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HomeMy WebLinkAboutBUSINESS PLAN (2) SITE DIAGRAM FACILITY DIAGRAM I'-"! ~u$ ;.-.ess Name: !' Area MaD = o~ [ --~ Ncr-.h Name of Area: ADJUSTMENTS TO ACCOUNTS RECEIVABLE DATE ~ ~ S ADJUSTMEY ( ) .SERVICE PRO2~RTY OWNER = ...... CORY~---C.-'--D I ADJ. TO SELLING AMOUNT EZLL!NC- AMOUNTJ ~iL: ~1(C, - (-) DATE t 1 APPROVED -CITY of' BAKERSFIELD HAZARDOUS MATERTALS 'r NVENTORY Farm and ADticulture [] Standard Business [] NON--TRADE SECRETS - ~ ~--/ - '' : REFER TO~~~NS-~R~ROPER CODES -- I 2 ) 4 5 6 1 8 9 10 11 12 13 Il CodeTrans coae[Yge A,tHax Av~rageRet AnnuelEsL Heasureun~ts onl ~e ~ont COntPress ContTemp ColeUS Locqtion.XheEe ~ by tlaeeSseeOf Uixture/CoeDonents ~ype Storea In PaClllty ~t ]nstru:L~ons Physical and Health Hazard C.A,S. Humber Component II Hame t C.A,S Number (Check all tha[ apply) ' ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ lmmediaceCOmponen[ 12 Name IC.A,S. Number Health of Pressure Health Component,3 Name SC.A.S. Number Physical and Health Hazard C.A,S. Humber Component II Name I C.A,S. Number (Check 81/ that ComponenL 12 Name t C.A,S. Number ~ Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release ~ Immediate Uea ILh of Pressure Health Component 13 Name I C.A.S. Humber (Check a11 that apply) He~l~ of Fressure Healt~ Physical 8nd Health ~alard C,A.S. Humber Component II Name I C.A,S, Number (Check 4/I that applH Component 12 Name I C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release ~ Immediate Health of Pressure Health Co~ponent 13 Name I C.A.S. Number EHERGEHCY CONTACTS fll ~me rT[le ~4 Hr Phone R~e Tl[le cer~t~ under ~ena~x g~a~ ~n~t ~navepe[sonal~L examln~eqo]m rami~ar.~it~ the ~nlo(maHpn ]u~aiLt~d in this ~nd all at,ached.dOcuments, and [pac cased on.my ]nqutry 9t.~nose Ifl~lVl~U]lS respons~o/e tot obtatn~n9 the tn~or~aHon. I believe that. the su~]~teo ~nforaaLIoo IS true, accurate, and complete. Hazardous Materials Divisio~''~ HAZARDOUS MATERIALS MANAGEMENT PLAN ' Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: B, EMPLOYEE NOTIFICATION AND EVACUATION: C, PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN. SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: B, RELEASE CONTAINMENT AND/OR MINIMIZATION: C, CLEAN-UP PROCEDURES' SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): SPECIAL'~ SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILI~: A. PRIVATE FIRE PROTECTION: B, WATER AVAILABILITY (FIRE HYDRANT): Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street RECEIVED Bakersfield, CA. 93301 JUN ! ]990 ,~ns'd ............ HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return tills form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME: ./~(~¢)~E LOCATION'. ~/2_ /,~J ~zrz~ , /~~, ff__-~. ~0 t.. MAILING ADDRESS' _<'~/?ff'/~,~'--~ ./~' ~//~"~-'-- CITY: STATE:_ ZIP: PHONE: ('~'~.,/-~2'?-"2~'7/' DUN & BRADSTREET NUMBER: SIC CODE: C~ PRIMARY ACTIVITY: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE FD15~ Bakersfield Fire Dept. ~. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS: MATERIAL SAFETY DATA SHEETS ON FILE' BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CO/DE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: l, ~-~_~ofQ~' ~--~ (~ CERTIFY THAT THE ABOVE INFOR* MATION IS ACCUitl)kTE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6,95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE FD1590 Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA,~ ~. ~,/~~ Y/0-~- LOCATION: qt L l~ ~ MAILING ADDRESS: ~'M~-- CITY: F*~~e(~ STATE: :~ ZIP: ~ ~ I PHONE: ~ DUN · BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: OWNER' ~-'~' L I i'':~ MA,',N~ A~O~"::SS: ~ ~x ~~ ~r ~,~~{~ ~ ~¢~.~ SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24. HR. PHONE FDI~ Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE 'DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 2. FO1590