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Home My WebLink AboutBUSINESS PLAN 11/25/2003 Hazardous Materials/Hazardous Waste Unified Permit ... CONDITIONS OF .PERMIT ON REVERSE SIDE .... '" -. This _hermit is issued fOr the following: · [] Hazardous Materials Plan El Unde~round Storage of H~rdous M~t~'ials Permit ID #:: 0t5-000-001802 [] Risk Management Program MARKS EXPRESS LUBE [] Hazardous WasteOn-Site Treatment LOCATION: 3621 cALIFORNIA AVE ELD. OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Approved by: ' Bakersfield, CA 93301 ~ss~ Voice (661) 326-3979 FAX (661) 326-0576 ' Expiration Date: 'June 30.. 2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ......... ,,~,,.~,,~%~.~,,~,,~,,,~,, ......... This permit is issued for the following: [ssu~ by: B~ers~el~ CA 93301 Voice (805) 326-3979 F~ (805) 32~0576 Expiration Date: June 30~ 2000 M^RK VVIL~ON ¢ Mark's Express Lube Mark's Automotive 3621 California Avenue 4118 East Drive Bakersfield, CA 93309 Bakersfield, CA 93308 (805) 336-0898 (805) 325-9029 MA~KS EXPRESS LUBE SiteID: 0152021-001802 Manager :eo~ ~ %~ BusPhone: (661) 336-0898 Location: 3621 CALIFORNIA AVE D~u- Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 35B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:7549 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title FRANK HUTCHINS / STATION SUPER FERYAL SARRAFIAN / SH&E COMP COORD Business Phone: (760) 743-8787x Business Phone: (818) 736-5078x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : (661) 619-9423xCELL Pager Phone : (310) 489-6296x Hazmat Hazards: Fire DelHlth Contact : Phone: (661) 336-0898x MailAddr: 3621 CALIFORNIA AVE State: CA City : BAKERSFIELD Zip : 93309 Owner MARK WILSON : .~~F~i ~i' ~~~dL~ ~/ State: Phone: CA (661) 325-9029x Address City : BAKERSFIELD Zip : Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RCs: No ParcelNo: Emergency Directives: -1- 09~09~2003 MARKS EXPRESS LUBE SiteID: 015-021-001802 Fast Format ~ Training Overall Site -- Employee Training 10/06/1997 WE HAVE 2 EMPLOYEES AT THIS FACILITY. DO YOU HAVE MSDS SHEETS ON FILE??????????? V'~ GIVE A BRIEF SUMMARY OF YOUR TRAINING PROGRAM: Page 2 Held for Future Use Held f°r Future use I 9 09/09/2003 MARKS EXPRESS LUBE = SiteID: 015-021-001802 + Manager : BusPhone: (661) 336-0898 Location: 3621 CALIFORNIA AVE Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 35B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:7549 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title FRANK HUTCHINS / STATION SUPER FERYAL SARRAFIAN / SH&E COMP COORD Business Phone: (760) 743-8787x Business Phone: (818) 736-5078x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : (661) 619-9423xCELL Pager Phone : (310) 489-6296x Hazmat Hazards: Fire DelHlth Contact : Phone: (661) 336-0898x MailAddr: 3621 CALIFORNIA AVE State: CA City : BAKERSFIELD Zip : 93309 Owner MARK WILSON Phone: (661) 325-9029x Address : 4421 SOANNE AVE State: CA City : BAKERSFIELD Zip : 93309 +- -+ I Period : to TotalASTs: = GalI Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: I + += Hazmat Inventory One Unified List + +== Alphabetical Order -- All Materials at Site + +- -+- + + -+- + .... +- - -+ Hazmat Common Name... ISpecHazlEPA HazardsI Frm I DailyMax IUnitlMCPI ............................ ~ + + + + .... +- - -+ AUTOMATIC TRANSMISSION FLUID F DH L 85.00 GAL Low MOTOR OIL F DH L 200.00 GAL Min MOTOR OIL F DH L 700.00 GAL Min WASTE OIL F DH L 300.00 GAL Low I, /~,,.,,/.~ [..)~_a.e.r~ Do hereby certify that ! have (Type or p6nt name) reviewed the attached hazardous materials ma~age- ment plan for. b,,,.,,/,<, E~.~,.~ ~ and that it along with -- (Name of~u$ine~) any corrections constitute a complete and correct man- agement plan for my facility. + --~- + ~RKS EXPRESS LUBE SiteID: 015-021-001802 += Inventory Item 0003 = == Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME -4 AUTO.TIC TRANSMISSION FLUID Days On Site ~VOLINE ATF 365 Location within this Facility Unit Map: Grid: + CENTER OF INSIDE N WALL I CAS#64742_56_9 += STATE=+= TYPE ===+== PRESSURE ===+ TEMPE~TURE ==+ .... CONTAINER TYPE I Liquid I Pure I a~ient I a~ient I ABOVE GROUND TANK ~ + ~ ~ ~___ 4 + AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 85.00 GAL 85.00 GAL 40.00 GAL 4 ~ + + ~ HAZARDOUS COMPONENTS =--+===+= 100.00 Transmission Fluid (Petroleum-Based) No 0 + ~ --- ~===~ + ~===~ + ..... HAZARD ASSESSMENTS ===+ ~ ~ ..... ITSecretl RSIBioHazl Radioactive/Amount I EPA Hazards I NFPA USDOT# I MCP No No No No/ Curies F DH / / / Low ~ ~===~ ~===== 4 + ~ ~=====+ += Inventory Item 0001 Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME +-- MOTOR OIL I Days On Site CASTROL MOTOR OIL I 365 Location within this Facility Unit Map: Grid: +- + E END OF INSIDE N WALL I CAS#8020835 ..... +== += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Liquid I Pure I Ambient I Ambient I ABOVE GROUND TANK + .... =====+ 4 ~ +-~ + .... + AMOUNTS AT THIS LOCATION ..... + Largest Container I Daily Maximum I Daily Average 100.00 GAL 200.00 GAL 100.00 GAL + + +== ~_+ ~ ~ HAZARDOUS COMPONENTS +===+= + I I I RS l CAS# ~ ~ ======================== + +===+ + HAZARD ASSESSMENTS ===+ ~ ~=====+ ITSecretl RSIBioHazI Radioactive/Amount EPA Hazards I NFPA USDOT# I MCP No No No No/ Curies F DH / / / Min + ~===~ ~= ~ ~--+ ~ +=====+ 2 01/22/2002 + MARKS EXPRESS LUBE == SiteID: 015-021-001802 += Inventory Item 0002 Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME ~ MOTOR OIL Days On Site HAVOLINE MOTOR OIL 365 Location within this Facility Unit Map: Grid: + W END & CENTER OF INSIDE N WALL CAS# 8020835 += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Liquid I Pure I Ambient I Ambient I ABOVE GROUND TANK += =+ AMOUNTS AT THIS LOCATION =+ Largest Container I Daily Maximum I Daily Average 240.00 GAL 700.00 GAL 350.00 GAL + ~= HAZARDOUS COMPONENTS +===4 I wt. I I Rsl CAS# + += +===4 ==+ += +===+ + HAZARD ASSESSMENTS ===4 + ~ ..... TSecretl RS Bi°Haul Radi°active/Am°unt I EPA HazardsINo No No No/ Curies F DH NFPA/// IUsDOT# MinMCP + 7===+======% ~ =4 7= ~=====+ += Inventory Item 0004 Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ~ + WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: + ................ + IN LUBE PIT BELOW EACH BAY CAS# 221 += ~ + += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE + I Liquid [ Waste I Ambient I Ambient I ABOVE GROUND TANK I + ~ ~ ~ ~ + =+ AMOUNTS AT THIS LOCATION + I Largest Container I Daily Maximum I Daily Average I 600.00 GAL 300.00 GAL 150.00 GAL + + = = HAZARDOUS COMPONENTS + = = = · + 100.00 Waste Oil, Petroleum Based No 0 + + ---- ==+===4 + + +===+ ~ HAZARD ASSESSMENTS ===4 + ~ ..... + I TSecret INo NoRS I Bi°HasINo Radioactive/AmountNo/ Curies EPAF HazardsDH NFPA/// I USDOT# MCP [Low + + + ~ ==4 ~ += 7=====+ -3- 01/22/2002 + MARKS EXPRESS LUBE == SiteID: 015-021-001802 + 4 Fast Format + += Notif./Evacuation/Medical Overall Site + +== Agency Notification 10/06/1997 + PHONES AVAILABLE IN SHOP AND OFFICE TO CALL 911. + +=== Employee Notif./Evacuation 10/06/1997 VERBAL ..... Public Notif./Evacuation 10/06/1997 EXIT CUSTOMER WAITING AREA TO EITHER E OR W BAY DOOR EXITS. + --- .- + Emergency Medical Plan = 10/06/1997 MERCY-MEDI CENTER ON TRUXTUN AVE. -4- 01/22/2002 + MARKS EXPRESS LUBE = = SiteID: 015-021-001802 + + -- Fast Format + += Mitigation/Prevent/Abatemt Overall Site + +== Release Prevention 10/06/1997 + OIL IS DISPENSED PNEUMATICALLY THROUGH HOSE REELS. + ------+ +=== Release Containment 10/06/1997 + DRAINED OIL GOES INTO COLLECTION PANS AND IS TRANSFERRED BY GRAVITY INTO WASTE OIL TANKS AT END OF DAY. + .... Clean Up 10/06/1997 + ABSORBANT IN LUBE PIT. CRANES WASTE OIL COLLECTS USED OIL AND FILTERS (800) 272-6330. ~ Other Resource Activation =- -5- 01/22/2002 + MARKS EXPRESS LUBE SiteID: 015-021-001802 + 4 Fast Format + += Site Emergency Factors Overall Site + +== Special Hazards + + +=== Utility Shut-Offs 10/06/1997 + A) GAS - N/A B) ELECTTRICAL - OUTSIDE SW CORNER OF BLDG & BREAKER PANEL INSIDE SW CORNER C) WATER - OUTSIDE SW CORNER OF BLDG D) SPECIAL - SUMP PUMP IN BOTTOM OF LUBE BAY E) LOCK BOX - NO + ..... Fire Protec./Avail. Water = 10/06/1997 + PRIVATE FIRE PROTECTION - PORTABLE FIRE EXTINGUISHERS NEAREST FIRE HYDRANT - += + Building Occupancy Level --+ I -I- -6- 01/22/2002 + MARKS EXPRESS LUBE SiteID: 015-021-001802 + + ........... Fast Format + += Training -- - Overall Site + +== Employee .Training 10/06/1997 + WE HAVE 2 EMPLOYEES AT THIS FACILITY. DO YOU HAVE MSDS SHEETS ON FILE??????????? GIVE A BRIEF SUMMARY OF YOUR TRAINING PROGRAM: +=== Page 2 + + .... Held for Future Use Dear Business Owner: FIRE CHIEF RON FRAZE This notice is meant to act as a reminder that the California Health ADMINISTRATIVE SERVICES alld Safety Code, Chapter 6.95, requires any handler of hazardous materials 2101 'H' Street .ake~.e~, c^ 93301 to revise their hazardous materials business plan within 30 days of any one VOICE (805) 326-3941 FAX (805) 395-1349 of the following events; SUPPRESSION SERVICES 2101 'H' Street (l) A I00 per cent or more increase in the quantity of a Bakersfield, CA 93301 previously-disclosed material. VOICE (805) 326-3941 FAX (805) 395-1349 (2) Any handling of a' previously-undisclosed hazardous PREVENTION SERVICES 1715 Chester Ave, material, subject to the inventory requirements of Chapter Bakersfield, CA 93301 VOICE (805) 326-3951 6.95. FAX (805) 326-0576 ENVIRONMEWrN. SERVICES (3) Change in business ownership. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 (4) Change in business address. FAX (805) 326-0576 · rt~.l.G olvisto. (5) Change of business name. 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805)399-4697 Any questions regarding these required revisions, please call the FAX (805) 399-5?63 Hazardous Materials Division at (805) 326-3979. Sincerely yours, Director, Office of Environmental Services CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r'~ Floor, Bakersfield, CA 93301 FACILITY NAME /~Af0('~ '~,x/grE-<;c, Lzx,i)~ INSPECTION DATE I7--//0/0 FACILITY coNtrAcT BUSINESS ID NO. 15-210- ~0160.2. INSPECTION TIME / ~2,O NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program l~Routine [~l Combined ]~ Joint Agency {~ Multi-Agency ~l Complaint {~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate t.., / Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled V ]~/~°~C/ /--~//5 ~'t4/ Fire Protection ~" Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazar~lo~u~waste on site?: [~es l~ No ~//~~~ Questions regarding this inspection? Please call us at (661) 326-3979 Business Site/g.R)esponsible Party White- Env. Svcs. Yellow-Station Copy Pink-Business Copy Inspector:._.. MARKS EXPRESS LUBE :== SiteID: 015-021-001802 + Manager : BusPhone: (661) 336-0898 Location: 3621 CALIFORNIA AVE Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 35B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:7549 EPA Numb: DunnBrad: Emergency Contact~_/ Title Emergency Contact / Title FRANK HUTCHINS 7 STATION SUPER FERYAL SARRAFIAN / SH&E COMP COORD Business Phone: (760) 743-8787x Business Phone: (818) 736-5078x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : (661) 619-9423xCELL Pager Phone : (310) 489-6296x + Hazmat Hazards: Fire DelHlth Contact : Phone: (661) 336-0898xI MailAddr: 3621 CALIFORNIA AVE State: CA City : BAKERSFIELD Zip : 93309 Owner MARK WILSON Phone: (661) 325-9029x Address : 4421 SOANNE AVE State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gall Preparer: TotalUSTs: = Gal Certif'd: Res: No Emergency Directives: += Hazmat Inventory One Unified List + +== Alphabetical Order All Materials at Site + + + -+ ..... + -+ .... +-- -+ Hazmat Common Name... ISDecHazlEPA HazardsI Frm I DailyMax ~IUnitlMCPI + + ........... + ..... + + .... +- --+ AUTOMATIC TRANSMISSION FLUID F DH L 85.00 GAL Low MOTOR OIL F DH L 200.00 GAL Min MOTOR OIL F DH L 700.00 GAL Min WASTE OIL F DH L 300.00 GAL Low I, Do hereby certify that ! have (Type or plan! reviewed the a~ached ha. zardous materials ment plan for and that it along wa'th (Name Of 'Su~ine~) any corrections constitute a complete and correc~ msn- agement plan for my facili~. ...... + -~- 0~/22/2002 MARKS EXPRESS LUBE ~~ SiteID: 215-000-001802 Manager : :X~,(,-~_.J~U~L~-~ S~P 1 ~7999 BusPhone: (805) 336-0898 Location: 3621 CALIFORNIA AV~ .... > ~Map : 102 CommHaz : Low City : BAKERSFIELD !~L~Grid: 35B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code:7549 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARK WILSON / OWNER _~-~~A Business Phone: (805) 325-9029x Business Phone: (805) 336-0898x 24-Hour Phone : ( ) - x 24-Hour Phone : (805) Pager Phone : ( ) - x Pager Phone : ( ) - Hazmat Hazards: Fire DelHlth Contact : Phone: (805) 336-0898x MailAddr: 3621 CALIFORNIA AVE State: CA City : BAKERSFIELD Zip : 93309 Owner MARK WILSON Phone: (805) 325-9029x Address : 4421 SOANNE AVE State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ---- Hazmat Inventory One Unified List -- Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax Unit MCP AUTOMATIC TRANSMISSION FLUID F DH L 85 GAL Low MOTOR OIL F DH L 200 GAL Min MOTOR OIL F DH L 700 GAL Min F DH L 300 GAL Low WASTE OIL 1 08/16/1999 MARKS EXPRESS LUBE SiteID: 215-000-001802 = Inventory Item 0003 Facility Unit: Fixed Containers at Site AUTOMATIC TRANSMISSION FLUID Days On Site HAVOLINE ATF 365 Location within this Facility Unit Map: Grid: CENTER OF INSIDE N WALL CAS# 64742-56-9 F STATE I TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 85.00 GALI 85.00 GAL 40.00 GAL HAZARDOUS COMPONENTS 100.00 Transmission Fluid (Petroleum-Based) N 0 HAZARD ASSESSMENTS TSecret RS BioHazl Radioactive/Amount I EPA Hazards, NFPA USDOT# MOP No N° I IINo No/ Curies F DH / / / Low = Inventory Item 0001 Facility Unit: Fixed Containers at Site MOTOR OIL Days On Site CASTROL MOTOR OIL 365 Location within this Facility Unit Map: Grid: E END OF INSIDE N WALL CAS# 8020835 CONTAINER TYPE ~ STATE ~ TYPE PRESSURE TEMPERATURE /Liquid /Pure I Ambient I Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 100.00 GALI 200.00 GALI 100.00 GAL HAZARD ASSESSMENTS TSecretI ~SIBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# I MCP No N No No/ Curies F DH / / / Min -2- 08/16/1999 MARKS EXPRESS LUBE SiteID: 215-000-001802 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site MOTOR OIL Days On Site HAVOLINE MOTOR OIL 365 Location within this Facility Unit Map: Grid: W E~ & CE~ER OF INSIDE N WALL CAS# 8020835 F STATE -- TYPE PRESS~E [ TEMPE~T~E CO~AINER TYPE Liquid Pure Ambient Ambient ABOVE GROUND TANK AMO~TS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 240.00 GALI 700.00 GAL 350.00 GAL i %Wt. ~Z~DOUS COMPONENTS RS CAS# TSoorotN~SBioHazI HAZARDAiSESSMENTS Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No/ Curies F DH / / / Min -~ Inventory Item 0004 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: IN LUBE PIT BELOW EACH BAY CAS# 221 STATE I TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 600.00 GAL] 300.00 GAL 150.00 GAL HAZARDOUS COMPONENTS 100.00 Waste Oil, Petroleum Based N TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low 3 08/16/1999 F MARKS EXPRESS LUBE SiteID: 215-000-001802 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 10/06/1997 PHONES AVAILABLE IN SHOP AND OFFICE TO CALL 911. -- Employee Notif./Evacuation 10/06/1997 VERBAL -- Public Notif./Evacuation 10/06/1997 EXIT CUSTOMER WAITING AREA TO EITHER E OR W BAY DOOR EXITS. Emergency Medical Plan 10/06/1997 MERCY-MEDI CENTER ON TRUXTUNAVE. -4- 08/16/1999 F MARKS EXPRESS LUBE SiteID: 215-000-001802 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 10/06/1997 OIL IS DISPENSED PNEUMATICALLY THROUGH HOSE REELS. --Release Containment 10/06/1997 DRAINED OIL GOES INTO COLLECTION PANS AND IS TRANSFERRED BY GRAVITY INTO WASTE OIL TANKS AT END OF DAY. -- Clean Up 10/06/1997 ABSORBANT IN LUBE PIT. CRANES WASTE OIL COLLECTS USED OIL AND FILTERS (800) 272-6330. Other Resource Activation -5- 08/16/1999 F MARKS EXPRESS LUBE SiteID: 215-000-001802 Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 10/06/1997 A) GAS - N/A B) ELECTTRICAL - OUTSIDE SW CORNER OF BLDG & BREAKER PANEL INSIDE SW CORNER C) WATER - OUTSIDE SW CORNER OF BLDG D) SPECIAL - SUMP PUMP IN BOTTOM OF LUBE BAY E) LOCK BOX - NO Fire Protec./Avail. Water 10/06/1997 PRIVATE FIRE PROTECTION - PORTABLE FIRE EXTINGUISHERS NEAREST FIRE HYDRANT - Building Occupancy Level -6- 08/16/1999 F MARKS EXPRESS LUBE SiteID: 215-000-001802 Fast Format ~- Training Overall Site -- Employee Training 10/06/1997 WE HAVE 2 EMPLOYEES AT THIS FACILITY. DO YOU HAVE MSDS SHEETS ON FILE??????????? GIVE A BRIEF S~Y OF YOUR TRAINING PROGRAM: --Held for Future Use Held for Future Use -7- 08/16/1999 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: F~-~ P~V~ 1. To avoid ~gher actio~ re~ t~s fo~ ~t~ 30 days of receipt. 2. T~~ ~S~RS ~ ENGLISH. ~swer the questions below for the bus,ess as a whole. 4. Be as briefed concise as possible. SECTION 1: BUS,SS ~E~ICATION DATA LOCATION: '3 (~ 7_ f ~/~0 ~-~ ~ MAILING ADDRESS: ?~,,~- ~ CITY: ~-a~<c~s~ C-x.t~ STATE: <_,q ZIP: GT~O~PHONE: DUN & BRADSTREET ~ER: SIC CODE: PR/MARY ACTIVITY: OWNER: MAII.ING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER OF EMPLOYEES: 2.-- MATERIAL..SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQLrEST 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 TI--IE QUANTITIES AT NO TIME EXCEED TIlE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION I, CERTIFY THAT THE ABOVE INFORMATION 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 co s =s ~ SIGNATUR~ '~ TITLE DATE 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: ~ ~ 7'- ~o c~'tr.s~raz_ D. EMERGENCY MEDICAL PLAN: /t4C'0-¢5a - ~(_.--~ - HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: B. RELEASE CONTA/NMENT AND/OR MINIMIZATION: C. CLE~-~ PROCED~S: SECTION 8: ~ITY S~-O~S ~OCATION OF S~-O~S AT YO~ FAC~I~ NA~ GAS~ROP~: ~/~ ELEC~C~: ~'Ofi ~ ~ ~ ~c~& ~ ~~ ga~ r~g,~ ~~ WA~R: ~%,~ ~ Cm~ ~ ~a~ SPEC~: So~F ~omF I~ ~~ ~ ao~ ~ LOCK BOX: ~S~ ~ ~S, LOCATION: SECTION 9: P~A~ F~ PRO~CTION~A~R AV~~ITY A. PRIVATE FIRE PROTECTION: ~oa_~ c,~ B. WATER AVAILABILITY (FIRE HYDRANT): 4 ~OUS MATERIALS ENVENTORO Pag~ of Business Name /t~ ~ ~,e.~¢~.~5 LOIS,' Address ~ ~ ~ I ~/~Z.~/'--<~./~/~/a~ ~/ ~C~ DESC~ON 1)~ORYSTA~S:N~[ ]A~fion[ ]Re~[ ]~1~[ ] Ch~kffch~isaNONT~S~[ ]T~S~[ ] .2) Co~ Nme: ~ ~ ~T~ ~ ~~ O ~ ~ 3) ~T ~ (opfi~) C~N~e: ~~ ~ ~[ ] C~ 4 ) Ph~i~ & H~ P~SlC~ ~ ~ Ca~ F~e ~ R~ve [ ] SL~d~ Rel~ of~ [ ] lmm~ H~ (Acura) [ ] ~hy~ H~ (C~c) [ ] ~) was= c~s~cauos O~t ~ ~ Dm ~ so::) USE CODE ~ ~)e~SZC~S$a= ~ad{ ] Liqmd~] ~{ ] ~] ~ ] W~{ ] ~.~ ] 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) STOOGE COD~ ~mD~y~t ~ L~[ ]~]~[ ] a) C~ ~ Av~e D~y ~omt ]&O C~[ ] b)~: 3 ~ ~omt ~ c) T~m ~ ~ S~ Con~ I ~ ~ Days on Sim ~ ~ C~le ~ M~: ~ Y~, J, F, ~ ~ ~ J, J, ~ S, O, N, D 9) ~: Li~ CO~~ C~ % ~ ~ ~ ~ mo~ ~ 1) [ ] ch~ ~~ or 2) [ ] my ~ ~u 3) [ ] I)INVENTORYSTATUS:New[ ]Addition[ ]Revision[ ]Deletion[ ] Check if chemical is a NON Trad~ Secret [ ]Trad~Secret[ ] 2) Common Name: /-k/~kJCY'L. od~ /%oq'-Oc<. <~ L 3)DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH HazardCategones Fire~'c, JReactive[ ]Sudd~RelmseofPressum[ ] Immediate Health (Acute) [ ]DelayedHealth(Clmmic)[ ] 5) WASTE CLASSIFICATION O-digit co~ ffum DHS Form 8022) USE CODE ~-~ 6) PHYSICAL STATE Solid [ ] Liquid [,~] Gas [ ] Pure, Z.-- ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TINIE AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount '~d~O Lbs[ ]Gal[ ]ft3[ ] a) Container: 7__. Average Daily Amount 3 ~ Curies [ ] b) Pressure: Annual Amount ~oc.X:) c) Temperature Largest Size Container # Days on Site '~,~'~" CLrcle 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) [ ] chemical components or 2) [ ] any AHM components 3) [ ]. 10)LOCATION I certify under penal, of law, that I have personally emed and an fa~ with the inforr~a/~ this/~tld~all attach~ts~ I\ h ~ZARDOUS MATERIALS INVENTORY Page ~ of Business Name jt,qg~z~ 5 ~---..~O'~'S~ t._~g-C Address CHEMICAL DESCRIFrION 1) INVENTORY STATUS: New [ ]Addition{ ]Revision( ]Deletion[ ] Che~kifclmmcaflisaNONTradnSec~[ ]Trad~Seeret[ ] 2) Common Name: .~/M, JOL..,-~ ,,Ad'l- ~- 3) DOT # (optional) Chemical Name: ~*-,C.. ,-~...A,~.,, 5',/o-'" ~o tO AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH I4a~ardCategones Fire.Reactive[ ] Sudden Release of Pressure [ ] tmmed/otcHealth(Acute)[ ]DelayedHealth(Chroni¢)[ ] 5) WASTE CLASSWICATION (3-digit code flora DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ I Liquid [~l Gas [ I Pure [~-e'] Mixture [ ] Waste [ I l~,,,fioa~ive [ ] 7) AMOUNT AND lIME AT FACILITY~ UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount c> --, Lbs [ ] Gal l~l-ft3 [ ] a) Container:. Average Daily Amount glo Curies [ ] b) Pressure: Annual Amount I OOO c) T .em?emture Largest Size Container q,; ~ # Days on Site ~(::,_~ Ch'cie Which Months: All Year, $, F, M, A, M, J, $, A, S, O, lq, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most h~-~,,xtons 1) [ ] chemical components or 2) [ ] any AHM components 3) [ ] 10 )LOCATION I)INVENTORYSTATUS:New[ ]Addition[ ]Revision[ ]Deletion[ ] Check ff chemical is a NON Trade Seeret [ ]TradeSec~[ ] 2) Common Name: /,Aj~p''ca'T~-' O t/__ 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) Physical & Health PHYSICAL HEALTH HazarclCategories Fire[~"q]Reactive[ ]SuddenReleaseofPressure[ ] Immediate Health (Acute) [ ]DelayedHealth(Clmmi¢)[~-.,]- 5) WASTE CLASSIYICATION ~2_"L ~ O-digit code flora DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [~] Gas [ ] Pure [ ] Mixture [ ] W~ste ~ Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount ~'~r..~ Lbs[ ]Gal[4']fl3[ ] a) Container.. ~-' Average Daily Amount /S'Z) Curies[ ] b) Pressure: Annual Amount ~ c) Temperature Largest Size Container # Days on Site ~36~ Circle Which Months: All Year, $, F, M, A, M, $, $, A, S, O, lq, D 9) MIXTURE: List COMPONENT CAS# % WT AHM the three most b,o~,-clous l) [ ] chemical components or 2) [ ] any AffM components 3) [ I certify under penalty, of law, that I have personally examined and am familiar with the information on this and all attw. laed doeume~tz. I believe the submitted information is true. accurate and complete. FD 1916 (Revised 8-15-86) CITY OF BAKERSFIELD FIRE DEPARTMENT F~RE ORDINANCE V~O~T~ON ~ 7 7 TO: TITLE FIRM OR D.B.A. ADDRESS:~ ~ { ~ I~l'~ ~ ZIP CODE BUSINESS PHONE HOME PHONE CORRECT ALL LOCATION OF VIO~TION VIO~TION$ ~ CHECKED BELOW ~ f ~'~/~ ~ ' Violatio~ No. REQUIREMENTS Combustible waste / ~ 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) dry vegetation ~2 Provide noncombustible containers w~th tight fittin~ lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) 3 Relocate (N.E.C.) (U.F.C.) Combustible Storage combustible sto~age to provide at least 3 feet clearance around motor fuse bonfire door Extinguishers ~ 4 Relocate fire extin~uishe~ s) so that they will be in a conspicuous location, hangin~ 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) potable fire extin~uishe~ to be immediately accessible for use in (area). (U.F.C.) Recharge all fire extinguishers. Fire extinguishers shall be seMced at lease once each year, and/or a~er each use, by a person having a valid license or ce~ificate. (U.F.C.) Signs ~ Provide and maintain "EXW' sign(s) with letters 5 or more inches in height over each required exit (doodwindow) to fire escape. (U.F.C.) /~ ~vide and maintain appropriate numbers on a contrasting background and ~isible from the street to indicate the correct address of the building. (BM.C,)(U.F.C.) Fire doors/fire Separations] 9 Repair atl (crack, holes/openings) in plaster in (location). Plastering shall re~rn the su~ace to ~s original fire resistive condition. (U.B.C.) (Remov~Repak) (item ~ location). Self-closin~ doors shall be. design~ to close by gra~, or by the action of a merchanical device, or by an approved smoke and heat sens~ive device. Se~-closing doors shall have no a~achments capable of preventinfl the operation of the closin~ device. (U.F.C.) Exits Remove a{I obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) Provide a contrasting colored and permane~ly installed ele~ric light over or near required ex~ (location) ' indicate it as an ex~ (U.F.C.) Storage Remove all ~orage an~or other obstructions from (fire escape landings and stai~ays stair sha~s). ( Fire escape~stair sha~ are to be maintained fr~ kom obs~uctions at all ~mes.) ( U. F. C.) Electrical Applianc cords shall not be used in lieu of permanent approved widng. Install add~ional approved elect~cal o~lets where n~ded. (N.E.C.) (U.F.C.) Remove mulifiple a~achme~ co~s from specified electrica~ convenience outlet (one plug per outlet). (NEC.) (U.F.C.) Other REQUIREMENT BY ORDER OF THE FIRE CHIEF Date Completed: AFTER VIOLATIONS ARE CORRECTED, RETURN THIS NOTICE BY MAIL OR IN PERSON, TO:. By INSPECTOR INSPECTOR ~'~ ~(B~ (~E'~ LEGEND: U.F.C. Uniform Fire Code ~ ,~, ~ U.B.C. Uniform Building Code B.M.C. Bakersfield Municipal Code ~~ ~ ~ N.F.P.A. National Fire Protection Association ~ ~-~ N.E.C. National Electric Code HAZARDOUS MATERIALS INSPE~ON ~a]~ersfield l~e Dept. ~ OFFI'Tff-E OF ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Date Completed Business Namei fV/z~a e's ~-yPtzess Location: ~o 7_! W__~t_~ r-~-oq ~4 Business Identification No. 215-000 ~J~=,-,J (Top of Business Plan) Station No. ~ Shift Inspector Arrival Time: I,~ ,c<c) Departure Time: / ~-cc)Inspection Time: Adequate Inadequate Adequate Inadequate Address Visable [] ~ Emergency Procedures Posted ~ [] Correct Occupancy ~ El Containers Properly Labled I~ [] Verification of Inventory Materials ~ [] Comments: Verification of Quantities ~ [] Verification of Location ~ [] Verification of Facility Diagram Er" r-i Proper Segregation of Material ~ [] Housekeeping Comments: ~-~Q~ ~5~r~_ ,~O~/Z~5~ ~ Fire Protection ~ [] Electrical [] Comments: ~z:~J~'z- ~c.,,...r~ ,~z~oc~ ~ A-,,"~ Verification of MSDS Availablity [3 ~ c.-o,~ Fr~.e~,z. ~.u ~.rc..~ .. Number of Employees: "Z- El [] Comments: Verification of Haz Mat Training [] ~ ~.~. %"C ,s Comments: ~LC-~sE ~l'~,~J ~1 ~ 0.5 ~ ~,d.*.~ ~ [] [] Verification of Hazardous Waste EPA No. ~///',,x Abbatement Supplies and Procedures ~ [] Proper Waste Disposal ~ rl Comments: Secondary Containment Security ~ r-I Special Hazards Associated with this Facility: ~. L/'c..-.-z.? ~ -~.~c--,~,,,~_.--. Violations: ~¢.~C~ ~j_.~-¢~ (~sr~s /'7'p__,~,w,~ F-~... <J-,~,,rc~ . All Items O.K El I~siness Owner/Uana~r PRINT NAk'~ ~ SIGNATURE Correction Needed ~Ynite-Haz Mat Div. Yellow-Station Copy Pink-Business Copy LI.. FiRE DEPARTMENT TO: TITLE FIRM~~ ADDRESS: ZIP CODE BUSINESS PHONE HOME PHONE CORRECT ALL LOCATION OF VIOLATION VIOLATIONS CHECKED BELOW Violation No. REQUIREMENTS Combustible waste / Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) dry vegetation Provide noncombustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) Combustible Storage Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N.E.C.) (U.F.C.) Extinguishers Relocate fire extinguishers) 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 extinguishe~ he immediately accessible for use in (area). (U.F.C.) Recharge all fire 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.F.C.) and maintain appropriate numbers on a contrasting background and .visible from the street to indicate the correct address of the building. (R.M.C.) (U.F.C.) Fire doors/fireSeparations Repair all (cracks/holes/openings) in plaster in (location). Plastering shall return the surface to its original fire resistive condition. (U.B.C.) (Remove-Repair) (item ~t location). Self-closing doors shall he designed to close by gravity, or by the action of a merchanical device, or by an approved smoke and heat sensitive device. Self-closing doors shall have no attachments capable of preventing the operation of the closing device. (U.F.C.) Exits Remove all obstruction from hallways. Maintain all means of egress free of any storage. '(U. EC.) Provide a contrasting colored and permanently installed electric light over or near required exit (location) indicate it as an exit {U. EC.) Storage Remove all storage and/er other obstructions from ( Electrical Appliances Extension cords shall not be used in lieu of permanent approved widng. Install additional approved electrical outlets where needed. (N.E.C.) (U.F.C.) Remove mulitiple attachment cords from specified electrical convenience outlet (one plug per outlet). (N.E.C.) (U.F.C.) Other REQUIREMENT A~ER VIO~TIONS ARE CORRECTED, RETURN ~B~DER/, ] ~OF THE FiRE CHIEF ~ Date Completed: THIS NOTICE BY MAIL OR IN PERSON, TO: sy ~. ~~ ~r~ ~ ~r~0 LEGEND: U.F.C. Uniform Fire Code U.B.C. Uniform Building Code ~ '"~" ~ B.M.C. Bakersfield Municipal Code ~~0~ ~ ~ N.F.P.A. National Fire Protection Association ~ ~-~ N.E.C. National Electric Code