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HomeMy WebLinkAboutBUSINESS PLAN 7/9/1995!, ' Hazardous Materials/Hazardous Waste Unified Permit . CONDITIONS OF .PERMIT ON REVERSE SIDE .... 'This -~lit is issued for the followin _-: [] Hazardous Materials Plan El Und~'~round Storage of H~rdOus I~t~ials Permit ID #:: 0i 5-000-001400 El Risk Management Program Y O U N G S M A R K E T D Hazardous Waste On-Site Treatment LOCATION: 3030 BRUNDAGE LN Is sued by: Bake rs field Fi reDe pa rtme nt ~~p~~.ff~ , ~ OFFICE OF ENVIRONMENTAL SERVICES' '11 ~ ~7~s Chester Ave., 3rd Floor .Approved by: '11 ~ Bakersfield, CA 93301 · .... ~f~pct~:i~~-~, Issue Date II ,~l)_im~, Voice (661) 326-3979 ' - '" .". Il ~ FAX (661) 326-~576 ':'<:ExP~fionDate: ·June 30. 2003 I Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ,,~?mu~xi~;?:~',~,~ >~:~x~,~,~ :. This permit is issued for the following: ...... ~,~'~di'":i%/~,~!i:i~iilS<Z~x:iii::;i~;;:; ::;'!:.:::;'i::.~J~!i~Hazardous Materials Plan ~**~,'~i~':i'"i ~i:!! *:x'~*'~<;ii !!}!S ~,iii!!!ii~,. ~;~ ~:::~::~e[ground Storage of Ha~rdous Materials LOCATION 3030 B R U N DAG Es,::'{:?;~}~.::~:,~}:~/ B~S~J~LD CA .~:----. lssu~ by: o~c~ o~ ~o~~ s~ ~c~s 1715 Cheaer Ave., 3rd Floor ~ph Hu~~ O~ce of ~ea~! S~i~ B~e~el~ CA 93301 Voice (805) }2~3979 F~ (805) 326-0576 Expiration~,o: June 30. 2nnn YOUNGS MARKET SiteID: 215-000-001400 Manager : BusPhone: (805) 327-3526 Location: 3030 BRUNDAGE LN !~¥.~Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 36C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:5411 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title ~ / DIRECTOR_~ A0~ EVA~F~Aq~A~D 0,J,~e~/ MANAGER Business Phone: (805) 327-3526x~e Business Phone: (805) 327-3526xS~~ 24-Hour Phone : (805) 834-9675x ~¥-g~7~ 24-Hour Phone : (805) 664-1357x$2~ ?~ Pager Phone : ( ) - x~ Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 3030 BRUNDAGE LN State: CA City : BAKERSFIELD Zip : 93301 Owner WILLIAM YOUNG Phone: (805) 327-3526x Address : 3030 BRUNDAGE LN State: CA City : BAKERSFIELD Zip : 93304 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List ~ -- Alphabetical Order Ail Materials at Site ~ Name... ISpecHaz EPA HazardsI Frm DailyMax Unit MCP Hazmat Common BLEACH IH DH L 300 GAL Hi CLEANSER IH DH S 700 LBS Min INSECTICIDE F IH DH L 47 GAL UnR MOTOR OIL . ~ F IH DH L 22 GAL Min L~,, ~3.A ~'/o ~ ~'~-"l~0 her®by ce~ t~t ~ have ~ ~,am~ ~ ' 06/29/1999 / YOUNGS MARKET SiteID: 215-000-001400 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site I COMMON NAME / CHEMICAL NAME BLEACH Days On Site 365 Location within this Facility Unit Map: Grid: AISLE #18 CAS# 7681-50-9 Liquid /Pure Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average % 300.00 GAL 150.00 HAZARDOUS COMPONENTS 100.00 Bleach N 7681529 HAZARD ASSESSMENTS TSecretINo NoRSlBi°HazINo Radioactive/Amount I EPANo/ Curies Hazards IH DH NFPA/// USDOT# I MCPHi ---- Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ --- COMMON NAME / CHEMICAL NAME CLEANSER I Days On site 365 Location within this Facility Unit Map: Grid: AISLE #16 CAS# 7631-86-9 r STATE TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE Solid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average ~/53 LBS[ 700.00 LBS 400.00 LBS HAZARDOUS COMPONENTS 5.00 Calcium Chloride N 10043524 HAZARD ASSESSMENTS TSecret{ RSIBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# I MCP No No No No/ Curies IH DH / / / Min -2- 06/29/1999 YOUNGS MARKET SiteID: 215-000-001400 = Inventory Item 0002 Facility Unit: Fixed Containers on Site ~UlV~VlU~ ~Vl~ / ~ £ ~-~.L~ ~Vl~ INSECTICIDE Days On Site 365 Location within this Facility Unit Map: Grid: AISLE #16 CAS# 2843-00-6  STATE -- TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient METAL CONTAINR-NONDRUM I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average /~ ~o~. GAL 47.00 GAL 500.00 GAL HAZARDOUS COMPONENTS 100.00 Insecticides N 0 ~ HAZARD ASSESSMENTS TSecret RS BioHaz, Radioactive/Amount I EPA Hazards[ NFPA USDOT# MCP No N°]lINo No/ Curies F IH DH / / / UnR ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: AISLE #16 CAS~ 6474-53-3 Liquid Pure Ambient . Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average ~ GALI 22.00 GALI 100.00 GAL HAZARDOUS COMPONENTS %Wt. RN~oRS CAS# 100.00 Motor Oil, Petroleum Based 8020835 HAZARD ASSESSMENTS TSecret ~S BioHaz Radioactive/Amount I EPA HazardsI NFPA USDOT# I MCP No N No No/ Curies F IH DH / / / Min -3- 06/29/1999 F YOUNGS MARKET SiteID: 215-000-001400 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 05/02/1991 CALL 911 TO NOTIFY FIRE DEPARTMENT ~ Employee Notif./Evacuation 05/02/1991 STORE INTERCOM SYSTEM USED TO NOTIFY ALL DEPARTMENTS ------=,, Public Notif./Evacuation 05/02/1991 MANAGERS INSTRUCTED ON EVACUATION OF STORE IN THE EVENT OF AN EMERGENCY, EITHER THROUGH FRONT OR REAR OF STORE. ~ Emergency Medical Plan 05/02/1991 MERCY HOSPITAL. -4- 06/29/1999 YOUNGS MARKET SiteID: 215-000-001400 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 05/02/1991 ALL PERSONNEL TRAINED IN PROPER HANDLING OF HAZARDOUS MATERIALS. --Release Containment 05/02/1991 TWO FULL TIME JANITORS, COVERING OPEN FOR BUSINESS HOURS. CLERKS & BAGGERS TRAINED TO CHECK CONTAINERS CAPS WHEN STOCKING OR BAGGING. -- Clean Up 05/02/1991 IN THE EVENT OF LARGER SPILL, CUSTOMER SERVICE PERSONNEL WOULD BE USED IN CLEAN-UP. Other Resource Activation -5- 06/29/1999 YOUNGS MARKET SiteID: 215-000-001400 Fast Format Site Emergency Factors Overall Site Special Hazards ~ Utility Shut-Offs 01/07/1990 A) GAS - REAR OF STORE B) ELECTRICAL - PRODUCT BACK ROOM C) WATER - STREET D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - OVERHEAD SPRINKLERS THROUGHOUT, EXTINGUISHERS IN ALL DEPTS AND REAR & FRONT OF STORE, TRIPLE A ALARM SYSTEM NOTIFIES FIRE DEPT. FIRE HYDRANT - IN FRONT OF STORE. -- Building Occupancy Level -6- 06/29/1999 YOUNGS MARKET SiteID: 215-000-001400 Fast Format = Training Overall Site -- Employee Training 01/07/1990 WE HAVE 57 EMPLOYEES. WE HAVE MSDS SHEETS ON FILE FOR EACH HAZARDOUS MATERIAL WE HANDLE. NEW EMPLOYEES ARE VERSED IN TRAINING PERIOD ON MATERIAL HANDLING & SAFETY PROCEDURES. -----=- Page 2 --Held for Future Use Held for Future Use -7- 06/29/1999 + YOUNGS MARKET ~----7'~*-~=:~-==~ SiteID: 215-000-001400 + Manager : ,..~ BusPhone: (805) 327-3526 Location: 3030 BRUNDAGE LN ~ ........... Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 36C FacUnits: 1AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:5411 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title DENNIS JOHNSON / DIRECTOR EVA HAYWARD / MANAGER Business Phone: (805) 327-3526x Business Phone: (805) 327-3526x 24-Hour Phone : (805) 834-9675x 24-Hour Phone : (805) 664-1357x 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 + -4 + + ~--- ~ .... +---+ Hazmat Common Name... ISpecHazlEPA Hazardsl Frm I DailyMax lUnitlMCPl t -~ + ~ ~ .... +---+ BLEACH IH DH L 300 GAL Hi CLEANSER IH DH S 700 LBS Min MOTOR OIL F IH DH L ~gL2410 GAL Min INSECTICIDE F IH DH L ~? ~GAL ~ /o,a,~ Do hereby certify ~hat I have .... ~;,~ '~he att~h~d h~ardous materiais ~nanage- me~t p~an ~'or~~ ~~ and ~hat i~ along (Nama'~f R~sine~) .... ~" any corrections constitute a completo and corre~ man- a~mon~ ~lan for my facility, 03/17/92 YOUNGS MARKET 215-000-001400 NAR 23,3992 age 1 Overall Site with 1 Fac. Unit General Information By,, Location: 3030 BRUNDAGE LN Map: 102 Hazard: Low Community: BAKERSFIELD STATION 03 Grid: 36C F/U: 1 AOV: 0.0 Contact Name Title, Business Phone 24-Hour Phone, DENNIS JOHNSON DIRECTOR ~(805) 327-3526 x 1(805) 834-9675 EVA HAYWARD MANAGER~(805) 327-3526 x [(805) 664-1357 Administrative Data Mail Addrs: 3030 BRUNDAGE LN D&B Number: City: BAKERSFIELD State:. CA Zip: 93301- Comm Code: 215-003 BAKERSFIELD STATION 03 SIC Code: 5411 Owner: WILLIAM YOUNG Phone: (805) 327-3526 Address: 3030 BRUNDAGE LN State: CA City: BAKERSFIELD Zip: 93304- Summary p~n ~en~ P~n for my 03/17/92 YOUNGS MARKET 215-000-001400 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 BLEACH Liquid 300 High · Immed Hlth, Delay Hlth GAL CAS 9:7681-50-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GAL300 I Daily Average 150.00 GAL ~ Annual Amount 12,000.00 GAL Location Storage ~ Press T Temp PLASTIC CONTAINER IAmbient~AmbientlAISLE #TM -- Conc Components . MCP .. List 100.0% IBleach IHigh 02-002 INSECTICIDE Liquid 600 Unrated · Fire, Immed Hlth, Delay Hlth GAL CAS #: 2843-00,6 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: INSECTICIDE Daily Max GAL6~00 I Daily Average500.00GAL I Annual Amount3,900.00GAL Storage · Press T Temp Location METAL CONTAINR-NONDRUM Ambient~AmbientlAISLE #16 -- Conc Components ~ MCP List 100.0% IInsecticides Iunrated I 02-003 MOTOR OIL Liquid 200 Minimal · Fire, Immed Hlth, Delay Hlth GAL CAS #: 6474-53-3 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT ~ Daily Max GAL200 I Daily Average100.00~GAL I Annual Amounts,000.00GAL Storage ~ Press T Temp~ Location PLASTIC CONTAINER I Ambient~AmbientlAISLE #16 -- Conc Components MCP iList 100.0% IMotor Oil, Petroleum Based IMinimal 03/17/92 YOUNGS MARKET 215-000-001400 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-004 CLEANSER Solid 700 Minimal · Immed Hlth, Delay Hlth LBS CAS #: 7631,86-9 Trade Secret: No Form: Solid Type: Mixture Days: 365 Use: CLEANING Daily Max LBSI Daily Average LBS I Annual Amount LBS 700 ~1 400.00 5,000.00 Storage Press T TempI- Location PLASTIC CONTAINER IAmbientlAmbientlAISLE #16 -- Conc Components MCP List 5.0% ICalcium Chloride Minimal I 03/17/92 YOUNGS MARKET 215-000-001400 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification ~CALL 911 TO NOTIFY FIRE DEPARTMENT <2> Employee Notif./Evacuation STORE.INTERCOM SYSTEM USED TO NOTIFY ALL DEPARTMENTS <3> Public Notif./Evacuation MANAGERS INSTRUCTED ON EVACUATION OF STORE IN THE EVENT OF AN EMERGENCY, EITHER THROUGH FRONT OR REAR OF STORE. <4> Emergency Medical Plan MERCY HOSPITAL. 03/17/92 YOUNGS MARKET 215-000-001400 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ' ALL PERSONNEL TRAINED IN PROPER HANDLING OF HAZARDOUS MATERI~LS. <2> Release Containment TWO 'FULL TIME JANITORS, COVERING OPEN FOR BUSINESS HOURS. CLERKS & BAGGERS TRAINED TO CHECK CONTAINERS CAPS WHEN STOCKING OR BAGGING. <3> Clean Up IN THE EVENT OF LARGER SPILL, CUSTOMER SERVICE PERSONNEL WOULD BE USED IN CLEAN-UP. <4> Other Resource Activation 03/17/92 YOUNGS MARKET 215-000-001400 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - REAR OF STORE B) ELECTRICAL - PRODUCT BACK ROOM C) WATER - STREET D) SPECIAL - NONE E) LOCK BOX - NO <3> F~re Protec./Avail. Water PRIVATE FIRE PROTECTION - OVERHEAD SPRINKLERS THROUGHOUT, EXTINGUISHERS IN ALL DEPTS AND REAR & FRONT OF STORE, TRIPLE A ALARM SYSTEM NOTIFIES FIRE DEPT. FIRE HYDRANT - IN FRON~ OF STORE. <4> Building Occupancy Level 03/17/92 YOUNGS MARKET 215-000-001400 Page 7 00 - Overall Site <G> Training <i> Page 1 WE HAVE 57 EMPLOYEES. WE HAVE MSDS SHEETS ON FILE FOR EACH HAZARDOUS MATERIAL WE HANDLE. NEW EMPLOYEES ARE VERSED IN TRAINING PERIOD ON MATERIAL HANDLING & SAFETY PROCEDURES. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use '~ ' RECEIVED .... ~ Page 1 · 03/2'~/91 YOUNGS MARKET 215-000-( APR3 0igg! ' Overall Site with 1 Fac. Unit Ger~eral Ir~format ic,~ * ~'d ............ I Location: 303(]) BRUNDAGE LN Map: 102 Hazard: Lc, w Ident Nur,lber: 215-000-001400 Grid: 36C Area ,-,f Vul: 0.0 I DENNIS JOHNSON DIRECTOR (805) 327-3526 x (8(2)5) 834-9675 EVA HAYWARD MANAGER (805) 327-3526 x (8(])5) 664-135'7 Admir, istrative Data Mail Addrs: ,.sO,.s) BRUNDAGE LN D&B Number: City: BAKERSFIELD State: CA Zip: 933(])1- Corem Cc, de: 215-003 BAKERSFIELD STATION (])3 SIC Cc, de:, 5411 Owr~er: WILLIAM YOUNG Phor~e: (~) ~-~-~ Address: 3(:)3(]) BRUNDAGE LN State: CA City: BAKERSFIELD Zip: 933(])4- Summary ~, <~ ~' Do hereby certify that ~ haw (Type oF print name) reviewed the attached ment pbn for~W¢/~'~~:r,d th.t it ~lon9 with ~3/2~/91 YOUNGS MARKET 215-000-0(~0[) Page 2 Hazrnat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Ha ..~ ards For~ Quant ity MCP 02-001 BLEACH Liquid 3(])0 Hi gh I~ed Hlth, Delay Hlth GAL [)2-[)04 CLEANSER Sol id 700 Mi~i~a 1 Ir~r~ed Hlth, 'Delay Hlth ~ LBS 02-(!03 MOTOR OIL Liquid 200 Mi r~ir,~a 1 Fire, Imr~ed Hlth~ Delay Hlth GAL 02-002 INSECT I C I DE L i q u i d 600 Unrat ed Fire, Ir~r,~ed Hlth~ Delay Hlth GAL. i ~ [J3/2~/91 YOUNGS MARKET 215-000-(~ Page 3 00 - Overall Site <D> Not if. /Evacuat iota/Medical <1> Ager, cy Notificatior, <2> Er~ployee Notif. /Evacuatior~ <3> Public Notif. /Evacuatior, MANAGERS INSTRUCTED ON EVACUATION OF STORE IN THE EVEN]' OF AN EMERGENCY, EITHER THROUGH FRONT OR REAR OF STORE. <4> Ernerger, cy Medical Plat, MERCY HOSPITAL. ~.}3/2~/91 YOUNGS MARKET 215-000-0'~1~00 Page 4 00 - Overall Site <E> Mit igat iordPreverst/Abater~t <1> Release Prevent i or, <2> Release Cor, tair, rnerst TWO FULL TIME JANITORS~ COVERING OPEN FOR BUSINESS HOURS. CLERKS & BAGGERS TRAINED TO CHECK CONTAINERS CAPS WHEN STOCKING OR BAGGING. <3> Clears Up IN THE EVENT OF LARGER SPILL, CUSTOMER SERVICE PERSONNEL WOULD BE USED IN CLEAN-UP. <4> Other Resource Act i vat i ors ~ (.~'~3/2~/91 YOUNGS MARKET 215-000-0 O0 Page 5 O0 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - REAR OF STORE B) ELECTRICAL - PRODUCT BACK ROOM C) WATER - STREET D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE ~'ROTECTION - OVERHEAD SPRINKLERS THROUGHOUT, EXTINGUISHERS IN ALL DEPTS AND REAR & FRONT OF STORE, TRIPLE A ALARM SYSTEM NOTIFIES FIRE DEPT. FIRE HYDRANT - IN FRONT JIF STORE. <4> Held for Future use ~)3ZP_.~/91 YOUNGS MARKET 215-C 00 Page 6 (IlO -'Overall Site <G> -rrair, ing <1> Page 1 WE HAVE 57 EMPLOYEES. WE HAVE MSDS SHEETS ON FILE FOR EACH HAZARDOUS MATERIAL WE HANDLE. NEW EMPLOYEES ARE VERSED IN TRAINING PERIOD ON MATERIAL HANDLING & SAFETY PROCEDURES. <2> Page 2 as needed <3> Held for Futu~-e Use <4> Held fc, f' Future Use , ~.... ., 2130 STRE . iO~~j~~ BAKERSFIELD, CA. 93301 ¢~0~(2~ ~ , (805) 326-3979 /o~-~¢ I~~-~_~, OFFICIAL USE ONLY --- uOl~O0 ID~ ' '-"" BUSINESS NAME ~ ~~ HAZARDOUS MATERIALS RECEIVED BUSINESS PLAN AS A WHOLE ~AY10 ' FORM. 2A HAZ~ MAT. DIV, ~NSTRUCT~ONS; 1. To avoid further action, return this from within 30 days of receipt. 2.' .TyPE/PRINT ANSWERS IN ENGLISH. '3 .... "AnsWer '~he qU'es%~ons below for. ~he business as a whole.- · 4,. Be as brief and concise as possible... ' .... SECTION 1,: B~SINESS IDENTIFICATION DATA A., BUSZ.NESS NAHE: 0~ B. LOCATION / STREET ADDRESS: ~O SECTI.O~ ~; EMERGENCY NOT~F. ICAT[ON8 In case o~ an emergency involving %he release or threatened release a hazardous material, ca33 911 and 1-8OO-852-7550 or 1-916-427-4341. This will notify your local ~ire department and [he State Office of Emergency Services as required by law. '"' EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAHE AND T[TLE DURING BUS. HRS. AFTER BUS. HRS. SECTION 3; LOCATZON OF UTILITY SHUT-OFFS FOR BUSINESS AS A ~HOLE ~ A NATURAL GAS/PR~ANE: ~,, B. ELECTRICAL: ¢~¢~:' ,¢~¢ D. SPECIAL: E. LOOK BOX:' YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN BITE PLANS? YES / NO ..MSD8B? YES '/ NO ' ......... :" .... -':":' ':'"' ............. -' FLOOR' PLANS? YES / NO ' KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE EMERGENCY MEDICAL, ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION '6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EMPLOYEES WITH INI'C'IAL AND ·REFRESHER TRAINING IN THE SAFE HANDLING OF. HAZARDOUS MATERIALS, A. NUMBER OF EMPLOYEES AT THIS FACILITY B.. DO YOU HAVE MSDS (MATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS MATERIAL YOU HANDLE C. GIVE A BRIEF SUMMARY OF YOUR HAZARDOUS MATERIALS TRAINING PROGRAM- -tr., ~ ~.~.f,,7~. ~. mr; t,,~/ ,? ." .::/~,'-E.:.., ~ m~,~..'{:~: ~/'~, , f SECTION 7: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT HY BUSINESS IS'EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 0.95 OF THE CALIFORNIA HEALTH AND SAFETY CODE FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO -- TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 8: CERTIFICATION / accurate. I understand that this 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. 25500 Et Al.) and that inaccurate information constitute~ perjury. BAKERSFIELD CITY FIRE DEPARTMENT 2130 'G' STREET BAKERSFIELD. CA. 93301 " (805) 326-3979 r.., i ' - ~ OFFICIAL USE ONLY ~ ID# , It BUSINESS N,~ivi E HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE ,, 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: UZ'/'~/-'P /"" SECTION 1: H]'TIGATTON~ PREVENTION, ABATEHENT PROCEDURE~ $ECT];ON' 2: NOTIF]~CATION AND ~vACUAT;[ON PROCEDURES AT THE UNIT ONLY , ~ECTION '3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility'Unit contain Hazardous Materials? ...... NO 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 macked: NON-TRADE SECRETS ONLY (white focm ~4A-1 ) If YES, complete a hazardous' materials ~nventory foFm marked: TRADE SECRETS ONLY (Ye]Iow foFm ~4a-2) ~m addition to the ~o~-tFade -secret form. L~st only the trade· secrets on form 4A-2. SECTION 4: PRIV%TE FIRE PROTECTIO~ S~gT~ON 5: LOCATZON OF WATER SUPPLY FOR USE BY ~NERGENCY RESPONDER~ (F~re Hydrant) SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NATURAL GAS/PROPANE: /~ ,~,~.- 0/:' ,~,-..-/~. ~' , B. ELECTRIC,-,L.: C. WATER: D. SPECIAL: E. LOCK BOX' YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 3B- CITY of BAKERSFIELD , N O N '-- t R A L) E S E G R E T S ' ~.~e_j__of.~. CITY, ZIP: ~rr/~,~.~ 1~ ?~0~ CZTY, ZZP: ~E'~. DUN AND BRADSTR~ET NUMBER · ~. ~d · ~ TO ZMS~UCTIO~ FOR PROP~ COD~ frans Ty~e ~ Average Annual ~asure I ~ Cmt ~t C~t ~e L~Itt~ ~re ~N~, Nam of M~xtu~/~ts C~e C~e ~t ~t Est Units ~ SIte Iy~ Pr~l 1~1 C~e .. Stoe~ tn Facility ~ Inlt~tim~ Fire Hazard U__J Reactivity .-~"'J ~la~ u_d ~dd~ Release ~iatl Health of Pr~surl . H~lth ........... . ' ~t 13 Nm & C.A.S- ~% ' ............ ~?~2-~.~,. ~ , , . . Fire Hazaed =--d Reactivity ~ ~lay~ =--d ~dd~ Release I~tate Hea Ith of Pr~sure Hea Ith Health of Pr~sure Health, ...... .............. · i~ ..................... TTtT~ Certificat%~ .(Read and sikh aftcr coMpJetJnR all for'/~tainin9 t~ infor~tt~. I ~)ieve t~t t~ su~itted i~ormaIi~ is true accurate and c~olete. /// /2 ~ ~ CITY of BAKERSFIELD " OWNER NAME: ~g~ NAME OF T~ FACILITY: clrry, ZIP: CITY, ZIP: ~' DUN AND BRAD~T~EET NUHBER n~s. ro ~.s~crzo~ ro~ vnov~ co~,s trnns IyOe ~sn Av~rnq~ ~nnunl ~sur~ I ~ C~t ~t ~t ~e t~mtt~ ~e % ~ n,~ of [{ode Code ~t Amt [st Units ~ Site ly~ Pre~ ;~p C~e .. , Stor~ in Facility it ~e Inst~cti~s ~Phy~ical ~nd H~alth Hazard C,A.~. ~u-~r .......... ~ ............ C~*~t II Ne~ ~ C.l.S. Hca }th of rr~s~ur~ B~ith ((he~k all t~t apply) ~ ~ ~ealth of Preasure Heqlth ........... ~ , ~- .~ ~ ....... ~ ..... . . . tt . _ .... Health of Pre,;ute H~alth, ...... - .... ~ . . . F-- . . · -- ~ .... -- ~ ~ C~t'12 ~ ~ C.A.S. ~,~r ' Health of Pressure HealthC~t II N~ ~ C.~.S. ...... ~ .................................................... f ...... /~rtifV undee malty, of law that I have ~rs~ally e~amined and a, fa$iliar with t~ infornatim su~itt~tn this e~'~f~ec~ d~u~tt e~ t~t r ................ ~ ~ inquiry oI t~e individuals r.~sible fer/~btalnlng t~ info~t~, f ~l~eve t~t t~ Submitted ~ofor~at~ iS true accurate, and c~plete~ /~ ' // ~ } CI'F)' ql' 'L-L4 I~:£RsflELD m,szr~ss ~1~: J owu~n UAME: ~LLI/~4 Ut4t., ~S OF T~ ~A~LITY: 03~6 '~' R~F~R TO ZNSTRUCT~O~S FOR PROP~ CODff~ ':~'~:::' ~? ~..,,~ ~,.~.~ ,:.,~ ,..--~ z~- ~ -7 ~L, ,, ,.. iZZ~72.%7 .................................................. m .... .~,~., III t~t lDPlyl ..................... j ' "., .. ["'] ~ . . ' ~ . , . ~--" · ,~ c~t ~: ~, ~ r.~.S ,O,~ / s ',, ::::::::::::::::::::: I c.~ifv undp. ~.lty of la. th'at I I,~ve eers~elly'e.*~in.d .nj ~. f~. liar . th tF. nlor-Ati~ s,h-i~t~ ~ tfi~ .~1~ d~u~ts ,nd t~t b~ed ~ e' ~se Jn~tvid,,rl~ resemble . ~; ~r-~'~; '~ ........... ........ :~;_;~;;~ ........... = .................. CI ) o/' B,4KERSFIELD CITY. zIP: ~5~g/~l~, (~ ~Oq DUN AND BRADSTREET NUMBER ' " - RK~R TO INSTRUCTIONS FOR PROP~ COD~S ~-s Ith of h'~ tut t II~q hh Health nf P,.~ r~ Health I fl,a It h Of Ir ~urR H~lth .................................................................. [ ....