HomeMy WebLinkAboutBUSINESS PLAN 10/1/2003 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
E] Risk Management Program
[] Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002108
CALIFORNIA WATER SI
'.~' ~ :,.~ _.~
LOCATION: 3608 BRISBANE A'
~'~, ...... ~,~ IAKERSFIELD CA 93313
OFFICE OF ENVIRONMENTAL SER VICES' - ,~ .~
1715 Chester Ave., 3rd Floor Approved by:
Bakersfield, CA 93301
Voice(661)326-3979
/~661) 326-0576 Expiration Date: June aox. 200~
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This oermit is issued for the followin_.:
[] Hazardous Materials Plan
[] Underground Storage of Hazardous Materials
[] Risk Management Program
[] Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002108
CALIFORNIA WATER
LOCATION 93313
OFFICE OF ENVIRONMENTAL SER VICES' '
1715 Chester Ave., 3rd Floor Approved by: {,--RalpYHuey'~~ i Issue Date
Bakersfield, CA 93301 om¢¢ of EvimnmemlffServices "'
Voice (661) 326-3979
FAX (661) 326-0576 Expiration Date: 'June 30, 2003
usiness Name: 4.,~;Lo.-~,,-. ~.,~,,L....- S.,-v,'.--
Business Address: ~_. s4-~. zo~_-o~ ~t,,o~ ~,-i~,bc~,~e.
46
20 19 18 17 16
I1 12 1.3
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B[ ISBA ¥£
~ 56 57 58 59 60 61 62 6:3 Coq co5 B6
] '55 54 53 52 5l 50 49 48 47 46 45
15" PVC E-7319
+ CALIFORNIA WATER SERV STA20201 --- SiteID: 015-021-002108 +
Manager : ~ELVt~q--BY-R4D BusPhone: (661) S25-712~
Location: 3608 BRISBANE AVE Map : 123 CommHaz : Minimal
City : BAKERSFIELD 1 AOV:
~.%5~ Grid: 35B FacUnits:
CommCode: BAKERSFIELD STATION 13 SIC Code:4941
EPA Numb: DunnBrad:00-691-3578
Emergency Contact / Title Emergency Contact / Title
· 7~ EYRD '
MELv~ -~--TI/ST~'iCT MANAG~ TiM T~S~OAR / G~E~N
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) 45~-8200x
MailAddr: ~50 / grate:
City : ~ Mip : 95108
Owner CALIFORNIAW~TER SERVICE COMPANY Phone: (408) 451-8200x
Address : 1720 N FIRST ST State: CA
City : SAN JOSE / Zip : 95112
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: Yes
ParcelNo:
................................................ D~s~ct ~ag~-T~ ~do~ .... +
Emergency Direct ives: Asst. Dis¢~ct ~anag~-B~H Ha~¢r
Contact Person-~m~a 3o~s0n
CONTACT PERSON KI~-~B~9~-~K 832-2141. ~PboncNum~rs
Ma~g Ad.ess Cb~g¢:
~ Bak~sfield, CA 93304
mvi ®d a ach d h a ous ma e als
1 07/30/2003
L~I--o OFFICE OF ENVIRONMENTAL SERVICES
1~~~' 1715 Chester Ave., Bakersfield, CA (661) 326-3979
HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
1. To avoid further action, return this form ithin 30 clays ot rec'mpt
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:
LOCATION: ~ ,'-- ·
MAILING ADDRESS: -5 -n 'z '5 So. M -04-.
CITY: ~'~. v...~ .- s f-,'~_, d STATE: c_~, ZIP:q'~%o.4 PHONE:
OWNER: e.~,.,,-, e_ PHONE:
MAILING ADDRESS:
EMERGENCY NOTIFICATION
CONTACT TITLE BUS. PHONE 24 HR. PHONE
ItAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II. 1: DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORING PROCEDURES:
B. EMPLOYEE AND AGENCY NOTIFICATION:
C. ENVIRONMENTAL RESPONSE MANAGEMENT:
7.-4
D. EMERGENCY MEDICAL PLAN:
~AZARDOUS MATERIALS MANJ~EMENT PLAN
SECTION II.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
B. RELEASE CONTAINMENT AND/OR MITIGATION:
C. CLEAN-UP AND RECOVERY PROCEDU1LES:
o
.UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATURAL GAS/I'ROPANE: ~/'¥
WATER: .,,
SPECIAL:
LOCK BOX: ~ES)~Q) IF YES, LOCATION: -
PRIVATE FIRE PI~.OTECTION/WATER AVAILABILITY
A. I'RIVATE FIRE PROTECTION: - --
B. WATER AVAILABILITY (FIRE HYDRANT): ~'~- -kn,t~-o~4 ,, g- ~,.,,_~.
3
SECTIO .N.III; .TRAINING
NUMBEROF EMPLOYEES: ~4o,,,.~.- ~,,.~c,~,,,, ~.J,
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROG~M:
CERTIFICATION
I, '~,._~- t,--- A~,,~,. L',.- CERTIFY THAT TIlE ABOVE INFORMATION
IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FUIJ':ILL MY FIRM'S OI.~LIGATIONS UNDER THE "CALIFORNIA I. IEALTH AND SAFETY
CODi?' ON l lAZARDOUS MATERIALS (DIV. 20 CItAPTER 6.95 SEC. 25500 ET AL.) AND
TIIAT INACCURA'~I'E INFORMATION CONSTITUTES PER.FURY.
..--..~ n.." ,..~ ].~.'"'-.~ ,,~......-' t-...,.,.,-...-,-,.- %e,-.,,',,o ,-. ~. ,.-,-,:,o-
SIG'i~ATURE TITLE DATE
1.715 Cl,ester Ave., CA 93301 ~1) 326-3979
Page .......
. "I. FACILITY IDENTIFICATION
l lUSINESS NAME (Samo a; ~ACILI'W NAME or DB~-'~;l~-~u;i;m;s'~) ........................................... 3' [ BUSINESS PHONE
................................... aa6 SiC CODE
COUNTY I~ ~¢ ~
I
{)WNER MAILING
' ' '::" :": ' "" ' "~; ;:[ '~?,;'1:1 IR MEN ON :. t :
"' '" '{'" "~"'"' ' .... ':" ~ ':~ v-.' '
~ ':'a "'.'~'~:',~{'.,.'-,"'~,", ' ~:: ."~ ,~.;; ~": '¢' "
............ .~~..~~.~. , ~,~. , ~ ; ' ' . '.. _.' ..' .'.1,;'~ ,"~ , .. ".' ; , , ~: ,:~' ?'" ,: v .. . , ......
~ ~ CONTACT PHONE ~
CONTACT MAILING
Al)DRESS
.pRiMARy..:.' .. .: ..... .
co. .c s .. ECO"O*RV-
~,I.HOUR PttONE ~ ~ ~ 12~ 24-HOUR PHONE ~ ~ ~
PAGER # ~ 128 PAGER ~ ~. ~'l'~
ATION - , ~.'." '~'"~
C<.di~calion: Based on my Inqul~ of lboso Indiv[d.als rosponsiblo for obtaining Ihe Information, I ~rll~ undor ponally o[ law thai I havo personally
;..Im. h~iltar wllh lbo infom~!lon submilled In Ihis Invonlo~ and believe tho Information is truo, accurale, and ~mpIole.
HAMES OF OWNE~OPE~T~ (prinl) ~3~ TITLE OF OWNE~OPE~TOR
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FFICE OF ENVIRONMENT SERVICES
1715 Chester Ave., CA 93301 (661) 326-3979
. CHEMICAL DESCRIPTION
(0~ fo~ per mate~al per buddm~
~NEW ~ A~ ~ OE[E~ ~ REVISE ~ Page ~ o~
CItEMI~L LO~T~N · . 201[ CHEMI~L LO~TION ~.
O ~ ~ t ~ ~ , [ ~NFIDENTIAL (EP~) ~ ~es
~5 T~DE SECRET ~ Y~ ~ No 206
CI IEMI~L ~ME
20~
COM~N~ ' ~ EHS' ~Y~ ~No 208
210
p ~RE ~ m M~RE ~ w WASTE 2H ~O~ACT~ ~Y~ ~ 2~2 ~
CURIES
2~3"~
rHYSI~L STATE ~ s SOLID ~1 L~UID ~ O ~S 214 ~ROESTCO~NER ~ ~ 2~5
F FD HA~RD ~TE~RIES ~ l F~RE ~ 2 nEA~ ~ 3 PRESSURE ~E ~4 AC~ H~LTH ~ 5 CHRONIC H~LTH
ANNUAL WASTE ~/ 217 ~I~M 218 A~ 219 STATE WASTE CODE 220 I
u.~s- ffi ~. ~L ~ ~ cu ~ ~ · ~s. ~ ~ TONS 2l~ O~VS O. S~Xe
[Checkaffthal~] ~ A~VE~OUNDT~K ~e P~STI~NM~ALLICDRUM ~l FIBERDRUM ~m G~SBO~LE ~q ~IL~R 223
~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC BO~LE ~ r OTHER
~ C T~K INSIDE BUILDING ~ g CAR~Y ~ k BOX ~ o TOTE BIN
S]O~GE PRESSURE ~ a A~IE~ ~ aa.A~VE~IE~ ~ bm BELOW A~IENT
STOOGE TEMPE~TURE ~ a A~IE~ ~ ~ A~VEA~IE~ ~ ba BELOW A~IE~ ~ ~ CRYOGENIC
2~ 227 ~ Y~ ~ No 228 229
t { 230 231 ~Y~ ~232 233
I
4 238 239 ~ Y~ ~ No 240
5 ' 242 243 ~Y~ ~ 244 2.15
j ' Pi~ ~A~ & TITLE OF AU~OR~ED CO~ANY REPRESE~ATWE 81~TURE '
I
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