HomeMy WebLinkAboutBUSINESS PLAN
SITF_ DIAGRAM , ! FACILI, TY DIAGRAM
~usine~ Name: - '~SC_ou,,/~ '"FTYS_. ~.. ~i~AtC~ .
' Business ACC, re~: ._q"-OC,h
For Office Use Only
Firs~ In Stc'~Jon: Area Mca #
inspection Station: NORTH
r-~ ~,l.~.,,ll ,Tire centers 5800 s. Eastern Ave., 5th Floor
Evans Tire & Service Centers City of Commerce, CA 90040
C O M P A N ¥, . TEL: (213) 725-0099
FAX: (213) 725-0759
RECEIVED
JANUARY 20, 1995
BAKERSFIELD FIRE DEPARTMENT
HAZARDOUS MATERIALS DIVISION
2130 "G" STREET
BAKERSFIELD, CA 93301
RE: Discount Tire Centers #051
500 California Ave.
Bakersfield, Ca 93304
To Whom It May Concern:
Attached is our updated Hazardous Materials Management Plan
for our above location.
· Beerwert
~/Operations Manager
JDB/ao
BAKERSFIELD CITY FIRE DEPARTMENT
HAZARDOUS MATERIALS DIVISION
2130 "G" STREET
BAKERSFIELD, CA. 93301 ·
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: DISCOUNT TIRE CENTERS #051
LOCATION: 500 CAL'IFORNIA AVE
MAILING ADDRESS: 5800 S. EASTERN' AVE 5TH FLOOR
CITY: COi~4ERCE' STATE', CA ZIP' 90040 PHONE'. (213) 725-0099
DUN & BRADSTREET NUMBER: 059808634 SIC CODE: 7538
PRIMARY ACTIVITY' TIRE DEALER & AUTOMOTIVE REPAIR
OWNER: AKH COMPANY,INC.
MAILtNG ADDRESS: 5.800 S, EASTERN AVE. 5TH FLOOR COMMERCE, CA 90040
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE .BUS. PHONE 24 HR. PHONE
1. SHAWN DAY MANAGER (805) 324-4701 (209) 832-6934
2. SAM .... 'MAC/AS. ~. _:. ASST. MANGER ( 805 ) 324~4701 (805) ,.$46L0570~- .- . -
.. Bakersfield Fire Dept.
~ardous 1V~iterials Division ....
HAZARDOUS MATERIALS MANAGEMENT PLAN '
SECTION 3: TRAINING:
NUMBER OF EMPLOYEES: 5
MATERIAL SAFETY DATA SHEETS ON FILE: IN MANAGERS OFFICE
BRIEF SUMMARY oFTRAINING PROGRAM:
ALL EMPLOYEES MUST ATTEND OUR NEW EMPLOYEE CLASS PRIOR TO STARTING
TO WORK AT THE STORE. IN THIS CLASS NEW EMPLOYYES ARE INSTRUCTED IN:
1. HANDLING AND USE OF HAZARDOUS MATERIALS.
'2. HOW TO USE MSDS
3. 1/2~-HOUR VIDEO ON HAZARDOUS MATERIALS
· ~4. WRITTEN TEST
SECTION 4: EXEMPTION REQUEST:
I CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS IS EXEMPT FROM THE
REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALtFORNIA HEALTH &
SAFETY CODE" FOR THE' FOLLOWING REASONS:
WE OD NOT HANDLE HAZARDOUS MATERIALS.
XXX
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO
TiMEEXCEEE) 'THE MINIMUM REPORTING QUANTFT. IES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
JOHN D. BEERWERT
h. 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 SAFFzT'Y CODE"'
ON HAZARDOUS MATERIALSi'(DIV. 2(3 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURATE INFORM~'N.CONSTITUTES PERJURY.
~ .SIGNATURE TITLE DATE.
2.
Bakersfield Fire Dept
Hazardous Materials Div/si0n
HAZARDOUS MATERIALS MANAGEMENT PLAN
Unit Name: DISCOUNT TIRE CENTERS #051
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFiCATiON PROCEDURES:
1. THE STOREMGR. IS IN 'CHARGE OF EMERGENCY NOTIFICATION'AND HE WILL
HAVE AND USE A HAZARDOUS MATERIALC'EMERGENCY CHECKLIST. WHICH HE
WILL TURN OVER TO THE EMERGENCY RESPONDERS.
2. THE ASST..MANAGER WILL BE IN CHARGE, INTHE ABSENCE OF THE STORE MGR.
3. STORE MGR. WILL NOTIFY THE FIRE DEPARTMENT.
B. EMPLOYEE NOTIFICATION AND EVACUATION-:
Employees will be notified by shouting'and the waving, of'the arms.
Employees will evacuate the building through the closest, fastest, exit.
All employees will meet at a pre=determined staging area away from the
builing.
C. PUBLIC EVACUATION:
The public will be notified by the phone or in person by one of
the employees designated~by the' store manager.
O. EMERGENCY MEDICAL PLAN:
BAKERFIELD OCCUPATIONAL CENTER
4580 CALIFORNIA AVE.
BAKERSFIELD, CA 9.3309
(805) 327-4527. .
.. 'x -' : ' Ba~ersEel~Fbe Dept.
~tazard0us Materials Di~/si0n
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7' MITIGATION, PREVENTION AND ABATEMENT PLAN:
A. RELEASE PREVENTION STEPS:
Instruct carefu~ 'handling of HAZARDOUS.MATERIALS.
FIRE EXTINGUISHERS
ABSORBANTS FOR SPILLS
B. RELEASE. CONEA[NMENT AND/OR MINIMIZATION:
Any release of a Hazardous Materials will be stopped with
the absorbents and shop towels.
C. CLEAN-UP PROCEDURES:
The release will be cleaned uP by Employees using Approved Hazardous
Waste containers or a licensed HAZARDOUS WASTE CONTRACTOR will be
called in to clean-up the release.
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY}:
NONE
NATURAL GAS/PROPANE'
ELE'CTRICAL: BEHI.ND SOUTH EAST WALL
WATER: BACK OF SHOP SOUTHWE~ WALL
SPECIAL:
LOCK BOX: YES/NC).- IF YES, LOCATION:
SECTION 9: PRIVATE FiRE PROTECTION/WATER AVAILABILITY:
%. PRIVATE FiRE'PROTECT[ON:
Fire extinguishers, alarm system
B. WATER AVAILABIUTY (FIRE HYDRANT): : ..::
about 100 yards in front of building
A'
BA ,RSFIELD'CITY FIRE ( EPARTMENT
HAZARDOUS MATERIALS DIVISION
2_130 "G" STREET
BAKERSFIELD, CA..93301
(.805) 326-3979
HAZARDOUS MATERIALS INVENTORY
FACILITY DESCRIPTION
CHECK IF BUSINESS IS A FARM [ ]
BUSINESS NAME AKH COMPANY, INC,. :
FACILI/Y NAME DISCOUNT TIRE CENTERS ~051'
SITE ADDRESS' 5OO CALIFORNIA AVE
CITY BAKERSFIELD STATE CA ZIP 93304
NATURE OF BUSINESS· TIRE DEALER &. AUTOMOTIVE REPAIR
SIC OODE 7538 ~UN & BRADSTREET NUMBER 059808634
OWNER/OPERATOR AKH COMPANY, INC. RHONE (21.3) 7250099
MAILING ADDRESS 5800 "S. EASTERN AVE 5TH FLOOR
OITY COMMERCE ' STATE CA ZiP 90044
EMERGENCY CONTACTS
NAME SHAWN DAY TITLE MANAGER
BUSINESS PHONE (805) 324-4701 ~.4.-HOUR PHONE (209) 832-6934 '
NAME SA~ MAC~%S. TITLE ASST. MANAGER
BUSINESS PHONE (805) 324-4701 24-HOUR PHONE (805) 7~4~.0570.
BAKERSFII LD. CI'EY FIRE. DEPAI 'MENT
HAZARDOUS MATERIALS INVENTORY Page_of_
Business Name Address
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ 1 Addition [ ] Revision [ ] ~eletion [ ] Check if chemiceJ 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 Hea~th (Acute) [ ] Delayed Heath (Chronic) [ ]'
5) WASTE CLASSIFICATION (3-digit code from DH'S Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid [ 1. Gas [ ] Pure. [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TiME AT FACtUTY UNITS. OF MEASURE 8) STORAGE CODES
Maximum Oaily Amount: lbs [ ] gal [ ] ft3 [ ] a) Container.
Average Daily Amount: cur~es [ ] b) Pressure:
Annual Amount: c) Temperature:
L~rgest Size Container.
# Days On Site CircleW~ich Months: AllYesr, J, F, M, A, M, J, J, A. S. O, N, D
9) MIXTURE; Mst COMPONENT CAS # % WT AHM
the three most hazardous 1) [ ]
chemic~ components or .
any AHM components 2) [ ]
3) [ 1
10) Location'
CHEMICAL DESCRIPTION
1 ) INVENTORY STATUS: New [ ]' Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TP'ADE SECRET [ ] TRADE SECF{ET [
2) Comm;3n Name: 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ I Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE COOE
6) PHYSICAL STATE Sotid [ ] Uquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT ANO TiME AT FACILITY UNITS OF MEASURE 8) STORAGE CQOES
Maximum Daily Amount: lbs [ ] gal [ ] ~t3 [ ] a) Container:
Average Daily Amount: cudes [ ] b) Pressure:
Annual Amount: c) Temperature:
L~'gest Size Container:
# Days On Site Circle Which Months: Ail Yea~. J, F, M, A, M,' J, J, A, S, O. N. D
9) MIXTURE: List COMPONENT CAS # % WI' AHM
the three most hazardous 1) [ ]
chemic~ componen~ or
a~y AHM components 2} [ ]
3) [ l
10) Location
3anally of law, mat I have personally exarntneO and am familiar w~h ~he inforna~on suDrnitted on ~hi$ and a~l arZacheO docurnen~s. I believe
submitted informa~on is ~ue. accurate, and complete.
PRINT Name & TTtle of Author/zed Cornpany ~epresente~ve. Signature Date
BAKERSFIELD CiT . FIRE DEPARTMENT
HAZARDOUS IVtATERIALS INVENTORY Page_Lof_2_
:usiness Name DISCOUNT TIRE CENff'EPS:~,5-1 Ad_dress IA AVE-
CHEM_ICAL DESCRIPTION
'J) INV~_.NTORY STATUS: New ~)(j Addition[ j' Rev,s,on( f-P_.ee::<)n[ _]_~.- Ch,eckifcn.emicsJis aNON .-P. ACESECR~F [ ] TRAOESECRET ~ ,
2) co,==.-o,,,N~'~e: SAFETY-KLEEN- 105 PARTS'."~WASHING SOLVENT 3) cc: ¢ (~,o~] 1255
Che~,ca Name: HYDROCARBON SOLVENT AH:.~ [ 1 C~S = ~-
'~) PHYS,;CAL A H~At%'d, ?M'.-'S;CAL M-~AL~,q .
HAZ..z-P.O C.:J-~_GORIES Fire [~ Reaczive [ ] Sudden :~eiea.se of Pressure [ ] Immediale Hee.,'tn (Ac'~et [ ] C~iayed He.tn (Chro.mc) iX
:i "~)PH'fS;CALSTA~-:- Soiid[ ~ tJquid ~(] Gas [ i Pure ] .M.L~ure ~] V,'*-s~.e [ ] P, adioact, ive[ ]
Averace OaJjy AmounC ~ 0 curies [ ~ bi P:es~ure: 1
· { ~ Oa,/s Ca S;:e 365 C~,de Whit:-, :.~o=[hs: A, .Ye~:. J..=. M. A. U. 3. ~. k S. O. N. O
9) MIA,v'~'JR5: List · CCMPON~NT CAS ¢ % %;%
the =r~e most. haz.m'dous ~) C9-'C] 3 SATURATED HYDROCARBON 6474 ]-4 ]-9 85
che.q',ioaJ components or -'
~'w -=;~,:,~ oompo~s 2) TOLUENE';' -' 108-88-3 0 _ ~
=~ XYLENE 1330-20-7 1 .5
CHEMICAL DESCRIPTION ..... ::
_1 ) INV'Z~NTORY STA'FUS: New [~]· Addition [ ] ,=,e.,Asion [ ] C~!ed~n [ I C~eck ~ chemice] is a NON l'7-¢,gE SECRET [ ] h--~kD5
2) Comm~nNaz~e: PENNZOIL' HD MOTOR' OIL SAE 30 3) ~f~T¢(optioriaJ')
MOTOR OIL LUBRICANT AH,~[] CASe MIXm[]R~.
Che,.micaJ N .ame:
' ' . .... .t...-'. ..... ' ............... :2...:' .
4) PHYSICAL & HSALi';H pMys1c;~.-] .k - ......................... ~ ................
MAFARO CATEGORIES Fqre J~]] Reac-z. ive[ ] Suddea .~ele~Lse of Pressure ( ) Immediaze HeJ'.,h (Amc. e) [ ~ Delayed HeaJLh
' 51 W~,STE CLASSiFICADON 22 i g-diSk ood* ~.o~O~.S F0~ Satin .USECOOE .26 ................
[t 7) ,:,,MOUNT ANO ~/',~ AT FAC:UTY - UNITS OF k{=EASURE 8) STCRAG5
~.~verage Daily Amoun.:: ] cudas [ ] b) .=ress~re:
[J Annue] Amoun',: 1080 c:
t_~rges: Size Com. a~ner. ] 0 0 "·
~ Day's On Ske ] ~;; ~ C[tcf~ Vv,~ich ,?,onI,~s: ,~ v~.. J. F. ,M. A. M.'
· '..~- ~.~e~ ~o~: h~do~ ~) BASE-LUBRICATING OILS MIXTURE _~5-8
il c .... ca ¢om~.on,n~so, ~..~E SECRET 5-15 :'
~-w ;~u com~ena 2) DETERGENT/ INHIBITOR SYSTEM ' '
i ~1 POUR POINT DEPRESSANT TRADE SECRET ~'1'.00
~0) toc~o.' NORTH SIDE' OF BUILDING .....
I cemPty uric;er pemait~ of Ja~q. U]at ~ have perso~Jy exa~-u~e<~ an~ ern tarn~l~a~ w~m me ~nrorna~on suom~ea om m~s ac, a e. Jl atmcne~ aocua;entm
subtn~ed, imfotrnetiorl is U'ue, accurate, amd cot~plete. ' '
JOHN ~. - B EERWERT- 'OPERATi~DNs~i~MANAGER_._ 12- 06- 94
~glNT Neme & T~tle o! AuThorized Comoe.~cv ~,eoresen~dve Signature
BAKERSF LD CI'FY FIRE DEPAI MENT
HAZARDOUS MATERIALS INVENTORY Page]of 2
~usinessName DISCOUNT TIRE CENTERS #5~ddress 500 CALIFORNIA AVE
CHEMICAL DESCR} Pq]ON
:i
! 1) I,~V~_NTORYSTAi'US: Newel Addition[ ] Rev,sion[ ] ,Deletion[ I Check if c,bemicaJ is aNON ~'F~DESECR~T [ ] V'P~,OESECRET ~(]
I 2) co .... N~.: USED MOTOR OIL 3)
:i
'I Chem,¢-aNa=e: MOTOR OIL LUBRICANT AH~ [ ~ CAS =.MIXTURE
4) PHYS;CAL & H~.L%~ P~YSiCAL
H~.RO CA~GORIES F;re ~J Reactive [ ] Sudden FeJe~e of Pressur9
5) WAS~ C~SS;F;CA~ON 2 2 ] (3-digit code ~om OHS Fora 8022) USE COOE 2 6
8) PHYS;CAL STA~ Solid [ J Uquid tX G~ [ ] ~Lre [ ] M~ure [ I W~t~ kJ Radioa~e [ J
7) AMOUNi AND ~ME Ai FAC~U~ UNITS CF M~SURE 8) STOOGE COOES
M~Jmum O~ly Amount: ~ l~ [ ~ g~ ~] ~3 [ ] a) Con:~ner: 02
Aver&ge O~ly Amount: ~ curies [ ] b) Pressure: 1
Annu~ Amount: I ~ R ~ c) Tem~r~ure:
~ges; Size Cont~ner: ~ 0 0
¢ Oa~ On Site 365 Circ!eV~kn Momhs: All Ye~-. J. F, M, A, M. J, J. A, S, O. N, D
9) Mt~RE: Us~ ~MPON=NT CAS ¢ % V~ AHM
the three mos; h~dous 1) ]],.F?'~:~ ¥ ';': "-::; ' ~ "".' ? t'.'
chemJ~ com~aen[s or
~y AHM com~nen[s 2) -" [
3)
10) Lock,on SOU~ S~D~ O~
CHEMICAL DESCRI~ION
1) IN~ORYSTA~S: New[ ]' Addkion[ ] Re,sion[ ] Deletion[ ] CheckEchemi~is aNON ~ESECR~ [
2) Common N~e: 3) ~T ¢ (opdon~
Chemi~N~e: ' -':' ' , -
4) PHYSICAL & H~L~ : -. ' PHYSICAL ' H~L~
H~O CA~GORIES ' Fire [ ] Re~ive [ ] Sudden Rele~e of Pressure [ ] Immedi~e He~h (A~e) [ ] ~l&yed He~ (Chronic)
5) WASTE'C~SSiFICA~ON (~digit code ~om OHS Fo~ 8022) USE CODE'
~ 7) AMOUNT AND %M5 AT FACIU~ UNITS OF M~SURE 8) STOOGE
~t Average Omly Amounz: cudes [ ~ .... ' .... b) Pressure:
Annu~ AmounE c) Temper~ure:
~ ~ges: Size Cont~ner:
¢ 0~ On S~e Circle Which Months: Ye~. J. F. M.
M.
J.
J.
A.
O.
N.
D
the three mOS= h~dous I)
~y ~HM com~nen~ 2) [
10) Lo~ion
ce~ u~er pen~ oi law. mat I have pe~on~ly ex~n~ ~ ~ t~;ii~ w~ ~e
submiE~ inflation is ~e. accu~e, ~d complere.
PRINT Name & Title o! Au~adz~l Cornp~ny ~epresent~five Sigr~re Date
H M ~ P PLAN MAP
SITE DIAGRAM [ t FACILITY DIAGRAM
Bu$irless NQme: DISCOUNT TIRE CENTRRS #051
Busine~ Adctre~: 50o CALIFORNIA AVE
For Office Use Only
First In Station: Area Mop # of
inspection Station: NORTH ~''~
PLEASE SEE ATTACHMENT:'
× X×
X
-~ TI RE 240 GAL/ 5 C~AL US D
~ g S T ORAGE WASTE OIL '"~.OIL FILTER1 ~ x
I--I-Ij ~ 12_O GAL EACH ~ I ×
m
F- u~~ ~ / /k. NEW OIL / I i ×
~,o,. [] _ 4, mOO ~ _ I, ~xxxxxxxx×xx×x×x×xx×xx××
X
~ ×
z --:El EIO ×
~> SALES SAFETY
AREA KLEEN x
X
X
×
× ×
X ×
FACILITY AND SITE MAP
x ;
X
X X
x PARKING x
X ×
-X-)P-X---X-X-X--X--X--X X X~-XX X X X X X X X X X X X-X--X X--X X X X X X X X XX X-X--X-X-X-X--X--X-X-X-X-X-X-X-X-X-X-X'-X-X--X~X-X'-X-X-X-X'X-
u)O~ 500 CALIFORNIA AVE Z
-d 'm > 805 - 324 -4701
m.~
BAKERSFIELD CITY FIRE DEF RTMENT
BAKERSFIELD, CA. 93301 (805) 326-3979
H~ARDOUS MATERIALS INVENTORY
CHECK IF BUSINESS IS A FARM [ ]
BUSINESS NAME
FACILITY NAME
CITY STATE ZiP
NATURE OF BUSINESS .'"T',./e.~_. . ¢ /__Ot~E
SiC CODE DUN & BRADSTREET NUMBER
OWN ER/G P ERATO R PH O N E
MAILING ADDRESS
CITY STATE ZIP
EMERGENCY CONTACTS
NAME ¢14h"g'Jr"') ~.,&f¢ TITLE /'bA(~D.-..
BUSINESS PHONE · ~¢)g'"/ g'z-4 - ,470[ 24-HOUR PHONE ~"
NAME ~,O~ :~¢OP~. TITLE
REGK~N V L,EPC STAHOJd:~O ~
BAKERSFIELD CITY FIRE DEPA ,TMENT
H OUS MATERIALS INVEN'I I RY Pag~
~siness Name ,. Address
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition ( ] Revision [ ] Deletion [ ] Check if chemicaJ is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Neu'ne: ~J~''~>~F~--~'''''- ~ ! ~ 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [~1 Reactive [ ] Sudden Release of Pressure { ] . Immediate Health (Abute) [ ] Delayed Health (Chronic)~
5) WASTE CLASSIFICA~ON ~'~'7__] (3-digit code from OHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] licluid [ ] G~s [ ] Pure [ ] Mixture [ ] Waste ~ Radioactive [ ]
7) AMOUNT AND TIME AT FACILITY UNITS OF MEAsuRE 8) STORAGE CODES · ~
MaXimum Daily Amount: ~.~"'O lbs [] gal [-'~ ~t3 [] a) Contaner: ~t'l~r'~/---
Average Daily Amount: I ~.~- curies [ ] b) Pressure:
Annual Amount: ~...~'O c) Temperature: ~--
Largest Size'Container: ~- ~'"'-O
# Days On Site ~" Circle Which Months: -~ J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: tist COMPONENT CAS # % WT AHM
the three most haz~dous 1) [ ]
chemical components or
any AHM components 2) [ ]
3) [ ]
10) Location (.~ ~.O~a~./J_.. ,/~,~ ,~"~ ,.~ ~ .~-'~(r..)P ~ L
L//// CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: /r~~ (~) I ~ "~O /...r'T- 3) DOT # (optional)
ChemicaJ Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire ~ Reactive [ ] Sudden Reieaseof 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 Oaily Amount: / /O lbs [ ] gal ~' ft3 [ ] a) Container:
Average Daily Amount: · ~'~) cunes[ ] b) Pressure:
Annual Amount: .~O¢.~ c) Temperature:
La~gesl~ Size Container: I I
# Days On Site ~=.~-' Circle W~ich Months: ~r, J, F, M, A, M, J, J, A, S. O, N, D
9) MIXTURE: List COMPONENT CAS # % WT AHM
the three most hazardous 1) [ ]
chemic~ components or
any AHM components 2) [ ]
31 [ ]
cen3fy under penau~y ot iaw, ~a~ 1 have personally examined eno am farn~iia~' w~h ~e ~n~oma~on suDm~ect on ~i$ ano ali at~acl3eo clocumen~. I believe
BAKERSFILD CiTY FIRE DEPAP MENT
HAZARDOUS MATERIALS I NVENTi FIY Page_of_
9usiness Name. .~ Address
j~,,~ .r CHEMICAL DESCRIPTION
1) INVENTOR~' STATUS: New { ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: ~/~--~"~ (~L~.._~ /4~) ~'- ¢~) /.,,~.~" 3) DOT # (optional)
ChemicaJ Name: AHM [ ] 'CAS # ·
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release of Pressure [ ] ImmadiateHealth (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 Dally Amount: ~/~:~ lbs [] gal [~J ~3 [ ] a) Container: 0~-.~.
Average Dally Amount: ~ curies [ ] b) Pressure:
Annual Amount: ~ c) Temperature:
Largest Size'Container: / ! ~
# Days On Site '~' Circle Which Months: t//[llYe, e~ J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: List COMPONENT CAS # % vcr AHM
the three most hazardous 1) [ ]
chemic, a] components or
any AHM components 2) [ ]
3) [ ]
CHEMICAL DESCRIPTION
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 HeeJth (Chronic) [ ]
5) WASTE CLASSIFICATION (3-digit code from DHS Form ~022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FACIUTy UNITS OF MEASURE 8) STORAGE CODES
Maximum Dally Amount: lbs [ ] gal [ ] ~t3 [ ] a) Container:
Average Gaily Amount:' curies [ ] b) Pressure:
Annual Amount: c) Temperature:
Largest Size Container:
#DeysOnSite Circle Which Months: ' All Year, J, F, M, A, M, J, J, A, S, O, N, D
9) MIXTURE: fist COMPONENT CAS # % WT AHM
the three most hazardous 1) [ ]
chemic~ components or
any AHM components ~) [ ]
10) Location
cerOfy uncJer penalty of law, that I have personally exammecl an~t am familiar w~th ~e infomalTon suDm~tted on {his and ail attached clocumen~s. I believe ~h~
submitted information is ;~ue, accurate, and complete.
PRINT Name & Title of Authorized Company Representetfve Signature Date
BAKERSFIELD C1'! FIRE DEP.Z TMENT
"AZ DOUS MATERIALS INVEN EiRY
.usiness Name Address
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition ( ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: 3) DOT # (optional)
ChemicaJ Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive ( ] Sudden Release of Pressure [ ] Immediate HeeJth (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 FAClMTY UNITS OF MEASURE 8) STORAGE CODES
MaXimum Daily Amount: lbs [ ] gaJ [ ] ft3 [ ] a) Container:
Average Daily Amount: cubes [ ] b) Pressure:
Annual Amount: c) Temperature:
Lazgeat Size Container:
# Days On Site Circle Which Months: AIl Year, J. F. M. A. M, J. J, A,
9) MIXTURE; List COMPONENT CAS # % WT AHM
the three most hazm'dous 1) [ ]
chemicaJ components or
any AHM components 2) [ ]
3) [ l
10) Location
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion { ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: 3) DOT # (optionaJ)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure. [ ] Immediate HeaJth (Acute) [ ] Delayed HeaJth (Chronic) [ ]
5) WASTE CLASSIFICATION ,(3-digit code from DHS Form 8022) USE CODE
6) PHYSlCALSTATE 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: curies [ ] b) Pressure:
Annual Amount: c) Temperature:
Lsrgest Size Container:
# Days On Site Circle Which Months: All Year, J, F, M. A, M, J, J, A. S, O, N, D
9) MIXTURE: !Jst COMPONENT CAS # % WT AHM
the three most hazardous 1). [ ]
chemicaJ components or
any AHM components 2) [ ]
3) [ ]
10) Location
cer~fy un,er penai~y of law, ~hat I~ have personally examined and am farniiiar with the infomat~on sul3miffed on this and ail aEached documents. I believe
:ubmitte~ inforrneSon is ~,z~e, accurate, and complete.
~RINT Name & Title of Authorized Company Representabve Signature Date
Utilities General Account Maintenance PUTLS801
Acct Nbr: 245501 Bill Stat: NO Transfer-from: Page 1 of 6
Cyc Stat: CL Acct Cyc Stat: CL Transfer-to: Due: 411.67
1. Customer Name: DISCOUNT TIRE CENTERS
2. Social Sec Nbr: 3. Telephone: 805-324-4701
4. Service Address: 500 CALIFORNIA AVE
5. Service City: BAKERSFIELD 6. State: CA 7. Zip: 93304
8. Parcel ID: 006-502-04-00-3
9. Bill Cycle: 1 20. Water Svc Class:
10. Route Nbr: 47
11. Comments : T-F; SUD #2066
12. Prev Acct: 5650 23. Misc ServiceS: 23.1 122 1',2 YD 2 DAYS/WK
13. Service Date: 11/01/91 23.2 CGF COUNTY GATE FEE
14. Fund no: ~ ~. 23.3
15. Billto Adl:C/O A K H CORPORATION 23.4
16. Billto Ad2:6565 E WASHINGTON BLVD 24. Closing Date:
17. Bill-to City: CITY OF COMMERCE 18. State: CA 19. Zip: 90040
'Enter Save(S), Cancel(XX), Next Page(/), or Field # to Change
ALT-F10 HELP I ADDS VP I FDX I 9600 E71 I LOG CLOSED I PRT OFF I CR I CR