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HomeMy WebLinkAboutBUSINESS PLAN~'C~LIFORNIA WATER 93-01 SiteID: 015-021-002371 Manager : MELVIN BYR5 %%5% BusPhone: (661) 396-2400 Location: 428 20TH ST_.~ Map : 103 CommHaz : City : BAKERSFIELD '~%~ Grid: 30B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code:4941 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MELVIN BYRD / DISTRICT MGR TIM TRELOAR / ASST DIST Business phOne: (661) 396-2400x Business Phone: (661) 396-2400x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) ~- x Pager Phone : ( ) - x Hazmat Hazards: React ImmHlth Contact : MELVIN BYRD Phone: (661) 396-2400x MailAddr: 3725 H ST State: CA City : BAKERSFIELD Zip : 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 396-2400x Address : 3725 H ST State: CA City : BAKERSFIELD Zip : 93304 Period : to ' TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Dis~ictM~ag~-TimTreloar Emergency Directives: Asst. Di~ M~ager-BillHa~p~ Contact Person-Tamara Jonson Same Phone Num~rs i.'-~~ ,,jo[~3~ Do her~b:, certify tha~ I have (Iy~ or ~int n~e) ~vie~ed the a~ache~ h~a~'oou~ materials manage- ment p~n forCa~. (~~ and th::'.~, it along ~ith any corrections ~ns~i[u~e a complete and'~rr~ man- agemem plan for my tscili~y. -1- 10/10/2003 Hazardous Materials InventOry - Chemical Description -. " You must complete a separate Hazardous Matenais Inventory * Chemical OesC~ptton page for sach ttazardous material (hazardous sudstances an~l hazardous waste) if~at ~,ou handle at your facility in aggregate quantities equal to or greater than 500 pounds, 55 gailo~s. 200 cu~3ic feet of gas (calculated at ~andard temperature an(tpreesure) or the federal threshold planning quantity for Extremely Hazardous Su~3stances. wi3ichever is less. ALso complete a I~age for sectt radioaCtiVe matedal handled over' . quantities for wi~ich an emergency plan is required to be adooted pursuant to 10 C~=R 13arts 3n. 40. or 70. The coml31eted inventory $~louid reflect all reportable quan*Jtlea of hazardous materials at your facility, reported saOarately for each building or outeioe adjacent ama. with sal3arata pages for unique occurrences of physical state, storage" temperature and storage pressure. (Note: {he numbering ef tile instructions follows the data element numbers tiler are on the UPOF dagss. These data element numbers ag:e used for electronic submission and are the same as the numbering uaed in 27 OCR, Al3pendJx C, the Business Section of ttte Unified F~3gram Data Dietiosary.) Please number all'pages of your sui3mittal. This hetgs your CLIPA or AA Jdenfif~ whether the submittal is complete and if any pages am seoamted. 1. FAClUTY ID NUMBER - This number is essigned by the CUPA or AA. This is the ualque numOer which ldentifiss your facitity. ~. :~. BUSINESS NAME - Enter the ~'uil legal name of the business. 2{)0. AGD/DELETEJ REVISE - Indicate if the mstedal is t3eing added to the inventory, deleted ~rom the fnven~3ry, or if Ule inforrnaUon previously submitted is being revised- NOTE; You may choOSe to leave this tilank if you rasu/3mit your entire inventory annually. . 201. CHEMICAL LQCA~ON * Enter ~he building or outside/a(/tacant ama wttare the dazardous material is handled. A chemical that is stored at the same pressure and temperature, in multiple Iocati0ns within a building, san be reported on a single page. NOTE: This information is not subject to public disclosure pumuant to HSC ~.5508. ;Z02- CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses wtlidil are suPject to the Emergency Planning and Commu~lity Right to Know Act (EPCJ:[A) mUSt check 'Yes' to keep chemical location information confidential, if the business does not wish to keel3 chemical location information confidential chect( "No*. 203. MAi3 NUMBER - If a map is included, enter the number of the mai3 on which tile location of the hazardous material is shown. 204. GRID NUMRER - if grid coordinates are used enter tlle grid coor(~linetes of Ule map alat con'espond to the ldcatioh of the hazardous material. If applicable, multiple grid coordinates can be listed.. · · 205. CHEMICAL NAME - Enter the proper chemical name associated with Ule Chemical Al:~stract Service (CAS) number of the hazardous materfal.. This should be ~e International Union of Pure and Applied Chemistry (IUPAC) name found (:n the Material Safety Data Sheet (M~DS). NOTE; If the chemical is a mixture, do not complete this field; comp/em the "COMMON NAME' field instead. 206. TRADE SECRET - Check '"Yes" if the information in this sec~on is de(dared a trade secret, or "No' if it is not. State requirement: [f yes, and business is net subject to EPC~A, dis~osum of the designated bade secret inforrnaUon is bound by HsC §2551.1. Federal requirement: if yes. and business is ~ubject to EPCRA, dtsc~sure 6f the designated Trade Secret information is bound by '40 CFR and the business must submit a 'SubstanUation lo Accompany C. dalms of Trade Sesracy' form (,tO* CFR 350.27~ to USEPA. .' 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture containing a hazardous material 208. EHS - Check "Yes" if the hazardous material is an Exa'emely Hazardous Substance (EHS), as defined in 40 CFR, Part 355; Apaend[x A. if the matedal is a mixture containing an EHS, leave this section blank and comptsta the sec~on on hazardous comp,3neots below, . 209. CAS # - Enter (he Chemical Absa'act Service (CAS) number fol; ~e hazardous material For mixtures, enter the CAS number of the mixture if it has'been assigned a number d~sfinet from its components. If the mixture has no CAS number, leave this column bian~( and report the CAS numham of the individual hazardous' components in the appropriate section below. 210. FIRE CODE PI,a~.ARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of haza~inus materials which a business handles. This information shall only be provided ii' the local fire ~hief deems it necessary and requests the CUi3A or AA lo collect iL A ilst of the hazard classes and instructions on how to determine which class a mstedat falls under are indiuded in the appendices of Ardcte 80 of the Uniform Fire Code, If a material has more than one applicable hazard ciasa, indiude ail Contact CUPA or AA for guidance, 211.' HAZARDOUS MATERIAL TYPE - Check the one box. that best beSunbas the type of hazardous mstedal: pure, mixture or waste. If weste material, check only thal~ box.' If mixture or waste, complete hazardous components seetJon. 212. RAI31OACT]VE -Check 'Yes' if the hazardous material.is radloac~ve or 'No' if iris not. 213. CURIES - if the hazardous materfal is ,'~dioac~'ve` use thi~ area to ..report the activity in c~Jdes. You may use up to nine digit~ with a*ffoaUrtg decimal point to report · activity in cudes. 214. PHYSICAL STA'~ - Check the one box that best d~es the state in w~icfl the hazardous material is handled: solid, liquid or gas. 215. LARGEST CONTAINER * Enter the total capacib/of the largest container in which the material is stored. 216. FEDERAL HAZARD CATEGORIES - Check ail cateqories that describe the physical and health hazards associated with the hazardous material. PHYSICAL- HAZARDS HEALTH HAZARDS Fire: Flammal)te Uquids and Solids, Combustible [Jquids, l:~pttorfos, OxJdizem Acute Health (Iromedlate): Nlgi~ty Toxic, T~xio, Jrdtente, Sensitizers, Reactive: tlsstahle Reactive, O ~r~anic Peroxides. Water Resctive, Radfoac~ve other hazardous chemicats with an adverse edeet with short term e~ooeure P~'essura Rdiaase: Explosives, Compressed Gases. Blasting Agents Chronic Heatth (Detayad): Ceminegeus, other haza~:lous chemiCalS with an , adverse effect with Ionq term ex1:~asure 217. AVERAGE 0ALLY A~OUNT - Calculate the average dally amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/ outside area. Caio~iatJone s_hall be based on the previOUS year's inventory of material reP°rted on this page. Total all,daily amounts and divide by the number of days the chemical will be on ~ta. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This'amount should be consistent with the units rel~orte~ in box ~.1 and should not exceed ~at of maximum 'daily amount. · , · 2.18. MAX]MUM DAILY AMOUNT - Enter the maximum amount of each hazardous'material or mixture containing a hazardous material, which is handled in a building or adiacent/outside area at any one time over the course ct the year. This amount must contain at'a minimum last year's inventor/of the matadal m1~ortsd on this page, with the reflection of addjtJoes, deletions, or revisions projected for the c~rrent year. This amount should tie consistent with the units rePorted in box 219. ANNUAL WASTE AMOUNT - If the hazardous material being inventoried ia a waste, provide an estimate of the annual amount handled.. 220. STATE WASTE CODE - If the hazardous material is a waste, enter the appropriate California 3-digit hazardous waste code as ilstep on the back of the Uniform Hazardous Waste Manifest, 221. UNITS - C~eck the unit of measure that is most apl~ropndte for the material being reparted on this page: gallons, pounde, c~*~ic feet or tone. NOTE; if the material is a federally defined Extremely Hazardous Substance (EHS). all amounts must be rel~ortep in pounds. If matedal is a mixture containing an EHS. report the units that the mstedal is stored in (gallons, ~)ounds, cubic foe~. or tons). 222. DAYS oN SITE - Ust the total number of days during the year that the material is on site. 223. STORAGE CONTAINER - Check all boxes that describe the type of storage containers in w~ich the hazardous matsdal is stored. NOTE: if al~propriate, you may 224.. STORAGE PRESSURE - Check the one box that best Pescfibes the pressure at which the hazardous rfiatedal is stored. 225, STORAGE TEMPEP, ATURE - C~ac~ the one box that best deSCribes the tamperatura at which the hazardous matedal is stored. 226. HAT-ARDOU$ COMPONENTS 1o5 (% ~Y WF~GHT) - Enter the percentage weight of the hazardous component in a mixture, if a ~ange of percentages is avallahle, report the highest percentage in that range. (Rel~ort for compenents 2 through 5 in 2.30, 234, 2.38, and 227. HAZARDOUS COMPONENTS' 1-5 NAME - When reponing a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer'to MSDS or. Jn the case of trade secrets, refer to manufacturer). All hazardous coml30nents in the mixture present at greater 11 than 1% by weight if hOn.-carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than ~ve. hazardous compo,'nente are present above these percentages, you may attach an additional sheet of paper to capture the required information. When ml~3~ng wast~ mixtures, mineral and chemisal composition sllouid be listed. (Report for components 2 through 5 in 231,235, 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 EHS - Check "Yes' if the component of the mixture is considered an Extremely Hazarpous Substance as defined in 40 CFR, Part 355. or "No' ii[it is not. (Report for components 2. througt~ 5 in 222, 236. 240, and 2.44.) 229. HAZARDOUS COMPONENTS 1-5 CAS - L~t the Chemical Abstract Service (CAS) numbers as related to the hazardous c~3mponents in the mixture. (Repeal: for 246. LOCALLY COLLECTED iNFOP. MATION - This space'may be used By the CtJPA or AA to collect any aclOiUonal informaUon necessary to meet the requirements of their . individual programs. Contact the CUPA or AA for guidance. UPCF ([/99) 7 DES Form 2731 ~..'.~ ~s~ '~_~ OFFICE OF E~mo~rNt~ · .~ ~ ~ . · ~2~r~r 1715 Chester Ave., CA 93301 (661) 326-3.979 CHEMICAL'DESCRIPTION ·. (one [o~ per ma~ oer building or 200 Page 1. FACIU~ INFORMA~ON BUSINESS ~ME (E~e ~ FACI~ ~E ~ D~ ~ O~ng ~n~ ~) 3 J CONFtD~L (~C~) II. CH~ICAL INFORMA~ON 207 . ~ p PURE . ~m MITRE ~ w WA~ 211 ~OlOA~E ~ Y~ ~ NO 212 CURIES 213 . ~at apply) ' If BS, ~nt m~t be in lbs. ' ' ~OVEGROUND TANK ~ e ~ONM~A~C DRUM ~ i ~B~ DRUM ~ m G~85 ~ b UNO.GROUND T~K ~ f ~ ~ j ~G ~ n P~C 80~ ~ r O~ ~ c T~K INSIDE BU'I~ING ~ g ~OY ~ ~ ~X ~ o TO~ BIN ~ d ~QRUM ~ h SILO ~ ( CYUND~ ~ p T~KWA~N PRESSURE A~I~ ~ ~ ABOVE AMBI~ ~ be ~OW ~1~ ~4 ~RE ~a ~Sl~ ~ ~ AaOV~ AMSI~ ~ ba B~OW AMBI~ ~ c ~YaGaStC coMPoNENT EHS ~S %~ H~RDOUS 241 IlL 81GNA~RE P~'.T NAME & .~ OF AU~OR,~ CO.ANY ~S~ATIVE S~RE ~ ' OFFICE O'F ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 .BUSINE'S~ OWNER / OPERATOR.IDENTIFICATION FACILITY INFORMATION Page Of i ' I. FACIUTY IDENTIFICATION , ' FACILITY ID # ; ~ i i i~.~ I ~ i ~! Year Beginning mo i Year Ending ' BUSINESS NAME (Same as FACIIJTY NAME or DBA- Doing Business As) . 3 i BUSINESS PHONE : DUN & ' ' 108 SIC CODE ¢~Z/ 1o7 COUNT ,0" I!. OWNER INFOR~TION iil. ENVIRONMENTAL CONTA~ ' CONTACT NAME ~[[ ~~ 117 , CONTACT PHONE CONTA~ ~ILING ADDRESS ' 5~M~" .-PRIMARY- IV. EMERGENCY CONTACTS ~ECONDARY- 2~OUR PHONE ~A~ '~ 2~HOUR PHONE '~AI~ V. CERTIFICATION Ce~cafion: Based on my inquiw of ~ose individuals, responsible for ob~ining ~e india[on, I ce~ unde[ penal~ of law ~at I have pemonally examined and am ~millar ~ Be in~a~on submi~ in ~is inv~tow and believe the inflation is ~e, accu~te, an~;~mplete. · ~ OR DATE , 'NA~E OF DOCUMENT PREPARER ,35 SIGNATURE ~OPE~T ~A-M~'OF O~E~OPE~TOR (print) 136 ?]%E OF OWNE~OPE~TOR ~37 Business Owner/Operator Identification please submit the Business Activities page, the BUS, ness Owner/Opera[or IdenlfficalJon page (OES Form Z730), and Hazardaus Ma/e~als.- Chemical. Oes~otion pages (DES Form 2731) for all hazarclaus materials inventory' sul3mlssione. For the inventory to i:a considered complete- ' this page must be signed by the appropriate indivicluai. - Note: the numbering of ~'le inslruc~ons follows the data element numbers that are on: the. UPCF pages.. These data element numl3em are used ' ' ar etec~nic submission and are the same as the numbenng used in 27 CCR, Appendix C, the Business'Sen~ort of the Unified Pn=gmm Oata..~ict[Onary.)~ . Please' numt3er all pages of your su0mitteL This helps your CUPA or AA idenlJ~/whether the submittal is complete and if any pages' are SeParated. 1. FACII. JTY ID NUMBER - This number is assigned by the CUPA or AA. This is the unique number which identifies your facility. _3. - BUSINESS NAME - Enter the fuji legal name of-the business. 100. 8EG~NNING OATE- Enter the beginning year and date of the report. (YYYYMMDD) 301.. ENDING DATE - Enter the ending year and date of the report. (YYYYMMOD)' 102. ' BUSINESS PHONE - Enter the phone number, area code first and any extension. 103.' BUSINESS SITE ADDRESS - Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. .. 10.4. CITY - Enter the city or unincorporated area in w'nici~ business site is located. 105. ZIP CODE - Ente~' the zip code of business site.' The extra 4 digit zip may also be added. 106. DUN & SRADSTREET - Enter the Dun & Bradstreet number for the fadlity. The Dun & Bradstreet number may be obtained by call/rig (610) 882-7748 Or by Internet. 107. SiC CDDE - Enter the pdmary Standard Industrial CIassitfcation Code number for pdmary business activity. NOTE: If code is more than 4 digits, report only the first four. 108. COUNTY ~ Enter the county in which the business site is located. · 109. BUSINESS OPERATOR NAME - Enter the name of the business operator. 110. BUSINESS OPERATOR PHONE - Enter business operator phone number, if different from business phone, ama code first, and any extension. · 111. OWNER NAME - Enter name of business owner, if different from business operator. 112. OWNER pHONE - Enter the business owner's phone number if different from business phone, area code first and any extension. 113. OWNER MAI UNG ADDRESS - Enter the owner's mailing address if different from business site address. 114. OWNER CiTY - Enter ~he name of the city for the owner's mailing address. 115. OWNER STATE - Enter the 2 c~aracter state abbreviation for the owneYs mailing.address- 116. OWNER 7_JP CODE - Enter the zip code for the owner~ address. The exlm 4 digit zip may also be added. 117. ENVIRDNMENT.~L CONTAC'J;. NAME - Enter the name of the person, if different from-the Business Owner Or Operator, who receives all environmental .correspondence and w]]l respond to enforcement ac~vity. 118. CONTACT PHONE - Enter the phone number, if different from Owner or Operator, at which the environmental contact can be contacted, area code first, end any extension. 119. CONTACT MAiL/NG ADDRESS - Enter the mailing address where ail environmental conlact correspondenc~ should be sent, if different from the -" . site address: 120. CITY - Enter the name of the city for. the environmenta/conta~ mailing address. 121. STATE - Enter the 2 character state abbreviation for the environmental contact=s mailing address. 122. ZiP CODE - Enter the zip code for the environmental contacf~ mailing address; The ex~ 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME - Enter me name of a representative that can be contacted in case of an emergency involving hazardous materials at the business site. The contact shall have FULL facility access, site famliia~y, and auth(~b/to make decisions for tile business regarding incident mitigation. 124. TITLE - Enter the title of the primary emergency contact. 125. BUSINESS PHONE - Enter the business number for the pdmary emergency contact, area code first, end'any extensions.' 126. 24-HOUR PHONE - Eoter a 24--hour phone number for the primary emergency contact. The 24.-hou~ phone number must be one which is. answered 24 hours a day. If it is not the contact's home phone number, then the senvice answering ,the phone must be able to immediately contact the individual stated above. 127. PAGER NUMBER - Enter the pager number for the pdmary emergency contact, if available. 128. SECONDARY' EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contacted in the event that the primary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and au~odty to make decisions for the business regarclthg incident_rnittgation. 129. TTTLE - Enter the title of the secondary emergency contact. 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code limt, and any extension: 131. 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact, .The 24 hour Phone number must be'one which is answered 24 hours a day. if it is not the contacts home phone number, th, .e.~."-the service answering the phone must he able to immediately contact the individual stated a133ve. 132. PAGER NUMBER - Enter the pager number for the secondary emergency contact, if available. 133. ADDI~ONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUPAs or AAs to c~ilect any additional information necessary ~o meet the requirements of their indk, idual programs. G3ntact your focal agency, for'guidance. 134. DATE - Enter the date that the document was signed. (YYYYMMDD) '" .~ ..... ' 135. NAME OF DOCUMENT PREPARER - Enter the fi~ll name of the person who prepared the inventory submittal information. 136. NAME OF SIGNER - En~r the full pdnted name of the person signing the page. The signer certifle~to a.familiarity with the information submitted and that based on the sig~e~ inquiry of those individuals responsible for obtaining the information, ail the information submitted is a'ue, accurate and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially designated representative of the Owner/Operator, shati sign in the space provided. This signature certifies bhat the signer is familiar with the information submitted and that based on the signer~ inquiry of those individuals responsible for Distaining the information it is the sign~ belief that the submitted information is l~ue, accurate and complete. 137. TITLE OF SIGNER - Enter the title of the person signing the page. '-' ~.. 'Il:' ~.t~'~ OFFICE OF EN'VIRO~NTAL SERVICES ,. .... tn~,~r~_ 171'5'chester'Ave., Bakersfield, CA 933'0'1 (661) 326-3979 ": ., ' FACIL]~ INFOR~ON Busings A~vifies Addendum Page ~ of '" I. FACILI~ IDENTIFICATION D~FACI~ ~ 3 ' ~I. CONSOLIDATED PERMIT ACTIVITIES ..  . Is your Fa~ili~ Compliance. Plan subj~ to ~view by..~ for sa~s~ing ~e ~ndifions or.ese pe~i~? H. DEPARmENTQFTOXIOSUBSTANcES'CONmOL OYES ~O ¢ 'STANDARDI~n?PERMI~,.' I .- · All 'MOd~ons,. ~0 ~' Nen-RC~.~RDQUS. WAS~ FAcIu~ OYeS OYES ~O ¢ RC~ ~-RDOUS WAS~ FACILI~ I. ' SAN JOAQUIN VALLEY UNIFIED-AIR POLLUTION OYES ~O ¢ -. · AUTHORI~ TO CONS~UCT' CONSOL DIS~ICT ' OYES ~O ¢ PERMITTQ OPE~ · - J. sTA~ wA~R RESOURCES CONSOL BOARD oYEs ~O. ¢ WASTE DISCHAEGE REQUIREMENT ~L VArY REGIONAL WA~R QUAU~ CONSOL OYES ~NO ¢ GENE~L PERMITS ~ ~O' ' ¢ SPECIFIC PERMITS - · OYES ~ ¢ ~O~L PQ~UTI. ON DISCHARGE OYES E~MINA~ON S~S~M (NPDES)' K. CALIFORNIA iNTEG~D WASTE MANAGEMENT BOARD. OYES ¢ REGIS~ON PERMIT L KERN COUN~ RESOURCE MANAGEMENT AGENCY ENVI.RONME~TAL H~L~ SERVICES PERMITS · ~ES ONO ¢ :Dom'~fic-Water ~ell OYES ~O ¢ H~ MatMoni~dng Well Pe~it OYES ~NO ¢ S~fic System Pe~it OYES ,~NO ¢ Public S~mming Pool P~it ;' OYES ~NO ¢ Pood Facili~ ~ns~cfion Pe~it OYES ~O ~ Solid Waste Lo~i"En~mement Agen~ ,, (~) Relate. Pe~i~ ' OMES ~O ¢ M~i~l Waste R~at~ P~i~ M.' CI~ OF BAKERS~ELD WASTE WATER DIVISION i OYES O ~ IN~DUjSTR~L WA'S~ WA~R DISCHARGE ~ PERM~ NO~:. ¢ If you ch~ YES to any pa~ of S~ons III-H to II1~ above, ~en please addre~ all appli~ble pemit r~uir~ in Be.Fa~li~ Compliance Plan. I. FACILIW IDENTIFICATION F. HA~RDOUS WAS~: ~ d EPA ID number~mvide on ~is page 1. Generate h~o~ ~ste? oYEs O ~2 To ob~in EPA I~. please phone(916) 32~1781 2. Recy~e more ~an- 100 k~mo of'm~aable materials at O~S ~O ~3 ~ - RECYC~NG FORM the same Io~fian it was g~emt~? .' 3. Re~e mom than 100 k~m0 of r~dabte materials at OYES ~O ~4 ¢ RECYCMNG FORM an o~ite Io~fion d~erent ~m ~e point of g~emaon? ~0 4. Treat H~ous WaSm on site?' ' OYES ~5 '.~ ~ FACILI~ .FORM (DTSC Fo~ '1~2) - ~ ~'UNIT FORM (one per unit) 5. Su~ect ~o ~nancial A~umnce r~irem~m? OY~S ~0 m ¢ CER~FICATION OF FINANCIAL ASSU~NCE 6. Consolidate H~aus Waste generated at a remote OYES ~O ~7 ¢ ..,, REMO~ WASTE/. CONSOLIDATION SITE site? ~ ~ NO~FtCATION FORM G. PERMIT CONSOLIDATION ZONE: OYES ~8 ¢ ,. CONSOLIDA~D COMPLIANCE P~N J intend '~ consolidate o~er. Ca,EPA agen~ p~i~? ~ Inco$o~Qng ail o~er ~vimnmen~l [ (If yes, p/~se ~mpiete Section III and a~ch) ~ pe~it r~uimmen'~ p~ 27 CCR 1 3TE: i ~ If you check~ YES to any paa of Secg0ns IIA-IIG above, ~e~ in addition, to ~e ~s r~u~t~ -above, please Submit OES Fo~ 2730. UPCF 171991 $:\CIJ PAFO RMS1ACTlV ITY'wpd HAZARDOUS ~[.ATERIAL$ M. AN~GEI~fENT PLAN SE~ION III: T~~G ~ER OF E~LO~ES~ ': : ff~~ ~17~ .. · ~TE~ S~E~ DATA S~ETS ON F~:/~ ~/~ df/l~ ~'Y~T/o~ZE~i~ BRIEF SUMMARY OF TRA.IN~G PROGRAM: ..f'/7~ CERTIFICATION I,. ~/,,t'6qZf,~t',,t/ CF_,R'I~Y THAT TI-~' ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT TI-lIS INFORMATION WILL'BE USED TO "' FUI2ILL MY FII~,_M'S OBLIGATIONS IJN'DF~ THE."CALIFOR2WIA I--IEAL~ AND SAFETY CODE" ON HAZARDOUS MATERLALS (DIV. 20.CHAPTER 6.95 SEC- 25500 ET. AL.).AND TI--tAT ]~qAC~TE INFORMATI-QN CONS'III:u.:r~.$ PERJLrKY. HAg MAT MNGMI~T Pt~N & IN&T~UC HAZARDOUS ~,,L~.TERIAL$ ~IANAGEMENT PLAN SECTION II.2: ~LEASE ~SPONSE PL~ A. '~~ ASSESS~ ~ P~~ON ~AS~S:. B.. R_ELEASE coNTArNMENT AND/OR MXTIGAT~ON: C. CLEAN-UP AND RECOVERY PROCEDURES: UT~ SHUT_OFFS (LOCATION OF SHUT-OFFs AT YOUR FACILITY') SPE~:. LOCK BOX: ~S~ ~ ~S, LO~ON: P~A~ F~ PRO~CTION~A~R AVAU.~WY .... A. PRIVATE. FI1LE PROTECTION:. ,/?~ ,r2'?Y~.,~'/.f/-/Z~.~,/t/.J~/T2~ ' B. WATER AVAILABILITY (FIRE HYDRANT): /~ELL Z2/..fe~/-/,d,~6Z' .'. '"SECTION fL ·. A. LEAK.: DE~CTION AND.'MO~©~O ?R:OCEDUR.ES.: C. ENVIItO~IWTAL RESPONSE' MANAGEMENT: D. EMEKGENCY M~-DICAL PLAN:', · .. ' "~ . ..----.~.~:_ a. CITY OF BAKERSFIELD . · ~a.~ r~r ~7~5 Chester Ave., Bake~aelU, C~'(661j 326-3979 ~A Z~O.US ~TE~S. ~AGE~NT PLAN. ~STRUCTIONS' 1. To avoid ~er acfio~ re~ ~s fora within 30 ~ys of receipt. 2. T~~ ~S~RS~ ENGLISH.' . ' ~ 00~ 3. ~swer ~e quesfiom below for ~e bm~ess ~ ,a whole. 4. ' Be ~ bdef~deonc~e ~ possible.. .. 5. You may ~so ~ach Bus~s Omer / ~tor Fora ~d ~emic~ Des~pfion Fom(s)· to ~e.~ont of~spl~ ~eM ofcomple~g SEC~ON'L belOw f6r ~fi~ ~b~si~ SEC~ON ~: BUS.SS ~~ICA~ON DATA (- LOCA~0N:.. J2~ ~wt/ ~r2rrT. E~RGENCY NO~ICA~ON ...~ "- CO.ACT T~E BUS. PHO~ 24 E ~ ~O 78 ~," E- ~47 G" A. C. SITE DIAGRAM.[ ] FACILITY DIAGRAm! ~ N $:\PROCEDURE MAI,~JA L~ti~j'amimt .~pd