HomeMy WebLinkAboutBUSINESS PLAN (2) CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITYNAME(_~6~-,~L(-~ (~)/~5 ..~--A.\~ 1NSPECTIONDATE
ADDRESS [9 { q I g 't~ ,5'T- PHONE NO.
FACILITY CONTACT~/~c-~'~z- l~6dSa N BUSINESS IDNO. 15-210-
~SPECTION TIME ! ~ ~ {x~ NUMBER OF EMPLOYEES -/
Section 1: Business Plan and Inventory Program
[~outine [~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection
OPERATION C ¥ COMMENTS
Appropriate permit on hand
Business plan contact information accurate
Visible address
Correct occupancy
Verification of inventory materials
Verification of quantities
Verification of location
Proper segregation of material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled
Housekeeping
Fire Protection
Site Diagram Adequate & On Hand
C=Compliance V=Violation ~ %% 7t--'c:Z_. Jf..._..__~ ~ /¥ ~ C) t 7
Explain:
White - Env. Svcs. Yellow - Station Copy Pink - usiness Copy Ins
GORILLA PAINT BALL SiteID: 015-021-002288
Manager : BusPhone: (661) 323-1066
Location: 614 18TH ST Map : 103 CommHaz :
City : BAKERSFIELD Grid: 30D FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 01 SIC Code:
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
GENE HANSON / /
Business Phone: (661) 323-1066x BusineSs Phone: ( ) - x
24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire Press ImmHlth
Contact : GENE HANSON Phone: (661) 323-1066x
MailAddr: 614 18TH ST State: CA
City : BAKERSFIELD Zip : 93301
Owner Phone: (661) 323-1066x
Address : 614 18TH ST State: CA
.City : BAKERSFIELD Zip : 93301
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
Emergency Directives:
---- Hazmat Inventory One Unified List
--Alphabetical Order Ail Materials at Site
Hazmat Common Name... SpooHazlEPA HazardsI Frm DailyMax IUnitlMCP
CARBON DIOXIDE F P IH G 1275.,00'FT~3 /Min
I, '~¢rr'v 5.~'... Do hereby csr~ify tha~ ! have
re¥-ie~ed the ~ached h~ardous ma~sri~s
merit plan for
~ 0~/06/2003
GORILLA PAINT BALL SiteID: 015-021-002288
~ Inventory Item 0001 Facility Unit: Fixed Containers at Site
CARBON DIOXIDE Days On.Site
365
Location within this Facility Unit Map: Grid:
INSIDE REPAIR AREA AT REAR OF SHOP CAS#
124-38-9
Gas /Pure A~ove Ambient Cryogenic INSUL,TAlgK / CRYOGENIC
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum I Daily Average
425,00 FT3 1275,00 FT3 1275,00 FT3
HAZARDOUS COMPONENTS
%Wt', R~NoRS~ CAS#
100,00 Carbon Dioxide 124389
HAZARD ASSESSMENTS
TSecret ~SlBioHaz Radioactive/Amount EPA Hazards NFPA USDOT# I MCP
No N No No/ Curies F P IH / / / Min
2 '" ' 01/06/2003
GORILLA PAINT BALL SiteID: 015-021-002288
Fast Format
F Notif./Evacuation/Medical Overall Site
Agency Notification
-- Employee Notif./Evacuation
Public Notif./Evacuation
Emergency Medical Plan
-3- 01/06/2003
GORILLA PAINT BALL SiteID: 015-021-002288
Fast Format
F Mitigation/Prevent/Abatemt Overall Site
Release Prevention
~ Release Containment
-- Clean Up
Other Resource Activation
-4- 01/06/2003
GORILLA PAINT BALL SiteID: 015-021-002288
Fast Format
~ Site Emergency Factors Overall Site
Special Hazards
Utility Shut-Offs
Fire Protec./Avail. Water
Building Occupancy Level
-5- , 01/06/2003
GORILLA PAINT BALL SiteID: 015-021-002288
Fast Format
~ Training Overall Site
Employee Training
-- Page 2
--Held for Future Use
Held for Future Use
6 01/06/2003
1715 Chester Ave., 3
FACILITY NAME ~t ~ ~,~ ~ ~SPECTION DATE
~SPECTION TIME NUMBER OF EMPLOYEES
Section 1: Business Plan and Invento~ Program
~outine ~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint
OPERATION C V COMMENTS
Appropriate pc~it on hand
Business plan contact info~ation accurate
Visible address
Co~ect occupancy
Verification of invento~ materials'
Verification of location
Proper segregation of material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled
Housekeeping
Site Diagram Adequate & On Hand
C=Compliance V=Violation
Any hazardous waste on site?: ~ Yes ~o
Explain:
Questions regmding ~is inspection?
White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: ~?
cITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM I.NSPECTION CHECKLIST
1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301
FACILIIY GONTACT_ ~ ~r~ BUSINESS ID NO. 15-210- ~
~SPECTION TIME NUMBER OF EMPLOYEES
Section 1: Business Plan and Invento Program ./'~ ~0 . ..D .::~
~Routine ~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint
OPERATION C V COMMENTS
Appropriate permit on hand ~ ~'~-~'~'T ~
Business plan contact information accurate
Visible address
Correct occupancy
Verification of inventory mate. r!als .... ~ ~.
Verification of quantities '7~ ~ -~O :ff~(6 ,'-.,<'
Verificationoflocation . ttO~ ~O~ O.~'~t~,C~
Proper segregation of material
Verification of MSDS availability
Verification of Haz Mat training
" Verification of abatement supplies and procedure's
Emergency procedures adequate
Containers properly labeled
Housekeeping
S. ite, Diagram Adequate & On Hand
C=Compliance V=Violation
Any hazardous waste on site?: I~] Yes ~o
White- Env. S~,cs. Yellow- Station Copy Pink- Business Copy inspector:
CITY OF BAKERSFIELJ~
;E OF ENVIRONMENTAL 51liVICES
1715 Chester Ave., CA 93301 (661) 326-3979
'~'~'~~"'~ ~" HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
(one form per matedal per building or area)
,~EW [] A~D [] DELETE [] REVISE 200 Page __ of __
CHEMI~L ~ME
207
COM~N ~ME EHS' ~ Y~ ~ NO 2~
FIRE CODE H~ C~SSES (~plete if r~umt~ by t~l fire ~ie~ ..... 210
PHYSICALSTA~ ~ s SOLID ~I,LIQUID ~S 214 ~ ~RGESTCONTAINER 215
FED H~RD ~TE~RIES ~ 1 FIRE ~ 2 REACTIVE ~ 3 PRESSURE EELEASE ~ 4 ACUTE H~LTH ~ 5 CHRONIC H~LTH 216
(~ all that apply)
ANNU~WASTE 217 M~IMUM ~ ~ 218 ~ AVENGE 219 STA~ WASTE ~DE
UNITS' ~ ga GAL ~ CU FT ~ lb LBS ~ tn TONS 221 DAYS ON SITE
* If EHS, am~nt must be in lbs.
STOOGE CO~AINER ~ a ABOVEGROUND TANK ~ e P~STI~NONM~ALLIC DRUM ~ i VIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR
(Check alt ~at appty)
~ b UNDERGROUND TANK ~ f CAN ~ j BAG ~ n P~STIC BO~LE ~ r O~ER
~ c TANK INSIOE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BiN
~ d STEEL DRUM ~ h SILO ~yLINDER ~ p T~K WA~N
STOOGE PRESSURE ~ a AMBIENT ~a ABOVE AMBIENT ~ ba BELOW AMBIENT ~4
STOOGE TEMPE~TURE
~a AMBIENT ~ aa ABOVE AMBIENT ' ~ b3 BELOW AMBmENT ~ c CRYOGENIC 225
227 i
I 226 ~ ~Y~ ~No 228
3 ~ 2~ 235 [ ~y~No 236 237
239 i ~ ~ 241
238 ~ ~Y~ ~No 240
242 ~ Y~ ~ No 2~ 245
' ~'7~ ' ~
PRINT ~ME & TITLE OF AU~ORIZED COMPANY REP~ESENTATI~- SIGNATURE DATE 2~
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