See Below
9905034
SOLID
5520 C&F
EPA 418.1
Date Received: 05/10/99
05/10/99
05/10/99
Date Extracted:
Date Analyzed:
Method
Detection
Date TRPH Limit
Sampled (mg/kg) (mg/kg)
05/07/99 110 10
05/07/99 120 10
05/07/99 150 10
05/07/99 110 10
05/07/99 150 10
Not detected at or above limit of detection
Information not available or not applicable
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SAM Chain-of-Custody Record
- - -
Date 5 h {4ft c Page _l_ of-/-
Project Name 11'1 jt n ANALYSIS REQUESTED SAMPLE TYPE COPY OF LAB RESULTS MUST BE SENT TO:
Reference Wtv S. f.:>M0\-.1 t4.&> Dept. of Environmental HeaHh Address r1 0 'fQ.OI0 C€.N"r.eA'l... cplJ1 Site Aaaeaament and ....... , ..........
Mitigation Division
: c c !3 u. P.O. Box 129261 ;i c 5 i 11. 0 San Diego, CA 92112-9261 Lab To Be Used I X! : I i 0 8 d 1=: ; j rn ::J Cl z COMMENTS 12F 1-LfS_ q,)ft z·.o-s 'f... (\ k I
I IZ:to nv ... 'x lx X. I
l<f=3 t;' 'ij"3'-·r. 'I u..., "S"'A.oil'-
e k X X I
5-9' s, 0 "'-"\. <. x IX J
t3· or' Stc>e o...Au... x )( !->c I
r---.. r -......... I(-""' '
r-- \ '-f \ \ ............_
1'---, \ \ \ ( '\f'-1
\ \ \ ........ \ \ \ 'Sp€0 O{U I
1\ . 1"'-.. '\ "-..__ ___.-/
1 BY Date f..2-]Fls=l BY Date IRs:l 11\lnl .,_, .. BY "" Date 5 7L.tt. .-...· ...... TOTAL NO. OF CONtA••·----
Sample Conditions
'..c. ure Time Received On Ice Yes/No
Time Time Taoe Seal Intact
I
?:t{pt"' .,,. ...... Name -, " """ Name , .. .,.,,.," Or I Date Storage Requirements: v ............. , Ult'UIIJ .......... , Date Date Soli! , I
ru:CEIVED BY BY Time Site
.AT#
I .
.
''7 Time Time J7..!Uc-c/ L /)., Oct;ld (
2-"2., 1 '+ I A14 t.f '3 -......... Name ....... w Name -
,
"··---··· ..
Distribution: White - Laboratory
Yellow - Contractor/Responsible Party
"'• nnn '"""''' ""''"n' t..tr-n 01"'-
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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
Wal-Mart Store #1917
Pennit #AT 4432
Establishment #H 32274
170 Town Center Parkway
Santee, California 92071
Dear Mr. Lipeda:
•
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
Kurt Tatman
Project Manager
Enclosure
cc: Bill Payne, Wal-Mart Stores, Inc.
.
Project Name
Reference
Address
( - .. .
\
'
!() ,t..(...- Vl1 t:.e:r .11-· 1 <1 n
,..__ ----- ..
It \ \
" ... \ .
SAM Chain-of-Custody Record
ANALYSIS oiCU SAMPLE TYPE
-- \ \ \
I\ \ j_
Date C) h / "i'"l Page _I_ of-/-
COPY OF LAB RESULTS
MUST BE SENT TO:
Dept. of Environmental HeaHh
Site Aaaeasmenl and
Mitigation Division
u.. P.O. Box 129261
o San Diego, CA 92112-9261
0 z COMMENTS
X..!J l.f:.\ I I JL--1
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/
tNntttSHED BY , Date .. OQE.!F:
--..., '"' 1\ ·- lJRELII'Inl'tr;:., ;:: BY "" · tNnt•··-, ;:: BY t51gnalure
-""'""" Name
Date Date
.. ;a .. .... Time
Time Time
IP""'""" Name IP .. ,..,J Name
Date
II ... GIIJ II ... GIIJ
Sample Conditions
Received On Ice Yes/No
Seal Intact YestNo
, •a" .. ""l:l Or
Storage Requirements:
Time .. !RECEIVED BY (LAB) J- """
H# AT#-___ _
Date Date
[RECEIVED BY .- , "-"'"'"'t:U BY .. "";• '
Time .. , .. ,,. I __
li;.;;;: .. ..
1 _)
f'll"a•u• a
· ""'gw Name
... Distribution: White - Laboratory
i ·,It
DEH:SAM-999 (Rev 12/98) NCR .. Yellow - Contractor/Responsible Party Pink- SAM
SAM
H3 2 .--z..l"l /AIL-fL/) 2...
County of San Diego
' Department of Environmental Health
• •
UST Removal Field Notes
Site Address: 170 TOWN CENTER PARKWAY. SANTEE, CA 92071 Date: 5/7/99 Estab# H32274 Plan Check# AT4432
Disposal Location ofTank(s): ECI Piping:
Manifest#
Site Plan View +-N
DEH: SAM 900 (revised 12/98)
Comments on Back?
Yes No
1 ' I
Remote fill piping
H32274/AT4432 517/99
WALMART
170 TOWN CENTER PKY
SANTEE, CA 92071
UST prior to removal
' '
UST loading Remote fill removal
H32274/AT4432 5n/99
WALMART
170 TOWN CENTER PKY
SANTEE, CA 92071
Water in remote fill trench-- about 4 feet BSG
t.A AND WATER QUALITY DIVIUNDERGROUND STORAGE TANK SYSTEM CLOSURE REPORT ESTABLISHMENT N<;>.
SITE NAME (IV V' \ - ....,4 ..ff' /. 'U7
SITE ADDRESS \ lC t AJ"' Cc-A.-..r Q. . CONTRACTOR S, .1'-'fc;vt...., ) Number of tanks to be removed @] 3 4 5 6 7 8 · -----
_____________ _
FIRE AGENCY PRESENT
Dept. h--v-e-- ·.
6Es..JNo
-
Manifest
Tank rinsate/(amount & destination)
Penni! No. --:::::::::"-+-
lnspector '\f) _V! P-<:t.J
Tank ID No. loo 1. . . ' REMARKS
Capacity LOlli) (o J ...1
Tank Construction
Materials stored I wJ 4?- t').--1 • •
% L.E.L.
Dry ice/other (amt.)
Tank condition
Backfill soil type
Backfill condition
Native soil type
Native condition
Excavation odors?
Stockpile odors?
Water present? tJ 0
Ponded product? N\)
Piping removed? b
REINSPECTION REQUIRED GES) NO If yes, explair1_"'i2n; W vJ\- --.. ...A / NOTICE:
t:' \ ,, ....
You are hereby notified that on S t.!> I 1 ' , an Environmental Health Specialist conducted an inspection for the closure of 0 ,.._e.. 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). 0 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 cop:t of the analytical report directly to------------- at the address provided below. ,.J n
The SMfProgram has completed,itS review Of the analytical results for si.11npl8s colleCted at the. tank closure site and has detennhied the following: ·· · · · · · ·
0. coMPLETE. NO AtnQN REQUIRED· . . .
d' INITIATE CORRECTiVE ACTION MEASURES'(sH enc-losed lnfonnation). : ' ',, ' ' ' ' • • • J ' •• ' ' i '] • ' •• • , • • ' ': '. ,. • . ' " .
RevieWed by: ·· ·· · · . · pate · . 1 I Supervisor (Initial):
RECEIVEDBY
Environmental Health Specialist
SAM- P.O. Box 129261
c: >
PRINTED NAME Jof\t 1h0111t.pjo1
0 PHONE NUMBER VfK.!Iik-/52.;7 San Diego, CA (619) 338-2222 . .A
DEH:SAM-916 (Rev. 2/99) NCR
DISTRIBUTION: WHITE-RETURN TO SAM
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Heatth
I -
Type(s) of hazardous substance(s) released (mark all that apply):
0 Gasoline 0 Diese! 0 .Waste Oil 0 Other ·,
Is hazardous material ponded? 0 Yes* 0 No amount? . . -.
Estimated depth to groundwater below this site: ·feet Beneficial use?· 0 Yes 0 No SOIL CONDITIONS {Odors, Staining, Volume}: ----·
Describe backfill and its condition:
Describe native soil and its
' . -
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How was hazardous substance released?
- .·
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Tank condition (holes, corrosion, wrapping, seams, evidence or overfill) - - -
Estimated length of piping removed? feet Date tanks last used? Nearby water wells or surface waters? 0 Yes* 0 None noted *Describe
Any known sensitive receptors, i.e., underground vaults, utilities or basements nearby? 0 Yes* 0 None noted *Describe
COMMENTS:
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DEH:SAM-916 (Rev_ 2199) NCR Page 2 of 4
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County of San Diego
Department of Environmental Heatth
e
Permit Application Summary- Tank · ••
Permit Number: AT4432
Site Address: WAL-MART #1917
170 TOWN CENTER PY
SANTEE, CA 92071-3198
Establishment Number: H32274
Permit Status: Permit is currently ACTIVE.
Received: 03/29/1999
-·
Approved: 03/3111999
Expires:
Approved By: MARK S. MCPHERSON
APN:
38104123
Property Owner:
WAL MART STORES, INC
WAL MART STORES, INC
701 S WALTON BL
BENTONVILLE, AR 727160480
Responsible Party: {Responsible Party not provided}
Permit Fees Permit ' .' . Reinspection
$375.00
$300.00
03/2911999
05/0311999
Workers Consultant:
LICENSE/REG.#: 703850
Activity: I Tank closure by removal
Permit Activity:
Start Date End Date Staff
D & S ANTON CORPORATION
No company associated with this Worker.
1437 s VICTORIA A VENUE, F-382
VENTURA, CA 93003
(805) 650-2794 I. . )
--r &J t -\.._s s 1l:;)f:. -
Activity
/527
03/2511999 03/2911999 WARINA V. GARMO
03/2911999 03/3111999 MARKS. MCPHERSON
PERMIT APPLICATION RECEIVED
Permit Approval
05/03/1999 05/03/1999 MARTIN A. ORTEGA
05/0711999 'FI( '1: 1 1 RAPIST A
Printed on: 5/4/99 3:04:55 PM
/
/
Tank Removal Inspection
Tank Removal Inspection
Page I of 1
....._ ,.. ... .,...,.. •
. - I
-Permit Application Summary- Tank'··
Permit Number: AT4432
Site WAL-MART #1917
170 TOWN CENTER PY
SANTEE, CA 92071-3198
Establishment Number: H32274
Permit Status: Permit is currently ACTIVE.
Recci vcd: 03/2911999
Approved: 03/3111999
Expires:
Approved By: MARK S. MCPHERSON
APN:
38104123
Property Owner:
WAL MART STORES, INC
WAL MART STORES, INC
701 S WALTON BL
BENTONVILLE, AR 727160480
Responsible Party: {Responsible Party not provided}
Permit Fees Permit
Workers Consultant:
LICENSE/REG.#: 703850
Proposed Activity: I Tank closure by removal
Permit Activity:
Start Date End Date Staff
$375.00 03/29/1999
D & S ANTON CORPORATION
No company associated with this Worker.
1437 s VICTORIA AVENUE, F-382
VENTURA, CA 93003
(805) 650-2794
Activity
03/2511999
03/29/1999
05/03/1999
03/29/1999 WARINA V. GARMO PERMIT APPLICATION RECENED
03/31/1999 MARKS. MCPHERSON Permit Approval
/11 DN . Sergio Gracia Tank Removal Inspection
Printed on: 4/30/99 10:01:51 AM Page 1 of 1
County of San Diego
Department of Environmental Health
Site Assessment and Mitigation
•
Permit# AT 4432
Establishment # H 32274
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: Wai-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 be 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:
1) All product piping and underground storage tanks must be removed at the same time. Failure to do so will result in ·a re-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 advised:
All underground storage tanks that are to be removed or closed in place must be cleaned and properly inerted prior to the removal 1) 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 1000 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 (6!9) 338-2214 to schedule or cancel Plans Reviewed and Approved By: Mark McPherson / Date: 3/31/99 Notified v
. PERMIT. APPLICATIONg f:
PART I - p 03\PriiYs
GENERAL PROJECT PM L NY, fivd h1. Hi"/1L
. H I t.fttS
UNDERGROUND HAZARDOUS MATERIALS
C. TANK TOR: I .
Company IND.\ -M!rt 1 TN
PSrf' ' ''
PLAN CKN: ..
DATE
FEE PAID: ,.........--.,,...,
PLAN
HYDR:o UNIT: '} • \ . ..
Mailing Address
Phone ( (501} 2;TJ _q. . 24 Hr. Emergency Phone ( )Sb I 1-71 -fi't3'f D. CONTRACTOR PERFORMING WORK: .
Primary Contractor Dis A-1\.±oo Y,
Mailing Address <;. \/tLlbM;. AIL # F f-82.
Phone ( ) 605L (j,SQState Contractor License
Hazardous Substances Certificate 49-L.J4--T"""7'"--,-----,=-..--:---,--------..,.-------- ·E. APPLICATION SUBMITTAL, PLAN APPROVAL, PERMIT ISSUANCE, AND REQUIRED INSPECTIONS Submit one (1) original and two (2) copies of this application package, including plan drawings with the required fee to the Department of Environmental Health, Site Assessment and Mitigation Division (SAM), 1255 Imperial Avenue, San Diego, .CA 92101; or mail to P.O. Box 129261, San Diego, CA 92112-9261. Checks should be made payable to the County of San Diego. · A permit will be issued by SAM 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 SAM at least t\vo (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, Ill, IV. & V).
DEH:SAM-915 (Rev. 12/97) 1-1
County of San Diego
Department of Environmental Health
•.
F. PROJECT WORK TO BE COMPLETED: COMPLETE
Check Applicable Box APPLICATION FEB CODE PARTS TABLBG.
InstallatioDJConstruction of new tank(s) systems only .. •. 0 I & II . ... (without closing any existing tanks) ' . 0 Closure of existing tank(s) systems with installation of new t:inks (tank replacement)
I, II & Ill 1&2
Closure of existing tank(s) systems with no new tank installation 1&111 2 0 Interior coating/repair of an existing underground storage tank I&IV 3 0 Repipe/pipe-repair piping upgrade of an existing underground storage tank. I&V ...... facility
4 <··'
0 Installation/Construction of vaulted tanks VI. 5
G. I'EES: The_ fee shown below covers plan review, plan r!!·review and approval. The required field inspections and the frrst year's operating permit fees. Use the appropriate Fee Code as determined in Section F above.
FEE CODE Installation fee for first tanks $600.00 Fee: $ Installation fee for each additional tank No. X $100.00 $ Establishment Base Fee $160.00 Fee:· $
1 (Applies to establishments not currently under permit with DEH) ..
Operating Permit Fee per tank No. _. _ X $120.00 . Fee: $ (Does not apply to replacement tanks if the existing tank to be replaced has paid current operating permit fees) :
Closure fee for first tank $375.00 Fee: $ 375 - 2
Closure ' '
fee for each additional tank No. X $50.00 Fee: $
Repair/Interior coating fee for first tank $600.00 Fee: $ 3 Repair/Interior coating fee for each additional tank Np. X $100.00 Fee: $ Repipe/Piplng upgrade, pipe repair of an exisiing tank facility $600.00 Fee: $ 4 .,. --
Consultation fee (e.g. vaulted tank: minimum 2 hours) Fee: $ 5 __ Hours X 80.00
6 Re-inspection fee $300.00 Fee: $
Plan Re-Review $200.00 Fee: $
TOTAL FEE:$
I. PERMITS REQUIRED BY OTHER AGENCIES
FIRE DEPARTMENT---- APCD ___ _ BUILDING DEPARTMENT __ _ OTHER __ _ Provide copies of approved applications from these departments and others if needed.
DEH:SAM-915 (Rev. 8/96) I-2
County of San Diego
Department of Environmental Health
PERMIT APPLICATION
PARTIU
APPLICATION FOR PERMIT TO CLOSE .UNDERGROUND STORAGE TANK SYSTEM A. TOTAL NUMBER OF TANK SYSTEMS TO BE CLOSED · l NOTE; UST SYSTEMs INCLUDE TANK AND ALL PIPING.
B. DESCRIPTION OF TANKS TO BE CLOSED:
. . . .. ... DATE' -TANK'· . ' - ... TANK CAPACITY INSTALLED COMPOSITION \ \000 '-1 + 11=7/"Yfl ..
' - '-
C. HAS THE TANK SYSTEM EVER FAILED OR LEAKED?
D. REASON FOR TANKS TO BE CLOSED:
0 · Meet current requirements
!>l Replacement of existing tanks
J .
..
' . -'PA:NK
PRESENTLY IN USE?
YESO NO
MATERIALS· •::
STORED IN TANK
'
UNKNOWN 0
..
0 Tank system failure, briefly
0 Other, briefly
E. PREVIOUS OWNERS AND OPERATORS OF THE TANKS:
Dates
DEH:SAM-9 15 (Rev. 8/96) 111-1
Owner/Operator
' -. . .. ' .. •- I ' ' "
County of San Diego
Department of Environmental Health
F.
.
t<j RFMOVAL 0 CL,UREINP!ACB .·
SAMPLING PROTOCOL Tank ownerlauUtmized representative responsible for all sampling analyses and for tank systems lhalme to be removed. The excavation shall be exposed prior to the scheduled .,. sampling idcatified the Sampling is required for both tank and piping. The _tank and plpia!f ,,. must remrun m the CEC&vation until the SAM anspector approves the removal. · ·: · tank systems to be dosed in place. Submit an plan which must include soil sampling, reason .:· .! tank system in place and type of material to be used to fill the tank. Soil sampling and/or hydrostatic testing .iS· 8Js6 : required for piping closures. Tank system closure in place will only be considered after evaluating the risb 'itii.d'' .,_.,_._;·,>. -- ._ __ h_azards __ .... .:;.J· ,,,
c. oiSPosALsxmoFTANK: Coctnst :rod, l'5>7$B FOr\.Mc'f cA 1tm. _, Note: You must . . . : .. ' ':. " inform SAM of the address of where the tank and piping is to lx• disposed., Plans will be 4isaPProvid Withoi:rt"·,: · this infomution. · ' · . . · ,. · · · . .
H. ATIACH THREE COPIBS OF PLANS SHOWING THE FOLLOWING:
l. Property lines, site addmls, seale, north arrow.
2. Local:ion of all existing structures.
3. Location of all existing underground storage tank facilities.
4. Local:ion of underground storage tanks and piping to be closed.
5. ·Location of underground utility lines and vaults.
l. REQUIRED INSPECil:ON-PERMIT TO CLOSE
A representative from SAM must be on site at the time the tank(s) are closed.
1. TANK SYSTEM O.OSURE BY REMOVAL:
excavation sllali be exposed prior to the scheduled inspection. The tank owner/authorized representative on site must submit a Wlifotrn hazardous waste manifest demonstrating that the tank has been properly decontaminated.
A combustible gas instrument and soil sampling equipment must be on site. The SAM inspector will identify · sampling points.. The tank and piping must remain in the excavation until SAM approves the removal.
2. TANK SYSTEM CLOSURE lN PLACE: '•,
after approval of the alternate plan, Ute tank owner/authorized representative on site shall submit a uniform hazardous waste mrullfest demonstrating that the tank has been properly decontaminated. The SAM inspector shall verify that dJc tank system has been properly emptied and will wimess the filling with an approved inert substance. Piping approved to be closed in place by hydrostatic testing shall also be witilessed by SAM.
J. DECLARATION ·•
..
I declare that to the best of my knowledge and belief, the statements and information provided are correct and true. l understand th:
information in addition to that provided above may be needed in order to obtain final approval by the Site Assessment and Mitigatio Division. ·
I understand that tests lUld procedures that may be required by other departments and agencies to demonstrate adequate site safety ( Mitigation
suitability for further development (e.g. soil compaction testing) are in addition to the requirements of the Site Assessment e.n Division.
I will notify the Site Assessment and Mitigation Division at least two working days (48 hours) before work is to begin in order t schedule the required inspections. 1 under d that site and worker safety are solely the responsibility of the property owner or h agent and that this responsib" y is n or assumed by the County of San Diego.
SIGNATURE & 1TILE . __ :Rep
PRINT NAME (..,
TELEPHONE ( )$fl)" (,}jl)-L.fML_ DATE _3:_Z3:J+------
County of San Die!
DEH:SAM-9 l5 (Rev. 8/9G) IU-2 Dcractment of Environmental Heal .\. '• . '
1. 2.
3. 4.
WORKPLAN
FOR
EST.HN
PIAN CHECK#
UNDERGROUND STORAGE TANK CLOSURE
Site Name -1\q.A-- #-.\C\11
Site Address llo IbM\. CtJu. fM.w:,J
CB 5'1 O] (
Describe the existing land use in the surrounding area. (residential, commercial, schools) Describe the locations of nearest receptors and the prevailing wind.
Cnt-1\w.rc.,a.\. lv\t.suy-t Start.- 91-fotOCn
Explain how the excavation will be secured. Describe fencing/site security and other methods that insure public safety.
Sd<- -Jo . k \;.,; Conth ".A s. iliy :f!¥.. ffilltl!!d
5. If soil is to be stockpiled, describe the location on the Plan Cheek map. Describe method of soil containment (berming/covers, run-off control).
d.'£ w.tl k '® * wvu-64
'* URtt&l Ire\. Slo&c Avt.. cA . . ' (qoq) 6. Do you plan to conduct site assessment ,or .. -remedial work: beyond what is necessary to remove the underground storage tank:(s) and perform the mandatory soil sampling required by the Environmental Health Services?
0 Yes IZJ No
Ir Yes, a Workplan for Post-Tank Removal Investigation must be completed under the direction or a reglflfred
Signature ltUA Wl'Jl Ct!wt: · . Title AtJb. 'R.te.
Telephone
DER:HM-9176 (l/95)
Date
______ -..,.-
SECfiON 7 PAGE 40 county of San Diego
Department of Environmental Health
CITY OF SANTEE
Fire Department
Date: 3-d..<£-Cf9
TRANSMITTAL FORM
Plans Check I Inspection Fee
Project Name: WAf. -W1ARJ Q-ORE-#- /917 APN: ____ _
Project Address: 1 70 l7X.Dt..j CEAJ,J"Eie PA& k(LOAi.{ IEbS CeL
- ---- I
i
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Contractor: D $ ANtON Go Mf.A'"Ilf'IN Phone: I 8oS (at.!B (t8o5j (t/SO-:J7ql.f Sf€\JGN Fees are payable for the following:
.... L TN-I t:. -IJOCC 4100. c.:£_
'"DU"STALL TANt t..fctJ I oo
::.. '4\> l & 'o Total due: $ ;) 3c:J
. 03::<
WHITE- Fire Department CANARY - Finance
UNDERGROUND STORAGE TANK REMOVAL WORK PLAN
WAL-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 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 indicator (CGI) and oxygen meter and ventilation of the will be initiated, if necessary. , t The tank will be ventilated using a gas exhj:iuster -ice lbs per 100 gallons of tank . \Gj capacity) until the vapor concentration is reduced to an or equal to 10 percent of the lower V explosive limit (LEL). Once the tank atmosphere is determined safe, the tank and piping fl'\ (product and vent) will be removed from the excavation with a backhoe. The tank will be t./ blocked to prevent movement and inspected for evidence of holes, cracks or breaches. Following \" fU inspection, the tank will be transported off-site as Non-RCRA hazardous waste by a state 'Y " certified transportation company to a state certified tank destination, where the· tank will be A r cleaned and disposed as non-hazardous waste. All transportation and disposal documents will be V · , provided in the final report. . . .
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. ..
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.
SITE SAFETY PLAN
Please provide the following iriformation for the site:
Owner's Name: Wal-Mart Stores Inc. #1217
Site Address: 170 Town Center Parkway
Santee CA 92071
· Contractor On Site: D&S Anton Corporation . Phone Number: (805) 650-2794 Site Safety Officer: _______ _
Type of Facility: Retail Sa)es!Djstribution
Type of Work to Be Performed:
tank containing used oil
Removal of one 1 000 gallon capacity fihe[glass unde[ground sto[age Anticipated Hazardous Substances· (Attach Additional Sheets, If Required>:
(Please Include concentrations below. Note If free product historically on site.) Name
Used Ojl/Pettoleum
Bepzepe
Ethylbeozepe
Toluene
Expected Concentrations (ppm)
(List Medium -I.e., sou; water, or air)
Csom <PEL
(soj!) <PEL
(som <PEL
(soil) <PEL
(soil) <PEL
PEL Health Effects
(ppm)
400 ppm Din drow head nau jrrjt eyes
nose throat ·dry crac!ced skin
l..l2llm lrrjt eyes pose resp· &idd · bead:
oau· stanered &ait· fi&· anor lass
derm · hope marrow
100 ppm lrrit eyes roue merpb· bead· derm·
parco· coma
100 ppm Ft1: weak;· copf eqpb djzz bead·
dHated pupils lac· per muse ftl:.
insom · pores· derm
100 ppm Dizz excitement drow jpco
&tai:l:etinl: &idd jrrit eyes pose
throat· corneal yacuo!jzation apor
nau yomjt abdom pain derm
. " . '.
Site Decontamination Procedures, If Any: ..... o,..n..,e.__ _______________ _ Hospital/CUnic: Kaiser Foundation Hospital
Hospital Address: 203 Irayelodge Drive. El Cajon
First Aid Equipment/Instructions Available On Site:
Phone: (.619) 528-SOQQ
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.
•· !-j..J C) It
STATE OF CALIFORNIA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM A
COMPLETE THIS FORM FOR EACH FACILITY/SITE
MARK ONLY
ONE ITEM
GZJ 1 NEW PERMIT
0 2 INTERIM PERMIT
0 3 RENEWAL PERMIT
D 4 AMENDED PERMIT
0 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED. SITE
0 6 TEMPORARY SITE CLOSURE
I. FACILITY/SITE INFORMATION & ADDRESS· (MUST BE COMPLETED)
DBA OR FACILITY NAME
Wlli-1'4M{ '5tDit:'5 # 1117
NAME OF OPERA TOR
\JA.I- tvtuJ S'tna:s
ADDRESS
1owfl - NEAREST CROSS STREET PARCa I (OPTIONAL)
/70 fYI iS5iOn Gor"' e
CITY NAME • STATE I ZIP CODE SITE PHONE t WITH AREA CODE CA '/7.-07/ lPI'i-LfYCI.- '7900
of BOX 0coRPORATION D INDIVIDUAL 0 PARTNERSHIP D LOCAL-AGENCY D COUNTY-AGENCY. D STATE·AGENCY. D FEDERAL-AGENCY.
TO INDICATE DISTRICTS
• U owner of UST is a a!78nC:v. complete the lollowi'lg: name of S14!ervisor of cfMsion, sed.ion or off a whi:tl operates the UST TYPE OF BUSINESS D 1 GASSTATION D 2 DISTRIBUTOR D "IF INDIA: I' OF TANKS AT SITE E. P.A. I. D. • {optional} D 4 PROCESSOR 0 5 OTHER
RESERVATION j D 3 FARM OR TRUST LANDS
EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY)· optional
PHONE I WITH AREA CODE
50/- 2-TI- 1131
DAYS: NAME (LAST, ARST) PHONE I WITH AREA CODE
PHONE I WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE# WITH AREA CODE 1- 2-77- 'it3
II. PROPERTY OWNER INFORMATION· (MUST BE COMPLETED)
NAME w lll- tv1at SinrtS 1'1\C.
CARE OF ADDRESS INFORMATION
MAILING OR STREET ADDRESS t/ box to indicate D INDIVIDUAL D LOCAL-AGENCY D STATE-AGENCY 7oJ S. i tJalfur'l Slvtl DaJt '1379 (2]' CORPORATION D PARTNERSHIP D COUNTY-AGENCY D FEDERAL-AGENCY CITYN'ifm· -hilVitlr STAR I ZIP CODE
72 7J&-Cf37tt
I PHONE • WITH AREA CODE
z 77- '1'!37
Ill. TANK OWNER INFORMATION· (MUST BE COMPLETED)
NAME 5tore.s
CARE OF ADDRESS INFORMATION
u. i.l· w+ 'JIIC.
MAJur:; ;
7 STRS. ' 6 l.t ti , f>.ept
D INDIVIDUAL D LOCAL·AGENCY D STATE·AGENCY
'1379 ORPORATION D PARTNERSHIP D COUNTY-AGENCY D FEDERAL-AGENCY .JM,;i/1( ·!. I ZIPCDDE 7z 71 tr f3 79 I PHONE. WITH AREAi/JlE SIJI-"L77- I J' IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER· Call (916) 322·9669 if questions arise.
TY(TK> Ha 1414-l-lo lj IJ IB lsl11
V. PETROLEUM ST FINANCIAL RESPONSIBILITY· (MUST BE COMPLETED) -IDENTIFY THE METHOD(S) USED of box 10 in:focata 1 SELf-INSURED 0 2 GUARANTEE 0 3 INSURANCE 0 4 SURETY BONO 0 5 LETTER OF CREDIT 0 6 EXEMPTION 0 7 STATE FUND D 8 STATEFUND&CHIEFFINANCIALOFACERLETTER D 9 STATEFLND&CERTIFICATEOFDEPCSIT D 10 LOCALGOVT.MECHANISM D 99 OTHER VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or.ll is checked.
CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULIO BE USED FOR LIEGAL NOTIFICATIONS AND BILLING: l.o ll.!iZ( m.o
THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT
TANK OWNER'S & SIGNATURE)
. I> Sl. 9B
LOCAL AGENCY USE ONLY
COUNTY# JURISDICTION # FACILITY#
rn
LOCATION coDE • oPnONAL I CENSus TRACT# • OPTIONAL I SUPVISOR • DISTRICT coDE • OPnONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION· FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY.
OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM A (6-95)
.. • 0 ..
INSTRUCTIONS lFOJR COMl?LJET][NG FORM "A"
GENERAL INSTRUCTIONS:
SECTION 2711 OF TITLE 23. ctJAPTER 16. CALIFORNIA CODE OF REGULATIONS AND 25286. 25287. AND 25289 OF CHAPTER
6.7. DIVISION 20. CALIFORN!i\ HEALTH AND SAFETY CODE REQUIRE OWNERS TO APPLY FOR AN UST OPERATING PERMIT i .
I. One FORM "A" shall be completed for all NEW PERMIT CHANGES or any FACILITY/SITE INFORMATION CHANGES.
2. SUBMIT ONLY ONE(!) FORM "A" for a Facility/Site. regardless of the numberoftanks!Iocated at the site.
3. This fonn should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR.
4. Please type or print all requested information. \:1
5. Use a hard point writing·instrhment. you are mak.irili 3 _,. . \ '\ I ; 1• \ .
6. Tank owner must submit a facility plot plan to the local agency as part of the application showing the location of the USTs witJ1 respect to buildings and landmarks [Section 2711. (a)(8). C:CR]. . ·. , . ,·. ·' · .. ·, ;·." 11 ' • 1 • •.• ,
7. Tank owner must submit documentation Showing compliiinCe with state financial respori..o;:ibility requirements tO the local agency as part. of the· application for petroleum USTs [Section 2711 (a)(! I). CCR]. i \ .. • ' ,· • •, '\ \ ·,,;:I ., TOP OF FORM: "MARK ONLY ONE ITEM"
Mark an (X) in the box next ro the item thar best descrihes the reason form is being completed.
I. FACILITY/SITE INFORMATION & ADDRESS (MUST BE COMPLETED) I. Record name and address (physical location l of the underground rank(s). , NOTE: Address MUST have a valid physical location including city. state. and zip cdde. ' P.O. BOX NUMBERS ARE NOT ACCEPTABLE. '
Include nearest Cross streel and name of the operator.
2. Phone·numbcr must have an area code. If the night number is the same. write "SAME" in 'proper location.
3. Check the appropriate box for TYPE OF BUSINESS OWNERSHIP (ex. TIQr:"1lNDIVIDUAL. etc.). _! ·', '; \ ·, 1; , 4. Cheek the appropriate box for TYPE OF BUSINESS. . - •
5. If Facility/Sire is located within an Indian reservation or or her Indian trust lands\check the box marked. "YES".
6.·1ndicate the NUMBER of TANKS atthis SITE. . · \ . l '· · • . ; ', . \ . ...., I j I I •
! '
7. Record the E.P.A. ID #or write "NONE" in the space provided.
II. PROPERTY OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) Complete all items in this section. unless all irems are the oan>e as SECTION I: If !he same. write "SAME AS srm·:-across this section. Be.sure to check PROPERTY OWNERSHIP TYPE box. . ,. . ·. . . . . '- 'J Ill. TANK OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) · . ' \' ·' . : 1 • , J:; · ;; , ' .< Complete all items in this section. unless all•tcms are the same a.s SECTJON I: if the s:u&. "SAME AS SITE" across this section. Bc1 sure \ .. , .·. \ ,\':'- .·:: 1 ·•<:' .. ".:\
IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER (MUST BE COMPLETED. SEE ARTICLE 5. CHAPTER 6.75.
DIVISION 20. CALIFORNIA HEALTH AND SAFETY CODE.) .
Enter your Board of Equalization (BOE) UST storage fee account number which is requited before your penn it be . • Registration with the BOE will ensure that you will receive a quarterly storage fee return in reporting the per !\illl.on dire· cO. the number.of ! ·-. .' .. gallons placed in your USTs. The BOE will code persons exempt from paying the storage fee so returns will not be sent. If you do not have an ·'account number with the BOE or if you have any questions regarding the fee or exell\Pt\Qh. ple:i.se cal! the or write to · BOE at the following address Board ofEqualizatiotr. Fuel Ta.<es Division. P.O. Box 942879, Sacralnento. tA 94279-0001. v. RE'sroNsiBILn'Y <&wsT BE diMPLETED FOR PE>RoLEUM usTs oNLY. sEE sEcTioNs·z?, I·<hJ('Il·f OF TITLE 23. CHAPTER I6. CALIFORNIA CODE OF REGULATIONS.) Identify the method(s) used by the owner •nd/or operator. in meeting the Federnl and State financial responsibility requirements. USTs owned by any Federal or State agency as well as USTs are exempt from this requirement. i. · I · (_- (j · · .. VI. LEGAL NOTIFICATION AND BILLING ADDRESS , Check ONE BOX for the address that will be used for BOTH LEGAL AND BILLING t-lOTIFICATIONS.
TE FORM AS INDICATED [SEE 271 I
INSTRUCTION FOR THE LOCAL AGENCIES
The county and jurisdiction numbers are predetermined and can be obtained by calling tHe State Boord (916) 227-4303. The facility number may be a:;sign,cd by the local agency; however. this number must be numerical and cannot contain any alphabetical characters. If the lqcat agency prefers the State Board to assign the facility number. please leave it blank.
IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCURACY OF THE INFORMATION. THIS APPLICATION CANNOT BE PROCESSED IF THE BOE ACCOUNT NUMBER IS NOT FILLED IN. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AOI;NCY .. u:m ONLY" INFORMATION BOX. THE LOCAL AGJ¥"1CY THE .OR.'Gil'jAL AND yELLO'f ,t;:OP'( BE !!!5 T_ANK· . OWNER.· - ·- ·, · · ... · : ... ' · ·--, - · • · -· · ·. ' .... ' . - I, ';·,•
6195
. . STATE OF CAUFORNIA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
MARK ONLY
ONE ITEM
g 1 NEW PERMIT 0 2 INTERIM PERMIT
0 3 RENEWAL PERMIT
0 4 AMENDED PERMIT
0 5 CHANGE OF INFORMATION
0 6 TEMPORARY TANK CLOSURE
tXI 7 PERMANENTLY CLOSED ON SITE
0 8 TANK REMOVED
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:··
I. TANK DESCRIPTION COMPLETEALLITEMS- SPECIFYIFUNKNOWN
A. OWNER'S TANK I. D. I l)f\'(,n4J.]f\. B. MANUFACTURED BY: DwellS Cvm:'1<t \)u) C. DATE INSTALLED (MOIDAY/YEAR) .. D. TANK CAPACITY IN GALLONS: v \)f\'c::.IOWI'\
II. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM c.
A. 01 MOTOR VEHICLE FUEL rzJ 4 OIL B. c. 0 1a REGULAR UNLEADED Oa DIESEL 0 6 AVIATION GAS ··-····· 0 '1b"PREMIUM UNLEADED 0'4 GASAHOL 7 METHANOL 0 02 PETROLEUM 0 80 EMPTY 01 PRODUCT 0 1 c MIDGRADE UNLEADED 0 5 JET FUEL 0 8 M85
0 0 95 UNKNOWN 02 WASTE 0 2 LEADED 0 99 OTHER (DESCRIBE IN ITEM D. BELOW) 3 CHEMICAL PRODUCT D. IF(A.1)1SNOTMARKED, ENTER NAME OF SUBSTANCE 'i)j/ Sef,;; te C.A.S.#:
Ill. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF 0 1 DOUBLE WALL 0 3 SINGLE WALL WITH EXTERIOR UNER 0 5 INTERNAL BLADDER SYSTEM 095 UNKNOWN SYSTEM 0 2 SINGLE WALL 0 4 SINGLE WALL IN A VAULT 0 99 OTHER B. TANK 01 BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGLASS 0 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL 0 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM OB 100% METHANOL COMPATIBLE WIFRP (Prlmruy Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 095 UNKNOWN 0 99 OTHER C. INTERIOR 0 1 RUBBER UNED 0 2 ALKYD LINING EPOXY UNING 0 4 PHENOLIC LINING LINING OR 0 5 GLASS UNING 0 6 UNUNED 95 UNKNOWN 0 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100"4 METHANOL? YES_ NO_
0. EXTERIOR
0 1 POLYETHYLENE WRAP 0 2 COATING VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC
CORROSION
0 5 CATHODIC PROTECTION 0 91 NONE 0 99 OTHER PROTECTION
UNKNOWN
E. SPILL AND OVERFILL, etc. (YEAR! OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR)
STRIKER PLATE YES NO DISPENSER CONTAINMENT YES NO
IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPUCABLE A. SYSTEM TYPE A U 1 SUCTION A u 2 PRESSURE A{!)3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A@95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A u 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A® 95 UNKNOWN A U 99 OTHER
0. LEAK DETECTION 0 1 UNE LEAK 0 2 0 3 INTEAsmw. 0 • 0 5 D 99 OTHER V. TANK LEAK DETECTION
0 0
1 VISUAL CHECK
7 CONTINUOUS INTERSTITIAL
MONITORING
0 2 MANUAL INVENTORY 0 3 VADOZE 0 4 AUTOMATIC TANK
RECONCIUATION MONITORING GAUGING
0 B SIR 0 9 WEEKLY MANUAL 0 10 MONTHLY TANK
TANK GAUGING TESTING
VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN·PLACE) 0 5 GROUND WATER O 6 ANNUAL TANK
MONITORING TESTING G2r 95 UNKNOWN 0 99 OTHER
1. ESTIMATED DATE LAST USED (MDIDAY/YR) 2. ESTIMATED QUANTITY OF
SUBSTANCE REMAINING
3. WAS TANK FILLED WITH YES 0 NOD GALLONS INERT MATERIAL ?
THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I
I
LOCAL AGENCY USE ONLY THE STATE J.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY n JURISDICTION n FACILITY# TANK#
STATE I.D:# [I] I I I I I II I
PERMIT NUMBER I PERMIT APPROVED BY/DATE I PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION· FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. ALE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (6·95)
H t I
I
lf\ISTRUCTIONS FOR COMPLETING FORM
GENERAL INSTRUCTIONS
''811
Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287. and 25289 of Chapter 6. 7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit.
1. 2.
3. 4.
5. 6.
One shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES, REMOVALS and/or any other TANK INFORMATION CHANGE. - This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR.
Please type or print clearly all requested information.
Use a hard point writing instrument, you are making 3 copies.
Tank owners must suqmit a plot plan to the local agency showing the location of the USTs with respect to buildiligs and landmarks [2711 (a)(8) CCR]. ·'''
Tank owners rnust submit documentation showing compliance with state finar:1cial responsibility requirements to the local agency for petroleum USTs [2711 (a)(11) CCR].
TOP OF FORM: MARK ONLY ONE ITEM
1. Mark an (X) in the box next to the item that best describes the reason the form is being completed.
2. Indicate the DBA or Facility name where the tank is installed.
I. TANK DESCRIPTION- COMPLETE ALL, ITEMS:- IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex ..
AB70789).
B.- Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG).
C. Indicate the year the tank was installed (ex. 1987).
D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.).
II. TANK CONTENTS
A. 1. IF MOTOR VEHICLE FUEL, check box ·1. and complete items B & C.
2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D.
B. Check the appropriate box.
C. Check the type of MOTOR VEHICLE FUEl: (if box 1 is checked in A).
D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical · Abstriu:t Service number), if box 1 is NOT checked in A. t!- ·. '
Ill. TANK CONSIRUCTION- MARK ONE ITEM ONLY IN BOX A, B, C & D
1. Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION PROTECTION.
2. If OTHER, print in the space provided.
IV. PIPING INFORMATION
' 1. Circle "A" if above ground circle "U" if underground, and circle both if applicable.
2. If UNKNOWN circle; or if OTHER, print in space provided. .
• >.
3. lndic9te the LEAK DETECTION system(s) used to comply with the monitoring requirement for the p!ping.
V. TANK LEAK DETECTION
1. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank. \11. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE
1. ESriMATED QATE LAST USED- MONTH/YEAR (January, 1988 or 01/88)
2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons).
3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yek" or "No". . · TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDICATED (see section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES . . .. -·4
The statei.mderground storage tank identification number is composed of.the two digit county. number, Ui'e 'mre-s-tligit . jurisdiction number, the six digit facility number and the six digit tant<.numtier. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227 -43Q_3. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical·and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank.
IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCUI'l,A.CY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY. USE INFORMATION THE LOCAL AGENCY SHOULD. RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. ,, ...
. .: ...
... ,·
. ·.
. . .. .
:; ·:
f • I 1 ...
-.... ;·,
':
·. · ... ·:·. ·. ,· . . . . . . . .
· .. : .. _ :, :: ..
(
---+--:
I
.... . : :. ·, .
.. .
REMOVE EXISTING 1,000 GAL
UNDERGROUND USED OIL
STORAGE TANK
/'
v
/
SCALE
1 INCH= 50 FEET
I
I
I
I
I
..
__ .. ..;... -·.- .--· ___ · Jt . --- . ··.
. .'-.,_ .
.-.. . . ...
. ··:·· ,.· ,· ..
. , .. -·,.·
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: . .- .
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: .· .. .. .
. ..
. .. :.: .... ; . . •. ' ... . ,"·:.". . .
;. · .
. WAL-MART
STORE
"A!JY change in these plans may void this approval. This stamp not constitute or imply approval by other agenc1es." I
I
Bt
WAL-MART STORE #1917
SITE PLOT PLAN
170 TOWN CENTER PARKWAY
SANTEE, CA 92071
-· OF SAN DIEGO
,/
4 I I q{p
.;:)_
BUSINEss NAME ICCB tS2 ¥t>l"o c 0
ADDRESS qz.jJ{p fi7t
CITY /ZIP __ _f_A=--· _?f....:...::...Ol_:o:...:t..._ ..:...l___;_ ___ _ On the above date an inspection of your business/facility was conducted in order to determine compliance with the California Health Safety Code (H&S) 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 •• • 0
..
)ift;; tfikE
!__ (;lrO-fJ - .
·'·
'\lL:. Is Management Division, P.O. Box 85261, San Diego, CA, 92186-5261 DEH:HM-924 (5/95) NCR
/ 619) 338-2222
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
H
DATE J/- l I q
PAGE OF
<
VIOLATION REPQRT: The items checked below refer to specific section numbers of Titles 19/22/23 of the California Code of Regulations (CCR), Chapters 6.5, 6. 7, 6.95 of the Health and Safety Code (HSC), and/or the San Diego County Code (SDCC).
I HAZARDOUS WASTE REQUIREMENTS: II UNDERGROUND STORAGE TANK IUSTl REQUIREMENTS:
RECORD KEEPING
[ I Health Perm1t not obtained SDCC 68.905
[ I No EPA Identification Number 66262.12
[ I Waste Manifests/Receipts not on-site for
3 years 66262.40
I Manifest nc;>t properly completed 66262.23
I Manifest copy not sent to CAL-EPA 66262.23
I TSDF signed-manifest not on-site 66262.40
I Biennial report not sent to CAL-EPA 66262.41
I LOR Documentation not available 66268.7
I Exception Rpt. not filed with
CAL-EPA 66262.42 '
I Operating TSDF without authorization 25201
STORAGE AND HANDLING
[ I Waste stored longer than 90 days 66262.34
[ I Waste container missing/improperly labeled
66262.34
l Haz Materials not properly labeled 25124
I Waste container not kept closed 66265.173
I Waste container in poor condition 66265.171
I Waste container(s) not properly managed
66265.173 .
GENERAL UST REQUIREMENTS
V01 08 W [ I Health Perm1t not obtamed 68.1 005, 25284
V0105 w-- [ I Repair/modify/close permit not obtained
vonsw-- 68.1006
[ I UST Permit Application not submitted 25286(a)
V0120 W [ I Operating permit conditions violated 2712
V0115 w-- [ I Failed to notify HMMD of changes 25284
V0121 w-- [ I No owner/operator agreement 26293
V0122 w-- [ I No records of financial coverage 25292.2
V0123 w-- · [ I No maint/monit/calib records available
vonsw-- 2712lbl, 2641i
V0124W __
V0221 W
V0222w--
V0223W
V0202w--
V0205w--
vo21ow--
MONITORING REQUIREMENTS (SINGLE WAUl
[ I Leak Detection Method does not meet
performance standards 2643
I Annual Integrity test not conducted 25292
I Copy of tank test not submitted to HMMD
within 30 days 2643 · I Manual tank gauging ( < 2000 gal) 2645 not done properly
I Reconciliation not done properly 2646
I container not repackaged 66265.171 V0226 W
I Contamer incompatible with waste 66265.172 V0207 w--- 1 hicompatibles in the same container 66265.177 V0224 w--- 1 Incompatibles not stored separately 66265.177 V0213 w-- I Reconciliation not approved for facility 2646
I Dispenser meter(s) not calib annually 2646
I Improper liquid measurements 2646
1 lgnitible Wastes less than 50 feet 66265.176 V0214 w-- llgnitible Wastes not grounded 66265.31 V0215 w--- 1 Storage area not inspected weekly 66265.174 V0216 w--
DISPOSAL AND TRANSPORTATION
[ I Onauth. disposal of waste to 25189.5
[ I Waste determination not made 66262.11
[ I Unlawful transport of haz. waste 251 63
[ I Waste transported without manifest 66262.20 · [ I No Extremely Haz. Waste Permit 67430.1 V0313 W
V0319w--
V0315w--
V031&w--
V0317w--
TRAINING, CONTINGENCY PLAN 8r. EMERGENCY PROCEDURES
[ I Trammg records unavailable 66265.16 V0405 W
[ I Training program not adequate 66265.16 V0406 w---
I Stick 1n poor condition 2646
I Improper monthly reconciliation 2646
I Fa1led to report excessive variation 2646
I Pressurized Product Piping Leak Device
not tested annually 25292
MONITORING REQUIREMENTS lDOUBLE WALL) [ I Momtonng system not functional 2632 [ I No written monitoring procedure 2632
[ I Written response plan not available 2632
[ I Spill/Overfill equip. not maintained or Installed 2636 V3002 T
V3007rV3010T
V3011,.--
V3012,.--
V300&rV3013rV3001rV3014T __
V3015 T
V3016,.--
V3017T __
V3018 T
V3019,.--
V3020,.--
V3021,.--
V3022,.--
V3023,.--
V3024,.--
V3025T __
V3026 T
V3027,.--
V3028,.--
V3029,.--
1 I Facility not designed to mmimize release V0501 w-- RELEASE REPORTING 66265.31 -- [ I Failure to report an unauthorized release 25295 'V3009 T [ I Spill control equip not available 66265.32 V0508 W [ I Release record log not available 2651, 2650 V3030 ,.-- [ I A1sle space is obstructed 66265.35 V0509 w-- [ I No leak report/investigation/action 2652 V3031 T [ I Contingency plan not prepared and/or on file
66265.51, 66265.53 vosos w __
MISCELLANEOUS CLOSURE
( I Waste o1l contaminated 25250.7
[ I Used oil filters improperly managed 66266.130
[ I Damaged batteries improperly managed
V0225 W [ I Temporary closure req. not completed 2671
V0701 w-- [ I Abandoned tank not properly closed 25298
V0702 w-- [ I Permanent closure req. not completed 2672 66266.81
Ill HAZARDOUS MATERIALS BUSINESS PLAN REQUIREMENTS:
RECORD KEEPING
[ I Health Permit not obtained SDCC 68.11 05 V2001 W
[ I Business Plan not established/implemented V2002 w--- 25503.5
Business Plan not submitted to 25505 'V2007_ W '>
j' Business Plan not amended 25505 liti-(S l V2003 w-- [ ·1 Personnel Training Records not ava1 able 213r V2302 w--
RELEASE REPORTING
I I Fa1lure to report a release/threatened release
25507
V2008W __
BUSINESS PLAN ELEMENTS
I Emergency Response Plan inadequate 25504
I Emergency Contacts not providedlcurrent
25509
I Personnel Training Program inadequate 26504
I Inventory is incomplete 25504
I Site Map is not sufficient 26509
I Acutely Haz. Mat. not registered 25533
V3006 T
V3032,.--
V3033y--
V2201 W
V2203w--
V2301 W
V2oosw--
V22o2w--
v2oosw--
All violations must be corrected. Please call (619) 338-2222 if you have any questions.
DEH:HM-923 (Rev. 1/9S) NCR
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
r
COUNTY •• OF
.,
SAN DIEGO
COMPLIANCE INSPECTION REPORT
Page __;_I _ of 3
EST. NO. H __ _
DATE :S J&/'\7
TIME START END
US. CODE
SPECIALISTD
BUSINESS NAME kc f\G 1\Ct.d 10 CONTACT S·h ..ve l'Qcobs ADDREss 1 tt It, lb, s-s,o·"" & p, d TITLE Gt"l:')
CITY /ZIP Su .... 1 k e q 2 oJ 1 PHONE s &m - S!i'(iJLf On the above date an inspection of your business/facility was conducted in order to determine compliance with the California Health and Safety Code (H&S) Chapters 6.5, 6.7, 6.95; Titles 19, 22 and 23 of the California Code of Regulations (CCR); and the San Diego Cou !Y Code (SDCC). The following remarks are intended to provide guidance to correct the violations noted on the attached violat' Title
Department of Environmental Health, Hazardous Materials Management Division, P.O. Box 85261, San Diego, CA, 92186-5261 DEH:HM-924 (Rev. 1/96) NCR
(619) 338-2222
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
.... ' .. .
.-.
COUNTY OF SAN DIEGO
o(\ oi I k 1-kn
3·it)v - sto o
• EST. NUMBER H 3'?>)05
DATE __ s-_
PAGE _.,....._7 ..... =,___ OF =3:::._ __
foelow
tor ct\spchMJ _ .. ,
•
C0 re9v;reJ/.
\:1,.__4CDA foe_ f t4Y<. fr .:f!V_· c:..____;·---......,.,.--__,-- siiAature of Business Representative Title
· Department of Health Services, Environmental Health Services, Hazardous Materials Management Division, PO Box 85261, San Diego, CA. 92186-5261 *r . , \ 1:> I. 1 (619) 338-2222 , 0 ' A'11 tv o."' "'1 f\1\o.f 1\f't. ")
DISTRIBUTION: WHITE-RETURN TO HMMD
DHS:HM-9110 (Rev. 2/94) NCR YELLOW-BUSINESS RETAINS
li)
• OF SAN DIEGO • EST. NUMBER H 3350$"
DATE 'S I Co I 4]
S If:\GE 'S OF ___..."""""3 __
__
VIOLATION REPORT: The items checked below refer to specific section numbers of Titles 19/22/23 of the California Code of Regulations (CCR), Chapters
6.5, 6.7, 6.95 of the Health and Safety Code (HSC), and/or the San Diego County Code (SDCC).
I HAZARDOUS WASTE REQUIREMENTS: II UNDERGROUND STORAGE TANK {!!S!} REQUIREMENTS:
RE CORD KEEPING GENERAL UST REQUIREMENTS
[ 1 Health Penrut not obtained SDCC 68.905 V0108 W [ 1 Health Penrut not obtamed 68.1005, 25284 V3002 T [ 1 No EPA Identification Number 66262.12 VOIOS W-;z" [ 1 Repair/modify/close permit not obtained 68.1005 V3007T--- r)tWaste Manifests/Receipts not on-site for _ ...vonsw [ 1 UST Permit Application not submitted 25286(a) V3010T--- 3 years 66262.40 [ 1 Operating permit conditions violated 2712 V3011 T--- [ 1 Manifest not properly completed 66262.23 V0120W [ 1 Failed to notify HMMD of changes 25284 V3012T--- [ 1 Manifest copy not sent to DTSC 66262.23 vonsw-- [ 1 No owner/operator agreement 25284 V300ST--- [ 1 TSDF signed-manifest not on-site 66262.40 VOI21 w-- [ 1 No records of financial coverage 25292.2 V3013T--- [ 1 Biennial report not sent to DTSC 66262.41 V0122W-- [ 1 No maint/monit/calib records available 2712(b), 2641(j) V3001 T--- [ 1 LDR Documentation not available 66268.7 V0123W-- [ 1 Monitoring Equip. not tested annually 2630, 2641 V3003 T [ 1 Exception Rpt. not filed with DTSC 66262.42 V0116W-- [ 1 Operating TSDF without authorization 25201 V0124 W MONITORING REQUIREMENTS {SINGLE WALL! [ 1 Leak Detection MethOd does not meet V3014T ___
STORAGE AND HANDLING performance standards 2643
[ ] Waste stored longer tJlllli 90, 180, or 270 days 66262.34 V0221 W [ 1 Integrity test not conducted 25292 V3015 T [ 1 Failure to clean up hazwaste off of floor surface 66262.1 Ob V0313W-- ,[ l Copy of tank test not submitted to HMMD - -· V3016 T, •. - [ 1 Waste container missing/improperly labeled 66262.34 V0222W-- within 30 days 2643 [ 1 Haz Materials not properly fabeled 25124 V0223W-- [ 1 Manual tank gauging (<2000 gal) 2645 V3017T __ [ 1 Waste container not kept closed 66265.173 V0202W-- not done properly [ 1 Waste container in poor condition 66265.171 V020SW-- [ 1 Reconciliation not done properly 2646 V3018 T [ 1 Waste container(s) not properly managed 66265.173 vonow-- [ 1 Reconciliation not approved for facility 2646 V3019T-- [ 1 Damaged container not repackaged 66265.171 V0226W-- [ 1 Dispenser meter(s) not calib annually 2646 V3020T-- [ 1 Container incompatible with waste 66265.172 V0207W-- [ 1 Improper liquid measurements 2646 V3021T-- [ 1 Incompatibles in the same container 66265.177 V0224W-- [ 1 Stick in poor condition 2646 V3022T-- [ 1 Incompatibles not stored separately 66265.177 V0213W-- [ 1 Improper monthly reconciliation 2646 V3023T-- [ 1 lgnitible Waste less than 50 feet 66265.176 V0214W-- [ 1 Failed to report excessive variation 2646 . V3024T [ 1 Ignitible Waste not grounded 66265.31 V021SW-- [ 1 Pressurized Product Piping Leak Device [ 1 Storage area not inspected weekly 66265.174 V0216 W not tested annually 25292 V3025 T [ 1 No written monitoring procedure 2641 V3027T--
DISPOSAL AND TRANSPORTATION [ 1 No written emergency response plan 2641 V3027y- [ 1 Unauth. diSposal of waste to. 25189.5 V0313 W [ 1 SIR reporting incorrectly done 2646.1 V3004 T [ 1 Waste determination not made 66262.h · V0319W--
[ 1 Unlawful transport of haz. waste 25163 V031SW-- MONITORING REQUIREMENTS WALL! [ 1 Waste transported without manifest 66262.20 V0316W-- [ 1 Momtorlng system not fUnctional IT · V3026 T . [ 1 Extremely Haz Waste Permit not obtained 25205.7 V0317 W [ 1 No written monitoring procedure 2632 V3027T-- [ 1 Written emergency response plan not available 2632 V3028T-- V3029 T
Q)
TRAINING1 CONTINGENCY PLAN & EMERGENCY PROCEDURES:L. [ 1 SpilVOverfill equip. not maintained or installed 2635 M Tr.umng records unavruhible 66265.16 ·_. V0405 W Training program not adequate 66265.16 V0406 W
[ 1 Facility not designed to minimize release 66265.31 VOSOl W [ 1 Spill control equip not available 66265.32 VOS08 w __ [ 1 Aisle space is obstructed 66265.35 VOS09 W __ [ 1 Contingency plan not prepared and/or on file
66265.51, 66265.53
MISCELLANEOUS
·[ 1 Waste ml contaminated 25250.7
[ 1 Used oil filters improperly managed 66266.130
[ 1 Damaged batteries improperly managed 66266.81
[ 1 Facility has failed to notify local CUPA and DTSC of onsite treatment of hazardous waste (tiered pemitting)
[ 1 Onsite treatment of waste without authorization 25201 V0609W __
V022SW
V070l w--
V0702 W
V0125 W
V012SW--
III HAZARDOUS MATERIALS BUSINESS PLAN REQUIREMENTS:
RECORD KEEPING
[ 1 Health Penrut not obtained SDCC 68.1105
[ 1 Business Plan not established/implemented 25503.5
[ 1 Business Plan not submitted to HMMD 25505
[ 1 Business Plan not amended 25505
l)(Personnel Training Records not available 19 CCR 2732
RELEASE REPORTING
[ 1 Frulure to report a release/threatened release 25507 V2001 W
V2002W--
V2007W--
V2003W , - V2302W
V2008W __
RELEASE REPORTING
[ 1 Frulure to report an unauthorized release 25295
[ 1 Release record log not available 2651, 2650
[ 1 No leak report/investigation/action 2652
CLOSURE
[ 1 Temporary closure req. not completed 2671
[ 1 Unused tank not properly closed 25298
· [ 1 Permanent closure req. not completed 2672
[ 1 Failed to apply for temporary closure 25298
BUSINESS PLAN ELEMENTS
[ 1 Emergency Response Plan inadequate 25504
[ 1 Emergency Contacts not provided/current
25509
[ 1 Personnel Training Program inadequate 25504
[ ] Inventory is incomplete 25504
[ 1 Site Map is not sufficient 25509
[ 1 Acutely Haz. Mat. not registered 25533
Department of Environmental Health, Hazardous Materials Management Division, P. 0. Box 85261, San Diego, CA 92186-5261 DISTRIBUTION: WHITE-RETURN TO HMMD
DEH:HM-923 (Rev. 10/96) NCR ; YELLOW-BUSINESS RETAINS
V3009 T
V3030T--
V3031 T
V3006 T
V3032T--
V3033T--
V3008 T
V2201 W
V2203 W
V2301 W
V200SW--
V2202W--
V2009 W
Page ( · of( __
. \LE •
C 0 U N T:c} 0 F S A N D I E G 0
EST. NO. H 1
:150)
DATE J.f.1JJ1) · . . · · ., '·· .,, jTIME START 'i <o END q e__ L..._ __ c_o_·_MP_· _L_IA ____ N_c.....;.;.E_.·· IN......;....;_s_P_:E_c_T __ Io_N_' _RE_P_o_R_T __ __.;.:.____;,;,i_ . Bus. coDE • SPECIALIST))
BUSINESS NAME 1{ C B Q. CONTACT
ADDREss 2locap R<l TITLE _______ _
CITY/ZIP Q__s_l PHONE _______ _
On the above date an inspection of your business/facility was conducted in order to determine compliance with the California Health and Safety Code (H&S) 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. '
Title
Department of Environmental Health, Hazardous Materials Management Division, P.O. Box 85261, San Diego, CA, 92186-5261 DEH:HM-924 (Rev. 1/96) NCR
(619) 338-2222
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
KIOZ F"M
' '
71 fEB. -3 AlO :04
January 29, 1997
County of San Diego
Department ofEnvironmental Health
P.O. Box 85261
San Diego, CA 92186
Re: Est#HJ3505, 9416 Mission Gorge Road
Dear Sirs:
• PAR BROADCASTING Company
5745 Kearny Villa Road, Suite M
San Diego, CA 92123
FAX 619.279.9553
TEl619.565.6006
Please accept this letter as confirmation that Par Broadcasting Company, Inc. (Par) purchased the building and its contents located at 9416 Mission Gorge Road , Santee California from Compass Radio Group, Inc. on April I, 1996. Please change your records to show Par as the new owner and change the mailing address to our business offices loacated Kearny Villa Road, San Diego, CA 92123.
We are enclosing our check in the amount of$505.00 to cover the 1997 Hazardous Materials/ Health Permit Fees. Please contact me at extension 208 if you have any questions.
C 0 UN'TY • OF
.
SAN Page f o
EST. NO. H
DA TE _ _
TIME
BUS. COMPLIANCE INSPECTION REPORT
- SPECIAL . fu
1 CITY !ZIP ¥ q I P. ONE <Z£ ){(£:-· t/J11D , On the above date an inspection of your business/facility was conducted in order to determine compliance with the California Health and Safety Code (H&S) Chapters 6.5, 6.7, 6.95; Titles i9, 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.
JUL 2 1 199. ( lt_
Title
nv· onmental Health, Hazardous Materials Management Division, P.O. Box 129261, San Diego, CA, 92112-9261 DEH:HM-924 (Rev. 2/98) NCR
(619) 338-2222
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
/ County of San Diego
Department of Environmental Health
' COUNTY OF SAN DIEGO • EST.
DATE
PAGE
BusiNEss ADDREss: 5Lf l(e Ht.SS 101\ G-o "g-g tRd
I I
NUMBER H "33S05
£;t6;9B
<]- OF
ZIP CODE:
Title
nvironmental Health, Hazardous Materials Management Division, P.O. Box 85261, San Diego, CA, 92186·5261 DEH:HM-9110 (3/96) NCR
(619) 338-2222
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
OF SAN DIEGO -EST. NUMBER H ·33505
.. ... /..,...,..,...., DATE 1, 1 Co, q &
__ __
VIOLATION REPORT: The items checked below refer to specific section numbers of Titles 19n2/23 of the California Code of Regulations (CCR), Chapters
6.5, 6.7, 6.95 of the Health and Safety Code (HSC), and/or the San Diego County Code (SDCC).
I HAZARDOUS WASTE REQUIREMENTS: II UNDERGROUND STORAGE TANK (UST) REQUIREMENTS:
/
RECORD KEEPING
[ ] Health Permit not obtained SDCC 68.905
[ ) No EPA Identification Number 66262.12
i.<rwaste Manifests/Receipts not on-site for -- 3 years 66262.40 [ 1 Manifest not properly completed 66262.23
[ 1 Manifest copy not sent to DTSC 66262.23
[ 1 TSDF signed-manifest not on-site 66262.40
[ 1 Biennial report not sent to DTSC 66262.41
[ 1 LDR Documentation not available 66268.7
[ 1 Exception Rpt. not filed with DTSC 66262.42
[ ] Operating TSDF without authorization 25201
STORAGE AND HANDLING
[ 1 Waste stored longer than 90, 180, or 270 days 66262.34 [ ] Failure to clean up hazwaste off of floor surface 66262.1 Ob [ 1 Waste container missing/improperly labeled 66262.34 [ 1 Haz Materials not properly labeled 25124
[ 1 Waste container not kept closed 66265.173
[ 1 Waste container in poor condition 66265.171
[ 1 Waste container(s) not properly managed 66265.173
[ 1 Damaged container not repackaged 66265.171
[ 1 Container incompatible with waste 66265.172
[ ] Incompatibles in the same container 66265.177
[ 1 Incompatibles not stored separately 66265.177
[ 1 Ignitible Waste less than SO feet 66265.176
[ ] Ignitible Waste not grounded 66265.31
[ 1 Storage area not inspected weekly 66265.174
DISPOSAL AND TRANSPORTATION
[ 1 Unauth. disposal of waste to 25189.5
[ 1 Waste determination not made 66262.11
[ 1 Unlawful transport of haz. waste 25163
[ 1 Waste transported without manifest 66262.20
[ 1 Extremely Haz Waste Permit not obtained 25205.7
VOlOS W · vonsw __
V0120 W vonsw--
votzt w--
votzzw--
vo123 w--
von6w--
V0124 W
V0221 W
V0313W--
V0222W--
V0223W--
V0202W--
V0205W--
V0210W--
V0226W--
V0207W--
V0224W--
V0213W--
V0214W--
V0215W--
V0216W--
V0313 W
V0319W--
V0315W--
V0316W--
V0317 W
TRAINING CONTINGENCY PLAN & EMERGENCY PROCEDURES
Training records unavailable 6265.16
1 Training program not adequate 66265.16
1 Facility not designed to minimize release 66265.31
1 Spill control equip not available 66265.32
1 Aisle space is obstructed 66265.35
1 Contingency plan not prepared and/or on file
66265.51, 66265.53
MISCELLANEOUS
[ 1 Waste oil cgntaminated 25250.7
[ 1 Used oil filters improperly managed 66266.130
[ 1 Damaged batteries improperly managed 66266.81
[ 1 Facility has failed to notify local CUP A and DTSC of onsite treatment of hazardous waste (tiered pemitting)
1 Onsite treatment of waste without authorization 2520 I V0405 W
V0406 W.
VOSOl w--
VOSOSW--
V0509 W
V0609W __
V0225 W
V07ot w--
V07ozw--
V0125 W
V0125W--
III HAZARDOUS MATERIALS BUSINESS PLAN REQUIREMENTS:
RECORD KEEPING
Health Permit not obtained SDCC 68.1105
[ Business Plan not established/implemented 25503.5
· 'bd:'Business Plan not submitted to HMMD 25505
---1 ]Business Plan not amended 25505
[ 1 Personnel Training Records not available 19 CCR 2732
RELEASE REPORTING
[ 1 Failure to report a release/threatened release 25507 V2002 W
V2007 W
V2003
V2302 W
V2008W __
GENERAL UST REQUIREMENTS
[ 1 Health Permit not obtained 68.1005, 25284
[ 1 Repair/modify/close permit not obtained 68.1005
[ 1 UST Permit Application not submitted 25286(a)
[ 1 Operating permit conditions violated 2712
[ 1 Failed to notify HMMD of changes 25284
[ 1 No owner/operator agreement 25284
[ 1 No records of financial coverage 25292.2
[ 1 No maint/monit/calib records available 2712(b), 264l(j) [ 1 Monitoring Equip. not tested annually 2630, 2641
MONITORING REQUIREMENTS (SINGLE WALL)
[ ] Leak Detection Method does not meet
performance standards 2643
1 Integrity test not conducted 25292
] Copy of tank test not submitted to HMMD
within 30 days 2643
1 Manual tank gauging (<2000 gal) 2645
not done properly
] Reconciliation not done properly 2646
1 Reconciliation not approved for facility 2646
1 Dispenser meter(s) not calib annually 2646
1 Improper liquid measurements 2646
1 Stick in poor condition 2646
1 Improper monthly reconciliation 2646
1 Failed to report excessive variation 2646
1 Pressurized Product Piping Leak Device
not tested annually 25292
1 No written monitoring procedure 2641
1 No written emergency response plan 2641
1 SIR reporting incorrectly done 2646.1
MONITORING REQUIREMENTS (DOUBLE WALL)
[ 1 Momtoring system not functional 2632
/ [ 1 No written monitoring procedure 2632
[ ) Written emergency response plan not available 2632
[ ) Spill/Overfill equip. not maintained or installed 2635
RELEASE REPORTING
[ ] Failure to report an unauthorized release 25295
[ 1 Release record log not available 265 I, 2650
[ 1 No leak report/investigation/action 2652
CLOSURE
[ 1 Temporary closure req. not completed 2671
[ 1 Unused tank not properly closed 25298
[ 1 Permanent closure req. not completed 2672
[ 1 Failed to apply for temporary closure 25298
BUSINESS PLAN ELEMENTS
[ 1 Emergency Response Plan inadequate 25504
[ 1 Emergency Contacts not provided/current
25509
1 Personnel Training Program inadequate 25504
1 Inventory is incomplete 25504
1 Site Map is not sufficient 25509
1 Acutely Haz. Mat. not registered 25533
V3002 T
V3007T--
V3010T--
V3011 T--
V3012T--
V3005T--
V3013T--
V3001 T--
V3003 T
V3014 T
V3015 T
V3016T--
V3017 T
V3018 T
V3019T--
V3020T--
V3021 T--
V3022T--
V3023T--
V3024T--
V3025 T
V3027T--
V3027T--
V3004 T
V3026 T
V3027T--
V3028T--
V3029 T
V3009 T
V3030T--
V3031 T
V3006 T
V3032T--
V3033T--
V3008 T
V2201 W
V2203 W
V2301 W
V2005W--
V2202W--
vzoo9 w--
PLEASE CALL (619) 338-2222 OR YOUR INSPECTOR IF YOU HAVE ANY QUESTIONS.
Jv' 17, q f
DATE SIGNED TITLE
DISTRIBUTION: WHITE-RETURN TO HMMD
DEH:HM-923 (Rev. 1/98) NCR YELLOW-BUSINESS RETAINS
BUSINESS NAME K C.- p Q f;.c._e/, '3·
ADDRESS /VL;-u/-o'"' Gw· 9 e- fl._q{ I
CITY /ZIP S'c.._ "'- 2Z-n7/
-.L---OF Z--
EST. NO. H
DATE /2- 7 - 9 9
TIMESTART END __ _
SPECIALIST D.
CONTACT Dtc..l<
TITLE
PHONE '5-l't - <9 I 3 -z._
On the above date, an inspection of your business/facility was conducted in order to determine compliance with the California Health and Safety Code (H&S) Chapters 6.5, 6.7, 6.95; Titles 19,22 and 23 ofthe California Code of Regulations (CCR); and the San Diego County Code .. following remarks are intended to provide guidance to corre t the violations on the-attached violation tl ':' . R..ou-h\., u 3 2001.! -y;l"l r-1
TY'' ·" ·.(. ·• ;;t·- , ,."'. 4. v n -1 , e.· t.A/C:J
( yC... s
I
""'- q P' b /, 'U!yt......Dr ..,. T/
.b. s
' I
I
i; 7 C>(d= Lb <- r I 7=-r;..
!<-L?f eLo-c vf'h ....
d,',) f c>Iev( o...f -K<- Svft.
!:?-7-
Date Signed
d
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-924 (Rev. 2199) NCR
DISTRIBUTION: WJDTE- RETURN TO HMO
YELLOW-BUSINESS RETAINS
' County of San Diego
Department of.Environmental Health
COUJty OF SAN DIEGO • EST. NUMBER H
DATE 1?--t 7
PAGE
ZUJ?r
VIOLATION REPORT: The items checked below refer to specific section numbers of Titles 19/22/23 of the California Code of Regulations (CCR), Chapters
6.5, 6.7, 6.95 of the Health and Safety Code (HSC), and/or the San Diego County Code (SDCC). .
I HAZARDOUS WASTE REQUIREMENTS: II UNDERGROUND STORAGE TANK (USD REQUIREMENTS:
RECORD KEEPING
[ ] Health Permit not obtained SDCC 68.905
[ ] No EPA Identification Number 66262.12
[ ] Waste Manifests/Receipts not on-site for
3 years 66262.40
] Manifest not properly completed 66262.23-
] Manifest copy not sent to DTSC 66262.23
] TSDF signed-manifest not on-site 66262.40
] Biennial report not sent to DTSC 66262.41
] LDR Documentation not available 66268.7
] Exception Rpt. not filed with DTSC 66262.42
] Operating TSDF without authorization 25201
STORAGE AND HANDLING
] Waste stored longer than 90, 180, or 270 days 66262.34 ] Failure to clean up hazwaste off of floor surface 66262.1 Ob ] Waste container missing/improperly Iabeled-66262.34
] Haz Materials not properly labeled 25124
] Waste container not kept closed 66265.173
] Waste container in poor condition 66265.171
] Waste container(s) not properly managed 66265.173
1 Damaged container not repackaged 66265.171
] Container incompatible with waste 66265.172
] Incompatibles in the same container 66265.177
] ·Incompatibles not stored separately 66265.177
] Ignitible Waste less than 50 feet 66265.176
1 Ignitible Waste not grounded 66265.31
] Storage area not inspected weekly 66265.174
DISPOSAL AND TRANSPORTATION
[ ] Unauth. disposal of waste to 25189.5
[ ] Waste determination not made 66262.11
[ ] Unlawful transport of haz. waste 25163
[ ] Waste transported without manifest 66262.20
[ 1 Extremely Haz Waste Permit not obtained 25205.7
V0108 W
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TRAINING, CONTINGENCY PLAN & EMERGENCY PROCEDURES
[ 1 Training records unavailable 66265.16 V0405 W
[ 1 Training program not adequate 66265.16 V0406 w--
[ ] Facility not designed to minimize release 66265.31 VOSOl w-- [ ] Spill control equip not available 66265.32 VOSOS w-- \
I J space is obstructed 66265.35 V0509 W
j)([ Contmgency plan not prepared and/or on file
66265.51, 66265.53 vo609 w __
MISCELLANEOUS
[ ] Waste oil contaminated 25250.7
[ ] Used oil filters improperly managed 66266.130
[ ] Damaged batteries improperly managed 66266.81
[ ] Facility has failed to notify local CUPA and DTSC of onsite treatment of hazardous waste (tiered pemitting)
[ ] Onsite treatment of waste without authorization 25201 V0225 W
vo7ot w--
V0702 W
V0125 W
V0125W--
III HAZARDOUS MATERIALS BUSINESS PLAN REQUIREMENTS:
RECORD KEEPING
/4 ealt Permit not obtained SDCC 68.1105
..., 1 Business Plan not established/implemented 25503.5 ] Business Plan not submitted to HMMD 25505
] Business Plan not amended 25505
] Personnel Training Records not available 19 CCR 2732
RELEASE REPORTING
[ ] Failure to report a releaselthreate ed release 25507 V2001 W
V2002W--
V2007W--
V2003W--
V2302 W
V2008W __
·GENERAL UST REQUIREMENTS
[ ] Health Permit not obtained 68.1005, 25284
[ ] Repair/modify/close permit not obtained 68.1005
[ ] UST Permit Application not submitted 25286(a)
[ ] Operating permit conditions violated 2712
. [ ] Failed to notify HMMD of changes 25284
[ 1 No owner/operator agreement 25284
[ 1 No records of financial coverage 25292.2
[ ] No maint/monit/calib records available 2712(b), 2641(j) [ ] Monitoring Equip. not tested annually 2630, 2641
MONITORING REQUIREMENTS (SINGLE WALL)
[ ] Leak Detection Method does not meet
performance standards 2643
] Integrity test not conducted 25292
1 Copy of tank test not submitted to HMMD
within 30 days 2643
] Manual tank gauging (<2000 gal) 2645
not done properly
] Reconciliation not done properly 2646
1 Reconciliation not approved for facility 2646
1 Dispenser meter(s) not calib annually 2646
] Improper liquid measurements 2646
1 Stick in poor condition 2646
] Improper monthly reconciliation 2646
] Failed to report excessive variation 2646
] Pressurized Product Piping Leak Device
not tested annually 25292
1 No written monitoring procedure 2641
1 No written emergency response plan 2641
] SIR reporting incorrectly done 2646.1
MONITORING REQUIREMENTS (DOUBLE WALL)
[ ] Momtoring system not functional 2632
[ ] No written monitoring procedure 2632
[ ] Written emergency response plan not available 2632
[ 1 SpilVOverfill equip. not maintained or installed 2635
RELEASE REPORTING
[ ] Failure to report an unauthorized release 25295
[ ] Release record log not available 2651, 2650
[ ] No leak report/investigation/action 2652
CLOSURE
[ ] Temporary closure req. not completed 2671
[ ] Unused tank not properly closed 25298
[ 1 Permanent closure req. not completed 2672
[ ] Failed to apply for temporary closure 25298
BUSINESS PLAN ELEMENTS
[ ] Emergency Response Plan inadequate 25504
[ ] Emergency Contacts not provided/current
25509
] Personnel Training Program inadequate 25504
] Inventory is incomplete 25504
] Site Map is not sufficient 25509
] Acutely Haz. Mat. not registered 25533
Department of Environmental Health, Hazardous Materials Management Division, P. 0. Box·J29261, San Diego, CA 92112-9261 DISTRIBUTION: WHITE-RETURN TO HMMD
DEH:HM-923 (Rev. l/98) NCR YELLOW-BUSINESS RETAINS
V3002 T
V3007T--
V3010T--
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V2201 W
V2203 W
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vzoo9 w
ECOLOGY CONTROL INDUSTRIES
A Full Service Environmental Company
October 4, 1999
San Diego County Hazmat
1255 Imperial Avenue
3rd Floor
San Diego, CA 92101
ATTN: Joan Swenson
•
R E }: \I E [)
OcT 8 II AM '99
E WI i , _; ... ! !J. L
HEALTH Sti\VICES
RE: Above Ground Storage Tank Closure Notification
The Former KCBQ Radio Station
9416 Mission Gorge Road
Santee, California
Dear Ms. Swenson:
The purpose of this letter is to notify the County of San Diego Department of Environmental Health (CSDDEH) that Ecology Control Industries (ECI) will be removing a 6,000-gallon diesel above ground storage tank (AST) from 9416 Mission Gorge Road, in the City of Santee, Califomia;·the.former KCBQ Radio Station site. ECI was contracted by the U.S. Army Corps of Engineers (USACE) to remove and dispose of the one 6,000 gallon diesel AST and associated appurtenances from the former FEMA Site, KCBQ Radio Station (see Figure 1 -Area Map).
ECI shall remove the AST and associated appurtenances in accordance with all applicable USACE, federal, state, county and local guidelines.
As part of the USACE formerly used defense sites program (FUDS), the AST requires removal and disposal. ECI understands that a permit is not required by the CSDDEH and the Air Pollution Control District (APCD) for the AST removal at the site.
Please contact us at 310-320-2555 if you need any additional information on this project or if you have any comments. Thank you for your time and assistance.
Sincerely,
Ecology Control Industries
oject Manager ... .. '\-... '. : '"f / • '. ' (•
·-·
.. 'a}•,; ."!if' i'>.•,,· ...
i_: ::. · .. !!;:."· !.4 1 --q .. ;'',;• :_::_ i ,; .. ·; ':··::i: P::·; 19500 Normandie Avenue • Torrance, California 90502-1608 Tel: (310) 354-9999 • Tel: (BOO) 236-7324 • Fax: (310) 660-6926 www.ecologycontrol.com
r
L
(,\ ,,
. •• V'iS?BC'l'ICN DATE ,
)
I COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEALTH
I I ·.
,· _____ _ P. 0. BOX 129261, SAN DIEGO, CA 92112-9261 PHONE: 619-338-22.22
I ESTAB NUMBER
2 SIC-1
45 21
SIC-2
49 °
CENSUS TR/INC CODE
I
FIRE WATER
53 55
BUS CODE
I LJ I
28 SEWER ZONING
57 59
UNITS ANNUAL FEE EXPIR i:.'l\'rE {::{0-DAY)
I I I
l]
31 35 41
MAP ON FILE STATUS ASSESS6R' S PARCE:C. NO.
61 62 64
.. -·--"""'""'"-"'" ,., __
ESTABLISHMENT OWNER NAME
·ESTABLISHMENT ADDRESS:
STREET NUMBER DIRECTION STREET NAME (c !)!)r}s,:wl D
1U US
CITY
151
SECOND NAME OR NAME OF MANAGEMENT COMPANY:
187
127
STATE ZIP CODE
166 168
(IF DIFFERENT FROM ESTABLISHMENT ADDRESS):
&LOG/SUITE
147
(!IP.El'.) BUSINESS l?liONE
177
MAILING ADDRESS
STREET NUMBER DIRECTION STREET NAME BLDG/SUITE
I t ( / 1 1 1
{: D .-I l.-Vl.-1 -.{2-.-- 1
1 dc.- 1 ...-, ::;:-.
1 1 't-. .. ,--,.--..--...,----,,...,1 l.__ _ __.l
217 228 230 r 250
CITY STATE ZIP CODE
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1 ----l' g]{ I>'> 1
5 1
-If"--__.I ·254 269 !' 271 )
ESTABLISHMENT NAME: YES = 1
OTHER = 2
GAS STATION
REASO!: l"OR APPLICATION:
r5l 1- NEW LlJ 2 - RE-OPEN
'315
NAME OF PREVIOUS OWNER I I I I
316 •
CONTACT PERSON
314
IF OTHER, LIST TYPE OF BUSINESS:
NUMBER OF EMPLOYEES:
3 - OWNER CHANGE I
DATE BUS ASSUMED
366
***** ALL APPLICANTS PLEASE COMPLETE APPROPRIATE SUPPLEMENTARY FORMS ***** 'I DECLARE tlNDER PENALTY OFC-lllE:RJtlln' THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE STATEMENTS MADE HEREIN ARE CORRECT AND TRUE. I
HEREBY CONSENT TO ALL INSPECTIONS MADE PURSUANT TO LAW AND INCIDENTAL TO THE ISSUANCE OF THIS PERMIT AND THE OPERATION OF THIS BUSINESS.
DATE
DEH:HM-927 (Rev. 10/97)
COUNTY
-
OF SAN DIEGO
l>'
BUSINESS NAME 'RA-9l0
ADDRESS C\4llf, MI$Sicr-f-l Got<.6 R.o
CITY /ZIP ..SA 1-J\.G Ef
On the above date, an inspection of your business/facility was conducted in order to ine compliance w the and Safety Code (H&S) 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. omee. Use,Oniy ... ' . _.
. . .
'. :'( • __ ... -:-::- .: r- ,' •••
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; . ' . ' .
·:/j(.
?:-.."·".
0 S t= B-YATlCN
Date Signed
.. .e.c-Q·
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-924 (Rev. 2/99) NCR
DISTRIBUTION: WHITE- RETURN TO HMO
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
CO.TY OF SAN DIEGO EST. NUMBER H 33505
__ _
PAGE OF __ 2-____ _
__
VIOLATION REPORT: The items checked below refer to specific section numbers of Titles 19/22/23 of the California Code of Regulations (CCR), Chapters
6.5, 6.7, 6.95 of the Health and Safety Code (HSC), and/or the San Diego County Code (SDCC).
I HAZARDOUS WASTE REQUIREMENTS: II UNDERGROUND STORAGE TANK (UST) REQUIREMENTS:
RECORD KEEPING
[ ] Health Penrut not obtained SDCC 68.905
[ ] No EPA Identification Number 66262.12
[ ] Waste Manifests/Receipts not on-site for
3 years 66262.40
] Manifest not properly completed 66262.23
] Manifest copy not sent to DTSC 66262.23
] TSDF signed-manifest not on-site 66262.40
] Biennial report not sent to DTSC 66262.41
1 LOR Documentation not available 66268.7
] Exception Rpt. not filed with DTSC 66262.42
1 Operating TSDF without authorization 25201
STORAGE AND HANDLING
[ 1 Waste stored longer than 90, 180, or 270 days 66262.34 [ 1 Failure to clean up hazwaste off of floor surface 66262.1 Ob [ 1 Waste container missing/improperly labeled 66262.34 [ ] Haz Materials not properly labeled 25124
[ 1 Waste container not kept closed 66265.173
[ ] Waste container in poor condition 66265.171
[ ] Waste container(s) not properly managed 66265.173
[ 1 Damaged container not repackaged 66265.171
[ ] Container incompatible with waste 66265.172
[ ] Incompatibles in the same container 66265.177
[ ] Incompatibles not stored separately 66265.177
[ ] Ignitible Waste less than 50 feet 66265.176
[ ] Ignitible Waste not grounded 66265.31
[ ] Storage area not inspected weekly 66265.174
DISPOSAL AND TRANSPORTATION
[ ] Unauth. disposal of waste to 25189.5
[ 1 Waste determination not made 66262.11
[ ] Unlawful transport of haz. waste 25163
[ ] Waste transported without manifest 66262.20
[ ] Extremely Haz Waste Permit not obtained 25205.7
V0108 W
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V031SW--
V0316W--
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TRAINING, CONTINGENCY PLAN & EMERGENCY PROCEDURES
[ 1 Training records unavailable 66265.16 V0405 W
[ ] Training program not adequate 66265.16 V0406 w--
[ 1 Facility not designed to minimize release 66265.31 VOSOI w-- [ 1 Spill control equip not available 66265.32 VOSOS w-- [ 1 Aisle space is obstructed 66265.35 VOS09 w--
[ ] Contingency plan not prepared and/or on file --
66265.51, 66265.53 vo609 w __
MISCELLANEOUS
[ ] Waste oil contaminated 25250.7
[ ] Used oil filters improperly managed 66266.130
[ 1 Damaged batteries improperly managed 66266.81
[ ] Facility has failed to notify local CUPA and DTSC of onsite treatment of hazardous waste (tiered pemitting)
[ ] Onsite treatment of waste without authorization 25201 V0225 W
V070I w--
V0702 W
V0125 W
V0125W--
III HAZARDOUS MATERIALS BUSINESS PLAN REQUIREMENTS:
RECORD KEEPING
[ 1 Health Permit not obtained SDCC 68.1105
[ ] Business Plan not established/implemented 25503.5
[ 1 Business Plan not submitted to HMMD 25505
[ 1 Business Plan not amended 25505
[ ] Personnel Training Records not available 19 CCR 2732 V2001 W
V2002W--
V2007W--
V2003W--
V2302 W
V2008W __
GENERAL UST REQUIREMENTS
[ ] Health Permit not obtained 68.1005, 25284
( ] Repair/modify/close permit not obtained 68.1005
[ ] UST Permit Application not submitted 25286(a)
[ ] Operating permit conditions violated 2712
[ 1 Failed to notify HMMD of changes 25284
[ 1 No owner/operator agreement 25284
[ 1 No records of financial coverage 25292.2
[ 1 No maint/monit/calib records available 2712(b), 2641G) [ ] Monitoring Equip. not tested annually 2630, 2641
MONITORING REQUIREMENTS (SINGLE WALL)
[ 1 Leak Detection Method does not meet
performance standards 2643
1 Integrity test not conducted 25292
1 Copy of tank test not submitted to HMMD
within 30 days 2643
] Manual tank gauging (<2000 gal) 2645
not done properly
1 Reconciliation not done properly 2646
] Reconciliation not approved for facility 2646
] Dispenser meter(s) not calib annually 2646
] Improper liquid measurements 2646
] Stick in poor condition 2646
1 Improper monthly reconciliation 2646
] Failed to report excessive variation 2646
] Pressurized Product Piping Leak Device
not tested annually 25292
] No written monitoring procedure 2641
1 No written emergency response plan 2641
] SIR reporting incorrectly done 2646.1
MONITORING REQUIREMENTS WALL)
[ ] Monitoring system not functional 232
[ ] No written monitoring procedure 2632
[ ] Written emergency response plan not available 2632
[ ] SpilUOverfill equip. not maintained or installed 2635
RELEASE REPORTING
[ 1 Failure to report an unauthorized release 25295
[ 1 Release record log not available 2651, 2650
[ 1 No leak report/investigation/action 2652
CLOSURE
[ 1 Temporary closure req. not completed 2671
[ 1 Unused tank not properly closed 25298
[ ] Permanent closure req. not completed 2672
[ ] Failed to apply for temporary closure 25298
BUSINESS PLAN ELEMENTS
[ ] Emergency Response Plan inadequate 25504
[ ] Emergency Contacts not provided/current
25509
1 Personnel Training Program inadequate 25504
1 Inventory is incomplete 25504
1 Site Map is not sufficient 25509
] Acutely Haz. Mat. not registered 25533
DISTRIBUTION: WHITE-RETURN TO HMMD
DEH:HM-923 (Rev. 1/98) NCR YELLOW-BUSINESS RETAINS
V3002 T
V3007T--
V3010T--
V3011 T--
V3012T--
V3005T--
V3013T--
V3001 T--
V3003 T
V3014 T
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V3017 T
V3018 T
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V3020T--
V3021 T--
V3022T--
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V3025 T
V3027T--
V3027T--
V3004 T
V3026 T
V3027T--
V3028T--
V3029 T
V3009 T
V3030T--
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V3006 T
V3032T--
V3033T--
V3008 T
V2201 W
V2203 W
V2301 W
V200SW--
V2202W--
V2009 W
-·
COUNTYeF SAN DIEGO
COMPLIANCE INSPECTION REPO
BUSINESS NAME CONTACT
·, •
1 1
On the above date, an inspection of you{ business/facility was conducted in order to determine compliance with the California Health and Safety Code (H&S) 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.
Office Use Only
KC/5Q
I I
( 00 7.! !: /'if:: l.J::;;t'!Ct of. &
-...L- I dQ- ,j!JY •
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-924 (Rev. 2/99) NCR
DISTRIBUTION: WHITE- RETURN TO HMD
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
-·
COUNTYeF SAN DIEGO
COMPLIANCE INSPECTION REPO
BUSINESS NAME CONTACT
·, •
1 1
On the above date, an inspection of you{ business/facility was conducted in order to determine compliance with the California Health and Safety Code (H&S) 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.
Office Use Only
KC/5Q
I I
( 00 7.! !: /'if:: l.J::;;t'!Ct of. &
-...L- I dQ- ,j!JY •
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-924 (Rev. 2/99) NCR
DISTRIBUTION: WHITE- RETURN TO HMD
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
..
COUNTY OF SAN DIEGO
DATE __
'£ INSPECTION, REPORT I x_ TIME . _ . " , . . . . . BUS. CODE :?lk"f3li
crrYIZIP Sao-tee 9d.DJ I PH E )\-OCQ · , On the above date an inspection of your business/facility was conducted in order to determine c pliance with the California Health and Safety Code (H&S) Chapters 6.5, 6.7, 6.95; Titles 19, 22 and 23 of the California Code of R lations (CCR); and the San Diego County Code (SDCC). The following remarks are to provide guidance to the violations noted on th. e atta _. ed violation . . .J mfl-a I T nspechon (/) . "J.f!J rlJi. tJP
Jl)jW 1
Department of Environmental Health, Hazardous Materials Management Division, P.O. Box 129261, San Diego, CA, 92112-9261 DEH:HM-924 (Rev. 2/98) NCR
(619) 338-2222
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
/ County of San Diego
Department of Environmental Health
COUNTY OF • SAN DIEGO • EST. NUMBER H
DATE _"""""'(?.....__,__;___.) _ _.__! ........... 9 ........ ·8........,_ PAGE A OF 3 .
DEH:HM-9110 (3/96) NCR
susiNEss ADDREss: JD :Io..vn Cevrfev ziP coDE: __ _
:r,corf Y \j ""1lrL JlJe 5 rlvec re. @'-& qj c.u-\1 t ts 1 n a.. 3 g QAA 0 0 1"' e v. \J
(619) 338-2222
DISTRIBUTION: WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
-- -.
COUNTY OF SAN DIEGO EST. NUMBER H 5lf ;)_ lf
GENERAL REQUIREMENTS;
[ ] An Environmental Health Permit as a medical waste generator has not been obtained. 68.1203, 68.1204, and 117705 ...... V4101 w __ [ ] Unlawful disposal of untreated medical waste to an unauthorized point. 118340 ....................... V4102 W [ ] Improper treatment of medical waste using an unapproved method -- or proCedure. 118215 ........................... V4103 W [ ] Medical SOLID WASTE is not stored in a locked trash -- receptacle or enclosure so as to deny access to unauthorized [ ] "or "cuiting of sharps.waste. at "die" pouit.of" .. V 4104
W __
generation. ............................ V4105 W_
[ ] Medical waste was not separated from other waste at the point of origin. 118275 ............................. V4106 w __ [ ] Generator has not maintained reusable containers/bins for medical waste storage in a clean and sanitary manner. 118295 and 118305 ............................ V4107 w_ [ ] Storage time exceeded for frozen medical waste, e.g. greater than 90 days. 118280 ........................... V4108 W_ [ ] Generator did not clean-up a leak or spill of medical waste in an approved manner. 118300 ...................... V4109 w __ [ ] Generator has not secured the enclosure or designated accumulation area for medical waste containers so as to deny access to unauthorized persons. 118310 ............... V4110 W [ ] Operator did not PQSt an approved and legible biohazardous waste -- ( ... V4111 w __
properly marked red bags (non-sharps). lf8275 .......... V4112 W_ )<3
[ ] Generator did not store medical waste in apJlroved and Did not place a label with the generator's name, address, and phone n"\llllber on the outside of the red bag and/or s!larPs contamer. 68.1201 and 68.1205 ............... V4113 w __ [ ] Generator did not store sharps waste in approved and properly marked sharPS container. ll8275 ................... V4114 w __ [ ] Transportation of medical waste without State Hauler Registration or without a limited-quantity hauling exemption from County HMMD. 118025 ..................... V4115 W [ ] Generator did not have standardized written operating procedures -- for a steam sterilizer available onsite. 118215 ........... V4116 W [ ] Did not have recording thermometer checked for calibration -- annually. 118215 .............................. V4117 w __ [ ] Generator did not maintain records of thermometer calibration checks for at least 3 years. 118215 .................. V4118 w __ [ ] Operator did not use neat-sensitive tape or other approved method for cru;h load of medical waste treated ons1te. 118215 . V4119 w __ [ ] Need to use aoiological indicator or other approved method at least once a month to confirm proper disinfection
conditions. 118215 ............................ V4120 W __ [ ] Must tie-off red bags to prevent leakage or expulsion of contents duril!g haridling and storage. 118280 ........... V4121 w __ [ ] Did not containerize and place redllags in rigid, leak resistant, and covered containers or bw. 118280 ......... V4122 w __ [ ] Must have waste container/bin labeled on the lid and side so as to be clearly visible. 118280 ................... V4123 w __ [ ] Did not tape closed or tightly-lid a full sharps container ready for disposal, to preclude loss of contents. 118285 ..... V4124 w __ REQUJREMENIS: < po s per mon o waste
[ ] Medical Waste Management Plan has not been submitted to County HMMD (AnnUal Requirement) 68.1206 and 117935 .. V4025 W __ [ ] Must maintain and show proof of "onsite" medical waste treatment records for 3 years. 118215 and 117943 ........ V4026 W [ ] Generator did not retain on file disposal receipts and/or -- tracking documents for waste shipPed offsite for at least 2 years. 117945 .............................. V4027 W
[ ] Need to apply for·and receive a limited-quantity hauling -- exemption Tor "self-hauled" medical waste ( <20 pounds of waste per week). 118030 and 118025 ................ V4028 W [ ] Did not renew a limited-quantity hauling exemption -- annually. 118030 .............................. V4029 W [ ] Storage time exceeded for full sharps container(s)1 e.g. greater -- than 7 days at room temperatures (for > 20 pounos/month generator). 118285 ............................ V4030 W [ ] Storage time exceeded for red bag waste, e.g .. more than 7 days -- at room temperature (>20 pounas/month generator). 118280 . V4031 W [ ] Very small generator (e.g .. <20 pounds per month) -- inlpro rl storing waste for gre than 30 days onsite at room rature. 11828 . . . . . ................ V4032 w __ DEH:HM-9255 (5/97) NCR
DISTRIBUTION:
DATE _ _,...6'-+j...!....JJ f.__9L.I.ofj'----
.3 -=--3-
[ ] Maxinlum holding time exceeded for non-putrescible medical waste, e.g. greater than 180 days. 68.1203 ............. V4033 w __ LARGE OUANTITX WASTE GENERATORS;
(2 200 pounds of waste in a month)
[ ] Medical Waste Management Plan has not been submitted to County HMMD (Annilal Requirement). 117960 and 68.1206 . V4034 W __ [ ] Must maintain and show proof of "onsite" medical waste treatment records for 3 years. 118215 and 117975 ........ V4035 W __ [ ] Generator did not retain on file disposal receipts and/or tracking documents for waste shipPed offsite for at least £ r iui.t"siuiri>s comaiiter(s): e.g: irearei v
4036
w __ than 7 days at room temperature. 118285 .............. V4037 W [ ] Storage time exceeded for red bag waste, e.g. more than 7 days at room temperature. 118280 ...................... V4038 w __ PATIJOLOGX WASTE AND CIIEMOTHERAPX WASTE DANDLING;
[ ] Did not segregate chemotherapy waste from other
medical waste. 118275 .......................... V4039 w __ [ ] Generator did not label container holding chemotherapy waste with the words "chemotherapy waste" or other approved markings on the lid and sides. 118275 ................ V4040 w __ [ 1 . . . . . . V4041 w __ [ ] Generator did not label container holding pathology waste with the words "pathology waste" or otlier approved markings on the lid and side. 118275 ....................... V4042 w __ [ ] Unlawful disjJC?sal of pathology waste or chemotherapy waste to an unauthorized pomt. 118340 ................... V4043 w __ PHARMACEUTICAL WASTE DANDLING;
[ ] Generator did not segregate pharmaceutical waste from other medical waste. 118275g ......................... V4044 w __ [ ] Generator did not Iaber container holdjnB pharmaceutical waste with the words "incineration only or other approved markings on the lid and side. 118275g ................ V4045 W [ ] Storage time exceeded for pharmaceutical waste, e,g. more than -- 90 days. (2_ 10 P.<JundS per calendar year 118280e . V4046 w __ [ ] Very smaiJ quanttty generator of phaimaceuucal waste (e.g. < 10 pounds waste /calendar year) improperly storing waste for longer than one year. 118280e .............. V4047 w __ [ ] Unlawful disposal of pharmaceutical waste to an unauthorized point. 118340 and 118222 ........................ V4048 w __ ON-SITE MEDICAL WASTE TREATMENT fACILITY REOUIREMENTS;
[ ] Operator has not obtained an onsite medical waste treatment permit from the County. 117950, 118130, 118155, imd CCR 65620 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V 4049 W [ ] Must maintain an updated and complete copy of the -- medical waste treatment permit ons1te and available for review. CCR 65621(f}, 65623, 118165, and 118180 ....... V4050 W_ [ ] Did not comply with a condition of the medical waste treatment permit issued by the County. CCR 65623 . . . . . . . V 4051 W __ PHOTQCHEMJCAL and HAZARDOUS WASTE MGMT. AND DISPOSAL;
[ ] ... [ ] Generator has not maintained waste disposal records. e.g. manifests/milk-run receipts .. onsite for 3 years. 66262.40 .... [ ] Generator has not obtained an EPA ldenfification Number from the State DTSC for hazardous waste f:eneration. e.g. [ ] &hotoprocessing/hazardous waste. 66262. 2 ........... . ••••••
[ ] Generator did not maintain the container holding hazardous ...... . [ ] Generator did not submit a notification to the County prior to treating photochemi waste onsite (e.g. > 10 gallons/month: tiered penni · ). 5201.5 ...................... .
WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
V4052W_
V4053W_
V4054W_
V4055W_
V4056W_
Please complete the following questionnaire:
• •
SECTION A -MEDICAL WASTE GENERATION
1. Does your business or service generate, store, or handle any of the by-products or wastes listed in the box below?
Yes No 0
Circle the letters of the categories found at your business.
A.
@
cD
CD
F.
Laboratory Wastes- specimen or microbiologic cultures, stocks of infectious agents, live and attenuated vaccines, culture dishes, and devices used to transfer, inoculate, and mix cultures.
Blood or Body Fluids -liquid blood elements or regulated body fluids synovial, pleural, peritoneal, pericardial, and amniotic fluids), or articles contaminated With blood or body fluids.
Sharps- syringes, blades, slides or needles.
Contaminated Animals - animal carcasses, body parts, or bedding materials suspected of being contaminated with a disease communicable to humans.
Surgical Specimens - human or animal parts or tissues removed surgically or by autopsy.
Miscellaneous - any waste generated from the diagnosis, treatment, or immunization of humans or animals, or research pertaining there to.
2. Do you dispose of any items in #1 by discharging them into the sewer system, including down sinks, floor drains, toilets, etc.? Yes 0 No
If yes, which category(ies) of by-products or wastes?---------------
3. Do you decontaminate any of the items listed in #1 by steam sterilization (autoclaving) before disposal to trash can or dumpster?
Yes 0 No '!&
If yes, which category(ies) of by-products or wastes? ---------------
4. Do you dispose of any of the items listed in #1 through a registered medical waste hauler? Yes Jd
If yes, category(ies) of by-products or wastes? _....:.B=-.,,_• ..;:o(,'------------ No 0
S. If you answered yes of the above questions (1, 2, 3, or 4), your business or generate medical waste and a permit from the San Diego County Department of Environmental Health is required. Continue with Section B of the questionnaire.
DEH:HM-9095 (Rev. 10/97) Page 1 of 4 County of San Diego Department of Environmental Health • •
SECTION B - CURRENT PERMIT INFORMATION
1. Is your business or facility currently permitted by this Department for hazardous or medical waste handling?
Yes )8j" No D
If yes, what is the permit number (ex: HOOOOl) and the name of the permitted establishment?
2. Are you responsible for the management of hazardous or medical waste generated at this facility? Yes jzj No D
If no, please provide information listing the party responsible for medical waste management at your facility:
Name ______________________________________________________________ ___ (City) (Zip)
Phone # -------------------
Please complete the attached medical Waste Summary.
NOTE: If you do not generate medical waste, you are still required to return this form.
A representative of the San Diego County Department of Environmental Health may contact you to verify the information provided on this questionnaire.
DEH:HM-9095 (Rev. 10/97) Page 2 of 4
County of San Diego Department of Environmental Health
-
MEDICAL WASTE SUMMARY
•
Complete the following information regarding the handling of hazardous wastes at your business or service based upon your answers to SECTION A. Check statement.
D
This business or facility generate medical waste that requires a permit from the San Diego County Department of Environmental Health.
I have determined that this business or service does DQl generate medical waste requiring permits from the San Diego County Department of Environmental Health? I declare under penalty of perjury that to the best of my knowledge and belief the statements made herein are co"ect and true. I consent to all necessary inspections allowed by law and incidental to the issuance of required permit(s) and the operation o is business. ... Title
Date Phone O'fd58 · y{£0
__
Please complete the business information on the reverse of this page and return this questionnaire to the San Diego County Department of Environmental Health in the pre-addressed return envelope or mail using the following address.
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS MANAGEMENT DIVISION
P. 0. BOX 129261
SAN DIEGO, CA 92112-9261
If a San Die&o County Medical Waste Mana&ement Pennjt is required for your business or service, a representative of this Department will conduct an inspection of your business or facility.
DBH:HM-9095 (Rev. l0/97) Page 3 of 4
County of San Diego Department of Environmental Health
ESTAB NUMBER
• COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEALTH
P. 0. BOX 85261, SAN DIEGO, CA 92186-5261 PHONE: 619-338-2222
CENSUS TR/ INC CODE BUS CODE UNITS ANNUAL FEE EXPIR DATE (MO-DAY) I 91 '----1 I ._, I D . '---' ----'1 I.___'_' _' I
2 21 28 31 35
I I I
41 ASSESSOR'S PARCEL NO. SIC-1 SIC-2 FIRE WATER SEWER ZONING MAP ON FILE STATUS H
I ''II.___ CJCJCJCJ D u o-o-u-u
45 49 53 55 57 59 61
ESTABLISHMENT OWNER NAME jf" lp lA I Ia l:r lc. 141L I lmiA IN lA 16:16 10\ IE-IN 111> l:r..ll\{ I <!OJ. 74 ESTABLISHMENT ADDRESS:
STREET NUMBER
114
CITY
151
DIRECTION
D
125
. I
SECOND NAME OR NAME OF MANAGEMENT COMPANY: I I I I I I
187
MAILING ADDRESS
STREET NUMBER
217
CITY
254
ESTABLISHMENT NAME:
IFIP IAI IS lffll\liT IE IE I
284
REASON FOR APPLICATION:
D 1 -NEW
2 - RE-OPEN
3 - OWNER CHANGE
315
NAME OF PREVIOUS OWNER
316
CONTACT PERSON I I I I I
352
228
I I
STREET NAME
127
STATE ZIP CODE
1912IOI-,Itl -I
166 168
I I
230
STATE ZIP CODE
lq1 2 11 lols.l -I
269 271
NUMBER OF EMPLOYEES: IJBJ
I
64 (AREA) OWNER PHONE
104
BLDG/SUITE
IB' I
147
(AREA) BUSINESS PHONE
177
YES = 1
OTHER= 2
BLDG/SUITE
131oll
250
GAS STATION
314
IF OTHER, LIST TYPE OF BUSINESS:
DATE BUS ASSUMED
346
***** ALL APPLICANTS PLEASE COMPLETE APPROPRIATE SUPPLEMENTARY FORMS ***** I DECLARE UNDER PENALTY OF PERJURY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE STATEMENTS MADE HEREIN ARE ·cORRECT AND TRUE. I ro ro T
9 nm o-noo OF
DEH:HM-927 (Rev. 1/95)
.. COUNTY,F SAN DIEGO
BUSINESS NAME f'llecf,'c.c-.,( q.,-f· ':Pte..
ADDRESS 70 (oLA.J""' I
CITY /ZIP 5; U-V\ 1- "C-<- 9 1-o ?I
On the above date, an inspection of your business/facility was conducted in order to detennine compliance with the Safety Code (H&S) Chapters 6.5, 6.7, 6.95; Titles 19,22 and 23 of the California Code of Regulations (CCR); and the San Die:J!'"OJI.otllhfy (SDCC). The following remarks are intended to provide guidance to correct the violations noted on the attached violation : .. Ne.u.:>
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S1gnature of Busmess Representative Date 1gned
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-924 (Rev. 2199) NCR
DISTRIBUTION: WHITE- RETURN TO HMO
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
•
COUNTY OF SAN DIEGO EST. NUMBERH 5'12..2- 'f
DATE 8'- 13--95
PAGE k OF_2-__
BUSINESSADDRESS: 70 TOc.-Jn. Set"t-f.:e.<'- ZIP: 92-o7( YIOLAIION REPORT: The items checked below refer to specific section numbers of{h; California Health and Safety Code Sections 25100 and 117600 et. al.; the San Diego County Code of Regulatory Ordinances Sections 68.1201 et. al.; and the California Code of Regulations, Title 22 Sections 65600 et. al. and 66262.10 et. al. All violations must be corrected. Please call (619) 338-2222 or your Inspector if you have any questions.
GENERAL REQUIREMENTS;
[ 1
[ 1
[ 1
1)4
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
[ 1
An Environmental Health Permit as a medical waste generator has not been obtained. 68.1203, 68.1204, and 117705 ...... V4101 w __ Unlawful disposal of untreated medical waste to an unauthorized point. 118340 ....................... V4102 W Improper treatment of medical waste using an unapproved method -- or proCedure. 118215 ........................... V4103 W Medical SOLID WASTE is not stored in a locked trash -- receptacle or enclosure so as to deny access to unauthorized . or 'cuiting of sliaiPs' waste. at 'tlie" pouit 'of' . . V 4104
W __
generation. ............................ V4105 W_ Medical waste was not separated from other waste at the point of origin. 118275 ............................. V4106 w __ Generator has not maintained reusable containers/bins for medical waste storage in a clean and sanitary manner. 118295 and 118305 ............................ V4107 w_ Storage time exceeded for frozen medical waste, e.g. greater than 90 days. 118280 ........................... V4108 w_ Generator did not clean-up a leak or spill of medical waste in an approved manner. 118300 ...................... V4109 w __ Generator has not secured the enclosure or designated accumulation area for medical waste containers so as to deny access to unauthorized persons. 118310 ............... V4110 W Operator did not PQSt an approved and legible biohazardous waste . . V4111 w __ Generator did not store medical waste in approved and properly marked red ba_gs (non-sharps). lf8275 .......... V4112 W_ Did not place a label with the generator's name,
and phone number on the outs1de of the red bag and/or'-..._ sharps 68.1201 and ............. :·, V4113 W __ Generator d1d not store shal]ls waste m approved and properly -·. marked sha!'PS contain!!r. ll8275 ,. .................. V4114W __ Transportation of med1cal waste w1thout State Hauler · Registration or without a limited-quantity hauling exemption from County HMMD. 118025 ..................... V4115 W Generator did not have standardized written operating procedures -- for a steam sterilizer available onsite. 118215 ........... V4116 W Did not have recording thermometer checked for calibration -- annually. 118215 .............................. V4117 w __ Generator did not maintain records of thermometer calibration checks for at least 3 years. 118215 .................. V4118 w __ Operator did not use heat -sensitive tape or other approved method for eru;h load of medical waste treated ons1te. 118215 . V4119 w __ Need to useamological indicator or other approved method at least once a month to confirm proper disinfection
conditions. 118215 ............................ V4120 W __ Must tie-off red bags to prevent leakage or expulsion of contents during haridling and storage. 118280 ........... V4121 w __ Did not containerize and place redl>ags in rigid, leak resistant, and covered containers or b1ns. 118280 ......... V4122 w __ Must have waste container/bin labeled on the lid and side so as to be clearly visible. 118280 ................... V4123 w __ Did not tape closed or tightly-lid a full sharps container ready for disposal, to preclude loss of contents. 118285 ..... V4124 w __ BEOUJREMENTS· < po s per mon o waste
[ 1 Medical Waste Management Plan has not been submitted to County HMMD (Anriual Requirement) 68.1206 and 117935 V4025 W __ [ 1 Must maintain and show proof of "onsite" medical waste treatment records for 3 years. 118215 and 117943 ........ V4026 w __ [ 1 Generator did not retain on file disposal receipts and/or tracking documents for waste shipped offsite for at least 2 years. 117945 .............................. V4027 W __ [ 1 Need to apply for and receive a limited-quantity hauling exemption for "self-hauled" medical waste ( <20 pounds of waste per week). 118030 and 118025 ................ V4028 W [ 1 Did not renew a limited-quantity hauling exemption annually. 118030 .............................. V4029 W [ 1 Storage time exceeded for full sharps container(s)1 e.g. greater -- than 7 days at room temperatures (for > 20 pounas/monih generator). 118285 ............................ V4030 W __ [ 1 Storage ttme exceeded for red bag waste, e.g .. more than 7 days at room temperature (>20 pounds/month generator). 118280 . V4031 W [ 1 yery small generator (e.g .. <20 pounds per J_JIOnth) -- wproperly stormg waste for greater than 10 days ons1te at room temperature. 118280 ....................... V4032 w __ DISTRIBUTION:
DEH:HM-9255 (5191) NCR
[ 1 Mat'um holding time exceeded for non-rutrescible medical J!'f. , e.g. greater than 180 days. 68.120 ............. V4033 W_ ,-1i
Medical Waste Management Plan has not been submitted to County HMMD (AnnUal Requirement). 117960 and 68.1206 . V4034 W __ [ 1 Must maintain and show proof of "onsite" medical waste treatment records for 3 years. 118215 and 117975 ........ V4035 W __ [ 1 Generator did not retain on file disposal receipts and/ or tracking documents for waste shipped offsite for at least [ 1
. 3 years. 117975 .............................. V4036 W __ Storage time exceeded for full sharps container(s), e.g. greater than 7 days at room temperature. 118285 .............. V4037 W [ 1 Storage ttme exceeded for red bag waste, e.g. more than 7 days at room temperature. 118280 ...................... V4038 w __ PATIJOLOGX WASTE AND CHEMQTIIERAP¥ WASTE DANDLING;
[ 1 Did not segregate chemotherapy waste from other
medical waste. 118275 .......................... V4039 w __ [ 1 Generator did not label container holding chemotherapy waste with the words "chemotherapy waste" or other approved markings on the lid and sides. 118275 ................ V4040 w __ £ 1 ...... V4041 w __ [ 1 Generator did not label container holding pathology waste with the words "pathology waste" or oilier approved markings on the lid and side. 118275 ....................... V4042 w __ [ 1 Unlawful dis!X1sal of pathology waste or chemotherapy waste to an unauthorized pomt. 118340 ................... V4043 w __ PHARMACEUTICAL WASTE DANDLING;
[ 1 Generator did not segregate pharmaceutical waste from other medical waste. 118275g ......................... V4044 w __ [ 1 Generator did not Iaber container pharmaceutical waste with the words "incineration only or other approved markings on the lid and side. 118275g ................ V4045 W [ 1 Storage time exceeded for pharmaceutical waste, e,g. more than -- 90 days. (2 10 Jl:Ounds per calendar year geJ_Jerate<l) 118280e . V4046 W __ [ 1 Very smair quantity generator of pharmaceutical waste (e.g. < 10 pounds waste /calendaf year) improperly storing waste for longer than one year. 118280e .............. V4047 w __ [ 1 Unlawful disposal of pharmaceutical waste to an unauthorized point. 118340 and 118222 ........................ V4048 w_ ON-SITE MEPICAL WASTE TREATMENT fACILITY REQUIREMENTS;
[ 1 Operator has not obtained an onsite medical waste treatment permit from the County. 117950, 118130, 118155,
and CCR 65620 .............................. V4049 W [ 1 Must maintain an updated and complete copy of the -- medical waste treatment permit ons1te and available for review. CCR 6562l(t), 65623, 118165, and 118180 ....... V4050 W_ [ 1 Did not comply with a condition of the medical waste treatment permit issued by the County. CCR 65623 . . . . . . . V 4051 W __ PHOTOCHEMICAL and UAZARDQUS WASTE MGMI. AND DISPQSAL;
... V4052 w __ [ 1
[ 1 Generator has not maintained waste disposal records. e.g. manifests/milk-run receipts .. onsite for 3 years. 66262.40 .... V4053 w __ [ 1 Generator has not obtained an EPA Identification Number from the State DTSC for hazardous waste generation. e.g. waste. 66262.12 . . . . . . . . . . . . v 4054 w __ [ 1 Generator did not properly label the container holding hazardous waste. 66262.34 ....................... V4055 w __ [ 1 Generator did not maintain the container holding hazardous ....... V4056 w __ [ 1 Generator did not submit a notification to the County prior to treating photochemical waste onsite (e.g. > 10 gallons/month: tiered permitting). 25201.5 ....................... V4057 W __
WHITE-RETURN TO HMMD
YELWW-BUSlNESS RETAINS
• • INSP£C'l'ION
I I I I I I I
. COUNTY OF SAN DIECO DE:PAATMDn' OF DIVIRONMEHTAL
SPECIALIST USE OHl.Y
IIV.l.TH
P. 0. lOX 129261, SAN DIEGO. CA 92112-9261 PHONE: 619-338-2222 CENSUS TR/INC CODE BUS CODE: UNITS ANNUAL FEE E:XPIR (MO-DAYI I I I I I I I HS''t 7_.7..'-( II I ''I' I c=J I'' I II' I I I I I I I I I I 2 21 28 31 35 41 SIC-1 IIC-2 FIRE MATER SEWER ZONING MAP ON FILl STATUS ASSESSOR'S PAACEL NO. 1 , , , 11 ....__, 1 CJ CJ CJ u o CJ u-u-CJ-CJ
74 /
ts'rA.BLISHMENT ADDRESS:
STREE1' NUMBER
1?1 01 I I I I
1U
CITY
I I I I l I
_; C.. "' f- L <::...
151
53 55
DIRECTION
D
1l5
I I I
SECOND KAME 01t NAME OF COMPANY:
57 59
I I I I I I I I I I I I
G r f. Y:n.c.,
"
(l'IU:A) OWNER PHONE
,'Ls-8t.t 0 oo.
104
BLOC/SUITE
U I I I I I I I I I I lfl I I I [l_o LAJ11 Lr
j,
16 1
· I I
1l7 U7
STATE ZIP CODE (AREAl BUSINESS PHONE
j2AI I I I I I I -I .tt2o7t . . fill
L__j- I' I
166 168 177
I I I I .j I I I I I I I I I I I I l I
__________________________________________ _J
187
to.ILING ADDRESS (IF DIF'FERENT FROM ADOR£SSI:
STREET NUMBER OIJU:Cl'IC.."N STRJ::r.T NAME:
I BLOO/SUITE
I I I I I I I I l I D
l17
CITY
I I
254
ESTABLISHMENT
I I I I I I I
284
REASON roR APPLICATION:
r:ll
w 1 -NEW
2- RE-OPDf
315
NAME OF PIU:VIOUS OWNER
l
i=L I I I 'D . Pit fh . 316
CONTACT PERSON
3 - OWNER CHANGE
I I I I
c;: r f·
I I I I I
f2..0SS
352
I I
• 230
STATE
l69
ZIP COD!
l71
I I
I I
250
GAS STATION
3U
t"F tfn!n, LIST TYP£ OF BUSDO.:.SS:
DAT! BUS ASSUMED
lo1
7 1
z.
1 i/ 1
KI
346
••••• ALL APPLICANTS PLEASE COMPLETE APPROPRIATE SUPPI.EME:NTAAY FORMS ••••• I OECI.AJU: UNDER PENALTY OF PER.roRY THAT TO THE BEST OF MY IQIOWLE:DCE AHt> BELIEF THE STATEMENTS KADE HEREIN ARE CORRECT AND TRUE. I HEREBY CONSENT TO ALI. NECESSAAY INSPECTIONS IO.OE PIJRS\IANT TO t.AW 11ND INCIDDlTAL TO THE ISSUANCE OF THIS PERMIT AND THE OPERATION OF THIS BUSINESS.
DER:HM-tl7 caev. 10/t7l
SICTION • B - INVENTORY or HAZA&POOS MATERIALS •
A· "hazardous substance" is a chemical compound, or product for which a manufacturer or producer is required by to prepare a Material Safety Data Sheet (MSDS) for that substance. An MSDS is a document (usually 2 or 3 pages) which contains chemical composition information, fire and explosive data, health hazard data, reactivity data, spill or leak procedures, special protection information and special precaution information. An MSDS for a hazardous substance can be obtained from the supplier of that substance. Hazardous substances also include materials requiring placard warnings during transportation.
1. Does your establishment use or handle hazardous, substances in quantities equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet of compressed gas at any one time?
Yes 0 No 0
2. Review the health hazards data or health and safety section of the Material Safety Data Sheets (MSDS) to see if any chemicals or substances you use are designated as a cancer-causing substance (carcinogen) or substance which may cause birth defects, miscarriages, or damage to the human reproductive system (reproductive toxin). Does your establishment use or handle carcinogens or reproductive toxins? Yes 0 No 0
3. Does your establishment use or handle gases with Threshold Limit Values (TLV) or Time Weighted Average (TWA) of 10 parts per million or less? Yes 0 No 0
If you have answered "Yes" of the above questions (1, 2, or 3), you s12 use or handle hazardous materials that are subject to inventory requirements and a permit from the San Diego County Department of Environmental Health is required.
Continue with Section C of the questionnaire.
SECTION C - QNDIRGROQND STO&AGI
An "underground storage tank" is a tank, including piping, which holds hazardous wastes (as defined in Section A) or hazardous substances (as defined in Section B, regardless of volume) and has 10\ or more of the total volume located below grade.
Does your business have underground storage tanks as defined above? Yes 0 No 0
If you answered "yes", a permit from the San Diego County Department of Environmental Health is required.
Underground storage tanks may not be installed, removed, destroyed, repaired or operated without permits from this Department.
Continue with the Hazardous Materials Summary on page 4.
PL&ASB RETURN THIS SECTION
OEH:HM-,06 (R.v. 10/,7) -3-
County of San Diego
Department of Environmental Health
SAN DIEGO
I COMPLIANCE INSPECTION .I
BUSINESS NAME f)rs;bJw__s hwp.
ADDRESS _ __
CITY/ZIP ___ __
On the above date, an inspection of your business/facility was conducted in order to determine compliance the Health and Safety Code (H&S) 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.
MAR D 4
Jt1J dlr d J;Vuk atl))tiW br/?!m ··!fUa /s c/etf/Vt tU<) 9tW) - /AJII4k is fJtaJYt> · f
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a £ftc r Mun:yec Titl'
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-924 (Rev. 2/99) NCR
DISTRJBUTION: WHITE· RETURN TO HMO
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
COUNTY • OF SAN DIEGO
_ _!:QMPLJA.NCE INSPECTION.REPORT.
ADDRESS __
CITY /ZIP
On the above date, an inspection of your business/facility was conducted in or er to detennine compliance with the California Health and Safety Code (H&S) Chapters 6.5, 6.7, 6.95; Titles 19,22 and 23 ofthe 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. · Office Use Only
I
DEC 1 P. 2003
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM·924 (Rev. 2/99) NCR
DISTRIBUTION: WHITE- RETURN TO HMD
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
(
[t1 c.J r; t /off's /a r ,.-f (!'' &J , ('ci ff(
rl/tt./ /if If
-e
COUNTY OF SAN DIEGO
1-. INSlECTION_REI!ORT -1---
BUSINESS NAME +b r;: . Le 1 Mp
ADDRESS 70 TO'-<.l.....( PJ. P.KWA!' l3
CITY/ZIP CA- C\ '2- 0 7 (
On the above date, an inspection of your business/facility was conducted in order to Health and Safety Code (H&S) Chapters 6.5, 6.7, 6.95; Titles 19,22 and 23 ofthe 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 jBti'l" Ie.) ' .. ,
Office Use Only N !; y.J j3D g 1 1'-1 S S ·
---
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Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261; (619) 338-2222 DEH:HM-924 (Rev. 2/99) NCR
DISTRIBUTION: WHITE- RETURN TO HMO
YELLOW-BUSINESS RETAINS
County of San Diego
Department of Environmental Health
COUNTY OF SAN DIEGO EST. NUMBER H S"A_5"0 "2.,
DATE
PAGE _..:::..;;L __
BUSINESS ADDRESS: -z() IAI"l (14...w 10 'F'CeVIOLAIION REPORT: The items checked below refer to specific section numbers of l California Health and Safety Code Sections 25100 and 1 7600 et. a/.; the San Diego County Code of Regulatory Ordinances Sections 68.1201 et. al.; and the California Code of Regulations, litle 22 Sections 65600 et. al. and 66262.10 et. al. All violations must be corrected. Please call (619) 338-2222 or your inspector if you bave any questions.
GENERAL BEOVIREMENTSi
£ I An Environmental Health Permit as a medical waste generator has not been obtained. 68.1203, 68.1204, and 117705 ...... V4101 w __ [ I Unlawful disposal of untreated medical waste to an unauthorized point. 118340 ....................... V4102 W [ I Improper treatment of medical waste using an unapproved method or procedure. 118215 ........................... V4103 W [ I Medical SOLID WASTE is not stored in a locked trash -- receptacle or enclosure so as to deny access to unauthorized [ I 'or.cutting of sharps.wasie. at .the. point.of ... V 4104
w __ generation. :rf rfo5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . v 4 105 w_ [ 1 Medical waste was not separated from other waste at the point of origin. 118275 ............................. V4106 w __ [ I Generator has not maintained reusable containers/bins for medical waste storage in a clean and sanitary manner. 118295 and 118305· ............................ V4107 w __ [ I Storage time exceeded for frozen medical waste, e.g. greater than 90 days. 118280 ........................... V4108 W __ [ 1 Generator did not clean-up a leak or spill of medical waste in [ I Maximum holding time exceeded for non-putrescible medical waste, e.g. greater than 180 days. 68.1203 ............. V4033 w __ LARGE OUANIITY WASI'E GENERATQRS;
(2 200 pounds of waste in a month)
[ I Medical Waste Management Plan has not been submitted to County HMMD (Annital Requirement) . 117960 and 68.1206 . V4034 W __ [ I Must maintain and show proof of "onsite" medical waste treatment records for 3 years. 118215 and 117975 ........ V4035 w __ [ I Generator did not retain on file disposal receipts and/or tracking documents for waste shipped offsite for at least 3 years. 117975 .............................. V4036 W __ [ I Storage time exceeded for full shalpl! container(s), e.g. greater than 7 days at room tefl!perature. 118285 .............. V4037 w __ [ I Storage ume exceeded for red bag waste, e.g. more than 7 days at room temperature. 118280 ...................... V4038 w __ an approved manner. 118300 ...................... V4109 W __ [ 1 Generator has not secured the enclosure or designated PATHOLOGY WASTE AND CIIEMOTIIERAPY WASTE HANDLING; accumulation area for medical waste containers so as to deny access to unauthorized persons. 118310 ............... V4IIO W [ I Did !lOt segregate chemotherapy waste from other [ 1 Operator did not PQSt an approved and legible biohazardous waste -- med1cal waste. 118275 ................ : ......... V4039 W __ ·warning sign • in English and Spanish at the waste storage [ I Generator did not label container holding chemotherapy waste area(s). 118310 ............................... V4111 w__ with the words "chemotherapy waste" or other approved [ 1 Generator did not store medical waste in approved and markings on the lid and sides. 118275 ................ V4040 W __ properly marked red ba_gs (non-sharps). tr8275 .......... V4112 W__ [ I Did not pathology waste from other medical [ 1 Did not place a label w1th the generator's name, address, waste. 118275 ............................... V4041 W __ and phone number on the outs1de of the red bag and/or [ I Generator did not label container holding pathology waste sharps container. 68.1201 and 68.1205 ............... V4113 W__ with the words "pathology waste" or otfier approved markings [ 1 Generator did not store shal]ls waste in approved and properly on the lid and side. 118275 ....................... V4042 w __ marked sharps container. 111!275 ................... V4114 w__ [ I tUonlaanwunafuludthis0 pqrizedsal opofpamttho. 1
t
1 ogy was·te· o. r_ c_h_e_m_o_th_e_ra_p_y_w_a.st_e .. V404 3 w __ [ 1 Transportation of medical waste without State Hauler 8340 Registration or without a limited-quantity hauling exemption fromCountyHMMD. 118025 ..................... V4115W PHARMACEliTICAL-WASTE--IIANJ>hiNG. [ 1 Generator did not have stan<Jardized_written.operating..procedures -- sterilizer availlilile onsite. 118215 . · · · ..... · · V4116 W__ [ 1 did not segregate pharmaceutical waste from other [ 1 Did not have recording thermometer checked for calibration ed cal te 118275 V4044 w annually. 118215. · . · · · · · · · · · · · · · · · · · · · · · · · · · · · V4117 W__ [ 1 itOidhill. phanmce'uiical· . . . -- [ 1 Generator did not maintain records of thermometer calibration waste with the words •incineration onlyw or other approved checks for at least 3 years. 118215 .................. V4118 w__ markings on the lid and side 118275g V4045 W [ I Operator did not use heat-sensitive tape or other approved · · · · · · · · · · · · · · · · · method for each [ I Storage time exceeded for pharmaceutical waste, e.g. more than -- load of medical waste treated ons1te. 118215 . V4119 W__ 90 days. (2_ 10 IJ:OIInds per calendar year I18280e . V4046 w __ [ 1 Need to use aliiological indicator or other approved method [ 1 Very small quanUty generator of pharmaceuucal waste at least once a month to confirm proper disinfection (e.g. < 10 pounds waste /calendar year) improperly storing conditions.118215 · · · · · · · · · · · · · · · · · · · · · · · · · · · · V4120W__ wasteforlongerthanoneyear.ll8280e .............. V4047W [ 1 Must tie-off red bags to prevent leakage or expulsion of [ 1 Unlawful disposal of pharinaceutical waste to an unauthorized -- contents during handling and storage. 118280 ........... V4121 w__ point 118340 and 118222 V4048 w [ ) Did not containerize and place redoags in rigid, leak · · · · · · · · · · · · · · · · · · · · · · · · · -- resistant, and covered containers or bms. 118280 ......... V4122 W __ [ 1 Must have waste container/bin labeled on the lid and side so as to be clearly visible. 118280 ................... V4123 W __ [ 1 Did not tape closed or tightly-lid a full sharps container ready for disposal, to preclude loss of contents. 118285 ..... V4124 w __ SMALL OMtNIITY BEOUIREMENTS· ( < 200 pou per mon o waste V4025W __ [ 1 Medical Waste Management Plan has not been submitted to County HMMD (Annual Requirement) 68.1206 and 117935 [ 1 Must maintain and show proof of "onsite" medical waste treatment records for 3 years. 118215 and 117943 ........ V4026 w __ [ 1 Generator did not retain on file disposal receipts and/or tracking documents for waste shipPed offsite for at least 2 years. 117945 .............................. V4027 W __ [ 1 Need to apply for and receive a limited-quantity hauling exemption for "self-hauled" medical waste ( <20 pounds of waste per week). 118030 and 118025 ................ V4028 W __ [ 1 Did not renew a limited-quantity hauling exemption annually. 118030 .............................. V4029 w __ [ 1 Storage time exceeded for full sharps container(s)1 e.g. greater than 7 days at room temperatures (for > 20 pouoos/month generator). 118285 ............................ V4030 W [ 1 Storage time exceeded for red bag waste, e.g .. more than 7 days -- at room (>20 polllKfs/month generator). 118280 . V4031 w __ [ 1 Very small quantity generator (e.g .. <20 pounds per month) improperly storing waste for greater than 30 days onsite at room temperature. 1182 0 ....................... V4032 W __ DISTRIBUTION: D!;:H:HM-9255 (5/97) NCR
ON-SITE MEDICAL WASIE TREATMENT FACILITY REOUIREMENIS;
[I Operator has not obtained an onsite medical waste treatment permit from the County. 117950, 118130, 118155, and CCR 65620 .............................. V4049 W [ I Must maintain an updated and complete copy of the -- medical waste treatment permit ons1te and available for review. CCR 6562l(t), 65623, 118165, and 118180 ....... V4050 W __ [ I Did not comply with a condition of the medical waste treatment permit issued by the County. CCR 65623 . . . . . . . V 4051 W __ PHOTOCHEMICAL and HAZARDQUS WASTE MGMT. AND DISPOSAL:
[ I Illegal disposal of Dhotoprocessing/ hazardous waste to the sewer, trash, etc. "25189.5 ...................... . [ I Generator has not maintained waste disposal records. e.g. · manifests/milk-run .. onsite for 3 years. 66262.40 .... [ I Generator has not obtaini:d an EPA ldenufication Number from the State DTSC for hazardous waste f:eneration. e.g. [ I &hotoprocessinglhazardous waste. 66262. 2 . . . . . . . . . . . . h== ..... . [ I Generator did not maintain the container holding hazardous ...... . [ I Generator did not submit a notification to the County prior to treating photochemical waste onsite (e.g. > 10 gallons/month: tiered permitting). 25201.5 ...................... .
V4052W __
V4053W __
V4054W __
V4055W __
V4056W __
V4057 w __
oA Es N TITLE
WHITE-RETURN TO HMMD
YELLOW-BUSINESS RETAINS
'"'
• SAN DIEGO COUNTY
., DEPARTMENT OF ENVIRONMENTAL HEALTH- CUPA
HAZARDOUS MATERIALS DIY_ISION __ _ . --- ----
(; --- ----- --- -- ------ -- -----·-- - -
----- -- --- § P.O. BOX 129261, SAN DIEGO, CA 92112-9261 --<. .t> (619) 338-2222 FAX (619) 338-2377
1-800-253-9933
·.: ..
BUSINESS ACTIVITIES
I. FACILITY IDENTIFICATION
FACILITY ID #
3 1
7 I _-I
0 I
0 I
0 I . I H lo 121 . ·1 EPA ID H (Hazardous Waste Only) 2 BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) lL LG" MD
3 II. ACTIVITIES DECLARATION
NOTE: If you check YES to any part of this list,
please submit the Business Owner/Operator Identification page (OES Form 2730).
Does your facility ... If Yes, please complete these pages of the UPCF ....
A. HAZARDOUS MATERIALS
Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold DYES 4 HAZARDOUS MATERIALS INVENTORYquantity for an extremely hazardous substance specified in 40 CFR Part CHEMICAL DESCRIPTION (OES 2731) 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to lO CFR Parts 30, 40 or 70?
B. U!'I.'DERGROUND STORAGE TANKS (USTs} UST FACILITY (Formerly SWRCB Form A) . Own or operate underground storage tanks'! DYES ];6NO 5 UST TANK (one page per tank) (Formerly Form B) . Intend to upgrade existing or install new USTs? DYES ffNO 6 UST FACILITY UST TANK (one per tank)
I UST II"'SIALLATION-=-CEIU'IFICA'I'E--GF---
COMPLIANCE (one page per tank) (Formerly Form C)
. Need to report closing a UST? DYES Ia' No 7 UST TANK (closure portion -one page per tank) c. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs}
Own or operate ASTs above these thresholds:
---any tank capacity is greater than 660 gallons, or DYES E:r'No 8 NO FORM REQUIRED TO CUP As ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE
. Generate hazardous waste? DYES [?'NO 9 EPA ID NUMBER- provide at the top of this page
. Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MATERIALS REPORT (one materials (per HSC 25143.2)? DYES f2(No 10 per recycler) . Treat hazardous waste on site? DYES
ON SITE HAZARDOUS WASTE
!2r'No 11 TREATMENT- FACILITY (Formerly DTSC
Forms Jm)
ONSITE HAZARDOUS WASTE
TREATMENT - UNIT (one page per unit) (Formerly
DTSC Forms 1772 A,B,C,D and L)
I· Treatment subject to financial assurance requirements (for Permit by CERTIFICATION OF FINANClAL Rule and Conditional Authorization)? DYES ffNO 12 ASSURANCE (Formerly DTSC Form 1232) REMOTE WASTE I CONSOLIDATION SITE . Consoiidate hazardous waste generated at a remote site? DYES EJNo 13 ANNUAL NOTIFICATION (Formerly DTSC Form 1196)
. Need to report the closure/removal of a tank that was classified as HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? DYES ,la"No 14 CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS 15
. MEDICAL WASTE
Generate< 200 lbs/month of Medical!Biohazardous Waste? e:(YES D NO Generate L200 lbs/month of Medical/Biohazardous Waste? DYES G::r'NO I . Generate L200 lbs/month of Medical/Biohazardous Waste and treat any amount of medical waste? DYES J;;3"'NO Handle Toxic gases with threshold limit concentration (TL V) 10 ppm in any quantity? DYES !a"'No I
DEH:HM-UPCF-BUS1NESS ACTIVITIES (10/00) -2-
Business Activities ...
Submit the Business Activities page and the Business Owner/Operator ldent1ficat1on page (OES Form 2730), for all submiSSions NOTE. The numbenng of the instructions follows the data element numbers that are on this form These data element numbers are used for electron1c submission and are the same as the numbering used 1n 27 CCR. Appendix C. the Bus1ness Section of the Unified Program Data Dictionary Please number all pages of your submittal This helps the San Diecp County, Department of Environmental Health (DEH), Hazardous Materials D1vision (HMO) identify whether the subm1ttal1s complete and 1f any pages are separated.
1. FACILITY ID NUMBER - Enter your 5 digit Establishment Number (H#) on your Health Permit If you do not have a health permit, leave this blank.
2. EPA ID NUMBER - Enter your facility's 12-character U.S. EPA ID #. If you do not have a number, contact the Department of Toxic Substances Control (DTSC) at (800)- 61-TOXIC or (800) 618-6942, to obtain one.
3. BUSINESS NAME - Enter the full legal name of the business. This is the same as the terms "Facility Name" or "DBA"- Doing Business As.
4. HAZARDOUS MATERIALS ONSITE - Check the appropriate bcx to indicate whether you have a hazardous matenal onsite in the quantities listed in section A of this form. If "Yes", then you must then complete the Business Owner/Operator Identification page (OES Form 2730) and the Hazardous Materials Inventory- Chemical Description page (OES Form 2731 ), as well as a complete Hazardous Materials Business Plan (see HMO form DEH HM952).
5. OWN OR OPERATE UNDERGROUND STORAGE TANK (UST) -Check the appropriate box to indicate whether you own or operate USTs containing hazardous substances as defined in Health and Safety Code (HSC) Section 25316. If "YES," then you must complete one UST Facility page and UST Tank pages for each tank. You must also subm1t a monitoring program plan (See HMD handout DEH HM9222).
6. UPGRADE/INSTALL UST - Check the appropriate box to indicate whether you intend to install or upgrade USTs containing hazardous substances as defined in HSC Section 25316. If "YES," then you r-:1ust complete the UST Installation- Certificate oi Compliance page in addition to UST Facility and Tank pages, plot plan and monitoring program plan and the DEH installation, upgrade permit applications. Contact the HMO at (800)253-9933.
7. UST CLOSURE - Check the appropriate box if you are clos1ng an UST and complete the closure portion of the UST Tank pages for each tank. Submit a DEH closure application.
8. OWN OR OPERATE ABOVEGROUND PETROLEUM STORAGE TANK (AST) - Check the appropriate box to 111dicate whether there are ASTs onsite which exceed the regulatory thresholds. This program applies to all facilities storing petroleum 1n aboveground tanks. Petroleum means crude oil, or any fraction thereof, which 1s liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure (HSC Section 25270.2 (g)).
9. HAZARDOUS WASTE GENERATOR - Check the appropriate box to indicate whether your facility generates hazardous waste. A. generator is the person ur business whose acts or processes produce a hazardous waste or who causes a hazardous substance or waste to become subject to State hazardous waste law. Hazardous waste means a waste that meets any of the criteria for the identification of a hazardous waste adopted by DTSC p:.1rsuant to HSC 025141 "Hazardous waste" includes, but 1s not lim1ted to. federally regulated hazardous waste. Federal haza1·dous waste law is known as the Resource Conservation and Recovery Act (RCRA). Unless explicitly stated otherwise, the term "hazardous waste" also includes extremely hazardous waste and acutely hazardo:Js waste.
10. RECYCLE - Check the appropriate box to indicate whether your facility recycles more than 100 kilograms per month of recyclable material under a claim that the material is excluded or exempt per HSC Section 25143.2. Check "YES" and complete the Recvclable Materials Report pages, if you either recycled onsite or recycled excluded recyclable materials which were generated offsite Check "NO" if you only send recyclable materials to an offsite recycler. You do not need to report. i 1 ONSITE HAZARDOUS WASTE TREATMENT - Check the appropnate box to indicate whether your facility engages in onsi:e treatment of hazardous waste. "Treatment" means any method, technique, or process which is designed to change the physical, chemical, or biological character or composition of any hazardous waste or any matenal contained therein, or removes or reduces its tlarmful properties or characteristics for any purpose. Please contact the HMO to cietermine if any exemptions apply to your facil1ty. If your facility engages in onsite treatment of hazardous waste then complete the Onsite Hazardous Waste Treatment Notification - Facility page and one set of Onsite Hazardous Waste Treatment Notification - Unit pages with. waste and treatment process information for each unit
12 FINANCIAL ASSURANCE - Check the appropriate box to indicate whether your faci!ity is subject to financial assurance requirements for closure of an onsite treatment unit. Unless they are exempt, Perm1t by Rule (PBR) and Conditional!y Authorized (CA) operaticr,s are required to prov1de financial assura11ce for closure costs (per 22 CCR 67 450.13 (b) and HSC Sectior, 25245 4) !I your faci11ty :s subject to fi11ancial asst,rance requ1rements or cla1mi;1g an exempt:on then complete the Certification nf Financial Assura11ce page.
13. REMOTE WASTE CONSOLIDATION s:rE - Check tha appropriate box to ind1cate whetl1er your facility consolid.>tes hazardous waste generated at a remote site. Answer "YES" if you are a hazardous waste generator that collects hazardous waste i11itially at remote sites and subsequently transports the waste to a consolidation s!te ;ou also operc:te. You must be elig1ble pursuant to the conditions in HSC Section 25110.10. If your facility consolidates hazardous waste at a remote site, then r;omplete the Remote Waste Consolidation Site Annual Notification page. 14 HAZL\RDOUS WASTE TANK CLOSURE - Check the appropriate box to 1nd1cate whether the tank bemg closed woJid be class1fied as hazardous waste after its contents are removed. CtasslfiCJ!IOil could be based Your knowledge of the taflk and 1ts contents - The mixture rule - Test1ng of the tank - The l1sted wastes 1n 40 CFR 261.31 or 40 CFR 261.32 lnab1l:ty to remo•;e hazardous matenals stored 1n the tank.
If the tank being closed would be classified as hazardous waste after 1\s contents are removed. tnen you must complete the Hazardous Waste Tank Closure Cert1ficat1on page
15. LOCAL REQUIREMENTS - If you generate Medical Waste you are requ1red to obtam a Health Perm1t and subm1t a B1omedical Waste Management Plan. In addition to this, 1f you generate lbs on medical waste per month and treat any amount of med1cal waste on site you may be required to apply for a medical waste treatment permit with the HMO. TOXIC GASES If you handle tox1c gases with threshold limit concentration (TLV) .:::_10 ppm many ouant1ty, you are required to obtain a Hea!th Permit and submit an HMO Hazardous Materials Business Plan.
lJf 1111\1-l'PCF-Bl :sr:--;ESS .\CTIVITIFS (I 0/00) -3- '.\-1<
UNIFIED PROGRAM FACILITY/HEALTH PERMIT
APPLICATION
This business or service is required to obtain a Unified Program Facility/Health Permit from the San Diego County Department of Environmental Health. I answered "yes" to one or more of the questions on the "Business Activities" form.
D I have determined that this business or service does not require a Unified Program Facility/Health Permit from the San Diego County Department of Environmental Health.
I declare under penalty of perjury that to the best of my knowledge and belief the statements made herein are correct and true. I consent to all necessary inspections allowed by law and incidental to the issuance of required permit(s) and the operation of this business.
Title: fY)ano9eC
Printed Name: La u ne R osr Date: (,-I q. 0)
Phone: /,/{/-Y' cJJ?-'/IJlJD Type ofBusiness:_D=-....:;_oc/t;....:;___.;r'-----"'-(s __________ _ Please complete the business information on the following page and return this application to the San Diego County Department of Environmental Health at:
SAN DIEGO COUNTY
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261
SAN DIEGO CA 92112-9261
If a San Diego County Unified Program Facility/Health Permit is required for your business or service a · representative of this Department will contact your business. Permit fees will be determined from the contact and '-/' a billing statement will be mailed.
NOTE: If you do not use hazardous materials, generate hazardous waste, or have underground storage tanks you are still required to return this form.
A representative of the San Diego County Department of Environmental Health may contact you to verify the information provided on this application.
DEH:HM-906 (10/00)
\fJ ..... ______________ _
SAN DIEGO COUNTY
DEPARTMENT OF ENVIRONMENTAL HEALTH- CUPA
HAZARDOUS MATERIALS DIVISION
. __ §AN
(619} 338-2222 FAX (619} 338-2377
1-800-253-9933
··--- ---- --------11---
BUSINESS OWNER/OPERATOR IDENTIFICATION
FACILITY ID# ENDING DATE
BUSINESS NAME (Same as
120 121
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY123
124
125
126
127
ADDITIONAL LOCALLY COLLECTED INFORMATION:
ALWAYS SUBMIT A COPY OF THIS COMPLETED PAGE WITH SUBMITTAL OF ANY OTHER UNIFIED PROGRAM CONSOLIDATED FORM.
105
107
108
110
112
113
128
129
130
131
132
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.
SIGNA OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE
NAME OF SIGNER 137
-5- OES FORM 2730 (l/99)
Business Owner/Operator ldentificln ..
Please submit the Business Activities page, the Business Owner/Operator Identification page (OES Form 2730). and Hazardous Matenals Cher1ical .I Description pages (OES Form 2731) for all hazardous materials mventory submissions For the inventory to be cons1dered complete ' this page must be signed by the appropriate individual. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C. the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. Th1s helps your C::UPA or AA identify whether the subm1ttal is complete and if any pages are separated.
ALWAYS SUBMIT A COPY OF THIS COMPLETED PAGE WITH SUBMITTAL OF ANY OTHER UNIFIED PROGRAM CONSOLIDATED FORM.
1. FACILITY ID NUMBER- Enter your 5 digit Establishment Number (H#) on your Health Permit If you do not have a health permit. leave this blank.
3. BUSINESS NAME- Enter the full legal name of the business. This is the same as the terms "Facility Name" or "DBA"- Doing Business As. 100. BEGINNING DATE - Enter the beginning year and date (YYYYMMDD) of the inventory report, recyclable materials report, or on-site tiered permitting report for PBR sites.
101. ENDING DATE- Enter the ending year and date (YYYYMMDD) of the reports identified in #1 00. 102. BUSINESS PHONE- Enter the phone number, area code first, and any extension. 103. BUSINESS SITE ADDRESS- Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. If the mailing address is different, complete #113- #116. 104. CITY- Enter the city or unincorporated area in which business site is located. 105. ZIP CODE- Enter the zip code of business site. The extra 4 digit zip may also be added. 106. DUN & BRADSTREET- Enter the Dun & Bradstreet number for the faci!ity. The Dun & Bradstreet number may be obtained by calling (610) 882-7748 or by Internet
107. SIC CODE- Enter the primary Standard Industrial Classification Code number for primary business activity. NOTE: If code is more than 4 digits, only the first four.
108. COUNTY - Enter the county in which the business site is located. 109. BUSINESS OPERA TOR NAME - Enter the name of the business operator wh1ch is the name used for mailing correspondence. 110. BUSINESS OPERATOR PHONE- Enter business operator phone number, if different from business phone, area code first, and any extension. 111. OWNER NAME - Enter name of business owner, if different from business operator. 112. OWNER PHONE- Enter the business owner's phone number if different from business phone. area code first, and any extens1on 113. OWNER MAILING ADDRESS- Enter the owner's mailing address where business related correspondence should be sent. if different from business site address.
114. OWNER CITY- Enter the name of the city for the owner's mailing address. 115. OWNER STATE- Enter the 2 character state abbreviation for the owner's mailmg address. 116. OWNER ZIP CODE - Enter the zip code for the ownerDs address. The extra 4 digit zip may also be added. 117. ENVIRONMENTAL CONTACT NAME- Enter the name of the 1f different from the Business Owner or Operator, who wi!l respond to enforcement activity.
118. CONTACT PHONE- Enter the phone number, if different from Owner or Operator, at which the environmental contact can be contacted. 119. CONTACT MAILING ADDRESS- Er.ter the mailing address where all environmental contact correspondence should be sent 120. CITY- Enter the name of the city fer the environmental contact's mailing address. 121. STATE- Enter the 2 character state abbreviation for the environmental contact's mailing address. 122. ZIP CODE- Enter the zip code for the environmental contact's mailing address. The extra 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME- Enter the r;ame of a representative that can be contacted in case of an emergency involv1ng hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding Incident mitigation.
124. TITLE- Enter the title of the primary emergency contact. 125. BUSINESS PHONE- Enter the business number for the pnmary emergency contact, area code first. and any extensions 126. 24-HOUR PHONE - Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be cne which is answered 24 hours a day. If it is not the contact's home phone number, then the serv1ce a'swering the phone must be able to immediately contact the Individual stated above.
127. PAGER NUMBER- Enter the pager number for the prima;y emergency contact, if available. 128 SECONDARY EMERGENCY CONTACT NAME- enter the name of a secondary representative that can be contacted in the event that the primary emergency contact is not availabie. The contact shall ha'Je FULL facility access Site familianty, and authority to make decisions for the business regarding inC'der.t. mitigation.
1 :!9 TITLE - Enter tne title of the secondary emergency contact 130 8USINESS PHONE- Enter tile business telephone number for the secondary emergency cont3ct, area code firs:, and any extension. 131 24-HOUR PHONE -Enter J 24-hour phone number for the secondary emergency contact. The 24-hour phone number must be one that is answered 24 hours a day i! it is not the contact's home phone number. ther. the serv;ce an:;wering the pho'le must be able to immediately contact the indiviaual stated above.
132 PAGER NUMBER - Enter the pager rumber :or the secondary emergency co'ltact. if available 133. ADDITIONAL LOCALLY COLLECTED INFORMATION- This space may be used !or CUP As or A/\s to collect any additional Information necessary to meet the requirements of their individual programs. Contact your local agency for guidance 134 DATE - Enter the date that the document was sigred. (YYYYMMDDl 135. NAME OF DOCUMENT PRE PARER- Enter the full name of the person who prepared the inventory submittal information 136. NAME OF SIGNER- Enter the full printed name of the person signmg the page. The s1gner certifies to a familiarity with the submitted and that based on the signer's mquiry of those individuals respons1ble for obtain1119 the information all the information subm1tted is true. accurate and complete.
SIGNATURE OF OWNER! OPERATOR OR DESIGNATED REPRESENTATIVE- The Business Owner/Operator. or officially des1gnated representative of the Owner/Operator, shall s1gn in the space provided. This signature certifies that the signer 1s familiar w1th the information submitted and that based on the signer's Inquiry of those individuals responsible for obtaining the information it is the S1gner's belief that the submitted information is true. accurate and complete 137. TITLE OF SIGNER- Enter the title of the person signing the page.
R!OPERATOR IDE"ilii·ICATIO"i I IIJ.IJO) -6- Ul S I ( >R\1 ( 1 'I'll .
HOE H. LE, M.D.
April13, 2001
San Diego County
Dept of Environmental Health - CUPA
Hazardous Material Division
Attn: Martha
Fax: (619) 338-2377
RE: UNITED PROGRAM FACIUlY/HEALTH PERMIT APPLICATION FOR HOE H. LE, M.D.
Dear Martha:
RPR 13 '01 09:08
Caring
This notice is to request a Health Permit for Dr. Hoe H. Le. He was practicing as a provider with Physicians Medical Group, Inc. until 03/31/2001. As of 04/01/2001 Dr. Le stopped practicing with this group, began practice as an individual provider, and is now subleasing this solo practice at the same location. Relevant information to assist you in this process are as follows:
Business Name & Beginning Date
Hoe H. le, M.D.
Business Address & Phone Numbers
70 Town Center Parkway, Suite B
Santee, San Diego County, CA 92071
Office: (6619) 258-4000 Fax: (619} 448-1467
Business Owner Name
Hoe H. Le, M.D.
Owner & Contact Mailing Address
7801 Mission Center Court, Suite 300
San Diego, CA 92108-1391
Contact Name & Phone Number
Chi K. Tran (619} 298-3700
Please mail all relevant information and/or applications to the mailing address. If you have further questions, please contact me at anytime.
Sincerely,
Chi K. Tran
PROVIDER RELATIONS FOR DR. lE
70 TOWN CENTER PARKWAY • SUITE 8 • SANTEE, CA 92071
PHONE: (619) 258-4000 • FAX: (619) 448-1467
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT
PAGE _!___ OF 2 DATE I I I o I Zr.•/5'
RECORD lD #..bel/
TIME START tJ. "!Op END l:
SPECIALIST I
J0tJC. <'" _J..J, 1/ // INSPECTION CONTACT FACILiTY NAME _ £-___ c... _.u __ _ _ _____ _ .frllemy Gtzt/#I'M ADDREss __ 6_· __;./<_ !) ____ _ TITLE LoGs
ciTY ;ziP E _ _ _ ________ z==- On the above date, the County inspected your facility under the authority ofthe Cali fomia 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 ofRegulatoryOrdinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.1! & 25404.1.2) for an minor violation as defi ned in l:l& ·c 254tl4 and 25 117.6. "llti report may c ntain both mi ltOI' nnu t11ore slgnilict1nl ( · II) violati ons. I in or violati ons clo not include repeat \'i llnuons 0 1' violnfi ons remnining uncorrected lor more Limn 30 days (or 1lS specified below). Minor violations do 111 I includ.: kl1<1w lng, \ ill fu l. intent ional, or chmnic iolalion : nor do they include violati ns a pallcrn of neglect or disregard. The remarks hclnw urc inlC11ded to provide to correct LUlY on the utta hed violmi n rep rl. You mu ·t submit fl writ len re:;pon e to th is report within 0 ( J' a speci lied bclO\ ') ocmonstruting that all vi lations have been coJTected or include r1 written notice a I' disagreement that cleurly states the reason lo r any disputed Pr()mpt correction can protect you fh1m pena lties for a "minor violation". Penalties can be imposed for each day in violation for all other vi(·>lntions even il' thcy are conected promptly. Howe cr. corrccli n within 30 days (or as specified below) will make a penalty less likely.
NOTE: Reins ection fees will be har d if ad ditiona l ins ections are re uired to determine com linnce.
L!f D Unified Program Facility Permit current YY/A. Permit Expires on: /t> I I Zol) 8"' D Hazardous Materials Business Plan available ef JJ Contingency Plan available DLQG Gi'§QG c;r" ..-0 Employee training is adequate g...--:0 Employee training records available &:V" __D Waste disposal records available for review Universal waste !IV"" .-0 Emergency contacts current D Updated today 19" ...0 Waste containers Etla bcled fij3""' D Chemical inventory/map current D Updated today [9"' 0 Waste containers in good condition Consent to inspect granted hy : pectiou on tact Er'6ther: AL. Ma.l/0 -Jtvttt- /<OU!"IAI • /N5( CC..l7
The ilzardous Materials Business Plan (inventory & site map, emergency contacts, emergency response plan1 and employe tnining plan) is required by law to be certified online through the California Environmental Reporting 'ystem ( ERS). 'For additional information about hazardous materials business laos and CERS, o to: ht ://www.sdcount •.ca. ov/dch/hazmat/hmd-cer -inl'o.html CZ5 f I 13 ( '2q>t S
TITLE OF FACILITY REPRESENTATIVE
.rlment of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, Phone: (858 505-6880 htt l://www.sdcdeb.nr
HM-924 (08/ 13) NCR '(Y= Yes; N/A = Not Applicable) DISTRIBUTION: WHITE-HMO COPY; YELLOW-FACILITY COPY
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE INSPECTION REPORT
PERMIT # Z,,;z.. I CJ
DATE __ 1_1_!_2_1_!5_
PAGE z.._ OF 2...
FACILITY ADDRESS: q¥16 A ZIP ODE: _ 1 _Zc_ ? _/ __ _
e/Jifl;-?:>N V':)?{Z)J T*l_ S'y.!Tl?WI ),
A IUTY REPRESENTATIVE
HM-911 0 (06/11) NCR White: HMD Yellow: Facility
..c&l_t 13 I 2¢)/ 5"
DATE SIGNED
DEB-Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT
PAGE _!___ OF 2 DATE I I I o I Zr.•/5'
RECORD lD #..bel/
TIME START tJ. "!Op END l:
SPECIALIST I
J0tJC. <'" _J..J, 1/ // INSPECTION CONTACT FACILiTY NAME _ £-___ c... _.u __ _ _ _____ _ .frllemy Gtzt/#I'M ADDREss __ 6_· __;./<_ !) ____ _ TITLE LoGs
ciTY ;ziP E _ _ _ ________ z==- On the above date, the County inspected your facility under the authority ofthe Cali fomia 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 ofRegulatoryOrdinances (SDCC). This report serves as a Notice to Comply (H&SC 25187.1! & 25404.1.2) for an minor violation as defi ned in l:l& ·c 254tl4 and 25 117.6. "llti report may c ntain both mi ltOI' nnu t11ore slgnilict1nl ( · II) violati ons. I in or violati ons clo not include repeat \'i llnuons 0 1' violnfi ons remnining uncorrected lor more Limn 30 days (or 1lS specified below). Minor violations do 111 I includ.: kl1<1w lng, \ ill fu l. intent ional, or chmnic iolalion : nor do they include violati ns a pallcrn of neglect or disregard. The remarks hclnw urc inlC11ded to provide to correct LUlY on the utta hed violmi n rep rl. You mu ·t submit fl writ len re:;pon e to th is report within 0 ( J' a speci lied bclO\ ') ocmonstruting that all vi lations have been coJTected or include r1 written notice a I' disagreement that cleurly states the reason lo r any disputed Pr()mpt correction can protect you fh1m pena lties for a "minor violation". Penalties can be imposed for each day in violation for all other vi(·>lntions even il' thcy are conected promptly. Howe cr. corrccli n within 30 days (or as specified below) will make a penalty less likely.
NOTE: Reins ection fees will be har d if ad ditiona l ins ections are re uired to determine com linnce.
L!f D Unified Program Facility Permit current YY/A. Permit Expires on: /t> I I Zol) 8"' D Hazardous Materials Business Plan available ef JJ Contingency Plan available DLQG Gi'§QG c;r" ..-0 Employee training is adequate g...--:0 Employee training records available &:V" __D Waste disposal records available for review Universal waste !IV"" .-0 Emergency contacts current D Updated today 19" ...0 Waste containers Etla bcled fij3""' D Chemical inventory/map current D Updated today [9"' 0 Waste containers in good condition Consent to inspect granted hy : pectiou on tact Er'6ther: AL. Ma.l/0 -Jtvttt- /<OU!"IAI • /N5( CC..l7
The ilzardous Materials Business Plan (inventory & site map, emergency contacts, emergency response plan1 and employe tnining plan) is required by law to be certified online through the California Environmental Reporting 'ystem ( ERS). 'For additional information about hazardous materials business laos and CERS, o to: ht ://www.sdcount •.ca. ov/dch/hazmat/hmd-cer -inl'o.html CZ5 f I 13 ( '2q>t S
TITLE OF FACILITY REPRESENTATIVE
.rlment of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, Phone: (858 505-6880 htt l://www.sdcdeb.nr
HM-924 (08/ 13) NCR '(Y= Yes; N/A = Not Applicable) DISTRIBUTION: WHITE-HMO COPY; YELLOW-FACILITY COPY
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE INSPECTION REPORT
PERMIT # Z,,;z.. I CJ
DATE __ 1_1_!_2_1_!5_
PAGE z.._ OF 2...
FACILITY ADDRESS: q¥16 A ZIP ODE: _ 1 _Zc_ ? _/ __ _
e/Jifl;-?:>N V':)?{Z)J T*l_ S'y.!Tl?WI ),
A IUTY REPRESENTATIVE
HM-911 0 (06/11) NCR White: HMD Yellow: Facility
..c&l_t 13 I 2¢)/ 5"
DATE SIGNED
DEB-Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261
SAN DIEGO COUNTY
DEPARTMENT OF ENVIRONMENTAL HEALTH· CUPA
HAZARDOUS MATERIALS DIVISION
d:.005(4
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(619) 338-2222 FAX (619) 338-2377
1-800-253-9933
BUSINESS ACTIVITIES
Lowe's Home Improvement Warehouse
Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an 181 YES D NO 4 extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan DYES 181 NO 5
DYES 181 NO 6
HAZARDOUS MATERIALS INVENTORYCHEMICAL DESCRIPTION (OES 2731) (l:urm.!rly SWRCU Fonn Al
UST TANK (one page per tank) CI:Urmt;rly Form It)
UST FACILITY
UST TANK l<ll'll!f"'!rt.mk>
UST INSTALLATION -CERTIFICATE OF
COMPLIANCE (m'll.! page per tllllkl <l"ormcrly Form CJ
YES 18] NO 7
•
•
•
•
•
Generate hazardous waste?
Recycle more than I 00 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)?
Treat hazardous waste on site?
Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)?
Consolidate hazardous waste generated at a remote site?
MEDICAL WASTE
Generate <200 lbs/month of Medicai/Biohazardous Waste?
Generate 2:200 lbs/month of Medical/Biohazardous Waste? 181 YES
181 YES
DYES
DYES
DYES
DYES
DYES
DNO 8
DNO 9
181 NO 10
181 NO 11
181 NO 12
181 NO 13
181 NO 14
NO FORM REQUIRED TO CUP As
EPA ID NUMBER- provide al the lop of this
page
RECYCLABLE MATERIALS REPORT <n..,p.:r
n.'Cych!r)
ONSITE HAZARDOUS WASTE
TREATMENT- FACILITY <Formerly DTSC Fn=
1772)
ON SITE HAZARDOUS WASTE
TREATMENT- UNIT (unc page per unit) <Formerly
DTSC 11lrm.'l 1772 A. B. C.l> and 1.)
CERTIFICATION OF FINANCIAL
ASSURANCE <Formerly DTSC Form 1232>
REMOTE WASTE I CONSOLIDATION SITE
ANNUAL NOTIFICATION tl'ormcrly DTSC Form
1196)
HAZARDOUS WASTE TANK CLOSURE
CERTIFICATION ll'•rmcrly llTSC Form 1249>
Generate 2:200 lbs/month of Medicai/Biohazardous Waste and treat any amount of medical waste Handle Toxic gases with threshold limit concentration (TLV) # 10 ppm in any quantity? 0 YES [8:1 NO
0 YES [8:1 NO
0 YES [8:1 NO
0 YES [8:1 NO
DEH:HM-970t-UPCF-Business Activities (7/02)
DATE
UNIFIED PROGRAM FACILITY PERMIT
APPLICATION
GJ This business or service is required to obtain a Unified Program Facility Permit from the San Diego County Department of Environmental Health. I answered "yes" to one or more of the questions on the "Business Activities" form.
Date assumed business ownership at this location: o" I 1 € I o 4 0 I have determined that this business or service does not require a Unified Program Facility Permit from the £an Diego County Department of Environmental Health.
I declare under penalty ofpetjury that to the best of my knowledge and beliefthe statements made herein are correct and true. I consent to all necessary inspections allowed by law and incidental to the issuance of required permit(s) and the operatio of this business -
Printed Name: . Damon Chappell
!e of Business:
Mercantile-Retail of Home Improvement
Products.
Title: Hazmat Specialist
Date: \jo.zo-o3 \'
Phone#: ( 704 ) 7 sa 6005
Area Code
Please complete the business information on the following page and return this application to the San Diego County Department of Environmental Health at:
SAN DIEGO COUNTY
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261
SAN DIEGO CA 92112-9261
If a San Diego County Unified Program Facility Permit is required for your business or service a representative of will
this Department will contact your business. Permit fees will be determined from the contact and a billing statement be mailed.
NOTE: If you do not use hazardous materials, generate hazardous waste, or have underground storage tanks you are still required to return this form.
A representative of the San Diego County Department of Environmental Health may contact you to verify the information provided on this application.
DEH:HM-906 (08/02)
4 DEH:HM-952 (Rev. 07/02)
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 OWNER/OPERATOR IDENTIFICATION
County of San Diego
Department of Environmental Health
SAN DIEGO REGIONAL
HAZARDOUS MATERIALS QUESTIONNAIRE
' usin,e;r Contact
Y,J(j0'u.
c;rt d
;-
Ciry
State
State
Telephone#
Zip Code
Cf"'071
·Zip Code
Telephone#
OFFICE USE ONLY
UPFP# ;}.C ·;;)_ Sl5
BPDATE __
APN#
as-s - J."'i:L - g ¥
Project Contact Ntkle/ lrrclf,--!r:;d- Inc .
j')n/ atro..t:/a. ...... c:..t" t!r'"
The following questions represent the facility's activities, NOT the specific project description. .
PART 1: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicate by ched<ing the item. whether your business will use, process, or store any of the following hazardous materials. If any of the items are checked, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittaL ·
1. 0 Explosive or Blasting Agents 5. Peroxides 9. Reactives
2. 0 pressed Gases · 6. &' Ox1d1zers . 10. 0 ·
3. (i!""jlammable/Combustible Liquids 7. 0 Flyrophorics 11. (i!"Highly Toxic or Toxic Materials &'Flammable Solids . 8. (B'unstable Reactive:; 12. 0 Radioactives
13. 14. f:il'Other Health Hazards
15. 0 None of These
PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH- HAZARDOUS MATERIALS DIVISIONS (HMD): If the answer to any of the is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, 3id floor, San Diego, CA 92101.
Call (619) 338·2222 prior to the issuance of a building permil · Expe. cted date of .. h.. 09-·30-03 10:41
Ft:ES ARE REQUIRED.
YES NO ·
1. 0 .. (i" Is your business listed on the reverse side of this form?
2. 3.
4. 5.
6. Gr. 0 Will your business dispose of Hazardous Substances or Medical Waste in any amount? /ir 0 Will your business store .or handle Hazardous Substances in quantities equal to or greater than .---" 55 gallons, 500 pounds, 200 cubic or carcinogens/reproductive toxins in any quantiry? l.!!f . Will your business use an existing or install an underground storage tank? 0 Will your business store or handle Regulated Substances (CaJARP)? [It" Will your business use or install a Hazardous Waste Tank System (Title 22. Artide 10)? cr;x
0 CaiARP Exempt
EDNA I
Date 00
0 CaiARP Required
I
Date Initials
0 CalARP Complete
I
Date Initials
PART Ill: San Diego County Air Pollution Control District: It the answer is yes to any of the following questions, applicant must contact the Air Pollution Control District, 9150 Chesapeake Drive, San Diego, CA, 92123. Call (858) 650-4550 prior to the issuance of a building permil _.,;/ YES . 0
2. 0
3. 0
4. 0
NO .
Will the subject facility install or use any of the equipment listed on the Listing of Air Pollution Control District Permit Categories, on the reverse side of this form?
0 (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facilicy be located within 1,000 feet of the outer boundary of a .school (K through 12) as listed in the current Directoty of School and Communicy College Distrtcts. published by the San Diego County oi Education and the current California Private School Directory, complied in accordance With the provisions of Education Code Section 33190? · Does the building or structure for which this permit is requested contain any friable asbestos? l!1 Is there demolition involvin the removal of a load su portln structural member? I dedare under penalry of that to the best of my knowledge and belief Name of owner or Authorized Agent
FOR OFFICAL USE ONLY:
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ____________________________ --:------------------------ BY:_______________________________________________ DATE: ____ E.XEMFTOR NO FURTHER INFORMATION REQUIRED RELEASED FOR OCCUPAIICY
COUNTY-HMMO APCO APCO
. 'ENTERED JUL 1 7 2oofzy
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT
PAGE----\.-OF :2.__ DATE .a,_7 .
PERMIT# QW,(} /?
TIME START }'. &(SEND £1: OQ
BUS. CODE ___,/r_....._ _____ _
SPECIALIST 67;irtrau (t'c e
INSPECTION CONTACT/TITLE
/2retf 5f: Murb/1 I krJ Bll&zJvp.(_,c.J_tY'
PHONE: ((;f7) Z/2-l../100 ed. !?01
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 ofRegulations (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 NIA Y NIA
C C Unified Program Facility Permit current and available Permit Expires on: I I ./0
0 Hazardous Materials Business Plan available C Contingency Plan available t:r Employee Training is adequate C Employee Training records available l::t" C Waste disposal records available for review u.r C Waste containers kept closed 0 0
Emergency contacts current C Updated today C C Waste containers kept labeled
11.1 Chemical inventory current C Updated today (;I/ C Waste containers in good condition 1/)et" fl u..S1:, IS .I'n..!l. r1 t" c:77on
r RECEIVED JON 0 7 2007
Initials of Business
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.sdcountv.ca. ov/deh/hmd/index.html HM·924 (12/06) NCR DISTRIBUTION: WHITE· RETURN TO HMD; YELLOW·BUSINESS RETAINS '. . .
COUNTY OF SAN DIEGO
.. • • > i < ' > ' ' • '
EST. NUMBER H
DATE: _ _,S:"--"·
PAGE: --"',)"'----:-- OF _..o.;;d::::oo....===--
BUSINESS ADDRESS: q t((Cz !llJJs/UV\ f d
-EJ!A H=: Ct! L oaa;z. ,Ps- zr ?3
ZIP CODE: 'f:J Q 7j
f"Ie vt:fft
/110 wai? d.c1.h 'T/dzsccd on ..s /U:;.(;;-.11 o
I
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
I , . -
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) 338-23 77
HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION
The California Health & Safety Code CH&SCJ 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 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 0 EN/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 Regulatory Ordinances Section 68.1113.
gtesJ"tmly one of the following boxes:
[9' 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.
0 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 requirements specified in H&SC Section 25505(d)&(e)(2).
As an Authorized Representative, I certify under the penalty oflaw, that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. By checking any of the boxes above I also certify that : a)The information contained in the hazardol!s materials inventory most recently submitted to the CUPA or Administrative Agency is complete, accurate, and up to date; b) There has been no change.in t_!le quantity of hazardous materials reported in the most recently submitted inventory; and c) All hazardous materials subject to inventory are listed on the most recently submitted inventory.
* * IfHIRT box is checked, follow HIRT policy to indicate on the forms which hazardous materials make this a HIRT site.
DEH:HM-953 (05-06) NCR Distribution: White- HMO; Yellow- Business Retains ..
' .,
. ;:. ,;,.. .. .... ·j
'i ·-'
;..
ATTENTION:. HAZARDOUS MATERIALS HANDLER "
:» 55 gallons of a liquid.
:» 500 pounds of a solid substance.
:» . 200 cubic feet of compressed gas.
..,.. i .
:» A. toxic compressed gas (TL V.:::; 10 ppm) in ·any amount. :» Extremely .hazardous substances in quantities eqmll to or greater than the Threshold Planning Quantities.
A complete HMBP consists of the following elements as established in H&SC Section 25504:
:» Hazardous Materials Inventory
:» Site Plan
·:» List of Emergency Contacts
:» Emergency Response Plan
:» Employee Training Plan
The San Diego County, Department of Environmental Health, Hazardous Materials Division (HMD), as the administering·agency and with the concurrence of all the local fire jurisdictions, 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 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 hazargous · materials are stored and must also annually certify that the HMBP is current and maintained.on site.
Substantial changes as listed below must be submitted to the HMO within 30 days of the with a certifi.cati&n that the HMBP is current and maintained on site: · · ·· :» A 100% or greater increase or decrease in the quantity of any hazardous material on the inventory :» Addition or deletion of a hazardous material to the inventory :
:» Changes in the storage, location, or use of hazardous materials :» Any change in business name, ownership, or address
:» Any change in Emergency Coordinator/Contact information Instructions for Completing the Hazardous Materials Business Plan Certification
Note: The numbering of the instructions follows the data element numbers that are on Statewide reporting forms. These·data element numbers are used for electronic submission and are the same as the numbering used in ·p CCR, Appendix C. 1 .. FACILITY ID NUMBER - Enter the 6 character Permit Number from your Permit. it you do not have a leaye this blank.
3. BUSINESS NAME- Enter the full legal name of the business. This is the same as the terms "Facility Name" or "DBA"- Doing Business As. .,
103. BUSINESS SITE ADDRESS- Enter the street address where the facility is located. No post office box numbers allowed. 104. CITY- Enter the city or area in which ousiness site is located:
105. ZIP CODE- Enter the zip code of business site. The extra 4-digit zip may also be added. . ' ' ....... ·' .. ....
CARCINOGEN/REPRODUCTIVE TOXIN ANNUAL RENEWAL WITHOUT CHANGES- Any business which is required to submit a HMBP and handles a material which is a carcinogen·or. reproductive toxin, is required to submit a list of each-such material handled during the previous year to the Director of the•1;)epartment of Environmental Health. The list r:nust include all carcinogens and reproductive toxins handled in quantities. less than 55 gallons or 500 pounds. The list of such materials handled shall be renewed-each year. Check this box' to·certify that the information previously submitted is still correct and no. changes, additions or deletions are - necessary. See http://www.sdcounty.ca.gov/deh!hmd/forms hmd.html and HM-9243 (Disclosure of Hazardous Materials Information Bulletin) to find out if you are required to submit this list.. ' •... ·:: . . INITIAL CERTIFICATION: Check this box if you are submitting a newHMBf'.>. .
I h -.;\
I '· ..
ANNUAL CERTIFICATION WITHOUT CHANGES: Check this box if you are an ann.ual certification on an existing plan.
CERTIFICATION OF CHANGES/REVISIONS: Check this box if you are submitting changes to the hazardous materials inventory, list of emergency contacts, or the site plan. All pages should include the new submittal date. For multi-page site maps, include all pages with new submittal date. ·
DEH:HM-953 (05-06) NCR Distribution: White- HMO; Yellow- Business Retains
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) 338-23 77
HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION
The California Health & Safety Code CH&SCJ 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 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 0 EN/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 Regulatory Ordinances Section 68.1113.
gtesJ"tmly one of the following boxes:
[9' 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.
0 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 requirements specified in H&SC Section 25505(d)&(e)(2).
As an Authorized Representative, I certify under the penalty oflaw, that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. By checking any of the boxes above I also certify that : a)The information contained in the hazardol!s materials inventory most recently submitted to the CUPA or Administrative Agency is complete, accurate, and up to date; b) There has been no change.in t_!le quantity of hazardous materials reported in the most recently submitted inventory; and c) All hazardous materials subject to inventory are listed on the most recently submitted inventory.
* * IfHIRT box is checked, follow HIRT policy to indicate on the forms which hazardous materials make this a HIRT site.
DEH:HM-953 (05-06) NCR Distribution: White- HMO; Yellow- Business Retains ..
' .,
. ;:. ,;,.. .. .... ·j
'i ·-'
;..
ATTENTION:. HAZARDOUS MATERIALS HANDLER "
:» 55 gallons of a liquid.
:» 500 pounds of a solid substance.
:» . 200 cubic feet of compressed gas.
..,.. i .
:» A. toxic compressed gas (TL V.:::; 10 ppm) in ·any amount. :» Extremely .hazardous substances in quantities eqmll to or greater than the Threshold Planning Quantities.
A complete HMBP consists of the following elements as established in H&SC Section 25504:
:» Hazardous Materials Inventory
:» Site Plan
·:» List of Emergency Contacts
:» Emergency Response Plan
:» Employee Training Plan
The San Diego County, Department of Environmental Health, Hazardous Materials Division (HMD), as the administering·agency and with the concurrence of all the local fire jurisdictions, 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 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 hazargous · materials are stored and must also annually certify that the HMBP is current and maintained.on site.
Substantial changes as listed below must be submitted to the HMO within 30 days of the with a certifi.cati&n that the HMBP is current and maintained on site: · · ·· :» A 100% or greater increase or decrease in the quantity of any hazardous material on the inventory :» Addition or deletion of a hazardous material to the inventory :
:» Changes in the storage, location, or use of hazardous materials :» Any change in business name, ownership, or address
:» Any change in Emergency Coordinator/Contact information Instructions for Completing the Hazardous Materials Business Plan Certification
Note: The numbering of the instructions follows the data element numbers that are on Statewide reporting forms. These·data element numbers are used for electronic submission and are the same as the numbering used in ·p CCR, Appendix C. 1 .. FACILITY ID NUMBER - Enter the 6 character Permit Number from your Permit. it you do not have a leaye this blank.
3. BUSINESS NAME- Enter the full legal name of the business. This is the same as the terms "Facility Name" or "DBA"- Doing Business As. .,
103. BUSINESS SITE ADDRESS- Enter the street address where the facility is located. No post office box numbers allowed. 104. CITY- Enter the city or area in which ousiness site is located:
105. ZIP CODE- Enter the zip code of business site. The extra 4-digit zip may also be added. . ' ' ....... ·' .. ....
CARCINOGEN/REPRODUCTIVE TOXIN ANNUAL RENEWAL WITHOUT CHANGES- Any business which is required to submit a HMBP and handles a material which is a carcinogen·or. reproductive toxin, is required to submit a list of each-such material handled during the previous year to the Director of the•1;)epartment of Environmental Health. The list r:nust include all carcinogens and reproductive toxins handled in quantities. less than 55 gallons or 500 pounds. The list of such materials handled shall be renewed-each year. Check this box' to·certify that the information previously submitted is still correct and no. changes, additions or deletions are - necessary. See http://www.sdcounty.ca.gov/deh!hmd/forms hmd.html and HM-9243 (Disclosure of Hazardous Materials Information Bulletin) to find out if you are required to submit this list.. ' •... ·:: . . INITIAL CERTIFICATION: Check this box if you are submitting a newHMBf'.>. .
I h -.;\
I '· ..
ANNUAL CERTIFICATION WITHOUT CHANGES: Check this box if you are an ann.ual certification on an existing plan.
CERTIFICATION OF CHANGES/REVISIONS: Check this box if you are submitting changes to the hazardous materials inventory, list of emergency contacts, or the site plan. All pages should include the new submittal date. For multi-page site maps, include all pages with new submittal date. ·
DEH:HM-953 (05-06) NCR Distribution: White- HMO; Yellow- Business Retains ENTERED MAR 2 3 2010 jr
COUNTY OF SAN DIEGO PAGE_j_OF TE "3; S I /0
COMPLIANCE INSPECTION REPORT
PERMIT# .? (1J :l .. S{'f BUS.
' TIME START {'. ( (o END 3 ilu3
SPECIALIST ft''f
CONTACT
le'm. Sleet? e ( BUSINESS NAME_
(
ADDRESS------<- TITLE___.
CITY /ZIP , < ; t:l """ I e -a q' 2 0 l (
On the above date, the County inspected your business under the authority oftheCalifomia 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.
Y' N/A. NOTE:==
Unified Program Permit current
old" Hazardous Materials Business Plan available
Employee training is adequate
Waste disposal records available for review
Emergency contacts current D Updated today
Chemical inventory/map current today
y• N/A. Permit Expires on:_
D D Contingency Plan available DLQG CBQG
D Employee training records available
n.....-o Universal waste manage properly
ID/ Waste containers · osed rn..tlibeled
D Waste containers in good condition
Consent to inspect granted by: D Inspection Contact D Other:
-
-
I
D 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 tlie information required in the H&SC and is maintained at the site where hazardous materials are stored.
HM-924 ( 11/08) NCR
'
Initials of Business Representative
•
••
COUNTY OF SAN DIEGO
Small
•
Waste
PERMIT#.=
DATE j I 5 I (Q
PAGE .? OF
BUSINESS ZIP·
VIOLATION REPORT: The . . &
and/or the San Diego Cmmty Code (SDCC). Small Waste Generator=(SQG); Large Hazardous 40 of All violations must be corrected. Submit of return to compliance to your Specialist. You may use the Action Form to document your return to compliance. Your Specialist can provide this form. Please call (619) 338-2222 or your Specialist if you have any questions.
HAZARDOUS MATERIALS REQUIREMENTS HAZWASTE REQUIREMENTS FOR LOGs & SOGs Viol
# v VIOLATION DESCRIPTION
D 1001 UPF permit not obtained for hazardous materials. 68.905 D 1002 HMBP not established/implemented. 25503.5(a)
D 1004 HMBP not submitted to HMD. 25505(a)
D 1005 Emergency contact not provided or current. 25509(a)(7) D 1007 Highly toxic gas (TLV_sJO ppm) not
disclosed.68.1113(b)
D 1008 Annual carcinogen/repmductive toxin list not sent to HMD. 68.1113( c) E( 1009 Site map is not sufficient or complete. 25509(a)(5) & 25505(a)(2) D 1010 Did not repon release or threatened release. 25507(a), CCR 2703 D 1013 Copy of HMBP not onsite for inspector's review. 25505( e) D 1014 HMBP is incomplete/inade5uate/not amended to reflect changes. 25504, 25505(a)(2) &/or 2 509(a); 25505(b); 19 CCR 2729 D 1015 Did not have adequate employee training program 2732 &/or 25504 (c)
D 1016 Failure to have an adequate emergency response plan 25504 (b); 2731 D 1017 Business Plan not cenified annually. 25505(d) & (e)(2) D 1018 Inventory not amended for 100% increase of hazardous material onsite or inventory is incomplete. 25509,25510
HAZWASTE REQUIREMENTS FOR LOGs & SOGs
RECORDKEEPING
D 0131
D 0132
D 0133
D 0134
D 0135
D 0136
D 0137
D 0138
D 0140
D 0141
D 0142
D 0145
D 0146
D 0147
D 0148
D 0149
gram Facility (UPF) pennit not obtained. SDCC 68.905
tain & maintain a valid EPA lD Number. 66262.12(a)
d manifest copy to DTSC. 66262.23(a)( 4)
Unified Pro
Failed to ob
Failed to sen
Failed to fil e Exception Repon with DTSC. 66262.42
Failed toke ep waste manifests/receipts for 3 years available for inspecti on. 66262.40(a) & 25160.2(b)(3)
Did not hav e records of battery disposal. 66266.81(a)(4)(B) Failed to co mplete manifest properly. 66262.23(a)
Failed to ha ve TSDF copy of manifest onsite. 66262.40(a) Failed to hav e LOR documentation onsite. 66268.7(a)(8) Failed to ob tain approval forTSDF. 2520I(a)
Failed to no tify CUPA for eligible onsite treatment. 25201(a) ERMrepo rting not submitted biennially &/or available. 25143.10 e adequate records demonstrating claim of exemption for ecyclable Material (ERM). 25143.2(f) & 66261.2(g)
Failed to hav
ExcludedR
Failed toke
shipment. S
ep universal waste record for 3 years for offsite
QH:66273.19(b )&(c )(2); LQH:66273.39(b )&( c )(2)
eep copies of analytical results, waste analysis records, ennination results. (3 years) 66262.40(c)
Failed to k
or waste det
ep disposal receipts (3 years) for drained used oil
r drained fuel filters. 25250.22 and 66266.130(c)(5)
Failed toke
filters and/o
DISPOSAL AND TRANSPORTATION
f---- D 0301 Unauthorized disposal of hazardous waste. 25189.5(a) or 25189(d) 0302 Unlawful transponation of hazardous waste (HW). 25163(a) 0303 Did not use HW manifest for disposal.66262.20(a), 25160.2(b )9 0304 Failed to make a proper waste detennination. 66262.11 & 66260.200( c)
0305 Disposed of used oil illegally. 25250.5(a) and 25189.5(a) 0306 Disposed of latex paint illegally. 25217.1
0307
0308
Disposal of uni versa! waste to an unauthorized point.
25189.5(a); SQH:66273.ll(a); LQH 66273.3l(a)
dilution of hazardous waste. 66268.3(a)
Viol v VIOLATION DESCRI I PTION
STORAGE AND HANDLING
D 0216
D 0217
D 0218
D 0219
D 0220
D 0221
1-
D 0222
D 0223
D 0224
Failed to label hazard ous materials within I 0 days or less. 25124(b)(3)(A) & 662 62.34(f)
Failed to repackage d amaged/deteriorated hazardous material container within 96 h ours. 25124(b)(3)(B) & 66262.34(f) Failed to label &/or do se drained D used oil filters &/or D used fuel filters. 25250.22 an d 66266.130(c)(3)
Failed to pr'6,j"l6: seg filters. 6626 .13 (c)(6
regate used oil &/or fuel drained from
) or 25250.22(b)(4)
Spent lead acid batteri es not properly managed. 66266.81 satellite regulations. 66262.34(e)
el ERM. 25143.9(a)
Failed to comply with
Failed to properly lab
Failed to y,roperly rna
removed rom a contai
nage non-empty container or inner liner
ner. 66261.7 (b), (d) &/or (r)
Failed to mark date on
and/or manage it withi
empty container larger than 5 gallons
none year. 66261.7(e) & (f).
HAZWASTE REQUIREMENTS FOR SOGs ONLY
STORAGE AND HANDLING -Pursuant to 66262 34(d) •
D 0225
D 0226
D 0227
D 0228
D 0229
D 0230
D 0231
D 0232
D 0233
D 0234
2.34(d),
AHWwaste]
Accumulated waste too (> 180 or 270 days). 6626
CFR 262.34(e) & (f), &/or 5201(a) [>90 days for an
Did not accumulate waste in container or tank. 66262. 34 (d)(2) Failed to pror;'rly labeVdate hazardous waste contai ner &/or tank. 66262. 4(f)
Failed to keep container closed. CFR 265.173
Failed to conduct weekly inspections. CFR 265.17 4
Failed to maintain aisle space. CFR 265.35
Failed to properly separate incompatible wastes. C FR 265.177 FR 265.171
72. Waste accumulated in a container in JXX>r condition. C Failed to use a lined/compatible container. CFR 265.1
Did not maintain &/or operate facility to prevent rei
CFR 265.31
ease or frre.
to 66262.34(d)(2)
l--ID 0407 Employee training program not adequate. CFR 262.34(d)(5)(iii) 1------10 0408 Failed to postER plan by phone. CFR 262.34(d)(5)(ii) ---lo 0409
0 0410
---l
0 0411
---l
0 0412
.--------, HA Z
0 1612
0 1613
0 1614
1------1
0 1615
----<
0 1616
I ( -!)
Spill/fire control equip not available. CFR 265.32(c)
Failed to equip facility with internal communication or alarm.
CFR 265.32(a) & (b)
Failed to carry out contingency plan during an emergency.
CFR 262.34(d)(5)(iv)
Failed to have an emergency coordinator on call or available during emergency. CFR 262.34(d)(5)(i)
US WASTE TANK Pursuant to 66262 34(d)(2)
Hanudous waste immooe ly stored in a tank system that Dleaks, 0 is corroded, or failing. CFR 265.20 I (b )(2) Failed to comply with tank standanls which include: two feet of freeboard (where applicable), shut off for waste feed line, & daily and weekly inspections. CFR 265.201(b) & (c)
Failed to properly complete &/or document closure for a hazardous waste tank. CFR 265.20l(d) & 67383.3
Failed to safely accumulate ignitable or reactive waste in a tank.
CFR 265.201(e)
Failed to safely manage incompatible waste in a tank.
CFR 265.201(f)
DATE SIGNED TITLE OF BUSINESS
HM-923 (02/06) NCR DEH-Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 -
ENTERED 0 5 2011 .jk
COUNTY OF SAN DIEGO PAGEl_oF_3_ DATE '!/_ I :;}J. I ( L PERMIT# d;l_t:;'( tj_ BUS. CODE lr;ZD
COMPLIANCE INSPECTION REPORT TIME START Ll L l END __?: ( SPECIALIST h' r'2a!l{;lt.JD'Cf2 I
INSPECTION CONTACT /da_lrer 'Jok. (if.MHJ.
TITLE
PHONE ( fL_{fj_) 2{:J- lf [0.Q.
On the above date, the County inspected your tacility under the authority of the California Health and Safety Code (H&SC), to detennme comphance wtth apphcable provtstons 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 y• N/A' Permit Expires on: (0 I 3/ I I ( Hazardous Materials Business Plan available Contingency Plan available DLQG DSQG Employee training is adequate Employee training records available Waste disposal records available for review (i]../(j Universal waste maq.riged properly Ill/ D Emergency contacts current D Updated today / D Waste containers El' closed D labeled (g../'O Chemical inventory/map current D Updated today 19' D Waste containers in good condition Consent to inspect granted by: Contact D Other: ----------------------- fZov'"tty. e Dsp ee:Lian,
/ /l
I
IQ"This is an annual certification that the Hazardous Materials Business Plan (inventory & site map, I..!JlJ emergency contacts, emergencv response plan, and employee training plan) is current and includes all the .,,L, information required in the H&SC and is maintained at the site where hazardous materials are stored. Initials ofF ,..cmty Representative
PRINTED NAME OF FACILITY REPRESENTATIVE DATE SIGNED
So'noY'no- v:n.\\tf 9 1 1 a.o\\
SIGNA E OF FACILITY R. 'R ·.• , TITLE OFF ACILITY REPRESENTATIVE llM-924 (03111) NCR '(Y= Yes: N/A =Not Applicable) DISTRIBUTION: ;WIIITE-HMD COPY: YELLOW-FACILITY COPY
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE INSPECTION REPORT
PERMIT # 2-0 ;:1 S: ( 1
DATE _!!j_JD_!_jL__
PAGE ;J._ OF 3
FACILITY ADDRESS: 9 if fa /Ill /s e r<..rl. ZIP CODE: '1 ?--0 II ,Cir-cle one: Violation (before August 2002 ·Remark fter August 2002) ----No SPCC plan; Failed to amend SPCC plan
----Observation: This facility is storing gallons (shell capacity) of petroleum aboveground and requires a current Spill Prevention, Control and ----Countermeasures (SPCC) plan pursuant to HSC 25270.4.5(a); or this facility -------,1 failed to amend SPCC plan within 6 months of a facility change. ____ Corrective action:
Either A. Reduce your petroleum storage below 1320 gallons and submit, to HMO, evidence of the reduction including an
updated Hazardous Materials Business Plan and HMBP
Certification Statement.
or B. Contact a consulting firm to prepare and certify or amend and recertify your SPCC plan; if you are a qualified facility, you can write and certify or amend and recertify your own SPCC plan using the template on HMD's web site at:
http://www.sdcounty.ca.gov/deh/hazmat/hmd_apsa.html
----Be advised: The facility owner/operator must implement the SPCC plan and ____ maintain a copy on site available for inspection.
For questions or assistance, call our duty desk at (858) 505-6880. ----Correct this violation by November 10,2011.
DATE SIGNED TITLE OF FACILITY REPRES TATIVE
DEH-Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 -·.= ..
;'Of:-: '···
COUNTY OF SAN DIEGO PERMIT # C}.,Or9.. Sf q
COMPLIANCE INSPECTION REPORT DATE ' I ,"'7> I /( Small and Large Quantity Generators of Hazardous Waste Handlers of Hazardous Materials PAGE .,3 OF 3
FACILITY ZIP: __ ,,10LATION REPORT. The items checked below refer to specific section numbers ofTitles /9, 22 & 27 ofthe Californi 'odeofR egulations (CCR). Chapters 6.5. 6.67 & 6.95 of the Health and Safety Code, and/or the San Diego Coull!y Code (SDCC) Small Quantity Hazardous JJ'Oste Generaror=(SQG); Large Hazardous Waste Quantity Generator=(LQG); Code 40 of Federal Regulations=(CFR).
All l'iolations must be corrected. Submit documentation of return to compliance to your Specialist. You may use the Correcti\'e Action Form (HI\1-926) to document your return to compliance. Your Specialist can provide this form. Please call (858) 505-6880 or your Specialist if you have any questions.
HAZARDOUS MATERIALS REQUIREMENTS
.Y VIOLATION DESCRIPTION
1001
1002
UPF permit not obtained for hazardous materials. SDCC 68.905 Hazardous Materials Business Plan (HMBP) not established/ implemented. 25503.5(a)
1004 HMBP not submitted to the CUPA. 25505(a)
1005 Emergency contact not provided or current. 25509(a)(7) I 007 Highly toxic gas (TLV:SI 0 ppm) not disclosed. 68.1113(b) 1008 Did not submit annual carcinogen/reproductive toxin list. 68.1113(c) 1009 Site map is not sufficient or complete. 25509(a)(5) & 25505(a)(2) 1010 Did not report release or threatened release. 25507(a), 19 CCR 2703 1012 SPCC Plan not prepared. 25270.3 & 25270.4.5(a)
1013
1014
1015
Copy ofHMBP not onsite for inspector's review. 25505(e) HMBP is incomplete/inadequate/not amended to reflect changes. 25504, 25505(a)(2) &/or 25509(a); 25505(b); 19 CCR 2729 Did not have adequate employee training program 2732 &/or 25504(c) 1016 Failed to have an adequate emergency response plan 25504(b); 2731 1017 Business Plan not certified annually. 25505(d) & (e)(2) 1018 Inventory not amended for 100% increase of hazardous material onsite or inventory is incomplete. 25509, 25510
1019 SPCC Plan amendment not prerared within 6 months of change. 25270.4.5(a) [ref. CFR 112.1(b) & CFR 112.5]
Failed to submit Unified Program Consolidated Form(s) to the CUPA D 1020 forregulated activity or change of information. 27 CCR 15400.l(b) &/or SDCC 68.906; 68.909; &/or 68.908.2
HAZWASTE REQUIREMENTS FOR LOGs & SOGs
RECORDKEEPING
D Unified Program Facility (UPF) permit not obtained. SDCC 68.905 Failed to obtain & maintain a valid EPA ID Number. 66262.12(a) Failed to send manifest copy to DTSC. 66262D(a)(4)
0135
0136
Failed to file Exception Report with DTSC. 66262.42
Failed to keep hazardous waste mamfests/rcceipts for 3 years available for inspection. 66262.40(a) & 25160.2(b)(3 ), 25185(a)(4) Did not have records of battery disposal. 66266.81 (a)( 4)(B) 0137 Failed to complete manifest properly. 66262.23(a)
Manifest signed by the TSDF not available for inspection. 66262.40(a) Failed to have LOR documentation onsite. 66268.7(a)(8)
Failed to obtain approval for TSDF. 25201(a)
Failed to notify CUPA for eligible onsite treatment. 25201(a) ERM reporting not submitted biennially &/or available. 25143.10 Failed to have adequate records demonstrating claim of exemption for Excluded Recyclable Material (ERM). 25143.2(1) & 66261.2(g) Failed to keer records ofoiTsite universal waste (UW) shipment(s) available for mspection for 3 years. 66273.39(c) & (d)(2); 25185(a)(4) 0148 Failed to keep copies of analytical results, waste analysis records, or waste determination results. (3 years) 66262.40(c)
0149 Failed to keep disposal receipts (3 years) for drained used oil filters &lor drained fuel filters. 25250.22 & 66266.130(c)(5)
DISPOSAL AND TRANSPORTATION
D 030 I UllalJthorVOO di<r<&ll ofl=mb.ls \\:JSe. 251895(a) or25189(c) or(d) oc 251892(c) D 0302 Unlawful transportation of hazardous waste (HW). 25163(a) 0303 Did not use HW manifest for disposal. 66262.20(a); 25160(b)(l) or (2). 25160.2(b )(9)
0307
0308
Disposed of latex paint illegally. 25217 .I
Disposed ofUW to an unauthorized point. 25189.5(a) or 25189(c) or (d) or 25189,2(c ); 66273.31 (a)
Impermissible dilution of hazardous waste. 66268.3(a)
HAZWASTE REQUIREMENTS FOR LOGs & SOGs
I v;.JN I y VIOLATION DESCRIPTION
STORAGE AND HANDLING
Used oil intentionally contaminated with HW. 25250.7(a) Used oil filters improperly managed. 66266.130
Failed to label hazardous materials within 10 days or less. 25124(b)(3)(A) & 66262.34(1)
Failed to repackage damaged/deteriorated hazardous material container within 96 hours. 25124(b)(3)(B) & 66262.34(1) D 0218 Failed to label &/or close drained D used oil filters &/or D used fuel filters. 25250.22 & 66266.130(c)(3)
Failed to properly segregate used oil &/or fuel drained from filters. 66266.130(c )( 6) or 25250.22(b )(4)
Spent lead acid batteries not properly managed. 66266.81 Failed to comply with satellite regulations. 66262.34(e) Failed to properly label ERM. 25143.9(a)
0223 Failed to properly manage non-emnty container or inner liner removed from a container. 66261 ,7(b), (d) &/or (r)
Failed 10: rna.rk .date on empty container larger than 5 gallons &/or manage 11 wtthm one year. 66261.7(e) & (I)
Failed to properly dispose ofUW within one year. 66273.35(a) &/or(b) D 0238 Failed to manage UW in a manner to prevent relcase(s) to the environment. 66273.33 & 66273.33.5
D 0239 Failed to properly label or mark UW (non-CESQUWG). 66273.34 HAZWASTE REQUIREMENTS FOR SOGs ONLY
STORAGE AND HANDLING Pursuant to 66262.34(dl
Did not accumulate waste in container or tank. 66262.34(d)(2) Failed to properly labeVdate hazmlous waste container &/or tank. 66262.34(!) 0228 Failed to keep contamer closed. CFR 265.173
0229 Failed to conduct weekly mspectwns. CFR 265.174
0230 Failed to maintain aisle space. CFR 265.35
0231 Failed to properly separate incompatible wastes. CFR 265.177 0232 Waste accumulated in a container in poor condition. CFR 265.171 0233 Failed to use a lined/compatible container. CFR 265.172 Employee training program not adequate. CFR 262.34(d)(5)(iii) 0408 Failed to postER plan by phone. CFR 262.34(d)(5)(ii) 0409 Spill/fire control equip not available. CFR 265.32(c) 0410 Failed to equip facility with internal communication or alarm.
CFR 265.32(a) & (b)
0411 Failed to carry out contingency plan during an emergency.
CFR 262.34(d)(5)(iv)
0412 Failed to have an emergency coordinator on call or available during emergency. CFR 262.34(d)(5)(i)
HAZARDOUS WASTE TANK SYSTEMS Pursuant to 66262.34(dl(2) 1612
1613
1614
1615
Hazardous waste improperlY stored in a tank system causing D leaks, D corrosion. or D failure. CFR 265.20l(b)(2)
Failed to comply with tank standards which include: two (2) feet of freeboard (where applicable), shut off for waste feed line, and daily and weekly inspections. CFR 265.201(b) & (c)
Failed to properly complete &/or document closure for a hazardous waste tank. CFR 265.201(d) & 67383.3
Failed to safely accumulate ignitable or reactive waste in a tank.
CFR 265.20l(e)
1616 Failed to safely manage incompatible waste in a tank. CFR 265.201(1) 9 I I l\
DATE SIGNED TITLE OF FACILITY R PRESE ATIVE
DEH-Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 \ COUNTY OF SAN DIEGO
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 (H&SC), Division 20, Chapter 6.95, Section 25505 provides for the following:
The County of San Diego, 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.
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 annually certify that a complete HMBP has been prepared, is current and is maintained at the site where the hazardous materials are stored. See Back for instructions and further clarification FACILITY ID#
Lowe's of Santee, CA #1661
BUSINESS SITE ADDRESS
9516 Mission Gorge Road
CITY
Santee
104
II. CERTIFICATION STATEMENT
ZIP CODE
92071
103
105
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 Regulatory Ordinances Section 68, I I 13.
Check only ONE of the following boxes:
0 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.
iZ! 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 requirements specified in H&SC Section 25505(d) & (e)(2).
As an Authorized Representative, I certify. under the penalty oflaw, that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. By checking any of the boxes above I also certify that: a) The information contained in the hazardous materials inventory most recently submitted to the CUPA or Administering Agency is complete, accurate, and up to date; b) There has been no change in the quantity of hazardous materials reported in the most recently submitted inventory; and c) AU hazardous materials subject to inventory requirements are listed on the most recently submitted inventory.
DATE
3-1-J
TITLE OF SIGNER
Robert Gass Sr. HAZMAT lnte
------ I I
plans or for changes to site maps, chemical inventory and/or emergency contacts) **If HIRT box is checked, follow HIRT policy to indicate on the inventory forms which hazardous materials make this a HIRT site:
HM-953 (0311 0)
/
COUNTY OF SAN DIEGO
DEPARTMENT OF ENVIRONMENTAL HEALTH-CUP A
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 11-I&SCl. Division 20. Chapter 6.95 Section 25505 provides for the following:
The County of San Diego, 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.
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 annually certify that a complete HMBP has been prepared, is current and is maintained at the site where the hazardous materials are stored. See Back for instructions and further clarification FACILITY ID#
Lowe's of Santee, CA #1661
BUSINESS SITE ADDRESS
9416 Mission Gorge Road
CITY
Santee
104
II. CERTIFICATION STATEMENT
ZIP CODE
92071
103
105
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 Regulatory Ordinances Section 68.1113.
Check only ONE of the following boxes:
0 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. [8J 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.
0 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 requirements specified in H&SC Section 25505(d) & (e)(2).
As an Authorized Representative, I certify, under the penaltv of law, that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. By checking any of the boxes above I also certify that: a) The information contained in the hazardous materials inventory most recently submitted to the CUPA or Administering Agency is complete, accurate, and up to date; b) There has been no change in the quantity of hazardous materials reported in the most recently submitted inventory; and c) All hazardous materials subject to inventory requirements are listed on the most recently submitted inventory. u. HIRT SITE C**
s'
•.. FIRE DIST.
ESIGNATED REPRESENTATIVE
D *Emergency Contacts
D *Chemical Inventory
TITLE OF SIGNER
Sr. HAZMAT lnte
I I ------
I I ------
------ 1 I
*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.
A letter will be maile o business after processing of site map updates.
Specialist's Signature: (only required
•• lfi-IIRT box is checked, follow 1-IIRT policy to indicate on the inventory forms which hazardous materials make this a HIRT site.
HM-953 (03/11)- wi
' .. ::20;;JS/ q '7""" . .
COUNTY OF SAN DIEGO CUPA
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION 3/1/2012
P.O. BOX 129261, SAN DIEGO, CA 92112-9261 Date Submitted (619) 338-2222 FAX 1-800-253-9933
htto://www.sdcdeh.org
Aboveground Petroleum Storage Tank Facility Statement
Pagej_of 1
I. FACILITY/BUSINESS INFORMATION I FACILITYID# 13 17 I I o I o o I I FACILITY NAME (Same as BUSINESS NAME or DBA-Doing Business As) 3 Lowe's Of Santee, CA #1661
FACILITY ADDRESS 103
9416 Mission Gorge Road
FACILITY CITY 104 ZIP CODE IOl
Santee CA
92071
CONTACT NAME '"' CONTACT PHONE 118a
Robert Gass (704) 758-6033 X
Does the facility have an SPCC plan? IZ! Yes DNo 920 Date of last SPCC Plan Revision/Review:
(see reverse for instructions) 12/7/2009
II. TOTAL FACILITY CAP A CITY (in gallons) 921
Facility's total aboveground petroleum storage capacity for all tanks and containers greater than or equal to 55 gal.: 1555 gal. (see reverse for instructions) .
Capacity of the largest tank/container that stores petroleum at your facility (in gallons): 1500 gal.
III. TANK DETAILS for facilities with tanks I 0,000 gallons in capacity or more (attach additional forms if needed) 922 923 924 92l 926 927
Tank ID Contents Capacity Tank Age or Tank Secondary
Number (Gas, Diesel, etc.) (in gallons) Location (in years! Containment DYes DNo
SEE DYes DNo
SITE
MAP/PLAN
DYes DNo
FOR DYes DNo
TANK
LOCATION DYes DNo
DYes DNo
DYes DNo
' DYes DNo
.
IV. SIGNATURE
I certify under penalty of law that the information submined is accurate and complete to the best of my knowledge.
SIGNATURE OF 0WNFIUlR.T ANK FACILITY OPERATOR PRINTED NAME OF OWNER OR TANK FACILITY OPERATOR 136 DATE (MM/00/YYYY) 134 Robert Gass --
HM . . 9501 WI (10-08)
COUNTY OF SAN DIEGO
UPFP INSPECTION CHECKLIST
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 12/02/2016
RECORD ID #: DEH2003-HUPFP-202519
TIME START: 8:50 AM END: 10:50 AM
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Scott Simon
TITLE: Store Manager
PHONE:(619) 212-4100
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v44 Dated 8/4/2016 12:45
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: Pending Corrective Action
EPA ID NUMBER: CAL000285433
FACILITY CERS ID NUMBER:10377046
CERS LEAD USER: Maggie Ta
LAST CERS SUBMITTAL DATE: 08/02/2016
ENVIRONMENTAL CONTACT EMAIL: [email protected]
ENVIRONMENTAL CONTACT PHONE: 7047586033
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: 1610
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: Scott Simon TITLE: Store Manager
REMOVE BLANK CHECKLISTS FROM FINAL INSPECTION REPORT 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: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 12/02/2016 PAGE 1 OF 7
RECORD ID #: DEH2003-HUPFP-202519
TIME START: 8:50 AM END: 10:50 AM
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Scott Simon
TITLE: Store Manager
PHONE:(619) 212-4100
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: Scott Simon TITLE: Store Manager INTRODUCTION:
Routine Inspection
Inspection conducted 12/2/2016 with Janet Wheeler (assistant store manager) and Aaron Brewer (Loss Prevention and Safety Manager) who gave me permission to conduct the inspection. This business is a big box store and is subject to Hazardous Materials Business Plan (HMBP) due to reportable quantities of hazardous materials and hazardous waste. Business is also subject to Aboveground Petroleum Storage Act (APSA) due to reportable quantities of petroleum products stored in an aboveground tank. Business is currently a large hazardous waste generator.
HMBP is annually certified in CERS. Last submission 8/2/16.
Today's inspection consisted of HMBP, APSA and hazardous waste requirements.
VIOLATION # 1
HMD0138 Manifest signed by the TSDF not available for inspection. 22 CCR 66262.40(a) Classification: Minor
Observations:
Copies of manifest signed by the Treatment, Storage & Disposal Facility (TSDF) are not available for review during inspection.
Corrective Action Due By:01/01/2017
Submit copies of manifests (2014, 2015 & 2016) signed by the TSDF within 30 days to my attention.
VIOLATION # 2
3120001 Failed to maintain training records. 22 CCR 66265.16(d) and (e) HM-924(01/15)
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE
INSPECTION REPORT
INSPECTION DATE: 12/02/2016 PAGE 2 OF 7
RECORD ID #: DEH2003-HUPFP-202519
Classification: Minor
Observations:
This facility did not have employee training records available for inspection.
Corrective Action Due By:01/01/2017
Within 30 days submit training documentation (2015 and 2016) to inspector.
INSPECTION REMARKS:
*Bay City Electric Works, Inc does routine maintenance for (diesel) back up generator. *SPCC plan reviewed in 5-year period (8/2/2016) and was available on site for review. *Hazardous waste storage areas are inspected weekly and documentation kept electronically.
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 If you have any questions regarding this inspection, please contact Bridget Kieu ,(619) 602-0746, [email protected]
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
Aaron Brewer
TITLE OF FACILITY REPRESENTATIVE
Loss Prevention and Safety Manager
SIGNATURE
DATE SIGNED
12/02/2016
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: 12/02/2016 PAGE 3 OF 7
RECORD ID #:DEH2003-HUPFP-202519
FACILITY NAME: *LOWE'S #1661
ADDRESS: * 9416 MISSION GORGE RD 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
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: 12/02/2016 PAGE 4 OF 7
RECORD ID #:DEH2003-HUPFP-202519
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)
1 ✖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
0219 Failed to properly segregate used oil &/or fuel drained from filters.
HSC 25250.22(b)(4); 22 CCR 66266.130(c)(6)
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
Aboveground Petroleum Storage Act (APSA) Program
INSPECTION DATE: 12/02/2016 PAGE 5 OF 7
RECORD ID #:DEH2003-HUPFP-202519
Each violation checked below is for the section(s) of the California Health and Safety Code (HSC) 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
(Chapters 6.67 and 6.11 of Division 20 of the HSC)
# VIOLATION DESCRIPTION
4010001 Failed to prepare and implement a written spill prevention control and countermeasures (SPCC) Plan in accordance with 40 CFR Part 112 (sec. 112.3). HSC 25270.4.5(a)
4010013 Plan does not conform to and/or facility is not fully implementing, the latest version of the regulations in 40 CFR Part 112. HSC 25270.4.5(a) (see detail below)
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 68.905
4040001 Failed to immediately, upon discovery, report a one-barrel (42 gallons) or greater release of petroleum. HSC 25270.8
4010038 Failed to report required program data electronically. HSC 25404(e)(4), HSC 25270.6(b), SDCC 68.905
4010037 Failed to meet provisions of APSA exemption for oil-filled electrical equipment including containment and visual inspection. HSC 25270.2(a)(4)
REQUIREMENTS BASED ON 40 CFR 112.1-112.6
4010035 Failed to meet the conditions of a Qualified Facility. (40 CFR 112.3(a) (1), 112.3(g), 112.6.) 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 copy of the Plan on site (applies if facility is manned at least 4 hours/day). (40 CFR 112.3(e)(1).) HSC 25270.4.5(a) 4010010 Failed to make SPCC plan technical amendment(s) when the facility has had a change in: design, construction, operation, or maintenance which affects the facility's discharge potential. (40 CFR 112.5(a).) HSC 25270.4.5(a)
4010009 Failed to perform a 5-year review of the SPCC Plan. (40 CFR 112.5(b).) HSC 25270.4.5(a)
4010011 Failed to have a professional engineer certify technical amendments. (40 CFR 112.5(c). HSC 25270.4.5(a)
GENERAL SPCC REQUIREMENTS
BASED UPON 40 CFR 112.7
4010012 Failed to prepare a SPCC plan that follows the sequence of rule and/or to cross-reference; failed to prepare plan in writing; failed to prepare a plan that addresses additional procedures/methods/equipment not fully operational. (40 CFR 112.7 and 112.7(a)(1).) HSC 25270.4.5(a) 4010002 Failed to obtain facility management approval to commit resources to fully implement the SPCC Plan. (40 CFR 112.7.) HSC 25270.4.5(a) 4010014 Failed to discuss alternative environmental protection to SPCC requirements within SPCC Plan. (40 CFR 112.7(a)(2).) HSC 25270.4.5(a) 4010015 Failed to have an adequate facility diagram, including location of oil storage/transfer areas and connecting pipes, or no facility diagram included in SPCC plan. (40 CFR 112.7(a)(3).) HSC 25270.4.5(a) 4010016 Failed to adequately describe the physical layout of facility, including location of oil storage/transfer areas/connecting pipes or no description of physical layout included in SPCC Plan. (40 CFR 112.7(a) (3), 112.7(a)(3)(i-vi).) HSC 25270.4.5(a)
HM-950 APSA (02-15)
GENERAL SPCC REQUIREMENTS
BASED UPON 40 CFR 112.7 (continued)
# VIOLATION DESCRIPTION
4010017 Plan does not contain procedures for reporting a discharge if facility has no Facility Response Plan. (40 CFR 112.7(a)(4).) HSC 25270.4.5(a) 4010018 Discharge procedures are not adequately addressed if facility has no Facility Response Plan. (40 CFR 112.7(a)(5).) HSC 25270.4.5(a) 4010019 Failed to include prediction of the direction, rate of flow, and total quantity of oil which could be discharged from facility as a result of each type of equipment failure in the SPCC Plan. (40 CFR 112.7(b).) HSC 25270.4.5(a)
4010020 General Containment: Failed to provide, or discuss within the plan, appropriate containment/diversionary structures/equipment designed to address the typical failure, so that any discharge will not escape containment before cleanup occurs. (40 CFR 112.7(c).) HSC 25270.4.5(a)
4010004 Failed to have a professional engineer clearly denote and demonstrate the impracticability of appropriate containment/diversionary structures. (40 CFR 112.7(d).) HSC 25270.4.5(a)
4010005 Failed to prepare an Oil Spill Contingency Plan following the provisions of 40 CFR Part 109 for impracticability claim. This is not required if facility has a Facility Response Plan. (40 CFR 112.7(d)(1).) HSC 25270.4.5(a)
4010006 Failed to provide a written commitment of manpower, equipment, materials for impracticability claim. (40 CFR 112.7(d)(2).) HSC 25270.4.5(a)
4010021 Failed to address in SPCC plan/maintain complete records of:
inspections, tests/procedures for 3 years. (40 CFR 112.7(e), 112.8(c) (6).) HSC 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 Failed to conduct annual discharge prevention briefings to ensure understanding of SPCC plan. (40 CFR 112.7(f)(3).) HSC 25270.4.5(a) 4030001 Failed to address security of oil handling areas/valves, prevent unauthorized access to starter controls, cap/blank flange connections not in service and provide appropriate lighting to prevent vandalism and assist in discovery of discharges. (40 CFR 112.7(g).) HSC 25270.4.5(a)
4030002 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 Failed to provide system to prevent vehicular departure before disconnect from transfer lines. (40 CFR 112.7(h)(2).) HSC 25270.4.5(a) 4030004 Failed to inspect lowermost drains and outlets prior to filling and departure of tank car or tank truck. (40 CFR 112.7(h)(3).) HSC 25270.4.5(a)
4030016 Failed to evaluate field-constructed storage tank for brittle fracture and take appropriate action. (40 CFR 112.7(i).) HSC 25270.4.5(a) 4010007 Failed to include discussion of conformance with requirements listed in 40 CFR Part 112. (40 CFR 112.7(j).) HSC 25270.4.5(a)
C O U N T Y O F S A N D I E G O
COMPLIANCE INSPECTION REPORT
APSA Program (continued)
INSPECTION DATE: 12/02/2016 PAGE 6 OF 7
RECORD ID #:DEH2003-HUPFP-202519
SPCC REQUIREMENTS BASED UPON 40 CFR 112.8
Refer to APSA (HSC Chapter 6.67) for definition of “storage tank” # VIOLATION DESCRIPTION
4010027 Failure to restrain drainage from diked storage areas by valves to prevent discharge. (40 CFR 112.8(b)(1).) HSC 25270.4.5(a) 4030005 Failure 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 to facility and/or failed to ensure catchment basin 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 one pump where drainage waters are treated in more than one treatment unit and such treatment is continuous. (40 CFR 112.8(b)(5).) HSC 25270.4.5(a)
4030012 Storage tanks not compatible with materials stored or conditions such as pressure/temperature. (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)
4030011 Failed to keep containment bypass valves closed when not draining rainwater. (40 CFR 112.8(c)(3)(i).) HSC 25270.4.5(a)
4030006 Failed to inspect retained rainwater prior to discharge. (40 CFR 112.8(c)(3)(ii).) HSC 25270.4.5(a)
4030007 Failed to open and close bypass valve to drain rainwater under responsible supervision. (40 CFR 112.8(c)(3)(iii).) 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 storage tank for integrity, in accordance with industry standards that take into account size, configuration, and design, on a regular schedule or after material repairs. (40 CFR 112.8(c) (6).) HSC 25270.4.5(a)
4030014 Failed to perform scheduled storage tank tests and inspections by appropriately qualified personnel. (40 CFR 112.8(c)(6).) HSC 25270.4.5(a)
4010028 Failed to frequently inspect the outside of each storage tank for signs of deterioration, discharges, accumulation of oil in diked areas, including supports/foundations; failed to keep records of inspections, tests and comparison records. (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 provide each storage tank with a high level monitoring device, or implement procedures to prevent discharges caused by overfills, in compliance with 40 CFR Part 112. (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 Failure to frequently observe effluent treatment facilities, which discharge directly to navigable waters, to detect oil spills. (40 CFR 112.8(c)(9).) HSC 25270.4.5(a)
4030021 Failed to promptly correct visible discharges and/or remove accumulations of oil in diked areas. (40 CFR 112.8(c)(10).) HSC 25270.4.5(a)
4030024 (For mobile or portable storage tanks AND mobile refuelers) Failed to locate mobile or portable containers to prevent discharge. (40 CFR 112.8(c)(11).) HSC 25270.4.5(a)
4030020 (For mobile or portable storage tanks EXCEPT mobile refuelers) Failed to provide secondary containment sufficient to contain the capacity of the largest single compartment or container with sufficient freeboard for precipitation. (40 CFR 112.8(c)(11).) HSC 25270.4.5(a) HM-950 APSA (02-15)
SPCC REQUIREMENTS BASED UPON 40 CFR 112.8 (continued)
Refer to APSA (HSC Chapter 6.67) for definition of “storage tank” # VIOLATION DESCRIPTION
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)
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: 12/02/2016 PAGE 7 OF 7
RECORD ID #:DEH2003-HUPFP-202519
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 Failed to prepare a hazardous waste management performance report every 4 years. 22 CCR 67100.7, 67100.8
3010019 Failed to prepare a summary progress report (4 year req.) and/or keep onsite available for review. 22 CCR 67100.9, 67100.3
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 2 ✖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 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)
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) HM-926(01/15)
COUNTY OF SAN DIEGO
CORRECTIVE ACTION FORM TO
DOCUMENT RETURN TO COMPLIANCE
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 12/02/2016
RECORD ID #: DEH2003-HUPFP-202519
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Scott Simon
TITLE: Store Manager
PHONE:(619) 212-4100
E-MAIL:[email protected]
VIOL# DATE
CORRECTED
INDICATE HOW VIOLATIONS WERE CORRECTED
(Attach Any Supporting Documentation) DUE DATE
#1 HMD0138 01/01/2017
#2 3120001 01/01/2017
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 submitting false information.
PRINTED NAME OF FACILITY REPRESENTATIVE
TITLE OF FACILITY REPRESENTATIVE SIGNATURE
DATE SIGNED
SEND COMPLETED FORM AND SUPPORTING DOCUMENTATION TO THE ADDRESS LISTED BELOW
COUNTY OF SAN DIEGO USE ONLY
REVIEWED BY: DATE:
SPECIALIST'S COMMENTS:
All violations noted on date listed above were corrected Based On Information Provided By The Facility RTC entered by Specialist on:
Based On Field Verification By Specialist RTC entered by Office Assistant on:
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 http://www.sdcdeh.org 858-505-6880
January 5, 2016
Ms. Bridget Kieu
County of San Diego
"S}at\-Zf)b3- __, Z/) 'lS/4
Department ofEnvironmental Health, Hazardous Materials Division P.O. Box 129261
San Diego, CA 92112
RE: Lowe's #1661 in Santee, CA
Dear Ms Kieu:
As a Regional Environmental Compliance Coordinator for the California stores, I provide certain services to Lowe's Home Centers, Inc. including ensuring safety and environmental compliance at Lowe's retail locations.
In response to the December 2, 2016 inspection at Lowe's #1661 in Santee, CA, I would like to provide you with the information requested, as well as Lowe's response to each of the listed violations.
Violation #1: HMD0138 Manifest signed by the TSDF not available for inspection. 22 CCR 66262.40(a) Remediation #1:
Please see the attached completed manifests signed by the TSDF for the years 2014, 2015, and 2016. These manifests have also been sent to the store to keep for their records.
Violation #2: This facility did not have employee training records available for inspection.
Remediation #2
Lowe's performs annual HAZMAT training for all employees. This training includes spill response and emergency procedures for small and large spills. Additionally, Lowe's Advanced HAZMAT Training Program is annually required for select employees including all management staff. This training convers spill response protocols, operation and maintenance of equipment, laws/regulations and facility operations. Please see the attached training records for the store's primary hazardous waste handlers.
If you have any questions or need any additional information to close out this investigation, please feel free to contact me. If no further information is required, please reply either by letter or email that this inspection is closed.
Sincerely,
Kyle Jons
Regional Environmental Com pi iance Coordinator I Loss Prevention, Safety & HAZMA T 949-891-9000 X228
kyle. [email protected]
INSPECTION DATE: 12 02 2016 COUNTY OF SAN DIEGO RECORD ID II: DEH2003·HUPFP-202519
CORRECTIVE ACTION FORM TO
DOCUMENT RETURN TO COMPLIANCJ.i:
SPECIALIST: Bridget Kieu
INSPECTION ______ _
TITLE: Store Manager
.-;CILITY NAME: LOWE'S 111661
ADDRESS: -9-41_6_M,---IS-::-S-,-IO_N_G_O_RG_E_R_D ____________ _ PHON£ 1(619) 212-4100
E-MAIL:scott.simon·[email protected]
CITY/ZIP: SANTEE
VIOL#
#1 HMD0138
#2 3120001
DATE
CORRECTED
1/f/17
!/5// 7
/92071
INDICATE HOW VIOLATIONS WERE CORRECTED
{Attach Any Supporting Documentation)
1 . l';' ) , ( 1 c-<: -- ,- "'- ... -"'-""-,---1' . ..... ' ,>:"r rf i.' I L,\. ·r • .-.!:- ., ...,._,r,._).J}c ( ,. -r:,, r •vn..,..)
DUE DATE
01/01/2017
01/01/2017
I certify vnder penalty of law that til is foci/it:}• has corrected oil violations marked on the Compliance Inspection Report/Notice of Violation. llwvf!' personally examined and am familiar with the information submitted Md believe the Information is true, accurate and complete. 1 am authorized co file this certification tor the joci/ity, and am awate that there are significant penalti1?5 fonubmitting false information.
COU NTY OF SAN DIEGO USE OJLY
KEVIEWED BY: .J£3 . 1<-M.N...
SPECIALIST'S COMMENTS:
!
II violations noted on date listed above were corrected ased On Information Provided By The Facility
ased On Field Verification By Specialist
DATE:
I J
TC entered by Specialist on: /{ )/ d-tCJ J 7
D 'f I TC entered by Office Assistant on: .....:....------ Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 http;/lwwYY,s9cJkh • .org 858-505-6880
COUNTY OF SAN DIEGO
UPFP INSPECTION CHECKLIST
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 01/24/2019
RECORD ID #: DEH2003-HUPFP-202519
TIME START: 4:10 PM END: 6:00 PM
SPECIALIST: Vikki Denslow
INSPECTION CONTACT:David Carroll
TITLE: Assistant Store Manager
PHONE:619-212-4100
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: $0.00
INSPECTOR: Vikki Denslow
INSPECTION TYPE: Routine
INSPECTION STATUS: Pending Corrective Action
EPA ID NUMBER: CAR000279752
FACILITY CERS ID NUMBER:10377046
CERS LEAD USER: Sheila Caballero
LAST CERS SUBMITTAL DATE: 05/22/2018
ENVIRONMENTAL CONTACT EMAIL: [email protected]
ENVIRONMENTAL CONTACT PHONE: (949) 891-9000
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: ✖
BUSINESS CLOSE DATE:
HAZARDOUS MATERIALS: ✖
HAZARDOUS WASTE: ✖
ABOVEGROUND PETROLEUM STORAGE ACT:* ✖
TOTAL SHELL CAPACITY APSA: 1610
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: David Carroll TITLE: Assistant Store Manager
REMOVE BLANK CHECKLISTS FROM FINAL INSPECTION REPORT REFUSED TO SIGN TIME ACCOUNTING (Routine) TOTAL TIME ENTERED: 1.9
Date Time Group Type
01/24/2019 0.5 HMD Inspection Report Writing - Record
01/24/2019 0.2 HMD Inspection Travel Time - Record
01/24/2019 0.7 HMD Inspection HM/HW - Record
01/24/2019 0.5 HMD Inspection APSA Level 1 - Record
COUNTY OF SAN DIEGO
UPFP INSPECTION CHECKLIST
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 01/24/2019
RECORD ID #: DEH2003-HUPFP-202519
TIME START: 4:10 PM END: 6:00 PM
SPECIALIST: Vikki Denslow
INSPECTION CONTACT:David Carroll
TITLE: Assistant Store Manager
PHONE:619-212-4100
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v66 Dated 1/10/2017 14:30 INSPECTION REPORT EMAILS:
[email protected],[email protected],[email protected] RECORD COMMENT:
This retail store is open Monday-Saturday from 6 a.m. to 9 p.m. A five year review of the SPCC Plan will be due by August 2, 2021.
HM-924(01/15)
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 01/24/2019 PAGE 1 OF 8
RECORD ID #: DEH2003-HUPFP-202519
TIME START: 4:10 PM END: 6:00 PM
SPECIALIST: Vikki Denslow
INSPECTION CONTACT:David Carroll
TITLE: Assistant Store Manager
PHONE:619-212-4100
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: David Carroll TITLE: Assistant Store Manager INTRODUCTION:
Notice to Comply
-This purpose of this inspection was to evaluate this retail store for hazardous materials, hazardous waste, and aboveground petroleum storage act (APSA) requirements.
-The assistant store manager, David Carroll, granted consent for this inspection, and he was present for the duration of the inspection.
-This store had a 1500 gallon diesel tank, a cage of propane, and a universal waste storage area onsite. -It also had the following waste containers: five drums of toxics, three drums of aerosol cans, one drum of corrosive/alkaline liquids, one drum of flammable solids, a drum of non-RCRA hazardous waste liquid/latex paint/class 9 waste, a box of empty containers/paint tint, and two cans of waste oil/fuel.
-Waste oxidizing liquids and waste corrosive/acidic liquids were not observed during this visit. -The gates to the compactor were locked, and the compactor itself was also locked. -The Spill Prevention Control and Countermeasures (SPCC) Plan was dated December, 2011, and it had been recertified on August 2, 2016. The SPCC Plan had a Professional Engineer certification. -A five year review of the SPCC Plan will be due again by August 2, 2021. -A submittal was made in the CERS database on May 22, 2018.
Certify the Hazardous Materials Business Plan (HMBP) in the CERS database by May 22, 2019.
VIOLATION # 1
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)
Classification: Minor
Observations:
This store had a 1500 gallon diesel tank and a cage of propane onsite. Copies of employee training records were dated February, 2017. The assistant store manager did not know where the more recent employee training records were. This facility has the capacity to store reportable amounts of hazardous materials or hazardous waste (above 55 gallons/500 pounds/200 cu ft) and failed to maintain records of an adequate employee training program for the size of the facility and the nature of the hazardous materials handled. The training program shall, at a minimum, include methods for safe handling of hazardous materials; HM-924(01/15)
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE
INSPECTION REPORT
INSPECTION DATE: 01/24/2019 PAGE 2 OF 8
RECORD ID #: DEH2003-HUPFP-202519
procedures for coordination with local emergency response organizations; use of emergency response equipment; and emergency response procedures for a release or threatened release of hazardous materials.
Corrective Action Due By:02/23/2019
Have employees trained on hazardous materials management by February 23, 2019.
Complete and return a Corrective Action Form with copies of employee training records to Vikki Denslow of the Hazardous Materials Division by February 23, 2019.
VIOLATION # 2
3030007 Failed to properly label/date hazardous waste container &/or tank. 22 CCR 66262.34(f) Classification: Minor
Observations:
The container for the empty containers/paint tint had waste in it, but it did not have a hazardous waste label. The hazardous waste label for the non-RCRA hazardous waste liquid/latex paint/class 9 waste, one of the hazardous waste labels for the waste aerosols, and one of the hazardous waste labels for the waste toxics were illegible as they had faded. The hazardous waste label for the waste alkaline corrosive liquids, one of the hazardous waste labels for the waste aerosols, and one of the hazardous waste labels for the waste toxics did not include the accumulation start dates. Hazardous waste containers must be labeled with the following: The words "Hazardous Waste", the name and address of the generator, the composition and physical state of the waste, the hazardous properties of the waste, and the accumulation start date.
Corrective Action Due By:02/23/2019
Immediately begin labeling the containers with the required labeling.
Complete and return a Corrective Action Form with documentation that this violation has been corrected to Vikki Denslow of the Hazardous Materials Division by February 23, 2019.
VIOLATION # 3
HMD0138 Manifest signed by the TSDF not available for inspection. 22 CCR 66262.40(a); HSC 25185(a)(4) Classification: Minor
Observations:
The copies of two manifests that were signed by the treatment, storage, and disposal facility (TSDF) were not available.
The manifest numbers were 001543236PSC (dated April, 2017) and 001674522PSC (dated October, 2017).
Corrective Action Due By:02/23/2019
Obtain copies of the manifests described above that are signed by the TSDF.
Complete and return a Corrective Action Form with the signed copies of the two manifests to Vikki Denslow of the Hazardous Materials Division by February 23, 2019.
INSPECTION REMARKS:
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:
HM-924(01/15)
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE
INSPECTION REPORT
INSPECTION DATE: 01/24/2019 PAGE 3 OF 8
RECORD ID #: DEH2003-HUPFP-202519
https://public.govdelivery.com/accounts/CASAND/subscriber/new If you have any questions regarding this inspection, please contact Vikki Denslow ,(619) 804-1738, [email protected]
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
David Carroll
TITLE OF FACILITY REPRESENTATIVE
Store Manager
SIGNATURE
DATE SIGNED
01/24/2019
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: (858) 505-6880 http://www.sdcdeh.org
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: 01/24/2019 PAGE 4 OF 8
RECORD ID #:DEH2003-HUPFP-202519
FACILITY NAME: *LOWE'S #1661
ADDRESS: * 9416 MISSION GORGE RD 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 to the CUPA in CERS. HSC 25508(a)(1)(A); 27 CCR 15188(a),(b),(d) 1010003 Business Activities &/or Business Owner/Operator page not completed in CERS. 19 CCR 2652(a)(1); SDCC 68.904(b); HSC 25508(a)(1)(A) 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 annually as complete and accurate in CERS. HSC 25508(a)(1)(A), 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)(A); 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)(A); 19 CCR 2670, 2671
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 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)(A); 19 CCR 2658, 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 1 ✖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 68.905; 68.906, 68.907 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) HMD1008 Annual carcinogen/reproductive toxin list not submitted in CERS. SDCC 68.1113(b) 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) 2 ✖3030007 Failed to properly label/date hazardous waste container &/or tank. 22 CCR 66262.34(f) 3030010 Accumulated waste too long (>180 or 270 days) or (>90 days). HSC 25201(a), 25123.3(h)(1); 22 CCR 66262.34(d); 40 CFR 262.34(e) and/or (f) 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)
HAZARDOUS WASTE TANK SYSTEMS FOR SQGS ONLY
# VIOLATION DESCRIPTION
HM-923 (10-18)
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: 01/24/2019 PAGE 5 OF 8
RECORD ID #:DEH2003-HUPFP-202519
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 68.905 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 copy of the uniform hazardous waste manifest to DTSC within 30 days of shipment. 22 CCR 66262.23(a)(4) 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 have adequate records demonstrating claim of exemption or exclusion for recyclable materials. HSC 25143.2(f) HMD0142 Failed to notify the CUPA in CERS for onsite hazardous waste treatment/tiered permitting. HSC 25201(a) 3 ✖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)
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)
3030004 Failed to properly manage, store, label &/or recycle used oil filters &/or used fuel filters. HSC 25250.22; 22 CCR 66266.130 3050004 Generator intentionally contaminated used oil with another hazardous waste other than minimal amounts of fuel. HSC 25250.7(a), (c) 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) 3030057 Failed to comply with hazardous waste satellite container regulation. 22 CCR 66262.34(e) HMD0023 Failed to properly empty container, failed to manage non-empty container, or inner liner removed from a container. 22 CCR 66261.7(b), (d), (e) &/or (r) HM-923 (10-18)
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: 01/24/2019 PAGE 6 OF 8
RECORD ID #:DEH2003-HUPFP-202519
3030058 Failed to mark date on empty container larger than 5 gallons &/or manage it within one year. 22 CCR 66261.7(f) 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 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 electronic devices or CRTs from an offsite source to notify DTSC 30 days prior to acceptance. 22 CCR 66273.32(c) 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)
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)(3)
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 25211.3, 25212 (a), (b), and/or (c)
HM-923 (10-18)
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: 01/24/2019 PAGE 7 OF 8
RECORD ID #:DEH2003-HUPFP-202519
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 68.905 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) 4030043 Failed to have secondary containment and/or 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)(III)
REQUIREMENTS BASED ON 40 CFR 112.1-112.6
# VIOLATION DESCRIPTION
4010035 Failed to prepare an appropriate SPCC Plan within six months when the facility no longer meets the conditions of a qualified facility. (40 CFR 112.3(a)(1), 112.3(g), 112.6.) HSC 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) 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) HM-950 APSA (10-18)
C O U N T Y O F S A N D I E G O
COMPLIANCE INSPECTION REPORT
APSA Program (continued)
INSPECTION DATE: 01/24/2019 PAGE 8 OF 8
RECORD ID #:DEH2003-HUPFP-202519
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. (40 CFR 112.7(e), 112.8(c)(6).) HSC 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 Failed to conduct annual discharge prevention briefings to ensure understanding of SPCC plan. (40 CFR 112.7(f)(3).) HSC 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 112.8(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 112.8(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 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) 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) HM-950 APSA (10-18)
HM-926(01/15)
COUNTY OF SAN DIEGO
CORRECTIVE ACTION FORM TO
DOCUMENT RETURN TO COMPLIANCE
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 01/24/2019
RECORD ID #: DEH2003-HUPFP-202519
SPECIALIST: Vikki Denslow
INSPECTION CONTACT:David Carroll
TITLE: Assistant Store Manager
PHONE:619-212-4100
E-MAIL:[email protected]
VIOL# DATE
CORRECTED
INDICATE HOW VIOLATIONS WERE CORRECTED
(Attach Any Supporting Documentation) DUE DATE
#1 1020002 02/23/2019
#2 3030007 02/23/2019
#3 HMD0138 02/23/2019
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 submitting false information.
PRINTED NAME OF FACILITY REPRESENTATIVE
TITLE OF FACILITY REPRESENTATIVE SIGNATURE
DATE SIGNED
SEND COMPLETED FORM AND SUPPORTING DOCUMENTATION TO THE ADDRESS LISTED BELOW
COUNTY OF SAN DIEGO USE ONLY
REVIEWED BY: DATE:
SPECIALIST'S COMMENTS:
All violations noted on date listed above were corrected Based On Information Provided By The Facility RTC entered by Specialist on:
Based On Field Verification By Specialist RTC entered by Office Assistant on:
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 http://www.sdcdeh.org 858-505-6880
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February 14, 2019
Ms. Vikki Denslow
County of San Diego
P.O. Box 129261
San Diego, CA 92112
RE: Lowe's #1661 in Santee, CA.
Dear Ms. Denslow:
As the Regional Environmental Compliance Coordinator for the California stores, I provide certain services to Lowe's Home Centers, Inc. including ensuring safety and environmental compliance at Lowe's retail locations.
In response to the January 24, 2019 inspection at Lowe's #1661 in Santee, CA, I would like to provide you with the information requested, as well as Lowe's response to each of the listed violations.
Violation #1: 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. USC 25505(a)(4); 19 CCR 2659(b) · Remediation #1:
SPCC training was conducted at the store on 1/28/19. Please see the attached sign in roster for individuals trained.
Hazardous materials training is conducted online, yearly for all store employees. Please see the attached excel file for the dates each employee completed their annual training.
Violation #2: 3030007 Failed to properly label/date hazardous waste container &/or tank. 22 CCR 66262.34(t) Remediation #2:
Store dated the Excluded Recyclable Material label on the paint tint box and relabeled those drums with faded labels.
Please see the pictures below:
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_ ...... _.
Violation #3: HMD0138 Manifest signed by the TSDF not available for inspection. 22 CCR 66262.40(a); HSC 25185(a)(4)
Remediation #3:
I obtained the copies of the final TSDF signed manifests for 001543236PSC (dated April 2017) and 00 l 674522PSC (dated October 2017) and sent these to the store to keep filed. Please see the attached copies.
If you have any questions or need any additional information to close out this investigation, please feel free to contact me. If no further information is required, please reply either by letter or email that this inspection is closed.
Sincerely,
Kyle Jons
Regional Environmental Compliance Coordinator I Loss Prevention, Safety & HAZMAT 949-891-9028
[email protected]
HM-924(01/15)
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 01/04/2022 PAGE 1 OF 9
RECORD ID #: DEH2003-HUPFP-202519
TIME START: 3:30 PM END: 5:30 PM
SPECIALIST: Vikki T. Denslow
INSPECTION CONTACT:Aloha Lawler/Rene Escarcega
TITLE: Assistant Store Manager/Operations Manager
PHONE:619-212-4100
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 10/31/2022
CONSENT TO CONDUCT INSPECTION GRANTED BY: Aloha Lawler TITLE: Assistant Store Manager INTRODUCTION:
Notice to Comply
-The purpose of this inspection was to evaluate this retail store for hazardous materials, hazardous waste, and aboveground petroleum storage act (APSA) requirements.
-An assistant store manager, Aloha Lawler, granted consent for this inspection, and he was present for most of the inspection.
The operations manager, Rene Escarcega, was also present for part of the inspection. -This store had a 1500 gallon diesel tank for an emergency generator and a cage of propane with twelve cylinders (approximately 10 gallons each).
-This facility also had the following drums (approximately 50 gallons each): one containing corrosives, two containing toxics, one containing aerosols, three containing non-RCRA hazardous waste liquid/latex paint/class 9 waste, a drum containing universal waste/batteries, and an empty drum for oxidizers.
-This store also had a drum (approximately 20 gallons) containing waste oil/fuel, a box containing hazardous waste/concrete sealer, a box containing universal waste/electronic waste, four buckets containing universal waste/batteries, and approximately ten boxes containing universal waste/bulbs.
-The EPA ID number is active.
-Employee training records were dated August 20, 2021 through January 3, 2022. -The Spill Prevention, Control, and Countermeasures (SPCC) Plan was dated December, 2011, and it had a Professional Engineer certification. A five year review of the SPCC Plan had been completed on August 25, 2021.
A submittal was made in the California Environmental Reporting System (CERS) on February 25, 2021. Make another submittal in CERS by February 25, 2022 as the Hazardous Materials Business Plan must be certified in CERS on an annual basis.
VIOLATION # 1
3030007 Failed to properly label/date hazardous waste container &/or tank. 22 CCR 66262.34(f) Classification: Class II
Observations:
Approximately three of the drums that contained hazardous waste had not been properly labeled as hazardous waste. Some of the hazardous waste labels on the other containers had faded so that the generator information, etc. was illegible. Hazardous waste containers must be labeled with the following: The words "Hazardous Waste", the name and address of the generator, the composition and physical state of the waste, the hazardous properties of the waste, and the accumulation start date.
HM-924(01/15)
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE
INSPECTION REPORT
INSPECTION DATE: 01/04/2022 PAGE 2 OF 9
RECORD ID #: DEH2003-HUPFP-202519
Corrective Action Completed During Inspection:
The staff properly labeled the hazardous waste containers during the inspection.
Complete and return a Corrective Action Form to Vikki Denslow of the Hazardous Materials Division by February 3, 2022.
VIOLATION # 2
HMD0138 Manifest signed by the TSDF not available for inspection. 22 CCR 66262.40(a); HSC 25185(a)(4) Classification: Minor
Observations:
The copies of two manifests that had been signed by the treatment, storage, and disposal facility (TSDF) were not available at the store.
The manifest numbers were 023625263JJK (dated 10/13/21) and 000297409DAT (dated 11/7/19).
Corrective Action Due By:02/03/2022
Locate copies of the two manifests described above that are signed by the TSDF.
If signed copies cannot be located, contact your hazardous waste hauler and request that signed copies be sent to you.
Complete and return a Corrective Action Form with copies of the two signed manifests to Vikki Denslow of the Hazardous Materials Division by February 3, 2022.
INSPECTION REMARKS:
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 If you have any questions regarding this inspection, please contact Vikki T. Denslow, 619-804-1738, [email protected]
INSPECTION PHOTOS
None
INSPECTION ATTACHMENTS
Document Name Document Description
1 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
HM-924(01/15)
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE
INSPECTION REPORT
INSPECTION DATE: 01/04/2022 PAGE 3 OF 9
RECORD ID #: DEH2003-HUPFP-202519
PRINTED NAME OF FACILITY REPRESENTATIVE
Aloha Lawler/Rene Escarcega
TITLE OF FACILITY REPRESENTATIVE
Assistant Store Manager/Operations Manager
SIGNATURE
Signature Not Obtained
DATE SIGNED
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: 01/04/2022 PAGE 4 OF 9
RECORD ID #:DEH2003-HUPFP-202519
FACILITY NAME: *LOWE'S #1661
ADDRESS: * 9416 MISSION GORGE RD 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) and 25508(a)(1) 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) 1 ✖
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: 01/04/2022 PAGE 5 OF 9
RECORD ID #:DEH2003-HUPFP-202519
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) 2 ✖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: 01/04/2022 PAGE 6 OF 9
RECORD ID #:DEH2003-HUPFP-202519
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
Aboveground Petroleum Storage Act (APSA) Program
INSPECTION DATE: 01/04/2022 PAGE 7 OF 9
RECORD ID #:DEH2003-HUPFP-202519
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 qualified facility criteria. 40 CFR 112.6(a)(2), 112.6(b) (2)(ii); 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: 01/04/2022 PAGE 8 OF 9
RECORD ID #:DEH2003-HUPFP-202519
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: 01/04/2022 PAGE 9 OF 9
RECORD ID #:DEH2003-HUPFP-202519
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)
HM-926(01/15)
COUNTY OF SAN DIEGO
CORRECTIVE ACTION FORM TO
DOCUMENT RETURN TO COMPLIANCE
FACILITY NAME: LOWE'S #1661
ADDRESS: 9416 MISSION GORGE RD
CITY/ZIP: SANTEE /92071
INSPECTION DATE: 01/04/2022
RECORD ID #: DEH2003-HUPFP-202519
SPECIALIST: Vikki T. Denslow
INSPECTION CONTACT:Aloha Lawler/Rene Escarcega
TITLE: Assistant Store Manager/Operations Manager
PHONE:619-212-4100
E-MAIL:[email protected]
VIOL# DATE
CORRECTED
INDICATE HOW VIOLATIONS WERE CORRECTED
(Attach Any Supporting Documentation) DUE DATE
#1 3030007 01/04/2022 Corrected during inspection 02/03/2022 #2 HMD0138 02/03/2022
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 submitting false information.
PRINTED NAME OF FACILITY REPRESENTATIVE
TITLE OF FACILITY REPRESENTATIVE SIGNATURE
DATE SIGNED
SEND COMPLETED FORM AND SUPPORTING DOCUMENTATION TO THE ADDRESS LISTED BELOW
COUNTY OF SAN DIEGO USE ONLY
REVIEWED BY: DATE:
SPECIALIST'S COMMENTS:
All violations noted on date listed above were corrected Based On Information Provided By The Facility RTC entered by Specialist on:
Based On Field Verification By Specialist RTC entered by Office Assistant on:
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 http://www.sdcdeh.org 858-505-6880
-..
FlLE
SAN DIEGO REGIONAL
HAZARDOUS MATERIALS QUESTIONNAIRE
OFFICE USE ONLY
UPFP#: J.O 5"] S""7
Business Name Business Contact
PJt l CA vt-e 1-1 lC.. u:u N 1'
Project Address . City ·
! ll&llo-ruWN \"Prtt\::WAI'
Mailing Address City State Plan File#
7.AMt;. \ M-<D <;;:"
Telephone # ,
'f ( (;,.lq --, 4"(. 4u71 fl-" l oL{ . · The follOWing questions represent the facility's actiVities, NOT the specinc proJect description. · (.' PART 1: FIRE DEPAR!MENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATKlN: Indicate by drc!ing the ttem, !r 1your \I\ business will use, process, or store any of the following hazardous materials. if any of the items are circled, appficant must contact the Fire.Prol 'on with jurisdiction prior to plan submttta!. · · · \ll \ f ·
1. Explosive or Blasting Agents . 5. Organic Peroxides g_ Waler Reactives 13.
2. Compressed Gases 6. Oxidizers 10. Cryogenics · clP Other Health Haza ··3. Flammable/Combustible Uquids · 7. Pyrophorics · 11 .. Highly Toxic or Toxic Maleriais · 15 None of These
4. Flammable Solids . 8: Unstable Reactlves 12. · Radioactives · PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DMSIONS IHMD!: If the answer to any of the question$ is yes, applicant must contact the County of San Diego Hazardous Malerials Division, 1255 Imperial Avenue, 3"' floor, San Diego, CA 92101.
Call (619) 338-2222 prior to the issuance of a building permil FEES ARE REQUIRED. Expected dale of Occupancy _ __./ __ _,_/ __
1. 2.
3. 4.
5. 6.
YES NO
!I 0
rl 0
0 •
Is your business listed on the reverse side of this form? Will your business dispose of Hazardous Substances or Medical Waste in any amount? WiD yeur business store or handle Hazardous Substances in quantities equal to or grealer than 55 gallons, 500 pounds, 200 cubic or carcinogens/reproductive toxins in any quantity? 0 0
0 B Win your business use an existing or Install an underground storage tank? 0 wm your business store or handle Regulaled Substances (Ca!ARP)? • Will your business use or install a Hazardous Waste Tank System (Tolle 22, Artide 10)? 0 CaiARP Exempt
0 Ca!ARP Required
0 CaiARP Complete
Date Initials
PART Ill: San Diego County Air pollution Contrpl District: If the answer to any of the questions below is yes, applicant must contact the AU Pollution Control District (APCD), g150 Chesapeake Drive, San Diego, CA 92123, telephone (858) 650-4550 prior to the issuance of a building or demolition permil Note: if the answer to questions 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to commenting demolition or renovation, except demolition or renovation of residential structures of four untts or less. Contact the APCD for more information. ·
YES' NO
1. 0 • Will the subject facility or oonstruction activities lndude operations or equipment that emtt or are i:apable of emttting an air contaminant? (See the APCD fact sheet at h!!p:J/www sdapcd.org/info/facts/pe!T!lils.odf, and the list of typical equipment requiring an APCD permtt on the reverse side of this form. Contact APCD if you have any questions.)
2. , 0 0 (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be localed 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 h!!D:I/www cde ca.oov/relsd/: or contact the · appropriate school district)
3. 0 • Will there be renovation that Involves handling of any friable asbestos material, or disturbing any malarial that contains non-friable asbestos? -4. 0 • WiD there be demolition invoM the removal bf a load s o(tin structural member? 1 balness activities: Briefly describe proposed project:
. io itA!- 'fe+/Jo<t-\1'
' dedare under penalty of perjury that to the best of my knowledge and bell herein are true and correcl 12oe.e.rzr e JoN IO!lF-L4t; · . . Name of owner or Authorized Agent FOR OFFICIAL USE ONLY:
FIRE DEPARTMENT OCCUPANCY CLASSIFICATION·
BY: DATE: I L EXEMPT OR NO REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY ... _&'oii'T' :, ...... APC ... COUNTY-HMO APCD COUNTY-HMO APCD · IN! riALS ;;
f>_ -o s- :'
SIGNATURE DATE
8- ;],/-02:: J '#,.
I' OF '"
H:A;G /
nl<'U·l-lM.0171 ff\7/M\
,.. .
FACILITY ID#
PAGER#
SAN DIEGO COUNTY
DEPARTMENT OF ENVIRONMENTAL HEALTH- CUPA
HAZARDOUS MATERIALS DMSION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(619) 338-2222 FAX (619) 338-2377
1-800-253-9933
'
BUSINESS OWNER/OPERATOR IDENTIFICATION
BEGINNING DATE
CA ZIP D:::r-1 106 SIC CODE (4 digit If)
109 BUSINESS OPERATOR PHONE
124
125 BUSINESS PHONE
126 24-HOUR PHONr
127 p·---
ADDITIONAL LOCALLY COLLECTED INFORMATION:
E-MAIL:*
----- E-MAIL: •
Page_of_.
101
102
103
105
107
108
110
112
liB
119
122
128
129
13C
131
·--1-3;
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. 136 TITLE OF SIGNER'- 13
cf1'11/c MonRB(£
DEH:HM-UPCF-BUSINESS OWNER/OPERATOR IDENTIFICATION (05-04) 5 COUNTY !F SAN
.· ' :·-->;_,,-;:::,..; ·. ' .. ,· . :.-
:.coMPLIANCE ' . . - . . . ..-. . .
ENTERED MAR 1 4
.LOF _L DATE_Lj 22/
PEiuvm # zos;+rr
TIME START 0 END / 2: > 0
BUS. CODE _
SPECIALIST £h.h.a_rtt._
On the above date, an inspection of your business/facility was conducted in order to determine compliance with the Califomia Health and Safety Code (HSC) Chapters 6.5, 6.7, 6.95; Titles l9, 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: Reins ection fees will be char ed if additional ins ections are re uired to determine com Hance. ;.. N
0 /A Y N/A 2.-n
J<>L Unified Program Facility Permit current and available d"n: I I D D Hazardous Materials Business Plan available D &_____ Contingency Plan available .R' D Employee Training is adequate D £I Employee Training records available ·fiif D Waste disposal records available for review D Waste containers kept closed S.. D Emergency contacts current&: Updated today D Waste containers kept labeled D Eil Chemical inventory current D Updated today .1&. D Waste containers in good condition :t-.l(_&q_Q :
RECEIVED MAR 0 8 ?On7
D This is an annual certification that the Hazardous Materials Business Plan (inventory, emergency contacts, emergency response plan, and employee training plan) is current and includes all the information re uired i the H&SC and is 1 tained at the site where hazardous materials are stored. _j_jJZ; _filDate Signed
Initials of Business Representative
Title of Business Representative
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.sdcountv.ca. ov/deh/hmd/index.html HM-924 (03/06) NCR DISTRIBUTION: WHITE- RETURN TO HMD; YELLOW-BUSINESS RETAINS
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 ACTIVITIES
EPA 10 #(Hazardous Waste Only)
Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (mclude liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan uired to I 0 CFR Parts 40 or
B. UNDERGROUND STORAGE TANKS CUSTsl
Own or operate underground storage tanks?
Intend to upgrade existing or install new USTs?
Own or operate ASTs above these thresholds:
-any_ tank capacity is greater than 660 gallons, or
-the total capacity for the facility is greater than I ,320 gallons? D. HAZARDOUS WASTE
•
•
•
Generate hazardous waste?
Recycle more than I 00 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)?
Treat hazardous waste on site?
Treatment subject to financial assurance requirements (for Permit by Rule and Conditional Authorization)?
Consolidate hazardous waste generated at a remote site? • Need to report the closure/removal of a tank that was classified as hazardous waste and cleaned onsite?
E. LOCAL REQUIREMENTS
MEDICAL WASTE
Generate <200 lbs/month ofMedical!Biohazardous Waste?
Generate :::200 lbs/month ofMedical/Biohazardous Waste? DYES 4
D YES .111 NO 5
DYES 0NO 6
HAZARDOUS MATERIALS INVENTORYCHEMICAL DESCRIPTION (OES 2731) UST FACILITY (Fonnedy SWRCB Fonn A)
UST TANK (one pag!' per tank) (Formerly Fonn B)
UST FACILITY
UST TANK (one"" umk)
UST INSTALLATION- CERTIFICATE OF
COMPLIANCE (one page per tank) (Fonnerly Fonn C)
0 YES 0 NO 7 USTTANK(closurcportion-onepagepcrtank)
DYES g}No s
DYES !SiNO 9
DYES [SlNO
D_YES
DYES
DYES
DYES
10 II
12 13
14 NO FORM REQUIRED TO CUP As
EPA 1D NUMBER- provide at the top of this
page
RECYCLABLE MATERIALS REPORT (one"''
recycler)
ONSJTE HAZARDOUS WASTE TREATMENT
-FACILITY (Formerly DTSC Forms 1772)
ONSITE HAZARDOUS WASTE TREATMENT
-UNIT (one page per unit) (Formerly DTSC Fotms 1772 A,
B, C, D and L)
CERTIFICATION OF FINANCIAL
ASSURANCE (Fonnedy DTSC Fonn 1232)
REMOTE WASTE I CONSOLIDATION SITE
ANNUAL NOTIFICATION (Fonne<ly DTSC Fonn
1196)
HAZARDOUS WASTE TANK CLOSURE
CERTIFICATION {Fennelly DTSC Fmm 1249)
•
Generate :::200 lbs/month ofMedical!Biohazardous Waste and treat any amount of medical waste Handle Toxic gases with threshold limit concentration (TL V) # I 0 ppm in any quantity? iR,YES 0NO
LlYES INO
DYES NO
DYES NO
Business Activities
Subm1t the Busmess Activities page and the Business Owner/Operator Identification page (OES Form 2730), for all submissions. NOTE: The numbering of the instructions follows the data element numbers that are on this form. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, and the Business Section of the Unified Program Data Dictionaf¥.
Please number all pages of your submittal. This helps the San Diego County, Department of Environmental Health (DEH), Hazardous Materials Division (HMO) identify whether the submittal is complete and if any pages are separated.
1. FACILITY ID NUMBER- Enter the 6 character Permit# on your Unified Program Facility Permit (UPFP). If you do not have a Unified Program Facility Permit, leave this blank.
2. EPA 10 NUMBER- Enter your facility's 12-character U.S. EPA 10 #.If you do not have a number, contact the Department of Toxic Substances Control (DTSC) at (800)- 61-TOXIC or (800) 618-6942, to obtain one.
3. BUSINESS NAME- Enter the full legal name of the business. This is the same as the terms "Facility Name" or "DBA"- Doing Business As.
4. HAZARDOUS MATERIALS ON SITE -Check the appropriate box to indicate whether you have a hazardous material onsite in the quantities listed in section A of this form. If "Yes", then you must then complete the Business Owner/Operator Identification page (OES Form 2730) and the Hazardous Materials Inventory- Chemical Description page (OES Form 2731 ), as well as a complete Hazardous Materials Business Plan (see HMO form DEH:HM952).
5. OWN OR OPERATE UNDERGROUND STORAGE TANK (UST)- Check the appropriate box to ind1cate whether you own or operate USTs containing hazardous substances as defined in Health and Safety Code (HSC) Section 25316. If "YES," then you must complete one UST Facility page and UST Tank pages for each tank. You must also submit a monitoring program plan (See HMO handout DEH:HM9222).
6. UPGRADE/INSTALL UST- Check the appropriate box to indicate whether you mtend to install or upgrade USTs containing hazardous substances as defined in HSC Section 25316. If "YES," then you must complete the UST Installation- Certificate of Compliance page 1n addit1on to UST Facility and Tank pages, plot plan and monitoring program plan and the DEH installation, upgrade permit applications.
Contact the HMO at (800) 253-9933.
7. UST CLOSURE- Check the appropriate box if you are closing an UST and complete the closure portion of the UST Tank pages for each tank. Submit a DEH closure application.
8. OWN OR OPERATE ABOVEGROUND PETROLEUM STORAGE TANK (AST)- Check the appropriate box to indicate whether there are ASTs onsite which exceed the regulatory thresholds. This program applies to all facilities storing petroleum in aboveground tanks.
Petroleum means crude oil, or any fraction thereof, which is liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure (HSC Section 25270.2 (g)).
9. HAZARDOUS WASTE GENERATOR- Check the appropriate box to indicate whether your facil1ty generates hazardous waste. A generator is the person or business whose acts or processes produce a hazardous waste or who causes a hazardous substance or waste to become subject to State hazardous waste law. Hazardous waste means a waste that meets any of the criteria for the identification of a hazardous waste adopted by DTSC pursuant to HSC 325141. "Hazardous waste" mcludes, but is not limited to, federally regulated hazardous waste. Federal hazardous waste law is known as the Resource Conservation and Recovery Act (RCRA). Unless explicitly stated otherwise, the term "hazardous waste" also Includes extremely hazardous waste and acutely hazardous waste.
10. RECYCLE - Check the appropriate box to indicate whether your facility recycles more than 100 kilograms per month of recyclable matenal under a claim that the material is excluded or exempt per HSC Section 25143.2. Check "YES" and complete the Recyclable Materials Report pages, if you either recycled onsite or recycled excluded recyclable materials which were generated offsite. Check "NO" if you only send recyclable materials to an offsite recycler. You do not need to report.
11. ON SITE HAZARDOUS WASTE TREATMENT- Check the appropriate box to indicate whether your facility engages in onsite treatment of hazardous waste. "Treatment" means any method, technique, or process which is designed to change the physical, chemical, or biological character or composition of any hazardous waste or any material contained therein, or removes or reduces its harmful properties or characteristics for any purpose. Please contact the HMO to determine if any exemptions apply to your facility. If your facility engages in onsite treatment of hazardous waste then complete the Onsite Hazardous Waste Treatment Notification- Facility page and one set of Onsite Hazardous Waste Treatment Notification- Unit pages with waste and treatment process information for each unit.
12. FINANCIAL ASSURANCE- Check the appropriate box to indicate whether your facility is subject to financial assurance requirements for closure of an onsite treatment unit. Unless they are exempt, Permit by Rule (PBR) and Conditionally Authorized (CA) operations are required to provide financial assurance for closure costs (per 22 CCR Section 67 450.13 (b) and HSC Section 25245.4). If your facility is subject to financial assurance requirements or claiming an exemption, then complete the Certification of Financial Assurance page.
13. REMOTE WASTE CONSOLIDATION SITE - Check the appropriate box to indicate whether your facility consolidates hazardous waste generated at a remote site. Answer "YES" if you are a hazardous waste generator that collects hazardous waste initially at remote sites and subsequently transports the hazardous waste to a consolidation site you also operate. You must be eligible pursuant to the conditions in HSC Section 25110.10. If your facility consolidates hazardous waste generated at a remote site, then complete the Remote Waste Consolidation Site Annual Notification page.
14. HAZARDOUS WASTE TANK CLOSURE- Check the appropriate box to indicate whether the tank being closed would be classified as hazardous waste after its contents are removed. Classification could be based on:
-Your knowledge of the tank and its contents -The mixture rule -Testing of the tank -The listed wastes in 40 CFR 261.31 or 40 CFR 261.32. -Inability to remove hazardous materials stored in the tank.
If the tank bemg closed would be classified as hazardous waste after its contents are removed, then you must complete the Hazardous Waste Tank Closure Certification page.
15. LOCAL REQUIREMENTS- If you generate Medical Waste you are required to obtain a Health Permit and submit a Biomedical Waste Management Plan. In addition to this, if you generate _:::200 lbs on medical waste per month and treat any amount of medical waste on site you may be required to apply for a medical waste treatment permit with the HMO. TOXIC GASES: If you handle toxic gases with threshold limit concentration (TLV) _:o10 ppm in any quantity, you are required to obtain a Health Permit and submit an HMO Hazardous Materials Business Plan.
3 UPF.ermit#: z,o
DATE INSPECTED:_(_/ 0 7
UNIFIED PROGRAM FACILITY PERMIT
APPLICATION
This business or service is required to obtain a Unified Program Facility Permit from the San Diego County Department of Environmental Health. I answered "yes" to one or more of the questions on the "Business Activities" form. ---
Date assumed business ownership at this location:
This permit does not excuse any owner or operator from complying with all applicable federal, state, county or local laws, ordinances or regulations. The owner or operator is required to determine if another permit or approval from any other agency or department is necessary. The County, by issuing this permit, does not relinquish its right to enforce any violation of law. 0 I have determined that this business or service does not require a Unified Program Facility Permit from the San Diego County Department of Environmental Health.
I declare under penalty of perjury that to the best of my knowledge and belief the statements made herein are correct and true. I consent to all necessary inspections allowed by law and incidental to the issuance of required permit(s) and the operation of this business.
Signature: _____ _ 1
Printed Name: GAMBOA, H.A.
HMCJSW/A W) USN 9466
Type of Business: E-C\S t L O liY\+j
9 r\vY\ttV"lj C (}...'(e. (\in t 0
Title:
Date: 22To.n ;).QO 7
Phone#: (ro f 0) G4 s- 1.{-
Please complete the business information on the following page and return this application to the San Diego County Department of Environmental Health at:
SAN DIEGO COUNTY
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERJALS DIVISION
P.O. BOX 129261
SAN DIEGO CA 92112-9261
If a San Diego County Unified Program Facility Permit is required for your business or service a representative of this Department will contact your business. Permit fees will be determined from the contact and a billing statement will be mailed.
NOTE: If you do not use hazardous materials, generate hazardous waste, or have underground storage tanks you are still reguired to return this form.
A representative of the San Diego County Department of Environmental Health may contact you to verify the information provided on this application.
DEH:HM-906 (07-05) 4
. , I
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 OWNER/OPERATOR IDENTIFICATION
CA ZIP ()
106 SIC CODE (4 digit#)
BUSINESS OPERATOR PHONE
a{}. .
({
DEH:HM-UPCF-BUSINESS OWNER/OPERATOR IDENTIFICATION (05-04) Page_of_
101
102
129
130
5 • Business Owner/Operator ldentificati.
Please submit the Business Activities page, the Business Owner/Operator Identification page (OES Form 2730), and Hazardous Materials- Chemical Description pages (OES Form 2731) for all hazardous materials inventory submissions. For the inventory to be considered complete this page must be signed by the appropriate individual.
(Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.i Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated.
ALWAYS SUBMIT A COPY OF THIS COMPLETED PAGE WITH SUBMITTAL OF ANY OTHER UNIFIED PROGRAM CONSOLIDATED FORM.
1. FACILITY ID NUMBER - Enter your 6 character Permit# on your Unified Program Facility Permit (UPFP If you do not have a Unified Program Facility Permit, leave this blank.
3. BUSINESS NAME- Enter the full legal name of the business. This is the same as the terms "Facility Name" or "DBA"- Doing Business As. 100. BEGINNING DATE- Enter the beginning year and date (YYYYMMDD) of the inventory report, recyclable materials report, or onsite tiered permitting report for PBR sites. 101. ENDING DATE- Enter the ending year and date (YYYYMMDD) of the reports identified in #100. 102. BUSINESS PHONE- Enter the phone number, area code first, and any extension. 103. BUSINESS SITE ADDRESS- Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. If the mailing address is different, complete #113- #116. 104. CITY- Enter the city or unincorporated area in which busmess site is located. 105. ZIP CODE- Enter the zip code of business site. The extra 4-digit zip may also be added. 106. DUN & BRADSTREET- Enter the Dun & Bradstreet number for the facility. If you do not have one, leave this field blank. 107. SIC CODE- Enter the primary Standard Industrial Classification Code number for primary business act1v1ty. NOTE: If code is more than 4 digits, report only the four.
108. COUNTY- Enter the county in which the business site is located. 109. BUSINESS OPERATOR NAME - Enter the name of the business operator which is the name used for mailing correspondence. 110. BUSINESS OPERATOR PHONE- Enter business operator phone number, if different from business phone, area code and any extens1on. 111. OWNER NAME- Enter name of business owner, if different from business operator. 112. OWNER PHONE- Enter the business owner's phone number if different from business phone, area code first, and any extension. 113. OWNER MAILING ADDRESS - Enter the owner's mailing address where business related correspondence should be sent, if different from business site address.
114. OWNER CITY- Enter the name of the city for the owner's mailing address. 115. OWNER STATE - Enter the 2 character state abbreviation for the owner's mailing address. 116. OWNER ZIP CODE- Enter the zip code for the owner's address. The extra 4-digit zip may also be added. 117. ENVIRONMENTAL CONTACT NAME - Enter the name of the person, if different from the Business Owner or Operator, who will respond to enforcement activity.
118. CONTACT PHONE- Enter the phone number, 1f different from Owner or Operator, at which the environmental contact can be contacted. 119. CONTACT MAILING ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent. 120. CITY- Enter the name of the city for the environmental contact's mailing address. 121. STATE - Enter the 2 character state abbreviation for the environmental contact's mailing address. 122. ZIP CODE - Enter the zip code for the environmental contact's mailing address. The extra 4-digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME- Enter the name of a representative that can be contacted in case of an emergency involving hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation.
124. TITLE - Enter the title of the primary emergency contact. 125. BUSINESS PHONE- Enter the business number for the primary emergency contact, area code first, and any extensions. 126. 24-HOUR PHONE - Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above.
127. PAGER NUMBER- Enter the pager number for the primary emergency contact, if available. 128. SECONDARY EMERGENCY CONTACT NAME- Enter the name of a secondary representative that can be contacted in the event that the primary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation.
129. TITLE - Enter the title of the secondary emergency contact. 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code first, and any extension. 131. 24-HOUR PHONE- Enter a 24-hour phone number for the secondary emergency contact. The 24-hour phone number must be one that is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above.
132. PAGER NUMBER - Enter the pager number for the secondary emergency contact, if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION- This space may be used for CUPAs or AAs to collect any add1t1onal information necessary to meet the requirements of their individual programs. Contact your local agency for guidance. 134. DATE - Enter the date that the document was signed. (YYYYMMDD) 135. NAME OF DOCUMENT PREPARER- Enter the full name of the person who prepared the inventory submittal information. 136. NAME OF SIGNER - Enter the full printed name of the person signing the page. The signer certifies to a fam1lianty with the information submitted and that based on the signer's mquiry of those individuals responsible for obtaining the information, all the information submitted 1s true, accurate and complete.
SIGNATURE OF OWNER/ OPERATOR OR DESIGNATED REPRESENTATIVE- The Business Owner/Operator, or officially designated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted and that based on the signer's inquiry of those individuals responsible for obtaining the information it is the Signer's belief that the submitted information is true, accurate and complete.
137. TITLE OF SIGNER- Enter the title of the person signing the page. ./ .. H .AOOMAi>
()()J.fl V.lU ("II A\W2):)MH
DEH HM-UPCF-BUSINESS OWNER/OPERATOR IDENTIFICATION (05-04) 6 09/14/2010 14:59 FAX ENTERED 2 1 2010 f' 141004/005
D;OSl-51- County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH HAZARDOUS MATERIALS DIVISION P.O. BOX 129261, SAN CIEGO, CA 92112-9261 (619) 338-2222 FAX (619) 338-2377; 1.S00-253·9933
www.sdcounty.ca.gov/detllhazmat/hazmat...J!ermlts.html
Medical Waste Management Plan
Faeilltv Information Unified Program Facility
Permit#:_
Business
Date: k r /1-t WID
Name: l"bC 5anb..
Type of Business: Cl• t"""l c_
Address: 12.0
CA g'J-09-/ Slnlot No. StroetName cuv SUllo Zip Coae
Person for_lmp.!Jmjtntlr:mJI\!t.Niedical Plan
Name: rtM2 'Se.(tt'\Q
'""Pe..#f Otft CaA {.lj5 X 0//.:J
Types of wastes generated
1:8:1 Sharps - needles, broken glass. blades.
Estimated monthly lbs
Laboratory wastes • specimens or microbiological
cultures, stocks of infectious agents, live and
attenuated vaccines, and culture media.
Estimated monthly amount_ lbs
0 Waste contamlnat11d with fixatives or
chemotherapeutic agents.
Estimated monthly amount_ lbs
0 Pathology waste- recognizable human
anatomical parts.
Estimated monthly amount_ lbs
Other (please specify): Pharmaceutical
· Estimated monthly amount S:C/0 lbs
0 Blood or body fluids- liquid blood elements or
other regulated body fluids, or articles contaminated with blood or body fiuids.
Estimated monthly lbs
0 Isolation waste -waste contaminated with excretion, exudates, or secretions from humans or animals who are isolated due to highly
communicable diseases.
Estimated monthly amount_ lbs
0 Surgical specimens - human or animal parts or
tissues removed surgically or by autopsy.
Estimated monthly amount_ lbs
D Contaminated animals - animal carcasses, body parts, bedding materials.
Estimated monthly amount_ lbs
0 Home Generated Sharps
Estimated monthly amount 1 lba
Estimate of TOTAL monthly medical waste generated:J.Iy.CS fbs Method of treatment performed on site (if applicable):
0 Steam Autoclaving 0( Other state approved alternative technology (please specify below):
N/A
HM-9213 (05/08) Department ofEnvlronm;nlnl Ht:alrh .. Ha:t.:nrdaus Division 08/14/2010 14:59
Ill 005/005
FAX
Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Address: 527 N. Rice Ave.
City: Oxnard State £A ZIP Code 930308924
Phone #: (§QQ) ___ _
Contact Person:Michael Altman
Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:Tci,lnc.
Address: 241w Laurel St
· City: Colton State Code 92324
Phone #: -----
Contact Person: __ Phone#:(_). _____ _
I hereby certify to the best of my knowledge and believe the statements macte herein are correct and accurate.
Wr'l/1', c Wh,f-e- Name: ...,--
Type or Print
T
.
1 1te:_ He.o/ic-e{ ON'irt..-./
Signature: Date: K , 10
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste lbs/month) system
Plan to
breaks
be followed
down,
to
power
ensure the proper disposal of medical waste in the event of a natural disaster, treatment failure, spill, etc. (600 Characters max. for InteractiVe form- use aadltlonat eheetalf neceeeary).
In the event of a Natural Disaster, The BMC Is stock with a spill kit and enough barrels to contain the medicla waste for one week. If the clinic becomes overwhelmed, collection activities regulatory officials may be contacted to request variances or exceptions to the normal handling procedures (storage, packaging, handling, transportation) until the event Ia over. in the event of a treatment system breakes down, power failure or spill for longer than 5 days, there are back ue facilities In the region that will acceet waste.
HM-921 3 (05108) Oepllrtrnon! of Envitonmtntal Health-Hazardous Matoriots Division 4 C5fJ ENTERED 2 1 2011
t.N I t.t<t.U I'IM L l LU II
COUNTY OF SAN DIEGO PAGE_loF__2DATE I ll
COMPLIANCE INSPECTION REPORT I
-NA-ME----l-fu-1--U· ['--_..U!l
ciTY /ZIP __ q.J....LZa-_::JrrzL....L-J'[..__----
I
PERMIT# ::2..Q<:> BUS. CODE /a (l :
TIME START 1/! IJO END
SPECIALIST Ft I Tzt1J. {1,(1(,(_ ( e._ ' ' INSPECTION CONTACT I
On the above date, the County inspected your facility under the authority of the California Health and Safety Code (H&SC), to detennine compliance with applicable proviSIOI)S 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. I y· NOTE: Reins ection fees will be cha ed if additional ins ections are re uired to determine com liance. 1 / 19"" 0 Unified Program Facility Permit current y· N/A. Permit Expires on: I 3 I I 0/ li:V' Hazardous Materials Business Plan available 0 ci/' Contingency Plan available OLQG IMSQG [!I' . 0 Employee training is adequate 0 ltV' Employee training records available 0 Waste disposal records available for review j9/' 0 Universal waste man'!Bed properly !::" /0 Emergency contacts current 0 Updated today DV"O Waste containers ffi'Ciosed £:3"fabeled uv 0 Chemical inventory/map..}urrent IJI..f)pdated today [jJ/' 0 Waste containers in good condition Consent. to inspect granted by: mnspecti n Contact 0
..._ RECEIVED MAR 1 5 2011 ·
Ls
l1'. .stre. I.S
I·'
---------------------------------------------'!
D 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 re uired in the H&SC and is maintained at the site where hazardous materials are stored. Initials of Facility Representative 'I
l
b
.,
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 11 Phone: 619 338-2222 Toll Free: 800 253-9933 htt ://www.sdcdeh.or (11/08) NCR ·cY= Yes: N/A = Nol Applicable) DISTRIBUTION: WHITE-HMO COPY: YELLOW-FACILITY COPY. '•
PAGE;LQF 2DATE I ,;;)_ 3r_ IL
PERMIT# ::1(2 S 7S 7 BUS. CODE lr-lO
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT TIME START END I
SPECIALIST I I
INSPECTION CONTACT
TITLE
•:I PHONE( )
FACILITY NAME -------::=-----------rf-------
ADDRESS i I 0 .%:" Gn Tel' Arr!cM:r ')
CITY/ZIP ___________________ _
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. y· N/A' NOTE: Reinspection fees will be charged ifadditional inspections are required to determine compliance. 0 0 Unified Program Facility Permit current Y N/A' Permit Expires on: I I 0 0 Hazardous Materials Business Plan available 0 0 Contingency Plan available OLQG OSQG 0 0 Employee training is adequate 0 0 Employee training records available 0 0 Waste disposal records available for review 0 0 Universal waste managed properly 0 0 Emergency contacts current 0 Updated today 0 0 Waste containers 0 closed 0 labeled 0 0 Chemical inventory/map current 0 Updated today 0 0 Waste containers in good condition Consent to inspect granted by: 0 Inspection Contact 0 Other: ----------------------- -
I
.
: .-··
----------------------------------'!
Initials of Facility Representative
DATE SIGNED
2 I 2-3 120(/ TITLE OF FACILITY REPRESENT TIVE
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 (11/08) NCR '(Y= Yes; N/A =Not Applicable) DISTRIBUTION: WHITE-HMO COPY; YELLOW·FACILITY COPY 'I
I
HM-9213 (05/12) 1
The San Diego County Department of Environmental Health, Hazardous Materials Division is the local agency designated by the California Department of Public Health to implement the Medical Waste Management Act. This law governs the generation, handling, storage, transportation, treatment and disposal of medical waste to protect the public and the environment from potential infectious exposure to disease causing agents.
The Medical Waste Management Plan is a document that describes the types and amount of medical waste generated at a specific location, and indicates how wastes are managed to ensure proper treatment and disposal. All Large Quantity Generators (LQGs generate >200 lbs. of medical waste per month) and those Small Quantity Generators (SQGs generate <200 lbs. of medical waste per month) that treat their medical waste onsite are required to complete a Medical Waste Management Plan on the forms prepared by the enforcement agency. [Authority cited California Health and Safety Code § 117600 et seq.] Small Quantity Generators of medical waste who do not treat their medical waste onsite are not required to complete and submit this form to the local enforcement agency. Small Quantity Generators of medical waste who transport waste under a Limited Quantity Hauling Exemption issued by the Department of Environmental Health are, however, responsible for maintaining on file at their office a document stating how they contain, store, treat, and dispose of any medical waste generated. Completing a Medical Waste Management Plan and keeping it at their office can satisfy this requirement.
Attached is a “blank” Medical Waste Management Plan form for your use. Please complete and sign the form and mail the original to the address listed above. Retain a copy for your records. If there are changes in any of the information on your Medical Waste Management Plan, submit a revised form to the address listed above within 30 days of changes.
Annual submittal of the Medical Waste Management Plan is not required.
If you have any questions, please contact your area inspector or the Hazardous Materials Division Duty Desk at (858) 505-6880.
Attachment
"Environmental and public health through leadership, partnership and science" County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 2 MEDICAL WASTE – DEFINITION OF TERMS
MEDICAL WASTE means biohazardous waste or sharps waste that has been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents, those organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health. Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.
BIOHAZARDOUS WASTE means any of the following:
(a) Laboratory waste, including, but not limited to, all of the following:
(1) Human or animal specimen cultures from medical and pathology laboratories. (2) Cultures and stocks of infectious agents from research and industrial laboratories. (3) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including Brucellosis and Contagious Ecthyma, as identified by the department, and culture dishes and de-vices used to transfer, inoculate, and mix cultures. (b) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans. (c) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans.
(d) Waste, which at the point of transport from the generator’s site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans.
(e) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans. (f) (1) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to Chapter
6.5 (commencing with Section 25100) of Division 20.
(2) For purposes of this subdivision, “chemotherapeutic agent” means an agent that kills or prevents the reproduction of malignant cells.
(3) For purposes of this subdivision, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:
(A) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including, but not limited to, when tilted or inverted. (B) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping.
(g) Waste that is hazardous only because it is comprised of pharmaceuticals, as defined in Section 117747. Notwithstanding subdivision (a) of Section 117690, medical waste includes biohazardous waste that meets the conditions of this subdivision.
Biohazardous waste that meets the conditions of this subdivision is not subject to Chapter 6.5 (commencing with Section 25100) of Division 20.
SHARPS CONTAINERS are leakproof, rigid, puncture-resistant containers which when sealed cannot be reopened without great difficulty. These containers must be labeled with the words “Sharps Waste” or with the international Biohazard symbol and the word “BIOHAZARD.” These containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used. Needles and syringes shall not be clipped prior to disposal. “BIOHAZARD BAG” means a disposable red bag which is impervious to moisture and has strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage and handling of a waste-filled bag. A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport. The bags shall be RED in color and conspicuously labeled with the international biohazard symbol and the “Biohazard.” The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. If the waste is to be autoclaved, the outer bag may be colorless as long as the inner bag is red and both bags meet the stated strength criteria. All waste in red biohazard bags must be managed as MEDICAL WASTE.
STORAGE AREA WARNING SIGN is: A sign posted at a designated accumulation area used to store medical waste which must read in English, “CAUTION—BIOHAZARDOUS WASTE STORAGE AREA—UNAUTHORIZED PERSONS KEEP OUT” and in Spanish, “CUIDADO-ZONA DE RESIDUOS—BIOLOGICOS PELIGROSOS—PROHIBIDA LA ENTRADA A PERSONAS NO AUTORIZADAS” or in another language determined to be appropriate.
Intermediate storage areas shall be marked with the international biohazardous symbol or the signage noted above. These warning signs shall be readily legible from a distance of five feet.
PHARMACEUTICAL (a) “Pharmaceutical” means a prescription or over-the-counter human or veterinary drug, including, but not limited to, a drug as defined in Section 109925 or the Federal Food, Drug, and Cosmetic Act, as amended, (21 U.S.C.A. Sec. 321(g)(1)). (b) For purposes of this part, “pharmaceutical” does not include any pharmaceutical that is regulated pursuant to either of the following:
(1) The federal Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.A. Sec. 6901 et seq.). (2) The Radiation Control Law (Chapter 8 [commencing with Section 114960] of Part 9).
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 3 County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
Facility Information
Unified Program Facility
Permit #: ___________________
Business
Name: _________________________________________________________ Type of Business: Date: _ / _ / _
Address: CA
Street No. Street Name City State Zip Code
Person Responsible for implementing the Medical Waste Management Plan Name: ________________________________________________
Title: _________________________________________________ Phone: (______)_____________ x _______ Types of wastes generated
Sharps - e.g., needles, blades, scalpels, or broken glass or syringes contaminated with biohazardous waste.
Blood or body fluids - liquid blood or blood products,
or other regulated body fluids, or articles contaminated with liquid blood or body fluids.
Estimated monthly amount lbs Estimated monthly amount lbs Home-Generated Sharps Pathology waste - recognizable human anatomical parts.
Estimated monthly amount lbs Estimated monthly amount lbs Laboratory wastes - specimens or microbiological
cultures, stocks of infectious agents, live and attenuated vaccines, biologicals, and culture media.
Surgical specimens - human or animal parts or tissues
removed surgically or by autopsy and are suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs Liquid or semi-liquid biohazardous laboratory
waste - treated on site by chemical disinfection* and
discharged to sewer.
Isolation waste - waste contaminated with excretion,
exudates or secretions from humans or animals who
are isolated due to highly communicable diseases.
Estimated monthly amount lbs Estimated monthly amount lbs Waste contaminated with fixatives or
chemotherapeutic agents.
Contaminated animals - animal carcasses, body parts,
tissues or fluids suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs California-regulated pharmaceutical waste Other (specify):
Estimated monthly amount lbs Estimated monthly amount lbs Estimate of TOTAL monthly medical waste generated: ____________ lbs ONSITE MEDICAL WASTE TREATMENT ONLY: Method of medical waste treatment if performed onsite:
Steam Autoclaving Other state approved alternative technology (specify below):
____________________________________________________________ Onsite medical waste treatment records must be maintained for three years. HSC §117975 *Per HSC §118215(c), for liquid or semi-liquid biohazardous laboratory waste (§117635(a)), the treatment method must be recognized by the NIH, the CDC, or the American Biological Safety Association. If the chemical disinfection of the medical waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of HSC Chapter 6.5 (commencing with §25100) of Division 20.
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 4 Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City: ___________________________________ State __________ ZIP Code _____________ Phone #: (_______) ___________________ - ___________
Contact Person:___________________________________________________________________ Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:_____________________________________________________________________
Address: _________________________________________________________________________ City: ___________________________________ State ___________ ZIP Code _____________ Phone #: (______) ____________________ - ___________
Contact Person: __________________________________ Phone #:(_____) __________ - ______ I hereby certify to the best of my knowledge and believe the statements made herein are correct and accurate.
Name: __________________________________________________________________________ Type or Print Title: ____________________________________________________________________________ Signature: Date: ______ /______ /_______
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste (≥200 lbs/month) This plan is to be followed to ensure the proper disposal of medical waste in the event of a natural disaster, spill, treatment system break down, power failure, etc. (use additional sheets if necessary):
HM-9213 (05/12) 1
The San Diego County Department of Environmental Health, Hazardous Materials Division is the local agency designated by the California Department of Public Health to implement the Medical Waste Management Act. This law governs the generation, handling, storage, transportation, treatment and disposal of medical waste to protect the public and the environment from potential infectious exposure to disease causing agents.
The Medical Waste Management Plan is a document that describes the types and amount of medical waste generated at a specific location, and indicates how wastes are managed to ensure proper treatment and disposal. All Large Quantity Generators (LQGs generate >200 lbs. of medical waste per month) and those Small Quantity Generators (SQGs generate <200 lbs. of medical waste per month) that treat their medical waste onsite are required to complete a Medical Waste Management Plan on the forms prepared by the enforcement agency. [Authority cited California Health and Safety Code § 117600 et seq.] Small Quantity Generators of medical waste who do not treat their medical waste onsite are not required to complete and submit this form to the local enforcement agency. Small Quantity Generators of medical waste who transport waste under a Limited Quantity Hauling Exemption issued by the Department of Environmental Health are, however, responsible for maintaining on file at their office a document stating how they contain, store, treat, and dispose of any medical waste generated. Completing a Medical Waste Management Plan and keeping it at their office can satisfy this requirement.
Attached is a “blank” Medical Waste Management Plan form for your use. Please complete and sign the form and mail the original to the address listed above. Retain a copy for your records. If there are changes in any of the information on your Medical Waste Management Plan, submit a revised form to the address listed above within 30 days of changes.
Annual submittal of the Medical Waste Management Plan is not required.
If you have any questions, please contact your area inspector or the Hazardous Materials Division Duty Desk at (858) 505-6880.
Attachment
"Environmental and public health through leadership, partnership and science" County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 2 MEDICAL WASTE – DEFINITION OF TERMS
MEDICAL WASTE means biohazardous waste or sharps waste that has been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents, those organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health. Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.
BIOHAZARDOUS WASTE means any of the following:
(a) Laboratory waste, including, but not limited to, all of the following:
(1) Human or animal specimen cultures from medical and pathology laboratories. (2) Cultures and stocks of infectious agents from research and industrial laboratories. (3) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including Brucellosis and Contagious Ecthyma, as identified by the department, and culture dishes and de-vices used to transfer, inoculate, and mix cultures. (b) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans. (c) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans.
(d) Waste, which at the point of transport from the generator’s site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans.
(e) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans. (f) (1) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to Chapter
6.5 (commencing with Section 25100) of Division 20.
(2) For purposes of this subdivision, “chemotherapeutic agent” means an agent that kills or prevents the reproduction of malignant cells.
(3) For purposes of this subdivision, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:
(A) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including, but not limited to, when tilted or inverted. (B) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping.
(g) Waste that is hazardous only because it is comprised of pharmaceuticals, as defined in Section 117747. Notwithstanding subdivision (a) of Section 117690, medical waste includes biohazardous waste that meets the conditions of this subdivision.
Biohazardous waste that meets the conditions of this subdivision is not subject to Chapter 6.5 (commencing with Section 25100) of Division 20.
SHARPS CONTAINERS are leakproof, rigid, puncture-resistant containers which when sealed cannot be reopened without great difficulty. These containers must be labeled with the words “Sharps Waste” or with the international Biohazard symbol and the word “BIOHAZARD.” These containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used. Needles and syringes shall not be clipped prior to disposal. “BIOHAZARD BAG” means a disposable red bag which is impervious to moisture and has strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage and handling of a waste-filled bag. A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport. The bags shall be RED in color and conspicuously labeled with the international biohazard symbol and the “Biohazard.” The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. If the waste is to be autoclaved, the outer bag may be colorless as long as the inner bag is red and both bags meet the stated strength criteria. All waste in red biohazard bags must be managed as MEDICAL WASTE.
STORAGE AREA WARNING SIGN is: A sign posted at a designated accumulation area used to store medical waste which must read in English, “CAUTION—BIOHAZARDOUS WASTE STORAGE AREA—UNAUTHORIZED PERSONS KEEP OUT” and in Spanish, “CUIDADO-ZONA DE RESIDUOS—BIOLOGICOS PELIGROSOS—PROHIBIDA LA ENTRADA A PERSONAS NO AUTORIZADAS” or in another language determined to be appropriate.
Intermediate storage areas shall be marked with the international biohazardous symbol or the signage noted above. These warning signs shall be readily legible from a distance of five feet.
PHARMACEUTICAL (a) “Pharmaceutical” means a prescription or over-the-counter human or veterinary drug, including, but not limited to, a drug as defined in Section 109925 or the Federal Food, Drug, and Cosmetic Act, as amended, (21 U.S.C.A. Sec. 321(g)(1)). (b) For purposes of this part, “pharmaceutical” does not include any pharmaceutical that is regulated pursuant to either of the following:
(1) The federal Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.A. Sec. 6901 et seq.). (2) The Radiation Control Law (Chapter 8 [commencing with Section 114960] of Part 9).
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 3 County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
Facility Information
Unified Program Facility
Permit #: ___________________
Business
Name: _________________________________________________________ Type of Business: Date: _ / _ / _
Address: CA
Street No. Street Name City State Zip Code
Person Responsible for implementing the Medical Waste Management Plan Name: ________________________________________________
Title: _________________________________________________ Phone: (______)_____________ x _______ Types of wastes generated
Sharps - e.g., needles, blades, scalpels, or broken glass or syringes contaminated with biohazardous waste.
Blood or body fluids - liquid blood or blood products,
or other regulated body fluids, or articles contaminated with liquid blood or body fluids.
Estimated monthly amount lbs Estimated monthly amount lbs Home-Generated Sharps Pathology waste - recognizable human anatomical parts.
Estimated monthly amount lbs Estimated monthly amount lbs Laboratory wastes - specimens or microbiological
cultures, stocks of infectious agents, live and attenuated vaccines, biologicals, and culture media.
Surgical specimens - human or animal parts or tissues
removed surgically or by autopsy and are suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs Liquid or semi-liquid biohazardous laboratory
waste - treated on site by chemical disinfection* and
discharged to sewer.
Isolation waste - waste contaminated with excretion,
exudates or secretions from humans or animals who
are isolated due to highly communicable diseases.
Estimated monthly amount lbs Estimated monthly amount lbs Waste contaminated with fixatives or
chemotherapeutic agents.
Contaminated animals - animal carcasses, body parts,
tissues or fluids suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs California-regulated pharmaceutical waste Other (specify):
Estimated monthly amount lbs Estimated monthly amount lbs Estimate of TOTAL monthly medical waste generated: ____________ lbs ONSITE MEDICAL WASTE TREATMENT ONLY: Method of medical waste treatment if performed onsite:
Steam Autoclaving Other state approved alternative technology (specify below):
____________________________________________________________ Onsite medical waste treatment records must be maintained for three years. HSC §117975 *Per HSC §118215(c), for liquid or semi-liquid biohazardous laboratory waste (§117635(a)), the treatment method must be recognized by the NIH, the CDC, or the American Biological Safety Association. If the chemical disinfection of the medical waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of HSC Chapter 6.5 (commencing with §25100) of Division 20.
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 4 Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City: ___________________________________ State __________ ZIP Code _____________ Phone #: (_______) ___________________ - ___________
Contact Person:___________________________________________________________________ Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:_____________________________________________________________________
Address: _________________________________________________________________________ City: ___________________________________ State ___________ ZIP Code _____________ Phone #: (______) ____________________ - ___________
Contact Person: __________________________________ Phone #:(_____) __________ - ______ I hereby certify to the best of my knowledge and believe the statements made herein are correct and accurate.
Name: __________________________________________________________________________ Type or Print Title: ____________________________________________________________________________ Signature: Date: ______ /______ /_______
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste (≥200 lbs/month) This plan is to be followed to ensure the proper disposal of medical waste in the event of a natural disaster, spill, treatment system break down, power failure, etc. (use additional sheets if necessary):
COUNTY OF SAN DIEGO
I COMPLIANCE INSPECTION REPORT I
FACILITY NAME East County Primary Care Clinic
ADDRESS 110 Town Center Way
CITY /ZIP Santee, CA /92071
PAGE 1 OF 1 DATE 8127/2014 -==.:=..:.-'----------j
RECORD ID # DEH2005-HUPFP-205757
TIME START 0800 END 1500 ---'-'-"-"------!
SPECIALIST -'Ka=s.,ro=vi,c:.:.h _______ --1
INSPECTION CONTACT
Matthew Drake
TITLE _cE:::_P_,S'----------------i
PHONE 619 5329183
On the above date, the County inspected your fucility under the authority of the California Health and Safety Code to derermine compliance with applicable provisions of thcH&SC. and the San DiegoCountyCodeofRegulatmyOnlinanre;(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. y· N/A" NOTE: Reinsoection fees will be charged if additional inspections are required to determine compliance. 0 0 Unified Pr02ram Facility Permit current y· N/A" Permit Expires on: 5/3112015 0 0 Hazardous Materials Business Plan available 0 0 Contingency Plan OLQG OSQG 0 0 Employee Training is adequate 0 0 Employee Training records available 0 Waste disposal records available for review 0 0 Universal waste managed properly 0 Emergency contacts current OUpdated today 0 Waste closed labeled 0 0 Chemical inventory/map current 0 Updated 0 Waste containers in good condition Consent to inspect granted by: 0 Inspection Contact 0 Other: __
ROUTINE INSPECTION
A routine compliance inspection of medical waste was conducted with Matthew Drake, Environmental Protection Specialist. This clinic is a small quantity generator of medical waste. Consent for inspection was granted.
REMARKS:
A) The Medical Waste Management Plan (MWMP) was reviewed during the inspection. This facility reports generating approximately SS pounds of medical waste per month.
B) Medical waste tracking documents were reviewed. The hauler used at this facility is lngenium.
C) A request will be made by the inspector to add this Naval Medical Clinic invoice to the other Naval Medical Clinic invoices that are processed in November of each year.
The Hazardous Materials Business Plan (inventory & site map, emergency contacts, emergency response plan, and employee training plan) is required by law to be certified online through the California Environmental Reporting System (CERS). For additional information about hazardous materials business plans and CERS, go to: http://www.sdcounty.ca.gov/deh!hazmat/hmd-cers-info.btml PRINTED NAMEqFFACILITY REPRESENTATIVE DATE SIGNED
1 '\ 1 2) 1 - . TITLE OF FACILITY REPRESENTATIVE
partment of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 9 112-9261 Phone: (8581 505-6880 http://www.sdcdeh.oro
HM-9213 (05/12) 1
The San Diego County Department of Environmental Health, Hazardous Materials Division is the local agency designated by the California Department of Public Health to implement the Medical Waste Management Act. This law governs the generation, handling, storage, transportation, treatment and disposal of medical waste to protect the public and the environment from potential infectious exposure to disease causing agents.
The Medical Waste Management Plan is a document that describes the types and amount of medical waste generated at a specific location, and indicates how wastes are managed to ensure proper treatment and disposal. All Large Quantity Generators (LQGs generate >200 lbs. of medical waste per month) and those Small Quantity Generators (SQGs generate <200 lbs. of medical waste per month) that treat their medical waste onsite are required to complete a Medical Waste Management Plan on the forms prepared by the enforcement agency. [Authority cited California Health and Safety Code § 117600 et seq.] Small Quantity Generators of medical waste who do not treat their medical waste onsite are not required to complete and submit this form to the local enforcement agency. Small Quantity Generators of medical waste who transport waste under a Limited Quantity Hauling Exemption issued by the Department of Environmental Health are, however, responsible for maintaining on file at their office a document stating how they contain, store, treat, and dispose of any medical waste generated. Completing a Medical Waste Management Plan and keeping it at their office can satisfy this requirement.
Attached is a “blank” Medical Waste Management Plan form for your use. Please complete and sign the form and mail the original to the address listed above. Retain a copy for your records. If there are changes in any of the information on your Medical Waste Management Plan, submit a revised form to the address listed above within 30 days of changes.
Annual submittal of the Medical Waste Management Plan is not required.
If you have any questions, please contact your area inspector or the Hazardous Materials Division Duty Desk at (858) 505-6880.
Attachment
"Environmental and public health through leadership, partnership and science" County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 2 MEDICAL WASTE – DEFINITION OF TERMS
MEDICAL WASTE means biohazardous waste or sharps waste that has been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents, those organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health. Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.
BIOHAZARDOUS WASTE means any of the following:
(a) Laboratory waste, including, but not limited to, all of the following:
(1) Human or animal specimen cultures from medical and pathology laboratories. (2) Cultures and stocks of infectious agents from research and industrial laboratories. (3) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including Brucellosis and Contagious Ecthyma, as identified by the department, and culture dishes and de-vices used to transfer, inoculate, and mix cultures. (b) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans. (c) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans.
(d) Waste, which at the point of transport from the generator’s site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans.
(e) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans. (f) (1) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to Chapter
6.5 (commencing with Section 25100) of Division 20.
(2) For purposes of this subdivision, “chemotherapeutic agent” means an agent that kills or prevents the reproduction of malignant cells.
(3) For purposes of this subdivision, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:
(A) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including, but not limited to, when tilted or inverted. (B) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping.
(g) Waste that is hazardous only because it is comprised of pharmaceuticals, as defined in Section 117747. Notwithstanding subdivision (a) of Section 117690, medical waste includes biohazardous waste that meets the conditions of this subdivision.
Biohazardous waste that meets the conditions of this subdivision is not subject to Chapter 6.5 (commencing with Section 25100) of Division 20.
SHARPS CONTAINERS are leakproof, rigid, puncture-resistant containers which when sealed cannot be reopened without great difficulty. These containers must be labeled with the words “Sharps Waste” or with the international Biohazard symbol and the word “BIOHAZARD.” These containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used. Needles and syringes shall not be clipped prior to disposal. “BIOHAZARD BAG” means a disposable red bag which is impervious to moisture and has strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage and handling of a waste-filled bag. A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport. The bags shall be RED in color and conspicuously labeled with the international biohazard symbol and the “Biohazard.” The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. If the waste is to be autoclaved, the outer bag may be colorless as long as the inner bag is red and both bags meet the stated strength criteria. All waste in red biohazard bags must be managed as MEDICAL WASTE.
STORAGE AREA WARNING SIGN is: A sign posted at a designated accumulation area used to store medical waste which must read in English, “CAUTION—BIOHAZARDOUS WASTE STORAGE AREA—UNAUTHORIZED PERSONS KEEP OUT” and in Spanish, “CUIDADO-ZONA DE RESIDUOS—BIOLOGICOS PELIGROSOS—PROHIBIDA LA ENTRADA A PERSONAS NO AUTORIZADAS” or in another language determined to be appropriate.
Intermediate storage areas shall be marked with the international biohazardous symbol or the signage noted above. These warning signs shall be readily legible from a distance of five feet.
PHARMACEUTICAL (a) “Pharmaceutical” means a prescription or over-the-counter human or veterinary drug, including, but not limited to, a drug as defined in Section 109925 or the Federal Food, Drug, and Cosmetic Act, as amended, (21 U.S.C.A. Sec. 321(g)(1)). (b) For purposes of this part, “pharmaceutical” does not include any pharmaceutical that is regulated pursuant to either of the following:
(1) The federal Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.A. Sec. 6901 et seq.). (2) The Radiation Control Law (Chapter 8 [commencing with Section 114960] of Part 9).
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 3 County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
Facility Information
Unified Program Facility
Permit #: ___________________
Business
Name: _________________________________________________________ Type of Business: Date: _ / _ / _
Address: CA
Street No. Street Name City State Zip Code
Person Responsible for implementing the Medical Waste Management Plan Name: ________________________________________________
Title: _________________________________________________ Phone: (______)_____________ x _______ Types of wastes generated
Sharps - e.g., needles, blades, scalpels, or broken glass or syringes contaminated with biohazardous waste.
Blood or body fluids - liquid blood or blood products,
or other regulated body fluids, or articles contaminated with liquid blood or body fluids.
Estimated monthly amount lbs Estimated monthly amount lbs Home-Generated Sharps Pathology waste - recognizable human anatomical parts.
Estimated monthly amount lbs Estimated monthly amount lbs Laboratory wastes - specimens or microbiological
cultures, stocks of infectious agents, live and attenuated vaccines, biologicals, and culture media.
Surgical specimens - human or animal parts or tissues
removed surgically or by autopsy and are suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs Liquid or semi-liquid biohazardous laboratory
waste - treated on site by chemical disinfection* and
discharged to sewer.
Isolation waste - waste contaminated with excretion,
exudates or secretions from humans or animals who
are isolated due to highly communicable diseases.
Estimated monthly amount lbs Estimated monthly amount lbs Waste contaminated with fixatives or
chemotherapeutic agents.
Contaminated animals - animal carcasses, body parts,
tissues or fluids suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs California-regulated pharmaceutical waste Other (specify):
Estimated monthly amount lbs Estimated monthly amount lbs Estimate of TOTAL monthly medical waste generated: ____________ lbs ONSITE MEDICAL WASTE TREATMENT ONLY: Method of medical waste treatment if performed onsite:
Steam Autoclaving Other state approved alternative technology (specify below):
____________________________________________________________ Onsite medical waste treatment records must be maintained for three years. HSC §117975 *Per HSC §118215(c), for liquid or semi-liquid biohazardous laboratory waste (§117635(a)), the treatment method must be recognized by the NIH, the CDC, or the American Biological Safety Association. If the chemical disinfection of the medical waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of HSC Chapter 6.5 (commencing with §25100) of Division 20.
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 4 Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City: ___________________________________ State __________ ZIP Code _____________ Phone #: (_______) ___________________ - ___________
Contact Person:___________________________________________________________________ Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:_____________________________________________________________________
Address: _________________________________________________________________________ City: ___________________________________ State ___________ ZIP Code _____________ Phone #: (______) ____________________ - ___________
Contact Person: __________________________________ Phone #:(_____) __________ - ______ I hereby certify to the best of my knowledge and believe the statements made herein are correct and accurate.
Name: __________________________________________________________________________ Type or Print Title: ____________________________________________________________________________ Signature: Date: ______ /______ /_______
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste (≥200 lbs/month) This plan is to be followed to ensure the proper disposal of medical waste in the event of a natural disaster, spill, treatment system break down, power failure, etc. (use additional sheets if necessary):
HM-9213 (05/12) 1
The San Diego County Department of Environmental Health, Hazardous Materials Division is the local agency designated by the California Department of Public Health to implement the Medical Waste Management Act. This law governs the generation, handling, storage, transportation, treatment and disposal of medical waste to protect the public and the environment from potential infectious exposure to disease causing agents.
The Medical Waste Management Plan is a document that describes the types and amount of medical waste generated at a specific location, and indicates how wastes are managed to ensure proper treatment and disposal. All Large Quantity Generators (LQGs generate >200 lbs. of medical waste per month) and those Small Quantity Generators (SQGs generate <200 lbs. of medical waste per month) that treat their medical waste onsite are required to complete a Medical Waste Management Plan on the forms prepared by the enforcement agency. [Authority cited California Health and Safety Code § 117600 et seq.] Small Quantity Generators of medical waste who do not treat their medical waste onsite are not required to complete and submit this form to the local enforcement agency. Small Quantity Generators of medical waste who transport waste under a Limited Quantity Hauling Exemption issued by the Department of Environmental Health are, however, responsible for maintaining on file at their office a document stating how they contain, store, treat, and dispose of any medical waste generated. Completing a Medical Waste Management Plan and keeping it at their office can satisfy this requirement.
Attached is a “blank” Medical Waste Management Plan form for your use. Please complete and sign the form and mail the original to the address listed above. Retain a copy for your records. If there are changes in any of the information on your Medical Waste Management Plan, submit a revised form to the address listed above within 30 days of changes.
Annual submittal of the Medical Waste Management Plan is not required.
If you have any questions, please contact your area inspector or the Hazardous Materials Division Duty Desk at (858) 505-6880.
Attachment
"Environmental and public health through leadership, partnership and science" County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 2 MEDICAL WASTE – DEFINITION OF TERMS
MEDICAL WASTE means biohazardous waste or sharps waste that has been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents, those organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health. Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.
BIOHAZARDOUS WASTE means any of the following:
(a) Laboratory waste, including, but not limited to, all of the following:
(1) Human or animal specimen cultures from medical and pathology laboratories. (2) Cultures and stocks of infectious agents from research and industrial laboratories. (3) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including Brucellosis and Contagious Ecthyma, as identified by the department, and culture dishes and de-vices used to transfer, inoculate, and mix cultures. (b) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans. (c) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans.
(d) Waste, which at the point of transport from the generator’s site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans.
(e) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans. (f) (1) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to Chapter
6.5 (commencing with Section 25100) of Division 20.
(2) For purposes of this subdivision, “chemotherapeutic agent” means an agent that kills or prevents the reproduction of malignant cells.
(3) For purposes of this subdivision, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:
(A) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including, but not limited to, when tilted or inverted. (B) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping.
(g) Waste that is hazardous only because it is comprised of pharmaceuticals, as defined in Section 117747. Notwithstanding subdivision (a) of Section 117690, medical waste includes biohazardous waste that meets the conditions of this subdivision.
Biohazardous waste that meets the conditions of this subdivision is not subject to Chapter 6.5 (commencing with Section 25100) of Division 20.
SHARPS CONTAINERS are leakproof, rigid, puncture-resistant containers which when sealed cannot be reopened without great difficulty. These containers must be labeled with the words “Sharps Waste” or with the international Biohazard symbol and the word “BIOHAZARD.” These containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used. Needles and syringes shall not be clipped prior to disposal. “BIOHAZARD BAG” means a disposable red bag which is impervious to moisture and has strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage and handling of a waste-filled bag. A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport. The bags shall be RED in color and conspicuously labeled with the international biohazard symbol and the “Biohazard.” The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. If the waste is to be autoclaved, the outer bag may be colorless as long as the inner bag is red and both bags meet the stated strength criteria. All waste in red biohazard bags must be managed as MEDICAL WASTE.
STORAGE AREA WARNING SIGN is: A sign posted at a designated accumulation area used to store medical waste which must read in English, “CAUTION—BIOHAZARDOUS WASTE STORAGE AREA—UNAUTHORIZED PERSONS KEEP OUT” and in Spanish, “CUIDADO-ZONA DE RESIDUOS—BIOLOGICOS PELIGROSOS—PROHIBIDA LA ENTRADA A PERSONAS NO AUTORIZADAS” or in another language determined to be appropriate.
Intermediate storage areas shall be marked with the international biohazardous symbol or the signage noted above. These warning signs shall be readily legible from a distance of five feet.
PHARMACEUTICAL (a) “Pharmaceutical” means a prescription or over-the-counter human or veterinary drug, including, but not limited to, a drug as defined in Section 109925 or the Federal Food, Drug, and Cosmetic Act, as amended, (21 U.S.C.A. Sec. 321(g)(1)). (b) For purposes of this part, “pharmaceutical” does not include any pharmaceutical that is regulated pursuant to either of the following:
(1) The federal Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.A. Sec. 6901 et seq.). (2) The Radiation Control Law (Chapter 8 [commencing with Section 114960] of Part 9).
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 3 County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
Facility Information
Unified Program Facility
Permit #: ___________________
Business
Name: _________________________________________________________ Type of Business: Date: _ / _ / _
Address: CA
Street No. Street Name City State Zip Code
Person Responsible for implementing the Medical Waste Management Plan Name: ________________________________________________
Title: _________________________________________________ Phone: (______)_____________ x _______ Types of wastes generated
Sharps - e.g., needles, blades, scalpels, or broken glass or syringes contaminated with biohazardous waste.
Blood or body fluids - liquid blood or blood products,
or other regulated body fluids, or articles contaminated with liquid blood or body fluids.
Estimated monthly amount lbs Estimated monthly amount lbs Home-Generated Sharps Pathology waste - recognizable human anatomical parts.
Estimated monthly amount lbs Estimated monthly amount lbs Laboratory wastes - specimens or microbiological
cultures, stocks of infectious agents, live and attenuated vaccines, biologicals, and culture media.
Surgical specimens - human or animal parts or tissues
removed surgically or by autopsy and are suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs Liquid or semi-liquid biohazardous laboratory
waste - treated on site by chemical disinfection* and
discharged to sewer.
Isolation waste - waste contaminated with excretion,
exudates or secretions from humans or animals who
are isolated due to highly communicable diseases.
Estimated monthly amount lbs Estimated monthly amount lbs Waste contaminated with fixatives or
chemotherapeutic agents.
Contaminated animals - animal carcasses, body parts,
tissues or fluids suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs California-regulated pharmaceutical waste Other (specify):
Estimated monthly amount lbs Estimated monthly amount lbs Estimate of TOTAL monthly medical waste generated: ____________ lbs ONSITE MEDICAL WASTE TREATMENT ONLY: Method of medical waste treatment if performed onsite:
Steam Autoclaving Other state approved alternative technology (specify below):
____________________________________________________________ Onsite medical waste treatment records must be maintained for three years. HSC §117975 *Per HSC §118215(c), for liquid or semi-liquid biohazardous laboratory waste (§117635(a)), the treatment method must be recognized by the NIH, the CDC, or the American Biological Safety Association. If the chemical disinfection of the medical waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of HSC Chapter 6.5 (commencing with §25100) of Division 20.
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 4 Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City: ___________________________________ State __________ ZIP Code _____________ Phone #: (_______) ___________________ - ___________
Contact Person:___________________________________________________________________ Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:_____________________________________________________________________
Address: _________________________________________________________________________ City: ___________________________________ State ___________ ZIP Code _____________ Phone #: (______) ____________________ - ___________
Contact Person: __________________________________ Phone #:(_____) __________ - ______ I hereby certify to the best of my knowledge and believe the statements made herein are correct and accurate.
Name: __________________________________________________________________________ Type or Print Title: ____________________________________________________________________________ Signature: Date: ______ /______ /_______
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste (≥200 lbs/month) This plan is to be followed to ensure the proper disposal of medical waste in the event of a natural disaster, spill, treatment system break down, power failure, etc. (use additional sheets if necessary):
HM-9213 (05/12) 1
The San Diego County Department of Environmental Health, Hazardous Materials Division is the local agency designated by the California Department of Public Health to implement the Medical Waste Management Act. This law governs the generation, handling, storage, transportation, treatment and disposal of medical waste to protect the public and the environment from potential infectious exposure to disease causing agents.
The Medical Waste Management Plan is a document that describes the types and amount of medical waste generated at a specific location, and indicates how wastes are managed to ensure proper treatment and disposal. All Large Quantity Generators (LQGs generate >200 lbs. of medical waste per month) and those Small Quantity Generators (SQGs generate <200 lbs. of medical waste per month) that treat their medical waste onsite are required to complete a Medical Waste Management Plan on the forms prepared by the enforcement agency. [Authority cited California Health and Safety Code § 117600 et seq.] Small Quantity Generators of medical waste who do not treat their medical waste onsite are not required to complete and submit this form to the local enforcement agency. Small Quantity Generators of medical waste who transport waste under a Limited Quantity Hauling Exemption issued by the Department of Environmental Health are, however, responsible for maintaining on file at their office a document stating how they contain, store, treat, and dispose of any medical waste generated. Completing a Medical Waste Management Plan and keeping it at their office can satisfy this requirement.
Attached is a “blank” Medical Waste Management Plan form for your use. Please complete and sign the form and mail the original to the address listed above. Retain a copy for your records. If there are changes in any of the information on your Medical Waste Management Plan, submit a revised form to the address listed above within 30 days of changes.
Annual submittal of the Medical Waste Management Plan is not required.
If you have any questions, please contact your area inspector or the Hazardous Materials Division Duty Desk at (858) 505-6880.
Attachment
"Environmental and public health through leadership, partnership and science" County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 2 MEDICAL WASTE – DEFINITION OF TERMS
MEDICAL WASTE means biohazardous waste or sharps waste that has been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents, those organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health. Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.
BIOHAZARDOUS WASTE means any of the following:
(a) Laboratory waste, including, but not limited to, all of the following:
(1) Human or animal specimen cultures from medical and pathology laboratories. (2) Cultures and stocks of infectious agents from research and industrial laboratories. (3) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including Brucellosis and Contagious Ecthyma, as identified by the department, and culture dishes and de-vices used to transfer, inoculate, and mix cultures. (b) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans. (c) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans.
(d) Waste, which at the point of transport from the generator’s site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans.
(e) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans. (f) (1) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to Chapter
6.5 (commencing with Section 25100) of Division 20.
(2) For purposes of this subdivision, “chemotherapeutic agent” means an agent that kills or prevents the reproduction of malignant cells.
(3) For purposes of this subdivision, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:
(A) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including, but not limited to, when tilted or inverted. (B) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping.
(g) Waste that is hazardous only because it is comprised of pharmaceuticals, as defined in Section 117747. Notwithstanding subdivision (a) of Section 117690, medical waste includes biohazardous waste that meets the conditions of this subdivision.
Biohazardous waste that meets the conditions of this subdivision is not subject to Chapter 6.5 (commencing with Section 25100) of Division 20.
SHARPS CONTAINERS are leakproof, rigid, puncture-resistant containers which when sealed cannot be reopened without great difficulty. These containers must be labeled with the words “Sharps Waste” or with the international Biohazard symbol and the word “BIOHAZARD.” These containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used. Needles and syringes shall not be clipped prior to disposal. “BIOHAZARD BAG” means a disposable red bag which is impervious to moisture and has strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage and handling of a waste-filled bag. A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport. The bags shall be RED in color and conspicuously labeled with the international biohazard symbol and the “Biohazard.” The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. If the waste is to be autoclaved, the outer bag may be colorless as long as the inner bag is red and both bags meet the stated strength criteria. All waste in red biohazard bags must be managed as MEDICAL WASTE.
STORAGE AREA WARNING SIGN is: A sign posted at a designated accumulation area used to store medical waste which must read in English, “CAUTION—BIOHAZARDOUS WASTE STORAGE AREA—UNAUTHORIZED PERSONS KEEP OUT” and in Spanish, “CUIDADO-ZONA DE RESIDUOS—BIOLOGICOS PELIGROSOS—PROHIBIDA LA ENTRADA A PERSONAS NO AUTORIZADAS” or in another language determined to be appropriate.
Intermediate storage areas shall be marked with the international biohazardous symbol or the signage noted above. These warning signs shall be readily legible from a distance of five feet.
PHARMACEUTICAL (a) “Pharmaceutical” means a prescription or over-the-counter human or veterinary drug, including, but not limited to, a drug as defined in Section 109925 or the Federal Food, Drug, and Cosmetic Act, as amended, (21 U.S.C.A. Sec. 321(g)(1)). (b) For purposes of this part, “pharmaceutical” does not include any pharmaceutical that is regulated pursuant to either of the following:
(1) The federal Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.A. Sec. 6901 et seq.). (2) The Radiation Control Law (Chapter 8 [commencing with Section 114960] of Part 9).
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 3 County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
Facility Information
Unified Program Facility
Permit #: ___________________
Business
Name: _________________________________________________________ Type of Business: Date: _ / _ / _
Address: CA
Street No. Street Name City State Zip Code
Person Responsible for implementing the Medical Waste Management Plan Name: ________________________________________________
Title: _________________________________________________ Phone: (______)_____________ x _______ Types of wastes generated
Sharps - e.g., needles, blades, scalpels, or broken glass or syringes contaminated with biohazardous waste.
Blood or body fluids - liquid blood or blood products,
or other regulated body fluids, or articles contaminated with liquid blood or body fluids.
Estimated monthly amount lbs Estimated monthly amount lbs Home-Generated Sharps Pathology waste - recognizable human anatomical parts.
Estimated monthly amount lbs Estimated monthly amount lbs Laboratory wastes - specimens or microbiological
cultures, stocks of infectious agents, live and attenuated vaccines, biologicals, and culture media.
Surgical specimens - human or animal parts or tissues
removed surgically or by autopsy and are suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs Liquid or semi-liquid biohazardous laboratory
waste - treated on site by chemical disinfection* and
discharged to sewer.
Isolation waste - waste contaminated with excretion,
exudates or secretions from humans or animals who
are isolated due to highly communicable diseases.
Estimated monthly amount lbs Estimated monthly amount lbs Waste contaminated with fixatives or
chemotherapeutic agents.
Contaminated animals - animal carcasses, body parts,
tissues or fluids suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs California-regulated pharmaceutical waste Other (specify):
Estimated monthly amount lbs Estimated monthly amount lbs Estimate of TOTAL monthly medical waste generated: ____________ lbs ONSITE MEDICAL WASTE TREATMENT ONLY: Method of medical waste treatment if performed onsite:
Steam Autoclaving Other state approved alternative technology (specify below):
____________________________________________________________ Onsite medical waste treatment records must be maintained for three years. HSC §117975 *Per HSC §118215(c), for liquid or semi-liquid biohazardous laboratory waste (§117635(a)), the treatment method must be recognized by the NIH, the CDC, or the American Biological Safety Association. If the chemical disinfection of the medical waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of HSC Chapter 6.5 (commencing with §25100) of Division 20.
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 4 Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City: ___________________________________ State __________ ZIP Code _____________ Phone #: (_______) ___________________ - ___________
Contact Person:___________________________________________________________________ Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:_____________________________________________________________________
Address: _________________________________________________________________________ City: ___________________________________ State ___________ ZIP Code _____________ Phone #: (______) ____________________ - ___________
Contact Person: __________________________________ Phone #:(_____) __________ - ______ I hereby certify to the best of my knowledge and believe the statements made herein are correct and accurate.
Name: __________________________________________________________________________ Type or Print Title: ____________________________________________________________________________ Signature: Date: ______ /______ /_______
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste (≥200 lbs/month) This plan is to be followed to ensure the proper disposal of medical waste in the event of a natural disaster, spill, treatment system break down, power failure, etc. (use additional sheets if necessary):
HM-9213 (05/12) 1
The San Diego County Department of Environmental Health, Hazardous Materials Division is the local agency designated by the California Department of Public Health to implement the Medical Waste Management Act. This law governs the generation, handling, storage, transportation, treatment and disposal of medical waste to protect the public and the environment from potential infectious exposure to disease causing agents.
The Medical Waste Management Plan is a document that describes the types and amount of medical waste generated at a specific location, and indicates how wastes are managed to ensure proper treatment and disposal. All Large Quantity Generators (LQGs generate >200 lbs. of medical waste per month) and those Small Quantity Generators (SQGs generate <200 lbs. of medical waste per month) that treat their medical waste onsite are required to complete a Medical Waste Management Plan on the forms prepared by the enforcement agency. [Authority cited California Health and Safety Code § 117600 et seq.] Small Quantity Generators of medical waste who do not treat their medical waste onsite are not required to complete and submit this form to the local enforcement agency. Small Quantity Generators of medical waste who transport waste under a Limited Quantity Hauling Exemption issued by the Department of Environmental Health are, however, responsible for maintaining on file at their office a document stating how they contain, store, treat, and dispose of any medical waste generated. Completing a Medical Waste Management Plan and keeping it at their office can satisfy this requirement.
Attached is a “blank” Medical Waste Management Plan form for your use. Please complete and sign the form and mail the original to the address listed above. Retain a copy for your records. If there are changes in any of the information on your Medical Waste Management Plan, submit a revised form to the address listed above within 30 days of changes.
Annual submittal of the Medical Waste Management Plan is not required.
If you have any questions, please contact your area inspector or the Hazardous Materials Division Duty Desk at (858) 505-6880.
Attachment
"Environmental and public health through leadership, partnership and science" County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 2 MEDICAL WASTE – DEFINITION OF TERMS
MEDICAL WASTE means biohazardous waste or sharps waste that has been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents, those organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health. Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.
BIOHAZARDOUS WASTE means any of the following:
(a) Laboratory waste, including, but not limited to, all of the following:
(1) Human or animal specimen cultures from medical and pathology laboratories. (2) Cultures and stocks of infectious agents from research and industrial laboratories. (3) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including Brucellosis and Contagious Ecthyma, as identified by the department, and culture dishes and de-vices used to transfer, inoculate, and mix cultures. (b) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans. (c) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans.
(d) Waste, which at the point of transport from the generator’s site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans.
(e) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans. (f) (1) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to Chapter
6.5 (commencing with Section 25100) of Division 20.
(2) For purposes of this subdivision, “chemotherapeutic agent” means an agent that kills or prevents the reproduction of malignant cells.
(3) For purposes of this subdivision, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:
(A) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including, but not limited to, when tilted or inverted. (B) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping.
(g) Waste that is hazardous only because it is comprised of pharmaceuticals, as defined in Section 117747. Notwithstanding subdivision (a) of Section 117690, medical waste includes biohazardous waste that meets the conditions of this subdivision.
Biohazardous waste that meets the conditions of this subdivision is not subject to Chapter 6.5 (commencing with Section 25100) of Division 20.
SHARPS CONTAINERS are leakproof, rigid, puncture-resistant containers which when sealed cannot be reopened without great difficulty. These containers must be labeled with the words “Sharps Waste” or with the international Biohazard symbol and the word “BIOHAZARD.” These containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used. Needles and syringes shall not be clipped prior to disposal. “BIOHAZARD BAG” means a disposable red bag which is impervious to moisture and has strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage and handling of a waste-filled bag. A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport. The bags shall be RED in color and conspicuously labeled with the international biohazard symbol and the “Biohazard.” The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. If the waste is to be autoclaved, the outer bag may be colorless as long as the inner bag is red and both bags meet the stated strength criteria. All waste in red biohazard bags must be managed as MEDICAL WASTE.
STORAGE AREA WARNING SIGN is: A sign posted at a designated accumulation area used to store medical waste which must read in English, “CAUTION—BIOHAZARDOUS WASTE STORAGE AREA—UNAUTHORIZED PERSONS KEEP OUT” and in Spanish, “CUIDADO-ZONA DE RESIDUOS—BIOLOGICOS PELIGROSOS—PROHIBIDA LA ENTRADA A PERSONAS NO AUTORIZADAS” or in another language determined to be appropriate.
Intermediate storage areas shall be marked with the international biohazardous symbol or the signage noted above. These warning signs shall be readily legible from a distance of five feet.
PHARMACEUTICAL (a) “Pharmaceutical” means a prescription or over-the-counter human or veterinary drug, including, but not limited to, a drug as defined in Section 109925 or the Federal Food, Drug, and Cosmetic Act, as amended, (21 U.S.C.A. Sec. 321(g)(1)). (b) For purposes of this part, “pharmaceutical” does not include any pharmaceutical that is regulated pursuant to either of the following:
(1) The federal Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.A. Sec. 6901 et seq.). (2) The Radiation Control Law (Chapter 8 [commencing with Section 114960] of Part 9).
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 3 County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
Facility Information
Unified Program Facility
Permit #: ___________________
Business
Name: _________________________________________________________ Type of Business: Date: _ / _ / _
Address: CA
Street No. Street Name City State Zip Code
Person Responsible for implementing the Medical Waste Management Plan Name: ________________________________________________
Title: _________________________________________________ Phone: (______)_____________ x _______ Types of wastes generated
Sharps - e.g., needles, blades, scalpels, or broken glass or syringes contaminated with biohazardous waste.
Blood or body fluids - liquid blood or blood products,
or other regulated body fluids, or articles contaminated with liquid blood or body fluids.
Estimated monthly amount lbs Estimated monthly amount lbs Home-Generated Sharps Pathology waste - recognizable human anatomical parts.
Estimated monthly amount lbs Estimated monthly amount lbs Laboratory wastes - specimens or microbiological
cultures, stocks of infectious agents, live and attenuated vaccines, biologicals, and culture media.
Surgical specimens - human or animal parts or tissues
removed surgically or by autopsy and are suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs Liquid or semi-liquid biohazardous laboratory
waste - treated on site by chemical disinfection* and
discharged to sewer.
Isolation waste - waste contaminated with excretion,
exudates or secretions from humans or animals who
are isolated due to highly communicable diseases.
Estimated monthly amount lbs Estimated monthly amount lbs Waste contaminated with fixatives or
chemotherapeutic agents.
Contaminated animals - animal carcasses, body parts,
tissues or fluids suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs California-regulated pharmaceutical waste Other (specify):
Estimated monthly amount lbs Estimated monthly amount lbs Estimate of TOTAL monthly medical waste generated: ____________ lbs ONSITE MEDICAL WASTE TREATMENT ONLY: Method of medical waste treatment if performed onsite:
Steam Autoclaving Other state approved alternative technology (specify below):
____________________________________________________________ Onsite medical waste treatment records must be maintained for three years. HSC §117975 *Per HSC §118215(c), for liquid or semi-liquid biohazardous laboratory waste (§117635(a)), the treatment method must be recognized by the NIH, the CDC, or the American Biological Safety Association. If the chemical disinfection of the medical waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of HSC Chapter 6.5 (commencing with §25100) of Division 20.
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 4 Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City: ___________________________________ State __________ ZIP Code _____________ Phone #: (_______) ___________________ - ___________
Contact Person:___________________________________________________________________ Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:_____________________________________________________________________
Address: _________________________________________________________________________ City: ___________________________________ State ___________ ZIP Code _____________ Phone #: (______) ____________________ - ___________
Contact Person: __________________________________ Phone #:(_____) __________ - ______ I hereby certify to the best of my knowledge and believe the statements made herein are correct and accurate.
Name: __________________________________________________________________________ Type or Print Title: ____________________________________________________________________________ Signature: Date: ______ /______ /_______
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste (≥200 lbs/month) This plan is to be followed to ensure the proper disposal of medical waste in the event of a natural disaster, spill, treatment system break down, power failure, etc. (use additional sheets if necessary):
HM-9213 (05/12) 1
The San Diego County Department of Environmental Health, Hazardous Materials Division is the local agency designated by the California Department of Public Health to implement the Medical Waste Management Act. This law governs the generation, handling, storage, transportation, treatment and disposal of medical waste to protect the public and the environment from potential infectious exposure to disease causing agents.
The Medical Waste Management Plan is a document that describes the types and amount of medical waste generated at a specific location, and indicates how wastes are managed to ensure proper treatment and disposal. All Large Quantity Generators (LQGs generate >200 lbs. of medical waste per month) and those Small Quantity Generators (SQGs generate <200 lbs. of medical waste per month) that treat their medical waste onsite are required to complete a Medical Waste Management Plan on the forms prepared by the enforcement agency. [Authority cited California Health and Safety Code § 117600 et seq.] Small Quantity Generators of medical waste who do not treat their medical waste onsite are not required to complete and submit this form to the local enforcement agency. Small Quantity Generators of medical waste who transport waste under a Limited Quantity Hauling Exemption issued by the Department of Environmental Health are, however, responsible for maintaining on file at their office a document stating how they contain, store, treat, and dispose of any medical waste generated. Completing a Medical Waste Management Plan and keeping it at their office can satisfy this requirement.
Attached is a “blank” Medical Waste Management Plan form for your use. Please complete and sign the form and mail the original to the address listed above. Retain a copy for your records. If there are changes in any of the information on your Medical Waste Management Plan, submit a revised form to the address listed above within 30 days of changes.
Annual submittal of the Medical Waste Management Plan is not required.
If you have any questions, please contact your area inspector or the Hazardous Materials Division Duty Desk at (858) 505-6880.
Attachment
"Environmental and public health through leadership, partnership and science" County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 2 MEDICAL WASTE – DEFINITION OF TERMS
MEDICAL WASTE means biohazardous waste or sharps waste that has been generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, in the production or testing of biologicals, or which may contain infectious agents, those organisms classified as Biosafety Level II, III, or IV by the federal Centers for Disease Control and Prevention and may pose a substantial threat to health. Medical waste includes trauma scene waste. Medical waste does not include hazardous waste, radioactive waste, medical solid waste or household waste.
BIOHAZARDOUS WASTE means any of the following:
(a) Laboratory waste, including, but not limited to, all of the following:
(1) Human or animal specimen cultures from medical and pathology laboratories. (2) Cultures and stocks of infectious agents from research and industrial laboratories. (3) Wastes from the production of bacteria, viruses, spores, discarded live and attenuated vaccines used in human health care or research, discarded animal vaccines, including Brucellosis and Contagious Ecthyma, as identified by the department, and culture dishes and de-vices used to transfer, inoculate, and mix cultures. (b) Human surgery specimens or tissues removed at surgery or autopsy, which are suspected by the attending physician and surgeon or dentist of being contaminated with infectious agents known to be contagious to humans. (c) Animal parts, tissues, fluids, or carcasses suspected by the attending veterinarian of being contaminated with infectious agents known to be contagious to humans.
(d) Waste, which at the point of transport from the generator’s site, at the point of disposal, or thereafter, contains recognizable fluid blood, fluid blood products, containers or equipment containing blood that is fluid, or blood from animals known to be infected with diseases which are highly communicable to humans.
(e) Waste containing discarded materials contaminated with excretion, exudate, or secretions from humans or animals that are required to be isolated by the infection control staff, the attending physician and surgeon, the attending veterinarian, or the local health officer, to protect others from highly communicable diseases or diseases of animals that are highly communicable to humans. (f) (1) Waste which is hazardous only because it is comprised of human surgery specimens or tissues which have been fixed in formaldehyde or other fixatives, or only because the waste is contaminated through contact with, or having previously contained, chemotherapeutic agents, including, but not limited to, gloves, disposable gowns, towels, and intravenous solution bags and attached tubing which are empty. A biohazardous waste which meets the conditions of this paragraph is not subject to Chapter
6.5 (commencing with Section 25100) of Division 20.
(2) For purposes of this subdivision, “chemotherapeutic agent” means an agent that kills or prevents the reproduction of malignant cells.
(3) For purposes of this subdivision, a container, or inner liner removed from a container, which previously contained a chemotherapeutic agent, is empty if the container or inner liner removed from the container has been emptied by the generator as much as possible, using methods commonly employed to remove waste or material from containers or liners, so that the following conditions are met:
(A) If the material which the container or inner liner held is pourable, no material can be poured or drained from the container or inner liner when held in any orientation, including, but not limited to, when tilted or inverted. (B) If the material which the container or inner liner held is not pourable, no material or waste remains in the container or inner liner that can feasibly be removed by scraping.
(g) Waste that is hazardous only because it is comprised of pharmaceuticals, as defined in Section 117747. Notwithstanding subdivision (a) of Section 117690, medical waste includes biohazardous waste that meets the conditions of this subdivision.
Biohazardous waste that meets the conditions of this subdivision is not subject to Chapter 6.5 (commencing with Section 25100) of Division 20.
SHARPS CONTAINERS are leakproof, rigid, puncture-resistant containers which when sealed cannot be reopened without great difficulty. These containers must be labeled with the words “Sharps Waste” or with the international Biohazard symbol and the word “BIOHAZARD.” These containers must be labeled with the Generator’s name, address, and phone number in a conspicuous location on the container when first used. Needles and syringes shall not be clipped prior to disposal. “BIOHAZARD BAG” means a disposable red bag which is impervious to moisture and has strength sufficient to preclude ripping, tearing, or bursting under normal conditions of usage and handling of a waste-filled bag. A Biohazard bag shall be constructed of material of sufficient single thickness strength to pass the 165-gram dropped dart impact resistance test as prescribed by Standard D 1709-91 of the American Society for Testing and Materials and certified by the bag manufacturer. The bags shall be securely tied so as to prevent leakage or expulsion of solid or liquid wastes during future storage, handling, or transport. The bags shall be RED in color and conspicuously labeled with the international biohazard symbol and the “Biohazard.” The bags shall be labeled with the Generator’s name, address, and phone number in a conspicuous location on the bag when first used. If the waste is to be autoclaved, the outer bag may be colorless as long as the inner bag is red and both bags meet the stated strength criteria. All waste in red biohazard bags must be managed as MEDICAL WASTE.
STORAGE AREA WARNING SIGN is: A sign posted at a designated accumulation area used to store medical waste which must read in English, “CAUTION—BIOHAZARDOUS WASTE STORAGE AREA—UNAUTHORIZED PERSONS KEEP OUT” and in Spanish, “CUIDADO-ZONA DE RESIDUOS—BIOLOGICOS PELIGROSOS—PROHIBIDA LA ENTRADA A PERSONAS NO AUTORIZADAS” or in another language determined to be appropriate.
Intermediate storage areas shall be marked with the international biohazardous symbol or the signage noted above. These warning signs shall be readily legible from a distance of five feet.
PHARMACEUTICAL (a) “Pharmaceutical” means a prescription or over-the-counter human or veterinary drug, including, but not limited to, a drug as defined in Section 109925 or the Federal Food, Drug, and Cosmetic Act, as amended, (21 U.S.C.A. Sec. 321(g)(1)). (b) For purposes of this part, “pharmaceutical” does not include any pharmaceutical that is regulated pursuant to either of the following:
(1) The federal Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.A. Sec. 6901 et seq.). (2) The Radiation Control Law (Chapter 8 [commencing with Section 114960] of Part 9).
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 3 County of San Diego
DEPARTMENT OF ENVIRONMENTAL HEALTH
HAZARDOUS MATERIALS DIVISION
P.O. BOX 129261, SAN DIEGO, CA 92112-9261
(858) 505-6880 FAX (858) 505-6848
http://www.sdcdeh.org
Medical Waste Management Plan
Facility Information
Unified Program Facility
Permit #: ___________________
Business
Name: _________________________________________________________ Type of Business: Date: _ / _ / _
Address: CA
Street No. Street Name City State Zip Code
Person Responsible for implementing the Medical Waste Management Plan Name: ________________________________________________
Title: _________________________________________________ Phone: (______)_____________ x _______ Types of wastes generated
Sharps - e.g., needles, blades, scalpels, or broken glass or syringes contaminated with biohazardous waste.
Blood or body fluids - liquid blood or blood products,
or other regulated body fluids, or articles contaminated with liquid blood or body fluids.
Estimated monthly amount lbs Estimated monthly amount lbs Home-Generated Sharps Pathology waste - recognizable human anatomical parts.
Estimated monthly amount lbs Estimated monthly amount lbs Laboratory wastes - specimens or microbiological
cultures, stocks of infectious agents, live and attenuated vaccines, biologicals, and culture media.
Surgical specimens - human or animal parts or tissues
removed surgically or by autopsy and are suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs Liquid or semi-liquid biohazardous laboratory
waste - treated on site by chemical disinfection* and
discharged to sewer.
Isolation waste - waste contaminated with excretion,
exudates or secretions from humans or animals who
are isolated due to highly communicable diseases.
Estimated monthly amount lbs Estimated monthly amount lbs Waste contaminated with fixatives or
chemotherapeutic agents.
Contaminated animals - animal carcasses, body parts,
tissues or fluids suspected to be contaminated by agents which are contagious to humans.
Estimated monthly amount lbs Estimated monthly amount lbs California-regulated pharmaceutical waste Other (specify):
Estimated monthly amount lbs Estimated monthly amount lbs Estimate of TOTAL monthly medical waste generated: ____________ lbs ONSITE MEDICAL WASTE TREATMENT ONLY: Method of medical waste treatment if performed onsite:
Steam Autoclaving Other state approved alternative technology (specify below):
____________________________________________________________ Onsite medical waste treatment records must be maintained for three years. HSC §117975 *Per HSC §118215(c), for liquid or semi-liquid biohazardous laboratory waste (§117635(a)), the treatment method must be recognized by the NIH, the CDC, or the American Biological Safety Association. If the chemical disinfection of the medical waste causes the waste to become a hazardous waste, the waste shall be managed in accordance with the requirements of HSC Chapter 6.5 (commencing with §25100) of Division 20.
HM-9213 (05/12) Department of Environmental Health-Hazardous Materials Division 4 Medical Waste Management Plan
Registered Medical Waste Hauler used to remove untreated medical waste (if applicable):
Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City: ___________________________________ State __________ ZIP Code _____________ Phone #: (_______) ___________________ - ___________
Contact Person:___________________________________________________________________ Offsite treatment facility to which medical waste is transported (if applicable):
Facility Name:_____________________________________________________________________
Address: _________________________________________________________________________ City: ___________________________________ State ___________ ZIP Code _____________ Phone #: (______) ____________________ - ___________
Contact Person: __________________________________ Phone #:(_____) __________ - ______ I hereby certify to the best of my knowledge and believe the statements made herein are correct and accurate.
Name: __________________________________________________________________________ Type or Print Title: ____________________________________________________________________________ Signature: Date: ______ /______ /_______
Emergency Action Plan:
Note: This requirement only applies to Large Quantity Generators of Medical Waste (≥200 lbs/month) This plan is to be followed to ensure the proper disposal of medical waste in the event of a natural disaster, spill, treatment system break down, power failure, etc. (use additional sheets if necessary):
COUNTY OF SAN DIEGO
UPFP INSPECTION CHECKLIST
FACILITY NAME: SANTEE FAMILY MEDICINE
ADDRESS: 120 Town Center PKWY
CITY/ZIP: Santee /92071
INSPECTION DATE: 12/15/2016
RECORD ID #: DEH2016-HUPFP-002394
TIME START: 9:30 AM END: 10:30 AM
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Brianna Roberts, LVN
TITLE: Site Supervisor
PHONE:(619) 873-3440
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v50 Dated 11/21/2016 13:30
FACILITY REFERENCE DATA
ACCELA
CERS
RECORD STATUS: Pending Inspection
PERMIT EXPIRATION DATE: 03/11/2016
BALANCE DUE: $0.00
INSPECTOR: Bridget Kieu
INSPECTION TYPE: Routine,Status Verification
INSPECTION STATUS: Complete,Complete
EPA ID NUMBER:
FACILITY CERS ID NUMBER:10657582
CERS LEAD USER: Beatriz Payan
LAST CERS SUBMITTAL DATE: 05/04/2016
ENVIRONMENTAL CONTACT EMAIL:
ENVIRONMENTAL CONTACT PHONE: (619)445-6200
FACILITY INFORMATION
YES NO YES NO
INACTIVATION INSPECTION: ✖
CHANGE OF OWNER: ✖
CHANGE IN BUSINESS TYPE: ✖
BUSINESS TYPE: Medical Waste, Small Qty - No Treatment
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: ✖
BUSINESS CLOSE DATE:
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
Small Quantity Medical Waste Generators
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: Brianna Roberts, LVN TITLE: Site Supervisor
REMOVE BLANK CHECKLISTS FROM FINAL INSPECTION REPORT REFUSED TO SIGN
COUNTY OF SAN DIEGO
UPFP INSPECTION CHECKLIST
FACILITY NAME: SANTEE FAMILY MEDICINE
ADDRESS: 120 Town Center PKWY
CITY/ZIP: Santee /92071
INSPECTION DATE: 12/15/2016
RECORD ID #: DEH2016-HUPFP-002394
TIME START: 9:30 AM END: 10:30 AM
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Brianna Roberts, LVN
TITLE: Site Supervisor
PHONE:(619) 873-3440
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v50 Dated 11/21/2016 13:30 INSPECTION REPORT EMAILS:
[email protected]
RECORD COMMENT:
HM-924(01/15)
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT
FACILITY NAME: SANTEE FAMILY MEDICINE
ADDRESS: 120 Town Center PKWY
CITY/ZIP: Santee /92071
INSPECTION DATE: 12/15/2016 PAGE 1 OF 5
RECORD ID #: DEH2016-HUPFP-002394
TIME START: 9:30 AM END: 10:30 AM
SPECIALIST: Bridget Kieu
INSPECTION CONTACT:Brianna Roberts, LVN
TITLE: Site Supervisor
PHONE:(619) 873-3440
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 03/11/2016
CONSENT TO CONDUCT INSPECTION GRANTED BY: Brianna Roberts, LVN TITLE: Site Supervisor INTRODUCTION:
New Business/Initial Inspection
A medical waste inspection was conducted 12/15/2016 with Shannon Dukes, medical assistant. Permission to inspect and review documents was given to inspector via telephone by Brianna Roberts, LVN (site supervisor). Santee Family Medicine provides primary care for adults and children and performs minor surgeries (such as cyst removal). Business generates medical waste in form of red bag waste, sharps and also pharmaceutical waste which is handled as hazardous waste, and it is currently a small quantity generator of medical waste. Medical waste is disposed of monthly by Allied Medical Waste. During today's inspection there is no hazardous materials in reportable quantities observed on site.
Business began operating on September 1, 2016. Business had notified CUPA in March 2016 and they'd initially submitted Facility Information and inventory in CERS on 3/9/2016.
INSPECTION REMARKS:
* Please go in CERS and update your information including EPA id number CAL000420998 and RCRA pharmaceutical waste (for the inventory).
Then submit the update.
* Trash enclosure is secured during inspection.
* Pay permit fees within 30 days upon receiving the invoice.
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: 12/15/2016 PAGE 2 OF 5
RECORD ID #: DEH2016-HUPFP-002394
If you have any questions regarding this inspection, please contact Bridget Kieu ,(619) 602-0746, [email protected]
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
Shannon Dukes
TITLE OF FACILITY REPRESENTATIVE
Medical Assistant
SIGNATURE
DATE SIGNED
12/15/2016
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: 12/15/2016 PAGE 3 OF 5
RECORD ID #:DEH2016-HUPFP-002394
FACILITY NAME: *SANTEE FAMILY MEDICINE
ADDRESS: * 120 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
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: 12/15/2016 PAGE 4 OF 5
RECORD ID #:DEH2016-HUPFP-002394
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
0219 Failed to properly segregate used oil &/or fuel drained from filters.
HSC 25250.22(b)(4); 22 CCR 66266.130(c)(6)
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: 12/15/2016 PAGE 5 OF 5
RECORD ID #:DEH2016-HUPFP-002394
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, 68.1202 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 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 or comply with pharmaceutical waste hauling exemption). HSC 117935, 118032
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
COUNTY OF SAN DIEGO
UPFP INSPECTION CHECKLIST
FACILITY NAME: San Ysidro Health/Santee Family Medicine ADDRESS: 120 Town Center Pkwy
CITY/ZIP: Santee /92071
INSPECTION DATE: 12/17/2019
RECORD ID #: DEH2016-HUPFP-002394
TIME START: 4:30 PM END: 5:30 PM
SPECIALIST: Vikki T. Denslow
INSPECTION CONTACT:Kate Fowler/Savannah Rowinski
TITLE: Medical Assistants
PHONE:619-873-3440
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: 01/31/2020
BALANCE DUE: $170.00
INSPECTOR: Vikki T. Denslow
INSPECTION TYPE: Initial
INSPECTION STATUS: Complete
EPA ID NUMBER: CAL000420998
FACILITY CERS ID NUMBER:10657582
CERS LEAD USER: Beatriz Payan
LAST CERS SUBMITTAL DATE: 02/07/2019
ENVIRONMENTAL CONTACT EMAIL: [email protected]
ENVIRONMENTAL CONTACT PHONE: (619)445-6200
FACILITY INFORMATION
YES NO YES NO
INACTIVATION INSPECTION: ✖
CHANGE OF OWNER: ✖
CHANGE IN BUSINESS TYPE: ✖
BUSINESS TYPE: Medical Waste, Small Qty - No Treatment
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: ✖
BUSINESS CLOSE DATE:
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
Small Quantity Medical Waste Generators
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: Kate Fowler TITLE: Medical Assistant
REMOVE BLANK CHECKLISTS FROM FINAL INSPECTION REPORT REFUSED TO SIGN TIME ACCOUNTING (Initial) TOTAL TIME ENTERED: 1.2
Date Time Group Type
12/17/2019 0.5 HMD Inspection Report Writing - Record
12/17/2019 0.2 HMD Inspection Travel Time - Record
12/17/2019 0.5 HMD Inspection MW SQG - Record
COUNTY OF SAN DIEGO
UPFP INSPECTION CHECKLIST
FACILITY NAME: San Ysidro Health/Santee Family Medicine ADDRESS: 120 Town Center Pkwy
CITY/ZIP: Santee /92071
INSPECTION DATE: 12/17/2019
RECORD ID #: DEH2016-HUPFP-002394
TIME START: 4:30 PM END: 5:30 PM
SPECIALIST: Vikki T. Denslow
INSPECTION CONTACT:Kate Fowler/Savannah Rowinski
TITLE: Medical Assistants
PHONE:619-873-3440
E-MAIL:[email protected]
HM-9000(01/15) DEH CUPA Inspection eForm v66 Dated 1/10/2017 14:30 INSPECTION REPORT EMAILS:
[email protected],[email protected],[email protected],[email protected],[email protected],[email protected],bpayan@mtnh ealth.org,[email protected],[email protected],[email protected] RECORD COMMENT:
This medical office has had a change in ownership. Please apply the permit fees to the permit for the new owner.
HM-924(01/15)
COUNTY OF SAN DIEGO
COMPLIANCE INSPECTION REPORT
FACILITY NAME: San Ysidro Health/Santee Family Medicine ADDRESS: 120 Town Center Pkwy
CITY/ZIP: Santee /92071
INSPECTION DATE: 12/17/2019 PAGE 1 OF 2
RECORD ID #: DEH2016-HUPFP-002394
TIME START: 4:30 PM END: 5:30 PM
SPECIALIST: Vikki T. Denslow
INSPECTION CONTACT:Kate Fowler/Savannah Rowinski
TITLE: Medical Assistants
PHONE:619-873-3440
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 01/31/2020
CONSENT TO CONDUCT INSPECTION GRANTED BY: Kate Fowler TITLE: Medical Assistant INTRODUCTION:
Change of Ownership
-The purpose of this inspection was to evaluate this medical office for medical waste requirements. -A medical assistant, Kate Fowler, granted consent for this inspection, and she was present for the duration of the inspection.
Another medical assistant, Savannah Rowinski, was also present for part of the inspection. -This office had approximately ten sharps containers, two red bags, and a pharmaceutical waste container onsite. -The facility had less than 200 cubic feet of oxygen onsite. -The gates to the dumpster were locked.
The following minor violations were corrected during the inspection:
-Two of the sharps containers had been labeled with the generator's name and address, but not with the phone number.
A medical assistant added the phone number to the labels during the inspection. -The red bags and pharmaceutical waste container had not been labeled with the generator's name, address, or phone number.
A medical assistant added labels to the containers during the inspection.
A contact did not refuse to sign this report, but the contacts left the building before this inspection report was completed.
Sign and date page 2 of this report, and return a copy of the signed page to Vikki Denslow of the Hazardous Materials Division by December 19, 2019. (You can cross out "refused to sign".)
A medical assistant stated that this medical office has had a change in ownership. Complete and return a California Environmental Reporting System (CERS) application form for the new owner to Vikki Denslow of the Hazardous Materials Division by December 30, 2019.
Obtain a Unified Program Facility Permit for the new owner by January 31, 2020.
INSPECTION REMARKS:
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), HM-924(01/15)
COUNTY OF SAN DIEGO
SUPPLEMENTAL COMPLIANCE
INSPECTION REPORT
INSPECTION DATE: 12/17/2019 PAGE 2 OF 2
RECORD ID #: DEH2016-HUPFP-002394
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 If you have any questions regarding this inspection, please contact Vikki T. Denslow, 619-804-1738, [email protected]
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
Kate Fowler
TITLE OF FACILITY REPRESENTATIVE
Medical Assistant
SIGNATURE
Representative Refused to Sign
DATE SIGNED
Department of Environmental Health, Hazardous Materials Division, P.O. Box 129261, San Diego, CA 92112-9261 Phone: (858) 505-6880 http://www.sdcdeh.org
Drainage Study
For
The Exchange at
Santee Town Center
RICK Job No.20075
March 7, 2025
Revised: May 30, 2025
Revised: September 18, 2025
DRAINAGE STUDY
FOR
THE EXCHANGE AT SANTEE TOWN CENTER
Preliminary Engineering
Job Number 20075
___________________________________
Shavger Rekani, PE
PE #90893, Exp. 03/26
Prepared For:
Borstein Enterprises
11766 Wilshire Boulevard, Suite 820
Los Angeles, California 90025
Prepared By:
RICK
Water Resources Department
5620 Friars Road
San Diego, California 92110-2596
(619) 291-0707
March 7, 2025
Revised May 30, 2025
Revised September 18, 2025
Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 1 TABLE OF CONTENTS
1.0 INTRODUCTION .............................................................................................................. 2
2.0 HYDROLOGY ................................................................................................................... 6
3.0 HYDRAULICS................................................................................................................... 9
4.0 CONCLUSION................................................................................................................. 12 Figures:
Figure 1: Vicinity Map.....................................................................................................................5 Tables:
Table 1: Subarea Hydrologic Processes (Codes).............................................................................7 Table 2.2: Summary of Hydrologic Conditions...............................................................................8 Table 3.2: Pipe Hydraulic Processes (Codes)................................................................................11 Appendices:
Appendix A: Modified Rational Method Output [Pre-project] Appendix B: Modified Rational Method Output [Post-project & Post-project Mitigated] Appendix C: Backup for Weighted Runoff Coefficients & Isopluvials Appendix D: Inlet Sizing (to be included with a future submittal) Appendix E: Storm Drain Sizing Calculations
Appendix F: Hydraulic Capacity Calculations
Map Pockets:
Map Pocket 1: Drainage Study Map for The Exchange at Santee Town Center [Pre-Project] Map Pocket 2: Drainage Study Map for The Exchange at Santee Town Center [Post-Project] Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 2 1.0 INTRODUCTION
1.1 Project Description
This drainage study presents hydrologic and hydraulic analyses for the proposed The Exchange at Santee Town Center (herein referred to as the “project”). The project is located within the City of Santee, approximately 400 feet north of the intersection of Lowes Road and Mission Gorge Road. (See Figure 1, Vicinity Map). The proposed project is a new development project that proposes the construction of multifamily dwellings with 100 units, residential streets, and parking. The project’s existing condition is fully pervious area.
1.2 Drainage Characteristics
Pre-Project Condition
The pre-project site drains to two point of compliances (POC) – one west and the other east of the site. The west POC (POC 1) is a cleanout located at the northwest corner of the property, at the edge of Lowes Road and Lowes Driveway. POC 1 collects runoff through a series of curb inlets.
The first curb inlet located at Node 105, collects runoff from the fully pervious site primarily through a natural channel directly east of Node 105. Additionally, some street runoff from the eastern portion of Lowes Road travels north to the curb inlet at Node 105. The curb inlet at Node 120 collects runoff from the Walmart directly north of the site and from the western portion of Lowes Road. The curb inlet at Node 144 collects runoff from a portion of the United States Postal Service south of the site and the eastern portion of Lowes Road. The curb inlet at Node 146 collects runoff from the western portion of Lowes Road. Node 150 collects runoff from the adjacent Lowes parking lot. All storm drains confluence at POC 1 at Node 199 through a combination of 325 feet of reinforced concrete pipe (RCP). After leaving the project site, runoff from POC 1 flows through a series of approximately 1,700 feet of RCP storm drain to a headwall west of the site. The east POC (POC 2) is a grate inlet located east of the property, in between the existing businesses of David Corbin, MD – San Ysidro Health Center and Coastal Kids Dentistry & Orthodontics – Santee. POC 2 collects runoff at this grate inlet from a portion of the fully pervious site, the private road east of the site, and from a portion of the aforementioned establishments. Flows captured in POC 2 travel through a series of approximately 1,035 feet of RCP to a headwall, situated northeast Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 3 of the site. Both conveyance systems drain to the San Diego River, which ultimately flows west and discharges to the Pacific Ocean.
Post-Project Condition
Drainage patterns for the proposed condition will remain similar to drainage patterns in the preproject condition. POC 1 will remain the cleanout located at the northwest corner of the property, at the edge of Lowes Road and Lowes Driveway. POC 1 will collect runoff through a series of curb inlets from three distinct areas that confluence at POC 1. The first area includes the southern portion of the developed multi-family homes built from the project, where runoff is collected via three modular wetland units with overflow bypasses and directed to Node 110. Here, the flows from the proposed project will confluence with the southern offsite portion of the site, ultimately reaching POC 1. The second area primarily consists of the northern offsite area that includes Walmart and surrounding parking lot. These flows will have the same drainage patterns as in the pre-project conditions; however, flows collected by two modular wetland units from the proposed area will be directed to confluence with the flows from the northern offsite portion at Node 160.
These flows are then directed to POC 1. Lastly, the third area consists solely of the proposed development area. Flows will be collected by four modular wetland units located appropriately throughout the site. These flows will then confluence at Node 178 at the edge of the proposed development area before traveling directly west to confluence with the other two areas at POC 1.
Moreover, the tributary area of POC 1 will increase by 0.1 acres due to the proposed grading of the project. All storm drains will be RCP, and appropriate sizing can be found in Appendix E POC 2 will remain the grate inlet from the existing conditions. POC 2 will maintain the same drainage patterns from the road adjacent to the grate inlet, and a portion of the establishments east of the project. Additionally, the tributary area of POC 2 will decrease by 0.1 acres as a result of the increase in tributary area in POC 1. Runoff collected at both POC’s will travel north and drain to the San Diego River, which ultimately flows west and discharges into the Pacific Ocean. It is anticipated that POC 1’s peak flows from a 100-year, 6-hour storm event on the post-project site will be higher than peak flows from the pre-project site; however, due to the capacity of the storm drain system downstream of POC 1, there will be no detention necessary. Please see Appendix F for supporting hydraulic calculations.
Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 4 1.3 Hydrology, Hydraulics, and Detention
Hydrology and hydraulics are discussed in Sections 2.0 and 3.0 respectively of this report.
1.4 Water Quality
Post-project storm water runoff will be conveyed and managed via nine modular wetland systems and appropriately sized dispersion areas, designed pursuant to the guidelines from the City of Santee BMP Design Manual, dated February 2016. The modular wetland systems will be used to treat all the proposed development area. PDP SWQMP specific to the project is dated September 18, 2025 (or any revision made thereafter) and prepared by RICK.
Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 5 Figure 1: Vicinity Map
Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 6 2.0 HYDROLOGY
The hydrologic conditions were analyzed in accordance with the Drainage – Design Criteria in the City of Santee Public Works Standards (September 1982) and the June 2003 San Diego County Hydrology Manual.
2.1 Methodology
To determine the peak flows at the point of compliance (POC) identified on the provided drainage study exhibits, Advance Engineering Software (AES) 2014 Rational Method computer software version 21.0 was used. The hydrologic model was developed by first dividing each major drainage basin into several subareas. The delineation of each subarea was determined so that area within each subarea is comprised of similar hydrologic features, including topography, land use, and storm drain conveyance system (e.g., urban open channel, pipe, natural open channel, etc.). Nodes were identified at the upstream and downstream extents of each subarea, and subarea hydrologic data was determined, such as the land use(s) and drainage facility geometry, elevations, and lengths. Hydrologic backup information is included in Appendix C and AES output is provided in Appendix A and B for pre and post-project conditions respectively.
Next, the hydrologic data describing each subarea were incorporated into the AES software in order to create a node-link model for each watershed. For each subarea the AES software performs calculations for the specific hydrologic process occurring in the subarea. There are 15 different hydrologic processes programmed into the software, and each process is assigned a code number that is presented on the model results. The AES Rational Method computer software hydrologic processes code numbers are described in Table 1.
Table 1: Subarea Hydrologic Processes (Codes)
Code Subarea Type
Code 1 Confluence analysis at a node
Code 2 Initial subarea analysis
Code 3 Pipe flow travel time (computer-estimated pipe sizes) Code 4 Pipe flow travel time (user-specified pipe size) Code 5 Trapezoidal channel travel time
Code 6 Street flow analysis through a subarea
Code 7 User-specified information at a node
Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 7 Table 1: Subarea Hydrologic Processes (Codes)
Code Subarea Type
Code 8 Addition of the subarea runoff to mainline
Code 9 V-Gutter flow through subarea
Code 10 Copy mainstream data onto a memory bank
Code 11 Confluence a memory bank with the mainstream memory Code 12 Clear a memory bank
Code 13 Clear the mainstream memory
Code 14 Copy a memory bank onto the mainstream memory
Code 15 Hydrologic data bank storage functions
The hydrologic conditions were analyzed in accordance with the County of San Diego’s design criteria as follows:
San Diego County Hydrology Manual, June 2003:
Design Storm: 100-year. 6-hour (for storm drain systems) Runoff Coefficients: Weighted Runoff Coefficients(1)
0% Impervious Areas C=0.30 for Type-C soils
C=0.35 for Type-D soils
100% Impervious Areas C=0.9
Soil Type (Conservatively Applied) “D”
Design Storm Precipitation2 100-year, 6-hour, P=2.5 inches Rainfall Intensity: Based on time-intensity criteria per Section 3.0 of the County Hydrology Manual (San Diego County,
2003)
(1) Utilized to calculate composite ‘C’ values based on percent impervious. (2) Isopluvial map provided in Appendix C.
Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 8 2.2 Hydrologic Results
Rational Method Results
The 100-, 50-, and 10-year peak flow rates for the Pre- and Post-Project conditions are summarized in Table 2.1 below.
Table 2.2: Summary of Hydrologic Conditions
Drainage
Basin ID
POC
Return
Period
(years)
Project
Condition
Tributary
Area (ac)
Time Of
Concentration
(minutes)
Q (cfs)
100 1
100
Pre-Project 7.9 6.4 27.58
Post-Project 8.0 7.5 34.06
50 Pre-Project 7.9 6.4 26.28
Post-Project 8.0 7.6 32.63
10 Pre-Project 7.9 6.7 19.29
Post-Project 8.0 7.8 24.07
200 2
100
Pre-Project 0.9 5.0 4.94
Post-Project 0.8 5.0 4.56
50 Pre-Project 0.9 5.0 4.74
Post-Project 0.8 5.0 4.67
10 Pre-Project 0.9 5.0 3.55
Post-Project 0.8 5.0 3.28
Based on the Rational Method result and a comparison of the pre-and post-project POC’s, it can be observed that the peak discharge rate and tributary area to POC 1 has increased, while the peak discharge rate and tributary area of POC 2 has decreased. The rise in POC 1 is due to the increase in impervious area to this POC. The decrease in POC 2 is due to the tributary area reducing from pre-project to post project conditions. There will be no detention provided because of the capacity available downstream of POC 1 as set forth in the Santee Master Drainage Study. Please refer to section 3.2 for additional details. Ultimately, the proposed condition flow patterns are maintained from the existing conditions, except for 0.1 acres transferred from Basin 200 to Basin 100 due to the project’s grading. Flows captured in Basin 100 drain west while flows captured in Basin 200 drain east of the project site. These flows are then conveyed north and discharged into the San Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 9 Diego River. Refer to Appendix A and Appendix B of this report for pre- and post-project Rational Method calculations respectively and Appendix C for backup documentation.
The location of the POC, drainage boundaries, flow patterns, and pervious/impervious areas can be found on the work maps titled, “Pre-project Drainage Study Map for The Exchange at Santee Town Center” located in Map Pocket 1 and “Post-project Drainage Study Map for The Exchange at Santee Town Center located in Map Pocket 2.
3.0 HYDRAULICS
3.1 Hydraulic Methodology and Criteria
The 100-year post-project peak flow rates determined using the Modified Rational Method was used to size the on-site storm drain system. In addition, hydraulic analyses regarding inlet sizing calculations will be performed during final engineering and included in Appendix D.
3.1.1 Storm Drain Sizing
Storm drain pipe sizes were determined based on a normal depth calculation to verify storm drain capacity based on Manning’s equation.
Q= (1.486/n) A R 2/3 S ½
Where:
Q = Discharge (cfs)
n = Manning’s roughness coefficient
A = Cross-sectional Area of flow (sq. ft.)
R = Hydraulic radius (ft.) (where hydraulic radius is defined as the cross-section area of flow divided by the wetted perimeter, R= A/P)
S = Slope of pipe (ft./ft.)
The Manning’s roughness coefficient “n” of 0.013 was used for the hydraulic calculations. This value is typically used for reinforced concrete pipe (RCP), polyvinyl chloride (PVC), and high- Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 10 density polyethylene pipe (HDPE). The pipe sizes were evaluated based on the Rational Method flow rates with a 30% “bump up” sizing factor to account for hydraulic losses within the system.
Please refer to Appendix E for the storm drain sizes. The AES rational method results for the postproject condition are located in Appendix B of this report and may be referenced for further information concerning pipe flow.
3.2 Downstream Storm Drain Hydraulic Capacity
Using the 100-year peak flows determined using the Modified Rational Method, the post-project flow rate – 34.06 cfs – is higher than the pre-project flow rate –27.58 cfs, at POC 1. However, no detention will be provided because the storm drain system downstream of POC 1 has capacity for this increase of 6.48 cfs. This is proven through the implementation of the Santee Master Drainage Study (MDS) and the AES Pipeflow program. Please continue below for additional details.
3.2.1 Santee Master Drainage Study (MDS) Overview
The MDS is an update to the City of Santee’s existing 1990 MDS. These updates include comprehensive GIS updates and hydrologic and hydraulic (H&H) analysis. The objective of the study was to provide updated H&H analysis of the City’s storm water system, identify existing deficiencies, and provide Capital Improvement Program (CIP) projects that significantly enhance the City’s storm water Level of Service (LOS) and aid in future development.
The GIS updates to the MDS provide vital data to analyze H&H features of the project area and its surrounding vicinity, including pipe geometry, flow rate values, rim elevations, and hydraulic grade lines (HGL). These attributes will be used in the hydraulic capacity analysis.
3.2.2 AES Pipeflow
AES Pipeflow (2012) was used to analyze the pipe directly downsteam of POC 1. The program performs gradually varied flow and pressure flow profile computations. The results are provided in an incremental and summarized form and indicate reaches of open channel and pressure flow Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 11 within a given reach of pipe. The program also accounts for losses that may occur due to friction, junction structures, pipe bends, etc. The codes and an explanation of their function are as follows:
Table 3.2: Pipe Hydraulic Processes (Codes)
Code Subarea Type
Code 1 Friction Losses
Code 2 Manhole Losses
Code 3 Pipe-bend Losses
Code 4 Sudden Pipe-enlargement
Code 5 Junction Losses
Code 6 Angle-point Losses
Code 7 Sudden Pipe-reduction
Code 8 Catch Basin Entrance Losses
Code 9 Transition Losses
The pipe directly downstream of POC 1 is constructed of reinforced concrete pipe (RCP). The Manning’s roughness coefficient “n” used for the hydraulic calculations for RCP is 0.013.
3.2.3 Hydraulic Capacity Results
When comparing the discharge from the MDS and the peak post-project discharge, it can be seen that the MDS flow rate is 0.1 cfs larger. This means that the project is providing less flow than anticipated by the City of Santee.
Moreover, AES Pipeflow was utilized to compare the HGL’s from the anticipated conditions from the MDS and the proposed conditions from the project. The only parameter that changed between both runs was the flow rate at POC 1. The project’s HGL – 330.478 feet – is less than the MDS’s HGL – 330.484 feet. This displays that the project’s impact to the HGL is less than anticipated by the City of Santee. Additionally, the rim elevation of the cleanout at POC 1 is 331.76 feet, a difference of 1.28 feet from the project’s HGL in the post-project conditions. This satisfies section
3.2.1 of the September 2014 County of San Diego Hydraulic Design Manual and their minimum freeboard of 1.0 feet in HGL below the ground surface.
Prepared By: SFR:JS:ar/C20075/WR/Reports/Drainage_Study Rick Engineering Company – Water Resources Division 9-18-2025 12 As can be seen, while the post-project flow rate did increase from pre-project conditions, there is enough capacity downstream of POC 1 to account for this increase in flow. Therefore, it is anticipated that there will be no adverse effects to downstream drainage characteristics/systems as a result of the project. Please refer to Appendix F to see supporting documentation for the hydraulic capacity discussion.
4.0 CONCLUSION
This drainage study presents the hydrologic and hydraulic analyses for the Exchange at Santee Town Center Project. The project is a new development project located in the City of Santee. The pre-project and post-project peak discharge rates were determined using the Rational Method based on the hydrologic methodology and criteria described in the County of San Diego Hydrology Manual, dated June 2003.
Post-project flows will be treated per the City of Santee’s BMP Design Manual, dated February 2016. For more information on water quality sizing, please refer to the separate report titled, “Priority Development Project Storm Water Quality Management Plan (PDP SWQMP) for The Exchange at Santee Town Center,” dated September 18, 2025, or any revisions thereafter, and prepared by Rick Engineering Company.
Based on the Rational Method results and a comparison of the pre- and post-project POC, it can be observed that the post-project peak discharge rate and tributary area to POC 1 has increased, while the peak discharge rate and tributary area to POC 2 has decreased. Detention will not be implemented due to the available capacity downstream of POC 1. Therefore, it is anticipated that there will be no adverse effects to downstream drainage characteristics/systems as a result of the project.
APPENDIX A
Modified Rational Method Output
[Pre-project]
____________________________________________________________________________ ****************************************************************************
RATIONAL METHOD HYDROLOGY COMPUTER PROGRAM PACKAGE
Reference: SAN DIEGO COUNTY FLOOD CONTROL DISTRICT
2003,1985,1981 HYDROLOGY MANUAL
(c) Copyright 1982-2014 Advanced Engineering Software (aes) Ver. 21.0 Release Date: 06/01/2014 License ID 1261
Analysis prepared by:
RICK ENGINEERING COMPANY
5620 Friars Road
San Diego, California 92110
619-291-0707 Fax 619-291-4165
************************** DESCRIPTION OF STUDY ************************** * SANTEE TOWN CENTER *
* PRE-PROJECT CONDITIONS 10-YEAR EVENT, POC 1 *
* JN-20075 *
************************************************************************** FILE NAME: TC100E10.RAT
TIME/DATE OF STUDY: 19:27 09/09/2025
---------------------------------------------------------------------------- USER SPECIFIED HYDROLOGY AND HYDRAULIC MODEL INFORMATION:
---------------------------------------------------------------------------- 2003 SAN DIEGO MANUAL CRITERIA
USER SPECIFIED STORM EVENT(YEAR) = 10.00
6-HOUR DURATION PRECIPITATION (INCHES) = 1.800
SPECIFIED MINIMUM PIPE SIZE(INCH) = 18.00
SPECIFIED PERCENT OF GRADIENTS(DECIMAL) TO USE FOR FRICTION SLOPE = 0.90 SAN DIEGO HYDROLOGY MANUAL "C"-VALUES USED FOR RATIONAL METHOD NOTE: USE MODIFIED RATIONAL METHOD PROCEDURES FOR CONFLUENCE ANALYSIS *USER-DEFINED STREET-SECTIONS FOR COUPLED PIPEFLOW AND STREETFLOW MODEL* HALF- CROWN TO STREET-CROSSFALL: CURB GUTTER-GEOMETRIES: MANNING
WIDTH CROSSFALL IN- / OUT-/PARK- HEIGHT WIDTH LIP HIKE FACTOR NO. (FT) (FT) SIDE / SIDE/ WAY (FT) (FT) (FT) (FT) (n)
=== ===== ========= ================= ====== ===== ====== ===== ======= 1 30.0 20.0 0.018/0.018/0.020 0.67 2.00 0.0312 0.167 0.0150 2 14.0 9.0 0.020/0.020/0.020 0.50 1.50 0.0100 0.125 0.0180 GLOBAL STREET FLOW-DEPTH CONSTRAINTS:
1. Relative Flow-Depth = 0.50 FEET
as (Maximum Allowable Street Flow Depth) - (Top-of-Curb)
2. (Depth)*(Velocity) Constraint = 6.0 (FT*FT/S)
*SIZE PIPE WITH A FLOW CAPACITY GREATER THAN
OR EQUAL TO THE UPSTREAM TRIBUTARY PIPE.*
**************************************************************************** FLOW PROCESS FROM NODE 100.00 TO NODE 102.00 IS CODE = 21 ---------------------------------------------------------------------------- >>>>>RATIONAL METHOD INITIAL SUBAREA ANALYSIS<<<<<
============================================================================ *USER SPECIFIED(SUBAREA):
RESIDENTIAL (1. DU/AC OR LESS) RUNOFF COEFFICIENT = .3700 S.C.S. CURVE NUMBER (AMC II) = 0
INITIAL SUBAREA FLOW-LENGTH(FEET) = 50.00
UPSTREAM ELEVATION(FEET) = 337.90
DOWNSTREAM ELEVATION(FEET) = 337.00
ELEVATION DIFFERENCE(FEET) = 0.90
SUBAREA OVERLAND TIME OF FLOW(MIN.) = 7.638
10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 3.608
SUBAREA RUNOFF(CFS) = 0.11
TOTAL AREA(ACRES) = 0.08 TOTAL RUNOFF(CFS) = 0.11
**************************************************************************** FLOW PROCESS FROM NODE 102.00 TO NODE 105.00 IS CODE = 51 ---------------------------------------------------------------------------- >>>>>COMPUTE TRAPEZOIDAL CHANNEL FLOW<<<<<
>>>>>TRAVELTIME THRU SUBAREA (EXISTING ELEMENT)<<<<<
============================================================================ ELEVATION DATA: UPSTREAM(FEET) = 337.00 DOWNSTREAM(FEET) = 331.30 CHANNEL LENGTH THRU SUBAREA(FEET) = 518.55 CHANNEL SLOPE = 0.0110 CHANNEL BASE(FEET) = 2.00 "Z" FACTOR = 3.000
MANNING'S FACTOR = 0.030 MAXIMUM DEPTH(FEET) = 5.00
10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 2.577
*USER SPECIFIED(SUBAREA):
RESIDENTIAL (1. DU/AC OR LESS) RUNOFF COEFFICIENT = .3500 S.C.S. CURVE NUMBER (AMC II) = 0
TRAVEL TIME COMPUTED USING ESTIMATED FLOW(CFS) = 1.00
TRAVEL TIME THRU SUBAREA BASED ON VELOCITY(FEET/SEC.) = 1.65 AVERAGE FLOW DEPTH(FEET) = 0.23 TRAVEL TIME(MIN.) = 5.23 Tc(MIN.) = 12.87
SUBAREA AREA(ACRES) = 1.93 SUBAREA RUNOFF(CFS) = 1.74
AREA-AVERAGE RUNOFF COEFFICIENT = 0.351
TOTAL AREA(ACRES) = 2.0 PEAK FLOW RATE(CFS) = 1.82
END OF SUBAREA CHANNEL FLOW HYDRAULICS:
DEPTH(FEET) = 0.32 FLOW VELOCITY(FEET/SEC.) = 1.95
LONGEST FLOWPATH FROM NODE 100.00 TO NODE 105.00 = 568.55 FEET. **************************************************************************** FLOW PROCESS FROM NODE 105.00 TO NODE 105.00 IS CODE = 81 ---------------------------------------------------------------------------- >>>>>ADDITION OF SUBAREA TO MAINLINE PEAK FLOW<<<<<
============================================================================ 10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 2.577
*USER SPECIFIED(SUBAREA):
GENERAL INDUSTRIAL RUNOFF COEFFICIENT = .9000
S.C.S. CURVE NUMBER (AMC II) = 0
AREA-AVERAGE RUNOFF COEFFICIENT = 0.3667
SUBAREA AREA(ACRES) = 0.06 SUBAREA RUNOFF(CFS) = 0.14
TOTAL AREA(ACRES) = 2.1 TOTAL RUNOFF(CFS) = 1.96
TC(MIN.) = 12.87
**************************************************************************** FLOW PROCESS FROM NODE 105.00 TO NODE 120.00 IS CODE = 31 ---------------------------------------------------------------------------- >>>>>COMPUTE PIPE-FLOW TRAVEL TIME THRU SUBAREA<<<<<
>>>>>USING COMPUTER-ESTIMATED PIPESIZE (NON-PRESSURE FLOW)<<<<< ============================================================================ ELEVATION DATA: UPSTREAM(FEET) = 100.00 DOWNSTREAM(FEET) = 99.60 FLOW LENGTH(FEET) = 40.00 MANNING'S N = 0.013
ESTIMATED PIPE DIAMETER(INCH) INCREASED TO 18.000
DEPTH OF FLOW IN 18.0 INCH PIPE IS 5.4 INCHES
PIPE-FLOW VELOCITY(FEET/SEC.) = 4.37
ESTIMATED PIPE DIAMETER(INCH) = 18.00 NUMBER OF PIPES = 1 PIPE-FLOW(CFS) = 1.96
PIPE TRAVEL TIME(MIN.) = 0.15 Tc(MIN.) = 13.03
LONGEST FLOWPATH FROM NODE 100.00 TO NODE 120.00 = 608.55 FEET. **************************************************************************** FLOW PROCESS FROM NODE 120.00 TO NODE 120.00 IS CODE = 1 ---------------------------------------------------------------------------- >>>>>DESIGNATE INDEPENDENT STREAM FOR CONFLUENCE<<<<<
============================================================================ TOTAL NUMBER OF STREAMS = 2
CONFLUENCE VALUES USED FOR INDEPENDENT STREAM 1 ARE:
TIME OF CONCENTRATION(MIN.) = 13.03
RAINFALL INTENSITY(INCH/HR) = 2.56
TOTAL STREAM AREA(ACRES) = 2.07
PEAK FLOW RATE(CFS) AT CONFLUENCE = 1.96
**************************************************************************** FLOW PROCESS FROM NODE 110.00 TO NODE 112.00 IS CODE = 21 ---------------------------------------------------------------------------- >>>>>RATIONAL METHOD INITIAL SUBAREA ANALYSIS<<<<<
============================================================================ *USER SPECIFIED(SUBAREA):
RESIDENTIAL (1. DU/AC OR LESS) RUNOFF COEFFICIENT = .9000 S.C.S. CURVE NUMBER (AMC II) = 0
INITIAL SUBAREA FLOW-LENGTH(FEET) = 50.00
UPSTREAM ELEVATION(FEET) = 338.00
DOWNSTREAM ELEVATION(FEET) = 337.80
ELEVATION DIFFERENCE(FEET) = 0.20
SUBAREA OVERLAND TIME OF FLOW(MIN.) = 3.207
WARNING: THE MINIMUM OVERLAND FLOW SLOPE, 0.5%, IS USED IN Tc CALCULATION! 10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 4.743
NOTE: RAINFALL INTENSITY IS BASED ON Tc = 5-MINUTE.
SUBAREA RUNOFF(CFS) = 0.34
TOTAL AREA(ACRES) = 0.08 TOTAL RUNOFF(CFS) = 0.34
**************************************************************************** FLOW PROCESS FROM NODE 112.00 TO NODE 120.00 IS CODE = 51 ---------------------------------------------------------------------------- >>>>>COMPUTE TRAPEZOIDAL CHANNEL FLOW<<<<<
>>>>>TRAVELTIME THRU SUBAREA (EXISTING ELEMENT)<<<<<
============================================================================ ELEVATION DATA: UPSTREAM(FEET) = 337.80 DOWNSTREAM(FEET) = 331.30 CHANNEL LENGTH THRU SUBAREA(FEET) = 485.57 CHANNEL SLOPE = 0.0134 CHANNEL BASE(FEET) = 10.00 "Z" FACTOR = 12.000
MANNING'S FACTOR = 0.013 MAXIMUM DEPTH(FEET) = 5.00
10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 4.087
*USER SPECIFIED(SUBAREA):
GENERAL INDUSTRIAL RUNOFF COEFFICIENT = .8500
S.C.S. CURVE NUMBER (AMC II) = 0
TRAVEL TIME COMPUTED USING ESTIMATED FLOW(CFS) = 2.81
TRAVEL TIME THRU SUBAREA BASED ON VELOCITY(FEET/SEC.) = 2.62 AVERAGE FLOW DEPTH(FEET) = 0.10 TRAVEL TIME(MIN.) = 3.09 Tc(MIN.) = 6.30
SUBAREA AREA(ACRES) = 1.39 SUBAREA RUNOFF(CFS) = 4.83
AREA-AVERAGE RUNOFF COEFFICIENT = 0.853
TOTAL AREA(ACRES) = 1.5 PEAK FLOW RATE(CFS) = 5.12
END OF SUBAREA CHANNEL FLOW HYDRAULICS:
DEPTH(FEET) = 0.13 FLOW VELOCITY(FEET/SEC.) = 3.28
LONGEST FLOWPATH FROM NODE 110.00 TO NODE 120.00 = 535.57 FEET. **************************************************************************** FLOW PROCESS FROM NODE 120.00 TO NODE 120.00 IS CODE = 1 ---------------------------------------------------------------------------- >>>>>DESIGNATE INDEPENDENT STREAM FOR CONFLUENCE<<<<<
>>>>>AND COMPUTE VARIOUS CONFLUENCED STREAM VALUES<<<<< ============================================================================ TOTAL NUMBER OF STREAMS = 2
CONFLUENCE VALUES USED FOR INDEPENDENT STREAM 2 ARE:
TIME OF CONCENTRATION(MIN.) = 6.30
RAINFALL INTENSITY(INCH/HR) = 4.09
TOTAL STREAM AREA(ACRES) = 1.47
PEAK FLOW RATE(CFS) AT CONFLUENCE = 5.12
** CONFLUENCE DATA **
STREAM RUNOFF Tc INTENSITY AREA
NUMBER (CFS) (MIN.) (INCH/HOUR) (ACRE)
1 1.96 13.03 2.557 2.07
2 5.12 6.30 4.087 1.47
RAINFALL INTENSITY AND TIME OF CONCENTRATION RATIO
CONFLUENCE FORMULA USED FOR 2 STREAMS.
** PEAK FLOW RATE TABLE **
STREAM RUNOFF Tc INTENSITY
NUMBER (CFS) (MIN.) (INCH/HOUR)
1 6.07 6.30 4.087
2 5.16 13.03 2.557
COMPUTED CONFLUENCE ESTIMATES ARE AS FOLLOWS:
PEAK FLOW RATE(CFS) = 6.07 Tc(MIN.) = 6.30
TOTAL AREA(ACRES) = 3.5
LONGEST FLOWPATH FROM NODE 100.00 TO NODE 120.00 = 608.55 FEET. **************************************************************************** FLOW PROCESS FROM NODE 120.00 TO NODE 120.00 IS CODE = 81 ---------------------------------------------------------------------------- >>>>>ADDITION OF SUBAREA TO MAINLINE PEAK FLOW<<<<<
============================================================================ 10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 4.087
*USER SPECIFIED(SUBAREA):
GENERAL INDUSTRIAL RUNOFF COEFFICIENT = .9000
S.C.S. CURVE NUMBER (AMC II) = 0
AREA-AVERAGE RUNOFF COEFFICIENT = 0.5759
SUBAREA AREA(ACRES) = 0.08 SUBAREA RUNOFF(CFS) = 0.29
TOTAL AREA(ACRES) = 3.6 TOTAL RUNOFF(CFS) = 8.52
TC(MIN.) = 6.30
**************************************************************************** FLOW PROCESS FROM NODE 120.00 TO NODE 199.00 IS CODE = 31 ---------------------------------------------------------------------------- >>>>>COMPUTE PIPE-FLOW TRAVEL TIME THRU SUBAREA<<<<<
>>>>>USING COMPUTER-ESTIMATED PIPESIZE (NON-PRESSURE FLOW)<<<<< ============================================================================ ELEVATION DATA: UPSTREAM(FEET) = 100.00 DOWNSTREAM(FEET) = 99.53 FLOW LENGTH(FEET) = 47.00 MANNING'S N = 0.013
DEPTH OF FLOW IN 18.0 INCH PIPE IS 12.8 INCHES
PIPE-FLOW VELOCITY(FEET/SEC.) = 6.33
ESTIMATED PIPE DIAMETER(INCH) = 18.00 NUMBER OF PIPES = 1 PIPE-FLOW(CFS) = 8.52
PIPE TRAVEL TIME(MIN.) = 0.12 Tc(MIN.) = 6.42
LONGEST FLOWPATH FROM NODE 100.00 TO NODE 199.00 = 655.55 FEET. **************************************************************************** FLOW PROCESS FROM NODE 199.00 TO NODE 199.00 IS CODE = 10 ---------------------------------------------------------------------------- >>>>>MAIN-STREAM MEMORY COPIED ONTO MEMORY BANK # 1 <<<<< ============================================================================ **************************************************************************** FLOW PROCESS FROM NODE 130.00 TO NODE 132.00 IS CODE = 21 ---------------------------------------------------------------------------- >>>>>RATIONAL METHOD INITIAL SUBAREA ANALYSIS<<<<<
============================================================================ *USER SPECIFIED(SUBAREA):
GENERAL INDUSTRIAL RUNOFF COEFFICIENT = .9000
S.C.S. CURVE NUMBER (AMC II) = 0
INITIAL SUBAREA FLOW-LENGTH(FEET) = 50.00
UPSTREAM ELEVATION(FEET) = 340.00
DOWNSTREAM ELEVATION(FEET) = 338.20
ELEVATION DIFFERENCE(FEET) = 1.80
SUBAREA OVERLAND TIME OF FLOW(MIN.) = 1.661
10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 4.743
NOTE: RAINFALL INTENSITY IS BASED ON Tc = 5-MINUTE.
SUBAREA RUNOFF(CFS) = 0.30
TOTAL AREA(ACRES) = 0.07 TOTAL RUNOFF(CFS) = 0.30
**************************************************************************** FLOW PROCESS FROM NODE 132.00 TO NODE 140.00 IS CODE = 51 ---------------------------------------------------------------------------- >>>>>COMPUTE TRAPEZOIDAL CHANNEL FLOW<<<<<
>>>>>TRAVELTIME THRU SUBAREA (EXISTING ELEMENT)<<<<<
============================================================================ ELEVATION DATA: UPSTREAM(FEET) = 338.20 DOWNSTREAM(FEET) = 334.00 CHANNEL LENGTH THRU SUBAREA(FEET) = 419.80 CHANNEL SLOPE = 0.0100 CHANNEL BASE(FEET) = 10.00 "Z" FACTOR = 12.000
MANNING'S FACTOR = 0.013 MAXIMUM DEPTH(FEET) = 5.00
10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 4.743
NOTE: RAINFALL INTENSITY IS BASED ON Tc = 5-MINUTE.
*USER SPECIFIED(SUBAREA):
LIMITED INDUSTRIAL RUNOFF COEFFICIENT = .8700
S.C.S. CURVE NUMBER (AMC II) = 0
TRAVEL TIME COMPUTED USING ESTIMATED FLOW(CFS) = 2.49
TRAVEL TIME THRU SUBAREA BASED ON VELOCITY(FEET/SEC.) = 2.31 AVERAGE FLOW DEPTH(FEET) = 0.10 TRAVEL TIME(MIN.) = 3.02 Tc(MIN.) = 4.69
SUBAREA AREA(ACRES) = 1.06 SUBAREA RUNOFF(CFS) = 4.37
AREA-AVERAGE RUNOFF COEFFICIENT = 0.872
TOTAL AREA(ACRES) = 1.1 PEAK FLOW RATE(CFS) = 4.67
END OF SUBAREA CHANNEL FLOW HYDRAULICS:
DEPTH(FEET) = 0.14 FLOW VELOCITY(FEET/SEC.) = 2.81
LONGEST FLOWPATH FROM NODE 130.00 TO NODE 140.00 = 469.80 FEET. **************************************************************************** FLOW PROCESS FROM NODE 140.00 TO NODE 140.00 IS CODE = 1 ---------------------------------------------------------------------------- >>>>>DESIGNATE INDEPENDENT STREAM FOR CONFLUENCE<<<<<
============================================================================ TOTAL NUMBER OF STREAMS = 2
CONFLUENCE VALUES USED FOR INDEPENDENT STREAM 1 ARE:
TIME OF CONCENTRATION(MIN.) = 4.69
RAINFALL INTENSITY(INCH/HR) = 4.74
TOTAL STREAM AREA(ACRES) = 1.13
PEAK FLOW RATE(CFS) AT CONFLUENCE = 4.67
**************************************************************************** FLOW PROCESS FROM NODE 135.00 TO NODE 137.00 IS CODE = 21 ---------------------------------------------------------------------------- >>>>>RATIONAL METHOD INITIAL SUBAREA ANALYSIS<<<<<
============================================================================ *USER SPECIFIED(SUBAREA):
RESIDENTIAL (1. DU/AC OR LESS) RUNOFF COEFFICIENT = .3700 S.C.S. CURVE NUMBER (AMC II) = 0
INITIAL SUBAREA FLOW-LENGTH(FEET) = 50.00
UPSTREAM ELEVATION(FEET) = 337.90
DOWNSTREAM ELEVATION(FEET) = 337.00
ELEVATION DIFFERENCE(FEET) = 0.90
SUBAREA OVERLAND TIME OF FLOW(MIN.) = 7.638
10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 3.608
SUBAREA RUNOFF(CFS) = 0.11
TOTAL AREA(ACRES) = 0.08 TOTAL RUNOFF(CFS) = 0.11
**************************************************************************** FLOW PROCESS FROM NODE 137.00 TO NODE 140.00 IS CODE = 51 ---------------------------------------------------------------------------- >>>>>COMPUTE TRAPEZOIDAL CHANNEL FLOW<<<<<
>>>>>TRAVELTIME THRU SUBAREA (EXISTING ELEMENT)<<<<<
============================================================================ ELEVATION DATA: UPSTREAM(FEET) = 337.00 DOWNSTREAM(FEET) = 334.00 CHANNEL LENGTH THRU SUBAREA(FEET) = 369.00 CHANNEL SLOPE = 0.0081 CHANNEL BASE(FEET) = 10.00 "Z" FACTOR = 12.000
MANNING'S FACTOR = 0.030 MAXIMUM DEPTH(FEET) = 6.00
10 YEAR RAINFALL INTENSITY(INCH/HOUR) = 2.387
*USER SPECIFIED(SUBAREA):