The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN .1 [2] '~- i ~(~T ,,, < t4 KERN COUNTY FIRE DEPARTMENT ~ BAKERSFIELO, CA 93808 (805) 861-2761 9~ KCFD HMCU ooa [ BUSINESS ~ DO SOT ~RITE gBOVE THIS LISE '' H~Z~RDOHS M~TERI ~LS BUS I NESS PLAN '~' FORM ~A INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for your business as a whole. 4. Be as brief and concise as possible. But explain fully. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: 7-Eleven Food Store 2720-13936 B. PHYSICAL LOCATION/STREET ADDRESS: 3760 Bernard St. CITY: Bakersfield ZIP: 93306 BUS.PHONE: (805) 871-0377 C. MAILING ADDRESS: See Above. B. CITY: ! ZIP: BUS. PHONE: ( ), SECTION 2: EMERGENCY NOTIFICATIONS In cas~ 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. EMPLOYEE'S WHO SHOULD BE NOTIFIED IN CASE OF EMERGENCY: N'AME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. Harry Singh Ph# 805,./871-0377 Ph# 805/871-O377 B. David Taylor Ph# 805/834-2711 Ph# 805/324-9330 SECTION 3: LOCATION OF UTILITY SBUT-0FFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: None B. ELECTRICAL: Backroom Hallway C. WATER: Store Front/Side O. SPECIAL: 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 OVER SECTION 4: PRIVATE RESPONSE TEAM FOR ~USINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE Bakersfield Memorial Hospital 420 34th St. Bakersfield, CA 805/327-1792 .. ~ , . SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGP~ WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER C. PROPER USE OF SAFETY EQUIPMENT: .................. NO YES D. EMERGENCY EVACUATION PROCEDURES: ................. YES E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES I, ~r~--~i-m~h~b~C~-l-~4cc~v_., 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. SJGNATU ~~ct TITLE F-ranc,hi-see- DATE l'2_- k--~ HMCU-4 KERN COUNTY FIRE DEPARTNENT " 5642 VICTOR STREET BAKERSFIELD, CA 93308 OFFICIAL USE ONLY ID# BUSINESS NAME: 7-Eleven Food Store #13936 BUS I NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1, To avoid further action, this form must be returned by: 2. TYPE/PRI~'T YOUR ANSWERS IN ENGLISH. 3. Answer the questions be]ow for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT NAME: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES PREVENTIO.¥ - Training of all store operators completed regarding use of equipment and proper procedures pertaining to the handling of l~.azardous materi'als. MSDS sheets available for all persons to review. MITIGATION - Procedures in response to a release or t!lreatened release of a hazardous materials will be handled by T.Se Southland Corporation upon notification by the Emergency Coordinator. SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY The Emergency Coordinator shall implement procedures for the safety of all persons and the environment. Notification will be completed by the Emergency Coordinator, as instructed. HMCU-6 SECTION 3: HAZARDOUS NATERIALS FOR THIS UNIT 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 as defined by Section 6254.7 of the Government Code? ......... 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 on form 4A-2. SECTION 4: PRIVATE FIRE PROTgCTION 1. Fire extinguishers located at the facility. 2. Call 911 or (805) 861-2577. SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY ENERGENCY RBSPONDERS SECTION 6: LOCATION OF UTILITY S[IUT-OI~S AT TI~IS UNIT ONLY. A. NAT. GAS/PROPANE: None B. ELECTRICAL: Office - Northwest corner C. WATER: Store front/side 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 RNCU-6 KERN COUNTY FIRE DEPARTMENT I.D. # FORM 4A-I page~ of~' NON-- TRADIZ; S I~CR~-TS HAZARDOUS I~IATER I ALS INVENTORY BUSINESS NAME: 7-Eleven Food Store ~/2720-]~'3~36 O#NER NAME: The Southland Corporation PACILITY UNIT ~: ADDRESS: 3760 Bernard Street ADDRESS: 4U08 White Lane FACILITY UNIT NAME: CITY, ZIP: Bakersfield CiTY,ZIP: ~akersfieid 93309 _ PHONE ,: (~O5~87]-0377 PHONE ,: (805)834-2711 ]OFFICIAL USE CFIRS COD.E ,ONI. V ] 2 3 4 5 6 7 8 9 10 TYPE MA)[ ANNUAL CONT USE LOCATION IN .THIS · BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CO. DE CODE FAC.ILITY UNIT YT. ,,,.CHEMICAL OR COMMON N.ANE CODE GUIDE M -~ Ft 3 04 99 Sales Counter 100 CO2/Carbnn n~×~ NFLO 1013 NAME Steven S. Jones TITLE: Market Manager SI6NATURE:~ DATE: EMERGENCY ~CONTACTi. Harry Sin_~h TITLE: PHONE ~ BI S:__~805)87 .... ~. AFTER MRS: ~NERGENCY CONTACT: David Taylor ~: TITLE: Field Consultant PHONE # BUS HOURS: (805)834-27]] PRINCIPAL BUSINESS ACTIVITY: Convenience store w~rh ,q~lF-~r~ ...... ~ AFTER BUS HRS: .. ' C )UNTY THOMAS P. McCARTHY IF l! R }E DIE IPA\ IRT ~! IEN T ~,~,~,v~ SCHUYLER T. WALLACE 5642 Victor Stree-t Bakersfield, California93308 OPERATIONS DEPUTY CHIEFS DANIEL G. CLARK CHARLES E. DOWDY HAZARDOUS MATERIALS BUREAU CHARLES A. VALENZUELA (805) 861-276;l ADMINISTRATIVE SERVICES OFFICER (800) 322-0722 Ext. 2761 NORMAN R. BRIGGS Checked By Sent : Dear Business Owner: Due : The business plan you filed with the Kern County Fire Department is being returned to you for the following reasons: Form 2A not returned Fqc/Ptity Diagram: /x~missingW __Form 2A not complete __incomplete Form 3A not returned Site Diagram: missing __Form 3A not complete __incomplete /~nventory Sheet(s) not returned __Inventory Sheet(s) not complete Comments: PLEASE RETURN TIII$ lq)Rll ALONG #ITll TIlE CORRECTED BUSINESS PLAN BY ( Very truly yours, THOMAS P. McCARTHY Hazardous Materials Bureau 'ttl~-"' GW/jb ID# Protectint~ The Go/den Empire I HA~DOUS ~I2~TE R I ~r~$~ L~I~EAU l NSPECTI ON INSPECTION S~RY: ~UAL INSPECTION ~ EXEMPTION RE-INSPECTION COMPLAINT ALL ITEMS OK: [ ~] VIOLATIONS NOTED: [ ] 0 - Does not Apply 1 - In Compliance 2 - Correction Needed 3 - Verbally Warned 4 - N.O.V 5 - Citation 6 - Referred to (Specify) EMERGENCY PROCEDURES (CCR TITLE 19-2729 & 31) PREVENTION & CLEANUP PROCEDURES (CCR TITLE 19-2731 A. Agency Notification Plan (O.E.S., PD) ,~ L. Work Area Safety B. Employee Notification & Evac. Plan ( M. Clean-up Materials placement/availability C. Emergency Responder Notification --L N. Clean-up Equipment D. Medical Assistance ~ O. Fire Protection Systems / E. Private Response Team Procedures ('~ P. Waste Handling & Storage Q. Availability of Protective Equipment TRAININO REQUIREMENTS (CCR TITLE 19-2732) INV. & DIAGRAM VERIFICATION (CCR TITLE 19-2729) F. Training Records ~ R. Inventory Quantities O. MSDS Available to Employees --~ S. Storage, Container Cond., & Labeling H. Employees Famlllar with MSDS ~ T. Location in Facility Unit -~- I. Use of Personal Protective Equipment I U. Emergency Water Supply ! J. Waste Material Permits & License ~ V. Evacuation Plan & Area K. Employees familiar with evacuation W. Surrounding Exposures { plan. I X. Utility Shut-offs Y. Other Comments: A~/-J_~ t -i~/~l~ -- (~)[~_ -- ~- t~J'C~ ~-A~D'~ ~' ._~','~2..~' / Clearance 0ranted [ ~/~ Re-Inspection Required [ ] on__/ / D.E. Started I~ : ~-L~ Completed P : (~'~ Total Time~: [ ~'~ Mlles on Insp Inspector ~ Owner/Manager HMCU 14 ' " ~DOUS I~L~T E R I .Ar - $ ~ LrI~E AU INSPECTION S~RY: ~UAL INSPECTION ~ EXEMPTION RE-INSPECTION COMPLAINT ALL ITEMS OK: [ ~ VIOLATIONS NOTED: [ 0 - Does not Apply 1 - In Cospltance 2 - Correction Needed 3 - Verbally ~arned 4 - N.O.V 5 - Citation 6 - Referred to (Specify) EMERGENCY PROCEDURES (CCR TITLE 19-2729 & 31) PREVENTION & CLEANUP PROCEDURES (CCR TITLE 19-2731 A. Agency Notification Plan (O.E.S., FD) I L. Work Area Safety B. Employee Notification & Evac. Plan~ t M. Clean-up Materials placement/availability C. Emergency Responder Notification I N. Clean-up Equipment D. Medlcal Assistance -7-- O, Fire Protectt'on Systems g. Private Response Team Procedures /~ P. Waste Handling & Storage Q. Availability of Protective Equipment / TRAINING REQUIREMENTS (CCR TITLE 19-2732) INV. & DIA61~ VERIFICATION (CCR TITLE 19-2729) F. Training Records ~ R. Inventory Quantities G. MSDS Available to Employees ~ S. Storage, Container Cond., & Labeling H. Employees Familiar with MSD$ ~ T. Location In Facility Unit I. Use of Personal Protective Equipment I U. Emergency Water Supply J. Waste Material Permits & License ~ V. Evacuation Plan & Area K. Employees familiar with evacuation W. Surrounding Exposures plan. { X. Utility Shut-offs Y. Other Comments: A'LC~ [~t'4~t~,(~'~ (~ ~ I~}0 (~.A~Ot~d~ ~A~ Clearance Granted [ b~ Re:inspection Required [ ] on / / D.E. / Started [~ : ~'~) Completed ~ : ~-' Total Ttme~: ~" Mlles on Insp. CD Inspector , Owner/Manager HMCU '14 KERN COUNTY FIRE DEPARTMENT 5642 VICTOR STREET. BAKERSFIELD, CA 93308 BUSINESS NA~E INSPECTOR QUEST, IONNAIRE BUS! NESS PLAI~ AS A ~rI~OLE FOR USE WITH THOSE BUSINESSES CO~iPLETING A BUSINESS PLAN (2A). INSTRUCTIONS: 1. Complete this form only once for each occupancy. 2. Attach this form to BUSINESS PLAN (2A) and forward to Data Entry. BUSINESS PLAN VERIFIED 0N: I / [Jo / ~ SECTION 1: RESPONSE SUMMARY (Limit to 4-5 lines) SECTION 2: NOTIFICATION / EVACUATION OF AFFECTED PUBLIC (Limit to 13 lines) H~CU:5_ BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 [~ECEIVEB (805~326-3979 [ JUL 1 1987 Ans'd ............ 0FFICL~L USE 0NLY BUSINESS NAME HAZARDOUS MATERI ALS 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 whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: 7-Eleven Food Store #2125-139~ B. LOCATION / STREET ADDRESS: 3760 Bernard Street CITY: Bakersfield ZIP: 93306 BUS.PHONE: (805) 871-0377 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 uotify your local fire department and the State 0ffice of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. Harkirat Singh, Franchisee Ph~ (805)871-0377 Ph~ (805)871-0377 B. Kathy Mejia, District Manager 2125 Ph~ (805)834-2711 Ph~ (805)834-2711 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: None B. ELECTRICAL: Back Room Office C. WATER: Outside - front D. SPECIAL: 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 TEA~ FOR BUSINESS AS A ~g{OLE Emergency' Coordinator (pre-determined) shall notify all agencies and inter- company persons in the event of incident. Emergency Coordinator shall implement all necessary measures ±n regard to employee/environmental safety as instructed ,.b~'~raining received. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE Police/Fire Department: 911 Nearest E.R. to location is to be used in the event of injury. 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:...' .................................... 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 ?: HAZARDOUS )~ATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDs OF A SOLID, S5 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I, Harkirat Singh , 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 ~,(.~,(~t(~-'~,!~c~t'C~: ~t~ TITLE Franchisee DATE -7, ~', ~',7 - 2B - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFiC~AL USE ONLY ID# BUSINESS NAME: BUSI 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.' ...... ~ ....................... FACILITY UNIT~ FACILITY UNIT SECTION 1: MITIGATION, PREVENTION, ABATEMEN'r PROCEDbqRES . SECTION 2: NOTIFICATION ~\~D EVACUATION PROCEDURES AT THIS LA'IT ONLY I~AKERSFIEI, D CITY FIRE DEPARTMENT I.D. {e FORM 44-1 Page 1 of 1 NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BDSINESS NAME: 7-Eleuen~Food Store #2125-13936 OWNER NAME: The Southland Corpor. a~ion FACILITY UNIT #: 100 ADDRESS: 3760 Bernard Street ADDRESS: 1240 S. State College B]vFACILITY UNIT NAME: CITY, ZIP: Bakersfield 93306 CITY,ZIP: Anaheim 92806 PIIONE *:_(805) 871-0377 PHONE *: (714) 635-7711 IOFFICIAL USE CF~R'S COOE I ONLY 1 2 3 4 5 6 7 8~ 9' 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS 9; BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT:CODE CODE FACILITY UNIT WT. CHEMIC, AL OR C,QMMON NAME .CODE~ GUIDE (for carbo.atio M ~ Ft3 04 99 Near Sales Counter 100 CO2/Carbon ~ioxide of post mix) NFLG 10i3 NAME Kathy Mejia TITLE: District Manager SIGNATURE: DATE: EMERGENCY CONTACT: Harkirat Singh TITLE: Franchisee PHONE # BUS HOURS:(805)871-0377 AFTER BUS HRS: '(805)871-0377 EMERGENCY CONTACT: Kathy Me~ia TITLE: District Manager PHONE # BUS HOURS:~805)834-27]l PRINCIPAL BUSINESS ACTIVITY: Convenience stoce AFTER BUS HRS: (805)834-271]. - 4A-1 -