HomeMy WebLinkAboutBUSINESS PLAN 11/5/1991 HM~MP PLA~ MAP
sITE DIAGRAM F%~ FACILITY DIAGRAM
Business Address: 2..~t¢)! %.
For Office Use Only
First In Stc~tion: ~ Arec~ Mc~p # /~:;~ 4 of ~) 77~
Inspection Station: ~-G NORTH
'~ .. Bakersfield Fire Dept.
Hazardous Materials Division RECEIVE''~
2130 "G" Street
Bakersfield, CA. 93301
HAZARDOUS MATERIALS MANAGEMENT PLAN
" 1. ':1'o 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 brief and concise as possible.
SECTION 1' BUSINESS IDENTIFICATION DATA
MAILING ADDREss: .,J~/~ ~ "'
DUN & BRADSTREET NUMBER' SIC CODE:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24 HR. PHONE
2.
FD159(
Bakersfield Fire Dept.
.- Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING:
NUMBER OF EMPLOYEES:
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
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, ~'"~,,7//~- '/~,-' ,..~,,~9~/,-,~/-..4-~'~'' 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.
SIGNATURE TITLE DATE
Bakersfield Fire Dept. ~'~ -~
.- Hazardous Materials Division
HAZARDOUS MATERIALS'MANAGEMENT PLAN "':";:
Facility Unit Name:
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFICATION PROCEDURES:
.',
B, EMPLOYEE NOTIEICATION A~O EVACUATIOn:
C. PUBLIC EVACUATION:
D. EMERGENCY MEDICAL PLAN'
Bakersfield Fire Dept.'
.- Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A. RELEASE/.~ ~-~,¢~/LPREVENTION~z/R'~STEPS:'/~/O
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:'
C. CLEAN-UP PROCEDURES:
NATURAL GAS/PROPANE:
WATER' FF~ ~ ~'>~ ~' w~/L
SPECIAL:
LOCK BOX: YES N~O) IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER A~VAILABILITY:
A. PRIVATE FIRE PROTECTION'
B, WATER AVAILABILITY (FIRE HYDRANT):
4. FD159
Farm andXi[iculture [-]' StandardRusiness I-IHAZARDOUS HATERIALS 'FNVEN~ORY
·,t__ . NON--TRADE SECRETS.
;frans ]y~o Max AvtrHe ~' -Annual Neaspre I Coot Cunt Coot ~e loc4tjon. Whece.
~C~e cOOe A~ Ae: E~t Un,ts on ,~e 1ype Press leno Storeo Iff ~aclllty:~
Physical ond He!lth Hazard ~ C,A,S. N~mber Component II Name I C,A.S. Number
IC~eck
that
appl~)
ComPonent I~' Name I C.A.S. Humber
~ FireHa~ard ~ Reactivity ~Oelayed ~ Suddpfl Release ~ Immediate
Hen/th
Hen
, Component
(Check 41/ &hal
D Fire Hazard D Reactivity ~Oehyed
~ Health of Preisure
Component
Physical and Health Haz4rd
ICheck 811 that appld
Hazard 'n_ Reactivity' mediate Component
D
Fire
.
Component
-, ,
PhYsical'lad Pea)th Ualard
(Check all that apply)
Component
~ Fire Hazard ~ Reactivity
' ' Hen Ith of Pressure
EMERGENCY CONTACT
R~e Tftl~ 2~r Phone'' R~e
at~;ned.d~c~men~., ~ [Ba~ casco
SUO~ltteo~ ~lnlOr~Stl°fl .... tS [roe, accurate,
~.~,,.,., ,,tlc of
FILE CONTE:~TS SUMMARY
FACILITY' ~ , ""
PERMIT # :_~P'~~)Oc)~ ~ -
Activity Date # Of Tanks Comments
HI~MP PLA~ MAP
SITE DIAGRAM FACILITY DIAqRAM
............ - ..................... For Office. Use Only ........ ~ ................ :-
First In Station: Area Map # of
Inspection Station: NORTH
~c .~-..~,,~ ~ Bakersfield Fire De
~~~'~ ' Hazardous Materials Division
2130 "G" S~eet APR 2 6 1991
"Bakersfield, CA. 93301 ns d ............
HAZARDO US MATERIALS'MAN-AGEMENT'-P~A-N-
1. To avoia ~ffher action, return ~is form wi~in 30 aays of r~eipt.
2. ~PE/PRINT ANSWERS IN ENGLISH.
3. Answer ~e questions Delow for the O~ine~ as a whole.
4. Be Drier aha conc~e as po~iDle.
SECTION 1: BUSINESS IDENTIFICATION DATA
MAILING ADORESS: ~~----~
'c. 6 T¢,.~
DUN 8/, BRADSTREET NUMBER' SIC CODE;'
PRIMARY ACTIVITY: C.X~~'~,V~ ' C~-k~.~ /
OWNER:
MA~UNG Aa~ESS:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS. PHONE 24 HR. PHONE
,,~
2. ~: ~A/M~i~ m'*~h~e 3:-'1.5i:
Bakersfield l~Lre Dept.
Hazardous Materials Division
....-HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 3: TRAINING:
NUMBER OF EMPLOYESS'
MATERIAL SAFETY DATA SHEETS ON FILE:
BRIEF SUMMARY OF TRAINING PROGRAM:
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.
/
-' V/ WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
I, "~,~5~...,\ [ ~C:~ CERTIFY THAT THE ABOVE INFOR-
MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO
FULFILL MY FIRM'S O8LIGATiONS UNDER THE "CALIFORNIA HEALTH AND SAFETY COOE"
ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) ANO THAT
~/SIGNATURE ~ . TITLE /" DATE
2.
Bakersfield Fire Dept.
Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A. AGENCY NOTIFICATION PROCEDURES;
B. EMPLOYEE NOTIFICATION AND EVACUATION:
C. "PUBLIC EVACUATION:
D. EMERGENCY MEDICAL PLAN:
Bakersfield Fixe Dept. ~.~ .~-
Hazardous Materials Divisfl
· "" "HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENT[ON AND ABATEMENT PLAN:
.... : .................... A i ........ ~'R ELLA'S E P REV ENTIO N STEP S ................................. '~ '" -:--~ ................. - .........
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
C. CLEAN-UP PROCEDURES: ,..]OY~AL~ ~ -[E)¢-- O'il ~'~,~ ;[~-$
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)'
NATURAL GAS/PROPANE: 'Q~% ~ [('] LL~,, "'
ELECTRICAL:
WA'r r ' 5, "
SPECIAL:
LOCK BOX: YES/N IF YES, LOCATION:
SECTION 9:. PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A. PRIVATE FIRE PROTECTION:
· hLtdro_n~, aaei
.. B. WATER AVAILABILITY (FIRE HYDRANT)',
CITY of BAKERSFIELD
( HAZARDOUS MATERIALS INVENTORY
Farm and AgticulLure I-I Standard Business [] Pa'~e .... of ___~'_
NON--TRADE SECRETS
LOCATION; ~ ~ ~t~c ~ ' . ADDRESS; Z~I S n~S ~ STANDARD IND. L SS DE:
CIY
. REFER TO~~UCTZONS~R~ CODES --
, 2 3 4 , 5 6 , 8 g lO 11 12"t-13y
Trans lyre Hax Average ~ Aflnual ~easure I ~y~ Cone Cont Cen~ Use LocaCjon. Nhece.
of
~ixture/Co~onents
Code ~ooe Amt ACt Est Units on ~te Type Press Tem~ Code Stored .~n ~ac~ty 5em Instructions
Physical and Health Hazard ~ C.A,5. Humber Co~ponenC I1. Name ~ C.A,S. Number
(Check all that apoly)
, Component 12 Hame & C.A.S. Number
~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ ]~ed}ate
HeaTth of Pressure Health ~ '
Co~ponent ~3 Ha~e ~ C.A.S, Humber
Physical iod Health ~aTard C,A.S. Number Component I1 Name & C,A,S, Humber
(Check al/ that app~y~
Component 12 Name & C,A,S, Number
~ Fire Hazard ~ Reactivity~; ~ OelayedHearth ~ Suddenof Pre'ssureRelease ~ Immediate ,...
Health. Component 13 Name t C.A.a. NuAber
Physical and Health ~alard
tCheck 8/I that applyl E' '
~ Fire Hazard 'u Reacti ity ~ Belayed ~ Sudden Release ~ Immediate
Health of Pressure
Health
Physica.l.'.and Health Ua~ard ~ C.A,S. Number Component I1 Hame I C,A,S, Number
{Check 4//that apP/y~[ :
Component f~ Name A C.A.S, NuAber
~.Fire ~4zard ~ Reactiyity~/ ~ Belayed ~ Sudden Release ~
' ,' Health of Pressure
~ Component 13 Name &, C.A.S, Humber
EHERGENCY CONTACTS fll ,.
~e TTtle 'z4 Hr ~hone ~e Tttle
fertifjatioq .(Re~ a.n~.~ign after compl~tipg.al7 secti,on~)
cer[~ty under pena~t~ gl~a~ tn{t~ nave pe~sonald, examlnqoaqa ~ rami~r.vi:~ the in,or,ac]on ~u~ai:te~ in this and a]]
~~~~ of ownetiopierat6r, u~ owner/oper~tor's authorized representative