Addendum (PDF) — Paso Robles City Council, March 18, 2025 (part 6 of 12)

TC7484275.8s Page 215
J C PENNY STORE #2755 (Continued) S113148726
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000585632WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0125
Waste Quantity: 25
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20150916
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000585632WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0025
Waste Quantity: 5
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20150916
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000585632WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 787 of 1735 ends

TC7484275.8s Page 216
J C PENNY STORE #2755 (Continued) S113148726
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.025
Waste Quantity: 50
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20150916
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000585632WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.004
Waste Quantity: 8
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20150916
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000585632WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 141 - Off-specification, aged, or surplus inorganics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 788 of 1735 ends

TC7484275.8s Page 217
J C PENNY STORE #2755 (Continued) S113148726
Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.04
Waste Quantity: 80
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Additional Info:

Year: 2014
Gen EPA ID: CAL000322578
Shipment Date: 20141105
Creation Date: 4/1/2015 22:15:06
Receipt Date: 20141119
Manifest ID: 000626468WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0075
Waste Quantity: 15
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20141105
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000626468WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.004
Waste Quantity: 8
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 789 of 1735 ends

TC7484275.8s Page 218
J C PENNY STORE #2755 (Continued) S113148726
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20141105
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000626468WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.006
Waste Quantity: 12
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20141105
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000626468WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 141 - Off-specification, aged, or surplus inorganics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0125
Waste Quantity: 25
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 790 of 1735 ends

TC7484275.8s Page 219
J C PENNY STORE #2755 (Continued) S113148726
Shipment Date: 20141105
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000626468WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.004
Waste Quantity: 8
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20141105
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000626468WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.006
Waste Quantity: 12
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20141105
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000626468WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 791 of 1735 ends

TC7484275.8s Page 220
J C PENNY STORE #2755 (Continued) S113148726
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 141 - Off-specification, aged, or surplus inorganics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0125
Waste Quantity: 25
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20140520
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000586993WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: AZR000512343
Trans 2 Name: SRE TRANSPORTATION
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.005
Waste Quantity: 10
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20140520
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000586993WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: AZR000512343
Trans 2 Name: SRE TRANSPORTATION
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 792 of 1735 ends

TC7484275.8s Page 221
J C PENNY STORE #2755 (Continued) S113148726
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.003
Waste Quantity: 6
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20140520
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000586993WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: AZR000512343
Trans 2 Name: SRE TRANSPORTATION
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Additional Info:

Year: 2013
Gen EPA ID: CAL000322578
Shipment Date: 20131106
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000389539WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0065
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 793 of 1735 ends

TC7484275.8s Page 222
J C PENNY STORE #2755 (Continued) S113148726
Waste Quantity: 13
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20131106
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000389539WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 141 - Off-specification, aged, or surplus inorganics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.035
Waste Quantity: 70
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20131106
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000389539WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0065
Waste Quantity: 13
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 794 of 1735 ends

TC7484275.8s Page 223
J C PENNY STORE #2755 (Continued) S113148726
Shipment Date: 20131106
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000389539WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 141 - Off-specification, aged, or surplus inorganics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.035
Waste Quantity: 70
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20131106
Creation Date: 4/24/2014 22:14:56
Receipt Date: 20131116
Manifest ID: 000389539WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.006
Waste Quantity: 12
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20131106
Creation Date: 4/24/2014 22:14:56
Receipt Date: 20131116
Manifest ID: 000389539WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 795 of 1735 ends

TC7484275.8s Page 224
J C PENNY STORE #2755 (Continued) S113148726
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.01
Waste Quantity: 20
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20130604
Creation Date: 10/25/2013 22:15:23
Receipt Date: 20130624
Manifest ID: 005998869FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0025
Waste Quantity: 5
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20130604
Creation Date: 10/25/2013 22:15:23
Receipt Date: 20130624
Manifest ID: 005998869FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 796 of 1735 ends

TC7484275.8s Page 225
J C PENNY STORE #2755 (Continued) S113148726
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20130604
Creation Date: 10/25/2013 22:15:23
Receipt Date: 20130624
Manifest ID: 005998869FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20130604
Creation Date: 10/25/2013 22:15:23
Receipt Date: 20130624
Manifest ID: 005998869FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0285
Waste Quantity: 57
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 797 of 1735 ends

TC7484275.8s Page 226
J C PENNY STORE #2755 (Continued) S113148726
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Additional Info:

Year: 2012
Gen EPA ID: CAL000322578
Shipment Date: 20121227
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000489195WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 141 - Off-specification, aged, or surplus inorganics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.029
Waste Quantity: 58
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20121227
Creation Date: 6/27/2013 22:15:15
Receipt Date: 20130109
Manifest ID: 000489195WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0065
Waste Quantity: 13
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 798 of 1735 ends

TC7484275.8s Page 227
J C PENNY STORE #2755 (Continued) S113148726
Shipment Date: 20121227
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000489195WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.005
Waste Quantity: 10
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20121227
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000489195WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC-TS SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0065
Waste Quantity: 13
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20120717
Creation Date: 12/24/2012 22:15:22
Receipt Date: 20120803
Manifest ID: 005742038FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: CAD982523433
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 799 of 1735 ends

TC7484275.8s Page 228
J C PENNY STORE #2755 (Continued) S113148726
Trans 2 Name: DILLARD ENVIRONMENTAL
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0055
Waste Quantity: 11
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20120717
Creation Date: 12/24/2012 22:15:22
Receipt Date: 20120803
Manifest ID: 005742038FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: CAD982523433
Trans 2 Name: DILLARD ENVIRONMENTAL
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.024
Waste Quantity: 48
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20120717
Creation Date: 12/24/2012 22:15:22
Receipt Date: 20120803
Manifest ID: 005742038FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: CAD982523433
Trans 2 Name: DILLARD ENVIRONMENTAL
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: D001
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 800 of 1735 ends

TC7484275.8s Page 229
J C PENNY STORE #2755 (Continued) S113148726
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.009
Waste Quantity: 18
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20120717
Creation Date: 12/24/2012 22:15:22
Receipt Date: 20120803
Manifest ID: 005742038FLE
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: CAD982523433
Trans 2 Name: DILLARD ENVIRONMENTAL
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0135
Waste Quantity: 27
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20120117
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000460240WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: OKD981588791
Trans 2 Name: TRIAD TRANSPORT INC
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: Not reported
Waste Quantity: Not reported
Quantity Unit: Not reported
Additional Code 1: Not reported
Additional Code 2: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 801 of 1735 ends

TC7484275.8s Page 230
J C PENNY STORE #2755 (Continued) S113148726
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20120117
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000460240WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: OKD981588791
Trans 2 Name: TRIAD TRANSPORT INC
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: Not reported
Meth Code: - Not reported
Quantity Tons: 0.0085
Waste Quantity: 17
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Additional Info:

Year: 2011
Gen EPA ID: CAL000322578
Shipment Date: 20111025
Creation Date: 4/11/2012 20:30:30
Receipt Date: 20111105
Manifest ID: 000442928WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 331 - Off-specification, aged, or surplus organics RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.004
Waste Quantity: 8
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 802 of 1735 ends

TC7484275.8s Page 231
J C PENNY STORE #2755 (Continued) S113148726
Shipment Date: 20110801
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000390445WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.022
Waste Quantity: 44
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110801
Creation Date: 11/20/2012 22:15:16
Receipt Date: 20110811
Manifest ID: 000390445WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 214 - Unspecified solvent mixture RCRA Code: D001
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110801
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000390445WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 803 of 1735 ends

TC7484275.8s Page 232
J C PENNY STORE #2755 (Continued) S113148726
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: Not reported
Waste Quantity: Not reported
Quantity Unit: Not reported
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110801
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000390445WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.016
Waste Quantity: 32
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110801
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000390445WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 804 of 1735 ends

TC7484275.8s Page 233
J C PENNY STORE #2755 (Continued) S113148726
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110801
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000390445WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110801
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000390445WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 805 of 1735 ends

TC7484275.8s Page 234
J C PENNY STORE #2755 (Continued) S113148726
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110511
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000367387WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: CAD982030173
Trans 2 Name: ECOLOGY CONTROL IND
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.002
Waste Quantity: 4
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20110511
Creation Date: Not reported
Receipt Date: Not reported
Manifest ID: 000367387WAS
Trans EPA ID: IND058484114
Trans Name: HERITAGE TRANSPORT LLC / SIGNAL HILL
Trans 2 EPA ID: CAD982030173
Trans 2 Name: ECOLOGY CONTROL IND
TSDF EPA ID: AZD081705402
Trans Name: HERITAGE ENVIRONMENTAL SERVICES
TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: - Not reported
RCRA Code: Not reported
Meth Code: H141 - Storage, Bulking, And/Or Transfer Off Site--No Treatment/Reovery (H010-H129) Or (H131-H135)
Quantity Tons: 0.0105
Waste Quantity: 21
Quantity Unit: P
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 806 of 1735 ends

TC7484275.8s Page 235
E38 PANDA EXPRESS #1070 CUPA Listings S130390363
90 NIBLICK RD CERS N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
702 ft.

Focus Map:
5 0.001 mi.
3 ft. Site 6 of 7 in cluster E
CUPA SAN LUIS OBISPO:

Name: PANDA EXPRESS #1070
Address: 90 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0016331
Program Element Code: 0726
Program Element: HAZMAT DISCLOSURE - 1-4 HAZARDOUS MATERIALS Record Id: PR0021903
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: Not reported
Longitude: Not reported
CERS:

Name: PANDA EXPRESS #1070
Address: 90 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 701317
CERS ID: 10928599
CERS Description: Chemical Storage Facilities
Affiliation:

Affiliation Type Desc: Identification Signer
Entity Name: Lauren Rios
Entity Title: Utilities Coordinator
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Document Preparer
Entity Name: Diana M. Shinn
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Environmental Contact
Entity Name: Melissa Martinez
Entity Title: Not reported
Affiliation Address: 1683 Walnut Grove Ave.

Affiliation City: Rosemead
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 91770
Affiliation Phone: ,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 807 of 1735 ends

TC7484275.8s Page 236
PANDA EXPRESS #1070 (Continued) S130390363
Affiliation Type Desc: Operator
Entity Name: Jerry Pung
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (626) 201-2846,
Affiliation Type Desc: Parent Corporation
Entity Name: Panda Restaurant Group
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: CUPA District
Entity Name: SLO County Env Health
Entity Title: Not reported
Affiliation Address: 2156 Sierra Way
Affiliation City: San Luis Obispo
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93406
Affiliation Phone: (805) 781-5544,
Affiliation Type Desc: Facility Mailing Address
Entity Name: Mailing Address
Entity Title: Not reported
Affiliation Address: Panda Restaurant Group, Attn: Utilities Dept, 1683 WALNUT GROVE AVE.

Affiliation City: Rosemead
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 91770
Affiliation Phone: ,
Affiliation Type Desc: Legal Owner
Entity Name: Panda Restaurant Group, Inc.

Entity Title: Not reported
Affiliation Address: 1683 Walnut Grove Ave
Affiliation City: Rosemead
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 91770
Affiliation Phone: (626) 799-9898,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 808 of 1735 ends

TC7484275.8s Page 237
E39 DOUGLAS J HARRINGTON DDS A PROFESSIONAL DENTAL COR 1024871418 RCRA NonGen / NLR 118 NIBLICK RD CAL000440062
< 1/8 PASO ROBLES, CA 93446
Actual:
702 ft.

Focus Map:
5 0.001 mi.
3 ft. Site 7 of 7 in cluster E
RCRA Listings:

Date Form Received by Agency: 20181023
Handler Name: Douglas J Harrington Dds A Professional Dental Corporatic Handler Address: 118 NIBLICK RD
Handler City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAL000440062
Contact Name: WENDI HOBBS
Contact Address: 118 NIBLICK RD
Contact City,State,Zip: PASO ROBLES, CA 93446
Contact Telephone: 805-226-8508
Contact Fax: 805-226-8576
Contact Email: [email protected]
Contact Title: Not reported
EPA Region: 09
Land Type: Not reported
Federal Waste Generator Description: Not a generator, verified Non-Notifier: Not reported
Biennial Report Cycle: Not reported
Accessibility: Not reported
Active Site Indicator: Handler Activities
State District Owner: Not reported
State District: Not reported
Mailing Address: 118 NIBLICK RD
Mailing City,State,Zip: PASO ROBLES, CA 93446
Owner Name: Douglas J Harrington
Owner Type: Other
Operator Name: Wendi Hobbs
Operator Type: Other
Short-Term Generator Activity: No
Importer Activity: No
Mixed Waste Generator: No
Transporter Activity: No
Transfer Facility Activity: No
Recycler Activity with Storage: No
Small Quantity On-Site Burner Exemption: No
Smelting Melting and Refining Furnace Exemption: No
Underground Injection Control: No
Off-Site Waste Receipt: No
Universal Waste Indicator: Yes
Universal Waste Destination Facility: Yes
Federal Universal Waste: No
Active Site State-Reg Handler: ---
Federal Facility Indicator: Not reported
Hazardous Secondary Material Indicator: N
Sub-Part K Indicator: Not reported
2018 GPRA Permit Baseline: Not on the Baseline
2018 GPRA Renewals Baseline: Not on the Baseline
202 GPRA Corrective Action Baseline: No
Subject to Corrective Action Universe: No
Non-TSDFs Where RCRA CA has Been Imposed Universe: No
Corrective Action Priority Ranking: No NCAPS ranking
Environmental Control Indicator: No
Institutional Control Indicator: No
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 809 of 1735 ends

TC7484275.8s Page 238
DOUGLAS J HARRINGTON DDS A PROFESSIONAL DENTAL CORPORATIC (Continued) 1024871418 Human Exposure Controls Indicator: N/A
Groundwater Controls Indicator: N/A
Significant Non-Complier Universe: No
Unaddressed Significant Non-Complier Universe: No
Addressed Significant Non-Complier Universe: No
Significant Non-Complier With a Compliance Schedule Universe: No Financial Assurance Required: Not reported
Handler Date of Last Change: 20181120
Recognized Trader-Importer: No
Recognized Trader-Exporter: No
Importer of Spent Lead Acid Batteries: No
Exporter of Spent Lead Acid Batteries: No
Recycler Activity Without Storage: No
Manifest Broker: No
Sub-Part P Indicator: No
Handler - Owner Operator:

Owner/Operator Indicator: Owner
Owner/Operator Name: DOUGLAS J HARRINGTON
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 118 NIBLICK RD
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446
Owner/Operator Telephone: 805-226-8508
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Operator
Owner/Operator Name: WENDI HOBBS
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 118 NIBLICK RD
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446
Owner/Operator Telephone: 805-226-8508
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Historic Generators:

Receive Date: 20181023
Handler Name: DOUGLAS J HARRINGTON DDS A PROFESSIONAL DENTAL CORPORATIC Federal Waste Generator Description: Not a generator, verified State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: Yes
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 810 of 1735 ends

TC7484275.8s Page 239
40 ABL MADADI RCRA NonGen / NLR 1024776870
North 102 SPRING STREET CAC002996807
< 1/8 PASO ROBLES, CA 93446
Actual:
765 ft.

Focus Map:
1 0.002 mi.
8 ft.

RCRA Listings:

Date Form Received by Agency: 20190116
Handler Name: Abl Madadi
Handler Address: 102 SPRING STREET
Handler City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAC002996807
Contact Name: ABL MADADI
Contact Address: 5950 ENCINO ROAD #2
Contact City,State,Zip: GOLETA, CA 93117
Contact Telephone: 805-698-5335
Contact Fax: Not reported
Contact Email: [email protected]
Contact Title: Not reported
EPA Region: 09
Land Type: Not reported
Federal Waste Generator Description: Not a generator, verified Non-Notifier: Not reported
Biennial Report Cycle: Not reported
Accessibility: Not reported
Active Site Indicator: Handler Activities
State District Owner: Not reported
State District: Not reported
Mailing Address: 5950 ENCINO ROAD #2
Mailing City,State,Zip: GOLETA, CA 93117
Owner Name: Abl Madadi
Owner Type: Other
Operator Name: Abl Madadi
Operator Type: Other
Short-Term Generator Activity: No
Importer Activity: No
Mixed Waste Generator: No
Transporter Activity: No
Transfer Facility Activity: No
Recycler Activity with Storage: No
Small Quantity On-Site Burner Exemption: No
Smelting Melting and Refining Furnace Exemption: No
Underground Injection Control: No
Off-Site Waste Receipt: No
Universal Waste Indicator: Yes
DOUGLAS J HARRINGTON DDS A PROFESSIONAL DENTAL CORPORATIC (Continued) 1024871418 List of NAICS Codes and Descriptions:

NAICS Code: 621210
NAICS Description: OFFICES OF DENTISTS
Facility Has Received Notices of Violations:

Violations: No Violations Found
Evaluation Action Summary:

Evaluations: No Evaluations Found
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 811 of 1735 ends

TC7484275.8s Page 240
ABL MADADI (Continued) 1024776870
Universal Waste Destination Facility: Yes
Federal Universal Waste: No
Active Site State-Reg Handler: ---
Federal Facility Indicator: Not reported
Hazardous Secondary Material Indicator: N
Sub-Part K Indicator: Not reported
2018 GPRA Permit Baseline: Not on the Baseline
2018 GPRA Renewals Baseline: Not on the Baseline
202 GPRA Corrective Action Baseline: No
Subject to Corrective Action Universe: No
Non-TSDFs Where RCRA CA has Been Imposed Universe: No
Corrective Action Priority Ranking: No NCAPS ranking
Environmental Control Indicator: No
Institutional Control Indicator: No
Human Exposure Controls Indicator: N/A
Groundwater Controls Indicator: N/A
Significant Non-Complier Universe: No
Unaddressed Significant Non-Complier Universe: No
Addressed Significant Non-Complier Universe: No
Significant Non-Complier With a Compliance Schedule Universe: No Financial Assurance Required: Not reported
Handler Date of Last Change: 20190222
Recognized Trader-Importer: No
Recognized Trader-Exporter: No
Importer of Spent Lead Acid Batteries: No
Exporter of Spent Lead Acid Batteries: No
Recycler Activity Without Storage: No
Manifest Broker: No
Sub-Part P Indicator: No
Handler - Owner Operator:

Owner/Operator Indicator: Owner
Owner/Operator Name: ABL MADADI
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 5950 ENCINO ROAD #2
Owner/Operator City,State,Zip: GOLETA, CA 93117
Owner/Operator Telephone: 805-698-5335
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Operator
Owner/Operator Name: ABL MADADI
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 5950 ENCINO ROAD #2
Owner/Operator City,State,Zip: GOLETA, CA 93117
Owner/Operator Telephone: 805-698-5335
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 812 of 1735 ends

TC7484275.8s Page 241
D41 CVS PHARMACY NO 9925 RCRA-LQG 1016168136
North 187 NIBLICK RD FINDS CAR000240366
< 1/8 PASO ROBLES, CA 93447 ECHO
Actual:
709 ft.

Focus Map:
5 0.004 mi.
19 ft. Site 5 of 6 in cluster D
RCRA Listings:

Date Form Received by Agency: 20220228
Handler Name: Cvs Pharmacy #9925
Handler Address: NIBLICK RD
Handler City,State,Zip: PASO ROBLES, CA 93447
EPA ID: CAR000240366
Contact Name: NICOLE WILKINSON
Contact Address: CVS DR 2340
Contact City,State,Zip: WOONSOCKET, RI 02895
Contact Telephone: 401-770-7132
Contact Fax: 401-652-1901
Contact Email: [email protected]
Contact Title: SENIOR DIRECTOR, CORPORATE ENVIRONMENTAL HEAL EPA Region: 09
Land Type: Private
Federal Waste Generator Description: Large Quantity Generator Non-Notifier: Not reported
Biennial Report Cycle: 2021
Accessibility: Not reported
Active Site Indicator: Handler Activities
State District Owner: Not reported
State District: Not reported
Mailing Address: CVS DR 2340
Mailing City,State,Zip: WOONSOCKET, RI 02895
Owner Name: Longs Drug Stores California, L.L.C
ABL MADADI (Continued) 1024776870
Historic Generators:

Receive Date: 20190116
Handler Name: ABL MADADI
Federal Waste Generator Description: Not a generator, verified State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: Yes
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
List of NAICS Codes and Descriptions:

NAICS Code: 56299
NAICS Description: ALL OTHER WASTE MANAGEMENT SERVICES
Facility Has Received Notices of Violations:

Violations: No Violations Found
Evaluation Action Summary:

Evaluations: No Evaluations Found
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 813 of 1735 ends

TC7484275.8s Page 242
CVS PHARMACY NO 9925 (Continued) 1016168136
Owner Type: Private
Operator Name: Longs Drug Stores California, L.L.C.

Operator Type: Private
Short-Term Generator Activity: No
Importer Activity: No
Mixed Waste Generator: No
Transporter Activity: No
Transfer Facility Activity: No
Recycler Activity with Storage: No
Small Quantity On-Site Burner Exemption: No
Smelting Melting and Refining Furnace Exemption: No
Underground Injection Control: No
Off-Site Waste Receipt: No
Universal Waste Indicator: No
Universal Waste Destination Facility: No
Federal Universal Waste: No
Active Site State-Reg Handler: ---
Federal Facility Indicator: Not reported
Hazardous Secondary Material Indicator: N
Sub-Part K Indicator: Not reported
2018 GPRA Permit Baseline: Not on the Baseline
2018 GPRA Renewals Baseline: Not on the Baseline
202 GPRA Corrective Action Baseline: No
Subject to Corrective Action Universe: No
Non-TSDFs Where RCRA CA has Been Imposed Universe: No
Corrective Action Priority Ranking: No NCAPS ranking
Environmental Control Indicator: No
Institutional Control Indicator: No
Human Exposure Controls Indicator: N/A
Groundwater Controls Indicator: N/A
Significant Non-Complier Universe: No
Unaddressed Significant Non-Complier Universe: No
Addressed Significant Non-Complier Universe: No
Significant Non-Complier With a Compliance Schedule Universe: No Financial Assurance Required: Not reported
Handler Date of Last Change: 20220630
Recognized Trader-Importer: No
Recognized Trader-Exporter: No
Importer of Spent Lead Acid Batteries: No
Exporter of Spent Lead Acid Batteries: No
Recycler Activity Without Storage: No
Manifest Broker: No
Sub-Part P Indicator: No
Biennial: List of Years
Year: 2021
Click Here for Biennial Reporting System Data:

Year: 2015
Click Here for Biennial Reporting System Data:

Hazardous Waste Summary:

Waste Code: D001
Waste Description: Ignitable Waste
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 814 of 1735 ends

TC7484275.8s Page 243
CVS PHARMACY NO 9925 (Continued) 1016168136
Waste Code: D002
Waste Description: Corrosive Waste
Waste Code: D003
Waste Description: Reactive Waste
Waste Code: D005
Waste Description: Barium
Waste Code: D007
Waste Description: Chromium
Waste Code: D009
Waste Description: Mercury
Waste Code: D010
Waste Description: Selenium
Waste Code: D011
Waste Description: Silver
Waste Code: D024
Waste Description: M-Cresol
Waste Code: P001
Waste Description: 2h-1-Benzopyran-2-One, 4-Hydroxy-3-(3-Oxo-1-Phenylbutyl)-, & Salts, When Present At Concentrations Greater Than 0.3% (Or) Warfarin, & Salts, When Present At Concentrations Greater Than 0.3% Waste Code: P042
Waste Description: 1,2-Benzenediol, 4-[1-Hydroxy-2-(Methylamino)Ethyl]-, (R)- (Or) Epinephrine
Waste Code: P075
Waste Description: Nicotine, & Salts (Or) Pyridine, 3-(1-Methyl-2-Pyrrolidinyl)-,(S)-, & Salts
Waste Code: P081
Waste Description: 1,2,3-Propanetriol, Trinitrate (R) (Or) Nitroglycerine (R) Waste Code: U002
Waste Description: 2-Propanone (I) (Or) Acetone (I)
Waste Code: U034
Waste Description: Acetaldehyde, Trichloro- (Or) Chloral Waste Code: U129
Waste Description: Cyclohexane, 1,2,3,4,5,6-Hexachloro-, (1alpha, 2alpha, 3beta, 4alpha, 5alpha, 6beta)- (Or) Lindane
Waste Code: U165
Waste Description: Naphthalene
Waste Code: U188
Waste Description: Phenol
Waste Code: U205
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 815 of 1735 ends

TC7484275.8s Page 244
CVS PHARMACY NO 9925 (Continued) 1016168136
Waste Description: Selenium Sulfide (Or) Selenium Sulfide Ses2 (R,T) Handler - Owner Operator:

Owner/Operator Indicator: Operator
Owner/Operator Name: LONGS DRUG STORES CALIFORNIA, L.L.C.

Legal Status: Private
Date Became Current: 20081022
Date Ended Current: Not reported
Owner/Operator Address: Not reported
Owner/Operator City,State,Zip: Not reported
Owner/Operator Telephone: Not reported
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Owner
Owner/Operator Name: LONGS DRUG STORES CALIFORNIA LLC
Legal Status: Private
Date Became Current: 20091211
Date Ended Current: Not reported
Owner/Operator Address: ONE CVS DR
Owner/Operator City,State,Zip: WOONSOCKET, RI 02895
Owner/Operator Telephone: 401-765-1500
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Operator
Owner/Operator Name: LONGS DRUG STORES CALIFORNIA, L.L.C.

Legal Status: Private
Date Became Current: 20081022
Date Ended Current: Not reported
Owner/Operator Address: 1 CVS DR 2340
Owner/Operator City,State,Zip: WOONSOCKET, RI 02895
Owner/Operator Telephone: 401-765-1500
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: [email protected] Owner/Operator Indicator: Owner
Owner/Operator Name: LONGS DRUG STORES CALIFORNIA, L.L.C Legal Status: Private
Date Became Current: 20091211
Date Ended Current: Not reported
Owner/Operator Address: 1 CVS DR
Owner/Operator City,State,Zip: WOONSOCKET, RI 02895
Owner/Operator Telephone: 401-765-1500
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: [email protected] Owner/Operator Indicator: Owner
Owner/Operator Name: LONGS DRUG STORES CALIFORNIA, L.L.C Legal Status: Private
Date Became Current: 20091211
Date Ended Current: Not reported
Owner/Operator Address: 1 CVS DR
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 816 of 1735 ends

TC7484275.8s Page 245
CVS PHARMACY NO 9925 (Continued) 1016168136
Owner/Operator City,State,Zip: WOONSOCKET, RI 02895
Owner/Operator Telephone: Not reported
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Operator
Owner/Operator Name: LONGS DRUG STORES CALIFORNIA LLC
Legal Status: Private
Date Became Current: 20081022
Date Ended Current: Not reported
Owner/Operator Address: Not reported
Owner/Operator City,State,Zip: Not reported
Owner/Operator Telephone: Not reported
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Historic Generators:

Receive Date: 20160831
Handler Name: CVS PHARMACY #9925
Federal Waste Generator Description: Large Quantity Generator State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: No
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
Receive Date: 20220228
Handler Name: CVS PHARMACY #9925
Federal Waste Generator Description: Large Quantity Generator State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: Yes
Non Storage Recycler Activity: No
Electronic Manifest Broker: No
Receive Date: 20130619
Handler Name: CVS PHARMACY NO 9925
Federal Waste Generator Description: Large Quantity Generator State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: No
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 817 of 1735 ends

TC7484275.8s Page 246
CVS PHARMACY NO 9925 (Continued) 1016168136
List of NAICS Codes and Descriptions:

NAICS Code: 44611
NAICS Description: PHARMACIES AND DRUG STORES
Has the Facility Received Notices of Violations:

Found Violation: No
Agency Which Determined Violation: Not reported
Violation Short Description: Not reported
Date Violation was Determined: Not reported
Actual Return to Compliance Date: Not reported
Return to Compliance Qualifier: Not reported
Violation Responsible Agency: Not reported
Scheduled Compliance Date: Not reported
Enforcement Identifier: Not reported
Date of Enforcement Action: Not reported
Enforcement Responsible Agency: Not reported
Enforcement Docket Number: Not reported
Enforcement Attorney: Not reported
Corrective Action Component: Not reported
Appeal Initiated Date: Not reported
Appeal Resolution Date: Not reported
Disposition Status Date: Not reported
Disposition Status: Not reported
Disposition Status Description: Not reported
Consent/Final Order Sequence Number: Not reported
Consent/Final Order Respondent Name: Not reported
Consent/Final Order Lead Agency: Not reported
Enforcement Type: Not reported
Enforcement Responsible Person: Not reported
Enforcement Responsible Sub-Organization: Not reported
SEP Sequence Number: Not reported
SEP Expenditure Amount: Not reported
SEP Scheduled Completion Date: Not reported
SEP Actual Date: Not reported
SEP Defaulted Date: Not reported
SEP Type: Not reported
SEP Type Description: Not reported
Proposed Amount: Not reported
Final Monetary Amount: Not reported
Paid Amount: Not reported
Final Count: Not reported
Final Amount: Not reported
Found Violation: No
Agency Which Determined Violation: Not reported
Violation Short Description: Not reported
Date Violation was Determined: Not reported
Actual Return to Compliance Date: Not reported
Return to Compliance Qualifier: Not reported
Violation Responsible Agency: Not reported
Scheduled Compliance Date: Not reported
Enforcement Identifier: Not reported
Date of Enforcement Action: Not reported
Enforcement Responsible Agency: Not reported
Enforcement Docket Number: Not reported
Enforcement Attorney: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 818 of 1735 ends

TC7484275.8s Page 247
CVS PHARMACY NO 9925 (Continued) 1016168136
Corrective Action Component: Not reported
Appeal Initiated Date: Not reported
Appeal Resolution Date: Not reported
Disposition Status Date: Not reported
Disposition Status: Not reported
Disposition Status Description: Not reported
Consent/Final Order Sequence Number: Not reported
Consent/Final Order Respondent Name: Not reported
Consent/Final Order Lead Agency: Not reported
Enforcement Type: Not reported
Enforcement Responsible Person: Not reported
Enforcement Responsible Sub-Organization: Not reported
SEP Sequence Number: Not reported
SEP Expenditure Amount: Not reported
SEP Scheduled Completion Date: Not reported
SEP Actual Date: Not reported
SEP Defaulted Date: Not reported
SEP Type: Not reported
SEP Type Description: Not reported
Proposed Amount: Not reported
Final Monetary Amount: Not reported
Paid Amount: Not reported
Final Count: Not reported
Final Amount: Not reported
Found Violation: No
Agency Which Determined Violation: Not reported
Violation Short Description: Not reported
Date Violation was Determined: Not reported
Actual Return to Compliance Date: Not reported
Return to Compliance Qualifier: Not reported
Violation Responsible Agency: Not reported
Scheduled Compliance Date: Not reported
Enforcement Identifier: Not reported
Date of Enforcement Action: Not reported
Enforcement Responsible Agency: Not reported
Enforcement Docket Number: Not reported
Enforcement Attorney: Not reported
Corrective Action Component: Not reported
Appeal Initiated Date: Not reported
Appeal Resolution Date: Not reported
Disposition Status Date: Not reported
Disposition Status: Not reported
Disposition Status Description: Not reported
Consent/Final Order Sequence Number: Not reported
Consent/Final Order Respondent Name: Not reported
Consent/Final Order Lead Agency: Not reported
Enforcement Type: Not reported
Enforcement Responsible Person: Not reported
Enforcement Responsible Sub-Organization: Not reported
SEP Sequence Number: Not reported
SEP Expenditure Amount: Not reported
SEP Scheduled Completion Date: Not reported
SEP Actual Date: Not reported
SEP Defaulted Date: Not reported
SEP Type: Not reported
SEP Type Description: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 819 of 1735 ends

TC7484275.8s Page 248
CVS PHARMACY NO 9925 (Continued) 1016168136
Proposed Amount: Not reported
Final Monetary Amount: Not reported
Paid Amount: Not reported
Final Count: Not reported
Final Amount: Not reported
Evaluation Action Summary:

Evaluation Date: 20150723
Evaluation Responsible Agency: State
Found Violation: No
Evaluation Type Description: COMPLIANCE EVALUATION INSPECTION ON-SITE Evaluation Responsible Person Identifier: Not reported
Evaluation Responsible Sub-Organization: Not reported
Actual Return to Compliance Date: Not reported
Scheduled Compliance Date: Not reported
Date of Request: Not reported
Date Response Received: Not reported
Request Agency: Not reported
Former Citation: Not reported
Evaluation Date: 20140707
Evaluation Responsible Agency: State
Found Violation: No
Evaluation Type Description: COMPLIANCE EVALUATION INSPECTION ON-SITE Evaluation Responsible Person Identifier: Not reported
Evaluation Responsible Sub-Organization: Not reported
Actual Return to Compliance Date: Not reported
Scheduled Compliance Date: Not reported
Date of Request: Not reported
Date Response Received: Not reported
Request Agency: Not reported
Former Citation: Not reported
Evaluation Date: 20210702
Evaluation Responsible Agency: State
Found Violation: No
Evaluation Type Description: COMPLIANCE EVALUATION INSPECTION ON-SITE Evaluation Responsible Person Identifier: CUPA
Evaluation Responsible Sub-Organization: Not reported
Actual Return to Compliance Date: Not reported
Scheduled Compliance Date: Not reported
Date of Request: Not reported
Date Response Received: Not reported
Request Agency: Not reported
Former Citation: Not reported
FINDS:

Registry ID: 110055522974
Click Here for FRS Facility Detail Report:

Environmental Interest/Information System:

The California Environmental Reporting System (CERS) is a statewide web-based user and information exchange system to support over 140,000 regulated businesses and over 130 local agencies in electronically collecting and reporting significant hazardous materials, hazardous Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 820 of 1735 ends

TC7484275.8s Page 249
D42 CVS PHARMACY #9925 CERS HAZ WASTE S103637956
North 187 NIBLICK RD CUPA Listings N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
709 ft.

Focus Map:
5 0.004 mi.
19 ft. Site 6 of 6 in cluster D
CERS HAZ WASTE:

Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 23391
CERS ID: 10438747
CERS Description: Hazardous Waste Generator
Violations:

Site ID: 23391
Site Name: CVS Pharmacy #9925
Violation Date: 07-07-2014
Citation: HSC 6.95 25508(d) - California Health and Safety Code, Chapter 6.95, Section(s) 25508(d)
Violation Description: Failure to complete and/or electronically submit a business plan when storing/handling a hazardous material at or above reportable quantities.

CVS PHARMACY NO 9925 (Continued) 1016168136
waste and compliance and enforcement data as mandated by California law. Under oversight by Cal/EPA, certified local governing agencies (Unified Program Agencies - UPAs) consolidate, coordinate and provide consistent regulatory activities for six state and federal environmental programs.

All generators and treatment, storage, and disposal (TSD) facilities who handle hazardous waste are required to report to the EPA Administrator at least once every two years. The data collected is used to create the National Biennial Resource Conservation and Recovery Act (RCRA) Hazardous Waste Report. This data is processed within the RCRA Information (RCRAInfo) database
The California Environmental Protection Agency (CalEPA) has recently implemented a new data warehouse system (nSite). This data warehouse combines and merges facility and site information from five different systems managed within CalEPA. The five systems are: California Environmental Reporting System (CERS),EnviroStor, GeoTracker, California Integrated Water Quality System (CIWQS), andToxic Release Inventory (TRI).

The Resource Conservation and Recovery Act Information System (RCRAInfo) is EPA’s comprehensive information system in support of the Resource Conservation and Recovery Act (RCRA) of 1976 and the Hazardous and Solid Waste Amendments (HSWA) of 1984. It tracks many types of information about generators, transporters, treaters, storers, and disposers of hazardous waste.

Click this hyperlink while viewing on your computer to access additional FINDS: detail in the EDR Site Report.

ECHO:

Envid: 1016168136
Registry ID: 110055522974
DFR URL: http://echo.epa.gov/detailed-facility-report?fid=110055522974 Name: CVS PHARMACY NO 9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93447
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 821 of 1735 ends

TC7484275.8s Page 250
CVS PHARMACY #9925 (Continued) S103637956
Violation Notes: Returned to compliance on 07/17/2014.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HMRRP
Violation Source: CERS,
Evaluation:

Eval General Type: Compliance Evaluation Inspection
Eval Date: 04-01-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked N/A not addressed during inspection. In light of COVID19, CUPA Inspector signing for Cindy Aghazadeh.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-03-2013
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-23-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-23-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HWLQG
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-18-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 822 of 1735 ends

TC7484275.8s Page 251
CVS PHARMACY #9925 (Continued) S103637956
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HWLQG
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-03-2013
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-07-2014
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-07-2014
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HWLQG
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 07-17-2014
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 823 of 1735 ends

TC7484275.8s Page 252
CVS PHARMACY #9925 (Continued) S103637956
Eval General Type: Compliance Evaluation Inspection
Eval Date: 08-11-2022
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked N/A not addressed during inspection. In light of COVID19, CUPA Inspector signing for Cindy Aghazadeh.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 03-22-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 03-22-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-18-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked N/A not addressed during inspection. In light of COIVD19, CUPA Inspector signing for Cynthia Aghazadeh.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-07-2014
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-23-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Facility does not handle hazardous materials above reporting thresholds.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 824 of 1735 ends

TC7484275.8s Page 253
CVS PHARMACY #9925 (Continued) S103637956
Eval General Type: Compliance Evaluation Inspection
Eval Date: 08-11-2022
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 03-30-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 03-30-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked Na not reviewed during inspection. Please send me a copy of the last hazardous waste pick up manifest (March 2018) at [email protected] or fax to (805)781-4211 Attn Mattie.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 04-01-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Update Business phone number on Business Owner Operator form of Hazardous Materials Business Plan using CERS website. Current phone number is for the pharmacy. Items marked N/A not addressed during inspection.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Coordinates:

Site ID: 23391
Facility Name: CVS Pharmacy #9925
Env Int Type Code: HWG
Program ID: 10438747
Coord Name: Not reported
Ref Point Type Desc: Center of a facility or station.,
Latitude: 35.616210
Longitude: -120.682100
Affiliation:

Affiliation Type Desc: Property Owner
Entity Name: Longs Drug Stores California, L.L.C.

Entity Title: Not reported
Affiliation Address: One CVS Drive
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 825 of 1735 ends

TC7484275.8s Page 254
CVS PHARMACY #9925 (Continued) S103637956
Affiliation City: Woonsocket
Affiliation State: RI
Affiliation Country: United States
Affiliation Zip: 02895
Affiliation Phone: (401) 765-1500,
Affiliation Type Desc: Facility Mailing Address
Entity Name: Mailing Address
Entity Title: Not reported
Affiliation Address: CVS Health Attn: Erin Chilinski, CS Legal, One CVS Drive MC 1160 Affiliation City: Woonsocket
Affiliation State: RI
Affiliation Country: Not reported
Affiliation Zip: 02895
Affiliation Phone: ,
Affiliation Type Desc: CUPA District
Entity Name: SLO County Env Health
Entity Title: Not reported
Affiliation Address: 2156 Sierra Way
Affiliation City: San Luis Obispo
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93406
Affiliation Phone: (805) 781-5544,
Affiliation Type Desc: Identification Signer
Entity Name: Crystalyn Dogui-is, Agent for Longs Drug Stores California, L.L.C.

Entity Title: Regulatory Compliance Specialist, 3E
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Operator
Entity Name: Longs Drug Stores California, L.L.C.

Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (401) 765-1500,
Affiliation Type Desc: Parent Corporation
Entity Name: CVS Health
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Document Preparer
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 826 of 1735 ends

TC7484275.8s Page 255
CVS PHARMACY #9925 (Continued) S103637956
Entity Name: Crystalyn Dogui-is, Agent for Longs Drug Stores California, L.L.C.

Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Environmental Contact
Entity Name: 3E, Regulatory Services/CVS
Entity Title: Not reported
Affiliation Address: 3207 Grey Hawk Ct., Ste. 200
Affiliation City: Carlsbad
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 92010
Affiliation Phone: ,
Affiliation Type Desc: Legal Owner
Entity Name: Longs Drug Stores California, L.L.C.

Entity Title: Not reported
Affiliation Address: One CVS Drive
Affiliation City: Woonsocket
Affiliation State: RI
Affiliation Country: United States
Affiliation Zip: 02895
Affiliation Phone: (401) 765-1500,
Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 23391
CERS ID: 10438747
CERS Description: RCRA LQ HW Generator
Violations:

Violation Notes: Returned to compliance on 07/17/2014.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HMRRP
Violation Source: CERS,
Evaluation:

Eval General Type: Compliance Evaluation Inspection
Eval Date: 04-01-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 827 of 1735 ends

TC7484275.8s Page 256
CVS PHARMACY #9925 (Continued) S103637956
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked N/A not addressed during inspection. In light of COVID19, CUPA Inspector signing for Cindy Aghazadeh.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-03-2013
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-23-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-23-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HWLQG
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-18-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 828 of 1735 ends

TC7484275.8s Page 257
CVS PHARMACY #9925 (Continued) S103637956
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HWLQG
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-03-2013
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-07-2014
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-07-2014
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HWLQG
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 07-17-2014
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 08-11-2022
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked N/A not addressed during inspection. In light of COVID19, CUPA Inspector signing for Cindy Aghazadeh.

Page 829 of 1735 ends

TC7484275.8s Page 258
CVS PHARMACY #9925 (Continued) S103637956
Eval General Type: Compliance Evaluation Inspection
Eval Date: 03-22-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 03-22-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-18-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked N/A not addressed during inspection. In light of COIVD19, CUPA Inspector signing for Cynthia Aghazadeh.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 08-11-2022
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 830 of 1735 ends

TC7484275.8s Page 259
CVS PHARMACY #9925 (Continued) S103637956
Eval Date: 03-30-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 03-30-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Items marked Na not reviewed during inspection. Please send me a copy of the last hazardous waste pick up manifest (March 2018) at [email protected] or fax to (805)781-4211 Attn Mattie.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Coordinates:

Affiliation Type Desc: Property Owner
Entity Name: Longs Drug Stores California, L.L.C.

Entity Title: Not reported
Affiliation Address: One CVS Drive
Affiliation City: Woonsocket
Affiliation State: RI
Affiliation Country: United States
Affiliation Zip: 02895
Affiliation Phone: (401) 765-1500,
Affiliation Type Desc: Facility Mailing Address
Entity Name: Mailing Address
Entity Title: Not reported
Affiliation Address: CVS Health Attn: Erin Chilinski, CS Legal, One CVS Drive MC 1160 Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 831 of 1735 ends

TC7484275.8s Page 260
CVS PHARMACY #9925 (Continued) S103637956
Affiliation City: Woonsocket
Affiliation State: RI
Affiliation Country: Not reported
Affiliation Zip: 02895
Affiliation Phone: ,
Affiliation Type Desc: CUPA District
Entity Name: SLO County Env Health
Entity Title: Not reported
Affiliation Address: 2156 Sierra Way
Affiliation City: San Luis Obispo
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93406
Affiliation Phone: (805) 781-5544,
Affiliation Type Desc: Identification Signer
Entity Name: Crystalyn Dogui-is, Agent for Longs Drug Stores California, L.L.C.

Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (401) 765-1500,
Affiliation Type Desc: Parent Corporation
Entity Name: CVS Health
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Document Preparer
Entity Name: Crystalyn Dogui-is, Agent for Longs Drug Stores California, L.L.C.

Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Environmental Contact
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 832 of 1735 ends

TC7484275.8s Page 261
CVS PHARMACY #9925 (Continued) S103637956
Entity Name: 3E, Regulatory Services/CVS
Entity Title: Not reported
Affiliation Address: 3207 Grey Hawk Ct., Ste. 200
Affiliation City: Carlsbad
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 92010
Affiliation Phone: ,
Affiliation Type Desc: Legal Owner
Entity Name: Longs Drug Stores California, L.L.C.

Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000782
Program Element Code: 0711
Program Element: HAZMAT DISCLOSURE/WASTE GEN ONLY > TQ
Record Id: PR0018316
Cross Street: Not reported
Status Code: 04
Status: Active, exempt from billing
Latitude: 35.61621
Longitude: -120.68210
Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000782
Program Element Code: 0726
Program Element: HAZMAT DISCLOSURE - 1-4 HAZARDOUS MATERIALS Record Id: PR0011409
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61621
Longitude: -120.68210
Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000782
Program Element Code: 1010
Program Element: HAZWASTE GEN (RCRA-SQG)
Record Id: PR0016452
Cross Street: Not reported
Status Code: 04
Status: Active, exempt from billing
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 833 of 1735 ends

TC7484275.8s Page 262
F43 FILL & SAVE UST U004264799
North 1493 CRESTON RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 1 of 9 in cluster F
UST:

Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: 220716_006632
Permitting Agency: San Luis Obispo County Environmental Health CERSID: 10437304
Latitude: 35.6160200
Longitude: -120.659080
Owner type: Non-Government
CVS PHARMACY #9925 (Continued) S103637956
Latitude: 35.61621
Longitude: -120.68210
Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000782
Program Element Code: 1110
Program Element: UNIV WASTE GENERATOR (CESQUWG)
Record Id: PR0011594
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61621
Longitude: -120.68210
Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000782
Program Element Code: 1126
Program Element: HAZWASTE GEN (1-5 WASTE STREAMS)
Record Id: PR0002367
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: 35.61621
Longitude: -120.68210
Name: CVS PHARMACY #9925
Address: 187 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000782
Program Element Code: 1135
Program Element: CUPA FINE - HAZWASTE GEN
Record Id: PR0006422
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61621
Longitude: -120.68210
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 834 of 1735 ends

TC7484275.8s Page 263
FILL & SAVE (Continued) U004264799
Facility type: Motor Vehicle Fueling
Num of inuse ust: Not reported
Num of closed ust: 0
Num of oos ust: 0
Epa region: 9
Tribal lands: No
Tank owner name: MILT SOUZA
Tank owner mailing address: 2150 Heritage Loop Rd
Tank owner mailing city: Paso robles
Tank owner mailing zip: 93446
Tank owner mailing state: CA
Tank operator name: MILT SOUZA
Tank operator mailing address: 2150 Heritage Loop Rd
Tank operator mailing city: Paso Robles
Tank operator mailing zip: 93446
Tank operator mailing state: CA
Tankidnumber: 2
Tank status: Confirmed/Updated Information
Tank configuration: One in a Compartmented Unit
Tank closure date: Not reported
Tank installation date: 6/30/2003 12:00:00 AM
Tank num of compartments: 2
Tank contents: Premium Unleaded
Tank capacity gallons: 6000
Tank type: Double Wall
Tank pc construction: Steel
Tank pwpiping construction: Fiberglass
Tank piping type: Pressure
Tank piping construction: Double Walled
Tank sacrificial anode: No
Tank cp impressed current: No
Tank cp shutoff: No
Tank alarms: Yes
Tank ball float: No
Tank spill bucket: Yes
Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: 220716_006632
Permitting Agency: San Luis Obispo County Environmental Health CERSID: 10437304
Latitude: 35.6160200
Longitude: -120.659080
Owner type: Non-Government
Facility type: Motor Vehicle Fueling
Num of inuse ust: Not reported
Num of closed ust: 0
Num of oos ust: 0
Epa region: 9
Tribal lands: No
Tank owner name: MILT SOUZA
Tank owner mailing address: 2150 Heritage Loop Rd
Tank owner mailing city: Paso robles
Tank owner mailing zip: 93446
Tank owner mailing state: CA
Tank operator name: MILT SOUZA
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 835 of 1735 ends

TC7484275.8s Page 264
FILL & SAVE (Continued) U004264799
Tank operator mailing address: 2150 Heritage Loop Rd
Tank operator mailing city: Paso Robles
Tank operator mailing zip: 93446
Tank operator mailing state: CA
Tankidnumber: 3
Tank status: Confirmed/Updated Information
Tank configuration: One in a Compartmented Unit
Tank closure date: Not reported
Tank installation date: 6/30/2003 12:00:00 AM
Tank num of compartments: 2
Tank contents: Diesel
Tank capacity gallons: 6000
Tank type: Double Wall
Tank pc construction: Steel
Tank pwpiping construction: Fiberglass
Tank piping type: Pressure
Tank piping construction: Double Walled
Tank sacrificial anode: No
Tank cp impressed current: No
Tank cp shutoff: No
Tank alarms: Yes
Tank ball float: No
Tank spill bucket: Yes
Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: 220716_006632
Permitting Agency: San Luis Obispo County Environmental Health CERSID: 10437304
Latitude: 35.6160200
Longitude: -120.659080
Owner type: Non-Government
Facility type: Motor Vehicle Fueling
Num of inuse ust: Not reported
Num of closed ust: 0
Num of oos ust: 0
Epa region: 9
Tribal lands: No
Tank owner name: MILT SOUZA
Tank owner mailing address: 2150 Heritage Loop Rd
Tank owner mailing city: Paso robles
Tank owner mailing zip: 93446
Tank owner mailing state: CA
Tank operator name: MILT SOUZA
Tank operator mailing address: 2150 Heritage Loop Rd
Tank operator mailing city: Paso Robles
Tank operator mailing zip: 93446
Tank operator mailing state: CA
Tankidnumber: 1
Tank status: Confirmed/Updated Information
Tank configuration: Stand Alone Tank
Tank closure date: Not reported
Tank installation date: 6/30/2003 12:00:00 AM
Tank num of compartments: 1
Tank contents: Regular Unleaded
Tank capacity gallons: 20000
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 836 of 1735 ends

TC7484275.8s Page 265
FILL & SAVE (Continued) U004264799
Tank type: Double Wall
Tank pc construction: Steel
Tank pwpiping construction: Fiberglass
Tank piping type: Pressure
Tank piping construction: Double Walled
Tank sacrificial anode: No
Tank cp impressed current: No
Tank cp shutoff: No
Tank alarms: Yes
Tank ball float: No
Tank spill bucket: Yes
Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: Not reported
Permitting Agency: San Luis Obispo County Environmental Hea CERSID: Not reported
Latitude: 35.61602
Longitude: -120.65908
Owner type: Not reported
Facility type: Not reported
Num of inuse ust: Not reported
Num of closed ust: Not reported
Num of oos ust: Not reported
Epa region: Not reported
Tribal lands: Not reported
Tank owner name: Not reported
Tank owner mailing address: Not reported
Tank owner mailing city: Not reported
Tank owner mailing zip: Not reported
Tank owner mailing state: Not reported
Tank operator name: Not reported
Tank operator mailing address: Not reported
Tank operator mailing city: Not reported
Tank operator mailing zip: Not reported
Tank operator mailing state: Not reported
Tankidnumber: Not reported
Tank status: Not reported
Tank configuration: Not reported
Tank closure date: Not reported
Tank installation date: Not reported
Tank num of compartments: Not reported
Tank contents: Not reported
Tank capacity gallons: Not reported
Tank type: Not reported
Tank pc construction: Not reported
Tank pwpiping construction: Not reported
Tank piping type: Not reported
Tank piping construction: Not reported
Tank sacrificial anode: Not reported
Tank cp impressed current: Not reported
Tank cp shutoff: Not reported
Tank alarms: Not reported
Tank ball float: Not reported
Tank spill bucket: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 837 of 1735 ends

TC7484275.8s Page 266
F44 EVA MARIE INC DBA FILL & SAVE RCRA NonGen / NLR 1026489977 North 1493 CRESTON RD CAL000398912
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 2 of 9 in cluster F
RCRA Listings:

Date Form Received by Agency: 20140716
Handler Name: Eva Marie Inc Dba Fill & Save
Handler Address: 1493 CRESTON RD
Handler City,State,Zip: PASO ROBLES, CA 93446-3218
EPA ID: CAL000398912
Contact Name: ANTHONY AZZARI
Contact Address: 2120 HERITAGE LOOP RD
Contact City,State,Zip: PASO ROBLES, CA 93446
Contact Telephone: 805-237-0675
Contact Fax: Not reported
Contact Email: [email protected]
Contact Title: Not reported
EPA Region: 09
Land Type: Not reported
Federal Waste Generator Description: Not a generator, verified Non-Notifier: Not reported
Biennial Report Cycle: Not reported
Accessibility: Not reported
Active Site Indicator: Not reported
State District Owner: Not reported
State District: Not reported
Mailing Address: 2120 HERITAGE LOOP RD
Mailing City,State,Zip: PASO ROBLES, CA 93446
Owner Name: Eva Marie Inc
Owner Type: Other
Operator Name: Anthony Azzari
Operator Type: Other
Short-Term Generator Activity: No
Importer Activity: No
Mixed Waste Generator: No
Transporter Activity: No
Transfer Facility Activity: No
Recycler Activity with Storage: No
Small Quantity On-Site Burner Exemption: No
Smelting Melting and Refining Furnace Exemption: No
Underground Injection Control: No
Off-Site Waste Receipt: No
Universal Waste Indicator: No
Universal Waste Destination Facility: No
Federal Universal Waste: No
Active Site State-Reg Handler: ---
Federal Facility Indicator: Not reported
Hazardous Secondary Material Indicator: N
Sub-Part K Indicator: Not reported
2018 GPRA Permit Baseline: Not on the Baseline
2018 GPRA Renewals Baseline: Not on the Baseline
202 GPRA Corrective Action Baseline: No
Subject to Corrective Action Universe: No
Non-TSDFs Where RCRA CA has Been Imposed Universe: No
Corrective Action Priority Ranking: No NCAPS ranking
Environmental Control Indicator: No
Institutional Control Indicator: No
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 838 of 1735 ends

TC7484275.8s Page 267
EVA MARIE INC DBA FILL & SAVE (Continued) 1026489977
Human Exposure Controls Indicator: N/A
Groundwater Controls Indicator: N/A
Significant Non-Complier Universe: No
Unaddressed Significant Non-Complier Universe: No
Addressed Significant Non-Complier Universe: No
Significant Non-Complier With a Compliance Schedule Universe: No Financial Assurance Required: Not reported
Handler Date of Last Change: 20200904
Recognized Trader-Importer: No
Recognized Trader-Exporter: No
Importer of Spent Lead Acid Batteries: No
Exporter of Spent Lead Acid Batteries: No
Recycler Activity Without Storage: No
Manifest Broker: No
Sub-Part P Indicator: No
Handler - Owner Operator:

Owner/Operator Indicator: Owner
Owner/Operator Name: EVA MARIE INC
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 2120 HERITAGE LOOP RD
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446
Owner/Operator Telephone: 805-237-0675
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Operator
Owner/Operator Name: ANTHONY AZZARI
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 2120 HERITAGE LOOP RD
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446
Owner/Operator Telephone: 805-237-0675
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Historic Generators:

Receive Date: 20140716
Handler Name: EVA MARIE INC DBA FILL & SAVE
Federal Waste Generator Description: Not a generator, verified State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: Not reported
Recognized Trader Exporter: Not reported
Spent Lead Acid Battery Importer: Not reported
Spent Lead Acid Battery Exporter: Not reported
Current Record: Yes
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 839 of 1735 ends

TC7484275.8s Page 268
F46 FILL & SAVE CUPA Listings S108206847
North 1493 CRESTON RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 4 of 9 in cluster F
CUPA SAN LUIS OBISPO:

Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0006632
Program Element Code: 0301
Program Element: UST FACILITY ANNUAL PERMIT
Record Id: PR0010346
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: 35.61712
Longitude: 120.65896
Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0006632
Program Element Code: 0726
Program Element: HAZMAT DISCLOSURE - 1-4 HAZARDOUS MATERIALS Record Id: PR0010345
F45 FOOD FOR LESS EDR Hist Auto 1020651101
North 1465 CRESTON RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 3 of 9 in cluster F
EDR Hist Auto
Year: Name: Type:
2008 FOOD 4 LESS Gasoline Service Stations
2009 FOOD 4 LESS Gasoline Service Stations
2010 FOOD FOR LESS Gasoline Service Stations
2011 FOOD FOR LESS Gasoline Service Stations
2012 FOOD FOR LESS Gasoline Service Stations
2013 FOOD FOR LESS Gasoline Service Stations
2014 FOOD FOR LESS Gasoline Service Stations
EVA MARIE INC DBA FILL & SAVE (Continued) 1026489977
List of NAICS Codes and Descriptions:

NAICS Code: 44719
NAICS Description: OTHER GASOLINE STATIONS
Facility Has Received Notices of Violations:

Violations: No Violations Found
Evaluation Action Summary:

Evaluations: No Evaluations Found
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 840 of 1735 ends

TC7484275.8s Page 269
F48 FOOD-4-LESS CERS HAZ WASTE S121744671
North 1465 CRESTON RD CUPA Listings N/A
< 1/8 PASO ROBLES, CA 93446 CERS
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 6 of 9 in cluster F
CERS HAZ WASTE:

Name: FOOD-4-LESS
Address: 1465 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 141542
CERS ID: 10467208
CERS Description: Hazardous Waste Generator
CUPA SAN LUIS OBISPO:

Name: FOOD-4-LESS
Address: 1465 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0006429
Program Element Code: 0726
Program Element: HAZMAT DISCLOSURE - 1-4 HAZARDOUS MATERIALS Record Id: PR0017522
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: 35.61641
Longitude: -120.65886
Name: FOOD-4-LESS
Address: 1465 CRESTON RD
F47 JMC WIRELESS CUPA Listings S117845608
North 1475 CRESTON RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 5 of 9 in cluster F
CUPA SAN LUIS OBISPO:

Name: JMC WIRELESS
Address: 1475 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0007784
Program Element Code: 1125
Program Element: HAZWASTE GEN (1 WS <27 GAL/MO, SELF REPORTER) Record Id: PR0011872
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: Not reported
Longitude: Not reported
FILL & SAVE (Continued) S108206847
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: 35.61712
Longitude: 120.65896
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 841 of 1735 ends

TC7484275.8s Page 270
FOOD-4-LESS (Continued) S121744671
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0006429
Program Element Code: 1110
Program Element: UNIV WASTE GENERATOR (CESQUWG)
Record Id: PR0011587
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61641
Longitude: -120.65886
Name: FOOD-4-LESS
Address: 1465 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0006429
Program Element Code: 1120
Program Element: CHEMICAL RETAILER/HAZARDOUS WASTE GENERATOR Record Id: PR0011373
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61641
Longitude: -120.65886
Name: FOOD-4-LESS
Address: 1465 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0006429
Program Element Code: 1126
Program Element: HAZWASTE GEN (1-5 WASTE STREAMS)
Record Id: PR0016931
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: 35.61641
Longitude: -120.65886
CERS:

Name: FOOD-4-LESS
Address: 1465 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 141542
CERS ID: 10467208
CERS Description: Chemical Storage Facilities
Violations:

Site ID: 141542
Site Name: Food-4-Less
Violation Date: 06-19-2015
Citation: HSC 6.5 Multiple - California Health and Safety Code, Chapter 6.5, Section(s) Multiple
Violation Description: Haz Waste Generator Program - Training - General Violation Notes: Returned to compliance on 07/13/2015. IN THE NEXT 30 DAYS, CONDUCT

REQUIRED EMPLOYEE TRAINING AND SUBMIT DOCUMENTATION OF TRAINING TO LINNEA FAULKNER PREFERABLY AT [email protected].

Violation Division: San Luis Obispo County Environmental Health Violation Program: HW
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 842 of 1735 ends

TC7484275.8s Page 271
FOOD-4-LESS (Continued) S121744671
Violation Source: CERS,
Site ID: 141542
Site Name: Food-4-Less
Violation Date: 06-19-2015
Citation: HSC 6.5 Multiple - California Health and Safety Code, Chapter 6.5, Section(s) Multiple
Violation Description: Haz Waste Generator Program - Training - General Violation Notes: Returned to compliance on 07/13/2015. DEVELOP AND IMPLEMENT AN

EMPLOYEE TRAINING PROGRAM THAT INCLUDES CURRENT HAZARD COMMUNICATION AND HAZARDOUS WASTE EMERGENCY RESPONSE CONTINGENCY PLAN.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HW
Violation Source: CERS,
Site ID: 141542
Site Name: Food-4-Less
Violation Date: 06-19-2015
Citation: 40 CFR 1 265.31 - U.S. Code of Federal Regulations, Title 40, Chapter 1, Section(s) 265.31
Violation Description: Failure to maintain and operate the facility to minimize the possibility of a fire, explosion, or any unplanned sudden or non-sudden release of hazardous waste or hazardous waste constituents to the air, soil, or surface water which could threaten human health or the environment..

Violation Notes: Returned to compliance on 07/13/2015. RELOCATE THE HAZARDOUS WASTE STORAGE DRUMS AWAY FROM CRUSHER AND WALK IN FREEZER DOOR. LOCATE

HAZARDOUS WASTE DRUMS TO A LESS CONGESTED AREA TO PREVENT DAMAGE TO DRUMS.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HW
Violation Source: CERS,
Site ID: 141542
Site Name: Food-4-Less
Violation Date: 06-19-2015
Citation: 22 CCR 12 66262.34(f) - California Code of Regulations, Title 22, Chapter 12, Section(s) 66262.34(f)
Violation Description: Failure to properly label hazardous waste accumulation containers with the following requirements: "Hazardous Waste", name and address of the generator, physical and chemical characteristics of the Hazardous Waste, and starting accumulation date.

Violation Notes: Returned to compliance on 07/13/2015. PROPERLY LABEL ALL HAZARDOUS WASTE CONTAINERS AS STATED IN THE VIOLATION TEXT.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HW
Violation Source: CERS,
Site ID: 141542
Site Name: Food-4-Less
Violation Date: 10-28-2020
Citation: 22 CCR 12 66262.40(a) - California Code of Regulations, Title 22, Chapter 12, Section(s) 66262.40(a)
Violation Description: Failure to keep a copy of each properly signed manifest for at least three years from the date the waste was accepted by the initial transporter. The manifest signed at the time the waste was accepted for transport shall be kept until receiving a signed copy from the Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 843 of 1735 ends

TC7484275.8s Page 272
FOOD-4-LESS (Continued) S121744671
designated facility which received the waste.

Violation Notes: Returned to compliance on 10/29/2020. SUBMIT THE LAST TWO HAZARDOUS

WASTE MANIFEST TO CUPA INSPECTOR LINNEA CHANDLER VIA EMAIL AT [email protected]. MANIFEST COULD NOT BE FOUND DURING THE INSPECTION.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HW
Violation Source: CERS,
Evaluation:

Eval General Type: Compliance Evaluation Inspection
Eval Date: 04-20-2022
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-05-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-05-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Facility self-transports haz waste to Paso Robles Landfill as a CESQG.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 03-14-2023
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: CERS REVIEW
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 04-20-2022
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 844 of 1735 ends

TC7484275.8s Page 273
FOOD-4-LESS (Continued) S121744671
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-19-2015
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 07-02-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Please update your secondary emergency contact (Luis no longer at the store due to promotion).

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 10-28-2020
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 10-29-2020
Violations Found: No
Eval Type: Other, not routine, done by local agency
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 845 of 1735 ends

TC7484275.8s Page 274
FOOD-4-LESS (Continued) S121744671
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 07-13-2015
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HW
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 10-28-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Coordinates:

Site ID: 141542
Facility Name: Food-4-Less
Env Int Type Code: HWG
Program ID: 10467208
Coord Name: Not reported
Ref Point Type Desc: Center of a facility or station.,
Latitude: 35.616650
Longitude: -120.659110
Affiliation:

Affiliation Type Desc: Document Preparer
Entity Name: Jesus Jurado
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Property Owner
Entity Name: Hastings Interprises Inc.

Entity Title: Not reported
Affiliation Address: 504 First Street STE A
Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93446
Affiliation Phone: (209) 858-0101,
Affiliation Type Desc: CUPA District
Entity Name: SLO County Env Health
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 846 of 1735 ends

TC7484275.8s Page 275
FOOD-4-LESS (Continued) S121744671
Entity Title: Not reported
Affiliation Address: 2156 Sierra Way
Affiliation City: San Luis Obispo
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93406
Affiliation Phone: (805) 781-5544,
Affiliation Type Desc: Facility Mailing Address
Entity Name: Mailing Address
Entity Title: Not reported
Affiliation Address: 3021 Reynolds Ranch Road Suite #230 Affiliation City: Lodi
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 95240
Affiliation Phone: ,
Affiliation Type Desc: Legal Owner
Entity Name: PAQ Inc.DBA Food-4-Less
Entity Title: Not reported
Affiliation Address: 3021 Reynolds Ranch Road Suite #230 Affiliation City: Lodi
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 95240
Affiliation Phone: (209) 858-0101,
Affiliation Type Desc: Operator
Entity Name: Food-4-Less
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (805) 227-1661,
Affiliation Type Desc: Environmental Contact
Entity Name: Jesus Jurado
Entity Title: Not reported
Affiliation Address: 3021 Reynolds Ranch Suite #230
Affiliation City: Lodi
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 95240
Affiliation Phone: ,
Affiliation Type Desc: Identification Signer
Entity Name: Jesus Jurado
Entity Title: Contact
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 847 of 1735 ends

TC7484275.8s Page 276
F49 PAQ INC DBA FOOD 4 LESS RCRA NonGen / NLR 1024842075 North 1465 CRESTON RD CAL000392341
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 7 of 9 in cluster F
RCRA Listings:

Date Form Received by Agency: 20131231
Handler Name: Paq Inc Dba Food 4 Less
Handler Address: 1465 CRESTON RD
Handler City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAL000392341
Contact Name: JESUSJURADO FAIRFILED
Contact Address: 17935 MURPHY PARKWAY
Contact City,State,Zip: LATHROP, CA 95330-0000
Contact Telephone: 209-992-1463
Contact Fax: 209-858-0108
Contact Email: [email protected]
Contact Title: Not reported
EPA Region: 09
Land Type: Not reported
Federal Waste Generator Description: Not a generator, verified Non-Notifier: Not reported
Biennial Report Cycle: Not reported
Accessibility: Not reported
Active Site Indicator: Handler Activities
State District Owner: Not reported
State District: Not reported
Mailing Address: 17935 MURPHY PKWY
Mailing City,State,Zip: LATHROP, CA 95330-8771
Owner Name: Paq Inc
Owner Type: Other
Operator Name: Jesusjurado Fairfiled
Operator Type: Other
Short-Term Generator Activity: No
Importer Activity: No
Mixed Waste Generator: No
Transporter Activity: No
Transfer Facility Activity: No
Recycler Activity with Storage: No
Small Quantity On-Site Burner Exemption: No
Smelting Melting and Refining Furnace Exemption: No
Underground Injection Control: No
Off-Site Waste Receipt: No
Universal Waste Indicator: Yes
Universal Waste Destination Facility: Yes
Federal Universal Waste: No
FOOD-4-LESS (Continued) S121744671
Affiliation Type Desc: Parent Corporation
Entity Name: PAQINC
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 848 of 1735 ends

TC7484275.8s Page 277
PAQ INC DBA FOOD 4 LESS (Continued) 1024842075
Active Site State-Reg Handler: ---
Federal Facility Indicator: Not reported
Hazardous Secondary Material Indicator: N
Sub-Part K Indicator: Not reported
2018 GPRA Permit Baseline: Not on the Baseline
2018 GPRA Renewals Baseline: Not on the Baseline
202 GPRA Corrective Action Baseline: No
Subject to Corrective Action Universe: No
Non-TSDFs Where RCRA CA has Been Imposed Universe: No
Corrective Action Priority Ranking: No NCAPS ranking
Environmental Control Indicator: No
Institutional Control Indicator: No
Human Exposure Controls Indicator: N/A
Groundwater Controls Indicator: N/A
Significant Non-Complier Universe: No
Unaddressed Significant Non-Complier Universe: No
Addressed Significant Non-Complier Universe: No
Significant Non-Complier With a Compliance Schedule Universe: No Financial Assurance Required: Not reported
Handler Date of Last Change: 20180906
Recognized Trader-Importer: No
Recognized Trader-Exporter: No
Importer of Spent Lead Acid Batteries: No
Exporter of Spent Lead Acid Batteries: No
Recycler Activity Without Storage: No
Manifest Broker: No
Sub-Part P Indicator: No
Handler - Owner Operator:

Owner/Operator Indicator: Owner
Owner/Operator Name: PAQ INC
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 17935 MURPHY PKWY
Owner/Operator City,State,Zip: LATHROP, CA 95330-8771
Owner/Operator Telephone: 209-858-0101
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Operator
Owner/Operator Name: JESUSJURADO FAIRFILED
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 17935 MURPHY PARKWAY
Owner/Operator City,State,Zip: LATHROP, CA 95330-0000
Owner/Operator Telephone: 209-992-1463
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Historic Generators:

Receive Date: 20131231
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 849 of 1735 ends

TC7484275.8s Page 278
F50 BAHAMA BAY TANNING CUPA Listings S117845619
North 1485 CRESTON RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
3 0.004 mi.
19 ft. Site 8 of 9 in cluster F
CUPA SAN LUIS OBISPO:

Name: BAHAMA BAY TANNING
Address: 1485 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0007796
Program Element Code: 1110
Program Element: UNIV WASTE GENERATOR (CESQUWG)
Record Id: PR0011884
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: Not reported
Longitude: Not reported
PAQ INC DBA FOOD 4 LESS (Continued) 1024842075
Handler Name: PAQ INC DBA FOOD 4 LESS
Federal Waste Generator Description: Not a generator, verified State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: Yes
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
List of NAICS Codes and Descriptions:

NAICS Code: 44511
NAICS Description: SUPERMARKETS AND OTHER GROCERY RETAILERS (EXCEPT CONVENIENCE

RETAILERS)
NAICS Code: 44512
NAICS Description: CONVENIENCE STORES
NAICS Code: 44711
NAICS Description: GASOLINE STATIONS WITH CONVENIENCE STORES NAICS Code: 45291
NAICS Description: WAREHOUSE CLUBS AND SUPERCENTERS
Facility Has Received Notices of Violations:

Violations: No Violations Found
Evaluation Action Summary:

Evaluations: No Evaluations Found
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 850 of 1735 ends

TC7484275.8s Page 279
F51 FILL & SAVE CERS TANKS S112949743
North 1493 CRESTON RD HWTS N/A
< 1/8 PASO ROBLES, CA 93446 HAZNET
Actual:
807 ft.

Focus Map:
3 0.004 mi. CERS
19 ft. Site 9 of 9 in cluster F
CERS TANKS:

Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 116422
CERS ID: 10437304
CERS Description: Underground Storage Tank
HWTS:

Name: FILL & SAVE
Address: 1493 CRESTON RD
Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAC002597674
Inactive Date: 05/16/2006
Create Date: 11/16/2005
Last Act Date: Not reported
Mailing Name: Not reported
Mailing Address: 1493 CRESTON RD
Mailing Address 2: Not reported
Mailing City,State,Zip: PASO ROBLES, CA 934463218
Owner Name: MILT SOUZA
Owner Address: 1493 CRESTON RD
Owner Address 2: Not reported
Owner City,State,Zip: PASO ROBLES, CA 934463218
Owner Phone: Not reported
Owner Fax: Not reported
Contact Name: ANTHONY OZZARI
Contact Address: 1493 CRESTON RD
Contact Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 934463218
Contact Phone: Not reported
Contact Fax: Not reported
Facility Status: Inactive
Facility Type: TEMPORARY
Category: STATE
Latitude: 35.617879
Longitude: -120.659194
Name: FILL & SAVE
Address: 1493 CRESTON RD
Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAC002638676
Inactive Date: 07/26/2009
Create Date: 01/26/2009
Last Act Date: Not reported
Mailing Name: Not reported
Mailing Address: 1493 CRESTON RD
Mailing Address 2: Not reported
Mailing City,State,Zip: PASO ROBLES, CA 93446
Owner Name: FILL & SAVE MILT SOUZA
Owner Address: 1493 CRESTON RD
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 851 of 1735 ends

TC7484275.8s Page 280
FILL & SAVE (Continued) S112949743
Owner Address 2: Not reported
Owner City,State,Zip: PASO ROBLES, CA 93446
Owner Phone: Not reported
Owner Fax: Not reported
Contact Name: ANTHONY EZZARI
Contact Address: 1493 CRESTON RD
Contact Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 93446
Contact Phone: Not reported
Contact Fax: Not reported
Facility Status: Inactive
Facility Type: TEMPORARY
Category: STATE
Latitude: 35.617879
Longitude: -120.659317
HAZNET:

Name: FILL & SAVE
Address: 1493 CRESTON RD
Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 934463218
Contact: ANTHONY OZZARI
Telephone: 8052271666
Mailing Name: Not reported
Mailing Address: 1493 CRESTON RD
Year: 2009
Gepaid: CAC002597674
TSD EPA ID: CAT080013352
CA Waste Code: 222 - Oil/water separation sludge
Disposal Method: H039 - Other Recovery Of Reclamation For Reuse Including Acid Regeneration, Organics Recovery Ect
Tons: 9.87873
Year: 2005
Gepaid: CAC002597674
TSD EPA ID: CAT080013352
CA Waste Code: 222 - Oil/water separation sludge
Disposal Method: R01 - Recycler
Tons: 5.69622
Additional Info:

Year: 2009
Gen EPA ID: CAC002597674
Shipment Date: 20090202
Creation Date: 4/3/2009 18:30:27
Receipt Date: 20090210
Manifest ID: 001501327SKS
Trans EPA ID: TXR000050930
Trans Name: SAFETY-KLEEN SYSTEMS INC
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: CAT080013352
Trans Name: DEMENNO / KERDOON
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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TSDF Alt EPA ID: Not reported
TSDF Alt Name: Not reported
Waste Code Description: 222 - Oil/water separation sludge RCRA Code: Not reported
Meth Code: H039 - Other Recovery Of Reclamation For Reuse Including Acid Regeneration, Organics Recovery Ect
Quantity Tons: 9.87873
Waste Quantity: 2369
Quantity Unit: G
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Additional Info:

Year: 2005
Gen EPA ID: CAC002597674
Shipment Date: 20051129
Creation Date: 7/12/2006 18:32:38
Receipt Date: 20051129
Manifest ID: 24383666
Trans EPA ID: TXR000050930
Trans Name: SAFETY-KLEEN SYSTEMS INC
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: CAT080013352
Trans Name: DEMENNO / KERDOON
TSDF Alt EPA ID: CAT080013352
TSDF Alt Name: Not reported
Waste Code Description: 222 - Oil/water separation sludge RCRA Code: Not reported
Meth Code: R01 - Recycler
Quantity Tons: 5.69622
Waste Quantity: 1366
Quantity Unit: G
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
CERS:

Name: FILL & SAVE
Address: 1493 CRESTON RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 116422
CERS ID: 10437304
CERS Description: Chemical Storage Facilities
Violations:

Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-06-2016
Citation: HSC 6.7 25290.1(c)(3), 25290.2(c)(3) - California Health and Safety Code, Chapter 6.7, Section(s) 25290.1(c)(3), 25290.2(c)(3) Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Violation Description: Failure to keep water out of the secondary containment of UST systems installed on or after July 1, 2003 and before July 1, 2004, or on or after July 1, 2004.

Violation Notes: Returned to compliance on 06/06/2016.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-19-2020
Citation: HSC 6.7 25291(a)(2) - California Health and Safety Code, Chapter 6.7, Section(s) 25291(a)(2)
Violation Description: Failure to maintain secondary containment (e.g., failure of secondary containment testing).

Violation Notes: Returned to compliance on 10/16/2020. DIESEL TURBINE SUMP AND UDC 5-6 FAILED HYDROSTATIC TESTING. MINIMUM CONTAINMENT VERIFIED. WITHIN 14

DAYS, SUBMIT A FAILED SYSTEM ASSESSMENT AND A REPAIR PERMIT APPLICATION AND FEES. ALL FINAL REPAIRS AND TESTS TO BE COMPLETED WITHIN 120 DAYS.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-16-2022
Citation: HSC 6.7 25284.2 - California Health and Safety Code, Chapter 6.7, Section(s) 25284.2
Violation Description: "Failure to meet one or more of the following requirements: Install or maintain a liquid-tight spill container. Have a minimum capacity of five gallons. Have a functional drain valve or other method for the removal of liquid from the spill container. Be resistant to galvanic corrosion. Perform a tightness test at installation, every 12 months thereafter, or within 30 days after a repair to the spill container.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-12-2018
Citation: 23 CCR 16 2641(a) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2641(a)
Violation Description: Failure of leak detection equipment to be located such that equipment is capable of detecting a leak at the earliest possible opportunity.

Violation Notes: Returned to compliance on 06/29/2018. Please add sensor mount tubes to all turbine sumps.

Violation Division: San Luis Obispo County Environmental Health Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-05-2017
Citation: HSC 6.7 25290.1(c), 25290.2(c), 25291(a)(2), 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25290.1(c), 25290.2(c), 25291(a)(2), 25292(e)
Violation Description: Failure to maintain secondary containment (e.g. failure of secondary containment testing).

Violation Notes: Returned to compliance on 07/03/2017. Diesel turbine sump and under dispenser container 5/6 failed testing. Trouble shoot, repair, and retest under permit from this office within 90 days.

6.95, Section(s) 25508(a)(1)
Violation Description: Failure to complete and electronically submit a business plan when storing/handling a hazardous material at or above reportable quantities.

Violation Notes: Returned to compliance on 06/16/2021. Electronically review/certify the Hazardous Materials Business Plan through CERS by July 15, 2021.

Maintain a current copy of this document on site.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HMRRP
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-19-2019
Citation: HSC 6.7 25284.2 - California Health and Safety Code, Chapter 6.7, Section(s) 25284.2
Violation Description: "Failure to meet one or more of the following requirements: Install or maintain a liquid-tight spill container. Have a minimum capacity of five gallons. Have a functional drain valve or other method for the removal of liquid from the spill container. Be resistant to galvanic corrosion. Perform a tightness test at installation, every 12 months thereafter, or within 30 days after a repair to the spill container.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Violation Date: 06-12-2018
Citation: HSC 6.95 25508(a)(1) - California Health and Safety Code, Chapter

6.95, Section(s) 25508(a)(1)
Violation Description: Failure to complete and electronically submit a business plan when storing/handling a hazardous material at or above reportable quantities.

Violation Notes: Returned to compliance on 06/13/2018. Please certify your haz mat business plan on line via the Public Portal website.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HMRRP
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-16-2022
Citation: HSC 6.7 25284.2 - California Health and Safety Code, Chapter 6.7, Section(s) 25284.2
Violation Description: "Failure to meet one or more of the following requirements: Install or maintain a liquid-tight spill container. Have a minimum capacity of five gallons. Have a functional drain valve or other method for the removal of liquid from the spill container. Be resistant to galvanic corrosion. Perform a tightness test at installation, every 12 months thereafter, or within 30 days after a repair to the spill container.

Violation Notes: Returned to compliance on 07/16/2020. 91/DIESEL TANK ANNULAR FAILED TESTING TODAY. WITHIN 14 DAYS, SUBMIT A FAILED SYSTEM ASSESSMENT AND A REPAIR PERMIT APPLICATION AND FEES. ALL FINAL REPAIRS AND TESTS TO BE COMPLETED WITHIN 120 DAYS.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-12-2018
Citation: 23 CCR 16 2665 - California Code of Regulations, Title 23, Chapter 16, Section(s) 2665
Violation Description: Failure to comply with one or more of the following: Failure to install or maintain a liquid-tight spill bucket. Have a minimum Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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capacity of five gallons. Have a functional drain valve or other method for the removal of liquid from the spill bucket/spill container. Be resistant to galvanic corrosion.

Violation Notes: Returned to compliance on 06/12/2018. A small amount of liquid observed in the 87 fill sump. Removed during inspection. No violation.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-12-2018
Citation: HSC 6.7 25291(a)(1) - California Health and Safety Code, Chapter 6.7, Section(s) 25291(a)(1)
Violation Description: UST system is not made of or lined with materials that are compatible with the substance stored in the UST system.

Violation Notes: Returned to compliance on 06/29/2018. There is a build up of sludge in the bottom of the diesel tank. This sludge is often acid and can cause primary tank failure. Please schedule a tank bottom cleaning.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-25-2014
Citation: HSC 6.7 Multiple Sections - California Health and Safety Code, Chapter

6.7, Section(s) Multiple Sections
Violation Description: UST Program - Administration/Documentation - General Violation Notes: Returned to compliance on 07/15/2014.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 116422
Site Name: FILL & SAVE
Violation Date: 06-19-2019
Citation: HSC 6.7 25284, 25286 - California Health and Safety Code, Chapter 6.7, Section(s) 25284, 25286
Violation Description: Failure to submit a complete and accurate application for a permit to operate a UST, or for renewal of the permit.

Violation Notes: Returned to compliance on 07/09/2019. Site has double-walled vent and vapor piping. Overfill prevention verified by calibrating ATG probe.

Please uncheck the option for ball float on the SWRCB UST Form "B" (second page).

Violation Notes: Returned to compliance on 10/16/2020. SECONDARY PIPE FOR VAPOR LINE Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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FAILED TO MAINTAIN PRESSURE. SEVERAL ATTEMPTS MADE. WITHIN 14 DAYS,

SUBMIT A FAILED SYSTEM ASSESSMENT AND A REPAIR PERMIT APPLICATION WITH FEES. FINAL REPAIRS TO BE COMPLETED WITHIN 120 DAYS.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Evaluation:

Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-05-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-06-2016
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-16-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Mike Gutierrez from Paradise Services for annual monitoring system certification. Provide an an emergency spill kit on-site and maintain accessible. Items marked N/A were not reviewed/observed during the inspection by the CUPA Inspector. Ensure a copy of the testing report is sent to your inspector within 30 days.

In light of COVID19, CUPA Inspector signing for Patrick Abercronbie Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-16-2022
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: ON SITE WITH MIKE GUTIERREZ OF PARADISE SERVICES FOR AN ANNUAL MONITORING SYSTEM CERTIFICATION.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-17-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-17-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: ON SITE WITH MIKE GUTIERREZ OF PARADISE SERVICES FOR ANNUAL UST LEAK MONITOR CERTIFICATION.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-19-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-19-2020
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: ON SITE WITH MIKE GUTIERREZ OF PARADISE SERVICES FOR TRIENNIAL SECONDARY CONTAINMENT TESTING. ITEMS MARKED "N/A" WERE NOT PART OF THIS REPORT.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 07-03-2017
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: SB989 repair documentation received.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 07-08-2013
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 07-09-2019
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 08-06-2021
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: FACILITY SUBMITTED DOCUEMENTATION
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 10-13-2020
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-05-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-12-2018
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-25-2014
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 08-25-2014
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Date: 09-09-2022
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: DOCS RECEIVED FOR COMPLIANCE
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-05-2017
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: On site with Paradise Services for the annual monitor certification and the triennial SB 989 secondary containment test. Under dispenser containers 1/2 and 3/4 remain to be tested.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-06-2016
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-12-2018
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-13-2018
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-25-2014
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-04-2020
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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FILL & SAVE (Continued) S112949743
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-16-2022
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-19-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-19-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: ON SITE WITH MIKE AND MICHAEL GUTIERREZ OF PARADISE SERVICES FOR ANNUAL UST LEAK MONITOR CERTIFICATION.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-19-2019
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-29-2018
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Documentation of repairs received.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 12-04-2013
Violations Found: No
Eval Type: Other, not routine, done by local agency
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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FILL & SAVE (Continued) S112949743
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 12-04-2013
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 06-16-2021
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Coordinates:

Site ID: 116422
Facility Name: FILL & SAVE
Env Int Type Code: HMBP
Program ID: 10437304
Coord Name: Not reported
Ref Point Type Desc: Center of a facility or station.,
Latitude: 35.616020
Longitude: -120.659080
Affiliation:

Affiliation Type Desc: Environmental Contact
Entity Name: Anthony Azzari
Entity Title: Not reported
Affiliation Address: 2120 Heritage Loop RD
Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93446
Affiliation Phone: ,
Affiliation Type Desc: Legal Owner
Entity Name: GROCERY ONE INC
Entity Title: Not reported
Affiliation Address: 2120 Heritage Loop Rd
Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93446
Affiliation Phone: (805) 550-2788,
Affiliation Type Desc: UST Permit Applicant
Entity Name: ANTHONY AZZARI
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Entity Title: STATION MANAGER
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (805) 286-1224,
Affiliation Type Desc: UST Property Owner Name
Entity Name: MILT SOUZA
Entity Title: Not reported
Affiliation Address: 2120 Heritage Loop Rd
Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93446
Affiliation Phone: (805) 550-2788,
Affiliation Type Desc: Parent Corporation
Entity Name: FILL & SAVE
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: UST Tank Owner
Entity Name: MILT SOUZA
Entity Title: Not reported
Affiliation Address: 2150 Heritage Loop Rd
Affiliation City: Paso robles
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93446
Affiliation Phone: (805) 550-2788,
Affiliation Type Desc: CUPA District
Entity Name: SLO County Env Health
Entity Title: Not reported
Affiliation Address: 2156 Sierra Way
Affiliation City: San Luis Obispo
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93406
Affiliation Phone: (805) 781-5544,
Affiliation Type Desc: Identification Signer
Entity Name: Anthony Azzari
Entity Title: Station Manager
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Affiliation Type Desc: UST Tank Operator
Entity Name: MILT SOUZA
Entity Title: Not reported
Affiliation Address: 2150 Heritage Loop Rd
Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93446
Affiliation Phone: (805) 550-2788,
Affiliation Type Desc: Facility Mailing Address
Entity Name: Mailing Address
Entity Title: Not reported
Affiliation Address: 1493 Creston Road
Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93446
Affiliation Phone: ,
Affiliation Type Desc: Operator
Entity Name: MILT SOUZA
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (805) 550-2788,
Name: FILL & SAVE
Address: 1493 CRESTON ROAD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 467951
CERS ID: 110054313382
CERS Description: US EPA Air Emission Inventory System (EIS) Affiliation:

Affiliation Type Desc: Environmental Contact
Entity Name: SOUZANA MILT
Entity Title: Not reported
Affiliation Address: 3985 SOUTH HIGUERA
Affiliation City: SANLUISOBISPO
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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53 1145 NIBLICK, LLC BY SAMER MOHAMED 1026483290 RCRA NonGen / NLR North 1145 NIBLICK ROAD CAC003089359
< 1/8 PASO ROBLES, CA 93446
Actual:
806 ft.

Focus Map:
2 0.005 mi.
24 ft.

RCRA Listings:

Date Form Received by Agency: 20201021
Handler Name: 1145 Niblick, Llc By Samer Mohamed
Handler Address: 1145 NIBLICK ROAD
Handler City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAC003089359
Contact Name: CARL RAGGIO
Contact Address: 930 VISTA CERRO
Contact City,State,Zip: PASO ROBLES, CA 93446
Contact Telephone: 818-618-0575
Contact Fax: Not reported
Contact Email: [email protected]
Contact Title: Not reported
EPA Region: 09
Land Type: Not reported
Federal Waste Generator Description: Not a generator, verified Non-Notifier: Not reported
Biennial Report Cycle: Not reported
Accessibility: Not reported
Active Site Indicator: Not reported
State District Owner: Not reported
State District: Not reported
Mailing Address: 930 VISTA CERRO
Mailing City,State,Zip: PASO ROBLES, CA 93446
Owner Name: 1145 Niblick, Llc By Samer Mohamed
Owner Type: Other
Operator Name: Carl Raggio
Operator Type: Other
Short-Term Generator Activity: No
Importer Activity: No
Mixed Waste Generator: No
Transporter Activity: No
Transfer Facility Activity: No
Recycler Activity with Storage: No
Small Quantity On-Site Burner Exemption: No
Smelting Melting and Refining Furnace Exemption: No
Underground Injection Control: No
Off-Site Waste Receipt: No
Universal Waste Indicator: No
Universal Waste Destination Facility: No
52 ATASCADERO CHEVRON EDR Hist Auto 1020389440
South 1140 NIBLICK RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
807 ft.

Focus Map:
2 0.004 mi.
20 ft.

EDR Hist Auto
Year: Name: Type:
1992 ATASCADERO CHEVRON Gasoline Service Stations, NEC
1993 ATASCADERO CHEVRON Gasoline Service Stations, NEC
1994 ATASCADERO CHEVRON Gasoline Service Stations, NEC
1995 ATASCADERO CHEVRON Gasoline Service Stations, NEC
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 866 of 1735 ends

TC7484275.8s Page 295
1145 NIBLICK, LLC BY SAMER MOHAMED (Continued) 1026483290 Federal Universal Waste: No
Active Site State-Reg Handler: ---
Federal Facility Indicator: Not reported
Hazardous Secondary Material Indicator: N
Sub-Part K Indicator: Not reported
2018 GPRA Permit Baseline: Not on the Baseline
2018 GPRA Renewals Baseline: Not on the Baseline
202 GPRA Corrective Action Baseline: No
Subject to Corrective Action Universe: No
Non-TSDFs Where RCRA CA has Been Imposed Universe: No
Corrective Action Priority Ranking: No NCAPS ranking
Environmental Control Indicator: No
Institutional Control Indicator: No
Human Exposure Controls Indicator: N/A
Groundwater Controls Indicator: N/A
Significant Non-Complier Universe: No
Unaddressed Significant Non-Complier Universe: No
Addressed Significant Non-Complier Universe: No
Significant Non-Complier With a Compliance Schedule Universe: No Financial Assurance Required: Not reported
Handler Date of Last Change: 20201026
Recognized Trader-Importer: No
Recognized Trader-Exporter: No
Importer of Spent Lead Acid Batteries: No
Exporter of Spent Lead Acid Batteries: No
Recycler Activity Without Storage: No
Manifest Broker: No
Sub-Part P Indicator: No
Handler - Owner Operator:

Owner/Operator Indicator: Owner
Owner/Operator Name: 1145 NIBLICK, LLC BY SAMER MOHAMED Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 930 VISTA CERRO
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446
Owner/Operator Telephone: 818-618-0575
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Owner/Operator Indicator: Operator
Owner/Operator Name: CARL RAGGIO
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 930 VISTA CERRO
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446
Owner/Operator Telephone: 818-618-0575
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Historic Generators:

Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 867 of 1735 ends

TC7484275.8s Page 296
G54 WOODLAND CHEVRON RCRA NonGen / NLR 1024815356
South 190 NIBLICK RD CAL000313077
< 1/8 PASO ROBLES, CA 93446
Actual:
713 ft.

Focus Map:
5 0.015 mi.
79 ft. Site 1 of 4 in cluster G
RCRA Listings:

Date Form Received by Agency: 20061030
Handler Name: Woodland Chevron
Handler Address: 190 NIBLICK RD
Handler City,State,Zip: PASO ROBLES, CA 93446-4842
EPA ID: CAL000313077
Contact Name: DANIEL LARRISON
Contact Address: 190 NIBLICK RD
Contact City,State,Zip: PASO ROBLES, CA 93446
Contact Telephone: 805-237-8466
Contact Fax: 805-237-8617
Contact Email: [email protected]
Contact Title: Not reported
EPA Region: 09
Land Type: Not reported
Federal Waste Generator Description: Not a generator, verified Non-Notifier: Not reported
Biennial Report Cycle: Not reported
Accessibility: Not reported
Active Site Indicator: Handler Activities
State District Owner: Not reported
State District: Not reported
Mailing Address: 190 NIBLICK RD
Mailing City,State,Zip: PASO ROBLES, CA 93446-4842
Owner Name: Robert Tachovsky
Owner Type: Other
1145 NIBLICK, LLC BY SAMER MOHAMED (Continued) 1026483290 Receive Date: 20201021
Handler Name: 1145 NIBLICK, LLC BY SAMER MOHAMED
Federal Waste Generator Description: Not a generator, verified State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: Yes
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
List of NAICS Codes and Descriptions:

NAICS Code: 237210
NAICS Description: LAND SUBDIVISION
Facility Has Received Notices of Violations:

Violations: No Violations Found
Evaluation Action Summary:

Evaluations: No Evaluations Found
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 868 of 1735 ends

TC7484275.8s Page 297
WOODLAND CHEVRON (Continued) 1024815356
Operator Name: Daniel Larrison
Operator Type: Other
Short-Term Generator Activity: No
Importer Activity: No
Mixed Waste Generator: No
Transporter Activity: No
Transfer Facility Activity: No
Recycler Activity with Storage: No
Small Quantity On-Site Burner Exemption: No
Smelting Melting and Refining Furnace Exemption: No
Underground Injection Control: No
Off-Site Waste Receipt: No
Universal Waste Indicator: Yes
Universal Waste Destination Facility: Yes
Federal Universal Waste: No
Active Site State-Reg Handler: ---
Federal Facility Indicator: Not reported
Hazardous Secondary Material Indicator: N
Sub-Part K Indicator: Not reported
2018 GPRA Permit Baseline: Not on the Baseline
2018 GPRA Renewals Baseline: Not on the Baseline
202 GPRA Corrective Action Baseline: No
Subject to Corrective Action Universe: No
Non-TSDFs Where RCRA CA has Been Imposed Universe: No
Corrective Action Priority Ranking: No NCAPS ranking
Environmental Control Indicator: No
Institutional Control Indicator: No
Human Exposure Controls Indicator: N/A
Groundwater Controls Indicator: N/A
Significant Non-Complier Universe: No
Unaddressed Significant Non-Complier Universe: No
Addressed Significant Non-Complier Universe: No
Significant Non-Complier With a Compliance Schedule Universe: No Financial Assurance Required: Not reported
Handler Date of Last Change: 20180905
Recognized Trader-Importer: No
Recognized Trader-Exporter: No
Importer of Spent Lead Acid Batteries: No
Exporter of Spent Lead Acid Batteries: No
Recycler Activity Without Storage: No
Manifest Broker: No
Sub-Part P Indicator: No
Handler - Owner Operator:

Owner/Operator Indicator: Owner
Owner/Operator Name: ROBERT TACHOVSKY
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 190 NIBLICK RD
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446-0000 Owner/Operator Telephone: 805-237-8466
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 869 of 1735 ends

TC7484275.8s Page 298
G55 WOODLAND CHEVRON CERS TANKS S112929291
South 190 NIBLICK RD HWTS N/A
< 1/8 PASO ROBLES, CA 93446 HAZNET
Actual:
713 ft.

Focus Map:
5 0.015 mi. CERS
79 ft. Site 2 of 4 in cluster G
CERS TANKS:

Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 86512
CERS ID: 10438396
CERS Description: Underground Storage Tank
HWTS:

Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
Address 2: Not reported
WOODLAND CHEVRON (Continued) 1024815356
Owner/Operator Indicator: Operator
Owner/Operator Name: DANIEL LARRISON
Legal Status: Other
Date Became Current: Not reported
Date Ended Current: Not reported
Owner/Operator Address: 190 NIBLICK RD
Owner/Operator City,State,Zip: PASO ROBLES, CA 93446
Owner/Operator Telephone: 805-237-8466
Owner/Operator Telephone Ext: Not reported
Owner/Operator Fax: Not reported
Owner/Operator Email: Not reported
Historic Generators:

Receive Date: 20061030
Handler Name: WOODLAND CHEVRON
Federal Waste Generator Description: Not a generator, verified State District Owner: Not reported
Large Quantity Handler of Universal Waste: No
Recognized Trader Importer: No
Recognized Trader Exporter: No
Spent Lead Acid Battery Importer: No
Spent Lead Acid Battery Exporter: No
Current Record: Yes
Non Storage Recycler Activity: Not reported
Electronic Manifest Broker: Not reported
List of NAICS Codes and Descriptions:

NAICS Code: 44719
NAICS Description: OTHER GASOLINE STATIONS
Facility Has Received Notices of Violations:

Violations: No Violations Found
Evaluation Action Summary:

Evaluations: No Evaluations Found
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 870 of 1735 ends

TC7484275.8s Page 299
WOODLAND CHEVRON (Continued) S112929291
City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAC002564313
Inactive Date: 10/14/2003
Create Date: 04/16/2003
Last Act Date: Not reported
Mailing Name: Not reported
Mailing Address: 190 NIBLICK RD
Mailing Address 2: Not reported
Mailing City,State,Zip: PASO ROBLES, CA 934460000
Owner Name: ROBERT TACHOVSKY
Owner Address: 190 NIBLICK RD
Owner Address 2: Not reported
Owner City,State,Zip: PASO ROBLES, CA 934460000
Owner Phone: Not reported
Owner Fax: Not reported
Contact Name: DJ LARRASON
Contact Address: 190 NIBLICK RD
Contact Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 934460000
Contact Phone: Not reported
Contact Fax: Not reported
Facility Status: Inactive
Facility Type: TEMPORARY
Category: STATE
Latitude: 35.61553
Longitude: -120.686099
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 93446
EPA ID: CAL000138913
Inactive Date: 06/30/1998
Create Date: 03/19/1997
Last Act Date: Not reported
Mailing Name: Not reported
Mailing Address: 1040 CHESNUT # 1
Mailing Address 2: Not reported
Mailing City,State,Zip: PASO ROBLES, CA 934460000
Owner Name: WOODLAND CHEVRON
Owner Address: 190 NIBLICK RD
Owner Address 2: Not reported
Owner City,State,Zip: PASO ROBLES, CA 934460000
Owner Phone: Not reported
Owner Fax: Not reported
Contact Name: ROBERT TACHOVSKY
Contact Address: INACT PER 98VQ FINAL NOTICE
Contact Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 934460000
Contact Phone: Not reported
Contact Fax: Not reported
Facility Status: Inactive
Facility Type: PERMANENT
Category: STATE
Latitude: 35.61553
Longitude: -120.686099
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 871 of 1735 ends

TC7484275.8s Page 300
WOODLAND CHEVRON (Continued) S112929291
HAZNET:

Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
Address 2: Not reported
City,State,Zip: PASO ROBLES, CA 934460000
Contact: DJ LARRASON
Telephone: 8052378466
Mailing Name: Not reported
Mailing Address: 190 NIBLICK RD
Year: 2006
Gepaid: CAC002564313
TSD EPA ID: CAT080013352
CA Waste Code: 222 - Oil/water separation sludge
Disposal Method: R01 - Recycler
Tons: 6.94722
Year: 2003
Gepaid: CAC002564313
TSD EPA ID: CAD982444481
CA Waste Code: 135 - Unspecified aqueous solution
Disposal Method: H01 - Transfer Station
Tons: 0.819
Additional Info:

Year: 2006
Gen EPA ID: CAC002564313
Shipment Date: 20060328
Creation Date: 12/21/2006 18:30:30
Receipt Date: 20060329
Manifest ID: 24629525
Trans EPA ID: TXR000050930
Trans Name: SAFETY KLEEN SYSTEMS INC
Trans 2 EPA ID: Not reported
Trans 2 Name: Not reported
TSDF EPA ID: CAT080013352
Trans Name: DEMENNO KERDOON
TSDF Alt EPA ID: CAT080013352
TSDF Alt Name: Not reported
Waste Code Description: 222 - Oil/water separation sludge RCRA Code: Not reported
Meth Code: R01 - Recycler
Quantity Tons: 6.94722
Waste Quantity: 1666
Quantity Unit: G
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Additional Info:

Year: 2003
Gen EPA ID: CAC002564313
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 872 of 1735 ends

TC7484275.8s Page 301
WOODLAND CHEVRON (Continued) S112929291
Shipment Date: 20031105
Creation Date: 8/9/2004 8:46:56
Receipt Date: 20031112
Manifest ID: 22711214
Trans EPA ID: CAD980584510
Trans Name: PHILIP WEST INDUSTRIAL SERVICES
Trans 2 EPA ID: CAD063547996
Trans 2 Name: PHILIP TRANSPORTATION & REMEDIATION INC
TSDF EPA ID: CAD982444481
Trans Name: FILTER RECYCLING SERVICES INC
TSDF Alt EPA ID: CAD982444481
TSDF Alt Name: Not reported
Waste Code Description: 135 - Unspecified aqueous solution RCRA Code: Not reported
Meth Code: H01 - Transfer Station
Quantity Tons: 0.126
Waste Quantity: 30
Quantity Unit: G
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
Shipment Date: 20031023
Creation Date: 8/5/2004 10:14:17
Receipt Date: 20031105
Manifest ID: 22065143
Trans EPA ID: CAD980584510
Trans Name: PHILIP WEST INDUSTRIAL SERVICES
Trans 2 EPA ID: CAD063547996
Trans 2 Name: PHILIP TRANSPORTATION & REMEDIATION INC
TSDF EPA ID: CAD982444481
Trans Name: FILTER RECYCLING SERVICES INC
TSDF Alt EPA ID: CAD982444481
TSDF Alt Name: Not reported
Waste Code Description: 135 - Unspecified aqueous solution RCRA Code: Not reported
Meth Code: H01 - Transfer Station
Quantity Tons: 0.693
Waste Quantity: 165
Quantity Unit: G
Additional Code 1: Not reported
Additional Code 2: Not reported
Additional Code 3: Not reported
Additional Code 4: Not reported
Additional Code 5: Not reported
CERS:

Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 86512
CERS ID: 10438396
CERS Description: Chemical Storage Facilities
Violations:

Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 873 of 1735 ends

TC7484275.8s Page 302
WOODLAND CHEVRON (Continued) S112929291
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-06-2014
Citation: 23 CCR 16 2641(a) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2641(a)
Violation Description: Failure of sensor to be located in the proper position/location.

Violation Notes: Returned to compliance on 06/10/2014.

6.95, Section(s) 25508(a)(3)
Violation Description: Failure to complete and electronically submit hazardous material inventory information for all reportable hazardous materials on site at or above reportable quantities.

Violation Notes: Returned to compliance on 06/01/2022. Electronically update Chemical Inventory of Hazardous Materials Business Plan online at www.ezsubmitslogov.org within 30 days. Add propane and carbon dioxide.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HMRRP
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-24-2017
Citation: HSC 6.7 25290.1(c)(3), 25290.2(c)(3) - California Health and Safety Code, Chapter 6.7, Section(s) 25290.1(c)(3), 25290.2(c)(3) Violation Description: Failure to keep water out of the secondary containment of UST systems installed on or after July 1, 2003 and before July 1, 2004, or on or after July 1, 2004.

Violation Notes: Returned to compliance on 05/24/2017. Small amount of liquid present in 87 turbine, 91 fill, and diesel fill sumps. Liquid removed after leaving site. No violation.

6.7, Section(s) Multiple Sections
Violation Description: UST Program - Administration/Documentation - General Violation Notes: Returned to compliance on 06/10/2014.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-25-2022
Citation: HSC 6.7 25284.2 - California Health and Safety Code, Chapter 6.7, Section(s) 25284.2
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 874 of 1735 ends

TC7484275.8s Page 303
WOODLAND CHEVRON (Continued) S112929291
Violation Description: "Failure to meet one or more of the following requirements: Install or maintain a liquid-tight spill container. Have a minimum capacity of five gallons. Have a functional drain valve or other method for the removal of liquid from the spill container. Be resistant to galvanic corrosion. Perform a tightness test at installation, every 12 months thereafter, or within 30 days after a repair to the spill container.

Tested using applicable manufacturer guidelines, industry codes, engineering standards, or a method approved by a professional engineer. Tested by a certified UST service technician. Maintain records of spill containment testing for 36 months. "
Violation Notes: Returned to compliance on 06/28/2022. Liquid observed in 87 STP sump, 91 fill sump, DSL fill sump, and DSL STP sump. Liquid in sumps were tested with water finding paste and consistent with water with the exception of DSL STP sump. Technician believes fuel in DSL STP sump was not removed during a past repair. Have DO investigate sump for signs of leak during next DO inspection and send report to [email protected]. Diagnose and repair leak under permit from this office (if applicable) within 30 days and provide work order to [email protected]. Sump mats and sump lid gaskets observed in poor condition. Please replace to prevent future water intrusion into sumps.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-06-2014
Citation: HSC 6.95 25505(a) - California Health and Safety Code, Chapter 6.95, Section(s) 25505(a)
Violation Description: Owner/Operator failed to complete and/or submit a Hazardous Materials Business Plan when storing hazardous materials at or above the thresholds quantities of 55 gallons/500 lbs/200 cubic feet.

Violation Notes: Returned to compliance on 05/12/2014.

Violation Notes: Returned to compliance on 05/25/2022. Stand-alone sensor in UDC #5/failed testing. Sensor replaced like for like with Veeder Root 990-001 sensor, retested, and passed. No outstanding violation.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 01-26-2017
Citation: HSC 6.7 25290.1(c), 25290.2(c), 25291(a)(2), 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25290.1(c), Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 875 of 1735 ends

TC7484275.8s Page 304
WOODLAND CHEVRON (Continued) S112929291
25290.2(c), 25291(a)(2), 25292(e)
Violation Description: Failure to maintain secondary containment (e.g. failure of secondary containment testing).

Violation Notes: Returned to compliance on 03/22/2017. Dispenser container 1,2 failed testing. Dispenser container 7/8 not tested due to failing test boot.

Turbine sumps tested after my departure.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 01-08-2020
Citation: HSC 6.7 25291(a)(2) - California Health and Safety Code, Chapter 6.7, Section(s) 25291(a)(2)
Violation Description: Failure to maintain secondary containment (e.g., failure of secondary containment testing).

Violation Notes: Returned to compliance on 02/05/2020. 87, 91, and Diesel product piping failed testing due to failing test boots in corresponding STP sumps. 87 test boot likely needs to be replaced. Diagnose and repair test boots and schedule a witnessed retest with your inspector within 60 days.

6.95, Section(s) 25508(a)(3)
Violation Description: Failure to complete and electronically submit a site map with all required content.

Violation Notes: Returned to compliance on 06/01/2022. Add propane and carbon dioxide to site map and resubmit Hazardous Materials Business Plan within 30 days.

Violation Notes: Returned to compliance on 05/07/2020. STAND ALONE LEAK SENSOR IN UDC 7-8 WAS NOT FUNCTIONAL. IT WAS REPLACED DURING THE INSPECTION AND TESTED AS FUNCTIONAL-SHUTDOWN OF DISPENSER.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 876 of 1735 ends

TC7484275.8s Page 305
WOODLAND CHEVRON (Continued) S112929291
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-24-2018
Citation: 23 CCR 16 2636(f)(2) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2636(f)(2)
Violation Description: Failure of the functional line leak detector (LLD) monitoring pressurized piping to meet one or more of the following requirements:

Monitored at least hourly with the capability of detecting a release of 3.0 gallons per hour leak at 10 p.s.i.g. and restrict or shut off the flow of product through the piping when a leak is detected.

Violation Notes: Returned to compliance on 05/24/2018. 87 line leak detector failed testing. Check valve and siphon jet replaced during inspection and tested good.

6.7, Section(s) Multiple Sections
Violation Description: UST Program - Administration/Documentation - General Violation Notes: Returned to compliance on 05/29/2014.

Violation Notes: Returned to compliance on 06/10/2014.

Violation Notes: Returned to compliance on 06/20/2022. DSL secondary product line failed to hold pressure for one hour. Leak appears to be at test boot in DSL STP sump. Diagnose and repair leak with passing retest within 30 days. Contact your inspector at [email protected] to schedule retest.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 877 of 1735 ends

TC7484275.8s Page 306
WOODLAND CHEVRON (Continued) S112929291
Site Name: WOODLAND CHEVRON
Violation Date: 05-26-2016
Citation: HSC 6.7 25291 - California Health and Safety Code, Chapter 6.7, Section(s) 25291
Violation Description: Failure to maintain under-dispenser containment, sumps, and/or other secondary containment in good condition and/or free of debris/liquid.

Violation Notes: Returned to compliance on 05/26/2016. Small amount of water in 87 turbine sump. Removed during inspection. No violation.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 12-01-2021
Citation: 23 CCR 16 2636(f)(4) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2636(f)(4)
Violation Description: Failure to meet one or more of the following monitoring requirements in lieu of the requirement to be tightness tested every 12 months: The monitoring system maintains all product piping outside the dispenser to be fail-safe and shut down the pump when a leak is detected. The monitoring system shuts down the pump or stops flow when a leak is detected in the under dispenser containment (UDC).

Violation Notes: Returned to compliance on 01/11/2022. Under dispenser containers (UDCs) for the dispensers do not adequately contain a leak from dispenser appurtenances (filters) as required under Authority to Construct Installation Requirements Condition 7. Install State Water Board-approved diversion frames that will direct leaks from all dispenser appurtenances into existing UDCs or replace UDCs with new, wider UDCs that encompass entire dimension of the dispenser. Send work order and pictures for modified UDC system to your inspector at [email protected] within 30 days. Stand-alone sensor in UDC 11/12 was observed non functional on 11/30/21. Sensor replaced by Rickey Binger of B&T Services during today’s inspection, retested, and passed.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 01-26-2017
Citation: HSC 6.7 25290.1(c), 25290.2(c), 25291(a)(2), 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25290.1(c), 25290.2(c), 25291(a)(2), 25292(e)
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 878 of 1735 ends

TC7484275.8s Page 307
WOODLAND CHEVRON (Continued) S112929291
Violation Description: Failure to maintain secondary containment (e.g. failure of secondary containment testing).

Violation Notes: Returned to compliance on 03/22/2017. 87, 91, and Diesel product piping tests failed due to failing test boots in dispenser pans.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-06-2021
Citation: 23 CCR 16 2716(f) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2716(f)
Violation Description: Failure to maintain on-site, or off-site at a readily available location if approved by the UPA, copies of Designated Operator inspection records as follows: Designated operator monthly inspection records for inspections performed before October 1, 2018 must be kept for 12 months from the month of inspection. For inspections performed on or after October 1, 2018, copies of the "Designated Underground Storage Tank Operator Visual Inspection Report" must be kept for 36 months from the month of inspection.

Violation Notes: Returned to compliance on 07/29/2021. Observed missing DO report for December 2020. Provide missing DO report to your inspector within 30 days at [email protected].

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-13-2015
Citation: 23 CCR 16 2638 - California Code of Regulations, Title 23, Chapter 16, Section(s) 2638
Violation Description: Failure to test leak detection equipment as required every 12 months (VPH, sensor, LLD, ATG, etc.) and/or submit monitoring system certification to the CUPA within 30 days of completion of the test Violation Notes: Returned to compliance on 06/19/2015. Please ensure a copy of the monitoring system certification is sent to me within 30 days.

Violation Notes: Returned to compliance on 06/19/2015. 87 fill and turbine sumps contain a small amount of water. Removed during inspection. No violation
Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Site Name: WOODLAND CHEVRON
Violation Date: 05-24-2017
Citation: 23 CCR 16 2715(f) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2715(f)
Violation Description: Failure to have at least one employee present during operating hours that has been trained in the proper operation and maintenance of the UST system by a designated operator (DO).

Violation Notes: Returned to compliance on 06/09/2017. IMMEDIATELY schedule training with designated operator. Observed DO training documentation for current employees dated 2015. Manager reported that several new employees have not had the DO training at all. An employee who has had previous DO training must be at the facility during all operating hours. New employees shall be trained by the DO within 30 days of hire. Send your inspector a copy of the DO training sign-in sheet at [email protected] or fax to (805) 781-4211 Attn Mattie.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 01-08-2014
Citation: HSC 6.7 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25292(e)
Violation Description: Failure to maintain secondary containment, as evidenced by failure of secondary containment testing.

Violation Notes: Returned to compliance on 04/03/2014. PIPING UNTESTABLE DUE TO FAILED BOOTS IN DISPENSER PANS.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 06-20-2022
Citation: HSC 6.7 25284.2 - California Health and Safety Code, Chapter 6.7, Section(s) 25284.2
Violation Description: "Failure to meet one or more of the following requirements: Install or maintain a liquid-tight spill container. Have a minimum capacity of five gallons. Have a functional drain valve or other method for the removal of liquid from the spill container. Be resistant to galvanic corrosion. Perform a tightness test at installation, every 12 months thereafter, or within 30 days after a repair to the spill container.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Violation Date: 01-08-2014
Citation: HSC 6.7 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25292(e)
Violation Description: Failure to maintain secondary containment, as evidenced by failure of secondary containment testing.

Violation Notes: Returned to compliance on 04/03/2014. DIESEL TURBINE AND FILL SUMPS FAILED TESTING. DISPENSER CONTAINERS 1/2, 5/6, AND 11/12 FAILED TESTING. REPAIR UNDER PERMIT FROM THIS OFFICE. 87 SUMPS TESTED FTER MY DEPARTURE.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 01-08-2020
Citation: HSC 6.7 25291(a)(2) - California Health and Safety Code, Chapter 6.7, Section(s) 25291(a)(2)
Violation Description: Failure to maintain secondary containment (e.g., failure of secondary containment testing).

Violation Notes: Returned to compliance on 02/05/2020. 87 STP sump unable to undergo hydrostatic testing due to bad test boot. Sump tested for minimum containment below product piping penetration and passed. Diagnose and repair test boot and schedule a witnessed retest of sump with your inspector within 60 days.

Violation Notes: Returned to compliance on 07/29/2021. Fuel observed in Diesel STP sump, possibly coming from turbine union. Troubleshoot and repair within 30 days and send your inspector a copy of work order at [email protected]. DO reports for Oct 2020-Jan 2021 repeatedly cite liquid in UDC 9/10. Issue was not resolved for four months. Compliance issues cited in DO reports shall be corrected in a timely manner.

Liquid observed is diesel fill sump, 87 fill sump, and 87 STP sump.

Liquid tested as water with water finding paste and removed during inspection.

6.95, Section(s) 25505(a)(4)
Violation Description: Failure to provide initial and annual training to all employees in safety procedures in the event of a release or threatened release of a hazardous material or failure to document and maintain training Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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WOODLAND CHEVRON (Continued) S112929291
records for a minimum of three years.

Violation Notes: Returned to compliance on 06/09/2017. See UT46.

Violation Notes: Returned to compliance on 05/12/2014.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HMRRP
Violation Source: CERS,
Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-06-2021
Citation: 23 CCR 16 2712(b)(1)(G) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2712(b)(1)(G)
Violation Description: Failure to comply with one or more of the following overfill prevention equipment requirements: Alert the transfer operator when the tank is 90 percent full by restricting the flow into the tank or triggering an audible and visual alarm; or Restrict delivery of flow to the tank at least 30 minutes before the tank overfills, provided the restriction occurs when the tank is filled to no more than 95 percent of capacity; and activate an audible alarm at least five minutes before the tank overfills; or Provide positive shut-off of flow to the tank when the tank is filled to no more than 95 percent of capacity; or Provide positive shut-off of flow to the tank so that none of the fittings located on the top of the tank are exposed to product due to overfilling. Install/retrofit overfill prevention equipment that does not use flow restrictors on vent piping to meet overfill prevention equipment requirements when the overfill prevention equipment is installed, repaired, or replaced on and after October 1, 2018. For USTs installed before October 1, 2018, perform an inspection by October 13, 2018 and every 36 months thereafter. For USTs installed on and after October 1, 2018, perform an inspection at installation and every 36 months thereafter. Inspected within 30 days after a repair to the overfill prevention equipment. Inspected using an applicable manufacturer guidelines, industry codes, engineering standards, or a method approved by a professional engineer. Inspected by a certified UST service technician. Maintain records of overfill prevention equipment inspection for 36 months.

Violation Notes: Returned to compliance on 05/24/2021. Observed non-functional annunciator for overfill alarm during inspection. Repair and retest within 7 days and provide copy of work order to your inspector at [email protected]. If a fuel delivery should occur before repair is made, supervise filling and ensure correct amount of fuel is delivered to avoid overfill.

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Site ID: 86512
Site Name: WOODLAND CHEVRON
Violation Date: 05-26-2016
Citation: HSC 6.95 25508(d) - California Health and Safety Code, Chapter 6.95, Section(s) 25508(d)
Violation Description: Failure to complete and/or electronically submit a business plan when storing/handling a hazardous material at or above reportable quantities.

Violation Notes: Returned to compliance on 11/18/2016. Please review and update if necessary your online haz mat business plan (last submitted Jan 2015).

At a minimum, please change the dates at the top and in the certification section of the Form S Owner/Operator page.

Violation Division: San Luis Obispo County Environmental Health Violation Program: HMRRP
Violation Source: CERS,
Evaluation:

Eval General Type: Other/Unknown
Eval Date: 01-08-2014
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: ONSITE WITH B&T FOR THE TRIENNIAL SB 989 SECONDARY CONTAINMENT TESTING. ITEMS MARKED N/A NOT ADDRESSED DURING THIS INSPECTION. THIS FACILITY IS WITHIN 1500 FEET OF A DRINKING WATER WELL. PLEASE

IMMEDIATELY TAKE STEPS TO ASSESS FAILED COMPONENTS AND COMPLETE REPAIRS WITHIN 60 DAYS.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 01-11-2022
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Violation corrected. Received work order/photo of UDC deflector pan install.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-07-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: ON SITE WITH RICKY BINGER OF B&T SERVICE STATION CONTRACTORS FOR ANNUAL UST LEAK MONITOR CERTIFICATION.

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Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-24-2017
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: On site with James Welsch and Jose Valdez of B & T Contractors for annual monitoring system certification. Items marked N/A were not reviewed during inspection. Ensure a copy of the monitoring system certification report is sent to your inspector within 30 days. The alarm history showed fuel alarms in the 87 turbine sump dated Jan. 29, 2017 and March 1, 2017. A note on the DO report for the Jan. 29 alarm stated B & T responded to alarm and visually inspected the turbine sump with no liquid found nor the sensor out of place. A work order from B & T dated March 2, stated 2 gallons of gasoline removed from turbine sump with a small drip noticed coming from the product secondary line with no further information. A small amount of liquid was present in the subject sump under the product line today. When tested with water-finding paste (including just skimming the top), no fuel was detected. Secondary containment SB989 re-testing on 3/22/2017 shows 87 secondary line [Truncated]
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-24-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with James Welsch and Ricky Binger of B&T Services for annual monitoring system certification. Items marked N/A not reviewed during inspection. Ensure a copy of the testing report is sent to your inspector within 30 days. Site has ball floats.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-24-2018
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-26-2016
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: On site with B&T for the annual monitoring system test. Reminder: your triennial SB989 secondary containment test is due in January 2017.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Date: 06-09-2017
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-20-2022
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: **AMENDED INSPECTION REPORT 6/23/2022** On site with Ricky Binger of B&T Services for retesting of DSL secondary product line. Line passed one-hour pressure test. Items marked N/A not addressed during inspection. Ensure a copy of the testing report is sent to your inspector within 30 days.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-18-2021
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Pre-concrete primary testing with Joseph Abriera and Ricky Binger of B&T. All product piping passed testing. Single-wall vapor not ready to be tested, scheduled to be tested concurrently with product secondary piping.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 12-20-2013
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Post 89 grade to diesel tank conversion: verified operation of UDC sensors and shear valves. APCD testing resulted in a cold start of the TLS 350 panel. All sensors associated with panel verified to be in operation. Electronic line leak detectors tested good.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 01-26-2017
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: - On site with James Welsch and Jose Valdez of B&T Contractors for triennial SB 989 secondary containment testing. Items marked N/A not addressed during this inspection. This facility is within 1500’ of a drinking water well. Immediately take steps to assess failed components and complete repairs within 60 days. Submit test report within 30 days. -
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 02-05-2020
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: On site with Rickey Binger of B&T Contractors for triennial SB 989 secondary containment testing reinspection. 87,91, and diesel product piping passed testing. 87 product piping test boot replaced by B&T prior to inspection. 87 turbine sump passed hydrostatic testing.

Ensure a copy of the testing report is sent to your inspector within 30 days. Items marked N/A not addressed during inspection.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-06-2014
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-06-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Mike Molacek of B&T Services for annual monitoring system certification. Cold start occurred while on site, prior to starting monitoring certification for software upgrade. Recommend installing CO2 sensor in room with CO2 dewar. Stand-alone leak sensors tested as functional during inspection. Items marked N/A not addressed during inspection. Ensure a copy of the testing report is sent to your inspector within 30 days. In light of COVID19, CUPA Inspector signing for Jose Sanchez.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-13-2015
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-26-2016
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-10-2014
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-19-2015
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-30-2022
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Violation corrected. Received work order and photos for repaired DSL STP leak at turbine head.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-23-2021
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Vapor line pressure test.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-30-2021
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Condensed MC following post-concrete testing. Stand-alone sensor in UDC 11/12 failed to shut off dispenser. Per technician, sensor is being overnighted to facility to be installed and tested tomorrow.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 12-01-2021
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: Facility may resume operation following today’s inspection for the under-dispenser containment (UDC) and dispenser upgrade. Analysis of soil samples taken beneath UDCs on 11/10/2021 showed non-detect to Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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very low concentrations of contaminates below State Environmental Screening Levels. Follow up secondary containment testing shall be performed at facility within six months. Please contact me at [email protected] or (805) 781-1105 for scheduling. Project has exceeded Agency alloted time covered under permit. A remaining invoice for this Agency’s oversight will be provided to you for payment. In light of COVID19, CUPA Inspector signing for DJ Larrison.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 01-08-2020
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: On site with Rickey Binger of B&T Contractors for triennial SB 989 secondary containment testing. All annulars passed testing today. Site has single walled vent and vapor lines. This facility is within 1500’ of a drinking water well. Immediately take steps to assess failed components and complete repairs within 60 days. Ensure a copy of the testing report is sent to your inspector within 30 days. Items marked N/A not addressed during inspection.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 03-22-2017
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: On site with Mike Conoway and Les Henderson of B& T Service Station Contractors. Items marked N/A were not reviewed during the inspection. 87, 91, and Diesel product piping passed testing after repairs made to boots. The UDCs at dispensers 1/2 and 7/8 passed testing.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-06-2014
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-06-2021
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Date: 05-07-2020
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 05-12-2014
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 05-13-2015
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-25-2022
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-18-2016
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-22-2021
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Pre-concrete secondary containment inspection. Single wall vapor line did not pass testing.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-29-2021
Violations Found: No
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Type: Other, not routine, done by local agency
Eval Notes: Post-concrete secondary containment inspection of UDCs and secondary piping.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 04-03-2014
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-20-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-20-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Rickey Binger of B&T Services for annual Monitoring System Certification. Ball floats unable to be tested during inspection. Please test ball floats in accordance with triennial overfill prevention testing and send a copy of testing report to your inspector within 30 days. Items marked N/A not addressed during inspection.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-24-2017
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 05-25-2022
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: On site with Ricky Binger of B&T Services for annual monitoring system certification and 6-month SB989 testing of UDCs and product piping following UDC upgrade. Items marked N/A not addressed during inspection. Ensure a copy of the testing report is sent to your inspector within 30 days. In light of COVID19, CUPA Inspector signing Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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for DJ Larrison.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-02-2022
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Violation corrected. HMBP review and approval.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-09-2017
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 06-10-2014
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 08-02-2021
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Violations corrected. Received missing DO report and work order for DSL STP sump leak repair.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 12-18-2013
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Coordinates:

Site ID: 86512
Facility Name: WOODLAND CHEVRON
Env Int Type Code: HMBP
Program ID: 10438396
Coord Name: Not reported
Ref Point Type Desc: Center of a facility or station.,
Latitude: 35.614620
Longitude: -120.680670
Affiliation:

Affiliation Type Desc: Operator
Entity Name: Rob Tachovsky
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (805) 296-2994,
Affiliation Type Desc: Parent Corporation
Entity Name: WOODLAND CHEVRON
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: UST Tank Operator
Entity Name: Rob Tachovsky
Entity Title: Not reported
Affiliation Address: 1060 HERDSMAN
Affiliation City: TEMPLETON
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93465-
Affiliation Phone: (805) 434-9760,
Affiliation Type Desc: CUPA District
Entity Name: SLO County Env Health
Entity Title: Not reported
Affiliation Address: 2156 Sierra Way
Affiliation City: San Luis Obispo
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93406
Affiliation Phone: (805) 781-5544,
Affiliation Type Desc: Facility Mailing Address
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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WOODLAND CHEVRON (Continued) S112929291
Entity Name: Mailing Address
Entity Title: Not reported
Affiliation Address: 190 NIBLICK RD
Affiliation City: PASO ROBLES
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93446
Affiliation Phone: ,
Affiliation Type Desc: Identification Signer
Entity Name: DJ LARRISON
Entity Title: GENERAL MNGR
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Legal Owner
Entity Name: WOODLAND CHEVRON
Entity Title: Not reported
Affiliation Address: 190 NIBLICK RD
Affiliation City: PASO ROBLES
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93446
Affiliation Phone: (805) 237-8466,
Affiliation Type Desc: UST Permit Applicant
Entity Name: DJ LARRISON
Entity Title: MANAGER
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: (805) 237-8466,
Affiliation Type Desc: Document Preparer
Entity Name: MARCUS GARCIA
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Environmental Contact
Entity Name: Dj Larrison
Entity Title: Not reported
Affiliation Address: 190 Niblick Rd.

Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93446
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 893 of 1735 ends

TC7484275.8s Page 322
G56 WOODLAND CHEVRON UST U003786128
South 190 NIBLICK RD CUPA Listings N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
713 ft.

Focus Map:
5 0.015 mi.
79 ft. Site 3 of 4 in cluster G
UST:

Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: Not reported
Permitting Agency: San Luis Obispo County Environmental Health CERSID: 10438396
Latitude: 35.6146200
Longitude: -120.680670
Owner type: Non-Government
WOODLAND CHEVRON (Continued) S112929291
Affiliation Phone: ,
Affiliation Type Desc: UST Property Owner Name
Entity Name: ROB TACHOVSKY
Entity Title: Not reported
Affiliation Address: 1060 HERDSMAN
Affiliation City: TEMPLETON
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93465-
Affiliation Phone: (805) 434-9760,
Affiliation Type Desc: UST Tank Owner
Entity Name: Rob Tachovsky
Entity Title: Not reported
Affiliation Address: 1060 HERDSMAN
Affiliation City: TEMPLETON
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 93446
Affiliation Phone: 805349760,
Name: WOODLAND CHEVRON
Address: 190 NIBLICK ROAD
City,State,Zip: PASO ROBLES, CA 93446-4842
Site ID: 505641
CERS ID: 110021363843
CERS Description: US EPA Air Emission Inventory System (EIS) Affiliation:

Affiliation Type Desc: Environmental Contact
Entity Name: DJ LARRISON
Entity Title: Not reported
Affiliation Address: 190 NIBLICK ROAD
Affiliation City: PASOROBLES
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 894 of 1735 ends

TC7484275.8s Page 323
WOODLAND CHEVRON (Continued) U003786128
Facility type: Motor Vehicle Fueling
Num of inuse ust: Not reported
Num of closed ust: 0
Num of oos ust: 0
Epa region: 9
Tribal lands: No
Tank owner name: ROB TACHOVSKY
Tank owner mailing address: 1060 HERDSMAN
Tank owner mailing city: TEMPLETON
Tank owner mailing zip: 93446
Tank owner mailing state: CA
Tank operator name: ROB TACHOVSKY
Tank operator mailing address: 1060 HERDSMAN
Tank operator mailing city: TEMPLETON
Tank operator mailing zip: 93465-
Tank operator mailing state: CA
Tankidnumber: OWNER TANK #1
Tank status: Renewal Permit
Tank configuration: Stand Alone Tank
Tank closure date: Not reported
Tank installation date: 4/1/1997 12:00:00 AM
Tank num of compartments: 1
Tank contents: Regular Unleaded
Tank capacity gallons: 20000
Tank type: Double Wall
Tank pc construction: Steel
Tank pwpiping construction: Fiberglass
Tank piping type: Pressure
Tank piping construction: Double Walled
Tank sacrificial anode: No
Tank cp impressed current: No
Tank cp shutoff: No
Tank alarms: Yes
Tank ball float: Yes
Tank spill bucket: Yes
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: Not reported
Permitting Agency: San Luis Obispo County Environmental Health CERSID: 10438396
Latitude: 35.6146200
Longitude: -120.680670
Owner type: Non-Government
Facility type: Motor Vehicle Fueling
Num of inuse ust: Not reported
Num of closed ust: 0
Num of oos ust: 0
Epa region: 9
Tribal lands: No
Tank owner name: ROB TACHOVSKY
Tank owner mailing address: 1060 HERDSMAN
Tank owner mailing city: TEMPLETON
Tank owner mailing zip: 93446
Tank owner mailing state: CA
Tank operator name: ROB TACHOVSKY
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 895 of 1735 ends

TC7484275.8s Page 324
WOODLAND CHEVRON (Continued) U003786128
Tank operator mailing address: 1060 HERDSMAN
Tank operator mailing city: TEMPLETON
Tank operator mailing zip: 93465-
Tank operator mailing state: CA
Tankidnumber: OWNER TANK #3
Tank status: Renewal Permit
Tank configuration: Stand Alone Tank
Tank closure date: Not reported
Tank installation date: 4/11/1997 12:00:00 AM
Tank num of compartments: 1
Tank contents: Premium Unleaded
Tank capacity gallons: 10000
Tank type: Double Wall
Tank pc construction: Steel
Tank pwpiping construction: Fiberglass
Tank piping type: Pressure
Tank piping construction: Double Walled
Tank sacrificial anode: No
Tank cp impressed current: No
Tank cp shutoff: No
Tank alarms: Yes
Tank ball float: Yes
Tank spill bucket: Yes
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: Not reported
Permitting Agency: San Luis Obispo County Environmental Health CERSID: Not reported
Latitude: 35.61462
Longitude: -120.68067
Owner type: Not reported
Facility type: Not reported
Num of inuse ust: Not reported
Num of closed ust: Not reported
Num of oos ust: Not reported
Epa region: Not reported
Tribal lands: Not reported
Tank owner name: Not reported
Tank owner mailing address: Not reported
Tank owner mailing city: Not reported
Tank owner mailing zip: Not reported
Tank owner mailing state: Not reported
Tank operator name: Not reported
Tank operator mailing address: Not reported
Tank operator mailing city: Not reported
Tank operator mailing zip: Not reported
Tank operator mailing state: Not reported
Tankidnumber: Not reported
Tank status: Not reported
Tank configuration: Not reported
Tank closure date: Not reported
Tank installation date: Not reported
Tank num of compartments: Not reported
Tank contents: Not reported
Tank capacity gallons: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 896 of 1735 ends

TC7484275.8s Page 325
WOODLAND CHEVRON (Continued) U003786128
Tank type: Not reported
Tank pc construction: Not reported
Tank pwpiping construction: Not reported
Tank piping type: Not reported
Tank piping construction: Not reported
Tank sacrificial anode: Not reported
Tank cp impressed current: Not reported
Tank cp shutoff: Not reported
Tank alarms: Not reported
Tank ball float: Not reported
Tank spill bucket: Not reported
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: Not reported
Permitting Agency: San Luis Obispo County Environmental Health CERSID: Not reported
Latitude: 35.6146200
Longitude: -120.680670
Owner type: Not reported
Facility type: Not reported
Num of inuse ust: Not reported
Num of closed ust: Not reported
Num of oos ust: Not reported
Epa region: Not reported
Tribal lands: Not reported
Tank owner name: Not reported
Tank owner mailing address: Not reported
Tank owner mailing city: Not reported
Tank owner mailing zip: Not reported
Tank owner mailing state: Not reported
Tank operator name: Not reported
Tank operator mailing address: Not reported
Tank operator mailing city: Not reported
Tank operator mailing zip: Not reported
Tank operator mailing state: Not reported
Tankidnumber: Not reported
Tank status: Not reported
Tank configuration: Not reported
Tank closure date: Not reported
Tank installation date: Not reported
Tank num of compartments: Not reported
Tank contents: Not reported
Tank capacity gallons: Not reported
Tank type: Not reported
Tank pc construction: Not reported
Tank pwpiping construction: Not reported
Tank piping type: Not reported
Tank piping construction: Not reported
Tank sacrificial anode: Not reported
Tank cp impressed current: Not reported
Tank cp shutoff: Not reported
Tank alarms: Not reported
Tank ball float: Not reported
Tank spill bucket: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 897 of 1735 ends

TC7484275.8s Page 326
WOODLAND CHEVRON (Continued) U003786128
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: Not reported
Permitting Agency: San Luis Obispo County Environmental Health CERSID: 10438396
Latitude: 35.6146200
Longitude: -120.680670
Owner type: Non-Government
Facility type: Motor Vehicle Fueling
Num of inuse ust: Not reported
Num of closed ust: 0
Num of oos ust: 0
Epa region: 9
Tribal lands: No
Tank owner name: ROB TACHOVSKY
Tank owner mailing address: 1060 HERDSMAN
Tank owner mailing city: TEMPLETON
Tank owner mailing zip: 93446
Tank owner mailing state: CA
Tank operator name: ROB TACHOVSKY
Tank operator mailing address: 1060 HERDSMAN
Tank operator mailing city: TEMPLETON
Tank operator mailing zip: 93465-
Tank operator mailing state: CA
Tankidnumber: OWNER TANK #2
Tank status: Renewal Permit
Tank configuration: Stand Alone Tank
Tank closure date: Not reported
Tank installation date: 4/1/1997 12:00:00 AM
Tank num of compartments: 1
Tank contents: Midgraded Unleaded
Tank capacity gallons: 10000
Tank type: Double Wall
Tank pc construction: Steel
Tank pwpiping construction: Fiberglass
Tank piping type: Pressure
Tank piping construction: Double Walled
Tank sacrificial anode: No
Tank cp impressed current: No
Tank cp shutoff: No
Tank alarms: Yes
Tank ball float: Yes
Tank spill bucket: Yes
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility ID: Not reported
Permitting Agency: San Luis Obispo County Environmental Hea CERSID: Not reported
Latitude: 35.61462
Longitude: -120.68067
Owner type: Not reported
Facility type: Not reported
Num of inuse ust: Not reported
Num of closed ust: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 898 of 1735 ends

TC7484275.8s Page 327
WOODLAND CHEVRON (Continued) U003786128
Num of oos ust: Not reported
Epa region: Not reported
Tribal lands: Not reported
Tank owner name: Not reported
Tank owner mailing address: Not reported
Tank owner mailing city: Not reported
Tank owner mailing zip: Not reported
Tank owner mailing state: Not reported
Tank operator name: Not reported
Tank operator mailing address: Not reported
Tank operator mailing city: Not reported
Tank operator mailing zip: Not reported
Tank operator mailing state: Not reported
Tankidnumber: Not reported
Tank status: Not reported
Tank configuration: Not reported
Tank closure date: Not reported
Tank installation date: Not reported
Tank num of compartments: Not reported
Tank contents: Not reported
Tank capacity gallons: Not reported
Tank type: Not reported
Tank pc construction: Not reported
Tank pwpiping construction: Not reported
Tank piping type: Not reported
Tank piping construction: Not reported
Tank sacrificial anode: Not reported
Tank cp impressed current: Not reported
Tank cp shutoff: Not reported
Tank alarms: Not reported
Tank ball float: Not reported
Tank spill bucket: Not reported
CUPA SAN LUIS OBISPO:

Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0002645
Program Element Code: 0301
Program Element: UST FACILITY ANNUAL PERMIT
Record Id: PR0002643
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: 35.61466
Longitude: 120.68096
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0002645
Program Element Code: 0705
Program Element: STATE SITE SURCHARGE
Record Id: PR0007045
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 899 of 1735 ends

TC7484275.8s Page 328
H58 ARCO #5807 SWEEPS UST U003948774
North 195 NIBLICK RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
724 ft.

Focus Map:
2 0.016 mi.
82 ft. Site 1 of 7 in cluster H
SWEEPS UST:

Name: ARCO #5807
Address: 195 NIBLICK RD
City: PASO ROBLES
Status: Active
Comp Number: 16903
G57 TACHOVSKY ROB EDR Hist Auto 1021764797
South 190 NIBLICK RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
713 ft.

Focus Map:
5 0.015 mi.
79 ft. Site 4 of 4 in cluster G
EDR Hist Auto
Year: Name: Type:
1997 WOODLAND CHEVRON Gasoline Service Stations
1998 TACHOVSKY ROB Gasoline Service Stations, NEC
1999 TACHOVSKY ROB Gasoline Service Stations, NEC
2000 TACHOVSKY ROB Gasoline Service Stations, NEC
2001 TACHOVSKY ROB Gasoline Service Stations, NEC
2002 TACHOVSKY ROB Gasoline Service Stations, NEC
2003 TACHOVSKY ROB Gasoline Service Stations, NEC
2004 TACHOVSKY ROB Gasoline Service Stations, NEC
2005 TACHOVSKY ROB Gasoline Service Stations, NEC
2006 TACHOVSKY ROB Gasoline Service Stations, NEC
2007 TACHOVSKY ROB Gasoline Service Stations, NEC
2008 TACHOVSKY ROB Gasoline Service Stations, NEC
2009 TACHOVSKY ROB Gasoline Service Stations, NEC
2010 TACHOVSKY ROB Gasoline Service Stations, NEC
2011 TACHOVSKY ROB Gasoline Service Stations, NEC
2012 TACHOVSKY ROB Gasoline Service Stations, NEC
2013 TACHOVSKY ROB Gasoline Service Stations, NEC
2014 TACHOVSKY ROB Gasoline Service Stations, NEC
WOODLAND CHEVRON (Continued) U003786128
Latitude: 35.61466
Longitude: 120.68096
Name: WOODLAND CHEVRON
Address: 190 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0002645
Program Element Code: 0726
Program Element: HAZMAT DISCLOSURE - 1-4 HAZARDOUS MATERIALS Record Id: PR0001961
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: 35.61466
Longitude: 120.68096
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 900 of 1735 ends

TC7484275.8s Page 329
ARCO #5807 (Continued) U003948774
Number: 1
Board Of Equalization: Not reported
Referral Date: 08-26-93
Action Date: 08-26-93
Created Date: 04-03-92
Owner Tank Id: EC.P
SWRCB Tank Id: 40-000-016903-000001
Tank Status: A
Capacity: 10000
Active Date: 01-13-93
Tank Use: M.V. FUEL
STG: P
Content: REG UNLEADED
Number Of Tanks: 4
Name: ARCO #5807
Address: 195 NIBLICK RD
City: PASO ROBLES
Status: Active
Comp Number: 16903
Number: 1
Board Of Equalization: Not reported
Referral Date: 08-26-93
Action Date: 08-26-93
Created Date: 04-03-92
Owner Tank Id: EC.P
SWRCB Tank Id: 40-000-016903-000002
Tank Status: A
Capacity: 10000
Active Date: 01-13-93
Tank Use: M.V. FUEL
STG: P
Content: REG UNLEADED
Number Of Tanks: Not reported
Name: ARCO #5807
Address: 195 NIBLICK RD
City: PASO ROBLES
Status: Active
Comp Number: 16903
Number: 1
Board Of Equalization: Not reported
Referral Date: 08-26-93
Action Date: 08-26-93
Created Date: 04-03-92
Owner Tank Id: EC.P
SWRCB Tank Id: 40-000-016903-000003
Tank Status: A
Capacity: 10000
Active Date: 01-13-93
Tank Use: M.V. FUEL
STG: P
Content: REG UNLEADED
Number Of Tanks: Not reported
Name: ARCO #5807
Address: 195 NIBLICK RD
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 901 of 1735 ends

TC7484275.8s Page 330
H60 ARCO 42072 CERS HAZ WASTE S113117596
North 195 NIBLICK RD CERS TANKS N/A
< 1/8 PASO ROBLES, CA 93446 CUPA Listings
Actual:
724 ft.

Focus Map:
2 0.016 mi. CERS
82 ft. Site 3 of 7 in cluster H
CERS HAZ WASTE:

Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 93071
CERS ID: 10400635
CERS Description: Hazardous Waste Generator
CERS TANKS:

Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 93071
CERS ID: 10400635
CERS Description: Underground Storage Tank
CUPA SAN LUIS OBISPO:

Name: ARCO 42072
H59 5807 ARCO AM PM EDR Hist Auto 1021507846
North 195 NIBLICK RD N/A
< 1/8 PASO ROBLES, CA 93446
Actual:
724 ft.

Focus Map:
2 0.016 mi.
82 ft. Site 2 of 7 in cluster H
EDR Hist Auto
Year: Name: Type:
2012 5807 ARCO AM PM Gasoline Service Stations, NEC
2013 5807 ARCO AM PM Gasoline Service Stations, NEC
2014 5807 ARCO AM PM Gasoline Service Stations, NEC
ARCO #5807 (Continued) U003948774
City: PASO ROBLES
Status: Active
Comp Number: 16903
Number: 1
Board Of Equalization: Not reported
Referral Date: 08-26-93
Action Date: 08-26-93
Created Date: 04-03-92
Owner Tank Id: EC.P
SWRCB Tank Id: 40-000-016903-000004
Tank Status: A
Capacity: 10000
Active Date: 01-13-93
Tank Use: M.V. FUEL
STG: P
Content: REG UNLEADED
Number Of Tanks: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 902 of 1735 ends

TC7484275.8s Page 331
ARCO 42072 (Continued) S113117596
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000806
Program Element Code: 0301
Program Element: UST FACILITY ANNUAL PERMIT
Record Id: PR0002777
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61544
Longitude: 120.68117
Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000806
Program Element Code: 0705
Program Element: STATE SITE SURCHARGE
Record Id: PR0006423
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61544
Longitude: 120.68117
Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000806
Program Element Code: 0726
Program Element: HAZMAT DISCLOSURE - 1-4 HAZARDOUS MATERIALS Record Id: PR0002003
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61544
Longitude: 120.68117
Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0000806
Program Element Code: 1140
Program Element: HAZWASTE GEN UST SITE
Record Id: PR0016210
Cross Street: Not reported
Status Code: 02
Status: Inactive, non-billable
Latitude: 35.61544
Longitude: 120.68117
Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0016156
Program Element Code: 0301
Program Element: UST FACILITY ANNUAL PERMIT
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 903 of 1735 ends

TC7484275.8s Page 332
ARCO 42072 (Continued) S113117596
Record Id: PR0021720
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: Not reported
Longitude: Not reported
Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0016156
Program Element Code: 0726
Program Element: HAZMAT DISCLOSURE - 1-4 HAZARDOUS MATERIALS Record Id: PR0021719
Cross Street: Not reported
Status Code: 01
Status: Active, billable
Latitude: Not reported
Longitude: Not reported
Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Facility Id: FA0016156
Program Element Code: 1140
Program Element: HAZWASTE GEN UST SITE
Record Id: PR0021718
Cross Street: Not reported
Status Code: 04
Status: Active, exempt from billing
Latitude: Not reported
Longitude: Not reported
CERS:

Name: ARCO 42072
Address: 195 NIBLICK RD
City,State,Zip: PASO ROBLES, CA 93446
Site ID: 93071
CERS ID: 10400635
CERS Description: Chemical Storage Facilities
Violations:

Site ID: 93071
Site Name: ARCO 42072
Violation Date: 11-18-2014
Citation: 23 CCR 16 2638 - California Code of Regulations, Title 23, Chapter 16, Section(s) 2638
Violation Description: Failure to test leak detection equipment as required every 12 months (VPH, sensor, LLD, ATG, etc.) and/or submit monitoring system certification to the CUPA within 30 days of completion of the test Violation Notes: Returned to compliance on 12/01/2014. Please ensure a copy of the monitoring system certification report is sent to me within 30 days.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 904 of 1735 ends

TC7484275.8s Page 333
ARCO 42072 (Continued) S113117596
Site Name: ARCO 42072
Violation Date: 09-16-2022
Citation: 23 CCR 16 2715(c)(2) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2715(c)(2)
Violation Description: Failure to have at least one facility employee present during operating hours that has been trained in the proper operation and maintenance of the UST system by a designated operator (DO).

Violation Notes: Returned to compliance on 11/28/2022. New employee Kathy Bedwell requires training by designated operator. Have employee trained immediately and provide proof of training to your inspector at [email protected] within 30 days.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-28-2015
Citation: 23 CCR 16 2641(a) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2641(a)
Violation Description: Failure of sensor to be located in the proper position/location.

Violation Notes: Returned to compliance on 10/23/2015. Diesel turbine sump sensor not positioned at the lowest point in the sump. Unistrut secured with wire. Reposition sensor to the lowest point and securely attach sensor sleeve to a fixed surface.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 12-12-2013
Citation: 23 CCR 16 2636(f)(5) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2636(f)(5)
Violation Description: Failure to maintain all product piping outside the dispenser to be fail-safe and shut down the pump when a leak is detected and the monitoring system shuts down the pump or flow restriction occurs when a leak is detected in the under dispenser containment.

Violation Notes: Returned to compliance on 12/12/2013.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 12-18-2015
Citation: 23 CCR 16 2637 - California Code of Regulations, Title 23, Chapter 16, Section(s) 2637
Violation Description: Failure to comply with one or more of the following: conduct secondary containment testing, within six months of installation and every 36 months thereafter, conducted in accordance with proper practices, protocols, or test methods.

Violation Notes: Returned to compliance on 12/22/2015. Please ensure a copy of today’s testing is sent to me within 30 days.

Page 905 of 1735 ends

TC7484275.8s Page 334
ARCO 42072 (Continued) S113117596
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-21-2015
Citation: HSC 6.7 25286(a) - California Health and Safety Code, Chapter 6.7, Section(s) 25286(a)
Violation Description: Failure to submit an complete and accurate application for a permit to operate an underground storage tank, or for renewal of the permit.

Violation Notes: Returned to compliance on 10/23/2015. Please update your system forms in CERS to show storage of diesel fuel.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-19-2019
Citation: 23 CCR 16 2716(e) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2716(e)
Violation Description: For designated operator (DO) monthly inspections conducted before October 1, 2018, failure to comply with one or more of the following requirements: Be performed by an ICC certified DO. Inspect monthly alarm history report, check that alarms are documented and responded to appropriately, and attach a copy. Inspect for the presence of liquid/debris in spill containers. Inspect for the presence of liquid/debris in under dispenser containment (UDC) and ensure that the monitoring equipment is positioned correctly. Inspect for liquid or debris in containment sumps where an alarm occurred with no service visit. Check that all testing and maintenance has been completed and documented. Verify that all facility employees have been trained in accordance with 23 CCR 2715(c). For designated operator (DO) 30 day inspections conducted on and after October 1, 2018, failure to conduct the designated UST operator visual inspection at least once every 30 days.

Violation Notes: Returned to compliance on 09/19/2019. 87 main fill sump sensor alarms on 6/13/19 and 7/2/19 were recorded by the monitoring panel but were not addressed in the designated operator (DO) report. Multiple PLLD shutdown alarms also recorded on 3/18/19 and not addressed in the DO report. Ensure the designated operator is properly responding to alarms and maintaining documentation of responses in DO binder.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-19-2019
Citation: HSC 6.7 25284.2 - California Health and Safety Code, Chapter 6.7, Section(s) 25284.2
Violation Description: "Failure to meet one or more of the following requirements: Install or maintain a liquid-tight spill container. Have a minimum capacity of five gallons. Have a functional drain valve or other method for the removal of liquid from the spill container. Be resistant to galvanic corrosion. Perform a tightness test at installation, every 12 months thereafter, or within 30 days after a repair to the spill container.

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ARCO 42072 (Continued) S113117596
records of spill containment testing for 36 months. "
Violation Notes: Returned to compliance on 11/21/2019. 91 spill bucket did not pass liquid tightness test. Observed leaking gasket towards top of spill bucket possibly due to uneven fit with manway cover. Diagnose and repair spill bucket within 30 days and contact your inspector for a reinspection.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-28-2015
Citation: Un-Specified
Violation Description: UST Program - Administration/Documentation - For use of Local Ordinance only
Violation Notes: Returned to compliance on 12/22/2015. Approximately 1 quart of diesel fuel in diesel turbine sump. Diesel appears to be leaking from the gate valve union. Trouble and repair/replace union.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-15-2016
Citation: 23 CCR 16 2715(c) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2715(c)
Violation Description: Failure to comply with one or more of the following designated operator (DO) monthly inspection requirements: Be performed by an ICC certified DO. Inspect monthly alarm history report, check that alarms are documented and responded to appropriately, and attach a copy.

Inspect for the presence of liquid/debris in spill containers. Inspect for the presence of liquid/debris in under dispenser containment (UDC) and ensure that the monitoring equipment is positioned correctly.

Inspect for liquid or debris in containment sumps where an alarm occurred with no service visit. Check that all testing and maintenance has been completed and documented. Verify that all facility employees have been properly trained.

Violation Notes: Returned to compliance on 10/13/2016. A high product alarm was recorded by the monitoring panel on Dec 7 and was not addressed in the designated operator (DO) report. Three diesel annular space alarms recorded on Dec 18, and noted by DO. However, DO wrote that contractor was contacted but no service report was found in DO binder Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-28-2015
Citation: Un-Specified
Violation Description: UST Program - Administration/Documentation - For use of Local Ordinance only
Violation Notes: Returned to compliance on 12/22/2015. Ensure a copy of the secondary containment system testing is sent to me within 30 days.

Violation Division: San Luis Obispo County Environmental Health Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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ARCO 42072 (Continued) S113117596
Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-15-2016
Citation: HSC 6.7 25290.1(c)(3), 25290.2(c)(3) - California Health and Safety Code, Chapter 6.7, Section(s) 25290.1(c)(3), 25290.2(c)(3) Violation Description: Failure to keep water out of the secondary containment of UST systems installed on or after July 1, 2003 and before July 1, 2004, or on or after July 1, 2004.

Violation Notes: Returned to compliance on 09/15/2016. Small amount of liquid found in tank sumps. Removed during inspection. No violation.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-28-2015
Citation: HSC 6.7 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25292(e)
Violation Description: Failure to maintain secondary containment, as evidenced by failure of secondary containment testing.

Violation Notes: Returned to compliance on 12/22/2015. 87 main turbine sump failed testing. Electrical conduit not seated in unions. Repair and schedule a test of this sump. Diesel turbine leaking fuel and not tested. Under dispenser container (UDC) 7/8 failed testing. Troubleshoot, repair, and schedule a retest of this UDC. All repairs and final testing must be completed before December 30.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-21-2015
Citation: 23 CCR 16 2638 - California Code of Regulations, Title 23, Chapter 16, Section(s) 2638
Violation Description: Failure to test leak detection equipment as required every 12 months (VPH, sensor, LLD, ATG, etc.) and/or submit monitoring system certification to the CUPA within 30 days of completion of the test Violation Notes: Returned to compliance on 10/23/2015. Please ensure a copy of the monitoring system certification report is sent to me within 30 days.

6.7, Section(s) Multiple Sections
Violation Description: UST Program - Administration/Documentation - General Violation Notes: Returned to compliance on 12/20/2013.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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ARCO 42072 (Continued) S113117596
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-16-2022
Citation: 23 CCR 16 2716(f) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2716(f)
Violation Description: Failure to maintain on-site, or off-site at a readily available location if approved by the UPA, copies of Designated Operator inspection records as follows: Designated operator monthly inspection records for inspections performed before October 1, 2018 must be kept for 12 months from the month of inspection. For inspections performed on or after October 1, 2018, copies of the "Designated Underground Storage Tank Operator Visual Inspection Report" must be kept for 36 months from the month of inspection.

Violation Notes: Returned to compliance on 11/28/2022. Designated operator report on 1/12/2022 states work order for response to L9 87 main fill sump fuel alarm on 12/25/2021 was not able to be located. Provide work order to your inspector at [email protected] within 30 days.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 11-18-2014
Citation: 23 CCR 16 2636(f)(5) - California Code of Regulations, Title 23, Chapter 16, Section(s) 2636(f)(5)
Violation Description: Failure to maintain all product piping outside the dispenser to be fail-safe and shut down the pump when a leak is detected and the monitoring system shuts down the pump or flow restriction occurs when a leak is detected in the under dispenser containment.

Violation Notes: Returned to compliance on 11/18/2014. 91 STP sump sensor did not work.

Sensor replaced and tested good. No violation.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 08-03-2021
Citation: HSC 6.7 25291(a)(2) - California Health and Safety Code, Chapter 6.7, Section(s) 25291(a)(2)
Violation Description: Failure to maintain secondary containment (e.g., failure of secondary containment testing).

Violation Notes: Returned to compliance on 09/28/2021. Diesel and 87 main STP sumps did not pass hydrostatic testing. Both sumps were retested after my departure for minimum containment above sump collar and passed, per Service Technician. Submit a failed system assessment and repair permit application within 14 days and have all final repairs with CUPA witnessed test completed within 60 days. All other tank top sumps passed hydrostatic testing. UDCs and vent box continued to be tested after leaving site.

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ARCO 42072 (Continued) S113117596
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-15-2016
Citation: 23 CCR 16 2665 - California Code of Regulations, Title 23, Chapter 16, Section(s) 2665
Violation Description: Failure of the overfill prevention system to meet one of the following requirements: Alert the transfer operator when the tank is 90 percent full by restricting the flow into the tank or triggering an audible and visual alarm; or Restrict delivery of flow to the tank at least 30 minutes before the tank overfills, provided the restriction occurs when the tank is filled to no more than 95 percent of capacity; and activate an audible alarm at least five minutes before the tank overfills; or Provide positive shut-off of flow to the tank when the tank is filled to no more than 95 percent of capacity; or Provide positive shut-off of flow to the tank so that none of the fittings located on the top of the tank are exposed to product due to overfilling.

Violation Notes: Returned to compliance on 10/13/2016. A minimum of 19 overfills and 1 high product warning occurred in the past 12 months at this site.

Contact your fuel provider to ensure only the correct amount of fuel is dropped at this site to prevent potential releases. Please contact me when this is done.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-28-2015
Citation: HSC 6.7 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25292(e)
Violation Description: Failure to maintain secondary containment, as evidenced by failure of secondary containment testing.

Violation Notes: Returned to compliance on 12/22/2015. 87 siphon secondary line failed testing. Troubleshoot, repair, and schedule a retest of this line.

Alternatively, present a work plan to take line out of commission. All repairs and final testing must be completed before December 30.

Violation Division: San Luis Obispo County Environmental Health Violation Program: UST
Violation Source: CERS,
Site ID: 93071
Site Name: ARCO 42072
Violation Date: 09-28-2015
Citation: HSC 6.7 25292(e) - California Health and Safety Code, Chapter 6.7, Section(s) 25292(e)
Violation Description: Failure to maintain secondary containment, as evidenced by failure of secondary containment testing.

Violation Notes: Returned to compliance on 12/22/2015. Diesel, 87 siphon, and 87 main tank annulars remain to be tested. Tank annulars may be tested during post repair testing of failed components. 91 tank annular passed testing.

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TC7484275.8s Page 339
ARCO 42072 (Continued) S113117596
Evaluation:

Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-16-2022
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-17-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-19-2019
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Rodney Bredeson of FasTech for annual monitoring system certification. Audible/visual alarms were tested as part of triennial overfill prevention testing. Inform your inspector when a sensor is going to be replaced like for like. Per work order, 87 fill sump sensor was faulty and in alarm on 7/13/19. Sensor was replaced like for like with new 323 sensor and tested good. Items marked N/A not addressed during inspection. Ensure a copy of the test report is sent to your inspector within 30 days.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-28-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-28-2021
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Rickey Binger of B&T Services for SB989 retest of Diesel and 87M STP sumps and annual inspection. Annual monitoring certification performed on 9/13/2021 by Fastech (unwitnessed) did not note any failures. Facility documentation verified during inspection.

Ensure a copy of the testing report is sent to your inspector within 30 days. In light of COVID19, CUPA Inspector signing for Fred Boroumand.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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TC7484275.8s Page 340
ARCO 42072 (Continued) S113117596
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 11-18-2014
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 12-12-2013
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 12-12-2013
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-16-2022
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Patrick Pfrang of Tanknology for annual monitoring system certification. B&T Services replaced Veeder Root CPU Board and upgraded software with cold-started prior to arriving on site (prior approval by this Agency). Items marked N/A not addressed during inspection. Ensure a copy of the inspection report is sent to your inspector within 30 days. In light of COVID19, CUPA Inspector signing for Becky Escamilla.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-21-2015
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 09-28-2015
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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ARCO 42072 (Continued) S113117596
Eval Notes: On site with Fastech for the triennial SB 989 secondary containment testing. Items marked N/A not addressed during this inspection.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 10-23-2015
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-28-2022
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Violations corrected. Received work order for fuel alarm on 12/25/2021. Employee Kathy Bedwell no longer employed at facility.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 12-18-2015
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: On site with FASTECH for SB 989 post repair testing. Items marked N/A not addressed during this inspection. Components tested after repairs:

UDCs 1/2 and 7/8. Siphon line from 87 main to 87 auxiliary tank removed and sump walls patched. Both 87 STP sumps retested. Brine monitored vent and vapor lines found to have no communication. Brine system purged and secondary lines converted to dry-monitored. Brine sensor removed from vent box. Testing of vapor lines indicated a leak in a fitting just outside of UDC 1/2. Since 87 and 91 product lines were exposed, these secondary lines were tested as well. Annular spaces for the diesel, 87 main, and 87 auxiliary tanks also tested in presence of inspector (passing unwitnessed test during initial testing). All components passed testing.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 08-03-2021
Violations Found: Yes
Eval Type: Other, not routine, done by local agency
Eval Notes: On site with Joshua Bingham of FasTech for triennial SB989 secondary containment testing. All tank annulars passed 1 hour vacuum test. All piping passed 1 hour pressure test. Items marked N/A not addressed during inspection. Ensure a copy of the testing report is sent to your inspector within 30 days. In light of COVID19, CUPA Inspector signing for James Merkle.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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ARCO 42072 (Continued) S113117596
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 08-06-2018
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: On site with FASTTECH for the triennial SB 989 secondary containment test. Items marked N/A not addressed during this inspection. All tank annulars passed 1 hour vacuum tests. All piping passed 1 hour pressure test. Communication verified for the 91 line from turbine sump to UDC 1/2. All tank top sumps tested except the diesel turbine sump. All UDCs and vent box remain to be tested at the time of my departure.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-05-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-05-2018
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Robert Vargas and Henry Alvarez of Fasttech for annual monitoring system certification. Items marked N/A not reviewed during inspection. Ensure a copy of the testing report is sent to your inspector within 30 days.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-13-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-13-2017
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: On site with Luis Navarro of Fastech for the annual monitoring system certification. Items marked N/A not reviewed during inspection.

Provide documentation for fuel alarms that occurred on August 30, 2017 in 87 main, 87 secondary, and 91 annulars. No documentation of work performed or explanation for alarms found in DO binder. 87 secondary fill sump sensor and 91 turbine sump sensor were faulty. Both were replaced with new 323 sensors (like-for-like) and tested good. No Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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ARCO 42072 (Continued) S113117596
violation. Inform your inspector when a sensor is going to be replaced like-for-like. Work orders stated the 87 main fill sensor was replaced earlier this year without informing your inspector.

Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-15-2016
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-15-2016
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: On site with Fasttech for the annual monitoring system certification.

Recent changes to Federal law require inspection of overfill prevention equipment. This site has ball floats. Ball floats not inspected during this inspection.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 10-13-2016
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 11-18-2014
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Onsite with Marco and Henry of Fastech for the annual monitor certification.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-17-2020
Violations Found: No
Eval Type: Routine done by local agency
Eval Notes: In light of COVID19, CUPA Inspector signing for Becky Escamilla. Items marked N/A not addressed during inspection. On site with Edgar Arroyo of Fastech for annual monitoring system certification. Overfill prevention tested during previous monitoring system certification.

Line leak detectors continued to be tested after leaving site. Ensure a copy of the testing report is sent to your inspector within 30 days.

Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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ARCO 42072 (Continued) S113117596
Eval Division: San Luis Obispo County Environmental Health Eval Program: HMRRP
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-19-2019
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Compliance Evaluation Inspection
Eval Date: 09-21-2015
Violations Found: Yes
Eval Type: Routine done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 11-21-2019
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Violation noted as corrected. Received 91 spill bucket work order and test report from Marcus of B&T.

Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Eval General Type: Other/Unknown
Eval Date: 12-22-2015
Violations Found: No
Eval Type: Other, not routine, done by local agency
Eval Notes: Not reported
Eval Division: San Luis Obispo County Environmental Health Eval Program: UST
Eval Source: CERS,
Coordinates:

Site ID: 93071
Facility Name: ARCO 42072
Env Int Type Code: HWG
Program ID: 10400635
Coord Name: Not reported
Ref Point Type Desc: Center of a facility or station.,
Latitude: 35.615430
Longitude: -120.680820
Affiliation:

Affiliation Type Desc: Identification Signer
Entity Name: Gabriela Arranaga
Entity Title: President
Affiliation Address: Not reported
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

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ARCO 42072 (Continued) S113117596
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Environmental Contact
Entity Name: Michael Shoar
Entity Title: Not reported
Affiliation Address: 195 NIblick Rd
Affiliation City: Paso RObles
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93446
Affiliation Phone: ,
Affiliation Type Desc: Document Preparer
Entity Name: Michael Shoar
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Facility Mailing Address
Entity Name: Mailing Address
Entity Title: Not reported
Affiliation Address: 195 NIblick Rd
Affiliation City: Paso Robles
Affiliation State: CA
Affiliation Country: Not reported
Affiliation Zip: 93446
Affiliation Phone: ,
Affiliation Type Desc: Legal Owner
Entity Name: Gabriela Arranaga
Entity Title: Not reported
Affiliation Address: 24928 Hearth Ct
Affiliation City: Valencia
Affiliation State: CA
Affiliation Country: United States
Affiliation Zip: 91354
Affiliation Phone: (661) 600-8381,
Affiliation Type Desc: Parent Corporation
Entity Name: Paso Robles Arco Ampm
Entity Title: Not reported
Affiliation Address: Not reported
Affiliation City: Not reported
Affiliation State: Not reported
Affiliation Country: Not reported
Affiliation Zip: Not reported
Affiliation Phone: ,
Affiliation Type Desc: Property Owner
Map ID MAP FINDINGS
Direction
Distance EDR ID Number
Elevation Site Database(s) EPA ID Number
Exhibit A

Page 917 of 1735 ends

Paso Robles City CouncilMarch 18, 2025

Paso Robles City Council
March 18, 2025