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Home My WebLink AboutBUSINESS PLAN (2) SITE DIAGF~M I , 1(~3-~ ( 5 FACILrT'y DIAGRAM Bmine~ Nome: For Office Use Only First In Stc'm3n: Area Mc: lnsoec,*ion Stc,'ion: NCIRTH j ~x .... , I ~30 .. H'AZARDOUS MATERIALS IN CTION Bakersfield Fire Dept. · '.:" .:::' ................ .'. '..' ................... ":.'.: ". .'.'...:.:.':." : ....... : .....".': :':' ·..'..'. "· / HAZARDOUS MATERIALS DIVISION 1715 Chester Ave. Bakersfield, CA 93301 Business Name: ~"~,~-~ ~.[.(~ ~'~ v' Location: ~'-'~ d) ~ -I-,L.- Business Identification No. 215-000 ~)0 (-/6 ! (Top of Business Plan) Station No. ('7 Shift /~ Inspector Arrival Time: //-/0'7 Departure Time: Inspection Time: s o o-o o , / n 7. Adequate Inadequate Adequate Inadequate Address Visable [] [3 Emergency Procedures Posted [] [] Correct Occupancy [3 [] Containers Properly Labled [] [] Verification of Inventory Materials [] [] Comments: __ Verification of Quantities [3 [] Verification of Location [] [] Verification of Facility Diagram [] [] Proper Segregation of Material [] [] Housekeeping [] [] Fire Protection [] [] Comments: Electrical rl [] Comments: Verification of MSDS Availablity [] [] Number of Employees: UST Monitoring Program [] [] Comments: Verification of Haz Mat Training I~l' [] Permits [] [] Comments: Spill Control 1'1 Hold Open Device [] [] Verification of Hazardous Waste EPA No. Abbatement Supplies and Procedures [] [] Proper Waste Disposal E! El Comments: __ Secondary Containment r-i Secudty ~ Special Hazards Associated with this Facility: Violations: / All Items O.K Business Owner/Manager PRINT NAME SIGNATURE CorrectioB Needed VVhite-Haz Mat Div. Yellow-Station Copy Pink-Business Copy u_ BAKERSFIELD SENIOR CENTER SiteID: 215-000-001761 Manager : BusPhone: (805) 325-1113 Location: 530 4TH ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 31D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:8322 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title WILLIE JOHNSON / MECHANIC MARTY MIKKELSEN / TRANS SUPER Business Phone: (805) 325-1113x Business Phone: (805) 325-1113x 24-Hour Phone : (805) 323-7562x 24-Hour~ Phone : (805) 836-2542x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Agency-Defined Topic Title F Hazmat Inventory One Unified List ~-- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax lUnitIMcP WASTE OIL F DH L 110 GAL Low WASTE ANTIFREEZE F DH L 110 GAL Low 1 04/28/1997 i BAKERS~LD CITY FIRE DEPAIrMENT HAZARDOUS MATERIALS DIVISION I715 -CHESTER '.AVE.; BAKERSFIELD, CA. 93301 .- HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: i. To avoid turtt3er action, return ;t3is form within 30 days of receil~t. 2. ~PEIPRINT ANSWERS [N ENGLISH. 3. Answer tl~e auestions Delow for the i:usiness cs a whole. /-~.~ \ 4. 5e Drier cna concise cs possiDle. SECTION l' BUSINESS IDENTIFICATION DATA :USiN~-.~ NAME: '~CATiON'~ ~ SECTICN_.°' EMERGENCY NC'TIFiC',.-,T,ON~ ' CONTACT TITLE BUS. PHONE $~_'_. mx.'a PHONE -- Hazardo~ ~aterials Divi.~ -.- ' HAZARDOUS MATERIALS MANAGEMENT PLAN · . -3 SECTION 3: TRAINING: NUMBER OF EMPLOYEES: ~ /.. MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY oF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: ! CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS IS EXEMPT FROM THE :,qE?ORT[NG REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: ;V,- DO NOT HANDLE :-'.AT,AROCUS MATERIALS. '.,VE DO HANDLE HA7ARCC. US MATERIALS, ~UT THE QUANTITiE~ AT NO TiMEEXCEE'D THE MINIMUM 'RE?ORTING QUANTITIES. 'OTHER ,,~ = cr-',~v x .......REASCN'I SECTION 5: CERTIFICATION: i, I'~. ~SrO CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNIDE~STAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY F!RM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFE:FY CODE" ON HAZARDOUS MATERIALS (DIV. 2~ CHAPTER 6.95 SEC. 25~G~ ET AL.) AND THAT INACCURATE INFORMATION. CC NSTITUTE~ FERJURY. SIGNATU~ TITLE OATE ...... · . ~ardous ~a~eris/s Division ~- HAZARDOU~ I~ATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: : EMPLOYEE NOTIFICATION AND E',/ACUATION: · .3. ~UBLIC EVACUATION: z:4cRGENC';' MEDICAL FL.'-.N · ' .' · B~ersfieldFire Dep~j , Hazardous NlateriaJ~ Divis~6n HA~RDO'US MA~RIALS MANAGEMENT P~N SECTION 7: M~IGATION, PREVEN~ON AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: RELEASE-CONTAINMENT AND/OR MINIMIZATION: SECTION 8: UTILITY SHUT-OFFS (LOCATION CF SHUT-OFFS AT YOUR FACILITY)' NATURAL C-AS/PROPANE: ~LE.STR,C,~=. u~.....,'. :C'X. , _S/NO .F YES, SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. ?RIVAEE F~RE PROTECT[ON: B. WATER AVAILABILffY (FIRE HYDRANT): · · BAKERSFIFaIID CITY FIRE DEPAR;F ENT HAZAR US MATERIALS INVENTOIgF Page_of__ CHEMI~ DE~RI~ON 1) IN~RY STA~: N~ ~ ~ [ ] R~n ( ] ~ [ ] Ch~ ~ ~ ~ a NON ~ 8~ [ ] ~ S~R~ [ ] C~m~ N~: ~M [ ] CAS 4) PH~ICAL & H~ PHYSlC~ H~CA~ES Rm ~ Re~[ ] S~en~Pre~ure [ ] I~He~e) [ ] ~~(Ch~) [ ] 5) WAS~ C~SSIRCA~ON ~ ~ ~ (~ ~e ~m DHS Fo~ ~) USE ~ 6) PHYSIC~STA~ ~1~ [ ] ~quid ~ ~ [ ] Pure [ ] M~ [ ] W~ ~ ~ [ ] ~ AMOUNT ~D ~ME AT FACIU~ UN~S OF M~SURE 8) STOOGE CODES A~ ~N A~um: ~ cudes [ ] b) Pre.urn: ~n~ ~unt: ~ c) Tempera: · ~OnS~e ~ Ci~e~hMomhs: AllYe~. J. F. M. A. M. J. J. A. S. O. N. D 9) MITRE: ~t COM~N~ CAS ~ % the throe most ~ 1) ~~ O~ [ chem~ ~m~ or ~y AHM ~m~ 2) [ ] [ ] CHEMICAL DESCRI~ION 1) IN~TORYSTA~S: New~] Add,ion[ ] Re,sion{ ] ~le~n[ ] Che~em~isaNON~ES~R~ [ ] ~S~R~ [ ] 2) Compri N~: ~~ ~1 ~~ 3) ~T * Chem~ N~e: AHM [ ] CAS 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~D CA~GORIES Fire [ ] Rea~ive [ ] Sudden Rele~e of Pressure [ ] Imm~i~e He~h (Ac~e) ~ ~1~ He~ (Chron,) [ ] 5) WAS~ C~SSIFICA~ON (3-digR code from DHS Fo~ 8022) USE CODE 6) PHYSICALSTA~ Solid [ ] Liquid ~ G~ [ ] Pure [ ] Mi~um [ ] W~te [ ] R~ [ ] 7) AMOUNT AND ~ME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES M~mum Daly Amount: ~ [~ [ ] ga ~3 [ ] a) Contaner: Averse D~ly Amount: ~ cunes[ ] b) Pressure: Annu~ Amount: ~ c) Tem~ure: ~gest Size Cont~ner: · Oa~OnS~e ~ Circle ~ich Months: NIYe~. J. F. M. A. M. J. J. A. S. O. N. D 9) MITRE: Dst COMPONENT CAS · % ~ ~M t~ethreemosth~ous 1) ~~ ~T/~~ chemi~ com~nen~ or ~y AHM ~m~nents 2) [ 3~ ce~ under pen~ of law. ~at I have pemonatly ex~in~ ~ ~ f~fli~ w~ ~e infomason submi~ on ~is ~ ~1 a~ d~umen~ I beSeve ~fll~ N~me & E~e of A~o~z~ Com~y fleuresen~ve i~ BAKER I :IELD CITY FIRE DEi: RTMENT HAZARDOUS MATERIALS INVENTORY Page_.of · us/ness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if che~ i~ a NON TRADE SECRET [ ] ~ SECRET [ ] 2) Common Name: 3) DOT ~ (oFG~-,i'~ Chemical Name: AHM [ ] CAS ~ 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate HeaJttt (Acute) [ ] Delayed HeaJth (Chronk=) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Uquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioa~ve [ ]. 7) AMOUNT AND TiME AT FACIETY UNITS OF MEASURE 8) STORAGE CODES Maximum Dally Amount: Ib~ [ ] gal [ I fi3 [ ] a) Container. Average Dally Amount: cunas [ ] b) Pressure: AnnueJ Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D 9) MIXTURE: LJst COMPONENT CAS #' % W'T AHM the three most hazardous 1 ) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 1 O) Location CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New [ ] Addition [ ] Revision ( ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TP, ADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] [iCluid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT ANO TIME AT FACIMTY UNITS OF MEASURE 8) STORAGE CODES Maximum C~a~ly Amount: lbs [ ] gal [ ] ft3 [ ] a) Container. Average Daiy Amount: cunas[ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. O. N. D 9) MIXTURE: LJst COMPONENT CAS # % WT AHM the three most hazardous 1 ) [ ] chemical components or any AHM components 2) [ ] 3) [ 1 10) Loc.,~mn cen#y under ~enai~y of law, that I have ~ersonaily examined and am familiar with the infome#on submitted on this and ail a~ached document. I be#eve 83e '~emitted informer~on is 0'ue, accurate, an~ complete. RINT Name & Title of Au;hodzed Company Represente~ve Signature Date