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Home My WebLink AboutBUSINESS PLAN ITE DIAGJ:L~M ~______~ FAC[ DIAGRAM For O~ice Use Only I F~st In Stc~n: Area Mc= ~ tn~cectten Stc~on: NORTH Formica · Wilson-Art Tub Enclosures (805) 327-8671 525 E California Ave. Bakersfield, Ca 93307 Rudy Martinez Manager : BusPhone: (805) 327-8671 Location: 525 E CALIFORNIA AV Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 32A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 02 SIC Code:2434 EPA Numb: DunnBrad: ~==============:~= _ + Emergency Contact / Title /il Emergency Contac~ / Title RUDY MARTINEZ / OWNER ~~'A~-~~eGARZ'~---~J / CO-OWNER Business Phone: (805) 327-8671x ~s's--PSone: (805) 327-8671x 24-Hour Phone : (805) 397-5697x ~~ur Phone : (805) 363-0509x Pager Phone : ( ) - x I Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Agency-Defined Topic Title += Hazmat Inventory One Unified List + +== MCP+DailyMax Order Ail Materials at Site + + ................................ +- + ........... + ..... + + .... +- - -+ Hazmat Common Name... ISpeoHazlEPA HazardsI Frm I DailyMax IUnitIMCPI + -+- + -+- + + .... +- - -+ OXYGEN F IH DH G 200 FT3 Low, WASTE OIL F DH L 55 GAL Low I, Do ne~'eb¥ ce~ify fha'~ ~ have (Ty~:~ or print name) ment plan for and ti"~:~: Jt alone with (Name of Business) any corre~ions constitute a complete a'~'~d co~'~ect man- agement plan for my facility. Date -1- 09/15/1997 Bakersfield Fire Dept. ~ OF ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Date Completed ~ I'~) ~-3~ BusinessNamei ~x ~ ~C~ C.2~'~ ~~ Business Identification No. 215-000 ~Q t ~ ~ ~op of Business Plan) Sta~on No. ~ Shift ~ Inspector ~0~%o ~ ~ ~rival Time: I ~ ~ Depadumlime: l ~ ~ $~ Inspec~on } ~ ,'~. Adequate Inadequate Adequate Inadequate ~ ~ ~ Emergency Procedures Posted ~ ~ Occupancy ~ ~ Containem Propedy Labled ~ ~ latedals ~ ~ Comments: Verification of ~ ~ ~ ~ Verification of Facili~ Diagram ~ ~ ,' Proper Segrega~on of Matedal ~ ~ Housekeeping ~ ~ Fire Protection ~ ~ Comments: Electrical ~ D Comments: Verification of MSDS Availabli~ ~ Number of Employees: UST Monitoring Program ~ ~ Comments: Verification of H~ Mat Training ~ ~ Pe~its D ~ Comments: Spill Control ~ ~ Hold Open Device ~ ~ Verification of H~rdous EPA No. ~batement Supplies and Procedures ~ ~ Disposal ~ ~ Comments: Secondar ~tainment ~ ~ ~dty ~ ~ Special Hazards Associated with this Facility: ~~ ^ r~ ~ Violations: ~ / All Items Business Owner/Manager PRINT NAME ~ SIGNATURE Correction Needed W'nite-Haz Mat Div. Yellow-Station Copy Pink-Business Copy BAKElt~FIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION I715 -CHESTER.".AVY..~ BAKERSFIELD, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT'PLAN INSTRUCTIONS: .I 1. To avoid further action, return this form within 30 days of recoiler. 2. WPEIPRINT ANSWERS IN ENGUSH. ~ ~ 3--" 3. Answer the questions ~elow for the ~usiness as a w~ote. ~~. SECTION 1' BUSINESS IDENTIFICATION DATA ,~,~:,~G DR ~,,. STATE:__ ZIP: ~3~7 PHONE: SECTION --. EMER®ENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24. HR. PHONE Materials Division .... . HAZARDOUS MATERIALS MANAGEMENT PLAN ' . V SECTION 3: TRAINING: NUMBER OF-EMPLOYEES: ~__._-. MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECT[ON 4: EXEMPTION REQUEST: :c',, i,,A~ MY :USINE~o IS EXEMPT FROM THE : CErTiFY UNDER ?ENALTY OF ..~,~URY'U -' " ' --' ~qE?ORTiNG REQUIREMENTS OF CHAPTER 6.95 OF THE :'CALIFORNIA HEALTH & SAFETY COO~:',. FGR THE-fOLLOWiNG ~._A,.QNS:'"c ~ NOT HANDL: HALAROCUS MATERIALS. ' M~IcI~IALS, EUT Ira= QUANTITiE~ AT NO nAZ..A ~DGUS "-'-'~ -' '" WE 'DC :dANDLE ' ' -' ~ TiMEE:(CEEO THE MINIMUM ,~EFCRTING ~UANT~Ic~. .-, ,~EP, ,'~:=,,""-v REA$CN'I SECTION 5' CERTIFICATION: i, CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDEESTAND THAT THtS 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 FERJURY. - '~ SIGNATURE '- TITLE DATE ...... Hazardous Materials D[visio~ HAZARDOLI.~ I~AIERIALS MANAGEMENT PLAN Facility U'nit Name: " SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION' ~'~. ,:UBL!C EVACUATION: ::zlc:~=cNC, ME'DiCAL FLAN B sJ~er.~field F~e Dept. Hazardous Materi~d~ Division HA~RDO'US MATEEIALS MANAGEMENT P~N SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENT{ON, STEPS: 3. RELEASE-CONTAINMENT AND/OR MINIMIZATION: ..., ~.. ~:.-,N-U? :ROCEDURES: SECTION 8: UTILITY SHUT-OFFS <.,,_,..,,.~,,-,,IICN OF SHUT-,OFFS AT YOUR FACILITY'): NATURAL ,~AS/?RC?ANE: ~' _ ~ ~. ,.-~ ~_. , ~-CT~ ~,. LOCK ~CX: './'--S/NO ~r' '"ES, ~_....,C,-,.,,ON SECTION 9: PRIVATE FIRE PROTECTiON/WATER AVAILABILITY: A. PRIVATE FiRE PROTECTION: ~";", E~ B. WATER AVAILABILITY (FIRE HYDRANT): ,z~.. T" BAKERSFIELD-CITY FIRE DEPARTMENT · ' HA RDOUS MATERIALS INVE ORY Page_of__ ~s~ness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New[ ] Addition[ ] Re~iaion{ ] Deletion[ ] Che~kifeflemiceJi~aNONTRADESECRET [ ]~'TRADESECRET [ ] 2) C~mn~n Name: ~.J'/~c~ ~ ~ ! ~L~ 3). DOT # (oplional) ChemiceJ Name: AHM { ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARDCATEGORIE$ Fire ~ Reactive[ ] 5udden Release of Pressure [ ] Immeelle Health (Acute) [ ] DelayedHeaJltt(Ch~onic) 5) WASTE CLASSIFiCATION ,(3-digit code from DH$ Form 8022) USE CODE 6) PHY$1CALSTATE Solid [ ] Liquid 4VI Gas [ ] Pure [ ] Mixture [.] Waste ~- Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum OallyAmount: ~'~'"'" lbs [ ] gaJ ,J~'] ~3 [ ] a) Container. Average Oally Amount: C' ~ cunes[ ] bi Pressure: Annual Amount: ~- <~' ¢) Temperature: Largest Size'Container. ~- ~ # Days On Site '~-~ Circle Which Months: All Year. J, F, M. A. M, J, J, A. $, O. N, D 9) MIXTURE: List COMPONENT CAS # % WT' AHM the ~ree most hazardous 1) [ chemical components or any AHM components 2) [ ] 3) [ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New[ ] Addition[ ] Revision[ ] Deletion[ ] Check if chemicaJ is a NON TRADE $ECRET [ ] TRADE SECRET [ ] Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) { ] 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE COON 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Rad~ [ ] 7') AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Dally Amount: 2.~ lbs [ ] gal [ ] fl3 ~ a) Container. Average Dally Amount: ~-L~--'-~-- cunes[ ] b) Pressure: Annual Amount: ~.~aO c) Temperature: Largest Size Container: # Days On Site "~:>~'"~ Circle Which Months: All Yee. r. J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTLIRE: list COMPONENT CAS # % WT AHM the three most hazardous 1), [ ] chemical components or any AHM components 2) [ ] 3) [ ] ' ceffify un,Yet pen~Uty of law, Zhat I have personally exammect anti am famJtiar wiO~ ~he mfoma~fon submitted on ~hi$ ancl ail at~ached document~ I believe me PRINT Name & Title of Au~horizect Company Represenlative ~igna~l'&~ Date BAKERSFIEd CITY FIRE DEPARTm IENT HAZARDOUS MATERIALS INVENTOR"/' Page__of_.~ ' usiness Name Address CHEMICAL DESCRIPTION, 1) INVENTORY STATUS: New[ ] Addition[ ] Rev~i~n[ ] Deletion[ ] Chect(ifa~emiceli~&NONTRADESECRET*[ ],,TRADESECP, ET [ ] 2) Common Name: 3) DOT # (Ol:~k~nll) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Imme<JleteHealt~ (Acute) [ ] Dela~/lelHeeJIIt"(Chmnk=) [ ] .5) WASTE CLASSIFICATION .(3-digit code from DHS Form 8022) USE CODE S) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure ( ] Mixture [ ] Waste [ ] ~ [ ]. 7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] ga [ ] ft3 [ ] a) Container. Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Lm'gest Size Container: # Days On Site Cimle 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 ) [ ] chemic, a] components or any AHM components 2) [ ] [ ] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition ( ] Revision [ ] Deletion [ ] Check tf 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 [ ] ImmedleteHeaith (Acute) [ ] Delayed HeaJth (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 FACIMTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: tbs [ ] ga] [ ] 1t3 [ ] a) Container. Average Daily Amount: cunes[ ] b) Pressure: Annua] Amount: c) Temperature: Largest Size Container: ,I* Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A. S, O, N, D g) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemiceJ components or any AHM components 2) [ ] 3) [ ] 10) L~ca~ion cerbfy unc/~r penalty of law, that I have personally exarninecl and am familiar with gle infome~fon subm/itecl on gli$ ant~ all atZactle~ ~/ocuments. I believe ~bmitted information is true, accurate, and complete. RINT Name & T/tie of Authorized Company Representative Signature Date