Loading...
HomeMy WebLinkAboutBUSINESS PLAN (2) · s Waste Unified Permit 'Hazardous Matenals/Hazardou. CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: ~, ,,~:?...:::";?.'i.'ii~ii ',i,::,~i~i~',':::i~iil;;i:;'.:;i;i~;ii'.~,ili;.i:,?.;~:~:Hazardous Materials Plan ,./??" ~' ,i!~ :~."?%:'iii?~: ~i!~i.'~. ii~:~:iiii;;!:!?ii~ii'U~de[gr°und storage of Hazardous Materials ALI AUTOMOTIVE :5.'"/'~?' ~ ........ ~/" . ............. %:: i~i:.i '~ :i ,/ .i~i':"=.."'.: ?..::;i( "-:.~i;¢~' .:~ :: ":.:L~ i'. ~.. ~ 'i: :~[:=':'-. ~ ~=~:, "~::.~ :~ '~:~:'~.. ':b.. ~. . ; '~ ~,, ~[:.. ',..?~ ~::.. "'....':~ "~[;;~' ~L' ~;~:,.~:... ...... "? ~" ' ~ ~ F'~ :~ ,.:~;~ ~:,"... "'~.~ ~..,'- )i ~.:~ .........~ .......',:~' , .... ~: ' ~tS. . ,.'~ [: :~ ~.' L. · .......... ;::~.:~ ~ ? ~ ~ ~,,'........~]~ ~: '.....~ ?.-~ ~,,.. .............. ..:~ .... ~, .~ .~[.. '~::;~ ':,;~. ...:'~: ~;~ :~ ;, '".,, .,,.. :: ~' · '~, ~..,- , 'I $ :.~:~"  Bakersfield Fire Depa~ment Approved by: 1715 Chewer Ave., 3rd Floor ~,~.,~o, June 30, 2000 Voice (~05) ]26-~979 ~xpimtio~ Date: . ~ (~0s) ~-0~ STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501 TRUXTUN AVE BAKERSFIELD, CA.9330i-5201 ( 8050,. 326,3979. ".' ~. BhKe~u~ iELD,'.'Ch. 93307~ CUSTOMER NO: ,.: 39 .... "'. CUSTDMER,'TYPE' ES/ 3906 CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT ' . FOR OUESTiONS OR CHAN~ES TO YOUR A~OLNT, PLEASE CALL THE NUMBE~ AT THE TOP OF THIS STATEMENT. CURRENT OVER 30 OVER 60 OVER 90 ..... b-~7. 86 DUE DATE: 12_/01/98 PAYMENT DUE: 567. 86 TOTAL DUE: $567. 86 · :.t:::.~.:::,'..t': ::it "AND..t H~KE 7 C'~EC~ ".~:~'Y~g~E: :'TO :..~.. :,~:" ": :::. ': '~:' 7{':.:: ::"~ ::: ~':::' ~:'~.~., ." ':;~ :~::.: :,... ,:.:: .' :'..,:. ~.,,. ':': .":~;: "~ ..'Y: '.'.'.;:.:. :...:'.. '..':: ".. :". :':.'..'.'...':'".' I~: ~'~{~:t'? :'.t::.:.yc i:.T.Y:~:"D'Y:.."B~E~:sFIELDi~::====================================== .:.:: ':..> :t'::'. :~:.';:'. :..': :::....":...'~ ::.'B'A~ERSF tELDF.": ~.: 2-...'" .? t~:~ .'~::: ~:':-':..:.C ~'...' ':: ~3303.~ ~0.6.7 '~:.: '.::'"' 'i..:.>..i: ..A.:~ :t~: ::'..:.:..:.'.:~ ::: ~:. "~-.: ...':~t'~.7.. :::. ~.:...~ ...: .... ::'.:.. '.' :~v." :::'... ::..... y..... ":... ::.,' ~::'......'..., :. ?' ~"t;?:. ~': >:?' t':' i': ~.:::. :. :.. :'.' ?.'.~::::t' ?.:.':':}~t:~.::.:...t~::::' 5~:':· ~::': ~'~ '~7~?"tY:':".~.'..":':~ :.'. t~:...::.:; ....~?'.:: ::.;. :~ :..~'?::t ::'. :. ~.t'. :.:: :: ::::~ }~ :.}.:};:: ~>. ~.:.::~/.'::: t':.:.~:.: :~;: :.::~: ~': :':'~:. :' ~;...::~. ~t :~: ::' ~t ~:'~.. ::; :..:: ~;....:;: :..:.::~ ).:::.....:.: ?..:.~...' :..:' '..'.. ,':.'...::>y?.:" ....'. '...:~::..: ::.-.~...~.: ' : '. ")' ' · ,: .: .."..:..:.. :: · :..:. :"..." .' ¢:~. h..';~..~'...: ~: ':' ..- ' ·:··2..' : ". '.....'... :.~ '..~'.: .' '. ?:'.' ~'.cus~a~:.. ~a ::"~" '.. :':...'.~ ~:' ". '.'.: '. 39%' .: ..'.: .:::...':::~ ~ :: '.':. ~.':: ':. :: ::~..~:~ ..: .> :' ~: CuS,o~'m.:,.v¢;[~?~ ~s:2 ::::: ~.'~. "~:3'%~.:::' ~"...~...: ~. 'c'.'.. A.' ~::.."~: · ..~ .v ....... ." :...: '. '.'" .'.A'.::' ':... ::. ~": .~ :: ~:.7.. ::: '.. :..: ':' :".', .'~;. :..: :" :: ;:': ~..:.:. '..'...'' ."..'? .:.....:..:.... ....:'.: :: .';' }:..'...: .... .; .~ ~..,. .... :. . : /:,.,.....:~ '. ~.. · .'.:. ..~..~ ~..y::" ?.?..:.: .../:~:: ~... :;.>.:~.".:.:. :>-.. ~..~ ....... ".':.: y:.?~.. · .... ..... :.: :.:.':~:. ,...?: .'"...'.... ~.:.~..'.- ..:.... ~:~ .'~::~.".: .:: :.......:.....:.......~:~ ......~:.:............. CITY OF BAKERSFIELD '~-~ '.~"-~- ='-' - _ ~!<~ ~:*_ .... .~ · ~[ --_.,~;, :.._ .-. ~ ~ --3 :.~ ~ P.O. BOX2057 / -- ' c? ~' ~-~"~" :.'~ ~ · . ' ;~'.i ,, ' BAKERSFIELD, CALIFORNIA ~ ~ .,: ........... ~; ~ ~ . . R~RN SE~ICE R~~D~ ~ [* '~ * * '~ ~ ~'~ '~c~'~ - ~ {' '..'. ~ ': ... :.~:.. _.... ': .... - / :' ..: . ..' J ~i.' GIT~ OF BAKERSFIELD ~'~r~'~' P.O. BOX 20,57 ' "' '-~ : :' ' ~;' 5 :" 5 .' ~,,,_ . BAKERSFIELD, CALIFORNIA 9~ R~RN SERVICE REQUESTED ALIA205 ~07202~ ~596 O~ O~/08/g~ :AL~ AUTO~OTIV~ ~05 ~IN~ AV~ BAK~RSFIgLD ~ ~~ ~ ~.~ ~,~,,,,~,,,~,u,,,,,~,,,~,u~,,,,~,~,~,,,~,~,~,'~,,,~,~,a '. ~/~- ~?~'~.% OFFICE OF ENVIRONMENTAL SERVICES ~'I~' ~ ~i~--------~ 171S CHESTER AVENUE, 3RD FLOOR - "' ~..~..-~,. ~ ~ ..... ~ BAKERSFIELD, CA 93301 (sos) . H~ARDOUS MATERIALS INVENTO~,~>""'"""'~:(~'~~~ i SF5C:~ IF ~USINESS IS A FArM [ =,z,C;L;TY NAME NA~ U,m: CF ~USiNESS ~ ~ :, ,SiC CODE ~ ' 'DUN & BPADS~,::~ NUMBER C'WNEF,/G?:F,,%TC'?~ ~ 6 ¢~ , ~...L, ~1'~ PHONE MAILING ADDRESS ~o % ~~' ~ ~ ~ EMERGENCY CONTACTS BUSINESS PHONE {~O~."-..,,) 00-.-~7 Z.3 ~-C 24-HOUR PHONE BUSINESS PHONE L~_~.] 3 2.-L-- //_~-'~-- - 24-HOUR PHONE HAZ DOUS MATERIALS INVEI ORY ~siness Name Address -~'- .... ) INVENTORY STATUS: New [ ] Addition J J ReVlon [ J Deletion J ] Checl~ if chemical is a NON TRA~E SECRET [ ] ~ SECRET [ J '~) Common Ne, me: 3) DOT ~' (ol:~x,~l) · ChemCal Name: AHM [ ] CAS # ..t) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ j Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Detaye~l HeaJfll (Chromc) [ ] ~) WASTE CLASSIFICATION (3-cligit cocle from DHS Form 8022) USE CODE · 3) PHYSICAL STATE Solid [ ] I_Jc!u~d [ ] Ga~ [ ] Pure [ ] Mixture [ ] Waste [ ] Ra*~iioectJve [ ] ?) AMOUNT AND TIME AT FAC'-[~J-'~ ........... UNITS OF MEASURE 8) sTORAGE CCDES MaxJmum Da'iy Amount: :bs [ ] ~1 [ ] ,~3 [ ] a) Conr, mner: Average gaJN Amount: :unes [ ] b) Pressure: AnnuaJ Amount: c) Temoerazure: Largest Size'Contmner: -~ Days On Site Circle Which Months: ..~ll Ye~. J. F. M, A. M. J. J. A. S, O. N. 9) MIXTIJRE: List COMPONENT CAS # % WT AHM · .~e three most naza~clous ! } [ c~em~cm ¢omoonenr. s or any AHM coml:x~nents 2~ 0) Locaz~on CHEMICAL DESCRIPTION INVENTORY STATIJS: New [ ! ~c~difton [ ] ReWSion [ ] Detet~on f I Chec~ if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (ol:~:ional) Chem~caJ Name: AHM [ ] CAS # PHYSICAL & HEALTH PHYSICAL HEALTH __~AZ.A~D_CA.'T~_GOBiES Fire [ !__~eac~e_L._l.~SucLcl.eo_~Ret_e~se of Pressure [ ] ImmecliateHeaJtJl (Acute) [ ] Delayecl Heeflth (ChroniC) [.] WASTE CLASSIFICATION (3-~ig~ code from OHS Form 80221 USE CODE PHYSICAL STATE Solid [ ] Liou~d [ ] Ga~ { ] Pure [ j MLx'ture [ ] Waste AMOUNT AND TIME AT FACILITY UNITS CF MEASURE 8) STORAGE CODES Maximum O~uly Amount: tbs [ ] geJ [ ] ft3 [ ] a) ContaUne~ Average Oran Amount: cunes[ ] b) Pressure: AnnuaJ Amount: c) Temperature: L.a~cjest Size Contmner~ ~ Day~ On Site C~rc. Je Which Montf~s: AJI Yeaz. J. MIXT1JRE: I.Jst COMPONENT CAS # % WT ' AHM t/~e three most haZamous ~ ) [ cnem~.zl comoonents or any AHM components 2) [ O) I.oca~n ' aroiy under penauty o//aw, t~at i nave pemona,y exarmne~ ar~ am [ammw w~m ~e ~nioma~on suomta'eei on m~e eno mi ~ document, I Detmve me =m~ infon'na~on is t~e, accurate, anet c, om/NeW. ._. ~'... .'INT Name & 7~tle of Acrtl~nzeo Coml~any Ref~resenta~ve $igne~tre - ~!-iazardous iV~ateriais Dbrision HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION3: TRAINING: MATERIAL SAFE~ DATA SHEETS ON FILE: ~ BRIEF SUMMARY OF TRAINING PROGRAM' SECTION 4: E×EMPTION RE~.UEST: I CERTt:v UNOER ?ENALTY C,F =eR JURY -""-' MY "" ..... ~,~ =USiNESS IS EXEMPT FROM THE REPORTING x~.=UIREMENTS ,OF CHAPTER 6.95 C'F -~ I, ,: "CALIFORNIA '-':" '-" "- '-" , ,,-,'~. L, n '& SAFETY C',..u- F'._.'R liner-wLU...-"' "'WING x=.'-'.~N..' ....... ',"./E DO NOT HANDLE .... ' "-'US ~'"" ~ r-:A/, .-,F,C ~. MATu. rdALa. -~"'~C-H-A-N'~'C'E-~7i%.ZTTED-C-U'S-i'Ei~T'E R-I'~IZS-7 B-U-'FZHE-~U'A-N i i Ti-E'S A T NO ,,..,,~z..-.....,=z'.-., THE MINIMUM ,~.EFCRT(N~ - ... .... ,~ r_ A ,., C N', C'THER (SP'-'''''''''v ~"- SECTION 5' CERTIFICATION: MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL ~E USED TO r-.xM S OBLIGATIONS UNDER ,r".," "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC.. "25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATUTEE TITLE ...... BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD,.CA 93301 (805) 326 3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: i-.' TO avoiu]urTner octibn~r~'~uin']-E~% tb-~-~it]~i~ 3-'~ days-of receipt. 2. ~P~/PRINT ANSWERS IN ENGLISH. 3. Answer the questions be~ow for The ~usiness cs a whole. 4. Be Dr;et cnC concise cs 2c~igie. SECTION ]' BUSINESS IDENTIFICATION DATA ~ ~ NUMBs:,: SiC CODE: ;v ~,m..~,lVlI ,. SECTION 2: EMERGENCY NOTIFICATION: ,._.uNTACT TITLE BUS PHONE z¢-24 HR , HONe 8s7_zz . , ,. Fo// 2. Hazardous iVlaterials HAZARDOUS MATERIALS MANAGEMENT PLAN Faoility Unit Nc:me: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: :.x*o~ r,.vu: NCTiFiCATiCN AND :.,,.-..,_,U,-.~ON: C. ?U~LIC EVACUATION: ",, '.. O. EMERGENc','' MEDICAL PLAN' HAZARDOUS MATERIALS MANA*GEMENY PLAN . .-.',, . .f~ ~..;. SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. R"- PREVENTION STEPS' B. ., 'RELEASE-CONTAINMENT AND/OR MINIMIZATION: '" .~.'~'-'_~ EA N-U ? ? R C' C c'~ U ~ z~',..~~. ' o J ? "I/ ° SECTION 8: UTILITY SHUT-OFFS ,: LC'"" "'''''~ ..... "-" " ~,-~i,t_..N ,~:r :HUT-OFFS AT ',"OUR FA,_.~LITY): NATURAL ,'-' ,ix,. ','V,--'. 1 ~. :", .' · ':c E.C .... LOC','( BOX: YES/NO '!F ',VE,~, LOCATION' SECTION 9: PRIVATE FiRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): ~ '