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Home My WebLink About4400 COFFEE ROAD (2)HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION FORM br Use by Unidocs Member Agencies or where approved byyour Local Jurisdiction Authority Cited: Health andSafety Code §25503.3(c); 19 CCR §2729.5(c) To: Agency Name: Bakersfield Fire Department, Fire Prevention Services Agency Mailing Address: 1600 TRUXTUN AVENUE Bakersfield, CA 93301 Pursuant to Section 25503.3(c) of California Health and Safety Code (HSC), the Hazardous Materials Business Plan (HMBP) certification described below is hereby submitted for the following facility: Facility Name: CVS Pharmacy # 9975 Facility Street Address: 4400 COFFEE RD Date of Current HMBP: 03/01/2011 I certify that: (Check the appropriate box.) City: Bakersfield I have personally reviewed the Hazardous Materials Business Plan currently on file with your agency and certify that the HMBP is complete and accurate. (See bottom ofpage for details.) If this facility is subject to Federal Emergency Planning and Community Right to Know Act (EPCRA) reporting requirements, I have submitted the following documents with this Certification Form: Unified Program Consolidated Form UPCF) Business Activities page; UPCF Business Owner /Operator Identification page with current signature and date; Hazardous Materials Inventory Statement page(s) with an original signature, photocopy of an original signature, or signature stamp on each page for all Extremely Hazardous Substances (EHS) handled at or above their Federal Threshold Planning Quantity (TPQ) or 500 pounds, whichever is less, or 0 Revisions to the Hazardous Materials Business Plan are necessary. The HMBP as revised is complete and accurate and is being implemented. A copy of the revisions has been electronically submitted or is enclosed with this Certification along with a signed UPCF Business Owner /Operator Identification page and UPCF Business Activities page if the HMBP revision include changes to the Hazardous Materials Inventory Statement. OWNER/OPERATOR CERTIFICATION: I hereby certify under penalty of law that, based upon my inquiry of those individuals responsible for obtaining the information reported above, I believe that the submitted information is true, accurate, and complete. I understand that a revised HMBP must be submitted within 30 days of any change in this facility's storage or handling of hazardous materials that would require updating of the IIMBP. Name of Owner /Operator(Print): " cr-Wnba"'"' Agent forLonaorua Stores ceinomla ,LLc. Title: Regulatory Compliance Specialist, 3E Company Phone: (760) 602 -8700 Signature, Date: 01/11/2012 By checking the upper box on this form, you are certifying that: The information contained in the HMBP most recently submitted is complete, accurate, and up -to -date; and There has been no change in the quantity of any hazardous material as reported in the most recently submitted Hazardous Materials Inventory forms; and The facility has not begun handling any hazardous material in a HMBP reportable quantity that is not currently listed in the Hazardous Materials Inventory; and The most recently submitted HNIBP contains the information required by Section 11022 of Title 42 of the United States Code; and There have been no substantial changes in the facility's operations that would require revision of the current HMBP. UN -039 - 1/1 www.unidoes.org Rev. 10/09/07 Facility Information Business Activities: CERS Business file: / //H:fbwilbanks/ Regulatory / CVS /HMBP /2012Bak isfield/124853.h(m k Canfornla Environmental Reporting System: Business ?PCon R s'!atoly pnpa[miant :Arms^* $AQiat IMIS R=Cds Help am 9ttb11tltJtslt F41:1011ltles Cou+110— 1bf Buskileea LONGS DRUG STORE 417: Business Activities Home » Facility (10024312) )) Fact* Information: Business ActitiiYes We lidsform to Identify the acthfties occlrirg atyour facility that are regulated under CaGforrda's Lkified Hazardous Wasteand Hazardous Materials Management Regulatory Program CERS will prods guidance on completing the reporting require ems for base business acd4fles. Submittal Guidance l AS (1) 10 RaWked (o) I A, Waning (1) I a Adyaay (0) I i' Wenroa*Jw- * r= mo llore:.ue. mat probaWy .ppytoyou hm m nor repbedtorsdw bdom UbrWhV theFaoaity rnram.flM VubmIlral .I.me+t. The Faulty Namehas dY rged. fromLONGS DRUG STORE 417 to CVS Pharmacy ft9975. Caneei Site identlflcatlo FaWityNerthet .L;_-',-':rf';'f:?C 'i..V`,.l!°.A CVS Phamwcy # 9975 iJ L,.. ;r,,,.+a"s, 7; BurineaaShaAddr A' '! F x :Mras 4400CCFFEE PD BAKERSFIEW. CA93308 {'.`i7T,..tr yyCOUiCemEJ'niC i N f P. CERS ID i3t10024312 t? #g1 aterdous -Mate Does yourfacify has on site (for any purpose) at any one lime, hazardous materials at or above1 gaAonsfar liquids, 500 pounds for solids, or 20Dcutdcfeet for compressed gases (Include liquids In ASTs and 115Ta); x the Ifyes. CERS WE prompt you to c-plawappicadaFederalthresholdquantityforanextremelyhazardoussubstancespedfiadh140CFRPart355, Append'oc Yes A or B; orhandle rardobgical melerisls in quantifies for which an emergency plan is required pursuant to 10 CFR additionalfomreldocurentation. Pmts 30, 40 or 707!1 Jnde,Mround-Petroteum -S+ore If yes, CERS WIPrompt you to complete Does you facility ovn or operate underground storage tanks? 1;, No additional formsldocunenfetion. nazaragua-vvas - Does your Fac' Is youfacility a Hazardous Waste Generator'lw' Yes If yes, pro4de an EPA ID Number. CALDDD356793 Doesyour facliy recycle more than 100 kg/mordn oftoduded orexampled recyclable materials (per HSC I #' No Ifyea, CERS will prompt you to amplete 25143.2)74t II addilonalforn-Wdocu eraabon. Does you fadiy gnat hazardouswaste on -sile7 4 No Ifyes, CERS will promptyou te complete eddltional forms/documanlason. Is your facility's treatment sub)sOto financial assurance requinsu.. (for Permit by Rule and Conditional I No 11fyes, CERS will prompt you to complete Authorization)? iP i Il additional formsIdoarnentedon. Does you facility consoidate haazadouswaste generated at a remote site? iY ter No If yes, CERS WE promptyou to complete addiQanelfomn.WdocurenfaQon. Does you facility need to report the cbaue/rerto%al of a tank that was classffed as hazardous waste and cleaned No If yes. CERS wepromptyou W complete on -site? 4 I additional forms/docwremBlon. Does your fadiy generate In arty single calendar morM 1,000 Idlograna (kg) (2.200 pounds) or mom offederal Ifyes, obtain afederal EPA ID Mme, RCRA Iomdcuswaste, or generatein arty single calendar mini h, or eccu uiate atany Ome, 1 kg (2.2 pounds) of No file Biennial Report (EPA Form RCRA acute hazardous waste; or generate or aomm late atany time mme Ohms 10D kg (220 Ponds) of spill cleanup 8700.13XB), and satisfy requirements for materials contaminated with RCRA acute hazardous waste. ; RCRA large Quantity Generator. Isyour facility a Household HazardousWaste (H" Collection site ?4 I R;' No l If yes, see CLPAfor required fame. h i 1 oft 1/11/2012 7:06 AM FacilityInformation Business Activities: CERS Business file: / //H- /bwilbanks/ Regulatory/ CVS/ HMBP /2012/Bakersfield/124853.btm E Aboveground Petroleum Storage Doesyour faclity a-An or operate ASTe abrne ftleae rtrasholds? Store greatertram 1,320 gallons of Pave= If yes, coordfnata utih your local agency products (newor used) In ebvAvvund tanks or containers. it '. No Storage Ac Abo)epround Petroleum StoragePct (APSA) compliance. Regulated Substance Does your facility have Regulated Suhsiances stored onste in quantifies greaterthan Ole threshold quantities f. No if yes. coordinate Wth your local agency established by the California Accidental Release prevention Program (CWARP)z t responsible for Cat4RP. Additional 1nformatlon Provide arty additional information as necessary andfor requhed by your local regulators} V C—lad at•, 1ECompany Regulatory Department on 3n T201010:59 AM Vrt Updated By3ECompany Regulatory Department on 1x10201210:05AM Version 2.00.DDDB I EMancenents I CERS central Diagnostics I Ccndnons of use I Priyacy Policy I CorAad I HNP California Environmental Reporting System: Busiress 102012 California Environments! ProtectionAgency CERS TedricalAssfstace:leoe.caaw Lkff ed ftgramGenerel Assistance: Canted your local rernlatorlsl CERS Help CEPS Help 'ib Settings Settings My Business: LONGS DRUG STORE 417 jASelect Business i 2 of 1/11/2012 7:06 AM Facility Information Business Owner /Operator Notification: CERS Bus... https : / /cersbusiness.calepa,ca.gov/ 28753 / Facility/]0024312 /Submittal... California Environmental Reporting System: Business . Co oap ! RgulatDry DeoartmenCsAccairit_ Sign Out . -.,_I%k x Melling Addrepa —.--- -- rimary:Emergency Qpntac . Melling Address 4' First 3 LastName G CVS Caremark, Atln: Dianne E. Durand One CV.$ Drl%e- 23082A 3D,COfWANY CHyv7a+ State ZIP/Postal Code in Tllle'l`_ Woonsocket N 02895 24HOUR EMERGENCY. CALL CENTER Business Phone 24 -HourPhone a Pager NymD@r d VNlltll :. First3 Lest Name Phone LongsDrug Stares California, L.L.C. (401)7.05-1500 MaHh1g Address. CVS Caremark, One CVS Drhe- 230132A City LPIPostalCode Woonsocket 02895 .. Country United States FhV & LastName Phone CVS Caremark 4017851500 Emoil ik Mailing Address •. One CVS Drl%w23062A City aPfPostal Code Woonsocket 02895 Country United Stalas I Name of Slgner ? THb of Signer ( Date Signad/SubnOtted rR Rebecca Wilbanks, Pgertfor Longs Drug Stores California, LLC. Regdatory. Corrpiange SPKWSL 3E Conperly 1/1112012 jName ofDocument Prepdrer ' AdditionalInformation 1 Rebecca Wlbanks, Agentfor Longs DrugStores Callforrda, L.L. C:,: - l Locally-collected Fields Some or all of the following fields may be required by your local regulator(s). . First 8 LastName Phone CVS Caremark, Attn: Dianne E. UArand 4017703315 Malting Address1OneCVSDrive-23062A 1 pity . Zip Code Woonsocket 02895 Country United States f crnaled 9y: 9y4em.bminis foron 912 99:59AM Lest Itpdat•d By: 3E Company Regulatory DepaMern on I W7012 1:51 PM 1 of2 1/19/20121:52 PM Date: 01/11/12 Non -Waste Hazardous Materials Inventory Statement For use by Unidocs Member.4gencies or where approved byyour LocalJurisdiction Business Name- Saaaeas FacilityName arDBA) CVS Pharmacy # 9975 Ty a ofReport on This Page: 9A4- Delete; Revise Page 1 of 3 Ose papa perbudding Chemical Location: ei,;b;y,r,ge A,) Retail sales floor EPCRA Confidential Location? ® Yes; ® No Trade Secret Information? ® Yes Ix7 No Facility ED # i "$° PC"o n/ 1 5 0 2 1 1 5 5 5 3 1. Haz Class 2. Map and Grid or Location Code 3. Common Name 4. Hazardous Components For mixtures only) Chemical % Name Wt. EHS CAS No. 5. Type and Physical State 6. Quantities Max. Average Largest Daily Daily Coat 7. Units S. Storage Codes Storage Storage Pressure Temp. 9. Hazard Categories 3.00 MAP: 1 GRID: Flammable u ufdS.IJ -o.s. q 58.82 29.4132 a.fm Inns p <.mh. amb. pnG erdease auoebeaMcbmoiehdthsolid liquid gas Cnd-v Or-6 —im) DsysOn Sitg 365 Sra ae ig -' C"Na -- EIIS 3.00 MAP: GRID: Flammable I,ids,rl.o.s. a i p°C 58.63 29.131 x m paaads ambunt amh x amb,m amb. t lzr- solid hgrid pradva e) P m On 365 stomas Coate ser' CAS No.: HAS 01 MAP: GRID:- miamao asfeet a iem limb aarb. limb amb. Qyag fue eatve pmemerelease aanebeahh daordchabh ca&. ive 1:1 solid liquid gas Curie pr.••:"..,:"•) Dart On Olk: Sarm C0 .• CAS ¢ El BAS 13 MAR. GRID: 13 pme mirmae gahons pounds cufeet sons embitm amh eab. am6iem amh emb. fee pressnrerelease BMW brakh c3maicbeahh ad—cl— solid liquid sW Coda: f¢nmh i) Oxxv On Slit: Steraee Contahrer.• S.- 6HS MAP: GRID: Pure m V&- ponds rufrar Cl amhiam amb. amb. Is Qy,gma rrJma acnebeekh cbrorkheahh tsdioaoav DI solid liquid gee Shcdfa: fnr.6o.m'z) D.. On scot Cootmer.' CAS No•: Ws MAP: GRID: r»R paa5dw- Rer tons ambiear a rb tmb. ambomr limb amb. e%yog— fire prcmae release acts heeah chromehmhh mdroeaive solid mid 883 a. C=: Ofr.de.aire) 1 Situ= to fG is ysyq arersm a rue A AbovegroundTank B B.1— groundTank C TankInsideBuildinr SI—_ amrsee arw -%I= o ydm arose erns 345- D Stud Doan G Cmhny J Bab M Glass BoalearJg P TankWagon B Plas[i</No ftRicDram H Sib N Bo N Plastic BottlealJag Q RAC. F Can t Fiber Drum L Cylinder O ToteBm R Other 1f E RA, sign below: UN -020EA - 12 bttp: / /www.unidoc&org Rev. 04/24/00 Date: 01/11/12 Non -Waste Hazardous Materials. Inventory Statement For use by Unidocs Member Agencies or where approvedbyyour LocalJurisdiction Samn Fa Name CVS Pharmacy # 9975SameuR.n3trNameor DBA) Y Type ofReport on This RaviAdd; [] Delete; Revise Page of 3 0"F ? bwe' R°' Chemical Location: PHOTO DEPARTMENT; RECEIVINGB.AdlinowraCe Arm) EPCRA Confidential Location? ® Yes; No Trade Secret Information? ® Yes; No Facility ID # AS—y' Um OnNl 1 5 0 2 1 1 5 5 5 3 1. I1az Class 2. Map and Grid or Location Code 3. Common Name 4. hazardous Components For mixtures only) Chemical % Name Wt. ERS CAS No. 5. Type and Physical State 6. Quantities Max. Average Largest Daily Daily Cont 7. Units 8. Storage Codes Storage Storage Pressure Temp. 9. 11azard Categories 2.20 MAP: 1 GRID: E -7; F -3 Helium 438 219 219 X ca. feet tom amh. x ambient anh arogedc fire prmverek- acute health rhrotriebealth mrltnadm solid liquid gas ptra&cu. =) Dan On Sits 365 S.tsaeE 7440-59-7 lip MAP: GRID: pure ntame PR— Pmmds eLL feet toss a ebient amt! ftc E amhiea mb. tb. ayo8auic 6e reactive pressure reiea.e chronichealth radioactive d C9tti ttrr.aio,ri.a) D_ on Silt• Stone Sartain -' CAS No.: ffiIS MAP: GRID: Pure ttmmm 8a11nra pow uu fact t+ffi amh mt rtfi ambr errbier autb, El ayogeme fie tearriw pressmerelease heaealtlt rndmerays solid liq[nd gas Ste tlrr.& °) Daism.Qa Sits CAS No.: ENS MAP: GRID: coo t. powds uu far trrs ash amb, amb a amb. Yes it reaeiw pt morelease sanehealth duroaich_hh radi.&i solid liquid Bps Ca Vrad:m;,e) Dan On SLiaY4 K' rem: Kus MAP: GRID: U pure nirmno galbas pow mfxt ambient mb. amb- nbieat mb. amb. cwe fire r.a- pressurercleae muchealth radiaediva 8 solid liquid If - di...:._) DEYLOn s+ent container.• CASNo.: Ens MAP: GRID: ae Pow at feet amh anb. amb amb, eps -i. reactive pnssunerelease aonehealth cLrorithealth ii..uive solid hquid P. o of-ft-f-) P_0, Or: slo* ^ CSN.: MS 11 t -Pat, 3tonte lree A AbovegroundTuck B Belo groundTads C Took InsideBuilding L" Dtmaee r7 yyg{ amr-M rsoe "x15 Ana rvx y osorxe rvoe Sda4 asmaee t.oe If EPCRA, sign below: D Steel Dnmt G Carboy 7 Bag M GlmBor&DTNji P Tank wwo. E PlatwNe—taBie D= H Sb K Boor N Plastic BouteorJug Q RailCa R Can I PiIw Ilium L Cylinder O TaeBin R Other UN -020EA -1/2 http: //www.ouidocLorg Rev. 0424100 Non -Waste Hazardous Materials Inventory Statement Date: 01/11/12 For use by Unidocs Member Agencies or where approved byyour LocalJurisdiction Business Name: tSaroe aa FadfnyNameor DBA) CVS Pharmacy # 9975 Type ofReport on This Page: Add; Delete; Revise Page a of S c0— PaP- b"Bdm[) Chemical Location: A,r,, Retaif Sales Floor EPCRA Confidential Location? ® Yes; No El NoTradeSecretInformation. Yes; Facility ID # raroRrny, 1 s 0 2 s s s s 1. Haz Class 2. Map and Grid or Location Code 3. Common Name 4. Hazardous Components For mixtures only) Chemical % Name Wt. ERS CAS No. Type and Physical State 6. Quantities Max. Average Largest Daily Dail Cont. 7. Units 8. Storage Codes Storage Storage Pressure Temp. 9. Hazard Categories 5.10 MAP: 1 cR>D: oxidizing Liquid, N.O.S. E nz 56.69 28.34 1.32 Fo d, p<amb. x x peswereleese dwmclrcehh solid liquid g. Oh e:) SIt6 365 storied ysaf' CAS N°•: ms 1:1 MAP:° GRID: a>lXl1aC P%- amb. amh away teatbve pessue dam aW.heakb da h..hh redxpctise solid li*d Cs Pr-d u;m) Oa On Sec StslBee conumcr.• CAS No. El eHS MAP: GRID: Pure mu¢nte geaons pruak at feet mm mof>icot eafi amh fr= 11 iextiw p—amrd- afeheahb dwiiichakh DI solid ligaid P3 Colin: vvdvai.o) Danon Sasrate coa d:• CAS {o. EHS El MAP: GRID: Pure mi h. suBow p m h idea 1ms anibirm amb. amb. mbiem amb. emb. li.e Ere reeaive pcmaerelearn irateheath dmvchahb rsdiaauive 0 solid liquid E19" Cpl1H Nvdamc) P92Q_n 9 ee Coohdaer• cwsr7p: xHS MAP GRID: C1 tae I pomrds ar feat amh. erab. amb, ractise P r idea: suobahh damticheahh sed'mecdve maid liquid g- c_ :e. pfr.din.ctiw) Danon fig: Storan Coatdae[:• CASNa. Has MAP: GRID: pure o¢i: pions P-As ar fed a nb as emh r h ambientf[<= jog. . e ractiw p w=rekm muebb chm ishahh r,dW.V. solid Ggaid g. Calris Ir,ae;a.m o7 DanOn it : SterazsGnfau.er^ CASN- 6HS a.aae aroraxe a.oe A Abovagtmmd7mk B BelowpowdTmk C TankInsideBuildiM lim o omee i ra -Ndm oioraae . a.ci< erg, o<e a.R ---qm sa= IfEPCRA, sign below: D Strsl Ilium G Carboy J Beg M Glass Botdeorhg P TankWagon E - - --- -Diom H silo K Box N Plastic Botdeorfug Q Rail Car F Can 1 FiberDrum L Cylinder O Tote Bin R Oder UN-020EA - 1/2 http: / /www.unidocs.org Rev. 04124/00 Date; 01 /11 /12 Hazardous Waste Inventory Statement For use by Unidocs Member Agencies or where approvedby your Local Jurisdiction Business Name: ^l • Same wFaeJatyName or DBA) `"VS Pharmacy # 9975 Type ofRe ort an This Page: X Add; [Delete; Revise Page 2 of 4 o•F•awb x•r rw Chemical Location: R@CElVlflquid -VS- eAte) 9 EPCRA Confidential Location? [I Yes; [R No Trade Secret Information? Yes; Q No Facility ID Al 4°c'u-- 0-1y) 1 5 0 2 1 1 1 5 5 5 3 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Map and Grid or Hazardous Components Type and Quantities Annual Storage Codes Haz Location Chemical % Physical Max. Average Largest Waste Storage Storage Hazard Class Code Waste Stream Name Name Wt ERS CAS No. State Daily Daily Coat Amount Units Pressure Temp. Categories 2.1 0 MAP: GRID: G -2 Compressed as, RammableN.O.S. Propane 100.00 749&8 waste 50 25 10 200 galbm Mfiz tom embiva amb. vabirm Iamb. t—y cbeehh fire uoreham 1M97-8 M care ethad: Recycled po-site El Treated On-cite solid liid 0 gas Cork. Or .e alvs) Rim 365 stortae c °ruiner ' warro cove: 141 1 GRID: G-2 onsumer U State Regulated Nan Regulated UquM, 100.00 Mhchrre waste 150 75 10 600 a•mm a> 5.1 10RL ar6iemH- h grim X the reuse fthmhhx clnojehmhh ndoacure Management Method: Shipped Off -site ReeledOn -site El Treated Orraite Cl solid8liquid Colin: ur'" re) Dan On Sbs: 365 S tag N •rte Code 135 MAP: 1 GRID: GRID: Consumer r0 u , State Regulated Non Regulated Solid, 100.00 ff Mbrhrre W85te 150 75 10 600 WileMN,... ea fat t e91 0 <emb, c amb. v— lasethmj $ a preen— relate amaelaeah6 r ManagemeutMethod: Shipped Off -site RecycledOn -site Treated On-cite solid liquid gas 365 wasteCode: 181 MAP: 1 GRID: G Fluorescent amp Bulbs, Universal Waste Mercury 1.00 7439 -97-6 waste 50 1 0 200L Vwreb of lee un aah p <, aab. Iamb. genic revive primerelease1aaueboaih h. ndoacdve lead OAde Zoo 1317-38 -8 Maagement Method: Shipped Off -,ice Recycled Onsite Treated Oa -rite Glass (soda lime) 75.00 solid liquid Cl awl D3[! On sik 365 stoma Coatei>t• to waste Coder Fluorescent Phosphor 3-DU E] El 2.10 MAP: 1 GRID: G -2 Waste erns s, Consumer Aerosols 100.00 Mix " wasfz 50 25L 1 0 2200 P mE.1 rw emblem mb amble,, am6 arae x x Bas reactive pressure rename aaeheahh rhronieheahb Re Cleaning APP Management Method: Shipped Off -cite Recycled On -site Treated On-sdo PersonalCareProducts solid liquid fair!,,: N –' W) Dow 0o s=4' 365 slor•e• Contain 1214slats woo C• Airfresheners MAP: GRID: G -2 B a 9 Universal Waste ARsc Consumer Batteries 1oo.0o Mbdure vASfe 50 25 10 200 aagoem p01' m ihet em gale. p <am6 N<-k. > unh aroamic rattive prQmetelem aaae brahh chronichuhh ra&.ti. cp,AaAA ev a gaga Shipped off -site RecycledOn -rite Treated On-siro e solid liquid r C. Dan On S!L' 365 st>tmt cy.tinSG' stet£ Cody. s SSA ..mr>L!e. s.oe &M-A 3105 a A AboregrormdTank D Steel Drum G Cnrbcy H Belowgrermd Tack t Phetic/NonmdaDic Dann H silo C Turk hordeBuilding F Can I Fiber Drum UN -0208 - 1/2 SIyys H krLYA, sign below: J Bag M GlassBottleerrJug P Tank Wagon H Boa N Plastic Bottle or Jug Q Rag Cer L Cylinder O ToroBia R Odra hap: / /www. unidonsorg Rev. 05!18/00 Hazardous Waste Inventory Statement Date: o? 1? 12 For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Business Name: Smoe u Faculty Nameor DBA)CVS Pharmacy # 9975 Type of Report on This Page: NAM; Delete; Revise Page 3 of 4 Onspetaperhaadingorw) Chemical Location: R@C81VI11B- Mnr/StoraleArta) 9 EPCRA Confidential Location? Yes; MNo xTradeSecretInformation? El No Facility ID # AS-Y u- Only) 1 5 0 2 1 1 5 5 5 3 1. Haz Class 2. Map and Grid or Location Code 3. Waste Stream Name 4. Hazardous Components Chemical % Name Wt EHS CAS No. s. Type and Physical State 6. Quantities Max. Average Largest Daily Daily Cont. 7. Annual Waste Amount 8. Units 9. Storage Codes Storage Storage Pressure Tern . 10. Hazard Categories s.00 MAP: GRID: G-2 Waste Corrosive Liquids, N.O.S. (Acidic) Mtsc. Cmoslve (Acidic) Products 100.00 Mhd,ae waste 25 12.510 100 rs 1 mfd t- s o <-6' oyogenie x x IdWo e ae6eahh e Hydra flodcAdd 20.00 7647 -01-0 Mane El shipped Off -site Q Recycled nAuoricAdd 20.00 76643&3 solid liquid t3: w--W -) Dsn Oa 365 StR. fil, sulc wade Code: 791 SulturkAdd 20.00 x 766463 -B Acetic Add 20.00 6419 -7 8.00 MAP: 1 GRID: G-2 s 01rOS Liquids, N.O.S. (Basic) Misr- C000sive (Basic) Products 100.00 Mbthua waste 25 12.510 1 00 NPF' XIS m ft 1°" ambmt ML Q <amb, s x x x i fin ursiv° Pnsswe 'et. c)uoruehem" Ammordum Hydrwdde 20.00 1336.21 -6 en. ameat Met ShippedOff4ite RecycledOn-site 11 TreatedOn-sift Cakhun Hydroxide 20.00 130582-0 solidBliquid PS S:adts: B^10' -) p()g sill: 365 S191i1 CAelaiag' staf W mCodC 122 Potasslum HydroAde 20.00 E] 1310563 El 3.00 GRID: G -2 Waste anima a Liquids, N.O.s NIIsc Flerttmel>fe Liquid Pfoduds 100.00 Mtxhire waste 150 75 10 600 o emh eab Ws aarelam akhTX=-'=C hmLh Alcohol 59.09 MbQue Management Method: Shipped Off -site I RecycledOn-site TreatedOn-site Acetone 50.00 67 -64-1 solid liquid n:.dmive) Qn Si 365 Storm ru:• s Waste Code: 214UghterFluid50.00 El mwum Petroleum Distillates 59.00 El 8002-05-9 5.10 MAP: 1 GRID: G -2 Waste X D9 Liquid, N.O.S. Mist, OtddWn9 Products 100.00 Mbdure waste 25 12.510 100 mom ms m>bient m:e;em yO e X ere x pressureretese x eO0f6 x clnaNh Peroxides C] M&Wre Management Method: Shipped Off- ite Recycled On-sift Treated O"ite solidBliquid sas orr.eia -i.e) DMOn Snc: sJ Vic• 5!014WasreC*4 131 MAP: GRiD: waste Prnads fret 10°5 ambimn arob. comb. smbieat curb smh e e rnerlile wa.b -ath en;cbulth rye Mame®ent Method: Shipped O1€eito Recycled On -sift Treated Orraite solidHliquid gas C °rice oTr.a;am. DMOn sus Sto contai4r' sass Wpm C. MAP: GRID: waste V5E a smb rnt scrub smbnit curb. fug reactive nre:t a'c hmkb rsdmeiw Manseement Method: Shipped Off-sift I Recycled On-site solidHliquid u F) non o 5>Jf storage Cantaiau' s Wwe Ca4e s aluxu m A Abovegrotmd Tank B Bebwgrouod Tsok C Tank Inside Building y @ ororvxe. sine ,&dm a.onee tm S.M aceraee .toe saes& Oyy.am s.vo 5--My If EPCRA, S1g0 Ow: D Steil lhum G Cuboy J Bag M (lawBordeorJug P Tank Wagon C Pb,6,Vo -1 isDk H S9n K Box N PlankBottle or Jug Q Reis Car F Can 1 FiberDrum L Cylinder O ToleBin R Other UN -020B -1/2 http:/ /www.unidoc&org Rev. 05/18/00 Date: 01 / 11 / 12 Hazardous Waste Inventory Statement For use by Undoes MemberAgencies or where approvedby your Local Jurisdiction Business Name: CVS Phaft118C # 9975SamemFacilityNameorDBA) Y Type ofReport on This Page: 0 Add; El Delete; Revise Page 4 of 4 Onenave per bwae •r o+) ChCD1iCal Lomb°° Pharmacy and ReceivingB.W A.` ) Y 9 EPCRA Confidential Location? Yes; 0 No Trade Secret Information? E) Yes; x No Facility ID # Aaorcy UmOrtHJ 1 5 D 2 1 1 5 5 5 3 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Map and Grid or Hazardous Components Type and Quantities Annual Storage Codes Huz. Location Chemical % Physical Max. Average Largest Waste Storage Storage Hazard Class Code Waste Stream Name Name Wt. EHS CAS No. State Daily Daily Coat Amount Units Pressure TemP. Categories 6.10 MAP: GRID: G-2, E-4 o)ac S. rganlc, N.O.S. FPyrethrins 30.00 Mbct" waste 25 12.510 100 Np= m eet r.a p <aab md X pffiaerxlam anteheaEh rbrui.heebh t 20.0o Mbdure May¢emeat Method: Shipped Off -site Recycled On -sue fff TreatedOo-trite Calt)onate 20.00 Mb.ttre 8 solid liquid gas CM1 tttr.a mnd PATI.l2H elite: 365 srm_-a.P:a.,... nom•• LWIt wo"Code: 131Copperandlimo2o.00 Mbdure Over tha Comfier Pharrracedicars 50.00 Mbdura 6.10 MAP: GRID: G-2, E-4 Waste Toxic Solids, Organic, N.O.S. (Acxlte McolineC-utn 100.00 MWM 25 12.5 25 100 tan, an*, vyagm c p—relane Kate hahb chrome b-Ith El rJic» tine Patches 100.00 Mbdure et>>od: Shipped Offsite Yekd Owe Treed On-site w retn tematy corakm mw raddeal p1s) 100.00 Mbdwe solid liquid gas rte: Of—) Av 365 S S= Wawa c.de 311 MAP: GRID: waste gdbm pounds amtdmr amh OK embimt lime. e mclive relearn byte ra6oa re Management Method: Shipped Off -site Recycled Orr -sac Ttemd Oa-site solideliquid gas Caries; u —) Am on gip to tSte warn ceae MAP: waste gaHore mbitat mbant rte GRID: pamrds aoa f aolr. ay amh amh orwt native p roremieue antebeaeh o chabh K MameementMethod, Shipped Off -aite Recycled On-site Treated On-site solid liquid gas urn- -) PQ s 00e.• t( wrote Cod MAP. GRID: waste ga0ors pwds a. @er embcnr amh amb. emh cot amh avb. e e rmctive p+erelease daaoi,: babe adwrbve Manaeemeat Method: Shipped Off -site Treated On -site solid liquid Saa[!!a: D*n.4. 2a: Stones Sd•nli :• s waste coda MAP: GRID: waste galls pamds a>. leer whcot amb, amt' ameiem wb. amll. c fire sectiw panne rde wmbcwffi daoosba1th e Ma ear M Secyc Off-site Retycled Oa -site Treated On sue solid liquid El gas Caris i_) Dars on Slit: Stores Ste" Info wmtecede: 1p ygQt AIM rvoe A AbovevmundTmrk B Bebwyoand Tara: C Tank }aide BmMmg IJN -020B - 1/2 Idim Drornc SADY Aroraee lym D StedDrum G Carboy E FbmtcMameiswi D_ a Sao F Can 1 FiberDram I Beg M (Hasa BattleorIng P Taak Wagon K B_ N PlaneBottle or hrg Q RailCar L Cylinder O Tot. Bin R other bttp://www.unidoeLorg IfEPCRA, sign below: Rev. 05/1810O CVS Pharmacy Page 1 of 1 Attachment Employee Training Program Employees are trained periodically on the proper handling and storage of currently identified hazardous materials and hazardous wastes, as applicable. This identification process is ongoing, and training modules are developed and implemented on an ongoing basis. The training modules currently in place, including the Hazardous Waste Training Program and the Health, Safety & Environment Program and associated video provided by CVS's photo processing vendor, Kodak, are available upon request. HAZARDOUS MATERIAL MANAGEMENT PLAN- A]Eltapi n APPLICATION Fllitd nc z' SECTION DISCOVERY & NOTIFICATION ARTX r 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 a Fax: 661- 852 -2171 Page 1 of 2 e. trioir .(.v— +4 NrtYr'_." St}hH_+Z:, r.- j\?LL"h!.EN+Yl /1 i '' C.. BUSINESS NAME (FACILrrY NAME or DBA) CVS Pharmacy #9978 ADDRESS (for local ua only) 4400 Coffee Rd FACILITY ID.l;µ I u = - CA - drr. . _ Oi .M A. LEAK DETECTION AND MONITORING PROCEDURES: All hazardous materials are kept In their original containers and are visually Inspected by store personnel periodically. B. EMPLOYEE AND AGENCY NOTIFICATION: Employee notification through verbal communication. Agency notification to be advised by 3E Company. C. ENVIRONMENTAL RESPONSE MANAGEMENT: 3E Company will be contacted for spill clean up procedures through the CVS Safety Hotline: (877) CVS -2040 or (800) 85e -1885 for the hearing Impaired. In the event of a spill, 3E will Instruct the callerto Immediately isolate the area. 3E will evaluate the situation and provide proper spill clean up instructions K applicable. If the situation requires Emergency assistance, 3E will notify the CVS corporate contact and dispatch an Emergency contractor upon client approval. If the spill poses immediate risk to human life or the environment, 3E will advise the railerto call 9 -1 -1. 3E will advise on the proper storage of spilled materials according to local, state and federal regulations. In addition, 3E will evaluate If State or Federal reporting Is necessary. D. EMERGENCY MEDICAL PLAN: In the event of an emergency, the manager on duty will contact 911. ELf?, SIS I pV k,4a YIS2 <E A. HAZARD ASSESMENT AND PREVENTION MEASURES: All hazardous materials are kept in their original containers and are visually inspected by store personnel periodically. B. RELEASE CONTAINMENT AND /OR MITIGATION: 3E Company will be contacted for spill clean up procedures through the CVS Safety Hotline: (877) CVS -2040 or (800) 856 -1885 for the hearing Impaired. In the event of a spill, 3E will instruct the caller to Immediately isolate the area. 3E will evaluate the situation and provide proper spill clean up instructions if applicable. If the situation requires Emergency assistance, 3E will notify the CVS corporate contact and dispatch an Emergency contractor upon client approval. Ifthe spill poses Immediate risk to human life or the environment, 3E will advise the caller to call 9-1 -1. 3E will advise on the proper storage of spilled materials according to local, state and federal regulations. In addition, 3E will evaluate if State or Federal reporting is necessary. C. CLEAN -UP AND RECOVERY PROCEDURES: The spilled materials will be property disposed of according to local, state and federal regulations. FD2169 (Rev 08/07) Page 2 of 2 R31, 0011 ' UTILITY SHUT -OFFS (LOCATION OF SHUT -OFFS AT YOUR FACILITY) Please see Map 1- Interior MapNATURALPRPAN ELECTRICAL: Please see Map 1- Interior Map WATER: Please see Map 1- Interior Map SPECIAL: N/A LOCK BOX: YES 27 NO IF YES, LOCATION: N/A PRIVATE FIRE PROTECTION /WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: N/A B. WATER AVAILABILITY (FIRE HYDRANT): Please see Map 2 - Exterior. mlW—m- NUMBER OF EMPLOYEES: 12 MATERIAL SAFETY DATA SHEETS ON FILE: F9 YES G NOv IF YES, LOCATION: MSDS records are maintained electronically by 3E Company and can be accessed via fax or online. BRIEF SUMMARY OF TRAINING PROGRAM: Employees are trained periodically on the proper handling and storage of currently identified hazardous materials and hazardous wastes, as applicable. This identification process is ongoing, and training modules are developed and implemented on an ongoing basis. The training modules currently in place, including the Hazardous Waste Training Program and the Health, Safety & Environment Program and associated video provided by CVS's photo processing vendor, Kodak, are available upon request. d`. Based on my Inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined a m f ift r vlth the information submitted and believe the Information Is true, accurate, and complete. SIG_ RED R/OPE OR 5 NATED REPRESENTATIVE DATE 477 01/15/2012 F SIGNS Pjl T) 47E TITLE OF SIGNER 479 Rebecca Wilbanks, Agent for Longs Drug Stores California, L.L.C. Regulatory Compliance Specialist, 3E Company F02169 (Rev 08107) ANNOTATED SITE MAP BUSINESS NAME: SITE ADDRESS: 4400 COFFEE ROAD MAP #1 OF 2CVSPHARMACY #9975 BAKERSFIELD, CA 93308 0 A B C D E F G H I SCALE: UNDEYIM DATE: 01/11/2012 Z i 2 3 4 5 6 ` 7 i _ ! ^: I I I p I CALIFORNIA I — FIRS SXTINGULSBSR ANNOTATED SITE MAP BUSINESS NAME: SITE ADDRESS: 4400 COFFEE ROAD MAP #1 OF 2CVSPHARMACY #9975 BAKERSFIELD, CA 93308 0 A B C D E F G H I SCALE: UNDEYIM DATE: 01/11/2012 Z i 2 3 4 5 6 ` 7 i _ ! ^: I I I p I HAZARDOUS MATERIAIS BUSUGM PLAN I — FIRS SXTINGULSBSR FE FIRE MT HAZARDOUS AASn STORAGE HASLl i COMPRESSED GAS CYLINDER f>n RE A O GAS MAIN IEIVING A RATER MAW O ELECTRIC MAIN FE FOOD & BEVERA E I I 4 PREPARED BY: O i FE COMPANY I I 5207 Grey Bawk Court, Suite 200 Carlsbad, CA 82010 CALIFORNIA ANNOTATED SITE MAP BUSINESS NAME: SITE ADDRESS: 4400 COFFEE ROAD MAP #1 OF 2CVSPHARMACY #9975 BAKERSFIELD, CA 93308 2 3 4 5 7 A B C D E F G $ I HAGEMAN RO I I I } Locus - RETAIL - I II I ( ( I I RESIDENTIAL RETAIL OPS — — I — F-1 — CABLES I ! 4 — — -1 - I I I I VONSI MUL SmHo PAi TG I I I I I I I (P:fs:m:ENTIAL SCALE: UNDEPINID DATE: 01/11/2012 LEGEND SAn H WUGE ARRA FIRE HYDRANT SMEW DRAIN PREPARED BY: 3E COMPANY 3207 " Hawk Court, Sdte 200 Carlsbad. CA 92010