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Home My WebLink AboutBUSINESS PLAN ,i, SITE/FACILITY .AGRAM FORM 5 NORTH SCALE: "~USI~ESS N'~M[: ' FLOOR: .OF j~ DATE:~,'~/~ FfCILITYtN~ME: UNIT ~: OF ~' (CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM r~ (Inspector's Comments): -OFFICIAL USE ONLY- - SA - SITE DIAGRAM (Requlr~ ;ems) 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys. 11. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Wire street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Drainage Canals, Ditches, d. Gates Creeks, 13~ Powerllnes §. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15, Storage Tanks: Identify the c. Metal construction capacity in gal. a. Above ground d. Access Door b. Underground 6. Utility Controls a. Oas 16. Diking or Berm b. Electricity I?. Evacuation Route c. Water 18. Evacuation Area: Identify the Fire Suppression Systems: location where a. Fire Hydrants employees will meet. b, Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fir& Pump 22. Type of Hazardous Material/Waste Stored 8. Fire Oepartment Access or Used (See Below) TYPB OF HAZARDOUS MATERIAL F = Flammable E - Explosive L - Liquid R * Radlological C - Corrosive 0 - Oxidizer G = Oas P = Poison M = Water Reactive T = Toxic S = Solid H = Cryogenic O = Waste B = Etiological Example: Flammable Liquid a FL - FACILITY DIAGRAM (Required items in addition to the abo~e) 1. Risers for Sprinklers 8. Fire Escapes Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest. 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets May 25, 1990 70: Nina Mayer, Accounts Receivable FROM: Ralph E. Huey, Hazardous Materials Coordinator SUBJECT: Mid Valley Pipe and Tank Nina, account # HM 477601 is no longer in business. This account has been turned over for collection to Bill Descary. I have an owners names of Alvin Petris~ 2501 University Ave., Bakersfield. There is probably nc point to send any further statements. Thanks April 4~~ 1990 TO: Bill Descary, City Treasurer FROM: Ralph E. Huey, Hazardous Materials Coordinator SUBJECT: Mid Valley Pipe and Tank Account # HM 477601 has a current charge of $100.00 with no previous balance. I can find no current phone listing or forwarding address for this company. I have an owners name of Alvin Petris~ 2501 University Ave, Bakersfield~ Ca. with a home phone of 872-1225. No one ever answers thst phone, but it has not been disconnected. Their plan has been on file since May 1B89 so they are responsible for this billing. Please collect. Thanks . BA 51:IELD C! FIRE DEPARTMENT : BAKERSFIELD, CA. 93301 (805) 326-3979 OFFICIAL USE ONLY ID# ' BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A t#&~ 3 ~I INSTRUCTIONS; ~? HAZ, MAI', 1. To avoid further action, return this ~rom within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the ques%ions below for the business as a whole. 4. Be as brief and concise as possible. ~CTION 1;. BUS[NESS IDeNTiFiCaTION DATA A. BUSZNESS NAHE: ~;~ V~l'l~u ~ ~4 ~a~l< I~.1~ ' B. LOCAT[ON/ ST-REST ADDRESS: ~. ,~'~ ,~. C[TY:.~~' Z[P: ~_~ BUS. PHONE: ~ ) S~GT~ON 2: ENERGENCY NOTZFZCATZONS Zn case of an emergency involving ~he re~ease or threatened release a hazardous material, cai] 911 and 1-800-852-7550 or 1-916-427-4341. This wi~] no~i¢y your ]oca] fire degar[men[ and the State O~f~ce of Emergency Services as required by law. ENPLOYEES TO NOTIFY IN CASE OF ENERGENCY: NAHE AND TZTLE DURZNG BUS. HRS. AFTER BUS. HRS. SECTZON 3: LOCATZON OF UTZLZTY SHUT-OFFS FOR BUSZNESS AS A WHOLE A. NATURAL ~AS/PROPANE: ~ ~+ ~G~ B. ELECTRZCAL: ~ ~[~ ~ C. WATER: ~,,~ ~4 Lnn~r ~r ~ D. SPECZAL: E. LOCK BOX: YES / ~ ZF YES, LOCATZON: ZF YES, DOES ZT CONTAZN SZTE PLANS? YES / NO NSDSS? 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 SECTION 6: EMPLOYEE TRAINING EHPLOYERS ARE REQUIRED TO HAVE A TRAININ~ PROGRAM WHICH PROVIOES EHPLOYEES WITH ~N~TIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS HATER~ALS. A. NUMBER OF EHPLOYEES AT THIS FACILITY B. DO YOU HAVE NSDS (HATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS HATERIAL YOU HANDLE ? ~.~ C. ~IVE A BRIEF SUMMARY OF YOU~ HAZARDOUS MATERIALS TRAININ~ PRO~RA~: SECTION 7; EXEMPTION ] CERTIFY UNDER PENALTY OF PERJURY THAT NY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 8.95 OF THE CALIFORNIA HEALTH AND. SAFETY CODE FOR THE FOLLOWZNG. REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TINE ~XC~ED T~ ~INI~U~ R~PORTIN~ eUANTITIES. OTHER (SPECZFY REASON) SECTZ~N eg CERTZF~CATZON I, ~lu$~ /~x , certify that ~he above information is accurate, I understand that this information will be used to fulfill my firm's obligations under the new California Health and Safe~y code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury, BA~RSFIELD CITY FIRE DEPARTMENT 2130 'G' STREET BAKERSFIELD. CA. 93301 (805) 326-3979 OFFICIAL USE ONLY ID# BUSINESS NAME HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 3^ ~NSTRUCT.~ONS 1. To avoid further action, this form musl; be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer 1;he quesl;ions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible FACILITY UNIT · ~-~ FACILITY UNIT NAME: S~CT[ON 1: N[T~GAT[ON, PREVENT~QN,.ASATEMENT PROCEDURES SECTION 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? ...... ~ NO If Yes, see @. 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-1) If YES, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (Yellow form ~4a-2) in addition to the non-trader secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE ~Y EMERGENCY R~$PONDERS (Fire Hydrant) SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT TH~S UNIT ONLY. A. NATURAL GAS/PROPANE: B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 3B- "~' CITY of BAKER SF1ELD "' }-::ii: '; ':': ":: :? .i .... . , - ' J Page Z._ of c ' -' BUSINESS NAME: , .t//.~ LI ,tJ'f t ~'m._:. OWNER NAME: ..... , ,,~,h., .,T~/q., .... NAME OF ~ACILITY: LOCATION:~..: '~--~'=~.. ..... , ' ..... ADDRESS~ ~[ ~tl~t~ ~,/~, -- STANDARD IND.~S~O~ ./~ PHONE ~: ~1-~ --' , - PHON~ ~:' ~--/~ ..... -- - - Code Code Aet Amt Est Units ~ Site [y~ Press I~p C~e Stored In Facility See Instructlms r-~ r r--~ ' ~t 12 N.N I C.A.S, Number / ': Health of Pre~,vrl. ' , HHlth ;/ ...... ' - ....... C~t I1 Na~ I C,A.S. Physical ~nd Health Hazard C,l,S, Numar '~.~ . ~mt II NIN I C,l.S, Numar (~heck all t~t apply) ....... iT-- - ' [~. r--~ ;. On.mt 12 Nan I C.J.S. Numar Health , of Prflsurl flNlth ~' ~ ~t I] Na~ & C.A.S. Nul~r (C~ck all ~t apply) , ; I Health of Pressure Health ~ ..... I- Health of Pressure Health Certitic~tion (Read and sign after co=pJetJ~R aJJ I certify under p~alty of law that [ have oersonally examined and al f8ltller vita t~ lnformetlm lu~ttt~ In tall I~ ell Itt~um~tl, and t~t based ~ ~ inquiry of t~se individuals respmsible for obtainino the infor~tt~ I believe, t~t t~ submitted lnformattm ti true occuratt, and c~plete. ' ~ / / BAKER~r~_LD CITY FIHIr., DIr. I..'AHIM~-Ni ': ¢" ~ ~ 2130 'G' STREET (805) 326-3979 omcw use o. LY ID# HAZARDOUS MATERIALS RECEIVED BUSINESS PLAN AS A WHOLE~¥18 1989 FORM 2A HAZ, MA~ 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 the business as a whole. 4. Be as brief and concise as possible' SECTION 1: BUSINESS IDENTIFICATION DATA B. LOCATION / STREET ADDRESS: ~-~LI SEQTION 2; EMER6ENOY NOTIFIOATION8 In c~se of an emergency involving ~he release or ~hre~tened release of a hazardous material, o~ll 911 and 1-800-852-7550 or 1-918-427-4341, This will notify your lo6al fire depar~men~ ~nd the 8~te Office of Emergency Services a8 required by law. EMPLOYEES TO NOT~FY ~N CASEOF EMERGENCY: NAHE AND TITLE DURING BUS. HRS. AFTER BUS. A. PH~ PH~ B. PH~ ,,.PH~ SECTION 3; ~OCAT[ON OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NATURAL GAS/PROPANE' B. ELECTRICAL' C. WATER' D. SPECIAL' E. LOCK BOX: YES / NO IF YES, LOCATION' IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / FLOOR PLANS? YES / NO KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOL~ SECTION...5: ,.LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM 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 (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~-~~~-~-~-~-~U-~ERiALS~- .................. ~_ __- WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 8: CE~TIFICATIQN I, C~~ ~ ,certify that the above information is accurate, I understand that 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 inaccurate information constitutes perjury, ~~ ~,~ ~¢ Contractors Uce~' · I ' X PIPE AND T~.~K VALLEY \ INSULATION' MECHANICAL INSULATION OILFIELD PIPE AND TANK WRAP METAL CLAD · HOT OR COLD APPLICATION DAVID WlLUAMSON 524 BU'FI'E STREET Reid Supervisor BAKERSFIELD, CA 93305 Estirr~tor 24 Hr. Phone [805) 871-6460