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Home My WebLink AboutBUSINESS PLAN (2) Hazardous Materials/Hazardous Waste Unified Permit .. CONDITIONS OF .PERMIT ON REVERSE SIDE This permit is issued for the following: [] Hazardous Materials Plan [] Underground Storage of H=-=rdous Materials Permit ID #:: 015-000-001733 El Risk Management Program ROSALES HEAVY DUTY = Hazardous WasteOn-Site Treatment LOCATION: 240 E 11TH-ST ' OFFICE OF ENVIRONMENTAL SER VICES' ' ~ · .~~ 1715 Chester Axle., 3rd Floor Approved by: a,~ 'Bakersfield, CA 93301 OfliccofEv~c~...o, Issue Date ' Voice (661) 326-3979 ,i FAX (661) 326-0576 Expiration Date: '-Ii.n~ .~n~ 20fl] [I Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE .......... .~:~,~,~:,,,~,~,:-~.~?=~==~:~::,,~,~,, ........ This permit is issued for the following: :.¢:~'?':':: ~?/.2:;~;:,::::;~::;,~:2;;Eii::i?'-i;~;:;.El'Hazardous Materials Plan ROSALES HEA~ DU~ TOWING: ......... :::;::;::~:::~':':' ";~:~.*'~ ................. "":'-~::'~",~;'~"~:~:;':~,,~" :~;; % ~', ~i~.~[~;;'' ';,".'?" .........j]~;i¢.i~;':iji~ji~;~;:,;~¢;::. ~ j 'i','~ ";;~:,:)';.. ~;,.¢~:¢;:ij~,.~[:.... :;'?~;. LOCATION240E11TH ,,.!~;.:",,'::,¢',:?~,,,:.¢:.~,' ........... '~:~::~¢'%~..." ~J~ ¢ ......... · '-:' ,. ,.~ ..... ' ¢,', -¢ ¢ ~'. ,¢':,:,~,,',:,,~':,-:,~:,:':~','::,4,~4...." ¢ '" "" ":: . ,,-,.,j****~,.,., ..;**~:,~*******~i~ ~,. ,ij~,~***~ ~,~ .................... ~ ............ ~:i;"-----;:."~, i*;;"~' ~:4;~' ,*', ,,.:., .,*'.*%,:,~,r Ch' ,~¢;:' ,J;." .'",,~i* '~-. ~. ;¢;~J~,~¢¢~:~illil:i~ i¢~' .~,~&.~ ~:...~.-...~ h ...~: ......... .~ ~ ~[~ ............ ~h. ~q~'.k~ . % ........ '.'-:~%..~i ~ .,{~i~: ~ ~:' .:,;;;;~;:~?..:;. ~;.. i;..L.L;:.J,r.~::,~'.:'.:;:;;" -~;;i '~i~, ~¢:i'¢~,'' ~,' ,¢¢ ~ ~, i..,~:" "%~u~:"' ...." · ?;": ,:.,, ;'"'" 4~i~::,,-!{? {}{}{. ':zE};¢ ~'~¢' ..,::~=:,¢:~" ;~ .: { i .L~¢¢~' Issu~ by: B~ersfield Fke Depa~ment Approved by: 1715 Cheaer Ave., 3rd Floor ~ Office of ~en~l B~e~fiel~ CA Voice (805) 326-3979 F~ (805)326-0576 Expiration Date: June 30, '2000 ITE DIAGRAM FACILITY DIAGRAM Business Name: ;~,,.,~.A(.~.s ~A~,./Y O~T~ ~ ~ For Office Use Only First ~n Stction: Area Mc~ # 'al InsoectJon Stc,~on: NOFITH L; ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Manager : BusPhone: (661) 327-2423 Location: 240 E llTH ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 32A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 02 SIC Code:7549 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title NESTOR ROSALES / OWNER SERGIO AGUILERA / SON-IN-LAW Business Phone: (661) 327-2423x Business Phone: (661) 327-2423x 24-Hour Phone : (661) 872-0616x 24-Hour Phone : (661) 324-1807x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: (661) 327-2423x MailAddr: 240 E llTH ST State: CA City : BAKERSFIELD Zip : 93307 Owner NESTOR ROSALES Phone: (661) 327-2423x Address : 240 E llTH ST State: CA City : BAKERSFIELD Zip : 93307 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: Res: No Emergency Directives: ~ Hazmat Inventory One Unified List ~--Alphabetical Order Ail Materials at Site Hazmat Common Name... SpeoHaz]EPA HazardsI Frm DailyMax IUnitlMcP ACETELYNE E F P. IH G 179.00 FT3 Hi ARGON F P IH G 336.00 FT3 Min OXYGEN F IH DH G 249.00 FT3 Low WASTE OIL F DH L 15.00 GAL Low 1 04/08/2002 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME ACETELYNE Days On Site 365 Location within this Facility Unit Map: Grid: IN QUANSET BLDG NEAR OFFICE CAS# 74-86-2 FSTATE ~ TYPE I PRESSURE TEMPERATURE CONTAINER TYPE Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 179.00 FT3 179.00 FT3 179.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Acetylene Yes 74862 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site 9 COMMON NAME / CHEMICAL NAME ARGON Days On Site 3'65 Location within this Facility Unit Map: Grid: IN QUANSET BLDG NEAR OFFICE CAS# 7440-37-1 F STATE ~ TYPE i PRESSURE TEMPERATURE CONTAINER TYPE Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 336.00 FT3 336.00 FT3 336.00 FT3 HAZARDOUS COMPONENTS .%Wt. RS CAS# 100.00 Argon No 7440371 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min 2 04/08/2002 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 9 F Inventory Item 0003 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE QUANSET BLDG CAS# 7782-44-7 FSTATE ~ TYPE I PRESSURE TEMPERATURE CONTAINER TYPE Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 249.00 FT3 249.00 FT3 249.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MCP No No No No/ CuriesI F IH DH / / / Low F Inventory Item 0004 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: SE CORNER OF YARD. CAS# 221 F STATE ~ TYPE i PRESSURE TEMPERATURE CONTAINER TYPE Liquid /Waste Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 15.00 GAL 15.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MCP No No No No/ CuriesI F DH / / / Low -3- 04/08/2002 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format F Notif./Evacuation/Medical Overall Site Agency Notification 03/27/2001 PHONES IN OFFICE AND SHOP OFFICE. Employee Notif./Evacuation 03/27/2001 = PHONE CONNECTED TO BUZZER SYSTEM. VERBAL WARNING SUFFICIENT IN SHOP YARD. CELLULAR PHONES IN VEHICLES. Public Notif./Evacuation 03/27/2001 RESIDENTIAL TO THE S. Emergency Medical Plan 03/15/1996 MERCY HOSPITAL COVERED BY INSURANCE PLAN. -4- 04/08/2002 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format F Mitigation/Prevent/Abatemt Overall Site Release Prevention 03/15/1996 GAS CYLINDERS CHAINED TO CARTS. Release Containment 03/15/1996 JOHNNIE CAT USED AS ABSORBANT. Clean Up 03/27/2001 CRANES USED FOR WASTE OIL PICK UP. Other Resource Activation -5- 04/08/2002 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format Site Emergency Factors Overall Site Special Hazards Utility Shut-Offs 03/27/2001 A) GAS - N/A B) ELECTRICAL - INSIDE E SHOP BLDG C) WATER - OUTSIDE SE CORNER OF LOT D) SPECIAL - N/A D) LOCK BOX - NO Fire Protec./Avail. Water 03/27/2001 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER IN SHOP. NEAREST FIRE HYDRANT - LOCATED AT SE CORNER OF WALLACE & llTH. Building Occupancy Level 6 04/08/2002 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format Training Overall Site Employee Training 03/27/2001 WE HAVE 2 EMPLOYEES AT THIS FACILITY. WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES FAMILIAR WITH MSDS. Page 2 Held for Future Use Held for Future Use -7- 04/08/2002 = ROSALES HEA~ DUTY TOWING ~ SiteID: 015-021-001733 _ Manager : . sPhone: (805) 327-2423 Location: 240 E llTH ST / b'6U0~ ~ap : 103 Com~az : Low City : BAKERSFIELD /~: ~rid: 32A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 02"~'~~SIC Code:7549 EPA NuB: DunnBrad: Emergency Contact / Title Emergency Contact / Title NESTOR ROSALES / OWNER STERGIO AGUILERA / SON-IN-LAW Business Phone: (805) 327-2423x Business Phone: (805) 327-2423x 24-Hour Phone : (805) 872-0616x 24-Hour Phone : (805) 324-1807x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 240 E llTH ST State: CA City : BAKERSFIELD Zip : 93307 Owner NESTOR ROSALES Phone: (805) 327-2423x Address : 240 E llTH ST State: CA City : BAKERSFIELD Zip : 93307 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: F Hazmat Inventory One Unified List ~--- As Designated Order Ail Materials at Site Hazmat Common Name... ISpocHazIEPA HazardsI Frm I DailyMax IUnitlMCP ARGON F P IH G 336.00 FT3 Min ACETELYNE F P IH G 179.00 FT3 Hi OXYGEN F IH DH G 249.00 FT3 Low WASTE OIL F DH L 15.00 GAL Low '1, N~s'f"o," ~ .~o~-I~Do hereby certify that ~ have (Typ~ or print name) reviewed the a~ached hazardous materials manacje- ment plan for ~sr~e~ ~o~o;~and that it alon{~ with (Name of Business) any corrections constitute a complete and correct man- agement plan for my facility. ,. . o / o o o ~ ~.. Signature ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME ARGON Days On Site 365 Location within this Facility Unit Map: Grid: IN QUANSET BUILDING NEAR OFFICE. CAS# 7440-37-1 Gas }Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum' .Daily Average FT3 336.00 FT3 336.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Argon No 7440371 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME ACETELYNE Days On Site 365 Location within this Facility Unit Map: Grid: IN QUANSET BUILDING NEAR OFFICE CAS# 74-86-2 VSTATE -- TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 179.00 FT3 179.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Acetylene Yes 74862 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi 2 02/01/2001 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 F Inventory Item 0003 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE QUANSET BUILDING. CAS# 7782-44-7 FSTATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 249.00 FT3 249.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low F Inventory Item 0004 Facility Unit: Fixed Containers at Site COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: SOUTHEAST CORNER OF YARD. CAS# 221 F STATE I TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Ambient Ambient DRUM/BARREL-METALLIC Waste Liquid AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 15.00 GAL 15.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MCP No No No No/ CuriesI F DH / / / Low -3- 02/01/2001 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format F Notif./Evacuation/Medical Overall Site Agency Notification 03/15/1996 PHONES IN OFFICE'AND SHOP OFFICE Employee Notif./Evacuation 03/15/1996 PHONE CONNECTED TO BUZZER SYSTEM. VERBAL WARNING SUFFICIENT IN SHOP YARD. CELLURAR PHONES IN VEHICLES. Public Notif./Evacuation 03/15/1996 RESIDENTIAL TO THE SOUTH Emergency Medical Plan 03/15/1996 MERCY HOSPITAL COVERED BY INSURANCE PLAN. -4- 02/01/2001 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site Release Prevention 03/15/1996 GAS CYLINDERS CHAINED TO CARTS. -- Release Containment 03/15/1996 JOHNNIE CAT USED AS ABSORBANT. Clean Up 03/15/1996 CRANE,S USED FOR WASTE OIL PICK UP. Other Resource Activation -5- 02/01/2001 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format Site Emergency Factors Overall Site Special Hazards Utility Shut-Offs 03/15/1996 NATURAL GAS/PROPANE: N/A ELECTRICAL: INSIDE EAST SHOP BUILDING WATER: OUTSIDE SE CORNER OF LOT SPECIAL: N/A ~-LOCK BOX-: Fire Protec./Avail. Water 03/15/1996 = FIRE EXTINGUISHER IN SHOP FIRE HYDRANT AT SOUTHEAST CORNER OF WALLACE & llTH. Building Occupancy Level 6 02/01/2001 ROSALES HEAVY DUTY TOWING SiteID: 015-021-001733 Fast Format ~ Training Overall Site Employee Training 03/15/1996 NUMBER OF EMPLOYEES: 2 MATERIAL SAFETY DATA SHEETS ON FILE: YES BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES FAMILIAR WITH MSDS Page 2 Held for Future Use Held for Future Use -7- 02/01/2001 zJanersneict J~'ure J3ept ..... [l~ardous 1V~aterials Di'cision HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: ~ MATERIAL SAFETY DATA SHEETS ON FILE: "T BRIEF SUMMARY OF TRAINING PROGRAM: SECT[ON 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS tS EXEMPT FROM THE ,-m ,,:E, ORTING RE,G. UIREMENTS OF C',--[APTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WEDO HANDLE HAZARDCUSMATERIALS, BUT THE QUANTITIES AT NO TiMEzXCE--D THE MINIMUM RETORTING ~UANTrTIES. ,mr ,~ SECTION 5: CERTIFICATION' I, AJ~'=5'7-o-',fc~ %,A.c.~'$ CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAI' THIS INFORMATION WILL SE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAP'TER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE "7--. HAZARDOUS MATERIALS DIVISION 171,5-CHESTER'.AVl-'. ~ ~ :~ ¢~ BAKERSFIELD, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer ~he auestions below for the ~usiness as a whole. 4. Be grief aha conc=e as Do.iDle. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME' LOCATION: "Z/---/0 MAILING ADDRESS: ~l,. ~'~,~,l=.. ZIP ~ 33o'7 PHONE: "~Z.."7 "'Z/--47,.% DUN & BRADSTREET NUMBER' SiC CODE: ?RIMARY ACTIVITY: OWNER: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. t,J~o~ (Zo~pc~£ OcJ~ ~'z'/-z4z"s o~'TZ-OGf,6 B~kersfield. Pire Dept. Hazardous ivIaterials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENT[ON STEPS: RELEASE. CONTAINMENT AND/OR MINIMIZATION: ~or..-t~,zz:E C~¢T c7¢¢___zo .A% ,~¢-,.~__.)r_.~..¢~..r. , ROCr_.DURES C. CLEAN-UP 0 ,"- · C__. /'CA.,,~ ¢_-. '.S ,r..3c.e-o ~ ,...¢'~,:;..-r-~" 0,,.... ¢,o,/.. op SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY')' NATURAL GAS/PROPANE: ~LECTR!C,qL: Ir-,) % ,~ O~ . ^-r_ . ~:3VT,~, ~: ~ ~ c._P..~,"L of:::: ,-.~"c- ,V,--, LOC',< lC.X: YE.S/NO iF YEt, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION' ~,, ¢c~ B. WATER AVAILABILITY (FIRE HYDRANT)' ~ Hazardous Materials Divisior~ ,- HAZARDOUS MATERIALS MANAGEMENT PLAN Fertility Llnit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: EMPLOYEE NOTIFICATION AND EVACUATION: C. ?UBUC EVACUATION: EMERGENC'," MEDICAL ?LAN: BAKERSFII D CITY FIRE DEPARI/IENT HAZARDOUS MATERIALS INVENTORY Page_of__ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New ~f~ Addition ( ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE 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 [ ] Liquid [ ] Gas ~ Pure ~ Mixture [ ] Waste [ ] Radioactive [ ]. 7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Dally Amount: ~-'~'~ lbs [] ga] [I f(3 ~, a) Container: 4 Average Dally Amount: ~.~cT.( curies [] b) Pressure: Annual Amount: '~..~ c) Temperature: Largest Size Container: # Days On Site ~ ~ .~j'- Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # _ -..% WT AHM the three most h=ardous ~) C.~7'-~C--~ (~_.~ [ ] chemical components or any AHM components 2) [ ] 3) [ ] CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New'~f Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: ~'-~,~,C"~T~ 0 I ~ 3) DOT # (optionaJ) 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 [ ] Liquid ~ Gas [ ] Pure [ ] Mixture [ ] Waste ~ Radio~-'tive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: /'.~'- lbs [ ] gal ~ 1t3 [ ] a) Container: Average Daily Amount: / ~ cudes [ ] b) Pressure: Annual Amount: ! ~ c) Temperature: Largest Size Container: .~"' # DaysOnSite '~=,~'" Circle Which Months: AllYear, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS# ~E~'~ AHM the three most hazardous 1) ('~ ~ 5,'~"¢.~ <:~ l, ~-- _~ [ ] chemical components or any AHM components 2) [ ] 3) [ ] cerlffy under penal~/ of law, that I have personally examined and am familiar with the infomat~on submitted on this and all attached documents. I believe the submitted information is ~e, accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date BAKER :IELD CITY FIRE DEI: RTMENT · HAZARDOUS MATERIALS INVENTORY Page_of__ Business Name ~)S~d.~-~ '~('-O~,J'~ ~OE~-- Address "~40 ~ - ~ ~ ~ ~ CHEMICAL DESCRI~ION 1) IN~NTORY STA~S: New ~ Add,ion [ ] Revision [ ] ~letion [ ] Ch~k E chemi~ is a NON ~DE SECR~ [ ] ~DE S~R~ [ ] 2) Compri N~e: ~ 3) ~T ~ (op~ Chemi~ N~e: AHM [ ] CAS · 4) PHYSICAL & H~L~ PHYSICAL H~ H~RD CA~GORIES Fire [ ] Rea~Ne [ ] Sudden Relate of Pressure ~ Immedi~e He~h (Ac~e) [ ] ~yed He~ (Chron.) [ ] ' 5) WAS~ C~SSIFICA~ON (3~igit ~de from DHS Fo~ 8022) USE CODE ~ 6) PHYSICAL STA~ Solid [ ] ~quid [ ] G~ ~ Pu~ ~ M~m [ ] W~te [ ] R~io~ [ ] ~ AMOUNT AND ~ME AT FAClU~ ~ ~ UNITS OF M~SURE 8) STOOGE CODES M~mum DalyAmount: I~ [ ] g~ [ ] ~3 ~ ~) Con.neE ~ Average DaN A~unt: ~ ~ ~ cudes [ ] b) Pressure: ~ Annu~ Amount: ~ ~ ~ c) Tem~r~ure: ~ ~gest Size'Cont~ner: ~ ~ · O~OnS~e ~ Cimle~h Moths: AIIYe~, J. F, M, A, M. J. J, A. S, O, N, O the throe most h~dous 1 ) ~~~ ~ [ ] chemi~ com~nenm or ~y AHM com~nen~ 2) [ ] 3) [ l ~o) Lo~o~ ~ ~~ ~C~ ~ ~~ CHEMICAL DESCRI~ION 1) IN~NTORY STA~S: New ~ Add,ion [ ] Revision [ ] Deletion [ ] Check ~ chemi~ is a NON ~DE SECR~ [ ] ~DE SECR~ [ ] 2) Common N~e: .~~C~' 3) ~T · (opfion~ Chemi~ Name: AHM [ ] CAS · 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GORIES Fire ~ Rea~ive [ ] Sudden Rele~eof Pressure ~ Immedi~eHe~h (Ac~e) [ ] ~layed He~h (Chronic) [ ] 5) WAS~ C~SSIFICATION (3-dig~ code Eom DHS Form 8022) USE CODE ~ 6) PHYSICAL STA~ Solid [ ] Liquid [ ] G~ ~] Pure ~ Ui~ure [ ] W~te [ ] Radio~e [ ] 7) AMOUNT AND TIME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES ~ M~imum Daily Amount: ~ ~ [ ] ga [ ] ~3 ~ a) Cont~ner: Average Daly Amount: ~ ~ ~ cudes [ ] b) Pressure: ~ . Annu~ Amount: ~,~ ~ c) Tem~r~ure: ~ ~gest Size Contaner: ~ ~ ~ Days On Site ~ Circle~ich Months: AilYe~, J, F, M, A, M, J, J, A. S, O, N, D 9) MITRE: ~st COMPONENT CAS · % ~ ~M the three most h~dous 1) ~~L~ ~ [ ] chemi~ com~nen~ or ~y AHM com~nents 2) [ ] 3) [ 1 ce~'~ under pen~ of law, ~at I have pemonatly examin~ ~d am f~ili~ wi~ ~e infomaSon submi~ on ~is ~ all a~ch~ document. I believe ~e submi~info~a~onis~e, accu~te,~dcomplete.~.~ ~~~ ~~ ~ ~~ ~-~ PRI~ Name & ~fle of A~odz~ Com~ny Represen~ve