HomeMy WebLinkAboutBUSINESS PLAN 12/1/2003 Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This _permit is issued for the following:
[] Hazardous Materials Plan
[] Underground Storage of Hazardous Materials
Permit ID #:: 015-000-000762 [3 Risk Management Program
SPECIALTY TRIM & AWNING [].~rdou. w. sto On-S.oT,~t.~t
LOCATION: 631 CALIFORNIA AVE 'IE[.D
OFFICE OF ENVIRONMENTAL SER VICES ~ ~
1715 Chester Ave., 3rd Floor Approved by: "Lmyu'~ey, O~.~ ~ss~ r~t~
Bakersfield, CA 93301 ofn~ofe,~o,~,,~xs~,i~s ~
Voice (661) 326-3979
FAX (661) 326-0576 ExpimtionDate: ~un~ ~O; ~OO3
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
......... ~,~,,,;~,,;,~:~,,,~:~,,,~,,~,r,~,~,,~ .............. This permit is issued for the following:
PERMIT ID# 015-021000762 · ~,'/i='~i' ;~,~ ~,;i ii!iii;;" ?!!!:!!! !:i:~ i!*:i}!!r:!?i:::~?,ii~,~?,i~Skl;Ma:Bagement Program
~ "='- "- '
........
Is~ by:
O~CE OF E~R O~AL S~ ~CES
1715 Chewer Ay,., 3rd Floor
Office of ~en~l S~i~
B~e~fiel~ CA 93301
Voice (805)
F~(805) 32~057b Expiration Date:June 30, 2000
TE/FACILIT¥ D RAM
- ~ ~o.,_.c.,..[l .~,....4- ,.,.,.,,,,,- I t
DATE:7 /l /~'7FACILITY NAME: (~5 [ C&~.~'~w. dv~_'j UNIT ~: 0F
(CHECK ONE) SITE DIAGRAM FACILITY DIAGR.~M
(Inspector's Comments): -OFFICIAL USE ONLY-
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Manager : BusPhone: (661) 322-7360
Location: 631 CALIFORNIA AVE Map : 103 CommHaz : Minimal
City : BAKERSFIELD Grid: 3lB FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 06 SIC Code:2394
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
JERRY MARGRAVE / OWNER TOM O'NEAL /
Business Phone: (661) 322-7360x Business Phone: (661) 322-7360x
24-Hour Phone : (661) 831-5057x 24-Hour Phone : (661) ~6~343~x~7~
Pager Phone : (~/) ~5--7~x Pager Phone : ( ) - x ~
Hazmat Hazards: Fire Press ImmHlth DelHlth
Contact : Phone: (661) 322-7360x
MailAddr: 631 CALIFORNIA AVE State: CA
City : BAKERSFIELD Zip : 93304
Owner JERRY MARGRAVE Phone: (661) 322-7360x
Address : 7601 PACK SADDLE CT State: CA
City : BAKERSFIELD Zip : 93309
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: Res: No
ParcelNo:
Emergency Directives: ~,~/%~,
reviewed the attached hazardous materials manage-
ment plan for ~'D~-~,/4/~'~,'.~ ~that it along with
-- ' (Name ~Elusines$)
any corrections constitute a complete and correct man-
agement plan for my facility.
1 12/01/2003
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
~ Hazmat Inventory By Facility Unit
-- MCP+DailyMax Order Fixed Containers on Site
Ha zmat Common Name...~-~--~ ,,SDecHaz I EPA Hazards I Frm I Da i~ax__l~n_~i~__1MCP
PROPANE F P IH DH G k 5.00 FT3 Hi
OXYGEN F P IH G '~92.00 FT3 LOW
CARBON DIOXIDE F P IH G 5~?0'0-.-F-T-3-~in
ARGON F P IH G 345.00 FT3 Min
2 12/01/2003
3 12/01/2003
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
= Inventory Item 0001 Facility Unit: Fixed Containers on Site
ACETYLENE Days On Site
365
Location within this Facility Unit Map: Grid:
SE CORNER OF BLDG CAS#
74-86-2
Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER
Largest Container I AMOUNTS AT THIS LOCATION
Daily Maximum Daily Average
55.00 FT3 I 55.00 FT3 25.00 FT3
HAZARDOUS COMPONENTS
%Wt.I RSI CAS#
100.00 Acetylene Yes 74862
TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No N No No/ Curies F P IH / / / Hi
---- Inventory Item 0005 Facility Unit: Fixed Containers on Site 9
PROPANE Days On Site
365
Location within this Facility Unit Map: Grid:
SJ4-4?JD~d .... ~~,-~'~m_ BLDC '~'~"~'~.~ TABLE CAS#
Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container { Daily Maximum I Daily Average
5.00 FT3I 5.00 FT3I 3.00 FT3
HAZARDOUS COMPONENTS
%Wt. R{ RS{ CAS#
100.00 Propane~Yes~ 74986
HAZARD ASSESSMENTS
TSecretl oRSIBi°HaZNo N No Radioactive/Amount No/ Curies EPA HazardsIF P IH DH NFPA/// USDOT# I MCPHi
4 12/01/2003
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
~ Inventory Item 0002 Facility Unit: Fixed Containers on Site
OXYGEN Days On Site
365
Location within this Facility Unit Map: Grid:
SE CORNER OF BLDG CAS#
7782-44-7
F STATE = TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE
/Pure I Above Ambient Ambient I PORT PRESS CYLINDER
Gas . .
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum I Daily Average
92.00 FT3I 92.00 FT3I 50.00 FT3
HAZARDOUS COMPONENTS
100.00 Oxygen, Compressed N 7782447
HAZARD ASSESSMENTS
TSecretI ~slBioHazI Radioactive/Amount EPA HazardsI NFPA USDOT# MCP
No N No No/ Curies F P IH / / / Low
= Inventory Item 0004 Facility Unit: Fixed Containers on Site ~
CARBON DIOXIDE Days On Site
365
Location within this Facility Unit Map: Grid:
N~J~T--T4D RESTROo~i., ~-u~, CAS#
Gas Pure Above AmbientIi Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
510.00 FT3I 510.00 FT3 400.00 FT3
100.00 Carbon Dioxide N 124389
TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No N No No/ Curies F P IH / / / Min
-5- 12/01/2003
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
~ Inventory Item 0003 Facility Unit: Fixed Containers on Site
ARGON Days On Site
365
Location within this Facility Unit Map: Grid:
CENTER OF BLDG 30FT REAR CAS#
7440-37-1
Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum I Daily Average
345.00 FT3I 345.00 FT3I 200.00 FT3
HAZARDOUS COMPONENTS
%Wt. ~SI CAS#
100.00 Argon N 7440371
HAZARD ASSESSMENTS
TSecretI ~SIBioHazI Radioactive/Amount EPA HazardsI NFPA USDOT# I MCP
No N No No/ Curies F P IH / / / Min
-6- 12/01/2003
F SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
~ Notif./Evacuation/Medical Overall Site
--Agency Notification 11/21/2000
CALL 911.
-- Employee Notif./Evacuation 11/21/2000
DIAL 911 OR FIRE DEPT 324-4552 OR POLICE 327-7111. NOTIFY IMMEDIATE
NEIGHBORS AND PROCEED TO EVACUATION POINT. VERBAL COMMUNICATION USED OVER
PHONE INTERCOM SYSTEM. THEN NOTIFY IMMEDIATE NEIGHBORS IF THEY NEED TO
EVACUATE LOCATION AND PROCEED TO EVACUATION POINT.
-- Public Notif./Evacuation 06/18/1990
WE HAVE A SMALL AMOUNT OF HAZARDOUS MATERIALS AND PUBLIC EVACUATION WOULD
NOT BE NECESSARY, HOWEVER IN CASE OF FIRE WE WOULD CALL FIRE DEPARTMENT.
Emergency Medical Plan 06/11/1997
FIRE DEPARTMENT - 324-4542
POLICE DEPT - 327-7111
HALL AMBULANCE - 327-4111
GOLDEN EMPIRE - 327-9000
-7- 12/01/2003
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
~ Mitigation/Prevent/Abatemt Overall Site
-- Release Prevention 06/18/1990
KEEP ONLY NECESSARY AMOUNTS OF HAZARDOUS MATERIALS ON HAND TO ADEQUATELY
OPPERATE BUSINESS FUNCTIONS. VISUALLY INSPECT CONTAINERS REGULARLY AND HAVE
SUPPLIERS INSPECT CONTAINERS WHEN THEY REFILL.
Release Containment
-- Clean Up 06/18/1990
IN CASE OF A SPILL WE WOULD CLEAN UP LIQUID SPILL WITH DIRT OR ABSORBENT AND
THEN HIRE PRIVATE HAZARDOUS WASTE CONTRACTOR TO REMOVE WITHIN 90 DAYS.
Other Resource Activation
8 12/01/2003
F SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
F Site Emergency Factors Overall Site
Special Hazards
--Utility Shut-Offs 11/21/2000
A) GAS - IN ALLEY
B) ELECTRICAL - CENTER OF BLDG INSIDE
C) WATER - IN ALLEY
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 11/21/2000
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS THROUGHOUT BLDG. EMPLOYEES ARE
ADVISED OF THEIR LOCATION. EXTINGUISHERS ARE INSPECTED ANNUALLY.
FIRE HYDRANT - SW CORNER OF PROPERTY ACROSS ALLEY.
Building Occupancy Level
9 12/01/2003
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
~ Training Overall Site
-- Employee Training 11/21/2000
WE HAVE 4 EMPLOYEES AT THIS FACILITY.
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES MUST READ HAZARD COMMUNICATION
AND EMPLOYEES GUIDE TO CALIFORNIA HAZARD COMMUNICATION GUIDE, MUST BE READ
ONCE A YEAR. REVIEW SAFETY DATA SHEETS AS CHEMICAL ARE REFILLED. CONTAINERS
ARE INSPECTED REGULARLY. POST CAL OSHA REGULATIONS AND HAVE SAFETY DATA
SHEETS AVAILABLE FOR REVIEW AT ALL TIMES.
Page 2
--Held for Future Use
Held for Future Use
-10- 12/01/2003
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES .~[~.~ % %%%%'
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3ro Floor, Bakersfield, CA 93301
FACILITYNAME~,~C~'{d"Vri~,,_a- i~,~o~,~ ~SPECTIONDATE %22~ 3
ADD.SS ~} Oocl~o~ ~ ~ ~_ PHONE NO.
FACILITY CONTAC~t~Maea ~ao ~ . BUSINESS ID NO. 15-210- OOO 7~ Z
SPECT ONE gO Z: o NV ER E PrOV ES
Section 1: Business Plan and lnvento~ Program
outine ~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection
OPERATION C V COMMENTS
Appropriate permit on hand
Business plan contact information accurate
Visible address ~ ,,
occupancy ')( ,,,
Correct
Verification of inventory materials , ,
Verification of quantities
Verification of location
Proper segregation of material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures .....
Emergency
procedures
adequate
Containers properly labeled
Housekeeping
Fire Protection~, ~"~
Site Diagram Adequate & On Hand
C=Compliance V=Violation ~' ~ /,/ ~.~ <~'~
Any hazardous waste on site?: I~] Yes
Explain:
Questions regarding this inspection? Please call us at (661) 326-3979 l~(mess Site I~esponsible Party
F SPECIALTY TRIM & AWNING INC ; ~ SiteID: 015-021-000762
Manager : BusPhone: (805) 322-7360
Location: 631 CALIFORNIA AVE ' Map : 103 CommHaz : Minimal
City : BAKERSFIELD Grid: 3lB FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 06 SIC Code:2394
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
JERRY MARGRAVE / TOM O'NEAL /
Business Phone: (805) 322-7360x Business Phone: (805) 322-7360x
24-Hour Phone : (805) 831-5057x 24-Hour Phone : (805) 366-8~=q~x~O
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire Press ImmHlth DelHlth
Contact : ~ ~,,~;~,~ Phone: ( ) - x
MailAddr: 631 CALIFORNIA AVE State: CA
City : BAKERSFIELD ../~ ~ Zip : 93304
Owner JERRY MARGRAVE ~!~,~ ~-- ~ Phone: (805)322-7360x
State: CA
Address : 7601 PACK SADDLE CT
City : BAKERSFIELD '~ Zip : 93309
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
Emergency Directives:
-- Hazmat Inventory One Unified List
--As Designated Order Ail Materials at Site
Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax Unit MCP
ACETYLENE F P IH G 55.00 FT3 Hi
OXYGEN F P IH G 92.00 FT3 Low
~ ~3~ F P IH G 345.00 FT3 Low
CARBON DIOXIDE F P IH G 510.00 FT3 Min
PROPANE F P IH DH G 5.00 FT3 Hi
I, ~/.,~,~'./ /~,.-,,.,~,.- Do hereby cer~if~ ~h~l~ ha,,e
~ or P~n~me)
reviewed ~he a~ached hazardous materials mar. age.
men' plan for .~?(~/~~nd ,ha~ i~ alon~ .,~vi~h
any corrections constitute a comple~ and correc~ man-
agement plan for my facility.
SPECI~TY TRIM & A~ING INC SiteID: 015-021-000762
~ Inventory Item 0001 Facility Unit: Fixed Containers on Site
~UtvUVl~ ~Vl~ / ~£ ~ ~Vl~
ACETYLENE Days On Site
365
Location within this Facility Unit Map: Grid:
SE CORNER OF BLDG CAS#
74-86-2
F STATE ? TYPE PRESS~E ----F TEMPE~T~E CONTAINER TYPE
Ambient PORT PRESS CYLINDER
/Gas Pure Above Ambient I ' '
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
FT3I 55.00 FT3 25.00 FT3
HAZ~DOUS COMPONENTS
%Wt. CAS#
100.00 Acetylene 74862
HAZARD ASSESSMENTS
ITSoorot~SBioHazlRadioactive/AmOuntEPAHazardsNO N No No/ Curies F P IH NFPA/// USDOT#MCPHi
-- Inventory Item 0002 Facility Unit: Fixed Containers on Site
OXYGEN Days On Site
365
Location within this Facility Unit Map: Grid:
SE CORNER OF BLDG CAS#
7782-44-7
F STATE i TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container ~ Daily Maximum Daily Average
FT3L 92.00 FT3 50.00 FT3
HAZARDOUS COMPONENTS
%Wt. ~S CAS#
100.00 Oxygen. Compressed N 7782447
HAZARD ASSESSMENTS
TSecret RS BioHaz, Radioactive~Amount, EPA Hazards, NFPA USDOT# MCP
No N°llINo No/ Curies F P IH / / / Low
-2- 10/12/2000
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
= Inventory Item 0003 Facility Unit: Fixed Containers on Site
STARGON Days On Site
365
Location within this Facility Unit Map: Grid:
CENTER OF BLDG 30FT REAR CAS#
124-38-9
i=== STATE T TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Gas Mixture Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
FT3I 345.00 FT3 200.00 FT3
HAZARDOUS COMPONENTS
%~e I CAS#
N~S 124389
2A~~-~~ssed INo 7782447
~0.00JArgon No 7440371
TSecret RS BioHaz HAZARD ASSESSMENTS
Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P IH / / / Low
---- Inventory Item 0004 Facility Unit: Fixed Containers on Site 9
CARBON DIOXIDE Days On Site
365
Location within this Facility Unit Map: Grid:
NEXT TO RESTROOM E SIDE CAS#
124-38-9
Gas /pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container [ Daily Maximum I Daily Average
FT3I 510 . 00 FT3I 400 . 00 FT3
HAZARDOUS COMPONENTS I
100.00 Carbon Dioxide N 124389
HAZARD ASSESSMENTS I
TSecret oRS I BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP
No N No No/ Curies F P IH / / / Min
-3- 10/12/2000
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
= Inventory Item 0005 Facility Unit: Fixed Containers on Site
~lvUVl~ ~Vl~ / ~1 ~/-kJ..~ ~Vl~
PROPANE Days On Site
365
Location within this Facility Unit Map: Grid:
SW CORNER FRONT SECT BLDG UNDER TABLE CAS#
74-98-6
STATE 7 TYPE PRESSURE ~ TEMPERATURE CONTAINER TYPE
Pure
Gas Above Ambient I Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
FT3I 5.00 FT3 3.00 FT3
HAZARDOUS COMPONENTS
100..00 Propane 74986
HAZARD ASSESSMENTS
I ,
,TSecret, ~S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
llNo N No No/ Curies F P IH DH / / / Hi
-4- 10/12/2000
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
~- Notif./Evacuation/Medical Overall Site
-- Agency Notification 06/18/1990
CALL 911
-- Employee Notif./Evacuation 06/18/1990
DIAL 911 OR FIRE DEPT 324-4552 OR POLICE 327-7111. NOTIFY IMMEDIATE
NEIGHBORS AND PROCEED TO EVACUATION POINT. VERBAL COMMUNICATION USED OVER
PHONE INTERCOM SYSTEM. THEN NOTIFY IMMEDIATE NIGHBORS IF NEED EVACUATE
LOCATION AND PROCEED TO EVACUATION POINT.
-- Public Notif./Evacuation 06/18/1990
WE HAVE A SMALL AMOUNT OF HAZARDOUS MATERIALS AND PUBLIC EVACUATION WOULD
NOT BE NECESSARY, HOWEVER IN CASE OF FIRE WE WOULD CALL FIRE DEPARTMENT.
Emergency Medical Plan 06/11/1997
FIRE DEPARTMENT - 324-4542
POLICE DEPT - 327-7111
HALL AMBULANCE - 327-4111
GOLDEN EMPIRE - 327-9000
5 10/12/2000
F SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
~ Mitigation/Prevent/Abatemt Overall Site
--Release Prevention 06/18/1990
KEEP ONLY NECESSARY AMOUNTS OF HAZARDOUS MATERIALS ON HAND TO ADEQUATELY
OPPERATE BUSINESS FUNCTIONS. VISUALLY INSPECT CONTAINERS REGULARLY AND HAVE
SUPPLIERS INSPECT CONTAINERS WHEN THEY REFILL.
Release Containment
-- Clean Up 06/18/1990
IN CASE OF A SPILL WE WOULD CLEAN UP LIQUID SPILL WITH DIRT OR ABSORBENT AND
THEN HIRE PRIVATE HAZARDOUS WASTE CONTRACTOR TO REMOVE WITHIN 90 DAYS.
Other Resource Activation
-6- 10/12/2000
F SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
~ Site Emergency Factors Overall Site
Special Hazards
--Utility Shut-Offs 06/18/1990
A) GAS - IN ALLEY
B) ELECTRICAL - CENTER OF BUILDING INSIDE
C) WATER - IN ALLEY
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 06/18/1990
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED THROUGHOUT BUILDING.
EMPLOYEES ARE ADVISED OF THEIR LCATION. EXTINGUISHERS ARE INSPECTED
ANNUALLY.
Building Occupancy Level
7 10/12/2000
SPECIALTY TRIM & AWNING INC SiteID: 015-021-000762
Fast Format
~ Training Overall Site
-- Employee Training 06/11/1997
WE HAVE 4 EMPLOYEES AT THIS FACILITY.
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES MUST READ HAZARD COMMUNICATION
AND EMPLOYEES GUIDE TO CALFIRONIA HAZARD COMMUNICATION GUIDE, MUST BE READ
ONCE A YEAR. REVIEW SAFETY DATA SHEETS AS CHEMICAL ARE REFILLED. CONTAINERS
ARE INSPECTED REGULARLY. POST CAL-OSHA REGULATIONS AND HAVE SAFETY DATA
SHEETS AVAILABLE FOR REVIEW AT ALL TIMES.
Page 2
-- Held for Future Use I
Held for Future Use I
8 10/12/2000
CITY OF BAKERSFIELD FIRE DEPARTMENT O~ O~-/~
OFFICE OF ENVIRONMENTAL SERVICES ~.
UNIFIED pROGRAM INSPECTION CHECKLIS~,~,
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILI ~ '~ '~ INSPECTION DATE l'~_/~/OlD
ADDRESS [./ ' t ~'ff ]~ 6~ PHONE NO. ~Z ~3 ~
FACILITY CONTACT~~ ~~~e BUS.ESS ID NO. 15-2~0-
~SPECTION TIME ~ ~ ~ . NUMBER OF EMPLOYEES
Sectign 1: Business Plan and Inventory Program
Routine ~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection
.................................. C COMMENTS"'
Appropriate pe~it on hand ~ ~ / ~ ~l~
Business plan contac[i?f~ation accurate ............... ~ ~ ~b~&tNf ~
Co.eot occupancy / ~
Verification of location
Proper s~gr~gation of material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled
Housekeeping
Fir~ Protection ~
C~Complian~e
V~Violation
Any hazardous waste on site?: ~ Yes
Questions rog~ding ~s lnapeotioa? Please call us at (661) 326-3979 ~ss Site Responsible Paay
SPECIALTY TRIM & AWNING INC U '- ~ ~llll~ SiteID: 215-000-000762
Manager : JUN ~ 0 1997 ~P~o~;~ (805) 322-7360
Location: 631 CALIFORNIA AV , . CommHaz : Minimal
City : BAKERSFIELD ~ G d: 3lB FacUnits: 1AOV:
CommCode: BAKERSFIELD STATION 06 SIC Code:2394
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
JERRY MARGRAVE / TOM O'NEAL /
Business Phone: (805) 322-7360x Business Phone: (805) 322-7360x
24-Hour Phone : (805) 831-5057x 24-Hour Phone : (805) 366-0954x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire Press ImmHlth DelHlth
Agency-Defined Topic Title
---- Hazmat Inventory One Unified List
-- MCP+DailyMax Order Ail Materials at Site
Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax Unit MCP'"
ACETYLENE F P IH G 55 FT3 Hi
PROPANE F P IH DH G 5 FT3 Hi
STARGON F P IH G 345 FT3 Low
OXYGEN F P IH G 92 FT3 Low
CARBON DIOXIDE F P IH G 510 FT3 Min
~, J ~r(-~/~-~r~.<- Do hereby ~i~ ~ha~ ~ hsve
~ Or pdnt~)
reviewed the attached ha':a;dous ma~e~als manage-
ment plan for~,~r~~ ~ha~ ~ along ~i~h
. (Name o~u=inesS)
any ~rmc~ions constitute a complete and co~e~ ma~-
agemem plan for my facili~.
-1- 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
~ Inventory Item 0001 Facility Unit: Fixed Containers on Site
ACETYLENE Days On Site
365
Location within this Facility Unit
SE CORNER OF BLDG CAS#
74-86-2
F STATE i TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3
55.00 25.00
DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3
HAZARDOUS COMPONENTS
%Wt. EHS CAS#
100.00 Acetylene No 74862
-2- 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
~ Inventory Item 0005 Facility Unit: Fixed Containers on Site
PROPANE Days On Site
365
Location within this Facility Unit
SW CORNER FRONT SECT BLDG UNDER TABLE CAS#
74-98-6
F STATE i TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3
5.00 3.00
DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3
HAZARDOUS COMPONENTS
%Wt. EHS CAS#
100.00 Propane No 74986
3 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
Inventory Item 0003 Facility Unit: Fixed Containers on Site
STARGON Days On Site
365
Location within this Facility Unit
CENTER OF BLDG 30FT REAR CAS#
124-38-9
F STATE -- TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Gas Mixture I Above Ambient I Ambient I PORT. PRESS. CYLINDER
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 I DailyAvg this Loc FT3
345.00I 200.00
DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3
~L~UU~ ~U~U~N'I'~
%Wt. EHS CAS#
7.50 Carbon Dioxide No 124389
2.50 Oxygen, Compressed No 7782447
90.00 Argon No 7440371
-4- 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
= Inventory Item 0002 Facility Unit: Fixed Containers on Site
OXYGEN Days On Site
365
Location within this Facility Unit
SE CORNER OF BLDG CAS#
7782-44-7
~ STATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3
92.00 50.00
DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3
HAZARDOUS COMPONENTS
%Wt. EHS CAS#
100.00 Oxygen, Compressed No 7782447
-5- 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
= Inventory Item 0004 Facility Unit: Fixed Containers on Site
CARBON DIOXIDE Days On Site
365
Location within this Facility Unit
NEXT TO RESTROOM E SIDE CAS#
124-38-9
r STATE 1 TYPE PRESSURE i TEMPERATURE CONTAINER TYPE
Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS STORED AND IN USE
Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3
510.00 400.00
DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3
HAZARDOUS COMPONENTS
%Wt. EHS CAS#
100.00 Carbon Dioxide No 124389
6 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
Fast Format
~ Notif./Evacuation/Medical Overall Site
-- Agency Notification 06/18/1990
CALL 911
-- Employee Notif./Evacuation 06/18/1990
DIAL 911 OR FIRE DEPT 324-4552 OR POLICE 327-7111. NOTIFY IMMEDIATE
NEIGHBORS AND PROCEED TO EVACUATION POINT. VERBAL COMMUNICATION USED OVER
PHONE INTERCOM SYSTEM. THEN NOTIFY IMMEDIATE NIGHBORS IF NEED EVACUATE
LOCATION AND PROCEED TO EVACUATION POINT.
-- Public Notif./Evacuation 06/18/1990
WE HAVE A SMALL AMOUNT OF HAZARDOUS MATERIALS AND PUBLIC EVACUATION WOULD
NOT BE NECESSARY, HOWEVER IN CASE OF FIRE WE WOULD CALL FIRE DEPARTMENT.
Emergency Medical Plan 06/18/1990
FIRE DEPARTMENT - 324-4542
POLICE DEPT - 327-7111
HALL AMBULANCE - 327-4111
GOLDEN EMPIRE - 327-9000
-7- 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
Fast Format
~ Mitigation/Prevent/Abatemt Overall Site
-- Release Prevention 06/18/1990
KEEP ONLY NECESSARY AMOUNTS OF HAZARDOUS MATERIALS ON HAND TO ADEQUATELY
OPPERATE BUSINESS FUNCTIONS. VISUALLY INSPECT CONTAINERS REGULARLY AND HAVE
SUPPLIERS INSPECT CONTAINERS WHEN THEY REFILL.
-- Release Containment
-- Clean Up 06/18/1990
IN CASE OF A SPILL WE WOULD CLEAN UP LIQUID SPILL WITH DIRT OR ABSORBENT AND
THEN HIRE PRIVATE HAZARDOUS WASTE CONTRACTOR TO REMOVE WITHIN 90 DAYS.
Other Resource Activation
8 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
Fast Format
Site Emergency Factors Overall Site
Special Hazards
-- Utility Shut-Offs 06/18/1990
A) GAS - IN ALLEY
B) ELECTRICAL - CENTER OF BUILDING INSIDE
C) WATER - IN ALLEY
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 06/18/1990
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED THROUGHOUT BUILDING.
EMPLOYEES ARE ADVISED OF THEIR LCATION. EXTINGUISHERS ARE INSPECTED
ANNUALLY.
Building Occupancy Level
--9- 04/25/1997
SPECIALTY TRIM & AWNING INC SiteID: 215-000-000762
Fast Format
~fTraining Overall Site
-- Employee Training 10/23/1991
WE HAVE 4 EMPLOYEES AT THIS FACILITY
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE
EMPLOYEES MUST READ HAZARD COMMUNICATION AND EMPLOYEES GUIDE TO CALFIRONIA
HAZARD COMMUNICATION GUIDE. MUST BE READ ONCE A YEAR. REVIEW SAFETY DATA
SHEETS AS CHEMICAL ARE REFILLED. MUST BE READ AT LEAST ONCE A YEAR.
CONTAINERS AND INSPECTED REGULARLY. POSTED CAL-OSHA REGULATIONS AND HAVE
SAFETY DATA SHEETS AVAILABLE FOR REVIEW AT ALL TIMES.
-- Page 2
-- Held for Future Use
Held for Future Use
-10- 04/25/1997
Do hereb.~.- certify that I has-e reviewed the ~'EC~[[V[[[~
JAN 1 7 1989
attached Hazardous M~ec~Zs b~s~ness pZ~ Angd ............
~or · ~, / ~' name o~ business
and that it along with the attaohed additions
or corrections constitute a comolete and correct
Business Plan for my facilit.~-.
ciate
BUSINESS NAME SPECIALITY TRIM & AWNING INC ID NUMBER Z1S-OO~-~0~76Z
LOCATION 631 CALIFO~I~ AV HIGH HAZARO RATING I
l, OVERVIEW
LAST CHANGE 07/14/88 BY ESTER
JURIS CODE 215-00B JURIS B~KERSFIELD STATION OB
MAP PAGE 103 GRID 3lB FACILITY UNITS 1 HAZARD RATING
RESPONSE SUMMARY
ZR SEC 4) EMPLOYEES ARE TRAINED TO RSSESS PROBLEM. IF FIRE CRLL FIRE DEPT
911 OR 324-'454Z AND IF POSSIBLE PUT OUT UITH WATER OR EXTINGUISHERS
IF TO LARGE OR ORN6EROUS EVACUATE BLDG AND NOTIFY IMMEDIATE
NEIGHBORS.
EMERGENCY CONTACTS ZA SEC
JERRY MARGRAVE -- 3ZZ-7~BO OR 831-S057
TOM O'NEILL - 3ZZ-?360 OR 366-0954
UTILITY SHUTOFFS 2A SEC 3)
R) GAS ~ IN ALLEY B> ELECTRICAL. - CENTER OF BLOB INSIOE
C> WATER - IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO
NOTIFICATION / PUBLIC EVACUATION
LAST CHANGE / / BY
< NO INFO~RTION RECOR~D FOR THIS SECTION >
PRfiE 1 1~/ZB/88 ll:SZ
MI-TFERIRL SAFETY DATA SYSTEMS, INC. (805) 648-6800
BUSINESS N~ME SPECIALITY TRIM & fiUNING INC ID NUMBER 215-0~)-000762
LOCATION ~3i CRLIFORNIR R? HIGH HRZRRD RRTING 1
~. Ht~Z Milt ',rRAININE~ SUMMi~RY-
< NO INFO~MRTION ~CORDED FOR THIS SECTION >
4. ~OCRL EMERGENCY MEDICAL ASSISTANCE
LRST CHRNGE 07tl4/B8 BY ESTER
SEC 5> FIRE DEPflRTMENT - 324-4542
POLICE DEPT - 327-7111
HfiLL ~MBtJLANCE -
GOLDEN EMPIRE -
PAGE Z lZ/Z. BIB8 11:52
MflTERIflL SflFETY DRTfl SYSTEMS, INC. (805)
BUSINESS NAME SPECIALITY TRIM ~ AWNING INC ID NUMBER
LOCATION B31 CALIFORNIA ~V HIGH H~Z~RO R~TING
FACILITY UNIT
R. OVERALL HAZARDOUS MATERIALS INVENTORY
LAST CHB~E ~7/~5/88 BY ESTER
ID TYPE NAME MR)( 8MT UNIT .HAZARD
LOCATION CONTRINMENT USE
~ PURE ACETYLENE 5S FT3 EXTREME
SE CORNE~. OF ~Lm PORT~E ~ESS. CVS. UELO~N~/SOCOER~N~
~0 PERCENT COW~ONENTS ~ ~C. H~ZnRD L~ST
~Z4~.~ ~ee.e nCETVLENE /- ~ EXmE.E
Z PUnE OXYGEN ~Z FT3 HZ~H
S~ CO~NER OF ~L~ PORTR~CE P~ESS,. CVL. ~ELD~N~/SOCOER~N~
ID PERCENT COMPONENTS ~ ~ HAZARD LIST
~ HIGH
3 MIXTURE STRRGON 345 FT3 HIGH
CENTER OF BLOB 3,F'T ~ERR PORTABLE PRESS. C~L. ~ELOING/SOLOERING
ID PERCENT COMPONENTS HRZ.RD LIST
1~65.~ B,.~ ARGON NONE
1251.~ ?.S CARBON DIOXIDE LOW
Z359.00 Z.50XYGEN,.COMPRESSED HIGH
4 PURE CARBON DIOXI~ 51~ F'r3 LOW
NEXT TO RESTROOM E SIDE PORI'RBLE PRESS. CYL. OTHER
ID PERCENT COMPONENTS .~ ~ ~ HAZARD LIST
]Z5~.~ tee.e CARBON OIOXIDE / -~ = LOW
PAGE 3 t2/Z8/88 11:SZ
MATERIAL SAFETY DATA SYSTEMS, iNC. (805) 648-68(~
BUSINESS NRME SPECIRt. ITY TRIM & AWNING INC ID NUMBER 215-(~-0~0762
LOCRTION 831 Cf~LIFORNIA RV HIGH H~Z~RD E~TING ~
B. FIRE PROTECTION / ~RTEE SUPPLIES
< NO INFORMATION RECORDED FOR THIS SECTION >
D. EMPLOYEE NOTIFICATION / EVRCU~TION
L~ST CHRNGE 0'/'~88 BY ESTER
3fi SEC 2) DIRL 911 OR FIRE DEPT 324-455~ OR POLICE 327.-71 t 1. NOTIFY IMMEDIRTE
NEIGNBORS RND PROCEED TO EVRCURTION POINT.
PRGE 4 12128188 t1:52
MRTERIRL SRFETY DRTR SYSTEMS, INC. (895) 848-G800
BUSINESS NAME SPECIALITY TRIM & 8WNING INC ID NUMEtER ZIS-OOO-O~)(D?BZ
LOCfiTION B~I CALIFORNIA AV HIGH HAZARO RATING
MITIGATION / PREVENTION / ABATEMENT
LAST CHANGE ~~ BY ESTER
3~ SEC t) KEEP ONLY NECESSARY AMOUNTS OF HAZARDOUS MATERIALS ON HAND TO
ADEQUATELY OPPERATE BUSINESS FUNCTIONS. VISUALLY INSPECT CONTAINERS
REGULARLY AND HAVE SUPPLIERS INSPECT CONTAINERS UHEN THEY REFILL.
PAGE S ~2/ZB/88 11:BZ
MATERIAL .SAFETY DATA SYSTEM~, !N£. (80S) G48-G800
CITY of BAKERSFIELD
- ~ ~o Z~s~uc~zo~s ~o~ P~oP~ CODgS
Trams Tyoe ~ax Averaqe Annual Measure I ~s Cmt Cmt :~t Use L~att~ Nhere ~Nbyt Na~s of Mixture/Core.tS
Code Code Art Art Est Units ~ Site ly~ Prfll I~ C~e Stored tn Facility See Instructims
P~al and Health Hazard C.A.S. Nue~r 7~- ~ - ~ C~ent Il Na~ i C.I.S. Number
tha~ a~ply)
Fire Hazard L__J Reactivity [~ ~lay~~ ~dd~ Release L_J I~late
Health' of Pressure H~lth ................................................................
C~t 13 Name & C.A.S. Number
..... C~mt 12 Na~ $ C.I.S. Numar
~Fire Hazard u--J ReactJvtty
Health / . of Pr~sure H~lth
~om~t 13 Nam E :.a.S. Nuibee
Ph~ical(c~k allandt~tHealthapply)Hazard C.A.S. Numar ~mt II Nam & C.A.S. lum~r~__~ ~~~~
Health ..........
-- ] r--~ ~ r~ r~ C~mt 12 NaN & C.A.S. HUmber
Fire ~azard ~ reactivity Oelayed ~ ~dd~ Release ~lKlate
Health of Pres~re Health .......
CM~t I~ Na~ & C.A.S. Number
Certification (Rea~ and sJEn after coapJetJnE ail sections/
[ certify under ~alty of la. that I have ~ersonally examined and as fasflfar ufth t~ tnforaattm subattt~ In this and ali attac~ d~un~ts, and t~t ~sed ~ ny inquiry of t~se individuals resp~Mble
CITY of BAKERSFIELD
NO N-- T RAD E S E C R E T S ~,ge.~of.~
With o~ ~ Mlth ........
~lth of P~ ~lth .......
(C~k m11 t~t
~lth of Pr~su~ ~lth
,lrttficlti~ (Reed and si~ after coJpJetJng al] sections/
certify ~er ~lty of 1~ tMt ] ~ve Mes~IIly ex~i~ ~ am fNililr with t~ inf~ti~ su~it~n this ~ e11 etCW MtS. ~ tMt ~ ~ ~ i~i~ of t~ tMtvt~)I ~lib)l
",,~-- 2130 "G" STREET
-'. · BAKERSFIELD, CA 93301 -~...
' / (805) 326-3979
OFFICIAL USE ONLY
HAZ~RDOU~ ~AT~R~
BU~I~~ PLA~ ~ ~ ~HOL~
~OR~
1. To avoid fu~the~ action, ~etu~n this fora by
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Ans~e~ the questions belo~ fo~ the business as a ~hole.
4. Be as brief and concise as possible,
S~CTION 1: BUSINESS ID~I~ICATION DATA
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-~00-852-7§50 or 1-916-427-4341. This will notify
your local fire department and the State Office of Emergency Services as required by
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NAM_E~.AND TITLE DURING BUS. HRS. AFTER BUS. HRS.
SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE
A' NAT' GAS/PROPANE: '~ ~)\i~ ~
B. ELECTRICAL: ~,/~," ~,/~ -- /,~,~, ~ F_
C. WATER: /~ ~(/~,
D. SPECIAL: /
E. LOCK BOX: YES /~ IF YES, LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO
FLOOR PLANS? YES / NO KEYS? YES / NO
- 2A -
/
SECTION 4: PRIVATE RESPONSE TEA1W FOR BUSINESS AS A WHOLE
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
SECTION 6: EMPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES,OR NO INITIAL. REFRESHER
A, METHODS FOR SAFE HANDLING OF HAZARDOUS
:~TERIALS:...' .................................... ~ NO ~ NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: .......................... YES (~p YES
C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO ~ NO
D. EMERGENCY EVACUATION PROCEDURES: ................. ~ NO 6~ NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES (~ YES
SECTION ?: HAZ~uqDOUS ~TERIAL
CIRCLE ~OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS ~UkTERIAL IN QUANTITIES LESS THAN 500POUND~0F A
SOLID! 55 GALLONS OF A LIQUID,, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... - ~=~ NO
I, ., certify that the above information is accurate.
I understand that~his information will be used to fulfill my firm's obligations under
the new California 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 DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
ID#
BUSINESS NAME:
BUSINESS PLAN
SINGLE FACILITY UNIT
FORM SA
INSTRUCTIONS 1. To avoid further action, this form must be returned
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions belo~ for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.
FACILITY UNIT# / FACILITY UNIT NAME: ~"~-C"~-\~'~.
SECTION 1: MITIGATION, PRE~NTION, ABATEMENT PROCEDURES
SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS U?;IT ONLY
SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY
A. Does this Facility Unit contain Hazardous Materials? ...... YES NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YES NO
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form
If Yes, complete a hazardous materials inventory fo~m marked:
TRADE SECRETS ONLY (yellow form #4A-2) in addition to the non-trade
secret form. List only the trade secrets on form 4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
SECTION 5: LOCATION OF WATER SUPPLY FOR USE By EMERGENCY RESPONDERS
SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY.
A. NAT. GAS/PROPANE:
B. ELECTRICAL:
C. WATER: '
D. SPECIAL:
E. LOCK BOX: YES / NO IF YES, LOCATION:
IF YES, SITE PLANS? YES / NO MSDSs? YES / NO
FLOOR PLANS? YES / NO KEYS? YES /' NO
- 3B -.
BAKERSFIELD CITY FIRE DEPARTMENT
I.D. ~* FORM 4A-I Page o'f
NON--TRADE SECRETS
HAZARDOUS MATERI ALS INVENTORY
ADDRESS: ~.,'~\ ~.~[.-~,'.,.,,.~,.~ a,-, -. ~ ADDRESS: ?Z~/ ~/~ ~/~ ~ FACILITY UNIT NAME: ,. _
CITY. ZIP: ~~,~/~ eK~o~ CITY,ZIP: .~< ~/~
PHONE {: -{~-7Yio PHONE {: ~Y/-~'7 IOFFICIAL 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
-'
_ .~ ~
~AME: TITLE: SIGNATURE: DATE:
EMERGENCY ~r~v ~r~ TITLE:/~ PHONE ~ ~BUS HOURS:
~ ~ AFTER BUS HMS:
EMEROENOY CONTACT: ~ ~-'~/ TIT~E: /f~ PHONE t BUS HOURS:
PR~'NCIPAL BUSINESS ACTIVITY: /~,~ ~~r,~ -- AFTER BUS. RES:
- 4A-1 -