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California Self-Inspection Form for Business Plans, Hazardous Waste and Hazardous Materials(HWIHM SECTION II: (COMPLETE WEEKLY) TYPE OF CONTAINER: HAZARDOUS WASTE CONTAINER(DRUMS)INSPECTIONS 55 GALLON DRUM THIS SECTION TO 13E COMPLETED BY ALL RYDER CALIFORNIA FMS FACILITIES ❑ OTHER: (1) (2) (3) (4) (5} (B) (7) STORAGE AREA USED FREE OF SPIVS ANTIFREEZE IS AND LEAKS COMPLETED CA CONTAINERS INCOMPATIBLE WASTE STORED STORED ONLY IN MONTH (INCLUDING CONTAINERS HAZARDOUS CLOSED WASTE WITHIN 30-GALLON & SECONDARY PROPERLY WASTE LAsms WHEN NOT IN PROPERLY AuzwED CONTAINER(S)OR INSPECTED BY: DAY CONTAINMENT) LABELED VISIBLE USE SEPARATED TIMEFRAME IN KOoL-KART PRINT NAM .t ,UYes❑No ;ffYes❑No Yes❑No I-'Yes❑No .@'Yes❑No ❑YesffNo Yes❑No •GL+ p it0o ❑Yes❑No ❑Yes❑No 1 ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No ❑Yes❑No Q 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 Q 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 III: (COMPLETE MoNTHLY) HAZARDOUS MATERIAL BUSINESS PLAN-HMBP THIS SECTION TO BE COMPLETED BY ALL RYDER CALIFORNIA FMS FACILITIES CERS ID No.: 1 CERS information is up4o-date and a copy of the HMBP is filed in California Locations'Green Folder No 5.1. es ❑No 2 HMBP and/or Tank Permit Is current and posted. Yes ❑No • Note HMBP Permit Issue Date. zi02.o • Note Tank Permit Issue Date. (Note NIA d facility's HMBP and Tank Permit are the same document or if facility y �� does not require a Tank Permit.) 1 • Note date of HMBP and/or Tank Permit expiration date date,month, yean. ?1d�io 3 Annual HMBP Employee Training has been completed and a copy of the completed Training Log is filed in Califomia LOcatlons'Green Foldar No.24.7. (For training requireme ts,refer to EP Procedure No.2.16, LIST State Operator ❑Yes ❑No Train( : _ Q j f $► L14J�°S 444a r a„ -f- 4 Facil s HMBP Siternapis current and Posted in facility's _ common areas. ) Yes ❑No 5 Have any significant changes occurred,,as defined below? If yes,notify Ryder Fu I rvices immediately. Yes ONO • Any newly acquired hazardous material? • A 100%or greater Increase In the quantities of materials previously reported on location's inventory list? • Any cha es to the contact information listed on the HMBP eme!gency contact page? (Eg.:New SMs,MMs,TICS s I Emergency Response and/or Contingency Plans are available for inspection and are filed in California Locations'Green ❑Yes El No Folder No.5.1. IMPORTANT--IF SUPPORT IS NEEDED TO RESOLVE ANY ISSUES)IN SECTION III ABOVE,EMAIL RYDER FUEL SERVICES(RFS)AT (COMPLIANCE(ORYDERFS.COM)AND ATTACH A SCANNED COPY OF THIS COMPLETED FORM. SECTION IV: (COMPLETE MONTHLY) ---- •--- DESIGNATED OPERATOR(DO)ASSURANCE REVIEWS THIS SECTION TO 13E COMPLETED BY ALL RYDER CALIFORNIA FMS FACILRIES WITH LISTS MONITORED BY A 3RD PARTY VENDOR EXAMPLES: TAIT ENVIRONMENTAL,BALCH&BING14AM ENVIRONMENTAL,ETC. 1 Co of 3rd Pany Vendor's(DO)Certification is current/valid and filed in Green Folder No.30. Yes ❑No Proof of UST Owner's(Statement of Designated UST Operator)expiration dates are current/not expired and copies are Yes ❑No 2 filed in Green Folder No.30. Copies of DO's monthly inspections have been reviewed,and alarm history reports)and any follow-up items have been Yes ❑No 3 resolved and recorded. Copies are filed in Green Folder No.30. 4 3nd Partv Vendor's rmof of site employee training is current and filed in Green Folder No.30. Yes ❑No I Copies of current year passing Annual Testing(i.e.Leak Detector test,ATG Certification,Shear Valve and Spill Buckel Yes ❑NO 5 tests)are filed in Green Folder No.36 Note(date,month,year)of last passin9 test: I Copy of current(within 3 years of current calendar year)passing SB989 Secondary Containment Testing is filed in Green Yes ❑No 6 I Folder No.36. Nate date, month, ear of last assin SB989 test: 7 Cony of current ear's jOctober of current calendar ear Financial Responsibility is filed in Green Folder No.32. Yes ❑No COMMENTS l CORRECTIVE ACTIONS TAKEN: e.;L f la A v w_ P,CA- 1- 107 � --UhWdV IMPORTANT-_Rt'-rwBEFORESIGNING: THE FACILITY MANAGER(SM,SSM,OR MM)MAY DELEGATE COMPLETION OF THE ES-47 TO OTHER SHOP EMPLOYEES SucH AS SUPERVISOR%TICS, CSSS,AND TECHNICIANS. HOWEVER,QDLLY THE FACILITY MANAGER 1 MAINTENANCE MANAGER CAN,SIGN THIS FORM. BYSIGNING BELOW,THE FACILITYMANAGERI MAINTENANCE MANAGER(C NFIRMS!REIIRE AND(CERTIFIJFS CDMPLEF7QN)OF THUS FORM. _ NAME TITLE: — =Si9NATURE: FOR ASSISTANCE,CONTACT RYDER ENVIRONMENTAL SERVICES AT(ENVIRONMENTAL SERVICES@RYDER.COM Retention Period: Indefinitely ES47(0112019)-Page 2 of 2 File Indefinitely in the Quarterly California HMBP Self Inspection Form folder