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Home My WebLink AboutBUSINESS PLAN 'The', Image Source 5472 California Avenue ~ ~\Exit Bakersfield, CA 93309 805/633-3700 I I I Photo Fixer C emical Storage Electric Panel Corrosive #quids u~I [ Chemicals in use Gas, Water shutoffs outside building O ~ Waste. S. torage for disposal service No internal spinkler system Fire Hydrant Wall Mounted N Front Door CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 i~znaOovs UAV~ainLS Im~S~oav ~ ~ C~CK ~ BUS.SS IS A F~ [ ] [.~: [ SIC CODE D~ & BmS~ET~ER ~ 6-'5q6- ~qq OWNER/OPERATOP, '-~-Q_~ ~>C&r~l~kl~ , C~(2) PHONE MAm~NG ADDKESS ~,v-~E ~% c~c'~ CITY STATE ZIP EMERGENCY CONTACTS NAME '~-'pV'k3Ce -~3~'DC~'d-'t'- TITLE BUSINESS PHONE [O9'~'~o" Oo"~)/C~ 24 HOUR PHONE BUSINESS PHONE ¢:20- :"-)/.~ 24 HOURPHONE · ~C~ DESC~ON I) ~ORY STA~S: New [ ] A~fion [ ] Rc~ { ] ~lefi~ [ ] Ch~k ffch~ is a NON Tm~ S~ [ ] T~ S~ [ ] 2) Comon Nme: ~~[ ~~ 3) ~T ~ (option) 4) Physi~ & H~ P~SIC~ 5) WAS~ C~SmCAnON ~41 (3~t ~ ~ D~ F~ 8022) USE CODE 6) P~SIC~STA~ Sohd[ ] Liq~d[~ ~[ ] ~e[ ] ~e[ ] W~[ ] ~five[ ] 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) STOOGE CODES ~mD~y~omt ~' ~, Lbs[ ]~[~[ ] a) Con~ Av~ Dmly ~o~t ~ - C~ [ ] b) ~e: I ~ ~o=t ~ e) T~~ ~ Da~ on Site C~le ~ch M~: ~ J, F, ~ & ~ J, J,& S, O, N,.D 9) ~: List ~ CO~~ C~ 1)~ORYSTA~S:New[ ]A~fion[ ]Re~si~[ ]~lefi~[ ] Ch~kffch~isaNONT~S~[ ]T~~[ 2) Co--on Nme: ~ ~ %~C J) ~ ~ 4) Physi~ & H~ P~SIC~ ~dCa~go~ Fke[ ]R~five[ ]S~Rclmof~[ ] lmm~H~(A~)[~lay~H~(C~)[ ] 5) W~ C~S~CA~ON ~4 ~ (3~t ~ ~mDm Fora 8022) USE CODE 6) P~SIC~STA~ Sohd[ ] LiqMd[~[ ] ~e[ ] M~[ ] W~[ 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) STOOGE CODES Av~e D~y ~o~t '~ W~. C~ [ ] b) ~e~: I ~ ~o~t ~ c) Tm~ ~ Days on Si~ _ ~ C~le ~ch M~: ~J, F, ~ & ~ J, J, & S, O, N, D 9) ~: List _ CO~~ . , ~, ~ _. C~ _ I c~O md~ ~ of law, ~t I M~ ~ly em~ ~d m f~ m~ ~, ~bmfion on ~s ~d ~1 a~ ~mm. I P~ Nme & Title of Au~o~ Comfy R~mfive ~ Si~e ~ Dam ~C~ DESC~ON I)~ORYSTA~S:New[ ]A~on[ ]Re~[ ]~le~[ ] C~k~ch~isaNONT~S~[ ]T~S~[ ] 4) Physi~ ~ H~ P~SIC~ 5) WAS~ C~S~CA~ON ~l (3~t ~ ~ Dm Fo= 8022) USE CODE 6) P~SlC~STA~ So~d[ ] Liqmd[~ ~[ ] ~:[ ] ~e[ ] W~[ ] ~five[ ] 2) Co--on Nme: 3) ~T ~ (option) Ch~Nme: ~[ ] C~ 4) Physi~ & H~ P~SlC~ ~d Ca~ofi~ Fke [ ] R~fiye [ ] S.aa~ Rel~ of~ [ ] ~m~ H~ (Acu~) [ ] ~lay~ H~ 5) W~ C~S~CA~ON (3~t ~ ~m D~ Fo~ 8022) USE CODE 6)PWfSIC~STA~ SoHd[] Liq~d[ ] ~'[ ] ~[ ] ~[ ] W~[ ] .~v~[ 7) ~O~ ~ ~ AT FAC~ ~ OF ~~ 8) STOOGE CODES ~~D~ly~o~t L~[ ]~[ ]~[ ] a) Con~ ~ Days on Site C~le ~ch Mon~: ~ Y~, J, F, ~ ~ M, ~, J, ~ S, O, N, D me ~ mo~ ~~ I) [ ] { ch~ ~m~ or 2). [ ] I 0)L~A~ON P~ N~e ~ Title of Au~o~ C~m~y R~five 'Si~e ~' Da~ - CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PR2NT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION ~: BUStNESS mE~rriFICATION D^T^ BUSINESS NAMe: %~sFV I -~r,c. ~mS.,.~¢- LOCATION: ~'~ V___ ~O.~i-~Oy-~(a_ ~2h)~~ ~n.[~GADDRESS: ~-~z_ ~%,-c,~_ ~ CITY: ~-"~'-ef'~ e~. ~ STATE: DUN & BRADSTREET NUMBER.: ~ ~- ~ '~- ~-~ ~ SIC CODE:~ MAmINGADDRESS: ~e ~ ~_~-~ SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN , SECTION 3: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: 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 I-IEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALs, BUT THE QUANTITIES AT NO TIME EXCEED THE 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 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDI, IRES A. AGENCY NOTIFICATION PROCEDURES: ' ~ ~~'""-t - ~/-45~.-'~5~L~ .'. ,...., B. E~LO~ NoT~CA~ON ~ EVACUA~ON: C. P~LIC EVACUA~ON: D. EMERGENCY MEDICAL PLAN: 3 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROG~RAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~'~(wL&C'i~ X~O~(-..~' INSPECTION DATE Section 4: Hazardous Waste Generator Program EPA ID # [] Routine ~}ltCornbined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS / Hazardons 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 of occurance Established o,' maintains a contingency plan and training (~_.~ Hazardous waste accunmlation time fi-ames Containers in good condition and not leaking Containers are compatible ~vith 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 daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC ( Retains manifests tbr 3 years Retains hazardous waste analysis for 3 years Retains copies of used ()il receipts for 3 years Determines if waste is restricted fi'om land disposal C=Compliance V=Violation Inspector: [./Ol/~_.5~ Office of Environmental Services (805)326-3979 Businte..ss Site Responsible i~arty \Vhite - Env. Svcs. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ~ //a4AF_r¢5 ...,~:yot'gO.,* INSPECTION DATE [l/~0 ADDRESS ~7~ ~f~M~ ~ PHONENO. ~ -~OO FACILITY CONTACT t(~t5~ 5~~ BUSINESS ID NO. 15-210- INSPECTION TIME ~ ~t~ NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [2l Routine ~ Combined 121 Joint Agency [21 Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact in~brmation accurate Visible address 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 Any hazardous waste on site?: [~es [~ No Questions regarding this inspection? Please call us at (805) 326-3979 ~usine~ss-Site Responsible "~,~ty White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: ' CITY OF BAKERSFIELD FIRE 'DEPARTMENT '.!/ OFFICE OF ENVIRONMENTAL SERVICES '~ UNIFIED PROGRAM INSPECTION CHECKLIST .4,' 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITYNAME'~' l~q,a4kC ff~o~¢O..~ INSPECTION DATE ADDRESS ~dtTZ~ C.A~f-~J~& ,~" PHONE NO. ~,~:'~ - FACILITY CONTACT W,~$~'x/ 5t~C-',a~t'~q~'' BUSINESS ID NO. 15-210- INSPECTION TIME '~c..~ v,,/t,,-4 NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [] Routine ~ Combined [2i Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATI0N · C V COMMENTS Appropriate permit on hand tkJO'T' ~t~ ! Business' plan contact intbrmation accurate· Visible address· . b/ Correct occupancy Verifica. tion of inventory materials b/ · Verification of quantities ]ga( Verification of location ', Proper segregation of material Verification of MsDs availability . ~' Verification of Haz Mat training /~.~J "}'O [~ ~P~-t> Verification of abatement supplies and procedures ~ .' Emergency procedures adequate ~' Containers properly labeled ~ ~dJ$"ff -t,~ ~t~'e.- Za4~ff'l., Housekeeping 'bg ' - Fire Protection W/ Site Diagram AdeqUate & On Hand ~ . C=Compliance V=Violation .Any hazardous waste on site?: . ~es ' [] N°. Explain: 1.~2>~ ~a~'~~tc.. t~'t "~-"-'¢~ r Questions regarding this inspection? Please call us at (805) 326-3979 ~~y 'ox.J, White - E'nv. Svcs. Yellow - Station Copy Pink - Business Copy Inspe.ctor: CITY OF BAKER~IELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 FACILITY INFORMATION Page Of __ BUSINESS NAME (Same as FACILI~ NAME or DBA- Doing Business ~) 3 BUSINESS PHONE 102 CITY ~ CA ZIP ~o5 DUN & ~ SIC CODE 107 B~DSTREET (4 Digit ~) COUN~ 1ce 112 CONTACT NAME ~7 CONTACT PHONE CONTACT MAILING ADDRESS CITY ~2o STATE ~2~ ZIP TITLE ~ ~ ~2~ TITLE ~(1~¢~ ~3o BUSINESS PHONE ~33 - ~ 7~ ,26 BUSINESS PHONE ~3, 24-HOURPHONE ~ ' 72~ 3 127 24-HOURPHONE ~ _~ 132 PAGER ~ ~28 PAGER ¢ ~33 Cedification: Based on my inquiw of ~ose individuals responsible for chaining the information, I cedi~ under penal~ of law that I have personally examined and am familiar with the infomation submi~ed in this inventow and believe the info~ation is t~e, accurate, and complete. SIGNATURE OF OWNE~OPE~TOR DATE 1 ~ NAME OF DOCUMENT PREPARER NAMES OF O~EBOPE~TOR (¢dnl) 136 TITLE OF OWNE~OPE~TOR 137 0£5 FORM 2730 (7/9~) P:\OES2730.TV4.wpd CITY OF BAKERSFIFai D ' FFICE OF ENVIRONMENTA SERVICES 1715 Chester Ave., CA 93301 (805) 326-3979' UNDERGROUND STORAGE TANK FACILITY Page __ of __ TYPE OF ACTION [] 1 NEW SITE PERMIT [] :3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION (State type of change) [] 7 PERMANENTLY CLOSED SITE (Check one item only) [] 4 AMENDED PERMIT [] 8 TANK REMOVED 400 [] 6 TEMPORARY SITE CLOSURE I. FACILITY / SITE INFORMATION ' BUSINESS NAME (Same es FACILITY NAME or DBA - Doing Business As) 3 FACILITY lO # ~ ~ . 1 NEAREST CROSS STREET 401 FACILITY OWNER TYPE [] 4 LOCAL AGENCY/DISTRICT* [] 1 CORPORATION [] 5 COLINTY AGENCY* [] 2 INDIVIDUAL [] 6 STATE AGENCy* BUSINESS [] I GAS STATION [] 3 FARM [] $ OTHER 403 TYPE [] 3 PARTNERSHIP [] 2 DISTRIBUTOR [] 4 PROCESSOR [] 6 COMMERCIAL . . . . [] 7 FEDERA,L~.AGENCY* 402 TOTAL NUMBER OF TANKS Is facility on Indian Res,=_.rvation or *If owner of UST a public agency: namb of supervisor of REMAINING AT SITE trustlands? division, section or office which operates the UST. (This is the contact person for the tank records.) 406 4O4 [] Yes [] ~1o 405 ii. PROPERTY OW"E. INFORM^T O. =. PROPERTY OWNER NAME 407 PHONE 408 MAILING OR STREET ADDRESS 409 CITY 410 STATE 411 ZIP 412 PROPERTY OWNER TYPE [] 2 INDIVIDUAL [] 4 LOCAL AGENCY I DISTRICT [] 6 .';TATE AGENCY 413 [] 1 CORPORATION [] 3 PARTNERSHIP [] 5 COUNTY AGENCY [] 7 FEDERAL AGENCY TANK OVVNER NAME 414 PHONE 415 MAILING OR STREET ADDRESS 416 CITY 417 STATE 418 ZIP 419 TANK OWNER TYPE [] 2 INDIVIDUAL [] 4 LOCAL AGENCY / DISTRICT [] 6 .<;TATE AGENCY 420 [] 1 CORPORATION [] 3 PARTNERSHIP [] 5 COUNTY AGENCY [] 7 FEDERAL AGENCY · ' IV. BOARD I~F ~:QUAL!ZATION UST STORAGE FEE AccOUNT NUMBER .' f TY (TK) HQ 4 4 - / Call (916) 322-9669 if questions arise 421 V, PETROLEUM .UST FINANCIAL RESPONSIBILITY .' INDICATE METHOD(S) [] 1 SELF-INSURED [] 4 SURETY BOND [] 7 STATE FUND [] 10 LOCAL GOV'T MECHANISM [] 2 GUARANTEE [] 5 LETTER OF CREDIT [] 8 STATE FUND & CFO LETTER [] 99 OTHER: 422 [] 3 INSURANCE [] 6 EXEMPTION [] 9 STATE FUND & CD · VI, LEGAL NOTIFICATION AND MAILING ADDREss ·i : ChecA one box to indicate which address should be used for legal notifications and mailing. [] 1 FACILITY [] 2 PROPERTY OWNER [] 3 TANK OWNER 423 Legal notification and mailing will be sent to the tank owner unless box 1 or 2 is chec.~ed. VII, APPLICANT SIGNATURE Certification: I certify that the information provided herein is true & accurate to the best of my knowledge SIGNATURE OF APPLICANT DATE 424 PHONt: 425 NAME OF APPLICANT (print) 428 TITLE OF APPLICANT 427 ISTATE UST FACILITY NUMBER (For local use only) 1998 UPGRADE CERTIFICATE NUMBER (For local use only) (Formerly SWRCB Form A) July 1, 1998 P:~USTFAC-A.FM4.wpd OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one form per material per building or area) ~DD [] DELETE [] REVISE 200 Page __ of __ BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 C.EM,CALLOCAT,ON 201CONF,DENT,ALC"EM'CALLOCAT'O"(EPCRA) aYes r No 202 ID # ~ ~ .~ 1 MAP # (optional) GRID # (optional) 205 TRADE SECRET [] Yes [] No 206 CHEMICAL NAME ~//f,~.TE ~i~ ~...~~::~/C ~', p( C....Z~ ,, Subject to EPCRA, refer toiinstructions 207 COMMON NAME EHS* [] Yes [] No 208 .b$. ,. . :...:.,.. ::~:,:~;..:..:.:;~,:? FIRE CODE HAZARD CLASSES (Complete if requested by local fire c:~ief) 210 TYPE [] p PURE [] m MIXTURE 4~w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 PHYSICAL STATE [] s SOLID ~ LIQUID [] g OAS 214 LARGEST CONTAINER L/O 215 FED HAZARD CATEGORIES [] 1 FIRE ,~ 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH . ~"S CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE /0~) 217 MAXIMUM 1~-~ 218 AVERAGE ~...~ 219 STAT~,.WASTE CODE ' 220 AMOUNT DALLY AMOUNT DALLY AMOUNT UNITS* [~ll'ga GAL [] cf CU FT [] lb LBS [] tn TONS 221 DAYS O~:~ITE 222 * If EHS, amount must be in lbs. STORAGE CONTAINER [] 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 BOTFLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k aOX [] o TOTE BIN [] d STEEL DRUM [] h SILO [-'1 I CYLINDER [] p TANK WAGON STORAGE PRESSURE I~ a AMBIENT [] aa ABOVE AMBIENT [] ba 8ELOWAMBIENT 224 STORAGE TEMPERATURE - ~'a AMBII~NT [] 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 N,~ME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 OES FORM 2731 (7/98) P:\OES2731 .TV4.wpd CITY OF I AI ERSF LD ,OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (805) 326-397P H~RDC~US UATERIALS INVENTORY Chemical Description Form ~ne fo~ per material ~er building or ama) ~ ADD ~ DELETE ~ R~ISE ~ Page ~ of BUSINESS NAME (~e ~ FACILI~ NAME ~ O~ - O~ng ~n~s ~) 3 CHEMICAL LO~TION CHEMI~L LO~TION ~ Y~ CO.mOENT~AL (~PC~) 205 T~DE SECRET ~ Y~ 207 COM~N ~ME EHS* ~ Y~ ~ No 208 FIRE ~DE H~RD C~S (~pJete Jf r~u~t~ by J~ fire ~ 210 ~PE ~ p ~RE ~ m MIXTURE D w WASTE 211 ~ ~IOACTIVE DY~ ~No 212 I CURIES 213 PHYSI~L STATE ~ s SOLID ~1 LIQUID D g ~S 214J ~RGEST ~AINER 215 FED H~RO ~RIES ~ 1 FIRE ~ 2 R~CT~E D 3 PRESSURE REL~SE D 4 AC~E H~LTH ~ 5 CHRONIC H~L~ 216 (Ch~ all that apply) ~U~ANNU~ WASTE 21'7 I ~IMUM DALLY AMOU~ 218 ~ A~GE DALLY ~U~ ~' 219 STATE WAS~ ~DE DAYS ON SITE UNITS* D ga ~ ~ d cu ~ ~ lb LBS D m TONS 221 * If EHS. ~nt mu~ ~ in lbs. STOOGE CO~AINER ~ a ~VEGROUND TANK E] e P~STI~NONM~ALLIC DRUM ~ i FIBER DRUM ~ m G~SS ~LE ~ q ~IL ~R ~3 (Check afl ~at app.) ~ b UNDERGROUND T~K E]f ~ ~ j BAG ~ n P~STIC 80~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~J g ~Y ~ k ~X ~ o TOTE BIN ~ d STEEL DRUM El h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ a AMBIE~ ~ aa ~VEAMBIE~ ~ ba BELOW A~IE~ ~4 STOOGE TEMP~RE ~ a ~BI~ ~ aa A~VE ~BIE~ ~ ba BELOW~BIE~ ~ c CRYOGENIC 1 226 ~7 ~ Y~ ~ No 228 ~0 231 ~ Y~ ~ No 232 233 234 235 ~ Y~ ~ No 236 237 238 239 ~ Y~ ~ NO 240 241 242 243 ~ Y~ ~ No 2~ 245 PRINT ~A~E & ~ITLE OF AUTHORIZED COmPlY RE~SE~ATIVE SIG~TURE DATE 24~ DES FORM 2731 (7198) p:\OES2731 .TV4.w~d ., · CITY OF BAKER ELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one form per matedal per building or area) "~ADD [] [] 200 Page of DELETE REVISE BUSINESS ~ME (Same as FACILI~ NAME ~ DBA - D~ng Busin~ ~) 3 205 T~DE SECRET ~ Y~ ~ No 206 CHEMICAL ~ME ~~ ~e~C (~ ,, Subj~ to EPC~. refer to iinstmctions 207 FIRE CODE H~RD C~SSES (C~plete if r~u~t~ by I~1 fire ~ie0 210 ~PE p PURE .~m MI~URE ~ w WASTE 211 ~DIOACTIVE D Y~ ~ No 212 CURIES 213 PHYSICAL STATE ~ s SOLID ~1 LIQUID D g ~s 214 ~RGEST CO~AINER ~ 215 FED H~RD CATE~RIES . ~ I FIRE ~2 R~CTIVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~LTH ~5 CHRONIC H~LTH 216 (Ch~ all that apply) AMOUNT DAILY AMOUNT DAILY ~U~ UNITS* ~ga~L ~CU~ D lbLBS D tn TONS 221 DAYS~E~ 222 * If EHS. amount must be in lbs. STOOGE CO~AINER D a ABOVEGROUND TANK D e P~STIClNONM~ALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR 223 (Check afl that apply) ~b UNDERGROUND TANK Df ~ ~j BAG ~n P~STICBO~LE ~r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY D k BOX O d STEEL DRUM ~ h SILO ~ I CYLINDER STOOGE PRESSURE ~ a AMBIENT ~ aa ABOVE AMBIE~ ~ ba BELOWAMBIENT 224 STOOGE TEMPE~RE ~ a AMBI~ ~ aa ABOVE AMBIE~ ~ ba BELOW AMBIENT 242 243 ~ Y~ ~ No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SI~TURE D~TE 246 OES FORM 2731 (7~98) P:\OES2731 .TV4.wpd CITY OY BAKERSF D :OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (805) 326-397'.9 HAZARDC,US MATERIALS INVENTORY Chemical Description Form (one form per material per budding or ama) [] ADO [~] DELETE [] REVISE 200 Page __ pt BUSINESS NAME (Same a~ FACILITY NAME pt DBA - Doing Business As) 3 CHEMICAL LOCATION 20! CHEMICAL LOCATION CONFIDENTIAL (EPCRA) '-'~'A-C'I-~i~J4~-I~'~ ~ ~t ---1 MAP tt (opbsnal) 203 GRID # (opt/onal) 204 205' TRADE SECREt' [] Yes [] No 206 CHEMICAL NAME If Subject to EPCRA, ref~ to iinstmctio~s 207 COMMON NAME EHS° [] Yes [] No 208 CAS ti 209 ' ~sEHS is'Yes', all amounts below mu~ be in :-.':!:~'. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chie0 210 TYPE [] p PURE [] m MI~CI'URE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 LARGEST CONTAINER 215 PHYSICAL STATE [] s SOLID Eli LIQUID [] g GAS 214 FED HAZARD CATEGORIES [] 1 FIRE El2 REACTIVE ~3 PRESSURE RELEASE r-14 ACUTE HEALTH r-J5 CHRONIC HEALTI'i 216 (Chec~k all that apply) ANNUAL WASTE 21.7 MAXlMUIVI 218 I AVERAGE :" 219 STATE WASTE CODE 220 AMOUNT DAILY AMOUNTI DALLY AMOUNT DAYS ON SITE 222 UNITS* [] ga G/d. [] cf CU FT [] lb LBS [] tn TONS 221 * ff EH,'~, amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK E] · PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [] h UNDERGROUND TANK E]f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER [] c TANK INSIDE BUILDING E] g CARBOY [] k BOX [] o TOTE BIN r"'] d STEEL DRUM E]h SILO [] I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT 224 STORAGE TEMPERATURE [] a AMBIISNT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT [] c: CRYOGENIC 225 1 226 227 [] Yes [] No 228 229 2 230 231 [] 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 PRINT NAME & TITLE OF AUTHORIZED coNIPAI~'~ REPRESENTATIVE ....... ~iGNATURE DATE 246 OES FORM 2731 (7/98) p:\OES2731.TV4-wpd OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one form per material per bu#~ing or area) // ,~AOO [] DELETE [] REVISE 200 Page ~__ of __ BUSINESS NAME (Same es FACILITY NAME or DBA - Doing Business As) 3 201 CHEMICAL LOCATION [] Yes [] No 202 CHEMICAL LOCATION I~! I~/~ ~ ~'"~['0~/~ ~-.~)~ CONFIDENTIAL (EPCRA) 205 TRADE SECRET [] Yes [] No 206 207 COMMON NAME EHS° [] Yes [] No 208 FiRE CODE HAZARD CLASSES (Complete if requested by I(x:al fire chie0 210 TYPE [] p PURE ~ m MIXTURE [] w WASTE 211 RADIOACTIVE FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [~] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH ,~ 5 CHRONIC HEALTH 216 (Chec~ all that apply) ANNUAL WASTE 217 I MAXIMUM ~___...~... 218 AVERAGE g~ 219 STATE WASTE CODE 220 AMOUNT DALLY AMOUNT DAILY AMOUNT ' If EHS, amount mu~t STORAGE CONTAINER [] a ABOVEGROUND TANK [] o PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 2.23 (Check all that apply) [] 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 AMBI{'NT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 ~2~ ~crcF, ~ ~7 [] yes ~o 2~t 0 t I 7- ~75- / 2~ ~,B{:L~m<~s ,u.~ ~So, uarc 2~g •yes ~ ~o ~-,~z4- ox- 7 2.1 242 24:1 [] Yes [] No 244 245 ' " & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 OES FORM 2731 (7/98) P:\OES2731 .TV4,wDcl CITY OF BAKERS LD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY Chemical Description Form (one ~rrn per material per ~udding or ama) ~ ADD ~ DELETE ~ R~I:~E ~ Page ~ of BUSINESS ~ME (S~e ~ FACILI~ ~ME ~ DBA - ~ng ~,sin~ ~) CHEMICAL LOCATION 201 CHEMI~I. LO~TION CONFIDEntIAL (EPC~) ~ Y~ ~ No 202 J 205 T~I)E SECRET ~ y~ ~ ~ CHEMI~L ~ME If ~bj~ to EPC~, ref~ to iins~i~s 207 FIRE ~DE H~RD'c~SSES (~plete if r~t~ by I~1 fl~ 210 ~PE ~ p PURE ~ m M~RE ~ w WASTE 211 J ~IOACT~E ~ Y~ ~ No 212 ~, CURIES 213 [ PHYSI~L STATE ~ s ~LID ~1 LIQUID ~ g ~S 214 ~GEST~AINER 215 FED H~ ~ES ~ 1 FIRE ~ 2 R~CT~ ~ 3 ~SSURE ~SE ~ 4 AC~E H~LTH ~ 5 CHRONIC H~LTH 216 (~ ~1 that a~ply) A~UNT~NUAL WASTE 2,7 ~ ~IMUMDAiLY ~OU~ 218 ~ A~GEDAiLY ~U~ ~' ~lg STATE WAS~ ~OE ~0 UN.S* ~ ga ~L ~ d CU ~ ~ lb LBS ~ m TONS ;~1 DAYS ON S~ ' ff EHS, ~nt must be in lbs. : STOOGE CO~AINER ~ a ~OVEGROUND T~K ~ e ~STI~ONM~LIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~ (Check all ~at app.) ~ b UND~GROUND T~K ~ f ~N ~ j ~G ~ n P~STIC BO~LE ~ r OTHER ~ c TANK INSIOE BUI~ING ~ g ~Y ~ k BOX ~ o TOTE BIN ~ d STEEL DRUM ~ n SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ a ~IE~ ~ aa ~VE~BIE~ ~ ba BELOWAMBIE~ ~4 STOOGE TEMPE~RE ~ a ~1~ ~ aa A~VE ~BIE~ ~ ba BELOW AMBIE~ ~ c CRYOGENIC ~5 ~ 226 ~ ~ Y~ ~ No 2~ 229 2 ~0 231 ~ Y~ ~ No 232 233 3 234 235 ~ Y~ ~ NO 236 4 238 239 ~ Y~ ~ No 240 241 5 242 243 ~ Ym ~ No 2~ 245 PRINT NAME & TITLE OF AUTHORIZED COMP~ REPRESENTATIVE SI~TYRE DATE DES FORM 2731 (7/98) p:&OES2731 .TV4.wpd