HomeMy WebLinkAboutBUSINESS PLAN
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (805) 326-3979
iS 3a0::o~Se.°f re¢
SECTION 1' BUSINESS IDENTIFICATION DATA
BUSINESS NAME: ~Oqer,'c4m r~wC)t.r'l oJf'i Ogll~c t_ ~ ~t~.r~ +5
LOCATION: I~ZO [~('OeqOt'4&t e /_~r~.
MAn.ING ADDRESS: I~/~2_. ,~c~q4q ~+.
CITY: ~l~ffMZ5 ~/(~ /--0 STATE: ~10 Zii~: ~3301PHONE: ,3Z~-{o~o~
DuN & BV,.~ST~ET NU~EV,: q~ed Re,~ il, ~'r e cdc ~ . sic CO~E:
O~R: '] ~r-;"g -" ,' - _
SECTION 2: E~RGENCY NOT~ICATION
CONTACT TITLE BUS. PHONE 24 I-IR. PHONE
/
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING
NUMBER OF EMPLOYEES: ~ O
MATERIAL SAFETY DATA SHEETS .ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
sc, C- Y ,
SECTION 4: EXEMPTION REQUEST
I CERTIFY UNDER PENALTY OF PERJUKY 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~ia'3c° r~ CERTIFY THAT THE ABOVE
INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFO~TION 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 PERJURY.
SIGNATURE TITLE DATE
2
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES
A. AGENCY NOTIFICATION PROCEDURES:
B. EMPLOYEE NOTIFICATION AND EVACUATION:
C. PUBLIC EVACUATION:
D. EMERGENCY MEDICAL PLAN:
3
HAZARDOUS MATERIALS MANAGEMENT PLAN
.S. ECTION 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)_
NATURAL GAS/PROPANE:
ELECTRICAL:
WATER:
SPECIAL:
LOCK BOX: YES/NO IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION:
B. WATER AVAILABILITY (FIRE HYDRANT):
4
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (805) 326-3979
HAZARDOUS MATERIALS INVENTORY
FACILITY DESCRIPTION
CHECK IF BUSINESS IS A FARM [ ]
OWNER/OPERATOR ~, ~). ~ PHONE
MAO,rNG ADDRESS lq/Il V ~, '~- ~ta y' ~ Fd,
EMERGENCY CONTACTS
BUSINESS PHONE 53Z5"- 6, av6 f' 24 HOUR PHONE
BUSINESS PHONE 0°oo - z ~(~. ~?_o ~o 24 HOUR PHONE
HA~OUS MATERIALS INVENTO]
BusinessNam¢ ('Aoae.,rcco.,,a '~cOO~O+£o~,~.{ Address {~,Zo {~r~-n.c{c~ L-t3 Page~of
CHEMICAL I)ESCRIPTION
I)INVENTORYSTATUS:New[ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Tmde Seeret [ ]TradeSecret[ ]
2) Common Name: ~--'; ¢ e OO 0 ¢ ¢-S - /~ta SUrraer' 3) DOT # (optional)
Chemical Name: AHM [ ] CAS # -
4) Physical & Health PHYSICAL I-IF_ALTH
Hazard Categories Fire [ ] Reactive [ ] Sudd~ Relea.~ of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ]
5) WASTE CLASSIFICATION O-digit code flora DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [--~q Liquid [ I Gas [ ] Pure [ ] Mixture [ I Waste [ ] Radioactive [
7) AMOUNT AND TIME AT FACILrrY UNITS OF ~URE 8) STORAGE CODES
Maximum Daily Amount '3T, ooo £6~ Lbs[x]Gal[ ]fi3[ ] a)Containax.
Average Daily Amonnt ~ooo LS~ Curies[ ] b) Pressure:
Annual Amount /5-o~ o~o t.. 6~ c) Temperature
Largest Size Container KZ ~+ T~/te,~cO?--
# Days on Site 9/9 Cimle Which Months: AIl Year. J. F, M. A. M,/~, A, S. O, N, D
9) MIXTURE: List . COMPONEK~ CAS# % WT AHM
the three most hazardous 1) .J~k-. ~ ~ A c ,/ ~, I,:, ,~
, t'
any AHlVl components 3) [ ]
,__o ocA O 15 to o e' L to.
1) INVENTORY STATUS: New [ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trade Secret [ ]TradeSeeret[ ]
2) Common Name: 3) DOT # (optioual)
Chemical Name: AHM [ ] CAS #
4) Physical & Health PHYSICAL HEALTH
I-IazardCategories Fire[ ]Reactive[ ]Sudd_enReleaseofPressure[ ] ImmediateHeaith(Acute)[ ] Delayed Health (Chronic) [ ]
5) WASTE CLASSIFICATION O-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid [ ] Oas [ ] Pure [ ] ~ [ ] Waste [ ] P,a~oa~ve [ ]
7) AMOUNT AND TIME AT FACILITY 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: All Year, J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: List COIvtYO~ CAS# % WT AHIVl
the three most tumrdous 1) [ ]
chemical components or 2) [ ]
any AHM components 3) [ ]
10)LOCATION
[ 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
AMERICAN PROMOTIONAL EVENTS, INC.
STAND CONTRACT # LOCATION # DATE
BRAND SALES ASSOCIATE
CITY ORGANIZATION
SIZE CONSTRUCTION STYLE BACK DOORS
BILLBOARDS A-FRAMES BANNERS PENNANTS
SET-UP FROM TO DOWN DATE
ADDRESS
INTERSECTION
THOMAS GUIDE-COUNTY PAGE GRID INSPECTION DATE
SPECIAL INSTRUCTION
REVISION # DATE
SETBACKS - CURBS SIDEWALK BUILDINGS
Bid. 7 150 ft. Sierra N
40 ft. International
I I
40 ft. Machinery
Bid. 5
1620
Brunda~e L~
.
O Fire Hydrant
BRUNDAGE LANE