Loading...
HomeMy WebLinkAboutBUSINESS PLAN "~I TE/FACI LI TY D I AG RA/VI FORM NORTH SCALE: BUSINESS NAME: FLOOR: OF Van:s Discount Model Mart 1 1 DATE: 6 ? ? FACILITY NAME: UNIT.~. OF Van's Discount Model Mart 1 1 '(CHECK ONE) SITE DIAGRam! FAC!LITV DIAGR.~ x 1. Address: Identify 'tu~ 9. Lock (key] ' '..' ..~ principle buildings '= ~.... by the Street numbers. 10. MSDS Storage Box '~ .I 2. Street(s), Alleys, 1]. Railroad Tracks ~' Driveways, and Parking Areas adJacsn~ to the 12. Fence or Barrier property, Include the a. Wire street names.. ':* b. Masonry 3. Storm Drains, Culvert{, Yard Drains' : c. Wood 4. Drainage C~nals, Ditches, d. Gates Creeks, 13. Poweriines $. Buildings a. Frans construction 14. Guard Station b. Masonry construction 15, Storage Tanks: Identify the .... - ~, Above ground d. Access Door : b. Underground a. Gas 16. Diking or Ber~ b. Electricity ~?. Evacuation Route c. #star 18. Evacuation Area: . Identify the 7. Fire Suppression Systeml: location where a. fire Hydrants employees will b. Fire Sprinkler 19. Outside Hazardous Connectionl #site Storage c. Fire S~andpipe {0. Outside Hazardb~ Connections Material Storage d. Water Control Valves 21. Outside Hasardoud for protection systeme Material "- Use/Handling e. Fire Pump 12. Type of Hazardous'' Material/Waste .-. Stored 8. Fire Oepartaan~ Access or Used (See S els.) ': C .- Corro;/ve ...... 0 - Oxidizer *O - Gas' -~'" W - Water Reactive T - Toxic 8 - Solid 'R - Cryogenic . O - Matte B - ~tlologlcmi Exasple: Fla~ble Liquid - FACILI~ D[AG~ (Requlged l~e~s la addl~loa ~o the. a~e) ~. Rleor. for ~pri~Jer~ ~. ~lre g~ca~l .. ~, Partitions 9, Air ~nd/t/oning UnLts 3, Stalreaye: Indicate the '10, levels served free 3torage 4. Escalator: ]~dica~e the levels served fro~ l~, Inside Hazardous highest to lo.st. ~terialm Storage 5. Elevator 13. Inilde Bazardoul ~terlale Uee/~and]lng a. Attic Access 14. Se~r Drain ~. Skyl~ght, · ~-' ((~/.~/~/" BAKERSFIELD ClW FIRE DEP~~ 2130 "G" S~EgT RECEIVED B~RS~I~D, CA 9330i . (8o ) / JUN 1 9 1987 Antd ............ OFFICIAL ~SE OSLY $USINESS N~E HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A .... INSTRUCTIONS: ..... - ~-~ __ 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 w~'ple. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: Van's DiscoUnt Model Mart B. LOCATION / STREET.ADDRESS: 1029 Baker St. E~st Bakersfield, CA. CITY: Bakersfield ZIP: 93305 BUS.PHONE: (805) 395 1327 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 ~N~f~-~iN-~C~ASE~OF--EMERGENCY::_- -- A. Van ~an Mills Ph~ 395 132v Ph~ 871 5!58 B. = PhS Ph~ SECTION ~: LOCATION OF ~ILI~ S~-OFFS FOR BUSI~SS AS A ~OLE A. NAT. GAS/PROPANE: B. ELECTRICAL: Re~ of store in s~. co~ty~ C. WATER: D. SPECIAL: E. LOCK BOX: YES / ~ IF YES, LOCATION:" IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? VES / NO FLOOR PLANS? YES / NO KEYS?~ YES / NO - 2A - SECTION' 4:"PRIVATE RESPONSE TEAi~ FOR BUSINESS AS A WHOLE Van Loan Mills 871-5158 SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS A~E REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRA[NING~IN THE FOLLOWING'AREAS.' CIRCLE YES' OR NO INITIAL REFRESHER. A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:.... .................................... YES ~0) YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES:L~C£L£...,...,........... YES N~ YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES YES NO E. DO YOU NAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES YES NO SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR 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: ......~ NO I, Van Loan Mills , 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. SIGNATURE ~- TITLE Proprieter DATE 6 / ~, / n~ -2B - · BAKERSFIELD CITY*FIRE DEPARTMENT 21.50 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# 015~ BUSINESS NAME: Van's Dis¢oun% Model Mart BUSI NESS PLAN SINGLE FAC~[ L I TY UNIT FORM 3A INSTRUCTIONS 1. To avoid further 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# 01580 FACILITY UNIT NAME: yan's Dtseoun% Model SECTION 1': MITIGATION, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY ~A. Does this Facility Unit contain Hazardous Materials? ...... YES N0 \ If yES~ see B. If NO, continue with SECTION'S. -: B. Are any of the hazardous materials a bona fide Trade Secret YES NO If. 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 oil form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY E.~RGENCY RESPONDER$ SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS./PROPAN~ NA B. ELECTRICAL: 0utside rear of shop to left of door, C. WATER: Outside rear of shop. D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs?' YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO I?D. # FORM 4A-1 © Page . 1 o~ ' ~ NON.--TRADE SECRETSI HAZ "RDOUS MATERI ALS I NV,ENTORY BUSINESS NAME: Van's Discoung Model ,Mar% OWNER NAME: Van Loan Mills FACILITY UNIT #: ADDRESS: 1029 B~er S%. ADDRESS: same ,/ FACILITY UNIT NAME: same ~,~ CITY, ZI~P: B~ersfield 9~05 CITY,ZIP: same ~ P~O~E ~: 395-1~7 PHONE ~: same -~. [OFFICIAL USE CFIRS CODE , ~ [ ONLY 1 2 3 ,4 5 6 ', 7 S ' 9 o 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T CODE ~~ AMOUNT UNIT CODE CODE FACILITY UNIT , WT. CHE~IqlL OR COMMON NAME CODE GUIDE M / 20 gal. 2~0 gal. GAL [~10 F~ re~ NO. W~T OOR~ FU~ 5~ ~RO //~  %op s~o~ showcase M 317 %1268 3~ ~ 3~s 09/ So. wall . M ~; 16~ 4oz. ~ j~ 09 pai, nt So. wall ' C~Q 291 1 oz ll j~s 09 Pa ~ top %h~ showcase C~Q ~"I~NA~E: V~n Lean ~tt 1~ TI~LE: ~ner SIGNATURE: ~ DATE: E~$RGENCY CONTACT: V~ l~.n Mtll~ - ~ TITLE: ~ner ?HONE · BUS ~O~RS: 395-1327 · " ..... ~' ~ AFTER BUS HRS: 871-5158 'EM'E,RGENCY CONTACT:, { TITLE: .. ?HONE $ BUS HOURS: ' P~g,I~,~IPAL BUSINESS ACTIVITY: ~, AFTER BUS HRS: '~' " ,, - 4A-1 -