HomeMy WebLinkAboutBUSINESS PLAN 11/1/1999 Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
........... ~,,~,~=~,~,~ ........ This permit is issued for the following:
..,~'~i?ii':~i?i'.~!'~,;:?.,:'?~::;ii ii'~i?iii~: ~ ~?~[~ ~e[ground Storage of H~rdous Materials
PERMIT ID~ 015~21~00922
BI~ BEE~
~:~..~ i=~,,,m~,,:,, ~ .- ..~imi,,: ~ .t, '~.,[~,~ ...~I~ ':~.. ......... ~,. .
~'-:-. '..[ ~' y ~:~ '.":, --': ,~.::::-~.. ~. '~I ' ~ ~ ~ ~'~[~. F'~ ~ ~ ~ ~ ~.. '~,. ~ ·
~!---."~ :i:", .;~ ~!~i..~~ ,-:]]'~] ~im ~* '~-~ ~i"-.. "-~.ii
. '~lii;]....-"" ..-?~>,..'"~:']iii~ ]iii~ii~ iiili~ ~i~ iiM=? ~?~i!~i~ '[i~' ..q~ ' i ,~~ ,
Issu~ by:
B~e;~field Fke Depa~ment Approved by: ~~~'
o~c~ o~ ~o~~ s~
1715 Chewer Ave., 3rd Floor ~/ ~ph Hu~~
Office of ~enml S~id~
B~e~fiel~ CA 93301
Voice (805) 32~3979
F~ (80S)~2~S76 ExpkationDate: ~n~ ~0. ~OO0
ITE DIAGRAM i ,[ FACILITY DIAGRAM
Business Name: ~OS~J ~ '~ ~
Busine~ Actctre~: ~"' /--¢ /---4- 4- (_~.~-~ F'~c._,,J,~, Z~J
For Office Use Only
First tn Station: Area MOo # of
In$~ection Station: NORTH ~--/"'~
a) CCNTAINE,=I'CCOES ·
01. Unaergrauna tank ¢9. Glass cOntainer(s)
02. Abcvegrouna rani< 1o. P!asac container(s)
03. ~x~ Pre~u~ea ~nk 11. 9ex(es)
Q4. Po~DIe 0~~ ~indem ~2. ~ag(s)
05. Insu~[~ tan~ 13. Meal con~in~ (not dmz)
(inc~uaes c~i~) 14. In macnine~ or pinching
07. C~ms er ~affe~s - non-metallic ~5.
08. C~r~y(s) gg. C~er-
b) P~ESSURE CODES
I - ~e material is ~o~ a[ ambi~t (no~i a~osonenc) procure.
2 - ~e matenai is ~o~ a( grater t~an amoien( ~ressur~
3 - The matenais is s[or~ at [e~ ~an amOien~ ~ressure.
c) TEMPERATURE C~OES
4. The ma[enat is ~or~ at amoient (suffoun~in~) =emcem~re.
5 - The ma[erial is s~or~ a[ greater ~an am~iem :emoem[ure.
5 - The ma[er~ai is s;ore~ ~[ less than amoien[ =amoers[ure.
7 - ~e. ma[enal is szoreG un,er c~ogenic
U$~ COOES
01. A(3ctitive 20. Fungtc{.de 39. Washing
3,2. Aal~eslve 21. Gdnaing ~. Wa~e
~3. Aercs~ 22. ~eattng ~1 .. Water Trea~ent
~4. Anesthetic 23. ~ar~tc~ce. '42. Wei~ing/soldenng
05. ~ac=enci~e 2~. lns~ac=ce ~. Well
C5. ~iast[ng 25. ~ns~c~onai ~. Oil trea~ent
37. C4[s~ys~ ~. L,j~n~n~ 45. Re~te
C8. C;eamng 27. Me~i~ ~t~/~r~cess ~. Airc~ sy~ems
;9. Ccctan[ ~8. Neu~,zsr ~7. Ba~eW etude
;0. Ccc,ng ~g. ~z~nt~ng ~. Brea~ing
~ 1. Cnlling 30. PesUc:ae 49. O~ng
~ 2. 0~ng 3~. Riaang 50. ~nisn~
13. Emutsifieri~emutsffier ~2. ~rese~a[Ne 51. ~re
I~. E~c~ing ~3. ~efining 52. Hy~muiic ~ulomen:
1 5. ~oenmen:al ~. 5ea~er ~3. RoaGIH~ maintenance
1~. FaCn~[:on 35. S~my~ng 54. Tes:lng
1 7. Femlizstion 35. S[eniizer 55. ~oie~ie c~emt~ts
gg. C~er - s0ec:~
~8. Fcrmuiaucn 37. S~omge .,. ,
~g. Fue~ ~8. 5m~er
2 · ~ v ~ ~TANC~A~O ~ ~*a
BIZZ EEE #2 Rs-. iE DI SiteID:215-000-000922
Manager : I N0V ~8,]999 ~sPhone: (805) 322-9030
Location: 5444 C.~LIFOR__N'IA A~ES. '~ ' ~ap : 102 CommHaz : Minimal
City : BAKERSFIELD - IBy: . ~rid: 34D FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 11 SIC Code:
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
RAJAB A. SHARBATI / OWNER MIRIAM SHARBATI / WIFE
Business Phone: (805) 322-9030x Business Phone: (805) 322-9030x
24-Hour Phone : (805) 622-1102x 24-Hour Phone : (805) 622-1102x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Hazmat Hazards: Fire React ImmHlth DelHlth
Contact : Phone: ( ) - x
MailAddr: 5444 CALIFORNIA AVE State: CA
City : BAKERSFIELD' Zip : 93309
Owner RAJAB ALI SHARBATI Phone: (805) 622-1102x
Address : 8425 STUART CT State: CA
City : BAKERSFIELD Zip : 93311
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
Emergency Directives:
ment plan for~ ~,c ~~~ that ~t a~o~' ~h
any corre~ions m~stituto a comp~e and ~¢~
agement pan for my Aciii~.
-1- 10/12/1999
F BIZZY BEE #2 SiteID: 215-000-000922
---~ Hazmat Inventory By Facility Unit
-- As Designated Order Fixed Containers at Site
Hazmat Common Name... ISpecHazlEPA Hazards Frm DailyMax IUnitlMCP
PERCHLOROETHYLENE DRY CLEANING F R IH DH L 100 Low
2 10/12/1999
BIZZY BEE #2 SiteID: 215-000-000922
Inventory Item 0001 Facility Unit: Fixed Containers at Site
COMMON NAME / CHEMICAL NAME
PERCHLOROETHYLENE DRY CLEANING SOLVENT Days On Site
365
Location within this Facility Unit Map: Grid:
IN DRY CLEANING MACHINE AT REAR OF STORE. CAS#
127184
~ TYPE
STATE PRESSURE TEMPERATURE CONTAINER TYPE
/Liquid ~Pure [ Ambient I Ambient I IN MACHINE/EQUIP
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
100.00 90.00
HAZARDOUS COMPONENTS
100.00 Perchloroethylene N 127184
HAZARD ASSESSMENTS
ITSecretI RSIBioHaz Radioactive/Amount I EPA Hazards I NFPA USDOT# MCP
No No No No/ Curies F R IH DH / / / Low
-3- 10/12/1999
F BIZZY BEE #2 SiteID: 215-000-000922
Fast Format
~ Notif./Evacuation/Medical Overall Site
--Agency Notification 10/16/1995
TWO PHONES IN STORE, ONE IN FRONT, ONE IN BACK, TO BE USED TO DIAL 9-1-1 IN
CASE OF EMERGENCY.
-- Employee Notif./Evacuation 10/16/1995
VERBAL WARNING IS SUFFICIENT TO NOTIFY EMPLOYEES AND CUSTOMERS TO QUICKLY
LEAVE THE STORE THROUGH THE FRONT ENTRANCE.
-- Public Notif./Evacuation 10/16/1995
PUBLIC IS NOT ALLOWED ANYWHERE EXCEPT RECEPTION AREA IMMEDIATELY INSIDE
FRONT DOOR.
Emergency Medical Plan 10/16/1995
MERCY SOUTHWEST HOSPITAL.
10/12/1999
BIZZY BEE #2 ~~~~~~~~ SiteID: 215-000-000922
i~ Mitigation/Prevent/Abatemt ~~~~~~~ Overall Site
i~ Release Prevention ~~~~~~~~~ 10/16/1995
DRY CLEANING MACHINE IS SELF CONTAINED.
OWNER PERIODICALLY REMOVES WASTE SOLVENT FROM MACHINE INTO 5 GALLON BUCKET.
LID IS KEPT ON TIGHT WHILE WASTE IS IN STORAGE.
WASTE SOLVENT AND FILTERS ARE REMOVED BY "B_AD" DISPOSAL~ A LICENSED
HAZARDOUS WASTE HAULER.
-5- 10/12/1999
BIZZY BEE #2 ~~~~S~~~~ SiteID: 215-000-000922
Site Emergency Factors
i~ Special Hazards
iSSS Utility Shut-Offs SSS~SSS~S~SS~~~S~S~SSS~ 10/16/1995
NATURAL GAS/PROPANE: NORTHWEST CORNER OF BUILDING COMPLEX.
ELECTRICAL: AT REAR OF STORE.
WATER: INSIDE BOILER/STORAGE ROOM.
SPECIAL: NONE
LOCK BOX:
iS&&& Fire Protec./Avail. Water &SS&SSS&SS&SSS&SSSSSSSSSSS&SSSSSSSS 10/16/1995
PRIVATE FIRE PROTECTION: FIRE EXTINGUISHER INSIDE STORE.
WATER AVAILABILITY: AT CALIFORNIA AND LENNOX.
6 10/12/1999
BIZZY BEE %2 ~~~~~~~~ SiteID: 215-000-000922
Training ~~~~~~~~~~~ Overall Site
i~ Employee Training ~~~~~~~~~ 10/16/1995
NUMBER OF EMPLOYEES: 1
MATERIAL SAFETY DATA SHEETS: IN BACK OF STORE, ON MACHINE.
BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE GIVEN INITIAL AND ANNUAL
TRAINING ON I"I~ZJ~DS OF PERCHLORETHYENE. HOWEVER, ONLY THE Oh~IER OPERATES
THE CLEA_NER ITSELF.
-7- 10/12/1999
CITY OF BAKERSFIELD
CLAIM VOUCHER
IVendor No. I I certify that this claim is correct and valid, and isa proper
charge against the City Agency and account indicated.
CLAIMANT'S NAME AND ADDRESS:
Bizzy Bee #2 (AUTHORIZED SIGNATURE OF CITY AGENCY)
5444 California Ave
Bakersfield, CA 93309 Date: 04-01-99 Initials of Preparer:
CITY DEPARTMENT: FINANCE
PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable)
This customer made a duplicate payment on this years Haz Mat bill in the amount of $178.50.
We have since made an adjustment to the California State surcharge in the amount of $8.50
leaving them with a credit of $187.00.
Dept. El / Objt Project # Invoice # Amount Date of Invoice
0000 7900 $187.00
VOUCHER TOTAL $187.00
SECTION 72, PENAL CODE "INANCE DEPT. USE ONLY
Section 72, Presenting False Claims. Every person who with intent to defraud,
presents for allowance or for payment to any state board or officer, or any
county, town, city district, ward or village board or officer, authorized to allow
or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, -'xamined & Approved for Payment Amount
or wdting, is guilty of a felony.
STATEMENT OF ACCOUNT
CITY OF BAKERSFIELD
i50i TRUXTUN AVE
BAKERSF!ELD~ CA 9~30i-520i
DATE: 4/01/99
TO: BIZZY BEE
~444
BAKERSF I ELD,j
CUSTOMER NO'
. O0
2/04/?~ /~i~MENT;~ -i;,;,.,;,~-~-,> -.- ":~'>" '" ..... ~ 178. 50--
SSO01 3/31/9~ Ch~ge ~djusgment~.('~' 4/30%~ 8. 50-
'~ ;: ..... ~'~ j - , .
FOR QUESTIONS OR CHAN~S 'TO YOUR ACCOUNT PLEASE
CALL THE NUMBER AT THE TOP OF THIS STATEMENT.
CURRENT OVER 30 OVER 60 OVER 90
8.50-
DUE DATE: 5/03/~ PAYMENT DUE: 187.00-
TOTAL DUE: $187.00--
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE .~'- / / -~C:~ NEWACCOUN'r i
ADDRESS CHANGE
CLOSE ACCT j
' FINANCE CHARGE I ~, ,~ I
OTHER ADJ i/X~'j
,/
CUSTOMER NAME (~*, '~:~_'~/ ~e~ ~ "~--'-~
MAILING ADDRESS 'c::~(~t._~ L~ CO.~[; "~( f~ O, ~',J '0__
CITY '~._~~'\ ~-~,~ STATE ?~- ZIP CODE
SITE ADDRESS
PARCEL NUMBER
(~F APPUCA~L=")
ADJUSTMENT
i CHG DATE CHARGE CODE ADJUSTMENT AMOUNT
APPROVED BY ~'
BAKERSFIELD CITY FIRE DEPARTMENT
HAZARDOUS MATERIALS DIVISION
BAKERSFIELD, CA. 93301 ~ .:~ ~
HAZARDOUS MATERIALS MANAGEMENT PLAN
iNSTRUCTiONS:
1. To avoicl tutti, er action, return this form within 30 days of receipt.
'2. ~PE/PRINT ANSWERS IN ENGLISH.
3. Answer the auestions below for t~e Dusiness as a w~ole.
Be D~ief an~ concise cs
SECTION l' BUSINESS IDENTIFICATION DATA
5USINESS NAME: ~~ ~'~-~-- ~- ?-'-
LOCATION' .~'"4 4 4 ~.~_, F'-o,z ~u,/~ ~
MAILING ADDRESS: D/A-,,-, ~
CITY: STATE:_ ZIP: 9~5o~ PHONE:
DUN & BRADSTREET NUMBER' SIC CODE;
PRIMARY ACTIVITY' 'br~',~' ¢ ac-"~ G~-
MAILING ,ADDRESS:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24 HR. PHONE
h~akersfield Fire ]Dept.
t~ardous 1V[ateriab D/vision
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING:
NUMBER OF EMPLOYEES:
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
SECTTON 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 OD NOT HANDLE HAZARDOUS MATERIALS.
WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO
TiMEEXCEEO THE MINIMUM RE?ORTING QUANTIFIES.
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 "CAUFORNIA HEALTH AND SAFETY CODE"
ON HAZARDOUS MATERI,ALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT
INACCURA]'E INFORMAZ~ON.CONSTITU1'ES PERJURY. .
SIGNATURE TITLE DATE
.. ~Bakersf~eicl Fire Dept, ,
~ ..... Hazardous Materials Division~
" HAZARDO US I~ATERIALS MANAGEMENT' PLAN
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A, AGENCY NC)TIFICAT[ON PROCEDURES:
B, EMPLOYEE NOTIFICATION AND EVACUATION:
C. PUBLIC EVACUATION:
O. EMERGENCY MEDICAL PLAN'
B ~ lclFir Dept
..,..' : .. ' m~:l~r$ e e .
Hazardous 1Viaterials Division
HAZARDOUS MATERIALS MANAGEMI~NT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A. RELEASE PREVENTION STEPS'
B. RELEASE-CONTAINMENT AND/OR MINIMIZATION:
C. CLEAN-UP P~OCEgU2ES:
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROpANE:
ELECTRICAL: ,AT- fZC. w'~-
SPECIAL:
LOCKBOX: YES/NO !FYES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A. PRIVATE FIRE PROTECT[ON:
B. WATER AVAILABiLLTY (FIRE HYDRANT): '
A~- (_.,o, c.,/--~(z_,,/,~ ~ C.c_.~,u~< ....
BAKERS/ii, ELD CITY FIRE DEP.6a :ITMENT
i HAZ/ DOUS MATERIALS INVEI I 'RY Page_of_
3usiness Name Address ~' -/---{L ~
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: p ~:N~ F~'/.-(~ t"~--~--~L-C~'~--'~J~ 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSlCAL STATE Solid [ ] Liquid [~J Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES
Maximum Dally Amount: ~/~3~) lbs [ ] gal [ ] ft3 [ ] a) Container:
Average Oally Amount: ,c~ O curies [ ] b) Pressure:
Annual Amount: ~ c) Temperature:
largest Size Container:
# Days On Site '~'"' Circle 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
any AHM components 2) [ ]
3) [ ]
10) Location /,~'~J /.~/?._(t.'/
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New[ ] Addition[ ] Revision[ ] Deletion[ ] Check if chemical is aNON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: ~1,0~, (~ ~::;>~_.~...~r/.~--1-14~L~'-fV4~. 3) DOT # (optional)
ChemicaJ Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ]
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSlCAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STQRAGE CODES
Maximum Daily Amount: lbs [ ] gal [ ] ~t3 [ ] a) Container:
Average Daily Amount: cudes [ ] b) Pressure:
Annual Amount: c) Temperature:
Largest Size Container:
# Days On Site CimleWhich 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
any AHM components 2) [ ]
3) [ ]
i certify un?,efp]~n/~Jty of law~tthat I have personally examined and am familiar With the infomation submitted on this and all attached documents. I believe th,
submitted ihl~tJon is ~j~~and complete.
PRIl~r Na~e & ~ ' pany Representative Signature Date
BAKERSF/.D CITY FIRE DEPAI: MENT ..
HAZARDOUS MATERIALS INVENTORY Page_of__ °
Business Name Address
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check ifchemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) common Name: 3) DOT # (optional)
Chemical Name; AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immedlnte Health (Acute) [ ] Delayed Health (Chronic) [ ] ·
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT ANO TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES
MaxJmum Dally Amount: I1:~ [ ] gal [ ] ~3 [ ] a) Container:
Average Dally Amount: cudes [ I b) Pressure:
Annual Amount: c) Temperature:
Largest Size'Container:
# Days On Site Circle Which Months: All Year, J, F, M, A, M, J. J, A, S, O. N, D
9) MIXTURE:. List COMPQNENT CAS # % WI' AHM
the three most hazardous 1 ) [ ]
chemical components or
any AHM components 2) [ ]
3) [ ]
10) Location
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ]
2) Common Name: 3) DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ]
5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ]
7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES
Maximum Daily Amount: lbs [ ] gal [ ] ft3 [ ] a) Container:
Average Daily Amount: cudes [ ] b) Pressure:
Annual Amount: c) Temperature:
Largest Size Container:
# Days On Site Circle 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
any AHM components 2) [ ]
3) . [ ]
10) Location
r ce~'h/uncler penal~y of law, that I have personally examined and am familiar with the infomatlon submitted on this and all a~ched doc~Jments. I believe ~.
submitted informa#on is flue, accurate, and complete.
PRINT Name & Title of Authorized Company Representative Signature Date