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BISPO HEALTH DEPARTMENT Routine Inspection
vironmental Health Reinspection No
Luis Obispo, CA 93406 Complaint Investigation
UND STORAGE TANK/WASTE GEN RA OR
IT/NOTICE OF VIOLATION
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Date _
Contact Perso�1" _
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_ Title/Position:--"°`�•�'
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UNDERGROUND STORAGE TANKS (COMP # )
(CA H&S Code, Div. 20, Chap. 6.7)
ATL. # GENERAL
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I Com I Viol
20. Permit to operate
21. Inventory reconciliation...
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22. Precision tank test
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23. Leak detectors
a
TANK CLOSURE
24. Permit a groved
25. Temporary closure
26. Removal/in place abandonment
a) Tanks purged
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b Tanks rinsed
c Soil samples taken
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WASTE GENERATORS COMP #
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27. EPA identification number
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28. Variances and/or exemptions
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29. Manifests .�
30. Waste oil receipt
31. Training program/records
32. Contingency Ian
33. Material stored in proper containers
& labeled
34. Incompatibles not stored together
35. Storage - 90 days
36. Fire extinguishers
37. Spill containment
rnia Health & Safety Code and the California Code of
Inspector's Signature.
Owner/Operator Signature
NOTE: Signature indicates receipt of this document only and not an admission of the facts.
Page of
805-781-5544
COUNTY OF SAN LUIS OBISPO HEALTH DEPARTMENT Routine Inspection
Division of Environmental Health Reinspection No
P.O. Box 1489, San Luis Obispo, CA 93406 Complaint Investigation
HAZARDOUS MATERIAL/UNDERGROUND STORAGE TANK/WASTE GEN RA OR
I SPECTION REPORT/NOTICE OF VIOLATION
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Facility Name: �'� �- Date -
Facility Address: T Contact Perso��
_ Title/Position-off
HAZARDOUS MATERIALS (2185) (COMP # )
(CA H&S Code, Div. 20, Chap. 6.95) �04.7
UNDERGROUND STORAGE TANKS (COMP # I
(CA H&S Code, Div. 20, Chap. 6.7)
ATL. # GENERAL
Com I Viol
20. Permit to erase
21. Inventory reconciliatio
22. Precision tank test
BUSINESS I.D. FORM
1. Complete
Com I
Viol
2. Verity emergency hone number,
3. Location of utilities
INVENTORY
_
23. Leak detectors _
TANK CLOSURE _
4. Hazardous material & amounts listed
5. Material stored in proper containers
& labeled
24. Permit approved
25. Temporary closure
6. Incompatibles not stored together
26. Removal/in place abandonment
7. Spill containment provided
\
a Tanks purged
PL LAN
b Tanks rinsed
8. Plot plan submitted
c Soil samples taken
9. Verify streets & adjacent ui ihas
WASTE GENERATORS COMP M
10. Location of hazardous materials N,,
27. EPA identification number
11. Fire extinguishers/water source IN.
28, Variances and/or exemptions
12. Emergency shut-off switches
29. Manifests
✓
13. Location & verification of MSDS
30. Waste oil receipt
14. Sewers stem and/or storm drains
31. Training program/records
15. Staging area
32. Contingency Ian
16. Chan es/modifications in previous year
33. Material stored in proper containers
& labeled
EMERGENCY RESPONSE PLAN
17. Adequate emergency response procedures
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34. Incompatibles not stored together
18. Adequate evacuation procedures
35. Storage - 90 days
19. TRAINING PROCEDURES
36. Fire extinguishers
37, Spill containment
The above marked items represent violations of the California Health & Safety Code and the California Code of
Regulations and must be corrected.
COMMENTS
V f 'T/ r %ice_
Inspector's Signature
Owner/Operator Signature
NOTE: Signature indicates receipt of this document only and not an admission of the facts.
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