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Home My WebLink AboutBUSINESS PLAN .~' CITY OF BAKERSFIELI ,~ Lla;t~; ,~._o iFFICE OF ENVIRONMENTAL :ES t ,an ts Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days 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. .. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front' of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: (" EMERGENCY NOTIFICATION ' CONTACT TITLE BUS. PHONE 24 HR. PHONE H '~A~OUS MATERIALS MANAGEi NT PLAN SECTION II, 1: DISCOVERY AND NOTIFICATIONS (" A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: ...... _~" ~~ .... of ~" :~ ¢//'--~.~ ......................... C. ENVIRO~NTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: HA; tDOUS MATERIALS MANAGE PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. ~LEASE CONTENT A~/OR ~TIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) ELECrPaCAL: /~,~6e_. ~a~ ~/~r~.c~,¢; ~ ~ ~. WA~R:' SPEC~: LOCK BOX: ~S~ · ~S, LOCA~ON: PRIVATE FIRE PROTECTION/WATER AVAILABILITY B. WATER AVAILABILITY (FIRE HYDRANT): ' - ~r V. ~o.<-bL z,~.-f Co 3 HAZarDOUS MATERIALS MANAGEi PLAN .....~ t SECT[ON [I[: TRAINING (- NUMBER OF EMPLOYEES: ~) "'" "' MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM:- CERTIFICATION // , CODE" ON HAZARDOUS lVI~~LS ~. 20 C~~R 6.95 SEC. 25500 ET ~.) ~~CC~TE ~~~ CONS~ES PE~Y... ~~~ Si~AT~ · ~ / TITLE -- / MAT Ml~tOMl~r P~N & INSTRUC 4 CITY OF BAKERSFIELD OF ENVIRONh, IENTAL .'ES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS FACILITY INFORMATION INSTRUCTIONS BUSINESS OWNER / OPERATOR FORM I. FACILITY IDENTIFICATION: Enter the reporting period (year beginning and ending) for the facility information. Enter the business name and site address and phone number of your business. Do not use P.O. box numbers. Enter the Dun & Bradstreet or federal tax identificati__qon number for your business. Enter the Standard Industrial Classification (SIC) number for your business. Each type of bUsiness has a Standard IndUstrial Classification code number. Some common SIC codes are listed on the back of this page. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Development Department, or by calling our office at (661) 326-3979. Enter the name and phone number of the person responsible for operating the business. II. OWNER INFORMATION: List the legal business owner or corporation name and provide the headquarter address or residential address if owned by an individual and phone number. III. ENVIRONMENTAL CONTACT: Identify the person who is primarily responsible for environmental compliance at the business. This person may be either the business owner, one of the emergency contacts, an environmental manager, or consultant. IV. EMERGENCY CONTACTS: List the name, title, and phone numbers of two people at the business who can respond if the Bakersfield Fire Department requires additional information or other assistance. These contact persons must have keys or access to all areas of the facility, be available for emergency call-outs, and have decision-making authority to call on other resources (such as hazardous waste, clean-up companies) as necessary. V. CERTIFICATION: The business owner or operator must sign, date, and also identify the document preparer. COMMON STANDARD INDUSTRIAL CLASSIFICATION {SIC) CODES · 0 { l 1 Wheat p.roduction 0724 Cotton ginning 5821 Eating places 01 t 5 Corn production 0541 Grocery store 5813 Drinking places (Alcohol service) 0131 Cotton production 1541 Dry cleaners 5983 Fuel oil dealers 0139 Field crops, except cash 2911 Oil refineries grains . 5984 LPG dealers 3441 W~/d-i~'g/fabrication- 0161 Vegetables & melons 7342 Pest control structural 0172 Grapes '7532 Auto top, body, 3443 Welding/fabrication - upholstery repair 0173 Tree nuts boiler Auto paint shops 0174 Citrus fruits 3569 Machine shop 7533 Auto exhaust repair 0175 Deciduous tree fruits 4222 Cold Storage 7536 Auto glass replacement 0179 Other tree fruits & nuts 4925 Compressed gas supplier " _ 7537 Auto transmission 0192 General farms, primarily 5093 Automobile salvage repair crop 5169 Chemical supply 7538 General auto repair 0241 Dairy farms ... 5511 Motor vehicle dealers 7542 Car washes 0252 Chicken eggs '(new & used) 8071 Chemical laboratory 0253 Turkey eggs 5521 Motor vehicle (used only) 285'1 Paint manufacture 5531 Auto & home supply stores 0291 General farm, primarily livestock & animal 5541 Gasoline service stations specialties 2 S'FA I'E WAS'FE CODE 220 it' the hazardous ~ waste, enter the appropriate Calitbmia 3-~ ~rdous waste code ;ks listed on the back of the Unitbrm Hazardous Waste Manifesc A list of common State Waste Codes are included on page 4 of these instructions. UNITS 22 ! Check the unit of measure that is most appropriate for the material being reported on this page: gallons. pounds, cubic feet or tons. NOTE: [f the material is a federally defined Extremely Hazardous Substance (EHS). all amounts must be reported in pounds. [f material is a mixture containing an EHS. report the units that the material is stored in (gallons, pounds, cubic feet, or tons). DAYS ON, SITE 222 List the total number of days during the year that the material is on site. STORAGE CONTAINER 223 Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE; If appropriate, you may choose more than one. STORAGE PRESSURE 224 Check the one box that best describes 'the pressure at which the hazardous material is stored. STORAGE TEMPERATURE 225 Check the one box that best describes the temperature at w, hich the hazardous material is stored. HAZARDOUS COMPONENT I - 5 (% by weight) 226, 230, 234,238,242 If a range of percentages is available, report the highest percentage in that range. HAZARDOUS COMPONENT 1 - 5 Name 227, 231,235,239, 243 When reporting 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, in the case of'trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non- carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. HAZARDOUS COMPONENT I - 5 EHS 228,232,236, 240, 244 Check "Y" for yes if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or "N" for no, if it is not. HAZARDOUS COMPONENT 1 - 5 CAS 229, 233,237, 241,245 List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. III. SIGNATURE: 246 Please print name, title, sign and date each chemical description form. If you have any questions please call us at (661) 326-3979 3 [FORNIA WASTE C Code Description Code Description [norg:mics 241 Tank bottom waste [ I :\cid solution 2 < pH < 7 with metals 251 Still bottoms with halogenated organics (antimony, arsenic, barium, beryllium, 252 Other still bottom waste cadmium, chromium, cobalt, copper, lead, 261 PCB's and material containing PCB's mercury, molybdenum, nickel, selenium, silver, 271 Organic monomer waste (includes unreacted thallium, vanadium and zinc) resins) 112 . Acid solution without metals 272 Polymeric resin waste 113 Unspecified acid solution 281 Adhesives 121 Alkaline solution pH >12.5 with metals (see 291 Latex waste 1 l 1) 311 Pharmaceutical waste . _ 122 Alkaline solution without metals 321 Sewage sludge 123 Unspecified alkaline solution 322 Biological waste other than sewage sludge 131 Aqueous solution (2 < pH < 12.5) containing 331 Off-spec, aged or surplus organics reactive anoins (azide, bromate, chlorate, 341 Organic liquids (nonsolvents) with halogens· cyanide, fluoride, hypochloritc, nitrite, 343 Unspecified organic liquid mixture perchlorate and sulfide anions) · 351 Organic solids with halogens 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues Sludges. 10% or more 411 Alum and gypsum sludge 134 Aqueous solution with total organic residues 421 Lime sludge less than 10% 431 Phosphate sludge 135 Unspecified aqueous solution 441 Sulfur sludge 141 Off-spec, aged, or surplus inorganics 451 Dcgreasing sludge 151 Asbestos containing waste 461 Paint sludge 161 FCC Waste 162 Other spent catalyst .481 Tetraethyl lead sludge 171 Metal sludge (see 111) 491 Unspecified sludge waste 172 Metal dust and machining waste (see I I I) 181 Other inorganic solid waste Miscellaneous 511 Empty pesticide containers 30 gal or more Organics 512 Other empty container 30 gal or more 211 Halogenated solvents (methylene chloride, 513 Empty containers less than 30 gal chloroform, TCE, TCA) . . . 521 Drilling mud 212 Oxygenated solvents (acetone, butanol, MEK) 531 Chemical toilet waste 213 Hydrocarbon solvents (stoddard solvent, 541 Photo chemical/photo processing waste ~ylene) 551 Laboratory waste chemicals. 214 Unspecified solvent mixture 561 Detergent and soap 221 Waste oil and mixed oil 571 Fly ash, bottom ash, and retort ash 222 Oil/water separation sludge 581 Gas scrubber waste 223 Unspecified oil - containing waste 591 Baghouse waste 231 Pesticide rinse water 611 Contaminated soil from site clean-ups 232 Pesticide and other waste associated with 612 Household wastes pesticide production L $.tCIIP:IFORMS~IIA, ZMAT FACILITY' INFO INST .......... x -. '- .. . ..................... 4 ,, .ll~a a s ,, !_~. o OFI~ OF ENVIRONMENTAL SOVICES 'N,m ~,~rstorr 1715 Chester Ave., CA 93301 (661) 326-3979 FACILITY INFORMATION " ' .... ' Business Activities Page ~ of -- I. FACILITY IDENTIFICATION FACILITY ~0 # igor o/rice use .3~ly -olease leave talanl() I EPA lO # DBAJFACILI rY NAME .......... ---~. I1. ACTIVITIES DECLARATION Does Your Facility... ~ If Yes, Please Complete... · 1. Have on site (for any purpose) hazardous materials at or i ~ CONSOLIDATED COMPLIANCE PLAN above 55 gallons for liquids, 500 pounds for solids, or 200 ~:. ! Minimum required planninq elements: cuft for compressed gases (include liquids in ASTs and ·, · Emergency Response Plan USTs)? I · Maps 2. Have anY amount of an explosive matedal (other than OYE. S ~NO s · Training ammunition) on site? · Prevention · Certifications -B:'-~'~GUEAf~b-S0~:rAgi~-i~"(h~;) OYES ~NO s ~ DES FORM 2731 (Che~ica, Have onsite RS at greater than the threshold planning v' RISK MANAGEMENT PLAN (RMP Sut)ma to USEPA) quantit!es established by the California Accidental v' CONSOLIDATED COMPLIANCE PLAN Release Prevention program (CalARP)? - , · Incorporating CalARP Program Elements ' ~'.--b}qb Ei~6 0-~'b-ST~)fi, A~;-Ei'=rAN ~-¢U Srs) OYES ~lNO ? ¢' U &~'-F-/~ i~.'l TY ' ~-~'~l~i · ~. Own or operate Underground Storage Tanks? -:. v' MST TANK FORM (one ~ Intend to upgrade existing or install new USTs? OYES ONO $ v' UST FACILITY FORM v~ UST TANK FORM v' MST INSTALLATION FORM (one ~e~ tank) --~.'"'T',':',NK-CLOSURE / REMOVAL ......... OYES ~INO 9 ~' UST TANK FORM (do,ute secfion--o~e per lank) 1. Need to report closing a UST that held hazardous materials or waste? 2. Need to report the closure/removal of a tank that was OYE~' ~INO ~o v' TANK CLOSURE FORM classified as hazardous waste and cleaned onsite? "-E]'"~-0~E 'GROUND PETRO~vl STORAGE TANKS (ASTs) '. OYES -~l~NO ~ ' v' CONSOLID,~TED COMPLIANCE PLAN Own or operate ASTS above these thresholds: any tank ~ · Incorporating Federal Spill Prevention ~ Control and Countermeasure (SPCC) capacity is greater than 660 gallons or the total capacity ; : : Elements pursuant to 40 CFR Part 112 for the facility is greater than 1,320 gallons. "F'~'-~-I,~.~RD~US WASTE: ~ i V' [~'-~'~'~'~j~b"~'~/ide on this page 1. Generate hazardous waste? ' OYES ~,10 ~ i To obtain EPA ID/¢. please phone (916) 324-1781 2. Recycle more than 100 kg/mo of recyclable materials at OYES ~NO ~3 :: v~ RECYCLING FORM the same location it was generated? 3. Recycle more than 100 kg/mo of recyclable materials at OYES I~NO ~4 v' RECYCLING FORM an offsite location different from the point of generation? 4. Treat Hazardous Waste on site? OYES ~NO ~5 v' TP FACILITY FORM (DTSC Form 1772) v' TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requirements? OYES ~NO ss v' CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a remote ! OYES` ~INO ~? v~ REMOTE WASTE I CONSOLIDATION SITE site? i . NOTIFICATION FORM a." PERMIT CbN,~0[i'b~-'i:l'0'N'zb~Ei................................ [-(~"1;~[~"~1~-'~''' ,8 ' v" CONSOLIDATED COMPLIANCE PLAN Intend to consolidale other Cai/EPA agency permits? i · Incorporating all other environmental (If yes, please complete Section III and attach) ! permit requirements per 27 CCR 10410 Il /OM checked YES to any part of Sections IIA-IIG above, that{ in addition to the forms requested above, please Submit DES Form 2730. UPCF (?199) S:tCU PAFORMS~AC TIVITY.w~O OF ENVIRONMENTAL · 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ( FACILITY INFORMATION 13usmess Activities Addendum Page ~ of I. FACILITY IDENTIFICATION DSN~ACILI~ ~ME III. CONSOLIDATED PERMIT ACTIVITIES Is. your Facility Compliance Plan subject to review by... -- ' f~r satisfying the conditions of these permits? ' H. DEPARTMENT Of TOXIC SUBSTANCES CONTROL OYES ~--~'-- i ~ ...... '~-'N-E~I~-~i~'D-~'~I~ ................ '7-' .... : · All Modifications OYES ~NO v' Non-RCRA HAZARDOUS WASTE FACILITY. OYeS I~NO , v" RCRA HAZARDOUS WASTE FACILITY "'1]' S--,~.-~']~A-(~IN V,~L-t~IF:';Y-'~N-"iFI"-~-~-~,[~'~OLLUTION OYES ~tNO ¢ AUTHORITY TO CONSTRUCT CONTROL DISTRICT OYES I~NO v' PERMIT TO OPERATE J. STATE WATER RESOURCES CONTROL BOARD OYES (~NO v' WASTE DI~:'HARGE REQUIREMENT (WDR) _:NTRAL VALLEY REGIONAL WATER QUALITY CONTROL OYES (~NO v' ' GENERAL PERMITS ~OARD OYES ~NO v' SPECIFIC PERMITS i ~ NATIONAL POLLUTION DISCHARGE OYES ~NO , ELIMINATION SYSTEM (NPDES) K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD OYES ~NO ,v' REGISTRATION PERMIT L. KERN COUNTY RESOURCE MANAGEMENT AGENCY . ENVIRONMENTAL HEALTH SERVICES PERMITS OYE~' ~NO v' Domestic Water Weld Permit '.. OYES ~INO " ~ - haz Mat Monitoring Well Permit OYES t~NO V' Septic System Permit OYES I~NO v' Public Swimming Pool Permit OYES ~NO v' Food Facility Construction Permit OYES ~NO v' Solid Waste Local Enforcement Agency · ' (LEA) Related Permits : ' OYES,I~NO v' Medical Waste Related Permits ' I~t~-~:'['~y"O-I~ §,~R'[~h§~l'~i'~§¥[-'vFA¥i:-~"~/gi-§i6'~ ............-'~;i~-~'~i~5 ............ 12 .......I-~D--U-S-T-R'J,'~['W/~§TE WATER DISCHARGE PERMIT NOTE: v' If you checked YES to any part of Sections III.H to III.M above, then please address all applicable permit requirements in the Facility Compliance Plan. ..... ~,..,~, ~_ OFFICE OF ENVIRONMENTAL SERVICES · :-i. rtttm ~ 17l~hester Ave., CA 93301 (661)~6-3979 BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION Page I. FACILITY IDENTIFICATION -FACILITY ID # ~oo ~ Ye_ar ~,,inning Year Ending BUSINESS NAME (SameasFAClLITYNAMEorDBA-OoingBusnessAs} 3 ' B-JJSJNE~;S ~PHONE '~,'~ ' SITE ADDRESS/~ / ~ ~J ............ ~03 ~/~. .... ~.~, ~. , ~ ................ , ............. ' ............................ ". ............. ~,~ ~~~/~"'~ ...... ~~L ........... ~, ~ '~'" ~ / ................... 110 ~1. OWNER INFORMATION OWNER ~ILING ADDRESS ~3 ~, ..... - .......... ~2o STAT . ~ . ................. ' ~ ,2, ZIP ~3~ c~_~___~~<./~_.~~---:-~~';'._; ..... _~ 7 -PRIMARYr . IV. EMERGENCY CONTACTS . ~ECONDARY- .............. 4....~=~. ~ .................................... . ........................................... : ............................................... ;~' ............ ' ........... ~ ......................... ' ~32 :~4:~o~...o.~ ~L ~-/7~ ,,, ~ ~,..o~. ~,?~_..__~ .... ~.~..~~ ................. ._ V. CERTIFICATION ~, ,.L ................ , Certification: Based on my inqui~ of ~ose Individ~l~nsible for obtaining the informatlon~ ce~i~ under penalty of law ~at I have personally examin~ and am familiar with lh~rmation submitt~ i~ invento~ and believe the info~a~n is ~e, accurate, and complete. /) S:~CUPAFORMS\OES2730.T',/4.wlsd !PCF (7199) Business Owner/Operator Identification Please submit II~e =3us~ness Act~wt~es page. t ~ness Owner/O~erator Idenl~flcalJon page (OES F 730). and Haza~ous ~terals - Chemi~l O~cnouon pages {OES Fo~ 273 t ) for all ~azar~ous matenals inventow submi~ions. For ~e inven~to be ~nsider~ ~mple~e . ~s page must be s~g~ 0y ~e 3ppropnate ,~i~d~l. Note: ~e numbenng of ~e ,ns~cBons follows ~e da~ element numbem ~at are on ~e uPCP page. ~e da~ dement num~ are ~ jr ~ectron~c submission and are the ~me as ~e num~enng us~ in 27 CCR. Appendix C. ~e Business S~tion of ~e Unifl~ Pr~m Oa~ Otc~ona Please numOer all pages el your suom,Ral. Th~s helps your CUPA or ~ idenB~ whe~ ~e submi~l is ~mplete and if any pages are separate. 1: FACILITY I0 NUMBER - Th~s number ;s ass~gn~ by the CUPA or ~. This is ~e unique number whi~ identities your facili~. 3. · ~USINESS NAME - Enter ~e ~111~al name of ~e Ou~ne~. tOO. BEGINNING OATE- Enter the ~innmg year and date of ~e repo~. (~MMDO) 101. ENDING OATE- Enter the ending y~r and dam of ~e r~. (Y~MMOO) '102. BUSINESS PHONE - Ent~ ~e p~ne number, area ~e flint, and any ~ten~on. 103. BUSINESS SITE ADDRESS - Enter ~e s~eet addre~ ~ere ~e ~cili~ is Io~t~. No post offi~ box numbem are allowS. ~is in~a~on must provide a means to g~mphi~lly Io~te ~e ~Qli~. 104. CI~-- Enter ~e ~ or unin~rat~ area in ~i~ busin~ site is lo~t~. --~. 105. ZIP CODE - Ent~ the ~p c~e of busine~ site. ~e ex~ 4 digit zip may al~ ~ add~. .;~--~ 106. DUN & B~DSTREET - Enter ~e Dun & Brads~t number ~r ~e ~Qli~. ~e Dun & B~ds~eet number may be ob~in~ by ~lling ....... (61'b) 882-7748 or by Intemet. 107. ~ COOE- Enter ~e pdma~ Standard Indus~al Cla~ifi~on C~e number for pdma~ busine~ acfi~W. NOTE: If ~e is mom ~an 4 digit, re~ only ~e ~mt four. 108. COUN~ - Enter ~e ~un~ in ~i~ ~e busine~ site is Io~t~. 109. BUSINESS OPE~TOR ~ME - Enter ~e ~me of ~e busin~ operator. 110. BUSINESS OPE~TOR PHONE - Ent~ ~n~ o~tor p~ne numbs, ~ diff~t ~m bu~n~ ~e, ar~ ~e flint, a~ any ~n. ' 111. O~ER ~ME - Enter ~me of ~in~ ~, ~ different ~m busin~ o~. 112. O~ER PHONE - Ent~ ~e bu~ne~ o~s p~ne num~ if differ~t ~m b~in~ p~ne, ar~ ~e flm~ a~ any ~e~°n. 113. O~ER ~ILING ADORESS - Enter ~e ~s maili~ addr~s if different ~m ~n~ site addr~. 114. O~ER CI~ - Enter ~e name of ~e d~ ~r ~e ~s mailt~ addr~. 115. O~ER STATE - Enter ~e 2 ~mct~ s~te abbre~a~on for ~e ~s maili~ addr~. 116. O~ER ZIP CODE - Enter ~e zip ~de ~or ~e o~er~ addr~. ~e ex~ 4 d~it ~p may al~ be add~. 117. ENVIRONMENTAL CO'ACT ~E - Enter ~e ~me of ~e per.n, if different ~om ~e Bu~n~ ~ or Operator, ~o r~iv~ all en~mnm~l ~nd~ a~ ~11 r~ ~ ~m~t a~. 118. CONTACT PHONE - Enter ~e p~ne numbs, if d~erent ~m ~er or Opera.r. at ~i~ ~e ~mnm~l ~n~ ~n be ~n~, ~e flint, and any ~t~sion. 119. CO.ACT ~ILING-ADORESS - Enter ~e maili~ addr~ ~em all en~mnm~l ~ ~en~ s~uld be ~ E d~t ~m ~e ~to addr~. , 121. STATE - Enter ~e 2 ~amcter s~te abbre~a~n ~ ~ en~men~l ~n~ct~ mai~ addr~. 1~. ZIP CODE - Ent~ ~e ~p ~e for ~e en~men~ ~n~c~ mailing ~dr~. ~e ~ 4 d~ ~p may al~ be add~. 12~. PRIORY EMERGENCY CO,ACT ~E - Ehter ~e name of a reprobative ~t ~ be ~n~ in ~se of an ~e~e~ in~M~ ~rdous materials at ~e b~in~ site. ~e ~n~ct shall have FULL ~dli~ a~. site ~miliad~, and au~d~ to make d~o~ ' [or ~e busin~ r~ardi~ inddent mifiga~on. 124. TITLE - Ent~ ~e flue of ~e pdma~ emergen~ ~n~ 125. BUSINESS PHONE - Ent~ ~e busings numb~ ~ ~e pHma~ emergen~ ~n~ ar~ ~e flint, a~ any exte~ions. 126. 24-HOUR PHONE - Enter a 2~ur p~ne numb~ ~ ~e pdma~ eme~en~ ~c[ ~e 2~ p~ numar m~t be o~ ~i~ Is a~ 24 houm a day. If it is ~t ~e ~n~s ~me p~ne num~, ~m ~e ~ a~d~ ~e p~ne m~t ~ able imm~iat~y ~n~ ~e i~l s~t~ a~. 127. PAGER NUMBER - Ent~ ~ pager ~m~ ~ ~e ~ eme~enw ~n~ if a~i~ble. 128. SECONDLY EMERGENCY CO~A~ ~ME - Enter ~e ~me of a s~a~ r~0ve ~t ~n ~ ~n~ .in ~e ~ent ~t ~e r~arding inddent mifiga~on. 129. TITLE - Enter ~e fi~e of ~e s~a~ eme~ ~n~. . 130. BUSINESS PHONE - Enter ~e busine~ t~ep~ne numar for ~e s~a~ eme~e~ ~ area ~e ~m~ and ahy extension~ 131. 24-HOUR PHONE - Enter a 2~ur p~ne numb~ gor ~e ~nda~ ~ergen~ ~n~ct. ~e 24 ~ur ~one number must be one ~i~ is an~er~ 24 houm a day. If it is not ~e ~n~'s ~me phone number, ~ ~e seM~ a~eH~ ~e p~ne must be able to imm~iat~y ~n~ ~e i~i~dual s~t~ a~ve. 132. PAGER NUMBER - Enter ~e pager number ~r ~e s~nda~ ~e~enw ~n~ct, if a~ilable. 1~. ADDITIONAL LOCALLY COLLECTED INFOR~TION - ~is space may be us~ for CUP~ or ~ to ~llect any addi~onal info~a~on n~ ~ meet ~e r~uir~en~ of ~dr i~Md~l pr~mms. ~n~ ~r I~1 age~ for guidan~. 1~. DATE - Enter ~e date ~at ~e d~um~t ~s slgn~. (~MMDD) i35. ~ME OF DOCUME~ PREPARER - Enter ~e ~11 name of ~e p~n ~o pmpar~ ~e invento~ submi~l info~a~on. 136. ~ME OF SIGNER - En~r ~e full pdnt~ name of th per~n signing ~e page. The s~ner ce~fl~ ~ a famillari~ ~ ~e [n~a~on submitt~ and ~at bas~ on the signer~ i~ui~ of ~se i~i~duals res~nstble for ob~ini~ ~e in~o~a~on, all ~e info~a~n submi~ is ~e, a~umte and ~mplete. SIGNATURE OF OWNE~ OPE~TOR OR DESIGNATED REPRESENTATIVE - The Busings ~eflOperator, or o~cially deslgnat~ represen~tive of the ~edOp~r, s~ll dgn in ~e spa~ pro~. ~is ~nature ~fl~ ~at ~e signer is ~mlllar ~ ~e info~atlon submi~ and ~at bas~ on the signer~ inqul~ of ~ose I~lviduals resemble for ob~ining ~e Info~aUon it is ~e signe~s belief ~a~ ~e submilt~ ingrain is ~e, a~mte and ~mpleto. 137. TITLE OF SIGNER - Enter ~e UUe of ~e pe~n signing ~e page. ]-,~ ~t~ ~ OFI ;E OF ENVIRONMENTAL ~.t¥'ICES t~,a n rm~r I Chester Ave., CA 93301 (661 16-3979 "'""~'~ .... ' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (ot~e !ornt Der matenal DOt' Dl,~:~t~tg y NEW I"1 ADD [~ DELETE f-] REVISE 200 : :' "" : Paqe cf I. FACILITY INFORMATION , .... .o.. -7 ' ' 5: ..... '/ ' II. CHEMICAL INFORMATION 205 TRADE SECRET CHEMICAL NAME /'~ -- ~ . · [] Yes ,~No 206 -x;: ............. 209 ~'1 f £HS is' Ye~." ail amoual.t below nmz~ be ia II~ ~ii~-c-o-6i[ F-~a-6 ~.~a~'{'Ccinp~e~e ~ requaate~ by Ima~ r,~e cn~0 - 210 't:Ybl~ ...... [] I~ PURE E]m MIXTURE [] w WASTE 211 · RADIOACTIVE []Yes [] No 212 CURIES 213 PHYSICAL STATE [] $ SOLID []1 LIQUID ,~g GAS 214 LARGEST CONTAINER 215 FEO HAZARD CATEGORIES ,~ ,~3 tr'~ ~ a~l mat apply) ! FIRE [] 2 REACTIVE PRESSURE RELF-A~E E] 4 ACUTE HEALTH E] 5 CHRONIC HEALTH 216 .WASTE 2,, , /OOo c-F AV RA .f, O0 ,~ r ~ DAILY AMOUNT . DALLY AMOUNT UNITS* [] ga GAL ~ cf CU FT [] lb LB~ Lr'"] In TONS 221 DAY~ON SITE 222 STORAGE CONTAINER [] a ABOVEGROUND TANK [] a I~.ASTIC/NONMETALLIC DRUM [] i FIBER DRUM · [] m GLASS BO'iCt'LE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK ~'] f CAN [] j BAG E] n PLASTIC BOTTLE [] r OTHER [] C TANK INSIDE BUILDING E] g CARBOY E]k BOX n o TOTE BIN [] d STEEL DRUM [] h SILO ]~1 CYLINDER [] p TANK WAGON [] a AMBIENT ~/aa ABO~ AMBIENT E]ba BELOW AMBIENT 224 STORAGE PRESSURE ' ',~'a AMBIENT [] aa ABOVE AMBIENT nba BELOW AMBIENT [] ¢ CRYOGENIC 225 STORAGE TEMPERATURE '~ 220 i 227 i [] Yes [] No ............... i .t I ......... 223o i z~ ,, []yes [] No 232 ................. L ........................................................................................ L ..................... '._ ................................... , t 237 · , 2',4 235 J n ,,-es [] No 23e ~ 241 4 ; 238. 239 ~[]yes []No 240 P~"~-~'~A~E 8v'T'i:I;L~ 6~'~'T-~'~R~t~'~'MPANY RE~PRESEb~f~¥1~ff ............... '"-~I~I~.,~'U~ .............. 7---7'.~/ ............... .................... ............. . ..... .......... JPCF (719g) $:\CUPAFORM$\OES2731 ,TV4.wpd H~ Materials Inventory - Chemical ption 2~. A~O/OELET~ REVISE. ln~le ~ ~e malenal ~s ~,ng add~ ~o ~be ~nvenlo~, dele~ from the ,nvenlo~, or if the info~a~ion p~evious~ subm~ff~ is ~ng r~i~d. NOTE: YOu may ~se [o leave t~s ~lan~ ~f you resubm,t '~ur entire invento~ annualS. ZOf. CHEMfCAL LOCATION - Enter ~e Du~ing or oulS~d~ adjacen( area where (he hazardous ma(e~iat is handle. A c~em~J ~a( is st~ a( the same pressure and tem0e(alure, ~n mulbple I~{ions w~lhin a Ou~lding, ~n be ~ep0~ed on a sidle ~e. NOTE;.This in~o~ation is no( subject [o public discJosure pumuanl ~ HSC 2~ CHEMICAL LOCATION CONF~OENTtAL. EPC~ - All ~usme~es which a~e subject [o the Emergency Planning and Communi~ Rig~( (o Know Act ~EPC~) must cnec~ 'Yes' ~o ~0 c~em~l I~a[ion [nfo~a[~ ~n~dential. I~ I~e business d~S not wish ~o keep c~emi~l l~tion information ~n~dential c~ec~ 203. MAP NUMBER - I[ a mag ~s ~ncl~ded, emer the numar pi the map on which the I~t~n of the h~ardous material is sho~. 2~. GRIO NUMBER - I( grid c~dinates are used. enter the gr~d c~dinates o~ the map that court.nd to the l~al~on o~ ~he hazardous material. I(a~pli~ble. c~rdina[es can be 205. CHEMICAL NAME · Enter the proper chemical name as~ia~ ~(h ~e Chemi~l Abs~act Se~e (CAS) number o~ ~he hazardous material. This shou~ be {n[ema(~nal Union of Pure and Appli~ Chem~sW (IUPAC) M~ found on ~e Maler~l Sa~6~ Dale Sheel (MSDS). NOTE: If the ~emi~l is a mixture. ~mplete [his field; ~plele the 'COMMON ~ME' ~e~ i~d. 2~, T~OE SECRET - Check ~es' E ~e informa{~ tn ~ s~ is ~ a [Mde sepal. ~ 'No' E il ~ not. S~e ~uiremen~ I[ yes, a~ b~ess is nol subje~ to ~C~ di~e of ~e ~s~[~ ~e s~et info~n ~ ~und by HSC {25511, F~eMI requ~emen[: I~ ~s. and b~s is ~ub~ ~ ~C~, d~um of ~e d~Mt~ T~ ~et info~a~ ~ ~und by 40 CFR and the ~siM~ must submit a 'Su~n~n to A~mp~y C~ ~ T~ ~ f~ (40 CFR 3~.27) ~ USEP~ 207. COMMON N~E - Enter ~e ~m~ n~e or ~de n~e of ~e hK~ matedal ~ m~um ~i~ a hazards mate~l. 208. EHS - Ch~ ~' if the h~s matedal ~ an ~e~N H~ Subs~e (EHS), as de~n~ ~ 40 CFR, Pa~ ~. ~ ~ If the mate~l iS a ~n~in~g an EHS. leave th~ sect~n blank a~ ~mplete the s~n on ~u$ ~m~nts be~w. 209. CAS ~ - Enter Ihe Chem~l ~stm~ SemiM (C~) numar [~ ~e h~a~us ~ted~. F~ mmtu~es, enter ~e CAS numar of ~he m~ute if it has ~n a~ a numar d~tin~ from its ~m~nen~. If {he minim has ~ CAS num~, leave ~is ~lumn b~nk and re~ the ~S num~m of the in(~l h~a~ ~m~nen~ in ~e appropriate s~n bel~. 210. FIRE COOE H~RD C~SSES - Fire C~e H~ard C~es descd~ to ~mt res~nders the ~ and level of h~ardous materials whi~ a busine~ haoles. Th~ in(o~at~n s~ll on~ ~ provided ~[ the I~1 ~te cb~e[ deems it ~a~ and requests ~e CUPA or ~ [o ~ll~[ [I. A list of the hazard c~sses and insulins on h~ to dateline whJ~ ~ss a matedal ~alls u~e/are J~cJ~ J~ ~e ap~ndiMs of ~cte ~ or,he Un~o~ Fire ~e. If a matet~l ~s m~e ~an appli~ble hazard. C~, i~tude all. ~n~ CUPA o) ~ f~ gu~anM. 211, H~DOUS MATERi~ ~PE, - Ch~ the ~e ~x ~a( ~st dead.s ~e ~e pt ~a~ mate~k pure. m~um or ~ste. If ~ste mattel. ~ on~ t~t if mix.re or waste, compMte h~ard~s ~en~ 213. CURIES - If ~e h~ar~us mate~l is r~ct~e. ~ th~ ~ to re~ ~e a~ in ~es. Y~ may use up ~ nine d~ wiffi a ~a~g d~i~al ~t to 215. ~GEST CO~AINER - Enter ~ ~o~1 ~p~i~ of t~ ~est ~ntai~t in wh~ ~e mate~l ~ ~. . 216. FEDE~L H~D CATEG~IES - Check att ~t~ ~at d~ ~e phial a~ hMl~ ~s a~t~ ~ ~e ~za~s mate/~J. PHYSICAL ~RDS H~L~ ~RDS Fire: F~mmab~ ~qu~s and ~i~s. ~mb~fible L~u~s. ~mph~, O~d~ers Ac~e Health (Immediate): H~h~ To~, To.c, I~n~. ~em, Reactive: Unstable Reac[~e, O~an~ Petox~es. Wa[e( RMV, ~d~e o~r haza~ ~ls ~ffi an ~ effe~ ~(h s~ term ex~u~e Pressure Release: Exp~s~es. ~mpressed Gases. B~sti~ Agents Chronic Health (Delayed): Ca.hogans. o~er ~at~ ~m~ ~ a~ adve~ e~t wi~ ~ te~ ex.sure 217. AVENGE OAILY AMOUNT - Ca.late ~e avenge da~ a~unt of ~e h~ar~ ~tedal or m~ture ~ntaining a h~ar~us material, in M~ buil~ ~ ad~Mn~ ~m~e area. Ca~ulaa~s s~ll be based on ~e p~us years invento~ of ~te~l re~ ~ ~ page. To~l all daily amoun~ and d~e by ~ numar days the c~mi~l will ~ on site. I~ this is a mate~l ~at ~s not pr~sly been present at ~s l~tl~, the amount shall ~ the a~mge ~i~ a~un[ y~ p~oj~t to be on han~ du~ the ~ur~ o( ~e year. Th~ am~nt sh~ ~ ~sistent ~ ~e u~ m~ed in ~x 221 and s~u~ not exM~ ~al o~ m~mum dai~ amount. 218. M~IMUM DALLY AMOU~ - Enter ~e maximin amen[ Pt eKh h~ar~ matedal ~ minute ~ng a ~ous ~t~l. whi~ b ~nd~ ~ a buiM~ ~ adjacenU~e area at any one time over ~e ~ume of ~e year. ~is am~nt must ~n~in al a minimum ~s[ yea~s inven~ o~ ~e ~le~l r~ ~ 219. ANNUAL WASTE ~OUNT. If t~ ~s material ~ing i~en~ is a ~ste. ~e an esama[e of ~e annual a~t ha~l~. 2~. STATE WASTE CODE - I~ the ~rd~s mate~l is a ~ste, enter ~e appr~te California ~it ha~us waste ~e as ~s[~ ~ ~e ~ o~ ~e Unifo~ H~a~s Waste Manifest. 22~. UNITS - Chex the unit o~ measure thai Js most app~opHale ~or the ~eHal ~i~ re~ on th~ page: gallons, pounds. ~b~ ~eet or tons. NOTE: If the ~te~l b a ~ede~al~ defined Extremely Hazardous Substance (EHS). all a~unts must ~ re~d~ in ~un~. I~ matedal is a m~ure ~ntaining an EHS. re~ ~ um~ ~t the ma[edal is sto[~ in (gallons. ~unds. cubic (~[ ~ tons). 222. DAYS ON SiTE - L~st the tolaJ numar o~ days dur~ the ~ar ~at the mater~l J~ on site. 223. STOOGE CONTAINER. Ch~k all ~xes ~hat des~ [he type of stomge ~ntaine[s in whic~ the hazardous material is stored. NOTE: I~ appropriate. ~u may 224, STOOGE PRESSURE - Check the one box that best desk.s the pressure al wh~h ~e h~ardous ma[edal ~s stored. 225. STOOGE TEMPE~TURE. Check ~e one box thai ~st dead.s the ~empera{ute at which t~ haza~ous malapai is s~(ed. 226, H~RDOUSCOMPONENTS 1-5(%BYWEIGHT).Eme~the~n[age~htof~eh~ar~us~mponentinam~ture. lfarangeo~pe~cen[ages~available, re~d Che ~hes~ percen~ in that ~a~e. (Re~ f~ ~m~nen{s 2 th~ 5 ~n 230. 2~, 2~. a~ 242.) 22~. H~ROOUS COMPONENTS I-5 N~E - When repo~i~ a h~atdous material ~at is a mixture. Iisi up to ~ve ~em~al ~mes of hazardous c~p~ents in mmture ~ pe~Mnt weight (~efe~ ~ MSOS pt, in the ~se o~ ~ade secret, re,er to manufacturer). All hazardous c~nents in the mixlute present at greater ·an 1% by ~h( i( no~-ca(cin~en~, ~ 0. 1% by ~ht ~( ca(cin~en~, s~u~ ~ (e~. II ~re lhan ~ve h~a/~us ~mponen~ are present a~ve p~(cenlages. ~u may attach an addit~nal sheet o~ ~r to capture the requ~ info.attn. ~en reposing waste mixtures, mine~l and chemi~l ~m~si~n sh~ld be listed. (Rein ~ comp~ents ~ thtoug~ 5 in 231,235, 239, a~ 243.) 228. H~ROOU$ COMPONENTS I-5 EHS - Check 'Yes' i~[he ~mponent o( (he mix(ute ~s cons~e(~ an Ex(remedy Haza~us Subsla~e as de,ned in 40 CFR, Pa~ 355, pt 'No' iLi~ is nol. (Repo~ fo( com~nen(s 2 through 5 in 232. 236. 240. and 244.) 229, H~RDOUS COMPONENTS f-5 CAS - ~st (he Chemical Abslra~ Se~e (CAS) numbers as relat~ to the hazardous ~m~nent$ in the mixture. (Repeat for 246. LOCALLY COLLECTED INFORMATION · Th~s space may be uS~ by the CUPA or ~ ~o cofiec[ any addilional in(o~mation necessa~ lo meal the r~u~emen~a of ~eir indiwdual p~rams. Conlact [he' CUPA or ~ for guidanM. ~PCF (1/99) 7 OES Fo~ 27~ I CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL'SERVICES ___ 1715 CHESTER AVE., BAKERSFIELD, CA (661) 326-3979 SITE AND FACILITY DIAGRAM INSTRUCTIONS FOR HAZARDOUS MATER/ALS MANAGEMENT PLANS These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit a site diagram. If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing and additional detail map, facility diagram', for each of these areas. Include instructions that show the route to your business if it is in a remote location. All diagrams must be on 8 ¼ x 11 paper and drawn using a straight edge tool. SITE DIAGRAM INSTRUCTIONS The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually within 300 feet. If you Will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include all of the following information: 1. Check the box on the top lef~ comer of the form provided that indicated "Site Diagram". 2.. Print the name of your business, as shown in your HMMP, on the top of the diagram. 3. Label the location of the hazardous materials and identify them by name and type of hazard (ie. Flammable liquid, corrosive solid). 4. Label the location of utility shutoff points for gas, electric and water services. 5. Label the location of fire hydrants. (.. 6. Label portions of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. (The diagram form provided includes a north arrow). ~~ on diagram I~gible easily ~- 8. All labeling ~ identification the must and understandable at the scale submitted. Diagrams musT'be sufficiently legible to produce a legible copy. Try to avoid the use of abbreviations or symbols. If you must use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follow these instructions. F,~ILITY DIAGRAM INSTRUCTIONS Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. 1. Check the box in the upper fight hand corner of the form provided that indicated "Facility Diagram". 2. Print the name of your business as shown on your HMMP: Print the name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. Ifa map represented the first of four areas, it would be labeled #1 of 4. 4. Follow instructions (3 -8)* for site diagrams regarding the specific details to be included on'each facility diagram. UNDERGROUND STORAGE TANK FACILITIES PLEASE NOTE: * If you operate an Underground Storage Tank (UST) facility, the facility diagram shah also specify the location(s) of the UST continuous leak monitoring system and/or the location(s) where the UST monitoring will be performed. 2 SITE DIAGRAM I ~, -- FACILITY DIAGRAM L Business Name: '---~ fro_. ./~dfC oJ , / / Business Address: 'd-// &/-~ 72r/-, ,/~,./<.er3"/'/'.e./~... ('~.,- ' DISASTER AND EMERGENCY PROCEDURES POLICY AND PROCEDURES INTRODUCTION J Building Description LOCATION: 209 & 211 21s'r Street, Bakersfield, CA 93301 DESCRIPTION: One front door entrance atthe north side of 209 and one front door entrance at the north side of 211. The north entrances enter into office areas. Both 209 and 211 have adjoining warehouse space at the south side of the building. Both warehouses are connected by an open archway in the warehouse area. Both warehouses have two exits on the south side, a roll up door and an exit door. ESCAPE ROUTE North Parking Lot 211 2t"' Street 209 2t s~ Street _~f~ in--Window - q- ...... ,~i'hdow'~--: ,' "~-=--:-~--'~-~+~.;~.;.~'~mi~.~__ OFFICE OFFICE OFFICE WAREHOUSE WAREHOUSE Roll Up Door Alley Entrance Roll Up Door LEGEND: ~,~g:.: ~.~ T= toilet S= sink ~""-"" TM ~Exlt~ Fire Extinguisher Electrical Breaker Box