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Home My WebLink AboutBUSINESS PLAN 5/17/1989 BAKF::~I'-I-,-"LD OI1 Y !.--IHh__.. 2130 'G" STREET BAKERSFIELD, CA. 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NAME HAZARDOUS MATERIALS RECEIVED BUSINESS PLAN AS A WHOLE FORM 2A HA[, MAT, DiV. ];NSTRUCTIONS: 1. To avoid furt, her act, ion, ret, urn r~his from wil:,hin 30 days of receipl~. 2. TYPE/PRINT ANSWERS :IN ENGL]:SH. 3. Answer t, he quest, ions below for t~e business as a ~hole. 4. Be as brief and concise as possible. SECTION 1~;I BUSINESS IDENTIFICATION OATA A. BUSINESS NAHE: B. LOCATION / STREET ADDRESS' ,~ o~/~ ~',,¢~¢ ,..~ ~;- Bus. PHONE SECTION 2; EHERGENCY NOTIFICATIONS ]:n case ot= an emergency involving t, he re~ease or t, hreat, ened release o' a hazardous material, ca~ 911 and 1-800-852-7550 or 1-916-427-,'~341. This wi~ not, iCy your ~oca~ fire depart, ment- and t, he St, at, e Office of Emergency Services as required by ~aw. EHPLOYEES TO NOT[FY IN CASE OF EHERGENCY: NAHE AND TZTLE DUR:[NG BUS. HRS. AFTER BUS. HRS SI~¢T]:ON 3; I.,OCATION OF UTILITY SHUT-OFF~, FOR BUS'[NESS AG A WHOLE A NATURAL GAS/PROPANE: oo~zS',~¢ ~k~,/ · /V~- B. ELECTRICAL: IV-~n,+'l-¢.. ~--I ¢¢,~v-.--r--_~-r~y'c.,-¢,e E. LOCK BOX: ' YES /(~ ]:F YES, LOCATION' IF YES, DOES IT CONTA]:N SITE PLANS? YES / NO HSDSS? YES / NC, FLOOR PLANS? YES / NO KEYS? YES / NC' SteveMcEIvy / ," Director of Loss Preventio~r--~ Pacific Southwest Division 6655 Crescent Street Ventura, California 93003 Telephone: 805-658-8015 Fax #: 805-658-6176 SECTION 4~ pRiVATE RESPONSE TEAM FOR BUS,NESS AS A WHOLE SECTION 5: LOCAl, EHERGENCY M~DICA~ AS$~STAN¢~ FQR YOUR BU$~NESS AS A WHQL~ SECTION 6; EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES .EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF H~ZARDOUS MATERIALS. A. NUMBER OF EMPLOYEES AT THIS FACILITY ~', B. -'DO YOU HAVE MSDS (MATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS MATERIAL YOU HANDLE ? t/~_.% . ~./.,:~. ,F.~,~,.' ..... C. GIVE A BRIEF SUMMARY OF YOUR HAZARDOUS HATERIALS ~RAINING PROGRAM' S~el'), ~ ~o m,~:~ ,'-- ':" ,:'~ ~.'~ ~)'m ~ ~'T~ , ~i , / ~ro~, 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 I, ~,~-~,./¢~ /~t~,/ .... / , certify that the above information i accurate. I understand that this information wi]] 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 inaccurate information constitutes perjury. SIGNATURE ~-,--~.... . TITLE L~:4 ~¢.~.~=.:~,~. DATE ~,/~h ~ ~. BAKERSFIELD CITY FIRE DI MENT 2130 'G' STREET BAKERSFIELD, CA, 93301 (805) 326-3979 OFFICIAL USE ONLY ~ ID# II BUSINESS NAME HAZARDOUS MATERIALS RECEIVED BUSINESS PLAN AS A WHOLE '~AY19 1969 FORM 3A HA-./.-. ~.AT DiV. ];NSTRUCT~:ONS 1. To avoid furt~her acl;ion, ~,his form mus~, be ret, urned by: 2. TYPE/PR]:NT YOUR ANSWERS ]:N ENGL~:SH. 3. Answer t, he clues~,~ons below ~or THE FAC]:L]:TY UNIT L]:STED BELOW 4, Be as BRIEF and CONCISE as possible FACILITY UNIT # FACILITY UNIT NAME: SECT[ON 1: MITiGATiONs. PREVENT[ON, ABATEMENT PROCEDURES SECT[ON 2: NOTIFICATION 'AND EVACUATION PROCEDURES AT THE UNIT ONLY SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... Y~ NO If Yes, see 8. If NO, continue with SECTION 4 B. ~.Are ~ny 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-1) Zf YES, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (Yellow form ~4a-2) in addition to the non-trade- - -- - secret- ~orm.- --Li-st---onJ~y-.the-t. rade SECTION 4: PRIVATE F~RE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS (Fire Hydrant) SECTION 6: LOCATION OF UTILITY SHUT-OFF~ AT TH[~ UNIT ONLY. A, NATURAL GAS/PROPANE: 8. ELECTRICAL: C. WATER: IF YES, SITE PLANS? YES / NO MSDSs? YEs / NO FLOOR PLANS? YES / NO KEYS? ,YES / NO - 3B- Fare and lQriculture '~-~ Standard 9us,ness '~/' ~'"~'~Z J~ll~O~'~'~ ~,~l~e~"~ 1:~-11~'"r ~S I ~~~0'~~' NO N-- 'J'R AD E S E C R E T S BUSrNESS NAM~:~mo,aX OWNER NAMe: ~X~Z'*o,r= 2~C. NAME OF T~S FACILITY: LOCATION: ~/~ ~',~YC~ ~o~:~ ADDRESS: ~(~--~ ¢~r~<~.~ 3r. STANDARD IND. CLASS CODE ~// CITY. ZlP~,r$~2C~,J 9~O~ CITY, ZlP~ ~...~ ~.A ~OOJ DUN AND BRADSTREET NUMBER p.o~ ~: ~m-~/~ ~.oN~ ~: (~o~-¢ ~ ~-~o1~ - - ~ ~ Z~U~IO~ ~ ~OP~ COD~ , 2 ) 4 S i I I I II 11 1~ 1] C~e C~e ~t ~t Est ~its m Slte I~ ~ lm ~ .. St~ in F~ltt~ ~ ~ / C~k dll t~t C.l.S. ~ ~t II ~ i C.A.S. ~ '"'"m~ O' ~lth o~ P~e ~lth ~lth of P~ ~lth ...... i P~ical ~ ~lth ~Z4~ C l.S. ~ ....... ~ rite N~zlrd u_~ Reactivi{y ~--~ ~1~ L__~ ~d~ Rel~se u_J I~tlte Health of Pr~sure HHIth ..... - P~ic~l ~ XHIth ~zl~ C.A.S. ~ ............ ~t II h i C,l.5, ~ Flee Hazard ~--~ ~tivity ~ ~ ~le~ u ~ ~ddm Rel~se I~lete H~lth of Pr~sure '~ealth ...... - ...... [NfRGENCY CffirACTS II Ii~'~ ................................... Hili ....................... ]I-R~'P~ ....... l~ Tl~li' HIF-~I"-- .... 2e~tilicat~ {~ead and si~n affcr coepletin~ ail sections}' I certtlV ~der ~lty of 1~ t~t I ~ve ~rs~illy e~amin~ ~ am fNiliar ,tth t~ tnf~ti~ su~itt~ in this ~ ill ett~ ~tl. ~ t~t ~s~ ~. i~i~ of t~. t~tvi~l~ Io~ ob~aming't~ inf~ti~ I ~lieve t~t t~ ~u~itt~ info~ti~ is tr~, accurate. ~d c~plete. ~ ~) , ~,"-c~ ~-- L-or ~ "~'c~.,~.~. ~,~ ~? /'~, ~ .0~ o,,,~,.~ ~,m o, ~..~..,o. o} ~.7o~.[0., ..~u.,,~ ~....,~.~ ~ .................. ~ .............................. ~'--~'"' ~ ~[~-~,~ ........................... F'r'~~a'-A~ieultur' ~ Standard Bus,n,ss ~ ~Z~~O~ ~~ ,I'RADE PHONE ~: ~-- ~/ ~ PHON~ ~: ~0~ ~~[~1 _ _ - - ?~ans Ty~ ~x A~iqe ~} ~esu~ I ~ Cmt ~t ~t ~e L~ttm ~ ~ ~ ~ of RJxt~/~tl t~e C~e ~t ~t ~st ~its m Stta ly~ ~s Tm ~ St~ In F~iltty M ~ Inst~ti~ ~6}th of P~re ~lth ,(~i ,11 ~ apply) ' ' ' , ...... ,--~'~ r-- ~ r--~ r--~ -- ~lth of P~Iu~ ~lth * .......... P~icll ~ HNlth Hizard C.A.S. ~ ~t I1 ~k ell t~t L.l ...... t ............ LJ ........... r ........... i ~ .t ..... ~ .... ~_l .... m ..... ' .............. P~ic~l ~ H~lth ~t~rd C.A.S. ~ ~t I1 Nm ~C~k ~11 t~ a~ly) ..................... Health of Pr~Surl Health Certificati~ (Read and sJKn after compJetJnE all sections) ~ertJfv ~der ~ity of la~ t~t I ~ve ~rs~alty e~ae~n~ and le faeilJar ~ith t~ Jnfor~ti~ su~itt~ tn this ~ to~ obtaining :~ inf~t~. J ~lieve t~t :~ su~itt~ intor~ti~ ~s t~. accurate, ~d c~olete. /~ .; - ~. - ~ -* CITY of BAKERSFIELD FIRE DEPARTMENT ~ 2101 H STREET D. S. NEEDHAM ~ BAKERSRELD, 93301 FIRE CHIEF 326-3911 Dear Business Owner: Enclosed please find a copy of your response to the Hazardous Material Business Plan request. We have found it necessary to reject your plan for the following reason(s) as checked below. ~ Illegible Business Plan (please print or type information in English). Form 2A r---l Missing orr--] Incomplete Form 3A ~'/~issing or[---] Incomplete Form 4A ~--I Missing or~--] Incomplete Form 5A Site Diagram ~-I Missing or ~ Incomplete Facilities Diagram ~ Missing or~ Incomplete This is to be corrected and resubmitted within 30 days to: Bakersfield City Fire Department Hazardous Materials Division 2130 "G" Street Bakersfield, CA 93301 If additional copies of any forms are needed they can be picked up from the Hazardous Materials Division at 2130 "G" Street in person. Sincerely Yours, / Hazardous Materials Coordinator REH/eg