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Home My WebLink AboutBUSINESS PLAN SITE/FACILITY DIAGRAM NORTH SCALE: BUSINESS NAME: FLOOR: OF DATE: FACILITY NAME: UNIT ~: OF (CHECK ONE) SITE DIAGRAY / FACILITY DIAGR~ Inspector's Comments): -OFFICIAL USE ONLY- - 5A - SITE DIAGRAM (Req items) 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys, Ii. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property, include the a, Wire Street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4, Drainage Canals, Ditches, d, Gates Creeks, 13. Powerllnes 5. Buildings a. Frame construction 14. Ouard Station b, Masonry construction 15, Storage Tanks: Identify the c. Metal construction capacity in gal. a. Above ground d. Access Door b. Underground 6. Utility Controls a. Gas 16. Diking or Berm b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: Identify the Fire Suppression Systems: location where a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fire Pump 22. Type of Hazardous Material/Waste Stored 8. Fire Oepartment Access or Used (See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E = Explosive L = Liquid R = Radlological C = Corrosive 0 = Oxidizer 6 = Oas P = Poison W = Water Reactive T = Toxic S = Solid H = Cryogenic O = Waste B = Etiological Example: Flammable Liquid = FL FACILITY DIAOP,~ (Required items in addition to the above) 1. Risers for Sprinklers 8. Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest. I1. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage 5, Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets BAKEi~r'~_LD CITY FIRE DEPAR-iMENi' ' ~: ,, ..' 2130 'G' STREET ~ ;~ · BAKERSFIELD, CA. 93301 (805) 326-3979 /0~-~ OF~C~L US~ O.L~ BUSINESS NAME HAZARDOUS MATERIALSRECEIVED BUSINESS PLAN AS A WHOLE ~APR 2 5 FORM 2A HAZ. MAT. DIV. INSTRUCTIONS: 1. To avoid further action, return this from within 30 days of receipt. 2. TYPE/PRiNT ANSWERS iN ENGLISH. 3. Answer ~he questions below for %he bus,ness as a whole. 4. Be as b~e~ ~nd concise as possible. SECTION 1; BU~NESS iDENTiFiCATiON DATA A. BUSINESS NAME: ~ ~~1~0 ~~T B. LOCATION / STREET ADDRESS: ~ CITY:. ~~,~ ' ZIP: ~30~ BUS. PHONE: (~) SECTION ~; EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This wil~ notify your local fire depar~men[ and [he S%ate Office of Emergency Services as required by law. EHPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAHE AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. ~~/~ ~~ PH~ ~ ~ ~ PH~ B. PH~ PH~ SECTION 3; LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A, NATURAL GAS/PROPANE: B, ELECTRICAL: -.~(~ ~ ~~ C, WATER: ~//.~5 ~ ~ ~~ ~ ~~ ' D, SPECIAL: E. LOCK BOX: YES / NO iF YES, LOCATION: iF YES, DOES iT CONTAIN SiTE PLANS? YES / NO NSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES'/ NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5' LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EHPLOYERS ARE REQUIRED TO HAVE A TRAINING PROGRAM WHICH PROVIDES EHPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE SAFE HANDLING OF HAZARDOUS HATERZALS, A. NUMBER OF EMPLOYEES AT THIS FACILITY ~ B, 'DO YOU HAVE MSDS {MATERIAL SAFETY DATA SHEETS) FOR EACH HAZARDOUS HATERIAL YOU HANDLE ~ f~/~-~ · C. GIVE A BRIEF SUHNARY OF YO~ HAZARDOUS HATER~ALS TRAINING PROGRAN: SECTION 7: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE CALIFORNIA HEALTH AND SAFETY CODE FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS, WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 8; CERTIFICATION I, ..~/~z~/~/ ~-~ , certify that the above information is accurate. I understand that~ this information will be used to fulfill my firm's obligations under the new Cal'ifornia Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. ~' ' BAKERSFIELD CITY FIRE D RTMENT ~'~' 2130 'G' STREET BAKERSFIELD, CA. 93301 (805) 326-3979 ~ OFFICIAL USE ONLY ~ ID# II BUSINESS NAh4E HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 3A INSTRUCTIONS 1, To avoid further action, 1;his form musl: be returned by: 2, TYPE/PRINT YOUR ANSWERS IN ENGLISH, 3, Answer the quesl;ions below ~or THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible FACILITY UNIT # ,FACILITY UNIT NANE: SECT[ON 1: HIT[GAT[ON, PREVENT[ON, ABATEHENT PROCEDURES ~ECT~ON 2; NOTIFICATION 'AND EVACUATION PROCEDURES AT THE UNIT ONLY ,ECTION 3' HAZARDOUS MATERIALS FOR THIS UNIT ONLY ' A. Does this Facility Unit contain Hazardous Materials? ...... YES NO If Yes, see B. NO, continue with SECTION 4 B. Ar any of the hazardous materials a bona fide Trade Secret? YES NO If complete a separate Hazardous materials inventory form arked- NON-TRADE SECRETS ONLY (white form ~4A-1) If YE~ complete a hazardous materials inventory form marked- TRADE ~CRETS ONLY (Yellow form ~4a-2) in addition to the non-trade secret List only the trade secrets on form 4A-2. SECTION 4: PROTECTION SUPPLY FOR USE BY EMERGENCY RESPONDER~ (Fire Hydrant SECTION 6' LOCATION OF UTILI IT-OFFS UNIT A. NATURAL GAS/PROPANE: B. ELECTRICAL: C. WATER: D. SPECIAL: E, LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES / NO ~s? YES / NO FLOOR PLANS? YES / NO YES / NO - 3B - CITY of BAKERSFIELD ,~ NON--TRADE SECRETS ' Page .... of .... BUSINESS NAME: /L ~.A~;~ ~ OWNER NAME: ~/~ ........... ~~ NAME OF t~ FACILITY: LOCATION: ~, ~Z,~ ~ ADDRESS: /~Z/~p <,'L {/~.~- ~ d~ ~ STANDARD IND. CLASS CODE CITY, ZIP: ~/~4~,' ~ F~ ¢4.~ Y CITY, ZIP }E~'~¢~i ~,~/~ ~// /'~ DUN AND BRA~T~ET NUMBER PHONE ~: k--' ~2~ qQ'~ PHONE ~: ~'~ -.-f~.} , ~ ~ ~J - ans Ty~ ~x Average ~.uel ~asu. I ~ Cmt ~t ~t ~, L~tt~ N~e %W~ Nam of e C~e ~t ~t Est Units ~ Site TyN P~I TW C~l Stor~ in Facility~' ~ inst~ti~ Ph~ical and H~lth Hazard C.A.S. ~ ~t II ~ ~ C.A.S. ~r (~k ail t~t a~ly) e Hazard c_~ Reactivity -- ~ ~--J ~ Rel~se ~--~ I~iate Health of P~ure ~lth ] IIllL .... l ........... ~1 ..............I .......... J ..... I ...... 1 ...... I L_J..::: I ' P~ical a~ H~ith Hazard CiA.S. ~ at II Ne i C.l.S. ~ (C~k oll t~t apply) g ] Fire Hazard ~ ] Reactivity ~_d ~la~ ~--a ~ ReiN~ ~--~ HHIth of P~ H~lth ....L__[_L .......... m .l I L__rI I I..... I P~tcai md H. lth Hiza~ C.A.5. ~ at I1 h i C.A.S. ~ (C~k aH t~t apply) -- r--~ r--~ -- -- ~t 12 Nm &C.A.S. ~ ~ ~ Hre Hazard ~_d Reactivity ~_d ~la~ ~ ~ ~dd~ RelHse ~ ~ I~ate Health of Pr~sure Health ' ~ .~ ........................... .......... ,.~_._~_. (C~k 4ll t~t a~iy} L ~ Her Hazard g ] Reactivity ~--~ ~la~ [--] ~dd~ Release ~_d Health of Pe~sure Health ............ ~ ............................................ . - .... ~[1; ....................... 2T-RF'P~ ....... Rjr' Tt~ll ~I~F'P~ ...... Certificati~ (Read and sJgn after completing all sections) I certify ~der ~alty of 1ne t~t I ~ve ~rsmallyexaam~ and aa faeiliar .ith t~ infor~tim su~itt~ tn this a~ all ett~c~ ~ts, and t~t ~s~ m W in;uiw of t~e t~tvi~als r~sible for ~btaining t~ intor~tim. I ~lieve t~t t~ su~itt~ infor~tim is true, accurate, and cmole~. / ~ ~ O~'Sl]a~ ............................ % BAKERSFIELD RECEIVED NOV 0 6 1991 October 15, 1991] HAZ. MAT. DIV. E1Barralito Market 429 James Street Shafter, California 93263 RE: Hazardous Materials Account HM391601 ,Mr;-~Pere~or-Mr~H,a:ro.um~: ..... The City of Bakersfield has demanded payment in full on'the above mentioned account. To date we have not received payment. The city is prepared to file an action against you in small claims. If you wish to avoid legal action or if you have questions about the bill please call me immediately at 326-3933. Drew Sharples Financial Investigator cc: file City of Bakersfield · Treasury Division · P. O. Box 2057 Bakersfield · California · 93303 (805) 326-3757 ... ~...,:' MEMORANDUM -~ JANUARY 9, 1991 TO: RALPH HUEY, HAZARDOUS MATERIALS SUBJECT: HM ACCOUNTS HM 475001 Hooper Air Conditioning' '~ Building'at 520 E. 19th ..... - down.-.No longer jnhabit.ab!e~i:~.iMoved to 423 Sumner 4M 391601 ~'~EI Barril;i 'March 'mak6']