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Home My WebLink AboutBUSINESS PLAN BAKERSFIELD CI,T~, FIRE DEPARTMENT ~ ~ 2130 STREET ~ BAKERSFIELD, CA. 93301 _~ ~'~ / (805) 326-3979 ~. ~ ~ OFFICIAL USE ONLY ID# BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this from 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. ~CTION 1; BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: -'~~~ B. LOCATION / S~REET ADDRESS: ~ J I~+~ CITY:.~[:~f~-~2~£~-~ ZIP: ~ ~.~3~/ BUS. PHONE: (~m5~3~3-~'~ SECTION 2; EMERGENCY NOTIFICATIONS In case of an emergency involving :he 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 depar~men[ and the S~ate Office of Emergency · Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAHE AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A.~/[/~ -'T-/-f~-J,r)~]~/L'/ PH# $~)-~/ pH#~?/-~¥~L- B PH#~ ~ PH# SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NATURAL GAS/PROPANE: /l//~,/~'~' B. ELECTRICAL: . GA,/ ~1! 9J~J~ ¢~Ji/,~/~'~7'"c'-Z) ~ ]~r+~ ~'-~' C. WATER: ~~ ~Y,~ ~'~'~I,4y~ O. SPECIAL: . /~x'~/~.~=.~ E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A SECTION 5: LOCAL EHERGENCY HED~CAL ASSISTANCE FOR YOUR BUS~NESS AS A WHO~ SECTION 6: EMPLOYEE TRAINING EHPLOYERS ARE REQUIRED TO HAVE A TRAiNiNG PROGRAH NH~CH PROVIDES EHPLOYEES N~TH ~N~T~AL AND REFRESHER TRAiNiNG ~N THE SAFE HANDLING OF HAZARDOUS HATER~ALS, A. NUMBER OF EMPLOYEES AT TH~S FACILITY B, DO YOU HAVE NSDS (NATER~AL SAFETY DATA SHEETS) FOR EACH HAZARDOUS NATER~AL YOU HANDLE ~ C. G~VE A BRIEF SUMMARY OF YOUR HAZARDOUS MATERIALS TRAiNiNG PROGRAM: SECTION 7; 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 AND SAFETY CODE FOR THE FOLLOWING, REASONS: ~ WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANO~E HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES, · OTHER (SPECIFY REASON) SECTION 8: CERTIFICATION I', ~/IE~' ~ , certify that the above information is accurate. I understand that this information will be used to fulfill my firm's obligations under th~ new'California Health and Safety code on Hazardous Material. s. (Div, 20 Chapter 6.95 Sec'. 25500 Et Al.) and tha~ inaccurate information constitutes perjury, SIGNATU TLE ~Lxj~~ DATE BAKERSFIELD CITY FIRE. DEPARTMENT 2130 'G' STREET BAKERSFIELD. CA. 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 3A ~NSTRUCT~ONS 1. To avoid further action, this form must be 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 UNIT # ,FACILITY UNIT NAME' SECT[ON 1: NIT[GAT[ON, PREVeNTiON. ABATENENT PROCEDURES ~ECT[ON 2: NOTIFICATION 'AND EVACUATION PROCEDURES AT THE UNIT ONLY SECTION 3: ~AZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does~his Facility Unit contain Hazardous Materials? ...... YES NO If NO, con~i,~ue with S~ECTI ON 4 8. Are any of the ~dous materials a bona fide Trade Secret? ~ES NO If NO, complete/~ sel3~ate Hazardous materials inventory form marked:/.NON-TRADE ~EqRETS ONLY (white form #4A-1) If YES, comp. lete a hazardous materials inventory form marked: TRADE SECRETS ONLY (Yellow form f4a-2) in addition to the non-trade- secret form. List only the trade seCrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS (Fire Hydrant) SECTION 6: ION OF UTILITY SHUT-OFFS AT THIS UNIT LY A. NATURAL GA~7~.~E: B. ELECTRICAL: ' D. SPECIAL: E. LOCK BOX: YES / NO IF YES, ~OCATION: IF MSDSs? YES / NO YES, SITE PJyANS? YES / NO FLOOR PI~ANS? YES / NO KEYS?- YES / NO - 3B- CITY of BAKERSFIELD ~ON~TR~D~ ~R~W~ BUSINESS NAME:~~ ~. .OWNER NAME: ~1~ F T~g~ ~t NAME OF T~ FACILITY: LOCATION: ~ -~-~ ADDRESS: ' STANDARD IND. CLASS CODE CITY, ZIP: R~M~j~ ~~ CITY, ZIP:-~~J~ DUN AND BRADSTREET NUMBER ~ ~ ~ 4 S 6 T B ~ 10 11 12 11 li Tra~s Ty~ ~x Average ~nua] ~asu~ I ~ Cmt ~t ~t ~e L~tt~ N~e TN~, Nam of C~e C~e ~t ~t Est Units m Stte Ty~ Pr~e Trna C~ Stor~ in Fac~ltty ~ Inst~cttms Ph~ical and Health Hazard C.A.S. ~ C~mt 11 ~ & C.l.S. ~ ~1 tMt apply) Hazard ~--. Reactivity ~--~ N14~ ~ ~ela~e ~--- l~tate Health of P~re HMith ......... ~t la ~&C.A.S. ~ P~ic, l ~ H, lth Hazard C.A.S. ~ ~t II N, & C.A.S. ~ (C~k all t~t apply) ~~-- ~ Ft~ Hazard [ ] ~ct~vtty [ ~ ~la~ ~--J ~m eel~ ~--J i~late ~- ~-, ' NNlth of P~ ~lth ......... _,L_L: I L [ I .i__ ! I L .... l ................. - r--~ r--n -- -- ~t 12 Nm&C.~.S. ~ [ ~ Fine Hazaed u--d Reactivity ~--~ ~la~ ~ ~ ~dd~ Rel~se ~ ~ I~ate Health of Pr~sure Health '~ , ...... ....... L' .......... L ............. L ........... J. I !:: ~_~__.1 ..... J .... _, (C~k all t~t aaaly) ..................... - -- -- r--~ -- C~t 12 Nm & C.A.S. ~ ~ Fine Hazard [ ~ R~ctivity ~ ~ ~la~ u_J ~dd~ Rel~se I-Jrt I~tete Health of Pe~sure Health ....... - ...... ~t 13 N~ & C.A.S. N~e ~NE~GENCY C~TACTS I1 12 RS~': ................................... ~[]i ....................... H'RF-P~i ........ lib Tt~li' ~-al- Certfficati~ ~ead an~ s~n after coep]etjng a]J [ certify ~dee ~alty of 1aa t~t ] ~ve ~rs~allyexaain~ and a. feeiliar .tth t~ infoe~itt~ tn this ~ ~11 attac~ d~ts, ~d t~t ~s~ ~ ~ inqui~ of t~e for obtaining t~ infor~tim, I ~lieve t~t t~ su~itt~ info~ti~ is true accurate a~ q~ple~. ~i['~[~'~Hi[i~I-H[I~'~T'~[~[['Ol-~7~[H~['~'~E~i~'~[[[~gt~H~ ' ' .......... O~'Si~ ............................ SITE/FACILITY DIAGRAM FORM 5 NORTH SCALE: BUSINESS NAME: FLOOR: .OF DATE: / FACILITY NAME: UNIT #: OF (CHECK ONE) SITE DIAGRAM ~ FACILITY DIAGRAM / Inspector's Comments): -OFFICIAL USE ONLY- - 5A - S[T£ DIAGRAM (Req~ items) ~ : ~ ~- '1. Address: Identify the 9. Lock Box '~- principle buildings '~' by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys. 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 (Masonry construction 15. Tanks: Storage Identify the · c. Metal construction· capacity in 8al. a. Above ground d. Access Door b. Underground 6. Utility Controls a. Gas ~{/CV~q/~' 16. Diking or Berm ( ~Electricity · i?. Evacuation Route ( Water 18. Evacuation Area: Identify the ?. Fire Suppression Systems: location where a. Fire Hydrants employees will meet. b. Fire Sprinkler , 19. Outside Hazardous Connections Waste Storage c. Fire Standpipe 20,.Outside Hazardous Connections Material Storage d~ Water Control Valves 21. Outside Hazardous for proiecfion systems M~terlal i Us~/Handling e. Fire Pump 22. Type of Hazardous Material/Waste Stored 8. Fire Department Access or Used (See .Below) ; TYPE OF HAZARDOUS-- --MAT'ERI~L''' F = Flammable E = Explosive L.= ~lquld R = Radlologlcal C = Corrosive 0 = Oxidizer O = Gas P = Poison W = Water Reactive T .= Toxic S' ;'Solid H = Cryogenic .D =,Waste ' 'B' - Etiological Example: Flammable Liquid = FL FACILITY DIAORAM (Required items in addition to the above) 1. Risers for Sprinklers 8. Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest. 11. Inside Hazardous Masts 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. Sewer Drain Inlets MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE ~-/\-~c~ NEWACCOUNT i ADDRESSCHANGE CLOSE ACCT ' FINANCE CHARGE, ;OTHER ADJ , CUSTOMER NAME MAILING ADDRESS SITE ADDRESS PARCEL NUMBER (IF APPMCABLE) ADJUSTMENT CHG DATE '"CHARGE CODE I ADJUSTMENT AMOUNT APPRO~D BY CUSTi~PE & NO. ~ ~_~ ~-~ MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE /-~/- ~"/. NEWACCOUNT ~ ADDRESS CHANGE CLOSE ACCT FINANCE CHARGE t ' OTHER ADJ MAILING ADDRESS SITE ADDRESS PARCEL NUMBER (IF APPLICABLE) ADJUSTMENT CHG DATE ' CHARGE CODE ADJUSTMENT AMOUNT REMARKS' APPROVED B~,~~ ..~ MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE C~_~_ ~ NEVV ACCOUNT ADDRESS CHANGE CLOSE ACCT FINANCE OTHER ADJ PARCEL NUMBER (IF APPLICABLE) ADJUSTMENT CHG DATE ~ CHARGE CODE ADJUSTMENT AMOUNT APPROVED BY ~: r~ll~: nAmR? tlnllq~ PAYMENT_ DIIE: 388.10 STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-0000 .; (805) 326-3979 ., · CUSTOMER NO: 3459 CUSTOMER TYPE: ES/ .3459 .... CHAR~ .... DATE DES~TPmTON D~ CO H~ . 1026 MONTEREY STREET B~ERSFIELD, CALIFORNIA 93305 '- '.' ~STU~N TO 5~ND~ nli~! name? ~/nl /qR PAYMRNT DUE: 388.~0 STATEMENT OF ACCOUNT CITY OF BAKERSFIELD ~ 1501 TRUXTUN AVE BAKERSFIELD, CA 93301-0000 (805) 326-3979 TO: DANMAN CO - 901 18TH STREET m~?~ BAKERSFIELD, CA 93301 CUSTOMER NO: 3459 CUsToMER TYPE: ES/ 3459 P.O. BAKERSFIELD, CALIFORNIA93303 ~ x. .~a /r,~e:~;~: ADDRESS CORRECTION REQUESTED : DANMAN CO ~OV~D L~T NO ~DDR~ RETURN TO SENDER