000 kgJyr. of hazardous waste on site. ❑ ❑ GT22 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 §25244.19, 25244.21) ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: t certification, amounts of wastes generated, process description, block diagrams, and implementation ,i schedule of selected source reduction measures. (HSC §25244.19) �% - C:\DOCUME-i\Repro\LOCALS-i\Temp\c.lotus.notes.data\2 Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 Environmental Health Services (805) 781-5544 P.O. Box 1489 2156 Sierra Way 4 city q san Luis osispo San Luis Obispo, CA 93406 Fire.Department (805) 781-7380 Date:-q Time: t FACILITY NAME: AD RESS: / G' d�1 PHONE: 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM EFW data entry by: KPR h _ :� LYfd�l AGENCY ❑ EHS CITY FIRE INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint ❑ Other PROGRAMS INSPECTED: Business Plan A HW Generator ❑ UST ❑ AGT I ❑CALARP REINSPECTION REQUIRED: ❑ NO ❑ YES IJ Business Plan I �HWGenerator ❑ UST ❑ AGT ❑CALARP BUSINESS PLAN YE NO N/A ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN �� ❑ TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) EMERGENCY RESPONSE PLAN ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 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 ❑ ❑ j AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25270) COMMENTS Go to http://www.stopublichealth.org/environmentalhealtWhazardous_materials.htm, to obtain forms to comply with BPOl-BPO3, TRO1 and ER01 GPS Coordinates: Latitude: deg min decimal min Longitude: deg min _decimal min INSPECTOR: �/ /j /W"TL `� / l / FACILITY REP: C:\DOCUME--1\Repro\LOCALS-1\Temp\c.lotus. notes.data\i_Inspection Form Page 1.doc 24-Jan-06 FACILITY NAME:_ _ ADDRESS: ___ HAZARDOUS WASTE GENERATOR Lbs or gals EPA ID NUMBER: Total generated/month: _ (average) Tiered Permit: ❑CESW J ❑CESQT [_]CA ❑PBR Waste oil: Solvents: Treatment Equipment: Antifreeze: Others: YES NO N/A VIOL. # EPA ID NO/PERMITS ❑` ❑ ❑ GTOI Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION 0' ❑ ❑ GTO3 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge []analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑' ❑ ❑ GT05 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 22 CCR §66262.12) ❑milkrun ❑other ' ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ ❑ GTO7 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GTO8 Hazardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ ® GT09 Hazardous waste "satellite" collection is managed properly (complete labelinglaccumulation time155-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑' ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) 0 ❑ ❑ GT11 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) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or - reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted ❑ ❑ ❑ GT16 (Title 22 . 174) Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ ❑ ❑ GT17 , 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 ❑ ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ ❑ GT19 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) (Title 22 CCR§ 66266.130) ❑ ❑ ❑ GT20 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) Q❑ ❑ GT21 Solventstother 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. ❑ ❑ 1. GT22 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 §25244.199 25244.21) ❑ ❑ ❑ GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUME---1\Repro\LOCALS~1\Temp\c.lotus. notes.data\2 Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 ' Environmental Health Services (805) 781-5544 P.O. Box b 2156 Sierraa Way city q san Luis osispo `. - San Luis Obispo, CA 93406 Fire Department (805) 781-7380 Date: S/�d o Time: FACILITY NAME: ADDRESS: PHONE: 2160 Santa Barbara Avenue San Luis Obispo CA 93401-5240 CERTIFIED .UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM EFW data entry by: INSPECTION TYPE ❑ Routine ❑ Reinspection ❑ Complaint ❑ Other 0 AGENCY ❑ EHS rTv CITY FIRE L PROGRAMS INSPECTED: I Q Business Plan I ❑ HW Generator I ❑ UST I ❑ AGT I ❑CALARP I REINSPECTION REQUIRED: I ❑MO ❑ YES I [ /Business Plan I ❑ HW Generator I El I ❑ AGT I ❑CALARP BUSINESS PLAN YES NO N/A f Tj' ❑ ❑ BPOI Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) []], ❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) E�, ❑ BPO3 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) _ TRAINING PLAN ❑ �_� TROT Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ TRO2 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) ' � EMERGENCY RESPONSE PLAN LJ ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) ❑ ❑ ER02 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 AT02 SPCC Plan is maintained on site or nearest field office. (HSC 25210) COMMENTS Go to http://www.slopublichealth.org/environmentalhealth/hazardous_materials.htm, to obtain forms to comply with BP01-131`03. TRO1 and ER01 --e ...... ucr uuu umrmas min INSPECTOR: �� ° FACILITY REP: U(, C:\D0CU4_1\ReP LOCALS-1\Temp\c.lotus. notes. data\1—Inspection Form Page 1.doc 24-Jan-06 r FACILITY NAME: 1 } �I�DDRESS: `-' r `HAZARDOUS WASTE GENERAT EPA ID NUMBER: Tiered Permit: Treatment Equipment: 0 (/X Lbs or gals �(/ ) J LJ` Total generated/month: (av rage) CESW CESQT CA ❑1'BR Waste oil: Solvents• 1/ . ' o h Antifreeze: Others:ll,� YES. NO N/A VIOL. # EPA ID NO/PERMITS ® ❑ ❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ® ❑ ❑ GT03 Hazardous waste determination conducted (Title 22 CCR §66262.11) ❑own knowledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GT05 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 22 CCR §66262.12) ❑milkrun ❑other �i Ln'J ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) [D/ ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS F2 ❑ ❑ GT08 wastes are accumulated on site as rollows (Title 22 CCR §66262.34) rHazardous u 90 days if waste generated per month is greater than or equal to 100 kg (2201bs.) [� 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.21bs.) is held on site for over 90 days. ®/ ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) ❑ ❑ GT11 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) 0 ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or - reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) FT, ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) [2 ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) I ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted Q ❑ ►e GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) , LLIJ El ❑ GT17 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)) ❑g+ / RECYCLABLE WASTE GT18 Used is hazardous oil managed as waste until recycled (includes proper labeling, storage, etc) (HSC � §25250.4) y�, t L V ❑ ®'` GT19 Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed J rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22 CCR§ 66266.130) ❑ ❑ GT20 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) �f ❑ ❑ GT21 Solvents/other 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. ❑ ❑ FT9" GT22 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 §25244.19, 25244.21) ❑ ❑ �', GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) C:\DOCUMEw1\Repro\LOCALS-1\'Temp\c.lotus.notes.data\2_.Hazardous Waste Generator.doc 20-Jul-04 20-Jul-04 cityof Mn falls owspp Fire Department (805) 781-7380 2160 Santa Barbara Avenue San Luis Obispo CA 93401 5240 CERTIFIED UNIFIED PROGRAM AG ENCY (CUpA) HAZARDOUS MATERIALS INSPECTIOR Date: � %�� N FORM Time: ,/O - /i A h FACILITY NAME: 4DDRESS: NONE: Environmental Health es Servic (805) 781-5544 P.O. Box 1489 2156 Sierra Way San Luis Obispo, CA 93406 PROGRAMS INSPECTED ED INSPECTION REQUIRED: AGY - ❑ EHS ❑ AG DEPT �] CITY FIRE E W datary py: INSPECTION TYPE ine FREUntspection ❑ Complaint ❑ Other Hw Generator ❑ UST ❑ YES ❑AGT MISSION TO INSPECT: Inspections may involve obtaining Plan ❑ HW Generator ❑UST iinin corn fiance with ado ted codes. ❑AGT GRANTED BY g photographs, reviewing and copying records, and NAME/TITLE NO 0 Business Plan ❑CALARP ❑CALARP NO NSA BUSINESS PLAN - ❑ ❑ BPOI Business plan is Complete, current ❑ ❑ BPO2 Inventor P & available during inspection (HSC 25503.5, Title 19 C ❑ BP03 Y of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) Site layout/facilit CCR 2729) y maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN I ❑ TROl Facility has a ❑ TR02 PPropriate training program (Title 19 CC Training documentation is maintained on site for current personnel (Title 19 CC 66265.16) R 66265.16) R 2732 & 22 CCR EMERGENCY RESPONSE PLAN ❑ EROl Contingency g Y Plan is ❑ complete, updated, and maintained on site ER02 CCR § 66265.53/54) Facility is operated and maintained to (HSC 25504, Title 19 CCR 2731 & 22 hazardous materials/waste constituents to the environment. pre Ere. explosion, or release o1' equipment including an alarm Mpinta' q3 and ea ca tons system (Title 19� R 2731 re or appropriate & 22 CCR 66265.31- ATOl ABOVEGROUND PETROLEUM STORAGE TANK ACT AT02 SPCC Plan is reviewed and certified b y H registeredI SPCC Plan is maintained on site or nearest field Off engineer within last 5 yrs. (40 CFR 112.5(b)) to htt�;//wwwslopublicheaJth.�rg/ro��/h Ce• (HSC 25270) ardous_matenas,h161, toobtain formstocomply with BP01-BP03, TROT � -_ and EROI de: -deg --min `decimal min Longitude: y �dmin,_�decimal min i ( FACILITY REp; LS_I\Templc.lotus. notes .datall_inspection Form•Page 1.dnr 1Q_ j_ FACILITY NAM ADDRESS: HAZARDOUS WASTE GENERATOR EPA ID NUMBER: Tiered Permit: !% Treatment �`SW CESQT Total generated/month: Lbs or gals Equipment: CA ❑I'IiR Waste oil: (av Solvents: ) YES-, -, NO N/A VIA # ❑ o GT01 2 ED ❑ ❑ ❑ Z Antifreeze: ;1 EPA ID NO/PERMITS Generator has an EPA ID number to treat, store, dispose, our transport or transfer hazardous waste (Title 22CCR §66262.12) IP Not, Cap HAZARDOUS WASTE (800) 618-6942 to obtain � DETERMINATION y CAL EPA ID number. Hazardous waste determination conducted (Title 22 CCR §66262.11) ]own knowledge ❑analysis ❑other Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262. DISPOSAL/TRANSPORTATION Hazardous wastes were transported and/or dis 40.(c)) a 4horization from DTSC (HSC Posed to a facilit with an EPA ID NO. and �� milkrun §25189.5, 'Title 22 CCR y zardous wastes are shi #66262.12) Permit or ❑ G7'07 ❑other peed with manifest (Title 22 CCR §66262.2Q) Manifests and/or receipts are properly completed/retained b §66263.42/ 66262.23) El STORAGE AND MANAGEMENT OF CONTAINERS/TANKS tor for 3 years (Title 22 CCR ° (:T08 azardous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 90 days if tussle generated per month is greater than ore equal to 1 ❑180 days if waste generated per month is less than 100 k q kg (2201bs.) �72! 270 days if waste generated g (see note) note) Per month is less than 100 I<g and transported more than 200 miles (sec Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13 20011 acutely/extremely hazardous waste over 1 k EJ GTE Hazardous waste "satellite" collection a managed pro �� ),if arI `�� ❑ g (2.2 lbs.) is held on site for over 90 days. or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ GT10 Ignitable or reactive wastes are located IS properly (complete labeling/accumulation time155-gal CCR ❑ ❑ GTII §66265.176) m (50 feet) from facility's property line (Title 22 CCR Containers of hazardous waste are proper) WASTE,,, waste composition/ h y labeled (includes appropriate CCR 166262.31 P ysical state, hazardous properties, nme/a date, "HAZARDOUS ❑ GTI2 � 66262.34) ess of generator) (Title 22 31 & ; Containers/tanks containing hazardous wastes are in good condit;,,„/I„ ��a�ll�,�l �� ,,,;nimi reaction (Title 22 CCR §66265.171/.191, 66265.I77(c)) f ❑ GT13 Containers/tanksJlinerssre compatible with waste stored or transferred release or ❑ GT14 6265. e i Containers storinghazardous wastes are closed/sealed (Thee 22 e R §66265. 173)- (Title 22 CCR§66265.172) ti265.3 ❑ GT15 Weekt :.,r lie tea where hazardous waste containers are stored is conducted ❑ GT16 (Tile 22 CCR§66265.174) Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.19 ❑ GT17 Empty containers or inner liners is(b)) within one year f greater than 5 gal has d 5) T GT03 GT04 (=T05 GT06 o date emptied (Title 22 CCR §66261.7 ()when emptied and are managed properly RECYCLABLE WASTE © GTIS Used oil is managed as hazardous waste until recycled (includes GT19 §25250.4) ( udes proper labeling, storage, etc Used oil filters for recyclinnagedg g � ) (HSC rainproof container, ec cling`are maned used oil properly (drained of free flowing liquid CCR§ 66266.130) and transferred for metal recla�r'tored in closed G720 Spent lead -acid batteries are being (Title 22 lading for recycling, reuse, or reclamationrly (Title stored CCR §66266.81) GT21 Solvents/other recyclable materials are managed as hazand rdous offsite under na;inifest or bill of #66266'3) ass wastes until recycled (Title 22 CCR SOURCE REDUCTION: For facilities generating >12,000 kg./yr, of haze GT22 Generator is subject to SR14 and hats prepared and retained current source re able make them available to the inspector within 5 days. reduction waste on site. GTE Source Reduction Evaluation and Plan contains the following five elements; Auction documents or is Y (HSC §25244.19, 25244.21) certification, amounts of wastes generated, process description, block diagrams, schedule of selected source reduction measures. (HSC §25244.19) and implementation _"'JOCUME-11ReproILOCALS-11Temnit-i.,,..., . Environmental Ilealf►- Services (805) 781-5544 v 1 L y of San Luis i P.O. Box 1489 I Fire Department (805) 781-7380 I I II I i r� 2156 Sierra Way .San Luis Obispo, CA 93406 2160 Santa Barbara Avenue I -s y�;;y Department of :%Li-iculture/NIeasu►'eiileiit San Luis nhisno CA 93401-5240 Standards (805) 781-5910 Utilities Department • (805) 781-7215 1 2156 Sierra Way Suite A *San Luis Obispo, CA 93401 879 Morro Street • San Luis Obispo, CA 93401 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIALS INSPECTION FORM Date: I o� / I I / �� EFW data entry by: Time: 30 FACILITY ID NO: AGENCY INSPECTION TYPE. FACILITY NAME: is leerl7ef j ❑ DEH Routine ❑ AG DEPT ADDRESS: a� i C U P�'p ❑ Reinspection ❑ ITY FIRE ❑ Complaint CITY UTILITIES ❑ Other PHONE: PROGRAMS INSPECTED: Business Plan5H7WGenerator ❑ Cal ARP ❑ UST ❑ AGT ❑ Tiered Permitting REINSPECTION REQUIRED: �O❑ YES ❑ Business Plan W Generator [:]Cal ARP ❑ UST [� iV ❑ AGT ❑Tiered Permitting PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YE,' NO N/A ❑ BP01 Business plan is complete, current, & available during inspection (HSC §25503.5, Title 19 CCR §2729) k I—]❑ BP02 Inventory of hazardous materials is complete (HSC §25504, Title 19 CCR §2729) V ❑ BP03 Site layout/facility maps are accurate (HSC §25504, Title 19 CCR§ 2729) TRAINING PLAN ❑ ❑ TROT Facility has appropriate training program (Title 19 CCR §2732 & 22 CCR §66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR §2732 & 22 CCR §66265.16) EMERGENCY RESPONSE PLAN P' ❑ ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC §25504, Title 19 CCR §2731 & 22 CCR §66265.53/54) ❑ ER02 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 communications system (Title 19 CCR §2731 & 22 CCR §66265.31- .43) - COMMENTS: GPS Coordinates: Latitude: _deg _min decimal min Longitude:degmindecimal min Inspector: Facility Representative: A* A:\CUPA inspection forms 2.doc 20-Mar-03 FACILITY NAME: DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA ID NUMBER: _ G �%� (y (y (p g o a� �• r �as r gals �_� Total encratec mont ct j rage) Tiered Permit: ❑('H:S11' CESQT ❑(':1 ❑PBR Waste oil: Solvents: a� rj GeK Treatment Equipment: Antifreeze: Others: �j�7 /� U7-ro)h cti !v erl►y�ene YE NO N/A VIOL. # EPA ID NO/PERMITS ❑❑ GT01 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR §66262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number. HAZARDOUS WASTE DETERMINATION ❑ ❑ GT03 Itaz; dous «aste determination conducted ("Title 22 CCR §66262.11) «n knoksledge ❑analysis ❑other ❑ ❑ GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR §66262.40.(c)) DISPOSAL/TRANSPORTATION ❑ ❑ GT05 Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or wt orization from DTSC (HSC §25189.5, Title 22 CCR §66262.12) m i 1 krun ❑other ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR §66262.20) ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR §66263.42/ 66262.23) STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 f i c rdous wastes are accumulated on site as follows (Title 22 CCR §66262.34) 911 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13,200 lbs.)and no acutely/extremely hazardous waste over 1 kg (2.2 lbs.) is held on site for over 90 days. ❑ ❑ GT09 Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or 1-qt limit) (Title 22 CCR §66262.34(c)) ❑ ❑ GT10 Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR §66265.176) ❑ ❑ GT11 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) ❑ ❑ GT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction (Title 22 CCR §66265.171/.191, 66265.177(c)) ❑ ❑ GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR§66265.172) ❑ ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR §66265.173) ❑ ❑ GT15 Weekly inspection of areas where hazardous waste containers are stored is conducted ff—iffie__12 CCR§6 .17 ) ❑ ElGT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR §66265.195) ❑ GT17 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 ❑ ❑ GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC §25250.4) ❑ ❑ GT19 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) (Title 22 CCR§ 66266.130) ❑ ❑ Rf GT20 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) ® GT21 Solvents/other 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. ❑ ❑ GT22 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 §25244.19, 25244.21) ❑ ❑ ® GT23 Source Reduction Evaluation and Plan contains the following five elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. (HSC §25244.19) A:\CUPA inspection forms.doc 19-Sep-02 FACILITY NAME: ADDRESS: SUMMARY OF OBSERVATIONS/VIOLATIONS 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. Fj Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. 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. VIOLATIONS NUMBER MINOR MAJOR CORRECTIVE ACTION REQUIRED COMMENTS: y Inspected By: �� Facility Rep Na j M �a Q Date: 0 I Signature: ` Sign the certification below and mail this form to the CUPA inspector after all corrective :act iuli.c have been completed. Retain a copy for your records. Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner/Operator: Title: Date: A:\CUPA inspection forms.doc 19-5ep-02 Division of Environy- ,Petal Health ' � (805> •rat-5544 --`—. i P.O. Box 1489 2156 Sierra Way •San LObispo, CA 93406 Department of Agriculture/Measurement Standards (805) 781-5910 2156 Sierra Way Suite A •San Luis Obispo, CA 93401 �IL nr1r T 117 ir" TTXTTT,�TT;'T T1Tl l�s-'�n ♦ w.r ♦---T�--1 Fire Den.- ent(805)781-7380 216U Sin, rbara Avenue San Luis po CA 93401-15240 •,r.�. , i. Utilities Department • (805) 781-7215 879 Marro Street ®San Luis Obispo, CA 93401 Date: �� /,,�] / C% �� HAZARDOUS MATERIALS INSPECTION FORM Time ► f EFW data entry by: FACILITY ID NO: AGENCY ❑ DEH ❑ AG DEPT Y FIRE �ZY UTILITIES INS'h:CTION TYPE Routine ❑ Reinspection ❑ Complaint ❑ Other FACILITY NAME: 7� �� r or ; ADDRESS: T • PHONE: PROGRAMS INSPECTED: Business Plan tW Generator ❑ UST ❑ AGT ❑ Tiered Permitting REINSPECTION REQUIRED: O ❑ YES ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑ Tiered Permitting PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining compliance with adopted codes. GRANTED BY (NAME/TITLE): BUSINESS PLAN YES NO N/A ❑ ❑ BPO1 Busines�plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR 2729) i❑ ❑ BP02 Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729) Ley-17/ ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) TRAINING PLAN ,� ❑ ❑ TRO1 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) I , Y ❑ ❑ TR02 Training documentation is maintained on site for current personnel (Title 19 CCR 2732 & 22 CCR 66265.16) FMERGENCIV n ❑ ER01 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR § 66265.53/54) �/n ❑ ER02 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 communications system (Title 19 CCR 2731 & 22 CCR 66265.31- .43) COMMENTS: V-6 61v/nL INSPECTOR: FACILITY REP: r/A1s1L11 Y NAMh:_ _ _ - - -- - - DATE: INSPECTOR: HAZARDOUS WASTE GENERATOR EPA ID NUMBER: r� //! . �� Lbs or gals(average) Tiered Permit: d�idrLit _ Total generated/month: CESW ❑CF.sQT ❑CA ❑PBR Waste oil: Solvents: Treatment Equipment: _ Antifreeze: Others: YES/ NO N/A VIOL. # EPA ID NOMERMITS GTO1 Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title 22CCR 66262.12) If Not, Call (800) 618-6942 HAZARDOUS WASTE DETERMINATION ❑ ❑ GT03 hazardous waste determination conducted (Title 22 CCR 66262.11) ❑ ❑ ❑own knowledge []analysis ❑other GT04 Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR 66262.40.(c)) DISPOSAL/TRANSPORTATION d ❑ ❑ GTO5 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 22 CCR 66262.12) ❑milkrun service ❑other ©� ❑ ❑ GT06 Hazardous wastes are shipped with manifest (Title 22 CCR 66262.20) 1(W, ❑ ❑ GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR 66263.42/ 66262.23) / STORAGE AND MANAGEMENT OF CONTAINERS/TANKS ❑ ❑ GT08 Hazardous wastes are accumulated on site as follows (Title 22 CCR 66262.34) ❑ 90 days if waste generated per month is greater than or equal to 100 kg (220 lbs.) ❑ 180 days if waste generated per month is less than 100 kg (see note) ❑ 270 days if waste generated per month is less than 100 kg and transported more than 200 miles (see note) Note: Applies only if hazardous waste accumulated on site never exceeds 6000 kg(13200 Ibs.)and no ❑ ❑ Gacutely/extremely hazardous waste over I kg (2.2 lbs.) is held on site for over 90 days. T09 Hazardous "satellite" waste collection is managed properly (complete labeling/accumulation time/55-gal ❑ ❑ or 1-qt limit) (Title 22 CCR 66262.34(c)) GTIO Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR ❑ ❑ 66265.176) GTII Containers of hazardous waste are properly labeled (include% :appropriate date, "HAZARDOUS WASTE," waste composition/physical state, hazardous properties, name/address of generator) ('Title 22 ❑ ❑ CCR 66262.34) CT12 Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or © ❑ ❑ reaction (Title 22 CCR 66265.171/.191, 66265.177(c)) GT13 Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR 66265.172) ❑ —I ❑ GT14 Containers storing hazardous wastes are closed/sealed (Title 22 CCR 66265.173) I C- 14WOO4t" inspeeticwof-arens-where-hazardcontainers are stored is conducted (Title 22 CCR 66265.174) ❑ ❑- GT16 Daily inspection of all tank systems is conducted and documented (Title 22 CCR 66265.195) ❑ ❑ GT17 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 ❑ ❑ U GT18 Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (HSC �--( ❑ ❑ L 25250.4) GT19 l red 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) (Title 22 ❑ ❑ L/ CCR 66266.130) GT20 Spent lead -acid batteries are transferred offsite under manifest or bill of lading for recycling, reuse, or ❑ ❑ reclamation (Title 22 CCR 66266.81) GT21 Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR 66266.3) SUMN' �2Y OR OBSERVATIONSNIt �ATIONS No violations of underground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and requirements were discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑ Violations were observed/discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or proposed action, please inform us in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing certifying that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a 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 proposed corrective actions. The issuance of this Summary of Violations does not preclude CUPA from taking administrative, civil, or criminal action as a result of the violations noted or that have not been corrected within the time specified. VIOLATIONS NUMBER MINOR MAJOR CORRECTIVE ACTION REQUIRED COMMENTS: Inspected Facility Rep N �� j Date: - y e-1 t -7C/ 4 Signature: � O:\DOCUMENT1Jeffpli-ORMS1lnspecfiot) fQfi-ns\CUPA ii15pectIOt1 fOriTIs,doc 10-Sep-01