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HomeMy WebLinkAboutBUSINESS PLAN STATEMENT OF AC~OtNT CITY OF BAKERSFIELD 1501 TRUXTUN AVE BAKERSFIELD, CA 93301-0000 (805) 326-3979 DATE: 5/01/97 TO: EDS MARKET AND BP QAS P 0 BOX 71171 BAKERSFIELD, CA 93387-1171 CUSTOMER NO' 2873 CUSTOMER TYPE: ES/ 2873 CHAEQE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT 4/01/97 BEGINNING BALANCE 332.58 HMO06 4/30/97 Charge adjustment 5/30/97 2.18-- FINANCE CHARGE HMO06 4/30/97 Charge adjustment 5/30/97 2.18-" FINANCE CHARGE HMO06 4/30/97 Charge adjustment 5/30/97 2.18-- FINANCE CHARGE HMO06 4/30/97 Chmrge adjustment 5/30/97 2.18- FINANCE CHA~E HMO06 4/30/97 Charge adjustment 5/30/97 ~. 18-- FINANCE CHARGE HMO06 4/30/97 Charge adjustment 5/30/97 2.18- FINANCE CHARGE CONTINUED ON NEXT PAGE.,. DATE: 5/0i/~7 REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD P.O. BOX ~057 BAKERSFIELD CA 93303-2057 CUSTOMER NO~ ~873 CUSTOMER TYPE~ ES/ 2873 STATEMENT DF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-0000 (805) 32&-3979 DATE~ 5/01/97 TO: ED~ MARKET AND BP QAS P 0 BOX 71i7i BAKERSFIELD, CA 93387-ii71 CUSTOMER NO: 2873 CUSTOMER TYPE: ES/ 2873 CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT HMO06 4/30/97 Charge adjustment 5/30/97 2.18- FINANCE CHARGE HMO0~ 4/30/97 Charge adjustment 5/30/97 2.18-- FINANCE CHARQE HMOO& 4/30/97 Cha~ge adjustment 5~30/97 2.18- FINANCE CHARGE HMO06 4/30/97 Charge adjustment 5/30/97 2.18- FINANCE CHARQE HMO06 4/30/97 Cha~ge adjustment 5130/97 2.18- FINANCE CHARQE HMO06 4/30/97 Charge adjustment 5t30/97 2. iS- FINANCE CHARGE CONTINUED ON NEXT PAGE... DATE: 5/0t/97 I, REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD P.O. BOX 2057 B~KERSFIELD CA ~3303-~057 sU~TDMER NO: 2873 CUSTOMER TYPE: ES/ 2873 STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-0000 (805) 326-3979 DATE: 5/01/97 TO: EDS MARKET AND BP QAS P 0 BOX 7i17i BAKERSFIELD, CA 93387-Ii7i ~ ~ CUSTOMER T'~E: ES/ CUSTOMER ND: :B7~ 2~87~3_~ CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT HMO06 4/'30/97 Cha~ge adjustment 5/30/97 2.18- FINANCE CHARQE HMOO& 4/30/97 Charge adjustment 5130/97 2.18- FINANCE CHARQE HMOO6 4/30/97 Charge adjustment 5/30/97 22.01- ADMIN SERVICE FEE HMO17 4/30/97 Charge adjustment 5/30/97 5.05- ADMIN SERVICE FEE HMO17 4/30/97 Charge adjustment 5/30/97 .50- FINANCE CHARQE HMO17 4/30/97 Charge adjustment 5/30/97 .50-- FINANCE CHARQE CONTINUED ON NEXT PAQE... DATE: 5/01/~7 REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD CA 93303-2057 CUSTOMER NO: 2873 CUSTOMER TYPE: ES/ 2873 STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-0000 (805) 326-3979 DATE: 5/01/97 EDS MARKET AND BP QAS P 0 BOX 71171 BAKERSFIELD, CA 93387-1171 CUSTOMER NO: ~873 CUSTOMER TYPE.:.-ES/ ~8~3 CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT NM017 4/30/97 Cha~ge adjustment 5130197 .50-- FINANCE CHARGE HMO17 4/30/97 Cha~ge adjustment 5/30/97 50- FINANCE CHARQE HMO17 4/30/97 Charge adjustment 5/30/97 .50- FINANCE CHARQE HMO17 4/30/97 Charge adjustment 5/30/97 .50-- FINANCE CHARQE HMO17 4/30/97 Charge adj.u~tment 5/30/97 .50- FINANCE CHARQE HMO17 4/30/97 Charge adjustment 5/30/97 .50-- FINANCE CHARQE CONTINUED ON NEXT PAQE... DATE: 5/01/97 REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD CA 93303-2057 CUSTOMER NO: ,2873 CUSTOMER TYPE: ES/ 2873 STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-0000 (805) 326-397~ DATE: 5/01/97 TO: EDS MARKET AND BP QAS P 0 BOX 71171 BAKERSFIELD, CA 93387-1i71 CUSTOMER NO: 2873 ~ CU~T_OMER TYPE:~£S/ ~_ ~75~ CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT HMO17 4/30/97 cha~ge adjustment 5/30/97 50- FINANCE CHARQE HMO17 4/30/97 Charge adjustment 5/30/97 50-- FINANCE CHARQE HMO17 4/30/97 Charge adjustment 5/30/97 50-- FINANCE CHARGE HMO17 4/30/97 Charge adjustment 5/30/97 50-- FINANCE'CHARGE HMOi7 4/30/97 Cha~gm adjustment 5/30/97 50- FINANCE CHARGE HMO17 4./30/97 Charge adjustment 5/30/97 50- FINANCE CHARGE CONTINUED ON NEXT PAGE... DATE: 5/01/97 ~ REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD P.O, BOX 2057 BAKERSFIELD CA 93303-2057 CUSTOMER NO: 2873 CUSTOMER TYPE: ES/ 2873 STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 150I TRUXTUN AVE BAKERSFIELD, CA 93301-0000 (805) 3~6-3979 DATE~ 5/01/97 TO: EDS MARKET AND BP CAS P 0 Box 71171 BAKERSFIELD, CA 93387-1i7i C iRT - ~R~ OMER NO, 3 CHARGE DATE DESCRIPTION REF-NUMBER DUE D~TE TOTAL AMOUNT FOR QUESTIONS OR CHANQES-TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. CURRENT OVER 30 OVER 60 OVER 90 DUE DATE: 6/02/97 PAYMENT DUE' 268.00 TOTAL DUE' $268.00 PLEASE DETACH AND SEND THIS COPY WITH REMITTANCE DATE: 5/01/97 DUE DATE: 6/02/97 REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD CA 93303-2057 CUSTOMER NO: 2873 CUSTOMER TYPE: ES/ 2873 TOTAL DUE: $268.00 H M._.~ PP I_:M'q ~' MAP SITE DIAGRAM [ I FACILI~ DIAGRAM For Office Use Only First In Station: Area Map # of Inspection Station: NORTH ~"'"~ iTE DIAGRAM ~ FACTLITY DIAGRAM F-J. / ~ Ncr'~ Name 0~ Area: ,.-., ~ PROPERTY 1) Property: 430 E CALIFORNIA AV, BAKERSFIELD CA 93307-1140 C007 APN: 016-480-10-00 Use: SERVICE County: KERN, CA Tax Rate Area: 000-1003 Total Value: $182,632 Census: 15.00 Prop Tax: $4,293.06 Land Value: $76,001 Map Pg: 227-B3 Delinq TaxYr: Imprv Value: $106,631 New Pg: Exemptions: Assd Yr: 1996 Phone: % Improved: 58% Owner: BANK OF STOCKDALE FSB Mail: 5555 CALIFORNIA AVE #105; BAKERSFIELD CA 93309 SALES INFORMATION IMPROVEMENTS LAST SALE: PRIOR SALE: Bldg/Liv Area: Transfer Date: 09/12196 02104192 # Units: Sale Price/Type: $213,100 UNKNOWN # Bldgs: Document #: 117202 66270533 # Stories: Document Type: TRUSTEE'S DEED GRANT DEED $/SF: 1st TD/Type: Yrblt/Eff: Finance: Total Rms: Junior TD's: Bedrms: Lender: Baths(F/H): Seller: FIRST INDEPENDENT TR DEE Fireplace: Pool: Title Company: Bsmt Area: Transfer Info: Construct: SITE INFORMATION Flooring: Air Cond: Improve Type: Lot Size: Heat Type: Zoning: Lot Area: Quality: County Use: 2304 Parking: Condition: Bldg Class: Park Spaces: Style: Flood Panel: Site Influence: Other Rooms: Flood Zone: , Ground Lease: Phys Chars: Legal: B2461 Comments: Copyright © 1996 TRW REDI Property Data Page: 1 of 1 "--~. BA .FIELD FIRE ARTMENT ' "~' ', HAZARDOUS MATERIALS DIVISION ~(~' ~ 2130 "G" STREET RECEIVED BAKERSFIELD, CA. 93301 ~~ (805) 326-3979 ~ H~ARDOUS MATERIALS INVENTORY HAZ. MAT. DIV. CHECK IF BUSINESS IS A FARM ,[_] -E--'i)"$ ' FACILITY NAME ' 7<S--~(bO J · NATURE OF BUSINESS ,~//',/,,-],' SIC CODE ~'~--/--/',/ DUN & BRADSTREET NUMBER OWNER/OPERATOR MAILING ADDRESS EMERGENCY CONTACTS. BUSINESS PHONE 5 %5- ¢1 ?¢ 24-HOUR PHONE NAME ~ ~,/ ~~~.-¢ TITLE BUSINESS PHONE ' ~ 5 - ¢( ~ 24-HOUR PHONE LE~ STANOAF~O F'O ~ .~3~ 3~ 1~ la'C~310N 'V i " BAKERSFi -D CITY FIRE DEPAI -'MENT HAZARD OUS MATER IALS_I NVENTOR'Y Pag Name Address , ,'.~.. CHEMICAL DESCRIPTION 1) INVENTORY .ST,.ATL~S: Ne, .w~! .] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [~ TRADE SECRET [ ] 2) Common Name: /~'~/'~1~_~ ~-Z ~ ~.2-'-~ L ~. ~ 3) DOT # (optional) 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ~ Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) .~ Delayed Health (Chronic) code from DHS Form 8022) USE CODE .~'~ 5) WASTE CLASSIFICATION (3-digit 6) PHYSICAL STATE Solid [] Liquid ,~ Gas [] Pure [] Mixture~)~ Waste [] Radioactive [] 7) AMOUNT AND TIME AT FACIUTY . UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: ..~_ _~_ lbs [ ] gal [~ 1t3 [ ] a) Container: ~14 JE~e~/,q~L~ Average Daily Amount: /'..~_/~)~ curies [ ] b) Pressure: / -- Annual Amount: c) Temperature: Largest Size'Container: ./~.~./~ ~ Days On Site Circle Which Months: (.~llYe~, J, F, M, A, .M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT · CAS # % WT AHM , the three most hazardous 1) [ ] chemical components or. any AHM components 2) [ ] 3) [ l 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New[ ] Addition[ ] Revision[ ] Deletion[ ] Check if chemical is aNON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemica~ Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] gal [ ] ~t3 [ ] a) Container:. Average Daily Amount: cudes [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: #DaysOn Site Circle Which Months: AIIYe~r, J, F, M, A, M, J,'J, A, S, O, N, O 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) ..r. [ ] 3) [ 10) Location ' I betieve submitted inforrna~on is true, accurate, andcomplete.~..~.....~ ~~/~/~ ~/?_~"'¢~i/'~ ' ~":' ~ ~ ~ ~/~~' ~' ~)~ [SR'IN~ 'Nam'e & Titl~'olr Aut~(~ized ~ompany Repres~nta6ve .//;~i~natUre - ./~,,~ ~ - u,,- 4/! Date FRE DEPARTMENT 2101 H STREET ii D.S. NEEDHAM BAKERSFIELD, 93301 FIRE CHIEF · 326-3911 Dear Business Owner: This notice is meant to act as a reminder that the California Health and Safety Code, Chapter 6.95, requires any handler of hazardous materials to revise their hazardous materials business plan within 30 days of any one of the following events: (1) A 100 Der cent or more increase in the quantity of a Dreviously-disclosed material. (2) Any handling of a previously-undisclosed hazardous material, subject to the inventory requirements of ChaDter 6.95. (3) Change in business ownership. (4) Change in business address. (5) Change of business name. Any Questions regarding these required revisions, please call the Hazardous Materials Division at (805) 326-3979. Sincerely yours, alph E. ~~ Cdous Materials Coordinator REH/d "WE CARE" ,,0 ~ ..~,~ ~~ c~?,,'., FIRE DEPARTMENT 2101 H STREET D. S. NEEDHAM BAKERSFIELD, 93301 FIRE CHIEF 326-3911 JANUARY 22, 1991 DEAR MR. ALQUADSI, NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YOUR BUSINESS , LOCATED AT 430 E. CALIFORNIA AVENUE BAKERSFIELD, CA 93307, ON JAN. ZZ, 1991 THE FOLLOWING HAZARDOUS MATERIALS REGULATION VIOLATIONS WERE IDENTIFIED: 1. A'HAZARDOUS MATERIALS BUSINESS PLAN SHALL BE COMPLETED REGARDING THE HANDLING AND STORAGE OF GASOLINE PRODUCTS. VIOLATION OF CH. 6.95 CALIFORNIA HEALTH AND SAFETY CODE SEC.25503.5 (a) Any business, except as provided in subdivision ~b), which handles a hazardous material or mixture containing a hazardous material which has a quantity at any one time during the reporting year equal to, or greater than, a total weight of 500 pounds, or a total volume of 55 gallons, or 200 cubic feet at standard temperature and pressure for a compressed gas, shall establish and implement a business plan for emergency response to a release or threatened release of a hazardous material in accordance with the standards in the regulations adopted pursuant to Section 25503. The above violations must be corrected by February 22, 1991. ' The department will schedule a re-inspection of your facility to verify compliance. If you have any questions regarding this notice, please contact Barbara'Brenner at 3Z6-3979. Sincerely, ~ '~ ~ . . Barbara Brenner Hazardous Materials Planning Technician O Bakersfield Fire Dept. HAZARDOUS MATERIALS DIVISION Date Completed Business Name: ~F j~ ~J~:~-t'- '-+ '~ P Location: ~,~D E. C~L--t F. RECEIVED Business Identification No. 215-000 ~ ~' 0 (Top of Business Plan) FEB I 2 1991 Station No. ~ Shift '~ Inspector J~ ON~r'~-- HA~ t~AT' DIV. Adequate Inadequate Verification of Inventory Materials ~ Verification of Quantities ~  / Verification of Location ~ Proper Segregation of Material ~ Comments: Verification of MSDS Availablity ~ Number of Employees Verification of Haz Mat Training ~ Comments: "~,,n/' Verification of Abatement Supplies & Procedures ~/ "' Comments: Emergency Procedures Posted I~ Containers Properly Labeled ~ Comments:  Verification of Facility Diagram ~ Special Hazards Associated with this Facility: ]~[ON~__ Violations: CON,TlkC_T--'~ i~DNON i~'L.-- (~Ubsl 32..3-,fo1"7'"/ ,~,o.~, ~'$,5"-5-~'q(,=, 2.-~H~:, Correction Needed ~ ~ n ss Owner/Manager FD 1652. (~v. 1-90} ~q~it~-Haz I~t Dht, Yellow-Station ~py Pink-Busine~ P.x~y ~t~ ~ ~l~ Bakersfield Fire Dept. ~ \~. ~ .' RECEIVED  Hazardous Materials Division 2130 "G" Street F£§ 2 1 199J Bakersfield, CA. 93301 HAZ. MAT. DtV, 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 brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~6 T~ z.~ ~UN '& ~A~ST~EET NUMS~: PRIMARY ACTIVITY: ' MAILING ADDRESS: ~O ~, ~'~ SECTION 2: EMERGENCY NOTIFICATION: CONTACT x,?TLE BUS. PHONE 24 HR. PHONE FDIE~, 'Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAININ6: NUMBER OF EMPLOYESS: , MATERIAL SAFETY DATA SHEETS ON FILE: Y'~--~ BRIEF SUMMARY OF TRAINING PROGRAM: U ~ ' ' We_.-- ' ~..¢o,~c,.--, ~-~ . : .:.~:- ~. I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE 'DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE (DUANTITIES AT NO TIMEEXC.EED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, i-~ ~ v,.~ ,, t~,- ~ o~L.~,~ CERTIFY THAT THE ABOVE INFOR- 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. .. . ~ - ~,~..~ ~-/~-?/ "// '~'~'I~,IATUR~/ '"~'"~""'"'~ ~"~ TITLE DATE FD159¢, ~ · ' 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: UTILIW SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ELECTRICAL: On ¢~---[~ '~"-~-; ^5 A-lie/ .... WATER: ~ ~_r- l'~-,-fi ~ ~',~ ,---, /'"~¢,.,-- SPECIAL: LOCK BOX: (~O IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: '~ ~¢-¢ ex,~',~5, u~,l-,,.-r'-s c,,-, ~u~.i Io(;.-,.j B. WATER AVAILABILITY (FIRE HYDRANT): £ 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: CITY of BAKERSFIELD Farm and Agticulture FI Standard Business I-]HAZARDOUS MATERTALS TN~/ENTORY NON--TRADE SECRETS page / of - · ? Ni:l-I=R IO-iN~IIYUC;IJUN~ hUM PROPER CODES - - I 2 3 4 5 S I! Ii 10 II 12 II/~)' Names of ,ixture/Coeoonents Treins !ycle I~ax Av.erage Annual NRasure I {;ont ~;ont {~ont ~le Locqtion.¥heEe. Code code Act ACt Est un,ts on e /ype Press memo Stored In I-Utility See Instructions. Physical And tle,ith Haz,rd C.A.S. Number ~ ~-~,~k,',~ Component. II Name & C.A.$. Number (~ o~ I;.q e_ / / Fu e.,'/! (Check all that apply) .. ~ Fire Hazard ~ Reactivity ~1~ Delayed [] Sudden Release ~ lmmHeedailatLhe Component I~ Name & C.A.S. Number Health of Pressure Component 13 Name I C.A.S. Number C.A.$. Wu,bur ~'-/:/'~l ~'g' Component, II Name & C.A.S. Number (Check ali that apply) J~..Fire Hazard FI Reactivity FI Delayed [] Sudden Release [] leq'edi'a't'e C°'p°nent, eau;, ~2 Name ~ C;A.S. Nueeer Hem/th of Pressure Component 13 Name I C.A.S. Number Component 12 Name I C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ lm~i~ Hem ICh of Pressure  .. Component 13 Name I C.A.~. Number Physical end Health UH8rd C,A,S~ Number. Component II Name & C.A.S. Number (Check all that app/H Component 12 Name t C.A.S. Number ~ Fire Hazard ~ Reactivity ~ 0elayed D Sudden Release ~ Health of Pressure Component 13 Name I C.A.S. Number ~ - ~r Phone Name Tl [Tm 2~ ~r T~--~ Gerti[i'gatioq ,(Re~ a.n~.~fgn afCpr compl~Cfc~g.a~L.~c~fPn~) certify unoer pena~c~ oYUW tnqt ] nave peEsonal~y, examln~Hqo la rami~].a[ Vltgtne )nloceaHpn iu~mittpd in this.and all ~acp~d.d0cwment~, an~ t~ac cased on.my ~nqu~ry 9f.tnose tnotvtoua~s responsto/e tot obta~ntng the information. [ bem~eve that the suomlcceo Intoreltlo~ IS [rue, lccurl[e, lng complete. ~~~le of ~ ~rlooerator UH o, ner/operatOr authorlzeU rel~resefltatlve Signature OiL. , BAKERS I ELD CITY FIRE DEP/ TMENT " HAZARDOUS MATERIALS INVENTORY Page_o~_ Business Name Address CHEMICAL DESCRIPTION 1) INVI~NTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release Of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) wASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE solid [ ] Liquid [ ] Gas [ ] . Pure [ ] Mixture [ ] Waste, [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] gal [ ] ft3 [ ] e.) Container: Average Daily Amount: cudes [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size'Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List . COMPONENT CAS # % WT ~,HM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] 3) '[ ] 10) Location CHEMICAL DESCR!PTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILiTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: cudes [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1 ), [~' ] chemical components or ~ny AHM components 2) ' ~ [ ] lO) Location / believe submitted informa#on is ~ue, accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date BAKERSF IiLD CITY'FIRE DEPAI IMENT HAZARDOUS MATERIALS INVENTORY Page CHEMICAL DESCRIPTION 1) iNVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET ~,L TRADE SECRET [ ] 2) Common Name: C)~ (~57; !~.w. _~,~ / .~'~.~' ./~/~.,~' ~J~V/IL~.O~/~' 3) DOT #(optional) 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GORIES Fire ~ Reactive [ ] Sudden Rele~e of Pressure [ ] Immediate Health (Acute) ~ Delayed He~h (Chronic) 5) WAS~ C~SSIFICAT, O, ~ ~t (3-digit code from DHS Fo~ 8022) USE CODE P ~ ~ ~ . 6) PHYSICALSTA~ .Solid [ ] Uquid ~ G~ [ ] Pure [ ] Minute ~ W~te [ ] Redioa~e [ ] M~imum DalyAmount: I~ [ ] g~ ~ ~3 [ ] a) Coat.net: ~ Average Daily Amount: ~~ cu~es [ ] b) Pressure: Annum Amount: c) Temper~ure: ~gest Siz.'Contalner: /~ · DaysOnSite ...... Circle ~ich Months: ~J, F, M, A, M, J, J, A, S, O, N, D g) MI~URE: Ust ,, __ COMPONENT CAS, % ~ AHM the three most h=~aous 1 ) _Y~/~ ~ /~ -- ;~ - 7 chemicN componen~ or ~ / any AHM com~nent, 2) I~ ~ /0~' ~' ~ 10) Loc=ion CHEMICAL DESCRI~ION. 1) IN~NTORY STA~S: New [ ] Add,ion [ ] Revision [ ] Deletion [ ] CheckEchemi~ is = NON ~DE SECR~ ~] ~DE SECR~ [ ] Chemic~ N~e: H~dr~C~.~ b~ -- AHM~ CAS' H~RD CATEGORIES Fire ~ Rea~ive [ ] Sudden Rele~eof Pressure [ ] ]mmedi~e He~th (Ac~e) ~ ~layed He~th (Chronic) 5) WASTE C~SSIFICATION ~Z I (3-digit code from DHS Form 8022) USE CODE ~. I ~'~ 0 6) PHYSICALSTA~ Solid [ ] Liquid ~ G~ [ ] Pure [ ] Minute ~ W~te [ ] Radioa~ive [ ] 7) AMOUNT AND TIME AT FACIU~ UNITS OF M~SURE 8) STOOGE COOES a~imumOallyAmount: ~ .1~ [ ] g~ ~ ~3 [ ] a) Contanet: Average Dmly Amount: ~ cudes [ ] b) Pressure: Annu~ Amount: ' c) Temper~ure: ~gest Size Contaner: ~. ~ · Da~ On Site Circle~ich Months: ~J, F, M, A, M, J, J, A, S. O, N, D 9) MITRE: Ust COMPONENT CAS · % ~ AHM chemi~ com~nen~ or 10} Lo.ion I believe submi~ in~a~on is ~e. accum.. ~, compiete. ' /~ ~~--~~ ~-- " .BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION 2130 "G" STREET BAKERSFIELD, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid turther action, return this form within 30 days of receipt. ~'eb~rua~:¥ 7, 1994 '2. TYPE/PRINT ANSWERS IN ENGLISH. ', 3. Answer the questions below for the bCJ-~iness as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA LOCATION: g/¢ ¢' DUN & ~RADSTREET NUMBER: SIC MAILING ADDRE33: ~d SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24. 'HR. PHONE 2. .. ,-. ~.~ Bakersff~9tcl 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: O. EMERGENCY MEDICAL PLAN: · Bakers~_eld Fire Dept. Hazardous l-%Eateria[s Division HAZARDOUS 'MATERIA[~ MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: 8. RELEASE-'CON'FAINMENT AND/OR MINIMIZATION' C. CLEAN-UP PROCEDURES' SPECIAL: LOCK SOX: YES N,(N,(~"~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER"AVAILABIUTY: A. Pre,vA'rS F~r~E PROTECTION' B. WATER AVAILABILtTY (,FIRE HYDRANT}' ' --:sF',,,,...~_. %~, ~~ ....... L TO: CiTY O KERS IE D:, ~ I ~ ~ITY OF BAKERSFIE~ ~ / APPUCAN, SHOU~ ALLOW TWO WEEKS CALIFORNIA ~ - ~OR NECE,SARY INSPE~NS. P.O. BOX 2057 ; ~ LICENSE ' ' ' BAKE~FIELD, CA 93303 ~PLICgTION FOR BUSINESS LICENSE/I~X CErTIFICaTE CHANGE oF ADDRESS ' ' PURSUANT TO ORDINANCES OF THE CITY OF B~ER~IELD ~ - ' ~ (~amte Mcen~ R~ui~ ~ Each L~fl0n) ~MES AND ADDRESSESOF ALL OWNERS (Or P~nciple Officem, ~ a ~ration) NAME HOME ADDRESS TELEPHONE INSPECTION RECORD' H.O.P. ' Zoning AUTHORIZATION DATE:. REQUIREMENTS OR CONDITIONS PLANNING DEPT. BUILDING DEPT. FIRE DEPT ~' iAPPLICATION CONTINUED: TYPE OF ORGANIZATION: PARTNERSHIP r~ CORPORATION D FEDERAL EMPLOYER IDENTIFICATION NUMBER DATE COMMENCED BuSINESS IN BAKERSFIELD // ~/ / ~// p'~"~ " CAMFORNIA STATE CONTRACTOR'S MCENSE NUMBER, IF ANY NATURE OF BUSINESS FORMERLY AT THiS LOCATION FORMER OWNER ~AZ. MaT. 06/12/92 EDS MARKET & BP GAS 215-000-0002 ?age 1 Overall Site with 1 Fac. Unit General Information Location: 430 E CALIFORNIA AV Map: 103 Hazard: Low Community: BAKERSFIELD STATION 02 Grid: 32A F/U: 1AOV: 0.0 iContact Name Title i Business Phone i 24-Hour Phenol DNAN AL-QUDSI IoWNER (805) 323-6134 x (805) 835'589~ Administrative Data Mail Addrs: 430 E CALIFORNIA AV D&B Number: 77-026-3127 City: BAKERSFIELD State: CA Zip: 93307- Comm Code: 215-002 BAKERSFIELD STATION 02 SIC. Code: 5541 Owner: ADNAN AL-QUDSI Phone: (805) 323-6174 Address: 430 E CALIFORNIA AV State: CA City: BAKERSFIELD Zip: 93307- Summary I, :~J,~ ~&~' Do hereby certify that I have ~lewed ~ ~hed h~a~ous materials m~age- ~ plan for~ p'~ ~/~,~ ~d that it along with ~ ~ions ~nS~ute a complete and correct man- ~ent plan for my facility. 06/12/92 EDS MARKET & BP GAS 215-000-000260 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL -- 10,000 I 8,000.00 48,600.00 Storage~ Press T Temp Lo~ation UNDER GROUND TANK I Ambient~Ambient FRONT OF BUILDING -- Conc Components - MCP .----[List 100.0% IGasoline ModerateI 02-002 GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL~ CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GALI Daily Average GAL ] Annual Amount GAL 10,000 ~ 8,000.00 48,600.00 Storage~~Press T Temp Location UNDER GROUND TANK IAmbient~AmbientlFRONT OF BUILDING -- Conc Components MCP List 100.0% IGasoline IModeratel 02-003 GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL 10,000 ~ 8,000.00 48,600.00 Storage Press I Temp~ Location UNDER.GROUND TANK Ambient~AmbientlFRONT OF BUILDING -- Conc Components ~ MCP List 100.0% IGasoline IModeratel 06/12/92 EDS MARKET & BP GAS 215-000-000260 Page 3 0.0 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 WE WOULD NOTIFY THE FIRE AND POLICE DEPARTMENTS AND ALSO THE NATIONAL RESPONSE CENTER IF REQUIRED. IN CASE OF SPILL (LARGE) OR FIRE TELEPHONE ACROSS THE STREET IF. SAFE, IF NOT SAFE TELEPHONE DOWN ABOUT 1/2 MILE. <2> Employee Notif./Evacuation VERABAL NOTIFICATION AND CALL 911 FROM SAFE AREA. WE HAVE NO EMPLOYEES, BUT WE WOULD DO A HEAD COUNT AND ANY ONE NOT HERE WOULD BE CALLED BY PHONE. <3> Public Notif./Evacuation WE WOULD WARN THEM VERBALLY OR BY TELEPHONE. <4> Emergency Medical Plan NEAREST HOSPITAL 06/12/92 EDS MARKET & BP GAS 215-000-000260 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention FUEL IS CONTAINED UN UNDERGROUND TANKS. SAFETY UNIT SHUT OFF VALVES AND ALL OTHER SAFETY EQUIPMENT REQUIRED BY LAW. <2> Release Containment THE TANKS BEING UNDERGROUND AND WE COMPLY WITH ALL LAWS. <3> Clean Up WE WOULD USE AN ABsORBANT MATERIAL. KITTY LITTER WHICH WE HAVE ON HAND AT ALL TIMES. <4> Other Resource Activation 06/12/92 EDS MARKET & BP GAS 215-000-000260 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - ON WALL FACING ALLEY C) WATER - NEAR LARGE SIGN/NEAR SIDEWALK D) SPECIAL - NONE E) LOCK BOX - YES - FOR ELECTRIAL ON ALLEY <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN BUILDING FIRE HYDRANT - CORNER OF CALIFORNIA AND TULARE - BEHIND THE GASOLINE TANKS <4> Building Occupancy Level 06/12/92 EDS MARKET & BP GAS 215-000-000260 Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 2 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: WE ARE A HUSBAND AND wIFE OPERATING THE STORE, WE KNOW HOW TO SHUT OFF PUMPS ELECTRONICALLY. IF THIS DOESN'T WORK WE SHUT. THEM OFF MANNUALLY. IF THERE IS A LARGE SPILL IT NEEDS TO BE PICKED UP WITH ABSORBANT MATERIAL. IN CASE OF EVACUATION WE EVACUATE TO AL LEAST 1/2 MILE OF PROPERTY IN CASE OF FIRE. IN CASE OF THIS TYPE OF EMERGENCY WE WOULD CAL~ FIRE DEPARTMENT. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use