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Home My WebLink AboutBUSINESS PLAN 10/6/1989 oP---M ~ ) FF ~'6~: -o ¢--M S- ~EoT I '", i: ~ I ""bcc~, O Bakersfield Fire l pt. ttazardous Materials Inspection Date Completed Plan ID # 215-000. 1~3- (Top right comer Business Plan) REGE|V[~D Station No. ~ S~R ~ Impector 0ti 0 6 1989 ~. ~T. DIV. Adequate Inadequate Verification of Invento~ Materials ~ ~ Verification of Quantities ~ ~ ~ Verification of Location ~ ~ ~ ~oper Se~egafion of Matefi~ c~ ~ ~ Co~: Verification of MSDS Availabfliw ~ ~ Vehficafion of ~z ~at Tr L ~ ~ Co~: ~ Ve~cafion~~e~uO~es & Procedures ~ ~ ~e~ency Pr~ed~s Prated ~ ~ Containers Properly Labeled ~ ~ Verifcafion of Facility Diagram Special Hazards Associated with this Facili_w,: .tja_. ~)3ax~ /'m~c2/_. ~9, ,-55t FO 1652 (Rev.'3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office 2130 'G' STREET ~ BAKERSFIELD, CA. 9330'1 (805) 326-3979 OFFICIAL USE ONLY ID # ' ' BUSINESS NAME RECEivED HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A ~ HAZ. MAT. DIV. I.NSTRUCT~ONS: 1. To avoid further ac~on, re~urn [h~s from w~h~n 30 days of rece~. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer ~he questions below for [he bus,ness as a who~e. 4. Be as brief and concise as possSb~e. SECTION 1: BUSINESS IDENTIFICATION DAT~ A. BUSINESS NAME: I~D~ ~r ). B. LOCATION / STREET ADDRESS: ~U~ ~~ ~ ~/~ C[TY'~~~~ ZIP: ~0~ BUS. PHONE: SECTION 2: EHERGENCY NOTiFiCATiON8 ~n case of an emergency ~nvo]v~nB ~he re]ease or ~hrea~ened a hazardous ma~e~a], mail 911 and 1-800-852-7550 o~ 1-91~-~27-~3~1. Th~s w~]] no~fy your local f~re depar~men~ and ~he 8~a~e Off~ce of Emergency Services as required by law. EMPLOYEES TO NOT[FY IN CASE OF EMERGENCY: NAHE AND TITLE DURING BUS, HRS. AFTER BUS. HRS. 1 B. ~ ' PH~ ~~~ SECT[ON 3: kOCAT[OH OF UTILITY SHUT-QFFS FOR BUSINESS AS A WHOLE B. ELECTRICAL: ~~ ~ ~ D. SPECIAL: E. LOCK BOX: YES ~~IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLF . .' .".;; !.-' SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAH WHICH PROVIDES EHPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS MATERIALS. A. NUMBER OF EMPLOYEES AT THIS FACILITY B. 'DO YOU HAVE MSDS (HATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS MATERIAL YOU HANDLE ? ... C. GIVE A BRIEF SUHMARY OF YOUR HAZARDOUS MATERIALS TRAINING PROGRAM: SECTION 7: EXEMPT[ON REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT NY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE CALIFORNIA HEALTH AND SAFETY CODE FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS HATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 8; CERTIFICATION I, '~-~~ ~z~c~ , certify that the above information is accurate. I understand~hat 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 SIGNATURE.,~'~~.TITLE frl~?-/,(-~_,~- '.DATE 3-~-~ 2130 STREET BAKERSFIELD, CA. 93301 (805) 326-3979 t OFFICIAL USE ONLY II BUSINESS NAME J I D # HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 3A [NSTRUCT~ON~ 1. To avoid further action, lshis form musl; be relsurned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the queslsions below for THE FACILITY UNIT L]:STED BELOW Be as BRIEF ancl CONCISE as possible UNIT · /~'~' FAClL]:TY UNIT NANE: FACILITY S. ECT]:ON 1: HIT];GAT];0N, PRE~VI~NT~ON, AI~ATEHENT PROCEDURES ~ECTION :~; NOTIF3:(;ATION AN0 I~VA(:;:UAT;[ON PROCEDURES AT THE UNIT ONLY ,ECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... (~E~ 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 marked: NON-TRADE SECRETS ONLY (white form #4A-I) 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 t.he trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS (Fire Hydrant) SECTION ~' LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NATURAL GAS/PROPANE.: e. ELECTRICAL- ~OOJ<¢c~ t¢~ ~fl~ 7~/ W D. SPECIAL: E. LOCK BOX: YES /(N~/)IF YES, LOCATION: v IF YES, SITE PLANS? YES / NO MSDSs?~ NO FLOOR PLANS? YES / NO KEYS?'~ / NO - 3B- CITY of BAKERSFIELD Ir~nl Ty~ ~x A~raqe ~aJ ~su~ I ~ Cmt ~t ~t he L~tt~ ~e ~ i of Ntxt~l~tl (~e C~e Mt Mt Est Units m Site l~ ~1 Tm CW St~ in FKillty ~ Inst~tt~ ~hysical ~d H~lth h of Pj~re ~lth of Pm~ ~lth Health of P~u~ HHlth H~lth of Pr~sure Health ............. C~rtlficati~ (Resd and siKn after co~pJetJnR ali sections) I certify ~der ~l~y of 1~ ~t I ~ve ~rsmallye=am~n~ end am familiar CITY BAK£RSPfE?D FIRE DEPARTMENT ~/~~~ 2101 H STREET O. S. NEEDHAM ~ ~IJ(B:ISRELO. ~T FIRE CHIEF 326-2911 May 9, 1989 Dear Business Owner: Enclosed please find a copy of your response to the Hazardous Material Business Plan reques:. We have foune it necessary :o reject your plan for the following reason(s) as checked below. ~ Illegible Business Plan (please print or type information in English). Fom 2A ~ Missing or ~ Incomplete Form 3A ~ Missing or ~ncomplete ~ / Form CA ~ Missing or ~ncomplete ~/C_ Form 5A ~ ~'~s(~. Site Diagram r-~ Missing or ~ Incomplete Facilities Diagram F-"T Missing or~--~ Incomplete This is to be corrected and-resubmitted within 30 days to: Bakersfield City Fire Deoartment Hazardous Materials Division 2130 "G" Street Bakersfield, CA 93301 If additional copies of any forms are needed they can be picked uD from the HazarUous Materials Division at 2130 "G" Street in person. Sincerely Yours, ,,. /Ralph E. Hu~y'"~ ~ Hazardous Materials Coordinator REH/eg Oear Busirless Owner-. Enclosed please find a copy of your ~sponse to the Hazardous Material Business Plan request. We have found it necessary to ~jec: ~ur p)~ for ~e following reason(s) as ~ec~ed below. Il]~ible Business Plan (please print or t~e i~o~tion Fo~ ~ ~ Missing or~ Inc~plete Fo~ 4A ) ) Missing or ~nco~lete ~/~ Site Oiagr~ ~ Missing or ~ Incomnlete Facilities 0iagr~ ~ Missing or~ Inc~lete This is to be corrected and resubmitted ~ithin 30 days t~: Bakersfield City Fire Oeuar~ent HazarDous Materials Division 2130 "G" Street Bakersfield, CA 93301 '" If additional copies of any fo~s are needed they can be picked u~ f~m the Hazardous Materials Division at ~!30 "G" Street in person. Sincerely Yours, / /Ralph E. Hu~ ~ ' HazarUous Materials Coordinator RE~/eg BAKER~r~:LD CITY FiRE DEPAHiM~NI ~ 2130 'G' STREET ~ BAKERSFIELD CA. 9330'1 ~O ~ 3 (805) 326-3979 ~-~ c~ ~' OFFICIAL USE ONLY I~ i I'~ ID# ....... BUSINESS NAME RECEIVED HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE '~P~ 2 6 198~ FORM 2A HAZ,. MAT. DIV. INSTRUCTIONS: 1. To avoid further action, return this from within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for %he bus,ness as a whole. 4. Be as brief and concise as possible. SECTION 1: BUS[NESS IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: ~r ~-~--~-~ ~-~ '¢~'-/~'" CITY?. ~~~0 ziP: SECTION 2: EHERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, cai] 911 and 1-800-852-7550 or 1-916-427-4341. This w~]] notify your local fire departmen[ and %he S%a~e Office of Emergency Services as required by ENPLOYEES TO NOTIFY ZN CASE OF ENERGENCY: NAHE AND TITLE DURING BUS, HRS, AFTER BUS, HRS, SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NATURAL GAS/PRO~ANE: ~-~ '~';=- B. ELECTRICAL: ~f~ ~ m~ C. WATER: ~.~ ~ ~ D. SPEC[AL' E. LOCK BOX: YES ~[F YES, LOCATION' IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAl. ASSISTANCE FOR YOUR BUSINESS AS A WHOLE · ,,,' ,, ' ¢o.sjo 5 22/6- SECTION 6: EMPLOYEE TRAINING EHPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS HATERIALS. 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- SECTION 7: 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 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 '~'~'~1~ '~-~__.~_~ , certify that the above information is I, accurate. I understand~hat 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 SIGNATURE ~ TITLE ~r-u~-z,(.~,,F~ DATE ? B RSFIELD CiTY FIRE D RTMENT 2130 'G' STREET BAKERSFIELD. CA. 93301 (805) 326-3979 tl ~ ID# II BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 3A ZNSTRUCT~ONS 1. To avoid further acl;ion, 1;his form musl; be rel;urned by: 2. TYPE/PRTNT YOUR ANSWERS TN ENGLISH. 3. Answer the cluesl;ions below For THE FACILITY UNIT LTSTED BELOW 4. Be as BRIEF and CONCISE as possible _~_~/-~.~ ~/~Z~L-- FACILITY UNIT SECTION1: .~T~;(~AT];ON, pREVeNTS;ON, ^.ATS. ENT PROCEDU.ES ~ECT~ON 2; NOTIFICATION 'AND EVACUATION 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 N~ If NO, complete a separate Hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-1) If YES, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (Ye]Iow form ~4a-2) in addition to'the non-trade ...... sec~et-fo-~m¢---bi.st--enqy, tbe_tEade .se~.r_ets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5; ~,0CAT~ON OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS (Fire Hydrant) SECTION §- LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NATURAL GAS/PROPANE.: B. ELECTR]:CAL' L00.~¢-~ t'~O~m ¢-'lbflr'O'~ 7~'/ W D. SPECZAL: E. LOCK BOX: YES /(N~)IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs?~ NO FLOOR PLANS? YES / NO KEYS?'~ / NO - 3B- CITY of BAKERSFIELD N 0 N -- LOCATION: CrTY, ZIP: ~.~'~ D~ ~~ CITY, ZIP: ~-r~ ~307 DUN AND BRADSTREET NUMBER C~e C~e ~t ~t Est Units m SRe l~ ~s T~ ~ St~ ~n F~tltty ~ ~ I~t~tt~ (C~k all t~t i~ly) h of P~ ~lth (C~k ell t~t apply) of (C~k oil t~t o~ly) t_a Fire Haza~d ~--J R~ctivtty ~--~ HHlth (C~k all t~t ~wly) CWt F~e Hozeed ~--~ ~tivity ~le~ ~dd~ Reline -- flfllth of Prflsure Hflith ............ Certlficati~ (Read and sJgn after completing all sections) I cef~ttfy ~der miry of