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HomeMy WebLinkAboutBUSINESS PLAN ~ H M~M P PLA~ MAP ~' sITE DIAGRAM C-~ FACILITY DIAGRAM I----i I' Business Name: Ch(]~ ~S"0~9~ ~U'~ ~(~ ' · -'"' FOr' Office Use Only First In Station: Area Map # 'of Inspection Station: ~ NORTH ~ .. GHON ~s $ON~ ~'~ Auto Repair AUTO REPAI~ Specializing in V-6 Rebuilt Engines. Brakes.Tune-Ups'Air Conclitioning Tire Service. Lube Job. Front Wheel Drive All Vehicles Domestic & tmDort 604 Butte St. 631-~460 Bakersfield Ca. CITY OF' BAKERSFIELD · P.O. BOX 2057 BAKERSFIELD, CALIFORNIA 9aaoa-2os7 ADDRESs CORRECTION REQUES1ED ~?' ..... ,~. x.~ · *~. DO NOT FORWARD ~ CA 93305 Bakersfield Fire Dept. Hazardous Materials Division I"IAR 9 1992 2130 "G" Street Bakersfield, CA. 93301 Ans'd ............ 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. BUSINESS NAME _ On ~O~ "~' ~oc~,,o,.. ~o~ ~,.,t/~ '~. SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR PHONE FD1 Bakersfield Fire Dept. azardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION' 3: TRAINING: NUMBER OF EMPLOYEES: 5 MATERIAL SAFETY DATA SHEETS ON FILE: ~j.~', I/~e_4 -~rOcrk ~r~o,f'~-% 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 & ~R 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 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..25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE 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: 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: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ~Dq~ SPECIAL:' ~',-~)© ~ ~ LOCK BOX: YES(~~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): ~ -!~?:~ "' 4, FD15<; I~Z~DOUS ~'E'ERI~LS TNV~NTORY ~ Fa~ and Agriculture ~ Standard Business < Page.__of ~ NON - ~E SEC~T LOCATION: ~O~ a~ ~D~SS: /O//~. F{o~ ~, ~.. ST~ IND. CLASS CODE: CITY, ZIP: ~ ~ ~' ~ ~33OD CITY, ZIP: ~e~,~/~ ~.~ g3:Yo_V DUN ~D B~ST~ET N~BER/FEDE~ ID ~ % - PHONE ~: 6~- ~O ' PHO~ .%: '3~-O~ -- -- - -- -- -- ~DES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Tr~. ~e ~ Average ~nual Measure , Days Con~ Cent Cent ~s~ _~oca~?n ~e~_. % by ~s of M~ture/Com~nen=s Cod~ C~e ~ ~t . ~ Units on Si~e ~ Press Te~ coae ~_ u=orea in ~'ac~uy ~ , /See Ins~ruc~ons~ Ph~ical and H~lth Hazard C.A.S. Nu~er Component J 1 N~ ~ C.A.S. N~ ~ (Check all that apply) Co~onent ~ 2 N~ & C.A.S. N~er ~ F,re Hazed ~ Sudden Release ~ ~ctiv*t~ ~ l~*ato ~ Dolay~ Of Pressure H~lth H~lth Co~onen~ ~ 3 N~ & C.A.S. N~er Physical and H~l=h Hazard C.A.S. N~er Component ~ I N~ & C.A.S. N~er (Check all ~ha~ apply) " Component ~ 2 Na~ & C.A.S. N~er '~ Fire Hazed ~ Sudden ~loase ~ R~ctivi~y ~ I~iate ~ Delay~ -- ~ of Pressure H~lth Health Component ~ 3 Na~ & C.A.S. N~er Physical and H~lth Hazard C.A.S. N~er Compon~t ~ i N~ & C.A.S. N~er (Check all t~t apply) Component ~ 2 Na~ & C.A.S. N~er ~ Fire Hazed ~ Sudden Release ~ R~ct*v*ty ~ I=~iat. ~ Delay~ of Pressure H~lth H~lt~ Co~onent ~ 3 N~ & C.A.S. Nu~er E~RGENCY CONTACTS %1 %2 Na~ Title 24 ~. Phone N~e Title 24 ~ Phone I certify ~der p~nlty of law t~t I ~ver ~rsonally ~in~ ~d ~ f~ili~ with the info,arieL su~itted in th~s ~d all attached d~ts ~d ~at ~sed on ~ in~ of those ~ndividuals res~nsible for obtaining the ~nfo~tion. I believe t~t the su~itted ~nfo~ation ~s t~e, acc~ate, and c~plete. AND O~FICIAL TITLE OF OWNER/OPERATOR OR OWNER/OPERATOR'S AUTHORIZED ~p~E.~'~%TIVE SIGNATURE DATE SIGNED