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HomeMy WebLinkAboutBUSINESS PLAN CALIFORNIA iERVICE COMPANY BAKERSFIELD D~ 3725 SOUTH H STREET · BAKERSFIELD, CA 93304-6538 ° (661)396-2400 May28,2003 Bakersfield Fire Department Environmental Services 1715 Chester Avenue Bakersfield, CA 93301 To Whom It May Concern, Attached you will find Hazardous Materials Management Plans for 5 water utility facilities. We have revised our chemical inventory for our field operations center and added four new facilities. If you have any questions regarding any of these plans, please feel l~ee to call me at 661-832-3765 Ext. 1049. Thank you, Tamara Johnson Maintenance Supervisor California Water Service Company-Bakersfield DISTRICT OFFICES: ANTELOPE VALLEY · BAKERSFIELD · BEAR GULCH · CHICO · DIXON · DOMINGUEZ · EAST LOS ANGELES · HERMOSA-REDONDO · KERN RIVER VALLEY · KING CI~' · LIVERMORE · LOS ALTOS SUBURBAN · MARYSVILLE · MID-PENINSULA · OROVILLE · PALOS VERDES · REDWOOD VALLEY · SALINAS · SELMA · SOUTH SAN FRANCISCO · STOCKTON · VISALIA · WESTLAKE · WILLOWS , ~ Bakersfield Fire Dept. HAZARDOUS MATERIALS MANAGEMENT PLAN-FORMS ~~D Environmental Services ~ (, / ~*R~ ] ,) 1715 Chester Ave Section Discovery and Notification ~?/~,.~,qr Bakersfield, CA 93301 Page 1 of 2 ~ Tel: (661)326-3979 ' INSTRUCTIONS 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINTANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. " SECTION I: FACILITY IDENTIFICATION BUSINESS NAME (S_ .....I ,-I,-- FACILITY NAME or DBA - Doing Busi .... As) ( OOO I PLOYEE AND AGENCY NOTIFICATION: C.~M~TAL RESPONSE MANAGEMENT: D. EME~EDICAL P~N: SECTION 11.2: RELEASE RESPONSE P~N A. H~RD ASSESMENT AND PREVENTION MEASURES: B. RELEASE~AINMENT AND/OR MITIGATION: C. CLEAN-UP ~VERY PROCEDURES: ~2085 :" ' Pagb :~ of 2 SECTION 11.2: RELEASE RESPONSE PLAN~ON'T. UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATU~' GAS,PROPANE LOCK ~OX: ~ YES ~NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY B. WATER AVAI~BILITY (FIRE HYDRANT): SECTION II1: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: Gq ~'~ci~40C-f'l'C.~ BRIEF SUMMARY OF TRAINING CERTIFICATION Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personnaly examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER / OPERATOR OR DESIGNATED REPRESENTATIVE I DATE 477 NAME OF SIGNER (print) 478 TITLE OF SIGNER 479 HAZARDOUS MATERIAL INFORMATION ~nvironmental Services ~~~~ 1715 Chester Ave Page 1 of Bakersfield, CA 93301 Tel: (661)326-3979 I. FACILITY IDENTIFICATION '. Year Beginning 1{0 Year Ending 101 BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 1~2 SITE ADDRESS CiTY DUN & BRADSTREET ~b [ SIC CODE COUNTY 108 OPERATOR NAME ~ I~9 OPERATOR PHONE 110 II. OWNER INFORMATION OWNER NAME 111 OWNER PHONE 112 OWNER MAILING AOORESS Ill. ENVIRONMENTAL CONTACT CONTACT~NAME~_~ i-~ ~---~[ O (~O ~7 CONTACT PHONE CONTACT MAILING ADDRESS 119 CiTY 120 STATE 121 I ZIP 1;~ I -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 ~NAME 129 TITLE 125 JTITLE ~ 130 BUSINESS PHONE 126 I BUSINESS PHONE / ~'~ 131 u, Lot- .--sqb- 2qoo I Obi- ',5_52- ~'4-HOUR PHONE 127 24-HOUR PHONE 132 PAGER No 128 PAGER No 133 V. CERTIFICATION Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penaify of law that I have personalty examined and am familiar with the information submitted in this inventory and believe the infon'nation is t~ue, accurate, and complete. ~~)PERATOF((~rint) t36 TITLE OF OWNER/OPERATOR , 137 fd2090 ~:' ~~ ~ Bakersfield Fire Dept. ' HAZARDOUS MATE NVENTORY Environmental Services CHEMICAL DESCRIPTION 1715 Chester Ave Bakersfield, CA 93301 Tel: {661)326-3979 (one form per material per building or ama) [] NEW [] ADD [] DELETE I~1 REVISE 200 Page1 of B~SI~ESS ~A~E (~me as FACI[IW ~ME ~ DBA - ~in9 Busings As) 3 CHEMiC~ L~ATION 201 CHEMIC~ L~AIION ~2 CHEMIC~ ~E 205 ~DE SECRET ~ Y~ ~ No 206 COMMON ~ME . , 207 CA 209 FIRE COOE ~aO C~E8 (~ote if r~u~ by I~1 tim ~ief) 2~0 2111 212 CURIES 213 ~PE ~ p PURE ~ m MI~U~ ~ w WASTE ~OlOACTI~ ~ Yes ~ No 214 ~RGEST CONTAINER 215 PHYSIC~ STATE ~ s SOLID ~ I LIQUID ~ g ~S 216 FED H~RD CAIEGORIES ~ 1 FIRE ~ 2 E~CIIVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~IH ~ 5 CHRONIC H~LIH (Ch~k al~ that 21~ AEgGE 219 8TAIEWASTE 2~ ANNUAL WASIE 217 ~MUM 4, oo UNITS' ffi ga ~L ~ ~ CU ~ ~ lb LBS ~ tn TONS 'If EHS, am~nt must ~ in I~. ~'~ ~3 STOOGE CONTNNER ~ a A~VEGROUND T~K ~ f C~ ~ k ~X ~ p TANK WAGON (C~k afl ~at ap~y) ~ b UNDERGROUND T~K ~ g CAR~Y ~ I CYLINDER ~ q ~IL CAR ~ c TANK INSIDE BUILDING ~ h SILO ~ m G~ ~E ~ r OTHER ~ d STEEL DRUM ~ i FIBER DRUM ~ n P~STIC BO~E ~ e P~STIC/NONM~LIC DRUM ~ j BAG ~ o TO~ BIN ~4 STOOGE PRE~URE ~ a AMBIENT ~ aa A~ AMBIENT ~ ba BELOW AMBIENT / 225 SIO~6E IEMPE~IURE ~ a ~BIENI ~ aa A~E AMBIE~ ~ ~ BELOW AMBIENI ~ c CRYOGENIC / 2 230 23~ ~ Yes ~ No 232 233 3 2~ 235 ~ Y~ ~ No 2~ 237 4 238 239 ~ Yes ~ No 240 24~ S 242 243 ~ Yss ~ No 2~ 24S ., ,, :., ,.. :,..%.:: ' HAZARDOUS MAT INVENTORY Environmental Services CHEMICAL DESCRIPTION 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 (one form per material per building or area) [] NEW [] ADD [] DELETE ~1~ REVISE 200 Page1 of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CHEMICAL LO~ATION ~f CHEMICAL LOCATION O~ ¢~ CONF,DENT,AL~EPC~,, ~ Yea ~ No ~ II. CHEMICAL INFORMATION CHEMICAL NAME . 205 TRADE SECRET ~ Yes ~ No 206 ~ %~ r ~L ~ ~ ~ [~ ~ ~.~ [ ~ ~ ~'~) [f Subject to EPCRA, refer to inst~ctions COMMON~ NAME 207 ~ EHS* ~ Yes ~ No CAS No. 209 *If EHS is~Yes," all amounts ~low must be FIRE CODE H~RD C~SSES (Complete if requested by Io~1 fire chief) 210 211 212 CU~ 213 TYPE ~ p PURE ~ m Mi~URE ~ w WASTE ~DIOACTIVE ~ Yes ~ No 214 ~RGEST CONTAINER 215 PHYSICAL STATE s SOLID-- ~ I LIQUID ~ g GAS 200 216 FED H~RD CATEGORIES i (Check all that apply) ~] I FIRE ~ 2 REACTIVE [] 3 PRESSURE RELEASE ~ 4 ACUTE HEALTH 5 CHRONIC H~LTH ANNUAL WASTE 217 MAXIMUM 218 ~ AVERAGE 219 STATE WASTE 220 AMOUNT ~/a s' oo .OO ' 221 DAYS ON SITE 222 UNITS' ~ ga GAL ~ cf CU FT ~ lb LBS ~ tn TONS 223 STORAGE CONTAINER ~ a ABOVEGROUND TANK ~ f CAN ~ k BOX ~ p TANK WAGON (Check all that apply) ~ b UNDERGROUND TANK ~ g CARBOY ~1 CYLINDER ~ q ~ILCAR ~ c TANK INSIDE BUILDING ~ h SILO ~ m G~SS BOTTLE ~ r OTHER ~ d STEEL DRUM ~ i FIBER DRUM ~ n P~STIC BO~LE ~ e P~STIC/NONMETALLIC DRUM ~ j BAG ~ o TOTE BIN 224 STORAGE PRESSURE ~ a AMBIENT ~ aa ABOVE AMBIENT ~ ba BELOW AMBIENT 225 STORAGE TEMPERATURE ~ a AMBIENT ~ aa ABOVE AMBIENT ~ ba BELOW AMBIENT ~ c CRYOGENIC %~ H~RDOUS COMPONENT EHS CAS ~ ~ 226 ~[Lt'~ ~0~ 0~(O~ 227 ~Yes ~No 228 OO~~q 229 230 231 ~ Yes ~ No 232 233 3 234 235 ~ Y~ ~ No 236 237 4 238 239 ~ Yes ~ No 240 241 5 242 243 ~ Yes ~ No 244 245 Ill. 81GNATURE " OUS MATE NVENTORY l~n~rironmental Se~'~ices DESC Rii - i N = ..... 1715 Chester Ave B~ersfield, CA 93301 Tel: (661)326-3979 (one fo~ ~r matedal ~r building or ama) ~ N~ ~ ADD ~ DELETE ~ REVISE 200 Page1 of BUSINESS ~ME (~me as FACILI~ ~ME ~ DBA - Ooing Busin~ ~) 3 CHEMIC~ L~ATION. ~1 CHEMIC~ L~ATION 202 CHE~C~ ~E ~5 ~DE SECRET ~ Y~ ~ ~ 206 COMMON NAME 207 208 CAS NO.~ 209 *If EHS is'Y~," all a~un~ ~1~ m~ ~ FIRE CODE ~RO CBB~S (C~ple[~ ~ r~u~a ~ I~1 fi~ ~J~) 210 211 212 CURIES 213 ~PE ~ p PURE ~ m MIXTURE ~ w WASTE ~DIOACTIVE ~ Yes ~ No 2141~RGE~ CO~AINER 215 d 216 FED ~RD CATE~RIES ~ 1 FIRE ~ 2 R~IVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~LTH ~ 5 CHRONIC H~ (Ch~ all ~at apply) 218 A~GE 219 STATEWAS~ 220 ANNU~ WASTE 217 ~IMUM u.~s' ~ ~ ~ ~ ~ cu a ~ ~ ~ss D tn ~O.S If EHS, am~m ~ust ~ in I~. ~3 STOOGE CONTNNER ~ a A~VEGROUN~ T~K ~ f C~ ~ k 8OX ~ p TA~K WAGO~ (Check afl ~at app~ ~ b ~N~E~GROUND T~K ~ g ~Y ~ I CYLIN~E~ ~ q BIL CA~ ~ c TANKINSIDE BUILDIN6 ~ h SILO ~ m GB~ ~E ~ r OTHE~ ~ d STEEL D~UM ~ i FIBEE D~UM ~ n PBSTIC BO~E ~ e PBSTIClNONM~[LIC DRUM ~ j BAG ~ o TOTE BIN ~4 STOBGE PRE~URE ~ a A~BIE~T ~ aa A~ A~BIE~T ~ ~ BELOW A~BIE~ 225 STOOGE TEMPE~EE ~ a ~BIENT ~ aa A~ A~BIE~T ~ ba BELOW AMBIE~ ~ c CRY~ENIC 2 2~ 231 ~ Yes ~ No 232 233 4 2~ 239 ~ Y~ ~ No 2~ 241 5 242 243 ~ Y~ ~ No 2~ 245 PRINTN~E&TI~EOFAUTHORI~DCOMP~YRE~ESENTATIVE: ;. ,1<~ .- . :' . , .,. ' .'- . ,].(./ i.; :.~,,; SIGNORE DA~ ~ 246 ~ Bakersfield Fire Dept. ' ' GEMENT PLAN Environmental Services ~IT-~ F~~ ~~-~ 1715 Chester Ave Bakersfield, CA 93301 Pg 1 ofl Tek (661)326-3979 SITE DIAGRAM *~' DIAGRAM .~: FACILITY BusinessName: ~(~/~(~r~i~ L~~ ~'~i~ &, &+OL IZ~-Ot Business Address: ~Z,~ 5, "~" I .~, ~-~. 0~ ._~ ~11 ~,vc / i 77~- ",," c~ - ~.~ NO~TH ~i- ~0, ~ ~~ .~ M~~easeindi~tedirectionofNoRh~~v~ ~.' CITY OF BAKERSFIELD ~,, ..~.. . o,mcz o~ ~mo~~~s~v~c~s ,~ ~Rr 1715 Chester Ave., Bakemfiel~ CA (661) 326-3979 RA 7~OUS ~TE~LS ~AGE~NTPL~ ~ ~ST~UCTIONS: ~. To avoid ~er action, m~ ~s to~ wi~ 30 ~ys otmc~ipt. ~ [i ) 2. T~~ ~S~RS~ E~GLtSE. 3. ~swer ~e quesfio~ below for ~e b~ess ~ a whole. ~ & 0 b [ 4. Be ~ bHef ~dconcise ~ possible. .. 5. You may MsO ~ch Bm~s O~er / ~tor Fo~ ~d ~e~c~ Des~pfion Fo~(s). to ~e.~ont of ~s pl~ mtead of comple~g SE~O~I. below ~r ~6M ~bmi~i~ SEC~ON ~: BUS--SS ~E~iCATION DATA ~CTION ri. ~: DISCOVERY AND NoTIFrCATIONS :' .... ': :':'::' A. LEAK DETECTION AND. M@NIT©R-I~G ?ROCED.URES,: · C//'zc, c//VZ'/_c_.c T',2,e£z2 //v' ~. ~Pr.O~ A~ ~ctF_~c¥ :N, oT'Z~CA,n:O~: · /'7¥/.,r'/.f ,4,v' Z,'A//U',,C//Z/£,O ,.¢/?£. D. EMERGENCY IVIEDICAL PLAN:" /¢/z,Z2/~4~ A~3'/.f~-A/vL'~ a/~uz~ L¢£ ,~4~b'/D~D /¢? IVZ4C~r't/~J'IYT,¢Z- -' 2 " 'HAZARDOUS/~L~TER/AL$ ~L~NAGEMJ~NT PLAN SECT[ON [I.2: ~LEASE ~SPONS~ PL~ A. H~~ ASSESS~ ~ P~~ON ~AS~S:. B. RELEASE CONTAE'¢MENT AND/OR MITIGA~0N: Z/~ o'/,o ' t"///e~£/,'v'~- £[CrgA//.2,4,¢ ? fsA/7',4//u',e/[,4/T c. CLEm~-U~ ~ ~COV~R¥ tmOCEZ~UR~s: ( UTILWY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FAC]iLITY) SPECIAL: LOCK BOX: YES{~ IF YES, LOC:ATION: PR2MATE FIRE PROTECTION/WATER AVAII.ABILITY A. PRFVATE FIRE PROTECrION: F/,'£F" E,,t'F/,,~'b/~/~'//~,~-:ox,/X'/7'~- B. WATER AVAILABII.fTY (FIRE HYDRANT): H.,4~AR~OU$ bq-ATERIALs ~,'IANAG'EM~ENT PLAN .-. SE~ION [II: T~~G B~F S~Y OF T~~G PROG~: ~?T~ VIZ/T~ A~E ~4o~ ~AIL~ ~Y CERTIFICATION IS ACC~TE. I ~~ST~ ~T ~S ~O~ON ~L'BE US~ TO HA.Z MAT ~G;k,R'4T PLAN .~' INS'TRUC 4 - '"~, '"'*~,~ ~..~ .~~P~ ~. CITY OF BA~EESFIELDsERViCES ~ OFFICE. OF E~O~NT~ ....... - FACi'LI~ }NFORMATION Business At,viBes ~age I. FACtLI~ IDENTIFICATION ' ~I. ACTIVITIES ~ Does. Your Facili~... If Yes, please ComPlete... ~ A. HA~RDOUS MATERIALS ~$ES ONO 4 ¢ OE.S FORM 27al (~ ~ 1. Have on Site (~r'any pu~Ose) h~<ous' mate~ats at or ¢' CONSOLIDA~ COMPUANCE P~N above 55 gallons-~( Muid$;. 500 pounds for solids, or 200 Minimum r<ui~' ptanninq etemen~ cuff for compr~s~ gas~ (include liquids in ASTs and · Eme~en~ R~ponse'Pl~ USTs)? · Maps 2. Have any amount Dean explosive mate~al (o~er ~an OYES ~NO s · T~ining ammuni~on) on site? · Preven~on · C~fions / B. REGULA~D SUBSTANCES (RS) OYES ~NO 8 ¢ DES FORM 2731 (~i~ e~pa~ Have onSite RS atgr~ter ~an ~e ~reshold planning ¢ RISK ~GEMENT P~N (aMP ~bmit ta quan~es es~tish~ by ~e Call,mia Acciden~l ¢ C'ONSOUDA~D COMPLIANCE Release P~venflen,.p~g~m (Ca~RP)? · In~om~ng Ca~RP program C. · UNDERGROUND STOOGE TANKS (USTs) OYES ~O 7 ¢ UST FA,CIU~ FORM i¢ .UST T~NK FORM'(~e:~t~) ~. Own or operate Unde~mund'Stomge Tanks? ~ . ( Intend 'to upgrade ~isdng or instil new USTs? OYES ~N0 a ~, US~ FAC1M~ FORM ' ¢ UST TANK FORM ¢ UST INSTA~TION FORM (~e p~ ~) D. TANK CLOSURE / REMOVAL OYES ~O . 9 ¢ UST TANK'FORM (d~um s~e ~ 1. Ne~ ~o repo~ closing, a, UST ~at h~ h~ous rear.als or ~ste? 2. ' N~ to repo~ ~e ctosur~ removal of a ~nk ~at was OYES ~No ~0 ' ¢ TANK. CLQ~RE FORM' classifi~ as ha~rdous waste and ~ean~ onsite? . E. ABOVE GROUND P~O'LEUM STOOGE TANKS (ASTs) OYES ~NO ~ ¢ CONSO~DATED, COMPMANCE P~N Own or operate ASTs above ~ese ~r~holds: any ~nk · In~om~ng F~eaI Spill Prevention ca~aci~ is greater ~an 660 gallons or ~e to~l ~paci~ Con~l and Counte~easure (SPCC) for ~e ~cili~ is greater ~an 1,320'gallons. EJ~en~ pu~uant to ~ CFR Pa~ 112 F. HA~RDOUS WAS~: ¢ EPA ID number~mvide on ~is page 1. Generate h~ous ~ste? OYES ~O ~2 To ob~in EPA ID¢, please phone(916) 32~1781 2. Recycle more ~an'100 kg/mo of' mcyctable materials at OYES ~NO ~3 ¢ - RECYCLING FORM · e same [o~fion it was generate? . ~,' 3. Recycle more ~an 100 kemp 0f r~clable materials at '.~ OYES RECYCLING FORM an o~ite Io~on different ~m ~e point of g~e~don? ' 4. Treat H~ardous Waste on site? OYES ~5 '? TP FACILI~ FORM (DTSC Fo~ 1~2) ¢ ~'UNIT FORM (one per unit) 5. Su~ect to ~nandal Assurance r~uirements? OYeS ~NO m ~ CERTIFiCATiON OF FiNANCiAL ASSU~NCE 6. Consolidate H~rdous Waste genemt~ at a remote OYES ~0 ~7 ¢ , REMO~ WASTE Z CONSQLID~-TION SI~ site? NQ~FtCATiON FORM G. PERMIT CONSOLJDA~ON ZONE: ' OYES O m ¢ CONSOLIDA~D COMPLIANCE P~N Intend [o consolidate o~e¢ Ca,EPA agency pe~i~? ~ ~ Inco~omdng. all o~er envimnmen~ (If yes, please complete Secdon III and a~ch) , pe~it r~uiremen~ per 27 CCR '10410 ]TE: / If you ch~k~ YES to any pa~ of Sec~0ns tlA-IIG above, ~e~ in addi[on to the fo~s r~u~t~ .above, please Submit DES Fo~ 2730. UPC~' fT/ggt S:'~CU PAFO RMS~,CTqVITY.w~ d OFFICE OF E~NVIRONM~NT3~ SERVICES' i' - 1715 'Chester Ave., B~kersfield, CA 9330'1 (661) 326-3979 FACILITy INFORMATION Business Activities Addendum Page ~ of t . I. FACILITY IDENTIFICATION ' ~ FACILJT~ Iii # (For o~ca use only - please leave Jsianl() 1 EPA ID ~ 2 ' DBA/FACILITY NAMIE III. CONSOLIDATED PERMIT ACTIVITIES Is your Fa_,cility Compliance-Plan subject to review by... for satisfying, the co_ndifions ofthese permits? H. DEPARTMENrrOFT(DXIOSUBSTANCESCONTROL OYES (~O ' ~ 'STANDARDI~F~ER'MI'T,,, ,~. -- · 'All' Modifii~tions,,, OYES (~O ~" Non-RCRA. HAZARDOUS:WASTE FACIUTY OYES (~O I' v~ RCRA HAZARDOUS WASTE FACILITY t. SAN JOAQU.IN VALLEY UNIFIED-AIR' POLLUTION OYES (~NO' ¢ AUTHORITY TO CONSTRUCT . CONTROL DISTRICT OYES (~O ~' PERMIT.TO OPERA,-TE ' · ' J. sTATE WATER RESOURCES CONTROL BOARD OYES (~1~10 ' ~' WASTE DISCHARGE REQUIREMENT :NTRAL VALLEY REGIONAL WATER QUALITY CONTROL OYES (~40 ¢' GENERAL PERMITS ~ARD : OYES (~¢NO v' SPECIFIC PERMITS OYES (~O v' NATIONAL POLLUTION DISCHARGE E[JMINATION sYSTEM (NPDES)' K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD OYES (~NO v~ REGISTP,,ATION PERMIT L KERN COUNTY RESOURCE MANAGEMENT AGENCY i ENVIRONMENA'AL HEALTH SERVICES PERMITS !(~ES ONO v' :Dom'esticWate?Well Permit iOYES (~O v' Haz Mat'Monit°dng. Well Permit iOYES (~NO ¢' Septic System Permit iOYES (~O ¢' Public Swimming Pool Permit 'OYES (~¢'NO v' Food Facility Construction Permit 'OYES (~O V' Solid Waste Local 'Enforcement Agency i i~ (LEA) Related, Pem~its i O.-YES (~O v' Medical Waste R~tated Permits M. CITY OF BAKERSFIELD WASTE WATER DIVISION i OYES ~'/~O v' , INDU;STRIAL WA.'STE WATER DISCHARGE i PERMIT _ NOTE: v' If you checked YES to' any part of sections I II-H'to III-M above, then please address all applicable permit.requirements in the Facility Compliance Plan. ~'~CUPAFOla, Mb~Iy a~e~lum.w~i CITY OF BAKERSF~D 17t5 Chester Ave.. CA 93301 (66,1) 326-3979 BUSINE'S~S OWNER / OPERATOR IDENTIFICATION FACILITY INFORMATION Page ~ Of - I. FACILITY IDENTIFICATION ~'" ~ ~ * i i i ~i Year Beg.inning mo Year Ending BUSINESS NAME (Same as FACILITY NAME or DBA- 0Ding Business As) 3 BUSINESS PH0-~I-~ --~o2 DUN & ~o8 i' SiC CODE II. OWNER INFORMATION ADDRESS II!. ENVIRONMENTAL CONTA~ .. CONtaCT NAME j~ ~~. .r , CO.rACT PHON~ CONTACT ~ILING ,-PRIMARY- iV. EMERGENCY CONTACTS ' ~ECONDARY- BUSINESS PHONE ~/' ~q~'-~¢6~ 12S I' BUSINESS PHONE d~/-~ fg ~ 2~HOUR PHONE ~[ 127 j 2~HCUR: PHONE ~/~ V. CEETIFICAT1ON 3e~ficafion: Based on my inqui~ of ~ose individuals responsible for ob~ining ~e inflation, I ce~ under penal~ of taw ~at 1 have pemonatly examin~ and am ~miliar wiB ~e info~afion submi~ in ~is inventow and believe ~e inflation is ~e, accu~te and;complete. ' SIGNATURE OF~NE~OPE~TOR DATE ~34 ~ NAME OF 0OCUMENT PREPARER ~35 ~ TITLE OF OWNE~OPE~TOR .q-\r.I i P A ~QI~ MS'~OE S2730.TV4.wDd Business Owner/Operator Identification please sut3mit the 8usiness Activities page, [he BUS, noes Owner/Operator Identification page (OES Fo~n Z730), and Hazardous Materials - Ch '.e~.ical. Description pages (DES Form 2731) for ail hazardous materiaLs inventory'suJ3miSaons. For the inventory to he cansidered complete- this page must be signed by the appml3rfate/ndividuai. ~lote: the numbering of the instructions follows the data etement numbers that are on~ the. UPCF pages.. These: data eiernent numbers are used: ' or ~ectmnic submission and are the same as the numbe.dng used in 27 CCR, Appendix C, the Business Sectfor~ of the Un,ed Prcgram Data.Dictionary.) Please numt~er all pages of your SLIbmittai. This heJl3s your CUPA or ,~ identify whether the submittal is complete and if any pages are separated. 1. FACILITY ]0 NUMBER - This numt3er is assigned by the CUPA or AA. This is the unique number which identifies your facility. 3..~ BUSINESS NAME - Enter the fuji legal name of. the business. 100. BEGINNING OATE- Enter the beginning year and date of the report. (YYYYMMDD) 101. ENDING DATE - ~:nter the ending year and date of the report. (YYYYMMDD) 102. BUSINESS PHONE - Enter the phone number, area code fir,st` and any extension. 10.3. BUSINESS SiTE ADDRESS - Enter the street address where the facility is tocated. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 104. CITY - Enter the city or unincorporated area in which business site is located. 105. ZJP CODE - Enter the ;dp cc~le of business site. The extra 4 digit Tip may also he added. 106. DUN & BRADSTREET - Enter the Dun & 8radst]'eat number for the fadJity. The Dun & Bradstreet number may be obtained by calling (610) 882~77'48 or by Intemet. 107. SIC CODE - Enter the pdmary Standard Industrial Classification Code number for pdmary business ac~vity. NOTE; If code is more than 4 digits, report only the first four. 108. COUNTY ~ Enter the county in which the business site is located. 109. BUSINESS OPERATOR NAME - Enter the name of the business operator. 110. BUSINESS OPERATOR PHONE - Enter busin~ss operator phone number, if different from business phone, ama code first, and any extension. 111. OWNER NAME - Enter name of business owner, if different from business operator. 112. OWNER PHONE - Enter the business owner's phone number if different from business phone, area code first, and any extension. 113. OWNER MAII_JNG ADDRESS - Enter the owner's mailing address if different fi'om business site address. 114. OWNER CITY - Enter the name of the city for the owners mailing address. 115. OWNER STATE - Enter the 2 character state abbreviation for the owneCs mailingaddress. 116. OWNER 7_JP CODE - Enter the zip code for the owners address. The extra 4 digit zip may also be added. 117. ENVIRONMENTAL CONTACT. NAME - Enter the name of the person, if different from.the Business Owner Or Operator, who receives all environmental .correspondence and ,,viii respond to enforcement activity. 118. CONTACT PHONE - Enter the phone number, if different fi'om Owner or Operator, at which the environmental contact can be contacted, area code ~rst, and any extension. 119. CONTACT MAILING ADDRESS * Enter the mailing address where all environmental contact correspondenc~ should be sent, if different fi'om the site address. [20. CITY - Enter the name of the city for the environmental contect=s mailing addr-,~s. 121. STATE - Enter the 2 character state abbreviation for the environmental contact=s mailing address. 122_ 7_JP CODE - Enter the zip code for the environmen~ contac~ mailing address; The extra 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representative that can be contacted in case of an eme~jency involving hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisfo~s for'the business regarding incident mitigation. 124. TITLE - Enter the title of the primary emergency contact. 125. BUSINESS PHONE - Enter the business number for the pdmary emergency contact, ama code lirst` and any extensiOns. 126. 24-HOUR PHONE - EOter a 24--hour phone number for the primary emergency contact. The 24-hour, phone number must be one which is answered 24 hours a day. If it is not the contacts home phone nUmber, then the service answering,the phone must be able to immediately c~ntact the individual stated above. 127. PAGF_R NUMBER - Enter the pager number for the pdmary emergency contact, if available. 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a seconda~ representative that can I:;e contacted in the event that the pdmary emergency contact is not available` The contact shall have FULL facility access, site familiarity, and authority to make derisions for the business regarding incident mitigation. 129. TITLE - Enter the ~e of ~e secondary emergency contact. 130. BUSINESS PHONE - Enter the business ~etephone number for the secondary emergency contact, area cocle ~rst, and any extension: 131. 24-HOUR PHONE - Enter a 24-hour phone number for the secondary emergency contact. The 24 hour pt~one number must beone which is answered 24 hours a day. If it is not the contact's home phone number, th~the service answering the phone must be able to immediately contact the individual stated above. 132. PAGER NUMBER - Enter the pager number for the secondary emergency contact, if available, 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUPAs or AAs to collect any additional information necessary ~o meet the requirements of their individual programs. Contact your local age~cy, for'g,,idance. 134. DATE - Enter the date that the document was signed. (YYYYMMDD) ': .~ ~.:' ~' ' · ' 135. NAME OF DOCUMENT PREPARER - Enter the full name of the person who prepared the inventory submittal information. 138. NAME OF SIGNER - En~r the fuji pdnted name of the person signing the page. The signer certifie~to a famitiadty with the informal~on submitted and that based on the signer~ inquiry of those individuals responsible for obtaining the information, all the information submitted LS true, accurate and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially designated representative of the Owner/Ope~'ator, ~aii sign in the space provided. This signature cortices that the signer is familiar with the information submitted and that based on the signers inquiry of those i~dividuais responsible for obtaining the informaffen it is signe~ betief that the submitted information is true, accurate and complete. 137. TITLE OF SIGNER - Enter the title of the person signing the page. ~ I ' OFFICE OF ENVIRONMENTAL SERVICES · 1715 Chester Ave., CA 93301 (661)326-3.979 "'~-" '~--* HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION NEW (one form per material Der building or a~ea) I'-1 ADD F'I DELETE [] REVisE 200 Page I. FACILITY INFORMATION BUSINESS NAME (Same aa FACILITY NAME or DBA. Ooing Business As) 3 i CONPIDEN'n^L (EPCRA) II. CHEMICAL INFORMATION 205 TRADE SECRET ~ Yes ~'No 206 CHEMIC. AL NAME 2O7 COMMON NAME ,~/~ d///.-~ ZY'/Z '~ R//Yd' mS' ZlY~ FIRE ~DE ~O C~SSES (C~pl~e if r~u~*~ ~y I~l tim ~ . ~PE ~ p PURE ~m MITRE ~ w WASm 211 ~ ~DIOA~E ~ Y~ ~No 212 CURIES 233 PHYS~LSTAm ~ ~ SOUD ~U~U,* ~ g ~S 2~ i ~RoesrCOmA~ER ~OO ~H~RD~GORIES ~ FIRE ~2 R~VE ~3 PRESSURE~SE ~4 A~H~m : HRONICH~Lm ~/~. 216 [~ ~ ~e~ apply) ~ a ABOVEGROUNO TANK ~ e P~ONM~A~C DRUM ~ i FtB~ DRUM ~m~S 80~ ~ q ~L ~at ~ b UNO.GROUND T~K ~ f ~N ~ j ~G ~n P~C 80~ ~ r O~ ~ c T~K INSIDE BUI~ING ~ g ~RBOY ~ k BOX ~ o TQ~ BIN ~ d S~DRUM ~ h SILO ~ I GYUNO~ ~ ~ TANKWA~N STOOGE PRESSURE AMBI~ ~ ~ A~VEAMBI~ ~ ba B~O~AMBI~ .. · STOOGE ~P~RE ~a AMBI~ ~ aa ABOVE AMBI~ ~ ba B~OW AMBI~ ~ ¢ CRYOG~IC %~ H~EDOUS COMPONENT EHS ~S . ~3 ~8 j ~9 ~Y~ ~No 2~ 241 III. SIGNA~RE P°'mT NAME & D~ OF AU~ORI~ COMPANY R~RES~A~E SIGN~ ~ Hazardous Materials Inventory. Chemical Description ~ - You must complete a separate Hazardous ~latedals ~nventory - Chemical Dsschption page t'or each hazardous material (hazardous substances and hazardous waste) that you hanOls at your racitify in aggregate quantities equal to or greater than 500 pounds, 5,5 gallons, 200 cubic feet of gas (calculated at ~tandard temperature and' pressure) or the federal thras/~oid planning quantity for Extremely Hazardous Substances, whicJlever is less. Also complete a page for eac~ radioactive rnetenal handled over quantities for which an emergency plan is require~ [o be adopted pursuant to I0 Cf:R Parts 30, 40. er 70. The completed inventory should reflect ail reportsOte quantities' of hazardous marshals at your facility, reported separately for eact~ building or outside adiacant area, with celebrate page.s for unique occurrences of physical state, stOrage temperature and storage pressure. (Note; the numOering of the insmJctions follows the data element numbem that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 OCR, Appendix' C, ~a Business Section of the Unified Procjram Oats Otcflona~y.) P~ease number all pages of your submittal. This helps your OUPA or AA identify whether the submittal is complete and if any pages am separats~ 1. FACILITY rD NUMBER - This number is assigned by ~e CUPA or AA. This is the unique number whirr1 identifies your facility, g. 3. BUSINESS NAME - Enter the full legal name of. the business. 200. ADD/DELETE/REVISE - Indicate if the material is being added to the inventory, deleted imm the inventory, or if the information previouaiy submitted is being revise~t., NOTE; You may choose [o leave this blank if you resubmit your entire inventory annually. 201. CHEMICAL LOCATION - Enter the building or outside/aOjacent area where the ~lazarrious material is handled. A chemical thal is stored at the ~ne pressure and temperature, in multiple locations within a building, can be reported on a single page. NOTE: This information is not subject to public disciosurs pumuant to H.SC §25506, 202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses which are eubiect to the Emergency Planning'and Community Right to Know Act (EPCRA) must c~eck "Yes' ~o keep chemical location information confidential. If the business does not wish to keep chemical location information confidential check. ~No'. 203. MAP NUMBER - If a map is included, enter the number of the map on which the location of the hazardous matadal is shown. 204. GRID NUMBER - If grid coordinates are used, enter the g~id coord!nates of Ule map that correspond to tile location of the hazardous material. If applicable, multiple gdd coordinates can be listed. 205. CHEMICAL NAME - Enter the proper chemical name aSSOOated with the Chemical Abstract Service (CAS) number of the hazardous matorial. This should be the Intematienai Union of Pure and Applied Chemist~/ (IUPAC) name found on the Matedai Safety Data Sheet (MS~.S). NOTE; if the chemical is a mixture, do not complete this field; complete.the "COMMON NAME" reid insta~d. 206. TRANE SECRET - Chec~ '"Yes" if the information in this section is dec~ared a trade secret, or "No' if it is no[ State reCluiremest: [f yes, and business is nm subject to EPCRA, dis~osure of the designated trade secret information ia bound by HsC §25511. Federal requJrament: if yes, and business is ~ubject to EPCRA, disclosure ~f the dssigrtated Trade Secret information is bound by 40 C~R and the business must submit a "Subetanfiation to Accompany Cisims of Trade Secrecy' form (40' C~=R 350.2'~ to U.SEPA. 207. COMMON NAME - Enter the common name or t~de name of the hazardous material or mixture containing a hazardous material . 208. EHS - Chec~ "Yes" if the hazardous matedai is an Ext~smely Hazardous "substance (EH$), as defined in 40 CFR, Part 355, Appendix A. if the matadai is a mixture containing an EHS, leave this section blank and compJeto the sermon on hazardous caml:x~nents below. 209. CAS # - Enter the Chemical Abstract Service (CAS) number for the hazardous material For mixtures, enter the CA.S number of the mixture if it had'been assigned a number distinct from its components. If the mixture has no CA.S number, leave this colurml bisnk and report the CAS numbers of the individual hazardous components in the ap0ropriata section betow. 210. FiRE CODE HAZARD Ct.ASSES - Fire Code Hazard CJesses deSCribe to first responders the type and level of hazardous materials which a business handles. This information shall only be provided if the local fire chief deems it necessary and requests the CUPA or AA to collect iL A list of the hazard classes and instructions on how to determine which class a matedaI fails unrier are included in the appendices of A~cle 80 of the Uniform F~re C~le. if a materisl has mom than ope ' ' applicable hazard class, include all. Contact CUPA or AA; for guidance. 211.' HAZARDOUS MATERIAL TYPE - ChecX the one box. that best describes the type of hazardous matariaE pure, mixture or waste, if waste matedai, chec~ only that box. if mixture or waste, compieta hazardous components section. 212. RADIOACTIVE - Chec~ "Yes" if the hazardous matsriat,!s radioac~ve or 'No' if it is not, 213. CURIES - If the hazardous material is radioactive, use this area to _.report the activity in cudes. You may use up to nine digita' with a.foaang decimal point to report activity in curies. - 214. PHYSICAL STATE - Cbec~ the One box that be~t desc~'tbes the state in which the hazardous mateda{ is handled: solid, liquid or gas. 215. LARGEST CONTAINER - Enter the total coPacJb/ of the largest container in which the material is stored. 216. FEDERAL HAZARD CATEGORIES - Check all categories that describe the pi"~sidai and health hazards assOcrated with the hazardous materfai. PHYSICAL- HAZARDS HEALTH HAZARDS Fire: Flammable Liquids and Solids, Combustible Liquids, P,/rophorics, Oxidizers Acute Health (immediate): Highly Toxic, Toxic, In'itants, Senaitize~ Corrosives, Reactive: Unstable Reactive, Or'~anic Peroxides. Water Reactive. Radioactive other hazardous chemioais with an adverse effect with short term e~posure Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): CarcinogenS, other haza~ous chemiCalS with an adverse effect with ton.q term ex~:~osure 217. AVERAGE DAILY AMOUNT - Calculate the average daily amount of the hazardous matariai or mixture containing a hazardous material, in each bullCling or adjacent/ outside area. Calculations s_hati be based on the previous year's inventory of matedai reported on this page. Total ail daily amounts anti divide by the numi::~r of- days the chemical will be on site. if this is a material that has not previdusly been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported,, in bOx 221 and shoulri not exceed that of maximum daily amount, , · 218. MAXIMUM DAIt,Y AMOUNT - Enter the maximum amount of each hazardous'material or mixture c~ntaining a hazardous material, whic~ is handle~l in a bui~ding or adiacentToutside area at any one time over the course of the year. This amount must contain at a minimum last years inven~ry of the material re~orted on ~ page, with the re~ection of additions, deletions, or revisions projected for the current year. This amount should be c~onsistent ~ the units reported in box 22.1. 219. ANNUAt, WA"STE AMOUNT - if the hazardous material being inventoried is a waste, provide an sstimata of the annual amount handled. 220. STATE WA.aTE CODE - If the hazardous matedal is a waste, enter the appropriate California 3-digit hazardous waste code as listed on the bac~ of the Unif°n'n Hazardous Waste Manifest. 221. UNITS * Check the unit of measure that is most appropriate for the matedai being reported on {his page: gallons, pounds, cubic feet or tons. NOTE~ If the matedaJ is a federally defined Extremely Hazardous Substance (EH"S), ail amot~nts must be reported in pounds, if material ts a mixture containing art EH,S, rs~:~ort the units tt~t the material is storeri in (gallons, pounds, cubic feet, or tuna). 222_ DAYS oN SITE - List the total number of days during the yea~ that the material is on site. 2.23. STORAGE CONTAINER - Check all boxes that deschbe the type of storage containers in which the hazarrious matedai is Stored. NOTE: If appropriate, you may choose more than one. " 224. STORAGE PRES"SURE - Check, the one box the[ best deSC~bes the pressure a*, which the hazardous ,l'i~tenal is stored. 225. STORAGE TEMPERATURE - Chec'X the one box that best deSCribes the temperature at which the hazardous material is stored. 225. HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) - Enter the perc~ntags weighl of the hazardous component in a mixture, if a range of percentages ~s avaiisble, report the highest percentage in that range. (Report for components 2 through 5 in 230, 234, 238, and 24?..) 22.7. HAZARDOUS COMPONENTS 1-5 NAME - When reporting a hazardous matedai that is a mixture, list up to five chemical names of hazardous components in that mixture by percent weight (refer'to M.SI~S or, in the case of t~qe secrets, refer to manufacturer), A[~ hazardous components in the mixture present at greater than 1% by weight if non-caroinegecic, or 0.1% by weight if carcinogenic, should be reported. If mom than t'Ne' ha~'.ardous compc~nents are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. (Report for components 2 through 5 in 231,235, 239, and 243.) 22.8. HAZARDOUS COMPONENTS 1-5 EHS - Chec~ "Yes" if the component of the mixture is considered an Extremely Hazar~ious Substance as defined in 40 CFR, Part 355. or 'No" it, it is not, (Report for components 2 through 5 tn 2.32, 23B, 240, and 244.) 229. HAZARDOUS COMPONENTS 1-5 CAS - List the Chemicoi Abstract Service (CAS) numbers as relatsd to the hazardous components in the mixture. (Repeat for 2-5.) 246. LOCALLY COLLECTED INFORMATION - This space' may be used by [he CUPA or AA to collect any additional information necassa~ to meet the requirements of their individual programs. Con,act the CUPA or AA for guidance. UPCF (I/99) 7 OES Form 2731 -,:;'r-,' .0 ITE DIAGRA~I [.~] FACILITY DIAGRAm! ~ " Business Name: Business Address: $:\pR.O~'DUR~ MA NUAL',diagramh~.~v~