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California Self-Inspection Form for Business Plans, Hazardous Waste and Hazardous Materials HW1HM TYPE Of CONTAINER. SECTION H: HAZARDOUS WASTE CONTAINER(DRUMS INBPECTIONB (COMPLETE WEEKLY) ❑ 55 GALLON DRUM THIS SECTION TO BE COMPLETED BY ALL RYDER CALIFORNIA FMS FACILITIES ❑ OTHER: (1) (2) (3) (4) {5) (8) (7) STORAGE AREA USED FREE OF SPILLS ANTIFREEZE0 AND LLAKS COMPLETED CAL TAINERS INCOMPA143LE WASTE STORED STORED ONLY INMONTH (INCLUDING CONTAINERS HAZARDOUSLOSED WASTE WITHW 30.GALLONSECONDARY PROPERLY WASTE LABELSN NOT IN PROPERLY ALLOWED CONTAINER(9t074 INSPECTED BY: DAY CONTAINMENT LABELED VISIBLEUSE SEPARATED TIMEFRAME NI KOOL_KART PRINT NAME 1 77❑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 ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yea❑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 ❑Yes❑No ❑Yes(]No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No SECTION Ill: HAZARDOUS MATERIAL BUSINESS PLAN-HMBP (COMPLETE MONTHLY) Q 1 THIS SECTION TO BE COMPLETED BYALL RYDERCALIFORNIA FMS FACIUTIES CERS ID No.: 1 CERS information is up-to-date and a copy of the HMBP is filed in Green File Folder No.4.1. 0 Yes ❑No 2 HMBP and/or Tank Permit is current and posted. �]+ Yes o • Note date of HMBP and/or Tank Permit expiration date date,month,year). Z Note HMBP Permit Issue Date. Note 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 fled in Green File EfYes ❑NO. Folder No.24.7. For training requirements,refer to EPC Procedure No.2.16. 4 Facility's HMBP Sitemap is current and posted in facility's common areas. F1 Yes Na 5 Have any significant changes occurred,as defined below/ If yes,notify Ryder Fuel Services immediately. Yes ❑Nc • 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 CIMs,FOMs,TICS 6 Emergency Response and/or Contingency Plans are available for inspection and are filed in Green File Folder No.5.1. I es ❑N. IMPORTANT—IF SUPPORT IS NEEDED TO RESOLVE ANY ISSUE(S)IN SECTION Ilt ABOVE,EMAIL RYDER FUEL SERVICES(RFS) AT(COMPLIANCEt70 RYDERFS.COM)AND ATTACH A SCANNED COPY OF THIS COMPLETED FORM. NOTE YOUR REQUEST(S)IN THE COMMENTSICORRECTIVE ACTION SECTION BELOW. SECTION IV: DESIGNATED OPERATOR DO ASSURANCE REviEWS (COMPLETE MONTHLY) THIS SECTION TO BE COMPLETED BY ALL RYDER CALIFORNIA FMS FACIUTIES WITH LISTS MONITORED BY A 3RD PARTY VENDOR ExAMPLES: TAIT ENVIRONMENTAL,BALCH&BINGHAM ENVIRONMENTAL;ETC. 1 Copy of 3rd Party Vendor's DO Certification is currentivalid and filed in Green File Folder No.30. Cyyes ❑ Proof of UST Owners Statement of Designated UST Operator expiration dates are current and filed in Green File Folder Y s ❑ 2 No.30. Copies of DO's monthly inspections have been reviewed and signed within 72 hours. Alarm history report and any follow- 0/ es [ 3 u items have been resolved and noted. Copies are filed in Green File Folder No.35. 4 Proof of site employee training is current and filed in Green File Folder No.30. ❑Yes [ 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. Note date,month, ear of last assin test: Yes f Copy of current(within 3 years of current calendar year)passing SB999 Secondary Containment Testing is filed in Green Yes 6 File Folder No.36. Note(date,month, ear)of last passing SB989 test: Copy of current year's(October of current calendar year)Financial Responsibility is filed in Green File Folder No.32 or 5.1 [xYes 7 CERS. COMMENTS I CORRECTIVE ACTIONS TAKEN: PLEASE READ BEFORE SIGNING: THE FACILITY MANAGER(OM,SOM,OR FOM)MAY DELEGATE COMPLETION OF THE ES-47 TO OTHER SHOP EMPLOYEES SUCH AS SUPERVISORS,TICS,CSSS,AND TECHNICIANS,HOWEVER,ONLY THE FACILITY MANAGER I FIELD OPERAMNS MANAGER CAN SIG THIS FORM. BY SIGNING BE , E FACILlry MANAGER/FIELD OPERATIONS MANAGER(CONFIRMS REVIEW D(G COMPLETION) SI OF THI NAME: RLE' SIG TURt FOR AssISTAkCE,CONTACT RYDER ENVIRONMENTAL SERV S MEN S ES@RYDER.com) Retention Perin ES-47(06/2021)—Page 2 of 2 File Indefinitely in the Quarterly California HM9P Self Inspection FE