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HomeMy WebLinkAboutBUSINESS PLAN SITE/FACILITY D I.AGRAM SCALE: BUSIh'ESS N~[E: v' FLOOR: / 0F ff (CHECK ONE) SITE DIAGRk%[ FACILI~ DIAGR.%a / I(Inspector's Comments): -OFFICIAL USE ONLY- 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. Id. MSDS Storage Box 2. Street(s). Alleys. lt, Railroad Tracks Driveways, and PsrWln[ Areas adjacent to tho la. Fence or Barrier property. Include the s. Wire street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Ornlnage Canals. Oltches. d. Gates 13. Powerllnes a. Frame construction 14. Guard Station b. Nasonry construction 15. Storage Tanks: Identify the c. #sial construction capacity in gal.. a. Above ground d. Access Door b. Dnderground 6. Dtllity Controls a. Oas 16. Diking or Bern b. Electricity I?. Evacuation Route c. Water 18. Zvacuation Area: · Identify the ?. Fire Suppression Systems: location eamrn a. Fire Hydrants e~ployeea will b. Fire Sprinkler 19. Outside Hazardous Connections #asia Storage c. Fire Standpipe 20. Outside Hazardous Connections N~terla! Storage d. Water Control Valves 21. Outside Hazardous for protection systems Naterin! Oeo/~m~dllng e. Fire Pu~p 22. Type oE Hazardous Naterial/Waeta Stored 8. Fire Oepartaent Access or Used (See klow) TyPE OF tiAZ~U~DOUS ~ATERIA~ F · Fla~sabla E .- Explosive L - Liquid R · Radlologlcal C - Corrosive 0 - Oxidizer G - Gas P - Poison Water Reactive T - Toxic S - Solid H - Cryogenic O - Waste B - Etiological Example: Flausable Liquid - FL FACILITY OIAGRA~ (Required items in addition to the above) 1. Risers for Sprinklers 8. Fire Escapes 2. PatriCians 9. Air Goad[Cloning Uflltm 3. Stairways: Indicate the 10. Wlndow~ levels served from highest to lowest. Il, Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served ~rom 12. Inside Hazardous highest co lowest. Natertals Storage S. Elevator 13. Inside Hazardous · ' ' Haterlsle Use/Handling 6. Attic Access 14. Sewer Drain Inlets ?. Skylights CITY of' BAKERSFIELD "WE CARE" FiRE DEPARTMENT 2101 H STREET S. D. JOHNSON June 9, 1992 BAKERSFIELD, 93301 FIRE CHIEF 326-3911 Heng Hor 4719 Edra Avenue Baldwin Park, CA 91706 Re: Tank investigation at 103 Baker Street, Bakersfield, CA Dear Mr. Hor, This is to inform you that this department has reviewed the results for the tank investigation associated with the property located at the above stated address. Based upon information submitted, this:office is satisfied with the investigation performed and concurs that no underground tanks are present in the areas previously in question. A copy of this letter will be placed in your underground tank file and the file will be closed. If you have any questions regarding this matter, please contact me at (805)-326-3797. cerelv~ -J .. A. Dunwo._~~_ ~ _ __ rdous Material Specialist rground Tank Program ' Bakersfield Fire Dept. HazardoUs Materials Division 2130 "G" Street ,l~lt 2 4 19£! Bakersfield, CA. 93301 ~ns't/. .... HAZARDOUS MATERIALS MANAGEMENT. PLAN INSTRUCTIONS:' 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 os o whole. 4. Be brief and doncise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION: MAILING ADDRESS: CITY: ~,0.~'~: ;.,~ ~ STATE: '~ T¢-~ ~:.'~.~ DUN 8~ BRADSTREET NUMBER' SIC CODE: PRIMARY ACTIVITY: OWNER: ~ " ¢ MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE FDI5¢ Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS' MANAGEMENT PLAN SECTI,C)N 3: TRAINING: NUMBER OF EMPL©YESS: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REGIU,EST'. '/ I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE 'DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION:r;.. I, '~ HtO ¢doA ~4vOo ~ CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNbERSTAND THAT THIS INFORMATION WILL 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 THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE FD159,' CITY of BAKERSFIELD "WE C,4 RE" FiRE DEPARTMENT 1'--'" t '~--fi ] 2101 H STREET D. S NEEDHAM BAKERSFIELD 9330: FIRE CHIEF 326-391 I Dear Business Owner: This notice is meant to act as a reminder that the California Health and Safety Code, Chapter 6.95, requires any handler of hazardous materials to revise the~ir hazardous materials business pian within 30 days of any one of the following events: (1) A 100 per cent or more increase in the quantity of a previously-disclosed material. (2) Any handling of a previously-undisclosed .hazardous material, subject to the inventory requirements of Chapter 6.95. (3) Chan~e in business ownership. (4) Chan~e in business add~ess. (5) Chan~e of business name. Any ~uestions ~e~a~din~ these ~e~uimed ~evisions, ~lesse call the Hazardous Materials Division at (805) 32~-3979. Sincerely yours, ~/'~ ~~ ~ ~t'//~ REH/ddOUS Materials Coo~dinato~ ~ ~(0~/~S ~90~ ~//' " CITY OF BAKERSFIELD ~.~*~* %*? '~ ' · · BOX 2057 ! RAKERSFiKi_i~'? ~ALli:nD ~iA · E CORRECTION RE( ADDRESS :,::'~LDO NOT FORWARD · ?*' /- ':' ':~Yg0HS' WELD I NG :. *, ./_ -.- .'. ':' ": 103 ~AKER ~ST ~-,~; .... CA; 93305 · ' ~:,q;~-~'~,:.....,. ',",-'~,, .?* ..:: :.~' :. ~.:, . : , - ~ :.' 'r~. , . ... : ~ · ./. ...... ~ .. .... ~_ - - -.- - -~' - Dear Business Owner: This notice is meant to act as a reminder that the California · Health and Safety Code, Chapter 6.95, requires any handler of hazardous materials to revise their hazardous materials business Dlan within 30 days of any one of the following events: (1) A 100 Der cent or more increase in the quantity of (,' . a previouSly-disclosed material. (~-) Any handling of a Dreviously-undisclosed hazardous ,, material, subject to the inventory requirements of Chapter 6.95. (3) Change'in business ownership. (4) Change in business address. (5) Change of business name. Any questions regarding these required revisions, ~lease call the Hazardous Materials Division at (805) 326-3979. ¢~~- ,. ' "~ ~a ~~ ~~ ~.. ~ . dous Materials Coordinator /-~-~/. ~1~ '!ty~e or ~rin~ name~ 'i~7 f~] ........... Do hereby oerti~y that I have revie~ced the attached Hazardous Hateria!s business ~lan ~ (name of business) and that. it along with the attached additions or corrections constitute a complete and correct Business Plan for my facility. CIT,.Y of BAKERSFIELD NON--TRADE SECRETS ~ P~ge .... of .... BUSINESS , (C~k ell tMt a~ly) [ ~ Ft~zard ~--~ bcttvtty ~lth of P~ic~l ~ ~lth (C~k all t~t ~iy) - -- r -- Hfllth of P~ ~lth (C~k ill t~t ~iy) - fl~ith of Pr~sure ~alth " ..... - ..... ; ........ BUSINESS NAME YWOMS WELDING ID NUMBER 215-000-000561 LOCATION 103 BAKER ST HIGH HAZARD RATING 3 I . OVEt~V I EW LAST CHANGE 06/10/88 BY ESTER JURIS CODE 215-002 JURIS BAKERSFIELD STATION 02 MAP PAGE 103 GRID 29C FACILITY UNITS I HAZARD RATING 3 RESPONSE SUMMARY 2A SEC 4) NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS 2A SEC 2) JOHN YWOM - 325-7007 OR 872-0627 WALTER NORTH - 322-7805 UTILITY SHUTOFFS 2A SEC 3) A) GAS - NONE B) ELECTRICAL - BEHIND BLDG ON RIGHT SIDE CORNER C) WATER - IN ALLEY BEHIND THE WIRE FENCE D) SPECIAL - NONE E) LOCK BOX - NO 2 . NOTIFICATION / PUBLIC EVACUATION LAST CHANGE /- //~/ BY < NO INFORMATION RECORDED FOR THIS SECTION PAGE 1 12/27/88 11:42 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME YWOMS WELDING ID NUMBER 215-000-000561 LOCATION 103 BAKER ST HIGH HAZARD RATING 3 3 . HAZ MAT TRAINING SUMMARY LAST CHANGE /, //~/ BY < NO INFORMATION RECORDED FOR THIS SECTION > 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 06/10/88 BY ESTER 2A SEC 5) MERCY HOSPITAL 2215 TRUXTUN AVE 327-3371 PAGE 2 12/27/88 11:42 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME YWOMS WELDING ID NUMBER 215-000-000561 LOCATION 103 BAKER ST HIGH HAZARD RATING 3 FACILITY UNIT 01 A. OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 06/10/88 BY ESTER ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE. 1 PURE OXYGEN 310 FT3 HIGH NORTH SIDE EAST CORNER PORTABLE PRESS. CYL. WELDING/SOLDERING ID PERCENT COMPONENTS HAZARD LISTS 2359.00 100.0 OXYGEN, COMPRESSED HIGH 2 PURE ACETYLENE 180 FT3 EXTREME NORTH SIDE EAST CORNER PORTABLE PRESS. CYL. WELDING/SOLDERING ID PERCENT COMPONENTS HAZARD LISTS 1241.00 100.0 ACETYLENE EXTREME B . F-FRE PROTECTION / WATER SUPPL ~-ES LAST CHANGE 06/10/88 BY ESTER 3A SEC '4) WE HAVE HAND FIRE EXTINGUISHERS FOR FIRE PROTECTION. 3A SEC 5) PAGE 3 12/27/88 11:42 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME YWOMS WELDING ID NUMBER 215-000-000561 LOCATION 103 BAKER ST HIGH HAZARD RATING 3 D . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 06/10/88 BY ESTER 3A SEC 2) ONLY 1 PERSON IN BLDG. GET SELF OUT. CALL 911 FROM SAFE PLACE. E . MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 06/10/88 BY ESTER 3A SEC 1) IN CASE OF LEAKAGE I WOULD IMMEDIATELY RETURN TO SELLER. TANKS ARE PROPERLY SECURED, PROPER VALVES AND FITTINGS. PAGE 4 12/27/88 11:42 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 ~ BAKERSFIELD CITY FIRE' DEPART)lENT R ~ C ~ ~ V ~ 0 "'~"~~ 2130 "G" STREET · BAKERSFIELD, CA 93301 OCT I$ 1987 (805) 326-3979 I~(~, A/]8'g ............. OFFICIAL USE ONLY ID# HAZARDOUSMATERIALS ~~, '-~ BUSTNESS PLAN AS A WHOLE INSTRUCT I ONS: " 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 ~hole. 4. Be as brief and concise as possible. SECTIO~ 1: B~SI~SS IDE~I~IC~TIO~ A. B~SISESS SA~E: ~O~S ~ELDINO B. LOCATIO~ / STREET ABBRESS: ~O~ B~K~ S~REET C~TY: B~KE~SF~ Z~P: ~0¢ eUS.P~O~: (~O~) ~25-7007 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. A. ~OHN Y~OM, SON Ph# ~2~-7OO7 Ph# 872-O627 B. WALTER F. NORTH Ph# 322-78Og Ph# ~22-7~0~ SECTION 8: LOCATION 0F UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: NONg B. ELECTRICAL: BF~IND BUILDING ON THE ETGHT SIDE CORNT;~ C. WATER: IT IS ON THE ALLEY BEHIND THE WIRE FENCE. D. SPECIAL: ~ONE 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 NONE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE MERCy HOSPITAL SECTION 6: EMPLOYEE TRAINING EMPLOVERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOVEES WITH INITIAL' AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FO~-~E 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 Y0~BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS 'THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I, DAE HO YWOM , certify that the above information is accurate. I understand that this information 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 perjury. 'BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUSINESS PLAN SINGLE FACILITY UNIT FORM SA INSTRUCTIONS 1. To avoid furlher action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# NONE FACILITY UNIT NAME: ~0M'SWE~ING SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDb~ES IN CASE OF LEAKAGE I WOULD IMI~IEDIA~IELY RETURN TO SELLER. SECTION 2: NOTIFICATION AND EVACUATION PROCEDbRRES AT THIS h'm/IT ONLY SECTION 3: HAZARDOUS MATERIALS FOR THIS b~IT ONLY A. Does this Facility Unit contain Hazardous 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 rf No, complete a separate hazardous materials inventory form marked:'NON-TRADE SECRETS ONLY (white form #4A-l) 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 we hAVE HAND FIRE'EXTINGUISHERS ONLY. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION,6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS/pROPAN~] NONE B. ELECTRICAL: BEHIND BUILDING ON THE RIGHT SIDE CORNER. C. WATER: IT IS ON THE ALLEY BEHOND THE t~RE FENCE. D. SPECIAL: NONE E. LOCK BOX: YES / NO IF YES, LOCATION: IF'YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 3B - i.D. ~ FORM 4A-I Pa~e ..of .~.~, NON--TRADE SECRETS 'j IIAZ ARDOUS MATERI ALS' INVENTORY ' Al)DRESS: ~O~ -~~ ~T-- ' -- ADDRESS~ ~ ~ ~(~0 ~my FACILITY UNIT NAME:. ~j~T~,~ YI'E MAX ANNUAL CUNT ESE LOCATION IN Tills ~ By llAZARI) I}.O.T DUE AHOUNT AHOUNT UNIT CODE ,CODE FACILIT~ ONIT WT. ~llE~lqAb OR COH~ON NAHE CODE GUIDE_ ~AME: T ITLE: S'ON,~*"nv DATE: };MERGENCY CONTACT: TITLE: PIIONE ff BUS IIOURS: AFTER BUS llRS: EHF~RnENCY CONTACT: TITLE: PIlONE ~ BUS HOURS: pRLNCIPAL BusINESS ACTIVITY: AFTER BUS. IlRS: