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HomeMy WebLinkAboutBUSINESS PLAN SITE/FACILITY DI AGR~ NORTH ,~SCALE: BUSINESS NAME: _ F£OOR: OF ~ DAT[: '" / FACIEITY NAME: UNIT ~: OF (CHECK ONE) SITE BIAGRAM ~ FACILrTY DrAGR.~. SITE ~£AGRAM '(Requl] ) '' ' ~ ~ . 1. Address: Identify the .. 9. Lock (ke'~)i. Box ~i principle buildings : ' ~ ' 10. MSDS Storage Box ' ~' by the Street numbers. - 2. Street(s), Alleys, '/ 1'1. Railroad Tracks : i Driveways, and Parking . .. - , Areas adjacent to the, 12. Fence or Barrier- ~ property. Include the a..Wi're~ street names '' - L. ' ' b. Masonry - , · 3. storm Drains, Culverts, , - ~ard Drains c. Wood ' 4. Drainage ·Canals, Ditches, d. Gates .- Creeks. 7. 13. Powerlines ':' §. Buildings ' .,.-" .-> ~i-~=~.-~"~.~.'. .,.-~..,.'.~.~ =~ a;- Frame construction~-.-J"~>/>,' :J'?-~',~':'='y ~-'" ,"14~ Guard'Station ..... ~'.~'-' · b. Masonry coust~uction . 1S. Storage TankS:· ! '. ~ ' Identify the i .. '.' {c. Metal~'construction "-~ ' capacity in gal. ,. %.. ,~,,,~.=/]. ,~ =~ ..?~.{. ~...., ~. ~?,:,:~..~-. ,.=....., .~ ........:.: ............. =.~ ....... ~,..~,,,..,., . ..~ .?.:.~. ~,..:..= a~., Above.~re~n~' ~ · ~d.'Access Door ~./ ~ ~..c! ~ . . ~ . . ; / ': .... '~"' ~'"" '6~ U~ill}Y Controls ,' ?..~..: ~. ,:~, .'.L bZ Undergrouud . · ,- ....... ·, . -" . a..'iGaa ' . , .'i. :' ' · ' , ...~,' 'j~' ., - i. 16.'Dlktn~',or Be}m ......... · ' ,' ..... ......... : ....... ~' b. Electricity ' ................... 17. Evacuation Houte ':' 'i c. Water r'~ .. 18. Evacuation Area: - , ,-/ - 'Identify the 7. Fire Suppression Systems: location where a. Fire Hydrants emp[oyees will' I ......... ,, ,~ ..... ~- ............ meet.' .... '~ b. Fire Sprinkler' ' : ''" 19. Outside Hazardous ~ ' 7 ~, Connections ,. - ,,. Waste Storage ~ L . · c. Fi~e;'Sthn~pipe 20. butside Ha~rdou~ - .. ~Conn~ctions >~ .. Mhteri,al Storage .. '~ ~ ' .,.:,, .':~ · ;.: d~' Water.'.Control~;.Vaives . · .:,:;~.~ --.~ '-;'- ~., ....... ..2.1.,.Outsld~ Hazardous,...' ........ :,,:.~..'.:.-<.'-,'.' :v ..... ;~ :, % ::i;~.~i-.: .'", . for protectto~ systems Material · ~ .:.,. ,Use/Handling.. '' ' e, Fl:~e Pump "'- - 22. ~ype of Hazardous : Material/Waste " ~ · ~ -Stored' ......... 8':"~1~ O~partment Access or 0sed ('See ..I '~ -.. Below), :. ~-., ~ ' " ~ TYPE-OF HAZARDOUS MATERIAL F .=~Ela~mable .. g..":~x~si've~---~i .... Liquid ~R'= Radtological ..... ...... : .......................... ~ ';' ~o~r~sloe 0 = Oxidizer G = ~s P = Poison ' '~ W = .Water Reactive T ~ To S = S~iid :~.- ~yoge~ic .... i ~,. D ~ Waste '~'B" ~ Example: ~mma~le Liquid = 'FL~', . : ..... :'"¢ .... ' ....... ~A~ILITY DIAGRAM, (Required items 'in 'add'l~i'o~ to the above) " '? 1. Risers for Sprinklers \, '. 8. Fire Escapes ~ , · 2. Partitions O. Alr[Condltlonln~ ~nits · ': 3. StairwaYs: Indicate the ',:' ;10. WindoWs ' ' ~ levels served from . highest to lowest. ,/11. Inside Ha~ardoua Waste , Storage 4. Escalator: Indicate the . , ~ ,, ' levels, served from 12. Inside Hazardous . · highest' to lowest . Materials Storage · 5. Elevator · . 13. "Inside Hazardous " ' Materials ~se/Hand]lng ' ' . 6. 'Attic Access - ~ .'. 14. Sewer Drain Inlets J :, ' . - . ~,-,'=, ,~-,~--', -~ , OCT 0 6 ~~' .,. (805} '32~-~79 ' ' ~ ' HAZ, MAT..DIV, HAZARDOUS MATE~iALS " . BUSINESS PLAN AS A W OLE FORM 2A. . I' 1o avoid ~u~h~e ac~i'on, e~u~n ~hl~ ~eo~ ~th~n ~0 d~y~ o~ :_'-4. Be'as b~ief and concise, as possibla. . - · . ..... . . ~-~. R: BUS,NESS NRME: ~~'S. ~m~_' ~~L,~ CZTV: ~P~ ZZP: ~~1 eUS. PHO.E: ~, ~- ~ECTION 2: ~ EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, ~all 911 and 1-800-852-7S50 or 1-g16-427-4~¢1. This will noti~,, Fou? local fire department and the State Office of Emergency ...... Servicm5 as pequired by law. EMPLOYEES TO NOTIFY IN CnSE 0F EMERGENCY: N~ME ~NO TITLE DURING BUS. HRS. AFTER BUS. HRS. ,SECTION'3:' LOCATION OF UTILITY sHuT-oFFS FOR'BUs~hEs~ RS A·QHOLF YES, LOC~TION: -ZF YES .... DOES IT CONT~IN 'OTTE ' FLOOR P{_,~NS? YES '." r'tO ....... KEVq? '/¢~ = / NO SECTION 4: 'PRtURTE RE:PONaE-'TEAM FOR' BUSINESS .ES ,~ WHOLE .". ~ECTION S: . ¢OCBL EMERfENCY MED!C~E aSSISTaNCE FOR YOUR B~JSINESS ~S ~ WHOLE SECTION 6: -EMPLOYEE TRAINING -.- EMPLOYERS ~E RE2UIEED TO HAVE A TR~INtNG PROGRAM WHICH PROVIOES EMPLOYEES . WITH INITIAL AND REFRESHER TRAIN!N~ IN THE SAFE HANDLING OF HAZAROOUS M~TERIALS. ~ ~ :' A. NUMBER OF EMPLOYEES ~T'T-IS-~CILITY ' ~" B. DOM~TER I~LYOU H~VEyou.MSBSHANDLE( M~TER IAL? SBFET~. . SHEETS) FOR. EACH HAZARDOUS C. 6IVE ~ BRIEF SUMM~RY OF YOUR H~ZAROOUS M~TER!~LS TRAINING PROGRAM: ' SECTION-7: EXEMPTION REQUEST ' ' ' Z CERTrFY ~JNOER PENaL'fY OF PERJURY THaT MY BUSZNESS ,rS EXEMP~ FROM THE REPORTING REQUIREMENTS'.OF CH~PTE'R ~.9S OF THE CRL!FORNI~ HEALTH ~NO S~FETY COOE FOR THE FOLLOWING RE~SONS: . WE O0 NOT H~NDLE HRZhROOUS M~TERI~LS. - HE O0 HANDLE HGZhROOUS M~TER!GLS, BUT THE QUANTITIES ~T NO TIME EXCEED THE MINIMUM REPORTING QLI~NT!T!E~. · . OTHER (SPECiEY RE~SON) . . .,~ SECTIONn: a~'ur~t~' t undarqtand that this information will be u~ed to fulfill my .firm'.s.obiiga~ions under 'f, he new, Ca!i.focnia. Health ~nd Safat,/ code on H~zardous Ma~,er'iel~ (O'iv,, 2~ ChaPter 8.~5 Sbc. 2S~3~o. ~*,,, ~!. ,~ and that ~nacCurate information %i' " ' .... '~' "''. BAKERSFIELD C11~' FiRE DEPARTMENT 2130 "6v STREET BAKERSFIELD,' CA 93301 OFFICIAL USE ONLY iD# BUSINESS FORM 3A INSTRUCTIONS 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW ....... ''4' Be' a~ ~RIE. F'and' 'cONqlSE as pds'sible.,' ",' ...... ' ............... SECTION 1: HITIGATION~ PRE~ION, ~ABATE~E~ PROCED~ES SECTIO~ 2: ~OTIFICAT, IOR ~ ~ACUAT-I~ PROCEDb~ES AT T~,IS ~T ORLY. SECTION 3: HAZARDOUS MATERIALS FOR THIS M'NiT oNLY. '. A. Does t'his Facility Unit contain Hazardous Mater.ia!s? ..... ·~ NO T~' YES see 3.' IF NO, continue with SECTrON 4, . ,.:~_ hazardous ma'te)'ia2s ;-.t bona fide Trade Sec?e~' YES - , : :If No, complete a'separate hazardous materials inventory' " form marked: ~ON-TRADE SECRETS ONLY (whSte form If. Yes, complete a hazardous materials inventory form marl'ed: ~. T~DE SECRETS ;OSLY (y, ellow.for~ ~4~-2) in addition to the non- - SECTION 6: LOCATION OF ~ILI~ S~T-OFFS .AT THIS UN'IT.'0NLY.. B."ELECTRICAL: ' D SPgCrAE: .E LOCK BOX: YES ~IF YES, LOCATION: IF YEs, SiTE PLANTS? VES / N~ MSDSsg VES -: "FLOOR PLANS? YES /' NO KEYS? . 'YES' .," XO - 3B -