The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN .... : ---- OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER / OPERATOR IDENTIFICATION FACILITY INFORMATION · . \ ~ I. FACILITY IDENTIFICATION BU.SINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 BUSINESS PHONE ,02 SITE ADDRESS 103 C'~~",/--..~....J~' ' ,04 CA I!ZIP .~.,_~.~ ~ ,05 DUN & : ~06 SIC CODE ,07 BRADSTREET (4 Digit COUN~~ ~~ ~08 OPE~TOR NAME ~ ~ ~09 ~ OPE~TOR PHONE ~0 / OWNER NAME ~j~ ff~r~'~~ ,1, OWNER MAILING ~ ', ADDRESS: f ~ /~/~/~~ ~ ,,3 CONTACT NAME . 117 CONTACT PHONE 118 CONTACT MAILING 119 ADDRESS Cl~ ~ ~' ~ 120 STATE 121 ZIP 122 ~',... . .~ . :.. <.. :~ .~. -~... ::..~%:.,,~.: ?~',;~;.-~,,,,,: :< :.:::.%~.~ :::::::::::::::::::::::,. ?~' ':'" ~?' ::~ ~': :: A~ECONDARY- TITLE ~~ ~25 TITLE ~ ~ ~~ ~30 BUSINESS PHONE ~ ~_ ~ ~ ~26 BUSINESS PHONE ~ ~ ~ ~ ~ ~3~ 24-HOUR PHONE 127 24-HOUR PHONE 132 PAGER ~ ~ ~/ ~ ~ ~ 7 128 PAGER ~ ~/~ ~ ~/~ 133 Cedification: Based on my inqui~ of those individuals responsible for obtaining the information, I cedi~ under penal~ of law that I have pemonally examined ~nd am familiar with the information submiEed in this invento~ and believe the information is true, accurate, and complete. GNATURE OF ~~ /DATE 134 NAME OF DOCUMENT PREPARER ~35 ~WNE~OPE~TOR (print) ~36 TITLE OF OWNER/OPE~TOR 137 UPCF (7/99) S:\CU PAFORMS\OES2730.TV4.wpd OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 .. HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per material per building or area) [] NEW [] ADD [] DELETE [] REVISE 200 Page __ of __ · , I. FACiliTY INFORMATION BUSINESS NAME (Same as FACILITY NAME or I~BA - Doing Bu~ 3 201i CHEMICA~,~.,~.,'~TION .~ CHEMICAL LOCATION [] Yes [] No 202 · I CONFIDENTIAL (EPCRA) ~ .~':;i ! ~ ~!i~ ' I ' (optional) 203 GRID # (optionaO 204 i "~, INFORMATION · ,' ''; ". II, CHEMICAL If Subject to EPCRA, refer to instructions 207 COMMON NAME EHS* [] Yes [] No 208 CAS # 209 , "If ;;HS ii'Yes,' all amounts bclow must bc ia lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire ct~iet) 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 I RADIOACTIVE [] Yes [] No 212 i CURIES 213 [] s SOLID ['-~1 LIQUID [] g GAS 214 I LARGEST CONTAINER ~'~"~ 215 PHYSICAL STATE FED HAZARD CATEGORIES [] 1 FIRE []2 REACTIVE []3 PRESSURE RELEASE []4 ACUTE HEALTH [--~5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217 MAXIMUM .~,'--- ~"'"-' 218 ! AVERAGE 219 STATE WASTE CODE 220 AMOUNT DAIL~ AMOUNT -"~ -'~ ! DALLY AMOUNT UNITS* LeX-ga GAL [] cf CU FT [] lb LBS [] tn TONS 221 DAYS ON SITE 222 · If EHS, amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER TANK INSIDE BUILDtNG [] g CARBOY [] k BOX [] o TOTE B~N STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] aAMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT [] c CRYOGENIC 225 1 226 /'(~ I 227 [] Yes ['-~ No 228 229 2 I 230 231 [] Yes [] No 232 233 3 I 234 235 [] Yes [] No 236 237 242 243 [] Yes [] No 244 245 ~'RINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 : UPCF (7/99) S:\CUPAFORMS\OES2731 .'l'V4.wpd -? O CE OF ENVIRONMENTAL SERVICES t~nt~rn~l~lrr 1715 Chester Ave., CA 93301 (661) 326-3979 ~--~"*'~ HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per matedal Der ~utlding or area) [] NEW [] ADD [] DELETE [] REVISE 200 Page __ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CHEMICAL LOCATION .rc~V ~ [~..~._..l~ 201i CHEMICAL LOCATION [] Yes · . ! CONFIDENTIAL (EPCRA) No 2O2 ~-A-~'[~'9'f~ ~--,, '~ ~{ ,~ ~ 7 '~ 11 MAP#(optional) 203 GRID#(op'-tional) -- II, CHEMICAL INFORMATION. : '~" ..... 205-'] TRADE SECRET [] Yes [] No 206 207 ! .. COMMON NAME EHS* * ' [] Yes [] No 208 *If EHS is'Yes,' all amooms below must be/n lbs. FIRE CODE HAZARD CLASSES (Ceraple[e if requested by local rite chief) 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 i RADIOACTIVE []Yes []No 212 CURIES 213 ] RGEST ~ 215 PHYSICAL STATE [] s SOLID [-'11 LIQUID . [] g GAS 214 I ~ FED HAZARD CATEGORIES [] I FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Chec& all that apply) ANNUAL WASTE 217 I MAXIMUM 218 ! AVERAGE 219 STATE WASTE CODE 220 AMOUNT i DALLY AMOUNT ! DAILY Ak.~UNT UNITS' [] ga GAL "~cf CU FT [] lb LBS [] tn TONS 221 DAYS ON SITE 222 ' If EHS, amount must {)e in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [--]p UNDERGROUND TANK []f CAN [~j BAG ~-']n 'PLASTIC BOTTLE []r OTHER c TANK INSIDE BUILDING [] 9 CARBOY [] k BOX [] o TOTE d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT 224 STORAGE TEMPERATURE [] aAMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 []Yes []No 228 229 2 ; 230 231 [] Yes [] NO 232 233 3 I 234 235 [] Yes [] No 236 237 4 I 238 239 [] Yes [] No 240 2-;~ 242 243 [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHO~IZ'i-~ C,t. '~'" NY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd t~,,~term~'r 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INYENTORY CHEMICAL DESCRIPTION (one form l~er material ~er bu#ding or area) [] NEW [] ADO [-1 DELETE [] REVISE 200 Page __ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CHEMICAL LOCATION 201' CHEMICAL LOCATION [] Yes [] No 202 , CONFIDENTIAL (EPCRA) · II, CHEMICAL INFORMATION .. CHEMICAL NAME ~ If Subject to EPCI:~,. refer to instructions 207 -, COMMON NAME EHS' [] Yes [] No 208 CAS # 209 i .*IfEHS is'Yes,' aU amoaats below mus~ be in ~S. FIRE CODE HAZARD CLASSES (Complete if requested by local fire cflief) 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 i RADIOACTIVE [] Yes [] No 212 CURIES 213 "LARGEST CONTAINER ,~------%~ 215 PHYSICAL STATE [] s SOLID [~]1 LIQUID [] g GAS 214 j FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) MAXIMUM ~ ~..~.~ 218 AVERAGE 219 STATE WASTE CODE 220 ANNUAL WASTE 217 I AMOUNT ~ ~) DAILY AMOUNT AMOUNT ] O.~AIV UNITS' ~ GAL [] ~ CU FT [] lb LBS [] tn TONS 221 DAYS ON SITE 222 ' If EHS. amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n ~LASTIC BOTTLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN fd STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT 224 STORAGE TEMPERATURE [] aAMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 2 230 231 [] Yes [] No 232 233 3 i 234 235 [] Yes [] No 236 237 242 243 [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd -t FII~ ~ 0 CE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HA~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION {one fo~ ~er material ocr ~utlding or a~a) ~ NEW ~ ADD ~ DELETE ~ REVISE 200 Page ~ of I. FAClLI~ INFORMATION BUSINESS NAME (Same as FACILI~ NAME ~ DBA - Doing Busings ~) ~ 3 CHEMICAL LOCATION 2011 CHEMICAL LOCATION ~ Yes ~ No 202 ~ CONFIDENTIAL (EPC~) , '~ ~.?~;. i ~ 1~ ~P~(optiona~ 203 . GRIO~(op~ionaO I1. CHEMICAL INFORMATION · . · 205 ~ T~DE SECRET ~ Y~ ~ No 205 GHEMI~L NAME ~ ----~fC.~ 207 ~ If Subj~ to EPC~. refer ,o instructions.. COM~N NAME ~ EHS' ~ Y~ ~ No ~8 I FIRE CODE H~RD C~SSES (Complete if r~u~t~ by I~1 fire '2~0 ~PE ~ ~ PURE ~ m MIXTURE ~ w WASTE 211 ~ ~OlOACTIVE ~ Y~ ~ No 212 ' CURIES 213 PHYSICAL STATE ~ s SOLID ~1 LIQUID ~ g GAS 214 ~ ~AINER } 215 FED H~RD~TEGORIES ~ I FIRE ~2 REACTIVE ~3 PRESSUREREL~SE ~4 ACUTEH~L~ ~5 CHRONICH~LTH 216 (Ch~ all that apply) ANNUAL WASTE 217,~ ~IMUM 218 ~ AVENGE 219 ' STATE WASTE CODE ~0 A~UNT ~ DAILYA~UNT . ~ DAILYA~UNT UNITS' ~ ga GAL CU~ ~ lb LBS ~ tn TONS 221 ~ DAYSONSITE ~2 ' If EHS. amount mus~e~n lbs. STOOGE CONTAINER ~ a ABOVEGROUND TANK ~ e P~STIONONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR (Check all that apply) UNDERGROUND TANK ~ f CAN ~ j BAG ~ n P~STIC BO~LE ~ r OTHER TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BIN STEEL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WAGON STOOGE PRESSURE ~ a AMBIENT ~ aa ABOVE AMBIE~ ~ ba BELOWAMBIENT STOOGE TEMPE~TURE ~ a AMBIENT ~ aa ABOVE AMBIENT ~ ba BELOW AMBIE~ ~ c CRYOGENIC 2 ~ 230 231 ~Y~ ~No 232 3 ~ 234 235 ~ Y~ ~ NO 236 237 Yes ~No 244 ~ PRINT NAM6 & TITLE ~F AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd -- ~~-~-- O CE OF ENVIRONMENTAL SERVICES t,Wnnrm rr 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form ~er material per building or area) I-1 NEW [] ADD [] DELETE [] REVISE 200 Page __ of __ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CHEMICAL LOCATION 201i CHEMICAL LOCATION [] Yes [] No 202 i CONFIDENTIAL (EPCRA) i FAC~L,TY,D #~~i : i,...._t ' II. CHEMICAL INFORMATION -. CHEMICAL NAME i If Subject to EPCRA, refer to instructions · 207 '. .. COMMON NAME i EHS* []Yes []No 208 CAS # 209 i '*if EH$ is'Yes,' a~ ammm~s below mast be FIRE CODE HAZARD CLASSES (Compte~e it requested by tocal r~re 210 TYPE ~ p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 [] s SOLID t~]l LIQUID [] g GAS 214 ~CONTAINER __? 215 PHYSICAL STATE FED HAZARD CATEGORIES [] I FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) - i ' ' ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE CODE 220 AMOUNT , DAILY AMOUNT DAILY AMOUNT , UNITS' [] ga GAL CU FT [] lb LBS [] In TONS 221 ~ DAYS ON SITE 222 ' If EHS, amount must be in STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS 80'I-rLE [] q RAIL CAR 223 (Check all that apply) UNDERGROUND TANK [] f CAN [] j BAG [] n ~LASTIC BO']-rLE [] r OTHER TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT r-] aa ABOVE AMBIENT [] ba BELOWAMBIENT 224 STORAGE TEMPERATURE " [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBtEN]' [] c CRYOGENIC 225 .... :.'~W'T ' ~..~,..~:~ ~-. -...-. :. :...:~.c.-.::v:..:~-~<':'.:, ',.-~: :HAZARDOUS COMPONENT.. ~.~-~-:-;~{.::-;-': ::.......-. :.9. :~ :...~::~?]~.~?~';.,:.:EHS'~::~' i-..'::: :.. u~S # I 226 ~::~.\ ~_~ '-'~ ! {~ ~'~,~ i []Yes []No 228 229 · ; 230! ~ I [ 2 i 231 i ~]Yes []ND 232 233 3 I 234 235 []Yes [] No 236 237 238 239 [] Yes [] No 240 24; 242 243 Yes [] No 244 245 ". ', ' !.4: .... "'":'.' . :',, .,. ::;:,"~=':!,:~,.'..:!i ". . . .... ' ~'.. ' ; "':/,.'.'~ i'- '.:}. '. ' :.i:':.'I~, :<'ILL SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUP, AFORMS\OES2731.TV4.wpd FAX Transmittal E R $ F I i=. L D Cover Sheet CALIFORNIA Bakersfield Fire Dept. Office of Environmental Sex, rices 1715 Chester Ave. · Bakersfield, CA 93301 FAX No. (,.~.~z..) 326-0576 · Bus No. (:~) 326-3979 Today's Date "¢/~')/ o [ Time ~ .'0 0 No. of Pages' /// 04/27/01 09:03 8661 326 0576 BFD HAZ MAT DIV ~001 *** ACTIVITY REPORT TRANSMISSION OK TX/RX NO. 9756 CONNECTION TEL 3224512 CONNECTION ID START TIME 04/27 08:57 USAGE TIME 06'45 PAGES RESULT OK Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This ~ermit is issued for the followin~J: [] Hazardous Materials Plan [] Underground Storage of HazardOus Materials- [] Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002195 KOOL LINE EXPRESS LOCATION 3502 93308 ~..~.. ~g OFFICE OF ENVIRONMENTAL SER VICES ' 1715 Chester Ave., 3 rd Floor Approved by: C Ralpl/rHuey, r~~5 Issue Date Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: ? , --. CITY OF BAKERSFIELD ~ OFFICE OF ENVIRONMENTAL SERVICES 1715Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS ANAGEMENT PLAN 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA MAILING ADDRESS: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 H~tx PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. l: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C., ENVIRONMENTAL RESPONSE MANAGEMENT; .,, , ~ loP5 D. EMERGENCY MEDICAL PLAN: 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: .~¢o,c ~ o,'I .'.? ~W.3.,..~ ~.'~ ~,'d~.~. B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: WATER: SPECIAL: LOCKBOX: YE~ IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: dCd~ ~ BRIEF SUMMARY OF TRAINING PROGRAM: ~/~.i,~,',', ,e lt h,~_a,.-.M.~z.,.,. ,'o,~,',.~ I~; ~'~. CERTIFICATION I, ~,e~_,~. ~2~"~,'~ ~/q CERTIFY THAT THE ABOVE INFORMATION IS A-CCUKATE. I UNDERSTAND THAT THIS INFORMATION 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. 25560 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. TITLE DATE 4