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Home My WebLink AboutBUSINESS PLAN Hazardous Materials/HazardouS Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This _=ermit is issued for the following: [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials Permit ID #:: 015-000-001101 [3 Risk Management Program . QUATES TRUCK & A UT0 BOI n Hazardous Waste On-Site Treatment LOCATION: 421 E 18TH ST Issued by: Bakersfield Fire Depa~ment OFFICE Of EN~RONMENTAL SER ~CES' 1715 Chester Ave., 3rd Floor Approved by: Issue ~te Bakersfield, CA 93301 om~orE,~s~i~= r Voice (661) 326-3979 F~ (661) 326-0576 Exp~tionDate: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ....... ,,,,~,~¢,?,???~,~,,~, ~. This permit is issued for the following: LOCATION 421 E 18TH ~,: ... ........... .~:,,~:. ,..~. BA~RS~j~D CA 93305 .......... .....~ ~l~-.''', ~ ~'-~ ~=;~ ...... :~ ~'J~i~ .~'~E ~ ' ~ ~F~ ~ J' 'I ~;~::~' ~"~ '~ ~'"-..'~ l..- ~, --.. '~-~-.-.7~ Issu~ by: omc~ o~ ~o~L s~ uc~s 1715 Chewer Ave., 3rd Floor B~enfiel& CA 93301 Voice (805) ~2~979 ITE DIAGRAM ~ FACILITY DIAGRAM Business Name: ~~ "/~/~ ~ ~ For Office Use Only First In Station: Area Map ~ of Inspection Station: NORTH IT E DIAGRAM ~ - LI TY DIAGRAM HI~MP' PI.,A.I~ MAP Business Nome: Business AOclress: First In Station: Area Map # ,,.of Inspection Station: NORTH CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY CONTACT ~a~ /~'~i*- BUSINESS ID NO. 15-210- INSPECTION TIME_/q/t? NUMBER OF EMPLOYEES~-x) Section 1: Business Plan and Inventory Program ,~ Routine [~ Combined [~ Joint Agency [~ Multi-Agency ~.~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appr. opriate permit on hand Business plan contact information accurate ' Visible address [,/ Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material bt/ Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures V/ Emergency procedUres adequate Containers properly labeled Housekeeping v/ Fire Protection Site Diagram Adequate & On Hand //' C=Compliance V=Violation ~ Any hazardous waste on site?: [~ Yes ~ No ~ Explain: Questions regarding this inspection? Please call us at (661) 326-3979 6/Bt~siness Sit~/R~'¥ons~fl~e Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ('~),IA-[-E fi,-,,4~ /Z)ac~y INSPECTION DATE ~'- ADDRESS ~7_1 ~.i~'-~"<o~}''-, - PHONENO. (~(~-0(~(~ FACILITY CONTACT_ /~t BUSINESS ID NO. 15-210- INSPECTION TIME } k/2-0 NUMBER OF EMPLOYEES [ 9,~¢thectc ~ ocr q Section 1: Business Plan and Inventory Program ~ -Oo"r / fo [~outine [] Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand I/ Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials t/ Verification of quantities Verification of location Proper segregation of material t/ Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping ~,' Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [] Yes [~o Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Busin I~ ie Party White-Env. Svcs. Yellow- Station Copy Pink-Business Copy Inspector: 2~~~y/,-/ QqATES~TRUCK & AUTO BODY REPAIR SiteID: 015-021-001101 Manager : BusPhone: 636-0696 Location: 421 E 18TH ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 30D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 02 SIC Code:7532 EPA Numb: DunnBrad:548-56-4890 Emergency Cont~,,~. Title Emergency Contact / Title RAY RUIZ f f ~ ~OWNER --/ ~/~ / ~Business Phohe~ (8/0/S)~ 636-0696x ~f Business Phone: ( ) - x 24-Hour Phone t (~5)]~~x-- .2A-Hour Phone : ( ) - x Pager Phone ~ { J ~-¢,~ x Pager Phone : (~.~ - x /- -'/ ImmH~th' ~ DelHlth Hazmat Hazards: Fire Press ~ /~,1.1 \ ' MailAddr: 421 E 18TH ST State --CA City : BAKERSFIELD Zip 93305 / Owner RAMON RUIZ Phone ~~6-0696x Address : 421 E 18TH ST State A City : BAKERSFIELD Zip : Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List ~ Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax lUnitlMcP ACRYLIC/ENAMIL MIXTURE PAINTS F DH L 60.00 GAL Mod OXYGEN F P IH G 240.00 FT3 Low 1 06/18/2001 QUATES TRUCK & AUTO BODY REPAIR SiteID: 015-021-001101 Manager : BusPhone: (661) 636-0696 Location: 421 E 18TH ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 30D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 02 SIC Code:7532 EPA Numb: DunnBrad:548-56-4890 Emergency Contact' / Title Emergency Contact...-_~ Title RAY RUIZ / OWNER / Business Phone: (661) 636-0696x Business Phone: ( ) - x 24-Hour Phone : (661) 397-3116x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: (661) 636-0696x MailAddr: 421 E 18TH ST State: CA City : BAKERSFIELD Zip : 93305 Owner RAMON RUIZ Phone: (661) 636-0696x Address : 421 E 18TH ST State: CA City : BAKERSFIELD Zip : 93305 ........ Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: += Hazmat Inventory One Unified List + +== Alphabetical Order Ail Materials at Site + ................................ + ....... + ........... + ..... + .......... + .... +---+ Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax lUnitlMCPI ACRYLIC/ENAMIL MIXTURE PAINTS F DH L 60.00 GAL Mod OXYGEN F P IH G 240.00 FT3 Low I, Do hereby certify that I have {Type or p.6,~t r,~m.~) re,,ie~,ed tim mtached hazardous materials manage- mar,'~ plan for and that it along with (Name ot Business) any corrections constitute a complete and correct man- agement plan for my facility. -+ .I- -1- 01/18/2002 Signature Date MISCELLANEOUS RECEIVABLES ADJUSTMENT ADORES8 CHANGE CLOSE ACCT j · OTHER =J ' I'~ Ci~ ~C~C~; ~[~ STATE ~ ZIP CODEq SITE ADDRESS PARCEL NUMBER ADJUSTMENT I ~ CHG DATE CHARGE CODE ADJUSTMENT AMOUNT interoffice MEMORANDUM i Lo~' / from: DREW SHARPLES - FINANCIAL INVESTIGATOR~ · ubl~t: ENVIRONMENTAL SERVICES ACCOUNTS date: Janua~ 27, 1998 1 3273-ES 421 E 18TM ST QUATES TRUCK & AUTO BOD, Y Judgment was granted on this account 2-26-97. Any future billings will need to be on ~ separate account. 190 NOT BILL THIS ACCOUNT AGAIN. I suggest a field check be done prior to any more billings. *' HAZARDOUS MATEF~-S INSPECTION eersfield Fire Dept. , Hazardous Materials Division ~ Date Completed ~/'//~',,~ h Business Name: ~d~.5 ~u~ + ~u~ ~ LocaUon: ~/ ~. /~ ~ Business IdenUfica~on No. 215-000 //~/ (Top of Business Plan) StaUon No. ~ ShiE ~ Inspe~or ~~/~ ArdvalTime: ~~ Depa~ureTime: ~~ Inspe~onTime: /~ /~' Adequate Inadequate Verifica~on of Invento~ Mate~als~ RECEIVED ~" ~ ~- ~ ~, VerificaUon of Ouan~es ~' ~ ~ 0 '1 199~ Ver,,c,,ono, oca, on ~'1- ~" '~',,.~.,d~_ .~,~ Proper SeDregafion of Material ~ ~ HAZ. MAT. DIV. ~ Commen~: Veriflca~on of MSDS Availabili~~ ~. Number of Employees: / Verifica~on of Haz Mat Training~ Commen~: Veriflca~on of ~atement Supplies & Procedures ~ Commen~: EmerDenw Procedures Posted ~ Containers Propedy Labeled ~ Commen~: Vorifica~on of Facil~ Diagram 8pocial Hazards ~s~oeiatod wi~ ~is Facili~: Violations: ~ Busin~ ~er~anager PRINT ~ME Wh~H~ Mat D~ Yellow4aUon ~py Pink-Busings ~py 0,7/23791 QUATES. & AUTO BODY REPAIR 215 -001101 ~/ Page 1 Overall Site with 1 Fac, Unit General Information Location:.-~0G0 E~"' .... ~ z~l ~,i , Map: 103 Hazard: Low Ident Number: 215-000-001101 Grid: 29D Area ~of Vul: 0.0 Contact Name Title Business Phone 24 Hour' ph~ne- IRAY RUIZ [OWNER (805)( ) 323-5106_ Xx (805)( ) 397-31'16 Administrative Data Mail addrs: P~ E 19TH-ST~[~.[~~-- D&B Number: 5'~8~56-48'90 City: BAKERSFIELD State: CA Zip: 93305- Comm Code: 215-002 BAKERSFIELD STATION 02 SIC Code: 7532 Owner: R/~ON'RHIg Phone: (80:5) 323-5'106 Address: 4100 ADIDAS LN State: .CA" City: BAKERSFIELD Zip: 93313- Summary ' ":'~': t~a ous mat -.. merit plan fo -r'~, ~ a,,..,~ ..... and a[ it ng with ~ n'' ~. ~[ ,~t,:,:.,[~; ti~~ any corrections const~!u~e a complete and~e~ msn- '.' agement pl~~ ,. ,... · ,. 97/23791 QUATES & AUTO BODY REPAIR 215~0-001101 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCP 02-002 ACRYLIC/ENAMIL MIXTURE PAINTS Liquid 60 Moderate Fire, Delay Hlth GAL 02-001 OXYGEN Gas 240 Low Fire, Pressure, Immed Hlth FT3 ~7/23Y91 QUATES & AUTO BODY REPAIR 215~0-001101 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-002 ACRYLIC/ENAMIL MIXTURE PAINTS Liquid 60 Moderate Fire, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: PAINTING Daily Max GAL ~ Daily Average GAL ] Annual Amount GAL o.oo I o.oo Storage Press T Temp Location METAL CONTAINR-NONDRUMIAmbient~AmbientlNE CORNER SHOP & SPOT ROOM -- Conc Xylene, Components I MCP ~List 40.0% Mixed ModerateI 10.0% IT°lueneIM°deratel 5.0% In-Butyl Acetate ModerateI 5.0% INaphtha ModerateI 5.0% IMineral Spirits ModerateI 02-001 OXYGEN Gas 240 Low Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3 ~ Daily Average FT3 T Annual Amount FT3 I 120.00 I 80.00 Storage Press T Temp Location PORT. PRESS. CYLINDER Above ~AmbientlON CART -- Conc Components 100.0% IOxygen, Compressed ILo~CP IList 07/23791 QUATES T~K & AUTO BODY REPAIR 215~0-001101 Page 4 -00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL911 <2> Employee Notif./Evacuation TELEPHONE LOCATED BY OPEN DOORWAY. EVACUATION BY NORTH BAY DOORS OR DOOR AT SOUTH END OF BUILDING AND CALL 911. <3> Public Notif./Evacuation <4> Emergency Medical Plan MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD, CA. (805) 327-1792 07/22/91 QUATES T/K & AUTO BODY REPAIR 215~0-001101 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ALL CONTAINERS OF PAINT & THINNERS ARE SEALED WHEN NOT IN USE AND STORED IN METAL CABINETS. ANY ACCIDENTAL SPILLS ARE CLEANED UP WITH SAWDUST. OXYGEN AND ACETYLENE CYLINDERS CHAINED TO THE WALL <2> Release Containment PROPER VALVES AND FITTINGS <3> Clean Up NONE, JUST REPLACE THE TANKS <4> Other Resource Activation. 97/2~/91 QUATES & AUTO BODY REPAIR 21~0-001101 page 6 00 - Overall Site <F> Site ~Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - WEST OUTSIDE WALL OF BUILDING C) WATER -~ ~ESIDE OF BUILDING D) SPECIAL - E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT - NCr~_T::::-~F,T ~'u~ <4> Building Occupancy Level ~07/2~/91 QUATES T~K & AUTO BODY REPAIR 21 0-001101 Page 00 - Overall Site <G> Training <1> Page, 1 WE HAVE 2 EMPLOYEES AT THIS FACILITY - OWNER OPERATED WE DO NOT HAVE MATIERAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use Bakersfield Dept. HAZARDOUS MATERIALS DIVISION Date COmpleted 6- Z..5'- ~ 7._ Business Name: ~ ~-'r'~5 -~ur,_~ ~ ~,~'T'o ~o Dy Location: ~ 2./ E.. / 8 -- Business Identification No. 215-000 / I o I .... (Top of Business Plan) JUN Station No. ~.- Shift /~ Inspector Z~o/,,/~ P,,. By .,. Adequate Inadecuate Verification of Inventory Materials ~~Comments:' Verificati°n °f Quantities I~' /,/'~?~ ...... Verification of Location Proper Segregation of Material Verification of MSDS Availablity Number of Employees ~ - C~ b.,, Verification of Haz Mat Training Comments: ~_(~u~--_5'1'~-.~ - [.-t~u[ I,,toT ¢o~ Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Faci!ity Diagram Special Hazards Associated with this Facility'~ All Items O.K. ' I~] ~ ~~~c.,,.*~Z_ Correction Needed I~ I~usiness~i~wner/Manag.~r~ FD 1652 (Rev. 1-90) White-Haz Mat Div, Yellow-Station Copy Pink-Business Copy -- '- .-..-- MINGO'S BODYWORKS 421 East 1 8th Street Bakersfield, Cai ifomla ' '" ..... Phone 324-5717 . . -, .:.. .... .:.. ...... .. ....... ...-.:: .: :, ,IZ.~,,'; " " :'"' ' : '",' '.'""'. ..... ": .... '~"...'.' ~ -.> ...... :"" ..... ":?' :,.' i:,i · ' . . . :..'.':..: .i' . :.'~ ~.-' . .. '"'....' --..- ... · ~ z. / .~ /,~'r'~.,r'~- .,,'~//,v~"~' ,,'~,,~,>, ,' Hazardous Materials Inspection ~ ~ ~Adequate Inadequate ~ Vefificafi°n °f Invent°~~ ~~1 ~ ~ ~~ ' ~ VefificafionofQuanfities ~ ff ~°per~e~egao~~n °f Matefi~~ Verification of MSDS Availability [-] [] Number of Employees Verification of Haz Mat Training [~ [--] Verifcafion of Abatement Supplies & Procedures Emergency Procedures Posted Containers Properly Labeled ~] [--] Comnlexlts: Verification of Facility Diagram [~ [-~ Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office REFERRAL TO FINANCE DEPARTMENT FOR COLLECTION c3: ~O_a?.~_~ Referri-ng De[:k~rtment/Section Person Making Reforra! Account Number Type of Billing Name(Business Name of Commercial Account) Site Address Mailing Address ~ Telephone s N~} ~dress and Telephone N~r · 0 ~nth/Year Month/Year ,. ~unt Due B List Collection Efforts by De~nt ~ior to Referral: ~~~ ' THIS BILLING HAS BEEN VERIFIED AS ACCURATE AND VALID Authorized Signature (Original to Cash Management, copy to Accounts Receivable) NM 6~8/90 Hazardous Materials Division J U N ! 5 1990 2130 "G" Street 0j~ Bakersfield, CA. 93301 A,8'd ............ : HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1, To avoicl further action, return this form within 30 clays Of receipt. 2, TYPE/PRINT ANSWERS IN ENGLISH. 3, Answer the cluestions below for the business as a whole. 4. Be brief oncl concise as po~ible. SECTION 1: BUSINESS IDENTIFICATION DATA LOCATION' t O~ 0 ~__, ,,~ I -~ S':,-/-I~ MAILING ADDRESS: J~O ~- CITY' 1~~. I0 STATE: DUN ~ BRADSTREET NUMBER' OWNER: ~, ~.~. SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLEBUS, PHONE 24 HR. PHONE ~, f?,~ /2.,~. o:,~ ~o~_ ~ ~-~r:~ (~) z~z-sl I 2. Bakersfield Fire Dept. Hazardous 5Iaterials Division "'HAZA]~IOOUS MATERIALS MANAGEMENT PLAN SECTION 3:- TRAINING: NUMBER OF EMPLOYESS: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, ~LU ("~. ~f"~r~',-,~--~ CERTIFY THAT THE ABOVE INFOR- MATION/IS AccURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE U,,kers~eld Fire DePt. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: c. CL~AN-UP SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' NATURAL GAS/PROPANE: ~"~/~' ELECTRICAL' F.__le,-~fic.~/ ~o,/ or', Ouze0s I ~/~ %~ SPECIAL: k)t~' _ LOCK BOX: YES/~_____~- IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A, PRIVATE FIRE PROTECTION: B, WATER AVAILABILITY (FIRE HYDRANT): Baker$fielcl Fire Dept Hazardous Nlaterials mivisio: HAZARDOUS MATERIALS MANAGEMENT PLAN Facilih/Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: B, EMPLOYEE NOTIFICATION AND EVACUATION: C. PuBEIC EVACUATION: D, EMERGENCY MEDICAL PLAN: Bakersfield Fire Dept. Hazardous Materials Division ~,- .,,';. ~,~ ~:; HAZARDOUS MATERIALS MANAGEMENT PLAN ;;~' '" · t SECTI.ON;.3:,; TRAINING: NUMBER OF EMPLOYESS: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM' SECTION 4: EXEMPTION REGUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6,95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: MATIONZ~S A'~CURA~I'E. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. " TITLE / DATE 2. ~ FD1590 Bakersfield Fire Dept. RECEIVED Hazardous Materials Division 2130 "G" Street APR ~ 7 1990 Bakersfield, CA. 93301 HAg. MAT. DIV. HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1, To ovoid further action, return this form within 30 cloys of receipt. 2. TYPE/PRINT ANSWERS. IN ENGLISH. 3. Answer the questions below for the business os o whole. 4. Be brief aha concise os possible. SECTION 1' BUSINESS IDENTIFICATION DATA LOCATION' !ee~ ~_-,, MAILING ADDRESS: CITY', ~~~ STATE' D DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS, PHONE 24 HR. PHONE 1, FD15~ · ' CITY of BAKERSFIELD HAZARDOUS MATERIALS INVENTORY Firm ,ndAgticulture [J Standard Business 0 NON--TRADE SECRETS Page _] .... ~ S NAME: ~ ~L~;--~ OWNFR NAME' ~ ~ ~;~ NAME OF THIS FACILITY: )~I~N; 1~ ~-1 ~ ~~ A~D~S~; ~1~ ~,~~o~. ~IANDARD IND, CLASS ~ODE:' _ .... Y ~IP: ~ ~ ' ~ CJIY. ZIP~~ ~ ~a. ~ o~ DUN AND BRAOSI~EE/ NUMB[R ........... :,., ' , ,,..,,, ,,,.,,, , , ~yqe Nix Avtreqe Cole See Instru:ttons tins I ~ont Cant ~ont Us Locqtjon. Vhe[e. Storeo in FICtlI~y LOft AIL Ant Est Untt5 on e lype Press lamp '~, ' ,,d Health Hazard C.A.a. Number Component II Nile I C.l.S. Number all that opplyl NeBO C.A.S. Number Hem/Lb or Pr assure Hem Ith Component i3 Nile I C.A.S. NUmber H, zlrd ~ Reactivity ~ Sudden Release ~ l~,ediete C°Bp°nent 12 Name I C.A.a. NUmber , of Pressure Health COmponent 'hVlital Ifld Petlth ffezlrd C.A.S. Humber Component II NIne I C.A.a. lumber IChec~ all thlt Ipplyl Component 12 Name I C.A.S. Number 0 rife Hazard 0 Reactivity ~ 0elayed ~ Sudden Release U Health of Pressure Health " ). Component l] NeBe I C.A.S. Number "hv~icpl I~d Ptllth Ulil~d C.A.5. Number Component Il Name I C.A.a. Number Component 12 Hame I C.A.S. Number ~ ~,,e Hazard ~ Reactivity I:1 Delayed ~ Sudden Rein,se II Immediate Hem/th of Pressure Hem ILh Component I] Hame I C.A.S. Number '~i~atioq (Remd and sion fir{pr complqLipg..all..p~cqi~nq) ...... ~l~ed.dOcVaefltl. in{ tht based on By Iflquir/ 9l.~nose lfl~vtoua~s respon5~/e for obtaining the ~nlor~at~on. I belteve that the April 30th, 1990 DEAR Mr. Ruiz; NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE WE HAVE RECEIVED YOUR REQUEST FOR EXEMPTION FORM FOR QUATE'S TRUCK AND AUTO BODY LOCATED AT 1000 E 21st STREET. DURING THE FOLLOW UP INSPECTION COMPLETED APRIL 30th, IT HAS BEEN DETERMINED THAT YOU ARE A HANDLER OF HAZARDOUS MATERIALS AND 1) REPORTABLE QUANTITIES OF OXYGEN, CO2, PAINT A WERE OBSERVED BUT NOT REPORTED. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.25503.5 (a) Any business, except as provided in subdivision (b), which handles a hazardous material or mixture containing a hazardous material which has a quantity at any one time during the reporting year equal to, or greater than, a total weight of 500 pounds, or a total volume of 55 gallons, or 200 cubic feet at standard temperature and pressure for a compressed gas, shall establish and implement a business plan for emergency response to a release or threatened release of a hazardous material in accordance with the standards in the regulations adopted pursuant to Section 25503. VIOLATION OF CH. 6.96 CALIFORNIA HEALTH & SAFETY CODE 25509(A)(1-4) The annual inventory form shall include, but shall not be limited to, information on all of the following which are handled in quantities equal to or greater than the quantities specified in subdivision (a) of Section 25503.5: (1) A listing of the chemical name and common names of every hazardous substance or chemical product handled by the business. (2) The category of waste, including the general chemical and mineral composition of the ~.~ste list, ed by pro~abie maximum and minimum ~o~cent~'at[ons, of ever~~ hazardous waste handled by the business. (3) A listing of the chemical name and common names of every other hazardous material or mixture containing a hazardous material handled by the business which is not otherwise listed pursuant to paragraph (1) or (4) The maximum amount of each hazardous material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which is handled at any one time by the business over the course of the year. 2) NO APPARENT EMERGENCY RESPONSE PLAN PRESENT VIOLATION OF CALIFORNIA HEALTH AND SAFETY CODE CHAPTER 6.95, 25504(B) Business plans shall include all of the following: Emergency response plans and procedures in the event off a reportable or threatened release of a hazardous material, including, but not limited to, all of the following: (1/ Immediate notification to the administering agency and to appropriate local emergency rescue personnel and the office. (2) Procedures for the mitigation of a release or threatened release to minimize any potential harm or damage to persons, property, or the environment. (3) Evacuation plans and procedures, including immediate notice, for the business site. ~//31 FLAMMABLE LIQUID STORAGE CABINETS ARE NOT PROPERLY LABELED VIOLATION OF UFC 80.103IF) Visible hazard identification signs as specified in U.F.C. Standard No. ?9-3 shall be placed at all entrances to and in locations where hazardous materials are stored, handled or used in quantities requiring a permit. VIOLATION OF UFC 80.109 (a) General. When provisions of this code require that hazardous materials be stored in storage cabinets, such cabinets shall be in accordance with this section~ Cabinets shall be conspicuously labeled in red letters on contrastin~ backyround HAZARDOUS-KEEP FIRE AWAY. (b)Construction. Cabinets ma)- be constructed of wood or metal. Cabinets shall be listed or constructed in accordance with the following: A. Unlisted metal cabinets. Metal cabinets shall be of steel having a thickness of not less than 0.043 inch. Doors shall be will-fitted, self- closing and equipped with a latching device. Joints shall be riveted or welded and shall be tight fitting. The bottom of a cabinet designed for the containment of liquids shall be liquid tight to a height of at least % inches. B. Wooden cabinets. Wooden cabinets, including the doors, shall be of not less than 1-inch Exterior grade plywood, or equivalent, which is compatible with the material being stored. Doors shall be well fitted, self-closing and equipped with a latch. The bottom of a cabinet designed for the containment of liquid shall be liquid tight to a height of at least 2 inches. Cabinets shall be painted with an intumescent-type paint. 4) OILY RAGS AS WELL AS RAGS USED TO WIPE UP PAINT AND THINNER WERE PERMITTED TO ACCUMULATE ON THE FLOOR VIOLATION OF UFC 79~1311 & 11.201 Disposal of waste. Combustible waste material and residues in a building or unit operating area shall be kept to a minimum, stored in covered metal receptacles and disposed of daily. Accumulation of waste material. (b) All combustible rubbish, oily rags or waste material, when kept within a building or adjacent to a building, shall be securely stored in metal or metal- lined receptacles equipped with tight-fitting covers or in rooms or vaults constructed of noncombustible materials. (c) It shall be unlawful to accumulate or store combustible waste matter beneath trailers or at any other place within an auto and trailer camp. (d) Commercial dumpsters and containers with an individual capacity of 1.5 cubic yards or greater shall not be stored or placed within 5 feet of combustible walls, openings or combustible roof eaves lines. 5 t4AS~ OIL STORAGE CONTAINERS NOT PROPERLY LABELED. VIOLATION OF OSHA 1910.1200 (1) The chemical manufacturer, importer, or distributor shall ensure that each container of hazardous chemicals leaving the workplace is labeled, tagged or marked with the following information: (i)Identity of the hazardous chemical(s). (ii)Appropriate hazard warnings; and (iii)Name and address of the chemical manufacturer, importer, or other responsible party. (4) Except as provided in paragraphs (3) and (4) the employer shall ensure that each container of hazardous chemicals in the workplace is labeled, tagged, or marked with the following information: (i)Identity of the hazardous chemical(s) contained therein; and (ii)Appropriate hazard warnings. (5) The employer may use signs, placards, process sheets, batch tickets, operating procedures, or other such written materials in lieu of affixing labels to individual stationary process containers, as long as the alternative method identifies the containers to which it is applicable and conveys the information required by paragraph (2) of this section to be on label. The written materials shall be readily accessible to the employees in their work area throughout each work shift. (7) The employer shall not remove of deface existing labels on incoming containers of hazardous chemicals, unless the container is immediately marked with the required information. (8) The employer shall ensure that labels or other forms of warnings are legible, in English, and prominently displayed on the container, or readily available in the work area throughout each work shift. Employers having employees who speak other languages may add the information in their language to the material presented, as long as the information is presented in English as well. 6) WASTE OIL CONTAINERS NOT PROPERLY CLOSED. VIOLATION OF UFC 80.103(C) Defective containers which permit leakage or spillage shall be disposed of or repaired in accordance with recognized safe practices; no spilled material shall be allowed to accumulate on floors or shelves. 7) WASTE OIL ALLOWED TO SPILL ONTO THE GROUND. VIOLATION OF CH.6.5 OF THE CALIFORNIA HEALTH AND SAFETY CODE SECTION 25250.4 "Used oil regulated by the department shall be managed as a hazardous waste in accordance with the requirements of this chapter until it has been recycled. Used oil which is not recycled shall 'be disposed of, or transported out of the state, as a hazardous waste in accordance with this chapter". "Section 25250.5 Disposal of used oil by discharge to sewers, drainage systems, surface or groundwaters, watercourses, or marine waters; by incineration of burning as fuel; or by deposit on land, is prohibited, unless authorized under other provisions of law. the use of used oil as a dust suppressant or weed control agent is prohibited". The above violations must be corrected by MAY llth 1990 The department will schedule a re-inspection of your facility to verify compliance. If you have any questions regarding this notice, please contact Ralph Huey at 326-3979. Sincerely,. Hazardous Materials Coordinator I IMPORTANT MESSAGE FOR I AM DATE / ~ /~ - ~'~Z~ TIME I/~/~ · P.'I~.' M OF '~ PHONE NO. ~,~ ? ~5 ~'~'" ! ~': RETURNED YOUR CALL ME&.qAGE SiGNE~~~'~ ASSOCIATED L1-A2334 I N~TRUCT I Section 1 - Business Identification Data:. List business name, street address of the physical location of the business, mailing address and phone number of the business. If you are not familiar with your Dun and Bradstreet number or SIC code, contact your bookkeeper, financial officer or consultant. Section 2 - Emergency Notification: List two persons who have full access to the facility including locked areas and that are knowledgeable about your materials and processes. Section 3 - Traininq: List the· number of employees that are ~working in the area of the hazardous materials, use or storage. Include all employees who have any occasion to bin those areas. Give a brief summary of your Hazardous Materials Training Program. Employees are required by state law to have a program which provides employees with initial and refresher training in the followinq areas: 1) ~Methods for safe handling of the hazardous materials used by your business. 2) The Cai OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. 4) The prevention, minimizing and clean up procedures. you have developed for your business. 5) The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. 6) Procedure to coordinate with and assist the local emergency personnel that msy respond to your business. 7) Who and how to call~ for immediate assistance in the event of an accident involving hazardous materials. HAZAR~OU8'.MAT£RIAL8 MANAB£M£NT PLAN Section 4 - Exemption Request: If you feel you are exempt from the Hazardous Materials. reporting requirements of Chapter 6.95 of the California Health and Safety Code, check the appropriate box. Section 5 - Certification: Sign, date and return before the due date to a~oid further action. S~ti~n 6 - Not±f±cstion and .Evscuation Procedures: A) Agency Notification Procedures: What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -- What procedures are used to notify these parties. B) Employee Notification and Evacuation: How are your employees notified in case of a hazardous materials emergency. What evacuation procedures exist for the orderly and safe evacuation and accounting of all employees in case of an emergency requiring evacuation. C) Public Evacuation: What if any contingency plans do you have for the evacuation of surrounding pub%lc, in case of a hazardous materials emergency at your facility. D) Emergency Medical Plan: Summarize your plan for handling medical emergencies occurring at your business. List the local medical facility capable of handling an accident involving a hazardous materials exposure involving Hazardous Materials used at your business. Section 7 - Mitigation, Preventfon snd Abatement Plan: A) Release Prevention Steps: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B) Release Containment and/or Minimization: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined ................. a's possible'. HAZARDOUS' MATERIALS MANAGEMENT PLAN C) Clean-up Procedures: Explain what clean up procedures wiii be implemented in case ~of~'~le~--~t' your' bus±ness~ ......... This'~hO~Id address small spills, as well as 'a major release of material once the materials is contained. Section 8 - Utility Shut-Offs: List locations of shut offs using compass points and known or obvious landmarks. If yoh have a lock box list its location also. Section 9 - ~rivate Fire ~rotection/Water Availability: A) ~rivate Fire ~rotection: Describe on-site fire protection for your business or facility unit, including sprinklers, extinguishers, alarm systems and private response teams. B) Water Availability (Fire Hydrant): Give the location of the closest water supply or fire hydrant to be used by the fire department in case of an emergency. NOTE If your business covers either a l~rge geographical ~rea or consists of several facilities (separate manufacturing or storage areas), Sections 6, 7, 8, and 9 of the (HMMP) must be completed for each facility. You must also complete a separate inventory and facility diagram for e~ch facility unit or building. O Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN 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 brief and concise as possible. SECTION 1" BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION: MAILING ADDRESS: CITY: STATE' ~ ZIP' PHONE: DUN & BRADSTREET NUMBER: SIC CODE' PRIMARY ACTIVITY: OWNER: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR, PHONE 1. 2. FD1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN sECTION 3: TRAINING: NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM' SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIF, ORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BEUSE~DTO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 255fl0 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE FD1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: ' NOTIFICATIONAND*'EVACU;~TION PROCEDURES: ....... '": ........ ~- ..... "- .......... A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: . C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): . FD159o' HAZARDOUS MATERIALS MANAGEMENT PLAN INVENTORY INSTRUCTIONS 11. USE CODES: (Continued) 21. Grinding 34. Sealer 22. Heating 35. Spraying 23. Herbicide 36. Sterilizer '24-. -Insecticide ..... 37. ~.S.torage 25. Instructional 38. Stripping 26. Lubricant 39. Washing 27. Medical Aid or Process 40. Waste 28. Neutralizer 41. Water Treatment 29. Painting 42. Welding Soldering 30. Pesticide 43. Well Injection 31. Plating 44. Oil Treatment 32. Preservative 99. Other - Specify' 33. Refining 12. LOCATION W~ STORED IN THIS FACILIT~ Briefly indicate the location of the material within the building/facility unit using compass points and obvious landmarks. 13. PERCENT BY WEIGHT Indicate the concentration of each pure substance as a percentage of total'weight. In the case of mixtures and wastes enter the maximum expected concentration of the three most Hazardous Components. Round off.%. 14. NAHES OF MIXTURE/COMPONENTS EMEHGENCY CONTACTS: Enter the name, title and phone numbers of two persons who are knOwledgeable about this facility% PLEASE BE CERTAIN THAT FORMS ARE PROPERLY SIGNED AND DATED AT THE BOTTOM 3 CITY of BAKERSFIELD i HAZARDOUS MATERIALS INVENTORY Farm and Agriculture FI StaAdard Business [] ~' R AD E S[C C R E T S Page ....... of BUSINESS NAME: OWNER NAME: NAME OF THIS FACILITY: LOCATION; ADDRESS; STANDARD IND CLASS CODE: .... CITY. ZIP: CITY. ZIP: DUN AND BRAD§TREET NUMBER ............ PHC E #' - - PHONE #: REFER 70--~NSTR[J~7~O/VS--F-OFi~PROPER CODES - - lrans !YRe Nax Averagei Annual Measure I ys Cont Cont Cont Us location.¥he{e. Code coue Ami Amt ~ Est Units on)lie Type Press lump Cole wt See lnstru:tlOnS . Stored In kacl/Ity Physical and Health Hazard : C.A.5. Number Component II Name I C.A.S. Number (Check all that apply) ! Component 12 Name I C.A.S. Number O Fire Hazard I-1 Reactivity Fl Belayed [] Sudden Release [] Immediate Health of Pressure Health -- I Component 13 Name I C.A.S. Number i I I I!1 I I I I I I I Physical mod Health Ua~ard (Check al/ that apply) t C.A.$. Number Component II Name I C.A,$. Number i Component 12 Name I C.A.S. Number [] Fire Hazard Ill Reactivity) [] Belayed I-1 Sudden Release I-) immediate Health of Pressure Health ~ Component 13 Name I C.A.S. Number Physical end Health Ua~erd , C.A.S. Number Component Il Name & C.A.S. Number (Check 811 that aPp/Yl i Component 12 Name I C.A.S. Number O Fire Hazard I-) Reactivity.! [] Belayed I'-) Sodden Release [] Immediate Health of Pressure Health ii Component 13 Name & C.A.$. Number .,,~ Physici)"ihd Health Ualard I C.A.S. Number Component II Name I C.A.S. Number (Check all'that app/yl Component 12 Name I C.A.S. Number [] Fire Hazard Fl Reactiviti F1 0eleyed [] Sudden Release [] Health of Pressure Component 13 Name I C.A.S. Number EHERGEHCY CONTACTS ¢1 . -. #2 Name iitie z4 Hr Phone Name Title erti[i~atioq ,(RepfJ and.~ign af~pr comp l~tiog.all secti.on~) cer[IKy.unoer penal~X @l)a) thqt I nave personal)Y.examlnqOlqo Qm Tamillm[vitb the. inlo(mat)pn )u~mitt~d in this end a11 at'~acnea.o~cvments, afl~ tpac omseo~on.my Inquiry 9~.tnose InalVlauams responslome Tot ootalnln9 the imormatlOfl. I believe that the suomltteo In[ormatlofl IS true, accurate, and compiete. ~i~e en~ dficiai ti~e of owner/operator OH owner/operator's authorized representative Sl~4-t. ure ? : CTTY of BAKERSFIELD " HAZARDOUS MATERIALS ' INVENTORY Farm and Agriculture [-] Standard Business I-] NON--TRADE SECRETS BUSINESS NAHE: , OWNER NAHE: NAHE OF THZS FACILZTY: LOCATION; ~ ADDRESS: STANDARD ZND CLASS CODE[ CITY. ZIP: , CZTY. ZIP: DUN AND BRAD§TREET NUHBER PHONE fi: , PHONE #: - - - - ! REFER TO ~wvnUCT~ON;~-'FCTR--PROP'ER CODES, Trans !y~e Nax Ay?rage! Annual Neasure ! gy~ Cent Cent Cent Use Location?eEo. xw~y Names of ~ixture/Cc~onencs Code CODe AmC AmC , Est Units on 51ce Ty~e Press Temp Code Stored in ~acl/1Cy See Instructions Physical and Health Nazard i C.A.S. Humber Component I1 Name ~ C.A.S. Number (Check all that apply) i ' Component 12 Name I C.A.S, Humber I-I Fire Hazard F1 Reactivity! E] Delayed [] Sudden Release [] Im~i~ ! Health o[ Pressure ~, Component 13 Name ~ C.A.B. Number PhYsical a~d Health Uazard i' C.A.B. Humber Component I~ Name & C,A.S. Number (Check al1 that app/~! I ~ Component 12 Name ~ C.A.S. Number I-I Fire Hazard F! ReactivitYi I-1 Delayed [] Sudden Release [] ]m~i~ ....... ' Health of Pressure Component 13 Name & C.A.B, Number Physical and Health Hazard I C,A,S. Number Component fl Name & C,A.S, Number (Check all that apply) - i '. Reactivity I-] Fire Hazard r'l I [] Delayed I-1 Sudden Release [] ]m~i~ Component 12 Name & C,A,S, Number ' Health of Pressure Component 13 Name & C.A.B, Number Physical'and Health ~a%ard i, C.A.S. Number Component I1 Name t C.A,S, Number (Check all.that apP~Y/ i* ! Component 12 Name & C.A.S. Number [] Fire Hazard E] Reactivit~ [] Oelayed [] Sudden Release [] ]m~i~ · ,' Health of Pressure [ Component 13 Name ~ C.A.S. Number EHERGENCY CONTACTS #1! #2 ~me ' TTtle z4 Hr PhOn~ /~e 'Tltle ertifi atio .(Re~¢l a,n.d. ~ fgn a£~¢r c0mp7~8 fog ,a 1 l sect i.on~) cer[~!y.unter ~ena~[X q~'~af tn~[ t~avepe[sonal~f, examin~qo~m tami~la(,~it~ the.into(ma~]pn fu~mitte~ in this,~nd all t~a;neo,~c~men[~, an~ [~a[ oaseo o~.mf ~nqu~rf ~f.[nose ~nol~loua/s respens~o~e for oo[a~n~n~ [ne~nformat~on, ! believe that the uom~tteo l~torml[lo~ Is [rue, accurate, ano colp/e[e, Na~e e,d oficili-L'ttle of o~ner/op~rator OH o,ner/op~rator's authorized representative Dgd~ture Oi[.T-Sf{~ed - BAKERSFIELD CITY FIRE DEPARTMENT I D # FORM 4A-1 Page _e-_ NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BUSINESS NAME: ~Y/$'7'~.'~ 7'~4u(~-~mqT'o/$oO,~/~/~OWNER NAME: f~,~tr;~,~ /~/F~ FACILITY UNIT ADDRESS: /00o ~, A/ Gr 5~ ADDRESS: ~/~o .~D/~ ~A~f FACILITY UNIT NAME: CITY, ZIP: m~M,~.~t~ C.~ /~o~ . CITY,ZIP: ~/<~5'~/~ ~, PHONE ~: ~0~- ~-~/~ PHONE ~: ~0~- 3FF-3//~' [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 OUIDE NAME: ~,~&/.A ~uRX TITLE: B~o/<~P~[' SIGNATUR~_~.~/~~ DATE: EMERGENCY CONTACT: ~B~N ~/Z TITI,~:.O&~~ PHONE ~ BUS HOURS: ~-~-~/~ AFTER BUS HRS: EME~GENCY CONTACT: ~I~P0A~ ~)~0~ TITLE: .. PHONE ~ BUS HOURS: ~o~. 3~F- "P~INCIPAL BUSINESS ACTIVITY:~UTO ~vOyPm/~r~'P$t~ AFTER BUS HRS: gD~- - 4A-1 - HAZARDOUS MATERIALS MANA ENT PLAN INVENTORY INSTRUCTIONS 5. ANNUAL AMOUNT: This should represent the anticipated annual (thru put) number of units of the material· ..... 6 .... MEASURE UNITS: .............. LBS = Pounds, for materials stored as solids GAL = Gallons, for materials stored as liquids FT3 = Cubic Feet at S..T.P., for materials stored as gases CUR = Curies, for radioactive materials 7. DAYS ON SITE: Days anticipated that this material will be at this site, for the calendar year reporting. 8. CONTAINER TYPE: (Use appropriate code) 01. Underground Tank 09. Glass Container(s) 02. Aboveground Tank 10. Plastic Container(s) 03. Fixed Pressurized Tank 11. Box(es) 04. Portable Pressurized Cylinders 12. Bag(s) 05. Insulated Tank (includes 13. Metal Containers (not cryogenics) drums) 06. Drums or Barrels - Metallic 14. In Machinery or processing equipment 07. Drums or Barrels - Non-Metallic 15. Bin(s) 0S. Corboy(s) 99. Other - specify 9. CONTAINER PRESSURE (Use appropriate code) 1 = Ambient Pressure (1-Atmosphere) 2 = Greater than'Ambient Pressure ~ 3 = Less than Ambient Pressure 10. CONTAINER TE~IPERATURE (Use appropriate code) 4 = Ambient Temperature 5 = Greater than Ambient Temperature 6 = Less than Ambient Temperature 7 = Cryogenic Conditions 11. USE CODES: (Use appropriate code) 01. Additive 11. Drilling 02. Adhesive 12. Drying 03. Aerosol 13. Emulsifier/Demulsifier 04. Anesthetic 14. Etching 05. Bactericide 1§. Experimental 06. Blasting 16. Fabrication 07, Catalyst 17. Fertilizer 08. Cleaning 18. Formulation 09. Coolant 19. Fuel 10. Cooling 20. Fungicide .HAZARDOUS MATERIALS MANAGEMENT PLAN r INVENTORY INSTRUCTIONS GENERAL INFORMATION: · ...... ....... Important.: ....... If-yOu~'-require'-more inventorY-'f~rms-than the one ........ "- provided, you should make p~o.tocopies of the forms prior to entering any information on them. The additional copies must be on the same color paper as the original. Information must be typed/printed in English. Make a copy for your records. Complete business name and address information. If t hey have been required, the number of separate facility units will be determined by the Bakersfield City Fire Department. Give each facility unit a common name, and a one or two digit number. NOTE: An inventory form must be made for each separate facility unit. The top of the form must be completed for each facility - s h o w i n g Business name and ~ocation as well as owner name and mailing address. Also include "SIC" Standard Industrial Classification Code and if available Dun and Bradstreet Number. Non-Trade Secrets (White Form). Non-Trade Secret Materials in one facility unit.. Trade Secrets (Yellow Form). Trade Secret Materials in one facility unit. · 1. TRANSACTION CODE: Is this inventory sheet new, an addition, deletion or update to your hazardous materials business plan. A '= Addition D = Deletion U = Update N = New 2. TYPE/CODE: 0 For the purpose of this entry,' there are three types of hazardous materials: P = Pure M = Mixtures of pure substances W =.Wastes. (Also add appropriate waste code) 3. MAXIMUM AMOUNT: This should represent the maximum number of units of this material present at any one time. (Refer to the "UNIT" section of these instructions) 4. AVERAGE AMOUNT: This should represent.the average amount, usually on hand at any ......... one---time. ' ...................... ~ Bakers re D t. Hazardous Materials Inspection Date Completed ~-~ Plan ~D # ~.15-000°c~ (Top ~ght co~e~ Bus~ess ~]a~) statio~ ~o. s~ ~e~o~ Adequate Verification of Quantities JUt 2 6 1989 VedficaQon of Location HAZ. MAT. ~oper Se~egadon of Mated~ Co~: Ve~cafio~ of MSDS A~aflab~ Nmber of Employees '~ ~D ~ ¢ 0 Verification of Haz Mat Trai~ng Coltllllents: Verification of Abatement Supplies & Proced es ~~.~ [~ Conlme. n~: ' Emergency Procedures Posted Containers Properly Labeled Comlnents: Verification of Facility Diagram [---] [-~ Special Hazards Associated with this Facility: /~2/F/~, 2~/~5 ~ct,5/'~¥ ~ <5 ' Violations: FO 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office SITE DIAGRAM ~' FACILITY DIAGRAM $1'TE DIAGRAM FACILITY DIAGRAM FAOILITY DIAGRAM INSTRUCTIONS Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. 1. Check the box in the upper right band corner of the form provided that indicates "Facility Diagram" 2. Print the name of your business as shown on your MMMP. Print the name of the area that this map represents. This name should De the same name that you used on this area's inventory report. 5. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled ~1 of 4. Follow instructions ( 5 - 7 ) for site diagrams regarding the specific details to De included on each facility diagram. 'MAP INSTRUCTIONS -,-- FOR HAZARDOUS MATERIALS MANAGEMENT pLANs These instructions explain t~e use of the site diagram and the facility diagram. Normally, emall and medium size businesses will only 6ave to submit a site diagram. ~ If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing an additional de.tail map, facility diagram, for each of these areas. Include instructions that show the route to your business if it is in a remote location. SITE DIAGRAM INSTRUCTIONS ( See Sample Diagrams, Attached) The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually with in ~00 feet. If you will be showing specific area detail on facility diagrams, use the site diagram to Show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include all of the following information. 1. Check the box on the top left corner of the form provided that indicates "Site Diagram". 2. Print the name of your business, as shown in your HMMP, on the top of the diagram. Label the location of the hazardous materials and identify them By name and type of hazard ( i.e. flammable liquid, corrosive sOlid ). 4. Label the location of utility shutoff points for gas, electric and water services. 5. Label the location of fire hydrants 6. Label portions, of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. ( The diagram form provided includes a north arrow.) Map labeling must be legible and ~aslly unOerstan~aDle. Try .................. to avO%d the use=-~f-~bbr'evi~tions'-d~-'~mb~l's- ~f-,you-must--use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follo~ these instruotions. SECTION 3: HAZARDOUS MATERIALS FOR THIS b~IT ONLY A. Boes this Facility Unit contain Hazardous Materials? ...... NO If YES see B If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES ~ If No, complete a separate hazardous· materials inventory form marked: NON'TRADE SECRETS ONLY (white form #4A-l) 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 only the trade secrets on form 4A-2. SECTION 4: PRIVAT~ FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 8: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT 0NLY. NAT. GAS/PROPAN~'~ B. ELECTRICAL: 'C. WATER: D. SPECIAL: E. LOCK'BOX: YES ./(~ fF YES, LOCATION: IF YES, SITE PLANS? YES ./-NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUS I NESS PLAN SINGLE FACILITY UNIT FORM SA INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions belo~ for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# / FACILITY UNIT NAME: SECTION '1: MITIGATION, PREVENTION~ ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY ~/El.F-l~h~o,~B /,0 C,,4Z6~ &y oF'~/V ~O~/~u//O~~ SECTION 4: PRIVATE RESPONSE TEAlV[ FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL 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. A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...' .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO E. DO YOU ~AINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION ?: HAZARDOUS I~ATERIAL CIRCLE Y~OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POU,~O~ A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... ( YESJNO I, ~q~~'~~ , certify that the above information is accurate. I undecstand that.this~'infocmation will be used to fulfill my firm's obligations undec the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes pecjury. BAKERSFIELD CITY FIRE DEPARTNENT ~,~'/'. 2130 "G" STREET RECEIVED I BAKERSFIELD, CA 93301 ', (805) 326-3979 [D~-~(~ NOV ............ Ans'd iD# U01101 BUSINESS NA~E HAZARDOUS I~IATER I AL S BUSINESS PLAN AS A WHOLE FORM 2A I~S~CT I O~8: 1. To avoid further action, return this form b~ 2. TYPE/PRIST ASS~ERS IS ESGLISH. ~. Answer the questSons belo~ for the business as a ~hole. 4. Be as brief and con'c~se as possible. SECTIO~ 1: B~SI~ESS IDE~I~IC~TIO~ B. LOCgTIOS / STREET ADDRESS: /~ ~, ~/~ ~ ~'~ SECTION 2: E~tERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 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. SECTION 3: LOCATION 0F UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: ~0N~ B. ELECTRICAL: C. WATER: D. SPECIAL: ~ ~o~ E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A -