HomeMy WebLinkAboutBUSINESS PLAN 9/9/1996 I
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
.......... ,,~,~;~,~v~;~,,~;~,~,,:~ ......... This permit is issued for the following:
~ i~ i ~ground Storage of Hazardous Materials
~u~ LION HOTEL
LOCATION 3100 C~Q~DEL ~O
Issu~ by:
B~ersfield F~e Depa~ment Approv~ by:
1715 Chewer Ave., 3rd Floor
B~el~ CA 93301
Voice {805)
Map I of 2
~; ~,,'""~ ~,RDOUS MATERIALS MANAGEMEN'~A~- N
SITE DIAGRAM [] FACILITY DIAGRAM []
Business Name: Red Lion Hotel
Business Address: 3100 Camino Del Rio Court. Bakersfield. California 93308
For Office Use Only
First in Station:. Area Map// Of
Inspection Station: NORTH ~
Quality Inn
Rosedale Hwy 58 ' Fire Hydrant
..
~.~t?poo~ '.
'. lo.,,(92
M~n ~ ·
Fire ~ ~.
GtJtt; .~.o~... , ,~
Th~'m Om Storsgo
Electdc Shut-off
· Hyd
· ** rant
Pool
.....
~0 X
"""~---~ct ~~ Fire Hydrant
............ ' ~1~210 ...... .~.-.m r,
.......... · , 500 Gd. Di~ A~
........ ~u~l
Marrio~ Hotel Fire H ,-, ~
Ramada Inn
Map 2 of 2
~- ,, H DOUS MATERIALS MANAGE ENT N
SITE DIAGRAM [] FACILITY DIAGRAM []
Business Name: Red Lion Hotel
Business Address: 3100 Camino Del Rio Court. Bakersfield. California 93308
For Office Use Only
First in Station:, Area Map# .Of
Inspection Station: NORTH
BASEMENT AREA
(Building E)
· . eL~ -..
.... PROTECTED BY AUT£
,(Corro~ Solids AREA
L Environmental, Inc.
Earth & Environmental SEP 1 0 1996 1824 Norris Road
Bakersfield, CA 93308
By__. Tel (805) 392-1 $44
~ Fax (805) 392-7782
Project No. 6-222-803500
1715 Chester Avenue, 3r, d Floor ~'~'~- ~ ,
Bakersfield, CA 93301
Attn: Mr. Ho~ward Winns
RE: HAZARDOUS MATERIALS MANAGEMENT PLAN
RED LION HOTEL
3100 CAMINO DEL RIO COURT
BAKERSFIELD, CALIFORNIA 93308
Dear Mr. Winns:
AGRA Earth & Environmental (AEE) is pleased to submit the attached Harardous Materials
Management Plan (HMMP) on behalf of Red Lion Inns and Hotels for the above referenced
facility. Should you have any questions or comments please contact the undersigned at
(805)392-1344 or Mr. John Thoennes at (805)632-2242.
Yours truly,
AGRA Earth & Environmental
Dale A. Joh~~
Project Manager
F:\800 FILES~letters\6-8036.DJ
Engineering & Environmental Services
~ Recycled Paper
BAKERSFIELD CITY FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
1715 CHESTER AVENUE, 3RD FLOOR
BAKERSFIELD, CA 93301
HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
'~. To cvoic :umber cction. ;e~u:n :;-,is fc:m wllnln 30 Ccys ot receipt'.
-v~c/c~ ~7 ANSWERS IN ENGL!£H.
mc_.. ,C, ~ '5'¢; c-% w FtO[e.
· 5e Df:el Cr, C concise CS .....
SECTION ~' 3USINESS 1DENTIF!CATIC. N DATA
RED LION HOTEL
~,~. 3100 CamJno Del Rio Court; R~k~r.qfiP_ld. CA 93308
.... ~.;,~, ~.',zzc~ 3100 Camino Rio Court
.... -"' Bakersfield ~7.'~.7. E: CA =,n. ..,
..... =:~. 93308 DUONE: (805) 323-7111
~U:'~ ~ ~,Z.~ "7.~ .... '"'~-~' ~ 5821 /
--' .,u,~,~::~. SiC ~OC'E:
Red Lion Inns & Hotels
P.O. Box 1027.98666, Vancover, WA 98663
cECTION '". =,,. ~
-, -' ....I~R,=ENCY NOTiF!CATiON:
.. CONTACT T:TL: BUS. PHONE 24 HR. ?HONE
John Thoennes Director Of Eng. (805)632-2242 (805)396-81a1(~.ome)
Raul Reyes Eng. Supervisor (805)632-2242 (805)337-2272(Pager)
BAKERSFIELD FIRE DEPARTMENT
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
NUMBER OF EMPLOYEES: 13
MATERIAL SAFETY DATA SHEETS ON FILE: YES, In engineering office & laundry
BRIEF SUMMARY OF TRAINING PROGRAM:
All employees having access to and/or working in areas containing hazardous materials are trained in the:
Identification of hazardous materials and knowledge CAL OSHA Hazardous Communication Standard as it applies
to hazardous materials.
· Location of Material Safety Data Sheets (MSDS) and what information is listed on them for each product/chemical.
· Labeling and safe handling of containers containing hazardous materials.
· Proper use of.emergency response equipment (PPE, absorbents, fire extinguishers, etc.) and their location in the
workplace.
· Hazardous Spill Control Procedures: Employees to secure area: turn off electric power to spill area: notify
Emergency Response Chief (Director of Engineering or Engineering Supervisor); locate emergency response
equipment; and contain spill using proper protective clothing, safety equipment and absorbent materials. If spill is
large (greater than 10 gallons), Emergency Response Chief shall contact EcoLab at (800)326-002_6 to assist in
cleanup operation.
~Evacuation procedures: Employees to evacuate building(s) through nearest exterior door.
~ 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 TIME EXCEED
THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
i~ 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.
~ DATE
BAKERSFIELD FIRE DEPARTMENT
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name: Red Lion Hotel - Bakersfield
~ NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFICATION PROCEDURES:
Upon identification of an unauthorized release of hazardous material, employee shall notify Director of
Engineering; if he is not available than Engineering Supervisor shall be notified. The first respondent shall
be designated Emergency Response Chief (ERC); he shall determine if local fire department (Kern County
Fire Department - @ 911) and/or emergency response team (EcoLab @ 800-326-0026) shall be notified.
The Emergency Response Chief shall notify Manager on Duty (MOD) of situation and what emergency
procedures has been mobilized.
B. EMPLOYEE NOTIFICATION AND EVACUATION:
Employee notification shall be by verbal commands, employees shall exit the area through the nearest
exterior door and meet at staging area. Staging area will be the parking lot on the east end of property.
C. PUBLIC EVACUATION:
Should public evacuation of the hotel facility be ordered by the local authorities (ie. Fire Chief) the ERC
shall determine if the evacuation shall be partial (one room, one floor, one wing, etc.) or total (entire
property). The evacuations shall be either horizontal (move guests and employees across floors to safe
refuge areas such as stairwells or separate areas behind fire doors), or vertical (move guests and
employees to up or down stairwells). All evacuees shall be directed to designated staging areas which
shall be the nearest parking area away from the hotel for verification of evacuation.
D. EMERGENCY MEDICAL PLAN:
Should the ERC determine that the unauthorized release of hazardous material(s) would require an
emergency medical response, he would contact EcoLab @ (800)328-0026 and Bakersfield City Fire
Departme.nt @ 911. Employees exposed to hazardous material would be transported to Mercy Hospital
located at 2215 Truxtun Avenue in Bakersfield, CA.
BAKERSFIELD FIRE DEPARTMENT
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
~,~ MITIGATION. PREVENTION. AN ABATEMENT PLAN;
A. RELEASE PREVENTION STEPS:
Employees are trained in the proper procedures for hazardous waste storage, handling and labeling. In
addition employees are trained in the proper methods for hazardous waste disposal. Record keeping.
requirements are reviewed annually, as are MSDS updates and safety procedures for hazardous materials
handling.
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
When an unauthorized release of a hazardous material has occurred, employees are trained to: secure
area; turn off electric power to spill area; locate fire extinguishers; contain spill with absorbent materials;
and contact Director of Engineering or Engineering Supervisor. Employees are trained in the use of
personnel protection clothing and safety equipment (PPE) required to contain a hazardous material release.
C. CLEAN-UP PROCEDURES:
Absorbent materials (kitty liter, absorbent socks and dikes, wipes, etc.) will be utilized to contain and
clean of the hazardous material release. The absorbent material shall be placed in a properly labeled
waste drum(s). Waste drum(s) to be disposed of at a properly licensed disposal facility or recycled.
Should the spill be greater than 10 gallons, employees are trained: to secure area; turn off electric power
to Spill area; using proper safety equipment and protective clothing, attempt to contain spill and prevent it
from entering storm drains or running off-site, if safe; locate fire extinguishers; and notify Director of
Engineering or Engineering Supervisor (ERC). The ERC shall be responsible for notifying the Fire
Department and EcoLab at (800)326-0026 to assist in cleanup operation. After the spill has been cleaned
up, a review of emergency response plan and emergency notification procedures shall be undertaken by
the Director of Engineering to ensure coordination with the local fire department, clean-up contractor, etc.
~ UTILITY SHUT-OFFS ILOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATURAL GAS/PROPANE: East side facility on southeast corner of Building A
ELECTRICAL: On the southwest corner of the exterior of Building A
WATER: Near the northwest corner of the exterior of Building B. adiacent to Cam/no Del Rio Court
SPECIAL:
LOCK BOX: YESO IF YES, LOCATION:
~[C~LID_~L~ PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A. PRIVATE FIRE PROTECTION: NONE
B. WATER AVAILABILITY (FIRE HYDRANT): 2-on West, 1-on North, 2-on East, & 1-on South
BAKERSFIELD CITY FIRE DEPARTMENT
~~~ OFFICE OF ENVIRONMENTAL SERVICES
%, ._ .~~ _.'~ 1715 CHESTER AVENUE, 3RD FLOOR
BAKERSFIELD, CA 93301
. (805) 326-3979
'z~I~~ HAZARDOUS MATERIALS MANAGEMENT PLAN
INSTRUCTIONS:
To c,.,oic :uFhqer ac:ion, ;e;u:n :;",is :c:m w~tn~n 30 Ccys ot receJoL
2. ~Pc_/PRINT ANSWERS IN ENGLISH.
3. Answer -mt cues;ions Cetow ' ' :r,e cs c
..... c.
5e or;et ~--' concise cs
SECT]ON ~' EUSINESS IDENTIFICATIC..H DATA
....... :';,--'.,v~z. RED LION HOTEL
L%:,.~.-:-,'7;~,N' 3100 C, am~no Del Rio Court~ Rak~rsfi. c. ld: CA 93308
..... ~..~..l .... ',:ZC: 3100 Camino Rio Court
.... -"' Bakersfield
=;~.93308 (805) 323-7111
~"~: : ............ ,,~--. ~ 5821/
~., ~z,~.~z..~z: .,~,cz:~.
~.:..,,,~.:. ~.,¢ .... Hospitality
~'*:~q~2'~,~ Red Lion Inns & Hotels
.,':.-,._::N~ -Z~5: P.O. BOX 1027 98666, Vancover, WA 98663
SECTION 2: :ME.RGENCY NOTiFiCATiON:
CwN!~C, ..... BUS. PHONE 24 hR..HONe
;. John'Thoe'nnes Director Of Eng. (805)632-2242 (805)396-8141(~ome).
2. Raul Reyes Eng. Supervisor (805)632-2242 (805)337-2272(Pager)
BAKER I IELD C TY FIRE DEP, TMENT
HAZARDOUS MATERIALS INVENTORY Page_.Lof'~'
~usinessName RED LION HOTEL Address 3100 Camino Del Rio Court, Bakersfield CA
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New { ] Addition [ ] Revision/~-]J;~letion { ] Check if ch~mk=aJ is a NON TRADE SECRET [ ] TRADE
SECRET
[
]
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire I I Reactive {~ Sudden Release of Pressure { ] Immediate HeeJth (Acute) ~ Delayed HeaJth (Chronic) [
5) WASTE C~'SS,F,CA~ON I ~ / (~-d~, code ~om ~HS ~o.~.0~, ~SE CODE ~ ~7
Maximum Omi¥ Amount; !bs I ] gaJ x[~ fro [ ] aI Container.
Average OeJIy Amount: curies [ ] b) Pressure:
Annum Amount: ~ (~)C) c) Temperature:
Lazges! S~ze'Contzuner:
# [Days O.1 S,te ~ ~.~ C]rc:e Which Months: ~Ye~.-~..)J. F. Mm A. M. J. J. A. S. O. N. 0
9) MIXTURE: Us~ CCMPONENT CAS # % VVT AHM
;ne tnree most n~-zazoous ~)
~ny AHM comcx3nents 2}. [
CHEMICAL DESCRIPTION
) INVENTORY STATUS: New ( ] Addmon [ ] Rewsion j/~--Deleuon ( ] Check< rf cnemm~l is ~ NON TRADE SECRET
4) PHYSICAl_ & HE..~LTH PHYSICAL HEALTH
HAZARD CA'rEGORJES F~re [ ~ Reactive ~ ] Sudden Release of Pressure [ ] !mmedi~e Hea~th ~Acute} [ ] Delayed HeaJth (Chronic) [ ]
5)' AS EC SS,F,C* iON t3 ( .'. - i itcooe,,omOHSFo ,0 , SECO0E z./ (
6) PHYSiCAL STATE 3olid ~.' Liclu=d [ ] Gas [ ] Pure [/~ Mixture [ I Waste [ ] Radioactive [ ]
7) AMOUNT AND ;ME AT FAC~UTY i/z'J jNITS./OF MEASURE 8) STORAGE CODES
Maximum C,a~iy Amount: ~ ?s ~r...c_aJ [ ] It3 [ ] al Contaner:
Averace Caiy Amount: cunes I' ] b) Pressure:
Annum Amount: c] Temper~ure:
Laxges~ S~=e Contzuner: i
# Days On Site ~ (~.~- C:,rc!eWhich Months: . F. M. A. M. J. J. A. S. O. N. D
9) M~XTURE:. Lst COMPONENT CAS #
- the tl~ree most naz~oous 1) [ ] ' ·
cnem~caJ comoonenL~ or :
any AHM components ~) [ ]
3~ [ 1
cerory Dnaer pen~v cr mW [ha~ II nav~ personauy exa'~n,nea ~no am jamUiar w/~ ~e inJome~on suom,rteo on m,s aaa ~1 attache<3 do~,brnenm.
'Rl~me & Title' of Auzhorizec~ Company ~epresen~ve Signature Date
' BAKER JlELD CITY FIRE DEP,J TMENT
HAZARDOUS MATERIALS INVENTORY Page~.of~__'
3usinessName RED LION HOTEL Address 3100 Camino Del Rio Court, Bakersfield CA
CHEMICAL DESCRIPTION
1) INVENTORY STATUS.' New ( ] Addition [ ] Revision ~ Deletion ( ] Check if chemical is ~ NON TRADE SECRET I~ TRADE SECRET [ ]
2) CommonN~me: <_~ ~'c~O. ~1~,[,~. 3) DOT* (opaomU)
4) PHYSICAL & H~L~ PHYSICAL H~
H~RD CA~GORIES Fire [ ] Reactive { ] Sudden Relate of Pressure [ ] Immediate He~th (Ac~e) [ ] ~{ayed He~h (Chronic) [ ]
5) WAS~ C~SSIFICA~O" I~ I (3-digm co~e from OHS Fo~ 8022) USE CODE ~ i
6) PHYSICAL STA~ Solid { } Uquid [ ] G~ [ ] Pure ~ M~ure [ ] W~te [ ] R~ioa~we [ ]
7) AMOUNT AND ~ME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES ,
M~lmum Omiy Amoun,:~. ~ ~ J' j g~ ~ ~3 [ ] a) Contaner: J
Average O~ty Amounl; ~, Z ~ :~nes [ ] b) Pressure: I
~nnu~ Amount; ~ c) Tem~r~ure:
~gesl Size Cont~ne[ ~, ~
~ gays O~ S~te ~ C}c~e ~Jcn Months: ~.~. F. M. A. M. ;. d, A. S. O.
9) MI~E: ~s{ COMPONENT CAS ~ % ~ AHM
:ne three mos~ n~oous 1 ) [ ]
C~emm~ com~eo~ OF
~y AHM com~nenls 2) [
CHEMICAL DESCRI~ION
i) JN~NTORY STA?GS: New ( J AddRion [ J ~ewsion ~elet~on ( ] Check ff cneml~ is a NON ~DE SECR~
2) CommonN~e: ~('mJ ( ~AS'~ 3) ~T, (optlon~)
Chem,c~ Name: AHM ( ] CAS ~
4) PHYSICAL & H~L~ PHYSICAL
H~O CA~GOR)ES F~re J ] ~ea~e ~Sudden Rele~e of Pressure { } !mmedi~e He~h (Ac~e) [ ] ~layed He~h (Chronic) j ]
5) WASTE C~SSIF'CATiON I i ~ (3~igK coa. from OHS Fo~ 8022) USE COO~ ~ ( .I
6) PHYSiCALSTA~ 3ot~d [ ] Liquid ~ g~ [ ] Pure j ] Minute ~. W~te [ ] Radioamme [ ]
7) AMOUNT ANO T;ME AT FAC~U~ JNITS OF M~SURE 8) STOOGE CODES
M~lmumCally Amoun[: ~ :bs ( i G~ A3 [ ] a} Con,s.er:
AveraGe ~aiy Amount; ~ cunes [ ] b) Pressure:
Annu~ Amount: c) Tem~r~ure:
~gest S~ze Contaner: ~ ~ . , i
· OaysCnSite ~ Ckcie~ichMonths:~~F. M, A. M. J. J. A. S, O. N. D
9) MITRE: Lst - COMPONENT CAS · % ~ AHM
cneml~ com~nen~ Or
ce~ bn~er pen~ or mw, ~a~ i ~hav~ pe~ona¢iy exami~ ~ ~ t~ui~ w~ ~e inromason suom~ on m¢s ~ ~1 a~cn~ ~ocumen~,
~~*ubmi~ info~a~on~ ?ts ~e.~~~~accu~te. and complete. ~' ~ ' ~' ~~~
~Rl~ Name & Ti~e oi A~or, zed Com~nyRepresenm~ve / ~ ~n~re ,. Da~
BAKER IIIELD EP/ TM
CITY FIRE D ENT
HAZARDOUS MATERIALS INVENTORY Page~f.~'-
3usinessName RED LION HOTEL : Address 3100 Camino Del Rio Court, Bakersfield CA
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New ( ] Addition [ ] Revision~J~....E~letion ( ] Check ifchemmeJ is a NON TRADE SECRET,~ TRADE SECRET [ ]
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire [ J Reactive [ ] Sudden Rele~e of Pressure { ] Immediate Hearth (Acute) [ ] D~layed Health (Chronic) [
5) WASTE CLASSIFICATION '~- Z-- / ,(3-digit code from DHS Form 8022) USE CODE Z ~-
6) PHYSICAL STATE Solid [ I Liquid ~ Ge~ { I Pure { ] MLx'ture ~ We, ste { ] Radioactive [ ]
7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES
Average Omly Amount: / ~ tunes { ] b) Pressure: /
Annu~ Amount: / ~.....~ c) Temperature' ZT'T
Larges! S~ze Container: ..~5
# Days O~Site ~ (O~- Circ:eWhich Months: ~ J. F. M. A. M. J. J. A. S. O. N.
9) ;AIXTUR~: '.~st COMPONENT CAS # % WT AHM
the three most hazardous 1 )
any AHM comoonen[s 2)
j
CHEMICAL DESCRIPTION
1) iNVENTORY STA~5: 5.1ew { ! Addition [ I Rev,sionJ~ Delet,on ( } Cheo< rf cnem,c~ is-a NON TRADE SECRET
-"
C.~em,cm Name: ' f-O edtV~ ~ ~D~_ AHMll CASt J//A
~) PHYSICAL & HF_hLTH PHYSICAt HEALTH
HAZARD CATEGORIES Fire { ] aeactWe ( ] Sudclen Release et P:essum ~ tmmediate HeaJth IAcute) { ] ~layed HeeJth (Chronic% ( ]
5) WASTE CLASSIF!CATiON ~- i Z--- (3~igit coae from OHS Form 8022) USE CODE O ?
6) PHYSICAL STATE 3olid ( } '~cluid ~X~ Gas [ ] Pure { i Minute ~ Waste ( ] Radioactive ( ]
7) AMOUNT AND TiME AT FACIUTY JNITS OF MEASURE 8) STORAGE CODES
Max,mum C,a,,¥ Amoun[: ~ 0 :~'s ..~ gaJ [ ] ~3 [ ] al Container:
Averac. e Cmiy Amount: ~ O cunes I ] b) Pressure: I ,I
Annum Amount: ~ (~ c) Temperature: c~ .I
La~ges~ 5~z.e Contmner: '. O
#DaysCnSite ~ Clrc,e Which Months: ~. F. M. A. M. J. J. A, S. O. N. D :'
- :h, ,,re, mos, ,as=oous , ~ 0__ h. o r c~ cl i 'g I ct ~ ~- t~ ~t eq- i,,a ,~ e ...... 7 5' -_-- ~ ,'~ ~ i ] · .
cnemlcaJ comoonents or : .
3) [ l
cer~rY Onoer pena/w, ci iaw. d~ar i nave pe/~ona,y examined and wn /~u~,ief w/rn ~e /n/oma~on suom/lTeo ot~ ~/s and cji arraclleo oocumenm.
~RINT Name & Title oi Au~orize(~ Comoany Reoresenmo've Date
BAKER IELD CITY FIRE DEP, TMENT
HAZARDOUS MATERIALS INVENTORY Page__~f~'
~usinessName RED LION HOTEL Address3100 Camino Del Rio Court, Bakersfield CA
CHEMICAL DESCRIPTION
1) INVE. NTORY STATUS: New { ] Addition [ ] Revision~letion [ ] Check if chemical is a NON TRADE SECRET ,~ TRADE SECRET [ ]
2) Common N~me: ~-~ ~O, ~J~ ~-~ I,~ ~' ~ (,'--- 3) DOT # (ommnaQ
' 4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire ~ Reactive~Sudden Relee~e of Pressure { ] Immediate Health (Acute) [ ] Delayed HeaJtb (Chronic) [ ]
5) WASTE CLASSIFICATION 5/3 (3-digit code from OHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid ~ Gas [ ] Pure { ] Mixture ,~ Waste [ ] R~u:lioactive
7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES "
U~,n, um m,iyAmount: O,:~ ~ ti gal ~ *~ [1 a~ Contorted: ! % ',
Average Dmly Amount: ~.~. ~ curies { I b) Pressure: / .,
:,nnum Amount: ~ c) Temperature:
Largest S,ze Container: ~ o ~
#Ca~OnSite ~:Z~(o~ C:rc:e~M'~ich Months:(AIIYeaf~. J. F. M. A. M. J. d. A. S. O. N.
&qy AldM comoonems 2) [ J
CHEMICAL DESCRIPTION
I) INVENTORY STATUS: New { ] Addition [ ] Rew$ion ~,~..Oeleuon ( ! Check ~ cnem,caJ is a NON TRADE SECRET
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire j ] Reactive ~ Sudden Release of Pressure [ J tmmediate Hea~th/Acute) ~ Delayed HeaJth (ChronicJ [ 1
6) PHYSiCAL STATE Solid J ) Licluid j~ G~ [ ] Pure J~, Minute [ J W~te J ] Radioa~e { ]
7) AMOUNT AND T;ME AT FACIUTY UNITS OF MF_.ASUFIE 8) STORAGE CODES J
Max,mum C, aay Amount: I 5 bs ( ] gal {~J.._ ft3 [ ] a) Contmner:
Average O~,iy Amount: ~' curies [ ] b) Pressure:
Annum Amount: ~' 0 c) Temperature:
Largest S~ze Container: J ~
# Days Cn Site ~5 Circle Which Months:(~lm ~e&r.,.¢.~ F. M. A. M. J. J. A. S. O. N. D
9) MIXTURE:. Lst CCMPONENT CAS # % WT AHM
- the three mos~ nazaxoous ~ )
cnem~caJ comoonemsor : .
a~y AHM components 2) [ ] 'i
3! [1 :-i
ceroC, Onoer pena~, cf law. ~'ai~l nave(person~ui¥ exa~mineo a~ am iarn,iar w~dl me inromeDon suDmerteO on rays a/lo ~1 an~cneO ~¢cumen~. i be¢~eve rn~
· ubmirfeo informazson ix 17ue, accurate, and corn
~R/~amo & Ti~e o/ Au'~oriz~o Comoany /RepresenmOve Signature Date
, BAKER IELD CITY FIRE DEP TMENT
HAZARDOUS MATERIALS INVENTORY Page~_of'~_~'
]usinessName ~D ~ZO~ ~O~ Address 3100 Oam~o De~ ~o Cou~L~ ~a~e~s~eZd
CHEMICAL DESCRI~ION
1) IN.TORY STA~S: New [ ] Add.on [ ] Re~n ~n { ] Check E ~em~ ~ a NON ~E
4) PHYSICAL & H~L~ PHYSICAL H~
H~RD CA~GORIES Fire [ ] Reac[Ne [ ] Sudden Relate of Pressure ~ Immedi~e He~h {Ac~e) [ ] ~yed
5) WAS~ C~SSIFICA~ON ~ ~ ,, (3-dig~ cede from OHS Fo~ 8022~ USE COOE ~ ~
6) PHYSICALSTA~ Solid [ ] Uquid ~ G~ [ ] Pure [ ] M~ure IN W~te [ ]
7) AMOUNT AND ~ME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES
M~,mumO~iyAmoun~: ~ ~ ( ] g~ ~ ~3 [ ] a) Cont~nec
Average O~N Amoun(: ~ ~/O tunes ( ~ b) Pressure:
~nnu~ Amount: ~~ c) Tem~r~ure:
~ges, S,ze Contmner: ._(
On Site ~ ~ C:rc:e ~ich Months: ~ J. F. M. A. M. J. J. A. S. O. N.
9) MITRE: Us[ COMPONENT CAS ~ % ~ AHM
CHEMICAL DESCRI~ION
i) IN~N~ORY STA~S: New [ ] Addition [ ] ~ev~sion ~ Deletmn [ .} Chec, ~ cnem~ is a NON ~DE SECR~
4) PHYSICAL & HE~L~ PHYSICAL H~L~
H~D CA~GCRiES Fire ~ Rea~ { ] Sudden Rele~eof Pressure ~ ~mmedi~e Herb {~e)
6) PHYSiCALSTA~ Solid [ ! U~uid ~ G~ { ] Pure [ ~ Minute ~ W~te [ ] Radioa~we { ]
7) AMOUNT ANO T;ME AT FACtM~ JNITS OF M~SURE 8) STOOGE CODES
M~,mum Ca.v Amount: 0-5 , 'bs ( ] g~ ~ '3 [ ] al Conlaner: , I 3
Average Cmiy Amount: ~,~ cunes I ] bi Pressure:
Annum Amount: ~ c) Tem~r~ure:
~gest Si:e Confiner: ~ ~
-
· Days Cn Site ~ /~ ~ C;~cte~ich Months: J.F.M.A.M.J.J.A.
9) MITRE:. ~st CCMPQNENT CAS.~ . %
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· ubmi~ info~on is ~e, ~ccu~e, and complete.
~RI~ Name & Ti¢e of A~onzed Company Re~resenm~ve
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DE
TMENT
"*' HAZARDOUS MATERIALS INVENTORY PageLCof__.
CHEMICAL DESCRIPTION
1) INVENTORY STATUS: New { ] Addition [ ] Revision J~..I)eletion { ] Check if chemlcaJ is., NON TRADE SECRET,¢[~ TRADE SECRET
ChemlcaJ Name: AHM [ ] CAS ¢
4) PHYSICAL & HEALTH PHYSICAL HEALTH
HAZARD CATEGORIES Fire ~ Reactive ( ] Sudaen Release of Pressure ~ Immediate HeeJ~h (Acute) [ J O~fayed He~fth (Chronic)
5) WASTE CLASSIFICATION (3-dig~, coae from OHS Form 8022) USE CODE
6) PHYSICAL STAT~ Solid [ j Uquid { ] Gu ~ Pure { ] M~'ture { ] W~te { ] R~udioective [
7) AMOUNT ANO TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE COOES
/
Average Oa~t¥ Amoun[: /O¢~ curies [ ] b) Pressure;
-~nnu~J Amount: ' ~ c) Tem~r~ure:
~gest S~2e Cont~ner: ~
~ ~avs On S~Ie '~ C:rc:eWhich Moqlns: F.M.A.M.d.d.A.S.C.N.
9) MITRE: %st COMPONENT CAS ~ % ~ AHM
f
~qy AHM com~nems 2}
CHEMICAL DESCRI~ION
i~ IN%~NTORY STATdS. New J ] Addfflon [ ] Rev,sion ~Delet~on ( ] Check ~ cnem,~ is a NON ~ADE SECR~
3hem~c~ Name: AHM [ ] CAS ~
4) PHYSICAL & HE~L~ PHYSICAL H~L~
d~D CA~GCR:ES Fire ~ ~ea~we j ] Sudden Relate of ~ressum J ] :mmedi~e He~h f~e) ~ ~layed He~h (Chronml
i
5) WASTE C~SSIFiCATiON f3~ig~ cooe from OHS Fo~ 8022) USE CODE J
6) PHYSICAL STA~ 3ohd [ ] LJ. uld ~ g~ [ ] Pure ~ Minute [ J W~te [ ] Radio~ctNe [ ]
M~lmum Cauy AmounI: ~O O bs ( ] ~m ~ a3 [ ] a) Conz~ner:
Average Caiy Amoun(: ~00 tunes ( ] b) Pressure:
Annu~ Amount: ~ 00 C~ Tem~r~ure:
~gesl S;:e Cont~ner: ~OO ~
· Oa~CnSite ~ ~ C:rcte~ichMonms: ~lYe~ F. M. A. M. J. J. A. S, O. N. O
9) MI~JRE~ Ls~ COMPONENT CAS · %
' the three-mos[ n~uoous 1~ [
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3)
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~Rl~ Name & T/fie c/A~nortzeO Company ReDresenm¢ve