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Home My WebLink AboutBUSINESS PLAN 04/14/92 SOUTHERN AUTO SUPPLY. 215-000-001027 Page 1 Overall Site with 1 Fac. Unit General Information Location: 500 OAK ST Map: 102 Hazard: Moderate Community: BAKERSFIELD STATION 03 Grid: 35B F/U: 1 AOV: 0.0 Contact Name ~ Title Business Phone t 24-Hour Phoneq BOB DESHERLIAISTORE MANAGER (805) 325-7444 x 1(805) 322-8769 ~U~=W~¢I4~-. -~ (805) 325-7444 x ](805) ~] Administrative Data Mail Addrs: 500 OAK ST D&B Number: 95-269-9155 City: BAKERSFIELD State: CA Zip: 93304- Comm Code: 215-003 BAKERSFIELD STATION 03 SIC Code: Owner: SOUTHERN AUTO SUPPLY INC Phone: (805) 327-0288 Address: P O BX 2426 State: CA City: BAKERSFIELD Zip: 93303- Summary 04/14/92 SOUTHERN AUTO SUPPLY 215-000-001027 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 MOTOR OIL Liquid 385 Minimal · Fire, Delay Hlth GAL CAS #: 8020835 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: COOLING Daily Max GALI Daily Average GAL I Annual Amount GAL 385 ~ 192.00. 10,000.00 Storage~;Press T Temp Location PLASTIC CONTAINER Iambient~AmbientlSHOP AND DISPLAY AREA -- Conc Components MCP ---TList 100.0% IMotor Oil, Petroleum Based IMinimalI 02-002 GREASE Liquid 95 Minimal · Fire, Delay Hlth LBS CAS #: 8020835 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max LBSI Daily Average LBS I Annual Amount LBS 95 ~ 42.00 . 500.00 Storage~~Press.T Temp Location PLASTIC CONTAINER IambientlAmbient{SHOP AND DISPLAY AREA -- Conc Components MCP ~List 100.0% ILubricating Oil (Petroleum-Based) IMinimal I 02-003 SOLVENTS Liquid 81 Moderate · Fire GAL CAS #: 64741-81-5 Trade Secret: No Form: Liquid. Type: Pure Days: 365 Use: CLEANING Daily Max GAL81I~ Daily Average40.00GAL I Annual Amount240.00GAL Storage~~Press l Temp Location ABOVE GROUND TANK IAmbientlAmbientlSHOP AND DISPLAY AREA -- Conc' Components ~ MCP List 100.0% INaphtha IModeratel 04/14/92 SOUTHERN AUTO SUPPLY 215-000-001027 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-004 FREON R-12 Gas 1190 Minimal · Fire, Pressure, Immed Hlth FT3 CAS #: 75718 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: COOLING Daily Max FT3 I Daily Average FT3 I Annual Amount FT3 1,190 ~ 595.00 11,900.00 Storage Press T Temp Location PORT. PRESS. CYLINDER IBelow ~Below ISHOP AND DISPLAY AREA -- Conc Components ~ MCP List 100.0% IDichlorodifluoromethane IMinimal I 02-005 .ANTIFREEZE Liquid 500 Low · Immed Hlth, Delay Hlth GAL CAS #: 107211 Trade Secret: No Form: Liquid TyPe: Pure Days: 365 Use: COOLANT/ANTIFREEZE Daily Max GALI Daily Average GAL I Annual Amount GAL 500 ~ 250.00 30,000.00 Storage Press T TempI Location PLASTIC CONTAINER AmbientlAmbientlSHOP AND DISPLAY AREA -- Conc Components MCP List 100.0% 'lEthylene Glycol Low ~ I · 02-006 GLUE/CEMENTS Liquid 206 Unrated · Fire, Immed Hlth, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: ADHESIVE --Daily Max GALI Daily Average GAL I Annual Amount GAL 206 ~ 103.00 618.00 ~Stor~geIIPress T Temp Location METAL CONTaINR-NONDRUMIambientJambientlSHOP AND DISPLAY AREA -- Conc Components MCP List 80.0% [AlaPhatic Hydrocarbon {Unrated [ 04/14/92 SOUTHERN AUTO SUPPLY 215-000-001027 Page 4 02 ' Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-007 CAUSTIC SODA Solid 500 Moderate · Fire, Reactive, Immed Hlth LBS CAS #: 1310732 Trade Secret: No Form: Solid Type: Pure Days: 365 Use: CLEANING Daily Max LBS I Daily Average LBS I Annual Amount LBS 500 ~ 250.00 1,500.00 Storage iiPress T Temp ' Location DRUM/BARREL-METALLIC IAmbient~AmbientlSHOP AND DISPLAY AREA -- Conc Components. MCP ---/List 100.0% ICaustic Soda IModeratel 04/14/92 SOUTHERN AUTO SUPPLY 215-000-001027 Page 5 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL FIRE DEPARTMENT 911 <2> Employee Notif./Evacuation EMPLOYEES KNOW IF AN EMERGENCY OCCURS'TO GET EVERYONE OUT OF THE BUILDING AND AWAY FROM SPILL OR FIRE,. AND CALL 911. <3> Public Notif./Evacuation PUBLIC NOT ALLOWED IN BACK OF BUILDING - ANY CUSTOMERS IN THE BUILDING WILL BE NOTIFIED VERBALLY OR OVER THE PA SYSTEM. <4> Emergency Medical Plan NEAREST HOSPITAL 04/14/92 SOUTHERN AUTO SUPPLY 215-000-001027 Page 6 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention ALWAYS KEEP LIDS ON CANS TIGHT AND SEALED ALSO STORAGE CANS ARE IN GOOD SHAPE. WE TRY TO KEEP HAZARDOUS MATERIAL SEPARATE. WE KEEP BAGS OF ABSORBANT HANDY TO PUT ON ANY SPILLAGE. WE ALSO HAVE HOT TANK AND CLEANER OUTSIDE OF BUILDING. <2>.Release Containment SMALL QUANTITIES PACKAGED FOR RESALE. USE ABSORBANT MATERIALS TO PICK UP SPILLS. <3> Clean Up USE ABSORBANT MATERIAL TO PICK UP SPILLS. <4> Other Resource Activation 04/14/92 SOUTHERN AUTO SUPPLY 215-000-001027 Page 7 00 - Overall Site <F> Site Emergency Factors '<1> Special Hazards <2> Utility Shut-Offs A) GAS - NORTHWEST CORNER OF BUILDING B) ELECTRICAL - NORTHWEST CORNER OF BUILDING C) WATER - PARKING LOT AT BASE OF UTILITY POLE D) SPECIAL - NONE· E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - PRIVATE FIRE PROTECTION - FIRE EXTINGUISHES THROUGHOUT THE BUILDING AREAS. FIRE HYDRANT - LOCATED ON THE SOUTHEAST CORNER OF CHESTER LANE AND OAK STREET. <4> Building Occupancy Level 04/14/92 SOUTHERN AUTO SUPPLY 215-000-001027 Page 00 - Overall Site <G> Training <1> Page 1 WE HAVE 15 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: MONTHLY SAFETY MEETINGS <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 2 1991 '~/. HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To 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 o whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA LOCATION: ~'0o 0 ~ ~ MAILING ADDRESS: ~O ~ AV~ DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY' $~~ ~ VTO ~4 grS ADDreSS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE '~ 24 FIR. PHONE 1, FD1590 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 iEXEMPT~ROM ,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!, HAZARD:OUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM"REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, b r~ ~' ,~. CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTANDTHATTHISINFORMATIONWILLBEUSEDTO FULFILL MY.FIRM'S OBLIGATi'ONS UNDER THE "CALIFORNIA":HE'ALTH'AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT 'I'NACCURATE INFORMATION CONSTITUTES P.ERJURY..~ SIGNATURE. D~T'E 2. FD 1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: ~:>U")-~ ~/~,/~ ~I U~'C> SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A.' AGENCY NOTIFICATION PROCEDURES: ' B, EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN' Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: MITIGATION, PREVENTION' ANi~'"~,BATEMENT PLAN: A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' GAS/PROPANE: ~ ELECTRICAL: ~ -' ' SPECIAL: LOCK BOX: YE~) IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FINE PROTECTION: .,, B. WATER AVAILABILITY (FIRE HYDRANT): '4, ~:D1590 Bakersfield Fire Dept. -HAZARDOUS MATERIALS DIVISION Date Completed }0--,~ ~-~'/' Location: ,.-,7,,Z- -~'/ ~/~/~T~-'-~ ,/--/~, RECEIVED BusinessldentificationNo. 215-000 z~n/O,2..7 ('ropof Business Plan) OCT 2 8 199~ Adequate Inadequate Verification of Inventory Materials I~ Verification of Quantities ~ ~ Verification of Location ~ Proper Segregation of Material~ ,~,~,,~ Comments: Verification of MSDS Availablity ]~] Number of Employees Verification of Haz Mat Training ~ Comments: Verification of Abatement Supplies & Procedures I~ Comments: Emergency Procedures Posted ~ Containers Properly Labeled ~ Comments: Verification of Facility Diagram ~ Special Hazards Associated with this Facility: All Items O.K. ~ Correction Needed I~ Business Owner/Manager FD 1652 (Rev, 1-90) White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy ~' - -' ~ RECEIVED 10/23/90 SI tN AU'FO SUPPLY 215-000-0[~27 Page Overall Site with 1 Fac. Unit NOV 1 ~ General Ir, format ior, HAZ MAT. Location: 3231 CHESTER LN Map: 102 Hazard: Moderate Ide'r,t Number: 215-000-001027 Grid: 35B Area c,f Vul: 0.0~ Contact Name. , '1 Title Business Phone ~(805) HUT WATKINS (805) 325-7444 x (805) 871-8153 Mail Addrs: 3231 CHESTER LN ~ D&B.Number:~-- City: BAKERSFIELD State: CA Zip: 93301- Comrn Code: 215-003 BAKERSFIELD STATION .~ IC Code: Address: P 0 BX 2426 State: CA City: BAKERSFIELD Zip: 93303- Summary ~, ~ Do hereby certi~ (lype or print r~-ne) ~ .............. r~';d '~hat k along w~th mer, t plan ,.. ......... ' "'. ~, c :~mp~'te and corre~ agement plan for my 'iaciiity. 10/23190 SOUTHERN AUTO SUPPLY 215-000-001027 Page Hazrslat Inverstory List irs MCP Order 02 - Fixed Containers ors Site Pln-Ref Nar~e/Hazards Fc, r~ Quant ity MCP 02-003 SOLVENTS ? 81 Moderate GAL 02-007 CAUSTIC SODA ? 500 Moderate LBS 02-005 ANT I FREE Z E ? 500 Low GAL ~ ool ~E/OILS ~ 385 Mini~al GAL 02-002 GREASE/~ ? 95 Mini;~al ........ LBS 02-004 FREON ~-18 ? 1~ 190 ~ini~nal FTS 02-006 GLUE/CEmENTS . ? 206 Ur, rat ed GAL 10/23/90 SOUT AUTO SUPPLY 215-000-0 27 Page 3 O0 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification <2> En~ployee Notif./Evacuation EMPLOYEES KNOW IF AN EMERGENCY OCCURS TO GET EVERYONE OUT OF THE BUILDING AND AWAY FROM SPILL OR FIRE, AND CALL 911. <3> Public Notif. /Evacuation <4> Er~ergency Medical Plan NEAREST HOSPITAL 10/23/9£) SOUTHERN AUTO SUPPLY 215-0()()-001027 Page 4 ()0 - Overall Site <E> Mit i gat ion/Prevent/Abater~t <1> Release Prevention ALWAYS KEEP LIDS ON CANS TIGHT AND SEALED ALSO STORAGE CANS ARE IN GOOD SHAPE. WE TRY TO KEEP, HAZARDOUS MATERIAL SEPARATE. WE KEEP BAGS OF ABSORBANT HANDY TO PUT ON ANY SPILLAGE. WE ALSO HAVE HOT TANK AND CLEANER OUTSIDE OF BUILDING. <2> Release Containr~ent <3> Clear, Up <4> Other Resource Activation l~/~d/90 SOUT N AUTO SUPPLY 215-O[~D-D 27 Page 5 ¢)(1) _ Overall Site <F> Site Er~ergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NORTHWEST CORNER OF BUILDING B) ELECTRICAL - NORTHWEST CORNER OF BUILDING C) WATER - PARKING LOT AT BASE OF UTILITY POLE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - PRIVATE FIRE PROTECTION - FIRE EXTINGUISHES THROUGHOUT THE BUILDING AREAS. FIRE HYDRANT - LOCATED ON THE SOUTHEAST CORNER OF CHESTER LANE AND OAK STREET. <4> Held for Future use 10/23/90 SOUTHERN AUTO SUPPLY .-1~-0¢)0-0.1¢)=7 Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 15 EMPLOYEES AT.THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE? ~ . BRIEF SUMMARY OF TRAINING: <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use CITY of BAKERSFIELD F . . ._ HAZARDOUS MATERIALS INVENTORY arm and Ag[iculture [-] Standard Business '1~ : / .' "~,~ ~ A . ~ NON--TRADE SECRETS · Code CODe Ami Amt Esi Unl[s on iype Press Temp Co~eSLored in ~act~lcy See instructions Physical(Check alland[hatHealthapcy)Hazard --- C,A.S. Number_. ~ q~ V'/~ ~/- ¢ Co,,onen[ II Name I C,it5, Number 0 - -~ :: HealLh of Pressure , Componen[ 13 ~ame I C.A.S. Number Physical ~Dd HemlLh Hazard ~ C,A,S. Humber Componen~ ~ Hame & C<A.S. Humber ~ '-~ .... ' (Check all that mpply) ~ ~ire Hazard ~ctivi[y U Delayed U Sudden Release ~m~%~i¢~ Componen[ ,2 Na,e& C.A.S. Nu,ber Has lib of ~ressure , Componen[ 13 Name I C.A.S, Number Ph;;ica] and Health H,zard :' C.A.S. Number Component fl 'Nam;~ C(A.~¢umber ~ ~ , . Component 12 Name I C,A.S, Number / ~ Fire Hazard D Reac[ivity ~ D Sudden~f Pressure Release ComponenL I3 Hame I C,A.S. Number P~,sical and HeaICh ~aTard C.A.S. Number ~1~ Componen[ ,~ Nam;i C~k. SCNum~er 7 Component 13 H~me I C.A.S. Hu~ber ~e T 24 Hr Phone ;erti¢i¢~tioq .(Re~ ¢.n¢.~ign af~¢r-complctipg,all sectipn~) ~~~le of o e IOP~ a 0w .r/operato 'S auC' 'ze' O'"e tiC' e signature CITY of BAKERSFIELD HAZARDOUS MATERIALS INVENTORY Farm andAgticulture 19 Standard Business 19 NON--TRADE SECRETS P~ge BUSINESS NAME- OWNER NAME: NAME OF THIS FACILITY: LOCATION: ' ADDRESS: ' STANDARD IND, CLASS CODE: PHONECITY' .:ZIP': CITY...~ZIP: DUN AND BRADSTREET NUMBER I 2 3 4 5 6 7 8 9 10 11 12 13 Trans !Y~e ,ax Average Annual ,easure 'Sit~YSe Cont ~ont Cont Us Locqtjon?e{e. ?vt Names of ,ixture/Cem:onents Code ~ooe AmC AmC Est Un,ts on Type Press Temp Co~e See Instructions ~torea ~n eac~ty Physical and Health Hazard C.A.S Number ~ Component Il Name ~C.~.S~umbe; / - (Check all that ao;ly) ' --~e Hazard. ~ ReactivitY'- He h~l~d ~ Suddenof Pressure Release ~ ]mmediateC°mp°nen[Heal[h 12 NaaelC.A.S. Number Component 13 Name I C.A.S. Number N8me~ ~hysical and ~e8lCh Hazard l' C,A.S. Number Componen~ I1 C,~,~umber D Fire Hazard D Reactivity D 0elayed-- ~den Release ~mmedi~ec°mp°nen[ Name C.A.S, Number ~ Health of PressureHealth Component 13 Name I C.A,S. Number [~[y~ical- and Health Hazard C.A.S. Numberl'~''~. Component ,I NamelC.[.S~umber--._ {Check 811 Chat app]y} Componen: I~ Name I C,A,S. Number ~ Fire Hazard ~ ReacCivi:y ~ Oelayed ~ Sudden Release ~ lmm~di~e Health of Pressure HealC~ ~ Component 13 Name I C,A.S. Number ~Phvsical and Health ~aTard C.A'.S. Number Component II Name I C.A,S, Number ,(Check all that applyl Componefl: 12 Name & C.A.S. Number ~ Fire Hazard ~ Reactivity ~ OelayedHearth ~ Sud~nof PressureRelease ~ Im~i~ Component 13 Name I C.A.S, Number EHERGEHCY COHTACTS fll Name Title · ~4 ,r Phone Name TlLle 2T Hr P~One ertifi atio Re and f naf C com 1 ting ~l) sections) f ceF~,~, un'er pena,~, o?~ thqt :~,v~:e~sonai~.exa,ln:~aq~:, fami1:ar.,it~ the jnfor,ation :u~eitte~ in this and all a&~acned.d0cument}, mn~ t[mc omseo on.my :nqulry 9i.tnose lnoiviouais responsible tor obtminin9 the lnTormation. I believe that the suDmltteo lntormatlOfl is crum, accurate, mno complete, ~ ~d oficiai t~le of owner/operator oH owner/operatbt'~ authorized representative Signature BAKERSFIELD, CA ~330! ( 005)'. 320-39"/9 i 03_3G~ ID, 001027 BUSINESSFoR~PL~N 2AAS A WHOLE ~¢ ~ 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 SECTION 2: EMERGENCY NOTIFICATIONS In'case of an emersency involving the release or threatened release of a hazspdous material, call 911 and 1-800-852-7550 oP 1-910-427-4341. This will notify ¢.~:¥,:y6ur local flre department and the State Office of Emersency Services as required bY EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE - ~ DURING BUS. HRS. AFTER SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE B. ELECTRIC~L:n -.--.~. n~ . h ~ D. SPECIAL: .%x~ ~ ~ E. LOCK B0X: YES~__~IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - .f SECTION 4: PRIVATE RESPONSE TEAM 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 ATERIALS: ....................................... YES YES C. PROPER USE OF SAFETY EQUIPMENT: ................. : YES YES D. EMERGENCY EVACUATION PROCEDURES: ................. YES ~ YES ~ E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES YES SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 PQ_DgD,~ OF A SOLID, 55 GALLON,~OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ..... I,~%~%~-~, , certify that the above information is accurate. I understand that this information will be used to fulfill my firm's obligations under the new Callfornta Health and Safety. code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. 2!30 "G" STREET BAKERSFIELD, CA 93301 BUSINESS NAHE: BUSINESS PLAN SINGLE FACILITY IINIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE,,'PRIN'T YOUR ANSWERS iN' ENGLISH. 3. Answe? the questions below for THE FACILITY UXIT LISTED BE.LOW 4. Be as BRIEF and CONCISE as possible. · SECTION !: MITIGATION, PR~,~iON, ABATEME}~ PROCEDL~ES SECTION 3: f{AZARDOUS MATERrAES FOR THIS b~."IT A. Does this Facility Unit contain Hazardous }Mteria!s? ...... If YES, see B. If NO, continue with SECTION 4~ B. Are.any of the hsz~rdous materials a bona fide Trade Secret YES If No, complete a separate hazardous materials inventory form m~rked: NON-TRADE SECRETS ONLY (white form If Yes, complete a hazardous materials inventory form marked: ~ADE SECRETS ONLY (Fellow form ~4A-2) in addition to the non-trmde secret form. List only the trnde secrets on form 4A-2. SECTION 4: PRIVA~ FIRE PROTECTION ~ .~, ~ _~:~ LOCATION LOCK BnX: !'E !Y YES , L,.J'"C. kT!O.'.~ : I.D. ~ FORM 4A-1 Page of NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY ~ { ONLY t 2 3 4 5 6 7 8 9 lO TY~E MAX ANNUAL CONT USE LOCATION IN THIS- ~ BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT ~T. CHEMIQAL OR COMMON NAME CODE OUIDE NAME: ..... TITLE: : ~ ~ SIGNATURE: - DATE: EMERGENCY cONTACT: ~ TITLE: ~~ ~ PHONE ~ B{ S:~~j~ AFTER HRS: 3~- EMERGENCY CONTACT: ~~ ~~/~g ~ TITLE: J~ ~. PHONE { BUS HOURS:~~W .... - 4A-{ - 1.0. ~ FORM 4A-! Page of NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BUSINESS; NAME: OWNER NAME: FACILITY UNI, T #:°' ~D~)R'Ess: ADDRESS: FACILITY UNIT NAME: P~O~E ~: PHONE ~: {OFFICIAL USE CFIRS CODE _,[ ONLY 1 2 3 4 5 6 7 8 9 10 TYP~ MAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T CO.~E AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT MT. CHEMICAL OR C~NNON NAME CODE GUID~ NAME TITLE: SIGNATURE: DATE EMERGENCY CoNTAcT: TITLE: { BUS URS: AFTER BUS/ ,,, : EMERGENCY CONTACT: TITLE: PHONE { BUSYHOURS: P~INCIPAL BUSINESS ACTIVITY: AFTER BUS HRS: - 4A-1 - ~ U.S. DEP~RTMENT OF LABOR ~°'< OMB NO. 44-R1387 '~ Occu~tiona~ ~fe~ =n~ ~1~ ~mini~i=n R~uir~ und~ USOC SB~ety end Heal~ R~lafione for Ship Shipbuilding, and Shipbreakiq (29 CFR ~915, 1916, 1917} SECTION I Porter Mfg. & Supply Corp.' ~818) ~8-32~3/333-,57~ 221~ No. Chico Avenue~ South E1 Monte~ C~ 9]733 Chloroprene synthetic rubber/resin ~ASGACINCH Gasket Sealer (GE;) Synthetic rubber[Mixture (confidential~ SECTIO~ H - HAZARDOUS iNGREDiENTS PAINTS, PRESERVATIVES, & ~LVEN~ % TLV TLV ~ni~~ ALLOYS AND ~ETALLIC COATINGS CATALYST ALLOYS VEHICLE M~O ~ETALLIC COATING~ FILLER SOLVENTS Blended 80 ACGIH PLUSCOAT~N= On CO.=.LUX .ODmVES See be[o~ 20 500 OTHERS in ai P TLV HAZARDOUS MIXTURES OF OTHER LIGUIDS, ~EIO~, OR G~E~ % (Uni~) oxides H~ous i'n~:e~ients: Solvent b[en~ (Aromatic and al~phatlc solvents) 80 ACGIH 500 .... 8o~c~m ~Nm (e~.~ SP~c~IC ~Av~?Y (~o~ '0. 8 8' PERCENT, VOkATI~ VAPOR PRESSURE (mm Hg.) ~Y VOLUME (%) EVA~RATION RATE VAPOR DENSITY (AIRol} 2-- ~ ( SOLUBILITY IN WATER~eAllAlbLe aP.eaRANC~.OOOO~ Neutral/amber color. Mobile liquid. Punsent solvent )dor. SECTION iV - F~RE AND EXPLOSION H~ARD DATA 0or. r.c.c. [ EXTINGUISHING MEDIA Carbon dioxide or dry chemical SPECIAL FIRE FIGHTING PROCEDURES ~usun- ~,R[ ~.o=xpuos~o. Hnze.os ngerous when exposem To open flame. Can react vigorously when .exposed to oxidizing materials. PAGE (1) (Continued on ~e~ si~) Form OSHA-20 , ~ . Rev. May 7~ ~ SECTION V - HEALTH HAZARD DATA THRESHOLD LIMIT VALU~ MAC/ACGIH accepted ~00 ppm in air (Maximum allowable concentration) EFFECTS OF OVEREXPOSURE IIeadache~ nausea~ loss of appetite~ bad taste~ lassitude,I impairment of cooridnation and reaction time. EM£RCENCYAmDF~RSTAIDPROC~OURES Inhalation: Remove to fresh air & administe Skin contact: Remove with mineral spirits followed bs soap & water. Eye contact: Flood with larg~ ~uantities of water For ten minutes. I~estion: D0 NOT A~TEMPT .~o e~{~pty stomach.b~, causing SECTIONVI - P~ACTIVITYDATA CALL ~HYSiCtAN .... 5TABILITY C~DITION5 TO AVOID UNSTABLE When heated it emits toxic STAaL~ X Avoid oxidizing materials, Water HAZARDous DECO~POS~T~ON PnODUCTS ...... Qzidizinm mate:~i~ls _, '-' CONO,T'ONS TO AVO,D MAZA~DOUS ~Y OCCUR POLYMERIZATION WILL NOT OCCUR SECTION VII - SPILL OR LEAK PROCEDURES STEPS TO BE TAKEN IN CASE MATERIAL I$ RELEASED OR SPILLED Provide adequate ventilation. .Avoid breathin~ vapors. Use rubber gloves. Soak up spillage with clean~ dr~ rags. WASTE DISPOSAL METHOD Di~p0. se' of in accordance with Federal, State~ County and local regulations. Landfill or incineration. Do NOT incinerate containers SECTION VIii - SPECIAL PROTECTION INFORMATION RESP, RATOR'¥ P~OTECTION [$peci[v.ty~e}] . " --Not require.d if ven~z±a~on is adequ, ate. (See below) LOCAL EXHAUST ~PECIAL ,,~:,,~^r,o~ .General di!ution~ ventilation of ~u. fficient vol.urea.. Keep MECHANICAL {Generalj OTHER !vapor conc. below 500 pp "PROTECTIVE GLOVESNO . 66 6r equal '" I EVE PROTECTION solvent resist~nt B.F, Goods,ch,I Holdfast & Safety glasses w/sidesh eld OTHER PROT~[CTIVE EQUIPMENT _If required~ use Bureau of, Min..es approved TTpe B or~...a, nic v.apor mask or best recommended SECTION IX - SPECIAL PRECAUTIONS / PRECAUTIONS TO [~E TAKEN Jl~ HANDLING AND STORING Keep container tightl~ closed. Store as close as posslble to 70°F. out of direct sunlight. Keep away from heat, sparks, flame, electrical OYHER PRECAUTION5 equipmen[. Avoid breathing of vapors. Avoid prolonged & repeated contact with skin. PAGE (2) Form OSHA-20 GPO 933.54" Rev. May 72