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*USINESS NAME 'JO' i,i'sl CH c NU BER 215-ooo-ooo86o
LOCATION 1109 E 19TH ST :~5 HIGH HAZARD RATING 4
1 . OlzEB~~IEW
LAST CHANGE 06/07/88 BY ESTER
JURIS CODE 215-002 JURIS BAKERSFIELD STATION 02
MAP PAGE 103 GRID 29D FACILITY UNITS 1 tIAZARD RATING 4
RESPONSE SU~IMARY
2A SEC 4) ONE MAN OPERATION (NO EMPLOYEES WORK AT THIS ADDRESS ON A REGULAR
BASIS).
EMERGENCY CONTACTS 2A SEC 2)
ELMER P JOHNSON - 325-0113 OR 325-0204
UTILITY SHUTOFFS 2A SEC 3)
A) GAS - AT HOUSE IN FRONT B) ELECTRICAL - AT HOUSE IN FRONT
C) WATER - AT HOUSE IN FRONT D) SPECIAL - NONE
E) LOCK BOX - NO
4 . LOCAL EMERGENCY MEDICAL ASSISTANCE
LAST CHANGE 06/07/88 BY ESTER
· 2A SEC 5) MEMORIAL HOSPITAL
420 34TH ST
327-1792
PAGE 1 06/07/88 09:55
MATERIAL SAFETY DATA SYSTE~tS, INC. {805) 64.8-6800
BUSINESS NAME JOHNSON CHEMICALS ID NUMBER 215-000-000860
LOCATION 1109 E 19TH ST HIGH HAZARD RATING 4
FACILITY UNIT 01
A . OVIElqlALL H.iZ.iRDOUS ~IATElq~IALS I N~TENTORI~
LAST CHANGE 06/07/88 BY ESTER
ID TYPE NAME MAX AMT UNIT HAZARD
LOCATION. CONTAINMENT USE
1 PURE CHLORINE 34362 FT3 EXTREME
W SIDE OF YARD PORTABLE PRESS. CYL. PESTICIDE
ID PERCENT COMPONENTS HAZARD LISTS
1028 00 100 0 CHLORINE
· · EXTREME EPA
2 MIXTURE CAUSTIC SOLUTION 600 GAL HIGH
CENTER OF YARD ABOVE GROUND TANKS NEUTRALIZER
ID PERCENT COMPONENTS HAZARD LISTS
1560.00 30.0 SODIUM HYDROXIDE, SOLUTION HIGH
FIRE PROTECTION / $~AT E !~ SUPPLIES
LAST CHANGE 06/07/88 BY ESTER
3A sEc 4) ONE DRY FIRE EXTINGUISHER AND GARDEN HOSE(S) FOR FIRE PROTECTION.
3A SEC 5) FIRE HYDRANT AT E TRUXTUN AVE AT ROBINSON ST (NORTH SIDE OF STREET).
PAGE 2 06/07/88 09:55
MATERIAL SAFETY DATA SYSTEMS, INC, (805) 648-6800
BUSINESS NAME JOHNS~ CHEMICALS ~D NUMBER 215-000-000860
LOCATION 1109 E 19TH ST HIGH HAZARD RATING 4
FACILITY UNIT 01
D . E ivII:)LOYEE NOTIFICATION / E$~ACUA?ION
LAST CHANGE 06/07/88 BY ESTER
3A SEC 2t 911 & VERBAL NOTIFICATION.
E . MITIGATION / PREVENTION / ABATEMENT
LAST CHANGE 06/07/88 BY ESTER
3A SEC 1) CHLORINE IN VENDOR'S APPROVED CONTAINER AND VALVES, FITTINGS, ETC.
ARE INDUSTRY STANDARD AND OUR TANKS ARE ALL TESTED AND CERTIFIED PER
INDUSTRY STANDARDS. APPROXIMATELY 30% CAUSTIC SOLUTION IS IN A
CLOSED CIRCULATION SYSTEM MADE OF SCHED 80 PVC WHICH HAS TWO LARGE
SUMPS TO PREVENT ACCIDENTAL SPILLS. THIS SYSTEM IS ONLY OPERATED
WHILE A QUALIFIED OPERATOR IS ACTUALLY USING IT. POWER IS
DISCONNECTED (UNPLUGGED) WHEN NOT IN USE.
PAGE 3 06/07/88 09:55
MATERIAL SAFETY DATA SYSTEMS, INC. {805) 648-6800
.. SITE/FACILITY DIAGRIL~I' ·
.DATE: ./ / FACILITY N~ME: ' UNIT =:' OF
(CHECK ONE) ' SITE DIAGR.%M FACILfTY DfAGR.%M
(.Inspector's Comments): -OFFICIAL USE'ONLY-
- 8A -.
·
'1
SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
.A. Does this Facility Unit contain Hazardous Materials? ...... 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 invento'ry
'form marked: NON-TRADE SECRETS ONLY (white form ~4A-1)
tf Yes, complete a hazardous materials inventory form marked:
TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade
secret form. List ·only the trade secrets on form 4A-2
SECTION 4:'PRIVATE FIRE PROTECTION
SECTION 5: LOCATION OF WATER SUPPLY F~R' USE BY EMERGENCY RESPO~ERS
.'
E LOCK BOX: YES / No rF YES, LOCATIOS:
FLOOR PLANS? YES KEYS? YES
- 3B -
· BAKERSFIELD CiTY·FiRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
ID#
BUSINESS NAME:
BUS I NE-SS PLAN
SINGLE FACILITY UNI.T
FORM 3A
INSTRUCTIONS
1. To..av. oid further action, this form must be ...returned by:
2. TYPE/'PRtNT YOUR'ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED EEl. OW
· .4. Be as BRIEF and CONCISE as possible.
FACILITY UNIT# FACILITY UNIT NB.ME: ,.
SECTION 1: MITIGATION, PRE~NTION, ABATEMENT PROCEDURES
SECTION 2: NOTIFICATION AN~ EVACUATION PROCEDURES AT THIS UNIT ONLY
SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
S~CTION 5: LOCAL E~ERGENCY ~EDICAL ASSIST~CE FOR YOUR BUSINESS AS A ~HOLE ·
SECTION 6: EMPLOYEE T~INING.
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM'WHICH PROVIDES EMPLOYEES WITH INITIAL AND.
REFRESHER' TRAINING.IN THE FO'LLOWIN~-'AREASi..
CIRCLE YES.OR NO .. .~ '~' INITIAL'.. REFRESHER".
A.'METHODS"FOR sAFE'HANDLING OF HAZARDOUS ' ':' '
~TERIALS':...- .................................... ~ NO (~ NO'
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: .... : ..................... YES ~ YES (~
c.'PROPER use OF SAFETY EQUIPMENT: .................. No NO
D EMERGENCY EVACUATION PROCEDURES: .................YES (~ YES ~
E DO YOU ~INTAIN EMPLOYEE TRAINING RECORDS: ....... YES ~ YES N(~
SECTION 7: ~ZARDOUS ~TERI~
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS ~4TERIAL IN. QUANTITIES LESS THAN,500 POUNDS. 0.~
SOLID, 55 GALLONS-OF A LIQUIb?tOR 200 CUBIC FEET OF A COMPRESSED GAS:.' .....
I, ~-/~4~ ~, .J~~O~ , certify that the above information is accurate.
I understand-that this information ~ill be used to fulfil't my firm's obligations under
the new California Health and Safety code on Hazardous Materials" (Div. 20 Chapter 6.98
Sec. 2§§00 Et Al.) and that inaccurate information constitutes perjury.
SIGNATURE TITLE DATE ' '
..
Oq.j BAKERSFIELD CITY FIRE DEPARTMENT
"~? 2130 "G" STREET RECEIVEr]
(8os) 326-39?9 JUL 2 ~ 1987
oTbS? ~ ~ a,s'd ............
OFFICIAL USE ONLY
BUSINESS NAME
HAZARDOUS MATERIALS ....
BUS:I. NESS- PLAN AS A WHOLE
FOR~ 2A
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
A. BUSINESS NAME: dob kl SON C~eiq// , C~
SECTION 2: E~RGENCY NOTIFICATIONS
In case of an emergency involving the release ov threatened release of a
hazardous material, call 911 and 1-800-852-7550 o~ 1-916-427-4341. Thls will uotify
you~ local fi~e department and the State Office of Emergency Services as ~equlred by
law.
E~PL0 NOTIFY IN CASE 0F E~ERGENCY:
SA~E, ASD TITLE~/ - -- DURING BUS. HRS. AFTER BUS. HRS.
SECTION 8: LOCATION. 0F ~ILI~ S~-0FFS' FOR BUSI~SS AS A ~0LE
E. LOC~ BOX: YES ~XO IF YES, LOCATION: '
~F YSS, DO~S IT CO~TA~ S~T~ PLA~S?
FLOOR PLANS? YES / ~0 KEYS? YES / ~0
BAKERSFIELD CITY FIRE DEPARTMENT
I,D. # FORM 4A-1 Page" of
NON--TRADE SEC~
HAZARDOUS' MATERI ALS
'~/ ~' f~ ,.?
.-'BUSINESS NAME: .. w ~°~7 ~(C~- O~ER NA~E: ~/~r ~ ~'~ FACILITY ~IT. e:
PHONE ~: $~5---Of[~ PHONE ~: ~K~--OLO~ [OFFICIAL USE CFIRS CODE
ONLY
1 · 2 3 4 5 6 7 8 9 10
TYPE MAX 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 O ~;
~_~~~ xr~ °~~o ~.~;~, ~~, 'too c~/~,'~ ~ F~ -
I
,, ~ ~ ~ ~ / ~/
FURE
,~ DATE: 7 -f
EMERGENCY CONTACT: TITLE: PHONIC# BUS HOURS: ~Z~--OII~
AFTER LBUS HRS: ~Z ~-OZo ~
EMERGENCY CONTACT: TITLE: PHONE # BUS HOURS:
PRINCIPAL BUSINESS ACTIVITY: AFTER BUS HRS:~
- 4A-i -
SITE/FACILITY D I AG RD~Pl
FORM $'
DATE: / / FACILITY N~ME: ' UNIT ~: OF
(CHECR ONE) SITE DIAGRAM FACILITY DIAGRAM
. . - ~ . ,,,% (~ ~
· ~.Z__-~' ]~,'.~...~ f'~ 1~<,,
',',., , ./~~"~" ,
. , .
· ' ~'i~- '~_~ ",.~"~ .. ' '
. ~.... " ~ -...:..... ',~',3 ~_/
· ~~..x.~ · ' '- "
(Inspector's Comments): -OFFICIAL USE ONLY-
S[T£ DfAGRA~ (Re~ it~
1. Address: identify Lhe '9. Lock(key) Box ~
principle buildings '
by the Street numbers. 10. MSDS Storage Box
2. Street(s), Alleys, 11, Railroad Tracks
Driveways, and Parking
Areas adjacent to the 12. Fence or Barrier
property, include the a. Wire
street names.
~ b. ~a~onry
3. Storm Drains, Culverts.
Yard Drains c. Mood
4. Drainage Canals~ Ditches, d. Gates.
Creeks,
i3. Powerlines
a. Frame construction 14. Guard Station
b. Masonry construction 15. S~orage Tanks:
Identify ~he
c. Metal construction capacity tn ~1.
a. Above ground
~ d. Access Door
6. Utility Controi8 ~dO~ ~'_~ b. Underground , OF
m. Oas ~T P-rO~'~ ]6. DJking or 8ers /v
b. Electricity ~A --~ 17. Evacuation Route
. gvacuatlon
c Mater 18.
' Identify the
7. Fire Suppression Systems: '~ lo~atloa where ~{~
b. Fire Sprinkler '~0 d' / If. Outmide Hazardous
Co~ectiona ~ Malt~ Storage ~
Connections / Material Storage.
d. ~ater Control Valves ~~ ~ 21. Outside ~azardous
fo~ pro~ec~lon systeas ?atertal
22, Ty~o~ ~azardoue
Material/Waste
Stored
8. Fire Department Access o~ Used (See
TYPE OF ~'~US ~TERIA~
F - Fl~able [ - ~ploeiv~ L - Liquid R - Radiologtcal
C - Corrosive 0 -.Oxidizer G -- Gas '~ P - Poison
g - ~ate~ Reactlve T - Toxic 9 - Solid H - Cryogenic
D - Waste B - Etiological
Example: Fishable L/quid - ~L
FAC[LITY D[AG~ (Required l~ess~:a~'l~on to ~he
I. Risers for Sprinklers /.// ~ ' ~ 8. Fire Escapes
9. AI~ Coadltlodln~
3. S~alrways: Indicate the ~ / 10. Mind.s
levels served from ~ .... / ..
hlghes~ to lowest. ~ ll. Inside Hazardous Waste
Storage
4. E~cala~or: l~dlca~e' the
levels served rroe 12. Inside Razardous
hlShes~ ~o loees~. ~a~erlals S~oraee
~. E1evetor 13. Inalde Hazardous
~erlals ~se/aandlln~
6. i~tlc Access
7. Skylights