The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN 9/18/2001CALIFORNIA WATER SERV] CO 35-02 SiteID: '~15-021-002370 Manager : ~ BusPhone: (661) 396-2400 Location: 730 BRLTNDAGE LN CommHaz ,~%%%~% Map : 124 : City BAKERSFIELD Grid: 06A FacUnits: 1 AOV: : CommCode: BAKERSFIELD STATION 06 SIC Code:4941 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MELVIN BYRD / DISTRICT MGR TIM TRELOAR / ASST DIST MGR 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: React ImmHlth Contact :~rE~-U~"N~9¥R~-- Phone: (661) 396-2400x MailAddr: 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Owner CALIFORNIA WATER SERVICE COMPANY Phone: (661) 396-2400x Address : 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Period : to TotalAST~: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: r ~ Di~i~ M~ag~-Tim ~elo~ Emergency Direct ives: As~. Di~ M~-Bill H~p~ Conta~ P~son-Tam~a Johnson Same ~one Numbers g, ,,'-~m~]~ ~e~ Do hereby c~rtify that ~ have ffy~ ~ ~int n~e) r~ewed ~hs a~ached h~aroous materials manage- mere plan fo~R~fi ~~ and th~[ it along ~h iN,me ol any corrections constitute a compiets and corrs~ agemem plan ~or my facility, -1- 10/10/2003 / ~o OFFICE OF E~IRONME~TAL SERVICE8 ~ ~ 1715 Chester Ave., Bakersfield, CA (66D 326-3979 TE S. AGE NT'PL 1 To avoid ~er action, re~ ~s fo~ wi~ 30 days of receipt. ~ ~ 61 ~ 2. T~~ ~S~RS-~ ENGLISH. fi~ 0 o ~ 3. ~swer ~e questiom below for ~e b~iness ~ a whole. .~ ~ a ( 4. ' Be ~ bhef~d concise ~ possible. ~ .. 5. You may flsO a~ach Bus.eSs O~er / ~erator FO~ ~d Che~c~ Description Fo~(s) · to ~e front offs pl~ ~stead ofcomple~g sE~ON'I, below for ~fi~ sub~ssion. SEC~ON I: BUS.SS mE~ICA~ON DATA E~RGENCY NOT~ICA~ON .,~: H:AZARDOUS M:ATEI~ALS MANAGEMENT P~_:AN SECT[ON IL 1: DISCOVERY AND NoT~[CATIONS A. LEAK DETECTION AND MONITORING PROCEDURES:: B. EMPLOYEE AND AGENCY NoTIFIcATION: 7"/-//.f /5' A/q /,/,,t/MA,4/',,V'£D _fl ?~'. D. EMEKGENCY MEDICAL PLAN:" 2 HAZARDOUS MATERIALS ~'IANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PKEVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCBDLrRBS: U2'YLITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACEL1TY~ SPEC~: LOCK BOX: ~S~ ~ ~S, LOCATION: P~ATE F~ PROTECTION~A~R AVA~.~ITY"' A. PRIVATE FIRE PROTECTION: FI~_~ ~'/("7'/A/,f,f//JHE~ ,~o/ff' dY/T-Z- B. WATER AVAILABILITY (FIRE HYDRANT): W'~'/-/- O/./C//A~_d~ 3 HAZARDOUS MATER/ALS IYLANAGEM'ENT PLAN SECTION III: TRAINING CERTIFICATION ~s ACCUV, XT~. ~ UNVERST,q,/V ~x-~:r rsss ~O~~ON ~L'B~ USeD TO CODE" ON ~~OUS ~~S ~. 20-~~R 6.95 SEC. 25500 ET~.) ~T ~ACC~~ ~O~QN CONS~ PE~Y. ~ T~E DATE HAZ MAT MNGMNT PI.AN ~. IN-~RUC 4 -~ .... ,a CITY OF BAKt;RSFIELD ~ss ~ OFFICE OF ENVIRONMENTAL SERVICES ? ~,a,~, ~._.~ ,r~rr 1715 Chester Ave., CA 93301 (661) 3,26,3979' Business Activities Page of i I. FACILITY IDENTIFICATION ~C~-fi-T'7 ,O ';i'i[:~;?~--~-; ~ ~' :-.i.~i~- ~ ~i&~ ..... -3' 'l" ~m ,o ~ .................... L II. ACTIVITIES DECLARATION Does Your Facility,.. 'If Yes, Please Complete .... -j A. HAZARDOUS MATERIALS Lt~YES ONO 4 ~' DES FORM 2731 (Chemic~ Oesm¢aon Form) I 1. Have on Site (for any purpose) hazardous materials at or v'' CONSOLIDATED COMPLIANCE PLAN i above 55 gallons fo..r.:liquids; 500 pounds for Solids, or 200 Minimum required' planninq elements: i cuff for compressed gases (include liquids in ASTs and · Emerpenby' Response i USTs)? · Maps ! 2. Have any amount of.:.an explosive material (other than OYES (~NO 5 · . Training ammunition) on site? · Prevention · · Certifications B. REGULATED SUBSTANCES (RS) OYES O 6 ¢' DES FORM 2731 (Chemim aesmmion Have onsite RS 'at'greater than the threshold planning .v' RISK MANAGEMENT PLAN (RMP Submit to USEP^) quantities established by the California ACcidental v' CONSOLIDATED COMPLIANCEPLAN Release Prevention,program (CalARP)? ., · Incorporating CalARP program Eleme.nts C. UNDERGROUND STORAGE TANKS (USTs) OYES ~)NO 7 v' UST FACILITY FORM 4. Qwn or operate UndergrOund Storage Tanks? v' UST T~NK FORM'(one:pertan~) Intend to upgrade existing or install new USTs? OYES (~N0 ~ ¢ uST FACILITY FORM · 2 UST TANK FORM v' UST INSTALLATION FORM (one per tan~) D. TANK CLOSURE 1 REMOVAL OYES (~O .. 9 ~ USTTANK'FORM (ctosuresecfion--onepertank) 1. Need to report ciO~!ng,a UST that'held hazardous materials or waste? ' 2.' Need to report the Closure/removal of a tank that~was OYES (~O ~o ~ TANK· CLOSURE FORM' classified as hazardous waste and. cleaned onsite? E. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) OYES (~O 11 ~' CONSOL DATED COMPUANCE PLAN Own or operate ASTS above these thresholds: any tank · Incorporating Federal Spill Prevention .capacity is great~? than 660 gallons or the total capacity · ' Control and Countermeasure (SPCC) for the facilib/is g~:eater than 1,320' gallons. Elements pursuant to 40 CFR Part 112 F. HAZARDOUS WASTE: v' EPA ID number~provide on this page 1. Generate hazardous waste? (~YES (~NO ~2 To obtain EPA ID#, please phone(916) 324-1781 I 2. Recycle more than 100 kg/mo of recyclable materials at OYES (~O 13 'v' - RECYCLING FORM the same Iocati~~ it was generated? 3. Recycle more than 100 kg/m0'0f'recyclable materials at ' OYES (~'NO ~4 v' RECYCLING FORM ' an offsite location different from the point of generation? · 4. Treat Hazardous Waste on site? ~ ' OYES(~NO ~5 i. i~' TP FACILITY FORM (DTSC Form 1772) ~ v' TP'UNIT FORM (one per unit) 5. Subject to Financial Assurance requirements? OYES (~O is v' CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a remote (~YES (~O ~7 v' ../ REMOTE WASTE / CONSOLIDA~T1ON SITE ~ site? . / NOTIFICATION FORM G. PERMIT CONSOLIDATION ZONE: OYES(~'~- 18 v' CONSOLIDATED COMPLIANCE PLAN i Intend'to consolidate other Cai/EPA agency permits? · Incorporating all other environmental ~ (Jr yes, please complete Section III and attach) permit requirements per 27 CCR 10410 ~' ]TE: i / If you checked YES to any part of Sections IIA-IIG above, ther~ in addition to the forms requested .above, please Submit DES Form 2730. ! UPCF (?/99) S:\CiJ PAFORMS~,CT~VITY.wpd OFFICE OF ENVIRONM~NT3~L SERVICES '~ ,~-- 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 FACILITY INFORM,~,TIGN ~usiness Activities Addendum ~ge ~ I. FACILI~ IDENTIFICATION FAC]LI~ ID ~ (For o~ ~e ~ - pl~e I~ve bl~) I ~ ~A ID ~ 2 D~FACI~ ~ME r 3 III. CONSOLIDATED PERMIT ACTIVITIES Is your.F~ciJi~ CompliancePlan subje~ to review by... for sa~s~ing ~e condi~ons or,ese pe~i~? H. DEPAR~ENT OF TOXIC SUBSTANCES, CON~OL OYES ~O ¢ 'STANDARDIZ~PERMI~, OYeS ~o ¢, -No.-RC~ ~.~Ous WAS~ ~AC~U~ OYES ~O ¢ RC~ H~RDOUS WAS~ FACILITY L SAN JOAQUIN VALLEY UNIFIED.AIR'POLlUTION OYES ~O ¢ AUTHORI~ TO CONSTRUC~ .. CONTROL DIS~ICT ' ' OYES ~O ¢ PERMITTQ OPE~TE ' J. STA~ WA~R RESOURCES CO~ROL BOARD oYEs ~O ¢ WASTE DISC~RGE REQUIREMENT (~R) ~NT~L VALLEY REGIONAL WA~R QUALI~ CONTROL - OYES ~NO ¢ GENE~L PERMITS : ~yES ~O ~ SPECIFIC PERMITS OYES ~O ¢ NATIO~L POLLUTION DISCHARGE EEIMINATION SYSTEM (NPDES)' K. CALIFORNIA IN~G~D VVASTE MANAGEMENT BOARD, OYES ~O ~ REGIS~TION PERMIT L. KERN COUN~ RESOURCE :MANAGEMENT AGENCY ENVIRONMENTAL H~L~ SERVICES PERMITS ~ES ONO ~, . Dem~fic'Wate~ Well Pe~Jt OYES ~O ¢ H~ Mat Monit°dng Well Pe~it OYES ~NO ¢ Septic System Pe~it OYES ~O ¢ Public Swimming Pool Pe~it "OYES ~O ¢ Food Facili~ Cons~cfion Pe~it OYES ~O ~ Solid Waste Lo~rEnfomement Agen~ ~.',:~ (L~) Relat~ Pe~i~ OYES ~O ¢ M~i~l Waste R~lat~ Pe~its ' M. CI~ OF BAKERS~ELD WASTE WATER DIVISION OYES ~0 ¢ , INDUSTR~L WA'STE WA~R DISCHARGE PERMIT NOTE: ' - : ¢ If you check~ YES 'to any paK of S~fions IlI-H' to III-M above, ~en please addre~ all applicable pe~it r~uir~en~ in ~e Fadli~ Compliance Plan. J~y 1, ~ 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER/OPERATOR IDENTIFICATION FACILITY INFORMATION Pass I. FACILITY IDENTIFICATION FACILITY ID # I ~ [~t , : :~J ~ ~ i i 11 Year Beginning mo 'Year Ending BUSINESS NAME (Same aS FACILI~ NAME or 0SA- Doing B~in~s As) 3 BUSINESS PHONE-j- ........................ lo~ - DUN & ~o6 SIC CODE ' lol COUN~ .-, ' OPE~TOR NAME ~Z/~/~ ~T~ ~/~ ~~Y ~o9. OPE~TOR PHONE ~/~ "~ ~o II. OWNER INFORMATION OWNe~ ~A~UN~ II!. ENVIRONMENTAL CONTACT CONTACT NAME ~ ~g~ ~7 ~ CONTACT PHONE CONTACT ~ILING ADDRESS ,-PRIMARY- IV. EMERGENCY CONTACTS ~ECONDARY'- 2~HOUR PHONE ~ ~27 ~ 2~HOUR PHONE ~[ ,32 V. CERTIFICATION ' Ce~fica~on: Based on my inqui~ of ~ose individuals responsible for ob~ining ~e in~aaon; ce~ under~ penal~ of law ~at have pemonally examined and am ~miliar wi~ the info~aaon su~mi~ in ~is invento~ and believe the infe~a~on is ~e, accu~te, and;complete. ,' E~~ 13~ , T1TL~ ~ ~E~OPE~-~ ....... ,37 JPCF (7199) S:\CU PAFORMS\OES2730.TV4.wpd Business Owner/Operator Identification Please submit the Business Ac~:ivitJes page, the Business Owner/Operator ~dentification page (OES Form Z730), and Hazardous Materials - Che..m. ical- Description pages (DES Form 2731 ) for all hazardous materials inventory' submissions. For the inventory to be censid~'ed complete. this page must be signed by the appropriate individual. Note: the numbenng of the ins;truc~Jons foJlows the data element numbers that are on the UPCF pages.. These data element numbers are used ' ' .~r'e~ectronic submission and are the same as the numbenng used in 27 CCR, Appendix C, the Business Section, of the Unified Program Data..Dict[onary.) Please' number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER - l'his number is assigned by the CUPA or AA. This is the unique number which identifies your facjtity. 3..~ BUSINESS NAME - Enter the futi legal name of the business. 100. BEGINNING DATE - Ente~' the beginning year and date of the report. (YYYYMMDD) 101. ENDING DATE - Enter the, ending year and date of the report. (YYYYMMDD)" 102. BUSINESS PHONE - Enter the phone number, area code first, and any extension. 103.' BUSINESS SITE ADDRESS - Enter the street address where the facility is located, No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 104. CITY - Enter the city or unincorporated area in which business site is located. 105. 7_JP CODE - Enter the 7_Jp code of business site. The ex~a 4 digit zil3 may also be added. 106. DUN & BRADSTREET - Enter the Dun & Elrads~eet number for the facility. The Dun & Bradsa'eet '~umber may be obtained by calling (610) 882-7748 or by Intemet. 107. SiC CCDE - Enter the pdmary Standard Industria! Ctass/ficetion Code number for primary business activity. NOTE: If code is more than 4 digits, report only thE., first four. ' . 108. COUNTY ~ Enter the county in which the business site is located. 109. BUSINESS OPERATOR NAME - Enter the name of the 'business operator. 110. BUSINESS OPERATOR PHONE - Enter busin~es operator phone number, if different from business phone, ama code first, and any extension. · 111. OWNER NAME - Enter name of bus/ness owner, if different ff~3m bus/ness operator. 112. OWNER PHONE - Enter the business owner's phone number if different from business phone, area code first, and any extension. 113. OWNER MAILING ADDRESS - Enter the owner's mailing address if different from business site address. 114. OWNER CITY - Enter the name of the city for the owner's mailing address.' 115. OWNER STATE - Enter the; 2 character state abbreviation for the owner's mailing:address~ 116, OWNER ~JP CODE - Enter' the zip code for the owner~ address. The ~ 4 digit zip may also be added. 117.' ENVIRONMENTAL CONTAC'~. NAME - Enter the name of the person, if different from-the Business Owner or Operator, who receives all environmental .corresponder)ca and will respond to enforcemen[ activity. 118, CONTACT PHONE - Enter the phone number, if different from Owner or Operator, at which .the environmental contact can be contacted, ama code first, and any extension. 119. CONTACT MAILING ADDRESS - Enter the mailing address where all environmental contact correspondence should be sent, if different from thE; site address. ~20. CITY - Enter the name 0fthe city for the environmental contact~ mailing address. 121. STATE - Enter the 2 character state abbreviagon for the environmental contact=s mailing address. 122; ZIP CODE - Enter the zip cc~le for the environmental contact=s mailing address: The exlm 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be contacted in case of an emergency involving hazardous materials at the business site. The contact shall have FULL fadlity accel_s, site familiarity, and authority to make dec~sions for the business regarding incident mitigation. 124. TITLE - Enter the ~t~e of the primary emergency contact. 125. BUSINESS PHONE - Enter the business number for the pdmary emergency contact, area (~le first, and any extensions. 126. 24-HOUR PHONE - Eoter a 24-hour phone number for the pdmary eme~ency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone nUmber, then the service answering .the phone must be able immediately contact the individual stated above. 127. PAGER NUMBER - Enter the pager number for the pdmary emergency contact, if available. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondary representative that can be contacted in the event that the pdmary emergency contact is not available. The contact shall have FULL fadlity access, site familiarity, and au~odty to make derisions for the business regarding inddent_mitiga~on. 129. TITLE - Enter the title of the ;secondary emergency contact. 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code first, and any extensio~ 131. 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24 hour phone number must be one which is answered 24 hours a day. If it is not the contaCt's home phone number, th, ~e~~. the service answering the phone must be able to immediately contact the indMdual siatad above. 132. PAGER NUMBER - Enter the pager number for the secondary emergency contact, if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUP,as or AAs to collect any additional information necessary to meet the requirements of their indN/dual programs. Contact your fo(ag agency.for'guidance. 134. DATE - Enter the date ~at ~e document was signed. (YYYYMMDD) 135, NAME OF DOCUMENT PREPARER - Enter the full name of the person who prepared the inventory submittal information. 138. NAME OF SIGNER - En~r the full pdnted name of the person signing the page. The signer certJfles't~ a familiarity with the information submitted and that based on the signer~ inquiry of those individuals reSponsible for obtaining the information, all the information submitted is true, accurate and complete. SIGNATURE OF OWNER/OPERAT(DR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially deSignated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted and that based on the signer~ inquiry of those individuals responsible for obtaining the information it is the signer--s belief that the submitted information is t~ue, accurate and complete. 137.. TITLE OF SIGNER - Enter the title of the person signing the page. 'h'~ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES . 1715 Chester Ave., CA 93301 (661) 326-3979 ""~="~ ~'"~'-- HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION NE (one form per matet~al ~er builcling or area} W [] ADD [] DELETE [] REVisE 200 Page L FACILITY' INFORMATION BUSINESS NAME (Same as FAC1LI'r~' NAME or DE~ ~ Doing Business As) 3 ~ CONFIDENTIAL (EPCRA) .FACILfrY lO # '~ ~ ~' i!~1 - ~" ~:~ ' !' i i ~ J . ! 204 II, CHEMICAL INFORMATION --205 i TRADE SECRET Q Yes ~o 206 207 , FIRE CODE ~RD C~SSE~ (Complete if r~u~t~ by I~1 tim ~ie0 ~Pe C ~ ~U~E ~'~ M~E ~ ~ WASTE ~ ~ ~OA~VE QY~ ~No ~2 CUR~ES ~3 PHYSI~LSTATE : C s SOUO ~ MOULD C g ~S 214 ~. ~RGESTCO~AINER ~O ~H~RD~TE~RIES ~1 FIRE ~2 R~ C3 PRE~URE~SE ~4 A~H~L~ :~ CHRONICH~L~ ~0J/~ 216 f~ ~1 ~at apply) , * If SS. ~ount mbt be in lbs. STO~E CONTA~N~ ~ ~dL ~ ABOVEGROUND TANK ~ e ~ONM~C DRUM ~ i F~B~ DRUM ~ m.G~S BO~ ~ q ~IL (Che~all~etapp~) ~b UND~GROUNDTANK ~f ~N ~j ~G ~P~C BO~ ~r O~ ~ c TANK INSIDE BUILDING ~ g ~RBOY ~ k ~X ~ o TQ~ BIN ~ d S~DRUM ~ h SILO ~t CYMNDER ~ p T~KWAGON STOOGE PRESSU~ ~a AMBI~ ~ ~ ABQVEAMBI~ ~ be 8~OWAMBIENT ~4 STOOGE ~MP~RE ~a A~I~T ~ aa AEOV~ AM81~ ~ ba a~OW ~81E~' ~ c CRYO~NIC %~ H~RDOUS COMPONENT EHS CAS . ~ u~ ~0 ~' ~0¢~1~2q ~7 ~ 241 i ~8 ~9 ~Y~ ~No 2~ ~ 242 2~' ~.y ~ NO 2~ IlL SIGNORE - Pm'NT ~ME & ~T~ OF AU~OR,~ COMPANY REPRES~TATIVE ~I~TURE ~ ' JPCF (7~99) S:\CUPAFORMS\OES2731 .TV4.wpd Hazardous Materials Inventory - Chemical Descr!ption · you must complete a separate Hazarclous Materials inventory - Chemical Description page i'or eaci3 hazardous matsdal (hazardous substances and hazardous waste) that you handle at your fac~tib/in aggregate quantities equal to or greater than 500 pounds. 55 gallons. ;ZOO cubic feet of gas (calculated at S~andard temperature an~' presst~re) or the fec~eral threshold planning quantity for Extremely Hazardous Substances, whichever is less. ALso complete a page for eac~ radioactive material handled over quantities/or which an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40. or 70. The completed inventory si~oul(~ reflect all reportable quantillea of hazardous marshals at your fac;lilly, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state, storage temperature and storage pressure,. (Note: the numbering of the instructions follows the data element numbem that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering use~ in 27 CC,R, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or AA identify whether the submittal is compista and if any pages are separated. 1. FACIUTY iD NUMBER - This number is assigned by the CUPA or AA. This is the unique number whictt identifies your facility. 3. BUSINESS NAME - Enter the fuji legal name of the business. 200. ADD/DEL~J'F-/REVISE - thdioata if the matadal is being added to the inventory, delated from the inventory, or if the information previously submitted is being revised. NOTE; You may choose to leave this btanR ~fyou resubmit your entire inventory annually. Z01. CHEMICAL. LOCATION - Enter the building or outside/adjacent area where the hazardous matsdai is handled. A chemical that is stored at the same pressure ertd temperature, in multiple rocatipns within a building, can be reported on a Single page. NOTI=. This infcrmailon is not subject to public disclosure pumuant to HSC §25506. 202. CHEMICAL LOCATION CONFtDEN:FIA~ - EPCRA - All businesses which are subject to the Emergency Planning and Community Rght to Know Act (EPCRA) must c~eck "Yes" to keep c~emicat location information confidential. If the business does not wish to keep chemical location information confidential chec~ 'No'. 203. MAP NUMBER - If a map is incfuded, enter the number of the map on w~Jch the JooatJon of the hazardous matadaJ is shown. 204. GRID NUMBER - If grid coorclinatss are used, enter the gdd coordinates of the map that correspond to the location of the hazardous material, if applicable, multiple grid coordinates can be Itsted. 205. CHEMICAL NAME - Enter the proper chemical name ass~c_~ iated with the Chemical Abstract Service (CA~) number of the hazardous material.. This shouid be the Intemaaona Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safely Data Sheet (MSDS). NOTE: If the c. Jqemioal is a mixture, cio not complete this field; corr~plets the 'COMMON NAME" field instead. 206. TRADE SECRET - Chec~ "Yes' if the information in this section is dec~ared a trade secret, er 'No' if it is not. State requirement: If yes, and business is not subject tO EPC_,P,A, disclosure of the designated b'ade secret information ia bound by Hsc 925511. Federal requirement: If yes, and business is aubject to EPCRA, disclosure bf the designated Trade Secret informaUon is bound by 40 CFR and the business must submit a 'Substantiation to Accompany Claims of Trade Secrecy' form (40- CFR 350.27) to USEPA. 207. COMMON NAME - Enter the common name or trade name of the hazardous matadal or mixture containing a hazardous material. 208. EHS - Chec~ 'Yes" if the hazardous mater/al is an Extreme/y Hazardous ,Substance (EHS), es defined in 40 CFR, Part 355, .,~,opendix A. If the maledal is a mixture containing an EHS, leave this section blank and complete the section on hazardous.components beinw. 209. CAS # - Enter the Chemical Abstract Service (CAS) number for the hazardous matadaL For mixtures, enter the CAS number of the mixture if it has'been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank; and report the CAS numbers of the individual hazardous comPonentS in the appropriate section below. 210. FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This information shall only be provided if the local fire chief deems it necessary and requests the CUPA or AA to collect it. A list of the hazard classes and instructions on how to determine which class a matedal falls under'are included in the appendices of Article 80 of the Uniform Fire Code. If a material has moro than one applicable haZard class, include ail Cohtact CUPA or AA for guidance, · 211. HAZARDOUS MATERIAL TYPE - Check the one bo~ that best describes the type of hazardous malarial: pure, mixture or waste. If waste material, check only that box. If mixture or waste, complete hazardous componepts sect~rc 212.RADIOACTIVE- Check 'Yea' if the hazardous materi~,!s radioactive or 'No' if it is not. 213. CURIES - If the hazardous matedal is radioactive, use this area to _.report the activity in cudes. You may use up to nine dig~ with a floating decimal point to report activity in cudes. 214. PHYSICAL STATE - Chec~ the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas. 215. lARGEST CONTAINER - Enter the total capacity of the largest container in which the material is stored. 216. FEDERAL HAZARD CATEGOI:~IES - Check siJ categories that desc~be the physical and health hazards associated with the hazardous material. PHYSICAL- HAZARDS HEALTH HAZARDS Fire: Flammable LJquids and Solicls. Combustible [Jquids. P~/rophorics, Oxidizers Acute Health (Immediate): Highly Toxic; Toxic, Irritants, Sensitizers, Corrosives, Reactive: Unstable Reactive, Organic Peroxides, Water Reactive, Radioactive other hazardous chain/cole with an adverse effect with short term exposure Pressure Release: Explosives, Compressed Gases. Blasting Agents Chronic Health. (Delayed): CarcinogenS. other hazardous chemiCals with an adverse effect with Ion.q term exposure 217. AVERAGE DAILY AMOUNT ~ (.-,alculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/ outside area. Calculatic~ns shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemiosi w/Il b(t on ~Jte. If this is a mstadal that/'las not previously been present at this location, the amour~t shall be ~e average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. . 218. MAXIMUM DAILY AMOUNT * E"~tar the maximum amount of each hazardous'material or mixture containing a hazardous malarial, which L~ handled in a building or adjacant/outside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the matedal reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219. ANNUAL WASTE AMOUNT * If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. 220. STATE WASTE CODE - if the hazardous matedal is a waste, enter the appropriate California 3-digit hazardous waste code as listed on the be~k of the Uniform Hazardous Waste Manifest* 221. UNITS - Chect( the unit of measure that ie most appropdats for the matadai being reported on this page: gallons, pounds, cubic feet or tone. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), ail amoqnts must be reported in pounds, if material [sa mixture containing an EHS, report the units that the material is stored ~n (!gallons, pounds, cubic feet, or tons). 222. DAYS oN SITE - ~st the total number of days during the yea~; that the malarial is on site. 223. STORAGE CONTAINER - Check all boxes that describe the type of storage containers in which the hazardous matsdal is stored. NOTE; If appropriate, you may 224. STORAGE PRESSURE - ChecJ( the one box that best describes the pressure at which the hazardous niatedal is stored. 225. STORAGE TEMPERATURE - Check the one box that best describes the temperatura at which the hazardous material is stored. . 226. HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) - E~tsr the percentage weight of the hazardous component in a mixture, if a range of percentages is available, report the highest percentage in that range. (Report for components 2 through 5 in 230. 234, 238, and 242-) 227. HAZARDOUS COMPONENTS 1-5 NAME - When repa~ng a hazardoua matadal that is a mLxture, Jist up to five chemioal names of hazardous components in that mixture by percent weight (refer'to MSDS or, in the case of trade secretao refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non-oaroinegenic, or 0.1% by weight if carcinogenic, sbouid be reported. If more than five' hazardous compcinenta are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listad. (Reporl for components 2 through 5 in 231,235. 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 EHS - Check *Yes' if the component of the mixture is considered an Extremely Hazardous Substance as'defined in 40 Ct=R, Pad 355, or "No' ii-it is not. (Report for components 2 through 5 in 232, 236, 240, and 244.) 229. HAZARDOUS COMPONENTS 1-5 CAS - List the Chemical Abst~ct Service (CAS) numbers as related to the hazardous components in the mixture. (Rapeat for 246. LOCALLY COLLECTED INFORMATION - This space'may be used by the CUPA or AA to collect any additional information necessary to meet the requirements pt' their individual programs. Contact the CUPA or AA for guidance. UPCF (1/99) 7 0£.S Form 273 STA. 3.5 . .: -' ' ~ ' ........ ~,....:..:.: BRuNDAe~ .'.' . ' ..,.., ..,,:,~,~, ...... 8 C.I. A : - .' .'"'"~- .... '. ..~ .. .., '~ ~R. ' ~ FI~ ....................... ~5~ ITE DIAGRA~ [ ] FACILITY DIAGtc~ ~ "