Post on 07-Jul-2020
STATE OF CALIFORNIA ENVIRONMENTAL PROTECTION AGENCY
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
In the Matter of:
Cylinder Depot Inc. 5350 G Street Chino, California 9171 O
EPA ID No. CAL000406576
Respondent.
Docket No. HWCA 2018-7413
ORDER TO CORRECT VIOLATIONS
Health and Safety Code Section 25187
INTRODUCTION
1.1. Parties. The State Department of Toxic Substances Control
(Department) issues this Order to Correct Violations (Order) to Cylinder Depot Inc.
(Respondent).
1.2. Site. Respondent has accepted high pressure compressed gas
cylinders containing acetylene; 20-pound propane cylinders ( commonly used for
barbeques), 30, 40, and 100-pound cylinders for propane, one-pound one time use
bottles of propane, butane and mapp gas. Respondent has also received
compressed gas cylinders of helium, oxygen, nitrogen, carbon dioxide, and fire
extinguishers for the purpose of recycling the contents and the containers. The
Respondent accepts, stores, and consolidates hazardous waste at the following
site: 5350 G Street, Chino, California 91710 (Site).
1.3. Permit/Interim Status. The Respondent does not have a state permit,
certificate, registration, interim status or any authorization to accept, store, or
consolidate hazardous waste.
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1.4. Jurisdiction. Section 25187 of the Health and Safety Code authorizes
the Department to order action necessary to correct violations when the
Department determines that any person has violated specified provisions of the
Health and Safety Code or any permit, rule, regulation, standard, or requirement
issued or adopted pursuant thereto.
1.5. All exhibits attached to this Order are incorporated herein by this
Reference.
DETERMINATION OF VIOLATIONS
2. The Department has determined that:
2.1. Respondent violated Health and Safety Code section 25201 (a) in that
on or about April 9, 2015 to January 31, 2018, Respondent accepted hazardous
waste at the Site without a hazardous waste facilities permit or other grant of
authorization from the Department, to wit: Respondent accepted hazardous waste
compressed gas cylinders, and other hazardous wastes at the Site without a permit
or other grant of authorization from the Department.
2.2. Respondent violated Health and Safety Code section 25201(a) in that
on or about April 9, 2015 to January 31, 2018, Respondent stored and
consolidated hazardous waste at the Site without a-hazardous waste facilities
permit or other grant of authorization from the Department, to wit: Respondent
stored hazardous waste received from off-site without a permit or other grant of
authorization from the Department.
2.3. Respondent violated California Code of Regulations (CCR), title 22,
section 66262.23(a), in that on or before January 31, 2018, Respondent failed to
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complete hazardous waste manifests for hazardous waste received and
transported off-site.
2.4. Respondent violated CCR., title 22, section 66265.16, in that on or
before January 31, 2018, Respondent failed to provide facility personnel with
hazardous waste training that teaches them to perform their duties in a way that
ensures the facility's compliance with the requirements of CCR, title 22, Chapter
15. Respondent has never conducted hazardous waste training for facility
personnel.
SCHEDULE FOR COMPLIANCE
3. Based on the foregoing Determination of Violations, IT IS HEREBY
ORDERED THAT:
3.1 .1 . Respondent shall not accept hazardous waste at the site without a
permit or other form of authorization from the Department.
a. Respondent shall hire a qualified and independent third-party contractor
with expertise in hazardous waste management to identify, manage, and dispose
of the hazardous waste at the Site.
b. Respondent shall submit a Work Plan within fifteen (15) days of the date
the Summary of Violations was issued to Respondent by the Department (February
6, 2018, see Exhibit 1 ). The Work Plan shall describe the process and safety
procedures for identifying, managing, and removing all hazardous waste at the
Site, including the name and contact information of the third-party contractor, and a
schedule for implementing the Work Plan.
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c. Respondent shall not handle, move or manage any of the hazardous
waste or hazardous materials, i.e., compressed gas cylinders at the Site until the
Department has received and approved the work plan.
d. Respondent shall implement the Work Plan upon approval by the
Department.
e. Within 21 days of the effective date of this Order, Respondent shall
submit to the Department an inventory of all hazardous waste and hazardous
materials on site.
f. Within 30 days of the effective date of this Order, Respondent shall
remove all hazardous waste from the Site. Respondent shall give the Department
at least one-week advance notice of the date and time hazardous waste will be
packaged and removed from the Site to allow Department staff to observe and
monitor the removal activities. Copies of the hazardous waste manifests shall be
provided to the Department one (1) day after the hazardous waste is removed from
the Site.
3.1 .2. Respondent shall not store and consolidate hazardous waste received
from off-site without a permit or other grant of authorization from the Department.
3.1.3. Respondent shall complete a hazardous waste manifest for all
hazardous waste shipped from the Site.
3.1.4. Within thirty (30) days of the Effective Date of this Order, Respondent
shall comply with CCR, title 22, section 662625.16 to provide facility personnel with
training that teaches them to perform their duties in a way that ensures the facility's
compliance with State and Federal hazardous waste laws and regulations.
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A list of training courses and copies of training certificates received by
Respondent's employees shall be provided to the Department upon completion of
the training. Respondent owners, managers, and employees shall not manage or
handle hazardous waste until they have received training in hazardous waste
management and until compressed gas cylinders and hazardous materials have
been identified by the third-party contractor as nonhazardous waste.
3.1.5. Respondent shall conduct all actions required by Sections 3.1.1. thru
3.1.4. in compliance with Chapter 6.5 and Chapter 6.8 of Division 20 of the Health
and Safety Code and the applicable regulations in Division 4.5 of Title 22 of the
CCR.
3.2. Submittals. All submittals from a Respondent pursuant to this Order
shall be sent to:
Alfredo Rios Environmental Program Manager Department of Toxic Substances Control 5796 Corporate Avenue Cypress, CA 90630-4 732
3.3. Communications. All approvals and decisions of the Department made
regarding submittals and notifications will be communicated to Respondent in
writing by the Branch Chief, Department of Toxic Substances Control, or his/her
designee. No informal advice, guidance, suggestions, or comments by the
Department regarding reports, plans, specifications, schedules, or any other
writings by Respondent shall be construed to relieve Respondent of the obligation
to obtain such formal approvals as may be required.
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3.4. Department Review and Approval. If the Department determines that
any report, plan, schedule, or other document submitted for approval pursuant to
this Order fails to comply with the Order or fails to protect public health or safety or
the environment, the Department may:
a. Modify the document as deemed necessary and approve the document
as modified, or
b. Return the document to Respondent with recommended changes and a
date by which Respondent must submit to the Department a revised document
incorporating the recommended changes.
3.5. Compliance with Applicable Laws: Respondent shall carry out this
Order in compliance with all local, State, and federal requirements, including but
not limited to requirements to obtain permits and to assure worker safety.
3.6. Endangerment during Implementation: In the event that the Department
determines that any circumstances or activity (whether or not pursued in
compliance with this Order) are creating an imminent or substantial endangerment
to the health or welfare of people on the site or in the surrounding area or to the
environment, the Department may order Respondent to stop further
implementation of this Order for such period of time as needed to abate the
endangerment. Any deadline in this Order directly affected by a Stop Work Order
under this section shall be extended for the term of the Stop Work Order.
3.7. Liability: Nothing in this Order shall constitute or be construed as a
satisfaction or release from liability for any conditions or claims arising as a result
of past, current, or future operations of Respondent. Notwithstanding compliance
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with the terms of this Order, Respondent may be required to take further actions as
are necessary to protect public health or welfare or the environment.
3.8. Site Access: Access to the site shall be provided at all reasonable
times to employees, contractors, and consultants of the Department, and any
agency having jurisdiction. Nothing in this Order is intended to limit in any way the
right of entry or inspection that any agency may otherwise have by operation of any
law. The Department and its authorized representatives shall have the authority to
enter and move freely about all property at the Site at all reasonable times for
purposes including but not limited to: inspecting records, operating logs, and
contracts relating to the Site; reviewing the progress of Respondent in carrying out
the terms of this Order; and conducting such tests as the Department may deem
necessary. Respondent shall permit such persons to inspect and copy all records,
documents, and other writings, including all sampling and monitoring data, in any
way pertaining to work undertaken pursuant to this Order.
3.9. Data and Document Availability. Respondent shall permit the
Department and its authorized representatives to inspect and copy all sampling,
testing, monitoring, and other data generated by Respondent or on Respondent's
behalf in any way pertaining to work undertaken pursuant to this Order.
Respondent shall allow the Department and its authorized representatives to take
duplicates of any samples collected by Respondent pursuant to this Order.
Respondent shall maintain a central depository of the data, reports, and other
documents prepared pursuant to this Order. All such data, reports, and other
documents shall be preserved by Respondent for a minimum of six years after the
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conclusion of all activities under this Order. If the Department requests that some
or all of these documents be preserved for a longer period of time, Respondent
shall either comply with that request, deliver th~ documents to the Department, or
permit the Department to copy the documents prior to destruction. Respondent
shall notify the Department in writing at least six months prior to destroying any
documents prepared pursuant to this Order.
3.10. Government Liabilities: The State of California shall not be liable for
injuries or damages to persons or property resulting from acts or omissions by
Respondent or related parties in carrying out activities pursuant to this Order, nor
shall the State of California be held as a party to any contract entered into by
Respondent or its agents in carrying out activities pursuant to the Order.
3.11. Incorporation of Plans and Reports. All plans, schedules, and reports
that require Department approval and are submitted by Respondent pursuant to
this Order are incorporated in this Order upon approval by the Department.
3.12. Extension Request: If Respondent is unable to perform any activity or
submit any document within the time required under this Order, the Respondent
may, prior to expiration of the time, request an extension of time in writing. The
extension request shall include a justification for the delay.
3.13. Extension Approvals: If the Department determines that good cause
exists for an extension, it will grant the request and specify in writing a new
compliance schedule.
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OTHER PROVISIONS
4.1. Additional Enforcement Actions: By issuance of this Order, the
Department does not waive the right to take further enforcement actions or to
impose penalties for the violations requiring immediate correction pursuant to this
Order.
4.2. Penalties for Noncompliance: Failure to comply with the terms of this
Order may also subject Respondent to costs, penalties, and/or punitive damages
for any costs incurred by the Department or other government agencies as a result
of such failure, as provided by Health and Safety Code section 25188 and other
applicable provisions of law.
4.3. Parties Bound: This Order shall apply to and be binding upon
Respondent, and its officers, directors, agents, employees, contractors,
consultants, receivers, trustees, successors, and assignees, including but not
limited to individuals, partners, and subsidiary and parent corporations.
4.4. Time Periods. "Days" for purposes of this Order means calendar days.
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RIGHT TO A HEARING
5.e Respondent may request a hearing to challenge the Order. Appeale
procedures are described in the attached Statement to Respondent.
EFFECTIVE DATE
6.eThis Order is final and effective fifteen days from the date it is served one
Respondent, unless Respondent requests a hearing within ttie fifteen-day period.
Date· of Issuance: February 9, 2018
Signature on Original
Alfredo Rios Environmental Program Manager Department of Toxic Substances Control
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STATE OF CA\..IFORNIA ENVIRONMENTAL PROTECTION AGENCY
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
In the Matter of:
Cylinder Depot, Inc. 5350 G Street Chino, California 91710
EPA ID.No. CAL000406576
Docket No. HWCA 2018-7413
STATEMENT TO RESPONDENT
Enforcement Order
Respondent.
TO THE ABOVE RESPONDENT: ·
An Order to Correct Violations (Order) is attached to this statement and is
hereby served upon you. The Order has been filed by the Department of Toxic
Substances Control (Department).
UNLESS A WRITTEN REQUEST FOR A HEARING SIGNED BY YOU OR
ON YOUR BEHALF IS DELIVERED TO THE DEPARTMENT OR POSTMARKED
WITHIN FIFTEEN DAYS AFTER THE DATE OF THE COVER LETTERYOU
RECEIVED WITH YOUR COPY OF THE ORDER, YOU WILL BE DEEMED T,O
HAVE WAIVED YOUR RIGHT TO A HEARING IN THIS MATTER. IF YOU DO
NOT FILE A TIMELY HEARING REQUEST, THE ENFORCEMENT ORDER
BECOMES FINAL AUTOMATICALLY.
The request for a hearing may be made by delivering or mailing one copy of
the enclosed form entitled "Notice of Defense" or by delivering or mailing a Notice
of Defense as provided in section 11506 of the Government Code to:
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Amilia Glikman Chief Counsel Office of Legal Counsel Department of Toxic Substances Control 1001 I Street, 23rd floor, P. 0. Box 806 Sacrame.nto, California 95812-0806
The enclosed Notice of Defense, if signed and filed with the Department, is
deemed a specific denial of all parts of the Order, but you will not be permitted to
raise any objection to the form of the Order unless you· file a further Notice of
Defense as provided in section 11506 of the Government Code within fifteen days
after service of the Order upon you.
If you file a Notice of Defense within the time permitted, a hearing on the
allegations made in the Order will be conducted by the Office of Administrative
Hearings of the Department of General Services in accordance with the procedures
specified in Health and Safety Code section 25187 and Government Code sections
11507 et seq.
The hearing may be postponed for good cause. If you have good cause,
you must notify the Department within ten working days after you discover the good
cause. Failure to notify the Department within ten days_ will deprive you of a
postponement.
Copies of sections 11507.5, 11507.6, and 11507.7 of the Government Code
are attached. If you desire the names and addresses of witnesses or an
opportunity to inspect and copy items in possession, custody, or control of the
Department,
you may contact:
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Amilia Gllkman Chief Counsel Office of Legal Counsel Department of Toxic Substances Control 1001 I Street, 23rd Floor P. 0. Box 806
· Sacramento, California 95812-0806
Whether or not you have a hearing, you may confer informally with the
Department to discuss the alleged facts, determinations, corrective actions and
penalty. An informal conference does not, however, postpone the twenty-day
period you have to request a hearing on the Order. An informal conference may be
pursued simultaneously with the hearing process.
You may but are not required to be represented by counsel at any or all
stages of these proceedings.
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GOVERNMENT CODE
Section 11507 .5. Exclusivity of discovery provisions
The provisions of Section 11507.6 provide the exclusive right to and method of discovery as to any proceeding governed by this chapter.
Section 11507.6. Request for discovery
After initiation of a proceeding in which a respondent or other party is entitled to a hearing on the merits, a party, upon written request made to another party, prior to the hearing and within 30 days after service by the agency of the initial pleading or within 15 days after the service of an additional pleading, is entitled to (I) ·obtain the names and addresses of witnesses to the extent known to the other party, including, but not limited to, those intended to be called to testify at the hearing, and (2) inspect and make a copy of any of the following in the possession or custody or under the control of the other party:
(a) A statement of a person, other than the respondent, named in the initial administrative pleading, or in any additional pleading, when it is claimed that the act or omission of the respondent as to this person is the basis for the administrative proceeding;
(b) A statement pertaining to the subject matter of the proceeding made by any party to another party or person;
(c) Statements of witnesses then proposed to be called by the party and of other persons having personal knowledge of the acts, omissions or events which are the basis for the proceeding, not included in (a) or (b) above;
(d) All writings, including, but not limited to, reports of mental, physical and blood examinations and things which the party then proposes to offer in evidence;
(e) Any other writing or thing which is relevant and which would be admissible in evidence;
(f) Investigative reports made by or on behalf of the agency or other party pertaining to the subject matter of the proceeding, to the extent that these reports (I) contain the names and addresses of witnesses or of persons having personal knowledge of the acts, omissions or events which are the basis for the proceeding, or (2) reflect matters perceived by the investigator in the course of his or her investigation, or (3) contain or include by attachment any statement or writing described in (a) to (e), inclusive, or summary thereof.
For the purpose of this section, "statements" include written statements by the person signed or otherwise authenticated by him or her, stenographic,
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mechanical, electrical or other recordings, or transcripts thereof, of oral statements by the person, and written reports or summaries of these oral statements.
Nothing in this section shall authorize the inspection or copying of any writing or thing which is privileged from disclosure by law or otherwise made confidential or protected as the attorney's work product.
Section 11507.7. Motion to compel discovery
(a) Any party claiming the party's request for discovery pursuant to Section 11507.6 has not been complied with may serve and file with the administrative law judge a motion to compel discovery, naming as respondent the party refusing or failing to comply with Section 11507.6. The motion shall state facts showing the respondent party failed or refused to comply with Section 11507 .6, a description of the matters sought to be discovered, the reason or reasons why the matter is discoverable under that section, that a reasonable and good faith attempt to contact the respondent for an informal resolution of the issue has been made, and the ground or grounds of respondent's refusal so far as known to the moving party.
(b) The motion shall be served upon respondent party and filed within 15 days after the respondent party first evidenced failure or refusal to comply with Section 11507.6 or within 30 days after request was made and the party has failed to reply to the request, or within another time provided by stipulation, whichever period is longer.
(c) The hearing on the motion to compel discovery shall be held within 15 days after the motion is made, or a later time that the administrative law judge may on the judge's own motion for good cause determine. The respondent party shall have the right to serve and file a written answer or other response to the motion before or at the time of the hearing.
(d) Where the matter sought to be discovered is under the custody or control of the respondent party and the respondent party asserts that the matter is not a discoverable matter under the provisions of Section 11507.6, or is privileged against disclosure under those provisions, the administrative law judge may order lodged with it matters provided in subdivision (b) of Section 915 of the Evidence Code and examine the matters in accordance with its provisions.
(e) The administrative law judge shall decide the case on the matters examined in camera, the papers filed by the parties, and such oral argument and additional evidence as the administrative law judge may allow.
(f) Unless otherwise stipulated by the parties, the administrative law judge shall no later than 15 days after the hearing make its order denying or granting the motion. The order shall be in writing setting forth the matters the moving party is entitled to discover under Section 11507.6. A copy of the order shall forthwith be
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served by mail by the administrative law judge upon the parties. Where the order grants the motion in whole or in part, the order shall not become effective until 1 O days after the date the order is served. Where the order denies relief to the moving party, the order shall be effective on the date it is served.
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State of California - Oal~ornla Environmental Protection Agency
Department of Toxic Substances Control 9211 Oakdale Avenue Chatsworth, CA 91311 ..
SUMMARY OF VIOLATIONS·I On 1/3-1/2018 and 2/2/2018 , the Department of Toxic Substances Control (DTSC), Californi!I Environmental Protection Agency, conducted an Investigation at: ·
Faclllty NamE1:
Facility A<!dress: 5350 G ~tr'ee.t
Ct:iino, CA
EPA ID Number: ----'---'---cALo0040651a · County: . San Bernadino .
---As a result of this Investigation, violations of hazardous W!!Ste laws, regulations,. and . requirements l.isted on the attached pageswere discovered. All violations mullt be corrected; the actions,
·
you·must take to ¢orrec(the vtolati9ns are ljstei:f with eEich violati9n. If you . disagree fiit!l any ofJhe yic,il!!llo.os or proposed c()rregjive a1:t1011s.listeid In.this summary of.
Violations, yo\J 11~ould inform. prsc:. Additional vlPlations ml'iy bEl fou~d .after the.site visit,and these will be ldentlfied In the Violation. section Of the inspection report. . . .
You may reque.st a riieeting with OT~q to discuss the in,~peqtlon, inspecjion report, Qr the Summary of Vi9latlotis. The issuapce 9f this, Summary of Violations does nc:>tprec;lui:fe DTSC
· from taking administrative, civil, or criminal action as a result of the violations not1;1d In the Summary of Violations or violations that have not been corrected within the time provided. A false statement that compliance has been 'achieved is. a vlolallon of the law and punishable by a fln~ of ooUess than *2,00.0 or more than $25,000 for each 09currence. PT$C may re-inspec;tthis f<!.Qilfty at any !lme. ... • · ,. .
Company Representative Accepting· Summary
Name:
Signature:
Title:
Date:
DTSC Representative
Name: Antonia Becker
Signature: .Signature on Original
. Title: Environmental Program manager
Date: February 6, 2018
Page 1or_·_.DTSC 1563 (11/12/2014)
State of Callfomla - Callfornla Envtronmental Protection Agency
Department of_Toxic Substances Control 9211 Oakdale Avenue
Chatsworth, CA 91311
. .___I__S_U_M_M_A_R_Y_O----,-F_V_IO_LA_T_IO_N_S_ ____,
January 31 & February 2,
Facility Name: _C__.Y._li_nd_e_r_D_e_.__p_ot_________ Date: _2_0_1_8____
SECTION I: NON .. MINOR VIOLATIONS AND REQUIRED CORRECTIVE ACTION (Vio~ations not considered Minor Violations)
..
You must correct th~ following violatlon(s) within the specified time frame for each violation. ·
Violation 1:
Cylinder Depot, vlolated Health and Safety Code, section 25201(a), in that it accepted hazardous waste at a facility, area, or point without a hazardous waste facilities perrriit or other grant of authorization frorn the Department of Toxic Substances Control (DTSC), to wit: .
On or before April 9, ·2015 to January 31, 2018 it accepted ha~rdous waste compressed gas cyllnders and other hazardous waste at its Chino, California ~~- .
Corrective Action: Cylinder Depot shall immediately cease accepting ~nd consolidating Hazardous waste compressed gas cylinders and other hazardous waste. Cylinder Depot shall hire a thirdparty ·contractor with expertise in ~azardous waste management to Identify, manage, and dispose of the hazardous waste at Cylinder Depot. Cylinder Depot shall submit a work plan within 15 days for the identifi.cation and removal· of all hazardous waste including hazardous waste compressed gas cylinders from the site. The workplan shall include how a determination will be made on whether a waste on site is a hazardous waste or a nonhazardous waste and whethe.r the waste originally came on a hazardous
. waste manife~t. The plan shall also include a timeline to start and finish the removal of hazardous waste. Cylinder Depot shall not handle or manage any waste or materials that may- potentially be hazardous waste until DTSC has received and approved the workplan.
DTSC 1565 (11/12/2014) Page 2 of 4
State of California - California Environmental Protection Agency
Department of Toxic Substances Control
Vio•lation 2:
.
·
Cylinder Depot, violated Health and Safety Code, section 25201 (a), in that it stored and handled (consolidated) hazardous waste at a facility, area, or point without a hazardous waste facilities permit or other grant of authorization from the Department of Toxic Substances Control (DTSC), to wit:
On or before April ·g, 2015 to January 31, 2018 it stored and handled (consolidated) hazardous waste compressed gas cylinders and other hazardous waste at its Chino, California facility.
Corrective Action: Cylinder Depot shall cease storing and consolidating hazardous waste. ·
Violation 3:
Cylinder Depot violated Cal. Code Regs., title 22, section 66262.23(a), in that It failed to complete a hazardous waste manifests· for compressed gas cylinders shipped offslte, to wit:
On or before January 31, 2018, it failed to complete a hazardous waste manifests for hazardous waste it received under a hazardous waste manifest.
Corrective Active: Cylinder Depot shall immediately cease accepting and consolidating hazardous waste compressed gas cylinders. All remaining hazardous waste received by Cylinder Depot shall be sent offsite as hazardous waste.
Violation 4:
Cylinder Depot violated Cal. Code Regs., title 22, section 66266'.16, in that, It failed to provide facility personnel with a complete training program that teaches them to perfonn their duties in a way that ensures the facility's compliance with the requirements of this chapter, to wit:
On or before January 31, 2018, it failed to provide facility personnel with a complete training program that teaches them to ·perform their duties in a way that ensures the facility's compliance with State and Federal laws and regulations
Corrective Active: Cylinder Depot shall immediately provide facility personnel with a complete training program that teaches them to perform their duties in a way that ensures the facility's compliance with State and Federal laws and regulations. Copies of the training courses ·and certificates shall be provided to DTSC_ upon completion of the training. Employees .
DTSC 1565 (11/12/2014) Page 3 of4
. .
State of Callfornla -Callfomla Envlrorvnental Protection Agency
pepartment ofTo?(iC Substances C9n_trql- __
of Cylinder Depot shall not manag~ or handie hazardous waste until they have received training in hazardous waste mana_gement.
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DTSC 1565 (11/12/2014) Page 4of 4
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
STATE OF CALIFORNIA ENVIRONMENTAL PROTECTION AGENCY
DEPARTMENT OF TOXIC SUBSTANCES CONTROL
In the Matter of:
Cylinder Depot, Inc. 5350 G Street Chino, California 91710
EPA ID No. CAL000406576
Respondent.
Docket No. HWCA 2018-7413
NOTICE OF DEFENSE
Health and Safety Code Section 25187(d)
I, the undersigned Respondent, acknowledge receipt of a copy of the
Order to Correct Violations, Statement to Respondent, Government Code
sections 11507.5, 1 1507.6, and 11507.7, and two copies of a Notice of Defense.
I request a hearing to permit me to present my defense to the allegations
contained in the Order to Correct Violations.
Dated:__________________________
__________________________________ (Signature of Respondent)
Please Type or Print the Name and Mailing Address of Respondent
(Name)
(Street Address)
(City) (State) (Zip)
(Telephone Number)
(Inspector)
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