HomeMy WebLinkAboutBUSINESS PLAN 4/28/1998 Hazardous Materials/Hazardous Waste Unified Permit
. CONDITIONS OF-PERMIT ON REVERSE SIDE
This hermit is issued for the followlrl_~:
[] Hm,~rdous Materials Plan
[] Underground Storage of HazardOus Materials
Permit ID #:: 015-000-001875 -. 13 Risk Management Program >
ABH AUTO SALES AND BOD'. o Hazardous WssteOn-Site Treatment
LOCATION: 615 BROWN ST IELD
Issued by: . Bakersfield Fire Department . ·
~ OFFICE OFENVIRONMENTAL SERVICES'
'[['_/~.~ 1715 Chester Ave., 3rd Floor Appl!oved bY: ~~wl,~,~~ ~~-'~~
~ Bakersfield, CA 93301 ~,~ ~atc
~)'~_~r~ Voice (661) 326-3979
· .: Expiiati°n'Date: 'June 30. 2003
ITE DIAGRAM
Business Name: ~_~--~ ~-~o~.-.~ ~, t ~ ~ ~. ~ ,-.t~
Business Address:
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (805) 326-3979
~~OUS ~TE~LS ~~ORY
DESC~TIO~/
C~CK ~ BUS.SS IS A F~ [ ]
BUSINESSNAME ,q_13_ H PrtJTO 6,t~C~5 ~qAlO
FACILITY NAME
SITE ADDRESS (~ I ~ t~ F~O eOM BT.
CITY ~,~cc ~25FZ-ffc~ STATE d/,q - ZIP 9 ~30~
NATUREOFBUSINESS ~. uTO ~11 t6,.$
SIC CODE DUN & BRAI)STREET NUMBER
OWNER/OPERATOR LOXS t~pJa~ ~ PHONE
MAn.INGADDRESS [,15 ~9_6o0ro 3T.
EMERGENCY CONTACTS
NAME ~) A ~ X- D ~. t. ~ ~ ¢_ C ~: TITLE
BUSINESS PHONE ~ 33 ~ L~ ~- I 24 HOUR PHONE
NAME ¢Dc~e-- ~-t,;~_t~a-t~o~-- TITLE
BUSINESS PHONE 3L~-~~ 24 HOUR PHONE h~
-' - Page of
C~C~ B[SC~ON
1) ~ORY STA~S: New [ ] A~on [ ] Re~ [ ] ~le~ [ ] Ch~k ifch~ is a NON T~ S~ [ ] T~ ~ [ ]
2) Co~on N~e: ~0~0 ~ o ~ ~ 3) ~T ~ (option)
Ch~ N~e:
4) Physi~ & H~
~dCa~es F~e[~R~five[ ]Sudd~Rel~of~e~e[ ] lmm~a~H~(Acute)[ ]~lay~H~(C~c)[ ]
5) WAS~ C~S~CA~ON (3~t ~ ~ D~ F~ 8022) USE CODE
6) P~sIC~STA~ So~d[ ] Liq~d[~[ ] ~[ ] ~[ ] W~[ ] ~five[ ]
7)~O~~~ATFAC~ ~OF~~ 8)STO~GECOD~ 06~ _
Av~e D~y ~o~t ~ [ ] b) ~e:
~ ~o~t I ~o ~-w 9~O~ c) T~~
~ Da~ on Si~ C~le ~ch M~: ~J, F, ~ & ~ $, J, & S, O, N, D
9) ~: List CO~~ C~
· e ~ mo~ ~ 1) [ ]
ch~ ~n~ or 2) [ ]
~y ~ ~n~m 3) [
10)L~A~ON ~ OF ~ ~ ~'~
1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trade Seeret [ ]TradoSeeret[
2) Common Name: O ~ ~:L-C"2 ~ 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) Physical & Health PHYSICAL HEALTH
Hazard Categories Fire [ ] Reactive [ ] Sudd~ Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic)
5) WASTE CLASSIFICATION (3-digit code fxom DHS Form 8022) USE CODE
6) ?HYSlC~ ST^~ SoUd [ ] Liquid [ ] Cas [~ Pure [ ] Mixture [ ] Waste [ ] V.a, iioactive [ ]
7) AMOtn,rr/e4D Tn~ AT FACn.xrY uNrrs oF MFa~SURE 8) STORAOE CODES
Maximum Daily Amount Lbs [~ [ l fl3 [ ] a) Containmz. ~) ~
^verage Daily Amount Curies [ ] b) Pressure:
Annual Amount t~( T~Ft-t,J fi_ m-~,~ ~ c) Temperature
Largest Size Container
# Days on Site Circle Which Months: ~ff, aff, J, F, M, A, M, $, J, A, 8, O, N, D
9) MIXTURE: List COMPONENT CAS# % WT AHM
the three most hazardous 1) [
chemical components or 2) [
any AHM components 3) [
I certify under penalty of law, that I have personally examined and am familiar with the information on this and all attached docunmnts. I
believe the submitted information is txue, accurate and complete.
PRINT Name & Title of Authorized Comlmny Representetive - - Signa[ure ~ D~te
Page of
Business Name Address
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret
2) Common Name: I~_ ~__~:T/~ (__~--/t~ ~' 3) DOT # (optional)
Chemical Name: AI-IM [ ] CAS #
4) Physical & Health x,']R/~eac PHYSICAL HEALTH
Ha~ardCategories Fire[ five[ ]SuddenReleaseofPressure[ ] Immediate Health (Acute) [ ]DelayedHealth(Chroni¢)[
5) WASTE CLASSI~ATION (3-digit code from DHS Form 8022) USE CODE
/
6) PHYSICAL STATE Solid[ ] Liquid[ ] Oas[~ Pure[ ] Mixture[ ] Waste[ ] Radioactive[ ]
7) AMOUN'r AND TIME AT FACILITY UNITS ~F MEASURE 8) STORAGE CODES
Mmmum Dai y Amount Ubs b./l [ Iea [ I a) Co.tm .
Average Daily Amount Curies [ ] b) Pressure:
Annual Amount q.'rPo~ '~q y_~/~-, c) Temlx~ramre
Largest Size Container
Days on Site Circle Wkich Months: ~J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: List COMPO~ CAS# % WT AHM
the three most h~ardous 1) [
chemical components or 2) [
any AI-IM components 3) [
10)LOCATION
1)]]'~/EN'rO~¥STA~S:Ne~[ ]A~lifio~[ ]Re~i~ian[ ]D~lefio~[ ] ¢~ki£chcmi~lisaNO~Tr~S~,'~t[ ]Tred~S~t[
2) Common Name: 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) Physical & Health PHYSICAL HEALTH
Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [
5) WASTE CLASS CAT ON (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid[ I Liquid[ ] Gas[ I Pure[ ] Mixture[ ] Waste[ ] Radioactive[ l
7) AMOUNT AND TIME AT FACIL1TY UNITS OF IVlEASURE 8) STORAGE CODES
Maximum Daily Amount Lbs [ ] Gal [ ] ft3 [ ] a) Container:
Average Daily Amount Curies [ ] b) Pressure:
Annual Amount c) Temperature
Largest Size Container
# Days on Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, lq, D
9) MIX'I1JRE: List COMPONENT CAS# % WT AI-IM
the three most hazardous 1) [
chemical components or 2) [
any AHM components 3) [
10)LOCATION
I certify under penalty of law, that I have personally examined and am familiar with the information on this and all attached documents. I
believe the submitted information is true, accurate and complete.
PRINT Name & Title of Authorized Company Representative Signature Date
Page of
Bus/ness Name Address ~
CHEMICAL I)ESCRIFFION
I)INVENTORYSTATUS:New[ ]Addition[ ]Revision[ ]Deletion[ ] Check ifchemical is a NON Trade Secret [ ]TradeSecret[ ]
2) Common Name: 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) Physical & Health PHYSICAL I-IF_AL~
HazardCategofies Fire[ ]Reactive[ ]SuddenReleaseofPressure[ ] Immediate Health (Acute) [ ]DelayedHealth(Chroni¢)[ ]
5) WASTE CLASSIFICATION O-digit code flu,,, DHS Form 8022) USE CODE .~
6) ?HYslcAL STATE SoUd [ ] Liquid [ ] Oas [ ] ~ [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FACIIXrY UNITS OF MEASURE 8) STORAGE CODES
Maximum Daily Amount Lbs [ ] Gal [ ] ft3 [ ] a) Containe~.
Average Daily Amount Curies [ ] b) Pressure:
Annual Amount ¢) Temperature
Lax~est Size Container
# Days on Site Circle Which Months: All Year, $, F, M_, A, M, J, J, A, S, O, N, D
9) MIXTURE: List COMPONENT CAS# % WT AI-IM
the three most hazardous 1) [ ]
chemical components or 2) [ ]
any AHM components 3) [ ]
10)LOCATION
1) INVBNTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Chcck if chemical is a NON Tradc Secret [ ]TradeSccret[ ]
2) Common Name: 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) Physical & Health PHYSICAL HEALTH
Hazard Categories Fire[ ]Reactive[ ]SuddcnRelcaseofPressure[ ] rmmediateHealth(Acute)[ ] Delayed Health (Chronic) [ ]
5) w~TE CL~ssn~cATION (3-disit c~te from DltS Form S02~-) USE COD~.
6) PHYSICAL STATE Solidi ] Liquid[ ] Gas[ ] Pure[ ] Mixture[ ] Waste[ ] R,~lioactive[ ]
7) AMOUNT AND TIME AT FAClLrrY UNITS OF MEASURE S) STORAGE CODES
Maximum Daffy Amount Lbs [ ] Gal [ ] fl3 [ ] a) Containe~.
Average Daily Amount Curies [ ] b) Pressure:
Annual Amount c) Temperature
Largest Size Container
# Days on Site C/role Which Months: All Year, $, F, M, A, M, $, $, A, S, O, N, D
9) MIXTURE: List COMPONENT CAS# % WT AHM
the three most b_sTsrdous 1) [ ]
chemical components or 2) [ ]
any AI-IM components 3) [ ]
10)LOCATION
I certify under penalty of law, that I have pe~onally examined and am familiar with the information on this and all attached documents. I
believe the submitted information is true, accurate and complete.
PRINT Name & Title of Authorized Company Representative Signature Date
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
171S Chester Ave., Bakersfield, CA (80S) 326-3979
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.
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESSN~.~Vm: &~ ~X-~ %~,~% $
LOCATION: I0
CITY: ~-~ .~. ~-~,% t~_C ~D STATE:'q.~r~ - ZIP: ~'-~))~PHONE:
DUN & BRADSTREET NUMBER: SIC CODE:
PRIMARY ACTIVITY: ~ Q~ ~ ~ ~ ~
OWNER: L~r~ 6~6 ~0 ~ "~
MAILING ADDRESS: ~ \~ 33,{Z-6 ~ ~ %~ .
SECTION 2: EMERGENCY NOTIFICATION
CONTACT TITLE BUS. PHONE 24 HR. PHONE
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING
NUMBER OF EMPLOYEES: ~ 2_
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
SECTION 4: EXEMPTION REQUEST
I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM
THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH
& SAFETY CODE" FOR THE FOLLOWING 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, C~ ~ ~ c,~,v ~2~ ~, 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 PERILrRY.
LA SIGN~ (~- TITLE DATE
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES
A. AGENCY NOTIFICATION PROCEDURES:
B. EMPLOYEE NOTIFICATION AND EVACUATION:
C. PUBLIC EVACUATION:
TMe~ go'~c, sc o..,,~%T 'g, 6 ~T t~r~% .T~-~.~--r~2.._
D. EMERGENCY MEDICAL PLAN:
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN
A. RELEASE PREVENTION STEPS: -~]~
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
C. CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-OFFS _(LOCATION OF SHUT-OFFS AT YOUR FACILITY)_
NATURALGAS/PROPANE: tz, e_.v ~ -r .~v ~.,~,.~ c ~
ELECTRICAL: ~e-o ~ 'T r~ r- p_qm Cc7 to u -r-
WATER: ~:e--O ~/T' ~-~o'~¢_~qc~' (Ou'r %-~01~
SPECIAL:
LOCK BOX: YES~ IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION: 7~..,L"I:'t~- ~'xxto~:.xO:l~eg-5.
B. WATER AVAIl.ABILITY (FIRE HYDRANT):
4