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Home My WebLink AboutBUSINESS PLAN .~, FACILITY GIAGRAM ~ECEIVEB SlY E DIAGRAM .~, J U t 3 0 -~- "',,? SITE/FACILITY DIAGR~ NORTH SCALE: BUSINE~ N~E: FLOOR: 0F DATE: / / FACIL~Y N~ME: ~ .~ UNIT ~: OF (CHECK ONE) SITE DIAGRAM ~ FACILI~ DIAGR.~ (Inspector's Comments): -OFFICIAL USE ONLY- S ~T£ D[AGRAM (Re~ I terns) ke .: ; ": / l, Address: Ideflti~q~l~he '9. Lock ( Box ~ ~- principle buildings · ' .., ,. ',''~,, ~, by the Street numbers, lO. MSDS Storage Box 2. Street(.), Alleys, .11. Railroad Track. '' Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Wire s~reet names. b. Masonry 3, Storm Grains. Culverts. Yard Drains c. Wood 4. Drainage Canals. Ditches, d, GaZes Creeks, 13. Powerlinea 5. Buildings a. Frame construction 14. Guard Station b. construction IS. Tanks: Masonry Storage identify the c. Metal construction capacity in gal. a. Above ground d. Access Soot b. Underground e. Utility Controls a. Gas 16. Diking or Berm b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: identify the ?. Fire Suppression Systeas: location where a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c. Fire Siafldpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fire Pu~p 22. Type of Hazardoua Material/Waste Stored 8. Fire Department Access or Used (See TYPE OF HAZARDOUS MATERIAL F - Fishable 8 - Explosive L - Liquid R - Radlological c - Corrosive 0 - Oxidizer O - Gas P - Poison M - Mater Reactive T - Toxic 9 - Solid H - Cryogenic D - Masts B - Etiologlca! £xanplo: Flammable Liquid - FACILITY OlAOP~ (Required Items in addition ~o the above) 1. Risere For Sprinklers 8. Firs Escapes 2, Partitions 9. Alt Conditioning Unite 3. Stairways: Indicate the 10, Windows levels served from highest to lowelt, ll. Inside Hazardous Waste Storage 4, Escalator: Indicate the levels served from 12. inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Materials Uae/Handling 8. Attic Access " 14. Se~r Drain Inlets 7. Skylights ~'~ l~field Fire Dept. HAZARDOUS MATER'S INSPECTION · ~ . ...................... ,~,~,,~ ...... ~ ~ ........ ~:~ Haz~us'Matedals Division Date Completed //-/ Business Name: ~ ~, ~ ~ ~ ~ Location: /O~ ~ / ~ ~ Business Identification No. 215-000 ~/~ ~ (Top of Business Plan) Station No. Shift Inspe~or ~al Time: Depa~m Time: Inspe~on Time: Adequate Inadequate Verification of Invento~ Materials Verification of Quan~es Verification of Loca~on Proper Segregation of Material Verifica~on of MSDS Availabil~ Number of Em ~'~ Verifica~on of Haz Mat Training Commen~: __ of Abatement Supplies & Procedures Commen~: ~ 5.~ Emergency Procedures Posted Containers Prope~ Labeled Verifica~on of Facil~ Oiagram Hazards Associated ~ ~is Facile: Violal~ons: I All Items O.K O Business Owner/Manager PRINT NAME SIGNATURE Correction Needed r'l White-Haz Mat Div Yellow. Station Copy Pink-Business Copy ~ CITY of BAKERSFIELD FIRE DEPARTMENT ~ FIRE SAFETY CONTROL & HAZARDOUS MATERIALS DIVISIONS 1715 CHESTER AVE. * BAKERSFIELD, CA * 99301 R.E. HUEY November 30, 1995 R.B. TOBIAS, HAZ-MAT COORDINATOR FIRE MARSHAL (805) 326-3979 .:~ (805) 326-3951 John Fleming Precision Collision Repair 1000 18th Street Bakersfield, CA 93301 Dear John: Per your request, please find a computer generated printout of the business plan for C N Johnston Body Works, the former tenant at 1000 18th Street. I have also enclosed a complete set of blank inventory forms. You can make corrections on the computer print out, but, use the new forms for any inventory changes and for a site diagram or map. If you have any questions, please feel free to call. Sincerely, //') ~. ~.. /,,/ ._ .-.~.>'-'- .f - /. : .... , ..'/5 ,,":..,..~": ..... · J Ralph E. Huey Hazardous Materials Coordinator REH/dlm enclosures 02/24/92 C N JOHNSTON BODY WORKS 215-000-000165 Page 1 Overall Site with 1 Fac. Unit General Information Location: 1000 18TH ST Map: 103 Hazard: Moderate Community: BAKERSFIELD STATION 01 Grid: 30C F/U: 1AOV: 0.0 I C°ntactName IF~eh~ ~ ~ Title i Bus ines s Ph~~.u-r--P.hone- {~24~4e~-8~ '( 8~22=-1m~8~' ~BENDER MANAGER (805) 324-4708 x 1(805).~2-7448 Administrative Data Mail Addrs: 1000 18TH ST D&B Number: 04-115-6266 City: BAKERSFIELD State: CA Zip: 93301- Co~ Code: 215-001 BAKERSFIELD STATION 01 ~ SIC Code: Phone:~og Owner: '-' ' ~e~i~ ~ ~g~,~o~' Address: ~Si ~che~ ~~ ~ State: CA City: ~FiE5D - ~a/N~ ~Ze~l< ~ Zip: ~ Sugary ' ('ryP'O'pd,.,,.~.) " reviewed the atmchect ~aZardous materials manage- ment plan t~,~ N' ~'-o ~ ~ ~o,,And ~that it along with' any corrections constituts a complete and correct man- ag~ment plan for my facility. 02/24/92 C N JOHNSTON BODY WORKS 215-000-000165 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN ' Gas 3370 Low · Fire, Pressure, Immed Hlth FT3 CAS ~: 7782-44~7 Trade Secret/: No / Form: Gas Type: Pure /Oays: 365 Use: WELDING SOLDERING / .Max~ Daily FT3~ ~ ~aily Average FTJ Annual Amount FT3 Storage~(~' ~/ ~ _4,000.00 · Press I Temp Location .PORT. PRESS. CYLINDER Iabove IAmbientlNoRT~ EAST WALL -- Conc Components MCP --~List 100.0% IOxygen, Compressed ILow 02-002 ACETYLENE Gas 3300 High · Fire,. Pressure, Immed Hlth FT3 CAS #: 74-86-2 Trade Secret: ~,o/ / Form: Gas Type: Pure k _Da~:/ 365 Use: WELDING SOLDERING Max~ I ;~Da~y Ave Daily FT3___~ rage FT3 Annual Amount FT3 · 2,000.00 4,000.00 Storage Press T Temp Location PORT. PRESS. CYLINDER [above ~ambientlNORTH EAST WALL -- Conc Components MCP List 100.0% IAcetylene ~ IHigh I ' 02/24/92 C N JOHNSTON BODY WORKS 215-000-000165 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation CALL TO LEAVE BUILDING IN CASE OF FIRE <3> Public Notif./Evacuation WE HAVE 6 VERY LARGE DOORS CALL FIRE DEPARTMENT SMALL AMOUNT OF PAINT <4> Emergency Medical Plan MEMORIAL HOSPITAL - 420 34TH ST - 327-1792 MERCY HOSPITAL - 2215 TRUXTUN AV - 327-3371 02/24/92 C N JOHNSTON BODY WORKS 215-000-000165 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt · <1> Release Prevention OXYGEN AND ACETYLENE BOTH CHAINED TO WALL USE PROPER VALVES AND FITTINGS <2> Release Containment <3> Clean Up <4> Other Resource Activation 02/24/92 C N JOHNSTON BODY WORKS 215-000-000165 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - ALLEY B) ELECTRICAL - INSIDE SHOP REAR RIGHT CORNER WALL C) WATER - ALLEY D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - WE HAVE 17 FIRE EXTINGUISHERS - NO WATER TIE INTO THE BUILDING FIRE HYDRANT - IN ALLEY BETWEEN 18TH & 19TH ON O STREET NORTH CORNER <4> Building Occupancy Level 02/24/92 C N JOHNSTON BODY WORKS 215-000-000165 Page 6 ~00 - Overall Site <G> Training <1> Page 1 WE HAVE ~EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: WE HAVE MEETINGS <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use HAZARDOUS NA~ERIALS INVENTORY ~ Farm and Agriculture ~--] Standard Business ~ Page__of__ NON - TRADE SECRET LOCATION: /OOO ~ , ~ .' / ADDRESS: STANDARD IND. CLASS CODE: CITY, ZIP: CITY, ZIP: DUN AND BRADSTREET NUMBER/FEDERAL ID PHONE #: , PHONE #:- _ _ - - REFER TO INSTRUCTIONS FOR PROPER CODES '1 2 3 4 5 6 7 8 9 10 11 12 13 14 Tra~s Type Max Average Annual Measure # Days Cont Cont Cont Use Location Where % by Names of Mixture/Comp6nents Code Code Amt Amt Amt Units on Site Type Press Temp Code Stored in Facility wt See Instructions IV' t' P, I ~:) I / ~-~ I ?~ I/v-~'~ I &6~--io'-/ I :7__. I ~. I '/zl-/,,to ~, L, 0~./ Physical and Health Hazard C.A.a. Number Component # i Name '& C.A.S. Number ./ . (Check all that apply) Component # 2 Name & C.A.S. Number / [] Fire Hazard ~ Sudden Release ~ Reactivity ~ Immediate ~ Delayed of Pressure Health Health Component # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # 1 Name & C.A.S. Number (Check all that apply) Component # 2 Name & C.A.S. Number [] Fire Hazard [] Sudden Release [] Reactivity [] Immediate [] Delayed of Pressure Health Health Componen~ # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # i Name & C.A.S. Number (Check all that apply) Component # 2 Name & C.A.S. Number of Pressure Health Health C~mponent # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # I Name & C.A.S. Number (Check all that apply) Component # 2 Name & C.A.S. Number of Pressure Health Health Component # 3 Name & C.A.S. Number EMERGENCY CONTACTS #1 #2 Name Title 24 Hr. Phone Name Title 24 Hr Phone :ertification (READ AND SIGN AFTER COMPLETING ALL SECTIONS) I certify under peanlty of law that I hayer personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those individuals resPOnsible for obtaining the information. I believe that the submitted information is true, accurate, and complete. NAME AND OFFICIAL TITLE OF OWNER/OPERATOR OR OWNER/OPERATOR'S AUTHORIZED REPRESF~N'IL%TIVE SIGNATURE DATE SIGNED - · Bakersfield Fire D~'l~g. R E c Ely E ~ Hazardous Materials Inspection O C'[ 1 6 1989 Date Completed tO; ~ ~ - %' c~ns'd ............ Business Name : ~ ~ ~~ ~. ~o~ Location: ~000 ~ Plan ID · 215-000 ' t ¢ ~ (Top right comer Business Plan) Station No. ~ SN~ A Inspector ~c&~ Adequate Inadequate Verification of Invento~ Materials ~ ~ Verification of Quantities ~ ~ Verification of Location ~ ~ ~oper Se~egafion of Material '~ ~ Co~B: Verification of MSDS Availabfli~ ~ ~ Nmber of Employees ~ Verification of Haz Mat Trai~ng ~ ~ Co~: Ve~cafion of Abatemem Supples & Procedures ~ Co~: ~e~ency Pr~ed~es Posted ~ ~ Gontainers Properly Labeled ~ ~ Co~: Ve~cafion of FaciU~ Dia~ ~ ~ Speci~ Haz~ds ~sociated ~th t~s Fac~: ~olafio~: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office ,,"~. _-?% %,l CiTY ~ RECEI~D HAZ. ~AT. DIV. Do hereby c=-t~ :-- ' ~ ~z~ that I have reviewea the attached Hazardous Materials business ~lan for c.N. Johnston Bo~.[ WorksT Inc. (name of business) and that it along with the attached additions or corrections constitute a complete and correct Business Plan for my facility. sl~na~ur.e date - · "- ' 'CITY of BAKERSFIELD Far, and Agriculture ' ' Standard 8usi.ess ~ Z'ZJ~L?:J~.RI::)OT..TS ~~~ ~~ ~ ~~~.0~' CITY, ZIP:~~,~. q~O/ CITY, zIP:FD~ -~ ~STO..[~ DUN AND BRADSTREET NUMBER. ~ ~0 Z~S~UC~ZO~S ~0~ PROP~ COD~S l~o,s Ty~e Hax Average Annual Heasu~ I ~ C~I ~ G~I Use L~a~l~ ~ ~Nbyl Nam of ~ Fire Hazard ~--~ Reactivity-~- ~]ay~ ~ ~dd~ Re]ecsc ~--~ Health of Pressure H~lth ............. C~t' 13 Name & C.A.S. Number (Check ail t~t ap~ly) -- ~ ' . ................................... ~Fir. r--~ C~t m2 NaN & C.A.S. Nu,~ --u Reactivity ~lay~ ~dd~ Release ~--J IM~iate ........... Health of Prusure H~lth Ph~ical and Health Hazard C.A.S. Num~ ~t II NaM & C.A.S. Nua~ (C~k all t~t apply) [ ] Fire Hazard ,~--u Reactivity u--J Oelay~ ~--J ~ddm Release ~--J l~iate Health of Pr~su~ Health ) C~et 13 Na~ & C.A.S. Numar Ph~ical and Health Hazard C.l.S. Num~P Cm~et I1 Na~ & C.l,S. (Ch~k all that aaoiy) r--~ Ca,et 12 Na~ ~ C.A.S. ~ ~ Fire Hazard ~ ~ Reactivity ~-- Oelay~ ~dd~ Release l~tate Health of Pr~sure Health .............. Ca,et I1 Na~ A C.A.S. Nua~e ,Certificat~ (Read and sJRn after compJetln~ all sectlons) certify under ~alty of la, th~t,l have. oerspnallyexae~ned and aa faailiar etth t~ infor~a~~~n thi}~a~ attac~ua~ts, and t~t ~sed m W inquiw of t~se individuals res~sible CITY of BAKERSFIELD Farm and 10riculture t...J Standard Business ~ I'~:JI:~LZARDOUS ~v~.al:~TERi ~t.r.S 'i" ~~~.O~' ~ page .... of ADDRESS: . ~VI,~ ~ ff~, ~ ~ STANDARD IND. CLASS CODE: CITY, ZlP:~e~~e~ff~{ ~,30/ CITY, ZIP:~'~.2~~ ~ ~ ~( DUN AND BRAOSTREST NUMBE~ lrans lyre Max Averaqe Annum Measure I ~s C~t Cffit Cffit Use L~attffi W~ :~N~t' Na~s of M~xture/C~ts Code Code ' Art Art Est Units ffi Site Iy~ Presl THa C~e .. Stored in Facility See Instructiffis .ffl_ff} ..... ~ ......... ~m__k_~.~.~~ ............. ~~2~3.._~~ ........................ Health of Pre~sure ~lth ............................................................. ., , · ~ ~ , . .. _~1_~1~__~_L.~6~1_..~~1 ..... lzgTf~&.l~..J_i~2?-_~.L~~.~~ ....... ,_.~_~~..~~~ ........ (ch.~..,,?t .pp~v) ....... ~.-~ ~'~ -gT~ff~' / .... ~ ~~+-:-~~:-~-~ .......... u_d Fire Hazard L--J Reactivity u_d ~lay~ .~--d ~dd. Release ~J l.~t~t~ t~ ~ -~?~ 0 /~~[ t~~A~--~~ ....... ' Health Of Pr.sure - ' H.Ith ,~ /:~ ' ' C~om~t I Nam i C.& S. .~e ~ ~ ; ~ ~' .... ~ ...... t ............ 1 ...... 2 ...... L ......... ,[ t-D~~I___I ' ..... ' . ....... Ph~ical and Health Hazard C.l.S. Nua~ ~et II la~ i C.A.S. (C~k all tMt apply) r-q r--~ r--q r-a r--q C~t 12 Na~ & C.A.S. ~--" Fire Hazard.~--a Reactivity ~--J 0elay~ ~--d Sudd~ Release ~--J i~iate Health of Pr~sure Health -~. C~et I1 Na~ I C.A.S. ~um~e .... 1: ..... l ............ l .............. L .......... 1 ~ .L2.~1__2 ............. Ph~ical and Health Hazard C.A.S. Numar C~ffit I1 Na~ & C.l.S. (Ch~k ail that r--n r--~ r--q [--] r--~ C~t 12 NaN & C.A.S. c_d F~re Hazard ~--J Reactivity. ~--~ ~layed -- ~dd~ Release ~--J S~ate . Health of Pr~sure Health ............. C~et 13 Na~ & C.A.S. Numar ~iG ................................ . m~E---~ ................. n-~rpm~ ....... .~ .... ~ ....................... Tm~ ............. ~- ........ -~[-,~-p~, ......... .,Certification (Read and s~En after compJetlnE all ~ectlons) I certify unden ~atty of law that I have personally examined efld am familiar etch t~ tnfarm~ln thjrC~ll /ttac~ d~ue~ts, and t~t ~sed ~ ~ inquiry of t~se individuals ees~sible foe obtaining th. informing.. 1 .lieve t~t t. submitted infon.ati, i. true..~curat...n~_~ : . · ....-....------------- ~ _~- BUSINESS NAME C N JOHNSTON BODY WORKS ID NUMBER 215-000-000165 LOCATION ' 1000 18TH ST HIGH HAZARD RATING 3_ 1. OVERVIEW LAST CHANGE 11/13/87 BY ESTER JURIS CODE 215~001 "JURIS BAKERSFIELD STATION 01 MAP PAGE 103 GRID 30C FACILITY UNITS 1 HAZARD RATING 3 RESPONSE SUMMARY 2A SEC 4) DON BENDER - 832-7448 EMERGENCY CONTACTS 2A SEC 2) MEMORIAL HOSPITAL - 420 34TH ST - 327-1792 MERCY HOSPITAL - 2215 TRUXTUN AV - 327-3371 UTILITY SHUTOFFS 2A SEC 3) A) GAS - ALLEY B) ELECTRICAL - INSIDE SHOP REAR RIGHT CORNER WALL C) WATER - ALLEY D) SPECIAL - NONE E) LOCK BOX - NO LAST CHANGE / /PJ~/~ BY ~, ~- '(-~_ ~ ~< N~N~ION RECORDED~~~_.FOR THIS SECTION > PAGE 1 12/13/88 14:53 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME C N JOHNSTON BODY WORKS ID NUMBER 215-000-000165 LOCATION 1000 18TH ST HIGH HAZARD RATING 3 FACILITY UNIT 01 A . OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 10/15/87 BY EVAMC ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE OXYGEN 3370 FT3 HIGH NORTH EAST CORNER PORTABLE PRESS. CYL. WELDING/SOLDERING ID PERCENT COMPONENTS HAZARD LISTS 2359.00 100.0 OXYGEN, COMPRESSED HIGH 2 PURE ACETYLENE 3300 FT3 EXTREME NORTH EAST CORNER PORTABLE PRESS. CYL. WELDING/SOLDERING ID PERCENT COMPONENTS HAZARD LISTS 1241.00 100.0 ACETYLENE EXTREME FIRE PI~OTECT I ON / WATER SUPPLIES LAST CHANGE 11/13/87 BY ESTER < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 3 12/13/88 14:53 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME C N JOHNSTON BODY WORKS ID NUMBER 215-000-000165 LOCATION 1000 18TH ST HIGH HAZARD RATING 3 3 . HAZ MAT TRAINING SUMMARY / ,,._. ~, y,~,,.~ ~ST CHANGE / I~J7 ~ BY < NO INFORMATION RECORDED FOR THIS SECTION > 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 11/13/87 BY ESTER 2A SEC 5) MEMORIAL HOSPITAL - 420 34TH ST - 327-1792 MERCY HOSPITAL - 2215 TRUXTUN AV - 327-3371 PAGE 2 12/13/88 14:53 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME C N JOHNSTON BODY WORKS ID NUMBER 215-000-000165 LOCATION 1000 18TH ST HIGH HAZARD RATING 3 n . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 11/13/87 BY ESTER 3A SEC 2) CALL TO LEAVE BUILDING IN CASE OF FIRE CALL 911 E . MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 11/13/87 BY ESTER 3A SEC 1) OXYGEN AND ACETYLENE BOTH CHAINED TO WALL USE PROPER VALVES AND FITTINGS PAGE 4 12/13/88 14:53 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-! Page ',. of~' NON--TRADE SECRETS HAZARDOUS MATERIALS INVENTORY BUSINESS NAME: OWNER NAME: FACILITY UNIT #:~~ ADDRESS: ADDRESS: FACILITY UNIT NAME: CITY, ZIP: CITY,ZIP: PHONE #: PHONE #: [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. CHEMICAL OR COMMON NAME CODE GUIDE NAME: TITLE: SIONATURE: DATE: EMERGENCY CONTACT: TITLE: PHONE # BUS HOURS: AFTER BUS HRS: EMERGENCY CONTACT: TITLE: PHONE # BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: AFTER BUS HRS: - 4A-1 - SECTION 3: HAZARDOUS MATERIALS FOR THIS b~IT ONLY A. Does this Facility Unit contaln Hazardous Materials° YES NO If YES, see B. If continue with SECTION 4. B. Are any the hazardous materials a bona fide Trade Secret NO If No, corn a separate hazardous materials inventory form marked: [-TRADE SECRETS ONLY (white form #'4A-l) If yes, corn 'hazardous materials inventory form mark TRADE SECRETS (yellow form #4A-2) in addition 'to mn-trade secret form. List ~ly the trade secrets on form 4A-2. SECTION 4j PRIVATE FIRE ?ION SECTION 5: LOCATION OF WATER SUPPLY BY EMER~ RESPON~ERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT lIS UNIT ONLY. A. NAT. GAS/PROPANe] B. ELECTRICAL: C. WATER: D. SPECIA,~: 'E. LOCK BOX: YES IF YES, LOCATION: YES SITE PLANS? YES / NO MoD,.s° YES / NO FLOOR PLANS2 YES ,/ NO KEYS? YES / NO - :313 - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 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: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCED~E~ SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - 3A - SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE 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:...- ....................................~ NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ¥~Y~ NO 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: ....... /f~S~N0 YES NO SECTION 7: HAZAPJ)OUS I~ATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A i,55GALLONS OF m LIQUID, OR~ 200 ~..UBIC FEET OF A ~OM?. RESS~D G.~,$:'. ..... . '~ NO ~ ~ ~'~f'~~, c~er ify 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. - TITLE ' DATE~ ~, BAKERSFIELD CITY FIRE DEPARTMENT ' ~3~//_~-' 2130 "G" STREET JUN9 1987 i ~ BAKERSFIELD, CA 93301 (805) 326-3979 ~ ID# SiNESS HAZARDOUS MATERI ALS BUSINESS PLAN AS A WHOLE FORM 2A 1. To avoid further action, return this foPm 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 SECTION 2: EI~ERGENCY 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. ~ AND TITLE / ) ~ DURING BUS. SECTION 3: LOCATION OF ~ILI~ S~-OFFS FOR BUSI~SS AS A ~OLE D SPECIAL: ~ IF YES, DOES IT CONTAIN SITE PLANS.'? ~/ NO MSDSS? YES / NO FLOOR PLANS? ~ / NO KEYS9 YES / NO - 2A -