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HomeMy WebLinkAboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit · D Unde~mund Stom~ of H~ous ~flals Permit ID ~:: 015~00~01967 ~ RiskManage~tP~mm ~ Hm~ous Wa~e On-Site T~t DISCOUNT TIRE CENTERS LocATIoN: ~56 CALI'FORNIA' AVE OFFICE OF EN~R ONMENTAL S~R ~CEX':~ : ApP~oV~ by: HAZArd' _,~OUS MATERIALS'-~:':~ION TIME CHARGED-'--_ BUSINESS/DEAPRTMENT NAME: ADDRESS: 4 &,~Wo ~.~,~A PROJECT DESCRIPTION: PROJECT NUMBER: ~ DATE,;. NAME; CHGD: COMMENTS:. n PROJECT COMPLETION: DATE: ~RSFIELD FIRE DEPARTMENT ~--'"~NVlRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301' (805) 326-3979 TANK REMOVAL INSPECTION FORM FACILITY 8~{t~era~ Aec ~h~,! ADDRESS z/qgG ~h~,2 O~R ~%~ ~%~ ~o~ PE~IT TO OPE~TE9 CO~CTOR ~ ~t~ CO,ACT PERSON TEST METHODOLOGY ~ ~ ~ PRELI~ARY ASSESSME~ CO.Ho[(~: ~*~CO~ACT PERSON CO~ RECIEPT ~c~ &~e ~ LEL% PLOT P~ CONDITION OF TANKS CONDITION OF PIPING CONDITION OF SOIL ~y ' ~TE XNSPECTOR8 ~E 8Z~TURE <'~. PRPORTT TOBE RENTED FOR A // PROPOSED MOBIL MART / ..'.'~. TI RE STORE / ~" / ~, CASHIER B'OX TOEII REI~OVED ,."'/'/ ~!© I '~.' L__:_' --~ I 1 I 1 , II CALIFORNIA ,~V ENUE C^L FORM,^ nOBiL I'-'~S~, CAL,FORN,,* ^v£. i BAltE~SFi£L'D CALIF. 15/IO/8/, ISCALE N~:~I'I FORM ~ ~ IF NORTN SCALE: BUS INESS N~E: i _ Inspector's Comments): -OFFICIAL US£ ONLY- H~CU-i~ UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 ' FACILiTy NAME "~-~ ~Oa.J ~-e'-~ INSPECTIONOATE ~-03 FACILITY CONTACT ~)ot'v'O%a,~ J~'_,~,.) lc_ BUSINESS ID NO. 15-210-t9/$". 07_/-DOing 7 INSPECTION TIME , ~O ~--,,,..~ NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program {~DRoutine [~ Combined [~ Joint Agency [~ Multi-Agency U~ Complaint {~ Re-inspection OPERATION C V COMMENTS / Appropriate permit on hand Business plan contact information accurate ' ~ '~'"~O~Ooa,n -~., f l e Visible address Correct occupancy t,," 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 , '~ ~t~d.O~ 0.'! ¢']"0 Housekeeping Fire Protection ' "" Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ~es [~] No ,C'~-~., ~~ Explain: (~ ~- I~ Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspecto(/~_~ '~ '~': ~~i~'!OFFICE.OFENVIRoNMENTAL SERVICES ~.~/~ ,~ ED'PROGRAM I.NSPECTION CHECKLIST ~SPECTION.TIME ~ ~" ~7~:~': ~'~' NUMBER OF EMPLOYEES'" Section 1: BUsineSs:Plan and lnVeat°~Program ~ Routine ~ Combined '~ Joint:Agency ~ Mu!ti~Agency ~ complaint ~ Re-inspect,on CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ADD.SS q~ ~i-'~,~',~ ~ PHONE NO. ~-/f ~ FACILITY CONtACt_~n~ ~/~ BUSINESS IDNO. 15-210- ~SPECTION TIME ~O ~7~ NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~ Routine [~l Combined ~ Joint Agency [~ Multi-Agency ~.~ Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate ~ ~ orr Q o~7 ~ ~ [..e_ Visibleaddress Correct occupancy 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 Explain:Any hazardous waste on site?: ~Yes ~] Not. o_~f b- Oct Questions regarding this inspection? Please call us ~-3979~ Business Site"'R~'pons~le Party wh,,~- E... Sync. Vel,o,~ - S,at~o. Cov~ P,.k- a,~,.ess Copy lnspecto '~g~=~- · ~''''---- DISCOUNT TIRE CENTERS SiteID: 215-000-001967 Manager : ~/~ BusPhone: (661) 859-1159 Location: 4456 CALIFORNIA AVE~ Map : 102 CommHaz : City : BAKERSFIELD Grid: 35A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 03 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact /_ Title Business Phone: (661) 859-1159x '~usiness Phone: ~/}~'//~x 24-Hour Phone : ( ) - x 24-Hour Phone : (~)~ -/~f~x Pager Phone : ( ) - x Pager Phone : (~)~ -~F~x Hazmat Hazards: Fire DelHlth Contact : ~,~¥~¥~'~ Phone: (661) 859~1159x MailAddr: 4456 C~IFO~IA AVE State: CA City : BAKERSFIELD ~ ~ 6 ~99 Zip : 93309 Owner DISCO~T TIRE CENTERS ....... ---"~ Phone: (661) 859-1159x Address : 4456 C~IFO~IA AV~ : ...... State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = gal Preparer: TotalUSTs: = ~al Certif'd: Res: No Emergency Directives: ---- Hazmat Inventory One Unified List -- Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpocHazlEPA HazardsI Frm DailyMax IUnitIMCP MOTOR -OIL F .... DH L 200 -GAL Min WASTE ANTIFREEZE F DH L 55 GAL Low WASTE OIL · F DH L 110 GAL Low · ~, Do hereby certify th~t~ havSe 55 sAL UnR (Type o~ print name) -- reviewed the attached hazardous materials manage- any corre~ions ~nstRute agement p~n for ~y ~. oa/o~/~ F DISCOUNT TIRE CENTERS SiteID: 215-000-001967 ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE SW CORNER OF SHOP' CAS# 8020835 F STATE -- TYPE PRESSURE --r TEMPERATURE CONTAINER TYPE Liquid Pure Ambient / Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 200.00 GALI 200.00 GAL 100.00 GAL HAZARDOUS COMPONENTS %Wt. ~S CAS# 100.00 Motor Oil. Petroleum Based N 8020835 HAZARD ASSESSMENTS TSecret ~S BioHazl Radioactive/Amount I EPA Hazards NFPA I USDOT# MCP No N No No/ Curies F DH / / / Min ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ -- COMMON NAME / CHEMICAL NAME WASTE ANTIFREEZE Days On Site. 365 Location within this Facility Unit Map: Grid: OUTSIDE NW CORNER OF BLDG CAS# 107-21-1 VSTATE I TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average' 55.00.GAL[ 55.00 GAL 55.00 GAL  HAZARDOUS COMPONENTS ~ %Wt. S CAS# 30.00 Ethylene Glycol N 107211 HAZARD ASSESSMENTS TSecret, RS BioHaz, Radioactive~Amount, EPA Hazards,' I ' 'o NFPA USDOT# MCP No N No No/ Curies F DH / / / Low 2 08/02/1999 DISCOUNT TIRE CENTERS SiteID: 215-000-001967 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE NW CORNER OF BLDG CAS# 221 STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid I Waste AmbientIi Ambient DRUM/BARREL-METALLIC AMOUNTS AT,THIS LOCATION Largest Container Daily Maximum Daily Average 110.00 GAL 110.00 GAL 55.00 GAL HAZARDOUS COMPONENTS %Wt. ~SI CAS# 100.00 Waste Oil, Petroleum Based N HAZARD ASSESSMENTS TSecret{ RSIBioHaz Radioactive/Amount EPA Hazards I NFPA USDOT# MCP No No No No/ Curies F DH / / / Low ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME WASTE OIL FILTERS Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE NW CORNER OF BLDG CAS# 221 rSTATE I TYPE PRESSURE --[ TEMPERATURE CONTAINER TYPE Solid Waste Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container I Daily MaximuTM Daily Average _ 55.00 GALI 55.00 GAL 55.00 GAL HAZARD ASSESSMENTS I TSecret RS BioHaz I Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -3- 08/02/1999 DISCOIINT TIRE CENTERS SiteID: 215-000-001967 Fast Format ~Notif./Evacuation/Medical Overall Site Agency N°tificati°n Employee Notif./Evacuation tt Public Notif./Evacuation Emergency Medical Plan 4 08/02/1999 F DISCOUNT TIRE CENTERS SiteID: 215-000-001967 I ~ Fast Format F Mitigation/Prevent/Abatemt Overall Site Release Prevention --Release Containment -- Clean Up Other Resource Activation -5- 08/02/1999 DISCOUNT TIRE CENTERS SiteID: 215-000-001967 ~ Fast Format F Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 08/02/1999 A) GAS - B) ELECTRICAL - C) WATER - D) SPECIAL - E) LOCK BOX - Fire Protec./Avail. Water 08/02/1999 PRIVATE FIRE PROTECTION - NEAREST FIRE HYDRANT - Building Occupancy Level 6 08/02/1999 DISCOUNT TIRE CENTERS SiteID: 215-000-001967 ~ Fast Format ~ Training Overall Site -- Employee Training 08/02/1999 HOW MANY EMPLOYEES DO YOU HAVE AT THIS FACILITY???????? DO YOU HAVE MSDS SHEETS ON FILE??????? GIVE A BRIEF SUMMARY OF YOUR TRAINING PROGRAM: Page 2 I Held for Future Use Held for Future Use -7- 08/02/1999 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-39?9 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 as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA CITY: ~/~d~_~-~- STATE: ~ ZIP'~(-,~,6~ PHONE~' ~'~. D~ & B~S~T ~ER: .......... SIC CODE: SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 I-IR. PHONE HAZARDOUS M~3TERIALS MANAGEMENT PLAN SECTION 3' TRAINING NUMBER. OF EMPLOYEES: -BRIEF 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. : 'a'/' WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT · NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION .... I, ~ff ~,,,"-,--g--,.. CERTIFY THAT THE ABOVE INFORMATION tS ACCURATE. t UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH ET AL) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDQ"RE$ A. ' AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTnrlCATION AND EVACUATION: C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: ~/~ B~ZARDOUS MA~~S MANAGEMENT PLAN sEcTION 7; M~TIQATION. PREVENTION AND ABATEMENT PLAN ' A. RELEASE PREVENTION STEPS' . . SECTION g: ~I~ S~-O~S ~OCA~ON OF S~-O~S AT YO~ FACm~ SPEC~: LOCK BOX: ~~ ~ ~S, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAIl,ABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY ~ HYDRANT.): ~..(- OFFICE OF ENVIRONMENTAL~SER~3 1715 Chester Ave., CA 93301 (661)~-3979 Page __ Of __ F^CILITY I1~ # ~t ~ Year Beginning lOO lol BUSINESS N~E (~me as FACIL[~ NAME or DBA- Doi~ Business ~) 3 BUSINESS PHONE lO2 SITE ADDRESS ~~G ~X~, ~ ~A 103 c,~ ~ c~ z,~ ~ DUN & ~06 SIC CODE 107 B~DSTREET (4 Digit g) COUNTY ~os OPE~TOR NAME ~09 OPE~TOR PHONE ~0 OWNER NAME ~ OWNER PHONE ~2 OWNER MAILING ADDRESS ~3 CITY ~4 STATE ~s ZIP CONTACT NAME ... ~17 ~ CONTACT PHONE 118 CONTACT MAILING ~9 ADDRESS CITY ~20 STATE ~2~ ZIP 122 TITLE ~2s TITLE ~30 BUSINESS PHONE 126 BUSINESS PHONE ~3~ 24-HOUR PHONE ~27 24-HOUR PHONE 132 PAGER ~ ~28 PAGER ~ 133 Cedification: Based on my inqui~ of those individuals responsible for ob~ining the information, I ce~ under penal~ of law that I have personally examined and am familiar with the info~ation submi~ed in this invento~ and believe the Info~ation is true, accu~te, and complete. SIGNATURE OF O~E~OPE~TOR DATE 1~ NAME OF DOCUMENT PREPARER~ 135 NAMES OF O.E.OPE~TOR (pdn,) 136 TITLE OF O.E.OPE~TOR .~"~ O~ 137 FORM 2~ (3/99) OFFICE OF ENVIRONMENTAL SERVICES 1715 Cliester Ave., CA 93301 (661) 326-3979 ~'*~*'"~"; ~ ~ ~ HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one form per material per building or area) [] ADD [] DELETE [] REVISE 200 Page __ of __ BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ' HEMICAL LOCATION ........ '~ -- '~'" 2011 CHEMICAL LOCATION I'-~ Yes I--I No 202 CHEMICAL NAME L,,,~J' ~K--~, ~ ~ f ~ If Subject to EPCRA. refer to iinstructions 207 / EHS* []Yes []No 208 COMMON NAME CAS# 209 | ~. fflf, EHS is~es'~:al] amounLs bel~ must be:ln'~ FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE [] p PURE [] m MIXTURE . ~w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 PHYSICAL STATE [] s SOLID [~1 LIQUID [] g GAS 214 LARGEST CONTAINER f f O 215 FED HAZARD CATEGORIES J~ 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Chec~ all that apply) AMOUNT '.~"O 0 DALLY AMOUNT DAILY AMOUNT OAYS ON S~TE 222 UNITS' [] ga GAL [] cf CU FT [-'1 lb LBS [] tn TONS 221 * If EHS, amount must be in lbs. STORAGE CONTAINER [] i '~IBER DRUM [] m GLASS BO"CrLE [] q RAIL CAR 223 (Check al/ that app/y) ._ ([~ ABOVEGROUNDTANK []e PLASTIC/NONMETALLICDRUM [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTrLE [] 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 [] ba BELOW AMBIENT [] c CRYOGENIC 225 226 227 [] Yes [] No 228 229 230 231 [] Yes [] No 232 233 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 242 243 [] Yes [] No 244 245 · NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 I Form 2731(3/99) I CITY OF BAKERSFIEL rtttm I OFFICE OF ENVIRONMENTAL SERVICES t AttrM,t r 1715 Chester Ave., CA 93301 (661) 326-3979 '~"~'~ ~ *'~ ~' H~RDOUS MATERIALS INVENTORY Chemi~l Description Form (one ~ per ma~dal per building or ama) ~ ADO ~ DELETE ~ R~ISE 200 Page ~ of BUSINESS ~ME (Same ~ FACILI~ ~ME or DBA - Doing Busin~ ~) 3 CHEMICAL LOCATION. O~ 'O~ ~ ~~ ~ ~ 201 CONFIDE~IALCHEMICAL LO~TION(EPC~) ~Y. ~No__202 FAC LI~ ID ~ ~ I ~P ~ (optionaO 203 GRID ~ (opt~naO 205 T~DE SECRET ~ Y~ ~ No 2~ CHEMICAL ~ME ~X~ &~T~ ~ ~ If Subj~ ,o EPC~. refer ,o iinst~i~s 207 COMMON ~ME EHS* ~ Y~ ~ No 2~ CAS ~ 209 *,:~EEHSi~ ~n~:~el~must:~ FIRE CODE H~RD C~SSES (~mplete if r~u~t~by I~1 fire ~ieO 210 ~PE ~ p PURE ~ m MI~URE ~w WASTE 211 ~DIOACTIVE ~ Y~ ~ No 212 CURIES 213 PHYSICAL STATE ~ s SOLID ~1 LIQUID D g ~s 214 ~RGEST CO~AINER 215 FED H~RD CATE~RIES ~ 1 FIRE ~ 2 R~CT~E ~ 3 PRESSURE REL~SE ~4 ACUTE H~LTH D 5 CHRONIC H~LTH 216 (~ all that apply) AMou~ANNUAL WASTE ~ ~ 217 DALLY ~U~~IMUM ~ ~ J ~ 218 AVENGE 219 STATE WASTE CODE DAILY AMOU~ UNITS* ~ ga ~L ~ ~ CU FT D lb LBS ~ m TONS 221 DAYS ON SiTE * ff EHS, amount must be in lbs. STOOGE CO~AINER ~ a ABOVEGROUND TANK ~ e P~STIONONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~[ ~R 223 (Check all that apply) . -- ~ b UNDERGROUND TANK D f CAN .... ~ j BAG ' D n P~STIC BO~LE D r OTHER ~ C TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BIN ~d STEEL DRUM ~ h SILO ~1 CYLINDER ~ p TANK WAGON STOOGE PRESSURE ~a AMBIE~ ~ aa A~VE AMBIE~ ~ ba BELOW AMBIE~ ~4 STOOGE TEMPE~TURE ~ a ~BIE~ D aa ABO~ ~BIE~ ~ ba BELOW AMBIE~ ~ c CRYOGENIC 225 226 227 ~ Y~ ~ No 228 230 231 ~ Y~ ~ No 232 ~3 2~ 235 ~ Y~ ~ No 236 238 239 ~ Y~ ~ No 240 24~ 242 243 ~ Y~ D No 2~ 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 Form 2731(3/99) CITY OF BAKERSFIELD · rtttw I OFFICE OF ENVIRONMENTAL SERVICES Attrt t r 1715 Chester Ave., CA 93301 (661) 326-3979 -a~,.,~ ~ ,.~ ~-,~- HAZARDOUS MATERIALS INVENTORY Chemi~l Description Form (one fo~ per ma~l per building or ama) ~ ADD ~ DELETE ~ REVISE 200 Page ~ of ~ ~ ~ ~-~,~ . ~ .... ,.~ ~..,- ~, ~. ..... ~:~'-~ ::~: ~': ~;~x~:;F~:~ :~:&W:':': ~:':~:~.~: ~:~:':: :¥~ : ~' ': ~: BUSINESS ~ME (Same ~ FACILI~ ~ME or OBA - ~ng Busin~ ~) 3 201 CHEMICAL LOCATION ~ Y~ ~ No 202 . 205 T~DE SECRET B Y* B No CHEMICAL NAME d~C~ O ~ ~ ~ ~__~ If Subj~ ,o EPC~, ref~ ,o 207 COMMON ~ME EHS* ~ Y~ D No '2~ CAS~ 209 FIRE ~DE H~RD C~SSES (~plete if r~u~t~ by I~1 fire ~ie~ 210 ~ p PURE ~ m MI~URE ~w WASTE 211 ~DIOACTIVE ~Y~ ~ No 212 ~ CURIES 213 ~PE PHYSICAL STATE ~s SOLID ~1 LIQUID D g ~s 214 ~RGEST CO~AINER ~ 215 FED H~RD ~TEGORIES ~ I FIRE D 2 R~CTIVE ~ 3 PRESSURE REL~SE ~ 4 AC~E H~LTH ~ 5 CHRONIC H~LTH 216 (Ch~ all that apply) ANNUAL WASTE 217 I ~IMUM ~ 218 AVENGE 2~9 STATE WASTE CODE AMOUNT DAILY A~U~ DAILY ~UNT DAYS ON SITE UN~TS' ~ ga ~ ~ ~ CU ~ ~ ~b LaS ~ tn TONS * E EHS, ~nt m~t be in lbs. "STOOGE CO~AINER D a ABOVEGROUND T~K D e P~STI~ONM~LIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR , 223 (Check all ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~ j ~G ~ n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g ~RBOY ~ k BOX ~ o TOTE BIN ~ STEEL DRUM ~ h SILO ~ I CYLINDER ~ p TANKWAGON STOOGE PRESSURE ~ a AMBIE~ D ~ A~VEAMBIE~ ~ ba BELOWAMBIE~ 224 STOOGE TEMPE~TURE ~ a ~BIE~ ~ ~ ~ ~BIE~ ~ ba BELOW AMBIE~ ~ c CRYOGENIC ~5 226 227 [] Yes [] No 228 229 230 231 [] Yes [] No 232 233 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240. 241 .,, ,,, 24.t PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATI. 246 ¢ . - ~.~IIIBI;ESI~IIE. ~;[~' MICHELIN' Troy F!eeman 4456 California Form 273~(3/99) Tel (805)"859-1159 Bakersfield, C^ 93309 , OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 -,:~..~,~ ~~l,m..~ ~,. HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one form per materfal per building or ama) ri ADD [] DELETE [] REVISE 200 Page __ of __ BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 C,EM,CALLOCATION C:a/,jC.- CONFIDENT,ALCHEMICALLOCAT'ON(EPCRA) r]yes aND 2O2 FACILITY.. ,,' .:: O #. ~ ~ . ;-. ! MAP # (optional) , 203 GRID # (optional) ~ ' 204 205 TRADE SECRET [] Yes J--J No 206 CHEMICAL NAME 207 COMMON NAME EHS* [] Yes [] No 208 FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE ~l~p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 PHYSICAL STATE [] s SOLID J~l LIQUID [] g GAS 214 LARGEST CONTAINER ~,.~ 215 FED HAZARD CATEGORIES ,~ 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) AMOuNTANNUAL WASTE 217 J MAXlMUMDAiLY AMOUNT '~.OO 218 I AVERAGEDAILY AMOUNT /_ I~) 0 219 STATE WASTE CODE 220 DAYS ON SITE 222 UNITS* J~)ga GAL [] cf CU FT [] lb LBS [] tn TONS 221 * If EHS, amount must be in lbs. STORAGE CONTAINER {J~a ABOVEGROUND TANK ' [] e PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTrLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [] I CYLINDER [] p TANKWAGON STORAGE PRESSURE ~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE ~1~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 226 227 [] Yes [] No 228 229 230 231 [] Yes [] No 232 233 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 242 243 .[] Yes [] NO 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 Form 2731(3/99) CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROG~RAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 9330'1 FACILITY NAME DI%CO-'t~ ~R"c'~' INSPECTION DATE -~(~/~'~ Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ,g~Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous xvaste determination has been made EPA ID Number. (Phone: 916-324-1781 to obtain EPA ID #) ~ · Authorized for waste treatment and/or storage Reported release, fire. or explosion within 15 days ofoccurance ~ ~ Estahlished or maintains a contingency plan and training ~ /A./ ~-..O~ Hazardous waste accumulation time fi'ames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed ~vhen.not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided ,~ ~ Conducts dailv inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels l/ · Proper management of' used oil filters Transports hazardous waste with completed manifest ~"'~ Sends manifest copies to DTSC /L/~, ~/Jc [ Retains manifests tbr 3 years Retains hazardous xvaste analysis for 3 years /.~ Retains copies of used {)il receipts lbr 3 years Determines if waste is restricted fi-om land disposal C=Compliance V=Violation Office of Environmental Services (805) 3264979.o- ~ ..-- / ..B~sin~s Site"Responsible Party \Vhite - Env. Svcs. Pink - Business Copy