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Home My WebLink AboutBUSINESS PLAN 9/18/2003~J _ ~_MOBILE.SAFETY_&_INDUST'L_S_UPPLY -. T ~~ _ i` 3624 BUCK OWENS BLVD:-- -- --~ ~~:., ;~ F~ Hazardous .Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This _r~ermit is issued for the following; [] Hazardous Materials Plan [] Underground Storage of Hm,~rdous Materials Permit ID #:: 015-000-001272 [] Risk Management Program MOBILE SAFETY COMPANY [] Hazardous Waste On-Site Treatment :-.~ ~:', ¢~:~ ~ ~.~., . LOCATION: 3624 BUCK OWENS BLVD 6 :IELD ..... ¢ ~ , - ~ ~ .",j ~,~,~ ', ~ · ..~ ~:, ,> ~:~':'. ~ OFFICE OF EN~R ONMENTAL SER VICES - 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 ~~ F~ (661) 326-0576 Exp~tionDate: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ........... ,~,~,~,~,~,~,~,,~,,~,~=,,~, ................ This permit is issued for the following: rsm MOBILE SAFE~ COMPANY LOCATION 3624 PIERCE ~?,:= A:'",." ~ ~; . ~ ... ,~.-.. ....... "_... ~ssu~ by: B~er~field Fire Depa~ment Approv~ by: OFFICE OF EN~RO~AL S~ ~CES 1715 Chewer Ave., 3rd Floor ~ Office of ~en~l S~i~ B~emfiel~ CA 93301 Voice (805) 32~3979 F~ (80s) ~-0s76 Exp~tion Date: ~ ~ :,~ ~.~ .qr. GAS DETECTION · SALES & SERVICE · P~TAL ~. ~,~ ~ ~ ~AFETY C~ ~ ~ ~ I~1~ '1 MOBILE SAFETY ~ - - SiteID: 015-021-001272 Manager· : ' ~ ~ Phone: (661) 323-~ Location. 3624 BUCK OWENS BLVD ~ ~U-v_~%Map · 102 Com~az · Minimal City : BAKERSFIELD ~ %%~%~d: 23B FacUnits: 1 AOV: CommCode: CO~TY STATION 66 ~ ~ ~I~Code: 7359 EPA Nu~: ~ ~~~Brad:~ ~ .....: /~ ~ /J ~)l'~jl~''. ~ ~..~ ~ ~ i' Emergency Contact / Title Ub ~ Emergency Contac~ / Tztle . Business Phone: (661) 323-4529x ~'-- Business Phone: (~{)'5~% -~%~ x 24-Hour Phone : (661) ~~/-/m:~ 24-Hour Phone : (~% ~ Phone : (~)~-~x ~hone : (~ Hazmat Hazards: Fire Press Im~lth Contact : Phone: (661) 323-4488x MailAddr: 3624 BUCK OWENS BL~ State: CA City : BA~RSFIELD Zip : 93308 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: RSs: No ParcelNo: Emergency Directives: -1- 09/12/2003 MOBILE SAFETY COMPANY SiteID: 015-021-001272 ~ Fast Format F Si~e En~ergency Factors Overall Site Special Hazards ~ Utility Shut-Offs 12/20/2000 A) GAS - PLANTAR IN FRONT OF BLDG B) ELECTRICAL - C) WATER- -I~OF BLDG NEAR WALKWAY LOCK SPECIAL BOX Fire Protec./Avail. Water 1_2/2_0/2000 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND SPRINKLER SYSTEM. NEAREST FIRE HYDRANT - IN FLOWER BED. Building Occupancy Level 7 09/12/2003 MOBILE SAFETY/IND. SU ~ INC. SiteID: 015-021-002854 Manager : KEVIN GALL~-~BusPh°ne: (661) 323-4529 Location: 3624 BUCK OWENS BLVD ~ Map : CommHaz : City : BAKERSFIELD ~ -Grid: FacUnits: 1 AOV: CommCode: COUNTY STATION 66 .~.i SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title KEVIN GALL / MANAGER KARI MITCHELL / PRESIDENT Business Phone: (661) 323-4529x Business Phone: (661) 323-4529x 24-Hour Phone : (661) 201-1034x 24-Hour Phone : (661) 201-1026x Pager Phone : (661) 587-8966xHOME Pager Phone : (661) 589-8268xHOME Hazmat Hazards: Fire Press ImmHlth ---'Conta~ ': KEVIN GALL Phone: (661) 323-4529x MailAddr: 3624 BUCK OWENS BLVD State: CA City : BAKERSFIELD Zip : 93308 Owner KARI MITCHELL Phone: (661) - 58x98268 Address : 6913 COPPER CREEK WY State: CA City : BAKERSFIELD Zip : 93308 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: 1 10/13/2003 MOBILE SAFETY COMPANY ~ SiteID: 015-021-001272 Manager : <~// BusPhone: (661) 323-4488 Location: 3624 BUCK OWENS BLVD 6 .Map : 102 CommHaz : Minimal City : BAKERSFIELD Grid: 23B FacUnits: 1 AOV: CommCode: COUNTY STATION 66 SIC Code:7359 EPA Numb: DunnBrad:36-067~4261 Emergency Contact / Title E~ergency Con~ac~ / Title LARRY MCHENRY / OWNER /~_/~ /~L/~/c~ / U ~ Business Phone: (661) 323-4529x Bdsiness Phone: ( ) - x 24-Hour Phone : ~ 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : Phone: (661) 323-4488x MailAddr: 3624 BUCK OWENS BLVD 6 State: CA City : BAKERSFIELD Zip : 93308 Owner LARRY MCHEN-RY Phone: (661) 393-0983x Address : 7217 ELIAS State: CA City : BAKERSFIELD Zip : 93308 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... I SpecHaz EPA HazardsI Frm DailyMax Unit MCP GRADE D BREATHING AIR F P IH G 6000.00 PT3 Min I, /-/9'/'Y¥//~~~ D0 hereby certify that ~ have · (Ty~6e or print name) / reviewed the aitached hazardous materials manage- ment plan for j~/~-~ and that i~ along witl'~ (Name of Business) ' any corrections constitute a complete and correct man- agemen~ plan for my facility. -1- 12/19/2000 MOBILE SAFETY COMPANY SiteID: 015-021-001272 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~UlVUVl~ ~Vl~ / ~ ± ~./4.J~ ~vl~ GRADE D BREATHING AIR Days On Site 365 Location within this Facility Unit Map: Grid: SE CORNER OF BLDG CAS# r STATE ~ TYPE i PRESSURE [ TEMPEP~ATURE CONTAINER TYPE Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average FT3I 6000.00 FT3 3000.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Air N° HAZARD ASSESSMENTS TSecretNo NoRS BioHazNo, Radi°active/Amount I EPA HazardsNo/ Curies F P IH NFPA/// USDOT# I MCPMin -2- 12/19/2000 F MOBILE SAFETY COMPANY SiteID: 015-021-001272 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 10/04/1990 CALL THE FIRE DEPT. -- Employee Notif./Evacuation 10/04/1990 VERBAL NOTIFICATION TO EVACUATE THE BLDG AND CALL 911. ~ Public Notif./Evacuation 10/04/1990 INTERCOM AND VERBAL NOTIFICATION. Emergency Medical Plan 10/04/1990 CALL 911 AND TRANSPORT TO ANY HOSPITAL. -3- 12/19/2000 F MOBILE SAFETY COMPANY SiteID: 015-021-001272 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 10/04/1990 COMPRESSED GASSESSTORED IN HIGH PRESSURE SAFETY CYLINDERS. CYLINDERS PROPERLY RESTRAINED. -- Release Containment -- Clean Up Other Resource Activation -4- 12/19/2000 F MOBILE SAFETY COMPANY SiteID: 015-021-001272 I Fast Format F Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 10/04/1990 A) GAS - PLANTAR IN FRONT OF BLDG B) ELECTRICAL - NE CORNER OF BLDG C) WATER - IN FRONT OF BLDG NEAR WALKWAY D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 10/04/1990 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND SPRINKLER SYSTEM NEAREST FIRE HYDRANT - IN FLOWER BED Building Occupancy Level -5- 12/19/2000 MOBILE SAFETY COMPANY EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE SiteID: 015-021-001272 i iE Training EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE Overall Site i iEE Employee Training EEEEEEE~EEEEEEEEEEEEEEEEEEEEEEEEE~EEEEEEEEEEE 12/19/1990 i o WE HAVE 10 EMPLOYEES AT THIS FACILITY. ° o WE DO NOT HAVE MSDS SHEET ON FILE FOR THIS MATERIALS. o o BRIEF SUMMARY OF TRAINING PROGRAM: FIRST AID AND CPR, HAZARDOUS o COMMUNICATION AND FIRE TRAINING. o o o o o o O CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME l~\t~,lt. 50.(-t~,-t . INSPECTION DATE .t,a/tet[oo ADDRESS ~.d _f2a~l,' Oa~51 fl{ ~ PHONE NO. ~3e~3 ' q3'"~ ~ FACILITY CONTACT BUSINESS IDNO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES . Section 1: Business Plan and Inventory Program ~ Routine [~ Combined [~ Joint Agency {~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V' COMMENTS Appropriate permit on hand Business plan contact information accurate / Visible address Correct occupancy Verification of inventory materials Verification of quantities /' Verification of location Proper segregation of material Verification of MSDS availability k,/ Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection L Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~l Yes [~ No _~~~ Explain: Questions regarding this inspection? Please call us at (661)326-3979 ~sin~s; S'i!e.e.~S]~e sPon~/! epo.~/,~/5,~artyarty White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: ~ ~ MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE z~._ _C~-~c~ NEVi/ACCOUNT ADDRESS CHANGE CLOSE ACCT · FINANCE CHARGE · OTHER ADJ SITE ADDRESS PARCEL NUMBER ~F APPUCA~[~') ADJUSTMENT I CHG DATE CHARGE CODE I ADJUSTMENT AMOUNT . ; / APPROVED BY~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACiLITy CONTACT BUSINESS IDNO. 15-210-OO INSPECTION TIME ,3 ?,rt,./ NUMBER OF EMPLOYEES Section I: Business Plan and Inventory Program · .l~l ROUtine J~l Combined t Agency J~l Multi-Agency [2l Complaint [~ Re-inspection OPERATION C V COMMENTS '.., Appropriate permit on hand b/ !B'.~i~iness plan contact intbrmation accurate Visible address 12' · Correci occupancy .. [,// ..: Verification of inventory materials fi' ~ ~ c~ (~_ . .Verification of quantities I,/ Iqc. Verification of location t," Proper segregation of material ..... Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and proceflures Emergency.procedures adequate I/ Containers properly lab)ele~i Housekeepin~. v Fire Protection Site Diagram Adequate & On Hand C=Compliance . .~V=Violatio~.. -' .,.,: Any hazardous, waste on site?: Questions regarding this inspection? Please call tis at (805) 326-3979"' -- /'Jl3usin~ Site l;~onsib,l~e'' Party While - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector-~.~ -- · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ADDRESS .~ PHONE NO." FACILITY CONTACT BUSINESS ID NO. 15-210-~"O ' INSPECTION TIME ~ ? ~t/' NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program 14 12i Routine [21 Combined t Agency 1~1 Multi-A [21 Complaint [~i Re-inspection OPERATION . ~C V COMMENTS Appropriate permit on hand ~ ...,. ~ '" ~/ Business plan contact intbrmation adcurate ~ ~~ p..(~. '/~ ~_~ ~ , Visible address Correct occupancy ~,,./ ' Verific. al, ion of inventory materials :~,'., ~! ~ P~x~y~.v4, t~ C.)'?._ , Verification of quantities "~:;~ ~ I~tt R ec-~ Verification of location Proper segregation of material Verification of MSDS availability Verification ofHaz~Mat training [k~ ~., ~lc~ Verification of abatement supplies and procedures ~ ., Emergency procedures adequate Containers properly labeled ~' Housekeeping Fire Protection ? .,' Site Diagram Adequate & On Hand C=Compliance V=Violation ,Any hazardous waste on site?: [21 Yes ~~o Questions regard lng th is in,spection? Please callus at (805)326-3979~"/~usi n~e R~,/e~.¢onsib(e/~'' -- Party White - Env. Svcs. Yellow - Station Copy Pink- Business Copy Inspecto~:x D'7/27/92 MOBILE SAFETY COMPANY 215-000-001272~ p! i~ e Overall Site with 1 Fac. Unit Iti AUG 11 1992 General Information 8¥ Location. 3624 PIERCE RD ~9--~ Map: 102 Hazard: Minimal iCommunity: COUNTY STATION 66 Grid: 23B 'F/U:/ 1 AOV: 0.0 Contact Name Title Business Phone m~24-Hour Phone- LARRY MCHENRY OWNER (805) 323-4488 x ~ ,'(805) 366-6424 ( ) 3~?-~-~x ~/ ( )3~5-0q$3 Administrative Data Mail Addrs: 3624 PIERCE RD ~9--~L~ D&B Number: 36-067-4261 City: BAKERSFIELD State: CA Zip: 93308- Comm Code: 215-066 COUNTY STATION 66 SIC Code: 7359 Owner: LARRY MCHENRY ~ Phone: (805) ~ Address: ~._~-.. =~=~.~,~ ~ ~ ~f~ State: CA City: -BAKERSFIELD Zip: 9~ ~3~ Summary ~7/27/92 MOBILE SAFETY COMPANY 215-000-001272 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 G~DE D BREATHING AIR Gas 6000 Minimal · Fire, Pressure, I~ed Hlth FT3 CAS #: Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily M~x~k j Daily Average FT3 T ~Annual ~ount FT3 /~-J~. 3,000.00 , 60,000.00 Sto~~I Press T TempI Location PORT. PRESS. CYLINDER IAbove I~bientlSE CORNER OF BLDG -- Conc Components MCP List 100.0% lAir [Minimal I 05/27/92 MOBILE SAFETY COMPANY 215-000-001272 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL THE FIRE DEPT. <2> Employee Notif./Evacuation VERBAL NOTIFICATION TO EVACUATE THE BLDG AND CALL 911. <3> Public Notif./Evacuation INTERCOM AND VERBAL NOTIFICATION. <4> Emergency Medical Plan CALL 911 AND TRANSPORT TO ANY HOSPITAL. , ~7/27/92 MOBILE SAFETY COMPANY 215-000-001272 Page 4 O0 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention COMPRESSED GASSES STORED IN HIGH PRESSURE SAFETY CYLINDERS. CYLINDERS PROPERLY RESTRAINED. <2> Release Containment <3> Clean Up <4> Other Resource Activation ~7/27/92 MOBILE SAFETY COMPANY 215-000-0012.72 Page 5 O0 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - PLANTAR IN FRONT OF BLDG B) ELECTRICAL - NE CORNER OF BLDG C) WATER - IN FRONT OF BLDG NEAR WALKWAY D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND SPRINKLER SYSTEM NEAREST FIRE HYDRANT - IN FLOWER BED <4> Building Occupancy Level CITY OF BAKERSFIELD ~,' HAZARDOUS MATERIALS INVENTORY Farm and Agriculture andard Business ~ . Page c~__ NON - TRADE SECRET CITY, ZIP: ~~~-[~_ ~ ~ ~, ~3~, CITY,' ZIP: ~-~~-~'~6[ CF%-~, _~o~DUN AND BRADSTREET NUMBER/FEDERAL ID REFER TO INSTRUCTIONS FOR PROPER CODES i 2 3 4 5 6 7 8 9 10 11 12 13 14 Trans Type Max Average Annual Measure # Days Cent Con~ Cent Use Location Where % by Names of Mixture/Components Code Code Amt Amt Amt Units on Site Type ~,press Temp Code Stored in Facility wt See Instructions Physical and Health Hazard C.A.S. Number Component # 1 Name & C.A.S. Number (Check all that apply) Component # 2 Name & C.A.S. Number of Pressure Health Health Component # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # 1 Name & C.A.S. Number .. (Check all that apply) Component # 2 Name & C.A.S. Number ~ Fire Hazard ~ Sudden Release '~ Reac~ivity ~- Immediate [] Delayed of Pressure Health Health Component # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # 1 Name & C.A.S. Number (Check all that ap,ply). Component # 2 Name & C.A.S. Number ~ Fire Hazard ~ Sudden Release ~ Reactivity [] I~edtate ~ Delayed of Pressure Health Health Component # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # 1 Name & C.A.S. Number (Check all that apply) Component # 2 Name & C.A.S. Number of Pressure Health Health Component # 3 Name & C.A.S. Number EMERGENCY CONTACTS #~ #2 Name Title 24 Hr. Phone Name Title 24 Hr Phone Carttftcat~on (READ AND SIGN AFTER COMPLETING ALL SECTIONS) I certify u~der peanlty of law that I hayer personally examined and am familiar with the information submitted in this and all attached documents and that based on ~y inquiry of those individuals responsible for obtaining the tnfor~ation. I believe that the submitted information is true, accurate, and complete. iNAME AND OFFICIAL TITLE OF OWNER/OPERATOR OR OWNER/OPERATOR'S AUTHOKIZ~D REPRESENTATIVE SIGNATURE DATE SIGNED Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 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 brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME' 'J~ OJ~ i I g S~-rP~_.;ty" ~)' LOCATION: :~o~V Pi,cRC Rmd 5 MAILING ADDRESS~ ~m~ ,- MAILING ADDRESS: "3~ ~ P/e,~E~ M ~ SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 2. FD1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYES& ? MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 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 DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON] SECTION 5: CERTIFICATION: MATION IS ACCURATE. I UNDERST~;ND 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. :25500 ET AL.) AND THAT ~~E INFORMATION CONSTITUTES PERJURY. TITLE DATE 2. FD1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: ~ ua~ua-~ X--tx £u_/,'d;~ C, PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES: S'=¢T~O. ~.' UT..',' S.UT-O.=S ELECTRICAL: SPECIAL: LOCK BOX: YE~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): ~. FD1 $~0 C]'TY of BAKERSF'rELD HAZARDOUS HATERTALS TNVENTORY Farm and Agticulture [-] Standard Business 0 NON--TRADE SECRETS · Pa~,e of irans ]yqe ~ax Ay?rage Annual Measure I Ovae ~ont Cont Cont Us Locatjon.Whe[e. Code ~oe Am~ A,t Est Un,ts on.,~ ,,, ~ype Press Temp Co~e See Instructions Stored Physical and Health Hazard C.A.S. Number ~' Component II Name I C.A,S. Number (Check all that apgl~J ~ Fire Hazard ~ Reactivity ~ Delayed ~dden Release ~ediate Componen~ Name Number Health of Pressure Health Component t3 Name ~ C,A,S, Number Physical and Health Hazard C,A,S. Number Componen[ll Name I C.A,S. Number (Check al/ tha[ apply) Component 12 Name ~ C.A,S. Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Im~i~ Health of Pressure Componen[ 13 Name & C.A,S, Number Physical ~nd Health Hazard C,A,S, Number Component 11 Name I C,A,S, Number {Check ~11 that sDgl~) Componen~ 12 Name & C,A,S, Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate Hearth of Pressure Health Component 13 Name S C,A,S, Number Physical sndHealthHazard C,A,S, Number Componentll Name t C,A,S, Number (Check al1 that apply) Component 12 Name ~ C,A,S, Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Health of Pressure Component 13 Name S C,A,S, Number EHERGENCY CONTACTS ~erti~jgatioq ,(Re~ ~.nd.~ign after compl~ti~g,all secti~nq) i::so ".s" S~-ET RECE'I r/ , . ,, o~[c:.4a u'sa oa'~v' '~'- ~ ~"~- ' BUSINESS ' P~.~' A~ A ,'(3': ~, To avoid further action, re~rn this fot-m by 2. ~'PE/PRINT ANSWERS IN E~GLISH. 3. Answe~ the questions below fo~ the business as a whole. ., 4. Be as b~ief and concise as pgssible. ', '':' .::, .' ::.' ., , . , -~ " /'~ .' . , 2'.' SE~ION' 1: BUSI~SS ID~IFICATION DATA · ,.,'"'. g 50CATION ~/.~STREET ADDRESS: ~ ',':.~-:., (, . ,..... ....... or threatened ,.nelease, In. case of-an e=er~enF~",~nvoivin~ ~h r~iease ......... hazardous =ate~ial, c~ll '91'~'and ;-,.800-~52~T550 o~ your l~i fire 'department,.~d ~he St~e ~f..~e of Eme~ency;Se~vice's~ as . ~ . :.. E)IPLOYEES TO NOTI~ ~N CASE 0F ~!ER~E~TCY: ~.:. ,.:. .: , :...' NAME ~ITLE DLRING BUS.'~ERS SE~ION 3: 50CATION OF ~ILI~ S~f-OFFS FOR 3USI~SS'AS~' A. NAT.. GAS/PROPANE: ;-~.;.~c, , B. ESECTRICAL: C. WATER: , . ,.,. ,,,. ~,, D. SPECIAL; E. ~0CK BOX,:, yES /~ [F YES, gocA'rI0:,;'.~ ~- · rF ~ES, DOES rT C0~'TA).:: SrTE PLA~S? '~, ~ES'/ ':N0"- FLOOR PLANS? YES / N0 . · ~.,.,. . ' ~::;. - 2.% SECTION 4: PRIVATE RESPONSE TE'~M FOR BUSINESS AS A WHOLE ' '~ SE~ION 5: LOCAL EMERGENCY MEDICAL ASSISTanCE FOR YOb~ BUSI~SS AS A - ~ . ..., ', SE~ZON 6:. ~LO~E ~IN~NG : ' ~t[,/, ~.,.'~,.~ RE:RESr;R?r,,~XzNG .IN ~HE FOLLOWING AREAS.' · ' '~ % ", ";~ "c~, .*: ' '.q: ' ::':' '~' ~' ~" CIRCLE ~S OR .NO ............ A. METHODS'FOR SAFE HANDLING OF HAZARDOUS ,- , B. PROCEDURES FOR COORDINATING ACTIVITIES '~ _~ .,. ~ .... ,WITH 'RESPONSE 'AGENCIES ~ :'.'; ..... .... ~..'..L .:.:[ .'..: .-'~4 C. PROPER USE OF SAFE~. EQUIPMEh~: ............ '7....'.'~,"NO D. EMERGEN~ EVACUATION 'PROCEDURES: .................. ;. E. DO vn ~ . · ~ MAiN~AiN EMPLO%~E TRAINING RECORDS: ....... NO SECTION 7: ~Z~DOUS ~I~ '. '" CYRCLE ~':'~O:2 ~". '' ':"' ~ .r' :.,~,': ~,~'.~, 'DOES YOL~ BUSINESS ~h~LE HAZARDOUS ~TERIAL IN QUXh~ITIES LESS THAN'.' ~"SOLiU~ GALLONS 'OF~A-,LIQUID. , OR 200 CUBIC FE~T..OF .A..,COMPRESSED I~., cer~ that the a~ove I~a~~'t~s ~formation will.be used-to fulfill.,m~'~firm's:;:'obl~ t~ ~~af~t~ cod~ on:. Haz~Kd~s ~gterials (Div. '.20~ Sec.' 2~500 Et Al. ) '~nd, thai~'~i'~ac'~u'r'at'e~ i~fG~ma.~b6 'C~fis~'~t~'~s S I GNATL~[ _TITLE DATE , BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFiCTAL USE ONLY ID# BUSINESS NAME: BUS I NESS PLAN SINGLE FACILITY UNIT 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 b~IT NAME: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS L~."IT ONLY SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does thi. s Facility Unit contain Hazardous Materfa!s? ...... YES ~0 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 form marked: NON-TRADE SECRETS ONLY (white form ~4A-1) If..¥es, 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 8: LOCATION' OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS · SECT{ON 6: LOCATION OF UTILITY SHbW-OFFS AT THIS b~'IT ONLY. A. NAT. GAS.,"PROPANE'~ B. ELECTRICAL: C. WATER: D. SPECIAL: E rOCK BOX: VES .; NO IF YES, LOC.~.T:O.,,: FLOOR ~)r ~,N~') YES / NO '~";'vS~ YES - 3B - " ' :. BAKERSF!EI, D CITY FiRE DEPgRTMEN? I.D. # FORH 4A-1 Page __ of NON''TRADE SECRETS 'IIAZARDOUS MATERI ALS I NVENTORY NA/4E FACILITY UNIT ~: NAME: BUSINESS - owNER : 'ADDRESS: 'ADDRESS: FACILITY U~IT NAHE: CITY, ZIP: CITY,ZIP PHONE ,: pHONE ,: [OFFICIAL USE CF IRS CODE~ 1 2 3 4' ' .5, _ _ 6 7 ' 8 9 10 TYPE MAX ANNUAL ' ':' C. ONT USE LocATION IN THIS ~ BY HAZARD D.O.1 CODE A~OUNT A~OUNT UNIT CODE CODE FACILITY UNIT '- ~T. UHEMIqAL OR COMMON NAME CODE GUID~