HomeMy WebLinkAboutBUSINESS PLAN (2) Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This permit is issued for the following:
LOCATION
200
4TH
;:~ ,, '... ~4' .[~=' '~." ~L4'
Is~ by:
B~er,field Fke D~ment Approv~ by: ~~~~'
O~CE OF E~R O~AL S~ ~CES / ~ph Hu~~ J
1715 Chewer Ave., 3rd Floor ~ O~ce of ~ml S~iem
B~e~fiel~ CA 93301
Voice (805) 32~3979
F~ (805)32~576 Expiration Date: ~un~ ~0,
~. U~e~mund Storage of H~ffious ~als
~ormit ID ~:: 015-000-000504 ' . -. ~ Risk~nage~P~mm.
FLEET PARTS & INSTRUMEI ..'-:-.~'...',. ~-''
kOGAIIO~: 200 4IH Sl .....
Issuedby: Bakersfield Fire Department .. ~ ... · .. · ,~ ..
OFFICE OF ENVIRONMENTAL SER VICES'
1'715 Chester Ave., 3rd Floor ': " Approved by: '
Bakersfield, CA 93301 Omceof£v~Services
Voice (661) 326-3979
FAX (661) 326-0576 Expiration Date: '-Iun~_
BusL~essName: .~L~T ~/~l~.~' 4 ~-[:'lvST 0.~
Busin~ss Adch~ss: '~ "~t~ H~~', ~ ' ':
Ve~cc ~
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES ~'~ % %%%3
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3~ Floor, Bakersfield, CA 93301
ADD.SS CONTAC~ ~ ~- PHONENO. 3~U~be
FACILITY ~~ ~$~ BUSINESS ID NO. 15-210-
~SPECTION TIME ~1.~. NUMBER OF EMPLOYEES
Section 1: Business Plan and lnvento~ Program
~utine ~ 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 abatement supplies and procedures /
Emergency procedures adequate
Containers properly labeled
Housekeeping /
Fire Protection
Site Diagram Adequate & On Hand
C=Compliance V=Violation /
AnyExplain: hazardous waste on site?:
Questions regarding this inspection? Please call us at (661) 326-3979 ' Business S~te Responsible Party
White- Env. Svcs. Yellow- Station Copy Pink-Business Copy Inspector:L~-~~
FLEET PARTS & INSTR TS CO INC SiteID: 015-021-000504
Manager : _~ BusPhone: (661) 324-4001
Location: 200 4TH ST%%~ ' Map : 103 CommHaz : Low
City : BAKERSFIELD ~ Grid: 31D FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 06 SIC Code:
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
MILTON BUSWELL / OWNER BRADY BUSWELL /
Business Phone: (661) 324-4001x Business Phone: (661) 324-4001x
24-Hour Phone : (661) 831-4197x 24-Hour Phone : (661) 872-8485x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire Press ImmHlth
Contact : Phone: (661) 324-4001x
MailAddr: 200 4TH ST State: CA
City : BAKERSFIELD Zip : 93304
Owner MILTON BUSWELL Phone: (661) 831-4197x
Address : 4116 ERIN CT State: CA
City : BAKERSFIELD Zip : 93309
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
1 08/13/2003
CITY OF BAKERSFIELD
CLAIM VOUCHER
IVendor No. I certify that this claim is correct and valid, and is a proper
charge against the City Agency and account indicated.
CLAIMANT'S NAME AND ADDRESS:
Fleet Parts & Instruments Co Inc (AUTHORIZED SIGNATURE OF CITY AGENCY)
200 4th Street
Bakersfield, CA 93304 Date: 04-01-99 Initials of Preparer:
CITY DEPARTMENT: FINANCE
PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable)
This customer made a duplicate payment on this years Haz Mat bill in the amount of $128.50.
We have since made an adjustment to the California State surcharge in the amount of $8.50
leaving them with a credit of $137.00.
Fund Dept. Base El / Objt Project # Invoice# Amount Date of Invoice
11 0000 123 7900 $137.00
VOUCHER TOTAL $137.00
SECTION 72, PENAL CODE FINANCE DEPT. USE ONLY
Section 72, Presenting False Claims. Every person who with intent to defraud,
presents for allowance or for payment to any state board or officer, or any
county, town, city district, ward or village board or officer, authorized to allow
or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, Examined & Approved for Payment Amount
or writing, is guilty of a felony.
STATEMENT OF ACCOUNT
CITY OF BAKERSFIELD
1501TRUXTUN AVE
BAKERSFIELD, CA 93301-5201
(805).' 326'-3~79 · .
"' :"- ~-' ,' DATE: 4/01/99
TO: FLEET PARTS & INSTRUMENTS. CO. !: .... ' ':': ' ' '"' "'
200 4TH ST ; . "":".~ :.]::;: ',i'.'," ..... "~
CUSTOMER NO:. 2971 ..' cusTO.MER'~"T,YPE: ES/ 2971
CHARGE DATE DESCRIPTION .'~:. REF-NUHSER 'DUE'..DgTE TOTAL hHOUNT
¢.
~/01/~ g~O'I~I~O B~L~CE ..... · ...."~":~.".. :~ .......
. :... · . O0
.::.. >'..~.:~' ~:': '. ~ · . 1~. 50--
SSO01 G/31/~ Cha~e adjustmen~ -' ' 4/30/9~ 8. 50-
CA STATE SURCHARGE " "'~ ";'
. ~ , ~ .. ..... ~.
:
.~,~ .'~ '.'.' .. ~
FOR GUESTIONS OR CHANOEs:'To'YouR ACCOUNT PLEASE
CALL THE NUMBER ~T THE TOP OF THIS STATEMENT.
CURRENT OVER 30 OVER 60 OVER 90
8. 50-
DUE DATE: 5/03/99 PAYMENT DUE: 137. O0--
TOTAL DUE: $iG7. O0--
lI
~:'.' · ... ::',~:" REMI:T:.~:'AND'MAKE:' 'CHECK.. P~YABLE::'~q '
:¥':'..'". ':'."..::~ "BflX'. ~057'~ .....
.~"~.":. '":':"'.BA[ERSFIELD '"'. ': '.:: "". '. "..: CA.'. '...,aaoa.2o.57...:'.:~'.:~(aos)':~:
~.~. ..~.. ::~ ::.~: '.~ :........,..::.:... :.:......... ...... ..:.. :~: .:~.: . ' .... ..'..-':: . ?.. ..~:.. .::. ..':.>.'::..~ .:: :: ~.; ~:.: .. .? ::,~'.. :~::;:'.?.: :: ::~ ::~ ...~..:~ ~ :.:~ ?..:.:.. ::~.::~'..?::.:?:: .C.?.~::.:.'.~:.?.~;.? ~.'~.' '~:.:':~.~:"'...'::..'~:· :".'.',~:~'
.. ' "..' ........ '~. '...':: :~..' .' *o~c' n.u~: ';:... ~ :~:.~::..:.:: ~:~:'*"i~~ 'oo.'¥L: '~ .~:".
-'"
FLEET PARTS & INSTRUMENTS CO INC :...:~,
.... ,>,; ~i :~_~.~.~
/'" BusPhone: (805) 324-4001
Manager : ~-,.
Location: 200 4TH ST ,/!'~? t 1~? Map : 103 CommHaz : Low
/' '~ Grid: 31D FacUnits: 1 AOV:
City : BAKERSFIELD / "¥~: ...... '~.":-~:'.'~:~c
CommCode: BAKERSFIELD STATION '06 SIC Code:
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
MILTON BUSWELL / BRADY BUSWELL / TITLE
Business Phone: (805) 324-4001x Business Phone: (805) 324-4001x
24-Hour Phone : (805) 831-4197x 24-Hour Phone : (805) 872-8485x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire Press ImmHlth
Phone: ( ) - x
Contact :
MailAddr: 200 4TH ST State: CA
City : BAKERSFIELD Zip : 93304
Owner MILTON BUSWELL Phone: (805) 831-4197x
Address : 4116 ERIN CT State: CA
City : BAKERSFIELD Zip : 93309
TotalASTs: = Gal
Period : to TotalUSTs: = Gal
Preparer: RSs: No
Certif'd:
Emergency Directives:
One Unified List
Hazmat Inventory Ail Materials at Site
[--- As Designated Order
Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax IUnitlMCP
PAINT KRYLON F P IH L 186 GAL Hi
CARB CLEANER F P IH L 126 GAL Mod
L FA~k ~v.~,~,e/-.L Do h~mby cerfi~ ~hm ~ hav~
Cf~ or p~nt
m¥i~v~d ~h~ a~1ach®d h~ardous ma~a~s r~anag~-
agem~n~ p~a~ for my
e~.qrtat,Jro
-1- 02/18/1999
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
~ Inventory Item 0001 Facility Unit: Fixed Containers on Site
COMMON NAME / CHEMICAL NAME
PAINT KRYLON Days On Site
365
Location within this Facility Unit Map: Grid:
BLDG 2 - LOWER LEVEL EAST WALL - NE PORTION CAS#
FSTATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid Mixture Above Ambient Ambient METAL CONTAINR-NONDRUM
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
/ GAL 186.00 GAL 100.00 GAL
HAZARDOUS COMPONENTS
%Wt. RS CAS#
16.00 Propane No 74986
36.00 Acetone No 67641
20.00 Toluene No 108883
25.00 Xylene, Mixed No 1330207
HAZARD ASSESSMENTS
TSecret RS BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MCP
No No No No/ CuriesI F P IH / / / Hi
2 02/18/1999
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
F Inventory Item 0002 Facility Unit: Fixed Containers on Site
COMMON NAME / CHEMICAL NAME
CARB CLEANER Days On Site
365
Location within this Facility Unit Map: Grid:
BLDG 2 - LOWER LEVEL EAST WALL - NE PORTION CAS#
75-09-2
Liquid I Mixture Above Ambient Ambient METAL CONTAINR-NONDRUM
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
/ GAL 126.00 GAL 90.00 GAL
HAZARDOUS COMPONENTS
%Wt. RS CAS#
30.00 MEK No 78933
20.00 Isopropyl Alcohol No 67630
30.00 Naphtha No 8030306
HAZARD ASSESSMENTS
TSecret RS BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MCP
No No No No/ CuriesI F P IH / / / Mod
3 02/18/1999
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
~Notif./Evacuation/Medical Overall Site
Agency Notification 07/31/1992
CALL 911
Employee Notif./Evacuation 07/31/1992
INTERCOM TO CALL PEOPLE OUT OF BUILDING AND CALL 911
Public Notif./Evacuation 07/31/1992
CALL 911 AND ALL EXITS ARE CLEARLY MARKED.
Emergency Medical Plan 04/21/1997
MEDI CENTER - 820 34TH ST - (805) 325-6334.
-4- 02/18/1999
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
F Mitigation/Prevent/Abatemt Overall Site
Release Prevention 07/31/1992
EVACUATE PROPERTY AND CALL 911 IF THERE IS A SPILL.
Release Containment 04/21/1997
WE HAVE TEN 40 POUND BAGS OF QUICKSORB
CleanUp 07/31/1992
AS PER HAZ MAT INSTRUCTIONS
Other Resource Activation
-5- 02/18/1999
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
~ Site Emergency Factors Overall Site
Special Hazards
Utility Shut-Offs 07/31/1992
BUILDING #2
A) GAS - WEST OUTSIDE WALL OF 401 UNION
B) ELECTRICAL - SOUTHEAST CORNER
C) WATER - WEST FRONT
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 07/31/1992
PRIVATE FIRE PROTECTION - PRESSURE WATER AT ALL BUILDING, ALL BUILDING HAVE
FIRE EXTINGUISHERS.
FIRE HYDRANT - 4TH & UNION, SOUTHWEST CORNER
Building Occupancy Level
6 02/18/1999
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
F Training Overall Site
Employee Training 04/21/1997
WE HAVE 12 EMPLOYEES AT THIS FACILITY
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE
BRIEF SUMMARY OF TRAINING: CAL OSHA STANDARDS. SAFETY MEETING EVERY OTHER
MONTH.
Page 2
Held for Future Use
Held for Future Use
-7- 02/18/1999
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE .~-/I -~c~ NEWACCOUNT
ADDRESS CHANGE;
CLOSE ACCT
'FINANCE CHARGE I
MAILING ADDRESS
SITE ADDRESS
pARCEL NUMBER
(IF APPUOABLE)
ADJUSTMENT
CHG DATE J CHARGE CODE I ADJUSTMENT AMOUNT
APPROVED BY
FLEET PARTS & INSTRUMENTS CO I.i; ~i SiteID: 215-000-000504
~P~ 17 1997u~i
Manager : , ,,, B~sPhone: (805) 324-4001
Location: 200 4TH ST ,,,,~,~ /' ~
V Ma : 103 CommHaz : Low
City : BAKERSFIELD ',=.~---- -~r d: 31D FacUnits: 1AOV:
CommCode: BAKERSFIELD STATION 06 SIC Code:
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
MILTON BUSWELL / FRDD CII~S~ ~0y /6u~ek~ ~
Business Phone: (805) 324-4001x Business Phone: (805) 324-4001x
24-Hour Phone : (805) 831-4197x 24-Hour Phone : (805) ~-3~--5~x ~7~ ~8~
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire Press ImmHlth
Agency-Defined Topic Title
~ Hazmat Inventory One Unified List
E-- MCP+DailyMax Order Ail Materials at Site
Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax IUnitlMcP
PAINT KRYLON F P IH L 186 GAL Hi
CARB CLEANER F P IH L 126 GAL Mod
~, BtzP, oy 6us~,~l-L Do hereby c~ti~, that ! h~ve
~ or print ~)
rsviewed the a~ached hazardous mat~als manage-
ment plan for ~Le~T ~A~S a~ that it alo~ with
(Name of
any corre~ions constitute s complets and corr9~
a~ement plan ~r ~y ~c~.
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
~ Inventory Item 0001 Facility Unit: Fixed Containers on Site
COMMON NAME / CHEMICAL NAME
PAINT KRYLON Days On Site
365
Location within this Facility Unit
BLDG 2 - LOWER LEVEL EAST WALL - NE PORTION CAS#
STATE I TYPE I PRESSURE I TEMPERATURE I CONTAINER TYPE I
Liquid Mixture Above Ambient Ambient METAL CONTAINR-NONDRUM
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL
186.00 100.00
DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL
HAZARDOUS COMPONENTS
%Wt. EHS CAS#
16.00 Propane No 74986
36.00 Acetone No 67641
20.00 Toluene No 108883
25.00 Xylene, Mixed No 1330207
-2-
FLEET PARTS & INSTRUMENTS C0 INC SiteID: 215-000-000504
~ Inventory Item 0002 Facility Unit: Fixed Containers on Site
COMMON NAME / CHEMICAL NAME
CARB CLEANER Days On Site
365
Location within this Facility Unit
BLDG 2 - LOWER LEVEL EAST WALL - NE PORTION CAS#
75-09-2
F STATE ] TYPE I PRESSURE I TEMPERATURE I CONTAINER TYPEAmbient CONTAINR-NONDRUM
Liquid Mixture Above Ambient METAL
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL
126.00 90.00
DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL
HAZARDOUS COMPONENTS
%Wt. EHS CAS#
30.00 MEK No 78933
20.00 Isopropyl Alcohol No 67630
30.00 Naphtha No 8030306
-3-
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
F Notif./Evacuation/Medical Overall Site
Agency Notification 07/31/1992
CALL 911
Employee Notif./Evacuation 07/31/1992
INTERCOM TO CALL PEOPLE OUT OF BUILDING AND CALL 911
Public Notif./Evacuation 07/31/1992
CALL 911 AND ALL EXITS ARE CLEARLY MARKED.
Emergency Medical Plan 07/31/1992
MEDI CENTER
820 34TH ST
(805) 325-6334
-4-
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
~Mitigation/Prevent/Abatemt Overall Site
Release Prevention 07/31/1992
EVACUATE PROPERTY AND CALL 911 IF THERE IS A SPILL.
Release Containment 07/31/1992
WE HAVE 10 40 POUND BAGS OF QUICKSORB
Clean Up 07/31/1992
AS PER HAZ MAT INSTRUCTIONS
Other Resource Activation
-5-
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
~ Site Emergency Factors Overall Site
Special Hazards
Utility Shut-Offs 07/31/1992
BUILDING #2
A) GAS - WEST OUTSIDE WALL OF 401 UNION
B) ELECTRICAL - SOUTHEAST CORNER
C) WATER - WEST FRONT
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 07/31/1992
PRIVATE FIRE PROTECTION - PRESSURE WATER AT ALL BUILDING, ALL BUILDING HAVE
FIRE EXTINGUISHERS.
FIRE HYDRANT - 4TH & UNION, SOUTHWEST CORNER
Building Occupancy Level
-6-
FLEET PARTS & INSTRUMENTS CO INC SiteID: 215-000-000504
Fast Format
~ Training Overall Site
Employee Training 07/31/1992
WE HAVE 14 EMPLOYEES AT THIS FACILITY ~ /~ /~ /~ ~
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE
BRIEF SUMMARY OF TRAINING: CAL OSHA STANDARDS. SAFETY MEETING EVERY OTHER
MONTH.
Page 2
Held for Future Use
Held for Future Use
-7-
10/10/94 FLEET PARTS & INSTR~ENTS CO INC 215-000-00 1
Overall Site with 1 Fac. Unit
General Information
Location: 200 4TH ST Map:103 Haz:3 Type: 3
City : Grid: 31D F/U: 1 AOV: 0.0
Contact Name Title Contact Name Title
MILTON BUSWELL / FRED CHASE /
Business Phone: (805) 324-4001x Business Phone: (805) 324-4001x
24-Hour Phone : (805) 831-4197x 24-Hour Phone : (805) 831-5873x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Administrative Data
Mail Addrs: 200 4TH ST D&B Nu~er:
City: BAKERSFIELD State: CA Zip: 93304-
Co~ Code: 215-006 BAKERSFIELD STATION 06 SIC Code:
Owner: MILTON BUSWELL Phone: (805) 831-4197
Address: 4116 ERIN CT State: CA
City: BAKERSFIELD Zip: 93309-
Sugary ~
I, ~rr~ay /~us~a~Do hereby certify that I have
reviewed the attached hazardous mated, als m~::~.age-
ment plan for F/-e~-T- ~P~r'F_x and that it along with
any corrections constitute a complete and correct man-
agement plan for my facility.
10/10/94 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 2
Hazmat Inventory List in MCP Order
02 - Fixed Containers on Site
Pln-Ref Name/Hazards Form Max Qty MCP
02-001 PAINT KRYLON Liquid 186 High
· Fire, Pressure, Immed Hlth GAL
02-002 CARB CLEANER Liquid 126 Moderate
· Fire, Pressure, Immed Hlth GAL
10/10/94 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 3
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-001 PAINT KRYLON Liquid 186 High
· Fire, Pressure, Immed Hlth GAL
CAS #: Trade Secret: No
Form: Liquid Type: Mixture Days: 365 Use: AEROSOL/INFLATION
Daily Max GAL Daily Average GAL Annual Amount GAL
186 I 100.00 I 800.00
Storage Press -- Temp Location
METAL CONTAINR-NONDRUM Above Ambient BLDG 2 - LOWER LEVEL EAST WALL -
NE PORTION
-- Conc Components MCP Guide
16.0% Propane Extreme 22
36.0% Acetone Moderate 26
20.0% Toluene Moderate 27
25.0% Xylene, Mixed Moderate 27
02-002 CARB CLEANER Liquid 126 Moderate
· Fire, Pressure, Immed Hlth GAL
CAS #: 75-09-2 Trade Secret: No
Form: Liquid Type: Mixture Days: 365 Use: AEROSOL/INFLATION
Daily Max GAL Daily Average GAL Annual Amount GAL
126 I 90.00 I 460.00
Storage Press - Temp Location
METAL CONTAINR-NONDRUM Above Ambient BLDG 2 - LOWER LEVEL EAST WALL -
NE PORTION
-- Conc Components MCP Guide
30.0% MEK Moderate 26
20.0% Isopropyl Alcohol Moderate 26
30.0% Naphtha Moderate 27
10/10/94 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 4
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
INTERCOM TO CALL PEOPLE OUT OF BUILDING AND CALL 911
<3> Public Notif./Evacuation
CALL 911 AND ALL EXITS ARE CLEARLY MARKED.
<4> Emergency Medical Plan
MEDI CENTER
820 34TH ST
(805) 325-6334
10/10/94 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 5
00 - Overall Site
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
EVACUATE PROPERTY AND CALL 911 IF THERE IS A SPILL.
<2> Release Containment
WE HAVE 10 40 POUND BAGS OF QUICKSORB
<3> Clean Up
AS PER HAZ MAT INSTRUCTIONS
<4> Other Resource Activation
10/10/94 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 6
00 - Overall Site
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
BUILDING #2
A) GAS - WEST OUTSIDE WALL OF 401 UNION
B) ELECTRICAL - SOUTHEAST CORNER
C) WATER - WEST FRONT
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - PRESSURE WATER AT ALL BUILDING, ALL BUILDING HAVE
FIRE EXTINGUISHERS.
FIRE HYDRANT - 4TH & UNION, SOUTHWEST CORNER
<4> Building Occupancy Level
10/10/94 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 7
00 - Overall Site
<G> Training
<1> Employee Training
WE HAVE 14 EMPLOYEES AT THIS FACILITY
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE
BRIEF SUMMARY OF TRAINING: CAL OSHA STANDARDS. SAFETY MEETING EVERY OTHER
MONTH.
<2> Page 2
<3> Held for Future Use
<4> Held for Future Use
HAZARDOUS MATERIALS DIVISIOh'~I~.
~ Date Completed
Business Name: ~/~' ~ ~ P~'" ¢'~ ~ ~'-~'~' ~' ~'~"~ ~"~-~'
Location: ,1. d"~ .5/-~
Business Identification No. 215-000 ~ 5"~4 (Top of Business Plan)
Station No. ~ Shift ,":) Inspector
Adequate Inadequate
Verification of Inventory Materials
// Verification of Quantities r~
Verification of Location
Proper Segregation of Material
Comments:
Verification of MSDS Availablity ~L
x.~ Number of Employees
,~,0~,~'t2~ Verification of Haz Mat Training
Comments:
Verification of Abatement Supplies & Procedures
Comments:
Emergency Procedures Posted
Containers Properly Labeled
Comments:
Verification of Facility Diagram
~pecial Hazards Associated with this Facility: ,~'~'~ ~?'~
" "
V~ations: ,,~
.~ k,~,x,_j/_.,,// AllltemsO.K. ~
Correction Needed
Business Owner/l~l'anager
FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy
HAZARDOUS .S INSPECTION ,'.: Fire Dept. ~'
Hazardous Materials Division
Date Completed
ausinessName: ~'~ ~c~ ~, ~~x~~
Loca~on: ~ ~ ~ ~ ~ ~ ~C~ ~ .
Business Iden~fica~on No. 215-000 ~oo ~ O~ (Top of Business Plan)
Arrival Time: ~.'~0Depa~re Time: ~' ~ Inspe~on Time: /~r~ ..... '
Adequate Inadequate
Verifica~on of Invento~ Materials
Ve~fica~on of Ouan~es
~orifica~on of [oca~on
Propor 8,Fofla~on o[ Material
Commen~:
Vorifica~on of MSD8 ~vailabili~
Number of Employees:
Verifica~on of Haz Uat lraining
Verifica~on of ~batomont Supplios & Procodur~s
Gommon~: ~mer~ency Rocodures Postod
Containers Properly Labeled
~ommen~:
¢~~~i~ Verificafio~ of Facil~ Diagram
' Hazards Associatod ~ ~is Facili~:
Busine~ ~er/Manager PRINT ~ME SIGNATURE Correc~on Needed
Wh~H~ Mat D~ Yellow-S~on ~py Pink-Busings ~py
04/14/92 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page
Overall Site with 1 Fac. Unit
General Information
Location: 200 4TH ST Map: 103 Hazard: Moderate
Community: BAKERSFIELD STATION 06 Grid: 31D F/U: 1 AOV: 0.0
Contact Name Title Business Phone 24-Hour PhOne-
MILTON BUSWELL (805) 324-4001 x (805) 831-4197
FRED CHASE (805) 324-4001 x (805) .831-5873
Administrative Data
Mail Addrs: 200 4TH ST D&B Number:
City: BAKERSFIELD State: CA Zip: 93304-
Comm Code: 215-006 BAKERSFIELD STATION 06 SIC Code:
Owner: MILTON BUSWELL Phone: (~) ~ ~/-~ I 97
Address: 4116 ERIN CT State: CA
City: BAKERSFIELD Zip: 93309-
Summary
?#AY 1 199
HAZ M~T. ~tV.
rovio~d ~h® ~ch~ hazardous mater~als msn~gs~
~ plan for (~o,~) ~nd ~ha~ i~ ~o~ ~h
, ./ ,. ~'~ ;, ~
04/14/92 FLEET PARTS & INSTRUMENTS CO INC 215-000-0.00504 Page 2
02 - Fixed ContainerS' on Site
Hazmat Inventory Detail in Reference Number Order
02-001 PAINT KRYLON Liquid 186 High
· Fire, Pressure, Immed Hlth GAL
CAS #: Trade Secret: No
Form: Liquid Type: Mixture Days: 365 Use: AEROSOL/INFLATION
Daily Max GAL I Daily Average GAL I Annual Amount GAL
186 ~ 100.00 800.00
Storage Press - Temp Location
METAL CONTAINR-NONDRUM Above Ambient BLDG 2 - LOWER LEVEL EAST WALL -
NE PORTION
-- Conc Components MCP List
16.0% Propane Extreme
36.0% Acetone Moderate
20.0% Toluene Moderate
25.0% Xylene, Mixed Moderate
02-002 CARB CLEANER Liquid 126. Moderate
· Fire, Pressure, Immed Hlth GAL
CAS #: 75-09-2 Trade Secret: No
Form: Liquid Type: Mixture Days: 365 Use: AEROSOL/INFLATION
Daily Max GAL Daily Ayerage GAL Annual Amount GAL
126 I 90.00 I 460.00
Storage Press -- Temp Location
METAL CONTAINR-NONDRUM Above Ambient BLDG 2 - LOWER LEVEL EAST WALL -
NE PORTION
-- Conc Components. MCP List
30.0% MEK Moderate
20.0% Isopropyl Alcohol Moderate
30.0% Naphtha Moderate
04/14/92 FLEET PARTS & INSTRUMENTS C0 INC 215-000-000504 Page 3
02 - Fixed Containers on Site
Hazmat Inventory Detail in Reference Number Order
02-003 OXYGEN Gas 330 Low
· Fire, Pressure FT3
CAS #: 7782-44-7 Trade Secret: No
Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING
Daily Max FT3 Daily Average FT3 Annual Amount FT3
3'30 I 150.00 I 330.00
Storage I Press T Temp I Location
PORT. PRESS. CYLINDER Above ~Ambient METAL BLDG ON EAST SIDE OF LOT
-- Conc Components MCP ~List
100.0% IOxygen, Compressed ILow
02-004 ACETYLENE Gas 280 High
· Fire, Pressure FT3
CAS #: 74-86-2 Trade Secret: No
Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING
Daily Max FT3 Daily Average FT3 Annual Amount FT3
280 I 120.00 I 280.00
StorageI Press T TempI Location
PORT. PRESS. CYLINDER IAbove ~AmbientlMETAL BLDG ON EAST SIDE OF LOT
-- Conc Components MCP List
100.0% IAcetylene IHigh --~
04/14/92 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 4
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
<2> Employee Notif./Evacuation
INTERCOM TO CALL PEOPLE OUT OF BUILDING AND CALL 911
<3> Public Notif./Evacuation
<4> Emergency Medical Plan
MEDI CENTER
820 34TH ST
(805) 325-6334
04/14/92 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 5
00 - Overall Site
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
EVACUATE PROPERTY AND CALL 911 IF THERE IS A SPILL.
<2> Release Containment
<3> Clean Up
<4> Other Resource Activation
04/14/92 FLEET PARTS & INSTRUMENTS C0 INC 215-000-000504 Page 6
00 - Overall Site
<F> Site Emergency Factors
<1> Special. Hazards
<2> Utility Shut-Offs
BUILDING #2
A) GAS - ?
B) ELECTRICAL - SOUTHEAST CORNER
c) WATER -,WEST FRONT
D) SPECIAL - NONE
E) LOCK BOX - NO "
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - ???????????
FIRE HYDRANT - 4TH & UNION, SOUTHWEST CORNER
<4> Building Occupancy Level
04/I4/92 FLEET PARTS & INSTRUMENTS CO INC 215-000-000504 Page 7
00 - Overall Site
<G> Training
<1> Page 1
WE HAVE ?? EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
BRIEF SUMMARY OF TRAINING:
<2> Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
(Z,v~e or prinz name)
RECEIVED
Do hereb.'~: o_rt ~~-'- FEB 8
= _~., that I have reviewed the
attached Hazardous Materials business plan
(name of business)
and tha{ it along with the attached additions
or corrections constitute a complete and correct
Business Plan for mM facility.
s lgna~ur.e date
BUSINESS NAME FLEET PARTS & INSTRUMENTS CO INC ID NUMI ZIS-OO~-OOOSO4
LOCATION 200 4TH ST HISH HAZARD RATING
1. OVERVIEW
LAST CHANGE 11/1G/87 BY ESTER
JURIS COOE ZtS'-008 JURIS BAKERSFIELD STATION OG
M~P PAGE 103 GRID 31D FACILITY UNITS 1 HAZARD RATING ~
RESPONSE SUMMARY
ZA SEC 4) NO PRIVATE RESPONSE TEAM
EMERGENCY CONTACTS 2A SEC Z)
MILTON BUSWELL, PRES - 3Z4-4001 OR 831-4197
FRED CHASE, FOREMAN - 3~4-4~1 OR 831-S873
UTILITY SHUTOFFS ZA SEC 3) BUILDING ~Z
A> GAS - ? B) ELECTRICAL - SOUTHEAST CORNER C) WATER - WEST FRONT
D) SPECIAL - NONE E) LOCK BOX - NO
NOTIFICATION / PUBLIC EVACU~tTION
LAST CHANGE / / BY
< NO INFORMATION RECORDED FOR THIS SECTION >
PAGE 1 IZ/Z'3/88 1G:S?
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 64.8-6800
BUSINESS NAME FLEET eAR"rS & INSTRUMENTS £0 INC ID NUME Z1S-000-0~0S04
LOCATION 200 4TH ST HIGH HRZRRD RATING
~. HAZ MAT TRAINING SUMMARY
LAST CHANGE / / BY
< NO INFORMATION RECORDED FOR THIS SECTION >
LOCAL EMERGENCY MEDICAL ASSISTANCE
LAST CHANGE 10/09/87 BY ESTER
ZA SEC S) MEDI CENTER
820 34TH Sir.
<805) 3ZS-G334
PAGE 2 1Z/Z3/88 IS:S?
MATERIAL SAFETY DAT~ SYSTEMS~ INC. (805) 648-6800
BUSINESS NAME FLEET Pt & INSTRUMENTS CO INC ID NUME ZLS-000-000504
LOCATION Z00 4TH ST HIGH HAZARD RATING
FACILITY UNIT 0~
A, OYERALL HAZARDOUS MATERIALS INVENTORY
LAST CHANGE 11/OS/87 BY ESTER
ID TYPE NAME MAX AMT UNIT HAZARD
LOCATION CONTAINMENT USE
1 MIXTURE PAINT KRYLON 188 GAL. EXTREME
8LDG Z NE PORTION LEVEL1 PORTABLE PRESS. CYL. AEROSOL
ID PERCENT COMPONENTS HAZARD LIST
100G.00 30. O ACETONE HIGH
II18.00 ZS.O XYLENE, MIXED HIGH
IlSS.OZ 18.0 PROPANE EXTREME
I130.00 15.0 TOLUENE HIGH
Z MIXTURE CARB CLEANER 1Z6 GAL EXTREME
BLDG Z NE LOWER LEVEL PORTABLE PRESS. CYL. AEROSOL
ID PERCENT COMPONENTS HAZARD LIS'r
Z234.~ ZS.O METHYLENE CHLORIDE MODERATE
2580,01 20.0 TETRACHLOROETHYLENE HIGH
10G1.OI 12.0 CRESYLIC ACID HIGH
120~,00 12.0 NAPHTHA EXTREME
1'759.OO 10.0 1,3-DICHLOROBENZENE HIGH
B. FIRE PROTECTION / WATER SUPPLIES
~A SEC S) HYDRANT - 4TH & UNION, SOUTHWEST CORNER
PAGE 3 lZ/2~/88 1G:S?
MATERIAL SAFETY DATA SYSTEMS, INC. (80S) G48-G800
BUSINESS NAME FLEET PARTS & INSTRUMENTS CO INC ID NUMB[ Z15-00~-0~>S04
LOCATION Z00 4TH ST HIGH HAZARD RATING
D. EMPLOYEE NOTIFICATION / EVACUATION
LAST CHANGE 11/1G/87 BY ESTER
SEC Z) INTERCOM TO CALL PEOPLE OUT OF BUILDING RND CALL
E. MITIGATION / PREVENTION / ABATEMENT
LAST CHANGE 10/09/87 BY ESTER
3R SEC I~EVACU~TE PROPERTY AND CALL 911 IF THERE IS A SPILL.
PAGE 4 1Z/Z3/88 16:57
MATERIAL SAFETY DA'FA SYSTEMS, tNC. (885) G48-68GG
CITY of BAKERSFIELD - . =
Farl ~nd 19ric'ultur! ~ Standard Business
LOCATION: 1oO ~r~ ~F ADDRESS: ~/~ ~ ~. STANDARD IND. CLASS CODE
CITY. ZIP: ~~/~=c~, ~. 9~JO~ -CITY. ZIP: ~S~/E=~ , CA-. ~Og DUN AND BRADSTREET NUMBER
PHONE ~: ~o~-~z~-V~o t PHONE ~: ~- ~/-g/~7 ~ ~ & = ~ ~ - 0 /
· ' ~ TO I~S~UCTIOmS ~ PROP~ CODES --- / ---
/.M_l~_l__J&k.__l ~oo !.%oo ~cl as~-I ,~ I ~ I 4 t 3 ,-..-.,~_-.~-~r2~.~ ............. . .....
....................................~ k~ J~ J ~o' L%o. Is~3*~i .... '~ I~ I~ I~ ,~?""~"-~~7 ,.~.,_<r~.e_~..~.__~,/
P~ical and Heelth Haza~ C.~.$. ~u~ 7~-~ ~- '~ · ~ II ~a~ ~
(Check all t~t ag;ly) .' ~ ~w~ '_ _
._9_1, ~_l /~ I /o '_i so 1~'"12~1/3 ! ~ I~ I~ '~""~='-~-~
-- ~--J -- ~dd~ ~ele~se ~- late .
H.lth of Pr~re H. Ith - " ' ' .......
.~_.l /x I /o .l(o I~-.1~ I/3 I z I 4 13 !~/~;~'
;~ic~l and He~tth H~Za~ .. C.l.S;. ~l~ J~t I! NaN J
(Ch~k all t~t ;ooly)
<. -.
H~lth of Pr~mre He~lt~ "' ' ....
~, ./I ·
""" :' ' '
BUSINESS NAME: ~'~~.~'-.~ ~ /~ '~ /~ OWNER NAME: HAME OF T~ FACILITY:
LOCATION: ADDRESS: STANDARD IND. CLASS CODE
C~TY, ZXP: " ~TY, ZXP: · DUN AND ~RADSTREET NUMBE~
PHONE ~: PHONE
~ ~ Z~S~UC~ZO~S ~0~ ~ROP~ CODES
lr9ns Type ~x. ' Average Annual ~.~re I ~s C~t ~t C~t Use L~at~ N~.e ~ by Nam of Nixture/C~mts
Code (:ode bt Amc ~t ~ts m Site ly~ ~ess Imp C~e - 5cor~ in Facility Nt See Inscructi~s
H~lth :of P~sure HMIth
P~ical ~nd Health Hazo~ C.l.S. ~ ~ ~ ~g-
(C~ck all t~c apply)
~ ~e azard ~--~ le~cttvtt~ -- R lease [ ~ I~tate
HHlth - of Pmsu~ HHICh
Ph~tcal 4nd Health Hoza~ _C.A.S. ~ --7 ~ ' ~
(C~k ail t~t apply) .
· Health ~ Pr~sure Health ~ '
· Health of P~e Healt~= .
~ERGENCY C~TACT$ II
Certificnti~ (Read and s~Kn a~t~r co~pJ~t~n~ 8J] sectJons)
certify vnde, ~elty o.f law th4t.l ~ve ~rsmallyeKamin~ ~d mm familiar with t~ tnfor,ti~ su~itt~ tn this ~ Itl lttK~ ~CI. and t~c ~s~ m W in~i~ of t~se t~tvi~als res~sible
200 Fourth ST.
Bakersfield Ca., 93304
(805)-324-4001, in Ca. 1-800-582-3912
MEMORANDUM
TO: ALL PERSONNEL
SUBJECT: MATERIAL SAFETY DATA SHEETS
DATE: FEB.24,1989
Copies of MSDS for' all hazardous substances to which employees of
this company may be exposed are kept in the RIGHT TO KNOW STATION
located on the left door of the double doors at the rear of the main
building. The RIGHT TO KNOW STATION binder will include MSDS for the
~oilowing manufacturer, supplier or products.
Borden (Krylon paint)
Berr'yman Products
Luber¢iner Penetrating Fluid
LuberEiner Starting Fluid
Oxygen
Acetylene
Sarety-Clean Corp
Each employee is directed to study these data sheets, to observe
all recommendations and safety procedures appropriate to these
products.
i have read and observed the above memorandum.
Employee Date
- 1 -
.. B2~/ERsF I ELD
Farm and Agriculture ~Standard Business '~ Page / of ~
2 3 4 5 6 7 8 9 lO I~ 12 X3 ' 14
~m ~ ~ A~ra~ ~ Meas~ ! Oa~ Con~ C~ Con~ Uae · ~ ~ % ~ ~ of ~/C~nents
c~e C~e ~ ~ ~ U~ on site ~ P~ss ~ Code .. S~ ~ Fac~t~ ~ See InaCtions
a~ t~ ~ply)
-
· . . . ~~3 ~ - , .
% CITY OF Bi%/(E RSF I E~-D
-] Farm and Agriculture [] Standard Business '~ Page
-:' NON -- TRADE SECRET.
L~ATION: ~D~SS: : ST~ 'I~. ~S CODE:
CITY, ZIP: CI~,. ZIP: ~ D~ ~ ~ST~ET ~ER/FEDE~ ID
PHO~ ~:' PHO~'..~:' -- _ - _ -- -- -
~ 2 3 % 5 6 7 8 9 10 11 12
~s ~ ~ A~ra~ ~u~ ~as~ ~ Da~ Cont C~ Con~ Use - ~ ~ % ~ R~ of ~/C~nen~s
C~e C~e ~ ~ ~ U~ on ~lte ~ P~sm ~ Code S~d ~ Facllt~ ~ See' Znst~tons
~ "
I I I I ! I I i I I I :,-..
(cb~ ~ ~: ~y) . ... '
.- ~~. ~, 2 ~ m c.~a. ~' '
I I ! ' i' I I I I I i'"
~tc~ ~ ~~ C.A.S.'~' · . _ . . ~~L~.& C.A.B. ~ --. '
.
0FF[C[AL USE ONLY
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FOR~ 2A
INST OCTIONS:
1. To avoid further action, retur'n 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
CITY: ~~l~ ZIP: q~O~ BUS.PHONE:
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7850 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 ~URING BUS. HRS. AFTER BUS. HRS.
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE:
D. SPECIAL: ~ .
E. LOCK BOX: YES/~) IF YES, LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO 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
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 NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: ........................... YES~ YES NO
C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO YES NO
D. EMERGENCY EVACUATION PROCEDURES: ................. ~S NO .YES NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... ~ YES NO
SECTION ?: HAZARDOUS MATERIAL
CIRCLE~ OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS_OF· A
SOLID, 55 GALLON~F A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:.' .... '.' ~ NO
I ,~~~'/-i~,~/~ , 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 "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 returned 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#D ~- -- FACILITY UNIT NAME: ~{.-
SECTION 1: MITIGATION, PRE~NTION, ABATEMEN~ PROCEDURES .'
SECTION 2: NOTIFICATION AND EVACUATION PROCEDbqlES AT THIS b,~.'IT' ONLY
- 3A -
SECTION 3: HAZARDOUS MATERIALS FOR THIS b~IT 'ONLY
A. Does this Facility Uni contain Hazardous Materials? =~- (¥~
t ....... NO
If YES, see B.
If NO, continue with SECTION ,i.
B. Are .any of the hazardous materials a bona fide 1.fade Secret YES
If No,. complete a separate hazardous materials inuentor¥
~ form marked: NON-TRADE SECRETS ONLY (white form #4A-l)
.If Yes, complete a hazardous materials invento~.'y 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. (SAS /PROPANE ~
SLECrRICAL: OCZ
C. WATER;
D. SPECIAl.:
r= YES LOCATION:
E. LOCK BOX: YES .. ~ ~' '
YES SITE PLANS? YES / NO MSDSs? YES / ~:~
FLOOR PLANS? YES / NO KEYS? YES ./ NO
- 3B --
~" '. :.NON'--'TRADE' SECRETS
.: · 'HAZARDOUS' ~IATER I AL~' INVENTORY:
! ' ONLY
~PE MAX' ANNUAL CONT USE LOCATION IN THIS ~.'BY .. HAZARD D.O.T
ODE AMOUNT -AMOUNT UNi~ CODE CODE FACILITY UNIT MT. CHEMICAL OR COMMON NAME' .CODE GUIDE
.~ERGENCY CONTACT: ~~ ~e4~ TITLE: ~4H~?c~ P~r5 PHONE. *' BUS, HOURS':
""" :" ' ~~ f~r~. :-'--".--." ': - ' ~e "':" -'"~" "~