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HomeMy WebLinkAboutBUSINESS PLAN..... ~'~ SITE/FACILITY DI F O I~ I~ ..~ i' NORTH SCALE: BUS INESS NAME: FLOOR: OF DkTE: / / FACILITY N~E: UNIT ~: OF , (CHECK ONE) SITE DIAGR.~! ~ ..... FACILITY DIAGR.~M (Inspector's Comments): -OFFICIAL USE ONLY- SiTB BIAGRA~ ~teas) 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys, ' Il. Railroad Tracks Driveways, and Parking Al-ess adjacent to the 12. Fence or Barrier property. Include the a. Wire street naaes. b, Musonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Orainage 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. Evacuatiou Route c. Water 18. Evacuation Area: Identify the 7. Fire Suppression Systems:' location where a. Fire Hydrants employees will mee~. b. Fire Sprinkler 19. Outside Hazardous Connections Masts Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous for protection systems Material Use/Handling 'e, Firs Pump 22. Type of Hazardous Material/Waste Stored 8. Fire Department Access or Used (Sss Below) Type OF HAZARDOUS MATERIAL F "Flammable E · Bxplomive L · Liquid R · Radiological C - Corrosive 0 - Oxidizer G - Gas P · Poison Water Rt~acttve T - Toxic S - Solid H - Cryogenic O - Waste B - Etiological Example: Flannable Liquid - FL FACILITY DIAGRAM (Required lteaa in addition to the above) 1. Risers for Sprinklers 8. Fire Sacapee 2. Partitions 9, Air Conditioning Units 3. Stairways: Indicate the I0. Windouu levels served from highest to lowest, li. Inside Hazardoul Waste Storage 4, Escalator: lndlcata the levels sarved ~rom 12. lucida Hazardous highest to lowest. Materials Storage S. Elevator 13. Inside Hazardou~ Materials Use/liandllng S. Attic Access 14. Sewer Drain Inlets 7. Skylights STOTLER CO INC SiteID: 015-021-000018 Manager : BusPhone: (661) 322-7700 Location: 917 34TH ST Map : 103 CommHaz : UnRated City : BAKERSFIELD Grid: 19C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title DICK STOTLER / OWNER / Business Phone: (805) 322-7700x Business Phone: ( ) - x 24-Hour Phone : (805) 871-7006x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : DAN STOTLER Phone: (661) 322-7700x MailAddr: .917 34TH ST State: CA City : BAKERSFIELD Zip : 93301 Owner DICK STOTLER Phone: (661). 322-7700x Address : 2520 CORTO ST State: CA City : BAKERSFIELD Zip : 93306 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: = Hanmar Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax lUnit MCP ACETYLENE E F P IH G 143.00 FT3 Hi OXYGEN F IH DH G 249.00 FT3 Low I, ~R~. ~ ~ ~ Do hereby ce~i~ tha. I h~e ~Y~ ~ ~int ~e) reviewed the attached h~ardous materials manag~ ment plan for~~ ~.~ ~d that it ~ong with. (~e of Bus~) any ~r~ions ~nstitute a ~mplete and ~rr~ ma~ ~ement plan for my f~li~. 04/18/2003 STOTLER CO INC SiteID: 015-021-000018 Fast Format Training~ Overall Site  Employee Trainin~ Page 2 I Held for Future Use Held for Future Use 6 04/i8/2003 f STOTLER CO INC SiteID: 015-021-000018 Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs Fire Protec./Avail. Water Building Occupancy Level -5- 04/18/2003 STOTLER CO INC SiteID: 015-021-000018 Fast Format Mitigation/Prevent/Abatemt Overall Site I Release Preventi°n Release Containment Clean Up Other Resource Activation -4- 04/18/2003 STOTLER CO INC SiteID: 015-021-000018 Fast Format ~Notif./Evacuation/Medical ' Overall Site Agency Notification Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan 3 04/18/2003 STOTLER CO INC SiteID: 015-021-000018 = Inventory Item 0002 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME ACETYLENE Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE W SIDE OF SHOP CAS# 74-86-2 Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION ! Largest Container I Daily Maximum I Daily Average 143.00 FT3I 143.00 FT3I 143.00 FT3 HAZARDOUS COMPONENTS %Wt. I RSl CAS# 100.00 Acetylene Yes 74862 HAZARD AssESSMENTS TSecretNo INORS BioHaz~ No Radi°active/Am°unt I EPA HazardsNo/ Curies F P IH NFPA/// USDOT# I MCPHi ---- Inventory Item 0001 Facility unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE W SIDE OF SHOP CAS# 7782 -44 -7 FSTATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas I Pure Above Ambient I Ambient I PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 249.00 FT3 249.00 FT3 249.00 FT3 HAZARDOUS COMPONENTS 100.00 Oxygen, Compressed No 7782447 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Low 2 04/18/2003 DICK STOTLER . ~._~71~,~-~,~I PRESIDENT - STOTLER coMPANY, INC. Established 1975 SHEAR PIN RELEASE COUP~JNGS - STOTLER CASING PATCH - B.O.P. SALES AND RENTALS ~. Phone: 661.322.7700 917 34th Street Fax: 661.322.7703 Bakersfield, CA 93301 USA WEB: www.stotlerco.com E-MAiL: info(~stotlerco.com or sales@stotlerco.com SALES STOTLEI~ Cb'Y(PANY, INC' Established 1975 SHEAR PIN RELEASE COUPLINGS ' STOTLER CASING PATCH- B.O.P. SALES AND RENTALS Phone'. 661.322.7700 917 34th Street Fax: 661.322.7703 Bakersfield, CA 93301 USA WEB: www.stotlerco.com E-MAiL: info@stotierco.com or sales@stotlerco.com CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~'~'~'"OT~cc-'~ C_C.)- INSPECTION DATE ~_a,/~'~(~[ Al)DRESS '°t("? 2;/-4r~'- PHONE NO. 3'2..2- -7700 FACILITY CONTACT ~,a~,.J c*o~t.~.<._ BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ,[~.Routine [~ Combined I~ Joint Agency [21 Multi-Agency [..] Complaint [2] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials ~)<~J / Verification of quantities '2~ [~-~ ~ <2/.2- Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ~] Yes ~No Explain: , Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Par~ 1 White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: ~,-)' ~'L--3 XxJ ~t'ur~ =.'AYMEN'r~ ' PLEASE MAKE CHECKS PAYABLE TO: CITY OF BAKERSFIELD HAZAi~OOUS I~ATER! ALS 19 [ V IS ION CITY OF BAKERSFIELD P.O. BOX 2057 - ~SRELD, CA 93303~057 ACCOUNT NO. ' ~ Previous 8atance ~az~r.~ous -,ater, ~ . · ,~ ~ ~r ~'~l J ,, ,- . .' · ............................... ~ .. '. I' ~' ~ ,~_ / ':::::203.00 Current Charges <: · / .~ ~ ~ ~ [";~: . . . · . : . .: .' ~ . . ":.' .. . . ~ ~ -- ~ ~ .... . '..,.....:'..,,' ~'..:..: ;..'~. ,~.-~. :':'~:":.~.:.';~1:~ :t;;%".::[f'.",:.t:~..:.~.. X... ';..' ~[S": BD'L I~ ~2u~' ~ ~:~b:~:ILLI~IG'.~'DAIE.-A-'''10:;' - ' ~' ' . O -t ' '"':':"" '"" '"; '""' ' ~'" :'"" ' ' · ' · I ~ ~-T-r~-T~-?~--6~C ~"ST~~'LER ~NVO~CE NUMBER I ~ ~7 J~rH ST~ ~ ~ ' MUST RETURN THIS COPY WITH PAYMENT. I . ~ ' ' 02/05/93 STOTLER CO INC 215-000-000018 Page 1 Overall Site with 1 Fac. Unit General Information Location: 917 34TH ST Map: 103 Hazard: Moderate Community: BAKERSFIELD STATION 04 Grid: 19C F/U: 1 AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- DICK STOTLER OWNER (805) 322-7700 x (805) 871-7006 ( ) - x ( ) - Administrative Data Mail Addrs: 917 34TH ST D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-004 BAKERSFIELD STATION 04 SIC Code: 2569 Owner: W. R. STOTLER Phone: (805) 322-7700 Address: 2520 CORTO ST State: CA City: BAKERSFIELD Zip: 93306- Su~mmary . . FEB 1993 HAZ. MAT. DIV. I, D~/<: .... ~'~7'~/-:~, Do hereby ce~ify that t have' U~ ~ pm',t name) reviewed the attached hazardous materials manage- ment plan for. (~.~ o, ~1~,.) ~' and that it along with any corrections constitute a complete and correct man- agement plan for my facility. 02/05/93 STOTLER CO INC 215-000-000018 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCP 02-001 ACETYLENE Gas 130 High · Fire, Pressure, Immed Hlth FT3 02-002 OXYGEN Gas 282 Low · Fire, Pressure, Immed Hlth FT3 02/05/93 STOTLER CO INC 215-000-000018 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-001 ACETYLENE Gas 130 High ~ Fire, Pressure, Immed Hlth FT3 CAS #: 74-86-2 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 ----~-- Annual Amount FT3 130 ~ 330.00 660.00 Storage Press T Temp Location PORT. PRESS. CYLINDER IAbove IAmbiontlMACHINE SHOP -- Conc Components MCP Guide 100.0% IAcetylene IHigh [17 100.0% Acetylene High 17 -- Notes 02-002 OXYGEN Gas 282 Low ~ Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 I Annual Amount FT3 282 ~ 282.00 562.00 Storage Press I Temp~ Location PORT. PRESS. CYLINDER Above IAmbientlMACHINE SHOP -- Conc Components MCP ---TGuide 100.0% Ioxygen, Compressed ILow ! 14 02/05/93 STOTLER CO INC 215-000-000018 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911. <3> Public Notif./Evacuation <4> Emergency Medical Plan MEMORIAL HOSPITAL - 420 34TH STREET - 327-1792 02/05/93 STOTLER CO INC 215-000-000018 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention PROPERLY CHAINED AND STORED WITH PROPER FITTINGS. <2> Release Containment <3> Clean Up <4> Other Resource Activation 02/05/93 STOTLER CO INC 215-000-000018 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - SIDE OF BUILDING B) ELECTRICAL - INSIDE BUILDING C) .WATER - LOCATED IN ALLEY D) SPECIAL - NONE E) LOCK BOX.- NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - ?????????? FIRE HYDRANT - ????????? <4> Building Occupancy Level 02/05/93 STOTLER CO INC 215-000-000018 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE 1 EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE??????????? BRIEF SUMMARY OF TRAINING: ??????????????? <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use C)2/12/92 STOTLER~3 INC ]'~'T~TLER SALES ~O(:)-00(~.~kr.j ~-,~ Page 1 Overall Site witln 1 Fac. U'nit I~I~cIV~u General Ir~fc, rmatic, r~ ~ 1 Locatior,: 917 34TH ST Map: 103 Hazard: Moderate  Commur, ity: BAKERSFIELD STATION 04 Grid: 19C F/U: 1 AOV: 0.0 P 4 - H n ~ i r P h o r~ e-. Contact Name W Title ~ Business Phone DICK STOTLER ~0 NER (805) 322-7700 x ~(805) 871-7006 Admi'nistrative Data Mail Addrs: ~1'7 34TH ST D&B Number: City: BAKERSFIELD State: CA Zip: ~3301- Corem Code: 215-004 BAKERSFIELD STATION 04 SIC Code: ~5~9 Owr~er: W. R. STOTLER Phor~e: (805) 322-7700 Address: 2520 CORTO ST State: CA City: BAKERSFIELD Zip: 93306- [Surnmary Il ~ ~ ,5'Z'orz-~4. __ O0 hereby certily that ! have ~le~d the a~ached baz~0us m~enms m~,~ me~ plan torah- any ~rr~ion~ c~,: ~:itute a complete a~ ~ ma~ 8~ement plan for my .)~/i2/92 STOTLER CO INC & STOTLER SALES 215-000-000018 Page Hazmat Irlventr',ry List irf MCP O~der (-)2 - Fixed Cor, tainers or, Site Pl r~-Ref Name/Hazards Form Quarft ity ~4CP 02-001 ACETYLENE Gas 3S0 ~//Hi gh 02/12/~2 STOTLER~ INC & STOTLER SALES 21W00-000018 Page 3 O© - OYerall Site <D> Notif. /EYacuatior~/Medical <1> Agency Notification CALL 911 <2> Employee Notif. /Evacuatior, VERBAL AND CALL 911. <3> Public Notif./Evacuation <4> Emergency Medical Plan MEMORIAL HOSPITAL - 420 34TH STREET - 327-1792 (:)2/12/92 STOTLER CO INC & STOTLER SALES 215-000-000018 Page 00 - Overall Site <E) Mit igat iorl/Preverlt/Abaterl~t Release Preverlt ior~ PROPERLY CHAINED AND STORED WITH PROPER FITTINGS. <2) Release Contairm~er~t <3> Clean Up <4> Other Resource Activation 02/12/9;~ ' STOTLE INC & S.OTLER SALES 21~ NO0-000018 Page 5 00 - C,erall Site (F) Site Ersle.ger~cy Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - SIDE OF BUILDING B) ELECTRICAL - INSIDE BUILDING C) WATER - LOCATED IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - ?????????? FIRE HYDRANT - ????????? <4> Building Occupancy Level 02/12/92 STOTLER CO INC & ST'OTLER SALES 215-000-000018 Page 6 00 - Overall Site <G> Trairsirlg < 1 > Page 1 WE HAVE ~.~.~ EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF-- SUMMARY OF TRAINING: <2> Page 2 as rleeded <3> Held fc,~' Futu,'e Use <4> Held for Future Use ? ./~o..~.,,.. %~, CITY oj' BAKER3FIELD RECEIVED ~ m~/~/~ YF~ ~P~4 JAN 1 1 1989 (tyge or ~r~n~ name) ~B'] ............ Do hereby· c=~tify~ that I have reviewed the 0 attached Hazardous Haterials business Dian for ~ (name of business) and that it along with the attached additions or corrections constitute a complete and correct Business Pl.an for my facility. signazur.e date STOTLER CO. INC. 9].7 34th Street Bakersfield, CA 93301 CITY of BAKERSFIELD NON--~I?RADE SECRETS ' %ge .... of .... LOCATION: ~/~ ~ ~ ADDRESS: ~ ~~ PHONE ~: ~-~ ~ PHON~ ~: ~/-?~ ~ _ _ - _ _ _ - ~ ~ f~U~fO~ ~ ~0~ Trnns Ty~ ~X A~r~ ~] MSu~ I ~ Cmt ~t ~t b L~ttm (~e C~e Mt Mt Est Un~ts m Site T~ ~ TW ~ St~ In FKtIIty ~ ~ I~t~t~w ~k 411 t~t 4~ly) ~lth of Pm~ ~lth [~F ~--~ r--~ ~. r--~_ ~t 12 With of Pwm bith ............. ~t 13 ~&C.A.S. P~ical ~ ~lth ~zl~ C.l.S. ~ ~t I1 ~ - r--~ r--~ r--~ r--~ ~t 12 Nm&C.A.S. Hflith of P~surt ~lth P~tcll ~ HHlth ~zl~ C.A.S. ~ ~t I1 ~ & C.l.S. (C~k all t~t ,Nly) ~-~ ~-~ [-~ [-~ ~ c~t B2 ~ H~lth of Pr~surl Health , ~t 13 ERGENCYC~TACTS IT Cerctf~c~r~ (Read and si~ after coapJ~t~n~ a/J s~ctJons) certt~ ~der ~lty of lee t~t I ~ve ~rs~allyexamin~ ~d la f~iTilr with t~ tnfor~ti~ su~itt~ in this ~ Ill g4~ ano~fTlclal hTle oT ~er~rator O~ ~er7o~raior s au[~rlz~ reor.~iaTlve Si~;TG~i ...................................................... ~ii'Si~R~ ............................ · 2130 "G" STREET BAKERSFIELD, CA 9330]. (805) 326-3979 OFFICIAL USE ONLY BUSINESS NAME HAZARDOUS lVtATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further 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 ' ' ~: - /' /,tz~ ~.. ~ - ' B. LOCATION / STREET ADDRESS: ~37 .~n :'~/ ~;',~ CITY:f. ,~C:'~%''~ :' :? ZIP: "::~', .,, ~ BUS.PHONE: SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. B. Ph# Ph# SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE 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 -- / /~.~/,M IA~ITI~L REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS' MATERIALS:.... .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO -' DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POU~.D.~S_,~OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS:..~... ~E~ NO I, .... '. !-~ ~v ~ ~'(~. , certify that the above information is accurate. I unde~ta~d t~% th~s ~nformation 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 per3ury. BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUSINESS PLAN SINGLE FACILITY UNIT FORM 8A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. $. 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, PREVENTIONr ABATEMENT PROCEDb~ES pg~ oP.o~V .C.,~ ,~,~ ' ~'~'~ ~ ¢- .$7~.~'~,¢"".:: SECTION 2: NOTIFICATION .~YD EVACUATION PROCEDURES AT THIS I~CIT ONLY SECTIOM 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardo.~s Materials? ...... YES NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form ~4A-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 $: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO~ERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS b~'IT O~Y. A. NAT. GAS/'PROPANE~% B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES ,/ NO tF YES, LOCATION: iF YES SiTE PLA;X.~. VES ~..'0 MSD.gs.° YES" FLOOR PLANS? YES /' NO YEYS? YES .'" - 3B - BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page of. NON--TRADE SECRETS HAZARDOUS MATERI ALS I NVENTORY BUSINESS NAME: ~?'~' ~/ ~---~,' ~-~ c~:~ OWNER NAME: ~, ~c-~ FACILITY UNIT ~: ,, ADDRESS: ~l~ '~ ~/~ ,~ ADDRESS: ~f~ ~cl~ 5~ FACILITY UNIT NAME: CITY, ZIP: ~2'~<,~/z~ ~y,~.~/ CITY, ZIP: ~f<'~/~-/~/ f,, PHONE ~: ~) ~'7~' PHONE ~: ~l~7~:~i {OFFICIALONLY USE CFIRS CODE 1 2 3 4 5 U~E 7 8 9 10 TYPE ~AX ANNUAL CONT LOCATION IN THIS ~ By HAZARD D.O.T ,~OOE AMOUNT AM~T UNIT CODE CODE FACILITY UNIT WT CHEMICAL OR COMMON NAME CODE GUIDE ' . "*"u: ~, ~ ~*'~4 TITLE: ~~/~. S-GNATURE: ~~ ~~~ DATE: E~ERGENCY CONTACT: ~ <Y:'~k~ TITLE: ~i~'A/f~ PHONE ~ BUS HOURS: ~Z-yT~ ~ AFTER BUS HRS: EMEROENCY CONTACT: TITLE: .. PHONE ~ BUS HOURS: PRINCIPAL BUSINESS. ACTIVITY: /~ffc~//~ ,5'~ AFTER BUS. HRS: - 4A-1 -