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HomeMy WebLinkAboutBUSINESS PLAN SITE/FACILITY DI AGR~ F ORI~I NORTH SCALE: BUSINESS ~A~E :~.~ ' f \ , UNIT O~q~ ~ DATE~ /~ /~ FACILITY N~E: (CHECK ONE) SITE DIAGR~ ~vj FACILITY DIAGR~ I(Inspecto__~om~ents): -OFFICIAL USE ' ONLY- - ~ -~HM476801 · Account Number ACCOUNTS RECEIVABLE.ADJUSTMENT January 12~ 1994 Date New Account New Address Esther Duran Close Account From. Service Change Other Adjustments : X Fire Department - Hazardous Materials Division Department/Division JOHN KIMBERGER WELDING Billing Name 2656 CALLOWAY DR · Billing Address Site Address Pamel # (if Applicable) Landlord Name & Address (If Applicable) ADJUSTMENT Last Billed Correct Billing Adjustment to Effective Date of Billing Change 158.00 0 01-12-94 Remarks: KAREN KIMBERGER OF JOHN KIMBERGER WELDING S~ATES THAT THEY MOVED TO 7440 DOWNING WHICH IS LOCATED IN THE COUNT~ AND HAVE BEEN PAYING COUNT~ FEES. VERIFIED WITH ANN~'I'E AT COUNT~ H~. MAT. WE WILL R~/ERSE THIS BILLING. Page: 1 Account Billing/Collection Activity Inquiry SUTL108 Acct : 476801 Cyc St: CL Bill St: NO Cyc: 5 Rt: Seq: SSN : Parcel: .... Svc Cls :e Name : JOHN KIMBERGER WELDING Svc Add: 2656 CALLOWAY DR Amt due: 1518.00 Current Period Postings Lst Pmt: -59.15 Type Desc Date Amount Receipt # Pmt Dte: 02/08/93 -- Prior Bills -- Date Balance 01/01/94 158.00 03/17/93 0.00 01/01/93 0.00 01/01/92 0.00 01/01/91 0.00 02/15/90 0.00 06/26/89 0.00 Enter '/' For Bill History,'P' To Print Report, ~/C' For Credit and Deposit History or 'XX' To Exit ALT-F10 HELP I ADDS VP I~FDx I 9600 E71 I LOG CLOSEDI PRT OFF I CR CB ......... % 7ff¢0 - . . , . _ -'. .... ' PLE~SEMAKEC CKSP RETURN pAYMENTS TO:' H AZ ~ RDOU5 ,4AT E ~ ~ CITY OF BAKERSFIELD , BAKERSFIELD, CA 93303-2057 cOUNT NO, , -..- . _-~:... : :,.~- .~,.... '. j . .- -:..:. .... " '"?: :~ '-., ,j .- .; -,..r, -, -' '"'"  cONCERNiNG THiS B~LL, PLEASE PHONE; · . , INVOICE NUMBER .... . . . - ........ ' ....... CUSTOMER cOPY "' March It 1990 Nina Mayer~ Accounts Receivable FROM~ Ralph E. Huey~ Hazardous Materials Coordinator SUBJ£CT: John Rimberger Welding Nina~ account # 476801 was annexed into the City on December 2~ 1988. They were bill for the entire fiscal year 1988-1989~ they should be prorated from December 2~ 1988 until June 30~ 1989 and billed for the entire current year. Please fix and rebill this customer. Thanks~ Valerie ?~... x 5642 VICTOR STREET ~ ~\-~' BAKERSFIELD, CA 93308 NOV '~ O 19~ (805) 861-2761 BU~ INESS' ~=E 0 ~m ~~ DO NOT ~RITE ABOVE THIS LINE . , HAZARDOUS MATERI ALS RECEIVEO ~USZNESS PLAN ~NS~C~iONS: HAZ. MAT, DIV. ~. To ~void fu~he~ ~io~, ~e~u~n ~hi~'~, by JU;~ 3 0 ~988 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for your business as a'whole. 4. Be as brief and concise as possible. But explain fully. SECTION 1: BUSI~SS ID~IFICATION DATA B. PHYSICAL LOCATION/STREET ADDRESS: ~ Ca~t~L,~~ CITY: )~,~~ ZIP: ~/~ BUS.PHONE: ~0~ 5--F9~/ ~ CITY:~. ZIP:~5~I~ ~ P.0NE: ('05) 5DI-GCGq SECTION 2: EMEROENCY NOTIFICATIONS ~-- ~ ~ ~ In case of an e~ergenc~ involving the release or threatened release of a hazardous ~aterlal, call 011 and 1-800-852-7550 or 1-010-497-4341. Thls ~11 notify your local fire department and the State Office of E~ergoncg Services as required by la~. E~PLOYEES ~HO SHOULD B~ SOTI~IED I~ C~SE OF E~ERGESCY: NAME AND TITLE. ~ DURING BUS. HRS. AFTER BUS. HRS. ~ S~ION 3: ~OOATION OF ~I~I~ S~-OFFS FO~ ~USI~S~ ~ A ~0~ · A. NAT. GAS/PROPANE: ~~ ~ ~~ ' O. SPECIAL: ~ E. LOCK.BOX: YES ~IF YES, LOCATION: IF YES, OOES IT CONTAIN SITE PLANS? YES / NO ~SDSS? YES / NO FLOOR PLANS9 YES / NO KEYS? YES / NO OVER SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE Do you have a group of employees trained to handle minor accidents involving hazardous , "~ ..materials? Yes No If,'~s,o. please~explain. ~ [ 'l SECTION 5: C~OSEST LOCAL E~ER6ENCY ~EDICAL ASSIST~CE FOR YOUR BUSINESS HOSPITAL N&ME: '1. C~ ,~O ~';~ ~xO,'T~ ~2 PHONE: AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER MATERIALS: YESN~ YES 8. PROCEDURES FOR COORDINATING ACTIVITIES WIT}{ RESPONSE AGENCIES: .......................... YES ~ YES ~ C. PROPER USE OF SAFETY EQUIPMENT: ......... ' ......... YES~ YES D. EMERGENCY EVACUATION PROCEDURES: ....... : ......... YES YES E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES YES , certify that the abov'e information is / accur/a~e. I u~erst~d t~t this information will be used to fulfill my firm's (.__~igations_u~fder t elt~_~ California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. HMCU-4 KERN COUNTY FIRE DEP~ 5642 VICTOR STREET BAKERSFIELD. CA 93308 ID# BUSINESS NAME: DO NOT WRITE ABOVE THIS LINE -BUSINESS PLAN FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 30~ 3 0 10°98 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. But explain fully SECTION 1: P~ION~ I~INII~I~.ATION~ ~ Cl'.F~-UP PROCKI~URE$ SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES FOR THE EI~PLOYEES TO USE THAT ~ IN Tills FACILITY SECTION 3: HAZARDOUS NATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... ( ~ES) N0 If YES, see B. If N0, continue with SECTION 4. B.Are any of the hazardous materials a bona fide Trade Secret as / ~ defined by Section 6254.7 of the Government Code? ......... YES If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY'(yellow form #4A-2) in addition to the non-trade secret form. List only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE PROTECTION SYSTE/~S SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. GAS/PROPANE: c. WATER: O. SPECIAL:/~~ E. LOCK BOX: YES /~IF YES, LOCATION; IF YES, SITE PLANS? YES / N0 MSDSs? YES / NO FLOOR PLANS? YES /' NO KEYS? YES..,'" NO HMCU-6 Farm and Agriculture ~---J KERN COUNTY FIR. E D~-PARTMENT HAZARDOUS MATERI ALS INVENTORY n -- ~ DUN AND S~andard Business LOCATION: ~z,~ ~_//~f .~k~~~ADDRESS: ~/ c~TY, zzPT ~- - - ~ czTY, zIP: .~,~.~.~d C~ '9~>z~ ...... R~FER ~0 INSTRUCTIONS FOR PROPER-CODES I 2 3 ~ 5 6 7 8 9 10 ll Tpans [ype Max Avepage Annual MeasuPe Cent Cent Cent Use % by Names of Mixture/Components Code Code Amt Amt Est Units lype Ppess lemp Code Nt See [nstpuct ions Health ..... . .... -=- ..... _ .................. 'Fire u--J Delayed Health C.A.S. Number .... ~_~_~ .... . ~--J Reactivity ~--~ Sudden Release of Pressure on Site .... Health r-'-~ r---~ ~ r 13) ~ Days ~ React~v~y ~ Sudden Release of g~essu~e on S~te u--'~ Immediate ._ ~ ~_ i'3~_ _.~ r~ ~,~ ___ ~_~E Health j ~ ................ ~-J FiPe L ..... ~ Delayed Health ............. ~ ........... r' "~ L~ 13) ~ Days L.--J Reactivity Sudden Release of Pressure on Site ....... I R~ ~u~~ ~ ) '~ ~ ,~ o~ u~ · MAR · . .... Certificati~c~ad~J~n after completing all sections) I certify under penalty of law that I have'personally examined and am familiar with the informa~n' submit~d.in this. and all attachede, documents, and that based inquiry of those individuals responsible for obtaining the information, I believe that the sullied infUSion i~ue~ccur~_, and complete. INVENTORY CODE SHEET Trans Code (Column 1) Use Codes (Column 10) A = Add This Item 01 Additive D = Delete This item 02 Adhesive R = Revised Information 03 Aerosol/Inflation 04 Anesthetic 05 Bactericide Type Code (Column 2) 06 Blasting ~ 07 Catalyst P = Pure Material 08 Cleaning M = Mixture of Substances 09 Coolant/Antifreeze W = Waste (Must Also: Add 10 Cooling Appropriate Waste Code from 11 Drilling "Waste Code Sheet") 12 Drying 13 Emulsifier/Demulsifier 14 Etching Measure Units (Column 6) i5 Experimental/Analytical LBS = Pounds 17 Fertilizer TON = Tons (2,000 lbs) 18 Formulation~Manufacturing GAL = Gallons 19 Fuel BBL = Barrels (42 ga!s) 20 Fungicide Ft3 = Cubic Feet 21 Grinding CUR = Curies 22 Heating 23 Herbicide 24 Insecticide Container Type (Column 7) 25 Instructional 26 Lubricant 01. Underground Tank 27 Medical Aid or Process 02. Aboveground Tank 28 Neutralizer 03. Fixed Pressurized Cylinders 29 Painting 04. Portable Pressured Cylinders 30 Pesticide 05. Insulated Tank (Includes 31 Plating Cryogenics) 32 Preservation 06. Drums or Barrels - Metallic 33 Refining 07. Drums or Barrels - Non- 34 Sealer Metallic 35 Spraying 08. Carboy(s) 36 Sterilizer 09. Glass Container(s) 37 Storage/In Storage 11. Box(es) 39 Washing 12. Bag(s) 40 Waste 13. Metal Containers (Not Drums) 41 Water Treatment 14. In Machinery or Processing 42 Welding Soldering Equipment 43 Well Injection or Service 15. Bin(s) 44 Oil Treatment. 16. Unlined Sumps 45 Resale 46 Aircraft Systems 47 Battery/Electrolyte Container Pressure (Column 8) 48 Breathing Air 49 Drafting Aid 1 = Ambient Pressure 50 Finished Product 2 = Greater Than Ambient Press 51 Fire Protection 3 = Less than Ambient Press 52 Hydraulic Equipment 53 Road/Hw¥ Maintenance Container Temperature Column 9) 54 Testing 4 = Ambient Temperature 55 Wholesale Chemicals 5 = Greater than Ambient 99 OTHER-Specify on 6 = Less than Ambient Temp but not another page ~, Cryogenic '7~= Cryogenic Condi ~ns [~~I/DOUS l~4ATER! A~ BIJI~EAU V I NSPECTI ON ~ INSPECTION S~RY: ~UAL INSPECTION ~ EXEMPTION RE-INSPECTION ~~T, giV. A~ ITemS OR: [~ ~IO~ATIO~8 NOT[D: [ ] 0 - Does not Apply 1 - In Colpltance 2 - Correction Needed 3 - Verbally ~arned 4 - N.O.V 5 - Citation 6 - Referred ~o (Specify) EMERGENCY PROCEDURES (CCR TITLE 19-2729 & 31) PREVENTION & CLEANUP PROCEDURES (CCR TITLE 19-2731 A. Agency Notification Plan (O.E.S., FD) L. Work Area Safety B. EIployee Notification & Evac. Plan M. Clean-up Materials placement/availability C. Emergency Responder Notification N. Clean-up Equipment D, Medical issistance~ ..... O. Fire Protection Systems E. Private Response/~,. Procedures ~~e ~ ( lve Equl e T~ININ6 REQUIREMENT~ (CCR TITLE 19-2732)/~I~. & DIAGRA/4 VERIFICATION (CCR TITLE 19-2729) F. Training Records / R. I~entory qu~titles _ 6. NSDS Available to Employee~~ S Storage, Contain~ ~d~, & Labeling H. E~ployees Familiar ~DS ~~ In ~cllity Unit I. Use of Personal Pr~~~en~ ~ncy ~ater Supply J. ~aste ~aterial~sit~cen~ V t~ua~ Plan & Area K. E~pioyees fa~iar ~it~uatlon ~ ~~ng Exp~ures plan. , / X UtlliW Shut-offs Y Other Co~ents: Clearance Granted~ Re-inspection Required [ -~. I'NSPECTiON S~RY: ~UAL INSPECTION-~ EXEMPTION RE-INSPECTION CO~PLAINT ALL ITEMS OK: [~, .~IOLATIONS NOTED: [~ ] 0 - Does not Apply I - In Compliance '2 - Correction Needed 3 - Verbally ~arned 4 - N.O.V 5 - Citation 6 - Referred to (Specify) E~ERGENCY PROCEDURES (CCR TITLE 19-2729 & 31) PREVENTION & CLEANUP PROCEDURES (CCR TITLE 19-2731 A. Agency Notification Plan (O.E.S., PD) L. ~ork Area Safety B. E~ployee Notification & Evac. Plan N. Clean-up Naterlals placement/availability C. E~ergency Responder Notification N. Clean-up Equipment D, ~edlcal Asslstancef O. Fire Protectloa Systess E Private Response/~ea~ Procedures ~~.~~~d~ng~&~St~e ~ / Q. Aval ~ab-t~l~'y-of~P-~o~e_~e Equtp~e~~ ~ ~D T~ININ6 REQUIREMENTS (CCR .TITLE 19-27 IAG~ VERIFICATION (CCR TITLE 19-2729) · ~. Tralnln~ Reco,d~ R. Inventor~ ~. ~SDS ~v~tlabl~ to' g~plo~ee, S. Storage, Contatne~ Cond., h Labeltn~ I. ~e of Personal. P~ecttve gqulp~ent ~. ~er~enc~ ~t~r Suppl~ J. Waste ~aterlal ..~ermlts ~ License V. ~vacuatlon Plan h Area g. E~ployees fa=tqt, ar ~lth evacuation ~. Surrounding Exposures plan. X. Utility Shut-offs Y. Other Co~ents: i ~'"'~ ...... - / Clearance Granted~] Re-inspection Required [ ] on / /' Started /¢ : ~D Co.pieted t5 : ~ Total Ti.e~: ~'0 ~, on In~ KERN COUNTY FIRE DEPARTNENT 5642 VICTOR STREET. BAKERSFIELD, CA 93308 BUSINESS NA~E INSPECTOR QUEST, IONNAIRE BUSI NESS PLAN AS A I~rHOLE FOR USE WITH THOSE BUSINESSES COMPLETING A BUSINESS PLAN (2A). INSTRUCTIONS: 1. Complete this form only once for each occupancy. 2. Attach this form to BUSINESS PLAN (2A) and forward to Data Entry. BUSINESS PLAN VERIFIED ON: /~ /~© / ~ sECTION 1: RESPONSE SlaY (Limit to 4-5 lines) SECTION 2: NOTIFICATION / EVACUATION OF AFFECTED PUBLIC "('Limit t"o 13 lines) H~CU~5_