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Home My WebLink AboutBUSINESS PLAN $ I TE/~",A.C I L I T¥ D l ,AGI:~ F 01::~.1~ ,,~ NORTH SCALE: BUS INESS N>%~{E: FLOOR: OF '1'-"~'Lo' I' I (C~ECK ONE) SITE DIAGR.~I FACILITY DIAGR.~ F R [o~I. _...--z..~IK]~ ..~ - · ~ . ( '/ L ~,~~ Inspector's Comments): -OFFICIAL USE ONLY- - ~ - SiTE DIAGRAM (Requir ems) 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSDS Storage Box 2. Street(s), Allays. 11. Railroad'Tracks Dulvewaya, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Wire street names. b. Masonry 3. Storm Drains. Culverts, Yard Drains c. Wood 4. Drainage Canals, Ditches, d. Gates Creeks, 13. Powerllnes §. Buildings a. Frame construction 14. Guard Station b. Masonry construction IS. Storage Tanks: Identify the c. Metal construction capacity in gal. a. Above ground d. Access Door b. Underground S. Utility Controls a. Gas 16. Diking or Berm b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: Identify the 7. Fire Suppression Systems: location where a. Fire Hydrants employees will meet. b, Fire Sprinkler 19. Outside Hazardous Connections Masts Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Water Control Valves 21. Outside Hazardous for protection systems Material Uae/Handling e. Fire Pump 22. Type of Hazardous Material/Masts Stored B. Fire Department Access or Used (See Below) ]~yPE OF HAZARDOUS MATERIAL F - FIMmable E - F. xploalve L · Liquid R - Radlologlcal c · Corrosive O - Oxidizer G - Gas P - Poison M - Water Reactive T - Toxic g - Solid H - Cryogenic D - Waste B - Etiological Example: Fla=-able Liquid · FL FACILITY DIAGR~ (Required items in addition to the above) 1, Risers for Sprinklers 8. Fire Escapes 2, Partitions O. Air Conditioning Unit. 3. Stairways: Indicate the 10. Mlfldo~m levels lerved from highest to lowest. 11. Inside Haxardous Masts Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Waterlals Use/Handling 6. Attic Access "14. Sewer Drain Inlets 7. Skylights --' Bakersfield Fire Dept.' ' ~ HAZARDOUS MATERIALS DIVISION ,~ Date Co.rnpleted ~/O ,--,~ £ - ~'/ Business Name: ?~,~, ,._R'r'~£~'""r ,,,~oJ) ,-~.. Location: :2- g' 0 ':/ ~: ~,,,<'T~,'~ Business Identification No. 215-000 ~ (Top of Business Plan) Station No. / Shift -~ Inspector Adequate Inadequate Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Comments: umber of Employees ~ c,J,d~...p., Verification of Haz Mat Training Comments: Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted ,,~ Containers Properly Labeled Comments: ~~n of Facility Diagram'-'-~ Special Hazards Associated with this Facility: Violations: All Items O.K. -'" Correction Needed,~ ~usfn"ess O~w~/Ua~ - /- FD 1652 (Rev. 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy 03/29/91 _._ KERN OFF ROAD 215-000-000537 Page Overall Site with, 1 Fac. Unit General Information Location: NO LONGER IN BUSINESS "r~P-_ ~T~'- Map: 10~ Hazard: Unrated ~Ident Number: 215-000-000537 ~0~ Grld: 50~ ~rea of Vul: 0.0 Contact Name Tltle · Buslness Phone 24 Hour Phone- ~. :~E~.~T T~YLOR (8OD) Z22-ZVZ? x-' (8~) SSS 2471 Ha&Z ~ddrs: 2509 CHESTER ~V D&B Number= C&~y: BKERSFZELD' S~abe: C~ Z&p: Comm Code: 225-00Z B~KERSF~ELD STATION 02 SIC'Code: O~ner: ~N~T E. & CHuo~ 'i'R~'LOR, Phone: ( ) - Address~n~ CHEgT~R AV I~ ~~~ State:, CA City: BAKERSFIELD~--~ Zip: 95501- ~ Summary i 03/29/91 KERN OFF ROAD' 215-000-000557 Page 2 Hazmat Inventory List in MOP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCP 02-002 ACETYLENE Gas 125 Fire, Pressure, lmmed Hlth FT3 02-001 OXYGEN Gas .~-~-- Low Fire, Pressure, Immed Hlth ~¢~ FT3 02- ~ L ' ~"~'~ ~ L_OW Fire, Delay Hlth GAL 02-003 ARGON Gas ~ Minimal Fire, Pressure, Immed Hlth 797 FT3 02-005 FREON Ga2__2i~ rYn~a-t htr-e, Pmessume, lmmed Hlth FT3 Ci~ · o~Bakersfield TII~NSMITTAL SLIP Date ........ ...~.....-...~...-...~./.. ................... To. ..~.~.~.;..~-~. :. .._ ./_./..~.~..:..~.~ ......................... From ......... ~..~.....~....~.~.~.~. ........ ' .......... For Your:-- ~f /~ [] Signature [] Action ormation ile Pl~ose: · u [] Return [] See Me [] Follow Up [] Prepare Answer Copy to: ..................................................................................................... Memo: .................................................................................................. M EM ORA N D U M JUNE 6, 1991 TO: VALERIE, HAZARDOUS MATERIALS FROM: DREW SHARPLES, FINANCIAL INVESTIGATOR~ SUBJECT: HM ACCOUNTS HM 406401: I changed the mailing address to owner's resident. c/o Jane Elaine Taylor 1700 LeMay Bakersfield, CA 93304 ~ Bakersfield Fire Dep HAZARDOUS MATERIALS DIVISION Date Completed /_~, Business Name: J/-..e..,"~ 0_~-1L-"' /),_o,~ RECEIVED Location: DEC 0 6 1990 Business Identification No. 215-000 ~or),~$'7 (Top of Business Plan) H~7 I~IAT. DIV. Station No. I Shift ~ Inspector ~ ¢//o/Z',/v. % Adequate Inadequate Verification of Inventory Materials ~ Verification of Quantities ~ Verification of Location ~' Proper Segregation of Material ~ ents: ~o ~.o~,~.,- ~ ,~.~o,,,_ Verification of MSDS Availablity ~ Number of Employees ~.. Verification of Haz Mat Training ~ Comments: /.J~.~.~ ~ ~'i~:~.- Verification of Abatement Supplies & Procedures ~ Comments: Emergency Procedures Posted ~ Containers Properly Labeled ~] Comments: C---r~Jt",..',.,,,..~.~ v~e~,{' '~ /o~ Verification of Facility Diagram ~ Special Hazards Associated with this Facility: Violations: orrection Needed~us~ss Owner/Manager ~ ~ FD 1652 (Rev. 1-90) White-Haz Mat Div, Yellow-Station Copy Pink-Business Copy .... HAZAI:~DOUS. MATERIALS MANAGEMENT PLAN ~ INSTRUCT IONS TYPE OR PRINT LEGIBLY Section 1 - Business Identificati°n~Data: List business name, street address of the physical location of the business, mailing address and phone number of the business. If you are not familiar with your Dun and Bradstreet hummer or SIC code, contact your bookkeeper, financial officer or consultant. Section 2 - Emergency Notification: List two persons who have full access to the facility including looked areas and that are knowledgeable about your materials and processes. Section 3 - Traininq: List the number of employees that are working in the area of the hazardous materials, use or storage. Include all employees who have any occasion to bin those areas. Give a brief summary of your Hazardous Materials Training Program. Employees are required by state law to have a Program which provides employees with initial and refresher training in the followinq areas: 1) Methods for safe handling of the hazardous materials used by your business. 2) The Gal OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. 4). The prevention, minimizing and clean up procedures you have developed for your business. 5) The emergency evacuation plans you have developed, ss well as, your notification procedure and medical plan. 6) Procedure to coordinate with a'nd assist the local emergency personnel that may respond to your business. 7) Who and how to call for immediate assistance in the event of an accident involving hazardous mat~rials. HAZARDOUS MATERIALS MANAGEMENT PLAN Section 4 - Exemption Request: - - If you feel you are exempt from the Hazardous Materials reporting requirements of Chapter 6.95 of the California Health and Safety Code, check the appropriate box. Section 5 - Certification: Sign~ date and return before the due date tc avoid further action. ~i~n 6 - Noti£±cati~n and Evacuation Procedures: A) Agency Notification Procedures: 'What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -- Whet procedures are used to notify these parties. B) Employee Notification and Evacuation: How are your employees notified in case of a hazardous materials emergency. What evacuation procedures exist for the orderly and safe evacuation and accounting of all employees in case of an emergency requiring evacuation. C) Public Evacuation: What if any contingency plans do you have for the evacuation ~of surrounding public, in case of a hazardous materials emergency at your facility.' D) Emergency Medical Plan: Summarize your plan for handling medical emergencies occurring at your business, hist the local medical facility capable of handling an accident involving a hazardous materials exposure involving Hazardous Materials used at your business. Section 7 - Mitigation, Prevention and Abatement Plan: A) Release Prevention Steps: Explain the procedures that yo~ have developed and implemented to held prevent, an incident from occurring. These steps could include,- but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B) Release Containment and/or Minimization: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials lncbdent at your.business as small or confined as possible. HAZA~RDOUS MATERIALS MANAGEMENT PLAN C) CLean-up Procedures: Explain what clean up p~oceGu~es will be implemented in ca~e of a Felease at you~ business. This should address small spills, as well as a major release of material once the materials is contained. Section 8'- Utility Shut-Offs: List locations of shut offs using compass points and known or obvious landmarks. If you have a lock box list its location also. Section 9 - Private Fire Protection/Water Availability: A) Private Fire Protection: Describe on-site fire protection for your business or facility unit, including sprinklers, extinguishers, alarm systems and private response teams. B) Water Availability (Fire Hydrant): Give the location of the closest water supply or fire hydrant to be used by the fire department in case oi an emergency. NOTE If your business covers either a large geographical area or consists of several facilities (separat'e manufacturing or storage areas), Sections 6~ 7, 8, and 9 o~ the (HMMP) must be completed for each facility. You must also complete a separate inventory and facility diagram fo~ each facility unit or building. Bakersfield Fire Dept. Hazardous Materials Division 'Bakersfield, CA. 93301 JAI~ t 5 1991 HAZ. MAT, DtV, HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 clays of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA MAILING ADDRESS: ~~ DUN 8~ BRADSTREET NUMBER' SIC CODE~: PRIMARY ACTIVITY: OWNER: MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SEgTION 3: TRAINING: NUMBER OF EMPLOYESS: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REG~UEST: 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 TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. .OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, CERTIFY THAT THE ABOVE INFOR- MATION 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 IN/~CCURATE INFORMATIO~C ON~TITUTES PERJURY. 2, FDI Bakersfield Fire Dep Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN' R315~.' R~TURN PAYMENTS TO: ' ' I - PLEASE MAKE CHECKS PAYABLE TO: P.O. BOX 2057 . ~ ' ' ~ , ~ ,, ',' ' '" CITY OF BAKERSFIELD BAKERSFIELD, CA 93303-2057' .,..,ACCOUNT NO. ~4~& "' CUS?OMER 'cOpy "'.' C~TY OF ~,AKE~SF~EL~ - P.O. ~OX 2057 '~ 'KERN OFF RORD ~0,6~0 '~ 2509 CHESTER RV ~ BAKERSFIELD CA 9330[- 03 30- BAKERSFIELD CITY FIRE DEPARTMENT BAKERSFIELD, CA 93301 l 0FFIC[AL USE ONLY USINESS NAME HAZARDOUS MATER I ALS BUSINESS PLAN AS A WHOLE FORM 2A 00( 537 INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions belo~ for the business as a ~hole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDE~IFICATION DATA A. BUSINESS NAME: ~~d 'OW~ ~0~ SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS, HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WIIOLE A. NAT. GAS/PROP~NE: ~X.~OT T0~k/~['~.Od . D SPECIAL: ~ E LOCK BOX: YES ~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO 2A - SECTION 4: PRIVATE RESPONSE TEAN FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...- .................................... f~E~ NO NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~ E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES YES SECTION ?: I{AZARDOUS WATERIAL CIRCLE YES OR NO , DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS :~HAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I,C[-~(~ ~~D~-----~ , certify that the above information is accurate. I ~nder~and t-~at ~-h]~ ~~ill be used to fulfil.l/my firm's obligations under the new California Health and Safety code on Hazardous' Materials (Div. 20 Chapter 6.98 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. BAKERSFIELD CITY FIRE DEPARTMENT 2180 "G" STREET BAKERSFIELD, CA 95301 OFFICIAL USE ONLY ID# BUSINESS' NAME: BUS I 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 UNIT# FACILITY UNIT NAME: SECTION 1: MITIGATION, PREVE~ION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCED5~RES AT THIS b~.'IT ONLY SECTION 3: HAZARDOUS MATERIALS FOR THIS UNiT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... YES NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES NO If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form ~4A-t) 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 SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 8: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. SilT. GAS./PROPAN~'~ B, ELECTRICAL: C. WATER: D. SPECIAL: LOCK BOX: YES / NO IF YES, LOCATION: IF YES, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT ~ ' I.D. t~ FORM 4A-1 . Page of NON--TRADE SECRETS HAZARDOUS MATERI ALS I NvENT~oRY BUSINESS NAME: OWNER NAME ITY UNIT #: ADDRESS: '~ C.[~~ ADDRESS: ~~.~~~ ~ __F~CILITY UNIT NA~E: CITY, ZIP: ~~~ ~~ CITY,ZIP:~~ ~ PHONE {: ~-~-~~ PHONE ~: ~-~Z~-~ [OFFICIAL USE CFIRS CODE ' -- ' { ONLY i 2 3 4 9 6 7 8 9 10 TYPE RAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T ~CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE GUIDE ,,. _~ . ~ ~ EHERGENCY CONTACT: ~~ ~~ TITLE: ~,P~ PHONE ~ BUS HOURS: A~T~ BUS .~S: ~ PRINCIPAL BUSINESS ACTIVITY:- ' ~O~ ~~ . AFTER BUS "RS: - 4A-1 -