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BUSINESS PLAN 3/4/1992
RISK RANKING - KMART, 34TH STREET FACILITY RISK .INDEX 0.5 X 3 = 1.5 INSPECTION HISTORY 1 X 3 = 3 POPULATION EXPOSED 4 X 2 = 8 MCP 4 X 1 = 4 TOX FACTOR 0.6 X 1 = 0.6 (200 GAL X 15.35 LB/GAL/1000 LB)(.4) = 1.2/2 = 0.61 TOTAL SCORETM 17.1 FACILITY RISK INDEX· RATING W = Activities or conditions that increase the likelihood of a release. 1 x .5 = 0.5 (NO. OF YES ANSWERS 0N THE QUESTIONNAIRE 1-13. Add 1 yes to each facility for storage and minimal handling X = Accident / safety record. 0 (REASONABLE=0, INADEQUATE=0.25, GROSSLY INADEQUATE=0.5) Z = Not directly addressed in the questionnaire. 0 (OTHER COMPLICATING FACTORS MINIMAL=0, CONSIDERABLE=0.5, SUBSTANTIAL=i.0) FACILITY RISK INDEX = 0.5 RATING FI = X + Y + Z RATING RATIONALE: Risk increases with increasing process complexity and potential for human error. POPULATION EXPOSED - RATING 1. IS TOXIC MATERIAL APT TO BECOME AIRBORN RAPIDLY ? i.e. A GAS, FINE DUST, HIGHLY VOLATILE LIQUID NO=0 YES= 2 0 IF ANSWER TO #1 IS. NO, PROCEED TO #6 IF ANSWER TO #1 IS YES, ESTIMATE THE EVACUATION RADIUS, USING THE BAKERSFIELD FIRE DEPT. GRAPH MODEL, AND ANSWER QUESTIONS 2-5. 2. IS THERE A SCHOOL WITH IN THE EVACUATION RADIUS ? NO=O, YES=2 0 3. IS THERE A NURSING HOME OR HOSPITAL WITH IN THE EVACUATION RADIUS ? NO=0, YES=i 0 4. IS THERE RESIDENTIAL HOUSING WITHIN THE ~ EVACUATION RADIUS ? NO=O, YES=I 0 5. IS THE POPULATION DENSITY OF THIS AREA HIGHER THAN THE AVERAGE DUE TO ALOT OF MULTISTORY BUILDINGs ? NO=0, YES=i 0 6. WHAT IS THE OCCUPANCY OF THE BUILDING THAT AHM IS STORED OR HANDLED IN ? 4 LESS THAN 5 PEOPLE=i 6 - 25 PEOPLE =2 26 - 50 PEOPLE =3 MORE THAN 50 PEOPLE =4 TOTAL POPULATION EXPOSED RATING = 4 RATING RATIONALE: Releases that are limited to onsite consequences will limit the exposed population. As the number of persons onsite increases, evacuation and and response efforts become more complicated, and the potential for injury increases. O Bakersfield Fire Dept. HAZARDOUS MATERIALS DIVISION Date Completed Business Name: ~- Loca, on: Business Identification No. 215-000 !/r-))--~ (Top of Business Plan) Station No. '~ Z f"[r4T~ Shift Inspector Adequate Inadequate Verification of Inventory Materials ~ Verification of Quantities I~ Verification of Location ~ Proper Segregation of Material ]~] Comments: Verification of MSDS Availablity~ Number of Employees Verification of Haz Mat Training][~ Comments: Verification of Abatement Supplies & Procedures I[~ Comments: Emergency Procedures Posted ]~ Containers Properly Labeled [~ Comments: Verification of Facility Diagram I~ Special Hazards Associated with this Facility: /)r/Id '/,~,,f~CTfOn ~.~' All Items O.K. Correction Needed Business Owner/Manager FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT 2101 H STREET S. D. JOHNSON September 14, 1992 BAKERSFIELD, 93301 FIRE CHIEF 326-3911 Ted Sisco K-Mart #4102 401 34th St. Bakersfield, CA 93301 Mr. Sisco: The hazardous materials inventory filed for K-Mart #4102 on 3-4-92 reports a maximum of 200 gallons of 100% sulfuric acid the garden shop area. This information does not agree with the acutely hazardous materials (AHM) inventory filed in 1990 for storage of sulfuric acid: A copy of the AHM registration form is attached. If sulfuric acid is stored or used in the garden shop as a cleaner check the information on the attached print out for accuracy. Use the inventory form to add the sulfuric acid stored in wet cell automotive batteries. Check the material safety data sheets for these products to determine the percentage of sulfuric acid that is in each solution. Complete the attached AHM registration form reporting the maximum amount of sulfuric acid that has been reported on the inventory. Please date and sign the printout of the K-Mart inventory with any corrections boldly marked on it. Return the inventory report for the battery acid and the. AHM registration form with the printout. This information should be submitted to the Hazardous Materials Division by October 15, 1992. Call me if I can be of any assistance. Sincerely, Barbara Brenner Hazardous Materials Planning Technician cc: Ralph Huey FACILITY INFORMATION FORM Please answer each of the following questions by circling Y (yes) or ~N (no.).. 1. Is any acutely hazardous material (AHM) manufactured or used in a chemical reaction ? Y /~N3 2. Is any other flammable gas, flammable liquid or explosive material manufactured or used in. a chemical reaction ? Y /~N ) 3. Is any reaction in 'question 1 or 2 a moderately or highly exothermic reaction ( e.g. alkylation esterfication, oxidation, nitration,~polymerization or condensation) or one involving electrolysis ? Y 4. Can any unplanned release of a AHM to the atmosphere result from the malfunction of any scrubbing, treatment or neutralization system or the discharge of a pressure relief system ? Y 5. Does any physical or ~chemical process in which an AHM is produced or used involve a batch process ? Y / ~ 6. Does any physical or chemical proCess involve the production or use of any AHM at a pressure in excess of 15 psig ? Y / 7. In excess of 275 psig ? Y / 8. Does any physical or chemical process involve the production or use of an AHM at a temperature above 125 degrees F ? Y 9. In excess of. 250 degrees ? Y 10. Can any explosive dust be present in any closed container within 100 feet of an AHM or otherwise be present in the same building as an AHM ? Y / 11~ Is there any ignition source or open flame within 100 ft. of any process, storage or transfer area where a flammable or explosive AHM is present , except where there is a firewall providing protection ? Y / 12. Is any lined or non-metallic pipe used in the transfer of any AHM ? Y / 13. Is any~equipment or piping handling any AHM more 10 years old ? Y PLEASE PROVIDE THE FOLLOWING INFORMATION : ( Attach additional pages if necessary) 1.. Your .company's current workers compensation ~il/% experience modification factor. 2. How many people occupy the building in which ~' AHM's are used or stored ? ~-~,~'~ ~ 3. Gibe details of all aCcidents which involved any hazardous material and all other instances when the fire department has been summoned in an emergency. 4. Briefly described the operations process at your plant and the specific processes utilizing'AHM's, including storage proceedures. 5. Briefly describe the equipment being used in the processes' involving AHMs. 6. Report quantity of AHM(s), referenced in the cover letter, that this business handles. a) Maximum amount on hand at any one time. b) Please attach a Material Safety Data Sheet for any material that is a mixture. Do not include MSDS for pure substances. DEMOGRAPHIC DATA: State the straight line distance in feet between the business property line and each of the following. 1. Nearest school. 2. Nearest daycare center, hospital, nursing home or similar facility. 3. Nearest residence/motel etc. \ 4. Nearest occupied building. Business Name: AddreSs I certify that the foregoing information is true and correct to ~th~//best of my knowledge. Signature: /~u~ ~// ' Title: ~ Corral ~[~4~ Date: ~/f~/~ -3- 02/27/92 K MART 215-000-001102 Page 1 Overall Site with 1 Fac. Unit General Information Location: 401 34TH ST Map: 103 Hazard: Low Community: BAKERSFIELD STATION 04 Grid: 19D F/U: 1 AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- KEN SEARS (805) 327-3094 x (805) 327-4436 Administrative Data Mail Addrs: 401 34TH ST D&B Number: 38-072-9500 City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-004 BAKERSFIELD STATION 04 SIC Code: 5399 Owner: K MART Phone: (805) 327-3097 Address: 401 34TH ST State: CA City: BAKERSFIELD Zip: 93301- Summary RECEIVED M~ fl 9 ~992 HAZ, UAT, DIV. I, _;J'- IP..,~,,, ~. Do hereby certily that I have revlewecl the attached hazardous materials m=nage- ment plan for k"v~,,'t 6'//~'Zand that it along with any corrections constitute a complete and correct man- agement plan for my facility. .. / s~n~mre - " rm. ' '~- / 02/27/92 K MART 215-000-001102 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 AEROSOL PAINT Liquid 140 High · Fire, Pressure, Reactive, Immed Hlth, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: 'AEROSOL/INFLATION Daily Max GAL I Daily Average GAL T Annual Amount GAL 140 I 70.00 ~ 1,000.00 Storage Press T Temp Location// PORT. PRESS. CYLINDER IABovo /AmBiontI~R'~'R ~X/// ' -- Conc Components MCP List 30'0% IAcet°ne IM°deratel 15.0% IToluene Moderate 25.0% IXylene, Mixed Moderate 16.0% IPropane Extreme 02-002 BLEACH Liquid 300 High · Fire, Reactive, Immed Hlth, Delay Hlth GAL CAS #: 7681-52-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: WASHING Daily Max GAL ~ Daily Average GAL T Annual Amount GAL 300 I 100.00 | 1,200.00 / Storage Press I Temp Location ~// PLASTIC CONTAINER AmbientlAmbientlSW CCn~:En-~ ~%~/~&~'~,3 -- Conc . Components MCP List 100.0% ISodium Hypochlorite High [ 02-003 INSECTICIDES Liquid 400 Unrated · Fire, Pressure, Reactive, Immed Hlth, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: INSECTICIDE Daily Max GALI Daily Average GAL I Annual Amount GAL 400 ~ 600..00 · 2,100.00 Storage~~Press T Temp Location PLASTIC CONTAINER IAmbient~AmbientlGaRDEN SHOP/HOUSEWARES -- Conc Components MCP List 100.0% Ilnsecticides IUnrated I 02/27/92 K MART 215-000-001102 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-004 HERBICIDES Liquid 200 Unrated · Fire, Reactive, Immed Hlth, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: HERBICIDE Daily Max GAL I Daily Average GAL I Annual Amount GAL 200 I 150.00 _ 828.00 Storage IIPress T Temp Location PLASTIC CONTAINER IAmbient~AmbientlGaRDEN SHOP -- Conc Components MCP List 100.0% IHerbicides IUnrated I 02-005 MURIATIC ACID Liquid 200 High · Fire, Reactive, Immed Hlth, Delay Hlth GAL CAS #: 764-70-10 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GALI Daily Average GAL I Annual Amount GAL 200 ~ 55.00 660.00 Storage Press T TempI Location PLASTIC CONTAINER AmbientlAmbientlGARDEN SHOP -- Conc Components MCP List 100.0% IMuriatic Acid High I 02-006 SULFURIC ACID Liquid 200 High · Fire, Reactive, Immed Hlth, Delay Hlth GAL CAS #: 7664-93-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GAL t Daily Average GAL I Annual Amount GAL -- 200 I 70.00 . 660.00 Press'T Temp I~~0~l . PLASTIcS~~NER IAmbient/Ambient ?t/'_ Conc MCP --TList ~1/ ~. ISulfuric ~cid (EPA~ Components [High ~EPA 02/27/92 K MART 215-000-001102 Page 4 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-007 F~EON R-12 Gas 600 Minimal · Fire, Pressure, Immed Hlth, .Delay Hlth FT3 CAS #: 75-71-8 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: COOLING Daily Max FT3 I Daily Average FT3 I Annual Amount FT3 600 ~ 1,500.00 2,142.00 Storage Press T Temp Location METAL CONTAINR-NONDRUM Above IAmbientlSE WALL -- Conc Components MCP List 100.0% 'Dichlorodifluoromethane Minimal I 02-008 ENGINE CLEANERS Liquid 300 Moderate · Fire, Pressure, Reactive, Immed Hlth,.Delay Hlth GAL CAS #: 803-03-06 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: CLEANING Daily Max GALI Daily Average GAL I Annual Amount GAL -- 300 I 150.00_ 2,000.00 StorageIIPress T Temp Location PLASTIC CONTAINER Iambient~AmbientlSE WALL -- Conc · Components M~P ---TList 80.0% IStoddard Solvent IModeratel 02-009 OIL Liquid 1500 Minimal~ · Fire, Immed Hlth, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GALI Daily Average GAL ] Annual Amount GAL · 1,500 ~ 1,000.00 5,000.00 StorageIIPress T Temp Location PLASTIC CONTAINER IAmbientlAmbientlSE WALL -- Conc Components MCP List 100.0% IMotor Oil, Petroleum Based IMinimal I 02/27/92 K MART 215-000-001102 Page 5 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-010 CO2 CANISTERS Gas 1000 Minimal · Fire, Pressure, Immed Hlth FT3 CAS #: 124-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max1,000FT3I~ Daily Average 814.00FT3 I Annual Amount 9,768.00FT3 -- Storage Press T Temp~ Location PORT. PRESS. CYLINDER Above ~AmbientIS WALL -- Conc Components MCP List 100.0% ICarbon Dioxide IMinimal I 02-011 HELIUM J Gas 350 Minimal · Fire, Pressure, Immed Hlth FT3 CAS #: 7440-59-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily Max FT3 Daily Average FT3 Annual Amount FT3 350 I 225.00 I 500.00 , Storage Press T Temp Location . ~/// PORT. PRESS. CYLINDER Above. lAmbient -- Conc Components I MCP List 100.0% IHelium .02-012 REFRIGERANT R-12 Gas 200 Minimal · Fire, Pressure, Immed Hlth FT3 CAS #: 75-71-8 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: COOLING Daily Max FT3I Daily Average FT3 I Annual Amount FT3 200 i 85.00 1,000.00 Storage Press T Temp Location PORT. PRESS. CYLINDER IAbove ~AmbientlSE CORNER -- Conc Components MCP ~List 100.0% IDichlorodifluoromethane IMinimal I 02/27/92 K ~RT 215-000-001102 Page 6 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-013 PAINT Liquid 1000 Moderate · Fire, Reactive, I~ed Hlth, Delay Hlth GAL CAS #: 803-03-06 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: PAINTING Daily Max GAL I Daily Average GAL I Annual Amount GAL -- 1,000 ~ 2,000.00 10,000.00 Storage Press T Temp Location /' METAL CONTAINR-NONDRUMIAmDiontlamDientI~E-~R~ -- Conc Components MCP List 25.0% Mineral Spirits IModeratel 15.0% Naphtha Moderate 5.0% Methyl Ethyl Ketone Moderate 3.0%. Ethylene Glycol Low 02-014 GUM TERPENTINE Liquid 200 Moderate · Fire, Reactive, Immed Hlth, Delay Hlth GAL CAS #: 800-66-42 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: PAINTING Daily Max GAL I Daily Average GAL ~ Annual Amount GAL 200 I 100.00 . 500.00 Storage Press T Temp Locati~ METAL CONTAINR-NONDRUMIAmbientlAmbientl~o~c~_ -- Conc Components MCP List 100.0% [Turpentine IModeratel 02-015 CHARCOAL LIGHTER FLUID Liquid 200 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 800-66-42 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CATALYST Daily Max GAL Daily Average GAL Annual Amount GAL 200 I 100.00 I 5..00.00 _ / Storage I Press T Temp I Lo ation / P~ASTIC CONTAINER IAmbient~Ambientl~--~R~- -- Conc Components . CP List 100.0% IPetroleum Naphtha ModerateI 02/27/92 K MART 215-000-001102 Page 7 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-016 COLEMAN CAMP FUEL Liquid 600 Low · Fire, Immed Hlth, Delay Hlth GAL CAS #: 800-66-42 ~Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CATALYST Daily Max GAL I Daily Average GAL ~ Annual Amount GAL -- 600 I 300.00 ! 1,000.00 Storage Press T Temp Loc METAL CONTAINR-NONDRUMIAmbient~Ambient~--WA~ -- Conc Components MCP List 100.0% {Petroleum Unrefined Hydrocarbons IL°w I 02-017 PROPANE Gas 500 High · Fire, Pressure, Immed Hlth, Delay Hlth FT3 CAS #: 74-98-6 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: FUEL Daily Max FT3I Daily Average FT3 I Annual Amount FT3 500 {- 500.00 1,500.00 Storage I Press T Temp I Location FIXED PRESS. CYLINDER Above ~Ambient SE CORNER OF STORE OUTSIDE -- Conc Components MCP List 100.0% IPropane IExtreme I 02-018 ANTIFREEZE Liquid 200. Low · Fire, Immed Hlth, Delay Hlth GAL CAS #: 107-21-1 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: COOLANT/ANTIFREEZE Daily Max GALI Daily Average GAL I Annual Amount GAL -- 200 ~ 100.00 1,000.00 Storage Press T TempI Location PLASTIC CONTAINER Ambient~AmbientlS WALL -- Conc Components ' MCP List 100.0% IEthylene Glycol IL°w I 02/27/92 K MART 215-000-001102 Page 8 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL ~11 <2> Employee Notif./Evacuation NOTIFICATION AND'EVACUATION BY P.A. SYSTEM AND DEPT SALES FLOOR HELP IF FIRE IS UNCONTROLABLE AT STORE LEVEL. NOTIFICATION IS DONE VERBALLY IF'FIRE CAN BE HANDLED BY EMERGENCY RESPONSE TEAM. P.A. SYSTEM AND BY HOUSE PHONE SYSTEM FOR RELEASE OR SPILLAGE OF HAZARDOUS MATERIALS, CUSTOMER EVACUATION BY P.A. SYSTEM CUSTOMERS WILL BE REQUESTED TO LEAVE BY THE CLOSET EMERGENCY EXIT OPPOSITE THE SPILL OR RELEASE. <3> Public Notif./Evacuation PUBLIC EVACUATION TO BE HANDLED BY PUBLIC ADDRESS SYSTEM AND MEMBERS OF THE MANAGEMENT TEAM. THE AREA OF THE SPILL OR RELEASE WILL BE ISOLATED UNTIL DETERMINATION OF MATERIALS CAN BE MADE. IF HAZARD LEVEL IS LOW THEN CLEAN UP WILL BE MADE AT STORE LEVEL. IF HAZARD LEVEL IS MODERATE OR HIGH THEN 911 EMERGENCY NUMBER WILL BE USED. ANY DECISION OF SEVERITY WILL BE BASED ON CONSULTATION WITH MSDS SHEETS OR BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION. <4> Emergency Medical Plan 2A SEC ~5) MEMORIAL HOSPITAL - 420 34TH ST - 327-1792 02/27/92 K MART 215-000-001102 Pag9 9 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ALL MERCHANDISE PACKAGED AND STORED FOR RETAIL SALES IN SMALL QUANTITIES ON SALES FLOOR. <2> Release Containment <3> Clean Up IN CASES OF SMALL SPILLS, ABSORBENT (SAND OR KITTY LITTER) IS AVAILABLE, ALONG WITH PROTECTIVE CLOTHING - CLASS EDUCATIONON HANDLING OF HAZARDOUS MATERIALS AND AVILABILITY OF MSDS TO ALL EMPLOYEES AVAILABLE. <4> Other Resource Activation 02/27/92 K MART 215-000-001102 Page 10 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards AMMUNITION AT REAR OF STORE IN SPORTING GOODS. <2> Utility Shut-Offs A) GAS - ON TOP OF PROPANE TANK B) ELECTRICAL - ELECTRICAL ROOM C) WATER - RECEIVING ROOM MAIN STOCKROOM D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - OVERHEAD SPRINKLER SYSTEM ON A SUPERVISED ALARM SYSTEM. BAKERSFIELD FIRE DEPARTMENT NOTIFIED BY ALARM MONITORING COMPANY UPON ANY RELEASE FROM SPRINKLER SYSTEM. HAND HELD FIRE EXTINGUISHERS LOCATED ON SALES FLOOR AND STOCKROOM AREA. FIRE HYDRANT - AT FRONT OF STORE AND AT NORTHWEST CORNER OF PARKING LOT <4> Building Occupancy Level 02/27/92 K MART 215-000-001102 Page 11 00 - Overall Site <G> Training <1> Page 1 WE HAVE 125 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: TRAINING WILL BE A SEMI FORMAL CLASSROOM SETTING WITH VERBAL, WRITTEN AND VIDEO AIDS. NEW EMPLOYEES WILL BE GIVEN INITIAL TRAINING AT HIRE AND ADDITIONAL TRAINING SHOULD BE ASSIGNED TO WORK IN A DEPARTMENT THAT ROUTINELY HANDLES HAZARDOUS MATERIALS. REFRESHER COURSES WILL BE GIVEN EVERY 6 MONTHS. <2> Page 2 as needed <3> Held for Future'Use <4> Held for Future Use INSTRUCTIONS; Superscripts: 1. Quantities for RMPP compliance are "equal to or greater than" the minimum criteria and apply to chemicals handled "at any one time". 2. Businesses handling reportable quantities of Acutely Hazardous Materials that have not submitted a business plan MUST contact local Administering Agencies. The business plan submission date will assure the Administering Agency that a business plan has been submitted and is on title. This will also immediately identify businesses that have not submitted business plans. 3. "Process Designation" is provided as a reporting option (with the approval of the Administering Agency) for facilities that can most easily report by process. Thus, facility RMPP registration data could be submitted in a similar format to a business plan that is divided by process. "By process" data can initiate an emergency response to a process incident raflu~ llum a general emergency response to a major facility. Process designation can simplify inspections for major facilities and improve future emergency response. 4. Refer to the EPA list of Extremely Hazardous Substances from the Federal Register (Volume 52, No. 77, p. 13397 et. sea_., April 22, 1987). Each chemical has a threshold planning quantity. This list may be changed by EPA on an annual basis. Updates of this list may be available early in 1988. To comply with this element, you may attach a copy of the inventory submitted to your Administering Agency from your business plan and highlight all Acutely ....... ~us-Materials. It~s-rb. cbrtahended thal-facilifi~s-li~t tflJ~kti'Emei-~ 1~7~rdohS Chemicals hahdled in quantities equal to or in excess of 1) 500 pounds, and 2) any EPA threshold planning quantity less than 500 pounds. 5. Do not include Trade Secret information in these descriptions. Genera[: For emergency response pmlx)ses, it would be desirable to describe the following to the Administering Agency: 1. Batch Process: a. What raw materials? b. What operating pressure range? c. What operating temper~,~ range? d. Batch capacity rating? e. Product characteristics? (e.g., chemical stae, flammability, toxicity, etc.) f. Critical grocess points and characteristics? 2. Continuous process: ('.similar information as above.) NOTE: "Pursuant to §25534, Ihe Administering Agency may require the submission of a Risk Management Prevention Program (RMPP), if the ,a, dmlni~ Agency determines that file handler's ~ may present an acutely hazardous materials accident risk. The handler shall prepare the RMPP in accordance with subdivision (c) lot §25534]. The RMPP shall be lneinred within 12 months following the request made by ~ Administering Agency pursuant to this section." (§ 25534 (a) I-~ea~th and Safety Code) An amendment to the RMPP must be submitted to the Administering Agency within 30 days of: 1. Any additional handling of acutely hazardous materials. 3. Change of address, business ownership, or business name. (§ 25533 (c) Health & Safety Code) · EVERY BUSINESS REQUIRED TO SUBMIT AN RMPP SHALL IMPLEMENT THE APPROVED RMPP · California Office of Emergency Services FORM HM 3777 (1-15-88) ACUTELY HAZARDOUS MATERIALS REGISTRATION FORM THIS FORM MUST BE COMPLETED BY THE OWNER OR OPERATOR OF EACH BUSINESS IN CALIFORNIA WHICH AT ANY TIME HANDLES ANY ACUTELY HAZARDOUS MATERIAL IN QU .ANTITIES GREATER THAN $00 POUNDS, 55 GALLONS OR 200 CUBIC FEET OF GAS AT STP. 1 THIS FORM SHALL BE COMPLETED AND SUBM1TIED TO YOUR LOCAL ADMINISTERING AGENCY. (§25533 & 25536 Health & Safety Code) I~ E C E I V E: [] Note Instructions on reverse Business Name I~:- I~ ~ t~'C' An~'d ............ Business Site Address "lbl ~cI'F-H---ST'. "~K~SF~X?.~-Lt.~ Business Mailing Address (if different) ~'-,~, Business Phone ,.'~.f~ -,~ E) 9~/ Business Plan Submission Date2/C/&T/~''' Process Designation3 ACUTI~LY HAZARDOUS MATERIALS HANDLED4 -USE ADDITIONAL PAGES IF NECESSARY- CHEMICAL NAME QUANTITY GENERAL DESCRIPTION OF PROCESSES AND PRINCIPAL EQUIPMENTS: SIG NATU R F.~~~x ~~_.-~ ~,.~ TITLE ~.~ PRINTED NAME ~'Tu/',',',V ('~q,~/--cc'~ DATE California Office of Emergency Services FORM HM 3777 (1-15-88) May 1 ~ 1990 Dear Busir~ess Mar~ager: The following questionnaire is a supplement to the Acutely Hazardous Materials Registration Form previously submitted by your business as required under Section 25534 of the California Health & Safety Code. This registration indicates tha~_~K'Mart] handles ~ulfuric acid,~)an acutely hazardous material ( AHM ), in an amount greater than the planning quantity for this chemical. Additional information is necessary in order to complete the risk management planning functions of this~ agency. ]'his questionnaire should be completed by an officer of the company or other person having substantial management control over all operations at the facility. If there is any doubt as to whether or not the answer to a question is yes or no~ the answer "yes" shall be given. With in two weeks of receipt, complete and return the questionnaire to: The Bakersfield Fire Department Hazardous Materials Division 2130 G Street Bakersfield, CA 93301 If you need additional information, please call 326-3979. S i ncere 1 y, Barbara Brenner Hazardous Materials Plar~ning Technician Q Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed Business Name: fi' - ~e-U Location: ~o/ $~' ~ 0~[ 0 ~ 1989 Plan ID # 215-000//0 Z.-- (Top right comer Business Plan) ~,AZ. MAT. ~DIV, Station No. 4- Shift ~ Inspector. Adequate Inadequate Verification of Inventory Materials [~ [] Verification of Quantities [] Verification of Location ~] [--] Proper Segregation of Material ~] Comments: ~ ~,~:~- ~ ~oo ~. --~o Verification of MSDS Availability Number of Employees Verification of Haz Mat Training Verification of Abatement Supplies & Procedures ~] [~] Comments: EmergencyProcedures Posted y)~] [~] Containers Properly Labeled Comrnexlts: Verification of Facility Diagram ~I {~ Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office !*c~-oe or Dr±n*~ namei · . .~,e'd attached Hazar4ous F1a~er~a~s business ~lan f'o ~ ~///~ T lname of business l [[~ I and that it along with the attached additionsHA~,M.AT, OiV' or cor]?ections constitute a complete and correct Business Plan for my facility. _ date ~USINESS NAME K HARTI~F ID ZJS-OOO-GGllOZ LOCATION 401 3~TH ST HIGH HAZARD RATING Z 1, OVERVIEW ' [.'ASTCH~NGE G'2'/Z~£88 BYESTER SURIS CODE ZTS-004 JURIS BARERSF~ELD S'rATL"ON 04 .... MAP PAGE 105 GRIg 190 "' FACI'EITT~U~I~[S'! HAZARD RATING RESPONSE SUMMARY ZA SEC; 4.)' (ATTACHMENT) MALE' EMPLOYEES SHO{JLD RESPOND TO THE AREA WITH AVRILAALE FIRE EX'TINGUISHERS. MANAGEMENT WILL TAKE CHAF~SE ANO AOVISE IF FIRE DEP'¥ IS NEEDED. OEPT PERS'ONNEL"SMOU[O"STATI'ON THEMSELVES AT '[HE NEAREST EXIT AND CONTROl. THE'EXIT. SEN'IOR'PE~SONNEL SHOULO GIVE APPROPRIATE DIRECTION AS REQUIREO. IF THE STORE IS TO BE EVACUATED, MANAGEMENT WILL. MAI(E THE OECIStON AND ANNOUNCEMENT.- EMERGENCY CONTACTS 2A SEC Z) TED SISCO - 3Z?-3094 OR KEN SEARS UTILITY SHUTOFFS R) GAS - ON TOP OF PROPANE TANK '8)'E~LYCTRICAL ='ELECTRICAL ROOM C) WATER - RECEIVING ROOM MAIN STI]CI(R'OOM' O)".SPEC[RL - NONE E) LOCK 80X - NO Z. NOTIFICATION / PUBLIC EVACUATION LRSI"CHANGE / / BY < NO INFORMATION RECORDED FOR"TFilS SECTION > PAGE I 1Z/19/88 11:37 HRTERIRL-SAFETY ~]RTR "SYSTEHS ,' I NC ' ("BUS)' "GZ~B= BB(~iD LOCATION 401 34TH ST HIGH HAZARD RATING 2 3. HAZ MAT TRAINING ~UMMARY LAST CHANGE / / BY ~ ~00 ~ ~ ' < NO' INFOR~R~ION'~C~OED'~FO~'~TR'IS'sECTION > 4. LOCAL EMERGENCY MEDICAl. flS'SiSTRNCE [RST'CRRNGEOT/Zg/88 BY ESTER SEC 5) MEMORIAL HOSPITAL -- 420 ~4'FH S'¥"- 327-1792 PRGE 2 1Z/l~/OB 11:~7 MflTERIRL SAFETY 'Dfl-FR SY'STEMS,"%NC.'('BOS) B4B-G800 BUSINESS NAME K ID NU Z1$-OOO-(~2HIOZ 'LOCATION 401 34TH ST HIGH HAZARD RATING Z FACILITY UNIT 01 R. OVERALL HAZARDOUS MATER~RI~S"IN~ENTORY ..... LRST"CHRNGE' 087'ZG/88 BY ESTER ID TYPE NAME " MAX AMT UNIT HAZARD LOCATION CO~F~rNMENT USE' 1 MIXTURE AEROSOUS (SPRAY'P~tNT) "70 GAL EXTREME HARDWARE ~' PORTABLE-PRESS;CY[. PAINTING ID PERCENT COMPONENTS HRZRRD LIST t~6.00 30.0 ACETONE ....... HIGH 1118.00 ZS.O XYLENE, 'MIXED HIGH 1155.0Z 16,0 PROPANE .... EXTREME 1130,00 15.0 TOLUENE HIGH 2 PURE BLEACH ....... 60 GAL UNKNOWN HOUSE~ARES PLASTIC CONTAINER[SI CLEANING ID PERCENT COMPONENTS- HAZARD LIST 1tG5.00 100.0 SODIUM'HYPOCHLORITE UNKNOUN ~ MIXTURE MIXED REROSOL"CRN~~' 1350 FT3 UNKNOUN 08/ HOUSEUARES/COSMETIC$ PORTABLE 'PRESS~ CYL. AEROSOL ID PERCENT COMPONENTS~''' HAZARD L. IST 4 PURE INSECTICIDES Z00 GAL. UNKNOWN GARDEN SHOP/HOUSEgRRES PLRSTI'C' CONTRINER['SI' INSECTICIDE ID PERCENT COMPONENTS HAZARD LIST · .-105G.00 100.0 INSEC'FICID~ UNI<NOgN S PURE HERBICIDES 150 GAL UNKNOWN ORRDEN SHOP PLRSTI'C"CONTAINERES~ HERBICIDE ID PERCENT COMPONENTS '~' HAZARD LIST. -1057.00 100.0 HERBI"L-~OES UNKNOWN 6 PURE MURIATIC ACID 55 GAL HIGH GARDEN SHOP ~ERSTIC"CONTRINE. R[S7 CLEANING ID PERCENT COMPONENTS HAZARD LIST 1078.02 100,,0 MU'R~T~C"~C~D' HIGH 7 PURE SULFURIC ACID 70 GAL HIGH GARDEN SHOP PLASTIC CONTaINER[SI CLEANING ID PERCENT COMPONENTS HAZARD LIST 10'7G.00 100.0 SULFURIC ACID'(EPA) .... HIGH EP 8 PURE FREON R-t~ ZI4Z FT3 LO~ A~JTOMOTIVE FORTRBLE'RRE'S'~. CYE. COOLING ID PERCENT COMPONENTS HAZARD LIST PAGE ~ .... 1ZTYB'/"88 11': 3'7' MATERIAL SAFETY 'DATR'"'S¥STEMS, 'I'NC. "(-BUS) G48-G800 BUSINESS NAME K MART~ ID 21$-000-00110Z LOCATION 401 ~4'¥H ST HIGH HAZARD RATING 2 FACILITY UNIT 0t A. OVERALL HAZARDOUS MATERIALS INVENTORY < * CONTINUED ~ ) L~ST'CH~NGE'~O'8'FZ~/88' 8¥"ESTER' ID TYPE NAME MAX AMT UNIT HAZARD L. OC AT I ON CONT~I'NMENT USE 8 PURE FREON R-I~ 25'4Z FT3 LOW ( * CONTINUED * ~ .... ID PERCENT COMPONENTS~' HAZARD LIST 108G,~q) 100.0 DICHLORODIFLUOROMETHANE LOW 9 MI)(TURE ENGINE CLEANERS 150 GAL HIGH AUTOMOTIVE PLASTIC CONTAINER[S] CLEANING ID PERCENT COMPONENTS HAZARD LIST , o .osSTOOO RO SOLVENT , EXTREME t0 PURE OIL '- / ~ 588 GRL UNKNOWN 8UTOMOTIVE '"PE'~STIC CONTaINER[SI LUBRICnNT I0 PERCENT COMPONENTS' HAZARD LIST 2888.8~ 1~,8 MOTOR OIL UNKNOWN Il PURE COZ CANISTERS 814 FT3 LOW C~FETERIA/DELI, FIXED'~E~S.T~NKS OTHER ID PERCENT COMPONE'~' HAZARD LIST 1Z PURE HELIUM ZZS FT3 UNKNOWN SERVICE DESK 'FIXEO'PRESS.'I'ANKS OTHER I0 PERCENT COMPO~T~" HAZ~O LIST Z8~'7.~8 188.~ HELIUM UNKNOWN 3. PURE REFRIGERANT R-12 8S FT~ LOW EPPLI~NCE/HAROWARE/STOCK PORTABLE P~ESS. CYL. COOLING I0 PERCENT COMPONENTS HAZARD LIST 188G.88 188.~ DICHLORODiFLUOROMETHANE LOW ]4 MIXTURE PAINT ZG~ GAL EXTREME HOME CENTER METAL ~NT~I'NERS 'PAINTING ID PERCENT COMPONENTS HAZARD LIST ~83.87 2S.~ MINERAL SPIRITS EXTRE~ 1Z8~,~ 1S,~ N~PHTHA EXTREME ~]48,88 S.~ METHYL ETHYL KETONE HIGH Z882,~. 3,8 ETHYLENE'GlYCOL UNKNOWN lB PURE GUM TERPENTINE BS G~L HIGH HOME CENTER METAL CONTAINERS PGINTING ID PERCENT COMPONENTS ..... HAZARD LIST P~GE 4 ..... 1~/1918B 11:5'7 MRl'ERIRI.-S~FETY'"DATA'SYSTEMS,'INC."~'BOS')"S~B~6800 BUSINESS NAME K MART I0 Z1S-OOO-~4~I10Z °LOCATION 401 34TH ST HIGH HAZARD RATING Z FACILITY UNIT 01 OVERALL~ HAZARDOUS MATERIALS INVENTORY ( * CONTINUED * )'~[RS~'CHRNGE 08£Z~£8~ B~'ESTE. R ID TYPE NAME MR)( AMT UNIT HAZARD LOCATION .... CONTRINPETNT' US~ 15 PURE GUM 'TERPENTI~E SS G~L HIGH ( ~ CONI'INU~D'~ ) ID PERCENT COMPONENTS' HAZARD LIST Z666.00 100.0 TDRPENTINE -- HIGH Boo- z PURE C HARC O~L" L [GH'rl~Rr' FI OIO .... 350 GAL EXTREME BAILING ROOM PLRS¢~C 'CONT~INER£ Si CATALYST ID PERCENT COMPQNENTS' HAZARD LIST ~03.0~ 100.0 PETROLEUM NAPHTHA EXTREME FiRE PROTECTION / WftTER'SZIPPEIES' L~ST"CHFINGE' '/ / ' BY ( N0 INFO~MATI'0N'RECO~"FOR T~IS SEC-fION >' PAGE 5 lZ/t9/88 11:'~? MAI'ERI AL SPIFE'T¥ 'I]FFFA 'SYSTEMS ," 'lNg. ('8g)S') '"B48- GB'00 BUSINESS NF~ME K M~RT ID 21S-000-00110Z LOCflTION 40! Z~4TH ST HIGH HfZ~RD R~TING 2 D. EMPLOYEE NOTIFICfiTION / EVaCUaTION LF.~St' CHANGE O7/Z9/88 BY ESTER '! ~P~ SEC Z) NOTIFICflTION fNO EVRCUfTION'BY P.a. SYSTEM RND OEPT SP~LES FLOOR i HELP IF FIRE IS' UNCON'TROL'flBLE P~T' STORE' LEVEl .... NOTIFICP, TION IS DONE VERBRLLY IF' FI'RE CF~N "BE H'FtNDLED BY 'EMERGENCY RESPONSE lEaH, E. MITIGF~TION / PREVENTION"2" flBF~TEMENT ' ,',-,~ ,~:- .., ,. LE~T 'CFi~NGE 07/Zff/8'FY BY ESTER ,-58 SEC 1) fLL MERCHANDISE PfCKfGED RIND STORED FOR REI'fIL SSL. ES IN SM~LL. QUANTITIES ON SflL'ES"FLOOR:~ PaGE B 12/t9/88 11:3'7 MRTERIRL SRFE'T'F' F]~TH 'SYSTEMS, INC". ' ( 80~)' B48-BS~ 40UTELY HAZ4ROOUS MATERIALS REGISTRATION AND RISK M6NAGEMENT ~NO PREVENTION PROGRAM GHEOK LIST 3. R.M.P,P. REQUESTED s. R.~.P,P. ~PROV~O 6. R.M,P.P, INSPEO~ION ..... COMMENTS:, BUSINESS N~ME'- I.D. NUMBER CARE" FIRE DEPARTMENT 2101 H STREET D. S. NEEDHAM BAKERSFIELD, 93301 FIRE CHIEF 326-3911 April 12, 1989 K-Mart 401 34th Street Bakersfield, Ca. 93301 Dear Business Owner: The enclosed "Acutely Hazardous Materials Registration Form" must be completed by any business, handling above the minimum reporting quantity of any material on the EPA list of Extremely Hazardous Substances. (Fed. Register Vol. 52, No 77, P. 13397). Your company has reported handling the following Acutely Hazardous Materials: SULFURIC ACID Please return the completed Acutely Hazardous Materials Registration Form to: Bakersfield City Fire Department Hazardous Materials Division 2130 G STreet Bakersfield, Ca. 93301 If you have any questions regarding this form please call Duane Meadows or Ralph Huey at 326-3979. Duane ~~' Hazardous Material Planning Technician DJM/ed AHMREG.FOR _ Bakersfield Fire Dept. RISKMANAGEMENT AND PREVENTION PROGRAM CHECK LIST 2. A.H.M. RE~EZ~TED ~'l~-~r· 3. R.M.P.P. REQUESTED 4. R.M.P.P. REVIEWED 5. R.M.P.P. APPROVED 6. R.M.P.P. INSPECTION COMMENTS: BUSINESS NAME I. DNUMBER CITY of BAKERSFIELD ,,.¢- . FIRE DEPARTMENT D. S. NEEDHAM ~?- ~, ~ ~ ~ © ~101 H STREET BAKERSFIELD, 93301 FIRE CHIEF 326-3911 Dear Business Owner: The enclosed "Acutely Hazardous Materials Registration Form" must be completed by any business, handling above the minimum reporting quantity of any material on the EPA list of extremely hazardous substances. (Federal Register Volume 52, No. 77, P. 13397). Your company has reported handling the following acutely hazardous material: Sulfuric Acid Please return the comoleted Acutely Hazardous Materials Registration Form to: Hazardous Materials Division 2130 G Street Bakersfield, CA 93301 If you have any questions regarding this form please call Barbara Brenner at 326-3979. Sincerely, Barbara Brenner Hazardous Materials Planning Technician BB/ed Encl. ,< HAZARDOUS NTORY - .~..-.'--' ....r.-:; _. '/~?.;.., ...~ 8USINKS9 NAME: ~~ OMNER NAME: ':" ) ':.' ~:~'?.:;-/.:~:~}2'~::~.): ......... ':j"~':.?':'~' :~ '"' FAciLiTYf~NI~ ADDRESS: Hot ~%m ~- ADDRESS: " :'.. ' FACIL.ITY... . . .. UNI~ NAME'S, CITY, ZIP :~~ ~ CITY,ZIP: · ; ..... ' ......... ~ ..... PHONE ~: ,~-~O~q' PHONE ~: ~ =" '" 'R-: ~' ' O~FICIAL USE.~.CFIRS CODE .... =.-. .?L'~j .'j_', HAZARD ,'O T PYPE MAX ANNUAL CONT USE LOCATION iN THIS · BY ..:. ".. :.~:. .... ~- ~DE AMOUNT AMOUNY UNIT CODE CODE .FACILIT~ OW,IT. MT, ~CHEWICAL OR COMMON NAME '- ~"' 'COD~.. ,OOlOB -' , · · ' . ;-; .... ' ". :- '"' ~~-' 0~.~ ' ~.' -. . . .... : ~ · ,, ,,-. '. .~~-, ~ERGENCT cONTACT~ TITLE: · BUS HOURS:'~ '~ERGENCV CONTACT: ~ ~~ TITLE: O%N- '~&~t-~' ' PHONS t 8US' HOURS= RINCIPAL BUSINESS ACTIVITY: C~tm: ~~. S~ (~~ · APTER BUS HRS: ' ..,. .~ ~.~..: .: . .~.--,-.- -~. ... .~. BAHERSFIKLD CITY ,Filth EPAUTJlKJlT~'[~'t' ~ ; 9:" ' ADDRESS: ADDRESS: " FACILITY. UNIT NAMK'.. CITY. ZIP: CITY,ZIP: ': :"'" ' PHONE ~: PHONE ~: F' - )FPICIAL .~$E :CFZR$ CODE 1 ..... 2 ~-. 3- 4 5 6 : ~ 8 . ~ :~:--" , . YPS NAX ANNUAL CONT USE LOCATION IN THIS · BY ....... '~-"~..:. ~ .... :"';'~ ........ '~"~'" HAZARD D.'O.T ODE ANOUNT A~OUNT UNIT CODE CODE FACILITY UNIT,,, ., MT. .CHENIcAL 0R COMMON ~AM~' '~ CODE GUID~ " : i . ' ': " "L' · ~' ; '-.,,':'"=": . '~ "~.-':', /" ~ ' ': : ": ': ~;"':' ' ' _ -~. - , ~ ~ ~' :' - "z ." ; "- "4 ' '., - · '.~.: ~ ' :~ -/ -L ' :i.' ' .'- / ...... ,: .... . : ',' . . _.'. . , :. , . Z ~ ::,~- ~ ..,]'~': ., . : : - - ~.' .. : -. . :~ ~ .:.. . i ' .~. : · .. '~ ..... -.. · ~,~ 1~.[ :.~ ~T3 5~1 )0_ .. 'u~,zn,~ee - "_2 ........ ~~-~ eo~'c~}'. ''''~ ..... ''~. ~:~:' _,_,. ~ME: TITLE: ':. SIGNATURE.: : DATE': ' ' ~ERGENCV coNTACTi TITLE: PHONK · BUS HOURS: AFTER BUS HRS: ~ERGENCY CONTACT: TITLE: ' PHONK 8 BUS HOURS~ ~NCIPAL BUSINESS ACTIVITY: ADDRESS: ADDRESS: ** ~ , FACILITY UNIT NAME:**'~*-* PHONE ~:. . , PHONE ~: *.*" ~** OFFICIAL .USE *CFIRS CODE ;YPK, MAX ANNUAL ~CONT USE LOCATION IN THIS · BY *-~' ~*'~** ** .... ..:'~ .... *'; ~*:.. ........ ~ ,=:*,. HAZARD D,O.T ~DE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT. MT. CHEMICAL, 0R COMMON HAME -*~ *,CODE GUIDE ." .: ;.;. - . , - ............. .- . AME: TITLE: SIGNATURE.~ .... ** DATE: .~ERGENCY CONTACT~ TITLE; PHONE $ BUS HOURS: , . ~: . - AFTER BUS HRS~ ~ERGENCV coNTACT: ~ '* TITLE:~ --. PHONE ~ BUS HOURS*' ~INCIPAL BUSINESS ACTIVITY: ACUTELY HAZARDOUS MATERIALS REGISTRATION FORM TI-IlS FORM MUST BE COMPLETED BY THE OWNER OR OPERATOR OF EACH BUSINESS IN CALIFORNIA WHICH AT ANY TIME HANDLES ANY ACUTELY HAZARDOUS MATERIAL IN QUA~NTrIIES GREATER THAN 500 POUNDS, 55 GALLONS OR 200 CUBIC FEET OF GAS AT STP. ~ THIS FORM SHAI.L BE COMPLETED AND SUBMITTED TO YOUR LOCAL ADMINISTERING AGENCY. (§25533 & 25536 Hemlfll & Safct~ Code) Note Instructions on reverse eullness Name ~'- )'~ Fir"r- ~_r~rp, ,, Business rata Address .... ~/O/ ~ y/ Business Mailing Address (If different) Bulinesl Phone ~,o~- ~-.~*~ - ~o9/~ Business Plan Submission Date2 Proc~$ Designation3 ACUTELY HAZARDOUS MATERIALS HANDLE~)4 -USE ADDITIONAL PAGES IF NECESSARY- CHEMICAL NAME QUALITY GENERAL DESCRIPTION OF PROCESSES AND PRINCIPAL EQUIPMENTS: California Office of Emergency Servic~i FORM HM 3777 (1-15-88) ~ OCTOBER 12, 1988 DEAR MR. KEN SEARS; NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YOUR BUSINESS "K ~ART", LOCATED AT 401 34th STREET, BAKERSFIELD'~ CA 93301 ON 0CT.-12 THE FOLLOWING HAZARDOUS MATERIALS REGULATION VIOLATIONS WERE IDENTIFIED: 1) SEVERAL HAZARDOUS MATERIALS PRESENT WERE NOT INCLUDED IN YOUR BUSINESS PLAN INVENTORY, THESE INCLUDE BUT ARE NOT LIMITED TO (WASTE OIL, LIQUID POOL CHLORINE, COMPRESSED OXYGEN ) VIOLATION OF CH. 6.96 CALIFORNIA HEALTH ~& SAFETY CODE 25509(A)(1.-4) The annual inventory form shall .include, but shall not be limited to, information on all of the following which are handled in quantities equal to or greater than the quantities ~pecified in subdivision (a) of Section 25503.5: (1) A listing of the chemical name and common names of every hazardous substance or chemical product handled by the business. (2) The category of waste, including the general chemical and mineral composition of the waste listed by probable maximum and minimum concentrations, of every hazardous waste handled by the business. (3) A listing of the chemical name and common names of every other hazardous material or mixture containing a hazardous material handled by the business which is not otherwise listed pursuant to paragraph (1) or (2). ' (4) The maximum amount of each hazardous material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) ·which is handled at any one time by the business over the course of the year. THIS INFORMATION MUST BE MAINTAINED CURRENT. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.2§50§ (b) In addition to the requirements of Section 25510, whenever a substantial change in the handler's operations occurs which requires a modification of its business plan, the handler shall submit a copy of the plan revision to the administering agency within 30 days of the operational change. (c) The handler shall, in any case, review the business plan, submitted pursuant' to sUbdivisions (a) " and (b), on or before January 1, 1988,' and at least once every two years thereafter, to determine if a revision -is needed and shall certify to the administering agency "/""' "that the review was made and that any necessary changes were made to the plan, A copy of these changes shall be submitted to the administering agency as part of this (d) Unless exempted from the business plan requirements under this chapter, any business which - handles a hazardous material shall annually submit a completed inventory .form to the administering agency of the county or city in which the business-is located. ' Notwithstanding any other provisions of the law, an .. inventory form shall be filed on or before January 1,. -':-~ . 1988, for the 1988 calendar year, and annually' " thereafter.. Thi~ inventory shall be filed annually, notwithstanding the review requirements of subdivision (c). 2) WASTE OIL CONTAINER NOT PROPERLY LABELED. VIOLATION OF OSHA 1910.1200 (1) The chemical manufacturer, importer, or distributor shall ensure that each container of hazardous chemicals leaving the workplace is labeled, tagged or marked with the following information: (i)Identity of the hazardous chemical(s). (ii)Appropriate hazard warnings; and (iii)Name and address,of the chemical manufacturer, importer, or other responsible party. (41 Except as provided in paragraphs (3~ and (4) the employer shall ensure that each container of hazardous chemicals in the workplace is labeled, tagged, or marked with the following information: (i)Identity of the hazardous chemical(s) contained therein; and (ii)Appropriate hazard warnings. (5) The employer may use signs, placards, process sheets, batch tickets, operating procedures, or other such written materials in lieu of affixing labels to individual stationary process containers, as long as the ~lternative method identifies the containers to which it is applicable and conveys the information required by paragraph (2) of this section to be on label. The written materials shall be readily .accessible to the employees in their work area throughout each work shift. , ~ (7) The employer shall not remove of deface · · "~existing labels on incoming containers of hazardous''~''~' chemicals, unless the container is immediately marked with the required information. '~"~'~!~'~'L (8) The employer shall ensure that labels or other forms of warnings are legible, in English, and ': ...-' prominently displayed on the container, or readily available in the work area throughout each work shift. Employers having employees who speak other'languages may ~ ' ' add the information in their language to the material presented, as long as the information.is presented in '~: · . English as well. .. , .~.~ 3) BATTERY ACID,. PRO[ANE, AND CAMPER FUEL UNDERSTATED IN INVENTORY VIOLATION OF CH. 6.96 CALIFORNIA HEALTH & SAFETY CODE 25509(A)(4) The annual inventory form shall include, but shall not be limited to, information on all of the following which are handled in ~uantities equal to or greater than the quantities specified in subdivision (a) of Section 25503.5: (4) The maximum amount of each hazardous material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which is handled at any one time by the business over the course of the year. 4) COMPRESSED GAS CYLINDERS (HELIU~ LOCATED AT THE INFORMATION COUNTER AND CARBON DIOXIDE LOCATED IN THE BAILING ROOM) NOT PROPERLY STORED. VIOLATION OF UFC 74.107 (a) General. Ail compressed gas cylinders in service or in storage shall be adequately secured to prevent failing or being knocked over. EXCEPTIONS: (1) Compressed gas cylinders in the process of examination, servicing and refilling are exempt from this section. (2) Medical gas cylinders may be stored and used in the horizontal position in accordance with nationally recognized standards. 5) MATERIAL SAFETY DATA SHEETS NOT AVAILABLE IN THE AUTO REPAIR AREA VIOLATION OF OSHA 1910.1200. ' :' (g) The employer shall maintain copies of'the -required material safety data sheets for each hazardous chemical in the workplace, and shall ensure that they are readily accessible during each work shift to employees when they are in their work area(s) "" (h)(1) INFORMATION ~mployees shall be informed Of: (i)The requirements of this section (ii)Any operations in their work area where hazardous chemicals are present; and, (iii)The location and availability of the ' written hazard communication ~rogram, ~ including the required list(s) of hazardous chemicals, and material safety data sheets · . required by this section. 6) HAZARDOUS MATERIALS SAFETY TRAINING IN THE AUTO REPAIR AREA INADEQUATE. VIOLATION OF OSHA 1910.1200(H) (2) Training. Employee training shall include at least: (i)Methods and observations that may be used to detect the presence or release of a hazardous chemical in the work area (such as monitoring conducted by the employer, continuous monitoring devices, visual appearance or. odor of hazardous chemicals when being released, etc.); (ii)The physical and health hazards of the chemicals in the work area; (iii)The measures employees can take to protect themselves from these hazards, including specific procedures the employer has implemented to protect employees from exposure to hazardous chemicals, such as appropriate work practices, emergency procedures, and personal protective equipment to be used; and, (iv)The details of the hazard communication program developed by the employer, including an explanation of the labeling system and the material .. safety data sheet, and how employees can obtain and use the appropriate hazard information. - VIOLATION OF CALIFORNIA HEALTH AND SAFETY Business plans shall include all of the following. Emergency response plans and procedures in the ...... event of a reportable or threatened release of a . hazardous material, including, but not limited to, all of the following: (1) Immediate notification to the .administering agency and to appropriate local emergency rescue personnel and the office (2) ProcedUres for the mitigation of a release or threatened release to minimize any potential · .. harm or damage to persons, property, or the environment. (3) Evacuation plans and procedures, including immediate notice, for the business site. 8) SULFURIC ACID (BATTERY ACID) IS ONE OF THE 366 CHEMICALS LISTED AS ACUTELY HAZARDOUS MATERIALS AND THEREFORE AN ACUTELY HAZARDOUS MATERIALS REGISTRATION FORM MUST BE FILED FOR THAT MATERIAL. FORMS ENCLOSED. A SEPARATE FACILITY DIAGRAM AND INVENTORY SHOULD BE SUBMITTED FOR THE AUTO REPAIR AREA. ' The above violations must be corrected by NOVEMBER 15th 1988 The department will schedule a re-inspection of your facility to verify compliance. If you have any questions regarding this notice, please contact Ralph Huey at 326-3979. Sincerely, /Ralph E.Huoy Hazardous~" ' Materials Coordinator CC RON DEKNEEF "K MART" OCTOBER 12, 1988 DEAR MR. KEN SEARS; · NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YOUR BUSINESS "K MART", '~!i~'~LOCATED AT 401 34th STREET, BAKERSFIELd, CA 93301 ON ~' ~ ~ ...~ OCT. ~2 THE FOLLOWING HAZARDOUS MATERIALS REGULATION j,- , VIOLATIONS WERE IDENTIFIED: ~:"1 ) SEVERAL HAZARDOUS MATERIALS PRESENT WERE NOT INCLUDED IN '-YOUR BUSINESS PLAN INVENTORY, THESE INCLUDE BUT ARE NOT LIMITED TO (WASTE OIL, LIQUID POOL CHLORINE, COMPRESSED OXYGEN ) VIOLATION OF CH. 6.96 CALIFORNIA HEALTH : ,- ~ &' SAFETY CODE 25509(A) (1-4) ~.'." . ~,_ The annual inventory form' shall include, but shall not be limited to, information on all of the following which are handle.d in quantities equal to or greater than the quantities specified in subdivision (a) of Section 25503.5: (l) A listing of the chemical name and common names of every hazardous substance or chemical product handled by the business. (2) The category of waste, including the general chemical and mineral composition of the waste listed by probable maximum and minimum concentrations, of every hazardous waste handled by the business. (3) A listing of the chemical name and common names of every other hazardous material or mixture containing a hazardous material handled by the business which is not otherwise listed pursuant to paragraph (1) or (2). (4) The maximum amount of each hazardous· material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which is handled at any one time by the business over the course of the year. THIS INFORMATION MUST BE MAINTAINED CURRENT. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.25505 (b) In addition to the requirements of Section 25510, whenever a substantial change in the handler's oDerations occurs which requires a modification of its :- business plan, the handler shall submit a copy of the plan revision to the administering agency within 30 days of the operational change. ~ (c) The handler shall, in any case, review the business plan, submitted pursuant to subdivisions (a) ' and (b), on or before January 1, 1988, and at least once every two years thereafter, to determine if a revision -is needed and shall certify to the administering agency · ~- that the review was made and that any necessary changes were made to the plan, A copy of these changes shall be submitted to the administering agency as part of this certification. .-. · (d) Unless exempted from the business plan requirements under this chapter, any business which handles a hazardous material shall annually submit a completed inventory.form to the administering agency of the county or city in which the business is located. Notwithstanding any other provisions of the law, an inventory form shall be filed on or before January 1, 1988, for the 1988 calendar year, and annually thereafter. Thi~ inventory shall be filed annually, notwithstanding the review requirements of subdivision (c). 2) WASTE OIL CONTAINER NOT PROPERLY LABELED. VIOLATION OF OSHA 1910.1200 (1) The chemical manufacturer, importer, or distributor shall ensure that each container of hazardous chemicals leaving the workplace is labeled, tagged or marked with the following information: (i)Identity of the hazardous chemical(s). (ii)Appropriate hazard warnings; and (iii)Name and address~'of the chemical manufacturer, importer, or other responsible party. (4) Except as provided in paragraphs (3) and (4) the employer shall ensure that each container of hazardous chemicals in the workplace is labeled, tagged, or marked with the following information: (i)Identity of the hazardous chemical(s) contained therein; and (ii)Appropriate hazard warnings. (5) The employer may use signs, placards, proc~s~ sheets, batch tickets, operating procedures, or other such written materials in lieu of affixing labels to individual stationary process containers, as long as the alternative method identifies the containers to which it is applicable and conveys the information required by paragraph (2) of this section to be on label. The written materials shall be readilY..accessible to the employees in their work area throughout each work shift. (7) The employer shall not remove of deface ":existing labels on incoming containers of hazardous chemicals, unless the container is immediately marked "with the required information. (8) The employer shall ensure that labels or other .. forms of warnings are legible, in English, and prominently displayed on the container, or readily available in the work area throughout each work shift. Employers having employees who speak other languages may add the information in their language to the material presented, as long as the information is presented in English as well. 3) BATTERY ACID, PRO~ANE, AND CAMPER FUEL UNDERSTATED IN INVENTORY VIOLATION OF CH. 6.96 CALIFORNIA HEALTH . & SAFETY CODE 25509(A)(4) The annual inventory form shall include, but shall not be limited to, information on all of the following which are handled in quantities equal to or greater than the quantities specified in subdivision (a) of Section 25503.5: (4) The maximum amount of each hazardous material or mixture containing a hazardous material disclosed in paragraphs (1), (2), and (3) which is handled at any one time by the business over the course of the year. . 4) COMPRESSED GAS CYLINDERS (HELIUM LOCATED AT THE INFORMATION COUNTER AND CARBON DIOXIDE LOCATED IN THE BAILING ROOM) NOT PROPERLY STORED. VIOLATION OF UFC 74.107 (a) General. All compressed gas cylinders in service or in storage shall be adequately secured to prevent falling or being knocked over. EXCEPTIONS: (1) Compressed gas cylinders in the process of examination, servicing and refilling are exempt from this section. (2) Medical gas cylinders may be stored and used in the horizontal Dosition in accordance with nationally recognized standards. §) MATERIAL SAFETY DATA SHEETS NOT AVAILABLE IN THE AUTO REPAIR AREA VIOLATION OF OSHA (g) The emDloyer shall maintain copies of the Tequired material safety data sheets for each hazardous chemical in the workDlace, and shall ensure that they are readily accessible during each work shift to emDloyees when they are in their work area(s) ':'(h)(1) INFORMATION. EmDloyees shall be informed of: (i)The requirements of this section (ii)Any oDerations in their work area where hazardous chemicals are Dresent; and, (iii)The location and availability of the written hazard communication Drogram, including the required list(s) of hazardous chemicals, and material safety data sheets .... required by this section. 6) HAZARDOUS MATERIALS SAFETY TRAINING IN THE AUTO REPAIR AREA INADEQUATE. VIOLATION OF OSHA 1910.1200(H) (2) Training. EmDloyee training shall include at least: (i)Methods and observations that may be used to detect the Dresence or release of a hazardous chemical in the work area (such as monitoring conducted by the employer, continuous monitoring devices, visual aDDearance or.odor of hazardous chemicals when being released, etc.); (ii)The Dhysical and health hazards of the chemicals in the work area; (iii)The measures employees can take to protect themselves from these hazards, including specific procedures the employer has implemented to protect employees from exposure to hazardous chemicals, such as a~Dro~riate work practices, emergency ~rocedures, and ~ersonal protective equipment to be used; and, (iv)The details of the hazard communication program developed by the employer, including an explanation of the labeling system and the material safety data sheet, and how employees can obtain and use the appropriate hazard information. ..... 7) EMERGENCY PLAN INADEQUATE. - ~' VIOLATION OF CALIFORNIA HEALTH AND SAFETY " Business plans shall include all of the following: Emergency response plans and procedures in the event of a reportable or threatened release of a hazardous material, including, but not limited to, all of the following: (1) Immediate notification to the administering agency and to appropriate local emergency rescue personnel and the office. (2) ProcedUres for the mitigation of a release or threatened release to minimize any potential harm or damage to persons, property, or the environment. (3) Evacuation plans and procedures, including immediate notice, for the business site. 8) SULFURIC ACID (BATTERY ACID) IS ONE OF THE 366 CHEMICALS LISTED AS ACUTELY HAZARDOUS MATERIALS AND THEREFORE AN ACUTELY HAZARDOUS MATERIALS REGISTRATION FORM MUST BE FILED FOR THAT MATERIAL. FORMS ENCLOSED. A SEPARATE FACILITY DIAGRAM AND INVENTORY SHOULD BE SUBMITTED FOR THE AUTO REPAIR AREA. The above violations must be corrected by NOVEMBER 15th 1988 The department will schedule a re-inspection of your facility to verify compliance. If you have any questions regarding this notice, please contact Ralph Huey at 326-3979. Sincerely, /Ralph .E. Huey t Hazard'ous Materials Coordinator .. · ' '..~. ' CC I~ON DEKNEEF "K MART" ' HAZARDOUS MATERIALS INSPECTION IlO ~ ~o.: ~Ot ~~ ~- RECEIVED SEP 2 ~ 1988 Ans'd ............ V~R~F[C~tT~ON OF H~Z ~tT TI~,INI~ ~--~ V~RIUI~tTION OF ~$ ~V~ILABL~ ~ SPE(~JtL ~%Z~DS ~,~JtT~D ~ITH TBIS FACILITY: -' ~' ~'" ' ' ?'-?"~: CITY-of BAKERSFIELD, ~ l~ - I ::: 4 " .S~ -. ' s' 1- ~'~ ' 9- ~ ~0-' I~ ;, -..,..-'. '; 12" ~-. - ,. ., .: , .' j ~.~-. -.. ,,..:, - ',; ,:.; .. '.....';~*:~ '.: ,:, ?: ::... · _. _.. .... .: '"'. . ~ ' ".. . (~f, tc~ ~ll tt~t epply) . . · ~ith - ot ~r¢~sure ' ~lth ' . - : .- ~r 11 ~ I C.A.S. ~u,t~r _ ~ ': " r-i- ' r--~ ' '~ "' ' ' ~ ~t~te ,. C~t 12 ~ i C.~.S. ~... . .: ..- ' , . · . .:. , .. .. '-': ._'-:'.... : . ~.:..:{::~': ~ :. :" ._ - -' :' .: , ":' :'- ~ 13 ~&CAs. THIS FORM MUST BE COMPLETED BY THE OWNER OR OPERATOR OF EACH BUSINESS IN CALIFORNIA V~q{[CH AT ANY TLME HANDLES ANY ACUTELY HAZARDOUS MATER/AL IN QUOS GREATER THAN 500 POUNDS, 55 GALLONS OR 200 CUBIC FEET OF GAS AT STP. TI-lIS FOR~ SHALL BE COMPLETED ANrD SUBNf[TI~D TO YOUR LOCAL ADMINISTERING AGENCY. (§25533, & 25536 Health & Safety Code) .Business Site Addre** _, ,/7/0/ ~.4~ Business ~al[lnO Address (if dlfferen~) Business Phone, <~>o~'- ~P-'~- 9o ~/_A [Business Plan Submlaslon Date2 Process Designation3 A.Ct_I~F_~A_.~_~_p~IALS_~~4 -USE ADDITIONAL PAGES IF NECESSARY. SIGNATURE . r-~ ~, '~,7--~'?'~_ 'ITTLE ' 5&7~V'!~L-" /'~ PRINTED NAME '~-<-~ .~_~/~"~/-' DATE Califomla Office of 5merger~'y Servie~ FO~M HM 3777 (,1-15-~8) .USINESS NAME: ~-~AP~ OWNER NAME: ~-~A~T Cp,)GP NAME OF T~ F}~.~LITY: ~,OCATION:~Q~ 3~ ~T ADDRESS:~IO0 '~V~37 ?X,~ ~trDf~Z STANDARD IND. CLASS CODE ~ TO INS~ROOTIO,VS FOR PROP~ COD~S / ~ ~ 4 ' 5 6 7 8 9 ~0 II 12 ~3 ~pe Max Average ~nuai ~asure I Oys C~t C~t C~t Use [~t~ ~h~e %Hr Na~s of ~xtu~e/Com~c~ Cote ABt ~mt ~st Units ~ ~te Type Pres~ Te.o ~c~e ~to?~ {n FacJlfty · ~e [~st?ucti~s Fire Hazard ~ Reactivity ~lay~~dd~ Release~ Health of Pressure ~ Ich r--a ~ C:~t 12 ~a~ i C.I.S. Nuebar ' J ~h~'sScal a~d Health Hala~d J (C~k ~]1 ~kat apply) C.A.~. Num~? .......................... ~c~?~t ~ R~ G C.A.S. F{re ~azaed ~-- Reactivity L__] Oeh'(~ Sudd~ ReJ~seL__a Xealth of Pressure Heai~h C~t 13 N~ i C.A.S. Fire Hszard [~ Reactivity ~ Oelay~ [--~ ~dd~ Release [~l~ate J Health of Pressure Health ....... .'ertificaCi~ (Read and sign after comp]etJnff ail .... .......................... CITY of BAKERSFIELD ; , P~qe .... of .... ~OCATION:~OI ~'1~ _~T. ADD~ESS:~IOO W~7 ~[~ ~V~ STANDARD IND. CLASS CODE ~ ~o z~sr~vcrxoss ~o. ~so~ cov~ .{ode C~e ~t linc Est Units ~ Ski Ty~ ~ress T~O C~ .. St~ tn Facility ~ ~e lnstructi~s Hea ich of Pr~sur~ ff~ Irh (~h~k all t~ ,pply) ~ Flee Hazard ~ ~eaccivity ~ ~lay~ ~ ~d~ Rel~e~ l~tate C~t 12 ,aN & C.A.S. ~ CertiflcaC~ (Read and s~gn a~ter compJeCing ail sections) ' '.. CITY of BAKERSFIELD ~., ~d ~ric.~ture ~--- Sta.~ard ~usin~ss ~ ~~:~]~)C~J:S ~2%.'~'~ ~T_.~ '!" ~age .... of %USZNFJSS NAME: ~-JV"~PJ~ OWNER NANE: ~-~R~W ~. .AHa OF T~ FACILITY: LOCAT2ON:~OI .~C.l~ ~. ADDRESS:~}OO W~ ~F~ ~(~q~l~ STANDARD iND. CLASS CODE a~ ro r~s~crross vo~ wov~ PhysiCal ~od Health Hazard C.I.S. Nu~r~ h~t II tt~ & C.A.~. . H~ith et Pressure H~llh Five Hazaed ~_a Reactivity Oete~ Sudd~ Release H~lth of Pressure X~lth .... Fire Hazard ~--J Reactivity ~dd~ Rel~se l~fate H~ith o~ Pr~sur. Heait~ :: - ...... , ~-,~ ,, -, , , ~~'- ~qe .... of SUSINESS NAME: ~- /V~AIZT' OWNER NAME: ~;I'~A~C~I' f'~'.)l?P NAME OF T~ F~.~C!T~: LOCATION:qOl ~'l~ AT ADDRESS:~)OO W~-~7 ~.~A ~,C:~F~l~ STANDARD IND. CLASS CODE CITY, ZIP:~}<~.-~C]~ q'~qO[ CITY, ZIP:T~O~ ~~'~ ~O8~ DUN AND BRADSTREET NUMBE~ _ . ~ TO INS~gCTIOMS FOR PROF~ CODES Code C~e Ant ~,t Est Units ~ e Ty~ Press r~ C~e .. Stor~ in F~citi~y · ~e [nstructi~s Hen ich of Pressure ~ ' ~e~ith of Pr~sure H~ith ~ea Ich of Pr~sure H~a J th (¢h~k all that *p¢lyj __~_~ u_ a Fire Hazard Reectivity -- ~lay~ ~dd~ Release Health of Pressure fleaitn :ercificaCt¢ (Read and sJ~ after coap]etJng a]] sections) :or obtaining t~ inf~ti~, I ~lteve tMt~ su~ltt~ tntor~tlm ~s c~e, ~ra e, ~a c~~/~/ ',~ ~R~- ~]'TTT]a oT o~er~r~ to~r.z~repres~lve ~ CITY of BAKERSFIELD : ..---. · Paqe LOCATION:qOI .3~1~ ~T. ADDEESS:~IO0 W~57 CITY, ZIP: ~t<~.~AJ% ~.~ CITY. ZIP:T~..~~~ ~O8~ DUN AND BRADSTREET NUMBER ~ ro z.vsmucrro~s ~o~ Tram . Type Nax Average ~flual ~asure I ~s C~t ~t ~t Uso ~ealth of Pressure ~lth Fire ~ota,'d ~ ~eacttvtty ~ ~]ay~ ~- ~ ~ Release ~ i - ~ealth of Pr~sure ~lth ~e~lth Qf Pr~sure ~eaita ~t Health of Pr~sur. Healtfl ..... CartlficiCf~ (Read and s~gn after comple:Jn~ all sections) -' '~ BAKEESFIELn, CA 93301 (805) 326-3979 ~0~ I~ 1967 _ ~ 05-lq 0 ~i~. ........... OFFICIAL USEONLY' ,~s~..~ss ~ 0 0110'2 BUSIneSS PL~ AS A WHOL~h~ 1. To avoid further action, return this foem by 2. ~E/P~I~ ~SWERS IN 3. Answer the questions belo~ for the business ~s a ~hOie. 4. Be as b~ief ~d concise ~s possible. ,. ,.. SE~TON 1: BUS.SS ~~IC~T~0N D~TA SECTION 2: E~GENCY NOTIFICATIONS Kn case of an emergency involving the release or threatened release of a. hazardous material, ¢all gX! and 1-800-8S2-?$§0 or 1-918-427-43¢1. This will ~otif¥ your local ~lre'dep~rtment and the State Office of ~mer~ncy S~rvices as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: A.NAME z~' ~ AN~ .,TITLE/~..:/) '~ ~f'~'~ Ph, DURING,_,,~/~., ~z)~BUS' ~RS' Ph, AFTER,~?BUS._ ~HRS' , SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A Nf[0LE O. SPEC [AL: E. LOCK BOX: YES ': ~.~ IF YES, LOCATION: IF YES, DOES IT CONTAIN S~TE PSANS? YES /..~0 ~SDSS? YES / NO ,. FLOOE P[~NS? YES / ~0 KEYS? YES / NO s£cTIoN 4~':::,PRIVAT£ RESPONSE TE~'4 FOR 'BUSYNESS AS A WHOLE ~' " < ~-'" '~ x '., . .... ~ "~.z.~i 4~' ~'~/~: ..~,>~.~:' .~ir" ,/· ~f,,~/,') SECTION 5: LOCAL ~'qEROENCY MEDICAL ASSISTANCE FOR YOUR BUSY:TESS AS A ~OLE : -.....~ t '. ~PLO~RS ARE REQU~R~ TO REFRES~R ~INING IN THE FOLLOWING AR~S. CIRCLE ~S 0R ~0 I~'IT]AL RE~ES~ A. ~ETHODS FOR SAFE ~NDLING 0F B. PROCED~ES FOR COORDfNAT]NG ACT]VIT:ES w:~ R~spo~s~ AS~C]~S: .......................... ~> ~0 ~ '~0 "' C. PROPER US~ OF SAF~ ~UrP~T: .................. ~ ~0 ~ N0 D. ~ERGEN~ EVACUATION PROCEDURES: ................. E. 00 YOU ~INTAIN E~PLOYEE ~AI~'ING RECORDS: ....... SE~ION Ti. ~Z~DOUS CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS )fATERIAL IN QUANTITIES LESS THAN$00 POL~DS OF A SOLID, SS GALLONS OF A LIQUID, OR Z00 CUBIC FEET OF A COMPRESSED GAS: ...... I, ,/~??j~/ //~/~'~,/.'t"~ , certify that the above information'is accurate.' [ understand that chis infor~&tkon will be used to fulfill my firm's oblfEations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 2S$00 Et Al.) and that inaccurate information constitutes BAKERSFIELD CI!"f FIRE DEPART>lENT 2.,~ 3 ) STREET / BAKERSFIELD CA 0Fi~C:AL USg ONLY BUSINESS NAME: ..................... . , I~STRUCTIO~S 1. To ~void further action, this ~orm must be returned by: 2. TYPE/PRINT YOUR ANSWiiRS !N ENGLISH, ~, Answer the questions below' for THE ,~, ............ L~S~D BELOW 4. Be as E~IEF and CONCISE as possible. SECTION 1: ~ITIGATI~E~5~!O~, A~ATE~ES~ PROCE~L~E~ SECTION ~: NOTIFICATION AT.~ EVACUATION PROCEDL~E$ AT THIS b~'IT O.YLY a EMERGENCY_.SQUAD RESPONS .IBI.L. _ . ' :-'. .~ .:, '.: : .;. ' . ~. , ] .~... . · ~ ", ~ ........ ~ ,','" ' ~ ....... · ' ~'i .....".'" · .... Z'~'~'? " ~' follo~in'g s ould' t~keP '~" At the onset of t~e e~ergency th~ h lace Sec~lty & senior management to the front of the ,store ...~-.:... ~.... Off,ce personnel out of the office.,.~.~fe on lack, all do°rs locked, et~y at ~yaway ~ Ma~e employees to the closest Caroline and d~orm for f~her Dept. M~s or assistants to the Caroline exit nearest their 'de~ment a~ supe~lse Senior Assistant, Sec~lty, or Mdse M~ to check that staffing exists ~t all exits Members of Managemen~ not at work are to be phoned at home and ~vise~ Wustern Regional Office to be informed i~ediately by phone and/or mail~ Police Depa~ment and/or Fire Department notified if needed by .management only In c~se of f~e~. '. .. A .c~e Red indicates a fire in a ce~ain area. M~le. employees should respond ~o thm~ are~ ~ith ~v~ilable fMe e~in~lahera ' ~mnagement ~ill take charge mhd ~vise if F~e Dep~ment is .ne~ Dept. Persoanel should 'station the2selves ~t the newest exit and control the exit Senio~ pe6aonnel should ~ive appropriate direction as requ~ Ef the store is to be evacuated, M~agement will make the decision ~d ~o~ce2ent ~n evacuation: Caroline doors are to be manned as noted, above and all pox'sonnel are to help dxre~ safe and peaceful controlled exit by all customers md per~o~el. Dept. Managers should see that theadjolning area ls clear of'all people. After evacuation Dept. M~s shall remain at the exit for f~her d~ection Local authorities are to be contacted by management ONLY A TYPICAL assigmment' would be as follows (if the listed people were working) ~;'RONT OF S'I'ORE: Store Manager ...... Security Manager ~'t:t CAROLINE ONE Appliance manager West CAROLINE ONE Apparel manager GARDEN SHOP Carden Shop manager A~TOMOTIVE Auto Shop manager '' CAROLINE TWO Sportlr, g Co~s manager .~.:. CAROLIME THREE Receiving manager ..... CAROLINE FOUR Receiving staff C~ROLI~E F~E Receiving staff CA~OLI~E SIX Stockman or Day po~er ' .... "' CAROLinE ShWEN Home Center manager . '":' In the event the above people are not working, the~ mssist~t or"next.resp~mible person should assume the duties. Our public ~dress system is ~ttery protected, so ~ the event of any emerg~cy. (even a'power blackout) you will recei,.~ ~ditional d~ections over the P.A, Safety ls the FIRST PRIOR~Y'. ...... ~ N~ TA~. A~ A~ION TO ENDANG~ YOURSE~ A CUSTOM~. If you are trapped by a fire .... ge~ low and close to the floor, do ' not attempt to get through the fire, help ,ill a~ive but. you must stay put, " breathe t~ou~ a cloth to prewent smoke l~alation. CO~ON SENSE ~Y SAVE YOUR L~E OR SOM~NE ELSES' .D. · -:-i ': - .":.'~--: -.-':- ·~.." -' ' · ' - FOR# 4A-S ' --. ' '- ..':~'-:~;: :"-.';:." Y" :.. ?'~:":~ ~?"' "- ' ' HAZARDOUS. MATERIALS ' I NvE'NToRY-~i.?:.',:,'.':'"'':.,. BUSINESS NA:NE: OWNER NAME: ADDRESS: ADDRESS: " '-'.' --- FACILITY UNIT ~AWEi'-=:'::?'?' CITY, ~IP: CITY,ZIP: :-'-'- ,:- "''' ' ...... ~ ~ ' '" PHONE ~: ,~ = PHONE ~: ...... .~-- OFFICIAL - , .... ...:., ..~ -~..,'~/~., :~.. -ypE 1AX ANNUAL CONT USE LOCATION IN THIS · BY ~'. ,,.~ ~'~ :..-..~::-.,,_?~..:,~.:~.~,~.~..X~:~?. HAZARD D.'O.T ~ODE AMOUNT ANOINT UNIT CODE CODE FACILITY UNIT. MT. C.H~MICAL'0R COMMON NAME ..-w:-, 'CODg '~ OUID~ ' ~' '"'~ "" ~' ":~:~'"'"~'~ ~t~:~ ~'-.:' '~-~ ~ ;';"~ "'¥"~'~':':" ~' :x~;:' ~:;' :a'~ ~:-'~':?. a?' ?-:~-~ .... ' ~q:?' "~ "iqq~''':~-'; "i'g" ' aao:~,~'a~. -' ~' ": ~b'~ '?! .; '-~'-~: ~-'::'~.~-~:'-~.:.-:::-;~',; :-.':- ~'-'9 ' 'i ... --'t '..' ~ '. ' ' ........ .:,.:-:.' , .' '...::~ :,,. - : _ .~ ';-._.' j .- - , . . " ~'"'~:~':':':'"~' ~:::":"'"'?:"-":' "::;::~': ':'"" .... ""-~ "~'' '" '" ...... '"' ~' '~/~ '~':''' ":'"' -' "' .,..~,.:~::...:.,. .....~ ..... .... , ...,=... ~:...,. ~. -:.-.. ., ..,, ,.,~ .....~.. '.. ,_:-. .... : ~::x'- :.---u .... ' ..s'" '""'-. ' .... '. ' ' "'-' ' '.' ' ':' ' "' ~q:' ' ":~':: ':.: ::'-.Z'.--~.'-:?~.":~.= -,-~ 'q' .::.:~.~,. . =' 5:~. ')'-.'Z~"' ' -~'~'" · '-L"' ' ': ' '' ~' "' ' ' .'.: .. : z~"C'. - ' ' .....-.' - ' '" ::' t' t": " ' ' .. . ~ ' -.~ { ':... .-~'~L._ '~ .~ :- v.. .'...:~'~:, > '.. ' . ' :' '" .i %jz-.-.: "t'x .' .,.~.= .:~ · ..-. 'x': :: /. .~' .".- -. :] .. . . . - . -. -,.,~, ' , ,, , ? ".~. · .- x,,,.;: .... ~. -.--. ,-, ..: t:..' .~..~. : ...... . ~ . t -.- PHONE t: · PHONE ~: -: .... '. OFFICIAL USE,.CFIR$ CODE ODE AMOUNT AMOUNT UNIT CODE CODE FAC[LI'TY UNIT. MT. .CHEMICAL OR COMMON NAME '.'"-~ :CODE OUID~ ~ERGENCY CDNTACTi : TITLE-. P~ONE · BUS HOUR~-. .... ~ ' .-" -.-'- ...... ~ERGENCY CONTACT: -'" " TITLE: ' PHONE I BUS HOURS. ~INCIPAL BUSINESS ACTIVITY:_.. ~co uvv~ " ' ~A ........ ' '-'=' .... : ~ ~"~ ''-~"-"~' -'~ '~: " OWNER NAME- - ....... ': ~' ....... ~ ':'":~'"' '~ ..... FAC~L=T ~ ' "': ': .... ADDR · ~ ' - ' ~', ..... ~ ....... "..": I Y ~NIT. ADDRESS: ESS: ":/ :' ' :'.- ' ~ :FACILITy UNIT NAMK.i'~::;:~;-'~: CITY, ZIP: CiTY,Zip: . .; . ..: ....: .. ~. ~.~=.?..~,?.:~-.,...,.. ~..... ...... PHONE -~: PHONE ~:~ '- ; "~-~b'. ..... ~ ':~*-'*.:".'L~'~ OFFICIAL OSE~CFIRS-CODE ~ypE1 NAX2 . ~-ANNUAL3 4 5 6 ?___ " 8 .' .:~/..,/;+..: .~,. :~-:,~' ~!-9 ../%?,~?::~.~ ~:~ ~:;:~...;.~:~c::./:: :: . . lO: ,'-.-: CONT USE ~DE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT. : MT. -:CHEMICAL OR.'COHMON'NANE':L/~:":~ CODE GUIDE io.-~0-~C~ ,5~ lqo~ '-: ....._ :. ~..,?.:....:~..,:.::~:..~..;:,:~ .... ~~:r ..... ~.~¢~ ~ -?- ~ ~V~~ .~?~ .., '..~,.:~' -.. , ~ ~... ~~.- :-.: - -t~-_, ~/~.~:~~..=:~~,..::~,:::.;~=:,-.,. ~.-.-~?~-:-~: ,- ~.:'.:.:.~. ..... EXPU ..,.: :- ~ · . , . ~ '/ . _:'." j- -. ,: , ,.' ,:' :..-,.C, ..,.:'.-~ .:':.. . ,:..:-,~...,~:-.. '.. -. , L,~ . ..:. "~: ~'i:Z''~'' ':'q~:~' ~S~ o~ 3~' 'Hne~m~'~~ · ~s~,~c.,'~<~'~'ai~'~;':-. '-~' ~.':::-':. ~L:~ . .. -. ...,. ;.: ,,-' = ~-: %. , ,. ) . .., -... :' .~:%&,t:L,.-' :' ':r'"; ' ~ '" " ' "' :. · ..::..: ..y :;'. .-.-..-..-:.,.::. . . . .... ..... '/' "' ~t - ;' -:. - -:~-~- -- · - ...... . ;.- '~ ., , :..'. :'~.-:t ..... ~6~_ 0~ , ' "'l'~"" ""~rN.-- ~ 06 &~ d~~~ ~oo~ '' .... ' ' "~'""' ; :~*~ - "' 2'¢'-:'" ?- r~ u oq'~ ~~- g~ d¢~c~'~:.": ':.-".~' ";" -:':':":~":'".--_.:=."" ~,,~,."' ;' ' "--":" ~"~' ' "' '" ~' gIGNATURE~ DATEr~:' ~ERuENC~ CONTACT~, TITLE: PRONE ~ BUS HOURS: "· ..... ' .... ~ . ' ' -. .~ .: .= . . '- AFTER' BUS HRS: ~ERGENCV ~NTACT: ' ' TITLE: ' ' 'PHONE t BUSr HOURS* P?NCIPAL BUSINESS ACTIVITY: ' ~ J~OUNT AMOUNT .UNIT CODE CODE 'FACILITY UNIT, ~Y, ":CHEMICAL 'OR-COMMON .NAME"--~: 'J '~ODE 6UIDE ~- ~~ ~ ....... . ..... . ......... ,RINCIPAL BUSINESS ACTIVITY: - · · ' ' ,.,, ~. ,APTER BUS HRS:.. ~ ~"' ' ACUTELY H(~ARDOUS MATERIALS RE(I~STRATION FORM THIS FORM MUST BE COMPLETED BY THE OWNER OR OPERATOR, OF EACH BUSINESS IN CALIFORNIA WHICH AT ANY, TIME HANDLES ANY A~LY HAZARDOUS MATERIALIN QUA~"ITIES GREATER THAN 500 POUNDS, 55 GALLONS OR 200 CUBIC FEET OF GAS AT ~TP.z TI-HS FORM SHA[~ BE COMPLETED AND SUBMTITED TO YOUR LocAL . · ADMINISTERING AGENCY. (§25533 & 25536 Health & Safety Code) ~, Note instructions on reverse au,ira, Nam. .. K~-~rm ~c~. . ' ' Bu~lne~a Mailing Addre~ (If different) ~,,~ Bu~ine~. Phone ,~o~-- 2o.7- ~o5/$ ' Buslne$. Plan Submla.ion Date2 Proce~e Dealgtmtlon3 ACUTELY HAZARDOUS MATERIALS HANDLED4 -USE ADDITIONAL PAGES IF NECESSARY- . CHEMICAL ~AME. ~' GENERAL DES.~I:IIP'I'ION OF PROCESSES AND PRINCIPAL EQUIPMENTS: .... PRINTED NAME ~ ~~, DATE Cadiomil Offi(~ of Emergency Servtc(i FORM HM 3777 (1-1~88) RISK RA, NKING - K MSRT SULFURIC ~OIO FBCILITY RISK INDEX INSPECTION HISTORY POPULaTiON EXPOSED MOP TOX F~CTOR FACILITY RISK INDEX RATING ~3 = 8clivilies or cof~dil, ions -~ha+,, imcr, ease ~,he likelihood of a r I ~ ,5 = 0.5 (NO. OF YES ANS;~ERS ON THE QUESTIONNSIRE hdd ] yes to ~ach facility fop s%orage and minimal X = This factor refleo%s a company's claim (safe%y) h.[s(ory. ('WORKER COMP FA~..T.~R' *' F~', .MF~XIMUM EXPECTED IS ~,5) Self repot%ed acciden~ / safe~y r'ecomd. 0,25 (RE~SONABL. E=O, INAOEQUATE=O,,2S, 8ROSSLY !NADEQUATE / A discre~ionamy ca~agory used %o accoun( for factors no~ direc(ly addmessed in the questionnaire. (OTHER COMPLIChTIN8 FhCTORS MINIM~L=O, CONSIOERABLE=~.5, SUBST~NTI~L=!.O) FACILITY RISK INDEX = t.75 RATING Ft = W + X + Y + Z RATING R~TtONALE: Risk. increases wi.+.h increasint.~ process complexi%y and po%en~ial fo human el~ror, POPULATION k,.P,..,oEO '- R..~ I 1, IS TOXIn MaTeRiAL APT TO BECOME ~IRBORN ~xAPIDI_Y i,e~ ~ GAS, FINE DUST, tiIGHLY VOL,~TILE LIQUID NO= ~ YES=~ ~ IF ANSWER TO ~t tS NO, PROCEED TO IF 6r'TSWER TO ~! IS YES, ESTIMATE THE EVACUATION RADIUS, USING THE · BhKERSFZELD FIRE DEPT GRAPH ~ODEL RNO ~NS~,IER QUES~ZUt'4 2, IS THERE ~ SCHOOL WITH IN THE EVhCt. Jf~TiON R~DZUS ? NO=O, YES=i ~, IS THERE h NURSING FIOME OR HOSPiTSL WITFI !N THE EU~CUhTION RF~DIUS ? , NO=~, YES=I 0 4. tS THERE REStDENT'IAL HOUSING ~ITHIN THE EUACLATION RADIUS ? NO=~, YES=I S, IS THE POPULhl'ION DENSITY OF THIS ARE6 HIGHER THF4N THE ~VERhGE DUE TO aLOT 0f MULTISTORY BUILDINGS NO=O, YES=1 0 8, WHAT ~u T~E r -,~'~ ,tv -¢' 3CC,,J~Af4¢, OF THE BUILDING THaT ~HM IS STORED OR H~NDLED IN ? 4 LESS THAN 5 PEOPLE=t ~ '- 25 PEOPLE =2. z~ - sc PEOPL. E =~ MORE THAN 58 PEOPLE =4 TOTAL POPULATION EXPOSED RATING = S _~C, ILiTY INFORMATION FORM Please answer each of the following questions by circiiny Y (yes) or N (no). ,i 1. Is any acutely hazardous material (AHM) i manufactured or used in a chemical reaction ~ Y / 2. Is any other flammable gas, flammable liquid or explosive material manufactured or used in a chemical reaction '~ Y / 3. Is any reaction in question 1 or Z a moderately or highly exothermic reaction ( e.g. alkylation esterfic~tion,-~6xid'ation, nitration, p~me~izati'6-n - or condensation) or one involving electrolysis ~ Y / 4. Can any unplanned release of a AHM to the atmosphere result from the malfunction of any scrubbing, treatment or neutralization system or the discharge of a pressure relief system ~ Y / 5. Does any physical or chemical process in which an AHM is produced or used involve a batch process ? Y / 6. Does any physical or chemical process involve the production or use of any AHM at a pressure in excess of 15 psig 9 y / 7. In excess of 275 psig 9 y 8. Does any physical or chemical process involve the production or use of an AHM at a temperature above 125 degrees F 9 y /~ 9. In excess of 250 degrees ? Y 10[ ~an any explosive dust be' presen~ in any closed container within 100 feet of an AHM or otherwise be present in the same building as an AHM ? Y / 11. Is there any ignition source or open flame within 100 ft. of any process, storage or transfer area where a flammable or explosive AHM is present , except where there is a firewall providin~ protection ? Y 12. Is any lined or'non-metallic pipe used in the transfer of any AHM ~ ¥ / 13. Is any equipment or piping handling any AHM more 10 years old '~ Y / PLEASE PROVIDE THE FOLLOWING INFORMATION : ( Attach additional pa.yes if necessary) 1. Your company's current workers compensation experience modification factor. 2.How many people occupy the building in which AHM's are used or stored ? 3. Give details of all accidents which involved any hazardous material and all other instances when the fire department has been summoned in an emergency. 4. Briefly described the operations process at your plant and the specific processes utilizing AHM's, including storage proceedures. -2- 5. Briefly describe the equipment being used in the processes involving AHMs. 6. Report quantity of AHM(s), referenced in the cover a) Maximum amount on hand at any one time. 20o b) Please attach m Material Safety Data Sheet for any material that is a mixture. Do not include MSDS for pure substances. DEMOGRAPHIC DATA: State the straight line distance in feet between the business property line and each of the following. 1. Nearest school. ~ ~ ~~ 9.. Nearest daycare center, hospital, nursing home or similar facility. ~,~?~ ~k'~ 3. Nearest residence/motel etc. ~' 7~ 4. Nearest occupied building. ~ ~~ Business Name: g~] ~ I certify that the foregoing information is true and correct to the be~t of my knowledge. S ign~t~re: ~~ ~~~ _ -3-