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Home My WebLink AboutBUSINESS PLAN 8/2/2013 CON DITIONS OF':.PERMIT;7~ ON ~.'REVERSE SIDE ' ' ~ Unde~mu~ Storage of H~Ous ~als .. O Risk ~n~e~ Pr~mm Permit ID ~:: 0~ 5~00~00089 :-*' * ~ HmMous Waste O~Si~ T~t l~u~ by: B a ke rs field Fire Depa~me nt .'.' ~ ~ OFFICE OF EN~R ONMENTAL SER ~CES~ ~' '' ' ~ *' ' Bakersfield, CA 93301 om~ofE~~s~ic~ - ' Voice (661) 326-3979 F~ (661) 326-0576 Exp~tionDatc: ou~. GALE~S MARINE SUPPLY INC SiteID: 015-021-000089 Manager : MARK GALEY / BusPhone: (661) 327-5711 Location: 2720 AUTO MALL DR/ ~ Map : 123 CommHaz : Moderate City : BAKERSFIELD Grid: 24C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATIONV13 SIC Code:5551 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title DON GALEY / MANAGER GEORGE BOSTON / SERVICE MANAGER Business Phone: (661) 327-5711x Business Phone: (661) 327-5711x 24-Hour Phone : (661) 873-0363x 24-Hour Phone : (661) 393-3235x Pager Phone : ( ) - x Pager Phone : ~i) ~ -~/~x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: (661) 327-5711x MailAddr: 2720 AUTO MALL DR State: CA City : BAKERSFIELD Zip : 93313 Owner DON GALEY Phone: (661) 872-0811x Address : 3408 PANORAMA DR State: CA City : BAKERSFIELD Zip : 93305 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~[~ FORMERLY AT 404 BERNARD ST. ~ ~/ I ~.~or~e ~,/~s~_ Do hereby certify that I have reviewed the attached I~azardous materials manage- ment plan for~(~~ ~/'Y~,~;x~and thst it along with any corrections constitute a complete and correct man- agement pta~n for my facility. -1- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ Hazmat Inventory By Facility Unit -- MCP+DailyMax Order Fixed Containers on Site Hazmat Common Name... ISpocHazlEPA HazardsI Frm DailyMax lunitlMCP ACETYLENE ETHYNE F DH G 120.00 FT3 Hi GASOLINE DH L 500 00 GAL Mod MINERAL SPIRITS F DH L 55 00 GAL Mod OXYGEN F IH DH G 281 00 FT3 Low DIESEL F IH DH L 110 00 GAL Low WASTE OIL F DH L 55 00 GAL Low ARGON F P IH G 145 00 FT3 Min, MOTOR OIL F DH L 55 00 GAL Min 2 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site m COMMON NAME / CHEMICAL NAME ACETYLENE ETHYNE Days On Site 365 Location within this Facility Unit Map: Grid: ON WELDING CART CAS# 74-86-2 FSTATE I TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 120.00 FT3 120.00 FT3 100.00 FT3 HAZARDOUS COMPONENTS 100.00 Acetylene Yes 74862 HAZARD ASSESSMENTS TSecretl ~SIBioHazNo N No Radioactive/Amount No/ Curies EPA HazardsF DH NFPA/// USDOT# I MCPHi 3 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME GASOLINE Days On Site UNLEADED GASOLINE 365 Location within this Facility Unit Map: Grid: 80FT NW OF SHOP APPROXIMATELY 40FT FROM PROPERTY LINE CAS# 8006619 F STATE T TYPE i PRESSURE i TEMPERATURE I CONTAINER TYPE Liquid Pure Ambient Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 500.00 GAL 500.00 GAL I 300.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS I ~SecretI ~SIBioHaz( Radioactive/Amount EPA Hazards ( NFPA I USDOT# MOP No N No No/ Curies DH / / / Mod -4- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site MINERAL SPIRITS Days On Site SOLVENT, NAPHTHA (PETROLEUM) 365 Location within this Facility Unit Map: Grid: CENTER OF SHOP, ON OIL RECOVERY PLATFORM CAS# 8052-41-3 ~ STATE ~ TYPE PRESSURE~ TEMPERATURE CONTAINER TYPE Ambient I Ambient DRUM/BARREL-METALLIC Pure Liquid I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 40.00 GAL %Wt. S CAS# 100.00 Mineral Spirits' N 8030306 l I I HAZARD AiSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -5- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ Inventory Item 0.009 Facility Unit: Fixed Containers on Site OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: ON WELDING CART CAS# 7782-44-7 F STATE TYPE PRESSURE TEMPER3~TURE CONTAINER TYPE Gas --J--/Pure Above AmbientIi Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 281.00 FT3I 281.00 FT3 200.00 FT3 HAZARDOUS COMPONENTS 100.00 Oxygen, Compressed N 7782447 HAZARD ASSESSMENTS lTSecretl ~S[BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No N No No/ Curies F IH DH / / / Low -6- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 = Inventory Item 0002 Facility Unit: Fixed Containers on Site DIESEL Days On Site 365 Location within this Facility Unit Map: Grid: CENTER OF SHOP OF SPILL RECOVERY PLATFORM CAS# 68476-34 -6 Liquid /Pure Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION LargestContainer I Daily Maximum Daily Average 55.oo GALI $$,~ ~ GAL ~5.00 GAL HAZARDOUS COMPONENTS 100.00 Diesel Fuel No. 2 N 68476302 HAZARD ASSESSMENTS TSecretI ~slBioHazI Radioactive/Amount I EPA HazardsI NFPA I USDOT# MCP No N No No/ Curies F IH DH / / / Low 7 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: CENTER OF SHOP, ON OIL RECOVERY PLATFORM CAS# 221 r STATE ~ TYPE '1 PRESSURE --[ TEMPERATURE CONTAINER TYPE Liquid /Waste Ambient Ambient I DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 55.00 GALI 55.00 GALI 25.00 GAL HAZARDOUS COMPONENTS I 100.00 Waste Oil, Petroleum Based N 0 HAZARD ASSESSMENTS No No I No No/ Curies F DH / / / Low WASTE DATA Treated On Site I CA C°de I US COdeNo GAL Generated/Mo.] GAL Generated/Yr. 320.00 Treatment UnitID: Unit Type: Agency-Defined Text Label -8- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ ~ Inventory Item 0008 Facility Unit: Fixed Containers on Site 9 -- COMMON NAME / CHEMICAL NAME ARGON Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 7440-37-1 rSTATE --~ TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 145.00 FT3 I 145.00 FT3 70.00 FT3 HAZARDOUS COMPONENTS 100.00 Argon N 7440371 HAZARD ASSESSMENTS ITSecretl'RS[BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No No No No/ Curies F P IH / / / Min -9- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 ~ ~ Inventory Item 0007 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME MOTOR OIL Days On Site OUTBOARD MOTOR OIL, REFINED PETROLEUM OILS 365 Location within this Facility Unit Map: Grid: CENTER OF SHOP, ON SPILL RECOVERY PLATFORM · CAS# 8020835 F STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE , I IAmbient Pure Ambient Liquid DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 55.00 GALI 55.00 GAL 20.00 GAL HAZARDOUS COMPONENTS 100.00 Motor Oil, Petroleum Based N 8020835 HAZARD ASSESSMENTS TSecretl ~SIBioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No N No No/ Curies F DH / / / Min -10- 08/13/2003 F~GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 03/23/1999 IF SITUATION WARRANTS CALL 911 AND/OR CALL CITY OF BAKERSFIELD ENVIRONMENTAL SERVICES AT 326-3979. -- Employee Notif./Evacuation 03/23/1999 IN THE EVENT OF A FIRE OR POSSIBLE EXPLOSIVE SITUATION, ANNOUNCE INSTRUCTIONS OVER PA SYSTEM. ALL EMPLOYEES WILL EXIT AT NEAREST OUTSIDE DOOR AND REPORT TO MAIN ENTRANCE OF STORE FOR HEAD COUNT. -- Public Notif./Evacuation 03/23/1999 ANNOUNCE OVER PA SYSTEM FOR~PUBLIC TO EVACUATE SHOW ROOM, USING MARKED Emergency Medical Plan 03/23/1999 CALL 911 OR TAKE INJURED PERSON TO SW MERCY MEDICAL CENTER, 400 OLD RIVER RD, 663-6000. -11- 08/13/2003 F GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 Fast Format = Mitigation/Prevent/Abatemt Overall Site --Release Prevention 03/23/1999 ALL DRUMS CONTAINING WASTE OIL, SOLVENT, OUTBOARD OIL, GEAR LUBE OR DIESEL ARE PLACED ON A CONTAINMENT GRID; LIQUIDS ARE HAND PUMPED IN SMALL . --Release Containment 03/23/1999 BARRELS ALSO ARE CAPPED, UNLESS PUMP IS INSTALLED. -- Clean Up 03/23/1999 ANY OILS, sOLVENTS ETC SPILLED INTO CONTAINMENT UNIT CAN BE PUMPED OR WIPED OUT. ANY LIQUID SPILLED ON FLOOR CAN BE CLEANED UP WITH ABSORBANT. Other Resource Activation -12- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 Fast Format ~ Site Emergency Factors Overall Site -- Special Hazards 12/19/1991 CALL 91i -- Utility Shut-Offs 03/23/1999 A) GAS - METER & SHUFOFF ON S WALL OF SVC DEPT B) ELECTRICAL - MAIN DISCONNECT IN UTILITY RM - DOOR IS MARKED C) WATER - W WALL OF SVC BLDG - IN FRONT OF HANDICAPPED PARKING D) SPECIAL - GASOLINE CIRCUIT BREAKER IN UTILITY RM, MARKED E) LOCK BOX - NO Fire Protec./Avail. Water 03/23/1999 PRIVATE FIRE PROTECTION - ?????SPRINKLER SYSTEM OR FIRE EXTINGUISHERS????? NEAREST FIRE HYDRANT - AT ST CURB ENTRANCE, IN PARKING LOT ON CENTER ISLAND MOST WESTERN AND NEAR CURB .ON E SIDE OF BLDG. ~ ~ ~~7 /,~ ~/~.~ Building Occupancy Level -13- 08/13/2003 GALEYS MARINE SUPPLY INC SiteID: 015-021-000089 Fast Format Training Overall Site -- Employee Training 03/23/1999 WE HAVE/EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE IN BOOKCASE IN SHOP BREAKROOM. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE SHOWN WHERE PWER SHUTOFFS FOR GAS PUMP ARE LOCATED. THEY ARE ALSO SHOWN WHERE ABSORBENT IS STORED IN CASE ANY OILS, SOLVENTS OR ETC. ARE SPILLED ON FLOOR. ALL DRUMS OF THESE MATERIALS ARE STORED ON A RACK WITH A 6" DEEP 30" WIDE 12' LONG TRAY FOR SPILLAGE RECOVERY. ALL EMPLOYEES ARE TOLD TO CONTACT GEORGE OR MARK IN CASE OF ANY SPILLS. Page 2 --Held for Future Use Held for Future Use -14- 08/13/2003 Bakersfield Fire Dept. UNIFIED PROGRA SPECTION CHECKLIST Entronmental Services ,, , ' -, , , " ,,,', - ~--~,---~ 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, C^ 9330] Tel: {661)326-3979 : FACILITY NAME INSPECTION DATE INSPECTION TIME PHONE No. No. of Employees FACILITYCONTACT Business ID Number · ? '-'.'"~"" ~'... "':"'. Sectl°n-l: Bus ness Plan and ln~ent°ry Pr°gmm '"- W ~,r~ ,~ . ~'/, :.'i.. ~:: i.~..": :~..~". . :' · ;'::-:~,,~' : : · · . · ".' ': ' ' .... ! i-I Routine l"1 Combined I"1 Joint Agency [] Multi-Agency [] Complaint [] Re-inspection C V fc=comp~iano~ OPERATION COMMENTS \ V=Violation [;~'" (-II APPROPRIATE PERMIT ON HAND d [] BUSINESS PLAN CONTACT INFORMATION ACCURATE [~ [] VISIBLE ADDRESS ~[]~ CORRECT OCCUPANCY d FI VERIFICATION OF INVENTORY MATERIALS [] [] VERIFICATION OF QUANTITIES [] [] VERIFICATION OF LOCATION [] [] PROPER SEGREGATION OF MATERIAL ~ [] VERIFICATION OF MSDS AVAILABILITYE ~ [] VERIFICATION OF HAT MAT TRAINING [] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~/'r'~ EMERGENCY PROCEDURES ADEQUATE ~ [] CONTAINERS PROPERLY LABELED d [] HOUSEKEEPING --~"~ [] FIRE PROTECTION ~ [] SITE DIAGRAM ADEQUATE & ON HAND EXPLA,N: ~-~'-~, ~) V~ - - ,nspec~r ............. ,aoge No: '1 ~,7~pink ::~C:; R'sp''sible ~ White - Environmental Se~i~s Yellow - ~ation ~py ~ ~- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: . 2.. ~~~ ~S~S ~swer the ~.estiom below ~or ~e b~sb~ss ~ ~ whole. 4. ~e ~ b~e~J ~.~ise ~ possible.. SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING NLFIVtBER OF EMPLOYEES: /9 MATERIAL SAFETY DATA SHEETS ON FI~.E: ~K) ~ Go lA C.&~x_. BRIEF SUMMARY OF TRAINING PROGRAM: I CER~Y ~ER PEN~TY OF P~Y ~T ~ BUS~-SS IS E~T ~OM ~ ~PORT~G ~Q~S OF C~~R 6.95 OF & S~~ CODE" FOR ~ FOI.LO~O ~ONS: ~ DO NOT ~LE ~~OUS ~~S. ~ DO ~LE ~~OUS ~~S, B~ ~ QU~~S AT NO T~ EXCEED ~ ~ ~ORT~G QU~IT~S. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, ~ ~oo~¢.'' (dY_ ,'(qoS Yc_).Q CERTIFY THAT THE' ABOVE INFORMATIOtq IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH A~ SA~¥ CO~." OS ~e.~O~S MAr~,,X.S 0~. :0 C~,a'~ ~.9~ S~C. ~.SS00 ~r ~.~ A~ r~r ~^CCt~.Ar~ ~O~ArZOS cos,srIro'ms ~,~.~¥. - gION~TU~E xrrLE DAWE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES B.: EMPLOYEE NOTIFICATION AND EVACUATION: " C. PUBLIC EVACUATIO151.: D. EMERGENCY MEDICAL PLAN: · ~ .. > ~ ~ g '.,.,., ~ - ~ ILs, ZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: M~TK~ATION. PREVENTION AND ABATEMENT PLAN_ ' B. - ~EASE CO~~~ ~/OR ~ZATION: SECTION 8: ~.~ S~-O~S ~OCA~ON OF ,S~.O~S AT YO~ FACm~ LOCK BOX: ~S~O · ~S, LOCA~ON: , ~0 SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY :, A. · PRIVATE FIRE PROTECTION: , B.' W.,.A, ,~.TER AVAII,ABILITv (FIRE HYDRANT): 4 CITY.OF BAKERSFIELD ' OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield., CA (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION ..,CHECK.IF BUSINESS IS A FARM [ ] :_ BUSINESS NAME FACILITY NAME SITE ADDRESS NATURE OF BUSR~SS sic CODE -~-75 / DU~ & 8P. ADSTREET Nt~EP. 0WNE~V0PE~,AT0~. ,. EMERGEN~ CONTACTS Bus.ss PHO~ · CHEMICAL DEscRIFrIoN 1) INVE2~ORY STATUS: New [ ] Addition C~.] Revision [ ] Beletion [ ] Check if chemical is a NON Trade Secret J~, Trade Secret [ ] 2) Common Name: C) ~0 ~. ~ ~-4"~ (__~/k-~,~(' ¢ Aa(~ 3) DOT # (optional) Ch~i~ Nme: ~ [ I CaS # '3d)O to -6,I-C~ Hazard Categories Fire [ eactive [ ] Su,/_~en_ Release of Pressure 5) WaSTE CLASSII*ICATION ' O-digit cocl~ fzom OHS Form 8022) USE CODE 6) ?HYSlCAL STATE Solia [ I Liquid INQ c-~ [ ] Pure [~'1 Mix-tare [ ] Wa.st~ [ ] Radio~tive [ 7) AMOUNT AND TIME AT FACIL1TY UNrI~ OF MEASURE 8) STORAGE CODES Maximum Daily Amount ,5'00 Lbs[ ]C-al[~lft3[ ] a)Contain~. Average Daily Amount ~13(~ Curies[ ] b) Pressure: . /°tt~l,/~l.~,~O'T" ,amn,,-I ,a. mount ~7 ooo c) Temtmature ~q ~ # Days on Site ,g (,~-- Circle Which Months: i 1~, M, A, M, J, J, A, S, O, Il, D 9) MIXTURE: List CpM~NENT '" "- CaS# % WT AHM chemical components or 2) _ '- . . . , . ' [ ] any AI-IM components 3) , [ 1) I31VENTORY STATUS: New [" ]Additibn[,2~R~vision[ ]Deletion[, ] Ch~kif~hemicalisaNOlaTradeSecret[ ]'rradeSecret[ ] 2) Common Nme: ~ ! ~q ~t_.. 3) DOT # (optiomd) "" Chef,me: I~rrS~u F-oF~-- ~z_ ~[M[ ] caS# 4) Physical & Heal~ '~ ' ' .< <" PHYSICAL -... ~ ..... HEALTH HazardCategoriea Fire[ ]Reactive[ ]Sudd_enReleaseofPres.~{ ]' Immediat~ Health (Acute) [ ]DelayedHealth(Clmmi¢)[ ] 5) WASTE CLASSIFICATION 'O-digit ¢°def~m DHS F°rm 8022) ' '- USE CODE [ °t 6) PHYSICAL STATE ' S61ii:l [ I Liquid [~xl Cas.[ I Pure [~ ~j[: ]...W,..a~..[ I RadioaCtive [ l 7) AMOUNT AND TIME AT FACILITY UNITS OF IVlEASURE 8) STORAGE CODES Maximum Daily Amount -3"~5'" Lbs[ ]Gal[,~lfL3[ ] a)Coutainea:. Average Daily Amount ~:~" Cut#es [ ] b) Pressure: g~ Annual Amount //0 ¢) Teml~rature /~,.~ Largest Size Con~oincr . ~q"l~. # Days on Site '.~ ~, ~-' Cimle Which Months: , F, M, A, M, $, J, A, S, O, N, D 9) MIXTURE: List COMPONENT ..... CaS// % w'r AHM chemicalthethreem°st hazardous".COmlmn~ts br .1)2): '~ - ' . . "' .... ( ' . i . [ l any AI-IM components 3) [ ]- I certify under'penalty of law, that l'have personally exmmea and ~ familiar with'the ifil'om'lion on thi~' md ~11 atla¢la~d docummm. I believe the submitted information is Into, ac, curate and complete. PRINT Nmg & Title of^uthorized Company Representati ' Signature "-' Date CI~MICAL DESCRll~FION I) ~ORY STA~S: New [ ] A~on [ ] Re~ ~ ~le~ [ ] C~k ~c~ is a NON Tm~ S~ [~ T~ S~ [ ] 4) Physi~ & H~ P~SIC~ 8~-m Ca~gofi~ F~ [~ R~ve [ ] Sudd~ Rel~ of~ [ ] tmm~ H~m (acu~) ~J mlay~ ~)w~s~c~s~cA~oN 2Z !,, O~t~aoa~mFo~S022) USECODE 90 6) P~StC~ STem ~Ua [ I niq~a ~ ~ [ I ~ [ I ~e ~] w~ [ I ~ve [ 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) STOOGE CODES t Da~ on Sim ~ ,' C~le ~ch MmV: ~ L F, ~ & ~ ~, L & S, O, N, D 1)~ORYSTA~S:New[ ]A~fion[ ']Re~g~]~lefi~[ ] Ch~k~~isaNONT~~[ ]T~~[ 4) Ph~i~ & H~a P~SIC~ ~dCa~ofi~ F~R~five[ ]S~Rel~of~[ ]r~H~m(Acu~)~la~H~m(C~O~] 6) P~SIC~STA~ Solidi ] Liq~d~ ~[ ] ~e[ ] ~~] W~[ ] ~ve[ 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) STOOGE CODES ~e~ S~ Con~ Days on Site ,~ ~ C~le ~ch Mon~: ~, F, ~ & ~ J, J, & S, O, D 9) ~: Lia ~y ~ mm~m~ 3) [ ] ~lieve ~e ~bma~ ffomfim is m, ~m~ ~d mmple~. P~ N~e i Title Of Au~o~ Comfy R~mfi¢e Si~e ' ' Di~ "'" ' CI~M~CAL DESCIUPTION 1) 12,[VENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret {~] 2) Common Name: l~{,klL ~e>~,~ }.~ /%o~o$' O't) 3)DOT#(optionld)-" 4) Physical & Health PHYSICAL HEALTH Hazard Cat~ories Fire [~,J Reactive [ ] S,_,dd~ Release ofPressur~ [ ] lm,.~i,,~ Health (Acute) [~-].~layed Health (Chrenic) 5) WASTE CLASSnrICATION O-digit cod~ from DHS Form 8022) USE CODE' ' 6) PHYSICAL STATE Solidi ] LiqUidly] Oas[ ] Pur~[ ] Mixt~e[ ] Waste[ ] Radion~tive[ ] 7> AMO~ ~D ~ Aw.F^cmrrr u~rrrs ol: lV~SASUI~ S) s'roRAoE CODES. OC,, ' '~&m'""D~yAmo=t SS. Lbsi {Oal~.lfU[ I a)Contain< Averag~DailY'Ai~o.unt Z. O Curies[ ] b) Pressure!,, . ~{yt~tP~ee~ f" AnnuaIAmo~t ' .fi'S c) T~npera~ ~%Sre~'}-- Largest Siz~ Contain= _~ ~"' ~ ' # Days on Site .q t~%= ~ Circle Which Months: (~Y~ F, M, A,'M, $, $, A, S, O, N, D 9) MIXTURE: List ~ CAS# % WT AHM the thre~ most hazardous I) . d~q ? q~2' ~/- '7 [ 1) INVENTORY STATUS: Ne~ Addition ~ Revision [ ]Deletion[] Checkifchemicalis'aNONWradeseCret[ ]Tradegecret[ ChemicalName:' ' '~_{",~Ob) : AHM[ l: CAS# 4) Physical & Health PHYSICAL HF_ALTH I4_azardCategoriea Fire[ ]Re~i4e[ ]Sudd~nRelea,~ofPreaaareN] Immediate Health (Acute) [ ]DelayedHealth(Chwni¢)[ ] 5)'WASTE CLASSIFICATION " (3-disit ood~ from DH~ Form 8012) USE CODE'. ?9 ~ ~6) PHYSICAL STATE Solid [ ] LiqUid [ ] Gas ~ Pure [-/(] Mixtu~'[ ] Waste [ ] Radion~ive [ l 7) AMOUNT.AND,TilVIE AT FACILITY LrNITS OF MEASURE / 8) STORAGE CODES "Max~tUnDa]!y.Amount i~'-~-- Lbs[ ]Gal[ ]R3[~] a)Contaiuer:-' Average, D.ail~ ..A~. o.u~. t,, '] ~ Cur/es [ ] b) Pressurd-' .' Annual Amount 70 c) Tempera/u~' Largest S/ze Container ] h ~,-- # Days on Site ~ Circle Which Months: ~~1, F, M, A,'M, I, I, A, S, O, N, D 9) MUcrtn~: List · ..,.COM~O~ ' ~' ' ' '5~qP-. the three most hazardous 1) .~ ~_-~0/O :"' ..... ~: ~:~"~'~:' TM ~ · , - { l chem/cal components or 2) ' ' ' ' :" :~ ':' ' '"'~ :' ' any AH]vi components 3) . [ ]' I certil~ under penalty of law, that I have lm'sonally examined and am tkmiliat with the inlbnnation on this and all auach~ d~-ummts. I " believe the submitted infomlation ia true, acxurate ~ud complete. .~00~/~.4 ~ P~ Name{ & Tide of Author/zed Company Representative Signature Date / CI~MICAL DESCRIFrlON 4) ~i~ a H~m P~SIC~ ~ ~Ca~ F~'~]R~ve[ ]S~mRel~of~~] ~H~(A~)[ ]~~(C~c)[ ] COD ~)P~SIc~sTA~'' ~d[ ] ~iq~d[ ] ~[~] ~e[ ] ~[ ] W~[ ] ~ve[ ] 7) ~O~.~,~ AT FAC~ ~ OF ~~ g) STOOGE COD~ '~~D~qY:~o~t I0o L~[ ]~[ ]~[~] a) Con~ ' OV[ Y Days ~ Si~ ~- C~le ~ch M~: ~, F, ~ ~ ~ ~, ~, ~ 8, O, N, D ch~m~or 2) ~ .... ' ' ' ' ' '" ~''" ' ~ , ~ '' " [ ] ~y ~ ~m~ 3) "" [ ]. 1) ~ORY STA~S: N~w [ ] A~don ~] R~ [ ] ~ledoa [ ] Ch~k ~~ ~ a NON T~ S~ [ ] T~ ~ [ ] 2) Co--on N~e: ~y~ 3) ~T ~ (Opdo~) () ~ 4) Physi~ & H~ P~SIC~ 5) w~ C~S~CA~ON ' ' (3~t ~ ~m D~ ~ g022) USE CODE. '"~ -6) P~S~C~STA~ So~d[ I Liq~d[ I ~1 ~e[Ml ~'[ I W~{ I ~ve[ 1 7) ~O~,~~ aT ~AC~ ~ OS ~~ S) STO~OS CODSS "~pa~..~o~t Z~{. k~{ 1~{ I~[KI a)con~ ~ Av~e.D~y~o~t. ~ . C~[ ] b)~e: .' ~e~ S~ C~ ~ ~ I ~ J,'J, & S, O,'N, ' ' ~ Days ~ Si~ ~ C~le ~ch Mon~: F, ~ &'~ D 9) ~: L~ · CO~~ ~: · C~ % ~ ch~m~or 2) t ~ · . '""' . ', [ ] ~y ~ ~m~ 3). . .[ ] l