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Home My WebLink AboutBUSINESS PLAN SITE/FACILITY ID A G R.~2v~ FORM 5 -~- NORTH SCALE: BUS I~'ESS N'A.~[E: FLOOR: OF DATE: / / FACILITY NAME: UNIT =: OF (CHECK ONE) SITE DIAGRAM FACILITY D[AGR.~M , (Inspector's Commen~s): -OFFICIAL USE ONLY- CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME :~F~-~o,D*_ ¢',¢;J~- INSPECTION DATE ~-~-~q ADDRESS ~ ff I h 13 ~ ~:-~&~ PHONE NO. ,~ FACILITY CONTACT I~'/~ BUSINESS ID NO. 15-210- O~O ~7 INSPECTION TIME ~ ~ NUMBER OF EMPLOYEES ~ Section l: Business Plan and Inventory Program ~ ~~-~ ~7 ~Routine ~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection OPERATION / Ci V] COMMENTS Appropriate permit on hand , Business plan contact inl-brmation accurate Visible address Correct occupancy / 61c~' IF-~i ~,, Verification of inventory materials Verification of quantities / Verification of location Proper segregation of ma~al Verification of MSDyavailability Verification of H~Mat training Verification/abatement supplies and procedures Emergen/procedures adequate Comakers properly labeled Site Diagram Adequate & On Hand C=Compliance V-Violation Any hazardous waste on site?: [~1 Yes [~0 Explain: Questions regarding this inspection? Please call us at (805)326-3979 Business Site~cspTsib/le Party Jif/// White - Env. Svcs. Yellow- Station Copy Pink - Business Copy Inspector~ ~~ ~ STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE. BAKERSFIELD, CA 93301-5201 ~' DATE: 2/01/99 TO: BRUNDAQE FiXIT · 24i9 BRUNDAQE LN BAKERSFIELD, CA 93504 CUSTOMER NO: 3197 CUSTOMER TYPE: ES/ 3197 -----F, -C---'"7-- ~?'~''-. , CHARQE DATE D~SCRIPTION REF-NUMBER DUE DA~E~ TOTAL AMOUNT 1/15/99 BEQINNIN~ BALANCE ~ 178. 50 FOR QUESTIONS OR CHANQES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. CURRENT OVER 30 OVER 60 OVER 90 178. 50 DUE DATE: 3/03/99 PAYMENT DUE: 178.50 TOTAL DUE: $178.50 CUSTOMER NO' 3~7 CUSTOMER TYPE: ES/ 3~7 TOTAL DUE: $178, ~0 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ............... ,,,,~.,??~?~?~,,,~,,,~ .............. This permit is issued for the following: ,~?/'?'?/. ,~!:~! i?:::iii ;ii!ii,~ .,~ i !ii~, ii?:::ii i;~ ~emround Storage of Hazardous Materials PERMIT ID# 015-021000947 '~i~i:'I !~:,i:~.!!:~ii':ii~iiiiii!iiiii;:''' ...::3!:!! !!.::i!~!!!i!!i?~::~ i[i~ii:;~!i~kli~agement Program ..... . ".j "'~:~':= ?,4 -"=~ ~' r. , ...... :~::::~',',~?~J[?~'" ~ ~ ~ ~ '''~ ~' ~, .... ~ ~ ~ ~' .'"'-..:"~ ~':-:..'-= ~=, ~:-:_*:::::::..:.:. /*/, -..~ ,~ .~ '~ { , · , ,= .. / . . ,. ~~ ~, . '..,~*, ~.-'"-..~ ~:'"~ ....., ~:~.' ................... · =~'~[~C,,~ .~"T ~".~:f,=;~' =~'".."=~ 7, '"-..~ '~ ~ .... ~:::~= "=~?~?~p,.'; ~[' .=~ ':.. ~:~' ~:'-.--_.'$ ~ :~, '~..-,,.~,J... 7~ 'a ........ '~,::.:: ' '~, "L. ":.",'." ...::'~ · -~;;:; ........... . L.~; Issued by: Bakersfield Fire Department Approved by: [ ~ ' 17 15 Chester Ave., 3rd Floor ce of ~es Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805)326-0576 Expiration Date: June 30, 2000 BRUNDAGE FIXIT L AU~ 15 IU~/ SiteID: 215-000-000947 Manager : BusPhone: (805) 322-5547 y; Location: 2419 BRUNDAGE LR B. Map : 102 CommHaz : Low City : BAKERSFIELD ~ Grid: 36C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code: EPA Numb: DunnBrad:95-270-183 Emergency Contact / Title Emergency Contact / Title JOHN HUMECKY / 4~4~EHUMECKY ~ / Business Phone: (805) 322-5547x Business Phone: (805) 322-5547x 24-Hour Phone : (805) 835-0577x 24-Hour Phone : (805) 366-6229x Pager Phone : ( ) - x 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... ISpecHazlEPA HazardsI Frm I DailyMax Unit MCP GASOLINE F IH DH L 20 GAL Mod WASTE OIL F DH L ~.~O ~ GAL Low MOTOR OIL F DH L ~54-3d9- GAL Min corrections a~eme~ p~a~ for -1- 07/28/1997 BRUNDAGE FIXIT SiteID: 215-000-000947 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site GASOLINE Days On Site 365 Location within this Facility Unit INSIDE MAIN SHOP CAS# FSTATE TYPE PRESSURE , TEMPERATURE CONTAINER TYPE Liquid Pure AmbientI Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 20.00 GAL 20.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Gasoline No 8006619 -2- 07/28/1997 BRUNDAGE FIXIT SiteID: 215-000-000947 = Inventory Item 0001 Facility Unit: Fixed Containers on Site WASTE OIL Days On Site 365 Location within this Facility Unit OUTSIDE SOUTHEAST CORNER OF BLDG CAS# ~ STATE [ TYPE PRESSURE [ TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 55.00 GAL 25.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Waste Oil, Petroleum Based No 0 -3- 07/28/1997 BRUNDAGE FIXIT SiteID: 215-000-000947 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site MOTOR OIL Days On Site 365 Location within this Facility Unit FOR RESALE AND IN STORAGE ROOM CAS# F STATE [ TYPE PRESSURE i TEMPERATUREI CONTAINER TYPE Liquid Pure Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 130.00 GAL 100.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 -4- 07/28/1997 BRUNDAGE FIXIT SiteID: 215-000-000947 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification 06/26/1992 CALL 911 -- Employee Notif./Evacuation 06/26/1992 911 IS CALLED AND EMPLOYEES USE NEAREST EXITS Public Notif./Evacuation 06/26/1992 9-1-1 IS CALLED AND THE FIRE DEPARTMENT TO MAKE SURE THE PUBLIC IS NOTIFIED. Emergency Medical Plan 06/26/1992 CALL 911 -5- 07/28/1997 BRUNDAGE FIXIT SiteID: 215-000-000947 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 06/26/1992 ALL MATERIALS LISTED CONTAINED IN SAFE CANS AND STORED IN A SAFE MANNER. -- Release Containment 06/26/1992 RELEASE CONTAINMENT WILL BE HANDLED BY THE FIRE DEPARTMENT OR HAZARDOUS MATERIALS DIVISION. -- Clean Up 06/26/1992 IF SPILLAGE OCCURS DIATOMITE IS USED TO ABSORB. IF FLARE UP OCCURS FIRE EXTINGUISHERS ARE LOCATED NEAR EACH WORK AREA. DRY ABSORBANT MATERIALS IS PROPERLY STORED AND DISPOSED OF. Other Resource Activation 6 07/28/1997 BRUNDAGE FIXIT SiteID: 215-000-000947 Fast Format Site Emergency Factors Overall Site Special Hazards -- Utility Shut-Offs 01/07/1990 A) GAS - NORTH EAST CORNER OF BUILDING B) ELECTRICAL - SOUTH CENTRAL ON BUILDING C) WATER - FRONT ON STREET D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - FOUR FIRE EXTINGUISHERS FIRE HYDRANT - CORNER OF PINE AND BRUNDAGE Building Occupancy Level -7- 07/28/1997 BRUNDAGE FIXIT SiteID: 215-000-000947 Fast Format ~ Training Overall Site -- Employee Training 03/05/1991 WE HAVE,EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE REVIEW MATERIAL SAFTEY DATA SHEETS AND HAZARDS OF MATERIALS WITH ALL EMPLOYEES ON A REGULAR BASIS -- Page 2 -- Held for Future Use Held for Future Use 8 07/28/1997 18/92 BRUNDAGE FIXIT 215-000-0009 Page 1 Overall Site with 1 Fac. Uni~ i JUN 1199£ b~ General Information By I L0cation: 2419 BRUNDAGE LN Map: 102 Hazard: Low I Community: BAKERSFIELD STATION 03 Grid: 36C F/U: 1 AOV: 0.0 Contact Name Title ~ Business~phone I 24-Hour Phone- JOHN HUMECKY 1~805) 322-5~47 x (805) 835-0577 MATT HUMECKY 1(805) 322-5547 x 1(805) 366-6229 Administrative Data Mail Addrs: 2419 BRUNDAGE LN D&B Number: 95-270-183 City: BAKERSFIELD State: CA Zip: 93304- Comm Code: 215-003 BAKERSFIELD STATION 03 SIC Code: Owner: MATTHEW HUMECKY Phone: (~0~)3~ -~ Address: 8417 ROSEWOOD AV State: CA City: BAKERSFIELD Zip: 93306- Summary ~, o hereby cerl~ Iflat I have - (TyPe'or prl~ - / reviewed ~h~ mtach~d h~ardous ~e~als manage- merit plan ~~~z~nd that it a~ong any ~rrections ~nsU*~u~e a comp~te and corr~ man- agement plan for my f~ility. · ~ ~ ,.., ~ .., 03/18/92 BRUNDAGE FIXIT 215-000-000947 Page 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number order 02-001 WASTE OIL ~ Liquid 55 Low · Fire, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GALI Daily Average GAL I Annual Amount GAL 55 ~ 25.00 120.00 Storage~~Press T Temp Location DRUM/BARREL-METALLIC IAmbient/AmbientlOUTSIDESOUTHEAST CORNER OF BLDG -- Conc Components MCP ---TList 100.0% IWaste Oil, Petroleum Based ILow 02-002 MOTOR OIL Liquid 130 Minimal · Fire, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GAL Daily Average GAL Annual Amount GAL 130 I 1.00.00 I 420.00 StorageIIPress T Temp Location PLASTIC CONTAINER IAmbient/AmbientlFOR RESALE AND IN STORAGE ROOM -- Conc Components MCP ---TList 100.0% IMotor Oil, Petroleum Based IMinimal I 02-003 GASOLINE Liquid 20 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL -- Daily Max GALI Daily Average GAL I Annual Amount GAL 20 ~ 20.00 / 200.00 StorageIIPress T Temp Location METAL CONTAINR-NONDRUMIAmbient/AmbientlINSIDE MAIN SHOP -- Conc Components I MCP List 100.0% ']Gasoline IModeratel 03/18/92 BRUNDAGE FIXIT 215-000-000947 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation 911 IS CALLED AND EMPLOYEES USE NEAREST EXITS <3> Public Notif./Evacuation <4> Emergency Medical Plan CALL 911 03/18/92 BRUNDAGE FIXIT 215-000-000947 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ALL MATERIALS LISTED CONTAINED IN SAFE CANS AND STORED IN A SAFE MANNER. <2> Rel'ease Containment <3> Clean Up IF SPILLAGE OCCURS DIATOMITE IS USED TO ABSORB. IF FLARE UP OCCURS FIRE EXTINGUISHERS ARE LOCATED NEAR EACH WORK AREA. DRY ABSORBANT MATERIALS IS PROPERLY STORED AND DISPOSED OF. <4> Other Resource Activation 03/18/92' BRUNDAGE FIXIT 215-000-000947 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NORTH EAST CORNER OF BUILDING B) ELECTRICAL - SOUTH CENTRAL ON BUILDING C) WATER - FRONT ON STREET D) SPECIAL - NONE E) LOCK.BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FOUR FIRE EXTINGUISHERS FIRE HYDRANT - CORNER OF PINE AND BRUNDAGE <4> Building Occupancy Level 03/18/92 BRUNDAGE FIXIT 215-000-000947 Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 5 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE REVIEW MATERIAL SAFTEY DATA SHEETS AND HAZARDS OF MATERIALS WITH ALL EMPLOYEES ON A REGULAR BASIS <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use CITY OF BAKERSFIELD , HAZARDOUS MATERIALS INVENTORY ' ~ Farm and Agriculture [] Standard Business :.~ Page__of__ NON - TRADE SECRET BUSINESS NAME: " OWNER NAME: NAME OF THIS~<FACILIT¥: LOCATION: ADDRESS: ! STANDARD IND. CLASS CODE: CITY, ZIP: CITY, .. ZIP: ~ DUN AND BRADSTREET NUMBER/FEDERAL. ID -- -- PHONE H: PHONE ..H :" _ -- REFER TO INSTRUCTIONS FOR PROPER CODES " i 2 3 4 5 6 7 8 9 10 11 12 13 14 Trans Type Max Average Annual Measure # Days Cent Cent Cent Use Location Where % by Names of M~xture/Co~ponents Code Code . Amt Amt Amt Units on Site Type Press Temp Code Stored in Facility wt See Instructions __]__! ! __ Physical and Health Hazard C.A.S. Number Component # 1 Name '& C.A.S. Number (Check all that apply) Component # 2 Name & C.A.S. N~mber [] F,re Hazard ~ Sudden Release ~ Reactivity ~ Imediat. ~ Delayed of Pressure Health · Health . ~: Component # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component 9' I Name ia C.A.S. Number (check all that apply} . . /Component # 2 Name & C.A.S. Number of Pressure ". Health Itealth Component # 3 ~ame & C.A.S. Number Physical and Health Hazard C.A.S. Number ':' Component # i Name & C.A.S. Number (Check ~11 that apply) '"" Component # 2Name& C.A.S. Number of Pressure Health Health Component # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # i Name & C.A.S. Number (Check all that apply) Component # 2 Name a C.A.S. Number of Pressure Health Health Component # 3 Name & C.A.S. Number EMERGENCY CONTACTS #1 #2 Name Title 24 Hr. Phone Name Title 24 Hr Phone certification (READ AND SIGN AFTER COMPLETING ALL SECTIONS) I certify under peanlty of law that I haver pereonally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those individuals responsible for obtain/ng the information. ! believe that the submitted information is true, accurate, and c~mplete. NAM~'AND OFFICIAL TITLE OF OWNER/OPERATOR OR OWm~K/OP]~TOR'S A~'£uO~IZED ~u~p~E.~'~z~'ivE SIGNATURE ,.:.j DATE SI~NED BAKERSFIELD CITY FIRE DEPARTNENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE. ONLY HAZARDOUS MATERI ALS BUSINESS PLaN AS A WHOLE FORM 2A INS~UCTION$: ~ 1. To avoid further action, return this fo~m by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3.' Answer the questions be]o~ fop ~he business as a ~hole. 4. Be as b~ie[ and concise as possible. SECTION 1: BUSINESS IDE~IFICATION DATA A. BUSINESS NA~E: ~~~ ~/'~ SECTION 2: E~ERGENCY 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. / B. ,'~/,~-/- //g//;~-~/ Ph~ 32~-~7 Ph~ / · SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: /~/~. /fO~c'/~ B. ELECTRICAL: ~/~~,Z 0~ ~. C. WATER: ~o~ ~ D. SPECIAL: E. LOCK BOX: YES.~NO~IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL ~JSE ONLY ID# BUSINESS PLAN SINGLE FACILITY UNIT FORM' 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer 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, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT' ONLY .. - 3A - 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: ......... : ................ Y~', NO Y~_~_~,NO C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO ~NO D. EMERGENCY EVACUATION PROCEDURES: ............ SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDous MATERIAL IN QUANTITIES~THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... fY~ NO I, /~/~;'77~ '.'-~/,fW'cz-d~.~'~//, certify that the above information is accurate. I understand that th~s 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. 28500 Et Al.) and that inaccurate information constitutes perjury. SIGNATURE TITLE DATE - 2B - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit con,.aln Itazardous )lateria!,.:? ..... If YES, see B. If NO, continue with SECTION 4. · B. Are any of the hazardous materials a bona fide Trade Secret YES If No,. complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (M~.ite form ~..IA-1) If Yes, complete a hazardous materials inventor~ fcnm marked: TRADE SECRETS ONLY (yelJow form ~4A-2) in additio, to the non-tv;tale secret form. List only the trade secrets on for,,. 4A--2. SECTION 4: PRIVATE FIRE PROTECTION SECTION $: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. a. N:\T. :'.:AS B. ELECTRIC.aL: ! C. WATER: O. SPECIAl.: · . x',- ./~ tF ' ~ LOC,K BoX: .,..S YES, I. OC..~TION: ~£gfE'Y/E/e~l.. tA// ZOC~'/c~z?~9 ~-~C~: IF YES, SITE PLANS.') YES /' NO MSDSs? YES PI,OOR PLANS? YES ./' NO KEYSO YES ..'" - 31~ - Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business os a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: LOCATION' MAILING ADDRESS: CITY: ~-~,'~,'~' STATE:_ ZIP :7~-~SZ/L/P H O N E: DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: OWNER: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS, PHONE 24 HR. PHONE 1, 2. Bakersfield Fire Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS: ~ MATERIAL SAFETY DATA SHEETS ON FILE: ~-//~ BRIEF SUMMARY OF TRAINING PROGRAM: 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 MINIMUM REPORTING QUANTITIES. 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. DATE 2. CITY of BAKERSFIELD " HAZARDOUS MATERIALS INVENTORY Fare and Agriculture FI 5t. andard Business [] NON--TRADE SECRETS Page of Tr/ns~ 2 ] 4 5 6 1 8 9 I0 I!~ 12 13 [yge ~ax Avfrage Annual Measure I~)~e~., ~on: Cent Cent Us Location.WheEe. ~w~y. Hames of ~ixturelComponents Code LoDe Amt Act Est Ufllts on /ype Press Iemp CoueS:ored In Pacl/Icy See Iflstructlons Physical end ~ealthHazard C.A.S. Number Component II Hame I C.A.S. Humber (Check ali that apply) ~re Hazard ~ ReacLiyi[, ~,yed ~ Sudden Re,ease ~ Component 12 Name I C.A.S. Number - Health of Pressure Health Component 13 Name I C.A.S. Number (~1// that lpP/H ~ Fire Hazard ~ Reactivitx ~ Delayed ~ Sudden Release ~ Im~i~C°mp°nent 12 Name I C.A.S. Number Health of Pressure .-. ComponenL 13 Name I C.A.S. Number Physical And HealthUalard C,A.S. Number Component II Name I C,A,S. Number ~" (~h~ that apply, ~Fire Hazard U Reactivity ~d ~ Sudden Relesse ~mediate Component 12 Name I C.A.S. Number ~h of Pressure Health Component 13 Name I C.A.S. Number Physical end Health Ualard' C.A.S. Number Component II Name I C.A.S. Number (Check 81/ that app/yl Component I~ Name I C.A.5. Number ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Immediate Hea ICh of Pressure Health Component 13 Name I C.A.S. Number EHEROEHCY COHTACTS fll Name Title 2i ~r pnone Name Title Certifi atio Re and ~ naf ~ c~m 7 Cf ~ ~7~ s cC fens) I ,cerL,~y unger pena,~, ~, thqt ]~avPpe~sona~.examlnqFeq~ J, ~miliaLvitb ~e ,nform,Llon Su~mitt¢O in this.end all su~,~tteaaC~a;hed .dDcD~ent~, ~n~or,at ~onanq~crue,~Ps~ oaseaaccura~e,On.,y ana~nqu~rYco,p~e~e.Dt' ~nose ~na~v ~aua~s respons~o~e tot obtaining the Information.. [ be~ ~eve ~ ~ ..Chat the