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HomeMy WebLinkAboutBUSINESS PLAN 11/7/2006 Hazardous. Materials/Hazardous Waste Unified Permit .,~ .CONDITIONS' OF ~PERMIT~.ON REVERSE SIDE · '" '; · ~ 'i-:. This ~ermit is issued for the following: I;1 Hazardous Materials Plan E] Underground Storage of HazardOus Materials Permit ID #:: 015-000-001763 [3 Risk Management Program 'JOHN PIERCE TRUCK a H.~rdous Waste On-Site Treatment LOCATION: 4615 E BRUNDAGE LN OFFICE OF ENVIRONMENTAL SER VICES '. 1715 Chester Ave., 3rd Floor "' '-APP,r°~edby: ' . (..~pU'Huc~.~i Bakersfield, CA 93301 "' ::' :i- . OfficeofEv~S~rvic~s -~ Voice (661) 326-3979 :" '.',: · .FAX (661) 326-0576 .Expi~a~ionDate:~ JL~lle 30.. 2003 · ~ '--':":-' -'.i( ':"-':, ,~ - '"' "' "' ~ Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ........... ,~,..~,,~'?i~??,??~:~,,,~,?.,;,~, .......... This permit is issued for the following: ' .:,??i!"i: [,!~i~,~:!!!::'*~ ........... "~'iii~iill ii:~:. :,i!i~:!i{i~ i!i?'"',iiii;:i;~!~;:O~e[ground Storage of Hazardous Materials PERMIT ID# 015-021001763 :,?~ii~.:~i!i ~!.i;~' :~i~ii !ii!i iI::~' ...:,!!!!!:'~!!i!i!i! i~!~!~:?'?!!!::?.?.!!iiiiii~ i~k:,i::~pagement Program ....... ~ ~.! , ~? .--... ?~. ~ ..... ?, :',.. '%? "~,z:'" ...*" ,,'" ,~* ..." ...' ..* ..-"? .c ,. ?. ,,. ,, ~, ? .~ ~,,..~,:*'*  B~ersfield Fke Department Approved by: OFFICE OF E~R O~AL 5E~ ~CES u~ 1715 Chewer Ave., 3rd Floor f~m B~e~fiel~ CA 93301 Voice {805) 326-3979 F~ (80S) ~26~S76 Expiration Date: BAKERSFIELD CITY Fi'RE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 ~'~.L~8~05) 326-3979 HAZARDOOS MATERIALS MANAGEMENT PLAN ~'2.1' _ TOTYPE/PRiNTavoid fu__rt~her_, action,__je_t_urnANSWERS IN ENGUSH.th[s foEm.w__ithiO_30, days of_receipt. ~"-NOV* 7 1991~ * L~/ 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. By. SECTION 1' BUSINESS IDENTIFICATION DATA ......... MAILING ADDRESS: -/;..:2~.//,, zJZ/.~ J ,~ /--~,.--.-z~vr_;..,, ' DUN &BRADSTREETNUMBER' - --" SIC CODE: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 2. Bakers~eld Fire Dept. lazardous ~ateriab Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYEES: ~) MATERIAL SAFEIY 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 OD HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TiMEEXCEE© THE MINIMUM REPORTING QUANTFI'tES. MATION IS ACCURATE. I UNOERSTANOTHATTHISINFORMATION WILL-BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATiON-CONSTITUTES PERJURY. ~' SIGN~,T~URE- TELE '! / bATE. · .. Bakersff~eld Fire Dept. ~c'.~,~ Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT' PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: lB, EMPLOYEE NOTIFICATION AND EVACUATION' C. PUBLIC EVACUATION: O. EMERGENCY MEDICAL PLAN' ~ Bakersfield F~re Dept. ~:-:;~, ,~'~ Hazardous Materials Division ...... HAZARDO'US MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT· PLAN: A. RELEASE PREVENTION STEPS: B. RELEASE'CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: WATER: SPECIAL: ~-~ LOCK BOX: YES/NO iF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:. A. PRIVATE FIRE PROTECTION: /V' ~' ~/ '~'''~o BAKE jS FI ELD ITY FIRE D ARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR :- "' ':': *:'" * - BAKERSFIELD, CA 93301 (805) 326-3979 *. HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME- /.,~'~. FACILITY NAME , NATU*E OF BUSINESS' SiC~¢~DE '~~ DUN & B~DSTREET NUMBER MAILING ADDRESS CiTY STATE ZIP EMERGENCY CONTACTS NAME TITLE BUSINESS PHONE 24-HOUR PHONE BAKERSFiJ .D CITY FIRE DEPAFI MEN?' HAZAR 3US MATERIALS INVENTORY, ' ~siness Name ,~Jxt,t.P~ ~.J~f~APJ~4~ddress ~!~*" CHEMICAL DESCRIPTION De '; ': 1 ) INVENTORY STATUS: New [ ] Addition [ ] ReV~,ion' lotion [ ] Checl( if chemical is a NON TRADE SEC,RET* [ '] * 'i3RAD~ SECRET [ ] 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release of Pressure [ ] lmmediate Heaith (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-dig~t code from DH$ Form 8022) USE CODE sTATE Solid [ ] Liquid)~,~ .//~as_//~,~=::~l ~ [ ] c~cx..~ ~w,t,~Pure, [ ] Mixture [ ] Waste [ I Radioactive [ ] $) PHYSICAL 7) AMOUNT AN~ TIME AT ~AC~UT~ ~ UN~T~ OF M~SU,E a). STO~E COOES ,~. Average Daily Amount: curies [ ] b) P~easure: - ' Annual Amount: q~~ c) Temperature: [.~gest Size'Cont~'ner. ~ l'] ifJI # Deys On Site ' Circle Which Months: All Year, J, F, M. A, M. J. J. A. S, O, N, D chemical components or any AHM components 2) _ _ [ ] 3) [ 10) Location /, CHEMICAL DESCRIPTION 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive( ] Sudden Reie~e of Pressure [ ] Immadiate Heaitll (Acute) [ ] Delayed Heaith (Chronic) [ ] 5) WASTE CI~,S$1FICATION (3-:dig~t ~:od~, from OHS Forrn 602~i USE CODE 5) PHYSICAL STATE Solid [ ] Liquid [ ] Gas { ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum O~'ly Amount: lbs [ ] ga [ ] 1t3 [ ] a) Container. Average Omly Amount: cunas[ ] b) Pressure: Annual Amount: c) Temperature: L.~'gest Size Contmner. # Days Qn Site Circ. JeWhich Months: AllYe~-, J, F, M, A. M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT ' AHM the three most hazardous 1) [ ] ct~emicaJ components or ~ AHM components 2) [ ! 1 10) :e~ly under penally of law, 03et t have pemonally exarmneo eno am iam~iiat wim ~e ~nioma~on sub,~, on ~m~ted informe#~J~J, tktru~e, accurate, and c~mptete. ..... ~IINT ~e & 77tie of Au~tmr~ comPanY Represenm~ve Signature Date BAKERSFIELD CITY FIRE DEPARTMENT HAz, Dous MATERIALS INVEN RY Page of 3usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ } Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optiomd) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE cLAssIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FAClMTY UNITS OF MEASURE 8) STORAGE CODES Msximum Daily Amount: ............ lbs [ ] gel [ _] -~t3 [. ] ~) Container; Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J. J, A, S, O. N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 10) Location CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check ff chemical is s NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) ChemicaJ Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immadiste Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] ga] [ ] ft3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On S~te Circle Which Months: All Year. J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemicaJ components or any AHM components 2) ~ [ ] 3) [ ] 10) Location certify under penalty of law, that I have personally examined and am familiar with ~he infomation submitted on this and all attached document~. I believe submitted informa~on is true, accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date BAKERSIF LD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS INVENTORY Page_of_ ~usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check ff chemical is a NON :I'RADE SECRET' [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS #. 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [, ] Immadiate Health (Acute) [ ] Delayed Health (Chronic) [ ] ' 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND T1ME AT FAClMTY UI'~TS OF MEASURE 8) STORAGE CODES Maximum Oaily Amount: lbs [ ] gal [ ] tt3 [ ] a) Container: Average Daily Amount: cudes [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size'CoRtainer: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N. D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1). [ ] chemical components or any AHM components 2) [ ] 3) [ ] 10) Location CHEMICAL DESCRIP'rlON 1 ) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-dicjit code fi'om DHS Form 8022) USE CODE .-- 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILiTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] gaJ [ ] ~t3 [ ] a) Container: Average Daily Amount: cudas [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1), [ ] chemicaJ components or any AHM components 2). [ ] 3) [ ] 10) Location · ? cern'fy under penal~y of law, that I have personally examined and am familiar With the infomabon submitted on this and all attached documents. I believe th~ submitted information is ~ue, accurate, and complete. PRINT Name & Title of Authorized Company Represente#ve Signature Date