HomeMy WebLinkAboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit
COnDITIOnS OF PERMIT O~ REYER$£ SIDE
· , · ::: This permit is issued for the followin_.:
[] Hazardous Materials Plan
E] Underground Storage of HazardOus Materials
[] Risk Management Program
[] Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002127 ,. ~
HEYART
LOCATION 5300 93309
OFFICE OF ENVIRONMENTAL SERVICES' '. ~' ~ DEC 1 4
1715 Chester Ave., 3rd Floor Approved by: "(~P~'U"~Y'~i ~.~
Bakersfield, CA 93301 OfficcofEviro~Services ~
Voice (661) 326-3979
· FAX (661) 326-0576 Expiration Date: 'Juice 30.. ~}OO3 '
ENTRANCE
~'
TREATMENT 1 INSURANCE RECEPTION
PROCESSINg
WAITING
CONSULT
TREATMENT 2
DEVELOPE RM
TREATMENT.. 5 X-RA Y ,
~OFFICE 1 OFFICE 2 TREATMENT 4
YOU ARE HERE
NEAREST EXIT
CUST TY._~a NO. ,.~'~(o(°-'~
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE J- / 7- ~ ( NEWACCOUNT
ADDRESS CHANGE
CLOSE ACCT
' FINANCE CHARGE J
~ OTHER ADJ i 'V"
SITE ADDRESS
PARCEL NUMBER
(IF APPUCABLE)
ADJUSTMENT
CHG DATE CHARGE CODE ADJUSTMENT AMOUNT
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
HAZARDOUS MATERIALS MANAGEMENT PLAN
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.
5. You may also attach Business Owner / Operator Form and Chemic~)I3~iption~Eorm(s)
to the front of this plan instead of completing SECTION I. below for m~tml subm~ssfonc~
SECTION I: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: ~ -
MAILING ADDRESS:
MAILING ADDRESS:
EMERGENCY NOTIFICATION ,
CONTACT TITLE .BUS. PHONE. ~ 24 HR. PHONE
2.
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II. 1: DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORING PROCEDURES:
B. EMPLOYEE AND AGENCY NOTIFICATION:
C. E~RO~NT~ ~SPONSE ~NAGE~NT:
2
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES: L~I¥'~-.
B. RELEASE CONTAINMENT AND/OR MITIGATION:
i~c need¢4. 0
C. CLEAN-UP AND RECOVERY PROCEDURES:
o,/-o+
ELECTRICAL:
WATER:
SPEOIAL: ,
LOCK BOX: 'YES/NO IF YES, LOCATION:
PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION:
B. WATER AVAILABILITY (FIRE HYDRANT):
3
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION III: TRAINING
" NUI~IBER'OF EMPLOYEES:
MATERIAL SAdiST? DATX S'I~gETs'O .N.F,ILE: ' '~2~'~.. --.,D
,. ' BRIEF"S~Y OF TRAIb'ffNG'PR~OG ~RAM:
CERTIFICATION
i. 0~,~o~u ~4~u~ ~TIFYT.^TT.~OV~O~T~ON
IS ACCURATE. [ftJNDERSI~ND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S OBLIGATIONS LINT)ER THE "CALIFORNIA HEALTH AND SAFETY
CODE" ON HAZARDOUS MATERIALS (DIV. 20. CHAPTER 6.95 SEC. 25500 ET AL.) AND
THAT INACCUR&TE INFORMATION CONSTITUTES PERJURY.
'~I~~~ / - TITLE IJATE
'" 4
OFFICE OF ENVIRONMENTAL VICES
1715 Chester Ave., CA 93301 (661) 326-3979
BUSINESS OWNER / OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page __ Of __
............ As) / I 3 ~U NI~S P_.~Ht)NE .... ~ 402
BUSINI~SSHe~.r~NAME (Salne as ~' rOf~ rQ i~ C~6~II~ITYeNAME or DBA-Doina ,usiness
c,Ty t.l L, ,o4 CA z,P o/,. b6q
DUN & '~o6 SIC CODE lO7
BRADSTREET (~ Digit #)
COUNTY ~ r Itl ,o~
OPERATOR NAME
ADDRESS ~ 13
CONTACT NAME ~~~ ~7 CONTACT PHONE
118
CONTACT ~ILING ~9
ADDRESS
CITY 120 STATE ~2~ ZIP 122
24-HOUR PHONE I I ,~, 24-HOUR PHONE
PAGER g ~2S PAGER ~ 133
CeAification: Based on my inqui~ of those individuals responsible for obtaining the info~ation, I ~di~ under penal~ of law that I have personally examined
and am ~miliar with the info~ation submi~ed in this invento~ and believe the information is tree, accurate, and ~mplete,
SIGNAT~E OF OWNE~OPE~TOR DATffi / ~ ~34 NAME OF DOCUMENT PREPARER 135
N~MES OF~E~OPE~~t) ~36 TITLE OF OWNE~OPE~TOR
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~ ~'~ '-' CITY OF BAKERSFIEL~
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (661) 326-3979
"~-'"~~'"'~-" HAZARDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
(one form per matedal per building or area)
[] NEW I"'1 ADD [] DELETE I'"l REVISE 200 Page __ of __
BUSINES~ I~ME (Same as F~,CILITY,~J~IV~ or DBA- Doing Business I~S) 3
{ iropracf'i
CONFIDENTIAL (EPCRA) No 202
FACILI'P/~ ~:~ I ' ' 1 MAP # (optional) 203 GRID # (optional) 204
If Subj~ to EPC~, refer to inst~ions
~If EHS h~,". ~.~low must ~
CAS~ 209 :'~:~.:~?::''' :'. ~':~.-~ ~
FIRE ~DE H~RD C~SSES (~plete if r~u~t~ by I~1 fire
210
~PE ~ p PURE ~ m MITRE ~ w WASTE 211 I ~DIOACT~E ~ Y~ ~ No 212 CURIE~ 213
PHYSIC~T.~' ~, SOLID ~' LIQUID ~ g ~S 214 ~RGESTCONTAINER D ~1~ 215
FED H~RD CATEGO~ES ~ I FIRE ~ 2 R~CTIVE ~ 3 PRESSURE REL~SE ~ 4 ACU~ H~Lm ~5 CHRONIC HEALTH 216
(Ch~ all that ap~ly)
A~UNT ~/ ~ DAILYA~U~ DAILYA~U~
~ ga ~L ~ d CU ~ ~ lb LBS ~ tn TONS 221 DAYSON SITE
* If EHS, am~nt must be in lbs.
STOOGE CONTAINER ~ a ABOVEGROUND TANK ~ e P~STI~NONM~ALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223
(Check afl that apply)
~ b UNDERGROUND TANK ~ f CAN ~ j BAG ~ ~ r OTHER
~ c TANK INSIDE BUILDING ~ g ~RBOY ~ k BOX ~ o
~ d STEEL DRUM ~ h SILO ~ I CYLINDER ~ p
STOOGE PRESSURE ~ a A~IE~ ~ aa ABOVE AMBIE~ ~ ba ~4
STOOGE TEMPE~TURE ~ aAMBIE~ ~ aa ABOVEA~IE~ Dba BELOW AMBIENT ~ c CRYOGENIC ~5
l'l 226 227 r-J~o 228 ,,~j~,. 229
i 230 231 J'-I Yes [] No 232 233
3 I 234 235 [] Yes [] No 236 237
[]Yes []No 2a0
242
245
[] Y~ [] No 24a
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