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Home My WebLink AboutBUSINESS PLAN SITE/FACILITY DIAGRAM ~ ~ FORM 5 (CHECK ONE) SITE DIAGRAM FACILITY DIAGR.~M :" - SA - SITE DIAGRAM }d Items) I. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys, 11. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Wire street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Drainage Canals, Ditches, d. Gates Creeks, 13. Powerllnes 5. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c. Metal construction capacity la gal. a. Above ground d. Access Door b. Underground 6. Utility Controls a. Gas 16. Dtktn~ or Berm b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: Identify the 7. Fire Suppression Systems: location where a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fire Pu~p 22~ Type of Hazardous StoredMaterial/Waste 8. Fire Department Access or Used (See Below) TYPE OF ~IAZARDOUS ~ATERIAL F - Flammable g - Explosive L - Liquid R = Radlologtcal C = Corrosive 0 - Oxidizer G - Gas P = Poison W = Water Reactive T = Toxic $ = Solid H = Cryogenic O = Waste B = Etiological Example: Flameable Liquid FACILITY DIAGRA~ (Required Items In addition to the, abo~e) 1. Risers for Sprinklers 8, Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest. 11. Inside Hazardous Wastk Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage S. Elevator 13. Inside Hazardous Materials Use/Handling S. Attic Access · 14. Sewer Drain Inlets 7. Skylights 415 NINETEENTH STREET · BAKERSFIELD, CALIFORNIA 93301 PHONE 805/323-1458 REGEIVi~D Do hereb.Tc certify that I ha-ce reviewed the attached Hazardous .~laterials business plan ~"~'~ ............ (name of business) and that it along with the attached additions or corrections constitute a complete and correct Business Plan for mM facilit.~-. /__p,/' sz~na~ure date CITY of BAKERSFIELD '~_., ~ HAZARDOUS MATERI ALS I NVENT.ORY' Farm and i~}riculturs Standard Business LOCATION:. · _ -' ~ l ADDRESS: ~O/ & ~ STANDARD IND. C~RSS CODE C~e C~e ~t ~t Est~ Units on Site T~ ~ Tm ~ St~ in F~tJity ' ~ I~t~ti~ 4~1y) ~lth Of P~q ~lth (C~k all t~t a~ly) ~lth of tr~m ~lth .... L_I L .......... [. .l I .t I ! I I ................................... (C~k iii t~t r--~ ~t ~ N~&C.A.S. ~ H~ith of P~su~ NNlth H~ith of Pr~sure Health ..... - Certificati~ (Read and sJ~ after completing aJ] sections) I cerOfy ~der ~lty of 1~ t~t ! ~ve ~r;mallyexae~n~ ~d aa f~il~ar .tth t~ tnformtim su~itt~ tn this ~ all ett~ ~ts. ~ t~t ~ m W ~tW of t~e t~tvt~ls ~sible for obtaining t~ int~mttm, I ~lieve t~t t~ su~itt~ info. tim is t~. accurate, and cmalet~.~ ' 'RECEIVED1 1987 . 4', BAKERSFIELD CIT~2' FIRE' DEP~d{~3iElqT JUL 2130 "G" STREET BAFJZRSFIELD, CA 93801 Ans'd ............ (805) 326-3979 OFFICIAL USE ONLY BUSINESS PLAN AS ~s~uc~o~s: ~'~ ............ 1. To avoid further action, return this for~ b~ 2. TYPE/PRIST ASS~ERS IS E~GLISH. 3. Ans~ee the questions belo~ for the business as a ~hole. 4. Be as brief and concise as possible. SECTIO~ 1: B~SI~ESS IDE~IFIC~TIO~ SECTION 2: EMER6ENCY 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 0ffice of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME ~ TITLE DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLlZ. B. ELECTRICAL: /~ l~ ~ ( ~ ( ~ ~, ~ ~ ~/~ ~/~ D. SPECIAL: .... ~o'~ F / ' / E. LOCK BOX: YES / N0 IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / N0 MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / N0 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE ,/vd SECTION 5: LOCAL E~RGENCY ~DICAL ASSIST~CE FOR YO~ BUSINESS AS A ~HOLE SECTION 6: EMPLOYEE TRAINING 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:.... .................................... WITH RESPONSE AGENCIES: .......................... ~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. NO EMERGENCY EVACUATION PROCEDURES: ................. -NO (TT~S~ NO-/~ D. E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES N0,~ SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE ~ZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A i,~9~,/~,~. ~ ~ 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 inaccu~,ate information constitutes perjury. _ BAKERSFIELD CI~ FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY BUSINESS pLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be r'eturned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT NAME: SECTION 1: MITIGATION, PREVENTION, ABATE, MENT PROCEDURES. ~ ~ NOTIFICATI0[ k~ ETACUATI~N PROCE~U~ES AT. ~.H!S ~NI} 0N~Y; . - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contz~in Hazardous.Materials? ...... YES NO If YES, see B. If NO, continue with SECTION 4, B. Are any of the hazardous materials a bona fide Trade Secret YES NO 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 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. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS./.PROPAN~ B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES / ~0 MSDSs? YES /' NO FLOOR PLANS? YES / NO KEYS° YES / NO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page ..... NON--TRADE SECRETS HAZARDOUS I~IATE R I ALS I NVENTORY " BUSINESS NAHE: ~*q~r' C C~ OWNER NA~E: ~. ~ Ke.K/~y~ FACILITY UNIT ~:~ ADDRESS: ~ /(~/~ ~' ~ ADDRESS: ~ ~ ~'~ FACILITY UNIT NAME: CITY, ZiP: ~;;rf,e~ C~I~ ~i CITY,ZIP: ~e~,~ei~ ~(~ ~.o~ ~: ~c% ~ ~ ~.o~ ~: $~-}'~a~ ' Io~C~A~ us~ c~s coo~ 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~~ABOUNT AMOUNT UNITi CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE ...... NA~E: TITLE: ~ ~ ~ SIGNATURE: DATE: E~ER~ENCY CONTACT~ TITL~ ~ ~O~ [ ~S ~O~RS~ ~j ~FTER BUS ~RS~ 3~ o E~ROE~CY co~c~r TIT~ .. ~O~E ~ aUS ~OU~S~ ~ ~ ~ ' P~INClPA~ ~USlNESS ~CTIVITY: ~FTE~ ~S ~S~