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HomeMy WebLinkAboutBUSINESS PLAN:ti:v` 'tea _ i~ - ;~' ~_ ~ ~~ ,~ - . - r" h I ~ - -- -~ ---- --- -_ -- - - - -_- - - _ - - ---- NLIB ..... ,...,,-",.,;lc,-, CA TITLE INSURANCE CO. · . Il-liS FIJ~.T l'._; FO."~ Ir.,[,-":.U:',.:ATiOr,;/~L Pb~PO~S ONLY 'I 100 CHESTER AVENUE Arno OOE3 ;',10~' CO:',~;~lL;'rE ^ ~':Att[ OF 1-H~$ POL!CY. BA~.c,-.~rJ,-cD, CALIFORNIA - 93301 ' ' BAKERSFIELD CITY FIRE DEPARTMENT . 2130-"O" STREET ~ BAKERSFIELD, CA 95302 (805) 326-3979 OFFICIAL USE ONLY 000002 BUSINESS NAME HAZARDOUS' MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid furthe~ 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 SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or th'reatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify y~ur local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: D. SPECIAL: E. LOCK BOX: YES / NO I~ 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 TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH'INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A.'METHODS FOR SAFE HANDLING OF HAZARDOUS ' MATERIALS:......: .................................. (~ NO .~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO ~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. (~D~NO 2f~SP NO D.' EMERGENCY EVACUATION PROCEDURES: ................. ~ NO' ~ NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... ~ NO ~ NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:.'~ .... YES'~  _~--C-iLe~/'~ , certify that the above information is accurate. I'u , I 'de/i~tand th~Sth~is information will be used to fulfill my firm s obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. B~ERSFIELD CITY FIRE DEPARTME.~ 2130 "G" STREET BAKERSfiELD, CA 9~01 0~FiCIAL USE ONLY ID~ BUSINESS NAME: BUS I NESS PLAN SINGLE FACILI'TY UNIT · - FOR~ INSTRUCTIONS 1. To avoid further action, th~s form must be retu~-ned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONClSE as .possible. SECTION 1: MITIGATION, PRE~NTION~ ABATEMEN~ PROCED~ES SECTION 2: NOTIFICATION kND EVACUATION PROCED~TRES AT THIS b~IT - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS b~'IT ONlY ,A. Does this Facility Unit contain Haz*.rdous Materials? ...... 5© If YES, see B. If NO, continue with SECTION 4. · B. Are any of'the ~azardous 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 0NLY'(¥eliow 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 S: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPOS"OERS SECTION 6: LOCATION OF UTILITY SI~.IT-OFFS AT THIS bP¢!T ON~LY. · N:~. GAS/PROPANE5 ~' ~ ~s' _o~ ~i{4~9 B.ELECTRICAL: C. WATER: D. SPECIAL: E. LO~K BOX: YES /~!F YES, LOCATION: IF YES, SITE PLANS? YES .I MO MSDSs9 YES /' ??0 FLOOR PLANS? YES / NO KEYS?' YES / NO - 3B - I O # C/~C._,2~.C,,~3..~,/ . BAKERSFIELD CITY FIRE DEPARTMENT · · FOR~ 4A-1 Page ~'of NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY PHONE ~: J~-~i' PHONE {:~ ~Fy-~oY~ [OFFICIALONLY USE CFIRS CODE 1 2 3 4 5 6 7 j': 8 9 l 0 TYPE MAX ANNUAL CONT ,USE LOCATION IN THiS % BY HAZARD D.0.T j'%CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT ~ WT. CHEMIQAL OR COMMON NAME CODE GUIDE 'X~~ ;~ AFTER BUS HRS: EMERGuNCY CONTACT: ~,,~ ~j~ TITLE: o~e~ .. PHONE 9 BUS HOURS: ~-~; '~RI~CIPAL BUSINESS ~CTIVITY: AFTER BUS HRS: - 4A-1 - ,".~'_'7~ ~),CITY ox" BAKERSFIELD,.".,2~u~,,~..~ ,,~ '.', ~_. 't .'/ ~ . ~ ,,~ · "'.}-., ?-~:<, u.::.' '.,; '~II~ AY~ L. CIFrO~ Do hereb~~ eertiZy that I have revie~ced 'th'e .......... attached Hazardous Fiaterials~business plan GIFFORD ELECTRIC for ' (name of business) and that it along with the.attached additions ~,~ corrections constitute a complete and correct Business Plan for my facility. __ date - ? BUSINESS NAME GIFFORD ELECTRIC ID NUMBER 215-000-000002 LOCATION 400 30TH ST HIGH HAZARD RATING 2 1 . OVERVIEW LAST CHANGE 07/01/88 BY ESTER JURIS CODE 215-004 JURIS BAKERSFIELD STATION 04 MAP PAGE 103 GRID 19D FACILITY UNITS 1 HAZARD RATING 2 RESPONSE SUMMARY 2A SEC 4) RYAN AND ERIC GIFFORD. EMERGENCY CONTACTS 2A SEC 2) RYAN GIFFORD - 325-2428 OR 589-9042 ERIC GIFFORD - 325-2428 OR 834-3790 UTILITY SHUTOFFS 2A SEC 3) A) GAS - SE CORNER OF BLDG B) ELECTRICAL - MAIN PANEL IN WAREHOUSE NW CORNER ~) WATER - AT STREET JUNCTION BOX D) SPECIAL - NONE E) LOCK BOX - NO -NoT I F I CAT I'ON'--/~- is-UR L-'I ~ - ~E'¢)7~C-'UA T"I-O N~ LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION PAGE 1 12/12/88 14:54 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME GIFFORD ELECTRIC ID NUMBER 215-000-000002 LOCATION 400 30TH ST HIGH HAZARD RATING 2 3 . HAZ MAT TRAINING SUMMARY LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 07/01/88 BY ESTER 2A SEC 5) MEMORIAL HOSPITAL - 420 34TH ST - 327-1792 (2 BLOCKS AWAY). PAGE 2 12/12/88 14:54 MATERIAL SAFETY DATA 'SYSTEMS, INC. (805) 648-6800 BUSINESS NAME GIFFORD ELECTRIC ID NUMBER 215-000-000002 LOCATION 400 30TH ST HIGH HAZARD RATING 2 FACILITY UNIT 01 A . OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 07/01/88 BY ESTER ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE GASOLINE 1000 GAL HIGH MIDDLE W SIDE PROPERTY UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LISTS 1182.00 100.0 GASOLINE HIGH B . FIRE PROTECTION / WATER SUPPLIES LAST CHANGE 07/01/88 BY ESTER 3A SEC 4) FIRE EXTINGUISHERS LOCATED THROUGHOUT BUSINESS FOR FIRE PROTECTION. 3A SEC 5) FIRE HYDRANT LOCATED ON STREET SE CORNER OF LOT. PAGE 3 12/12/88 14:54 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME GIFFORD ELECTRIC ID NUMBER 215-000-000002 LOCATION 400 30TH ST HIGH HAZARD RATING 2 D . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 07/01/88' BY ESTER 3A SEC 2) CLEAR PREMISES - CALL 911 FOR FIRE ONLY~ E . MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 07/01/88 BY ESTER 3A SEC 1) UNDERGROUND GASOLINE LEAK - NO SMOKING, ELECTRICAL TO PUMP OFF AT ALL TIMES, UNLESS BEING USED. ONLY QUALIFIED DELIVERY PEOPLE FILL TANK. PAGE '4 12/12/88 14:54 MATERIAL SAFETY DATA SYSTEMS, INC. {805) 648-6800 CITP of BAKERSFIELD' '~ 4~ HAZARDOUS MATERI ALS INVENTORY Farm and A(Triculture ~ Standard 9usines$ ' ~ % ' NO N-- 'I' RAI) E S E C R E TS BUSINESS NAME:...___ GIFFORD ELECTRIC,,.~.OWNER. ,...NAME Frank Giffor( NAME OF T~$ FACILITY: '-.400-30~h St. ADDREss: ~bUU3'~e~'~:~'~_~s Ave. STANDARD IND. CLASS CODE CITY~ ZIP: Ba~=i~lield 93301 CITY, ZIP: Bakersfield 93309 DUN AND BRADSTREET NUMBER P~ONE ~: 325-2428 P~ONE ~: 3~/-~zzu __ - ___ - (~e C~e Mt Mt Est ~its m Site T~ ~ IM ~ .. St~ tn FKlllty ~ ~ I~t~tt~ .o_IE_I ........... i J L_l_ 1 o / I I I[~1 Ph~ic~l ~ ~lth ~Z~H C.A.S. ~ ' ' ~/' r--~ -- ~--~ r--~ ~lth of P~ ~lth ~}'._[ .... 1 ........... ~1, ............. 1 ! ..... 1 ...... k_3~L3 I .................... P~icll ~ ~lth H~z~ C.A.S. ~ ~t (C~k ill t~t a~ly) - r--~- ' --~ ~ ~-~ ~t~ M&C.A.S.~ ~lth of ~m Mlth ' ' ..... L_I L .......... I [ I ,l I I I -I ...... P~lcal ~ Mlth ~te~ C.A.S. ~ Wt I! (C~k 811 t~t a~iy) ~-. -- r--~ r--~ ~ J ~tve Haza~ [--"_a ~tivtty [-~ ~le~ ~--a ~ ~lme L_a I~tite ~lth of P~ Mlth" L_t ........... L ............ ~ .......... ], _t~2{: ~ i__~ ' , ...... - -. -- ~--~ [--~ H~lth of Pr~surl Mlth N(nGENCYCmTACTS I1 RY~ GIFFO~ ~9~:--~P-: .......... 589-9042 12 ERIC GIFFO~ ~.P. ~3~.~ ....... N~-7 ......................... 7 ......... ,,~,, ;I-~'p~ ...... Certlficati~ (Read and sign after coepJetJng all sections) I certify ~der ~tty of 1~ t~t I ~ve wrsmelly e.~in~ ~ il fNitiir with t~ tnformtim ~M~tt~ tn LMs ~ ell ettKM ~ts. ~ t~t Msff m W.i~iW of t~e IMtviMIs m~sibll for obta;~iflg t~ infantry. I ~l~eve t~t t~ su~itt~ info. tim is t~. accurate. ~d . ' ~xan Gifford. President · " ' RECEIVED .... ~ . ~, ~'~' 2500 ~ '~ ~ .-114; ' ~', .... ~_ 5000' - ~ ~ 2J42' " inCu~ed, are;obY~'16ad' ~ih~':sP6cified. Contractor', signature'represent~'acCeptaaCe ; " , . , i, _ . . ..-,, :.;.,..-. of terms IOr Da~ment .and confi~s;that tank NO..OF TANKS TOTAl: :.['~. NET;~NS TH~S IS ~?CERTtFY THE RECEI~ ~ND'ACCEPTANCE OF THE TANK(S),~S SPECIFIED~'BOVE, ALL M~ERI~L~,SPEC FiED , BAKERSFIELD FIRE DEPARTMENT, / //~ ~,~ ~ BUREAU OF FIRE PREVENTION ~ ~'~'- ~'7 Date APPLICATION 'Application No. In conformity with provisions of pertinent ordinances, codes and/or regulations, application is made by: ~ ' Name of ~om~ny ; ~ ' ~ddress to display, store, instoll, use, operote, sell or handle materials or pr~esses involving or creating con- ditions deemed hozardous to life or pro~ as follows: Aul~oriz~ -S 7 . .~. ~ tRN'.COUNTY HEALTH DEPARTMI HEALTH OFFICER ~ 2700 M Street Leon M Hebertson, M.D. Bakersfield, California ENVIRONMENTAL HEALTH DIVISI°N Mailing Address: DIRECTOR OF ENVIRONMENTAL HEALTH 1415 Truxtun Avenue Vernon 5. Relchard (805} 861-3636 ~RMIT FOR PERMANENT ~ PERMIT NUMBER A853-06 UNDERGROUND HAZARDOUS JBSTANCES STORAGE FACILITY ~CILITY NAME/ADDRESS: OWNER(S) NAME/ADDRESS: CONTRACTOR: ifford Electric Gifford Electric D & J Construction ~O0 30th Street 400 30th Street P.O.'Box 5202 ~kersfleld, CA BakerSfield, CA Bakersfield, CA' License # A428493 Phone: 805-325-2428 Phone: 805-327-1871 : 1989 CRMIT FOR CLOSURE OF PERMIT EXPIRES March 23~ .~TANK(S) AT ABOVE AppROVAL DATE December 23~_ 1988 · Dolores Gough ........................ POST ON PREMISES ........................... CONDITIONS AS FOLLOW: It is the responsibility of the Perm]ttee to obtaSn permits which may be required by other regulatory agencies prior to b~giniling work. Permittee must notify' the County Ilea]th Depavtment at (805) 861-3636 two working days pr~o-~--~ tank (removal) to arrange for required inspection(s). Pe~mitte ~us~ Obtain a City Fire Department permit ~Klo_E to Initiating closure action. Tank closure activities must be per Kern Gounty Health and Fire Department approved methods'as described tn Handbook UT-30. a. A minimum of two samples must be retrieved beneath the center of each tank at depths of approximately two feet and six feet. Sample Analysis a. All samples must be analyzed for benzene, toluene, xylene, and total petroleum hydrocarbons. If any contractors other than those listed on permit and permit application are to be utilized, p~ior approval must be granted by the specialist listed on the permit. DISTRICT OFFICES Oalano · Lamont . Lake llabella · Mol&va · Rldgecreat · Shaftm' . Taft· PERMIT NUMBER A853-06 .]RMIT FOR PERMANENT-~ ADDENDUM UNDERGROUND HAZARDOUS IBSTANCES STORAGE FAGILITY Copies of transportation manifests must be submitted to the Health Department within five days of waste disposal. All applicable state laws for, hazardous waste disposal, transportation, or treatment must be adhered to. The Kern County Health Department must be notified before moving and/or disposing of any contaminated soil. · ,. Permittee is responsible for making sure that ,,tank disposition tracking record" issued'with this permit is properly f~]led.out and returned within 14 .days of tank removal. · Advise this office of the time and date of the proposed sampling with 24 hours advance notice. . Results must be submitted to this office within' three days of analysis completion. :dr ~-28-88 ~rmits\gifford.pe~ Bakersfield Fire . DePt Hazardous Materials Inspection Date Completed Business Name: ~(~ / ,~ FO ,~ ~D ~--~-L6-G 7-,~ / ~ Location: ~f00 ~_~ O ~' '.~'-~, P1an ID # 215-000 OO 7_ (Top right comer Business Plan) -. Ade~.ar.e Inadequate Verification of Inventory Materials RECEIVED Verification of Quantities SEP 1 2 1989 [] H./~Z. MAT. DIV. Verification of Location Proper Segregation of Material " Comments: //,u'o~/~,~.~c3,c;,d ,~c,'~/. --;-/-~,a~//_~ Verification of MSDS Availability [---] Number of Employees 7 Verification of Haz Mat Training [~] ~'~ Comments: Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted [-~ ContainerScomments:Properly Labeled ~[~] Verification of Facility Diagram [--] Special Hazards Associated with this Facility: Violations: FO 1652 (Rev. 3-89) , White-Haz ~at Div. Yellow-Station Copy Pink-Business Office