HomeMy WebLinkAboutBUSINESS PLAN ~;?---.:-~: · HM M P P L ~ MAP
MEMORANDUM
February 27, 1995
TO: Esther Duran, Hazardous Materials ~/
FROM: Drew Sharpies, Financial Investigator
SUBJECT: Hazardous Materials Account
HM647601 5420 California Avenue, Martins Stockdale Pharmacy
Bankruptcy case #95-10788-B-7 was filed 2-17-95. Cloase the
existing account. This is a liquidation case, therefore,
there is no need to open a new account. Adjust off all
charges dated after the case date.
~ Bakersfield Fire Dept.
~ Hazardous Materials Division
2130 "G" Street ~E~.~! I/ED
. i Bakersfield, CA. 93301 APR
· A,g'$ ...........
HAZARDOUS MATI:RIA£$ MANAGI:MENT PLAN
INSTRUCTIONS:
2. TYPE/PRINT ANSWERS IN ENGLISH,
3, Answer IBc questions below for ?Be business os o wBolo.
4. Be brief ancl concise as possible,
SECTION 1' BUSINESS IDENTIFICATION DATA
BUSINESS NAME: ]~RT/M'~ ..PT'/Jdk.'l),~i.~ /~N,'f4f, IR¢"/ Id. O, ]7,
LOCATION: ,~'~ ¢ f---~Z ~ fz:~eCf/l fl
MAILING ADDRESS:
CITY' ~KE~F1(~ STATE: ~ ZIP' ~d¢ PHONE:
DUN & BRADSTREET NUMBER: SIC CODE:
PRIMARY ACTIVITY:
MAILING ADDRESS:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS, PHONE 24 HR. PHONE
ersfield Fire Dept. , ~.; .... ~
~'Hazardous Materials Division ~, .,' ~
HAZARDOUS MATERIALS MANAGEMENT PLAN ~ .... ~
SECTION 3: 'TRAINING:
NUMBER OF EMPLOYESS: /,.~'
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
/~/'&O~' ~Z.~- //~,vo~-
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, ~/~//,d ~- ~/~'r/~/ CERTIFY THAT THE ABOVE INFOR-
MATION IS ACCURATE. I UNDERSTANDTHATTHISINFORMATION 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.
RE TITLE DATE
FD1590
Bakersfield Fire Depl
Hazardous Materials Divis
HAZARDOUS MATERIALS MANAGEMENT PLAN
sEcTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A'~, RELEASE PREVENTION STEPS:
B.: RELEASE CONTAINMENT AND/OR[MII~TMIZA'TION-'~
~PF,~ D~/ /'~ a,tJ p'44/~'/ ~ .//£
C', CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)'
S~ECIAL:
LOCK BOX: YES/NO IFYES, LOCATION:
PRIVATE FIRE PROTECTION'
B.i WATER AVAILABILITY (FIRE HYDRANT)'
4, FD1590
{~rt Bakersfield Fire Dept.
azardous Materials .Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name: ./~r~'Y d~z-ez~<oe~ /~'~4~,v'
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A, AGENCY NOTIFICATION PROCEDURES:
B, EMPLOYEE NOTIFICATION AND EVACUATION:
C, PUBLIC EVACUATION:
D. EMERGENCY MEDICAL PLAN:
CI'TY of BAKERSFIELD
F]rmend Agriculture U Standard Business ~HAZARDOUS
MATERIALS
~NVENTORY
V. ~F z//'/~I/l~ 0¢d, 1~, NON--TRADE SECRETS Paqe / '!o .~;,_L~~
BUSINESS NAME: N~'[ ~/~'0~/.~r ~4~ OWNER NAHE' ~/~ ~ ~C~ NAME OF THIS FACILITY-
LOCATION; ~/7 ~~ ~ ADDRESS: ~y~)~ L~, ~ STANDARD IND CLASS CODE-
CITY. ZIP'~hO~O . ~ ~~ C1TY. ZIP~'~f~. ~ e~y~¢ DUN AND BRAD~TREE~ NUHBE~
~v~rage Yeasure5]t~Y~e ~ont Con~ Con~ ~s Loca~ion?e[e.
Code ~ooe Aa~ ~mt Es~ Un,ts on ~ype Press le=~ Co~eSee Instructions
Stored an
Physical and Health Hazard C.~.S. Number 7~-~-~ Component Il Hame & C.A.S. Number
(Check all that apply)
D Fire Hazard U Re,ctivity D OelayedHeatth ~Suddenof,ressureRelease D
Component 13 NaAe I C.A.S. Number
Physical 8fldHeslChHlzlrd C.k.S. Number CompofleflC II Hame S C.A.S. Humber
(Check all Chat
CoAponen[ 12 NaAe I C,A.S, Number
~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate
Health of Pressure
Health
Component 13 Name I C.A.S. Number
Physical and ~ea)thHazard C.A.S. Number Component l1 Name I C.A.S. Number
(Check al1 that
Component 12 Name t C.A.S. Number
~ Fire Hazard ~ Reactivity ~ OelayedHealth ~ Suddenof PressureRelease ~ Im~il~e
Coaponenb 13 Name I C.A.S. Number
Physical and Health Hazard C.A.S. Humber Component II Hame I C.X.S. Number
(Check ali Chat apply)
Compoflen[ I~ NaAe ~ C.~.S. Number
~ Fire Hazard ~ Reactivity ~ 0elayed ~ Sudden Release ~ Immediate
Health of PressureHealth .
Component 13 Name ~ C,A.S. Humber
E~ERGEHCY COHTACTS fll
~m~ ~Tle 2~ Hr Phone R~e HUe
ertificatioq ,(Re~ And.~ign after comp Tecio .a77 secCiPn~)
cer~]fy under penamil gl~F [n~[ ]navepe[son~,exaalnffOeqo~a taai~ar.~itb the )ntor~a[]on ~u~aitted in this ~nd all
at~aCned,docg~ent~, ano t~[ eased on.~y tnqu]ry ~.[nose their]Duals responsio~e ~or obtaining ~he ~nror~aL~on, [ believe that
N~ ~00ttClil [ltl~ 0 0 . /Op~ ~[0 0 e~ra o' s a [horized reDrese~tative
O Bakersfield Fire ept. "
Hazardous Materials Inspection
Date Completed
Business Name: '~ ~~ ~ ~r,,,,- .....
~o,~. . .--,.,.=, v,'u
Plan ID # 215-000.~-' (Top right comer Business Plan) H~7... MAT. DIV,
Adequate Inade.~q~uate
Verification of Inventor Materials ~] ~
Verification of Quantities [] J~
Verification of Location [~ ~
l~'oper Se~'egation of Material Y] .~
Co~mnemts:
Verification of MSDS Availability
Number of Employees
Verification of Haz Mat Training
Comments:
Verification of Abatement Supplies & Procedures
Comments:
Emergency Procedures Posted
Containers Properly Labeled
Comments:
Verification of Facility Diagram [~ .J~
Special Hazards Associated with this Facility:
Violations: ~LI0 l~. l~'~.- Fl~kJ "FI L~-D.
/
FD 1652 (Bev. 3-89) White-Haz Mat Div. Yellow-Station Copy Pink-Business Olflce /
STOCKDALE PHARMACY
[Stockdale West Shopping Center)
5420 C~.~.IFORN~A
JOHN C, MARTIN, MGR, TELEPHONE
DARYL MARTIN, PHARM. O. BUS. 324-4§49