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HomeMy WebLinkAboutBUSINESS PLAN 2/3/2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This hermit is Issued for the followin_=: [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program PERMIT ID # 015-021 ~000181 [] Hazardous Waste On-Site Treatment HPS MECHANICAL, LOCATION: 3100 E BELLE CA 93307 OFFICE OF ENVIRONMENTAL SER VICES' - r~ ~ 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Omccotev~-om~rs~ices ~ Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: 'June 30, 2003 HPS MECHANICAL INC SiteID: 015-021-002289 %%%% KENNY POURROY ~% BusPhone: (661) 397-2121 Manager : Location: 3100 E BELLE TERRACE~- Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC' Code:3494 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title LES DENHERDER / OWNER KENNY POURROY / MANAGER Business Phone: (661) 397-2121x Business Phone: (661) 397-2121x 24-Hour Phone : (661) 366-3151x 24-Hour Phone : (661) 834-9963x Pager Phone : ( ) - x Pager Phone : (661) 979-6173x Hazmat Hazards: Fire ImmHlth DelHlth Contact : KENNY POURROY Phone: (661) 397-2121x MailAddr: 3100 E BELLE TERRACE State: CA City : BAKERSFIELD Zip : 93307 Owner LES DENHERDER Phone: (661) 397-2121x Address : PO BOX 6386 State: CA City : BAKERSFIELD Zip : 93386 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List ~ --Alphabetical Order Ail Materials at Site ~ Hazmat Common Name... ISpocHazIEPA Hazardsl Frm DailyMax ]UnitlMcP FUEL F IH DH L UnR . -1- 1/13/2003 / 11/13/2003 THU 15:02 FAX 587' KERN SECURITY SYSTEMS ~002/002 Security Sy.vtems Comme rcla! Re,~ide~tial Your Security is our Concern B,r,t,,.y Fire State Licenses LQ343 & PP011312 CCTV Hold Up Card Acce.*s Guard & Patrol Music Choice Direct TV November 13, 2003 Fire Marshal i 7 ! 5 Chester Avenue, Ste.3 City of Bakersfield Bakersfield, Ca 93301 RE: 3100 E. Belle Terrace This will serve as notification of reconnection of the fire system at the above address. With this correspondence, Kern Security Systems, Inc. has fulfilled its obligation of notification. Sincerely, · · '"~.~ ,~evin Ormonde Manager Kern Security Systems, Inc. CC: Building Owner/Tenant 2701 Fruitvale Avenue, Bakersfield, CA 93308 · 661 588 HELP · 661 587 7000 fax HPS MECHANICAL INC SiteID: 015-021-002289 Manager : KENNY POURROY BusPhone: (661) 397-2121 Location: 3100 E BELLE TERRACE Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:3494 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title LES DENHERDER / OWNER KENNY POURROY / MANAGER Business Phone: (661) 397-2121x Business Phone: (661) 397-2121x 24-Hour Phone : (661) 366-3151x 24-Hour Phone : (661) 834-9963x Pager Phone : ( ) - x Pager Phone : (661) 979-6173x Hazmat Hazards: Fire ImmHlth DelHlth Contact : KENNY POURR©Y-- ~ ~ ........ Phone: (661) ~97-2121x MailAddr: 3100 E BELLE TERRACE State: CA City : BAKERSFIELD Zip : 93307 Owner LES DENHERDER Phone: (661) 397-2121x Address : PO BOX 6386 State: CA City : BAKERSFIELD Zip : 93386 Period : to TotalASTs: = Gal Preparer': TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hanmar Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax Unit MCP FUEL _1/ ~x~~ F IHDH L UnR "Oo hereby certify -1- 01/30/2003 HPS MECH3~NICAL INC SiteID: 015-021-002289 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~U~ ~vl~ / ~±~ ~Vl~ FUEL Days On Site 365 Location within this Facility Unit Map: Grid: CAS# STATE ~ TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid /Mixture I Ambient . Ambient I PLASTIC CONTAINER ~240UNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average HAZARDOUS COMPONENTS %Wt. CAS# HAZARD ASSESSMENTS TSecretl RSlBioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No No No ~ No/ Curies F IH DH / / / UnR -2- 01/30/2003 ~ HPS MECHANICAL INC SiteID: 015-021-002289 Fast Format ~ Notif./Evacuation/Medical Overall Site ----Agency Notification -- Employee Notif./Evacuation 02/06/2002 MANAGEMENT VISUAL INSPECTS TANKS AND ALERT OWNER IF ANY VISUAL PROBLEMS ARE FOUND Public Notif./Evacuation Emergency Medical Plan ~ 02/06/2002 ANY MEDICAL ATTENTION NEEDED IS EITHER PROVIDED BY THE NEAREST HOSPITAL OR EMT'S. -3- 01/30/2003 F HPS MECHANICAL INC SiteID': 015-021-002289 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site l R elease Prevention --Release Containment 02/06/2002 TANKS HAVE ALL REQUIRED CONTAINMENT FITTINGS AND SPECIALS. -- Clean Up 02/06/2002 KITTY LITTER Other Resource Activation 02/06/2002 TANKS HAVE ALL REQUIRED CONTAINMENT FITTING AND SPECIALS. 4 01/30/2003 HPS MECHANICAL INC SiteID: 015-021-002289 Fast Format Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs -- Fire Protec./Avail. Water Building Occupancy Level -5- 01/30/2003 HPS MECHANICAL INC SiteID: 015-021-002289 Fast Format = Training Overall Site -- Employee Training 02/06/2002 SAFETY PROGRAM Page 2 I Held for Future Use I Held for Future Use -6- 01/30/2003 PLEASE DE~,~CH AND SE{~D THIS COPY W ITH_~EMITTANCE DATE: 1/01/03 DUE DATE: 1/~i/OJ HPS CUSTOMER NO: 3573 CUSTOMER TYPE: ES~ 3573 REMIT AND MA~E CHECk{ PAYABLE TO: CITY OF =l,~=~,:, n PO DOX BAKERSFIELD CA ~3303-2057 TOTAL DUE: $4~. O0 "~ ~Did you Notice? HPS Plumbing Services has changed We are now HPS Mechanical Inc. Please make sure that your records have been updated with our name and location changes. Mailing Address Location P.O. Box 6386 3100 E. Belle Terrace Bakersfield, CA 93386 Bakersfield, CA 93307 New Phone # 661 397-2121 New Fax #661 396-2589 Toll Free #888 324-2121 · For'thoSe ofyou who have madethis correction, we thank you. If not, PLEASE update your records. THANKS! HPS MECHANICAL INC. SiteID: 015-021-002289 Manager : KENNY POURROY BusPhone: (661) ~-2121 Location: 3100 E BELLE TERRACE~ Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 19D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:3494 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title LES DENHERDER / OWNER~- KENNY POURROY / MANAGER.S- Business Phone: (661) ~z~-2121x Business Phone: (661) ~-2121x 24-Hour Phone : (661) 366-3151x 24-Hour Phone : (661) 834-9963x Pager Phone : ( ) - x Pager Phone : (661) 979-6173x oHazmat Hazards: Fire ImmHlth DelHlth Contact : KENNY POURROY Phone: (661) ~2121x MailAddr: 3100 E BELLE TERRACE ~ State: CA City : BAKERSFIELD Zip : 9330~ q~C)~ Owner LES D~HERDER Phone: (661) ~3~121x Address : ~ ~0 ~)oX' ~~ State: CA City : BAKERSFIELD Zip : 93386 Period : to· TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hanmar Inventory One Unified List --Alphabetical Order Ail Materials at Site Hanmar Common Name... ISpecHazlEPA HaZardsI Frm DailyMax Unit MCP FUEL F - IH DH L UnR reviewed ~he a~ach~d haz~rd0u~ m~l®~ls mana~e- men~ plan for%{D~ .q--,J,..,.~ ,~ ~nd ~h~ ~ along wi~h (~ o~) 'any corrosions ~ns~i~u~e ~ ~mp~ and ~s~ ~an~ HPS MECHANICAL INC SiteID: 015-021-002289 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site FUEL Days On Site 365 Location within this Facility Unit Map: Grid: CAS#  STATE i TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average I RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No INo No No/ Curies F IH DH / / / UnR 2 09/26/2002 HPS MECHANICAL INC SiteID: 015-021-002289 Fast Format F Notif./Evacuation/Medical Overall Site --Agency Notification -- Employee Notif./Evacuation 02/06/2002 MANAGEMENT VISUAL INSPECTS TANKS AND ALERT OWNER IF ANY VISUAL PROBLEMS ARE FOUND Public Notif./Evacuation Emergency Medical Plan 02/06/2002 ANY MEDICAL ATTENTION NEEDED IS EITHER PROVIDED BY THE NEAREST HOSPITAL OR EMT'S. 3 09/26/2002 HPS MECHANICAL INC SiteID: 015-021-002289 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site Release Prevention -- Release Containment 02/06/2002 TANKS HAVE ALL REQUIRED CONTAINMENT FITTINGS AND SPECIALS. -- Clean Up 02/06/2002 KITTY LITTER Other Resource Activation 02/06/2002 TANKS HAVE ALL REQUIRED CONTAINMENT FITTING AND SPECIALS. -4- 09/26/2002 HPS MECHANICAL INC SiteID: 015-021-002289 Fast Format Site Emergency Factors Overall Site Special Hazards Utility Shut-Offs Fire Protec./Avail. Water Building Occupancy Level -5- 09/26/2002 HPS MECHANICAL INC SiteID: 015-021-002289 Fast Format ----- Training Overall Site -- Employee Training 02/06/2002 SAFETY PROGRAM -- Page 2 Held for Future Use 1 Held for Future Use I 6 09/26/2002 - ...... -'- OFFICE OF ENVIRONMENTAL SERVICES ~'~ B a s v I r o 1715 Chester Ave., Bakersfield, CA (661) 326-39~ HAZA OUS MATE ALS NAGEMENT PLAN INSTRUCTIONS SECTION I. - BUS.ESS ~ENTIFICATION DATA: 0GY The Business O~er / Operator Eo~, Chemical DescriPtion Fo~(s) ~d other Fo~s (e.g.: underground storage t~ info~ation, h~dous w~te ~eatment, etc., ~ needed) may be submitted ~ ~e first section of the H~dous MatefiMs M~agement PI~ order to avoid duplication of info~ation for MitiM submissions. " HAZA~OUS ~TE~ALS ~AGE~NT PL~ SECTION II. 1 - DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Describe the procedures and equipment used to detect any release or threatened release of a hazardous material from any storage container, tank, or vessel at your business. Please provide a written explanation that also includes the make and model number of any automated or electronic leak detection equipment in use at your facility. B. EMPLOYEE AND AGENCY NOTIFICATION: What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -- What procedures are used to notify these parties? At a minimum, you must call 9-1-1 and the Office bf Emergency Services at 1-800- 852-7550 to report any spills that are a threat to life, safety or the environment, or for other non-emergency spill reporting, please call our office at (661) 326-3979. C. ENVIRONMENTAL RESPONSE MANAGEMENT: Please describe who will be responsible for what activities (notifying authorities, clean-up companies, etc.), and what the chain-of-command is at your facility for making sure these activities are carried out. D. EMERGENCY MEDICAL PLAN: Summarize your plan for handling medical emergencies occurring at your business. List / ( '- the local medical facility capable of handling an accident ;, "~Iving Hazardous Materials used at your business. 1 A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B. RELEASE CONTAINMENT AND/OR MITIGATION: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined as possible. C. CLEAN-UP AND RECOVERY PROCEDURES: Explain what clean up procedures will be implemented in case cfa release at your business. This should address small spills, as well as a major release of material once the material is -.. contained. Hazardous Waste: Please provide the name of the hazardous waste company that regularly removes the wastes from your business, and how often that waste is removed. (, Please keep all disposal receipts for the last three years available on site for inspection. UTILITY SHUT-OFFS List locations of shut offs using compass points and known or obvious landmarks. If you have a lock box containing keys and maps of the facility for the Fire Department to use, please list its location also. .. PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. Private Fire Protection: Describe on-site fire protection for your business or facility unit, including sprinklers, fire extinguishers, alarm systems and private · - response teams. B. Water Availability (Fire Hydrant): Give the location of the closest water supply or fire hydrant to be used by the Fire Department in case of an emergency. List the number of employees that are working in the area of the hazardous materials, use or storage. Include all employees who have any occasion to be in those areas. Give the location where Material Safety Data Sheets (MSDS) are kept on file. The MSDS must be readily available on site in a place where employees can access them. Give a brief summary of your Hazardous Materials Training Program. Employees are required by State law to have a pro,am which provides employees with initial and refresher training in the following areas: 1) Methods for safe handling of the haZardous materials used by your business. 2) The Cai OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. .. 4) The prevention, minimizing and clean up procedures you have developed for your business. 5) The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. (' 6) Procedure to coordinate with and assist the local emergency personnel that may respond to your business 7) Who and how to call for immediate assistance in the event of an accident involving hazardous materials. CERTIFICATION Please fill in your name, title, and sign and date on the signature line. IMPORTANT You must return this plan, inventory forms, and map within 30 days of receipt. If you have any questions please call us at (661) 326-3979 - ( Thank youfor helping to keep ottr All America City cleaner, and safer. CITY OF BAKERSFIEL{ 'FFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661)326-3979 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 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 fi'ont of this Plan instead of completing SECTION I. below for initial submission. SECTION I: BUsINEss IDENTIFICATION DATA BUsINESS NAme: /Af~ ~ ~ ~t,~: ,,. ~, T,,,.. ". (. LOCATION: '~ ~. COco -k~-- ,.E,..k b-. "~'e_t CITY: ~)th-\C-_ra-fl~.t~-k. STATE: C/+- ZIP: 06; .,,PHONE: PRIMARY ACTIVITY: (_ ,2~.&l~r,J EMERGENCY NOTIFICATION ' : - · CONTACT " '"' 'TITLE ' BUS. PHONE '24,HR. PHONE HA~I)OUS MATERIALS MANAGi PLAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. ENVIRONMENTAL I~'~P'0NSE MAI~,~bEMENT: D. EMERGENCY MEDICAL PLAN: ,eT~/,..~. f ~,/-X-.~,'",'.-,~ -"-'~'"'~/' ' '~ '4*7' /z~ -~..- ~ z.,.,,,./,,--/ o-- - . .'.~ . , .'.' .', · .,. ,, ? · ~ ,'. ,.,'. SECTION II.2: RELEASE RESPONSE PLAN A.HAZARD ASSESSMENT AND PREVENTION MEASURES: /(,../~? L,.~ /~.. /~,~/ ~,~ ~,~--/ / '~ ~ ~ ~ ~ £ '~ ~F ' ~ " /~ ' ,ff'_.c,o .s-,... ,' /& /'~- /'..o,,.,6./~..d /;.,- B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS {'LOCATION OF SHUT-OFFS AT YOUR FACILITY), ,IgA-Tro~,2~L GA~/FKOI'ANE: ' SPECIAL: LOCK BOX: YES4~~ IF YES, LOCATION: PRIVATE FIRE' PROTECTION/WATER AVAILABILITY PRIVATE FIRE PROTECTION: ,, B. WATER AVAILABILITY (FIRE HYDRANT): ,O~.r ) (,._,-,. ~-~d~._ ~ ,,~ HA OUS MATERIALS MANAGI PLAN SECTION [II: TRAINING NUMBER OF EMPLOYEES: ~. u't ~' MATERIAL SAFETY DATA SHEETS ON'riLE:~' 9'~-,~ --. BRIEF. SUMMARY OF TRAINING PROGRAM: CERTIFICATION IS A~CURA~E. I UNDERSTAND THAT THIs INFO.~I~., TION WILL BE USED TO . FULFII,L MY FIRM'S OBLIGATIONS UNDER THE' CALIFORNIA. HEAL.TH:AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 ~Ec. 25500 ET AL.) AND ' THAT INACCURATE iNFORMATION CONSTITUTES PERJURY. TITL~ 'DATE II^Z MAT MNOMNT PLAN & INSTRUC ~ trl~g ~ OFFICE OF ENVIRONMENTAL SERVICES · . t7. ts Chester Ave., Bake, rsfield, CA (661) 326-3979 HAZARDOUS MATERIALS FACILITY' INFORMATION INSTRUCTIONS BUSINESS OWNER / OPERATOR FORM I. FACILITY IDENTIFICATION: Enter the reporting period (year beginning and ending) for the facility information. Enter the business name and site address and phone number of your business. Do not use 'P.O. box numbers. Enter the Dun & Bradstreet or federal tax identification number for your business. Enter the Standard Industrial Classification (SIC) number for your business. Each typeof business has a Standard Industrial Classification code number. Some common SIC codes are listed on the back of this page. Other SIC codes may be obtained from your worker's . compensation insurance forms, the State of California Employment Development' Departmenti or by calling our office at (661) 326-3979. Enter the name and phone number of the person responsible for operating the business. II. OWNER INFORMATION: List the legal business owner or corporation name and provide the headquarter address or residential address if owned by an individual and phone number. III. ENVIRONMENTAL CONTACT: Identify the person who is primarily responsible for environmental compliance at the busine_ss. ~ ~ _Th. is_ pe~on may be either the business owner, one of the emergency contacts, an environmental manager, or consultant. IV. EMERGENCY CONTACTS: List the name, title, and phone numbers of two people at the business who can respond if the Bakersfield Fire Department requires additional information or other assistance. These contact persons must have keys or access to all areas of the facility, be available for emergency call-outs, and have decision-making a,:thority to call on other resources (such as hazardous waste clean-up companies) as necessary. V. CERTIFICATION: The business owner or operator must sign, date, and also identify the document preparer. 0111 .Wheat production 0724 Cottoh ginning 582 [ Eating places 01 l 5 Corn production 054 l Grocery. store 5813 Drinking places (Alcohol service) 013 l Cotton production 1541 Dry cleaners 5983 Fuel oil dealers 0139 Field crops, except cash 2911 Oil refineries grains 5984 LPG dealers 3441 Welding/fabrication- 0161 Vegetables & melons 7342 Pest control structural 0172 Grapes 7532 Auto top, body, 3443 Welding/fabrication - upholstery repair 0173'Treenuts ' ' boiler ~ Auto paint shops 0~74 Citrus fruits 3569 Machine shop 7533 Auto exhaust repair 0175 Deciduous tree fruits 4222 Cold Storage 7536 Auto glass replacement 0179 Other tree fruits & nuts .4925 Compressed gas supplier 7537 Auto transmission 0192 General farms, primarily 5093 Automobile salvage repair crop 5169 Chemical supply 7538 General auto repair 0241 Dairy farms 5511 Motor vehicle dealers 7542 Car washes 0252 Chicken eggs (new & used) 8071 Chemical laboratory 0253 Turkey eggs 5521 Motor vehicle (used only) 2851 Paint manufacture 5531 Auto & home supplY stores 0291 General farm, primarily livestock & animal 5541 Gasoline service stations specialties 2 S'rA rE WAS'I'E CODE .. , 220 It' tile hazardous material 'is a waste, enter the approPriate California 3-digit hazardous waste code as listed on thc back or' the Uniform Hazardous Waste Manifest. A list of common State Waste Codes are included on page 4 of these instructions. UNITS 221 Check tile unit of measure that is most appropriate for the material being reported on this page: gallons. pounds, cubic t~et or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If'material is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). DAYS ON SITE 222 List the total number of days during the year that the material is on site. STORAGE CONTAINER ·223 Check ali boxes that describe the type ofstorage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. STORAGE PRESSURE 224 Check the one box that best describes the pressure at which the hazardous material is stored. STORAGE TEMPERATURE 225 Check the one box that best describes the temperature at which the hazardous material is stored. HAZARDOUS COMPONENT 1 - 5 (% by weight) 226, 230, 234, 238,242 If a range of percentages is available, report the highest percentage in that range. HAZARDOUS COMPONENT 1 - 5 Name 227, 231,235,239, 243 When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). Ali hazardous components in the mixture present at greater than 1% by weight if non- carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. HAZARDOUS COMPONENT 1 - 5 EHS 228, 232, 236, 240, 244 Check "Y" for yes if the component of the mixture is considered an Extremely Hazardous Substance as - defined in 40 CFR, Part 355; or "N" for no, if it is not. · - HAZARDOUS COMPONENT 1 - 5 CAS ' · 229, 233,237, 241,245 List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. III. SIGNATURE: 246 Please print name, title, sign and date each chemical description form. If you have any questions please call us at (661) 326-3979 :~;,,,.~:,~,. ~ CALIFORNIA,WASTE CODES Cod..~_~e Description Code Descripth~n [ndrganics 241 Tank bottom waste i 11 Acid solution 2 < pH < 7 with metals 251 Still bottoms with halogenated organics · - · (antimony. arsenic, barium, beryllium, 252 Other still bottom waste cadmium, chromium, cobalt, copper, lead, 261 PCB's and material containing PCB's mercury, molybdenum, nickel, selenium, silver, 271 Organic monomer waste (includes unreacted thallium, vanadium and zinc) resins) 112 Acid Solution without metals 272 Polymeric resin waste 113 Unspecified acid solution 281 Adhesives 121 Alkaline solution pH >12.5 with metals (see 291 Latex waste l 11) 311 Pharmaceutical waste .. [22 Alkaline solution without metals 321 Sewage sludge 123 Unspecified alkaline solution 322 Biological waste other than sewage sludge 131 Aqueous solution (2 < pH < 12.5) containing 331 Off-spec, aged or surplus organics reactive an6ins (azide, bromate, chlorate, 341 Organic liquids (nonsolvents) with halogens cyanide, fluoride, hypochlorite, nitrite, 343 Unspecified organic liquid mixture perchlorate and sulfide anions) 351 Organic solids with halogens 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues Sludges 10% or more 411 Alum and gypsum sludge 134 '~ Aqueous solution with total organic residues 421 Lime sludge less than 10% 431 Phosphate sludge 135 Unspecified aqueous solution 441 Sulfur sludge 141 Off-spec, aged, or surplus inorganies 451 Degreasing sludge 151 Asbestos containing waste 461 Paint sludge 161 FCC Waste < . 471 . Paper s!udgc/pulp 162 Other spent catalyst 481 Tetraethyl lead sludge . 171 Metal sludge (see 111 ) 491 Unspecified sludge waste 172 Metal dust and machining waste (see 1 !I) 181 Other inorganic solid waste Miscellaneous 511 Empty pesticide containers 30 gal or more Organics 512 Other empty container 30 gal or more 211 Halogenated solvents (methylene chloride, 513 Empty containers less than30 gal ' chloroform,-TCE, TCA) 521 Drilling mud 212~ Oxygenated solvents (acetone, butanol, MEK) 531 Chemical toilet waste 213 Hydrocarbon solvents (stoddard solvent, 541. Photo chemical/photo processing waste xylcne) 551 Laboratory waste chemicals 214 Unspecified solvent mixture 56i Detergent and soap 221 Waste oil and mixed oil 571 Fly ash, bottom ash, and retort ash 222 Oil/water separation sludge 581 Gas scrubber waste 223 Unspecified oil - containing waste 591 Baghouse waste 231 Pesticide rinse water 611 Contaminated soil from site clean-ups 232 Pesticide and other waste associated with 612 Household wastes ' pesticide production S:~CtJPAFORMS~IIAZMAT FACILITY INFO INST. 4 ~..~,', .s ,: ,'~.,_~ OFFICE OF ENVIRONMENTAL SERVICES ~lRr~r 1715'Chester Ave~, CX~93301 (661) 326L3979 Business Activities Page I, FACILITY IDENTIFICATION FACILI~ ID $ {F~ office u~o ~ly - ~lease ~eave Ol~k) I . ~A I0 d OB~FACILI~ NAME II. ACTIVITIES DECLARATION ........................................ [56~ ~6u}'~t~7..- ..................................... -.' .................... i~ ~,es,"~i';;;-e Cornplete...-- 1. Have on site (for any purpose) hazardous materials at or v' CONSOLIDATED COMPLIANCE PLAN above 55 gallons for liquids, 500 pounds for solids, or 200 i Minimum required plannin.q elements: cuft for compressed gases (include liquids in ASTs and : · Emergency Response Plan USTs)? / , · Maps 2. Have any amount of an explosive material (other than OYES(~)'~NO s · Training ammunition) on site? ' · Prevention · Certifications "~;'-~'~GUI~Af~b-sI.~.~:I:,~,~'~-(~S) OYES ~ ~ v" DES FOR/~'2'~3-1"('~'m;~f-b-eso'io-'--~,'~'-~r~l .................. Have onsite RS at greater than the threshold planning ,/ RISK MANAGEMENT PLAN (RMP Su~m~ fo USEP^) quantities established by the California Accidental v" CONSOLIDATED COMPLIANCE PLAN Release Prevention program (CalARP)? · Incorporating CalARP Program Elements C. UN'D'~I~[J'I~I'I~-~:rORAGE TANKS (.USTs.) OYES (~-'--*-'; v; ....... 0~"F-,~;i~ITY'"F-(~M ............................ ~. Own or operate Underground Storage Tanks? v' UST TANK FORM (one pa' lank) Intend to upgrade existing or install new USTs? OYEs (~NNO 8 ~' 'UST FACILITY FORM V' UST TANK FORM v' UST INSTALLATION FORM (one per mn~0 / "-~.-"'I:.~,N~-CLOSURE / REMOVAL ~--~'~'~;~-- 9 v' UST TANK FORM (closure sec~o~-ene pa' tank) 1. Need to report closing a UST that held hazardous maledals or waste? / 2. Need to report the closure/removal of a tank that was OYES (~O ~0 v' TANK CLOSURE FORM classified as hazardous waste and cleaned onsite? E. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) S ONe , v" CONSOLIDATED COMPLIANCE PLAN Own or operate ASTs above these thresholds: any tank · Incorporating Federal Spill Prevention capacity is greater than 660 gallons or the total capacity . * Control and Countermeasure (SPCC) for the facility is greater than 1,320 gallons. Elements pursuant to 40 CFR Part 112 · -F'~-~.~I~DOUS WASTE: v' EPA ID number--provide on this page 1. Generate hazardous waste? OYES (~O ~2 To obtain EPA ID//, please phone (916) 324-1781 2. Recycle more than 100 kg/mo of recyclable materials at OYES (~O ~3 v' * RECYCLING FORM the same location it was generated? 3. Recycle more than 100 kg/mo of recyclable materials at OYES (~10 ~4 v' RECYCLING FORM an offsite location different from the point of generation? 4. Treat Hazardous Waste on site? OYES (~O ~s v' TP FACILITY FORM (DTSC Form 1772) :v' TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requiremenls? OYES (~ ~s,' v' CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a remote OYES r? [ v' REMOTE WASTE / CONSOLIDATION SITE site? = ' NOTIFICATION FORM G. PERMIT C~N~0[.[~'A-~I'O~'Z~I~: ................................ . '(~V/=§"~:o" 'i~ ":"'v; ...... ~oi~S6'ubXfEb-coUpLYXi~ci="~*~ .............. Intend to consolidate other Cai/EPA agency permits? ' · Incorporating all other environmental (If yes, please complete Section III and attach) permit requirements per 27 CCR 10410 3TE: ~ If you checked YES to any part of Sections IIA-IIG above, ther{ in addition to the forms requested above, please Submit DES Form 2730. UPCF (?/99) S:~CU PAF ORM S~ACTIVITY.wp~ CITY OF BAKERSFIELO !" ~';i~?~''~ OFFICE OF ENVIRONMENTAL SERVICES .~ ~,--~' . .... 1715 Chester Ave,, 8akers_fie!d,.CA 93501.(66!)..~2.6-3979 ~.. FACILITY INFORMATION Business.Activities Addendum Page ~ of ~ I. FACILITY IDENTIFICATION .......................................................................................................FACILITY ID # {FOr o/f~ce use O~ly . please leave blank) i' : ' [~5.~Td ~ .................... ~ OBA/~ACILITY NAME ....................................................... ~ III. CONSOLIDATED PERMIT ACTIVITIES Is your Facility Compliance Plan subject to review by... i for satisfying the conditions of these permits? H. DEPARTMENT OF TOXIC SUBSTANCES CONTROL -- OYES ~'~-- ~ ....... '~'-N-I~I~J~'~=E~;~I~ .................... ~. · All Modifications OYES ONO v' Non-RCRA HAZARDOUS WASTE FACILITY OYES ONO ~ RCRA HAZARDOUS WASTE FACILITY I. SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION S ONO v' AUTHORITY TO CONSTRUCT CONTROL DISTRICT OYES ONO v' PERMIT TO OPERATE J. STATE WATER RESOURCES CONTROL BOARD OYES ' v' WASTE DISCHARGE REQUIREMENT (WDR) :NTRAL VALLEY REGIONAL WATER QUALITY CONTROL OYES (_ONO v' GENERAL PERMITS - , .. , . OYES ONO v' SPECIFIC PERMITS OYES ONO v~ NATIONAL POLLUTION DISCHARGE ELIMINATION SYSTEM (NPDES) K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD OYES "~' v' REGISTRATION PERMIT (~NO ENVIRONMENTAL HEALTH SERVICES PERMITS L. KERN COUNTY RESOURCE MANAGEMENT AGENCY OYES v' Domestic Water Well Permit '- . OYES ONO. v' Haz Mat Monitoring Wel!permit ' OYES ONO v' Septic System Permit OYES ONO v' Public Swimming Pool Permit OYES ONO ~ Food Facility Construction Permit OYES ONO v' Solid Waste Local Enforcement Agency (LEA) Related Permits OYES ONO v' Medical Waste Related Permits PERMIT NOTE: v' if you checked YES to any part of Sections III-H to III-M above, then please address all applicable permit requirements in the Facility Compliance Plan. ",,'--,'~;l~L~J-~~,~ OFIR~CE OF ENVIRONMENTAL ~q~VlCES ~~ ~r 1715 Chester Ave., CA 93301 (661) 326-3979 Y~ .... ' H~RDOUS MATERIALS INVENTORY ..... CHEMICAL DESCRIPTION ., (one fo~m I. FAClLI~ INFORMATION CH~MI~L L0~TION CONFIDENTIAL (E~) II. CHEMICAL INFORMATION CHEMI~L ~ ~7 co~N ~ :.,..- [ - :. EHS' '~PE .' ~" ~ ~ ~RE ~RE ~ w W~TE 211 ; ~A~. ~ Y~ ~ NO 2~2 CURIES 213 PHYSI~L STATE.:~ . ~ ~ a ~UO ~QUID ~ g ~ 214' ~ST ~NER ' 215 ~WASTE 217 ; ~M 218 i A~ 219 $TATEW~DE i ~LY~U~~ ~LY~ " UN~S' ,~ .~ ~ ~ D m L~. ~ m TO~ =~ ~YSONS~S STOOGE ~N~R ~~OU~ T~K ~ · ~~IC DRUM ~ i R~ DRUM ~ m G~ ~E (Check aR ~at ~b U~OUNDT~K ~f ~ ~j ~G ~n ~IC ~E ~ O~ER ~ d ~ DRUM ~ h SILO ~ I ~ER ~ p T~K WA~N STOOGE ~ESSU~ ~1~ ~ ~ ~~ ~ ~ ~LOW~I~ %~ ~R~US ~MPONE~ EHS ~S 2 2~0 ' ~I ~Y~ ~ 232 : , ~S OY~O~ 236 J : ...~ ......................... ~ 241 4 238 ~9 ~ Y~ ~ NO 240 ~ 5 ; 242 243I ~Y~ ~N° 244 } 245 IlL SIGNATURE .]PCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd ~ ', Ha'zardo, us Materials Inventory - Chemical Description YOU must .;omplela ,I .;ep,lr,)le H.I.:,.I~'clous J~lale~%~ls ~nventot'/· Chum<al ~escr~pl~on page for each I~azar~ous matar~al (hazardous substances and ~azardous waste) quanl~l~es tar ~n~ch .in ~mer0oncy Dian ~s (~u~red to ~e ,ldoOl~ pUrSUant (o 10 CFR Paffs 30, 40. or 70. the c~plel~ ~nvento~ s~oulq reflect all repona~le q~nll~a M ~atoous ~n,]tor~als 31 your (ac~l~ly. re.ned separately for e~h Ou~ing or ~e adjacenl area. w~lh separale p~es f~ un~ue ~rrences of Ohys~l [emp~ature tnd sierra Orassute, tNote: the numOenng of the ~nalruclion~ (OI~K the data element num~ that ~e off the UPCF pages. These data element numbe~ ~e us~ (or eJectromc submission 3n~ are the same as ~he num~nng uSe~ ~n 27 CCR, Appen~x C, the 8usme~ Sect~n of the Um~ed P~rom Dale OiclJo~.) ~m~r 311 p~es of your submittal. This helps your CUPA or ~ ~denti~ whether ~ submitlal ~s ~molele and ~f any pages are Separated. I. FACILITY ID NUMBER · Th~s numar is ass~gn~ Dy the CUPA ~ ~ ThW M ~ u~ue n~r wh~ ~nli~es your faoli~. 3. BUSINESS NAME · Enter the full I~al name of t~e ~usine~. 2~, ADO/OELET~ RE~SE - Indicia if ~e malenal is ~ a~ to Ihe invenl~. ~t~ lr~ ~e ~nv~l~, or if ~e info.alan pre~us~ submi~ is ~ng ~. NOTE: You may ch~se Io leave this blank ~f y~ re~t ~ut entire ~vent~ annualS. ~1. CHEMICAL LOCATION. Enter ~e bui~ing or outsidg a~ecenl ama where ~e ~ardous male~l is h~l~. A ~em~l ~at i9 st~ at the.same ~essure an~ tem~rature, in multiple ~ns w,lhin a. bui~i~, ~n be re.ned on a ~le p~e. NOTE: This info~aUon is no( subject to public disclosure ~muant ~ HSC ~25506. · · 202. CHEMICAL LOCATION CONFIDENTIAL - EPC~ - NI bus~ne~s wh~h ~re su~e~ to the'Emerg~y Pla'nning ahd Communi~ R~ght Ia Know Act. (EP~) check *Yes' to keep chem~l I~a~on info~at~ ~n~enlial. If ~e b~ess d~s n~ ~h {o keep chemi~l I~n information ~n~denfial che~ *No*. 203. M~ NUMBER - If a ~p is inc~d~, enler the numar el ;he map ~ ~h t~ ~n of ~e h~ardous ~lefial is sho~. 2~. GRID NUMBER - If gdd c~rdlnales are used. emer the ~nd ~ates of ~e map Ihat ~ to ~e l~at~n o~ Ihe hazardous material. If appli~ble, mu~p~ ~rdi~tes ~n be lis{~. 205. CHEMICAL NAME. ~ter the prier ~emical name a~at~ mffi ~e C~I A~act Sem~ (~S) numar of the haza~s material. This shouM Intemat~l Uni~ of Pure and ~p~ Ch~s~ (lUPAC) ~ ~ou~ ~ ~e Mater~l Safe~ Da~ Sheet (MSDS). NOTE; If the ~emi~l is a mktum, ~mplete ~is fie~; ~p~te ~e 'COMMON ~ME* ~M i~. 2~. T~DE SECRET - Check ~es' ~ ~e infotmal~ in ~ ~ ~ ~ a ~ ~L ~ ~o' ~ ~ ~ ~L S~te r~en~ If yes. a~ b~ ~ ~ ~ ~ ~ di~ of ~e ~s~ ~e s~et ~f~n ~ ~und by HSC ~25511. F~eml regiment: If ~, a~ b~s is ~ ~ ~ d~_~ ~ ~e d~l~ T~ ~ inf~ ~ ~und by 40 CFR and ~ must su~il a 'Su~mn~n to ~m~ C~ ~ T~ ~ f~ (~ CFR ~.2~ ~ U,~Ep~ 207. COMMON ~E - Enter ~e ~ ~e or ~ ~ ~ ~e ~ ~ ~ ~um ~i~ a ~ ~t~l. ~. EHS - ~ ~' ~ ~e h~s mated~ is an ~ ~ ~ (EHS). ~ ~rm~ ~ 40 ~ P~ ~. ~ ~ If the male~l Is a m~ ~nmining an EHS, Ieee ~ se~ b~nk a~ ~p~le ~ s~n on ~us ~ ~. 2~. ~ ~ - Enler the Chem~l ~s~ ~ (C~) n~ f~ ~e ~ ~te~ F~ m~s, ~1~ ~e ~S numar of the m~e ~ it ~s ~n ~ a numar distin~ from i~ ~m~en~. If t~ mmtum ~ ~ ~S num~. ~e ~is ~lumn b~nk ~ mp~ t~ ~S num~m of ~ ~d~l h~ ~m~en~ ~ ~e approp~te ~on bel~. 210. FIRE CODE H~D C~ES - ~re ~e H~ard C~ de~ ~ flint ~ers t~ ~ and I~el of h~a~ mate~ls ~i~ a ~ine~ ~le~ info.arian s~ on~ be ~ded if the I~1 ~e ~ief d~ ~ ~a~ a~ mquesls ~e CUPA ~ ~ ~ ~t il. A list of ~e h~a~ classes ~ i~ on h~ to dateline whi~ ~ss a mate~al fa~s u~ are i~ in ~e ap~s of ~e ~ of [he Un~o~ Fke ~e, If a material ~s ~ ~an appl~ble h~ ~s, J~ all. ~n~ CUPA ~ ~ 211.' H~DOUS ~T~I~ ~PE - ~ ~e ~e ~x ~a{ ~st ~ ~e ~ of ~s mate~l: pure, m~um 0r ~te. If ~ste mat~al, ~ o~ ~t If mix~m ~ ~ste, ~p~te h~rd~s ~en~ 212. ~IOACTIVE. ~ ~es' ~ ~e ~ ~t~ b ~e ~ 'No' ~it ~ ~b 213. CU~ES - If ffia h~us mate~l is ~e. ~ ~ ~ ~ m~ ~e ~ ~ ~Hes. Y~ ~ ~e up to ~ne ~ ~ a ~at~ d~al ~int ~ reda 214. pHYSI~L STA~ * C~ ~e ~e ~x ~t b~t d~ ~ s~ ~ ~ ~ ~s mat~l is ~dl~: ~ F~uM ~ gas. .' 215. ~GEST cO~NNER - Ent~ ~ to~l ~ of ~ ~ ~r in ~ ~e ~te~ b M~. . 216. FED~ H~D ~TEGORIES - C~ a~ ~t~ ~t d~, ~e p~l a~ h~l~ ~s ~t~ ~ ~ ~s mattel. .,. PHYSIC~ ~RDS , I ,, H~ ~RDS ,, Fi~: F~m~Ue ~u~ and ~l~s. ~bus~ ~s, ~m~. O~em ~ A~e H~I~ (~m~late): H~h~ T~. To~ I~n~, ~i~e~ ~, React~e: Unstable Rea~e, O~an~,PeroxM~. Water R~e. ~ I ~ ~a~ ~1~ ~ an ~me effe~ ~th s~A term ex~e Pressure Release: ~p~s~es. ~e~ed Gases. B~sti~ ~ . ~ Chronic Health (DeJay~): ~. o~er h~er~S ~ ~ ' ~ ~ e~ ~ ~ ,te~ ~sure ' ~ Z. A ~GE.DAIL~ ~UNT . Ca~ ~e a~ da~ a~t Of ~ h~er~ ~te~/~ m~m ~i~ng a h~a~ mate~l, In ~ ~di~ ~ ~Me ama. Ca~ula~s s~ be ~ on ~e p~ ~s ~en~ ~ ~te~l re~ ~ ~ ~. To~l all daily amoun~ and d~e by ~ numar da~ ~e ~m~l ~11 ~ ~ site. If ~'~ a ~;e~l ~t ~s ~ ~ ~ pm~nt at ~s ~, ~e a~ shall ~ t~ a~ ~ a~t pr~t to be ~ ~nd du~ t~ ~u~ ~ ~e year. ~b ~nt s~M ~ ~tent ~ ~e u~ m~d ~ ~x 221 a~ shouM not ~ ~at of ~mum ~i~ am~nL 218. ~IMUM ONLY ~OU~ - ~ter ~e ~um ~N ofe~ ~ ~ ~ ~ ~ a ~s ~ter~l, whi~ ~ ~d ~ a bul~ adja~nF~ area at a~ ~e t~ ~er ~ ~e ~ ~ ~. ~ a~ must ~ al a m~ ~ ~s ~v~to~ ~ ~e ~te~} re~ 219. ~NUAL WASTE ~NT - If t~ ~s metal ~ ~ Is a ~e, ~ an e~te ~ ~ annul a~nt h~. . 2~. STA~ WAS~ CODE - If ~ h~a~s metal ~ a ~ste, ~ter ~e ap~ C~ia ~il ha~us waste ~e as ~t~ ~ ~e ~ of ~e Unifo~ H~s Waste Man,esL 221. UNITS * Ch~k the unil of measure I~t is most ap~op~le ~r t~ ~te~al ~i~ m~ on t~ p~e: gal~. ~unds, ~b~ f~t or tons. NOTE; If ~e ~te~l ~ a f~eral~de~n~ExV~elyH~a~ousSu~n~(EHS).alla~n~mu~.m~in~nds. If~tedalisam~ure~ntain~anEHS, re~un~t Ihe malarial is st~ in (gaa~s, ~unds, cub~ f~L ~ ~2. DAYS ON SITE. List {he to,al ~m~r of days du~ ~e ~ar ~at ~e material ~ ~ site. 223. STOOGE CONTAINER - Ch~k all ~xes that des~ ~e t~e of storage ~nta~ers in whi~ ~e haza~ous matedal is stored. NOTE: I~ appropriate, ~u may ~se m~e ~an one. 224. STOOGE PRESSURE - Check ~e one box that ~$t desk.s t~ procure at ~i~ ~e h~ar~us mattel is stored. 225. STOOGE TEMPE~TURE - C~ ~e one box ~a{ ~ de~s ~/empe~m at ~ I~ haza~s ~tedal is s~red. 226. H~DOUS COMPONENTS 1-5 (% BY WEIGH~ - Enter ~e ~n~ge ~ht of ~e h~ar~u~ -nmponenl in a m~ture, If a ~nge of percentages ~ ava~able, re~ ~ ~hest parentage in ~at ~e. (Re~ f~ ~m~nen~ 2 ~ 5 in 230. 2~,. ~ a~ 242,) 227. H~OOUS COMPONENTS 1-5 N~E - W~n re~ a h~a~ous malarial ~at is a m~[ure, list up to ~ve ~em~l ~mes of hazardous components ~ that m~;~e by parent ~ight (re,er ~ MSDS ~, in ~ ~se of ~e s~e~, m[er to manuf~ture~}. NI ~zardous c~n~ in the mixlum ~esenl at g~ter Ihan 1% by ~ht if non~r~n~enic, ~ 0.1% by ~ht if ~r~n~en~. s~uld ~ re~. If more than ~we h~ar~us ~mponen~ are present a~e ~se pe~n~ges,~umayattachanaddR~nals~oi~rto~pturether~uir~informat~, ~enre~ingwaslemixtures, minerala~ch~m;~cnm~sil~n sh~ld ~e listed. (Re~ f~ ~mponenls 2 Ihr~gh 5 in 231,235, 239, a~ 243.) 228. H~RDOUS COMP~ENTS 1.5 EHS - Check 'Yes' ~f I~e ~m~enl of the mixture is cons~er~ an Exlmmely Hazar~us Subsla~e as de,ned in 40 CFR, PeA 355, or 'No" i[R is not. (RepoA (or com~nents 2 through 5 in 232. 236, 240, and 244.) 2~. H~ARDOUS COMPONENTS ~.5 CAS * Lisl the Chemical Abs~a~ Se~e (CAS) numbers as relal~ to Ihe hazar~us ~m~nenls in the mixture, (Repeat ~or 2-5.) 246. LOCALLY COLLECTED INFORMATION - This space may be us~ by Ihe CUPA or ~ to coll~l 3ny a~dilional in~mation necesse~ {o moot Ihe requirements o~ their ~nd~wdua~ pr~rams. Conlact t~e CUPA ~ ~ for gu~an~. UPCF' (1/99) 7 0£S Porn~ 273 ! CITY OF BAKERSFIEL! . '~ ' ~' OFI~E OF ENVIR(J~MENTAL S~VICES fi.., ' $ O ~,~ ~715 Chester Ave., CA.93301 (661)326-3979 - ~ .... ' ~us~ess ow~e~ ~ OPe~O~'me~T~m~T~O '~ '-~, FACILI~ INFORMATION I. FACILITY IDENTIFICATION FACILITY ID.# ' il I :. : Year Beginning ~oo Year Ending BUSINESS NAME ~Same as FACiLITY NAME or DSA- Ooi~g Business' :~s) ................. ~3 "BUSINESS PHONE ................ 702 SITE ADDRESS 703 .DUN-& ....... ~06 SiC CODE ~07 B.~..?.STREET . (4 Digit #) COUNTY ~<~ e.,~ ~,..~ OPERATOR NAME L,,.~ ~, ~[:~ ~,-~,- ~¢. 4'" 109 OPERATOR PHONE II, OWNER INFORMATION O.~.~.~_,.~_~_E.__~_._~ ..... _~ t--~.....t..~ ,,, O~ERPHONE... ~ I 1~4 i STATE l~S ZIP III. ENVIRONMENTAL CONTACT CONTACT NAME ~3' CONTACT PHONE CONTACT MAILING ADDRESS CITY ~20~ STATE 12~ ZIP ~22 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- TI.T~. ....... ~,~ 1~ [ TITLE . ~~ . 130 BUSINESS PHONE ~ ~ ~ ~ ~. ~ .......... ~26 ~ BUSINESS PHONE ~ ~ ~- ~ i ~ ~ ~3~ 24.HOUR' p~..._.~.~.:~.~ ..... '~_~ f27 : 24-HOUR PHONE ~[~, ~ ~ V. CERTIFICATION ~ertifi~tion: Bas~ on my inqui~ of ~ose individuals responsible for obtaining the info~atlon, I ce~i~ under penal~ of law that I have personally examin~ and am familiar ~ ~e information submi.~ in this invento~ and believe the info~atlon Is tree, accurate, and complete. SIGNATURE OF O~E~OPE~TOR '~AMESOF .................................................................... OWNE~OPE~TOR (pdnt) l'~'''1', rifLE O~'O~E~0'PE~oR ....................................... 137 ~CF (7/99~ S:~CUPAFORMS~OES2730.~4.wpd *""* ~iness Owner/Operator Identifi, Pleas~ rsubm~t the Business ActJw~Jes page. the Bus~ness Owner/Oi3erator IdenlJltcalJon page (OES Fo~ 27~). and Ha~r~ous ~{~ials. Chemi~l o~p~n ~ges (OES Fo~ 273 ~) for all ~zardous mate~ats invento~ suOmi~ons. For ~e inven~ ~ be ~nsider~ ~mpiele ~is pa~ must be s~gn~ by ~e appropna{e i~iv~l. Noir:; ~e numbing of ~e ins~c~ons foll~s ~e da~ element numbem ~at are ~ ~e UPCF page. ~e da~ ~ement numb~ are Jr ~onic submission and are Ihe ~me as ~e numbenng us~ in 27 CCR, Appendix C, ~e Business S~t~n of ~e Unifi~ Pr~mm Da~ DIc~ona~.} Please number all pages of your suOmiEal. This helps ~ur CUPA or ~ id~ whe~ ~e submi~l is ~mplete and if any pages are separate, 1. FACILITY IO NUMBER. Th~s number is assign~ Dy the CUPA or ~. ~is is ~e unique number whi~ identi~es your facili~. 3. BUSINESS ~ME - Ent~ ~e ~11 I~al name of ~e busine~. 100. BEGINNING DATE - Enter ~e b~inning year and date of ~e re~. (~MMDD) 101. ENDING DATE - Enter the ending y~r and date of ~e r~A. (Y~MMDO) 102. BUSINESS PHONE - Ent~ ~e p~ne number, a~ ~e ~mt, a~ a~ ~tension. 103. BUSINESS SITE ADDRESS - Enter ~e s~eet addre~ ~ere ~e ~li~ is I~t~. No ~st offi~ ~x numbem are allowS. ~is in~a~on must pm~de a mea~ to g~mphi~lly I~te ~e 1~. Cl~ - Enter ~e ~ or unin~mt~ ar~ in ~i~ busin~ site is I~t~. 105. ZIP CODE - Ent~ ~e ~p ~e of busine~ site. ~e ex~ 4 digit ~p may al~ be add~. 106. DUN & B~DSTREET - Enter ~e Dun & Brads~t number for ~e ~dli~. ~e Dun & Bmds~t number may be obta~'~ b~"~lli~g ' ' , - (610) 882-7748 or by Inlemet. 107. SIC CODE - Enter ~e pdma~ S~nda~ Indus~l Cla~ifi~6on ~e numb~ for pdma~ bu~ne~ acfi~. 'NOTE: If ~e is more ~an 4 digit, re~ on~e flint four. 108. COU~ - Ent~ ~e ~un~ in ~i~ ~e bus~ ~le is Io~l~. 1~. BUSINESS OPE~TOR ~ME - Enter ~e ~me of ~e b~in~ ophir. 110. BUSINESS OPE~TOR PHONE - Ent~ ~n~ op~ ~ne n~, E di~t ~m ~in~ ~e. ar~ ~e tirol a~ any ~on. 111. O~ER ~ME - Ent~ ~me of ~ ~, ~ diff~ent ~m ~ ~. 112. O~ER PHONE - ~t~ ~e b~n~ ~s ~e ~m~ if d~t ~ b~in~ ~, a~ ~e flm~ and any ~e~n., .... 113. O~ER'~ILI~G ~DORESS - Ent~ ~e ~s maili~ addr~ if d~ent ~m bu~n~ site addr~. 114. O~ER Cl~- Enter ~e ~me of ~e ~ ~ ~e ~s ~ili~ ~r~. 115. O~ER STATE - Ent~ ~e 2 ~m~ s~te ab~e~on ~r ~e ~s maalng ~dr~. 116. O~ER ZIP CODE - Ent~ ~e ~p ~de for ~e o~er~ a~r~. ~ ~ 4 digit ~p may al~ be add~. 117. ENVIRONMENT~ CO~ACT ~E - Enter ~e ~me of ~e ~n, if differ ~m ~e Bu~n~ ~ or Operator, ~o r~i~ all ~mnm~l ~~e~ a~ ~11 m~ ~ ~~t a~. ' .... '. ' · '. 118. CONTACT PHONE. En~r ~e p~ne numbs, if d~e~t ~m ~ ~ ~em~r. at ~i~ ~e ~mnm~l ~n~ct ~n be ~n~. ar~ ~e ~m~ ~ any ~on. . '~ ,* ..,. 119. CO~ACT ~ILING ADDRE~ - Ent~ ~e maili~ addr~ ~ere all ~mnm~l ~n~ ~en~ s~uld be sen~ E d~t ~m ~e ~te addr~ ~. Cl~- Enter ~e ~me of ~e d~ ~r ~ ~mnm~l mn~.~ maa~d~r~. 121. STA~ - Enter ~e 2 ~am~er s~te ab~e~a~ ~ ~e ~m~l ~ maia~ addr~. 1~. ZIP CODE - Ent~ ~e ~p ~e ~ ~e ~en~ ~n~c~ ~ ~d~. ~ ~ 4 d~it ~p may al~ be add~. 123. PRIORY EMERGENCY CO~A~ ~E - ~t~ ~e ~me of a r~r~e ~t ~n be ~n~ in ~se of an eme~e~ in~M~ ~o~ mat~a~ at ~e b~in~ ~te. ~e ~n~ ~1 ha~ FULL ~dli~ a~, ~te ~miliaH~, and au~ to make d~io~ ~r ~e busin~ r~a~i~ i~d~t mi~n. 124. TI~E - Ent~ ~e aae of ~e pdma~ ~erg~ ~n~ 125. BUSINESS PHONE - Ent~ ~e b~n~ numb~ ~ ~e ~ma~ em~ ~n~ ~ ~e tirol a~ a~ ~e~ions. 126. 24-HOUR PHONE - Ent~ a 2~ur p~ne num~ ~ ~ pH~ em~ ~ ~e 2~ p~ numar m~t be ~ ~i~ Is a~ 24 ~m a day. If it is ~t ~e ~s ~e ~ ~, ~ imm~t~y ~n~ ~ i~l s~t~ a~. 127. PAGER NUMBER ~ En~ ~ ~g~ ~ ~ ~ ~ ~~ ~ if a~e. 128. SECONDLY EMERGENCY CO~ACT ~E - Ent~ ~e ~me ora ~a~ r~r~e eme~ ~n~ is ~t a~aable. ~e ~ta~ ~1~ ~ve FULL ~d~ a~. ~te ~miliad~, a~ a~H~ to make d~ons ~r ~e.b~in~ r~ardi~ inddent miagaa~. 1~. T~LE - Ent~ ~e ~ae of ~e s~a~ ~e~w ~n~. , . ,.. 1~. BUSINESS PHONE.~ Ent~ ~e ~ne~ ta~e numar for ~e ~a~ ~ ~n~ ar~ ~e 131. 24.HOUR PHONE.- Enter a 2~r p~ne numb~ [~ ~e ~a~ ~e~e~ ~na~ ~ 24'~r ~one number must be one ~i~ is a~er~:24 ~um,aday. If it is not ~e ~n~s ~me ~e numbs, ~ ~m~iat~y ~n~ ~ i~l s~t~ a~v9. 132. PAGER NUMBER - Enter ~e pa~ numb~ ~r ~e se~a~ ~en~ ~n~ if a~ilable. 133. ADDITIO~L LO~LLY COLLECTED INFOR~TION - ~is spa~ may ~ ~ ~r CUP~ m ~ to ~ll~t any addifio~l info~aaon n~ ~ m~t ~e r~uir~ of ~r ~d~ ~s. ~n~ct ~ur I~1 age~ ~r g~dan~. 1~. DATE - Enter ~e date ~at ~e d~t ~s s~n~. (~MMDD) 135. ~ME OF DOCUME~ PREPA~R - Enter ~e ~11 ~me of ~e p~n ~o prepar~ ~e invento~ subtotal info~aUon. 136. ~ME OF SIGNER - En~r ~e ~ pdnt~ name of ~e per~n ~gning ~e page. ~e s~ner ce~fi~ ~ a famillad~ ~ ~e in~aUon submitt~ a~ ~at bas~ on ~e signer~ i~ui~ of ~se i~ividuals res~nsible for ob~ini~ ~e info~ation, all ~e info~a~n submiE~ is ~e, a~mle a~ ~mplete. SIGNATURE OF O~E~ OPE~TOR OR DESIGNATED REPRESE~ATIVE - The Busings ~neflOpe~tor, or officially designat~ r~resen~flve o[ the ~/Ope~r. sh'~l sign in ~e spa~ pm~d~. ~is signature ~fl~ ~at ~e signer is ~millar ~ ~e info~atlon submiE~ and ~at bas~ ~ ~e signer~ inqui~ o[ ~ose i~i~duals res~n~ble for ob~inl~ signe~s belief ~at ~e submi~ ingrain is ~e, a~rate and ~mplete. 137. TITLE OF SIGNER - Enter ~e ~e of ~e pe~n signing ~e page. '~' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 SITE AND FACILITY DIAGRAM INSTRUCTIONS FOR HAZARDOUS MATERIALS MANAGEMENT PLANS These instructions explain the use of the site diasram and the facility diagram. Normally, small and medium size businesses will only have to submit a site diagram. If you have subdim'ded your business into smaller areas becaus~ of the complexity or ~ then you will be completin8 and additional detail map, facility diagram, for each of these areas. Include instructions that show the route to your business it it is in a remote location. SITE DIAGRAM INSTRUCTIONS The site diagram is used to show your bnsine~ and to indicate the businesses that immediately..~ surround your property, usually within 300 feet. Ifyou will be showing specific area detail on ~° facility diagrams, use the site diagram to show an overall layout of'the plant. If you ~ not ~"~i;. submitting facility diagrams, the site map must include all of the following information: 1. Check the box on the top left comer of the form prov/ded that indicated "Site Diagram". 2. Print the name of your business, as shown in your HMMP, on the top of the ':.~ :3. Label the location of the hazardous materials and identify them by name and type of hazard (ie. Flammable liquid, corrosive solid). 4. Label the location of utility shutoff points for gas, electric and water services. 5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic spdnlder systems. 7. Label the direction representing north on the diagram. (The diasram form provided includes a north arrow). Map labelin8 must b~e iel~and easily Unde~tandable. Try to the use of'abbreviation~ or~'~'~. symbols. If you must use them, provide a lesend explainin8 your system. Maps may be returned for correction if you fail to follow thee instru~.ion. FACILITY DI~Gl~ I~$TRUCTION$ Facility diagrams are supplements to the site diagram. Use them to show the subdivision details ora larl~e business. 1. Check the box in the upper right hand comer of the form provided that indicated "Facility Diagram". 2. Print the na~e of your business as shown on your ttMMP. Print the name of the area that this map repre~mts. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled #1 of 4. 4. Follow instruction (3 -7) for site diagrams regarding the specific details to be - included on each facility diagram.. -. usiness Name: Bu~ine~ Addre~: Kenny Pourroy Purchasing Manager kenny @ hpsplumb/ng.com 401 34th Street Bakersfield, CA 93301 -.CA Lic. #793014 (661) 324-2121 Fax: (661) 322-5648