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HomeMy WebLinkAboutBUSINESS PLAN 'Specializing In...Collision Repair, Restoratien & Customizing" Red Harden, Owner ..u ~ ,-,v ........ ~, i 830 California Ave, i .'8D5'~ 3~4-934~ '~?!'e,~ eld. CA 93304 . CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ~ q 6 )-~- UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ ~/~t~L, g'/zPl0/..,~ INSPECTION DATE' ADDRESS /0,.5~_ " l~''/// ~' ' ' PHONE NO.. (d(,,i~_ ..5~'~--~'~' c.~a. ~ol-,a~'l[ FACILITY CONTACT lotct, l~ ~4. tl,qYt.."t' BUSINESS ID NO. 15-210--~9,~0.7...~'~' INSPECTION TIME iq3o t/es NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program J~l~outine [21 Combined [~ Joint Agency I~ Multi-Agency [,~ Complaint {~1 Re-inspection OPERATION CIV COMMENTS App[opriate permit,on hand f flflt/tt:~57' ~ 0/5"'-000 Business plan contact information accurate Visible address Correct occupancy Verification of:inventory materials ,,/ Verification of quantities Verification of location / Proper segregation of material Verification of MSDS availability ' ~Verification of Haz Mat training J · Verification of abatement supplies and procedures v/ Emergency procedures adequate, d Containers properly labeled d Housekeeping / Fire Protection d /~ Site Diagram Adequate & On Hand ~//&~ ~ /~,f~ 0 /' 7 C=Compliance V=Violation hazardous waste on site?: [~] Yes '~ No AnyExplain: Questions regarding this inspection? Please call us at (661 ) 326-3979 ~]~vess Si~e~ Responsible Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: . ACME POOL SUPPLY ~iteID: 015-021-000299 Manager : BusPhone: (661) '327-8955 Location: 1030 19TH ST Map : 103 CommHaz : Moderate City : BAKERSFIELD 'Grid: 30A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC 'Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title WILLIAM M BAYLY / OWNER SAL DEL RIO / EMPLOYEE Business Phone: (661) 327-8955x Business Phone: (661) 327-8955x - ~/.;~// 24-Hour Phone : (661) .... D~t' 24-Hour Phone : (661) 632-3475x Pager Phone : (661) ~-~x_~/~2/ Pager Phone ( ) - x Hazmat Hazards: Fire React ImmHlth · Contact : Phone: (661) 327-8955x MailAddr: 1030 19TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner WILLIAM M BAYLY Phone: (661) Address : 5301 UPLANDS OF THE KERN DR S6ate: CA City : BAKERSFIELD Zip : 93308 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: FORMERLY AT 2030 L ST. '1, ~3~ /6J~ ~/~__ Do I~ereby certify th~ I h~e reviewed the' a~ached h~ardous mmerials manag~ ment p~n for~~- ~/and tha~ i~ along with ~ (~e ~ ausi~) ~n~ cor;~ions ~ns~i~ute $ ~mple~e and ~;;e~ m~n- ~gemen~ p~n ;or ~ ;~cili~. -1- 06/16/2003' ACME POOL SUPPLY eID: 015-021-000299 ~ Hazmat .Inventory By Facility Unit -- MCP+Dai~yMax Order Fixed Containers on Site Hazmat Common Name... ISpocHazlEPA Hazardsl'Frm DailyMax IUnitlMCP BROMINE TABLETS F R IH S 60.00 LBS Ext DRY CHLORINE ' S 600.00 LBS .Hi LIQUID CHLORINE ~ HYDROCHLORIC L 100.00 GAL Hi SODIUM HYPOCHLORITE .L 100.00 GAL Hi CONDITIONER - CYANURIC CHLORIDE S 300..00 LBS Mod SODIUM DICHLOR S 300.00 LBS Mod CALCIUM HYPOCHLORITE S 200.00 LBS Mod SODIUM CARBONATE . S 400.00 LBS Low SODIUM BISULFATE S 100.00 LBS Min SIMAZINE-2 CHLORO-4 S 40.00 LBS UnR -2- 06/16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site BROMINE TABLETS· Days On Site 365 Location within this Facility Unit' Map: Grid: .'SHOWROOM CAS#' F STATE TYPE PRESSURE TEMPERATURE CONTAINER TyPE Solid Mixture Ambient I Ambient ·PLASTIC CONTAINER AMOUNTS AT THIS LOCATION · Largest Container LBS .~ Daily Maximum 60.00 , LBS Daily Average 30.00 LBS · HAZARDOUS COMPONENTS wt- .. RS, CAS# 92.50 Bromochlorodimethylhydantoin N°I 126067 [ I I HAZARD ASSESSMENTS . TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No ~ No No No/ Curies F R IH / / / Ext MISC. LOCAL AGENCY DATA Ag.Definedl: Ag. Defined2: Ag.Defined3: Ag. Defined4: Ag.Defined5: Ag. Defined6: Ag.Defined9: Ag.Defined8: Ag. Defined9: Ag -- Ag. Definell -3- 06/16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 ~ Inventory Item 0001 Facility Unit: Fixed. Containers on Site DRY CHLORINE -. Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# ~ STATE -- TYPE PRESSURE ~ ~TEMPERATURE CONTAINER TYPE Mixture Ambient I PLASTIC CONTAINER Solid Ambient AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average LBSI · 600.00 LBS 400.00 LBS HAZARDOUS COMPONENTS %Wt. RS{ CAS#. 90.00 Trichlorosilane Yes 10025782 HAZARD ASSESSMENTS TSecret "RS Bi°Hazl Radi°active/Am°untNo No No No/ Curies EPA Hazards NFPA/// IUSDOT# HiMCP MISC. LOCAL AGENCY DATA Ag.Definedl: Ag.Defined2: Ag. Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag. Defined7: Ag.Defined8: Ag. Defined9: A~.Definel0: -- Ag.Definell 4 06/16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 F ~Inventory Item 0003 Facility Unit: Fixed Containers on Site ~iVliVl~ ~Vl~ / ~1± ~ ~ LIQUID CHLORINE -HYDROCHLORIC ACID Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# r STATE =' TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient I Ambient ' PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL . 10 0.0 0 GAL 4 0.0 0 GAL HAZARDOUS COMPONENTS %Wt. R{ RS{ CAS# 12.50 Hydrochloric Acid ~Yes~ 7647010 HAZARD ASSESSMENTS TSecretNo NoRS Bi°Haul Radi°active/Am°untNo ' No/ Curies EPA HazardsI NFPA/// IUSDOT# HiMCP MI SC. LOCAL AGENCY DATA Ag. Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Definel0: -- Ag. Definell -5- 06/16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 '~ Inventory Item 0004~ Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# ' 7681529' r STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Pure ' I Ambient I Ambient PLASTIC CONTAINER ~ , AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average GAL 100.00 GAL 40.00 GAL [ I HAZARDOUS COMPONENTS ~ I %Wt. S 'CAS# 12.50 Sodium Hypochl.orite N 7681529 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP~ No No' No/ Curies / / / Hi MISC. LOCAL AGENCY DATA Ag. Definedl: Ag.Defined2: Ag. Defined3: Ag.Defined4: Ag.Defined5: Ag. Defined6: Ag. Defined7: · Ag.DefinedS: Ag. Definedg: Ag.Definel0: - Ag.Definell 6 06/16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ ~~ ~vl~ / ~±~ ~Vl~ CONDITIONER - CYANURIC CHLORIDE Days On Site 365 ' Location within this Facility Unit Map: Grid: SHOWROOM & S SIDE BLDG~ CAS# r STATE T ~TYPE PRESSURE I TEMPERATURE CONTAINER TYPE Sol id Pure Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily 'Maximum Daily, Average LBSI 300.00 LBS 150.00 LBS HAZARDOUS COMPONENTS N~oRS %Wt. RS CAS# 100.00 Cyanuric Chloride 108770 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# · MCP · No N No No/ Curies~ / / / Mod MISC. LOCAL AGENCY DATA Ag.Definedi: Ag.Defined2: Ag.Defined3: Ag. Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: · Ag.Defined8: Ag. Defined9: Ag.Definel0: -- Ag. Definell -7- 06/16/2003 ACME POOL SUPPLY SiteiD: 015-021-000299.~ = Inventory Item 0011 Facility Unit: Fixed Containers On Site · ~~ ~vl~ / ~£~ ~vl~ SODI~ DICHLOR' Days On Site 365 LocatiOn within this Facility Unit Map: Grid: SHOWROOM CAS# ~ STATE TYPE PRESSURE TEMPE~TURE CONTAINER TYPE ISolid I Mixture A~ient I A~ient P~STIC CONTAINER ~O~TS AT THIS LOCATION Largest Container I . Daily Maximum Daily Average LBSI 300.00 LBS 150.00 LBS' l'l'%wt' ~ZARDOUSCOMPONENTS ~S CAS# 65.00 Sodium Dichloroisocyanurate N 2893789 ~ZARD ASSESSMENTS ]TSecret ~S BioHaz] Radioactive/Amount EPA Hazards I NFPA I USDOT# MCP No N No No/ Curies / / / Mod MISC. LOCAL AGENCY DATA Ag.Definedl: Ag. Defined2: Ag.Defined3: Ag. Defined4: Ag. DefinedS: Ag.Defined6: Ag. Defined7: Ag.Defined8: Ag.Defined9: Ag.Definel0: -- Ag. Definell' -8- 06/16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 ~ Inventory Item 0010 Facility Unit: Fixed Containers on Site CALCIUM HYPOCHLORITE Days On Site · . 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# rSTATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid ~ ! Mixture Ambient Ambient . PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average LBSI 200,00 LBS 100,00 LBS HAZARDOUS COMPONENTS 1 65.00 Calcium Hypochlorite N 7778543 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP I No N No No/ Curies / / / Mod MISC, LOCAL AGENCY DATA Ag. Definedl: Ag. Defined2: Ag,Defined3: Ag.Defined4: Ag,Defined5: Ag. Defined6: Ag,Defined7: Ag'.Defined8: Ag,Defined9: Ag,Definel0: -- Ag,Definell -9- 06/16/2003 ACME POOL SUPPLY SiteID: 015-021r000299 ~ Inventory Item 0007 Facility Unit: Fixed Containers on Site ~U~U~ ~vl~ / . ~±~ ~Vl~ SODI~ CARBONATE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# 497198 F STATE TYPE PRESSURE TEMPE~TURE CONTAINER TYPE Solid I Pure A~ient I A~ient' I P~STIC CONTAINER I~O~TS AT THIS LOCATION Largest Container Daily Maximum Daily Average LB.S 400.00 LBS 200.00 LBS ~ZARDOUS COMPONENTSoI %Wt. . RsI CAS# 100.00 Sodium Carbonate N 497198 ~ZARD AssESsMENTS TSecret N~S Bi°Hazl Radi°active/Am°unt EPA Hazards I NFPANo ~ No No/ Curies / / / USDOT# MCP MISC. LOCAL AGENCY DATA Ag. Definedl: Ag.Defined2: Ag. Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.DefinedS: Ag.Definedg: Ag.Definel0: -- Ag. Definell . -10- 06/.16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 = Inventory Item 0005 Facility Unit: Fixed Containers on Site SODI~ BISULFATE Days On Site 365 Location within this Facility Unit Map: Grid': SHOWROOM CAS# ~ STATET TYPE PRESSURE TEMPE~TURE , C~ONTAINER TYPE Solid j Mixture A~ient. A~ie~t PLASTIC CONTAINER ~O~TS AT THIS LOCATION Largest Container [ Daily Maximum Daily Average LBS 100.00 LBS 50.00 LBS ~ZARDOUS COMPONENTS %Wt. I ~S . CAS# 91.00 Sodium Bisulfate N 10034845 ~ZARD ASSESSMENTS TSecret ~S BioHaz] Radioactive/Amount EPA Hazards I NFPA USDOT# I MCP No N No No/ Curies / / / MiL MISC. LOCAL AGENCY DATA Ag. Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.DefinedT: Ag.Defined8: Ag. Definedg: Ag. Definel0: --'Ag. Definell -11- 06/16/2003 ACME POOL SUPPLY " SiteID: 015-021-000299 ~ ~ Inventory Item 0009 Facility.unit: Fixed Containers on Site SIMAZINE-2 CHLORO-.4 Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# F STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE~ I Ambient Mixture Ambient Solid BAG AMOUNTS 'AT THIS LOCATION , Largest container I Daily Maximum Daily Average LBSI 40.00 LBS 20.00 LBS HAZARDOUS CoMpONENTS %'Wt. I RS CAS# I' HAZARD ASSESSMENTS I oRS BioHazl Radioactive/Amount EPA HazardsI NFPA USDOT# MCP TSecret 'N No No/ Curies - No / / / UnR MI SC. LOCAL AGENCY DATA Ag.Definedl :· Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag. Defined7: Ag. Defined8: Ag.Defined9: Ag.Definel0: -- Ag. Definell -12- 06/16/2003 f ACME POOL SUPPLY SiteID: 015-02i-000299 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification - ~ 01/19/2000 CALL 911. -- Employee Notif./Evacuation 03/12/1992 WE~HAVE ONE EMPLOYEE - TRAINED IN BASIC HAZ MAT PROCEDURES. ON DAYS WHEN MY FATHER IS IN IF WE HAD A PROBLEM WE WOULD VERBALLY NOTIFY EACH OTHER AND EXIT THE BEST POSSIBLE WAY.. -- Public Notif'/Evacuation 03/12/1992 WOULD VERBALLY NOTIFY ANY NEIGHBORS IF A PROBLEM OCCURRED. Emergency Medical Plan 04/09/1998 HALL AMBULANCE SERVICE - 100I 21ST ST MERCY HOSPITAL - 2215 TRUXTUN AV SAN JOAQUIN HOSPITAL - 2615 EYE ST -13- 06/16/2003 ACME POOL SUPPLY SiteID: 0151021-000299 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 01/19/2000 LIQUID CHEMICALS ARE IN SECONDARY PLASTIC CASES. ALWAYS KEEP 100 LBS -OF SODA ASH CONTAINER OPEN TO PUT ON ANY AcID SPILLS AND FIRE EXTINGUISHERS AT-DOOR ENTERING. STORAGE ROOM. WATER HOSE & BIB READY TO FLOOD ROOM. ALL 'DRY CHEMICALS ON PALLETS ABOVE ANY LIQUID SPILL IN ROOM. -- Release Containment 04/14/1994 STORAGE ROOM NL~SONARY WALLS WITH CEMENT FLOOR, WITH EARTH PIT 3' BY 3' FOR DRAINAGE IF NECESSARY. -- Clean'Up 04/14/1994 WOULD CLEAN Up WITH LICENSED ENVIRONMENTAL CONTRACTOR. Other Resource Activation -14- 06/16/2003 ACME POOL sUpPLY SiteID: 0152021-000299 Fast Format ~ Site Emergency Factors Overall Site  SPecial Hazards . -- Utility Shut-Offs 04/09/1998 A) GAS = ALLEY REAR OF BLDG B)~ ELECTRICAL - INSIDE BLDG NEXT DOOR C) WATER - D) SPECIAL - NONE E) LOCK BOX NO Fire Protec./Avail. Water 01/19/2000 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN PLACE. NEAREST FIRE HYDRANT - LOCATION ON THE NW CORNER OF 19TH & N ST. Building OccupanCy Level -15- 06/16/2003 ACME POOL SUPPLY SiteID: 015-021-000299 Fast Format = Training Overall Site -- Employee Training 01/19/2000 WE HAVE 2 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: BASIC TRAINING GIVEN IN WHICH CHEMICALS WiLL NEUTRALIZE EACH OTHER AND SOME FIRE DEPT SEMINARS~ATTENDED AND NSPI TRAINING FOR SWIMMING HANDLING PROCEDURES. -- Page 2 I Held for Future Use Held for Future Use -16- 06/16/2003 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ,,~ ~,o4 ~ /~,#/s INSPECTION DATE /~-.- dO- ADDRESS ?0 fo / 'Pi ~ .'(]. PHONE NO. $,,~-"/' .~ '~ b-~' ~ '/3ayfv BUSINESS ID NO. 15-2.10- FACILITY CONTACT INSPECTION TIME J,.~'~,.,',,,~" NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ,~ Routine ~ Combined ~ Joint Agency [~ Multi-Agency ~.~ Complaint [~ Re-inspection OPERATION C V COMMENTS ApPr. oPriate permit on hand Business plan contact information accUrate Visible address Correct occupancy Verification of inventory materials Verification of quantities · Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Diagram Adequate & On Hand / C=Compliance V=Violation Any hazardous waste on site?: [~ Ye~ ~ No Explain: C~. i~t~R~$ Questions regarding this inspection? Pi~e ¢~11 us m (661) 326-3979 . ponsi White - Env. Svcs. Yellow - Station Copy Pink- Business Copy Inspector: ~C~POOL SUPPLY === SiteID: 015-021-000299 + Manager : BusPhone: (661) 327-8955 Location: 1030 19TH ST ,~ Map : 103' CommHaz : Moderate City : BAKERSFIELD Grid: 30A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad: .... -- =+ + Emergency Contact / Title I Emergency Contact / Title WILLIAM M BAYLY / OWNER I SAL DEL RIO / EMPLOYEE Business Phone: (661) 327-8955x Business Phone: (661) 327-8955x 24-Hour Phone : (661) 322-8828x 24-Hour Phone : (661) 632-3475x Pager Phone : (661) 334-6664x Pager Phone : ( ) - x Hazmat Hazards: Fire React ImmHlth Contact : Phone: (661) 327-8955x MailAddr: 1030 19TH ST State: CA City : BAKERSFIELD Zip : 9330'1 Owner WILLIAM M BAYLY Phone: (661) 334-6664x Address : 5301 UPLANDS OF THE KERN DR State: CA City : BAKERSFIELD Zip : 93308 Period : to TotalASTs: = GalI Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: FORMERLY AT 2030 L ST. += Hazmat Inventory One Unified List + +== Alphabetical Order All Materials at Site ................................ + ....... + ........... + ..... + .......... + .... +- - -+ Hazmat Common Name... ISpecHazlEPA HazardsI Frm I DailyMax IUnitlMCPI ................................ + ....... + ........... + ..... + .......... + .... +- - -+ BROMINE. TABLETS F R IH S 60 00 LBS Ext CALCIUM HYPOCHLORITE S 200 00 LBS Mod CONDITIONER - CYANURIC CHLORIDE ~ S 300 00 LBS Mod DRY CHLORINE S 600 00 LBS Hi LIQUID CHLORINE - HYDROCHLORIC L 100 00 GAL Hi SIMAZINE-2 CHLORO-4 S 40 00 LBS UnR SODI-UM BISULFATE S 100 00 LBS Min SODIUM CARBONATE~ S 400 00 LBS Low! SODIUM DICHLOR S 300 00 LBS Mod SODIUM HYPOCHLORITE L 100 00 GAL Hi 1 03/21/2002 +~ACME~POOL SUPPLY SiteID: 015-021-000299 += Inventory Item 0006 - == Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME =~ BROMINE TABLETS I Days On Site 365 Location within this Facility Unit Map: Grid: + ................ SHOWROOM .CAS# += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE ..... I Solid I Mixture I Ambient I Ambient I PLASTIC CONTAINER + ~ ~ ~--+ ~ + .... ~ ~AMOUNTS AT THIS LOCATION I Largest Container Daily Maximum I Daily AVerage LBS 60.00 LBS 30.00 LBS +----- + .... ~ ~ ~== HAZARDOUS COMPONENTS = + + RS 92.501Bromochlorodimethylhydantoin 126067 ~ +===- ~===+ ~ ~===~ ~ HAZARD ASSESSMENTS ===4- + =+ ..... ITSecretlNo NoRSIBi°HazINo Radioactive/Amount No/ Curies EPAF HazardsR IH NFPA/// USDOT# I MCP + ~===+ ~= ~ ~= ~ +=====+ += Inventory Item 0010 Facility Unit: Fixed Containers on Site + +== COMMON NAME / CHEMICAL NAME ........ * ~= .... + CALCIUM HYPOCHLORITE I Days On Site 1365 Location within this Facility Unit Map: Grid: + ................ SHOWROOM CAS# + .... ~ =+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I SOlid I Mixture I Ambient IAmbient I PLASTIC CONTAINER + ~- +==== ==+= ~===---- +___ + AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average LBS 200.00 LBSI 100.00 LBS ~ ~ + ....... ~ HAZARDOUS COMPONENTS +===+ 65.00 Calcium Hypochlorite No 7778543 + ~ + +===+ + ..... HAZARD ASSESSMENTS ===+= + ~ ..... I TSecret INo NoRS I Bi°HasINo Radioactive/AmountNo/ Curies EPA HazardsI NFPA/// USDOT# MCP +===4 + -----4 + ~ 2 03/21/2002 +' ACM~ POOL SUPPLY SiteID: 015-021-000299 %= Inventory Item 0002 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME CONDITIONER - CYANURIC CHLORIDE I Days On Site 1365 Location within this Facility Unit Map: Grid: + ................ SHOWROOM & S SIDE BLDG +===== + += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Solid I Pure I Ambient ~ ==+= =4 =+== + ----+ ~ + AMOUNTS AT THIS LOCATION Largest Container Daily Maximum LBS 300.00 LBS I 150.00 LBS +- _ ----+=====-- =====+------ + ~ HAZARDOUS COMPONENTS ==+===4 100.00 Cyanuric Chloride No 108770 + ~ --- =------_ +===4 ~ +===4 =~--- HAZARD ASSESSMENTS ===4 --+ ........ + ..... ITSoorotl RSIBi°Hazl Radi°active/Am°unt EPA Hazards I NFPA I USDOT# MCP'INo No No No/ Curies / / / Mod += +===+ ~ += Inventory Item 0001 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME - ~ ........ DRY CHLORINE [Days365On Site Location within this Facility Unit Map: Grid: + ................ SHOWROOM I CAS# ~ -- ==+ ....... += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Solid I Mixture I Ambient IAmbient I PLASTIC CONTAINER ~ ~=-- ~ ~= +=---- ~ + AMOUNTS AT THIS LOCATION == Largest Container I Daily Maximum I Daily Average LBS I 600 . 00 LBS I 400 . 00 LBS +- + HAZARDOUS COMPONENTS - +===+ = 90.00 Trichlorosilane ' Yes 10025782 + ~ ==+===+ + +===+ + ........... HAZARD ASSESSMENTS ===4 += + ..... ITSeOret]No NoRS]Bi°HasINo Radi°active/Am°unt I EPANo/ Curies HazardsI NFPA/// IuSDOT# HiMCP + ~===~ =+ ~ -- ~ + ~--------==----+ -3- 03/21/2002 +'ACME~POOL SUPPLY = SiteID: 015-021-000299 += Inventory Item 0003 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME ~ LIQUID CHLORINE - HYDROCHLORIC ACID Days On Site 365 Location within this Facility Unit Map: Grid: + ................ SHOWROOM CAS# + 4----- 4- += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE 4- I Liquid I Mixture I Ambient I Ambient I PLASTIC CONTAINER I + AMOUNTS AT THIS LOCATION· + I' Largest ContainerGAL Daily Maximuml00.00 GAL I Daily Average40.00 GAL .I 4 ~ --- HAZARDOUS COMPONENTS + = = = 4 + 12.50 Hydrochloric Acid Yes 7647010 4 ~ +===4 4- 4 +===+ ...... 4 HAZARD ASSESSMENTS ===+ ~ + ..... + ITSecretlNo NoRS[Bi°HasINo Radi°actiVe/Am°unt I EPANo/ Curies Hazards NFPA/// USDOT# I MCPHi 4 4-===4 4- +, ~- .... ~ 4-=====+ += Inventory Item 0009 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME + .... · SIMAZINE-2 CHLORO-4 I Days On Site 365 Location within this Facility Unit Map: Grid: + ................ SHOWROOM I CAS# += STATE=+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Solid I Mixture I Ambient I Ambient I BAG 4 + ~ =4 + 4 4- AMOUNTS AT THIS LOCATION ---+ Largest Container Daily Maximum I Daily Average LBS 40.00 LBS 20.00 LBS + ~ + ~--+ + 4- HAZARDOUS COMPONENTS 4-===~ ---+ I wt. I I Rsl CAS# + 4-===4 4-= HAZARD ASSESSMENTS ===a ~ k ..... TSecretINo NoRS I Bi°HasINo Radioactive/AmountNo/ Curies EPA Hazards NFPA/// USDOT# I MCP 4 ~===4 ~ ~ 4-= 4- k=====+ 4 03/21/2002 + ~CME~POOL SUPPLY SiteID: 015-021-000299 + += Inventory Item 0005 Facility unit: Fixed Containers on Site + +== COMMON NAME / CHEMICAL NAME 4-- 4- SODIUM BISULFATE I Days On Site 1365 _Location within this Facility Unit Map: Grid: + ................ + SHOWROOM I CAS# += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE ~ I Solid I Mixture I Ambient I Ambient I PLASTIC CONTAINER I 4- 4- 4-= 4-= 4-= -----+ + + AMOUNTS AT THIS LOCATION + I Largest Container Daily Maximum I Daily Average LBS 100.00 LBS 50.00 LBS ~ ~ HAZARDOUS COMPONENTS ~===+ 4- 91.00 Sodium Bisulfate No 100.34845 ~ ~===~ ~ HAZARD ASSESSMENTS ===4 ~ + ..... + ITSecretl RSlBioHazl Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No No No No/ Curies / / / Min ~ +===~ ~ + ~ ~ + + += Inventory Item 0007 Facility Unit: Fixed Containers on Site + +== COMMON NAME / CHEMICAL NAME ---4 + SODIUM CARBONATE Days On Site 365 Location within this Facility Unit Map: Grid: + ................ + SHOWROOM I CAS# 497198 4 =======+= 4- += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE 4- IS°lid IPure IAmbient IAmbient I PLASTIC CONTAINER I 4 ~ + + 4-= ~+ ~ . 4- AMOUNTS AT THIS LOCATION = 4- Largest Container Daily Maximum I Daily Average LBS 400.00 LBS 200.00 LBS 4 .I 4-= ~- 4 ~ HAZARDOUS COMPONENTS ~===+ ~ 100.00 Sodium Carbonate No 497198 -~ 4 =========== + + t' 4 ~===4 + HAZARD ASSESSMENTS ===+ 4 +=====+ ITSecretl RSIBioHazI Radioactive/Amount EPA Hazards NFPA USDOT# I MCP No No No No/ Curies / / / Low 4 +==='~ ~- + 4- 4 +=====+ -5- 03/21/2002 + ~CME~POOL SUPPLY SiteID: 015-021-000299 += Inventory Item 0011 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME ~ SODIUM DICHLOR I Days On Site I Location within this Facility Unit Map: Grid: + ................ SHOWROOM CAS# +=== += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Solid I Mixture I Ambient I Ambient I PLASTIC CONTAINER + + 4 4 4 + + AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average LBS I 300.00 LBS I 150.00 LBS + + + .... + + HAZARDOUS COMPONENTS -+===4 65.00 Sodium Dichloroisocyanurate No 2893789 q t =+===4 += ~===q =4 HAZARD ASSESSMENTS ===+--- + ~ ..... ITSecretl RSIBi°Hazl Radi°active/Am°unt EPA Hazards ] NFPA I USDOT# MCP INo No No No/ Curies / / / Mod += += + ~ 4 ~------ + ~=====+ += Inventory Item 0004 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME + SODIUM HYPOCHLORITE Days On Site 365 Location within t.his Facility Unit Map: Grid: +- SHOWROOM CAS# 7681529 + ~--~ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Liquid I Pure I Ambient I Ambient I PLASTIC CONTAINER +---- ~- + ~= ~ + ~ AMOUNTS AT THIS LOCATION I Largest Container Daily Maximum I Daily Average GAL 100.00 GAL I 40.00 GAL 4 ~ HAZARDOUS COMPONENTS +===4 12.50 Sodium Hypochlorite No 7681529 4 ~ +===4 4 +===4 ~ HAZARD ASSESSMENTS ===+ 4 +===== TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi + ~===4 ~ + ~ 4 =+=====+ 6 03/21/2002 +~ ACM~ POOL SUPPLY - SiteID: 015-021-'000299 ~ = Fast Format + += Notif./Evacuation/Medical Overall Site +== Agency Notification == 01/19/2000 CALL 911. +=== Employee Notif./Evacuation == 03/12/1992 WE HAVE ONE EMPLOYEE - TRAINED IN BASIC }{AZ MAT PROCEDURES. ON, DAYS WHEN MY FATHER IS IN iF WE HAD A PROBLEM WE WOULD VERBALLY NOTIFY EACH OTHER AND EXIT THE BEST POSSIBLE WAY. + + .... Public Notif./Evacuation 03/12/1992 WOULD VERBALLY NOTIFY ANY NEIGHBORS IF A PROBLEM OCCURRED. + Emergency Medical Plan == 04/09/1998 HALL AMBULANCE SERVICE - 1001 21ST ST MERCY HOSPITAL - 2215 TRUXTUN AV SAN JOAQUIN HOSPITAL - 2615 EYE ST that I have revie',,¥ed the att"a~ed hazardous materials mal~acje- m, er, t ptan for ~~z~- ~~and that it aioncJ with ' (Name of BUsiness) any corrections constitute a complete and correct man- agement plan for my facility. -?- 03/21/2002 ACME POOL SUPPLY SiteID: 015-021-000299 + Fast Format + += Mitigation/Prevent/Abatemt Overall Site + +== Release Prevention -- 01/19/2000 + LIQUID CHEMICALS ARE IN SECONDARY PLASTIC CASES. ALWAYS KEEP 100 LBS OF SODA ASH CONTAINER OPEN TO PUT ON ANY ACID SPILLS AND FIRE EXTINGUISHERS AT DOOR ENTERING STORAGE ROOM. WATER HOSE & BIB READY TO FLOOD ROOM. ALL DRY CHEMICALS ON PALLETS ABOVE ANY LIQUID SPILL IN ROOM. =+ +=== Release Containment = 04/14/1994 + STORAGE ROOM MASONARY WALLS WITH CEMENT FLOOR, WITH EARTH PIT 3' BY 3' FOR DRAINAGE IF NECESSARY. + ..... Clean Up 04/14/1994 + WOULD CLEAN UP WITH LICENSED ENVIRONMENTAL CONTRACTOR. + Other Resource Activation ~ -8- 03/21/2002 + A~M~ POOL SUPPLY SiteID: 015-021-000299 ~ Fast Format += Site Emergency Factors Overall Site +== Special Hazards -- +=== Utility Shut-Offs 04/09/1998 + A) GAS - ALLEY REAR OF BLDG B) ELECTRICAL - INSIDE BLDG NEXT DOOR C) WATER - D) SPECIAL - NONE E) LOCK BOX - NO + .... Fire Protec./Avail. Water 01/19/2000 + PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN PLACE. NEAREST FIRE HYDRANT - LOCATION ON THE NW CORNER OF 19TH & N ST. Building Occupancy Level 9 03/21/2002 + ~CME POOL SUPPLY SiteID: 015-021-000299 + 4 - Fast Format + += Training Overall Site + +== Employee Training = 01/19/2000 + WE HAVE 2 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: BASIC TRAINING GIVEN IN WHICH CHEMICALS WILL NEUTRALIZE EACH OTHER AND SOME FIRE DEPT SEMINARS ATTENDED AND NSPI TRAINING FOR SWIMMING HANDLING PROCEDURES. + + +=== Page 2 + I =+ + .... Held for Future Use ~ + ~ Held for Future Use - + -102 03/21/2002 ACME POOL SUPPLY SiteID: 015-021-000299 Manager : BusPhone: (661) 327-8955 Location: 1030 19TH ST Map : 103 CommHaz : Moderate City ~ BAKERSFIELD Grid: 30A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title WILLIAM M BAYLY / OWNER SAL DEL RIO / EMPLOYEE Business Phone: (661) 327-8955x Business Phone: (661) 327-8955x 24-Hour Phone : (661) 322-8828x 24-Hour Phone : (661) 632-3475x -Pager Phone : (661) 334-6664x Pager Phone : ( ) - x Hazmat Hazards: Fire React ImmHlth Contact : Phone: (661) 327-8955x MailAddr: 1030 19TH ST State: CA City : BAKERSFIELD ,~ Zip : 93301 Owner WILLIAM M BAYLY Phone: (661) 334-6664x Address : v.STA~ SS~)I ~)F~D~ ~ State: CA City : BAKERSFIELD -[i%~ V--~-~ T~-, Zip : 9-3-3~5 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: RSs: No Emergency Directives: FORMERLY AT 2030 L ST. ~ Hazmat Inventory One Unified List --As Designated order Ail Materials at Site Hazmat Common Name... ISpocHazlEPA HazardsI Frm I DailyMax ~nitlMcP DRY CHLORINE S 600.00 LBS Hi CONDITIONER - CYAN-URIC CHLORIDE S 300.00 LBS Mod LIQUID CHLORINE - HYDROCHLORIC L 100.00 GAL Hi SODIUM HYPOCHLORITE L 100.00 GAL Hi SODIUM'BISULFATE S 100~00 LBS Min BROMINE TABLETS F R IH S 60.00 LBS Ext SODIUM CARBONATE S 400.00 LBS Low SIMAZINE-2 CHLORO-4 S 40.00 LBS UnR CALCIUM HYPOCHLORITE S 200.00 LBS Mod SODIUM DICHLOR S 300.00 LBS Mod 1 07/31/2000 ACME POOL SUPPLY ,~ ~ SitelD: 215-000~000299 Manager : ~ BusPhone: (805) 327-8955 ] 103 ComntHaz : Moderate Location: 1030 19TH ST ~y~l~Q/ ~ Map : City : BAKERSFIELD < Grid: 30A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title WILLIAM M BAYLY / OWNER SAL DEL RIO / EMPLOYEE Business Phone: (805) 327-8955x Business Phone: ('805) 327-8955x 24-Hour Phone : (805) 322-8828x 24-Hour Phone : (805) 632-3475x Pager Phone : (805) '334-6664x Pager Phone : ( ) - x -Hazmat Hazards: Fire React ImmHlth Contact : Phone: (805) 327-8955x MailAddr: 1030 19TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner WILLIAM M. BAYLY Phone: (805) 334-6664x Address : 1900 ALTA VISTA State: CA City : BAKERSFIELD Zip : 93305 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: FORMERLY AT 2030 L ST ~- Hazmat I'nventory One Unified List ~ -- MCP+DailyMax Order Ail Materials at Site ~ Hazmat Common Name... IspecHazlEPA HazardsI Frm I' Da~ilyMax IunitlMcP BROMINE TABLETS F R IH S 60.00 LBS Ext DRY CHLORINE S 600.00 LBS Hi - ,, 00.00 CO~ITIONER - CYniC CH~~~~o hereby o~ai~ Ihm~ hays 300. oo LBS Mod SODI~ DICHLOR 'U~brp~,i~)/'/ S 300.00 LBS Mod c~cI~ ~POCHLORIT~evieWed the a~ached h~a~s maieg~s m~nags- 200.00 LBS Mod SODI~ ~BONATE 400.00 LBS Low SODI~ BIS~FATE ment plan for~~ ~and that il al0~ wiih 100. oo nBS Min SI~ZINE-2 CHLORO-4 '' (~ofSa~l 40.00 LBS UnR any corrections constitute a ~mplele and ~rre~ man- agement plan ~r my ~cili~. . 12/20/1999 F ACME'POOL SUPPLY .SiteID: 215-000-000299 ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME BROMINE TABLETS Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CASS STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE I ~Solid I Mixture I Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION I Largest Container Daily Maximum Daily Average LBS 60.00 LBS 30.00 LBS HAZARDOUS COMPONENTS I I 92.50 Bromochlorodimethylhydantoin N 126067 HAZARD ASSESSMENTS I ITsecret [RS BiOHaz Radioactive/AmountNo No No No/ Curies EPA HazardsF R IH NFPA/// I USDOT# MOPExt ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME DRY CHLORINE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# FSTATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid /Mixture I Ambient IAmbient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average LBSI ! 600 . 00 LBS 400.00 LBS HAZARDOUS COMPONENTS 90.00 Trichlorosilane Yes 10025782 HAZARD ASSESSMENTS ITSoorOtNo NoRS BioHazNo IRadi°active/AmountNO/ Curies EPA Hazards NFPA I USDOT# MCP/// Hi -2-' 12/20/1999 ACME POOL SUPPLY SiteID: 215-000-000299 ~ ~ Inventory.Item 0003 Facility Unit: Fixed Containers on Site -- COMMON NAME ~/ CHEMICAL NAME I LIQUID CHLORINE - HYDROCHLORIC'ACID Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# r STATE ~ TYPE~ PRESSURE TEMPE~TURE CONTAINER'TYPE Liquid I Mixture Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container ' Daily Maximum Daily Average GAL 100.00 GAL 40.00 GAL ~ZARDOUS COMPONENTS %Wt- I RSlCAs#' 12.50 Hydrochloric Acid Yes 7647010 HAZED ASSESSMENTS TSeorOtNo I NoRS BioHazNo IRadi°active/Am°untNo/ Curies. EPA Hazards NFPA/// IUSDOT# MOPHi ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within, this Facility Unit Map: Grid: SHOWROOM ~' cAS# ~ ~ 7681529  STATE -q--.TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid /Pure Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest~ C°ntainer I Daily Maximum Daily Average GALI 100.00 GAL 40.00 GAL HAZARDOUS COMPONENTS oRSi CAS# %Wt. N 7681529 12.50 Sodium Hypochlorite HAZARD ASSESSMENTS IITsecretNo NoRS BioHazNo Radioactive/Amount Hazards NFPA I USDOT# MCPNo/ Curies EPA / / / Hi -3- 12/20/1999 ACME POOL SUPPLY SiteID: 215-000-000299 = Inventory Item.0002 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME CONDITIONER - CYANURIC CHLORIDE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM & S SIDE BLDG CAS# F STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid I Pure Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum' Daily Average LBS 300.00 LBS 150.00 LBS HAZARDOUS COMPONENTS 100.00 Cyanuric Chloride N 108770 HAZARD ASSESSMENTS TSecretl RSIBioHaz Radioactive/Amount EPA Hazards [ NFPA USDOT# MCP No No No No/ Curies / / / Mod = Inventory Item 0011 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SODIUM DICHLOR I Days365On Site Location within this Facility Unit Map: Grid: SHOWROOM, .CAS# FSTATE -- TYPE PRESSURE TEMPERATURE · I CONTAINER TYPE Solid Mixture Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container .Daily Maximum I Daily Average LBS 300.00 LBS I 150.00 LBS · HAZARDOUS COMPONENTS 65.00 Sodium Dichloroisocyanurate N 2893789 HAZARD ASSESSMENTS ITSecretI RSIBioHazl Radioactive/Amount I EPA Hazards I NFPA I USDOT# MCP No No No. No/ Curies / / / Mod -4- , , 12/20/1999 ACME POOL SUPPLY siteID: 215-0002000299 = Inventory' Item 0010 Facility Unit: Fixed COntainers on Site -- COMMON NAME / CHEMICAL NAME ~ CALCIUM HYPOCHLORITE I Days On Site . 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# STATE = TYPE PRESSURE TEMPERATURE CONTAINER TYPE rS°lid I Mixture IAmbient, IAmbient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest' Container· Daily Maximum Daily Average LBS 200.00 LBS 100.00 LBS HAZARDOUS COMPONENTS 65.00 Calcium Hypochlorite N 7778543 · HAZARD ASSESSMENTS TSecret RS BioHaz I Radioactive/Amount EPA Hazards NFPA USDOT# MCP No INO I No No/ Curies / / / Mod ---- Inventory Item 0007 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME SODIUM CARBONATE Days On Site ··365 Location within this Facility Unit Map: Grid: SHOWROOM CAS% 497198 F STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid /pure I Ambient IAmbient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 'Daily Average LBS 400.00 LBS 200.00 LBS HAZARDOUS COMPONENTS 100.00 Sodium Carbonate N 497198 HAZARD ASSESSMENTS· . ITsecretl RSIBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No No No No/ Curies / / / Low -5- 12/20/1999 ACME POOL SUPPLY SiteID: 215-000-000299 ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SODIUM BISULFATE Days On Site 365 Location. within this Facility Unit Map: Grid: SHOWROOM ~. CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE FSotid Mixture I Ambient I Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average LBS 100 . 00 LBS I 50 . 00 LBS HAZARDOUS COMPONENTS 91.00 Sodium Bisulfate N 10034845 HAZARD ASSESSMENTS ITSecretI RS'IBioHazl Radioactive/Amount I EPA Hazards I NFPA USDOT# MCP No No No No/ Curies / / ~/ Mit = Inventory~Item 0009 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SiMAZiNE_2 CHLOROL4 Days On Site 365 Location within this'Facility Unit Map: Grid: SHOWROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE FSolid Mixture Ambient I Ambient I BAG AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average LBS 40.00 LBS 20.00 LBS NoI I IN° · No No/ Curies / / / UnR · . -6- 12/20/1999 ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format = Notif./Evacuation/Medical Overall Site ~ Agency Notification 03/12/1992 · CALL 911 ~ Employee Notif./Evacuati0n 03/12/1992 WE HAVE ONE EMPLOYEE - TRAINED IN BASIC HAZ MAT PROCEDURES. ON DAYS WHEN MY FATHER IS IN IF WE HAD A PROBLEM WE WOULD VERBALLY NOTIFY EACH OTHER AND EXIT THE BEST POSSIBLE WAY. Public.Notif./Evacuation 03/12/1992 WOULD VERBALLY. NOTIFY ANY NEIGHBORS IF A PROBLEM OCCURRED. Emergency Medical Plan 04/09/1998 HALL AMBULANCE SERVICE - 1001 21ST ST MERCY HOSPITAL - 2215 TRUXTUN AV SAN JOAQUIN HOSPITAL - 2615 EYE ST -7- 12/20/1999 F ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format = Mitigation/Prevent/Abatemt Overall Site --Release Prevention 04/09/1998 LIQUID CHEMICALS ARE IN SECONDARY PLASTIC CASES. ALWAYS KEEP 100 LBS OF SODA ASH CONTAINER OPEN TO PUT ON ANY ACID SPILLS AND FIRE EXTINGUISHERS AT DOOR ENTERING STORAGE ROOM. wATER HOSE & BIB READY TO FLOOD ROOM. ALL DRY CHEMICALS ON PALLETS ABOVE ANY LIQUID SPILL IN ROOM. --Release Containment 04/14/1994 STORAGE ROOM MASONARY WALLS WITH CEMENT FLOOR, WITH EARTH PIT 3' BY 3' FOR DRAINAGE IF NECESSARY.' -- Clean Up 04/14/1994 WOI_~D CLEg2q' UP WITH LICENSED ENVIRONMENTAL CONTRA. CTOR. Other Resource Activation -8- 12/20/1999 F ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format F Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 04/09/1998 A) GAS - ALLEY REAR OF BLDG B) ELECTRICAL - INSIDE BLDG NEXT DOOR C) WATER - D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 04/09/1998 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN PLACE ~D SPKINKLEKS IN THE NEAREST FIRE HYDRANT - LOCATION ON THE NW CORNER OF 19TH & N ST. Building Occupancy Level 9 12/20/1999 ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format ~ Training Overall Site -- Employee Training 04/09/1998 WE HAVE 2 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: BASIC TRAINING GIVEN IN WHICH CHEMICALS WILL NEUTRALIZE EACH OTHER AND SOME FIRE DEPT SEMINARS ATTENED AND NSPI TRAINING FOR SWIMMING HANDLING PROCEDURES. Page 2 I Held for Future Use I Held for Future Use -10- 12/20/1999 ACME pOoL SUPPLY RECEIVED SiteID: 215-000-000299 i IVIAR~3 0 1998 Manager : ~'~1'~'~ BusPhone: (805) 327-8955 Location: 1030 19TH ST Map : 103 Com~az : Moderate · City : B~ERSFIELD ~'~ Grid: 30A FacUnits: 1 AOV: CommCode: B~ERSFIELD STATION 01 SIC Code: EPA Nu~: DunnBrad: ,Emergency Contact / Title Emergency Contact / Title WILLIAM M BAYLY / OWNER VERNON ALLEN / Business Phone: (805) 327-8955x Business Phone: (805) 327-8955x 24-Hour Phone : (805) 322-8828x 24-Hour Phone : (805) 834-4229x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire React ImmHlth Emergency Directives: F Hazmat Inventory One Unified List ~-- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name.... ISpooHazlEPA HazardsI Frm DailyMax UnitlMcP BROMINE TABLETS F R IH S 60.LBS Ext DRY CHLORINE S 600 LBS Hi LIQUID CHLORINE - HYDROCHLORIC L 100 GAL Hi SODIUM HYPOCHLORITE L i00 GAL Hi .CONDITIONER -CYANLTRIC CHLORIDE S 300 LBS Mod SODIUM DICHLOR .S 300 LBS Mod CALCIUM HYPOCHLORITE S 200 LBS Mod SODIUM CARBONATE S 400 LBS- Low SODIUM BISULFATE ' S 100 LBS Min SIMAZINE-2 CHLORO-4 /~ S 40 LBS UnR reviewed the ~a~]~d haz~cuts .,. ment plan for any cormc~om~ agement pl~n for my f~ciJi~. -1- 02/19/1998 F.ACME POOL SUPPLY SiteID: 215-000-000299 ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site -- COMMON NAME /CHEMICAL NAME BROMINE TABLETS Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# STATE TYPE · PRESSURE --r TEMPERATURE CONTAINER TYPE I~Sol~d~ Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION '~ I Largest Container I Daily Maximum Daily Average LBS 60.00 LBS 30.0.0 LBS HAZARDOUS COMPONENTS 92.50 Bromochlorodimethylhydantoin N 126067 HAZARD ASSESSMENTS I TSecret INo NoRS I BioHazINo Radi°active/Am°unt I EPANo/ Curies F RHazards I NFPAIH / / / USDOT# MCPExt ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME DRY CHLORINE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# STATE ~ TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE Solid ~Mixture Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average LBSI 600.00 LBS 400.00 LBS HAZARDOUS COMPONENTS %Wt. ~S CAS# 90.00 Trichlorosilane N 10025782 HAZARD ASSESSMENTS TSecret I RS IBioHaz IRadi°active/AmountNo No No. No/ Curies EPA Hazards NFPA/// I USDO~# M0PHi -2- 02/19/1998 ACME.POOL SUPPLY SiteID: 215-000-000299 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME- LIQUID. CHLORINE - HYDROCHLORIC ACID Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# STATE I TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container· I Daily Maximum Daily Average GALI 100.00 GAL 40.00 GAL HAZARDOUS COMPONENTS 12.50 Hydrochloric Acid N 7647010 HAZARD ASSESSMENTS TSecret I RS I BioHazNo No No Radioactive/AmountNo/ Curies EPA HazardsI'' NFPA/// USDOT# HiM0P ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM cAs# 7681529 F STATE TYPE PRESSURE I TEMPERATURE CONTAINER TYPE ./Liquid Pure Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION I Largest Container I Daily'Maximum Daily Average GAL · 100..00 GAL 40.00 GAL HAZARDOUS COMPONENTS 12.50 Sodium Hypochlorite N 7681529 ·[I II HAZARD ASSESSMENTS ]TSeoret, RS,BioHazl Radioactive/Amount EPA Hazards NFPA USDOT# MCP liNe NoliN° No/ Curies / / / Hi 3' 02/19/1998 ACME POOL SUPPLY SiteID: 215-000-000299 = Inventory Item 0002 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME CONDITIONER -~CYANURIC CHLORIDE Days On Site 365 Location-within this Facility Unit Map: Grid: SHOWROOM & S SIDE BLDG CAS# F STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid /Pure I Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average · LBS 300.00 LBS 150.00 LBS HaZaRDOUS COMPONENTS I CAS# 100.00 Cyanuric Chloride N 108770 HAZARD ASSESSMENTS TSecret I RS IBi°HazNo No No Radioactive/AmountNo/ Curies EPA Hazards NFPA/// I USDOT# MCP.Mod ~- Inventory Item 0011 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SODIUM DICHLOR Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# FSTATE TYPE PRESSURE TEMPERATURE I CONTAINER TYPE Solid~! Mixture AmbientIi Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container DailYMaximum Daily Average · LBS 300.00 LBS 150.00 LBS HAZARDOUS COMPONENTS · 65.00 Sodium Dichloroisocyanurate N 2893789 HAZARD ASSESSMENTS ITSecretl RSIBioHaz Radioactive/Amount EPA Hazards I NFPA [ USDOT# MOP No N© No No/ Curies / / / Mod -4- 02/19/1998 ACME POOL SUPPLY SiteID: 215-000-000299 ~ Inventory Item 0010 Facility Unit: Fixed Containers on Site ~vl~ ~Vl~ / ~~.~-~.~ ~Vl~ CALCIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# ~ STATE TYPE PRESSURE [TEMPERATURE CONTAINER TYPE Solid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average LBSI 200.00 LBS 100.00 LBS HAZARDOUS COMPONENTS 65.00 Calcium Hypochlorite N 7778543 HAZARD ASSESSMENTS TSecret' RS'BioHaz Radioactive/Amount EPA Hazards NFPA USDOT#, MCP No[NoI No No/ 'Curies / / / Mod = InVentory Item 0007 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SODIUM CARBONATE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# 497198 Solid /Pure Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average LBS 400.00 LBS 200.00 LBS HAZARDOUS COMPONENTS %Wt. I ~S CAS# 100.00 Sodium Carbonate N '497198 HAZARD ASSESSMENTS TSoorotN~slBioHaz Radioactive/Amount EPAHazards NFPA [USDOT# MOP No No No/ Curies / / / Low -5- 02/19/1998 ACME POOL SUPPLY SiteID: 215-000-000299 = Inventory Item 0005 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SODIUM BISULFATE Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid i Mixture I Ambient I Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average · LBS 100.00 LBS 50.00 LBS HAZARDOUS COMPONENTS 91.00 Sodium Bisulfate N 10034845 HAZARD ASSESSMENTS · ITsecretl RSIBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No No No No/ Curies / / / Min = Inventory Item 0009 o Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME SIMAZINE-2 CHLORO-4 Days On Site 365 Location within this Facility Unit Map: Grid: SHOWROOM CAS# F STATE TYPE PRESSURE ITEMPERATURE I CONTAINER TYPE I Ambient Mixture Ambient Solid BAG AMOUNTS AT THIS LOCATION I Largest Container I Daily MaximumI Daily Average LBS 40.00 LBS 20.00 LBS i %Wt. i HAZARDOUS COMPONENTS RS CAS# ' HAZARD ASSESSMENTS ITsecret No RS BioHazI Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No No No/ Curies / / / UnR -6- 02/19/1998 F ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 03/12/1992 CALL 911 -- Employee Notif./Evacuation 03/12/1992 WE HAVE ONE EMPLOYEE - TRAINED IN BASIC HAZ MAT PROCEDURES. ON DAYS WHEN MY FATHER IS IN IF WE HAD A PROBLEM WE WOULD VERBALLY NOTIFY EACH OTHER AND EXIT THE BEST POSSIBLE WAY. -- Public Notif./Evacuation 03/12/1992 WOULD VERBALLY NOTIFY ANY NEIGHBORS IF A PROBLEM OCCURRED. Emergency Medical Plan 03/12/1992 HALL AMBULANCE SERVICE - 1001 21ST ST MERCY HOSPITAL - 2215 TRUXTUN AV SAN JOAQUIN HOSPITAL - 2615 EYE ST -7- 02/19/1998 F ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format = Mitigation/Prevent/Abatemt Overall Site --Release Prevention 04/14/1994 LIQUID CHEMICALS ARE IN SECONDARY PLASTIC CASES. ALWAYS ~EEP 100 LBS OF SODA ASH CONTAINER OPEN TO PUT ON ANY ACID SPILLS AND FIRE EXTINGUISHERS AT DOOR ENTERING STORAGE ROOM. wATER HOSE & BIB READY TO FLOOD ROOM. ALL DRY CHEMICALS ON PALLETS ABOVE ANY LIQUID SPILL IN ROOM. --Release Containment 04/14/1994 STORAGE ROOM MASONARY WALLS WITH CEMENT FLOOR, WITH EARTH PIT 3' BY 3' FOR DRAINAGE IF NECESSARY. -- Clean UP 04/14/1994 WOULD CLEAN UP WITH LICENSED ENVIRONMENTAL CONTRACTOR. Other Resource Activation 8 02/19/1998 F ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format ~ Site Emergency Factors Overall Site iSpecial Hazards --Utility Shut-Offs 01/.07/1990 A) GAS - SOUTHWEST CORNER OF BUILDING B) ELECTRICAL - INSIDE NORTHEAST ROOM OF BUILDING C) WATER - NORTH SIDE OF BUILDING AT SIDEWALK D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN PLACE AND SPRINKLERS IN THE CHEMICAL STORAGE ROOM FIRE HYDRANT - NORTHWEST CORNER OF BUILDING Building Occupancy Level -9- 02/19/1998 ACME POOL SUPPLY SiteID: 215-000-000299 Fast Format = Training Overall Site -- Employee Training 03/12/1992 WE HAVE 2 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: BASIC TRAINING GIVEN IN WHICH CHEMICALS WILL NEUTRALIZE EACH OTHER AND SOME FIRE DEPARTMENT SEMINARS ATTENED AND NSPI TRAINING FOR SWIMMING HANDLING PROCEDURES. -- Page 2 -- Held for Future Use I Held for Future Use I -10- 02/19/1998 HAZARDOUS MATERIALS INVENTORY Page of Business Name Address CHEMICAL DESCRIPTION I ) IlqVE~ORY STATUS: New [ ] Addition [ ].Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4)'Physical & Health PHYSICAL HEAL'tH H~,,--dCategories Fire[ ]Reactive[ ]SuddeaReleaseofPressure[ ] lmmediateHealth(Acute)[ ]DelayedHealth(Chroni¢)[ ] 5) WASTE CLASSIFICATION. O-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ]. Liquid [ ] Cas [ ] Pu~ [ ] ~ture [ ] Waste [ ] Radioactive.[ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE coDEs Maxim.~ Daily Amount Lbs[ lC-ali ]~£ ] a)Contain~ Average Daily Amount Curies [ ] b) Pressure: Annual Amount ¢) Tempemtm'e Largest Size Container # Days on si,re Circle Which Months: AIl Year, J, F, M, A; M. J', J', A. S, O, N, D 9) MIXTURE: List COIVlPONENT CAS# % WI' AHM the three most bAT,~rdous 1) [ ] chemical components or 2) [ ] nay AHM componeats 3) [ ] 0)LOCATION I)INVENTORYSTATUS:New[']Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trade Secret [ ]TradeSecr~[ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS #. 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive'[ ]Su_~aO,~_ ReleaSeofPres.sure[ ] lmmediateHealth(acute).[ ]D~layedHealth(Chrunic)[ ] ~) WAST~ CLa. SSnnCAT~OS O-ai~it cod~ fium.DH8 Fora a0il) USE COD~ 6) PHYSICAL ST^TE Solia [ I Uiquia [ ] Cas [ I Pu~ [ ] Mixture [ ] Waste £ I t~lioacas~ [ 1 7) AMOUNT AND TIME AT FACILITY UNITS OF IVlFASURE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] C-al [ ] ft3 [ ] a) Containor: Average Daily Amount Curi~ [ ] b) Pressu~: Annual Amount ¢) Tempe~atu~ Largest Siz~ Contain~ ' # Days on Site Ciml~ Which Month~: AIl Year, $, F,M"A, M, $, J, A, S, O, N, D 9) MIXTURE: List COMPO~ CAS# % WT AHM the thr~ most hazardous - 1) '[ ] chtnnical componeats or 2) · [ nay AI-IM components 3) [ ] 0)LOCATION " certify under penal~ of law, that I haw porsonally examin~l and am'familiar with th~ information on this nad all attached documeats. I believe th~ submitted information is true, accurat~ and complete. PRIlqT Nam~ & Title of Autho~ Company R~mtativ~ $ignatu~ Dam I OUS MATERIALS INVENT ~ HAZ~ O~Y Page of' 7-'Business Name Address CHEMICAL DESCRIPTION l ) [NVffNTOR¥ STATUS: New ( ] Addition [ ] Revision [ ] Deletion [ ] Check/fchemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common ~ame: - ~ 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health :PHYSICAL HEALTH Hazard Categories Fire [ ] Re'Ye [ I Sudden Relea,~ ofPressut~ [ I rm~i*t~ Health (Acute) [ ] Delayed Heslth (Chronic) [ ] 5) WASTE CLASSIHCATION (3-digit cod~ fi'om DHS Form 8022) USE CODE 6) PHYSICAL ST^TE SoUa [ ] Liquia [ ] C-as [ ] Pur~ [ ] Mixture [ ] Waste [ ] ~A,~ioa~tive [ 7) AMOUNT AND TIME AT FACILITY ~ UNITS OF ME,a~URE 8) STORAGE CODE~ Maximum Daily Amount Lbs [ l Gal [ l fl3 [ ] a) Containec. AveregeDaily Amount Curies[ ] b) Pressure: . Annual Amount ¢) Tempera~ Largest Size Container . # Days on Sit~ Circle Which Montl~: All Year, I. F, M, A, M, I, I, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous~ 1) [ ] . chemical components or 2) [ ] any AHM components 3) [ ] ~0)LOCATtON 1) INVENTORY STATUS: New [ ]Addition[ ]Revis/on[ ]Delet/on[ ] C~kK~~aNONT~~[ ]T~~[ 1 2) Co~ N~e: 3) ~T ~ (~fi~) Ch~N~e: ~[ ] C~# 4) Ph~i~.~ H~m ~SIC~ ~ca~ F~{ l~[ ]S~Rel~of~[ ] [~H~(A~)[ ]~h~~(C~)[ ] f) W~ C~S~CAUON (3~t ~ ~ D~ F~ ~) USE CODE 5) P~SIC~STA~ ~d[ ] Liq~d[ ] ~[ ] ~[ ] ~[ ] W~[ ] ~v~[ ] 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) STOOGE COD~ ~mD~y~o~t '~ L~[ ]~[ ]~[ ] a) Con~ Av~e ~ly ~o~t C~ [ ] b) ~: ~ ~o~t c) T~~ ~ S~ C~ t Da~ ~ Sim C~le ~ch M~: ~ Y~, I, F, ~ ~ ~ ~, I, ~ S, O, N, D 9) ~: Li~ CO~~ C~t % ~ · e ~ mo~ ~ 1) [ ] ~y ~ ~~ 3) [ ] 10 )L~A~ON [ c~i~ ~ ~ orlaw, ~t l ~ ~ly ~ ~ ~ r~ ~ ~ ~on on ~s ~d ~1 s~ ~m~. I P~ N~e ~ Title of Au~o~ Comfy R~~ve Si~ Page of' Business Name Address CHEMICAL DESCRIPTION i) ~VENTORY STATUS: New [ l Addition { I Revision [ I Dei~'ti~ i' ]: Ch~k ifchemical is a NON Trad~ Se(a~t [ l rrad~ S(xa~t · 2) Common Name: 3) DOT # (optional) Chemical Name: AHlVi [ ] CAS # 4) PhYsical & Health PHYSICAL ~. HEALTH Hazard Categories Fire [ ] Reactive [ ] Sudden Release ofPres.su~ [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) 5) WASTE CLASSIFICATION (3-digit cod~ fi-om DHS Form 8022) USE CODE 6) PHYSICAL STATE Solidi I Liquid[ I Gas[ I Pure[ I IViixture[ I Waste[ I Radioactive[ l 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ' Lbs [ ] Gal [ ] ~ [ ] a) Container: Average Daily Amount curies [ ] b) Pressure: Annual AmoUnt c) Temperature Largest Size ConUdner # Days on Site Cimlc Which Mouths: All Year, $, F, M, A, lyf, J', $, A, S, O, N, D 9) MIXTURE: List COIVlPONENT CAS# % WT AHIVl the three most h---,'dous 1) [ chemical components or 2) [ any ~ exauponents 3) [ 10)LOCATION 1) I]qVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trnde Secret [ ]Trnd~[ 2) Common Name: 3) DOT # (optional) Chemical Name: ' AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Re, active[ ]SuddenRelenSeof~[ ] TmmediateHealth(Acute)[ ] Delayed Health (Chronic) [. ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid 7) AMOUNT AND TIME AT FACILITY UN1TS OF MEASURE' 8) STORAGE CODES Maximum Daily AmoUnt Lbs [ ] Gal [ ] fi.3 [ ] a) Container:. Average Daily AmoUnt Curies [ ] b) Pressure: Annual Amount' c) Temperature Largest Size Container # Days on Site Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WI' AHM the three most b~,dous 1) [ ] chemical components or 2) [ ] any AHM components 3) [ i 0)LOCATION [ certify under penalty of law, that I have personally examined and am familiar with the information on this and ail attached documents. believe the submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Representative Signature Date HAZARDOUS MATERIALS INVENTORY Page of ' Business Name Address '- CHEMICAL nESCRIFrION I) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Delefipn.! ~:.]..Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PhYsical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION O-digit code fix~m DHS Form 8022) . USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Oas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] Gal [ ] ft3 [ ] a) Cuntaia< Average Daily Amount Curies [ . ] b) Pressure: Annual Amount ¢) Temperature Largest Size Container # Days on Site Circle Which Months: All Year, $, F, IV[, A, M, $, $, 3., S, O, N, D 9) MIXTURE: List COMPONENT . CAS# % WT AHM the three most hazardous 1) [ ] chemical components or 2) [ ] any. AHM components 3 ) [ ] 10)LOCATION 1)INVHNTORYSTATUS:Ncw[ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trede Seeret [ ]Tradesoeret[ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHlVl [ ] CAS # 4 ) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive[ ]SuddenRelesseofPressure[ ] rmmediateHealth(Acute)[ ]DelayedHealth(Chroni¢)[ ] 5) w~s~ Ct~SSnnC^~ON (3"a~it cede Cma Dm Form a022) USE CODE 6) ?mrsxcAI, ST^TE SoViet 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] Gal [ ] t~ [] a) ¢ontain~ Avenge Daily Amount Curies [ ] b) Pressure: Anaual Amount ¢) Temperature Largest Size Container # Days on Site Circle Which Months: All Year, $, F, M, A, M, $, $, A,~ S, O, N, D 9) MIXTURE: List COMPONEHT CAS# % WT AHM the three most hazardous 1) [ ] chemical components or 2) [ any' ^I-tM components 3 ) [ ] 10)LOCATION I certify under penalty of law, that I have pemmally examiaed and am familiar with the iafonnation on this and all attached doomaents. believe the submitted information is trim, accurate and complete. PRINT Name & Title of Authorized Company Representative Signature Date Page of ~'> Business Name · Address CHEblICAL I)E$CRIPTION ~)[NVENTORYSTATUS:New[ ]Addition[ ]Revision[ ]Deletion[~] Check ff chemical is a NON Trad~ Secret [ ]TradeSeeret[ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH :HazardCategofi~ Fire[ ]Reactiw[ .]$,_,dd_~aReles.~ofPressum[ ] lmm~tiateHealth(Acute)[ ]l~laye~tHealth(chronic)[ ] s) w^s'm ct~,sstmc^ztoN O-ai~t co~ from DHS Form S0~-~) USE COD£ 6) PHYSICAL STATE Solid[ ] Liquid[ ] Gas[ ] Pum[ ] Mixture[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AN'D TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] Gal [ ] 1t3 [ ] a) Contains: Av~rag~ Daily Amount Curi~s [ ] b) Prestone: Annual Amount ¢) Tem~ratet~ Largest $iz~ Container # Days on Sim Circle Which Months: Ail Year, $, F, M, A, M, $, $, A, $, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the thn~ most hazardous I) [ ] chemical compononts or 2) [ ] any ~ compommts 3) [ ] 10)LOCATION I)INVENTORYSTATUS.~NeW[ ]Addition[ ]Revision.[ ]Deletion[ ] CheckifchemicalisaNONTtad~Secx~[ ]Trad~Sect~[ ] 2) Commou Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire[ ]Reactive[ ]SuddenRelesseofPressure[ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WAST~ CLASSnUCAHON (3-,~t code from Dm Form S022) USS COD~- .6) PHYSICAL STATE SoUd [ ] Liquid [ ] Cas [ ] Pure [. ] Mixture [ ] Wast~ [ ] P, aaioacUve [ ] 7) AMOUNT AND TIME AT FACILrrY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] Gal [ ] fl3 [ ] a) Contains. Average Daily Amount Curies [ ] b) Pmssu~: Annual Amount c) Temperature Largest Siz~ Container # Days on Site Circle Which Months: Ail Year, J, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AttM the. flu'ce most hazardous 1) [ ] chermcal components or 2) [ ' ] any AHM components 3) [ ] 0 )LOCATION certify undo' p~ty of law, that I have l~ly examined aud am familiar with the information on this and all attached documents. I b~lieve the submitted infonuatiou is ~ accurate ~nd complete. · PRINT Name & Title of Authorized Company Representative Signature Date H~RDOUS MATERIALS INVENT~Y Page of Business Name Address CHEMICAL DESCRIFrION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health - PHYSICAL ' HEALTH Hazard Categories Fire[ ]Reactive[ ]SuddenReleaseofPressure[ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSWICATION O-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solidi ] Liquid[ ] Gas[ ] Pure[ ] Mixture[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] Gal [ ] fl3 [ ] a) Container: Average Daily Amount Curies [ ] b) Pressure: Annual Amount c) Temperature Largest Size Container # Days on Site Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most ba~'srdous 1) [ ] chemical components or 2) [ ] any AHlVl components 3) [ ] 10)LOCATION 1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trade Secret [ ]TradeSecret[ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AI-IM [' ] CAS # 4) Physical & Health PHYSICAL HEALTH Hazard Categories Fire [ ] Reactive [' ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION O.digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solidi ] Liquid[ ], Gas[ ] Pure[ ] Mixture[ ] Waste[ ] Radioactive[ ] 7) AMOUNT AND TIME AT FACILrrY UNITS OF ~URE 8) STORAGE CODES Maximum Daily Amount Lbs [ ] Gal [ ] fl3 [ ] a) Container: Average Daily Amount Curies [ ] b) Pressure: Annual Amount · c) Temperature Largest Size Container # Days on Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most hazardous 1) [ ] chemical components or 2) [ ] any AH/vi components 3) [ ] 10 )LOCATION I certify under penalty oflaw, that I have personally examined and am familiar with the information on this and ail attached documents. I believe the submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Representative Signature Date · HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIOATION, PREVENTION ~ ABATEMENT PLAN A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OK MININflZATION: C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS _(LOCATION OF SHUT-OFFS AT YOUR FACILITY) WATER: SPECIAL: LOCK BOX: YE~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAU.ABILITY (FIRE HYDRANT): 4 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. . PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: 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 OFPERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAP~ TER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: wEDo NOT HAI~LE HAZARDOUS I~xATERIALS. ' WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT ,.', -,.. NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) , SECTION 5: CERTIFICATION - _ . INFORMATION IS ACCU~Tfi. J~qDERSTAND 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 Ami:, comm,'r s i.' ' SfONAT~~ TITLE . 2 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: <~xs~t~ /~V'~ A~% q~c.9't-. Zo'~ d_ ~- .1. To avoid furthei' action, return this form within 30 day's 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. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ..~ Cr~ ~ -~ooL~ ~0tg/z't_ ¢~ LOCATION: t'O.--TD l ~ ~ MAII.ING ADDRESS: (030 tq -v~ DUN & BRADSTREET NUMBER: SIC CODE: MAmmaADDP. ESS: /z~_~',,9 /~'/-~ -,.~7~ '7 SECTION 2: EMERGENCY NOTIFICATION "' CONTACT TITLE BUS. PHONE 24 I-IR. PHONE