HomeMy WebLinkAbout9600 HAGEMANCUPA BUSINESS PLAN
HAZARDOUS MATERIALS, REGULATED SUBSTANCES
CaIARP), USTs, ASTs & HAZARDOUS WASTE REPORTING
BAKERSFIELD FIRE DEPT.- COUNTY OF KERN
Bakersfield Fire Department
2101 `H" Street
Bakersfield, CA 93301
Please find enclosed our recertification Hazardous Materials Business Plan and Emergency
Response Plan for the following facility:
Save Mart #96
9600 Hageman
Bakersfield, CA 93312
If you have any questions about this CUPA Business Plan, please contact the Save Mart
Supermarkets Compliance Department:
Nikki Borup I Compliance Analyst
P.O. Box 3689 1 Modesto, CA 95352
P: (209) 548 -6516 1 F: (209) 530 -1846 1 nborup@savemart.com
Sincerely
n Nalezny
Safety Specialist
209) 548 -6619
nag` lezny(u),savemart.com
U NI DOCS
FACILITY INFORMATION
BUSINESS ACTIVITIES
I. FACILITY IDENTIFICATION
FACILITY ID # EPA ID # (Hazardous Waste Only) 2
Agency Use Only) 000359737
BUSINESS NAME (Sane as Facility Name or DBA - Doing Business As) 3.
Save Mart #96
BUSINESS SITE ADDRESS 9600 Hageman 103.
BUSINESS SITE CITY Bakersfield 104 CA ZIP CODE 93312 jQ5
II. ACTIVITIES DECLARATION
NOTE: If you check YES to any part of this list,
lease submit the Business Owner/Operator Identification page.
Does your facility... if Yes, lease complete these pages of the UPCF...
A. HAZARDOUS MATERIALS
Have on site (for any purpose) at any one time, hazardous materials at or
above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for
compressed gases (include liquids in ASTs and USTs); or the applicable YES NO 4. HAZARDOUS MATERIALS INVENTORY —
Federal threshold quantity for an extremely hazardous substance specified in CHEMICAL DESCRIPTION
40 CFR Part 355, Appendix A or B; or handle radiological materials in
quantities for which an emergency plan is required pursuant to 10 CFR Parts
30, 40 or 70?
B. REGULATED SUBSTANCES
Have Regulated Substances stored onsite in quantities greater than the YES ® NO 4a. Coordinate with your local agency responsible for
threshold quantities established by the California Accidental Release CalARP.
Prevention Program (CalARP )?
C. UNDERGROUND STORAGE TANKS (USTs) UST OPERATING PERMIT APPLICATION —
Own or operate underground storage tanks? YES ® NO 5. FACILITY INFORMATION
UST OPERATING PERMIT APPLICATION —
TANK INFORMATION
D. ABOVE GROUND PETROLEUM STORAGE
Own or operate ASTs above these thresholds: YES ® NO 8. No form required to CUPAs
Store greater than 1,320 gallons of petroleum products (new or used) in
aboveground tanks or containers?
E. HAZARDOUS WASTE
Generate hazardous waste? YES NO 9. EPA ID NUMBER — provide at top of this page
Recycle more than 100 kg/month of excluded or exempted recyclable YES ® NO lo. RECYCLABLE MATERIALS REPORT
materials (per FISC §25143.2)? one perrecycler)
Treat hazardous waste onsite? YES ® NO 11. ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION — FACILITY PAGE
ONSITE HAZARDOUS WASTE TREATMENT
NOTIFICATION — UNIT PAGE (one pageperunit)
Perform treatment subject to financial assurance requirements (for Permit by YES ® NO 12. CERTIFICATION OF FINANCIAL ASSURANCE
Rule and Conditional Authorization)?
Consolidate hazardous waste generated at a remote site? YES ® NO 13. REMOTE WASTE CONSOLIDATION SITE
ANNUAL NOTIFICATION
Need to report the closure /removal of a tank that was classified as hazardous YES ® NO 14. HAZARDOUS WASTE TANK CLOSURE
waste and cleaned onsite? CER'T'IFICATION
Generate in any single calendar month 1,000 kilograms (kg) (2,200 YES ® NO 14a. Obtain federal EPA ID Number, file Biennial
pounds) or more of federal RCRA hazardous waste, or generate in Report (EPA Form 8700- 13A/B), and satisfy
any single calendar month, or accumulate at any time, 1 kg (2.2 requirements for RCRA Large Quantity Generator.
pounds) of RCRA acute hazardous waste; or generate or accumulate
at any time more then 100 kg (220 pounds) of spill cleanup materials
contaminated with RCRA acute hazardous waste?
Serve as a Household Hazardous Waste (HHW) Collection site? YES ® NO 14b. See CUPA for required forms.
F. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) 15.
Save Mart #96 Page 1 of 20 April 2012
UNIDOCS
FACILITY INFORMATION
BUSINESS OWNER/OPERATOR IDENTIFICATION
I. IDENTIFICATION
FACILITY ID # BEGINNING DATE 100 ENDING DATE 101
Agency Use Onll) H I 1
BUSINESS NAME (Same as Facility Name or DBA- Doing Business As) 3. BUSINESS PHONE 102,
Save Mart #96 661 588 -4420
BUSINESS SITE ADDRESS 103. BUSINESS FAX 102a.
9600 Ha eman 661 ) 588 -0114
BUSINESS SITE CITY 104. ZIP CODE 105. COUNTY 108.
Bakersfield CA 93312 Kern
DUN & BRADSTREET 106. PRIMARY SIC 107. PRIMARY NAICS 107a.
007874480 15411
BUSINESS MAILING ADDRESS toga.
1800 Standiford Ave.
BUSINESS MAILING CITY 1086. STATE 108c- ZIP CODE 108d.
Modesto I CA 195350
BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110.
Save Mart Supermarkets 209 577 -1600
II. BUSINESS OWNER
OWNER NAME 111. OWNER PHONE 112.
Save Mart Supermarkets 209 577 -1600
OWNER MAILING ADDRESS 113.
1800 Standiford Ave.
OWNER MAILING CITY 114. STATE 115 ZIP CODE 116.
Modesto 1 CA 1 95350
III. ENVIRONMENTAL CONTACT
CONTACT NAME 117. CONTACT PHONE 118.
Sherry Aebersold 209 548 -6569
CONTACT MAILING ADDRESS 119. CONTACT EMAIL 119a.
1800 Standiford Ave. saebersold@savemart.com
CONTACT MAILING CITY 120. STATE 121. ZIP CODE 122.
Modesto 1 CA 1 95350
PRIMARY - IV. EMERGENCY CONTACTS -SECONDARY -
NAME 123. NAME 128.
Stephen Woods Drake Strader
TITLE 124. TITLE 129.
Store Manager Sr. Director of Operations
BUSINESS PHONE 125. BUSINESS PHONE 130.
661 588 -4420 559 297 -1721
24 -FIOUR P14ONE 126. 24 -HOUR PHONE 131.
661 428 -8114 559 999 -7382
PAGER# 127, PAGER # 132.
N/A N/A
ADDITIONAL LOCALLY COLLECTED INFORMATION: 133.
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and
am familiar with the information submitted and believe the information is true, accurate, and complete.
SI FURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134.
q,9(2- 2,)12-
NAME OF DOCUMENT PREPARER 135.
Gina Nalezn
E F S NE print) 136. TITLE OF SIGNER 137.
Sherry Aebersold Director of Compliance/ISO
Save Mart #96 Page 2 of 20 April 2012
UNIDOCS
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION
One page per material per building or area)
ADD DELETE REVISE
200.
I. FACILITY INFORMATION
BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3.
Save Mart #96
CHEMICAL LOCA'T'ION 201. CHEMICAL LOCATION CONFIDENTIAL EPCRA 202.
Floral or produce backroom 1 YES ® NO
FACILITY ID # 1. MAP # (optional) 203. GRID # (Optional) 204.
Agency Use Only)
II. CHEMICAL INFORMATION
CHEMICAL NAME 205. TRADE SECRET 206.
Helium Compressed P- 4602 -G El Yes ®NoifsubjecttoEPCRA , refer toinstructions
COMMON NAME 207. EHS* 208.
Helium Yes ®N°
If EHS is "Yes," all amounts below must be in lbs. CAS# 209.
7440 -59 -7
FIRE CODE HAZARD CLASSES (Complete IfregwredhyCUPA) 210.
HAZARDOUS MA'T'ERIAL 211. RADIOACTIVE 212. CURIES 213.
TYPE (Check one item only) ® a. PURE b. MIXTURE c. WASTE Yes ® No N/A
PHYSICAL STATE 214. LARGEST CONTAINER 215.
Check one item onl3) a. SOLID b. LIQUID ® c. GAS 217
FED HAZARD CATEGORIES 216.
Check all that apply) a. FIRE b. REACTIVE ® c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220.
108.5 217 N/A N/A
UNITS* a. GALLONS ® b. CUBIC FEET c. POUNDS d. TONS 221. DAYS ON SITE 222.
Check one item only) * if EHS, amount must be in pounds. 365
STORAGE a. ABOVEGROUND TANK f. CAN Elk. BOX p. TANK WAGON 223.
CONTAINER b. UNDERGROUND TANK g. CARBOY ® I. CYLINDER q. RAILCAR
c. TANK INSIDE BUILDING h. SILO m. GLASS BOTTLE r. OTHER
d. STEEL DRUM i. FIBER DRUM n. PLASTIC BOTTLE
e. PLASTIC/NONMETALLIC DRUM j. BAG o. TOTE BIN
STORAGE PRESSURE a. AMBIENT ® b. ABOVE AMBIENT c. BELOW AMBIENT 224.
STORAGE TEMPERATURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225.
WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
226.
T .
227. 228.
Yes No
229.
230.
2.
231. 232.
Yes No
233.
234,
3,
235. 236,
Yes No
237.
238.
4,
239. 240,
Yes No
241.
242. 243. 244.
Yes No
245.
Ifmore hazardous components are present at greater than I% by weight if non - carcinogenic, or 0.1 % by weight ifcarcinogenic, attach additional sheets ofpapercapturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246.
DOT Hazard Class:
II'EPCRA, Please Sign Here.
If this facility is subject to Federal Emergency Planning and Community Right to Know Act ( EPCRA) reporting requirements, a signature is required at the
bottom of the form if the page lists an Extremely Hazardous Substance (EHS) handled at or above its Federal Threshold Planning Quantity (TPQ) or 500
pounds, whichever is less.
Save Mart #96 Page 3 of 20 April 2012
UNIDOCS
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION
One page per material per building or area)
zoo.
ADD DELETE REVISE
I. FACILITY INFORMATION
BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3.
Save Mart #96
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL EPCRA 202.
Outside front of store & utility room in backroom YES ® NO
FACILITY ID # MAP # (Optional) '203. GRID # (Optional) 204.
Agency Use Only)
II. CHEMICAL INFORMATION
CHEMICAL NAME 205. TRADE SECRET 206.
Odorized Commercial Propane Yes ®NoIfsubjecttoEPCRA,rel'ertoinstructions
COMMON NAME 207. EHS* 208.
Propane Yes ®No
IfEHS is "Yes," all amounts below must be in lbs. CAS# 209.
Various
FIRE CODE HAZARD CLASSES (Complete ifrequiredhyCUPA) 210.
HAZARDOUS MATERIAL .211. RADIOACTIVE 212. CURIES 213.
TYPE (Check one acn, oniv) a. PURE ® b. MIXTURE El c. WASTE El Yes ONO N/A
PHYSICAL STATE 214. LARGEST CONTAINER 215.
Check one bent only) a. SOLID ® b. LIQUID c. GAS 5 gallons
FED HAZARD CATEGORIES 216.
Check all that apply) a. FIRE b. REACTIVE E e. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220.
100 gallons 1 200 gallons 1 N/A N/A
UNITS* ® a. GALLONS b. CUBIC FEET c. POUNDS d. TONS 221. DAYS ON SITE 222.
heck one item only) * If EHS, amount must be in pounds. 3655
STORAGE a. ABOVEGROUND TANK f CAN k. BOX p. TANK WAGON
223.
CONTAINER b. UNDERGROUND TANK g. CARBOY ® I. CYLINDER q. RAIL CAR
c. TANK INSIDE BUILDING h. SILO m. GLASS BOTTLE r. OTHER
d. STEEL DRUM i. FIBER DRUM n. PLASTIC BOTTLE
e. PLASTIC /NONMETALLIC DRUM j. BAG o. TOTE BIN
STORAGE PRESSURE a. AMBIENT ® b. ABOVE AMBIENT c. BELOW AMBIENT 224.
STORAGE TEMPERATURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225.
WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
226.
I. 88%
227.
Propane
228,
Yes ® No
229.
74 -98 -6
230.
2. 2%
231.
Ethane
232.
Yes ® No
233.
74 -84 -0
234.
3. 7%
235.
Propylene
236.
Yes ® No
237.
15 -07 -1
238.
4. 2%
239.
Butanes
240,
Yes ® No
241.
Various
242.
s. 1 %
za241
Ethyl Mereaptard
z4a.
Yes NoE3 ®
245.
75 -08 -1
If more hazardous components are present at greater than 1% by weight if non - carcinogenic, or 0.1 % by weight ifcarcinogenic, attach additional sheets of paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246.
DOT Hazard Class:
if EPCRA, Please Sign Here.
If this facility is subject to Federal Emergency Planning and Community Right to Know Act ( EPCKA) reporting requirements, a signature is required at the
bottom of the form if the page lists an Extremely Hazardous Substance (EHS) handled at or above its Federal 't- hreshold Planning Quantity (TPQ) or 500
pounds, whichever is less.
Save Mart #96 Page 4 of 20 April 2012
UNIDOCS
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION.
One page per material per building or area)
ADD DELETE REVISE
200.
I. FACILITY INFORMATION
BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3
Save Mart #96
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL EPCRA 202.
Refrigeration and Air Conditioning Systems - throughout store YES Z NO
FACILITY ID # 1. MAP # (Optional) 203. GRID # (Optional) 204.
Agency Uve Only)
II. CHEMICAL INFORMATION
CHEMICAL NAME 205. TRADE SECRET 206.
Chlorodifluoromethane R22 F1 Yes ®No
Ifsubject to EPCRA, referto instructions
COMMON NAME 207. El -1S* 208.
Freon R22 El Yes ONO
If EHS is "Yes," all amounts below must be in lbs. CAS# 209.
75 -45 -6
FIRE CODE HAZARD CLASSES (Complete ifregniredhyCUPA) 210.
HAZARDOUS MATERIAL 211. RADIOACTIVE 212. CURIES 213.
TYPE (Check one item onh) Z a. PURE b. MIXTURE c. WASTE Yes Z No N/A
PHYSICAL STATE 214. LARGEST CONTAINER 215.
Check one item only) a. SOLID b. LIQUID ® e. GAS 1200
FED HAZARD CATEGORIES 216.
Check all that apply) a. FIRE b. REACTIVE Z c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220.
4125 1 4125 1 N/A N/A
UNITS* a. GALLONS b. CUBIC FEET Z c. POUNDS d. TONS 221 DAYS ON SITE 222.
Check one item only) * If EHS, amount nwst be in pounds. 365
STORAGE a. ABOVEGROUND TANK f. CAN Elk. BOX P. TANK WAGON 223.
CONTAINER b. UNDERGROUND TANK g. CARBOY 1. CYLINDER q. RAIL CAR
c. TANK INSIDE BUILDING h. SILO m. GLASS BOTTLE ®r. OTHER
d. STEEL DRUM i. FIBER DRUM n. PLASTIC BOTTLE
e. PLASTIC /NONMETALLIC DRUM j. BAG o. TOTE BIN
STORAGE PRESSURE a. AMBIENT ® b. ABOVE AMBIENT 224. c. BELOW AMBIENT
STORAGE TEMPERATURE a. AMBIENT b. ABOVE AMBIENT ® c. BELOW AMBIENT d. CRYOGENIC
225.
WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
226.
1.
227. 228.
Yes No
229.
230.
2.
231, 232,
Yes No
233.
234,
3.
235. 236,
Yes No
237.
238,
4,
239. 240.
Yes No
241.
242.
5.
243, 244.
Yes No
245.
If more hazardous components are present at greater than I % by weight ifnon - carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246.
DOT Hazard Class:
IfEPCRA, Please Sign Here.
If this facility is subject to Federal Emergency Planning and Community Right to Know Act ( EPCRA) reporting requirements, a signature 1s required at the
bottom of the form if the page lists an Extremely Hazardous Substance (EHS) handled at or above its Federal Threshold Planning Quantity (TPQ) or 500
pounds, whichever is less.
Save Mart #96 Page 5 of 20 April 2012
UNIDOCS
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION
One page per material per building or area)
ADD DELETE REVISE
200.
I. FACILITY INFORMATION
BUSINESS NAME (Same as Facility Name or DBA - Doing Business As) 3.
Save Mart #96
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL EPCRA 202.
Refrigeration and Air Conditioning Systems - throughout store YES Z No
FACILITY ID # 1 MAP # (optional) 203. GRID # (optional) 204.
Agency Use Only)
II. CHEMICAL INFORMATION
CHEMICAL NAME 205. TRADE SECRET 206.
Genetron 404A or HFC 404A Ifsubjectto6PCPA , refer toinsuucuuns Yes Z No
COMMON NAME 207. EHS* 208.
Freon 404A Yes ®No
If EHS is "Yes," all amounts below must be in lbs. CAS# 209.
Various
FIRE CODE HAZARD CLASSES (Complete ifrequiredby CUPA) 210.
N/A
HAZARDOUS MATERIAL 211, RADIOACTIVE 212. 213.
TYPE (Check one item only) a. PURE Z b. MIXTURE c. WASTE Yes Z No
FURIES
N/A
PHYSICAL STATE 214. LARGEST CONTAINER 215.
heck one ilem only) a. SOLID b. LIQUID Z c. GAS 194
FED HAZARD CATEGORIES 216.
Check all that apply) a. FIRE b. REACTIVE Z c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220.
194 194 1 N/A N/A
UNITS* a. GALLONS b. CU131C FEET Z c. POUNDS d. TONS 221. DAYS ON SITE 222.
Check one item only) * If EI-IS, amount must be in pounds. 365
STORAGE a. ABOVEGROUND TANK f. CAN k. BOX p. TANK WAGON 223.
CONTAINER b. UNDERGROUND TANK g. CARBOY I. CYLINDER q. RAILCAR
c. TANK INSIDE BUILDING h. SILO In. GLASS BOTTLE ®r. OTHER
d. STEEL DRUM i. FIBER DRUM n. PLASTIC BOTTLE
e. PLASTIC /NONMETALLIC DRUM j. BAG o. TOTE BIN
STORAGE PRESSURE a. AMBIENT Z b. ABOVE AMBIENT c. BELOW AMBIENT 224.
STORAGE TEMPERATURE a. AMBIENT b. ABOVE AMBIENT ® c. BELOW AMBIENT d. CRYOGENIC 225.
WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
1. 44%
226.
CHF2CF3 (Genetron 125)
227
Yes Z No
228. 229.
354 -33 -6
230.
2. 52%
231.
CH3CF3 (Genetron 143a)
232.
Yes Z No
233.
420 -46 -2
234.
3. 4%
235.
CH2FCF3 (Genetron 134a)
23G.
Yes Z No
237.
811 -97 -2
238.
4,
239. 240.
Yes No
241.
242. 243. 244.
Yes No
245.
If more hazardous components are present at greater than I % by weight ifnon - carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246.
DOT Hazard Class:
If EPCRA, Please Sign Here.
If this facility is subject to Federal Emergency Planning and Community Right to Know Act (EPCRA) reporting requirements, a signature is required at the
bottom of the form if the page lists an Extremely Hazardous Substance (EHS) handled at or above its Federal 'threshold Planning Quantity (TPQ) or 500
pounds, whichever is less.
Save Mart #96 Page 6 of 20 April 2012
UNIDOCS
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION
One page per material per building or area)
ADD DELETE REVISE
200.
I. FACILITY INFORMATION
BUSINESS NAME (Saute as Facility Name or DBA -Doing Business As) 3,
Save Mart #96
CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL EPCRA 202.
Backroom YES Z NO1
FACILITY ID # 1. MAP '# (Optional) 203. GRID # (Optional) 204.
Agency Use Only) 1
II. CHEMICAL INFORMATION
CHEMICAL NAME 205. TRADE SECRET 2206.
Sulfuric Acid If subject to EPCRA; refer toinsimctions
Yes ®No
COMMON NAME 207 EHS* 208.
Lead Acid Batte Yes ®No
If EHS is "Yes," all amounts below must be in lbs. CAS# 209.
Various
FIRE CODE HAZARD CLASSES (Complete iifreyuirehbyCUPA) 210.
Corrosive
HAZARDOUS MATERIAL 211. RADIOACTIVE 212. CURIES 213.
TYPE (Cheek one item only) a. PURE Z b. MIXTURE c. WASTE Yes Z No N/A
PHYSICAL STATE 214. LARGEST CONTAINER 215.
Check one hem only) a. SOLID Z b. LIQUID c. GAS 29.1 gallons
FED HAZARD CATEGORIES 216.
Check all that apply) a. FIRE Z b. REACTIVE c. PRESSURE RELEASE Z d. ACUTE HEALTH Z e. CHRONIC HEALTH
AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT ANNUAL WASTE AMOUNT 219. SPATE WASTE CODE 220.
102 gallons 204 gallons N/A N/A
UNITS* Z a. GALLONS b. CUBIC FEET c. POUNDS d. TONS 221. DAYS ON SITE 222.
Check one item only) * If EHS, amount roust be in pounds. 365
STORAGE a. ABOVEGROUND TANK f. CAN k. BOX p. TANK WAGON
223.
CONTAINER b. UNDERGROUND TANK g. CARBOY [11. CYLINDER q. RAILCAR
c. TANK INSIDE BUILDING h. SILO m. GLASS BOTTLE Z r. OTHER
d. STEEL DRUM i. FIBER DRUM n. PLASTIC BOTTLE
e. PLASTIC/NONMETALLIC DRUM j. BAG o. TOTE BIN
STORAGE PRESSURE Z a. AMBIENT b. ABOVE AMBIENT
224.
c. BELOW AMBIENT
STORAGE TEMPERATURE Z a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225.
WT HAZARDOUS COMPONENT (For mixture or Haste only) EHS CAS #
1. 40%
226.
Sulfuric Acid
227
Z Yes No
zz8.
7664 -93 -9
229
230.
2.
231. 232.
Yes No
233.
234.
3,
235. 236.
Yes No
237.
238.
4,
239. 240.
Yes No
241.
242.
5.
243. 244.
Yes No
245.
Ifmore hazardons components are present at greater than 1% by weight ifnon - carcinogenic, or0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION 246.
DOT Hazard Class:
If EPCRA, Please Sign Here.
If this facility is subject to Federal Emergency Planning and Community Right to Know Act (EPCRA) reporting requirements, a signature is required at the
bottom of the form if the page lists an Extremely Hazardous Substance (EHS) handled at or above its Federal Threshold Planning Quantity (TPQ) or 500
pounds, whichever is less.
Save Mart #96 Page 7 of 20 April 2012
EMERGENCY RESPONSE PLAN
Save Mart #96
9600 Hageman
Bakersfield, CA 93312
County of Kern
Date: April 2012
Save Mart #96 Page 8 of 20 April 2012
Emergency Response /Contingency Plan
Hazardous Materials Business Plan)
Authority Cited: HSC§ 25504(b); 19 CCR §2731; 22 CCR §66262.34(a)(4)
All facilities that handle hazardous materials in HMBP quantities must have a written emergency response plan. In addition, facilities
that generate 1,000 kilograms or more of hazardous waste (or more than 1 kilogram of acutely hazardous waste or 100 kilograms of
debris resulting from the spill of an acutely hazardous waste) per month, or accumulate more than 6,000 kilograms of hazardous waste
on -site at any one time, must prepare a hazardous waste contingency plan. Because the requirements are similar, they have been
combined in a single document, provided below, for your convenience. This plan is a required module of the Hazardous Materials
Business Plan (HMBP). If you already have a plan that meets these requirements, you should not complete the blank plan,
below, but you must include a copy of your existing plan as part of your HMBP.
This site - specific Emergency Response /Contingency Plan is the facility's plan for dealing with emergencies and shall be implemented
immediately whenever there is a fire, explosion, or release of hazardous materials that could threaten human health and /or the
environment. At least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for
inspection by the local agency. A copy of the plan and any revisions must be provided to any contractor, hospital, or agency with
whom special (i.e., contractual) emergency services arrangements have been made (see section 3, below).
1. Evacuation Plan
a. The following alarm signal(s) will be used to begin evacuation of the facility (check all that apply):
Bells; Horns /Sirens; ® Verbal (i.e., shouting); ® Other (specify PA system announcements & instructions
b. ® Evacuation map is prominently displayed throughout the facility.
Note: A properly completed HMBP Site Plan satisfies contingency plan map requirements. This drawing (or any other drawing that
shows primary and alternate evacuation routes, emergency exits, and primary and alternate staging areas) must be
prominently posted throughout thefacility in locations where it will be visible to employees and visitors.
2. a. Emergency Contacts
Fire /Police /Am bulance
State Office of Emergency Services
b. Post- Incident Contacts
Bakersfield City Fire Department
Kern County Waste Management
California EPA Department of Toxic Substances
Cal OSHA Division of Occupational Safety and Health
Phone No.: 911
Phone No.: (800) 852 -7550
Phone No.: (661) 326 -3979
Phone No.: (800) 552 -5376
Phone No.: (559) 297 -3901
Phone No.: (559) 445 -5302
Kern County Air Pollution Control District Phone No.: (661) 862 -5250
Central Valley Regional Water Quality Control Board Phone No.: (559) 445 -5116
Phone numbers for agencies in Unidoes Member Agency geographic jurisdictions are available at vvww.unidoes.ors.
c. Emergency Resources
Poison Control Center* Phone No.: (800) 222 -1222
Nearest Hospital: Nalne: Mercy South West Hospital Phone No.: (661) 663 -6000
Address: 400 Old River Road
3. Arrangements with Emergency Responders
City: Bakersfield
Ifyou have made special (i.e., contractual) arrangements with any police department, fire department, hospital, contractor, or
State or local emergency response team to coordinate emergency services, describe those arrangements below:
No special arrangements have been made with local or State departments, contractors, emergency response
teams or services.
Save Mart #96 Page 9 of 20 April 2012
4. Emergency Steps /Procedures
The facility will be accessible to county's designated emergency response personnel. When a release is
observed or anticipated, the following steps will be taken:
a) INITIALLY, determine the existence or potential existence of hazardous material. Where unidentified
substance or vapors are involved in these incidents, it is always prudent to assume they are toxic or
hazardous until determined otherwise.
b) IMMEDIATELY, ascertain the location of any incident involving hazardous materials and contact the
Business Emergency Coordinator /Store Manager and make the appropriate dispatch of emergency
equipment.
c) THE BUSINESS EMERGENCY COORDINATOR/STORE MANAGER or his /her designee will
contact 911 and the County Health Department who will initiate the emergency response plan. The Store
Manager is to notify neighbors on all sides of the facility if necessary.
d) SCENE MANAGEMENT shall be the responsibility of the Store Manager until the arrival of public
safety response personnel. In such instance, the Store Manager will cooperate with and support the
lawfully designated Scene Manager.
e) PROTECTION OF SCENE It is imperative to protect responders and by- standers from injury or
contamination. Personnel first on the scene should immediately take steps to secure the area and
establish perimeter control at a safe distance until such time as agency personnel, e.g., police or fire,
arrive and assume this responsibility.
f) EVACUATION The Scene Management Officer must determine if there is any potential danger to
individuals in the area and take appropriate steps to notify and evacuate the business and neighbors. In
major incidents, County and /or City Disaster Officials will be involved. Evacuation, reception and care
will be followed as described in the County Major Disaster Plan.
g) CLEAN -UP RESPONSIBILITY is determined by the cause of the incident. If caused by our company,
we are responsible for clean up (either by company personnel or approved contractor).
h) DECONTAMINATION Appropriate steps must be taken to decontaminate all victims and response
personnel. Local hospitals have facilities to assist in this procedure. Care must be taken to avoid spread
of contamination by vehicles leaving the scene. Victims may be contaminated.
i) EMERGENCY MEDICAL RESPONSE When needed the Store Manager or his/her designee should
contact the business physician and appropriate hospital and other medical services if transported by
company employees). If 911 is called, County Communications will be responsible for dispatching all
necessary ambulances and coordinating reception of victims at appropriate hospitals. They will follow
normal prescribed procedures, supplemented with specific information if contamination is involved.
j) IDENTIFICATION As requested, County Communication will relay information between the response
units at the scene and certain other agencies. In all incidents, follow procedure in the order listed in this
Plan. Use supplemental information as required.
Use pre - established and current call lists.
k) QUESTIONS All questions regarding requirements of Business Plans should be directed to the
Bakersfield City Fire Department.
Save Mart #96 Page 10 of 20 April 2012
Emergency Response Plan for Hazardous Materials Incidents
a) FIRES: Sound the fire alarm.
Advise that hazardous materials are involved.
Call 911-
Notify Store Manager, Senior Director of Operations, Risk Management, Senior Manager of W /C, G/L
and Safety /Food Safety.
Assist in implementing Evacuation Plan.
b) DRAINAGE OR WATERWAY INCIDENTS: Notify the Store Manager, Senior Director of
Operations, Risk Management, Senior Manager of W /C, G/L and Safety /Food Safety and the
Compliance Department. When there is a potential for hazardous material of any type to enter drainage
ditches or waterways, call 911, the local CUPA, State Emergency Response and National Response
agencies and give full particulars.
C) NATURAL GAS LEAKS: Leaks may occur in large transmission lines, in the secondary mains, in the
lines connecting mains to the building, or buildings. Gas & Electric Company will respond to all such
incidents, either on public or private property.
In the event of breaks or leaks, or smell of gas is reported, call 911. Fire departments will be dispatched,
and in the event of major incidents, a Scene Management Officer will be required, as in other hazardous
material incidents.
d) OTHER SPILLS OR LEAKS: Notify 911 AND the County Health Department.
Releases to be Reported
a) This business will, upon discovery, immediately report any release or threatened release of a hazardous
material to the County Health Department, and to the Fire Department. This business will provide all
State, City, County, Fire, and Public Health or Safety Personnel and emergency rescue personnel with
access to the facility.
b) Release is defined as spilling, leaking, pumping, pouring, emitting, emptying, discharging, injecting,
escaping, leaching, dumping, or disposing into the environment, unless permitted or authorized by a
regulatory agency.
C) Threatened Releases means a condition creating a substantial probability of harm when the probability
and potential of harm make it reasonably necessary to take immediate action to prevent, reduce, or
mitigate damage or persons, property, or the environment.
Responsibilities
a) It is the responsibility of the Store Manager /PIC (Person in Charge) to respond to all Hazardous
Materials Incidents; ensure that the necessary notification to emergency response agencies are made;
manage the scene until relieved by agencies who have jurisdictional responsibility for coordination of
the scene. He /she has the responsibility to complete the necessary reports of the incident and make them
available to the Facility Manager or his /he designee.
b) It is the responsibility of all employees to conduct his /her job on a safe manner and in accordance with
safety rules designated to protect employees, public health and the environment.
Save Mart #96 Page 11 of 20 April 2012
C) Current inventory information on hazardous materials /hazardous waste handled and stored on site in
addition to a current business response plan shall be maintained on file with the County Health
Department.
d) A current facility map will be maintained on file and posted throughout the facility. All employees must
know emergency exits /routes and evacuation procedures.
e) This information is to be made available to all employees and public agencies at all times. The store
should keep a copy of this plan as a supplement of the Emergency Action Plan Manual.
5. Evacuation Plan
Steps needed to be followed when in response to Fire, Explosion, Spill or Major Hazardous Material
Emergency Incidents.
a) Purpose: To evacuate employees, contractors, customers and other personnel to a safe location in an
orderly manner in the event of an emergency.
b) Notification: Call 911, Store Manager, Senior Director of Operations, Risk Management and the
Compliance Department.
c) Alarm: In the event of an emergency the Store Manager or PIC will use the Store PA system or Fire
Alarm to warn/notify store personnel and customer of the emergency.
d) Supervisory Personnel (Store Manager or Person in Charge): Will call 911, Senior Director of
Operations and Risk Management; use fire alarms and /or PA system to notify Customers and Store
Personnel; take a head count at the designated gathering area; and, report any missing persons to the
lawfully designated Scene Manager or response team (i.e. Fire Department).
e) Evacuation Signal: Will consist of the building fire alarm or announcement over the PA system.
f) Exit Routes: Refer to the Evacuation site plan for marked fire exits /routes.
g) Assembly: Store Manager will designate a safe meeting location/area outside the building, location will
be identified on all evacuation maps throughout the store.
Save Mart #96 Page 12 of 20 April 2012
6. Emergency Equipment
22 CCR §66265.52(e) [as referenced by 22 CCR §66262.34(a)(4)] requires that emergency equipment at the facility be listed.
Completion of the following Emergency Equipment Inventory Table meets this requirement.
EMERGENCY EQUIPMENT INVENTORY TABLE
1. Equip Category 2. Equipment Type 3. Location 4. Description
Personal
Protective
Equipment,
Safety
Equipment,
First Aid
Equipment
Cartridge Respirators
Chemical MonitorinE Equipment (describe
Chemical Protective Aprons/Coats
Chemical Protective Boots
Chemical Protective Gloves Backroom Rubber gloves, latex gloves,
Face Shields Backroom Plastic shields /chemical goggles
First Aid Kits /Stations (describe) Throughout
Facility
Basic first aid supplies (bandages,
ointments, etc
hard Hats
Plumbed Eye Wash Stations Backroom Permanent units connected to water supply
Portable Eye Wash Kits (i.e. bottle type)
Respirator Cartridges (describe)
Safety Glasses /Splash Goggles Throughout
Facility
Plastic shields /chemical goggles
Safety Showers
Self- Contained Breathing Apparatuses
SCBA)
Other (describe)
Fire
Extinguishing
Systems
Automatic Fire Sprinkler Systems Throughout
Facility
Multiple -unit ceiling sprinklers
Fire Alarm Boxes /Stations Throughout
Facility
Pull Units
Fire Extinguisher Systems (describe)
Other (describe )Fire Emir uishers Varies Wall mounted units
Spill
Control
Equipment
And
Decontamination
Equipment
Absorbents (describe) Backroom
Store Shelf Kitty Litter or Spill Magic
Berms /Dikes (describe)
Decontamination Equipment (describe
Emergency 'tanks (describe)
Exhaust Floods Bakery /Deli Grease /exhaust fan systems over cooking
areas
Gas Cylinder Leak Repair Kits (describe)
Neutralizers (describe)
Overpack Drums
SUMPS (automatic ) Truck Dock Automatic
Other (describe)
Communications
And
Alarm
Systems
Chemical Alarms (describe)
Intercoms /PA Systems Throughout
Facility
Telephone PA system
Portable Radios
Telephones Throughout
Facility
Inter - company & Outside lines
Underground Tank Leak Detection Monitors
Other (describe)
Additional I
Save Mart #96 Page 13 of 20 April 2012
7. Employee Training Plan
Hazardous Materials Business Plan)
Authority Cited: HSC Section 25504(c); 22 CCR §66262.34(a)(4)
All facilities that handle hazardous materials in HMBP quantities must have a written employee
training plan. This plan is a required module of the Hazardous Materials Business Plan (HMBP).
A blank plan has been provided below for you to complete and submit if you do not already have
such a plan. If you already have a brief written description of your training program that
addresses all subjects covered below, you are not required to complete the blank plan,
below, but you must include a copy of your existing document as part of your HMBP.
Check all boxes that apply. [Note: Items marked nvith an asterisk ( *) are required]:
1. Personnel are trained in the following procedures:
Internal alarm /notification *
Evacuation/re-entry procedures & assembly point locations*
Emergency incident reporting — Notify 911 and Corporate.
External emergency response organization notification — Conducted by Store Manager (if
needed).
Locations and contents of Emergency Response/Contingency Plan — Store Office.
Facility evacuation drills that are conducted at least (spec) (e.g. "Quarterly ", etc.) -
Annuallypolicy review and signoff, no evacuation drills conducted.
2. Chemical Handlers are additionally trained in the following:
Safe methods for handlin and storage of hazardous materials *
Location(s) and proper use of fire and spill control equipment — No equipment used, use
Spill Magic an(Vor kitty litter.
Spill procedures /emergenc rocedures — Call 911.
Proper use ofpersonal protective equipment *
e.g.
Specific hazard(s) of each chemical to which they may be exposed, including routes of
exposure
i.e. inhalation, ingestion, absorption) Material Safety Data Sheets (MSDS
Hazardous Waste Handlers /Managers are trained in all aspects of hazardous waste
management specific to their job duties (e.g. container accumulation time requirements,
labeling requirements, storage area inspection requirements, manifesting requirements,
etc.)
3. Emergency Response Team Members are capable of and engaged in the following:
Personnel rescue procedures
Shutdown of operations
Liaison with responding agencies
Use, maintenance, and replacement ofernergencyemergency response equipment
Refresher training, which is provided at least annually *
e.g.
Emergency response drills, which are conducted at least (spec)
Quarterly ", etc.)
Save Mart #96 Page 14 of 20 April 2012
Training includes the components described below.
a) Familiarization with this Plan, evacuation signal and assembly point.
Initial "New Hire" hands on training
Annual safety review (Individual)
Company Safety Review:
Upon Transfer
Promotion
b) Safety rules including procedures for safe handling of hazardous material, emergency response
responsibilities, and use of emergency response equipment and supplies should be available and /or
referenced on -site. Documentation of training for each employee is to be maintained on site.
Hands on Safety Training Manual (HOSTM)
Injury and Illness Prevention Program
Emergency Action Plan Manual
Emergency Evacuation Procedures
StrongPak Program: Potentially Hazardous Products and Hazmat Waste Processes
Materials Safety Data Sheets
c) Annual refresher training.
1) Programs to familiarize employees with the Business Response Plan:
Individual review of the Emergency Action Plan Manual
Signoff of Emergency Evacuation Procedures
Individual Annual Safety Review
Annual Company Safety Review
2) Programs to familiarize employees with safety rules, hazardous materials training procedures,
and emergency response responsibilities.
Review of Hands on Safety Training Manual
Individual Annual Safety Review
Annual Company Safety review
3) Describe how employees will be given annual (or more often) refresher training:
Individual annual safety reviews
Annual Company Safety review
NOTE It is required that training records be kept on each employee in order to be prepared for
emergencies and to reduce your liability. Training records are required of Hazardous
Waste Generators by law.
Save Mart #96 Page 15 of 20 April 2012
8. Record Keeping
Hazardous Materials Business Plan)
All facilities that handle hazardous materials must maintain records associated with their
management. A summary of your record keeping procedures is a required module of the
Unidocs Hazardous Materials Business Plan (HMBP). A blank summary has been provided
below for you to complete and submit if you do not already have such a document. If you
already have a brief written description of your hazardous materials record keeping
systems that addresses all subjects covered below, you are not required to complete this
page, but you must include a copy of your existing document as part of your HMBP.
Check all boxes that apply. The following records are maintained at the facility. [Note: Items
marked with an asterisk ( *) are required.]:
Current employees' training records (to be retained until closure ofthefacility) *
Former employees' training records (to be retained at least three years after termination of
employment) *
Training Program(s) (i.e. written description ofintroductory and continuing training)
Current copy of this Emergency Response/Contingency Plan *
Record of recordable/reportable hazardous material /waste releases
Record of hazardous material /waste storage area inspections
Record of hazardous waste tank daily inspections *
Description and documentation of facility emergencyernergency response drills
Note: The above list ofrecords does not necessarily identify every type ofrecord required to be maintained by the
facility.
Self- Inspection Form
Check the appropriate box:
We will use the Unidocs "Hazardous Materials /Waste Storage Area Inspection Form" to
document inspections.
We will use our own documents to record inspections. (A blank copy ofeach document used
must be attached to this HMBP.)
Save Mart #96 Page 16 of 20 April 2012
Hazardous Material/Waste
Aboveground Storage Area Area Inspected:
Inspection. Form
a
o
Explain any problems found and corrective actions taken in the "Comments" section.
THIS FORM DOES NOT APPLY TO UNDERGROUND TANKS - Maintain completed form at Safety Station.
IJN -023 hI tp: / /w-ww. unitucs. urK Rev. 05/16/()0
Save Mart #96 Page 17 of 20 April 2012
Supplemental to Required HMBP
Earthquake Inspection
The following areas will be inspected after earthquake- related ground motion:
Helium Cylinders /Tanks
Propane Cylinders /Tanks
M Refrigeration Systems
Hazardous Waste Storage Areas
If spills, leaks or damages are detected, Store Management will take the appropriate actions that include:
Spill clean -up
Notifying the appropriate local, state or federal agencies
Notifying the appropriate company personnel including: Senior V.P. Operations, Directors, Risk
Management, Compliance
Contacting vendors for repairs
Hazard Mitigation Procedures
The following procedures will provide for mitigation, prevention, or abatement of hazards to persons,
property or the environment:
Proper handling /storage of hazardous materials
Proper handling /storage of hazardous wastes
Employees Trained on hazardous material handling
Emergency Action Plan in place
Save Mart #96 Page 18 of 20 April 2012
Storage/Facility Map for Save Mart #96
Located at: 9600 Hageman, Bakersfield, CA 93312
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Save Mart #96 Page 19 of 20 April 2012
Site Map for Save Mart #96
Located at: 9600 Hageman, Bakersfield, CA 93312
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P, Emergency meeting location: Grass strip front of Bakery side
entrance.
Save Mart #96 Page 20 of 20 April 2012