HomeMy WebLinkAbout289 Prado CUPA recordst
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Environmental Health Services
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
Department of Agriculture
2156 Sierra Way, Suite A
San Luis Obispo, CA 93401
- -\,
(80s)78r-ss44 gt_vof
frAnluso8*$p
(80s) 78r-7380
CERTIFIED UNIF'IED PROGRAM AGENCY (CUPA)
10t2112003
WILLIAM INGALLS
ENVIRONMENTAL CONTACT
INGA, INC - DBA TTM BRASS WORKS
289 PRADO RD
SAN LUIS OBISPO, CA 93401
SUBJECT: REQUEST FOR ANNUAL CHEMICAL IIWENTORY T]PDATE
FACILITY #: FA0005162 289 PRADO RD, SAN LUIS OBISPO
Please review your curent Business Plan for any significant changes that may have taken place within your facility
and/or your chemical inventory. The number of hazardous materials you handle and/or the number of hazardous waste
streams you generate impact your fees. Your fees are based on the hazardous materials business plan we have on file
for your business. We bill annually in December. In order for your bill to accurately reflect your inventory, please
complete and return this form and copies of the attached Form I (if necessary), not later than 1215103. Attached is our
listing of your last reported chemical inventory.
If you have made additions/deletions to the listed chemicals, an increase/decrease in quantity, or a change in storage
location, please notifu us by completing the attached chemical inventory form, and include these changes. If the listed
chemicals, quantities, locations, and units are coffect, sign this letter and return it to City of San Luis Obispo Fire
Department. Refer to the enclosed Hazardous Materials Business Plan Reporting Requirements for reporting
requirements and exemptions.
Your inventory will be verified during your next annual inspection. Failure to provide accurate chemical inventory
information is a violation of the California Health & Safety Code, sections 2550I through 25515, and may result in
civil and/or criminal penalites.
If you have questions, please call Kerry Boyle, Hazardous Materials Section, at (805) 78I-7383.
(80s) 781-s910 Fire Department
2160 Santa Barbara Avenue
San Luis Obispo, CA 93401-5240
l\l\L{rr^*fr1 ,t'
D. Kerry Boyle, Hazardous Materials Coordinator
City of San Luis Obispo Fire Department
K The listed chemicals, quantities, locations, containers, and physical state are correct as listed
The listed information is incorrect or has changed. I have attached a copy of Form I with the correct in-
formation for each chemical in our inventory.
il -tz-CI<
Title Date
Rpt.9612
INGA,INC - DBA THE BRASS WOKKS
REQI.IEST FOR ANNUAL CHEMICAL INVENTORY UPDATE
Our records show you have the following inventory at your facility
NAME
common: RADIATORTESTER --I-ANL 6F t;lAffi?<
scienffic: RADTATOR TESTER - la^Jk- DFXlad<_.p-
CONTAINERSffEEtrffiffi-
ATEACH 2,
LOCATION: 3.
LOCATTON(S):
1.
.,
3.
PHYSICAL STATE CODE: LIQUID
LOCATTON(S):
1.
2.
3.
PHYSICAL STATE CODE: LIQUID
LOCATTON(S):
1.
)
3.
PHYSICAL STATE CODE: LIQUID
LOCATTON(S):
1.
2.
3.
t0/2U2003
PAGE 2
DAILY AMOUNTS:Average:
Maximum:
NAME
Common:
Scientitic:
CONTAINERS
AT EACH a
LOCA
DAILY AMOUNTS:Average:
Maximum:
NAME
Common: ALUMINUM
Scientific:
CONTAINERS 1.DRUM,
AT EACH
LOCA 3.
'',A.IIJI AIYIT-'UI\ I S:Average:
Maximum:
NAME
Common: RADIATOR
Scientitic:
l.s DRUM,
AT )
Average:
Maximum:
3.
I5O GALLONS
I5O GALLONS
55 GALLONS
55 GALLONS
55 GALLONS
55 GALLONS
I5O GALLONS
I5O GALLONS
DAILY AMOUNTS:
PHYSICAL STATE CODE: LIQUID
JUL 6 2001
,rililitilililililllllllll Gtyofsan luls oBtspo
FIRE DEPARTMENT
2160 Santa Barbara Avenue . San Luis Obispo, CA 93401-5240 ' 805/781-7380
"Courtesy E Seruice"
HAZARDOUS MATERIALS BUSINESS PLAN UPDATE F'ORM
FACILITY NAME:
ADDRESS t
coNrACT pERSoN: Bp. -fila+us TELEPHONE:EoS - s+4 -8s4/
Annual Inventory Update (due each year)
X No significant changes in inventory have occurred since the last Business Plan or inventory was
submitted.
New inventory forms are attached.
[ ] Replace previous inventory with attached inventory.
[ ] Replace only designated pages of inventory.
tl
Additional Comments
X
Yearly Review and Recertification
I certify that the Business Plan has been reviewed and the information contained in the Business
Plan is accurate and complete as of this date.
Other Updates
t ] Please incorporate the following information into the Business Plan for this
foniiit.'.
I declare, under penalty of pe{ury, that the information provided herein is true and
correct to the best know
Signature:%Date
Printed Name:
Please Return to: Molly Brown, Hazardous Materials Section
City Fire Department
2160 Santa Barbara Avenue
San Luis Obispo, CA 93401-5240
H:/BUSINESS PLAN UPDATE FORM MOLLY
The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. &Telecommunications Device for the Deaf (805) 781-7410. V
))
1t24t00Site Visit Packet
Facility
Facility Name:
Operator:
Address Number:
Address:
Suite:
CitY:
zip'.
CrossStreet:
BRASS WORKS
BILL INGALLS
289
PRADO RD
SAN LUIS OBISPO
93401
Parcel No:
Phone No:
Facility Type:
053-252-043
(805) 544-8841
Permit No
Facility Number:
60-0138
Miscellaneous
SIC Code
Dun Bradstreet
Business License
Guarantor Number
Status:
Permit Expiration Date:
Business Owner
Name:
Address:
CitY:
State:
zip:
Phone:
Environmental Gontact
Name:
Address:
CitY:
State:
zip:
Phone:
GurrentBalance: $73.00
Property Owner
Name:
Address:
Care Off Address:
City:
State:
zip:
Phone:
BRASS WORKS
289 PMDO RD
BILL INGALLS
SAN LUIS OBISPO
CA
93401
(805) 544-8841
Operator
Name:
Address:
CitY:
State:
Zip:
Phone:
BRASS WORKS
289 PRADO RD
SAN LUIS OBISPO
CA
93401
BRASS WORKS
289 PRADO RD
SAN LUIS OBISPO, CA 93401
Components
Hazardous Component
1t24tOO
HMMP Range: Not APplicable
Tiered Permit(s):
CaIARP: No
Ghemical lnventory Report
Permit No: 60-0138 %WT EHS cAs#
Chemical Name:
CAS NO:
Avg Daily Amt:
Type:
LORIG ACID
Grid No:
n EHS
55 Units:GAL
Physical State:
55 Max Daily Amt:
Pure
tr
tr
n
n!
HLORIC ID
Page 1 of 1
ID number : LOB4 Grid : I1B
Address : 289
St.reet : PRADO ROAD
Apt/Unit :
Assignment.:4C InsPecLor : 20
Business :THE BRASS WORKS
Bus phone 2544-8841
Bus type :F
tqan hours , 2.01()&FFt"qrr"rr.y :2
Resp party:BILL-INGALLS o
ne sp pfrone': B Wf+€t=.56-G
Emer phone'805/(61 -Qact ,
Prop owner:PAGO TRUST PHILLIP NORTON
PO address:763-B FOOTHILL #I97
PO city/st: SLO CA
PO zip :93405
Lock box : Y^ LocaLion:SIDE-A OF 285 BY COLUMN
Cl-ear date :05-2 0 - 99
Hood tesL : -
Sprink test:06-01-96^ Location:FULL
Al.arm l-ocation : SPRINKLERS
No halon
No basement piPes
No stand pipes
No vent system
RemoLe : Y
Fire Flow :
Const type:3-NR
Stories :,2
Area bldg : 4565
Occ area z 4565
Occ load :45
Occ c]ass =F2Permits :ART 4-22, 46
Vi-olaLions:
-'1.-(^
t
' '
:it- .'
't'i " ,*(xn /f- ( 4ru fr)"
"^l: (.'..
(;t/t'I"'to
1 lrq
?eU2_
b.y'o^, a/"t+s
' /\,lnrg, {'t'o a
/.! .,
Previous violations : O5- 03 - 96
Previous viol-at.ions t 04 -LB - 94
Crit Locat:KEY BOX S-A OF 285 BY COLUMN
preplan:haz:METHANE/OZ BRAZING MANI- FOLD UN #2489. NZ COM-
PRESSED 55 G HF, S-C, 2B5PRADO STOREROOM.
Notes zHAZ MATS, W/C PERMIT RICK MILHEM, GEN MGR
462-3]-48
Permit mon: 5
Permit. amL: 152.00
Permexdate : 0 5 - 0 I - 0 0permir. inf: 1) STORE/HANDLE/USE HAZARDOUS MATERIALS
PER UFC ART]CLE 51 76.00
2) WEI,DING/CUTTING OPERATIONS 76.OO
Environmental Health Services Division
(80s) 781-ss44
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
THIS PERMIT IS ISSUED FOR TIIE FOLLOWING:
, ru, FA0005162
i-. INGA,INC - DBA THE BRASS WORKS
.
.. 289 PRADO RD
SAN LUIS OBISPO, CA 9340I
VALID FROM DATE: 0l/01/2004
VALID TO DATE: 1213112004
SHffi"o*il$po
CERTIFIED UNIFIED PROGRAM AGENCY
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo, CA 93401-5240
AUTHORIZATION IS GRANTED FOR THE FOLLOWING:
0762 PROOO7629 SLO CITY-HAZARDOUS MATERIALS HANDLER I-4
I176 PR0007938 SLO CIry- WASTE GENERATOR (l-5 waste streams)
OWNER:
INGALLS, WILLIAM
289 PRADO RD
SAN LUIS OBISPO CA 93401
a
cuRTrs A. BATSON, R.E.H.S.
DIRECTOR ENVIRONMENTAL IIEALTH SERVICES
ft(
WOLFGANG KNABE, CrrfEF
CITY OF SAN LUIS OBISPO FIRE DEPARTMENT
THIS AUTHORTZATION/PERMIT TO OPERATE IS NONTRANSFERABLE AND MUST BE POSTED ON-SITE IN A CONSPICUOUS PLACE.
THIS OPERATING PERMIT WITH ALL CONDITIONS AI\D ATTACHMENTS,INCLUDING MONITORING PLANS, SHALL BE
RETAINED AT TIIE FACILITY AT ALL TIMES.
INGA, INC - DBA THE BRASS WORKS Facility Identification Number: FA0005162
Page: 2
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
PERMIT CONDITIONS
In order to maintain the Permit to Operate, the permit holder must comply with thefollowing provisions of related laws concerning management of hazardous materials. Any
violation of the conditions mcty be causefor revocation of the Permit/Aathorizatian to Operate:
3. Hazardous Materials Business Plan Program: California Health and Safety Code, Division 20, Chapter 6.95, Article I and Title I 9 California Code of Regulations.
s. Ilazardous Waste Generator Program: California Health and Safety Code, Division 20, Chapter 6.5, Articles l-13, Section 25100 et seq., and Title22, California Code of
Regulations, Chapter 20.
e. Aboveground Petroleum Storage Tanks (AGT) Spill Prevention Countermeasure Control (SPCC) Plans: California Health and Safety Code, Division2},Chapter 6.67 and40
The Permit to Operate is to be maintained on-site and is valid for a period of one year
Environmental Health Services Division
(8os) 781-ss44
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
THIS PERMIT IS ISSUED FOR THE F'OLLOWING:
FACILITY: FA0005162
-. INGA. INC - DBA THE BRASS WORKS
289 PRADO RD
SAN LUIS OBISPO, CA 93401
VALID F'ROM DATE: 01/01/2005
VALID TO DATE: 1213112005
CERTIFIED TJNIFIED PROGRAM AGENCY
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo, CA 93401-5240
$tyst
mfirws
AUTHORIZATION IS GRANTED FOR TIIE F'OLLOWING:
0762 PROOO7629 SLO CITY-HAZARDOUS MATERIALS HANDLER I-4
1176 PR0007938 SLO CITY- WASTE GENERATOR (l-5 waste streams)
OWNER:
INGALLS, WLLIAM
289 PRADO RD
SAN LUIS OBISPO CA 93401
a
CURTIS A. BATSON, R.E.H.S.
DIRECTOR" ENVIRONMENTAL HEALTH SERVICES
ft(
WOLFGANG KNABE, CHIEF
CITY OF'SAN LUIS OBISPO F'IRE DEPARTMENT
TIIIS AUTHORIZATIONiPERMIT TO OPERATE IS NONTRAI\SF'ERABLE AND MUST BE POSTED ON-SITE IN A CONSPICUOUS PLACE.
THIS OPERATING PERMIT WITH ALL COI{DITIONS AI\D ATTACHMENTS,INCLUDING MONITORING PLANS, SHALL BE
RETAIIYSD AT THE FACILITY AT ALL TIMES.
INGA, INC - DBA THE BRASS WORKS
Page: 2
Facility Identification Number: FA0005 1 62
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
PERMIT CONDITIONS
In order to maintain the Permit to Operate, the permit holder must comply with the following provisions of related laws conceming management of hazardous materials. Any
violation of the conditions may be causefor revocation of the Permit/Authorization to Operate:
a. Hazardous Materials Busin'ess PIan Program: California Health and Safety Code, Division 20, Chapter 6.95,Article I and Title 19 California Code of Regulations.
e. Hazardous Waste Generator Program: California Health and Safety Code, Division 20, Chapter 6.5, Articles l-13, Section 25100 et seq., and Title 22, Califomia Code of
Regulations, Chapter 20.
e. Aboveground Petroleum Storage Tanks (AGT) Spill Prevention Countermeasure Control (SPCC) Plans: Califomia Health and Safety Code, Division 20, Chapter 6.67 and 40
The Permit to Operate is to be maintained on-site and is valid for a period of one year.
HAZARDOUS TERIALS BUSINESS PLAN
FORM S - SANLUIS COUNTT T'NITED PRO,ZIM AGNYCY
BUSINESS OWNER/O PERATOR IDEI\ITIFICAIilON
I. IDENTTTTCATION
- Doing 8sin6 Aj)
NAME (s:m a FACIUTY qNAMEN PHONE lo2
t03
4rsfrCITY
CA ZIP t05
oBtyCLJvl
BUSINESS NAME
&tarvla €PLA,N BUSINESS PHONE
tr. BUSINESS OWNERNAME
/81€ut
OWNER
u2
OWNER ADDRESS
e
A'f/hBeCITY
A-STATEClr ztP CODE
YL
E}WIRONMENTAL CONTACTm.
€zffiCONTACTNAME
CONTACT PIIONE
CONTACT
-ft-.o
C*rnzzt*CITY
t2Q 12lSTATEC*ZTP
YLrV. EMERGH\CY COIVTACTSNAMEl8LdNAI\{E
t2a.5 ,9c.
TITLE
CFo
TTTLE
PHONE Fr PHONE
24.HOURPHONE.
2+HOUR PHONE
PAGER #/CFI L PHONE #-
gPAGERltcFrI
ADDITIONAL IOCALLY COI.I,ECTEI'INFORIvTATIoN:
'D wirl lbc I bavc
Ey
rnd
nvlCf pendtyof hw
ofttocc ttcrc{orsrtlc Irndsrbniocdrhcbclicrcishformrtiontruc,rndtocuiatc,conplcre.
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O:IDOCUMENTUefriT\FORMSlBusiness ptan Forms\FRM-S.DOC OgrcOn2
HAZAPOOUS BUSINESS PLAN
FORM S. SANLUIS OBISPO COTJNTY UNIFIEDPRr- -AGENCY
BUSINESS OWNER/OPERATOR IDENTTFICATION .'AN 2 4 2OO3
ffr U,!L I. IDENTIFICATION
loz
o 5-BUSINESS
BUSINESS NAME (sme as F,ICILITY NAME c DBA -Doing BsirBs As)
0 103
ADDRESSBUSINESS
0o 6(o
CA
t05
o
ZIP CODE
Lu/5
l(X
SPO{J
lot
COI'NTY
1t0
// YlAg0-5BUSINESS OPERATOR
BUSINESS OPERATORNAME
t't/ ttt
U. BUSINESS OWNER.
l12
00(/0
OWNERPHONE
r. / N6/tL{".S
OWNERNAME
LLIKA ll3
OWNERMAILING ADDRESS
P o {3oX ll6ZIP CODE
? 3qe3
l15STATE
c4-CITY
kTfttcftr)'€rto
Itr. ENVIRONMENTAL CONTACT
YoJ-4- ss
CONTACTPHONECONTACT NAME
N6 LL9
o /Lo
CONTACTMAILING ADDRESS
PA"l
0q
ZIP CODESTATE
c-ftL//tl5 oBtSPa
120
CITY s
IV. EMERGENCY CONTACTS -SECONDARY--PRIMARY-
€ba{rlt+ tvt /N6rtLL.s
r28NAME
ILLI
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NAME
tst tt rs{t/rC€'
TITLE
a€5 (
t24
TITLE
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BUSINESS PHONEBUSINESS PHONE
9os - 5 -s8
24.HOUR PHONE
PAGER#/CELLPIIONE#132
t26
t27
PAGER # / CELL PHONE #
2+HOI]RPHONE
,CDDITIONAL LOCALLY COLLECTED IMORMATION
t33
am familiar
adexamhedlawofIhavetbatIpersonallyunderidormation,ccrtif peDaltytbeforthoscofobtainiryindividualsonBascdresponsibleinquirymy
ls aodtheinforoationaccurale,truc,complerc.bclievcadsubmittedinformation
OF
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O:\DOCUMENTUefip\FORMS\Business Plan Forms\FRM-S' DOC 08/08/02
'j
Business Owner/Operator Identification
Please submit the Business Activities page, the Business Owner/Opcrator ldentification page (OES Form2730), ald Hrrardous Materials - Chemical Description
pages (OES Form 2731) for all bazardous materials inventory submissions. For the inventory to be considered complete
this page must be signed by the appropriate individual.
(Note: the numbering of the instructions follows the data element numbers th2t are on the LJPCF (Unified Program Consolidated Fonn) pages. These dah element
numbcrs are used
for electronic submission and are the s:rme as the mrmbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Daa Dictionary.)
Please number all pages of your subminal. This helps the Departnent of Toxic Substances Control (DTSC) idenrify whether the submitral is complete anrl if any
pages are separated.
3. BUSINESS NAME - Enter the ftrll legal namc of thc business.
l. BUSINESS PHONE - Enter the phone number, area code fint, and any exrension.
2' BUSINESS SmE ADDRESS - Enter the street address where the facility is located. No post office box numbers are allowed. This inforrration must provide a
mears to geographically locarc the facitity.
3. CITY - Enter the city or unincorporated area in which business site is located.
4. ZIP CODE - Enter the zip code of business site. Tbe extra rt.digit zip may also be added.
108. COUNTY - Enter the coutrty itr which the business site is located.
109. BUSINESS OPERATOR NAME - Enter the name of the business operator.
I 10. BUSINESS OPERATOR PHONE - Enter business operator phone number, if different from business phone, area code first, and any extension.ll1. OWNER NAME - Enter name of business owner, if different from busiaess op€nrror.
I 12. OWNER PHONE - Enter the business owner's phone number if different from business phone, area code first, and any extension.
113. OWNER MAILING ADDRESS - Enter the owner's ruiling address if different from business site address.
ll4. OWNER CITY - Enter the name of the city for tbe owner's mailing address.
115. OWNER STATE - Enter the 2-character state abbreviation for the owner's mailing address.
116. OWNER ZIP CODE - Enter the zip code for &e owner's address. The extra 44igit zip may also be added.
I 17- EI'{VIRONMENTAL CONTACT NAME - Enter the name of the person, if differcnt from the Business Owner or Opcrator, who receives all environmental
correspondencc and will respond to enforcement activity.
I 18. CONTACT PHONE - Enter the phone number, if different from Owner or Operator, at which the environmental contact can be contacted, area code first, and
any extension.
I t9. CONTACT MAILING ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent, if different from the site
address.
120. CITY - Enter the name of the city for the environmental contact's mailing address.
121. STATE - Enter the 2-character state abbreviation for the environmental contact's mailing address.
122. ZIP CODE - Enter the zip code for the environnental contact's mailing address. The extra 4digit zip may also be added.
123. PRMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be contacted in case of an emergency involving hazardous
materials at the business site. The ssntagl 5hrlt have FULL facility access, site familiarity, and authoriry to make decisions for the business regarding
incident mitigation.
D4. TffLE - Enter the title of the primary emergency contact.
125. BUSINESS PHONE - Enter the business number for the prinary emergency contact, area code first, and any extcnsions.
126. 2+HOUR PHONE - Enter a 24-hour phone rnrmber for the primary emergency contact. The 24-hour phone numbcr must be one which is answered 24 hours
a day. If it is not the contact's home phone numbcr, then the service answering the phone must be able to immediately contact the individual sated
above.
127. PAGER NIJMBER - Enter the pager number for the prinary energency contact, if available.
128- SECONDARY EMERGENCY CONTACT NAME - Enter the name of a sccondary representative that can be contacred in thc event rhat the primary
emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business
regarding incident mitigation.
n9- TInLE - Enter the title of the secondary emergency contact.
130. BUSINESS PHONE - Enter tbe business telephone number for the secondary emergency contact, area code first, and any extension.l3l. 2+HOUR PHONE - Enter a 2+hour phone number for the secondary emergency contact. The 24 hour phone number nust be one which is answered 24
hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately conact the irytividual stated.
132. PAGER NUMBER - Enter the pager number for the secordary emergency contact, if available.
133' ADDffiONAL LOCALLY COLLECTED INFORMATION - This space may be used for DTSC to collect any additional infomntion necessary to meer rhe
requirements of thcir iodividual progfiurur. Contact DTSC, or your local agency for guidance.
134. DATE - Enter the date that the docusrent was signed. fffYyMMDD)
135. NAI4E OF DOCUMENT PREPARER - Enrcr the full name of the person who prepared the inventory submittal information.
136. NAME OF SIGNER - Enter the full printed name of the person signing the page. The signcr certifies !o a familiarity with the infonnation submiued and that
based on the sigrrr's inquiry of those individuals responsible fe1 6!6ining the information, all the information zubmittcd is tue, accurate and complete.
SIGNATIJRE OF OWNER/ OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owrcr/Operator, or officially designatcd representative
of the Ovmcr/Operator, shall sign in the spacc provided. This signauue cenifies that the signer is familiar with &e information submined aDd &at based
on the signer's inquiry of thosc idividuals responsible for obaining the information it is the signer's belief that the submiued information is true,
accurate ald complete.
137. TITLE OF SIGNER - Entcr the title of the penon signing the page. :
S.DOC 8-Aug-02
O: \DOCUMENTUeffp\FORMS\Business Ptan Forms\FRM-
FORM I - SAN LUrS OBTSPO COLTNTY CERTTFTED UNTFTED PROGRAM AGENCY (CupA)CHEMICAL Ii\rVtrNTORy
material or
DruvrseEeoo
I. FACILITY INFORMATION
2B ?"o,Lu
BUSINESS NAME Fas(Same ACILTTY NAME DBAor Bus lnessDoing As)
ScD 3
CHEMICAL LOCATIO
202LOCATIONCONFIDENTIAL
NO
FACILITY ID #I 203(optionel)GRID# (optionatt 2U
II. CIIEMICAL ON
d,v'o ctnlori c A"iL
CHEMICAL NAME
H
20s TRADE SECRET
If Subject to
2M
instructionsEPCRA, refer to
Yes No
COMMON NAME
tr (v\+r-
m't
Dvo EINo 2@EHS*
cAs#
*If EHS is .,Yes", all amounts below must be in lbs.
FIRE CODE HAZARD CLASSES (Complete if rcquired by CUPA)
2t0
HAZARDOUS MATERI-AL TYPE
(Chcck one i(em only)E a. PURE D b. MIXTURE WASTE RADIoACTIVE I Yes ftI No
213
CURIES
PHYSICAL STATE
(Chcck one item only)E a. SoLrD D u. uquo c. GAS L"A,RGEST CoNTATNER 5<
FED HAZARD CATEGORIES
(Chcck all thar apply)fl a. FIRE Q u.E C. PRESSURE RELEASE g d. ACUTE HEALTH EI C. CHRONIC HEALTH
DAILY )a
A Y AMOUNTS'2t9-e-ANNUAL WASTE
D a. GALLONS E b.
(Chcck one itcm
UNTIS'FEET Ec. POUNDS E u. rorus 221
EIIS, amount must be in pounds.
DAYS ON SITE:zbs
E u. uNnencnouND TANK! c. TANK INSIDE
;k[u. sreEr- onuu
a.
ClCTTTAINER f. CAN
g. CARBOY
h. SILO
J. BAG
K. BOX
I. CYLINDER
r. OTHER
q. RAIL CAR
e.DRUM m.u3
trtrtrtr
E n. PI..ASTIC BOTTLE
FIBER
o. TOTE BIN
p. TANK WAGON
STOMGE PRESSURE E[a.E u. anovenvsENr Ic. BELOWAMBIENT 224
STORACETEMPEMTURE fu^.E u. enove,{MsIENr I c. BETOW AMBIENT E u. cnvoceNrc
%wT COMPONENT (For mixture or waste only)EHS cAs #
226
227 Eyo Dwo
210
2 231
Dyo [No
3 235
! yes D bro
4 D Yes D tlo
24t
5 D yes E r.ro
211 245
pepcr epturhgorchogcoic,r$eG loforulioo.
lf reba.dos.@pocrc taa paqo( t( tacttcr ttau % bt wckht tf moorcircgcui<, or 0.1* b, wcight
A,lfuA ptr cDtlu€.rlahm d/ ri, T.^1rL{s t/24/o3,
^ 6t.a._r,_
ADD TIONAL LOCALLY COLLECTED INFORMATION
3Page- of-
A:\FRM-|.DOC 05/30/00
l
)
FORM I - SAN LUrS OBISPO COUNTy CERTTFTED UNTFTED PROGRAM AGENCY (CupA)
CHEMICAL II\IVENTORY
material or
DrcvrseDnnn!oelere 200
I. FACILITY INFORMATION
<LOo\nc-Z 8? P '"'"Lo PC-
BUSINESS NAME (Same As FACILITY NAME or DBA - Doing Business As)
CHEMICAL
CHEMICAL LOCATION CONFIDENTIAL
EPCRA
YES
FACILITY ID f I MAP# (oprionat)203 GRID/ (oprionrtl
II. CHEMICAL INFORMATION
i->t,l\a.d,izior. l"esJ+r
CHEMICAL NAME 205+ Aa,/<zt_
TRADESECRET fI y.s 206
toIf refer to instructions
No
l<P,.c!. M,Lfu{ Tes k t -,t- t J a4+u-
COMMON NAME
EHS*I Ycs EINo
cAs#209 *If EHS is .,Yes", all amounts below mtrst be in lbs
FIRE CODE IIAZARD CLASSES (Compl€re if requircd by CUPA)
HAZARDOUS MATERI,AL TYPE
(Check one ilem only)E A. PURE E b. MIXTURE E C. WASTE
ll 2t2
RADIOACTIVE E yes E[No CURIES
PHYSICAL STATE
(Check one item ooly)E a. soLID E u. r-tQuto E c. GeS 0{I-A,RGEST CONTAINER
FED HAZARD CATEGORIES
(Chcck all ftar apply)I a' FIRE E u' Ree.grtve E c. nRESSURE RELEAsE E c. ecurp HgelTs E e. cHRoNrc HEALTH
2t6
AVEMGE DAILY 2t7
l5o DAIL AMOUNT
150
219
0
ANNUAL WASTE STA WASTECODE u0
uNrrsi
(Ctrcck orc itcm only)
EI a. GALLONS fJ o.22t
be in pounds..If mustemoutrt
E u. cusrc reE-r E c. POUNDS 2?2DAYS ON SITE:
:3(-
trtrtr
f. CAN
s. CARBOY
h. srl-o
trtrtr
n. PI;{,STIC BOfiLE
o. TOTE BIN
p. TANK WAGON
e.DRUM DRUMC1CNTAINER
trtr
CYLINDER
BAG
BOX
a. ABOVE TANK m. GLASS
t.
k.
l.
r. OTHER
q. RAILCAR
b. UNDERGROUND TANK
c. TANK INSIDE BUILDING
El a. AMBIENT E U. esOVe AMBTENT E c. BET-oWAMBIENTSTOMGE PRESSURE
STORAOE TEMPEMTURE M a. ^MBIENT E u. esove AMBIENT I C. BELOWAMBIENT E d. CRYOGENIC XE
%wT HAZARDOUS COMPONENT (For mixture or waste only)EHS cAs #u6 xn Dyo ENo
u9
2n
2 23t
Evo DNo 233
zy
3 235
Dy"r f]No
2t6 231
238
4 [Yes ENo
240
242
5 nYes Eruo
244
f.K c@lFE[G ara preo( r( taaaacr rteas of p.pcr ap(urtdt th. rcqslrcdr(archl% by rcirha lf rcourcimgcuic, or 0.1* by Fctta
A,ldxi (4 uy\uctr5c,ho" 1){ LJ,ftqntts t /z+/03. a&,u_o_
ADDITTONAL I.OCALLY COLLECTED INFORMATION 216
3Page--of
A:\FRM-|.DOC 05/30/00
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O:\DOCUMENTUeffp\FORMS\Business Plan Forms\FRM'M DOC 08/08i02
FORM E
SAI.I LUIS OBISPO COUNTY CERTIFIED IINIFIED
PROGRAM AGENCY (CLJPA)
EMERGENCY RESPONSE PLAI\
Or Hazardous Waste Contingency Plan
Date: l-/t -o j
SECTION I.A: BUSINESS IDENTIFICATION DATA
SSWotd?S - €t
BUSINESSNAtvtE
sftN t-t4t s 6/t/5 /o Lft 73 0
E
SITEADDRESS
fl-tso lL$ &D
CITY zXP CODE
FACIUTYI'MT
PdnQo lLortl stnl LLI|S attluf o, C4-
TET.EPHONE NI.'MBER
f3{o/eflq
CITY ZPCODE
BUSINESS MAIUNG ADDRESS
If your businas hos a license or pumitlrom any olthefollotoing agencia, please infrcae the document numbet
l. Hazardous Marcrials
Underground Storage #
2. Hazardous Waste
Generator #
3. AirPollution Contol
Distict#
4. Responding Fire DePt
&Pemit#
ctTY of' ,tN Lttt' a9rsf O
+t F tag
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 io, yo* reference and.to assist.emergency resporuie personnel in responding to a
hazardous materials emergency at your facility. List ttre name and phone number of the utility company'
Telephone #
Telephone #
Telephone #
Telephone #
vTo - 743 -5 OD o
Electic Service PG r E
voP - laZ- 2)'oo
Gas Service
Sanitation
WaterDistict
.5O CftL.z*5
sa5 - s{E-0875
/4 t55/oAj i>1slesrll-
C,.au 'Y E'16/ltt*e4lrd (gos- 7s/-5J.5L
SECTION I-B: OWNER CERTIFICATION OF DATA (Certiff either I or 2)
1. This is a lxrw phn X1pDATED Existing plan. I have personally examined the inforrration it contains and am familiar with the
operation of the plan. (If you check either of ae afrve two options, contin;e to complete the remainder ofthe Emergency Response /
Contingency Plan).
t if ?il;i*i.qui.o no change and is on file with San Luis obispo county certified unified Program Agency and does not need any
cUai-ge. (If you check this section, please proceed directly to Fonn T, the Training Program')
I certifyunderpenalty of lawthatthe above
t^€tNLLI
PRINT NAME OF OWNER OR OPERATOR
A A)
and accurate.
l'l*-oj
DATE
I 'lX-o
DATE
DOCUMENTS PREPARED BY
Lt-5
l_
^.\n/\nl lnttr NIT\ laffn\tr11Qll<\FL rcinacs Plan Fnrmq\FRM-F DOC OAIOB|A2
SECTIONII: EMERGENCY RESPONSE pLAIyS AND PROCEDURES
Note:complet€ all sections of this Emergency Rcsponse Procedure below. use of terms such as 'N/A' (Not Applicable) will not b€ acceptred.A' FIR-E' SPILL, oR RELEASE: The fire code requires immediate notification through dialing 9ll, by whoever first sights theincident In the event of release or spill of hrzardous materials, you must atso notif]:
l' San Luis obispo County Certified Unified Program Agency during business hours @ 80$7gI-5544. After business hoursdial 911.
2- The state office of Emergency services - (g00) gs2-7s50 or (9te 262-1621.
List the individuals responsible for verifying that these calls have been made and also indicate their position in your company.
FOR VERITryING TIIE DIALING OF 9II:
L6 c41r1v1gg1tt-fnNJ cF> /s.-
-PtLFtGffi#
NAME
POSITION
Individual responsible for calling San Luis Obispo County Certified Unified Program Agency and the State Office ofEmergency Services:(Normally the Emergency Coordinator of your business.)cF" /Sz-.r,#3+t€;t+lf'Ls c4 Sn^KgAt ftrF.J
NAME
B.List the local
or threatened
POSmON
emergency medical facilifieslhat will be used by your business in the event of an accident or rqury caused by a releaserelease of hazardous materials.
EO
'TOP
dfi1 /rl ft0o,Vi/* Aa*D S4N LLtls a$tStt*Y#i*r{f-gsf*
NAME ADDRESS CITY
CITY
PHONE
NAME
C. List
Primary:
ADDRESS
PHONE
tfre Emerge4cy Qoordinator(s) at your faciliw.LE cHf\t\4dll(.Ri,{ AF>we*'d#trb5-fq /*884/ v tz t/ /*
NAME At4aoaa cr-rtrndl.n*l pss ros.lY
BUSINESS PHONE 24 HRPHONE PAGER#
Secondary:
NAME
D.
't'l(€ -'eA"'q,tffNT
TITLE
305-5 E'/ I
BUSINESS PHONE 24HRPHONE PAGER#
Does your business have an on-site emergency response tearn?
event ofa release or threatened release ofhazardous materials.
f]Ves [lNo Describe procedwes your business will follow in the
z
t
If you have acutely hazardous materials above threshold planning quantities, list @y name and address) adjacent neighboring
businesses and residences, schools, hospitals, etc. Inctude sensitive facilities (schools, hospitals and rest homes) within 1'000 feet
(straight-line distance from your property line). List telephone numbers for all businesses; for aparfrnent buildings, list manager's
phone. Do not list telephone numbers for private residences.
E.
tlott{
F.Briefly describe your strndard operating procedures in the event ofa release or threatened release ofhazardous materials'
Emergency response procedurei must c-omply with all federal, state and local regulations. Existing emergency response procedures
may be referenced and attached to this document.
1. prevention - Describe the accident potentials associated with the hazardous materials present at your facility. What actions would
your business take to reduce accidenfpotentials? Include description ofsafety, storage, and containment procedures.
Tff€5 -t*L. Dr3ltvl c otALr) t Et*
2. Equipment - List the emergency response equipment at your faciliff (e.g. fire extinguishing systems, spill control equipment,
decontamination equipment).
Item Maintenance Procedure
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exnt/t,utttf€K // tl L. sE'At/ll{
s// tL
/4/fort Y ftritY
///K5r 4/2
aJ fil/ fo4f 4'to,U T#LY/T
3. Evacuation - Describe how you will immediately evacuate your facility. Where are the designated meeting locations?
What commgnications or alarms are used? How will you operate these during power failure?
LocationUse
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F/K{
9641f/LoL
sq/PtY AaorYt9//LL co/t/?-tlAaL
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*11 6 H+Zt /lo a c 'ttt '+7-E(/,rL 4FL€rrJ€o ccL(ts 0 uL)t?€'rL tv/LLlf A' L
/ atn 896-79 212 t/'f/d .tLL P{KSOU5 LE,4 YF Pfr #t/s{s ,4Y srrFtsT €XF'f4/4
ItSS{/tlt5L€,? Slt i// yv /aJ /-3 40 r'rc,,tj oh//'t€/L w/LL /u+Kt -tuz€-/L
r t/+c u trf s 4/(.€.+CC>U ^/T€0 Fo 4-
3
O:\DOCUMENTUeffp\FORMS\Business Plan Forms\FRM'E.DOC OBIOAIO?
4. Shutdown - Describe the procedures to shutdown the facility in case of an emergency
c €F,q €rLc EA/ cY Wtt-t-€ .s(n{ 7,4 L€cT,<ja
PoWTrc ftM D /Y/tTilft t-L 6/fJ /S T4Ei/EE ft/YD 7/,r f .?
t4n /E L€FT T4€/*ea /s ts
5a. Response - Describe what is done to lessen or mitigate the harm or damage done to person(s), property, or the environmen! and toprevent the event from getting worse or spreading. What is your immediate r95po*" to,
Fire:CoMTtLoL f/rtftLL /.,d /T/t {. Ex r/86 Lt lS 4." 5.4 d,*€-FSe e
L oNS q ro 4LE ru/< lOWe f s fe.SstELf
Explosion: El/fCuAf€+LL /{ttsa't/s 7// F4c*t AFFS /77 L3C477$Mt/t/O ctLL
Spill: a41p711g: SllLL To,trt4il/-ES r /Yt:{A. {'l.t{,,f/35 eftBtA./ 7- FotL szt,teL S/d//Vs /ttg/S
tilD OA 4€//T FotL L/*A6€4 SfrtLS 5TO/L€4€ S/A{l{ //V .St/"W" 7L;CF
Earttrquake:EVtcu*TF i-LL /t'AS *rt/s . s4aT OFF ELc"cYEIc ,"ood€4 -rqPf LY+N0 (/t S
/F /0.:s/6 Ls.
Major Power Failure:€LE<-b/€rl P+iltt */Vd Sf ct/te..{d'l 5{;J
Flood: S#qf O FF ELEC.lc/Tf /1-A/t S SIlPILY.LL ao{/s
tleuJ S T€ co,tl T*lttt*fl_S *tt F" S't$1 *
b. Is this facility located on a 100-year flood ptain? ffies lftoc' Earthquake - Identify facility areas and list mechanical or other systems that require immediate inspection or isolation because oftheir rmlnerability to earttrquake related ground motion.
L
( rce tture-\
6.Clean-Up - How do youiandle the complete process of cleaning up and disposing of hazardous material releases at your facility?Note: Notify the certified unified progran Agency when clean up is complJte.
L L 0 LO at-flia/ T u/t/Q/ /-r
(r)o/eR /o L/f-/U * S//t/-S
C,LO lj ?xy- sJ fd,.f s W*$!df FA
c
G' Location - Your business is required to keep a copy of the Business Plan and related Material Safety Data Sheets (MSDS) on-site.Describe where this information is located.
K€-? 7- y'!,' {J./f;iilf f././ { )<V T* $,::' ii!'f{rt:'t^l (nopRq st 71 tAl /f,U o l4sas +/Lt
4
O:\DOCUMENTUeffp\FORMS\Business ptan Forms\FRM-E.DOC 08/08/02
t
FORM T
SA}{ LUIS OBISPO COI.INTY CERTIFIED UNIFIED
PROGRAM AGENCY (CUPA)
EMPLOYEE TRAINING PROGRAM Date: / - /9'oz
A"
I
Describe the safety training for all employees in the event of a release or threatened release of hazardous materials. This
training shall include, but n-ot be limited to the following: new employee training, annual training, and safety meetings which
cover familiarization with the facility's hazardcommunication program and Emergency Response Plan/contingency Plan'
Summarize the taining for all employees that work with or come in contact with hazardous materials/hazardous wastes. Describe how
these employees are trained to avoid exposure'
#8v,, " .jav $#€TS Tft*ttV/rj& I F /fLL Edl /tc'V"fsS y'tv' f:'q*^#low
*A/fl /+4 74-4fia{-s ,I,/rf 5T€ E/h FLaY{€s ,1'/L€7r'/t/4./€ /)tKfloq 5 /tt fr 7EA/6 LS
0/D €c€5s*K Y rX fo,ruE{ ,+A/D 4-c7'/o ldi -s 7-8 (; /F- rft'EY &Ee{-
ltr h ft.eLt&-s€/s//LL)atr + 4ftZrfAtlala-t //t 'fT€r<//f L /W,t"t 76 0c<t0(sEX/ o 5{0 olL
z. Surrmarize taining specific to those employees that would respond to a release or tkeatened release of hazardous materials or
hazardous waste.
70 as(.tt*'fare*L S+n€TY Fif"/Nt- -f*{t?5 {a sp"g\,4"A/'oE/vl/t-a laas ,+lL€ r/<ft/r/€a
t &t ILIY{€J ArLt V<*///€D /// ffl€ L{sF of t4/YoTH€/L ,r*trcfl /1 Fl4f-A€il€€-s
E / /,q E.{'r# eL-s p1;.,t";,ratI F*6 c otu Tt cT lN rrlf
L'TE. FI lLo f€€J e x2 .,4.{nK€ /tLL
n///2 Et/4cL(,f f €fH/. //ZE/s|/sfs .E^/* c/f/-LS FJ /E(.1,*tt-Y' f//
d-/L€ 'TN-4 /i/€a / t\/ tlJ eF s//{-.L satrt't"/€-t r /f/g '<tr
,f//)s .f,tof f--oFF ,t
e'.J &r,ge'{P
6-.ts
{ze s f/tA
ftl-c62941///-€u oF ff€
5
O:\DOCUMENTUetfp\FORMS\Business Plan Forms\FRM-T.DOC OB|OS|O2
J Indicate Aequency and duration of raining for employees that work with or come into contact with hazardous materialsAazardous
waste.
lV /nlfL -€tl/ea/ Ta .fLt fltaYb*J f,/,/l€ Ot
c - 6 //€/V *LL /Co YE*J a,1/ cF
,4- r€4/<
S,+tr €TY i4 t/gtg aNEF-' 4 /n@u-r4
4. Describe how your employees access taining materials. @.g., bulletin board, employee newslefter, staffmeetings, etc.)
T<t /t/ /A/(, N ert ts e 4-A€- /lasTED Ol€Z rtfe W4-St ^f//t/K */t/$ ,aA,/ T-zE-
l$ t{fl N 'tE orlK "t,.t"/.r tn r' 7't/*:" ."f,€,tP tfrt/t ,fZ€/j/.5 f,a -cse,) *7-
TY EJI:F:'T'tni 6-:
B. List pers_on(s) in charge-of training and indicate their qualifications to conduct the training.Ltr CHtu<5zz-ft7|t
t o nrl c( a75 T/L*////n/d */e r{+J o//€4- 30 '/'ed/tl EY/w4/#{c{:
f/(e/r'/6 /jq t//t€S{
c.Indicate where training records are kept (Records must document the type of training, duratiog completion dates, names and
positions of employees receiving training and the name of instructor/tainer.)
TLf ////^)(,l€/a ,(2J 'f/L€f /A/ frf€ (4 FF/TF' F/{E-€r'tfif,at *-7.=
6
O:\DOCUMENTUeffp\FORMS\Business ptan Forms\FRM-T.DOC OB1OSIO2
. FORM S. SAII LUIS
FA stuL
CALENDARYEARBEGINNING (t)ENDTNG(2)(3) PAGE r OF
(5)
(tos ) sil -ss<t
t,zpo-{xr 4
Vffi bWldorx$-BUSINESS
NAME I
SITE
ADDRESS
CITY
DI,'N&
BRADSTREET
OPERATOR
NAME
(4)
(6)
(7)
(10)
(12)
Agq ?e,+,to t?+n>
*o h^;" hr>Fo STATE (E)ztP.(9,431a I
src coDE (4 DIGIT #) (ll)illn
ta|-s'{4 -8841
CA
OWNERNAIW (I4)
oPERATORPHONE (13)
owNERPHONE(ls)()
OWNERMAILING
ADDRESS
crTY (17)
(16)
srATE (18)nPQ9'
ENVIRONMENTAL CONTACTLQE
CoNTACTNAME (20)CoNTACT PHONE (21)to€- s44- 8r4 Il'.|{,tt,i t {: ;'*^ i' s
MATLTNGADDRESS (22)
crTY Q3)
:8 Traqoo RoA>
Srqry h;" O\,ipo STATE (24)4 zrP Qs)4s1o I
NAME (31)
TITLE (32)# Pr.si&ot
BUSTNESS PHONE (33)80€. 54{. tYll
NAME Q6),
TITLE Q7)
BUSTNESS PHONE (28)
24-HOURPHONE Q9'
PAGER# (30)
oNSTTEAHM (36)l_lYcs [tNo
24.HOURPHONE
PAGER# (35)
ACUTELY
Ifyes, and above Threshold Planning Quantities, attach a shcet ofpaper with a gencral description ofthc
process and principal equipmenl
(34)
CIT lm
rnd bclicve thc informetion ls truc,.ccuratc and complcie.
" Print Namc of Dooument Prcparcr (38)
\
Signaore of tlr4erlOperator (le;
E^,ri :l-"
rq$
z-Lz-o\.
a
W
fiDs -574 -EK4 I
ADDITIONAL LOCALLY COLLECTED INFORMATION
(37)
ffi
'D 4l+l
MICOi\{t\'lOMIVP\DOC{Jiv'll:N l\JPOlil,"l-'OllivtS\OF}rlcli97\l'-ORtvlS\FRiVt-S.DOC l0/20/199.C 9r22 Atvl
(1)flaop l-loeuere lXlnevrse
FORM I - San Luis Obi. o County Hazardous Material Unifi. ' agogram Invdntory Form
' Chemical Description Page
, (see instruction page iv)
z oF (3)PAGE (2)q
. BUSINESS MII'IE:
oHEM|CAL LOCATTON (4)
MAP# (s)
Brz*ss b{DpLs -oNl<c>o.,g(*
CVq,aL stDff*L Paom /u)*r+ Ia^tp fr#
GRID # (6)
D!SCLOSURE
A H t4
CHEMICAL LOCATION IS CONFIDENTIAL AND NOT SUBJECT
TRADE SECRET(10)CHEMTCAL NAME C/)
coMMoN l.lAME (8)
cAs # (e)
wPE (12)
PHYSTCAL STATE (13)
HAZARD CATEGORTES (16)
STATEWASTE CODE (17)
DAYS ON S|TE (18)
r-ARGEST CONTATNER (t 9)
SToRAGE CONTATNER (24)
STORAGE PRESSURE (25)
STORAGE TEMPERATURE (26)
flpune fllruxrune Elwnsre
uNrTs (20)
It EHS amounts must b€ in lb.
RADTOACTTVE (14)Flv D?lN (15)
EHS (rl)
tF EHS BOX tS ry'
AtL AMOUNTS MUST BE IN LBS
pCURIES
RIaMareNr Enaove nuetEirr EseLow AMBIENT
AMBIENT AMBIENT
EHS
MA)( DAILYAMT(21)
AVG DAILYAMT(22)
ANNUAL WASTE AMT (23)
,? q&
a
NUMBERo/oWf1t
l*to%
t-)o?o
HAZARDOUS
2
3
4
5
HEALTH HEALTHRELEASE
CU FT
roNs
EL
GROUND TANK
GROUND TANK
DRUM
INSIDE EUILDING
DRUM DRUM
CAR
WAGON
BIN
BOTTLE
BOTTLE
v
NY trlN
[-lv EIN
l-lv [-lH
l-'lv l-lr.t
l-lv l-ln
-?Lkl3q"
-7LL44gL
(31) ADDTTONAL LOCALLY COLLECTED INFORMATION
z
Ll:\COlvil.lON\WP',1$CLrN{[N-nJPOEl-\[ORlvlS\Of nCE9ruORIt'1S\fRI!'t-l.DOC l0l2u/l$8 9:22 A['l
FORM I - SAN LUIS OBISPO COUNTY CERTIFIED LINIFIED PROGRAM AGENCY (CUPA)
CHEMICAL II{\IENTORY
material or
!oelere Inevtse 2@
nann
w o{LKs LJ>Ldd ACILITY INFORMATION
As)'Lzq Sco7r^"/r,
3
R.LBUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business
x02CONFIDENTIALCHEMICAL LOCA
EPCRA
YES
CHEMICAL LOCATION
GRID# (optional 2uIMAP# (optional)203
FACILITY ID #
II. CHEMICAL INFORMATION
TRADE SECRET
If Subject to EPCRA, refer to instructions
206Yes
CHEMICAL NAME
205
fl Yes EI-No
208
EHS*COMMON NAME
*If EHS is "Yes", all amounts below must be in lbs
209
CAS#
FIRE CODE HAZARD CLASSES (Complete if required by CUPA)
2t3
CURIESMDIoACTtvE E v". i{.NoHAZARDOUS MATERIAL TYPE
(Check one item only)I a. PURE Eu. uxrune E c. WASTE
2ll
{t 2t5
LARGEST CONTAINERPHYSICAL STATE
(Check one item onlY)I a. SOLID E b, LIQUID E C. GAS
214
FED HAZARD CATEGORIES
(Check all that aPPIY)
f| a. FIRE pU. neecrrve E c. PRESSURE RELEASE ELd. ACUTE HEALTH Kl e. CHRONIC HEALTH
STATE WASTE CODEANNUAL WASTE AMOUNTMAXIMUM DAILY AMOUNT 218
AVERAGE DAILY
r)/5--
DAYS ON SITE:365-UNITS*
(Check one item
E b, CUBIC FEET E C. POUNDS
*If EHS, amount must be in Pounds.
E d. ToNs 2Zl
.Wf,oNs
E b. UNDERGROUND TANK
E c. TANK INSIDE BUILDING
p*u. srEel onuvt
D f. cAN
I g. CARBOY
fl h. srl-o
ntrtr
E N. PLASTIC BOTTLE
EI o. rorE BIN
fl p. TANKwAGoN
i. FIBER
r. OTHER
q. RAIL CAR
DRUMe.
CONTAINER
trtr
a. ABOVE GROUND TANK m.BOTTLE
j. BAG
K. BOX
I. CYLINDER
E C. BELOW AMBIENT
STORAGE PRESSURE
224
E[A. AMBIENT E b. ABOVE AMBIENT
STORAGE TEMPEMTURE EIA. NVSTENT D b. ABOVE AMBIENT E d. CRYOGENICfl c. BELOW AMBIENT
225
CAS #EHSHAZARDOUS COMPONENT (For mixture or waste only)VoWT 229
n Yes flNo
228227
233
! Yes flNo
232231230
.,
23't236
lYes nNo
235234
3
241
lYes lNo
240
4
745
! Yes flNo
244243242
5
(be requlredof peperaatrch sdditioul, or 0.1% bylI ruore
ifcoopoeo(s rrc Preua st Sreaaer tlrau l% by weigbt if
ADDITIONAL LOCALLY COLLESTED INFORMATION
3
Page---- Of----A:\FRM-l.DOC
DADD floelern Enpvtse 2@
Ld (+<Xrv&€ P{,l\il I. FACILITY INFORMATION
2*%1 SCO6^*)*o VLBUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
CHEMICAL LOCATION 202
NO
EPCRA
YES
CHEMICAL LOCATION
20t
GRID# (optional)I MAP# (optional)203
FACILITY ID #
II. CHEMICAL INFORMATION
to EPCRA, refer to instructioru
206SECRET
If
Yes No
K^&i GA-or kCHEMICAL NAME 'T e,oLC-t-AA
fl Yes F No
208
EHS*COMMON NAME
207
*If EHS is "Yes", all amounts below must be in lbs'cAs#
2r0
FIRE CODE HAZARD CLASSES (complee if required bv CUPA)
CURIES
lla
RADIOACTIVE E Y"' KNOHAZARDOUS MATERIAL TYPE
(Check one item onlY)E a. PURE @u. Iraxrune fl c. wASTE
2rl
LARGFJT CONTAINER 55'
2t5
PHYSICAL STATE
(Check one item onlY)E a. soLID F-u. I-lQuto fl c. GAS
FED HAZARD CATEGORIES
(Check all that aPPIY)
fl a. FIRE fl b. REACTTVE E c. PRESSURE RELEASE n d. ACUTE HEALTH fl e' CHRONIC HEALTH
2t6
STATE WASTE CODE 220
(L,
219
a
ANNUAL WASTE218MAXIMUM DAILY AMOUNTt50217/50AVEMCE DAILY AMOUNT
DAYS ON SITE:36s
222
UNITS*
(Check one item
E b. CUBIC FEET D C. POUNDS
*If EHS, amount must be itr Pounds'
Ed.Ra. GALLONS
223
E r. OTHER
E q. RAILCARE b. UNDERGROUND TANK
E c. TANK INSIDE BUILDING
Ekd. srEEL DRUM
trtru
n. PLASTIC BOTTLE
o. TOTE BIN
p. TANKWAGON
i. FIBER
j. BAG
K. BOX
E I. CYLINDER
DRUMe.
CONTAINER trtrnn
m. GLASS BOTTLE
fl f. cAN
a. ABOVE GROUND TANK
g. CARBOY
h. sILo
XI,A. AMBIENT E b. ABOVEAMBIENT ! C' BELOW AMBIENTSTOMGE PRESSURE
224
STORAGE TEMPEMTURE RA. AMBIENT E b. ABOVE AMBIENT E C. BELOW AMBIENT E d. CRYOGENIC
CAS #EHSHAZARDOUS COMPONENT (For mixture or waste only)%wr
[ves nNoI
213
nves nNo
2
21't
lYes nNo
3
241
! Yes flNo
2J9
4
245
E Yes flNo24
5
weigh( ifl% by weiglrt U ooo<erci{og€oic, or 0.1%sheGsi(ach prp€r epturhg thc required inforution.
If ruore lsurdou compoaeots are predt r( treat€r
ADDITIONAL LOCALLY COLLECTED INFORMATION
FORM I - SAN LUIS OBISPO COLiNTY CERTIFIED {.INIFIED PROGRAM AGENCY (CUPA)
CHEMICAL ITWENTORY
material or
3
Page__-- Of--A:\FRM-l.DOC 05/30/00
: ,-foRM E .z!.)
SAN LUIS OBISPO COUNTY H'AzARDOUS MATERIALS UNIFIED PROGRAM
, AGENCY
EMERGENCY RESPONSE PI.AN
, Or Hazardouswaste ContingencyPlan
(see instruction page vii)
Page 4r ot 4'
Date /-/2-zarb
SECTION l-A: BUSINESS IDENTIFICATION DATA
@ \greq,Jouq - Fvo\pt'*o,EL
A',SNESSI{AME
28q DO TZne>S/^r k;t 5 q o
APCODES]TEADDRESS CJTY
FACIL|TYUit]T IEI..EPHONE NI'MBER
BUSINESS MAILIM| ADORESS crY AP CODE
lf your buslness las a lJcense or pemtt fum any ol the followlng agencles, plase lndlcate the document number.
1. Hazadous Materials
Undeqround Storage #
2. Hazardous Waste
Generator#
3. Air Pollution ConUol
District#
4. Responding File Dept
& Permit#
7
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
personnelin responding to a hazardous materials emergency at your facility. List the name and phone number of the utility
company.
ElectricService PGnE -€ozro
Gas Service a' C*u
5 rzoSt4 t-
Telephone#
Telephone#
Telephone#
Telephone#
ruTl4z-7- zzob
tusl 3 -aw<
-Sz e-
Sanitation /VIt >stoil I)
WaterDisfict
SECTION l-B: OWNER CERTIFICATION OF DATA (Certify either 1 or 2l
1. This is a fflneW Rnn []UPOATED Existing Plan. I have personally examined the information it contains and am
familiarwith th6 operation of the plan. (lf you check either of the above two options, continue to complete the remained of the
Emergency Response/ Contingency Plan).
2. E This 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.)
l"certiff under penalty of law that the above information is true and accurate.
I
PRINT l\lAME OF OI/VI.IER OR OPERATOR SIGMTURE DATE
DOCTJMEIITS PREPARED EY SIGT.IATURE DAIE
4
I : .....,r:i?1.
) ease5 otl
',
SEGTION II: EMERGENCY RESPONSE PLANS AND PROCEDURES
Note: Complete all sections of thls Emergency Response Procedute below. Use of terms suctt as "lVff (Not Applicable) will not be accepted.
A. FIRE, SPILL OR RELEASE: The fire code requtres immediate notificationthrough dialing 911, by whoeverfirst
slghts the lncldenl ln the event of release or spill of hazardous materials, you must also notfi:
1. San Luis Obispo Gounty Hazardous Materials Unified ProgramAgency during buslness hours @ 805-781-
5544. After buslness hourc dial 911.
2. The State Office of Emergency Services - (800) 852-7550 or (9{ 6) 262-1621 .
Llst the indivlduals responslble for verifylng that these calls have been made and also indlcate their position ln
yourcompany.
FOR VERIFYING THE DIALING OF 911 :
lA),lltllM tr-. Taanu-s P*
"/r,#I{AME , POSTTON
lndividual responsible for calling San Luis Obispo County Hazardous Materials Unified Program Agency and the State Office of
Services: (Normally the Emergency Coordinatorof your business.)
11
I{AIIIE FOSITION
B. List the local emergency medicalhcilities that will be used by your business in the event of an accident or injury caused
by a release or threatened release of hazardgus materials.
/V)ED =TD? 2F.1 ,LLJu,,^ E I SLo
l\lAME ADDRESS cnY PHONE
MME ADDRESS crY PHONE
C. List the Emergency Coordinator(s) at your facility.
Primary:fr Pras s-
BUSINESS PHONE 24 HR PHONE PAGER#l{AME TITLE
Secondary:
l.lAME EUSINESS PHONE 24 HR PHONE PAGER*
D. Does your business have an on-site emergency response team? fJVes filtto tt yes, describe procedures your
business will follow to notiff your on-site emergency response team in the ei'ent of a retease or threatened release of
hazardous materials.
5
.l .r....-jlulrij
otq
E. lf you have acutely hazardous materials above threshold planning quantities, list (by name and address) adjacent
neighboring businessesand residences, schools, hospitals, etc. lncludesensltivefacllities(schools' hospitalsand
rest homes) wlthin 1,000 feet (stralghuinedlstance from your property line). List telephone numbers for all
businesses; for apartment buildings, list manage/s phone. Do not list telephone numbers for nlvate resifences.
;
4 )oa le
F. Briefly describe your 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.)
l. Prevention - Describethe accidentpotentialsassociatedwith the hazardousmaterialspresentatyourfacility. \A/ttat
actions would your business take to reduce accident potentials? lnclude description of safety, storage and conbinment
procedures.
2. Equipment - List the emergency response equipmentat yourf;acility (e.9. ftre extinguishingsystems, spill contol
equipment, decontamination equipment). lncludesummary of maintenanceprocedurcs.
Item Maintenance Procedure
Ft L
sptLL
F,asT n rD
3. Evacuation - Describe how you will immediately notify and evacuate your facility. \Mtat communicationsor alarms are
used? How willyou operate these during powerfailure?
Use Location
Fte-e(ADarzDl-u)Att-s '^> SltoP
ytLL ca^.frt?.DL 9,,',tPnLU P&A
t ltanc- h)tDP),,lrLt -</lDD
lF4 z L
B
Assn*tnLE. 1Ar A SH FF- tjPU)/Al}f )fuf/ot) Du)atER /t ),tzlAtzz E lZF^ ALL
6
- ;..,.',.. ..1
Page -lt1
4. Shutdown - Describethe shutdown for each site or facility\-
,<-
'Tt+r+T AtL Pe.Q,-srvrl< *lnt E LEFT f/+E tu4t<F (
Sa. Response - Describewhat 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. \Mat is your immediate response to:
Fire:EvTtuzutst/e.K-, 6,<-'€tr{eJ
LL 4s
Explosion:a-2-
Spill A>attsta/<atZt '7?, <rt/14L't Esr /25E An.v>c nrq)f Fe 4 SP/LLli
Severe Ground Motion:
Major Power Failure:
Flood:
ulAffe-t AAra lJAz-aQ.>+tt r u )AcfF
LL
e k2p <EalEr\
b. ls thls facility located on a lO0-yearftood plain? fflVes f]t'to
c. Ground Motion - ldentify 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
materials at your facility? Note: Notify tlle Hazardous Materials Unified Program Agency when clean up is complete.
*tA/LLt- gPt / LEAI ) -, ) 0 f)DA) F tt) tt)|1 rLl < hltr) 4R</)P-REilT'11 t\
72/)PER-- Dl < 0rtSA'Z-
G.Location ;Your business is required to keep a copy of the Business Plan and related MSDS sheets on'site. Describe
where this inf6rmation is located.
ARE EEPf ra))DEA) A)Etaf TbB,sstrvEss fLAil AilD az?s>s
7
aE
RMT
SAN LUIS OBISPO COUNTY HATARDOUS MATERIALS UI..iIFIED
PROGRAM AGENCY
' EMPLOYEE TRAINING PROGRAM
Page ) ot I
Date: /-tz - zooo
A. Describe the safety procedure training for all employees in the event of a release or threatened release of
hazardous materials. This training shatl include, but not be limited to, the following: new employde training,
annual training, perlodlc refresher courses, and familiarlzation with Emergency Plans and Procedures of this
Buslness Plan / Gontingency Plan.
1. Summarize specific job descriptions for all positions that work with or come in contact with hazardous materials/
hazardouswaste and indicate how these specific positions are trained for their job responsibilitiesor hazards of exposure
(describe training program). Designate whether employee is working with hazardous material (HM), hazardous waste
(HW), or both (B).
I
2. Summarize training specific to emergency response pesonnel that deal with either hazardous material or hazardous
waste release or threatened release.
'+l%*2 fr
I
M:\COi,IwION\WP\DOCUMENT\,JpOEL\FORMS\OFFICE9?\FORMS\FRrvr-T.DOC]0/2Ai,L998 9:22 pJ4
,'.'..:in.
-hbh
of
t-
3. lndicate ftequency and duration of training for each type of employee noted above (a table may be used).
#rpna .aJEEfttDAS -lr'ELD m)4 ,+.rptlT/y
4. lndicate how your business facilitates employee access to training materials. (e.9., bulletin board, employee newsletter,
staff meetings, etc.)
1TIE ?t)LL E-T'/a ) EDM )^2</ffi^S/#)P ^*r)t.) k.F_ -r-v\.aZs<^6t-\ Af
B. List the perconnel in charge of training and indicate qualificationsof personnel conducting the training.
C.. ' lndicate where records are kept. Records must document training including training duration and completion dates,
names and positions of employees receiving training, and the name(s) of instructors/ trainer.
,g ':
M:\coMptoN\wp\DocuMEN?\'JpoEL\FoRMs\oFFrcEg7\FoRMs\FRM-T.Doc10/20/!gg8 9:22 AM
_ai.rf .l
s"" r.f?$$2 #M,k qh" Materiars unined program A1 ,cy
d0/v1t4 E r-4 t4 u PrLoTaZT4
FORM M - MAP GRID (see instructionpasev)
Pag'3 rt1
Map #
fijtt,,r^
3
I Fun
A B c D E F
1
2 ,a.-$
)di D
"lttltA,
/&/
rrtl oY
ln J c.e
,"/'
G H J K L M N
1
2.Y
N 3
4
yu".AL,^-3l I
5
fl 6*:J-sN 7
*-!J'^-aI 8
-*0-
,*"n^'rA s&33
' 4aA
I
A&
Jn,n /-,rr/
H
10
11
12
1313
14
I/t ^/
/i\
h.
-it
@nK^4'n/Ls@ 3 r*
\
@
@
14
A B c D E F G J K L M N
4
\
e
Scale: linch= $ Feet
Business Name:r" IUGA , /A,) 7-,Date: thzlzno
Address: /Sq ?rl,+oo Rono I
Number of Employees in Facility D.eRicted Above - Day = B Night =Page of
3'
M:\covfiuroN\wp\DocuvtENT\,JpoEL\FoRMs\oFFrcEgz\FoRMs\FRM-M.Docr"o/20/,].gsg 9:22 Ar"t
t
"f
INGA,INC.
EI\4ERGENCY/CONTINGENCY RESPONSE PLAN
, FOR
LIQUID SPILLS, FIRES, EARTHQUAKES AND FLOODS
I Procedures For Dealing With Breach Of Liquid Containers
1) Whoever notices the breach of liquid immediately notiry all employees in the building
including the owner/manager.
2) Shut off electric power and gas.
3) Distribute mops to all employees from holding area next to dryer adjacent to liquid tanks.
Break out absorbent materials and put on liquid as appropriate.
4) Using mops, buckets, shop rags and absorbent soak up all liquid and put into plastic
trash containers.
5) Using'caustic soda beads, neutralize the liquid to a pH of 7 to 8.
6) After the liquid has been neutralized, drain liquid into city sewer.
U Procedures For Dealing With Fire
1) Whoevo notices the fire immediately notiS all employees in the building including the
owner/manager.
2) Office staff will dial 91 1 to report the fire.
3) Employees will evacuate the building.
4) If the fire is small and localized, employees will use fire extinguishers to extinguish the
bLaze.
5) If the fue is too large to put out with a fire extinguisher, all employees evacuate the
building and seek safety in an upwind location.
6) Owner/manager to shut off electric power and gas supply if possible.
289 Prado Road, San Luis Obispo, California 93401 (805) 544-8841 FAX (805) 544-5615
...
rrtt
i.
III : Procedures For Dealing With Earthquake
1) At fust sign of earthquake all employees evacuate the building as promptly as jossiUte
using the closest exit available.
2) Once the earthquake iqover the owner/manager will shut off the electric power.
3) If the building is damaged send alt employees home until the structure is declared safe to
work in.
4) If the building is undamaged, wait 30 minutes before reentering the building.
fV ., , Procedures For Dealing With Flood
1) Send all employees home before the water rises high enough to prevent their leaving.
2) Shut off electricity and gas supply.
3) Make sure that all hazardous material containers are sealed.
r ::; i!:'
:)"..:
t
Gounty of San Luis Obispo op
lul s oBtspo
clty
san
Fire Department (805) 78'l-7380
2'160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
EFW data
entry by:
Environmental Health Services
(805) 781 -5544
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HMARDOUS MATERIALS INSPECTION FORM
Date: Y '1i"ii,l1
\l
I rme:
FACILITY NAME:
ADDRESS:
AGENCYn eHs
N AG DEPT
E"crrY FIRE
INSPECTION TYPE
! Routine I Reinspection
.El'-'Complaint n otnerr-
Result Code: _70 _80 _90
Action Code: _32 _37 _33 _31pnbr.re: f -(-r't,r \I'"'IFV!"nt
Ftr* Generator n usr ! eer ncnmnpPROGRAMS INSPEGTED:! Business Plan
n Business Plan E ttw Generator,"! usr n ecr f]cnmnpREtNSpEciloN REeutneo: j,r{ rrro t] YES
RMISSION TO INSPECT
Int with
ons may involve obtaining photographs, reviewing and copying records, and
codes. GRANTED BY NAM
YES NO COSnn nnn nnn n
un
n
n
tr
n
n
n
BPOl
BPO2
BPO3
TROl
TRO2
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 layout/facility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facitity has appropriate training program (Title 19 CCR2732 & 22 CCR 66265,16)
Training documentation is maintained on site for current personnel (Titte 19 CCR2732 & 22 CCR
6626s.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR273I &22
ccR $ 6626s.s3ts4)
Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of
hazardous materials/waste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-
.43)
ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC PIan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR 112.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 25270)
nn
EROl
ERO2
ATOl
ATO2
COMMENTS GO
GPS Coordinates: Latitude: _deg min_decimal
to obtain forms toI comply with -BPO3, TRO1 EROl
mrn
FACILITY REP:
40,Ii
INSPECTOR:
,L,'il,8/),i tft""1'4
t.4Jtf !
\ ,,,
/' a_I'ctyol-
san lurs
Environmental Health Services
(805) 781-5544
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
oBtspo r5
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
Date:l
Time:
YES NO N/A
a/e s/r
w t] nffitl nwn,r
BPOl
BPO2
BPO3
TROI
TR02
PLAN
Businei's plan ts
of
current, & available duringirispecfioii (iiSC 25503.5, Title 19 CCF.2729)
is complete (HSC 25504, Title 19 CCR2729)
maps accurate (HSC 25504, Title 19 CCR2729)
W tr Nn w n
Facility program (Title 19 CCR2732 & 22 CCR 66265.16)
on site for current personnel (Title 19 CCR2732 & 22 CCR$
i
i.
ENCY
FACILITY NAME:
ADDRESS:
AGENCY
n EHS
ltr] crtY prne
T laint /fowvt/,(d/
-+-l
N TYPE
EFW data
entry by:
Routine
ReinspectionI comp
X ottrer
PHONE:
Business Plan W** Generator n usr I acr EcnmnpINSPECTED:
| -l-/
,rH Fusiness Plan F,*Generalor [-l usr n rcr !cllnneREINSPECTION REQUIRED:,{-\ nYES,
,:.
i .'t, '. : l,,tij,,
maintiined on site (HSQ'25504, Title 19 CCR 2731 & 22n
tr
W
w/
and
on
X!n,r
EROl
ERO2
plan is
CCR $
Facility is
hazardous
equipmbnt
ABOVEG
SPCC ls
and
to prevenUminimize/mitigate lire, explosion, or release of
Co to
GPS Coordinates: Latitude:
-deg
i min---decimal min
FACILITY
constituents to the environment. Maintains all
alarm and communications system (Title 19 CCR
PTORAGE TANK ACT
a registered engineer within last 5 yrs. (40 CFR 112.5(b))
(HSC 25270) ,
to obtain t5rlns to C6mpty with BP01-BP03, TROl and ER01
required or appropriate
2731 & 22 CCR 66265.31- .431
dA
WA
COMMENTS
'J"
INSPECTOR:
\Temp\c.lotus.spection Form Page 1.doc 24-Jan-06
mln
I,, FAclLlw
EPAIDNUMBER:
Tiered Permit:
Treatment
Equipment:
t
'', .- ADDR
HAZARDOUS WASTE GENERATOR
l:til!-
Lbs or gals
Total generated/month:
Waste oil: Solvents:
Antifreeze: Others:
YES NO N/Aa" n n
a'n
a/
a/'
El/
n
n
trtr
w
t
n
n
n
D
tr!
tr
nn
n
n
n
u
n
u
vrol.#
GTOl
GTO3
GTII4
GTO5
GT2O
GT21
GT?2
GT23
*iluiiro"\iiIj
EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous
22CCR966262.12) If Not, Call (800) 6f8-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title 22 CCRS66262.ll')
nown knowledge flanalysis flother
Hazardous waste analysiVtest records are kept for at least 3 years (Title 22 CCR $66262.40.(c))
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or
w'
a'
n
n
nnn
Tn
w-
w'
n'
n
a/"
EI"
El-
w"tr'
El'
arrthorization from DTSC (HSC $25189.5' Title ?2CCR966262.12)
Emitt<run Eother
GT06 Hazardous wastes are shipped with manifest (Title22 CCR $66262.20)
GT07 Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR
866263.42t 66262.23)
STORAGE.AND MANAGEMENT OF CONTAINERS/TANKS
GT08 ' :Hazardous wastes are accumulated on site as follows (Title22CCR $66262.34)
: E gO Oays if wastb generated per month is greater than or equal to lfil kg (220 tbs.)
i"" t E ttO aays if waste generated per month is less than lfi) kg (see note)
I ZZO Oays if wastG generated per month is less than lffi kg and tra;rsported more than 2fi) miles (see
note)
Note: Applies only if hazardous waste accumulated on site never exceeds 6fiX) kg(13'2fi] lbs.)and no
acutely/extremely hazaTdous waste over lkg(2.21bs.) is held on site for over 9() days.
GT09 Hazardous waste "satellife" collection is managed properly (complete labeling/accumulation time/S5.gal
or l-qt limit) (Title 22 CGR $66262.34(c))
GT10 Ignitible or ieactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR'
s6626s.t76)GTll Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTE,t'waste composition/physical state, hazardous properties, name/address of generator) (fitle 22
ccR $66262.31, 66262.34)
GT12 Contal4erVtanks containing hazardous wastes are in good condition/handled to minimize release or '
reactioir(Title 22 CCR 966265.17 U.l9l, 66265.177 (c))
GT13 Containetdtanks/liner"s are compatible with waste stored or transferred (Title22 CCR$66265.172)
1.GT14 Containers btoring hazardous wastes are closed/sealed (Title 22 CCR $66265.173)
QffS Weekly insprjction of areas where hazardous waste containers are stored is conducted
\ (fitle 22 CCRS66265.174)
GTf6 Daily inspection of all tank systems is conducted and documented (Titte 22 CCR $66265.195),
CfiZ Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly
. withip'one year of d:te emptied (TitleZ2 CCR $66261.7 (f))I nncvcLABLE wAsrr
GT18 :. Used oil is managed as hazardous waste until recycled (includes proper labeling, storage, etc) (IISC
$2s2s0.4)
GT19 ' Used oil'filteit for recycling are managed properly (drained of free flowing liquid, stored in closed
r, rainproof container, labeled "drained used oil filtersrt' and transferred for metal reclamation) (Title 22
ccR$ 66266.130)
',Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (Title22 CCR $66266.8f)
Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR
$66266.s)
SOURCE REDUCTION: For facilities generating >12,000 kg./yr. of hazardous waste on site.
Generator is subject to SBl4 and has prepared and retained current source reduction documents or is
able make them available to the inspector within (5) days. (HSC 52524/,.19,25U4.21)
Source Reduction Evaluation and Plan contains the following five elements:
certification, amounts of wastes generated, process description, block diagrams, and implementation
schedule ofselected source reduction measures. (HSC S25244.f9)
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Environmental Health Services
(805) 781-5544
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, CA 93406
,-'l
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san luls rl
Flre Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
Date: tnlJftu EFW data
entry by:
NAME:FACI
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Time:n
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YES N/ANOuTn
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 fayouUfacility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
66265.t6)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22
ccR $ 6626s.s3154)
Facility is operated and maintained to prevenVminimize/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'.431
ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs. (40 CFR U2.5(b))
SPCC Plan is maintained on site or nearest field office. (HSC 2527'0)
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Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR 566262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted ("Iitle 22 CCR $66262.11)
/own knowledge f]analysis f]other
i{Azardous waste analysis/test records are kept for at least 3 years (Title 22 CCR $66262.40.(c)
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or
Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR
866263.42t 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title22 CCR 566262.34)
n gO Aays ifwaste generated per month is greater than or equal to 100 kg (220 lbs.)
I f,SO Oays if waste generated per month is less tl{an 100 kg (see note)
Q4lO daysif waste generated per month is less than!0O kg and transported more tlian 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 (2.2lbs.) is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/S5-gal
or l-qt limit) (Title 22 CCR 5662623a@))
Ignitable or reictive wastes are located 15 m (50 feet) from facility's property Iine (Title 22 CCR
s6626s.176)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title 22
ccR $66262.3 l, 66262.34)
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or
reaction (T itle 22 C CR S 66265. L7 I l.l9l, 6626 5.17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred ("Iitle 22 CCRS66265.172)
Containers storing hazardous wastes are closed./sealed (Title22 CCR $66265.173)
Weekty inspection of areas where hazardous waste containers are stored is conducted
ccR$ 66266.130)
Spent lead-acid batteries are beirig properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse, or reclamation (Iitle22 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 525244.19,25244.21)
Source Reduction Evaluation and Plan contains the following five elements:
certification, amounts of wastes generated, process description, block diagrams, and implementation
schedule ofselected source reduction measures. (HSC S25244.19)
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Environmental Health Services
(80s) 781-5544
P.O. Box 1489
2156 Sierra Way
San Luis Obispo, C4,93406
gHff"s,*po - r,.: J1'''.':.'.r,-rii!{-'
EFW data
entry by:
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
Date: lo/ffih'f
FACILITY NAME
ADDRESS:*
Routine
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nspections may involve obtaining photographs, reviewing and copying records, and
determininq compliance with adopted codes. GRANTED BY (NAME/TITLE):
PERMISSION TO INSPEGT: I
Time:
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BUSINESS PLAN
Business plan is complete, current, & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504' Title 19 CCR2729)
Site layouUfacility maps are accurate (HSC 25504, Title 19 CCR2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22 CCR
6626s.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCRn3l &22
ccR $ 6626s.s3/s4)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or release of
hazardous materials/waste constituents to the environment. Maintains all required or appropriate
equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-
.43)
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ABOVEGROUND PETROLEUM STORAGE TANK ACT
SPCC Plan is reviewed and certified by a registered engineer within last 5 yrs.
SPCC Plan is maintained on site or nearest field office. (HSC 25270)'i cFR 112.s(b)
To
COMMENTS tu^
FACILITY REP:ltt/INSPECTOR:N
C:\D0C LS-1 \Temp\c.lotus. nr:tes.data\1 -lnspection Form 1.dac 20-Jul-04
FACILITY NAME
EPA ID NUMBER:
Tiered Permit:
Treatment
Equipment:
ADDRESS:
HAZARDOUS WASTE GENERATOR
* u,,!l
Lbs or gals
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GT16
GT17
GT18
GT19
GT2O
GT2I
GT22
GT23
EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR566262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title 22 CCR $66262.11)
nown knowledge Zanalysis nother
Hazardous waste analfris/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 525189.5, Title 22 CCR 566262.12)
Emilkrun nother
Hazardous wastes are shipped with manifest (Title22 CCR $66262.20)
Manifests and/or receipts are properly completed/retained by generator for 3 years (Title 22 CCR
s66263.421 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title22 CCR $66262.34)
n gO Oays if waste generated per month is greater than or equal to 100 kg (220 lbs.)
! 180 days ifwaste generated per month is less than L00 kg (see note)
p ZIO days if waste generated pei 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 lkg (2.2|bs.) 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|t
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
s6626s.176)
Containers of hazardous waste are properly tabeled (includes appropriate date, "HAZARDOUS
WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title22
ccR $66262.3 L, 66262.34)
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or
reaction (T itle 22 C CR $ 66265. l7 I I .19 l, 6626 5.17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCR$66265.172)
Containers storing hazardous wastes are closed/sealed (Title22 CCR 566265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted
(Title 22 CCR$66265. 174)
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 labeling, storage, etc) (HSC
$2s2s0.4)
Used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed
rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title22
ccR$ 66266.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse' or reclamation (Title22 CCR $66266.81)
Solvents/other recyclable materials are managed as hazardous wastes until recycled (Title 22 CCR
s66266.3)
SOURCE REDUCTION: For facitities 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 525244.19,25244,21)
Source Reduction Evaluation and Plan contains the following five elements:
certification, amounts of wastes generated, process description, block diagrams' and implementation
schedule ofselected source reduction Ineasures. (HSC $25244.19)
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Environmental Heal "- rServtces
(80s) 78r-ss44
P.O. Box 1489
2156 Sierra Way .San Luis Obispo, CA 93406
Department of Agriculture/Measurement
Standards (sos) 7s1-s910
2156 Sierra Way Suite A oSan Luis Obispo, CA 93401
ir.of San Luis Obis
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Ohisno CA 934O1-52AO
Utilities Departmsnf r (805) 781-7215
I
879 Morro Street r San Luis Obispo, CA 93401
CERTIFIED UNIFIED PROGRAM AGENCY (CUPA)
HAZARDOUS MATERIALS INSPECTION FORM
H r"r t-l tJ,"1 3c
FACILITY ID NO:
etFACILITY NAME:
ADD
Reinspection
Complaint
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n usr n lcr I Tiered PermittingPROGRAMS INSPECTED:dBusinessPlan {uw Generator I c"llnp
nacr I Tiered PermittingE Business Plan f] Hw Generator Ll c"tlnp n usrRI'INSPEC'T-ION RIiQ UIRIJD :
n No rntrrcs
PERMISSION TO INSPECT: Inspections may involve obtaining photographs, reviewing and copying records, and determining
rompliance with adopted codes. GRANTED BY (NAME/TITLE):
Date:
Time:
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Business plan is complete, current, & available during inspection (HSC $25503.5, Title 19 CCR $2729)
Inventory of hazardous materials is complete (HSC $25504' Title 19 CCR $2729)
Site layouUfacility maps are accurate (HSC S25504, Title 19 CCR$ 2729)
TRAINING PLAN
Facility has appropriate training program (Title 19 CCR $2732 & 22 CCR $66265.16)
Training documentation is maintained on site for current personnel (Title 19 CCR 52732 &
22 CCR S6626s.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 525504' Title 19 CCR
9273t & 22 CCR $6626s.s3/s4)
Facility is operated and maintained to prevenUminimize/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 566265.31-
.43)
COMMENTS:
GPS Coordinates: Latitude:
-deg -min-decimal
min Longitude:-deg min-decimal min
fnspector Facility Representative:
A:\CUPA inspection forms 2.doc 20-Mar-03
FAOILITY NAME:
EPA ID NUMBER:
Tiered Permit:
Treatment
Equipment:
DATE:
HAZARDOUS WASTE GENERATOR
NO/\'&-EI6n w [cnsor trc.r npnn
INSPECTOR
Total generated/month:
Waste oil: Solvents:
Antifreeze: Others:
i!fr Lbs or gals
(average)
YES NO N/AE-E- W
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EPA ID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (Title
22CCR966262.12) If Not, Call (800) 618-6942 to obtain your CAL EPA ID number.
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (Title 22 CCR 566262.11)
lown knowledge [analysis lother
Hazardous waste analysis/test records are kept for at least 3 years (Title 22 CCR $66262.40.(c))
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO. and permit or
authorization from DTSC (HSC 525189.5, Title 22 CCR566262.12)
!milkrun f]other
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
966263.421 66262.n)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title22 CCR $66262.34)
fl gO Oays if waste generated per month is greater than or equal to 100 kg (220 lbs.)
n fSO days ifwaste generated per month is less than 100 kg (see note)
ZZIO 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 lkg Q.2lbs.) is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/S5-gal
or l-qt limit) (Title 22 CCR 56626234@))
Ignitable or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCR
s6626s.t76)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTE," waste composition/physical state, hazardous properties, name/address of generator) (Title22
c cR $66262.3 l, 66262.34)
Containers/tanks cpntaining hazardous wastes are in good condition/handled to minimize release or
reaction (T itle 22 C CR $ 66265. I 7 I I .19 l, 66265.17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (Title 22 CCRS66265.172)
Containers storing hazardous wastes are closed/sealed (Title22 CCR $66265.173)
Weekly inspection of areas where hazardous waste containers are stored is conducted
(Titte 22 CCRS66265. 174)
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 labeling, storage, etc) (HSC
$2s2s0.4)
Used oil filters for recycling are managed properly (drained of free flowing liquid' stored in closed
rainproof container, labeled "drained used oil filters," and transferred for metal reclamation) (Title 22
ccR$ 66266.130)
Spent lead-acid batteries are being properly stored and transferred offsite under manifest or bill of
lading for recycling, reuse' or reclamation (Title22 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
abfe make them available to the inspector within (Srdays. (HSC 525244.19,25244.21)
Source Reduction Evaluation and Plan contains the following five elements:
certification, amounts of wastes generated, process description, block diagrams, and implementation
schedule ofselected source reduction measures. (HSC $25244.19)
A:\CUPA inspection forms.doc 1 9-Sep-02
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SUMMARY OF OBSERVATIONS/VIOLATIONSt ; ,',:.
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discovcijed.
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No violations of underground storage tank, hazardous materials, or hazardous waste laws/regulations were
SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facilityi
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 CIIPA 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 dchieved 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 lindings 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.
NUMBER
VIOLATIONS
MINOR MAJOR CORRECTIVE ACTION REQUIRED
OofrWffiT
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Inspected By:
Date:
Facility Rep Name:I lt
for your records.
0 Signature:A
Certification: I certify und€r penalty of perjury that this facility has complied with the corrective actions listed on this
inspection form.
Signature of Owner/Operator:Title:Date:
Sign the certification below and mail this form to the CUPA inspector after all corrective actions have
A:\CUPA inspection forms.doc'19-Sep-02
Division of Environm.<gl-Heallh
(80s) 781-s544 |
P.O. Box 1489
2156 Sierra lVay rSan Luis Obispo' CA 93406
Denartment of Agriculture/Measurement
Standards (8os) 781-s910
2156 Sierra Way Suite A rSan Luis Obispo' CA 93401
t of San Luis Obi
Fire Department (805) 781-7380
2160 Santa Barbara Avenue
San Luis Obispo CA 93401-5240
Utilities Department r (805) 781-7215
nate: (o I
Time: @
Q r0)
lb0
879 Morro Street r San Luis Obispo' CA 93{01
CERTIFIED UNIFTED PROGRAM AGENCY (CUPA)
HMARDOUS MATERIALS INSPECTION FORM
(.1rr l-tw
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EFW data
entry by:rvt
FACILITY ID NO:
FACILITY NAME:
ADDRESS: >94 (Taa
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! lct n TieredPermittingfl Hwcenerator n ustwK"rtYES ! Business PlanREINSPECTION REQUIRED:
PERMISSION TO INSPECT: rnspections rnay involve obtaining photographs, reviewing and copying records, and determining compliance
with adonted codes. GRANTED BY (NAME/TITLE):
YES, NO N/Ad, n nw, tr nwrtr
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BUSINESS PLAN
Business plan is complete, currenl & available during inspection (HSC 25503.5' Title 19 CCR2729\
Inventory of hazardous materials is complete (HSC 25504' Title 19 CCR2729)
Site layouUfacility maps are accurate (HSC 25504' Tifle 19 CCR2729)
TRAININGPLAN
Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16')
Training documentation is maintained on site for current personnel (Title 19 CCR2732 & 22
ccR 66265.16)
EMERGENCY RESPONSE PLAN
Contingency plan is complete, updated, and maintained on site (HSC 25504' Title 19 CCR
2731 & 22 CCR $ 66265.s3l54)
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)
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COMMENTS:
INSPECTOR:F'ACILITY REP:
Repro 1001 rev 1 o:\DocUMENfueffp\FORMS\lnspection forms\cUPA inspection forms.doc 10-sep-01
I . FAdiLITY NAME:DATE:
HAZARDOUS WASTE GENERATOR
EPA ID
NUMBER:
Tiered Permit:
Treatment EquiPment:
INSPEGTOR:
Total generated/month:
Waste oil: Solvents:
Antifreeze: Others:
'tiii
Lbs or gals
(average)
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#
w
VIOL. #
GTOl
GTO3
GTO4
GTO5
GTO6
GTOT
GTOS
GTO9
GTlO
GTIl
GTI2
GT13
GT14
GT15
GT16
GT17
GTI8
GTI9
GT2O
GT2I
authorization from
!milkrun service
EPA ID NO/PERMITS
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
Hazardous waste determination conducted (Title22 CCR 66262'11)
[own knowledge lanalYsis [other
il"ardous wasti analysiVtest records are kept for at least 3 years (Title22 CCR 66262'40'(c))
DISPOSAL/TRANSPORTATION
Hazardous wastes were transported and/or disposed to a facility with an EPA ID NO' and permit or
T
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tr
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nn
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tr
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tr
ddtrn
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t]
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
66263.421 66262.23)
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (Title22 CCFI66262.34)
fl m Oays if waste generated per month is greater than or equal to 100 kg (220 lbs')
E fgO days ifwaste generated per month is less than 100 kg (see note)
DZlOdays 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 lbs.)and no
acutely/exiremelyiazardous waste over lkg(2.2|bs.) is held on site for over 90 days'
Hazardous waste,,satellite" collection is managed properly (complete labeling/accumulation time/55-gal
or l-qt limit) (Title 22 CCR 6626234@))
tgnitaule or reactive wastes are located 15 m (50 feet) from facility's property line (Title 22 CCF(
66265.t76)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS
WASTE," waste composition/physical itate, ha"ardous properties, name/address of generator) (Title22
ccR 66262.34)
Containers/tanks containing .hazardous wastes are in good condition/handled to minimize release or
reacti o n (T itle 22 C CR 662 65. I 7 I l.l9 l, 66265.17 7 (c))
Containers/tanks/liners are compatible with waste stored or transferred (Tltle 22 CCR 66265'172)
containers storing hazardous wastes are closed/sealed ("Iitle 22 CCR 66265.173)
weekly inspection of areas where hazardous waste containers are stored is conducted
(T itle 22 CCR 66265.17 4)
iaily inspection of all tank systems is conducted and documented (Title 22 CCR 66265'195)
Empty containers or inner liners greater than 5 gal has date when emptied and are managed properly
within one year of date emptied (Title22 CCR 66261'7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, storage' etc) (HSC
252s0.4\
used oil filters for recycling are managed properly (drained of free flowing liquid, stored in closed
rainproofcontainer, labeled ,,drained used oil filters," and transferred for metal reclamation) (Title22
ccR 66266.130)
Spent lead-acid batteries are transferred offsite under manifest or bill oflading 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',)
n
I ') '')" SUMMAT{Y OR OBSERVATIONS/WOLa.TIONS
No violations of underground tank, hazardous materials, inventory, and hazardous waste laws, regulations, and J{ilui..t"nt, *er"
discovered. SLO CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to ydilr facility.
Violations were obseryed/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 ofthe law and punishable by a line
ofnotlessthan$2,000ormorethan$25,000foreachviolation. Yourfacilitymaybereinspectedrnytimeduringnormalbusinesshours.
You may request a meeting with the Program Manager to discuss the inspection findings and/or proposed corrective rctions. 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
MINOR MAJOR CORRECTWE ACTION REQUIRED
{
n
NUMBER
COMMENTS:
Inspected By:
Date:
Facility Rep Name:
Signature:
repro ll27 rev 1 O :\DOCU ME NT\Jeffp\FORMS\l nspection forrns\C U PA irrspection forlns.doc 1 0-Sep-01
Division of Environmental Heallh
P.O. Box 1489
2156 Sierra Way .51n Luis Obispo' CA 93406
Denartment of Agriculture/lVleasurement
Standards (8ot ztr-sglo
2156 Sierra Way Suite A .San Luis Obispo, CA 93401
,)
M[lIroCity of San Luis Obispo ffi
Utilities Department o (805) 781-7215
955 Morro Street o San Luis Obispo, CA 93401
D^t",v+llilli,i
CERTIFIED UNIFIED PROGRAM AGENCY
HAZARDOUS MATERIALS
INSPECTION FORMTime
Record ID Prog/Ele Svc Result Action Insp Min.Facility Violation
2
Vr;nt
NO
(24 HR)
TEL. NO.(DAY):
FACILITY LOCATION:
ENYISION FACILITY
FACILITYNAME:
t/'
TYPE OF INSP.: lt[Routtn" ll R.-in.p. I lComptaint
INSPECTING AGENEY:
-',n onn Wcrcv urrlrrrEs nocH
PROGRAMS INSPECTED:
REINSPECTION REQUIRED: I No N YES
{-r,Generator fl usr n acr
n uw Generator fl usr n acr
Business Plan
Business Plan
CONSENT: Consent to conduct inspection which may involve obtaining photographs, review and copying of records, and
determination of compliance with UST, AGT, and hazardous materials/waste handling requirements.
Reason (if refused):_Granted Refused By (Name/Title)
NO N/ANTTf
TNtrn
YESE,w
d,t
vIoL. #
TROl
TRO2
EROl
ERO2
VIOI,. #
BPOI
BPO2
BPO3
GENERAL REQUIRJMENTS
TRAINING
Faculty has appropriate training program (fitle 19 CCR2732 & 22 CCR 66265.16)
Training documentation is maintained on site for current personnel (Iitle l9 CCR2732 & 22 CCR 66265.16)
CONTINGENCYIEMERGENCY PLAJ\
Contingency plan is complete, updated, and maintained on site (HSC 25504, Title f 9 CCR 2731 & 22 CCR &
6626s.s3ts4)
Facility is operated and maintained to prevenUminimize/mitigate fire, explosion, or relcase ofhazardous
materials/waste constituents to the environment. Maintains all required or appropriate equipment including an
alarm and communications system (Iitle 19 CCR 2731 & 22 CCR66265.31-.43)
BUSINESS PLAN
Business plan is current & available during inspection (HSC 25503.5, Title 19 CCR2729)
Inventory of hazardous materials is complete (HSC 25504, Title 19 CCR 2729)
Site layout/facility laps are accurate (HSC 25504, Title l9 CCR2729')
)aEg Non,IvonWT
N/Al
&{(f+ ')vn> - otL
HAZARDOUS WASTE GENERATOR
EPAIDNo: NOI,I t2
Tiered Permit:- CESW
-
CESQT
-
CA
-
PBR
Treatment Equipment:
Total generated/mo:-lbs or gals
Waste Oil:_ Solvents:_
Anti-freeze: Others:
LEsn
n
N/A,
@c
d
d
d
d,d
c
tdV
tr
fl.w,w
w
tW,*t
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n
n
!
n
nn
n
n
nn
n
nnn
n!
nn
n
n
T
trnddnn
VIOL. #
GTOI
GTO2
GT03
GTO4
GTO5
GTO6
GTOT
GTO8
GTO9
GTlO
GTIl
GT12
GT13
GTl4
GTl5
GTI6
GTIT
GT18
GT19
GT2O
GT2I
EPAID NO/PERMITS
Generator has an EPA ID number to treat, store, dispose, transport or transfer hazardous waste (fitle 22CCR
66262.t2)
Generator has a permit or authorization to conduct on-site waste treatment (Iitle 22 CCR 66270.1)
HAZARDOUS WASTE DETERMINATION
Hazardous waste determination conducted (litle22 CCR 66262.1f)
[o*o knowledge nanalysis [other
Hazardous waste analysis/test records are kept for at least 3 years (Iitle 22 CCR 66262.40'(c))
DISPOSAL/TRANPORTATION
Hazardous wastes were offered to transporter and/or disposed to a facility with an EPA ID No. and permit
or authorization from DTSC (HSC 25189,5, Title 22 CCR66262.12)
l-lmilkrun service
-
noth",
-
Hazardous wastes are shipped with manifest (fitle 22 CCR66262'20)
Manifests are properly completed/retained by generator for 3 years $itle 22 CCR 66263.421 66262.23\
STORAGE AND MANAGEMENT OF CONTAINERS/TANKS
Hazardous wastes are accumulated on site as follows (fitle 22 CCR 66262.34)
days ifwaste generated per month is > 100 kg (220 lbs.)
180 days ifwaste generator per month is- less than 1000 kg (See Note)
< 270 days ifwaste generator 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 6000 kg and no acutely/extremely
hazardous waste over I kg is held on site for over 90 days.
Hazardous waste "satellite" collection is managed properly (complete labeling/accumulation time/55-gal or l-qt limit)
(litle 22 CCR 66262.34(c))
Ignitable or reactive wastes are located 15 m (50') from facility's property line (fitle 22 CCR66265,176)
Containers of hazardous waste are properly labeled (includes appropriate date, "HAZARDOUS WASTE," rvaste
composition/physical state, hazardous properties, name/address ofgenerator) (fiile22 CCR66262.34)
Containers/tanks containing hazardous wastes are in good condition/handled to minimize release or reaction Cfitle
22 CCR 66265.77 ll.191, 66265.177 (c\)
Containers/tanks/liners are compatible with waste stored or transferred (Iitle 22 CCR 66265.172)
Containers storing hazardous wastes are closed/scaled (Iitle 22 CCR66265,173)
Weekly inspection of areas where haz. waste containers are stored is conducted/documented (Iitle 22 CCR
66265.174)
Daily inspection ofall tank systems is conducted and documented (litle22 CCR 66265.195)
Empty containers or inner liners > 5 gal has date when emptied and managed properly within one year of date
emptied (title 2 CCR 66261.7 (f))
RECYCLABLE WASTE
Used oil is managed as hazardous waste until recycled (includes proper labeling, 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) (litle22 CCR 66266.130)
Spent lead-acid batteries are transferred offsite under manifestation for recycling ' reuse, or reclamation (fitlc
22 CCR 66266.8t)
Solvents/other recyclable materials are rnanaged as hazardous wastes until recycled (litle22 CCR 66266.3)
SUMMaRY OR OBERVATIONS/VIoLnTIoNS
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 violatiorx must be corrected by implementing the corrective action listed by each
violation. Ifyou disagree with any ofthe violations or proposed action, please inform us in writing.
All minor 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 compliiice 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 at any time.
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
NO.MINOR MAJOR CORRECIVE ACTION REQUIRED
TRO
ERO
BPO
GTO
wDo
UTO
ATO
COMMENT:
Insp. Agency
Date:
L l*
I irL€;,i Facility Rep:
la .atL'
L5
Title:
^-{
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1'
msds sections
San Luis Obispo, California - From your search history - Learn more
Terms
Thank you
Regards,
Michael Flores
On Apr tI,2OL8 3:24PM, "Boyle, Kerry" <kbovle@slocitv.org> wrote
Hi Michael: I responded to the complaint from you that I received on April 10,2018 for 289 Prado Road in
San Luis Obispo. I reviewed the file for this address and the last tenant storing hazardous waste or
hazardous materials was "The Brassworks" which closed in 2006. The current tenant is a bakery operation
and I met with the production baker. He said that prior to them taking occupancy of the building they cleaned
the inside as follows: 1) the first step was to use compressed air and remove dust etc. from the ceilings,
walls, and floors; 2) a high pressure washer and cold water was used to wash all of the interior surfaces; 3)
' another cleaning of the interior surfaces was performed using hot water in the high pressure washer; 4) an
epoxy coating was applied to the floors; 5) sidewalls had panels applied for easy clean up from bakery
operations. No violations were noted during the inspection and no corrective action is warranted. Thank
' you, Kerry
Kerry Boyle
Hazardous Materials Coordinator
CITYOF
strnlflrs onmpo
9
: Fire Department
' '(
.\
Boyle, Kerry
From:
Sent:
To:
Subject:
Saturday, April 14, 20187:L7 PM
Boyle, Kerry
RE: Complaint Investigation at 289 Prado Road, San Luis Obispo
Attn: Kerry Boyle,
Thank you for checking on possible chemical contamination to the production of our one of our local bread supply
operations. ls it your opinion, or fact that all chemical contamination has been delt with at the 289 Prado Rd. San Luis
Obispo,Ca.934OL?
Please be possitive of your information on chemical recovery at this location.
(NEGLIGENCE) ls very serious in any of our agencies here in San Luis Obispo County.
Thank you for your time in this matter.
Regards,
On Apr L2,2OL87:52 AM, "Boyle, Kerry" <kbovle@slocitv.org> wrote:
Hi I have no idea what you are referring to. The Brassworks was sold in 2006 and vacated the
facility at 289 Prado Road at that time, which is now 12 years later. I do not have any records of a General
Contractor, there are no current permits or a business license, no Safety Data Sheets for this former
tenant. Thank you for your concerns and interest but I have nothing else to provide you. Kerry
From: [mailto:
Sent: Wednesday, April 11, 2018 5:12 PM
To: Boyle, Kerry <kbovle@slocitv.ors>
Subject: Re: Complaint lnvestigation at 289 Prado Road. San Luis Obispo
Attn. Kerry Boyle
RE: (CHEMICAL CLEAN-UP)
Thank you for the information concerning 289 Prado Rd.
San Luis Obispo,Ca.93401-.
TheinformationprovidedmakesnomentionoftheGeneral contractorutilizedlntheMSDAcleanup,anddisposalof
chemicals at this particular location. Please provide the contractors current permits, and business licence information.
1
This public information must be documented
Boyle, Kerry
From:
Sent:
To:
Subject:
Ehrbar, Barbara
Tuesday, April 10, 2018 12:51 PM
Boyle, Kerry
Possible Chemical Contamination at 289 Prado
Kerry,
This concern came into our Code Enforcement email this morning. Can you follow-up with Blake from
Supervisor Hill's office?
Thanks.
Barbara Ehrbar
Administrative Assistant I I I
CITTOF
sffnI,IIIsoBlspo
Community Development
879 Morro Street, San Luis Obispo, CA 93401-3934
E behrbar@slocity.org
T 805.781 .7170
slocity.org
Good morning.
This is Blake Fixler, legislative assistant to County Supervisor Adam Hill. We received the notification below through our
website. The individual who left it is referencing possible chemical contamination at 289 Prado Rd. Apparently the site
used to be a radiator repair facility and is now a rock climbing gym that serves bread? The current address is for SLO Op
Climbing.
Since this address is within San Luis Obispo city limits, I am forwarding this notification on to you. Will you let me know
if there is anything you need from me or if a response would be warranted from Supervisor Hill's office? Their contact
information is included in the email below.
Thank you
Blake Fixler
Legislative Assistant District 3
San Luis Obispo County Supervisor Adam Hill
(80s) 78L-4336
bfixler(Oco.slo.ca. us
L055 Monterey St. Rm D430
San Luis Obispo, CA 93408
1
COUNTY
E SAN LUIS
OBISPO
COUNTY OF SAN LUIS OBISPO
From: Web Notifications
Sent: Sunday, April 8,2OL8 4:L2 PM
To: Board of Supervisors <Boardofsups@co.slo.ca.us>
Subject: Contact Form Topic: Board of Supervisors meetings/business
Topic: Board of Supervisors meetings/business
Your Name:
Your Email:
U.S. phone number: (
Message: Dear Sirs, Please see ,and document information concerning chemical contamination at 289 PRADO ROAD SAN
LUIS OBISPO,.CA 93401. SAN LUIS OBISPO CITY CODE INSPECTORS. OSHA INSPECTORS CANCER CAUSED UTILIZING
cHEM|CALS tN THE COURSE OF MANUFACTERTNG RADTATORS (SILVER SOLDTERING),ECT. CAL POLY STUDENTS CLIMBED
AT THE SLO CO-OP ROCK CLIMBING GYM PUBLIC CONSUMING BREAD FROM THE BAKERY BAKED AT 289 PRADO RD. SAN
LUIS OBISPO, CA. INDIVIDUAL'S CONSUME BREAD BAKED AT A FACILITY THAT FORMALLY MANUFACTERED RADIATORS
UTILIZING CHEMICALS FOR SEVERAL YEARS AT THIS LOCATION. THE BRASSWORKS RADIATOR COMPANY TRUSSES AND
CEILLINGS MUST BE INSPECTED BY OSHATRUSSES AND CEILINGS HAVE BEEN CONTAMINATED WITH CANCER CAUSING
AGENTS FROM THE BRASSWORKS RADIATOR MANUFACTERING COMPANY. CHEMICALS INCLUDE BUT NOT LIMITED TO:
SILVER SOLDIER ACETYLENE GASES CORE STAMPING FLUX, ECT. PRE EXISTING BUSINESS CLIMBING (CO.OP CLIMBING
GYM)AT 289 PRADO RD. SAN LUIS OBISPO,CA.?
Security code: 664369
BoardOfSupervisorsl D: 267
Form inserted:4/8/2078 4:11:39 PM
Form updated: a/8/2018 4:11:39 PM
2
I'IdI- UC' U ' TJJ: JT€Errv.tt'tJrttnufltar neatEn rIJu3, rttL-1c. 1L P. r
I Nc,R, INc.
Posr Orrtcr Box 939 . ArAscaprno, CA 93421-09]9 . 80\/461-9006 . 805/466-4860 rnx
t? toEf
Ivlalclr 5,2007
County of San Luis Obispo
Environmerrtal Fjealth Sen ices Division
21.56 SiercaYiay
P.O. Box 1489
San Luis Obispo, CA 93406
ltRrlpfl??Ftll
&lH $ i:.$i#:I"l
Re: Change of ownership of the business known as "l'nr BnessvoRrs" effective 09-08-05 ancl
Rcquest to dissassociate INce, Inc. from Faciliry ID #FA0005762 and reassign to new owncrs
To tVhom It May Concern:
I am writing to inform you that the business known as THr BRassvonrs, which is still located at
289 Prado Road in San Luis Obispo, was sold on September 8, 2006, to Elizabethan Chamber-
lairr EnterprGesJnc. The new owners' names are Lee and Alexandra Chamberlain, and the
phone and fax numbers remain unchanged, B05-544-8841 and 805-544-5575, respectively.
The information you have on file for IxcA, Irsc. nBn THU BnlsswoRrs is therefore no longer
valid. I am respectfully requesting that you remove the names of \?trLraur.t INcatLs and INce, INc.
from this account as of September 8, 2006. As Elrzagurxaru Cururanrm-a;N Exrsnpnrsrs, Inc. is still
dcring business as Tnr Bnnssruconr<s, please continue ro send your annual invoice to them at 289
Prado Road, San Luis Obispo, CA 93401-
Please contact me if you have any questions. My husband, \K/illiam E. Ingalls, and I, Deborah
M. Ingalls, are the corporate officers of INca, Inc., and will remain so until its forrnal dissolu-
tion in the near future. I can be reached during normai business hours at 805-451-9006, by fax
at 805-466-4860, or by e-mail at deborah.ingalls@sbcglobal.net. Thank you in advance for your
pronlpt attention to this rnatter.
Sincerely
,*A [yn'141
0
q
t)
\)Deborah M. ingalls
n
n IEIIV\
I
t]
T
ENVIRONMENTALHEATTII
t--)
,-"- \
Gtyo[san lrirs oBrspo,rlilllllllllllllll
879 Morro Street. San Luis Obispo, CA 93401
June 30,2003
INGA Inc - DBA The Brass Works
289 Prado Road
San Luis Obispo, CA 93401
RE: Hazardous Waste Determination and Disposal
Dear Mr. Ingalls:
A routine Industrial Waste Inspection was conducted at your facility on 05/15/03. The
inspection documented that the solution in the aluminum brightener tank would have to
be tested for heavy metals to determine if it is a hazardous waste.
I returned to your facility on 05/16/03 and collected a sample which was submitted to
Creek Environmental Labs for analysis. I received the test results on06111103. The test
results show that the solution is in excess of your permit discharge limits for copper,
nickel, and zinc (see attached) and therefore must be disposed of as a hazardous waste by
a registered waste hauler on manifest.
Please have the aluminum brightener solution properly disposed of within 30 days of the
receipt of this letter. I will then re-inspect your facility in order to document proper
disposal of this waste.
Do not hesitate top contact me at 78I-7426 if you have any questions.
Thank you,
Daniel Goulet
Industri al Waste Inspector
City of San Luis Obispo
fffi Cry of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. 1Q
Teldcommunications Device for the Deaf (BO5) 781-7410 \3/
Chair-of-Cust
:
od
:
Ro-ad, Suite,C-5, San Luis Obispo; CA 934p1 www,cfeeHabs.corn lab@creeklabs.corn phone (805): Order #
Sl- = Soil/Solid
-Jun'11,2003 3 23PM CRF.T( LABS
)
No.6B32 P,, 2
i+
t'l
.)
CREEK ENVI RON MENTAL LABORATORIES, I NC.
141 SUBURBAN ROAD, SUITE C-5 . SAN tUlS OBISPO, CA 93401 ' (005) 54F9038 ' FAX (805) s454107
Page l,
BilI Ingalle
The Brass Works
289 Prado Road
San Luie ObisPo, CA
hog Numlrerr 03-C578?
Order: K1880
Froject; AI Brightener Tank
Received; 05/L6/0393401
SAIqPLE DESCRIPTION
========= = ============EE =======-r
A,L Erightener Tank
==========E;=
REPORT OF AI{AIJYTICAL REEUIJrS
SAMPLED BY
Danie1 Goulet
J--======
RESIIITT * R'Ir'
SAMFI,ED
pA'gB ;6 fIME IYIATRIX
==== =E================
os / LG / 03@1.3 : 31 AqueouE
=============F =========E========
UNITS METHOD AI{AI'YZED
ANAIJYTE WF
SilverilArsenic W
Barium
Berylllum
Cadmium
Nog Detected
5.2''''
Not Detected
Not Detected
Nots Deuected
Not Detected
9,3 a.it
Lr 200
Not Detected
Not Detected
9.3 .:tr:
L4 lrs'
Not DetecEed
Not, Detected
Not Detected
Not Detected
13, 000 ...
5 nglL
s t g/T'
0. s ng/L
0.1 fi\s/L
0 ,5 trE/I'
o. s w/r"
L mg/r"
2 W/L
O - 0O05mE/L
1 mg/L
1 Yng/L
2 II|fi/L
50 mEI/L
5 rits/L
s rrl.g/L
0.5 wlL
20 rrl1/I'
Cobalt
d"ntootu*#'{ coppe, O,O I
MercutY
Molvbderrurnh xt eiut T,E l
fu=="^u#Antimony
Selenium
ThaIlium
Vanadium
gf z"te 6,5
EPA
EPA
EPA
EFA
EPA
EPA
EPA
EPA
EPA
EPA
EFA
EPA
EPA
EPA
HPA
EP.A
EPA
501_0
50r0
601_0
6010
6010
60.ro
601_0
601_0
7470
6 010
6010
6010
6010
6010
601_0
60ro
5 010
05/2L/03
o5/2t/03
05/2L/03
oB/2L/a3
05/2L/03
os/2L/03
os/2t/03
os/2L/03
o5/22/03
05/2L/03
o5/2L/a3
05/2t/03
05/2L/03
os/2r-/03
oE/2L/03
05/2L/03
05/2t/03
* R.L- - ReporEing Limlt 'RESIIIJTS, reported ag ilNot Detedted'r meaDs not detected aboVe
CREEK EN\IIRONMENIIAL LABORATORIES
Lab
R^L.
6 ?RTNTEO oN &tcYctcD P^pER
Osborne
I tt i
!
rfi,
07123102
Brass Works
289 Prado Road
Sart Luis Obispo, CA 93401
Metals used in the production of a radiator
Nickel - Radiator neck is nickel plated
Tin and Lead - Solder
Brass - Cooling tubes
kon - Radiator bracket
Step #1 - Aluminum Brightener
Tank is filled with a solution to remove flux and to etch metal prior to painting. All of the
radiators and sub parts are subject to this treatment.
The aluminum brightener liquid is made with a 10% phosphoric acidlI}Tohydtofluoric
acid stock solution which is diluted with water, 8 parts water to 1 part stock solution.
The aluminum brightener is neutralized with sodium hydroxide prior to discharge to the
sewer. It is first transferred to a 55 gallon plastic trash can, neutralized, and then
discharged. This process is repeated until the entire tank has been emptied. The
aluminum brightener tank holds approximately 55 gallons'
Recent discharges : 1012610I, 0Il L9 /02, 05 124/02
Step #2 - Rise Tank
Tap water is used to rinse aluminum brightener off of radiators after step #1. The rinse
tank captures this rinse water. The liquid in the tank is neutralized with sodium hydroxide
prior to discharge to the sewer. It is first transferred to a 55 gallon plastic trash can,
neutralized, and then discharged. This process is repeated until the entire tank has been
emptied. The rinse tank holds approximately 55 gallons.
Recent discharges : I0 I 25 I 0I, 03 I 141 02, 05 I 241 02.
Step #3 - Test Tank
Used to test for leaks in finished radiators. Solution is water with a powdered dye which
turns the solution yellow. Radiators are immersed in the tank and a compressed air source
is attached to the neck of the radiator. The dye allows small air leaks to be easily seen.
'-') /-\
'''ir,
60 radiators a month are tested in the test tank. The solution is neutralized with sodium)il
hydroxide prior to discharge to the sewer. It is first transferred to a 55 gallon plastic trash
can, neutralized, andthen discharged. This process is repeated until the entire tank has
been emptied. The test tank holds approximately 150 gallons.
The test tank is emptied approximately every 60 days.
Solder Dross
Solder is purchased from Conquest Metals in Los Angeles. Solder dross generated by
Brass Works is picked up by Conquest Metals.
BRAS9'IORKS GHEMICAL DISCHARa-\ LOG
I
Date Chemical
PH Before
Neutralization
PH After
Neutralization Gallons'i';1,
Changed
By
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MEMORANDUM
TO: Tom Baasch, Building Official
FROM: Michael Smith, Hazardous Materials Inspector
DATE: February 27,199I
RE: The Brass Works - 289 Prado Road, Suite E
In an earlier memo dated February 25, 1991, regarding 289 Prado, Suite E, I had expressed my concern
over the application of flammable liquids associated with spraying operations which are proposed for
this facility. In talking with Greg Gouveia, the property owner and owner of the Brass Works, he has
indicated to *" that the use of flammable liquids for spraying will be discontinued and replaced with a
water-base type of paint.
Therefore, assuming that his intentions will be met at this new facility, special control measures or
related permits foripraying will not be required by the Fire Department. Furthermore, I recommend
that as a condition of issuing a final occupancy permit, a condition be included that prohibits the
spraying or application of flammable liquids within this facility.
If you have any questions, please call me at ex: 380.
John Dompke, F'ire Protection Engineer
Spencer Meyer, Plan Check Inspector
cc:
ms2604-2.mem
TO
4
FROM
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SIGNED
lSEPlEgBU o4s 468
PO|-Y PAK (s0 SETS) 1P168
NO REPTY NECESSARY REPLY REQUESTED - USE REVERSE SIDE