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Home My WebLink AboutBUSINESS PLAN (2) Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This oermit is issued for the followin._: [] Hazardous Materials Plan [] Underground Storage of HazardOus Materials [] Risk Management Program [3 Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002226 JIFFY LUBE LOCATION 3208 93304 l ssu ed by: Bake rsfield Fi re Department ~~~9 ,/ ~.~ OFFICE OF ENVIRONMENTAL SERVICES' · ,"' ',~II. 2 3 ~{~Or 1715 Chester Ave., 3rd Floor Approved by: ~Ralpl/Huey, l~'~~,~ · Issue Date Bakersfield, CA 93301 Omceof£v~om~a~Se~ic~s ~ Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: June 30; 2003 759 Ga ons Dexron II - N Stairs I Stairs , 365 Gallons 20~50 "~ 365 Gallor ons 5~30 --- Motor Oil 365 Gallons Motor Oil 1066 lions Motor Oil 100 GallonsTrans Fluid +3 Grease 54kg GL5 54kg Waste Oil 362 Gallons Each Each with Secondary Containment Jiffy Lube Store =1726 3208 California Avenue, Bakersfield, CA 93304 Lower Level IDumpster N Crushed \\ Coolant Filters 55 Gallons Electrical Shut Off Gas Shut Off~'"~ Open Drive Through Bays ~ Shelving :- ~ :: ,~" · Bottled Oil ,, . ~., . .,- S irs Stairs Bath ~I~ .. ,.~- Lobby Office Pits with Rolling Drain Pans / J~ '/ , ' '-', / Water Shut Off Ground Level Plot Plan , _ -.. - . . '~ '-. ~ , Jiffy Lube Store #1726 " ..... ' ' ' - -' 3208 California Avenue, Bakersfield, CA 93304 JiFF~ LUBE SiteID: 015-021-002226 Manager: ~OL~O L~I0& BusPhone: (661) 859-0183 Location: 3208 CALIFORNIA AVE %B%% Map : 102 CommHaz : Low City : BAKERSFIELD %%?Y% Grid: 35B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:7538 EPA Numb: DunnBrad:33-0518793 EmergenCy Contact / Title Emergency Contact / Title RL~Y AP~URU~ / MANAGER STEVE SHIELDS / DIRECTOR Business Phone: (661) 859-0183x Business Phone: (310) 831-1043x 24-Hour Phone : ~) ~ ~o~. 24-Hour Phone : (310) 384-9066x ~= ......... : I x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Contact : PEPPER TREE INC, DBA JIFFY LUBE Phone: (310) 831-1043x MailAddr: 595 W 7TH ST 202 State: CA City : SAN PEDRO Zip : 90731 Owner PEPPER TREE INC, DBA JIFFY LUBE Phone: (310) 831-1043x Address : 595 W 7TH ST 202 State: CA City : SAN PEDRO Zip : 90731 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: -1- 08/14/2003 F~JIFF~ LUBE SiteID: 015-021-002226 ~ Hanmar Inventory By Facility Unit -- MCP+DailyMax Order Fixed Containers at Site Hazmat Common Name... ISpooHazIEPA HazardsI Frm I DailyMax lunitlMcP WASTE OIL F DH L 1050.00 GAL Low TRANSMISSION FLUID F DH L 759.00 GAL Low WASTE ANTIFREEZE F DH L 55.00 GAL Low ANTIFREEZE L 55.00 GAL Low ~ ~ F DH L 25.00 LBS MOTOR OIL F DH L 2440.00 GAL Min -2- 08/14/2003 F~JIFF~ LUBE SiteID: 015-021-002226 ~ Item 0003 Facility Unit: Fixed Containers at Site GEM OIL ~ DaysO_j~-Site w~c ~ F65 Location ility Unit Map: Grid: BASEMENT / CAS# 64742-57-0 Liquid Pure [ A~ient A~ient DR~/B~REL-METALLIC AMOUNTS LOCATION Largest Container I Dai imum I Daily Average 30.00 LBS 25 LBS 15.00 LBS I COMPONENTS %Wt. CAS# 100.00 Light Machi )il 8020835 HAZARD ASSESSMENTS [TSecret Radioactive~Amount I EPA Hazards I NFPA ~USDOT# [ MCPI No No No/ Curies F DH / / / I ~ Low ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~ MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: BASEMENT CAS# 8020835 Liquid {Pure Ambient Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container , Daily Maximum I Daily Average 1066.00 GALI 2440.00 GALI 1000.00 GAL HAZARDOUS COMPONENTS 100.00 Motor Oil, Petroleum Based N 8020835 HAZARD ASSESSMENTS{ TSecretoRS,Bi°Has,'. Radioactive/Amount EPA Hazards, NFPA USDOT# MCP No N No No/ Curies F DH / / / Min -6- 08/14/2003 :~J~F~Y LUBE SiteID: 015-021-002226 Fast Format Site Emergency Factors Overall Site -- Special Hazards --Utility Shut-Offs 07/23/2001 A) GAS - NE CORNER OF STRUCTURE B) ELECTRICAL - NE CORNER OF STRUCTURE C) WATER - S SIDE OF STRUCTURE AT MAIN ENTRY DOOR D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/23/2001 PRIVATE FIRE PROTECTION - (DO YOU HAVE ANY FIRE EXTINGUISHERS OR IS YOU BUILDING SPRINKLERED???????????) NEAREST FIRE HYDRANT - ON SIDEWALK AT CALIFORNIA AVE IMMEDIATELY IN FRONT OF BLDG, S SIDE. Building Occupancy Level -9- 08/14/2003 ~ KERN COUNTY ENVIRONMENTAL HEALTH SERVICES (661) 862-8700 ? .":~: '. i': i-' .~ "~- ~' '.i":' ' i~i::~ ~ C.i~I~:(:.?; iiiii¢ >i:;~.~:~~ ii~.i~!:;ii~;C;~::7'~; ':-!; .ii .?:"- : '.. :~' :. ~: ...'i · : ~ : · -BasinessName:i~" :. :.:.': "!.-i i.":.'.~ .i ' MaP." . -DONOT'.WRITE IN: THIS BOX HAZARDOUS MATERIALS BUSINESS PLAN FORM 2 Forms Due By: SECTION 1: BUSINESS IDENTIFICATION DATA A. Full Legal business Name: Pepper Tree; INC. DBA B. Physical ~cation/Street Addres~'~ ~ ~ ~ ~ O~ ~ z p: ZZO Business Phone: ~ C. Mailing Address: 595 W. 7th Street~ ~uite 20~ City: San Pedro Zip: 90731 D. Have you filed a Business Plan with the department under a different name within the last two years? YES NO If yes, under what name did you file? E. This submission is a NEW or REVISED ~ Business Plan F. Does your business handle any ofthe "acutely ha~rdous substances" listed on the enclosed handout in addition to other types of materials? YES__ NO ~ SECTION 2: EMERGENCY NOTIFICATIONS In the event of an emergency involving the release or threatened release of a hazardous material, telephone 9-1-1, and then (800) 852-7550 or (916) 262-1621. This will notify your local fire department and the State Office of Emergency Services, as required by state law. Additional federal reports may be required. Persons who should be notified in case of an emergency at your business that have full access and can provide technical assistance: NAME AND TITLE DURING BUSINESS HOURS AFTER BUSINESS HOURS -CONTINUED ON REVERSE - SECTION 3: LOCATION OF THE MAIN UTILITY SHUT OFFS FOR THE ENTIR SINESS D. Special/other: E. Lock Box: YES or NO If yes, location: lf yes does it contain: Site Plans? YES or NO MSDS? YES or NO Floor Plans? YES or NO Keys? YES or NO SECTION 4: PRIVATE RESPONSE TEAM DESCRIPTION Do you have a group of employees trained to handle minor accidents involving hazardous materials at your business? YES or NO If yes, you must explain the level of training and equipment they possess'and how they are notified to respond. SECTION 5: IDENTIFICATION OF THE CLOSEST APPROPRIATE EMERGENCY MEDICAL ASSISTANCE AVAILABLE TO YOUR BUSINESS Comments/Additional information: - CONTINUED ON NEXT PAGE - (2) CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: [ ~)'2._-"~g 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 as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of'completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA ~IL~GADD~SS: T fW Dam k kc CITY: S~N P~0~,) STATE: a~ ZIP: q0'/~hONE:~]O y~l ]O4~ ~073~ EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN .. SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. E~IRO~NTAL ~SPONSE ~NAGE~NT: D. EMERGENCY MEDICAL PLAN: HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: N % WATER: ~ ~'tO~ o ~ SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: { L MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION IS ACC~TE. I ~DERSTA~-~ Z~Z Z~IS n~O~ZION WmL BE VSED ZO CODE" ON ~Z~OVS ~ZE~ALS 0~IV. 20 C~ZER 6.95 SEC. 25500 ET A~.~ AND TE INFORMATIO7 CONSTITUTES p.ER3URY. 4 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER / OPERATOR IDENTIFICATION FACILITY INFORMATION Page __ Of I. FACILITY IDENTIFICATION F~C'L'~ '~ * ' ~ ~ I : I '~Year. Be~ginning :co Year Ending // / u. BUSINESS ~ME (Same as FACILI~ NAME or DBA- ~i~ Business ~) SITE ADDRESS . , ~o~ DUN & ~ ~ SIC CODE · -. II.OWNER INFORMATION O~ER ~ILIN~ ?~ TAL.cONTAc CONTACT NAME ~.p ~ ~ Hi.Co ~ 1,1 : CONTACT PHONE CONTACT ~ILING ~ ~9 -PRI Y~ ~ '"' "IV, E ERGENCYCONTACTS ':" ~ECONDARY- PAGER ~ ~2~ PAGER g V, CERTIFICATION Ce~ifi~on: Ba~d on my inqui~ of ~ose individuals responsible for obtaining the information, I ~i~ under penalW of law ~al I have personally examined and am familiar w~~ation submitted in this inve~ believe the info~ation is tree, accurate, and ~mplete. ~ OF O~ ~~OR (print)~ 136 ~ TITLE OF O E~TOR 137 UPCF (7/99) S:~CUPAFORMS\OES2730.TV4 wpd my OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 '~'-'"~--"' ~"~' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fo~ oer mate~al per buSding or ~ NEW ~ ADD ~ DELETE ~ REVISE ~ Page ~ I. FAClL~ INFORMATION BUSINESS ~ (~me ~ FACILI~ ~ME ~ DBA - ~ng Bu~n~ ~) 3 ..... d .... ................................................... FA~[~-~ ~ ' ~ 1. ~ ~ (op~naO ~3 GRID ~ (op~naO ....... ~-~' II. CHEMICAL INFORMATION ~5 T~DE SECRET ~ Y~ ~No 206 ~S J ~ *If EHS is'Yin,' ~ ~u ~low mst ~ FIRE ~DE ~D ~SSES (~plete ~ r~u~t~ by I~ fire ~ie0 210 ~PE CURIES 213 FED ~D ~TE~RIES 1 FIRE O 2 R~CT~ O 3 PRESSURE RE~SE O 4 A~ H~L~ ~ ~RONIC H~LTH 216 O (~ ~1 that ap~y) ANNU~ WAS~ 217 ~ ~I~M /./_ 2t8 ~ A~GE ~ ~ 219 STA~ WASTE ~DE 2~ ~ ~ ~ DAYS ON SITE 222 UNITS* ~a ~L ~ d CU FT lb ~S m TONS 221 ' ff EHS. ~nt must ~in,bs. ,3 C .~ STOOGE ~AINER ~ a A~VEGROUND TANK ~ e ~STI~NMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223 (C~ a8 ~at apply) ~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n ~STIC BO~LE ~ r O~ER ~ c T~K INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TO~ BIN S~EL DRUM ~ h SILO I CYLINDER p TANK WA~N STOOGE PRES~ ~ a A~IE~ ~ ~ A~VE AMBIE~ ~ ~ BELOWA~IENT ~4 STO~ ~MPE~TURE ~a A~IE~ ~ ~ A~VE A~IE~ ~ .ha BELOW A~IENT ~ c CRYOGENIC 225 %~ :." ~' ~ "': :. ~.::'~RDOUS COMPONENT EHS CAS ~ 1 226 ~ ~7 ~Y~ ~No 2~ 2~ 2 23O i 231 233 3 2~ ! 235 ~Y~ONo 236 237 4 ~ 2~ ~ ~9 ~ Y~ ~ ~ 240 241 ' I 5 242 J 243 ~ Y~ ~ NO 244 245 II1. SIGNATURE PRINT ~ & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~~~ DA~E 246 UPCF (7~99) S:\CUPAFORMS\OES2731 .TV4.wpd -~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 '~'""~"~'---'~"" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form ~er matenal per building or area ~ NEW ~ ADO ~ DELETE ~ REVISE ~ Page ~ I. FAClLI~ INFORMATION '6U~'~T~ ~- ~'~ Ci~i~ '~-&~ ~ ~s ~ ) .................................................................................... .... q6_ ..... ....... ............................ CHERYL LO~TION ~ ~ ~ CHEMICAL LO~TION ~ Yes ~No ~ N ~ ~NFIDENTIAL (EPC~) ...... ............................................ ~ ~ If Subj~ lo EPC~, refff Io instm~i~s ~7 CO~N ~ / ~S ~ ~9 'If EHS is'Y~,' ~1 ~s ~w must ~ ~ lbs. FIRE ~OE H~RO G~SSES (~plete ii r~u~t~ by I~1 ~re ~i~ 210 'PE ~ p PURE ~ m MITRE 0 . WASTE 211 ~OIOAGT~E ~Y~ ~ ....... 21; ~i~'~ .............. PHYSI~ STA~ ~ s ~LID ~ LIQUID ~ g ~S 214 ~RGEST ~mAINER ~~. ] 215 - / ~D ~RO ~TE~RIES ~ 1 FIRE ~ 2 R~CT~ ~ 3 PRESSURE REL~SE ~ 4 AC~ H~L~ ~5 CHRONIC HEALTH 216 (~ ~1 thai apply) A~UNT DAILY A~U~ ~ ; DAILY A~U~ ~ ~ UNITS* ~ga ~L ~ d CU FT D lb LBS ~ tn TONS / 221 DAYS ON SITE 222 STOOGE ~AINER ~ a A~VEGROUND TANK ~ · P~STI~NMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ ~ ~[L ~R 223 (~eck all ~at ap~y) ~ ~ UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC 80~LE ~ r OTHER ~ c T~K iNSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TOTE BIN ~d S~EL DRUM ~ h SiLO ~ I CYUNOER ~ ~ TANK WA~N STOOGE PRESSURE ~ a A~IENT ~ ~ A~VEA~IE~ ~ ba BELOWA~IE~ 224 STO~ TEMPE~TURE ~aA~IENT ~ ~ A~VEA~IE~ ~ ~a 8ELOWAMBIENT ~ c CRYOGENIC 225 %~ ~ H~RDOUS COMPONE~ ' EHS ~ CAS ~ i 1 2~ ~i 227 ~ Y~ ~ No 228 2 230 ; 231 ~ Y~ ~ No 232 233 ~ 2~ ': 2~5 ~ Y~ ~ ~o 23~ 237 4 2~ ' 230 ~ Y~ ~ ~o 240 241 ~ 243 ' ~y~ ~No 244 5 242 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~~~~ ............................. ~ .... ~J~ ' UPCF (7~99) S:\CUPAFORMS\OES2731 .TV4.wpd L~:b OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 .... ~ .... ' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one Icom [] NEW I'-] ADO [] DELETE [] REVISE 200 Page __ si __ I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ......... CHEMICAL LOCATION ~ ~, _ ~- ~ 201 CHEMICAL LOCATION ~t~'.,° CONFIDENTIAL (EPCRA) 202 II. CHEMICAL INFORMA~ON ~5 T~DE SECRET ~ Y~ ~No 206 CHEMI~L ~E If Su~j~ to EPC~ ref~ to insignias ~S g ~ *if EHS is'Y~,' ~1 ~nts ~w must ~ ~ lbs. FIRE ~DE H~RD G~SSES (~plete if r~u~t~ by I~ fire ~i~ 2~0 ~PE ~YSI~LSTATE O s SOLID ~ LIQUID a g ~S 214 ~RGEST~NTAINER ~ [ kq. -- _ 215 (~ aa thai apply) 1 FIRE ~ 2 REA~NE ~ 3 PRESSURE REL~SE D 4 A~TE H~Lm CHRONIC HEALTH 216 A~UNT .DAILY A~U~ ~ DAILY A~U~ DAYS ON SITE 222 UNITS* ~ ga ~L ~ d CU FT lb LBS ~ ~ TONS 221 * If EHS, am~nt must be in lbs, STOOGE ~NTAINER D a ABOVEGROUND T~K ~ e P~STI~ONMET~LIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223 (Check all ~at apply) ~ b UNDERGROUND TANK ~ f ~N ~ j ~G ~ n P~STtC 80~LE ~ r OTHER ~ c T~K INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TOTE BIN S~EL DRUM ~ h SILO ~ I CYLINDER ~ TANK WA~N STOOGE PRESSURE ~ a AMBIE~ ~ ~ A~VE A~IE~ ~ ba BELOW A~IE~ 224 STO~ ~E~TURE ~a AMBIE~ ~ ~ A~VE A~IE~ ~ .~a BELOWA~IE~ D c CRYOGENIC 225 %~ '' H~RDOUS COMPONENT EHS 1 ~6 ' 227 ~ Y~ ~ No 228 2 230 ; 231 ~ Y~ ~ No 232 233 3 2~ ~ 235 ~Y~No 236 237 4 238 : 239 ~ Y~ ~ No 240 241 5 242 ~ 243 ~ Y~ ~ No 244 245 III. SIGNATURE UPCF i7/99) S:\CUPAFORMS\OES2731 .TV4.wpd -~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 '~'*"*~'~'"*'~"*' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form l~er materfal l~er bud(ting Or ~rea, ~ NEW ~ ADO ~ DELETE ~ REVISE 2~ Page I. FAClLI~ INFORMATION BUSINESS NAME (~me ~ FACILI~ ~ME ~ DBA - ~ng Busings ~) 3 CHEMISE LOCATION ~1 CHEMICAL LaoTIaN ~ Y~ ~N ~NFIDENTIAL (EPC~) o 202 II. CHEMICAL INFORMATION ~5 T~DE SECRET ~ Y~ ~No 2~ CHEMI~L ~ME '~ ~ ~0 ~ If Subj~ to EPC~. ref~ ,o instruo,~s ~7 FIRE ~OE H~RD C~SSES (~plete if r~u~t~ by I~1 fire ~i~ 210 D p ~RE ~ m MIX.RE D w WASTE 211 ~DIOACT~E D Y~ ~No s ~LID ~1 LIQUID ~ g ~S 214 ~RGEST ~AINER ~ ~ PHYSI~L STATE 215 (~ ~ ~al apply) 1 FIRE ~ 2 REACTI~ ~ 3 PRESSURE REL~SE ~ 4 A~TE H~L~ 5 CHRONIC HEALTH 216 ANNUAL WASTE 2i7 ~IMUM 7~/~ 2i8 A~GE ~ 2i9 STATE WASTE CODE 220 A~UNT DAILY A~U.T DAILY A~Um 00 DAYS ON SITE 222 UNITS' ~ ~ GAL ~ d CU FT ~ lb LBS ~ m TONS 221 ' If EHS. ~nt must ~ in lbs. STOOGE ~AINER (Oa~attthata~F) a A~VEGROUNOTANK ~e P~STI~ONMET~LIOD~UM ~i ~IBERORUM ~m G~SS BO~LE ~q ~IL~R 223 ~ b UNDERGROUND TANK ~ f ~N ~ j ~G ~ n P~TIO BO~LE ~ r OTHER ~ ~ T~K ~NSIDE BUiLDiNG ~ g ~R~Y ~ k BOX ~ o TO~ B~N ~ d S~EL DRUM ~ h SiLO ~ ~ OYUNDER ~ p TANK Wa~N 8TO~GE PRESSURE ~ a A~IENT ~ ~ A~VE A~IE~ ~ ba BELOWA~IfiNT 224 STO~ ~MPE~TURE ~a AMBIENT ~ ~ ABOVE AM8IE~ ~.~a BELOW AMBIENI ~ c GRYOGENIG 225 %~ '. .~ROOUs COUPONENT EHS ~ CAS 1 226 227 ~ Y~ ~ NO 228 2~ 2 ~0 ~ ~ Y~ ~ No 232 233 3 234 235 ~ Y~ ~ No 236 237 4 238 23g ~ Y~ ~ No 240 S 242 243 ~ Y~ ~ No 244 245 Iff. SIGNATURE P~INT MA~ & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE ~~ ~ ~--~ .................. ~- '- UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd OFFICE OF ENVIRONMENTAL SERVICES '--t~'4m r~tlrr~r ~.~ ~,~n ,-~~ ,,~ . 1715 Chester Ave., CA 93301 (661)326-3979 -'~"' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION {one form l)er material l)er building or area} [] NEW I--I ADD [] DELETE [] REVISE 200 Page __ of __ I. FACILITY INFORMATION -'~U~i~ESS NAME (Same as FACILITY NAME o~ DBA - Doing Business As) ......................................................... ...... D_6. ..... .... ...................... CHEMICAL LOCATION ~ -{-.-'~--.J'~--"'~'~--. 201 CONFIDENTIALCHEMICAL LOCATION(EPCRA) [] Yes -- FA~-F ...... ~g~'~-'- .... ~-"-~'-'~-.~, .......... o 2O2 .'~ ........ ...---r .... ~ (Dp i) ................. -20-~-" ~,~ ~-(-O~t~n-a~ ....................... ~04 II. CHEMICAL INFORMATION 205 TRADE SECRET [] Yes ~No 206 CHEMICAL NAME If Subject to EPCRA. refer to inslructions 207 CAS # 209 : 'If EH$ il'Yes,' all amoe~[s below must be in Ib~. FIRE CODE HAZARO CLASSES (Complete if requested by local tire cfliel') 210 'TYPE E] p PURE ~ m MIXTURE [-I w WASTE 211 RADIOACTIVE [-I yes ]~ ........ 2-~2-- '-C-U-~iI~s- ............... s SOLID ~1 LIQUID [] g GAS 214 PHYSICAL STATE LARGEST CONTAINER 21.5 FED HAZARD CATEGORIES ~ (Check aa that apply) 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH 5 CHRONIC HEALTH 216 UNITS' ~ga GAL [] cf CU FT E] Ih LBS [] tn TONS 221 DAYS ON SITE 222 ' If EHS. amo,Jn, musf be in ,bs. 3_.~,~ .~'"' .......... STORAGE CONTAINER (Check att that apply) ABOVEGROUNDTANK r-~e PLASTIC/NONMETALLICDRUM r-Ii FIBERDRUM Elm GLASS BOTTLE E]q RAILCAR 223 [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE ~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE {~ a AMBIENT [] aa ABOVE AMBIENT []_ b.a BELOW AMBIENT [] c CRYOGENIC 225 %WT ' '~.HAZARDOUS COMPONENT : EHS CAS # ~ 229 1 226 ~ 227 ~ Yes [] No 228 2 230 23~ [] Yes [] No 232 233 3 234 235 [] Yes [] No 236 237 4 238 239 [] Yes [] NO 240 241 5 242 243 [] Yes [] NO 244 245 II1. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE -/~--~IGN"~E -- -~~ ............................ ~,' -- UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd ~ ~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 '~ ~ ~ ~ H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fO~ ~er material ~er bu~ing 9r ~rea, ~ NEW ~ ADO ~ OELETE ~ REVISE ~ Page I. FAClLI~ INFORMATION BUSINESS ~E (Same ~ FACILI~ ~ME ~ DBA - ~ng Busings ~) ~,c~i~,o-, . ::.~ ~. ................ T'~",'~ ......................... ~-"'-~i~'~-~ ............................ ~- 205 T~DE SECRET ~ Y~ ~No 206 CHEMI~L If Subj~ IO EPee, ref~ Io insl~di~s ~7 ~ Y~ ~NO 208 FIRE ~OE H~O ~SSES (~plete ii r~u~l~ ~y I~1 fire ~i~ ~PE D . PURE ~ MIX'RE O w WASTE 211 ~OlOACT'~ DY. ~ ....... ~,2 '~-~i'~ ............... ~S.. (~ al that ~y) ~ FIR[ ~ 2 ~CTIVE ~ 3 PRESSURE REL~SE O 4 A~ H~L~ A~UNT . DAILY A~U~ ~ : DALLY ~U~ DAYS ON SITE 222 UNITS' ga ~L ~ d CU~ ~ lb LBS ~ , TONS 221 ~ , / ~ ' If EHS. ~nt mu~ ~ in lbs. STO~GE ~AINER (Check a8 ~at ~ply) A~VEGROUND TANK ~ e P~STI~N~TAL~C DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223 UNDERGROUND TANK ~ f ~N ~ j BAG ~n P~TIC BO~ ~ r OTHER DC T~KINSIDE BUILDING Og ~R~Y Ok BOX OD TO~ BIN ~O~" ~ d S~EL DRUW ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ a A~IE~ ~ ~ A~VE A~IE~ Oba BELOWA~IE~ 224 STO~ TE~E~TURE ~a AMBIE~ O aa ABOVE A~IE~ Oba BELOWA~IE~ ~ c CRYOGENIC 223 %~ ' H~ROOUS COMPONENT · ,EHS I CAS I ~ 227 OY~ ONo 228 ] 2~ 2 ~0 231 O Y~ O No 232 . 233 3 234 235 ~ Y~ O No 236 ' 237 4 238 239 ~ Y~ O No 240 241 5 242 243 ~ Y~ ~ No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE .//~ATUR~ .~ b~ UPCF (7~99) S:\CUPAFORMS\OES2731 .TV4.wpd TO: j~____~ ~-"('.-J ~' ITITLE IFIRM OR D.B.A. ADDRESS:~'~ ~ ~' ~j~l r~,d~j,.l.~ zip CODE BUSINESS PHONE HOME-PHONE' CORRECT ALL LOCATION OF VIOLATION VIOLATIONS CHECKED BELOW Violation No. REQUIREMENTS Cnmbustible waste / {emove and safely dispose of all ha~mdous refuse and dry vegetation on the above premises (U.F.C.) tation Provide noncombustible containers with tight fitting lids for the storage of corobustible waste and rubbish pending its safe disposal. (U. EC.) Combustible Storags Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door '(N,£.C.) (U.F.C.) Extinguishers Relocate fire extinguishe~ s) so that they will be in a conspicious location, hanging on brackets with the top to the extinguisher not more than 5 feet above the floor. ( N. F. P.A. # 10) Provide and install approved (type ~ size) portable fire extinguishm be immediately accessible for use in {area~. {U.F.C.I Recharge all tim extinguishers. Fire extinguishers shall be serviced at lease once each year, and/or after each use, by a person having a valid license or certificate. (U.F.C.) Signs Provide and maintain "EXIT' sign(s) with letters 5 or more inches in height over each required exit (door/window) to fire escape. (U. EC.) Provide and maintain appropriate numbers on a contrasting background and .visible from the street to indicate the correct address of the building. (B.M.C.) (U.F.C.) Fire doors/fire Repair all (cracks/holes/openings) in plaster in (location). Plastering shall retum the surface to its original fire resistive conditiorL (U.B,C.) (Remove-Repair) (item ~ location). Self-closing doore shall be designed to close by gravity, or by the action of a roerchanical device, or by an approved smoke and heat sensitive device Serf-closing doore shall have no attachments capable of preventing the operation of the closin9 device. (U.F.C,) Exits Remove all obstroction from hallways, Maintain all means of egress free of any storag~ (U.F.C.) Provide a contrasting colored and permanently installed electric light over or near required exit (location) indicate it as an exit, Storage Remove all storage and/or other obstTuctions Eom ( fire escape landings and stainA/ays stair shafts). ( Fire escapes/stair shafts are to be maintained free from obstTuctions at ail times. ) ( U. F. C.) Extension cords shall not be used in lieu of permanent approved vvbing. Install additional approved electrical outlets where needed. (N. EC.) (U.F.C.) Remove mulitiple attachment cods from specified electrical convenience outlet (one plug per outlet). (N. EC.) (U.F.C.) Other REQUIREMENT Person receiving notice of violation: COU~ AC~O~ ~AY BE I~A~ Signature BY ORDER OF THE FIRE CHIEF Date Completed: A~ER VIO~TIONS ARE CORRECTED, RETURN By THIS NOTICE BY MAI~ OR IN PERSON, TO: INSPE~OR INSPE~OR ~ ~ ~ LEGEND: U.F.C. Uniform Fire Code ~ ,,~,, ~ U.B.C ...... Uniform Building Code B.M.C. Bakersfield Municipal Code ~e;~ ~A ~330~ N.F.P.~ National Fire Protection ~sociation P~=~ ~2~-~ N.E.C. National Electric Code