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Home My WebLink AboutBUSINESS PLANCAL WATER SRVC CO ~sTa ass-o~~ 141 BLISS STREET TA :T CALIFORNIA WATER SRV 159-O1 Manager TIM TRELOAR Location: 141 BLISS ST City BAKERSFIELD SiteID: 015-021-001948 BusPhone: (661) 837-7200 Map 103 CommHaz High Grid: 32C FacUnits: 1 AOV: CommCode: BFD STA 06 EPA Numb: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact / Title TIM TRELOAR / DISTRICT MGR RUDY VALLES / ASST DIST MGR Business Phone: (661) 837-7200x Business Phone: (661) 837-7271x 24-Hour Phone (661) 837-7200x 24-Hour Phone (661) 837-7271x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact BILL ROSICA Phone: (661) 837-7278x MailAddr: 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 837-7200x Address 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Based on my inquiry of those individuals ~uppgfsspa~ @y p,y~ ~ ~ ~AO~ J V L C~~1 i U U responsible for ob":wining tr,e information, Irertify e . under penalty of Saw that l have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~~~ ~7 /~ a~ ature 0~ -1- 07/10/2007 ~. F CALIFORNIA WATER SRV 159-01 SiteID: 015-021-001948 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpeCHaz EPA Hazards Frm DailyMax Unit MCP SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi -2- 07/10/2007 -3- 07/10/2007 C ' F CALIFORNIA WATER SRV 159-O1 ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Location within this Facility Unit FENCED ENCL NEXT TO PUMP STATE TYPE PRESSURE Liquid TMixture T Ambient SiteID: 015-021-001948 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7681-52-9 TEMPERATURE CONTAINER TYPE Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAL ru~c,HxLV U ~ ~:viYirvlV ~lv 1 %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 ria'~GS-~KL A~.71",.7~1~1L";1V'1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -4- 07/10/2007 F CALIFORNIA WATER SRV 159-01 SiteID: 015-021-001948 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/16/2006 ~ CALL 911 AND 800-852-7550 OR 916-427-341. ,_ r.lll~J1V~/CC 1VVl.1L / LiVdl:Udl.1V11 Public Notif./Evacuation 05/16/2006 WE WOULD PREFER TO RELY ON EMERGENCY SERVICES PERSONNEL TO DETERMINE IF AN EVACUATION IS NECESSARY. HOWEVER, WE WILL EVACUATE THE AFFECTED LOCAL POPULATION, AS NECESSARY, IF EMERGENCY SERVICES PERSONNEL ARE NOT AVAILABLE. Emergency Medical Plan 08/01/2006 MERCY HOSPITAL. -5- 07/10/2007 ;. -, F CALIFORNIA WATER SRV 159-O1 SiteID: 015-021-001948 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/16/2006 ~ SODIUM HYPOCHLORITE IS STORED IN AN ABOVEGROUND SECURE AREA. Release Containment 04/30/1999 THE SODIUM HYPOCHLORITE IS SECONDARILY CONTAINED. 1, l C 0111 ll~J Other Resource Activation -6- 07/10/2007 ~, `s F CALIFORNIA WATER SRV 159-O1 SiteID: 015-021-001948 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .~Nv~1.a.L nc~c~aiu~ Utility Shut-Offs 05/16/2006 A) GAS - N/A B) ELECTRICAL - SERVICE BOX INSIDE FAC C) WATER - N/A D) SPECIAL - N/A E) LOCK BOX - NO Fire Protec./Avail. Water 10/18/2006 FIRE HYDRANT - WELL DISCHARGE. Building Occupancy Level 05/16/2006 UNMANNED SITE -7- 07/10/2007 ,, ... ti F CALIFORNIA WATER SRV 159-O1 SiteID: 015-021-001948 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/26/2007 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: CALIFORNIA WATER SERVICE CO PROVIDED THE FOLLOWING TRAINING: SAFETY PROCEDURES IN THE EVENT OF A HAZARDOUS MATERIALS RELEASE OR THREATENED RELEASE; HAZARD COMMUNICATION STANDARD; EVACUATION PROCEDURES; PROPER HANDLING OF HAZARDOUS MATERIALS; AND HMMP IMPLEMENTATION. rayC ~ nciu tvi rul. uJ:C 1150 aaclu tvt r ul. uJ_C 1.1.7"C -8- 07/10/2007 ~~. :r CALIFORNIA WATER SRV 159-01 SiteID: 015-021-00194$ Manager :. TIM TRELOAR Location: 141 BLISS ST City BAKERSFIELD BusPhone: (661) 837-7200 Map 103 CommHaz High Grid: 32C FacUnits: 1 AOV: CommCode: BFD STA 06 EPA Numb: SIC Code:4941 DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact / Title TIM TRELOAR / DISTRICT MGR RUDY VALLES / ASST DIST MGFt Business Phone: (661) 837-7200x Business Phone: (661) 837-7271x 24-Hour Phone (661) 837-7200x 24-Hour Phone (661) 837-7271x Pager Phone ( ) - x -Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact BILL ROSICA Phone: (661) 837-7278x MailAddr: 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 3-°5 '~~ Address 3725 S H ST State: CA f337~7200 City BAKERSFIELD Zip 93304 Period to TotalA5Ts: = Coal Preparers TotalUSTs: = Kral Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK ENT'D ~~~ 2 3 2007 Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~'~~ Z 6 G Si ture pa~® -1- O1/29/~007 F CALIFORNIA WATER SRV 159-O1 SiteID: 015-021-00194 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Sitr~ ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit Nt~P SODIUM HYPOCHLORITE ~ F P IH L 2.00.00 GAL Hi -2- O1/29/~b07 F CALIFORNIA WATER SRV 159-01 SiteID: 015-021-00194$ ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit 1~~P SODIUM HYPOCHLORITE ~ F P IH L 2.00.00 GAL ~i -2- O1/29/~007 -3- Ol/29/~d07 ~. ,~ F CALIFORNIA WATER SRV 159-01 ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Location within this Facility Unit FENCED ENCL NEXT TO PUMP STATE TYPE ~ PRESSURE Liquid TMixture I Ambient SiteID: 015-021-00194 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7681-52-9 TEMPERATURE CONTAINER TYPE Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 200.00 GAS - t1AGH.tCLVU~ 1:V1~1rVlvl'~1v'1'S %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 riAL,HKL A~~L'~571~lL'~1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F P IH / / / Hi -4- 01/29/2007 ~1 F CALIFORNIA WATER SRV 159-01 SiteID: 015-021-00194$ ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/16/2075 ~ CALL 911 AND 800-852-7550 OR 916-427-341. ~mpioyee Nozii.~~vacuaLion Public Notif./Evacuation 05/16/2016 WE WOULD PREFER TO RELY ON EMERGENCY SERVICES PERSONNEL TO DETERMINE IF AN EVACUATION IS NECESSARY. HOWEVER, WE WILL EVACUATE THE AFFECTED LOCAL POPULATION, AS NECESSARY, IF EMERGENCY SERVICES PERSONNEL ARE NOT AVAILABLE. Emergency Medical Plan 08/O1/20E75. MERCY HOSPITAL. -5- O1/29/Z007 F ~ F CALIFORNIA WATER SRV 159-01 SiteID: 015-021-0019~~ ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/16/20n6 ~ SODIUM HYPOCHLORITE IS STORED IN AN ABOVEGROUND SECURE AREA. Release Containment 04/30/1939 THE SODIUM HYPOCHLORITE IS SECONDARILY CONTAINED. l.icall v~ ~_ v l.lict iZC.7VUl 1.C 1"11:L1VGLL1V11 -6- O1/29/~007 F CALIFORNIA WATER SRV 159-O1 SiteID: 015-021-00194$ ~ Fast Format ~ ~ Site Emergency Factors Overall Sites ~ ~7~/Cl.:l cl1 na~cLl.u~ Utility Shut-Offs 05/16/2005 A) GAS - N/A B) ELECTRICAL - SERVICE BOX INSIDE FAC C) WATER - N/A D) SPECIAL - N/A E) LOCK BOX - NO Fire Protec./Avail. Water 10/18/2005 FIRE HYDRANT - WELL DISCHARGE. Building Occupancy Level 05/16/20015 UNMANNED SITE -7- Ol/29/~007 ~. F CALIFORNIA WATER SRV 159-01 SiteID: 015-021-0019~~ ~ Fast Form~:t ~ ~ Training Overall Sits ~ ~ Employee Training 05/16/20E~~5 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: CALIFORNIA WATER SERVICE CO PROVIDED THE FOLLOWING TRAINING: 1. SAFETY PROCEDURES IN THE EVENT OF A HAZARDOUS MATERIALS RELEASE OR THREATENED RELEASE. 2. HAZARD COMMUNICATION STANDARD. 3. EVACUATION PROCEDURES. 4. PROPER .HANDLING OF HAZARDOUS MATERIALS. 5. HMMP IMPLEMENTATION. rage ~ Held for Future Use nciu iui ru~uic u5C -8- O1/29/~007 ' Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST R F R s e , n 90o Truxtun Ave., suite 210 u .__ ,: ~.~.~ .:.~_ ...:w.... ..,,~._~~ _ FIRE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program aRrM r Tel.: (661) 326-3979 _ Fax: (661) 872-2171 C V ~ C=Compliance OPERATION V=Violation COMMENTS .i~ ^ APPROPRIATE PERMIT ON HAND C1~ ^ BUSIneSS PLAN CONTACT INFORMATION ACCURAT~N~~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1" In /Shift of Site/Station # Business Site /Responsible Party (Please Print) ^ YES ~NO - White -Prevention Services Yellow -Station Copy Pink -Business Copy - FD 2155 (Rev. 09/05 - - - - _ ..Section 1; Business P)an and Inventory Program __ ~~~ OUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION rf - `ti + CALIFORNIA WATER SRV 159-01 _________________________ SiteID: 015-021-001948 + Manager BusPhone : ( 6 61) . "~~4-6~6 Location: 141 BLISS ST Map 103 CommHaz High City BAKERSFIELD Grid: 32C FacUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:4941 EPA Numb: DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact. / Title TIM TRELOAR j DISTRICT MGR ~~'t~~ ~dl~~s / ASST DIST MGR Business Phone : ( 6 61) ~~~6--~~t~37-'~~o Business Phone : ( 6 61) -3~fi--~~0~0 x cG,37~7 7 ~ 24-Hour Phone (661) -""'~ 2" ^^~_~'37-7~~ 24-Hour Phone (661) 3A~-= 1ro0~~37-T T~ Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact ~~~ ~oSiC~ ------------------------------------- Phone: (661) _ _ _ __ ___ MailAddr: 3725 S H ST State: CA 837-7Z7~ City BAKERSFIELD Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) 396-2400x Address 3725 S H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~~~ PROG A - HAZMAT l ~' ~/ ENT PROG T - ABOVEGROUND STORAGE TANK ® U A~~ 012p~ 6 Based on my inquiry of those individuals responsible for obtaining the information, I certify .~~/ under penalty of law that I have personally ~l examined and am familiar with the information submitted and believe the information is true, accurate, and complete. S~ L 2 ature Dat ~a ~~;~~ -1- 05./16/2006 Hazardous Materials/Hazardous WaSte unified Permit .. CONDITIONS OF,,P.ERMIT ON REVERSE SIDE ' - ·. This oermit is issued for the followino_: EI ~.~,~rdous M~terlal~ Plan 13 Underground Storage of Hazardous Materials Permit ID #:: 015-000-001948 [] Risk Management Program CALIFORNIA WATER SERV ~ Hazardous Waste On-Site Treatment LOCATION: 141 BLISS ST Issued by: Bakersfield Fire Department ., OFFICE OF ENVIR ONMENT~tL SER VICES' ~ ,~ · 1715 Chester Ave., 3rd Floor Approved by: (~ RalpllrHuey, D~~i Issue Date Voice · {661) 326-3979 FAX {661)326-0576 ~. Expiration Date: CALIFORNIA WATER ~STA159 SiteID: 015-021-001948 + Manager : ~ BusPhone: (661) 396-2400 ocation: 141 BLISS ST ~,~_ Map : 103 CommHaz : Moderate C ~ Grid: 32B FacUnits: 1 AOV: ity BAKERSFIELD CommCode: BAKERSFIELD STATION 06 SIC Code:4941 EPA Numb: DunnBrad:00-691-3578 + Emergency Contact / Title Emergency Contact / Title 5~'uLa~I~qBYRD ------/ DISTRICT MGR'" 'rim TK~EL-f)AR / ASST~T ~T~T MGR Business Phone: (661) 396-2400x Business Phone: (661) 396-2400x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : M~aViN sX~o Phone: (661) 396-2400x MailAddr: 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Owner CALIFORNIA WATER SERVICE COMPANY Phone: (661) 396-2400x Address : 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 c Period : to TotalASTs: = GalI Preparer TotalUSTs: = Gal ertif'd RSs: No arcelNo Emergency Directives: District Manager-Tim Treloar Asst. District Manager-Bill Harper Contact Person-Tamara Johnson Same Phone Numbers 1 07/30/2003 CALIFORNIA WATER SERV CO STA159 SiteID: 015-021-001948 Manager : MEL BYRD BusPhone: (661) 396-2400 Location: 141 BLISS ST Map : 103 CommHaz : Moderate City : BAKERSFIELD Grid: 32B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:4941 EPA Numb: DunnBrad:00-69123578 Emergency Contact / Title Emergency Contact / Title MELVIN BYRD / DISTRICT MGR TIM TRELOAR / ASSIST DIST MGR Business Phone: (661) 396-2400x Business Phone: (661) 396-2400x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : MELVIN BYRD Phone: (661) 396-2400x MailAddr: 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Owner CALIFORNIA WATER SERVICE COMPANY Phone: (661) 396-2400x Address : 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory One Unified List --As Designated Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax Unit MC~ CHLORINE F P IH L 200.00 GAL Ext ~y~ or'pd~t ~) reviewed ~hs a~ached h~ardous mmefials ma~'~age- mere plan for c ~ ~ and ~ha~ i~ alo~ wi~h (Na~ of any corrs~ions cons'~i~u~s a ~mple~s and corrsc~ man- agemen~ plan ;or my ~acili~. -1- 07/19/2000 CALIFORNIA WATER SERV CO STA159 SiteID: 015-021-001948 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site CHLORINE Days On Site SODIUM HYPOCHLORITE 12.5% 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7882-50-5 Liquid I. Pure . Above. Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 200.00 GAL 200.00 GAL 200.00 GAL ' HAZARDOUS COMPONENTS %Wt. ~S CAS# 12.50 Sodium Hypochlorite N 7681529 HAZARD ASSESSMENTS TSecret RIRSIBioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No~ No No/ Curies F P IH / / / Ext -2- 07/19/2000 F CALIFORNIA WATER SERV CO STA159 SiteID: 015-021-001948 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 04/30/1999 CALL 911 AND (800) 852-7550 OR (916) 427-341. -- Employee Notif./Evacuation 04/30/1999 N/A - Z/NMANNED SITE. -- Public Notif./Evacuation 04/30/1999 WE WOULD PREFER TO RELY ON EMERGENCY SERVICES PERSONNEL TO DETERMINE IF AN EVACUATION IS NECESSARY. HOWEVER, WE WILL EVACUATE THE AFFECTED LOCAL POPULATION AS NECESSARY, IF EMERGENCY SERVICES PERSONNEL ARE NOT AVAILABLE. Emergency Medical Plan 04/30/1999 MEDICAL ASSISTANCE WOULD BE PROVIDED BY MERCY HOSPITAL. -3- 07/19/2000 F CALIFORNIA WATER SERV CO STA159 SiteID:· 015-021-001948 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 04/30/1999 SODIUM HYPOCHLORITE IS STORED IN AN ABOVE GROUND SECURE AREA. -- Release Containment 04/30/1999 THE SODIUM HYPOCHLORITE IS SECONDARILY CONTAINED. Clean Up Other Resource Activation -4- 07/19/2000 F CALIFORNIA WATER SERV CO STA159 SiteID: 015-021-001948 ~-- Fast Format F Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 04/30/1999 A) GAS - N/A B) ELECTRICAL - SERVICE BOX LOCATED INSIDE FACILITY C) WATER - N/A D) SPECIAL - N/A E) LOCK BOX - NO -- Fire Protec./Avail. Water 04/30/1999 PRIVATE FIRE PROTECTION - ????????? NEAREST FIRE HYDRANT - ON SITE WELL DISCHARGE. Building Occupancy Level -5- 07/19/2000 CALIFORNIA WATER SERV CO STA159, SiteID: 015-'021-001948 Fast Format = Training Overall Site -- Employee Training 04/30/1999 WE HAVE NO EMPLOYEES AT THIS FACILITY IT IS AN I/NMANNED SITE. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TP~AINING PROGRAM: CALIFORNIA WATER SERVICE COMPANY PROVIDED THE FOLLOWING TRAINING: 1. SAFETY PROCEDURES IN THE EVENT OF A HAZARDOUS MATERIALS RELEASE OR THREATENED RELEASE. 2. HAZARD COMMUNICATION STANDARD. 3. EVACUATION PROCEDURES. 4. PROPER HANDLING OF HAZARDOUS MATERIALS. 5. HMMP IMPLEMENTATION. -- Page 2 I --Held for Future Use Held for Future Use -6- 07/19/2000 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA-tS~s~26-3939. INSTRUCTIONS: 1. To avoid further action, retum'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 brie£and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA LOCATION: I '~ I i~ ~_v~'~ ,a, ~ ~ I ~__..~, ~~G ~D~SS: D~ & B~ST~ET ~ER: P~Y ACTIVITY: OWNER: ~/', ~"~ MAILING ADDRESS: ~'~ ~-- SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAININO NUMBER OF EMPLOYEES: N MATERIAL SAFETY DATA SHEETS ON FILE: SECTION 4: EXEMPTION REOUEST I CERTIFY UNDER PENALTY OF PEPJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER. 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWINO REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, J~l ~,,~ J--J ¢ CERTIFY THAT THE ABOVE ~O~T~ON ~S ACCtm~TE. I UZ',raE~,ST,~',ID THaT THZS rN~O~V~TtON W~t,.BE USED TO ~Ut,~ILL MY ~n~aw s OBLIOATtONS tn'~E~ THE "C~O~ m~ ~ S~Tv co~r' ON ~~OUS ~t~S (gtV. ~0 C~~ ~.OS S~C. ~SS00 ~t ~.)'~ ~ ~ACC~t~ ~O~t~O~ CO~Stt~S ~~V. SIGNA~ ~E DA~ 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: D. EMERGENCY MEDICAL PLAN: HAZARDOUS MATERIALS MANAGEMENT PLAN .SECTION 7: MITIGATION, PREVENTIONAND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: ~ot>,~a~.~ ~'r~OCHL-C~- rr~_ B. RELEASE CONTAINMENT AND/OR MINIMIZATION: "T'~ ~o~J~,~ ~4',~woc~.o~ ,'~ C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: SPECIAL: [-4 LOCK Box: YES(~ tF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAIt,ABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): ~ta~ ~-~',r~.,~.,-r- -(~)t4 ~ rv~ \~t_,- 4 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCKIPTION CHECK IF BUSINESS IS A FARM [ ] SIC CODE Z~:~ZI } DUN & BKADSTREET NUMBER (~)C) - ~,~ I -- ~5'7~ EMERGENCY CONTACTS BUS.SS PHO~ ~ ~-~ O0 24 HO~ PHO~ u,j ot s MATm S Page t,,, of I ..... ~~ D~~ON I)~ORYSTA~S:N~A~[ ]~[ ]~1~[ ] C~kffch~isaNONT~~~T~~[ ] 2) c~ ~m~: ~X~l ~ ~ g~ ~Ca~gm~s F~[ ]R~cfive[ ]S[~Rel~of~[ ]~H~&(Am~)[ ]~H~(C~c)~ 5) WAS~ C~SS~CA~ON (3qi~t ~ ~m DHS 6) P~SIC~ SIA~ Sohd [ I Liqmd ~1 ~ [ I ~ ~1 ~ [ I W~ [ I ~~ [ 1 7) ~O~ ~ ~ AT FAC~ ~S OF ~~ 8) STOOGE COD~ ~mD~ly~omt ~ Lbs[ ]~lm[ ] Av~c Dmly ~omt 2~O Crees[ ] b)~: ~est S~e Con~ 2 ~ ~ ~ ~ on Site ~ C~le ~ch Mon~: ~ Y~, J, F, ~ & ~ J, J, & S, O, N, D 9) ~: List CO~~ C~ % · e ~ most h~o~ 1 ). [ ] ~y ~ ~~ 3) ,, [ ] [ ~ ~ORY STA~S: ~ew ~ ] Addition [ ] Revision [ ] ~le~on [ ] Ch~k ifch~ is a NON Trade S~ [ ] T~~[ ] Ch~i N~e: 4) Physi~l ~ H~I~ P~SIC~ ~ ' . 6)P~SIC~STA~ Solidi ] Liquid[ ]. O~[ ] ~[ ] ~[ ] W~[ ] ~~[ ] 7~ ~O~ ;LND ~ A'F FAC[~Y' L~S~A~ 8) STOOGE CODES M~m Daily ~omt ~ L~ Gal [ ] 1~3 [ ] a) Average Daily ~omt ~ ~ Crees [ ] b) ~: ~ml ~omt ~~ Lagest Size ~on~er ~ Days on Sit~ ~ Circle ~hch Monks: .~1 Ye~, J, F, M, A, M, J, J, & S, O, N, D " 9) ~: List CO~O~ C~ ~e ~ most ~~ 1 ) [ ] ~ ~~u J) [ I ~ m~ ~ of law. ~t I ~ve ~ly ~ ~4 m t~li~ ~ ~e ~fi~ m ~s ~d ~ ~ ~ I F~ Nm~ ~ rifle of Aum~ Comfy R~mUve . Si~