Ncil20251210 — Santee City Council, December 10, 2025 (part 11 of 13)

IV. Inspection of Used Oil Tank Systems
In your letter, you indicate that Wal-Mart should apply to the County for an exemption from the mandated periodic engineering assessments of used oil tanks by completing the AST Exemption Application you enclosed. Wal-Mart intends to apply for exemptions covering all eight TLE locations in the County of San Diego. Based on the AST Exemption Application you provided, Wal-Mart understands that the approval of the tank system from the local Fire Marshal having jurisdiction each location is a necessary condition for receiving the exemption. Per a recent conversation you had with one of my associates, we understand that prior approvals received from Fire Marshalsfor example, approvals received when the used oil tanks were initially installed-may suffice to meet this requirement. Wal-Mart has searched its files for such prior approvals.

The following table summarizes our findings:

Location Status of Fire Marshal Approval
13425 Community Rd., Poway, CA 92064 AST Exemption Application completed on March 24, 2003 with Fire Marshal Joseph
D. Walter's signature (enclosed)
3382 Murphy Canyon Rd., San Diego, CA Approval to be requested 92123
170 Town Center Pkwy., Santee, CA 92123 Approval to be requested 1800 University Drive, Vista, CA 92083 Approval to be requested [A]ny one or combination of tanks (including underground pipes connected thereto) which is used to contain an accumulation of regulated substances, and the volume of which (including the volume of the underground pipes connected thereto) is I 0 per centum or more beneath the surface of the ground. Such term does not include any- ( A) farm or residential tank of 1,100 gallons t;-r less capacity used for storing motor fuel for noncommercial purposes,
(B) tank used for storing heating oil for consumptive use on the premises where stored, (C) septic tank, ·
(D) pipeline facility (including gathering lines}-
(i) which is regulated under chapter 601 of title 49, or (li) which is an intrastate pipeline facility regulated under State laws as provided in chapter 601 of title 49, and· which is determined by the Secretary to be connected to a pipeline or to be operated or intended to be capable of operating at pipeline pressure or as an integral part of a pipeline, (E) surface impoundment, pit, pond, or lagoon,
(F) storm water or waste water collection system,
(G) flow-through process tank,
(H) liquid trap or associated gathering lines directly related to oil or gas production and gathering operations, or (I) storage tank situated in an underground area (such as a basement, cellar, mineworking, drift, shaft, or tunnel) if the storage tank is situated upon or above the surface of the floor.

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manatt
manatt I phelps I phillips
Mr. John Misleh
May 15,2007
Page6
710 Dennery Road, San Diego, CA 92154
75 N Broadway, Chula Vista (W), CA
91910
705 College Blvd., Oceanside, CA 92057
13487 Camino Canada, El Cajon, CA
92021
Inspection of Fire Marshal occurred on
September 5, 2003 (application for this
inspection
Approval to be requested
Approval to be requested
Approval to be requested
For the two stores where we have found an approval from the local Fire Marshal, or a prior AST Exemption Application, we will be forwarding our application for an exemption shortly. For the six stores where we have not found an approval or a prior AST Exemption Application, we will be requesting such approvals immediately. We will obtain these approvals as expeditiously as possible and include them in our AST Exemption Applications for the remaining locations.

Thank you for the opportunity to respond to your letter. We anticipate being back in touch with your office soon. In the meantime, please do not hesitate to call me at (31 0) 312-4353 should any questions arise.

Enclosures
cc: Nelson Jackson, Esq.

Mr. Tim Buckley
Mr. Gary Vernon
41113545.3
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WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMO
Two double wall Storage Tanks holding used oil.

Tank capacity: 400 gallons
WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
Piping and labeling of tbe storage tank.

UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleb /R. Drummond, HMO
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WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMD
Hazardous Waste label on the used oil tank showing the waste accumulation and pick-up record.

WAL-MART STORES, Inc. (Store 1917) UPFP: 132274 Date: March 20, 2007 Address: 170 Town Center Pkwy, Santee, 92123 Photos by: J. Misleh /R. Drummond, HMD Space between the two tanks showing residues of oil on the floor . •
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WAL-MART STORES, Inc. (Store 1917)
Address: I 70 Town Center Pkwy, Santee, 92 I 23
Storage tank mounted on metal base
WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMO
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMO
Wastewater sump tank in the corner of the Lube Bay.
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3 WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
Floor in the Lube Bay.

WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMO
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMO
Oil- water-sludge separator in floor of Lube Bay.
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WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Plm-y, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleb /R. Drummond, HMO
Oil- water-sludge floor sump. A stick inserted into tbe sump indicates oily waste inside the sump (visual observation).

WAL-MART STORES, Inc. (Store 191 7)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleb IR. Drummond, HMO
A close-up of the oil-water waste in the floor sump as it dripped from a measuring stick. 9 10
5 WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMD
A close-up of the oil-water waste from the floor sump puddling on the sump lid.

WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMD
Two storage tanks holding new motor oil. Tanks are up against the wall.

Tank capacity: 275 gallons
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WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
Piping of the storage tank.

WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Ce nter Pkwy, Santee, 92123
Storage tank mounted on metal base
UPFP: 132274 Date: March 20, 2001
Photos by: J. Misleh IR. Drummond, HMO
13 UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh IR. Drummond, HMO
14 7
WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
Piping of the storage tank.

WAL-MART STORES, Inc. (Store 1917)
Address: 170 Town Center Pkwy, Santee, 92123
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleh /R. Drummond, HMD
UPFP: 132274 Date: March 20, 2007
Photos by: J. Misleb /R. Drummond, HMD
QiJ.water clarifier outdoors near the open service bay entrance. •
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GARY W. ERBECK

DIRECTOR
March 27, 2007
Oinunty nf

DEPARTMENT OF ENVIRONMENTAL HEALTH

HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112·9261
(619) 338·2222 FAX (619) 338·2377
1-800-253-9933
www.sdcdeh.org
David A. Rand, Attorney
Manatt, Phelps, and Phillips
11355 West Olympic Boulevard
Los Angeles, CA. 90064-1614

JACK MILLER

ASSISTANT DIRECTOR
Re: Wal Mart Stores Lube Bays, Used Oil/Petroleum Storage Tanks Dear Mr. Rand:

This letter is in reply to your correspondence dated October 6, 2006 to the Hazardous Materials Division (HMD) regarding below grade vaulted underground storage tanks (USTs) . The correspondence requested that the HMD review the measures taken by Wal Mart to satisfy the UST exemption criteria set forth in HSC §25283.5 for eight locations.

Three San Diego County locations were evaluated on March 20, 2007 by HMD staff. The Lube Bays were inspected and the used oil and product oil steel storage tanks were checked to determine if they were exempt USTs.

Based on the observations and the statute, all three locations had storage tanks that did not fully comply with the HSC §25283.5 exemption.

Poway location Lube Bay: The two used oil tanks met the UST exemption; however, the two product oil tanks in the Lube Bay are not eligible for the exemption, because they cannot be visually inspected around all sides and the bottoms. Tim Bulkley, District Manager, TLE ,Wal Mart stated the single-walled product oil storage tanks were going to be replaced in the future. Enclosed are photos taken of the tanks.

Murphy Canyon Road location Lube Bay: The one used oil tank and the two product oil tanks in the Lube Bay are very close to the walls and cannot be visually inspected. See photos enclosed with this letter. There was oily debris and unknown liquid on the floor behind the product oil tanks along the wall, and we could not tell if these tanks were leaking or if better housekeeping needs to be done. The used oil tank is very close to the two adjacent walls in the corner of the Lube Bay and it was difficult to see behind this tank. The two underground sump lids, piping, and electrical cord on the floor adjacent to the used oil tank are presenting an obstruction to observers trying to squeeze into one corner to see behind the large used oil tank. These tanks need to be relocated or moved to allow for unobstructed viewing of all exterior surfaces of the tanks in order to be exempt pursuant to HSC §25283.5.
"Environmental and public health through leadership, partnership and science" David Rand - 2 - March 27, 2007
Santee location Lube Bay: The two used oils tanks in the middle of the Lube Bay can be visually inspected on all sides and bottoms. However, the product oil tanks are very close to the wall and cannot be visually inspected (all exterior surfaces). See photos enclosed. The two product oil tanks need to be moved or relocated in order to be exempt pursuant to HSC §25283.5.

Sump Waste Issue: In addition, an onsite review by HMD staff of waste disposal records was done for waste removed from the Lube Bay floor sumps in the past. The waste observed inside some of the floor sumps was visually evaluated and oily waste was observed when the sumps were checked. The sump waste was oily, dark colored, and physically thicker than water. Tim Bulkey, District Manager, indicated that Island Environmental has been· transporting the sump waste offsite for disposal. and that they usually pump out the Lube Bay floor sumps every six months.

Waste disposal receipts were presented issued by Island Environmental for 2006 and the sump waste were being disposed of using a transporter shipping document that states the waste is "non-hazardous".

Be advised the waste generator (Wal Mart) is legally responsible for doing a proper waste classification of their sump wastes. If used oil .is accumulating inside these sumps, or if testing of the sludge and/or wastewater demonstrates the Lube Bay sump waste is hazardous waste pursuant to Title 22 ·of the California Code of Regulations, then the use of a non-hazardous waste shipping document is a violation and should be discontinued. Hazardous waste (including used oil) must be shipped offsite from Wal Mart locations using a standard hazardous waste manifest or a consolidated manifest following State requirements. 1 Within 15 days of receipt of this letter, please provide photocopies to my attention of all waste classification information for the sump wastes removed from the eight TLE locations in San Diego County over the past three years (reference CCR §66262.11 & §66262.40). The waste classification information requested includes, but is not limited to, pertinent waste generator records, all analysis results from testing representative samples of the sump wastes, waste profile documents, or similar records.

The floor sumps inside the Lube Bays at the Poway and Murphy Canyon Road locations present another potential issue regarding UST statute and regulation. These floor sumps are operated to accumulate waste, including oils or petroleum substances. The sumps make use of a sump pump to remove (pump) the waste to an oil-water separator, where the oil is separated from the wastewater. For the most part, the oil-water separators receiving pumped waste from the Lube Bay sumps were installed outside the Lube Bays. The waste collection sumps appear to be singlewalled and made of concrete set (below grade) into the floor of the Lube Bays. If these floor sumps ever contained a hazardous substance then they may meet the definition of a UST and require registration and an operating permit from the HMD to operate these underground sumps. 2 As of the date of this letter, Wal Mart has not registered their underground sumps in the Lube Bays as USTs with the HMD. Within 30 days of this letter, provide a detailed statement in writing to the HMD which addresses the regulatory status of these Lube Bay sumps with regards to compliance with State UST law (HSC §25280 etc.). Based on observations made by the HMO on March 20, 2007, these sumps may be subject to UST • ·\
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David Rand - 3 -
management regulations and require
recordkeeping, and significant upgrades. 3
leak
March 27, 2007
detection, additional
Hazardous Waste Tank System: The three Lube Bay locations visited appear to be large quantity generators of hazardous waste 4 • Used oil is regulated in California as hazardous waste. Therefore, hazardous waste tank standards are required by large quantity generators. One requirement that Wal Mart must document and keep records onsite is the professional engineer's (PE) tank assessment pursuant to CCR §66265.192.

The engineer's assessment report or an exemption must be kept up to date and onsite available for inspector's review. The PE exemption request procedure for used oil tanks is explained in the enclosed HMD form and instructions entitled, "AST Certification & Engineering Assessment Exemption". If Wal Mart does not wish to complete the PE exemption process, then they will need an independent engineer's assessment report per CCR §66265.192.

If you modify the storage tanks or install new ones in the Lube Bays to achieve compliance with HSC 25283.5, we strongly recommend you submit a plan before you do the work to make sure the Lube Bay tanks will be exempted by the HMD pursuant to State law. Plans can be submitted using our consultation procedure and final inspections will be performed of the work to exempt a tank in the Lube Bay. The HMD consultation forms and application are attached to this letter.

The remaining five Wal Mart locations that still need to be inspected by HMD should incorporate the guidance and regulations explained in this letter to ensure a successful appraisal of the Lube Bay storage tanks pursuant to HSC §25283.5 criteria. If you have any questions, please contact me at 858-495-5213.

Sincerely,
John Misleh, Supervisor
Hazardous Materials Division
Enclosures: Digital Photos taken March 20, 2007
HMD Application for UST consultations
Island Environmental 2006 sump waste disposal receipts
Used Oil Tank Assessment Exemption Request Form
Cc: Tim Bulkley, District Manager, Wal Mart TLE
Rafaela Drummond, HMD
Mike Vizzier, HMD, Chief
Mary Avastu, HMD
Robert Rapista, HMD
Sylvia Mosse, HMD
HMD files # 135594; # 132227, and# 132274.
1 HSC §25250.1(a). 2 HSC §25281 (h); and §25284. 3 Title 23 CCR §2610 et. al. 4 Title 22 CCR §66262.34(a)(1)(A) adopts the hazardous waste tank standards regulations found in §66265.190 et.al.

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Keith Waara, EHS Ill, San Diego, CA
Dept. of Environmental Health
Hazardous Materials Division
P.O. Box 129261
San Diego, CA 92112
. . ·--- --
1430 Blue Oaks Blvd.

Suite 140
Roseville, CA 95747
July 25, 2008
Subject: Wal-Mart #5023- 1200 Highland Ave., National City, CA 91950 Permit# 202831. Inspection date May 22, 2008.

Response to July 9, 2008 request for clarification
Mr. Waara:

I want to thank you for the several conversations we have had recently on the management of aerosol ·containers. I also really appreciate the positive recognition in our conversations by the County of San Diego on our environmental performance in California as we continue to make enhancements to our existing program.

In addressing your request for further clarification on identifying "non-functional non-empty aerosols with the actuators still intact," I have attached memos distributed to our California Wai-Mart and Sam's Club facilities which clarify to our Associates that "sometimes an aerosol may appear as though it is not damaged because the actuator spray mechanism is in place but a customer has indicated the spray mechanism did not function properly and in such cases the defective slip should indicate this and this aerosol MUST be managed in the blue drum."
In addition to the above-mentioned memo, we are working on a poster to further enhance our program's communication on items which should not be sent to a Return Center.

Beyond aerosol management on the "Do Not Send" poster we are also considering including discussion and photos of items such as pool chemicals, fireworks, ammunition, leaking hazardous items, CFLs/Fiuorescents, power equipment with fuel, photo chemicals and construction materials from new, expanded or remodeled facilities.

I suspect the above information will indicate we have addressed your request for clarification. Please contact me directly at (916) 770-8521 should you have any questions.

Lastly, the next time you plan to visit one of our facilities I would be more than happy to 0 •
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meet you and conduct the visit/inspection together to better provide information on our environmental program.

Regards,
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Kenneth W. Woodlin ·
Sr. Director- Environmental Compliance
Attachments (2)
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July 25, 2008, Email communication sent to all California Wai-Mart Market Managers, Market Technical Specialists and Assistant Managers in attendance at the Wai-Mart Week 17 Environmental Management System Training.

For Wai-Mart Associates:

Previously the California Environmental Management team sent a communication on empty aerosol management to cover with your management team. Our next talking point provides further clarification on the management of nonfunctioning and/or damaged aerosol cans. Immediately, below is a detailing of how one should manage nonfunctioning and/or damaged aerosol cans in California.
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***Always manage nonfunctioning and/or damaged aerosols in the blue drum located at the Hazardous Waste Central Storage Area.

An aerosol missing the spray nozzle (actuator) is ALWAYS considered damaged as it can no longer operate as intended by the manufacturer. Sometimes an aerosol may appear as though it is not damaged because the actuator spray mechanism is in place but a customer has indicated the spray mechanism did not function properly and in such cases the defective slip should indicate this and this aerosol MUST be managed in the blue drum . •
Never send aerosols to the Return Center when the spray nozzle (actuator) is damaged/missing or when a customer has indicated the spray mechanism no longer operates as intended by the manufacturer. For example if a customer returns an aerosol and when asked for reason of return states the aerosol did not work or is broken then this MUST be written on the defective slip and it MUST be managed in the blue drum.

Follow these steps when determining if the spray nozzle or actuator is damaged (ALL STEPS MUST BE REVIEWED): .
1) Check the aerosol to ensure it has the spray nozzle or actuator. If the spray nozzle or actuator is missing, it MUST be managed in the blue drum. (Never (emove an actuator from the. can. An aerosol with a missing spray nozzle or actuator can no longer be used as intended by the manufacturer and MUST be managed in the blue drum.)
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2) Look at the spray nozzle to see if it appears damaged or clogged. (An item from the sales floor can be used for visual comparison to determine if the spray nozzle is •
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damaged or clogged.) If the spray nozzle appears defective, damaged, or clogged it MUST be managed in the blue drum. Do not attempt to fix the damaged or clogged nozzle.
3) Check the aerosol can for a defective tag indicating it will not operate or it is damaged or broken. Any aerosol with a defective tag indicating it will not operate, is damaged, or is broken MUST be managed in the blue drum regardless of whether it appears as though it could function normally . •
DO NOT •

PRESS THE SPRAY NOZZLE ON AN AEROSOL TO DETERMINE IF IT IS OPERABLE.
***Again always manage damaged al;lrosqls in the blue drum located at the Hazardous Waste Central Storage Area.
***Always manage aerosols missing an actuator in the blue drum located at the Hazardous Waste Central Storage Area.
***Always manage aerosols with a-defective tag indicating it will not operate or it is damaged or broken in the blue drum located at the Hazardous Waste Central Storage Area.

Refer to the CG 703/704 (Wai-Mart) or CG 904/905 (Sam's Club) on THE WIRE for more information.

Call the Compliance Hotline at 1-800-530-9923 with any questions . •
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July 25, 2008, Email communication sent to all California Sam's Club Market Managers, and Operations Managers in attendance at the Wai-Mart Week 22 Environmental Management System Training.
;. For Sam's Club Associates:

A couple weeks have passed since we all gathered together for a full day of Environmental Management System training. As discussed during that training we said periodic notices would be sent to you highlighting particular focus areas of environmental management at your facility. As our initial communication, we are providing information on the management of nonfunctioning and/or damaged aerosol cans. Immediately, below is a detailing of how one should manage nonfunctioning and/or damaged aerosol cans in California.·
***Always manage nonfunctioning and/or damaged aerosols in the blue drum located at the Hazardous Waste Central Storage Area.

Never send aerosols to the Return Center when the spray nozzle (actuator) is damaged/missing or when a customer has indicated the spray mechanism no longer operates as intended by the manufacturer. For example if a customer returns an aerosol and when asked for reason of return states the aerosol did not work or is broken then this MUST be written on the defective slip and it MUST be managed in the blue drum.

Never donate aerosols to charities when the spray nozzle (actuator) is damaged/missing or when a customer has indicated the spray mechanism no longer operates as intended by the manufacturer. For example if a customer returns an aerosol and when asked for reason of return states the aerosol did not work or is broken then this MUST be written on the defective slip and it MUST be managed in the blue drum. •
Follow these steps when determining if the spray nozzle or actuator is damaged (ALL STEPS MUST BE REVIEWED):
1) Check the aerosol to ensure it has the spray nozzle or actuator. If the spray nozzle or actuator is missing, it MUST be managed in the blue drum. (Never remove an actuator from the can. An aerosol with a missing spray nozzle or actuator can no longer be used as intended by the manufacturer and MUST be managed in the blue drum.)
2) Look at the spray nozzle to see if it appears damaged or clogged. (An item from the sales floor can be use.d for visual comparison to determine if the spray nozzle is damaged or clogged.) If the spray nozzle appears defective, damaged, or clogged •
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it MUST be managed in the blue drum. Do not attempt to fix the damaged or clogged nozzle.
3) Check the aerosol can for a defective tag indicating it will not operate or it is damaged or broken. Any aerosol with a defective tag indicating it will not operate, is damaged, or is broken MUST be managed in the. blue drum regardless of whether it appears as though it could function normally.

DO NOT PRESS THE SPRAY NOZZLE ON AN AEROSOL TO DETERMINE IF IT IS •
OPERABLE.
***Again always manage. damaged aerosols in the blue drum located at the Hazardol:ls •
Waste Central Storage Area.
***Always manage aerosols missing an actuator in· the .blue-drum located at the Hazardous Waste Central Storage Area.
***Always manage aeros.ols with a defective tag indicating it will not operate or it is damaged or broken in the blue drum located at the Hazardous Waste Central Storage Area.

Refer to the CG 703/704 (Wai-Mart) or CG 904/905 (Sam's Club) on THE WIRE for more information.

Call the Compliance Hotline at 1-800-530-9923 with any questions . •
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ENTERED FEB 0 3 2011 f • '

COUNTY OF SAN DIEGO

COMPLIANCE INSPECTION REPORT

BUSINESS NAME
ADDRESS \1-D '\DU)t..J.

CITY/ZIP 1 Q:z..o-:r-\
_L OF _/ DATE ____.__, ___,__,
PERMIT # I '-f
TIME sTART 10 1om
BUS. CODE
SPECIALIST H (£

INSPECTION CONTACTITJTLE
]l)MH'I \.-\euoW L ¥\SST
PHONE: ({py;r) i..f+C1 ..... i-qC0
On the above date, an inspection of your business/facility was conducted in order to determine compliance with the California Health and Safety Code (HSC) Chapters 6.5, 6.7, 6.95; Titles 19, 22 and 23 of the California Code of Regulations (CCR); and the San Diego County Code (SDCC).

The following remarks are intended to provide guidance to correct the violations noted on the attached violation report. -
NOTE: Reinspection fees will be charged if additional inspections are required to determine compliance.

Y N/A Y N/A
0 0
0 0 D 0
0 0 D 0
0 0 0 0
0 D 0 0
0 0
RECEIVED FEB 0 3 2011
-
x!LtLt£2E
Date Signed
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: 619 338-2222 Fax: 619 338-2377 1-800-253-9933 htt ://www.sdcount .ca. ov/deh/hmd/index.html HM-924 ( 12/06) NCR DISTRIBUTION: WHITE- RETURN TO HMD; YELLOW-BUSINESS RETAINS --
•

OFFICE USE
SAN DIEGO REGIONAL .lflf)l

HAZARDOUS TERIALS QUESTIONNAIRE BP
Business Name Buslness Contact Telephone#
Walmart Store #1917
Project Address
170 Town Center Parkwa
Vicki In ram 479 204-0220
City ==-----,s"'t,-at""e---!Z,-ip.::.C;od-=:-e-
•
APN#
Santee CA 92071
Mailing Address City State Zip Code Plan File#
2001 S.E. lOth Street Bentonville AR 72716
Project Contact Telephone#
Chelsea Covin ton Maass, Permit Coordinator 415 782-4101 The following questions represent the facility's activities, NOT the specific project""d:,.es:::c,:rf;.p"Ot:Cio,.::n:.. =-='--------- or any
to plan submittal.

1. Explosive or Blasting Agents 5. Organic Peroxides

2. Compressed Gases 6. Oxidizers

9. Water Reactives

10. Cryogenics
Indicate by circling the item, whether your business
must contact the Fire Protection Agency with

13. Corrosives

14. Other Health Hazards

3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These.

4. Flammable Solids B. Unstable Reactives 12. Radioactlves lo the Issuance of a
FEES ARE REQUIRED. Expected Date of Occupancy:

YES NO

1. 1!!1 0 Is your business listed on the reverse side of this form? (check all that apply).

2. 1Kl 0 Will your business dispose of Hazardous Substances or Medical Waste in any

3. 1!!1 0 Will your business store or handle Hazardous Substances In quantities equal to 55 gallons, 500 pounds. 200 cubic feet, or carcinogens/reproductive toxins in any

4. 0 Will your business use an existing or install an underground storage tank?

5. 0 Will your business slore or handle Regulated Substances (CaiARP)? tha'NO V 2 0 2008
DEH
answer to any of
,CA92101.

CaiARP Exempt
Date
Required
Initials
0 Complele
If the answer to any of the questions below Is yes, applicant must contact the Air 31-1649, telephone (858) 586·2600 prior to the issuance of a building or demolition permit. Note: If the answer to 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation, except demolition or renoyation of residential structures of four units or less. Contact the APCD for more Information.

YES NO

1. 0 rl!l Will the subject or construction activities Include or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet at
, and the list of typical equipment requiring an APCD permit on the reverse side of this from. . ·

2. 0 0 (ANSWER IF QUESTION 1 IS YES) I the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)? (Public and privale schools may be found after search of the California School Directory at hHp://www.cde.ca.gov/re/sd/; or contact the appropriate school district).

3. 0 1&1 Will there be renovation that Involves handling of any friable asbestos materials, or disturbing any material that contains non-triable asbestos?

4. 0 1&1 Will there be demolition Involving the removal of a load supporting structural member? describe business activities:
il
I declare under penalty of that to lhe best of my knowledge Chelsea Covington Maass
Name of owner or Authorized Agent
FOR OFFICIAL USE ONLY:

Briefly describe proposed project: 0
si
10 1 9 1 08
Date
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ___________________ --:------------ BY:_______________________ DATE:
__ .t.../ __ _,_/ __ _
HM·917t (04/07)

REQUIRED
APCO
RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY REI EASED FOR OCC=U;.;PA..;.N;.;CY_;_ _____ _

COUNTY-HMO APCO COUNTY-HMO APCO
County of San Diego- DEH- Harnrdous Materials Division
GARY W. ERBECK

DIRECTOR
November 19, 2008
Wai-Mart Store #1917
of

DEPARTMENT OF ENVIRONMENTAL HEALTH

HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112·9261
(619) 338-2222 FAX (619) 338-2377
1-800-253-9933
www.sdcdeh.org
170 Towne Center Parkway
Santee, CA 92071
Dear Sir or Madame:

JACK MILLER

ASSISTANT DIRECTOR
RE: BELOW GRADE SERVICE PIT NEW/USED OIL TANKS LOCATED AT WAL-MART STORE WAL-MART STORE #1917, 170 TOWNE CENTER PARKWAY, SANTEE, CA 92071 PERMIT #132274
The County of San Diego, Department of Environmental Health (DEH), Hazardous Materials Division (HMO) is the San Diego County Certified Unified Program Agency (CUPA). The HMO, as the CUPA, is responsible for implementing and enforcing the Calif:lrnia State underground storage tank (UST) laws and regulations. ·
On September 4, 2008, Michelle Price with HMO conducted a site visit at the above location to determine whether 4 - 400 gallon (2- 400 gallon new oil and 2 - 400 gallon used oil) tanks located in the below grade service pit area, meet the UST exemption requirements underthe California Health & Safety Code (HSC), Chapter 6.7,Section 25283.5. Based on the tanks final construction and location, HMO has determined that the4- 400 gallon tanks will satisfy the UST exemption requirements. Please be advised in order for the 4- 400 gallon tanks to maintain the exemption, you must comply the requirements of(HSC), Chapter 6.7, Section 25283.5 as stipulated below:·
a) All exterior surfaces of the tank, including connected piping, and the floor directly beneath the tank, can be monitored by direct viewing.
b) The structure in which the tank is located is constructed in such a manner that the structure provides for secondary containment of the contents of the tank, as determined by the local agency designated pursuant to Section 25283.
c) The owner or operator of the underground storage tank conducts weekly inspections of the tank and maintains a log of inspection results for review by the local agency, designated pursuant to Section 25283, as requested by the local agency. d) The local agency designated pursuant to Section 25283 determi.nes without objection from the board that the underground storage tank meets reql.irements wliich are equal to or more stringent than those imposed by this chapter.
"Environmental and public health leadership, partnership and science" Please be advised that failure to maintain the exemption criteria under HSC Chapter 6.7, Section 25283.5 may nullify or cause revocation of the underground storage tank exemption. If future amendments are made to the State law or regulations, the exemption may be subject to change or revocation. If future modifications are made to this tank, you should contact our Department for prior approval before commencing construction activities.

Please maintain a copy of this letter onsite to be made available for review during regulatory inspections by State or local agencies.

Robert Rapista, Supervising Environmental Health Specialist Hazardous Materials Division
cc: Cecilia Lewallen, Environmental Health Specialist IlL HMO Michelle Price, Environmental Health Specialist II, HMD File# 132274 HUVT6
COUNTY OF SAN Dill GO CUP A OFFICE USE ON'i!/ l21-'2- :z.._ DEPARTMENT OF ENVIRONMENTAL HEALTH UPFP#

HAZARDOUS MATERIALS DIVISION
P.O. BoK 129261, San Diego, CA 92112-9261 Reviewer (619) 338-2222; Toil free 1-800-253-9933; Fax (619) 33B-23n www,§dcounty.ca.gov[deh/hmd/ DAppruvo ORJ:jcl:l
Call!:

CLAIM OF EXEMPTION FROM UNDERGROUND STORAGE TANK REGULATION AND LAW ,·: :: .: :i ''i: T>·;";i ;c;J;; !'J{:j!';:'-1;:·:,:: -:, :! FACIUTY NAME: Wai-Mart Store #1917
FACILITY ADDRESS: 170 Town Center Parkway Santee 92071
Stll!el Number Sheet Name City Zip Code
:.=Rli$Ti?.'. ;;:r\·;:.i;) ,: : \::·:2 ;: ':: .:

Name: Wai-Mart Store #1917
Malllng Address: 170 Town Center Parkway
Cily: Santee Slale: CA Zip: 92071
Phone: ( 619) 449-7900 E-Mail:
!:ART?.; TANK INFORMATION:"; :, ::;,:; '. .. . . .. ., . :· ...... . . .. :! ... ':I •:'1 Name/IDI# (If applicable): Conslrucllon Malerlals (sleel, nberglass, concrete, other): steel Capacity {gallons): 4 x400 Type ofCon•lnlcllon {single wall, double wall, otller): double wall Tank Localion (specify w11ere on lhe pmperty): in the pit area of the TLE PART 4- CLA/fVI OF EXEMPTION (CHOOSE 1, 2, 3, OR 4.)
0 1. The tank stores (and has only stored) a non-hazardous substance and is non-regulated.

Complete Parts 5 & G.
0 2. The tank stores or could store a hazardous substance and is exempt pursuant to Ch. 6.7 H&SC §25281 (y).

Choose A, 8, C, or D.
0 A. A lank with a capacity of 1;100 gallons or less which is located on a farm and which stores molar vehicle fuel used primarily for agricultural purposes and not for resale. 0 B. A lank which is located on a farm or atlhe residence•or a person, which has a capacity of 1,1 DO gallons or less, and which stores home heatlng oil for consumptive use on the premises where slored. 'Mark a loca!lon:

D Single family residence 0 Dormllory
D Multiple family residence D Hotei/Motei/Condotel
0 Barracks D Other (speciiy):

D c. A structure exempted by H&SC §25281 (choose one):

D sumps D oil field gathering lines D well cellars
D separators D refinery pipelines D separation sumps
D stonn drains D lagoons D lined or unlined pits
D catch basins D evaporation ponds 0 Other:

1. Attach addJUonellnfonnaUonldlagrams describing the tanks structure, process, description of materials used or generated In the process, the treatment method, and the method & frequency of filllng and emptying the structure.

2. Sumps which are a part of a monlloring system required under H&SC §25291 or §26292 and sumps or other structures defined as underground storage tanks under the federal act are not exempted by this subparagraph.

I D D. A tank holding hydraulic fluid for a closed loop mechanical system that uses compressed air or hydraulic fluid to operate llfls, elevators, and other similar devices. ' ' Be advised: structures idenURed in subparagraphs (C) and (D) may be regulated by lhe SWRCB and any Regional Board pursuant to the Porter-Cologne Water Quality Control Act (Division 7 (commencing wllh §13000) of the Water Code) to ensure that they do not pose a threat to water quality. {
HM:978 (10-07)
IE) 3. The tank and associated piping are located In a vault or basement, which meets the requirements of H&SC § 25283.5. All of the following criteria must be met (1) All exterior surfaces of the lank, Including connected piping, and the floor directly beneath the tank, can be monitored by direct viewing. (2) The structure In which the tank Is located Is constructed In such a manner that the structure provides for secondary containment of the contents of the tank, as determined by the local agency designated pursuant Ia H&SC §25283. (3} The owner oroperetorofthe undergrnund storage lank conducts weekly lnspecUons of the lanlt and maintains a log of Inspection results for review by the local agency, designated pursuant to H&SC §25283, as requested by the local agency. (4) The local agency designated pursuant to H&SC §25283 determines without objecUon frnm the board !hat the underground storage tank meets requirements that are equal to or more stringent than those Imposed by this chapter.

D 4. The tank Is exempt per CCR 2621. Choose A, B, C, D, E or F.

D A. A liquefied petroleum gas tank.
0 B. A liquid asphalt tank.

D c. A sepllc tank.
0 D. Tanks containing radioactive material such as spent fuel pools, radioactive waste storage lanl1s, and similar lanlls · under the Atomic Energy Act of 1954 (42 USC 20·1·1) and following. 0 E. An emergency containment Lank kept empty to receive accidental spills and approved for such use by the apprnprfale local agency. Maintain approval letter atlanlt location. 0 F. Undergrnund storage lanlts containing hazardous wastes as defined In H&SC §25316 are regulated pursuant to 22 CCR §66265.190 eL al. :·Pii.Rf5 .. 8f.siibsianceictJeliiicat cCinipi:isiti2!ii CJ(au maienals eiierstoreCI ilitiie-·tantc ·· ' . ::·:; (silecltitlliiavVme'lats ir present (e. 9 .. r:llroniiiuii. cop/:ie't,"nicJceit. elc:;.; •· . . .. ·. • . .. ... · .. 0 PRIOR TO 1/1164: Subslance(s): Chemical Composlllon (%We'1ghl I %Volume):
0 ON/AFTER 111/64: Substance(s): Chemical Composition (%Weight I %Volume):
used oil I new oil
Is U1e tank: 0 A. Empty 0 B. Unknown 181 c. Tanlt bottom sludge or liquid remains inside lank : ,IY.P,[?,.i •.. .. hCJze.(QqiJ.s, C,Cl_flJP!Y. P!e Gali{ornia ljndergrounq .·.· , · ..... .. _, · ltii aua&iieci.'tJiplnfi.).uliaH ::' · , ; diirc?nnatr:.. anEii#s, «:se)-'i6.$Ilf/iia'i:ttl:!e. ·tariWstri/.ct!itTJlf1 ·;,at · ":1.\':·:·;.::..'::: U :?Y2i !{ \'/·u:.:/ '-: \' ··· :::· .. ·._;:: i ;\ '-': :: ·i: ::.:, ;: '! The request will be reviewed and either approved or rejected. An apprnved copy of thts claim should be maintained on stte avaDable for ravlaw during lnspecUon. Attach any additional Information (e.g., lab analysis) to support the clalm that the underground storage tank/structure Is not regulated or Is exempt from the regulations.

Laurie Dickard Permit Coordinator
PrlntName
( 479 ) 619-3815 April 15, 2008
Telephone Dale
HM:978 (10-07)
WAL*MART®

COMPLIANCE
December 14, 2009
t.l StiaW"' Shaw Environmental, Inc.

RE: Walmart I Shaw Partnership for Managing Permitting Requirements To Whom It May Concern,
This letter is to inform you that Walmart Stores, Inc. has contracted with Shaw Environmental Inc. (Shaw) to manage all permit renewals for an indefinite period of time. Permitting, registration, notification responsibilities will now be handled by Shaw. Walmart has provided the attached limited Power of Attorney which provides Shaw the authority to sign applications as an agent for Walmart Stores, Inc.

Any future correspondence, permits and associated renewal invoices should be provided to:

Shaw Environmental, Inc.

ATTN: Licensing Support
11206 Thompson Avenue
Lenexa, KS 66219
If you have any additional questions, please contact Shaw at the following:

Phone: 877-829-5505
Fax: 225-987-3705
Email: [email protected]
Thank you,
Shaw Environmental, Inc.

Enclosures:

Invoice 513217 and $574.00 Payment
Invoice 503059 and $1041.00 Payment

SAN DIEGO COUNTY

DEPARTMENT OF ENVIRONMENTAL HEALTH- CUPA

HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(619) 338-2222 FAX (619) 338-2377
'--- 1-800-253-9933
BUSINESS OWNI(R/OPRRATOR IUt<:NTfFJCATION
I. IDENTIFICATION
FACILITY ID#
1 3
1 7
1 I o 1113121217
1 BEGINNING DATE 100 I ENDING DATE 101
0 0 4
07/13/2010 08/31/2011
BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 BUSINESS PHONE 102 Wai-Mart Store #1917 619-449-7900
BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a
170 Town Center Parkway
BUSINESS SITE CITY 1041 ZIP CODE 105 COUNTY
Santee CA 92071 San Diego 108
DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a 05-195-7769 5311 4529, 812922, R111 01
BUSINESS MA!LING ADDRESS 108a
702 Southwest 81
" Street

BUSINESS MAILING CITY STATE ZIP CODE
Bentonville 108 b AR 108 c 72716-0500 108d

BUSINESS OPERATOR NAME BUSINESS OPERATOR PHONE
Wai-Mart Stores., Inc., 109 479-204-2324 110
II. BUSINESS OWNER
OWNER NAME 111 OWNER PHONE 112
Wai-Mart Stores., Inc., Attn: Licensing 479-204-2324
OWNER MAILING ADDRESS 113
702 Southwest 81
" Street
OWNER MAILING CITY 114 STATE 1151 ZIP CODE 116
Bentonville AR 72716-0500
Ill. ENVIRONMENTAL CONTACT
CONTACT NAME 117 CONTACT PHONE 118
Nathan Stines, Environmental Compliance Manager 479- 372-8253 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a
702 Southwest 81
" Street
CONTACT MAILING CITY 120 STATE 121 I ZIP CODE 122
Bentonville AR 72716-0500
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARYNAME 123 NAME 128 Tina Hertenstein Tammy Mello
TITLE 124 TITLE 129
Store Manager Asst. Manager
BUSINESS PHONE 125 BUSINESS PHONE 130
619-449-7900 619-449-7900 "')A Ur'\lln n1 ,,....,,... 126 "')A Ur"\lln .,..., , ...... ·- 131 r>AGER # 1271 PAGER# 132
ADDITIONAL LOCALLY COLLECTED INFORMATION: Billing Address: Shaw Environmental, Inc. Attn: Licensing Support 133 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete.

Qli!INERIOPERATOR OR DESIGNATED REPRESENTATIVE DATE 1341 NAME OF DOCUMENT PREPARER 135 Zr/I'D// 0 Shaw Environmental Inc.,
NAME OF SIGNER (print) 136 TITLE OF SIGNER 137
Nathan Stines Environmental Compliance Manager

SAN DIEGO COUNTY

DEPARTMENT OF ENVIRONMENTAL HEALTH-CUP A

HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
1-800-253-9933 (619) 338-2222 FAX (619) 338-2377

HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION
The California Health & Safety Code fH&SC), Division 20, Chapter 6.95, Section 25505 provides for the following:
/
The San Diego County, Department of Environmental Health, Hazardous Materials Division (HMO), as the administering agency, requires a business that handles hazardous materials to submit the hazardous materials inventory, a list of emergency contacts, and a site plan, in lieu of a complete Hazardous Materials Business Plan (HMBP), only after the initial submittal of a complete HMBP. The business must certify that a complete HMBP has been prepared and is maintained at the site where the hazardous materials are stored. A complete HMBP includes the items to be submitted to the HMO and an Emergency Response Plan and Employee Training Plan, as established in H&SC Section 25504. The business must also annually certify that the HMBP is current and maintained on site. See Back for instructions and further clarification.

FACILITY ID#
Wal-Mart Stores, Inc. (Store# 1917)

BUSINESS SITE ADDRESS
170 Town Center Parkwa
CITY 104
II. CERTIFICATION STATEMENT
0 CARCINOGEN/REPRODUCTIVE TOXIN ANNUAL RENEWAL WITHOUT CHANGES: This is an annual renewal to certify that the list of carcinogens and/or reproductive toxins last provided is a current list as specified in the San Diego County Code of Re ulator Ordinances Section 68.1113.

Check only one of the following boxes:
0 INITIAL CERTIFICATION: INITIAL CERTIFICATION: This is to certify (H&SC Section 25505(e)(l)) that a complete HMBP, which includes the hazardous materials inventory, a list of emergency contacts, a site plan, emergency response plan, and employee training plan, has been prepared and is maintained at the site where the hazardous materials are stored. 0 ANNUAL CERTIFICATION WITHOUT CHANGES: This is an annual certification (H&SC Section 25505(d)&(e)(2)) that the HMBP, which includes the hazardous materials inventory, a list of emergency contacts, a site plan, emergency response plan, and employee training plan, is current and includes all the information required in H&SC Section 25504, and 25509, and Is maintained at the site where the hazardous materials are stored.
[8J CERTIFICATION OF CHANGES/REVISIONS: This is to certify that the HMBP has been reviewed (H&sc Section 25505(c) & 25510) and all necessary changes/revisions have been made. The HMBP is current and Is maintained at the site where the hazardous materials are stored. Attached are changes to the hazardous materials inventory and/or list of emergency contacts. For site map revisions, submit only the pages that have a change or revision and attach to this certification. This submittal satisfies annual certification re uirements s ecified in H&SC Section 25505 d e 2 .

AS AN AUTHORIZED REPRESENTATIVE, I CERTIFY UNDER THE PENALTY OF LAW, THAT I HAVE PERSONALLY EXAMINED

AND AM FAMILIAR WITH THE INFORMATION SUBMITTED AND BELIEVE THE INFORMATION IS TRUE, ACCURATE, AND

HIRT SITE
[]**FIRE
DIST.

Contacts
DATE

TITLE OF SIGNER
Environmental Compliance Manager
*Note: Indicate the date that the inventory and/or ER contact information in the KJV A database was reviewed and changes were submitted for processing. If the inventory and ER contact information are exactly the same as it is recorded in KJV A, no changes need to be submitted.

Hazardous Materials Business Plan acceptance date will be changed to the acceptance date on new site map.

SAN DIEGO COUNTY

DEPARTMENT OF ENVIRONMENTAL HEAL TH-CUPA

HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848

HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION
The California Health & Safety Code (H&SC). Division 20. Chapter 6.95, Section 25505 provides for the following:

The San Diego County, Department of Environmertai Health, Hazardous Materials Division (HMD), as the administering agency, requires a business that handles hazardous materials to submit the hazardous materials inventory, a list of emergency contacts, and a site plan, in lieu of a complete Hazardous Materials Business Plan (HMBP), only after the initial submittal of a complete HMBP. The business must certify that a complete HMBP has been prepared and is maintained at the site where the hazardous materials are stored. A complete HMBP includes the items to be submitted to the HMD and an Emergency Response Plan and Employee Training Plan, as established in H&SC Section 25504. The business must also annually certify that the HMBP is current and maintained on site. See Back for instructions and further clarification.

FACILITY ID#
BUSINESS NAME (Same"' FACILITY NAMEo' DBA- Doing Bosin<ss A•) Walmart #1917

BUSINESS SITE ADDRESS
170 Town Center Parkwa
CITY 104
II. STATEMENT
0 CARCINOGEN/REPRODUCTIVE TOXIN ANNUAL RENEWAL WITHOUT CHANGES: This is an annual renewal .to certify that the list of carcinogens and/or reproductive toxins last provided is a current list as specified in the San Diego County Code of Re ulalor Ordinances Section 68.1113.

Check only one of the following boxes: .

I 0 INITIAL CERTIFICATION: INITIAL This is to certify (H&SC Section 25505(e)(1)) that a complete HMBP, which includes the hazardous materials inventory, a list of emergency contacts, a site plan, emergency response plan, and employee training plan, has been prepared and is maintained at the site where the hazardous materials are stored. 0 ANNUAL CERTIFICATION WITHOUT CHANGES: This is an annual certification (H&SC Section 25505(d)&(e)(2)) that the HMBP, which includes the hazardous materials :inventory, a list of emergency contacts, a site plan, emergency response plan, and employee training plan, is current and includes all the information required in H&SC Section 25504, and 25509, and is maintained at the site where the hazardous materials are stored.

IZI CERTIFICATION OF CHANGESfREVISIONS: This is to certify that the HMBP has been reviewed (H&SC Section 25505(c) & 25510) and all necessary changes/revisions have been made. The HMBP is current and Is maintained at the site where the hazardous materials are stored. Attached are changes: to the hazardous materials inventory and/or list of emergency contacts. For site map revisions, submit only the pages that have a change or revision and attach to this certification. This submittal satisfies annual certification re uir ments s ecified in H&SC S ction 25505 d e 2 .

AS AN AUTHORIZED REPRESENTATIVE, I CERTIFY UNDER THE PENALTY OF LAW, THAT I HAVE PERSONALLY EXAMINED

AND AM FAMILIAR WITH THE INFORMATION SUBMITTED AND BELIEVE THE INFORMATION IS TRUE, ACCURATE, AND

HIRTSITE
[]**FIRE
DIST.
ite Map
D *Emergency

TITLE OF SIGNER
Senior Manager, Environmental Health & Safety
),. 1 1 r 1 _LL_ *Note: Indicate the date that the inventory and/or ER contact ..:.1: information in the KIVA database was reviewed and changes were : I 1 submitted for processing. If the inventory and ER contact information -.- ------ are exactly the same as it is recorded in KIVA, no changes need to be i submitted.

Hazardous Materials BJsiness Plan acceptance date will be changed to the acceptance date on new site map.

ENTERED JUN 1 4 201fy

COUNTY OF SAN DIEGO

COMPLIANCE INSPECTION REPORT
PAGE _I_ OF ___!f DATE l-( I ¥£:: !I
PERMIT# [3 r2c:l 7 L{BUS. CODE k I
TIME START 1( {S-END /_: 3 I_
SPECIALIST r; 'TZ.etJ. e;.ur,'ce,
( Vi3;,., ') INSPECTION t1l A I
w Of lrl L (j f!. WI a:l.t:t.L
TITLE
PHONE ( (d l ) ciTY/ZIP --S.a,.:TZe q ;;)_ (1) 7 I
On the above date, the Cmmty inspected your facility under the authority of the California Health and Safety Code (H&SC), to detennine compliance with applicable provisions of the H&SC, the California Code of Regulations (CCR), and the San Diego County Code of Regulatory Ordinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.8 & 25404.1.2) for any minor violations as defined in H&SC 25404 and 25117.6. This report may contain both minor and more significant (Class II) violations. Minor violations do not include repeat violations or violations remaining uncorrected for more than 30 days (or as specitied below).

Minor violations do not include knowing, willful, intentional, or chronic violations; nor do they include violations showing a pattern of neglect or disregard.

The remarks below are intended to provide guidance to correct any violations indicated on the attached violation report. You must submit a written response to this report within 30 days (or as specified below) demonstrating that all violations have been corrected or include a written notice of disagreement that clearly states the reason for any disputed violations. Prompt correction can protect you from penalties for a "minor violation". Penalties can be imposed for each day in violation for all other violations even if they are corrected promptly. However, correction within 30 days (or as specified below) will make a penalty less likely.

NOTE: Reinspection fees will be charged if additional inspections are required to determine compliance.

Unified Program Facility Permit current Permit Expires on: /0 I :S I I 1/ Hazardous Materials Business Plan available E:r D Contingency Plan available DLQG Employee training is adequate D D Employee training records available Waste disposal records available for review GV D Universal waste man)lged properly Emergency contacts current D Updated today 13/ D Waste containers l!fclosed D labeled Chemical inventory/map current I:91Jpdated today 13' D Waste in 17 Consent to inspect granted by: Pei,y"'>>J'-.V\ 'fr; Jh/m. photo!:/"iAl This is an annual certification that the Hazardous Materials Business Plan (inventory & site map, emergency contacts, emergency response plan, and employee training plan) is current and includes all the information required in the H&SC and is maintained at the site where bazardous materials are stored.

PRINTED NAME OF FACILITY REPRESENTATIVE DATE SIGNED
'"Du \A c...CA..""' ? 'f 1 5 1 I ( TITLE OF FACILITY
Initials of Facility Representative
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: 619 338-2222 Toll Free: 800 253-9933 htt ://www.sdcdeh.or HM-924 (11/08) NCR '(Y= Yes: N/A =Not Applicable) DISTRIBUTION: WHITE-HMD COPY: YELLOW-FACILITY COPY COUNTY OF SAN DIEGO EST. NUMBER H I 3,;< .;2 7 £(
DATE: l(-S[://
PAGE: ;:2,. OF __ t+-Y--
-$,o (/ / 14-even 1' !no Gn 77kl '+-- Q,Mff?IZ! ¢'4 > 11 (e s ,/?k J() , slgnel b. 1 t.j z,5
,.n r:ec oVI /.:2- a11r/L
revi'eweA ,?1.-:+ lf-tl <t#{J'&d's 72 /z e a& ..<J;;,v.a??,., · I 1 •
Gv Ne.( f rv-e__. &-<b' en '· u t' tr ' fu he ( eu cb Cori7iiiih e c . or!( .sc'des. ,
4u,'vqletzTJq 7/!tJ}/'fa//dlt'J?t!/;@t!jN12tti7Jlkn .s/te, __. 4-B-tr ASVV\
Signature of Business Representative Date Signed Title
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-9110 (Rev. 2199) NCR
DISTRIBUTION: WHITE-RETURN TO HMO

YELLOW-BUSINESS RETAINS
COUNTY OF SAN DIEGO PERMIT# ( 3 .;2;{_ 7f/
DATE !i_t _EO _Lj_
SUPPLEMENTAL COMPLIANCE INSPECTION REPORT PAGE __3._ OF __!j_ - :;; -?t2t ,f:;;;; :t:iJ::fh "J
MC cemuvuTcUJ7r:n 10$ nee m uhrm ,' C- ; ' "
- k) c?! q &eT cyl,h INs sli:h A e/;12rV\ 72 JJz/ £/loon s « ?!!;Jzu:x:!n:;zoe P'¢k2 s ••

SIGNATURE OF BUSINESS REPRESENTATIVE
HM-9110 (11/08) NCR White: HMD Yellow: Business retains

DATE SIGNED TITLE OF BUSINESS REPRESENTATIVE
DEH-Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261

COUNTY OF SAN DIEGO
MEDICAL WASTE REQUIREMENTS·
COMPLIANCE INSPEC'flON REPORT
PERMIT # /3 ;;;>..;:::)_ 71/
DATE
PAGE
BUSINESS ADDRESS: -+/_2'-'-u.L.· -:-::---:-----::-::-:-=---:--:-:::c:-:-::-- VIOLATION REPORT: The items checked below refer to specific section numbers of the California Health and Safety Code Sections 25100 and 117600 et. a/.; the San Diego County Code of Regulatory Ordinances Sections 68.1201 et. a/.; and the California Code of Regulations, Title 22 Sections 65600 et. a/.

All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use tbe Corrective Action Form to document your return to compliance. Your Specialist can provide tbese forms. Please call (619) 338-2222 or your Specialist if you bave any questions.

STORAGE AND LABELING

VIOL VIOLATION DESCRIPTION
D V4201 UPF Pennit not obtained. 117705, 68.905
D V4202 Medical Waste (MW) not separated from other waste at point of origin. 118275
D V4203 Enclosure or designated accumulation area for MW containers not secured. 118307, 118310
D V4204 MW designated accumulation area not posted with an approved and legible biohazardous waste "warning sign"
in English and Spanish. 118310
D V4205 Medical SOLID WASTE not secured to deny
access to unauthorized persons. 68. 1211
D V4206 Spill of MW not properly cleaned up. 118300
D V4207 Sharps not stored in approved and properly marked sharps container. 118285(a)(d)
D V4208 Full sharps container not taped closed or tightly-lidded to preclude loss of contents. 118285(b)
D V4209 Red bags/sharps container not labeled with generator's name. address. and phone number. 68.1205,68.1206
D V4210 MW not stored in approved and properly marked
red bags. 118275
D V4211 Red bags not tied off to prevent leakage/expulsion of contents during handling and storage. 118280(a)
D V4212 Red bags not containerized in rigid, leak resistant, and covered containers or bins. 118280(b)
D V4213 Waste container/bin not labeled on the lid and
side so as to be clearly visible. 118280(b)
D V4214 Reusable containers/bins for MW storage not kept clean/sanitary. 118295, 118305
D V4215 Frozen (OC/32 F) MW stored >90 days. 118280(d)(2) D V4306 Full sharps container stored >30 days at >O"C. ll8285(c) D V4307 Red bag waste stored >7 days at >O"C (for generators of >20lbs/month). 118280(d)(l)(A)
D V4308 Red bag waste stored >30 days at >O"C (for generators of <20lbs/month). 118280(d)(l)(8)
D V4309 MW interim storage area not marked with warning sign or a biohazard symbol legible from 5 ft. 118307, 118310 D V4310 MW Interim storage area not properly secured. 118307

TREATMENT AND DISPOSAL
D V4251 MW treated by unapproved method/procedure. 118215 D V4252 Standardized ·written operating procedures for steam sterilization not available. 118215(2)(A)
D V4253 Recording thermometer not calibrated annually.
118215(2)(8)
D V4254 No records of annual thennometer calibration checks onsite for at least the past 3 years. 118215(2)(8)
D V4255 Heat-sensitive tape/other approved method not used for each load treated onsite. ll8215(2)(C)
D V4256 Monthly biological indicator or other approved method not used to confmn proper disinfection. 118215(2)(0)
D V4257 Onsite steam sterilization did not reach 121 "C/250 "F for 30 minutes. 118215(2)(8)
D V4258 Treatment records/logs of dates, time and temperature not available for 3 yrs. 118215(2)(E)
D V4259 Disposal of untreated MW to an unauthorized
point. 118340

TRANSPORTATION REQUIREMENTS
VIOL VIOLATION DESCRIY110N
D V4260 Transportation of MW without State Hauler
Registration or a (LQHE) from HMD. 118025
D V4304 No LQHE for "self-hauled" MW
(<20 pounds ofwaste/wk). 118025, ll8030(a)(l)
D V4305 LQHE not renewed annually as required. 118030(b) D V4311 Medical Waste tracking documents not in vehicle transporting MW. 118040(c)
D V4312 MW tracking documents/logs not maintained for 3 years for LQHE. ll8040(a)
SMALL QTY. GENERATORS ONLY (<200 lbs/mo) MW)
0 V4301
D V4302
D V4303
D V4309
Medical Waste Mgmt. Plan (MWMP) not submitted
to HMO (initial/updates if onsite treatment). 117935
Did not maintain and show proof of .. onsite" medical
waste treatment records for 3 yrs. 117943, 118215(2)(E) Did not retain on file disposal receipts/tracking
documents for waste shipped offsite for 2 yrs. 117945(b) MWMP or equivalent information not onsite. 117945

REQUIREMENTS FOR LARGE QUANTITY GENERATORS ONLY
200 pounds of waste generated per month)
El
V4351
V4352
V4353
MWMP not submitted to HMO (initial/updates).
117960, 117970
Records of MW treatment not available for 3 years.
117975. 118215(2)(E)
Did not retain on file disposal receipts/tracking documents for at least 3yrs. for waste shipped off site. 117975 PATHOLOGY. CHEMOTHERAPY. PHARMAC. & HAZ. WASTE
D V4401 Cherne waste not segregated from other MW. 118275(e) D V4402 Cherne waste container not properly labeled. ll8275(e) D V4403 Illegal disposal of chemo waste. 118340
D V4411 Pathology waste not segregated from other MW. 118275(!) D V4412 Pathology waste container not properly labeled. 118275(!) D V4413 Illegal disposal of pathology waste. 118340
D V4421 Pharmwaste not segregated from other MW. 118275(g) [91 V4422 Pharmwaste not properly labeled. ll8275(g)
D V4423 Pharmwaste stored >90 days when container full, or stored longer than one year (max. allowable time). 118280(e)
D V4432 Illegal disposal ofpharmwaste. 118340, ll8222(b) D V444l Illegal disposal of photolhazwaste to sewer/trash. 25189.5

ONSITE MW TREATMENT FACILITY REQUIREMENTS
D V45\)l Onsite MW treatment penni! not obtained/renewed. 117950,118130,118135,65620,65623
D V4502 Current copy of the MW treatment penni! not available. 65621(!), 65623. 118165, 118180
D V4503 Condition(s) of the MW treatmt. permit violated. 65623 SIGNATURE OF BUSINESS REPRESENTATIVE DATE SIGNED TITLE OFUSINESS Rfu>RESENT A TIVE DEH:HM-9255 (7/07) NCR
DISTRIBUTION: WHITE-RETURN TO HMD: YELLOW-BUSINESS RETAINS Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Wai-Mart (#1917)
Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April8, 2011; Photographs by Fitzmaurice
Container storing Hazardous Waste & Waste Pharmaceuticals located in pharmacy. 7lf
4/11/2011
1 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing Hazardous Waste & Waste Pharmaceuticals.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Hazardous Waste & Waste Pharmaceuticals.
4/11/2011
2 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing flammable liquid waste.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing flammable liquid waste.
4/11/2011
3 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Box containing absorbent material.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
IMG_2032
4/11/2011
4 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing toxic solid Hazardous Waste.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing toxic solid Hazardous Waste.
/3.2.27'1
4/11/2011
5 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Two cylinders storing helium compressed gas used for balloons.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Damaged boxes/containers storing alcoholic beverages.
4/11/2011
6 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
One of two Aboveground Storaee Tanks contalnln& Used Oil located at Tire·Lu be Express.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
One of two Abovearound Storage Tanks contalnln& Used Oil located at Tire·lube Express. 4/11/2011
7 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Two of two Above1round Storage Tanks containing Used Off located at Tire-lube Express.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
One of two Above1round Storage Tanks contalnln1 Used OU loated at Tire-Lube Express. 4/11/2011
8 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Quick charge station for automotive batteries at Tire-Lube Express.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Quick charge station for automotive batteries at Tire-Lube Express. l3 :2_;2 71{
4/11/2011
9 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Acid neutralizer at quick charge station for automotive batteries.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Tank containing carbon dioxide gas
4/11/2011
10 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Tank containing carbon dioxide gas.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing Hazardous Waste & Waste Pha rmaceuticals located in pharmacy. 4/11/2011
11 Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing Hazardous Waste & Waste Pharmaceuticals located In pharmacy.

Wai-Mart (#1917) 170 Towne Center Parkway, Santee, 92071 April 8, 2011; Photographs by Fitzmaurice
Container storing Hazardous Waste & Waste Pharmaceuticals located in pharmacy. 4/11/2011
12 COUNTY OF SAN DIEGO PERMIT
CORRECTIVE ACTION FORM TO SPECIALIST: C
DOCU NT RETURN TO COMPLIANCE INSPECTION DATE: '( I g:-; /j CONTACT: ________ _
FACILITY NAME---t,.<--\:+-'-"J'lr--<-L+¥f-1-J.'----,--------- ADDRESS --+f+-7.JLO--L-lkt. .... CITY S q,Jee_ ZIP J/
VIOL# DATE Indicate How Violations Were Corrected
CORRECTED (Attach any supporting documentation.)
1 lv !2:_11hf1L . A-s. (AjJJ1/lft'"f: aff STtit/niJ.
2 /)Mtdt4CN;/C4.1
(.s jJIYJpef.·t., 'kiJef,tf 4J 41'
/v I I
3 I I
\ /v I I /. /''7
4 . \
'
\ i I lv I I ..
5 ' 'J },
lv I I ' '
6 /v I I --'
7 lv I I
8 lv I I
9 lv I I
1 0
/v I I
I certifY under penalty of law that this facility has corrected all violations marked on the Compliance Inspection Report/Notice of Violation. I have personally examined and am familiar with the information submitted and believe the information is true, accurate and complete. I am authorized to file this certification for the facility, and am aware that there are significant penalties for submillingfalse information.

Responsible Party:-------......,=-=-:-------- Job Title. __________ _ Print Name - Signature of Responsible Party:----------------Date: £1 ((t; I / { Send completed form and supporting documentation to the address listed below COUNTY OF SAN DIEGO USE ONLY: Reviewed by: r:-; 'li-etta.r.J..rt. e e .!.)_! 1 Date: :S 1[2 I lf
' (Specialist's name and date required for processing) ' Specialist's comments:
noted on date listed above were corrected.
?s:sed on information provided by the facility
D Based on field verification by Specialist
in Kiva by Specialis/on: ,.,I IC/_JI DRTC entered in Kiva by Office Assistant on:

Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 http://www.sdcdeh.org 619-338-2222; 1-800-253-9933
I I
HM·926 ( 12/09) NCR DISTRIBUTION: WHITE·RETURN TO HMO YELLOW·FACILITY RETAINS

SAN DIEGO COUNTY I
HAZARDOUS MATERIALS DMSION AUG 2 2 2012
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-QSO FAX (858) 505-6848 ENVIRONMENTAL
HEALTH

HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION
The California Health & Safety Code (H&SC). Division 20. Chapter 6.95. Section 25505 provides for the following:

The San Diego County, Department of Environmental Health, Hazardous Materials Division (HMO), as the administering agency, requires a business that handles hazardous materials to submit the hazardous materials inventory, a list of emergency contacts, and a site plan, in lieu of a complete Hazardous Materials Business Plan (HMBP), only after the initial submittal of a complete HMBP. The business must certify that a complete HMBP has been prepared and is maintained at the site where the hazardous materials are stored. A complete HMBP includes the items to be submitted to the HMO and an Emergency Response Plan and Employee Training Plan, as established in H&SC Section 25504. The business must also annually certify that the HMBP is current and maintained on site. See Back for instructions and further clarification.

Walmart#l917
0 CARCINOGEN/REPRODUCTIVE TOXIN ANNUAL RENEWAL WITHOUT CHANGES: This is an annual renewal to certify that the list of carcinogens and/or reproductive toxins last provided is a current list as specified in tbe Sao Diego County Chl!(!k only one of the following boxes:
0 INITIAL CERTIFICATION: INITIAL CERTIFICATION: This is to certify (H&SC Section 1550S(e)(l)) that a complete HMBP, wbicb includes the hazardous materials inventory, a list of emergency contacts, a site plan, emergency response plan, and employee training plan, bas been prepared and is maintained at the site where tbe hazardous materials are stored. 0 ANNUAL CERTIFICATION WITHOUT CHANGES: This is an annual certification (H&SC Section 15S05(d)&(e)(1)) that tbe HMBP, which includes tbe hazardous materials inventory, a list of emergency contacts, a site plan, emergency response plan, and employee training plan, is current and includes all tbe information required in H&SC Section 15504, and 15509, and is maintained at the site where the hazardous materials are stored.
1:8] CERTIFICATION OF CHANGES/REVISIONS: This is to certify that the HMBP bas been reviewed (H&SC Section 15505(c) & 15510) and all necessary changes/revisions have been made. Tbe HMBP is current and is maintained at the site where the hazardous materials are stored. Attached are changes to the hazardous materials inventory and/or list of emergency contacts. For site map revisions, submit tbe tbat have a or revision and attach to this certification. This submittal satisfies annual certification

AS AN AUTHORIZED REPRESENTATIVE, I CERTIFY UNDER THE PENALTY OF LAW, THAT I HAVE PERSONALLY EXAMINED

AND AM FAMILIAR WITH THE INFORMATION SUBMITTED AND BELIEVE THE INFORMATION IS TRUE, ACCURATE, AND

OR DESIGNATED REPRESENTATIVE
Site Map
0 *Emergency
Hazardous
Environmental Health &
*Note: Indicate the date that the inventory and/or ER contact infonnation in the KJV A database was reviewed and changes were submitted for processing. If the inventory and ER contact infonnation the same as it is recorded in KJV A, no changes need to be date on new site map.
emergency
REMARKS: ____________________________________________________ ___ \
ENTERED-MAR 0

SAN DIEGO REGIONAL

HAZARDOUS MATERIALS QUESTIONNAIRE
Business Contact Telephone#

OFFICE USE ONLY
UPFPj/ I !2.2. 'l y
HV# ?lto8
BP
Business Name Walmart Store #1917
619 449-7900
Project Address City
170 Town Center Parkway
Mailing Address City
Santee
State
CA
APN#
Plan File# 170 Town Center Parl<way Santee
State
CA

1. 2.

3. 4. 0 (;Z]

5. 0 0"

6. 0

7. 121 0
Expected Date of Occupancy: __ 1 __ 1
(for new construction or remodeling projects)
Is your business listed on the reverse side of this fonn? (check ail that applyl. wm your business dispose of Hazardous Substances or Medical Waste in any amount? Will your business store or handle Hazardous Substances in equal to or thfln,!j5 gallons, 500 pounds 200 cubic feet, or carcinogens/reproducllve toxins in any quantity? \-I--: I; 1J WID your business use an existing or install an underground storage tank? WIU your business use or tnstaU a Hazardous Waste Tank System (TiUe 22, Article 10}? Will your business store or handle Regulated Substances (Ca!ARP}? Will your business store petroleum in tanks or containers at your facility with a Iota . o · to or greater than 1,320 gallons? (CaUfomla's Aboveground Petroleum Storage Ad). 0 CatARP Exempt
I
Date Initials
0 CaiARP Required
I
Date ln1tials
0 CaiARP Complete
I
Date Initials
PART
POllution
Ill:
control

SAN DIEGO
District
COUNTY AIR CONTROL DISTRICT: If the answer to any of the questions below Is yes, applicant must contact the Air permH. Note:
(APCD}. 10124 OGrove Roa<{ san Doege, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition commencing demofilion
if the answer
or
to questions 4 or 5 Is yes, applicant must also submit an asbestos notifiCation form to the APCD at least 10 working days prior to renovation, excapt · .. :. _____ .c :.-:....:.:. __ ::.: .. :of residential structures of four units or less. Contact the APCO for more information. YES NO

1. 0 1.21 Will
APCD
the subject facHity or construction activities include operations or equipment that emit or are capable of emtnlng an air contaminant9 (See the faclsheet at !1:'1' .··,,,wv •. soJ:,uvJ.qmllnfRflH;J.;;IoP.nni!;;.ecif, and the fist of typical eq>Jipment requiring an APCD permtt on the reverse side of this from. Contact APCD If you have any questions).

2. 0
0 0
0 0 (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject be located wrthln 1,000 feet of the outer boundary of a school (K through 12)? (Search the California School Direotory at c;de.g..aovlrel:.cll for public and private schools or contact the appropriate school district). IZ) Has a survey been performed to delennine the presern:e of Asbestos Containing Materials? 3. 4 5.
1ZJ Wit there be renovaUon that Involves handling of any friable asbestos materials, or disturbing eny material the! contains non-friable asbestos? 1;21 WBI there be demolition involving the removal of a toad supporting structural member? Btiefly describe buslness activities: Briefly describe proposed project Retail Sales Replace 240-gallon Waste Oil AST with 193-gallon AST 1 declare under penally of perjury that to the best of my knowledge and belief UJe respon;;es Name
(I '41
of
1t1
Owner
IU. l- a ' c'OQ.;f;:1u. cY4' <" e or Authorized Agent "S$l&t\lre cl Owner or Auth ed Agent 0:11 (') I
Dale fJt1 I A 6i §:vt Pi t>foe:o- FOR OFRCIAL USE ONLY:

BY:
________________________________________________ __ FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: __________________ ____
EXEMPT OR NO fURTHER INFORMATION REQUIRED "'" PERMIT BUT NOT FOR OCCUPANCY RELEAS£0 FOR OCCUPANCY GOUNTV-HMD• APCO Ai APCO COUNTY-HMO APCD
( J>wwfi
.J
"-..._ Ho;.M'V/ •A stamp in this IXlx 2!1!Y exempts businesses from co lpleting or a Hazaroous Materials Business Plan. Other permitting requorements may stiU eppty.

IJM-9171 (02111) County of San Diego- DEH- Hazardous Materials Division . -...
_Q}_l2.Lo5Ll

SAN DIEGO REGIONAL

HAZARDOUS MATERIALS QUESTIONNAIRE

OFFICE USE ONLY
i J22.1 L-1
HV# i1J :z 3to 8
BPDATE __
Business Name Walmart Store #1917 Telephone#
619 449-7900
Business Contact
Project Address
170 Town Center Parkway
CHy
Santee
Cily
Santee
Slale
CA
Slale
CA
APN#
Plan File#
The following question represent the facility's activities, NOT the specific project description. will
PART
use,
1: FIRED
process,

PARTMENT
or store any of
AZARDOUS MATERIALS DIVISION: OCCUPANCY CL SIFICAnON: lndicale by circling the Hem. whether your business jurisdiction prior to plan submHtal. Facili1y's
the following
Square
haza ous materials. if any of the items are circled. app icant must contact the Fire Protection Agency with Footage (including proposed project): 1os,ooo SF

1. E losive or Blasting Agents 5. Organic Peroxides Q. Water Reactrves:::::> <:ii" Corrosives:::.S

1. 2.

3. 4.

5. 6.

7. C6 Oxidizei"S:::> 10. Cll!llQPnics 14. Other Health Hazards

7. Pyrophoncs ct1 HiQhiY Toxic or Toxic Matefials=:::::, 15. None of These.

8. Unstable Reactives 12. Radioaclives
Expected· Date of Occupancy: ___ 1 __ 1
(for new construction or remodeling projects)
Is your business listed on the reverse side of this form? (check all thai apply). - Will your business dispose of Hazardous Substances or Medical Waste ih any amount? Will your business store or handle Hazardous Substances in equal to or gallons, 500 pounds 200 cubic feet. or carcinogens/reproductive toxins in any quantity? r f: c: !, :1 WIR your business use an existing or install an underground storage tank? Will your business store or handle Regulated Substances (CaiARP)? Will your business use or Install a Hazardous Waste Tank System (TiUe 22, Article 1 0)? Will your business store petroleum in tanks or containers at your facility with a to or greater than 1,320 gallons? (California's Aboveground Petroleum Storage Act). 0 CaiARP Exempt
I
Date Initials
0 CaiARP Required
I
Date Initials
0 CaiARP Complete
I
Date lniUals
POllution
PART Ill:

COntrol

SAN DIEGO
District
COUNTY
(APCD), 10124

AIR POLLUTION
Old Grove Road,
CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air permH. Note: if the answer to questions 4 or 5
San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition commencing demofition or renovaUon, except
is yes, applicant must also submit an asbestos notification form to the APCD at least 10 worf<ing days prior to · ·--·-····-__ . ___ : __ :of residential structures of four units or less. Contact the APCD for more infomnation.

YES NO

1. 0 J;il Will
APCD
the subject facnity or construction activities Include opereUons or equipment that emil or are capable of emitting an air contaminant'? (See the faclsheet al !1:•P. r
of
and the list of typical equipment requiring an APCD penn it on the reverse side this from. Contact APCD if you have any quesoons).
0 0
0 0
0 (ANSWER ONLY IF QUESTION 1 IS YES) WBI the subject be located within 1,000 feet of the outer boundary of a school (K through 12)?

2. 3.

4. 5.
(Search the California School Directory at hllo:<twww.cde,oa.oovlrelsdl lor public and private schools or contact the appropriate school district).

Ill Has a survey been performed to determine the presence of Asbestos Containing Materials? Ill Wit there be renovation thatJnvotves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? 1;21 WBI there be demo6t\CJn inv?fving the removal of a load supporting structural member? Briefly describe business activities: Briefly describe proposed project Retail Sales Replace 240-gallon Waste Oil AST with 193-gallon AST I declare under penalty of that to the best of my knowledge and belief IIJe · :orrect. ,.,.,,,.,..,,u t
Name-of OWner
e or Authorized Agent or Auth ed Agent
{Jt1 I 1\IC:c' tt fF. Gvt A td-e> FOR OFFICIAL USE ONLY:
0:1. I (") I / ::L
Date
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ________________________ BY:
____________________________________________ --:------:------------------- _ EXEMPT OR HO FURTHa INFORMAllON REQUIRED RELEASED FOR OCCUPANCY COUNTY-HMO* APCO APCD
'A stamp in this x 2!!Jy exempts
IIM-9171 (0211 I) County of San Diego- DEH - Hazardous Materials Division u==H '2:X2-11Jupr::p- 1322nt.f -- - -- -- "

5\.AbrY'll+ec:ll r"' RrA
COUNTY OF SAN DIEGO PAGEj___ DATE 2 /13 J2JI3
PERMIT# 1322r"J4 BUS. CODE I'$

COMPLIANCE INSPECTION REPORT
FACILITYNAME WQ]- M,ort s+ote-#-
ADDRESS I'J¢ bWf"' Cb-1-b-- 7
CITY /ZIP 5ca vrtcC Cf 20 '11
TIME START z:to END 1g_

SPECIALIST

INSPECTION CONTACT
TITLE Ct s.s+.

PHONE ( (b !0! ) (-\ "' - 19¢ct .. On the above date, the County inspected your facility under the authority of the California Health and Safety Code (H&SC), to detcrmmc compliance wrth applicable provtstons of the H&SC. the California Code of Regulations (CCR). and the San Diego County Code ofRcgulatory Ordinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.8 & 25404.1.2) for any minor violations as defined in H&SC 25404 and 25117.6. This repon may contain both minor and more significant (Class II) violations. Minor violations do not include repeat vrolations or violations remaining uncorrected for more than 30 days (or as specified below).

Minor violations do not include knowing, willful, intentional, or chronic violations; nor do they include violations showing a pattern of neglect or disregard.

The remarks below arc intended to provide guidance to correct any violations indicated on the attached violation repon. You must submit a written response to this repon within 30 days (or as specified below) demonstrating that all violations have been corrected or include a written notice of disagreement that clearly states the reason for any disputed violations. Prompt correction can protect you from penalties for a "minor violation". Penalties can be imposed for each day in violation for all other violations even if they are corrected promptly. However, correction within 30 days (or as specified below) will make a penalty less likely. y· N/A' NOTE: Reinspection fees will be charged if additional inspections are required to determine compliance. 0 0 Unified Program Facility Permit current y• N/A. Permit Expires on: \0 I 2 I I.@ I'=? D D Hazardous Materials Business Plan available D D Contingency Plan available DLQG DSQG D D Employee training is adequate D D Employee training records available D D Waste disposal records available for review D D Universal waste managed properly D D Emergency contacts current D Updated today D D Waste containers D closed D labeled D D Chemical inventory/map current D Updated today D D Waste containers in good condition Consent to inspect granted by: fJ Inspection Contact D Other: ----------------------- HM-924 (03/11) NCR
nvironmental Health, Hazardous Materials Division, P.O. Box 129261, Phone: 858 505-6880 htt ://www.sdcdeh.or
Initials of Facility Representative
Yes; N/A Applicable) DISTRIBUTION: WHITE-HMO COPY; YELLOW-FACILITY COPY

COUNTY OF SAN DIEGO
PERMIT# \322'11.J
DATE I 13 t2Dt3
SUPPLEMENTAL COMPLIANCE INSPECTION REPORT PAGE '2.. OF 2 FACILITY ADDRESS: l'1<:P' ]0\NV'"l Cc=vrby ZIP CODE: 9 '20'1/ S\Z3I.zniZ.

No obset\led

DATE SIGNED
ellow: Facility DEH-Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261

COUNTY OF SAN DIEGO

UPFP INSPECTION CHECKLIST
FACILITY NAME: Walmart #1917
ADDRESS: 170 TOWN CENTER PKWY
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 08/20/2015
RECORD ID #: DEH2002-HUPFP-132274
TIME START: 11:40 AM END: 1:17 PM
SPECIALIST: BRIDGET KIEU
INSPECTION CONTACT: KEVIN GRABER
TITLE: AUTO CARE CENTER MANAGER
PHONE:(619) 449-8215
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v30 Dated 8/3/2015 13:00

FACILITY REFERENCE DATA
ACCELA

CERS
RECORD STATUS: Permit Renewed
PERMIT EXPIRATION DATE: 10/31/2015
BALANCE DUE: $1,769.00
INSPECTOR: BRIDGET KIEU
INSPECTION TYPE: Routine
INSPECTION STATUS: Complete
EPA ID NUMBER: CAR000206631
FACILITY CERS ID NUMBER:10148997
CERS LEAD USER: Nancy Tran
LAST CERS SUBMITTAL DATE: 06/24/2015
ENVIRONMENTAL CONTACT EMAIL: [email protected] ENVIRONMENTAL CONTACT PHONE: 479-633-4593

FACILITY INFORMATION

YES NO YES NO
INACTIVATION INSPECTION: ✖
CHANGE OF OWNER: ✖
CHANGE IN BUSINESS TYPE: ✖
BUSINESS TYPE: Retail Stores
ISSUE INITIAL INVOICE: ✖
ASSESS NON-NOTIFICATION FEE: ✖
ASSESS RE-INSPECTION FEE: ✖
FACILITY SUBJECT TO BASE FEE: ✖
FACILITY SUBJECT TO CUPA FEE: ✖
UPDATE FACILITY ADDRESS IN AA: ✖
HAZARDOUS MATERIALS: ✖
HAZARDOUS WASTE: ✖
ABOVEGROUND PETROLEUM STORAGE ACT:* ✖
TOTAL SHELL CAPACITY APSA: 0
UNDERGROUND STORAGE TANK: ✖
CALARP PROGRAM LEVEL: 1 2 3 N/A
MEDICAL WASTE: ✖
MW FACILITY GENERATING OVER 200 LBS PER MONTH: ✖
EPIC PARTICIPANT: ✖
HOW MANY TLV GASES ARE AT THE FACITLITY : 0
GENERATOR STATUS : LQG SQG CESQG RCRA LQG N/A
TIERED PERMIT LEVEL(S) : CESQT CESW CE-L CE-CL HHW PBR CA N/A

PRIMARY BILLING CODE
Not Applicable

SECONDARY BILLING CODE
Not Applicable

TERTIARY BILLING CODE
Not Applicable
INSPECTION SCOPE:

HAZARDOUS MATERIALS: GEN HAZMAT
APSA: YES UST: YES
MEDICAL WASTE: SQG SQG - TREATS

LQG LQG - ABREVIATED LQG - TREATS
HAZARDOUS WASTE: SQG LQG
CALARP: 1 2 3
TIERED PERMITTING: CESQT CESW CE-L CE-CL

CA PBR HHW
CONSENT TO CONDUCT INSPECTION GRANTED BY: INSPECTION CONTACT ✖ NAME: KEVIN GRABER TITLE: AUTO CARE CENTER MANAG

REFUSED TO SIGN
INSPECTION REPORT EMAILS:

[email protected],[email protected],[email protected] RECORD COMMENT:

HM-924(01/15)

COUNTY OF SAN DIEGO

COMPLIANCE INSPECTION REPORT
FACILITY NAME: Walmart #1917
ADDRESS: 170 TOWN CENTER PKWY
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 08/20/2015 PAGE 1 OF 6
RECORD ID #: DEH2002-HUPFP-132274
TIME START: 11:40 AM END: 1:17 PM
SPECIALIST: BRIDGET KIEU
INSPECTION CONTACT: KEVIN GRABER
TITLE: AUTO CARE CENTER MANAGER
PHONE:(619) 449-8215
E-MAIL:[email protected]
On the above date, the County inspected your facility under the authority of the California Health and Safety Code (H&SC), to determine compliance with applicable provisions of the H&SC, the California Code of Regulations (CCR), and the San Diego County Code of Regulatory Ordinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.8 & 25404.1.2) for any minor violations as defined in H&SC 25404 and 25117.6. This report may contain both minor and more significant (Class II) violations. Minor violations do not include repeat violations or violations remaining uncorrected for more than 30 days (or as specified below). Minor violations do not include knowing, willful, intentional, or chronic violations; nor do they include violations showing a pattern of neglect or disregard. The remarks below are intended to provide guidance to correct any violations indicated on the attached violation report. You must submit a written response to this report within 30 days (or as specified below) demonstrating that all violations have been corrected or include a written notice of disagreement that clearly states the reason for any disputed violations. Prompt correction can protect you from penalties for a "minor violation". Penalties can be imposed for each day in violation for all other violations even if they are corrected promptly. However, correction within 30 days (or as specified below) will make a penalty less likely.

NOTE: Reinspection fees will be charged if additional inspections are required to determine compliance.

Yes N/A
✖ Unified Program Facility Permit Current
✖ Hazardous Materials Business Plan Available
✖ Employee Training is Adequate
✖ Waste Disposal Records Available for Review
✖ Emergency Contacts Current Updated today
✖ Chemical Inventory/Map Current Updated today
Yes N/A
✖ Contingency Plan Available ✖ LQG SQG
✖ Employee Training Records Available
✖ Universal Waste Managed Properly
✖ Waste Containers ✖ Closed ✖ Labeled
✖ Waste Containers in Good Condition
Permit Expires On 10/31/2015
CONSENT TO CONDUCT INSPECTION GRANTED BY: KEVIN GRABER TITLE: AUTO CARE CENTER MANAGER INTRODUCTION:

THIS FACILITY IS A RETAIL STORES INCLUDING AN AUTOMOTIVE DEPARTMENT AND A PHARMACY. FACILITY IS SUBJECT TO HAZARDOUS MATERIALS BUSINESS PLAN (HMBP), MEDICAL WASTE AND HAZARDOUS WASTE. FACILITY COLLECTS USED OIL FROM PUBLIC AND GENERATES APPROXIMATELY 1000 GALLONS (PER MANAGER KEVIN GRABER) OF USED OIL (FROM THEIR SERVICE) WHICH MAKES THEM BECOME A LARGE QUANTITY GENERATOR OF HAZARDOUS WASTE.

INSPECTION REMARKS:

1. HMBP WAS CERTIFIED ON 8/29/14. (DUE ON 8/29/2015)
*Please remember that you will need to re-certify your submission once every 12 months (Note: To annually re-certify the HMBP, you MUST submit the Facility Information, the Chemical Inventory, and the HMBP Site map). OR you must re-submit within 30 days if there are any significant changes to your business.

2. TRAINING IS CONDUCTED TWICE A YEAR AND DOCUMENTATION WAS AVAILABLE ONSITE FOR REVIEW.

3. FACILITY USES MAIL-BACK SYSTEM FOR MEDICAL WASTE. LOG WAS AVAILABLE FOR REVIEW.

4. PUBLIC COLLECTION USED OIL LOGS WERE AVAILABLE FOR REVIEW.

Helpful Websites:
• For guidance documents on hazardous materials-related topics, go to: http://www.sandiegocounty.gov/content/sdc/deh/hazmat/hmd_publications.html • For information on the California Environmental Reporting System (CERS), go to: http://www.sandiegocounty.gov/content/sdc/deh/hazmat/hmd_cers.html • If you have questions on: permit fees, business plan requirements, or hazardous waste regulations, go to: http://www.sandiegocounty.gov/content/sdc/deh/hazmat.html • To find out the latest San Diego County News and receive updates, subscribe to our govdelivery emails:
https://public.govdelivery.com/accounts/CASAND/subscriber/new HM-924(01/15)

COUNTY OF SAN DIEGO

SUPPLEMENTAL COMPLIANCE

INSPECTION REPORT
INSPECTION DATE: 08/20/2015 PAGE 2 OF 6
RECORD ID #: DEH2002-HUPFP-132274
If you have any questions regarding this inspection, please contact BRIDGET KIEU , (619) 602-0746, [email protected]

INSPECTION PHOTOS
All regulated businesses are required by law to submit their Unified Program-related information and business updates online through the California Environmental Reporting System (CERS). For additional information about CERS, go to: http:// www.sandiegocounty.gov/deh/hazmat/hmd_cers.html

PRINTED NAME OF FACILITY REPRESENTATIVE

KEVIN GRABER

TITLE OF FACILITY REPRESENTATIVE

AUTO CARE CENTER MANAGER

SIGNATURE

DATE SIGNED
08/20/2015
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: (858) 505-6880 http://www.sdcdeh.org

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Handlers of Hazardous Materials and Small and Large Quantity Generators of Hazardous Waste INSPECTION DATE: 08/20/2015 PAGE 3 OF 6
RECORD ID #:DEH2002-HUPFP-132274
FACILITY NAME: *Walmart #1917
ADDRESS: * 170 TOWN CENTER PKWY CITY/ZIP: *SANTEE 92071 Each violation checked below is for the section(s) of the California Health and Safety Code (HSC), California Code of Regulations (CCR), or the San Diego County Code (SDCC) indicated in italics. Incorporated provisions of Title 40 of the Code of Federal regulations (CFR) are noted for reference. All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use the Corrective Action Form (HM-926) to document your return to compliance. Please call (858) 505-6880 or your Specialist if you have any questions. HMBP = Hazardous Materials Business Plan; CUPA = Certified Unified Program Agency; CERS = California Environmental Reporting System; SQG = Small Quantity Hazardous Waste Generator; LQG = Large Quantity Hazardous Waste Generator Hazardous Materials Requirements
# VIOLATION DESCRIPTION
1010001 HMBP not established/ implemented. HSC 25505(a) and 25507(a) 1010002 HMBP not submitted to the CUPA in CERS. HSC 25508(a)(1)(A); HSC 25404(e)(4); 27 CCR 15188(a), (d)
1010003 Business Activities and/or Business Owner/Operator Identification not completed in CERS. 19 CCR 2729.2(a)(1); HSC 25404(e)(4) 1010004 Chemical inventory incomplete or not submitted in CERS. HSC 25505(a) (1); 25506; 25507; and 25508(a)(1)(A)
1010005 Site map not submitted in CERS or not sufficient. HSC 25505(a)(2) and 25508(a)(1)(A)
1010006 HMBP not updated to reflect inventory changes or facility information.

HSC 25508.1(a-e)
1010007 HMBP not updated to reflect substantial change to the handler's operations. HSC 25508.1(f)
1010008 HMBP not certified annually as complete and accurate in CERS. HSC 25508.2
1010010 Emergency response procedures to mitigate a release or threatened release not adequate, not established or not submitted in CERS. HSC 25505(a)(3) and 25508(a)(1)(A)
1010011 Failure to notify property owner in writing that the business is subject to the HMBP program. HSC 25505.1
1010012 Failure to provide a copy of HMBP to the property owner within five working days upon request from property owner. HSC 25505.1 1010014 Failure to submit emergency response plan in CERS, when not meeting agricultural handler exemption. HSC 25507.1(a) and 25508(a)(1)(A) 1010015 Failure to submit employee training plan in CERS, when not meeting agricultural handler exemption. HSC 25507.1(a) and 25508(a)(1)(A) 1010016 HMBP not established or submitted in CERS, when not meeting the remote site exemption. HSC 25507.2 and 25508(a)(1)(A)
1020001 Employee training plan for hazardous materials management not adequate, not established or not submitted in CERS. HSC 25505(a)(4) and 25508(a)(1)(A)
1020002 Initial and/or annual employee training not conducted for hazardous materials management and/or employee training records not available or not maintained for 3 years. HSC 25505(a)(4)
1040001 Hazardous materials release or threatened release not reported to the CUPA and OES immediately upon discovery. HSC 25510(a)
4010001 Failed to prepare and implement a written Spill Prevention Control and Countermeasures (SPCC) Plan in accordance with 40 CFR 112 (sec. 112.3). HSC 25270.4.5(a)
HMD
1001 Unified Program Facility permit not obtained for hazardous materials.

SDCC 68.905
HMD
1005 Emergency contact not provided or current. HSC 25508.1(f) HMD
1007 Highly toxic gas (TLV<10 ppm) not disclosed. SDCC 68.1113(b) HMD
1008 Annual carcinogen/reproductive toxin list not submitted. SDCC

68.1113(c)
HMD
1013 HMBP not readily available for review. HSC 25505(c) Hazardous Waste Requirements for SQGs ONLY
HMD
0219 Failed to properly segregate used oil &/or fuel drained from filters.

HSC 25250.22(b)(4); 22 CCR 66266.130(c)(6)
HMD
0226 Did not accumulate waste in a container or tank. (40 CFR 262.34(d)(2).) 22 CCR 66262.34(d)(2)
HMD
0412 Failed to have an emergency coordinator on call or available during an emergency. (40 CFR 262.34(d)(5)(i).) 22 CCR 66262.34(d)(2) HM-923 (03-15)
Hazardous Waste Requirements for SQGs ONLY (continued)
# VIOLATION DESCRIPTION
3030007 Failed to properly label/date hazardous waste container and/or tank. 22 CCR 66262.34(f)
3030010 Accumulated waste too long (>180 or 270 days) (>90 days for an acutely hazardous waste). (40 CFR 262.34(e) and (f).) HSC 25201(a); 22 CCR 66262.34(d)
3030013 Failed to accumulate hazardous waste in a container that is in good condition. (40 CFR 262.34(d)(2); 265.171.) 22 CCR 66262.34(d)(2) 3030015 Failed to accumulate or store hazardous waste in a lined/compatible container. (40 CFR 262.34(d)(2); 265.172) 22 CCR 66262.34(d)(2) 3030017 Failed to properly close hazardous waste container(s). (40 CFR 262.34(d)(2); 265.173.) 22 CCR 66262.34(d)(2)
3030019 Failed to inspect hazardous waste storage area at least weekly. (40 CFR 262.34(d)(2); 265.174.) 22 CCR 66262.34(d)(2)
3030022 Failed to properly separate incompatible waste. (40 CFR 262.34(d)(2); 265.177.) 22 CCR 66262.34(d)(2)
3030030 Failed to maintain and/or 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. (40 CFR 262.34(d)(4), 265.31.) 22 CCR 66262.34(d)(2)
3030036 Failed to maintain adequate aisle space. (40 CFR 262.34(d)(4); 265.35.) 22 CCR 66262.34(d)(2)
3010022 Failed to post, next to the telephone, emergency information containing the location of emergency equipment, contact names, and numbers. (40 CFR 262.34(d)(5)(ii).) 22 CCR 66262.34(d)(2) 3020001 Failed to ensure employees are trained for hazardous waste handling, compliance with regulations, and emergency response procedures. (40 CFR 262.34(d)(5)(iii).) 22 CCR 66262.34(d)(2)
3030032 Failed to maintain or have emergency equipment, supplies, or equivalents. 1) An internal communication or alarm system; 2) A device, such as a telephone; 3) Portable fire extinguishers, fire control equipment, spill control equipment, and decontamination equipment; and 4) Water at adequate volume and pressure (40 CFR 262.34(d)(4); 265.32) 22 CCR 66262.34(d)(2)
3030039 Failed to implement contingency plan during an emergency, spill/ release. (40 CFR 262.34(d)(5)(iv).) 22 CCR 66262.34(d)(2) Hazardous Waste Tank Systems for SQGs ONLY
3030024 Failed to maintain sufficient freeboard of 2 ft in uncovered tanks to prevent overtopping unless the tank is equipped with a containment structure, a drainage control system or a diversion structure with a capacity that equals or exceeds the volume of the top 2 ft of the tank. (40 CFR 62.34(d)(3); 265.201(b)(c).) 22 CCR 66262.34(d)(2) 3030025 Failed to provide an overfill protection device on continuously fed hazardous waste tank. (40 CFR 262.34(d)(3); 265.201(b)(4).) 22 CCR 66262.34(d)(2)
3030027 Failed to conduct daily tank inspection of the discharge system, monitoring equipment, and tank level. (40 CFR 265.201(c)(1), 265.201(c)(2), 265.201(c)(3), 262.34(d)(3).) 22 CCR 66262.34(d)(2) 3030028 Failed to conduct weekly inspections of the construction materials, fixtures, and surrounding areas of the hazardous waste tank. (40 CFR 265.201(c)(4); 265.201(c)(5); 262.34(d)(3).) 22 CCR 66262.34(d)(2) 3050007 Failed to properly decontaminate and document closure of a hazardous waste tank system. (40 CFR 265.201(f).) 22 CCR 67383.3 HMD
1612 Hazardous waste improperly stored in a tank system causing leaks, corrosion, or failure. (40 CFR 265.201(b).) 22 CCR 66262.34(d) HMD
1614 Failed to pre-notify the CUPA in writing prior to closing a hazardous waste tank system. 22 CCR 67383.3(a)(1)
HMD
1615 Failed to properly accumulate ignitable or reactive waste in a tank system. (40 CFR 265.201(g).) 22 CCR 66262.34(d)(2)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Hazardous Materials and Hazardous Waste (continued)
INSPECTION DATE: 08/20/2015 PAGE 4 OF 6
RECORD ID #:DEH2002-HUPFP-132274
Hazardous Waste Requirements for SQGs and LQGs

RECORD KEEPING/OPERATIONAL REQUIREMENTS
# VIOLATION DESCRIPTION
3010001 Unified Program Facility (UPF) permit not obtained for the generation of hazardous waste. HSC 25404.1; SDCC 68.905
3010029 The facility has not submitted complete and accurate facility information in CERS. HSC 25404(e)(4); 27 CCR 15188(b)
3010002 Failed to obtain and/or maintain an active EPA ID. 22 CCR 66262.12 3010008 Failed to properly complete a uniform hazardous waste manifest. 22 CCR 66262.23(a)
3010009 Failed to complete the hazardous waste manifest Exception Requirement. 22 CCR 66262.42
3010010 Failed to maintain uniform hazardous waste manifest, consolidated manifest, or bills of lading copies for 3 years. HSC 25160.2(b)(3), 25185(a)(4); 22 CCR 66262.40(a)
3010011 Failed to send hazardous waste manifest copies to the Department of Toxic Substances Control (DTSC). 22 CCR 66262.23(a)(4)
3010013 Failed to meet the consolidated manifesting requirements for waste shipment. HSC 25160.2; 22 CCR 66262.40(a)
3010014 Failed to retain disposal records of spent lead batteries for 3 years. 22 CCR 66266.81(a)(4)(B)
3030006 Failed to determine if a hazardous waste is restricted or prohibited from land disposal. 22 CCR 66268.7(a)
3010016 Failure of recycler who recycles more than 100 kilograms per month of recyclable material under a claim that the material qualifies for exclusion or exemption to provide and submit in CERS the required information. HSC 25143.10(a), (c), and/or (d)
HMD
0149 Failed to keep disposal receipts for drained used oil filters and/or drained fuel filters for 3 years. HSC 25250.22; 22 CCR 66266.130 HMD
0148 Failed to have copies of analytical records, waste analysis records, and/ or waste determination results for 3 years. 22 CCR 66262.40(c) HMD
0140 Failed to have Land Disposal Restriction documentation onsite for 3 years. 22 CCR 66268.7(a)(8)
3250005 Failed to obtain a Treatment, Storage and Disposal Facility (TSDF) permit or authorization to store/treat/dispose of hazardous waste.

HSC 25201(a)
3050005 Failed to have adequate records demonstrating claim of exemption for Excluded Recyclable Materials. HSC 25143.2(f); 22 CCR 66261.2(g) 3210001 Failed to notify the CUPA in CERS for onsite hazardous waste treatment/tiered permitting. HSC 25201(a)
HMD
0138 Manifest signed by the TSDF not available for inspection. 22 CCR 66262.40(a)
Hazardous Waste Requirements for SQGs and LQGs

DISPOSAL AND TRANSPORTATION
3010007 Failed to prepare a hazardous waste manifest for the transport of a waste for off-site transfer, treatment, storage, or disposal. HSC 25160(b)(1) or (2), 25160.2(b)(9); 22 CCR 66262.20(a)
3030005 Failed to make a proper waste determination. 22 CCR 66262.11, 66262.40(c)
3050001 Failed to use a California registered hazardous waste transporter to transport hazardous waste. HSC 25163(a); 22 CCR 66263.41 3050002 Failed to properly dispose of hazardous waste at an authorized facility.

HSC 25189.5(a); 25189(c),(d); 25189.2(c)
3130002 Impermissible dilution of hazardous waste. 22 CCR 66268.3(a) HMD
0305 Disposed of used oil illegally. HSC 25250.5(a); 25189.5(a); 25189(c),(d); 25189.2(c)
HMD
0306 Disposed of hazardous waste latex paint improperly. HSC 25217.1 HM-923 (03-15)
Hazardous Waste Requirements for SQGs and LQGs

STORAGE AND HANDLING
# VIOLATION DESCRIPTION
3030001 Failed to meet requirements, when handling, and storing spent lead acid batteries. 22 CCR 66266.81(a)(1)
3030003 Failed to properly manage 'damaged' spent lead acid batteries. 22 CCR 66266.81(b)
3030004 Failed to properly manage, store, label, and/or recycle used oil filters and/or used fuel filters. HSC 25250.22; 22 CCR 66266.130 3050004 Failed to properly manage contaminated used oil as a hazardous waste. HSC 25250.7(a), (c)
HMD
0222 Failed to properly label Excluded Recyclable Materials (ERM). HSC 25143.9(a).

HMD
0216 Failed to label hazardous material container within 10 days after the container was discovered to be mislabeled or inadequately labeled.

HSC 25124(b)(3)(A); 22 CCR 66262.34(f)
HMD
0217 Failed to repackage damaged/deteriorated hazardous material container within 96 hours. HSC 25124(b)(3)(B); 22 CCR 66262.34(f) HMD
0221 Failed to comply with hazardous waste satellite container regulation. 22 CCR 66262.34(e)
HMD
0223 Failed to properly empty container, failed to manage non-empty container, or inner liner removed from a container. 22 CCR 66261.7(b), (d) and/or (r); 66262.34(f)
HMD
0224 Failed to mark date on empty container larger than 5 gallons and/or manage it within one year. 22 CCR 66261.7(e),(f)
Universal Waste Handler Requirements
3010004 Failed to obtain an EPA ID number from DTSC or US EPA prior to storing 5,000 kg or more of universal waste. 22 CCR 66273.32(a),(b) 3020002 Failed to maintain universal waste handler training records for 3 years. 22 CCR 66273.36(c),(d)
3020003 Failed to properly train handlers of universal waste in universal waste management and response procedures. 22 CCR 66273.36(a),(b) 3030008 Failed to properly label or mark a universal waste (non-Conditionally Exempt Small Quantity Universal Waste Generator). 22 CCR 66273.34 3030011 Failed to properly dispose of universal waste within one year. 22 CCR 66273.35(a) and/or (b)
3030046 Failed to keep records of offsite universal waste (UW) shipment(s) available for inspection for 3 years. HSC 25185(a); 22 CCR 66273.39(c), (d)(2)
3030051 Failed to meet the accumulation standards for universal waste aerosol containers and waste handling. HSC 25201.16(f)
3040004 Failed to manage universal waste in a manner to prevent release(s) to the environment. 22 CCR 66273.33; 66273.33.5
3050003 Disposal of universal waste (UW) to an unauthorized point. HSC 25189.5(a), 25189(c),(d); 25189.2(c); 22 CCR 66273.31(a)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Medical Waste Generators
INSPECTION DATE: 08/20/2015 PAGE 5 OF 6
RECORD ID #:DEH2002-HUPFP-132274
Each violation checked below is for the section(s) of the California health and Safety Code (HSC), California Code of Regulation (CCR), or the San Diego County Code (SDCC) indicated in italics. All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use the Corrective Action Form (HM-926) to document your return to compliance. Please call (858) 505-6880 or your Specialist if you have any questions. UPF = Unified Program Facility; MW = Medical Waste; USPS = United States Postal Service; DOT = Department of Transportation

STORAGE AND LABELING
# HMD VIOLATION DESCRIPTION
4201 UPF Permit not obtained. HSC 117705; SDCC 68.905
4202 Medical waste (MW) not separated from other waste at the point of origin. HSC 118275
4203 Enclosure or designated accumulation area for MW containers not secured. HSC 118307, 118310
4204 MW designated accumulation area not posted with an approved, legible biohazardous waste "warning sign" in English & Spanish which can be read from 25 ft. HSC 118310
4205 Medical SOLID WASTE not secured to deny access to unauthorized persons. SDCC 68.1211
4206 Spill of MW not properly cleaned up. HSC 118300
4207 Sharps not stored in approved and properly marked sharps container.

HSC 118285(a) & (d)
4208 Full sharps container not taped closed or tightly-lidded to preclude loss of contents. HSC 118285(b)
4209 Primary containers accumulating MW not labeled with generator's name, address, and phone number. SDCC 68.1205
4210 Medical waste not stored in approved and properly marked biohazard bags. HSC 118275(a)
4211 Biohazard bags not tied off to prevent leakage/expulsion of contents during handling and storage. HSC 118280(a)
4212 Biohazard bags not containerized in rigid, leak resistant, and covered containers or bins when placed for storage, handling, or transport. HSC 118280(b)
4213 Waste container/bin not labeled with the words "Biohazardous Waste" or with the international biohazard symbol and the word "BIOHAZARD" on the lid and sides. HSC 118280(c)
4214 Reusable containers/bins for MW storage not kept clean and sanitary.

HSC 118295, 118305
4215 Frozen (0°C/32°F) biohazardous waste stored >90 days. HSC 118280(e) (2)
4306 Full sharps container stored >30 days at >0°C. HSC 118285(c) 4307 Biohazard bag waste stored >7 days at >0°C (for generators of >20lbs/ month). HSC 118280(e)(1)(A)
4308 Biohazard bag waste stored >30 days at >0°C (for generators of <20lbs/ month). HSC 118280(e)(1)(B)
4219 MW interim storage area not marked with warning sign or biohazard symbol legible from 5 ft. HSC 118307, 118310
4220 4220 MW interim storage area not properly secured. HSC 118307

TREATMENT AND DISPOSAL
4251 MW treated by unapproved method/procedure. HSC 118215 4252 Standardized written operating procedures for steam sterilization not available. HSC 118215(a)(2)(A)
4253 Recording thermometer not calibrated annually. HSC 118215(a)(2)(B) 4254 No records of annual thermometer calibration checks onsite for at least the past 2 years. HSC 118215(a)(2)(B)
4255 Heat-sensitive tape/other approved method not used for each load treated onsite. HSC 118215(a)(2)(C)
4256 Monthly biological indicator or other approved method not used to confirm proper disinfection. HSC 118215(a)(2)(D)
4257 Onsite steam sterilization did not reach 121°C/250°F for 30 minutes.

HSC 118215(a)(2)(B)
4258 Treatment records/logs of dates, time, and temperature not available for 2 years. HSC 118215(a)(2)(E)
4259 Disposal of untreated MW to an unauthorized point. HSC 118340 HM-9255 MW ( 02-15)

TRANSPORTATION REQUIREMENTS
# HMD VIOLATION DESCRIPTION
4260 Transportation of MW without State Hauler Registration, USPS or requirements of the DOT "Materials of Trade Exceptions." HSC 118025 4311 Medical waste tracking documents/logs not in vehicle transporting medical waste. HSC 118040

SMALL QUANTITY GENERATORS ONLY
(<200 pounds of medical waste generated per month)
4301 Medical Waste Management Plan (MWMP) not submitted to HMD (initial/updates), if onsite treatment. HSC 117935
4302 Did not maintain and show proof of "onsite" medical waste treatment records for 3 years. HSC 117943
4303 Did not retain on file disposal receipts, tracking/shipping documents for medical waste shipped offsite for 3 years. HSC 117945 4309 MWMP or equivalent information not onsite (only for SQG doing onsite treatment). HSC 117935

LARGE QUANTITY GENERATORS ONLY
(≥ 200 pounds of medical waste generated per month)
4351 MWMP not submitted to HMD (initial/updates). HSC 117960, 117970 4352 Records of medical waste treatment not available for 2 years. HSC 117975, 118215(a)(2)(E)
4353 Did not make available disposal receipts, tracking/shipping documents for at least 2 years for medical waste shipped offsite. HSC 117975

CHEMOTHERAPY, PATHOLOGY, PHARMACEUTICAL

HAZARDOUS & UNIVERSAL WASTES
4401 Trace Chemo waste not segregated from other MW. HSC 118275(a)(4) 4402 Trace Chemo waste container not labeled "Chemotherapy Waste" or "CHEMO" on the lid and the sides. HSC 118275(a)(4)
4403 Illegal disposal of chemo waste. HSC 118340
4411 Pathology waste not segregated from other MW. HSC 118275(a)(5) 4412 Pathology waste container not labeled "Pathology Waste" or "PATH" on the lid and the sides. HSC 118275(a)(5)
4413 Illegal disposal of pathology waste. HSC 118340
4421 Pharm waste not segregated from other MW. HSC 118275(a)(6) 4422 Pharm waste not labeled "Incineration Only or HIGH HEAT" on the lid and the sides. HSC 118275(a)(6)
4423 Pharm waste stored >90 days when container full, or stored longer than one year (maximum allowable time). HSC 118280(f)
4432 Illegal disposal of pharm waste. HSC 118340, 118222(b) 4441 Disposal of photo/hazwaste to an unauthorized point. HSC 25189.5 3030046 Failed to keep records of offsite universal waste shipment(s) available for inspection for 3 years. HSC 25185(a)(4); 22 CCR 66273.39(c),(d)(2) 3050003 Disposed of universal waste to an unauthorized point. HSC 25189.5(a); 25189(c),(d); 25189.2(c); 22 CCR 66273.31(a)

LQG MW ONSITE TREATMENT FACILITY
(≥ 200 pounds of medical waste generated per month)
4501 Onsite MW treatment permit not obtained/renewed. HSC 117950, 118130, 65620, 65623
4502 Current copy of the MW treatment permit not available. HSC 65621(f), 65623, 118165, 118180
4503 Condition(s) of the MW treatment permit violated. HSC 65623

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Large Quantity Generators (LQG) of Hazardous Waste
INSPECTION DATE: 08/20/2015 PAGE 6 OF 6
RECORD ID #:DEH2002-HUPFP-132274
Each violation checked below is for the section(s) of the California Health and Safety Code (HSC), California Code of Regulations (CCR), or the San Diego County Code (SDCC) indicated in italics. . All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use the Corrective Action Form (HM-926) to document your return to compliance. Please call (858) 505-6880 or your Specialist if you have any questions. DTSC = Department of Toxic Substances Control; RCRA = Resource Conservation and Recovery Act; LQG = Large Quantity Hazardous Waste Generator; VOC = Volatile Organic Compound Hazardous Waste Requirements for LQGs ONLY

RECORDKEEPING/OPERATIONAL REQUIREMENTS
# VIOLATION DESCRIPTION
3010018 *** Missing Description for Section Number : 3010018and Guidesheet type: HW (LQG) - Recordkeeping
3010019 *** Missing Description for Section Number : 3010019and Guidesheet type: HW (LQG) - Recordkeeping
3010021 Failed to adequately complete a source reduction report and maintain for review. HSC 25244.19, 25244.21; 22 CCR 67100.3, 67100.4, 67100.5 3110007 (RCRA LQG) Failed to complete the Biennial Report by March 1st on even numbered year and maintain it onsite for 3 years. 22 CCR 66262.40(b), 66262.41(b)

STORAGE AND HANDLING
3130003 Failed to properly label/date hazardous waste container or tank. 22 CCR 66262.34(f), 66262.34(a)(2), 66262.34(a)(3)
3130004 Accumulated hazardous waste more than 90 days without a DTSC storage permit. HSC 25201(a); 22 CCR 66262.34(a) and (c) 3130005 Failed to transfer waste from a container that is in poor condition to another container that is in a good condition. 22 CCR 66265.171 3130006 Failed to accumulate hazardous waste in a lined or compatible container. 22 CCR 66265.17
3130007 Failed to keep a hazardous waste container closed. 22 CCR 66265.173(a)
3130008 Failed to inspect hazardous waste storage area(s) at least weekly. 22 CCR 66265.174
3130009 Failed to keep reactive and/or ignitable waste at least 50 ft. from the property line. 22 CCR 66265.176
3130010 Failed to properly separate incompatible waste. 22 CCR 66265.17(b), 66265.177
3130013 Failed to maintain or operate the facility to minimize the possibility of a fire, explosion, or release of hazardous waste or its constituents to the air, soil, or water. 22 CCR 66265.31
HMD
0235
Did not accumulate hazardous waste in a container or tank. 22 CCR 66262.34(a)(1)(A)

TRAINING, CONTINGENCY PLAN & ER PROCEDURES
3110011 Failed to prepare a written Contingency Plan to minimize human hazards or threat to the environment. 22 CCR 66265.51(a) 3110012 Failed to maintain onsite a copy of the Contingency Plan and all its revisions and submit a copy to the local emergency agencies that may be called upon to provide emergency services. 22 CCR 66265.53 3120001 Failed to maintain training records. 22 CCR 66265.16(d) and (e) 3130015 Failed to test and maintain all communications or alarm systems, fire protection equipment, spill control equipment, and decontamination equipment. 22 CCR 66265.33
3130016 Failed to maintain aisle space to allow the unobstructed movement of personnel, fire protection, spill-control equipment, etc. to any area of facility operation in an emergency. 22 CCR 66265.35
3130017 Failed to take precautions to prevent accidental ignition or reaction of ignitable or reactive waste, including the posting of a "No Smoking" sign(s). 22 CCR 66265.17(a)
3130018 Failed to immediately implement the facility Contingency Plan during an emergency. 22 CCR 66265.51(b)
HMD
0402 Employee training program not adequate. 22 CCR 66265.16(a) and/or (b)
HMD
0413 Contingency plan content is missing information and/or listing of required actions or descriptions. 22 CCR 66265.52
HMD
0414 Failed to train employees at least annually. 22 CCR 66265.16(c) HMD
0415 Failed to equip facility with required emergency equipment, internal communication system, and/or spill response equipment. 22 CCR 66265.32
HMD
0417 Failed to have an emergency coordinator on call or available during emergency. 22 CCR 66265.55
HM-923 LQG (03-15)
Hazardous Waste Tank System for LQGs ONLY
# VIOLATION DESCRIPTION
3110013 Failed to obtain and maintain a written assessment certified by an independent, qualified, registered professional engineer for the hazardous waste tank system. 22 CCR 66265.192(a), 66265.192(h), or 66265.191(a)
3110014 Hazardous waste tank system assessment documentation failed to include all required information. 22 CCR 66265.192(k)
3110015 *** Missing Description for Section Number : 3110015and Guidesheet type: HW (LQG) - Tank System
3130011 Failed to maintain tank operating requirements: 1) Spill prevention control; 2) Overfill prevention control, and/or; 3) maintenance of sufficient freeboard in uncovered tanks. 22 CCR 66265.194(a),(b) 3130012 Failed to conduct daily inspections and/or maintain the inspection records for hazardous waste tank system. 22 CCR 66265.195(a)(c) 3130019 Failed to provide proper secondary containment and/or leak detection for hazardous waste tank system. 22 CCR 66265.193(a)
3130020 Failed to inspect and document the cathodic protection system within six months after initial installation, and annually thereafter, and to inspect all sources of impressed current at least bimonthly. 22 CCR 66265.195(b)
3140001 Failed to properly respond to a tank system spill/leak, follow emergency procedures as required and/or keep secondary
containment empty. 22 CCR 66265.56, 66265.196, 66265.194(c) 3150002 Failed to properly close a hazardous waste tank system ensuring the minimization of further maintenance and requirements are met. 22 CCR 66265.111, 66265.114, 66265.197, 67383.3
HMD
1604 Failed to maintain secondary containment empty. 22 CCR 66265.196(b) and (c); 66265.194(c)
HMD
1607 Failed to adequately design or maintain corrosion protection. 22 CCR 66265.191(b)(3) or 66265.192(a) and (f)
HMD
1608 Failed to complete annual integrity assessment for existing hazardous waste tank system without secondary containment. 22 66265.191(a) (e)
HMD
1609 Failed to remove unfit hazardous waste tank system from service. 22 CCR 66265.196
HMD
1611 Failed to properly complete and/or document closure of a hazardous waste tank system. 22 CCR 67383.3, 66265.197(a), (b)
HMD
1619 Failed to have required safety measures for hazardous waste tank system holding ignitable or reactive waste. 22 CCR 66265.198(a)(b) HMD
1620 Failed to immediately remove from service a hazardous waste tank system that leaked or failed. 22 CCR 66265.196(b),(c)
HMD
1621 Failed to notify DTSC when a release to environment occurred from a hazardous waste tank system. 22 CCR 66265.196(e)(1)or(3) HMD
1622 Failed to meet air emission standards for HW tank system with VOC waste. 22 CCR 66265.202 and 66265.1082 (a)(b) or (c)
HMD
1623 Failed to develop written plan and schedule to perform VOC emissions monitoring. 22 CCR 66265.1089(b)
HMD
1624 Failed to comply with the 3 year record keeping requirement for tank accumulating VOC waste. 22 CCR 66265.1090(a)
HMD
1625 Failed to properly control air pollutant emissions for tank accumulating VOC waste. 22 CCR 66265.202, 66265.1083(b) and 66265.1085(b)

COUNTY OF SAN DIEGO

UPFP INSPECTION CHECKLIST
FACILITY NAME: Walmart #1917
ADDRESS: 170 TOWN CENTER PKWY
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 08/01/2017
RECORD ID #: DEH2002-HUPFP-132274
TIME START: 12:15 PM END: 1:30 PM
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Maria Baltzley
TITLE: Assistant Store Manager
PHONE:(619) 449-7900
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v65 Dated 6/30/2017 16:00

FACILITY REFERENCE DATA
ACCELA

CERS
RECORD STATUS: Permit Renewed
PERMIT EXPIRATION DATE: 10/31/2017
BALANCE DUE: $0.00
INSPECTOR: Bridget Kieu
INSPECTION TYPE: Routine
INSPECTION STATUS: Complete
EPA ID NUMBER: CAR000206631
FACILITY CERS ID NUMBER:10148997
CERS LEAD USER: Erica Hermsen
LAST CERS SUBMITTAL DATE: 08/24/2016
ENVIRONMENTAL CONTACT EMAIL: [email protected] ENVIRONMENTAL CONTACT PHONE: 4796337502

FACILITY INFORMATION

HAZARDOUS MATERIALS: ✖
HAZARDOUS WASTE: ✖
ABOVEGROUND PETROLEUM STORAGE ACT:* ✖
TOTAL SHELL CAPACITY APSA: 0
UNDERGROUND STORAGE TANK: ✖
CALARP PROGRAM (CERS): ✖
CALARP PROGRAM LEVEL: 1 2 3 N/A
MEDICAL WASTE: ✖
MW FACILITY GENERATING OVER 200 LBS PER MONTH: ✖
EPIC PARTICIPANT: ✖
NUMBER OF TLV GASES AT THE FACILITY: 0
HW GENERATOR STATUS : LQG SQG CESQG RCRA LQG N/A
TIERED PERMIT LEVEL(S) : CESQT CESW CE-L CE-CL HHW PBR CA N/A

PRIMARY BILLING CODE
Not Applicable

SECONDARY BILLING CODE
Not Applicable

TERTIARY BILLING CODE
Not Applicable
INSPECTION SCOPE:*
HAZARDOUS MATERIALS: GEN HAZMAT APSA UST
MEDICAL WASTE: SQG SQG - TREATS

LQG LQG - ABBREVIATED LQG - TREATS
HAZARDOUS WASTE: SQG LQG
CALARP: 1 2 3
TIERED PERMITTING: CESQT CESW CE-L CE-CL

CA PBR HHW
CONSENT TO CONDUCT INSPECTION GRANTED BY: INSPECTION CONTACT ✖ NAME: Maria Baltzley TITLE: Assistant Store Manager

REMOVE BLANK CHECKLISTS FROM FINAL INSPECTION REPORT REFUSED TO SIGN TIME ACCOUNTING (Routine) TOTAL TIME ENTERED: 1.8
Date Time Group Type
08/01/2017 0.5 Record Drive Time
08/01/2017 0.5 Record Report Writing
08/04/2017 0.5 Record HazMat HazWaste
08/04/2017 0.3 Record Medical Waste SQG

COUNTY OF SAN DIEGO

[email protected]
RECORD COMMENT:

HM-924(01/15)

COUNTY OF SAN DIEGO

COMPLIANCE INSPECTION REPORT
FACILITY NAME: Walmart #1917
ADDRESS: 170 TOWN CENTER PKWY
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 08/01/2017 PAGE 1 OF 2
RECORD ID #: DEH2002-HUPFP-132274
TIME START: 12:15 PM END: 1:30 PM
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Maria Baltzley
TITLE: Assistant Store Manager
PHONE:(619) 449-7900
E-MAIL:[email protected]
On the above date, the County inspected your facility under the authority of the California Health and Safety Code (H&SC), to determine compliance with applicable provisions of the H&SC, the California Code of Regulations (CCR), and the San Diego County Code of Regulatory Ordinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.8 & 25404.1.2) for any minor violations as defined in H&SC 25404 and 25117.6. This report may contain both minor and more significant (Class II) violations. Minor violations do not include repeat violations or violations remaining uncorrected for more than 30 days (or as specified below). Minor violations do not include knowing, willful, intentional, or chronic violations; nor do they include violations showing a pattern of neglect or disregard. The remarks below are intended to provide guidance to correct any violations indicated on the attached violation report. You must submit a written response to this report within 30 days (or as specified below) demonstrating that all violations have been corrected or include a written notice of disagreement that clearly states the reason for any disputed violations. Prompt correction can protect you from penalties for a "minor violation". Penalties can be imposed for each day in violation for all other violations even if they are corrected promptly. However, correction within 30 days (or as specified below) will make a penalty less likely.

NOTE: Reinspection fees will be charged if additional inspections are required to determine compliance.

Yes N/A
✖ Unified Program Facility Permit Current
✖ Hazardous Materials Business Plan Available
✖ Employee Training is Adequate
✖ Waste Disposal Records Available for Review
✖ Emergency Contacts Current Updated today
✖ Chemical Inventory/Map Current Updated today
Yes N/A
✖ Contingency Plan Available LQG ✖ SQG
✖ Employee Training Records Available
✖ Universal Waste Managed Properly
✖ Waste Containers ✖ Closed ✖ Labeled
✖ Waste Containers in Good Condition
Permit Expires On 10/31/2017
CONSENT TO CONDUCT INSPECTION GRANTED BY: Maria Baltzley TITLE: Assistant Store Manager INTRODUCTION:

Routine Inspection

Inspection was conducted today 8/1/17 with Valantina Yako, Pharmacy Manager and Maria Baltzley, Assistant Store Manager, who also granted permission for this inspection. Business is a retail store and has a pharmacy onsite. Business is currently subject to Hazardous Materials Business Plan (HMBP) requirements for having helium gas in reportable quantities. Business generates hazardous waste and medical waste and both managed by Stericycle. Business is a small generator of hazardous waste.

HMBP certified annually in CERS. Last submittal made 8/24/16 (due on 8/24/17 if no change)

Today's inspection consisted of HMBP, hazardous waste and medical waste requirements.

INSPECTION REMARKS:

INSPECTION PHOTOS
None
HM-924(01/15)

COUNTY OF SAN DIEGO

SUPPLEMENTAL COMPLIANCE

INSPECTION REPORT
INSPECTION DATE: 08/01/2017 PAGE 2 OF 2
RECORD ID #: DEH2002-HUPFP-132274
All regulated businesses are required by law to submit their Unified Program-related information and business updates online through the California Environmental Reporting System (CERS). For additional information about CERS, go to: http:// www.sandiegocounty.gov/deh/hazmat/hmd_cers.html

PRINTED NAME OF FACILITY REPRESENTATIVE
Maria Baltzley

TITLE OF FACILITY REPRESENTATIVE
Assistant Store Manager

SIGNATURE

DATE SIGNED
08/04/2017
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: (858) 505-6880 http://www.sdcdeh.org

COUNTY OF SAN DIEGO

UPFP INSPECTION CHECKLIST
FACILITY NAME: Walmart #1917
ADDRESS: 170 TOWN CENTER PKWY
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 08/19/2019
RECORD ID #: DEH2002-HUPFP-132274
TIME START: 2:30 PM END: 5:30 PM
SPECIALIST: Vikki Denslow
INSPECTION CONTACT:Jamie Martinez/Kevin Graber
TITLE: Assistant Store Manager/Auto Care Manager
PHONE:(619) 449-7900
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v66 Dated 1/10/2017 14:30

FACILITY REFERENCE DATA
ACCELA

CERS
RECORD STATUS: Permit Renewed
PERMIT EXPIRATION DATE: 10/31/2019
BALANCE DUE: $1,780.00
INSPECTOR: Vikki Denslow
INSPECTION TYPE: Routine
INSPECTION STATUS: Pending Corrective Action
EPA ID NUMBER: CAR000206631
FACILITY CERS ID NUMBER:10148997
CERS LEAD USER: Laura Payne
LAST CERS SUBMITTAL DATE: 11/05/2018
ENVIRONMENTAL CONTACT EMAIL: [email protected] ENVIRONMENTAL CONTACT PHONE: 4796337502

FACILITY INFORMATION

HAZARDOUS MATERIALS: ✖
HAZARDOUS WASTE: ✖
ABOVEGROUND PETROLEUM STORAGE ACT:* ✖
TOTAL SHELL CAPACITY APSA: 1150
UNDERGROUND STORAGE TANK: ✖
CALARP PROGRAM (CERS): ✖
CALARP PROGRAM LEVEL: 1 2 3 N/A
MEDICAL WASTE: ✖
MW FACILITY GENERATING OVER 200 LBS PER MONTH: ✖
EPIC PARTICIPANT: ✖
NUMBER OF TLV GASES AT THE FACILITY: 0
HW GENERATOR STATUS : LQG SQG CESQG RCRA LQG N/A
TIERED PERMIT LEVEL(S) : CESQT CESW CE-L CE-CL HHW PBR CA N/A

PRIMARY BILLING CODE
Not Applicable

SECONDARY BILLING CODE
Not Applicable

TERTIARY BILLING CODE
Not Applicable
INSPECTION SCOPE:*
HAZARDOUS MATERIALS: GEN HAZMAT APSA UST
MEDICAL WASTE: SQG SQG - TREATS

LQG LQG - ABBREVIATED LQG - TREATS
HAZARDOUS WASTE: SQG LQG
CALARP: 1 2 3
TIERED PERMITTING: CESQT CESW CE-L CE-CL

CA PBR HHW
CONSENT TO CONDUCT INSPECTION GRANTED BY: INSPECTION CONTACT NAME: Jamie Martinez TITLE: Assistant Store Manager

REMOVE BLANK CHECKLISTS FROM FINAL INSPECTION REPORT REFUSED TO SIGN TIME ACCOUNTING (Routine) TOTAL TIME ENTERED: 4.5
Date Time Group Type
08/19/2019 1 HMD Inspection Report Writing - Record
08/19/2019 0.5 HMD Inspection Travel Time - Record
08/19/2019 3 HMD Inspection HM/HW - Record

COUNTY OF SAN DIEGO

[email protected],[email protected],[email protected] RECORD COMMENT:

This retail store/TIUGA facility is open every day from 6 am to 12 midnight HM-924(01/15)

COUNTY OF SAN DIEGO

COMPLIANCE INSPECTION REPORT
FACILITY NAME: Walmart #1917
ADDRESS: 170 TOWN CENTER PKWY
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 08/19/2019 PAGE 1 OF 2
RECORD ID #: DEH2002-HUPFP-132274
TIME START: 2:30 PM END: 5:30 PM
SPECIALIST: Vikki Denslow
INSPECTION CONTACT:Jamie Martinez/Kevin Graber
TITLE: Assistant Store Manager/Auto Care Manager
PHONE:(619) 449-7900
E-MAIL:[email protected]
On the above date, the County inspected your facility under the authority of the California Health and Safety Code (H&SC), to determine compliance with applicable provisions of the H&SC, the California Code of Regulations (CCR), and the San Diego County Code of Regulatory Ordinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.8 & 25404.1.2) for any minor violations as defined in H&SC 25404 and 25117.6. This report may contain both minor and more significant (Class II) violations. Minor violations do not include repeat violations or violations remaining uncorrected for more than 30 days (or as specified below). Minor violations do not include knowing, willful, intentional, or chronic violations; nor do they include violations showing a pattern of neglect or disregard. The remarks below are intended to provide guidance to correct any violations indicated on the attached violation report. You must submit a written response to this report within 30 days (or as specified below) demonstrating that all violations have been corrected or include a written notice of disagreement that clearly states the reason for any disputed violations. Prompt correction can protect you from penalties for a "minor violation". Penalties can be imposed for each day in violation for all other violations even if they are corrected promptly. However, correction within 30 days (or as specified below) will make a penalty less likely.

NOTE: Reinspection fees will be charged if additional inspections are required to determine compliance.

Yes N/A
✖ Unified Program Facility Permit Current
✖ Hazardous Materials Business Plan Available
✖ Employee Training is Adequate
✖ Waste Disposal Records Available for Review
✖ Emergency Contacts Current Updated today
✖ Chemical Inventory/Map Current Updated today
Yes N/A
✖ Contingency Plan Available ✖ LQG SQG
✖ Employee Training Records Available
Universal Waste Managed Properly
✖ Waste Containers ✖ Closed Labeled
✖ Waste Containers in Good Condition
Permit Expires On 10/31/2019
CONSENT TO CONDUCT INSPECTION GRANTED BY: Jamie Martinez TITLE: Assistant Store Manager INTRODUCTION:

The purpose of this inspection was to evaluate this retail store for hazardous materials, hazardous waste, medical waste, and Aboveground Petroleum Storage Act (APSA) requirements. An assistant store manager, Jamie Martinez, granted consent for this inspection, and she was present for the duration of the inspection. The auto care manager, Kevin Graber, arrived later. A summary of violations was provided during the inspection on August 19, 2019, and this final inspection report was delivered on August 20, 2019.

The auto repair shop at this store had the following tanks: two 275 gallon oil tanks, a 400 gallon used oil tank, a 200 gallon used oil tank, a 25 gallon oil tank, and a 50 gallon windshield washer fluid tank. (All of these tanks are in underground areas, with the exception of the 200 gallon used oil tank.)
-This shop also had a large container for metal used oil filters and an empty drum for non-metal used oil filters. -Safety Kleen picks up used oil from this large quantity hazardous waste generator on a weekly basis. -The auto care manager stated that this shop no longer does air conditioning or antifreeze services. -Cintas services the rags, and Johnson Control picks up the used batteries.

This store also had two cages of propane, approximately 1500 cubic feet of refrigerant, and three empty helium cylinders onsite.

The store also had a drum of waste aerosols, approximately 25 buckets for hazardous waste (flammable solids, flammable liquids, corrosive liquids, oxidizing liquids, etc.), and several boxes for universal waste. The store also has a compactor.

The pharmacy had a sharps container and a pharmaceutical/hazardous waste container onsite. Side A of the pharmaceutical waste container was for loose, expired, and damaged pharmaceuticals, while side B was for empty waste pharmaceutical containers. Controlled substances are kept in a locked cabinet. A mail-back service is used for the sharps waste.

-Employee training on hazardous materials/waste is done on an annual basis, and copies of employee training records are available in a database.
-Daily tank inspection logs were available.
-A waste oil tank assessment dated May 18, 2017 was certified by a Professional Engineer on December 31, 2017. -The Spill Prevention Control and Countermeasures (SPCC) Plan dated May, 17, 2017 was certified by a Professional Engineer on May 18, 2017. A five year review of the SPCC Plan will be due by May 18, 2022.

HM-924(01/15)

COUNTY OF SAN DIEGO

SUPPLEMENTAL COMPLIANCE

INSPECTION REPORT
INSPECTION DATE: 08/19/2019 PAGE 2 OF 2
RECORD ID #: DEH2002-HUPFP-132274
The hazardous waste labels on the buckets were difficult to read because the writing on the labels had smeared and the lighting was not bright. There was also inadequate aisle space as the hazardous waste containers were directly in front of each other. (The buckets had to be moved in order to read the hazardous waste labels.) These minor violations were corrected during during the inspection as a hazardous waste pick-up occurred. Ensure that all hazardous waste labels are visible and legible, and maintain adequate aisle space in the hazardous waste storage area.

A submittal was made in the California Environmental Reporting System (CERS) on August 14, 2019.

Make the following changes to CERS by August 27, 2019:
-The SPCC Plan was dated 5/17/17, but CERS indicated that it was dated 7/18/18. Correct the date in CERS. -If the maximum amount of helium onsite is below 1000 cubic feet, you may delete or "discard" the inventory sheet for the helium. (Note that if you do not delete that inventory sheet, the store may be charged permit fees for that inventory item.) INSPECTION REMARKS:

INSPECTION PHOTOS
None
All regulated businesses are required by law to submit their Unified Program-related information and business updates online through the California Environmental Reporting System (CERS). For additional information about CERS, go to: http:// www.sandiegocounty.gov/deh/hazmat/hmd_cers.html

PRINTED NAME OF FACILITY REPRESENTATIVE
Kevin Graber

TITLE OF FACILITY REPRESENTATIVE
Auto Care Manager

SIGNATURE

DATE SIGNED
08/20/2019
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: (858) 505-6880 http://www.sdcdeh.org
HM-924(01/15)

COUNTY OF SAN DIEGO

COMPLIANCE INSPECTION REPORT
FACILITY NAME: Walmart #1917
ADDRESS: 170 TOWN CENTER PKWY
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 03/14/2023 PAGE 1 OF 13
RECORD ID #: DEH2002-HUPFP-132274
TIME START: 11:15 AM END: 2:15 PM
SPECIALIST: Manan Patel
INSPECTION CONTACT:Dan Courtwright
TITLE: Store Manager
PHONE:(619) 449-7900
E-MAIL:[email protected]
On the above date, the County inspected your facility under the authority of the California Health and Safety Code (H&SC), to determine compliance with applicable provisions of the H&SC, the California Code of Regulations (CCR), and the San Diego County Code of Regulatory Ordinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.8 & 25404.1.2) for any minor violations as defined in H&SC 25404 and 25117.6. This report may contain both minor and more significant (Class II) violations. Minor violations do not include repeat violations or violations remaining uncorrected for more than 30 days (or as specified below). Minor violations do not include knowing, willful, intentional, or chronic violations; nor do they include violations showing a pattern of neglect or disregard. The remarks below are intended to provide guidance to correct any violations indicated on the attached violation report. You must submit a written response to this report within 30 days (or as specified below) demonstrating that all violations have been corrected or include a written notice of disagreement that clearly states the reason for any disputed violations. Prompt correction can protect you from penalties for a "minor violation". Penalties can be imposed for each day in violation for all other violations even if they are corrected promptly. However, correction within 30 days (or as specified below) will make a penalty less likely.

NOTE: Reinspection fees will be charged if additional inspections are required to determine compliance. ✖ Unified Program Facility Permit Current
✖ Hazardous Materials Business Plan Available
✖ Employee Training is Adequate
✖ Waste Disposal Records Available for Review
✖ Emergency Contacts Current Updated today
✖ Chemical Inventory/Map Current Updated today
✖ Contingency Plan Available ✖ LQG SQG
✖ Employee Training Records Available
✖ Universal Waste Managed Properly
✖ Waste Containers ✖ Closed ✖ Labeled
✖ Waste Containers in Good Condition
Permit Expires On 10/31/2023
CONSENT TO CONDUCT INSPECTION GRANTED BY: Dan Courtwright TITLE: Store Manager INTRODUCTION:

On 03/14/2023, I conducted a Certified Unified Program Agency (CUPA) routine inspection at Walmart #1917, to verify compliance with Hazardous Materials Business Plan (HMBP), Hazardous Waste, Medical Waste and Aboveground Petroleum Storage Act (APSA) requirements. This business is a chain retail store that contains a prescription pharmacy and an automotive center. Consent to conduct today's inspection was granted by Dan Courtwright, Store Manager.

Based on observations during inspection, this facility is subject to the following CUPA programs:
- Hazardous Materials Business Plan (HMBP) requirements for storing reportable amounts (≥55 gallons, 500 pounds, or 200 cubic feet) of hazardous materials on-site. For more information regarding HMBP, go to: https://www.sandiegocounty.gov/content/dam/sdc/deh/hmd/pdf/HM-952%20(04-2021).pdf

- Hazardous Waste requirements as a generator of hazardous waste. Based on observations and hazardous waste manifests reviewed during today's inspection, at this time this facility appears to be a large quantity generator (LQG) of hazardous waste for generating more than 1,000 kilograms (~2,200 pounds or ~270 gallons) of hazardous waste per month.

- Medical waste requirements as a generator of medical waste. Based on observations and waste disposal records reviewed during today's inspection, at this time this facility appears to be a Small Quantity Generator (SQG) of medical waste for generating less than 200 pounds of medical waste per month.

- Aboveground Petroleum Storage Act (APSA) requirements for having one or more stationary Tanks in Underground Area (TIUGA), each with a storage capacity of 55 gallons or more of petroleum product; requiring this facility to a Spill Prevention, Control, and Countermeasure (SPCC) Plan that meets all requirements of Part 112 of Title 40 of the Code of Federal Regulations (CFR).

This facility's Hazardous Materials Inventory was verified during today's inspection in comparison to the most recent California Environmental Reporting System (CERS) submittal made on 08/03/2022. CERS ID: 10148997 INSPECTION REMARKS:

HMBP Remarks:
1) The facility's last full CERS submittal was made on 08/03/2022. Certify all 3 sections (Facility Information, Inventory, and Plans) of the HMBP annually or within 30 days of a significant change. A copy of the HMBP was available for review during HM-924(01/15)

COUNTY OF SAN DIEGO

SUPPLEMENTAL COMPLIANCE

INSPECTION REPORT
INSPECTION DATE: 03/14/2023 PAGE 2 OF 13
RECORD ID #: DEH2002-HUPFP-132274
inspection..

2) Employee training records for the past 3 years regarding hazardous materials management and emergency response procedures were available digitally and reviewed. Continue to conduct initial and annual training and maintain training records.

3) A current Contingency Plan/Emergency Information was accessible and posted in a central location. Ensure this information stays current.

Hazardous Waste Remarks:
1) Based on records reviewed, the hazardous waste storage area is inspected daily.

2) Facility's EPA ID # CAR000206631 was active at the time of inspection. Hazardous Waste generators must report annually to the Department of Toxic Substances Control (DTSC) in order to maintain an active CalEPA number. Details and FAQs regarding the annual DTSC Electronic Verification Questionnaire (eVQ) Online System is available online at: https://evq.dtsc.ca.gov/ Home.aspx

3) Hazardous waste manifests for the past 3 years were available and reviewed during the inspection. Clean Harbors is their hazardous waste hauler for the facility's retail hazardous waste. Safety-Kleen is their hazardous waste hauler for their automotive waste (i.e.: waste filters, used oil...)
(As an LQG, your hazardous waste must be picked up within 90 days of the accumulation start date. Hazardous Waste Manifests must be maintained on-site for 3 years.)

4) Hazardous Waste tank assessment was available/reviewed and signed by Jeffrey N. Hillson, Professional Engineer (APTIM)

5) This facility is a Used Oil Collection Center and accepts used oil from the general public. Logs of used oil collected were available and reviewed.

Medical Waste Remarks:
1) All primary medical waste containers were observed with appropriate generator information labels.

2) Medical waste tracking documents for the past 3 years were available and reviewed during inspection. This facility uses Sharps Compliance mail back program to properly dispose their sharps waste.

- Sharps waste can be stored for 30 days after the container is full or 90 days after the container is full if stored below 0°C (~32°F) - For an overview of medical waste requirements and storage time limits, go to: https://www.sandiegocounty.gov/content/dam/sdc/deh/hmd/pdf/hm-9214%20(11-16).pdf

APSA Remarks:
1) Based on observations during the inspection, the total aboveground petroleum storage capacity at this facility is at least 1150 gallons. This facility is subjected to APSA requirements for having one or more stationary Tanks in Underground Area (TIUGA)

2) This facility's SPCC Plan was last certified on 07/18/2018 by Jeffrey N. Hillson, Professional Engineer (APTIM). Ensure to review and certify your SPCC Plan at least once every 5 years.

3) This facility's SPCC Plan includes an adequate facility diagram.

4) This facility's SPCC Plan follows the requirements of 40 CFR 112.7

Additional SPCC Plan and APSA observations:
- Loading/unloading areas or racks and any equipment used in its process have general containment with spill kits readily available.

HM-924(01/15)

COUNTY OF SAN DIEGO

SUPPLEMENTAL COMPLIANCE

INSPECTION REPORT
INSPECTION DATE: 03/14/2023 PAGE 3 OF 13
RECORD ID #: DEH2002-HUPFP-132274
- All aboveground storage tanks (ASTs) are double walled with sized containment (Appendix A). Tests on ASTs are conducted annually.
- All daily/monthly inspections are conducted per Section 5.4. Supporting monthly inspections logs were available for review. - No visible discharges observed at the time of the inspection.

Additional Remarks:
1) The contents of this report were reviewed with Dan Courtwright during the inspection.

Helpful Websites:
• For guidance documents on hazardous materials-related topics, go to: https://www.sandiegocounty.gov/content/sdc/deh/hazmat/hmd_publications.html • For information on the California Environmental Reporting System (CERS), go to: https://www.sandiegocounty.gov/content/sdc/deh/hazmat/hmd_cers.html • If you have questions on: permit fees, business plan requirements, or hazardous waste regulations, go to: https://www.sandiegocounty.gov/content/sdc/deh/hazmat.html • To find out the latest San Diego County News and receive updates, subscribe to our govdelivery emails:
https://public.govdelivery.com/accounts/CASAND/subscriber/new If you have any questions regarding this inspection, please contact Manan Patel , (858) 260-1898, [email protected]

INSPECTION PHOTOS
None

INSPECTION ATTACHMENTS
None
All regulated businesses are required by law to submit their Unified Program-related information and business updates online through the California Environmental Reporting System (CERS). For additional information about CERS, go to:
https://www.sandiegocounty.gov/deh/hazmat/hmd_cers.html

PRINTED NAME OF FACILITY REPRESENTATIVE
Dan Courtwright

TITLE OF FACILITY REPRESENTATIVE
Store Manager

SIGNATURE

DATE SIGNED
03/14/2023
Department of Environmental Health and Quality, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: (858) 505-6880 http://www.sdcdehq.org

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Handlers of Hazardous Materials and Small and Large Quantity Generators of Hazardous Waste INSPECTION DATE: 03/14/2023 PAGE 4 OF 13
RECORD ID #:DEH2002-HUPFP-132274
FACILITY NAME: *Walmart #1917
ADDRESS: * 170 TOWN CENTER PKWY CITY/ZIP: *SANTEE 92071 Each violation checked below is for the section(s) of the California Health and Safety Code (HSC), California Code of Regulations (CCR), or the San Diego County Code (SDCC) indicated in italics. Incorporated provisions of Title 40 of the Code of Federal regulations (CFR) are noted for reference. All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use the Corrective Action Form (HM-926) to document your return to compliance. Please call (858) 505-6880 or your Specialist if you have any questions. HMBP = Hazardous Materials Business Plan; CUPA = Certified Unified Program Agency; CERS = California Environmental Reporting System; SQG = Small Quantity Hazardous Waste Generator; LQG = Large Quantity Hazardous Waste Generator

HAZARDOUS MATERIALS REQUIREMENTS
# VIOLATION DESCRIPTION
1010001 Failed to establish and implement a HMBP. HSC 25505(a) and 25507(a) 1010002 HMBP not submitted in CERS within the required timeframe. HSC 25508(a)(1); 27 CCR 15188(a),(b),(d) 1010003 Business activities &/or Business Owner/Operator page not complete or accurate in CERS. 19 CCR 2652(a)(1); SDCC 68.904(b); HSC 25508(a)(1), 25508(a) (3)
1010004 Chemical inventory incomplete or not submitted in CERS. HSC 25505(a)(1); 25507(a); 25508.1(a-b); 19 CCR 2654 (a) or (d) 1010005 Site map not submitted in CERS or not sufficient. HSC 25505(a)(2); 25508.1(f); 19 CCR 2652(a)(3) 1010006 Failed to update HMBP in CERS within 30 days of a substantial change to any portion of the HMBP, including inventory changes or facility information.

HSC 25508.1(a-f); 19 CCR 2654(d); SDCC 68.904(c)(6)
1010008 HMBP not certified as complete and accurate in CERS by the required due date. HSC 25508.2, 19 CCR 2654(b) 1010010 Emergency response plan and procedures to mitigate a release or threatened release not adequate, not established or not submitted in CERS. HSC 25505(a)(3), 25508(a)(1), 25508(a)(3); 19 CCR 2658
1010011 Failure to notify property owner in writing that the business is subject to the HMBP program. HSC 25505.1 1010012 Failure to provide a copy of HMBP to the property owner within five working days upon request from property owner. HSC 25505.1 1010014 Failure to submit emergency response plan in CERS, when not meeting agricultural handler exemption. HSC 25507.1(a) and 25508(a)(1); 19 CCR 2670, 2671
1010015 Failure to submit employee training plan in CERS, when not meeting agricultural handler exemption. HSC 25507.1(a), 25508(a)(1), 19 CCR 2670, 2671 1010016 HMBP not established or submitted in CERS, when not meeting the remote site exemption. HSC 25507.2 and 25508(a)(1) 1020001 Employee training and/or plan for safety procedures in the event of a release or threatened release of a hazardous material not adequate, not established or not submitted in CERS. HSC 25505(a)(4), 25508(a)(1), 25508(a)(3); 19 CCR 2659(a) 1030001 (AWM) Failure of agricultural handler to post warning signs on buildings where pesticides, petroleum, or fertilizers are stored, that are visible from any direction of probable approach, contain all required information, and are in appropriate language. HSC 6.95 25507.1(a)(2); 19 CCR 2670, 2671 1020002 Initial &/or annual employee training not conducted in safety procedures for a hazardous material release or threatened release &/or employee training records not available or not maintained for 3 years. HSC 25505(a)(4); 19 CCR 2659(b) 1040001 Hazardous materials release or threatened release not immediately reported to the CUPA and OES upon discovery. HSC 25510(a); 19 CCR 2631(a) HMD1001 Unified Program Facility permit not obtained for hazardous materials. SDCC 68.904; 68.905; 68.906, 68.907; 68.907.1 HMD1005 Emergency contact not provided or current in CERS. HSC 25508.1(f); SDCC 68.904(b) HMD1007 Highly toxic gas (TLV<10 ppm) not disclosed in CERS. SDCC 68.1113(a) 1010017 HMBP not readily available to facility personnel or the CUPA. HSC 25505(c)

HAZARDOUS WASTE REQUIREMENTS FOR SQGS ONLY
# VIOLATION DESCRIPTION
HMD0226 Did not accumulate waste in a container or tank. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(2) 3030007 Failed to properly label/date hazardous waste container &/or tank. 22 CCR 66262.34(f) 3030010 Failed to properly dispose of hazardous waste within 180 days (or 270 days if waste is transported over 200 miles). 22 CCR 66262.34(d); HSC 6.5 25123.3(h)(1)
3030013 Failed to accumulate hazardous waste in a container that is in good condition. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(2), 265.171 3030015 Failed to accumulate or store hazardous waste in a lined &/or compatible container. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(2), 265.172 3030017 Failed to properly close hazardous waste container(s). 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(2), 265.173 3030019 Failed to inspect hazardous waste storage area at least weekly. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(2), 265.174 3030022 Failed to properly separate incompatible waste. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(2), 265.177 3030030 Failed to maintain &/or operate facility to minimize the possibility of a fire, explosion, or any unplanned sudden or non-sudden release of hazardous waste or hazardous waste constituents. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(4), 265.31 3030036 Failed to maintain adequate aisle space. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(4), 265.35 3010022 Failed to post, next to the telephone, emergency information containing the location of emergency equipment, contact names and phone numbers. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(5)(ii)
3020001 Failure to ensure employees are thoroughly familiar with proper waste handling and emergency procedures during normal facility operations and emergencies. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(5)(iii) 3030032 Failed to maintain the following emergency response equipment or equivalent: 1) An internal communication or alarm system; 2) A communication device, such as a telephone; 3) Portable fire extinguishers, fire/spill control equipment and decontamination equipment; and 4) Water at adequate volume and pressure. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(4), 265.32 3030039 Failed to have an emergency coordinator on the premises or on call, and available during an emergency. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(5)(i) HMD0412 Failed to implement and/or coordinate emergency response measures during an emergency, spill/release. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(5) (iv)
3010030 Failed to submit an Exception Report to DTSC for hazardous waste manifest. HSC 25123.3(h)(2); 22 CCR 66262.42(a), (c-d)

HAZARDOUS WASTE TANK SYSTEMS FOR SQGS ONLY
# VIOLATION DESCRIPTION
HM-923 (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Hazardous Materials and Hazardous Waste (continued)
INSPECTION DATE: 03/14/2023 PAGE 5 OF 13
RECORD ID #:DEH2002-HUPFP-132274
3030024 Failed to operate uncovered tank to ensure at least 2 ft. of freeboard to prevent overtopping, unless the tank is equipped with a containment structure, a drainage control system, or a diversion structure with a capacity that equals or exceeds the volume of the top 2 ft. of the tank. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(3), 265.201(b)(c)
3030025 Failed to provide an overfill protection device on continuously fed hazardous waste tank(s). 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(3), 265.201(b)(4) 3030027 Failed to conduct daily tank inspection of discharge control system, monitoring equipment and waste level. 22 CCR 66262.34(d)(2); 40 CFR 265.201(c) (1-3), 262.34(d)(3)
3030028 Failed to conduct weekly hazardous waste tank inspection(s) to detect signs of leakage and ensure that the construction materials, fixtures and surrounding areas of the tank are in good condition. 22 CCR 66262.34(d)(2); 40 CFR 265.201(c)(4 & 5), 262.34(d)(3) 3050007 Failed to properly remove all waste upon closure, decontaminate, and document the closure of a hazardous waste tank system. 22 CCR 67383.3; 40 CFR 262.34(d)(3), 265.201(f)
HMD1612 Hazardous waste improperly stored in a tank system causing leaks, corrosion, or failure. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(3), 265.201(b) HMD1614 Failed to pre-notify the CUPA in writing prior to closing a hazardous waste tank system. 22 CCR 67383.3(a)(1) HMD1615 Failed to properly accumulate ignitable or reactive waste in a tank system. 22 CCR 66262.34(d)(2); 40 CFR 262.34(d)(3), 265.201(g)

HAZARDOUS WASTE REQUIREMENTS FOR SQGS AND LQGS

RECORD KEEPING/OPERATIONAL REQUIREMENTS
# VIOLATION DESCRIPTION
HMD0131 Unified Program Facility Permit not obtained &/or maintained for the generation of hazardous waste. SDCC 68.904; 68.905; 68.907.1 HMD0150 Failed to submit complete and accurate Facility Information in CERS. 27 CCR 15188(b-c); SDCC 68.904(b) 3030053 Failed to maintain waste analysis records, analytical records &/or waste determination results for at least 3 years. 22 CCR 66262.40(c) 3010002 Failed to obtain &/or maintain an active EPA ID Number. 22 CCR 66262.12(a) 3010008 Failed to properly complete a uniform hazardous waste manifest. 22 CCR 66262.23(a) 3010009 Failed to submit an Exception Report to DTSC for hazardous waste manifest. HSC 25123.3(h)(2); 22 CCR 66262.42(b), (c), &/or (d) 3010010 Failed to maintain copies of Uniform Hazardous Waste Manifest, consolidated manifest, or Bills of Lading for 3 years. HSC 25160.2(b)(3), 25185(a)(4); 22 CCR 66262.40(a), 66262.23(a)(3)
3010011 Failed to send a copy of the uniform hazardous waste manifest that originated in paper form to DTSC within 30 days of shipment. 22 CCR 66262.23(a)(4); HSC 25160(b)(1)(c)
3010013 Failed to meet the consolidated manifesting requirements for waste shipment. HSC 25160.2(b)(3) &/or (c) 3010014 Failed to retain at the generator's place of business disposal records of spent lead-acid batteries for at least 3 years. 22 CCR 66266.81(a)(4)(A) &/or (B) 3030006 Failed to determine if a hazardous waste is restricted or prohibited from land disposal and has to be treated. 22 CCR 66268.7(a)(1) 3010016 Failure of recycler who recycles more than 100 kilograms per month of a recyclable material to submit the biennial Recyclable Materials Report (RMR) in CERS when claiming exclusion or exemption. HSC 25143.10(a), (c) &/or (d) HMD0149 Failed to keep disposal receipts for drained used oil filters and/or drained fuel filters for 3 years. HSC 25250.22; 22 CCR 66266.130(c)(5) HMD0152 Failed to report &/or update the required inventory information for hazardous waste(s) generated at the facility in CERS. SDCC 68.904(a)(2) HMD0140 Failed to have Land Disposal Restriction documentation onsite for 3 years. 22 CCR 66268.7(a)(8) 3250005 Failed to obtain a Treatment, Storage and Disposal Facility (TSDF) permit or authorization to store/treat/dispose of hazardous waste. HSC 25201(a) 3050005 Failed to properly manage a recyclable material. HSC 25143.2, 25143.9 HMD0142 Failed to notify the CUPA in CERS for onsite hazardous waste treatment/tiered permitting. HSC 25201(a) HMD0138 Manifest signed by the TSDF not available for inspection. 22 CCR 66262.40(a); HSC 25185(a)(4) 3010035 Failure to annually submit notification of generator's intent to remotely consolidate hazardous waste. HSC 25110.10(d) 3010037 Failure to notify the CUPA of aerosol can processing procedures prior to commencement of operations. HSC 25201.16(j)

DISPOSAL AND TRANSPORTATION
# VIOLATION DESCRIPTION
3010007 Failed to prepare a hazardous waste manifest for the transport of a waste for off-site transfer, treatment, storage, or disposal. HSC 25160(b)(1) or (2), 25160.2(b)(9); 22 CCR 66262.20(a)
3030005 Failed to make a proper waste determination. 22 CCR 66262.11, 66262.40(c) 3050001 Failed to use a DTSC registered hazardous waste transporter to transport hazardous waste. HSC 25163(a) 3050002 Failed to properly dispose of hazardous waste at an authorized facility. HSC 25189.5(a) HMD0308 Impermissible dilution of hazardous waste. 22 CCR 66268.3(a) HMD0305 Disposed of used oil illegally. HSC 25250.5(a), 25189.5(a) HMD0306 Failed to properly dispose of oil-based paint &/or hazardous waste latex paint liquid. HSC 25217.1, 25189.5(a)

STORAGE AND HANDLING
# VIOLATION DESCRIPTION
3030001 Failed to meet the management requirements when handling or storing spent lead-acid batteries. 22 CCR 66266.81(a) 3030003 Failed to properly manage 'damaged' spent lead acid batteries so as to minimize the release of acid and lead and to protect the handlers and the environment 22 CCR 66266.81(b)
3030012 (RCRA LQG) Failed to properly dispose of hazardous waste within 90 days. 22 CCR 66262.34(a), (c); HSC 6.5 25123.3(b)(1) 3030004 Failure to properly manage used oil filters and/or fuel filters in accordance with the requirements. HSC 25250.22; 22 CCR 66266.130 3050004 Failure to prevent intentional contamination of used oil with other hazardous waste other than minimal amounts of vehicle fuel. HSC 25250.7(a) HMD0222 Failed to properly label Excluded Recyclable Materials (ERM) accumulated in a container or tank. HSC 25143.9(a) HMD0216 Failed to label hazardous material container within 10 days after the container was discovered to be mislabeled or inadequately labeled. HSC 25124(b)(3) (A); 22 CCR 66262.34(f)
HMD0217 Failed to repackage and properly label damaged/deteriorated hazardous material container within 96 hours. HSC 25124(b)(3)(B); 22 CCR 66262.34(f) HMD0219 Failed to properly segregate used oil &/or fuel drained from filters. HSC 25250.22(b)(4); 22 CCR 66266.130(c)(6) HM-923 (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Hazardous Materials and Hazardous Waste (continued)
INSPECTION DATE: 03/14/2023 PAGE 6 OF 13
RECORD ID #:DEH2002-HUPFP-132274
3030057 Failed to comply with hazardous waste satellite container regulation. 22 CCR 66262.34(e) 3030058 Failed to mark date on empty container larger than 5 gallons &/or properly manage it within one year. 22 CCR 66261.7 3030060 Failure of the owner or operator managing laboratory hazardous waste in a laboratory accumulation area to comply with the accumulation, storage, management, training, and/or record-keeping requirements. HSC 25200.3.1(b) and/or (c)

UNIVERSAL WASTE HANDLER REQUIREMENTS
# VIOLATION DESCRIPTION
3010004 Failed to obtain a California ID Number from DTSC or federal ID Number from USEPA prior to accumulating 5,000 kgs or more of Universal Waste. 22 CCR 66273.32(a-b)
HMD0151 Failed to maintain universal waste handler training records for 3 years. 22 CCR 66273.36(c),(d) 3020003 Failed to properly train handlers of universal waste in universal waste management and response procedures. 22 CCR 66273.36(a),(b) 3030008 Failed to properly label or mark Universal Waste container, package, or pallet (excluding CESQUWG) 22 CCR 66273.34 3030011 Failed to properly dispose of Universal Waste within one year. 22 CCR 66273.35(a) &/or (b) HMD0147 Failed to keep records of offsite Universal Waste shipment(s) available for inspection for 3 years. 22 CCR 66273.39(c),(d)(2) 3030051 Failed to meet accumulation, labeling, marking, &/or containment standards for Universal Waste aerosol containers. HSC 25201.16(f) 3040004 Failed to manage universal waste in a manner to prevent release(s) to the environment. 22 CCR 66273.33; 66273.33.5, 66273.33.6 HMD0307 Disposal of universal waste (UW) to an unauthorized point. HSC 25189.5(a); 22 CCR 66273.31(a), 66273.8(b) 3010005 Failure of a universal handler of PV modules, electronic devices, and/or CRTs from an offsite source to notify DTSC 30 days prior to acceptance. 22 CCR 66273.32(c), (e)
3010020 Failure of a universal waste handler to submit an annual report that includes all required information to DTSC by February 1 of every year. 22 CCR 66273.32(d), (f)
3010006 Failure of the universal waste handler who sends electronic devices or CRTs to any foreign destination to notify DTSC 60 days prior to export and send a copy to the CUPA. 22 CCR 66273.40(a)(2),(3)
3110030 Failed to notify the CUPA of aerosol processing procedures prior to commencement of operations. HSC 25201.16(j)

CERTIFIED APPLIANCE RECYCLER REQUIREMENTS
# VIOLATION DESCRIPTION
3010033 Failure to obtain Certified Appliance Recycler certification (CAR) from DTSC. HSC 25211.4 3010034 Failure of certified appliance recycler (CAR) to provide documentation that all materials that require special handling (MRSH) have been properly removed and managed. HSC 25211.2, 25211.3
3030055 Failure of certified appliance recycler (CAR) to properly remove and dispose of all materials that require special handling (MRSH). HSC 25212 HM-923 (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Handlers of Hazardous Materials and Small and Large Quantity Generators of Hazardous Waste INSPECTION DATE: 03/14/2023 PAGE 7 OF 13
RECORD ID #:DEH2002-HUPFP-132274
Each violation checked below is for the section(s) of the California Health and Safety Code (HSC), California Code of Regulations (CCR), or the San Diego County Code (SDCC) indicated in italics. Incorporated provisions of Title 40 of the Code of Federal regulations (CFR) are noted for reference. All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use the Corrective Action Form (HM-926) to document your return to compliance. Please call (858) 505-6880 or your Specialist if you have any questions. HMBP = Hazardous Materials Business Plan; CUPA = Certified Unified Program Agency; CERS = California Environmental Reporting System; SQG = Small Quantity Hazardous Waste Generator; LQG = Large Quantity Hazardous Waste Generator

HAZARDOUS WASTE REQUIREMENTS FOR LQGS ONLY

RECORDKEEPING/OPERATIONAL REQUIREMENTS
# VIOLATION DESCRIPTION
3110008 Failed to prepare every four years a source reduction evaluation review and plan. 22 CCR 67100.4(a), HSC 25244.19(a) 3110009 Failed to prepare a summary progress report every four years. 22 CCR 67100.9(a) 3110010 Failed to complete a hazwaste management performance report and/or maintain for review. HSC 25244.20(a), 25244.21(a); 22 CCR 67100.3(a) 3110007 (RCRA LQG) Failed to complete the Biennial Report by March 1st on even numbered year and maintain a copy for 3 years. 22 CCR 66262.40(b), 66262.41(b)
3010009 Failed to submit an Exception Report to DTSC for hazardous waste manifest. HSC 25160(b)(3); 22 CCR 66262.42(b), (c), &/or (d)

STORAGE AND HANDLING
# VIOLATION DESCRIPTION
3130003 Failed to properly label/date hazardous waste container or portable tank. 22 CCR 66262.34(f), 66262.34(a)(2), 66262.34(a)(3) 3030012 (RCRA LQG) Failed to properly dispose of hazardous waste within 90 days. 22 CCR 12 66262.34(a), (c); HSC 6.5 25123.3(b)(1) 3130004 Accumulated hazardous waste more than 90 days without a DTSC storage permit. HSC 25123.3(b)(1); 22 CCR 66262.34(a) and (c) 3130005 Failed to transfer waste from a container that is in poor condition to another container that is in a good condition. 22 CCR 66265.171 3130006 Failed to accumulate hazardous waste in a lined or compatible container. 22 CCR 12 66262.34(a); 22 CCR 15 66265.172 3130007 Failed to keep a hazardous waste container or portable tank closed. 22 CCR 66265.173(a) 3130008 Failed to inspect hazardous waste storage area(s) at least weekly. 22 CCR 66265.174 3130009 Failed to keep reactive and/or ignitable waste at least 50 ft. from the property line. 22 CCR 66265.176 3130010 Failed to properly separate incompatible waste. 22 CCR 66265.17(b), 66265.177 3130013 Facility failed to maintain and/or operate to minimize the possibility of a fire, explosion, or any unplanned sudden or non-sudden release of hazardous waste or hazardous waste constituents to air, soil, or surface water which could threaten human health or the environment. 22 CCR 66265.31 HMD0235 Generator did not accumulate hazardous waste in a container or tank. 22 CCR 66262.34(a)(1)(A)

TRAINING, CONTINGENCY PLAN & ER PROCEDURES
# VIOLATION DESCRIPTION
3110011 Failed to have a written Contingency Plan which is designed to minimize hazards to human health or the environment from fires, explosions, or any unplanned sudden or non-sudden release of hazardous waste or hazardous waste constituents to air, soil, or surface water. 22 CCR 66265.51(a) 3110012 Failed to maintain onsite a copy of the Contingency Plan and all its revisions and submit a copy to the local emergency agencies that may be called upon to provide emergency services. 22 CCR 66265.53
3120001 Failed to maintain training documents and records at the facility. 22 CCR 66265.16(d) & (e) 3130015 Failed to test and maintain all communications or alarm systems, fire protection equipment, spill control equipment, and decontamination equipment to assure its proper operation in time of emergency. 22 CCR 66265.33 3130016 Failed to maintain aisle space to allow the unobstructed movement of personnel, fire protection, spill-control equipment, etc. to any area of facility operation in an emergency. 22 CCR 66265.35
HMD0418 Failed to take precautions to prevent accidental ignition or reaction of ignitable or reactive waste, including the posting of a "No Smoking" sign(s), & separate and protect from sources of ignition or reaction. 22 CCR 66265.17(a) 3130018 Failed to immediately implement the Contingency Plan during an emergency and whenever there is a fire, explosion, or release of hazardous waste or hazardous waste constituents which could threaten human health or the environment. 22 CCR 66265.51(b) 3020002 Employee training program not adequate. 22 CCR 66265.16(a) and/or (b) 3010023 Contingency plan content is missing information and/or listing of required actions or descriptions. 22 CCR 66265.52 HMD0414 Failed to train employees at least annually. 22 CCR 66265.16(c) 3130014 Failed to equip facility with required emergency equipment, water at adequate pressure and volume, internal communication system, &/or spill response equipment. 22 CCR 66265.32
HMD0417 Failed to have an emergency coordinator on the premises or on call, and available to respond during an emergency and when a release occurs. 22 CCR 66265.55

HAZARDOUS WASTE TANK SYSTEM FOR LQGS ONLY
# VIOLATION DESCRIPTION
3110013 Failed to obtain and maintain a written assessment certified by an independent, qualified, registered professional engineer for the hazardous waste tank system. 22 CCR 66265.192(a), 66265.192(h)(1), or 66265.191(a) 3110014 Hazardous waste tank system assessment documentation failed to include all required information. 22 CCR 66265.192(k) 3110015 Failed to obtain CUPA approval prior to the replacement of equipment for a tank system. 22 CCR 66265.192(l), 66265.192(m) 3130011 Failed to maintain tank operating requirements: 1) Spill prevention control; 2) Overfill prevention control, and/or; 3) maintenance of sufficient freeboard in uncovered tanks. 22 CCR 66265.194(a),(b)
3130012 Failed to conduct daily inspections and/or maintain the inspection records for hazardous waste tank system. 22 CCR 66265.195(a)(c) 3130019 Failed to provide proper secondary containment and/or leak detection for hazardous waste tank system. 22 CCR 66265.193(a) &/or (c)(3) 3030042 Failure to inspect cathodic protection systems, if present, according to the following schedule to ensure that they are functioning properly: (1) the proper operation of the cathodic protection system shall be confirmed within six months after initial installation, and annually thereafter; and (2) all sources of impressed current shall be inspected and/or tested, as appropriate, at least bimonthly (i.e., every other month). (3) The owner or operator shall document in the operating record of the facility an inspection of the above items. 22 CCR 12 66262.34(a)(1); 22 CCR 15 66265.195(b), 66265.195(c)
HM-923 (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Hazardous Materials and Hazardous Waste (continued)
INSPECTION DATE: 03/14/2023 PAGE 8 OF 13
RECORD ID #:DEH2002-HUPFP-132274
3130020 Failure of the owner or operator to inspect and document the cathodic protection systems to ensure the proper operation within six months after initial installation, and annually thereafter; and all sources of impressed current at least bimonthly (i.e., every other month). 22 CCR 12 66262.34(a); 22 CCR 15 66265.195(b), 66265.195(c)
3140001 Failed to properly respond to a tank system spill/leak, follow emergency procedures as required, and/or remove all released waste from the secondary containment. 22 CCR 66265.56, 66265.196, 66265.194(c)
3150002 Failed to properly close a hazardous waste tank system ensuring the minimization of further maintenance and requirements are met. 22 CCR 66265.111, 66265.114, 66265.197(a), 67383.3
HMD1604 Failed to maintain secondary containment empty. 22 CCR 66265.196(b) and (c); 66265.194(c) HMD1607 Failed to adequately design or maintain corrosion protection. 22 CCR 66265.191(b)(3) or 66265.192(a) and (f) HMD1608 Failed to complete annual integrity assessment for existing hazardous waste tank system without secondary containment. 22 66265.191(a) (e) HMD1609 Failed to immediately remove unfit hazardous waste tank system from service. 22 CCR 66265.196 HMD1611 Failed to properly complete and/or document closure of a hazardous waste tank system. 22 CCR 67383.3, 66265.197(a), (b) HMD1619 Failed to have required safety measures for hazardous waste tank system holding ignitable or reactive waste. 22 CCR 66265.198(a)(b) HMD1620 Failed to immediately remove from service a hazardous waste tank system that leaked or spilled waste. 22 CCR 66265.196(b),(c) HMD1621 Failed to notify DTSC when a release to environment occurred from a hazardous waste tank system. 22 CCR 66265.196(e)(1)or(3) HMD1623 Failed to develop and/or implement a written plan and schedule to perform VOC emissions inspections and monitoring of tank or container. 22 CCR 66265.1089(b)
HMD1624 Failed to comply with the 3 year record keeping requirement for tank accumulating VOC waste. 22 CCR 66265.1090(a) HMD1625 Failed to properly control air pollutant emissions for tank accumulating VOC waste. 22 CCR 66265.202, 66265.1083(b) and 66265.1085(b) 3130026 Failed to meet emissions control standards for HW tank system with VOC waste. 22 CCR 66265.202 and 66265.1082 (a),(b) &/or (c) 3130022 Failed to label stationary hazardous waste tank as hazardous waste and mark with accumulation start date. 22 CCR 66262.34(f)(2) &/or (3) 3130025 Failure to comply with VOC emission requirements for containers and/or a portable tank. 22 CCR 66262.34(a)(1); 66265.178 3030062 Failed to comply with the emission control standards for equipment (piping, valves, pumps, connectors, etc.) containing 10% or more VOCs. 22 CCR 66262.34(a)(1)(A) & 66265.1050(b)
HM-923 (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Aboveground Petroleum Storage Act (APSA) Program
INSPECTION DATE: 03/14/2023 PAGE 9 OF 13
RECORD ID #:DEH2002-HUPFP-132274
Each violation checked below is for the section(s) of the California Health and Safety Code (HSC), California Code of Regulations (CCR), or San Diego County Code ("SDCC") indicated in italics. Incorporated provisions of Title 40 of the Code of Federal Regulations (CFR) are noted for reference. All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use a DEH Corrective Action Form (HM-926) or other correspondence to document your return to compliance. Please call (858) 505-6880 or your Specialist if you have any questions.

GENERAL APSA FACILITY REQUIREMENT
(CHAPTER 6.67 OF DIVISION 20 OF THE HSC & SDCC)
# VIOLATION DESCRIPTION
4010001 Failed to prepare a Spill Prevention, Control, and Countermeasures (SPCC) Plan. HSC 25270.4.5(a), 40 CFR 112.3, 112.6 4030038 Failed to implement the SPCC Plan. HSC 25270.4.5(a), 40 CFR 112.3, 112.6 4010032 Failed to submit a tank facility statement or update/certify Business Plan annually. HSC 25270.6(a)(1) or (a)(2) 4010033 Failed to pay the APSA program fee or obtain Unified Program Facility Permit. HSC 25270.6(b), SDCC 68.904; 68.905; 68.907.1 4040001 Failed to immediately, upon discovery, report a one-barrel (42 gallons) or greater release of petroleum to Cal OES and the CUPA . HSC 25270.8 4010037 Failed to meet conditions of APSA exemption for oil-filled electrical equipment including containment and visual inspection. HSC 25270.2(a)(4), 25270.4.5(a)
4030043 Failed to have secondary containment and leak detection if piping connected to tank in an underground area (TIUGA) cannot be directly viewed on all sides. (Refer to HSC 6.67 for direct viewing; DOES NOT apply to: 1. Piping connected to a tank that contains new oil/used oil for lubricant or coolant in a motor engine or transmission, or oil-filled operational/manufacturing equipment. 2. Piping connected to a tank used solely in connection with a fire pump or emergency system, legally required by standby system, or optional standby system. 3. Piping connected to a petroleum hazardous waste tank that complies with hazardous waste tank standards (22 CCR Ch. 15, Art. 10) and facility has been issued a unified program facility permit pursuant to HSC 25404.2 for generation, treatment, accumulation, or storage of hazardous waste.) (24CCR Title 9 Section 5703.6.2.2.) HSC 25270.4.5(a), HSC 25270.2(o)(1)(C)(iv)
4030044 Failure of an owner/operator of an excluded tank in an underground area (TIUGA) with less than 55-gallon capacity to have secondary containment, conduct monthly inspections, and/or maintain a log of inspections. HSC 6.67 25270.2(a)(8) HMD5104 Failed to submit, and keep up to date, the APSA program element in CERS. SDCC 68.904; 27 CCR 15188(a),(b),(c),&(f) REQUIREMENTS BASED ON 40 CFR 112.1-112.6
# VIOLATION DESCRIPTION
4010035 Failed to prepare an appropriate SPCC Plan within 6 months when the facility no longer meets the Tier I or Tier II qualified criteria. 40 CFR 112.6(a)(2), 112.6(b)(2); HSC 6.67 25270.4.5 (a)
4010047 (Qualified Facility only- Tier I or II) Failed to have management, or a Professional Engineer if applicable, certify the SPCC Plan and comply with the certification requirements. (40 CFR 112.6(a)(1), 112.6(b).) HSC 25270.4.5(a) 4010048 (Qualified Facility only- Tier I) Failed to certify the SPCC Plan according to 40 CFR 112.6(a)(1) if a technical change has been made to the facility design, construction, operation, or maintenance. (40 CFR 112.6(a)(2).) HSC 25270.4.5(a) 4010052 (Qualified Facility only- Tier II) Failed to have technical amendment(s) certified by management, or a Professional Engineer if applicable. (40 CFR 112.6(b) (2), 112.6(b)(2)(i).) HSC 25270.4.5(a)
4010054 (Qualified Facility only- Tier I) Failed to include in the SPCC Plan a prediction of direction and total quantity of oil potentially discharged from the facility as a result of each type of major equipment failure. (40 CFR 112.6(a)(3)(i).) HSC 25270.4.5(a) 4030041 (Qualified Facility only- Tier I) Failed to provide bulk storage containers/tanks with adequate sized secondary containment to contain the capacity of the largest container plus freeboard for precipitation; failed to position/locate mobile or portable containers to prevent a discharge. (40 CFR 112.6(a) (3)(ii).) HSC 25270.4.5(a)
4030042 (Qualified Facility only- Tier I) Failed to provide systems or follow procedures to prevent overfills as described in the SPCC Plan; failed to routinely test overfill equipment to ensure proper operation. (40 CFR 112.6(a)(3)(iii).) HSC 25270.4.5(a) 4010003 Failed to have a Professional Engineer certify and review the SPCC Plan. (40 CFR 112.3(d).) HSC 25270.4.5(a) 4010008 Failed to maintain a complete copy of the SPCC Plan at the facility if the facility is normally attended at least four hours per day, or at the nearest field office if the facility is not so attended. (40 CFR 112.3(e)(1).) HSC 25270.4.5(a) 4010010 Failed to make SPCC Plan technical amendment(s) within six months when the facility has had a change in design, construction, operation, or maintenance which affects the facility's discharge potential; failed to implement within six months following preparation of the amendment. (40 CFR 112.5(a), 112.5(b).) HSC 25270.4.5(a)
4010009 Failed to perform and properly document a five-year review of the SPCC Plan. (40 CFR 112.5(b).) HSC 25270.4.5(a) 4010039 Failed to have technical amendments certified by a licensed Professional Engineer. (40 CFR 112.5(c).) HSC 25270.4.5(a)

GENERAL SPCC REQUIREMENTS
BASED UPON 40 CFR 112.7
# VIOLATION DESCRIPTION
4010012 Failed to prepare a written SPCC Plan in accordance with good engineering practices and any applicable more stringent State rules, regulations, and guidelines; failed to prepare a SPCC Plan that follows the sequence of rule or provides a cross-reference; failed to prepare a SPCC Plan that addresses additional procedures/methods/equipment not fully operational; failed to obtain facility management approval for implementation of the SPCC Plan . (40 CFR 112.7 and 112.7(a)(1).) HSC 25270.4.5(a) 4010014 Failed to include alternative environmental protection to SPCC requirements within SPCC Plan. (40 CFR 112.7(a)(2).) HSC 25270.4.5(a) 4010015 Failed to include in the SPCC Plan an adequate facility diagram, or no facility diagram included. The facility diagram is not required for a Tier I Qualified Facility. (40 CFR 112.7(a)(3).) HSC 25270.4.5(a)
4010016 Failed to adequately describe in the SPCC Plan the physical layout of facility, types of oil and storage capacities, tanks, containers, equipment, mobile refuelers, portable containers, transfer operations, and other required information. (40 CFR 112.7(a)(3), 112.7(a)(3)(i-vi).) HSC 25270.4.5(a) 4010017 Plan does not contain procedures for reporting a discharge, and/or a contact list and phone numbers for the facility response coordinator, National Response Center, cleanup contractors with an agreement for response, and all appropriate Federal, State, and local agencies. (40 CFR 112.7(a)(4).) HSC 25270.4.5(a)
4010018 Discharge response procedures are not adequately organized to be readily accessible in an emergency. (40 CFR 112.7(a)(5).) HSC 25270.4.5(a) 4010019 Failed to include in the SPCC Plan a prediction of the direction, rate of flow, and total quantity of oil that could be discharged for each type of major equipment failure where experience indicates a reasonable potential for equipment failure. (40 CFR 112.7(b).) HSC 25270.4.5(a) 4010020 (General Containment) Failed to provide, or include in the SPCC Plan, the appropriate containment, diversionary structures, or equipment to prevent a discharge that will not escape containment before cleanup occurs, including typical failure mode and most likely quantity of discharge. (40 CFR 112.7(c).) HSC 25270.4.5(a)
4010004 Failed to clearly explain why appropriate containment/diversionary structures are not practicable and/or SPCC Plan claiming impracticability is not certified by a licensed Professional Engineer. (40 CFR 112.7(d).) HSC 25270.4.5(a) HM-950 APSA (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
APSA Program (continued)
INSPECTION DATE: 03/14/2023 PAGE 10 OF 13
RECORD ID #:DEH2002-HUPFP-132274
4010005 Failed to prepare an Oil Spill Contingency Plan following the provisions of 40 CFR Part 109 for impracticability claim. (40 CFR 112.7(d)(1).) HSC 25270.4.5(a)
4010006 Failed to provide a written commitment of manpower, equipment, materials when claiming impracticability. (40 CFR 112.7(d)(2).) HSC 25270.4.5(a) 4010021 Failed to have record of inspections and integrity tests signed by the appropriate supervisor or inspector, keep written procedures and records of inspections and integrity tests for at least three years, and/or keep comparison records for bulk storage containers subject to 40 CFR 112.8(c)(6). (40 CFR 112.7(e), 112.8(c)(6).) HSC 25270.4.5(a)
4020002 Failure to conduct spill prevention briefing for oil-handling personnel at least once a year to assure adequate understanding of the SPCC Plan, including:

1. Known discharges or failures, 2. Malfunctioning components, 3. Any recently developed precautionary measures. 40 CFR 1 112.7(f)(3); HSC 6.67 25270.4.5(a)
4020001 Failed to train oil-handling personnel on: operation/maintenance of equipment to prevent discharges; discharge procedure protocols; applicable laws, rules, and regulations; general facility operations; and the contents of the SPCC Plan. (40 CFR 112.7(f)(1).) HSC 25270.4.5(a) 4010022 Failed to designate person accountable for discharge prevention who reports to facility management. (40 CFR 112.7(f)(2).) HSC 25270.4.5(a) 4010023 Failure to include in the SPCC Plan an adequate description of employee training. 40 CFR 1 112.7(f)(1), 40 CR 1 112.7(f)(3), HSC 6.67 25270.4.5(a) 4030001 Failed to address security and access control of the oil handling, processing, and storage areas to both prevent acts of vandalism and assist in discovery of discharges. (40 CFR 112.7(g).) HSC 25270.4.5(a)
4030002 (For loading/unloading racks) Failure of the secondary containment, and/or rack drainage to flow to a catchment basin, treatment system, or quick drainage system, and hold at least the maximum capacity of the largest single compartment of any tank car or tank truck. (40 CFR 112.7(h)(1).) HSC 25270.4.5(a)
4030003 (For loading/unloading racks) Failed to provide an interlocked warning light or physical barriers, warning signs, wheel chocks, or vehicle brake interlock system in the area adjacent to the loading/unloading rack to prevent vehicles from departing before complete disconnection of transfer lines. (40 CFR 112.7(h)(2).) HSC 25270.4.5(a)
4030016 Failed to evaluate field-constructed storage tank for brittle fracture or other catastrophe and take appropriate action. (40 CFR 112.7(i).) HSC 25270.4.5(a 4010013 Failure to discuss in the SPCC Plan conformance with SPCC requirements and other effective discharge prevention and containment procedures or any more stringent State rules, regulations and guidelines. (HSC 6.67 25270.4.5(a); 40 CFR 112.7(a)(1), 112.7(j)) 4030034 (For oil-filled operational equipment) Failed to provide general secondary containment or fulfill alternative requirements to general secondary containment. (40 CFR 112.7(k).) HSC 25270.4.5.(a)
SPCC REQUIREMENTS BASED UPON 40 CFR 112.8 & 112.20
REFER TO APSA (HSC CHAPTER 6.67) FOR DEFINITION OF "STORAGE TANK" # VIOLATION DESCRIPTION
4010027 Failed to restrain drainage from diked storage areas by valve(s) or manually activated pump/ejector to prevent discharge. (40 CFR 112.8(b)(1).) HSC 25270.4.5(a)
4030005 Failed to use valves of manual, open-and-closed design, for drainage of diked areas. (40 CFR 112.8(b)(2).) HSC 25270.4.5(a) 4030008 Facility drainage system from undiked areas not designed/equipped to retain oil or return oil to facility and/or failed to ensure catchment basin is not in an area subject to flooding. (40 CFR 112.8(b)(3), 112.8(b)(4).) HSC 25270.4.5(a) 4030009 Failed to provide at least two lift pumps and permanently install at least one pump where drainage waters are treated in more than one treatment unit and such treatment is continuous, and pump transfer is needed. (40 CFR 112.8(b)(5).) HSC 25270.4.5(a) 4030012 Storage tanks not compatible with materials stored or conditions of storage. (40 CFR 112.8(c)(1).) HSC 25270.4.5(a) 4030010 (Sized Containment) Secondary containment not sized to contain the entire capacity of the largest single storage tank plus freeboard for precipitation. (40 CFR 112.8(c)(2).) HSC 25270.4.5(a)
4030013 Failure to ensure diked areas are sufficiently impervious to contain discharged oil. (40 CFR 112.8(c)(2).) HSC 25270.4.5(a) 4030006 Failed to ensure all of the following before allowing drainage of uncontaminated rainwater from diked area: keep bypass valve normally sealed closed, inspect the retained rainwater, and open then reseal bypass valves under responsible supervision. (40 CFR 112.8(c)(3).) HSC 25270.4.5(a) 4010026 Failed to maintain adequate records (or NPDES permit records) of drainage from diked areas. (40 CFR 112.8(c)(3)(iv).) HSC 25270.4.5(a) 4030017 Failed to provide corrosion protection for partially buried storage tanks. (40 CFR 112.8(c)(5).) HSC 25270.4.5(a) 4030015 Failed to test or inspect each aboveground tank or container for integrity on a regular schedule and after material repairs. (40 CFR 112.7(e), 112.8(c)(6).) HSC 25270.4.5(a)
4030014 Failed to ensure tanks are inspected and tested by an appropriately qualified person in accordance with industry standards. (40 CFR 112.7(e), 112.8(c) (6).) HSC 25270.4.5(a)
4010028 Failed to include in the SPCC Plan procedures to test or inspect each aboveground container for integrity in accordance with industry standards on a regular schedule, after material repairs are made, by qualified personnel; failed to include the frequency and type of testing and inspections based on container size, configuration, and design. (40 CFR 112.8(c)(6).) HSC 25270.4.5(a) 4030018 Failure of steam return/exhaust of internal heating coils, which discharge into an open water course, to be monitored, passed through a settling tank, skimmer, or other separation system. (40 CFR 112.8(c)(7).) HSC25270.4.5(a) 4030019 Failed to engineer or update each container/tank installation in accordance with good engineering practice to avoid discharges and/or failed to provide at least one of the following overfill prevention devices: audible/visual high liquid level alarm, high liquid level pump cutoff devices, audible or code signal communications between tank gauge and pumping station, or fast response system for determining liquid levels, such as computers, telepulse or direct vision gauges. (40 CFR 112.8(c)(8)(i-iv).) HSC 25270.4.5(a) 4030022 Failed to regularly test liquid level sensing devices to ensure proper operation. (40 CFR 112.8(c)(8)(v).) HSC 25270.4.5(a) 4030023 Failed to observe effluent treatment facilities frequently enough to detect any potential for discharges as described in 40 CFR 112.1(b). (40 CFR 112.8(c) (9).) HSC 25270.4.5(a)
4030021 Failed to promptly correct visible discharges and/or remove any accumulations of oil in diked areas. (40 CFR 112.8(c)(10).) HSC 25270.4.5(a) 4030020 (For mobile or portable storage tanks EXCEPT mobile refuelers) Failed to position or locate mobile or portable storage container, and/or failure to provide secondary containment with sufficient capacity to contain the largest single mobile or portable container/compartment and sufficient freeboard for precipitation. (40 CFR 112.8(c)(11).) HSC 25270.4.5(a) 4030025 Failed to inspect buried piping when exposed for any reason; failed to do additional examination or take corrective action if corrosion damage is identified. (40 CFR 112.8(d)(1).) HSC 25270.4.5(a)
4030027 Failed to provide corrosion protection for buried piping. (40 CFR 112.8(d)(1).) HSC 25270.4.5(a) 4030028 Failed to cap/blank-flange piping connection at transfer point and mark its origin if not in service. (40 CFR 112.8(d)(2).) HSC 25270.4.5(a) 4030029 Failed to design pipe supports to minimize abrasion/corrosion and to allow for expansion/contraction. (40 CFR 112.8(d)(3).) HSC 25270.4.5(a) 4030026 Failed to regularly inspect aboveground valves, piping, and appurtenances. (40 CFR 112.8(d)(4).) HSC 25270.4.5(a) 4030030 Failed to conduct integrity and leak test on buried piping at installation, modification, construction, relocation or replacement. (40 CFR 112.8(d)(4).) HSC 25270.4.5(a)
4030031 Failed to adequately warn vehicles entering facility to protect piping and other transfer operations. (40 CFR 112.8(d)(5).) HSC 25270.4.5(a) HM-950 APSA (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
APSA Program (continued)
INSPECTION DATE: 03/14/2023 PAGE 11 OF 13
RECORD ID #:DEH2002-HUPFP-132274
4010044 Failed to complete and maintain at the facility the Substantial Harm Criteria certification form when owner or operator determines that the facility could not be reasonably expected to cause substantial harm to the environment. (40 CFR 112.20(e).) HSC 25270.4.5(a) 4010029 Failed to adequately discuss in the SPCC Plan all applicable bulk storage containers, including compatibility with material stored and conditions of storage, and description of sized secondary containment capable of containing the largest single container and sufficient freeboard to contain precipitation. 40 CFR 1 112.8(c )(1) & (2); HSC 6.67 25270.4.5 (a) HM-950 APSA (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Medical Waste Generators
INSPECTION DATE: 03/14/2023 PAGE 12 OF 13
RECORD ID #:DEH2002-HUPFP-132274
Each violation checked below is for the section(s) of the California health and Safety Code (HSC), California Code of Regulation (CCR), or the San Diego County Code (SDCC) indicated in italics. All violations must be corrected. Submit documentation of return to compliance to your Specialist. You may use the Corrective Action Form (HM-926) to document your return to compliance. Please call (858) 505-6880 or your Specialist if you have any questions. UPF = Unified Program Facility; MW = Medical Waste; USPS = United States Postal Service; DOT = Department of Transportation

MEDICAL WASTE GENERATORS

STORAGE, LABELING, AND DISPOSAL
# VIOLATION DESCRIPTION
HMD4200 Failed to obtain or maintain a Small Quantity Medical Waste Registration or a Unified Program Facility Permit. HSC 117705; SDCC 68.904, 68.905, 68.906,

68.907.1, 68.1201
HMD4201 Failed to submit or report in CERS chemical inventory information for hazardous waste and/or medical waste, and keep up to date. SDCC 68.904(a)(2) HMD4202 Medical waste (MW) not separated from other waste at the point of origin. HSC 118275 HMD4203 Enclosure or designated accumulation area for MW containers not secured. HSC 118307, 118310 HMD4204 MW designated accumulation area not posted with an approved, legible biohazardous waste "warning sign" in English & Spanish or in another language, in addition to English which can be read from a distance of at least 25 feet. HSC 118310 HMD4205 MW interim storage area not marked with warning signs or international biohazard symbol legible from a distance of 5 feet. HSC 118307, 118310 HMD4206 MW interim storage area not properly secured. HSC 118307 HMD4207 Sharps not stored in approved container or labeled with the words "sharps waste" or with the international biohazard symbol and the word "BIOHAZARD". HSC 118285(a) & (d)
HMD4208 Sharps containers, including those used to containerize trace chemotherapeutic wastes, lined with a plastic bag or inner liner. HSC 117750 HMD4209 Full sharps container not taped closed or tightly-lidded to preclude loss of contents. HSC 118285(b) HMD4210 Primary containers accumulating MW not labeled with an electronic tracking system label or a label with generator's name, address and phone number.

SDCC 68.1205
HMD4211 Medical waste not stored in approved and properly marked biohazard bags. HSC 118275(a) HMD4212 Biohazard bags not tied off to prevent leakage or expulsion of contents during storage and handling. HSC 118280(a) HMD4213 Biohazardous bags not containerized in rigid, leak resistant, and covered containers or bins when placed for storage, handling, or transport. HSC 118280(c)
HMD4214 Biohazard bag not ASTM D1709 certified. HSC 117630(b) HMD4215 Biohazard bag(s) are not red, except when yellow to further segregate trace chemo waste or white for pathology waste. HSC 117630(b) HMD4216 Biohazard bags not placed in a USDOT-approved container lined with a biohazard bag that is ASTM D1709 and ASTM D1922 certified. HSC 117630(b) HMD4217 Waste container or bin not labeled with the words "Biohazardous Waste" or with the international biohazard symbol and the word "BIOHAZARD" on the lid and sides. HSC 118280(c)
HMD4218 Reusable containers or bins for MW storage not thoroughly washed and decontaminated and maintained in a clean and sanitary manner. HSC 118295, 118305
HMD4219 MW interim storage area not marked with warning signs or international biohazard symbol legible from a distance of 5 feet. HSC 118307, 118310 HMD4220 MW interim storage area not properly secured. HSC 118307 HMD4221 Full sharps container stored more than 30 days at >0°C. HSC 11828(c) HMD4222 Biohazard bag waste stored more than 7 days at >0°C (for generators of 20 or more pounds a month). HSC 118280(e)(1)(A) HMD4223 Biohazard bag waste stored >30 days at below 0°C (for generators of <20lbs/month). HSC 118280(e)(1)(B) HMD4224 Materials of Trade Exemption: transportation logs not maintained for 2 years at the receiving facility HSC 117946(3), 117976(3) HMD4225 Materials of Trade Exemption: transportation logs do not contain the name of the person transporting the medical waste, the number of containers of medical waste transported, the date the medical waste was transported. HSC 117946(3)(a-c), 117976(3)"(a-c) HMD4226 Disposal of untreated MW to an unauthorized point. HSC 118340

SMALL QUANTITY GENERATORS ONLY
(<200 POUNDS OF MEDICAL WASTE GENERATED PER MONTH)
# VIOLATION DESCRIPTION
HMD4301 Medical Waste Management Plan (MWMP) not submitted to HMD within 30 days of generating medical waste or making updates to the MWMP. HSC 117935, SDCC 68.1202(c)(2)(B)
HMD4302 Did not maintain and show proof of "onsite" medical waste treatment records for 3 years. HSC 117943 HMD4303 Did not maintain on file disposal receipts, tracking or shipping documents for medical waste shipped offsite for at least 3 years. HSC 117945 HMD4309 MWMP or equivalent information not onsite. HSC 117935, 118032

LARGE QUANTITY GENERATORS ONLY
(>= 200 POUNDS OF MEDICAL WASTE GENERATED PER MONTH)
# VIOLATION DESCRIPTION
HMD4351 Medical Waste Management Plan (MWMP) not submitted to HMD within 30 days of generating medical or making updates to the MWMP. HSC 117960, 117970
HMD4352 Records of medical waste treatment not available for 2 years. HSC 117975, 118215(a)(2)(E) HMD4353 Did not make available disposal receipts, tracking or shipping documents for at least 2 years for medical waste shipped offsite. HSC 117975

MW ONSITE TREATMENT FACILITY
# VIOLATION DESCRIPTION
HMD4500 Treated medical waste generated offsite without a permit from the California Department of Public Health (CDPH). HSC 118130 HMD4501 Onsite MW treatment permit not obtained or renewed. HSC 117950, 117925, 118130; 65623 HMD4502 Current copy of the MW treatment permit not available. HSC 118165, 118180; CCR 65621(f), 65623 HM-9255 MW (08-21)

C O U N T Y O F S A N D I E G O

COMPLIANCE INSPECTION REPORT
Medical Waste Generators (continued)
INSPECTION DATE: 03/14/2023 PAGE 13 OF 13
RECORD ID #:DEH2002-HUPFP-132274
HMD4503 Condition(s) of the MW treatment permit violated. CCR 65623 HMD4504 Operators who treat medical waste not trained in proper equipment use, proper protective equipment to wear and if necessary, proper cleanup of spills.

HSC 117967(a), 117938(b)
HMD4505 Initial and/or annual training for operators that treat medical waste not provided. HSC 117967(b), 117938(b)(2) HMD4506 Initial and/or annual training documentation for operators that treat medical waste not available for two years. HSC 117967(c), 117938(b)(3) HMD4507 MW treated by unapproved method/procedure. HSC 118215 HMD4508 Standard written operating procedures for steam sterilization not established. HSC 118215(a)(2)(A) HMD4509 Recording thermometer not calibrated annually. HSC 118215(a)(2)(B) HMD4510 No records of annual thermometer calibration checks onsite for at least the past 2 years. HSC 118215(a)(2)(B) HMD4511 Heat-sensitive tape or other approved method not used for each load treated onsite. HSC 118215(a)(2)(c) HMD4512 Monthly biological indicator or other approved indicator not used to confirm proper sterilization. HSC 118215(a)(2)(D) HMD4513 Onsite steam sterilization did not reach 121° C (250° F) for at least 30 minutes. HSC 118215(a)(2)(B) HMD4514 Treatment records or logs of dates, time, and temperature not maintained for at least 2 years. HSC 118215(a)(2)(e) HMD4515 Treated sharps waste is not destroyed or public access to the treated sharps waste not prevented. HSD118225(c) HMD4516 Emergency Action Plan not established or provided to HMD. HSC 118235 HMD4517 Treatment Closure Plan not established or provided to HMD. HSC 117935(j), HSC 117960(j)

CHEMOTHERAPY, PATHOLOGY, PHARMACEUTICAL, HAZARDOUS, AND UNIVERSAL WASTES # VIOLATION DESCRIPTION
HMD4401 Trace chemotherapy waste not segregated from other MW. HSC 118275(a)(4) HMD4402 Trace chemotherapy waste container not labeled "Chemotherapy Waste" or "CHEMO" on the lid and the sides. HSC 118275(a)(4) HMD4403 Illegal disposal of chemotherapy waste. HSC 118340 HMD4411 Pathology waste not segregated from other MW. HSC 118275(a)(5) HMD4412 Pathology waste container not labeled "Pathology Waste" or "PATH" on the lid and the sides. HSC 118275(a)(5) HMD4413 Illegal disposal of pathology waste. HSC 118340 HMD4421 Pharmaceutical waste not segregated from other MW. HSC 118275(a)(6) HMD4422 Pharmaceutical waste not labeled "HIGH HEAT" or "INCINERATION ONLY" on the lid and the sides. HSC 118275(a)(6) HMD4423 Pharmaceutical waste stored more than 90 days when container is full, or stored longer than one year (maximum allowable time). HSC 118280(f) HMD4424 Failed to notify HMD of any tracking document discrepancies between pick up and disposal of pharmaceutical waste. HSC 118032(c)(4) HMD4432 Illegal disposal of pharmaceutical waste. HSC 118340, 118222(b) HMD4441 Disposal of photo/hazwaste to an unauthorized point. HSC 25189.5 HMD0147 Failed to keep records of offsite Universal Waste shipment(s) available for inspection for 3 years. 22 CCR 66273.39(c),(d)(2) HMD0307 Disposal of universal waste (UW) to an unauthorized point. HSC 25189.5(a), 25189(c),(d); 25189.2(c); 22 CCR 66273.31(a), 66273.8(b) HM-9255 MW (08-21)
... .... ......... _
""
•• •
FILE WORK SHEET __ _

DATE COMMENTS INITIALS
DHS:HM-96lib1 (6/91) County of San Diego. DHS. EHS. HMMD. Site Assessment & Mitigation (SA/MJ v
v
v
•
COUNTY: OF SAN DIEGO
DE}'ARTMENT OF HEALTH SERVICES

ENVIRONMENTAL HEALTH SERVICES
HAZARDOUS l't"..A-·fALs MANAGEMENTt.DIVISION
P.O.BOX 85261 SAi"i DIEGO 92186-5261
(619) 338-2222

MONITORING EQUIPMENT AND INTEGRITY TEST VERIFICATION REPORT EST# H PLAN CHECK# NT lvle3
SITE ADDRESS 1.,0 iO.UbJo CITY<;ANTE:E zrpq9-0'11
ESTABLISHMENT NAME __ (t::_:f ___________________ _
CONTRACTOR NAME PHONE#
REQUIRED DOCU:MENTS YES NO
Integrity Test Report Received X
!-!MMD'S Certification of Tank System Installation al1d FORM C ")( HMMD'S Certification of Monitoring Equipment Installation received 'x -
---
Monitoring and Response plans received )..

MONITORING SYSTEM CHECK BY: ROP.>£.'12-T DATE: "f I
Number of monitoring probes installed L YES NO
----
Monitoring devices installed as shown on HMMD approved plans ----- Tank (interstitial space) -- --_J __ ------ I Manway sumps ). ·- Fittings ---
Secondary containment piping X
Shut down device on turbine with alarm
Monitoring devices operational X

SPILL/OVERFILL PREVENTION CHECK YES NO
Catchment Basin on fill pipe installed X
Ball Float Valves on vent and vapor lines Installed SE.E. 12£n ---- Product Level Sensing Device "x
Positive shutoff on fill pipe
r
' MONITOlUNG EQUIPMENT VERIFICATION APPROVED G@ NO
-
----;-------

REINSPECTION AND REINSPECTION FEE REQUIRED ')(

FINAL OPERATING PERMIT ISSUED X
REMARKS: 1"'1AI-lvfA(..,1\ .. t-.:>OT Ut,: 0. G:x2v\ Mu)T f,€. .. 8.-t OA.V). tl.L>O Su(t) ....... lT L€..1-r-a.-
IA..>C...S tt-J .

Received Name: / Date: '?
DHS:HM-9 I 67 (Rev 7 /92)

STATE OF CALIFORNIA

STATE WATER RESOURCES CONTROL BOARD

CERTIFICATION OF COMPLIANCE

FOR UNDERGROUND STORAGE TANK INSTALLATION
FORM C

COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM
I. SITE LOCATION
STREET __ P_a __
CITY ______ s_a_n_t __ e_e _________________ COUNTY ______ s_a_n __ o_i_e_g:;..o ________________ _ II. INSTALLATION (mark all that apply):
0 The installer has been certified by the tank and piping manufacturers. 0 The installation has been inspected and certified by a registered professional engineer. 0 The installation has been inspected and approved by the implementing agency.

All work listed on the manufacturer's installation checklist has been completed. 1:g) The installation Contractor has been certified or licensed by the Contractors State License Board. 0 Another method was used as allowed by the implementing agency. (Please specify.) Ill. OATH I certify that the information provided is true to the best of my belief and knowledge. 7 Phone ( G/Pl .n;2-Sl'7'/

LOCAL AGENCY USE ONLY
STATE
TANKI.D. #
COUNTY#
ITJ
JURISDICTION#

I I I I
FACILITY# TANK#

I I I I I I
FORM C (7191) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FOR0035C7 ..... ..-.,
I
INSTRUCTIONS FOR COMPLETING FORIVI "C": TANK INSTALLATION CERTIFICATION :

INSTRUCTIONS
I

1. Each tank system must be in co.11pliance with the iederal end state technical sUmdEJrcls, containe:' in law and !egulations, ipr tank and piping installation.

2. This ceni"ico;rirm shril be complsted by eitherlthe UST owner ot representative. I

3. One cerlificc:tion :s .cquired for esch trnk system. This iorm shall be used to mflke the required certlficf.ltion.

4. Please type r·• . , ''1t clearly all requ::lsted (vor prin'ling, please use a ha.·cl :JO•·:' '" .· ·., :.1.:o:rument). 1
I
I

5. Submit the comr.J:etad to the Local Implementing Agency.

I
I. INSTALLATION: iVIJ-\R:< A'...L QF THE ITi:IVlS THAT TO INDlCATE THAT THE INSTALLATION REQUIREMENTS A\RE IVIET.
ll.

I
OATH: YANK OV:NEA OR AGENT SHALL CERtiFY, BY SIGNJf\JG THE CEAT!FlCJ-\TIQi\J, THAT Tf-!:: INFORMATION PROVIDED IS TRUE AND I •

THE PERSON'S NAME SHOULD BE PRINTED UNDER THE
SIGNATURE. 1
. .....
" \ .. ' '• ' .... '. ·.

I
.... '\ ..... o::: '.,,\ ' • ,., j \' .\ ·, ) .• \., . \ . ' ' ') '": I' • • '•' . •" \ ' \ • • '-
··L
!
I
rt··· 93 14: 59 TEL 61956.4
--·- ..........
. oil.. .

April 12, 1993
TO:

ATTN:

RE:

County of San Diego
H.M.M.D. Department
P . o . Box 8 52 6 1
San Diego, CA 92186
Mr. Robert Rapista
Walmart Store Waste Oil Tank @ I 107 Towne Centre Parkway, Santee, CA Dear Robert,
Per our inspection on today's date, this letter is written Corning
confirmation that a ball float was indeed installed in the Owens 1, 000 gallon waste oil tank that was installed at the
above referenced address.

If you should have any questions or need additional information, please do not hesitate to call me at (619) 562-5141.

Michael R. Goodwin
President
MRG:rns
\
8645 Argent Street, Suite A • santee, CA 92071 • License 1\JO. 433 894 FAX <619l 562·0664 • Phone <619.1 562·5·141
P. 2
•This
warranty.
checklist must bo complatad In its entirety by a trained OfC Tanks contractor to validate theo30 year structural Job .. .....i..J.L?.

Installation Contractor
--za:_,_,f) t.JeA}e.c .ihd:a .. .WJ' ··---·- .. ___ _
GZ.8. .. Foreman: _j,/ill _-t'.,-.
...... .. . ....2i.!!!.. . ..:5(7t1-P"·!t1t•r ----------- --· Representative:
tn=e""ta""l""la""fti=lo=n=c'l5'"he=c=;k""l;;=ls""t== To be inl;laled b;:· A. Handling and Testing
0 Tank tested at5 psi for 4', 6', 6' and 10' dlametertanks: 3 psi for 12' diameter tanks. Soapy water solution applied and the entire tank surface carefully inspected for air bubbles.
wall tanks tested in strict conformance with "Test Instructions" label on tank (Label No. L.22.20). Do not connectthe air hose directly to fitting in emnulsrsp&ce.

B. BedS. Backfill Material
Meets all ASTM C..33 requirements for quality and soundness. No more than 3% of backfill materials passes through a #8 sieve.

Supplier l\ld1m t Stttll
iype (In accordance with installation specifications.)
I_J Pea Gravel-Clean naturally rounded aggregate, with particle size not less than 1/6" g,r more than%" in diameter.
&'Crushed Stone or Crushed Gravel-Washed crushed stone or gravel with angular particle si<:e not less than 'Ia" or more than 1,12" in diameter.

IJ Sieve analysis from a qualified soil engineer or from the supplier.

C. Hole Size
tlrStablewalls-4', 6', 8' and 10' diametertanks-18" minimum (24" preferred) between adjacent tanks and between tanks and hole walls. 0 Stabtewalls-12' diametertanks-24" minimum betwe"'n tanks and hole walls and 24" between adjacent tanks.
r·J Unstable walls-1/a tank diameter minimum between tanks and hole walls: 18" minimum between adjacent tanks. (24" for 12' diameter tanks).

D. Ancllorlng
:: Hole flooding from high water table anticipated.

Cl Hole flooding from external surtace water anticipated.

CJ Completed in accordance with Installation Instructions -·--Slab___ Deadman
G 9wner's representative aware of anchoring requirements. !if Not required.

E. lnstallstlon Procedures
t. Minimum 12" level backfill bed of approved material. 2 .Initial backflll-1 st two 1 2" lifts pushed completely under tank bottoms between ribs and under end caps to eliminate all voios.

3. Completed backfilling to tops of tanks in uniform lifts.

4. Tanks not filled until backfilled to the tops ol the tanks. Exception: wet holes. See 0/C Tanks Publication 3-PE-6304.

5. Tanks completely filled with water or product after backfill is to I he top of tanks.

6. Depth of bury/slab for traffic bonds. 4'-10' diameter tanks: 36" of backfill. or 30" of backfill plus 6" of asphalt, or 18" of backfill plus 6" of reinforced concrete.
1 2' dlametertanks: 38" of backfill plus 6" of asphalt or 36" of backfill plus 6" of reinforced concrete.

7. Filter fabric hole liner is recommended fort he following installations:
a. Tidal condition or frequenliy changing water table
b. Unstable soils (muck or landfill)
c. Water condition with silty soil
See installation instructions 3-PE-6304 for recommended brand name filter

8. Reference 0/C Tanks publication 3-PE-6304 tor complete installatiorl instructions.

Foreman
;n!;/
Ji.j_ ___ _ .Tf:.,_-' __ ... _
:7f!...V ---·--
_z_l-
........Lu__ __ _
_-m___ __ _ .1fiJ... __
Owner's
Representative
' l \ \ "--' ___ .. ____ _
'.
( \... \ ... ;
( '--1.....: -·--·----
G"""'J ____ _
L-1 u -- Lc "-"---
(_ l_A.,.) -· --
Ap'i· .• f2"
P. 4
.. 93 15:00 1234
.,.,.,..,-----·-------
F. Tank Inspection Procedures Jo" '•.
" Tank NumbE•r
2 3 4 5
a. Underwriters LaboratOri!IS iabol number (to correspond with Invoices ._ "1871.7.. and UL labol on tank.) --- ----· -·-- --·-- b. Tank nominal capacity(gallons) ___Jf)/;Q_ ---- ----·-- --·- ------ e. Tank Measurements in Inches (S&e instructions below) to confirm that tank has proper support.

1. After pressure test, measure tank Internal
--- ------- - ------ ------·- diameter prior to
backfilling. 1!:1 -- .. ---- __ ., __ ----- -----

2. After at subgrade, mea from tank bottom to top of ,, fill tube prior to insertion of drop tubEl. --·-- ------ ----- -----

3. After backfill is at subgrade pnor to insQrtlon of drop tuba. measure from bottom of tho fitting to the top of the fill tubo. ---- -··--- ------- -------

4. Calculatt:d tank Internal diameter with bllCktlllat &ubgrade ., (subtract measurement #3 from measurement #2). ..5!i ...

5. Calculated tank
------ -------- --- --- deflection (subtract measuremGnt #4 from moasurElment 61 ). ----- -·-- ---- ------
All maasuraments for vertlccl deflection are made from the bottom of the tank 10 the bottom of the NPT fitting.

All measurements should be made in lnehlls using a standard non-metallic gauging stick.

All measurQments should be mada through the fill tube fitting.

Measurement t may be aboveground or In hole prior to backfilling.

Maaauroment 2 must be made prior to inser1ion of drop lube, but after fill pipe has bean Installed. ,-----------,
I 1 ""•surement 1
'-·---------'
'
L __ ..
,.----------, I
I I -'----:='"'
I I
I I nail
I'

I -----'
MClQGUI'<7m<>nl t is the inside aiumster of
the tank at the gauge opening. Measure
from the bottom of the tanK to the bottom
of the fitting. This measurement should be
taken prior to placing any backfill. Aecord
measurement '1,
Measurement2 Is the distance from the
bottom of the tank to the top of the fill tube.

This measurement should be taken prior
to Insertion oflhe drop tube_ Backfill
should bo to sub grade at this time. Record

2. IVloaeuremont 3 is the distance from the
bottom of the fitting to the top of the fill
tube. This Is taken by driv·
ing a nail Into the 1" point at a right angle
to the dipstick.

Lower the dipstick down the fill tube far
enough to extend below the bottom of the
fitting. Lift the dipstick until the nail catchss on the lip of the fitting. Read measurem0nt at the top of the till pipe.

Subtract 1 " to allow for the point where the
nail is in the dipstick_
Pub. No. 15·Pf!·8$iU-1 Lllhg If\ U.S.A., M0111y, 1989
•...

MGeSUrlllm<lnt 4 is the calculated tank in tarnal diarneler (subtract measure· ment 3 from maasurem11nt 2).

MeasuromentSis the calculated tank internal dell (subtract measurement 41rom mea&uremant 1 ).

WARNING: If thEI answer in moasurement /ISis In excess oftha appropriate value shown In Table A,lmm0dlale/y contact the m.mufacturer's Installation manager prior to proceeding with the lnstalla\lon.

Tobi&A
tank maximum
diameter deflection --.---·---··---- 4' Y2" - ·----·-- ---- ·-- ___ -- 8' 1 v.• -- --·-------· ·-- 10' 1'h"
12' H'>"
NOTE: Contractor must be a
trained 0/G Tanks contractor to
validate the 30 year structural
warranty.

NOTE: Owner must retain this document to substantials any future structural warrentyclaim.
-
0/C Tanka Corporation One Levis Square, Box 10025 Toledo, Ohio 43599-0025 Fiberglas Tan< Installation Managll>r
(419)248·7371
e> • 99110/C nnko CotJ*ailon ........... t .... ....:..::::..J; ... .... n STATE Of CAUFORNIA ), •
COUNTY OF .,..,}/Jftj .
'
i
.QCKW)'ffl.EOOMENT -Gtner.a:I-WI:i&c.oft.:s H:rm C'l..'lCA-Rm· 5-.82 YrolCOTlS. INC. I! 2J
ohis _ /d- of __ __ , in tile year 199' .:2 llafore me. tile undersigned. a Notary Public In and for grd Slate. !)ersona!ly appeared 1 -------______ • personalty rmown to me
(or I) roved to me on the basis rJI satisfaclory evidence) to be the person_ whose name _ _ _ ____ subscribed to the wtrnin instrument, and acknowledged to me lhat _he_ eKecuted it.

WinlESS my hand and ollicial seal.
bc. {/ · Juv!-£/
Notary Public in arnl lllf S;Jid State.
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uNDERGROUND STORAGE TANK. SYStEM

CEKIIFICATION OF INSTALLATION
EST # PC# DATE OF INSfALLATION -----
SITE ADDRESS 170 Towne Centre Parkway CITY Santee ZIP 92071 -------- ESTABLISHMENT NAME Walmart Store
CONTRACTOR NAME _G_TB_C_o_m....:p:....a_n_:y:__ ______ _ PHONE# ( 61 9 ) 56 2- 51 4 1 Complete the information below as applicable. Provide this form at the time of the second inspection (Monitoring Equipment and Integrity Test Verification) to the Hazardous Materials Specialist. Failure to submit the above information will result in an incomplete or failed inspection and may require you to reschedule the second inspection and pay a re-inspection fee. ·
- INSTALlATION DESCRIPTION
Tank Manufacturer Tank size Contents UL#

INSTALLATION COMPLETION LIST
Installation Certification Steps Initial Date
1- Correct Excavation Size And Location /, /..L.
2- Bedding and Backfill Matertals used I I Sand 9<) Gravel k#t' 3- Cathodic Protection: I I Tank I I Piping :> ;/;pk
4- Tank Ballasting: I I Buoyancy Calculations Anchor Straps 1<3Vtr 5- Holiday Test Certification hJu,/. SJ );'A'.t'"
6- Secondary Containment Piping Test Certification: _3'_psi for..bt!.._ Tninc: 1 "9b..2#3
7- Positive shutoff device installed at 95% full /)A//? e_ I declare that the installer has been certlfled by the tank and ptptng manufacturers and that the above tank(s) have been set and backftlled to the manufacturer's spedflcations . Siatureof Authorized Print name
Representative
wkA CA
Address · City St
comnT c. 8AK DD!lGO
DEPAK'IliiEKT OF BEAL'IB SI!RVICES
ENVIRONMENTAL HEALTH SI!RVICES
DHS:HM-9009 (REV 7/92)
92t?71
Zip Phone
11AZA1tDCK18 IIA%ERL\L8 IIILVIAQ£MEZIIT DlVJSJON
P.O. BOll: 868:U
MN DIEGO, CA. 92138-8281 (819) 338-2222
't .-.,

UNDERGROUND STORAGE TANK

CERTIFICATION OF MONITORING EQUIPMENT INSTALLATION
EST # PC# DATE OF INSTALLATION W-)0
SITE ADDRESS 170 Towne Centre Parkway CITY Santee ZIP 92071 - '.;MONITORING EQUIPMENT INSTALLER fl--T,B U 1-'.s-llt;>'t"r/ 5t .5V,_h MONITORING EQUIPMENT SYSTEM 1YPE Pek,/u-/- C/2 /121/1/
Complete the information below and provide it to the Hazardous Materials Specialist at the time of the second inspection (Monitorlllg and Integrity Test VeriflcaUon). Failure to submit this information will result ln an Incomplete or failed inspection and may require you to reschedule the second Inspection and pay a re-inspection fee.

MONITORING EQUIPMENT
- ---· - ----· ----· ....

INSTALLATION DESCRIPTION MANUFACTURER MODEL NUMBER
Leak Detection System C-/J //// /J/
Product Level Sensing Device
Product Line Leak Detectors
Secondary Containment Tank Monitors
Tank Interstital Sensors fo'tO 2/0
Manway /Sump/Fitting Sensors j?o/vl-ert- MO
Secondary Containment Pipe Sensors

INSTALLATION COMPLETION LIST
Monitoring Equipment Certification Steps Initial Date
1- The equipment meets the manufacturer's written
specifications for installation. -7)1?/r;y
2- The Sensors have been preset or calibrated per
written manufacturer's speciflcatlons.
3- The correct number of sensors have been Installed '
according to approved plans.

I certify that the control panel and the sensors are Installed and operational to the manufacturer's specifications Installer's signature
COUN"IY OF BAN DIEGO

DEPARTMENT OF HEALTH SERVICES

ENVIRONMENTAL HEALTH SERVICES
DHS:HM-9002 (REV7/92)
Print name
I
Date

HAZARDOUS MATERIALS MANAGEMENT DIVISION
P.O. BOX 85621
BAN DIEGO, CA. 92138-5261 (619) 338-2222

TANI-NTEGRITY TEST
HAZARDOUS MATERIALS MANAGEMENT DrviSION
·· ,., · OFFIC:E·,USE ·oNLY. .. : :·. ::.'
.. ·... . <tJ
TAN)<
l.OCATION
TANI< OI'EHATOR
TAN I<
OWNEH
crrv
NAME
NAME

ADD HESS
CnY
for Tnnk Sygtem Teot.lng:

Trl;mnual Product Sucllon/Hcmote Fill Line
ZIP qzol
PHONE
ZIP
O Annual test O Retest After Repair 0 Suspected Leak
0 Annual Product Pressure Une NEW Tl\ N 1'\
PRESENCE OF GROUNDWATER MUST BE DETERMINED OR TEST RESULTS WllL BE for dclr.rmlnln!l groundwater In lnnk c.xcnvnllon -------------------------'---- \Vas r,rnunrlwalcr cnr:mJnlcrc:d fn tank r..xcnvntfon? 0 Yes 0 No If stale grottndwnlcr con1pcnsatlon procedure used -----------------------------'- Anlomnllc !.In•: Leak Dclr.clor Tcslr.d In accordance wflh CCH Section 2611 (I) 0 Yes 0No Typr. of l'rorlncl Line/Fill Delivery:
·rypc nf Spfll;r_,,.,.rflll Prevention:

Tnnk
No.
0 0
PrcsstJd7.crl O Remote Fill 0 Suction [iJ.fuer wo...ste · o; I l'oslllvc Shut OIT 0 IJall Floats 0 High L.cvel Nann
·r hr.sr. lent result• hnve been con dude<! nnd performed, by a teeter certified according to the requirements of the tnnk test equipment mnnttfnclurer. The tester In llcen•ed by the Water Resources Control Board Office of Tank Te•tcr Llcenslnn nnd mecln the requirement• of Subchnpter 17, Tille 23, of theCA Code of regulations (Effective .Jnnunry I, 1()!10). The tnnk owner hnR been notified of the•e rcoulto, nnd has been advised of the reporting rcqnl rcmcnt• lor lntcJ!rlty teotlng. This liST tlJ!htneos te•t Is approved by the State Water Resources Control llonrd(SWHCI!). hns received third pnrty verlncntlon, nnd meets Its applicable limitations. · nf I Jc<.11'.>' l'lbo;ler
COUNTY 01" SAN DIEGO
DEI'AHTMENT OF IIF.ALTII SERVICE.q

ENVIIWNMENTAL IIEALTII SEHVICES
IJIJS:mf.!Jfi:, (lli':V 7/92)
. Dntc _m_q_t_93. 4 -5 -93

HAZARDOUS MATERIALS MANAGEMENT DIVISION
1'.0. DOX 85621
SAN DrF'.GO, CA. 92138-5281 (819) 338-2222
TANK OPERATOR/OWNER WALI'lART
ADDRESS TOWN CENTER RD.
!ill... (619)562-5142

TATIVE GTB RICK JOHNSON

REASON FOR TEST ANNUAL TEST SUSPECTED LEAK NO
RETEST NEW TANK X OTHER REI'lODEL
DISTANCE FROI'l GRADE TO WATER BELOW TANK

TANKS/LINES TO BE TESTED IDENTIFICATION CAPACITY BRAND/SUPPLIER STEEL/FIBERGLASS #1 WASTE 550 N/A FIBERGLASS

WATER TEST

INSTALLATION DATA COVER-CONCRETE SIPHONES PUMPS
WASTE
OIL
OFF!CALS TO BE CONTACTED LOCAL HEALTH DEPARTI'lENT TO BE SENT COPY OF TEST REPORT BY CUSTOI'lER

TANK ID TANK TANK PRODUCT LINE LINE DATE

TEST RESULTS NUMBER PASS/FAIL GAL I HOUR PASS /FAIL GAL/HOUR #1 PASS .004 PASS .000 3/29/93

TYPE OF TEST EQUIPMENT AINLAY TEGRITY TESTER

COMMENTS PETROTITE LINE TESTER

THERMAL TEST TECHNICIAN TIM MONTIJO
CERTIFICATION LICENSE 91-1090
4/6/90
314
JOB: WAL IIART DATE: 3/29/93 TECHNICIAN: BOB MONTIJO
JOB ADDRESS: TOWN CENTER RD. 92071 LICENSE: 91-1138
Tank. l.D. and Product: #1 MAIN
Tank. Diameter: 45"
Fill Pipe Length: 38"
Water In Tank. Start Water In Tank. Cinsl: N/A
End Water in Tank. (insl: WATER TEST N/A
Start Water in Tank. (gall: N/A
End Water in Tank. (gall: N/A
Product Volume:

Nominal Capac.ity (gallons) 550
Actual Capacity (gallons) 550
Deduct Water in Tank. 0
Total Product Volume: 550
Piping: 5
Total: 555
Fill Pipe
Extension Height of Water Table Above Tank. Bottom: N/A Density of Tank. Product: N/A
Density of External Water: WATER TEST 0.036
Additional Head Required: N/A
Note: To avoid possilbe tank. damage the added pressure from a fill pipe extension must never exceed 5 psi.

Preliminary
Test Data A.P.l. Gravity at .......... DEGREES WATER TEST A.P.l. Gravity (corrected to 60 degrees f)
Coefficient of Expansion .00011500
Test Data
Start Test: 0900AM End Test 1030Af1 Test Time 90
Slope -.0002928
Test Time 90
Temperature Change During Test (degrees Farenheitl -0.026 Product Volume (a) 555
Temperature Change (b) -0.026
Coefficient of Expansion (c) .00011500
Volume Change Due To Temperature (d) = (a) X (b) X (c) -0.002 Cumulative Volume Change (e) 0.008
Volume Change Not Due to Temperature =Cdl+Cel 0.006
Leak. Rate (f) x 60 I 90 0.004
THIS TANK f1EETS THE CRITERIA FOR TIGHTNESS ESTABLISHED BY NATIONAL FIRE PROTECTION ASSOCIATION BULLETIN. N. F. P. A. 329.

Comments
:

MONTIJO ENVIRONMENTAL co.

P.O. Box 83 Poway, CA 92064 (619) 748-0533
Job: WALMART Date: 3/29/93
Address: SANTEE, CA.

Linear Rearesion Slooe For Last 90 Test Minutes -.0002928 Tank I. D. # #1 MAIN
Time Average Volume Volume Cumulative
Minutes Temperature Before After Change Change
0 58.3726 0.087 0.000 0.000
5 58.3873
10 58.3708
15 58.3687 0.087 0.086 -0.001 -0.001
20 58.3612
25 58.3547
30 58.3500 0.086 0.085 -0.001 -0.001
35 58.3581
40 58.3555
45 58.3583 0.085 0.085 0.000 -0.001
so 58.3667
55 58.3733
60 58.3821 0.085 0.084 -0.001 -0.002
65 58.3805
70 58.3470
75 58.3406 0.084 0.083 -0.001 -0.003
80 58.3346
85 58.3309
90 58.3289 0.083 0.081 -0.002 -0.005
95 58.3392
100 58.3362
105 58.3345 0.081 0.080 -0.001 -0.006
110 58.3343
115 58.3576
120 58.3523 0.080 0.078 -0.002 -0.008
JOB:

JOB ADD.

LINE
ID
#1

UN LEAD
ID
ID
ID

WALMART
TOWN CENTER RD.

SANTEE CA '

MILITARY ADDITIONAL
TitlE COMMENTS
930 Isolate Line/Begin
945 First Reading
1000 Second Reading
1015 Third Reading
1030 Forth Reading
Bleedback

COMMENTS
Isolate Line/Begin
First Reading
Second Reading
Third Reading
Fourth Reading
Bleedback

COMMENTS
Isolate Line/Begin
First Reading
Second Reading
Third Reading
Fourth Reading
Bleedback
BEFORE
BEFORE
BEFORE
BEFORE
TECHNICIAN:

LICENSE NUMBER:

PRESSURE
AFTER
40 40 40
40 40
40 40
40 40
AFTER
AFTER
AFTER

BOB MONTIJO
91-1138

WASTE OIL TANK DRAIN LINE ' VOLUME

BEFORE AFTER

0.047

0.047 0.047

0.047 0.047
BEFORE
BEFORE
BEFORE
DATE 4/5/93

NET CUMULATIVE

CHANGE CHANGE

0.000 0.000

0.013

CHANGE CHANGE

WALMART

TOWN CENTER RD
SANTEE.CA

LOA DING
DOC K

MISSION GORGE
0 WALMART
T
0 w
N
c
E
N
T
.E
R
MONTIJO ENVIRONMENTAL CO.

P.O. BOX 83
POWAY. CA. 92074-0083
(619)748-0533
.\
lSTSC:HFHCLE 0 RESCEE>N!Im 0 FEEPAID 0
.. -
CONTACT PHONE I 5=-..:::b:.=..-=:;..:......L.......L.-1

TYPE OF INSPECTION

CERTIFICATION AND PRESSURE TEST INSPECTION D

MONITORING EQUIPMENT AND INTEGRITY TEST VERIFICATION
D CClSCREINPIACE D

TANKREPAIR D
SPECIALISTS REMARKS:

REINSPECTION FEE DUE D

UPDATED PLANS REQUIRED D
{10/90)
TANKSiSII!MREPIPE D
RECORD OF PRESSURE PLOTTED OVER TDIE ·.·
--------- U/L SUP REG ·. ·.
psig psig psig psig

RECORD OF PRESSURE PLOTTED OVER TIME
REG W/0
psig psig
April 12, 1993
TO:

ATTN:

RE:

County of San Diego
H.M.M.D. Department
P. 0. Box 85261
San Diego, CA 92186
Mr. Robert Rapista
Walmart Store Waste Oil Tank @
107 Towne Centre Parkway, Santee, CA
Dear Robert,
APR 13 II 15 AM I 93
.. HEALTii s:::\VICES
Per our inspection on today's date, this letter is written confirmation that a ball float was indeed installed in the Owens Corning 1, 000 gallon waste oil tank that was installed at the above referenced address.

If you should have any questions or need additional information, please do not hesitate to call me at (619) 562-5141.

Michael R. Goodwin
President
MRG:ms
8645 Argent Street, Suite A • Santee, CA 92071 • License No. 433 894 FAX (619l 562-0664 • Phone (619l 562-5141
0/C
TANKS
*This checklist must be completed in its entirety by a trained 0/C Tanks contractor to validate the 30 year structural warranty.

Job Name Wad Mo.rt Owner LUaJ fv1 ,·u+ ,;;:i/,&d
Job Address /Zt) ....,..._
lt)L-UQ (Jwler
Installation Contractor Foreman:

Owner Representative:

Installation Checklist To be initialed by:

A. Handling and Testing
0 Tank tested at 5 psi for 4', 6', 8' and 1 0' diameter tanks; 3 psi for 12' diameter tanks.

Soapy water solution applied and the entire tank surface carefully inspected for air bubbles.

Gd'!Souble wall tanks tested in strict conformance with "Test Instructions" label on tank (Label No. L.22.20). Do not connect the air hose directly to fitting in annular space.

B. Bed & Backfill Material
Meets all ASTM C-33 requirements for quality and soundness. No more than 3% of backfill materials passes through a #8 sieve.

Supplier Ndim t slm!l
Type }g'iU.,·kd &vl: (In accordance with installation specifications.) 0 Pea Gravel-Clean naturally rounded aggregate, with particle size not less than 'Ia" gr more than%" in diameter.
13"Crushed Stone or Crushed Gravel-Washed crushed stone or gravel with angular particle size not less than 1
/ 8 " or more than 1
/ 2" in diameter.
0 Sieve analysis from a qualified soil engineer or from the supplier.

C. Hole Size
urStablewalls-4', 6', 8' and 10' diametertanks-18" minimum (24" preferred) between adjacent tanks and between tanks and hole walls. 0 Stablewalls-12' diameter tanks-24" minimum between tanks and hole walls and 24" between adjacent tanks.
0 Unstable walls-V2 tank diameter minimum between tanks and hole walls; 18" minimum between adjacent tanks. (24" for 12' diameter tanks).

D. Anchoring
0 Hole flooding from high water table anticipated.
0 Hole flooding from external surface water anticipated. 0 Completed in accordance with Installation Instructions ___ Slab ___ Deadman 0 9wner's representative aware of anchoring requirements.

IZ"Not required.

E. Installation Procedures

1. Minimum 12" level backfill bed of approved materiaL

2. Initial backfill-1st two 12" lifts pushed completely under tank bottoms between ribs and under end caps to eliminate all voids.

3. Completed backfilling to tops of tanks in uniform lifts.

4. Tanks not filled until backfilled to the tops of the tanks. Exception: wet holes. See 0/C Tanks Publication 3-PE-6304.

5. Tanks completely filled with water or product after backfill is to the top of tanks.

6. Depth of bury/slab for traffic bonds.
4'-1 0' diameter tanks: 36" of backfill, or 30" of backfill plus 6" of asphalt, or 18" of backfill plus 6" of reinforced concrete.
12' diameter tanks: 38" of backfill plus 6" of asphalt or 38" of backfill plus 6" of reinforced concrete.

7. Filter fabric hole liner is recommended for the following installations:
a. Tidal condition or frequently changing water table
b. Unstable soils (muck or landfill)
c. Water condition with silty soil
See installation instructions 3-PE-6304 for recommended brand name filter fabrics.

8. Reference 0/C Tanks publication 3-PE-6304 for complete installation instructions.

Loti
Contractor
Foreman
"J!Z!
TN
.. 1 fV
"TB./
,fJ
71V
"I&L
Owner's
Representative
( L-L'
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l
( ( ·' ")
(._LJ..._;
\
• F. Tank Inspection Procedures
a. Underwriters Labomtories label number (to correspond with invoices and UL label on tank.)
b. Tank nominal capacity (gallons)
c. Tank Measurements in inches (see instructions below) to confirm that tank has proper support.

1. After pressure test, measure tank internal diameter prior to backfilling.

2. After backfill is at subgrade, measure from tank bottom to top of fill lube prior to insertion of drop tube.
"?871 7
J()OO
fliP .. 54 /I flfJJ"
)I
.. ·,. . .· - .
. ..
·• Tank Number
2 3 4 5

3. After backfill is at subgrade prior to insertion of drop tube, measure from bottom of the fitting to the top of the fill tube. •

4. Calculated tank internal diameter with backfill at subgrade (subtract measurement #3 from measurement #2).

5. Calculated tank deflection (subtract measurement #4 from measurement #1 ).

Measurement Instructions
,, 51-1
-9--
All measurements for vertical deflection are made from lhe bottom of the tank to the bottom of the NPT fitting.

All measurements should be made in inches using a standard non-metallic gauging stick.

All measurements should be made through the fill tube fitting.

Measurement 1 may be above ground or in hole prior to backfilling.

Measurement 2 must be made prior to insertion of drop tube, but after fill pipe has been installed. " read mches
measurement 3
Measurement 1 is the inside diameter of
the tank at the gauge opening. Measure
from the bottom of the tank to the bottom
of the fitting. This measurement should be
taken prior to placing any backfill. Record
measurement 1.

Measurement 2 is the distance from the
bottom of the tank to the top of the fill tube.

This measurement should be taken prior
to insertion of the drop tube. Backfill
should be to subgrade at this time. Record
measurement 2.

Measurement 3 is the distance from the
bottom of the fitting to the top of the fill
tube. This measurement is taken by driving a nail into the 1" point at a right angle to the dipstick.

Lower the dipstick down the fill tube far
enough to extend below the bottom of the
fitting. Lift the dipstick until the nail catches on the lip of the fitting. Read measurement atthe top of the fill pipe.

Subtract 1" to allow for the point where the
nail is in the dipstick.

Pub. No.15-PE-8894-I Uthoin U.S.A., May, 1989
Measurement 4 is the calculated tank internal diameter (subtract measurement 3 from measurement 2).

Measurement 5 is the calculated tank internal deflection (subtract measurement 4 from measurement 1 ).

WARNING: lithe answer in measurement #5 is in excess ofthe appropriate value shown in Table A, immediately contact the manufacturer's installation manager prior to proceeding with the installation.

Table A
tank
diameter
4'
6'
8'
10'
12'
maximum
deflection
'h"
%"
l'h"
11h"
NOTE: Contractor must be a
trained 0/C Tanks contractor to
validate the 30 year structural
warranty.

Installation was in accordance with 0/C Tanks Corporation Pub. #3-PE-6304 ••
'lb;;./'13
Oilte 1
NOTE: Owner must retain this document to substantiate any future structural warranty claim.
0/C
TANKS
0/C Tanks Corporation
One Levis Square, Box 10025
Toledo, Ohio.43699-0025
Fiberglas Tank Installation Manager
(419)248-7371
.o;· •·. Copyright©
_.\ ',;:__. ...... "' .. .,· :.· ...

STATE OF CALIFORNIA
COUNTY OF J /1/l)
ACKNOWlEDGMENT -Generai-Wolcolfs Form 233CA-Rev 5-82
©1982 WOLCOTTS, INC. (pnce class 8·21
}ss.
/ .,;). '!?\ 0 .../)4 _,. / a 3 On this day of , in the year 19_7 _, before me, the undersigned, a Notary Public in and for said State, personally appeared 7-<&skY' I /Chz cfM. Sffllk:j --------------------·personally known to me
(or proved to me on the basis of satisfactory evidence) to be the person_ whose name _ _____ subscribed to the within instrument, and acknowledged to me that _he_ executed it.

WITNESS my hand and official seal.

Notary Public in and for said State.
·• .. 'I
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•' COUN1Y OF SAN DIEGO . . ·e
DEPARTMENT OF HEALTH. SERVICES

ENVIRONMENTAL HEALTH SERVICES

HAZARDOUS -TERIALS MANAGEMENT DMSION
P.O. BOX 85261 SAN DIEGO 9218S·5261
(619) 338·2222
' I \ \
·-

UST PRESSURE TEST INSPECTION REPORT
EST# IIIJJ? t.r PLAN CHECK# clf It f I
SITE ADDRESS __ _ ZIP ·1'ri, ?=t
ESTABLISHMENT NAME wAc m/l.u Jtb)J.:, J?:'<.

CONTRACfOR NAME (rt;., PHONE# r 1L 1'6 ,;
PROJECT TYPE: New Tank Installation 0 Replpe/RepaJr 0 Other · YES. ·NO·
ENTIRE PRIMARY SYSfEM AT 5 PSI

TANK MANUFACTURERS CHECKLIST OF INSTALLATION RECEIVED
HMMD'S APPROVED PLANS ON SITE Y:s
TEST BY: DATE: I I ltJif l.f1
Product type d : 5)- 3: -l ( I" ,.,..,t J!:,'tt . v
c-./·0
Tank/Vent/Vapor •t . .r I 't.!? 'f13lg I 'f13lg Time: I 'f13lg I 'f13lg I 'f13lg Product line
Time: I psig I 'f13lg I psig I 'f13lg I psig
SECONDARY CONTAINMENT 'YES NO YES·· :.No· YES· NO YES. 'NO YES NO Tank
Man way I Fl ttlngs )1,.-r
Fill Lines fd
Automatic Line Leak Detectors
fl/ I fJ .. Installed
Jq -o V<. -I]_- /!)':r_;.,, 1 .. /} o 1/J-< c "'(IV/
Cl/•c.Kt.,'St df F.u: _ Flvt1<..]

PRESSURE TEST AND TANK SET APPROVED

REINSPECTION JND FEE REQUIRED
Received by: 1/Jfb l L ---
Name. e2S·-P
I .,
' . -
Tj!.J.r c 1'1;/V/l s /.
..)
YES NO
_!'!J
/1/0
J6 "'J_ _, ti L Uf {-
..
lSI' sc !Hf"tll.E D RFSI >IE) •11 m D FEEPA1D D
J:::WlE: u/;o/?2 EST.I H3227tf p.c.f /IITIJ/3
SHXIAU'SI': JO#AAI/IIA FROM:

INSPECTION DAY/DATE: -- IJlNEM/!,E/2... 2L/. /9?2 '

INSPECTION
,
..$77li<C.>
SITE ADDRESS: lit) tow/\1 CPrrE/l J'Y M../1/T££ t:t,;.o7 I , , CONTRACTOR: GT& Co. - -- I<.Lc- ---- --- - 'l
CONTACT PERSON: 'Pfi(B; t (b (f/) 67..'·2-.!7 '1,

TYPE OF INSPECTION

CERTIFICATION AND PRESSURE TEST INSPECTION D

MONITORING EQUIPMENT AND INTEGRITY TEST VERIFICATION D
ae&JKEBYRDofOVAL D aOSOREJNHACE D
TANKREPA1R D TANKSISII:MREMFE D
SPECIAL INSTRUCTIONS: h i.
'
' ' ( l ...._.

SPECIAUSTS REMARKS:

REINSPECTION FEE DUE CJ

UPDATED PLANS REQUIRED D
COMMENTS:
(10/90)
.. . -
RECORD OP PRESSURE OVER T:IME ·.·
----------- ---------- --------- 0/L REG W/0 ·.-:
psig psig psig psig

RECORD OP PRESSURE PLOTTED OVER TIME
0/L
psig
. '
·,

COUNTY OF SAN DIEGO

HAZARDOUS MATERIALS MANAGEMENT DIVISION

UNDERGROUND HAZARDOUS MATERIALS STORAGE TANK FACIUIY

PERMIT APPLICATION
PART I

GENERAL PROJECT INFORMATION
I
A. SITE ADDRESS: 170 Tciw¢1 CtNf-<v f/(.wt
Oty . G4 Zip
B. PROPER'IY OWNER:

Assessors Parcel No. 38:l - O'i l - os::

Company WALM..tt't- ,S-hl,,i , It:u:. Contact RDN c Lo-e.v- ; A" Mailing. Address 70l £ Wdtof..l:l aty 2Jp
Fhone(SO/J Z73- '-(OOO
24 Hr. Emergency Contact f<dN CL.o.e,.,. 2 73 - '-IOIJfJ C. TANK OPERATOR: ·.· --- ··,_
Company wdLt:idt:r INc, j Contact RoN
Mailing Address 170 74wd ftwt CJ1y 2Jp 9207/
Rume (Sot J · 2-73 - Ljooa .,
24 Hr. Emergency Contact R..Q.t::J. 273- l.f_ooo
D. CONTRACTOR:

Primary Contractor G=TB Cot1fAH1 Contact f</c \tqJ.wsoN Mailing Address 86Lf.£ Ai$<4 Sf/, S'u/-k A CJ1y .)Af/fe,;. 2Jp Rxme(6/9 )
State Contractor Ucense '-1,?3 89 't.

Worker's Compensation Insurance Company 'tiP df.dl.tt. 's t .x;..J,.dt!.l{r CO ni' l"A.

E. APPUCATION SUBMITTAL, PLAN APPROVAL, PERMIT ISSUANCE, AND REQUIRED INSPECTIONS Submit three (3) copies of this application package, including plan drawings, With the required fee to the Department of Health Services, Hazardous Materials Management Division, 1255 Imperial Ave .. San Diego, CA or mail to P.O. Box 85261, San Diego, CA 92138-5261. Checks should be made payable to the County of San Diego.

A permit wtll be Issued by the HMMD upon review and approval of the application and plans. The required fees must be submitted With the application package. Information In addition to that presented In the application package may be needed In order to obtain final approval. No work Is to begin on the proposed project until a permit has been Issued. The required Inspections cannot be scheduled until a permit Is Issued.

Once the permit has been issued, it is the responsibility of the permittee to notify the HMMD at least two (2) working days In advance to schedule each required Inspection.

Construction stages at which Inspections are required are indicated In each subpart of this application form (I.e., Part II.III IV, and V).

DHS: HM-915 (7/91)
•••
F. PROJECT WORK TO BE COMPlETED: COMPLETE FEE CODE
Check Applicable Box APPLICATION TABLE G.

PARTS
of new tank(s) only
(without -• any tanks)
I&D 1
0 Closure of existing tank(s) with
Installation of new tanks (tank ., I.n&m 1&2
oclosure of ... tank(s) with no I & III 2
'new tank
olnterlor of an exlsting I&IV 3 _, _, 'tank
'· ·•· of an existing D .. tank facility·
I&V 4
0 Installation/Construction of vaulted
tanks
VI 5
G. FEES: The fees shown below cover plan review, plan re-revtew and approval, the required field Inspections and the first year's operating permit fees. Use the appropriate Fee Code as determined In Section F above.

FEE CODE
Installation fee for first tank $600.00 Fee: $ 0() I 0() Installation fee for each additional tank No. __ x $100.00 Fee:$ Establishment Base Fee $160.00
(Applies to establishments not currently under pennit with Fee:$ f"Q 100 1 HMMD)
Operating Permit Fee per tank No._l _x $120.00
Fee:$ (Does not apply to replacement tanks if the existing tank to tzo, oo be replaced has paid current operating pennit fees)·
State SW'Charge per tank No._j__;c $56 Fee:$ 5'6,00
Plan Re-Review $200.00 Fee:$
Closure fee for first tank $375.00 Fee:$
2 Closure fee for each additional tank No,__x $50.00 Fee:$ Plan Re-Review $200.00 - Fee:$
Repair/Interior coating fee for first tank $600.00 Fee:$ 3 Repair/Interior coating fee for each additional tank
No..:.....-x $100.00 Fee:$
Plan Re-Review $200.00 Fee:$
4 Repipe/Pipe-repair of an exlsting tank facility $600.00 Fee:$ Plan Re-Review $200.00 Fee:$
5 Consultation fee (e.g. vaulted tank: minimum 2 hours) Fee:$ __ Hwrsx $80.00 TOTAL FEE:$ Cf3C,
L PERMITS REQUIRED BY otHER AGENCIES/
FIRE DEPI'. o-H F Lc. AR:D / BtDG DEPI'. arnm -:--:---
Provide copies of approved applications from these departments and others if needed.

DHS: HM·915 (7/91) 1-2
e COUNTY OF SAN DIEGO e

HAZARDOUS MATERIALS MANAGEMENT DIVISION

I PARTU I
APPLICATION FOR PERMIT TO CONSIRUCf UNDERGROUND SfORAGE TANK FACILnY BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER- Call (916)739-2582 for Information rrrmJHQ 14 14 1-1 o Is I z. I 1 ll I w I
NOTE: Application will be disapproved without this lnfonnation A. TOTAL NUMBER OF TANKS TO BE INSTALlED _ __._ __
B. TYPE OF PRIMARY CONTAINMENT
TANK NO. MANUFACTURER COMPOSITION CAPACITY STORAGE MATERIAL I f!iwcfol's Cu,..,;N9' ·n h-et'lTLAs.s LDOD WArl-e. 0; L C. TYPE OF SECONDARY CONTAINMENT
D Multiple compartment double wall tanks
Double wall tanks D Concrete vault
D Flexible Uner (manufacturer) ___________________ _
D Other, briefly describe ______________________ _
D. UNDERGROUND STORAGE TANK LEAK DETECTION SYSTEM
R7J Continuous leak detection device within the secondary containment. connected to an I,..2:::::J audible/visual alarm system.

Manufacturer /Model _____ _
D Daily monitoring of the space between the primary and secondary containments using "dip stick" readings.

NOTE: THIS METHOD IS AVAJLABLE FOR MOTOR VEHICLE FUEL STORAGE ONLY. 0 Other. briefly describe ______________________ _
E. UNDERGROUND STORAGE TANK PIPING MATERIALS AND CONSTRUCTION PRODUcr PIPING: Primary containment __ .,!_A.!..J,oO!..-,s;c:.M.!.!r'....:-+/,-=.L..-------- Secondary containment ---'-A:....O:.__,S:..,('!.;.;..:..r'tl,.<..:.: ______ _ VAPOR VENT, FILL PIPING: Primary containment _ __.A...._.Q"--S.""M"""'r'..t..fl.,-'-'------ (fltt!ngs and unused bungs) Secondary containment
DHS:HM-915 (REV 7 /92) 11-1
OF PRODUCT SiSIEM (LE., PRESSURIZED. suAN. REMOTE FILL) Motor vehicle fuel tanks ----"'....L.A<..:...---------------- Waste oU tanks __ _,R:.,.:eM=...""4fi .... ______________ _ Other tanks. briefly descrtbe __ __._N.:..:O:..<.N..:..E=--------------- NQIE: MANIFOLDED PRODUCf DELIVERY SYSIEMS BEOUIRE
SECONDARY CONTAINMENr AND CONIJNUOus MONITORING.

G. UNDERGROUND STORAGE TANK PIPING LEAK DETECTION SYSTEM Continuous monitoring device within the seccmda'Y containment _________________________________________________ __ -AND0 Leak detector on pressurized llne (must shut down pump and activate alann)• Manufacturer ------------------------------------------- -oRo Continuous monitoring device shuts down pump and activates a1ann• "NOTE: not required for DOD pressurized systems (i.e. suction, remote fill) H. CORROSION PROTECTION FOR UNDERGROUND PIPING
0 Coated and Cathodically Protected Steel
gj Fiberglass
I. UNDERGROUND STORAGE TANK SPILL/OVERFILL PREVENTION SYSTEM Catchment Basin surroUJ111ing the product fiD pipe
Manufacturer (?_ft/..L -
-ANDSecondary contaJnment for vent. vapor, and tank riser piping with Ball Float Valves or Product Level Sensing Device with High level Alarm
Manufacturer OWtN'S. CorN,'cly'
-oRo Positive shutoff device In fill pipe at 95% full
Manufacturer-------------------------------
-oRAp Level Sensing Device with High Level Alarm and Ball Float Valves Manufacturer ________________________________ ___ J. TYPE/MANUFACTURER OF VAPOR RECOVERY SYSTEM TO BE USED "' Stage I Recovery System _______ ______________ _
Stage II Recovery System ____ ......,'-'--------------
K DESCRIBE HOW YOU PROPOSE TO BAlLAST THE TANKS FROM FLOTATION fi'ANKS MUST BE BALIJ\STED IF IDGHEST ANTICIPATED GROUNDWATER IS AT LEAST 25' BELOW GROUND SURFACE) E6l
D
D
Anchor Straps per Manufacturer's specification with deadman and/or slab Bouyancy Calculations (must be submitted)
Depth of Groundwater: ft
L. CERTIFICATION
Attach a certification from the manufacturer, or his authorized representative, of the tank and piping materials as to the capabll1ty of the tank and piping materials to store the proposed ha7-ardous materials.

DHS:HM-915 (REV 7 /92) 11-2
M. ATTACH THREE COPIES OF PLANS SHOWING THE FOU.OWING:

1. Location of all existing and proposed structures.

2. Location of all existing underground tanks and piping ( Indicate If tanks are to be closed or replaced). ·

3. Location of all proposed tanks and piping.

4. Cross section of tank and piping system. This drawing must show secondary containment of tank and piping, sptll/overflll prevention devices, leak detection equipment with the correct number of sensing probes and extension of all pipes and ancillary equipment to finish grade.

6. Location of underground utility vaults and llnes.

7. Site plan showing site address, nearest cross street and property lines. (scale and north arrow must be used).

N. REQUIRED INSPECTIONS- NEW UNDERGROUND STORAGE TANK INSTAlLATIONS EACH NEW TANK INSTALLATION MUST BE INSPECfED BY THE HMMD. 1WO

INSPECTIONS ARE REQUIRED

1. FIRST INSPECTION: CERTIFICATION AND PRESSURE TEST INSPECTION -pressure test of entire primary system (tank, product, vent, vapor, fill). Tank manufacturer's certification of tank set must submitted to the Inspector at time of Inspection.

2. SECOND INSPECTION: MONITORING EQUIPMENT AND INTEGRl'IY TEST

VERIFICATION
-performance check of the monitoring system. HMMD'S Certification of Tank System Installation, Certification of Monitoring Equipment, Integrity test report, Form C, and Monitoring and Response plans must be submitted to the Inspector at time of Inspection. An documents must be submitted before final opetating permit will be issued.

0. DECLARATION
I declare that to the best of my knowledge and belief the statements and Information provided alone are correct and true. I understand that Information In addition to that provided above may be needed In order to obtain a permit from the Hazardous Materials Management Division (HMMD) and that no work Is to begin on this project until the permit Is Issued.

I understand that any changes In design, materials or equipment will void my permit to construct If prior approval is not obtained. I further understand, that a permit to operate the underground storage tank will not be Issued until the HMMD Inspector approves the Second Inspection.

I will notify the Hazardous Materials Management Division at least two working days (48 hours) in advance to schedule each required Inspection. I understand that site and worker safety are solely the responsibility of the property owner or his agent and that this responsibility is not shared nor assumed by the County of San Diego.

SIGNATURE & TITLE:

PRINT NAME:
__
DHS:HM-915 (REV 7 /92) 11-3
. a. J·· - ··-IV --··
''JI.f\y(;llaiiYt' tn lllt':>t:'_f.IIO.I_'"m':'y ••·"v .,.., '' This not constitute or imply approval by <L 'H WAL - MA({T
f> t. i
!
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•
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li IIVII"UN IAN I' CONTACT THE DEPT 0 -
AT 338-2214 AT LEAST TWO ... /
.JII"'nln'.lu vU!"\:11 :TIOI\lTO-" ;_ ·-.

REQUIRED FIELD INSPECTION."""'' DIJLE THE FIRST -- · ··· ·.• i - .

II/
t:t
• . . . • • t "'
- . -,. -: ... ·:.. r -· ..

WAL- MAY't
170 /owrl f£wj
CA, 92.07/
ftr M..cHISI'141tvrt'J Syrt 's
"•I r'l.,lr
Cov- '
t;;.I.C:..::;.__
l 1 li
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;_)/._:_ ... . . . . WID . . · : · . · . ·. .. .1. All & STEEL SHALL BE ·,.;•: •. :· •. · ·. COHPLETElY BITUHJNOUS COATED.
'•! 2. TAt-e< TO BE INSTALlED IN
·. · ACCOOOANC£ W/ NFPA 30 & 31
• · • . . At«J TAN< "FGA LA TEST . · INSTAI..LATION JNSTRt.CTIONS.

3. All WASTE OIL PIPING AHO '. #:.:;. .· · . EllJJPMENT SHALl HEEl NfPA . : :.:-. 30 & 329.
6·71!, C OMf tfl.ri · ,
I 0 - f"r -. Cf 2-
2' VENT lll£ TO BUILOIOO
2' OOUOLE WALL FIBERGLASS VASTE
OIL PIPING OUALOY 3000l

OR APPROVED EOUAL
._-fi't S(}l£0. -40 PVC FACTOOY

SIOTTEO TEST WELL CASING SLOTS
.06' APPROX. 1/-4' APART 2' WIDE
KH--@HOOITOfUNG VELL PAillE
12' SANOIP£A GRAVEl UJSHIOO PER HANUFACTI,JlERS RECOHMENDATJOOS 16 I 12' CIC B.ll. TOP & OOTTIJ4 ·.
112'+ 6'x19' PLOW STEEL WlAE ROPE & CADLE CLAMP
Pl. 12' x3/4 'x12' WELDED TO 1' EY£ TYPE ANCHOR BOLT
. . · ··:. :·
... · ... - -.. . . ; ... ----·... . . .... 7 ...

UNDERGROUND WASTE OIL TANK DETAIL
·, : . · .. NTS AE: 11H1

SANTEE FIRE DEPARTMENT
Bureau of Fire Prevention
8950 Cottonwood
Santee, California 92071
Phone: 448-3648
LIQUID STORAGE DATE _ __:_;:;/ o+/_,_1 /'-'i-"'2--:;_ __ _ Company installation I remo va 1 made for
Address of installation/removal: /70 r .. wN c.,.cl}y,.

N arne of company rna k i n g i n s t a 1 I at ion 1 remo v a 1 Address of installer/remover: Rt.'i.J Ar:;lP<i:S-1. .'vuJtx"<!, CAt ?u·zl NO TANKS SHALL BE INSTALLED CLOSER THAN FOUR (4) FEET FROM ANY PROPERTY LINE OR BUILDING. ALL TANKS SHALL BE COVERED WITH THREE {3) FEET OF EARTH UNLESS CIRCUMSTANCES PREVENT SAME. ALL ENCROACHMENT PERMITS SHALL BE SECURED BEFORE PERMIT IS ISSUED.

TANKS SHALL BE UNDERWRITER APPROVED OR EQUIVALENT.

Wi.lRK

TANK USE OF TYPE OF
NEVI, CAPACITY STORED LIQUID: LIQUID STORED: TANK
NO. OF IN RETAIL, GASOLINE, SERIAL
TANKS ETC. GALLONS PRIVATE, ETC. KEROSENE, ETC. NO. I
I ('.} "( i, 000 I fnvA+<- I OtL I I
I
I
, i I I I
' i
I I I

TYPE OF I DISTANCE DISTANCE
STORAGE: TYPE OF SUPPLY: INSTALLED INSTALLED TANK
ABOVE GROUND, RmOTE OR I FRQt.1 FROM SERIAL
BELOW GROUND INDIVIDUAL PUMP I BUILDING PROPERTY LINE NO. /S.,.. L, w !< t 1'-'<t) f-<-
' I O?S"/ /??/
!
I
DIMENSION OF PROPERTY WHERE TANKS ARE TO BE INSTALLED ___ FT. X ___ FT.

NUMBER AND CAPACITY OF EXISTING TANKS: NO. ____ _
f-ltJ/'J NO·----- TOTAL CAP. ______ _ NO. ____ _
TOTAL CAPACITY OF NEW AND EXISTING TANKS. __ --;---------

LOCATION OF REMOTE CONTROL EMERGENCY
THIS APPLICATION SHALL BE COMPLETED PRIOR TO INSPECTION. WHEN READY FOR INSPECTION, TELEPHONE 448-3648. ff
SUBrHTTED BY: ADDRESS F, S"-v/ir A SA-NiT"'<::_
('A 2t1?1
THESE TANKS f·1UST BE INSTALLED ACCORDING TO LAW AND \40RK SHALL NOT BE STARTED BEFORE PERMIT IS ISSUED. NO TANKS OR PIPING SHALL BE COVERED BEFORE THEY HAVE BEEN INSPECTED BY THE FIRE MARSHAL OR HIS DEPUTY.

PERMIT APPROVED __________ _
I NSTALLATIOifRH10VAL : ________ _
{See other side for Inspection Procedure)
./

COUNTY OF SAN DIEGO

DEPARTMENT OF HEALTH SERVICES
CHECK # NT1663
EST # H32274
DATE: 10/23/92

HAZARDOUS MATERIALS MANAGEMENT DIVISION

PLAN CHECK CORRECTIONS AND COMMENTS FOR UNDERGROUND STORAGE TANK FACILITY SITE NAME: WALMART STORES, INC./GTB COMPANY
SITE ADDRESS: 170 TOWN CENTER PARKWAY, SANTEE 92071
DESCRIPTION OF PROPOSED ACTION: INSTALL ONE REMOTE FILL WASTE OIL UNDERGROUND STORAGE TANK SYTEM.

NOTE:

A FINAL INSPECTION WILL NOT BE SCHEDULED PRIOR TO THE SUBMITTAL OF A BUSINESS PLAN TO THIS DEPT FOR REVIEW.

PLANS REVIEWED AND APPROVED

SHOULD YOU HAVE ANY QUESTIONS, PLEASE CALL
MARY PETERS AT (619) 338-2207
07/28/1999 03:30 7656401655
•

KLEENCO PETROLEUM CO
-
PAGE 01
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Fax
T01 ROBERTRAPISTA From: TONY THOMPSON
Fax:

Phone:

Re: < CC: \
Rl Urgant CIPor Ravl- Cl Please Comment 0 ..._Reply
.. . :::: . . >:· ... · .. : .
: · .. · · .. ;:>.··::;{:>.:L<·:-·· ....

TANK CERTIFICATE FOR DESTRUCTION

BEST REGARDS,

TONY THOMPSON
r}•:· . . :'!;:•
:
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209 WILLOW LANE • ANDERSON. IN •46012-1027 •1800-370-5970 . . .
.... ·:: . ; ·. . ' . .
07/28/1999 03:30
15:46 42353 0
1252 Quarry Lane
P.O. Bo• 9Q19
Pleasanton, CA 94566
(9251 426-2600
May 25, lSISISJ
Mr. Tony Thompson
KLEENCO PETROLEUM SERVICES, INC.
209 Willow Lane
Anderson, IN 46012
Dear Mr. Thompson:

KLEENCO CO
STRATA
PAGE 02
PAGE 02
Clayton

LABORATORY

SERVICES
Client Ref.: WAL-MART #1917
Clayton Projecc No.: 99050.34
Attached is our analytical laboratory report for the samples received on May 10, 1999. Also enclosed is a copy of the Chain-of-CUstody record acknowledging receipt of these samples.

Please note that the analytical results are provided by Mccampbell Analytical.
we appreciate the opportunity to assist you. If you have any questions concerning this report, please contact Client Services at (925) 426-2657.

Sincerely,
Patricia Flynn
Client Services Representative
San Francisco Regional Office
PVF/pvf
Attachments
California DHS ELAP Certification Number 1196
Cla'(fDn labaratot"f S.""''ca It a Olvlaian af CllytOr\ Oroup SC!rvlc."C;,. 1ft<":, Atlan1a • Boston • • Cleveland • Danbury • Detroil • Honolulu • • • Miromi Minna.2.polia • Now Yolk • Phtlatlelphla • Portlarsd • Roelcford • San Priinl:l,t:o • 9a...,annah 4 4 Wichita 87/28/1999 83:38
07/28/1999 15:46 . .
.. 42353 .. 121

KLEENCO CO
STRATA
Analytical Results
for
Kleenco Petroleum Inc.

Client Reference: WAL-MART #1917
Clayton Project No. 99050.34
PAGE 83
PAGE 03
Clayton
lAOORATORV

Page 2 of 2 ends

Sample Identification: See Below
9905034
SOLID
5520.C&F
EPA 418.1
Date Received: 05/10/99
05/10/99
05/10/99
Lab Number:

Sample
Preparation Method:

Method Reference:

Lab
Number Identification
-01 RFl-4.5
-02 RP'2-4.5
-03 RF3-3.5
-04 S-9'
-OS E-9'
Date
Sampled
05/07/99
05/07/99
05/0?/99
05/07/99
05/07/99
ND: Not detected at or above limit of detection
Information not available or not applicable
Date Extracted:

Date Analyzed:

Method
Detection
TRPH Limit
{mg/kg) (mg/kgl
110 10
120 10
150 10
110 10
150 10
SAM Chaln-of-Cuatody Record

ANALYSIS REQUESTED SAMPLE TYPE
-\i . p• j Q ; • • • .. • ••
Dal8 s h 1 "'V\ < Page ..1... of -/-
COPV OF LAB RE8UI. TS
MUST BE SENT TO:

DIP- of ErwillarvnlnfAI
IIIIGIIIIon DNlalon
P.O.IIox 1211281
o , _ s.n _...;; Diego. ____ CA IR1 1UJS1 _

COUMENTS
r - \ "' \ --...._ '-. \ I"-. i \ '-. \ "'-.f'-1
Dati Dale ' Dall 15 TOTALNO.C:ECOHJAINERS
____ -( -·-·· s...., .. eandltk1M I A1 , • rl1
11 Srilnawra 1--,-_.,...,lgnalura . I 11118 R.-ed On lee VelliNo

1.7J.,.,W
8 TTme Time • I TaDa Seallnlacl "· ...... ·
n ft. Printed Name
Name ' ,:1.,.,. • rrinted Name --·- ShlprnentJHandllng Or ' tr (NO u- Storage Requlremenls:
1--=-.....,--f"tompall'/ 1---.riCompany
Dale Date , ... .. .. RECEIVED BY 1lA8 Tlma
AH .
lsignablre Time Time 09;]0 !'
Pnnled Name 1-Prt_n_te_d,.,..Na-me------1 2-L-1'f ')_\
Dlsltlbvlton: While • laboralofy • . \
Yellow· ConlraciOffRespanslble Par1y Coumy or _ Depar1menl ot Environmental He,llllh 87/28/1999 83:38
FROM
bl!( o!lli;Lo
I'A 81{1.0 ..
7656481655
• FAX NO. :

ECI FONTRNA
KLEENCO PETROLEUM CO PAGE 85
• Jul. 28 1999 02: lBPM Pl
N0.307 P.4/4
Oepar4f11Qnr of T tta•t
'8CtoltNma.

HI 1h.lad
•1 1'1011 toqw·..d b)'
DO NOT WIITE BELOW THIS liNE •
._ ... ;c•,os ..r ....... ,,:,-. t.•
I I :.: JOOQ : ........ : ·.<'
07/28/1999 03:30
FROM
7656401655 KLEENCO PETROLEUM CO PAGE 06
• FAX NO. : • Jul. 28 1999 02:19PM P2
DAY . S99
TELEPHONE B:SI!JAMij ECI R T I F I c A )E N0.307
(909) JS5 5601 . SERVICES CrloMPANY c:usTOMEn
FOR: 'iP'?f C!G."'I' Ol!!I!IRQL TAN I< NO.

LOCATION: ___ F_u_N_TA_NA_. c_A ___ _
VISUAL GAST!CM11:,14 SMPN
TeST MI!TMOO . ·-.. .

DATE: IJllol.; o\1\.1 TIME: __
LAST PRODUCT WasleOII ____________ __
This is to certify that I ha11e p111rscnally determined that this tank is in accordance with the American Petroleum lnati\Utl and have found the condition to be in accordance with lte assigned d&alenatlon.

This certificate Is based on conditions axlstlng 111 the tim• the Inspection t\erein set torth was completed and is Issued to compliance With all CjUalificatfona and instruotions. -· . . :·-
TANK SIZE-- 111'1111 CBAlLQN TI\NK CONDITION __ __ •=I_HL_· ·----- REMARKS: .. LOINI!R EXPLOSIVE UUIT LESS THAN 0 1'111 f:RtCKSON.If.IC. HERE e·r Cn" I I Ht INQ, THE PERMITS FOR. AND HAS AC'Ce'PTeD lHf. TAN II uwt;.L:!. I (; v:. --------
··-----
-----·· ·--------------------------· -------
the evenl ul anv affectlflEJ 'he !lll3·free conaiiiDns of the abolle taoks. or 1t 1n daunt.

Immediately all hot wDrk llod· conta¢ tile undersiQfl!!d, permit II valid for 2• hours if no plllfSICIII or armospheroc c11anges occur

STANDARD SAFETY DEIJQNATION
SAFE. FOR MEN: r.leana thai Ill 1hl CC1f!lpattrnel11 or apac:e ao deelgnated (a) Tf1a Olt)'gen c:ontent of the lltmasphere 1s ar least 19.!> percent by volume: anct that (b) mluariBIB In tne 11moapt·11r. are wilt1in permlssable Ooncentratior>s, ana (C) In ths Jl•dgmerll of the lnapto!Dr, tile ,.,ld&.u!a ere not capable of producing toxic mat!!rlals under existing atmgepheroe w1111e mstnte1neel N Chreecea on the Inspector's certificate.

SAI'I£ roR FIAE: Meaos that In the CQmpartment so designated (8) Tl'le gf materrals In the &llflO&PhllrA li belgw 10 percent Qf rtJe lower limit; and that (b) In !/leo j<Jd§rni!lnt of the lnsp8CI<.Ir. Ito" resldt.oes are r>ot ol produCing a l'llgher conce"'ratlgn tht permitted under existing at!TIO$pl'1eric: conditions in !he presence or ftr• and wn11e maintained as dlractiCI on tha lnaplldor's certtflca!e, Arid further. (c) All adjacent spaccm have mlther been c1esnee1 to pteveo! the sprear:l of firs, ere aatJslac::rorlly inert$d, or ifl the case of fuel Eal'lkl, 118ve been 1ru1ed as deemed necessary by the Inspector.

T
The acl<nowlad!:IU receiPt of thh! certificate 1111d understa,ds the cortdltlone and l•mllahum; whtch 1!
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DATE .COMMENTS INITIALS
111.5- C...IL ln/5 _'37.5
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DHS:HM-9611b1 (6/91) County of San Diego, DHS, EHS. HMMD. Site Assessment & Mitigation (SA./M) .. -- ' uti» AND WATER QUALITY DIVI. . ' . UNDERGROUND STORAGE TANK SYSTEM CLOSURE REPORT ESTABLISHMENT NO.

SITENAMEL0AL- VV7P..,12:1 -:Pf.!'1tl
SITE ADDRESS If Q 'TOQ!V

CONTRACTOR
Number of tanks to be removed 'G) 2 3 4 5 6 7 8
Decontamination by \W(
Manifest No. -,):s,...t ll"'lt>f'?!($sl tfOoj C" I$ 2.D Z,"2..

Tank rinsatel(amount & destination)
Tank ID No. rT tiD/
Capacity LBDO
Tank Construction I F l '3G12< CICA
Materials stored
%LE.L
Dry ice/other (amt.)
Tank condition
Backfill soil type
Backfill condition
Native soil type
Native condition
Excavation odors?
Stockpile odors?
Water present?
Ponded product?
Piping removed?
PLAN CHECK NO. AT t..f'-13 z_
PHONE _______________
ZIP "1"2DL/
PHONE

FIRE AGENCY PRESENT
Dept.

C§)No
Permit
m . . . .. ' REMARKS . . . . ·.

REINSPECTION REQUIRED YES NO lfyes, explain 6l?"T.)\<"· ·""""" , NOTICE: You are notified that on '5" t'1:- /\"' , an Environmental Health Specialist conducted an inspection for the of Elb:=l'*?(t 1 hazardous substance underground storage tank(s). A summary of the conditions follows:
0 An unauthorized release of a hazardous substance has been observed by the Environmental Health Specialist. You are hereby required to initiate Corrective Action measures (See Page 4 for details).

A determination of this site's status is pending the Site Assessment and Mitigation (SAM) Program's receipt and review of analytical results for the samples taken from the tank and/or piping closure site. A laboratory report must be submitted to SAM within 30 days. Please request that the laboratory send a copy of the analytical report directly at the address provided below.
....... -f/ ' -v
RECEIVED BY , 1_ Jl. '\j a .LL 7 Health ()
PRINTED NAME JYloh(!?d() SAM- P.O. Box 129261
Lfl 'j:-: Q San Diego, CA 92112-9261 (619) 338-2222
PHONE NUMBER bO _2.L_D - 91J
DEH:SAM-916 (Rev. 2199) NCR
DISTRIBUTION: WHITE-RETURN TO SAM

YELLOW-BUSINESS RETAINS

Page 1 ends

County of San Diego
Department of Environmental Health
•
Type(s) of hazardous substance(s) released (mark all that apply):
0 Gasoline 0 Diesel Oil 0 Other----------------
Is hazardous material ponded? 0 Yes* A No Estimated ambunt? ------:-------- Estimated depth to groundwater below this site: feet Beneficial use?)8r Yes 0 No • SOIL CONDITIONS (Odors. Staining. Volume):
" Describe backfill and its condition:J>§A lo.)O 1:>\!>Gol.o'll.A.jtor? t.Jt::'fEO Describe native soil and its condition: m<t.f.fv.,._ S1 1+-no d U' c..ot..>I"Aol'f'IOA..I . 1 --rz...r."""
......,\-"'I 0-AHow was hazardous substance released?
Tank condition (holes, corrosion, wrapping, seams, evidence or overfili)Dav-bl.J- i-2.v,slkP ....... I
Estimated length of piping removed? ...,so Date tanks last used?---------- Nearby water wells or surface noted
*Describe _______________________ ' . Any known sensitive receptors, i.e., underground vaults, utilities or basements nearby?"[] Yes* 0 None noted *Describe ______________________________________________ _ COMMENTS: __________________________________________________________ _ DEH:SAM-916 (Rev. 2199) NCR Page 2 of 4
' , '
County of San Diego
Department of Environmental Health
August 11, 1999
Mr. Robert Lapista
County of San Diego
•
Department of Environmental Health
Site Assessment and Mitigation
P.O. Box 129261
San Diego, California 92112-9261
Underground Storage Tank Closure Report
Wai-Mart Store #1917
Permit #AT 4432
Establishment #H 32274
170 Town Center Parkway
Santee, California 92071
Dear Mr. Lipeda:
•
Auc I G 9 4G AM '99
c ,, 11 1··.· \· , • ,J 1 A l.
\.. T ' ' • ' l ' ''
HEALTH SEHY\CES
l•
On behalf of Wal-Mart Stores, Inc., Kleenco Petroleum Construction, Inc. (Kleenco). is pleased to provide the UST Closure Report for the above referenced facility.· This report documents removal of one 1,000 gallon capacity used oil UST on May 7, 1999. If you have any questions, please contact me at 800/370-5970. Best regards. · Sincerely,

KLEEN CO
(ov Kurt Tatman
Project Manager
Enclosure
cc: Bill Payne, Wal-Mart Stores, Inc.
,,
i
209 WILLOW LANE • ANDERSON, IN • 46012-1027 • 1800-370-5970 98182364.542
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Auc 16 9 41 AH '99
· ··rlTAL t t'l 00: '!' ' l '. O I '

HEALTH SERVICES
Underground Storage Tank Closure Report
Wal-Mart Store #1917
170 Town Center Parkway
Santee, California
Prepared for
Wal-Mart Stores, Inc.
701 South Walton Boulevard
Bentonville, Arkansas 72716
Prepared by
Kleenco Petroleum Construction, Inc.
209 Willow Lane
Anderson, Indiana 46012-1027
(800) 370-5970
August 1999
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Underground Storage Tank Closure Report
Wal-Mart Store #1917
170 Town Center Parkway
Santee, California
Reviewed by:

Kleenco Petroleum Construction, Inc.
98182364.542
I Date
WAL-MART #1917

SANTEE, CALIFORNIA
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• TABLE OF CONTENTS •

1.0 Site Description
Figure 1 - Vicinity Map
Figure 2 - Facility Layout and Sampling Locations

2.0 Removal Activities

3.0 Sampling Procedures
Table 3-1 -Sample Identification

4.0 Laboratory Analyses
Table 4-1 - Analytical Data Summary

5.0 Site Restoration

6.0 Conclusions and Recommendations
Appendix A -Site Photographs
Appendix B -UST Closure Work Plan and Other Required Permits Appendix C -Tank Destruction and Disposal Documentation Appendix D -Laboratory Analytical Reports
98182364.542
111
1-1
1-2
1-3
2-1
3-1
3-1
4-1
4-1
5-1
6-1
WAL-MART #1917

SANTEE, CALIFORNIA
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• 1.0 SITE DESCRIPTION •
Kleenco Petroleum Construction, Inc. (Kleenco) removed one underground storage tank (UST) at Wal-Mart Store #1917 located at 170 Town Center Parkway, Santee, San Diego County, California (the facility). The tank was a 1,000 gallon capacity used oil UST located adjacent and west of the Tire and Lube Express (TLE) service area. The tank and piping were constructed of double-walled fiberglass. Figure 1 is a vicinity map that shows the location of the facility. Figure 2 is a site map that shows the layout of the UST relative to other features at the site. Photographs of the UST removal activities are provided in Appendix A. 98182364.542
1-1
WAL-MART #1917

SANTEE, CALIFORNIA
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SCALE 1 : 24000
2000 0 2000 4000
----- - - -

KLEEN CO
9818236 06199 SA
FEET
209 WILLOW LANE
ANDERSON, INDIA.NA 48012
PHONE SOD-370·5970 FAX 785-840·1855
1-2
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' 8000 N

VICINITY MAP
WAL-MART STORE #1917

ELCAJON, CA

QUADRANGLE
1967, PHOTOREVISED 1975
FK!URE
1 170 Town Center Parkway- Santee, CA
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• 2.0 REMOVAL ACTIVITIES •
Kleenco performed the UST removal activities in accordance with rules and regulations set forth by the County of San Diego Environmental Health Department, Division of Site Assessment and Mitigation (SAM). The UST Closure Work Plan form was completed and submitted to the SAM prior to closure activities. The plan was approved on March 31, 1999, and a closure permit (#AT 4432) was granted for this project. A copy of the plan and permit are included in Appendix B·.

Field activities associated with the UST removal were initiated on May 7, 1999.

Prior to commencement of the removal process, the bulk of used oil was removed from the tank by Asbury Environmental located in San Diego, California. The overburden above the tank was removed both manually and with a backhoe to expose the tank. The six inches of overlying concrete was broken up and taken to a local recycling facility. Prior to removal, an inert atmosphere was created in the tank by introduction of dry ice (C02) at a rate of 1.5 pounds per 100 gallons tank capacity. The atmosphere inside of the tank was checked with a combustible gas indicator (CGI) to measure the lower explosive limit (LEL). The tank registered zero percent LEL. Permission from Mr. Robert Rapista, Environmental Health Specialist of the County of San Diego Department of Environmental Health, was given to remove the UST. The 1,000 gallon used oil UST and associated piping were removed from the excavation and inspected for evidence of cracks, breaches, or other failures. No evidence of cracks, breaches, or other failures were observed. Labeling on the tank ends revealed: double-walled tank, 1000 gallons, UL #38717, net 2560 lbs weight, and dry 950 lbs weight. The tank was transported intact by Ecology Control Industries (ECI) of Torrence, California to Erickson, Inc. of Richmond, California as a nonRCRA hazardous waste (waste manifest #98752022) for destruction. The tank was cleaned, triple rinsed, and scrapped as non-hazardous waste, and the sludge was drummed and properly disposed by ECI. Destruction and disposal documentation are included in Appendix C.

The dimensions of the UST excavation at the time of backfilling were seventeen feet by eleven feet by eight feet in depth. Backfilling was approved on May 7, 1999 by Mr. Rapista. 98182364.542
2-1
WAL-MART #1917

SANTEE, CALIFORNIA
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• 3.0 SAMPLING PROCEDURES
Mr. Robert Rapista, Environmental Health Specialist, was on-site to direct soil sampling activities.

Soil samples were collected by Tony Thompson of Kleenco. Following the removal of the UST, two soil samples were collected from the sidewalls of the UST excavation. One soil sample was collected from the east sidewall of the UST excavation at a depth of 9.0 feet below grade. One soil sample was collected from the south sidewall of the UST excavation at a depth of 9.0 feet below grade. Three soil samples were collected beneath the product piping and were sampled at depths of 3.5 feet, 4.5 feet, and 4.5 feet below grade.

All excavation samples were collected from undisturbed native soil in the excavator bucket, placed in laboratory 8 oz. glass jars with teflon-lined lids, and immediately placed on ice for preservation. All product piping samples were collected from undisturbed native soil with a stainless steel core sampler lined with I 1
h" x 6" brass sleeves with teflon-lined plastic end caps and immediately placed on ice for preservation. New disposable latex sample gloves were donned prior to each sample collection. Prior to shipment of the samples, Mr. Rapista certified and sealed the sample containers. Each sample was submitted, through proper chain of custody procedures documenting each stage of possession and handling, for laboratory analysis.

I Saml!le Number I
RFl - 4.5'
RF2- 4.5'
RF3- 3.5'
s- 9.0'
E- 9.0'
98182364.542
TABLE 3-1

SAMPLE IDENTIFICATION
Locatio!!ffiescril!tion
Remote Fill Sample, Below Product Piping, Native soil, 4.5' below grade
Remote Fill Sample, Below Product Piping, Native soil, 4.5' below grade
Remote Fill Sample, Below Product Piping, Native soil, 3.5' below grade
Below Tank South, Native soil, 9.0' below grade from south sidewall Below Tank East soil 9.0' h"low Prad" from <>ast
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WAL-MART #1917

SANTEE, CALIFORNIA
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5.0 SITE RESTORATION
Kleenco completed site restoration activities on May 7, 1999. All excavated fill material was placed back in the excavation, per Mr. Rapista's approval. Approximately 8 tons of pea-gravel were brought in from a clean off-site source and placed in the excavation to fill the void created by the removed tank. The pea-gravel was placed to within six inches of surface grade. Kleenco re-surfaced the remaining six inches with concrete, worked to a neat finish. 98182364.542
5-1
WAL-MART #1917

SANTEE, CALIFORNIA
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6.0 CONCLUSIONS AND RECOMMENDATIONS
The underground storage tank removal project at Wal-Mart Store #1917 located in Santee, California involved the removal of one 1,000 gallon capacity used oil tank. The tank and product piping were transported off-site by Ecology Control Industries and disposed of by Erickson, Inc.

Based upon laboratory analytical data and the absence of soil staining, discoloration, or free product, past operation of the UST did not result in an unauthorized release of used oil. On behalf of Wal-Mart Stores, Inc., Kleenco is requesting that the County of San Diego Department of Environmental Health SAM issue site closure. No further action is recommended. 98182364.542
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WAL-MART#I917

SANTEE, CALIFORNIA
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APPENDIX A

SITE PHOTOGRAPHS
98182364.542
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WAL-MART #1917

SANTEE, CALIFORNIA
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Photo 1: One thousand
gallon capacity used oil
UST prior to removal
from the site.

Photo 2: Exposed piping
trench prior to removal
from the site.

WAL-MART #1 917

SANTEE, CALIFORNIA
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APPENDIXB

UST CLOSURE WORK PLAN AND OTHER REQUIRED PERMITS
98182364.542 WAL-MART #1917

SANTEE, CALIFORNIA
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UST CLOSURE WORK PLAN
98182364.542
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WAL-MART #1917
SAN1EE, CALIFORNIA
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UNDERGROUND STORAGE TANK REMOVAL WORK PLAN
W AL-MART STORE #1917
170 TOWN CENTER PARKWAY, SANTEE, CALIFORNIA 92071
One 1,000 gallon capacity fiberglass used-oil containing underground storage tank (UST) will be removed from the above referenced site. Application for removal will be submitted to San Diego County Environmental Health Department (SDCEHD) and Santee Fire Department (SFD).

Following approval from SDCEHD and SFD, tank removal activities will. be scheduled and notification given to allow inspection and supervision of tank removal.

Site Safety Consideration
Underground utilities will be located by contacting Underground Service Alert (800/422-4133) at least 48 hours in advance of tank removal activities. A safety meeting will be completed prior to initiation of work activities. The work area will be demarcated and access to the work area restricted to authorized personnel only. A fire extinguisher will be onsite during tank removal activities. All work will be completed utilizing level D personnel protection.

Tank Removal
The contents of the tank will be pumped prior to removal activities. Product removal will be 1 .. completed by Wal-Mart's contract used-oil waste vendor. The concrete and over-burden above the tank will be removed both manually and with a backhoe to expose the top of the tank. The level of combustible vapors and oxygen within the tank will be measured with a combustible gas I indicator (CGI) and oxygen meter and ventilation will be initiated, if necessary.

The tank will be ventilated using a gas exh11uster 1.5 lbs per 100 gallons of tank V ¢ capacity) until the vapor concentration is reduced to less than or equal to 10 percent of the lower I explosive limit (LEL). Once the tank atmosphere is determined safe, the tank and piping t-V tf_ (product and vent) will be removed from the excavation with a backhoe. The tank will be .1'('1 blocked to prevent movement and inspected for evidence of holes, cracks or breaches. Following

11... ..J -)' J-: inspection, the tank will be transported off-site as Non-RCRA hazardous waste by a state t \ ,.,.,t" certified transportation company to a state certified tank destination, where the tank will be ., · cleaned and disposed as non-hazardous waste. All transportation and disposal documents will be provided in the final report. I
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Excavation Assessment
Following tank removal, the excavation cavity will be assessed for evidence of product leakage and/or spillage. The assessment will involve visual. inspection of the base and side walls of the excavation. Soil samples will be collected from the excavation cavity, beneath product piping, and from excavated soils returned to the excavation. All excavation samples will be collected from the excavator bucket by pounding a clean 2 inch x 6 inch brass sleeve into freshly exposed native soil. Each sample will be immediately placed on ice for preservation. New disposable latex gloves will be donned prior to each sample collection. Each sample will be submitted, through proper chain-of-custody procedures documenting each stage of possession and handling, for laboratory analysis. Soil samples will be analyzed according to local agency and/or inspector requirements. All samples will be analyzed by a California certified laboratory.

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Site Restoration
At completion of tank removal and environmental assessment activities, the excavated backfill will be returned to the excavation. In addition, enough backfill to fill the void created by the removed tank will be brought in from a clean offsite source and placed in the excavation. The fill material will be compacted to prevent subsidence and the area affected by excavation will be resurfaced with concrete.

Site Contamination
If contaminated soil and/or groundwater is encountered, notification of an unauthorized release will be submitted to the SDCEHD and Regional Water Quality Control Board (RWQCB).

Additional remediation and/or site assessment activities will be completed as required by the SDCEHD. .

Reporting
A final report documenting completion of all work activities and excavation assessment will be prepared and submitted to the SDCEHD and SFD. The final report will include photographs, site map, vicinity map, soil description, analytical reports, tank and sludge disposal documentation and other documentation as required by SDCEHD and SFD.

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SITE SAFETY PLAN
Please provide the following information for the site:

Owner's Name: Wa!-Mart Stores Inc 111917
Site Address: 170 Town Center Parkway
Santee CA 92071
· Contractor On Site: D&S Anton Corporation . Phone Number: (805) 650-2794 Site Safety Officer: D...,.oi.Un....:YLJa..,n..,.hu.oo!lalse"'r ________ _ Type of Facility: Retail Sa!es/Djstrjbutjon
Type of Work to Be Performed:
tanJc containin& used oil
Removal of one 1 000 aallon capacity fiberalass underaround storage Anticipated Hazardous Substances - <Attach Additional Sheets. If Required):
(Please Include concentrations below. Note If free product historically on site.) Name
Used Oj\tpettoleum
Benzene
Ethylbenz.ene
Toluene
Expected Concentrations (ppm)
(List Medium -I.e., son; water, or air)
<som <PEL
<soUl <PEL
Csom <PEL
Csoill <PEL
(soil> <PEL
PEL
(ppm)
Health Effects
400 ppm Djzz drow head nau irrjt eyes.
nose throat dcy crac!ced skjp
.1..ppm lrrit eyes pose reqr gjdd · head·
pan· stanered gait' ftg· anor lass
derm · bone marrow
100 ppm Jrrjt eyes roue memb· head· derm·
narco· coma
100 wm Ftg wealc· cop( eu!W di7.7. head·
. dUated I!UPils lac· per muse ftg.
jpsom · pores· derm
100 ppm Djzz excitement drow jpco
staggering gjdd jrrit eyes nose
throat· corneal vacuolization aoor
nau vomit abdom pain denn
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Site Decontamination Procedures, If Any: ...,N.,.o""n""e ..__ ________________ _ Hospital/Clinic: Kaiser Foundation Hospital
Hospital Address: 203 Iravelodge Drive EI Cajon
First Aid Equipment/Instructions Available On Site:

Phone: (619) 528-5()()()
CA 92020
Emergency/Contingency Plans & Procedures, Special Instructions: In eyent of emergency. site personnel shall meet at a designated location as identified on the day work begins Location of First Aid equipment to be identified
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OTHER REQUIRED PERMITS
98182364.542
•
WAL-MART #1917

SANTEE, CALIFORNIA
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ANP .WATER QUALiTY ..• ISIQN

UNDERGROUND STORAGE TANK SYSTEM CLOSURE REPORT
ESTABLISHMENT NO. H3.ZZ7'-I PLAN CHECK NO. kr4'-fsZ..

SITE NAME WAI- Mf:::..IZ I J:+.ICJ fl PHONE
SITE ADDRESS no Tou.=>t-> ZIP 4201 I

CONTRACTOR PHONE
Number of tanks to be removed G)2 3 4 5 6 7 8 FIRE AGENCY PRESENT @No Decontamination '- LE f::>0ib- Dept. by
Manifest No. .-,p,t--1 k I '52..02"2. Permit No.

Tank rinsate/(amo4nt & destination) Inspector?. '1/p Yl Tank ID No. TOD/ . . •1,·.·. ·REMARKS
capacity ,• .. IDDO !.) 1P 1'1 t(.. --c::o u (10 r-. L- (.._ Tank Construction FI'3.£.Q. pCA '5. -WD l-lo<....t:::5
Materials stored OIL 1-.rZYf6:) .
% L.E.L. <. 5'1 0
Dry ice/other (amt.) lbs
Tank condition '> ( !) ( oT
Backfill soil type -W6PV1 7&vG,L ifPrEN · Backfill condition I p--fl u,J t---.J prtQ <lZ..ICiti...Jr : Native soil type )1'1£ 0/ L.J fv\ £...L ':" ..... \1. S1L.-T f!»o-ve 0?...)"' ( f't .

Native condition (z)
Excavation odors? 1--=>()1-0-G
Stockpile odors? IAN!:.. 0..::lt!-U• TO
. Water present? L.-\ES lo oc:.. CL€At-"42J • tf:llPo\ eJ- 1 Ponded product? WD PCVL£""> l-1A "L 6. '"JD..)J ')
Piping removed? I.A I;:. s -) rill 'T u
REINSPECTION REQUIRED YES NO If yes, explain 1)11"' ---r-r .:::::.C::.--(Cil (!>71 \),.I NOTICE: You are notified that on <) I 1- /'1.0.. , an Environmental Health Specialist conducted an inspection for the closu of ON: 1 hazardous substance underground storage tank(s). A summary of the conditions follows:
0 An unauthorized release of a hazardous substance has been observed by the Environmental Health Specialist. You are here. A required to initiate Corrective Action measures (See Page 4 for details).

A determination of this site's status is pending the Site Assessment and Mitigation (SAM) Program's receipt and review of analyti< results for the sa·mples taken from the tank and/or piping closure site. A laboratory within :
days. Please request that the laboratory send a copy of the analytical report directly to I frl.D at the address provided below. . .
• It Is the responsibUity of the tank ()wner/operator or their agent to maintain the tank site=tO·a sate 'secu manner: .. ,,·.:: ·.·"-· · ..·,;·:,-,.· · :.:.:- ):-:·· :: .... :,, .. ·:.; .. . :,:,'., · ·· .. ··: .. :·:.:,i ... • Notify the local Fire sAM Program. a present .. -;•,; •, ,' -, -L.: \ -· : . : ,: i' ': :) ... 'r ··-",;.:• -.i::t .?:J./ ' , .; :J :; ,;, _;; I ... : i: . ::·.r· :;,:1 "::·' :.,:·; .... ; 'r .' ; ,, :- .. Authorization to the tank for.safety purposes or:ki:I<?YJ.I:! release has been mitigated to the satisfaction Qf SAM or any q_ther ulat ry agel\,cy{ ') · · · . ·, : . · • · RECEIVED BY r1-n'''}
'-- ..-1/ 1-- .t1. r-.. L1
PRINTED NAME -(v/'·[ .. Health lj .

PHONE NUMBER &bo/no- 5'1'J0

Page 3 ends

SAM- P.O. Box 129261 .

San Diego, CA 92112-9261 ··(619) 338-2222
...

County of San DiE
Department of Environmental He:

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County of San Diego •
Department of Environmental Health
Site Assessment and Mitigation
•
Permit # AT 4432
Establishment # H_lllli
Date: March 31. 1999
Expiration Date: March 31. 2000
Permit for Underground Storage Tank Construction/Closure SITE NAME: Wal-Mart Store #1917
SITE ADDRESS: 170 Town Center Parkway. Santee. CA. 92071 OWNER NAME: Wal-Mart Stores
OWNER ADDRESS: 701 S. Walton Blvd. Bentonville. AR. 72716 _ DESCRIPTION OF PROPOSED WORK: Remove one Underground storage tank(s) and all associated product piping PERMIT CONDITIONS:

For tank systems that are to he removed, the excavation shall be exposed prior to the scheduled inspection and sampling points identified by the Site Assessment and Mitigation Division (SAM) inspector. Sampling is required for both tank(s) and piping. The tank(s) and piping must remain in the excavation until the SAM inspector approves the removal.

Please Note:

I) All product piping and underground storage tanks must be removed at the same time. Failure to do so will result in are-inspection and $300.00 re-inspection fee.
2) If any piping is to be closed in place you must submit a $200 Permit re-review fee and a site map showing the location of the piping and proposed sampling points in accordance with Page III-2 Section F. of the Permit Application. 3) If the tank is being hauled as a hazardous waste you must wrap the entire tank with plastic sheeting.

Please be adyised:

All underground storage tanks that are to be removed or closed in place must be cleaned and properly inerted prior to the removal I) The tanks are visually free from all product, sludge, rinsate and debris. Residual staining caused by soil and waste consisting of light shadows, slight streaks, or minor discoloration's, and soil and waste in cracks, crevices and pits may be present. 2) Tanks that held a Hazardous material or hazardous waste that had the potential to generate flammable vapors, must be properly inerted. A combustible gas indicator (CGI) which is properly calibrated shall be used to measure the concentration of flammable vapor at the top, center and bottom of the underground storage tank. The concentration of flammable vapor must be below twenty percent of the Lower Explosive Limit (LEL) for the material that was contained in the tank( s) and the oxygen concentration shall be the same as that of ambient air, approximately 20.8%. The underground storage tank(s) must inerted with dry ice using a minimum of 15 pounds for every I 000 gallons of tank capacity.
3) Failure to have the tank properly cleaned prior to the time of the removal will result in the cancellation of the removal and will require are-inspection and $300.00 re-inspection fee.

This office must be given at least 48 hours notice for all required Underground Storage Tank Activity. Please contact the Site Assessment and Mitigation Division, Plan Check desk at (619) 338-2214 to schedule or cancel inspections.

Plans Reviewed and Approved By: Mark ......._, _pate: 3/31/99 Notified
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I APPENDIXC
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TANK DESTRUCTION AND DISPOSAL DOCUMENTATION
98182364.542 WAL-MART #1917

SANTEE, CALIFORNIA
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State of California-Environmental Protection
Form Approved OMS No. 205CHl039
print or type. Form designed for use Deportment ofT oxic Substonc£ Sacramento, Coliforni.
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01)
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.4. Generator's Phone I
(I)\
I

5. Transporter 1 Company Nome
lcolnnv L;ontrol tnoustnt<;;

7. Transporter 2 Company Nome
b.

CA 9'2071

6. US EPA 10
CA09820301
EMFF!GENC 'V CONT ACl :{909)355-&60'!
T ..tnh( s j.'f.7919

2. Page 1 i in the area!
1 ii not required by Federal low.

16. GENERATOR'S CERTIFICATION: I hereby declare that the contenti of this consignment ore fully and accurately described above by proper shipring nome and ore classified, and labeled, and ore in all respects in proper condition for transport by highway according to applicable international and notiono government regulations.

If I om o Iorge quantity generator, I certify that I have a program in place to reduce the volume and fo)(icity .of waste generated to the degree I have determined to be economica practicable and that I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human heo' and the environment; OR, if 1om a small quantity generator, I hove mode a good faith effort to minimize my .waste generation and select the best waste management method that available to me and that 1 con afford.

DTSC 8022A (4/97)
EPA B70Q-22
DO NOT WRITE BELOW THIS LINE.

Yellow: GENERATOR RETAit·
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DAY (.JlJN. 24. 1999

TELEPHONE
(909) 3S5 5601
FOR:
13738 Slover Avenue • Fontana, Calfforriia 912337
cCOLOOV '-'ONTROI. TANt< NO.

CA.

LOCATION:---------- DATE: 5.'11/99
VI::.UAL SMPN
t-' • .:l/'1
N0.3349S

CUSTOMER
JOB
7919
"'"' ,, ; ·\1\.1
TIME:--·

I TEST METHOD LAST PRODUCT--------
I This is to certify that 1 have personally determined that this tank Is in accordance with the American Petroleum Institute and have fOUI1d the condition to be in accordance with Its assigned designation.

Tills certificate is based on conditions existing flt the time the inspection herein set forth was .. :·
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TANK SIZE---
SAt=E ,:u:ojc CONDITION-----·-·· ·-----
REMARKS: .. nx:<GEN LOWER EXPLOSIVE LIMIT LESS THAN 01% ERiCKSON, lt-IC. HER!: B'/ CERflfil·.":,, C!IP I l HI •\l.<tliJL IJUMBEREO HA$ BEEN CUT OPEN, PROCESSED. AND T!-lt::REFORtc IR• .'itl.i II'( ':UI< , ___ _ I I t:O HAZARDOUS WASTe FACII.I ry
·-··-----.. HAS THE APPROPRIAtE PERMITS FOR, AND liJI::> Ac..-cePreo THf T MIK c vl'> f l 11" Pf<OCESSING, ... ------
··-----
-----··. ··------
In the evenl uf Hny physical or atmosphttric coa[lges affecting the gas-free conditions of the above tanks. or of on any dn•lh!, immadialely slop all hot work l'lnQ contac;:l the undersigned. This permit Is valid for 24 hours if no physocHI or a1mosphenc cllanges occur

STANDARD SAFETY DESIGN'ATION
SAFE FOR MEN: Means lhal in the compartment or space so designated (a) The oxygen content of the atmosphere os ar least t9.!:l percenl by volume; and tl'lat (b) Toxic mluertala In the atmosphere within pormlssaple conce11tretions. and (c) In lhe llldgmenl ol lhe Inspector. lhe reslctues qre not capable of producing toxic materials un!l!ir !ixisting alrnospheroc cond•l1nns wt11le ma1nla1ned as Clorecred on the Inspector's certificate.

SAFE FOR FIRE: Means that In the compartmeflt designated (a) The concentration of flammable matenals on the atmospherA 1s below 10 percent of the lower explosive limit; and that (b) In the of the Inspector. I he res1e1ues are ''01 ol producong a higher concentratlal'l that permitted under existing atmospheric conditions i11 lhe presence of f1re and whole maontained as directed on the lnsppctor's certificate, Md further, (c) All adjacent spaces have either been cleaned I sulloctenrly 10 prevent the spreeo of fire, are satisfactorily inertt;od, or in the case of fuel tank9, 1'18ve been as ceenoed necessary by 1he Inspector.

I Tile u11dersogned represematlve receipt of this certificate and understands the conditions and lmlllallofls under whoch ot ···--." -· ) / \. CiJ. \1 (h\ J\-.(,
I ...... }Sf; i'/\ .. -
II ___ A_e_P ____ N_·;_A_n_v_E ______ ______________________ _____ · ____________ I
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23;57
Jll"1.24.199'3 Wl rOI'Ilil'fl
PAGE e: . ' • I'«J,Nf t-.o ..
'\.._;/'
Ne. _____ _
TAl'"K DISPOSAL FORM •
P.o. •: ------
Co a traetor: C.ON1:1101 t tHJU S l_U llS
Add rail; U'DI Stonr Aveaue
(' li II """'io . M OOMI't\ -""
Addn": Jt \ r t!l '...N\ tru. 't'\LJ L-. n. .IY\..'1J..Q.

J)utination: 'Y Jl'\l .\\r.w.6 ll
IIATI 1 11MI ll'KOJIC'ri:D " IPUlnEJ)IY I uc .•
SPJCIIU. TDQ{I'I;
ITDBOOT:

SERVICES IW(J)IJlEl) COST QtJAX'ITl'Y OAU.ONS TVPI I'!& 'I TOT.U. r 11 TONS
_DIIpolal r.. zoo.oo -- uo , I .14
_ltdNilft IAU!q 1\llle 150.00 - ., . ,,:
_Dit,..lll ru "'' l'traalt 300.00 ::3!;::
!10 l. '
,,.
loeG(\f) , . ... _FibcrsiaA Tlllllt Dlaporal r.o 400.00 - IOOO(f) , ' •• I _rll,crsiUI Tllk DcliwNI zoo.oc - 1500 , .n
Dl•paul I'• z.=o.oo - :IOOC F ,
150!1 r 1.14
F• :1!0.00 ' -- 11000 r IJ3 --- 4DIIO ' U4
TOTAL CJWLGUt J - JOOO r Ul
All reeJ tnaarred are 11'1' lad '11111111 rp.aneJ. - 10110 f z.u - 'PSOO J ,.,
Ter.., •" '" 30 sa,.. rro• "* rif - lOGO ' J ...

CGntnttor't dpal'ln rtp,.-ob ae!:'IIIUCI - - r 1.n
IIDd CODranN tbal rMk - 1- , •. u

IIC'OO ' UJ
1010nJ COIDpllu wltll ataillnl. - T.CII:j Total J':l J NETTONS t J Tot:ll S:[ I I COifnACTOr.•& -k. Jibe !'llaa ::3> a: scc.r J
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San Francisco Regional Offic1252 Quarry Lane
P.O. Box 9019
Pleasanton, CA 94566
(925) 426-2600
Fax (925)426-0106
May 25, 1999
Mr. Tony Thompson
KLEENCO PETROLEUM SERVICES, INC.
209 Willow Lane
Anderson, IN 46012
Dear Mr. Thompson:
• Clayton

LABORATORY

SERVICES
Client Ref.: WAL-MART #1917
Clayton Project No.: 99050.34
Attached is our analytical laboratory report for the samples received on May 10, 1999. Also enclosed is a copy of the Chain-of-Custody record acknowledging receipt of these samples.

Please note that the analytical results are provided by McCampbell Analytical.

We appreciate the opportunity to assist you. If you have any questions concerning this report, please contact Client Services at (925) 426-2657.

Sincerely,
Patricia Flynn
Client Services Representative
San Francisco Regional Office
PVF/pvf
Attachments
California DHS ELAP Certification Number 1196
Clayton laboratory Services is a Division of Clayton Group ServiCes, Inc.

Atlanta • Boston • Chicago • Cleveland • Danbury • Detroit • Honolulu • Indianapolis los Angeles • Miami Minneapolis • New York • Philadelphia • Portland • Rockford • San Francisco • Savannah • Seattle • Wichita I
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I Sample Identification:

Lab Number:

I Sample Matrix/Media:

Preparation Method:

Method Reference:

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Lab I Number
-01
1 -02
-03
-04 1-05
Sample
Identification
RF1-4.5
RF2-4.5
RF3-3.5
S-9'
E-9'
•
Analytical Results
for
•
Kleenco Petroleum Inc.

Client Reference: WAL-MART #1917
Clayton Project No. 99050.34
Clayton

LABORATORY

SERVICES

Page 2 of 2 ends

Santee City CouncilDecember 10, 2025

Santee City Council
December 10, 2025