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Home My WebLink AboutHAZARDOUS WASTE (2)STATE OF CALIFORNIA--CALIFORNIA ENVIRI ~OTECTION AGENCY PETE WILSON, ~overnor DEPARTMENT OF TOXIC SUBSTANCES CONTROL 400 P STREET, 4TH FLOOR P.O. BOX 806 SACRAMENTO, CA 95812-0806 (916) 323-5871 April 6, 1995 EPA ID: CAD074328048 SAN JOAQUIN COMMUNITY HOSPITAL ForfacEity located at: BRIAN GEORGE 2615 EYE ST 2615 EYE ST BAKERSFIELD, CA 93303-2615 BAKERSFIELD, CA 93303-2615 Authorization Date: April 6, 1995 Dear Conditionally Authorized and/or Conditionally Exempt Facility: ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDITIONAL AUTHORIZATION AND/OR CONDITIONAL EXEMPTION The Department of Toxic Substances Control (DTSC) has received your facility specific notification (form DTSC 1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form DT'SC 1772B and/or 1772C). Your notifications are administratively complete, but have not been reviewed for technical ad~luacy. A technical review of your notifications will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws or regulations are found. The Department acknowledges receipt of your completed notification for the treatment unit(s) listed on the last page of this letter. These units operating under Conditional Authorization or Conditional Exemption are authorized by California law without additional Department action, pursuant to Health and Safety Code sections 25200.3 and 25201.5. Your authorization to operate continues until you notify DTSC that you have stopped treating waste and have fully closed the unit(s). You will be charged annual fees calculated on a calendar year basis for each' year you operate and have not notified DTSC that the units have been closed. You must notify the DTSC 60 days before first treating hazardous wastes in any new unit. You must also notify the DTSC whenever any of the information you provided in these notifications changes. To revise information, mail a cover letter to the above address explaining the changes, attach only the pages of your notification package that have changed, and re-sign and date at the signature space on page 3 of form 1772. Your status to operate under Conditional Authorization and/or Conditional Exemption is contingent upon the accuracy of information submitted by you in the notifications mentioned above, and your compliance with all applicable requirements in the Health and Safety Code. Any misrepresentation or any failure to fully disclose all relevant facts shall render your authorization to operate null and void. You are also required to properly close any treatment unit. Additional guidance on closure will be issued and distributed to all authorized onsite facilities later this .year. C Page 2 EPA ID: CAD074328048 If you have any questions regarding this letter, or have questions on operating requirements for. your facility, plea.~ contact the nearest DTSC regional office, or this office at the letterhead ~ldress or phone number. Sincerely, Michael S. Homer, Chief Onsite H~rdous Waete Treatment Unit Permit Streamlining Branch H~rdons W~ste ~Management Program Enclosure cc: ASTRID JOHNSON DTSC REGION 1 STATE REGULATORY PROGRAM 1515 TOLLHOUSE CLOVIS, CA 93611 STEVE MCCALLEY KERN COUNTY ENVIRON. HEALTH SERVICES DEPT 2'/00 M STREET, SUITE 300 BAKERSFIELD, CA 93301 Page 3 EPA ID: CAD074328048 ENCLOSt~ ~ Units authorized to operate at this location: UNDER CONDITIONAL AUTHORIZATION: UNDER CONDITIONAL EXEMPTION: 1 ~'" ~ ~ ~ ~/~ ,(".,~ Un~ ~o~ ~e~oa ~d ~a~ Aurora. ~ R~ ~7 /1 ..//~ ~} P~e r~ to t~ ~t~ I~~ b~ore ~g ~ fo~ You ~ ~t~ for ~ ~ o~ ~g t~ ~ ~ing ~ ~t~c~ion fo~. D~C ~ ~ You m~ ~a~ a ~e ~ ~fic ~t~c~n fo~ for e~ ~ ~ ~ ~m ~e ~ ~ ~ pa~ o/ ~ ~mp~ ~t~loa ~ ~ i~'c~¢ t~ tot~ ~ of ~ ~ ~ top o/~ ~g¢ ~ ~ 'Page__ o/__~ P~ ~o~ E~d ~ N~ on ~ ~a~ ~ ~ro~ ~ o/ t~ ~fo~ioa ~q~' ~ fi~ ~ ~ ~ta~. L N~CATION CA~GO~ N~ oF ~ ~d at~ch~ ~t ~fic no~fio~ for ~ ~ re~. A. ~ Condido~ly Exempt-S~l ~ Tr~t~at D. Pe~t by Rule B. /,. Conditio~ly ~emp~-S~ifi~ W~t~I~ ~. Com~i~ m mC TXON ~O ~D~, ~ D~~: COU~Y (o~y ~l~m if ~ U CO~A~ P~RSON PHO~ ~5~( DTSC 1772 (I/9~) Prate ~ ~llI. ,CERTIYICAT_IONS: This fot~axt be signed by an authorized corporate off. Jr an~ other person ia th~ ~ompan~ who hex operatio~l control and pet~J~ns dectsion-maiclng functlons that govern opeYff~lbn of the facility ~ Title 22, Califoinia ~ Code of Regulations (CCR) Section 66270.11). All three copit~ muxt haw original~ignarure~ Waste Minimizati0q I certify that I have a program in plac.~ to redu~ the volume, quantity, and to:deity of waste generated to tl~ degr~ I have determined to be economically practicable and that I have $~lected the practicable method of treatment, atorage, or dispoaal cuci~tly available to me which minimiz~a the pr-,:a~nt and futur~ tha'~at to human h~alth and the ~vironm~t. Tiered Permlttln~ Certiflcatiqq I certify that the trait or units de_~ribed in thes~ d~uments me~t the elilo'bility and operating r~luir~me, nts of state statut~ and r~gulations for the indicated p~rmitting tier, including generator and .~condary ¢ontainmmat r~lulr~ments. I underatand that i.f any of the units ol~rate under Permit by Rule or Conditional Authorization, I will. also be requir~ to provide required financial asaurane.~ for ¢losur~ of the trmtment unit by January 1, 1995. I certify under l~nalty of law that this document and all attaetunent~ wer~ pr~paxed under my direction or ~tl~rvi$ion in -_ceordanc~ with a Syat~m designed to aaaum that qualified peraonnel properly gather and evaluat~ the information Submitted. gla$~ on my inquiry of the l~raon or l~r~on$ who manage the system, or thom dim:dy responsible for gathering the information, the information ia, to the ~ of my knowledge and belief, true, accurate, and complete. I am aware that them am Substantial penalti~a for submitting ~ information, including the possibility of fmcs and impriaonm~t for knowing violations. Nam~ (Print or Typ~)'- O Tide ~ 'Dad signed OPERATING REQUIREMENTS: Pleuse note that generators treating hazardous waste onsite are required to comply with a number of operating requirement, r which differ depending on tht tier(s). The~e operating requirements are set forth in the $tatutes and regulations, some of which are referenced in the 27er-~pecific Fact Sheet~ available from the Department's regional and headquartem oj~ce~. SUBMISSION PROCEDURES: You must ~nbmit two eopie~ of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section 400 P. Street, 4th Floor, Room 445.9 (walk in only) P.O. Box S06 &zcramtnto, CA 95812-0806. You must also ,xubmlt one copy of the notification and attachrnen~ to the local regulatory agency in your jurisdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy ax part of your operating record. ¢411 three forms mu~ have ~ signatures, not photocopie~. DTSC 1772 (1/95) Page 3 , CONDITION~,Y EXEMYr-SPECIFIED ~'TESTREAMS ~ SPE~C N~I~ON ~c to H~ ~d ~fe~ C~e ~on ~20l.~(c)) ~e ~~c Faa Sh~ con~ a ~ of ~e o~nE ~~ for ~ ~o~. ~ m~ew ~ ~~ ~y ~o~ compl~ or mb~nE ~ no~fion / -.. // ~ Ea~ ~it m~ ~ c~ ~~ ~ ~e~ on ~ p~t p~ mta~ to Fora I ~. ~ign ~ own uniq~ n~ m ea~ unit. ~e n~ ~ ~ xeq~mial (I, 2, 3) or ~ing ~ ~ ~u ~e. ~~ Moa~iy To~ Voi~e T~t~: ~ ~or /~ ~o~ ~fimac~ Money To~ Vol~e Slo~: ~ ~or g~lo~ ~ NO ~e folbwing are the e~gib~ w~t~tre~ ~ ~e~ proc~. Plebe ~ all applic~ b~: ~ 1. T~ r~im m~ or c~ in accor~nce ~ ~e m~actur~s im~cfiom (indu~ on~ ~d pr~pr~ted ma~). ~ 2. T~t conmin~ of I10 g~lom or 1~ ~dty ~t ~nmin~ b~do~ ~ by ~ or ph~ pr~, ~ ~ ~, z~, g~n~, or p~ct~. ~ 3. D~ ~ ~, ~ ~ by ~e dep~mt p~t ~ Title ~, C~, ~on ~261.~, by pr~ or by ~ve or hmt-~ded eva~fion ~ ~ove ~. ~ 4. ~nefic ~p~fion or ~~ to r~ove com~n~ from s~al ~te, ~ d~ifi~ by ~e dep~h,~t p~t to Title ~, CC~ ~fion aNOn* $. NO A~0R~A~QN ~ ~~ ~ ~!;~ ad~c or ~ ~) ~ f~ ~ ~fion of ion ~e m~ ~ ~ ~ ~. ~ ~ ~n~t ~ mo~ ~ 10 ~( add or ~ by w~ ~ ~ ~31e f~ ~ ~pfiom) ~ 6. Neu~ ad~c or ~ine ~) ~t~ from ~e f~d p~i~ ind~. ~ 7. R~ov~ of ailv~ f~m photofi~ng. The vol~e Hmit for condifio~ ~pfion h $~ g~lom ~ g~tor {at ~e ~e l~fion} in ~y ~d~ mon~. *N~* R~ve~ of 10 ~llo~ or 1~ ~r mon~ of sH~er from photo~niahlng ~ ~mple~ly exempt from ~i~g; ~ fo~ n~ not ~ sub~. DT$C 1772B (~/95) Page I0 JAN. ~OOM ,? 'FLLIOF~. TEC. I-I. U.,IOF~K. FNC " I "~¢'"'~ J 45' LEAD GLASS E c~ AD I ~ ' , 5'-¢ tN) ~AY CASl _ ' TA~E I I L~KERS ~S ~ ~1 C' LO~E~ ~ 7~- 10' -- PHASE I BLINO~'O or..~. ' OFF ICE OO0~ JAN. PATIENT ~OL~INO L _ _ -- J X-RAT OFFICE S.TATE'C'F CALIFORNIA-ENVIRONMENTAL PROTECTION AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBS CES CONTROL TIERED PERMITTING CERTI17ICATION OF RETURN TO COMPLIANCE For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers In the matter of the Violation cited on · O//zy'.,/gs" As Identified in the Inspection Report dated b//z.~'/Gs" Conducted by: ~ao,,'a/ 2. SA~4rmz/¥-, ~ f'S d.~ (agency(s)) I certify under penalty of law that: 1. Respondent has corrected the violations specified in the notice of violation cited above. 2. I have personally examined any documentation attached to the certification to establish that the violations have been corrected. 3. Based on my examination of the attached documentation and inquiry of the individuals who prepared or obtained it, I believe that the information is true, accurate, and complete. 4. I am authorized to file this certification on behalf of the Respondent. 5. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Name print or Type) Ti{lc ~igr~ture ..,/ Date Signed Company Name / EPA ID. Number DTSC-R.ETCOMP.CRT (8104) . ~.ALIrUM~IIA-CNVII~UNMI;N I AL F~U I ~ I IUN AU~N~ PETE WILSON, Gov~ dEPARTmENT OF ~OXIC SUBS~CES CONTROL C~CKLIST ~ ~~ ~~CATION ~SPECTION ~PORT FOR Petit b~ Rule, Conditional7 Author~ed, ~d Conditionally Exempt Notifiers NO~ S~ET ~is sheet ~cl~es i~pector ob~e~io~ ~ ~a~ upon the violatio~ ident~ed on the ~e~list ~ nu~er). In some c~e~, it i~icat~ how the fadli~ ~houM co~ect the violation. It a~o includes the ~me~ of any others panicip~ing in thi~ i~peaion. Onsite Che'cklis~'(D) Page , of ?,L... At,gust 2, 199~ ST~LIFORNIA-ENVIRONMENTAL PROTECTION AGENCY PETE WILSON. Governor CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers SIC CODE(S): b'et,,z ' INSPECTION DATE: "~n ~,.r'/ ~ 7 YJ' LOCal # NOTIFIED UNIT COUNT: PBR CA CESW o7 CESQT TOTAL CORRECT UNIT COUNT: PBR ~ CA .. CESW ! CESQT. TOTAL. / Thts checklist and inspection report Identify violations'of state law regarding onsite treaters of hazardous waste, operating under an onsite permitting tier. This inspection verifies the Information provided on form DT$C 1772. It also covers generator requirements, although a separate checklist may be used for those requirements. A checkmark Indicates violation of the law, which are explained In more detail on the attached note sheets. The governing laws are the Health and Safety Code (HSC) and Title 22 of the California Code of Regulations (22 CCR). Generat~r Standards: F. ach inrpection a~ency may u~e their own ~enerator bupection checklist or protocoit, which are summarized below. A full evaluation of. each item or document it not,conducted during the Verification Inspection, unle~ seriota deficiencie~ are ~u~pected. ~.'.'-_ tLO/X C°ntin'g-enC~p]an.has.been p~pared (adequately minimize releases, has alarm/communication '~...a 'R' ~Jis~ e~aerg~ncy equipmcatand phone numbers for emergency coordinators). _.. ...~ ,?4~.l't~,~slk.trafm.i~..~d.~...u~..e~.. ts and. records prepared for employees handling hazardous waste. -. = ...... -,:~.~;~ w~ld¥,, ia.Rood conditton, wtth IRmtables/r~acttves 50-feet from property line). ~:~ ..ta~ .~..~...ag~ ..s. tanda~.,..,(either secondary containment or ihtegrity assessments, plus · 'J. '::i~"< :".taorage _ . l~.ts~la~e., lied,: compatibility, inspected'daily, in good condition, with "'""--. ignitables/reacti.ves feet fro6 "property' line): ....... · ~l'r~.atnlei~.'Items-Faclllty Wide: ~'acitity nuat submit a roaed Form tZ'/2 to correct erron or omissions.) 6. 06, All units under PBR, CA, and CE are properly indicated on Form DTSC 1772. (Add any new units with unit sheets or correct tier on the unit sheet.) 7.0K Ali generator identification irdormation on Form DTSC 1772 is correct. 8.07'- The submitted plot plan/map adequately shows the location of all regulated units. 9.6~. There are records documenting compliance with sewer agency pretreatment standards and industrial waste discharge requirements, where applicable. ~' 10. Generator has prepared/maintained source reduction documents requirements (SB 14/SB 1720). For many wastes, a checklist or plan is required onlE it armual hazardous waste volume is over 5.000 kilograms (approx 11.000 pounds or 1,350 gallons). H$C 25244.15, 25244.19-.21 For CA or PBR notifiers: ~ 11. Thc generator has an armual waste minimization ccrtit'ication. (PBR On.site Checklist (A) Page 1 of / August 2, 1994 CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers UNIT SHEET Complete one unit sheet, for each unit either listed in' the notification or identified during the inspection. Unit Numl~er: / Unit Name: /"],~,~ Notified Tier: E,i:~co Correct Tier: <2 z~ ~ Notified Device Couni: Tanks -~ Containers Correct Device Count: Tanks ~ Containers For each Unit: NO 12.~ All hazardous wastes treated are. generated onsite. ~' 13. The unit notification is accurate aa to the number of tank(s) and/or container(s). .....14.t~ The estimated notification monthly treatment volume is appropriate for the indicated tier. ,, 15.1 The waste identification/evaluation is appropriate for the tier indicated. 16. The wastestream(s) given on th~ notification form are appropriate for the tier. 17.~" The trea~P~'ess(e~)Siv.en...O.n' the notification form are appropriate for the tier. . 18" The .ri,Md~ ~i~eme~i~'i i2fformafion on the. form is correct and documented for the unit. ,9 - Th.' itid[a ' $r permit on. the notification form is correct. ~r.-- 2o.~ There:i~e'i~ffth~i°pe~..'attd~,~ctlons and a record of the dates, volumes, residual ma~ge~, a~~.~f ~.w. gte~ff~ ~tl~.t~.~, ~ the,.umt..-;: - ..... -22 ~¢. Th~.~'"~ in~t/i~.ii'~p~tI0n'~g maintained of the ~pections conducted, ' 23.'~ If th~ unit'h~ [~e~i closed, the generator has notified DTSC and the local agency of the r. loSure.;, - For' each CA or PBR unit: ,.. 24./b'0' The generator has secondary containment for treatment in containers. For each PBR unit: 25. There is a waste analysis plan 26.//'~ There arc waste analysis records· 27. There is a closure plan for thc unit. Unit Comments/Observations: (if this is a unit tb.a~ was not included on the notificarion forzn, the violatio,t is opera~ing ENTOI= TOXIC EUBSTANCES CONTROL ~~, CA 9~27 CiI~K~T A~ ~ITIAI, V~IFICATION ~SPE~'ION RE~RT FOR "~ ~,~l by Ru~,'Cou~llo~Uy Authm~d, iud Cou~tlo~Hy ~~ NutW~e~ Complete o,~ ~t ~et ~r e~h mdt eitl~r l~tM in t~ not~c~ion Or Met;t~ during ti~ lmpectlon. UaltN~ben ~ U~N~e: ~L ~6 NoiSed ~v~ Count: Ta~ ' Coulalu~ / Cor~l ~vi~ Couut~ Ta~ = _ Conla~ For all Uult~i; NO 12. Ail hazaxdoua wastes t[e. ate. d arc teuemted m~ite. 13. Thc unit notifi~tion information ia ~u~ aa m ~a numar of tank(a) or cuntalu~r(s). ~ 14. The ~fima~ nudfi~fion moulhl/lr~lmeut volume ia appropdam for thc indi~ der. ~ 15. ~t~ w~e [deul~llo~evalualiou is a~rop~a~ for ~c tier indi~. 16. ~t~ w~tr~(s) ~ivcn on fltc nodfi~tion form ~c appropHa~ for fltc der. 17. Th~ tr~tmeut pr~(~) ~ivmt on ~c nodfi~fion form arc appropria~ for ~c ticr. 18. ~m ~iduab ~ualcmeul infon:~fion ~ ~o form is ~r~'~t a~d d~umcn~ for ~ unit. '" .19, ~ indi~ b~ for ual ueedlnl n federal ~1 on Ol~ notifi~tion form is ma~iemeat, ~d ty~ of was~ ~ ~ ~c unit.' ~ . 22 ~c~c i~ a' wriUe~ h~cllua lei of ~c ins~dons ~nduc~. ' - ~. 23. If dzc unit ha~ b~"cl~, linc g~mr b~ uoflfied DTSC and the I~al a~ency of the Far ~ CA or eBR uull~ 24.~ Thc generator h~s ~ouda~T coalalmueul for Ir~lmeul ~ cenlaiue~. For ~ch PBR uuil~ 25...~ Thc~c i~ a w~(e anulys~ plau and wa~ an~ysi~ "' 2~ ~'hcrc ia a ci~m~ plan for thc unit. [Jnil Commenla/ObscL~alJot~: (~'thb. b. a unit th~ w~ nut i,,~'l~ un th~ ,,ut~cmiun furm. the viu~iun b opgr~i,ag w,ko~ a p~ t,,~t 115C ~ 201[a).1 {').~ilc. ('hccklia! (B) Page .2 of .A.. .. FCbmary 10, 1994 ARTMENT OF' TOXIC SUBS CES CONTROL CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers SIGNATURE SHEET Onsite Recycling: Only answer.if this facility recycles-more than 100 kilograms/month o[ hatardous waste onsite. 28. ,vgThe appropriate local agency has been notified. HSC 25143.10 29. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. Releases: If there has been 'a release, provide the following information: number of reteases, date(s), type(s) and quantity of mateffals/waste, and the cause(s). Use unit sheet or attach additional pages. YES' 30. Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or haZardous waste constituents from onsite treatment units? 31. Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from any location at this facility? For purposes of a Tiered Permitting inspection, an unauthorized and/or accidental release to the environment does not include spills contained within containment systems. This report may identify conditions observed this date that are alleged to be violations of one or more sections at the California Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of hazardous waste.' The violations may be described in more detail on the attached note sheets. If a~ violations are noted, the facility is required to the submit a signed Certification of Return to Compliance within 60 days, unless otherwise specified. (A certification form is provided.) If any corrections are needed to the initial notification, the fadlity will submit a revised notification within 30 days to. the Department of Toxic Substances Control with a copy to the local enforcement agency. Inspector(s): Lead Inspector: /, ,,~ Other Inspector: Signature: ~Q~,., CC --5~'/~~'C' signature: Print Name:J),~,.,j, l _C/,v~,~ 4e Print Name: Title:/)~.3t~rb.v~.~ ~5~b.~ ~t~i,,,, 3c,',,-/,', 4 Title: Agen6)}: l)a-,,{ Te~/;. _5',_./,r l, '.-,_~'f'$,.'/~, { Agency: Phone NumbS. r: ,..~- 5' ) '_e ~ :7-'_,-73'c. Phone Number: Facility Representative: Yum- signature ackno,,Hedges receipt of this report and does not itnply agreement with the findings. / .) Signature:. -"/, .". :-'.;' .("> ....-,. _. _ , Print Name: / Onsite Checklist ~.C) Page ?.._ of / August 2, 1994 +-TP101A. + ~ ~ ~ ~red Permitting System Screen 1 of 2 Onsite Notifier Information EPA ID: CAD074328048 Initial Date: 040193 Init/Amend/Renew: A (I/A/R) Amended Date : 022295 Renewal Date: I. Conditionally Exempt, Small Quantity Treater Units 1 Conditionally Exempt, Specified Wastestream Units Conditionally Authorized Units Permit by Rule Units Commercial Laundry Variance (Section 25205.7) Total Fee Attached: Check No: II. BOE: Company Name: SAN JOAQUIN COMMUNITY HOSPITAL Address 1:2615 EYE ST 2: City: BAKERSFIELD CA ZIP: 93303-2615 County: KERN Region: 1 Contact First: BRIAN Last: GEORGE Phone: 805/326-4115 Ext: .Enter the'data and press ENTER to go to screen 2 +-F2=Cncl F4=Ina--F5=Unit-F6=Hist .... F8=Next-F9=DVal--Entr=Acpt+ February 16, 1995 Department of Toxic Substance Control Program Data Management Section 400 P Street, 4th Floor, Room 4453 P.O. Box 806 Sacramento, CA 95812-0806 Dear DTSC: Mr. David L. Shumate of your Fresno office conducted an inspection of our facility on January 25, 1995. A copy of the "Checklist and Initial Verification Inspection Report" is attached for reference only. In response our department has now in place a source reduction checklist with our compliance manual. The department is currently operating radiographic processors at what it believes to be achieving maximum waste minimization at the most economically practicable method. The department is watching the developing technology market.and where feasible will responded with equipment purchases that will further reduce our waste. In our renovation of our Cardiac Cath Lab Department we failed to report to your office in a timely fashion the close out of Unit #2. As of July 1994, the reclaimer unit was removed and returned to the owner, Sigma Medical Imaging of Fresno. The spent fixer is now collected in approved containers and batch processed at Unit #1 with the Siltech recycler unit. A completed amendment form, 1772, with the corrections made is enclosed for your records. In addition, changes to our department will occur on or about April 1, 1995, as Unit #1 is relocated in the department just down the hall about 40' from its current location. Enclosed is two plot maps for your records. The explanation is as follows. The Diagnostic Imaging Services Department is undergoing major renovation. A new location for the main darkroom will occur. The current treatment plan, i.e., Siltech recycler, batch processing, super canisters, etc. will remain in effect as our records indicate. Only the location will change. Plot map "B" provides the current and new locations. A Member of Adventist Health System/West ,~615 Eye Street Post Office Box 2615 Bakersfield, California 93303-2615 805/395-3000 Next a very small back-up darkroom is being made in the old radiology office. All spent fixer is to be collected in an approved container and batch processed at Unit #1. Plot map "A" is provided to identify the location of this darkroom. In review there will be only one treatment site at this facility, Unit #1, and four containers. Those containers are located at the Cardiac Cath Lab, surgical processor, small darkroom processor, and of course at Unit #1. Should you have any further questions, please feel free to contact me at (805)326-4115 for my assistance. Thank you for your assistance and time. Sincerely, Brian K. George Supervisor, DIS pc: David L. Shumate, DTSC Kern County Environmental Health Services Billy Martin, SJCH, Safety Department ~.~E (~F C,~LIF'ORNIA--ENVIRoNMENTAL PROTE GENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL ~ 400 P Street, 4th Floor P.O. Box 806 Sacramento, CA 95812-0806 (916) 323.-5871 September 26, 1995 EPA ID: CAL000063449 EXPRESSLY PORTRAITS INC/FRESNO FASHION ROGER BLAKE Initial Authorization: 11/16/93 1151 TRITON DR #C Amendment Date: 05/15/95 FOSTER CITY, CA 94404 For facility located at: 643 E SHAW FRESNO, CA 93710 Dear Onsite Treatment Facility.' The Department of Toxic Substances Control (DTSC) has received your facility specific Amended notification (form DTSC 1772). Your notification is administratively complete, but has not been reviewed for technical adequacy. A technical review of your notification will be conducted when an inspection is performed. At any time, you may be inspected and will be Subject to penalty if violations of laws or regulations are found. The Department acknowledges receipt of your completed Amended notification for the treatment unit(s) listed on the last page of this letter. These units are authorized by California law without additional Department action. Your authorization to .operate continues until you notify DTSC that you have stopped treating waste and have fully closed the unit(s).. DTSC has revised its database records to reflect your status and has notified the Board of Equalization (BOE). You will be billed annual 'fees by BOE calculated on a calendar year basis for each year you operate and/or have not notified DTSC that the units have been closed. 'If you have any questions regarding this letter, or have questions on operating requirements-for your facility, please contact the nearest DTSC regional office, or this office at the letterhead address or telephone number. Sincerely, Sangat Kals, Ph.D., Chief '~iered Permitting Complianc.e 'Section State Regulatory Program Division c~: See next page. .' G ~-~,~'E OF ~ALIFORNIA--ENVIRONMENTAL AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL ~ 400 P Street, 4th Floor P.O. Box 806 Sacramento, CA 95812-0806 EXPRESSLY PORTP, AITS INC/FRESNO FASHION EPA I-D:: CAL000063~49 Pa~e 2 cc= ASTRID JOHNSON GARY M. CAROZZA DTS¢ REGION 1 FRESNO COUNTY STATE REGULATORY PROGRAH COUNTY HEALTH SERVICES 1515 TOLLHOUSE 1221 FULTON ~ALL CLOVIS, CA 93611 P.O. BOX 11867 FRESNO, CA 93775 STATE BOARD OF EQUALIZATION STEPHEN R. RUDD, ADMINISTRATOR ENVIRONMENTAL FEES DIVISION P.O. BOX 942879 SACRAMENTO, CA 94279-0001 Units authorized to operate at this location: UNDER CONDITIONAL EXEMPTION: 1 }US WASTE TREAT LEN'I' NOTIFICATION FOI: I !frj ~ FACILITY SPECIFIC NOTIFICATION For U~e by Har-~rdou~-Waste Gene.atom Pe.~ormmg Treatment [] Ixdtial Under Coaditioaal Zxemptiou and Conditional Authorization.. and by Permit By Rule Facilities "' .'. ?lease refer to the attached [r. rrr.~c:ior~ before completing this form. You may nodfiY for more than one permitting tier by using this notification form, DTSC 1772.. You m~r attach a separate unit specific notification form for each unit at this Location. There are differera unit specific notifica, tion forrn~ for ,ach of the four categories and an additional notification form for rrans.t>orra3le trearrttent units (T77.J'O. You only have to submit forms for the tier(x) that cover your unit($J. Discard or recycle the other unused forms. Number each page of your completed notification pacY. ag, and indicate the total number of pag,s at the top of each page at the 'Page ~ of __' Put your EPA iD Number on ,ach page. P~eas¢ provide, all of the information requested: al! field~ must be completed e~cept those that state 'if different' or 'if available'. Pleme type the information provided on thi~ form a. nd any attacbJnents. lDte notification will not be conskitrezl come, Ieee without p .ayrnent ofl the appropriate fee for each tier under which you are operating. (Please note that the fee is per TIEJ~ not per UMT. For example, if you operate $ units bus they are all Conditional~ Aushorizecl, you only owe 51,240, NOT5 rirn~ $l,240. If'you operate any. permit by. Rute units and any units under Conditional Ausharizcaion you owe $2,280.} Checic~ should be made payable to the Depanmera of Toxic Substances Control and be stapled to the top of this form. Pleaae fill in the checJ~ number in the box above. . L NOTITICATION CATEGORIES , Indicate the number of units you operate in each tier. Thi. r will alJo be the number of unit a'pecifi¢ notification forrr~ you mu. re attach. Number of units and attached unit sg~:ific notitlcations Fee per Tier A. ... Conditionally Exempt-Small Quantity Treatment (Form DTSC 177ZA) $ I00 B. [ Conditionally Exempt-Specified Wa~testr,~m (Form DT$C 1772B) $ 100 C. Con~titionally Authorized (Form DTSC 1772C) $1,1413 D. Permit by Rule (Form DT$C 1772D) $1,140 ~ Total Number of Uait~ Total F~ A::w. hed$ II. GENERATOR IDENTIFICATION EPA ID NI. rMBER CAL. O ~ 0 2 ~' ,~- ~L ~L ~ BOE NUMBER (if &va/fable) H__I~IQ__ __ _ CFF~ co ^cr P XSOS ale PUO 32 DTSC 1772 (1/93) page I COUNTRY (only complete it' ~ USA) ITL TYPE OF COM~.~NY: STA~DARD I~DUSTR.TAL CLASS~CATiON (~C) CODE: Use eit~ o~ or ~o SIC c~ t~ b~t d~be your comp~y'~ pr~u~$, ;~c~, or i~l a~i~. ~p~: ~ P~ro~ng ~ 36~ ~'~ dr~ ~ ~I1 M~ ~ ~/~ ' W. ~OR PE~ ~A~rS: Che~ y~ or ~ to each q~ion: ~S NO ~ ~ 1. Did you fil~ a PBR Nofi~ of ~tent to ~mta (DTSC Fo~ ~2) ~ 1~ for ~s I~o~? ~ ~ 2. Do you now hava or ~v~ you aver h~ld a sram ~=~do~ ~t~ f~i~ ~ ~t or Mm~ ~ for my of ~ tr~tma~t ~? ~ ~ 3. Do you now hav~ or ~v~ you av~r haiti a ~11 ~t or ~tafim sm~ for my o~r af~s l~tioa? ~ ~ 4. Hav~ you aver bald a ~ i~ by ~a Dep~nt ofTo~c Su~ Coati f~ now aofi~mg for ~ ~ V. PR/OR ENFORCEiVtENT ~gTORY: No~ reqg/tedfrom gentraxor~ on/y ~g NO ~ .. Wi6i, ~e l~t ~ y~. ~ ~s ficility ~ ~e ~bj~t of ~y ~n~cd~. jud~m. o~ r~ltmg from m ~tion by ~y 1~, s~. or f~e~ ~v~ ~ p~c h~ ~o~t'~y? (For ~e pu~ of ~ fo~, a noti~ of vio~on d~ not ~timm it w~ not co~t~ ~d ~ a ~ order.) If you ~ Y~, ch~k ~s ~x md ~ a l~mg of ~c~o~. j~m. g~e~, or ~ md a ~py of ~e ~ver ~t from ~h d~ (~ ~e ~tmc~o~ for ~g DTSC 1772 (1/93) 33 ' Page 2 EPA ID NUMBER( ?~ ~ of~ V'[. A'I-T A C I-h'% I]LN'I' S: [~ I. A plot pi:im~? de-'~iIing the [oc~tion(s) of the covered trait(s} in relation to the facility 6o,,~danes. [] L A u~t .s~c~c ~otific~tio~ form for ~ch ~mit to ~ cover~ a~ ~s l~tio:. CERT~CATIONS: Tn~ fo~ m~t be si~ned by an authoriz~ co~or~e o~cer or a~ o~ pe~on in the com~a~ pe~o~ ~ion-~ng ~ncio~ t~t govern op~ation of tht faciIi~ (p~ title 22. Califomia C~e of Regu~io~ (CCR) secion ~270.11). ~ ~ ~p~ ~ ~ o~g~ xig~. W~te Minimi~tion I ~i~ ~t I ~v~ a pm~m ~ pl~ to ~u~ ~e voiu~ ~d toxici~ of ~ta g~ae~t~ to hav~ dat~ to ~ ~ao~ly p~cti~ble ~d ~t [ ~v~ ~l~t~ ~ p~ble ~ of ~ent, sto~g~, or di~ ~uiram~a~ of smta s~mt~ ~d ~tatioas for ~a ~di~t~ ~ttmg tier, mc~g g~mr ~d ~o~ to provide r~uir~ ~c~ ~u~ by ~ ~, t994, ~d coaduct a ~ [ ~vim~ ~t by J~ ~, ~5. [ ~ni~ ~der ~ of law ~t ~s d~um~t ~d all at~c~ea~ w~r~ prepa~ ~der my ~on or ~isio~ ~ ~i~ a system d~ to ~ur~ ~t q~ifi~ ~1 pro~rty ga~ar ~d ~v~ ~a ~fo~ao~ ~b~t~. ~ on my of ~e ~ or ~ who ~g~ ~a system, or ~o~ dir~tly ~nsibla for g~a~g ~a ~6o~, ~ ~~ [ ~ awar~ ~t ~a~ ~a ~bs~6~ ~alti~ for ~b~ttmg f~ ~fo~tioa, ~cl~g ~ ~b~ of ~ ~ ~fi~t for ~o~g violator. Si~ Da~ Si~ , OFERATING REQUYR.E?~ENTS: Ptease note that generator~ treating hazardous waste oruite are required to comply with a numb~ of operating requirt~nen~ which differ depending on the tier(x) under which one o.oerates. ~Tte. se operating requirerntnts are set forth in the xtatute, x and regulaxions, some of' which are referenctd in the ~er-Specific Faatsheetx. SU'BM~ISSION PROCF, DURE~: You must xubrnix tw~ aogi~ of this compl~ed notifiaation by certified mail, return receipt requ~ed, to: Department of Taxic Substances Com'rol - Form 1772 Onsite Hazardous Waste Treatment Unit 400 P Street, 4th Floor (walk in only) P.O. BoxS06 Sacramento, CA 95812-0806. You must also submit one cove', of th~ notification and attachments to the baal regulatory agency in your jurisdiction as li~text in th~ ir~truction materials. You must also retain a colTy as part of your operating record. All three forms must have original signatures, nat copies. 34. DTSC 1772 (1/93) Page 3 CO,NI)ITIONALLY EXEMTT - SPECIFIED WA. STESTREA.?5IS UNIT SPECIFIC NOTIFICATION (purs'uant to Health and Safety Cc>dc S~tioa 2520 [.5(c)) N'UM2BER OF TREAT~iEN'T DEVICES: Tank(s) ,~ , Coaralner(sl -"' Each unit mu.re be clearN. M. entified arm labeled on the plot plan attached to Form ! 772. d~rsign a unique number to each unit. l'Txe number can be sequential (l, 2, $) or using any rystern you choose. Check the type(s) of waxtestream(.c) and treatment proc~$(ex). I. WASTESTR.EA~L.q A~NT) TREAT~flENT PROC~: Estimated Monthly Total Volume Treated: pounds and/or . galloms The following are the eligibte wart~rrreamx and proce&re_x. Pteare check all applicab& boxy: ['"3 I. Treats re.sins mixed ia ac. zordanc~ w/fh the manufacturer's iastmcdons. 2. Treat containers of I I0 gallons or leas capacity time coataiaed hazardous waste by rinsing or physscal proc.~.ses, such as cmskiag, dxredding, grinding, or puacmrmg. · , [~] 3. Dry/ag .special wastes, as classified by the department purmJaat to title 22, CCK, section 6626 I. 124, by pressiag or by pa.~sive or heat-a/ded evaporation to remove water. [] 4. Magnetic separation or screening to remove componeats from .s!x~ial wa.sm, as classified by the cie?artme~t pursuant to title 22, CC~. s~:tioa 66261.124. [] 5. Neutralize acidic or allcal;ne Coa-q~) xm~.st~s fi. om the t'egeum-atiorl of' ioll C['hi$ waste e. am:tot ¢ontaia mom than I0 pete. mat acid or bas~ by weight to be eligible for e. ondirional cx;u.ue, tiom) [] 6. Neutralize acidic or alkaline (ba~) wasms from the food processing industry. ~] 7. Recovery of silver from photofini~h~g. The volum~ l;~i~ for conditional ¢,xempriou is 500 gallons per generaxor (at the santo location) in any calendar mon~. 8. Gravity se~:~rat:ioa of tl~ foilowirtg, iacludiag the u.~ of floc. zulanm and dema~fiers if [] a. Thc ~',~ng of solids from the was~ wh~r~ the rewriting utuenus/liquid strum is eot hazardoua. ['-] b. The st~paxa~on of oil/water mixtures and .s~%nxation sludges, if tl~ average oil recovered per rmmth is less thau 25 barrels (4,* gallons per barrel). [~] 9. Neutralizing acidic or alkaline (base) material by a state ~rtified laboraxory or · laboratory educational institution. Cio 1:~ eligible for ¢oaditioaal exemption, this wast~ carmot contain mor~ than 10 acid or base by weight.) 40 DTSC 1772B (1/93) Paee 9 CONDI-I'IONALLY EX'MXmr ' SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFiCA~ON (,pumu. ant to Health and Safety Code Section 25201.5(c)) ri. NA.R.RAT1WE DESCRI3:rrlONS: Provide a brief description of the spec~l~c waxte rreaxe, d and the treatment proc~rs 1TI. RE$[DUA.L M.~'NAGEMnF--.N'I': Chec£ yes or no to each question as it applies to all residuals from this treatment unit. YES NO [~1 [-'] 1. Do you disci:taxge noa-b,?-rdous aqueous wasne to a publicly owned treatment workz (POTW')/sewer? ["] ~1 2. Do you discharge non-hazardous aqueous was~o under an N'PDE5 permit? [] [] 3. Do you have your residual hazardous wast~ hauled offsite by a regis~r~l Ntzardous wast~ ~er? If ~u do, where is ~ w~tc ~nt? Che~ all t~ appQ. ~ a. Offsitc r~ycl~g ~ b. ~c~ ~tment ~ c. Di~ to t~d ~ d. Fu~er tmt~nt [~ [-~ 4. Do you dispos~ of non-hazardous solid waste residues a~ m off~m loc. axion? J-'] r"] 5. Other method of disposal. Specify:. IV. BASIS FOR NOT NVVDING A FEDERAL PER,MIr: In order to d~rnonsrrate eligibility for one of ri~ onsite treatment tiers, facilitiex are re.~red to provide the baxis for dtterrnirdng that a hazardous waste perrna i~ not req. uirt~d und~ the federal Resource Conservation and Recovery Aa (RtZRA) and the federal regulatiottr adopted uruttr RCRA ('l-,tl~ 40, Codt of Fe.d~ral Regulzuion~ (CFRJ). C"m~ose the rea. ton(s) tlmt d~cribe tl~ otx-ration of your onsite rrerume~ anit~: [-] t. The h=?a,-dous wazto N:iag treated is not a h-~ardous wazm under fe~terld law ~lthougll it is mgula~ m & hazardous wa.sm under Califorma stau: law. ["] 2. Tho wast: is treated in wastowat:r treammat ttrdts (tanks), as d~fmed in 40 CFR Pm 2t50.10, md ~.tm'g~d to ~ publicly owned treatment works (POTW)/s~wcring agency or under m NPDES pm'mit. 40 ~ 264.1~){6) mrd 4O CFR 270.2. 41 , DTSC 1772B (I/93~ Pt~¢ 10 ~ CON'DfTIONA. LLY E,'~E~EFT - $?E£ITfED WASTESTR.EAMS UN~ SPE~IFI~ NO~FICA~ON (pu~t to H~I~ ~d Safety C~e S~tio~ ~20L5(c)) BASIS FOR NOT N~ED~G A ~DE~ PE~: (confinu~} 3. ~e w~te is tr~t~ ~ eiemen~ aeut~limtio~' ~. ~ de~ ~ ~ CFR P~ 260. I0. ~d di~g~ to a PO~/~we~g agency or ~der m NPDES ~t. ~ CFR 2~. l(g)(6) ~d a0' CFR 270.2. 4. Tae w~ is tr~t~ m a to~ly encto~ t~t~at f~itity ~ de~ m ~ CFR Pa~ 2~. 10; ~ CFR 2~. 1 (g)(5). 5. Tae co,my gene~t~ no more am I~ ~g (appmxi~ly 27 gallons) of ~do~ ware ~ a ~en~ ~na ~d is ~tigible ~ a f~e~ conditio~ly ex~mpt s~ll q~ g~nemtor. ~ C~ 2~. I0 ~d ~ CFR 261.5. 6. ~ w~te is tr~t~ ~ m ~umulatiou ~ or ~n~er ~ 90 ~ys for over 1~ ~g/~n~ g~e~to~ md 180 or 270 ~ys for geae~tors of 1~ to 1~ icg/month. ~ CFR 22.34, ~ cSR 270.1(c)(2)(i}, md ~e P~mble to ~ M~ch 24, ~986 F~e~l R~g~ter. 7. R~yclable ~tenals ~ ~tam~ to r~over ~ouo~lty si~fi~t ~ of silv~ or oaer ~r~o~ ~. ~ CFR 261.6(a)(2)(iv), ~ CFR 2~. l(g)(2), md ~ C~ 2~.70. 8. E~ff ~n~er ~g m~or ~m~t. ~ CFR 261.7. V. TRANSPORTABLE TREATM~ENT UNIT: Please refer to the Instructions for rn~re infotw~rion. YES NO ['-] ~1 Is th:is unit a Transportable Treatment Haiti If you answered yes, you must also complete and attach Form 17T2E m this page. The Tier-Specific Fact. sheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification p~ctr~ge. DTSC 1772B (1/93) ~-2 page ~ RECEIVED BY: :~ . Hazardous Waste [',.~,anao~,.;,.nt"' ! 'FLAY 15 1995 May 4, 1995 DEPARTMENT OF TOXIC SUBSTANCES CONTROL Department of Toxic Substances Control Program Data Management Section 400 p Street, 4th Floor, Rm. 4453 P.O. Box 806 Sacramento, CA 95812-0806 RE: Studio #18 revised 1772 form EPA #CAL000063449 To whom it may concern: In response to the inspection of the facility located at Fresno Fashion Fair, 643 East Shaw, Fresno, CA 93710, please find enclosed two copies of a revised 1772 form, Onsite Hazardous Waste Treatment Notification, as requested from Mr. Shumate of the California Environmental Protection Agency. Please feel free to call me if you have any questions. Sincerely, Director, Technical Services . 1151 Triton Drive Suite C Foster City California 94404 415 578 929! FAX ,415 578 988t ~TATE OF CALIFORNIA--CALIF0 PROTECTION AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL ~ 400 P STREET, 4TH FLOOR P.O. BOX 806 ~NT~'~9~?~6 September 26, 1995 EPA ID: CAD983672155 TEXACO E&P INC/MCKITTRICK CO-GENERATION SAM DURAN For facility located'at: PO BIN "H" SEC 18/T30S/R22E TAFT, CA 93268 MCKITTRICK, CA 93251 Dear Onsite Treatment Facility: The Department of Toxic Substances Control (DTSC) has received your letter notifying DTSC of your closure request to operate under permit by rule, and/or conditional authorization, and/or conditional exemption. We have reviewed your letter and have approved your closure. DTSC considers yOur treatment activities to be closed as of 08/14/95 and no longer subject to the conditions of Permit by Rule, Conditional Authorization or Conditional Exemption. DTSC has revised its database records to reflect your new statu~'. and has notified the Board of Equalization of the change. If you have any questions or need further information, please contact the appropriate regional office or the Tiered Permitting Compliance Section at the letterhead address or phone number. S.~erely, Tiered Permitting Compliance Section State Regulatory Program Division ~ Hazardous Waste Management Program cc: ASTRID JOHNSON STEVE MCCALLEY DTSC REGION 1 KERN COUNTY STATE REGULATORY PROGRAM ENVIRON. HEALTH SERVICES DEPT 1515 TOLLHOUSE 2700 M STREET, SUITE 300 CLOVIS, CA 93611 BAKERSFIELD, CA 93301 STATE BOARD OF EQUALIZATION STEPHEN R. RUDD, ADMINISTRATOR .ENVIRONMENTAL FEES DIVISION P.O. BOX 942879. SACRAMENTO, CA 94279-0001 Texaco Exploration and Production 1nc 25251 H,,vv 33 August 9, 1995 ~ Dep~ment of Toxic Subst~ces Control SUBStANCeS tv... Onsite H~dous Waste Treatment Unit ~ A~n.: M. S. Homer PO Box 806 Sacr~ento, CA 95812-0806 Subject: Closure-Hazardous Waste Treatment McKittrick Cogeneration Facili~ Account Number: HF HQ 38-003713 Sec 18, T30S, ~2E McKittrick, CA 93251 EPA ID: C~983672155 Enclosed please find a letter sent in February to your offices informing you of our closure,of this facility regarding any treatment of hazardous wastes. We have yet to receive a closure notice or acknowledgment of this information. In the meantime, we are paying a Hazardous Substance Tax to the State Equalization Board. Would you please forward acknowledgment of closure or inform the State Board of Equalization that this facility is no longer operating as a treatment site, or if this can not be accomplished, let us know why the closure notification notice is insufficient for these purposes. You can reach me at (805) 768-3235. Sincerely: Denis L. Brown ' Regulatory Compliance Coordinator Denver Producing Division pbrclsr.doc. USA OFFICIAL SPONSOR OFTHE 1992 U.S. OLYMPIC TEAM · STA,T~.E OF ~ALIFORNIA-ENVIRONMENTAL PROT.,~ION AGENCY PETE WILSON, Governor ~'~--A~~'~' ~'-'~'~"~~~ ~"~'NTROL CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR ~ Per~t by Rule, Condition~ly Author~ed, ~d Condition~ly Exempt Notifiers FACILITY N~E: ~ ~,~,~ ~,~,,,~/~ flo~/;/~/ EPA ID NUMBER: c~ cTY~g~ ae~ PHYSICAL ADD.SS: ~/~o ~v~ '~rc~ ~er~l~ ~- ~.~o_~ - ~/'~ FACILITY CONTACT-N~E: ~/~ ~o~ PHONE: ~O~9 ~w~- ~//~ SIC CODE(S): g0ow INSPECTION DATE: ~n. ~ /TY~ ~cal g NOTIFIED UNIT COUNT: PBR ~ CA ~ CESW ~ CESQT ~ TOT~ ~. CO--CT UNIT COUNT: PBR~ CA C~W ] CESQT ~ TOT~ / This checklist and inspection report identify violations'of state law regarding onsite treaters of hazardous waste, operating under an onsite permitting tier. This inspection verifies the information provided on form DTSC 1772. It also covers generator requirements, although a separate checklist may be used for those requirements. A checkmark indicates violation of the law, which are explained in more detail on the attached note sheets. The governing laws are the Health and Safety Code (HSC) and Title 22 of the California Code of Regulations (22 CCR). Generator Standards: Each inspection agency may use their own generator inspection checklist or protocols, which are summarized below. A full evaluation of each item or document is not conducted during the Verification Inspection, unless serious deficiencies are suspected. NO 1.0k Contingency plan has been prepared (adequately minimize releases, has alarm/communication system, lists emergency equipment and phone numbers for emergency coordinators). 2.0 (~' Written training documents and records prepared for employees handling hazardous waste. 3.0& Meet container management standards (storage time limits, closed, labelled, compatibility, inspected weekly, in good condition, with ignitables/reactives 50. feet from property line)· 4. a,'r] Meet tank management standards (either secondary containment or integrity assessments, plus storage time limits, labelled, compatibility, inspected daily, in good condition, with ignitables/reactives 50 feet from property line). 5.0{~ All wastes are properly identified. Treatment Items-Facility Wide: (Facility must submit a revised Form 1772 to correct errors or omissions.) 6. ON All units under PBR, CA, and CE are properly indicated on Form DTSC 1772. (Add any new units with unit sheets or correct tier on the unit sheet.) 7.0~ All generator identification information on Form DTSC 1772 is correct. 8. Off. The submitted plot plan/map adequately shows the location of all regulated units. 9.6~ There are records documenting compliance with sewer agency pretreatment standards and industrial waste discharge requirements, where applicable. J 10. Generator has prepared/maintained source reduction documents requirements (SB 14/SB 1726). For many wastes, a checklist or plan is required onJ. y if annual hazardous waste volume is over 5,000 kilograms (approx 11,000 pounds or 1,350 gallons). HSC 25244.15, 25244.19-.21 For CA or PBR notifiers: 11. The generator has an annual waste minimization certification. (PBR submit with renewals.) Onsite Checklist (A) Page 1 of / August 2, 1994 STA~E OF CALIFORNIA-ENVIRONMENTAL PROT~ION AGENCY PETE WILSON, Governor C~CKLIST ~ ~~ ~ICATION ~SPECTION ~PORT FOR Pemit by Rule, Condition~ly Author~ed, ~d Condition~ly Exempt Notifiers ~ S~ET Complete one unit sheet for each unit either listed in the not,catiOn or ident~ed du~ng the inspection. Unit Number: / Unit N~e: Notified Tier: ~ ~ Correct Tier: C Notified Device Count: T~ks Correct Device Count: T~ks For each Unit: ,NO 12.0~ All hazardous wastes treated are generated onsite. / 13. The unit notification is accurate as to the number of tank(s) and/or container(s). 14.c~ The estimated notification monthly treatment volume is appropriate for the indicated tier. 15..I The waste identification/evaluation is appropriate for the tier indicated. 16.! The wastestream(s) given on the notification form are appropriate for the tier. 17. The treatment process(es) given on the notification form are appropriate for the tier. 18. The residuals management information on the form is correct and documented for the unit. 19 The indicated basis for not needing a federal permit on the notification form is correct. ,,, 20.0~ There are written operating instructions and a record of the dates, volumes, residual management, and types of wastes treated in the unit. 21.o,~ There is a written inspection schedule (containers-weekly and tanks-daily). 22 ag' There is a written inspection log maintained of the inspections conducted. 23.' ~,~ If the unit has been closed, the generator has notified DTSC and the local agency of the 'closure. For each CA or PBR unit: 24.///c/The generator has secondary containment for treatment in containers. For each PBR unit: 25. There is a waste analysis plan 26./~ff There are waste analysis records. 27. There is a closure plan for the unit. Unit Comments/Observations: (If this is a unit that was not included on ~he notification form, the violation is operating without a permit-HSC 25201 (a). Also note if the activity is currently ineligible for onsite authorization.) Onsite Checklist (B) Page / of~ August 2, 1994 STATE OF CAUFORHIA.ENVIRONId~NTAL PROTECTION AGENCY PETE WIL~Otl. G,avetno, R£~ilON 1-10151 C~y&u Way. ~g ~ - ~ CII~[~ AD INITIAl, VDIFICATION INSPECTION gE~gT FOg ~il by Rule,-Cuu&lio~Uy Aulhor~d, aud Coudilio~Uy ~l~ Nol~en UNIT SIIEET Compl~t~ o~ m~il s~gt for ~h mdt gidgr list~ in th~ not~c~ion Or ~~ during fig im~c'tioa. UaitNmnber: ~ U~t Name: ~ ~ /~ NoiSed ~v~ Couat; 'fa~' Coulaiue~ / Cora'~l ~vi~ Couul: Tau~ __ Coula~ea~ __ For ali U~it~: 12. All hazardous wastes trcate41 arc geuerated oqsite. - 13. Th~ milt notifi~tion information is a~urag as ~ ~c llUill~[ of tank(s) or contaiacr(s). 14. Thc ¢~tiinat~ nofifi~fioa muulhly Ir~lmenl volume i~ appropfiam for Ill= indica~ tier. 15. Th~ w~le identifi~tio~valuatiou ia ippropfiam for fl~¢ ti¢~ indi~. 16. ThC w~tr~n(s) giwn on tim nonfiction form arc appropria~ for tim der. 17. 'l'h~ tr~tmCut pt-~e~(~) given ua tim noafi~doa form arC appfopria~ for the tier. 18. Thc ~iduah umuagcmcill information on ~e form is ~rr~t aiid d~umen~ for thc unit. "' 19. Thc indi~ b~h for not needing a federal ~i~ii ua aia notifi~tioa [o1'ill is ~rr~t. ~ 20. q'h~r~ ar~ wriUca o~rating ia~lructio~ and a r~ufd of Hie dates, voluaics, feaidual ntmlagetneat, ~id t~a of wasps U~ ia a~e unit. 21. There is a wriUea itn~lioa ~hedule (~n~ncrs-w~kly ~d ~aks-daily). 22 Thcr~ ia a writlcu i~ctioa log of file inactions ~nduc~. '~ 23. If Iht unit has b~li clo~, thc gcac~tor h~ notified DTSC and the i~ai agency of the clouts. For each CA or PBR uuit; 24.//,q Thc generator has secuudury contaimueut for trealmeut ia containers. For each PBR uuit; There ia a waste analysis plau and wast~ analysis records. ~:¢Y"~ There is a closure pla,, for thc unit. IJuil CommealMObs~iwalioi~s: (If this h' a unit th~a was not indud/.d un lt~ ,oti./icoaiun funn. th~ via&alan is opcrming wilhom a p~ mit.. tl$C ZS 2O l (a). ) Oasiu: Checklist (B) Page .,~.. of -.k, February 10, 1994 STATE OF.CALIFORNIA-ENVIRONMENTAL PROTEF~TION AGENCY ~ ~ ~ ~ . ___. ~ PETE WILSON, Governor DEPARTMENT OF TOXIC SUBS'i'~CES CONTROL CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers SIGNATURE SHEET Onsite Recycling: Onty anxwer~if this facility recycles more than 100 kilov, rams/month o[ hazardous waste onsite. .NO 28. ,qt/The appropriate local agency has been notified. HSC 25143.10 29. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. Releases: If there has been a release, provide the following information: number of releases, date(s), type(s) and quantity of materials/waste, and the cause(s). Use unit sheet or attach additional pages. YES.- 30. Within the last tlu:ee years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from onsite treatment units? 3 I. Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from any location at this facility? For purposes of a Tiered Permitting inspection, an unauthorized and/or accidental release to the environment does not include spills contained within containment systems. This report may identify conditions observed this date that are alleged to be violations of one or more sections at the California Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of hazardous waste. The violations may be described in more detail on the attached note sheets. If any violations are noted, the facility is required to the submit a signed Certification of Return to Compliance within 60 days, unless otherwise specified. (A certification form is provided.) If any corrections are needed to the initial notification, the facility will submit a revised notification within 30 days to the Department of Toxic Substances Control with a copy to the local enforcement agency. Inspector(s): Lead Inspector: o77. ~ /2_5~'~ /' ~ Other Inspector: Signature: _~w/~ Signature: Print Name: /P4,.¥,:0 /-. _5"'},.~J ~,. 4e Print Name: Title:/q.~ ~ t~r"/Pv,~ J~,.~x J:,~,,-. 5c,~,-/,'~ -f Title: agenc);:~'~..%~,/'. T~x/; .._;o.[s ~,'~.~'/'7%,-/ro [ Agency: Phone NUmber: oro~> ~) -,w g :z-_e~.¢o Phone Number: Facility Representative: Your signature acknowledges receipt of this report and does not imply agreement with the findings. Signature :~ ,4e ,~a", ,~~,~'_a,._ Print Name:-~r-t'Ot r9 Title: c~ t~a5 p,4rl); l~z:rr" - 3. J..5. Date: "' Onsite Checklist (C) Page / of / August 2, 1994 ST~TION~ . . AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers NOTE SHEET This sheet includes inspector, observations and expands upon the 'violations identified on the checklist (by number). In some cases, it indicates how the facility should correct the violations. It also includes the names of any others participating in this inspection. ,, Onsite Checklist (D) Page / of / Aukust 2, 1994 SAN JOAOUlN COMMUNITY HOSPITAL February 16, 1995 Department of Toxic Substance Control Program Data Management Section 400 P Street, 4th Floor, Room 4453 P.O. Box 806 Sacramento, CA 95812-0806 Dear DTSC: Mr. David L. Shumate of your Fresno office conducted an inspection of our facility on January 25, 1995. A copy of the "Checklist and Initial Verification Inspection Report" is attached for reference only. In response our department has now in place a source reduction checklist with our compliance manual. The department is currently operating radiographic processors at what it believes to be achieving maximum waste minimization at the most economically practicable method. The department is watching the developing technology market and where feasible will responded with equipment purchases that will further reduce our waste. ~ In our renovation of our Cardiac Cath Lab Department we failed to report to your office ina timely fashion the close out of Unit #2. As of July 1994, the reclaimer unit was removed and returned to the owner, Sigma Medical Imaging of Fresno. The spent fixer is now collected in approved containers and batch processed at Unit #1 with the Siltech recycler unit. A completed amendment form, 1772, with the corrections made is enclosed.for your records. In addition, changes to our department will occur on or about April 1, 1995, as Unit #1 is relocated in the department just down the hall about 40' from its current location. Enclosed is two plot maps for your records. The explanation is as follows. The Diagnostic Imaging Services Department is undergoing major renovation. A new location for the main darkroom will occur. The current treatment plan, i.e., Siltech recycler, batch processing, super canisters, etc. will remain in effect as our records indicate. Only the location will change. Plot map "B' provides the current and new locations. A Member of Adventist Health SystemNVest 2615 Eye Street Post Office Box 2615 Bakersfield, California 93303-2615 805/395-3000 Next a very small back-up darkroom is being made in the old radiology office. All spent fixer is to be collected in an approved container and batch processed at Unit #1. Plot map "A" is provided to identify the location of this darkroom. In review there will be only one treatment site at this facility, Unit #1, and four containers. Those containers are located at the Cardiac Cath Lab, surgical processor, small darkroom processor, and of course at Unit #1. Should you have any further questions, please feel free to contact me at (805)326-4115 for my assistance. Thank you for your assistance and time. Sincerely, Brian K. George Supervisor, DIS pc: David L. Shumate, DTSC Kern County Environmental Health Services Billy Martin, SJCH, Safety Department S~T~:3'E~,,CALIFORNIA-ENVIRONMENTAL PROTE~ AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL TIERED PERMITTING CERTII*ICATION OF RETURN TO COMPLIANCE For Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers In the matter of the Violation cited on' O/,,/Z.~A~'~ As Identified in the Inspection Report dated ~/,/z~//~''' Conducted by' ~a~,,~ L. ~c,4~mar/e-, ~ Y'-5 ~-' (agency(s)) I certify under penalty of law that: 1. Respondent has corrected the violations specified in the notice of violation cited above. 2. I have personally examined any documentation attached to the certification to establish that the violations have been corrected.. 3. Based on my examination of the attached documentation and inquiry of the individuals who prepared or obtained it, I believe that the information is true, accurate, and complete. 4. I am authorized to file this certification on behalf of the Respondent. 5. I am aware that there are significant penalties for submitting false information, including the possibility of f'me and imprisonment for knowing violations. Name (Print or Type) Tifle ,~ign~ture ,// u Date Signed Company Name EPA ID. Number DTSC-RETCOMP.CRT (8/94) Pag~ 1 of ~,~ ONSITE-HAZARDOUS WASTE TREATMENT NOTIFICATION FORM FACRATY SPECIFIC NOTIFICATION - For Us~ by H.~.rdoua Wa~t8 Gcneratora P~n'forml.g Treatment l-I Initial Under Coalition! Exemption and Conditional Authorization, [] and by Permit By Rule F~ilitiea Please refer to the attached lnsrructiom before compl~ing thi~ for~ You may notify for more than one permitting tier by uMng this notification form, DT~C 1772. You mast attat:h a separate trait specific notification form for each unit at this location. There are di.~erent unit specific n~tification form. r for each of the four categories and an additional notification form for tran.~rmble tremment unit. r (TITJ'a). Irou only have'to submit forrn~ for the tier(a) that cover your unit(a). Discard or recyclt the other unu~ed form~. Number each page of your completed notification package and indicate the total numl~ of pages at the top of each page a~ the 'Page ~ of__: Put your EPA ID Number on each page. Please providt all of the inform~ion requested; all field~ mum be completed except tho~e that mate 'if different' or 'if available'. Please type the information provided on thi~ form and any attachment~. The notification fees are asaessed on the basi. r of the number of tiers the notifier will operate under, and will be collected by the State Board of Equalization. DO NOT S~ND YOrJ'R YE~ WITFI THIS NOTIFICATION FORM., L NOTIFICATION CATEGORIES Indicate the number of units you operate in each tier. This will also be the number of unit specific notification form~ you must attach. Conditionally E. aempt ~ Quantity Tre~znent ot~erationt may not operate ~ umttr any other t~, Number of units and attached unit specific notifications for each tier reported. A. Conditionally Exempt-Small Quantity Tre, atm~nt D. Permit by Rule B. / Conditionally Exempt-Specified Waste, stream E. Commercial Laundry C. Conditionally Authorized F. Variance (Section 25143) II. GENERATOR IDENTII:ICATION EP^ SUMBER C,O__ .Z Z SUM ER (ii' a,, ila le) (DBA-Doing itaain~aa As) CONTACT PERSON '~'~r ~'a v~ /~az~'-~ PHONE NUMBER(PDg") 32/~ - MAILING ADDRESS, IF DIFFERENT: COMPANY NAME / , For DT$C U~ Only CITY ~ ZIP COUNTRY sW (o~ly ¢om4~lcu: {f .o~ U CONTACT PERSON PHONE NLrMBER( · - (l~rs~ Name) (Las~ Name) DTSC 1772 (I/95) Page I VIII. CERTII~ICATION$: This form must be signed bY an authorized corporate oj~cer or any other person in the company who has operational control and performs decision-making functions that govern operation of the facility (per ~tle 22, Califoi, nia Code of Regulations (CCR) Section 66270.11). All three c~pie~ mm't have original ~ignature~. ~ Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. Tiered Permitting Certification I certify that the unit or units described in the~ documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I understand that i.f any of the units operate under Permit by Rule or Conditional Authorization, ! will also be required to provide r~quired financial assurance for closu~ of the treatment unit by January 1, 1995. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or thom directly r~..~ponsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there ar~ substantial penalties for submitting false information, including tho 'possibility of fines and imprisonment for knowing violations. Name (Print or Type) Title ~' Signature ~/ (-/ Date Signed OPERATING REQUIREMENTS: Please note that generators treating hazardous waste on~ite are required to comply with a number of operating requirements which differ depending on the tier(s). These operating requirements are set forth in the statutes and regulations, some of which are referenced in the ~Ter-Specific Fact Sheets available from the Department's regional and headquarters o~ces. SUBMISSION PROCEDURES: You must submit two copie, v of this completed notification by certified mail, return receipt requested, to: Department of Toxic Substances Control Program Data Management Section 400 P. Street, 4th Floor, Room 4453 (walk in only) P.O. Box 806 Sacramento, CA 95812-0806. You must also submit one copy of the notification and attachments to the local regulatory agency in your juri. vdiction as listed in Appendix 2 of the instruction materials. You must also retain a copy as part of your operating record. All three forms must have original signatures, not photocopies. i DTSC 1772 (1/95) Page CONDITIONALLY EKEMFr - SPECIFIED WASTESTREAMS UNIT SPECIe'lC NOTIFICATION ' - (pursuant to Health and Safety Cod~ Section 25201.$(c)) - The Tier-Specific Fact Sheets contain a S~,mmnry Of the operatin~ ~ents for this category. review those requirements carefully before completing or submitting this notification package. N'X.RV~ER OF TREATMENT DEVICES: ~ Tank(s) .~ Coutainer(s)/Container Treatment A~a(s) Each unit tn~t b~ clearly identified and labeled on thc plot plan attached to Form 1772..d~$ign your own unique number to each unit: The numb~ can be sequential (1, 2, $) or ~ing any ~$tern yon choose. £nt~ the estimated monthly total volurt~ of l'umardou$.w~te treated b~ thi~ unit. This should be the rna.,drnu~ or high~ treated in any month. Indicate in th~ narrati~ ($e~ion II) if yo. ur operation~ hav~ ,ea.~onal variation.~. Estimated Monthly Total Volume Treated: pounds and/or /~'~3 gallons Estimated Monthly Total Volume Stored: pounds and/or gallons YES NO ["='] [~ Is the waste treated in this unit radioactive? D [~ Is the waste treated in this unit a bio-h~,:,~rd/infeczious/medical waste? ["=] [] Is remotely generated hazardous waste (HSC 25110.10) treated in this unit? The following are the eligible wa~testreams and treatment processes. Please check all applicable bootes: ['-] 1. Treats resins mixed or cured in accordance with the manufacturer's instructions (including one-pnr~ pre-impregnated materials). ['=] 2. Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as ca-ushlng, shredding, grinding, or puncturing. [-'] 3. DrTing special wastes, as classified by the department pursuant to Title 22, CCR, Section 66261.12~ by pressing or by passive or heat-aided evaporation to remove water. ["-] 4. Magnetic separation or screening to remove components from special waste, as classified by the depa~h~{ent purstmnt to Title 22, CCR, Section 66261.124. m:~TOT~ ~. NO AUTI~ORIZATION IS NEEDED to neutrnl~_ acidic or alkaline (base) wastes fro~ regeneration of ion exchange media used to d,-mi,,ernli~_ water. (This waste cannot contain than 10 percent acid or base by weight to be eilgible for this exemption-) f"'=[ 6. Neutralize acidic or alkaline (base) wastes from the food processing industry. [~ 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is ~00 gallons per generator (at the same location) in any calendar month. ~:NOTE~: Recovery of 10 gallons or less per month of sHYer from photof{nishing is completely exempt from permitting; thi.q form need not be submitted. DTSC 1772B (I/95) Page I0 J,a,N. '~ 'DOR BLINOe¢ or..r- ' OFF IC E DO0~ JAN. I FILE INPUT zz~ cone EPA ID ~_/~c00'TL/A~.~Ocf~ FILE TYPE OTHER REMARKS STATE O~F CALIFORNIA--ENVIRONMENTAL ~ AGENCY PETE WILSON, Governor DEPARTMENT OF TOXIC SUBSTANCES CONTROL 400 P Street, 4th Floor P.O. Box 806 Sacramento, CA 95812-0806 (916) 323-5871 12/10/93 EPA ID: CAD074328048 SAN JOAQUIN COMMUNITY HOSPITAL For facility located at: BRIAN GEORGE 2615 EYE STREET 2615 EYE STREET BAKERSFIELD, CA 93303-2615 BAKERSFIELD, CA 93303-2615 Authorization Date: 12/10/93 Dear Conditionally Authorized and/or Conditionally Exempt Facility: ACKNOWLEDGEMENT OF UNITS OPERATING UNDER CONDITIONAL AUTHORIZATION AND/OR CONDITIONAL EXEMPTION The Department of Toxic Substances Control (DTSC) has received your facility specific notification (form DTSC 1772) and forms for Conditional Authorization and/or Conditional Exemption for Specified Wastestreams (form DTSC 1772B and/or 1772C). Your notifications are administratively complete, but have not been reviewed for technical adequacy. A technical review of your notifications will be conducted when an inspection is performed. At any time, you may be inspected and will be subject to penalty if violations of laws or regulations are found. The Department acknowledges receipt of your completed notification for the treatment unit(s) listed on the last page of this letter. These units operating under Conditional Authorization or Conditional Exemption are authorized by California law without additional Department action, pursuant to Health and Safety Code sections 25200.3 and 25201.5. Your authorization to operate continues until you notify DTSC that you have ,stopped treating waste and have fully closed the unit(s). You will be charged annual fees calculated on a calendar year basis for each year you operate and have not notified DTSC that the units have been closed. You must notify the DTSC 60 days before first treating hazardous wastes in any new unit. You must also notify the DTSC whenever any of the information you provided in these notifications changes. To revise information, mail a cover letter to the above address explaining the changes, attach only the pages of your notification package that have changed, and re-sign and date at the signature space on page 3 of form 1772. Your status to operate under Conditional Authorization and/or Conditional Exemption is contingent upon the accuracy of information submitted by you in the notifications mentioned above, and your compliance with all applicable requirements in the Health and Safety Code. Any misrepresentation or any failure to fully disclose all relevant facts shall render your authorization to operate null and void. You are also required to properly close any treatment unit. Additional guidance on closure will be issued and distributed to all authorized onsite facilities later this year. Page 2 EPA ID: CAD074328048 If you have any questions regarding this letter, or have questions on operating requirements for your facility, please contact the nearest DTSC regional office, or this office at the letterhead address or phone number. S~ly, Michael S. Homer, Chief Onsite Hazardous Waste Treatment Unit Permit Streamlining Branch Hazardous Waste Management Program Enclosure cc: SUSAN LANEY DTSC REGION 1 SURVEILLANCE & ENFORCEMENT BR. 10151 CROYDON WAY, SUITE 3 SACRAMENTO, CA 95827 STEVE MCCALLEY KERN COUNTY ENVIRON. HEALTH SERVICES DEPT 2700 M STREET, SUITE 300 BAKERSFIELD, CA 93301 Page 3 EPA ID: CAD074328048 ENCLOSURE 1 UNDER CONDITIONAL AUTHORIZATION: UNDER CONDITIONAL EXEMPTION: 1 2 ' ' ~..~\~") ~F ~ Page 1 of ]...~/ o ONSI W TE T ATME NO CATION FO i . FACIL~ SPECIFIC NO~FICA~ON For U~ by Hmrdo~ W~te Gene~tom Peffo~ng T~t~nt ~ti~ Under Conditio~l Exemption ~d Conditional Au~oh~tion. ~ R~vi~ ~d by Pe~t By Rule Faciliti~ P~, r~ to t~ ~ta~ l~t~io~ b~ort ~p~ing thix fom. You m~ ~t~for ~r, t~n o~ ~itting ti~ ~ ~ing th~ not~io~ fo~, D~C 1~. You m~t ~ta~ a xepar~ unit xp,c~c ~t~c~ion fom for ea~ unit ~ th~ ~c~ion. ~er~ are d~ ~it ~pe~fie ~t~ion fo~ for ,a~ of th~ four categoriex a~ an ~itio~l ~t~c~ion fom for tra~~ tr,~ unit~ ~'~). ~o~ on~ ~ to ~ubmit fo~ for th, tier(x) that cov~ your unit(~). D~d or re~c~ t~ ot~ un~ fo~. ~ ~ ~g, offer ~mp~t~ ~t~c~ion pac~ge a~ i~icate th~ total n~ of ~g~ ~ t~ top of ea~ pag~ ~ 'Pag~ ~ ~'. Put yo~ EPA ~ ~b~ on ea~ page. Pleme pro~d~ all of th, infom~ion r, qu~t~; all fie~ m~t ~mpi~ ~t tho~, t~ ~t~e '~ d~ent' or '~ avai~ble'. P~e ~e tht info--ion pro~ on thix fo~ a~ a~ attar. ~ ~t~ion ~ll ~t ~ ~Mer~ com~l~* ~thout p~'ment of the appropriat, fe, for ~ ti~ ~ whi~ you ar~ oper~ing. ~le~* ~ t~ ~h* f~* ~ ~ ~ER ~t p~ ~. For ~mple. ~you operate 5 unit, b~ th~ are all Co~itio~lly Authorize, you on~ ~ $1,1~, ~OT ~ t~ ~I.I~. lf yo~ operate any Pe~it by Rule unit~ a~ ~ ~nit~ u~ Co~itio~l Autho~z~ion you ~ $2,2~.) ~ ~ ~ ~t p~lt to the Department of Toxic $ubxtanc~ Control a~ be ~tapl~ to th~ top of th~ fo~.' P~, ~t~ ~nr EPA ~ ~ on th~ ~e~ ~ill in the check n~b~ in t~ ~ ~. I. N~CiTION C~GO~ l~ic~, th, ~ of unit~ ~ op~at, in each ti~. ~ix will a~o be the number of unit ~fic ~t~c~ion fo~ you m~t N~ ~ ~ ~d a~ ~t s~fic ~fifi~fiom F~ ~r Ti~ (~t per A. Condifio~iy Ex~mp~~~m~n~ (Fo~ DTSC 177~) $ 1~ ~ ~ Toffi Numar To~ F~ A~h~ $ 1~ n. EPA ID NUMBER CA~ ~ ~ ~ ~ ~ ~ ~ ~ BOE NUMBER (if ,v~le) H__H~ ~BA-~ ~ ~) K ~ " PHYSIC~ L~A~ON ~ ~ ~ '~ a ...~ ,.~ ,k..~ ~,_~ : Page .EPA ID NUMBER O~c~c-'~.>--~ ,,.J. ~ "<' '~' MAILING ADDRESS) W DIFFERENT: COMPANY NAME (DBA) ~--c~=.. STREET CITY STATE ZIP - ~ COUNTRY (only complea~ if not USA) CONTAC'I' PERSON PHONE NUMBER( ) '. ('Fu's~ Name) (Last Name) IH. TYPE OF.CObH'ANY: STANDARD INDUSTRIAL CLASSII='ICATION (SIC) CODE: Use either one or two SIC codes (a four digit number) that best de. scribe your company's products, services, or industrial acff~ity. Example: 7584 t~'lunofini~hing lab. 3672 Printed circuit boards IV. PRIOR PF..RM~ STATUS: C~ y~ or no to each qu~tion: ~ N[~/1. Did file a PBR Notice of Intent to Operate (DTSC Form 8462) in 1992 for this location? you [-'] ~ 2. Doyou now have or have you ever held a state or federal b-)n,xlous waste facility full permit or interim status for any of these treatment units? [~] . ~ 3. Do you now have or have you ever held a state or federal full permit or interim status for any other Imzatdotts wa~ activities at this location? f-'] ~/ 4. .Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment you am now notifying for at this loc~tion? [-'1 .[~ 5." Has this location ever been inspected by the state or any local agency as a hn,n~dous waste generator? V. PRIOR ENFORCEMENT HISTORY: /got mpdredfrom gentraun't onty noffy/ng as oond/t/ona//y extra/ri. No F'=] D Within the last three years, has this facility been the subject of any convictions, judgments, settlements, or final ' orders .~ulting from an action by any local, state, or federal environmental, b,,~nlo6s wasie; or public health enforcement agency? (For the imqx~ses of fltis form, a notice of violation does not constitute an order and need not be'reported unless it was not corrected and becam~ a final order.) ]-"] lfyouanswe, red Yes, check this box and attach a listing of convictions, judgments, settlements, or orders and n copy ofthe cover sheet from each document. (See the Instructions for mom information) DTSC 1772 (!/93) . .. Page 2 EPA ID NUMBER( ~ ,:~. Page 3 of }/ VI. ATTACH3fENTS: ~J/ !. A plot plan/map detailing the location(s) of the covered unit(s) in relation to the facility boundaries. /~ 2. A unit specific notification form for each umt to be covered at this location. VII. CERTIFICATIONS: This form must be signed by an authorized corporate officer or any other person in the company who has operational control and performs decision-making functions that govern operation of the facility (per title 22, California Code of Regulations (CCR) section 66270.1I). All three copies must have original signmur~. Waste Minimization I certify that I have a program in place to reduce the volume, quantity, and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment. Tiered Permittinn Certification I certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the indicated permitting tier, including generator and secondary containment requirements. I understand that if any of the units operate under Permit by Rule or Conditional Authorization, I will also be required to provide required financial assurances by January 1, 1994, and conduct a Phase I environmental assessment by January 1, 1995. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ~re that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are substantial penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. Name (Print or Type) . Title Signature /" Date Signed OPERATING REQUIRISMENT5: Please note that generators treating hazardous waste onsite are required to comply with a number of operating requirements which differ depending on the tier(s) under which one operates. These operating requirements are set forth in the ~tatutes and regulations, some of which are referenced in the ~er-Specific Factsheets. SUBI~flSSION PROCEDURES: You must ~ two copier of this completed notification by certified mail, return receipt requested, to: · Department of Toxic Substances Comrol Form ! 772 Onsite Hazardous Waste Treatment Unit 400 P Street, 4th Floor (walk in only) P.O. BoxSO0 .. S~cramc, nto, CA 95812-0806. You mart also tulmslt one ~ of the notification and attachments to the local regulatory agency in your jurisdiction as listed in the .instruction materials. You must al.~o retain a copy as part of your operating record. All three forms mutt have original signatures, not photocopies. " : , EPA ID NUMBER ~ ~ Page ..~ of~( · CONDITIONALLY EXEMTrF - SPECIFIED WASTESTREAMS '~ UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) UNTr NAbm ~ ff'~ /~) UNIT ID NL~IBER NUMBER OF TREATMENT DEVICES: Tank(s) ,~ Container(s) Each un. must be clearly identified and labeled on the plot plan attached to Form 1772. Assign your own unique number to each unit. The number can be sequemial (I. 2, 3) or using any rystem you choose. Enter the estimated monthly total volume of hazardous waste treated by. this unit. 77~is should be the maximum or highest amount treated in any month. Indicate in the narrmive (Section II) if your operations hove seasonal variations. I. WASTESTREAMS AND TREA'FMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or /~ ~') gallons The following are the eligible wastestreams and treatment processes. Please check all applicable boxer: I~] 1. Treats resins mixed in accordance with the maaufacturer's instructions. [--[ 2. Treat containers of 110 gallons or less capacity that contained hazardous waste by rinsing or physical processes, such as crushing, shredding, grinding, or puncturing. ['-] 3. Drying special wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by passive or heat-aided evaporation to remove water. [==] 4. Magnetic separation or screening to remove components from special waste, ns classified by the department purstmnt to title 22, CCR, section 66261.124. f"'] 5. Neutrali~ acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (This waste cannot contain more than 10 percent acid or base by weight to be eligible for {xmditional exemption.) 67. Neutralize acidic or alkaline (base) wastes from the food processing industry.. · Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per gene~tor (at the sam, location) in any calendar month. 8. Gravity separation of the following, including the uae of flocculants and demulsifiers if [='] a. The settling of solids from the waste where the resulting aqueous/liquid stream is not hazardous.' [-] b. The separation of oil/water mixtures and separation sludges, if the average oil t~eovered per month is le~s .. than.2$ barrels (42 gallons per ban-el). ["] 9. Neutralizing acidic or alkaline (base) material by · state certified laborato~ or · laboratory operated by an educational institution. (To be eligible for conditional exempti6n, this wast~ cannot contain'more th.,, 10 percent . acid or hse by wei~t.) CONDITIONALLY EXEMI:rr - SPECIFIED WASTESTREAMS ¢ UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.5(c)) H. NARRATIVE DESCRIFFIONS: Provide a brief description of the specific waste treated and the treatment procex$ used. 1. SPECIFIC WASTE TYPES TREATED: . ~ ~ .~..~ ~, ~.,- ~-,C,. ~..~\ '~- ~ '~.~.~i~ ! 2. TREATIVIENT PROCESS(ES) USED: ~ ~ ~-"~-~:-'c,~t_~' ',-~ c' -- / III. RESIDUAL MANAGEI~IENT: Chick Yes or No to each quextion ax it applies to all residual~ from thi_...~ treatment unit. I~ 1. Do you discharge non-hazardous aqueous waste to a publicly owned tr~tment work~ (POTW)/.~wer? ['"i ~ '2. Do you di~harge non-hazardou~ aqueous waste under an NPDES l~rmit? [-] 3. Do you have your residual hayardous waste hauled offsite by a regi,tesed ha~ardo~ wast~ hauler? /~ou do, what, is the waste ~nt? Check all that apply. ,. Offsite D b. Thermal treatment [~ c. Disposal to land ~i d. Fm'ther tr~atn~t I-'] ~ 4. Do you di~l~o.~ of non-hA:,ardo~ solid wast~ re~idu~ at an off, itc location? ["] Jaod of ai t d. IV. BASIS FOR NOT NEEDING A FEDERAL PERMIT: In order to demonstrate eligibility for one of the onsite treatment tiers,facilities are required to provide the basis for determining that a hazardous waste permit is not required under the federal Resource Conservation and Recovery Act (RCRA) and the federal regulatio.ns adopted under RCRA (~tle 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: , {'"] 1. The hazardous wast~ being treated is not a bATanious wast~ under federal law although it is regulated as a hazardous waste under California state law. ~J 2. 'l'be was~ is treated in wastewater treatment units (tanks). as d~fined in 40 CFR Part 260.10, and discbarg~ed to publicly owned treatment works (POTW)/sewering agency or under an NPDES permit. 40 CFR 264. l(gX6) and 40 CFR 270.2. DT$C 177~!:1 tV IO3~ o,,_~.. ,~ CONDITIONALLY EXEMPT - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (purmant to Health and Safety Code Section 25201.$(c)) IV. BASIS FOR NOT NEEDING A FEDERAL PEP~FIT: (continued) Q 3. The waste is treated in elementary neutralization units, as defined in 40 CFR Part 260.10, and discharged to a POTW/sewering agency or under an NPDES permit. 40 CFR 264,1(g)(6) and 40 CFR 270.2. l'-! 4. The waste is treated in a totally enclosed tr~tment facility as defined in 40 CFR Part 260.10; 40 CFR 264. l(g)(5). D 5. The company generates no more than I00 kg (approximately 27 gallons) of ba=.ardous waste in a calendar month and is eligible as a federal conditionally exempt small quantity generator. 40 CFR 260.10 and 40 CFR 261.5. D 6. The waste is treated in an accumulation tank or container within 90 clays for over I000 kg/month generators and 180 or 270 days for generators of 100 to 1000 kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), and the Preamble to the March 24, 1986 Federal Register. ~ 7. Recyclable materials are reclaimed to recover economically significant amounts of silver or other precious metals. 40 CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), and 40 CFR 266.70. [~1 8. Empty container rinsing and/or treatment. 40 CFR 261.7. [-"] 9. O~her. Specify: V. TRANSPORTABLE TREATM~.NT UNIT: Check Yes or No. Please refer to the lmtruction~ for more informmion. ['=] Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to tiffs page. The Tier-Specific Factsheeta contain a summary of the ope~ting requirements for this category. Please review those requirements carefully before completing or submitting this notification package. DTSC 1772B (ID3) ' EPA ID NUMBER '~.~ Page Z of ]_.( · CONDITIONALLY EXEI HrF - SPECIFIED WASTESTREAMS UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 2S201.5(c)) NUMBER OF TREATMENT DEVICES: Tank(s) ontainer(s) Each unit mu. ri be clearly identified and labeled on the plot plan attached to Form 1772. Assign your own unique number to each unit. The number can be sequential (1, 2, 3) or using any system you choose. Enter the estimated monthly total volume of hazardous waste treated by this unit. Thix should be the maximum or highest amount treated in any month. Indicate in the narrative ($eaion Il) if your operations have seasonal variations. I. WASI'ESTREAMS AND TREATMENT PROCESSES: Estimated Monthly Total Volume Treated: pounds and/or ~_-'") gallons The follow,lng are the eligible wastestreams and treatment processes. Please check all applicable boy. es: [-'] I. Treats r~sins mixed in accordance with the manufacturer's instructions. [-'] 2. Treat containers of I I0 gallons or less capacity that contained huT~ous waste by rinsing or physical processes, such as crushing, simxiding, grinding, or puncturing. [-'] 3. Drying special wastes, as classified by the department pursuant to title 22, CCR, section 66261.124, by pressing or by l~.ssive or heat-aided evaporation to remove water. ["'] 4. Magnetic separation or screening to remove components from special waste, as classified by tl~ department pursuant to title 22, CCR, section 66261.124. [='] 5. Neutndi~ acidic or alkaline (base) wastes from the regeneration of ion exchange media used to demineralize water. (This waste cannot contain more thall 10 percent acid or base by weight to be eligible for conditional exemption.) [--] 6. Neutraliz~ acidic or alkaline (base) wastes from the food processing industry.. 7. Recovery of silver from photofinishing. The volume limit for conditional exemption is 500 gallons per generator (at th~ san~ location) in any calendar month. 8. Gravity separation of the following, including the use of flocculants and deanulsifiers if [~] a. The settling of solids from the waste where the resulting aqueous/liquid stream is not ['=] b. The separation of oil/water mixtures and separation sludges, if the average oil recovered per month is less · ~than 2~ barrels (42 gallons per barrel). [--] 9. Neutralizing acidic or alkaline (base) material by · state certified laboratory or · laboratory operated by an educational institution. (To be eligible for conditional exemption, this waste cannot contain mo~ than 10 acid or base by weight.) , , EPA ID NUMBER . ; ~' . ".' Page f CONDrrIONALL¥ EXEI~fl~I' - SPECIFIED WASTESTREAMS · ' UNIT SPECIFIC NOTIFICATION (pursuant to Health and Safety Code Section 25201.$(c)) H. NARRATIVE DESCRIlYFIONS: Provide a brief description of the specific waste treated and the treatment process used. 1. SPECIFIC WASTE TYPES TREATED: ~'--~(-'~_.L..I :,-'-~---. ~,-¥~,LL..,,_! '~ '\ ~ ~.~'--' 2. TREATMENT PROCESS(ES) USED: ,~, III. RESIDUAL blANAGEI~iF, NT: Check Yes or No to each question as it applies to all residuals from t. his treatment unit. [-'! 1. Do you di~harge non-hazardous aqueous waste to a publicly owned treatment works (POTW)/s~wer? D ~ 2. Do you discharge non-h~mardous aqueous waste under an NPDE$ permit? [~J 3. Do you have your residual bnTardou~ waste hauled offsite by a registered h~ardou~ w~te hauler? lf you do, wher~ i~ th~ w~te ~nt? Check all that apply. ~. Off~ite r~y¢ling 1-] b. Thermal treatment [~] c. Disposal to land D d. Further treatment · ~ 4. Do you dispose of non-hn,nnlous solid waste residue~ at an offsite location? [-I [~ 5. Other method of dislx~al. Specify:, IV. BASIS FOR NOT NEEDING A FEDERAL PERMYI': in order to demonstrate eligibility for one of the onsite treatment tiers, facilities are required to provide the basis for dete~',nining that a ha:ardou, v waste permit is not required under the federal Resource Conservation and Recovery Act (RCR~I) and the federal regulatiotu adopted under RCRA ('l'ttle 40, Code of Federal Regulations (CFR)). Choose the reason(s) that describe the operation of your onsite treatment units: , r"'[ 1. The hazardous waste being treated is not a hn~nlous waste under federal law ailhough it is ~gulated as a hazardous wast~ undm' California state law. " ~] 2. TI~ was~ is treated in wa~ewater treatment units (tanks). as d~fined in 40 CFR Part 260.10, and discharged to a publicly owned treatment works (POTW)/sewering agency or under an NPDES permit. 40 CFR 264. i(g)(6) and 40 CFR 270.2. SPA ID NUMB£R ~ Page _~ of .~ CONDITIONALLY E,"O~M~FT - SPECIFIED WASTESTREA!~ ~ ,. UN~ SPECIFIC NO~FICA~ON ~u~t ~o H~i~ ~d Safe~y C~ ~tion ~201.5(c)) BASIS ~R NOT ~ED~G A ~DE~L ~l~: (con~nu~) 3. ~e ~te is tr~t~ ~ ele~ neutmlimtion ~, ~ de~ in 40 CFR Pa~ 2~.10, ~d ~g~ w a ~/~we~g agency or ~der ~ NPDES ~t. 40 CFR 2~.1(g)(6) ~d ~ CFR 270.2. 4. ~e ~te is t~t~ ~ a totally enclo~ tr~tment facility ~ deem ~ ~ CFR P~ ~. 10; ~ CFR 2~. I ~)(5). 5. ~e ~m~y genemt~ no mm ~ 1~ kg (approxi~tely 27 gallons) of hn~nrdo~ w~ ~ ~ ~en~ ~n~ ~ is eligible ~ a f~ ~nditionally exempt s~ll q~tity generator. ~ CFR 2~.10 md ~ CFR 261.5. 6. ~e ~te is t~t~ ~ ~ a~umulation ~ or ~nminer wi~in ~ ~ys for over 1~ kg}mn~ genemm~ ~d ! 80 or 270 &ys for genemto~ of 1~ to 1~ kg/month. 40 CFR 262.34, 40 CFR 270. l(c)(2)(i), ~d ~e P~ble to &e Ma~h 24, 1986 F~e~ Register. 7. R~yclable ~tefials are ~iai~ to r~over ~ono~lly si~fi~t ~ of silver or o&er p~io~ ~mls. ~ CFR 261.6(a)(2)(iv), 40 CFR 264. l(g)(2), ~d 40 CFR 2~.70. 8. Empty ~n~er ~g ~or tr~t~nt. 40 CFR 261.7. ~ s~io: V. TRANSPORTABLE TREATMENT UNIT: Check Yes or No. Please refer to the Instructions for more information. [-'l Is this unit a Transportable Treatment Unit? If you answered yes, you must also complete and attach Form 1772E to this page. The Tier-Specific Factsheets contain a summary of the operating requirements for this category. Please review those requirements carefully before completing or submitting this notification package. DTSC 1772B (1/9~ Page I I TI-IMBGRAPt MICROBIOLOG' m:rm~ ~ DARK II ~OOM, ~ TECH. I::HEN./SPE um.,L' E3 #1 TRa~L RAD./[ m~' [ CnN ' RrlnM ~ L _ ". HEMATOLOGY '~i ! X- R A Y -- n,, "~JAN. · #2 r~ LABORATORY RA]]./FLU[ , iI J~J GER'S ~ ~ X-RAY ~ - --~ rlFF ]-CE CLERK \ ~, WORK ROOM' ElF r I C E TR TMENT TREATMENT ~ ~ ! I~FF ICE STRE C~NIROL 3,. , PATIENT.- .~, TEST . ULsoL 'II]EO F I HOLDING > ~.~1 r'~ VESTIBULE NUCLEAR 1, ~J ' CATH LAB 3 ~ DARKR ]D, T~AT~NT D rFIC~ ~ HO' LA} II, :{', ,l , " · - i CAT~ LAB m .... EQUIPMENT ~ CLOSET 1 ' ..; ~' 'F~cllit~ Specific Form: D ~ box C~ 0 m. A~hm~ - ~~s ' ~ U~t ~~t m '- I. W~~~t'~ " .--' '~' ?- · ..~- ,.. - · ' ~ .. . ¥. ~.;.~;~ . Unit Specific Forms: Unit # r=[ unit' Nn~Unit ID Numben' - Information missing r=[ Number of'~t ~ -~ number (x is ~le) I. Waste~tman~ ~d TRatn~t ~ f""[ · Total Volume Trent~ - No quantity ..... C] 'W~s ~'None mrk~l -(circle mari~ o~es, ~op form only) [-1 V. TranSP°rtnble Trentment Unit -'If n~'ked, set aside for specinl handling Additional Comments/Probbm~: Unit Speelfk Fonm: Unit I " .. r'i unit Name/Unit ID Number - Information missin~ f=] Number of Treatment ~ - No number (x'~s I. Wastestreams and Treatmmt Pmcess~ '":' ?:':~.' .... ' C] Total Votume Trea~l -~ quantity "'"'~ .:': '" ":" 0 -.son mnrk ¢circte mar top.fwm C] m. ~ 'Man~nnmt - ~3 -.'l~n' not eheck~ ~slan Yes {~n's can be blank) Additional ..... ~'"?~ ~ ' "' ~'