HomeMy WebLinkAboutBUSINESS PLAN 7/29/1987 Hazardous Materials/Hazardous Waste Unified Permit
.~.CONDITIONS OF:PERMIT, ON REVERSE SIDE
~. ' : ~ ':- This _~mit is issued for the following:
' [] H-'anlous Materials Plan
' El Underground Storage of Hazardous Materials
Permit ID #:: 015-000-00t 380 [] Risk Management Program
IDEAL CLEANERS [] H.~dous Waste On-SRe Treatment
LOCATION: 307OBRUNDAGE LN
,'~..~.:.'_ -.
OFFICE OF ENVIRONMENTAL SER VICES' ' /'
Bakersfield, CA 93301 oenc~orEv~mamTs~i~ ~
Voice (661) 326-3979
FAX (661) 326-0576 Expiration Date: 'J~ll~ aO. 2003
· - ~.... .~, ~?.'-:-:i:.:: ~'~ ,?:',-', ,,,
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This permit is issued for the following:
.,~"~[~?.i.~!:~??~:~:'::~iiiiiiiiiiii!iilL ~iii!}i!iiii,: iii?~;::::iii?iii~iiJ~i~erground Storage of H~rdous Materials
LOCATION 3070 BRUNDAG
~...,,.---.j :::~ ............ .:,.--;~;~;%= ~: :~ · ., .! ~, ~'~% ~.~ ............. ..--.:~
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~,-,... ..._"7.,, L;.,. "~'~)'~;~ ~;~;~":' ~r'..'~ '''' '-,. '''~'~ ]ii~
"~-.-....2~ ~i~" % =~;~7~-'~:.~ii ,,~li ~ ,= ,~,.;~ .,4~,~"' 2'i ', ",.~'
~ ~-'~.':~.~'~i~ ~;;%E?=-~''''`~ E"~ ~ ~ [. ~ "-'..~,~;.:~'q~,. ~ , :, iJ~
Issu~ by:
O~ICE OF E~RO~AL
1715 Chewer Ave., 3rd Floor Office of ~enml
B~e~el~ CA 93301
Voice (805}
F~ (805) 326~576 Exp~tionDate: June 30, 2000
SITE/FACILITY D I AGRA'4
F O I~I 5
DATE: / / FACILITY NAME: UNIT #: OF
(CHECK ONE) SITE DIAGRAM ~,J FACILITY DIAGRAM ~
Inspector's Comments): -OFFICIAL USE ONLY-
HMCU-13 ~
'HAZARDOUS MATERIALS '
ERN COUNTY FIRE (805)861-276 04/15/88
I~'.O. BOX 81796 . DUE BY
AKERSF,ELD, CA. 93380-1796 05/25/88
FOR BUSINESS AT, 30?0 BRUNDAGE LANE
DATE. DESCRIPTION DEBIT CREDIT BALANCE
04/08/88 SCHED ADJUSTMENT 181.00 -181.00
04/15/88 ANNUAL FEE (GROUP A) 50.00 -131.'00
CURRENT OVER 30 OVER 60 OVER 90 OVER 120
-131 . 00CR 0,00 0 . 00 0.00 0.00
THIS, FEE IS FOR THE REVIEN AND PROCESSING OF YOUR ENERGENCY PLAN AND
THE INSPECTION OF YOUR BUSINESS PER STATE LAN. CHECKS ONLY PLEASE!...
015-010-000807 IDEAL CLEANERS
K.C.F.D, HAZARDOUS NATERIALS 3070 BRUNDAGE LANE
P.O. 8OX 81796 BAKERSFIELD CA 93304
BAKERSFIELD, CA. 93380-1796
. HAZARDOUS MATERIALS
I~ERN COUNTY FIRE (805)861-2761 01/11/88
]II~I~'.Q. BO)(18~79'6 / DUE BY
I~AKE'RSF'IELD., CA. 93380-1796 ~ 02/22/88
hUN ~U~lIN~ A I: 3070 RUNDAGE LANE
DATE DESCRIPTION DEBIT CREDIT BALANCE'
01/11/88 ANNUAL FEE (GROUP 1) t81.00 18t.00
CURRENT OVER 30 OVER 60 OVER 90 OVER t20
181.00 0.00 0.00 0.00 0,00
THIS IS A STATE MANDATED PROGRAM. FEES ARE SET BY COUNTY ORDINANCE.
PLEASE DO NOT SEND CASH~ PENALTY ASSESSED IF NOT RETURNED BY DATE DUE
/IDEAL CLEANERS
M3070 BRUNDAGE LANE
BAKERSFIELD CA 93304
015-010'-0.00807
HAZARDOUS MATERIALS I
KERN COUNTY FI.RE (805)861-276 02/23/89 I
P..O. BOX 81796 DUE BY I
BAKERSFIELD, CA. 93380-1796 03/23/89 I
FOR BUSINESS AT: 3070 8RUNDAGE LN
DATE DESCRIPTION DEBIT CREDIT BALANCE
02/23/89 t988 ANNUAL FEE (GROUP A) 50.00 50.00
CURRENT OVER 30 OVER 60 OVER 90 OVER 120
50.00 0.00 0.00 0.00 0.00
THIS FEE IS FOR THE REVIEW AND PROCESSING OF YOUR EMERGENCY PLAN AND
THE INSPECTION OF YOUR BUSINESS PER STATE LAW. CHECKS ONLY PLEASE!..
K.C.F.D. HAZARDOUS MATERIALS IDEAL CLEANERS
P.O BOX 81796 ~O 3070 BRUNDAGE LN
' ·
BAKERSFIELD CA 93380-1796 BAKERSFIELD CA 93304
iR .CE VED SiteID: 015-021-001380
IDEAL CLEANERS [[~ 0CT ~52000
Manager : BusPhone: (805) 322-8152
Location: 3070 BRUNDAGE LN~By:,l, Map : 123 CommHaz : Low
City : BAKERSFIELD ,, Grid: 0la FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 03 SIC Code:7216
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
CLAYTON KENNEDY / FRANK KENNEDY /
Business Phone: (805) 322-8152x Business Phone: (805) 322-8152x
24-Hour Phone : (805) 323-9574x 24-Hour Phone : (805) 323-9325x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire React ImmHlth DelHlth
Contact : Phone: (/~/) 3~P.j ~;~
MailAddr: 3070 BRUNDAGE LN State: CA
City : BAKERSFIELD Zip : 93304
Owner CLAYTON O KENNEDY ~ Phone: ( &~ [) ~ ~$ ~ ~ x
Address : ~-~.-Q~J~!AF~P/O~e~ State: CA
City : BAKERSFIELD Zip : 93301
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
Emergency Directives:
~ Hazmat Inventory One Unified List
-- As Designated Order Ail Materials at Site
Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax lunitlMcP
PERCHLORETMYLENE F IH DH L 70.00 GAL Low
WASTE PERCHLOROETHYLENE R L ~0. $~ GAL Low
I.(/'~/~-/g~,~- /~¢~o hereby certify that ,have
f (Type or print name) /
reviewed the attached hemardous materials manage-
ment plan fo~.~,l. ~.~'~5 and ~ha~ i~ along with
(Name of Business)
any corrections constitute a complete and correct man-
agement plan ~or my facility.
IDEAL CLEANERS SiteID: 015-021-001380
= Inventory Item 0001 Facility Unit: Fixed Containers on Site
PERCHLORETHYLENE Days On Site
365
Location within this Facility Unit Map: Grid:
DRY CLEANING MACHINE AND STORAGE TABLE CAS#
STATE I TYPE PRESSURE --i TEMPERATURE CONTAINER TYPE
Liquid Pure Ambient Ambient ABOVE GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
GAL] 70.00 GAL 70.00 GAL
HAZARDOUS COMPONENTS
%Wt. ~S CAS#
100.00 Perchloroethylene N 127184
HAZARD ASSESSMENTS
I TSecret ~S I BioHazI Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No N No No/ Curies F IH DH / / / Low
-- Inventory Item 0002 Facility Unit: Fixed Containers on Site
-- COMMON NAME / CHEMICAL NAME
WASTE PERCHLOROETHYLENE Days On Site
365
Location within this Facility Unit Map: Grid:
CAS#
127-18-4
F STATE -- TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE
Liquid Pure Ambient Ambient IN MACHINE/EQUIP
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
20.00 GALI 20.00 GAL 20.00 GAL
HAZARDOUS COMPONENTS
100.00 Perchloroethylene N 127184
HAZARD ASSESSMENTS
ITSoorot RS BioHaz Radioactive/Amount EPA Hazards I NFPA I USDOT# MCP
No No No No/ Curies R / / / Low
2 09/28/2000
IDEAL CLEANERS
i~ Notif./Evacuation/Medical
i~ Agency Notification
O
NOTIFY FIRE DEPARTMENT °
O
i~ Employee Notif./Evacuation
o
EMPLOYEES LEAVE TO MEET IN PARKING LOT o
o
i~i~ Public Notif./Evacuation
o
O
i~ Emergency Medical Plan
O
MERCY HOSPITAL o
2215 TRUXTUN AV o
BAKERSFIELD, CA °
(805) 327-3371 o
O
-3- 09/28/2000
IDEAL CLEANERS EE~5E/~E6E/56/~E~5~5E/~/SEEEEEEEEEEEEEEEE~EE SiteID: 015-021-001380
i~ Mitigatio~Prevent/Abatemt ~~~~~ Overall Site
i~ Release Prevention ~~~~~~~ 01/07/1990 i
o
MAINTAIN EQUIPMENT
o
i~ Release Contai~ent ~~~~~~ 01/07/1990
PLACE WASTE IN DRUMS FOR HAZARDOUS WASTE HAULING BY SAFETY ~EEN o
o
i~ Clean Up ~~~~~~~~ 01/07/1990
O
MOP SPILLS AND RECLAIM o
O
i~ Other Resource Activation
o
o
aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee
-4- 09/28/2000
i IDEAL CLEANERS ~~~~~~ SitelD: 015-021-001380
i~ Site Emergency Factors ~~~~~~ Overall Site
i~ Special Hazards
o o
o o
i/~/~ Utility Shut-Offs ~6~/~/~/~6~~/~/~/~/~/~/~/~5/~/5~~ 01/07/1990
O O
° A) GAS - SOUTHWEST CORNER OF BUILDING °
o B) ELECTRICAL - REAR OF BUILDING o
o C) WATER - FRONT OF LOT ON BRUNDAGE °
o D) SPECIAL - NONE °
° E) LOCK BOX - NO o
o o
i~ Fire Protec./Avail. Water ~~~~~ 01/07/1990
o O
° NO PRIVATE FIRE PROTECTION °
O O
O O
o FIRE HYDRANT - SOUTH END OF PROPERTY ACROSS BRUNDAGE LN °
O o
i~ Building Occupancy Level
O o
O o
-5- 09/28/2000
i IDEAL CLEANERS 6~6~~~~~ SiteID: 015 -021-001380 i
i~ Training ~~~~~~~~ Overall Site
i/5~ Employee Training/~/~/5/~/5/~/~/~/5~i~/~/5~/~/~/~~~ 01/07/1990
O O
o THERE ARE~,~. EMPLOYEES AT THIS FACILITY o
o O
° DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE ? ~ ~ °
O o
o SUMMARY OF TRAINING PROGRAM: o
o o
O O
O O
i~ Held for Fumre Use
O O
O O
i~i~ Held for Fumre Use
O O
O O
-6- 09/28/2000
04/18/91 IDEAL CLEANERS 215-000- 380 Page 1
Overall Site with 1 Fac. Ur, it
Ger, eral Informat i
IL,z, cat~'or,: 3(-)70 BRUNDAGE LN Map: 123 Hazard: Low
Ilder, t Number: 215-000-001380 Grid: OiA Area of Vul: 0.0
...... , Cor~tact Name Title ~ .......... · Busir~ess Phor~e ........ i~ 24 Hour Phor~e]
CLAYTON KENNEDY ~ (805) 388-8158 x ~(805) 383-9574~
(805) 322-8 -- (8(,)5) 323-9325~
FRANK KENNEDY ~ . , _ 15~ x
Admir, istrative Data
Mail Addrs: 3070 BRUNDAGE LN ' D&B Number:
City: 'BAKERSFIELD State: CA Zip: 93304-
Corem Code 21~-.)0~ BAKERSFIELD STATION 03 SIC Code: 7216
Owner: CLAYTON 0 KENNEDY Phone: (~S) ~5
Address: 1661 OLIVE ST State: CA
City: BAKERSFIELD Zip: 93301-
F Surnmary
04/18/91 IDEAL CLEANERS 215-000-001380 -Page 2
i Hazr~at Inverltory List in MCP Order
(])2 - Fixed Cor~tainers on Site
Plr~-Ref Nar~e/Hazards For~ ~ Quar~t ity MCP
02-001 PERCHLORETHYLENE L i q u i d 7(:) Low
Fire~ I~l~ed Hlth, Delay Hlth GAL
04/18/91 IDEAL CLEANERS 215-000- 38[) Page
O0 - Overall Site
<D> Not i f. /Evacuat icrc/Medical
<1> Ager, cy Notificatior,
NOTIFY FIRE DEPARTMENT
<2> Employee Notif./Evacuatior,
EMPLOYEES LEAVE TO MEET IN PARKING LOT
<3> Public Notif./Evacuatior,
<4> Emergency Medical Plarl
MERCY HOSPITAL
2215 TRUXTUN AV
BAKERSFIELD, CA
(805) 327-3371
04/18/91 IDEAL CLEANERS 215-000-001380 Page 4
00 - Overall Site
<E> Mit igat ior,/Prever, t/Abater~t
(1> Release Prever, tior,
MAINTAIN EQUIPMENT
<2> Release Cor, tairm~ent
PLACE WASTE 'IN DRUMS FOR HAZARDOUS WASTE HAULING BY SAFETY KLEEN
<3> Clear, Up
MOP' SPILLS AND RECLAIM
<4> Other Resource Act i vat i or,
04/i8/91 IDEAL CLEANERS 215-000- 380 Page 5
00 - Overall Site
<F> Site~ Emerger~cy Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - SOUTHWEST CORNER OF BUILDING
B) ELECTRICAL - REAR OF BUILDING
C) WATER - FRONT OF LOT ON BRUNDAGE
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec. /Avail. Water
NO P~RIVATE FIRE PROTECTION
FIRE HYDRANT - SOUTH END OF PROPERTY ACROSS BRUNDAGE LN
<4> Building Occupancy Level
04/18/91 IDEAL CLEANERS 215-000-001380 Page 6
OO - Overall Site
<G> Trairsing
<1> Page 1
THERE ARE ~ EMPLOYEES AT THIS FACILITY
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE ? yes
SUMMARY OF '[RAINING PROGRAM:
<2> Page 2 as r~eeded
<3> Held for Future Use ~
<4> Held f,:,¥' Future Use
CITY of BAKERSFIELD
Farm and Agriculture ~ Standard Business ~HAZARDOUS MATERIALS INVENTORY
NON--TRADE SECRETS
LOCATION;~O~r~A~. t~ ~ ~ ADDRESS:~g/ ~ ~ ~ STANDARD IND. CLASS CODE~
' REFER TO~STR~C~ONS FUR PROP~
I 2 3 4 5 6 7 8 9 10 11 12 · 13 14
Tr~ns ~Yqe Hax Average' Annual Heasure I ~y~ Cont ConL ConL Us LocaL~on.~he(e. S~b~t Na~es of ~ixture/¢o~oonents
Code ~oae AmL Ami EsL Units on 5Ice Type Press Temp Co~eStored ~n ~ac]~cy See Instructions
Physical and Health Hazard ~ C.A,S, Number Component Il Hame I C.A,S. Number
(Check a)l that applx)
Fire Hazard ~ Reactivity.~ ~ Oelayed ~ Sudden Release ~ ZmAedi~teC°mp°nent 12 Na~e & C.A.S. Number
~,~ Health of PressureHealth Component 13 Name I C,A.S. Number
(Check 8// Chat 8pply/
Component 12 Name & C,A.S, Number
~ F~re Hazard ~ Reactivity ~ ~ Delayed ~ Sudden Release ~ Immedi~C~
Health of Pressure
Health
Component 13 Name & C.A.S. Humber
Physical And Hellt'h Hazard .~ C,A.a. Humber * Component I1 Name & C,A.S, Number
(Check ~/1 that apply) '~
CoAponent 12 Name & C,A,S. Number
~ F~re Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Immediate
~ea lth of PressureHeamth .
Component 13 Name I C.A.S. Humber
Physical '8hd Health Hazard C,A,S. Number Component II Name & C,A;S, Number
(Check all .Chat
ComponenL 12 Name & C.A.S. Number
~ Fire Hazard ~ Reactivity ~ Oelsyed ~ Sudden Release ~ [mmedi.~t~
Health of Pressure
Healt~
Component 13 Hame ~ C,A,S, Humber
R~e/ 2~ Hr rhone ' ~e Title
~erti~i~tioq ,(Re~d e.nd.~ign after compl~tipg,all sectipn~)
. cer~lty .unoer penmmtx p?~ tn4t I nave ~e[sonalff. ex~mlnqq~qo ~m ~amill~r.~it~ the jntormat~pn submitted in this ~nd all
attained o0cgment~, mng tBmt omseo on.my Inquiry ~t.~nose lnolv~ou~ms responsiome tot obt~ming :ne ]ntorm~t~on, I believe that the~
~~i~ Of o~neriope,rat~ uH o,ner/operator~s autflorized reoresentative
April 18~ 1991
Mr. Clayton Kennedy
Ideal Cleaners,
3070 Brundage Lane
Bakersfield, Ca. 93304
Dear Mr. Kenned¥~
Enclosed you will find a computer printout of the Hazardous
Materials Management Plan that we have in the computer. Due to a
change in the laws that went into effect January~ 1989~ we need to
have a new inventory form (enclosed) filled out. This form must be
filled out and returned to our office by April 30~ 1991.
If you have any questions please don't hesitate to contact us
at {805) 326-3979.
Sincerely Yours~
Ralph E. Huey
Hazardous Materials Coordinator
REH: vp
Enclosures
Bakersfield Fire Dept.
HAZARDOUS MATERIALS DIVISION
Date Completed
Business Name: ..'TI~"O ~ (~ L. F~AdJ ~
Location: ~ 0 7'6 "~tJ'D/t~,¢-.-/-~), REGEtVEO
Business Identification No. 215-000 ¢D/~ ~0 (Top of Business Plan)
Station No. ~ Shift f---"" Inspector~ /v'~OO°7-'~--
Adequate Inadequate
Verification of Inventory Materials I~]
Verification of Quantities ~
Verification of Location ~
~ Proper Segregation of Material
Comments: "r/~.~l'~ ~/0~~ 4 ~ ~A.-F-_ ~~3'~'L~?l~.
Verification of MSDS Availablity ]~]
Number of Employees
Verification of Haz Mat Training ~
Comments:
Verification of Abatement Supplies & Procedures I~
Comments:
Emergency Procedures Posted I~
Containers Properly Labeled ~ ~[~
Comments:
Verification of Facility Diagram ~
Special Hazards Associated with this Facility:
Violations:
All Items O.K. ~
Correction Needed ~
Business Owner/Manager
FD 1652 (Rev. 1.90) White-Haz Mat Div, Yellow-Station Copy Pink-Business Copy
~... -' KERN COUNTY F IRE DEPARTlV, ENT
.~ 5642 VICTOR STREET
~)~iH O:~0~ BAKERSFIELD, CA 90:308
(sos) JUL
HAZ ARDOU. S MATERI ALS
BUSIneSS ~L'AN AS A WHOL~
FORM 2A ~GEIVED
INS~UCTIONS: 1 7 1989
HAZ.
~. To avoid further action. ~eturn tMs form by
MAT.
D~,
2. TYP~/PR[NT ANSWBRS IN ~NGL[SH.
3. Answer the questions be]ow for the bus,ness as a whole.
4. Be as brief and concise as possible.
SECTION ~: BUS~NESS ~DE~IFICATION ~ATA
A. BUSINESS NAME: ~~ ¢~,~j ~
307n
B. LOCATION / STREET ADDRESS: ~ ~
CITY ~ ~ ZIP: S.PHONE: (
.... ~e~;,~'," ': ~.,.,,~.
SECTION 2: E~RGENCY NOTIFICATIONS
In case of an emergency involvin~ the release or .threatened ~elease of a
hazardous material, call 911 and 1-800-852-7550 or ~-9~6-427-4341. This ~ill notify
you~ local fire department and the State Office of Emergency Services as required by
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAME/~D T.~TLE ' ~ DURING BUS. HRS. AFTER BUS. HRS
C. WATER: ffro~T ~ L6T a~ ~
D. SPECIAL:~
E. LOCK BOX: YES /~ IF YES, LOCATION: ~0
IF YES, DOES IT CONTAIN SITE PLANS~ YES / NO MSDSS~ YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO
-Over- HMCU-4
SECTION 4: ~/r~'~"[~R~ONSE TE/~ FOR BUSINESS AS A WHOLE
SECTION 5: LOCAL EMERGENCY I~IEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
SECTION 6: EMPLOYEE TRAINING
EMPLOYE~s 'ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITN INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL REFRESHER
A. METHODS FOR SAFE HANDLING OF HAZARDOUS
MATERIALS: ....................................... .YE_~ NO YES NO
B. PROCEDURES FOR COORDINATING.ACTIVITIES
WITH RESPONSE AGENCIES: .......................... YES ~ YES NO
C. PROPER USE OF SAFETY EQUIPMENT: .................. ~q~ NO YES NO
D. EMERGENCY EVACUATION PROCEDURES: ................. ~ NO YES NO
E. DO yOU MAINTAI~ EMPLOYEE TRAINING RECORDS: ....... YES ~ YES NO
.T~/~---0,'~ --- /
I un~s,~nd tha~ ~his inf~mation will be used to fulfill my firm's obligations under
the new CalifoPnia Health and Safety code on HazaPdous Materials (Div. 20 Chapter 6.95
Sec.'25500 Et Al.) and that'inaccurate information constitutes per3ury.
I~CU-4
KERN COUNTY FIRE DEPARTMENT
5642 VICTOR STREET
BAKERSFIELD, CA 93308
OFFICIAL USE ONLY
BUSINESS NAME:~ ~- . ~e~
BUSI NESS PLAN
SINGLE FACILITY UNIT
FORM SA
INSTRUCTIONS 1. To avoid further action, this form must be returned bY:~'[
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions belo~ for THE FACILITY UNIT LISTED BEL0~
4, Be as BRIEF and CONCISE as possible.
FACILI~ ~IT~ FACILI~ ~IT N~:
SECTION 1: MITIGATION~ PRE~ION, ABATE~ PROCED~ES
SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIs UNIT ONLY
HMCU-6
SECTION 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 as
defined by Section 6254.7 of the Government Code? ......... YES
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form #4A-l)
If Yes, complete a hazardous materials Inventory form marked:
TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade
secret form. List only the trade secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS
SECTION 6: LOCATION OF UTILITY SBUT-OFFS AT THIS UNIT ONLY.
A. NAT. GAS/PROPANE:
B. ELECTRICAL:
C. WATER:
D. SPECIAL:
E. LOCK BOX: YES ~ IF YES, LOCATION:
IF YES, SITE PLANS? YES / NO MSDSs? YES / NO
FLOOR PLANS? YES / NO KEYS? YES / NO
HNCU-6
KERN COUNTY FIRE DEPARTMENT
I.D. # FORM 4A-1 page~ of~
NON--TRADE SECRETS
__~ HAZARDOUS MATERI ALS INVENTORY 51C
~Rk~-~ ~ 0;~NER NAMI~ ~. ~x. ~ ~ FACILITY UNIT ~:
BUSINESS NAME:~ ~
ADDRESS: V~P~-~)?'-~. [ ~, ADDRESS: ~' ~7l~[~ * FACILITY UNIT NAME:
CITY, ZI~': ~Z.~.~.~-~',,~<~. ~f~?~ft CITY.ZIP: !o~,if~ ~
' ~ ONLY
] 2 3 4 5 6 7 8 9 10
TY~E ~AX ANNUAL CONT USE LOCATION IN .THIS · BY
BAZA~D
D..O.T
~-- X~O ~ FA,CILITY ~N.IT ~T. CHEMICAL O~ COMMON NAME .CODE GUIDE'
N~E :~ T,I TLE: ~ eP SIGNATURE: .~~ DATE:
· '~E~ERGENCY CONTACT: ~~-'~ TITLE: ~)~_~ PHO ~ BUS~.~.,S: ~.~.~.
~ AFTER BUS ~RS: '~
.E~ERGENCY CONTACT: ~_~ / ~ ~ TITLE: PHONE ~ BUS HOURS: ~ ~
':PRINCIPAL BUSINESS ACTIVITY:~ [)~ ~~ ,~? AFTER BUS ~RS:
~ · ~CU-- 9
CONTAINER CODES TYPE CODES ~
01. Underground Tank P = Pure
02. Aboveground Tank M = Mixtures of pure
03. Fixed Pressurized Tank substances
04 Portable Pressurized Cylinders W = Wastes (Also add
05 Insulated Tank (Includes Cryogenics) appropriate waste
06 Drums or Barrels - Metallic code)
07 Drums or Barrels - Non-Metallic
08 Carboy(s)
09 Glass Container(s)
10 Plastic Container(s)
11 Box(es) UNIT CODES
12 Bag(s)
13 Metal Containers (Not Drums) LBS = Pounds
14 In Machinery or processing equipment TON = Tons (2,000 lbs)
15 Bin(s) GAL = Gallons
99 OTHER - Specify on separate sheet BBL = Barrels (42 gals)
Ft3 = Cubic Feet
- CUR = Curies
USE CODES
01. Additive 23. Herbicide
02. Adhesive 24. Insecticide
03. Aerosol 25. Instructional
04. Anesthetic 26. Lubricant
05. Bactericide 27. Medical Aid or Process
06. Blasting 28 Neutralizer
07 Catalyst 29 Painting
08 Cleaning 30 Pesticide
09 Coolant 31 Plating
10 Cooling 32 Preservative
11 Drilling 33 Refining
12 Drying 34 Sealer
13 Emulsifier/Demulsifier 35 Spraying
14 Etching 36 Sterilizer
15 Experimental 37 Storage
16 Fabrication 38 Stripper
17 Fertilizer 39 Washing
18 Formulation 40 Waste
19 Fuel 41 Water Treatment
20 Fungicide 42 Welding Soldering
21 Grinding 43 Well Injection
22 Heatingr _ -44 Oil Treatment
99 OTHER-Specify on
HAZARD CODES
EXPL - Explosive ORMA - Anesthetic, Irritant
CMLQ - Combustible Liquid ORME - Hazardous Waste
CMSL - Combustible Solid ORMS - Other regulated
Material B,C,and D
CR~T - Corrosive Material PSNA - Poison A (Gas)
FLGS - Flammable Gas PSNB - Poison B (Liquid or Solid)
FLLQ - Flammable Liquid RADI - Radioactive
FLS!. - Flammable So]id WATR - Water Reactive
NFLG - Non-Flammable Gas ETIO - Etiological Agent
OGFX - Organic Peroxide PYRO - P~rophoric, Hypergolic or
spontaneously combustible
OXID - Oxidizer
CRYO - Cryogenics
KERN COUNTY FIRE DEPARTMENT
ALSO SERVING Thomas Po McCarthy
THE CITIES OF Chief
Arvin
Hazar~us ~terials ~ntrol Unit
5642 Victor Street
Bakersfield, California 93308
Telephone (805) 861-Z761
Dear Business Owner:
The bdsiness plan you filed with the Kern County Fire Department is being
returned to you for t'he following reasons.
Box for Official Use OnlX
~ written in on Form Form 5:
Form 2A not returned Facility Diagram
No signature on Form Site Diagram
~ ~isslng
needs to fill out Sections 1-5
Form 3A - Large facility Other
needs to fill out Sections 1-6
Inventory Sheet "
(Form 4A-1,2,8} not returned
~(Form 4A-1,2,3) not complete
Please tetu~ t~Js form ~Jth the cottected business plan and pesubmJt
days
t~ C~t~M~ i+ A p//xr¢~l~ Very truly yours.
pLLCA>'~ tsT F~E T~:~ THO~S P. McCARTHY, CHIEF
/
Geoff I~:i]ford. Capta.in
Haza:'dods Materials Control Unit
I~..~ ~C~_~ H~kI~DOUS lVL~TBRI;EI.~BUREAU
r I NSPECTI ON FO3q~V[
INSPECTION S~RY: ~UAL INSPECTION fEXBMPTION RE-INSPBCTION COMPLAINT
ALL ITEMS OK: [ ~] VIOLATIONS NOTED: [ ]
O - Does not Apply I - In Compliance 2 - Co~ectlon Needed 3 - Verbally ~a~ned
4 - N.O.V 5 - Ci~a~loa 6 - Renewed ~o (Specify)
EMERGENCY PROCEDURES (CCR TITLE 19-2729 & 31) PREVENTION & CLEANUP PROCEDURES (CCR TITLE 19-2731
A. Agency Notification Plan (O.B.$., FD) I L. #ork Area Safety
B. Employee Notification & Evac. Plan I M. Clean-up Materials placement/availability
C. Emergency Responder Notification I N. Clean-up Equipment
D. Medical Assistance I O. Fire Protection Systess
E. Private Response Teak Procedures ~-~ P. #aste Handling & Storage
Q. Availability of Protective Equipment
TRAINING REQUIREMENTS (CCR TITLE 19-2732) INV. & DIAGRAI/ VERIFICATION (CCR TITLE 19-2729)
F. Training Records (~ R. Inventory Quantities
G. MSDS Available to EIployees I S. Storage, Container Cond., & Labeling
H. Employees Familiar with MSDS ~ T. Location In Facility Unit
I. Use of Personal Protective Equipment~- U. Emergency #ater Supply
· J. Waste Material Permits & License I V. Evacuation Plan & Area _~_
K. Employees familiar with evacuation W. Surrounding Exposures
plan. I X. Utility Shut-offs
Y. Other
Comments: ~ J ./~
/
Clearance Oranted [~ Re-inspection Required [ ] on / / D.E.
Started ]~: ~[~ Completed }~: l~ T~a~me. : /~ Miles on I~p
I~spector O~a~t~/Mana~
KERN COUNTY FIRE DEPARTNENT
5642 VICTOR STREET,
BAKERSFIELD, CA 93308
I
ID#
,BUSINESS NA~E
INSPECTOR QUESTIONNAIRE
BUSX NESS PLAN AS A ~rI-IOLE
FOR USE WITH THOSE BUSINESSES COMPLETING A BUSINESS PLAN (2A).
INSTRUCTIONS: 1. Complete this form only once for each occupancy.
2. Attach this form to BUSINESS PLAN (2A) and forward to Data Entry.
BUSINESS PLAN VERIFIED ON: ~ / ~- / ~
SECTION 1: RESPONSE SUI~Y (Limit to 4-5 lines)
SECTION 2: NOTIFICATION / EVACUATION OF AFFECTED PUBLIC (Limit to 13 lines)~/
HMCU:~
KERN COUNTY FIRE DEPARTMENT
5642 VICTOR STREET
BAKERSFIELD, CA 93308
BUSINESS NA~E ,
TNSPECTOR' S QUESTIONNAIRE
SINGLE FACILITY UNIT
FOR USE WITH THOSE BUSINESSES COMPLETING A BUSINESS PLAN FORM (2A) THAT
REQUIRES A BREAKDOWN INTO FACILITY UNITS (FORM 3A).
INSTRUCTIONS: 1. Complete this form for each FACILITY UNIT.
2. Attach this form to BUSINESS PLAN 3A and forward to Data
Entry.
BUSINESS PLAN VERIFIED ON: <~'/ ~ /
FACILITY UNIT #: FACILITY UNIT NAME:
SECTION 1: SPECIAL I~AZARDS ASSOCIATED WITH THIS UNIT ONLY
HMCU-7