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Home My WebLink AboutHAZ-BUSINESS PLAN 2/27/2012 (COPY)YRC Worldwide Inc. 10990 Roe Avenue Overland Park, KS 66211-1213 Phone 913 696 6100 yrcwcorn 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 1` The completed Hazardous Materials Business Plan including the Business Activities, Business Own/Operator 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 of toxic 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. Shinners@yrcw.com. Th you, St e . Sa Manager Enclosures cc: Antonio Mensurado, 822 Bakersfield Fire Department HAZARDOUS MATERIAL MANAGEMENT PLAN BUSINESS ACTIVITIES PAGE HAZARDOUS MATERIAL FACILITY INFORMATION) H R S F D FIRE,, ARr r BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue Bakersfield, CA 93301 Phone: 661-326-3979 Fax: 661-852-2171 FD2143 (Rev 01/08) I FACILITY IDENTIFICATION FACILITY ID # (for office use only) 3 EPA ID # BUSINESS NAME (FACILITY NAME or DBA) 103 YRC, INC. (822) II ACTIVITIES DECLARATIONr DOES Your Facility... If Yes, Please Complete... 129 A. HAZARDOUS MATERIAL XYes 0 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 required Dlannina 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) 0 Yes XNo 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 CalARP Program Elements C. UNDERGROUND STORAGE TANKS (USTI AYes 0 No UST FACILITY FORM 132 1. Own or operate Underground Storage Tanks? UST TANK FORM (one per tank) Yes (XNo UST FACILITY FORM 133 2. Intend to upgrade existing or Install new UST? UST TANK FORM (one per tank) UST INSTALLATION FORM (one per tank) D. TANK CLOSURE /REMOVAL 0 Yes ¢[No 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 0 Yes D[No UST TANK CLOSURE FORM was classified as hazardous waste and cleaned onsite? E. ABOVEGROUND PETROLEUM STORAGE TANKS 0 Yes §t No HAZARDOUS MATERIAL MANAGEMENT PLAN AST) Incorporating Federal Spill Prevention Control and Countermeasure 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? 0 Yes XNo To obtain EPA ID Number, please phone (916) 324 -1781 2. Recycle more than 100 kg /mo of recyclable 0 Yes XNo RECYCLING FORM material at the same location it was generated? 3. Recycle more than 100 kg /mo of recyclable 0 Yes X No RECYCLING FORM material at an off -site location different from the point of generation? 4. Treat Hazardous Waste on site? 0 Yes KNo TP FACILITY FORM TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requirements? 0 Yes :6 No CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a 0 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) HA?ARDOUS MATERIAL MANAGEMENT PLAN BAKERSFIELD FIRE DEPARTMENT APPLICATION B R I D Prevention Services BUSINESS OWNER OPERATOR IDENTIFICATION FORM FIRE Bake T field, Avenue, is` Floor ARTIY T Bakersfield, CA 93301 HAZARDOUS MATERIAL FACILITY INFORMATION) Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 Page 1 of 2 FD2142(Rev 01/08) I:, FACILITY.-IDENTIFICATION FACILITY ID it 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 gAK E-RS95L -D 104 ZIP CODE 93313 105 CA DUNN & BRADSTREET # 00-699-8397 106 SIC CODE 4213 107 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 OVERLAND PARK 114 STATE 115 KS 2IP CODE 116 66211 -1213 III: ENVIRONMENTAL CONTACT CONTACT NAME STEVEN R. SH INNERS 117- CONTACT PHONE" 913- 344 -3615 118 CONTACT MAILING ADDRESS 10990 ROE AVENUE MS A6 0 5 ATTN : ENV SERVICES 119 T 7 7 T CITY OVERLAND PARK 120 STATE 121 KS ZIP CODE 122 66211 -1213 IV. EMERGENCY CONTACTS PRIMARY SECONDARY NAMEANTONIO 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. 5 F MENT PRE R 1 VVV 136 DATE 134 NAME 2/22/2012 OF DOCUMENT PREPARER(PRINT) KRYSTAL TATNEY 135 NAME O OWN R/ PERATO SIGN & P ) 137 TITLE OF DOCUMENT PREPARER - 138 STE . S E S CONSULTANT FD2142(Rev 01/08) HAZARDOUS MATERIAL MANAGEMENT PLAN CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIAL INVENTORY NEW ADD DELETE X REVISE 200 arn, Ii U FIkE. JF OnARTNAqfT BAKERSFIELD FIRE DEPARTMENT Prevention Services 1600 Truxtun Ave., Suite 401 Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page I of 2 One form per material, per buildinq, or area.) UU FD2144 (Rev 08/07) li'FACILITY INFORMATION BUSINESS NAME (FACILITY NAME or DBA) 3 YRC, INC. (822) CHEMICAL LOCATION 2oi CHEMICAL LOCATION 202 INSIDE SHOP CONFIDENTIAL (EPCRA) :1 Yeses No FACILITY ID # MAP # (optional) 203 GRID # (optional) 204 SITE MAP F2 II CHEMICAL'INFORMATION ti 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 X No ANTIFREEZE 208 If EHS Is yes, all amounts below must be InCASIf209 pounds. 107-21-1 FIRE CODE HAZARD CLASSES (complete If requested by local fire chief) 210 TYPE 211 RADIOACTIVE: C Yes .X No 212 213 PURE 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 :3 CU FT LES TONS If 365EHS, amount must be In lbs. STORAGE CONTAINER: 223 ABOVEGROUND TANK CAN BOX TANK WAGON UNDERGROUND TANK CARBOY CYLINDER RAIL CAR U TANK INSIDE BUILDING U SILO U GLASS BOTTLE Ll- OTHER X STEEL DRUM U FIBER DRUM U PLASTIC BOTTLE U TOTE BIN PLASTIC/NONMETALLIC DRUM BAG 224 STORAGE PRESSURE: AMBIENT ABOVE AMBIENT 0 BELOW AMBIENT 225 STORAGE TEMPERATURE: X AMBIENT ABOVE AMBIENT BELOW AMBIENT E CRYOGENIC O/o WT HAZARDOUS COMPONENT EHS CAS # 1 95 226 ETHYLENE GLYCOL 227 Yes 10 NO 228 107-21-1 229 2 5 230 DIETHYLENE GLYCOL 231 J Yes X No 232 111-46-6 233 3 234 235 7 Yes No 236 237 4 238 239 J Yes U No 240 241 5 242 243 1 Yes No 244 245 III. SIGNATURE-v, PRINT NAME & TITLE OF AUTHORIZE . D COMPANY REPRESENTATIVE (.SIGNAfUftJF DATE 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER /t"%, 2- 0 1/ JJt111 UU FD2144 (Rev 08/07) HAZARDOUS MATERIAL MANAGEMENT PLAN CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIAL INVENTORY NEW ADD DELETE X REVISE 200 134H , ew D FIRE ARTAIAfir 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 bulldinq, or area.) j FD2144(Rev 08/07) I. FACILITY.INFORMATION BUSINESS NAME (FACILITY NAME or DBA) 3 YRC, INC. (822) CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 UNDER FUEL ISLAND CONFIDENTIAL (EPCRA) 7 Yes 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 n Yes X No If subject to EPCRA, refer to Instructions COMMON NAME 207 DIESEL FUEL EHS' C Yes Na zoa 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 211 212 RADIOACTIVE: C Yes No CURIES 213 PURE P MIXTURE WASTE LARGEST CONTAINER 215 PHYSICAL STATE J SOLID 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 11,500 218 AVERAGE DAILY AMOUNT 219 STATE WASTE 220 AMOUNT DAILY AMOUNT 500 CODE 221 DAYS ON SITE 222 UNITS X GAL CU FT LBS 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 PLASTIC /NONMETALLIC DRUM BAG STORAGE PRESSURE: 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 Distillatg27 Yes XI No 228 68814 -87 -9 229 2 0 -40 230 Light Catalytic Cracked Distillate 231 J Yes IN No 232 64741 -59 -9 233 3 0 -0.05 234 SULFUR 235 Yes KNO 236 7704 -34 -9 237 4 238 239 J Yes U No 240 241 5 242 243 Yes No 244 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE I A UR DATE 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER 2--2-'4- Z01 2 j FD2144(Rev 08/07) BAKERSFIELD FIRE DEPARTMENT Prevention Services HAZARDOUS MATERIAL MANAGEMENT PLAN a s p o 1600 Truxtun Ave., Suite 401 FIRE Bakersfield, CA 93301 CHEMICAL DESCRIPTION FORM A-R M T Phone: 661- 326 -3979 •Fax: 661- 852 -2171 HAZARDOUS MATERIAL INVENTORY T Page 1 of 2 NEW ADD DELETE X REVISE 200 (One form per material, per bulidinq, 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 i ,.; . r j .., -a. r,.m.;:.,. I, rt;K :': •- A'i.`m4?x`Jn `;'.w- ,. ., x. II CHEMICAL INFORMATION ` CHEMICAL NAME 205 206 SOLVENT REFINED PARAFFINIC PETROLEUM OIL TRADE SECRET n Yes X No If subject to EPCRA, refer to Instructlons COMMON NAME 207 EHS' C Yes X 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 fire chief) 210 TYPE 211 212 RADIOACTIVE: C Yes X No CURIES 213 PURE X MIXTURE WASTE LARGEST CONTAINER 215 PHYSICAL STATE J SOLID IX 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 2111 AVERAGE 219 STATE WASTE 220 AMOUNT 1 DAILY AMOUNT 110 DAILY AMOUNT 80 CODE 221 DAYS ON SITE 222 UNITS X GAL 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 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 224 STORAGE PRESSURE: 4 AMBIENT ABOVE AMBIENT BELOW AMBIENT 225 STORAGE TEMPERATURE:X AMBIENT ABOVE AMBIENT BELOW AMBIENT C CRYOGENIC WT HAZARDOUS COMPONENT EHS CAS # 1 99 226 REFINED PETROLEUM DISTALLATE 227 Yes M No 228 64742 -54 -7 229 2 1 230 ZINC COMPOUNDS 231 J Yes JX No 232 68649 -42 -3 233 3 234 235 Yes NO 236 237 4 238 239 J Yes U NO 240 241 5 242 243 Yes No 244 245 III. SIGNACTURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE I A DATE 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER oh4_' Iel'V 2 Z-q— Z FD2144(Rev 08/07) HAZARDOUS MATERIAL MANAGEMENT PLAN CHEMICAL DESCRIPTION FORM HAZARDOUS MATERIAL INVENTORY NEW ADD DELETE X REVISE 200 L3R8PI A FIRE . ARTY 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 buildinq, 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) 7 Yes X No FACILITY ID # 1 MAP # (optional) 203 GRID # (optional) 204 SITE MAP E3/4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 206 LIQUIFIED PROPANE GAS TRADE SECRET fl Yes X No Ifsubject to EPCRA, refer to Instructions COMMON NAME 207 PROPANE EHS" C Yes X No zoa 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 Yeskf No 212 CURIES 213 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 MAXIMUM 218 AVERAGE 219 STATE WASTE 220 AMOUNT DAILY AMOUNT 189.6 DAILY AMOUNT 47.4 CODE 221 DAYS ON SITE 222 UNITS X GAL J 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: AMBIENT 11 ABOVE AMBIENT BELOW AMBIENT 224 225 STORAGE TEMPERATURE:$ AMBIENT ABOVE AMBIENT BELOW AMBIENT C CRYOGENIC O /oWT HAZARDOUS COMPONENT EHS CAS # 1 100 226 LIQUIFIED PETROLEUM GAS 227 Yes %I NO 228 74 -98 -6 229 2 230 231 J Yes U No 232 233 3 234 235 Yes 0 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 DATE 246 STEVEN R. SHINNERS, ENVIRONMENTAL SERVICES MANAGER 2_ I ' FD2144(Rev 08/07) UNDERGROUND STORAGE TANKS UNIFIED PROGRAM CONSOLIDATED FORMS APPLICATION UST FACILITY - (STATE FORM A) TYPE OFACTION: (Check one Item only) d 1. NEWSITE PERMIT d 2. INTERIM PERMIT BAKERSFIELD FIRE DEPT. Prevention Services s r i n 900 Truxtun Ave., Ste. 210 FIRQ Bakersfield, CA 93301ARTMrTel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of2 X 3. RENEWAL PERMIT c 6. CHANGE OFINFORMATION (Specifychange- d 7. PERMANENTLYCLOSED SITE r 4. AMENDED PERMIT localuse only) r 8. TANK REMOVED 400 t 8. TEMPORARYSITECLOSURE I. FACILITY /SITE INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID No YRC, INC.(822) NEAREST CROSS STREET 4o1 ACII `TY OWNER TYPE Lk 1. CORPORATION As 4. LOCAL AGENCY /DISTRICT• s 2. INDIVIDUAL e 5. COUNTY AGENCY* WOODMERE DRIVE tt 3. PARTNERSHIP As 6. STATE AGENCY* es 7. FEDERAL AGENCY* 402 BUSINESS TYPE e 1. GAS STATION z 3. FARM lir 5. COMMERCIAL es 2. DISTRIBUTOR t4. PROCESSOR e B. OTHER 40 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or If owner of UST a public agency: Give the EMAINING AT SITE 04 Trusllands? KYes Ys- No 405 Name of supervisorof division, section or office STEPHEN GUTIERREZ 1 which operates the UST. (This is the contact person for the tank records.) (Please print Contact person's name) 40 IL PROPERTY OW_ N.ER INFORMATION PROPERTY OWNER NAME 407 40 YRC, INC CIO YRC ENTERPRISE SERVICES, INC. 661)833 -1895 MAILING OR STREET ADDRESS 409 10990 ROE AVENUE MS A605 CITY 410 411 41 OVERLAND PARK KS 66211 PROPERTY OWNER TYPE FX1. CORPORATION ff 2. INDIVIDUAL AT 4. LOCAL AGENCY/ DISTRICT d 6. STATE AGENCY AT 3 . PARTNERSHIP AT 5. COUNTY AGENCY t 7. FEDERAL AGENCY 413 III. TANK OWNER INFORMATION TANK OWNER NAME 414 PHONE 41 YRC, INC (822) 1 661)833 -1895 AILING OR STREET ADDRESS 416 10990 ROE AVENUE MS A605 CITY 417 4181 ZIP CODE 41 OVERLAND PARK rTATE KS 66211 TANK OWNER TYPE . CORPORATION es 2. INDIVIDUAL Ar 4. LOCAL AGENCY/ DISTRICT it 6. STATE A ENCY es 3. PARTNERSHIP d 5. COUNTY AGENCY d 7. FEDERAL AGENCY 420 IV. BOARD OF. EQUALIZATION UST STORAGE FEE rY (TK) HQ 4 4 Can (916) 322 -9669 if questions arise 421 V. PETROLEUM UST FINANCIAL RESPONSIBILITY XrN. SELF - INSURED a 5. LETTER OF CREDIT es 9. STATE FUND & CD INDICATE METHOD(S) et 2. GUARANTEE As 6. EXEMPTION e 10. LOCAL GOVT MECHANISM es 3. INSURANCE a 7. STATE FUND r 99. OTHER: es 4. SURETY BOND AT 8. STATE FUND & CFO LETTER 4 VI. LEGAL NOTIFICATION AND MAILING.ADDRESS 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 owner unless box 1 or 2 Is checked. d 1. FACILITY Z 2. PROPERTY OWNER d 3. TANK OWNER 42 VII. APPLICANT SIGNATURE Ce ficati : I certify thatthe Informetlon .rovided hereln Is true end accurate to the best of m knowledge. SIGNATURE OF APPLICANT 424 4z 42 Ali A Z,2 913)344 -3615 NAME OF APPLICANT (print) V 427 TITLE OF APPLICANT 42 STEVEN R. SHINN S ENVIRONMENTAL SERVICES MANAGER STATE UST FACILITY NUMBER (Fo se ly) 429 1998 UPGRADE CERTIFICATE NUMBER (Forlocal use only) 43 FD 2093 (Rer. 09105) UNDERGROUND STORAGE TANKS BAKERSFIELD FIRE DEPT. UNIFIED PROGRAM CONSOLIDATED FORMS Prevention Services YRC, INC. (822) 1'. I7'3CIUT.YIq.N..,] BAs n 900 Truxtun Ave., Suite 210 APPLICATION I RQ Au r Bakersfield, CA 93301 TANK - (STATE FORM B) T Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of 4 TYPE OFACTION (Check one item only): d 1. NEW SITE PERMIT d 4. AMENDED PERMIT d I INTERIM PERMIT (Specify reason - forlocal use on1A Y& 3. RENEWAL PERMIT d 5. CHANGE OF INFORMATION d 8. TEMPORARY SITE CLOSURE d 7. PERMANENTLYCLOSED ON SITE Ad 8. TANK REMOVED 430 5USINFSP3 NAME (Sameas FACILITYNAME or D g Ms... AS) 3 YRC, INC. (822) 1'. I7'3CIUT.YIq.N..,] LOCATION llsl SITE nag 431 NORTHWEST OF TERMINAL DOCK, UNDER FUEL ISLAND J., TANK DESCRIPTION r 0 4 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK Yee XlJo 1 TDUS CO If'Yaa', complete onepageforeach compeflment DATE INSTALLED 0 AWMO) 435 5/89 12,000 N/A ADDITI ONAL DESCRIPTION (Forbcaluseonly) N/A f TA N1 K CONTENTS. ; TANK USE 43S PETROLEUM TYPE d 2. LEADED AT 99. OTHER 44 XXMOTOR VEHICLE FUEL XX 3. DIESEL Ifmarked, complete PetroleumType) d 1e. REGULAR UNLEADED d 4. GASOHOL440 A5 2. NON -FUELPETROLEUM tf 1b. PREMIUM UNLEADED d 5. JET FUEL AT 3. CHEMICALPRODUCT d 1c. MIDGRADE UNLEADED d 6. AVIATION FUEL AT 4. HAZARDOUSWASTE (Includes Used 011) d 5. UNKNOWN COMMON NAME (from Hazardous Materials Inventorypage) 441 Hazardous na a van Pepe DIESEL #2 68476 -34 -6 Illi TANK CONSTRUCTION; 44• TYPEOF TANK d 1. SINGLE WALL d 4. SINGLEWALLIN A VAULT d B9. OTHER Checkone itemDoty) 7FX DOUBLEWALL d 5. SINGLE WALLWITH INTERNAL BLADDER SYSTEM d 3. SINGLE WALLWITH EXTERIOR MEMBRANE LINER d 95. UNKNOWN TANK MATERIAL -P 44AmerysnkXtXt. BARE STEEL d 4. STEEL CLADW /FIBERGLASS d 99. OTHERCheckoneitemw1y) AT 2. STAINLESS STEEL RENFORCEDPLPSTIC(FRP) d 3. FIBERGLASS IPLASTIC .95. CONCRETE d 8. FRP COMPATIBLEW /100% METHANOL d 95. UNKNOWN TANK MATERIAL-Secondary tank 44 d 1. BARE STEEL d 4. STEEL CLAD d 10. COATED STEELCheckoneitemonly) PLASTICd2STAINLESSSTEELRENFORC ®RA4T1C (FRP) d 95. UNKNOWN YX 3. FIBERGLASS IPLASTIC 66. CONCRETE d 99. OTHER d6. FRPCOMPATIBLE W /100%METHANOL d9. FRP NOWCORRODIBLE JACKET TANK INTERIOR LINING d 1. RUBBER LINES 94. PHENOLIC LINING d 99. OTHER 44 ORCOATING Checkone item only) d2. ALKYD LINING d5. GLASS LINING 44T {i. EPDXY LINING d6. UNLINED DATE INSTALLED d95 UNKNOWN (Forlocaluse only) 448 44OTHERCORROSIONK1. MANUFACTURED CATHODIC PROTECTION d4. PIMPRESSED CURRENT PROTECTION IFAPPLICABLE d2. SACRIFICIALANODE 695 . UNKNOWN kE INSTALLED Checkone Mem Doty) X& FIBERGLASS REINFORCEDPLASTIC d99. OTHER localuse only) SPILL AND OVERFILL Z_ SPILL CONTAINMENT YEAR INSTALLED 450 TYPE (for localuse only) 451_Qy RFILL PROTECTIONEQUIPMENT EAR INSTALLED 45 Checkelthat apply) d 2 DROP TUBE 1989 LEAK ALERT ALARM d 3. STRIKER PLATE d2. FILLTUBE SHUT OFF VALVE d 4. EVR UPGRADE d 3. BALL FLOAT 64. EXEMPT IV:.:: -A--k% , K <'DETECTIQN' IF SINGLE (Check 'I/ atap ): 453 DO (Check werfam only): d 1. VISUAL (EXPOSED PORTION ONLY) d S. MANUAL TANK GAUGING (MTG) d 1. VISUAL (SINGLEWALL INVAULT ONLY) d 2. AUTOMATIC TANK GAUGING (ATG) d 6. VADOSE ZONE XX 2. CONTINUOUS INTERSTITIAL MONITORING AT 3. CONTINUOUS ATG AT 7. GROUNDWATER AS 3. MANUAL MONITORING d 4. STATISTICAL INVENTORY RECONCILIATION (SIR)- At 8. TANKTESTING BIENNIAL TANKTESTING AT 99. OTHER VI TANK?' CLOSURE' INF ,QRMATION: / PERMANENT:CLO.SUR_E IN PLACE, ESTIMATED DATE LAST USED (YRIMO/DAY) 455 ESTIMATED QUANTITYOFSUBSTANCE REMAINING 458 TANKFILLED WITH INERT MATERIAL? 4 gallons Y- d No FD 2094 (Ray.09105) UNDERGROUND STORAGE TANKS TANK (STATE FORM B) INSTRUCTIONS BAKERSFIELD FIRE DEPT. Prevention Services B MW 8 R 9 P 1 D 900 Truxtun Ave., Ste. 210 FIRS . Bakersfield, CA 93301 A T 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 (Rev.09106) UNDERGROUND STORAGE TANKS TANK — APPLICATION (CONT.D) (STATE FORM B) Page 3 of 4 d VI.: PIPING CONSTRUCTION . Check all that apply) ABOVEGROUND PIPING INFORMATION UNDERGROUND PIPING INFORMATION SYSTEM TYPE G 1 SUCTION G2 PRESSURE G 3GRAVITY 459 G 1 SUCTION Al2 PRESSURE G3 GRAVITY 458 G 1 SINGLE WALL G 95 UNKNOWN G i SINGLEWALL G 3 LINED TRENCH G99OTHER CONSTRUCTION G 2 DOUBLE WALL G 99 OTHER 462 XIEDOUBLE WALL G95 UNKNOWN 460 MANUFACTURER 463 MANUFACTURER 461 TE 3 G 1 BARE STEEL G 6 FRP COMPATIBLE WI 100% METHANOL G 1 BARE STEEL G 6 FRP COMPATIBLE WI 10D% METHANOL AND G2 STAINLESSSTEEL G 7 GALVANIZEDSTEEL G 2 STAINLESS STEEL G 7 GALVANIZED STEEL CORROSION G 3 PVC COMPATIBLE WITHCONTENTS G 5FLEXIBLE G 3PVC COMPATIBLEWITH CONTENTS G8 FLEXIBLEPROTECTIONG4FIBERGLASSG9CATHODICPROTECTIONYrXFIBERGLASSG9CATHODIC G5 STEELWl COATING G 95 UNKNOWN G 5STEEL W/ COATING G 95 UNKNOWN PROTECTION G 99 OTHER 465 G 99 OTHER 464 VII: PIPING LEAK DETECTION Check all that a ' "Iyj ABOVEGROUND PIPING INFORMATION UNDERGROUND PIPING INFORMATION SINGLEWALL PIPING SINGLE WALL PIPING 467 466 PRESSURIZEDPIPING (Chock allthat apply): PRESSURIZED PIPING (Checkallthat apply): G 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPHTEST An AUTO PUMP SHUT OFF FOR LEAK, G 1 ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TESTWLWAUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLEAND VISUALALARMS SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUALALARMS G 2 MONTHLY0.2 GPH TEST G 2 MONTHLY02GPH TEST G 3 ANNUAL INTEGRITY TEST (0.1 GPH) G3 ANNUALINTEGRITYTEST (0.1 GPH) G 4 DAILY VISUALCHECK CONVENTIONAL SUCTION SYSTEMS: (Check all thatapply): CONVENTIONAL SUCTION SYSTEMS: (Check all that apply): G4 DAILYVISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) G 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM TRIENNIAL INTEGRITYTEST (0.1 GPH) SAFESUCTION SYSTEMS: (Check a9 thatapply) G 6 G5 SELF MONITORING SAFE SUCTION SYSTEMS: (Check e9 that apply) SELF MONITORING GRAVITY FLOW: (Check all that apply): G 7 GB BIENNIALINTEGRITY TEST (0.1 GPH) GRAVITY FLOW : (Cheek ell that apply): GB DAILY VISUALMONITORING SECONDARILYCONTAINED PIPING G9 BIENNIAL INTEGRITYTEST (0.1 GPH) PRESSURIZED PIPING : (Checkel thatapply) SECONDARILY CONTAINED PIPING G7 CONTINUOUS TURBINE SUMP SENSOR MWAUDIBLEAND VISUALALARMSAND G e AUTO PUMP SHUT OFFWHENA LEAKOCCURS PRESSURIZED PIPING: (Checkellthat apply) XX AUTO PUMP SHUT OFF FORLEAKS, SYSTEM FAILUREAND SYSTEM DISCONNECTION G c NOAUTO PUMP SHUT OFF CONTINUOUS TURBINE SUMP SENSORyiMAUDIBLE AND VISUALALARMSAND (check one) G10 G e AUTO PUMP SHUT OFF WHEN A LEAKOCCURS G8 XXJTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) A= FLOW SHUT OFF OR RESTRICTION G b AUTO PUMPSHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION G9 XNNUAL INTEGRITYTEST (0.1 GPH) G71 G c NOAUTO PUMP SHUT OFF G12 AUTOMATIC LEAKDETECTOR SUCTIONlGRAVITYSYSTEM: (Check all thatapply) ANNUAL INTEGRITYTEST (0.1 GPH) CONTINUOUS SUMP SENSOR +AUDIBLEAND VISUALALARMSG70 G13 SUCTION /GRAVITY SYSTEM: (Check allthat eppty) DISCONNECTION: (Check all thatapply) CONTINUOUS SUMP SENSOR +AUDIBLEAND VISUAL ALARMS NOAUTO PUMP SHUT OFF EMERGENCY GENERATORS ONLY (Check a9 that apply) G12 AUTOMATICLINELEAK DETECTOR (3.0 GPH TEST) G74 ANNUAL INTEGRITYTEST (0.1 GPH) - - CONTINUOUS SUMP SENSOR WITHOUTAUTO PUMP SHUT OFF +AUDIBLEAND G73 VISUALALARMS EMERGENCYGENERATORSONLY (Check allthat apply) G15 G16 AUTOMATIC LINE LEAKDETECTOR (3.0 GPH TEST) CONTINUOUS SUMPSENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLEAND VISUAL ANNUAL INTEGRITY TEST (0.1 GPH) G14 ALARMS G17 DAILY VISUAL CHECK AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) G15 ANNUAL INTEGRITYTEST (0.1 GPH) G16 DAILY VISUAL CHECK G17 VIII. DISPENSER CONTAINMENT DISPENSER 66 G 1 FLOAT MECHANISM THAT SHUTS OFF SHEARVALVE G4 DAILYVISUAL CHECK CONTANMENT G2 CONTINUOUS DISPENSER PAN SENSOR -AUDIBLEAND VISUALALARMS G 5 TRENCH LINER I MONITORING Yea G No X{3 CONTINUOUSDISPENSER PAN SENSOR noAUTO SHUT OFF FOR G 6 NONE 469 DATE INSTALLED: DISPENSER + AUDIBLEAND VISUALALARMS IX. OWNER/OPERATOR SIGNATURE 1 certifythat the Information provided herein le true & accurate to the beat of knawled9e. SIGNATUREOF OWNERIOPERATOR 470 DATE 471 2-Zi'- ZOO 2 NAME OF OWNER/OPERATOR (pdnt) 472 TITLEOFOWNERIOPERATOR 473 STEVEN R. SHINNERS ENVIRONMENTAL SERVICES MANAGER Perrdt Number (For local me only) % / V74 I YermltApprwed 475 1 Permit Fxpire8on Date 476 FD 2094 (Rev. 09/05) HAZARDOUS MATERIAL MANAGEMENT PLAN B P D APPLICATION PIRe. SECTION DISCOVERY & NOTIFICATION *ARrm T 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 Two SECTI _ NI FACYIDENTIFICAT, ION' BUSINESS NAME (FACILITY NAME or DBA) YRC, INC. (822) ADDRESS (for local use only) 4901 LISA MARIE COURT FACILITY ID # 1 SEC_TI_ON'II -1 DISCOVERY AND. NOTIFICATIONS' e. A., .. 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. u ' SECTION,III 2 RELEASE,RESPONSEPLAN 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 DURIIT 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' II'.2 RELEASE RESPONSE PLANT (CONY,) r UTILITY SHUT -OFFS (LOCATION OF SHUT -OFFS AT YOUR FACILITY) NATURAL A • 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 MNO 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 TI _ ,:IN NO NUMBER OF EMPLOYEES: 15 MATERIAL SAFETY DATA SHEETS ON FILE: (Z YES ONO IF YES, LOCATION: IN MANAGER'S OFFICE BRIEF SUMMARY OF TRAINING PROGRAM: SEE ATTACHED TRAINING PLAN PAGE. C E RTrIFI C A Based on my inquiry of those ividuals 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 OF OWN O TO OR SI ATED REPRESENTATIVE DATE 477 2-Z '4 -7,0 1 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 app /!cable, specify any tesling/maintenance proceduresfintervals.. Attach additionalpages, numbered eopropdateiv. Uneeded. City of Downey Fire Department — Participating Agency 111 11 Brookshire Ave. Downey, CA 90241 Section IC: CONSOLIDATED CONTINGENCY PLAN FORM Part I: BUSINESS PLAN and CONTINGENCY PLAN 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 complete and submit. The items listed below are required per Health and Safety Code'Section 25504 C and Title 19 Section 2732. Facility personnel are trained as follows: Training shall be provided: 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 chemlcal to which employees may be exposed, including routes of exposure (i.e. inhalation, ingestion, absorptlon). Vf zr: ' HZA2DOUS' :111Ti4STE._;GiVERATd RTRAIIy1N 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 fQr 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 Fetalned at least three years after termination of employment). - City of Downey: Application Package 18 Last Updated: 6/2003 3cd/CUPAAppPack 1. Familiarity with all plans and procedures specIfied In the Contingency Plan. 2. Methods for safe handling of hazardous materials. 3. Safety procedures in the event of a release or threatened release of a hazardous material. P 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: 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 chemlcal to which employees may be exposed, including routes of exposure (i.e. inhalation, ingestion, absorptlon). Vf zr: ' HZA2DOUS' :111Ti4STE._;GiVERATd RTRAIIy1N 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 fQr 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 Fetalned at least three years after termination of employment). - City of Downey: Application Package 18 Last Updated: 6/2003 3cd/CUPAAppPack N REFERENCE TO NORTH INCLUDE ALL ADJACENT STREETS BY NAME DRIVEWAYIGATE e DOORS ERE EMERGENCY RESPONSE EQUIPMENT EVACUATION ROUTE EIS ADDITIONAL SYMBOLS: Symbol Date 2— i Description. MSDS EVACUATION/STAGING AREA p-p- FENCEIBARRIERS FIRE ALARM FIRST AID Q FIRE HOSE F FIRE EXTINGUISHER FIRE HYDRANT FLOOR DRAIN ADDITIONAL SYMBOLS: Symbol Date 2— i Description. MSDS MATERIAL SAFETY DATA SHEETS BEP BUSINESS EMERGENCY PLAN RAILROAD TRACKS QS SEWER STORM DRAIN UTILITI!'CONNECTIONSISHUTOFFS EI ELECTRIC METER ELECTRIC SHUTOFF GAS METER OG GAS SHUTOFF PUMP-SHUTOFF O WATER MAIN LINE GATE VALVE STORAGE TANKS O ABOVE GROUND TANK UNDERGROUND TANK Symbol' Description FACILITY 'NAME: L ADDRESS: 14, 11, I SITE MAP Data: 2-12-211 ADi7R 55: z11 ,01 Lise 4;7?.je i M 9331,E l 1 2 a I 4 5 RA 1 J3 J D f E Wit h. I °. FL DTESE FUEL G i I Data: 2-12-211 ADi7R 55: z11 ,01 Lise 4;7?.je i M 9331,E l FACT M MAP j FACILITY NAME: Dafe: 1 ADDRESS; ON 41mr i I • B V Y I rte- _._.- ._r..r- .ur- •r_._._ t w_r W_r D I j FACILITY NAME: Dafe: 1 ADDRESS; ON 41mr