Permit - Curbside - 2005-10-12 Stpte^.'f California—California Environmental Protection Agency Department of Toxic Substances Control
For DTSC Use only PERMIT BY RULE NOTIFICATION FORM
FOR PERMANENT HOUSEHOLD
Region HAZARDOUS WASTE COLLECTION FACILITIES
Please refer to the attached Instructions before completing this form.
❑ INITIAL NOTIFICATION _ REVISED NOTIFICATION. Put an asterisk in the left
margin next to the revised information.
I. GENERAL INFORMATION
ID NUMBER CAH 111 000 683
FACILITY NAME Costa Mesa SanitaL Dist. Door-to-Door Motor Oil/HHW Collection Program
FACILITY ADDRESS Vehicle operated by Curbside Inc. Office address: 1605 N.Spurgeon Street,
CITY Santa Ana,CA ZIP 92701
COUNTY Orange
LOCATION Vehicle,not stationary
(Description)
(Latitude&Longitude)
IL OPERATOR(PUBLIC AGENCY)
f9
NAME Costa Mesa Sanitation District
ADDRESS 628 West 19th Street
CITY Costa Mesa STATE. CA ZIP'92627
CONTACT PERSON Fauth Tom
(Last Name) (First Name)
TELEPHONE NUMBER 949/645-8400
III. CONTRACTOR INFORMATION(if applicable)
NAME Curbside Inc.
ADDRESS 1605 N.Spurgeon St
CITY Santa Ana STATE CA ZIP 92701
CONTACT PERSON Anderson William
(Last Name) (First Name)
TELEPHONE NUMBER (714)542-2222
DTSC 1094B(r sed 9/96) September 1996 Page 1
ID NUMBER CAH 111 000 683
PERMIT BY RULE NOTIFICATION FORM FOR
PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES
IIIV THE FOLLOWING LOCAL OR STATE PERMITS ARE REQUIRED FOR OPERATION OF THE PHHWCF
Transporters permit(#3526) Registered with DTSC for E-waste(#100332)
V PROPERTY OWNERSHIP
A. Is the property on which the PI II IWCF is located owned by the operator? Yes X No
If not,a written agreement between the operator and the property owner is required
Property Owner's Name. Curbside Inc Phone(714) 542-2222
Contact Person. William Anderson
VI. ACCEPTANCE AND MANAGEMENT OF SPECIFIC WASTE TYPES
A Will your facility accept wastes from conditionally exempt small quantity generators? Yes X No
B. Will your facility accept waste from any of the following programs,facilities,or transporters?
Curbside household hazardous waste collection program? Yes ❑ No _
2. Door-to-door household hazardous waste collection program? Yes X No _
• 3 Temporary household hazardous waste collection facility? Yes ❑ No =
4 Recycle-only household hazardous waste collection facility? Yes L No _
5 Mobile household hazardous waste collection facility? Yes — No —
6. Registered I-1W transporter carrying hazardous waste generated by a CESQG? Yes X No L
7 Registered HW transporter carrying waste from a loadcheck program? Yes — No
8 Registered HW transporter carrying abandoned waste under public agency oversight? Yes _ No
9 Other? Please explain Yes _ No _
C Does your facility categorically exclude any type of waste(e g.explosives,infectious waste,compressed gas cylinders,etc.)? If,
list those categories
Explosives, ammunition,compressed gas cylinders biological waste,nuclear/radio active waste,flares
D Will your facility conduct bulking of any of the following wastes° Consolidate used oil and antifreeze only
X used oil X antifreeze ❑ solvents
❑ water based paint _ miscellaneous wastes _ roofing tar or similar resins
contaminated with solvents
od-based paint _ gasoline caulking/patching compounds
photographic solutions _ adhesives
DTSC 1094B(r ed 9/96) Septe ibe 1996 Page 2
ID NUMBER CAE 1110006-83
PERMIT BY RULE NOTIFICATION FORM FOR
PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES
VII. WASTE VOLUME •
A. Please indicate the approximate total volume of hazardous waste brought to the facility in an average month
Gallons or 4,000 Pounds
B. What is the capacity of the container storage area(i.c. drums,roll off bins,etc.) at the facility?
1 Individual storage area total capacity 2,500-3,500 entire truck pounds
2. Individual storage area total capacity 55 gal drum(used oil)gallons/pounds
3 Individual storage area total capacity 30 gal drum(antifreeze) gallons/pounds
4 Individual storage area total capacity gallons/pounds
5 Individual storage area total capacity gallons/pounds
6 Individual storage area total capacity gallons/pounds
What is the total number of tank storage areas? None
1 Individual tank volume gallons. Waste stored •
2 Individual tank volume gallons. Waste stored
3 Individual tank volume gallons. Waste stored
4 Individual tank volume gallons. Waste stored
VIII. DAYS/HOURS OF OPERATION
On the average,how many days each month is the facility open to accept wastes?
6 Days per month
What are the hours of operation on the days that the facility accepts wastes from households and CESQGs9
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
This is a Door-to-Door program which schedules a collection date periodically as the need demands. From one or more days per
month. Waste is collected from the home. Please refer to the attached operational plan
•
DISC 1094B(r ed 9196) Seatemb 1996 Page 3 —
ID NUMBER CAH 111 000 683
PERMIT BY RULE NOTIFICATION FORM FOR
PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES
X. 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.
This is a door-to-door collection program. A resident calls the hotline and requests a collection at their home. A kit is sent to the home
In advance of the collection(kits are not sent to participants of used of/filter collection programs or when the resident has only used oil,
auto batteries,used oil filters or antifreeze). On the designated collection date the participant leaves the waste in the kit near their door
or garage.
During the day a customer service representative will arrive,pack the waste into containers by hazard class and go to the next home.
The waste is taken to a transfer facility for up to 10 days and shipped under a manifest to a TSDF for further processing. Please refer to
the attached operational plan for complete details.
Since this program uses a vehicle as a facility traditional inspection methods require modification. The following is recommended to the
CUPA.
The contractor will provide to authorized CUPA personnel the schedule of collections. At that point,the CUPA inspector can decide
which day to visit the collection vehicle. Curbside,the contractor will provide the inspectorwith the name and cell phone number of the
customer service representative assigned to collections for the City on the designated date. The CUPA inspector will call the CSR
between the hours of 7:30 AM and 12:00 Noon and arrange to meet the CSR somewhere in the City. The CUPA inspector can visually
inspect the vehicle and if necessary follow the CSR to one or more stops to observe the collection process. This procedure should replace a
traditional fixed location inspection.
•
•
DTSC 109413(r ed 9/96) Seotembe 1996 Pa 4 —
ID NUMBER CAH I11 000 683
PERMIT BY RULE NOTIFICATION FORM FOR
PERMANENT HOUSEHOLD HAZARDOUS WASTE COLLECTION FACILITIES
X. REQUIRED ATTACHMENTS •
A X Attached operational plan(a plot plan is not required)
13 X Certification of financial responsibility for closure (a statement is attached since there is no closure)
C. X Copy of a written agreement between the properly owner and facility operator
allowing operation of the PI-1I-IWCF cif applicable)
XI. OPERATOR CERTIFICATION(PUBLIC AGENCY)
'I 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 terminating
this program,due to its nature;a phase one assessment is not required.
'I 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 to assure that qualified personnel properly gather and
evaluate the information submitted Based on my inquiry of the person or persons who manage the system or 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.
James M. Ferryman President
Nan ' tint o'Tvpe Title •
di
Si)i i e(Principal executive officer rt anking elected Date Signed
offio. ,Title 22,Cal Code Reg sec ion 66270 11
•
DTSC 1094B(revs ed 9/96) Sept. The 1996 Page —