HomeMy WebLinkAboutBUSINESS PLAN 4/24/2001 Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT~ON REVERSE SIDE
: ~is ~R is issu~ for ~e follo~ng:
~ H~Mous Materials P~n
~ Unde~mund Storage of H~.Mous Mat~ls
Permit ID ~:: 015~00~01776 ~ RiskManagem~tP~mm
SPECIALTY HONDA CAR = .~ous WasteO~Site T~t
'LOCATION: 2907 BRUNDAGE LN ~
OFFICE OF ENVIRONMENT/iL SER VICES'
II~ 1715 Chester Ave., 3rd Floor Appr°vedby:
Issue Date
Bakersfield, CA 93301
Voice (661) 326-3979 '
· FAX (661) 326-0576 ,.. "- ~ :Expiration Date: June 30. 2003
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
'~ ....~,,~,~,~:~,,~,!!i:~,~?~?~!i~,,,~?.,, ,,,~ This permit is issued for the following:
.:=,//?~'?.?i::?.?''':;ii ...................... iljiii:::::!iiii!!!i:~D;~iU~ae:[ground Storage of Hazardous Materials
PERMIT ID# 015-021a01776 :,~:.~i?~i. :~, !,.,i:~,'!!;;~;.:~iJ;i~i!i~i~,~ ...!!?i!!!!!f;:!ii!~::::i!!!ii!%!!}!!!::..:.,~i!iil;~i;~i!i~kM~nagement Program
SPECIAL~ HONDA CAR REPAIE:;
LOCATION 2907 B R U N BAG E~'(:'::~'~',~='~
Is~ by:
B~er~field Fke D~a~ment Approved by: ~ ~ '
1715 Chewer Ave., ~rd Floor ce of~~
B~e~el~ CA 93301
Voice {805) ~26-~979
F~ (80S)~26~S76 ExpimtionDate: dun. ~0~ ~000
ITE DIAGRA~
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE
ADDRESS CHANGE
CLOSE ACCT ,
'FINANCE CHARGE I
OTH'ER AOJ
CUSTOMER NAME
P~CEL NUMBER
(IF APPUCABL~ .::'.
ADJUSTMENT
i CHG DATE CHARGE CODE "1 ADJUSTMENT AMOUNT
PO ~OX ~057
BAKERSFIELD CA 93303-2057 (66i) 326-3658
CUSTOMER NO: !~218 CUSTOMER TYPE: ES/ 15901
TOTAL ~,~- mS1 ~ 50
FINANCE DEPARTMENT
CiTY OF BAKERSFIELD
BAKERSFIELD, CALIFORNIA 93303
R~URN SERVICE REQUESTED
,_'_'5P~C~O7 ~:~0~.,.-'3o.-.-30 i~)oi 0(5 O~/O~/O.'L
RETURN TO SENDER
:,,'SPECl'ALT¥ HONDA
~.70g LE'r,SURE 5T
.~ .-... ~ ~, .-~.U ~.~, .~-il ~) e 4 Ihi,,, J h,,thli,,,,,lt,,,i,llh,,,ht,
D
April 27, 2001
Mr. Rocky Whittak
Specialty Honda Car Repair
FIRE CHIEF 2907 Brunflage
Lane
RON FRAZE Bakersfield, CA 93304
ADMINISTRATIVE SERVICES
2101 "H" Street Dear Mr. Whittak:
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349 Enclosed, please find a copy of the site diagram or facility diagram that you had
SUPPRESSION SERVICES previously submitted as part of your Hazardous Materials Management Plan
2101 "H" Street (HMMP). The diagram(s) submitted, have been rejected, because: 1) Label the
Bakersfield, CA 93301
VOICE (661)326-3941 location of utility shut-offpoints for gas, electric and water.
FAX (661) 395-1349
Please have the diagram(s) re-drawn and re-submitted by May 25, 2001. I have
PREVENTION SERVICES
1715 Chester Ave. also included a copy of the Site and Facility Diagram Instructions, and a blank
Bakersfield, CA 93301
VOICE (661)326-3951 form for your convenience. If you have any questions, please contact
FAX (661) 326-0576 Esther Duran at (661) 326-3658.
ENVIRONMENTAL SERVICES
1715 ChesterAve. Thank you for your assistance.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576 Sincerely,
TRAINING DIVISION
5642 Victor Ave. RALPH E. HUEY, DIRECTOR
Bakersfield, CA 93308
VOICE (661)399-4697 OFFICE OF ENVIRONMENTAL SERVICES
FAX (661) 399-5763
~ I~~S~(
Esther Duran, Accounting Clerk
Office of Environmental Services
ED\db
Enclosures
ITE DIAGRAM .__....=,~ ,~.,./ FACILITY DIAGRAM
Bus~z~s Nsm~:
$PBCIALTY HONDA CAR REPAIR~~' / SiteID: 015-021-001776
Manager : '/ BusPhone: (805) 328-1464
Location: 2907 BRUNDAGE LN Map : 102 CommHaz : Moderate
City : BAKERSFIELD Grid: 36C FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 03 SIC Code:
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
ROCKY WHITTAKER / OWNER JEREMY WHITTAKER / MECHANIC
Business Phone: (805) 328-1464x Business Phone: (805) 328-1464x
24-Hour Phone : (805) ~-~5~3~71 24-Hour Phone : (805)
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire DelHlth
Contact : Phone: (805) 328-1464x
MailAddr: 2907 BRLTNDAGE LN State: CA
City : BAKERSFIELD Zip : 93304 3z3~--e5~'~x~~1
Owner ROCKY & SHERRY WHITTAKER Phone: (805)
Address : ~I01 CYCL~N~ DR ~~ ~~~' State: CA
City : BAKERSFIELD ~ '~. Zip : 93313
Period : to = Gal
Preparer: ~O~ ~ ~otalUSTs = Gal
Certif'd: .~ ~6;~ RSs: No
Emergency Directives:
= Hazmat Inventory One Unified List
--As Designated Order Ail Materials at Site
Hazmat Common Name... SpocHazlEPA HazardsI Frm ] DailyMax Unit MCP
WASTE OIL F DH L 165 00 GAL Low
WASTE ANTIFREEZE F DH L 110 00 GAL Low
KEROSENE F DH L 55 00 GAL Low
AUTOMATIC TRANSMISSION FLUID F DH L 75 00 GAL Low
LUBE OIL F DH L 75 00 GAL Mit
SAFETY KLEEN SOLVENT L 35 00 GAL Mod
hcec horeby certify tha~ ] have
(T~pe or pdnt name)
reviewed the at~ached hazardous mmerials manage-
mere plan for~/5'~c-c-x'~'~~' c),o~/'~nd tha~ i~ along with
(Name of Business)
any corrections constitute a complete and correc~ man-
agement plan for my facili~.
SPECIALTY HONDA CAR REPAIR SiteID: 015-021-001776
~ Inventory Item 0001 Facility Unit: Fixed Containers at Site
-- COMMON NAME / CHEMICAL NAME
WASTE OIL Days On Site
365
Location within this Facility Unit Map: Grid:
SW CORNER INSIDE BLDG CAS#
221
rSTATE I TYPE PRESSURE ~l TEMPERATURE CONTAINER TYPE
Liquid Waste Ambient Ambient DRUM/BARREL-METALLIC
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
55.00 GALI 165.00 GAL 110.00 GAL
HAZARDOUS COMPONENTS
100.00 Waste Oil, Petroleum Based N
HAZARD ASSESSMENTS ·
ITSecretl RSIBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP
No No No No/ Curies F DH / / / -Low
~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~
-- COMMON NAME / CHEMICAL NAME
WASTE ANTIFREEZE Days On Site
365
Location within this Facility Unit Map: Grid:
SW CORNER INSIDE BLDG CAS#
107-21-1
F STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid [ Waste I Ambient I Ambient I PLASTIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
55.00 GAL 110.00 GAL 55.00 GAL
HAZARDOUS COMPONENTS
%Wt. ~S CAS#
30.00 Ethylene Glycol N 107211
HAZARD ASSESSMENTS
TSecretl RSIBioHazI Radioactive/Amount I EPA Hazards I NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
2 09/28/2000
SPECIALTY HONDA CAR REPAIR SiteID: 015-021-001776
~' Inventory Item 0003 Facility Unit: Fixed Containers at Site
-- COMMON NAME / CHEMICAL NAME
KEROSENE Days On Site
365
Location within this Facility Unit Map: Grid:
INSIDE SW CORNER OF BLDG CAS#
8008-20-6
STATE ~ TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE
Liquid /Pure Ambient I Ambient DRUM/BARREL-METALLIC
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
55.00 GAL 55.00 GAL 55.00 GAL
HAZARDOUS COMPONENTS
Wt. I CAS#
100.00 Kerosene N 70892103
HAZARD ASSESSMENTS
TSecret' RS'BioHaz' Radioactive/Amount EPA Hazards NFPA USDOT# MCP
NoIN°liN° No/ Curies F DH / / / Low
-- Inventory Item 0004 Facility Unit: Fixed Containers at Site ~
-- COMMON NAME / CHEMICAL NAME
AUTOMATIC TRANSMISSION FLUID Days On Site
365
Location within this Facility Unit Map: Grid:
INSIDE CENTER OF W WALL CAS#
64742-56-9
STATE -- TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Liquid Pure Ambient Ambient ABOVE GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
75.00 GALI 75.00 GAL 75.00 GAL
%Wt. HAZARDOUS COMPONENTS
100.00 Transmission Fluid (Petroleum-Based) NOS 0
HAZARD ASSESSMENTS
I TSecret NoRS I BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP
No No No/ Curies F DH / / / Low
3 09/28/2000
SPECIALTY HONDA CAR REPAIR SiteID: 015-021-001776
= Inventory Item 0005 Facility Unit: Fixed Containers at Site
-- COMMON NAME / CHEMICAL NAME
LUBE OIL Days On Site
365
Location within this Facility Unit Map: Grid:
INSIDE CENTER OF W WALL CAS#
F STATE ~ TYPE PRESSURE I TEMPERATURE CONTAINER TYPE
Liquid /Pure Ii Ambient , Ambient ABOVE GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
75.00 GAL 75.00 GAL 75.00 GAL
HAZARDOUS COMPONENTS
%Wt. ~S CAS#
100.00 Lubricating Oil (Petroleum-Based) N 8020835
HAZARD ASSESSMENTS
TSecret' RSlBioHaz'' ' Radioactive/Amount EPA Hazards NFPA USDOT# MCP
NoIN° IINo No/ Curies F DH / / / Min
= Inventory Item 0006 Facility Unit: Fixed Containers at Site
-- COMMON NAME / CHEMICAL NAME
SAFETY KLEEN SOLVENT Days On Site
365
Location within this Facility Unit Map: Grid:
INSIDE CENTER OF BLDG CAS#
rSTATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Liquid Mixture Ambient Ambient DRUM/BARREL-METALLIC
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
35.00 GALI 35.00 GAL 35.00 GAL
HAZARDOUS COMPONENTS
100.00 Naphtha Solvent N 8030306
HAZARD ASSESSMENTS
TSecret oRS I BioHaz Radioactive/Amount EPA Hazards NFPA I UBDOT# MCP
No N No No/ Curies / / / Mod
-4- 09/28/2000
-5- 09/28/2000
-6- 09/28/2000
SPECIAETY HONDA CAR REPAIR ~~~~ SiteID: 015-021-001776
Site Emergency Factors ~~~~~~ Overall Site i
i~ Special Hazards ~~~~~~~~~i
O
O
ii~EE Utility Shut-Offs EEEEEEE/SEEEEEEEEEEi~/5/5/SEEEEE/~EEEEE/SEEE~5/~/~EEE~ 04/17/1997
O
A) GAS - NW CORNER OF BLDG °
B) ELECTRICAL - INSIDE BACK OF MAIN BLDG ON SE SIDE °
C) WATER - METER AT NE SIDE BY STREET SIGN °
D) SPECIAL - NONE °
E) LOCK BOX - NO °
O
i~aa~ Fire Protec./Avail. Water aa~aaaaaaaaaaaaa~aaaaaaaaaaaaaaaaaa 04/17/1997
o
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS o
o
O
o
NEAREST FIRE HYDRANT - CORNER OF BRUNDAGE LN & OLIVE.
O
i~ Building Occupancy Level
O
O
-7- 09/28/2000
?
SPECIAI2TY HONDA CAR REPAIR
Training ~/~/3/~/~~~~~~ Overall Site
~/~ Employee Training ~/~/~/~/~/~~~~~ 10/14/1997
O
WE HAVE 2 EMPLOYEES AT THIS FACILITY. o
o
WE DO HAVE MSDS SHEETS ON FILE. °
O
BRIEF SUMMARY OF TRAINING PROGRAM: READ MSDS SHEETS. WALK THROUGH SHOP AND o
NOTE ANY UNSAFE PRACTICES. CALL 911 IF EMERGENCY. IF A SPILL OCCURS THEN o
AN ABSORBANT WOULD BE USED TO ABSORB ANY RESIDUE. o
o
O
O
i/~i~ee Held for Fumre Use
o
o
i~5~eee Held for Fumre Use
o
o
-8- 09/28/2000
SPECIAI~TY HONDA CAR REPAIR EEEEEEEE~EEEEE~EEEEEEEEEEE SiteID: 015-021-001776 i
Mitigatio~Prevent/Abatemt ~~~~~ Overall Site i ~~~t~l ~_ ~
i~ Release Prevention ~~~~~~~ 04/17/1997 i
WASTE OIL & COOLANT A~ STORED IN 55 GAL PLASTIC DRUMS. GO D . o
COOLANT ARE ALSO STORED IN PLASTIC DRUMS. ALL ARE ~PT IN~ CORNER OF BLDG o
AND ~ SI~OF BLDG. AN ABSO~ANT IS USED AND ~PT NEAR IN CASE OF ANY o
o
~VE WASTE PIC~D UP EVERY 2-4 WEEKS AND USE ABSO~ANT AROUND DRUMS.
o
O
USE ABSO~ANT TO CLEANUP THEN DISPOSE OF WITH COMPANY THAT PICKS UP OIL. OR
IF LARGE SPILL OCCURS DO WHAT FIRE DEPT SUGGESTS.
o
i~ Other Resource Activation
o
o
SPECIAETY HONDA CAR REPAIR ~/~~/~/5~/~/5~/~/~ S iteID: 015-021-001776
Notif./Evacuatio~Medical ~~~~~~ Overall Site i
i~ Agency Notification ~~~~~~~ 10/14/1997 i
o
CALL 911 AND HAVE POLICE CONTACT FIRE DEPARTMENT
O
i~ Employee Notif./Evacuation ~~~~~ 04/17/1997
o
IF A SPILL OF GREAT VOLUME OCCURS THY SHOULD LEAVE BLDG AND CONTACT POLICE
AT 911.
o
i~ ~blic Notif./Evacuation ~~~~~~ 04/17/1997 i
O
LET POLICE AND FIRE DEPT DECIDE IF EVACUATION IS NECESSARY.
o
i~ Emergency Medical Plan ~~~~~~ 04/17/1997
o
USE FIRST AID ~T, IF EMERGENCY CARE IS NEEDED GO TO URGENT CARE OR CALL 911
IF SEROUS. o
0
CITY OF BAKERSFIELD
omc~ Ol~ ~n~o~-~~rAL s~v~c~s
~~G~O~ STO~G~ T~ ~O~~
1715 Chester Ave., Bakenfield,
1. To avoid ~nher a~i°n, remm t~s fo~ ~t~ays of receipt.
2. T~E~ ~S~RS ~ ENGLISH.
3. ~swer the questions below for the business as a whole.
4. Be as brief ~d concise as possible.
SECTION 1: BUSINESS IDENTIFICATION DATA
LOCATION: 2_q O'-2 ~r~g,~ f3/k4.~ ~
D~ & B~S~ET ~ER: SIC CODE:
SECTION 2: E.XfERGENCY NOTIFICATION
CONTACT , t,t ~/.,, TITLE BUS. PHONE 24 HR. PHONE
1
ItAZARDOUS MATERIALS MANAGEMI~NT PLAN
SECTION 3: TRAINING
NUMBER OF EMPLOYEES: ~
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
I CERT~Y L~ER PEN~TY OF PE~Y ~T'~'B~S~SS IS E~T ~OM
T~ ~PORT~'G ~Q~~NTS OF C~TER 6.95 OF
& S~TY CODE" FOR T~ FOLLO~'G ~ASONS:
X~E DO NOT ~X~LE ~.~OUS ~~S.
\kT DO H.&NDLE I-LAZ.~d3OUS MATERIALS, BUT THE QUANTrrIE$ AT
NO TI~,[E EXCEED THeE *127X-DvlLL~vl REPORTING QUANTITIES.
'-~ OTHE_R_ (SPECIFY .IL~_:~S_ON-L
SECTION 5: CERTIFICATION
x~~ ~~~~-- CERTIFY THAT THE ABOVE
~qFO1LMA'I: IS ACcu~T~E. ~ L.'?,,-DERST.&N-D THAT THIS INFORMATION WILL BE
USED TO FL'LF1ZL M-Y FIRM'S OBLIGATIONS U~'NDER THE "CALIFORNIA HEALTH
AND SAFETY CODE" ON HAZARDOUS .XL-kTERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500
ET AL.) AND TI-L, kT INACCURATE INTO1L\4_ATION CONSTITUTES PERJURY.
~ION~T/~RE - -~ -TITLE' / DAT~
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES ..
A. AGENCY NOTI~CATION PROCEDURES:
B. EMPLOYEE NOTIFICATION AND EVACUATION:
C.
PUBLIC
EVACUAT. ION: , ,
D. EMERGENCY MEDICAL PL.-V',':
ltAZARDOUS MATERIALS MANAGEMENT PLAN
ECTION-7: MITIGATION, PREVENTION AND ABATEMENT PLAN
B RELEASE CONTAINMENT AND/OR MINIMIZATION: ,, .~- '- ,. ,,
X;ECTION 8: LWILITY SHUT-OFFS (LOCATION OF SHUT-OFFS A,T Y~O~UR FACILIT~
B. WAIER AVAILABILITY (FIRE HTDRANT):
4
:~ne~ Name Ack3ress
~ CHEMICAL DESCRIPTION
t INV~NTO~YSTA31JS: New! ! Addlienl ! Re~liMi( ] Deleaee! !
CommonNw: ~-~)~'~'~- ~ ~ 3) DOT #
C~emic~ N&me: AHM I J CA~
PI~YSlCAL & HEALTH PHYSICAL HEALTH
~AZARD CATEGORIES Fire ( ] Reicuve{ ] Suctclen Release of Pressure ! ! immeG~iateHeaJtll(Acute) [ ]
WASTE CLASSIFICATION (3-eig¢ coee from OHS Form 8022; USE CODE
PHYSICAL STATE Solid [ ] ~ou~ [ ] Ga~ [ J .=ute [ ] Mixture [ ] Waste t~
AMOUNT AND T1ME AT FACILITY '~ FciC" LJNITS CF MEASURE 8) STORAGE CODES
MaxdmumDa/IyAmoun£: :Ds [ ] c.a~ [ i ~3 [ ] aj Contaule~.
Average O-,~V Amount: :~nes / ] i=) Pressure:
~ Annua~ Amount: c) Temperature:
Largesl Size Contmnec - ~ ~-
~ Days On $~te C~rc~e Which Monins: All Ye~. J. F. M. A. M. J. J. A. S. O. N. D
MIXTURE; List COMPONENT CAS ,i* % WT AHM
:~e three most naza~aous ~) [ ]
:heroical comoonents or
any AHM comoonems :'~ [ ]
CHEMICAL DESCRIPTION ' '
',VENT(~RYSTAi~.S. ~ewi I :.cc~!cni ! =ewsionl' ] Cele[~on. Checi(rfcnemlcaJisaNONTRADESECRET [ ] TRADE SECRET [
~.-,em~cad Name: AHM [ ] CAS
:MYSICAL & Hg_ALT~'~ =HYS[CAL HEALTH
~~Z. AF~O CATEGCR!E$ ,=ire ~ ' =esc'uve i i Suc~oen Re,esso c~ .=°ess~re ' ' .mmeoiaze tqeaJtrt ~Acute) [
· ','ASTE CL.J, SSIFICATION. ~-clg~t cooke ~'om OHS For,"? SCg2! USE CCDE
=HYS!CAL STATE_ Solid ( ~ _=ulo [ ] Gas ( ] .=.ire ( ] Mixture ( ] Waste ( ] Ra~ll:Nu:l:lve ( ]
~,MOUNT AND T;ME :,T F.tC::J .'~' _NITS ~.-' '.:=_ASUAE 8) STORAGE CODES
Average ~aJN Amount: _~'-S'- :;~e$ i ; b) Pressure:
L.,~gest S,ze Ccn~mner:
'/~".'TURE: L~st C,~MPONENT CAS # .. % WT AHM
~e cnree most naz~rc=ous :' [ ]
nemlca~ comOonents or
ny AHM components 2.: [
3/under perjury or/aw, mat t nave oersoneJ)¥ examined eno am/am/,a~ w/D'? me/nromaDon suDrrutte~ on ttus. ano all aW
· N~m& ~ flue Of ~'~c.~z~ 'Com~.
Name Addr~
CH~ DESCRI~ON
PH~IC~ & H~ PHYSIC~ H~
WAS~ C~SSIFICA~ON (~ig~ ~e ~m OHS Fo~ 80~ USE CODE ,
~MOUNT AND ~ME AT FACI~ ;NITS CF M~SURE 8) STOOGE CODES
Annum A~un,: ~~' c) Tem.~m:
~est Size ContmneK
~ Oa~ On S~te
three most n~ous 1) [ ]
:nem~ com~nen~ or
AHM com~nen~ Z) [ ]
CHEMICAL DESCRI~ION
'.'VE_NTCRY STATUS: New ( ] ,~ac~!cn i ] =ews~on [ ] Ce~etlon ' Chec~(iY cnem~caJ is a NON TRADE SECRET [ ] TRADE SECRET
.;ommon Name: ~,.~~t-~_. -T'0~,<~>(,~- '~"~u ~ ('~ 3) DOT# (o~).
:.-,em~caJ Name: AHM [ ] CAS
=~YSICAL & HE.ALT;~ =HYSICAL HEALTH
-.~Z. AF1D CATEGOR!ES ,=ire [ ' =eacclve( 1 Suaden~e~e~secfP'essure : i imme(3ia~eHeaJthtAcute) [ ] DelavettHealth(Chron~c)
,','ASTE CLASSIFICAT3ON 3-o~(=~t cooe ~o'r~ OH~ Fc'~''m 8C22~ USE CCOE -
=HYSICAL STATE. Solid [ 1 _cu,a [ ] Gas [ ] .:ute ] Mixture [ ] Waste [ ] RaCllOaC~lve [ ]
;MOUNT AND T;ME AT FACIU ,'TY _NITS ~..-- k~=.E.,~SURE 8) STORAGE CC~E~
Ma.~imum C.a.v Amount: '7~:~' :s i ' --'-~ ' ' 93 [ a,l ConteJner:. ~-'
Average Oa~N Amount: :;~es ( ~ b) Pressure:
Annuai Amount: .~/"/~"-' c) TemDere~ure:
L.~rges! $;ze ContaJner:
~ Days On S~e ~,rc:e ~'v~:Cn ~,tontrts: .~ll Ye~'. J. ,--. M, A. M. J. J, A, $. O. N.
'.fIXTURE: Ust COMPONENT CAS #
· ~e three most nezaroous 1~ [ ]
:.~em~caJ comoonents or
,,ny AMM ¢omgollen($ ;1
,3/unoer Der~]~/ or law, mat J nave oersonal~y exammeo aha arn IEIJ71111~J' WlD'I D'le mrOmaDOn SUD.#~3 on G'?I~ ~ ali ..........
-°' ' '''*
' Narr~e & Ti~fe'o"t A~-~.~'e~ ~,omoa~y F~e~esenlaOve $ignalure ~ ' / l~tIl
.ness Name .,,. Aclaress .,,,.
CHEMICAL DESCRIPTION
Common Name: /.~tjP>~' ~.~z.-c.- 3) DOT ~' (olamm~ '
=,~emmal Name: NlM [ ] CAS
~AZARDCATEGORIE$ I~m [ ] Rea¢ll~ ] SuaaenReleaseofP~sum ! ! immeaiateHealllt(Acule) [ ]
wAs'rE CLASSIFICATION ,3-amJ. coae lmm OHS Form ~ USE CODE
=HY~ICALSTATE Solid [ ] l.~auid [ ] Ga.~ [ ] ,=ute [ ] Maxum [ ] Waste [ ]
:,MOUNT AND TIME AT FACILITY ;;NITS CF MEASURE 8) STORAGE CODES
Maximum 0advAmount: "~:~" :~ [i c.a~ (~. ~3 [] aJ Comamer: ~--
Annum An'~uflt: ~ ' c) Temperature:
La,'gesl Size Commner.
~ Oav~ On S~te ~,-c:e Which Morons: All Yem'. J. F. M. A. M. J. J. A. $. 0. N.
41XTURE' ~st COMPONENT CAS
'e mree most ne,zaraous '~1 [
,-.emfca~ comoonems or
iV AHM components ~', [
,VENTC,m,Y ~TAT',,.;$. New i ', -~ccmcn i ', =ev,szon i ] ~_,e~e~.on. ' ghecx rf cnemfca~ is a NON TRADE SECRET, [ ] T'RA~E SECRET
'em~caJ Name. ~HM i' ~ CAS
'YSICAL & ~E. AL~ =~YSICAL HF_A~TH
.ZARD CA,TEGC~,!E$ =i.e , ;eac:sve i ', Suaaen Re,ease c' ;-ess;re ,mmeamze mere/J1 IAcu~el [ ] 2e~el He~ (Chmnm)
:,ST.= CLA$SIFICA~CN 3-a~q~! co(3e ~om OHS Pcr'~ 8C=2' USE CC~E
~OUNT ;NC T;,,ME ;T F:C:~' _',,T.~ :: '.~=_~$~.F,E 8) STOP, AGE CCDE$
Averaqe Oa~rv Amount: ."~ :;,-,es : : =} Pressure:
Annum Amount: ~ c) TemDer~ure: <~-
L.azo. esl $~ze C~ntaJner:
.'TURE; L~st C.~MPCNENT CAS
~nree mos= hazardous ,'
;mlceJ comoonenl3 or
AHM coml3onen~ -': [
~ [ ]
~n~ & Ti#e ot A~,.-cn~eo Company F~o-r~enraDve - '
ness Name Address
CHEI~CAL DEECRII~rlON
Corinne. Name: 3) DOT ,e'
WAS~ C~S8~N (~ ~ ~ OHS Fo~ ~ U~E CODE
;H~IC~STA~ ~1~ [ ] ~aum ( ] G~ [ ] ~ure [ ] M~ ( ] W~ [ ]
~MOUNT AND ~ME AT F~CI~ . _ ~NITS CF M~SURE 8) STOOGE CODES
A~ O~ A~um: tunes { ] b) P~:
~nnum A~t: c) Te~:
~t S~e Commne~
~ Oa~ On S~te C~m=e ~icn Morons: AIl Ye~. J. F. M. A. M. J. J. A. 5. O. N. D
COMPONE~ CAS ~
~e mine most n~ ~ )
~em~ com~ne~ or
nv AHM cam~nen= Z~ [ ]
CHEMICAL DESCRI~ION
~NTC~Y STATJS: ~ew i ] ~acmcn i ~ =ews~on ~ ~ Cese~on ' C~ec~ d cnem~ is a NON ~DE SECR~ [ ] ~E SECR~ [ '
-em~c~ Name: AHM [ ~ CAS ~
"YSICAL & H~L~ =HYSICAL
:~RD CA~GCR~E$ Fire :ea~ve ( ; Suoaen ~e~e~e c~ ='essure '~ ~ ;m~a~e He~ (Ac~e) ~ ~
'~S~ C~SSIFICA~0N ~a~g~t coee ~om OHS Pe~ ~C22! USE CC~E
',~OUNT AND ~ME ~T F~C:~ _~,iTS C~ '.~S~E ~) STOOGE CC~E~
M~imum Ca,vAmoum: :s : : ~ ,: ~ ~a { a) Cont~ne~
Averaqe Oran Amount: :uses { ' ~) Pressure:
~nnum Amount: c) Tem~re:
~est S~ze Cont~ner:
= Oa~ On S,le ~,:c:e ~:cn Months; AJi Ye~. ; ~, ,M. A. M. J. J, A. S, O. N.
'~RE: ~s~ CCMPONENT CAS · % ~ AHM
~ mree mos~ n~ous ~ ~ [ ]
em~ ~m~ne~ or
v AHM ~m~nen~ Z} [ ]
Vame& Ti#e of A~c.'~zoO Company ReDmsenmOve Signature Oaee