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Correspondance - CR&R - 2015-02-25February 25, 2015 Scott Carroll General Manager Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 RE: Household Hazardous Waste Facility Renewal and Financial Assurance Dear Mr. Carroll: CR &R, Inc. appreciates the opportunity to provide Household Hazardous Waste collection services for the Costa Mesa Sanitary District. One of the regulatory requirements for this facility is to provide the County cf Orange Environmental Health Division with an annual update of the facility financial assurance for cost of closure. In addition, we have revised the Permit - by -Rule (PBR) form for the facility. Both of these documents are required to be signed by a "chief executive officer or elected official of the public agency". The PER was revised to reflect several operational changes at the facility. CR &R has added an additional hazardous waste storage container. In addition, the total amount of household hazardous waste brought to the facility was revised to reflect typical amounts of wastes from your jurisdiction. Regarding the facility closure cost financial assurance, CR &R provides an Insurance policy to the City for this facility's closure cost but Orange County also requires the attached Certificate of Self- Insurance. This Certificate does not require any funds be spent. It is only a pledge for payment if the facility closes in the future. As required by the California Code of Regulations, Title 22, Section 67450.30, the previous estimated closure cost is adjusted for inflation. The enclosed form Includes that revised cost estimate. In order to complete submittal, we need your signature or the signature of a Public Agency Official on the attached forms on page 5 and the last page. Please sign and date the forms and have them sent out via certified mail, with a return receipt, with a copy to the DTSC and the CUPA. Thank you for allowing CR &R to provide this service. Please contact me at (714) 826 -9049 if you have any questions. Sincerely, �Dean A. Ruffridge cR &R INco$PO rDyice President 11292 wkv P.O.BOX 125 STA N, CA 90680 800.826.9677 714.826.9049 714.890.6947 Fox CRRWASTESERVICES.COM .cv - - 1-1 State of California- California Environmental Protection Agency Department of Toxic Substances Control Fm msc useomy PERMIT BY RULE NOTIFICATION FORM FOR PERMANENT HOUSEHOLD Regim HAZARDOUS WASTE COLLECTION FACILFrIES Please refer to the attached Instructions before completing this form. Initial Notification © Revised Notification L GENERAL INFORMATION IDNUMBER: CA L000378106 FACILITY NAME CR &R Household Hazardous Waste Facility FACILITY ADDRESS 7571 Lampson Avenue CITY Garden Grove CA ZIP 92841 COUNTY Orange LOCATION The facility is located on the north side of (Description) the CR &R facility. It is not open to the public. (Latitude .@. Longitude) 33.781403, - 118.000395 R. OPERATOR (PUBLIC AGENCY) NAME Costa Mesa Sanitary District ADDRESS 628 W. 19th Street CITY Costa Mesa CONTACTPERSON Carroll psnName) TELEPHONE NUMBER ( 49)645.8400 III. CONTRACTOR INFORMATION (if applicable) NAME CR &R Incorporated ADDRESS 11292 Western Avenue STATE CA ZIP 92627 2716 Scott (Firs) Name) CITY CONTACTPERSON Stanton Ruffridge (Imt Name) STATE CA ZIP 90180 Dean (rice Name) DTSC 1094B (Revised 11108) Page 1 State of California- California Environmental Protection Agency Department of Toxic Substances Control TELEPHONENUMBER 7f 241806 -9249 PERMIT BY RULE NOTIFICATION FORM FOR PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECFIC IV. THE FOLLOWING LOCAL AND /OR STATE PERMITS ARE REQUIRED FOR OPERATION OF THE PHHWCF: OBTAINED OBTAINED Hazardous waste Transporter YEg� Iq0 Garden Grove planning approval YES NO� Home - generated sharps consolidation YES NO YES NO Hazardous Materials Disclosure YES NO YES No V. PROPERTY OWNERSHIP A. Is the property on which the PHRWCF is located owned by the operator? Yes NON If not, awritten agreement between the operator and the property owner is required. property owners Name CR &R Incorporated phans 7( 14 )806 -9049 VI. ACCEPTANCE AND MANAGEMENT OF SPECIFIC WASTE TYPES A. Will you facility accept wastes from conditionally exempt small quantity generators? Yes [:] No B. Will you facility accept waste from any ofthe following programs, fecilifies, or transporters? 1. Curbside household hazardous waste collection program? Yes No 2. Doouto -door household hazardous waste collection program? Yes No 3. Temporary household hazardous waste collection facility? Yes No 4. Recycle -only household hazardous wade facility? Yes No 5. Mobile household hazardous waste collection facility? Yes No 6. Registered 1-IW transporter carrying hazardous waste generated by a CESQG? Yes No 7. Registered HW transporter carrying waste from a loadcheck program? Yes No S. Registered HW transporter carrying abandoned waste under public agency oversight? Yes Non 9. Other? Please exolain Universal wastes C. Does you facility categorically exclude any type of waste (e.g. explosives, infectious waste, compressed gas cylinders, etc.)? If so, please list those Wegodes: D. Will you facility consolidate any of the following wastes? used oil B antifreeze water -based paint miscellaneous wastes oil -based paint contaminated with solvents 0 photographic solutions gasoline DISC 10948 (Revised 11/08) Page 2 WNUMBERCAL000378106 © solvents e ramiingtar mulkinepatching compounds adhesives PERMIT BY RULE NOTIFICATION FORM FOR PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES VII. WASTE VOLUME A. Please indicate the approximate total volume ofhazerdous waste brought to the facility in an average month. a,u­ — 2,300 Pnu,de B. What is the capacity ofthe container storage man (i.e., drums, roll off bins, etc.) at the facility? 1. Individual storage area total capacity 1,650 gallons/Pa.& gallons 2. Individual storage area total capacity 1,650 Rellons/pounds gallons 3. Individual storage areatotal capacity 1,650 galloms/pounds gallons 4. Individual storage amatotal capacity550 eallons/pounds gallons 5. Individual storage amatotal capacity 550 gallons/pounds gallons 6. Individual storage area total capacity 8000 gallons/pounds pounds What is the total number oftank storage areas? 0 1. Individual tank volume gallons. Waste stored 2. Individual tank volume gallons. Waste stated 3. Individual tank volume gallons. Waste stored 4. Individual tank volume gallons. Waste stored Vlll. DAYS/HOURSOF OPERATION On the average, how many days each month is the facility open m accept wastes? 23 Dayspermonth What are the hours of operation on the days that the facility accepts wastes from households and CESQGs? Example: Facility accepts CESQG wastes from 0900 -1300 on the first Friday of each month and accepts household wastes Monday through Thursday of each week from 1000 -1600 Household hazardous wastes are accepted from 8:00 am to 5:00 pm DTSC 10948 (Revised 11 /08) Page 3 ID NUMBER CALO003781 O6 from CR &R collection vehicles. Management of wastes and maintenance activities may occur at any time. PERMIT BY RULE NOTIFICATION FORM FOR PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES IX. FACILITY DESCRIPTION: Please describe the facility in enough detail that a person not familiar with the facility will be able to understand the facility design. Include a description of the lighting, fencing, secondary containment for storage areas, etc. he Household Hazardous Waste Facility is located in the northeast corner of a wastes (HHW) are stored in three large lockers or outside the lockers on secondary either asphalt or concrete. Wall mounted exterior lighting highlights the area. Fire extingulsheis are ieadliy available. The vehicles used for collecting wastes are also stored within the compound. r olle.aorl wagtpg are ramoyarl from thA milArAnn h' I d sorted by compatible hazard class and then placed into drums, storage cabinets, shelves, or other centsomers for storage. Maximum storage firne for wastes is one year. When sufficient quantities are collected, a hazardous waste hauler is contacted to remove e wastes to approvea Tacilives. The facility stores HHW from multiple. jurisdictions. DTSC 1094B (Revised 11/08) Page 4 ID NUMBER CAL000378106 PERMIT BY RULE NOTIFICATION FORM FOR PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES X. REQUIRED ATTACHMENTS A. W1 A plot plan of the facility B. F71 Certification of financial responsibility for closure C. F71 Copy of a written agreement between the property owner and facility operator allowing operation of the PFBdWCF ( if applicable) XI. OPERATOR CERTIFICATION (PUBLIC AGENCY) 1 certify that the unit or units described in these documents meet the eligibility and operating requirements of state statutes and regulations for the permit by rule tier. I understand that I am required to provide financial assurance for the costs of closing this facility. 1 also understand that I am required to file a Phase I Environmental Assessment at a later date as part of the permit by rule application." 1 certify under penalty of perjury under the laws of the State of California that this document and all attachments were prepared under my direction or supervision in accordance with a system designed m assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." ckasc� oy, c Name (Print or Type) Title Signature (Principal executive officer or ranking elected Date Signed official), CCR, Title 22, Section 66270.11 DTSC 10948 (Revised 11/08) Page 5 s � i i c I I � I I � , I N I I m I I 8 e n HHW � 311141n I fO X s 9ft4 in I I I I I I ' O n� F, I 00 QI ❑za �I HHW 31 R4in I SON I I�m I ?: O X 9ft41n }} =p J I x �V W O �I OLL I W � LL w x O I w' I rn p a x a I Q K mm I I U ulb116 zi X U Ul il4 LE LL — MHH I I I � I I I O w n Wind Rose Nearest to Garden Grove LOS ALAMITOS AAF [SLI] Windrose Plot [All Year] Period of Record: Ol Nov 2010 - Ol Nov 2011 Number of Obs: 14791 N Calm: 41.0% Avg Speed: 4.2 mph I E Wind Speed [mph] 2 -5 ® sa O 7 -10 O 10 -15 M 15-20 M 20+ State ofCelifomie- California Envirmunenml Notedion Agmry Dgratnu nt of Tonic Sul elmcee Control CERTIFICATE OF SELF - INSURANCE FINANCIAL ASSURANCE FOR COST OF CLOSURE TO BE USED BY PUBLIC AGENCIES OPERATING PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES r.c Public Agency: Address: Costa Mesa Sanitary District 628 W. 19th Street, Costa Mesa, CA 92627 -2716 Public Agency Official: Address: (if different from above) Scott Carroll This Agreement demonstrates financial assurance for the following cost estimate(s) for the Permanent Household Hazardous Waste Collection ?acilit iee listed below: Facility Name Address ID Number Closure Cost CR &R Household 7671 Lampson Avenue, Garden CAL000378106 Estimate: $ 7,970.00 Hazardous Waste Facility Grove, CA 92841 Date of Estimate: vtets Closure Cost Estimate: Date of Adjustment: Closure Cost Estimate: Date of Adjustment: Closure Cost Estimate: Date of Adjustment: DTSC 1220 (revised 2/96; modified for CUPA use 7120/99) DTSC 1220 (revised 2/96; modified for CUPA use 7120/99) State of Califomia- Califomia Environmental Protection Agency Depwancat ofTnue SuMtances Control CERTIFICATE OF SELF - INSURANCE FINANCIAL ASSURANCE FOR COST OF CLOSURE CERTIFICATION: Upon request by the Certified Unified Program Agency (CUPA), the public agency agrees to furnish the CUPA any documents pertinent to this coverage. Termination of this coverage will be effective only upon written notice, sent by certified mail, and only after the expiration of 60 days after a copy of such written notice is received by the CUPA as evidenced by the return receipts. The public agency official named below hereby certifies that funds shall be available to close the facility listed named on this form whenever final closure occurs. The public agency also certifies that once final closure begins, the public agency shall he responsible for paying out funds, up to an amount equal to the full amount of the most recent closure cost estimate, upon direction from the CUPA, to such party(ies) as the CUPA specifies. Public Agency Official: Title: C76vx,,t, Typed or Printed name of Person Signing: Date: PRIVACY STATEMENT This information is requested by the Certified Unified Program Agency under Health and Safety Code Section 25245 in order to verify adequate financial assurance for household hazardous waste collection facilities. Completion of the form is mandatory. The consequence of not completing the form is denial of a permit to operate a household hazardous waste collection facility. Information may be provided to U.S. Environmental Protection Agency(EPA, State Attorney General, Air Resources Hoard, California Integrated Waste Management Hoard, Energy Resources Conservation and Development Commission, Water Resources Control Board, Department of Toxic Substances Control, and California Regional Water Quality Control Boards. For more information or access to your records, contact the Certified Unified Planning Agency. DTSC 1220(revised 2/96; modified for CUPA use 7/20/99)