HomeMy WebLinkAboutBUSINESS PLAN2911 Brundage Ln. ~ Baker~fi~lfl, CA 93;~04
BAKERSFIELD CITY FIRE DEPARTMENT
HAZARDOUS MATERIALS DIVISION
1715 -CHESTER :.A,V£:
BAKERSFIELD, CA. 93301
HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
, 1. To avoid tu~ther 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 bdef and concise as possible.
SECTION 1' BUSINESS IDENTIFICATION DATA
MAILING ADDRESS:
OWNER:
MAILING ADDRESS'
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24. HR. PHONE
HAZARDOUS MATERIALS MANAGEM PLAN '
SECTION 3: TRAINI'NO:
NUMBER OF EMPLOYEES'
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM'
SECT[ON 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
TIMEEXCEEO 'THE MINIMUM REPORTING QUANTE. IES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
/
INACCURATE INFORMATION.CONSTITUTES PERJURY.
SIGNATURE TITLE DATE ....
Utilities General Account Maintenance PUTLS801
Acct Nbr: 311604 Bill Stat: NO Transfer-from: Page 1 of 6
Cyc Stat: CL Acct Cyc Stat: CL Transfer-to: 'Due: 1410.38
1. Customer Name: LAST DETAIL
2. Social Sec Nbr: 3. Telephone: 805-631-2921
4. Service Address: 2911 BRUNDAGE LN
5. Service City: BAKERSFIELD 6. State: CA 7. Zip: 93304
8. Parcel ID: 147-021-01-00-6
9. Bill Cycle: 1 20. Water Svc Class:
10. Route Nbr: 49
11. Comments :
12. Prev Acct: 6499 23. Misc Services: 23.1'132 1 ,3 YD 2 DAYS/WK
13. Service Date: 02/01/92 23.2 CGF COUNTY GATE FEE
14. Fund no: 23.3
15. Billto Adl:1704 AUBUSSON CT 23.4
16. Billto Ad2: 24. Closing Date:
17. Bill-to City: BAKERSFIELD 18. State: CA 19.. Zip: 93311
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