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Home My WebLink AboutBUSINESS PLAN SITE/FACILITY DIAGRAM FORM 5 NORTH SCALE: BUSIN£SS NAME:.~ ~ ~'t~/'1'1 {~ ' [~)/~'1/'',lq'' ''It' 'FLOOR: IOF~>~? DATE: FACILITY NAME: UNI. : OF (CHECK ONE) SITE DIAGRAM FACILITY DIAGRkM Inspector's Comments): -OFFICIAL USE ONLY- - 5A - SITE DIAGRAM (Reqt' Items) , ~ I 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 tn the 12. Fence or Barrier property, Include tile a. Wire street names. b. Masonry 3 Storm Drains, Culverts, Yard Drains c. Wood ' 4. Drainage Canals, Ditches, d. Gates Creeks, 13. Powerllnes 5. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c. Metal construction capacity In gal. a. Above ground d. Access Door b. Underground 6. Utility ConTrols a. Gas 16. Diking or Berm b. Electricity 17. Evacuation Route c. Water 18. Evacnatlon Area: Identify the 7. Fire Suppression Systems: location where a. Fire Hydrants, employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste 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 Pump 22. Type of Hazardous Material/Waste Stored 8. Fire Oepartment Access or Used {See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E = Explosive L = Liquid R = Radtologlcal C = Corrosive 0 = Oxidizer' 0 = Oas P = Poison W = Water Reactive T = Toxic S = Solid H = Cryogenic D = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAORAM (Required Items in addition to the above) 1. Risers for Sprinklers 8. Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest. 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets 0 Bakersfield Fire Dept. HAZARDOUS MATERIALS DIVISION Date Completed // 'l~usir~ess Name: K5 ~'"~.,~YYl -~. ~)~"~'" ~ Location: I-~ [ ,'~ 3 ~ P Business Identification No. 215-000 0[~)1 ~LJC~ (Top of Business Plan) Station No. q Shift ~ Inspector ~~ Adequate Inadequate Verification of Inventory Materials J~- J~J Verification of Quantities ~ J~] Verification of Locati~'~: J~- J~ Proper Segregation of Material ~ Comments: Verification of MSDS Availablity J~ J~J Number of Employees 7_.., Verification of HazUat Training J~ JJ~] Comments: Verification of Abatement Supplies & Procedures J~ J~] Comments: Emergency Procedures Posted ~ Containers Properly Labeled ~ Comments: Verification of Facility Diagram J~ J~] Special Hazards Associated with this Facility: Violations: _-'~,,'7,~/~ ~¢~ All Items O.K. ~ Correction Needed J~] I~in~'s 'Owher/a a~ager FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy BAKE~r t=LD DEPAL-{ I M~Nl CITY FIRE ~ 2130 'G' STREET BAKERSFIELD, CA. 93301 .AY~g89 (805) 326-3979 BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE J~ 29 1989 FORM 2A A,8'd ............ INSTRUCTIONS: 1. To avoid further action, return this from within 30 days of receipt. 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 ~OENTIFICATION ~ATA A. BUSINESS NAME: ~/. ~. F~NAG ' '~AI'k3T- ~ B. LOCATION / STREET ApDRESS: I~-gi ~~ CITY e~{~l~ ZIP: q~O~l'¢' BUS. PHONE: ~C)~) SECTION 2: ENERGENGY NOTIFICATION8 ~n case of an emergency ~nvolv~ng ~he release or ~hrea~ened release of a hazardous ma~er~a], ca]] 911 and 1-800-852-7550 or 1-918-427-4341. Th~s w~]l no~fy your loca] f~re depar~men~ and ~he S~a~e O~f~ce o~ Emergency Services as required by EMPLOYEE8 TO NOT~FY ]N CASE OF ENER~ENCY: NAHE AND TITLE DURING ~US. HRS. AFTER BUS, HRS, SECTION 3; LOCATION OF UTZLZTY SHUT-OFFS F~R eUSZNESS AS A WHOLE A, NATURAL GAS/PROPANE' B, ELECTR~CAL:~.~.~~¢ ~ ~.~ OP D. SPECIAL' E. LOCK BOX: YES / NO IF YES, LOCATION' IF YES, DOES IT CONTAIN SITE PLANS? YES / NO NSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO SECTION 4:. PR. IVA~T'ELRrESPONSEi '~- ":" TEAM FOR_BUSINESS AS A WHOLE_ SECTION 5: LOCAL EHERGENCY HED[CAL ASSISTANCE FOR yoUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EHPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS MATERIALS. A. NUMBER OF EMPLOYEES AT THIS FACILITY,%~ B. DO YOU HAVE MSDS (MATERIAL SAFETY DAT-~ SHEETS) FaR EACH HAZARDOUS MATERIAL YOU HANDLE ? C. GIVE A BRIEF SUMMARY OFIYOUR HAZARDOUS MATERIALS TRAINING PROGRAM: SECTION 7: 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 AND SAFETY CODE FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 8: CERTIFICATION I, ~~~ ~. '~-~E~ , certify that the above information is accuFate. I understand that this 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. BAKERSFIELD CITY FIRE DEPARTMENT 2130 'G' STREET BAKERSFIELD,. CA. 93301 (805) 326-3979 ~ OFFICIAL USE ONLY ~ ID,//" It BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 3A ];NSTRUCTIONS 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: SECTION 1: MITIGATION, PREVENTION. ABATEMENT PROCEDURES . SECTION ~; NOT;[F][¢^TION AND I[VACUATION PROCEDURES AT THE UNIT ONLY 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 inventory form marked: NON-TRABE SECRETS ONLY (white form ¢4A-1) If 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 FOR USE BY EMERGENCY RESPONDERS (Fire Hydrant) SECTION 6: LOCATION OF UTILITY SMUT-OFFS AT THIS UNIT ONLY. A. NATURAL GAS/PROPANE: B. ELECTRICAL: C. WATER: D. SPECIAL' E, LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 3B - CITY of BAKERSFIELD . Far, a.d Agriculture ~ Sta.dard eusi.ess ~-~ ~Z~DO~ ~~~ ~~ ~ N~~.O~' NON--TRADE SECRETS ' Page .... of .... LOCATION:1~'-~¢~-" ~'. ....... . ~-'a'~ ~D~s~;--~0~'~-~da)'~- ~'. ..... STANDARD IND. CLASS CODE - - - ~ ~ ~ ~S~U~O~ ~0~ P~OP~ ~OD~ 2 ] 4 S S 7 B g lO 11 12 13 1i C~e MC ~C Ese Units m Site TyM P~l TMg C~e Stoe~ Jn FacJllCy Nt ~ ins~ctJms Fire Hazard [--~ Reactivity u_J ~le~ u--J ~m Rel~se u--J Health of P~suee ~lth .......... (C~k emro t~t aD~y) '~' : ........ r--~ r--~ ~t 12 Nm'iC.A.S. ~ Fire Hazard [ ~ ~ctivtty L--J h)l~ L--J ~dK RI)N~ L~J i~tete fl~lth of P~su~ ~lth ................. ~t 13 ~ & :.A.S. ~ __L_t ...... : .... k ........... 1 t '1 .l 1_ I i, ! P~ical ~d H~lth Hazard C.l.S. ~ Wt II h i C.A.S. ~ (C~k all t~t a~Diy) Wt 12 Nmi C.A.S. ~ Hee Hazaed [ ] Reactivity ~--u ~le~ [ ] ~ddK Rel~se ~--~ I~Jate Health of P~Ksuee Health P~ic~l ~ H~lth ~zerd C.A.S. Numar C~mt II Nlm & C.l.S. N~ (Ch~k all t~ a~ly) ....................... r--~ [ ~ r--~ r--~ C~t 12 Nm& C.A.S. Fire Hazard ~--J Reactivity -- ~lay~ L_J ~ddm Release u--J Health of Pr~sune Hen]th ............. ~ ............................................ ~t 13 Nm i C.A.S. Numar Certificati~ (Read and sJKn after compJetJnE aJ] sections/ certify ~der ~el~y of ~e= ~ ~ ~ve ~rsmallye.em~n~ ~nd a= f~mJlJer ~h t~ Jnfor~tJm su~Jt~ ~n this ~ ell ett~c~ d~s, end ~ ~s~ m W ~n;u~ of t~e J~JvJ~els r~sJble ob~amJn~ t~ Jnfor~t)~. I ~lJeve ~; ~ su~J~ mfor~Jm ~s true. accurate, end c~. ) ~ ......................................... D~{{'S]~H~ ............................. March 1~ 1990 TO: Nina Mayer~ Accounts Receivable FROM~ Ralph E. Huey~ Hazardous Materials Coordinator SUBJECT: KB Frame~ Paint & Body Nina~ please void the bill for this handler~ (account #480801) all current and previous charges. Make this handler no longer in business. Thanks Valerie Page 3 Drive by Inspection Report OUE flAY RIECRRO ~/ ~abr~ca~on (805) 328-1 OUE flAY Bakersf~eld. Ca. ,. ~ (~5) 323-2000