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HomeMy WebLinkAboutBUSINESS PLAN (2) SITE/FACILITY DIAGRAM FORM DAIE: /' / FACILITY NA~ME: UNIT ~ OF (CHECK ONE) SITE DIAGRAM / FACILITY DIAGR.~M '"' ?~t~"~i'~' ' %" ' '"" .... ~ .... ~/' .... ~~/~~' " · '~- · , '":?.~. '.~, .-.r :. .~% '?)~' 'u¢.'".'?:~:~!'"l~m:~' -:~!~' '" .':~ 'x' '";'.: ~ ,... ..., : .. .... . ...... ... . .,..... ~'....... · .... L,-,,~ .... ' · ........,. , ..... :. ~ m .. ' (Inspector's Comments): -OFFICIAL USE ONLY- HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE RECEIVED ' I.o To avoid further action, return this from uithin 30 .days of race,pt. ' 2. TYPE/PRINT ANSWERS IN ENGLISH. ,: ..... 3. Answer the questions belo~ for th~ business:, as,,.a uhole~.,~,'"' 4. Be as brle~ and concise as possible SECTION*I: .BUSINESS IDENTIFICATION DATA" .. ~, : ......... SECTION 21 EMERGENCY NOTIFICgTION~ .... In case of'an'emergency~ involving the r~laase or'threatened relaase of a hazardous material, call 911 and I-BOO-B~Z-?.~SO or 1-~1B-427-4~41 This atll no{try your local fire dep~r[ment and the State Office of Emergency Services as required by law. : ~:'. ' ~" ' '" EMPLOYEES TO NOTIFY; IN CASE OF EMERGENCY: " .. NRHE ~NO TITLE "~ '~: ' DUff[N8 BUS. HRS.' ~FTER BUS. HRS. O. SPECIAL: E.' LOCK BOX: YES /~IF YES, LOCATION: .- IF YES, DOES IT CONTAIN SITE PLANS? YES / rio MSDSS? YES / FLOOR PLANS? YE~ / NO ~EYS? YE3 / SECTION ,~: PRIVATE RESPONSE TJ~AM FOR 8USI~IESS AS A WH~LE -' ,~' ' SECTION S: 'k0C6k EMERGENCY MEDICAL ~,S,SIST~NCE FOR YOUR BUSINESS 6S a WHOLE SE~T~.ON ~:" EMPLOYEE TRAiNiNG '-EMPLOYERS' 'ARE REQUIRED TO HAUE A TRAINING PROGRA~ WHICH PROUIDES E)tPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS ~. NUMBER OF EMPLOYEES ~T THIS F~CILITY C. GiVE A BRIEF SUHMARYJF YOUR HAZARDQUS ~ATERIALS TRAINING PROGRAMt :~ECTION 7: ' ~XEHPTiON REQUEST. I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEHPT FROM THE REPORTIN~ REQUIREMENTS OF CHAPTER G.9~ OF THE CALIFORNIA HEALTH AND SAFETY COOE,FOR.THE ~OLLO~IN6 REASONS: . ~ , ,,-.. ~ ~ .... gE O0 NOT HANOLE HAZARBOUS HATERIALS.- ~E O0 HANDLE HAZAROOUS ~TERIALS, BUT .THE QUANTITIES AT NO .., ~ TIHE',.EXCEED THE ~NI~UH REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 8: CERT IF~ATION .I.,' ~,~" , c~rt~fy thai the abov~ ~nforma~on acc~te. [ underS{and that this ~nformatJon u~11 be used to fulfill my f~s obJ~gat~on~ under the neu California Health and Safety code Hazardous ~ateP[als (D~v. 2~ Chap{e~ ~.9~.S~c. ZS~e E~ ~1.) and {ha~ ~naccura~e ~nforma~ion constitutes SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does tht. s Fac[litg Unit cont,iu Ha~nrdo,s ~at. erJa!s? ........ If YES, see B. If NO, continue ~ith SECTION 4, B. Are ::my of the hazardous materials :-t bonu fide Tr;t,.ie - ; .- · ...... If NO, "complete a.'separate hazardous materials Inventory' form marked: NON-TRADE SECRETS ONLY (~vhite form If Yes. complete a hazardous materials Inventory form ,~arked: TRADE SECRETS ONLY (~ello~ form ~4A-a)lln addition to the ~on-tra~e SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMEROENCY RESPONDERS , , i,""" SECTION .6,~., LOCAT.!O~ OF .,~TILI~ S~wOFFS.. AT..TH.IS. UNIT,..ONL~ ..... ~.... .. ..,:...,. ,. . ., .... ' .... ->., :.- .,.-~., · : ~'+" ' .": '?., :':"~:~'.A. '.NAT..GAS iPROpAN~ :~?i~.:,~ ~;,:..:.;::,:: .... ";'"'!;: :".' '.: t..'. ~ ,,..... ..... . .. . .. . '~.~d ~/], B. 'ELECTRICAL: ';~,t .' ) !'.'. ~ ! C. WATER: O. SPECIAL: E. LOCK BOX: YES /~IF YES, LOCATION: ' IF YES, SITE PLANS? YES / NO MSDSs? YES "NO FLOOR PLANS? YES ,/ NO KEYS? YES .' NO 3~ - BAKERSFIELD CiTY FiRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY BUSIN£SS NA,~iE: BUSINESS PLAN FORM 3A INSTRUCTIONS ,,,~'.,:..~:;..;.~:~: ?.~..,';.~.i!,.~?.~o .avoid:further ..~o.tton;., th.ls..form must be.'returned by: . ' ....-.- ..... '. .. ':.:.. ~:......, ._2. ~YPE/PRINT YOUR ~SWERS IN ENGLISH. ... .... ~ ' ' 3. Answer the questions' below for THE FACILITY UNIT LISTED BELOW '" '" "4~ 'Be a~'BRIEF'and cONcISE'~s possible.' .... " .... ' " / SECTION 1: ~ITIGATION, PRE~ION, ABATEME~ PROCED~ES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY ...