HomeMy WebLinkAboutBUSINESS PLAN 12/11/1995 ·~ ...........· ~?F%.~'..
SITE DIAGFL~M [ , FACILITY DIAGRAM
Business Name: ~Ac. ~-~ ~~
Busine~ AC~re~: ~ ~ ~ ~ ~u 4b ~
Far O~ice Use Only
Insc~ec:ion Stc,'ion: NORTH'
STATEMENT OF ACCOUNT
CITY OF BAKERSFIELD
1501TRUXTUN AVE
BAKERSFIELD, CA 93301-0000
(805) 328-3979
DATE:
5/01/96
TO: CAL AUtO TECH -~~
~13 E BRUNDA~E LN
BAKERSFIELD, CA 93307
CUSTOMER NO' 5262 CUSTOMER TYPE: ES/ 5262
4/15/96 BEOINNIN9 BALANCE II0.00
FOR QUESTIONS OR CHANQES TO YOUR ACCOUNT PLEASE
CALL 3~6-3~7~.
CURRENT OVER 30 OVER 60 OVER 90
I10.00
DUE DATE: 5/01/96 PAYMEN~--~E: 110.00
TOTAL DUE: ~110.00
PLEASE DETACH AND SEND THIS COPY WITH REMITTANCE
DATE: ~/O1/~& DUE DATE: 5/01/~
REMIT AND HAKE CHECK PAYABLE TO:
CITY OF BAKERSFIELD
P.O. BOX 2057
B~KERSFIELD CA 93303-2057
CUSTOMER NO: 5262 CUSTOHER TYPE: ES/ 52~2
TOTAL DUE: $110.00
-I
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BAKER flELD CITY FIRE DEP, RTMENT
HA RRDOUS MATERIALS INv oRY Page_of_
Business Name Address
CHEMICAL DESCRI~ION
1) IN~NTORysTA~S: New[ ] Add,on [ ] Revision[ ] ~letion[ ] Ch~kffchemi~isaNON ~DE SECR~. [ ] ~DE'S~R~ [ ]
2) Com~nN~,: ~'~ ~ ~/~ 3) ~T~ (o~.
Chemi~ N~e: ~M [
4) PHYSICAL & H~L~ PHYSIC~ H~
H~RD CA~GORIES ~re ~ Rea~Ne [ ] Sudden Rele~e of Pressure [ ] Immedi~e He~h (Ac~e) [ ] ~d He~ (Chron,) ~
5) WAS~ C~SSIFICA~ON ~ ~ ~ (3~ig~ ~de from DHS Fo~ 8022) USE CODE
6) PHYSICALsTA~ Solid [ ] Uquid [~ G~ [ ] Pure [ ] M~um [ ] W~te ~ ~ [ ]
~ AMOUNT AND ~ME AT FACIE~ UNITS OF M~SURE 8) STOOGE CODES
M~mum Daly Amount: [(0 I~ [] gN ~ ~3 [ ] a) Cont~nec
Averse O~ly A~unt: ~ cudes [ ] b) Pressure: (
~nuN Amount: ~ c) Tem~r~re:
~gest Size'Cont~ner:
· Da~ On S~e ~ Cimle~ich Momhs: AllYe~. J. F M. A. M. J. J. A. S. O. N. D
9) MITRE: Ust COMPONE~ . CAS · % ~ AHM
chemi~ com~nen~ or
~y AHM com~nenm 2) [ ]
3) [ ]
CHEMICAL DESCRI~ION
1) IN~NTORY ~TA~S: New ~ ] A~ion { ] Re~s~on { ] Deletion [ ] Check ~ chemi~ is
2) Common N~e: 3) ~T · (o~on~)
Chemi~ Name: AHM [ ] CAS
4) PHYSICAL & H~L~ PHYSICAL H~L~
H~RD CA~GORIES Fire [ } Rea~ive [ ] Sudden Rele~e of Pressure [ ] Immedi~e He~h (Ac~e) [ ] ~layed He~h (Chronic) [ ]
5) WAS~ C~SSIFICATION .(3~ig~ code from DHS Form 8022) USE CODE
6) PHYSICALSTA~ Solid [ ] Liquid [ ] G~ [ ] Pure [ ] MiAure [ ] W~te [ ] Radioa~e [ ]
7) AMOUNT AND TIME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES
M~imum Daily Amount: t~ [ ] g~ [ ] ~3 [ ] a) Cont~ner:
Average D~ly Amount: cudes [ ] b) Pressure:
Annu~ Amount: c) Tem~r~ure:
~gest Size Cont=ner:
· Days On Site Circle~ich Months: AllYe=. J. F. M. A. M. J. J. A. S. O. N. D
9) MITRE: Ust COMPONENT CAS · % ~ AHM
the three most h~dous 1) [ ]
chemi~ com~nen~ or
~y AHM ~m~nents 2) [ ]
3) [ ]
10) Lo~ion
ce~'~ un~er pen~ of law, ~at I have pemonally examin~ ~ am f~ili~ wi~ ~e mfomabon submi~ on ~is
PRl~Name& ~ofA~od~Com~)Represenm~ve "~ ~D~ Signa~ U ' - ' ~ barn
BAKERSFIIF D CITY FIRE DEPARa E 'NT
HAZARE/OUS MATERIALS INVENTO f Page of,-~-.~
.~usiness Name Address
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: Nev~ [ ] Addition [ ] Revision [ ] Deletion I ] Check if chemical is a NON TRADE SECRET [ ]. TRADE SECRET [ }
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 HeeJth ((~ronic) [ ]
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE ·
6) PHYSICAL STATE Solid [ i Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ].
7) AMOUNT AND TIME AT FAClMTY UNITS OF MEASURE 8) STORAGE CODES
Maximum Daily Amount: Ib~ [ ] gal [ ] ft3 [ ] ~) 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, N, D
9) MIXTURE: List COMPONENT CAS # % WT AHM
the three most hazardous 1). [ ]
chemical components or
any AHM components 2) [ ]
3) [ ]
10) Location
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
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 HeaJth (Chronic) [ ]
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FACIETY UNITS OF MEASURE 8) STORAGE CODES
Maximum Daily Amount: lbs [ ] gal [ ] fi3 [ ] a) Container:
Average Daily Amount: curies [ ] b) Pressure:
Annual Amount: c) Temperature:
Largest Size Container: ;'
# Days On Site Circle Which Months: Ali Year, J, F, M, A,.M, J, J, A, S, O, N, D
9) MIXTURE: List COMPONENT CAS # % WT AHM
the three most hazardous 1) [ ]
chemicaJ components or
any AHM components 2) · [ ]
3) [ ]
10) Location
certify under penal~y of law, that I have personally examined and am familiar with the infoma~fon submitted on this and all attached documents. I believe
submi~tt~J, informa~fon is true, accurate, and complete.
PRINT Name & Title of Authorized Company l~epresenteUve . Signature Date