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HomeMy WebLinkAboutHAZ-BUSINESS PLAN 2/27/2012YRC Worldwide Inc 10990 Roe Avenue Overland Park KS 66211 -1213 Phone 913 696 6100 yrcv "'Corn February 27, 2012 Bakersfield Fire Department Prevention Services Fire Station #1 2101 H Street Bakersfield, CA 93301 RE: Hazardous Materials Management Plan Certification 2011 YRC, Inc. (822) 4901 Lisa Marie Court Bakersfield, CA 93313 The completed Hazardous Materials Business Plan including the Business Activities, Business OwnlOperator Identification, Consolidated Contingency Plan, Site and Facility Maps, Hazardous Materials Inventory, and UST Facility Forms are enclosed for the YRC, Inc. location referenced above. There have been no operational changes or chemical inventory changes at this facility in 2011. This facility stores and uses four hazardous substances: Diesel, Motor Oil, Antifreeze, and Propane. Through careful study and audit, YRC, Inc. has determined that there are no extremely hazardous substances (EHS) present and are not required to report for releases oftoxic chemicals required by §313 of SARA, Title III. YRC Enterprise Services, Inc., is reporting on behalf of YRC, Inc. Should you have questions or need further information please contact me at YRC Environmental Services Department at 913)- 344 -3615 or via e -mail at Steve. Shinnersgyrcw.com. Th you, Stas Environmei Enclosures Manager cc: Antonio Mensurado, 822 Bakersfield Fire Department HAZARDOUS MATERIAL MANAGEMENT PLAN Ap. ; Ns_J" BUSINESS ACTIVITIES PAGE U Plot', IF HAZARDOUS MATERIAL FACILITY INFORMATION) ARTM 1 BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue Bakersfield, CA 93301 Phone: 661-326-3979 Fax: 661-852-2171 I. FACILITY IDENTIFICATION FACILITY ID # (for office use only) 3 EPA ID # BUSINESS NAME (FACILITY NAME or DBA) 103 YRC, INC. (822) II. ACTIVITIES DECLARATION DOES Your Facility... If Yes, Please Complete... 129 A. HAZARDOUS MATERIAL XYes No CHEMICAL DESCRIPTION FORM 130 1. Have on site (for any purpose) hazardous material HAZARDOUS MATERIAL MANAGEMENT PLAN at or above 55 gallons for liquids, 500 pounds for Minimum reauired olannino elements: solids, or 200 cu. ft. for compressed gases (include Emergency Response Plan liquids in AST and UST)? Maps Training Prevention Certification B. REGULATED SUBSTANCES (RS) Yes )ENo CHEMICAL DESCRIPTION FORM 131 1. Have on site RS at greater than the threshold RISK MANAGEMENT PLAN (RMP Submit to USEPA) planning quantities established by the California CONSOLIDATED COMPLIANCE PLAN Accidental Release Prevention program (CalARP)? Incorporating CaIARP Program Elements C. UNDERGROUND STORAGE TANKS (UST) XYes No UST FACILITY FORM 132 1. Own or operate Underground Storage Tanks? UST TANK FORM (one per tank) Yes (KNo UST FACILITY FORM 1332. Intend to upgrade existing or install new UST? UST TANK FORM (one per tank) UST INSTALLATION FORM (one per tank) D. TANK CLOSURE /REMOVAL Yes ¢ENo UST TANK FORM (Closure section - one per tank) 1. Need to report closing an UST that held hazardous material or waste? 2. Need to report the closure /removal of a tank that Yes DLNo UST TANK CLOSURE FORM was classified as hazardous waste and cleaned onsite? E. ABOVEGROUND PETROLEUM STORAGE TANKS Yes §tNo HAZARDOUS MATERIAL MANAGEMENT PLAN Incorporating Federal Spill Prevention Control and CountermeasureAST) 1. Own or operate AST above these thresholds; any SPCC) Elements pursuant to 40 CFR Part 112. tank capacity is greater than 660 gallons or the total capacity for the facility is greater than 1,320 gallons? F. HAZARDOUS WASTE EPA ID NUMBER - provide on this page 1. Generate hazardous waste? Yes CKNo To obtain EPA ID Number, please phone (916) 324 -1781 2. Recycle more than 100 kg /mo of recyclable Yes QiNo RECYCLING FORM material at the same location It was generated? 3. Recycle more than 100 kg /mo of recyclable Yes X No RECYCLING FORM material at an off -site location different from the point of generation? 4. Treat Hazardous Waste on site? Yes KNo TP FACILITY FORM TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requirements? Yes X No CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a Yes X No REMOTE WASTE /CONSOLIDATION SITE NOTIFICATION remote site? FORM NOTE: If you checked YES to any part of Sections IIA — IIF above, then In addition to the forms requested above, please submit BUSINESS OWNER /OPERATOR IDENTIFICATION FORM. FD2143(Rev 01/08) HAZARDOUS MATERIAL MANAGEMENT PLAN P1 I ANAPPLICATIONB T B A P BUSINESS OWNER /OPERATOR IDENTIFICATION FORM RrR>IIMA HAZARDOUS MATERIAL FACILITY INFORMATION) BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue, 1' Floor Bakersfield, CA 93301 Phone: 661 - 326 -3979 e Fax: 661 - 852 -2171 Page 1 of 2 I. FACILITY IDENTIFICATION FACILITY ID # 1 YEAR BEGINNING 100 YEAR ENDING 101 1/1/2011 12/31/2011 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 BUSINESS PHONE 102 YRC, INC. (822) 661 -833 -1895 SITE ADDRESS 103 4901 LISA MARIE COURT CITY >AW-15RSF1ELA 104 ZIP CODE 93313 105 CA DUNN & BRADSTREET # 106 SIC CODE 4213 107 00- 699 -8397 COUNTY 108 KERN OPERATOR NAME 109 OPERATOR PHONE 110 YRC, INC. (822) 913- 344 -3615 II. OWNER INFORMATION OWNER NAME YRC, INC. (822) 111 OWNER PHONE 913-344-3615 112 OWNER MAILING ADDRESS 113 10990 ROE AVENUE MS A605 ATTN: ENV SERVICES CITY 114 STATE 115 ZIP CODE 116 OVERLAND PARK KS 66211 -1213 III. ENVIRONMENTAL CONTACT CONTACT NAME STEVEN R. SH I NNERS 117 CONTACT PHONE 913- 344 -3615 118 CONTACT MAILING ADDRESS 10990 ROE AVENUE MS A6 0 5 ATTN : ENV SERVICES 119 CITY OVERLAND PARK 120 STATE 121 KS ZIP CODE 66211 -1213 122 IV. EMERGENCY CONTACTS PRIMARY SECONDARY NAME ANTONIO MENSURADO 123 NAME RYAN SUTTERFIELD 128 TITLE TERMINAL MANAGER 124 TITLE SUPERVISOR 129 BUSINESS PHONE 661- 833 -1895 X3 125 BUSINESS PHONE 661 - 833 -1895 X5 130 24 -HOUR PHONE 661 - 978 -0026 126 24 -HOUR PHONE 661 - 343 -0792 131 CELL PHONE 127 CELL PHONE 132 133 V. CERTIFICATION Certification: Based y Inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally e Amin d am famili it the information submitted In this Inventory and believe the information is true, accurate, and complete. S F MENT PRE R 136 DATE 134 NAME OF DOCUMENT PREPARER(PRINT) 135 2/22/2012 KRYSTAL TATNEY NAME O OWN R/ PERATO SIGN & P ) 137 TITLE OF DOCUMENT PREPARER _ 138 STE . S E S CONSULTANT FD2142(Rev 01/08) BAKERSFIELD FIRE DEPARTMENT Prevention Services HAZARDOUS MATERIAL MANAGEMENT PLAN H E R 8 A I_ D 1600 Truxtun Ave., Suite 401 FIRS Bakersfield, CA 93301 CHEMICAL DESCRIPTION FORM JUMARfA/ t Phone: 661 - 326 -3979 •Fax: 661- 852 -2171 HAZARDOUS MATERIAL INVENTORY 4401, Page 1 of 2 NEW ADD DELETE X REVISE 200 (One form per material, Oer bulldinq, or area.) I. FACILITY INFORMATION BUSINESS NAME (FACILITY NAME or DBA) 3 YRC, INC. (822) CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 INSIDE SHOP CONFIDENTIAL (EPCRA) C Yes X No FACILITY ID # 1 MAP # (optional) 203 GRID # (optional) 204 SITE MAP F2 II. CHEMICAL INFORMATION CHEMICAL NAME 205 206 ETHYLENE GLYCOL TRADE SECRET n Yes X No If subject to EPCRA, refer to Instructions COMMON NAME 207 EHS* C Yes 1}.0 NoANTIFREEZE 208 If EHS Is yes, all amounts below must be InCAS # 209 107-21-1 pounds. FIRE CODE HAZARD CLASSES (complete If requested by local fire chief) 210 TYPE 211 212 RADIOACTIVE: C Yes X No CURIES 213 PURE 'X MIXTURE WASTE LARGEST CONTAINER 215 PHYSICAL STATE J SOLID LX LIQUID L GAS 214 55 216 FED HAZARD CATEGORIES X FIRE REACTIVE PRESSURE RELEASE X ACUTE HEALTH X CHRONIC HEALTH Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE 220 AMOUNT DAILY AMOUNT 110 DAILY AMOUNT 80 CODE 221 DAYS ON SITE 222 UNITS X GAL :1 CU FT LBS TONS 365ifEHS, amount must be In lbs. STORAGE CONTAINER: 223 ABOVEGROUND TANK CAN BOX TANK WAGON UNDERGROUND TANK CARBOY CYLINDER RAIL CAR J TANK INSIDE BUILDING J SILO U GLASS BOTTLE L OTHER X STEEL DRUM U FIBER DRUM U PLASTIC BOTTLE U TOTE BIN PLASTIC /NONMETALLIC DRUM BAG STORAGE PRESSURE: X AMBIENT ABOVE AMBIENT BELOW AMBIENT 224 225 STORAGE TEMPERATURE:X AMBIENT ABOVE AMBIENT BELOW AMBIENT C CRYOGENIC WT HAZARDOUS COMPONENT EHS CAS # 1 95 226 ETHYLENE GLYCOL 222 1 Yes ]0 No 228 107 -21 -1 229 2 5 230 DIETHYLENE GLYCOL 231 J Yes XNO 232 111 -46 -6 233 3 234 235 Yes No 236 237 4 238 239 J Yes J No 240 241 5 242 243 Yes No 244 245 III. SIGNATUR PRINT NAME &TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGN U E DATE 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER JU FD2144(Rev 08/07) BAKERSFIELD FIRE DEPARTMENT Prevention Services HAZARDOUS MATERIAL MANAGEMENT PLAN s R p I 1600 Truxtun Ave., Suite 401 PIRG Bakersfield, CA 93301 CHEMICAL DESCRIPTION FORM ARTAI T Phone: 661 - 326 -3979 • Fax: 661 -852 -2171 HAZARDOUS MATERIAL INVENTORY Page 1 of 2 NEW ADD DELETE X REVISE 200 One form per material, per building, or area.) I. FACILITY INFORMATION BUSINESS NAME (FACILITY NAME or DBA) 3 YRC, INC. (822) CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 UNDER FUEL ISLAND CONFIDENTIAL (EPCRA) D Yes X No FACILITY ID # 1 MAP # (optional) 203 GRID # (optional) 204 SITE MAP F2 II. CHEMICAL INFORMATION CHEMICAL NAME 205 206 2 DIESEL FUEL TRADE SECRET Yes X No Ifsubject to EPCRA, refer to instructions COMMON NAME 207 EHS' C Yes X NoDIESELFUELzpa If EHS Is yes, all amounts below must be InCAS # 209 68476 -34 -6 pounds. FIRE CODE HAZARD CLASSES (complete if requested by local fire chief) 210 TYPE 211 RADIOACTIVE: C Yes X 212 No CURIES 213 I PURE X MIXTURE WASTE LARGEST CONTAINER 215 PHYSICAL STATE J SOLID LX LIQUID L GAS 214 12, 000 216 FED HAZARD CATEGORIES X FIRE REACTIVE PRESSURE RELEASE X ACUTE HEALTH X CHRONIC HEALTH Check all that apply) ANNUAL WASTE 217 MAXIMUM 11, 500 218 AVERAGE 219 STATE WASTE 220 AMOUNT DAILY AMOUNT DAILY AMOUNT 500 CODE 221 DAYS ON SITE 222 UNITS X GAL :1 CU FT LBS El TONS 365IfEHS, amount must be In lbs. STORAGE CONTAINER: 223 ABOVEGROUND TANK CAN BOX TANK WAGON X UNDERGROUND TANK CARBOY CYLINDER RAIL CAR U TANK INSIDE BUILDING U SILO U GLASS BOTTLE U OTHER U STEEL DRUM U FIBER DRUM U PLASTIC BOTTLE U TOTE BIN C PLASTIC /NONMETALLIC DRUM BAG STORAGE PRESSURE: X AMBIENT ABOVE AMBIENT BELOW AMBIENT 224 225 STORAGE TEMPERATURE:X AMBIENT ABOVE AMBIENT BELOW AMBIENT C CRYOGENIC WT HAZARDOUS COMPONENT EHS CAS # 1 0 -100 226 Full Range Straight Run Middle Distillat927 Yes XI No 228 68814 -87 -9 229 2 0 -40 230 Light Catalytic Cracked Distillate 231 J Yes XNo 232 64741 -59 -9 233 3 0 -0.05 234 SULFUR 235 Yes XNo 236 7704 -34 -9 237 4 238 239 J Yes U No 240 241 5 242 243 1 Yes C No 244 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE I A UR DATE 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER 2.-Z --- ap 2 I \ FD2144(Rev 08/07) j BAKERSFIELD FIRE DEPARTMENT Prevention Services HAZARDOUS MATERIAL MANAGEMENT PLAN B, H R S P I n 1600 Truxtun Ave., Suite 401 FIRE Bakersfield, CA 93301 CHEMICAL DESCRIPTION FORM ARM r Phone: 661 - 326 -3979 • Fax: 661 -852 -2171 HAZARDOUS MATERIAL INVENTORY Page 1 of 2 NEW ADD DELETE X REVISE 200 (One form per material, per building, or area.) I. FACILITY INFORMATION BUSINESS NAME (FACILITY NAME or DBA) 3 YRC, INC. (822) CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 INSIDE SHOP CONFIDENTIAL (EPCRA) Yes X No FACILITY ID # 1 MAP optional) 203 GRID # (optional) 204 SITE MAP F2 II. CHEMICAL INFORMATION CHEMICAL NAME 205 206 SOLVENT REFINED PARAFFINIC PETROLEUM OIL TRADE SECRET I Yes X No Ifsubject to EPCRA, refer to Instructions COMMON NAME 207 EHS" C Yes OS No MOTOR OIL 208 If EHS Is yes, all amounts below must be inCAS # 209 64742 -54 -7 pounds. FIRE CODE HAZARD CLASSES (complete If requested by local Flre chief) 210 TYPE 211 212 RADIOACTIVE: C Yes X No CURIES 213 PURE X MIXTURE WASTE LARGEST CONTAINER 215 PHYSICAL STATE J SOLID X LIQUID L GAS 214 55 216 FED HAZARD CATEGORIES X FIRE REACTIVE PRESSURE RELEASE X ACUTE HEALTH X CHRONIC HEALTH Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE 220 AMOUNT DAILY AMOUNT 110 DAILY AMOUNT 80 CODE 221 DAYS ON SITE 222 UNITS X GAL :1 CU FT LBS TONS 365fEHS, amount must be In Its. STORAGE CONTAINER: 223 ABOVEGROUND TANK CAN BOX TANK WAGON UNDERGROUND TANK CARBOY CYLINDER RAIL CAR U TANK INSIDE BUILDING U SILO U GLASS BOTTLE U OTHER X STEEL DRUM U FIBER DRUM U PLASTIC BOTTLE U TOTE BIN PLASTIC /NONMETALLIC DRUM BAG STORAGE PRESSURE: N AMBIENT 11 ABOVE AMBIENT 11 BELOW AMBIENT 224 225 STORAGE TEMPERATURE:X AMBIENT ABOVE AMBIENT BELOW AMBIENT C CRYOGENIC o /aWT HAZARDOUS COMPONENT EHS CAS # 1 99 226 REFINED PETROLEUM DISTALLATE 227 D Yes Xl No 228 64742 -54 -7 229 2 1 230 ZINC COMPOUNDS 231 J Yes XNo 232 68649 -42 -3 233 3 234 235 Yes No 236 237 4 236 239 J Yes U No 240 241 5 242 243 Yes No 244 245 III. SIGN URE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE I A DATE 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER Z Z- q — L 1 Z 1 \ I \ FD2144(Rev 08/07) HAZARDOUS MATERIAL MANAGEMENT PLAN CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIAL INVENTORY NEW ADD DELETE X REVISE 200 RS P I D FIRE, ARTff T BAKERSFIELD FIRE DEPARTMENT Prevention Services 1600 Truxtun Ave., Suite 401 Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 1 of 2 One form per material, per building, or area.) I. FACILITY INFORMATION BUSINESS NAME (FACILITY NAME or DBA) 3 YRC, INC. (822) CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 PROPANE TANK RACK CONFIDENTIAL (EPCRA) Yes X No FACILITY ID # 1 MAP # (optional) 203 GRID # (optional) 204MSITEMAPE3/4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 206 LIQUIFIED PROPANE GAS TRADE SECRET Yes X No If subject to EPCRA, refer to Instructions COMMON NAME 207 EHS- C Yes X NoPROPANEzoe If EHS Is yes, all amounts below must be InCAS # 209 74-98-6 pounds. FIRE CODE HAZARD CLASSES (complete if requested by local fire chief) 210 TYPE 211 RADIOACTIVE: C Yes X No 212 CURIES 213 X PURE MIXTURE WASTE LARGEST CONTAINER 215 PHYSICAL STATE J SOLID U LIQUID X GAS 214 7.9 216 FED HAZARD CATEGORIES X FIRE REACTIVE X PRESSURE RELEASE X ACUTE HEALTH C CHRONIC HEALTH Check all that apply) ANNUAL WASTE 217 218 AVERAGE 219 STATE WASTE 220 AMOUNT DAILY AMOUNT 189.6 DAILY AMOUNT 47.4 CODE 221 DAYS ON SITE 222 UNITS X GAL D CU FT LBS TONS 365IfEHS, amount must be In lbs. STORAGE CONTAINER: 223 ABOVEGROUND TANK CAN BOX TANK WAGON UNDERGROUND TANK CARBOY X CYLINDER RAILCAR U TANK INSIDE BUILDING U SILO U GLASS BOTTLE U OTHER U STEEL DRUM U FIBER DRUM U PLASTIC BOTTLE U TOTE BIN PLASTIC /NONMETALLIC DRUM BAG STORAGE PRESSURE: N AMBIENT ABOVE AMBIENT BELOW AMBIENT 224 225 STORAGE TEMPERATURE:X AMBIENT ABOVE AMBIENT BELOW AMBIENT C CRYOGENIC WT HAZARDOUS COMPONENT EHS CAS # 1 100 226 LIQUIFIED PETROLEUM GAS 227 1 Yes X) No 228 74 98 -6 229 2 230 231 J Yes U NO 232 233 3 234 235 Yes NO 236 237 4 238 239 J Yes U No 240 241 5 242 243 Yes No 244 245 III. SIG R PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE A R DATES 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER 2.2'T -2 Z I 1 FD2144(Rev 08/07) UNDERGROUND STORAGE TANKS UNIFIED PROGRAM CONSOLIDATED FORMS APPLICATION UST FACILITY - (STATE FORM A) TYPEOF ACTION: (Check one itemonly) er 1. NEWSITE PERMIT d 2. INTERIM PERMIT H 8 1 D FIRS ARTN T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of2 X 3. RENEWAL PERMIT . 5. GRANGE OF INFORMATION (Specify change- .r 7. PERMANENTLY CLOSEDSITE c 4. AMENDED PERMIT local u only) 8. TANK REMOVED 400 B. TEMPORARY 8175 CLOSURE f,A --jLITY /SITE INFORMAT_ ION„ I BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID No YRC, INC.(822) 111TU1111FFF NEAREST CROSS STREET 401 FACI OWNER TYPErON .es 4. LOCAL AGENCY /DISTRICT' 6 2. INDIVIDUAL .e 5. COUNTY AGENCY' WOODMERE DRIVE es 3. PARTNERSHIP ,K 6. STATE AGENCY' AK 7. FEDERAL AGENCY' 402 BUSINESS TYPE z 1. GAS STATION _- 3. FARM 5. COMMERCIAL es 2. DISTRIBUTOR es4. PROCESSOR 4s 6. OTHER 40 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or If owner of UST a pudic agency: Give the REMAINING AT SITE 404 Trust lards? $ Yes X No 405 Name of supervisor ofdivision, section oroffice STEPHEN GUTI ERREZ 1 hlch operates the UST. (This is the contact person forthe tank records.) (Please print Contact person's name) 49 II. PROPERTY OWNER INFORMATION . w PROPERTY OWNER NAME 407 40 YRC, INC C/O YRC ENTERPRISE SERVICES, INC. 661)833 -1895 AILING OR STREET ADDRESS 409 10990 ROE AVENUE MS A605 CITY 410 41 OVERLAND PARK ISTATE KS 66211 PROPERTY OWNER TYPE eX1. CORPORATION d 2. INDIVIDUAL is 4. LOCAL AGENCY/ DISTRICT 6. STATE AGENCY es 3 . PARTNERSHIP n 5. COUNTY AGENCY d 7. FEDERAL AGENCY 413 IIIJANKiOWNER]NFORMATION:; TANK OWNER NAME 414 41 YRC, INC (822) 661)833 -1895 AILING OR STREET ADDRESS 416 10990 ROE AVENUE MS A605 CITY 417 STATE 4,8 ZIP CODE 41 OVERLAND PARK KS 66211 TANK OWNER TYPE IfA. CORPORATION .K 2. INDIVIDUAL 4. LOCAL AGENCY/ DISTRICT et 6. STATE AGENCY er 3. PARTNERSHIP n 5. COUNTY AGENCY es 7. FEDERAL AGENCY 420 IV`9BOARD OFE UALIZAT:ION FUST STORAGE FEE ':I rM'" TY (TK) HQ 4 1 4 Can (916) 322 -9669 If questions arise 421 V.PETROLEUM UST FINANCIAL RESPONSIBILITY XY4. SELF - INSURED es 5. LETTER OF CREDIT A5 9. STATE FUND & CD INDICATE METHOD(S) .e 2. GUARANTEE ,ds 6. EXEMPTION A5 10. LOCAL GOVT MECHANISM es 3. INSURANCE @5 7. STATE FUND AK 99. OTHER: es 4. SURETY BOND es 8. STATE FUND & CFO LETTER 422 VI LEGAL NOTI_FICATION AND MAILING ADDRESS "': ]a:' : "' " Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank ownerunless box 1 or2 is checked. .es 1. FACILITY A 2. PROPERTY OWNER .es 3. TANK OWNER 42 VII" APPLICANT :SIGNATURE Ce ,., : 1 certif thatthe Information, iovlded heielri'Ia tri,e and d urate'to the' best of my knowled 6 . - . _ 42IGNATUREOFAPPLICANT42442 2' Lq" Zol2, 913)344 -3615 NAME OF APPLICANT (print) 427 TITLE OF APPLICANT 42 STEVEN R. SHINN S ENVIRONMENTAL SERVICES MANAGER TATE UST FACILITY NUMBER (FO se ly) 429 1998 UPGRADE CERTIFICATE NUMBER (Forlocal use only) 43 FD 2093 (Ray.09l06) UNDERGROUND STORAGE TANKS BAKERSFIELD FIRE DEPT. UNIFIED PROGRAM CONSOLIDATED FORMS Prevention Services B B R S P I n 900 Truxtun Ave., Suite 21041R97 p aff Bakersfield, CA 93301 APPLICATION r Tel.: (661) 326 -3979 TANK - (STATE FORM B) Fax: (661) 852 -2171 Page 1 of 4 TYPE OF ACTION (Check oneitem only): 1. NEW SITE PERMIT d 4. AMENDED PERMIT d 2. INTERIM PERMIT (Specify reason - forlocal use only) Y& 3. RENEWAL PERMIT e 5. CHANGE OF INFORMATION 45 6. TEMPORARY SITE CLOSURE c 7. PERMANENTLY CLOSED ON SITE c 8. TANKREMOVED 430 BUSINESS NAME e as FACILITY NAME or np Busmes. o.: YRC, INC. (822) LOCATION WITHIN 54TE (Opbronal) 431 NORTHWEST OF TERMINAL DOCK, UNDER FUEL ISLAND I. TANK DESCRIPTION YAW 0 432 TANKMANUFACTURER 433 COMPARTMENTALIZED TANK rYesXNo 1 TDUSCO If'Yee ", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 43E NUMBER OF 43 5/89 12,000 N/A ADDITI ORAL DESCRIPTION (Forlocal use only) N/A II., TANK'CONTENTS TANK USE 439 PETROLEUM TYPE d 2. LEADED A5 99. OTHER 44 XX MOTOR VEHICLE FUEL i(ai{ 3. DIESEL Hmarked, complete Petroleum Type) 45 1 . REGULAR UNLEADED d 4. GASOHOL440 d 2. NON -FUEL PETROLEUM 1b. PREMIUM UNLEADED d 5. JET FUEL 45 3. CHEMICAL PRODUCT d 1c. MIDGRADE UNLEADED d 6. AVIATION FUEL L 4. HAZARDOUSWASTE (Includes UsedOil) d 5. UNKNOWN COMMON NAME (from Hazardous Materials Inventory page) 441 rcn Hazard- Materials Inventory papa DIESEL #2 68476 -34 -6 Ilf:'TANK CONSTRUCTION TYPE OF TANK d 1. SINGLE WALL 44 6 4. SINGLE WALL INAVAULT d 99. OTHERCheckoneitemonDOUBLEWALLd5. SINGLE WALLWITH INTERNAL BLADDER SYSTEM 3. SINGLEWALLWITHEXTERIOR MEMBRANE LINER d 95. UNKNOWN TANK MATERIAL - Primary tank XeXl. BARE STEEL d 4. STEELCLADW/FIBERGLASS 44 99. OTHERCheckoneitemonty) d2. STAINLESS STEEL REINFORCEDPLASTIC (FRP) L3. FIBERGLASS / PLASTIC d 5. CONCRETE d 6. FRP COMPATIBLE W /100% METHANOL d 95. UNKNOWN TANK MA.TERIALSeconderytank K10. COATED STEEL 44 d 1. BARE STEEL d 1. STEELCLADW /FIBERGLASSCheckoneitemonly) K2. STAINLESS STEEL 17E1NFORCEDR.ASTIC(FRP) s 95. UNKNOWN YX3. FIBERGLASS / PLASTIC d 5. CONCRETE d 99. OTHER AK6. FRPCOMPATIBLE W /100 % METHANOL d 9. FRPNON - CORRODIBLE JACKET TANK INTERIOR LINING 41 1. RUBBER LINES d 4. PHENOLIC LINING d 99. OTHERORCOATING Check one item only) a2. ALKYD LINING -1 5. GLASS UNING 44 X-N. EPDXY LINING K 6. UNUNED DATE INSTALLED d95 UNKNOWN (Forlocaluse only) 416 44OTHERCORROSION1. MANUFACTURED CATHODIC PROTECTION d 4. RMPRESSEDCURRENT PROTECTION IF APPLICABLE d2. SACRIFICIALANODE d 95. UNKNOWN ATE INSTALLED Check one item only) XhC3, FIBERGLASS REINFORCED PLASTIC K 99. OTHER Forlocaluse only) SPILL AND OVERFILL XX. SPILL CONTAINMENT YEAR INSTALLED 450 TYPE( localuseonly) 451,a.RFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 check en that apply) ,R2. DROP TUBE 1989 LEAK ALERT `'t ALARM 4: 3. STRIKER PLATE 4' 2. FILLTUBE SHUT OFF VALVE C4. EVR UPGRADE 13 . BALL FLOAT (LA-00PW 6/50 d4. EXEMPT IV. TA_ NK LEAK DETECTION SINGLEIFWALL T (Ch-k (Ch-kall atap O (Checkone item only): 4 d 1. VISUAL (EXPOSED PORTION ONLY) a 5. MANUAL TANK GAUGING (MTG) d 1. VISUAL (SINGLE WALL IN VAULT ONLY) d 2. AUTOMATIC TANKGAUGING (ATG) d 6. VADOSE ZONE XX 2. CONTINUOUS INTERSTITIAL MONITORING IK 3. CONTINUOUS ATG d 7. GROUNDWATER 6 3. MANUAL MONITORING d 4. STATISTICAL INVENTORYRECONCILIATION (SIR) t d 6. TANK TESTING BIENNIALTANKTESTING es 99. OTHER V, TANK' CLOSURE INFORMATI04 PERMANENT CLOSUIR 'IN.'PLACE ' ° +3 ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITYOFSUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 45 Ilona eyes aS No FD 2094 (Ray.09/05) UNDERGROUND STORAGE TANKS TANK (STATE FORM B) INSTRUCTIONS BAKERSFIELD FIRE DEPT. Prevention ServicesaY_N. i 900 Truxtun Ave., Ste. Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 2 of 4 Complete the UST -Tank pages for each tank for all new permits, permit changes, closures and /or any other tank information change. This page must be submitted within 30 days of permit or facility information changes, unless approval is required before making any changes. For compartmentalized tanks, each compartment is considered a separate tank and requires completion of separate tank pages. Refer to 23 CCR 32711 for state UST information and permit application requirements. Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CM Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER -Leave this blank. This number is assigned by the CUPA. This is the unique number which identifies your facility. 3. BUSINESS NAME -Enter the full legal name of the business. 430. TYPE OF ACTION -Check the reason the page is being completed. For amended permits and change of information, include a short statement to direct the inspector to the amendment or changed Information. 431. LOCATION WITHIN SITE -Enter the location of the tank within the site. 432. TANK ID NUMBER -Enter the owner(s) tank ID number. This is a unique number used to Identify the tank. It may be assigned by the owner or by the CUPA. 433. TANK MANUFACTURER -Enter the name of the company that manufactured the tank. 434. COMPARTMENTALIZED TANK -Check whether or not the tank is compartmentalized. Each compartment is considered a separate tank and requires the completion of separate tank pages. 435. DATE TANK INSTALLED -Enter the year and month the tank was installed. 436. TAW CAPACITY -Enter the tank capacity in gallons. 437. NUMBER OF TANK COMPARTMENTS -If the tank is compartmentalized, enter the number of compartments. 438. ADDITIONAL DESCRIPTION -Use this space for additional tank or location description. 439. TANK USE- Check the substance stored. If MOTOR VEHICLE FUEL, check box 1 and complete Rem 440, PETROLEUM TYPE. 440. PETROLEUM TYPE -If box 1 is checked in Rem 439, check the type of fuel. 441. COMMON NAME -For substances that are not motor vehicle fuels (box 1 is NOT checked in item 439), enter the common name of the substance stored in the tank. 442. CAS No. -For substances that are not motor vehicle fuels box I Is NOT checked in item 439), enter the CAS (Chemical Abstract Service) number. This is the same as the CAS No. In item 209 on the Hazardous Materials Inventory- Chemical Description page. 443. TYPE OF TANK -Check the type of tank construction. If type of tank is not listed, check other and enter type. 444. TAW MATERIAL (PRIMARY TANK) -Check the construction material of the tank that comes into immediate contact on its inner surface with the hazardous substance being contained. If the tank is lined do not re the lining material in this Rem. Indicate the type of lining material in item 446. If type of tank material is not fisted, check r other and enter material. 445. TANK MATERIAL (SECONDARY TANK) -Check the construction material of the tank that provides the level of containment external to, and separate from, the primary containment. If type of tank material is not listed, check other and enter material. 446. TANK INTERIOR LINING OR COATING -If applicable, check the construction material of the interior lining or coating of the tank. If type of Interior fining or coating is not listed, check other and enter type. 447. DATE TANK INTERIOR LINING INSTALLED -If applicable, enter the date the tank interior lining was installed. This is to assist the CUPA to develop an Inspection schedule. 448. OTHER TANK CORROSION PROTECTION -If applicable, check the other tank corrosion protection method used. If other corrosion protection method is not listed, check other and enter method. 449. DATE TANK CORROSION PROTECTION INSTALLED - If applicable, enter the date the tank corrosion protection method was installed. This is to assist the CUPA to develop an inspection schedule. 450. YEAR SPILL AND OVERFILL INSTALLED -Check the appropriate box and enter the year in which spill containment, drop tube, and /or striker plate was installed. CHECK ALL THAT APPLY. 451. TYPE OF SPILL PROTECTION -Enter the type of spill containment, drop tube, and /or striker plate. FOR CUPA USE ONLY. 452. YEAR OVERFILL PROTECTION EQUIPMENT INSTALLED -Check the appropriate box and enter the year in which overfill protection was installed or whether there is an exemption from overfill protection. CHECK ALL THAT APPLY, unless tank is exempt. 453. TANK LEAK DETECTION (SINGLE WALL) -For single walled tanks, check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ALL THAT APPLY. If leak detection system is not listed, check other and enter system. 454. TANK LEAK DETECTION (DOUBLE WALL) -For double walled tanks or tanks with bladder, check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ONE ITEM ONLY. 455. ESTIMATED DATE LAST USED -For closure in place, enter to date the tank was last used. 456. ESTIMATED QUANTITY OF SUBSTANCE REMAINING IN TANK -For closure in place, enter the estimated quantity of hazardous substance remaining in the tank (in gallons). 457. TANK FILLED WITH INERT MATERIAL -For closure in place, check whether or not the tank was filled with an inert material prior to closure. ATTACHMENTS 1. Provide a scaled plot plan with the location of the LIST system, including buildings and landmarks. 2. Provide a description of the monitoring program. UST -Tank Page 2 Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. FD 2094 (R- 09/06) UNDERGROUND STORAGE TANKS TANK — APPLICATION (CONT.D) (STATE FORM B) Page 3 of 4 FD 2094 (Rev. 09/05) VI.. PIPING CONSTRUCTION (Check all that apply) ABOVEGROUND PIPING INFORMATION UNDERGROUND PIPING INFORMATION SYSTEM TYPE G 1 SUCTION G 2 PRESSURE G 3 GRAVITY 459 G 1 SUCTION ACK2 PRESSURE G 3 GRAVITY 458 G 1 SINGLE WALL G 95 UNKNOWN G 1 SINGLE WALL G 3 LINEDTRENCH G 99 OTHER CONSTRUCTION G 2 DOUBLEWALL G 99 OTHER 462 YGXDOUBLEWALL G 95 UNKNOWN 460 MANUFACTURER 463 MANUFACTURER 461 MATERIALS G 1 BARE STEEL G 6 FRPCOMPATIBLE W/ 100% METHANOL G 1 BARE STEEL G 6 FRP COMPATIBLEW/ 100% METHANOL AND G 2 STAINLESS STEEL G 7 GALVANIZED STEEL G 2 STAINLESS STEEL G 7 GALVANIZED STEEL CORROSION G 3 PVCCOMPATIBLE WITH CONTENTS G 8 FLEXIBLE G 3 PVC COMPATIBLE WITH CONTENTS G8 FLEXIBLEPROTECTIONG4FIBERGLASSG9CATHODICPROTECTIONMFIBERGLASSG9CATHODIC G 5 STEELW/ COATING G 95 UNKNOWN G 5 STEEL W/ COATING G 95 UNKNOWN PROTECTION G99 OTHER 465 G99 OTHER 464 VII. PIPING LEAK DETECTION Check all that apply) ABOVEGROUND PIPING INFORMATION UNDERGROUND PIPING INFORMATION SINGLE I SINGLE WALLPIPING 467 466 PRESSURIZED PIPING (Check allthat apply): PRESSURIZEDPIPING (Check all thatapply): G 1 ELECTRONICLINE LEAK DETECTOR 3.0 GPH TESTWITH AUTO PUMP SHUT OFF FOR LEAK, GI ELECTRONIC LINE LEAD( DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE ANDVISUALALARMS SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUALALARMS G 2 G 2 MONTHLY 01 GPHTEST MONTHLY0.2 GPH TEST G J ANNUAL INTEGRITY TEST (0.1 GPH) G3 ANNUAL INTEGRITY TEST (0.1 GPH) G 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: (Checkall that apply): CONVENTIONAL SUCTIONSYSTEMS: (Check all that apply): G4 DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIALPIPING INTEGRITY TEST (0.1 GPH) G 5 DAILY VISUAL MONITORING OFPUMPING SYSTEM TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS: (Check all that apply) G 6 G5 SELF MONITORING SAFE SUCTION SYSTEMS: (Check all that apply) SELF MONITORING GRAVITYFLOW: (Check an thatapply): G 7 G 6 BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW : (Check all that apply): G 8 DAILY VISUALMONITORING SECONDARILY CONTAINED PIPING G9 BIENNIALINTEGRITY TEST (0.1 GPH) PRESSURIZED PIPING : Check all that apply) SECONDARILY CONTAINED PIPING G7 CONTINUOUS TURBINE SUMP SENSOR WITHAUDIBLE AND VISUAL ALARMS AND G a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS X)b AUTO PUMP SHUTOFFFOR LEAKS, SYSTEM FAILUREAND SYSTEM DISCONNECTIONPRESSURIZEDPIPING: (Check all that apply) G c NO AUTO PUMP SHUT OFF CONTINUOUS TURBINE SUMP SENSOR AU AUDIBLE AND VISUAL ALARMSAND (check one) G10 G e AUTO PUMP SHUT OFFWHEN A LEAK OCCURS G8 OMA71C LINE LEAK DETECTOR (3.0 GPH TEST) y' (jjb FLOW SHUT OFF OR RESTRICTION G b AUTO PUMP SHUT OFF FORLEAKS, SYSTEM FAILURE ANDSYSTEM DISCONNECTION XNNUAL INTEGRITY TEST (0.1 GPH) G9GcNOAUTOPUMPSHUTOFF G71 G12 AUTOMATIC LEAD( DETECTOR SUCTIOWGRAVITY SYSTEM: (Check all that apply) ANNUAL INTEGRITY TEST (0.1 GPH) CONTINUOUS SUMP SENSOR +AUDIBLEAND VISUALNAftMSG10 G13 SUCTION /GRAVITY SYSTEM: (Check all that apply) DISCONNECTION: (Check all thatapply) CONTINUOUS SUMP SENSOR + AUDIBLEAND VISUALALARMS G11 NO AUTO PUMP SHUT OFF EMERGENCY GENERATORS ONLY (Checkall that apply) G12 AUTOMATICLINE LEAK DETECTOR (3.0 GPH TEST) G14 ANNUAL INTEGRITYTEST (0.1 GPH) CONTINUOUS SUMP SENSOR bQ'jtjQ AUTO PUMP SHUT OFF +AUDIBLE AND G13 VISUALALARMS EMERGENCYGENERATORS ONLY (Check at that apply) G15 AUTOMATIC LINE LEAKDETECTOR (3.0 GPH TEST) G16 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLEAND VISUAL ANNUAL INTEGRITY TEST (0.1 GPH) G14 ALARMS G17 DAILY VISUAL CHECK AUTOMATICLINE LEN( DETECTOR (3.0 GPH TEST) G15 ANNUAL INTEGRITYTEST (0.1 GPH) G16 DAILY VISUAL CHECK G17 VIII: DISPENSER CONTAINMENT DISPENSER 468 G 1 FLOAT MECHANISM THAT SHUTSOFF SHEAR VALVE G4 DAJLY VISUALCHECK CONTAINMENT G 2 CONTINUOUS DISPENSER PAN SENSOR +AUDIBLEAND VISUAL ALARMS G 5 TRENCH LINER / MONITORING Yee G No XX3 CONTINUOUS DISPENSER PAN SENSORtM AUTO SHUT OFF FOR G6 NONE 469 DATE INSTALLED: DISPENSER + AUDIBLE AND VISUALALARMS IX.' OWNER/OPERATOR SIGNATURE ; J I certifythat the information p—ided herein Is true 6accurate to the beet of knowledge. SIGNATUREOF OWNERIOPERATOR 470 DATE 471 NAME OF OWNER/OPERATOR(print) 472 TITLE OFOWNER/OPERATOR 47J STEVEN R. SHINNERS ENVIRONMENTAL SERVICES MANAGER P.Mt Number (For local use only) 74 ermit Approved 475 PermitExpiration Date 476 FD 2094 (Rev. 09/05) HAZARDOUS MATERIAL MANAGEMENT PLAN 0 S R F APPLICATION prRe . SECTION DISCOVERY & NOTIFICATION ARTM f FORMS) INSTRUCTIONS 1. To avoid further action, return this form within 30 days of receipt. 2. Type /print answers in ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. BAKERSFIELD FIRE DEPARTMENT Prevention Services 1600 Truxtun Ave., Suite 401 Bakersfield, CA 93301 Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 Page 1 of 2 SECTION I: FACILITY IDENTIFICATION BUSINESS NAME (FACILITY NAME or DBA) YRC, INC. (822) ADDRESS (for local use only) 4901 LISA MARIE COURT FACILITY ID # 1 SECTION II.1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: THE MOTOR OIL AST IS VISUALLY EXAMINED FOR LEAKS. THE DIESEL FUEL UST IS EQUIPPED WITH AN AUTOMATIC MONITORING DEVICE. B. EMPLOYEE AND AGENCY NOTIFICATION: THE SUPERVISOR ON DUTY WILL NOTIFY THE EMERGENCY CONTACTS, THE FIRE DEPARTMENT, AND THE YRC CHEMICAL HELP LINE (800- 395 - 5446). C. ENVIRONMENTAL RESPONSE MANAGEMENT: IN THE EVENT OF A LARGE RELEASE, THE FACILITY WILL BE EVACUATED AND THE NOTIFICATION PROCEDURE WILL BE FOLLOWED. IF NECESSARY A HAZARDOUS MATERIALS CONTRACTOR WILL BE COORDINATED THROUGH THE YRC CHEMICAL HELP LINE TO CLEAN UP THE SPILL. SMALL SPILLS WILL BE CLEANED BY TRAINED PERSONNEL USING ABSORBANTS AND AN OVERPACK DRUM TO CONTAIN RECOVERED MATERIAL UNTIL PROPER DISPOSAL. D. EMERGENCY MEDICAL PLAN: IN THE EVENT A SERIOUS INJURY OCCURS AT THE TERMINAL, 911 WILL BE CALLED FOR EMERGENCY SERVICE RESPONSE. ALL OTHER PERSONNEL SUSTAINING INJURIES WILL BE TRANSPORTED TO MERCY SOUTHWEST HOSPITAL AT 300 OLD RIVER ROAD, STE 200, BAKERSFIELD, CA 93311. SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESMENT AND PREVENTION MEASURES: YRC INC SPILL PEVENTION PRACTICES INCLUDE MONTHLY PRESENTATIONS AT SAFETY MEETINGS AND ANNUAL FIRST RESPONDER TRAINING AND HAZARD COMMUNICATION TRAINING. THE UST HAS AN AUTOMATIC MONITORING DEVICE. B. RELEASE CONTAINMENT AND /OR MITIGATION: EMPLOYEES DO NOT RESPOND TO HAZARDOUS MATERIALS EMERGENCIES. EMPLOYEES ARE TRAINED TO EVACUATE DURIIN EMERGENCIES AND CONTACT CONTRACTORS TO PROVIDE EMERGENCY RESPONSE. CLEAN -UP SUPPLIES AND EQUIPMENT ARE USED ONLY FOR NON EMERGENCY RELEASES WHERE EMPLOYEE SAFETY CAN BE MAINTAINED. C. CLEAN -UP AND RECOVERY PROCEDURES: IN THE EVENT OF AN INCIDENTAL RELEASE, THE SOURCE IS IDENTIFIED AND CONTROLLED SO THAT THE SPIL IS STOPPED. SPILL CONTAINMENT EQUIPMENT IS USED TO CLEAN AND CONTAIN THE SPILL UNTIL PROPER DISPOSAL. IN AN EMERGENCY, A HAZARDOUS MATERIALS CONTRACTOR WILL BE USED TO CLEAN UP EMERGENCY SPILLS. FD2169 (Rev 08/07) Page 2 of 2 SECTION IL2:. RELEASE RESPONSE PLAN (kCONT) f UTILITY SHUT -OFFS (LOCATION OF SHUT -OFFS AT YOUR FACILITY) NATURAL GAS PROPANE: ON THE NORTHERN PORTION OF THE WEST SIDE OF THE FACILITY ELECTRICAL: ON THE NORTHERN PORTION OF THE EAST SIDE OF THE FACILITY WATER: ON THE NORTHERN PORTION OF THE WEST SIDE OF THE FACILITY SPECIAL: THE PUMP SHUTOFF AND GAS SHUTOFF FOR THE DIESEL FUEL UST IS LOCATED ON THE EAST SIDE OF THE FUEL ISLAND. LOCK BOX: YES GCNO IF YES, LOCATION: PRIVATE FIRE PROTECTION /WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: NONE B. WATER AVAILABILITY (FIRE HYDRANT): LOCATED ON THE NORTH SIDE OF THE FACILITY. SECTION' "III:_` "TRAINING ' NUMBER OF EMPLOYEES: 15 MATERIAL SAFETY DATA SHEETS ON FILE: D. YES NO IF YES, LOCATION: IN MANAGER'S OFFICE BRIEF SUMMARY OF TRAINING PROGRAM: SEE ATTACHED TRAINING PLAN PAGE. CERTIFICATION x. Based on my inquiry of those)qVividuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and a familia i t e information submitted and believe the information is true, accurate, and complete. SIGNATUR F OWN /O TO OR ATED REPRESENTATIVE DATE 477 2-Zo 2 NAME OF SIGNER ( RIN 478 TITLE OF SIGNER 479 STEVEN R. HINN S ENVIRONMENTAL SERVICES MANAGER FD2169 (Rev 08/07) City of Downey Business Application Package Describe the equipment and its capabilities. If applicable, specify any testing /maintenance procedurWintervals.. Attach additional pages, numbered appropriately, ifneeded. City of Downey Fire Department — Participating Agency 11111 Brookshire Ave. Downey, CA 90241 Section IC: CONSOLIDATED CONTINGENCY PLAN FORM Part I: BUSINESS PLAN and CONTINGENCY PLAN V- Nl P;,YE =TR_ AI:N1 V..G All facilities that handle hazardous materials:.must have a written employee training plan. An outline of a typical plan is provided below for you to cottlplete and submit. The items listed below are required per Health and Safety Code Section 25504 © and Title 19 Section 2732. Facility personnel are trained as follows: Training shall be provided: P Initially for all new employees. 10. Annually, including refresher courses, for all employees. Note: These training programs may take Into consideration the position of each employee. Additional training should include: 1. Internal alarm /notification procedures. 2. Evacuation /re -entry procedures and assembly point locations. D 3. Material Safety Data Sheet (MSDS) training including specific hazard(s) of each chemical to which employees may be exposed, including routes of exposure (i.e. inhalation, ingestion, absorption). V1. ' HAZARDOUS ]NASTEENERAT fRZ AWING 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 1. 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. 2. 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: 1. Job title for each position at the facility that is related to hazardous waste management, and the names of the employee(s) filling the osition s . 2. Description for each position listed above (must include required skill, education, or other qualifications, as well as duties of employees assigned to the position). 3. Description of type 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. 5. Current employees' training records to be retained until closure of the facility). 6.. Former employees' training records to be 'retained at least three years after termination of employment). City of Downey: Application Package is Last Updated: 6/2003 3cd1CUPAAppI'ack 1. Familiarity with all plans and procedures specified In the Contingency Plan. P. 2. Methods for safe handling of hazardous materials. 3. Safety procedures in the event of a release or threatened release of a hazardous material. 1111* 4. Use of emergency response equipment and supplies under the control of the business. 5. Procedures for coordination with local emergency response organizations. Training shall be provided: P Initially for all new employees. 10. Annually, including refresher courses, for all employees. Note: These training programs may take Into consideration the position of each employee. Additional training should include: 1. Internal alarm /notification procedures. 2. Evacuation /re -entry procedures and assembly point locations. D 3. Material Safety Data Sheet (MSDS) training including specific hazard(s) of each chemical to which employees may be exposed, including routes of exposure (i.e. inhalation, ingestion, absorption). V1. ' HAZARDOUS ]NASTEENERAT fRZ AWING 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 1. 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. 2. 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: 1. Job title for each position at the facility that is related to hazardous waste management, and the names of the employee(s) filling the osition s . 2. Description for each position listed above (must include required skill, education, or other qualifications, as well as duties of employees assigned to the position). 3. Description of type 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. 5. Current employees' training records to be retained until closure of the facility). 6.. Former employees' training records to be 'retained at least three years after termination of employment). City of Downey: Application Package is Last Updated: 6/2003 3cd1CUPAAppI'ack N REFERENCE TO NORTH INCLUDE ALL ADJACENT STREETS BY NAME DRIVEWAY /GATE DOORS ERE EMERGENCY RESPONSE EQUIPMENT EVACUATION ROUTE EIS EVACUATION /STAGING AREA p-p-o- FENCE /BARRIERS FIRE ALARM FIRST AID F FIRE HOSE F FIRE EXTINGUISHER FIRE HYDRANT FLOOR DRAIN ADDITIONAL SYMBOLS: Symbol Description MSDS MATERIAL SAFETY DATA SHEETS BEP & BUSINESS EMERGENCY PLAN RAILROAD TRACKS QS SEWER STORM DRAIN UTILITY 'CONNECTIONS/SHUTOFFS FE] ELECTRIC METER EO ELECTRIC SHUTOFF . GAS METER O GAS SHUTOFF PUMP-SHUTOFF OW WATER MAIN LINE GATE VALVE STORAGE TANKS O ABOVE GROUND TANK UNDERGROUND TANK Symbol Description FACILITY 'NAME: Date 2-12-2-1i Z + ADDRESS: FACILITY 'NAME: Date 2-12-2-1i Z + ADDRESS: 04, SITE MAP 2 3 4 5 8 1 I1 rl c I( 1 1 I D i I Ei IE i AL— I F DI SS FUEL FACiLaTY MAXI €: Vo C - Z-AIC. Date: 2 JZ 12 ADDRtSS: p E Lrs t 4 C b, 93313 k N4 Ll FACILITY MA.P Date: . 2-1 4-)-'2- FACILITY NAME; T R wrcl . . ADDRESS., 091 l r l d 3 4 6 A s i l K- J- j I i D I 1 t I f G I Date: . 2-1 4-)-'2- FACILITY NAME; T R wrcl . . ADDRESS., 091 l r l