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Home My WebLink AboutBUSINESS PLAN 7/28/2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This _~ermit is issued for the followin_~: E] Hazardous Materials Plan [] Underground Stemge of Hazardous Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002221 LOCATION 2J/~7 93304 OFFICE. OF ENVIRONMENTAL SER VICES' · c" x~ Jill ~, 3 ~00! Bakersfield, CA 93301 OfficeofEvironmertl~Services ~ Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: June 30.. 2003 BRAKE MASTERS SiteID: 015-02i-002221 Manager : BusPhone: (661) 869-0777 %%~ Map : 123 CommHaz : Low Location: 2575 BRUNDAGE LN %%%% Grid: 0lA FacUnits: 1 AOV: City : BAKERSFIELD ~ CommCode: BAKERSFIELD STATION 03 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title FRANK PEACHEY / DM ~C~T ~ 'C-~ / STORE ~1~ Business Phone: (818) 342-0777x Business Phone: (661) 869-077Ix 24-Hour Phone J: (818) 535-7424x .~24-Hour Phone : (81%) °£5 I -06&3x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Contact : / Phone: (661) 869-0777x MailAddr: 2575 BRUNDAGE LN ·/ State: CA City : BAKERSFIELD / Zip : 93304 / Owner SOUTHERN CAL BRAKE MASTERS Phone: (909) 434-0360x Address : 9530 SIERRA AVE #18 ~ State: CA City : FONTANA · // Zip : 92335 Period : to/ TotalASTs: = Gal Preparer: / ' TotalUSTs: = Gal Certif 'd: RSs: No ParcelNo: Emergency Directives: any corrections constitu~e a complete and correct man- agemem plan ~0r my ~acility. -1- 07/15/2003 BRAK~ MASTERS SiteID: 015-021-002221 Manager : BusPhone: (661) 869-0777 Location: 2575 BRUNDAGE LN Map : 123 CommHaz : Low City : BJ~KERSFIELD Grid: 0lA FacUni~s: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code: EPA Num~: DunnBrad: Emergency Contact / Title Emergency Contact / Title FRANK PEACHEY / DM DON FERGESON / STORE Business Phone: (818) 342-0777x Business Phone: (661) 869-0777x 24-Hour Phone : (818) 535-7424x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Contact : Phone: (661) 869-0777x MailAddr: 2575 BRUNDAGE LN State: CA City : BAKERSFIELD Zip : 93304 Owner SOUTHERN CAL BRAKE MASTERS Phone: (909) 434-0360x Address : 9530 SIERRA AVE #18 State: CA City : FONTANA Zip : 92335 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: RSs: No Emergency Directives: ~_~_ '~ ~ ~' ~ ~ = Hazmat Inventory One Unified List --Alphabetical Order All Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax IUnitlMcP MOTOR OIL F DH L 420.00 GAL Min TRANSMISSION FLUID F DH L 120.00 GAL Low WASTE ANTIFREEZE F DH L 55.00 GAL Low WASTE, OIL F DH L 300.00 GAL LOW (Type or print name) reviewed the attached hazardous materials mal~age- ment plan/or J~/~'~f/~'~,~/L[and that it along with ~ (Name of BusineSs) any corrections constitute a complete and correct man- v, /i/ BRAKE MASTERS SiteID: 015-021-002221 = Inventory Item 0001 Facility Unit: Fixed Containers at Site ~lvUVl~ ~Vl~ / ~± ~Z**x_b ~Vl~ MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE SE CORNER OF SHOP CAS# 8020835 Liquid. Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 300.00 GAL 420.00 GALI 300.00 GAL - HAZARDOUS COMPONENTS 100.00 Motor Oil, Petroleum Based N 8020835 HAZARD ASSESSMENTS ITsecretl ~SlBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No N No No/ Curies F DH / / / Min = Inventory Item 0002 Facility Unit: Fixed Containers at Site ~lvUVl~ ~vl~ / ~ ~_~-~.L~ TRANSMISSION FLUID Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE SE CORNER OF SHOP CAS# 0 r STATE . TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 120.00 GALI 120.00 GAL 120.00 GAL 100.00 Transmission Fluid (Petroleum-Based) N TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No INO I No No/ Curies F DH / / / Low -2- 08/08/2001 BRAKE MASTERS SiteID: 015-021-002221 = Inventory Item 0004 Facility Unit: Fixed Containers at Site ~v~v~ ~v~ / ~ 1 ~Z--~.b ~vl~ WASTE ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE SE CORNER OF SHOP CAS# 107-21-1 r STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid {Waste I Ambient I Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 55.00 GAL 55.00 GAL 55.00 GAL 30.00 Ethylene Glycol N 107211 HAZARD ASSESSMENTS TSecretl~sIBi°HaZNo N No Radioactive/AmountNo/ Curies FEPAHazardsDH NFPA/// IUSDOT# MCP = Inventory Item 0003 Facility Unit: Fixed Containers at Site ~UiVHVlUN N~v15 / ~£ ~.~-..~,,L~ N~Vl~ WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE SE CORNER OF SHOP CAS# 221 STATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 300.00 GALI 300.00 GAL 300.00 GAL %Wt. HAZARDOUS COMPONENTS 100.00 Waste Oil Petroleum Based N~S CAS# , HAZARD ASSESSMENTS ITSecret,' RS,BioHaz,' ' Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F DH / / / Low 3 08/08/2001 p BRAKE MASTERS SiteID: 015-021-002221 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 08/08/2001 INDICATE WHAT YOUR PROCEDURES ARE. wEmployee Notif./Evacuation 08/08/2001 Public Notif./Evacuation 08/08/2001 ~OW ARE YOU GOING TO NOTIFY THE PUBLIC (CUSTOMERS IN YOUR SHOP OR NEIGHBORING BUSINESSES) IF THEY NEED TO EVACUATE. A/]SO, IS ANYONE IN YOUR COMPANY TRAINED TO HANDLE A HAZARDOUS MATERIALS RELEASE. IF SO, WHO AND WHAT ARE THERE QUALIFICATIONS. i(~ Emergency Medical Plan T~ 07/20/2001 WHAT MEDICAL FACILITY WOULD YOU WANT BE TAKEN TO FOR EMERGENCY TREATMENT? -4- 08/08/2001 BRAKE MASTERS SiteID: 015-021-002221 Fast Format = Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 07/20/2001 HOW DO YOU KEEP FROM SPILLING ANY NEW OR USED OILS OR TRANSMISSION FLUIDS. -- Release Contdinment 08/08/2001 ONCE YOU'VE HAD A RELEASE/SPILL HOW WOULD YOU CONTAIN IT, IN OTHER WORDS CONFINE IT TO THE SMALLEST AREA POSSIBLE (KEEP THE RELEASE/SPILL FROM SPREADING)??????????? ~~ /'~ --~" D ' Clean Up 08/08/2001 :] ONCE YOU'VE CONTAINED IT-HOW-ARE YOU-GOING TO CLEAN IT UP, WHAT PRODUCTS OR . COMPANY ARE YOU GOING TO USE????????? Other Resource Activation " -5- 08/08/2001 ~ BRAKE MASTERS SiteID: 015-021-002221 I Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 07/20/2001 A) GAS - E SIDE B) ELECTRICAL - S SIDE C) WATER - N SIDE D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 07/20/2001 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - OUT IN FRONT ON STREET. Building Occupancy Level 6 08/08/2001 BRAKE MASTERS SiteID: 015-021-002221 Fast Format ~ Training Overall Site -- Employee Training 07/20/2001 WE HAVE 5 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE IN OUR SAFETY/TRAINING BOOK. BRIEF SUMMARY OF TRAINING PROGRAM: FIRST AID, BACK INJURIES, GOOD HOUSEKEEPING, PROPER DRESS, EYE (HEAD) PROTECTION, FEET/LEG PROTECTION, GUARDS ON MACHINES, HAND PROTECTION, HAZARDOUS MATERIALS (MSDS), FITNESS HEALTH, ELECTRICAL, REPORTING HAZARDS, SPOTTING HAZARDS, TOOL SAFETY, AND --Held for Future Use Held for Future Use , 7 08/08/2001 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIA~~ N A GE~/~ENT PLAN }i TT'~r~;dRI~N~rt~T ~I~t~'l~t~I~ ~I~H. ithin 30 days ° f rec eipt ' ~ " 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA MAILING ADDRESS: ~,3'"'30 ('~ i ~../'LtL/oF ,,~'f.... ati*/ 0c/ CITY: ff-OtO ir'/~,q-' STATE?'r~ ZIP: qZJ~ P~HONE: PRIMARY ACTIVITy: d~' a~) /~ ~Sf ;/~ / ~ OWNER: Cgm./_ grt, L % PHONE: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 i-iR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. E~LOYEE A~ AGENCY NOTIFICATION: C. E~IRO~NTAL ~SPONSE MANAGEMENT: 6. ~ C~IO ~ ~U4 . D. E~RGENCY MEDICAL PL~: 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION I1.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. [~v r'" Oo r~ ,t~ ol -w~,rm s,~ ~-mI ~,&,~ .to ?~r- C. CLEAN-LIP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY') NATURAL GAS/PROPANE: ~ 1"' $ ELECTRICAL: ~ox.) ~ :~ ~ O Q-- WATER: h) o ,x_X- }4- q. ~O et_., SPECIAL: b,J o ~ ~ LOCK BOX: YE~°fNC~ IF YES, LO.CATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRAN _ l:-n.o,,O r"" ¢'rk HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: ,5-' MATERIAL SAFETY DATA SHEETS ON'FILE: /~55 5'/} I~'~9. ,~t,v't~. ~ oD/co BRIEF SUMMARY OF TRAINING PROGRAM: c~.~CA~ON ..... ~, ~~ ~C ~e~4~ c~I~Y ~.A~ ~.~ ~OW ~0~0~ ~S ACC~~. I ~~S~A~ ~ ~.~S ~0~ION ~.~ US~O ~0 ~ ~ O.Uaa~OSS ~~ ~.~"Ca~O~IA.~A~-- A~ S~Y }~~ T~°~ ~°~s~!~s m~~'. SIGk3 T~E - ' ~ TITLE t /DATE 4 .... '7~: .... ICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 .... ~'""~--'"~""' BUSINESS OWNER/OPERATOR IDENTIFICATION FACILITY INFORMATION Page __ Of " I. FACILITY IDENTIFICATION F ACILITYID# [ i ilii~/ i' [ I?~t I : I i I !11 Year Beginning' j' / ~o0 Year Ending ...... LJ__~__,_L_~___~?}_L ! .... bL/0/_Ay o / BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) ~' / 3 BUSINESS PHONE_ 402 .... ~.~£ ~f~5 ~c~r~g 661-~ ~'6¥--07'~ DUN & ~o6SIC CODE ~o; B~DSTREET }(4 Digit ~) co~.~ ~~ Coo ~ ~ ,0~ o~o..~ Do~ ~ ~s~ ~ ,o.o~o~.o~ ~[- : .:,::~ ,_ ~ ~.,': :.~ .~ ~ . . , , , .. : ,... ,~ ·, - .-~ ;~ OWNERNAME 00~ ~t~ ~0~ ,,1 [] OWNERPHONE 661- OWNER MAILING · ~ :. ~ ~ ~,~:; .": ;;:~:3~:~'"C~ : ::~:~:~ '::5:~.~;~~' ~:~t.~ ;-. ,:~ ::::~ ,.~ '...':- ~ ;: '¢~ .:. '~:~:'~;:.,?~.'~' :?:: ~,. ~':...- ..' ,.. ~'?: :~: .:~: CONTACT MAILING Cl~ ~ ~~ ~20 STATE~ ~2~ , ZiP ~~ BUSINESS PHONE ~ I ' ~6~--0~ ~ 126 BUSINESS PHONE ~1~ -~3~-W~Z~ ~*HOURPHONE 6Gl--Y~W-~S~ '~ ~*HOURPHO.E 91~ ~~%~d~ '~ Cedi~ati/n: B.ed ~ m~_inq~iof those individuals responsible for obtaining the information, I ce.i~ under penal~ of law that I have personally examined _and a~~ilia/wlth t~e iCr~at, ~n submi.ed in this invento~ and believe the infor~a?o, is tru ~ccurate, and copz~_?e. _ SIGNORE ~FJOW~OP~TOR /- DATE ' O 134 NAME OF DOCUMENT PREPARER 135 /'~~OWNE~PE~TOR (print) ~36 [ TITLE OF O~ER/OPE~TOR .... ~7 UPCF (7~99) S:\CUPAFORMS\OES2730.TV4.wpd CITY OF BAKERSFIEt OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 ...... ~'~"~ ~""" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION [one form per material per building or area) ~NEW [] ADD [] DELETE [] REVISE 200 Page __ of __ I. FACILITY INFORMATION ~ · BUSINESS NAME (Same as FACILITY NAIVE or DBA - Doing'Businesses) 3 CHEMICAL LOCATION 201i CHEMICAL LOCATION [] Yes [] No 202 I CONF/DENTIAL (EPCRA) FAClLITYID#1 I [~'~i:~il I i;!~ i i ' 11 MAP#(optionaO~ I 203iORlD#(°pti°nal) 204 · , ' ' ' . ~ F':- ' :;!: .; ,,. .,,, :: ....ii.'cHEMI~LiNF0~MATiON ',:" 205 TRADE SECRET [] Yes [] No 206 CHEMICAL NAME ~'~0 ~0 '~V~"' 0 ~ ~'""' If Subject to EPORA, refer to instructions 207 COMMON NAME EHS* [] Yes [] NO 208 ~ Se...C) otL.. CAS # 209 *If EHS is'Yes, · all amoumcs below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 p PURE [] m MIXTURE '~w WASTE 211 I RADIOACTIVE [] Yes [] No 212 TYPE CURIES 213 FED HAZARD CATEGORIES (Check all that apply) FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 ANNUAL WASTE i MAXIMUM 218 AVERAGE STATE WASTE CODE 220 AMOUNT yO0 4-C' ~'~~ 222 g ' DAYS ON SITE UNITS* a GAL [] cf CU FT [] lb LBS [] tn TONS 221 ' ' If EHS, amount must be in lbs. 30 STORAGE CONTAINER ,~.~ (Check all that apply) ABOVEGROUND TANK [] e PLASIIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] f CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT [] c CRYOGENIC 225 · ~: ':<',:~'~ ' :~HAZARDOUSCOMPONENT ~-:',':~, ;~::~: ,',' ,,.:,:~.~:: ?~: -. EH$' ' .:~ CAS# 1 226 227 [] Yes [] No 228 i 229 2 230 231 [] Yes [] No 232 233 3 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 ~; ,i? .... : .;- ',~"-.' ~ ; ' .:?~ ':~ff.~gT"::2.~: ?L';~' ~' .. ~" ~,. ~'.' '~- .--'~0-- 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 FACILITY NAME ~/~a/-~ /L,I.~"'~C4q--5 INSPECTION DATE ADDRESS ~..$--Z_'7 ~gr~..0-,,~ PHONE NO. ~q - o7?? FACILITY CONTACT ~o~ BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program I~ Routine ~]~_Combined [~ Joint Agency [~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand r~c.~9.,5~ ~,~.~.....r~ ,,d~P.- Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location 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 "/~(,~-a~- ~ ~e~n~~$ Site Diagram Adequate & On Hand C=Compliance V=Violation Explain:any hazard°us waste °n site?: ~Y~:~2 N°O~,OC~.~ ~ ~_ ~. ~ . Questions regarding this inspection? Please call us at (66 ! ) 326-3979 Business Sit~Res'~'on,~iT(o b' ' White - Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: ~.~l CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~lZ,e,~ ~~e_~, INSPECTION DATE '7/LO/C-~ Section 2: Underground Storage Tanks Program ~l Routine [~ Combined [21 Joint Agency [21 Multi-Agency ~l Complai~ [21 Re-inspection Type of Tank Number of Tanks Type of Monitoring Type of Piping OPERATION ,ff~ "V" COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current Certification of Financial Resp~ity Monitoring record ade.~and current Maintenance r~s adequate and current Failure~rrect prior UST violations ere been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) 'g~/'MmZ zz>/1 Z-O AGGREGATE CAPACITY' Type of Tank <A,-r~--t~ Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection (2:x~' o~ Proper tank placarding/labeling t.~t~7-~ Is tank used to dispense MVF? if yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO {~, t,..)/_~~Z-~it~(Res~' Inspector: ' USl~ess S Office of Environmental Services (805) 326-3979 White - F..nv. Svcs. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ /~/-~-e.. INSPECTION DATE Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ~ Combined [] Joint Agency [] Multi-Agency [] Complaint [3 Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use ~~ KEt..~ g_tO~ Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ~ C=Compliance V=Violation Inspector: ~l~.~ Office of Environmental Services (661) 326-3979 Site White - Env. Svcs. Pink - Business Copy OF ENVIRONMENTAL RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 "**"" ~ ~' ~*'**" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION --4_W (one [orm per mate~al per building or area) [] ADD [] DELETE [] REVISE 200 Page __ of BUSINESS ~ME (Same ~ FACILI~ ~ME ~ DBA - ~ng Busin~ ~) 3 201 CHEMI~L LO~TION ~ Y~ ~ No 202 · :: ;~ ~. :. :~:::~::~;,~...~:~: ~:.~.~?'..',~.:~7%.: ~:;~::~II:CHEMIC~JNFORMA~ON~;,~:~:~.-:.?~ ~ ,,* ,.¥ . · 205 T~DE SECRET ~ Y~ ~ No 2~ CHEMICAL ~ME ~ ~ ~ ~ E Subj~ to EPC~. ref~ to instm~i~s 207 COM~N ~ EHS* CAS~ 209 ~'... If ~S a :,Y~,. FIRE ~DE H~D C~SSES (~plete if r~t~ by I~l ~e 2~0 ~PE ~URE ~ m MITRE ~ w WA~E 211 ~DIOA~ ~Y~ ~No 212 ~ CURIES 213 PHYSI~L STA~ ~ s SOLID ~IQUID ~ g ~S 214 ~RGEST ~AINER ~ 215 ' FED ~RD ~TE~RIES ~IRE ~ 2 R~CT~ ~ 3 PRESSURE REL~SE ~ 4 AC~ H~L~ ~ 5 CHRONIC H~L~ 216 (~ ~1 that app.) UNffS' ~L ~ d CU~ ~ lb LBS D ~ TONS 221 J DAYSONSITE ~2 · ff EHS, am~nt must be in Ihs. STOOGE CO~AINER ~VEGROUND T~K ~ e P~STI~ONM~ALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~ 223 (Check all ~at apply) ~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC BO~LE ~ r O~ER ~ c T~K INSIDE BUILDING ~ g ~R~Y ~ k aOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ AMBIE~ D ~ A~VEA~IE~ ~ ba BELOWA~IENT ~4 STO~GETEMPE~TURE ~IE~ ~ ~ ~VEA~IE~ ~ ba 8ELOWA~IE~ ~ c CRYOGENIC 225 226 227 [] Yes [] No 228 229 2 I 230 231 []Yes [] No 232 233 t 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 ~ I 242 243 []Yes [] No 244 245 PRINT NAME a TITLE OF AUTHORIZED COMPANY REPRESE~ATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd s ~ rt~m I ICE OF ENVIRONMENTAL RVICES t~,nttrmt~r 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fon'n per mate~al per butl~mg or ama) _ ~ ~ ADO ~ DELETE ~ REVISE ~ Page ~ of , . .: ~L,.~ .-.~:~...~:~;: ... ... · .~ ~." -:. ?~ :~ ~..'~ ~.~ ..~' ~ · ~.; ~' ..... ~ . . · , BUSINESS NA~E (Same as FACILI~ ~ME ~ D~ - ~ng BuNn~ ~) 3 ~11 CHEMI~L LO~TION CHEMI~LLOCATION [~ I~ ~ ~~ ~ ~ ~ CONFIDENTIAL(EPC~) FACILI~ID' ~ ~ 1 ~P'(opt~naO ~3 ~ GRlD,(opt~naO ?~:~.~ ?':'..'.~:::~:.:~?:; ::~;:,:~::~.~:~;:~?~:?~.:~fl~HEMiC~/NFOEMA~ON:~:?:~:::'::::~~: ...::~:.'..... ~.~... . . ~ 205 T~DE SECRET CHEM,~L~ME ~~O~ ~ ~O'~ ,fSubj. toEPC~.ref, to,nst.~i.s COM~N ~ EHS' FIRE ~DE H~D C~SSES (~plete if r~u~t~ by I~ fire ~i~ 210 ~ CURIES 213 WPE PURE ~ m MITRE ~ w WASTE 21~ ~DIOACT~ ~ Y~ ~ No 212 ~ PHYSI~L STATE ~ s SOLID ~QUID ~ g ~S 214 ~RGESTCO~AINER ~O 215 FED ~RD ~TE~RIES ~IRE ~ 2 R~CT~ ~ 3 P~SSURE REL~SE ~ 4 ACU~ H~L~ ~ 5 CHRONIC H~LTH 216 (Ch~ ~1 ~at apply) A~u~ANNUAL WASTE 217 I ~I~MDAiLY A~U~ ~ 218 ~ AVE~GEDAiLY ~U~ 219 STA~ WAS~ ~DE UN.S* ~ ga ~L ~ d CU ~ ~ lb LBS ~ m TONS 221 ~ DAYS ON SITE · If EHS. am~nt must be in lbs. STOOGE CO~AINER ~VEGROUND T~K ~ · P~STI~ONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL (Check ag ~at apply) ~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC 80~LE ~ r O~ER ~ c TANK INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TO~ BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N ~A~IE~ ~ ~ A~VEAMBIE~ ~ ba BELOWA~IENT ~4 STOOGE PRESSURE ~IE~ ~ aa A~VE A~IE~ ~ ba BELOWA~IE~ ~ c CRYOGENIC STOOGE TE~E~TURE ~ 226 227 ~ Y~ ~ NO 228 1 2 ~ ~0 231 ~Y~ ~No 232 233 j 234 235 ~ Y~ ~ No 236 3 ~7 4 ~8 239 ~ Y~ ~ No 240 241 5t 242 243 ~ Y~ ~ No 244 245 PRINT ~ & TITLE OF AUTHORIZL ~ 1PA~ REPRESENTATIVE ~IG~TURE DATE 2~ UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd I trttrl ~ O ICE OF ENVIRONMENTAL RVICES tr .nnra r 1715 Chester Ave., CA 93301 (661) 326-3979 "~--~"**" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per matedal per building or ama) ~ ~ ADD ~ DELETE ~ REVISE ~ Page BUSINESS NAME (~me as FACILI~ ~ME ~ DBA - ~ng Busin~ ~) 3 CHEMICALLO~TION I~~ ~ ~~ ~ 5~ 201~ CHEMI~LLOCATION } CONFIDENTIAL FACILI~ lO, ~ ~ 1 ~P, (op~naO 203 GRID, (opt~naO~ 2~ ,, . :. ,:..:.: ,::.:... ,..... · . 205 T~DE SECRET ~ Y~ ~ No 2~ CHEMICAL ~ME ~ ~ ~ ~ ~ Sub~ to EPC~. ref~ ~7 COM~N ~ME EHS' FIRE CODE H~RD C~$SES (~pl~e ii r~u~t~ ~y I~1 fire ~i~ ' '" ' ' .............. 210 p PURE ~ m MITRE ~ WASTE 211 ~DIOACT~E U Y~ G NO 212 i ~PE CURIES 213 PHYSI~L STATE ~ s SOLID ~QUID ~ g ~S 214 ~RGESTCO~AINER ~ 215 FED ~RD ~TE~RIES ~IRE ~ 2 ~1~ ~ 3 PRESSURE REL~SE ~ 4 AC~ H~L~ ~ 5 CHRONIC H~LTH 216 (~ all ~at apply) ANNU~WAS~ 217 [ ~I~M 218 ~ A~GE 219 STA~WAS~DE A~U~ DALLY A~U~ ~ DALLY A~U~ . . I I UNffS* ~ ~L ~ d CU ~ ~ lb LBS ~ ~ TONS 221 DAYS ON S~E ~2 · ~ EHS. ~nt must be in lbs. STOOGE CO~AINER ~VEGROUND T~K ~ e P~S~NMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 2~ (Check ag ~at apply) ~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC BO~LE ~ r O~ER ~ c T~K INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~a AMBIE~ ~ ~ A~VE A~IE~ ~ ba BELOW A~IE~ ~4 STOOGE ~MPE~TURE ~IE~ ~ ~ A~VE A~IE~ ~ ba BELOW A~IE~ ~ c CRYOGENIC ~5 ~ 22~ 227 ~ ~ ~ ~o 228 2 i 230 231 ~Y~ ~ NO 232 233 3 234 235 ~ Y~ ~ No 236 237 238 239 ~ Y~ ~ No 240 241 242 243 ~ Y~ ~ No 244 245 '~::'::":f'" "'" ?"::~?~" ':E" PRINT NAME'& TITLE O~ AUTHORIZED COMPANY REPRESENTATIVE SIG~TURE OA UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd ~D~.~...~E. O~ CITY OF BAKERSFIE~ ~ ICE OF ENVIRONMENTAL S'ERVICES t~,~nt~r~t~'r 1715 Chester Ave., CA 93301 (661)326-3979 ~ ~ ADD ~ DELETE ~ REVISE ~ Page BUSINESS NAME (Same as FAClLI~ ~ME ~ DBA - ~ng Busln~ ~) 3 20~j ~fi~L LO~TJON CHEMICAL LO~TION ~ ~5/'O~ ~ ~ ~ ~ ~ CONFIDE~IAL EPC~) .... 205 ~ T~DE SECRET If SuDj~ to EPC~ ref~ to instm~s 207 ~ CO~N ~ ~ EHS*. FIRE ~DE H~ C~SSES (~plete ~f r~u~t~ by ~ ~re 210 ~PE ~ p PURE ~ m ~I~RE ~WASTE 211 ~DIOA~ ~Y~ ~No 212 ~ CURIES 213 PHYSI~L STATE ~ s SOLID ~IQUID ~ g ~S 214 ~GES~A~N~R ~ 215 FED ~RD ~TE~RIES ~ 1 FIRE ~ 2 R~ ~ 3 PRESSURE ~L~SE ~C~ H~L~ ~ 5 CHRONIC H~L~ 216 (Ch~ all that apply) ANNUALWAS~ 217~J ~I~M ~ 218 AVENGE . .. 219 STA~ WASTE CODE A~U~ DAILY A~U~ DAILY ~U~ UN.S* ~ ~L ~ ~ CU ~ ~ lb LBS ~ ~ TONS 221 DAYS ON SITE ~2 * E EHS, am~nt must be in lbs. STOOGE CO~NER ~ a A8OVEGROUND T~K ~STI~NM~ALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 2~ (Check all ~at app/y) ~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC BO~LE ~ r O~ER ~ c T~K INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TO~ BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~A~BIE~ ~ ~ A~VEA~IE~ ~ ba BELOWA~IE~ ~4 STO~GE~MPE~TURE ~IE~ ~ ~ A~VEAMBIE~ ~ ba BELOWA~IE~ ~ c CRYOGENIC 225 1 226 ~7 ~ Y~ ~ No 228 2 230 ~1 ~ Y~ ~ No 232 233 j 234 ~5 ~ Y~ ~ No 236 237 238 ~9 ~ Y~ ~ No 240 241 242 243 ~ Y~ ~ No 244 245 PRINT NA~ & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIG~TURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 ,TV4.wpd