HomeMy WebLinkAboutBUSINESS PLAN 1/14/1991
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(CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM
Inspector's Comments): -OFFICIAL USE ONLY-
February 25, 1991
Mr. Drew Sharples
Treasury Divisior~
City of Bakersfield .
P.O. Box 8057
Bakersfield, California 93303 ....................
RE: 2_061 S. Chester Avenue Bakersfield, Califorr~ia
Mr. Sharpies,
Per the reouest ire your letter dated January 29, 1991,
you are hereby irlforr~ed that Circle K CorDoratiorf secured arid
vacated the Drer~ises before Seotember 1, 1990. Moreover, the
Drer~ises is currerltly beir~u_ leased fror~ Apri-Er~nire to afl
individual r~a~ed Massaud Abbasi, 1908 Marc A Mitcher Court,
Bakersfield, Califorr~ia. This ir~dividual is ooeratir,_u a _uas
stat ior~ arid corlver~ier~ce store at the oroDerty orr Chester
Aver~ue. t have forwarded hir~ a packet from the City of
Bakersfield cc, r~tair~ir~_u, ir~for[~at ior~ cor~cerr~ir~_u his resDorl--
sibi!ities towards the Hazardous Materials Har~dlir~Q Program.
If you have ar~y add it ior~al Due'st ior~s, cor~tact rne as soor~ as
Dc, ssi ble.
C. B.,,-'ke
P. O. Box 490, San Jacinto, CA 92383 [] ' 714- 654~7311 [] FAX' 714~ 654-7i539 Q
RECEIVED
JAN ! 1991
............
January 10, 1991
Bakersfield City Fire Department
Hazardous Materials Division
2101 H Street
Bakersfield, CA 93301
RE: ~le K
26~1 St.C~ster A
Bakersfield, CA
Gentlemen:
On May 15, 1990 ("Petition Date") The Circle K Corporation and
certain affiliates ("Debtors") filed petitions for relief under
Chapter 11, Title 11, of the United States Code ("Bankruptcy
Code"). As a result of that filing, the automatic stay imposed by
Section 362(a) of the Bankruptcy Code prohibits creditors from
taking any action (including administrative) that could interfere
with the operations or the assets of the Debtors.
Pursuant to Section 365 of the Bankruptcy Code, Circle K has
rejected the lease at the Store identified above and located in
your jurisdiction. Because the Debtors have rejected the lease,
they were required by the bankruptcy court to vacate the premises
immediately. In vacating the premises, you are advised that, where
possible, the Debtors emptied all underground storage tanks
("USTs") present and took steps to secure the UST systems. Carbon
Dioxide (C02) storage and handling equipment was also removed from
the premises.
The Debtors encourage you to contact the Landlord concerning his
present or future plans for the subject property to determine
what requirements or responsibilities he may have regarding
hazardous materials. You may direct your inquiries concerning
this property to:
Agri-Empire
P. O. Box 490
San Jacinto, CA 92383
Bakersfield City Fire Department Page 2
Hazardous Materials Division January 10, 1991
Inquiries concerning any of the Debtors' activities should be in
writing, including the relevant Store number and address and
directed to:
The Circle K Corporation
1601 North 7th Street
Phoenix, Arizona 85006
Attention: Environmental Dept.
cc: Janet Jackim
Thank you for your anticipated cooperation.
Sincerely,
THE CIRCLE K CORPORATION
$ Bs ers eld Fire D t.
H-~.ardous Materials Division
B~ersfield, C~ 93301
HAZARDOUS MATERIALS MANAO M NT PLAN
INSTRUCTIONS:
1. To avoicl further action, return this form within 30 aays of receipt.
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the cluestions below for 1he Dusine~ as a whole.
4. Be or~ef ancl concise c~s po,uiOle.
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: Circle K Corporation $830
LOCATION: 2601 S. Chester Avenue
Circle K Corporate
MAILING ADDRESS: P. O. Box 52084, Phoenix, AZ 85072
CITY: Bakersfield STATE: CA ZiP: 93304 PHONE: (805) 834-3350
DUN & BRADSTREET NUMBER: 06-294-4160 SiC CODE: 5541
PRIMAEY ACTIVITY: Convenience Sto~e/Ga$ Station
OWNER: Circle K Corporation
MAIL1NGADDRESS: P. O. Box 52084, Phoenix, AZ 85072
SECTION 2: EMERGENCY NO~FICATION:
CONTACT TELE BUS. PHONE 24 HR. PHONE
1. Mike Spinuzzi - Zone Manager (209)298-3036 (805) 833-8881
2. Don Lewis - District Manager (209)298-3036 (209) 291-5910
Bakersfield Fire Dept.
Hazardous Materials Divisior~
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING:
NUMBER OF EMPLOYESS: 3
MATERIAL SAFETY DATA SHEETS ON FILE: Yes
BRIEF SUMMARY OF TRAINING PROGRAM:
Special On-the-job training in the handling of hazardous material(s) is provided in the following areas:
1. Prop~i maintenance and use of gasoline equipment.
2. Use of kitty litter for small spills.
3. Employees are instructed on proper response to police, fire department, emergency medical and
Circle K Environmental Department.
4. Each Circle K gasoline store has a Company supplied gasoline manual with MSDSs for gasoline and CO2.
A review of the contents of the Emergency Response Plan will be made by all new employees within one
month of hiring and by all employees on an annual basis.
Safety and emergency equipment usage training will provide familiarization with the location and proper
use of fire fighting equipment (fire extinguishers), the location of and procedures for facility shutdown
(including the location of turnoff valves for gas and electricity) and the proper use of equipment used
in the day to day business.
SECTION 4: 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
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION ,5: CERTIFICATION".
I, Mike Schumacher 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
INACCURATE INFORMATION CONSTITUTES PERJURY,
~ ~~_~ Division Manager
SIGNATURE TITLE DATE
e
FDI(~O
BakerSfield Fire Dept.
Hazardous MateriaLs Div~sio]
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING:
NUMBER OF EMPLOYESS: 3
MATERIAL SAFETY DATA SHEETS ON FILE: Yes
BRIEF SUMMARY OF TRAINING PROGRAM:
Special on-the-job training in the handling of hazardous material(s) is provided in the following areas:
1. Prop=~ maintenance and use of gasoline equipment.
2. Use of kitty litter for small spills.
3. Employees are instructed on proper response to police, fire department, emergency medical and
Circle K Environmental Department.
4. Each Circle K gasoline store has a Company supplied gasoline manual with MSDSs for gasoline and CO2.
A review of the contents of the Emergency Response Plan will be made by all new employees within one
month of hiring and by all employees on an annual basis.
Safety and emergency equipment usage training will provide familiarization with the location and proper
use of fire fighting equipment (fire extinguishers), the location of and procedures for facility shutdown
{including the location of turnoff valves for gas and electricity) and the proper use of equipment used
in the day to day business.
SECTION 4: 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
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION ,5: CERTIFICATION:
I, Mike Schumacher 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
INACCURATE INFORMATION CONSTITUTES PERJURY.
Division Manager
SIGNATURE TITLE DATE
e
FDIE~O
Bakersfield Fire DePt.
azardous Materi~l~ Divi~on
H ~AZARDOUS MATERIALS MANAGEMENT PLAN
Fo:ility Unit Nome: Circle K Corooration $830
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. A.,gENCY NOTIFICATION PROCEDURES:
If emergency response assistance not required, notify:
Bakersfield City Hazardous Materials Division 326-3979 AND
State Office of Emeroencv Services {BOO) ESZ-7550 WITHIN 24 HDUR$
If release poses present or potential hazard to human health & safety, property or environment,
and emergency assistance is required, in~..ediatel~ notify:
Fire Department -,Bakersfield Fire Deoartment 91!
Police Deoartment - Bakersfield Police Deoartment 911
Bakersfield City Hazardous Materials Division 911
£ta:e 0trice Of' kmeroencv 3erwces (BDO) 852-7550 or (916) 427-4341
EMPLOYEE NOTIFICATION AND 5VACUAII~JN:
Upon recognition of a release, the Duty clerk will verbally (shouting) notify all other site personnel,
The Clerk will ensure the shutdown of his/her area of responsibility (if possible) before evacuating,
This includes elimination of potential ignition sources in the case of the release of fla~able material.
Evacuation will follow the designated routes (if unobstructed) as diagramed on the Site/Plot Plan.
Employees will be notified to evacuate by verbal (shouting) ~thod to a pre-detemined evacuation
staging.area where all employees will be accounted for.
C. PUBLIC EVACUATION:
If evacuation from area deemed necessary, .these neighboring properties will be notified:
NAME ADDRESS PHONE
Sno-White Restaurant 2525 S. Chester Ave. 832-0711
Alex T. W. Restaurant 2625 S. Chester Ave. 831-0281
D. EMERGENCY MEDICAL PLAN:
The primary Company medical facility to treat employees injured by a hazardous materials incident:
Merc~; Hospital 2215 Truxton Ave. 327-337.1,
Additional Clinics and Hospitals:
Sakersfield F~e Dept~
Hazardous Materials D[v~si6~f
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
GASOLINE
A. RELEASE PREVENTION STEPS:
1. Steel ~osts installed to prevent vehicle collision with pumps
2. Vapor Recovery Systems used when filling underground tanks which are of fiberglass construction
3. Dual hose systems on pumps. Anti-lock nozzles at pumps
4. No sales to non-authorized containers
5. No smoking signs posted, self serve instructions posted
6. Tanks checked periodically for leaks by comparing gallonage measurements with sales records
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
1. Preventative diking with absorbent materials
2. Shut off all emergency switches to prevent further spillage
3. Barricade area to prevent possible exposure to general public
4. Avoid personal exposure to fumes/vapors and contact with liquid
5. Eliminate all sources of ignition in area of spill or vapors
6. Absorb liquids with absorbent materials and remove to safe area for evaporation
C. CLEAN-UP PROCEDURES:
1. Notify Circle K Environmental Director (714) 823-0691 for co-ordination with hazardous
waste disposal company to remove contaminated absorbent materials if required
CARBON DIOXIDE
A. RELEASE PREVENTION STEPS: Tanks are stored upright and firmly secured
B. RELEASE CONTAINMENT AND/OR MINIMIZATION: Close valve if safe to do so, open all doors to ventilate
C. CLEAN-UP PROCEDURES: Ventilate area immediately. Contact supplier, if leak in container/valve '
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL GAS/PROPANE: West wall of building, outside (meter)
a. Inside back room of store on bathroom wall (breakers)
b. West wall of building, outside (meter)
ELECTRICAL:
a. West wall of building, outside (mainline gate valve)
WATER: b. North side of site near driveway and sidewalk (meter)
Emergency gas shutoff switch:
SPECIAL: At cashier station on console
LOCK BOX: YES['~'O--") IF. YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A. PRIVATE FIRE PROTECTION:'
Fire extinguishers
B. WATER AVAILABILITY (FIRE HYDRANT):
Northeast corner of site at Dorian Drive
4, FDIS 3
HMMP PLAN MAP
SITE DIAGRAM ~ FACILITY DIAGRAM [-~
Business Name: Circle K Corporation #830
Area Map # l__of 1
~ North Name of Area: Circle K Corporation ~830
2§01 S. Chester Ave., Bakersfield CA
2601 South Chester Avenue, Bakersfiel,
Driveway
Water M · te r'-~'l~) Gao
Pumpe
IOallII O a I I ~eu/lJl~ t <~ Dr Ivewa
Reeldenoe
Reeldonoe ~
Counter Parking
*~Flre --
Reeldenoe ~ Renldenoe
atore #830
2601
8. Cheater
Ave. Drlvew&
neeldenoa
3' Brlok Well
Dirt Lot ~
Reeldenoe
6' Chalnllnk
" Fenoe Alex T.W. Reataurant
S. Chester
~,ve.
CiTY o'1: BAI EI.U:;FIELD
HAZARDOUS HATERTALS INVENTORY
Firm Ind Agriculture Fl Stindlrd Business ~] NON--TRADE SECRETS Pile
US[NESS HAHE: Circle K Co~po~atton ~830 ONriER HAHE: Ct~cle K Co,potation _ HAME OF THZS FACILTTY~~.~Po~aC~.~ .....
OCATlO":. ~6g' S, ~he, ter Avenue ~"~8S: -~". '0. Bo~ 52084 _ ~flfl~fl~Oe~i~SN~ ..... 5~41 ............
CJlY. ZIP:- Bakersfield. CA 93304 CITY- ZlP[~e~~5072 -
frans ]yql P~ I
Avtrpge A ,I H~a~pr, I See InsLru:Ltons
ICode ~oo, AB~ ABt URIne Off e s lemp SLored Iff Facility
, round tanks Gasoline - Regular
I ---I["1 oooo I ooo I C'I
Physical ~nd ,,llh ,amd ~.A.$. Humber 8006-6~-g Component II ,,~e I C.A.~. Humber Toluene ~08-88-3...
IEhect III Lhli ~pplII '
~ [ir~ Hmrd ~ ~e~cLillLl ~ ~l~d ~ Sudden Release ~ I~edlat~ Component I~ Ha~e I C.A.~. Humber Xylene
ilea/t, o/P~essure Ile~lth Co~ponenL I~ ,a~e I C.A.a. ,u,ber ~ethy~tere Butyl Ether 1634-04-4
,- "' Gasoline Unleaded
oooo [ ooo o, , s ,, ,.Oe , o nO -
P~sic~l Iod ,,lih ,si~rd C.~.$. Number 8006-6~.g Component II ~,,~ I C.A.$. Number Toluene 108-88-3
{Check ~11 Lhli ~PP/II
Co~ponenL Ii Hame I C.A.a. Humber Xylene 130-20-7
I/~ Ith of Pressur~
Co~ponen~ I~ hme I C.A.S. Hu,ber ~e~hyl~ert Butyl E~her 1634-04-4
Gasoline - Super Unleaded
10000 5000 36757 365
el mhd Pemlth Pszerd C.A.a. Humber 8006-61-9 -. Component mi Hame S C,A.S, Humber Toluene 108-88-3
k all LhmL epplyl
Component Ii Hame I C,A,S. Humber Xylene 130-20-7
Fire Helsrd F! Rescthit! FI Peleyed F! Sudden Relemse F1 Immediate
Ileelth o! Pressure Ilealth
Component Il Hame I C,A.S. Humber Methyltert Butyl Ethe~
In storeroom, back of store Carbon Dioxide, Carbonic Anhydride
Phvsicml mnd Pe!lLh ~elsrd C.A.a. Humber 124-38-9 Component II Hame I C,A.S, Humber
ICheck ell thaL Ipplyl
Component I~ Hame I C,A.$, Humber
J] Fire Hezerd F! ReecLIvlty '~ Delmyed FI Sudden Release FI Immediate
Ileelth of Pressure IlealLh
Component 13 Hame I C,A,S. Humber
n Lewis District Manager (209)291-5910
EHERGEtlCY COllTACl$ p ! Mike Spinuzzi Zone Manager (805)833-8881 #2Ri litl! II'RFT~(~T
:ubmlLted inlormaLIon Is true, eccurete, eno complete.
~ MIKE SCHUMACHER - DIVISION MANAGER . ~'l~iTute pit!'~l~--'
Farm and Agriculture '--J KERN COUNTY FIRE DEPARTMENT
" HAZARDOUS MATERI ALS INVENTORY
,r~,~ .u DUN
Standard
Business
LOCATION: Z~ ~ ~
CITY, ~~--
zIP:_~,~~~ ~9 CITY, ZIP:~=~. ~
PHONE ~: ~e~ ~ -~0 PHONE ~: (7~&~ 49~ - Ol~O_~_______ __~____ ~_.._~
STANDARD'-~ N~'
RE~ER rO rNsrRocrro~s rOR PROPER CODES
frans [ype Max Average Annual Measure Cont Cont Cont Use % by Names of Mixture/m~ompon~n~s
Code Code Amt Amt Est Units lype Press lemp Code Wt See Instruct ~ons
Health -- .._
~ Fire ~'Delayed Health C.A.S. Nombe, ...... ~_~_~.~)._~ ........
, ......, ,~.!_...~TX~. ~ .~._~ .._~ ~.~_
r-~ r'-n 13) ~ Days
-' ReactiviW u .... ' Sudden Release of Pressure on Site ~ .....
Health ................................................
Fire ~ Delayed Health C.A,S. Number
...............................
~ ....... n ~ .... ~ ...........................
r- '- ~ r -- ~ 13) I Days i~o~m
u__ ~ Reactivity ~ ....' Sudden Release of Pressure on Site ' .....
I
u_. J Immediate _~_~1~ ...... T~ ~_t__.~_~_~.._ ~____~_~
Hea { t h ..... . .......................... ~. ......
~ Fire ~ Delayed Health C.A.S. Number ~ '~'~ L
~ , , .... ~ ~3) ~ Days i~G~m
~---" Reactivity ~-- ~ Sudden Release of Pressure on Site ~ .... ~
____~_~_~.t~_~_~ ................ ~]--.
~- EMERL~ENCY CON1ACTS ~{ ~. m~o~ , mm,~ '-- T~le .....................................
~. ~ 4 ~ .' ,.~._~.~.:_~.~_~..~,~_~.~~ ~ ~ ~ ..................... ...... ~.~ .......................................... ~.*~ ~(~,,~"~,, -~'~"_ ~ .
KGF~--~ . ,~ ,e 2a' [~F'-P~a~-'- _
L
Cer~it~calioq (h'ead and s]~,~ after completJnH all sections)
~i[y~unler~( penalty of law that I have personally examined and am familiar with the information, subm'tted~ in lh~ a~ al1 attached documen.s,r ~_nd that ba~ed~ on m~
~se individuals responsible for o~ining the ~nformation, I believe that the submitted inform~s[l~ru~, accurate, and complete.
~;[T~-dF"6;n~F766~FJ6F-OR-6~fi~FZE~F~aF ~-~6[fi6FT~fa r~F~f~T~ 5{~6~fdF6 ......... "-~~ ................................... 0~(~
INVENTORY CODE SHEET
Trans Code (Column 1) Use Codes (Column 10)
A = Add This Item 01. Additive
D = Delete This item 02. Adhesive
R = Revised Information 03. Aerosol/Inflation
04- Anesthetic
05 Bactericide
Ts~)e Code (Column 2) 06 Blasting
07 Catalyst
P = Pure Material 08 Cleaning
M ="Mixture of Substances 09 Coolant/Antifreeze
W = Waste (Must Also: Add 10 Cooling
Appropriate Waste Code from 11 Drilling
<~Waste Code Sheet") 12 Drying
.- ?-~ 13 EmuisJfier/Demulsifier
~; //~& ~' ~ 14 Etching
":~/M~as__ure Units (Column 6) i5 Experimental/Analytical
~ 16 Fabrication
LBS %l~Pounds 17 Fertilizer
-TON = Tons (2,000 lbs) 18 Formulation/Manufacturing
GAL = Gallons 19 Fuel
BBL = Barrels (42 gals) 20 Fungicide
Ft3 = Cubic Feet 21 Grinding
CUR = Curies 22 Heating
23 Herbicide
24 Insecticide
Container T%~)e (Column 7) 25 Instructional
26 Lubricant
01. Underground Tank 27 Medical Aid or Process
02. Aboveground Tank 28 Neutralizer
03. Fixed Pressurized Cylinders 29 Painting
04. Portable Pressured Cylinders 30 'Pesticide
05. Insulated Tank (Includes 31 Plating
Cryogenics) 32 Preservation
06. Drums or Barrels - Metallic 33 Refining
07. Drums or Barrels - Non- 34 Sealer
Metallic 35 Spraying
08 Carboy(s) 36 Sterilizer
09 Glass Container(s) 37 Storage/In Storage
10 Plastic Container(s) 38 Stripper
11 Box(es) 39 Washing
12 5ag(s) 40 Waste
13 Metal Containers (Not Drums) 41 Water Treatment
14 In Machinery or Processing 42 Welding Soldering
Equipment 43 Well Injection or Service
15. Bin(s) 44 Oil Treatment
16. Unlined Sumps 45 Resale
46 Aircraft Systems
47 Battery/Electrolyte
Container Pressure (Column 8) 48 Breathing Air
49 Drafting Aid
1 = Ambient Pressure 50 Finished Product
2 = Greater Than Ambient Press 51 Fire Protection
3 = Less than Ambient Press 52 Hydraulic Equipment
53 Road/Hwy Maintenance
Container Temperature (Column 9) 54 Testing
4 = Ambient Temperature 55 Wholesale Chemicals
5 = Greater than Ambient 99 OTHER-Specify on
6 = Less than Ambient Temp but not anolher page
Cryogenic
7 = Cryogenic Conditi
Far., and Agriculture "--J KERN COUNTY FIRE DEPARTMENT
HAZARDOUS MATERIALS INVENTORY
Standard 8usiness '~ i)UN ~D [~RflDSi~Fi:~ NI~I.I<
........ ~'- .~O .........
~~ ADDRESS: %1~i ~~ %r
~F~ ~0 I~S~C~IO~S ~o~ ~o~ -~
1 2 3 a 5 6 ? 8 9 10 il
]tans ry~o Max ~verage Annu.]] Measure Cont Cont Cont Use % by Names of
Code Code ~m~ Amt Est Un,ts lype Press l~mp Code ~t See instruct ,OhS
-;:}:;,-J-..~--J_~_~__l_!!~9..l_!~_~___I~J___~L.l~ ..... ~ ..... 1 ..... 5_1 ,q ~ ¢~ ..................................................... ~ ¢~ ~~,.~ .....
~--J Immediate [ ,~ ~-~b~ ~ ~-~~ o~
"~ ~~~ - ~o~.~ .... ~_l~_..~,~
~Fire ~Delayed Health C.A.S. Number ~g6~l~ ................................
...............................
~---' --~ ~), 0~ ~ ............................
~ ....~ Reactivity L__.~ Sudden Re~ease of P~essu~e on Site
.............................................................
t --J Immediate
Health .......................................................
~ J Fire t._J Delayed Health C.A.S. Number
............. F~:: =-.h. .......
r .... ~ r--a 13) $ Days i
~--J Reactivity ~---~ Sudden Release o{ Pressure on Site
L-..J Immediate
Health
r -"-, r --, ...................................................
L_ J Fire L_. , Delayed Health C.A.S. Number
..................................
r .... ~ r .... , 1~) ~ Days t I ......................................................
L___, Reac~ivi[y L J Sudden Release o~ Pressure on Site .......
/ ~'-: ........ : .................................................... ~ .......................................
marne ---r ......................... I ..... Ti~lb-'N ....................................... ~1' RF",~noa6 ....... ~' '
....... ~---~M~ ................................................. , ...............................................................................................
Certification (Read and ,sYNn a/'ter comp.lmtJn~, al] sections) I J
I certify under penalty of la~ that I have personally examined and am familiar with the information submi~~it~ndj aJlJ attached documents ~nd that ba;~d on my
inquiry of those ~ndividuals re~pons~e for obtaining ~e information, I believe ~hat the submitted inf~mation ~ ~r~e, aicurate, and complete[ .... '
Name ano or;~c{a~ t{t/e ct owner/operator UN owner/opeF$[6F s'$~tH~{~6~-F6pF~eS{g[T~6 5~'~atuF6 ............ ~7~~ .......................... 5g{6-~ ......
Farm gricu]ture ~-~ KERN CO~ / ~'I~ DEPARIq~ENT
HAZARDOUS MATI~.RT ALS INVENTORY
RE~R ~0 INStRUCtiONS FOR PROPZR CODES
{ 2 3 4 5 6 7 8 9 10 i I
[rahs [ype Ndx Average Annua] Measure Cont C~t Cont Use ~ by Names of Ni~ture/Co,nponP{~i5
Code Code Amt lit Est Units Iype Press {emp Code Wt See Inbt ruct
~ [ire ~'Oelayed Ilea]th C.A.S. Number ...... ~_~.~.~ ........
c -' Reactivitv ~ -' Sudden Release of Pcessupe on Site ~ ....
~ Fire ~ De{eyed Health C.A.S. Number ....... ~.~.~).~ ........
, ..... ~ {.__ ~.. ~ ..........
L . J Reactivity ~ ' Sudden Release of Pressure ~ Site ........
~ Fire ~ Oelayed Health C.A.S. Number ..... ~.~_t.~ ........
~-" Ne,{c~iv{ty ~-- ~ Sudden Re{e~se ot Pressure on Site ..... '
.............................................. -~-; -~_ ~v ~ ~_~_z~_z ..........
~hqu~]y~o~ t~se individua]~ cespor~sible loc o~ining the ~nfoc~at ,on I believe [hat ~he submitted ~ntocm~{s~ru~, accurate, and comp{i~te; ' ' *
Na~ai ~[t/e of owner/opecatoc uN owner/opecaioF ~-~d~EdFT~dd ce~dd~ad[&[{Od ST~d~(dFd ......... "~ ................................ bJ~d
Form ADprO~e~J OM~ tJo 2050-0C72
Facility Idonllflcallon Ownor/Operntor Name
Tier Two .a.~. CIRCLE K ~I~ ~ ~ 8~n ,,,~, CI~ K ~~T~
EMERGENCY S"..l *.~,.,, 2691 ~_~ C~W M.,, ~0,.,, P-O- ~X 52C94,:: E~,.~.~
AND Clly ~ A~DC~T~T n Slale ~ Z'~ ' ' . .
HAZARDOUS .......... Emergency Conlact ...:.[~;:..L..
CHEMICAL ~ ~R "
INVENTORY N~m. ' Title
/.formation
~y C~,mlc,/ FOR [ ~' ] MI~ SPI~ZZI
j " ..... ,833-888
ONLY at. R~elv~ Phone 24
, Im~o~fin~: ~r.G ~11 Ins~rNcllo~5 ~E]or~ conJ~lE~ln~ JOrm Reporllng Period From J.nu.ry, ,,.,,,I ~o D.ceml~r,, 31,
, ,
...: . Physical Inventory ' Storage codeSand'Locations
.' Chemical Description : and Health ~. ~,. ~o. o~ "~'"{Nofi~COnfldefitlal)"
· . Hazards Dally Dally O~ys .......
' ' Amounl Amount On-alia : · .: .
' S
,:. leh~ ~, t.~ ~v} (coOe) {roOe) (dny~) ~torag* Code " ' torag~ Locatloh~'~'
s~,~ ~ X ~,,. B ~ 4 ~E~~ T~
Sudden
ChaD. Name C~T.T~ o~
ReactlvUy
~ Imm~lale {aCute]
~] Delayed (ch~onlcl
I~1 ~1].' pu~ BI. Solid Liquid O~l '.
S~rel ~ ,,, Fife
~ St dden Release
Chem. Name ., of P~essure
; .O.Cllvlty ~ ~ ~ : ----
: Immediate {acute)
Delayed (chronic}
that opply: Pure Mi~ Solid Liquid Gal
Sudden ~ete~so
Chem. Name of P~essu~e --
Imm~la Is (acute
Oelay~ {chronic)
Check oil ~that --.~ ~ ~ ~ ~
al'F';" Pu, e Mia ~olld Liquid Gal
Ce~llltcallon (filed and J/An a/itt completing nil atctlonJ) :~ ; Optional Allaohmenla (Checl one)
I celllly under ~nalty el law that I have ~rSonally examined and am familiar wilh the Info,marion sub,allied In this and ell ellechN d~umentl, a~ Ihal~ased
~ my I~ulry of I~fl I~lvlduall ~el~llblo I~ obtelnlng the Informally, I ~lleve thai Ihe Sub,~d InlormRllon IS true, sccuta~, a~d c~plele. ' :' ~ I ~lve itllchN I lite plan
PAT ~~ ~~~ DIOR . ~sR, 1 9
, ,.. C~d~nlll ib~evlall~l
Dale
~ ;.~,,,~ and nll.clal lille ~1 OWner/oporal~ O~ owner,'oue, alor' S authorized rep, esenlallve Slgnalure
Signed
:~ 2130 "G" STREET REC._J.ED/
BAKF. RSFIF. LD, CA 93301
(805) 326-39?9 SEP I 1987
Ans'd ............
OFFICIAL USE ONLY ~ ~
USINESS N~E .
HAZARDOUS MATERI ALS
BUSINESS PLAN AS A WHOLE
FORM 2A
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.
SECTION 1: BUSINESS IDENTIFICATION DATA
m. BUSINESS NAME:-~//6'~'~/.~ J~' ~fg_ ~---/~/~/~,'~Z~Z~/C)
B. LOCATION / STREET ADDRESS: ~/~Zg/ 9~', ~~~ ~~/~
CITY: ~~q~A~ ZIP: ~~ BUS.PHONE:
SECTION 2: E~ERGENCY 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 WHOLE
E. LOCK BOX: YES-/~.~3 IF %~ES, 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 TE~ FOR BUSINESS AS A WHOLE
SECTION $: 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:...- .................................... ~ NO ~ NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: .......................... ~ NO ~ NO
C. PROPER USE OF SAFETY EQUIPMENT: .................. Y~ES NO ~) NO
D. EMERGENCY EVACUATION PROCEDURES: ................. NO (~ NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... NO ~ NO
SECTION 7: HAZARDOUS HATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN $00 POUNDS
SOLID, $$ GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES N~
I, /~ ~c-~w*iA~ , 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 8.95
Sec. 25500 Et Al.) and that inaccurate information constitutes perjury.
SIGNA' TITLE . _ DATE
BAKERSFIELD, CA 93301
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 UNITe ~3~) FACILITY b~IT NAME:
SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES
OUR TRAINING PROGRAM INCLUDES FOLLOWING:
1. HOW TO EVACUATE ALL PEOPLE FROM THE SITE.
2. T~.r~PHONENUMBERS FOR FIREDEPARTMENTANDREGULATORY AGENCIES FOR
TIlV~.LYNOTIFICATION. ~
SECTION 2: NOTIFICATION ~%q] EVACUATION PROCEDL"RES AT THIS b~IT ONLY
OUR TRAINING PROGRAM INCLUDES FOLLOWING:
1. HOW TO HANDLE REPORTING AND CLEAN U~ OF UNAUTHORIZED SURFACE SPILLS OF
MOTOR FO-ELS.
2. HOW TO CHECK THE EQUIPMENT AND INSURE IT'S CORRECT USE TO pREVENT
UNAUTHORIZED SPILLS OF MOTOR FUELS.
BAKERSFIELD CITY FIRE DEPARTMENT ':_~"f'~O
I.D. # FORM 4A-1 Page
NON--TRADE SECRETS
HAZARDOUS MATERIALS INVENTORY
BUSINESS NAME: ~----IF"~_../~_ ~" ~~. OWNER NAME: 0_;~/~ ~ ~~ FACILITY UNIT ~: ~3~
ADDRESS:~I ~T~ ~~ ~ ADDRESS:/~D/ ~ 7~~ F'ACILITY UNIT NAME: ~
PHONE ~7 P.3~33~ PHONE ~:~D~>~ ~9/ [OFFICIAL USE CFIRS CODE
- ' -[ ONLY
I 2 3 4 5 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILIT~ UNIT WT. CHEMIqAL OR COMMON NAME CODE GUIDE
,,
NAME: ' TITLE: .~u~~ ~ SIGNATURE: DATE: ~-~-~ 7
_ - 4A-1
' F~.~ .~ BAKERSFIELD CITY FIRE DEP~I~T
- 2130 "G" S~EET
~,~ BAKERSFIELD, CA 93301
(805) 326-3979
USINESS N~ME -
BUSINESS PLAN AS A WHOLE
INS~UCTIONS:
1. To avoid further action, return this form by
2. TYPE/PRINT ANSWERS IN ENG'LISH.
3. Answer the questions below for the business as a whole.
4. Be ~s brief and concise as possible.
SECTION 1: BUSINESS IDE~IFICATION DATA
A. BUSINESS NAME:. ~/~/_.M~ ~ ~__~9~,~~/t~
B. LOCATION / STREET ADDRESS: ~~/ ~. ~7/~~~
CITY: ~Z'~C~~/~ ZIP: ~~ BUS.PHONE:
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 WHOLE
B. ELECTRICAL:
C. WATER: ~er/~,r'. S (c~,,.~a_/((" ~ ~ ~. ~, ~ ~ ~ l~ . __
D. SPECIAL:- ~/R.
~. ~oc~ sox: ~s ~-~ ~s ?~s, SOCAT~0~%
~ ~S, ~0~S ~T C0~TA~ SrT~ ~S~ WS / S0 ~SOSS~ V~S. / ~0
~oo~ ~s~ ~s / so Ksvs~ ~s / ~o
- 2A -
SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE
SECTION $: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOL~R 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:... .................................... ~ NO (~ NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: .......................... (~ NO (~
C. PROPER USE OF SAFETY EQUIPMENT: .................. Y~E NO ~) NO
D. EMERGENCY EVACUATION PROCEDURES: ................. NO (g~ NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... NO ~ NO
SECTION ?: F~ZARDOUS ~ATERIAr.
CIRCLE ~rES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS'OF,~
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES
I,. /~{~ ~K-~w~Am_~~ , certify that the above information is accurate.
I understand that this information will be used to fulfill my firm's obllgatlons 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.
'SIG~'A~~TITLE~DATE~. 2B -
KEOCOUNTY FIRE DEPARTMENT
~5642 VICTOR STREET~
BAKERSFIELD, CA 93308
OFFICIAL USE ONLY
ID~
BUSINESS NAME:
BUS I NESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
l. To avoid further action, this form must be returned by:
2. TY?E/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# ~30 FACILITY UNIT NAME:
SECTION 1: MITIGATION~ PREVENTIO~z ABATEMENT PROCEDURES
Our training program' includes the following:
1. How to handle reporting and clean-up of unauthorized
surface .spills of motor fuels.
2. How to check the motor fuels 'equipment and insure its
correct .use to .prevent unauthorized spills of motor fuels.
3. Unauthorized release of prcduct due to leaking tanks and
product lines is handled by the Environmental Geology
Department.
SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY
Our training program includes, the following:
1. How to turn off all power to pumps.
2. Proper instruction to evacuate all people from the site.
3. Make sure that all five extinguishers have proper service
and maintenance.
4. Emergency list of telephone numbers for Fire Department,
Hospital and Regulatory Agency for timely notification.
BAKERSFIELD CITY FIRE DEPARTMENT
NON--TRADE SECRETS
HAZARDOUS MATERI ALS INVENTORY
~"USINESS NAME:_~--I?"Cf~ /~' ~W~. OWNER NAME: O_/~/~ ~ ~W~ FACILITY UNIT
AODRESS:~dO/ ff~vTA, ~A~~ ~ ADDRESS:/gD/ ~a~ 7~~ F~CILITY UNIT NAME: ~ P_~O
PHONE ~f~)'~.]~3~ PHONE ,:~oa)~z~ ~9/ Io~v~cInn us~ cvr.s coo~
I
I 2 3 4 5 6 7 8 9 10
'YPE ~AX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T
ODE A~OUNT AHOUNT UNIT CODE CODE FACILITy UNIT WT. CHEmiCAL OR CO~0N 'NA~E COD~ GUIDE
MERGENCY CONTACT ~/~ ' TITI. E: ~o~ e ~afP~ PIIONE ~ BUS HOURS:~Yoa-~ ~3 ~
MERGENCY CONTACT: ~~ ~v~mJ~ TITLE: ~-~/C~ ~~ PHONE 9 BUS
: THE ClR L CORPORATION
OCT I9 1987
Ans'd
October 16, 1987 ............
Bakersfield City F~re Department
2130 "G" Street
Bakersfield, California 93301
Gent lemsn:
Enclosed you will find. corrected copies including the
"store plot" plans, of our stores located in the city of
Bakersfield.
If we can be of further assistance, please let us know.
Yours truly,
Pat Wright
Gasoline Facilities Supervisor