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					                                                                                                 Yes   No   N/A   Comment/Concerns
California
Water Quality

Propositions 65
       1 If the facility has 10 or more employees that manufacture, produce, assemble,
         handle, distribute, store, sell, and/or transfer a consumer product that is known
                                                                                                                    Please Input
         to contain a Proposition 65 listed chemical, is a written warning on or with the
         product?
       2 Is the warning "clear" and "reasonable" and communicated through:
                  a) Product labeling;
                  b) Signs;
                  c) Mass mailings;
                  d) Notices in the news media?
       3 Is workplace exposure marked with the following warning?
         "WARNING: Working in this area will expose you to the following
                                                                                                                    Please Input
         chemicals known to the State of California to cause cancer/birth
         defects/other reproductive harm?"
       4 Does the warning list the names of the chemicals for which the warning is given
         and advise the reader where more information may be obtained?
       5 Are listed chemicals discharged to potential or actual sources of California's
         drinking water?
                                                                                                                    Please Input


        6 Are warnings given for listed carcinogens that would result in a risk lower than
          the level of "no significant risk," or if exposures to listed reproductive toxicants
                                                                                                                    Please Input
          are less than one-thousandth of the no-observable-effect level (NOEL)?

        7 Do discharges to the state's drinking water sources exceed one-thousandth of
          the NOEL?                                                                                                 Please Input

        8 Do any discharges or releases meet both of the following criteria:
                 a) The discharge or release will not cause any significant amount of the
                 discharged or released chemical to enter any source of drinking water;
                                                                                                                    Please Input
                b) The discharge or release is in conformity with all other laws and with
                every applicable regulation, permit, requirement, and order?
NPDES - Permit Application
      9 Does the facility already have a NPDES permit or has a permit application been
                                                                                                                    Please Input
        submitted for the discharge?
    10 Did ONE of the following persons sign the last NPDES permit application:
                a) The principal executive officer (V.P. level or higher);
                b) A specifically delegated manager or other person who performs
                similar policy or decision-making functions (for a corporation);
                c) A general partner (for a partnership); or
                d) The proprietor (for a sole proprietorship)?
    11 Are ALL records of all data used in completing NDPES permit applications
        maintained for at least three years after the date the application was signed?



    12 Is any information submitted to the EPA as part of an NPDES permit application
                                                                                                                    Please Input
        claimed as confidential?
    13 Are such claims of confidentiality relating to information on a NPDES permit
        application asserted at the time of submission and submitted in a manner
        prescribed on the application form or instructions, or made by stamping the
        words "Confidential Business Information" on each page containing such
        information?
NPDES - Renewal of NPDES Permit
    14 Has a NPDES permit renewal application been submitted?                                                       Please Input
    15 Is a NPDES permit renewal application schedule being maintained such that the
        renewal application will be submitted 180 days prior to expiration of the current
        NPDES permit?
                                                                                           Yes   No   N/A   Comment/Concerns
NPDES - Permit Requirements
    16 Are there any discharges to surface waters that are not covered by the facility's
        NPDES permit and are not exempt from NPDES permit requirements?

                                                                                                              Please Input




NPDES - Discharge Limits - Categorical Standards
    17 Has an assessment of compliance with EPA categorical standards been made?
                                                                                                              Please Input

      18 Does the discharge comply with applicable categorical effluent guidelines and
         standards?                                                                                           Please Input

NPDES - Sampling and Monitoring
    19 Is the facility's discharge monitored?
                                                                                                              Please Input

      20 Do ALL of the following agree with the facility's NPDES permit:
                   a) Sampling frequency;
                                                                                                              Please Input
                   b) Monitoring; and
                   c) Analysis?
      21 Is the permittee using the method(s) of sample collection required by the
         facility's permit?                                                                                   Please Input

      22 Are proper sample collection procedures and sample preservation techniques
         being used?                                                                                          Please Input

      23 Are samples and measurements representative of the monitored activity?
                                                                                                              Please Input

      24 Are sample holding times (prior to analysis) in conformance with Guidelines
         Establishing Test Procedures for the Analysis of Pollutants (40 CFR 136)?
                                                                                                              Please Input


      25 Are EPA-approved analytical testing procedures (Guidelines Establishing Test
         Procedures for the Analysis of Pollutants (40 CFR 136 Tables 1A, 1B, and 1C)
                                                                                                              Please Input
         or alternate analytical procedures which have been approved by the Regional
         administrator being used for water/wastewater analysis?
      26 Is the site required to monitor for pH and/or temperature?                                           Please Input
      27 Are pH and/or temperature monitored?


      28 Is intake water analysis required by the NPDES permit?                                               Please Input
      29 Does the site sample and analyze its intake water?

NPDES - Monitoring Records
    30 Does the facility maintain monitoring records?
                                                                                                              Please Input

      31 Are monitoring records maintained for a minimum of three years?
                                                                                                              Please Input

      32 Do the monitoring records include ALL of the following items:
                a) The dates, times and exact locations of sampling or measurement;

               b) The name(s) of individual(s) who performed the sampling,
                                                                                                              Please Input
               measurements and analyses;
               c) The date analyses were performed;
               d) The analytical methods or techniques used; and
               e) The analytical results?
NPDES - Discharge Monitoring Report
    33 Has the facility submitted a Discharge Monitoring Report (DMR)?
                                                                                                              Please Input

      34 Do your DMR files show that DMRs have been submitted in a timely manner?
                                                                                                              Please Input

      35 Is any monitoring or analysis being performed more frequently than required by
                                                                                                              Please Input
         the NPDES permit?
                                                                                                 Yes   No   N/A   Comment/Concerns
      36 Are the results of additional monitoring or analysis reported in the DMR?



      37 Has the data in the DMR been checked for accuracy?
                                                                                                                    Please Input

      38 Did ONE of the following persons sign the DMRs:
                 a) A principal executive officer; or
                                                                                                                    Please Input
                 b) His duly authorized representative where a copy of the written
                 authorization has been filed with the Permitting Authority?
      39 Does the Discharge Monitoring Report (DMR) file indicate violations of any
         maximum daily discharge limitation(s) for any of the pollutants listed in the                              Please Input
         permit?
      40 Were the incident(s) of noncompliance reported orally within 24 hours to the
         appropriate agencies?



    41 Did the facility submit a written report within five days which included ALL of the
        following topics:
                 a) A description of noncompliance and its cause;
                 b) The period of noncompliance, including exact dates and times
                 (actual or anticipated); and
                 c) The steps taken to reduce, eliminate, and/or prevent recurrence of
                 noncompliance?
NPDES - General Conditions
    42 In the event of actual or potential noncompliance, has or will the facility be able
        to halt or reduce activities (such as manufacturing) where necessary, to                                    Please Input
        maintain NPDES permit compliance?
      43 Are all facilities and systems covered by the NPDES permit operated and
         maintained properly, including back-up and/or auxiliary facilities?                                        Please Input

      44 Does the facility supply all information requested by the permitting authority in a
         timely manner?
                                                                                                                    Please Input


      45 Does the facility allow entry, sampling, inspection and access to records
         requested by the permitting authority or the permitting authority's designated
         representative?                                                                                            Please Input


      46 Has the facility notified the permitting authority prior to any transfer of its NPDES
         permit?                                                                                                    Please Input

      47 Are all wastewater-related collection, treatment and disposal units in service
         and/or operational?                                                                                        Please Input

Discharges Associated with Industrial Activity
      48 Does your facility have a NPDES permit?

                                                                                                                    Please Input


      49 Are all records of the data used in completing the permit application and any
         supplemental information submitted kept for a period of 5 years after the date
         the application was signed?                                                                                Please Input


      50 Do all outfalls (except those that are completely and continuously submerged or
         are not assigned a Discharge Serial Number) have the required outfall tags?                                Please Input

      51 Has the Department been notified that a tag to mark the location of a pipe has
         been installed on the pipe by the effective date of the permit?                                            Please Input

      52 Do the tags contain ALL of the following information:
                 a) The name of the facility where the discharge originates;
                 b) The NPDES permit number;                                                                        Please Input
                 c) The NPDES Hotline phone number; and
                 d) The Discharge Serial Number for the particular outfall?
                                                                                                 Yes   No   N/A   Comment/Concerns
      53 If monitoring is required, are BOTH of the following TRUE:
                  a) Monitoring equipment is properly installed, used, and maintained;
                  and                                                                                               Please Input
                  b) The applicable discharge is properly monitored according to
                  Department guidelines?
      54 Have any of the following happened with regards to effluent monitoring?
                  a) Failure to submit a discharge monitoring report (DMR)
                  b) Reporting of effluent values that would make the facility a serious                            Please Input
                  violator for parameter that are required to be reported less frequently
                  than monthly?
Recordkeeping
      55 Is all monitoring data being retained for at least five years?
                  (This includes calibration and maintenance records and all original strip
                  chart recording for continuous monitoring instrumentation, copies of all
                                                                                                                    Please Input
                  reports required by the NPDES permit, records of all data used to
                  complete the application for a NPDES permit, and records of monitoring
                  information)
      56 Do records of monitoring information include ALL of the following:
                  a) The date, exact place and time of sampling or measurements;
                  b) The individuals who performed the sampling or measurements;
                  c) The date analyses were performed;                                                              Please Input
                  d) The individual who performed the analyses;
                  e) The analytical techniques or methods used;
                  f) The results of such analyses?
Requirements for Facility Alterations and Additions
      57 Has the facility been altered or have additions been made to the facility that fall
         under the following categories:
                  a) The alteration/addition meets one of the criteria for the definition of a
                  new source;
                  b) The alteration/addition could significantly change the nature or
                  increase the quantity of pollutants discharged;
                                                                                                                    Please Input
                  c) The alteration/addition is expected to result in a significant change in
                  the facility's residual use or disposal practices, and they may justify the
                  application of permit conditions that are different from or absent in the
                  existing permit;
                  d) The planned alterations/changes in the facility or activity may result
                  in noncompliance with the permit?
Noncompliance Reporting
      58 Have ANY noncompliant actions occurred at the facility and not necessarily
         limited to the following list:
                  a) Exceedance of effluent limitation that causes injury to persons;
                  b) Exceedance of effluent limitation that poses a threat to human
                  health;
                  c) Exceedance of effluent limitation that causes damage to the
                  environment;
                  d) Exceedance of effluent limitation that poses a threat to the                                   Please Input
                  environment;
                  e) Exceedance of effluent limitation that violates a daily maximum limit
                  for a toxic pollutant;
                  f) Any discharge of any toxic or hazardous pollutant which is not
                  covered under a permit;
                  g) Any upset or bypass not covered in this list;
                  h) Any anticipated bypass?
      59 Have any actions listed in question #11 (a-g) occurred?



                                                                                                                    Please Input




       60 Have any actions listed in question #11(g) occurred?

                                                                                                                    Please Input
                                                                                              Yes   No   N/A   Comment/Concerns
       61 Will an anticipated bypass be scheduled for this facility sometime in the future?


                                                                                                                 Please Input




       62 Has a serious violation occurred at this facility?

                                                                                                                 Please Input


Operation, Maintenance, and Emergency Conditions
     63 Is proper operation and maintenance of the treatment system or other
         equipment used to determine compliance achieved at the facility using at least
         the following methods (but not limited to) at a minimum:
                  a) Effective performance based upon treatment levels for which the
                  treatment works was designed;
                  b) Adequate funding;
                                                                                                                 Please Input
                  c) Effective management;
                  d) Adequate operator staffing and training;
                  e) Regulatory scheduled inspection and maintenance programs?
                  f) Adequate laboratory and process controls, including appropriate
                  quality assurance procedures, as described in 40 CFR 136 and
                  applicable State laws and rules.
     64 Is the facility exempt from the requirement to have an operation and
         maintenance (O&M) manual for the treatment system?                                                      Please Input

       65 If not exempt from O&M requirements, has an O&M Plan been developed for
          the treatment system?
                                                                                                                 Please Input

       66 Has an emergency plan been developed for the O&M Plan?

                                                                                                                 Please Input



Residuals Management
      67 Are there any residuals, grit, screenings, or other similar materials that must be
         dealt with for the water treatment system?                                                              Please Input

Pretreatment - Permit/Control Mechanism - Non-SIU
      68 Has the facility obtained the appropriate control mechanism for discharge to the
         POTW?                                                                                                   Please Input

Pretreatment - Permit/Control Mechanism - SIU
      69 Does the facility have a permit to discharge to a POTW?
                                                                                                                 Please Input

       70 Has the facility's permit to discharge to the POTW expired?
                                                                                                                 Please Input
Pretreatment - Discharge Limitations - Prohibitions
      71 Has the facility's discharge caused a pass through or interference at the
         POTW?                                                                                                   Please Input
                                                                                                 Yes   No   N/A   Comment/Concerns
      72 Does the facility's discharge include ANY of the following pollutants:
                a) Pollutants which create fire or explosion hazards in the POTW
                b) Pollutants which will cause corrosive structural damage to the
                POTW, or discharges with a pH lower than 5.0, unless the POTW is
                specifically designed to accommodate such discharges;
                c) Solid or viscous pollutants in amounts which will cause obstruction to
                the flow in the POTW resulting in interference;
                d) Any pollutant, including oxygen demanding pollutants, at a flow rate
                or concentration that would cause interference with the POTW;
                e) Heat in amounts which will inhibit biological activity in the POTW
                resulting in interference, or heat in such quantities that the temperature                          Please Input
                at the POTW exceeds 40 degrees Celsius (103 degrees Fahrenheit),
                unless alternate temperature have been approved for the POTW;

                 f) Petroleum oil, nonbiodegradable cutting oil, or products of mineral oil
                 origin in amounts that will cause interference or pass through;
                 g) Pollutants which result in the presence of toxic gases, vapors, or
                 fumes within the POTW at a quantity that may cause acute worker
                 health and safety problems; or
                 h) Any trucked or hauled pollutants, except at discharge points
                 designated by the POTW?
Pretreatment - Discharge Limitations - Local Limits
      73 Does the POTW have a sewer use ordinance approved by EPA or the state
         regulatory agency?
                                                                                                                    Please Input


      74 Is the facility in compliance with applicable local discharge limits?
                                                                                                                    Please Input


Discharge Limitations - Limits
      75 Does the facility dilute its discharges in order to meet any applicable standard?
                                                                                                                    Please Input

      76 Is the facility in compliance with applicable categorical discharge limits?
                                                                                                                    Please Input


Sampling and Monitoring - CIU
     77 Has the facility measured the average daily flow and maximum daily flow, in
        gallons per day, from EACH of the following:
                a) Regulated process streams; and                                                                   Please Input
                b) Other streams as necessary to allow the use of the combined
                wastestream formula?
      78 Has the facility performed sampling and analyses identifying the nature and
         concentration (or mass, where required) of regulated pollutants in the discharge                           Please Input
         from each regulated process?
      79 Are water samples collected and analyzed downstream from the pretreatment
         facility if one exists, or immediately downstream from the regulated process if no                         Please Input
         pretreatment exists?
      80 Are sampling and analyses performed according to the "Guidelines Establishing
         Test Procedures for the Analysis of Pollutants" (40 CFR 136)
                                                                                                                    Please Input


Recordkeeping
     81 Does the facility maintain records for all sampling and analysis activities?
                                                                                                                    Please Input


      82 Does the facility maintain records for ALL samples which include ALL of the
         following information:
                 a) Sampling date, time, location, method and name(s) of sampler;
                 b) Dates of analyses, names of analyses, methods and techniques; and

                  c) Results of all analyses?
      83 Are all the records related to monitoring kept for at least three years, or longer if
         relevant litigation is pending?
                                                                                                Yes   No   N/A   Comment/Concerns
Baseline Monitoring Report
      84 Did the BMR contain ALL of the following information:
                 a) The name and address of the facility and the names of the operators
                 and owners;
                 b) A list of any environmental control permits held by or for the facility;
                                                                                                                   Please Input
                  c) A description of the nature, average rate of production, and Standard
                  Industrial Classification of the operation(s); and
                  d) A schematic process diagram indicating the points of discharge to
                  the POTW from the regulated processes?
       85 Did the BMR indicate the measured average daily flow and maximum daily flow
          (in GPD) to the POTW from EACH of the following:
                  a) Regulated process streams; and                                                                Please Input
                  b) Other streams as necessary to allow the use of the combined
                  wastestream formula?

       86 Did the BMR identify the pretreatment standards applicable to each regulated
          process?                                                                                                 Please Input

       87 Did the BMR contain the results of sampling and analysis that identified the
          nature and concentration (or mass, where required) of regulated pollutants from
                                                                                                                   Please Input
          each regulated process?

       88 Was the BMR signed and certified as detailed in 40 CFR 403.12(l)?
                                                                                                                   Please Input

Baseline Monitoring Report - Existing Source
      89 Was a BMR submitted to the Control Authority within 180 days after the
         effective date of a categorical pretreatment standard to which the facility is
         subject?                                                                                                  Please Input


       90 Did the POTW perform the required sampling and analysis of the discharge in
          lieu of the facility?                                                                                    Please Input

       91 Did the BMR contain a certified statement indicating whether the facility was
          meeting the applicable pretreatment standards on a consistent basis, and, if not,
          whether additional operation and maintenance and/or additional pretreatment
          was required in order to meet the pretreatment standards?

       92 Did the BMR data indicate that additional pretreatment and/or operation and
          maintenance were required to meet pretreatment standards?                                                Please Input

Ninety-day Compliance Report
      93 Did the Ninety-day Compliance Report (NDCR) indicate the measured average
         daily flow and maximum daily flow (in GPD) to the POTW from EACH of the
         following:
                                                                                                                   Please Input
                  a) Regulated process streams; and
                  b) Other streams as necessary to allow the use of the combined
                  wastestream formula?
       94 Did the NDCR identify the pretreatment standards applicable to each regulated
          process?
                                                                                                                   Please Input


       95 Did the NDCR contain the results of sampling and analysis that identified the
          nature and concentration (or mass, where required) of regulated pollutants from
          each regulated process?                                                                                  Please Input


       96 Is the facility subject to equivalent mass or concentration limits?
                                                                                                                   Please Input

       97 Did the NDCR indicate the facility's long term production rate?



       98 Is the facility subject to standards expressed only in terms of allowable pollutant
          discharge per unit of production (or other measure of operation)?                                        Please Input
                                                                                               Yes   No   N/A   Comment/Concerns
      99 Did the POTW perform the required sampling and analysis of the discharge in
         lieu of the facility?                                                                                    Please Input

     100 Did the NDCR contain a certified statement indicating whether the facility was
         meeting the applicable pretreatment standards on a consistent basis, and, if not,
         whether additional operation and maintenance and/or additional pretreatment
         was required in order to meet the pretreatment standards?
     101 Was the NDCR signed and certified as detailed in 40 CFR 403.12(l)
                                                                                                                  Please Input

     102 Is the facility a new source?                                                                            Please Input
     103 Was the NDCR submitted to the Control Authority within 90 days following the
         date for final compliance with the applicable categorical pretreatment standard?




Biannual Compliance Report
     104 Were biannual compliance reports (BCR) submitted on-time during the months
         of June and December (or on other dates as required by the Control Authority)?

                                                                                                                  Please Input



     105 Did the BCR include a record of measured or estimated average daily flow and
         maximum daily flow for the reporting period for the discharge reported in 40
                                                                                                                  Please Input
         CFR 403.12(b)(4)

     106 Did the BCR indicate the nature and concentration (or mass, if required) of
         regulated pollutants in the discharge?
                                                                                                                  Please Input


     107 Is the facility subject to equivalent mass or concentration limits?
                                                                                                                  Please Input

     108 Did the BCR indicate the facility's long term production rate?



     109 Is the facility subject to standards expressed only in terms of allowable pollutant
         discharge per unit of production (or other measure of operation)?
                                                                                                                  Please Input


     110 Did the BCR include the facility's actual average production rate for the
         reporting period?

     111 If the facility monitors any pollutant (using an EPA approved method) more
         frequently than required by the Control Authority, were the results of these
         analysis included in the BCR?                                                                            Please Input


     112 Was the BCR signed and certified as detailed in 40 CFR 403.12(l)?
                                                                                                                  Please Input
                                                                                              Yes   No   N/A   Comment/Concerns
Pretreatment - Periodic Compliance Report - Non-SIU
     113 Were periodic compliance reports submitted to the Control Authority that met
         BOTH of the following requirements:
                 a) Reports were submitted at the required frequency; and                                        Please Input
                 b) Reports included all of the required wastewater discharge
                 information?
Pretreatment - Potential Problem Notification
     114 Did the facility immediately notify the POTW regarding the discharge that could
         potentially cause problems for the POTW?                                                                Please Input

Pretreatment - Noncompliance Notification
     115 Did the user notify the Control Authority within 24 hours after indicating that a
         violation of a pretreatment regulation had occurred?
                                                                                                                 Please Input


     116 Did the user repeat the sampling and analysis and report the results of the
         repeat analysis to the Control Authority if sampling was deemed noncompliance.
         Repeat analysis is not required if EITHER of the following conditions is true:

                  a) The Control Authority samples at the facility at least once per month;                      Please Input
                  or
                  b) The Control Authority samples at the facility between the time of the
                  initial sample and the time when the results of the initial sample are
                  received.
Reporting and Notification - Upset
    117 Did the categorical industrial user demonstrate that the noncompliance was the
         result of an "upset"?
                                                                                                                 Please Input


Charged Discharge Notification
    118 Has the facility notified the POTW in advance when there has been a
        substantial change in the volume or character of discharged wastewater?
                                                                                                                 Please Input


General Applicability
    119 Does Discharge to Groundwater (DGW) permits in the form of individual permits
         include the following groundwater discharge activities:
                 a) Surface impoundments;
                 b) Infiltration and percolation lagoons;
                 c) Overland flow systems;
                 d) Spray irrigation systems;
                 e) Mines, pits, and quarries;                                                                   Please Input
                 f) Schools, hospitals, large office buildings
                 g) Drinking water plants;
                 h) Industrial manufacturing facilities;
                 i) Campgrounds and mobile home parks;
                 j) Food processors;
                 k) Sewage treatment plants?
    120 Were ALL of the following activities NOT included when obtaining a DWG
         permit:
                 a) Single family residential subsurface sewage disposal systems;
                                                                                                                 Please Input
                 b) Return flows from irrigated agriculture;
                 c) Discharges that occurred prior to May 5, 1997, except existing
                 permitted discharges identified
    121 Did the DGW permits include a GWPP plan with the following information:
                 a) Monitoring wells located in each aquifer that may be impacted by the
                 discharge;
                 b) A program for effluent quality monitoring;
                 c) A schedule for mechanical and structural testing for berms, dikes,
                 liners, wells, and other critical devices;
                 d) A list of contaminants to be monitored, analyzed, and reported to
                                                                                                                 Please Input
                 DEP. In addition, procedures and techniques must be defined for
                 sample collection, prevention and shipment, analytical procedures, and
                 chain of custody control;
                 e) A plan for materials management;
                 f) Best management practices;
                 g) Procedures for discharging sampling;
                 h) Information regarding flow and effluent limitations?
                                                                                                Yes   No   N/A   Comment/Concerns
     122 Did the GWPP plan include one or more monitoring programs for the following:

                  a) Leak detection;                                                                               Please Input
                  b) Attenuation;
                  c) Nonpoint sources?
      123 Is any new commercial hazardous waste facilities located in areas where:
                  a) The depth to seasonally high water table rises within one foot of the
                  groundwater surface
                  b) The groundwater travel time is less than 10 years from the                                    Please Input
                  containment structure to the site boundary;
                  c) The site is located within one mile of a water supply well producing
                  over 100,000 gallons per day?
Site Remediation
      124 Were remedial investigations of groundwater conducted when:
                  a) A previously collected groundwater sample contains a contaminant
                  above the applicable remediation standard;
                  b) A soil sample collected form the area of concern, that lies within two
                  feet of the saturated zone or bedrock, contains a contaminant above the
                  applicable soil remediation standard
                  c) A soil sample collected from the area of concern anywhere in the soil
                  column contains a contaminant above the applicable soil remediation                              Please Input
                  standard and the contaminant is not going to be removed or remediated;

                  d) Any contaminant is detected that has a water solubility of greater
                  than 100 milligrams per liter at 20 to 25 degrees Celsius and the soil
                  between the contaminant and the saturated zone is less than 15 percent
                  silt and clay or the area where the soil contamination is located within
                  2,000 feet of a public water supply well.
    125 Were the following conditions present during a site investigation:
                  a) The date and duration of the discharge;
                  b) The identity and volume of the contaminants;
                  c) The date the remediation was completed:                                                       Please Input
                  d) Post-remediation soil sampling data establishing that all remediation
                  standards were met;
                  e) Any other relevant data support?
Groundwater Withdrawal
    126 Was it demonstrated that activities involved in the development of coastal areas
        will not:
                  a) Cause salinity intrusions into groundwater;
                                                                                                                   Please Input
                  b) Degrade water quality;
                  c) Significantly lower the water table or compressibility of the soil;
                  d) Decrease the base flow of adjacent water sources?
NPDES Permit
    127 Has a ROWD been filed if the facility falls into one of the dischargers
        categories:
                  a) Any person discharging waste, or proposing to discharge waste,
                  within any region that could affect the quality of the waters of the state,
                  other than into a community sewer system;
                  b) Each person that proposes a material change or proposed change in
                  the character, location, or volume of the discharge;                                             Please Input
                  c) Any person who is a citizen, domiciliary, or political agency or entity
                  of the state discharging waste, or proposing to discharge waste, outside
                  the boundaries of the state in a manner that could affect the quality of
                  the waters of the state within any region;
                  d) Any person operating, or proposing to construct, an injection well?
                                                                                      Yes   No   N/A   Comment/Concerns
     128 Has a ROWD been submitted for the following facilities:
                 a) Discharge of process wastewater not discharging to a sewer
                 (factories, cooling water, etc);
                 b) Confined animal facilities (dairies, feedlots, etc)
                 c) Waste containments (landfills, waste ponds, etc)
                 d) Construction sites;
                 e) Boatyards and shipyards;
                 f) Discharges of pumped groundwater and cleanups ( underground
                                                                                                         Please Input
                 tank cleanups, dewatering, spills);
                 g) Material- handling areas drainage to storm drains;
                 h) Sewage treatment facilities;
                 I) Filling of wetlands;
                 j) Dredging, filling, and disposal of dredge wastes;
                 k) Commercial activities not discharging to a sewer (e.g., factory
                 wastewater discharged to a storm drain);
                 l) Waste discharges to land?
Additional Notes:
                                                                                                 Yes   No   N/A   Comment/Concerns
California
Worker and Community Right To Know

EPCRA - Emergency Planning Notification
     1 Have all mixtures or formulations containing one percent or more of an
        extremely hazardous substance been evaluated for notification purposes?                                     Please Input

       2 Was the quantity of each extremely hazardous substance in each mixture
         aggregated to determine whether the amount at the facility exceeds the
         threshold planning quantity?
                                                                                                                    Please Input




       3 Did the facility notify all State Emergency Response Commissions with
         jurisdiction over the facility that the facility is subject to the Emergency Planning
         requirements?                                                                                              Please Input


       4 Was the notification submitted prior to May 17, 1987, or within 60 days after the
         facility first became subject to the Emergency Planning requirements?




       5 Has the facility provided the Local Emergency Planning Committee with
         information concerning ALL of the following subjects:
                   a) The information it has requested and which is necessary for
                   developing the local comprehensive emergency response plan; and
                   b) Any relevant changes occurring at the facility?
       6 Has the owner or operator of the facility designated a representative to serve as
         a facility emergency response coordinator?                                                                 Please Input

     7 Did the facility emergency coordinator notify the Local Emergency Planning
        Committee of his appointment before September 17, 1987, or within 30 days
        after the Local Emergency Planning Committee was established, whichever was
        earlier?
EPCRA - Emergency Planning and Response
     8 Does the facility follow the federal notification rules under 40 CFR 302 for
        facilities handling extremely hazardous substances (EHSs) in excess of their
        threshold planning quantity (TPQ)?                                                                          Please Input


       9 Was a business plan employed when the threshold amount or specified
         minimum quantity of hazardous materials is 500 lb. or 55 gallons, or 200 cubic                             Please Input
         feet for compressed gas, of EHSs in excess of the TPQ?
      10 Does the hazardous materials business plan include the following:
                  a) Hazardous material inventory (19 CCR 2729.2 to 2729.7).
                  b) Emergency response plans and procedures (19 CCR 2731).
                  c) Training program information (19 CCR 2732)?
      11 Are business plans amended within 30 days of:
                  a) A 100 percent or more increase in the quantity of a previously
                  disclosed material
                  b) Any handling of a previously undisclosed hazardous material in
                  excess of the threshold amount?
      12 If a business that is subject to the business plan requirements, does it satisfy
         inventory reporting requirements by completing and submitting to the CUPA or
         AA the following:
                  a) The business activities page of the unified program consolidated form
                  and business owner/operator identification page (OES Form 2730).
                  b) The hazardous materials-chemical description page (OES Form
                  2731).
                  c) An annotated site map if required by the CUPA or AA (19 CCR
                  2729.2)?
                                                                                               Yes   No   N/A   Comment/Concerns
      13 Does submission of the hazardous substance inventory under this section meet
         EPCRA Section 312 (Tier II) reporting requirements if the following additional
         requirements are met:
                 a) The business activities page of the unified program consolidated form
                 is submitted.
                 b) All trade secret claims are in compliance with the federal rules and a
                 "substantiation to accompany claims of trade secrecy" form is submitted                          Please Input
                 to EPA.
                 c) If the hazardous material being reported is an EHS under the federal
                 rules, the chemical description page, for that material, must contain an
                 original signature, a photocopy of the original signature, or a signature
                 stamp. (This signature may be placed in the box for locally collected
                 information)?
      14 Does the business plan include emergency response procedures for a release
         or threatened release of hazardous materials, scaled appropriately for the size
         and nature of the business, the nature of the damage potential of the hazardous
         materials handled, and the proximity of the business to residential areas and
         other populations including:
                 a) Immediate notification of:- Local emergency response personnel.- The
                 administering agency and the State Office of Emergency Services.-
                 Persons within the facility who are necessary to respond to an incident.
                                                                                                                  Please Input
                 b) Identification of local emergency medical assistance appropriate for
                 potential accident scenarios.
                 c) Mitigation, prevention, or abatement of hazards to persons, property,
                 or the environment.
                 d) Immediate notification and evacuation of the facility.
                 e) Identification of areas of the facility and mechanical or other systems
                 that require immediate inspection or isolation because of their
                 vulnerability to earthquake-related ground motion (19 CCR 2731)?

      15 Does the business plan include a training program that is reasonable and
         appropriate for the size of the business and the nature of the hazardous                                 Please Input
         materials handled.?
      16 Does the training program take into consideration the responsibilities of the
         employees to be trained and include:
                 a) Methods for safe handling of hazardous materials
                 b) Procedures for coordination with local emergency response
                 organizations
                 c) Use of emergency response equipment and supplies under the control
                 of the handler
                 d) All emergency response procedures required by 19 CCR 2731
                 e) Provisions for ensuring that appropriate personnel receive initial and
                 refresher training (19 CCR 2732)?
      17 Did the owner or operator of any business that handles hazardous materials in
         quantities equal to or greater than 55 gallons, 500 pounds, or 200 cubic feet of
                                                                                                                  Please Input
         gas at standard temperature and pressure, develop and submit an inventory
         report?
      18 Do the local forms contain content identical to the state and federal inventory
         forms and are developed with input from local emergency response personnel?                              Please Input

      19 Are all inventories submitted to the CUPA or AA, LEPC, the SERC, and the local
         fire department?                                                                                         Please Input

      20 Was the inventory report submitted on or before March 1, and annually
         thereafter?                                                                                              Please Input

EPCRA - Release Notification
    21 Is release notification reported for any kind of accidental release?                                       Please Input
    22 Are any release in excess of federal release reporting thresholds reported to the
                                                                                                                  Please Input
        NRC?
    23 Are all significant releases or threatened releases of a hazardous material,
        including oil, notified to government agencies as an emergency?
                                                                                                                  Please Input


      24 Are all significant spills or threatened releases of hazardous materials, including
         oil, immediately reported by telephone?
                                                                                                                  Please Input
                                                                                        Yes   No   N/A   Comment/Concerns
25 Does the notification meet the state requirements for a spill or threatened
   release and include:
           a) The identity of the caller
           b) The location, date, and time of spill, release, or threatened release
           c) The substances and quantities involved                                                       Please Input
           d) The name of the chemical that has been released, and, if known,
           whether the chemical is extremely hazardous or poses any potential
           hazards
           e) A description of what happened?
26 Do the business plans include emergency response plans and procedures in the
   event of a reportable release or threatened release of a hazardous material?                            Please Input

27 Does the response plan includes, but is not limited to:
           a) Immediate notification to the administering agency and to the
           appropriate local emergency rescue personnel.
           b) Procedures for the mitigation of a release or threatened release to
           minimize any potential harm or damage to persons, property, or the
           environment (CH&SC 25504)?
28 As soon as a person has knowledge of a release or a threatened release, did
   that person make an immediate, verbal report to the Office of Emergency
   Services and the AA?
                                                                                                           Please Input



29 Was the notification provided as soon as possible, but without:
           a) Impeding immediate control of the release or threatened release
           b) Impeding immediate emergency medical measures?
30 Did the immediate report include, at a minimum:
           a) The exact location of the release or threatened release
           b) The name of the person reporting the release or threatened release
           c) The hazardous materials involved in the release or threatened
           release
           d) An estimate of the quantity of hazardous materials involved
           e) If known, the potential hazards presented by the hazardous material
           involved in the release or threatened release?
31 Is the written emergency release follow-up notice sent to: Chemical Emergency
   Planning and Response Commission (CEPRC), 2800 Meadowview Road,                                         Please Input
   Sacramento, CA 95832?
32 Is any release to the environment from a hazardous substance storage tank
   reported to DTSC within 24 hours of its detection?                                                      Please Input

33 Is a leak or spill of hazardous waste exempted from hazardous materials storage
   tank notification requirements if it is:
                                                                                                           Please Input
            a) Less than or equal to a quantity of one pound.
            b) Immediately contained and cleaned up?
34 Was the CHP notified of any person who spills or dumps or causes the release
   of any hazardous material or hazardous waste on any California highway?                                 Please Input

35 Were all written reports submitted to CHP's Hazardous Materials Section within
   30 days of the date of incident discovery.
36 Did the report include:
           a) Time and date of occurrence
           b) A description of any injuries
           c) A description of any property damage
           d) A description of continuing danger to life at the scene of the incident
            e) An identification of the commodity and its classification
            f) Any other pertinent details?
37 Was the Office of Emergency Services notified immediately when any person
   who causes or permits any petroleum, hazardous substance, or sewage to be
   discharged into any waters of the state as soon as:
            a) That person has knowledge of the discharge.                                                 Please Input
            b) Notification is possible.
            c) Notification can be provided without substantially impeding cleanup
            or other emergency measures?
38 Are spills or overfills of a hazardous substance classified as an unauthorized
   release when it meets BOTH of the following conditions:
            a) The spill or overfill occurs while the hazardous substance is being
                                                                                                           Please Input
            placed in the UST.
            b) The spill or overfill is due to the use of improper equipment, faulty
            equipment, operator error, or inattention or overfilling?
                                                                                                Yes   No   N/A   Comment/Concerns
      39 Did owner or operator of a UST notify the local agency within 24 hours after an
         unauthorized release or condition has been detected or should have been
         detected?                                                                                                 Please Input


      40 Did owners and operators investigate the condition and take immediate
         measures to stop the release?
                                                                                                                   Please Input


      41 Has the UST owner or operator submitted a full written report with the following
         information within five working days of detecting an unauthorized release to the
         local agency:
                 a) The owner's or operator's name and telephone number.
                 b) A list of the types, quantities, and concentrations of hazardous
                 substances released.
                 c) The approximate date of the release.
                 d) The date on which the release was discovered.
                 e) The date on which the release was stopped.
                 f) A description of the actions taken to control and/or stop the release.

                 g) A description of the corrective and remedial actions, including
                 investigations that were undertaken and will be conducted to determine                            Please Input
                 the nature and extent of soil, groundwater or surface water
                 contamination due to the release.
                 h) The method of cleanup implemented to date, proposed cleanup
                 actions, and a time schedule for implementing the proposed actions.
                 i) The method and location of disposal of the released hazardous
                 substance and any contaminated soils or ground water or surface water.
                 Copies of any completed hazardous waste manifests for off-site
                 transport of these media shall be attached to the report.
                 j) A description of the proposed method of repair or replacement of the
                 primary and secondary containment.
                 k) A description of additional actions taken to prevent future releases.

      42 Has the owner or operator of an AST facility immediately, upon discovery,
         notified the OES of the occurrence of a spill or other release of one barrel (42
                                                                                                                   Please Input
         gallons) or more of petroleum in accordance with subdivision (a) of Section
         13272 of the Water Code?
      43 Does the permitted medical waste facility report to the Department of Health
         Services (DHS) any noncompliance with the Medical Waste Management Act
                                                                                                                   Please Input
         (CH&SC 25015 et seq.) that may endanger health, safety, or the environment?

EPCRA - CERCLA Hazardous Substance - Initial Notification
    44 Did the release of the CERCLA hazardous substance equal or exceed the
                                                                                                                   Please Input
        reportable quantity within a 24-hour period?
    45 Was the release of a CERCLA hazardous substance reported immediately to
        the National Response Center?
    46 If a mixture or solution was released, was the release reported when the amount
        of a hazardous constituent released exceeded its reportable quantity?

      47 If the release was not a federally permitted release, was it covered by an
         exemption?

      48 Did the facility emergency coordinator immediately notify ALL of the following
         authorities of the release:
                  a) The community emergency coordinator for the Local Emergency
                  Planning Committee of any area likely to be affected by the release; and                         Please Input

                 b) The State Emergency Response Commission for any state likely to be
                 affected by the release?
      49 In the emergency release notification, did the facility provide ALL of the following
         data:
                 a) The chemical name or identity of the substance released;
                 b) The quantity of the substance that was released;
                 c) The time and duration of the release; and
                 d) The medium or media into which the material was released?
                                                                                              Yes   No   N/A   Comment/Concerns
    50 Did the facility indicate in the emergency release notification ALL of the following
        information:
                 a) Whether the substance released is on the list of extremely hazardous
                 substances;
                 b) Information about any known or anticipated acute or chronic health
                 risks;
                 c) Advice for medical treatment necessary for exposed individuals, if
                 appropriate;
                 d) Proper precautions to take as a result of the release; and
                 e) The name and telephone number of the person(s) (emergency
                 coordinator) to be contacted for further information?
    51 Was the release of the CERCLA hazardous substance either of the following
        types of releases:
                 a) A transportation-related release; or
                                                                                                                 Please Input
                 b) A release during storage incidental to transportation, if the stored
                 substance was moving under active shipping papers and had not
                 reached the ultimate designee?
    52 Did the facility emergency coordinator dial 911 (or, in the absence of a 911
        number, the operator) to report the release?
EPCRA - CERCLA Hazardous Substance - Written Follow-Up
    53 Has the facility owner/operator submitted a written follow-up emergency notice
        (or notices, as more information becomes available) to the Local Emergency
        Planning Committee and any SERC which included ALL of the following
        information:
                 a) Up-to-date information about the release;                                                    Please Input
                 b) The actions taken to respond to and contain the release;
                 c) Known or anticipated acute or chronic health risks associated with the
                 release; and
                 d) Where appropriate, medical advice for exposed individuals?
EPCRA - CERCLA Hazardous Substance - Initial Telephone Notification
    54 Has the facility determined that the release qualifies for reporting under
        CERCLA section 103(f)(2) by ONE of the following means:
                 a) Using data, knowledge of the procedures or best professional
                                                                                                                 Please Input
                 judgment; or
                 b) Reporting the release to the National Response Center for a sufficient
                 period of time?
    55 Has the facility made a telephone call to the National Response Center
        identifying the call as an initial continuous release notification report?
                                                                                                                 Please Input


    56 Was ALL of the following information provided in the initial telephone call:
                a) The name and location of the facility or vessel; and
                b) The name(s) and identity(ies) of the hazardous substance(s) being
                released?
EPCRA - CERCLA Hazardous Substance - Initial Written Notification
    57 Has the facility made an Initial Written Notification to the EPA Regional Office
        within 30 days of the initial telephone notification?
                                                                                                                 Please Input


      58 Did the written notification report contain ALL of the following data:
                 a) The name of the facility or vessel;
                 b) The location, including the latitude and longitude;
                 c) The case number assigned by the National Response Center or the
                 EPA;
                 d) The Dun and Bradstreet number of the facility, if available;
                 e) The port of registration of the vessel; and
                 f) The name and telephone number of the person in charge of the facility
                 or vessel?
      59 Did the written notification contain the population density within a one-mile
         radius of the facility or vessel, described in ONE of the following ranges:
                 a) 0 - 50 persons;
                 b) 51 - 100 persons;
                 c) 101 - 500 persons;
                 d) 501 - 1,000 persons; or
                 e) More than 1,000 persons?
                                                                                                 Yes   No   N/A   Comment/Concerns
      60 Did the initial report contain the identity and location of sensitive populations and
         ecosystems within a one-mile radius of the facility or vessel?



      61 For each hazardous substance release claimed to qualify for reporting under
         CERCLA section 103(f)(2), was ALL of the following information supplied:

                  a) The name/identity of the hazardous substance;
                  b) The Chemical Abstracts Service Registry Number for the substance,
                  if available; and
                  c) If a mixture, the components of the mixture and their approximate
                  concentrations and quantities, by weight?
    62 For each hazardous substance release claimed to qualify for reporting under
        CERCLA section 103(f)(2), was ALL of the following information supplied in the
        initial report:
                  a) The upper and lower bounds of the normal range of the release (in
                  pounds or kilograms) over the previous year;
                  b) The source(s) of the release (e.g. valves, pumps seals, storage tank,
                  vents, stacks, stack height);
                  c) The frequency of the release and the fraction of the release from each
                  release source and the specific period over which it occurs?
    63 For each hazardous substance release claimed to qualify for reporting under
        CERCLA section 103(f)(2), was ALL of the following information supplied in the
        initial report:
                  a) A brief statement describing the basis for stating that the release is
                  continuous and stable in quantity and rate;
                  b) An estimate of the total annual amount that was released in the
                  previous year (in pounds or kilograms);
                  c) The environmental medium affected by the release; and
                  d) A signed statement that the hazardous substance release(s)
                  described is(are) continuous and stable in quantity and rate and that all
                  reported information is accurate and current to the best knowledge of
                  the person in charge?
    64 Did the initial report provide the following data as appropriate to the
        environmental medium affected by the release of a hazardous substance:
                  a) The name of the surface water body, if surface water;
                  b) The stream order or average flow-rate (in cubic feet/second) and
                  designated uses, if a stream;
                  c) The surface area (in acres) and average depth (in feet or meters), if a
                  lake; or
                  d) The location of public water supply wells within two miles, if on or
                  under ground?
EPCRA - CERCLA Hazardous Substance - Follow-Up Notification
    65 Has the facility submitted a follow-up notification of the continuous release within
        30 days after the one year anniversary of the initial written notification?
                                                                                                                    Please Input


      66 Has the person in charge of the facility or vessel evaluated each hazardous
         substance release to verify and update the information submitted in the initial
         written notification?
                                                                                                                    Please Input



      67 Does the follow-up notification include ALL of the following data:
                 a) The name of the facility or vessel;
                 b) The location, including the latitude and longitude;
                 c) The case number assigned by the National Response Center or the
                 EPA;                                                                                               Please Input
                 d) The Dun and Bradstreet number of the facility, if available;
                 e) The port of registration of the vessel; and
                 f) The name and telephone number of the person in charge of the facility
                 or vessel?
      68 Did the follow-up notification contain the population density within a one-mile
         radius of the facility or vessel, described in ONE of the following ranges:

                  a) 0 - 50 persons;
                                                                                                                    Please Input
                  b) 51 - 100 persons;
                  c) 101 - 500 persons;
                  d) 501 - 1,000 persons; or
                  e) More than 1,000 persons?
                                                                                              Yes   No   N/A   Comment/Concerns
      69 Did the written follow-up report contain the identity and location of sensitive
         populations and ecosystems within a one-mile radius of the facility or vessel
                                                                                                                 Please Input


      70 For each hazardous substance release claimed to qualify for reporting under
         CERCLA section 103(f)(2), was ALL of the following information supplied in the
         written follow-up report:
                  a) The name/identity of the hazardous substance;
                                                                                                                 Please Input
                  b) The Chemical Abstracts Service Registry Number for the substance,
                  if available; and
                  c) If a mixture, the components of the mixture and their approximate
                  concentrations and quantities, by weight?
      71 For each hazardous substance release claimed to qualify for reporting under
         CERCLA section 103(f)(2), was ALL of the following information supplied in the
         written follow-up report:
                  a) The upper and lower bounds of the normal range of the release (in
                  pounds or kilograms) over the previous year;                                                   Please Input
                  b) The source(s) of the release (e.g. valves, pumps seals, storage tank,
                  vents, stacks, stack height); and
                  c) The frequency of the release and the fraction of the release from each
                  release source and the specific period over which it occurs?
      72 For each hazardous substance release claimed to qualify for reporting under
         CERCLA section 103(f)(2), was ALL of the following information supplied in the
         written follow-up report:
                  a) A brief statement describing the basis for stating that the release is
                  continuous and stable in quantity and rate;
                  b) An estimate of the total annual amount that was released in the
                                                                                                                 Please Input
                  previous year (in pounds or kilograms);
                  c) The environmental medium affected by the release; and
                  d) A signed statement that the hazardous substance release(s)
                  described is(are) continuous and stable in quantity and rate and that all
                  reported information is accurate and current to the best knowledge of
                  the person in charge?
      73 Did the written follow-up report provide the following data as appropriate to the
         environmental medium affected by the release of a hazardous substance:

                a) The name of the surface water body, if surface water;
                b) The stream order or average flow-rate (in cubic feet/second) and
                                                                                                                 Please Input
                designated uses, if a stream;
                c) The surface area (in acres) and average depth (in feet or meters), if a
                lake; or
                d) The location of public water supply wells within two miles, if on or
                under ground?
EPCRA - CERCLA Hazardous Substance - Changes in Release
    74 Has there been a change in the source or composition of the release?                                      Please Input
    75 As soon after the change as there was sufficient basis for asserting that the
        release was continuous and stable in quantity and rate, did you report the
        release with an initial telephone call and a written notification as required under
        40 CFR 302.8(c)(1) and 40 CFR 302.8(c)(2)?



      76 Has there been a change in the release such that the quantity of the release
                                                                                                                 Please Input
         exceeds the upper bound of the reported normal range?
      77 Did you report it as a statistically significant increase in the release?




      78 If the change resulted in a number of releases that exceed the upper bound of
         the normal range, did the person in charge of the facility or vessel modify the
         normal range by ONE of the following methods:
                  a) Reporting at least one statistically significant increase report as
                  required under 40 CFR 302.8(c)(7) and informing the National Response
                  Center of the change; or
                  b) Submitting within 30 days of the telephone notification, written
                  notification to the appropriate EPA Regional Office describing the new
                  normal range, the reason for the change, the basis for stating that the
                  release in continuous and stable in quantity and rate?
                                                                                                 Yes   No   N/A   Comment/Concerns
      79 Has there been a change in any of the information submitted in the initial written
         notification or the follow-up notification other than a change in the source,                              Please Input
         composition, or quantity of the release?
      80 Has the person in charge of the facility provided written notification of the
         change to the EPA region within 30 days?




      81 Did the notification include the reason for the change, and the basis for stating
         that the release is continuous and stable under the changed conditions?




      82 Have all notifications of change included BOTH the case number assigned by
         the National Response Center or the EPA and also a signed certification
         statement?




      83 Has there been a statistically significant increase in hazardous substances
                                                                                                                    Please Input
         released in any 24-hour period?
      84 Was the National Response Center notified as soon as the person in charge of
         the facility or vessel had knowledge of the increase?




      85 Is each hazardous substance release evaluated annually to determine if there
         are any changes in the information submitted in the initial written notification, the
         follow-up notification and/or in a previous change notification?                                           Please Input


EPCRA - CERCLA Hazardous Substance - Recordkeeping
    86 Are all supporting documents, materials, and other information concerning the
        facility's continuous release reporting kept on file at the facility for one year?
                                                                                                                    Please Input


    87 Do all supporting materials substantiate the reported normal range of releases,
        the basis for stating that the release is continuous and stable in quantity and
                                                                                                                    Please Input
        rate, and the other information in the initial written report, the follow-up report,
        and the annual evaluations?
EPCRA - MSDSs
    88 For all hazardous chemicals stored on-site above the minimum threshold level,
        has the facility submitted EITHER of the following:
                 a) An MSDS for each hazardous chemical; or
                 b) A list of the hazardous chemicals arranged by hazard category,                                  Please Input
                 including the chemical name or common name of each hazardous
                 chemical and any hazardous component of each chemical (except
                 mixtures) as provided on the MSDS?
    89 Has the facility submitted a list of hazardous chemicals or the MSDSs to ALL of
        the following authorities:
                 a) The State Emergency Response Commission;
                 b) The Local Emergency Planning Committee; and
                 c) The fire department with jurisdiction over the facility?
    90 Was the initial submission of MSDSs or list of chemicals completed prior to
        October 17, 1990, or within three months of the date the facility became subject
        to the reporting requirement?
    91 Does the facility submit a new or revised MSDS for a hazardous chemical within
        three months whenever significant new information is discovered about the
        chemical?



      92 Was an MSDS or a revised list submitted within three months after a threshold
         was exceeded because of EITHER of the following events:
                 a) A new chemical was brought on-site which exceeded the TPQ; or
                 b) A chemical already on-site exceeded the TPQ?
      93 Has the Local Emergency Planning Committee (LEPC) requested an MSDS
                                                                                                                    Please Input
         from the facility to respond to an information request?
                                                                                              Yes   No   N/A   Comment/Concerns
      94 Was the requested MSDS provided within 30 days of the request?


      95 Has the facility ever been penalized for failure to comply with the MSDS
                                                                                                                 Please Input
         requirements?
      96 Was the problem corrected that led to the penalty for violations of the MSDS
         requirements?
      97 Are MSDSs kept in the workplace and accessible to employees during each
         work shift.
                                                                                                                 Please Input


      98 Are employees given access to an MSDS upon request?
                                                                                                                 Please Input

      99 Do Employers ensure that MSDSs are not removed or defaced?
                                                                                                                 Please Input
     100 If through maintenance or an employee request an employer notes a missing or
         incomplete MSDS, has a written request made to the manufacturer or importer
                                                                                                                 Please Input
         for the missing or incomplete information within 7 working days?

    101 If no response is received within 25 working days, is a copy of the written inquiry
        sent to Cal/OSHA?
Hazard Communication Standard
    102 Do you have a HazCom Plan?                                                                               Please Input
    103 Does the plan include the following:
                  a) Lists the hazardous substances in the workplace;
                  b) Ensures that all hazardous substances have MSDSs and labels;
                  c) Explains how hazard communication requirements are being met;
                  d) Outlines employee training and education programs;
    104 Is the list of hazardous substances accessible?
                                                                                                                 Please Input

     105 Does the facility have an effective injury and illness prevention program?
                                                                                                                 Please Input

     106 Does the program contain the following requirements:
                a) Meetings,
                b) Training programs,
                c) Postings,
                d) Written communications,
                e) A system of anonymous notification by employees about hazards, or
                f) Any other means that ensures communication with employees
     107 Are employees provided with warnings, either posted in the workplace or
         through product labeling, concerning any chemicals in their inventory that are
                                                                                                                 Please Input
         known to the state to cause cancer, birth defects, or other reproductive harm?

Inventory Form Reporting - Tier I/Tier II
     108 Has the facility prepared for ALL of the following requests from the fire
         department with jurisdiction over the facility:
                 a) An on-site inspection; and                                                                   Please Input
                 b) An information request, on the specific location of hazardous
                 chemicals at the facility?
     109 Has the facility ever been penalized for failure to comply with the inventory form
                                                                                                                 Please Input
         reporting requirements
     110 Was the problem corrected that led to the penalty for violations of the inventory
         form reporting requirements?


Inventory Form Reporting - Tier I
     111 Has the facility submitted a Tier I inventory form?
                                                                                                                 Please Input

     112 Was the inventory form submitted on or before March 1 of each year following
         the date when the facility became subject to the reporting requirements?
                                                                                                    Yes   No   N/A   Comment/Concerns
     113 Did the facility send the Tier I inventory form to ALL of the following authorities:

               a) The State Emergency Response Commission;
               b) The appropriate Local Emergency Planning Committee; and
               c) To the fire department that has jurisdiction over the facility?
   114 Did the inventory form contain ALL of the following information:
               a) The hazardous chemicals categorized according to the health and
               physical hazards established by the EPA; and
               b) Facility identification information (owner/operator, emergency
               contacts, and certification)?
   115 Did the inventory form include ALL of the following information for the preceding
        calendar year:
               a) The maximum amounts (in ranges) of all hazardous chemicals in each
               category;
               b) The average daily amounts (in ranges) of all hazardous chemicals in
               each category;
               c) The number of days the hazardous chemicals in each hazard
               category were on-site; and
               d) The general location of all hazardous chemicals in each category?
EPCRA - Mixtures
   116 For mixtures of hazardous chemicals, did the facility provide information on the
        submitted MSDS or inventory form using EITHER of the following methods:

                   a) Provide the information on each component in the mixture; or                                     Please Input
                   b) Provide the information on the mixture itself, so long as the reporting
                   of mixtures was the same for both MSDS and inventory form reporting?


     117 If the facility is reporting each component of a mixture which is a hazardous
         chemical, did it multiply the percentage by weight by the mass of the mixture to
         determine the quantity of the hazardous chemical in the mixture?

                                                                                                                       Please Input




     118 If the facility is reporting the mixture itself, did it report the total quantity of the
         mixture?
                                                                                                                       Please Input


   119 To determine whether the reporting threshold for an extremely hazardous
        substances was equaled or exceeded, did the facility aggregate ALL of the
        following quantities:
                 a) The quantity of the extremely hazardous substance present as a                                     Please Input
                 component in all mixtures at the facility; and
                 b) All other quantities of the extremely hazardous substance present at
                 the facility?
   120 If extremely hazardous substances are being reported and are a component of a
        mixture, did the facility report the extremely hazardous substances in EITHER of
        the following ways:
                                                                                                                       Please Input
                 a) The whole mixture, even if the total quantity of the mixture was below
                 its reporting threshold; or
                 b) The extremely hazardous component(s) of the mixture?
EPCRA - Toxic Chemical Reporting
   121 If the facility discharges storm water AND is subject to EPCRA Section 313, has
        the WATER QUALITY - FEDERAL module been completed?
                                                                                                                       Please Input


Inventory Form Reporting - Tier II
     122 Has the facility submitted a Tier II inventory form (either voluntarily or by
                                                                                                                       Please Input
         request)?
     123 Was the Tier II inventory form submitted by the following deadlines, as
         applicable:
                 a) On March 1 of each year, for submission in place of a Tier I form;
                 and
                 b) Within 30 days of a request by the State Emergency Response
                 Commission, the Local Emergency Planning Committee, or the local fire
                 department?
                                                                                                 Yes   No   N/A   Comment/Concerns
     124 Did the facility send the Tier II inventory form to ALL of the following authorities:

                 a) The State Emergency Response Commission;
                 b) The appropriate Local Emergency Planning Committee; and
                 c) To the fire department that has jurisdiction over the facility?
     125 Did the Tier II report include ALL of the following data:
                 a) The facility identification (including owner/operator, emergency
                 contacts, and certification);
                 b) The chemical name or common name of all chemicals as provided on
                 the MSDS;
                 c) The chemical properties of all hazardous chemicals listed, including
                 whether the chemical is pure or a mixture, whether it is a solid, a liquid
                 or a gas, and whether it is an extremely hazardous substance;

                  d) The hazard categories for all chemicals;
                  e) The manner in which hazardous chemicals are stored;
                  f) The general location of all hazardous chemicals in each category
                  (which may be claimed confidential and not released to the public); and

                 g) Whether an chemical identity is claimed as a trade secret?
    126 Did the Tier II form include ALL of the following information for the preceding
        calendar year:
                 a) The maximum amounts (in ranges) of all hazardous chemicals in
                 each category;
                 b) The average daily amount (in ranges) of all hazardous chemicals in
                 each category; and
                 c) The number of days the hazardous chemicals in each hazard
                 category were on-site?
Toxic Chemical Release Reporting - Form R
    127 When taking into account the amount of toxic chemicals on-site at the facility,
        did the facility include mixtures containing toxic chemicals or components of
                                                                                                                    Please Input
        trade name products which the owner or operator received from another
        person?
    128 Did the facility complete a toxic chemical release form for each reportable
        chemical and submit it to the EPA Administrator and designated state official on                            Please Input
        or before July 1, 1988 and by July 1 each year thereafter?
    129 If the facility manufactures or processes a toxic chemical, does it provide the
        required information to customers who must file the toxic chemical release form?                            Please Input

     130 If the facility manufactures or processes a toxic chemical, does it provide the
         required information to customers who must file the toxic chemical release form?                           Please Input

    131 Does the facility provide toxic chemical supplier notification information to
         customers in writing by January 1 of each year, that includes ALL of the
         following information:
                 a) A statement that the mixture or trade name product you supplied
                 contains a toxic chemical(s) subject to the reporting requirements;
                 b) The name and CAS registry number of each toxic chemical you sold;
                 and
                 c) The percent by weight of each toxic chemical in the mixture or trade
                 name product?
Form R - Recordkeeping
    132 Do you retain copies of submitted Form Rs for at least three years?
                                                                                                                    Please Input

     133 Does the facility retain supporting materials and documentation used to
         determine that the facility is covered under the regulations for at least three                            Please Input
         years?
     134 Do you retain supporting data and documentation of ALL of the following issues
         for at least three years:
                  a) Determination whether a reporting threshold applies;
                  b) Calculations used to determine the quantity of each toxic chemical
                                                                                                                    Please Input
                  released to the environment or transferred to an off-site location; and

                  c) Calculations of use indications and quantities of each toxic chemical
                  (including dates of manufacturing, processing and use)?
                                                                                              Yes   No   N/A   Comment/Concerns
     135 Do you retain ALL of the following records for at least three years:
                   a) Receipts or manifest associated with the transfer of toxic chemicals
                   to off-site locations;
                                                                                                                 Please Input
                   b) Documentation of reported waste treatment methods for each toxic
                   chemical; and
                   c) Development of estimates of any release or off-site transfer?
     136 Does the facility retain all supporting material used to determine whether
         supplier notification was required AND a copy of each supplier notice for at least                      Please Input
         three years from the date of submission?
     137 Are all records associated with toxic chemical release reporting kept at the
         facility which submitted the reports AND at the facility to which they apply?                           Please Input

     138 Are records readily available for EPA inspection?
                                                                                                                 Please Input
     139 If the facility ever received a penalty for a recordkeeping violation, was the
         problem that led to the penalty corrected?                                                              Please Input

Toxic Chemical Release Reporting - Reportable Chemicals
    140 Do any of the following conditions apply to the waste stream:
               a) The stream is a product:
               b) The stream is sent to a boiler or industrial furnace, where it is burned
               as fuel;
               c) The stream is a byproduct, intermediate, or a material that is used at
               the facility for the production of a product; or
                                                                                                                 Please Input
               d) The stream leaves the facility, and one or both of the following apply:

                  1) The stream is transferred to another facility for further processing
                  and is returned to the original facility; or
                  2) The stream is transferred to an intracompany facility for further
                  processing in the production of a product or provision of a service?
     141 Do ANY of the following circumstances apply to the chemical waste stream:

                 a) The stream contains one or more reportable chemicals that is
                 released into the environment;
                                                                                                                 Please Input
                 b) The stream enters a permitted waste treatment device for treatment;
                 and destruction, biological degradation or chemical conversion of the
                 stream occurs; or
                 c) The stream enters a device where all outputs release or dispose?
Pollution Prevention
     142 Is there a procedure in place at the facility which ensures that pollution
         prevention is a consideration in decision-making?
                                                                                                                 Please Input



Additional Notes:
                                                                                             Yes   No   N/A   Comment/Concerns
California
Standards Applicable to Generators of Hazardous Waste

General Requirements
      1 Does the facility comply with the more stringent regulations for the generation of
         hazardous waste?                                                                                       Please Input

Pollution Prevention
        2 If the facility generates more than 12,000 kg (13 tons) of hazardous waste or
          more than 12 kg of extremely hazardous waste in a calendar year, is a source                          Please Input
          reduction plan prepared?
        3 Does the hazardous waste source reduction program have the following:
                   a) A description of wastestreams and quantities generated;
                   b) An evaluation of feasible source reduction strategies;
                   c) The rationale for rejecting any source reduction alternatives;
                   d) An evaluation of the effects of methods chosen;
                   e) A timetable for making reasonable and measurable progress toward
                   source reduction; and
                   f) Certification by the generator and a registered professional?
        4 Are the following wastestreams exempted from inclusion in calculating
          hazardous waste volumes or weights produced as they are related to SB14:

                 a) Motor vehicle fluids and filters;
                 b) Lead acid batteries;
                 c) Household hazardous wastes;
                 d) Waste pesticides and pesticide containers collected by agricultural
                 commissioners;                                                                                 Please Input
                 e) Spent munitions and ordinance;
                 f) Decommissioned utility poles;
                 g) Oil generated from decommissioned refrigeration units;
                 h) Mercury relays and low-level radioactive tubes generated from
                 removal of telephone equipment
                 i) Lighting wastes including ballasts and fluorescent tubes;
                 j) Medical waste?
       5 Does the source reduction evaluation review and plan contain ALL of the
         following:
                 a) Name and location of the site;
                 b) SIC code;
                 c) Type of business activity conducted at the site;
                 d) Length of time the company has been in business at the particular
                 site;
                 e) Major products manufactured or services provided;
                 f) Number of employees;
                 g) General description of site operations;
                 h) Identification of major hazardous wastestreams;
                 i) Process contributing to the major wastestreams;                                             Please Input
                 j) Numeric goals for reducing hazardous wastes;
                 k) Generating source reduction measures;
                 l) Source reduction measure evaluations;
                 m) Any other information pertinent to evaluating and implementing
                 source reduction measures;
                 n) Selected source reduction measures;
                 o) Effects of source reduction measures on emissions and discharges
                 to air, water, and land;
                 p) Listing of rejected source reduction measures;
                 q) Timetable for implementation of the selected source reduction
                 measure?
       6 Does the owner/operator prepare a summary progress report and submit it to
         the DTSC on or before September 1 every four years?
                                                                                                                Please Input


       7 Does the hazardous waste management report provide an assessment of the
         effectiveness of each waste management approach implemented?
                                                                                                                Please Input
                                                                                              Yes   No   N/A   Comment/Concerns
       8 Does the hazardous waste management report contain:
                 a) Name and location of the site;
                 b) Four-digit SIC code(s) for the site;
                 c) Specific information for each wastestream, including the quantity of
                 hazardous waste generated, current hazardous waste management
                 approaches, effects of implemented measures since the baseline year,
                 and factors affecting waste generation and management during the
                 reporting year?
       9 Does the report summary also contain:
                 a) Name and location of the site;
                 b) A general report summary;
                 c) Abstracts of new waste management approaches;
                 d) Changes in business activity affecting waste generation;
                 e) New waste reduction achieved by site if the reporting year is different
                 from the baseline year?
     10 Were the following reviewed and certified by an engineer who is registered as a
         professional engineer, an individual who is responsible for the processes and
         operations of the site, or by an environmental assessor who is registered under
                                                                                                                 Please Input
         CH & SC 25570:
                 a) Plan and plan summary;
                 b) Report and report summary;
Recycling
     11 For hazardous wastes that are recycled, are they exempt from some treatment,
                                                                                                                 Please Input
         storage, and disposal rules?
     12 Do all hazardous waste generators, transporters, and facility operators comply
         with specific rules for recyclable materials (22 CCR 66266.3 to 66266.10)?                              Please Input

      13 Are the following wastes recycled:
                 a) Products that are either:
                     1) Commercial chemical products, including unused laboratory
                     products; or-
                     2) Used or unused petroleum products, including motor oils, hydraulic
                     fluids, cutting lubricants, and fortified weed oils.
                 b) Solvents, used or contaminated, including:
                     1) Halogenated solvents, such as trichloroethane, perchloroethylene,
                     methylene dichloride, chloroform, carbon tetrachloride, Freon.
                                                                                                                 Please Input
                     2) Oxygenated solvents such as acetone, methyl ethyl ketone,
                     methanol, ethanol, butanol, ethyl acetate.
                     3) Hydrocarbon solvents, such as hexanes, Stoddard, benzene,
                     toluene, xylenes, paint thinner.
                  c) Unspent acids and alkalis:
                     1) Unspent acids, such as hydrochloric, hydrofluoric, nitric,
                     phosphoric, sulfuric, in concentrations exceeding 15 percent.
                     2) Unspent alkalis, including hydroxides and carbonates of sodium,
                     potassium, and calcium and acetylene sludge
      14 Is written justification provided to Cal/EPA for NOT recycling one of the
         hazardous wastes listed:
                  a) Products that are either:
                     1) Commercial chemical products, including unused laboratory
                     products; or-
                     2) Used or unused petroleum products, including motor oils, hydraulic
                     fluids, cutting lubricants, and fortified weed oils.
                  b) Solvents, used or contaminated, including:
                     1) Halogenated solvents, such as trichloroethane, perchloroethylene,
                     methylene dichloride, chloroform, carbon tetrachloride, Freon.
                                                                                                                 Please Input
                     2) Oxygenated solvents such as acetone, methyl ethyl ketone,
                     methanol, ethanol, butanol, ethyl acetate.
                     3) Hydrocarbon solvents, such as hexanes, Stoddard, benzene,
                     toluene, xylenes, paint thinner.
                  c) Unspent acids and alkalis:
                     1) Unspent acids, such as hydrochloric, hydrofluoric, nitric,
                     phosphoric, sulfuric, in concentrations exceeding 15 percent.
                     2) Unspent alkalis, including hydroxides and carbonates of sodium,
                     potassium, and calcium and acetylene sludge
                                                                                                Yes   No   N/A   Comment/Concerns
      15 Does the disposal statement include the following:
                a) The general description, source, chemical composition, physical
                state, and amount of the waste;
                b) The amount of similar waste discarded or recycled during the 365-
                day period preceding the disposal at issue;
                c) An estimate of the amount of similar waste to be generated by the
                generator in the 365-day period succeeding the disposal at issue;
                d) A summary of the efforts made to find a use for the waste (e.g. used
                without processing, used after processing to remove or modify
                undesired properties, or used as a source of energy;
                e) Technologic, economics, or other reason for not recycling the waste,
                taking into account all relevant factors?
Small Quantity Generators (SQG)
      16 Do you have a EPA Hazardous Waste Generator ID number?
                                                                                                                   Please Input

      17 For a small quantity generator (SQG) (generating less than 200 pounds in any
         one month of medical waste) that treats medical waste on-site by steam
                                                                                                                   Please Input
         sterilization, incineration, or microwave technology, did the facility register with
         DHS
      18 For SQGs owning or operating a medical waste treatment facility, has it also
                                                                                                                   Please Input
         applied for a permit?
      19 For SQGs using on-site treatment, including an autoclave, incinerator, or
         microwave technology, does it pay the $100 registration and inspection fee                                Please Input
         every two years?
      20 For SQGs required to register, has a medical waste management plan including
         the following information been prepared:
                  a) Name and address of the generator
                  b) Type of business
                                                                                                                   Please Input
                  c) Type and estimated monthly quantity of waste generated
                  d) Type of on-site treatment
                  e) Name and address of waste hauler
                  f) A statement certifying that the plan is complete and accurate
      21 Does the SQG maintain individual treatment and tracking records for three
         years?                                                                                                    Please Input

      22 Has the SQGs prepared an emergency action plan complying with emergency
         regulations adopted by DHS?                                                                               Please Input

      23 Has all medical waste transported either by a registered hazardous waste
         transporter or by a person with an approved limited-quantity exemption?                                   Please Input

      24 For sharps waste that was rendered noninfectious, was it disposed by one of
         the following methods:
                  a) Incineration                                                                                  Please Input
                  b) Steam sterilization
                  c) Disinfection and encasement?
      25 If the facility contains or stores medical waste, does it comply with the following
         rules:
                  a) Contain medical waste separately from other waste at the point of
                  origin. Sharps containers may be placed in biohazard bags or in
                  containers with biohazard bags.                                                                  Please Input
                  b) Biohazardous waste has to be contained in a red biohazard bag
                  conspicuously labeled with the words "Biohazardous Waste" or with the
                  international biohazard symbol and the word "BIOHAZARD."
                  c) Sharps waste is required to be contained in a sharps container?
      26 If the facility contains sharps, does it comply with the following requirements:
                a) Place all sharps waste into a sharps container.
                b) Tape closed (or tightly seal lid) full sharps containers ready for
                disposal to preclude loss of contents.                                                             Please Input
                c) Store sharps containers ready for disposal for not more than seven
                days.
                d) Label sharps containers with the words "sharps waste" or with the
                international biohazard symbol and the word "BIOHAZARD."?
      27 Are any leaks or spills of a medical waste by a medical waste generator,
         hazardous waste transporter, or treatment facility decontaminated by
         procedures approved by DHS found at CH & SC 118295?                                                       Please Input
                                                                                           Yes   No   N/A   Comment/Concerns
      28 Does the medical waste treatment facility maintain the following records for
         three years:
                 a) The type of treatment facility, its capacity, and operating records                       Please Input
                 b) Copies of the tracking documents for all medical waste received for
                 treatment from off-site generators or from hazardous waste haulers?
      29 Does the SQG facility's calculation for waste generation match the hazardous
         waste generator status for SQGs marked on EPA Form 8700-12?
                                                                                                              Please Input


     30 If the SQG facility's calculations for waste generation does not match the
        information recorded on EPA Form 8700-12, did the owner/operator re-submit
        EPA Form 8700-12 with the new information?
     31 Did the owner/operator submit subsequent notification using EPA Form 8700-12
        if the facility's regulated waste activities change under the following
        circumstances:
                 a) If you start to market or burn hazardous waste for energy recovery
                 ("waste-as-fuel");
                 b) If you become a used oil fuel marketer;
                 c) If you become a large quantity handler of universal waste;
                 d) If the types of waste you generate change (such as, you are
                 generating new wastes that have different waste codes;                                       Please Input
                 e) If your facility (installation) moves to another location;
                 f) If the contact person (coordinator) at your facility changes;
                 g) If ownership of the facility (installation) changes;
                 h) If an additional owner has been added or replaced since the
                 installation's original notification; and/or
                 i) If the type of regulated waste activity you conduct changes (such as
                 your process changes and puts the waste under a different hazardous
                 waste code or category)?
Hazardous Waste Determination
     32 Have solid wastes been characterized to determine whether they are
        hazardous?
                                                                                                              Please Input


      33 Does the site determine that wastes are hazardous by any of the following?
                a) Testing;
                b) Knowledge of processes: or
                c) Both testing and knowledge of processes
      34 Are results of waste tests and waste analyses:
                a) Kept on file at the site for each waste stream; AND
                b) Retained for at least three years for ALL wastes tested
      35 Are waste analyses up to date?
                                                                                                              Please Input

Pollution Prevention
       36 Does the facility's waste minimization program include ALL of the following:
                  a) Demonstrated top management support;
                  b) The tracking of types and amounts of hazardous wastes and
                  hazardous waste constituents, including the rates and dates they are
                  generated;
                  c) A system for determining the true costs associated with hazardous
                  waste management and cleanup, including future liabilities;                                 Please Input

                  d) Looking at a process to see where materials can be prevented from
                  becoming a waste minimization opportunities might be;
                  e) A cost allocation system, which identifies those activities which
                  generate hazardous waste;
                  f) Periodic review?
SQG - Manifest - General Requirements
     37 Does the SQG use hazardous waste manifest forms?


                                                                                                              Please Input
                                                                                           Yes   No   N/A   Comment/Concerns
      38 Is ALL of the following identifying information provided in the SQG facility's
         manifests;
                 a) The generators name, mailing address, and telephone number;
                 b) The generators EPA Identification Number;
                 c) The transporter's name and EPA Identification Number;
                 d) The TSDF's name, address, and EPA Identification Number; and
                 e) The waste description required by DOT (proper shipping name,
                 hazard class and ID number)?
      39 Is EACH of the following true of the SQG facility's manifest
                 a) The manifests contain the signed generator's certification; and
                 b) Hand-signed copies of manifests are received from TSDFs within 60
                 days (or for any manifest not returned from the TSDF within 60 days, a
                 legible copy of the manifest and a brief explanation was submitted to
                 EPA); and
                 c) Copies of manifests are retained for at least three years from the
                 date the waste was accepted b the initial transporter?
      40 Did the owner/operator of the SQG facility receive signed copies of ALL
         manifests from transporters and/or TSDFs within 35 days of the shipment?                             Please Input

      41 For any manifest not returned within 35 days, was the transporter and/or TSDFs
         immediately contacted?                                                                               Please Input

      42 If a signed manifest was not received from the transporter and/or TSDF within
         45 days, were BOTH of the following actions taken:
                                                                                                              Please Input
                  a) An Exception Report was sent to EPA;
                  b) Copies of Exemption Reports were retained for at least three years?
      43 Has the generator prepared the California Uniform Hazardous Waste Manifest
         on the state form DTCS 8022A and if necessary, on the U.S. Environmental
                                                                                                              Please Input
         Protection Agency continuation sheet, Form 8700-22A before transporting any
         hazardous waste off-site?
      44 Are items A, B, D, F, I, and J completed for the California manifest?
                                                                                                              Please Input

      45 Has the generator sent a legible copy of the manifest to Cal/EPA within 30 days
         of shipment?
                                                                                                              Please Input


Pre-Transport Requirements - Marking
      46 Has each container of 110 gallons or less used in transportation been marked
         with the following words and information:
               HAZARDOUS WASTE--Federal Law Prohibits Improper Disposal. If
               found, contact the nearest police or public safety authority or the U.S.
                                                                                                              Please Input
               Environmental Protection Agency or the New Jersey Department of
               Environmental Protection.
               Generator's Name and Address________________________
               State Manifest Document Number___________________________
Recordkeeping and Reporting
      47 Are manifests being kept for three years as well as a signed copy from the
         owner or operator of the designated facility which received the waste.                               Please Input

      48 Has a Biennial Report been prepared, and does it detail the SQG facility's
         hazardous waste activities?
                                                                                                              Please Input


      49 Are ALL of these Biennial Reporting requirements followed:
                a) One copy of the report is submitted to EPA by March 1 of every even-
                numbered year;
                b) Biennial Reports are completed using EPA Form 8700-13A (or
                required State form); and
                c) Copies of the Biennial Reports are retained for at least three years?
                                                                                            Yes   No   N/A   Comment/Concerns
       50 Does the Biennial Report include ALL of the following:
                  a) The EPA Identification Number, name, and address of the generator
                  b) The calendar year covered by the report
                  c) The name, EPA Identification Number, and address for each TSDF
                  in the U.S. to which HW was shipped during the year;
                  d) The name and EPA Identification Number of each transporter used
                  to transport HW during the year;
                  e) A description, EPA hazardous waste number, DOT hazardous class,
                  and quantity of each hazardous wasted shipped off-site to a TSDF
                  within the U.S.;
                  f) The certification signed by the generator or authorized
                  representative?
Off-Site Transport
       51 When offering hazardous waste for off-site transport, does the SQG ensure that
          ALL of the following TSDF and waste hauler conditions are met:
                  a) Manifested hazardous wastes are shipped to properly permitted
                  TSDF;
                  b) Each TSDF to which manifested HW is being shipped has an EPA
                  Identification Number;                                                                       Please Input
                  c) Manifested hazardous wastes are transported only by waste haulers
                  that have EPA Identification Numbers;
                  d) There are records of the names of each hauler who transported
                  manifested hazardous waste and the waste hauled by each (this
                  information would be included on the facilities manifests)?
       52 Do containers of manifested hazardous wastes comply with the DOT packaging,
          labeling and marking requirements before they are transported?
                                                                                                               Please Input


     53 Are ALL of the following true for vehicles which are used to transport shipments
        of manifested hazardous wastes:
                a) The vehicles are placarded according to DOT regulations;                                    Please Input
                b) Outgoing trucks are inspected to verify proper placarding before they
                leave the facility?
SQG - Accumulation Time
     54 Does the SQG store hazardous waste on drip pads or in containment buildings?
                                                                                                               Please Input
      55 In order to use drip pads or containment buildings as accumulation units without
         obtaining a RCRA TSDF Permit or Interim status, has the generator complied
         with ALL of the following requirements for Large Quantity Generators (LQGs):

                 a) Personnel training requirements of 40 CFR 265.16;
                 b) Contingency plan requirements of 40 CFR 265, Subpart D (40 CFR
                 265.50-56);
                 c) Closure requirements of 40 CFR 265.111 and 265.114;
                 d) On-site accumulation limits (without a permit or interim status) to a
                 maximum of 90 days; and
                 e) The standards for drip pads (40 CFR 265, Subpart W), and/or
                 containment buildings (40 CFR 265, Subpart DD)?
      56 Are records kept concerning the removal of hazardous waste from drip pads
         and containment buildings, which identify:
                 a) A description of procedures which ensures all wastes are removed
                 from the drip pad and associated collection system at least once every
                 90 days;
                 b) The quantity of waste removed from the drip pad and the sump or
                 collection system; and
                 c) The date and time of each removal?
      57 Has the facility begun calculating the 90-day accumulation time period when the
         generator's total accumulation exceeds 100 kg of hazardous waste, one kg of
                                                                                                               Please Input
         acutely hazardous waste, or one kg of extremely hazardous waste (CCR
         66262.34(b)(1))?
      58 Does the owner/operator of the SQG facility assure that the following on-site
         HW accumulation time limits are met:
                 a) HW is accumulated for no more than 90 days; and/or
                                                                                                               Please Input
                 b) When the 90-day time limit is exceeded, the generator obtains an
                 extension from the regulating authority and removes the waste before
                 the extension expires?
                                                                                             Yes   No   N/A   Comment/Concerns
Hazardous Substance Storage
     59 If a reportable quantity of a hazardous substance was discovered, was the
        Cal/EPA notified within 30 days?
                                                                                                                Please Input


      60 Are California's UST requirements met for tank construction, installation, and
         closure?                                                                                               Please Input

      61 Are ASTs regulated by both the state fire marshal and Cal/EPA?
                                                                                                                Please Input

      62 Does the facility follow the federal U.S. Department of Transportation
         regulations for the storage and packaging of hazardous materials during                                Please Input
         transportation?
      63 Was the Cal/EPA notified with 30 days after the discovery of a release of a
         reportable quantity of hazardous substance?                                                            Please Input

      64 Are California's UST rules followed for petroleum and hazardous substance
         underground tanks, including heating oil tanks and farm tanks with capacities                          Please Input
         over 1,100 gallons?
Hazardous Waste Storage
     65 Do generators storing hazardous waste on-site comply with the state's more
        stringent tank and container management requirements?
                                                                                                                Please Input


      66 Do generators also comply with the following:
                  a) Clearly mark each container and tank with the date accumulation
                  began with such date being visible for inspection;
                  b) Label or clearly mark the containers and tanks as "HAZARDOUS
                  WASTE" with other words to indicate the composition and physical stat
                  of the waste, and the particular hazardous properties of the waste (e.g.
                  flammable, reactive)
                  c) Label all containers and tanks with the name and address of the
                  person producing the waste?
      67 Are all substances that are defined as hazardous wastes regulated under
         California rules?                                                                                      Please Input
                                                                                             Yes   No   N/A   Comment/Concerns
Leak Detection
      68 Do container transfer and storage areas have a containment system that is
         designed and operated in accordance with following state requirements:
                a) A base must underlie the containers that is free of cracks or gaps
                and is sufficiently impervious to contain leaks, spills, and accumulated
                precipitation until the collected material is detected and removed;

                  b) The base must be sloped or the containment system designed and
                  operated to drain and remove liquids resulting from leaks, spills, or
                  precipitation, unless the containers are elevated or are otherwise
                  protected from contact with accumulated liquids;
                  c) The containment system must have sufficient capacity to contain
                  precipitation from at least a 24-hou, 25-year storm plus 10% of the
                  aggregate volume of all containers or the volume of the largest
                  container, whichever is greater. Containers that do no contain free
                  liquids need not be considered in this determination;
                  d) Run-on into the containment system must be prevented unless the
                  collection system has sufficient excess capacity in addition to that
                  required to contain any run-on that might enter the system;
                  e) Spilled or leaked waste and accumulated precipitation must be
                  removed from the sump or collection area is as timely manner as is
                                                                                                                Please Input
                  necessary to prevent overflow of the collection system. If the collected
                  material is a hazardous waste, it must be managed as a hazardous
                  waste under state law. If the collected material is discharged through a
                  point source to US waters, it is subject to the requirements of Section
                  402 of the federal Clean Water Act.
                  f) The owner or operator must submit to Cal/EPA with the application
                  for a hazardous waste facility permit a written statement signed by an
                  independent, qualified professional engineer, registered in California,
                  that indicates that the containment system is suitably designed to
                  achieve the requirements of 22 CCR 66264.175;
                  g) Storage areas that store containers holding only hazardous wastes
                  that do not contain free liquids need not have a containment system,
                  except the wastes listed below, or provided that"
                     1) The storage area is sloped or is otherwise designed and operated
                     to collect and remove liquid resulting from precipitation; or
                     2) The containers are elevated or are otherwise protected from
                     contact with accumulated liquid;
                  h) Storage areas that store containers holding the following wastes that
                  do not contain free liquids must have a containment system: F020,
                  F021, F022, F023, F026, and F027
      69 Are secondary containment systems designed, installed, and operated to
         prevent any migration of wastes or accumulated liquid out of the system to the
         soil, groundwater, or surface water at any time during the use of the tank
         system; and capable of detecting and collecting releases and accumulated
         liquids until the collected material is removed?
                                                                                        Yes   No   N/A   Comment/Concerns
70 Do secondary containments systems meet the following conditions:
          a) Constructed of or lined with materials that are compatible with the
          wastes to be placed in the tank system and must have sufficient
          strength and thickness to prevent failure owing to pressure gradients,
          physical contact with the waste to which it is exposed, climactic
          conditions and the stress of daily operation;
          b) Provided with a foundation or base underlying the tanks capable of
          providing support to the secondary containment system, resistance to
          pressure gradients above and below the system and capable of
          preventing failure due to settlement, compression, or uplift. This base
          must be free of cracks or gaps and sufficiently impervious to contain
          leaks, spill, and accumulated precipitation until the collected material is
          detected and removed;
          c) Provided with a leak-detection system that is designed and operated
          so that it will detect the failure of either the primary or secondary
          containment structure or the presence of any release of hazardous
          waste or accumulated liquid in the secondary containment system within
          24 hours, or at the earliest practicable time if the owner or operator can
          demonstrate to Cal/EPA that existing detection technologies or site
          conditions will not allow detection of a release within 24 hours;

           d) Sloped or designed to drain liquids resulting from leaks, spills, or
           precipitation. Spilled or leaked waste and accumulated precipitation
           must be removed from the secondary containment system within as
           timely a manner as is necessary to prevent overflow of the containment
           system, but within no more than 24 hours, unless the owner or operator
           can demonstrate to DTSC that removal of the released waste or
           accumulated precipitation cannot be accomplished within 24 hours and
           that overflow of the containment system will not occur?

71 Do external liner systems meet the following conditions:
          a) Designed or operated to contain precipitation from a 25-year, 24-
          hour storm event plus the greater of 10% of the aggregate volume of all
          tanks or 100% of the capacity of the largest tank within its boundary,
          whichever is greater;
          b) Designed or operated to prevent run-on and infiltration of
          precipitation into the secondary containment system unless the                                   Please Input
          collection system has sufficient excess capacity to contain run-on and
          infiltration from a 25-year, 24-hour rainfall event;
          c) Free of cracks or gaps;
          d) Designed and installed to surround the tank completely and to cover
          all surrounding earth likely to come into contact with the waste if the
          waste is release from the tanks?
72 Do vault systems meet the following conditions:
          a) Designed or operated to contain precipitation from a 25-year, 24-
          hour storm event plus the greater of 10% of the aggregate volume of all
          tanks or 100% of the capacity of the largest tank within its boundary,
          whichever is greater;
          b) Designed or operated to prevent run-on and infiltration of
          precipitation into the secondary containment system unless the
          collection system has sufficient excess capacity to contain run-on and
          infiltration from a 25-year, 24-hour rainfall event;
          c) Constructed with chemical-resistant water stops in place at all joints
          if any;
                                                                                                           Please Input
          d) Provided with an impermeable interior coating or lining that is
          compatible with the waste being transferred, stored, or treated and that
          will prevent migration of waste into the concrete;
          e) Provided with a means to protect against the formation and ignition
          of vapors within the vault, if the waste being transferred, stored, or
          treated is defined as ignitable waste under 22 CCR 66261.21, reactive
          waste under 22 CCR 66261.23, and may form an ignitable or explosive
          vapor;
          f) Provided with an exterior moisture barrier or be otherwise designed
          or operated to prevent migration of moisture into the vault if the vault is
          subject to hydraulic pressure?
                                                                                                Yes   No   N/A   Comment/Concerns
      73 Do double-walled tanks meet the following conditions:
                 a) Designed as an integral structure so that any release from the inner
                 tank is contained by the outer shell
                 b) Protected, if constructed of metal, from both corrosion of the primary
                 tank interior and of the external surface of the outer shell;
                                                                                                                   Please Input
                 c) Provided with a built-in continuous leak detections system capable of
                 detecting a release within 24 hours, or at the earliest practicable time, if
                 the owner or operator can demonstrate to DTSC and Cal/EPA
                 concludes that the existing detection technology or site conditions would
                 not allow detection of a release within 24 hours?
      74 Does ancillary equipment have secondary containment that meet the following
         state requirements:
                 a) Aboveground piping that are visually inspected for leaks on a daily
                 basis;
                 b) Welded flanges, welded joints, and welded connections that are
                                                                                                                   Please Input
                 visually inspected for leaks on a daily basis;
                 c) Sealless or magnetic coupling pumps and sealless valves that are
                 visually inspected for leaks on a daily basis;
                 d) Pressurized aboveground piping systems with automatic shut-off
                 devices that are visually inspected for leaks on a daily basis?
      75 Does the facility establish a system of periodic maintenance, investigate false
         alarms, water in improper places, inaccuracies of leak detection systems, and
                                                                                                                   Please Input
         other problems associated with leaking substances?

SQG - On-Site Accumulation Training
     76 Does the owner/operator of the SQG facility assure that employees, whose
        work may associate them with hazardous waste accumulation areas, receive on-
                                                                                                                   Please Input
        the-job or classroom training about the facility they work in and their job
        responsibilities?
     77 Are ALL of the following training requirements met:
                  a) All facility personnel who handle hazardous waste in any manner,
                  participated in an initial training course related to their management of
                  hazardous waste within six months of beginning employment;
                  b) Each facility employee participated in an annual review of his or her
                  training;
                  c) The initial training and annual review was directed by a person
                  trained in hazardous waste management?
     78 Are personnel assigned in hazardous waste storage areas generally familiar
        with ALL of the following:
                  a) Facility start up procedures;
                  b) The normal operation of the facility;
                  c) Facility shut down procedures;
                  d) Communications or alarm systems;
                  e) The facility contingency plan;
                  f) Emergency shut down procedures;
                  g) A description of controls;
                  h) The fail safe features of the systems?
     79 Are personnel assigned in hazardous waste storage areas generally familiar
        with ALL of the following:
                  a) Operating problems;
                  b) Flow controls;
                  c) Monitoring;
                  d) Documentation;
                  e) Site operating procedures;
                  f) Maintenance requirements;
                  g) Equipment safety;
                  h) Personnel safety;
     80 Are documents containing ALL of the following information maintained at the
        facility:
                  a) Records of each current employees training;
                  b) Records of former employee training, for at least three years after
                  they leave
                  c) Job title, written job description and name of employee for each
                  position related to hazardous waste management;
                  d) Written description of type and amount of training (including
                  continual training) that will be given to person filling a hazardous waste
                  management position?
     81 Do all employers establish and carry out a formal OSHA training program?
                                                                                                                   Please Input
                                                                                         Yes   No   N/A   Comment/Concerns
82 Does this program provide the following training and instructions:
            a) To all employees when your program is first established;
            b) To all new employees;
            c) To all employees given new job assignments for which training has
            not been previously received;
            d) Whenever any new substances, processes, procedures, or
            equipment are introduced to the workplace and present a new or
            different hazard;
            e) Whenever new personal protective equipment (PPE) or different
            work practices are used on existing hazards;
            f) Whenever you or your supervisors are made aware of a new or
            previously unrecognized hazard;
            g) For all supervisors to ensure they are familiar with the safety and
            health hazards to which employees under their immediate direction and
            control may be exposed?
83 Is a training program present to instruct all supervisors about:
            a) How they are key figures responsible for the establishment and
            success of your injury and illness prevention program;
            b) The importance of establishing and maintaining safe and healthful
            working conditions;
            c) The responsibility for being familiar with safe and healthful working
            conditions;
            d) The responsibility for being familiar with safety and health hazards to
            which employees are exposed; how to recognize them; the potential
            effects these hazards have on employees; and rules, procedures, and
            work practices for controlling exposure to those hazards;

          e) How to convey this information to employees by setting good
          examples, instructing them, and making sure they fully understand and
          follow safe procedures;
          f) How to investigate accidents and take corrective and preventive
          action?
84 Does the safety training program convey the following to a facility's employees:

           a) That the success of the company's injury and illness prevention
           program depends on their actions as well as management's;
           b) The safe work procedures required for their jobs, and how these
           procedures protect them against exposure;
           c) When PPE is required or needed, how to use it and maintain it in
           good condition;
           d) What employees should do if emergencies occur in the workplace;

           e) That all employees must be knowledgeable about the materials and
           equipment they are working with, what known hazards are present, and
           how they are controlled;
           f) That no employee is expected to undertake a job until he or she has
           received instructions on how to do it properly and safely and is
           authorized to perform the job;
           g) That no employee should undertake a job that appears to be unsafe;

         h) That no employee should use chemicals without fully understanding
         their toxic properties and without the knowledge required to work with
         them safely;
         I) That all mechanical safeguards must always be kept in place;
         j) That they must report to a superior or designated individual all unsafe
         conditions encountered during work;
         k) That any work-related injury or illness suffered, however slight, must
         be reported to management at once;
         l) That PPE must be used when and where required, and it must be
         properly maintained?
85 Do employees receive training that includes an explanation of:
         a) The employer's program;
         b) The exposures associated with repetitive motion injuries (RMI);
         c) The symptoms and consequences of injuries caused by repetitive
                                                                                                            Please Input
         motion;
         d) The importance of reporting symptoms and injuries to the employer;

           e) Methods used by the employer to minimize RMIs
                                                                                               Yes   No   N/A   Comment/Concerns
      86 Does OES train and certify instructors and students with a curriculum that
         includes:
                  a) First-response training;
                  b) On-scene manager training;
                  c) Hazardous substance incident response training for management
                  personnel                                                                                       Please Input
                  d) Hazardous materials specialist training that equals or exceeds the
                  standards of the National Fire Protection Association;
                  e) Environmental monitoring;
                  f) Hazardous substance release investigations;
                  g) Hazardous substance incident response activities at ports?
      87 Do area plans establish training for emergency response personnel with the
         following information:
                  a) Emergency procedures for first response to a release or threatened
                  release
                  b) Health and safety procedures for response personnel;
                  c) Use of emergency response equipment and supplies;
                  d) Procedures for access to mutual-aid resources;
                  e) Identification of medical facilities capable of providing treatment for
                                                                                                                  Please Input
                  hazardous materials incidents;
                  f) Evacuation plans and procedures;
                  g) Monitoring and decontamination procedures for personnel and
                  equipment;
                  h) First-aid procedures for hazardous materials incidents;
                  I) Procedures for informing the public during emergencies;
                  j) Psychological stress that may be encountered during disaster
                  operations?
      88 Do hazmat business plans include a training program with the following:
                  a) Methods for sage handling of hazmat;
                  b) Procedures for coordination with local emergency response
                  organizations;                                                                                  Please Input
                  c) Use of emergency response equipment and supplies under the
                  control of the handler;
                  d) All procedures required by the hazmat regulations?
      89 Did employees with duties and responsibilities including emergency response,
         chemical operations, or hazardous substance processing receive additional
         training in:
                  a) Safety equipment and procedures used in the cleanup and removal
                  of a specific hazardous substance;
                  b) Standard operating procedures, including a detailed review of the
                  hazardous substance material safety data sheets, the safe handling
                                                                                                                  Please Input
                  practices for the hazardous substance, and the application of standard
                  operating procedures to actual conditions;
                  c) Emergency procedures regarding fires, leaks, and discharges;
                  d) Equipment familiarization;
                  e) Operating data collection and entry;
                  f) Equipment start-up and shutdown;
                  g) Control and adjustment of operating conditions.
On-site Accumulation - Preparedness and Prevention
      90 Is there AT LEAST ONE employee either on the premises or on call, who has
         been assigned the responsibility of coordinating emergency response                                      Please Input
         measures?
      91 Are ALL employees thoroughly familiar with proper waste handling and
         emergency procedures which are relevant to their responsibilities as follows:
                                                                                                                  Please Input
                  a) During normal facility operations; and
                  b) During emergencies?
      92 Does the owner/operator operate and maintain the facility so as to minimize the
         possibility of fire, explosion, and an unplanned release of hazardous waste                              Please Input
         constituents?
      93 Do potential hazards associated with the waste handled in the SQG facility
         require ANY of the following equipment to ensure safety from fire, explosion or
         unplanned releases of waste;
                  a) Internal communications or alarm system;                                                     Please Input
                  b) Telephone or two-way radio to summon outside help;
                  c) Fire extinguishers and other fire control equipment; and/or
                  d) Water at adequate volume and pressure?
                                                                                                Yes   No   N/A   Comment/Concerns
      94 Is the necessary safety equipment provided as follows;
                 a) Present and available for use;
                 b) Maintained properly;
                 c) Tested periodically?
      95 Whenever HW is being handled, is immediate access to communications and
         alarm systems assured as follows;
                 a) All personnel involved have immediate access to an internal alarm or
                 emergency communication device; and
                 b) When only one employee is on the premises working with hazardous
                 waste, the employee has immediate access to a telephone or two-way
                 radio?
      96 Has the fact that no safety equipment is necessary been demonstrated?




      97 Is sufficient aisle space maintained for the unobstructed movement of
         personnel, fire, spill response and other emergency equipment?
                                                                                                                   Please Input


      98 Has the owner/operator attempted to make arrangements with local authorities
         to familiarized them with their HW operations that include information about the
         following:
                                                                                                                   Please Input
                  a) The facility;
                  b) The hazardous waste handled there; and
                  c) The facility's emergency procedures?
On-site Accumulation - Contingency Plan/Emergency Response
      99 Does the SQG facility have a contingency plan that is designed to minimize
         hazards to health or the environment from fires, explosions or unplanned                                  Please Input
         releases of hazardous waste?
    100 Does the contingency plan include all of the following information:
                  a) The actions facility personnel must take in response to an
                  emergency situation (such as a fire or HW release)
                  b) The arrangements with local or emergency response teams;
                  c) A list of ALL required pieces of emergency equipment, their locations
                  and capabilities; and
                  d) A facility evacuation plan?
    101 Have copies of the contingency plan been sent to local police and fire
         departments, hospitals and state and local emergency response teams AND
         maintained at the facility?


     102 Is the contingency plan reviewed and immediately amended whenever ANY of
         the following circumstances arise:
                  a) Applicable regulations are revised;
                  b) The plan fails in an emergency;
                  c) The HW accumulation area or associated processes change in a
                  way that materially increases the potential for an emergency situation or
                  changes the response necessary in an emergency;
                  d) The list of emergency coordinates changes; or
                  e) The list of emergency equipment changes?
     103 Are ALL of the following emergency coordinator requirements being met:
                  a) The contingency plan list names, addresses and phone numbers
                  (home and office) of people qualified to act as emergency coordinator;
                                                                                                                   Please Input
                  b) Other possible coordinators are listed in the order they will serve as
                  alternates; and
                  c) At all times, an emergency coordinator is o the premises or on call?
     104 Has the on-site accumulation area had an imminent or actual hazardous waste
         emergency situation (i.e. spill, sudden release, leak, explosion, or ignition of any                      Please Input
         hazardous waste)?
     105 During the imminent or actual emergency situation, did the emergency
         coordinator (or the designee) immediately complete ALL of the following actions:

                  a) Activate internal facility alarms or communication systems, to notify
                  all facility personnel; and
                  b) Notify appropriate State and local agencies with designated
                  response roles if their help is needed?
                                                                                              Yes   No   N/A   Comment/Concerns
     106 In response to a release, fire or explosion, did the emergency coordinator take
         ALL of the following action:
                 a) Determined the character, exact source, amount, and a real extent of
                 any released material;
                 b) Assessed possible hazards (direct and indirect) to human health or
                 the environment that could result from the release, fire or explosion;
                  c) Where human health was threatened, notified local authorities and
                  the EPA (where applicable)
                  d) During an emergency, took reasonable measures to ensure that
                  fires, explosions, and releases would not occur, recur, or spread; and
                  e) After an emergency, provided for proper cleanup, storage, treatment
                  or disposal of waste or contaminated materials and equipment?
    107 If the owner/operator had to implement the contingency plan, was the following
        information recorded and reported:
                 a) A note was made in the operating record of the time, date, and
                 details of the incident; and
                 b) Within 15 days after the incident, a written report of the incident was
                 submitted to the Regional Administrator?
Contingency Plan
    108 Has the OES been notified by the emergency coordinator immediately after a
        contingency plan has been implemented?
                                                                                                                 Please Input


     109 Has the current telephone number of OES been included in the contingency
         plan?

     110 Were the DTSC and appropriate state and local authorities notified that the
         facility is properly cleaned up or remediated before the facility resumes                               Please Input
         operations?
     111 Did the emergency coordinator submit a written report disclosing the details of
         the incident that necessitated implementation of the contingency plan within 15                         Please Input
         days after the incident?
On-site Accumulation - Containers
    112 Is the container storage area inspected weekly?

                                                                                                                 Please Input


     113 Are the container storage area inspections:
                 a) Recorded; and
                 b) Maintained for at least three years?
     114 Does the inspection record for the container storage area include ALL of the
         following:
                 a) The date and time of inspection;
                 b) The name of the inspector;
                 c) The observations of the inspector;
                 d) The date and nature of remedial actions, if any remedial actions
                 were required?
     115 Are ALL of the following true of containers kept in an on-site accumulation area:

                  a) The containers are in good condition;
                  b) The containers shows no signs of leakage, spillage, rust, bulges, or
                  other damage;
                  c) Each container is labeled or marked clearly with the words,
                  "Hazardous Waste";
                  d) The containers are clearly marked with the date accumulation began;                         Please Input

                  e) The containers are kept closed except when waste is added or
                  removed;
                  f) The containers and/or their linings are compatible with the waste
                  stored in them; and
                  g) The containers are handled and stored properly so they won't
                  rupture or leak?
     116 If a container is found to be in poor condition or leaking, are EITHER of the
         following steps taken:
                  a) The entire container is transferred to one in good condition;                               Please Input
                  b) The contents of the original container are transferred to one in good
                  condition?
     117 Are containers holding ignitable or reactive waste located at least 50 feet from
         the facility's property line                                                                            Please Input
                                                                                            Yes   No   N/A   Comment/Concerns
118 Are hazardous wastes stored in containers in ANY of the following ways:
             a) Incompatible wastes, or incompatible wastes and materials are
             placed in the same container;
             b) Hazardous wastes are placed in an unwashed container that
             previously held an incompatible waste or material; or                                             Please Input
             c) Containers holding compatible hazardous wastes or materials are
             stored near other containers, piles, open tanks, or surface
             impoundments that contain wastes with which the container waste may
             not be compatible?
119 Where incompatible wastes or materials are stored in the same container, or
    stored in unwashed container that previously held incompatible wastes, are the
    wastes and materials managed as incompatible wastes, or incompatible wastes
    and materials in compliance with 40 CFR 265.17(b)?
120 Where containers holding compatible hazardous wastes or materials are stored
    near other containers, piles, open tanks, or surface impoundments that contain
    wastes with which the container waste may not be compatible, are those
    containers separated from the other materials or protected from them by means
    of a dike, berm, wall, or other device?
121 Does the owner/operator have any containers or inner liners which they wish to
                                                                                                               Please Input
    render "empty"?
122 Are the following containers considered "empty" when they meet the following
    standards:
             a) A compressed gas container when the pressure in the container
             approaches atmospheric pressure;
             b) For acutely hazardous waste containers, the inner liners prevent
             contact with the container, OR the containers are cleaned with solvent
             or other appropriate methods;
             c) For all other waste containers, when the wastes are removed using
             standard industry methods, OR the percent weight of remaining waste
             are reduced to the mandated levels.
123 Has a container or inner liner that held an acute hazardous waste or an
    extremely hazardous waste considered exempt from the state's hazardous
    waste management regulations if it either:
             a) Is triple rinsed using a solvent capable of removing the waste, and all
                                                                                                               Please Input
             pourable residue has been removed according to the method described
             in this section; or
             b) Is cleaned by another method shown in the scientific literature, or by
             tests conducted by the generator, to achieve equivalent removal?
124 Has the container or inner liner been managed by one of the following methods
    to retain exemption:
             a) Containers of 5 gallons or less may be disposed of at a solid waste
             facility as long as the container or inner liner is transported in
             compliance with DOT rules;
             b) Any size container or inner liner may be reclaimed for scrap metal on-
             site, if sent to an off-site reclaimer, the container or inner is packed and
             transported in compliance with DOT rules;
             c) Any size container or inner liner may be reconditioned or                                      Please Input
             remanufactured in compliance with DOT container reconditioning and
             remanufacturing rules wither on-site or, if sent to an off-site
             reconditioner or remanufacturer, it is packed and transported in
             compliance with DOT rules;
             d) Any size container or inner liner may be shipped to a supplier or to
             another intermediate location for accumulation, prior to disposal,
             reclamation, or reconditioning, provided that the container or inner liner
             is packed and transported in compliance with DOT rules?
125 For containers larger than 5 gallons, has the owners/operators of the empty
    containers performed the following:
             a) Marking the date the container was emptied;
             b) Disposing of, reclaiming, or reconditioning the container within one
                                                                                                               Please Input
             year of its empty date;
             c) Retaining, for at least three years, records of the name, address, and
             telephone number of the owner and operator of the facility where the
             empty container has been shipped?
                                                                                            Yes   No   N/A   Comment/Concerns
126 Are the following containers and inner liners excluded from California's waste
    management rules:
            a) Uncontaminated containers where an inner liner prevented contact
            with hazardous waste or hazardous material
            b) Containers or inner liners sent back to the e supplier to be refilled,
            provided that the following rules are met:
                1) The container or inner liner was last used to hold material acquired
                from the supplier;
                2) The container or inner liner is emptied in compliance with federal
                rules at 40 CFR 261.7;
                3) Supplier's reuse of the container meets the federal
                reconditioning/remanufacturing standards of 49 CFR 173.28;
                4) The container or inner liner is not treated before being returned to
                the supplier;
                5) The container is not treated by the supplier without permission
                from DTSC;
                6) The container or inner liner is refilled by the supplier with material
                that is compatible with the hazardous material that the container held                         Please Input
                previously, unless the container has been properly decontaminated;

             c) Emptied household material and pesticide containers or inner liners
             removed from containers of 5 gallons or less in capacity, if the container
             or inner liner is emptied by removing all contents that can be removed
             by practices commonly used to remove materials from that type of
             container;
             d) Compressed gas cylinders when the pressure in the containers
             approaches atmospheric pressure;
             e) Aerosol cans, provided that they do not contain a hazardous waste
             identified under the federal Resource Conservation and Recovery Act,
             and if the aerosol containers are emptied of contents and propellant to
             the maximum extent practicable under normal use;
             f) Containers made of wood, paper, cardboard, fabric, or other similarly
             absorptive material, as long as the containers are not in direct contact
             with and do not absorb the hazardous waste or hazardous material?

127 Are empty containers or container-like vehicles, other than a vessel or a barge,
    with a capacity greater than 110 gallons, used to transport hazardous wastes,
    hazardous materials, hazardous substances, or recyclable materials in bulk by                              Please Input
    air, highway, rail, or water classified as bulk containers?

128 Is a bulk container classified empty when:
             a) For a residue that contains acute hazardous waste or extremely
             hazardous waste, the container is empty in accordance with the empty
             container standard described in this section for acute hazardous waste
             and extremely hazardous waste;
             b) For a residue that contains hazardous waste or hazardous material,
             the residue is no more than 0.3% by weight of the total capacity of the
             bulk container?
129 Does the residue of hazardous waste or hazardous material in a bulk container
    follow the regulations of hazardous waste when:
             a) The bulk container ceases to be operated for hazardous waste or
             hazardous material transportation;
             b) The residue is from waste that was hazardous because of the
             characteristic of toxicity and, without prior removal of the residue, the
             bulk container is subsequently used to hold a product or recyclable
             material which would be reduced in quality, value, or usefulness,
             rendered nonrecyclable, or which would potentially have an adverse
             effect on human health or the environment by commingling with the
             residue;
             c) Without prior removal of the residue, the bulk container is
             subsequently used to hold a material that is chemically incompatible
             with the residue, including, but not limited to, those incompatible
             materials listed in Appendix V to 22 CCR 66264?
                                                                                                 Yes   No   N/A   Comment/Concerns
     130 If an off-site facility receives a bulk container, did the facility follow hazardous
         waste standards when:
                   a) The bulk container does not meet the empty standard for bulk
                   containers; or
                   b) Without prior removal of hazardous waste (or hazardous material)
                   residue, the bulk container is subsequently used to hold a material that
                   is chemically incompatible with the residue, including, but not limited to,
                   those incompatible materials listed in Appendix V to 22 CCR 66264?

SQG - On-site Accumulation - Air Emission Standards
    131 Does the facility manage any hazardous waste with organic concentrations of at
        least 10 ppmv that is associated with process vents?
                                                                                                                    Please Input


    132 Does the owner/operator maintain documentation of compliance under the CAA
                                                                                                                    Please Input
         as part of the facility's operating record?
On-site Accumulation - Containment Buildings
    133 For containment buildings, does the SQG maintain EITHER of the following at
         the facility:
                  a) Written procedures to ensure each waste remains in the unit for no
                  more than 90 days, written procedures for waste generation and
                                                                                                                    Please Input
                  management which are consistent with the 90-day storage limit, and
                  documentation that the procedures are implemented; or
                  b) Records which document that containment building is emptied at
                  least once every 90 days?
On-site Accumulation - Closure of Accumulation Sites
    134 Was the facility closed in a manner that minimized the need for further
         maintenance?
                                                                                                                    Please Input


    135 Was the facility closed in a manner that minimizes, or eliminates post-closure
         escape of ALL of the following to the ground, surface waters, or to the
         atmosphere:
                a) Hazardous waste;
                                                                                                                    Please Input
                b) Hazardous constituents;
                c) Leachate;
                d) Contaminated runoff; or
                e) Waste decomposition products?
    136 During closure were ALL of the following properly disposed of or
         decontaminated:
                a) All contaminated equipment;                                                                      Please Input
                b) All contaminated structures; and
                c) All contaminated soil?
Universal Waste - Lamps
    137 Does the facility generate universal waste lamps?

                                                                                                                    Please Input


     138 Are universal waste lamps contained in packages or containers as follows:
                  a) Containers and packages are structurally sound;
                  b) Containers and packages are compatible with the contents of the
                  lamps                                                                                             Please Input
                  c) Containers and packages are adequate to prevent leakage and
                  breakage under reasonably foreseeable conditions; and
                  d) Containers and packages show no sign of leakage?
     139 Have any universal waste lamps appeared to be leaking, spilling, or damaged
         so that they might leak?                                                                                   Please Input

     140 Was the lamp which was leaking, spilling or damaged moved to a container that
         meets ALL of the following requirements:
                a) The container is closed;
                b) The container is structurally sound;
                c) The container is compatible with the battery; and
                d) The container lacks evidence of leakage, spillage, or damage that
                could allow for leakage, spillage or damage?
                                                                                               Yes   No   N/A   Comment/Concerns
    141 Is EACH universal waste package or container which holds a lamp labeled or
         marked clearly with AT LEAST ONE of the following:
                  a) The words "Universal Waste Lamp(s)"; or                                                      Please Input
                  b) The words "Waste Lamp(s)"; or
                  c) The words "Used Lamp(s)"?
Universal Waste - Accumulation Time Limits
    142 Is universal waste accumulated for longer than one year from the date the
                                                                                                                  Please Input
         universal waste was generated or received from another handler?
    143 Is universal waste accumulated longer than one year only to gather sufficient
         quantities to facilitate recovery, treatment or disposal?
                                                                                                                  Please Input


     144 Is the handler able to prove how long the universal waste has been
         accumulating?                                                                                            Please Input

Universal Waste - Off-site Transport
    145 Does the universal waste handler always send or take universal waste to one of
         the following:
                  a) Another universal waste handler;                                                             Please Input
                  b) A destination facility; or
                  c) A foreign destination?
    146 Does the universal waste handler itself take waste off-site?                                              Please Input
     147 Where a universal waste handler sends or takes universal waste off-site, have
         they compiled with the regulations for universal waste transporters (40 CFR
         273, Subpart D)?
     148 Does the handler ever send a shipment of universal waste to another handler?
                                                                                                                  Please Input
    149 Whenever the handler has sent a universal waste shipment to another handler,
         has the receiving handler always agreed to receive the shipment?
    150 Has a universal waste shipment sent by the handler ever been rejected by the
                                                                                                                  Please Input
         receiving handler or destination facility?
    151 As the originating handler of a rejected shipment, did the facility do either of the
         following:
                 a) Take the universal waste back; or
                 b) Agree to a destination facility with the receiving handler?
Universal Waste - Small Handler
    152 Does the small quantity handler provide training which includes a description of
         proper handling and emergency procedures appropriate to the types of                                     Please Input
         universal waste handled at the facility?
Medical/Biohazardous Wastes
    153 Facilities that manage wastes that meet OSHA's definition for "regulated
         wastes" must comply with at least the following requirements:
                 a) Containing or discarding contaminated sharps;
                 b) Containing and discarding all (medical waste) contents and                                    Please Input
                 preventing leakage during handling, storage, transport, or shipping; and

                  c) Labeling or color-coding according to 29 CFR 1910.1030(g)(1)(i)?
    154 Unless exempted, facilities that manage medical wastes that meet DOT's
         definition for "regulated medical wastes" must comply with the following
         requirements:
                  a) Assignment of packing groups and applicable packaging section (49
                  CFR 173.134(c));
                                                                                                                  Please Input
                  b) Paper, labeling, placarding and marking requirements under 49 CFR
                  172 - General requirements;
                  c) Regulated medical waste (non-bulk packaging for hazardous
                  materials other than class 1 and class 7) (49 CFR 173.197); and
                  d) Infectious substance labeling requirements (49 CFR 172.432)?
Used Oil
    155 Does the facility dispose of any hazardous used oils?                                                     Please Input
    156 Are hazardous used oils disposed of according to hazardous waste
         requirements of 40 CFR 260 through 40 CFR 265, 40 CFR 268, 40 CFR 270,
         and 40 CFR 124?
    157 Does the facility dispose of used oils that are not hazardous wastes and cannot
                                                                                                                  Please Input
         be recycled?
    158 Are non-hazardous used oils disposed of according to the requirements of 40
         CFR 257 and 40 CFR 258?
                                                                                               Yes   No   N/A   Comment/Concerns
Used Oil - Generation, Collection, Aggregation
    159 Has there been a release of used oil from a facility after the effective date of the
          used oil management program?


                                                                                                                  Please Input




     160 Does the facility generate used oil that may have been mixed with hazardous
                                                                                                                  Please Input
         waste?
     161 Upon detection of a release, did the generator perform ALL of the following
         cleanup steps:
                 a) Stop the release;
                 b) Contain the released used oil;
                                                                                                                  Please Input
                 c) Clean up and manage properly the released used oil and other
                 materials; and
                 d) Repair or replace any leaking used oil storage containers or tanks
                 prior to returning them to service
     162 Is used oil shipped off-site from the facility?
                                                                                                                  Please Input
    163 Does the generator, collection center or aggregation point ship used oil off-site
          exclusively with transporters who have EPA Identification Numbers?
Used Oil - Generation, Collection, Aggregation - Storage
    164 Is used oil stored only in ANY of the following storage units:
                  a) Tanks;
                                                                                                                  Please Input
                  b) Containers; or
                  c) Units subject to regulation as permitted or interim status TSDF?
    165 Are all containers, aboveground tanks, and fill pipes which are used to store and
          transfer used oil:
                  a) In good condition, with no severe rusting, no structural defects and                         Please Input
                  no signs of deterioration;
                  b) Not leaking?
    166 Are all containers and aboveground tanks which are used to store used oil
                                                                                                                  Please Input
          labeled or marked clearly with the works "used oil"?
    167 Do you have a Professional Engineer signed Spill Prevention, Countermeasure,
          Control Plan?
                                                                                                                  Please Input


Used Oil - Transport/Transfer
    168 Has there been a release of used oil from the facility after the effective date of
                                                                                                                  Please Input
          the used oil management program?
    169 Upon detection of a release, were the following cleanup steps performed:
                 a) Stop the release:
                 b) Contain the released used oil;
                 c) Clean up and manage properly the released used oil and other
                 materials; and
                 d) Repair or replace any leaking used oil storage containers or tanks
                 prior to returning them to service?
Used Oil - Transport/Transfer - Storage
    170 Do containers and aboveground tanks at the facility have a secondary
          containment system?                                                                                     Please Input

    171 Does the secondary containment system consist of, at a minimum:
                  a) Dikes, berms, or retaining walls, and a floor that covers the entire
                  area within the dikes, berms, or retaining walls; or
                  b) An equivalent secondary containment system?
    172 Is the entire secondary containment system sufficiently impervious to used oil to
          prevent a release of used oil from migrating to the soil, groundwater, or surface
          water?
Used Oil - Transport/Transfer - Recordkeeping
    173 Are records kept of each used oil shipment accepted for transport?                                        Please Input
    174 Do records of used oil accepted for shipment include ALL of the following:
                  a) The name and address of the generator, transporter (except for
                  intermediate rail transporter), or processor/re-refiner who provided the
                  used oil for transport;
                                                                                                                  Please Input
                   b) The EPA Identification Number (if applicable);
                  c) The quantity of used oil accepted;
                  d) The date of acceptance; and
                  e) The signature of a representative of the supplier?
    175 Are records kept of each shipment of used oil delivered to another used oil
                                                                                                                  Please Input
          transporter, processor/ re-refiner, or used oil burner?
                                                                                                Yes   No   N/A   Comment/Concerns
     176 Do records of used oil delivered to another used oil transporter (except for
         intermediate rail transporter), processor/re-refiner, or used oil burner include
         ALL of the following:
                 a) The name and address of the receiving facility or transporter;
                 b) The EPA Identification Number of the receiving facility or transporter;

                  c) The quantity of used oil delivered;
                  d) The date of delivery; and
                  e) The signature of a representative of the receiving facility or
                  transporter?
    177 Are all records of shipments and/or deliveries maintained for a minimum of three
                                                                                                                   Please Input
          years?
Used Oil - Management
    178 Are shipments of used oil accompanied by either a hazardous waste manifest
          meeting the requirements of CH & SC 25160 and CH & SC 25161 or by what
                                                                                                                   Please Input
          the state calls a "modified manifest" (CH & SC 25250.8)?

     179 Do transporters complete a modified manifest and meet the following
         requirements?
                a) A separate manifest must be completed by each vehicle driver for
                each shipment of used oil.
                b) The transporter must complete both the generator's and the hauler's
                sections of the manifest using the hauler's name, EPA ID number,
                terminal address, and phone number.
                c) The transporter must attach legible receipts to the front of the
                manifest for each quantity of used oil received from a generator
                (receipts are used to determine the total volume of used oil in the
                vehicle).
                d) All copies of each receipt must contain all of the following information:-
                The name, address, EPA ID number, and telephone number of the
                                                                                                                   Please Input
                generator- The signature of the generator or its representative- The date
                of the shipment- The state manifest number- The volume of the used oil
                received- The used oil's proper shipping description including
                hazardous class and identification number, if applicable- The name and
                address of the permitted facility to which the used oil will be transported-
                The transporter's name, address, and EPA ID number- The driver's
                signature
                e) Submit all copies of the manifest to the designated facility for
                signature and dating by the facility's representative.
                f) Submit the generator copy of the manifest to Cal/EPA within 30 days
                of each shipment.
                g) Retain a copy of the manifest and all receipts for each manifest for
                three years?
     180 Do generators using a registered hazardous waste transporter keep a copy of
                                                                                                                   Please Input
         the used oil receipt for three years?
     181 Do generators who claim that used oil is exempt from regulation as hazardous
         waste because it meets the "purity" exemption standard set forth at CH & SC
         25250.1(b)(1) comply with the following:
                a) Notify Cal/EPA in writing of the claim of exemption (CH & SC
                25250.1(b)(2)).
                b) Ensure that the used oil has been tested and certified as being in
                compliance with the exemption's standards prior to transportation from
                the generator's site (CH & SC 25250.19(b)).
                c) Maintain for three years records of tests performed and a copy of the                           Please Input
                completed certification form received from the transporter (CH & SC
                25250.19(b)).
                d) Record in an operating log and retain for three years the following
                information on each shipment of recycled or exempted oil (CH & SC
                25250.19(c)):- Information on the generator- The name and address of
                the facility receiving the shipment- The quantity of oil delivered- The
                date of shipment or delivery- A cross-reference to the records and
                documents described in this section under Recycled Oil?
                                                                                               Yes   No   N/A   Comment/Concerns
Used Oil Filters
    182 Are used oil filters (UOFs) managed as hazardous waste unless one of the
         following applies (22 CCR 66266.130(a)):
                 a) The filters are deemed nonhazardous under state Cal/EPA rules or
                 applicable federal waste characterization procedures.
                 b) The filters are generated as household waste and are taken to a                               Please Input
                 collection location or picked up by a curbside collection system and
                 transferred for purposes of recycling.
                 c) The filters are managed and recycled in compliance with the
                 procedures described in this section?
    183 Are UOFs drained of all "free-flowing oil."?
                                                                                                                  Please Input

     184 Are UOFs accumulated, stored, and transferred in a closed rainproof container
         that is capable of containing any used oil that may separate from the filters                            Please Input
         placed inside?
     185 Are drums of UOFs sealed during transfer so that the used oil will not spill out if
                                                                                                                  Please Input
         the drums are laid on their sides?
     186 Are drums secured as a load to prevent movement or tipping during transfer?
                                                                                                                  Please Input
     187 For used oil that is separated from the filters during draining procedures, or that
         accumulates in the container in which the filters are stored or transferred and
                                                                                                                  Please Input
         remain there after the filters have been removed, are they managed as a
         hazardous waste?
     188 Are containers of drained UOFs labeled as "drained used oil filters" and not as
         hazardous waste?                                                                                         Please Input

     189 Do locations receiving UOFs place the date of receipt upon each container of
         filters received?                                                                                        Please Input

     190 Is storage of less than one ton of UOFs limited to one year?
                                                                                                                  Please Input

     191 Is storage of one ton or more of UOFs limited to 180 days. ?
                                                                                                                  Please Input

     192 For all storage beyond these limits, does the facility have a hazardous waste
         permit.?
                                                                                                                  Please Input


Additional Notes
                                                                                              Yes   No   N/A   Comment/Concerns
California
Air Quality Standards

Smoke Emissions From Fuel Combustion (opacity)
      1 Are there any stationary internal combustion engines located at this facility?

                                                                                                                 Please Input


       2 Are there any non-utility boilers (indirect heat exchange) at this facility with a
         rated heat input less than 10 mmBtu/hr that were built, modified, or
         reconstructed before June 10, 1989?                                                                     Please Input


       3 Are there any non-utility boilers (indirect heat exchange) at this facility with a
         rated heat input greater than or equal to 200 mmBtu/hr?                                                 Please Input

       4 Have the opacity observations been conducted concurrently with the initial
                                                                                                                 Please Input
         performance testing required by NSPS, using EPA-approved methods?
       5 Has EPA determined that the source(s) did not meet the applicable opacity
         standards?                                                                                              Please Input

Fugitive Emissions
       6 Was your local district contacted to determine what fugitive emission standards
                                                                                                                 Please Input
         are required at your facility?
Air Emission Permits
       7 Have all new or modified sources that resulted in an increase in emissions of
         certain organic compounds, nitrogen oxides (Knox), sulfur dioxide (SO2),
                                                                                                                 Please Input
         particulate matter (PM10), or carbon monoxide (CO) in excess of 10 pounds per
         day undergone best available control technology (BACT)?
NSR - Nonattainment Areas
       8 Were Orange County and Santa Clara County included in nonattainment areas?
                                                                                                                 Please Input
       9 Has Orange County exceeded levels for particulates (PM10)?
                                                                                                                 Please Input

      10 Has Orange County exceeded carbon monoxide levels?
                                                                                                                 Please Input

Particulate Emissions From Fuel Combustion
      11 Are there any stationary internal combustion engines located at this facility with
          a heat input greater than 1 mmBtu/hr?                                                                  Please Input

      12 Are there any non-utility boilers (indirect heat exchange) at this facility with a
         rated heat input less than 10 mmBtu/hr that were built, modified, or                                    Please Input
         reconstructed before June 10, 1989?
Particulate Emissions From Manufacturing Processes
      13 Are there any manufacturing processes at this facility that emit air contaminants
          to the atmosphere through a stack or chimney?                                                          Please Input

Sulfur Emissions
      14 Do any of the exhaust points, with a gas discharge ≥ 3,000 scfm, at the facility
         emit SO2 at a rate ≥ 50 lbs in any 60-minute period and ≥ 100 lb/hr rate at any
                                                                                                                 Please Input
         instant? (This does not apply to fuel combustion or emergency vents.)

      15 Is the gas discharge from any SO2 emitting stack < 1,000 scfm? (This does not
         apply to fuel combustion or emergency vents.)
                                                                                                                 Please Input


      16 Do any exhaust points at the facility emit SO3 or H2SO4? (This does not apply to
         fuel combustion or emergency vents.)
                                                                                                                 Please Input


      17 If SO3 and H2SO4 are discharged, have the proper stack tests been performed
         and recorded in a permanent log? (This does not apply to fuel combustion or
         emergency vents.)                                                                                       Please Input
                                                                                             Yes   No   N/A   Comment/Concerns
      18 Are any sulfur compounds other than SO2, SO3, and H2SO4 emitted from any
         exhaust points? (This does not apply to fuel combustion or emergency vents.)
                                                                                                                Please Input


Sulfur Limits in Fuels
      19 Is diesel fuel (#2 fuel oil) used at this facility in a combustion process?

                                                                                                                Please Input


      20 Is #4 fuel oil used at this facility in a combustion process?

                                                                                                                Please Input


VOC Emission Limits
     21 Are there any storage tanks present at this facility that store volatile organic
        compounds (VOC)?
                                                                                                                Please Input


      22 Are VOCs (non-gasoline) transferred into any tanks, installed after 12/17/1979,
         at this facility that have a maximum capacity greater than or equal to 2,000
         gallons?                                                                                               Please Input


      23 If the answer to #15 is 'Yes', is the calculated annual emission rate for any VOC
         storage tank > 1,000 lb/year?
                                                                                                                Please Input


      24 Are VOCs (non-gasoline) transferred from any tanks at this facility that have a
         maximum capacity greater than or equal to 2,000 gallons to a delivery vessel,
         other than railroad cars, with emissions > 2,000 lb/yr that is not used for < 30
         days to hold VOC from a storage tank undergoing repair or maintenance, used                            Please Input
         for groundwater remediation operations, or a vacuum truck used for cleaning
         operations?
      25 Do any tank trucks with a maximum capacity greater than or equal to 2,000
         gallons deliver VOCs to this facility?
                                                                                                                Please Input


      26 Is the answer to either #15 or #17 'Yes'?

                                                                                                                Please Input


      27 Do any delivery vessels, including rail cars, enter the facility that have a
         maximum capacity greater than or equal to 2,000 gallons and are loaded with
         VOC?                                                                                                   Please Input


      28 If the answer to either #18, #19, or #20 is 'Yes', have any leaking tank trucks
         been repaired at the facility?

                                                                                                                Please Input



      29 Is the answer to #17 'Yes'?
                                                                                                                Please Input

      30 Are there any open-top tanks and/or surface cleaners present at this facility?
         (this includes oil-water separators)
                                                                                                                Please Input


      31 If open-top tanks and/or surface cleaners are present, are the operating and
         maintenance instructions located at the equipment?
                                                                                                                Please Input


      32 Are there any surface coating operations present at this facility?
                                                                                                                Please Input
                                                                                                 Yes   No   N/A        Comment/Concerns
      33 If surface coating is done at the facility, does it include metal furniture coating?
                                                                                                                          Please Input


      34 If surface coating is done at the facility, are there any coatings that are not in
         compliance with the VOC content limit(s)?

                                                                                                                          Please Input




Boiler VOC and NOx Emission Limits
      35 Are there any non-utility boilers present at the facility that have a rated heat
         input greater than or equal to 20 mmBtu/hr?                                                                      Please Input
      36 Are the potential emissions of NOx at the facility less 25 tons/year?
                                                                                                                          Please Input
      37 Are the potential emissions of NOx at the facility for any day between May 1 and
         September 15 less than 137 lbs/day?                                                                              Please Input


                                                                                                                  Please input answers to above
                                                    Result of boiler applicability analysis:
                                                                                                                            questions

      38 Do any applicable boilers have a rated heat input greater than or equal to 50
         mmBtu/hr? (VOC Limits)
                                                                                                                          Please Input


      39 Do any applicable boilers have a rated heat input greater than or equal to 20
         mmBtu/hr but less than 50 mmBtu/hr? (VOC and NOx Limits)
                                                                                                                          Please Input


      40 Do any applicable boilers have a rated heat input greater than or equal to 50
         mmBtu/hr but less than 100 mmBtu/hr? (NOx Limits)                                                                Please Input

      41 Do any applicable boilers have a rated heat input greater than or equal to 100
         mmBtu/hr?                                                                                                        Please Input

Stationary Internal Combustion Engine VOC and NOx Emission Limits
      42 Are there any stationary internal combustion engines with a horsepower rating
                                                                                                                          Please Input
         greater than 500 HP?
      43 If there are engines located at this facility, do they meet the all of the following
         criteria: (1) Emergency generator subject to federally enforceable limit or
                                                                                                                          Please Input
         condition restricting operation to less than 500 hours per year; (2) Potential NOx
         emissions less than 25 tons/year?


               Result of stationary internal combustion engine applicability analysis:                            Please answer questions above


      44 Are there engines at the facility subject to the state VOC requirements?
                                                                                                                          Please Input

      45 Are there rich-burn engines at the facility subject to the state NOx limits?
                                                                                                                          Please Input

      46 Are there lean-burn engines at the facility fired by gaseous fuels that are subject
                                                                                                                          Please Input
         to the state NOx limits?
      47 Are there lean-burn engines at the facility fired by liquid fuels that are subject to
         the state NOx limits?                                                                                            Please Input

Reporting and Recordkeeping for VOC and NOx Limits
     48 Is this facility subject to VOC limitations? (if the answer to any questions from
         #14 to #37 indicates applicability to Section 16, answer 'Yes')                                                  Please Input

      49 Is this facility subject to NOx limitations? (if the answer to any questions from
         #26 to #37 indicates applicability to Section 19, answer 'Yes')                                                  Please Input

Operating Permits
                                                            Yes   No   N/A   Comment/Concerns
50 Have all proper state operating permits been obtained?
                                                                               Please Input
                                                                                               Yes   No   N/A   Comment/Concerns
      51 Is the facility in compliance with the following permit provisions to the extent
         contained in each permit:

                  a) Expiration data;
                  b) Emission limitations;
                  c) Limits on hours of operation;
                  d) Limits on the nature or quantity of fuel burned or raw material
                  processed;
                  e) Stack testing requirements and/or continuous emission monitoring
                  requirements;
                  f) Recordkeeping and reporting requirements;
                  g) Maintenance requirements; and
                  h) Alternate operating scenarios, where applicable?

      52 Are all sources registered with the appropriate state or local authorities?

                                                                                                                  Please Input


      53 Does the owner or operator of EACH registered source:

                  a) Maintain all registration documentation at the site for the time period
                                                                                                                  Please Input
                  specified by applicable or local regulations; and
                  b) Comply with all registration permit requirements?

NSPS - General Provisions
     54 To the extent practicable, is the facility maintained and operated in a manner
        consistent with good air pollution control practices for minimizing emissions,
        including during periods of startup, shutdown, and malfunction?                                           Please Input


      55 Has the owner or operator used any article or process that would conceal
         emissions from the compliance-testing analysis?                                                          Please Input

NSPS - Modification/Reconstruction
     56 Have there been any modifications to your facility that are subject to NSPS
        requirements?
                                                                                                                  Please Input


      57 Was compliance with the NSPS standards achieved within 180 days of the
         completion of any modification?



      58 Have any reconstruction projects occurred or been planned that meet BOTH of
         the following conditions:
                 a) Components at an existing facility are replaced; and                                          Please Input
                 b) The capital cost of the new components exceeds 50% of the fixed
                 capital cost that would be required to construct a comparable and
                 entirely new facility?
      59 Did the owner/operator of the facility notify EPA of the proposed replacement at
         least 60 days before commencement of the replacement construction?




NSPS - Performance Testing
     60 Has the facility conducted performance tests for its NSPS-regulated sources?
                                                                                                                  Please Input

      61 Was a performance test conducted within 60 days after achieving maximum
         production rate at the affected facility, but not later than 180 days after initial
         startup of the facility?


      62 Were performance tests conducted under conditions which are representative of
         the performance of the affected facility?
                                                                                   Yes   No   N/A   Comment/Concerns
63 Was EPA notified of the performance test at least 30 days prior to conducting
   the test?
                                                                                                 Yes   No   N/A   Comment/Concerns
      64 Were the performance tests conducted in ONE of the following manners:
                a) In accordance with the test methods specified in each applicable
                subpart of 40 CFR 60; or
                b) By using an equivalent test previously approved by EPA?
      65 Were ALL of the following test procedures implemented for each performance
         test:

                  a) Each performance test consists of three separate runs;
                  b) Each run is conducted for the time specified in the test method; and

                   c) The arithmetic mean of the results of the three runs is used in
                   determining compliance with the applicable standard?
      66 Did the owner/operator provide ALL of the following performance testing
         facilities:




               a) Sampling ports adequate for the test method applicable to that
               facility;
               b) Safe sampling platforms;
               c) Safe access to sampling platforms; and
               d) Utilities for sampling and testing equipment?
      67 Was a written report of performance test results sent to EPA?



     68 Bases on the written report of performance test results, did EPA determine that
        the facility was NOT in compliance with the applicable NSPS
NSPS - Opacity
     69 Have opacity observations been conducted at your facility?                                                  Please Input
      70 Were the opacity observations conducted in the following manner:
                a) Concurrently with the initial performance testing; and
                b) In accordance with EPA-approved methods?
      71 Has EPA determined that the facility failed to meet the applicable opacity
         standard?                                                                                                  Please Input

NSPS - Written Requirements
     72 Has the owner/operator of the facility provided written or electronic notification to
        EPA of the following dates, whenever applicable:
                a) The date which construction (or reconstruction) of an affected facility
                is commenced, postmarked no later than 30 days after such date; and                                 Please Input

                b) The actual initial startup date, postmarked within 15 days of such
                date?
      73 Has the owner/operator of the facility provided written or electronic notification to
         EPA of the following events, whenever applicable:
                a) The date upon which demonstration of the continuous monitoring
                system performance commences, no less than 30 days prior to such
                date;
                 b) The anticipated date for conducting the required opacity                                        Please Input
                 observations, no less than 30 days prior to such date; and
                 c) Any physical or operational change to an existing facility which may
                 increase the emission rate of any air pollutant to which a standard
                 applies, 60 days or as soon as practicable before the change is
                 commenced?
      74 Are records maintained of the occurrence and duration of ALL of the following
         periods:



                                                                                                                    Please Input
                  a) Any startup, shutdown, or malfunction in the operation of your facility;

                  b) Any malfunction of the air pollution control equipment; and
                  c) Any periods during which a monitoring system or device is
                  inoperative?
NSPS - Small Non-Utility Steam Generators - PM Emissions
     75 Does the small non-utility steam generating unit meet ALL of the following
        criteria:
                  a) It combusts coal, wood or oil; and                                                             Please Input
                                                                                                Yes   No   N/A           Please Input
                                                                                                                       Comment/Concerns
                b) It has a heat input capacity of 8.7 MW (30 million Btu/hour) or
                greater?
     76 Does the small non-utility steam generating unit which combusts coal, oil or
                                                                                                                  The small non-utility generator
        wood, discharge any gases to the atmosphere which exhibit greater than 20
                                                                                                                 shall not discharge excess gases
        percent opacity (6-minute average), except for one 6 minute period per hour of
                                                                                                                         to the atmosphere
        not more than 27 percent opacity?
NSPS - Small Non-Utility Steam Generators - SO2 Emissions
     77 Were the following affected facilities exempted from the sulfur dioxide percent
        reduction requirements:
                a) Those which have a heat input capacity of 22 MW (75 million
                Btu/hour) or less;
                b) Those which have an annual capacity for coal of 55 percent (.55) or
                less and are subject to a federally-enforceable requirement limiting
                operation to this level;                                                                                   Please Input
                c) Those located in a non-continental area; and
                d) Those that combust coal in a duct burner as part of a combined cycle
                system where 30 percent (.30) or less of the heat entering the steam
                generating unit is from combustion of coal in a duct burner and 70
                percent (.70) or more is from exhaust gases entering the duct burner?

     78 Does the small non-utility facility combust coal along with other fuels?                                           Please Input
     79 Does the facility that burns coal along with other fuels discharge any gases into
        the atmosphere that contain ANY of the following emission:
                 a) Sulfur dioxide in excess of 10 percent (.10) of the potential sulfur
                 dioxide emission rate (90 percent reduction); pr
                 b) Sulfur dioxide in excess of the emission limit determined by using the
                 formula in 40 CFR 60.42c(e)(2) of the full-text regulations?
     80 Does the small non-utility steam generating unit combust oil?                                                      Please Input
     81 Does the oil-burning steam generating unit meet ONE OR MORE of the
        following requirements:
                 a) No gases which contain sulfur dioxide in excess of 215 ng/J (.50
                 lb/million Btu) heat input are discharged into the atmosphere; or
                 b) No oil is combusted which contains greater than .5 weight percent
                 sulfur?
     82 Does the small non-utility steam generating unit combust coal, oil or both with
                                                                                                                           Please Input
        any other fuel?
     83 Does the facility which combusts coal, oil or both, with another fuel discharge
        any gases into the atmosphere that contain sulfur dioxide in excess of the
        emission limit calculated using the formula in 40 CFR 60.42(e)(2) of the full-text
        regulations?
     84 Is compliance with the sulfur dioxide percent reduction requirements, fuel oil
        sulfur limits, and sulfur dioxide emission limits determined based on EITHER of
        the following:
                 a) A 30-day rolling average; or
                 b) A certification fro the fuel supplier if the unit is ANY of the following
                 types of facilities:
                                                                                                                           Please Input
                 1) Distillate oil-fired facility with heat input capacity between 2.9 and 29
                 MW 910 and 100 million Btu/hour);
                 2) Residual oil-fired facility with heat input capacity between 2.9 and 8.7
                 MW (10 and 30 million Btu/hour);
                 3) Coal-fired facility with heat input capacity between 2.9 and 8.7 MW
                 (10 and 30 million Btu/hour)?
NSPS - Small Non-Utility Steam Generators - Test Methods and Procedures
     85 Does the owner or operator of the facility which is subject to particulate matter
        and/or opacity standards, determine compliance with the standards by
                                                                                                                           Please Input
        conducting an initial performance test, and subsequent performance tests as
        required by the EPA
     86 When initial and subsequent performance tests are performed to demonstrate
        compliance with particulate matter and/or opacity standards, are the tests
        conducted using the procedures and reference methods specified in 40 CFR
        60.45c(a) of the full-test regulations?
                                                                                               Yes   No   N/A   Comment/Concerns
87 Are initial performance tests for compliance with sulfur dioxide standards
   conducted in accordance with ALL of the following requirements:
            a) It is conducted over 30 consecutive operating days of the steam
            generating unit;
            b) The first operating day of the test is scheduled within 30 days after
            the facility achieves maximum production rate, but not later than 180
            days after the initial startup of the facility;                                                       Please Input
            c) The load during the 30 day period does not have to be the maximum
            design heat input capacity, but is representative of future operating
            conditions; and
            d) Compliance with the sulfur dioxide percent reduction requirements
            and the sulfur dioxide emission limits is determined using a 30-day
            average?
88 After the initial performance test is conducted, is compliance with the sulfur
   dioxide percent reduction requirements and the sulfur dioxide emission limits
   demonstrated using ALL of the following methods:
            a) A separate performance test is completed at the end of each steam
            generating unit operating day;
            b) A new 30-day average percent reduction and a sulfur dioxide                                        Please Input
            emission rate are calculated each day to show compliance with the
            standard; and
            c) Compliance is based on the average percent reduction and the
            average sulfur dioxide emission limits for 30 consecutive steam
            generating unit operating days?
89 Does the affected facility combust only coal, oil, or a mixture of coal and oil?
                                                                                                                  Please Input
90 Are ALL of the following procedures used at the coal/oil combustion facility when
   determining compliance with the sulfur dioxide standard:
            a) The procedures in Method 19 (40 CFR Part 60, Appendix A) are
            used to determine the hourly sulfur dioxide emission rate and the 30-day
            average sulfur dioxide emission rate; and
            b) The hourly averages used to compute the 30-day averages are
            obtained from the continuous emission monitoring system?
91 Does the affected facility combust coal and/or oil with other fuels?                                           Please Input
92 Is the adjusted hourly sulfur dioxide emission rate for the facility which combusts
   coal/oil with other fuels, computed using the formula presented at 40 CFR
   60.44c(e)(1) in the full-text regulations?



93 For a facility that is not subject to sulfur dioxide percent reduction requirements
   and which measures coal or oil emission rates using Method 19, were the
   parameters Ew (sulfur dioxide concentration in fuels other than coal and oil) or
   Xk (fraction of the total heat input from fuel combustion derived from coal and
   oil) measured when calculating the adjusted hourly sulfur dioxide emission rate?

94 Does the small non-utility steam generating unit meet ALL of the following
   criteria:
             a) It combusts oil; and                                                                              Please Input
             b) The owner or operator seeks to demonstrate compliance with fuel oil
             sulfur limits based on shipment fuel sampling?
95 Does the oil-combustion facility which is demonstrating compliance based on
   shipment fuel sampling, perform ALL of the following sampling:
             a) An initial performance test consisting of sampling and analyzing the
             oil in the initial tank of oil to be fired in the unit, to demonstrate that the
             oil contains 0.5 weight percent sulfur or less; and
             b) Sampling the oil in the fuel tank after each new shipment of oil is
             received, immediately after the tank is filled (whether or not it was
             empty) and before any oil is combusted, to demonstrate that the oil
             contains 0.5 sulfur weight percent sulfur?
96 Does the small non-utility steam generating facility meet BOTH of the following
   criteria:
             a) The owner or operator seeks to demonstrate compliance with the
             sulfur dioxide standards based on fuel supplier certification; AND
             b) It falls into one of the following categories:
             1) Distillate oil-fired facility with heat input capacity between 2.9 and 29                         Please Input
             MW 910 and 100 million Btu/hour);
             2) Residual oil-fired facility with heat input capacity between 2.9 and 8.7
             MW (10 and 30 million Btu/hour);
             3) Coal-fired facility with heat input capacity between 2.9 and 8.7 MW
             (10 and 30 million Btu/hour)?
                                                                                                Yes   No   N/A   Comment/Concerns
     97 For the facility demonstrating compliance based on fuel supplier certification,
        does the performance test consist of fuel supplier certification that includes the
        following, as appropriate for the fuel combusted:
                  a) For distillate oil: name of the oil supplier, and a treatment from the
                  supplier that the oil complies with the specifications under the definition
                  of distillate oil;
                  b) For residual oil: name of the oil supplier, location of the oil when the
                  sample was taken for analysis, sulfur content of the shipment or the oil
                  from which the shipment came, and the test method used; or
                  c) For coal: name of the coal supplier, location of the coal when a
                  sample was taken for analysis of its properties, the results of the
                  analysis of the shipment or the coal from which the shipment came, and
                  the test method used?
NSPS - Small Non-Utility Steam Generators - Monitoring Requirements
     98 Does the small non-utility steam generating unit meet ALL of the following
        criteria:
                                                                                                                   Please Input
                  a) It combusts coal, residual oil or wood; and
                  b) It is subject to the opacity standards (40 CFR 60.43c)?
     99 Does the coal/wood/residual oil combustion facility which is subject to opacity
        standards perform ALL of the following required activities:
                  a) Install, calibrate, maintain and operate a continuous emission
                  monitoring system for measuring opacity of emissions discharged to the
                  atmosphere; and
                  b) Record the output of the system?
   100 Is the continuous emission monitoring system operated in accordance with the
        applicable procedures under Performance Specification 1 (40 CFR Part 60,
        Appendix B of the full-text regulations)?
NSPS - Small Non-Utility Steam Generators - Reporting
   101 Did the owner or operator of the small non-utility steam generating facility submit
        to EPA notification of the date of construction or reconstruction, anticipated
        startup and actual startup, which included ALL of the following information:

                   a) Design heat input capacity and identification of fuels to be
                   combusted;
                   b) A copy of any federally enforceable requirement that limits the annual                       Please Input
                   capacity factor for any fuel or mixture of fuels;
                   c) Annual capacity factor at which it is anticipated the facility will
                   operate, based on all fuels fired and on each individual fuel fired; and
                   d) Notification if an emerging technology will be used to control SO2
                   emissions (note that EPA must determine whether the technology
                   qualifies as an emerging technology)?
     102   Has the owner or operator of the small non-utility steam generating facility which
           is subject to particulate matter, opacity or sulfur dioxide emission limits submit
           ALL of the following to EPA:
                   a) Performance test data from the initial performance test;
                                                                                                                   Please Input
                   b) Performance test data from subsequent performance tests; and
                   c) The performance evaluation of the CEMS, if applicable, using the
                   relevant performance specifications in 40 CFR 60 Appendix B of the full-
                   test regulations?
     103   Is the small non-utility steam generating unit a coal-fired, residual oil-fired or
                                                                                                                   Please Input
           wood-fired facility subject to opacity limits
     104   Does the owner or operator submit excess emission reports for any excess
           emissions from the affected facility which occur during the reporting period?
     105   Were all reports postmarked by the 30th day following the end of the reporting
           period?



     106 Is the small non-utility steam generating unit facility subject to sulfur dioxide
         emission limits, fuel oil sulfur limits, or percent reduction requirements under 40                       Please Input
         CFR 60.42c?
                                                                                                Yes   No   N/A   Comment/Concerns
     107 Did the owner or operator of the small non-utility steam generating facility that is
         subject to sulfur dioxide standards submit reports to EPA that contain ALL of the
         following information:
                 a) Calendar dates covered in the reporting period;
                 b) Each 30-day average SO2 emission rate or 30-day average sulfur
                 content; reasons for any noncompliance with emission standards; and
                 corrective actions taken;
                 c) Each 30-day average percent of potential SO2 emission rate;
                 reasons for any noncompliance with the emission standards; and
                 corrective actions;
                 d) Steam generating unit operating days for which sulfur dioxide or
                 diluent data have not been obtained for at least 75 percent of the
                 operating hours; justification; and corrective actions;
                 e) Times when emissions data were excluded from the calculation of
                 average emission rates; justification; and corrective actions taken; and

                  f) "F" factor used in calculations, method of determination, and type of
                  fuel combusted?
   108 Did the reports contain ALL of the following additional information:
                  a) Whether averages have been obtained based on a CEMS rather
                  than manual sampling methods;
                  b) If a CEMS is used - times when the pollutant concentration exceeded
                  the full span of the CEMS;
                  c) If a CEMS is used - modifications to the CEMS that could affect its
                  ability to comply with Performance Specifications 2 or 3 (40 CFR 60,
                  Appendix B of the full-text regulations);
                  d) If a CEMS is used - results of daily CEMS drift tests and quarterly
                  accuracy assessments; and
                  e) If fuel supplier certification is used to demonstrate compliance -
                  records of fuel supplier certification, and a certified statement by the
                  owner or operator that the submitted fuel supplier that the fuel submitted
                  fuel supplier certifications represent all of the fuel combusted during the
                  reporting period?
NSPS - Small Non-Utility Steam Generators - Recordkeeping
   109 Is the small non-utility steam generating facility subject to sulfur dioxide emission
        limits, fuel oil sulfur limits, or percent reduction requirements under 40 CFR                             Please Input
        60.42c?
   110 Did the owner or operator of the affected facility keep records of ALL of the
        following information:
                  a) Calendar dates covered in the reporting period;
                  b) Each 30-day average SO2 emission rate or 30-day average sulfur
                  content; reasons for any noncompliance with emission standards; and
                  corrective actions taken;
                  c) Each 30-day average percent of potential SO2 emission rate;
                  reasons for any noncompliance with the emission standards; and
                  corrective actions;
                  d) Steam generating unit operating days for which sulfur dioxide or
                  diluent data have not been obtained for at least 75 percent of the
                  operating hours; justification; and corrective actions;
                  e) Times when emissions data were excluded from the calculation of
                  average emission rates; justification; and corrective actions taken; and

                 f) "F" factor used in calculations, method of determination, and type of
                 fuel combusted?
     111 Did the records contain ALL of the following additional information:
                 a) Whether averages have been obtained based on a CEMS rather
                 than manual sampling methods;
                 b) If a CEMS is used - times when the pollutant concentration exceeded
                 the full span of the CEMS;
                 c) If a CEMS is used - modifications to the CEMS that could affect its
                 ability to comply with Performance Specifications 2 or 3 (40 CFR 60,
                 Appendix B of the full-text regulations);
                 d) If a CEMS is used - results of daily CEMS drift tests and quarterly
                 accuracy assessments; and
                 e) If fuel supplier certification is used to demonstrate compliance -
                 records of fuel supplier certification, and a certified statement by the
                 owner or operator that the submitted fuel supplier certifications represent
                 all of the fuel combusted during the reporting period?
     112 Are fuel supplier certifications used to demonstrate compliance with emission
                                                                                                                   Please Input
         standards?
                                                                                                 Yes   No   N/A   Comment/Concerns
     113 Do fuel supplier certifications for distillate oil, residual oil, or coal include the
         following information, for the appropriate fuel(s):
                 a) For distillate oil: name of the oil supplier, and a treatment from the
                 supplier that the oil complies with the specifications under the definition
                 of distillate oil;
                 b) For residual oil: name of the oil supplier, location of the oil when the
                 sample was taken for analysis, sulfur content of the shipment or the oil
                 from which the shipment came, and the test method used; or
                 c) For coal: name of the coal supplier, location of the coal when a
                 sample was taken for analysis of its properties, the results of the
                 analysis of the shipment or the coal from which the shipment came, and
                 the test method used?
     114 Does the owner or operator of each small non-utility steam generating unit
         record and maintain records of the amounts of each fuel combusted during each
         day?                                                                                                       Please Input


     115 Is the small non-utility steam generating unit subject to a federally enforceable
         requirement limiting the annual capacity factor for any fuel or mixture of fuels?                          Please Input

     116 Does the owner or operator of each affected facility subject to a federally
         enforceable requirement calculate the annual capacity factor individually for
         each fuel combusted?


     117 Is each required record maintained at the facility for at least two years following
         the date of the record?                                                                                    Please Input

NSPS - VOL Storage Vessels - Compliance
    118 Is the facility in compliance with the following elements of the NSPS for volatile
        organic liquids storage vessels, as applicable:
                  a) Standards for volatile organic compound (VOC) emissions control
                  (e.g. fixed roof/internal floating roof combination, external floating roof,
                  closed vent system and control device, or equivalent systems)(40 CFR
                  60.112b);
                  b) Testing and procedures for fixed roof/internal floating roof
                  combinations, external floating roofs, closed vent systems and control                            Please Input
                  devices, closed vent systems and flares (40 CFR 60.113b);
                  c) Alternative means of emission limitations (40 CFR 60.114b);
                  d) Reporting and recordkeeping requirements for fixed roof/internal
                  floating roof combinations, external floating roofs, closed vent systems
                  and control devices, closed vent systems and flares (40 CFR 60115b);
                  and
                  e) Monitoring requirements for storage vessels (40 CFR 60.116b)?
Hazardous Air Pollutants - "Hot Spots" Program
    119 For facilities that require submittal of an emissions inventory, was the annual
        emissions fees paid within 60 days of receipt of the notification from the local                            Please Input
        district?
Hazardous Air Pollutants - NESHAP Compliance
    120 Is ALL of the following equipment, which contains vinyl chloride or benzene,
        monitored for emissions of volatile hazardous air pollutants
                  a) Pumps;
                  b) Compressors;
                  c) Pressure relief devices in gas/vapor service;
                                                                                                                    Please Input
                  d) Open-end valves or lines;
                  e) Pressure relief devices in liquid service and flanges and other
                  connectors;
                  f) Product accumulators; and
                  g) Closed vent systems or control devices?
    121 Is all equipment at the site, such as pumps, and compressors, operated to
                                                                                                                    Please Input
        prevent releases of benzene and vinyl chloride?
    122 Is each piece of equipment in VHAP service marked so that it can be readily
                                                                                                                    Please Input
        distinguished from other pieces of equipment?
    123 Are inspections and maintenance of on-site equipment conducted on a routine
        basis?                                                                                                      Please Input

     124 Have any VHAP leaks been detected?

                                                                                                                    Please Input
                                                                                               Yes   No   N/A   Comment/Concerns
     125 Were the VHAP leaks repaired according to the following timetable:
                a) The leak was repaired as soon as practicable, not later than 15 days
                after it was detected; and
                b) A first attempt to repair the problem was made no later than five days
                after the leak was detected?
     126 Was all leaking equipment marked with the equipment ID number?



     127 For each leak, was identification and repair information recorded in a log and
         kept for 2 years in a readily accessible location?



     128 Is identification information and emission information kept in a readily accessible
         log for all equipment in VHAP service?
                                                                                                                  Please Input


     129 Does the facility submit semi-annual reports that contain all of the following:
                 a) Process unit identification;
                 b) An inventory of detected leaks and subsequent repairs;                                        Please Input
                 c) Dates of process unit shutdowns;
                 d) Revisions to equipment or processes; and
                 e) Monitoring and performance testing results?
Benzene - NESHAP Compliance
    130 Are all benzene air contamination sources subject to NESHAP in compliance
        with all permit, certificate, and regulatory requirements?                                                Please Input

     131 Is all equipment that contains benzene operated and maintained in compliance
         with the equipment leak provisions of 40 CFR 61 Subpart V?                                               Please Input

General Provisions - Old NESHAPs
    132 Unless properly exempted, are each of the NESHAP sources at your facility
         registered with the permitting authority?
                                                                                                                  Please Input


     133 Are ALL of the following true of stack sampling:




                a) If required, stack sampling under NESHAPs regulations has been                                 Please Input
                conducted within the required time limitations;
                b) Samples have been analyzed; and
                c) Hazardous pollutant emissions have been determined within
                applicable time limitations?
New NESHAPs / MACT - General Provisions
    134 Has the facility determined that the NESHAPs source under review is NOT
                                                                                                                  Please Input
        subject to a relevant standard or other requirement under 40 CFR 63?
    135 Has the facility kept a record of the reasons for the determination that the
        NESHAPs source under review is not regulated by a relevant standard under 40
        CFR 63?
    136 Do sources comply with each relevant NESHAPs subpart by the applicable
        compliance dates specified within each subpart?                                                           Please Input

New NESHAPs / MACT - Operations and Maintenance
    137 Does the source meet ALL of the following operation and maintenance
        requirements:
                 a) The source is operated and maintained at all times in a manner
                 consistent with good air pollution control practices for minimizing
                 emissions at least to levels required by all relevant standards;
                                                                                                                  Please Input
                 b) A written startup, shutdown, and malfunction plan is developed and
                 implemented in accordance with the provisions of 40 CFR 63.6(e)(3)(I)
                 through (e)(3(viii); and
                 c) All malfunctions are corrected as soon as practicable, and in
                 accordance with the startup, shutdown, and malfunction plan?
    138 Are all non-opacity, opacity, and visible emissions standards maintained at all
        times, except during startup, shutdown and malfunction, and as otherwise                                  Please Input
        specified in any applicable subpart under 40 CFR 63?
                                                                                              Yes   No   N/A   Comment/Concerns
New NESHAPs / MACT - Performance Testing
    139 If required to do performance testing or another form of compliance
        demonstration under a relevant standard, is the source in compliance with ALL
        of the following performance testing provisions:
                 a) Performance testing schedule (40 CFR 63.7(a)(2));
                 b) Requirements for notification of performance tests (40 CFR 63.7(b));

                 c) Quality assurance program and site specific test plan requirements
                                                                                                                 Please Input
                 (40 CFR 63.7(.c));
                 d) Performance testing facility requirements (40 CFR 63.7(d));
                 e) Performance test conduct requirements (40 CFR 63.7(e));
                 f) Alternative performance test methods (if applicable)(40 CFR
                 63.7(f)(1)); and
                 g) Data analysis, recordkeeping, and reporting requirements (40 CFR
                 63.7(g))?
New NESHAPs / MACT - Monitoring
    140 If required to do monitoring under a relevant standard, is the source in
        compliance with ALL of the following monitoring provisions:
                 a) Monitoring provisions (40 CFR 63.8(b));
                 b) Operation and maintenance requirements for continuous monitoring
                 systems (CMS)(40 CFR 63.8(.c));
                 c) Quality control program requirements (40 CFR 63.8(d));                                       Please Input
                 d) Performance evaluation requirements for continuous monitoring
                 systems (40 CFR 63.8(e));
                 e) Alternative monitoring methods (if applicable)(40 CFR 63.8(f)); and
                 f) Requirements for the reduction of monitoring data (40 CFR
                 63.89(g)(1))?
New NESHAPs / MACT - Notification
    141 Is the source in compliance with all of the following notification requirements, as
        applicable:
                 a) Initial notification requirements (40 CFR 63.9(b));
                 b) Procedures for requests for compliance extensions (40 CFR
                 63.9(.c));
                 c) Notification requirements for special compliance provisions (40 CFR
                 63.9(d));                                                                                       Please Input
                 d) Performance test notification requirements (40 CFR 63.9(e));
                 e) Notification requirements for opacity and visible emission
                 observations (40 CFR 63.9(f));
                 f) Additional notification requirements for continuous monitoring systems
                 (40 CFR 63.9(g));
                 g) Compliance status notification requirements (40 CFR 63.9(h))?
New NESHAPs / MACT - Recordkeeping and Reporting
    142 Are files of all information required by 40 CFR 63 (including all reports and
        notifications) maintained in a form suitable and readily available for review and                        Please Input
        inspection?
    143 Are the information files retained as follows:
                 a) Each file is retained for at least 5 years following the date of each
                 occurrence, measurement, maintenance, corrective action, report, or
                 record; and
                 b) At a minimum, the most recent 2 years of data are retained on site?

     144 Are all of the following reports submitted to the Administrator, as applicable:

                 a) Performance test results (40 CFR 63.10(d)(2));
                 b) Opacity or visible emission observations (40 CFR 63.10(d)(3));
                                                                                                                 Please Input
                 c) Progress reports (40 CFR 63.10(d)(4));
                 d) Startup, shutdown, and malfunction reports (40 CFR 63.10(d)(5));
                 e) Additional reports, as applicable, for continuous monitoring systems
                 (MCS)(40 CFR 63.10(e))?
New NESHAPs / MACT - Wood Furniture Manufacturing
    145 Is the facility in compliance with ALL of the elements of the NESHAP for wood
        furniture manufacturing operations which are applicable at this time?
                                                                                                                 Please Input
                                                                                               Yes   No   N/A   Comment/Concerns
New NESHAPs / MACT - Pharmaceutical Production
     146 Is the facility in compliance with each of the following elements of 40 CFR 63,
         Subpart GGG, as applicable;
                  a) Specified sections of the general NESHAPs provisions of 40 CFR 63,
                  Subpart GGG (40 CFR 63.1250(.c); 40 CFR 63, Subpart GGG, Table
                  1);
                  b) General standards (40 CFR 63.1252);
                  c) Storage tank standards (40 CFR 63.1253);
                  d) Process vent standards (40 CFR 63.1254);                                                     Please Input
                  e) Equipment leak requirement (40 CFR 63.1255);
                  f) Wastewater standards (40 CFR 63.1256);
                  g) Test methods and compliance procedures (40 CFR 63.1257);
                  h) Monitoring requirements (40 CFR 63.1258);
                  I) Recordkeeping requirements (40 CFR 63.1259);
                  j) Reporting requirements (40 CFR 63.1260)?
Risk Management Program
     147 Were facilities grouped into one of the three categories for each affected
         process below:
                  a) The affected process has a federally listed substance above the
                  threshold amount;
                                                                                                                  Please Input
                  b) The affected process has a state-only listed substance above the
                  threshold amount, and the substance is not on the federal list;
                  c) The affected process has a substance above the state threshold but
                  below the federal threshold?
     148

                                                                                                                  Please Input
         Have the threshold levels of the facility for toxic substances been taken from the
         CalARP program?
     149 For external events analysis included in the CalARP program, do the analysis
         include:
                  a) The types of human and natural-caused external events considered
                  in the hazard review required for program level 2 processes or the
                  process hazard analysis (PHA) required for program level 3 processes.
                  Seismic activity should be considered under natural events;
                                                                                                                  Please Input
                  b) The magnitude of the external events considered;
                  c) For each external event with a potential to create an off-site release,
                  the facility must include the date and findings of the most recent hazard
                  review of PHA and any changes affecting the review
                  d) The date of the most recent field verification on monitoring equipment
                  ensuring it is installed and maintained as designed?
     150 For all covered processes, has the stationary source complied with the Risk
         Management Program (RMP) requirements by the latest of the following:
                  a) June 21, 1999
                  b) Three years after the date on which a regulated substance is first                           Please Input
                  listed under 40 CFR 68.130;
                  c) The date on which a regulated substance is first present above a
                  threshold quantity in a process?
     151 Are all records supporting the implementation of the RMP maintained for 5
         years?
                                                                                                                  Please Input


     152 Was the AA notified when the facility modified a covered process and the
         modification either:
                 a) Significantly increases the amount of regulated substances handled                            Please Input
                 at the facility from the amount identified in the RMP
                 b) Significantly increases the risk as compared with the risk identified in
                 the RMP
                                                                                                     Yes   No   N/A   Comment/Concerns
     153 Are triennial reports being submitted to the DEP, within 90 days of the 36-month
         period ending on the anniversary date of the approval of the facility's program,
         that contain at least all of the following information:
                 a) An update of the supplemental Toxic Catastrophe Prevention Act
                 (TCPA) Program, if applicable
                 b) A description of significant changes to the management system
                 c) Documentation of the hazard review results for each hazard review
                 completed during the previous 3 years                                                                  Please Input
                 d) A summary of EHS accidents that occurred during the previous 3
                 years that includes a brief description of each accident and the causes
                   e) The compliance audit report for the previous three years ending on
                   the anniversary date, which contains all federal requirements and states
                   the scope of the audit, the techniques and methods used, and the
                   participants
     154 Is there an emergency response program (ERP) at the facility that contains all
         federal standards and the following:
                   a) A schedule for initial and annual refresher ER training for all
                   employees in relevant procedures to implement the ERP
                                                                                                                        Please Input
                   b) A schedule to perform at least on ER exercise per calendar year
                   c) A written assessment of the ERP and of the adequacy or need for ER
                   equipment after each plan implementation or each ER exercise
                   d) A description of the emergency notification system
     155 Does the emergency notification system include the following:
                   a) Immediate notification to DEP emergency communications center
                   (609-292-7172) by the emergency coordinator of an EHS accident or
                   imminent EHS accident, which includes: company name and address;
                   name, position, and phone number of caller; time of, or anticipated time
                   of, the accident and projected duration; chemical released; actual EHS                               Please Input
                   quantity or estimated quantity and possible off-site impact; weather
                   conditions
                   b) Emergency coordinator for the stationary source that must be
                   prepared to provide the DEPs emergency communications center with
                   updates if requested
     156 Have any of the following occurred:
                   a) EHS release that has no potential off-site impact
                   b) EHS release that results in no actual or potential injuries or fatalities                         Please Input
                   at the source
                   c) EHS release that does not activate the ERP
     157 Has the following been submitted to DEP, prior to June 21, 1999, regarding the
         facility's TCPA Program:
                   a) Identification of position titles, expertise, and affiliation of the persons
                   involved with the development of each element of the RMP
                   b) Description and profile of the area where the covered process is
                   situated, including proximity to populated areas and water supplies
                                                                                                                        Please Input
                   c) Identification of insurance carriers underwriting the source's
                   environmental liability and workers' compensation insurance policies,
                   including the address of the carrier, the type of policy, amount of
                   insurance, and limitations or exclusions to the policy
                   d) Identification of the EHS inventory as the source as end products,
                   intermediate products, by-products, or waste products
Risk Management Program - Risk Management Plan
     158           Has the owner submitted a single Risk Management Plan (RMP) for all
                                                                                                                        Please Input
                   covered processes?
     159           Was the RMP submitted no later than the latest of the following dates:
                 a) June 21, 1999
                 b) Three years after the date on which a regulated substance is first
                 listed under 40 CFR 68.130;
                 c) The date on which a regulated substance is first present above a
                 threshold quantity in a process?
     160 Is the RMP made available to the public?
                                                                                                Yes   No   N/A   Comment/Concerns
     161 Does the RMP include an executive summary that provides a brief description of
         all the following:
                  a) The accidental release prevention and emergency response policies
                  at the stationary source
                  b) The stationary source and regulated substances handled
                  c) The worst-case release scenario(s) and the alternative release
                  scenario(s), including administrative controls and mitigation measures to
                  limit the distances for each reported scenario
                  d) The general accidental release prevention program and chemical-
                  specific prevention steps
                  e) The 5-year accident history
                  f) The emergency response program
                  g) Planned changes to improve safety
Risk Management Program - Registration
     162 Is a single, completed registration form covering all regulated substances
                                                                                                                   Please Input
         handled in all covered processes included in the RMP?
     163 Does the registration include ALL of the following data:
                  a) Stationary source name, street, city, county, state, zip code, latitude
                  & longitude, method for obtaining latitude and longitude, and description
                  of location that latitude and longitude represent;
                  b) The stationary source Dun and Bradstreet number;
                  c) Name and Dun and Bradstreet number of the corporate parent
                  company;
                  d) The name, telephone number, and mailing address of the owner or
                  operator;
                  e) The name and title of the person or position with overall responsibility
                  for RMP elements and implementation; and
                  f) The name, title, telephone number, and 24-hour telephone number of
                  the emergency contact?
     164 Does the registration include all the following for each covered process:
                  a) Name and CAS number of each regulated substance held above the
                  threshold quantity in the process;
                  b) The maximum quantity of each regulated substance or mixture in the
                  process in pounds to 2 significant digits;
                  c) The five- or six-digit NAICS code that most closely corresponds to
                  the process; and
                  d) Program level of the process?
     165 Does the registration include all the following:
                  a) Stationary source EPA identifier;
                  b) Number of full-time employees at the stationary source;
                  c) Whether source is subject to OSHA standard for Process Safety
                  Management (29 CFR 1910.119);
                  d) Whether source is subject to the hazardous substance release
                  standards (40 CFR 355);
                  e) If the stationary source has a CAA Title V operating permit, the
                  permit number; and
                  f) Date of the last safety inspection of the stationary source by a
                  Federal, state, or local government agency and the identity of the
                  inspecting entity?
     166          If a stationary source is no longer subject to the Risk Management
                  Program, is a revised registration submitted to EPA within six months
                  indicating that the source is no longer covered?



     167 Is the RMP revised and updated as follows:
                 a) Within 5 years of initial submission or most recent update;
                 b) No later than 3 years after a newly regulated substance is first listed
                 by EPA;
                 c) No later than the date on which a new regulated substance is first
                 present in an already covered process above a threshold quantity;
                 d) No later than the date on which a regulated substance is first present
                                                                                                                   Please Input
                 above a threshold quantity in a new process;
                 e) Within 6 months of a change that requires a revised process hazard
                 analysis or hazard review;
                 f) Within 6 months of a changes that requires a revised offsite
                 consequence analysis (40 CFR 68.36); and
                 g) Within 6 months of a change that alters the Program level that
                 applied to any covered process?
                                                                                       Yes   No   N/A   Comment/Concerns
168 Has the implementing agency issued a preliminary written determination of
    necessary revisions to the RMP?


                                                                                                          Please Input




169 Has the owner or operator of the stationary source sent a written response to
    the implementing agency making ONE of the following statements:
            a) The revisions will be implemented in accordance with the timetable
            specified by the implementing agency; or
            b) The owner or operator rejects the revisions, and includes an
            explanation of the basis for rejection?
170 Was a written response sent to the implementing agency within 90 days of the
    issue of the preliminary written determination?


171 Does the public have access to all preliminary determinations and responses?



172 Has the implementing agency issued a final written determination of revisions to
    the RMP?
                                                                                                          Please Input


173 Within 30 days of the final determination, was the RMP revised and submitted?




174 Does the public have access to all final determinations?




175 For substances in a vessel or pipe, is the greatest amount of substance held in
    a single vessel or in a pipe used as the worst-case release quantity?
                                                                                                          Please Input



176 Have the following parameters been used to determine distance to endpoints:
    toxic endpoints and endpoints for flammables; wind speed/atmospheric stability
    class; ambient temperature/humidity; release height; surface roughness; dense                         Please Input
    or neutrally buoyant gases; and temperature of released substance?

177 Are all passive mitigation systems considered in the analysis of worst-case
    release scenarios?
                                                                                                          Please Input


178 Are all of the following records maintained regarding worst-case release
    scenarios:
             a) Description of the vessel or pipeline and substance chosen for
             scenario
             b) Assumptions used, including administrative controls and passive
                                                                                                          Please Input
             mitigation assumed to limit the release quantity
             c) Anticipated effect of the controls and mitigation on the release
             quantity and rate
             d) Parameters used
             e) Rationale for the selection of assumptions and parameters
                                                                                                Yes   No   N/A   Comment/Concerns
     179 For each release scenario, is all of the following information submitted in the
         RMP:
                 a) Chemical name
                 b) Percentage weight of the chemical in a liquid mixture (toxics only)
                 c) Physical state (toxics only)
                 d) Basis of results (name of model if used)                                                       Please Input
                 e) Scenario (explosion, fire, toxic gas release, or liquid spill and
                 vaporization)
                 f) Quantity released in pounds
                 g) Release rate
                 h) Release duration
     180 For each release scenario, is all of the following information submitted in the
         RMP:
                 a) Wind speed and atmospheric stability class (toxics only)
                 b) Topography (toxics only)                                                                       Please Input
                 c) Distance to endpoint
                 d) Public and environmental receptors within the distance
                 e) Passive mitigation considered
Risk Management Program - Toxic Substances
     181 Are any worst-case release scenarios developed for regulated toxic substances
         that are gases at ambient temperature and handled as a gas or as a liquid under
         pressure?                                                                                                 Please Input



     182 Unless passive mitigation systems are in place, is it assumed in the worst-case
         release scenario for each regulated toxic substance that the release rate is the
         total quantity divided by ten?



     183 Are any worst-case release scenarios developed for regulated toxic gases that
         are handled as refrigerated liquids at ambient pressure and also meet ONE of
         the following conditions:

                                                                                                                   Please Input
                 a) The released substance is not contained by passive mitigation
                 systems; or
                 b) The released substance is contained by passive mitigation systems
                 in a pool with a depth of one centimeter or less?
     184 For these regulated toxic substances, is it assumed in the worst-case release
         scenario that the quantity in the vessel or pipe is released as a gas over ten
         minutes?

     185 Are any worst-case release scenarios developed for regulated toxic gases that
         are handled as refrigerated liquids at ambient pressure and are contained by
         passive mitigation systems in a pool with a depth > 1 cm?
                                                                                                                   Please Input



     186 For the regulated toxic substances, is it assumed in the worst-case scenario that
         the quantity in the vessel or pipe is release instantaneously to form a liquid pool?                      Please Input

     187 Is the release rate of the regulated toxic substance calculated at the boiling point
         of the substance?
                                                                                                                   Please Input


     188 Are any worst-case release scenarios developed for regulated toxic substances
         that are liquids at ambient temperature?                                                                  Please Input
     189 For these regulated toxic substances, is it assumed in the worst-case release
         scenario that the quantity in the vessel or pipe is released instantaneously to
         form a liquid pool?


     190 Is ONE of the following determinations of surface area used to calculate the
         volatilization rate of the liquid pool:
                  a) The surface area is determined by assuming that the liquid spreads
                  to a pool one centimeter deep where passive mitigation systems are not
                  in place; or
                  b) The known surface area of the contained liquid is used where
                  passive mitigation systems are in place?
                                                                                               Yes   No   N/A   Comment/Concerns
     191 If the surface area where the release would occur is not smooth, are the actual
         surface characteristics taken into account when developing a worst-case
         scenario?
     192 Does the volatilization rate of the liquid take into account ALL of the following
         conditions:
                  a) The highest daily maximum temperature over the past three years;

                  b) The substance temperature; and
                  c) The concentration of the toxic substance if the liquid spilled is a
                  mixture or solution?
     193 Is the release rate of the regulated toxic substance to the air determined from
         the volatilization rate of the liquid pool?


Risk Management Program - Flammable Substances
     194 For all regulated flammable substances, is it assumed that the quantity of the
         substance vaporizes, resulting in a vapor cloud explosion?                                               Please Input

     195 For regulated flammable substance models based on TNT-equivalent methods,
         is a yield factor of 10% of the available energy released in the explosion used to                       Please Input
         determine the distance to the explosion endpoint?
     196 Are any worst-case release scenarios developed for regulated flammable
         substances that are gases at ambient temperature and handled as a gas or as a
         liquid under pressure?
                                                                                                                  Please Input



     197 In the worst-case release scenario for each regulated flammable gases, are
         BOTH of the following assumptions made:
                  a) The quantity in the vessel or pipe is released as a gas over ten
                  minutes; and
                  b) The total quantity is involved in the vapor cloud explosion?
     198 Are any worst-case release scenarios developed for regulated flammable gases
         that are handled as refrigerated liquids at ambient pressure and also meet ONE
         of the following conditions:
                  a) The released substance is not contained by passive mitigation                                Please Input
                  systems; or
                  b) The released substance is contained by passive mitigation systems
                  in a pool with a depth of one centimeter or less?
     199 In the worst-case release scenario for each regulated flammable gas, are BOTH
         of the following assumptions made:
                  a) The total quantity of the substance is released as a gas in ten
                  minutes; and
                  b) The total quantity of the substance will be involved in the vapor cloud
                  explosion?
     200 Are any worst-case release scenarios developed for regulated flammable gases
         that are handled as refrigerated liquids at ambient pressure and are contained
                                                                                                                  Please Input
         by passive mitigation systems in a pool with a depth greater than one
         centimeter?
     201 In the worst-case release scenario for each regulated flammable substance, is it
         assumed that the quantity which becomes vapor in the first ten minutes of
         release is involved in the vapor cloud explosion?


     202 Is the volatilization rate (release rate) for each regulated flammable substance
         calculated at the boiling point of the substance and at the conditions specified in
         40 CFR 68.25(d)?

     203 Are any worst-case release scenarios developed for regulated flammable
         substances that are normally liquids at ambient temperature?


                                                                                                                  Please Input
                                                                                                  Yes   No   N/A   Comment/Concerns
     129 In the worst-case release scenario for each regulated flammable substance, are
         BOTH of the following assumptions made:
                 a) The entire quantity of the substance in the vessel or pipe is spilled
                 instantaneously to form a liquid pool; and
                 b) The quantity which becomes vapor in the first ten minutes is involved
                 in the vapor cloud explosion?



     130 For any flammable liquids at temperatures below their atmospheric boiling point,
         is the volatilization rate calculated at the conditions specified in 40 CFR
         68.25(d)?




Risk Management Program - Five-Year Accident History
     206 Is a five-year accident history submitted with the RMP?
                                                                                                                     Please Input

     207 Does the five-year accident history include ALL of the following accidental
         releases from covered processes:
                  a) Accidental releases that resulted in death, injuries, or significant
                  property damage on site; and
                  b) Accidental releases that resulted in known offsite deaths, injuries,
                  evacuations, sheltering in place, property damage, or environmental
                  damage?
     208 For EACH accidental release included in the five-year accident history, is ALL of
         the following information reported:
                  a) Date, time, approximate duration of release;
                  b) Chemical(s) released;
                  c) Estimated quantity released in pounds and, for mixtures containing
                  regulated toxic substances, % by weight of released regulated toxic
                  substances in the liquid mixture;
                  d) Five- or six-digit NAICS code for the process;
                  e) Type of release event and its source; and
                  f) Weather conditions, if known;
     209 For EACH accidental release included in the five-year accident history, is ALL of
         the following information reported:
                  a) On-site impacts;
                  b) Known offsite impacts;
                  c) Initiating event and contributing factors, if known;
                  d) Whether offsite responders were notified, if known; and
                  e) Operational or process changes that resulted from investigation of
                  the release?
     210 Are all numerical estimates in the five-year accident history provided to two
         significant digits?



Ozone-Depleting Substances - Importers
    211 Prior to January 1, 1996, did the facility import any Class I, Group I, II, III, IV, V,
                                                                                                                     Please Input
        or VII controlled substances?
    212 Did the facility have sufficient unexpended consumption allowances for each
        Class I substance imported?


     213 After January 1, 1996, has the facility imported any Class I, Group I, II, III, IV, V,
                                                                                                                     Please Input
         or VII controlled substances?
     214 For each imported substance, did the facility remain within all of the following
         allowances:
                  a) Unexpended essential-use allowances or exemptions; and
                  b) Unexpended destruction and transformation credits?
     215 Prior to January 1, 2005, has the facility imported any Class I, Group VI
                                                                                                                     Please Input
         controlled substances?
     216 Did the facility have sufficient unexpended consumption allowances for each
         Class I, Group VI substance imported?
                                                                                        Yes   No   N/A   Comment/Concerns
217 After January 1, 2005, ahs the facility imported any Class I, Group VI controlled
                                                                                                           Please Input
    substances?
                                                                                        Yes   No   N/A   Comment/Concerns
218 For each imported substance, did the facility remain within all of the following
    allowances:
            a) Unexpended essential-use allowances or exemptions; and
            b) Unexpended destruction and transformation credits?
219 After January 1, 1995, has the facility imported any used Class I controlled
                                                                                                           Please Input
    substances?
220 Did the facility comply with the petition procedures under 40 CFR 82.13(g)(2)
    and (3)?


221 Has any person at the facility brought a container with a heel into the United
                                                                                                           Please Input
    States?
222 Is the amount of the heel brought into the United States reported quarterly?

223 Does the report certify that the residual amount in each shipment is less than 10
    percent of the volume of the container?



224 Does the report certify that the residual amount will be handled in EITHER of the
    following ways:
             a) Will remain in the container and be included in a future shipment;
             b) Will be recovered and transformed;
             c) Will be recovered and destroyed; or
             d) Will be recovered for a non-emissive use?
225 Is the final disposition of each shipment reported within 45 days of the end of
    each control period?


226 Did you restrict imports of Group I or Group II controlled substance to nations
    listed in Appendix C to Subpart A, Parties to the Montreal Protocol?
                                                                                                           Please Input



227 Did you restrict imports of Group III, Group IV, and Group V controlled
    substance to nations that are party to the London Amendments?                                          Please Input

228 Are imports of Class I Group VII controlled substances restricted only to foreign
    states that are party to the Copenhagen Amendments?
                                                                                                           Please Input


229 Within 45 days after the end of each quarter, do you submit a report that
                                                                                                           Please Input
    describes the facility's imported controlled substances?
230 Does the report include all of the following information:
            a) Summaries of the records required in 40 CFR 82.13(g)(1)(i) - 40 CFR
            82.13(g)(1)(xvi) for the previous quarter;
            b) The total quantity imported in kilograms of each controlled substance
            for the quarter;
            c) The quantity of those imported controlled substances that are used
            controlled substances:
            d) The levels of import (expended consumption allowances) of
            controlled substances for that quarter and totaled by chemical for the
            year to date; and
            e) The importer's total sum of expended and unexpended consumption
            allowances by chemical as of the end of that quarter?
231 Does the report include all of the following information:
            a) The amount of controlled substances imported for use in processes
            resulting in their transformation or destruction;
            b) The amount of controlled substances sold or transferred for use in
            processes resulting in their transformation or eventual destruction;
            c) The amount of controlled substances sold or transferred for an
            essential use:
            d) The amount of controlled substances imported with destruction and
            transformation credits; and
            e) Internal Revenue Service Certificates showing that the purchaser or
            recipient of imported controlled substances intends to transform those
            substances or destruction verifications showing that purchaser or
            recipient intends to destroy the controlled substances?
                                                                                            Yes   No   N/A   Comment/Concerns
232 Does the report include all of the following information:
           a) The certifications from essential-use allowance holders and
           laboratory customers stating that the controlled substances were
           purchased solely for specified essential uses or laboratory applications
           and will not be resold or used in manufacturing. If the sales are made
           directly to laboratories, certifications from laboratories that the controlled
           substances will only be used for laboratory applications and will not be
           resold or used in manufacturing; and

            b) In the case of laboratory essential uses, a certification from
            distributors of laboratory supplies that the controlled substances were
            purchased for sale to laboratory customers who certify that the
            substances will only be used for laboratory applications and will not be
            resold or used in manufacturing?
233 Are quarterly report(s) submitted to the EPA for Class I, Group VI substances
    contain all of the following information
            a) The amount of controlled substance sold or transferred during the
            quarter to a person other than the importer solely for quarantine and
            preshipment applications;
            b) A list of the quantities of controlled substance exported by the
            importer and or by other U.S. companies, that will be used solely for
            quarantine and preshipment applications; and
            c) One copy of a certification that the material will be used only for
            quarantine and preshipment applications from each recipient of the
            material and a list of additional quantities shipped to that same person
            for the quarter?
234 Do you maintain the record of the facility's imported controlled substances for
                                                                                                               Please Input
    three years?
235 Do the records for the imported Class I controlled substances include all of the
    following information:
            a) The quantity of each controlled substance imported, either alone or in
            mixtures, including the percentage of the mixture which consists of a
            controlled substance;
            b) The quantity of those controlled substances imported that are used
            and the information provided with the petition as under 40 CFR
            82.13(g)(2);
            c) The quantity of controlled substances other than transshipments or
            used, recycled or reclaimed substances imported for use in processes
                                                                                                               Please Input
            resulting in their transformation or destruction and quantity sold for use
            in processes that result in their destruction or transformation;

            d) The date, port of entry, and country from which the controlled
            substances were imported;
            e) The commodity code, importer number, bill of lading, invoices, and
            U.S. Customs Entry Summary form for the controlled substances
            shipped; and
            f) The quantity of imports of used, recycled or reclaimed Class I
            controlled substances and Class II controlled substances?
236 Do the records for the imported Class I controlled substances include all of the
    following information:
            a) Dated records documenting the sale or transfer of controlled
            substances for use in processes resulting in transformation or
            destruction;
            b) Copies of IRS certifications that the controlled substance will be
            transformed or destruction verifications that it will be destroyed;
                                                                                                               Please Input
            c) Dated records of the quantity of controlled substances imported for
            an essential-use or imported with destruction and transformation credits;
            and
            d) Copies of certifications that imported controlled substances are being
            purchased for essential laboratory and analytical applications or being
            purchased for eventual sale to laboratories that certify the controlled
            substances are for essential laboratory applications?
                                                                                            Yes   No   N/A   Comment/Concerns
    237 Do the records for the imported Class I, Group VI controlled substances include
        all of the following information:
                 a) Dated records documenting the sale or transfer of controlled
                 substances imported and sold for quarantine and preshipment
                 applications;
                 b) Written certifications that controlled substances imported solely for
                 quarantine and preshipment applications were purchases by distributors
                                                                                                               Please Input
                 or applicators to be used only for quarantine and preshipment
                 applications; and
                 c) Written verifications from a U.S. purchaser that the controlled
                 substance imported solely for quarantine and preshipment applications,
                 if exported, was exported solely for quarantine and preshipment
                 applications upon receipt of a certification in accordance with 40 CFR
                 83.13(h)?
    238 Has the facility imported any shipments containing over 150 pounds of a used,
                                                                                                               Please Input
        recycled or reclaimed controlled substance?
    239 Did the importer submit a petition to EPA at least 15 working days before the
        shipment left the foreign port of export?



    240 Did the petition for each shipment include ALL of the following information:
                a) The name and quantity of the used, recycled or reclaimed controlled
                substance to be imported;
                b) The name and address of the importer, the importer ID number, the
                contact person, and the phone and fax numbers;
                c) Name and address of the source(s) of the used, recycled or
                reclaimed controlled substance, including a description of the previous
                use(s), when possible;
                d) Name and address of the exporter and/or foreign owner of the
                material; and
                e) The U.S. port of entry for the import, the expected date of shipment
                and the vessel transporting the chemical?
    241 Did the petition for each shipment include ALL of the following information:
                a) The intended use of the used, recycled or reclaimed controlled
                substance;
                b) The name, address and contact person of the U.S. reclamation
                facility, where applicable;
                c) If the imported controlled substance was reclaimed in a foreign Party,
                the name and address of the foreign reclamation facility, the contact
                person at the facility, and the phone and fax number; and
                d) If the imported used controlled substance is intended to be sold as a
                refrigerant in the U.S., the name and address of the U.S. reclaimer who
                will bring the material to the standard required under CAA 608?

Additional Notes:
                                                                                               Yes   No   N/A   Comment/Concerns
California
Standards Applicable to Transport of Hazardous Materials

Administration - Management Systems
      1 Does the site have any hazardous materials that are shipped under a DOT
                                                                                                                  Please Input
        exemption?
      2 Does the facility meet all of the following requirements of shipping under a DOT
        exemption
                 a) The packages are shipped in accordance with requirements
                 contained within the written exemption(s);
                 b) The outside of each exempted package is plainly marked "DOT-E"
                 followed by the DOT exemption number;
                 c) Each shipping paper bears the notation "DOT-E" followed by the
                 DOT exemption number; and
                 d) If the exemption contains special carrier requirements, the shipper
                 furnishes a copy of the exemption to the carrier?
Enforcement
      3 Were shipments found to be in compliance with the hazardous materials
        regulations?                                                                                              Please Input

       4 Was a report issued by the inspector?
                                                                                                                  Please Input

       5 Were there any discrepancies noted in the report?



Emergency Response Information
      6 Does the facility provide Emergency Response Information for transported
        hazardous materials?                                                                                      Please Input

       7 Is emergency response information immediately available to all of the following:

                 a) Facility personnel, for use at all times when a hazardous material is
                 present; and                                                                                     Please Input
                 b) Federal, state, or local government agencies that respond to an
                 incident involving a hazardous material, or are conducting an
                 investigation which involves a hazardous material?
       8 Is the emergency response information presented in AT LEAST ONE of the
         following ways:
                 a) On a shipping paper:
                 b) In a document that includes both the technical name and basic
                 description of the hazardous material, and the emergency response
                                                                                                                  Please Input
                 information (such as a MSDS); or
                 c) In a document (such as an emergency response guidance document)
                 that cross-references the description of the hazardous material on the
                 shipping paper with the emergency response information contained in
                 the document?
       9 Does the facility's emergency response information include:
                 a) The basic description and technical name of the hazardous material;

                 b) The immediate hazards of health;
                 c) The risks of fire or explosion;
                 d) The immediate precautions to be taken in the event of an accident or                          Please Input
                 incident;
                 e) The immediate methods for handling fires;
                 f) The initial methods for handling spills or leaks in the absence of fire;
                 and
                 g) The preliminary first aid measures?
      10 Is the emergency response information:
                 a) Printed legibly in English; and
                                                                                                                  Please Input
                 b) Available for use away from the package containing the hazardous
                 material?
      11 For each shipment of hazardous materials, is an emergency response telephone
         number provided?
                                                                                                                  Please Input
                                                                                             Yes   No   N/A   Comment/Concerns
      12 Is the emergency response telephone number entered on shipping papers in
         one of the following locations
                 a) Immediately following the description of each hazardous material; or

                  b) If the telephone number applies to all the hazardous materials on the
                  shipping paper, in one, clearly visible, and identified location?
      13 Is the phone which receives emergency response telephone calls monitored at
         all times that hazardous material are in transit?



     14 Does the emergency response telephone number provide the required access to
        someone who:
                 a) Is knowledgeable of the hazards and characteristics of the hazardous
                 material being shipped; and
                 b) Has comprehensive emergency response and accident mitigation
                 information for the material?
Medical Wastes
     15 Did the permitted medical waste facility report to the Department of Health an
        noncompliance with the Medical Waste Management Act with a written report
        within 5 days with the following information:
                 a) A description of noncompliance and its cause;
                 b) The period of noncompliance, including exact starting and ending                            Please Input
                 dates and time frames, and the anticipated time it is expected to
                 continue if the noncompliance has not been corrected; and
                 c) The steps taken planned to reduce, eliminate, and prevent
                 recurrence?
Administration - Registration
     16 Has the facility submitted a registration statement to the DOT?
                                                                                                                Please Input

     17 Did the facility meet ALL of the following registration requirements:
                 a) The registration statement was submitted on DOT Form F 5800.2;
                 b) The statement was submitted to the DOT before the registration
                 deadline; and
                 c) The annual fee was paid?
     18 Are ALL of the following documents maintained at the facility's principal place of
        business for a period of three years from the issue date of the Certificate of
        Registration:
                 a) The Certificate of Registration; and
                 b) A copy of the registration statement?
Administration - Training
     19 Does the facility have a training program for employees who work with or near
        hazardous materials?                                                                                    Please Input

      20 Have all employees who have ANY responsibility for preparing hazardous
         materials for shipment received the necessary training on regulation                                   Please Input
         requirements?
      21 Is training of all new hazmat employees completed within 90 days after
                                                                                                                Please Input
         employment began
      22 When a hazmat employee's job function changes, is the appropriate training for
         the new job function completed within 90 days?                                                         Please Input

      23 Is the proper training/retraining given to hazmat employees at least once every
         three years?                                                                                           Please Input

      24 Are all incompletely trained hazmat employees under the supervision of a
         properly trained hazmat employee?
                                                                                                                Please Input


      25 Have all hazmat employees received:
                 a) General awareness/familiarization training;
                                                                                                                Please Input
                 b) Function-specific training; AND
                 c) Safety training?
      26 Are hazmat employees tested by the hazmat employer on the required training
         subjects?                                                                                              Please Input
                                                                                               Yes   No   N/A   Comment/Concerns
     27 Are both of the following TRUE about the maintenance of training records:
                a) Records of the previous three years training for hazmat employee are
                kept by the hazmat employer; AND                                                                  Please Input
                b) The training records are retained until 90 days after the date the
                hazmat employees no longer serves in such a capacity
     28 Do the training records include:
                a) The hazmat employee's name;
                b) The most recent date the hazmat employee completed training;
                c) A description, copy, or the location of the training materials used to
                                                                                                                  Please Input
                meet the training requirements;
                d) The name and address of the person providing the training; AND
                e) A certification that the hazmat employee has been trained and
                tested?
Highway Transport - Loading/Unloading
     29 Are the following loading and unloading practices implemented at the facility:

                  a) Packages containing hazardous material are secured against
                  movement within the loaded vehicle before it is allowed to leave the
                  shipper's property;
                  b) Smoking is prohibited on or about any vehicle during loading or
                                                                                                                  Please Input
                  unloading of any explosive, flammable liquid, flammable solid, oxidizing
                  material, or flammable compressed gas;
                  c) The handbrake or airbrake is triggered on motor vehicles while
                  loading or unloading hazardous materials; and
                  d) Only tools that could not adversely affect packages, containers, or
                  their closures are used?
      30 Is the facility in compliance with the modal segregation requirements?
                                                                                                                  Please Input

      31 Are the following fork-lift requirements met whenever fork lifts are used for
         loading and unloading hazardous materials:
                 a) The rear wheels or motor vehicle are chocked at all times; and                                Please Input
                 b) Only trained and authorized operators are allowed to utilize fork lifts?

Highway Transport - Portable Tanks/Cargo
     32 Is a "qualified" person, who meets all of the following requirements, in
        attendance during the loading and unloading of cargo tanks containing
        hazardous material:
                a) Is alert and located within 25 feet of the cargo tank and delivery hose
                                                                                                                  Please Input
                with an unobstructed view:
                b) Is aware of the nature of the hazardous materials;
                c) Has been instructed on emergency procedures; and
                d) Is authorized and has the means to move the cargo tank?
     33 Are tanks containing a residue of a hazardous material handled in the same
        manner as are full tanks?                                                                                 Please Input

Highway Transport - Hazardous Materials Table
     34 Is the Hazardous Materials Table reviewed prior to shipping each hazardous
        material to determine:
                a) If materials originating at the site are hazardous;
                b) The proper shipping name from column 2;
                c) The hazard class or division of the material from column 3:                                    Please Input
                d) The identification number of the material (UN or NA number) from
                column 4;
                e) The packing group(s) assigned to a material from column 5; and
                f) The label(s) to be applied to packages from column 6?
     35 Unless excepted, when a mixture or solution containing a hazardous material is
        not specifically listed in the Table, is it described using the proper shipping name
                                                                                                                  Please Input
        of the hazardous material with the qualifying word "mixture" or "solution"?

      36 When a mixture or solution containing two or more hazardous materials in the
         same hazard class is not identified in the Table by a specific description, is the
                                                                                                                  Please Input
         mixture or solution described using the most appropriate general shipping
         description (e.g., "Flammable liquid, n.o.s")?
                                                                                                Yes   No   N/A   Comment/Concerns
      37 Is the Hazardous Materials Table reviewed prior to shipping each hazardous
         material to determine:
                 a) Packaging requirements for non-bulk and bulk packaging from
                 columns 8b, 8c, and references cited therein;                                                     Please Input
                 b) Exceptions to packaging requirements from column 8a in addition to
                 those specified in subpart A of part 173; AND
                 c) Special provisions from column 7?
      38 Is the Appendix to the Hazardous Materials Table reviewed for each hazardous
         material to determent if the material is also listed as a hazardous substance?                            Please Input

      39 Is the facility in compliance with the classification and hazardous communication
         requirements in Parts 172 and 173 (Regulations for the use of the Hazardous
                                                                                                                   Please Input
         Materials Table and for Communications) not previously in effect?

Highway Transport - Infectious Substances
     40 Is the facility in compliance with all applicable regulatory requirements for
        Division 6.2 materials including regulated medical waste and infectious                                    Please Input
        substances affecting only animals?
Medical Wastes - Small Quantity Generators
     41 If the facility is a small quantity generator (SQG) (generating less than 200 lbs in
        any one month of medical waste) that treats medical waste on-site by steam
                                                                                                                   Please Input
        sterilization, incineration, or microwave technology, is it registered with DHS?

      42 Is this registration renewed every two years?

      43 Has the SQG owning or operating a medical waste treatment facility applied for
         a permit from the applicable enforcement agency?
      44 Has the following annual permit fees for a common storage facility been paid:

                  a) For storage facilities serving 10 or fewer generators, the permit fee is
                  $100;
                  b) For storage facilities serving 11 or more generators, but not more
                  than 50 generators, the permit fee is $250;
                  c) For storage faculties serving more than 50 generators, the permit fee
                  is $500?
      45 Has the registered SQG prepared a medical waste management plan including
         the following information:
                  a) Name and address of the generator;
                  b) Type of business;
                                                                                                                   Please Input
                  c) Type and estimated monthly quantity of waste generated;
                  d) Type of on-site treatment;
                  e) Name and address of waste hauler;
                  f) A statement certifying that the plan is complete and accurate?
      46 For SQG not required to register, are the following records related to
         transportation of medical waste off-site for treatment maintained for two years:
                                                                                                                   Please Input
                 a) Quantity of medical waste;
                 b) Date the waste was transported; and
                 c) Name of the waste hauler?
      47 Is anyone generating or treating medical waste ensuring medical waste is
         treated by one of the following methods prior to disposal:
                 a) Incineration at a permitted waste treatment facility;
                 b) Discharge to a public sewage system if the medical waste is liquid or
                 semi liquid and is neither of the following:
                    1) Liquid or semi liquid laboratory waste (CH & SC 117635)                                     Please Input
                    2) Microbiological specimens (CH & SC 117635)
                 c) Steam sterilization at a permitted medical waste treatment facility;

                   d) Other alternative medical waste treatment methods that are
                   approved by DHS?
      48 Are sharps waste rendered noninfectious prior to disposal by one of the
         following methods:
                   a) Incineration;                                                                                Please Input
                   b) Steam sterilization;
                   c) Disinfection and encasement?
      49 For each medical waste treatment facility issued a medical waste permit, has the
         facility provided DHS with an emergency action plan?                                                      Please Input
                                                                                             Yes   No   N/A   Comment/Concerns
      50 For facilities containing or storing medical waste, does the facility comply with
         the following rules:
                  a) Contain medical waste separately from other waste at the point of
                  origin. Sharps containers may be placed in biohazard bags or in
                  containers with biohazard bags;                                                               Please Input
                  b) Biohazards waste has to be contained in a red biohazard bag
                  conspicuously labeled with the words "Biohazardous Waste" or with the
                  international biohazard symbol and the word "BIOHAZARD";
                  c) Sharps waste is required to be contained in a sharps container?
      51 Does the facility comply with the following requirements for containing sharps:

               a) Place all sharps waste into a sharps container;
               b) Tape closed (or tightly seal lid) full sharps containers ready for
               disposal to preclude loss of contents;                                                           Please Input
               c) Store sharps containers ready for disposal for not more than seven
               days;
               d) Label sharps containers with the words "sharps waste" or with the
               international biohazard symbol and the word "BIOHAZARD"?
Highway Transport - Shipping Papers
     52 Does the facility use shipping papers for hazardous materials shipped from the
        site?                                                                                                   Please Input

      53 Are hazardous material identified on shipping papers by using at least one of the
         following methods:
                 a) Hazardous materials entered first;
                                                                                                                Please Input
                 b) Hazardous materials entered in a contrasting color; or
                 c) Hazardous materials identified by the entry of an "X" in a column
                 captioned "HM"?
      54 Do ALL hazardous materials descriptions on the shipping papers have the
         following characteristics:
                 a) Legible;
                                                                                                                Please Input
                 b) In English;
                 c) Free of any code or abbreviations; and
                 d) Include an emergency response telephone number?
      55 Are ALL of the following elements of the basic shipping description of a
         hazardous material included on shipping papers and entered in the following
         sequence:
                 a) Proper shipping name;                                                                       Please Input
                 b) Hazard class;
                 c) Identification number; and
                 d) Packing group, if any?
      56 Is the basic description on shipping papers free of unauthorized interruptions of
         the required sequence of elements, i.e., proper shipping name, hazard class,
                                                                                                                Please Input
         etc?

      57 Is the total quantity, by weight (or as otherwise appropriate), of each hazardous
         material on a shipping paper entered before and/or after the basic description?                        Please Input

      58 Is all additional information placed AFTER the basic shipping description?

                                                                                                                Please Input


      59 Are hazardous material shipping descriptions entered on shipping papers
         without abbreviations, except for those specifically authorized by the                                 Please Input
         regulations?
      60 Are ALL shipments of hazardous materials (not including hazardous wastes)
         shipped under ONE of the following conditions:
                 a) In a cargo tank supplied by the carrier;
                 b) By the shipper as a private carrier except for a hazardous material                         Please Input
                 that is to be reshipped or transferred from one carrier to another; or
                 c) For the return of an empty tank car which previously contained a
                 hazardous material and which ahs not been cleaned or purged?
      61 Is an acceptable, legibly signed, shipper's certification statement shown on each
         shipping paper for shipments of hazardous materials?


      62 Are hazardous wastes offered for highway transportation from the facility?                             Please Input
      63 Is an acceptable, legibly signed, shipper's certification statements shown on
         each shipping paper for shipments of hazardous wastes?
                                                                                                Yes   No   N/A   Comment/Concerns
Highway Transport - Specific Substances
     64 If the proper shipping name is "n.o.s.: or other generic description, is the name
        of the compound or constituent causing a material to be hazardous entered in                               Please Input
        association with the shipping description?
     65 If a hazardous material is a mixture of two or more hazardous materials, are the
        technical names of at least two components most predominately contributing to
                                                                                                                   Please Input
        the hazards of the mixture or solution entered on the shipping paper?

      66 If the proper shipping name of a hazardous substance does not identify the
         hazardous substance by name, is the name of the hazardous substance shown                                 Please Input
         in parentheses in association with the basic description?
      67 Are the shipments containing a hazardous substance described on the shipping
         paper by use of the letters "RQ" either before or after the basic shipping                                Please Input
         description?
      68 Are shipments of hazardous materials in limited quantities described on the
         shipping paper by use of the words "Limited Quantity" or the abbreviation "LTD                            Please Input
         QTY"?
      69 If empty packagings (drums) are shipped by common carrier, are they properly
         described on the shipping papers as a hazardous material or as a RESIDUE?                                 Please Input

     70 Has all hazardous waste, which had been offered, transported, or delivered,
        been accompanied with an EPA hazardous waste manifest, prepared in
        accordance with 40 CFR 262 (EPA regulations for hazardous waste generators),                               Please Input
        and signed, carried, and given as required in 49 CFR 172.205 (hazardous waste
        manifest requirements)?
     71 If a package contains an elevated temperature material and this fact is not
        disclosed in the shipping name (for example, when the words "Molten" or
                                                                                                                   Please Input
        "Elevated temperature" are part of the shipping name), does the shipping paper
        include the word "HOT" immediately preceding the shipping name?
     72 If a package contains a poison, and this fact is not disclosed in the shipping
        name or class entry, does the shipping paper include the word "Poison" or                                  Please Input
        "Toxic"?
Highway Transport - Poisonous by Inhalation Materials
     73 For materials which are poisonous by inhalation, are the words "Poison-
        Inhalation Hazard" or "Toxic-Inhalation Hazard" and the proper Hazard Zone
                                                                                                                   Please Input
        included on the shipping paper immediately following the shipping description?

Highway Transport - Marking
     74 Are packages/containers of hazardous materials marked prior to being offered to
        a carrier for transport?                                                                                   Please Input

      75 Are all non-bulk packages of hazardous materials marked with the proper
                                                                                                                   Please Input
         shipping name and the appropriate UN or NA identification number?
      76 Are combination packages of liquid hazardous materials legibly marked with
         package orientation markings that consist of two arrows pointing upwards with a                           Please Input
         line under them?
      77 Are packages of hazardous substances marked with "RQ" in association with
                                                                                                                   Please Input
         the proper shipping name?
      78 Are all package markings:
                  a) Durable, in English, and unobscured by labels or attachments;
                  b) Printed on or affixed to the surface of the package, or on a label, tag
                  or sign;
                  c) Displayed on a background of sharply contrasting color; AND
                  d) Located away from other markings (such as advertising) that could
                  substantially reduce their effectiveness?
      79 Are all non-bulk packages of hazardous material marked with the name and
         address of the consignee or consignor?
      80 Is the package marked with the proper shipping name without any abbreviations,
         except "W" for "with" or "W/O" for "without" in descriptions of ammunition, or                            Please Input
         "ORM" for "Other Regulated Material"?
      81 If the marked proper shipping name of a hazardous substance does not identify
         the hazardous substance by name, is the name of the hazardous substance
                                                                                                                   Please Input
         marked on the package, in parentheses, in association with the basic
         description?
      82 If a package is re-used to transport materials other than the material it originally
         contained, are the original markings removed or changed to identify the material                          Please Input
         it now contains?
      83 Are portable tanks containing hazardous materials shipped from the facility?
                                                                                                                   Please Input
                                                                                                Yes   No   N/A   Comment/Concerns
      84 Is the proper shipping name of the material marked on two opposite sides of the
         portable tank?


     85 If the portable tank has a capacity of less than 1,000 gallons, is the identification
        number marked on two opposite sides of the tank in association with the proper
        shipping name?
     86 If the portable tank has a capacity of 1,000 gallons or more, is the identification
        number marked on each side and each end of the tank?
Highway Transport - Poisonous by Inhalation Materials
     87 Is the facility in compliance with the marking requirements for materials that are
        poisonous by inhalation?
                                                                                                                   Please Input


Highway Transport - Labeling
     88 Does the site use warning labels, required by the DOT, for shipments of
        hazardous materials?                                                                                       Please Input

      89 Are the labels in accordance with DOT size and color specifications?
                                                                                                                   Please Input

      90 Is column (6) of the Hazardous Materials Table consulted to ensure that the
         proper labels are applied to packages?                                                                    Please Input

      91 Are DOT warning labels placed only on packages that contain the hazard
         represented by the label?                                                                                 Please Input

      92 When a mixed or consolidated packages of hazardous material are shipped, is a
         label placed on the outside of the package for each hazard class in the mixture
         or consolidation?                                                                                         Please Input


      93 When two or more labels are required on a package, are they displayed or
         affixed next to each other?                                                                               Please Input

      94 When the package is of a size or shape that does not allow normal labeling, are
         labels displayed on tags affixed to packages?                                                             Please Input

      95 Are additional labeling requirements adhered to, when applicable?
                                                                                                                   Please Input

Highway Transport - Placarding
     96 Does the facility use placards required by the DOT to indicate the hazards of the
        material shipped                                                                                           Please Input

      97 Do the placards meet the DOT size and color specifications?
                                                                                                                   Please Input

      98 Whenever a shipment requires placarding of the vehicle, does the shipper
         provide the required number of the proper placards to the carrier?
                                                                                                                   Please Input

      99 Do placards furnished to carriers represent the hazard of the materials offered
         to, and to be transported by, the carrier?                                                                Please Input

     100 Are placards provided for:
                 a) Any quantity of Table 1 hazardous material; and
                                                                                                                   Please Input
                 b) Table 2 hazardous materials when 1,001 pounds or more are offered
                 to the carrier at one time?
     101         Are freight containers and aircraft unit load devices, packaged with the
                 capacity of 640 cubic feet or more, placarded the same as are motor                               Please Input
                 vehicles?
     102         Are freight containers and aircraft unit load devices, which are packaged
                 with less than 640 cubic feet capacity, placarded with one placard and                            Please Input
                 two warning labels?
                                                                                              Yes   No   N/A   Comment/Concerns
Highway Transport - Placarding - Poisonous by Inhalation
    103 Is the facility in compliance with the placarding and hazard communication
        requirements for materials poisonous by inhalation under 49 CFR 172, Subpart
        F (Placarding)                                                                                           Please Input


Highway Transport - Placarding - Mode-specific Requirements
    104 Is the Placard Substitution Table from 49 CFR 171.14(b) being used as a
        guideline for current placarding practices?                                                              Please Input

Highway Transport - Packaging
    105 Are materials that have more than one hazard class or division, and that are not
        specifically listed in the Hazardous Materials Table, classed according to the                           Please Input
        highest applicable hazard class?
    106 For each material to be packaged for transportation, is the Hazardous Materials
        Table consulted to determine:
                a) The packing group in column 5 corresponding to the proper shipping
                name and hazard class for that material?
                                                                                                                 Please Input
                b) The applicable packaging specification section of 49 CFR 173 under
                column 8b or 8c; and
                c) Any special provisions or exceptions to specific packaging
                requirements under columns 7 and 8a?
    107 Is the Hazardous Materials Table AND 49 CFR 173.21 checked to see if a
        material or packaging for shipment is forbidden by the mode of transport
                                                                                                                 Please Input
        selected?

     108 Are the packaging specifications for each hazardous material obtained from the
         applicable sections of the transportation regulations 49 CFR Part 173?                                  Please Input

     109 Are all hazardous material packagings prescribed or permitted in the specified
         packaging section (Column 8 of the Hazardous Materials Table), OR otherwise
         authorized for hazardous materials shipment?                                                            Please Input


     110 If containers are reused, are they refurbished to meet the requirements of new
         containers?                                                                                             Please Input

     111 Are REUSED paper, plastic, film, or textile packagings utilized for the transport
         of hazardous materials?                                                                                 Please Input

     112 Are packages of hazardous materials prepared so that ALL of the following are
         TRUE for normal transportation conditions:
                a) There will be no significant release of the hazardous materials to the
                environment;
                b) The effectiveness of the packaging will not be substantially reduced;
                                                                                                                 Please Input
                and
                c) There will be no mixture of gases or vapors in the package which
                could, through any credible spontaneous increase of heat or pressure, or
                through an explosion, significantly reduce the effectiveness of the
                packaging?
     113 Does the facility ensure that packagings are compatible with their lading
         (contents)?                                                                                             Please Input

     114 Are packaging closures checked to ensure they are both designed and closed,
         so that under transportation conditions no release to the environment occur?                            Please Input

     115 Does this facility ship any packages that require venting?                                              Please Input
     116 For packages that require venting, are the provisions under 49 CFR 273.24(g)
         consulted to ensure that venting is permissible?
    117 Is sufficient ullage (outage) left in liquid-containing packagings to ensure that
        neither leakage nor permanent distortion of the packaging will occur during                              Please Input
        normal transportation conditions?
Packaging - Non-bulk Packaging
    118 For combination packages containing liquid hazardous materials, are the
        closures on inner packages upright?                                                                      Please Input

     119 Does the facility consider the nature and thickness of the outer packaging to
         ensure that friction occurring during transportation will not generate enough heat                      Please Input
         to dangerously alter the chemical stability of the package?
                                                                                              Yes   No   N/A   Comment/Concerns
     120 Is cushioning material within the package:
                 a) Placed so as to prevent breakage and leakage;
                 b) Placed to prevent movement within the package;
                 c) Incapable of reacting dangerously with the contents of the inner                             Please Input
                 packagings; and
                 d) Incapable of having its protective properties weakened in the event
                 of leakage?
     121 Are nails, staples, and other metallic devices secured so that they won't protrude
         from the outer packaging and damage inner packagings or receptacles?                                    Please Input

     122 Are filling limitations of non-bulk packages in compliance with the provisions of
         49 CFR 173.24a(b)?                                                                                      Please Input

     123 Do any outer non-bulk packagings contain more than one hazardous material?
                                                                                                                 Please Input
     124 Do the non-bulk packaging with more than one hazardous material conform to
         the provisions contained in 49 CFR 173.24(c)(1)?
     125 Does the facility ship hazardous liquids in receptacles:                                                Please Input
     126 Do liquids completely fill receptacles at a temperature of 55 degrees Celsius
         (131 degrees Fahrenheit) or less?
Railroad Transport - Loading/Unloading
     127 Are pre-trip inspections performed on ALL of the following rail cars:
                 a) All rail tank cars; and
                                                                                                                 Please Input
                 b) Other rail cars that will be used for transporting hazardous materials?

     128 Is each rail car containing hazardous material inspected, at ground level, for ALL
         of the following conditions:
                  a) Required markings;
                  b) Required labels;
                  c) Required placards;
                  d) Leakage; and
                  e) Securement of closures?
     129 Are packages containing hazardous materials loaded in such a was to prevent
         the packages from changing positions, falling to the floor, or sliding into each                        Please Input
         other during normal transportation?
     130 Are procedures in place that ensure compliance with segregation and separation
         requirements for hazardous materials in rail cars?
                                                                                                                 Please Input


     131 Are wheel stops used to prevent railroad cars from moving during loading and
         unloading operations?                                                                                   Please Input

     132 Are derail and/or bumper blocks provided on spur railroad tracks in accordance
         with OSHA regulations?                                                                                  Please Input

Railroad Transport - Tank Cars - Loading
     133 Do all tank cars containing flammable gases, flammable liquids, or compressed
         gases, meet at least one of the following requirements:
                  a) Offered to consignees having private-sidings;
                                                                                                                 Please Input
                  b) Offered to railroad sidings properly equipped for unloading; OR
                  c) In tank cars of type DOT-106A or 110A, were written permission for
                  removal been properly received and filed?
     134 Are all tank cars in compliance with the DOT requirements in 49 CFR 173.31
         that include:
                  a) Tank cars must meet the applicable specifications and regulations for
                  the transported material;                                                                      Please Input
                  b) All openings and protective housings must be properly closed,
                  secured, and inspected; AND
                  c) Tank cars that are past due for retesting must not be used?
     135 Do all tank cars meet the following DOT requirements:
                  a) Tank cars must be equipped with vertical restraint couplers; AND
                                                                                                                 Please Input
                  b) Tank cars must contain the proper amount of outage when loaded
                  with hazardous materials that may expand while in transit?
Railroad Transport - Tank Cars - Unloading
     136 Are tank cars containing hazardous materials unloaded by reliable and properly
         trained individuals?                                                                                    Please Input
                                                                                                Yes   No   N/A   Comment/Concerns
     137 Do the unloading personnel:
                a) Set brakes and block wheel on tank cars during unloading;
                b) Place caution signs on the track or tank car to warn approaching
                persons that the car is being unloaded;
                c) Use caution signs made of metal or other comparable material;
                                                                                                                   Please Input
                d) Check to ensure caution signs contain the required warning;
                e) Check to ensure letters on the caution signs the required size; and

                  f) Check to ensure letters on caution signs are white on a blue
                  background?
     138 Is the tank car safely relieved of all interior pressure BEFORE the manhole
         cover or outlet cap is removed?                                                                           Please Input

     139 Are ALL of the following actions taken immediately after a tank car is unloaded:

                a) Unloading connections are disconnected; and                                                     Please Input
                b) All valves and closures are made tight by the use of a bar, wrench or
                other suitable tool?
     140 Are tank cars attended by the unloader throughout the entire period of
         unloading, and until the car is disconnected from an unloading device?
                                                                                                                   Please Input

Railroad Transport - Hazardous Materials Table
     141 Is the Hazardous Materials Table reviewed prior to shipping each hazardous
         material to determine:
                 a) If materials originating at the site are hazardous;
                 b) The proper shipping name from column 2;
                 c) The hazard class or division of the material from column 3:                                    Please Input
                 d) The identification number of the material (UN or NA number) from
                 column 4;
                 e) The packing group(s) assigned to a material from column 5; and
                 f) The label(s) to be applied to packages from column 6?
     142 Unless excepted, when a mixture or solution containing a hazardous material is
         not specifically listed in the Table, is it described using the proper shipping name
                                                                                                                   Please Input
         of the hazardous material with the qualifying word "mixture" or "solution"?

     143 When a mixture or solution containing two or more hazardous materials in the
         same hazard class is not identified in the Table by a specific description, is the
                                                                                                                   Please Input
         mixture or solution described using the most appropriate general shipping
         description (e.g., "Flammable liquid, n.o.s.")?
     144 Is the Hazardous Materials Table reviewed prior to shipping each hazardous
         material to determine:
                 a) Packaging requirements for non-bulk and bulk packagings from
                 columns 8b, 8c, and references cited therein;                                                     Please Input
                 b) Exceptions to packaging requirements from column 8a in addition to
                 those specified in subpart A of part 173; AND
                 c) Special provisions from column 7?
     145 Is the Appendix to the Hazardous Materials Table reviewed for each hazardous
         material to determine if the material is also listed as a hazardous substance?                            Please Input

     146 Is the facility in compliance with the classification and hazardous communication
         requirements in Parts 172 and 173 (Regulations for the use of the Hazardous
                                                                                                                   Please Input
         Materials Table and for Communications) not previously in effect?

Railroad Transport - Infectious Substances
     147 Is the facility in compliance with all applicable regulatory for Division 6.2
         materials including regulated medical waste and infectious substances affecting                           Please Input
         only animals?
                                                                                                 Yes   No   N/A   Comment/Concerns
Railroad Transport - Mode-specific Requirements
     148 For hazardous materials shipped by rail, do the shipping papers contain the
         following notations, when applicable:
                 a) The reporting mark and number for hazardous materials shipped in
                 rail cars, freight containers, transport vehicles or portable tanks that
                 display a reporting mark and number;
                 b) For each Class DOT-113 tank car containing a flammable gas, the
                 notations "DOT-113," and "DO NOT HUMP OR CUT OFF CAR WHILE
                                                                                                                    Please Input
                 IN MOTION";
                 c) For a tank car that contains only the residue of a hazardous material,
                 the notation "RESIDUE: Last Contained ***," followed by the basic
                 description of the hazardous material last contained in the tank car; and

                d) For shipments of elevated temperature materials, an appropriate
                notation such as "MAXIMUM OPERATING SPEED 15 MPH."?
     149 Are tank cars that contain a hazardous material marked in the following manner:

                 a) With the identification number specified for the material on each side
                 and each end of the tank; and                                                                      Please Input
                 b) With the material's proper shipping name (or authorized common
                 name) on each side of the tank for materials listed at 49 CFR
                 172.330(a)(1)(ii)?
Railroad Transport - Placarding - Mode-specific Requirements
     150 Are procedures in place to ensure that required placards are affixed to the rail
         car before it is tendered to the rail carrier?
                                                                                                                    Please Input



     151 Are special provisions for placarding made whenever the following hazardous
         materials are transported:
                 a) Division 1.1 and 1.2 explosive materials - requires a white square
                 background
                 b) Material classed in Division 2.3 Hazard Zone A or 6.1 Packing Group
                 I Hazard Zone A which require POISON GAS or POISON placards
                 affixed to the rail car, including tank cars containing only a residue of the
                 material - requires a white square background;                                                     Please Input
                 c) Class DOT 113 tank cars used to transport a Division 2.1 (flammable
                 gas) material, including tank cars containing only a residue of the
                 material - requires a white square background; and
                 d) Each rail car containing Division 1.1 or 1.2 (explosive) ammunition
                 which also meets the definition of a material poisonous by inhalation -
                 placarded EXPLOSIVES 1.1 or EXPLOSIVES 1.2 and POISON GAS or
                 POISON INHALATION HAZARD?
     152 Is each placard on a rail car readily visible from the direction it faces, except
         from the direction of another rail car to which the car is coupled?                                        Please Input

Additional Information:
                                                                                                Yes   No   N/A   Comment/Concerns
California
Spills

Aboveground Storage Tanks (AST)
      1 Do owners or operators that have the following capacities comply with
        California's aboveground laws and regulations:
                a) Have a storage capacity of 1,320 gallons or less of oil, provided no
                                                                                                                   Please Input
                single container has a capacity in excess of 660 gallons; or
                b) Maintain a petroleum storage facility with a capacity of 10,000 gallons
                or more (CD & SC 25270.3)?
      2 Are the following tanks exempted:
                a) Pressurized vessels storing liquefied petroleum gases:
                b) Steam boilers storing liquefied petroleum gases;
                                                                                                                   Please Input
                c) Properly permitted hazardous waste storage tanks;
                d) Tanks used with the production of oil that are subject to the state oil
                and gas supervisor's authority?
Underground Storage Tanks (UST)
      3 Do petroleum and hazardous substance underground tanks, including heating oil
        tanks and farm tanks with capacities over 1,000 gallons in compliance with
        California's underground laws and regulations?                                                             Please Input


       4 Does operating permits from the local agency contain the following information:
                  a) UST location and description;
                  b) Hazardous substance(s) stored;                                                                Please Input
                  c) Monitoring system;
                  d) Person responsible and an emergency contact?
       5 For petroleum tank permit holders, has the fee of six mils ($.006) per gallon to
         the state Board of Equalization to finance tank cleanups through the state                                Please Input
         Underground Storage Tank Cleanup Fund?
       6 If the tank was installed after January 1, 1984, does is have primary and
         secondary containment systems?                                                                            Please Input

       7 Is the facility's monitoring program approved by the local permitting agency and
         in compliance with state rules as well as the UST operating permit                                        Please Input
         requirements?
       8 Has the facility verbally notified the local agency within 24 hours of detection and
         submitted a written report within 5 days of unauthorized releases from a UST
                                                                                                                   Please Input
         that are not contained within the secondary containment system?

       9 Has the owners, operators, and other responsible parties taken corrective action
         in response to an unauthorized release?                                                                   Please Input

      10 When the responsible party takes corrective actions, has the party prepared a
         work plan detailing the actions to be taken to achieve the required corrective
         action?
      11 Does the work plan contain a schedule and timeline for corrective action?

Discharge of Petroleum and Other Hazardous Substances
     12 Does the facility store, transfer, process, or use hazardous substances?

                                                                                                                   Please Input


      13 Does your facility have a total combined storage capacity > 20,000 gallons (or a
         solid/non-fluid equivalent of 167,043 lbs) for all hazardous substances except
         petroleum or petroleum products?
                                                                                                                   Please Input




      14 Does your facility have a total combined storage capacity > 200,000 gallons (or
         equivalent measure) for petroleum and non-petroleum hazardous substances?

                                                                                                                   Please Input
                                                                                              Yes   No   N/A   Comment/Concerns
      15 Is your facility a "vessel" (watercraft) that transfers hazardous substances to
         another vessel? (except certain cleanup, removal, and training activities)

                                                                                                                 Please Input



      16 Have you previously submitted SPCC plans
                                                                                                                 Please Input


      17 Has it been 5 years since the last approval or conditional approval of your SPCC
         plan?
                                                                                                                 Please Input


      18 Was new construction or installation, substantial modification, or replacement to:
         above ground storage tanks/space leak detection, monitoring or safety systems
                                                                                                                 Please Input
         submitted to DEP at least 60 days prior to the start of any such construction,
         installation, or modification?
      19 Have there been changes to name and mailing address of facility or registered
         agent, names and phone numbers of employees included in prior SPCC plans,                               Please Input
         or are your financial responsibility documents new or revised?
Construction and Release Detection
     20 Do aboveground storage tanks (AST) meet ALL of the following construction
        and release detection standards:
                a) Equipped with adequate secondary containment or diversion;
                b) The base underlying any new AST must be made of or surfaced with
                a material impermeable to passage or chemical attach by the stored
                substance;
                c) Pipes the enter the tank below the liquid level must be equipped with
                valves that can be remotely activated or are readily accessible, and
                close enough to the tank to prevent its contents from escaping outside
                the secondary containment area in the event of a pipe rupture;                                   Please Input

                  d) Mobile or portable ASTs must be protected by secondary
                  containment or diversion structures, and may not be located in areas
                  subject to periodic flooding or washout unless adequately protected from
                  discharge or being carried away; and
                  e) ASTs with internal heating coils must be designed so that any
                  leakage passing from the tank into the heating coil system will be
                  captured and contained in the secondary containment or wastewater
                  treatment system?
Spill and Overfill Prevention
       21 Are ASTs over 2,000 gallons in capacity equipped with ONE of the following:

                  a) A high liquid level pump cutoff device;
                  b) Direct communication between tank gauger and pumping station,                               Please Input
                  such as direct line of sight or telephone or radio communication; or
                  c) Fast response systems for determining liquid levels that result in
                  rapid shutdown of pumping?
Integrity Testing
      22 Are ASTs with a capacity greater than 2,000 gallons and installed prior to July
          22, 1990 tested for integrity or static head product and periodically inspected                        Please Input
          internally?
Closure Requirements
      23 When closing a UST, did the owners or operators notify DEP of all of the
          following information:
                   a) The facility registration number;
                   b) A statement as to whether the tank system is being removed or
                   abandoned in place;                                                                           Please Input
                   c) The date the UST is to be closed
                   d) The certification numbers and categories of serviced of business
                   firms performing closure activities and a subsurface evaluation; and
                   e) Any additional information required by DEP?
General SPCC Plan Guidelines
      24 Does a single aboveground storage capacity exceed 660 gallons; or the total
          capacity exceed 1,320 gallons; or the underground storage capacity exceed                              Please Input
          42,000 gallons?
                                                                                                Yes   No   N/A   Comment/Concerns
25 Did owners or operators of this facility make the following submissions to DEP at
   least 180 days before operations began
           a) Initial information;                                                                                 Please Input
           b) SPCC plan;

26 Does the facility have a Spill Prevention Control and Countermeasure Plan
   (SPCC Plan) prepared in writing?                                                                                Please Input

27 Was the facility's SPCC Plan:
            a) Prepared during the first six months of facility operation or within six
            months of the effective date of the SPCC plan regulations (March 26,
            1976) whichever is later;                                                                              Please Input
            b) Implemented no later than one year after the facility commenced
            operation; and
            c) Reviewed and certified by a Registered Professional Engineer?
28 Is a complete copy of the SPCC plan maintained at facilities that are attended at
   least eight hours per day OR if the facility is not so attended, at the nearest field                           Please Input
   office?
29 Does the SPCC Plan meet ALL of the following requirements:
            a) Is prepared in accordance with good engineering practices;
            b) Has the full approval of management at a level with authority to
            commit the necessary resources:
            c) Includes separate discussion paragraphs for additional facilities or
            procedures, methods, or equipment not yet fully operational, including a                               Please Input
            separate explanation of the details of installation and operational start-up

              d) Follows the sequence outlined in 40 CFR 112.7; and
              e) Includes a discussion of the facility's conformance with the
              appropriate guidelines listed in 40 CFR 112.7?
30   Does the SPCC Plan include both of the following, as applicable:
              a) For facilities which have experienced one or more spill events within
              twelve months prior to the effective date of 40 CFR 112 (March 26,
              1976), a written description of each such spill, corrective action taken
              and plans for preventing recurrence; and                                                             Please Input
              b) Where experience indicates a reasonable potential for equipment
              failure, a prediction of the direction, rate of flow, and total quantity of oil
              which could be discharged from the facility as a result of each major type
              of failure?
31   Does the SPCC plan contain a description of the physical plant that includes all
     of the following:
              a) A facility diagram with the location and contents of all tanks marked;
              b) Unit-by-unit storage capacity;
              c) Type and quantity of oil stored;                                                                  Please Input
              d) Estimates of quantity of oil potentially discharged:
              e) Possible spill pathways; and
              f) Spill controls such as secondary containment, equipment and
              procedures for control of a discharge?
32   Does the SPCC plan contain a contact list and phone numbers for:
              a) The facility response coordinator;
              b) The National Response coordinator;
              c) Cleanup contractors:
                                                                                                                   Please Input
              d) Fire departments;
              e) The Local Emergency Planning Committee;
              f) The State Emergency Planning Committee:
              g) Downstream water suppliers?
33   Is documentations in the Plan sufficient to enable the reporter of a discharge to
     provide the following information:
              a) The address and phone number of the facility;
              b) The names of individuals and organizations who have been notified;

             c) The spill date, time and material spilled;
             d) Estimates of the total quantity spilled, and the total quantity spilled
                                                                                                                   Please Input
             into navigable water;
             e) The source and cause of the spill and a description of the effected
             medium;
             f) Any damages or injuries caused by the spill;
             g) Actions being used to stop, remove and mitigate the discharge; and

             h) Whether an evacuation might be necessary?
                                                                                              Yes   No   N/A   Comment/Concerns
      34 Does the SPCC plan contain procedures for the following;
                a) Spill prevention, including routine handling of products (loading,
                unloading, facility transfers);
                b) Spill countermeasures for spill discovery, response and cleanup; and                          Please Input

                 c) Disposal of recovered materials in accordance with applicable legal
                 requirements?
    35 Within 60 days of any reportable spill event, was a report submitted to the EPA
        Regional Administrator and the state water pollution control agency that included
        all of the following:
                 a) The name and location of the site, name of the owner/operator, and
                 date of initial facility operation;
                 b) Maximum facility storage or handling capacity and normal daily
                 throughput;
                 c) A description of the facility including maps and flow diagrams;                              Please Input
                 d) A copy of the SPCC plan;
                 e) Cause(s) of the spill including a failure analysis of the system in
                 which the failure occurred;
                 f) Corrective actions and/or countermeasures taken;
                 g) Preventative measures taken to prevent recurrence; and
                 h) Such other information as the Regional Administrator requires
                 pertinent to the plan or spill event?
    36 Is the SPCC plan reviewed, updated, and if necessary, amended and certified
        by a Registered Professional Engineer under ALL of the following
        circumstances:
                 a) Every three years;
                 b) If a change in facility design, construction, operation, or maintenance
                                                                                                                 Please Input
                 affects the facility's potential to discharge oil;
                 c) If more effective prevention and control technology has been
                 demonstrated and field-proven to significantly reduce the likelihood of a
                 spill event; or
                 d) If required by the Regional Administrator?
    37 Are all required amendments or changes made to the SPCC Plan and fully
                                                                                                                 Please Input
        implemented within the appropriate time period?
SPCC Plan - Minimal Prevention Standards
    38 Have appropriate containment and/or diversionary structures been provided at
        the facility to prevent discharged oil from reaching a navigable water course,
        including AT LEAST ONE of the following systems or its equivalents:

                 a) Sufficiently impervious dikes, berms, or retaining walls;
                 b) Curbing;
                 c) Culverts, gutters, or other drainage systems;                                                Please Input
                 d) Weirs, booms, or similar barriers;
                 e) Spill diversion ponds;
                 f) Retention ponds;
                 g) Sorbent materials;
                 h) Curbing, drip pans (for offshore facilities); or
                 I) Sumps and collection systems (for offshore facilities)?
    39 When installation of containment or diversionary structures is impracticable, has
        the facility submitted the following information to EPA:
                 a) A clear demonstration of the impracticability;
                 b) An oil contingency plan; and
                 c) A written commitment of personnel, material and equipment required
                 to expeditiously remove harmful quantities of discharged oil
    40 If installation of containment or diversionary structures is impractible, is:
                 a) Tank integrity testing conducted every five years; and
                 b) Valve and piping leak/integrity testing conducted every year?
SPCC Plan - Onshore Facility Drainage
    41 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for onshore non-production facility drainage (40                          Please Input
        CFR 112.7(e)(1))?
                                                                                                   Yes   No   N/A   Comment/Concerns
      42 Is plant drainage engineered as follows:
                  a) Drainage from diked storage areas is retrained by manual, open-and-
                  closed valves or other positive means to present a spill or other
                  excessive leakage of oil into the drainage system or inplant effluent
                  treatment system except where plan systems are designed to handle
                                                                                                                      Please Input
                  such leakage, OR is emptied by manually activated pumps or ejectors;
                  and
                  b) Drainage from undiked areas, if possible, flows into ponds, lagoons
                  or catchment basins designed to retain oil or return it to the facility?

      43 If plant drainage is not engineered as specified in 40 CFR 112.7(e)(1)(I) through
         (III), is the final discharge of all in-plant ditches equipped with a diversion system
         that could, in the event of an uncontrolled spill, return the oil to the plant?

    44 If drainage waters are treated in more than one treatment unit, are the following
        methods used to move the water:
                a) Natural hydraulic flow; and                                                                        Please Input
                b) If pump transfer is needed, tow "lift" pumps with at least one of the
                pumps permanently installed when the treatment is continuous?
    45 If the facility is in a location subject to flooding, does the SPCC Plan provide
                                                                                                                      Please Input
        additional protection for events that may occur during the floods?
SPCC Plan - Onshore Bulk Storage Tanks
    46 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for onshore non-production facility bulk storage                               Please Input
        tanks (40 CFR 112.7(e)(2))?
    47 Do tanks used for the storage of oil meet ALL of the following conditions:
                a) Material and construction is compatible with the material stored and
                conditions of storage (i.e. pressure and temperature)
                b) Adequate secondary containment (e.g. dike, containment curb, pit,
                drainage trench) is provided for the entire contents of the largest singe
                tank (plus sufficient freeboard for precipitation);                                                   Please Input
                c) Provisions meeting the requirements of 40 CFR 112.7 (e)(2)(III)(A)
                through (D) are made for the drainage of rainwater;
                d) Corrosion protection is provided for a new underground metallic
                storage tanks and they are subjected to regular pressure testing; and
                e) Corrosion protection is provided for partially buried metallic tanks?
    48 Are aboveground tanks, including tank supports and foundations, being tested
        using techniques such as hydrostatic testing, visual inspection, or non-                                      Please Input
        destructive shell thickness testing?
    49 Is the outside of each aboveground tank frequently checked for signs of
        deterioration, leaks which might cause a spill, or accumulation of oil inside diked                           Please Input
        areas?
    50 To control leakage through defective internal heating coils, are the following
        factors applied, as appropriate:
                a) The stream return or exhaust lines from internal heating coils which
                discharge into an open water course are monitored for contamination, or
                                                                                                                      Please Input
                passed through a settling tank, skimmer, or other separation or retention
                system; and
                b) The feasibility of installing an external heating system is considered?

      51 Are tanks equipped with fail-safe engineering for overfill protection, including
         one or more of the following devices:
                 a) High liquid level alarms with audible or visual signal at a constantly
                 manned surveillance station;
                 b) High liquid level pump cutoff devices set to stop flow at a
                 predetermined tank content level;                                                                    Please Input
                 c) Direct audible or code signal communication between the tank
                 gauger and the pumping station; or
                 d) A fast response system for determining the liquid level of each bulk
                 storage tank such as digital computers, telepulse, or direct vision
                 gauges or their equivalent?
      52 Are liquid levels sensing devices tested regularly?                                                          Please Input
      53 Are plant effluent disposal facilities observed frequently enough to detect system
                                                                                                                      Please Input
         problems that could lead to an oil spill?
      54 Does the owner/operator promptly correct all visible oil leaks from tank seams,
         gaskets, rivets and bolts which result in a loss of oil sufficiently large to cause oil                      Please Input
         accumulation in diked areas?
      55 Are all mobile or portable storage tanks equipped with secondary containment
         and positioned to prevent discharges?                                                                        Please Input
                                                                                             Yes   No   N/A   Comment/Concerns
SPCC Plan - Transfer/Pumping Operations
    56 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for onshore non-production transfer/pumping                              Please Input
        operations (40 CFR 112.7(e)(3))?
    57 Does the site have any buried piping installations?                                                      Please Input
    58 Does the underground piping have protective wrapping, coating, and cathodic
        protection?
      59 Are ALL of the following true for buried piping installations:
                  a) The installations comply with relevant requirements in Technical
                  Standards and Corrective Action Requirements for Underground
                  Storage Tanks (40 CFR 280);
                  b) The installations are tested for leaks annually OR monitored monthly;
                  and
                  c) Records of testing are maintained for five years?
      60 If a pipeline is not in service, is the terminal connection at the transfer point
                                                                                                                Please Input
         capped or blank - flagged and marked as to origin?
      61 Are pipe supports designed to minimize abrasion and corrosion, and allow for
         expansion and contraction?
                                                                                                                Please Input


    62 Does the site have any aboveground valves and pipelines?                                                 Please Input
    63 Are the following true for each aboveground piping installation:
                a) Aboveground valves and pipelines are inspected regularly;
                b) The general condition of flange joints, expansion joints, valve glands
                and bodies, catch pans, pipe supports, locking of valves an metal
                surfaces are assessed regularly; and
                c) In areas where facility drainage is such that a piping failure might
                lead to a spill event, periodic pressure testing of piping is conducted?
    64 Are drivers entering an area with aboveground piping warned verbally or by
        appropriate signs to be sure that the vehicle, because of its size, will not
        endanger aboveground piping?
SPCC Plan - Loading/Unloading
    65 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for facility bulk loading and unloading (40 CFR                          Please Input
        112.7(e)(4))?
    66 Do the facility's tank car and truck loading and unloading procedures meet the
        minimum requirements established by the Department of Transportation (DOT)?                             Please Input

      67 Does the drainage from each rack area flow into a catchment basin or treatment
         facility designed to handle spills?                                                                    Please Input

      68 In these rack areas, is a quick drainage system used, with a containment system
         designed to hold at least the maximum capacity of any single compartment of an
         tank car or truck loaded or unloaded in the area?

    69 Do the tank car and truck loading and unloading procedures incorporate BOTH
        of the following work practices:
                 a) An interlocked warning light, warning signs or physical barrier system
                 are provided to prevent vehicular departure before transfer lines are                          Please Input
                 disconnected; and
                 b) The lowermost drain and all outlets of each tank car or truck are
                 checked for leakage prior to its filling and departure?
SPCC Plan - Onshore Facility Drainage
    70 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for onshore oil production facility drainage (40                         Please Input
        CFR 112.7(e)(5)(ii))?
    71 Are facility drainage systems designed to ensure that:
                 a) Dikes (or equivalent) at tank batteries and central treating stations
                 where an accidental discharge of oil would have a reasonable possibility
                 of reaching navigable waters have drains that are closed and sealed
                                                                                                                Please Input
                 except when rainwater is drained;
                 b) Field drainage ditches, and oil traps, sumps or skimmers are
                 inspected at regularly scheduled intervals for accumulation of oil; and
                 c) Accumulated oil is removed?
    72 Are facility drainage systems designed for the following situations:
                 a) Discharged oil is prevented from reaching navigable waters in the
                 event of equipment failure or human error; and                                                 Please Input
                 b) In locations subject to flooding, provision is made for additional
                 protection during floods?
                                                                                                 Yes   No   N/A   Comment/Concerns
Tank Equipment Standards
     73 If a major facility has an AST total storage capacity of 20,000 gallons or more of
        hazardous substance other than petroleum or petroleum products is an                                        Please Input
        adequate secondary containment system in place?
SPCC Plan - Inspections and Records
     74 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for inspections and records (40 CFR 112.7(e)(8))?                            Please Input

    75 Are all inspections required by the Oil Pollution Prevention regulations (40 CFR
        112) conducted in accordance with written procedures developed by the                                       Please Input
        owner/operator?
    76 Are the written procedures and records of inspections:
                a) Signed by the supervisor or inspector; and                                                       Please Input
                b) Maintained as part of the SPCC Plan for a three-year period?
SPCC Plan - Security
    77 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for security (40 CFR 112.7(e)(9))?                                           Please Input

    78 Does the facility provide ALL of the following security measures:
                a) The facility is fenced and entrance gates are locked when the facility
                is not in production
                b) All valves that allow outflow of product have security systems and
                remain closed when not in operation;
                c) All pump starter controls are accessible only to authorized personnel                            Please Input
                or are locked in the "off" position when not in operation;
                d) The loading/unloading connections of piping shall be capped or blank-
                flanged when not in service; and
                d) Facility lighting is adequate for discovery of spills and prevention of
                vandalism?
SPCC Plan - Personnel, Training and Procedures
    79 Does the SPCC plan include a complete discussion of the facility's conformance
        with the applicable guidelines for personnel, training, and spill prevention                                Please Input
        procedures (40 CFR 112.7(e)(10))?
    80 Are all oil-handling personnel provided with instruction in the following subjects:

                  a) Operation and maintenance of equipment to prevent oil discharges;                              Please Input

                 b) Applicable pollution control laws, rules, and regulations?
      81 Does the site have a designated person who is accountable for oil spill
                                                                                                                    Please Input
         prevention and reports to line management?
      82 Do operating personnel attend spill prevention briefing sessions to discuss spill
         events, equipment malfunctions, and precautionary measures?                                                Please Input

      83 Are the spill prevention briefing sessions conducted frequently enough to assure
         adequate understanding of the SPCC Plan?
      84 Are all personnel involved in oil-handling activities trained in ALL of the following
         subjects:
                  a) Equipment operation and maintenance;
                                                                                                                    Please Input
                  b) General facility operations;
                  c) Discharge prevention regulations; and
                  d) Contents of the SPCC Plan?
      85 Is training conducted according to the following schedules:
                  a) All employees receive eight hours of training within one year of the
                  effective date of this final rule and four hours training in subsequent
                  years;
                                                                                                                    Please Input
                  b) New employees receive eight hours training within their first week of
                  employment; and
                  c) All personnel participate in unaccounted drills at least once a year?

Spill Prevention - Oil Release
       86 Were the number of spills or discharges of oil or other petroleum products
                                                                                                                    Please Input
          documented in the last 12 months?
       87 For each spill or discharge, was ALL of the following information provided:
                  a) The date and time of the incident;
                                                                                                                    Please Input
                  b) The identity of the specific material spilled/discharged; and
                  c) The estimated quantity of the spilled/discharged material?
       88 For each spill or discharge, did the person in charge, or a person designated to
          report spills, determine whether or not any outside entities (e.g. federal, state
                                                                                                                    Please Input
          and local officials, emergency response teams) needed to be notified?
                                                                                                    Yes   No   N/A   Comment/Concerns
       89 For each spill or discharge, was the elapsed time between discovery and the
          notification determination documented?
       90 For each spill or discharge, were the appropriate authorities notified immediately
          after the discovery of the spill or discharge?
       91 For each spill or discharge, was the cause of the release documented?
                                                                                                                       Please Input
       92 For any spill or discharge, was any material (regardless of quantity) released to:

                   a) Surface water or other waters of the United States;
                                                                                                                       Please Input
                   b) Groundwater;
                   c) Air; or
                   d) Ground?
Spill Prevention - Reporting
       93 If any spill or discharge caused or contributed to a violation of an NPDES permit,
          was the violation reported in accordance with procedures set forth in the NPDES                              Please Input
          permit?
       94 If any spill or discharge endangered public health or the environment, was it
          reported by telephone within 24 hours to the EPA (or the state if the state has                              Please Input
          enforcement authority) and by written notice within five days?
       95 If required by the EPA, was a written report for any spill or discharge submitted,
          and did each report include ALL of the following:
                   a) A description of the noncompliance and its cause;
                   b) There period of noncompliance, including dates and times;                                        Please Input
                   c) The anticipated amount of time to correct the noncompliance; and
                   d) Steps taken to reduce, eliminate, and prevent recurrence of the
                   noncompliance?
       96 Were any recommended preventive measures implemented?
                                                                                                                       Please Input
       97 If a follow-up written report for any spill or discharge was required by another
                                                                                                                       Please Input
          agency other than the EPA, was the report submitted?
Spill Prevention - Remedial Action
       98 Was remedial action taken for each spill or discharge or oil, and did remedial
          action(s):
                    a) Control the source of the spill(s) or discharge(s), prevent further spills
                    or discharges, and halt or slow the spread of the spills(s) or                                     Please Input
                    discharges(s); and
                    b) Include mechanical or manual methods to recover spilled or
                    discharged petroleum from the water or adjoining shorelines?
       99 If chemical agents were included in any remedial action, were they used:
                    a) In accordance with National Contingency Plan (NCP); and
                                                                                                                       Please Input
                    b) With the permission of the Federal on-scene coordinator or a state
                    representative?
      100 For each spill or discharge did remedial action comply with:
                    a) Guidelines established in Coast Guard regulations (33 CFR 153) and
                    the National Contingency Plan (40 CFR 300); and                                                    Please Input
                    b) All state and local requirements for recovering oil and contaminated
                    materials?
      101 For each spill or discharge, were the long-term remedial actions taken
                                                                                                                       Please Input
          documented?
Spill Prevention - Hazardous Substance Release
      102 For facilities that use, produce, store, or dispose of hazardous substances, are
          other regulations referred to that contain requirements for hazardous substance
          release prevention and response including the following:
                  a) Process safety management requirements (29 CFR 1910.119,
                  covered in the FEDERAL - WORKER SAFETY module);
                  b) Chemical accident prevention requirements (Risk Management
                  Program, 40 CFR 68, covered in the FEDERAL - AIR QUALITY
                  module);
                  c) Emergency action plan requirements (29 CFR 1910.38, covered in                                    Please Input
                  the FEDERAL - WORKER SAFETY module);
                  d) Hazardous waste contingency plan and emergency procedures (40
                  CFR 264, Subpart D, covered in the FEDERAL - SOLID AND
                  HAZARDOUS WASTE module);
                  e) Stormwater discharge permit requirements (40 CFR 403, covered in
                  the FEDERAL - WATER QUALITY module);
                  f) Pretreatment standards (40 CFR 122.26, covered in the FEDERAL -
                  WATER QUALITY module)?
     103 Were the number of spills or discharges of hazardous substances documented
                                                                                                                       Please Input
         in the last 12 months?
                                                                                                Yes   No   N/A   Comment/Concerns
     104 For each spill or release, were ALL of the following documented:
                  a) The date and time of the incident;
                  b) The identity of thee specific material spilled/discharged; and                                Please Input
                  c) The estimated quantity of the spilled/discharged material; and
                  d) The location of the spill?
     105 For each spill, was it documented if the spill equaled or exceeded the reportable
                                                                                                                   Please Input
         quantity for that material?
     106 For each spill, did the person in charge of the facility or the person designated to
                                                                                                                   Please Input
         report spills notify the appropriate authorities immediately?
     107 For each spill, was it documented whether any agencies other than the National
         Response Center were notified by the person designated to report spills, and/or                           Please Input
         by the National Response Center?
     108 Were any substance(s) released in a spill defined as hazardous under the Clean
                                                                                                                   Please Input
         Water Act (CWA)?
     109 For ALL substances released during the spill which exceeded a reportable
         quantity under the Clean Water Act, did the person in charge of the facility or the
         person designated to report spills immediately notify ONE of the following
         entities in descending order of priority:
                  a) The National Response Center;
                  b) The On-scene Coordinator as designated in the Regional
                  Contingency Plan;
                  c) The Officer-in-Charge at any vicinity Coast Guard unit; or
                  d) The Commander of the Coast Guard District?
     110 Were any substance(s) released in a spill defined as hazardous substance(s)
                                                                                                                   Please Input
         under Superfund (CERCLA)?
     111 Did the person in charge or the person designated to report spill immediately
         notify the National Response Center by telephone?
     112 If an agency required a follow-up written report for any spill or release, was that
         report submitted by the deadline?
     113 For each spill or discharge, was material released:
                  a) Into waters of the United States; or
                  b) Into or onto the ground where it could affect either ground or surface
                  water?
     114 For any spill or discharge, were remedial actions recommended by any
                                                                                                                   Please Input
         regulatory agency(s)?
     115 Were all recommended remedial actions taken?

Business Plans
      116 For businesses that handle a specified minimum quantity of any hazardous
          material, has a business plan been submitted and administered with the
          following elements:
                  a) Hazardous material inventory;                                                                 Please Input
                  b) Emergency response plans and procedures; and
                  c) Training program information?
Spill Prevention - Reportable Quantity
      117 For each spill or release did the Emergency Coordinator (or his/her designee) do
          ALL of the following:
                  a) Activate facility alarms or communication systems;
                  b) Notify the Community Emergency Coordinator of the Local                                       Please Input
                  Emergency Planning Committee;
                  c) Notify the State Emergency Response Commission; and
                  d) Notify the National Response Center?
      118 For each spill or release did the Emergency Coordinator (or his/her designee)
          determine whether the release:
                  a) Could threaten human health or the environment outside the facility;
                                                                                                                   Please Input
                  b) Required immediate notice to the Community Emergency Coordinator
                  of the Local Emergency Planning Committee; and
                  c) Triggered the facility's hazardous waste contingency plan, and if so
                  notify the EPA Regional Administrator?
Spill Prevention - No Reportable Quantity
      119 For any release of one pound or more of a hazardous substance that is not on
          EPA's list of extremely hazardous substances and for which there is no
          reportable quantity that occurred ON or AFTER 4/30/88, did the Emergency
          Coordinator (or his/her designee) notify BOTH of the following:                                          Please Input
                  a) The Community Emergency Coordinator for the Local Emergency
                  Planning Committee; and
                  b) The State Emergency Response Commission?
                                                                                                Yes   No   N/A   Comment/Concerns
     120 Did the notice indicate ALL of the following:
                 a) The chemical name of any substance released;
                 b) That the substance was not on the EPA list of Extremely Hazardous
                 Substances;
                 c) The quantity of the substance released (estimate);
                 d) The time and duration of the release;
                 e) The name and telephone number of a contact person at the facility;

                  f) The environmental media into which the release occurred;
                  g) Health risks that could be triggered by the release and the
                  appropriate medical treatment and/or advice; and
                  h) Proper precautions to be followed during and after the release?
Spill Prevention - Extremely Hazardous Substance
      121 For each spill or release was a notice of the release given to ALL of the
          following officials:
                  a) The Community Emergency Coordinator;                                                          Please Input
                  b) State Emergency Response Commission; and
                  c) The National Response Center?
      122 For each spill or release, did the notice of release indicate ALL of the following:

                  a) The chemical name of hazardous substance released;
                  b) Whether the substance was on the EPA list of Extremely Hazardous
                  Substances;
                  c) The estimated quantity of the extremely hazardous substance;
                  d) The time and duration of the release;
                                                                                                                   Please Input
                  e) The name and telephone number of a contact person at the facility;

                f) The environmental media into which the release occurred;
                g) Any known or anticipated health risks that could be triggered by the
                release and appropriate medical treatment advice; and
                h) Recommendations on precautions to be followed during and after the
                release?
Additional Notes:

				
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