HomeMy WebLinkAboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This _oermit is issued for the following;
[] Hazardous Materials Plan
[] Underground Storage of Hazardous Materials
[] Risk Management Program
[3 Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002111
CAI,IFORNIA WATER
LOCATION CA
OFFICE OF ENVIRONMENTAL SER VICES' '- ' ' ~ NO~!
1715 Chester Ave., 3rd Floor Approved by:
Bakersfield, CA 93301 O~ceofE-v~ices'",d
Voice (661) 326-3979
FAX (661) 326-0576 Expiration Date: Jur~ 30; 2003
CITY OF BAKERSFIELd"
I trlR~ ~ OFFICE OF ENVIRONMENTAL SERVICES
t/1~)lR rM~J~rr 1715 Chester Ave., Bakersfield, CA (661) 326-3979
. HA.ZARDOUS MATERIALS T 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.
$. You may also attach Business Owner / Operator Form and Chemical Description Form(s)
to the front of this plan instead of completing SECTION I. below for initial submission.
· . SECTION I: BUSINESS IDENTIFICATION DATA
MAILING ADDRESS: :3.a.-/.~ ~o. ~4
CITY: ~.~.-~.~.~A STATE: c.~. ZIP: q33oq- PHONE:
OWNER: ~e~ e. PHONE:
MAILING ADDRESS:
EMERGENCY NOTIFICATION
CONTACT TITLE BUS. PHONE 24 HR. PHONE
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II. 1' DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORING PROCEDURES:
~.,-,_t,,. {~,..._; t;t-.7 ;> ,,,, o,,..'1~o , .,_ ,1 ~1,?,i..t 1~,1
B. EMPLOYEE AND AGENCY NOTIFICATION:
C. ENVIRONMENTAL RESPONSE MANAGEMENT:
7.4 t~-.
2
H~ARDOUS MATERIALS MANAG~ENT PLAN
SECTION II.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
Soft,..~ d, ni, o ~_kt~.,,~-~-,~ ,'.. ~-o.--.,t ,',,, ago..,.-
B. RELEASE CONTAINMENT AND/OR MITIGATION:
C. CLEAN-UP AND RECOVERY PROCEDURES:
UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATU1L~L GAS/PROPANE:
ELECTRICAL: $~_.-~,~,_ ~o-~ to~.~.~,~ ~,.~
WATER:
SPECIAL:
LOCK BOX: YES/~ IF YES, LOCATION: --'"--
PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION: -----
B. WATER AVAILABILITY (FIRE HYDRANT): 62,.-,_ -k..tlro..~4 ,,1- ~..,..-[t- ,~,~,.L,~-3e_t
0 ~
3
ItA~J~RDOUS MATERIALS MANAGEMENT PLAN
SECTION III: TRAINING
NUMBEROF EMPLOYEES: ~4o,,,-c. -
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
CERTIFICATION
I,.. ~[--{- .,,x.q~,~,.~ CERTIFY THAT THE ABOVE INFORMATION
IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY
CODE" ON f[AZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND
THAT INACCURATE INFORMATION CONSTITUTES PERJURY.
SIGNATURE TITLE DATE
4
~. ' ........,---- 'FICE OF ENVIRONMENTA~;ERVICES "' ":"'
'~~ ~15 Chester Ave., CA 93301 (66~ 326-3979 ~'~
FACILITY INFORMATION
Page Of
"" .. ., :.' !i:. I. FACILITY IDENTIFICATION
BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 ·BusINESS PHONE ....... 107
SITE ADDRESS lo3
DUN & ~06 SIC CODE
COUNTY I~ o. ~- ~,~
OWNER MAILING
,',v: ENVIRON MENTALCONTACT/ ;i)' ~:;? ;i,
~? CONTACT PHONE -
CONTACT NAME ~, ~ o_ ~o ~..~ ~ ~
CONTACT MAILING
ADDRESS
CITY ~ , STATE ~ tz~ ZIP
' 130
BUSINESS PHONE (~ ~. 3 ~ G Z ~ O O ,26 BUSINESS PHONE ~_~}___~_~_~)_~_L ............................. ~3'
24-HOUR PHONE 5 ~ ~ ~ ~2~ 24-HOUR PHONE ~&~ ~ ...............................
PAGER ~ ~ ~28 PAGER ~ ~
Cerli~calion: Based on my inqul~ of those individuals responsible for obtaining the information, I ~di~ under penal~ of law that I have personally examined
and am familiartwith the info~aflon submitted in this Invento~ and believe the information is tree, a~urate, and ~mplete.
UPCF (7~99) S:\CUPAFORMS\OES2730.TV4.wpd
CITY OF BAKERSFI~D
OFFICE OF ENVIRONMENTA~'SERVICES
1715 Chester'Ave., CA 93301 (661) 326-3979 ~ '
'~""'~'""'~'" HAZARDOUS MATERIALS INVENTORY
'. CHEMICAL DESCRIPTION
: '* (one form per matedal per budding or area)
]~NEW r-I ADD r'l DELETE I"l REVISE 200 , Page ~ of __
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BUSINESS ~ME (~e ~ FACIU~ ~ ~ O~ - ~ng Bu~n~ ~) ~ '
CIIEMI~L LO~TION ~d CHEMI~L LO~TION n. ~
L
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~ [ ~OESECRET ~V~ ~No 206
CHEMI~L ~ME - '
M~Nm~ ' , EHS* , ~Y~ ~No ~8
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FIRE CODE h-~D C~SSES (~pl~e If ~t~ by ~ r~e
2~0
~PE ~ p PURE ~ m MITRE ~ w WASTE 211 ~DIOACT~' ~ Y~ ~ ~ 212 ~ CURIES~ 21~
PHYSI~L STA~ ~ I SOLID ~1 LIQUID ~ g ~S 214 ~R~ST CO~AINER 215
~EO~RD~XE~mES ~ ~ mae ~2 ~m~ ~a P~SSU~L~SE ~4 AC~ H~L~ ~s CHRONiCH~LTH
ANNUAL WAS~ ~/~ 217 I ~I~M 216 A~ 2,9 I STA~.WASTE CODE 220
. uNffs' ~ ga ~u ~ ~ cu~ ~ th Les, ~ ~'TONs 22~ I oaYsONs,T[ '
' ~ EHs. ~.~ must ~ I. ~. : ' · [ ~ ~ ~ ......
~TO~GE cO~AINER
(Checka~that~) ~ A~VEGROUNDT~K ~e P~STI~NM~LICDRUM ~1 FIBERDRUM ~m G~SBO~LE ~q ~IL~ 223
~ b UNDERGROUND TANK ~ f ~N ~ J ~G ~ n P~S~C BO~LE ~ r OTHER
~ c T~K INSIDE BUILDING ~ g ~Y" ~ k BOX ~ o TOTE B~N
~ d S~EL DRUM ~ h SILO ~ I C~INDER ~ p TANK WA~N
STOOGE PRESSURE ~ · A~IE~ ~ ~ ~VE A~IE~ ~ ba BELOW A~IENT 224
STOOGE TE~TURE ~ a A~IE~ ~ ~ A~VE A~IE~- ~ ba BELOW A~IE~ ~ c CRYOGENIC 225
~ 226 ~7 ~ Y~ ~ No 228
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229
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2 I 230 = 231 D Y~ ~ ~ 232 233
4 I ~6 . 239 ~ Y~ D NO 240 241
~ Y~ ~ No 244
· . .,.,~.~?;~. ~. ~ ~ ,~.~,~,:~;.~,;~,, ~ ?.~[: ~....~. ,.,;~ . '~:~'.?- ~ '~'
pRINT NA~ & TI~E OF A~OR~D ~MPA~ REPRESE~A~E SIG~TU~ ~ ' / DATE 246
UPCF (7~99) S:\CUPAFORMS\OES2731.TV4,wpd
Business Name:
Business Address: