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Home My WebLink AboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE . This _~ermit is issued for the followinq; ~" [] Hazardous Materials Plan , [] Underground Storage of Hazardous Materials FI Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-001808 . .'.:;'~'.. ;' ,. - LA BARATA MEAT "'~":~"~'~ LOCATION 430 E 93307 TANK HAZARb0 0 i 5-000-001808-0001 PREMIU 10,000 · 0 ! 5-000-001808-0002 , .... 10,000 015-000-001808-0003 issued by: Bakersfield Fire Department :...'"'"' .. ~ _ ~/~.~.. . . c~ __ 1715 Chester Ave., 3rd Floor Approved by: (.~Ralp~Huey,~5 issue Date Bakersfield, CA 93301 Offic¢ofEviro~Services ~' Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: 'JM[le 30.. 2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This _m)rmit is issued for the followin_~: [] Hazardous Materials Plan [2] Underground Storage of Hazardous Materials I-I Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-001808 LA BARATA MEAT .~< , LOCATION 430 E 93307 TA~K HAZ^R~)OUS SUUSTAN ~t~XC~T 015-000-001808-0002 UNLEADED PL1JS GASOLINE, : ..... ' 10,000 ,, ~ON 015-000-001808-0003 REGULAR u~E~[D C~SOL-I~ 4. j~> OFFICE OF ENVIRONMENTAL SER VICES' aa 1715 Chester Ave., 3rd Floor Approved by: (....Ralpl/Hu~y,D~'-~! Issue Date Bakersfield,' CA 93301 Officeofevironm~Services ~ Voice (661) 326-3979 June 2OO3 FAX (661) 326-0576 Expiration Date: 7~U.. L~o CITY OF BAKERSFIELD OF ENVIRONMENTALq !CES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS 1N ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. .. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA. OWNER: '~.61 t~L MAILING ADDRESS: I EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE i. $ag^c :iNO~ p~r~r< (~,) g,s-go¢¢ (&&,) ~9-3ao~ SECTION il.~: DiSCOVErY AND NOTIF[CAT! A. LEAK DETECTION AND MONITORING PROCEDURES: EMPLOYEE AND AGENCY NOTIFICATIO~, C. ENVIRONMB~ RESPONSE ~.MANAGE~N~: . D. ~MERGFNC¥ M~DICAL SECTION II.2: RELEASE RESPONSE PLAN ~ A. HAZARD ASSESSMENT AND PREVENTION MEAS'~S: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDUR.E~" , UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) A. PRIVATE FIRE PROTECTION: (~) WATER AVAILABILITY (FIRE HYDRANT): 3 SECTION III: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS.,ON FILE: CERTIFICATION i, ,]<m~ ~'x~-f .C ~ OH c/ CERT~Y ~T ~ ~O~ ~O~T~ON IS ACC~TE. I ~ERST~ ~T ~S ~O~ON ~L BE USED TO F~FmL ~ F~'S OBLIGA~ONS ~ER ~E "C~O~ ~~ ~ S~E~ CODE" ON ~~OUS ~~S ~. 20 C~R 6.95 SEC. 25500 ET ~.) A~ ~T ~ACC~~ ~O~ON CONS~~S PE~Y. SIGNAT~ TITLE DATE IIAZ MAT MHOMh'T PLAN ,e INSTP. U¢ ( 4 ,, ,, orrll ENVIRONMENTAL SI ES ,ARrm rr 1715 Chester Ave., CA 93301 (661) 326-3979 Business Actw~ties I. FACILITY IDENTIFICATION II. ACTIVITIES DECLA~TION ............................... O;;S- ................................. : .................................... If Yes, Please Complete... ................................. .... ......... 1. H~ve on site ([or ~ny purpose) h~z~rdous m~le~ls ~I or ~ CONSOLIDATED COMPLIANC~ P~N ~ove ~ g~llons ~or liquids, ~00 pounds lot solids, or 200 ~ minimum requir~ pl~nnJnfl elements: cu a for compress~ g~ses (include liquids in ASts ~n~ : ~ ~mergency Response USts)? { · Maps 2. Have any amount of an explosive material (o~er than OYES~NO 5 ' · Training ammunition) on site? · Prevention · Ce~ifications ............................................................................. B. REGU~TED SUBSTANCES (RS) ~YES ~NO s ~ DES FORM 2731 (~i~ D~ti~ Have onsite RS at greater than the threshold planning ~ RISK MANAGEMENT P~N (~ su~ to USEPA) quantities establish~ by ~e California Accidental . ~ CONSOLIDATED COMPLIANCE P~N . Release Prevention program (CalARP)? ' · Incorporating CalARP Prog~m Elements C. UNDERGROUND STOOGE TANKS (USTs) ~&"~NO 7 ; ~ U&~-~['ITY"~-~ ............................ ~ Own or operate Underground Storage Tanks? ' ~ UST TANK FORM (~e ~ ~) Intend to upgrade exisang or instil new USTs? OYES ONO s ~ ~ UST FACILITY FORM ; ~ UST TANK FORM ~ ~ UST INSTAL~TION FORM (~e ~ ~) '~.-"'~NK~LOSURE / R~6~ ' OYES ~---~ ~ UST TANK FORM 1. Need to repo~ closing a UST ~at held hazardous materials or waste? 2. Need to repo~ the closure/removal of a tank that was ~YES ~NO ~o ~ TANK CLOSURE FORM classified as hazardous waste and clean~ onsite? "-~]'~0QE GROUND PETROLEUM STOOGE TANKS (ASTs) OYES ~--- ,, ~ C0~]D~C~-~PLIANCE P~N Own or operate ASTs above these ~resholds: any tank · Incorporating Federal Spill Preven~on capacity is greater ~an 660 gallons or ~e total ~paci~ Control and Countermeasure (SPCC) for the facili~ is greater ~an 1,320 gallons. Elements pumuant to 40 CFR Pa~ 112 ' '~-h~RO6US WASTE: ~ EPA ID nu~-~de on this page 1. Generate hazardous waste? OYES ONO ~z To obtain EPA ID~, please phone (916) 324-1781 2. Recycle more ~an 100 kg/mo of recyclable materials at OYES ~O ~3 ~ RECYCLING FORM the same Io~tion it was generated? 3. Recycle more than 100 kg/mo of recyclable materials at ~YES ~NO ~4 ~ RECYCLING FORM an o~site location different from the point o~ generation? 4. Treat Hazardous Waste on site? ~YES ~NO ~s ~ TP FACILITY FORM (DTSC Form 1772) I' ~ TP UNIT FORM (one per unit) to Financial Assurance requirements? OYES ~O ~ ~ CERTIFICATION OF FINANCIAL ASSU~NCE 5. Subject 6. Consolidate Hazardous Waste generated at a remote OYES ~NO ~ ~ REMOTE WASTE / CONSOLIDATION SITE si~e? -- NOTIFICATION FORM G. PERMIT CONSOLIDATION .......................................................... ZONE: ~r -~'Q~"~0 ..... ~'". ............................................................................... ~ CONSOLIDATED COMPLIANCE P~N Intend to consolidate other Cai/EPA agency permits? ~ · Incorporating all other environmental (If yes, please ~mplete Section III and attach) permit ~equirements pe~ 27 CCR 1~10 /ou checked YES to any part of Sections IIA-IIG above, the~ in addition to the [orms requested above, please Submit DES Form 2730. UPCF (7199) S:',CUPAFORMStACTIVlTY.wpd ~,Anrmwr O !r. OF ENVIRONMENTAL VICES ~ .... . 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ( FACILITY INFORMATIOt,, Business Aclivities Addendum Page of I. FACILITY IDENTIFICATION 'Fa'~l'~.i~' IO # (Fo~ 0ffi'~& use oo1~ '-~leas~;~'l~i';n.) ...................................................................... I' L~'~'/-6 ~ ................... ~ O8~vi~ac~u~ ~,~ME ............................................. *~ III. CONSOLIDATED PERMIT ACTIVITIES Is your Facility Compliance Plan subject to review by... i for satisfying the conditions of these permits? ' H. DEPARTMENT OF TOXIC SUBSTANCES CONTROL OYES ONO i ~ ...... '~-N~5~Si~i~b-~:'~k~lY ....... · All Modifications · OYES ONO v' Non-RCRA HAZARDOUS WASTE FACILITY OYES ONO , v' RCRA HAZARDOUS WASTE FACILITY ,. SAN JO^QU~N VALLEY UN,mD A,R POLLUT,ON OYES ONO ~ AUT,OR,T¥ TO CONSTRUCT CONTROL DISTRICT OYES C)NO V PERMIT TO OPERATE ~. STATE WATER RESOURCES CONTROL BOARD OYES ONO ¥' WASTE DISCHARGE REQUIREMENT {WDR) .:NTRAL VALLEY REGIONAL WATER QUALITY CONTROL OYES ONO ~/ GENERAL PERMITS ~'"'" dOARD OYES G)NO v' SPECIFIC PERMITS OYES ONO . v' NATIONAL POLLUTION DISCHARGE · ELIMINATION SYSTEM (NPDES) K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD OYES ONO , v' REGISTRATION PERMIT L. KERN COUNTY RESOURCE MANAGEMENT AGENCY ENVIRONMENTAL HEALTH SERVICES PERMITS OYES ONO v' Domestic Water Well Permit OYES ONO ~' Haz Mat Monitoring Well Permit OYES ONO v' Septic System Permit OYES ONO v' Public Swimming Pool Permit OYES ONO V' Food Facility Construction Permit OYES ONO ~/ Solid Waste Local Enforcement Agency (LEA) Related Permits : OYES ONO v' Medical Waste Related Permits PERMIT NOTE: v' If you checked YES to any part of Sections III-H to III-M above, then please address all applicable permit requirements in the Facility Compliance Plan. S,~CUPAFORM~v~I¥ a~e~m.~4xl 171.~ester Ave., CA 93301 (661) 3n2~-3979 BUSINESS OWNER / OPERATOR IDENTIFICATION FACILITY INFORMATION ............................... Page I. FACILITY IDENTIFICATION FACILITY ID # : ' I 1 ' Year Beginning ,00 Year Ending I BUSIN'ESS NAME (Same aa FACILITY NAME or DNA] [~Oin~j 8~sinesa As! ............. 3 ' BUSINESS PHONE - ~o~ SITE ADORESS ~o3 DUN & ~os SIC CODE ~o7 B~DSTREET (4 Digit ~) OPE~TOR NAME II. OWNER INFORMATION OWNER MAILING I III. ENVIRONMENTAL CONTACT ,Certification: Based on my inqui~ of ~ose individuals responsible for obtaining the information, I ce~i~ under penalty o~ law that I have personally examin~ ;and am Camiliar with the info~allon submitted in ~is invento~ and believe the information is true, accurate, and complete. ~AMES OF OWNERIOPE~TOR (print) ~3e T TLE OF OWNE~OPE~TOR PCF (7/g9) S:~CUPAFORMS\OES2730.T'./4.wpa siness Owner/Operator Identification ' ' Please sut)m,t Ir~e :3us~ness Actr,,,aes page, tlq~s~ness Owner/C~era~or Idenl~flcatlon page and Hazardous ~lerials. Chemi~l O~cnpaon pages (DES Fo~ 2731 ) for 311 ~azardous ma~enals inven~o~ submi~ions. For ~e inven~ow to be ~nsider~ ~mplele ~s ~age must be s~gn~ Oy ~e appropriate ~ote: ~e num0enng o~ ~e ,ns~cuons follows ~e da~ element num0e~ ~at are on ~e UPCF page. ~e da~ ~ement num~ are ~ jr ~ectron~c submission and are the ~me as ~e numbenng us~ ~n 27 CCR. Ap0endix C. ~e Business S~tion of ~e Un~fi~ Pr~m Oa~ OicUona Ptease number all oages of '/our suOm~al. Th~s halos your CUPA or ~ iden~ w~e~ ~e submi~l is ~mplete and if any oages are separate. 1. FACILITY ~ ~UMBER. Th~s number ~s ass~gn~ Oy the CUPA or ~. This Js ~e un~que number whi~ identifies your faczli~. 3. ~US~NESS NAME - Enter ~e ~11 f~al name of the Ousine~. 100. BEGINNING OATE. Enter the ~inning year and date of the reoo~. (~MMDO) 101. ENOING DATE. Enter the ending y~r and aate of ~e r~. (Y~MMOO) 102. BUSINESS PHONE - Ent~ ~e p~ne number, area ~e flint, and any ~ten~on. 103. BUSINESS SITE ADORESS- Enter the sffeet addre~ ~ere ~e ~cili~ is Io~t~. No post office box numbem are allowS. ~is in~a~on must provide a means to g~m~hi~lly lo~te ~e ~cili~. 104. CI~ - Enter ~e ~ or unin~at~ area ~n ~i~ busin~ site is 105. ZIP CODE - Ent~ ~e ~p c~e of busine~ site. ~e ex~ 4 digit zi~ may al~ be add~. 106. DUN & B~DSTREET - Enter ~e Dun & 8rads~t number ~r ~e ~li~. ~e Dun & Bmdsffeet number may be obtain~ by ~lling (610) 882-7748 or by Intemet. 107. SIC CODE - Enter ~e pdma~ Standard Indus~al Cla~ifi~on ~e number for pdma~ busine~ acfi~. NOTE: If ~e is more ~an 4 digit, re~ only ~e flint four. 108. COUN~ - Enter ~e ~un~ in ~i~ ~e busin~ site is Io~t~. 109. BUSINESS OPE~TOR ~ME - Enter ~e ~me of ~e busin~ operator. 110. BUSINESS OPE~TOR PHONE - Ent~ ~n~ op~tor p~ne num~, ~ diff~t ~m b~in~ p~e, ar~ ~e flint, a~ any ~n. 111. O~ER ~ME - Enter ~me of busin~ ~, E diff~ent ~m bu~n~ o~. 112. O~ER PHONE - Ent~ ~e bu~ne~ ~s p~ne num~ if different ~m b~in~ p~ne, ar~ ~e flint, a~ any ~e~n. 113. O~ER ~ILING ADDRESS - Enter ~e ~s maili~ addr~s if diff~ent ~m ~n~s site addr~. 114. O~ER CI~ - Enter ~e name of ~e d~ ~r ~e ~s maili~ addr~. 115. O~ER STATE - Ent~ ~e 2 ~amct~ s~te abbre~a~on for ~e ~s maili~ addr~. 116. O~ER ZIP CODE - Enter ~e zip ~de for ~e o~er~ addr~. ~e ~ 4 d~it ~p may al~ be add~. 117. ENVIRONMENTAL CONTACT ~E - Enter ~e ~me of ~e ~r~n, if different ~om ~e Bu~n~ ~er or Operator, ~o r~iv~ all en~mnm~l ~ff~~ a~ ~11 re~ ~ ~m~t ac~. 118. CONTACT PHONE - Enter ~e p~ne numbs, if d~erent ~m ~er or Opem~r, at ~i~ ~e ~mnm~l ~n~ ~n be ~n~. ar~ ~e tirol and any ~t~sion. 119. CO~ACT ~ILING ADDRESS - Enter ~e maili~ addr~ ~ere all en~mnm~l ~ ~~en~ should be senL ff diff~t ~m ~e ~te addr~. ~2~. Sr~T[ - Enter ~o 2 ~amcter smto a~ro~a~n ~ ~o on~men~l ~n~et~ mai~ addr~. 123. PRIORY EMERGENCY CO~ACT ~ME - Enter ~e ~me of a repressive ~t ~n be ~n~ in ~se of an eme~e~ in~M~ ~rdous materials at ~e b~in~ site. ~e ~n~ct shall have FULL ~dli~ a~, site ~miliad~, and au~d~ to ~ke d~io~ for ~e busin~ r~ardi~ inddent mi~on. 124. TITLE - Ent~ ~e flue of ~e pdma~ emergen~ ~n~ 125. BUSINESS PHONE - Enter ~e business numb~ ~ ~e pdma~ emergen~ ~n~ct, ar~ ~e flint, a~ any exte~ions. 126. 24-HOUR PHONE - Enter a 2~our p~ne numb~ for ~ pd~ eme~en~ ~n~ ~e 2~ur p~ numar must be o~ ~i~ Is a~ 24 houm a day. If it is ~t ~e ~n~s ~me p~ne num~, ~ ~e ~ a~d~ ~e p~ne m~t ~ able imm~t~y ~n~ ~e i~d~l s~t~ a~. 127. PAGER NUMBER - Enter ~ pager num~ ~ ~e ~ma~ emergen~ ~n~ If a~ble. 128. SECONDARY EMERGENCY CO~ACT ~E - Enter ~e ~me ora s~a~ r~r~ve ~t ~n ~ ~n~ in ~e ~ent ~t ~e emergen~ ~nB~ Js not a~ilable. ~e ~ s~ll ~ve FULL ~dli~ a~, ~te ~millad~, a~ a~d~ to m~ke d~ns ~ ~e b~in~ r~arding inddent miUga~on. 129. TITLE - Enter ~e flue of ~e s~nda~ eme~ ~n~. 130. BUSINESS PHONE - Enter ~e busine~ t~ep~ne numar for ~e s~a~ eme~e~ ~n~ area ~e flint, a~ any exte~io~ 131. 24-HOUR PHONE - Enter a 2~hour p~ne numb~ for ~e ~nda~ ~ergenw ~n~ct. ~e 24 ~ur ~one number must ~ one ~i~ is an~er~ 24 houm a day. If it is not ~e ~n~s home phone numbs, ~ ~e se~i~' a~ed~ ~e phone must be able to imm~iat~y ~n~ ~e i~ividual s~t~ a~ve. 132. PAGER NUMBER - Enter ~e pager number ~r ~e se~nda~ ~e~enw ~n~ct, if a~ilable. 133. ADOITIONAL LOCALLY COLLECTED INFOR~TION - ~is space may be us~ for CUPAs or ~ to ~llect any additional informaUon n~ to meet ~e r~uirements of ~r i~d~l prog~ms. ~n~ ~r I~1 agen~ for guidan~. 1~. DATE - Enter ~e date ~at ~e d~um~t ~s sign~. (~MMDD) 135. ~ME OF DOCUME~ PREPARER - Enter ~e ~11 name of ~e per~n ~o prepar~ ~e invento~ submi~l info.aEon. 136. ~ME OF SIGNER. En~r ~e ~11 pdnt~ name of · per~n signing ~e page. ~e s~ner ce~fl~ ~ a famillari~ ~ ~c in~aUon submitt~ and ~at bas~ on the signer~ inqui~ of ~se i~i~duals res~nsible for ob~ini~ ~e info~ation, all ~e info~a~n submi~ is tree, a~umte and ~mplete. SIGNATURE OF OWNE~ OPE~TOR OR DESIGNATED REPRESENTATIVE - The Business ~neffOperator, or officially deslgnat~ represen~ttve of the ~er/Op~tor. s~li ~gn in ~e space pro~d~. ~is sig~ture ~fl~ ~at ~e signer is ~millar ~ ~e info~ation submi~ and ~at bas~ on the signer~ inqul~ of ~ose i~lvfduals res~nNble for ob~ining ~e info~aflon it is ~e signe~s belief ~at ~e submitt~ in~a~on is ~e, a~mte and ~mpleto. 137. TITLE OF SIGNER - Enter ~e UUe of the pe~n signing ~e page. ..._. 171 hester Ave., CA 93301 (661) -3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one :Orm Der material Der ~ud~lng Or 3~d) NEW ~ ADO ~ OELETE ~ REVISE 200 I. FAClLI~ INFORMATION CHEMI~L LO~TION 201, CHEMI~L LO~TION ~ Y~ ~ No ~2 ' CONFIDENTIAL (EPC~) II. CHEMICAL INFORMATION CO~N ~E :EHS* 210 p PURE ~m MITRE ~ w WASTE 211 . ~DIOACTNE ~ Y~ ~ No 212 CURIES 213 PHYSI~L STATE ~ s ~LID ~1 LIQUID ~ g ~S 214 ~RGESTCO~AINER 215 ~c~ ~ ~at apply) U.ffS' ~ ~ D ~ m~ D m C~ ~ ~ TONS STOOGE CO~AINER 0 a ~GROUND T~K D · ~STI~ON~LIC DRUM ~ i FIBER DRUM (Check all ~at app~) ~b UNOER~OUNO T~K ~f ~ ~i ~G ~n P~STIC BO~LE ~r OTH~ ~ c T~K INSIDE BUI~ING ~ g ~BOY ~ k ~X ~ o TOTE BIN ~ d S~EL O~M ~ h SILO ~ t CYLI~ER ~ p TANK WA~N STOOGE PRESSURE ~ a ~BIE~ D ~ ~BIE~ ~ ba BELOW~BIE~ ~4 ~ STOOGE TE~TURE ~a ~IE~ ~ ~ ~ ~1~ Dba BELOW~IE~ %~ ~RDOUS COMPONE~ EHS CAS 23a 239 241 242 243 ~Y~ ~No 2~ } 245 III. SIGNATURE JPCF (7~99) S:\CUPAFORMS\OES2731 .'rV4.wpd Haz Materials Inventory - Chemical ption ,. I. FA~ILI TY ~O NUMBER · rh~s number ~S ~ss~gn~ 3y ~e CUPA or ~. Th~s ~s the un~ue numar w~c~ ,denli~es your fac=IiW, 3. BUSINESS NAME - Emer c~e ~ull I~al name oJ ~e =us~ness, ~. AOOIOELETE/REVISE - Ind~te ~ the malarial ~s ~ng add~ to the ~nvenlow, dele~ ~rom t~e ,nvenlo~. or if the info.etlon previousN suOm~Eed ~s ~ng revi~d. NOTE; You may c~se ~o reave ~bis 01an~ ~ you resubm~l ~ur entire invenlow annualS, 2~ CHEM~CAL L~CA T~N - En~e~ (he ~u~ding ~r ~uts~de~ a~jacent ~rea w~em ~he ~azar~us ma~eria~ is ~and~. A chem~l ~at is slor~ at ~he same pressure and temoerature, ~n multiple ~l~ns w~thm a building. ~n De reported on a sidle page. NOTE: Th~s in~o~alion is not subject [O public disclosure ~muant to HSC {25506. 202, CHEMICAL LOCATION CONFIDENTIAL - EPC~ - All ~usmesses which are subject (o ~he Emergency P~anning and Communi~ Right ~o Know Act (EPC~) must check 'Yes' to keeo cnem~l i~a~ion ~nfo~a~n ~n~den~ial. I~ t~e business d~s not wish (o keeo cnemi~l I~n [n~ormalion ~n~dential c~eck 'No'. 203. MAP NUMBER. I~ a map ,s included, artier ~he num~ o~ Ihe map on wb~h the J~t~n bt the h~ardous material is 2~. GRID NUMBER. If gnu c~rdinates are used, ente~ ~he 3r~d c~dinales bt the map ~hat corres~nd to t~e ~alion o~ Ihe hazardous material. If appli~ble, multiple coo~dinales can ~e 205. CHEMICAL NAME - Enter the ~roper chemical name as~a{~ ~th the Chemi~l Abstract Se~e (CAS) number o~ the haza~ous malenal. This s~ou~ be Iniemai~nal Union of Pure and Appli~ Chem~st~ (IUPAC) ~me ~ound on the Malarial Safe~ Data Sheet (MSDS). NOTE; If the ~emi~l is a mixture, ~m~lete ~is ~eld; ~p~le the 'COMMON ~ME' fle~ inst~d. 2~. T~DE SECRET - Check ~es' E [~e in~o~mal~ in ~ ~ ts ~ar~ a trade se~et, ~ 'No' E it ~ n~ S~[e ~uiremen~ If yes, a~ b~iness is nol sub~ to ~C~ di~ure of ~e ~s~t~ ~e s~et infomart ~ ~und by HSC ~2551 I. F~e~l ~equkemenl: I~ ~s, and busings is ~ub~ ~ ~C~. d~sum of ~e d~t~ T~ ~et inf~a~ ~ ~und by 40 CFR and I~ ~si~ · must submit a 'Su~n~n to A~mpany C~i~ of T~e ~ f~ (40 CFR 3~.27) ~ USEP~ 207. COMMON N~E - Enter ~e ~m~ name or ~de name o~ ~e h~a~us matadal ~ m~um ~i~ a ha~ous mate~l. 208. EHS · Ch~ ~' if the h~rd~s matedal is an ~e~N H~a Subs~e (EHS), as ~fin~ ~ 40 CFR, Pa~ 3~, ~k ~ If the male~l is a m~um ~nmining an EHS, leave th~ sect~n blank a~ ~mplete the s~n on ~r~us ~m~nls be~w. 209. CAS 8 - Enler the Chem~al ~stm~ Semi~ (CAS) numar f~ ~e h~ar~us ~ta~. F~ m~tures, enter ~e CAS numar of the m~ure if it has b~n a~ a numar d~tin~ from i~ ~m~nen~. I~ the mixture has ~ ~S numar, leave ~is ~lumn b~nk and rep~ the ~S num~m of the ind~ual h~a~s ~m~nenm in the appropriate s~t~n bel~. 21~. F~RE C~E H~RD C~SSES - Fire c~e H~ard C~es de~ t~ ~mt res~nders the ~ and ~eve~ ~f h~ard~us materia~s whi~ a busine~ ha~es~ Th~ info.arran s~ll onN ~ p~ovided if the I~1 ~te c~ie[ deems it ~a~ a~ requests the CUPA ~ ~ to ~ll~t it. A list o~ the hazard classes and i~ns on h~ to dateline whi~ ~ass a material falls u~er are incl~ in ~e ap~ndi~s of ~te ~ o~ the Unifo~ Fire ~e. If a material has appli~ble hazard class, i~lude all. ~n~ CUPA ~ ~ f~ guiana. 211.' H~DOUS MATERI~ ~PE - Ch~ the ~e ~x ~at ~st dead.s ~e ~e of ~ar~ mateHak ~re, m~um or ~ste. If ~sta male~al, ~k on~ If mix. re or waste, compile h~ardous ~en~ sec~n. 213. CURIES - If ~e h~ardous marshal is r~e, ~ thb ~ to re~ ~e a~ in ~des. Y~ may ~ up to nine d~ ~ a floa~g d~imal ~int 214. PHYSI~L STATE. C~ ~ ~e ~x ~at ~t d~s ~ state h ~ ~ h~s mate~l is h~dl~: ~IM, I~u~ ~ gas. 215. ~GEST CONTAINER - Ent~ ~ to~l ~p~i~ of t~ ~st ~ntai~r in wh~ ~e mate~l ~ ~. 216. FEDE~L H~D CATEGORIES - Check all ~t~ ~at d~ ~e phial a~ h~l~ ~s a~t~ ~ ~e ~za~s mater~l. Fire: F~mmab~ ~u~s and ~l~s. ~mbustible L~u~s, ~mph~, Oxid~ers Acme HeaEh (Immediate): H~h~ To~, Toffic, I~n~, ~m~em, ~, Reactive: Unstable React~e, O~an~ Perox~es. Walet R~. ~d~e o~r hazar~ ~ls ~ an ~ve~ effe~ ~lh s~ {erin e~ure Pressure Release: Exp~s~es, ~mptessed Gases, B~sting Agents Chronic Health (Delayed): Ca~n~ens, o~er ~ar~ c~mi~ ~ an adveme eff~l ~th ~ te~ ex.sure 217. AVENGE DAILY AMOUNT - Ca.late ~e average da~ly a~unt of ~e h~ar~us ~edal or m~ture ~n~ining a h~ar~us marshal, in ~ buildi~ ~ ad~nU ~e area. Ceruleans s~ll be based on ~e p~us years invento~ of ~te~l re~ ~ ~ page. To~l all daily amoun~ and dN~e by ~ numar of da~ the ~mi~l will ~ on site. If this is a mate~l ~at ~s no{ pr~s~ been present at ~s I~, the amount shall ~ ~he average ~i~ a~unt proj~t to be on hand dud~ the ~urse of ~e year. Thb am~nt sh~ ~ ~sistant ~ ~e unia m~fled in ~x 221 a~ s~uM not ex~ ~at o~ m~imum dai~ am~nt. 218. M~IMUM DAILY ~OU~ - Enter ~e maximum a~nt o~ e~h h~ar~us marshal ~ mi~e ~ a ~zardous mattel, whi~ ~ ~nd~ in a b~Mi~ adjacenV~e area at any one time over ~e ~ume of the year, ~is am~n~ must ~n~in at a m~um ~st ye~s ~ven~ of ~e male~l page. with ~ refle~ of ~dit~. delea~s, ~ mv~s pm~ed f~ ~e cuffent year. ~b ~nt sh~M ~ ~tenl w~ ~e un~ m~ in ~ ~1. 219. ~NUAL WASTE ~OUNT - If the ~s mate~l ~ i~ento~ is a ~ste, ~e an es~ma~e ~ ~e annual a~t handle. 220. STATE WASTE COOE - I~ [he hazardous matedal is a ~sta, enter ~e appr~ta California 3~it haza~us waste ~e as list~ ~ ~e ~ of ~e UNfo~ H~a~s Waste Man,est. 221. UNITS - Ch~k the unit of measure thai is most ap~te for t~ ~teHal ~i~ repo~ on t~ page: gal~ns, pounds, ~b~ feet or tons. NOTE: If Ihe ~ta~l b a ~edera~ defined Extremely Hazardous Substance (EHS), all amounts mus~ ~ re~ in ~unds. If male~al is a m~ure ~ntainJng an EHS. the material is sto~ed in (gallons. ~unds, cubic f~L ~ tons). 222, DAYS ON SITE - List [he total number of days during the ~ar ~at the malarial is on sits. 223. STO~GE CONTAINER - Ch~k all ~xes ~hat des~ ~he type of storage ~ntaine~s in which the hazardous material is sio~ed. NOTE: If appropriate, ~u may ch~se mo~e ~han one. 224, STO~GE PRESSURE - Check the one box that besl des~bes the pressure at which the hazardous material is s{ored. 225. STO~GE TEMPE~TURE. Check ~e one box thai ~st de~fi~s the temperature at which ~he haza~ous material is s~red. 226. H~RDOUS COMPONENTS I-5 (% BY WEIGHT) - Enter ~he ~r~ntage ~ight of ~e h~ardous ~mponen~ in a mix,ute. If a range of percentages ~ availab~, ~e~ ~he h~hest percentage in that range. (Re~ ~ ~m~nen{s 2 through 5 in 230, 2~, 2~, a~ 242.) 227. H~RDOUS COMPONENTS I-5 NAME - When ~epo~i~ a hazardous material ~al is a mixture, Iisi up to five chemical ~mes of hazardous c~ponents in mixlure by pedant weighl (re,er to MSDS o~, in Ihe ~se of trade secret, re~e~ to manufacturer). NI haza~ous c~nents in the mixlute presen{ al greater ~an I%by~h[ifnon<arcin~enic,~ 0,1% by ~igh[ if carcin~enic, should ~ re~. If more than ~ve h~af~us ~mpo~en~ a~e ptesenl a~ve ~ese pnrcenlages. ~u may attach an additional sheet o~ pa~f to capture the requir~ info~at~n. ~en tepo~ing waste mixtures, mineral and chemi~l ~m~si~n should ~e lisled. (Re~d ~o~ comp~enls 2 t~ough 5 in 231,235, 239, and 243,) 228. H~RDOUS COMPONENTS I-5 EHS - Check 'Yes' i~ the ~mponent o~ the mixlure is cons~et~ an Extremely Hazar~us Substance as defined in 40 CFR, Pa~ 355, or 'No' i~i~ {s not. (Repo~ ~or com~nents 2 thresh 5 in 232. 236, 240. and 244.) 229. H~RDOUS COMPONENTS 1-5 CAS * L[sl ~ho Chemical Abs~ra~ SemPe (CAS) numbers as relaled 1o Ihe hazardous ~m~nenls in the mixture. (Repeat for 2-5.) 246. LOCALLY COLLECTED INFORMATION - This space may be used by Ihe CUPA or ~ [o collect 3ny addilional info,marion necessa~ to meal [he tequiremenls of · indiwdual pr~rams. Contac~ Ihe CUPA bt ~ ~or guidan~. UPCF (I/99) .- 7 OES Fo~ 27~1 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVE., BAKERSFIELD, CA (661) 326-3979 SITE AND FACILITY DIAGRAM INSTRUCTIONS FOR HAZARDOUS MATERIALS MANAGEMENT PLANS These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit a site diagram. If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing and additional detail map, facility diagram, for each of these areas. Include instructions that show the route to your business if it is in a remote location. All diagrams must be on 8 ¼ x 11 paper and drawn using a straight edge tool. SITE DIAGRAM 'INSTRUCTIONS The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually within 300 feet. If you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include all of the following information: 1. Check the box on the top let~ comer of the form provided that indicated "Site Diagram". 2.. Print the name of your business, as shown in your HMMP, on the top of the diagram. 3. Label the location of the hazardous materials and identify them by name and type of hazard (ie. Flammable liquid, corrosive solid). 4. Label the location of utility shutoff points for gas, electric and water services. 5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. (The diagram form provided includes a north arrow). 8. All labeling a,~r~entification on the dia/o'am must be ble and easily understandable at the scale submitted. Diagrams must be sufficiently legible to produce a legible copy. Try to avoid the use of abbreviations or symbols. If you must use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follow these instructions. FACILITY DIAGRAM INSTRUCTIONS Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. 1. Check the box in the upper fight hand comer of the form provided that indicated "Facility Diagram". 2. Print the name of your business as shown on your HMMP.' Print the name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled #1 of 4. 4. Follow instructions (3 -8)* for site diagrams regarding the specific details to be included oneach facility diagram. UNDERGROUND STORAGE TANK FACILITIES PLEASE NOTE: * If you operate an Underground Storage Tank CIJST) facility, the facility diagram shah also specify the location(s) of the UST continuous leak monitoring system and/or the location(s) where the UST monitoring wffi be performed. 2 COtMblON STANDA.RD INDUSTRIAL CLASSIFICA~CODES r 01 l l Wheat production 0724 Cotton ginning 5821 Eating places ( 0 t 15 Corn production 0541 Grocery. store 58 l 3 Drinking places (Alcohol service) 0131 Cotton production 1541 Dry cleaners 5983 Fuel oil dealers 0139 Field crops, except cash 291 l Oil refineries grains 5984 LPG dealers 3441 Welding/fabrication- 0161 Vegetables & melons 7342 Pest control structural 0172 Grapes 7532 Auto top, body, 3443 Welding/fabrication - upholstery repair 0173 Tree nuts boiler Auto paint shops 0174 Citrus fruits 3569 Machine shop 7533 Auto exhaust repair 0175 Deciduous tree fi'uits 4222 Cold Storage 7536 Auto glass replacement 0179 Other tree fruits & nuts 4925 Compressed gas supplier 7537 Auto transmission 0192 General farms, primarily 5093 Automobile salvage repair crop .~ 5169 Chemical supply 7538 General auto repair " 0241 Dairy farms 5511 Motor vehicle dealers 7542 Car washes 0252 Chicken eggs (new & used) 8071 Chemical laboratory 0253 Turkey eggs 5521 Motor vehicle (used only) 285'I Paint manufacture 5531 Auto & home supply stores 0291 General farm, primarily livestock & animal 5541 Gasoline service stations specialties 2 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS FACILITY INFORMATION INSTRUCTIONS BUSINESS OWNER / OPERATOR FORM I. FACILITY IDENTIFICATION: Enter the reporting period (year beginning and ending) for the facility information. Enter the business name and site address and phone number of your business. Do not use P.O. box numbers. Enter the Dun & Bradstreet or federal tax identification number for your business. Enter the Standard Industrial Classification (SIC) number for your business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on the back of this page. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Development Department, or by calling our office at (661) 326-3979. Enter the name and phone number of the person responsible for operating the business. II. OWNER INFORMATION: List the legal business owner or corporation name and provide the headquarter address or residential address if owned by an individual and phone number. III. ENVIRONMENTAL CONTACT: Identify the person who is primarily responsible for environmental compliance at the business. This person may be either the business owner, one of the emergency contacts, an environmental manager, or consultant. IV. EMERGENCY CONTACTS: List the name, title, and phone numbers of two people at the business who can respond if the Bakersfield Fire Department requires additional information or other assistance. These contact persons must have keys or access to all areas of the facility, be available for emergency call-outs, and have decision-making authority to call on other resources (such as hazardous waste clean-up companies) as necessary. V. CERTIFICATION: The business owner or operator must sign, date, and also identify the document preparer. ITE DIAGRAM [__,] FACILITY DIAGRAM [ Business Name: ~ Business Address: L~O ~' ~t:: Ot~,r~)~ ~ ~V6, (20pd,~C::l~ ~ ~33o~ ~F CiTY OF B AKERSFIELD~ FICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661)326-3979 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 as brief and concise as possible. .. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the fi.ont of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: OWNER: I EMERGENCY NOTIFICATION CONTACT/ TITLE BUS. PHONE 24 HR. PHONE H RDOUS MATE~ALS MANAG ENT PLAN SECTION II, 1' DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. ENVIRONMENTAL RESPONSE MANAOEMENT: D. EMERGENCY MEDICAL PLAN: 2 HAZ~DOUS fi,lATER/ALS MANAGEMOT PLAN SECT[ON [[.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION~MEASUR. ES: . B. KELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: ~~ S~-OFFS ~OCATION OF 8~-OFFS AT YO~ FAC~ NATURAL GAS/PROI~ANE: WATER:' Oa,{ q,/a~k'L( SPECL a,: LOCK BOX: ~S~ · ~S, LOCA~ON: pR~ATE F~ PROTECTION~ATER AVAIL~ILIT~ A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILIT~ ( 3 H~ARDOUS MATERIALS MANAG~ENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: ,. 4 OFFICE OF ENVIRONMENTAL SERV'[CES 1715 Chester ,Ave., Bakersneld, CA (661) 326-3979 HAZARDOUS MATERIALS FACILITY INFORMATION INSTRUCTIONS BUSINESS OWNER / OPERATOR FORM I. FACILITY IDENTIFICATION: Enter the reporting period (year beginning and ending) for the facility information. Enter the business name and site address and phone number of your business. Do not use P.O. box numbers. Enter the Dun & Bradstreet or federal tax identification number for your business. Enter the Standard Industrial Classification (SIC) number for your business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on the back of this page. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Development Department, or by calling our office at (661) 326-3979. Enter the name and phone number of the person responsible for operating the business. II. OWNER INFORMATION: List the legal business owner or corporation name and provide the headquarter address or residential address if owned by an individual and phone number. III. ENVIRONMENTAL CONTACT: Identify the person who is primarily responsible for environmental compliance at the business. This person may be either the business owner, one of the emergency contacts, an environmental manager, or consultant. IV. EMERGENCY CONTACTS: List the name, title, and phone numbers of two people at the business who can respond if the Bakersfield Fire Department requires additional information or other assistance. These contact persons must have keys or access to all areas of the facility, be available for emergency call-outs, and have decision-making authority to call on other resources (such as hazardous waste clean-up companies) as necessary. V. CERTIFICATION: The bUsiness owner or operator must sign, date, and also identify the document preparer. COMMON ST.4.~DARD INDUSTRIAL CLASSIFIC~m-rlON {SIC) CODES 0 l t t Wheat production 0724 Cotton ginning 5821 Eating places 0115 Corn production 054 l Grocery. store 5813 Drinking places (Alcohol service) 013 l Cotton production 154l Dry cleaners 5983 Fuel oil dealers 0139 Field crops, except cash 2911 Oil refineries grains 5984 LPG dealers 3441 Welding/fabrication- 0161 Vegetables & melons 7342 Pest control structural 0172 Grapes 7532 Auto top, body, 3443 Welding/fabrication - upholstery repair 0173 Tree nuts boiler Auto paint shops 0174 Citrus fruits 3569 Machine shop 7533 Auto exhaust repair 0175 Deciduous tree fi'uits 4222 Cold Storage 7536 Auto glass replacement 0179 Other tree fruits & nuts 4925 Compressed gas supplier 7537 Auto transmission 0192 General farms, primarily 5093 Automobile salvage repair 5169 Chemical supply 7538 General auto repair 0241 Dairy farms 5511 Motor vehicle dealers 7542 Car washes 0252 Chicken eggs (new & used) 8071 Chemical laboratory 0253 Turkey eggs 5521 Motor vehicle (used only) 285t Paint manufacture 5531 Auto & home supply stores 0291 General farm, primarily livestock & animal 5541 Gasoline service stations specialties 2 * S'I'A I'E W..\S'FE CODE 220 II,' the hazardous material is a waste, enter the appropriate Calitbmia 3-digit hazardous waste code :ks listed on the back of' the Unil,orm Hazardous Waste Manifest. A list ol,'common State Waste Codes are included on page 4 o1" these instructions. UNITS 22 I Check the unit of measure that is most appropriate for the material being reported on this page: gallons. pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units that the material is stored in (gallons, pounds, cubic feet, or tons). DAYS ON SITE '-..~.. 222 List the total number of days during the year that the material is on site. STORAGE CONTAINER 223 Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. STORAGE PRESSURE 224 Check the one box that best describes the pressure at which the hazardous material is stored. STORAGE TEMPERATURE 225 Check the one box that best describes the temperature at which the hazardous material is stored. HAZARDOUS COMPONENT I - 5 (% by weight) 226, 230, 234, 238,242 If a range of percentages is available, report the highest percentage in that range. HAZARDOUS COMPONENT 1 - 5 Name 227, 231,235, 239, 243 When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non- carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. HAZARDOUS COMPONENT I - 5 EHS 228,232, 236, 240, 244 Check "Y" for yes if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355, or "N" for no, if it is not. HAZARDOUS COMPONENT 1 - 5 CAS 229, 233,237, 241,245 List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. III. SIGNATURE: 246 Please print name, title, sign and date each chemical description form. If you have any questions please call us at (661) 326-3979 CALIFQRNIA WASTE CODES Code Description Code Description hmrk, anics 241 Tank bottom waste I I I :\cid solution 2 < pH < 7 with metals 251 Still bottoms with halogenated organics (antimony. arsenic, barium, beryllium, 252 Other still bottom waste cadmium, chromium, cobalt, copper, lead, 261 PCB's and material containing PCB's mercury, molybdenum, nickel, selenium, silver, 271 Organic monomer waste (includes unreacted thallium, vanadium and zinc) resins) 112 Acid solution without metals 272 Polymeric resin waste 113 Unspecified acid solution 281 Adhesives "~ 121 Alkaline solution pH >12.5 with metals (see 291 Latex waste 1 l l ) 311 Pharmaceutical waste .. 122 Alkaline solution without metals 321 Sewage sludge 123 Unspecified alkaline solution 322 Biological waste other than sewage sludge 13 l Aqueous solution (2 < pH < 12.5) containing 331 Off-spec, aged or surplus organics reactive anoins (azide, bromate, chlorate, 341 Organic liquids (nonsolvents) with halogens cyanide, fluoride, hypoehlofite, nitrite, 343 Unspecified organic liquid mixture perchlorate and sulfide anions) 351 Organic solids with halogens 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues Sludges 10% or more 411 Alum and gypsum sludge 134 Aqueous solution with total organic residues 421 Lime sludge less than 10% 431 Phosphate sludge 135 Unspecified aqueous solution 441 Sulfur sludge 141 Off-spec, aged, or surplus inorganies 451 Degreasing sludge 151 Asbestos containing waste 461 Paint sludge 161 FCC Waste 471 Paper sludge/pulp 162 Other spent catalyst 481 Tetraethyl lead sludge 171 Metal sludge (see 111) 491 Unspecified sludge waste 172 Metal dust and machining waste (see 11 I)' 181 Other inorganic solid waste .Miscellaneous 511 Empty pesticide containers 30 gal or more Organics 512 Other empty container 30 gal or more 211 Halogenated solvents (methylene chloride, 513 . Empty containers less than 30 gal chloroform, TCE, TCA) 521 Drilling mud 212 Oxygenated solvents (acetone, butanol, MEK) 531 Chemical toilet waste 213 Hydrocarbon solvents (stoddard solvent, 541 Photo chemical/photo processing waste xylene) 551 Laboratory waste chemicals. 214 Unspecified solvent mixture 561 Detergent and soap' 221 Waste oil and mixed oil 571 Fly ash, bottom ash, and retort ash 222 Oil/water separation sludge 581 Gas scrubber waste 223 Unspecified oil - containing waste 591 Baghouse waste 231 Pesticide rinse water 611 Contaminated soil from site clean-ups 232 Pesticide and other waste associated with 612 Household wastes pesticide production S3f211P,,~',FORMS'~IIAZMAT FACILITY INFO INST. 4 >. ~ a CITY OF BAKERSFIELP ,~ ,:._.~,~, s ,: ,~,. ,, OFFICE OF ENVIRONMENTAL S 'ICES 1715 Chester Ave., CA 93301 (661) 326-3979 FACILITY INFORMATION " ' .... " Business Ac~iw~ies Page I. frAGILITY IDENTIFICATION OB~FACILI~ NAME ........... II. ACTIVITIES DECLA~TION Does Your Facili~... If Yes. Please Complete... 1. Have on site (for any purpose) hazardous mate~als at or ' ~ CONSOLIDATED COMPLIANCE P~N a~ove 55 0aliens for liquids, ~0 pounds for solids, or 200 ~ Minimum required planninq elements: cu R for compress~ gases (include liquids in ASTs and ~ ~ Emergency Response Plan USTs)? i · Maps 2. Have any amount of an explosive matedal (other ~an : OYES ONe s · Training ammunition) on site? : ~ Prevention ~ Ce~ifications -B;'-~GU~f'~YA~-~{"(~s) OYES ONe s ~ OES FOR~'~73-((-~g~,~,~-;~ .............. Have onsite RS at greater than the threshold planning ~ RISK MANAGEMENT P~N (R~ ~mi~ to USEPA) quantities established by the California Accidental . ~ CONSOLIDATED COMPLIANCE P~N Release Prevention program (CalARP)? e Incorporating CalARP Program Elements '~OhbE~6O-~'b-SYO~GE TANKS (USTs) OYES ONe , ,'~ UST FACILITY FORM ~. Own or operate Underground Storage Tanks? ' ~ UST TANK FORM (me ~ ~x) Intend to upgrade exis~ng or instil new USTs? OYES ONe ~.i ~ UST FACILI~ FORM ~ ~ UST TANK FORM ; ~ UST INSTAL~TION FORM (me ~tank) '~"'~NK-CLOSURE / REMOVAL OYES ONe 9 ' ~ UST TANK FORM 1. Need to rear closing a UST ~at held haza~ous materials or waste? 2. Need to repo~ the closure/removal of a tank that was OYES ONe ~0.J ~ TANK CLOSURE FORM classifi~ as hazardous waste and clean~ onsite? "-E~'~O~E 'GROUND PETROLEUM STOOGE TANKS (ASTs) OYES ONe ~ ~ CONSOLIDATED COMPLIANCE P~N Own or operate ASTs above these ~resholds: any ~nk ~ Incorporating Federal Spill Prevention ~paci~ is greater ~an 660 gallons or ~e total ~paci~ Control and Countermeasure (SPCC) for the facili~ is greater ~an 1,320 gallons. Elements pumuant to 40 CFR PaA 112 '~-~RD~US WASTE: ~ EPA ID nu~:L'~r~de on this page 1. Generate hazardous waste? OYES ONe ~2 To obtain EPA ID~, please phone (916) 324-1781 2. Recycle more ~an 100 kg/mo of recyclable materials at OYES ONe ~3 ~ RECYCLING FORM the same Io~tion it was generate? 3. Recycle more than 100 kg/mo of recyclable materials at OYES ONe ~4 ~ RECYCLING FORM an o~site location different Item the ~int of generation? 4. Treat Hazardous Waste on site? OYES ONe ~s ~ TP FACILITY FORM (DTSC Fo~ 1772) ~ TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requirements? OYES ONe ~ ~ CERTIFICATION OF FINANCIAL ASSU~NCE 6. Consolidate Hazardous Waste generated at a remote OYES ONe ~7 ~ REMOTE WASTE / CONSOLIDATION SITE site? NOTIFICATION FORM ~' .~u~r CO.SOUOAT~ON ZONE: -~"'~0 ..... ;;'" .................................................................................... ........................................................... . ~ CONSOLIDATED COMPLIANCE P~N Intend to consolidate other Cai/EPA agency permits? e Incorporating all other environmental (If yes, please ~mplete Section III and attach) , permit requirements per 27 CCR 10410 / '. you checked YES to any pad of Sections IIA-IIG above, the~ In addition to the forms request~ above, please Submit OES Form 2730. UPCF (7199) S:~CU PAFORMS~ACTIVlTY.wpd ,, ~;t;;..:~..~ CITY OF BAKERSFIEI~ ~,~r OFFICE OF ENVIRONMENTAL SERVICES ',' 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 FACILITY INFORMATION Business Activities Addendum Page of I. FACILITY IDENTIFICATION '~A~i/.i~v ~o ~ (F~ ~-~ usa ,n~ ~'~,eas~ OBAJi=ACILIT;? NAME ............................................... III. CONSOLIDATED PERMIT ACTIVITIES Is your Facility Compliance Plan subject to review by... ' for satisfying the conditions of these permits? ' H. DEPARTMENT OF TOXIC SUBSTANCES CONTROL OYES ONO , ~' STANDARDIZED PERMIT : · All Modifications OYES ONO v' Non-RCRA HAZARDOUS WASTE FACILITY OYES ONO ~ RCRA HAZARDOUS WASTE FACILITY "'l~' SAN JOA.QUIN VALLEY UNIFIED AIR POLLUTION OYES ONO v~ AUTHORITY TO CONSTRUCT CONTROL DISTRICT OYES ONO ~/ PERMIT TO OPERATE J. STATE WATER RESOURCES CONTROL BOARD OYES ONO v~ WASTE DISCHARGE REQUIREMENT (WDR) -'NTRAL VALLEY REGIONAL WATER QUALITY CONTROL OYES ONO ~' GENERAL PERMITS f clOARI~. v" SPECIFIC PERMITS OYES OHO v' NATIONAL POLLUTION DISCHARGE OYES ONO ELIMINATION SYSTEM (NPDES) K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD OYES ONO v' REGISTRATION PERMIT L. KERN COUNTY RESOURCE MANAGEMENT AGENCY ENVIRONMENTAL HEALTH SERVICES PERMITS OYES ONO ~' Domestic Water Well Permit OYES ONO v' Haz Mat Monitoring Well Permit OYES ONO v' Septic System Permit OYES ONO ~' Public Swimming Pool Permit OYES ONO v' Food Facility Construction Permit OYES ONO ~' Solid Waste Local Enforcement Agency (LEA) Related Permits : OYES ONO v' Medical Waste Related Permits · ~i~-~ii'v"o-F'ii,~K-ii~§~(~i'5"~¥~-,i,¥i~-~"di~i§i6'h' ........ T'~'f~- O-~ib ............ ~ ...... i'~'D-U~-T~'i~L'W,~§f'~"~A:i'-~R-6'm~;-6R'~,R--6~--~- PERMIT NOTE: v' If you checked YES to any part of Sections III-H to III.M above, then please address all applicable permit requirements in the Facility Compliance Plan. CITY OF BAKERSFIELD ~ OFFI0 OF ENVIRONMENTAL S~'ICES 1715 Chester Ave., CA 93301 (661) 3~-3979 BUSINESS OWNER/OPERATOR IDENTIFICATION FAClLI~ INFORMATION Page OI -- I. FACILITY IDENTIFICATION FACILITY tO # ~ ~ Year Beginning too Year Ending I BUSINESS NAME (Same a~ FACiLITY'"'NAME or OBA2 {~in'g'8~$i~es~ ~,s) .............. 3 "BUSINESS PHONE ......... SITE ADDRESS CITY ~04 CA ZIP DUN & los SIC CODE BRADSTREET . (4 Digit #) COUNTY OPERATOR NAME 109 OPERATOR PHONE I!. OWNER INFORMATION OWNER NAME ~1, OWNER PHONE OWNER MAILING ADDRESS 1,4 i STATE 1,5 ' ZIP III.ENVIRONMENTAL CONTACT CONTACT NAME 1,? CONTACT PHONE CONTACT MAILING ADDRESS CITY ,2o: STATE ~2~ ZIP 122 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 : NAME TITLE ,25 i TITLE ~ao BUSINESS PHONE ,2~ ! BUSINESS PHONE 24-HOUR PHONE 127 ' 24-HOUR PHONE 732 PAGER # ,20.: PAGER # 133 V. CERTIFICATION Certification: Based on my inquiry of those individuals responsible for oblaining the Information, I certify under penally of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information Is true, accurate, and complete. sIG'NA;I'URE OF OWNER/OPERATOR [ ~l~i'~[ i .......... ,'3, ~,~-~)~'DOCUMENT PREPARER ,35 NAMES OF OWNER/OPERATOR (print) , ~PCF (7~99) S:~CUPAFORMS~OES2730.T,/4.wpd {~_siness Owner/Operator Identif :ion Please submit Ihe ~usiness A¢tlvl(~es page, the Business Owner/O~:)erator Iclenl~flcation page (OES Form 2730), and Hazardous Materials - Chemical Oescnpuon pages (OES Form 2731 ) for all hazarc~ous matenals inventory submissions. For the inventory to be considered complete th~s page must be s~gned by the 3ppropnale mdiwdual. ~ote: the numbenng of ~e ,nsmactJons t'oIIows the data element numbers that are on the UPCF pages. These data element numbers are used jr electromc sul3m~ss~on and are Ihe same as ~he numbenng used in 27 CCR. Appendix C, the Business Section of the Unll]ed Program Data Olctiona P~ease number all pages of '/our submittal. Th~s l~el0s your CUPA or AA identify whether the submittal is complete and if any pages are separated. 1. FACILITY I0 NUMBER - Th~s number is assigned 0y the CUPA or AA. This is the unique number which identities your fac=li~. .3. BUSINESS NAME - Enter the full legal name of the 0usiness. 100. BEGINNING OATE- Enter ~he 0eginning year and date of the report. (YYYYMMDO) 101. ENDING OATE- Enler the ending year and date of the report. (YYY'YMMDD) 102. BUSINESS PHONE - Enter the phone number, area code I~rst. and any extension. 103. BUSINESS SITE ADORESS - Enter the street address where the facility is located. No post o(fice box numbers are allowed. This information must provide a means to geographically locate the facility. 104. CITY - Enter the city or unincorporated area in wflic~ business site is located..:... 105. ZIP CbOE - Enter the ap code of business site. The extra 4 digit zip may alSO be added. 106. DUN & BRADSTREET - Enter the Dun & Bradstreet number for the facility. The Dun & Bradstreet number may be obtained by calling (610) 882-7748 or by Intemet. 107. SIC CODE - Enter the primary Standard Industnal Classification Code number for pdmary business activity. NOTE: If code is more than 4 digits, report only the ~rst four. 108. COUNTY - Enter the county in which the business site is located. 109. BUSINESS OPERATOR NAME - Enter the name of the business operator. 110. BUSINESS OPERATOR PHONE - Enter business operator phone number, if different from business phone, area code first, and any extension. 111. OWNER NAME - Enter name of business owner, if different from business operator. 112. OWNER PHONE - Enter the business owner's phone number if different from business phone, area code firs[ and any extension. 113. OWNER MAILING ADDRESS - Enter the owner's mailing address if different from business site address. 114. OWNER CITY - Enter the name of the city for the ovaqer's maifing address. 115. OWNER STATE - Enter the 2 character stale abbreviation for the owner's mailing address. 116. OWNER ZIP CODE - Enter the zip code for the owner=s address. The extra 4 digit zip may also be added. 117. ENVIRONMENTAL CONTACT NAME - Enter the name of the person, if different from the Business Owner or Operator, who receives all environmental correspondence and will respond to enforcement activity. 118. CONTACT PHONE - Enter the phone number, if different from Owner or Operator, at which the environmental contact can be contacted, area code lirst' and any extension. 119. CONTACT MAILING ADORESS - Enter the mailing address where all environmental contact correspondence should be senL if different from the site addr~. ~20. CITY - Enter the name of tho city for tho en~ronmental contaet-~ maillng addr~. 121. STATE o Enter tho 2 character state abbrevia~on for the environmental contact~ msiling addmr~. 122. ZIP CODE - Enter the 2ip co:lo for the en~irenmental contae~ mailing addro~.q~. The ex~ra 4 digit ~p may al~ be added. 123. PRIMARY EMERGENCY CONq'ACT NAME o Enter tho name of a representative that can bo contacted in case of an emergency in~Mng hazardous materials at the bminess site. The contact shall have FULL fa~lity accel, site ~miliarity, and authority to make [or the bu$ine.ss regarding incident mi~gation. 124. llltE - Enter the title of the primary emergen~ contact. 125. BUSINESS PHONE - Enter the business number ~ the primary emergency contact, area code first, and any extemions. 128. 24-HOUR PHONE - Enter a 24-hour phone number for tho primary eme~ency conta~ The 24-hour phone number must be one which is an~,~tered 24 hours a day. If it is not tho contact's home phone humid, ~'~ the ~'~ce an~tering tho phone must be able to immediately contact tho indh~usl stated 127. PAGER NUMBER - Enter the pager number fa' the 13'imary emergency contact, if ava~ble. 17-8, SECONDARY EMERGENCY CONTACT NAME - Enter the name ora secondary representative that can be contacted .in the event that the prima7 emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 129. TITLE - Enter the title of the secondary emergency contact. . 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code firsL and ahy extension~ 131. 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact, The 24 hour phone number must be one which is answered 24 hours a day, If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individual stated above. 132. PAGER NUMBER - Enter the pager number for the secondary emergency contact, if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUP,as or AAs to collect any additional information necessary to meet the requirements of their individual programs, Contact your local agency for guidance, 134, DATE - Enter the date that the document was signed. (YYYYMMDD) 135, NAME OF DOCUMENT PREPARER - Enter the full name of the person who prepared the inventory submittal information, 136, NAME OF SIGNER - En~r the ~11 pdnted name o1' th person signing the page, The signer certifies to a familiarity with thc information submitted and that based on the signer=,s inquiry of those individuals responsible for obtaining the information, all the information submitted is true, accurate and complete, SIGNATURE. OF OWNERJ OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or ot'ficially designated representative of the Owner/Opera,or, shall sign in the space provided. This signature certJltea that the signer is familiar with the information submitted and that based on the signer=s inquiry of those individuals responsible for obtaining the information it is the signer=-s belle~ that the submitted information is line, accurate and completo, 137. TITLE OF SIGNER - Enter the tltie pt' the person signing the page. '~ ~' ' t o CITY OF BAKERSFIELD ~nnr~r 1715 Chester Ave., CA 93301 (661) 326-3979 r~-~' .... ' H~RDOH$ MAI~RIAL$ INVENTORY (oae ~ NEW ~ ADO ~ DELETE ~ REVISE ~ ~e -- of -- I. FACILI~ INFORMATION CHEMICAL LO~TION ~1, CHEMI~L LOCATION ~ Y~ ~ NO ~2 ~ ~ CONFIDENTIAL (EPC~) CHEMI~L ~ME .......................... 20? COM~N ~E EHS' CAS # 209 'Il' EHS i$'Y..' all ~D~ ...... O 0 PURE O m M~RE O w WASTE 211 · ~OIOACTNE ~ Y~ O No 212 ~0~"' 213 PHYSI~LSTATE ~ S ~LID ~1 LIQUID ~ g ~ 214 ~GESTCO~AINER 215 FED H~D ~TE~RIES ~ I FIRE ~ 2 ~CT~ D ~ ~ssu~ ~E ~ 4 ACU~ H~L~ ~ 5 CHRONIC H~L~ 216 t~ al ~at a~y) .WASTE 21~ ; ~M 218 ~ A~ 219 ~A~W~COOE STOOGE ~AINER ~ a ~GROUND T~K ~ · ~I~N~LIC DRUM ~ i FIB~ DRUM ~ m G~SS BO~LE (Check afl ~at ~b UNOER~OUND T~K ~f ~ ~j ~G ~n P~STICBO~LE ~r O~ER ~ c T~K IN~IOE BUI~ING ~ g ~Y ~ k ~X ~ o TOTE BIN ~ d ~EL ORUM ~ h SILO ~ I CYLINOER ~ 9 TANK WAGON STOOGE TE~TURE ~ a ~IE~ ~ ~ ~ ~IE~ ~ ba BELOW ~IE~ ~ c ~Y~EN~ %~ H~RDOUS COMPONE~ _l EHS ~ ~7 ~ DY. ONo 22e ~ 2 230 =1 ,, ~y~ ONo 232 ~ ....... ~ ~7 i ~ 241 4 ',' 2~ 239 J D Y. ~ No 240 ~, 5 ~ 242 .243,J DY. ONo 2~ ~ 245 III. SIGNA~RE UPCF (7199) S:\CUPAFORMS~OES2731,TV4.wpd Hazardous Materials Inventory - Chemical Description ate ~JS~ ?O~ ~l~CtrOn~C lu~l~S~On J~d 3re t~e ~ame Js '~e numoer~ng uaed ,n 27 CCR, A00end~x C, the ~us,ness Sechon of ~e Un,~ed Pr~ram 0ale 0ict~ona~.) P~ase l. FA~ILI TY ~0 NUMBER . Th~s number ,s 3ss~g~ ~y ;~e ~UPA or ~. This ~s Ihe un~ue numar w~ch ~denti~es your 3. BUSINESS NAME - Enler t~e ~111~al name pi t~e 2~. AOOIOELETEI REVISE - ;nd~te ,I the mater, al ,s ~,ng add~ (o the ~nvenlo~. dele!~ ~rom lhe ,nvenioq. or if the info.alien previousN subm~ffed NOTE; You may ch~se ~o leave this ~lank ,~you resuOm,t ~ur enlire invenlo~ 201. CHEMICAL LOCATION - Enler ihe Du,lding or outs~d~ a~jacenl area where ~he hazardous malarial is handle. temperature, ~n mulliple I~tions w~th~n a bu,ldin~, ~n ~e reposed on a sidle ~e. NOTE; This info.alien is nol suDject tO puDlic disclosure ~25506. 202. CHEMICAL LOCATION CONFIOENTIAL - EPC~ :'AI~ ~e~es wh~h are subject ~o the Emergency Planning and Communi~ Right ~o Know AC[ (EPC~) must c~ec~ 'Yes* [o keeo c~em~l I~alion info.alan ~n~dential. If the business d~s not wish to keep cbemi~l I~tion ;n(ormalion ~n~denlial check 'No'. 203. MAP NUMBER - If a map ,s included, enler the numar of the map on wh~h the I~tion o~ the h~ardous material is 2~. GRI0 NUMBER - If grid c~rdinates are used, emer Ihe ~tld c~ina/es og Ihe map that cortland [o the I~alion of ~he hazardous material. If appli~ble, mu~ c~rdi~ates can ~e 205. CHEMICAL NAME - Enter the proper chemical name as~iat~ ~lh ~e Chemi~l Abs~act SemPe (CAS) number o~ the haza~ous matenal. This s~ouM be Inlemalional Union of Pure and Appli~ Chem,s~ (IUPAC) ~me found on ~e Maler~l Safe~ Oala Sheet (MSDS). NOTE: If the ~emi~l is a mixture. ~mple/e this field; ~p~le the 'COMMON ~ME' ~eM inst~d. 2~. T~OE SECRET - Chec~ ~es' E the informat~ tn ~ ~on is ~ar~ a I~de sepal, m 'No' ~ ii ~ S~te r~uiremen~ If yes. and b~iness is not sub~ to ~C~ dictum of ~e ~s~t~ ~e s~et ~fo~n ~ ~und by HSC ~25511. F~e~l requkemen~: If ~s. and b~s is ~ub~ ~ ~C~. d~su~ of ~ d~t~ T~ ~et info~a~ ~ ~und by 40 CFR and I~ ~ mus~ submit a 'Su~mn~n to A~mp~y C~ of T~e ~ f~ (40 CFR 3~.27) to USEP~ 207. COMMON N~E - Enler ~e ~mon name or ~de name of ~e h~us matedal ~ m~um ~i~ a ~ male~l. 208. EHS - Ch~ ~es' if ~e h~s mattel is an ~ H~ Subs~e (EHS). as ~n~ ~ 40 CF~ PaR 3~. ~ A If~e ma/e~l ~ a m~um ~niaining an EHS. leave th~ sect~n b~nk a~ ~plele ~e s~n on ~r~us ~m~nls be~w. 209. CAS ~ - Enter Ihe Chem~l ~stm~ Semi~ (C~) numar f~ ~e h~a~us ~tedN. F~ m~tums, enter ~e CAS numar of t~ m~ure if it has ~n a~ a numar distin~ from i~ ~m~nen~. If the ~xi~ has ~ ~S numar, leave ~is ~lumn b~nk and m~ t~ ~S numbem of the indN~ual ~m~nen~ in the appropdale s~/~n bel~. 21~ F~RE C~E H~RD C~SsES - F~re C~e H~ard C~ descd~ ~ ~m~ res~nders ~he ~ and ~eve~ ~f h~a~d~ ma~e~ia~s whi~ a busine~ ha~s~ Th~ info~at~n shall on~ be provided if the l~l fire chief deems ii ~a~ and requesls ~he CUPA or ~ lo ~ll~t it. A list of the hazard ~sses and ins~ns on h~ to dateline whi~ ~ass a matedal ~a~s u~er are incl~ in the ap~ndi~s of ~le 80 of the Un~o~ Fire ~e. If a mattel has appli~ble hazard c~ss. i~lude all ~n~ CUPA or ~ f~ guiana. 211.' H~DOUS MATERI~ ~PE - Ch~ the ~e ~ ~al ~st de~d~ ~e ~e o~ ~a~ mateda~ pun. m~um or ~s/e. If ~sie mal~al. If mixture or waste, c~p~ie h~ard~s ~en~ 212. ~OlOACTIVE - Ch~k 'Yes' ~ ~e h~s ~le~ ~ md~e ~ 'No' if it is ~ 213. CURIES - If the h~ardous material is ~ctNe. ~ th~ ~ ~ reda ~e a~i~ in ~des. Y~ may use up ~ ni~ ~ ~ a floa~g d~al ~t to a~ity in 214. PHYSI~L STATE. C~ ~e ~e ~x ~at ~t d~s ~ s~ ~ ~ ~ ~s ma/e~l is h~dl~: solM, I~uM ~ gas. 215. ~GEST CONTAINER - Ent~ ~ to~l ~p~i~ of the ~sl ~ntai~r in wh~ ~e mate~l ~ ~. . 216. FEDE~L H~RD CATEGORIES - Ch~k all ~t~ ~al d~ ~e phial a~ h~l~ ~s a~t~ ~ ~e ~za~s mater~l. ~ PHYSICAL ~RDS J H~L~ ~RDS ~ Fire: F~mma~le ~u~s and ~l~s. ~mbus~ble L~u~s. ~mph~. Oxid~ers Ac~e Health (Immediate): H~h~ To~. To~c, Im~n~, ~em. ~, ~ Reactive: Unstable ReactNe. O~an~ Perox~es. Water R~e. ~d~ ( o~r hazar~ ~ ~ an ~ effe~ ~lh s~ ~m ex~e · I Pressure Release: Ex~losNes. ~mpressed Gases. B~sting Agenls Chronic Health (Delayed): Ca~ens. o~er h~ar~ ~mi~ ~ an I adveme e~t ~ ~ te~ ex.sure - 217. AVENGE DAILY AMOUNT - Cal~late ~e avenge dady a~unt of ~e h~ar~us maiedal or m~tum ~ntaining a h~ar~us material, in ~ buil~ ~e area. Ca~ula~s s~ll be based on ~e p~us yeaCs invento~ of ~te~l re~ ~ ~ page. To~l all davy amoun~ and dN~e by da~ the chemi~l will ~ on site. If this is a maxell ~at ~s noI prev~sly been presenl at ~is l~tl~, the anent shall ~ ~e avenge proj~t to be on hand du~ the ~ur~ of ~e year. Th~ anent sh~ ~ ~sisteni ~ ~e uni~ re~ed in ~x 221 a~ shou~ n~ ~ ~at o~ ~um dai~ amount. 218. M~IMUM DAILY AMOU~ - Enter ~e maximum am~nl o~ e~h ~ar~ matedal ~ mi~e ~ng a ~zardous ~1, whi~ ~ ~nd~ ad~cen~ou~e area at any one time ~er ~e ~me of the ~ar. ~is anent must ~n~in at a min~um ~st ~s inven~ of ~e ~ie~l page. with the refle~n of ~dit~, dele~. ~ mv~s pm~ed f~ ~e cuffenl y~t. ~b ~nt sh~ ~ ~btent w~ ~e un~ m~ in ~ ~1. 219. ANNUAL WASTE ~OUNT - If the ~s mate~l ~ i~en~ is a ~ste. ~e an es0male of ~e annual a~t handle. ~0. STATE WASTE CODE - I~ the ~zardous mate~l is a ~sle, enter ~e approp~ie Califomia ~it h~a~ous waste ~e as list~ on ~e ~ of ~e Unif~ H~a~s Waste Manifest. 221. UNITS - Ch~k the unil of measure that is most approp~le for the ~tedal ~i~ re~ on ih~ p~e: gallons. ~unds. ~b~ feet or tons. NOTE: If the ~te~l b a ledera[~ de,ned Extremely Hazardous Substance (EHS). all a~unts must ~ re~ in ~un~. If matedal is a m~ure ~niaining an EHS, re~ ~ u~ ~t the matedal is stor~ in (gallons. ~unds. ~bic ~l. ~ tons). 222. OAYS ON SITE - List the [o{al number pi ~ays during the ~ar ~at ~e ma~erial is on si~e. 223. STOOGE CONTAINER - Ch~k all ~xes that des~ the [ype of stooge ~ntalners in which the h~ardous material is stored. NOTE:l~a~pmpdale.~umay ch~se more [hen one, 224. STOOGE PRESSURE - Check the one box that besl desk.s the pressure at wh~h ~e h~atdous material is stored. 225. STOOGE TEMPE~TURE. Check ~e one box thai ~st dead.s [he temperature at which the haza~ous matedal is s~red. 226. H~RDOUS COMPONENTS I-5 (% BY WEIGHT) - Enter the ~r~n~ge ~ht of ~e h~ar~us ~mponeni in a m~ture. If a range of percenlages ~ ava~ab~. re~ the b~best percentage in that range. (Re~ ~ ~nents 2 ~to~h 5 in 230, 2~. 2~. a~ 242.) 227. H~RDOUS COMPONENTS I-5 N~E - When repo~i~ a h~ardous malapai ~al is a m~iure, list up ~o ~ve ~emical ~mes o~ hazardous c~ponenls in mixture by p~ni weight (~e~er [o MSOS o~. in the ~se of trade s~te~, re,er to manufacturer). NI haza~ous c~nenls in the mixture presenl al grea~r Ihan t%by~htJ~no~<arcin~en~.~ 0.1% by~hiifcarcin~en~.should~re~. Ifmorethan~veh~ar~us~mponen~ateptesenia~e~s8 pnrcenlages. ~u may attach an addit~nal sheet o~ pa~r to capiuro the requit~ in[otmat~n. ~en reposing waste mix{ures, mineral a~ chemi~l sh~ld be listed. (Re~ ~ ~mponents 2 ihr~gh 5 in 231,235, 239, and 243.) 228, H~ROOUS COMPONENTS 1.5 EHS - Che~ 'Yes' [t the ~mponent of the mixlure is cons~e~ an Extremely Hazar~us Substance as de~m~ in 40 CFR, Pa~ 355. or 'No' ~lii is noL (Repo~ for com~nenls 2 thm~h 5 in 232. 236. 240. and 244.) 229. H~ROOUS COMPONENTS 1.5 CAS - ~st [he Chem~al Abstra~ Se~e (CAS) numbers as relaled Io ~he hazardous ~m~nenls in the mixture. (Repeat for 2-5.) 246. LOCALLY COLLECTEO INFORMATION · This space may be used by lhe CUPA or ~ to ~llect any addilional ;nformalion necessa~ io meal ~he requiremen~ ;ndiv,dual pr~rams. Con{act the CUPA or ~ ~or guidan~. UPCff { 1/99) 7 OES Fo~ 27~ I B D : CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVE., BAKERSFIELD, CA (661) 326-3979 SITE AND FACILITY DIAGRAM INSTRUCTIONS FOR HAZARDOUS MATERIALS MANAGEMENT PLANS These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit a site diagram. If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing and additional detail map, facility diagram, for each of these areas. Include instructions that show the route to your business if it is in a remote location. All diagrams must be on 8 ~A x 11 paper and drawn using a straight edge tool. SITE DIAGRAM INSTRUCTIONS The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually within 300 feet. If you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include all of the following information: 1. Cheek the box on the top let~ comer of the form provided that indicated "Site Diagram". 2.. Print the name of your business, as shown in your HMMP, on the top of the diagram. 3. Label the location of the hazardous materials and identify them by name and type of hazard (ie. Flammable liquid, corrosive solid). 4. Label the location of utility shutoff points for gas, electric and water services. 5. Label the location of fire hydrants. ti., 6. Label portions of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. (The diagram form provided includes a north arrow). 8. All labeling a entification on the diagram must be ible and easily understandable at the scale submitted. Diagrams must be sufficiently legible to produce a legible copy. Try to avoid the use of abbreviations or symbols. If you must use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follow these instructions. FACILITY DIAGRAM INSTRUCTIONS Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. 1. Check the box in the upper right hand comer of the form provided that indicated "Facility Diagram". 2. Print the name of your business as shown on your HMMP.' Print the name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled gl of 4. 4. Follow instructions (3 -8)* for site diagrams regarding the specific details to be included on'each facility diagram. UNDERGROUND STORAGE TANK FACILITIES PLEASE NOTE: * If you operate an Underground Storage Tank (UST) facility, the facility diagram shall also specify the location(s) of the UST continuous leak monitoring system and/or the location(s) where the UST monitoring will be performed. 2 SITE DIAGRAM [,__] FACILITY DIAGRAM Business Name: Business Address: $:',PROCEDURE *~.NUA L,dia~rsmin~. wlxl CITY OF BAKERSFIEI · ~,,., ~. .a L~V ",, '..~., '~LL~ OF ENVIR6~MENTA ICES: 'l.?~tttt I 1715 Chester Ave.; CA.93301 (661) 326-3979-, ' "~~ '"~" ......... BUSINESS OWNE'R/OPERATOR'IDENTIFICATION ' ':.~ FAClLIW INFORMATION I. FACILITY IDENTIFICATION FACILITY ID,# : iJ I :" Year Beginning ' .. BUSINESS NAME (Same a~ FAClLI~N~E o~ DSA- ~ Busines~) ......... ~ "~SlNES~PHONE ..... _ ~o~ ~.- ~~ ............ : ..... SITE ADDRESS , ,~ ~- / ~' ~ .' ' ~03 C,T~ .'~ ........ ~'".'~ '[' ~' ........................ ' ............................. ;:""c'~'"' Z," '- ............. l~E~ ~.~. ............................................ ..: ........................................................ DUN & ~ SIC CODE ~o7 B~DSTREET (4 Digit .. : ~ 2 ............... OWNER ~ILING . : . III. ENVIRONMENTAL CONTACT OONTAOT ~ME .~ } -PRIMARY- IV. EMERGENCy CONTACTS ~ECONDARY- TITLE ~/~ U' 1~ [ TITLE .................. ~ " ........... ~ ....................... ' ......................... Certifi~tion: Baa~ on my inqui~ of ~o~e Indlvidual~ responsible for obtaining the info~ation. I ~e~i~ under penalW of law that I have personally examin~ and am familiar ~ ~e In~rmalion submitt~ in thi~ inventoq and believe tho info~ation i~ tree, accurate, and complete. s~S'AYu~"bV6~6-~g~ .................................. [' bXi~ .............. . ..... ,'~- ~'~X~'b'~'oocuu~hT'~a'O~ ................ ................................. ............................ ~. ~.~/ ............ PCF (7199) S:\CUPAFORMS[OES2730.'FV4.wpcl .~: .... *' Owner./Operator Ider ' Plea~';J~bm~t Ihe Business ACtiV,ties page, me 8u~n.s ~er/~mmr. Idenafl~on page (DES Fo~ 27~), and Ha~ous ~t~als - Ch~i~5 ' O~n ~ges (DES Fo~ 2731) for all ~rdous materials inven/o~ Submi~ions. For ~e inven~ to' be ~sider~ ~mple~e . ,.,.. ~is ~ge musl be s,gn~ by ~e appmpnare i~i~d~l. Wo~:~. ~e~numb~ng of ~e ins~c~onS/oll~s ~e da~ element nUmbem ~at-are ~ ~e UPCF page. ~e da~ ~ement numb~ are ~ . :, '* .... ~r a~ohic submissmn and are the ~me as ~e numbe~ng us~ in 27 CCR, Appe~ix C, ~e Business S~t~n of ~e Uni~ Pr~mm Da~ Dlc~ona~.) Plea~ numOer all pages of your subtotal. This hemps your CUPA or ~ idena~ ~e~ ~e subtotal is ~mplele and if any pages are sepami~. 1. FACILITY ID NUMBER - Th~s number is as~gn~ by the CUPA or ~. ~is is ~e unique number ~i~ identifies your facili~. 3. BUSINESS ~ME. Enler ~e ~ll I~al name of ~e bu~ne~. 100. BEGINNING OATE. Enter ~e b~nning year a~ date of ~e re~A. (~MMDD) 101. ENDING DATE - Enter the ending y~r and date of ~e r~A. (Y~MMDD) 102. BUSINESS PHONE - Ent~ ~e p~ne numbs, ar~ ~e flint, a~ a~ ~ten~on. 103. BUSINESS SITE ADDRESS - Enter ~e s~eet addre~ ~ere ~e ~dli~ is Io~t~. No ~st o~ ~x numbem are allowS. ~is in~a~on must pm~de a mean~ ~ g~mphi~lly I~te ~e ~dli~. 1~. CI~ - En{~ ~e ~ or unin~m~ area in ~i~ busin~ site is I~t~. 105. ZIP COOE- Ent~ ~e ~p'~e of busine~ site. ~e ex~ 4 digit ~p may al~ be add~. 106. DUN & B~DSTREET. Enter ~e Dun & Brads~t number for ~e ~ali~. ~e Dun & BmdsE~t number may be obtain~ by ~lling (610) 882-7748 or by In~emet. 107. SIC CODE - Enter ~e pdma~ S~nda~ Indus~al Cla~ifi~Uon ~e number for pdma~ busin~ ac~W. NOTE: If ~e is more ~an 4 digit, re~ only ~e flint four. 1'~. COU~ - Enter ~e ~un~ in ~i~ ~e busin~ site is Io~t~. 1~. BUSINESS OPE~TOR ~ME - Enter ~e ~me of ~e busin~ opera.r. . 110. BUSINESS OPE~TOR PHONE - Ent~ ~n~ o~t~ ~ne n~, If diff~t ~m ~sln~ p~e, ar~ ~e tirol a~ any ~on. 111. O~ER ~ME - Ent~ ~me of busin~ ~, E diff~ent ~m b~ ~r. 112. O~ER PHONE - ~t~ ~e bu~n~ ~s p~ne num~ if dlff~t ~ b~i~ p~, a~ ~e fimb and any ~e~n. 113. O~ER ~ILING ADDRESS - Ent~ ~e ~s maill~ addr~ if diff~ent ~m ~n~ site addr~. 114. O~ER CI~ - Ent~ ~e ~me of ~e d~ ~r ~e ~s maili~ addr~. 115. O~ER STATE - Enter ~e 2 ~m~ sale abbre~a~n ~r ~e ~s maal~ ~dr~. 116. O~ER ZIP CODE - Enter ~e ~p'~e for ~e o~er~ a~r~. ~ ~ 4 digit ~p may al~ be add~. 117: E~IRONMENTAL CONTACT ~E - Enter ~e ~me of ~e ~n, if differ~t ~m ~e Bu~n~ ~ or Operator, ~o r~ives all en~mnm~l ~~~ a~ ~11 m~ ~ ~~t a~. 118. CO~ACT PHONE - Enter ~e p~ne numbs, if d~erent ~m ~ or ~emDr, at ~i~ ~e ~mnm~l ~n~ct ~n be ~n~, ar~ -~: ~e ~m~ a~ any ~n. 119. CO~ACT ~ILING ADDRESS - En~ ~e maili~ addr~ ~ere all ~mnm~l ~ ~~en~ s~uld be ~nL E diff~t ~m ~e ,:. '" ~te addr~. - 120. CI~ - ~r ~e ~me of ~e d~ ~'~ ~mnm~=l mn~ mai~ddr~. 121. STA~ - Ent~ ~e 2 ~am~er s~te abbre~a~n ~ ~e ~m~l ~c~ ma~ addr~. 1~. ZIP ~DE - Ent~ ~e ~p ~e ~r ~e ~men~l mn~ ~il~ ~d~. ~ ~ 4 d~E ~p may al~ be add~ 123. PRIVY EMERGENCY C~A~ ~E - Enter ~e ~me of a repr~e ~t ~ be ~n~ in ~se of an eme~ in~M~ ~ous mat~a~ at ~e b~in~ ~te. ~e ~n~ s~l ~ve FULL ~dll~ a~, ~te ~milia~, and au~d~ D make d~lo~ ~r ~e busin~ r~a~i~ indd~t mi~n. 124. TI%E - ~t~ ~e aae of ~e pdma~ emerg~ ~na~ 125. BUSINESS PHONE - Ent~ ~e b~ numb~ ~ ~e ~ma~ em~w ~nacL =~ ~e tirol a~ any e~e~io~. 126. 24-Hour PHONE - Enter a 2~ur p~ne numb~ ~ ~ p~a~ em~w ~a~ ~e 2~ p~ numar m~t be ~ ~i~ Is a~ 24 ~m a day. Ifil is ~t ~e ~s ~e ~ n~, ~m ~e ~ a~ ~e p~ m~t imm~iat~ ~na~ ~e I~1 sat~ a~. 127. PA~R NUMBER ~ En~ ~ ~g~ ~ ~ ~e ~ ~enw ~ if a~ble. 128. SECONDLY EMERGENCY CO~ACT ~E - Ent~ ~e ~me of a ~a~ r~6ve ~t ~n ~ ~n~d~ eme~enW ~n~ is ~t a~aable. ~e ~ ~11 ~ve FULL ~dll~ a~, ~te ~mill~, a~ a~H~ to make d~ns ~r ~e b~in~ r~ardl~ i~dent miaga~. 1~. ~TLE - Enter ~e Uae of ~e ~a~ ~e~w ~n~. 1~. BUSINESS PHONE - Enter ~e bu~ne~ td~ne numar ~r ~e ~a~ ~enw mna~ ar~ ~e tirol and any extensor: ' 131. 24-HOUR PHONE - Enter a 2~ur p~ne numb~ for ~e ~nda~ ~e~e~ ~na~ ~e 24 ~ur ~one number must be one ~i~ is an~er~ 24 ~um a day. If it is not ~e ~n~'s home p~e numbs, ~ ~e ~ a~ed~ ~e p~ne must ~ able to imm~iatay ~n~ ~ i~l s~ 132. PAGER NUMBER - Ent~ ~e pager n~ber ~r ~e se~nda~ ~e~enw ~na~, if a~i~ble. 133. ADDITIO~L L~LLY COLLECTED INFOR~TION - ~is spa~ may ~ u~ for CUP~ ~ ~ to ~ll~t any addiUo~l info~Uon n~ to m~t ~e r~uir~ of ~dr i~Mdual ~s. ~n=ct ~ur I~1 age~ ~r gadan~. 1~. DATE - Enter ~e date ~at ~e d~t ~s s~n~. (~MMDD) 1~. ~ME OF DOCUME~ PREPARER - Enter ~e ~11 ~me of ~e p~n ~o pmpar~ ~e invento~ submi~l info~aUon. 136. ~ME OF SIGNER - En~r ~e ~11 p~nt~ name of ~e per~n signing ~e page. ~e s~ner ~fl~ D a famillad~ ~ ~e in~a~on submitt~ and ~t bas~ on the signer~ i~ui~ of ~ose i~ividuals res~nsible f~ ob~ini~ ~e info.alton, all ~e info~a~n submi~ is ~e, a~mte a~ ~mplele. SIGNATURE OF O~E~ OPE~TOR OR DESIGNATED REPRESENTATIVE - The Business ~ner/Operator, or o~cially designat~ r~resen~Uve of lhe ~/Op~lor. Sh~l sign in ~e spa~ pm~d~. ~is signature ~fl~ ~at ~e signer is ~millar info.a/Ion submiE~ and ~at bas~ on ~e signer~ inqui~ of ~ose i~i~duals res~nslble for ob~inl~ ~e info~a~on it is signe~s belief ~at ~e subml~ ingrain is ~e, a~mte and ~mplete, 137. TITLE OF SIGNER - Enter ~e Uae of ~e pe~n signing ~e page, ARNICERIA~ ~._~~"L RANCHERIT0~ ") [-~ ~'~([' '.~J- [Vmi)~ [ SiteID: 015-021-001808 I / Manager -. . A~ JAN'"~ ~ 200, ~usphone- (661) 328-1770. Locatmon: 430 E C~IFO~IA E ~ . ap : 103 Com~az : Low City : B~ERSFIELD .~:~- ~ ~rid: 3lB FacUnits: 1 AOV: CommCode: B~ERSFIELD STATION~ 06 SIC Code:5541 EPA Nu~: DunnBrad: Emergency Contact / Title E~rgenc~ .Co~ta~t / ~ Titl9 ~ Business Phone: (661) 328-1770x Business Phone: ( )~~ x 24-Hour Phone : (661) ~x~~- 24-Hour Phone : ( ) - x Pager Phone : (661)-2C~Lg=gx Y~O~ Pager Phone : ( ) - x Hazmat Hazards: Fire Press Im~lth Contact : Phone: (661) 328-1770x MailAddr: 430 E C~IFO~IA AVE State: CA City : BAKERSFIELD Zip : 933~07 O~er P~LO BUG~IN a Phone: (661) 87218098x Address : ~ -~CLiE rye-; E~ ~%~0f~J~ State: CA City : B~ERSFIELD Zip : ~ q~%~ Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: RSs: No Emergency Directives: I, ~/~ ~ ~_,.~,~-<~ _/J~ Do hereby certify that ~ have ~y~ or pdn~ ~) re,,iewed the a~aChod h~ardous mate~als manage- ment plan for /~~ and ~hm i~ along with (Name of Busine~) any corrections consiitum a complem and correc~ man- agement plan for my facili~. -1- 01/22/2001 CARNICERIA EL RANCHERITO SiteID: 015-021-001808 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: CARNICERIA EL RANCHERITO Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : Phone: ( ) - x Address: City : State: Zip: Type. : TANK OWNER INFORMATION Name : Phone: ( ) - x Address: City : State: Zip: Type : BOE UST Fee# : UNKNOWN Financ'l Resp: STATE FUND Legal Notif : Property Owner Mailing Address Date:10/03/2000 Phone: (661) 827-8098x Name:PABLO BUGARIN Ttl:OWNER State UST # : 1998 Upg Cert#: 00875 ~ Hazmat Inventory One Unified List --As Designated Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax Unit MCP PREMIUM UNLEADED L 10000.00 GAL Mod UNLEADED PLUS L ~ 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod P~~ E F P IH G ~ Hi -2- 01/22/2001 CARNICERIA EL RANCHERITO SiteID: 015-021-001808 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site PREMIUM UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: FRONT OF BLDG CAS# 8006-61-9 STATE ~ TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid /Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline No 8006619 HAZARD ASSESSMENTS TSecret RSIBioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N°I No No/ Curies / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site UNLEADED PLUS Days On Site 365 Location within this Facility Unit Map: Grid: FRONT OF BLDG CAS# 8006-61-9 rS TAT E TYP E P RES SURE --r T EMP ERATURE CONTAINER TYP E Liquid Pure Ambient/ Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION ~ Largest Container ~ Daily Maximum Daily Average 10000.00 GAL~ 10000.00 GAL 10000.00 G HAZARDOUS COMPONENTS wt.I CAS# Gasoline N 8006619 HAZARD ASSESSMENTS TSecretI ~SIBioHazI Radioactive/Amount EPA HazardsI NFPA I USDOT# ] MCP No N No No/ Curies / / / Mod 3 01/22/2001 CARNICERIA EL RANCHERITO SiteID: 015-021-001808 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site GASOLINE Days On Site REGULAR UNLEADED 365 Location within this Facility Unit Map: Grid: FRONT OF BLDG CAS# 8006619 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 10000.00 GALI 10000.00 GALI 10000.00 GAL HAZARDOUS COMPONENTS %Wt. ~S CAS# 100.00 Gasoline N 8006619 HAZARD ASSESSMENTSii TSecret RS BioHaz Radioactive/Amount, EPA Hazards ,o NFPA USDOT# MCP No N No No/ Curies / / / Mod ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~UVl~ ~vl~ / ~±~-'C~l-~ ~Vl~ PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 74-98-6 Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION I' I Largest Container Daily Maximum Daily Average 364.00 FT3 364.00 FT3 364.00 FT3 HAZARDOUS COMPONENTS 100.00 Propane 74986 -- HAZARD ASSESSMENTSI MCP TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA . USDOT# No N° No No/ Curies F P IH / / /I Hi -4- 01/22/2001 CARNICERIA EL RANCHERITO SiteID: 015-021-001808 Fast Format Notif./Evacuation/Medical Overall Site -- Agency Notification 09/09/1999 911 AND FIRE..~~, -- Employee Notif./Evacuation 09/09/1999 VERBAL. -- Public Notif./Evacuation 09/09/1999 N/A. Emergency Medical Plan 09/01/1999 -5- 01/22/2001 ~ CARNICERIA EL RANCHERITO SiteID: 015-021-001808 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 11/03/2000 MONITORING SYSTEM. Release Containment 11/03/2000 FOR SMALL ~T'~/~/~ SPILLS US KITTY LITTER, FOR LARGE SPILLS CALL 911 AND FIRE DEPT. -- Clean Up 09/09/1999 USE KITTY LITTER AS ABSORBANT, WHICH STORED IN 5 GAL BUCKET AND THEN PROPERLY DISPOSE OF IT. Other Resource Activation 6 01/22/2001 CARNICERIA EL RANCHERITO SiteID: 015-021-001808 Fast Format Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 09/01/1999 A) GAS - N/A B) ELECTRICAL - FRONT OF STORE NW WALL C) WATER - FRONT OF STORE SW WALL D) SPECIAL - NONE D) LOCK BOX - NO -- Fire Protec./Avail. Water 11/03/2000 PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS; 1 IN FRONT AND 1 IN BACK. NEAREST FIRE HYDRANT - ON THE CORNER OF TULARE AND CALIFORNIA AVE. Building Occupancy Level -7- 01/22/2001 CARNICERIA EL RANCHERITO SiteID: 015-021-001808 Fast Format ~ Training Overall Site -- Employee Training 11/03/2000 WE HAVE NO EMPLOYEES AT THIS FACILITY, SELF EMPLOYED. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: -- Page 2 ~ Held for Future Use I I Held for Future Use I -8- 01/22/2001