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Home My WebLink AboutBUSINESS PLAN 2130 G Stree[, Bakersfield, CA 93301 (805) 325-3979 TANK REMOVAL INSPECTION FORM FACILITY .~CvL9 ~'i~ ADDRESS OWNER ~~ ~~ PE~IT TO OPE~TE~ CO~CTOR ~ ~7-~ CO,ACT PERSON ~BO~TORY ~ .~ <~% $ OF S~PLES TEST ~ODOLOGY PRELI~ARY ASSESSMENT CO. ~ ~ .CO,ACT PERSON CO~ RECIEPT ~ LEL% ~~ '~, PLOT P~N CONDITION OF PIPING CONDITION OF SOIL t DATE INSPECTORS NAME S I GNATU~ BAKERSFIELD CITY FIRE DEPARTMENT " HAZARDOUS MATERIALS SITE/FACILITY DIAGI~S .,~'. FORM $ INSTRUCTIOSS 6ENERAL INSTRUCTIONS ,.,s. these instructions and..the attached fnrm to complete a SiTE DIAGRAM of %~e property and immediate surrounding area,, and a FACILITY DIAGRAM of each facility'unit"':or If the entire business can be Shown in adequate detail on the Site Plan, individual Facility Plans may not be necessary. The Inspector can assist you in making this Complete the ·information at the top Of the diagram f'orml" The box at the bottom of the form should be left blank. SITE DIfGR2J4 The SITE DIAGR~ should include the business and at least 300 feet from the property line. Identify the items listed on the SITE DIAGRAM using the symbols provided on the back. Include all items that apply. See the at~ached example. FACILITY DIAGRA~ : ' '" ' ~e~elop a':FAcILIT~'D~iAGIL/~' ~hat'~iil sh°w'the~building' interior and the immediate ......... :.,.~.exterior.,area... Comp!ete;a,s.eparate. FAC!LiTY DIAGRAM for each floor of a multi-story "'building. Identify on FACILITY DIAGRAM items iisted"under both "SITE DIAGRAM" and "FACILITY DIAGRAM" on the back'of this page. Use the symbols provided. Include all items that apply. See the.attached example. · - 5 - SIT E DIAGRAM L! TY DIAGRAM ~/~ ! 12/07/92 ROMERO AUTO TIRE 215-000-001373 ,, Page Overall Site with 1 Fac. Unit General Information Location: 800 E BRUNDAGE LN Map: 103 Hazard: Low Community: BAKERSFIELD STATION 06 Grid: 32C F/U: 1 AOV: 0.0 Contact Name Title Business ~P-~ne 24-Hour Phone- FRANK ROMERO ~/97FJ~0 TI ~ ( 805 )-8-3~-~-~ ~ ( 805,)~ ( ~zk - ~Z~qx (8~5.)3 ~3 - l o~. Administrative . Data Mail Addrs: 800 E BRUNDAGE D&B Number: City: BAKERSFIELD State: CA Zip: 93307- Comm Code: 215-006 BAKERSFIELD STATION 06 SIC Code: 7534 Owner: FRANK ROMERO JR Phone: (~~ -~6~ Address: 1016 E. BELLE TERRACE State: CA City: BAKERSFIELD Zip: 93307- Summary L_~ 7 ~7 0 / RECEIVED ' HAZ. MAT. DIV. 12/07/92 ROMERO AUTO TIRE 215-000-001373 ~ Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 WASTE OIL Liquid 300 Low · Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: WASTE Daily Max GALI Daily Average GAL I Annual Amount GAL 300 ~ 150.00 900.00 StorageIIPress T Temp Location UNDER GROUND TANK IAmbientJAmbientlNORTHEAST SIDE OF YARD -- Conc Components MCP Guide 100.0~ IWaste Oil, Petroleum Based Low I 27 02-002 GASOLINE Liquid 106 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL 106 ~ 106.00 106.00 Storage · Press .. Temp~ Location UNDER GROUND TANK Ambient AmbientlNORTHEAST SIDE OF YARD I (NOT IN USE AT THIS TIME) -- Conci Components MCP ---/Guide 100.0% IGasoline ModerateI .27 12/07/92 ROMERO AUTO TIRE 215-000-001373 ,:. Page 3 00 - Overall Site <D> Notif../Evacuation/Medical <1> Agency Notification 'CALL 911 OR CALL KERN OIL WASTE TO EVACUATE OR TAKE OIL WASTE AWAY <3> Public Notif./E.,va. cuat?n ~ ~ <4> Emergency Medical Plan KERN MEDICAL CENTER 1830 FLOWER STREET BAKERSFIELD, CA. (805) 326-2000 12/07/92 ROMERO AUTO TIRE 215-000-001373 ~ Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention TRY T° KEEP TAKE FROM GETTING TO FULL OR OVER FLOWING <2> Release Containment <3> Clean Up CONCRETE CLEANER FOR OIL <4> Other Resource Activation 12/07/92 ROMERO AUTO TIRE 215-000-001373 : Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUTSIDE B) ELECTRICAL- INSIDE C) WATER - OUTSIDE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water ONE FIRE EXTINGUISHER FIRE HYDRANT - ON THE SOUTH SIDE OF BRUNDAGE LAND AND MADISON STREET <4> Building Occupancy Level /~2/07/92 ROMERO AUTO TIRE 215-000-001373 ~ Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 2 EMPLOYEE WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use G Bakersfield Fire Dept. ql~i~// HAZARDOUS MATERIALS DIVISION v .,,,.? ._.~,~ Date Completed Business Name: ~ ~ ~o ~ ~.~ Location: ~ ~' ~ ~~ /~ U~u 0 Bu~ine~ Identification No. ~l~O00 ~o / 3 ? ~ ~op of Bu~ine~ Plan) 8ration No. ~ Shift ~ In~pe~or ~~u~ HAZ, MAT. DIV. Adequate Inadequat~ Verification of Invento~ Malerial~ ~ Verificmion of Ou~tilie~ ~ Verification of Loc~ion ~ o Proper Segregation of Maleri~~ mment~: NU Verification of MSD8 Availabli~ ~~z ~ ~ ~ tuber of Employee~ / Verification of H~ Mat Trainin~~ Commen~: Verification of Ab~emem 8upplie~ & Procedure~ ~ Comment~: Emergency Procedure~ Po~ted ~ 8p~ial H~ard~ A~ociated with lhi~ Facility: ~- ~~ ~ Violaions: , Correction Needed, I~ Business Ow~:/Ma'n~g~r '~y ' FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink. Business Copy ' HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE I .. To avoid furthmr action, re~urn this from within ~ days o¢ receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. ~. ~nswep ~hm qumB~ions bmlow for ~he business am a whole. -4. Be an brief and concise as possible. .'e SECTION J: BUSINESS iDENTIFICaTION D~T~ ..... 8. LOCATION,/ STREET ROORESS: ~d¢ .'"~ ~d~8~~. .~) SEOT~ON 2: EHER6ENCY NOTiFiCaTiONS In case of an emergency involving the release ar ~hrea'tened release a hazardous ma.terial, call ~11 and ~-8B~-852-7~5~ or 1-~1B-427-4341. This ~ill not~fy your local fire department and th~ e~a+~..._ Services as r~quired by law EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: ~EOT]oN ~: LOO~TZON OF UTiLiTY SHUT-OFFS FOR BUSZNESS ~S ~ ~HOLE B. ELECTRICAL: /~ ~/~t D. SPECZAL: E. LOCK BOX: YES / ~ ZF YES LOCATZON: ~F YES gOES IT CONTAZN SZTE pi Ab q? YE$/ NO HSBSS? r_= / FLOOR PLANS? YES / NO KEYS? YES / NO .. i SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS ~S A WHOLE ~ ~ ~ SECTION S: LOCAL EMERGENCY MEO!CAL 6SSISTANCE FOR YOUR BUSINESS ~S E QHOLE// S~ECT~O~ :6: EMPLOYEE TRAINING " ~P~;O~'ERS ~RE REQUIREO TO HaVE A TRAINING PROGRAM WHICH PROU!DES EMPLOYEES B. DO Y~'U..H~VE M~DS (MAT~RI~L S~FE~Y O~T~ SHEETS) FOR EACH H~Z~ROOUS ~/~/ C. GIVE ~ BRIEF SU~M~RY OF YOUR H~Z~ROOUS M~TER!~LS TRAINING PROGRAM: SECTION ?: E,XEMPT~O~ ~E,qV~ST I CERTIFY UNOER PENALTY OF PERJURY THET MY BUSINESS ~S EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER G.gS OF THE CGLIFORNI~ HEGLTH ~NO SEFETY COOE FOR THE FOLLO~)!NG EE~SONS: WE O0 NOT HANDLE HEZ~RDOUS M~TERIELS. WE O0 HANOLE H~ZGROOUS M~TER~LS~ 8UT THE QUENTITIES ~T NO i TIME EXCEED THE MINIMUM REPORTING Q~NTITIE~. OTHER (SPECIFY RE~SON) SECTION 8: OERTIFICETION " I, , certif't tha~ the above information accurate.' I understand that~i5 information wi!i be usad to fu!?ilt my " ~irm~s under the C~i~oroi~ H~Lth ~nd S&(~ty cod~ Hazardous Materials (Div. ~ Chapter ~.9S S~c. 2S500 Et ~!. ) and BAKERSFIELD CiTY FiRE DEPARTMENT 2!50 "G" STREET BAKERSFIELD, CA 93301 O~r.C~A~ USE ONLY BUS I NESS PLAN FOI~I¥I SA INSTRUCTIONS 2. TYPE/PRINT YOUR. ~S~ERS IN ENGhISH. 3. Answer the questions belo~ for THE FACILITY UNIT LISTED BELO~ 4. Be'aS'BRIEF'and CONCISE as .posSible FACILI~ ~IT~ FACILI~ ~IT N~: SECTION I: ~ITIGATION~ PRE~ION~ ABATEHEh~ PROCED~ES SECTION 2: NOTIFICATION .~d~D EvAcuATION PROCEDURES AT THIS UNIT 0N'LY - % SECTION 3: HAZARDOUS MATERIALS FOR THIS [~iT ONLY A. Does this Facility Unit con~ain Haz~,'4ous MaterJa!,3? ..... , If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardouu ma'te~'ia]~ a bona_Fide *'~,,ie~] ..... Sec:'e~ YES If No, complete 'a separate hazardous materials inventory '. '" "-' form marked: NON-TRADE SECRETS ONLY (white form =4A-l) If Yes, complete a hazardous materials inventory form marked: .T~DE SECRETS ONLY (yellow form ~4A-2) in addition .to the non-trade SECTION 4: PRIVATE FIRE PROTECTION .......... . . ..:........;,.....;SECTION 6.: .. LOCATION .OF IITILITY SHUT~OFFS..AT .THIS. UNIT ONLY..,. ....... ~':/~. . .::',.:A...NAT, .GAS/PROP~Y :..,~.:'~;..~ .... .~ ~>. -.,'--..:. ........ . 'O.o~'. ~ ~.. ao~'L~ 5~- .... :- " -, '": .B. B~CTRECA~: .... ./.~.~~; ... ..... . . . .... , .......... C. WATER: D. SPECIAL: E. LOCK BOX: YES' /~IF YES, LOCATION: iF VES ST~ , , .~E PLANS9 YES / Na MSDSs9 VES / NO FLOOR PLANS?. YES / NO KEYS? YES /' NO CITY of BAKERSFIELD '~__, ~HAZARDOUS MATERI ALS INVENTORY' ~erm 4nd *q~%cultur~ ~t~nd~rd NO N-- IRA D E S E C R E ~?S ' ~lth of P~ ~lth .................. ~t l] ~&C.A.S. ~ ~lth of ~m ~lth ~lth of P~ ~lth ~-~ -- -- -- r-- C~t 12 ~&C.A.S. ~ HHlth of re.sure ~lth COrttfica~i~ (Re~d and siKn after completJn~ all sections)