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HomeMy WebLinkAboutBUSINESS PLAN 10/2/2007li Freeway Liquors ' 2140 E_Brundage Ln_ __ _ ~~ ~ _.. ./ . h FREEWAY LIQUORS SiteID: 015-021-001321 Manager DON L CHILDERS BusPhone: (661) 323-0254 Location: 2140 E BRUNDAGE LN Map 103 CommHaz Moderate City BAKERSFIELD Grid: 33D FacUnits: 1 AOV: CommCode: KCFD STA 41 SIC Coder EPA Numb: DunnBrad: l2-793-5401 Emergency Contact / Title Emergency Contact / Title REX A CHILDERS / ASST MANAGER DON L CHILDERS / MANAGER Business Phone: (661) 323-0254x Business Phone: (661) 323-0254x 24-Hour Phone (661) 706-3093x 24-Hour Phone (661) 319-5515x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact Phone: (661) 323-0254x MailAddr: 2140 E BRUNDAGE LN State: CA City BAKERSFIELD Zip 93307 Owner LL•; OYD;~~G CHILDERS w:.:;.;~;;~,,.:;.;.. , ..,,, Phone : , „ ~ ,323 - 0254x ( 6, 61 ) . Address 6107 ROUNDUP WY . State: ~ , ~, , CA City BAKERSFIELD > ~,,,,,, ~ -~~,~~; Zip 9~~~'C~:Srt fib,: ~~;, , Period ~~~ to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ~NT'p oc r ~ ~~~~ Eased on my inquiry of those individuals responsible for obtaining the information, i certify under penalty of law that I have per,onally examined and am familiar with the information submitted and believe the information is true, `,.~l~ltf /D~ Z-~ 7 Signature Date -1- 10/01/2007 ,,~ ~"°` -- ~' ~ Prevention- Services ,rIJNIFIED PROGRAM INSPECTION CHECKLIST e, e R s r t D 9ooTruxtunAve., suite2lo -_ FIRE Bakersfield, CA 93301 SECTION- 1: Business Plan and Inventory Program ~ aRrM Tel.: (661) 326-3979 - - ~ Fax: (661) 872-2171 FACILITY NAME ~c ~ INSP TI N DATE 7 !t 6 INSPECTION TIME i ADDRESS - f ~0 ~ ~ _ - PHONE NO- '3.a3-~~d O OF EMPLOYEES FACILITY CONTACT - BUSINESS ID NUMBER 15-021- ~/ a- Section 1: Business Plan and Inventory Program ^ ROUTINE OMBINED~ ^ JOINT AGENCY ^ MCILTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~~~~ ~ ~ - ,~ t ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING - ^ FIRE PROTECTION ,~/ Id ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIO ~ REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 /I/~ !f ~ (/ nspector (Please Print) ~ Fire revention / 1" In /Shift of Site/Station # Business Site / Respo a Party (Please n - White -Prevention Services - Yellow -Station Copy Pink -Business Copy - FD 2155 (Rev. 09/05 ^ YES ~C7 NO ,$... r INSPECTIONS BUSINESS PLAN 8~ INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~C~A1at~-r ~ t C~~lm/ .. B D E R S F I L D P/RE A/PTM T Section 2: Und ground Storage Tanks Program BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 INSPECTION DATE: r~( ^ Routine Combined Join Agency ^ Multi-Agency Complaint ^ Re-Inspection Type of Tank ~~ Number of Tanks Type of Monitoring Type of Piping ~ OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes ,~t~ Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill I overspill protection? C =Compliance V =Violation Y =Yes N = No r Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services ~~ Business Site Responsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) ~. F FREEWAY LIQUORS SiteID: 015-021-001321 ~ STORAGE CONTAINER DATA (UST FORM A) - Last Action Type: - - FACILITY/SITE INFORMATION Business Name: FREEWAY LIQUORS Cross Street Business Type: Org Type: Total Tanks 2 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP RICH ENVIRONMENTAL ICC Nbr: 106416602 PROPERTY OWNER INFORMATION Name DON L CHILDERS Phone: (661) 323-0254x Address: City State: Zip: Type INDIVIDUAL Name DON L CHILDERS Address: City Type INDIVIDUAL BOE UST Fee# UNKNOWN Financ'1 Resp: STATE FUND Legal Notif Date:08/17/1999 Name:LLOYD CHILDRESS State UST # .~ TANK OWNER INFORMATION Phone: (661) 323-0254x State: Zip: Phone : (13 2 ) 6 - x Ttl:OWNER 1998 Upg Cert#: ~~ -2- .~ 10/01/2007 F FREEWAY LIQUORS SiteID: 015-021-001321 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PREMIUM UNLEADED GASOLINE REGULAR UNLEADED F F IH DH IH DH L L 12000.00 12000.00 GAL GAL Mod Mod -3- 10/01/2007 -4- 10/01/2007 F FREEWAY LIQUORS SiteID: 015-021-001321 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL GAL iZL-1GtiiCLVUJ l.Vl"lYV1V r,1V 1.7 °sWt . RS CAS# 100.00 Gasoline No 8006619 -- IlL-~GKKL E'lA.7P~~7A1"11:+1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME REGULAR UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL I 12000.00 GAL _~~~,.~...U~ COMPONENTS %Wt• RS CAS# 100.00 Gasoline No 8006619 I11iL~ti1CL tii J iJ L' J.71•1L'1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 10/01/2007 F FREEWAY LIQUORS SiteID: 015-021-001321 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/19/2006 ~ DIAL 911 AND REQUEST FIRE DEPARTMENT ASSISTANCE. NOTIFY LOCAL HAZARDOUS MATERIALS BUREAUS 326-3979. NOTIFY STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation 04/19/2006 THIS STORE ONLY HAS ONE EMPLOYEE PER SHIFT, THE EMPLOYEES ARE INSTRUCTED TO CALL MANAGERS. AFTER NOTIFING THE FIRE DEPT, MEET MANAGERS AT THE SE CRNR OF PROPERTY. Public Notif./Evacuation 01/07/1990 EMPLOYEES ARE INSTRUCTED TO CALL FIRE DEPARTMENT FIRST, THEN OBTAIN FIRE EXTINGUISHER AND STAND BY IN CASE SPILL IS IGNIGHTED, AND DIRECT THE PUBLIC AWAY FROM THE SPILL. Emergency Medical Plan 04/19/2006 CALL 911, ASK FOR AMBULANCE AND/OR FIRE DEPT. SEND INJURED TO KERN MEDICAL CENTER, 1830 FLOWER ST, 326-2000. -6- 10/01/2007 F FREEWAY LIQUORS SiteID: 015-021-001321 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/19/2006 ~ INSPECT EQUIMENT AND REPAIR, AS NEEDED. UST INSPECTION PROGRAM. Release Containment 04/19/2006 EMERGENCY PUMP SHUT-OFF ON GASOLINE COMPUTER CONSOLE, POUR GREASE SWEEP OR OTHER ABSORBENT MATERIAL ON SPILL, CALL FIRE DEPT FOR FOAM UNIT. Clean Up 04/19/2006 CLEAN UP SPILL WITH ABSORBENT MATERIALS, CONTACT LICENSED HAZARDOUS WASTE MATERIAL HAULER (MP VACUUM TRUCK SERVICE - ENVIRONMENTAL DIVISION). Other Resource Activation -7- 10/01/2007 F FREEWAY LIQUORS SiteID: 015-021-001321 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .~~c~.ia~. azac.aiu~ Utility Shut-Offs GAS - NE CRNR OF BLDG ELECTRICAL - MAIN BREAKER BET STOREROOM & COUNTER AREA WATER - SHUT-OFF VALVE E SIDE BLDG SPECIAL - GAS PUMP EMER SHUT-OFF ON COMPUTER CONSOLE 08/31/2007 Fire Protec./Avail. Water 04/19/2006 PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS. FIRE HYDRANT - E SIDE OF PROP. Building Occupancy Level 04/03/2006 6 EMPLOYEES -8- 10/01/2007 F FREEWAY LIQUORS SiteID: 015-021-001321 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 11/17/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: NEW EMPLOYEES ARE INSTRUCTED TO FIRST SHUT OFF FUEL PUMP WITH EITHER EMERGENCY PUMP SHUT-OFF ON CONSOLE OR PULL MAIN BREAKER. DIAL 911 AND ASK FOR FIRE DEPT AND/OR AMBULANCE. CALL ONE OF THE MANAGERS. STAND BY WITH FIRE EXTINGUISHER, IF PRACTICAL, AND DIRECT THE PUBLIC AWAY FROM THE SPILL. IF PRACTICAL, SPRINKLE GREASE SWEEP OR ABSORBENT MATERIAL ON SPILL TO HELP CONTAIN. rayc ~ nclu 1VL 1'uI.ULC U.7'C I1C1U 1VI t'UI.ULC V.5'~ -9- 10/01/2007 - ~ ~~ ~~ ;, UNIFIED PROGRAM INSPECTION CHECKLIST~E SECTION 1: Business Plan and Inventory Program ^ YES '~NO FACILITY NAME // ~ INSPECTION DATE 1NSPECTI~N TIME f2.•GE~R+ L-I Q 1A 0+2,5_, ADDRESS Z I N G ~ 7 j6L ~ PHON NO. O OF EMPLOYEES gyn. >1 p!~ E L J FAC1L{TY CONTACT USINESS ID NUMBER / 15-021- 6 Sec#ion 1: Business Plan and inventory Program ^ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION ~J C V ~ C=Compliance OPERATION V=Violation ~T ;~ ~, ~~~~ COMMENTS ^ APPROPRIATE PERMIT ON HAND L~ ^ BUSIII@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ,~ ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES (~ _ (~ ~D ^ VERIFICATION OF LOCATION o ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITY Q ~ VERIFICATION OF HAZ MAT TRAINING ~n-.ANN /NC, ~ar.~ ws ~,-~. ~ ~~ ~ _p Ot,t,..}. a ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ ~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTION/~S, REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326.3979 /~i/L~M' /~° ~ -~ ) i Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # sines Sit Respon le Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy , - FD 2155 (Rev. 09/05 Prevention Services e E R 5 F ,_ D -900 Truxtun Ave.> Suite 210 _.. FIRE Bakersfield, CA 93301 ~RrM r Tel.: (661) 326-3979 Fax: (661) 872-2171 tttlf-bU1J ~- INSPECTIONS B E R S F I L D BUSINESS PLAN & ~ rM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~'C.•E~+N~7 LI q,~ o2,s • Section 2: Underground Storage Tanks Program INSPECTION DATE: ~ 3( 0~ ^ Routine ^ Combined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank ~ ~ ~•ho ~ c~~ s Number of Tanks 2 Type of Monitoring~`~~~ ~G~ Type of Piping ~~.ESSu.2~ ~ ~+1 A~• S(4s s OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes ,~ No - Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: V~G ~'"~~ '`~ ~ ~"~ Questions regarding this inspection? Please call us at (661) 326-3979 • White -Prevention Services Aggregate Capacity Number of Tanks tf u n s Sit esponsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09105) + FREEWAY LIQUORS _____________________________________ SiteID: 015-021-001321 + Manager Location: 2140 E BRUNDAGE LN City BAKERSFIELD BusPhone: (661) 323-0254 Map 103 CommHaz Moderate Grid: 33D FacUnits: 1 AOV: CommCode: KCFD STA 41 EPA Numb: SIC Code: DunnBrad:12-793-5401 Emergency Contact j Title Emergency Contact / Title REX A CHILDERS / ASST MANAGER DON L CHILDERS / MANAGER Business Phone: (661) 323-0254x Business Phone: (661) 323-0254x 24-Hour Phone (661) 706-3093x 24-Hour Phone (661) 319-5515x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact Phone: (661) 323-0254x MailAddr: 2140 E BRUNDAGE LN State: CA City BAKERSFIELD Zip 93307 Owner LLOYD G CHILDERS ' Phone: (661) 323-0254x Address ~1Q 7 ~Y~~ (~(p ate C I~ City BAKERSFIELD _I : Zl !! p ~~ ~~~~ Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT PROG U - UST Based on my inquiry of those indiviauais responsible for obtaining the information, P certify under penalty of law that I have personally examined and am familiar with the informatia~~ submitted and believe the information is true, accurate, and com ~~~ ~te~ Signature- L"` ~ ~- 6 -O ~ Date ~NT'~ A ~~ ~ 9 . . ~DO~ -1- 04/03/2006 -' :. - ~~ .~_._ UNIFIED PROGRAM INSPECTION CHECKLIST ~' ~«i - . ~.., .. ...:. w.:, .... .... ..., ~Rrr SECTIORi 1-:- Business Plan and Inventory Program ~ BAKERSIF'IELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 BakersSeld, CA 93301 Tel.: (661) 326-3979 - Fax: (661) 872-2171 FACILITY NAME ~ NSPECTION DATE INSPECTION TIME A ~g HONE NO. O OF EMPLOYEES "T ~ ~.C z 3-~~ S~ FACILITY CONTACT USINESS ID NUMBER 15-021- Section 1: Business Plan end Inventory Program ^ ROUTINE BINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C . ~V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND BUSIrI@SS PLAN CONTACT INFORMATION ACCURATE ~/^ VISIBLE ADDRESS 7~F9 CORRECT OCCUPANCY ~^ VERIFICATION OF INVENTORY MATERIALS I~1 /CI VERIFICATION OF QUANTITIES ~7/8 VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL 4S CJ VERIFICATION OF MSDS AVAILABILITY ^~8 VERIFICATION OF HAZ MAT TRAINING ~A~j-' IY IIYC7 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES (~]/CT EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY LABELED 4 HOUSEKEEPING LC~/^ FIRE PROTECTION 1~_ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES NO EXPLAIN: - - - --------- -----------•----- - ~, O STIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (t3t31) 32a-3979 I spector (Please Pn t) Fire Prevention / 1" In / Shift of Site/Stetion q Business Sit School Site Responsible PaAy (Please Prnt) White -Prevention Services Yellow - Station Copy Pink - Business Copy FD2049 (Rev. 02/05) Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: '~,/',~/- ~ ,Gt ~- ,~ S Facility ID #: Facility Address: ~/~ v ~ ~~ iJnr~J.4 ~,L L ,-, l,3sf/C~ ? ' ti'/~~ ~ i -, ifl ~jj~ 7 Reason for Submitting this Form (Check One) t~ Change of Designated Operator Facility Phone #: ~ ~, / - ;3,2,3 -UZ y-y ^ Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRTMARY Designated Operator's Name: . ~ Relation to UST Facility (Check One) Business Name (If different from above): ~UtY~~ ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: ~~ _ • (~ ed. ~ ,~ ~ L~Service Technician ^ Third-Party ' International Code Council Certification #: ~oZ ~(p~ ~,~ - l~ L Expiration Date: Il ~~a ~C7~ AT,TF.RNATE 1 (Ontinnall Designated Operator's Name: '~/~ ~ ~~ ~~p / 1 Relation to UST Facility (Check One) Business Name (If different from above): ~ {C:(~l~Nl% 11Qa/1/h~it-' ^ Owner ^ Operator ^ Employee. Designated Operator's Phone #: (p(P~ ~ '~] Ll 3 ' ~g' , ~ Service Technician ^ Third-Party International Code Council Certification #: ~i7Z ~g~ yV - l9 L Expiration Date: ALTERNATE 2 (Ontionaq Designated Operator's Name: ' Ph~s `~lG,-{ Relation [o UST Facility (Check One) Business Name (If different from above): ~ f, G H '~N (~ j ~ ^ 'Owner ^ Operator ^ Employee Designated Operator`s Phone #: (pGj(- ~~((©, - ~(p ~ ®' Service Technician ^ Third-Pally lntcrnational Code Council Certification #: ~~ / ~pe(!" UG Expiration Date: ~l ~ '^~[~. NU'I'E: THE LOCAL REGULA'I'UKY AGENCY MUST 13L NO'I'IF1EU OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. I certify that, for the facility indicated at the top of this page, the individual(s) listed above will . serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). ~ ' Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances} applicable to underground storage tanks. NAME OF TANK OWNER OR OWNER'S AGENT (Please Print): ,~ SIGNATURE OF TANK OWNER OR OWNER'S AGENT: ~X LfI~ .y/~,~f DATE: ~ _ ~ - O ~ OWNER'S PHONE #; ~ ~ ~ "~ Z 3 -O L 5"'f September 2004 FREEWAY LIQUOR STORE SiteID: ~015-021-001321 Manager : BusPhone: (661) 323-0254 Location: 2140 E BRUNDAGE LN Map : 103 CommHaz : Moderate City : BAKERSFIELD Grid: 33D FacUnits: 1 AOV: CommCode: COUNTY STATION 41 SIC Code: EPA Numb: DunnBrad:12-793-5401 Emergency Contact / Title Emergency Contact / Title REX A CHILDERS / ASSISTANT MANAG DON L CHILDERS / MANAGER Business Phone: (661) 323-0254x Business Phone: (661) 323-0254x 24-Hour Phone : (661) 706-3093x 24-Hour Phone : (661) 319-5515x Pager Phone : ( ) - x Pager Phone : ( ) - x ....................................... + ...................................... Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 323-0254x MailAddr: 2140 E BRUNDAGE LN State: CA City : BAKERSFIELD Zip : 93307 Owner LLOYD G CHILDERS Phone: (661) 323-0254x Address : 505 BOBWHITE CT State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: · ~ /~'qOe of'print n~hle) reviewed the attached hazardou~ ment plan for~,~ any corrections con~titut~ agement plan for my facility. i 03/01/2004 FREEWAY LIQUOR STORE SiteID: 015-021-001321 STORAGE CONTAINER DATA (UST FORM A) .............. Last Action Type: ......................... FACILITY/SITE INFORMATION -= Business Name: FREEWAY LIQUOR STORE Cross Street : Business Type: Org Type: Total Tanks : 2 IndnRes/Trust: No PA Contact: ......................... PROPERTY OWNER INFORMATION ......................... Name : DON L CHILDERS Phone: (661) 323-0254x Address: City : State: Zip: Type : INDIVIDUAL ................... TANK OWNER INFORMATION ........................... Name : DON L CHILDERS Phone: (661) 323-0254x Address: City : State: Zip: Type : BOE UST Fee# : UNKNOWN Financ'l Resp: STATE FUND Legal Notif' : Property Owner Mailing Address Name:LLOYD CHILDRESS Ttl:OWNER State UST # : 1998 Upg Cert#: 00839 -+ -2- 03/01/2004 FREEWAY LIQUOR STORE SiteID: 015-021-001321 + += Hazmat Inventory By Facility Unit + +== MCP+DailyMax Order Fixed Containers on Site + ................................ + ....... + .... + ..... +- -+ .... +- - -+ Hazmat Common Name... ISpocHazlEPA HazardsI Frm I DailyMax IUnitlMCPl ................................ + ....... + ........... +- + -+ .... +- - -+ REGUI..d~ UNLEADED F IH DH L 15000.00 GAL Mod PREMIUM UNLEADED GASOLINE F IH DH L 12000.00 GAL Mod -3- 03/01/2004 + FREEWAY LIQUOR STORE SiteID: 015-021-001321 += Inventory Item 0002 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME --+ REGULAR UNLEADED I Days On Site 365 Location within this Facility Unit Map: Grid: + ................ UST 8006-61-9 += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Liquid I Pure I Ambient I Ambient I UNDER GROUND TANK 4 ~ =4 =4 + +--- + AMOUNTS AT THIS LOCATION == Largest Container Daily Maximum I Daily Average 15000.00 GAL 15000.00 GAL I 15000.00 GAL 4 ~ +== ~ HAZARDOUS COMPONENTS ---+=== 100.00 Gasoline No 8006619 ~===4 t HAZARD ASSESSMENTS===+= ~ + ...... TSecretl RSIBioHazl Radioactive/Amount EPA Hazards NFPA USDOT# I MCP No No No No/ Curies F IH DH / / / Mod ~===~ ~==: ~ ~=- ~ +=====- MISC. LOCAL AGENCY DATA Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag. Defined5: Ag. Defined6: Ag. Defined7: Ag.Defined8: Ag.Defined9: Ag.Definel0: +- Ag. Definell ................................................................ -4- 03/01/2004 FREEWAY LIQUOR STORE SiteID: 015-021-001321 += Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Acti°n Type: Location In Site: UST .............................. TANK DESCRIPTION .............................. Tank ID#: 2 Mfr: XERXES Compart Tank: N Installed: 01/1999 Capacity: 15000 Gals No. Of Comparts: 'Additional Info: +~ ............................... TANK CONTENTS ............................... I Tank Use: MOTOR VEHICLE FUEL Petrol Type: REGULAR UNLEADED Matl Name:REGULAR UNLEADED Cas #: 8006-61-9 ............................. TANK CONSTRUCTION ..... ~ ........................ Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1999 Alarm : Exempt: No Drop Tube : 1999 Ball Float : Striker Plate: 1999 Fill Tube S/O: 1999 ............................ TANK LEAK DETECTION ............................. Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -5- 03/01/2004 + FREEWAY LIQUOR STORE SiteID: 015-021-001321 += Inventory Item 0002 Facility Unit: Fixed Containers on Site + STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 + ............................. PIPING CONSTRUCTION UnderGround Piping At~oveGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : A.O. SMITH Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : + ..................... z ..... PIPING LEAK DETECTION ............................ UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT ............................ Installed: 03/17/1999 Type: DISP. PAN SENSOR W/ POS. SHUTOFF .......................... OWNER/OPERATOR SIGNATURE .......................... Date: 03/17/1999 Name:LLOYD CHILDRESS Ttl:OWNER Prmt Number: 1321 Approved: Yes Expiration Date: 06/30/2006 ............................ ~-- AGENCY DEFINED ............................... TANK/LINE TEST : CP CERT. : MANWAY INSP. : UST MONIT. CERT:10/01/2003 -6- 03/01/2004 + FREEWAY LIQUOR STORE -- -- SiteID: 015-021-001321 += Inventory Item 0001 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME ~ PREMIUM UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: + -+ UST CAS# 8006-61-9 += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Liquid I Mixture I Ambient I Ambient I UNDER GROUND TANK 4 =4 ~ ~ ~ ----+ + -+ AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL GAL + =+---- 4 ==+ 4 ~ HAZARDOUS COMPONENTS =+===~ 100.00 Gasoline No 8006619 4 ~ +==~ + ~===~ + HAZARD ASSESSMENTS ===4 += ~ ..... TSecretl RSIBi°Hazl Radi°active/Am°unt EPA Hazards I NFPA I USDOT# MCP 7===+= ..... ~ ~ ~ + ~=====+ MISC. LOCAL AGENCY DATA - Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag. Defined8: Ag.Definedg: A~.Definel0: +- Ag.Definell ................................................................ -7- 03/01/2004 FREEWAY LIQUOR STORE -- SiteID: 015-021-001321 += Inventory Item 0001 -- Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UST .............................. TANK DESCRIPTION .............................. Tank ID#: Mfr: Xerxes Compart Tank: N Installed: 1/1999 Capacity: 12000 Gals No. Of Comparts: Additional Info: ................................ TANK CONTENTS ............................... Tank Use: MOTOR VEHICLE FUEL Petrol Type: PREMIUM UNLEADED Matl Name:PREMIUM UNLEADED GASOLINE Cas #: 8006-61-9 ....................... TANK CONSTRUCTION -+ Type : DOUBLE WALL Material(p): FIBERGLASS Material(s): FIBERGLASS Lining : UNLINED Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1999 Alarm : Exempt: No Drop Tube : 1999 Ball Float : Striker Plate: 1999 Fill Tube S/O: 1999 ............................ TANK LEAK DETECTION ............................. Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -+ 8 03/01/2004 + FREEWAY LIQUOR STORE SiteID: 015-021-001321 += Inventory Item 0001 Facility Unit: Fixed Containers on Site + STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 +- PIPING CONSTRUCTION ............................ UnderGround Piping AboveGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : A.O. SMITH Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : + ........................... PIPING LEAK DETECTION ............................ UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT ...................... z ..... Installed: 03/17/1999 Type: DISP. PAN SENSOR W/ POS. SHUTOFF .......................... OWNER/OPERATOR SIGNATURE .......................... Date: 03/17/1999 Name:LLOYD CHILDRESS Ttl:OWNER Prmt Number: 1321 Approved: Yes Expiration Date: 06/30/2006 ............................... AGENCY DEFINED ............................... TANK/LINE TEST : CP CERT. : MANWAY INSP. : UST MONIT. CERT:10/01/2003 -9- 03/01/2004 + FREEWAY LIQUOR STORE = SiteID: 015-021-001321 + + Fast Format + += Notif./Evacuation/Medical Overall Site + +== Agency Notification 11/07/2000 + DIAL 911 AND REQUEST FIRE DEPARTMENT ASSISTANCE. NOTIFY LOCAL HAZARDOUS MATERIALS BUREAUS 326-3979. NOTIFY STATE OFFICE OF EMERGENCY SERVICES (800) 852-7550. + + +=== Employee Notif./Evacuation 11/07/2000 + THIS STORE ONLY HAS 1 EMPLOYEE PER SHIFT, THE EMPLOYEES ARE INSTRUCTED TO CALL MANAGERS. AFTER NOTIFING THE FIRE DEPT MEET MANAGERS AT THE SE CORNER OF PROPERTY. + .... Public Notif./Evacuation 01/07/1990 + EMPLOYEES ARE INSTRUCTED TO CALL FIRE DEPARTMENT FIRST, THEN OBTAIN FIRE EXTINGUISHER AND STAND BY IN CASE SPILL IS IGNIGHTED, AND DIRECT THE PUBLIC AWAY FROM THE SPILL. Emergency Medical Plan 11/07/2000 + CALL 911 ASK FOR AMBULANCE AND/OR FIRE DEPT SEND INJURED TO KERN MEDICAL CENTER, 1830 FLOWER ST, 326-2000. -10- 03/01/2004 + FREEWAY LIQUOR STORE SiteID: 015-021-001321 + ~ Fast Format + += Mitigation/Prevent/Abatemt == Overall Site + +== Release Prevention 11/07/2000 + INSPECT EQUIMENT AND REPAIR AS NEEDED. +=== Release Containment 11/07/2000 EMERGENCY PUMP SHUT OFF ON GASOLINE COMPUTER CONSOLE, POUR'GREASE SWEEP OR OTHER ABSORBANT MATERIAL ON SPILL, CALL FIRE DEPT FOR FOAM I/NIT. ..... Clean Up 11/07/2000 CLEAN UP SPILL WITH ABSORBANT MATERIALS, CONTACT LICENSED HAZARD WASTE MATERIAL HAULER (MP. VACUUM TRUCK SERVICE - ENVIRONMENTAL DIVISION). Other Resource Activation += .... -11- 03/01/2004 + FREEWAY LIQUOR STORE ' - SiteID: 015-021-001321 Fast Format += Site Emergency Factors --~ Overall Site +== Special Hazards +=== Utility Shut-Offs 11/07/2000 + A) GAS - NE CORNER OF BLDG B) ELECTRICAL - MAIN BREAKER IN BETWEEN STORE ROOM AND COUNTER AREA C) WATER - SHUT OFF VALVE E SIDE OF BLDG D) SPECIAL - GAS PUMP EMERGENCY SHUT OFF ON COMPUTER CONSOLE E) LOCK BOX - NO + .... Fire Protec./Avail. Water 11/07/2000 + PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS. FIRE HYDRANT - ON E SIDE OF PROPERTY. + + Building Occupancy Level ..... -t----- -t- -12- 03/01/2004 + FREEWAY LIQUOR STORE SiteID: 015-021-001321 + - Fast Format += Training Overall Site +== Employee Training == 11/07/2000 WE HAVE 6 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: NEW EMPLOYEES ARE INSTRUCTED TO FIRST SHUT OFF FUEL PUMP WITH EITHER EMERGENCY PUMP SHUT OFF ON CONSOLE OR PULL MAIN BREAKER - DIAL 911 AND ASK FOR FIRE DEPT AND/OR AMBULANCE - CALL ONE OF THE MANAGERS, STAND BY WITH FIRE EXTINGUISHER IF PRACTICAL, AND DIRECT THE PUBLIC AWAY FROM THE SPILL. IF PRACTICAL SPRINKLE GREASE SWEEP OR ABSORBANT MATERIAL ON SPILL TO HELP CONTAIN. + +=== Page 2 q + .... Held for Future Use I += + ..... Held for Future Use --- I -13- 03/01/2004 ;~qM M P P L A~,]VIA P SITE DIAGRAM~ FACILITY DIAGRAM Nor:h Name of Area: MR4$0101 ~ CITY OF BAF~ERSFIELD ~ 5/14/01 M~ellaneous Receivables In~ry 08:31:23 Customer ID . . . : 3888 Name: FREEWAY LIQUOR STORE Last statement : 5/01/01 Addr: LLOYD G CHILDERS Last invoice : 0/00/00 6107 ROUND UP WAY Current balance : 888.00 BAKERSFIELD, CA 93306 Pending ...... : .00 A ACTIVE ENVIRONMENTAL SERVICES Previous balance : 888.00 Deposit balance : .00 T~pe options, press Enter. Open Activity l=Select Opt Code Description Current Overdue Total due SS002 UST STATE SURCHARGE .00 96.00 96.00 UT001 UNDERGROUND TANK ANNUAL .00 792.00 792.00 F3=Exit F7=Pending activity F8=Charge hsty F9=Payment hsty F10=Combined detail F11=Invoice inquiry F12=Cancel F13=Auto charges F14=Deposit detail F21=Other tasks m ~ '¥ostage $ -3/4 _n 1 90 ', D" Certified Fee · Postmark/ ~=1 Return Receipt Fee ]- · 5 0 Here :rU (Endomement Required) : ~ Restricted Deliver/Fee (Endorsement Required) Total Post~ge &Fee~ $ 3.7 4 , I'l.J , Ltl [ Reciplent'$ Na~ae 'Please Print Clearl¥~ (To be. completed,by'maller~ ' ~ / MR. LLOYD CHILDRESS o~,~~-~~-~-¥~- .... ~ ............... ~ ....... . ...... ~- ~~¢'~i~'£i;'~'"~'X'"~;'~;'~' ..................................... " ~ SiteID: 015-021-001321 FREEWAY LIQUOR STORE ,_,~ j Manager : _ / BusPhone: (805) 323-0254 Location: 2030 E BRUNDAGE LN '~' Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 33D FacUnits: 1 AOV: CommCode: COUNTY STATION 41 SIC Code: EPA Numb: DunnBrad:12-793-5401 Emergency Contact / Title Emergency Contact / Title REX A. CHILDERS / ASSISTANT MANAG DON L. CHILDERS / MANAGER Business Phone: (805) 323-0254x Business Phone: (805) 323-0254x 24-Hour Phone : (805) ~ 24-Hour Phone : (805) ~u~=~=~u~4x Pager Phone : ( ) ~-_gD~ Pager Phone : ( )-g/~/~ Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 2030 E BRUNDAGE LN State: CA City : BAKERSFIELD Zip : 93307 Owner LLOYD G. CHILDERS Phone: ( ) - x Address : 505 BOBWHITE CT State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpocHazlEPA HazardsI Frm I DailyMax IUnitlMcP PREMIUM UNLEADED GASOLINE F IH DH L 12000.00 Mod REGULAR UNLEADED F IH DH L 15000.00 Mod reviewed the attached hazardous materials manage- ment plan for.;~-7.,. ~/~),~, X/,,?~ that it - (~of~,~.~- along ~ith any corrections constitate~- a complete and correct agement plan for my facili~.. FREEWAY LIQUOR STORE SiteID: 015-021-001321 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site PREMIUM UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 8006-61-9 F STATE i TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 12000.00I 12000.00 HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretI ~S BioHazI Radioactive/Amount I EPA Hazards ] NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site REGULAR UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 8006-61-9 F STATE i TYPE PRESSURE ,. i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container ! Daily Maximum Daily Average 15000.00L 15000.00 15000.00 HAZARDOUS COMPONENTS %Wt. R~NoRS~ CAS# 100.00 Gasoline 8006619 S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod -2- 10/31/2000 F FREEWAY LIQUOR STORE SiteID: 015-021-001321 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 01/07/1990 DIAL 911 AND REQUEST FIRE DEPARTMENT ASSISTANCE - NOTIFY LOCAL HAZARDOUS MATERIALS BUREAUS - 326-3979 NOTIFY STATE OFFICE OF EMERGENCY SERVICES (800) 852-7550 -- Employee Notif./Evacuation 01/07/1990 THIS STORE ONLY HAS 1 EMPLOYEE PER SHIFT, THE EMPLOYEES ARE INSTRUCTED TO CALL MANAGERS. AFTER NOTIFY FIRE DEPARTMENT AND TO MEET MANAGERS AT THE SOUTH EAST CORNER OF PROPERTY. Public Notif./Evacuation 01/07/1990 EMPLOYEES ARE INSTRUCTED TO CALL FIRE DEPARTMENT FIRST, THEN OBTAIN FIRE EXTINGUISHER AND STAND BY IN CASE SPILL IS IGNIGHTED, AND DIRECT THE PUBLIC AWAY FROM THE SPILL. Emergency Medical Plan 01/07/1990 CALL 911 ASK FOR AMBULANCE AND/OR FIRE DEPARMTNE SEND INJURED TO KERN MEDICAL CENTER 1830 FLOWER STREET BAKERSFIELD, CA. (805) 326-2000 -3- 10/31/2000 F FREEWAY LIQUOR STORE SiteID: 015-021-001321 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 01/07/1990 INSPECT EQUIMENTAND REPAIR AS NEEDED Release Containment 01/07/1990 EMERGENCY PUMP SHUT OFF ON GASOLINE COMPUTER CONSOLE, POUR GREASE SWEEP OR OTHER ABSORBANT MATERIAL ON SPILL, CALL FIRE DEPARTMENT FOR FOAM UNIT. -- Clean Up 01/07/1990 CLEAN UP SPILL WITH ABSORBANT MATERIALS, CONTACT LICENSED HAZARD WASTE MATERIAL HAULER (MP VACUUM TRUCK SERVICE - ENVIRONMENTAL DIVISION) Other Resource Activation -4- 10/31/2000 FREEWAY LIQUOR STORE SiteID: 015-021-001321 Fast Format ~ Site Emergency Factors Overall Site ..... Special Hazards ~ Utility Shut-Offs 01/07/1990 A) GAS - NORTH EAST CORNER OF BUILDING B) ELECTRICAL - MAIN BREAKER IN BETWEEN STORE ROOM AND COUNTER AREA C) WATER - SHUT OFF VALVE EAST SIDE OF BUILDING D) SPECIAL - GAS PUMP EMERGENCY SHUT OFF ON COMPUTER CONSOLE E) LOCK BOX - NO -- Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS FIRE HYDRANT - ON EAST SIDE OF PROPERTY Building Occupancy Level -5- 10/31/2000 FREEWAY LIQUOR STORE SiteID: 015-021-001321 Fast Format = Training Overall Site ~ Employee Training 01/07/1990 WE HAVE 6 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE NEW EMPLOYEES ARE INSTRUCTED TO FIRST SHUT OFF FUEL PUMP WITH EITHER EMERGENCY PUMP SHUT OFF ON CONSOLE OR PULL MAIN BREAKER - DIALL 911 AND ASK FOR FIRE DEPARTMENT AND/OR AMBULANCE - CALL ONE OF THE MANAGERS, STAND BY WITH FIRE EXTINGUISHER IF PRACTICAL, AND DIRECT THE PUBLIC AWAY FROM THE SPILL. IF PRACTICAL SPRINKLE GREASE SWEEP OR ABSORBANT MATERIAL ON SPILL TO HELP CONTAIN. -- Page 2 I --Held for Future Use Held for Future Use -6- 10/31/2000 MISCELLANEOUS RECEIVABLES ADJUSTMENT OTHER ADJ CUSTOMER NAME ~'C~-Oc~V L_~'~ooc, ~--c~c ~_ ZIP CODE SITE ADDRESS PARCEL NUMBER OF APPUCABLE) ADJUSTMENT I CHG DATE i CHARGECODE I ADJUSTMENT.AMOUNT : : REMARKS: r O~ APPROVED BY ~ - Manager : ~¥ 1 4 799? ~usPhone: (805) 323-0254 Location: 2030 E BRUNDAGE Lb X ~ap : 103 CommHaz : Low City : BAKERSFIELD , 8~y ~ ._ Grid: 33D FacUnits: 1AOV: CommCode: COUNTY STATION 41 SIC Code: EPA Numb: DunnBrad:12-793-5401 Emergency Contact / Title Emergency Contact / Title REX A. CHILDERS / ASSISTANT MANAG DON L. CHILDERS / MANAGER Business Phone: (805) 323-0254x Business Phone: (805) 323-0254x 24-Hour Phone : (805) 393-6793x 24-Hour Phone : (805) 834-9844x Pager Phone : ( )~%~ ~770x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Agency-Defined Topic Title ---- Hazmat Inventory One Unified List -- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 12000 GAL Mod SUPREME UNLEADED F IH DH L 12000 GAL Mod PREMIUM UNLEADED F IH DH L 10000 GAL Mod MOTOR OIL F DH L 300 GAL Min merit plan any corre¢ions ~st;;dte a complete and ~rrect mam- agememt plato ~or my ~acil~. 1 05/09/1997 F FREEWAY LIQUOR STORE SiteID: 215-000-001321 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit UST CAS# 8006-61-9 STATE--TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 12000.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. JEHS CAS# 100.00 Gasoline ~No [ 8006619 -2- 05/09/1997 FREEWAY LIQUOR STORE SiteID: 215-000-001321 ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site SUPREME UNLEADED Days On Site 365 Location within this Facility Unit UST CAS# 8006-61-9 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 12000.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Gasoline No 8006619 -3- 05/09/1997 FREEWAY LIQUOR STORE SiteID: 215-000-001321 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site PREMIUM UNLEADED Days On Site 365 Location within this Facility Unit WEST SIDE OF PROPERTY CAS# 8006-61-9 ~ STATE i TYPE PRESSURE I TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL I DailyAvg this Loc GAL 10000.00I 8000.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Gasoline No 8006619 -4- 05/09/1997 FREEWAY LIQUOR STORE SiteID: 215-000-001321 = Inventory Item 0002 Facility Unit: Fixed Containers on Site MOTOR OIL Days On Site 365 Location within this Facility Unit STORE ROOM AND CENTER OF STORE CAS# 8020835 Liquid Pure Ambient Ambient PLASTIC CONTAINER AMOUNTS STORED AND IN USE Lrgst Cent.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 300.00 240.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 -5- 05/09/1997 FREEWAY LIQUOR STORE SiteID: 215-000-001321 Fast Format F Notif./Evacuation/Medical Overall Site Agency Notification -- Employee Notif./Evacuation -- Public Notif./Evacuation Emergency Medical Plan -6- 05/09/1997 FREEWAY LIQUOR STORE SiteID: 215-000-001321 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site Release Prevention -- Release Containment -- Clean Up Other Resource Activation -7- 05/09/1997 FREEWAY LIQUOR STORE SiteID: 215-000-001321 Fast Format ~ Site Emergency Factors Overall Site -- Special Hazards -- Utility Shut-Offs -- Fire Protec./Avail. Water Building Occupancy Level 8 05/09/1997 FREEWAY LIQUOR STORE SiteID: 215-000-001321 Fast Format ~ Training Overall Site Employee Training -- Page 2 -- Held for Future Use Held for Future Use -9- 05/09/1997 Bakersfield Fire Dept. ~ ~c~ Hazardous Materials Division Bakersfield, CA. 93301 ~ns~, HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. BUSINESS NAME: ~ ~ ~ ~z,,,/]7 ,,,fl//. ¢ ~.. ,~ >... ~_,.C'~ C LOCATION: o~0,.~ ~',¢..¢r' _/~,ly~.//d,~ ~ ,~.. MAILING ADDRESS'. ~'ff Z~/~J'7" ~>~.~'/~~;.~ ~ C I Ty:/~/.~/.._r,,~/> g/~2 STATE: (/"2/.~ Zlp: ~,_~ ~ p H 0 N E L.~2~ - ~,~LS"/-// DUN & BRADSTREET NUMBER' ~-~_' T?J~-c.~.¢/~Sr/ SIC CODe: PRIMARY ACTIVITY: ('~',,~,.)"b,/~/~¢'~ .~' ./~g'7~.-'/ ,..j~,~>,..r SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE FD1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS: --,C/,x MATERIAL SAFETY DATA SHEETS ON FILE: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY 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 TIMEEXCEED THE N,,N, .~..,N, REPORTING OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, ~_-.--~-- CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION 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. y/S= A U: - - TITLE ' DATE 2. FD1590 Bakersfield Fire Dept4 Hazardous Materials Division' HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: ~~/ B, EMPLOYEE NOTIFICATION AND EVACUATION: C, PUBLIC EVACUATIO : ~ ~/~ ~ ~ D, EMERGENCY MEDICAL PLAN: Bakersfield Fire Dept. ,~. , " Hazardous Materials Division ', ' ~ ,, HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: ..Z~r~'e.-~-~7'" ~,e.e-~,~'~ B, RELEASE CONTAINMENT AND/OR, MINIMIZATION: C CLEAN-UP PROCEDURES: C',~4~' ~,,~, ~, W SECTION B: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' WATER: ~ SPECIAL: LOCK BOX: YE N: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A, PRIVATE FIRE P~ROTE,CTION: B. WATER AVAILABILITY (FIRE HYDRANT): 4, FD1590 CITY of BAKERSFIELD t'- Farm and Agriculture I1 Standard Business'',J~AZARDOUS MATERIALS INVENTORY NON--TRADE SECRETS Pacje // of / BUSINESS - ' REFER TO~N~TRO~~ROP~ Trans [yqe Hax Avgrage Annual Measure I51c0YSe Cont Cont Cont Us Location?mci. Hames oF ~ixture/Cep~onenTs Code LoDe AmC Amt Est Units on Type Press Temp CoueStored tn Pac~t~cy See [ns~ru:t~ons ~Physical amd Health ~azard C,~,5, Number Componen~ II Name I C,A.S. Numbe~ (Check al/ ~ha~ apply) ~ Hazard 0 Reac~ivit, ~:~ O Sudden,elease O Immediatec°.p°nen~ U Name I C.A.S. Number of Pressure Health ComponenL t3 Name I C.A.S. Humber Physical and Health ~azard C.A.S. Humber ComponenL II Name I C.A.S. Number (Check al/ tha~ ~: Component t2 Name I C,A.S. Number Hazard ~ Reactivity ,~layed ~ Sudden Release ~ Immediate ~ Heal~h of Pressure Health Component 13 Name t C.A.S. Number Physical and Health Ua;ard C,A.S. Number Componen~ II Name I C,A.S. Number ~Check ali thaC Componen: Name C,A.S. Number ~ Fire Hazard ~ Reactivity ~ DelayedHealCh ~ SuddenofPressureRelease ~ Im~edia~eHealth Component 13 Name ~ C.A.S. Number end Health~l~rd C.A.S. Number ComponenL II ~ I C,A,S. ~u~b~r / (Check all that app/yl ComponenL 12 Name I C.A.S. Number D Fire Hazard ~ Reac:ivity 00elayed 0 Sudden Release ~ lm~i~ Hem l:h of Pressure . Component 13 Name I C.A.S. Humber :erti[i;atioq .(Re~d ~,nd.~ign af~pr c~mpl~tipg.all sec~ipn~) ~u~mi:tcd in this.end all ;er~ny under penaltX priam tnqt l navepe(sonalmy.examlnq~eqo~m ~ami~ac.vit~ the.~n[o(maupn ~acned.dQcgmen[~, lng t~at oasea on.my ~nqu~ry 9;.tnose ina~v;aua~s responslo/e for oocaln~ng the r~ q~ oti~ rit~o~ o~n rrooera or OH owfl.t!o~erator s a,~tnori~eo reoresentatlVe~ ~~ FILE CONTENTS SUMMARY PE~IT 8: ~-%C~ ~..~ ENV. SENSITIVITY: Activity Date # Of Tanks Comments