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Home My WebLink AboutBUSINESS PLAN 8/12/2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This _permit is issued for the followinq: [] Hazardous Materials Plan [] Underground Storage of Hm,=rdous Materials Permit ID #:: 015-000-000780 [] Risk Management Program · [] Hazardous Waste On-Site Treatment BAKERSFIELD MUFFLER LOCATION: 301 19TH ST SFIELD OFFICE OF EN~RONM~NTAL SER ~CES ' 1715 Chester Ave., 3rd Floor Approved by: Issue Bakersfield, CA 93301 OmceofEv~S~icm Voice (661) 326-3979 F~ (661) 326-0576 Expiation Date: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE .......... ~.~,,~,=~,~,~.~:~,,~,,,~,,~ ................ This permit is issued for the following: 7:- -:~, .- ---..'~*'~ % ,.' ..";<'".."i~ ~: /1 ;" ' Issu~ by: O~CE OFE~RON~AL S~ ~CES ph Hu~,~~ I 1715 Chewer Ave., ~rd Floor ce of ~~ B~ersfiel~ CA 93301 Voice (805) 32~3979 F~ (80S)~6-0S76 Expiration~: dun~ ~O~ ~OOO SITE/FACILITY D I AG RAiVi FORM 5 NORTH SCALE: BUS.TNESS NA~IE :_ . FLOOR: DATE:./ / FACILITY NAME: UNIT -,''. OF (CHECK ONE) SITE DIAGR.~! FACILITY DIAGR.&%! I(Inspector's Comments): -OFFICIAL USE ONLY- CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES oC'T 6 ?~0~'~ UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r'~ Floor, Bakersfield, CA 93301 FACILITY NAME/~A"~5FIletO DauFftzt~ INSPECTION DATE ~' I Z.-d3 '~ ADDRESS ~Ot I ~T'H PHONE NO. ~'2. q '- ~-/~'g~' FACILITY CONTACT C~.tl,(~ [/~ETE~i BUSINESS ID NO. 15-210-0('~o~oC~ INSPECTION TIME /'~ r~_: ,,_ NUMBER OF EMPLOYEES ] Section 1: Business Plan and Inventory Program ~Routine [~ Combined [~ Joint Agency ~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate 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 Fire Protection V Site Diagram Adequate & On Hand .c~_ C=Compliance V=Violation Any hazardous waste on site?: Explain: Questions regarding this inspection'?. Please call us at (661) 326-3979 B~s~e~"s ~'i~e Responsible Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: ~..-n f ~"~,./~ BAKERSFIELD MUFFLER SERVICEtI,~-"CEIVED~ ' SiteID: 015-021-000780 Manager : - o - Location: 301 19TH ST City : BAKERSFIELD ~ V: CommCode: BAKERSFIELD STATION 04 SIC Code:7533 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title , MIKE KEEN ~/..I / OWNER _ ~ KEEN Business Phone:~ 324-48632 ~-~~ess Phone: ( ) 24-Hour Phonei ~ 24-Hour Phone Pager Phone ; ( ) : Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : Phone: ( ) - x MailAddr: 301 19TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner MIKE KEEN Phone: ~ ~i~8~x Address : 2920 PASADENA State: 'CA City : BAKERSFIELD Zip : 93305 Period : to TotalASTs: = Gal ,Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory~ One Unified List ~ --As Designated Order Ail Materials at Site ~ Hazmat Common Name... ISpocHazlEPA HazardsI Frm I DailyMax IUnitlMCP OXYGEN F P IH G 498.00 FT3 Low ACETYLENE F P IH G 660.00 FT3 Hi i, ~ I ~ ~'e_~A Do hereby certify that I have (Type or prin.t name) reviewed the attached hazardous materials manage- ment plan for ~4~-3~C,/,~/q',~that it along with ' '(Name'6f Busb~oss) any corrections constitute a complete and correct man- agement plan for my facili.~y. -i- 07/06/2000 BAKERSFIELD MUFFLER SERVICE SiteID: 015-021-000780 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE SW CORNER 'YARD CAS# 7782-44-7 F STATE ~ TYPE i PRESSURE i TEMPERATURE CONTAINER TYPE Gas ~Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS 'LOCATION Largest Container I Daily Maximum I Daily Average FT3I 498.00 FT3I 300.00 FT3 HAZARDOUS COMPONENTS %Wt. S CAS# 100.00 Oxygen, Compressed N 7782447 I ~ HAZg_RD ASSESSMENTS TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F P IH / / / ~ Low = Inventory Item 0002 Facility Unit: Fixed Containers on Site ACETYLENE Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE SW CORNER YARD CAS# 74-86-2 Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION [ Largest Container I Daily Maximum Daily Average FT3 660.00 FT3 450.00 FT3 HAZARDOUS COMPONENTS %Wt' I RSICAS# 100.00 Acetylene Yes 74862 HAZARD ASSESSMENTS TSoorotINO NoRS I Bi°HasINO Radioactive/AmountNo/ Curies EPAF P HazardsiH NFPA/// IUSDOT# MOP 2 07/06/2000 F BAKERSFIELD MUFFLER SERVICE SiteID: 015-021-000780 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 01/07/1990 CALL 911 BAKERSFIELD CITY FIRE DEPARTMENT OR CALL 911 -- Employee Notif./Evacuation 01/07/1990 VERBAL AND CALL 911 -- Public Notif./Evacuation 05/01/1997 SOUTHERN AUTO SUPPLY - 307 19TH ST - 324-9882 AND KCEOC - 300 19TH ST - 322-3041. Emergency Medical Plan 05/01/1997 MEMORIAL HOSPITAL - 420 34TH ST - 327-1792. -3- 07/06/2000 BAKERSFIELD MUFFLER SERVICE SiteID: 015-021-000780 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site m Release Prevention 04/16/1992 TANKS ARE STRAPPED UP IN BACK YARD. TANKS ARE TURNED OFF EVERY NIGHT AND ON EVERY MORNING. --Release Containment 04/16/1992 PORTABLE PRESSURIZED CYLINDERS -- Clean Up 04/16/1992 GASSES ONLY Other Resource Activation -4- o7/06/2000 BAKERSFIELD MUFFLER SERVICE SiteID: 015-021-000780 Fast Format ~ Site Emergency Factors Overall Site -- Special Hazards 01/07/1990 ELECTRICAL WIRING FOR HEATER --Utility Shut-Offs 01/07/1990 A) GAS - BACK YARD B) ELECTRICAL - EAST WALL BEHIND COUNTER C) WATER - IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 05/01/1997 PRIVATE FIRE PROTECTION - TEN FIRE EXTINGUISHERS FIRE HYDRANT - CORNER OF 18TH AND V STREETS Building Occupancy Level 5 07/06/2000 BAKERSFIELD MUFFLER SERVICE SiteID: 015-021-000780 Fast Format = Training Overall Site -- Employee Training 04/16/1992 WE HAVE 1 EMPLOYEE AT THIS FACILITY WE HAVE MATERIAL~SAFETYDATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: NO EMPLOYEES - OWNER DOES HAVE KNOWLEDGE OF OXYGEN AND ACETYLENE -- Page 2 --Held for Future Use Held for Future Use 6 07/06/2000 BAKERSFIELD MUFFLER SERVICE : SiteID: 215-000-000780 Manager. ~ NAY 11997 ~ · BusPhone: (805) 324-4863 Location: 301 19TH ST ~ Hap : 103 CommHaz : Low City : BAKERSFIELD / ~rid: 30D FacUnits: i AOV: CommCode: BAKERSFIELD STATION 04 SIC Code:7533 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MIKE KEEN / OWNER BILL KEEN / FATHER Business Phone: (805) 324-4863x Business Phone: ( ) - x 24-Hour Phone : (805) 871~J~k~?~O~ 24-Hour Phone : (805) 366-7625x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Agency-Defined Topic Title ---- Hazmat Inventory One Unified List -- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax lUnitlMCP ACETYLENE F P IH G 660 FT3 Hi OXYGEN F P IH G 498 FT3 Low I,£_ ~ ~y~o,.~",~o) Do hereby ce~i~ that ! have reviewed ~h~ ~'~:~:.chsd h~ardous materials manage-. ment plan ~o~ ~~,. and that i~ a~ wifh any corrections constitute a complete and ~rre~ man- agement plan for my f~ili~. BAKERSFIELD MUFFLER SERVICE SiteID: 215-000-000780 -- Inventory Item 0002 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME ACETYLENE Days On Site 365 Location within this Facility Unit OUTSIDE SW CORNER YARD CAS# 74-86-2 Gas Pure I, Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS STORED AND IN USE Lrgst Cent.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 660.00 450.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Acetylene No 74862 -2- BAKERSFIELD MUFFLER SERVICE SiteID: 215-000-000780 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site OXYGEN Days On Site 365 Location within this Facility Unit OUTSIDE SW CORNER YARD CAS# 7782-44-7 Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS STORED AND IN USE Lrgst Cent.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 498.00 300.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 HAZARDOUS COMPONENTS %Wt. I EHS CAS# 100.00 oxygen, Compressed No 7782447 -3- F BAKERSFIELD MUFFLER SERVICE SiteID: 215-000-000780 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 01/07/1990 CALL 911 Employee Notif./Evacuation 01/07/1990 VERBAL AND CALL 911 -- Public Notif./Evacuation 01/07/1990 ~ / KCEOC 300 19TH STREET 322-3041 Emergency Medical Plan 01/07/1990 MEMORIAL HOSPITAL 420 34TH ST 327-1792 -4- BAKERSFIELD MUFFLER SERVICE SiteID: 215-000-000780 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 04/16/1992 TANKS ARE STRAPPED UP IN BACK YARD. TANKS ARE TURNED OFF EVERY NIGHT AND ON EVERY MORNING. -- Release Containment 04/16/1992 PORTABLE PRESSURIZED CYLINDERS -- Clean Up 04/16/1992 GASSES ONLY Other Resource Activation -5- BAKERSFIELD MUFFLER SERVICE SiteID: 215-000-000780 Fast Format ~ Site Emergency Factors Overall Site -- Special Hazards 01/07/1990 ELECTRICAL WIRING FOR HEATER --Utility Shut-Offs 01/07/1990 A) GAS - BACK YARD B) ELECTRICAL - EAST WALL BEHIND COUNTER C) WATER - IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO --.Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - TEN FIRE EXTINGUISHERS FIRE HYDRANT - CORNER OF 18TH AND V STREETS Building Occupancy Level 6 BAKERSFIELD MUFFLER SERVICE SiteID: 215-000-000780 Fast Format ~ Training Overall Site -- Employee Training 04/16/1992 WE HAVE 1 EMPLOYEE AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: NO EMPLOYEES - OWNER DOES HAVE KNOWLEDGE OF OXYGEN AND ACETYLENE -- Page 2 -- Held for Future Use Held for Future Use I -7- 02/20/92 BAKERSFIELD MUFFLER SERVICE 215-000-000780 Page 1 Overall Site with 1 Fac. Unit General Information Location: 301 19TH ST Map: 103 Hazard: Low Community: BAKERSFIELD STATION 01 Grid: 30D F/U: 1 AOV: 0.0 Contact NameI Title i Business Phone i 24-Hour Phoneq MIKE KEEN OWNER (805) 324-4863 x (805) 871-3248~ Administrative Data Mail Addrs: 301 19TH ST D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: 7533 Owner: MIKE KEEN Phone: Address: 2920 PASADENA State: CA City: BAKERSFIELD Zip: 93305- Summary RECEIVED 2 5 1992 HA7 R~a~ DIV. I, _r~l I~._ ~.~(~v~ Do hereby certify that I have (Ty~ or print name) reviewed the attached ~azardous matedals manage- ment plan for'{.~.l~~and that it along with (,~m. rno ~f ~uslne~.~) -- any corrections cor~sti[~.e a complete and correct man- agement plan for my facility.. 02/20/92 BAKERSFIELD MUFFLER SERVICE 215-000-000780 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN Gas 498 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3 I Daily Average FT3 I Annual Amount FT3 498 I 300.00 ! 5,000.00 Sto I Press T Temp Location PORT. PRESS. CYLINDER IAbove ~AmbientlOUTSIDE SW CORNER YARD -- Conc Components MCP --List 100.0% IOxygen, Compressed ILow ~ 02-002 ACETYLENE Gas 660 High ~ Fire, Pressure, Immed Hlth FT3- CAS #: 74-86-2 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 [ Annual Amount FT3 -- 660 I 450.00! 3,500.00 Storage Press T Temp~ Location PORT. PRESS. CYLINDER Above I AmbientlOUTSIDE SW CORNER YARD -- Conc Components MCP List 100.0% [Acetylene IHigh I 02/20/92 BAKERSFIELD MUFFLER SERVICE 215-000-000780 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911 <3> Public Notif./Evacuation TIMS AUTO PARTS 307 19TH STREET 324-9881 KCEOC 300 19TH STREET 322-3041 <4> Emergency Medical Plan MEMORIAL HOSPITAL 420 34TH ST 327-1792 02/20/92 BAKERSFIELD MUFFLER SERVICE 215-000-000780 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention TANKS ARE STRAPPED UP IN BACK YARD. TANKS ARE TURNED OFF EVERY NIGHT AND ON EVERY MORNING. <2> Release Containment <3> Clean Up <4> Other Resource Activation 02/20/92 BAKERSFIELD MUFFLER SERVICE 215-000-000780 Page 5 00 - Overall Site <F> ~ite Emergency Factors <1> Special Hazards ELECTRICAL WIRING FOR HEATER <2> Utility Shut-Offs A) GAS - BACK YARD B) ELECTRICAL - EAST WALL BEHIND COUNTER C) WATER - IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - TEN FIRE EXTINGUISHERS FIRE HYDRANT - CORNER OF 18TH AND V STREETS <4> Building Occupancy Level 02/20/92 BAKERSFIELD ~FFLER SERVICE 215-000-000780' Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 1 EMPLOYEE AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use '~? P. ,,LLu :,-.-~. BAKERSFIELD .. ~"'~ ''~ ~' '"~ ."~ -*" ~:~,CITY of ~$~3 '~"~" ~"~ ~.~ . ~ ,,,~ ~ ~~ ' ~ (~yDe or Drin~ name) Do hereb3~ cert~ ~- ,- _za that I have revie~ed ~he [[~ ~ ~ t[~.~... attached Hazardous Materials bu. siness, ~lan (name of business) and that it along with the attached additions or corrections consti' ~ ~u~e a complete and correct Business ~lan for ~y facility. ~/ s igna~.ure - date CITY of BAKERSFIELD NO N-- Tt~AD E S E C R E TS ' ' Page ..~. of ..L ~ _~ t~e C~e Mt Mt Est Units m Site I~ ~I la ~ St~ in YKtltty,~ ~ IMt~ti~ ~lth of P~M ~lth ..................... (C~k Ill ~t aDP,y) ~ .... _ ..... (C~k ~11 t~t ~pply) (C~k ~ll t~t mly) H~ith of Fr~sure HHith , 1. OVERVIEW L¢-IST ('.'HRNGE iZ?}7/8'7 BY ESTER ,IURiS CODE .Z15-(_40i ,]'URIS BIr-/KERSF!ELO S'TRTiON Ol MAP Pf'-16E 103 GRID ;"~00 FACILITY iJNITS i HFtZRRO RATING '.l RESPONSE SUMMARY Zl"t SEC 4) HALL AMBULANCE EMERGENCY CONTACTS ZA SEC Z) MIKE KEEN - OWNER - 3Z4-4863 OR 871-3248 UTILITY SHUTOFFS ZA SEC 3) A) GAS - 8ACK YARD B) ELECTRICAL - EAST WALL BEHINO COUNTER C) WATER - IN ALLEY D) SPECIAL - NONE E) LOCK 80X - NO Z. NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY ( NO INFORmaTION RECORDED FOR THIS SECTION > P?tGE 1 !Z/ZB/88 ~Z~ZS i'IATERIAL SAFETY DATA '..':'.,c~'r'i..~¢' ~, ;.':, ~ ,-'. ,.~, Ii'lC. Ii]USINESS i'q£~H,.E EiFqKLTRSFIELI] M. UFFt_[!]:7 SERu[CE !D i'~UM~7, ER LOCFYFiON 3~)i !9"FH ST HiGH Hf:~ZRRO R~]-ii'.IG E~ ~,, HflZ HAT FRfllNING SU~MRRY Lf~ST (] HHN~E / / BY 4 NO INFDRMfl'FiON RECORDED FOR THI5 GECTION > LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE tZ/07/87 BY ESTER SEC S) MEMORIAL HOSPITAL 420 34TH ST 327-1992 PAGE Z 12128/88 MA'FERIf~L SAFETY OA'F,'q .SYSTEMS., iNC. (8r~5) $48-fi8(]~0 ID 'TYPE t',IPIME MAX AI'4T UNIT HBZARO L OC,q'T I ON CONTAi NMF'NT USE 1 PURE OXYGEN ADZ FT3 HiGH (]IJTStDE SW CORNER YARD PORTABLE PRESS. CYL. WELDING/SOLDERING !O PERCENT COHPONENTS HRZ~tRD LIST Z359.~0 100.0 OXYGEN, COMPRESSED HIGH Z PURE ACETYLENE GGO FT3 EXTREME OUTSIDE SW CORNER YARD PORTABLE PRESS. CYL. WELDING/SOLDERING ID PERCENT COMPONENTS HAZARD LIST '-tZ4t.00 100.0 ACETYLENE EXTREME B. FIRE PROTECTION / WATER SUPPLIES LflST CHANGE 1Z/07/87 8Y ESTER SEC 4) TEN FIRE EXTINGUISHERS FOR FIRE PROTECTION~ 3fl SEC S) FIRE HYDRANT CORNER OF 18TH & V ST. PAGE 3 1Z/Z8/88 iZ:ZS MATERIAL SAFETY OATR SYSTEMS, iNC. (8¢B) ig48-G8¢0 L. OCi:~T~ON 2.¥~i i~i'i"H S-~' Hi[GH HI:~ZFIR[} F¥~'f'ZiqG 2 g. F~,!PLOYEE !'IOT]iFi[Cf.:YI']iON / E~H-'~CL,iFI'FZ L,::~S'? Cldt~NGE i Z,"::~,7/!~7 J3Y ESTER SEC Z) VERBRL. ~ND CRLL Ell E. MITIGATION / PREVENTION / ABATEMENT LAST CHANGE IZ/07/87 BY ESTER SEC l) TANKS ARE STRAPPED UP IN BACK YARD. TANKS ARE TURNED OFF EVERY NIGHT AND ON EVERY ~ORNING, PC3GE 4 IZ/Z¢3/S8 !Z:Z.S HATER!AL SAFETY Of:t'FA c v ,:, '"¢ ~- ,.. c, ~ c, BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page NON--TRADE SECRETS HAZARDOUS I~IATE R I.AL S I NVENTORY ADDRESS. ~(~ ~.~x .~-~'r~.:~r' AODRESS: ~t~o '~~c~ FACILITY UNIT NAME: CITY, Z~P:' ~ . ~,- ~~ CITY,ZIP: ~k. ~. I ONLY 1 2 3 4 5 6 7 8 9 10"' TYPE ~AX' ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD D.O.T CODE AMOUNT A~OUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE .//-/./ NAH, E: TITLE: ~ ~.~ SIONATURE: / _~ DATE: E~RO~NCV CO.TACT: ~'~ K~ T~TL~: ~~ ~ ~.~N~'~ .US .OU~S:,, ~q-~ ' AFTER BUS .RS: ~t ' ~E~ERGENCY CONTACT: ~',~ ~ TITLE: ~~( .. PHONE ~ BUS HOURS: :~P~INCIPAL BUSINESS ACTIVITY: ' ~~( ~~ AFTER BUS HRS: - 4~-1 - HAZARDOUS MATERIALS INSPECTION U:X~'TO~: ..~O / / ~'+----"' .~"-r. VERIFICATION OF HAZ MAT TRAINING ~ VERIFICATION OF MSDS AVAILABLE ~ COMMENTS: VERIFICATION OF ABATEMENT SUPPLIES & PRO~URES ~-' COMMENTS: EMERGENCY PROCEDURES POS'r~_~J ~ CONTAINERS PROPERLY L~R~--r.~ ~ COMMENTS: ~'~ VERIFICATION OF FACILITY DI~-GRAM ~' ~,~ O~ ~c~y~/u~-~ ... VIOLATIONS: ~ SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain'Hazardous Materials? ...... YES ~_~ If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materlals a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (~hite form ~4A-1) If Yes, complete a hazardous materials inventory form 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. S-'Ec~T~'dN 4'~.-'P~ iV~T--~ F IRE '~ROTECT ! ON SECTION $: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. ' ' ''~ 6AS/PROPANE: D. SPECIAL: E. LOCK BOX: YES / ~ IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs? YES /' NO FLOOR PLANS? YES / NO KEYS? YES /' NO - 38 -. BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY BUSI NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answel- the questions below for THE FACILITY UNIT LISTED BELOW ." 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT N&ME: SECTION 1: MITIGATION, PRE~NTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS U}$IT ONLY SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE 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 NO YES NO 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 NO YES NO SECTION 7: HAZ~HtDOUS MATERIAL ...... CIRCLE YES OR DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POU~OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... fYE~ NO I, ~[~/~..~ /~__' F-/f--- , certify that the above information is accurate.'~ I understand that this information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. ~' BAKERSFIELD CITY FIRE DEPARTMENT ~" 2130 "O" STREET RECEIVED / ' BAKERSFIELD, CA 93301 (005) 326-3979 JUL 6 1987 Ans'd ............ OFFICIAL USE O~LV HAZARDOUS RTERI ALS BUSINESS PLAN AS A WHOLE INS~UCT IONS: 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. ~8'~ ............ SECTION 1: BUSINESS IDE~IFICATION DATA SECTION 2: E~RGENCY ~OTIFICATIONS 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 notLf~ your local fire department and the State Office o~ Emergency Services as required b~ la~. E~PLOYEES TO SOTIFY IN CASE 0F E~ERGENCy: ~AME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. B. Ph~ Ph~ SECTION-3: LOCATION 0F ~ILI~ ~-0FFS FOR BUSI~SS AS A ~0LE A. NA~;" GAS/PROPANE: %a' k ~ &i3 . D. SPECIAL: LOCK BOX: YES /~ IF YES, LOCATION: E'. IF YES, DOES IT CONTAIN SITE PLANS? YES / N0 ~SDSS? YES / NO FLOOR PLANS? YES / NO KEYS9 YES / NO