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HomeMy WebLinkAboutBUSINESS PLAN " SITE DIAGRAM [ , FAC I LITY DIAGRAM · " Business Nome: /~/~ ~..o},,x ' For Office U~e Only First Jn Stctton: Area McD# I ot inspection Station: NORTH " HAZARDOUS MATE~[.LS ~ i~kersfield Fire Dept.. ~_.~,,J.5 ~'E-c_,'~,~ Hazardous Materials Division Date Completed Business Name: ~ ~co~ ~ Location: ~OO ~%~ ~ ~ ~ Business Identification No. 215-000 (Top of Business Plan) Station No. ~ Shift Inspector ~~ Arrival Time: ~ Depa~ure Time: O~ Inspection Time: Adequate Inadequate Verification of Invento~ Materials ~ Verification of Quantities ~ Verification of Location ~ Proper Segregation of Material~ Commen~: Verification of MSDS Availabili~ ~ Number of Employees: Verification of Haz Mat Training ~ Commen~: Verification of Abatement Supplies & Procedures ~ Commen~: ~ ~E~ULAT,~ ~5~ ~ ~O ~(~%~ Emergency Procedures Posted ~ Containers Properly Labeled ~ Verification of Facili~ Diagram ~ Special Hazards Associated with ~is Facili~: Violations: Business Owner/Manager PRINT NAME Correction Needed White-Haz Mat Div Yellow-Station Copy Pink-Business Copy HAZARDOUS MATE LS I~' ~ ersfield Fire Dept. ~(~.E~,,,L~ ~',~<.~t <~,,g ~'.~ Hazardous Materials Division "~ Date Completed Business Name: ~, ,,Jc~_,~J - ~o~ Location: A{~ C~,,} ~HE /~r3 ~ Business Identification No. 215-000 (Top of Business Plan) Station No. 7 Shift ~ Inspector ~[fo~,~,,~.o ~-~),~ Arrival Time: ~c::~) Departure Time: ~.} Inspection Time: Adequate Inadequate Verification of Inventory Me,rials I'1 Verification of Quantities I~ I'1 Verification of Location I-~ I"1 Prope? Segregation of MaterialI~1 Comments: Verification of MSDS Availability ~ Number of Employees: Verification of Haz Mat Training l"'1 Comments: Verification of Abatement Supplies & Procedures ~ Comments: <~-'~ .A~c.u~u~.A'r,,,./~ c,,JA~'~'~ ~ ~o /wx~.~c-~%-'C'~ Emergency Procedures Posted l'1 Containers Properly Labeled (~ Comments: /~(^~Arz~ ~c~<.~-~ <~ ~.~.~"r~. ~,"z.u,,~ ~A~ ~ Pc. AcE.. Verification of Facility Diagram (~ Special Hazards Associated with this Facility: Violations: ,/~ ,~/~'.~0,~ E:_~/~,...- ~~~ All Items O.K Business ~er/Manager PRINT NAME SIGN~TUR~ Correction Needed White-H~ Mat Div Yellow-Sa~on Copy Pink-Business ~py 04/26/94 LINCOLN YORK 215-000-000528 Page 1 Overall Site with 1 Fac. Unit General Information Location: 4400 ASHE RD 209 Map:123 Haz:0 Type: 3 Community: BAKERSFIELD STATION 09 Grid: 15C F/U: i AOV: 0.0 Contact Name Title ~ Business Phone 24-Hour Phoneq MARK MORE~ PROJECT MANAGER 1(805) 832-2155 x (805) 334-6364! JOSEPH CESTERO ESTIMATOR (805) 832-2155 x (805) 634-6226~ Administrative Data Mail Addrs: 5650 DISTRICT BLVD #111 D&B Number: City: BAKERSFIELD State: CA Zip: 93313- Comm Code: 215-009 BAKERSFIELD STATION 09 SIC Code: Owner: ~,/~y C~$~o Phone: (~o~) Address: /~ ~ ~'l~O~ C~Kr State: City: ~m/~¢A5~,%,~ ziP:~3/3 - Summary reviewed the ~ttached hazardous materials manage- rnent plan forL~,~,//~ /v~,~,' and that it alO~l with any COrrections COnstitute a complete and COrrect man. agement plan for my facility. . ..~' ,. 04/26/94 LINCOLN YORK 215-000-000528 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-001 WASTE THINNER Liquid 25 Moderate · Fire, Delay Hlth GAL 02-002 LACQUER BASED PAINT Liquid 55 Moderate · Fire, Delay Hlth GAL 02-003 LATEX BASED PAINT Liquid 700 Unrated. · Fire GAL 04/26/94 LINCOLN YORK 215-000-000528 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-001 WASTE THINNER Liquid 25 Moderate · Fire, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Waste Days: 365 Use: WASTE Daily Max GAL25I~ Daily Average20.00GAL I Annual Amount55.00GAL -- Storage Press T Temp Location DRUM/BARREL-METALLIC Ambient~AmbientlNW INSIDE CORNER CENTER OF BLDG -- Conc Components MCP ---TGuide 0.0% Unrated I 0 0.0% Unrated I 0 02-002 LACQUER BASED PAINT Liquid 55 Moderate · Fire, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: PAINTING Daily Max GALI Daily Average GAL I Annual Amount GAL 55 ~ 55.00 55.00 Storage Press T TempI Location METAL CONTAINR-NONDRUM Ambient~AmbientlNW INSIDE CORNER CENTER OF BLDG -- Conc Components MCP ~Guide 15.0% Unrated 10.0% Unrated 02-003 LATEX BASED PAINT Liquid 700 Unrated · Fire GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: PAINTING Daily Max GALI Daily Average GAL --~-- Annual Amount GAL -- 700 ~ 500.00 3,000.00 Storage Press T TempI Location DRUM/BARREL-NONMETAL Ambient~AmbientlSE CORNER OF BLDG - Conc ~ Components ~ MCP ~Guide 04/26/94 LINCOLN YORK 215-000-000528 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation PA SYSTEM <3> Public Notif./Evacuation CONTACT 911 <4> Emergency Medical Plan CALL 911 CONTACT KMC, LET KNOW WE HAVE A HAZARDOUS MATERIALS EMERGENCY ON THE WAY. 04/26/94 LINCOLN YORK 215-000-000528 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ONLY MYSELT CAN RELEASE PAINT TO THE EMPLOYEES. <2> Release Containment KEEP ALL PAINT THINNERS OR LAQUER THINNER IN A HIGH VISIBLE YELLOW AREA. <3> Clean Up CALL PROFESSIONAL CLEANERS SUCH AT ACT 1, ARRANGEMENTS HAVE ALREADY BEEN ESTABLISHED. <4> Other Resource Activation 04/26/94 LINCOLN YORK 215-000-000528 page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - B)'ELECTRICAL - MAIN BREAKER OUTSIDE BLDG (EAST) C) WATER - VALVE AT MAIN OFFICE (NORTHEAST) D) SPECIAL '- E) LOCKBOX - YES, SMH (EAST) BLDG <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SPRINKLERS NEAREST FIRE HYDRANT - 'CORNER OF DISTRICT BLVD & ASHE RD <4> Building Occupancy Level 04/26/94 LINCOLN YORK 215-000-000528 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE 2 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: WE ONLY KEEP LATEX PAINT IN 5 GAL CANS, OCCASIONALLY WE WILL KEEP PAINT THINNER BUT NEVER MORE THAN 5 GALS, SAME WITH LAQUER THINNER. WE HAVE OUR EMPLOYEES WATCH A TAPE VIDEO ON SAFETY; KEEP EYES COVERED ETC. WE EXPLAIN HOW TO WASH OFF THINNER OFF THE SKIN ETC. THEY ARE TRAINED 1 DAY AT HIRE AND EVERY MONDAY MORNING THEREAFTER. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use HAZARDOUS MATE LS INSPECTION ~ ~,(ersfield Fire Dept. ~:; Hazardous Materials Division Business Name: ~ [,,,JCoL/,J Location: ~-4OO ~5t4~- r'cO '~- '2_~, Business Identification No. 215-000Lfn~'C-'"J') (Top of Business Plan) Station No. Shift Inspector Arrival Time:°o':~'0 Departure Time: ~, ,5"' Inspection Time:~'-~ ~', ''J Adequate Inadequate Verification of Inventory Materials [~/ r"l Verification of Quantities Verification of Location ~ ["1 Proper Segregation of Material Comments: ~.t-/oP ~5; Cc~;-.,~.,,J ~ /OG~'T"~. Verification of MSDS Availability Number of Employees: '"7 Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Emergency Procedures Posted I"1 ~_.____~ Containers Properly Labeled Comments: ~L-E_ASE PI.~.¢E. ~oJ,~.sTE." L.x.g£c.. Verification of Facility Diagram Special Hazards Associated with this Facility: Busine~ ~er/Manager PRINT Correction Needed WhRe-H~ Mat Div Yellow-S~on Copy Pink-Business' Copy · "* :' RDOUSMAT S INSPECTION ~';~ rsfield Fire Dept. >. :. '~i Hazardous Materials Division Date Completed Business Identification No. 215-000 (Top of Business Plan) Station No. Shift Inspector -J,-(,:=~,,.~r~ U,..), Arrival Time:<~ ;7>0 Departure Time: c), , ~ Inspection Time: ~' ~" ~, ,-,J Adequate Inadequate Verification of Inventory Materials ~ r'l Verification of Quantities ~ Verification of Location ~ Proper Segregation:of Material ~ r'1 Verification of MSDS Availability ~ Number of Employees: '7' Verification of Haz Mat Training ~ Comments: Verification of Abatement Supplies & Procedures, r'~ Emergency Procedures Posted [~ Containers Properly Labeled r'l Verification of Facility Diagram ~ Special Hazards Associated with this. Facility:. Violations: PLG^sE p'~.,ccg' H~.~Ar~a ¢.,,JArz,u,,~- / All Items O.K Business ~er/Manager PRINT ' ~ Correction Needed Whito-H~ Mat Div ~ellow-8~tion Cow Pink-Bu~ino~ BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION · BAKERSFIELD, CA. 93301 ,- HAZARDOUS MATERIALS MANAGEMENT PLANt INSTRUCTIONS: '2. ~P~/.PRINT ANSWERS IN ENGUSH. FEB 1994 3. Answer the questions below for the business as a whole. 4. Be brief and concise as po~ible. i ~/~ C.- By~ .................... SECTION 1' BUSINESS IDENTIFICATION DATA MAILING ADDRESS: CITY: ~ STATE: DUN ~ BRADSTREET N~MBER: ~' SiC CODE'. -- MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT : TITLE BUS. PHONE - 24 HR. PHONE .: ' .. .. ~]~akerafie[d Fire Dept. · '- ~l~:ardous/vfkterials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 5: TRAINING: NUMBER OF EMPLOYEES: Z- MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY oF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS tS EXEMPT FROM THE REPORTING REqUiREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE OD NOT HANDLE HA~ROOUS MATERIALS. TIMEEXCEEO THE MINIMUM REPORTING QUANT~tES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, /'~ ~ ~ ~ ¢V~c:,..r-~_.~ CERTIFY THAT THE ABOVE tNFOR- MATION IS ACCURATE. I. UNOERSTANO THAT THIS INFORMATION~WILL.BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNOER THE."CAUF©RNIA HEALTH ANO SAFETY COOE" ON HAZARDOUS MATERIALS (DIV. 20 CHA~TER 6.95 SEC. 25500 E'(" AL.) AND THAT INACCURATE INFORMATION-CONSTEUTES PERJURY. SIGNATURE · ' DATE 2. Bakersfield: Fire Dept. Hazardous Materials Division HAZARDO US. MATERIALS MANAGEMENT PLAN· Facility Unit Name: j....,,vc.~[,,,. ~,,t~ ' SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION' O. EMERGENCY MEDICAL PLAN: · Baker~_elclFire Dept. Hazardous iViaterials Division HAZARDOUS MATERIALS MANAGEMENT PLAN -"'- SECTION 7' MITIGATION, PREVENTION AND ABATEMENT PLAN: 0u-,--,,~ "~"'-- 8. RELEASE'CONTAINMENT AND/Of? MINIMIZATION' C. CLEAN-UP PROCEDURES' sEcTIoN 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACtUTY): NATURAL GAS/PROPANE: SPECIAL: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:. A. PRIVA'rE F~RE'PRO~'ECT~ON: S pp,.i,~J/( 8. W. ATER AVAILABILITY (FIRE HYDRANT): : ....... _ BAKERSFIELD 'CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION '2130 "G" STREET BAKERSFIELD, CA. 93301 (805) 326-3979 H.~.ARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME FACILITY NAME SIC CODE MAILING ADDRESS EMERGENCY CONTACTS BUSINESS pHONE ~',-::,..g"~- ,,¢'.~"Z-- 2.-.~'~--S'"'- 24-HOUR PHONE BUSINESS PHONE c-~o,A--c-,C.Fz...-~ ~ 24-HOUR PHONE .. BAKERSF! D CITY FIRE DEPA ENT HAZARDOUS MATERIALS INVENTORY. Page_of_" ~usinessName ~r~/C~'~.j (Jo(~. Address ~"~;~--) .~$~ ~ ~ ~ I CHEMICAL. DESCRI~ION ~ 1) IN~NTORYSTA~S: New~ Addition[ ] Revision[ ] Deletion[ ] Checkifchemic~isaNON~DESECR~ [ ] ~DESECR~ [ ] I ~i 2) CommonN~e: ~AS~'~ ~1~~ 3) DOT~ (opaon~) Chemi~ N~e: ~ ~ ~' ~1~ ~~ AHM [ ] CAS ~ 4) 'PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GORIES Fire ~ Reactive [ ] Sudden Rele~e of Pressure [ ] Immediate He~th (Acute) [ ] Delayed He~h (Chronic) 5) WAS~ C~SSIFICATION {~ (3-digit code from OHS Fo~ 8022) USE COOE 6) PHYSICAL STA~ Solid [ ] ~quid ~ G~ [ ]- Pure [ ] M~ure [ ] W~te ~ RadioactNe [ ] ' 7) AMOUNT AND ~ME AT FAClU~ Z ~ UNITS OF M~SURE 8) STOOGE CODES M~imum O~ly Amount: 1~ [ ] g~ [~ ~3 [ ] a) Contaner: ~.. Average O~ly Amount: ~0 cudes [ } b) Pressure: ! · Annu~ Amount: ~ c) Temper~ure: ~gest Size'Container: · Days On Site ~ Circle~ich Mont~s: All Ye~, J, F, M, A. M, J, J, A, S, O, N, O 9) MI~URE: ~st _ COMPONENT . CAS ~ . % ~ AHM the three mo,~ h~dous 1) ~ ~'&~, C ~0~~ ~Z-~--~ [] chemi~ com~nen~ or ~ny AHM com~nents ' 2) ~O LUE~ {.O~ ~--~ []  CHEMICAL DESCRI~ION 1) IN~NTORY' STA~S: New [ ] Addition [ ] Revision { ] Deletion [ ] Check E chemi~ is s NON ~DE S~ [ ] ~DE SECR~ [ ] Chemic~ Name: AHM [ ] CAS ~ 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GORIES Fire ~ Reactive [ ] Sudden Rele~e of Pressure [ ] ~mmedi~e Heath (Ac~e) [ ] ~layed He~th (Chronic) 5) WASTE C~SSIF1CATION (~digit code ~om OHS Form 8022) USE CODE 6) PHYSICALSTA~ Solid [ ] Liquid [~ G~ [ ] Pure ~ Minute [ ] W~te [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES Average Daly Amount: ~'~ cudes [ ] b) Pressure: Annu~ Amount: ~ c) Temper~ure: ~gest Size Cont~ner: · Da~ On Site ~ Circle~ich Months: ~lYe~. J, F, M, A, M. J, J, A, S, O, N, D 9) MITRE: Ust COM~~ CAS. ~ AHM' the three most h.~dous 1) ALl P~T~C ~~ ~74Z- ~9' chemi~ com~nen~or "~' ~ ce~ unOer pen~ of law, ~a~ ~ have pe~onaJ/y ex~in~ ~d ~/~fli~ w~ ~e mfoma~on su~m~ on ~is ~d ~J ~ch~ documen~ submi~ in~a~'on is ~e, accu~te, ~d complete. PRI~ N~e & ~e of A~odz~ Comfy Representative Signa~re BAKER IELD CITY FIRE DEi= :ITMENT HAZARDOUS MATERIALS INVENTORY Pagetof_ 3usiness Name 'L, ,',J c..o~%..~ r"'~( c.,V'~,. Address  CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [4 Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET ~TRADE SECRET [ ] 2) Common Name: ~ ~"~'~ ~'~$~;-i1~ ~::>~' ' ~ 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [~] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION ,(3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid ~ Gas [ ] Pure ~ Mixture [, ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES~ Maxamum Daily Amount: ~ lbs [] gal ~ tt3 [] a) Container: (JJ Average Daily Amount: ...%¢0 cudes [ ] b) Pressure: -- Annual Amount: "~13~0 .. c) Temperature: Largest Size Container: # Days On Site "~" Circle Which Months: All Year, J, F, M A,, M, J, J, A, s, o, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) /'~-JO ~.~J~'~O~J%, ~_c_.,~,~ov~,,JT-.~ [ ] chemicaJ components or any AHM components 2) .. [ ] 3) [ ] 10) Location .~ '~- (~O~AJ~"y'/._ O~ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release ofPressum [ ] Immediate Health (Acute) [ ] Delayed HeaJth (Chronic) [ ] 5) WASTE CLASSIFiCATiON (3-digit code from DHS Form 8022) USE CODE 6) PHYSIcAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure' [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACIMTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] gaJ [ ] t~3 [ ] a) Container: Average Dally Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: AllYe~r, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List . COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2). [ ] 3) 10) Location cerbfy un(~er penaJ~y of law, that I have personally examined and am familiar with the infoma~on sut~mitted on this anti all attached documents. I believe th~ submitted information is ~,z~e, accurate, and complete. PRINT Name & Title of Authorized Company Representetive Signature Date BAi~ER IELD ,..,ITY FIRE DE RTMENT HAZARDOUS MATERIALS DIVISION 17i5 CHESTER AVE. BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [' ] BUSINESS NAME FACILITY NAME SITE ADDRESS CITY STATE ZIP NATURE OF BUSINESS SIC CODE DUN & BRADSTREET NUMBER OWNER/OPERATOR PHONE ' MAILING ADDRESS CITY STATE ZIP EMERGENCY CONTACTS NAME TITLE BUSINESS PHONE 24-HOUR PHONE NAME TITLE BUSINESS PHONE 24-HOUR PHONE