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Home My WebLink AboutBUSINESS PLAN 11/1/1989 iTE DIAGRAM FACILITY DIAGRAM ~. Example ITE DIA'~RAM ~ FACi~I~Ty DIAGRAM ~,=:~e~ ~ame: OIL S~LL ~ON,ST'R A=ea Ma9 = o~ __/ L North Name of Ar~a: ' -- .:'~ SITE/FACILITY DI,,AGR;d~ FLOOR: 0F UNIT ~: 0F Inspector's. Comments): -OFFICIAL USE ONLY- S[T£ O[AGR~ (Requl items) 1. Address: Identify the 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. Hasonry 3. Storm Drains. Culverts. Yard Drains c. Wood. 4. Drainage Canals, Ditches, d. Gates Creeks, 13. Powerlines S. Buildings a. Frame construction 14. 0uard Station b. Masonry construction IS. Storage Tanks: Identify the c. Metal construction capacity in gal. a. Above ground d. Access Door h. Underground 6. UtillW Controls a. Oas 16. Diking or Berm b. Electricity 17. Evacuation Route c. Mater 18. Evacuation Area: Identify the 7. Fire Suppression Systems: location where a. Fire Hydrants employees will meet. 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 Use/Handling e. Fire PUnp il. Type of Hazardous Material/Meats Stored 8. Fire DepartRent Access or D.ed (See .. B~Iow) TyPE OF HAZARDOUS MATERIAL F - Flammable K - Explosive L - Liquid R - Radtologtcal C - Corrosive 0 · Oxidizer O - Gas P - Poison M - Mater Reactive T - Toxic S - Solid H - Cryogenic O - Waste B · E~lologlcal ' ~xampls: Fl.--able Liquid - FL FACILITY DIAORAW (Required items la addition to the above) I. Risers [or Sprinklers S. Fire Escapes I, Partitions ~, Air Conditioning Unite 3. Stairways: Indicate the 10. Wlfldo~ levels served from highest ~o lo~st. 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous high.at to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Nat.rials Use/Hudllng 6. Attic Access 14. Se~r Drain Inlets 7. Skylights " __ BM _44580 Accoun! Number ' " ACCOUNTS RECEIVABLE ADJUSTMENT ..... 2' 14-02 - :' New Account ...... Service Change. From: .'~ ....... <. ,. . , .. ~':J. re Departmenl;' - Raz Mat ·. ,Other Adl."-:'~.. I" ~'".' i '._' DepartmentJDivision .': ' ,... -'.: ' · ..: .-, .. :_...~:. ~--....,.-,:/;.--: ~;',;::~:~'.: :; '.-,~ :~'?: ..;."., ..~..=', ..'i.':.;,i:~.' :;...~ ": ' .. - .- .: :'...:. ~,_. ;..: ..:.:. -, .:' ::i:i' .: '..-i.-.' . . :..:.,.-~..-; ~ ,'.'..'.. !:.: :':~., ";'. i"::.~-'i,._:d.i'.~t:~' i. :": :""~:-i~:~.~:~.L'.i..: :i',i_'.:~!~: i;?:~:~?.:"i:.:-~ ." . · ' '. -'..-:~i" ' ,~' ,'---'-.'-" ';": '""~ ..... :~-:..~=-~:A,~?.~:'. ~. '~- -:. . . ',;::~"':~:~.~:?'--'~:;;".--'-.`!~:.:.:.:~d~`~?~:~.~./:<~:;:~:;~:??:~.~::``~?..``~..`~.~?~`~:%Z::~.:~ '.' " : ; .... C!arE'.Pluabzag '..:..-~'"?."'~ ::"-"~ "' .'. , Billing N~e "'" · : '..;.":~: - ~.~,~::~ ..... '.-; "-: ., .' ~-.: --- ' ' Billing Address. --' · :-.~.:>:...~-,.. ' . ' ' ;-'.' · '~'-':'f-.: ' ".':.'..~.~.;~ .;..:..~/;.:..' .,-. - .,. ~'.- :,' '...-.. ,;~_. -' -' , '... '.. .S~ -. .... -.- . ..' .."-: ~;;':;..c77,.'.';.---: '. "~- ;-f.J,:. ~. ;:,'F .'..' :.::; ' '.. '. ~. :~ ,','?.,'~"~..- --:-'-~. ::' "~'.-.'.f. -- .:~'::'~'- ':-':' , . Site Address ' .. I .' P~ce.I ~ (If Applicsble) . ' . L~ndlord Nsme& Address if Applic~le ADJUSTMENT .... . .-... ~Lsst - · COrrect IAdjustment . Effective D~te · ! .. : .~Billed ~ "' Billing ' · To Billing ,Of Change .~ ' ·. i $-9~:oo -'o - " ~,2-92 i. I. I Approved By: Remarks: Realoyed ust 6/91. Re year. - · . CLARK PLUMBING 315 - 30th STREET ' " BAKERSFIELD, CALIFORNIA PLUMBING &-MEGHANi~AL CONTRACTOR .- ' '.~ 93301 "THE BEST PLUMBER IN TOWN BY FAR" .', -. - PHONE 327-8668 -'~ ] LICENSE #371716 OCT 1.1 1991 Bakersfield Fire P HAZARDOUS MATERIALS DIVISION " Date Comp eted(:~--- { l=. ~'~::~) ~ ' ~. Business Identification No, 215-000 { 0 2'7(Top of Business Plan) .. Adequate Inade( Verification of Inventory Materials I~ ~] " Verification of Quantities ~] Verification of Location Proper Segregation of Material Comments: Verification of MSDS Availablity C] 'Number of Employees -~".C' ' Verification of Haz Mat Training C] omm'entsl / Verification of Abatement Supplies & Procedures I~/ / Comments: " Emergency Procedures Posted - · Containers Properly Labeled Comments: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: All ltems O.K. ~ ' Correction Needed Business Owner/Manager .' FD 1652 (Rev. 1-90) White-Haz Mat Div.~ Yellow-Station Copy Pink-Business Copy A,s' ............. NOTI FI CATI ON OF APPLI CATI ON -- FOR A PERMIT ACTI VI TY AT A UST FACILITY IN BAKERSFIELD CITY TYPE OF APPLICATIONS SUBMITTED: '-~~k /~(~~ ~ / DATE APPLICATION SUBMITTED: ~~/~/ APPLICATION SUBMITTED EOR WORK TO BE COMPLETED AT THE EACILIT~ LISTED BELOW: / FACILITY PERMIT NUMBER: ~ ~)f~3~ ~ DESCRIPTIONS OF WORK FOR WHICH PERMIT APPLICATION HAS BEEN SUBMITTED: SPECIALIST GIVEN THE APPLICATION: DATE GIVEN TO THE SPECIALIST: . lx 9/ / / · BAKERSFIELD FIRE DEPARTMENT .~/~/~,. .~-~, OF F,. ~.~.~,O. ~_ ~ , · Date APPLICATION Application No. In conformi~ with provisions of ~rtinent ordinances, c~es and/or regulations, .application is made / Name of Co~ny ,/'- ~ '~'~' / ' · Address to display, store, install, use, o~rate, sell or handle materials or pr~esses involving or creating con- ditions deemed hazardous to life.or pro~r~ as follows: O' ' / ~i~re~ntative ,.=,,~~ ..... ~..(~.(~ ........................ , .... ,~ ....... .~.~ ................. ~ ..... :~ .......... . ~,. (~.~ ,,. ~..~, ............................. RESOURCE MANAGEMENT AGENCY E~v~ronmentaJ HeaJth Set~ces Department RANDALL L. ABBOTT STEVE McCAll Fy, REHS, DIRECTOR DIRECTOR ^ir Pollution Control District DAVID PRICE [] W~LLL~M J. RODDY, APCO ASSISTANT DIRECTOR Planning & Development Se~ices Department 'rED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT PER MIT FOR PERMANENT_~sOS~E PERMIT NUMBER A 1500-06 OF ~ERGROUND ~OUS S~ST~CES STOOGE FAC~ FAC~ N~~DRESS: O~R(S) N~E/~DRESS: CO~~OR: Owen Clark T~t Owen Clark Sazama Bac~oe & ~mvation 315 30th Street 315 30th Street ~36 Sha~ Street Bak~field, CA 93301 Bake~field, CA ~301 Bake~field, CA 93312 R ~ Liceme ~A-531055 Phone: (805) 327-86~ Phone: (805) 589-7019 PE M FOR CLOS~E OF PERMIT E~ES Au~st'31, 1991 i T~K(S) AT ~O~ ~PROV~ DA: .......... : ......................................................... ; .......................... POST ON PREMISES ............................................................... ; ................................ CO~ONS ~ FO~OWS: 1. It ~ the r~mibili~ of the Pe~tt~ ~o obtain ~mim w~ch may ~ r~ui~d by other regulato~ agenci~ p~or to ~gi~g wo~ (i.e., Ci~ F~e and Building De~menB). Pemitt~ mint noti~ the Ha~a~om ~t~ ~nagemem Program at (805) ~1-3636 ~o wor~g ~ prior to tank removal or abandonment in pla~ to ~nge for ~a~ im~io~(s). 3. Tank clmu~ actMti~ mint ~ ~r ~m ~ En~mnmenml Health and ~ Depa~ment appmv~ meth~ ~ d~ in Hand~k ~-~. 4. It ~ the ~ntmctoffs ~mibi~ to ~ow and adhe~ to ag applimble la~ reg~ing the ~nd~ng, tm~mtion or t~tment of ~om ~te~ls. 5. ~e rank ~m~al ~ntmctor m~l ~ve a q~lffi~ ~mpany employ~ on site summing the tank rem~aL prior to wor~g umu~. 6. R any ~ntmao~ o~er t~ th~ l~t~ on ~mt and ~mit applimtion a~.to ~ util~, prior appml m~t ~ ~nt~ ~ the S~cialist l~t~ on the ~L D~tion [mm the sub~tt~ app~mtion ~ not allowed. 7. Soil Samplin~ ~ T~k ~ 1~ t~ or ~u~ to 1,~ ~o~ - a minimum of ~o ~mpl~ m~t ~ mtfi~ ~m' ~nmth the ~nter o[ the rank at dept~ of app~mte~ ~o f~t and s~ f~t. b. T~k ~ ~t~ t~ 1,~ to 10,~ g~om - a minimum of fo~ ~mpl~ m~t ~ ret~ one-th~ of the ~y in from the en~ of tach lank at dept~ of appmmately ~o [~t and s~ f~t. c. T~k s~ ~t~ t~ 10,~ gallo~ - a minimum of s~ ~mpl~ mint ~ mt~ one4ounh of the way in ~m the en~ of ~ch tank and ~neath the ~nter o[ mcr t~ at dept~ of app~ately ~o [~t and s~ f~u 8. Soil Sampling (piping arm): A minimum of ~o ~pl~ m~t ~ ~ at depl~ 0f app~mately ~o feet and s~ f~t for ~e~ 15 I~mr f~t of pi~ m and under the ~r ~m. 2700 "M" STREET, SUITE 300. BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-342.9 ~? PERMIT FOR PERMANENT ~ PERMIT NUMBER A I~0C OF UNDERGROUND HAZARDOUS ADDENDL SUBSTANCF. S STORAGE FACILITY 9. Soil Sample analysis: a. All mil samples retrieved from beneath gasoline (leaded/unleaded) tanks and appurtenances must be analyzed for benzene, toluene, xylene, and t~ petroleum hydrocarbons (for gasoline). b. All soi~ samples retrieved from beneath diesel tanks and appurtenance~ must be analyzed for total petroleum hydrocarbons (for diesel) and benze c. All soil samples retrieved from beneath waste oil tanks and appurtenances must be analyzed for total organic halides, lead, oil and grease. d. Ail soil samples retrieved from beneath crude oil tanks and appurtenances must be analyzed for oil and grease. e. All soil samples retrieved from beneath tanks and appurtenances that contain unknown substances must be analyzed for a full range of substan that may have been stored within the tank. 10. The following timetable lists.pre- and post-tank removal requirements: . Complete permit application submitted Al least two weeks prior to closure to Hazardous MateriaLs Management Program Notification to inspector listed on permit of date Two working days and time of closure and soft sampling Transportation and tracking' forms sent to Hazardous No later than 5 working days for transportation and 14 working MateriaLs Management Program. All hazardous waste days for the tracking form after tank removal manifests must be signed by the receiver of the hazardous waste Sample analysis to Hazardous MateriaLs Management No later than 3 working days after completion of analysis Program 11. Purging/Inerting Conditions: a. Liquid shall be pumped from tank prior to purging such that less than.8 gallons of liquid remain in tank. (CSH&SC 41700) b. Tank shall be purged through vent pipe discharging at least 10 feet above ground level. (CSH&SC 41700) c. No emission shaft result in odors detectable at or beyond property line. (Rule 419) d. No emission shall endanger the health, safety, comfort or repose of any person. (CSH&SC 41700) e. Vent lines shall remain attached to tank until the inspector arrives to authorize removal. RECOMMENDATIONS/GUIDELINES FOR REMOVAL OF UNDERGROUND STORAGE TANKS This department is responsible for enforcing the .Kern County Ordinance. Code, Division 8 and state regulations pertaining to underground storage tar. Representatives from this department respond to job sites during hank removals to ensure that the tanks are safe to remove/close and that the overall job performs: is consistent with permit requirements, applicable laws and safety smndard~ The following guidelines are offered to clarify the interests and expectations for: department. 1. 'Job site safety is one of our primary concerns. Excavations are inherently dangerous. It is the contractor's responsibility to know and abide by CAL-OS 1 regulations. The job foreman is responsible for the crew and any subcontractors on the job. As a general rule, workers are not permitted in improperly sic! excavations or when unsafe conditions exist in the hole. Tools and equipment are to be used only for their designed function. For example, backhoe buck are never substituted for ladders. 2. Properly. licensed contractors are assumed to understand the requirements of the permit issued. The job foreman is responsible for knowing and abiding the conditions of the permit. Deviation from the permit conditions may result in a stop-work order. 3. Individual contractors will be held re'~ponsible for their post-removal paperwork. Tracking forms, ha?ardous waste manifests and analyses documentation necessary for each site in order to close a case file or move it into mitigation. When contractors do not follow through on necessary paperwork. unma~l~ continues, processing time for completing new closures will increase. xalSOO-O6.ptc '~' ~ :'~"~ - ~ BAKERSFIELD CITY FIRE DEPAR ~. ~ ~~~ /~/ 2130 "G" STREET BAKERSFIELD, CA 93301 ~SINESS ~ ~ 001037 HAZARDOUS ~TERI ALS BUSINESS PLAN AS A WHOLE FORM 2A 1. To avoid further action, return this form by a'l:-p 3 0 1987 ANSWERS IN ENGLISH. 2. TYPE/PRINT 3. Answer the questions below for the business as a whole. - .......... 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involvin~ 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 0ffice of Emergency Services as required by EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE Db~ING BUS. ~RS. AFTER BUS. HRS. B. Ph# Ph~ SECTION 3: LOCATION OF UTILITY SH%rr-OFFS FOR BUSINESS AS A WHOLE A. ~AT. GAS/~RO~ANE: ~ ~7- ~ ~ ~LJ3. B. ELECTRICAL: ~ ,~ z! C. WATER: ~ ~t ~ D. SPECIAL: ~-~ E. LOCK BOX: YES ~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / ,NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TE/~ FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS YakTERIALS: . . .' .................................... YES NO ~q~S NO B~ PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO ~S NO C. PROPER USE OF SAFE~ EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES N'O · YES NO E. DO YOU ~INTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: ~Z~DOUS ~RI~ CIRCLE YES 0R N0 DOES YOUR BUSINESS HANDLE HAZARDOUS ~4TERIAL IN QUANTITIES LESS THA~ 500 POUNDS OF A SOLID, 5~ GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A C0~PRESSED GAS: ...... YES I, D~ '~ g~ ~, certify that the above information is accurate.' I understand that this information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous ~aterials (Div. 20 Chapter 6.95 Sec. 25~00 Et Al.) and that inaccurate information constitutes perjury. - 2B - 'BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# .... _ _ _ BUSINESS PLAN ~SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS. 1. To avoid further action, this .form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT NAME: BECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS L¥IT ONLY - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility ~nit . con~.a.~n Hazardous Mate_lalo. YES If YES, see B. If NO, continue with .SECTION 4. B. ~re any of the hazardous materials a bona fide Trade Secret YES NO If. No, comPlete.a separate hazardous materials inventory form marked: NON~,TRADE SECRETS ONLY (white form #4A-t) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (~yellow form #4A-2) in addition to the non-trade secret form. Lis.t only the tra'de secrets on form 4A-2. S~CTION 4: 'PRLVATE FIRE. PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONL'Y. A. NAT. GAS/PROPAN~[": B. ELECTRICAL: 'C. WATER: D. SPECIAL: E. LOCK BOX: .YES /~ tF YES, LOCATION: IF YES, SiTE PLANS? YES / NO MSDSs9 YES /' NO z NO FLOOR PLANS9 YES / NO KEYS9 YES - SB - . BAKERSFIELD CITY FIRE DEPARTMENT I O # FORM 4A 1 Page NON--TRADE SECRETS HAZARDOUS MATERI ALS I NVENTORY ADDRESS: ~/,~ ~o ~h 5 ~, ADDRESS: 7?o~/ ~u~ . 71'~P,e FACILITY UNIT NAME: PHONE ~: ~ 3 ~7- ~Gd ~ PHONE ~: ~D~-f~y~ [OFFICIAL USE CFIRS CODE ,,{ ONLY 1 2 3 4 5 6 7 8 9 10 cTYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T ODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIQAL 0R COMMON NAME ( CODE GUIDE NAME: ~' C Cm~< , TITLE: ~Y~. SIGNATURE:i~ DATE: EMERGENCY CONTACT: q ~ Ct~ ~ TITLE: .... ~;~~'" PHONE ~ BUS HOURS: ~--~&~ AFTER BUS HRS: ~gD --f E~ERGENCY CONTACT: TITLE: PHONE ~ BUS HOURS: ~ AFTER BUS HRS: >,'PRINCIPAL BUSINESS ACTIVITY: ~% ~'~' ~ -4A-1- . -" ",..BAKERSFIELD; CA:'93303':2~~'. J;'~aUNT N0. ',' ~ ~SS0~ ' ;'" ' ' RETuRNCITYTHIsOFcopyBAKERSFIELDwiTH PAYMENT - , ~,",~ . INQUIRIES CONCERNING'THIS'BILL,, LEASE PHONE: ~26--]9~'9 .... " ' ', . ,,".: ',.[.::" . '[:', , ..', ,. ',.,,~:,' INQglRIES CONCER~ING THIS BILL' PLEASE P~oN~: "~ ~, ~ ' ~ ' ' ~ Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed Business Name: C)t13 et'x C,-\ ~'*~ Location: :~ i S-- ~ o Plan ID # 215-000 ~O3~ (Top right comer Business Plan) Station No. 6 Shift I!, Inspecto,_ $,~, Adequate Inadequate dfication of Inventory Materials RECEIVED []. [~] Verification of Quantities · AUG 2 5 1989 Verification of Location HAZ. MAT. DIV. ~ [--] Proper Segregation of Material Comments: Verification of MSDS Availability Number of Employees _ ] ~. Verification of Haz Mat Training O ~ Comments: Verification of Abatement Supplies & Procedures ~ ~ Emergency Procedures Posted , .._ , [--] [~] Containers Properly Labeled [~. [-~ Verification of Facility Diagram [~ [-~ Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office 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: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF ~HUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION' SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A, PRIVATE FIRE PROTECTION: B, WATER AVAILABILITY (FIRE HYDRANT)' 4. FDI~. Bakersfield Fire Dept. Hazardous Materials Division 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 3: TRAINING: NUMBEROF EMPLOYESS: -/,~ MATERIAL SAFETY'DATA SHEETS ON FILE: .BRiEF SUMMARYOF:TRAININGPROGRAM: - SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENAL'TY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REpORTiNG REQU'IREMENTS 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 · ' ! 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 313 days of receipt.' 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for-the business os a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION: MAILING ADDRESS: CITY: STATE: ~ ZiP: PHONE: DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: OWNER: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. 2. FOl CITY of BAKERSFIiNvENToRyELD Farm and Agriculture Fl Standard Business ElHAZARDOUS HATERIALS BUSINESS ,AHE: OWNER ,AHE: ~ ~I~AI~ , NAHE OF THIS FACILITY: LOCATION: ~1~ 3o~ %~ ADDRESS; ~/~ ~ STANDARD IND CLASS CODE~ CITY. ZIP: ~K~r-~e~a ('Q · CITY, ZIP: ~e~/ -. DUN AND BRAD~TREET NUMBER PHONE ~: ~7-~6~ PHONE ~: ~A ~m?~ - - - REFER TO~STRUC~D~5 FUN PROP~ CODES -- ._ I 2 3 4 5 ' ' 8 9 10 11 12 ,l~y ,aces of ,ixture/ComDonen:s Trans ~y~e Max Ay?rage Annual Heasure I ~y~ ConL ConL ConL Us LocaLjon?ece. Code ~ooe Aa: Aa: EsL Un~Ls on ~ce Type Press Temo Co~eStored ~n eac~yN: See Ins:ructions Physical and Health Hazard C.A,S, Huaber Co~ponent I1 Naae ~ C,A,S, Number (Check all that ~ Hazard O Reactivity ~~ 0 Suddenof PressureRelease ~iateC°,p°nentHeal,h '2 Naae, C,A.S, Number i..jJ._ Component 13 Hame ~ C,A.S. Number Physical and Health Hazard C.A.S. Number Component I1 Name I C.A.S. Number (Check all ~ha[ apaly) Component 12 Name ~ C.A.S. Number 0 Fire Hazard 0 Reactivity 0 Delayed 0 Sudden Release 0 Im~i~ Health of Pressure Component 13 Name & C.A.S. Humber Physical and Health Hazard C.A.S. Humber Component Il Name & C.A.S. Number (Check a/1 that apply) Component 12 Name ~ C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Im~i~ Health of Pressure Component 13 Name; C.A.S. Number Iphysical and Health Ua;ard C.A.S. Nueber Component I1 Name I C.A.S. Hueber (Check all that app~y~ Component 12 Name S C.A.a. Number 0 Fire Hazard 0 Reactivity 00elayed 0 Sudden Release ~ Health of Pressure Component 13 Name & C.A.S, Number EHERGENCY CONTACTS fll ~ame TTtl~ ~e R~e Tltle .cerc]Ty unoer penamcx gl)a~ cnqc j navepe(sonalmy, examlnq~aq~m tamil]ar, vitU the jnxormac~pn ~uUmitt~U in this.and ~~~~le of owner/ooerat~k uH owner/operator's auchorited reptesentacive pature -' I-D~Z~US ~TI=R I~J--S ~2~AG~NT PI_A~N [w-~%l° INS~IRUCTION$ These instructions exDlain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit & single diagram that shows the overall business site in relationshiD to the surrounding businesses,' as well as, instructions that show the route to your business if it is in a remote location. If you have subdivided your business into smaller areas because of the comDlexity or size, then you will be completing an additional detail mad (facility diagram).for each of these areas. ~ Si~]E DiA~ INS~I~UCTIONS ,, (See Smile Diagrms, Attached) '1 Check the box on .the top left corner that indiCates -, "Site Diagram". Print the name of your business as shown in your HMMP. The site diagram is used to show your business and an indication of the businesses that immediately surround your proDerty, usually within 300 feet. This mad should show the location of the hazardous materials and should identify them by their hazard class, as shown by the symbols included with these instructions. The sample should assist you in determining the correct method of identifying storage locations. If your business site is located in a remote area or one which may Dresent a Droblem for' emergency rescue Dersonnel to find, you must also indicate the trsvel route to your business site. FACILIM DIA~=~ INS'I~I~UCTIONS 1 Check the box in the uDDer right hand corner that indicated "Facility Diagram". 2 Print the name of your business as shown in your HMMP. 3 IndiCate which area this is and the total number of facility diagrams that you are including. As an examDle, if your business has been subdivided into four areas and this mad reDresents the first area, this 'would be facility diagram $1 of 4. 4 Print the name of the area that this mad covers. This name should be t.he same name that you utiliZed on ~he tod of your.inventory reDort and HMMP. The Facility Diagram shows a smaller area of your business in more " detail than a site diagram. Use the symbols provided to indicate 'the aDDroDriate features of this Darticular area. Utility Con==o!s ~ MSDS Storage Fence (All Types) Gas "'"~'"'' Indicate Heig~= Electric' ~, Gate in Fence Water /-- Standard Door SDrinkler Fire De~=. T~Ks - Lis= ~ Fire Hydran= - Public ' ~ Railroad Trac~s ~ Fire Hydran= - Priva=e { ~O. 0oo Abovegro~d Tanks Automatic Sgri~lered Building or Area .~ .~ EVacua=ion Ar~a ~ ......... ar~a .. T~Des of Hazardous Materials Flamma~l, ~ Liquid Wa=er Reactive ~ Gas ~ ~ Explosive ~ ~d~ologi=ai Was=e E~le FI~a~le Li~i~ ~ ~ Poison ~ ~los~v, Gas ~ ~-IMMP P LA~ MAP' SITE DIAGRAM FACILITY DIAGRAM --~ Ncr-.h Name of Ar~-a: page 2 HA7 MAT BUS[NESS PLAN WHAT BUSINESSES ARE EXEMPT If you do not handle Hazardous Materials or if the quantities of Hazardous Materials are below the minimum reporting quantities at ail times during the year, you are exempt. Hazardous Materials which are stored in transit or temporarily maintained, in a fixedfacility for less than (50) thirty days during the course of transportation are e×empt from the inventory requirements of the law. -- NOTE -- (Hazardous Materials contained solely in a consumer product for direct distribution to, and use by, the general public are N 0 T e×empt from the reporting requirements of the law per this Administering Agency,) HOW DO BUSINESSES COMPLy Businesses that are required t~ comply with requirements of Chapter 6.95 Of California Health and Safety Code must submit a Plan. This Business Plan consists of: 1) Emergency Response Plans and Procedures. 2) Inventory of Hazardous Materials. .. 5) Training Program for Employees. . The forms for completing the Hazardous Materials Management Plan are attached to this letter. 8y correctly filling this Business Plan in you satisfy both the Federal Requirements (Tier I and Tier II Inventory Requirements of SARA Title III) as well as the California Requirements of Chapter 6~g5 of the California Health and Safety Code. Business owners are urged to read and become familiar with Chapter 6.95 of the California Health and. Safety Code. Copies are available at the Hazardous Materials Division of the Bakersfield Fire Department, 2150 G Street, Bakersfield, Ca. 95501 (805) 326-3979. The completed Business Plans or Exemption Request Form are required to be submitted within 50 DAYS of receipt of this letter. On-site inspections are required to insure compliance with the law. If you have any questions or need assistance with completing the Business Plan please call 526-5979. Sincerely, Ralph E. Huey Hazardous Materials Coordinator REH\ed FIRE DEPARTMENT 210~ H STREET D. S. NEEDHAM BAKERSFIELD. 93301 FIRE CHIEF 326-391~ Dear Bus,ness O~ner: Th~s packet contains &mportant Znformat~on ragard~ng your bus~ness and the requirements of Hazardous Materials I'nventory Regulat2ons. Both State and Federal la~s may requzre t~at your bus&ness complete a Hazardous .Mater&als Management Plan (HMMP). Please read ali the enclosed &nformat&on carefully, fa21ure to comply ~ith any port&on of the Bus&ness Plan requzrements may result L&abZl&t&es of up to $2,000 for each day &n ~hZoh the v&olat&on occurs. WHAT BUSINESSES MUST COMPLY If you handle, use, store or dZspose of Hazardous Substances at any t&me dur&ng the year Zn excess of the m~nzmum report&rig you must subm&t a Plan. Typ&oal everyday Hazardous Hater&als you may fznd &n your facility may ~nolude~ but are not limited to: compressed gasse~;.. ~uels - all types including p¢opane; solvents - most ~olvents ~ould be Hazardous Mater2als; o2ls - me~ and ~aste; thZnne~s; caustic co,rcs&ye materials; po2sonous on toxic materials, amd radioactive mater2als. Minimum State ~e~o~tzng quantzties ~o~ all hazardous mater&als are: 55 9alloms for liquids 500 pounds ~o~ 200 cub2c feet (at standard temperature and pmessure, for 9asses) For ali acutely Hazardous Materials the minimum reporting quantities are ¢oun~ on the list o¢ Extremely Hazardous Substances on the current ~¢~ List (Vol 52 No 77 of the Federal Reg2ste~.) This list is available at the Hazafdous Materzals Divzsion of the 8akers~2eld Fire Department, 21~0 G STreet, Bakersfield, Ca. 9~01. Your reporting requ2rememts are ezther the State quantit2es or the Federal (threshold plammzng quamtity) -- WH I OHE V E R IS LOWER If your facility is exempt or handles Hazardous Mater&als in quantities less than the minimum re'porting quantities please. fill out and return to th&s office Section (1) one, (4) four, and (5)'five of the Hazardous Materials Mamagement Plan.