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Home My WebLink AboutBUSINESS PLAN SITE/FACILITY FORM /~ q ~ ~/~'~' DI AG m~klVf NORTH SCA~E: F BUSINESS NAME: DATE :8 ~/~FACILITY N~ME: FLOOR: OF UNIT ~: OF (CHECK 0NE) SITE DIAGRAM FAC'IL ITY D IAGR.A~M w~ y Inspector's Comments): -OFFICIAL USE ONLY- SiTE DIAGRAM (RequlrWteas) 1. Address: Identify the principle buildings by the Street numbers. 2. Si.rent-(s), Alleys, Driveways, and Parking Areas adjacent to the property, Include the street names. '3. Storm Drains, Culverts, Yard Drains 9. Lock (key) Box 10. MSDS'Storage Box il. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c. Wood Drainage Canals, Ditches0 Creeks, 5. Buildings a. Frame construction d. Gates 13. Powerllnes 14. Guard Station b. Masonry construction c. Metal construction · d. Accese Door 6. Utility Controls a. Gas 15. Storage Tanks: Identify the capacity in gal. a. Above ground b. Underground 16. Diking or Berm b. Electricity 17. Evacuation Route c. Water ?. Fire Suppression Systems: a. Fire Hydrants 18. Evacuation Area: Identify the location where employees will meat, b. Fire Sprinkler Connections 19. Outside Hazardous Masts Storage c. Pire Standpipe Connections 20. Outside Hazardous Material Storage d. Water.Control Valves for protection systems 21. Outside Hazardous Material Use/Handling e. Fire 8. Fire Department Access 22. Type of Hazardous Material/Masts Stared or Used (See Below) TyPE OF HAZARDOUS HATERIA~ F - Flmenable g - Explosive L - Liquid R - Hadlologlcal C - Corrosive 0 . Oxidizer G - Gas P - Poison W - Water Reactive T - Toxic S - Solid H - Cryogenic D - Waste B - Etiological Example: Flammable Liquid - FL FACILITY DIAGRAM (Required items tn additlon to the above) l. Risers for Sprinklers 8. Fire Sscapes 2. Partitions O. Air Conditioning Unite 3. Stairways: Indicate the . 10. Windows levels served from highest to lo, et. 11. Inside Huardous Waste Storage 4. Escalator: Indicate'the levels served from 12. Inside Hazardous 'highest to,lowest. ,, #atsrials Storage 5. Elevator 13. 6. Attic Access ?. Skylights Inside Hazardous Materials Use/Handling Se~r Drain Inlets SPECIALTY METALS Manager : Location: 129 E 21ST ST City : BAKERSFIELD CommCode: BAKERSFIELD STATION 02 EPA Numb: / Title / (-805) 324-3516x (805) 589-8924x Emergency Contact THEODORE SPANKE Business Phone: 24-Hour Phone : pager Phone : ( ) - x BusPhone: Map : 103 Grid: 29A SiteID: 215-000-000979 (805) 324-3516 CommHaz : Moderate FacUnits: 1 AOV: SIC Code DunnBrad Emergency Cost ~?~ Bus iness Phol~/~f 24-Hour Phon~ ~: Pager Phone Hazmat Hazards: Fire Press ImmHlth DelHlth Agency-Defined Topic Title ~ Hazmat Inventory -- MCP+DailyMax Order Hazmat Common Name... ACETYLENE OXYGEN KEROSENE WASTE OIL ARGON EPA HazardsI Frm ISpecHaz[ F P IH G F P IH G F IH DH L F DH L F P IH G One Unified List Ail Materials at Site I DailyMax Unit}MCP 250 FT3 Hi 336 FT3 Low 55 GAL Low 55 GAL Low 336 FT3 Min -1- 06/10/1997 SPECIALTY METALS ~ Inventory' Item 0003 -- COMMON NAME / CHEMICAL NAME ACETYLENE Location within this Facility Unit NW CORNER SiteID: 215-000-000979 Facility Unit: Fixed Containers on Site Days On Site 365 CAS# 74-86-2 STATE -- TYPE Pure Gas PRESSURE , TEMPERATURE Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Lrgst Cont.this Loc FT3 DailyMax Stored FT3 AMOUNTS STORED AND IN USE DailyMax this Loc FT3 250.00 DailyMax Open Use FT3 Da[1yAvg this Loc FT3 250.00 DailyMax Closed Use FT3 %Wt. 100.00 Acetylene HAZARDOUS COMPONENTS EHS No CAS# 74862 2 06/10/1997 SPECIALTY METALS ~ Inventory Item 0002 -- COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit NW CORNER SiteID: 215-000-000979 Facility Unit: Fixed Containers on Site Days On Site 365 CAS# 7782-44-7 STATE -- TYPE /'Gas Pure PRESSURE TEMPERATURE I Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Lrgst Cont.this Loc FT3 DailyMax Stored FT3 AMOUNTS STORED AND IN USE DailyMax this Loc FT3 336.00 DailyMax Open Use FT3 DailyAvg this Loc FT3 336.00 DailyMax Closed Use FT3 %Wt. I 100.00 Oxygen, HAZARDOUS COMPONENTS Compressed EHSI CAS# INo 7782447 -3- 06/10/1997 SPECIALTY METALS = Inventory Item 0004 -- COMMON NAME / CHEMICAL NAME KEROSENE Location within this Facility Unit NORTH END SiteID: 215-000-000979 Facility Unit: Fixed Containers on Site Days On Site 365 CAS# 70892103 STATE -- TYPE ] PRESSURE Ambient Liquid Pure TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Lrgst Cont.this Loc GAL DailyMax Stored GAL AMOUNTS STORED AND IN USE DailyMax this Loc GAL 55.00 DailyMax Open Use GAL DailyAvg this Loc GAL 55.00 DailyMax Closed Use GAL %Wt. 100.00 Kerosene HAZARDOUS COMPONENTS EHS CAS# No 70892103 -4- 0~6/10/1997 SPECIALTY METALS ~ Inven'tory Item 0005 -- COMMON NAME / CHEMICAL NAME WASTE OIL Location within this Facility Unit NE CORNER .SiteID: 215-000-000979 Facility Unit: Fixed Containers on Site Days On Site 365 CAS# 221 rSTATE I TYPE PRESSURE Liquid Waste Ambient TEMPERATURE Ambient CONTAINER TYPE DRUM/BARREL-METALLIC Lrgst Cont.this Loc GAL DailyMax Stored GAL AMOUNTS STORED AND IN USE DailyMax this Loc GAL 55.00 DailyMax Open Use GAL DailyAvg this Loc GAL 55.00 DailyMax Closed Use GAL %W.t. 100.00 HAZARDOUS COMPONENTS Waste Oil, Petroleum Based EHS .°I CAS# -5- 06/10/1997 SPECIALTY METALS ~ Inventory Item 0001 -- COMMON NAME / CHEMICAL NAME ARGON Location within this Facility Unit EAST WALL CENTER SiteID: 215-000-000979 Facility Unit: Fixed Containers on Site Days On Site 365 CAS# 7440-37-1 STATE TYPE Gas Pure PRESSURE ~ TEMPERATURE Above Ambient I Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Lrgst Cont.this Loc FT3 DailyMax Stored FT3 AMOUNTS STORED AND IN USE DailyMax this Loc FT3 336.00 DailyMax Open Use FT3 DailyAvg this Loc FT3 336.00 DailyMax CloSed Use FT3 100.~0 Argon HAZARDOUS COMPONENTS EHS CAS# No 7440371 6 06/10/1997 SPECIALTY METALS SiteID: 215-000-000979 Fast Format Notif./Evacuation/Medical Agency Notification CALL 911 Overall Site 02/28/1990 -- Employee Notif./Evacuation WILL CALL 911 AND THEN LEAVE BLDG AND WAIT FOR HELP. 02/28/1990 -- Public Notif./Evacuation NONE LISTED 02/28/1990 Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 02/28/1990 7 06/10/1997 SPECIALTY METALS SiteID: 215-000-000979 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site 10/21/1991 ARGON BOTTLES, ACETYLENE AND OXYGEN BOTTLES ARE KEPT IN PORTABLE CART OR CHAINED TO SHOP WALL. 55 GAL OIL AND KEROSENE BARRELS ARE SEALED WITH LEAK PROOF CAPS. 100 LBS OF FLOOR SWEEP IS KEPT IN LARGE CONTAINER TO THROW ON ANY SPILL IN SHOP. -- Release Containment TURN OFF VALVES. LIQUIDS IN METAL CONTAINERS. LIQUIDS. .10/21/1991 USE FLOOR SWEEP TO CONTAIN -- Clean Up FLOOR SWEEP. PUT IN BAG AND DISPOSE OF PROPERLY. 10/21/1991 Other Resource Activation -8- 06/10/1997 SPECIALTY METALS SiteID: 215-000-000979 Fast Format Site Emergency Factors Special Hazards Overall Site -- Utility Shut-Offs A) GAS - OUTSIDE SOUTHEAST CORNER OF BUILDING B) ELECTRICAL - INSIDE SOUTHEAST CORNER OF BUILDING C).WATER - CENTER SOUTH SIDE OF BUILDING IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO .~ 02/28/1990 -- Fire Protec,/Avail, Water 02/28/1990 PRIVATE FIRE PROTECTION - THREE FIRE EXTINGUISHERS LOCATED ON OFFICE WALL AT ENTRANCE OF BUILDING ON WALL NEAR WORK BENCH AND ON WALL IN WELDING AREA, FIRE HYDRANT - CORNER OF 21ST AND UNION AVE APPROXIMATELY 500 FT FROM BUILDING, Building Occupancy Level -9- 06/10/1997 SPECIALTY METALS SiteID: 215-000-000979 Fast Format Training -- Employee Training WE HAVE 1 EMPLOYEES AT THIS FACILITY WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: Overall Site 10/21/1991 Page Held for Future Use Held for Future Use -10- 06/10/1997 SPECIALTY METALS Fast Format SiteID: 215-000-000979 Type+Category+Sub-Category+8'CharID Order One Unified List INSPECTIONS R~ference Dates Summary Description EVANS 02/03/1995 OK GAMBILL 03/11/1994 OK Reference Dates Summary Description BONNER 03/06/1990 OK BONNER 03/29/1991 OK BONNER 03/10/1992 OK KEROSENE NOW 10 GALLONS. BONNER 03/29/1993 OK -11- 06/10/1997 CUST NO. ~ MISCELLANEOUS RECEIVABLES ADJUSTMENT" NEW ACCOUNT ADDRESS CHANGE CLOSE ACCT FINANCE CHARGE I · OTHER AOJ ; CUSTOMER NAME MAILING ADDRESS SITE ADDRESS STATE ZIP CODE PARCEL NUMBER (IF APPLICABLE) ADJUSTMENT CHG DATE ' CHARGE CODE ADJUSTMENT AMOUNT APPROVED 05/22/91 e~ALTY METALS 215-0 Overall Site with 1 Fac. Unit General Information Page Location: 129 E 21ST ST Map: 103 Hazard: Moderate Ident Number: 215-000-000979 Grid: 29A Area of Vul: 0.0 Contact Name THEODORE SPANKE Title Business Phone (805) 324-3516 x ( ). - x Administrative Data 24 Hour Phone- 1(805)~ ( ) 5gq- Sq~~ Mail Addrs: 129 E 21ST ST City: BAKERSFIELD Comm Code: 2.15-002 BAKERSFIELD STATION 02 D&B'Number: State: CA Zip: 93305- SIC Code: Owner: THEODORE J. SPANKE phOne:. ( )3~ - ~IG Address: 801 EL RANCHO DR State: CA ~ City: BAKERSFIELD Zip: 93304- Summary ~,~..~ ,.~c~- /~'! Do hereby c~r~i~y thst ~ hays r®viswed ~he a~achcc~ [.,'a:.',a?dous materia~s ~an~gs- ment plan for~ any C~rrect[ons constitute a complete and correc~ m~ a~smsn~ p~n for my facili~,o 05/22/91 Pln-Ref Name/Hazards OALTY, METALS' 215-000-~9O Hazm~t Inventory List in MCP Order 02 - Fixed Containers on Site Form Quantity page MCP 2 02-003 ACETYLENE Fire, Pressure, Immed Hlth Gas 250 FT3 - High- 02-005 DRAIN OIL Fire,/Delay Hlth Liquid 55 GAL Low 02-004 KEROSENE Fir~, immed Hlth, Delay Hlth Liquid 55 GAL LOw 02-002 OXYGEN Fire, Pressure, Immed Hlth Gas 336 FT3 Low 02-001 ARGON. Fire, Pressure, Immed Hlth Gas 336 FT3 .Minimal 0~/22/91 OALTY METALS 215-0 00 - Overall Site <D> Notif./Evacuation/Medical Page 3 <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation WILL CALL 911 AND THEN LEAVE BLDG AND WAIT FOR HELP. <3> Public Notif./.Evacuation NONE LISTED <4> Emergency Medical Plan MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371 0~/22/91 OALTY METALS 215-0 00 - Overal! Site <E> Mitigation/Prevent/Abatemt Page 4 <1> Release Prevention' ARGON BOTTLES, ACETYLENE AND OXYGEN BOTTLES ARE KEPT IN PORTABLE CART OR CHAINED TO SHOP WALL. 55 GAL OIL AND KEROSENE BARRELS ARE SEALED WITH LEAK PROOF CAPS. 100 LBS OF FLOOR SWEEP IS KEPT IN LARGE CONTAINER TO THROW ON ANY SPILL IN SHOP. ~<2> Release Containment' <3> Clean Up <4> Other Resource Activation 0'5/'22/91 ~~ALTY METALS 215-000-~ 00 - Overall Site <F> Site Emergency Factors Page 5 <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUTSIDE SOUTHEAST CORNER OF BUILDING B) ELECTRICAL - INSIDE SOUTHEAST CORNER OF BUILDING C) WATER - CENTER SOUTH SIDE OF BUILDING IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - THREE FIRE EXTINGUISHERS LOCATED ON OFFICE WALL AT ENTRANCE OF BUILDING ON WALL NEAR WORK BENCH AND ON WALL IN WELDING AREA. FIRE HYDRANT - CORNER OF 21ST AND UNION AVE APPROXIMATELY 500 FT FROM BUILDING. <4> Building Occupancy Level Q5/22/91 ~P ~ALTY METALS 215-0 00 - Overall Site <G> Training Page <1> Page 1 , ~WE HAVE 1 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING:. <2> ~age 2 as needed <3> Held for Future Use <4> Held for Future Use · - -, i! CI'i'Y of BAKER EFI ELD · 1 ' HAZARDOUS MATERIALS INVENTORY Farm andAgticultuie' FI' Staddard Business [] NoN_TRADE. 'SECRETS ii ' Page ..... of'___ L CA 0 . ~TI N' /. ' ~ ~z~. ~ ,' .ADDRESS' ~ ~ L~. ~g STANDARD 1ND. CLASS PHONE fl: ~4~.~/~ I.' r~, ~5~ ~ CODES ~.- ~ '--- Names of 'Hixture/C¢~Donents ,' I 2 3?. 4 !' 5 6" I 8 9 10 II 12 I ,Iw!y 14 lrans-!ylle Hal lv.erpgeI Annual Neas.ure I~[e ~ont Cont-Coat ~e tocltion.~he'Ee. [, ' Code [ooe AmC AmC ESL UfllCS ' on /ype Press Iemp StoreO In kaCllICy ~ See lflstructlons ~ ' C.A.5. Number Component II Name I C.A.S. Number ~ Physical 8nd HeAlth:HAzArd / , (C~ 411 that apply)· . ?' Health Component 13 Name I C.A;S. Number physicll .lod Health[Mlard ~: C,A.S. Number Component II Name A C.A.S. Number ~ (Check all that app/H 0 Fire Hazard ~ Reactivity ' 0 Sudden Release ~. lm~i~ C°mp°nenL 12 Name I C.A.S. Number it: of Pressure ~ · ~ Componen~ I1 N4mel C.A.S. NUmber . ~:~'. Phy'sical and Health:Hazard ;; C.A.S':.Number } , Component Il Name t C.A.S. Number '} (Check 811 that ap~ly) .j - - ' ' ': ;i- ~: ~e ~ Component ,2 Name&C,A.S, Number ?. ~ C.A,S. Number Component II Name I C.l.S. Number Physical' nod Health 6alard (Check al/ that a~p/H i . fi · .. ' Component 12 Name i C,A.S, Number . ~ : 0 Fire Hazard ~ 0 Reactiv. itY O Oelayed O Sudden Release 0 [,~i~ ti J -- ' ' Health of Pressure I~ ] ~ Component 13' Name I C.A.S. Number ~) j ~r Phone -- ~ . : ~ HUe- ': 'ertif' atio ] Re "'and f n af r corn 1 ting ¢qll s cCions) . . . :?m~t~ted ~n~ormati(~n Is true, accurate, and co,Mete. ' ' f oMnar o ~rator uH owner/operator s authorlteo re,recitative - . ~. , ~ · :, I cI'I'Y of BAKER,St-.LELD '~ ' HAZARDOUS MATERIALS INVENTORY "Farm and Agriculture Fl' Standard Business [] "-"~' T'~-'^'-'E SECRETS PUS[NESS NAHE: ~P~-C'//'~-~"~'Y ,~'/~7'"/z]-,~ $OWNER NAHE: ~/~..Y~'- ¢.~,~_~ ~' ~ L CATION / , ~/~ '~ ADDRESS ~ ~' ~~ ~ ~ mum u z~u. ~U~ ~uuc: ....... Ptl0UE fl: ~ _~/~ I ~ "~O~NSTRU~f~dN~R~ROPER CODES -- t Nam of ,ixture/¢oeuonenT,,s'~ lrans !yqe Nax Avgrpge; Annual Hgasure I ICe ~ont Cent Cent Us Location.¥he[e. Stereo In Facility ..~ .. wi Code Loom AmL Amc Est units on _ .... mype Press lamp Cole . . See InstructIons // . Physical and Health'Hazard I C,A,S, Number' Component il Name I C,A,S, Number (Check ali that apply). ~ [ : re Hazard ~E] Reactivity ~ Release , Component I~ Name I C.A,S, Number { .. -'~ : ' o[Pressure Component 13 Name I C.A;S. Number - I Iii- II I I I I I I I i _ Physfcal add Health:Hazard I C,A,S. Number ~ Component Il'Name & C,A,S, Number (Check al/ that apply| ~ ] Component 12 Name I C.A.S. Number ! · ~ Fire Hazard ]1'1 Reactivity [] Delayed [] Sudden Release ['1 ]m~i~ -- Health of Pressure :! Component 13 .Name I C.A.S. Number Physical and Health:pHard i C,A.S. Humber Component II Name I C.A.S. Number (Check all that apply! . ' ii 1 -'~ Component 12 Name I C,A.S. Number 0 Fire Hazard i O Reactivity: 0 Delayed [] Sudden Release I-I Immediate Health of Pressure Health -- <I i i Component 13 Name I C.A,S. Number I " ~"~ysical-epd Health ~alard i C,A,S. Number Component II Name I C.A.S, Number (Check al/ that a!p/yl j ! ' Component 12 Name l C.A.S. Number 0 Fire Hazard i [] Reactivity [] Delayed [] Sudden Release [] lm~i~ : · Health of Pressure ) : Component 13 Name I C.A,S. Number ) I EHEROENCY CONTACTS #1 ,, #2 { N~ee TITIe 2¥1~F-P~e R~e Title !.rtiictinn{(Read and ~ fan a '~;~[{f~'u~]er oenil~) of'la, thatl ~av~ personally examlnq~laqd ti~ed'd~c,een~ ~anQ that 6asea on my mnQuiry of those ~no~v~euams responsiome ~or obtaining the mn~ormac~on. I belmeve Lhac. the s~m)tted ]n)ormaElgn is true, accurate, and cokp/ete, ~.~e~-~TT~lT-tltq~ of owner/op~ritor UH ow~erloperatorL~ iuT.~~r~t'it-~ SECTION $: HAZARDOUS MATERIALS FOR THIS b~IT ONLY .A. Does this Facility Unit contain Hazardous Materials..° ...... ~NO If YES,. see B. If NO, continue with SECTION 4. B. Are any. of the hazardous materials-a bona fide Trade Secpet YE If No, comPlete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form ~4A-1) If Yes, complete a hazardous materials inventory fbrm marked: TRADE SECRETS ONLY (yellow ·form ~4A-2) in addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTZO~ 5: ~OCAT[O~ O~ ~ATER SUPP~? POR USB B~ E~RG~C~ R~SPO~ERS S~gT]O~ 8: ~OgAT~O~ O~ gT~ S~T-O~S A~ T~]S g~T 0~. .-.~.~. B.' ELECTRICAL: C. WATER: D SPECLAL: E LOCK BOX: YES ./~ IF YES, LOCATION: IF'YES, SITE PLANS? YES .I NO MSDSs? YES ./ NO FLOOR PLANS? YES ./ NO KEYS?' YES / NO - 3B - ~":~ ~= ~ BAKERSFIELD CITY,FiRE DEPARTMENT 2130 "G" STREET · BAKERSFIELD, CA 93301 'OFFICIAL USE ONLY ID# · BUSINESS NAME: BUSI NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be re'tuz'ned by: 2. TYPE/PRI.YT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below 'for THE 'FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILI~ D~IT~ . -FACILI~ b~IT NA~: SECTION 1: MITIGATION, PRE~NTION, ABATEMENT PROCEDURES / / SECTION 2: NOTIFICATION ANq3 EVACUATION PROCEDb~RES AT THIS UNIT ,W~I_z-. ,~'~ z~' GT'] ,,4t,,'o ~~ - 3A - '?,~." 2130 "G" STREET RECEIVED BAKERSFIELD, CA 93301 (805) 326-3979 _.~ -v'~ AUS 2 8 1987 Ans'd ............ OFFICIAL USE ONLY ~ BUSINESS NAME HAZARDOUS lVL~TERIAL S BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this form by 2..TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. B '. ~ ~ SECTION 3: LOCATION OF ~[LI~ S~-OFFS FOR BUSI~SS AS A ~OLE A. NAT. GAS/PROPANE: B. ELECTRICAL: /~1~ ~,~ C. WATER: ~f~ .~, ~/~L~ ~ ~/Z~/~ /~ ~LV 'D. SPECIAL: / E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / N0 MSDSS~ YES / NO FLOOR PLANS~ YES / NO KEYS~ YES / NO 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING j/~) ~2~.~7..~yZ~ 7~,S EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND..- REFRESHER 'TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS '~"~ .MATERIALS:.'..- .................................... YES YES B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO YES. NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO~ E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES N~9/ YES ~O~ SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... /'~rE~ NO ~,. 7-/~2D~'9/~..J~':"?~:'/O/~:~~-certify that the above information is accurate. I unders%and th~.t this information will b$ used to fulfill my firm's obligations under the new California ~ealth and Safety code~on Hazardous Materials (Div. 20 Chapter 6.95 Sec': .25500 Et Al.) and that inaccurate information constitutes perjury. - 2B - HAZARDOUS BAKERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 NON--TRADE SECRETS MATERI ALS I NVENTO'R-Y Page OWNER NAME:'~/~JD~'~ ~ ~91%t/~E FACILITY UNIT ADDRESS: ~C)/3=~'d- ~A/~.~ ~)~, FACILITY UNIT NAME: -.--- c i TV, Z I P: ~5~e.~r~/~__x~>. ~_~ 9 ~ OFFICIAL USE CFIRS CODE ONLY 1 2' 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.0.T .CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT, WT. CHEMICAL OR COMMON NAME CODE GUIDE / / NAME 7-/'/'~O/90,ff'e .~ ..%~o/gA/A".~ TITLE: ORg~/_~-,~_ SIGNATURE ;-: EMERGENCY CONTACT:~5'~/C ~;z~MF~, TITLE: ~/i~'~=- PH~ HOURS: AFTE BUS HRS: · EMERGENCY CONTACT: ~OO~ ~~ TITLE: ~O,,L~ PHONE # BUS HOURS: PRINCIPAL BUSINESS ACTIVITY: ?~d~-~ 5~;~/~J~ ~,~ AFTER BUS HRS: