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Home My WebLink AboutBUSINESS PLAN 9/11/2003 per te Hazardous Materials/Hazardous Waste Unff~ed Permit CONDITIONS OF PERMIT ON REVERSE SIDE This _oermit is issued for the followincj: [] Hazardous Materials Plan [] Underground Storage of HazardOus Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-001739 JIFFY LUBE LOCATION 3727 ~.. -. ~: ~ OFFICE OF ENV1R ONMENTAL SER VICES~ · c" . 1715 Chester Ave., 3rd Floor Approved by: ~ JUN ~, '(~ Ra¥ff'Huey, D~: issue ~te Bakersfield, CA 93301 OmceofEv~~~icesTM Voice (661) 326-3979 F~ (661) 326-0576 ExpimtionDate: '~M~e 30~. 2003 Water ..._ [--~ Shut-Off Coolant Stairs Stairs Lobby IBath ................................................... Office Electrical Shut-Off ~ Air Compressor Sprinkl'er Jiffy Lube Store #2759 Stand-Pipe Crushed Filters $727 Auburn Avenue Ground Level Dumpster Stairs N ~ ~ Stairs Various Grades ! Motor Oil Each Tank 75 Gallons Vent ~ 500 Gallons I ATF 282 Gal. 282 Gal. \ 500 Gallons Gallons Waste Oil Motor Oil Motor Oil~ Motor Oil 500 Gallons Waste Oil Sprinkler Jiffy Lube Store #2759 3727 Auburn Avenue Lower Level JIFFY LUBE SiteID: 015-021-001739~ Manager : ,~.U~I~L C~TTJ A~ ~~ BusPhone: (661) 872-7901 Location: 3727 AUBURN ST Map : 103 CommHaz : Low City :.BAKERSFIELD Grid: 22B FacUnits: 1 AOV: SEP 18 CommCode: BAKERSFIELD STATION 08 SIC Code: EPA Numb: DunnBrad:04-523-8763 t Emergency Contact/ / Title Emergency Contact / Title ............ ~ ......................... ~,,,--,.~-. GENEP~AL MGR Business Phone: (310) 831-1043x Buslness Phone: (661) 872-7901x 24-Hour Phone : (210)- 52. .....~ 24-Hour Phone : (661) O71 ..... Hazmat Hazards: Flre DelHlth Contact : PEPPERTREE INC Phone: (310) 831-1043x MailAddr: 595 W 7TH ST 202 State: CA City ' S~ PEDRO Zip : 90731 Owner PEPPERTREE INC Phone: (310) 831-1043x Address : 595 W 7TH ST 202 State: CA City : S~ PEDRO Zip : 90731 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: -1- 08/14/2003 JIFFY LUBE SiteID: 015-021-001739 ~ Hazmat Inventory By Facility Unit -- MCP+DailyMax Order Fixed Containers at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax lUnitIMCP WASTE OIL F DH L 1000.00 GAL Low TRANSMISSION FLUID F DH L 500.00 GAL Low ,~.~, ,',~-Tv~ F DII L 23,, ....... ~ ~ .~ LC;; WASTE ANTIFREEZE F DH L 55.00 GAL LOW ANTIFREEZE L 55.00 GAL Low MOTOR OIL F DH L 1664.00 GAL Min if"' -2- 08/14/2003 ~/JIFFY LUBE SiteID: 015-021-001739 ~ ~ Item 0006 Facility Unit: Fixed Containers at Site ~,.~lvllvik;l~l~?q./-iivl.M=2 / ~l"i~lv!£ ~%.m, l~4~-iivl~ GEAR OIL ~ Days On Site Location ' thi Facility Unit Map: : ~ with~ s Grid / BASEMENT ~,. CAS# ./ 64742-57-0 ~ ST~T~. T~ :SOR~, T~M~,=TUR~, OONT~IN~ T~. I IAmbient DRUM/BARREL-METALLIC Pure Liquid L 0 CAT I ON Largest ContainerIDai Daily Average 240.00 LBSI 0.00 LBS 15.00 LBS COMPONENTS l i oRSI 100.00 Light Oil N 8020835 HAZARD ASSESSMENTS ITSooro BioHaz Radioactive/Amount I EPA Hazards USDOT# I MCP No No No/ Curies F DH / / Low ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ ~lv~vl~ ~v~ / ~ £ ~ ~vl~ WASTE ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: NW CORNER GROUND LEVEL CAS# 107-21-1 Liquid /waste Ambient Ambient PLASTIC CONTAINER I I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GI~L %Wt. S CAS# 30.00 Ethylene Glycol N 107211 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F DH / / / Low -5- 08/14/2003 ~ . · Bakersfield Fire Dept.~ Enironmental Service s 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 - Tel: (661)326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS PHONE No. NO. of Employees FACILITYCONTACT Business ID Number 15-o21 - ~..)/73 ~ ..j~fl~r~utine [] Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection [ C=Compliance ~ OPERATION COMMENTS ~. v=violation APPROPRIATE PERMIT ON HAND VISIBLE ADDRESS CORRECT OCCUPANCY VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL VEmF~CAT~ON OF MSDS AVA~LAB~U~E VERIFICATION OF HAT MAT TRAINING HOUSEKEEP~N~ F~RE PROTECTION SffE DIAGRAM ADEQUATE & ON HA~O ANY HAZARDOUS WASTE ON SITE?: ES [] NO · QUESTIONSi~_~~~ 'REGARDING THIS INSPECTION? PLEASE CALLN~. US AT (661) 326-3979___, ,~f_~~ White - Environmental Services Yellow - S~ation Copy Pink - Business Copy KERN COUNTY ENVIRONMENTAL HEALTH SERVICES (661) 862-8700 HAZARDOUS MATERIALS BUSINESS PLAN FORM 2 Forms Due By: SECTION 1: BUSINESS IDENTIFICATION DATA A. Full Legal business Name: Pepper Tree, INC- DBA ,-ri fly T.~be B. PhysicalLocation/Streetnddress:~'~'~1 ~-kJ~3~ ~:~OfLe Ciiy: ~--'~ C IL\~', ~ ~ Zip: ~ ~-~0{~ ~:::, Business Phone: ~ C. Mailing Address: 595 W. 7th Street, Suito_ City: San Pedro Zip: q~731 D. Have you filed a Business Plan with the department under a different name within the last two years? YES NO If yes, under what name did you file? E. This submission is a NEW__ or REVISED / Business Plan F. Does your business handle any ofthe"acutely hazardous/substances" listed on the enclosed handout in addition to other types of materials? YES NO I/ SECTION 2: EMERGENCY NOTIFICATIONS In the event of an emergency involving the release or threatened release of a hazardous material, telephone 9-1-1, and then (800) 852-7550 or (916) 262-1621. This will notify your local fire department and the State Office of Emergency Services, as required by state law. Additional federal reports may be required. Persons who should be notified in case of an emergency at your business that have full access and can provide technical assistance: NAME AND TITLE DURING BUSINESS HOURS AFTER BUSINESS HOURS - CONTINUED ON REVERSEL ZOOZ Z Z AON (1) SECTION 3: LOCATION OF THE MAIN UTILITY SHUT ~,S FOR THE ENTIRE BUSINESS A. Natural gas/propane: D. Special/other: E. Lock Box: YES or NO Ifyes, location: if yes doesit contain: Site Plans? YES or. NO MSDS? YES or NO Floor Plans? YES or NO Keys? YES or NO SECTION 4: PRIVATE RESPONSE TEAM DESCRIPTION Do you have a group of employees trained to handle minor'accidents involving hazardous materials at your business? YES or NO If yes, you must explain the level of training and equipment they possess and how they are notified to respond. SECTION 5: IDENTIFICATION OF THE CLOSEST APPROPRIATE EMERGENCY MEDICAL ASSISTANCE AVAILABLE TO YOUR BUSINESS . Comments/Additional information: - CONTINUED ON NEXT PAGE- (2) CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~'~£Y d t,,z~,~ INSPECTION DATE --~ -;~- o 'x_., Al)DRESS '3'7 ~7 ~u~,.,,e,,o -st" PHONE NO. ¢g7'z--- FACILITY CONTACT rd'./iri ~; t I,e g_ BUSINESS ID NO. 15-210- ~,o INSPECTION TIME/~'~'~ -~,-t¢~ - tq ,m,,o. NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~.~outine {~ Combined. [~ Joint Agency [~] Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V! COMMENTS Appropriate permit on hand 'b/ Business plan contact information accurate ~'~ /Page) ,"ff~,val~ e Visible address Correct occupancy Verification of inventory materials Verification of quantities v/ Verification of location 'v/ Proper segregation of material V Verification of MSDS availability b/ ~ot ~ ! Verification of Haz. Mat training 1,/' 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 Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White - Env. Svcs. Yellow - Station Copy Pink- Business Copy Inspector: ,V? _ · · ~.,~[;-:-------,~--.._. CITY OF BAKERSFIELD '** o OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS ~M~ENT PLAN 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA LOCATION: ,.372-,"7 ,~~,,~ Al]e-- CITY: ~'7'~7--. ~.~ ~,,:/g12 STATE: CPi ZIP:~Zt/_PHONE:~3/O O~ER:f4~e~ T~ee. ~k ,, PHONE:t Iota/ ~or3 EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1' DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. E~LOYEE A~ AGENCY NOTIFIgATION: C. E~IRO~ENTAL ~SPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: ! 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTA~MENT A~/OR MITIGATION: d C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: /V 0/~J~-~ ELECTRICAL: "~'/'4~ ~'DO' ~.l~'~'c ~- ~,-~,vUq'H ~'it)~: c~ LOCK BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: z..). CERTIFICATION I,-~-¢'~N G, ,~'¢~c0~ CERTIFY THAT THE ,'U~OVE m'FOR_~TION IS ^CCU~'rE. I UNI)ERSTAND T~T THIS r~FO~TION W~Lr, BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND ~Q~"G N~[~'~'UR E ~ ' TITLE DATE ICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER / OPERATOR IDENTIFICATION FACILITY INFORMATION Page ~ Of I, FACILITY IDENTIFICATION BUSINESS ~ME (~ as FACILI~ NAME of OBA- ~{~ Busies ~) 3 BUSINESS PHONE SITE ADDRESS :o3 DUN & ~ ~ SIC CODE -. II.OWNER INFORMATION ., ... .. · ~ .~::. ~-.. .. ~ ..:~ .. . · :':. · , ~:-::~..~: ...?..'..... · "'"?;~. ~..'~ III, ENVIRONMENTAL CONTACT ~ONTACTNAME ~~ ~i~L~.~' 117 CONTACT PHONE ~[0 ~/ /~ ,,8 CONTACT ~ILING 1 ~RIMARY, ' IV. EMERGENcYCONTAgTS .":'" ~ECONDARY- BUSINESSPHONE 6 b / ~ 7 ~ ~q 0 / ,26 BUSINESS PHONE (~ U~ '~_9_~,._~._~O_J_ ................. PAGER ~ ~2s PAGER ~ 133 V, CERTIFICATION Cedifi~tion: Ba~d on myj~f ~ose individuals responsible for obtaining the information, I ~di~ under penal~ of law ~at I have personally examined and am familiar ~th.~ info~on submitted in this invento~ ~ ~elieve the info~ation is tree, accurate, and ~mplete. NA~F O~N~E~TOR (print) ~ : TITLE OF O~NE~OPE~TOR UPCF (7~99) S:\CUPAFORMS\OES2730.TV4 wpd --~ Ftg£ ~ ' OFFICE OF ENVIRONMENTAL SERVICES t~,Attrt~r 1715 Chester Ave., CA 93301 (661) 326-3979 "-"*~~'"' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION NEW ~ ADD ~ DELETE ~ REVISE 2~ Page __ I. FACIL~ INFORMATION II, CHEMICAL INFORMA~ON 205 T~DE SECRET ~ Y~ ~No 206 CHEMI~L If Subj~ tO EPC~. ref~ to inst~mi~s ~7 ............. EHS' ~ Y~ ~No ~8 ~S ~ ~ *If EHS is'Yin,' ~1 ~oun~ ~w ~st ~ ~ ~s. FIRE ~DE H~RD C~SSES (~plete if r~u~t~ by I~l fire ~Je0 210 (~ ~1 thai app.) I FIRE ~ 2 R~CTIVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~L~ CHRONIC H~LTH 216 UNITS' ~.ga ~L ~ d CU FT ~ I~ LBS ~ m TONS 221 ff EHS. ~nt must be in lbs. STOOGE ~AINER (Check all that ap~y) A~VEGROUND TANK ~e P~STI~NONMETALLICDRUM ~i FISERDRUM ~m G~SS BO~LE ~q ~IL~R 223 UNDERGROUND TANK ~ f ~N ~ j ~G ~ P~STIC BO~LE ~ r O~ER ~d S~EL DRUM ~h SILO ~1 CYLINDER ap TANK WA~N p~ STO~GEPRESSURE ~ a AMBIENT ~ ~ A~VEA~IE~ ~ ba BELOWA~IE~ 224 STOOGE TEUPE~TURE ~a AMBIENT ~ aa ABOVE A~IE~ ~ ba BELOWAMBIENT ~ c CRYOGENIC 225 %~ '" ~ ' H~RDOUS COMPONENT EHS CAS 226,I 227 ~ Y~ ~ NO 228 230 ~ 231 ~ Y~ ~ ~ 232 233 234 i 235 ~ Y~ ~ NO 236 237 238 ~ 239 ~ V~ ~ NO 240 ~ 241 242 ~ 243 ~ Y~ ~ No 244 ' 245 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4 wpd " ........ ~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 '""'*~ .... HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per material per butl(~in~ gr I--I NEW [] ADO [] DELETE [] REVISE 200 Page __ of __ I. FACILITY INFORMATION '~O~'liqESS NAME (Same as FACILITY NAME er DBA - Doing Business As) ...................... CHEM,CALLOCAT,O. CHEM,CALLOCAT,ON p ~' ~ CONFIOENT~'L (EPCRA~ II. CHEMICAL INFORMATION 205 TRADE SECRET [] Yes ~No 206 CHEMICAL NAME If Subject to EPCRA, refer to instructions 2O7 EHS° [] Yes ~"No 208 CAS # 209 °If EH$ is'Yes.' all amounts betow must b~ in Ib~. FIRE CODE HAZARD CLASSES (Complete if requested.by local fire chief) 210 TYPE [] p PURE m MIXTURE [] w WASTE 2a a ~ RADIOAClIVE [] Yes ..... 212 -C-U-R~E~- ................ FED HAZARD CATEGORIES ~ (Check all that apply) FIRE [] 2 REACTiVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH CHRONIC HEALTH 216 AMOUNT h P o ~ I . DA,LYA'.OUNT 0 0 0 OA,~¥A..OUNT (l I u.rrs' l~!l, ga ~L [] a CU ~r [] ,, .ss [] t. TONS ~2~ · If EHS. amount must be in lbs. STOI~GE CONTAINER ~a~ (Check alt that appty) ABOVEGROUND TANK [] e PLASTIC~NONMEIALLIC DRUM [] i FIBER DRUM [] m GLASS BOI-FLE [] q RAIL CAR 223 [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOttLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h S~LO [] ~ CYUNDER [] ~ TANK WAGON STORAGE PRESSURE ~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENI 224 STORAGE TEMPERATURE ~:a AMBIENI [] aa ABOVE AMBIENI [].b.a BELOWAMBIENT [] c CRYOGENIC 225 %WT : · HAZARDOUS COMPONENT :: · EHS CAS # 1 226 227 , I-I yes [] No 228 229 2 230. 231 [] Yes [] No 232 233 3 234 ' 235 [] Yes [] No 236 231 4 238 239 [] Yes [] No 240 241 5 242 i 243 [] yes [] NO 244 245 UPCF (7/99) S:\CUPAFORMS\OES2731 TV4.wpd '~ ....... .. CITY OF BAKER: O OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fort71 Der matenal Oer butlding or ,~rea~ [] NEW E] ADD [] DELETE [] REVISE 200 Page __ of I. FACILITY INFORMATION ~U'~I~ESS NAME (Same as FACILITY NAME o~ DBA - Doing Business As) ............................................................ f. m ......................... CHEMICAL LOCATION _~ J t · / ~ A i ~ ' 20! CHEMICAL LOCATION E]Y t~/~ f.~p.4',/L~/- G'C-~(.t NO /-~v'~-~ CONF,OENT,AL~EPCRAI ~' ~No 202 / II. CHEMICAL INFORMATION 2O7 ................ g-r"/ - - ~ -0 0/'--' CAS #-. 209 *if EHS is'Ycs,' all amouats below must be ia lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE [] p PURE m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes PHYSICAL STATE E]s SOLID [~LIQUID []gGAS 214 LARGEST CONTAINER .~'~ q'(~ I' , 215 FED HAZARD CATEGORIES [] I FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH E~ CHRONIC HEALTH 2~ (Check all that apply) AMOuNTANNUAL WASTE 217 ' MAXIMUM. DAILY AMOUNT '~ [~]~ Cf 6~ 'v"~'/"~'"'- F~T ' 218 AVERAGEDAiLY AMOUNT~-- ~//~ 219 STATE WASTE CODE 220 DAYS ON SITE ~ 222 UNITS' ~¢,ga GAL [] lb LBS [] In TONS 221 ° If EHS. amount must be in lbs. ---.~-b STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all ~hat apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN ~1 STEEL DRUM [] h SILO r"] i CYLINDER [] p TANK WAGON STORAGE PRESSURE ~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOWAIVlBIENT 224 STORAGE TEMPERATURE ~aAMBIENT [] aa ABOVE AMBIENT [].~a BELOWAMBIENT [] c CRYOGENIC 225 %WT HAZARDOUS CoMpONENT ' EHS I CAS # 1 226 227 [] Yes [] No 228 229 2 230 231 [] Yes [] No 232 233 3 234 235 [] Yes [] No 236 237 4 238 i 239 [] Ye~ [] No 240 241 $ 242 i 243 [] Y~S [] No 244 245 III. SIGNATURE '~SRINT N,~ME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~ ~L_~ ..................... --~- -- b~---~-~ ...... ....... UPCF (7~99) S:\CUPAFORMS\OES2731 .TV4.wpd .' ';~(~ CITY OF BAKERSFIELD ~ ~o OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 '""'"~'~'""~"~"' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per material Der butlding or area I--J NEW I--J ADD [] DELETE [] REVISE 200 Page __ o! I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME o~ DBA - Doing Business As) ...................................................... f~£p.~._?~,,..~ s.~.., ..... ~..e.~ ...... J_,'.¢~,~ ..... L .~_~ ~ ......................... e 2O2 FACILITY ID : ; . ~ "~ 1 MAP # (ootional) 203 GRID # (optional) 20~ I1. CHEMICAL INFORMATION 205 TRADE SECRET [] Yes J~No 206 y C ~---~/%J ~ ~'~ {., L- If Subject ,o EPCRA. refe~ ,o instructions 207 ~o..o. ~ _A~. ~ _-_ ~/--~. :~/~. _~ ,--:~ ~- ~.s. o~ ~o ~o~ CAS # 209 *if EH$ is'Yes,' ail amo~ats I~low mus~ b~ i~ lbs. FIRE CODE HAZARD CLASSES (Complele if requested by local rite aie~ 210 TYPE []p.URE ~mM,X~RE []wWAS~E ~,, RAD,OAC.,VE []Y. ~o ....... ~-,:'-~-0-~'~- ................ ~',~' FED HAZARD CATEGORIES [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [J~5 CHRONIC HEALTH 2~ 6 1 FIRE (Che~ all that apply) AMOUNT . DAILY AMOUNT DALLY AMOUNT J~g DAYS ON SITE 222 UNITS' a GAL [] cf CU FT [] lb LBS [] tn TONS 221 -',E.S. am~n,m.,l~,~,~. STORAGE CONTAINER J--J a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTFLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK J--] f CAN [] j BAG [] n PLASTIC BO'FFLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN J~ STEEL DRUM h SILO I CYLINDER p TANK WAC4:)N STORAGE PRESSURE j~ a AMBIENT [] aa ABOVE AMBIENT c, [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [~a AMBIENT [] aa ABOVE AMBIENT nJ_ba BELOW AMBIENT [] c CRYOGENIC 225 %VVT ' HAZARDOUS COMPONENT EHS ! CAS # : 229 1 226 227 [] Yes [] No 228 2 230 23~ [] Yes [] No 232 233 3 234 235 [] Yes [] No 236 237 4 258 239 [] Yes [] No 240 241 5 242 243 [] Yes [] NO 244 245 III. SIGNATURE UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd · ~ ,'~?~ CITY OF BAKERSFIE! ~ FM£ ~ OFFICE OF ENVIRONMENTAL SERVICES ~ff~.Al~rllf~il~.~ 1715 Chester Ave., CA 93301 (661) 326-3979 "~""~' ' ~"" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per material oer budcling [] NEW J-J ADO [] DELETE [] REVISE 200 Page __ o~ __ I. FACILITY INFORMATION CHEMICAL LOCATION 201 CHEMICAL LOCATION ~ Yes CONFIDENTIAL (EPCRA) --.~ o 202 FACCI]¥~'~-~-' '~-'-~ .... ~'-~ ........................... i:' 'J~,:t~,l~'i~b~-n-~ ........................... :Z~'~' "" ~,l~il~ "~-O~-t~n~ ....................... 204 II. CHEMICAL INFORMATION 205 TRADE SECRET [] Yes ~No 206 j~ If Subject to EPCRA. refer to instructions 20? CAS # 209 *if EHS is'Yes,' all amoams below must be ia lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE [] p PURE ~'m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes gN~o ........ -2~-2-'~C-U-I~i'E~S- .................. 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH CHRONIC HEALTH 21 AMOUNT ; DALLY AMOUNT ~ DALLY AMOUNT ' ~ I 222 If EHS. amount must be in lbs. STORAGE CONTAINER (Check all that apply) ABOVEGROUNDTANK J-le PLAsTIC/NONMETALLIC DRUM J--li FIBERDRUM J-'Jm GLASS BO'I-TLE J-'Iq RAILCAR 223 [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BO'I-I'LE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY J'-J k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER J"-J p TANK WAGON jj~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE PRESSURE STORAGE TEMPERATURE J~aAMBIENT [] aa ASOVEAMBIENT []..b_a BELOWAMBIENT [] c CRYOGENIC 225 I %WT .. ::: HAZARDOUS COMPONENT EHS J CAS # 1 226 ! 227 r-~ r"'n ; 229 ! [_.1 Yes U No 228 2 230 ; 231 []Yes []No 232 i 233 I r 3 234 ! 235 : [] yes [--J No 236 i 237 I ~ ; 4 238 i 239 : []yes []No 240 : 241 5 242 j 243 ' [] yes [] NO 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE IlL sj~.~_ ~,~1~,1..~.,`1 A'I"I ,OC~ ........"~-"~-- ~ ................................................... · ~ d/ DATE 246 ..... ' . . UPCF (7~99) S:\CUPAFORMS\OES2731 .TV4 wpd ',,~.~,~.,~__~,,__. CITY OF BAKERSFIELi ~~"~ OFFICE OF ENVIRONMENTAL SERVICES I~ra~lr r~l~rr 1715 Chester Ave., CA 93301 (661)326-3979 "~~' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fo~ ~er material oer butl~ing or area) ~ NEW ~ ADD ~ DELETE ~ REVISE ~ Page I. FAClLI~ INFORMATION CHEMI~L LaoTIaN ~ ~ _ / , ~ ~I ~EMICAL LOCATION ~ Y~ ~No 02 ~ ~ ~NFIDENTIAL (EPC~) 2 /ACILI~ ID J . : J "" ' ' ~P ~ (opt~naO ~3 GRID ~ (opt~naO .... ~' II. CHEMICAL INFORMATION 205 T~DE SECRET ~ Yes ~No 206 CHEMICAL ~ME If Subj~ ~o EPC~, ref~ lo inst~mi~s ~S ~ ~ "If EHS is'Y~,' ~1 mats ~low must ~ ~ lbs. FIRE ~DE ~RD C~SSES (~plete if r~u~l~ by I~1 fire ~i~ 210 (~ ~ that apply) 1 FIRE ~ 2 R~CTIVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~L~ CHRONIC H~LTH 216 * If EHS, am~nt must ~ in lbs. STOOGE CONTAINER ~ a A~VEGROUND TANK ~ P~STI~ONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223 (~k all ~at ap~y) ~ b UNDERGROUND TANK ~N ~ j ~G ~ n P~STIC BO~LE ~ t OTHER ~ c T~K INSIDE BUILDING ~ ~RBOY ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ a AMBIE~ ~ ~ A~VE AMBIE~ ~ ba BELOW A~IENT 224 STOOGE TE~TURE ~a A~IENT ~ ~ A~VE A~IE~ ~ ~a BELOWAMBIENT ~ c CRYOGENIC 225 %~ -'. ..= .H~RDOUS COMPONENT "" EHS ~ CAS I 226 227 ~ Y~ ~ ~ 228 2~ 2 230 231 ~ Y~ ~ No 232 233 3 234 235 ~ Y~ ~ No 236 237 4 238 : 239 ~ Y~ ~ No 240 241 5 242 ~ 243 ~ Y~ ~ No 244 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~~-~/~~ ............................. : ..... ~X~-246 UPCF (7/9~) S:\CUPAFORMS\OES2731 .TV4.wpd