HomeMy WebLinkAboutBUSINESS PLAN
. Bakersfield Fire l ept.
Hazardous Materials Ins. p ect-ion
Date Completed ~-1~--~ 0
Location: Zz¥ VT-- A~v.J~x M~,
Plan ID # 21S-000 ['5 (~'Z (Top right comer Business Plan)
Station No. --~ Shift f~ Inspector
~'~T3~'[ k) ~_..~ .~_~ St~ ~ IX.SD ~.0 ~(~ Adequate Inadequate
Verification of Inventory Materials L ~ C)~ ~~ 0 ~ [--] [--]
Verification of Quantities []
Verification of Location [-] [--]
Proper Segregation of Material
Comments:
Verification of MSDS Availability []
Number of Employees
Verification of Haz Mat Training
Comments:
Verification of Abatement Supplies & Procedures [--]
Emergency Procedures Posted ~-~ []
Containers Properly Labeled [--] [--]
Comments:
Verification of Faci~ty Diagram 71. 1---]
Special Hazards Associated with this Facility:
Violations:
FO 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office
Msrch 8~ 1990
TQ:' Nina Mayer~ Accounts Receivable
FROM: Ralph £, Hue¥~ Hazardous Materials C~rdinat~
SUBJECT: E M Welding and Repair
Nina~ account #HM472601 is no longer in business, This account
should be voided for the current balance o~ $10Q, O0,
Thanks
- RE'TURN ~AYMENTS TO:. PLEASE MAKE CHECKS PAYABLE'TO:
CITY OF BAKERSFIELD
P.O. BOX 2057 CITY OF BAKERSFIELD
~AKE~FIELD, CA 93303-2057 ACCOUNT NO. fi~ ~?~ : BETU~N THiS'COPY WITH PAYMENT
~ , . ~:, ~=~-' '-. . .
STATE ~A~9~'~D PRO~Ai~
,,c,- .,~.:,..7..,~:,L .~ .~,.- .,., , ,.,;~'....' ;, : ~. ':.%~ ,..' . . :~ , , . T ,~.~.~;:~7,C~.;.7F;,/C ~.~'. · ,.~ ::.., ~ ,. . '.~,
'. :;:"~.~ ~::S" ::B' IE'L :.'~ S:;' 'D~,B:".-~;~'0N.
INQUIRIES. , CONCERNING' THIS BILL, PLEASE PHONE: ~ ~ ~' ~ J ~'" ' ' .... ' ' ' " "' '"
I
:~K~RSEIEL~ CA 9~304 ,
RETURN PAYMENTS TO: , PLEA~SE/V~AKE CHECKS PAYABLE TO:
CITY OF BAKERSFIELD HA~A~' 00US
BOx 2057 .~., CITY~ OF.-BAKERSFIELD '
50.
B~ERSFIELD, CA 93303-2057 ACCOONT NO.
INQUIRIES CONCERNING THIS BILL, PLEASE PHONE: ~ ~ ~ ~ q ~ ~
~A~E~SFIEL'D~ CA 93~0~
CUSTOMER .COPY
OFFICIAL USE ON'LY
2. ~'PE/PRZ~ ~SWERS ZN ~iGLISR.
S. An~er the questions below for the business as · whole.
4. Be as brief and concise as possible.
SE~ION !: BUS--SS ~!F!CATION DATA
B. LOCATION / STREET ADDRESS:
SECTION 2: ET4ERGEN~[ ~OTIF~CAT~ONS
In case of an emergency invoivin~ the release or threatened release of a.-
hazardous ~ateriai, call 91! and 1-800-8S2-TSS0 or !-9!6-42T-4341. This will notify
your ioc~i fi _ deg~rcmen~ and the
law.
ED~PLOYEES TO NOTIFY. IN CASE OF ~!ERGE~CY:
N~E ~D ~ITLE , ~O~, ~~--C%/k~¢''x' DURING BUS. ~RS. AFTER BUS. ~S.
B. Ph~ Ph=
SECTION 3: LOCATION OF UTILITY SR1]T-OFFS FOR 3USTD~E$S AS A
B. ELECTRICAL: ~-~c_~- ~'~,~',~ ~ ~ ~
O. SPEC !AC:
E. LOC',{ BOX: YES / NO IF YES, LOCATION: ~
IF YES. DOES IT C05;TA[}I SZTE ~ANS? YES / ZO ~4SDSS? YES /
FLOOR ~r, .~,,~,~,co. YES / 1~0 ~E'zS~,, . . ~'~,_~ ,/ .,0
270H~ V SV SS~i$.q~ ~OA MOM ZONVJ. SISS~' 'JVOIG~K 2,OI{2DH-gM3 UVO03 :_c. J~Oi.L03S
BAKERSFIELD CiTY FiRE DE?ARTi-iEXT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFiCiAL USE ONLY
!D~
BUS i~.iESS NAY. E:
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1.,,To avoid further action, this form must be returned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer r, he questions below for THE FACiLiTY U:,~iT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY L~IT~ FACILITY b~NIT N/EME:
SECTION 1: MITIGATION, PREVEB~!ON, ABATEMENT PROCEDbq~ES
SECTION 2: NOTIFICATION .~YD EVACUATION PROCEDL~ES AT THIS U:'iiT ONLY
'a-'~ " >~ATERIAiS FOR THiS U?'TT
SECT!ON 3: H.
A. Does ~his Facility Unit contain Hazardous ~ ~ ~a!s? ...... YES
~f YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES
If No, comp~.~e~a~ a sepa~..~e~ hazardous aaterials inventory ...
form marked: NON-TRADE SECRETS ONLY (white form ~4A-1)
Yf Ves, complete a hazardaus materials ............ ,
TRADE SECRETS ONLY (yellow form ''" ~ '
..... -_~ in addition to the hca-trade
ss'cret form List onlF the ~raa_ secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
SECTION 5: LOCATION OF WATER SUPPEY FOR USE BY E~RGENCY RESPOR~ERS
SECTION 6: LOCATION OF UTiLi~! S~JT-OFFS AT THIS UNIT ONLY.
A. NAT. 6AS,PROF.'\NE]
B. ELECTRICAL:
C. WATER:
. C' v~s NO :F YES, LOCATION:
E LO,K BOX: ..... /
=.r. OOp pr ,vt- ...... .'.;0 :(E¥S? V-~S ," ',.:O,
-'...-~.~.) : 1' if,,) /'
33 -
BAKERSFIELD CITY FIRE DEPARTMENT
I .D. # FORM 4A-I Page
NON--TRADE SECRETS
IIAZ ARi')OUS MATERI ALS I I>IVENTORY
I]USINE,qS NAME: ~ ~ ~ O~NER NAME; ~ FACII, ITV UNIT ~: ....
ADDRESS: ~k~ ~[~~ ' x ADDRESS: ..~~ ~~ FACILITY {INIT NA/,IE:
i
I 2 3 7 9
TYPE MAE ANNUAL LOCATION IN TiIIS IIAZAI(b
NAME: TITLE: _~3OJlX..h ~ V"' SIGNATURE: ~%'k.~ ~. ~. D A T E: ~<~r.\~_~ .....
EMERGENCY CONTACT: TITLE; PHONE # BUS IIOURS:
" AFTER ilUS HES:
EMERGENCY CONTACT: TITLE: PHONE # BUS HOLIES:
PRINCIPAL BUSINESS ACTIVITY: AFTER ilUS fIRS:
IRECEIVED
FEB 2 2 I~8~
HAZ. MAT. D~.
attached Hazardous Haterials business ~lan
for ~. · %de ~. ~
(name o£ business l
and that it along with the attached additions
or corrections constitute a complete and correct
Business Plan for my facility.
slgna%ure date
~USIN~ESS NAME E M WELDING AND REPAIR ID NUMBER 215-000-001362
LOCATION 2412 ARLANA ST HIGH HAZARD RATING 3
D . EMPLOYEE NOTIFICATION / EVACUATION
LAST CHANGE 12/29/88 BY ESTER
3A SEC 2) PULL THE TRAILER AND TANKS OUT OF THE GARAGE.
E . MITIGATION / PREVENTION / ABATEMENT
LAST CHANGE 12/29/88 BY ESTER
3A SEC 1) TRAILER BOLTED DOWN BOTH GASES.
PAGE 4 12/29/88 11:33
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
BUSINESS NAME E M WELDING AND REPAIR ID NUMBER 215-000-001362
LOCATION 2412 ARLANA ST HIGH HAZARD RATING 3
FACILITY UNIT 01
a . OVERALL HAZARDOUS MATERIALS INVENTORY
LAST CHANGE 12/29/88 BY ESTER
ID TYPE NAME MAX AMT UNIT HAZARD
LOCATION CONTAINMENT USE
I PURE OXYGEN 280 FT3 HIGH
IN GARAGE PORTABLE PRESS. CYL. WELDING/SOLDERING
ID PERCENT COMPONENTS HAZARD LISTS
2'359.00 100.'0 OXYGEN, COMPRESSED HIGH
2 PURE ACETYLENE 2300 FT3 EXTREME
'IN GARAGE PORTABLE PRESS. CYL. WELDING/SOLDERING
ID PERCENT COMPONENTS HAZARD LISTS
1241.00 100.0 ACETYLENE EXTREME
B . FIRE PROTECTION / WATER SUPPLIES
LAST CHANGE 12/29/88 BY ESTER
3A SEC 4) FIRE EXTINGUISHER FOR FIRE PROTECTION.
3A SEC 5) FIRE HYDRANT?
PAGE 3 12/29/88 11:33
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
BUS~NESS NAME E M WELDING AND REPAIR ID NUMBER 215-000-001362
LOCATION 2412 ARLANA ST HIGH HAZARD RATING 3
3 . HAZ MAT TRAINING SUMMARY
LAST CHANGE / / BY
< NO INFORMATION RECORDED FOR THIS SECTION
4 . LOCAL EMERGENCY MEDICAL ASS I STANCE
LAST CHANGE 12/29/88 BY ESTER
3A SEC 5) NEAREST HOSPITAL.
PAGE 2 12/29/88 11:33
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800
BUSINESS NAME E M WELDING AND REPAIR ID NUMBER 215-000-001362
LOCATION 2412 ARLANA ST HIGH HAZARD RATING 3
1 . OVEi~VIEW
LAST CHANGE 12/29/88 BY ESTER
JURIS CODE 215-005 JURIS BAKERSFIELD STATION 05
MAP PAGE 123 GRID 24D FACILITY UNITS I HAZARD RATING 3
RESPONSE SUMMARY
2A SEC 4) NO PRIVATE RESPONSE TEAM.
EMERGENCY CONTACTS 2A SEC 2)
EMET R. MIRANDA - 398-0851
UTILITY SHUTOFFS 2A SEC 3)
A) GAS - E SIDE OF HOUSE B) ELECTRICAL - E SIDE OF HOUSE C) WATER - W SIDE
OF HOUSE D) SPECIAL - NONE E) LOCK BOX - NO
2 . NOTIFICATION / PUBLIC EVACUATION
LAST CHANGE / / BY
< NO INFORMATION RECORDED FOR THIS SECTION
PAGE 1 12/29/88 11:33
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800