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Division of Environmr 'al Health �II�'I �� <br /> > Fire Deparm 805)781-7380 <br /> (805)781.5544 NW 2160 Santa Brool"Avenue <br /> P.O.Box 1489 San Laic Ohisno CA 9-IMI-5240 <br /> 2156 Sierra Way•San Luis Obispo,CA 93406 M.-,_ <br /> Department of Aericulture/Measurement 215 <br /> Standards (805)78i.5910 879MUtilities Department• Luis <br /> 781-72o, <br /> 879 Morro Street•San Luls Obispo,CA 93401 <br /> 2156 Sierra Way Suite A-San Luis Obispo,CA 93401 <br /> an CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) <br /> HAZARDOUS MATERIALS INSPECTION FORM EFW data <br /> Date: J�/�1/ 0 entry by: <br /> Time: :1'1 <br /> CODE CODE MINUTE'S VIOLATION CODF, <br /> 'I'hiS Seetion for agenc3 data tracking put-poses only <br /> FACILITY ID NO:- A CY INSPECTION TYPE <br /> FACILITY NAME T DEHIJ outine <br /> �• ADDRESS. ❑ AG DEPT Reinspection <br /> ❑ CITY FIRE ❑ Complaint <br /> �5Q ❑ CITY UTILITIES ❑ Other <br /> PHONE: <br /> ` PROGRAMS INSPECTED ❑Business Plan <br /> ❑HW Generator VfUST ❑ AGT El Tiered Permitting <br /> REINSPECTION REQUIRED: ❑ NO❑YES [I Business Plan ❑Dw Generator ❑UST ❑AGT ❑Tiered Permitting <br /> ERMLSSION TO INSPECT:Inspections may involve obtaining o phs,reviewing nd copying rec nd deternyining <br /> ompliance with adopted codes; GRANTED BY(NAMEITITLE}: - f t'- - .- L )/ - y)Y <br /> _ BUSINESS PLAN /' <br /> YES NO N/A <br /> ` <br /> E] E] 0 BPOI Business plan is complete,,curren[,&available duringinspection <br /> (HSC§25503.5,Tide 19 CCR§2729) <br /> E] r] BP02 Inventory of hazardous materials is complete(HSC§25504,Title 19 CCR§2729) <br /> ❑ E] BP03 Site layouttfacility maps are accurate(HSC§25504,Title 19 CCR§2729) <br /> TRAINING PLAN <br /> Ti01 Facility has appropriate training program(Title 19 CCR§2732&22 CCR§66265.16) <br /> un El 0 O. TR02 Training documentation is maintained on site for current personnel(Title 19 CCR§2732& <br /> 22 CCR§66265.16) <br /> EMERGENCY RESPONSE PLAN <br /> ❑ EROI Contingency plan is complete,updated,and maintained on site(HSC§25504,Title 19 CCR <br /> §2731&22 CCR§66265.53/54) <br /> ❑ El F1 ER02 Facility is operated and maintained to prevent/minimize/mitigate fire,explosion,or release <br /> of hazardous waste to the environment. Maintains all required or appropriate equipment <br /> includin an alarm and communications system(Title 19 CCR§2731&22 CCR§6626531- <br /> .43) <br /> �//7�J / J <br /> COMMENTS: ✓ ? O l 1 NT—•Cf�l /}tl!/.C',$ <br /> � //Q / & 6 / l/ <br /> Tye 14 de u 41- /�- <br /> A:\CUPA inspection forms.doc 19-Sep-02 <br />