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Home My WebLink AboutBUSINESS PLAN SITE/FACILITY DIAGRAM FORM 5 NORTH SCALE: BUS INESS NAME: FLOOR: OF ~E DATE:~'/4a/~7 FACILITY N~E: UNIT ~: OF (CHECK ONE) SITE DIAGRAM / FACILITY DIAGRA~ (Inspector's Comments): -OFFICIAL USE.ONLY- - SA - S[T£ O[AGR.aJ4 (Rec ~tees) . 1. Address: the 9. Lock Sox princiale buildings by the Street numbers. IO. MiDS Storage Box 2. Street(s). Allays. 11. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Wire street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Drainage Canals, Ditches, d. Gates Creeks, 13. Powerllnes 5. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c. Metal construction capacity in gal. a. Above ground d. Access Door b. Underground 6. Utility Controls a. Gas 16. Diking or Berm b. Electricity : 17. Evacuation Route c. Water .' - 18. ~vac'uatlon Area: Identify the ?. Fire Suppression Systems: locitlon where a. Fire Hydrants empIoyees mill teat. b. Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c, Fire Standpipe 201 Outside Hazardous Connections Material Storage. d. Water Control~Valves 21[ Outside Hazardous for protection'systems Material · Use/Handling e. Firs Pu~p 22. Type of Hazardous Material/Waste Stored 8. Fire Department Access or Used (See Below) TyPE OF EIAZARDOUS NATERIA~ F - Flammable g - Explosive L - Liquid R - Radlological Corrosive 0 - Oxidizer G - Gas P - Poison Water Reactive T - Toxic S - Solid H - Cryogenic O - Waste B - Etiological Example: Flanmable Liquid - FL FACILITY DIAGRAM (Required Items In addition to the above) 1. Risers for Sprinklers 8. Fire Sscapes 2. Partitions g. Ale Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lo,est. Il. Inside Hazardous Wasta Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Se~er Drain Inlets ?. Skylights ..... '', ~.~- ~ or prin~ name) ~A~. Do hereby certify that I have revie~ced the attached Hazardous Materials business ~lan (name of business) and that it along with the attached additions or corrections constitute a comDlete and correct Business Plan for my .facility. ' si~na~ur.e ..... da~e - BUSINESS NAME CHETS PHILLIP 66 SERVICE ID NUMBER 215-000-000040 LOCATION 231 E 18TH ST HIGH HAZARD RATING 2 1. OVERVIEW LAST CHANGE 01/25/88 BY EVAMC JURIS CODE 215-002 JURIS BAKERSFIELD STATION 02 MAP PAGE 103 GRID 29C FACILITY UNITS 1 HAZARD RATING 2 RESPONSE SUMMARY 2A SEC 4) NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS 2A SEC 2) HAMS NIELSON 327-3159 UTILITY SHUTOFFS 2A SEC 3) A) GAS - NONE B) ELECTRICAL - EMERGENCY SHUT OFF IN OFFICE, ELECTRICAL PANEL AT REAR OF BUILDING C) WATER SHUT OFF LOCATED REAR EAST SIDE OF DRIVE WAY D) SPECIAL - NONE E) LOCK BOX - NO 2 . NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 12/12/88 14:59 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 : BUSINESS NAME CHETS PHILLIP 66 SERVICE ID NUMBER 215-000-000040 LOCATION 231 E 18TH ST HIGH HAZARD RATING 2 3 . HAZ MAT TRAINING SUMMARY LAST CHANGE / / BY < NO INFORMATION SECTION > 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 01/25/88 BY EVAMC 2A SEC 5) TRANSPORT PERSON OR PERSONS TO HOSPITAL BY PRIVATE VEHICLE OR AMBULANCE PAGE 2 12/12/88 14:59 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME CHETS PHILLIP 66 SERVICE ID NUMBER 215-000-000040 LOCATION 231 E 18TH ST HIGH HAZARD RATING 2 FACILITY UNIT 01 A . OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 01/25/88 BY EVAMC ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE GASOLINE 3650 GAL HIGH- UNDERGROUND EAST SIDE UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LISTS 1182.00 100.0 GASOLINE HIGH 2 B . FIRE PROTECTION / WAT,E R SUPPLIES LAST CHANGE 01/25/88 BY EVAMC 3A SEC 4) PORTABLE FIRE EXTINGUISHERS AND PRE CONNECTED WATER HOSE WITH NOZZLE 3A SEC 5) FIRE HYDRANTS 75 FT SOUTH ON SONORA BETWEEN EAST 18TH AND EUREKA FIRE HYDRANTS 100 FT NORTH ON SONORA BETWEEN EAST 18TH AND EAST 19TH PAGE 3 12/12/88 14:59 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 ~ BUSINESS NAME CHETS PHILLIP 66 SERVICE ID NUMBER 215-000-000040 LOCATION 231 E 18TH ST HIGH HAZARD RATING 2 D . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 01/25/88 BY EVAMC 3A SEC 2) SHUT OFF ELECTRIC POWER, DIAL 911, VACATE IMMEDIATE AREA E . MITIGATION / PREVEN~T I ON / ABATEMENT LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > ~A~ZA~ 8A~ DA~A 8~8~N8~ ZNO, (805) 6~8-6800 CITY of BAKERSFIELD : PHONE ~: ~ ~ff~O~ - PHONE ~: ~ ~ - __ - _ _ (~ ~e bt ~t Est ~*ts m Site I[~k ~11 t~t i~ly) ~ ~ ~ .... h of P~ ~lth "_u_L~I__~_~Z_I...z~...I~Z/__.~~~~~J.~~~ /~ ~]_~~ " __ '.~ IL~I III INI I~ly~ ~lth ef ~m ~lth ..... ,~,~ ~ ~,~ ~.~ ~.,.,. ~~ ~~~.,.,.~ ' ~ .............. (C~ ill t~t a~ly) Fire Hazard ~-a R~tiv~ty [ ] ~ ~ ~l~fle [ ] I~tate of Pmsu~ ~lth · P~cll ~ HNIth ~1~ C.l.S. ~ ' ~t Il (C~k ill t~t mly) ~t 13 M&C.A.S. :N[aGENCY CffiIACTS II Certlficati~ (Read and si~ after coepJetJnK all sections) I cert~fv ~der ~lty ef 1~ t~t I ~ve ~rs~allye~,~ ~ ~ f~ilier for o~amin9 t~ tnt~tt~. I ~l~eve t~t t~ su~itt~ info--tim ~s t~. accurate. / / SECTION 4: PRIVATE RESPONSE TEAN FOR BUSINESS AS A ~IOLE SECTION 5: 'LOCAL EMERGENCY I~DICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED'TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS ,. MATERIALS:...- .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES('~b~ YES NO C. PROPER USE OF SAFETY EQUIPMENT:... ................ (~~"-'NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~_~ NO YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES ~ YES NO SECTION ?: RAZARDOUS ~4ATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:.'.?.... YES NO I, f/~ ~, ~,g/VD~,~,~/~/ , certify that the above information is accurate. I understand that this information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. - 2B - 2130 "G" STREET BAKERSFIELD, CA 9330! (805) 326-3979 OFFICIAL USE ONLY BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: " 1. TO avoid further action, return this form by 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. SECTION 1: BUSINESS IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: ~,~/ SECTION 2: E~[ERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-75S0 or 1-916-427-4341. This will notify Your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE ' DURING BUS. HRS. AFTER BUS. HRS. B. Ph# Ph# SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: /V~/~/~' . B. ELECTRICAL:~,~£~,vc~ ,_~f-o~ /~> OF~/~ -- ~'Z~.,~Z ~ ~ ~ ~,/~. C WATER:.~;-~o~- /o~zg~" ~ ~-L~'~- ~ /5~/F~-~.~ ~ D. SPECIAL: E. LOCK BOX: YES / NO I~ YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUS I NESS PLAN SI'NGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action,, this form must 5e returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY L.~, IT# FACILITY ~IT N~: ~Z~./} SECTION 1: ~ITIGATION~ PRE~ION~ ABATEHE~ PROCED~ES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... YES~ If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory . form. marked: NON-TRADE SECRETS ONLY (white form ~4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade secret form. List onls, the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILI~ SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS./PROPAN~ B. ELECTRICAL: C..WATER: D. SPECIAL: E. LOCK BOX: YES .r~ IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs? YES /' NO FLOOR PLANS? YES / NO KEYS? YES ./ NO - 8B - BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page NON--TRADE SECRETS · HAZARDOUS MATERI ALS I NVENTORY BUSINESS NAME: f/f~/~J f/l/L,;~ ~ OWNE~ NA~E: ~/F~ ~D2~l,~ FACILITY UNIT ADDRESS: ~/ ~. /~ ~ ~ ADDRESS: /~/~ ~%~;'g~- FACILITY UNIT NAME: CITY, ZIP:_ ~~~~ f2~ 7 CITY,ZIP: PHONE ,: ~- ~ PHONE ~: ~7/:--~~ [OFFICIAL USE CFIRS CODE ..[ ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIQAL OR COMMON NAME CODE.. GUIDE NAME: TITLE: O~~ m SIO~TUR ..... EMERGENCY CONTACT:~~J ~/~J.~ fTITLE~/~.~~_ 'PHON~ BU~ H~RS: AFTER BUS HRS: E~ERGENCY CONTACT: TITLE: .. PHONE ~ BUS HOURS: 'PRINCIPAL BUSINESS ACTIVITY: AFTER BUS HRS: - 4A-1 -