HomeMy WebLinkAboutBUSINESS PLAN (2)SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
A. Does this'Facility Unit contain Hazardous Materials? ....... Y~ NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES ~
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form ~4A-1)
If Yes, complete a hazardous materials inventory form marked:
TRADE SECRETS ONLY (yellow form #4A-2) ill addition to the non-trade
secret form. List only the trade secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
SECTION $: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS
SECTION B: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
A. NAT. 6AS.iPROPAN~
B. ELECTRICAL: ~
'C. WATER: /~Ld~y
D. SPECIAL: ~/~
E LOC : ox: YES / YES, LOCATIOn: / OtO
IF YES, SITE PLANS? YES / NO MSDSs? YES / NO
FLOOR PLANS? YES / NO KEYS? · YES / NO
- 3B -
BAKERSFIELD CITY FIRE DEPARTMENT
9.130 "G" STREET
BAKERSFIELD, CA 93801
OFFICIAL USE ONLY
ID#
BUSINESS NAE~E:
BUS I NESS PLAN
SINGLE F.ACILITY UNIT
FORM SA
INSTRUCTIONS 1. To avoid further action, this form must be retucned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH,
3. Ans:~er the questions belo~ for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as .possible.
SECTION 1: MITIGATION~ PR,EVENTION~ ABATEMENT PROCEDI~ES
SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS b~IT ONLY
BAKERSFIELD CITY FIRE DEPARTMENT
HAZARDOUS !tATER IALS
SITE/FACILITY DIAGRAMS
FOP, M $
INSTRUCTIONS
GENERAL INSTRUCTIONS
Use these instructions and the attached form to complete a SITE DIAGRAM'of the property
and immediate surrounding area, and a FACILITY DIAGRAM of each facility unit or
building.
If the entire business can be shown in adequate detail on the Site Plan, individual
Facility Plans may not be necessary. The .Inspector can assist you in making this
determination if there is a question.
Complete the information at the top of the diagram form. The box at the bottom of the
form should be left blank. ·
SITE DIAGRA~
The SITE DIAGR~ should include the business and at least 300 feet from the property
line. Identify the items listed on the SITE DIAGRAM using the symbols provided on the
back. Include all items that apply. See the attached example.
FACILITY DIAGRAM
Develop a FACILITY DIAGR~ that will show the building interior and the immediate
exterior area. Complete a separate FACILITY DIAGRAM for each floor of a multi-story
building. Identify on FACILITY DIAGR~ items listed under both "SITE DIAGRAM" and
"FACILITY DIAGRAM" on the back of this page. Use the symbols provided. Include all
items that apply. See'the attached example.
i. Address: Identi~ the 9. Lock Box
principle buildings
by the Street numbers. 10. MSDS Storage Box
': ~, - -~ 2. Street(s), Aiteys. t,t. Railroad Tracks
Driveways, and Parking
Areas adjacent to the i2, Fence or Barrier
property, Include the a. Wire
street names.
b. ~asonry
3. Storm Drains. Culverts.
Yard Drains c. Mood
4. Drainage Canals. Ditches, d. Gates
Creeks,
13. Poweriines
5. Buildings
a. Frame construction 14. Guard Station
b. Masonry construction 15. Storage Tanks:
Identify the
c. Metal construction capacity tn gal,
a. Above ground
d. Access Door
b. Underground
6. Utility Controls
· a. Gan 16. Diking or Berm
b. Electricity i?. Evacuation Route
c. Water 18. Evacuation Area:
Identify the
?. Fire Suppression Systems: location where
a. Fire Hydrants employees
b. Fire Sprinkler 19, Outside Hazardous
Connections Masts Storage
c, Fire Standpipe 20. Outside Hazardous
Connections Material Storage
d. Water Control Valves 21. Outside Hazardous
for protection systems Material
Uae/Handling
e, Fire Pu~p 22. Type of Hazardous
Material/Masts
Stored
8. Fire Department Access or Used (See
Selow)
TyPE OF HAZARDOUS KATER[A~
F - Fl~bie E - Explosive L - Liquid R - Radlological
C - Corrosive 0 · Oxidizer O - Gas P - Poison
Mater Reactive T - Toxic g - Solid B - Cryogenic
D -Maate B - Etiological
Example: FlaaJable Liquid · FL
FACILITY DIAGRAM (Required lteml in addlt'lon 'to the above)
l, Risers for Sprinklers 8. Fire Escapes
2. Partitlonl 9, Air Conditioning Unitl
3. Stairways: Indicate the 10. Mlndowa
levels served from
h/ghent to lo~eet, ii. Inside Hazardous Masts
Storage
4. Escalator: Indicate the
leveJa served from ]~. Inside Hazardous
highest to lo.est. #atertais Sto~age
5. Elevator 13. Inside Hazardous
Materials Use/Handling
6. Attic Access
14. Se~er Drain Inlets
?. Skylights
ECEIVED
NORTH SCALE: ' BUSINESS NAME: FLOOR: OF
DATE:./ / FACILITY N~E: UNIT .~'. OF
(CHECK ONE) SITE DIAGRAm! FACILITY DIAGR.~M
(Inspector's Comments): -OFFICIAL USE ONLY-
FOR IMP~TANT~i~ MESSAGEAa I~ '-
DATE~- ~5"~ t TIME P.'I~I.'
M
OF
PHONE NO.
TELEPHONED PLEASE CALL
CALLED TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH
MESSAGE
ASSOCIATED L1-A2334 p.,.~o,, u.~.
MINGO' BODY WORKS
421 East 18th Street- Bakersfield, California
Phone 324- 5717
Date ,~/'~'"~ ~ .,,
~-...-~'.-~'-~-~ ~/~,~.~L/~ k~
Address J/A ~.b~-~.~ I~f//~/,~L Phone
I.D. # FORM 4A-1 Page '~ oT ~
NON--TRADE SECRETS 2
HAZARDOUS NATERI ALS INVENTORY ~,
1 2 3 4 5 6 7 8 9 10
TYPE ~AX ANNUAL CONT USE LOCATION IN THIS ~ By HAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT , WT. CHEMIqAL OR COMMON NAME CODE OUIDE ]
NA~E: T~LE: ~~ SIONATURE: DATE:
PRINCIPAL BUSINESS ACTIVITY: ft~,Y ~~ AFTER BUS HRS: ~,~Z.~
' ,~.p t,//~A~ERSFIELO CZ~ FIRE OE~'A,~NT R E ~ E I V E ~
'/~ ~ 2~30 "6" S~EET
B~ERSF~ELD, CA 9330~ 0C~ 2 31987
(805) 326-3979 ~S'd.' ...........
OFFICIAL USE ONLY
HAZARDOUS lVtATERI ALS ~ ~ 3
INSTRUCTIONS:
1. To avoid further action, return 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
C I Ty:. ~>)~/~,,~--S ~~) ZIP: gJ~~ BUS.PHONE:
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 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:
A . . · ! ?7.¢ ?P * q
SECTIO~ 3: LOCATION OF lYrI~I~ SHU~-OF~S FOR 8USII~ESS AS A ~IOLE
B. ELECTRICAL:
c. WAWEn: ,~-Z.Z~'-'V' ' ' ''--' - -"
D. SPECIAL: '
E. LOCK BOX: YES / ~Tm'~IF YES, LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES ,.I NO
FLOOR PLANS? YES / NO KEYS? YES / NO
2A -
~ ~) Bakersfield Fire I~Pt.
Hazardous Materials Inspection
Date Completed ,
Business Name: ~ I/'4 6 0 S
Location: ~.1 E, / ~
Plan ID # 215-000 o~,~q (Top right comer Business Plan)
Station No. 2~ S~fi ~ Inspector ~0 ~N~
Adequate
Verification of Invento~ Materials
Verification of Quantities
Verification of Location
¢
Co~:
Vedfication of MSDS Availabfli~
Nmber of Employees
Vedficafion of Haz Mat Trai~ng
Coml~ents:
Verification of Abatement Supplies & Procedures
Comments:
Emergency Procedures Posted [~ [--1
Containers Properly Labeled [~ [~
Cominents:
Verification of Facility Diagram
Special Hazards Associated with this Facility:
Violations: O oa ~ a ~ S w,~Te ~ .'7~'^T
FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office