HomeMy WebLinkAboutBUSINESS PLAN 7/13/1987 ~ $7~ 3
(tv~e or Drin~ name
Do hereb.-? certifT that I have revie~,'ed the
RECEIVED
attached Hazardous Haterials business ~lan
H~t~. MAT. DIV.
for "
(name of business)
and that it along with the attached additions
or corrections constitute a complete and correct
Business Plan for my facility.
(/ "si~na%6r.e {./ date
BUSINESS NAME ? ELEVEN STORE ~ZlZS-I~g-3Z -ID NUMBE ~-000-0008Z0
LOCATION Z~l CHESTE HIGH HAZARD RATING 1 '.
i, OVERVIEW
LAST CHANGE 0Z/17/88 BY EVAMC
JURIS CODE ZlS-00~ JURIS BAKERSFIELD'STATION 0~
MAP PAGE 10Z GRID ~GA FACILITY UNITS I HAZARO RATING 1
RESPONSE SUMMARY ZA SEC 4) EMERGENCY COORDINATOR (PRE-DETERMINEO) sHALL
NOTIFY ALL AGENCIES ANO INTERCOMPANY PERSONS IN THE EVENT OF INCIDENT.
'EMERGENCY COOROINATOR SHALL IMPLEMENT ALL NECESSARY MEASURES IN REGARD TO
EMPLOYEE/ENVIRONMENTAL SAFETY AS INSTRUCTED BY TRAINING.RECEIVED
EMERGENCY CONTACTS ZA'.SEC 2)
JUDY FRIEDLY .~Z3~S661
KATHY MEJIfl 8~4~Z711
UTILITY SHUTOFFS ZA SEC 3)
A) GAS -NONE B) ELECTRICAL -- BACKROOM/HALLWAY C) WATER -'FRONT
D) SPECIAL - NONE E) LOCK 80X - NO
NOTIFICATION / PUBLIC EVACUATION'
LAST CHRNGE / / BY
< NO INFORMATION RECORDED FOR THIS.SECTiON >
PAGE 1 12/15/88 09:30
MATERIAL.SAFETY DATA SYSTEMS, INC. (805) G48-G88~)
BUSINESS NAME ?'ELEVEN FOOD STORE ~ZlZS-13B~Z ID NUMBER Z1s-OO~-O~OBZO
LOCATION Z33! CHESTER LN .= HIGH HAZARD RATING I
3. HAZ MAT TRAINING SUMMARY
LAST CHANGE / / BY
< NO INFORMATION RECORDED FOR THIS SECTION
4. LOCAL EMERGENCY MEDICAL ASSISTANCE
LAST CHANGE 02/17/88 BY EVAMC
ZA SEC S) NE~tREST E.R. TO LOCATION IS TO 8E USED IN THE EVENT OF INJURY
CALL 91;
PAGE Z 1~/1S/88 09:30
MATERt~L SAFETY DATA SYSTEMS, INC. (805) G48-G800
BUSINESS NAME '? El_EVE STORE ~ZlZS-1393Z ID NUM -000-0008Z0
LOCATION .Z331CHESTEI~--LN HIGH HA~ARO RATING 1
FACILITY UNIT 01
~. OVERALL HAZARDOUS MATERIALS INVENTORY
LAST CHANGE 02/17/88 BY EVAMC
ID TYPE NAME ///'~' MAX RMT UNIT HAZRRD
LOCATION' / .
. CONTAINMENT USE
I PURE C~RBON DyOXIOE · ZlZS FT3 LOW
NEAR S~LESCO'U~kTER. PORTABLE PRESS. CYL. OTHER
ID pERCENT/COMPONENTS ' HAZARD LIST
1ZSI~ C~RBON DIOXIDE LOW
FIRE PROTECTION / WATER SUPPLIES
LAST CHANGE / / BY.
< NO INFORMATION RECORDED FOR THIS SECTION >
PAGE 3 lZ/15/S8 09:30
MATERIAL SAFETY DATA SYSTEMS, INc. (BOS> 648-8800
BUSINESS NAME ? ELEVEN FOOD STORE ~ZlZS-13B3Z ID NUMBER ZlS-O~-0008ZO
LOCATION Z331 CHESTER LN HIGH HAZARD RATING !
D. EMPLOYEE NOTIFICATION t EVACUATION
· LAST CHANGE 09/29/88 BY ESTER
SEC 2> VERBAL AND CALL 911
FOR RELEASE OF HAZ MAT NOTIFY BAKERSFIELD FIRE DEPT H~Z MAT DIV
AND STATE OES.
E. MITIGATION i PREVENTION / RBATEMENT
LAST CHANGE 09/29188 BY ESTER
SEC 1) STANDARD GASOLINE STATION SAFETY FEATURES FOR GBS PUMPS/AUTO SHUT
OFFS, VAPOR SHIELDS, SHUT OFF VALVE-- COMPRESSED GASSES PROPERLY
STORED IN SMALL SAFETY CONTBINERS AND WITH PROPER FITTINGS,,
BUSINESS EMERGENCY PLAN ON FILE AT'EACH STATION
PAGE 4 1Z/1S/BB 09:~0
MATERIAL SAFETY DATA SYSTEMS, INC. (80S) B48-G800
~ . "~ ' BAKERSFIELD CITY FIRE DEPARTI~E~
BAKERSFIELD, CA 90301 JUl I3 1987
(6o5)
326-3979 ~ --- -- ,
OFFICIAL USE ONLY
00C820
INSTRUCTIONS:
1. To avoid further action; return this form by
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. I
SECTION 1: BUSINESS IDENTIFICATION DATA '
A. BUSINESS' N~u~E: 7-Eleven Food grnr~ ~?l?~lqqq?.
B. LOCATION / STREET ADDRESS: 2331 Chester Lane
CITY: Bakersfield ZIP: 9~304 BUS.PHONE: ( 805 ) g?~-5kGl
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an e~er~ency tnvolvin~ the release or threatened release of a
hazardous =aterial, call 911 and 1-800-852-7550 or 1-916-427-4341.- This ~111
~our local fire departsent and the State Office of Eser~enc¥'Servtces as required b~
law.
E~PLOYEES TO NOTIFY IN CASE 0F EI4ERGENCY:
NA1WE AND TITLE DURING BUS. HRS. AFTER BUS. HRS.
A. Judy Friedl~ Ph~ (805)323-5661 Ph~ same
B. Kathy Mejia PhS ~805)834-271t ph~ ~ama
SECTION 3: LOCATION OF UTILITY SHUT-OI~S FOR
BUSINESS
AS
A
lmOLE
A. NAT. GAS/PROPANE: None
B, ELECTRICAL: Backroom/Hallway
C. WATER: Front
D. SPECIAL:
g. LOCK BOX: YES /~0 IF YES~ LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? .Y~-E*S ./ NO MSDSS? ~*-ES / NO '
FLOOR PL~S? ~¥ES/ ~O KEYS? YES / NO
SECTION 4: PRIVATE RESPONSE TEAN FOR BUSINESS AS A WHOLE
· Emergency Coordinator (pre-determined) shall notify all agencies and inter-
company persons in the event of incident. Emergency Coordinator shall implement
all necessary measures in regard to employee/environmental safety as instructed
· ,,.~ ,, :.~'~ :~,,? by training received.
SECTION 5: LOCAL I~ERGENCY ,~EDICAL ASSISTANCE FOR YOUR BUSINESS AS A WROLE
Police/Fire Department: 911
Nearest E.,R. to location is to be used in the event of injury.
SECTION 6: E~PLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRA~ WHICH PROVIDES EMPLOYEES WITH INITIAL A~
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL REFRESHER
A. ~ETHODS FOR SAFE HANDLING OF HAZARDOUS
.V, ATERIALS: ....................................... YES NO YES NO
'B. PROCEDURES FOR COORDINATING ACTIVITIES
' WITH RESPONSE AGENCIES: .......................... YES NO YES NO
C. PROPER. USE OF SAFETY EQUIPNENT: .................. YES NO YES NO
D. E,'CERGENCY EVACUATION PROCEDURES: ................. -YES NO YES NO
E. DO .YOU NAINTAIN ENPLOYEE TRAINING RECORDS: ....... YES NO YES NO
SECTION 7: HAZARDOUS NATEltlAL
CIRCLE YES OR NO
'DOES YOUR BUSINESS i~'~DLE HAZARDOUS ~"~ATERIAL IN QUANTITIES LESS THAN §00 POL~DS OF A
SOLID, $5 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COr4PRESSED GAS: ...... YES ~0
I, Judy Friedly , certify that the above Information is accurate.
I understand that this information will be used to fulfill my firm's obligations under
the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95
Sec. 25500 Et Al.) and that inaccurate information constitutes perjury.
Franchisee,
- 2B -
BAKERSFIELD CITY FIRE DEPARTMENT
21BO "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
ID#
BUSINESS N~ME:
BUSI NESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS .. 1. To avoid further action, this form must be returned by:
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. .
FACILITY UNITe FACILITY UNIT N~ME:
SECTION 1: MITIGATION~ PREV~ION~ ABATEMENT PROCEDURES
SECTION 2: NOTIFICATION ~%q] EVACUATION PROCEDURES AT THIS b%'IT 05~LY
- 3A -
BAKERSFIELD CITY FIRE DEPARTMENT
I.D. ~ FORM 4A-1 Page 1 of ~ 1
NON--TRADE SECRETS
HAZARDOUS I~IATER I ALS I NVENTORY
BUSINESS-NAME: 7-Eleven Food Store #2125-13932 O~NER NAME: The ~outhland Corparar~au FACILITY UNIT
ADDRESS: 2331 Chester Lane ADDRESS: 1240 S. State College BlvdFACILITY UNIT NA~E:
C l TY, Z I P: Bakersfield 93304 C I TY, Z I P: Anaheim 92806
P~ONE ~:' (805)323-5661 PHONE ~: (714) 635-771~ OFFICIAL USE CFIRS CODE
1 2 3 4 -5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY [lAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT ~T. CNEMIqAL OR COMMON NAME CODE 6UIDE
. M ~ '-~ Ft3 04 99 Near Salag Cmllntar IDa CO2/Carbon D~ox~da NFLG 1013
NA~E: .Kathy Me~ia TITLE: Distr~ct Mana~ar SIGNATURE: DATE:
EM~?GENCY CONTACT: Judy Friedly TITLE: Frmnph~m~ P~ON~ ~ BUS ~O~R~:(805)323-5661
, AFTER BUS HRS: (805)323-566]
EMERGENCY CONTACT: Kathy Mejia TITLE: DJ~tr~ct Mflpnger PMONE [ BUS ~OUR8:.(805)834-2711
PRINCIPAL BUSINESS ACTIVITY: Convenience store AFTER BUS HRS: (805)834-2711
- 4h-1 -