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Home My WebLink AboutBUSINESS PLANCAL WATER SRVC CO ~csK-ZS~ 11500 BRIMHALL ROAD CALIFORNIA WATER SRV CBK-29 Manager TIM TRELOAR Location:. 11500 BRIMHALL RD W/JEWETTA City BAKERSFIELD SiteID: 015-021-002117 BusPhone: (661) 837-7200 Map 101 CommHaz High Grid: 25D FacUnits: 1 AOV: CommCode: KCFD STA 67 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: RSs 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 Address 3725 S H ST City BAKERSFIELD Period to Preparers Certif'd: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Based on my inquiry of those individuals responsible for obtaininc the information, I certify under penalty of tav/ that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Si ture Date JjJ~ ~ ~ ~ ~~l Phone: (661) 837-7200x State: CA Zip 93304 TotalASTs: = Gal TotalUSTs: = Gal RSs: Yes -1- 07/10/2007 ~ '~ F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on 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 r i F CALIFORNIA WATER SRV CBK-29 ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Location within this Facility Unit FENCED ENCLOSURE NEXT TO PUMP STATE TYPE PRESSURE Liquid TMixtur~mbient SiteID: 015-021-002117 ~ Facility Unit: Fixed Containers on 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 t1AGHKLVUb 1.:V1~lYV1Vi;1V"1~ %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 ril-'~GHKL a'~~.7L"i551~1L'1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No Yes No No/ Curies F P IH j / / Hi -4- 07/10/2007 ~, F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 08/30/2000 ~ CALL 911. Employee Notif./Evacuation Public Notif./Evacuation 10/05/1992 EVACUATION OF THE LOCAL POPULATION TO BE DETERMINED BY EMERGENCY SERVICES PERSONNEL, UNLESS EVACUATION IS NECESSARY PRIOR TO THEIR ARRIVAL. Emergency Medical Plan MERCY HOSPITAL, TRUXTUN AVE. 08/01/2006 -5- 07/10/2007 F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 09/27/1994 ~ DIESEL IS STORED IN AN ABOVEGROUND CONVAULT TANK. Release Containment 10/19/2006 IF AN ABOVEGROUND CONVAULT TANK WERE TO START LEAKING, ARRANGEMENTS WOULD BE MADE TO IMMEDIATELY REMOVE ALL FUEL FROM THE TANK. THE CONVAULT TANK HAS A BUILT-IN SECONDARY CONTAINER AND IS ENCASED IN CONCRETE. Clean Up 05/16/2006 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULATORY AGENCY. vi.iici 1CC5VUIVC HC:l.1Vdl.1Vi1 -6- 07/10/2007 F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~JCC:1d1 11d"GdI UPS' Utility Shut-Offs Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - WELL DISCHARGE. 10/19/2006 Building Occupancy Level 05/16/2006 UNMANNED SITE -7- 07/10/2007 F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/16/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rayC ~ nciu ivi ru~..utc vac Held for Future Use -s- 07/10/2007 ~~ ~~~ Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST ~~ e_- ~ R_5 F , ___0 90o Truxtun Ave., suite 210 ,_,_ ~_..._ . __. __ _ _... ~ ___ ~.. _ __ . . ~_~ ~~ ~___. .-_~- ., Fine Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program ~' "RrM r Tel.: (661) 326-3979 ~ ~ Fax: (661) 872-2171 r FACILITY NAME 1, y~ ~A~,\t~oCt~1~ ~al¢! Sety ~ ~J(~ ~- INSPECT]ION DATE ~I~ZZ v INSPECTION TIME ADDRESS ~ ~ ~ O ~ n ~ ~ P N NO. ~~ NO~E M PLO` Y~ A ~ ~ / ` -0 FACILITY CONTACT BUSINESS ID NUMBER 15-021- O o 2 ~ 1 . ~ Section 9 :..Business Plan. and Irwantory Program ROUTINE ^ COMBINED . ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT. ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ 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 i ~ Y~`t r~ a ~ f L \ `6U ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ I"IOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUES^TIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 L ~~~ n lL~~ ~~ Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Bu ss Site esponsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ^ YES ~10 { r~ CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 Manager TIM TRELOAR Location: 11500 BRIMHALL RD W/O JEWETTA City BAKERSFIELD CommCode: KCFD STA 67 EPA Numb: BusPhone: (661) 837-7200 Map 101 CommHaz High Grid: 25D FacUnits: 1 AOV: 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: RSs Contact BILL ROSICA MailAddr: 3725 S H ST City BAKERSFIELD Fire Press ImmHlth Phone: (661) 837-7278x State: CA Zip 93304 Owner CALIFORNIA WATER SERVICE CO Phone: (661) ~8--z~oo~ Address 3725 S H ST State: CA ~37~7200 City BAKERSFIELD Zip 93304 Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: Yes Gal Gal Emergency Directives: PROG A - HAZMAT ) PROG T - ABOVEGROUND STORAGE TANK ~N~'~ ~ ~~ ~ ~ 2Q07 Based on my ingtagry of tR~c~ae indfvlduals responsible for Afataining the ir'tf~pmation, I certify under penalty of laver that !Dave personally examined and am fatnlliar with the information submitted and balieve tits information is true, accurate, and complete. ~~-cue. Z G U > S' ature Oa -1- 01/29/2007 n F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-00211.7 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Sites ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MAP SODIUM HYPOCHLORITE F P IH L 200.00 GAL Hi. -2- Ol/29/~b07 -3- Ol/29/2b07 F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-00211'7 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SODIUM HYPOCHLORITE Days On Site 365 Location within this Facility Unit Map: Grid: FENCED ENCLOSURE NEXT TO PUMP CAS# 7681-52-9 Liquid TMixture ~ AmbRent~E ~ AmbientT~E ABOVEOGROUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL I 200.00 GAL ru~~t~tclJUUS uuriruivl~;lv-.1'~ %Wt. RS CAS# 12.50 Sodium Hypochlorite No 7681529 t1AGAttL A~51~;~~1~11;1V 1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MC1~ No Yes No No/ Curies F P IH / / / Hi -4- 01/29/2007 r .2 F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-00211`7 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Sits ~ ~ Agency Notification 08/30/20010 ~ CALL 911. Employee Notif./Evacuation Public Notif./Evacuation 10/05/192 EVACUATION OF THE LOCAL POPULATION TO BE DETERMINED BY EMERGENCY SERVICES PERSONNEL, UNLESS EVACUATION IS NECESSARY PRIOR TO THEIR ARRIVAL. Emergency Medical Plan MERCY HOSPITAL, TRUXTUN AVE. 08/01/2006 -5- 01/29/2007 4 F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Sits ~ ~ Release Prevention 09/27/199 ~ DIESEL IS STORED IN AN ABOVEGROUND CONVAULT TANK. Release Containment 10/19/2005 IF AN ABOVEGROUND CONVAULT TANK WERE TO START LEAKING, ARRANGEMENTS WOULD ~E MADE TO IMMEDIATELY REMOVE ALL FUEL FROM THE TANK. THE CONVAULT TANK HAS A BUILT-IN SECONDARY CONTAINER AND IS ENCASED IN CONCRETE. Clean Up 05/16/2005 RELEASE ABATEMENT WOULD BE PERFORMED BY AN INDEPENDENT REMEDIATION CONSULTANT, AS NEEDED, AND TO THE SATISFACTION OF THE RESPONSIBLE REGULAT0~2Y AGENCY. Other Resource Activation -6- 01/29/2007 F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ Fast Format ~ 'Site Emergency Factors Overall Site ~ special Hazaras Utility Shut-Offs Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - WELL DISCHARGE. 10/19/2006 Building Occupancy Level UNMANNED SITE 05/16/2006 -7- 01/29/2007 >y. F CALIFORNIA WATER SRV CBK-29 SiteID: 015-021-002117 ~ Fast Format ~ ~ Training Overall Sits ~ ~ Employee Training 05/16/20175 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rage L Held for Future Use Held for Future Use -8- Ol/29/~007 i v ; -~~- + CALIFORNIA WATER SRV CBK-29 _________________________ SiteID: 015-021-002117 ~3~ ~ 7zc~b Manager TIM TRELOAR BusPhone : ( 661) ~ "-~~~-~-6.6- Location: 11500 BRIMHALL RD W/O JEWETTA Map 101 CommHaz High City BAKERSFIELD Grid: 36B FacUnits: 1 AOV: CommCode: KCFD STA 67 SIC Code:4941 EPA Numb: DunnBrad:00-691-3578 Emergency Contact / Title Emergency Contact / Title TIM TRELOAR . / DISTRICT MGR ~~d~ ~dll~s / ASST DIST MGR Business Phone: (661) 3~~-6~@~tv'37••7L~b Business Phone: (661) '`_"=->~~93~-7L I 24-Hour Phone (661) ~°G-`'^^nv~'37-7Lao 24-Hour Phone (661) 39A~A3cu37-7' 7i Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: RSs Fire Press ImmHlth ` ~ I ~ ~ --------------- ~t5 its Contact ~ Phone • ( 6 61) 3~fr ~-4-6~A~ MailAddr: 3725 S H ST State: CA c°37-7z7~ 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: Yes ParcelNo: Emergency Directives: h( ~5 PROG A - HAZMAT 6v~/ PROG T - ABOVEGROUND STORAGE TANK ~~ CONTACT PERSON: 832-2141 ijased ors my inquiry of those individuals responsible for obtaining 4he information, I certify under penalty of law iha4 I have personally examined and am famllfar with the information submitted and believe the information is true, accurate, and complete. V~-~. ~ °L 2 U ~ ature Da a a.. ~~^~~ ~N~ AUG 0 1 2~D6 t______________________________________________________________________________+ -1- 05/16/2006 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This ~ermit is issued for the following_: El Hazardous Materials Plan [] Underground Storage of Hazardous. Materials [] Risk Management Program PER]V[]T ID # 015-021-002117 [] Hazardous Waste On-Site Treatment CALIFORNIA WATER F LOCATION: 11500 BRIMHAI~ CA 93312 ~....~ ?,,. ~'~. '.i~ ',!". ' OFFICE OF ENVIRONMENTAL SER VICES' ' ~ ~ ~[JG 1 5 1715 Chester Ave., 3rd Floor Approved by: ~.~lp~.~,.D~ ' , Bakersfield, CA 93301 Omee~fE~v.~ Issue Date Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: June 30:2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program El Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002117 CALIFORNIA WATER LOCATION 93312 OFFICE OF ENVIRONMENTAL SER VICES' ' '~' NOv 1 ZOO0 1715 Chester Ave., 3rd Floor Approved by: ('--RalpVHocy'D~'%~'~-~'~! lssu¢ Date Bakersfield, CA 93301 Oniceor£viromu~mgServices * Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: 'June 30, 2003 BusinessAd~ess: c~ ~+~. z~ ~0.~',', ~ FiD 4~5 8" PVC' ~ ............... ~ _i_ ~2 __ w l (C'[~VC FLD.J4 ) ~ ) 6~PVC FLD.341 B~IMHALL ROAD tVw KEt~N IIIC~H SCHOOL ~/4 FLD ,~ ~.!~ N SITE DIAGRAM Business Address: HANDEL - -- . ~ LANGLEY 2 - ~ SH~LLABARGER 8 rOXI~tL CArdIGANq4 IGRI~E ~ HARV[Y J to. c~4~ ~r ....... - ............ F~" ~ 9RI~HALL ~ u ' WitEflfl mY,{ ~ox l (~rrK CALIFORNIA WATER CBKSTA29 SiteID: 015-021-002117 Manager : M~9~%~-~A~R~- BusPhone: (661) 325-7128 Location: 11500 BRIMHALL RD Map : 102 CommHaz : Minimal City : BAKERSFIELD ~%Z ~ Grid: 31C FacUnits: 1 AOV: CommCode: COUNTY STATION 65 SIC Code:4941 EPA Numb: DunnBrad:00-691-3578 Emergency ContaCt / Title Emergency Contact / Title ME-AVIN BYRD / DISTRICT ~4rd~KG~'----~ELOAR----- / GEN~ Business Phone: (661) 396-2400x Business Phone: (661) 396-2400x 24-Hour Phone : (661) 396-2400x 24-Hour Phone : (661) 396-2400x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: RSs Fire Press ImmHlth Contact : Phone: (408) 4~0x MailAddr: I~D--BT~-~-%-5~ S~ City : -~ ~i-p : 95105-' Owner C - TER - VICE COMPANY Address : ~,2D N FIRST--S~f ~e: CA---~ City : ~SAAL~IQ_c~-- ..... Z~p Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: RSs: Yes ParcelNo: Emergency Direct ives: D~s~ct Manag~-T~m Trdoar Asst. Dist Manager~Bill Harper CONTACT PERSON K~;~--~J~R~-~ 832 - 2141. Contact Person-Tama~a Johnson Same Phone Numbers reviewed me *,~': .... -'-,,,..~ :.,,.,7¢,~-.:., .. ~ ........ merit plan for CALl(c. {~/tTc:~.~_and that i'.',' ~,,%:~::,] with (Name of Business)- ' any corrections cons~i~u~s ~ complete and correct man° agement plan for my ~acilRy. lO/lO/2OO3 CITY OF BAKERSFIE OFFICE 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 front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: (_~:t.o~.~,',~ u,,.a.~.k~-~..-,~,,-.~ co. LOCATION: r_..~. ~4.-~. z"t ~Se,~ ~.-:.,,.~t.,~ I"'~ MAILING ADDRESS: 3n-z.~ $o. ~4 CITY: ~.~,-~[,'~.ed STATE: t_~. ZIP: q3aoq- PHONE: PRIMARY ACTIVITY: 'P,.~,-,e,t,,/o¢ or- c[o,,,,~.,,l-,e._ OWNER: 5e~,,,, 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: B. EMPLOYEE AND AGENCY NOTIFICATION: 2 ~I~zARDOUS MATERIALS MANAG~ENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: 5t.'-~,L~-~'--* WATER: SPECIAL: ~/~, LOCK BOX: YEs/~O IF YES, LOCATION: -'--'- PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: ---- B. WATER AVAILABILITY (FIRE HYDRANT): SECTION III: TRAINING NUMBEROF EMPLOYEES: ~o,,,~ - MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION I, ._~-.,,_ ~_ ~_ A~ ~,.. ~ ~ ,,, 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 HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PE1UURY. SIGNATURE TITLE DATE 4 d"~/~-~ ~iFFICE OF ENVIRONMENT.~SERVICES -. rlttm ~ [715 Chester Ave., CA 93301 (661) 326-3979 "'--'~"'~' BUSINESS OWNER / OPU~TOa IDENTIFICATION FACILI~ INFORMATION Page Of ·. ,i.. '. :' ';' ' · :~i" ~:'1' FACILITY IDENTIFICATION ': F,',C~Lrr'r~P# [~ I I [~/!~] I I I I i I 'J Year Beginning ,oo t Year Ending / BUSINESS NAME (Samo as FACILITY NAME or DNA- Doing Business As) 3 BUSINESS PHONE ................... _c__o ~; [_, ..,',_a t.~ ~, ¢,- 5 t ~.,, ,. ~- co_. [._(.~_>_~.)_~_a..~__z._..+_.~.9 ......................... SITE ADDRESS ............... _(..~ ~-. ~4-m. ~.q ~ I~o¢:> · CITY 1~=~ 14...~e-a ~-t ~- t ~ ~on ZIP ,os DUN & ~os { SIC CODE ~o7 COUNTY I<. ~ ,' ~ ~o8 OPERATOR NAME (-~%~.[,.~..-,.~,~3,, ~,,.te..[-4~,. '¢'~e,.-.,~t~e. Co . 109 OPERATOR PHONE (~=,~a,i'~,,~,,~,,-,L%~..[ 110 OWNER MAILING ADDRESS "~'1'7..-~ '~ o. ~' %, [.... ~" '.= !':~: '~'~2(;~ ::~ ~,' '[~2' ~: .:"; ":~. :;;' +,:~= ~';:k;: = ~;:: ';:< ,~,~,.';"~v'i:,~: ." '~ ~[; :,% ,'. =.:5 CONTACT NAME il7 { CONTACT PHONE ~ CONTACT MAILING 1 ADDRESS TITLE D,~[~,~¢ ~~ ,2S TITLE ~k~[~[ 02s~2~¢ ~~r ......... .. ,~o BUSINESS PHONE (~1~ 3~Z~OO 126 BUSINESS PHONE (~ S~Zi~L .................... 24-HOUR PHONE 5 ~ 127 24-HOUR PHONE ~ &~ ~ PAGER ~ ~ 12S PAGER ~. ~ 133 Codification: ~asod on mg inqui~ of thoso indMduals rosponsiblo [or obtainin~ tho In[o~ation, I ~di~ undor ponal~ of law ~at I havo porsonally oxamined and am ~millar with tho info~aUon ~ubmittod In this Invonto~ and bofiovo tho in[ormatlon is tmo, accurato, and SIGNATURE OF OWNE~OPE~TOR DATE 134 NAME OF DOCUMENT PREPARER 135 NAMES OF OWNE~OPE~TOR (print) ~3s TITLE OF OWNE~OPE~TOR i37 UPCF (7/99) S:\CU PAFORMS\OES2730.TV4.wpd city _ql - OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL. DESCRIPTION (one form per mate~al per budding or a~a) ~NEW ~ ADD ' ~ DELE~ ~ RE~SE ~ Page ~''r ~'?'~',.= ~''~57 ':?~ ''~'?¥';~' ~'. ~ ~:'. ~: ~ :~,'' ~ ::J '~¥~ ~;;?~ ~ ~ ~"~'~ ~'='~'~:~'~'V~:>~'~ ':? : :~::,~ (~:~ =. '':' ,~ ' "'"'' .': BUSINESS NAME (Same ~ FACILI~ ~ME ~ D~ - ~ng Busln~ ~) 3 CtIEMICAL LOCATION . 20~ CHEMI~L LO~TION o- ,,. 205 T~DE SECRET ~ Y~ ~ NO 206 CHEMI~L ~ME 1~ ' '- If Subj~ to EPC~, ref~ 1o insulins COM~N~ME ~ EHS' ~Y~ ~ 208 cas ~ 2~ :¢¢ff s~s b'Y~.'"~ '~.-, ~ ~ ~ ~b~. - ~IRE CODE H~D C~SSES (~pl~e If r~u~t~ by I~ fire ~i~ 210 ' p PURE ~ m MitRE ~ w WASTE 2~1 ~D[OACT~E ~ Y~ ~ ~o 2~2 ~ CURIES 213 PHY$I~L STATE ~ $ 5OLID ~1 LIQUID ~ g ~$ 21~ ~RGEST~INER FED H~RD ~TE~RIES ~ 1 FIRE ~ 2 ~CT~ ~ 3 PRESSURE REL~SE ~ 4 AC~ H~L~ ~ 5 CHRONIC H~LTH 216 (Ch~ all that ap~ly) ANNUALWAS~ ./~ 217 ] ~I.M 218 ] A~GE 219 STA~ WASTE CODE 220 A~UNT DAILY A~U~ ~ DO ~ ~ t . DAILY A~U~ ~ O O ~ ~ [ . UN.S* ~ ga ~L ~ d CU ~ ~ lb LBS ~ m TONS 221 DAYS ON SITE ' 222 * ~ EHS. ~nt must ~ In lbs. STOOGE CO~AINER ~ a A~VEGROUND T~K ~ e P~STI~NM~ALLIC DRUM ~ I FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~ 223 (Check all that app.) ~ b UNDERGROUND TANK ~ f ~N ~ j SAG ~ n P~STIC BO~LE ~ r OTHER ~ C T~K INSIDE BUILDING ~ g ~R~Y ~ k aOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WAGON STOOGE PRESSURE ~ a A~IE~ ~ aa A~VE AMBIENT ~ ba BELOW A~IENT 224 STOOGE TEMPE~TURE ~ a A~IENT ~ ~ A~VEA~IE~ ~ ba BELOWA~IENT ~ c CRYOGENIC 225 I 226 ~7 ~ Y~ ~ No 228 229 234 ~5 ~ Y~ ~ No 236 237 238 mO ~ Y~ ~ No 240 241 ~ Y~ ~ No 244 - ,: .~ ~,:... ::,:. ~ ~?:;.~,~<,~?~.~'~.~: ,:.,;5.'~.'. ~.~'~,~..?~,~?,~(~::,:~.~.~¥~: ~,,~,:~.~:~,.::~??~.:'~ ', ~.~ ' =: ~,:',':, ~:.~ ,:.~.: ,:~-...~:~ ':=t" .... PRINT NAME & TJ~E OF AU~R~EO CO~A~ RE~ESE~A TNE SIGNORE i [ DATE 246 - ' - I ~' ~ ' ~ UPCF (7/99) S:~CUPAFORMS~,OES2731.TV4,w?