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Home My WebLink AboutBUSINESS PLAN ITE DIAGRAM 1~ FA'~ILITY DIAGRAM COUNTY OF KERN qB,000 sf . 11100~ ".S" Street COUNTY OF KERN 9,000 sf , _. ,. J .... .. " FENCED FENCED PARKING PARKING PART NOT A PART ~ ~ q28 California Avenue 40,000 sf NOT A PART FENCED -' PARK I NG NOT A PART '. E y of California : q2q California Avenue 68,000 sf NOT A PART NOT A PART - · ,;.S-I'TE/F'~CILI TY D! ..... : FACiL iT':' : U['~ [ T =: .... (CHECK ONE)' SITE DIAGR.4}f FACiL.[TY DIAGRAM ~ ,, (i~spectt}r's Comments): .-OFFICIAL USE ONLY- tCHECK ~.,'.~E SiTE DIAGRA:4 =aCrL'r~'~r 3'iAGRA>r ...... ,.~ e..,~ r~-,,.-~ ~ ~~' ' ' ''~~ ' , ~ , , inspector's Commen~s): -O~!CtAL USE ONEV- SITE DIAGRAM (Reqnired items) 1. Address: Identify the 9. Lock (key) Box : principle buildings by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys, 11. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Wire street names. b. Masonry 3, Storm Drains, Culverts, Yard Drains c. Wood 4, Drainage Canals, Ditches, d. Gates " Creeks, 13. Powerltnes 5. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c. Metal construction capacity in gal. a. Above ground -' d. Access Door .... ' b. Underground 6. Utility Controls - ' a. Gas 16. Diking or Berm : b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: :.- '-".' ~ Identify the 7. Fire Suppression Systems: location where a. Fire Hydrants employees will 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 ' ' * .... ~"'i~; . . Use/Handling '. · ~ . ~ , ,' e. Fire Pump 22. Type of Hazardous Material/Waste Stored -. 8. Fire Oepart~ent Access or Used (See Below) -:- :, . ,." ~. .. .: ~,_ TYPE OF HAZARDOUS MATERIAL F = Flammable E = Explosive L = Liquld R = Radtologlcal ¢ - Corrosive 0 = Oxidizer G = Gas P = Poison .. W = Water Reactive T = Toxic S = Solid H = Cryogenic D = Waste B = Etiological Example: Flammable Liquid ~ FL FACILITY DIAOR~ (Required items in addition to the'~bo~e) "* -*' '" : ~ '~" -' 1. Risers for Sprinklers .......... : ......... 8. Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: 'Indicate ~he 10. Windows levels served from highest to lowest. 11. Inside Hazardous ~aste Storage 4. Escalator: Indicate the lev. els served from 12. Inside Hazardous highest to lowest. Materials Storage 5, Elevator 13. Inside Hazardous ~ Materials Use/Handling '~ 6. Attic Acc~ .~-~-~ ,~ 14. l)raln Inlets 7. Skylights HAZARDOUS MATERIALS INS~CTION ~:~: Bakersfield Fire Dept. 1715 Chester Ave. Bakersfield, CA 93301 Date Completed Business Name: /~"~sT.~_ .~,,O /~ ~ - '~, Loca~on: ~q ~dz/~) ~ ~ Business Iden~fica~on No. 215-000-~o[~? ~ ~op of Business Plan) Station No. ~ Shift ~ Inspector ~ ~ ArrivalTime: /~0 Depa~ureTime: /~3~ InspecfionTime: ~quato Inadoquato ~dequato Ina~quate Address Visable ~ ~ Emergency Pr~edures Posted Coff~t Occupancy ~ ~ Containers Pro~dy Labled Verification of Invento~ Materials ~ ~ Comments: Verification of Quantities ~ Verification of L~ation ~ ~ Verification of Facili~ Diagram Pro~r Segregation of Uatedal D ~ Housekeeping Fire Protection Comments: Electrical Comments: Verification of MSDS Availabli~ ~ Numar of Employees: UST Monitoring Program Comments: Verification of H~ Mat Training ~ Pe~its Comments: Spill Control Hold O~n Device Verification of Hair. us Waste EPA No. ~atement Sullies and Procedures ~ Pro~r Waste Diesel Comments: Secon~ Containment Secufi~ Special Hazards Associated with this Facility: Violations: . . /V,,. Q,. ¥-,, . ,_. ,~___ .__ _ _ All Items O.K[] ,~ Business Owner/Manager PRINT NAME SIGNATURE ~ Correction Needed[] ~ ~ r~ White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy u_ HAZ~, RDOUS'MATERIALS INS]~CTION . :: Bakersfield ';~[re Dept. ,' ' V ~: 1715 Chester Ave, ' '-.. Bakersfield, CA 93301 Date Completed Business Name: ~5Z.~ /~ ~ - Business Iden~flca~on No. 215-000-~o~ ~ ~ of Business Plan) sta~on No. ~ Shift ~ Inspector ~ ~ ArrivalTime: /qTO Depa~ureTime:' / ?~ Inspec~onTime: Adequate Inadequate Adequate Inadequate Address Visable [] [] Emergency Procedures Posted r'l [] Correct Occupancy r'l [] Containers Propedy Labled [] [] Verification of Inventory Materials [] [] Comments: Verification of Quantities 13 [] Verification of Location Fl r"l Verification of Facility Diagram r-I [] Proper Segregation of Matedal [] [] Housekeeping [] [] Fire Protection 13 Comments: Electrical ' [] [] Comments: Verification of MSDS Availablity [] [] Number of Employees: UST Monitoring Program [] [] Comments: Vedfi~tioh 'of Haz Mat Training [] [] Permits [] [] Comments: Spill Control [] ..,. .[3 Hold Open Device ~ i"1 Verification of Hazardous Waste EPA No. Abbatement Supplies and Procedures [] [] ""' Proper Waste Disposal [] Comments: ' Secondary Containment I"1 [] .,,.' Secudty Special Hazards Associated with this Facility: /EJ, o '.,4'~ ~ ~/~ ~: 5' Busi;e;s O~wnerlManager PRINT NAME SIGNATURE Correction Needed VVhite-Haz Mat Div, Yellow-Station Copy ,, Pink-Business Copy HAZAR00,US MATE ,LS INSPECTION ~l~kersfield Fire Dept. * Ha~aFdous Materials Division i/ Date Completed Business Name: ~.S-//7'1'~'n ~-'-r~C, Location: /'/~//*'/ '6 ~ Business Identification No. 21,5-000 06/~ ~'" (Top of Business Plan) Station No. o/ Shift ("_ Inspector Arrival Time: //-J ~o Departure Time: /'z/'~O Inspection Time: / ~ i~c~tion of Inventory Materials ' ~0.~' 'j''l~cja '1~/ Verification of Quantities I--J /j~ /_/AZ. ~AT..I 2 ' / Verification of Location ~J~ ,~ ~o ~Comm Proper Segregation of Material Verification of MSDS Availability Number of Employees: Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram '(~ Special Hazards Associated with this Facility: Violations: ,.~'.'~,~,~ U,~/~.~-J-J~**~, ../""~.~.~_ [~~ All Items O.K Busine~ ~er~anager PRINT ~ME ~ / -SIGNATURE Correc~on Needed Wh~H~ Mat D~ Yellow-Sa~on ~py Pink-Business ~py 03/18/92 EASTMAN INC 215-000-001292 Page Overall Sit. with 1 Fac. Unit ' ~ General Information Location: 444 CALIFORNIA AV Map: 103 Hazard: Moderate Community: BAKERSFIELD STATION 06 Grid: 3lB F/U: 1 AOV: 0.0 Contact Name Title Business Phone ~' 24-Hour Phone- DON KIMMEL (805) 324-g~51 x ~(805) ~ JALANA 4~v~4~¢S (805) 324-9751 x /(~o5)F7~ -~7Z8 Administrative Data Mail Addrs: 444 CALIFORNIA AV D&B Number: 95-307-2905 City: BAKERSFEILD State: CA Zip: 93302- Comm Code: 215-006 BAKERSFIELD STATION 06 SIC Code: Owner: EASTMAN INC Phone: (213) 427-72?0 Address: 3366 E WILLOW ST State: CA City: SIGNAL HILL Zip:qo~o(~- Summary RECEW~D ~p{{ ~ 9 %99~ HAZ. MAT. D{V. reviewed ~he attached haza:~ous materfaL~ manage; f°r~-As'Td-~~and that it along with (Name ~:,~* any corrections consEilu{e a composts and correct agemen~ p{an for my facility. 03/18/92 EASTMAN INC 215-000-001292 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 DUPLICATING FLUID (METHYL ALCOHOL) Liquid '5760 High · Fire GAL CAS #: 67561 Trade Secret: No Form: Liquid Type: Pure- Days: 365 Use: OTHER Daily Max GAL Daily Average GAL I Annual Amount GAL. 5,760 I 3,000.00 o 17,180.00 Storage~~Press T Temp Location METAL CONTAINR-NONDRUMIAmbient~AmbientlSE CORNER WAREHOUSE -- Conc Components MCP List 100.0% IMethanol IHigh 03/18/92 EASTMAN INC 215-000-001292 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation LEAVE AT NEAREST EXIT (WE HAVE 6). <3> Public Notif./Evacuation NO CUSTOMERS NO,CLOSE NEIGHBORS - FURNITURE GUILD - VERBALLY <4> Emergency Medical Plan SAN JOAQUIN HOSPITAL - 2615 EYE ST - 327-1711. 03/18/92 EASTMAN INC 215-000-001'292 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention THEY ARE IN METAL CANS STACKED IN BOXES OF SIX AND ON PALLETTES. <2> Release Containment <3> Clean Up <4> Other Resource Activation 03/18/92 EASTMAN INC 215-000-001292 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUT FRONT B) ELECTRICAL - MIDDLE OF WAREHOUSE C) WATER - DRIVEWAY OUT FRONT D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM, FIRE EXTINGUISHERS FIRE HYDRANT - NORTHWEST CORNER OUTSIDE <4> Building Occupancy Level 03/18/92 EASTMAN INC 215-000-001292 Page 6 00 ~ overall Site <G> Training <1> Page 1 WE HAVE ~ EMPLOYEES AT THIS FACILITY WE HAVE ~MATERIAL SAFETY DATA SHEETS O_N FILE ....... BRIEF'SUMMARY OF TRAINING: WE GET TOGETHER AND TALK ABOUT MSDS AND ANY OTHER PROBLEMS THAT COME UP. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future USe ~ Farm and Agriculture ~ Standard Business i%' Page NON - TRADE SECRET BUSINESS NAME:_~$T~%~A3 =~3C~ OWNER NAME: ~%$T~V%~-AJ ~C_. "~' NAME OF THIS'~TF~CILITY: ~K~W~a~ao~ LOCATION:44~ c~ ~. ADDRESS:~%G~ 6. uJ~{~_3 ~: STANDARD IND.~CLASS CODE: CITY, ZIP: ~%~> ~$5~ CITY, ZIP: .~;,~.~ ~{'~t| ~,4 qO~06~ .i DUN AND BRADSTREET NUMBER/FEDERAL ID PHONE #: ~'3Z~-97~t PHONE,.#~'iRI_%~-4~O- 1~(50 -' q_ .,_ REFER TO INSTRUCTIONS FOR PROPER CODES" i 2 3 4 5 6 7 8 9 10 11 12 13 14 Trans Type Max Average Annual Measure # Days Cent Cent Cent Use Location Where % by Names of Mixture/Cnmponents Code Code Amt Amt Amt Units on Site Type Press Temp Code Stored in Facility w~ I See Instructions I .1 I I I I I i I I I ',, Physical and Health Hazard C.A.S. Number Component # 1 Name '& C.A.S. Number (Check all that apply) Component # 2 Name & C.A.S. N~mber ~ Fire Hazard ~ Sudden Release ~ Reactivity ~ Immediate '['~ Delayed '~ -.. of Pressure ~,. Health Health ' Component # 3 Name & C.A.S. Number t I I I I' I I I I I ,, I Phlmtcal end ltealth l~ard C.~.S. Nu~sr Component # 1 N~ & C.A.S. Nmnber (Check all that apply) (ii Fi~ Haz=. [] Sudden ~lease '~ ~eactivit¥ ~-- Zmmed~ate' [] De~ayed Component # 2 N~ ~ C.A.S. of Pressure L Health Health Component # 3 Name '& C.A.S. Number I I I I I I I I I I I Physical and Health Hazard C.A.S. Number .: .... Component # 1 Name G C.A.S. Number {Check all that apply) <,- : Component # 2'Name& C.A.S. Number Fire Hazard Sudden Release Reactivity Immediate Delayed -- of Pressure Health Health Component # 3 Name & C.A.S. Number Physical and Health Hazard C.A.S. Number Component # 1 Name & C.A.S. Number. (Check all that apply) . . Component # 2 Name a C.A.S. Number ~ Fire Hazard ~ Sudden Release ~ Reactivity ~ Immediate ~ Delayed ' Of Pressure Health Health Component # 3 Name & C.A.S. Number . "E~E~GENCY cONTACTS #l #2 Name ~itle 24 Hr. Phone Name .. , ; Title 24 Hr Phone Certification (READ AND SIGN AFTER COMPLETING ALL SECTIONS) I certify under peanlty of law that I hayer personally examined and am familiar with the tnfor~ation submitted in this and all attached documents and that based on my inquiry of those individuals responsible for obta/n/ng the Information, I believe that the submitted information is true, accurate, and cC~plete. NAME-AND OFFICIAL TITLE OF OWNER/OPERATOR OR OWNER/OPERATOR'S AUTHORIZED RI~PRESENTATIVE SIGNATURE .c,.' DATE SI~NED Overall Site with 1 Fac. Gerferal I rfformat ic, r~ ILocation: 444 CALIFORNIA AV Map: 1(])3 Hazard: Moderate Ilder, t Nurnber: 215-000-001292 Grid: 3lB Area of Vul: 0.0 Business Phone ~ 24 Hour Phor, e~ , Cor,~act Name I .... Title ~ , (805)' (805) ~-~, LINDA b'ALC~ ~A ~ (805) 324~ x _ JALANA MUNN ~ (805) 324-9751 x Admir~istrative Data Mail Addrs: 444 CALIFORNIA AV D&B Number: City: BAKERSFEILD State: CA Zip: 93302- Corem Code: 215-006 BAKERSFIELD STATION 06 SIC Code: Ow~,er: EASTMAN INC Phone: (~t~ ~ ...... R~.!A AV State: CA City: ~ ~~ ~ ~ Zip: 93302- Summary RECEIVED NOV 1 3 1990 ~,'~ '~ Ki~el ldo horeby certify ~h~t ~ hav~ ~ Or p~in[ n~ "' reviewed the ~tt~ch~d ha.z~rdous m:~[:::~:ls manage- ~en~ plan for~~.~,_~..'-.; :; ~'.,~'.~ ~ ~k,ng wi~h ~ny corre~bns ag~msnt plan ~or my 10/08/90 EASTMAN INC 215-000-001292 Page Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCP 02-001 DUPLICATING FLUID (METHYL ALCOHOL) ? 2,400 High GAL 10/08/90 STMAN iNC 215-000-00 Page 3 O0 - Overall Site <D> Notif./EYacuation/Medical <1> Age~c¥ Notification <2> Er~ployee Not if./Evacuatior, LEAVE AT NEAREST EXIT (WE HAVE 6). <3> Public Notif. /Evacuatior~ <4> Er~erger, cy Medical Plan SAN JOAQUIN HOSPITAL - 2615 EYE ST - 327-1711. EASTMAN INC 215-000-001292 Page 4 00 - Overall Site <E> Mit igat ic, n/Prevent/Abaternt <1) Release Preve~tior~ THEY ARE IN METAL CANS STACKED IN BOXES OF SIX AND ON PALLETTES. IF A SPILL WERE TO OCCUR WE WOULD FIRST TOWEL IT UP AND THEN MOP IT UP. <2> Release Cor~tain~ner~t <3> Clear~ Up <4> Other Resource Activatior~ 10/08/90 ~ASTMAN INC 215-000-0012O Page 5 (')0 - Overall Site <F> Site Eraergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - OUT FRONT B) ELECTRICAL - MIDDLE OF WAREHOUSE C) WATER - DRIVEWAY OUT FRONT D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - <4> Held for Future use 10/08/90 EASTMAN INC 215-000-001292 Page 6 O0 - Overall Site <G> Trairsing Page 1 WE HAVE 3 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE <2> Page 2 as needed <3> Held roY- Future Use <4> Held for Future Use ~ "CITY of BAKERSFIELD /j~AZAR DOUS HATERTALS INVENTORY Farm and Agriculture [.! Standard Business NON--TRADE SECRETS '.~USINESS HAH.E;. ~%~~ ~,~ OWNER NAHE: ~OC~¢~,O~5~ ~~,T~,~ F~T~DE LOCATIOH; ~H~ C~,~C~ _ ~.~- ADDRESS; ~%~ ~' .(~)xX~O~ ~ ~"'[l"~ua~&T~ NUHBE~ I ~ 3 4 5 6 I 8 ] lO II 12 xli~y tlapes' of Pixture/Co~ponents Irons ]yqe ~ax Aver89e Annual He8~ure I ~Y~e GonL Gent ~ont Us Locqtion. MheCe. /ype Press /emp Co~e Stored Iff FaCIlity See instru:tlons rhvsical and Health Hazard C.k,S. NuAber ~ X~ Component II Hame I C,A,S, Number IC~eck ~11 that appll} ~Haz]rd 'B Re]cLivik~ B Delayed B Sudden Release B Im~i¢¢~ Component NB~e I C.A.~. Number Health of Pressure Component I] Nam8 I C.A.S. Number I I ,,I I I I I I I I I - - PhviicAl A0d Pellth Hlzlrd C,A.S. Number CoAponen~ II Name I C,A.S. Number (Check all' &hit a~ly) '~ .... Component Ii Name I C.A.S. Humber B ~ire H~zBrd ~ ReBckivi~f B Delayed B Sudden Release B Immediate .. Health of Pressure Health Component 13 Name I C.A.S. Number I I I I I I I I t I I --. -- physic]l And Hell~h Hazard C.A.S. NuLber Componen~ II NAme I C.A.S. Number ComponenL I~ Name I C.A.S. Number B ~ire Hazard B Reactivity B Delayed B Sudden Release B Immediate . __ -- HealCh of Pressure Health Component 13 Name I C.A.S. Number ~h~sicA} Ind Health Ua{etd C,A,S, Humber Component II Ham8 I C.A,S. Number (Check 811 that Applyl Compoflenk 12 Hame I C.A.S. Number ~ Cite Hazard . ~ Reactivity D 0elayed ~ Sudden Release ~ Im~i~ Hea/Ch of Pressure CompoflenL 13 Name I C,A,S, Humber EHERGENCY CONTACTS fll~t~x~ ~ ~¢~ ~~)'x~ ~'??~ f12~ ~~ Ti~~ certify un'er enal~i el!aW LA~L lnAvepeEsona/~y, examln~qQqolmTamlllaf. Vlkbthe/nl . .P i ~ ' .d ' & ' .Q ., ,. ~EaSVtEr,~ CtTV ~!R~. DEP^~ r RECE)VED 2130 "G" STREET BAkErSfIELd, CA ~O~ JUN 6 1988 INSTRUCTIONS: 1. To avoid further action, return this foum by 2. TYPE/PRINT ANSWERS IX ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: .~~,,,F~,~ _~_~.~ B. LOCATION / STREET ADDRESS: ~'/~/~// ' ~ SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State 0ffice of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILIT7 Sh-b~-OFFS FOR BUSINESS AS A W]qOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: /w,-.~¢i[{.~, D. SPECIAL: E. LOC~ BOX: YES ~IF YES, LOCATION: IF YES, DOES tT CONTAIN SITE PLANS? YES / 510 MSDSS? YES ./ ~0 FLOOR PLANS? YES ,/ NO KEYS? YES ,/ NO - 2A - SECTION 4: PRIVATE RESPONSE TE.~LM FOR BUSINESS AS A WHOLE SECTION 8: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE 'SECTION 6: EMPLOYEE TRAINING : EM?LCYERS ARE REQUIRED TO HAVE A' ?ROGRAM WHICH ?ROViDES EMPLOYEES WITH !.~;IT!AL REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR ~0 iNiTiAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS >~TERIALS:...' .................................... ~ESb~NO YES 'NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: ........................... ('~-E~NO YES NO C'. PROPER USE OF SAFETY EQUIPMENT: ................. ..~..Y_~ONo YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES N~ YES NO SECTION 7: HAZARDOUS .MATERIAL CIRCLE YES - NO - NONE DOES YOUR BUSI)iESS HANDLE HAZARDOUS >t~TERIAL IN QUANTITIES LESS THAN 50,0 POU.~[DS OF A $~ GALLONS OF A LIQUID, OR ZOO CUBIC FEET OF A COMPRESSED GAS: ...... YES ~ SOLID, I, ~ Uc~-~m'~ ,certify that the above information is accurate. I understand that this information will.be used to fulfill my firm's oblif~tions under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter Sec. ZS$00 Et Al.) and that inaccurate information constitutes perjury. - 2B - BAKERSFIELD CITY FiRE DE~.~RT. Ia.',T 2130 "G" STREET BAKERSFIELD, CA 9.~,~01 BUSINESS XA>IE: d~/ SI NGLE FACI LI TY UNI T FORM 3A INSTRUCTIONS I. To avoid further action, this form must be re'tu~'ned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE EACII, ITY UNIT LISTED BELOW i. Be as BRIEF and CPNC~SE as possible ' SECTION 1: ~ITIGAT!ON, PR~N~ION, ABATE>IEL~ PROCEDUSES SECTION 2: NOTIFICATION AN'D EVAC ...... N P?.OCEDr.~ES AT THIS L~."iT O.YLY BAKERSFIEI, D CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page ..o~f,j~_ · i NON--TRADE SECRETS - ' HAZARDOUS MATERI ALS I NVENTORY BUSINESS NAME: ii OWNER NAME: FACILITY UNIT #: ADDRESS: ~' ADDRESS: FACILITY UNIT NAME: CITY, ZIP: ' CITY,ZIP: PHONE #: ' :' PHONE #: [OFFICIAL USE CFIRS CODE ! ONlY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT'CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE " i _ i' NAME: - ~ TITLE:~~ ~~ SIONATURE:~ ~Ui" ~ DATE:/~c~/ E~ERGENCY CONTACT: TITI~:~ ~~ ~ ~ P~ONE ~ BUS HOURS: ~ ~FTER B~S EMERGENCY CONTACT: ~/~~ ~~ TITLE: ~7 ~~ ~ PHONE ~ BUS HOURS: ' PRINCIPAL BUSINESS ACTIVITY: AFTER BUS HRS: BUSINESS LICENSE NO. PERMIT REQUIRE'D~ PERMIT ~/, , BUILDING CLASS/TYPE OF OCCUPANCY BUSINESS NAME ~ i~USlNESS OWNER ~ .. ~USlNESS MGR./RESPONSIBLE BUSINESS PHONE " ' '-~' . HOME PHONE' NO, OF FLOORS . ~ ~ ~ SQUARE FOOTAGE~ . VIOLATION NOTIC U ~ _ / OCCUPANT LOAD ',DAT~ OF R E INSPECTIONS' ~'~ '1) (2) (3 ~ECTOR STATION/SH I FT/STATION PHONE