HomeMy WebLinkAboutBUSINESS PLAN MEMORANDUM
October 11, 1994
TO: Esther Duran, Hazardous Materials ~_
FROM: Drew Sharpies, Financial Investigator
SUBJECT: Hazardous Materials Accounts
HM806101 2911Brundage Lane, Last Detail
Bankruptcy case #94-14504-A-7 was filed on 9-29-94.
Please close the account effective that date. The
business is no longer in operation.
RSFIELD CITY FIRE DEPARTI4ENT 2130 "G" STREET
B ERSFIELD. CA
(80 ) 2 -S9V9
HAZARDOUS ~TERI ALS
BUSINESS PLAN AS A "HOLE
I~S~CTI O~S:
2. TYPE/PRINT ANSWERS IN ENGLISH.
~. Answer the questions below for the business as a ~hole.
4. Be as brief and concise as possible.
SECTION ~: BUSI~SS IDE~IFICATION DATA
CITY: ~~¢,~0 ZIP: q550q BUS.PHONE: (~)
SECTION 2: EMERGENCY 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 AN~D TITLE DURING BUg. HRS. AFTER BUS.
A. ~Z~d~) C,o~ Ph~ ~%-OQ::'~k:' Ph~
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE: ~O0~0~.~ ~0~00~-~ O~' ~}2,O0~ OF~%C~/ ~y~t%L~,~{-,,
B ELECTRICAL: ~O~ ~qO ~ 5i~? {~~ , {~%}C
C WATER: ~00 ~v 5(~t'~ O~'T~ ~.~. C~iLO~.f, o~ ~,~t,g, ~ 0~d~ 5~. ~xn~ ~9tf-, ~ ~9~°,~.g.
D. SPECIAL:
E. LOCK BOX: YES /(~ IF YES, LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO
FLOOR PLANS? YES / NO KEYS? YES / NO
- 2A -
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOL~ BUSINESS AS A WHOLE
SECTION 6: S~PL0~E ~INING ~W~.' ~zy/~ ~ ~ ~e~ ~
E~PLOYERS ARE REQUIRED TO HAVE A PROGRA~ WHICH PROVIDES E~PLOYEES WITH INITIAL AND
REFRESHER TRAINING ~N THE ~OLLOWING AREAS.
CIRCLE YES OR'NO I~ITIAL REFRESHER
A. ~ETHODS ~OR SA~E HANDLING O~ HAZARDOUS
~TERIALS:... .................................... ~O YES
B. PROCEDURES ~OR COORDINATING ACTIVITIES
~ITH RESPONSE AGENCIES: .......................... ~0 YES
C. PROPER USE OF SAFETY EQUIPMENT: .................. ~NO YES NO
D EMERGENCY EVACUATION PROCEDURES: ................. ~ NO YES NO
E. DO YOU ~INTAIN EMPLOYEE TRAINING RECORDS: ....... YES~ YES NO
SECTION 7: ~Z~OUS ~TERI~
CIRCLE YES OR~
DOES YOUR BUSINESS HANDLE HAZARDOUS ~TERIAL IN QUANTITIES LESS THAN ~00 POUNDS OF A
SOLID, ~S GALLONS 0F A LIQUID, 0R ~00 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO
/ , certif~ that the ~bo~e information is accurate.
I understand that this information will be used to fulfill my fi~m's oblisations under
the new California Health and Safety code on Hazardous Materials (Div. ~0 Chapter 8.9~
Sec. 25S00 Et Al.) and that inaccurate information constitutes perjury.
- 2B -
BAKERSFIELD CITY FiRE DEPARTMENT
·
2130 "G" STREET
BAKERSFIELD, CA 93301
Orr ~ i:L. USE
ID#
BUS INESS '
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM SA
INSTRUCTIONS
I. To avoid further action, this form must be retu~'ned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACII, ITY U.%IT LISTED BELOW
4. Be as P. RIEF and CONCISE as possible.
FACILITY UNIT~ FACILITY b~NIT NAME:
SECTION 1: MITIGATION, PREVEN'fION, ABATEMENT PROCEDURES
SECTION 2: NOTIFICATION AND EVACUATION PROCEDE"RES AT THIS L~."IT ONLY
c'4'''' /°'''/
- 3A -
SECTION 3: HAZARDOUS MATERIALS FOR THIS b.'NIT ONlY
A Does this Facility Unit contain Ha,.ardous Materials? ...... YES NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES NO
If No, complete a separate hazardous materials inventory
'orm marked: NON-TRADE SECRETS ONLY (white form ~4A-1)
Yes, complete a hazardous materials inventory form marked:
E SECRETS ONLY (yellow form =4A-2) in addition to the non-trade
form. List only the trade secrets on form 4A-2.
SECTION 4: FIRE PROTECTION
SECTION 5: LOCATION OF SUPPLY FOR USE BY EMERGENCY RESPONDERS
SECTION 6: LOCATION OF UTILITY ~'UT-OFFS AT THIS UNIT ONLY.
A. XAT. GAS.,'PROPANE~
B. ELECTRICAL:
C. WATER:
· r , YES ' F
E _OCK BOX: NO [ YES, LOC
· IF YES, SITE PLANS? YES / XO MEDEs? YES "NO -
FLOOR PLANS? YES ." NO KEYS? YES .," NO
- 3B -
BAKERSFIELD CITY FIRE DEPARTMENT
I.D. m FORM 4A-1 Page
NON--TRADE SECRETS
HAZARDOUS MATERT ALS I NVENTORY
BUSINESS NAME: ~/~,,l~';'m~-~ ~",~J',~,'ff~'v,'~ OWNER NAME: ~'~'~'~ ~ FACILITY UNIT
ADDRESS:~//~~ ADDRESS: ~/ ~~ ~ FACILITY UNIT NAME:
, Z I P ~ ~ ~
CITY ZIP: ~~,~ ~~ CITY, : ~ - ~ ~
1 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE OUIDE
NA~E:~~~ TITLE: ~~ SIONATURE ~~~ DATE:
E~ERGENCV CONTACT: ~~~ TITLE: ~~ PH( ~ BUS HOURS:
-__ __ / AFTER BUS HRS:
~/~ ~~~ ~~~ PHONE ' BUS HOURS:
gHBRGBNCY CONTACT:~ ~. TITLE:
PR I. NC'I PAL BUS I NESS ACTYVY TY: ~-~ ~;~[~ ~~ AFTER BUS. HRS: ~2-
'- - 4A-I -'