HomeMy WebLinkAboutBUSINESS PLAN SITE DIAGRAM FACILITY DIAGRAM I'-"!
~u$ ;.-.ess Name:
!' Area MaD = o~
[ --~ Ncr-.h Name of Area:
ADJUSTMENTS TO ACCOUNTS RECEIVABLE
DATE
~ ~ S ADJUSTMEY
( ) .SERVICE
PRO2~RTY OWNER = ......
CORY~---C.-'--D I ADJ. TO
SELLING AMOUNT EZLL!NC- AMOUNTJ ~iL: ~1(C, - (-) DATE
t
1
APPROVED
-CITY of' BAKERSFIELD
HAZARDOUS MATERTALS 'r NVENTORY
Farm and ADticulture [] Standard Business [] NON--TRADE SECRETS
- ~ ~--/ - '' : REFER TO~~~NS-~R~ROPER CODES --
I 2 ) 4 5 6 1 8 9 10 11 12 13 Il
CodeTrans coae[Yge A,tHax Av~rageRet AnnuelEsL Heasureun~ts onl ~e ~ont COntPress ContTemp ColeUS Locqtion.XheEe ~ by tlaeeSseeOf Uixture/CoeDonents
~ype Storea In PaClllty ~t ]nstru:L~ons
Physical and Health Hazard C.A,S. Humber Component II Hame t C.A,S Number
(Check all tha[ apply) '
~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ lmmediaceCOmponen[ 12 Name IC.A,S. Number
Health of Pressure Health
Component,3 Name SC.A.S. Number
Physical and Health Hazard C.A,S. Humber Component II Name I C.A,S. Number
(Check 81/ that
ComponenL 12 Name t C.A,S. Number
~ Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release ~ Immediate
Uea ILh of Pressure
Health
Component 13 Name I C.A.S. Humber
(Check a11 that apply)
He~l~ of Fressure Healt~
Physical 8nd Health ~alard C,A.S. Humber Component II Name I C.A,S, Number
(Check 4/I that applH
Component 12 Name I C.A.S. Number
~ Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release ~ Immediate
Health of Pressure Health
Co~ponent 13 Name I C.A.S. Number
EHERGEHCY CONTACTS fll
~me rT[le ~4 Hr Phone R~e Tl[le
cer~t~ under ~ena~x g~a~ ~n~t ~navepe[sonal~L examln~eqo]m rami~ar.~it~ the ~nlo(maHpn ]u~aiLt~d in this ~nd all
at,ached.dOcuments, and [pac cased on.my ]nqutry 9t.~nose Ifl~lVl~U]lS respons~o/e tot obtatn~n9 the tn~or~aHon. I believe that. the
su~]~teo ~nforaaLIoo IS true, accurate, and complete.
Hazardous Materials Divisio~''~
HAZARDOUS MATERIALS MANAGEMENT PLAN '
Facility Unit Name:
SECTION 6: NOTIFICATION AND EVACUATION 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:
A, RELEASE PREVENTION STEPS:
B, RELEASE CONTAINMENT AND/OR MINIMIZATION:
C, CLEAN-UP PROCEDURES'
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
SPECIAL'~
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILI~:
A. PRIVATE FIRE PROTECTION:
B, WATER AVAILABILITY (FIRE HYDRANT):
Bakersfield Fire Dept.
Hazardous Materials Division
2130 "G" Street RECEIVED
Bakersfield, CA. 93301 JUN ! ]990
,~ns'd ............
HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
1. To avoid further action, return tills 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: ./~(~¢)~E
LOCATION'. ~/2_ /,~J ~zrz~ , /~~, ff__-~. ~0 t..
MAILING ADDRESS' _<'~/?ff'/~,~'--~ ./~' ~//~"~-'--
CITY: STATE:_ ZIP: PHONE: ('~'~.,/-~2'?-"2~'7/'
DUN & BRADSTREET NUMBER: SIC CODE: C~
PRIMARY ACTIVITY:
MAILING ADDRESS:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24 HR. PHONE
FD15~
Bakersfield Fire Dept. ~.
Hazardous Materials Division
HAZARDOUS 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 CO/DE" 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:
l, ~-~_~ofQ~' ~--~ (~ CERTIFY THAT THE ABOVE INFOR*
MATION IS ACCUitl)kTE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6,95 SEC. 25500 ET AL.) AND THAT
INACCURATE INFORMATION CONSTITUTES PERJURY.
SIGNATURE TITLE DATE
FD1590
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,~ ~. ~,/~~ Y/0-~-
LOCATION: qt L l~ ~
MAILING ADDRESS: ~'M~--
CITY: F*~~e(~ STATE: :~ ZIP: ~ ~ I PHONE: ~
DUN · BRADSTREET NUMBER: SIC CODE:
PRIMARY ACTIVITY:
OWNER' ~-'~' L I i'':~
MA,',N~ A~O~"::SS: ~ ~x ~~ ~r ~,~~{~ ~ ~¢~.~
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24. HR. PHONE
FDI~
Bakersfield Fire Dept.
Hazardous Materials Division
HAZARDOUS 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, 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 DATE
2.
FO1590