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HomeMy WebLinkAboutBUSINESS PLAN ..~, ITE/FACILITY D GRAM NORTH SCALE: BW-SJ4NESS NAME,: FL~OR: OF DATE~ / ] ~F-AC~ITY N~ .... ' ~~ U~IT ~: 0F (CHECK ONE) SITE DIAGR.~I ~ FACILITY DIAGR.~M Inspector's Comments): -OFFICIAL USE OSLY- - 5A - SITE: D[AGRA~ (Requ items) ,,~ ',. .~.j~ ,. ; 1. Address: Identify the 9. Lock Box principle buildings by the Street numbers. 10. MSDS SCornEr Box 2. Street(s), Alleys, 11. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Mire street names, b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Drainage Canals, Ditches, d. Gates Creeks, 13. Powerllnes S. Buildings a. Frame construction 14. Guard Station b. Masonry construction IS. 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 Manta 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 Waterial/Waste Stored 8. Fire Department Access or Used (See Below) TYpE OF HAZARDOUS MATERIA~ F - Flammable E - Explosive L - Liquid R · Radlologlcal C . Corroalve 0 - Oxidizer 0 - Oas P - Poison W - Water Reactive T - Toxic S - Solid H · Cryogenic O · Waste B · Etiological Example: Flammable Liquid · FL FACILITY DIAORA~ (Required items in addition to the above) 1. Risers for Sprinklers 8. Fire Escapes 2. Partltlona 9, Air Conditioning Unite 3. Stairways: Indicate the 10. Wlndmea levels served from higheot to lowest. 11. Inside Hazardous Waste Stcraga 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. #ateriala Storage S. Elevator 13. Inside Hazardous Materials Uae/Handling 6. Attic Access 14. Se~r Drain Inlets ' ?. Skylights HAZARDOUS MAT...,E~LS INSPECTION ~llkersfield Fire Dept. Ha~lfdous Materials Division Date Completed ct (c[ lq c~ Business Name: ~n.t-r~ ~ t ~ Location: ~ "') O 5'- ~3~.~ r- Business Identification No. 215-000 ~ ~.,~ (Top of Business Plan) Station No. -~ Shift -,~ Inspector I Arrival Time: [ ~ ,~O Departure Time: [ ~ ~'"(3 Inspection Time: [ 0 ~ ~ Adequate Inadequate RECE?~/ED Verification of Inventory Materials D r'l "~'P Verification of Quantities (-I HA<>. &lA T. Ol~ Verification of Location (~ Proper Segregation of Material Comments: Verification of MSDS Avail~ D Number of Employees: Verification o~.fJ~Mat TrainingI-~ r'l Comments: Verification of Abetment Supplies & Procedures (~ Comments: Emergency Procedures Posted (-~ Containers Properly Labeled [~ Verification of Facility Diagram ~-I Special Hazards Associated with this Facility:. Business Owner/Manager PRINT NAME SIGNATURE ~ C[orrec~n N~ed~. D White-H~ Mat Div Yellow-Safion Copy Pink-Business ~py  Bakersfield Fire Deptl HAZARDOUS MATERIALS DIVISIOI 'v/ Date Completed /~ ~7 Business Name: t~r<G~tiD '~/ ~= Location: //.~"O :5' ~,~/.IFo~,(Jl Business Identification No. 215-000 ~0 ~,5/3 (Top of Business Plan) StationNo. 3 Shift z~_ Inspector (~/4/~/~/z-/--. Adequate Inadequate verification of Inventory Materials ~ ~ RECEIVED Verification of Quantities ~ ~ OC'{' HA?- ~,/1AT. DIV. ~ Verification of Location ~ Proper Segregation of Material ~ Comments: Verification of MSDS Availablity ~' :: Number of Employees ~ Verification of Haz Mat Training I~] Comments: Verification of Abatement Supplies & Procedures I~"" ~ Comments: Emergency Procedures Posted I~ Containers Properly Labeled ~ Comments: Verification of Facility Diagram ~ ,./ Special Hazards Associated with this Facility: Violations: ,,~ 1']'~, '5 'A t.~E:/~ ~". ~o ~',4'/t¢-~ ¢ ~ PA~t_~-~O~wff...4 All,ems O.K. Bus,ness · - White-Haz Mat Biv. Yellow-Station Copy mn~-~us~ness Bakersfield Fire Hazardous Materials Inspection Date Completed Business Name: '-~ g-k~',, '~ It~ ' ~ECE!VSD Location: ~q o ~' ~"~,~t~o0~,~ II~-Y 2 ! !991 Plan ID # 215-000 ~ (Top right comer Business Plan) HAZ. S~T. DIV. Station No. ~ S~R ~ Inspegtor Adequate [nadequat~ Verification of Invento~ Materials Verification of Quan6ties Verification of Location ~oper Se~egafion of Matefi~ Verification of MSDS Availabfli~. N~ber of ~ployees Verification of Haz Mat Trai~ng Comlnents: ' ' Verification of Abatement Supplies & Procedures [--] c{~]~ ComInel2~: ' Emergency Procedures Posted [--] ~J Containers Properly Labeled ~ [--] Colnrnents: - Verification of Facility Diagram ~1~ Special Hazards Associated with this Facility: Violations: FD 1652 (Rev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Office Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street RECEIVED Bakersfield, CA. 93301 ~ OCr 2 7 ]9§9 HAZ. MAT, DIV. 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: ~.,~,,f'~-/,,V' LOCATION: /,~.d' ~-,~_/,,~'~;,G~/',~ MAILING ADDRESS: ~-~'¢~.~'" ~:~',~.,~'~] CITY: ,--.~'~~ f/~ STATE: DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: OWNER: ~z'z~. MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS, PHONE, 24 HR. PHONE 1. ~/-/V ~fl',~Z,~Z,,'~z-/' ~'~',,~--~ ~.j~.~--~,/7'~' ,..fi'P?-~a'//,re' ~,~,~-- Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN /;_S, ECTION~,~~_._~3~ TRAINING: / ~;.N U MB E~R'~.©IF~E M~E~9 ESS: ..~ MATERIAL SAFETY DATA SHEETS ON FILE: G'~~ ~Y~ IEF SUMMARY OF TRAiNiNG PROGRAM: 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 "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, 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 SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL,) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE FD1590 Bakersfield Fire Dept~ Hazardous Materials Divist~/ HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: ~--~z~z~ B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: EMERGENCY MEDICAL PLAN: ~ CiTY of BAKERSFI'ELD ZARDOUs HATER'rAES '.'rNVENTORY Fare and Agticulture ri Standard Business'... ' ':'" · "';;~:'/.~:; R A D E S ~ C R'E'"~-' s ' Page BUSINESS NAHE: ~<~',,~,'.~,'~.~,~. 7Z~'"' ~'""'¢'¢~"'~.' 'OWNER NAME: -~,~,z'-~..~. ~~' NAME OF THIS FACILITY: LOCATION; /~M ¢~z/~/~ ~zz~. ADDRESS;: ~ ~F~ W~y .. STANDARD IND. CLASS CODE~----~ ............ ~Hur~ ~: .~- ~/~¢ . PHONE ~: · L~ ~ ~ ' ': ', : ' - -~ - r~ - ' REFER TO~STRU~ZO~S~~ROP~ CODES I 2 ] 4 5 --" 6 ' 8 9 I0 Il ' ' 12 irans lyre ~ax Avgr~ge Xnnuil ...:.. Heasure ~ ;' I Cont Cont ConL Us '-[~cltjon Code ~ooe . AmC Amc EsL · :>:..': Units on e ' lype Press Temp Co3e 'Storea IA FaCility See instru:tlons ~ixture/Cep~onents ~ I w I/,~ I:~ I ¢~' ': I~, I:,: I ¢~ I ~ I v I~ I' ~..'.~,~:~ :~,~ ,,,~-~ ~,~ Physical gndPeAlthHazard C.A.S. ~umber Co~ponenCII Hame i C,A,S. Humber (Check al/ that apply) . uea/th of Pressure . He~lLh Co~ponenL f~ Na~e I C,A,S. Humber Physical and Health Ualard C,A.S. Number Component II Hame I C,A,S, Humber (Check a]l tha~ app/yl ~Fire Hazard ~ Reactivity ~ Delayed ~Sudden Release ~]mmediaLeC°eP°nent 12 Name I C,A,S, Humber Health ' . of Pressure Health ComponenL 13 Name I C,A.S. Humber Physical and Health Ualard C.A,S, Number Component Il Hame I C,A,S, Humber (CheGk ali that app/yJ Component t2 Name I C,A,S, Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ' ~ Immediate Health of Pressure Health Component 13 Hame I C.A.S, Humber Physical and Health Uatard C.k,S. Number Component II Name I C,A.S, Humber (Check all that app/~l ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ lm~i~ ComponenL 12 Name I C,A,S, Number Hearth of Pressure Co~ponen: 13 Ha~e & C,~,S. Humber ~EHERGEHCY CONTACTS ¢1~ ~~ .' ~WW~ ~-'~/~ fl2 ~% ~/~' ~~ ' ~me - TRIo 24 Hr Phone Rame ' Tltle ertifi;atioq .(Repd ~nd.~i¢n af.~r comp7et¢o¢.a77 [ cert,y unoer penaltX pl~a~ tnqt ! navepeEsonallLexamlnq~lqotm tami~aE, viL~ the jnloEmaupn fu~miLtPd in this and all . ~t'~aqhed.dQcgeenc~, an~ tpac oasea on.my Inquiry 9r.tnose InaIvlOulls responsible tor obtaining tne Information, I believe that ~e , _ . ~ / / CITY of BAKERSFIELD ,,, .. ::~ _.. / FIRE DEPARTMENT 2101 H STREET D. S. NEEDHAM O~2~ ,", [.)~'r* .'~. i 9~."-~ BAKERSFIELD. 93301 FIRE CHIEF 326-3911 DEAR i;lr, Ba;.-r, et.t NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YOUR BUSINESS Bargain Tire, LOCATED AT 1705 California Ave. BAKERSFIELD, CA 93304 ON OCTOBER 5TH THE FOLLOWING HAZARDOUS MATERIALS REGULATION VIOLATIONS WERE IDENTIFIED: 1) YOUR HAZARDOUS MATERIALS INVENTORY IS INCOMPLETE, MUST INCLUDE ALL COMPRESSED GASSES AND BE FILED ON NEW FORMS P ROV I DED. VIOLATION OF CH. 6.96 CALIFORNIA HEALTH & SAFETY CODE 25509(A) (1-4)  The ant, ual ir, ver,~,:,~y f,:,~m snail inolude, but shall not be limited t,:,, i'nforr,~ati,z,n ,:,n all ,:,f the following which are hat, riled ir, quantities equal to op greater thar, the quantities s~ecified in suOdivisiom (a) of Section 25503.5: (1) A iistir, g of the ~hemical name and common names of every hazar~c, us su~star, ce ,:,r ci~emical ppo~uct handled by the busir, ess. (~) The cateqory of waste~ ir, ciu~ir,~ the genepai chemical and ~inepal composition of the waste listed by ppoba~le maximum and ~inimum cor, centratior, s~ of every hazapdous waste har~dled by the business. (3) A i is~ir,~ of the chemical name and common names of every ,],thep hazaMdous matepial om ~ixtume ~ontainin~ a hazapdous matepiai handled by the business which is not othep~ise listed pumsuamt to pama~maph (1) om (~). (4) The maximum amour, t c,f each hazardc, us matepiai om mixtume containin~ a hazardous material disclosed in papagpaphs ( 1 ) ~ (~) ~ and (3) wbic~ is handled at ar, y c,r,e ti~,~e by the busir, essc, vep the coupse of the year. Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed Business Name: ~~ ~,x Location: ]~,~ (~.( ~C A~. RECEIVED Station No. ~ S~ ~,~ I nspecto r:~ ..... Adequate Inadequate Vedficafion of Invento~ Matedals Vefificafi°n °f Quantities Ve~ficafion of Location . Verification of M AvailabHi~ Vedficafion of Haz Mat Trai~ng Co~B: Ve~cafion of Abatement Supples & Procedures ComInents: Emergency Procedures Posted Containers Properly Labeled Comlzlenls: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: FD1652 (Rev. 3-89) White-HazMatDiv. Yellow-StationCopy~,~k-BusinessOffice ~, 2) WASTE OIL DRUM NOT PROPERLY LABELED VIOLATION OF OSHA 1910. 1200 (1) The cherJlical rJ~anufacturer, im~r, rter, or distributor shall erasure that each contair~er of hazardous chemicals leavir~g the workplace is laoele~, tagged~or marked with the followir~g infc, r~atior~: (i)Identity of the hazardous chemical(s). (ii)Appropriate hazard warr~ings; arid (iii)Name and address of the chemical manufacturer, importer, or other responsible party. (4) Except as provided in paragraphs (3) arid (4) the employer shall ensure that each container of hazardous chemicals in the workplace is labeled, tagged, or marked with the following ir~formation: (i) Identity of the hazardous chemical (s) co~tair~ed therein; and (ii)Appropriate hazard wafflings. (5) The e~ployer may use sigr~s, placards, process sheets, batch tickets, operating procedures, or other such written ~,~aterials ir~ lieu of affixing labels to individual statior~ary process contair~ers, as lor~g as the alternative method ider~tifies the contair~ers to which it is applicable arid cor~veys the information required by paragraph (~) of this sectior~ to be o~ label. The written materials shall be readily accessible to the employees in their work area throughout each wc, rk shift. (7) The employer shall not remove of deface existing labels or, ir, c,:,mir, g cor, tair, ers of hazardous chemicals, ur, less the cor, tair, er is immediately marked with the required informatior,. (8) The employer shall erasure that labels or other forms c,f warnings are legible, in English, and promir, er, tly displayed or, the cor, tair, er, or readily available ir, the work area throughout each work shift. Employers having employees who speak other languages may add the ir, format ior, in their lar, guage to the material preset, ted, as lor, g as the ir, format ior, is presented ir, English as well. 3) MATERIAL SAFETY DATA SHEETS NO7' AVAILABLE. VIOLATION OF OSHA 1910. 1200(H) (6) Chemical mar, ufacturers or importers snail ensu'~e that distribut,:,rs and manufacturing purchasers of hazardous chemicals are provided an appropriate n]aterial safety data sheet with their initial shipmerrb, arid with the first shipment after a n~aterial safety data sheet is updated. Tine chemical manufacturer or impc, rter shall either provide material safety data sheets with the shipped containers c,r send them to the manufacturing purchaser prior to or at the time of the shipment. If the material safety data sheet is not prc, vided with the ship[~]ent, the r~anufacturing purchaser shall obtain c,r~e from the chemical manufacturer, impc, rter, or distributor as soor, as pc, ssible. (h) Employee ir, formatior, ar, d training. Employers shall provide employees with information and training or, hazardous chemicals ir, their work area at the time of their initial assignment, and whenever a new hazard is introduced ir, to their work area. VIOLATION OF OSHA 1910. 1200(G) (9) Material safety data sheets may be kept in ~r,y form, including operating procedures, and may be designed to cover groups of hazardous chemicals in a wc, rk area where it may be more appr,-,priate to address the hazards of a process rather thar, individual hazardous chemicals. However, the employer shall er, sure that ir, all cases the required information is provided for each hazardous chemical, ar, d is readily accessible during each work shift t,-, emplc, yees when they are in their work area(s). 4) HAZARDOUS MATERIALS TRAINING INADEQUATE. VIOLATION OF OSHA 1910. 1200(H) (2) Training. Emplc, yee trair, ir, g shall ir, clude at ~ 1 east: (i)Methods and observations that may be used to detect the presence or release of a hazardous chemical in the work area (such as moni. toring conducted by the empl,:,yer, continuous monitoring devices, visual appearar, ce clr odor of hazardous chemicals when being released, etc. ); (ii)The physical and health hazards of the chemicals in the work area; (iii)The measures employees can take to protect themselves fr,_-,m these hazards, includ.ing specific procedures the e~plc, yer has implemer,ted to prc, tect empl,z, yees fr,z,m exposure to hazardous chemicals, such as appropriate work practices, emerger~cy p'rc, cedures, and persc, nal p'rc. tective equipmerst 'bo be used; arfd, (iv)The details of the hazard con~municatic, rf program developed by the employer, ir~cludir~g ar~ explarsation of the labeling system arid the material safety data sheet, and hc, w employees cars obtairs and use the appropriate hazard information. The abc, ve vi,-,latic, rss must be cc, rrected by October 20 th. 1989 The department will schedule a re-inspect ion of your faci!ity to verify compliar, ce. If you have arsy questior, s regardirsg this notice, please contact Ralph Huey at 326-3979. Sincerely, Ralph E. Huey Hazardous Mat erials Coordir, atc, r · BAKERSFIELD CITY FIRE DEPARTMENT ~.13o "G" STREET RECEIVED BAKERSFIELD, CA 93301 (805) 3~-3979 ,~JUL 8 1987 . - 0 3G'5 A,s'd ............ OFFICIAL USE ONLY USINESS NAME HAZARDOUS MATERI ALS BUSINESS PLAN AS A WHOLE FORI~ 2A 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN 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 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 Office of Emergency Services as required by law. ~TO NOTIFY IN CASE OF EMERGENCY: NAM~ND TITLE/; ~ DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: ~ B. ELECTRICAL: ~.~.%k~ C. WATER: ~.~9o ~.O{Z.~OE~C- D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION~- IF YES, DOES IT CONTAIN SITE PLANS? / NO MSDSS? YES / NO FLOOR PLANS? / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY )tEDICAL 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 MATERIALS:...' .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO -YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: HAZARDOUS MATERIAL ~as~ otc CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I ~~~4~,-~'x , certify that the above information is accurate. I understand that this 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. SIGNATURE~ T I TLE _{~)q~.~, DATE - 2B - SECTION 3: HAZARDOUS MATERIALS FOR THIS I~IT ONLY A. Does this Facility Unit contain Hazardous Materials9 ...... ~ES5 NO n oToroio If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES ~ If No, complete a separate hazardous materials inventory fm-m marked: NON-TRADE SECRETS ONLY (white form ~4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form ~4A-2) in addition to the non-trade secret form. List on!~- 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. NAY. GAS/PROPAN~~5 B. ELECTRICAL: C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES./ NO :,lo~,,.."°nSoo.., YES / !~0 FLOOR PLANS? YES / NO KEYS? YES / NO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUS I NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer' the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT# FACILITY UNIT NAME: SECTION 1: MITIGATION, PREVENTION, ABATEMEN"r PROCEDURES SECTION 2: NOTIFICATION ANq] EVACUATION PROCEDL~RES AT THIS UNIT ONLY BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page ~of NON--TRADE SECRETS HAZARDOUS HATERT ALS T NVENTORY BUSINESS NAME:i~I~'_~~i~tL~. OWNER NAME: ~~ ' FACILITY UNIT ADDRESS: I~Q~ 0~~~ ~_ ADDRESS: {~~f~-- FACILITY UNIT NAME: PHONE ~: ~~ PHONE m: %~4~c( , [OFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS m BY HAZARD D.O.T .CODE AMOUNT A~OUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIqAL OR COMMON NAME CODE OUIDE NAME: TITLE: SIGNATURE: DATE: EMERGENCY CONTACT: TITLE: PHONE # BUS HOURS: AFTER BUS HRS: EMERGENCY CONTACT: TITLE: . PHONE # BUS HOURS: 'PRINCIPAL BUSINESS ACTIVITY: AFTER BUS HRS: - 4A-1 -