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California Self-Inspection Form for Business Plans, Hazardous Waste and Hazardous Materials HWIHM TYPE OF CONTAINER: SECTION II: HAZARDOUS WASTE CONTAINER DRUMS INSPECTION$ (COMPLETE WEEKLY) ❑ 55 GALLON DRUM THIS SECT10N TO BE COMPLETED BY ALL RYDER CALIFORNIA FMS FACILITIES ❑ OTHER: (1) (2) (3) (4) (5) (6) (7�13 STORAGE AREA USE FREE OF SPILLS ANTIFRE AND LCAxs COMPL.EITO CA CONTAINERS INCOMPATIBLE WASTE STORED STORED ONLY IN MONTH (INCLUDING CONTAINERS HALARDous CLOSED WASTE WITHIN 30-GALLON A SECONDARY PROPERLY WASTE LABELS WNEN NOT IN PROPERLY ALLOWED CONTAINER(S)OR INSPECTED BY: ----PAY CONTAINMENT LARELEn VISIBLE USE SEPARATED TIMFFRAME W KOOL-KART PRINT NAME ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No [I Yes[I No [I Yes❑No Yes[I No ❑Yes[INo ❑Yes[:INo El Yes[INo [I Yes❑Na ❑Yes❑No ❑Yes❑No ❑Yos❑No ❑Yes❑No ❑Yos❑No ❑Yas❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes d No ❑Yas❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No SECTION III: HAZARDOUS MATERIAL BUSINESS PLAN-HMBP (COMPLETE MONTHLY) THIS SECTION TO BE COMPLETED BY ALL RYDER CALIFORNIA FMS FACiu-nES CERS ID NO,: 1 CERS information is up-to-date and a copy of the HMBP is fled in Green File Folder No.4.1, ZYes ❑No 2 HMBP andlor Tank Permit is current and posted. Yes ❑No • Note date of HMBP and/or Tank Permit expiration date date,month,year). • Nate HMBP Permit Issue Date. Z� • Nate Tank Permit Issue Date. (Note NIA if facility's HMBP and Tank Permit are the same document or if facility does not require a Tank Permit. 3 Annual HMBP Employee Training(EV300)has been completed and a copy of the Training Log is flied in Green File Folder No.24.7. For training re uirements,refer to EPC Procedure No.2.16, es ❑No 4 Facility's HMBP Sitemap is current and posted in facility's common areas. 9 Y s No 5 Have any significant changes occurred,as defined below? If yes,notify Ryder Fuel Services immediately. es ❑No • Any newly acquired hazardous material. • A 100%or greater increase in the quantities of materials previously reported within location's inventory. • Any changes to the contact information listed within the HMBP emergency contact page? E .:New OMs,FOMS,TICS 6 Emergency Response andlor Conlin Lancy Plans are available for inspection and are filed in Green File Folder No.5.1. j ffy'.S ❑ND IMPORTANT—IF SUPPORT 15 NEEDED TO RESOLVE ANY ISSUE(S)IN SECTION III ABOVE,EMAIL RYDER FUEL SERVICES(RFS) AT(COMPLIANCE�1Q RYDERFS.COM)AND ATTACH A SCANNED COPY OF THIS COMPLETED FORM. ' NOTE YOUR REQUEST(5)IN THE COMMENTSICORREc'mE ACTION SECTION BELOW. SECTION IV: DESIGNATED OPERATOR(DO)ASSURANCE REVIEWS (COMPLETE MONTHLY) THIS SECTION TO BE COMPLETED BY ALL RYDER CAUFORNIA FMS FACILITIES WITH LISTS MONITORED BY A 3RD PARTY VENDOR EXAMPLES: TAIT ENVIRONMENTAL,BALCH S BINGHAM ENVIRONMENTAL,ETC. 1 Copy of 3rd Party Vendor's 00 Certification is current/valid and filed in Green File Folder NO.30. Yes ❑NO Proof of UST Owner's Statement of Designated UST Operator expiration dales are current and filed in Green File Folder Yes ❑No 2 No.30. Copies of DO's monthly inspections have been reviewed and signed within 72 hours. Alarm history report and any follow- yes 3 u items have been resolved and noted, Copies are filed in Green File Folder No.35. ❑No 4 Proof of site employee training is current and filed in Green File Folder No.30. Y s [I No Copies of current year passing Annual Testing(i.e.Leak Detector test,ATG Certification,Shear Valve and Spill Bucket 5 tests are filed in Green File Folder No,36. Nate date,month, ear of last passingtest: Yes ❑No Copy of current(within 3 years of current calendar year)passing SB989 Secondary Containment Testing is filed in Green 6 File Folder No.36. Note(date,month, ear of last assin SB989 test: Yes ElNo Copy of current year's(October of current calendar year)Financial Responsibility is filed in Green File Folder No.32 or 5.1 Yes ❑No 7 CERS. COMMENTS I CORRECTIVE ACTIONS TAKEN: PLEASE READ BEFORE SIGNING: • THE FACILITY MANAGER(OM,SOM,OR FOM)MAY DELEGATE COMkI TION OF THE ES-47 TO OTHER SHOP EMPLOYEES SUCH A$ SUPERVISORS,TICS,CSSS,AND TECHNICIANS,HOWEVER,ONLY THE FACILITY MANAGER I FIELD OPERATIONS MANAGER CAN SIGN THIS FORM. BY SIGNING BELOW,THE FACIG7Y MANAGER/FIELD OPERATIONS MANAGER(CONFfRMS REVIEW)AND(C S OMPLE770N)OF THIS FORM. NAME TnLE: SIGxaT OR ASSISTANCE,CONTACT RYDER ENVIRONMENTAL SERVICES AT NMENT ERVICESNRYDER.COM) Retention Period: Indefinitely ES-47(06/2021)-Page 2 of 2 File Indefinitely in the Quarterly California HMBP Sell Inspection Form Folder 5.2 ]-Page 2�