HomeMy WebLinkAboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This hermit is issued for the following:
[] Hazardous Materials Plan
[] Underground Storage of Hazardous Materials
El Risk Management Program
[3 Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002121
CALIFORNIA WATER ..
IX)CATION: CHERRY BLOS,'
.~; ~,~, CA 93313
OFFICE OF ENVIRONMENTAL SERVICES'
1715 Chester Ave., 3rd Floor Approved by:
Bakersfield,
CA
93301
Voice (661) 326-3979
FAX (661) 326-0576 Expiration Date: June aO, 2003
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
This ~ermit is issued for the following:
[] Hazardous Materials Plan
[] UndergrOund Storage of HazardOus Materials
[] Risk Management Program
[] Hazardous Waste On-Site Treatment
PERMIT ID # 015-021-002121
CALIFORNIA WATER
LOCATION
Issued by: Bakersfield Fire Department ' '" ::: -. , ' ' - "
OFFICE OF ENVIRONMENTAL SERVICES: .... - " ~ " NOV" 1 2000
1715 Chester Ave., 3rd Floor Approved by: ~O'~~~
"C ~p~'"~'~. r~~.~ ~ssu~ ~t~
Bakersfield, CA 93301 Offic¢ofEvironma~ilScrvices -
Voice (661) 326-3979
F~x (660 326-0s76 Exp~ationDate: 'June 30.. 21303
Business Name: ~_~:~o..~',~. '~_~..-~.,..,,~,_,_
Business Address: c6,, -=,+-,,,. 3-~ <.~,.,..-/ ~to~.,o...,
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ITE DIAGRAM ~ FA IAGRAM ! ~ !
Business Address:c~,s,,--s~-~ :{--, c_~.,.-..-.-./ ~to,.~o,,,,-,, ~'/o
.t. J I,I ,'[ WOOl)Mi:NJ' ,'J MJJ t)
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CALIFORNIA WATER S CBKSTA37 SiteID: 015-021-002121
Manager : ,,ME-LViN BYRD BusPhone: (661)
Location: CHERRY BLOSSOM ST Map : 123 CommHaz : Minimal
City : BAKERSFIELD Grid: 22D FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 13 0~ ~ %%~% SIC Code:4941
EPA Numb: DunnBrad: 00 - 691 - 3578
+_- _-_-+
Emergency Contact / Title Emergency Contact / Title
MEL .... BYRD / nTqT~ICT MA~T~-E TiM TRELOAR? . / C,w.~ .SUPER
,
Business Phone: (661) 396-2400x Bushiness Phone: (661) 396-2400x
24-Hour Phone : (661) 396-2400x _/~-Hour Phone : (661) 396-2400x
Pager Phone : ( ) - x~ Pager Phone : ( ) - x
............ ........................
I MailAddr: ~-- ~tat.~: CA
City : ~ Zip : 95!08~-
Address : 1720 N FIRST ST State: CA
City : S~ JOSE Zip : 95112
Period : to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif ' d: - - ~~Y_e_~
ParcelNo:
................................................. D~s~ic~ ~a~-Tfm Trelo= ....
Emergency Directives: AssL D[s~[c~ ~aE~-B[H Ha~er
Con~ac~ Person-Tampa Jonson
CONTACT PERSON ~ IIEDRICK 832-2141.
Mail~g Ad~s ~ge:
3725 Sou~ "H" S~t
Bakersfield, CA 93304
reviewed the a~ached h~ardous materials mana~-
for~ ~~ and ~hm ~ do~ with
ment
plan
any ~ions constitute a ~mpls~e and ~rr~ mare
agement plan ~r my faulty.
+
1 07/30/2003
CITY OF BAKERSFIEL
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
HAZARDOUS MATERIALS MANAGEMENT PLAN ·
INSTRUCTIONS: ] 9}~~'- I
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 Chemical Description Form(s)
to the front of this plan instead of completing SECTION I. below for initial submission.
SECTION I: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: (._~.(.t..,.-,~',~. ~,j~_4-a~' <o~,--,,~-~ co.
LOCATION: c_~r._ ~.~e.. % '7 c..t~.~--.-7
MAILING ADDRESS: 3'n2.~ $o. d- ~+.
CITY: ~..~,-~[,~-~a STATE: c.~. ZIP: q'~'~oq- PHONE:
PRIMARY ACTIVITY: "Q,.,,-,~,.fo¢ ol- elo,,..,~.,,l-,e.._
OWNER: ~,e,-,,*_ PHONE:
MAILING ADDRESS: *~.~ ~
EMERGENCY NOTIFICATION
CONTACT TITLE BUS. PHONE 24 HR. PHONE
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION II. 1: DISCOVERY AND NOTIFICATIONS
A. LEAK DETECTION AND MONITORING PROCEDURES:
· ~;,..r,,. (~.,_', I;b7 ;:, ,,,,o,~(ko,.-J Ad.I,./ ~ ~'°'"'O;~"l ""~e~°'-/,.,_s.
B. EMPLOYEE AND AGENCY NOTIFICATION:
'zq-
C. ENVIRONMENTAL RESPONSE MANAGEMENT:
2
H~ARDOUS MATERIALS MANAG~ENT PLAN
SECTION II.2: RELEASE RESPONSE PLAN
A. HAZARD ASSESSMENT AND PREVENTION MEASURES:
B. RELEASE CONTAINMENT AND/OR MITIGATION:
C. CLEAN-UP AND RECOVERY PROCEDURES:
UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATURAL GAS/PROPANE:
ELECTRICAL: $~_.-.~,~,_ ~,.:.-~
WATER: ~/~,
SPECIAL: ~/~
LOCK BOX: YES~ IF YES, LOCATION:
PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION: ----
B. WATER AVAILABILITY (FIRE HYDRANT): gq~'*- -k.~,t~-o.~4 ,,~ ~,.-~l-
3
HAZ OUS MATERIALS MANAGEMENT PLAN
SECTION III: TRAINING
NUMBER OF EMPLOYEES:
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
CERTIFICATION
I, 23--._ t- ~- ~ ~.- L ~.~, CERTIFY THAT THE ABOVE INFORMATION
is ^CC~TE. I tm~ERSTAND THAT ThiS ~O~TIO~ ~ ~E VSE~ TO
FULFILL MY rI~'S OBLIGATIONS ~ER THE "CALIFO~IA HEALTH AND SAFETY
CODE" ON H~A~OUS MATERIALS ~IV. 20 C~APTE~ 6.95 SEC. 25500 ET AL.) AND
T~T INACC~TE ~O~TION CONSTI~TES PE~RY.
SIONA~E TI~LB DATE
4
~~ ~I~'ICE OF ENVIRONMENTAI~I~jERVICES
~r~l~rl FIR~ W 1715 Chester Ave., CA 93301 (6t 326-3979
-.,--,~:a~~..~ ~.,.- BUSINESS OWNER / OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page Of
'. :' ' ~ ../.' ~!~ I. FAClLITYIDENTIFICATION
...................... ~_L_I_[~_I.__A_~_'
BUSINESS NAME (Same as FACILITY NAME or DBA---Doing ................................................................ Business As) :~ ..... ~)0S'I~IESS'PH~)fiE ............... ,02
.................... _c.~, Lo. ~;_~ u~ ~ ,.~ 5 t~, ,~ co. [._(~.~..~.]._~._~..~__~.~_~_.~ .........................
SITE ADDRESS
c~ ~. ~ ¢, ~, ~ '~ I CA ziP ,05
DUN & ~06 SIC CODE
B~DSTREET ~O- ~ I - ~5~ ~ (4Digit~) ~
COUN~ I~ ~¢ ~ ~08
OPE~TORNAME ~L~¢~ ~$~ ~e¢~ ~O · 109 OPE~TORPHONE {~$~tWt ~o
. :.':~;: ~ :'II?OWN~E~ .~:..:~.. ,~. ...:...
ADDRESS ~5 S ~. ~ ~ ~. 113
'
:.," ' '~ '~':,"~r~ ~:~';"~'~, ~;~'~, ~.~u;~'~' ~,~..~x.~.~:III.~N~IRONMEN~fiE,~CONTAC~%~. ~ ,...~.: ......... ~,,. ~ · . .
CONTACT
NAME
/
117 CONTACT PHONE -
CONTACT MAILING 119
ADDRESS
CITY ~ l~l ZIP ~ 122
NAME ~.~ ~e~ 123 NAME ~
130
TITLE ~,;~;~ ~~ 125 TITLE ~',~ ~;~;~ ~~ ..................
BUSINESS PHONE (~1~ 3~OO ,26 BUSINESS PHONE (~ S~Zi~L .................... . .'3'..ii
132 m
24-HOUR PHONE S ~ lz7 24-HOUR PHONE ) ~ ~
133
PAGER ~ ~ 1~8 PAGER 4
Codification: 8a~od on my inqul~ of thoso indivldual~ ro~ponsiblo for obtainin~ tho In~ormation, I ~dl~ undor ponal~ o[ law ~at I havo porsonall~ oxamined
and am familiar w~th tho info~ation ,ubmittod In this Invonto~ and b~liovo tho Information is truo, accurato, and ~mploto.
_~.(,C~-~:~ ~ L~. s,.~,~ ~ ~L.~.___,~_~~._~.~ _~, ..............................
UPCF (7~99) S:\CUPAFORMS\OES2730.TV4.wpd
s., o OFFICE OF ENVIRONMENTAL-SERVICES
1715 Chester Ave., CA 93301 (661) 326-3979
"~'~"~' H~RDOUS MATERIALS INVENTORY
CHEMICAL DESCRIPTION
(one ~ per material ~r budding or ama)
~ Page
~NEW ~ ADD ~ DELETE ~ REVISE
~ ~ ? ',', ~ ?~ · ~: .',:~'e ~ '~'~ ,:~:~ .": , '; :. :'~':~:: ' ~'~:-' ~'~, ~:"~"~:~ ~:~'::~' ~ *'::~ '~,: ~:" ~'= ,~ ~::~?;:'', :~:~ ,:*"*~'.".~' ': ~. ** ':: .:'.; ':.,
3
BUSINESS ~ME (S~e as FACILI~ ~ME ~ O~ - ~ng Busin~ ~)
201[ CHEMICAL LO~TION n.
CttEMICAL LO~TION · [ ~NFIDENTIAL (EPC~) u Y~
O~ ~t~ .................................................... ~o4"':
205 T~DE SECRET ~ Y~ ~ No 2~
CHEMICAL ~ME . * If Subj~ to EPC~. refer to inslm~i~s
207
COM~N ~ME ' , EHS' ~ Y~ ~ No 208
~IRE CODE ~RD C~SSES (~plete If ~t~ by 1~ f~ ~t~ 210
~PE ~ p PURE ~ m MITRE ~ w WASTE 211 ~DIOACTIVE ~ Y~ ~ No 212 ~ CURIES~ 213
~RGEST CO~AINER 215
PHYSICAL STATE ~ S SOLID ~1 LIQUID ~ g ~S 214 ~ ~ t .
FED H~RD ~TE~RtES ~ 1 FIRE ~ 2 R~CT~ ~ 3 PRESSURE RELISH ~ 4 ACU~ H~L~ ~ 5 CHRONIC H~LTH 2~6
(Ch~ all that apply)
ANNUAL WASTE.,._ 217 I ~I~M O~ ~O 218 I A~GE ~ . 219 i STATE WASTE ~OE 220
UN~S' ~ ga ~L ~ d CU ~ ~ I~ Las ~ tn TONS 221 [ DAYS ON SITE ' 222
' E EHS, ~nt must ~ In I~. ~
STOOGE CONTAINER ~ a A~VEGROUND TANK ~ e P~STI~NM~ALLIC DRUM ~ t FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223
(Check all that app,)
~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC BO~LE ~ t OTHER
~ c T~K INSIDE BUI~ING ~ g CA~Y ~ k BOX ~ o TOTE SiN
~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WAGON
STOOGE PRESSURE ~ a A~IE~ ~ ~ ABOVEAMBIE~ Dba BELOW A~IENT 224
STOOGE TEMPE~TURE ~ a A~IE~ ~ aa A~VEA~IE~ ~ ba 8ELOWA~IENT ~ c CRYOGENIC 225
229
230 231 D V. D ~ 232
~8 239 ~ Y~ ~ No 240 241
5 242 243 ~ Y~ ~ No 244 245
: ..~ ........... ~,~;~..~,~ ~i ~,': ~ ,: ......... ~C;~:~~rI!!~SI~NA~RE.. ~, ~:, ,-:; ,~;:,,~;~:~. ~::~.:. ~.~ :,. ,....
(~RI~TNAME'&TITLEOFAUTHOR~EOCOMPA~REPRE~ATIVE SlG~TU~ ~ ~~ OAI~ 246
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