HomeMy WebLinkAboutBUSINESS PLAN 7/16/2010r . -7
BUSINESS - 'ACTIVITIES
KERN COUNTY ENVIRONMENTAL HEALTH SERVICES Unified Program Consolidated Form (UPCF)
DEPARTMENT FACILITY INFORMATION2700MSTREET, SUITE 300 <
BAKERSFIELD, CA 93301
661 862 -8700 Fax 661 862 -8701
Page I of
1. FACILITY IDENTIFICATION
FACILITY ID # (Agency Use only) 1 EPA ID # (Hazardous Waste Only) 2
BUSINESS NAME (Same as Facility Name of DBA -Doing Business As) 3i72 M W Corporation V002 A
BUSINESS SITE ADDRESS 103
677S r, H Strpp
BUSINESS SITE CITY 104 ZIP CODE 105
Bakersfield I CA 93307
Il. ACTIVITIES DECLARATION
NOTE: If you check YES to any part of this list,
lease submit the Business Owner/Operator Identification page KC Form 2730).
Does your facility... If Yes, please com lete these pages of the UPCF....
A. HAZARDOUS MATERIALS 4
Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS INVENTORY
55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed a YES NO
CHEMICAL DESCRIPTION
gases (include liquids in ASTs and USTs); or the applicable Federal threshold CONSOLIDATED CONTINGENCY PLAN
quantity for an extremely hazardous substance specified in 40 CFR Part 355,
Appendix A or B; or handle radiological materials in quantities for which an SITE MAP
emergency lan is required pursuant to 10 CFR Parts 30, 40 or 70?
B. REGULATED SUBSTANCES 4a
Have Regulated Substances stored onsite in quantities greater than the threshold CalARP - REGULATED SUBSTANCE
quantities established by the California Accidental Release prevention Program YES x NO REGISTRATION (KC Form 2736)
CalARP)?
C. UNDERGROUND STORAGE TANKS (USTs) 5 UST FACILITY (KC FormA)
Own or operate underground storage tanks? YES ® NO UST TANK (onepage pertank) (KC For, e)
D. ABOVE GROUND PETROLEUM STORAGE B
Own or operate ASTs above these thresholds:
Store greater than 1,320 gallons of petroleum products (new or used) in YES ® NO
NO FORM REQUIRED TO KCEHSD
aboveground tanks or containers.
E. HAZARDOUS WASTE 9 EPA ID NUMBER- provide at the top of
Generate hazardous waste? this page
YES x NO HAZ WASTE GENERATOR FORM
Recycle more than 100 kg/month ofexcluded or exempted recyclable 10
YES [N N0 RECYCLABLE MATERIALS REPORT
materials (per HSC 25143.2)? one per recycler) (KC Form 2732)
11 ON -SITE HAZARDOUS WASTE
TREATMENT - FACILITY (KC Form 1772£)
Treat hazardous waste on -site? YES ® NO ON -SITE HAZARDOUS WASTE
TREATMENT - UNIT (one pageper unit)
KC Form 1772u
Treatment subject to financial assurance requirements (for Permit by Rule and YES ® No
12 CERTIFICATION OF FINANCIAL
Conditional Authorization)? ASSURANCE (KC Form 1232)
Consolidate hazardous waste generated at a remote site? YES NOYES REMOTE WASTE / CONSOLIDATION
SITE ANNUAL NOTIFICATION
Need to report the closure /removal of a tank that was classified as 14 HAZARDOUS WASTE TANK CLOSURE
hazardous waste and cleaned on -site? YES. ® NO CERTIFICATION
Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or 14a Obtain federal EPA ID Number, file
more of federal RCRA hazardous waste, or generate in any single calendar YES ® NO Biennial Report (EPA Form 8700 -
month, or accumulate at any time, I kg (2.2 pounds) of RCRA acute hazardous 13A/B), and satisfy requirements for
waste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator.
spill cleanup materials contaminated with RCRA acute hazardous waste.
Household Hazardous Waste (HHW) Collection site? YES ONO
14b NO FORM REQUIRED TO KCEHSD
F. LOCAL REQUIREMENTS IS
A copy of the facility's Contingency/Emergency Response Plan is to be included with the original submission ofthe Business Plan. KCEHSD is to be
informed of any revisions to the plan. Please contact KCEHSD at the above number for assistance in completing the plan.
05/2008 revised KCForm 2729
Business Owner /Operator Identification
Please submit the Business Activities page (KC Form 2729), the Business Owner /Operator Identification page (KC Form 2730), and Hazardous Materials Inventory -
Chemical Description pages (KC Form 273 1) for all hazardous materials inventory submissions. For the inventory to be considered complete this page must be signed
by the appropriate individual. (Note: the numbering of the instructions follows the data element numbers that are on the Unified Program Consolidated Form (UPCF)
pages. These data element numbers are used for electronic submission and are the same as the numbering used in Division 3, Electronic Submittal of Information.)
Please number all pages ofyour submittal. This helps the Kern County Environmental Health Services Department (KCEHSD) identify whether the submittal is
complete and if any pages are separated.
1 FACILITY ID NUMBER — Leave this blank. This number is assigned by KCEHSD. This is the unique number which identifies your facility.
3 BUSINESS NAME - Enter the doing business as name.
100 BEGINNING DATE - Enter the beginning year and date ofthe report. (YYYYMMDD)
101 ENDING DATE - Enter the ending year and date ofthe report. (YYYYMMDD)
102 BUSINESS PHONE - Enter the phone number, area code first, and any extension.
102a BUSINESS FAX — Enter the business fax number, area code first.
103 BUSINESS SITE ADDRESS - Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a
means to geographically locate the facility.
104 BUSINESS SITE CITY - Enter the city or unincorporated area in which business site is located.
105 ZIP CODE - Enter the zip code ofbusiness site. The extra 4 digit zip may also be added.
106 DUN & BRADSTREET — Ifsubject to EPCRA, enter the Dun & Bradstreet number for the facility. The Dun & Bradstreet number may be obtained by calling
610) 882 -7748 or on the web at www.dnb.com.
107 SIC NUMBER - Enter the primary Standard Industrial Classification System Number. Required for EPCRA.
107a NAICS NUMBER - Enter the primary North American Industrial Classification System Number.
108 COUNTY - Enter the county in which the business site is located.
108a BUSINESS MAILING ADDRESS — Enter the mailing address to be used for all official business correspondence. This mailing address must be filled in.
108b BUSINESS MAILING CITY - Enter the name of the city for the business mailing address.
108c STATE - Enter the two character abbreviation of the state for the business mailing address.
108d ZIP CODE - Enter the zip code for the business mailing address. The extra 4 digit zip may also be added.
109 BUSINESS OPERATOR NAME - Enter the name of the business operator.
110 BUSINESS OPERATOR PHONE - Enter business operator phone number, if different from business phone, area code first, and any extension.
I I I BUSINESS OWNER NAME - Enter name ofbusiness owner, ifdifferent from business operator.
112 BUSINESS OWNER PHONE - Enter the business owner's phone number if different from business phone, area code first, and any extension.
113 BUSINESS OWNER MAILING ADDRESS - Enter the owner's mailing address, if different from business mailing address.
114 BUSINESS OWNER CITY - Enter the name ofthe city for the owner's mailing address, if different from business mailing address.
115 BUSINESS OWNER STATE - Enter the 2 character state abbreviation for the owner's mailing address, ifdifferent from business mailing address.
116 BUSINESS OWNER ZIP CODE - Enter the zip code for the owner's address, ifdifferent from business mailing address. The extra 4 digit zip may also be
added.
117 ENVIRONMENTAL CONTACT NAME - Enter the name ofthe person, who receives all environmental correspondence.
118 CONTACT PHONE - Enter the phone number, ifdifferent from Owner or Operator, for the environmental contact, area code first, and any extension.
119 CONTACT MAILING ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent.
119a CONTACT EMAIL — Enter the email address ofthe environmental contact in 117, if the contact has one.
120 CONTACT MAILING CITY - Enter the name ofthe city for the environmental contact's mailing address.
121 STATE - Enter the 2 character state abbreviation for the environmental contact's mailing address.
122 ZIP CODE - Enter the zip code for the environmental contact's mailing address. The extra 4 digit zip may also be added.
123 PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative to be contacted in case there is an emergency involving hazardous
materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident
mitigation.
124 TITLE - Enter the title of the primary emergency contact.
125 BUSINESS PHONE - Enter the business number for the primary emergency contact, area code first, and any extensions.
126 24 -HOUR PHONE - Enter a 24 -hour phone number for the primary emergency contact. The 24 -hour phone number must be one which is answered 24 hours a
day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above.
127 PAGER NUMBER - Enter the pager number for the primary emergency contact, ifavailable.
128 SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contacted in the event that the primary
emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding
incident mitigation.
129 TITLE - Enter the title ofthe secondary emergency contact.
130 BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code first, and any extension.
131 24 -HOUR PHONE - Enter a 24 -hour phone number for the secondary emergency contact. The 24 hour phone number must be one which is answered 24 hours
a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above.
132 PAGER NUMBER - Enter the pager number for the secondary emergency contact, ifavailable.
133 ADDITIONAL LOCALLY COLLECTED INFORMATION - Please include the Assessor's Parcel Number (APN) for the actual facility location.
134 DATE - Enter the date that the document was signed. (YYYYMMDD)
135 NAME OF DOCUMENT PREPARER - Enter the full name ofthe person who prepared the inventory submittal information.
136 NAME OF SIGNER - Enter the full printed name ofthe person signing the page. The signer certifies to a familiarity with the information submitted and that
based on the signer's inquiry ofthose individuals responsible for obtaining the information, all the information submitted is true, accurate and complete.
SIGNATURE OF OWNER/ OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner /Operator, or officially designated
representative of the Owner /Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted and
that based on the signer's inquiry of those individuals responsible for obtaining the information it is the signer's beliefthat the submitted information is true,
accurate and complete.
137 TITLE OF SIGNER - Enter the title of the person signing the page.
05/2008 revised) KC Form2730
BUSINESS OWNERMPERATOR IDENTIFICATION
KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form (UPCF)
2700 M STREET, SUITE 300 FACILITY INFORMATION
BAKERSFIELD, CA 93301
661 862 -8700 Fax 661 862 -8701
Page _ of
I. IDENTIFICATION
FACILITY ID# BEGINNING DATE 100 ENDING DATE 101
BUSINESS NAME (Same as FACILITY NAME or SBA- Doing Business As) 3 BUSINESS PHONE 102
N/A unmanned facilityT - Mobile West Corporation (SITE # SV00229A)
BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a
N/A
6775 S. H Street
BUSINESS SITE CITY 104 ZIP CODE 105 COUNTY 108
Bakersfield CA 93307 KERN
DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a
06- 632 -8376 4812
BUSINESS MAILING ADDRESS 108a
12920 SE 38th Street
BUSINESS MAILING CITY 108b STATE logo ZIP CODE load
Bellevue WA 980061
BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110
Carmen Martinez 925 - 521 -5952
II. BUSINESS OWNER
OWNER NAME III OWNER PHONE 112
T - Mobile West Corporation 425) 383 -4000
OWNER MAILING ADDRESS 113
12920 SE 38th Street
OWNER MAILING CITY 114 STATE 115 ZIP CODE 116
Bellevue WA 980061
III. ENVIRONMENTAL CONTACT
CONTACT NAME 117 CONTACT PHONE 118
Carmen Martinez 925 - 521- 5952
CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a
1855 Gateway BLVD, 10th Floor N/A
CONTACT MAILING CITY 120 STATE 121 ZIP CODE 122
Concord CA 94520
PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY -
NAME 123 NAME 128
Miguel Martinez T- Mobile West NOCC
TITLE 124 TITLE 129
Engineering - Field Manager N/A
BUSINESS PHONE 125 BUSINESS PHONE 130
805) 584 -5716 888) 662 -4662
24 -HOUR PHONE 126 24 -HOUR PHONE 131
888) 662 -4662 888) 662 -4662
PAGER # 127 PAGER # 132
N/A N/A
ADDITIONAL LOCALLY COLLECTED INFORMATION: 133
APN: - - -
Certification: Based on my inquiry ofthose 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.
SIGNAT& OF OWNER/O'FRATOR OR DESIGNATED REPRESENTATIVE DATE 134
7/16/10 1 NAME OF DOCUMENT PREPARER 135
mm asV.- Angie Keel EWS
NAME OF SIGNER (print) 136 TITLE OF SIGNER 137
Carmen Martinez Regional Compliance Manager
05/2008 revised) KC Form 2730
Hazardous Materials Inventory - Chemical Description
You must complete a separate Hazardous Materials Inventory - Chemical Description page for each hazardous material (hazardous substances and hazardous waste) that you
handle at your facility in aggregate quantities equal to or greater than 500 pounds, 55 gallons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the federal
threshold planning quantity for Extremely Hazardous Substances, whichever is less. Also complete a page for each radioactive material handled over quantities for which an
emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40, or 70. The completed inventory should reflect all reportable quantities ofhazardous materials at
your facility, reported separately for each building or outside adjacent area, with separate pages for unique occurrences ofphysical state, storage temperature and storage
pressure. (Note: the numbering of the instructions follows the data element numbers that are on the Unified Program Consolidated Form (UPCF) pages. These data element
numbers are used for electronic submission and are the same as the numbering used in Division 3, Electronic Submittal of Information.) Please number all pages of your
submittal. This helps the Kern County Environmental Health Services Department (KCEHSD) identify whether the submittal is complete and ifany pages are separated.
1 FACILITY ID NUMBER - This number is assigned by KCEHSD. This is the unique number which identifies your facility.
3 BUSINESS NAME - Enter the full legal name ofthe business.
200 ADD /DELETE/ REVISE - Indicate if the material is being added to the inventory, deleted from the inventory, or ifthe information previously submitted is being revised.
NOTE: You may choose to leave this blank if you resubmit your entire inventory annually.
201 CHEMICAL LOCATION - Enter the building or outside/ adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and
temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information is not subject to public disclosure pursuant to HSC §25506.
202 CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must
check "Yes" to keep chemical location information confidential. Ifthe business does not wish to keep chemical location information confidential check "No ".
203 MAP NUMBER -If a map is included, enter the number ofthe map on which the location of the hazardous material is shown.
204 GRID NUMBER -Ifgrid coordinates are used, enter the grid coordinates ofthe map that correspond to the location ofthe hazardous material. If applicable, multiple grid
coordinates can be listed.
205 CHEMICAL NAME -Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the
International Union ofPure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture, do not complete
this field; complete the "COMMON NAME" field instead.
206 TRADE SECRET - Check "Yes" if the information in this section is declared a trade secret, or "No" if it is not.
State requirement: Ifyes, and business is not subject to EPCRA, disclosure ofthe designated trade secret information is bound by HSC §25511.
Federal requirement: Ifyes, and business is subject to EPCRA, disclosure ofthe designated Trade Secret information is bound by 40 CFR and the business must
submita "Substantiation to Accompany Claims ofTrade Secrecy" form (40 CFR 350.27) to USEPA.
207 COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material.
208 EHS -Check "Yes" ifthe hazardous material is an Extremely Hazardous Substance (ELLS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture
containing an EHS, leave this section blank and complete the section on hazardous components below.
209 CAS # -Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number ofthe mixture ifit has been assigned a
number distinct from its components. Ifthe mixture has no CAS number, leave this column blank and report the CAS numbers ofthe individual hazardous components in
the appropriate section below.
210 FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This
information is not currently required by KCEHSD. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the
appendices ofArticle 80 ofthe Uniform Fire Code. Ifa material has more than one applicable hazard class, include all.
211 HAZARDOUS MATERIAL TYPE -Check the one box that best describes the type ofhazardous material: pure, mixture or waste. If waste material, check only that box.
Ifmixture or waste, complete hazardous components section.
212 RADIOACTIVE -Check "Yes" ifthe hazardous material is radioactive or "No" if it is not.
213 CURIES -Ifthe hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal pointto report activity
in curies.
214 PHYSICAL STATE - Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas.
215 LARGEST CONTAINER - Enter the total capacity ofthe largest container in which the material is stored.
216 FEDERAL HAZARD CATEGORIES - Check all categories that describe the Dhvsical and health hazards associated with the hazardous material.
PHYSICAL HAZARDS I HEALTH HAZARDS
Fire: Flammable Li uids and Solids, Combustible Liquids, Pyrophorics, Oxidizers Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers, Corrosives,
other hazardous chemicals with an adverse effect with short term exposureReactive: Unstable Reactive, Organic Peroxides Water Reactive Radioactive
Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens, other hazardous chemicals with an
adverse effect with long term exposure
217 AVERAGE DAILY AMOUNT - Calculate the average daily amount ofthe hazardous material or mixture containing a hazardous material, in each building or adjacent/
outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the
chemical will be on site. Ifthis is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand
during the course ofthe year. This amount should be consistent with the units reported in box 221 and should not exceed that ofmaximum daily amount.
218 MAXIMUM DAILY AMOUNT - Enter the maximum amount ofeach hazardous material or mixture containing a hazardous material, which is handled in a building or
adjacent/outside area at anyone time over the course ofthe year. This amount must contain at a minimum last year's inventory of the material reported on this page, with
the reflection ofadditions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221.
219 ANNUAL WASTE AMOUNT - Ifthe hazardous material being inventoried is a waste, provide an estimate ofthe annual amount handled.
220 STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3 -digit hazardous waste code as listed on the back of the Uniform Hazardous
Waste Manifest.
221 UNITS - Check the unit ofmeasure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: Ifthe material is a
federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. Ifmaterial is a mixture containing an EHS, report the units that the
material is stored in (gallons, pounds, cubic feet, or tons).
222 DAYS ON SITE - List the total number ofdays during the year that the material is on site.
223 STORAGE CONTAINER -Check all boxes that describe the type ofstorage containers in which the hazardous material is stored. NOTE: Ifappropriate, you may choose
more than one.
224 STORAGE PRESSURE - Check the one box that best describes the pressure at which the hazardous material is stored.
225 STORAGE TEMPERATURE - Check the one box that best describes the temperature at which the hazardous material is stored.
226 HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) - Enter the percentage weight ofthe hazardous component in a mixture. If a range of percentages is available, reporl
the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 242.)
227 HAZARDOUS COMPONENTS 1 -5 NAME - When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture
by percent weight (refer to MSDS or, in the case oftrade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if
non - carcinogenic, or 0.1% by weight ifcarcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an
additional sheet ofpaper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components
2 through 5 in 231, 235, 239, and 243.)
228 HAZARDOUS COMPONENTS 1 -5 EHS - Check "Yes" if the component ofthe mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355,
or "No" if it is not. (Report for components 2 through 5 in 232, 236, 240, and 244.)
229 HAZARDOUS COMPONENTS 1 -5 CAS - List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 2 -5.)
246 LOCALLY COLLECTED INFORMATION - Currently, no additional information is required by KCEHSD.
5/2008 revised) KC Form 2731
UNIFIED PROGRAM CONSOLIDATED FORM
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION
one page per materialper building or area)
171 Ann nri FTF RFVIRF 9nn Page of
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3
T - Mobile West Corporation (site # SVO0229A )
CHEMICAL LOCATION
Cabinet 1
201
CHEMICAL LOCATION 13 PSYes NoCONFIDENTIAL - 202
EPCRA
FACILITY ID # 1 MAP # (optional 203 GRID # (optionao 204
II. CHEMICAL INFORMATION
CHEMICAL NAME
Electrolyte Battery Containing Sulfuric Acid
205 TRADE SECRET 11 Yes ® No 206
If Sub'ect to EPCRA, refer to instructions
COMMONNAME Northstar (NSB100FT X 8) 207 EHS' Yes No 208
CAS # 7664-93-9 209 If EHS is'Yes', all amounts below must be in
FIRE CODE HAZARD CLASSES (Complete ifrequired by CUPA) 210
COR
HAZARDOUS MATERIAL a. PURE K3 b. MIXTURE El c. WASTE 211 RADIOACTIVE Yes ® No 212 CURIES 213
TYPE (Check one item only)
PHYSICAL STATE a. SOLID ® b. LIQUID c. GAS 214 LARGEST CONTAINER 76.8 lbs X 8 = 614.4 lbs 215
Check one item only)
FED HAZARD CATEGORIES a. FIRE ® b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH 216Checkallthatapply)
AVERAGE DAILY 217614.4 lbs MAXIMUM D Y 218ti4.4 lbS ANNUAL WASTE NSA 219 STATE WAYE
V
220
AMOUNT AMOUNT AMOUNT CODE
UNITS' a. GALLONS b. CUBIC FEET 13 c. POUNDS d. TONS 221 DAYS ON 222
Check one item only) ' If EHS, amount mustbe in pounds. SITE 3 6 5
STORAGE CONTAINER a. ABOVEGROUND TANK e. PLASTIC /NONMETALLIC DRUM Eli. FIBER DRUM m. GLASS BOTTLE q. RAIL CAR 223Checkallthatapply)
b. UNDERGROUND TANK Elf. CAN j. BAG n. PLASTIC BOTTLE ®r. OTHER
c. TANK INSIDE BUILDING g. CARBOY k. BOX 0. TOTE BIN
d. STEEL DRUM h. SILO 1:11. CYLINDER P. TANK WAGON
STORAGE PRESSURE [ a. AMBIENT b. ABOVE AMBIENT c. BELOWAMBIENT 224
STORAGE TEMPERATURE (2 a. AMBIENT b. ABOVE AMBIENT c. BELOWAMBIENT d. CRYOGENIC 225
WT HAZARDOUS COMPONENT (Formixture or waste only) EHS CAS #
1 50% 226 Lead 227 Yes 29 No 229 7439 -92 -1 229
2 20% 230 Lead Oxide 231 MYes 0N 232 1309 -60 -0 233
3 17% 234 Dilute Sulferic Acid Electrolyte 235Y Yes El 236
7664 -93 -9 237
4 238 239 Yes No 240 241
5 242 243 Yes No 244 245
I/ more hazardous components are present atgreater than 1% by weighti1non - carcinogenic, or 0.1% byweight ffcarcinogenic, attach additionalsheets of paper capturing the required intormatfon.
ADDITIONAL LOCALLY COLLECTED INFORMATION: 246
If EPCRA, Please Sign Here
UPCF (1/99) OES FORM 2731 (1/99)
UNIFIED PROGRAM CONSOLIDATED FORM
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION
onepage per material per building or area)
EI Ann Page ofgrvisi; 90n
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3
T - Mobile West Corporation (site # SVO0229A )
CHEMICAL LOCATION
Cabinet 2
201
CHEMICAL LOCATION Yes NoCONFIDENTIAL - 202
EPCRA
FACILITY ID # 1 MAP # (optionan 203 GRID # (opt/onal) 204
II. CHEMICAL INFORMATION
CHEMICAL NAME
Electrolyte Battery Containing Sulfuric Acid
205 TRADE SECRET Yes IN No 206
If Subject to EPCRA, refer to instructions
COMMON NAME power Safe (SBS C11 x 4) 207 EHS' [3Yes No 208
CAS # 7664-93-9 209 If EHS is'Yes', all amounts below must be in
FIRE CODE HAZARD CLASSES (Complete ifrequired by CUPA) 210
COR
HAZARDOUS MATERIAL a. PURE ZI b. MIXTURE c. WASTE 211 RADIOACTIVE Yes ®No 212 CURIES 213
TYPE (Check oneitem only)
PHYSICALSTATE a. SOLID ® b. LIQUID c. GAS 214 LARGEST CONTAINER 61.6 Ibs x 4 = 246.4 Ibs 215
Check one item only)
FED HAZARD CATEGORIES a. FIRE N b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH 216Checkallthatapply)
AVERAGE DAf.Yy 217
AMOUNT N6.4 lbs MAXIMUM DAILY 218
AMOUNT 246.4 Ibs
ANNUAL WASTE
AMOUNT N/A 219 STATE WA TE
CODE
220
UNITS' a. GALLONS b. CUBIC FEET 13 C. POUNDS d. TONS 221 DAYS ON 222
Check one item only) ' If EHS, amount must be in pounds. SITE 3 6 5
STORAGE CONTAINER a. ABOVEGROUND TANK e. PLASTIC /NONMETALLIC DRUM I. FIBER DRUM Elm. GLASS BOTTLE q. RAIL CAR 223Checkallthatapply)
b. UNDERGROUND TANK f. CAN j. BAG n. PLASTIC BOTTLE M r. OTHER
C. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN
d. STEEL DRUM h. SILO I. CYLINDER P. TANK WAGON
STORAGE PRESSURE [2 a. AMBIENT b. ABOVEAMBIENT c. BELOW AMBIENT 224
STORAGE TEMPERATURE [2 a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225
WT HAZARDOUS COMPONENT (Formixture orwaste only) EHS CAS #
1 6 0 0 226 Lead 227 Yes ® No 228
7439-92-1 229
2 17.50230 Lead Oxide 231 X1 Yes El No 232 1309 -60 -0 233
3 7.5% 234 Dilute Sulferic Acid Electrolyte 235 Yes No 236
7664 -93 -9 237
4 238 239 Yes No 240 241
5 242 243 Yes No 244 245
Itmore hazardous components arepresentatgreaterthan 1% by weight ifnon -carcinogenic, or 0.1% by weight itcarcinogenic, attach additionalsheets ofpaper capturing the required information.
ADDITIONAL LOCALLY COLLECTED INFORMATION: 246
If EPCRA, Please Sign Here
UPCF (1199) DES FORM 2731 (1/99)
UNIFIED PROGRAM CONSOLIDATED FORM
HAZARDOUS MATERIALS
HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION
one page permaterial perbuilding orarea)
Ann nFI FTF RFVISF 200 Page of
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3
T - Mobile West Corporation (site # SVO0229A )
CHEMICAL LOCATION
Cabinet 3
201
CHEMICAL LOCATION Yes 29 NoCONFIDENTIAL - 202
EPCRA
FACILITY ID # 1 MAP # (optional) 203 GRID # (optionap 204
II. CHEMICAL INFORMATION
CHEMICAL NAME
Electrolyte Battery Containing Sulfuric Acid
205 TRADE SECRET El Yes IN No 206
If Subject to EPCRA, refer to instructions
COMMONNAME BatteryCorp (BC- 12V26FT x 4) 207 EHS' 13Yes No 208
CAS # 7664-93-9 209 If EHS is'Yes', all amounts below must be in
FIRE CODE HAZARD CLASSES (Complete if requiredbyCUPA) 210
COR
HAZARDOUS MATERIAL a. PURE ZI b. MIXTURE c. WASTE 211 RADIOACTIVE Yes ® No 412 CURIES 213
TYPE (Check one item only)
PHYSICAL STATE a. SOLID ® b. LIQUID c. GAS 214 LARGEST CONTAINER 20.5 Ibs x 4 = 82 Ibs 215
Check one item only)
FED HAZARD CATEGORIES a. FIRE ® b. REACTIVE c. PRESSURE RELEASE d. ACUTE HEALTH e. CHRONIC HEALTH 216Checkallthatapply)
AVERAGE DAILY 217
82 1bS MAXIMUM DAILx 218 ANNUAL WASTE N/A 219 STATE WAgTE0 220
AMOUNT AMOUNT 02165 AMOUNT CODE
UNITS' a. GALLONS b. CUBIC FEET 3 c. POUNDS d. TONS 221 DAYS ON 222
Check one item only) ' If EHS, amount must be in pounds. SITE 3 6 5
STORAGE CONTAINER a. ABOVEGROUND TANK e. PLASTIC /NONMETALLIC DRUM 1:11. FIBER DRUM Elm. GLASS BOTTLE q. RAILCAR 223Checkallthatapply)
b. UNDERGROUND TANK f. CAN j. BAG n. PLASTIC BOTTLE ® r. OTHER
c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN
d. STEEL DRUM h. SILO I. CYLINDER p. TANK WAGON
STORAGE PRESSURE 11 a. AMBIENT b. ABOVEAMBIENT c. BELOW AMBIENT 224
STORAGE TEMPERATURE [2 a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225
WT HAZARDOUS COMPONENT (Formixtumorwasteonly) EHS CAS #
1 50% 226 Lead 227 El Yes P9 No 226 7439 -92 -1 229
2 2 1 •°6 230 Lead Oxide 231 91 Yes No 232 1309-60-0 233
3 22% 234 Dilute Sulferic Acid Electrolyte 235y Yes El 236
7664 -93 -9 237
4 238 239 Yes No 240 241
5 242 243 Yes No 244 245
Ifmare hazardous components am present atgreaterthan 1% by weight ifnon - carcinogenic, or0.1 % by weight ifcarcinogenk, attach additionalsheets ofpaper capturing the required Information.
ADDITIONAL LOCALLY COLLECTED INFORMATION: 246
If EPCRA, Please Sign Here
UPCF (1/99) IDES FORM 2731 (1/99)
CONSOLIDATED CONTINGENCY PLAN
KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form
2700 M STREET, SUITE 300 COVER PAGE
BAKERSFIELD, CA 93301
661 862 -8700 Fax 661 862 -8701
Page of
I. FACILITY IDENTIFICATION
FACILITY ID # EPA ID # (Hazardous Waste Only) Z
BUSINESS NAME (Same as Facility Name of DBA -Doing Business As) 3
T - Mobile West Corporation (SITE # SV00229A)
The Consolidated Contingency Plan provides businesses a format to comply with the emergency planning
requirements of the following two written hazardous materials emergency response plans required in California:
4 Hazardous Materials Business Plan (HSC Chapter 6.95 Section 25504 (b) and 19 CCR Sections 2729-
2732), and
4 Hazardous Waste Generator Contingency Plan (22 CCR Section 66264.52)
This format is designed to reduce duplication in the preparation and use of emergency response plans at the
same facility, and to improve the coordination between facility response personnel and local, state and federal
emergency responders during an emergency.
A copy of the plan shall be submitted to this Department and 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.
Describe below where a copy of your Contingency Plan, including the hazardous material inventories, Training
Records, and Site Map(s), are located at your business:
We appreciate the effort of local businesses in completing these plans and are available to assist
in any manner. If you have any questions, please contact this Department at (661) 862 -8700.
PLAN CERTIFICATION
I certify under penalty oflaw that I have personally examined and I am familiar with the information provided
by this plan and to the best ofmy knowledge the inform tion is accurate, complete, and true.
Printed Name ofOwner/ Operator Title of Owner /Operator
Carmen Martinez Regional Compliance Manager
Signature ofOwner/ Operator Date
7/16/10
We appreciate the effort of local businesses in completing these plans and are available to assist
in any manner. If you have any questions, please contact this Department at (661) 862 -8700.
ADVISORY
Page of
The site - specific Contingency Plan is the facility's plan for handling emergencies and shall be
implemented immediately whenever there is a fire, explosion, or release of hazardous materials or waste
that could threaten human health and /or the environment. The contingency plan shall be reviewed, and
immediately amended, if necessary, whenever:
Q The plan fails in an emergency
Q The facility changes in its design, construction, operation, maintenance, or other
circumstances in a way that materially increases the potential for fires, explosions, or releases
of hazardous waste or hazardous waste constituents, or changes the response necessary in an
emergency
Q List of emergency coordinators changes
Q List of emergency equipment changes
Submit a copy of any updates or changes to this Department.
II. EMERGENCY CONTACTS
PRIMARY SECONDARY
NAME 123 NAME 128MiguelMartinezMobileWestNOCC
TITLE Engineering - Field Manager 124 TITLE
N/A
129
BUSINESS PHONE 125 BUSINESS PHONE 130
805) 584 -5716 888) 662 -4662
24 -HOUR PHONE 126 24 -HOUR PHONE 131
888) 662 -4662 888) 662 -4662
PAGER # 127 PAGER # 132
N/A N/A
III. EMERGENCY RESPONSE PLANS AND PROCEDURES
A. Notifications
Your business is required by State Law to provide an immediate verbal report of any release or threatened release of a hazardous
material to local fire emergency response personnel, this Department, and the California Emergency Management Agency. If you have
a release or threatened release of hazardous materials, immediately call:
FIRE/PARAMEDICS/POLICE/SHERIFF
PHONE: 911
AFTER the local emergency response personnel are notified, you shall then notify this Department and the California Emergency
Management Agency.
Kern County Environmental Health Department: (661) 862 -8700 or after hours, call Dispatch at (661) 861 -2521
California Emergency Management Agency: (800) 852 -7550 or (916) 845 -8911
National Response Center: 800 424 -8802
Information to be provided during notification:
4 Your name and the telephone number from where you are calling.
4 Exact address of the release or threatened release.
4 Date, time, cause, and type of incident (e.g. fire, air release, spill etc.)
d Material and quantity of the release, to the extent known.
4 Current condition of the facility.
4 Extent ofinjuries, if any.
4 Possible hazards to public health and/ or the environment outside of the facility.
B. Emergency Medical Facility Page of
List the closest emergency medical facility that will be used by your business in the event ofan accident of injury caused by
a release or threatened release of a hazardous material
HOSPITAL /CLINIC: PHONE NO:
Mercy Hospitals Of Bakersfield 661-632-5000
ADDRESS:
2215 Truxton AVE
CITY: ZIP CODE:
Bakersfield 93301
C. Private Emergency Response
DOES YOUR BUSINESS HAVE A PRIVATE ON -SITE EMERGENCY RESPONSE TEAM? El Yes No
If yes, provide an attachment that describes what policies and procedures your business will follow to notify your on -site
emergency response team in the event of a release or threatened release of hazardous materials.
CLEANUP/DISPOSAL CONTRACTOR
List the contractor that will provide cleanup services in the event of a release.
NAME OF CONTRACTOR: PHONE NO:
CUBA 800 _579_ 2872
ADDRESS:
N/A
CITY: ZIP CODE:
N/A N/A
D. Arrangements with Emergency Responders
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 in the space below:
E. Evacuation Plan
1. The following alarm signal(s) will be used to begin evacuation of the facility (check all which apply):
Verbal ® Telephone (including cellular) x Alarm System Public Address System ® intercom
x Pagers E3. Portable Radio Other (specify):
2. Evacuation map is prominently displayed throughout the facility.
3. Name of individual(s) responsible for coordinating evacuation including spreading the alarm and confirming the business has
been evacuated:
F. Earthquake Vulnerability
Identify areas of the facility where releases could occur or would require immediate inspection or isolation because ofthe
vulnerability to earthquake related ground motion.
Hazardous Waste/ Hazardous Materials Storage Areas Production Floor Process Lines
Bench/ Lab Waste Treatment Other:
Identify mechanical systems where releases could occur or would require immediate inspection or isolation because of the
vulnerability to earthquake related ground motion.
Utilities Sprinkler Systems Cabinets Shelves
Racks Pressure Vessels Gas Cylinders Tanks
Process Piping Shutoff Valves Other:
G. Emergency Procedures Page of
Briefly describe your business standard operating procedures in the event of a release or threatened release of hazardous
materials /wastes:
1. PREVENTION (prevent the spill /release) - Consider the types of spills /releases associated with the hazardous
materials /wastes present at your facility. What actions does your business take to prevent these spills /releases from occurring? You
may include a discussion of safety and storage procedures.
Hazardous materials at site consist of "sealed" batteries within a heavily sealed
self - contained cabinet preventing accidental release.
2. MITIGATION (stop the release /spill) - Describe what actions are taken to reduce the harm or the damage to person(s),
property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate response to a
leak, spill, fire, explosion, or airborne release at your business?
Evacuate any necessary employee's from area of spill. Technician will immediately contact CURA
1- 800 - 579 -2872, (24/7/365) followed by call to supervisor. If possible, attempt containment
efforts.
3. ABATEMENT (clean up the spill /release) - Describe what you would do to clean up the spill /release. How do you handle
the complete process ofcleaning up and disposing of released materials at your facility?
Contact cleanup Contractor CUBA at (800) 579 -2872 (24/7/365)
6/2010 09:30 FAX 805 587 5720 T- MOBILE
Training:
Check all boxes which apply.
1. Personnel are trained in the following procedures:
721001/001
Internal alarm/ notitication
o azar ous materials
vacua ion re-en procedures & assem IV point locations
Emergency incident reporting
ix External emergency response organization notMcation
Location(s) ana contents-OT Emer enc es onse on in en an
2. Chemical Handlers are annually trained in the following:
Sate methods Tor handling and storage o azar ous materials
19 Location(s) and proper use OT Tire and spill control equipment
i proceclureslemergency proceduresProperuseOTRersonalprotectiveauimen
pe is azar s o each c emica o w isa they may be exposed, including routes of exposurei.e. inhalation In estion abso lion
LY Hazarclous VVaste tianalersimanagers are trained in all aspects of azar ous 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:
AV Personnel rescue procedures
bhUtdown ot o era ions
N Liaison wrtn respondina aciencies
IX Use, maintenance, and replacemen ot emergency response equipment
e res er training, which is provided at eas annua
Emergency response drills, which are conducted at eas (spec{fy, e.g., -Quarterly", etc)
Annually
Amendment of Contingency Plan:
This plan must be reviewed, and immediately amended, if necessary, whenever:
a. Applicable regulations are revised.
b. The plan fails in an emergency.
C. The facility changes its design, construction, operation, maintenance, or other
circumstances in a way that materially increases the potential for fires, explosions, or - --
releases of hazardous waste or hazardous waste constituents, or changes the --
response necessary in an emergency.
d. The list of emergency coordinators changes.
e. The list of emergency equipment changes.
o 116 /)
Em—ergen4 Coordinator Signature Date
N. Emergency Equipment Page _ of
22 CCR, Section 66265.52(e) [as referenced by Section 66262.34(a)(3)] 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.
Equipment
CategoryUategory
2.
Equipment
Type
3.
Location
4.
Description*
Personal
Protective,
Equipment,
Safety
Cartridge Respirators
Chemical Monitoring Equipment (describe)
Chemical Protective Aprons/Coats
Chemical Protective Boots
Equipment,
and
First Aid
Chemical Protective Gloves
Chemical Protective Suits (describe)
Face Shields
Equipment First Aid Kits /Stations (describe)
8 Hard Hats
Plumbed Eye Wash Stations
Portable Eye Wash Kits (i.e. bottle e)
Respirator Cartridges (describe)
j Safety Glasses/Splash Goggles
Safety Showers
Self- Contained Breathing Apparatuses (SCBA) Nicos N -95 Facial Mask
Other describe
Fire Automatic Fire Sprinkler Systems
Extinguishing
Systems
Fire Alarm Boxes /Stations
Fire Extinguisher systems (describe) A, B, C Fire Extinguiser
Other (describe)
Spill
Control
Equipment
j Absorbents (describe)
Berms/Dikes describe
Decontamination Equipment (describe)
and Emergency Tanks describe
Decontamination Exhaust Hoods
Equipment Gas Cylinders Leak Repair Kits (describe)
Neutralizers (describe)
Overpack Drums
Sums (describe)
Other (describe)
Communications
and
Alarm
Systems
Chemical Alarms (describe)
Intercoms/ PAS stems
Portable Radios
Telephones
Underground Tank Leak Detection Monitors
Other (describe) ou u
Additional
Equipment
Use Additional
Pages if
Needed.)
Describe the equipment and its capabilities. Ifapplicable, specify any testing /maintenance procedures /intervals. Attach additionalpages, numbered
appropriately, ifneeded.
Page of
V. EMPLOYEE TRAINING
All facilities which handle hazardous materials must have a current written employee training plan. The items
listed below are required per Health and Safety Code Section 25504 (c) and Title 19 Section 2732.
Training shall be provided:
d Initially for all new employees.
4 Methods for Safe Handling of Hazardous Materials.
Note: These trainingprograms may take into consideration the position ofeach employee.
Facility personnel are trained as follows:
d Familiarity with all plans and procedures specified in the Contingency Plan.
Q Methods for Safe Handling of Hazardous Materials.
4 Safety procedures in the event ofa release or threatened release of a hazardous material.
4 Use of Emergency Response equipment and supplies under the control ofthe business.
d Procedures for Coordination with local Emergency Response Organizations.
Additional training should include:
4 Internal alarm /notification procedures.
4 Evacuation/re -entry procedures and assembly point locations
4 Material Safety Data Sheet (MSDS) training including specific hazard(s) ofeach chemical to which employees may
be exposed, including routes of exposure (i.e. inhalation, ingestion, absorption).
VI. HAZARDOUS 'WASTE GENERATOR TRAINING
If your business is a hazardous waste generator, you are required to provide training in hazardous waste
management for all workers who handle hazardous waste at your site (22 CCR §66265.16). You are also
required to document training. The items below are required.
EMPLOYEE TRAINING
4 Facility personnel will successfully complete training within six months after the date of their employment or
assignment to a facility or to a new position at a facility.
4 Employees will not handle hazardous wastes without supervision until trained.
TRAINING DOCUMENTATION
The owner or operator must maintain the following documents and records at the facility:
d Job title for each position at the facility that is related to hazardous waste management, and the names of the
employee(s) filling the position(s).
d Description for each position listed above (must include required skill, education, or other qualifications as well as
duties of employees assigned to the position.
4 Description oftype and amount of both introductory and continuing training given to each employee.
4 Records that document that the requirements for training or job experience have been met.
4 Current employees' training records (to be retained until closure of the facility).
4 Former employees' training records to be retained at least three years after termination of employment).
6/2010 09:30 FAX 805 587 5720 T— MOBILE
Training:
Check all boxes which apply.
1. Personnel are trained in the following procedures:
Q001/001
internal a arm no i ca ion
Evacuation/re-en roce ures assem V point locations
Emergency incident reporting
La External emergency response organization notMcation - -
oca ions ana contents'OT tmerqency esponseluontingency Plan
2, Chemical Handlers are annually trained in the following:
Sate methods tor handling and storage o azar ous materials
Ix oca on s and proper use OT Tire and spill control equipment
N Spill procecluresterner2ency proceduresIKProperuseOTpersonalprotectiveauimen
peer is azar s o each c emica o w is they may be exposed, including routes ot exposurei.e. inhalation In estion abso Lion
Hazardous Waste tian-lersimanagers are trained in all aspects of azar ous 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:
W--P-ersonnel rescue proce ures
Shutdown of operations
Liaison With responainq agencies
IX Use, maintenance, ana replacemen ot emer_qency response equipment
LX e res er training, which is proviaea at eaS annua
Emergency response arms, Which are conducted at eas (specify; e.g., "Quarterly ", etc.)
Annually
Amendment of Contingency Plan:
This plan must be reviewed, and immediately amended, if necessary, whenever:
a. Applicable regulations are revised.
b. The plan fails in an emergency.
C. The facility changes its design, construction, operation, maintenance, or other
circumstances in a way that materially increases the potential for fires, explosions, or - -- - - -- -
releases of hazardous waste or hazardous waste constituents, or changes the
response necessary in an emergency.
d. The list of emergency coordinators changes.
e. The list of emergency equipment changes.
ID /
lam 16ee4 — 7116110
mergen WCoordinator Signature Date
T-MOblle Hazard Communications Training Course Summary (a /o March 2010)
T- Mobile employees who in the line of their job description or duties are exposed to any chemical are
required to participate in the online Hazard Communications Training Course at minimum once a year.
The course objectives and brief description of the purpose of the standard are outlined below:
Learning Objectives:
After completing the online course, employee will be able to:
Understand the purpose of the Hazard Communication Standard
Recognize who is covered by the Hazard Communication Standard
State the four basic parts of the Hazard Communication Standard (Hazard determination or
assessment; the written program, MSDS and labels and training)
Identify physical and health hazards of chemicals
o List what items should be included in a hazardous chemical inventory
Recognize what should be included in the written Hazard Communication program and what is
the appropriate PPE to be used with any given possible chemical exposure.
Recognize the information contained in a material safety data sheet (MSDS) and how it is used
and maintained in the workplace and be able to identify the NFPA signage requirement and
rating systems used in labeling. (i.e.; Blue, Red, Yellow and White as well as W and OX)
Purpose of the Hazard Communication Standard:
The OSHA HazCom Standard is found in 29 CFR 1910.1200
Requires employers to find all of the potential hazards of materials in the workplace and to tell
their employees about those hazards
Makes sure that employers and employees know the hazards of chemicals they work with and
how to protect themselves (reducing injuries and illnesses due to hazardous chemicals).
Ensures that the hazards of all chemicals produced in or imported into the US are examined, and
that the requirements for hazard communication in the workplace are the same everywhere in
the country.
Hazard Communication Training Course Summary.doc 3 -23 -10 -cmtz
INTENTIONALLY
LEFT
BLANK
TRAINING
RECORDS
NEEDED
FROM
PROJECT POC
SITE MAP
A site plan and storage map must be included with your Contingency Plan. For relatively small facilities, these
documents may be combined into one drawing. Since these drawings are intended for use in emergency
response situations, larger facilities (generally those with complex andlor multiple buildings) should provide an
overall site plan and a separate storage map for each building/storage area. A blank Facility Site Map has been
provided on the reverse side of this page. You may complete that page or attach any other drawing(s) which
contain(s) the information required below. Drawings are to be no larger than 11" x 17 ". Blue prints are not
acceptable.
1. Site Plan: This drawing shall contain, at a minimum, the following information:
a. Site orientation (North, South, etc.)
b. Date the map was drawn
C. Locations of all buildings and other structures
d. Parking lots and internal roads
e. Outside hazardous materials storage or use areas
f. Storm drain, sanitary sewer drain inlets, and dry wells
g. All wells (water, monitoring of underground tank systems, etc) if applicable
h. Evacuation routes, emergency exits, and staging/meeting areas
i. Adjacent property use
j. Locations and names of adjacent streets and alleys
k. Entrance and exit points /roads
2. Storage Map(s): The map(s) shall contain, at a minimum, the following information:
a. General purpose of each section /area within each building (e.g. "Office Area", "Manufacturing
Area ", etc)
b. Location of each hazardous material /waste storage, dispensing, use, or handling area (e.g.
individual underground tanks, aboveground tanks, storage rooms, etc.).
C. Entrances to and exits from each building and hazardous material /waste room/area
d. Location of each utility emergency shut -off point (i.e. gas, water, electric)
e. Location of each monitoring system control panel (e.g. underground tank monitoring, toxic gas
monitoring, etc)
t .
San Luis Obispo County Certified Unified Program Agency
FORM M - MAP GRID (see instruction page v) Map #
r, n i'4 +Ur r.,a„.
y ''(
l :.
fir `_'s`; , .'r` -q, ,J
r
2
3
12
13
14
n
Scale: 1 inch= Feet
Business Name: T - mobile west Corporation (SITE # SV00229A) Date: 7/16/10
Address: 6775 S. H Street Bakersfield, CA 93307
Number of Employees in Facility Depicted Above - Day = N/A Night = N/A unmanned facility
Page Of
4
CADocuments and Settings \rhendry\ Desktop \CUPA_Files \cupa \forms \FRM -M.DOC 07/09/09
o
e
13
14
A I B I C I D I E I F I G I H I I J I K I L I M I N
Scale: 1 inch= Feet
Business Name: T - mobile west Corporation (SITE # SV00229A) Date: 7/16/10
Address: 6775 S. H Street Bakersfield, CA 93307
Number of Employees in Facility Depicted Above - Day = N/A Night = N/A unmanned facility
Page Of
4
CADocuments and Settings \rhendry\ Desktop \CUPA_Files \cupa \forms \FRM -M.DOC 07/09/09
13
14
A I B I C I D I E I F I G I H I I J I K I L I M I N
Scale: 1 inch= Feet
Business Name: T - mobile west Corporation (SITE # SV00229A) Date: 7/16/10
Address: 6775 S. H Street Bakersfield, CA 93307
Number of Employees in Facility Depicted Above - Day = N/A Night = N/A unmanned facility
Page Of
4
CADocuments and Settings \rhendry\ Desktop \CUPA_Files \cupa \forms \FRM -M.DOC 07/09/09
San Luis Obispo County Certified Unified Program Agency
FORM M - MAP GRID (see instruction page v) Map #
Scale: 1 inch= Feet
Business Name: T - Mobile West Corporation (SITE # SV00229A) Date: 7/16/10
Address: 6775 S. H Street Bakersfield, CA 93307
Number of Employees in Facility Depicted Above - Day = N/A Night =N /A unmanned facility
4
Page Of
C: \Documents and Settings \rhendry\ Desktop \CUPA_Files \cupa \forms \FRM -M.DOC 07/09/09
r
San Luis Obispo County Certified Unified Program Agency
FORM M - MAP GRID (see instruction page v) Map #
Scale: 1 inch= Feet
Business Name: T - mobile west Corporation (SITE # Svo0229A) Date: 7/16/10
Address: 6775 S. H Street Bakersfield, CA 93307
Number of Employees in Facility Depicted Above - Day = N/A Night =N /A unmanned facility
4
Page Of
C: \Documents and Settings\rhendry\ Desktop \CUPA_Files \cupa \forms \FRM -M.DOC 07/09/09