HomeMy WebLinkAboutBUSINESS PLAN ,~,~, APPLIANCE
1815 B~ker Street Phone 322-2341
Bakersfield, C, iforr a 93305
~,~,.
~ ~'-- ~,~ ozTE/FACILITY DI R~dVI
NORTH SCALE: ,'B~INESS~NAME: ~ ~ ~ FLOOR: OF
. ~
Inspector's Comments): -OFFICIAL USE ONLY-
- 5A -
April 2~ 1990
TO: Nina Mayer~ Accounts Receivable /~ ~.,
FROM: Ralph E. Huey~ Hazardous Materials Coordinato
SUBJECT~:' Rhodes Appliance
Nina~ 'sccount # HM393101 hss a balance due of $150.00~ $75.00
current charges and $75.00 previous balance. The $75. Q0 current
charges should be voided snd the sccount closed.
Thanks
Bakersfield Fire Dept. ~gC~.tv~o
~// Hazardous Materials Division t~ 2 1990
~ 2130 "G" Street MAZ. MAT, D~V,
1~J , ~ Bakersfield, CA. 93301
HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
1. To ovoicl further action, return this form within 30 cloys of receipt.
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the questions below for the business os o whole.
4, Be brief ancl concise os possible.
SECTION 1' BUSINESS IDENTIFICATION DATA
LOCATION:
MAILING ADDRESS'
DUN & BRADSTREET NUMBER: SIC CODE:
PRIMARY AC!,,~:
OWNER:.
MAILING ADDRI:SS:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24 HR. PHONE
FD15~
Bakersfield Fire Dept. ~ "~"1~
.~ . Hazardous Materials Division~ '
": ..... ':" HAZARDOUS MATERIALS MANAGEMENT PLAN ,~
SECTION 3: TRAINING:
NUMBER OF EMPLOYESS:
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
SECTION 4: EXEMPTION REQUEST:
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 (SFECIFY REASON)
SECTION $: CERTIFICATION:
I, CERTIFY THAT THE ABOVE INFOR-
MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE"
ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURATE INFORMATION CONSTITUTES PERJURY.
TITLE DATE
2.
FD1590
BAKERSFIELD CITY FIRE DEPARTMENT
2~3o "G" STREET
BAKERSFIELD, CA 93301
(805) 326-3979
OFFICIAL USE ONLY
HAZARDOUS MATERIALS E~ ~~
BUSINESS PLAN AS a WHOL
FORM 2 A
INSTRUCTIONS:
1, To avoid further action, return this form by
2. TYPE/PRINT· ANSWERS IN ENGLISH.
3. Answer the questions below for the'business as a whole.
4. Be as brief and concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
SECTION 2: ENIERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify
your local fire department and the State Office of Emergency Services as required by
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAM~D T%Tr~ ~ DURING BUS. HRS.
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WI{OLE
· ·
,,.. u Jd nci
B. ELECTRICAL:- .~'j{:r {'~%t~'~F~"O-~ {~tc;ldlt~i ~'
C. WATER: ,.~ I~ PFhn ~e. - c4- ~'.u IH ~ n~..~
D. S~ECIAL: ,,"'"'m ...... '
E. LOCK BOX: YES ~ I~ YES, LOCATION:
IF YE, S, DOES IT CONTAIN SITE PLANS? YES / NO MSDS$? YES / NO
FLOOR PLANS? YES / NO KEYS? YES / NO
2A -
SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WItOLE
SECTION 5: LOCAL E~RGENCY ~EDICAL ASSIST~CE FOR YO~ BUSINESS AS A ~HOLE
SECTION 6: EMPLOYEE TRAINING ,
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL REFRESHER
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
MATERIALS:...' .................................... ~___~ NO
NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: .......................... ~-~_~SO ~> NO
C. PROPER USE OF SAFETY EQUIPMENT:.,. ................ ~N0 O~) NO
D. EMERGENCY EVACUATION PROCEDURES: ................. ~ NO (YE~ NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS,: ........ YES ~ YES ~0~
SECTION 7: HAZ~JlDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN $00 POUNDS OF A
so.up., ~5 o~(S~OF A L~QUID, OR 200 CUBIC FEET OF A COMPRESSED OAS: ...... ~NO
I ~ I ~~--~ ~~ , c er t if, that the above information is accurate.
I underst~d teat 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 inacQurate information constitutes perjury.
'BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE~0NLY
ID#
BUSINESS NAME:
BUS I NESS PLAN
SINGLE FACILITY 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.
SECTION 1: MITIGATION~ PREVENTION~ ABATEMENT PROCEDURES
,SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY
- 3A -
SECTION 3: HAZARDOUS, MATERIALS FOR THIS b~IT ONLY
A. Does this Facility Unit contain Hazardous Materials? ..... ~ NO
· i If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous.materials a bona fide Trade Secret YES~
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 on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY E~'dERGENCY RESPONDERS
SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
A. NAT. GAS/PROPANe":
C. WATER:
D. SPECIAL:
E. LOCK BOX: YES ~)F YES, LOCATION:
IF YES, SITE PLANS? YES / NO MSDSs9 YES / NO
FLOOR PLANS? YES / NO KEYS? YES /' NO
- 3B -
BAKERSFIELD CITY FIRE DEPARTHENT
I.D. # FORM 4A-1 Page __oE.-,
NON--TRADE SECRETS
HAZARDOUS MA TERI ALS INVENTORY
BUSINESS NAME: OWNER NAME: FACILITY UNIT #,: ~' '
ADDRESS: ADDRESS: FACILITY UNIT NAME:
CITY, ZIP: CITY,ZIP:
PHONE ~: PHONE #: {OFFICIALONLY USE CFIRS CODE
1 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD D.O.T
.CODE AMOUNT AMouNT UNIT CODE CODE FACI.LITY UNIT ~ WT. CHEMICAL OR COMMON NAME CODE GUID~
NAME. . TITLE: SIGNATURE: DATE:
EMEROENC¥ CONTACT:~}{o~, TITLE: PHONE # BUS HOURS:
AFTER BUS HRS:
EMERGENCY CONTACT: -~u,'v',?,.._ TITLE: .. PHONE # BUS HOURS:
PRINCIPAL BUSINESS ACTIVITY: ~{,~ ~¢~['~,,._ AFTER BUS HRS:
TE/FACILITY DI RD~4 FORM 55
NORTH SCALE: ~--.%[BUS~NESS N~IE: t FLOOR: OF
(CHECK ONE) SITE DIAGR.~M FACILITY DIAGR.%M