HomeMy WebLinkAboutBUSINESS PLAN BAKERSFIELD CITY FIRE DEPARTMENT '~
2130 "G" STREET RECEIVED
BAKERSFIELD, CA 93301
(805) 326-3979 JUL 6 1987
A,s'd ............
OFFICIAL USE ONLY
3USINESS NAbfE
HAZARDOUS MATERIALS
BUSINESS PLAN AS A WHOLE
FORM 2A
INSTRUCTIONS: 000513
1. To avoid further action, return this form by
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
A. BUSINESS NAME: J:~'$ G~*~6~
B. LOCATION / STREET ADDRESS: I~f)~
CITY: ~~F~ ~ ZIP:
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify
your local fire department and the State Office of Emergency Services as required by
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS.
A. ",,Jim ~-~¢0~ (OgO~) Ph# 327-7080 Ph# BFl-tOt~
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSI~SS AS A ~OLE
A. NAT.. 6AS/PROPANE: H~ CO~NE~ o~ o~S~O( oF ~.
B. ELECTRICAL: ~O~W~ ~a~
D. SP OZA :,., N/A
E. LOCK BOX: YES /~ IF YES, LOCATION: ~D i
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO
FLOOR PLANS? YES / NO KEYS? YES / NO
2A -
SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
SECTION 6: EMPLOYEE TRAINING.
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL REFRESHER'
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
MATERIALS:.... .................................... ~ NO ~) NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: NO NO
C. PROPER USE OF SAFETY EQUIPMENT: .................. NO NO
D. EMERGENCY EVACUATION PROCEDURES: ................. NO ~) NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES (~ YES NO
SECTION ?: HAZARDOUS MATERIAL
CIRCLE YES 0R NO
DOES YOUR BUSINESS HANDLE HAZARDOUS ,MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES N~
I, L ~f(,R.¥ ~j. ~D~uA~ , certify that the above information is accurate.
I understandthat this information will be used to fulfill my firm's obligations under
the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95
Sec. 25500 Et Al.) and that inaccurate information constitutes peroury.
- 2B -
BAKERSFIELD CITY FIRE DEPART~fENT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
ID#
BUSINESS NA~[E:
BUSI NESS PLAN
SINGLE FACILITY UNIT
FORM SA
INSTRUCTIONS 1. TO avoid fut'ther action, this form must be retugned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. AnsweP the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY UNIT# FACILITY UNIT NAME:
SECTION 1: MITIGATION, PREVENTIONI ABATEMEN"r PROCEDURES
/
SECTION 2: NOTIFICATION ~Nq] EVACUATION PROCEDb~RES AT THIS UNIT ONLY
/
· SECTION 3: ,HAZARDOUS MATERIALS FOR THIS UNIT ONLY
.A. Do.es this Facility Unit contain i~azardous Materials? ...... YES NO
/
If YES, see B. /~/~
If NO, continue with SECTION 4.
B. Are any of the hazardous m~'terials a bona fide Trade Secret YES NO
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (%vhite form
If Yes, complete a hazardous materials inve~ltor¥ form marked:
TRADE SECRETS ONLY (yellow form ~4A-2) in addition to the non-trade
secret foPm. Li-st only the trade ' ~ *
sec. e,.s oll for~ 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS
SECTION 6: LOCATION OF UTILITY SHUT-OF~S AT THIS UNIT O~LY.
A, N'AT. GAS,/PROPA?,~":
B. ELECTRICAL:
~occt7~ oo ~ ac c_a~7-c~ .
C. WATER:
D. SP~.C!~L:
E. LOCK BOX: YES .~!F YES, LOCATION:
IF YES, SITE PLANS? YES / NO MSDSs? YES / NO
FLOOR PLANS? YES / NO KEYS? YES / NO
BAKERSFIELD CITY FIRE DEPARTMENT .,
I.D. # FORM 4A-1 Page ~ of
NON--TRADE SECRETS
HAZARDOUS MATERI ALS I NVENTORY
BUSINESS NAME: ~-Jim'5 Gae..e~c~ ~ ~,N6 OWNER NAME: ~,m ~5~ FACILITY UNIT
ADDRESS: /aOI ~uNOh~ ~a.- ADDRESS: ~//~ L~T~a ~..... FACILITY UNIT NAME:
PHONE ~: 3~-7a~0, , PHONE.,, ~: ~]-~0[~ [OFFICIALoNLY USE CFIRS COOE
1 2 3 4 5 6 7 8 9 i0
TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY BAZARD ~D.O.T
CODE AMOUNT AMOUNT UNIT] CODE CO~E FACILITY UNIT WT. CHEMIQAL OR COMMON NAME CODE,., GUIDE
O~
~ X~ 300 GAL ,~,,D ~q ~oP ~ ~z(
' "
~ ~ 150 G~L oG o~ ~BoP C~l~G ~ocU~T ~LL~
N~ME: '~N 3. ~~ TITLE: GeN. ~e:' SIGNATURE'(~~ ~~~ DATE:
EMERGENCY CONTACT: ~ ~~N TITLE:, O~N~ ' ./ ~ONE · BUS HOURS: ....
AFTER BUS HRS:
E~ERGENCY CONTACT: L~y ~~ TITLE: ~N. ~G~, PHONE ~ BUS HOURS:
· PRINCIPAL BUSINESS ACTIVITY: %~o ~'P~{~ ,~Ctc%~ ~ UfHIC~ $C0~6{' AFTER BUS HRS:
- 4A-1 -