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Home My WebLink AboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit . CONDITIONS~OF,-PERMIT ON REVERSE SIDE This permit is Issued for the followina: E! Hazardous Materials Plan E] Underground Storage of Hazardous Materials Permit ID #:: 015-000-001830 n Risk Management Program FLOYDS STORES INC = Hazardous Waste On-Site Tmatrmmt LOCATION: 3940 CHESTER AVE OFFICE OF ENVIRONMENTAL SER VICES' ' " ' ' ~ ~ ' 1715 Chester Ave., 3rd Floor Appr°vedby: ' .Bakersfield, CA 93301 . :,:., OmceofEvimnm~t~Services ~ Voice (661) 326-3979 '~, ' FAX (661) 326-0576 . ,. Expimtion Date: 'Jul~e 30=. 2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ......... ,,,,~,~,~,,;~?~:~,,,~,,,m ................ This permit is issued for the following: ,?~!?: ~!i~ ;?':::;i iiiii!!iii~,, .,~ ili~ iill iiii;;::':i i!ii~iiJ~F~erground Storage of Hazardous Materials ~ F~ ~ ~ ? ..,~ ~ ..... ~, ~ ..... ~ .~ ~L'~=: '~.~'~][~:. Z?~ .~.~ ....... ~ .~,~ ~ LOCATION 3~0 CHESTER ~*?',J':~i;':;,;,~,.....'??'?' AKERS~I~LD CA. ~?'.:5'-~'~'~ ...... ~?~ ."~'~:,~,,~,..Z't:::~:'.~;;~.~Z:,.;:~.~;~,~ii~':':i~""% :~..=._' ' ~i. $ ~ ....... ~ ... '.7' ', "~ /~' [ssu~ by: B~er~field Fke Depa~ment Approved by: ~~'~~' OFFICE OFfeR ONe.AL S~ ~CES 1715 Chewer Ave., 3rd Floor · Office of ~enml S~i~ B~e~fiel~ CA 93~01 Voice (805) ~26-~979 F~ (80S)~26~S76 Expiration Date: ~Un~ ~O~ ~OO0 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 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 a whole. 4. Be as brief' and concise as possible. ................. 5.' You may also attach'Business Owner/Operator Form and Chemical~ DescriptionForm(g) ................... to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~L~G ~D~SS: CITY:~~~ FI~ P~Y ACTIVITY: OWNER: PHONE: MAILING ADDRESS: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE 2. ELV~ ~* A~g~~~ ¢l) ~Z7-fi/c~ ~bl) HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: l. l:?l :ql: :'' . HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-~ ~ ~COVERY PROCED~S: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) · - NATURAL GAS/PROPANE: ELECTRICAL: SPECIAL: LOCK BOX: YES/NO IF .YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUhdMARY OF TRAINING PROGRAM: CERTIFICATION I, ~CL(~ ~)d.~.f'~ CERTIFY THAT THE ABOVE INFORMATION 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 PEPUURY. SIGNATURE TITL~ DATE 4 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS INVENTORY INSTRUCTIONS CHEMICAL DESCRIPTION FORM Make as many copies of the chemical description form as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons ora liquid, 500 pounds ora solid or 200 cubic feet ora gas. Report any amount of any hazardous waste being generated or handled on site. I. FACILITY INFORMATION: Check the appropriate box for a new inventory or for additions, revisions or deletions to an existing inventory. Enter the business name at the top of the form. Enter the page number in the right hand corner. Describe the exact location of the hazardous waste or material being reported. NOTE: Chemical location int`ormation is considered confidential unless you check "no." Ifa site map is being submitted, you may refer to the map number and grid coordinates for the approximate location of the material, as shown on the map. II. CHEMICAL INFORMATION: Each of the instructions below correspond to the entry field with the same number on the chemical description form. CHEMICAL NAME 205 Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the International Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS): NOTE: Ir'the chemical is a mixture or a hazardous waste, do not complete this field; complete the "common name" field instead. TRADE SECRET 206 Check "Y" for yes if the information in this section is declared a trade secret, or "N" for no, if it is not. State requirement: If yes, and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by Health and Safety Code, Section 25511. Federal Requirement: If yes, and business is subject to EPCRA, disclosure of the designated Trade Secret int`ormation is bound by Title 40 Code of Federal Regulations (CFR) and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. COMMON NAME 207 Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. EHS 208 Check "Y" for yes if the hazardous material is an Extremely Hazardous Substance (EHS), as defined in 40 CFR, Part 355, Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. CAS # 209 Enter the Chemical Abstract Service (CAS) number for the hazardous material. For mixtures, enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number, leave this column blank and report the CAS numbers of the individual hazardous components in the section below. FIRE CODE HAZARD CLASSES (Please leave blank) 2 I0 HAZARDOUS MATERIAL TYPE 21 Check the one box that best describes the type of hazardous material: pure, mixture or waste. If waste material, check only that box. If mixture or waste, complete hazardous components section. RADIOACTIVE '~. 212 Check "Y" for yes if the hazardous material is radioactive or "N" for no, if it is not. CURIES 213 If the hazardous material is radioactive, use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. PHYSICAL STATE 214 Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gaseous (gas). LARGEST CONTAINER 215 Enter the total capacity of the largest container in which the material is stored. FEDERAL HAZARD CATEGORIES 216 Check all the physical and health hazards associated with the hazardous material: PHYSICAL HAZARD's: Fire: Flammable Liquids and Solids, Combustible Liquids, Pyrophorics, Oxidizers Reactive: Unstable Reactive, Organic Peroxides, Water Reactive, Radioactive Pressure Release: Explosives, Compressed Gases, Blasting Agents HEALTH HAZARDS: Acute Health (Immediate): Highly Toxic, Toxic, Irritants, Sensitizers,Corrosives, other hazardous chemicals with an adverse effect with short term exposure. ChrOnic Health (Delayed): Carcinogens, other hazardous chemicals with an adverse effect with long term exposure ANNUAL WASTE AMOUNT 217 If the hazardous material being inventoried is a waste, provide an estimate of the annual amount handled. MAXIMUM DAILY AMOUNT 218 Enter the maximum amount of each hazardous material or mixture containing a hazardous material, which is handled in a building or adjacent/outside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. AVERAGE DAILY AMOUNT 219 Calculate the average daily amount of the hazardous material or mixture containing a hazardous material, in each building or adjacent/outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location, the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. STATE WASTE CODE 220 If the hazardous material is a waste, enter the appropriate California 3odigit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. A list of common State Waste Codes are included on page 4 of these instructions. UNITS 221 Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amounts must be reported in pounds. If material is a mixture containing an EHS, report the units · that the material is stored in (gallons, pounds,.cubic feet, Or.tons). · DAYS ON SITE 222 List the total number of days during the year that the material is on site. STORAGE CONTAINER 223 Cheek all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE: If appropriate, you may choose more than one. STORAGE PRESSURE 224 Check the one box that best describes the pressure at which the hazardous material is stored. STORAGE TEMPERATURE 225 Check the one box that best describes the temperature at which the hazardous material is stored. HAZARDOUS COMPONENT I - 5 (% by weight) 226, 230, 234, 238,242 Ifa range of percentages is available, report the highest percentage in that range. ' HAZARDOUS COMPONENT 1 - 5 Name 227, 23 I, 235, 239, 243 When reporting a hazardous material that is a mixture, list'up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater than 1% by weight if non- carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If more than five hazardous components are present above these percentages, you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures, mineral and chemical composition should be listed. HAZARDOUS COMPONENT I - 5 EHS 228, 232, 236, 240, 244 Cheek "Y" for yes if the component of the mixture is considered an Extremely Hazardous Substance as · ' defined in 40 CFR, 'Part 355, or "N" for no,' if it is not. HAZARDOUS COMPONENT I - 5 CAS 229, 233,237, 241,245 List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture. III. SIGNATURE: 246 Please print name, title, sign and date each chemical description form. If you have any questions please call us at (661) 326-3979 CALIFORNIA WASTE CODES Code Description Code Description Inorganics 241 Tank bottom waste 111 Acid solution 2 < pH < 7 with metals 251 Still bottoms with haiogenated organics (antimony, arsenic, barium, beryllium, 252 Other still bottom waste cadmium, chromium, cobalt, copper, lead, 261 PCB's and material containing PCB's mercury, molybdenum, nickel, Selenium, silver, 271 Organic monomer waste (includes unreacted thallium, vanadium and zinc) resins) 112 Acid solution without metals 272 Polymeric resin waste 113 Unspecified acid solution 281 Adhesives 121 "Alkaline solution pH >12.5' xqithmetalS (s~e ...... 291 La~ex"waste 111) 311 Pharmaceutical waste 122 Alkaline solution without metals 321 Sewage sludge 123 Unspecified alkaline solution 322 Biological waste other than sewage sludge 131 Aqueous solution (2 < pH < 12.5) containing. 331 Off-spec, aged or surplus organics reactive anoins (azide, bromate, chlorate, 341 Organic liquids (nonsolvents) with halogens cyanide, fluoride, hypochlorite, nitrite, 343 Unspecified organic liquid mixture perchlorate and sulfide anions) 351 Organic solids with halogens 132 Aqueous solution with metals (see 111) 133 Aqueous solution with total organic residues Sludges 10% or more 411 Alum and gypsum sludge 134 Aqueous solution with total organic residues 421 Lime sludge less than 10% 431 Phosphate sludge 135 Unspecified aqueous solution 441 Sulfur sludge 141 Off-spec, aged, or surplus inorganics 451 Degreasing sludge 151 Asbestos containing waste 461 Paint sludge 161 FCC Waste 471 Paper sludge/pulp 162 Other spent catalyst 481 Tetraethyl lead sludge 171 Metal sludge (see 111) 491 Unspecified sludge waste 172 Metal dust and machining waste (see 111) 181 Other inorganic solid waste Miscellaneous 511 Empty pesticide containers 30 gal or more Organics 512 Other empty container 30 gal or more 211 Halogenated solvents (methylene chloride, 513 Empty containers less than 30 gal chloroform, TCE, TCA) ' ' 521' Drilling mud 212 Oxygenated solvents (acetone, butanol, MEK) 531 Chemical toilet waste 213 Hydrocarbon solvents (stoddard solvent, 541 Photo chemical/photo processing waste xylene) . 551 Laboratory waste chemicals 214 Unspecified solvent mixture 561 Detergent and soap 221 Waste oil and mixed oil 571 Fly ash, bottom ash, and retort ash 222 Oil/water separation sludge 581. Gas scrubber waste 223 Unspecified oil - containing waste 591 Baghouse waste 231 Pesticide rinse water 611 Contaminated soil from site clean-ups 232 Pesticide and other waste associated with 612 Household wastes pesticide production 4 ICE OF ENVIRONMENTAL RVIC, ES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per mate~fal per building oF.area) []NEW DADO DELETE 200 Page L BUSINESS ~ME (Same as FACILI~ ~ME ~ ~BA - D~ng Busin~ ~) 3 FACILI~ ID ~ ~ ~ ] I ~P ~ (op~naO 2~ 205 T~DE SECRET ~ Y~ ~ No 206 CHEMICAL ~ME If Subj~ to EPC~, refer to inst~ions CAS ~ ~9 *[f,~S ~s'Ym," ~ FIRE ~DE H~RD C~SSES (~mplete if ~u~t~ ~y I~1 fire ~ie~ 210 ~PE ~ p PURE ~ MIXTURE ~ wWASTE 211 ~ ~DIOACTIVE ~Y~ ~ 212 i CURIES 213 ~FIRE ~ 2 R~CTIVE ~ 3 PRESSURE RELEASE ~ 4 ACU~ H~L~ ~ 5 CHRONIC HEALTH 216 FED H~RD CATE~RIES (Ch~k all that apply) UNITS* ' If EHS, amount must be in lbs. STOOGE CONTAINER ~ a ABOVEGROUND T~K ~STI~NONMET~LIC DRUM ~ i FIBER DRUM ~m~SS BO~LE ~ q ~IL CAR 223 (Check ag ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~ j BAG ~n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WAGON STOOGE PRESSURE ~MBIE~ D aa ABOVE AMBIE~ Dba BELOW AMBIE~ 224 STOOGE TEMPE~TURE ~MBIE~ D aa ABOVEAMBIE~ ~ ba BELOW AMBIENT ~ c CRYOGENIC 225 1 ~ 226 227 ~ Y~ ~ No 228 22g 230 '231 Q Y~ ~ NO 232 233 ~ ~5 ~Y~No 236 237 ~8 239 ~ Y~ ~ NO 2~0 24J 242 243 ~ Y~ ~ NO 2~ 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/9g) S:\CUPAFORMS\OES2731 .'rV4.wpd OF ENVIRONMENTAI RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per matedal per building ~.area) [] NEW I~ ADD [] DELETE R~EVISE 200 Page _'~ of 3 ~- ] BuSI~ss NAME (Same as FAClLffY NAME or DBA - Doing Business As) 3 L 201~ · - CHEMICAL LOCATION CHEMICAL LOCATION [] Yes ~ 202 I; ' CONFIDENTIAL (EPCRA) t CHEMICAL ~ME If Su~j~ to J~CB, mf~r Io insl~io.s FIRE CODE H~D CBSSES (~mplete if requ~l~ by t~l fire ~ieQ 210 ~PE 213 PHYSI~L STATE . ~ s SOLID UID ~ g ~S 214 _~ 215 FED ~RD ~TEGORIES ~ 1 FIRE ~ 2 R~CTIVE ~ 3 PRESSURE REL~SE ~C~ H~LTH ~ 5 CHRONIC H~LTH 216 (Ch~ all that apply) A~UNT DAILY A~U~ DAILY A~U~ ~ DAYS ON SITE STa~aE CONTAINER ~ a A~OVEa~OUNO T~K ~ e P~STI~ONM~ALLIC DRUM ~ i FinER DRUM ~SS BO~LE ~ q ~IL ~ (Check all that apply) ~ ~ UNDERGROUND TANK ~ f CAN ~ j BAG ~n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ g TANK WAGON STOOGE PRESSURE ~IE~ ~ aa ABOVE A~IENT ~ ba BELOW AMBIENT 224 STO~GETEMPE~TURE ~MBIE~ ~ aa ABOVE AMBIE~ ~ ba ~ELOWAMBIENT ~ c CRYOGENIC 225 ~ ~ 228 , 227 ~ Y~ ~ No 228 22g 230 ~1' ~ Yes ~ No 232 1 233 2~ 235 ~ Y~ ~ No 236 237 238 ~9 ~ Y~ ~ No 240 241 242 243 ~ Y~ ~ No 2~ 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7~99) S:\CUPAFORMS\OES2731.TV4.wpd ~F CITY OF BAKERSFIF~) ICE OF ENVIRONMENTAE'SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 "~'~"~'"'~-'"' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one [o~ per ~edal per ~i/dlng ~ ~a) BUSINESS ~ME (S~e as FAClLI~ ~ME ~ OBA - D~ng Busin~ ~) 3 , CONFIDE~IAL (EPC~) FACILI~ ID ~ ~ ' ~ ] ' 1 ~P g (op~naO 203 GRID ~ (op~naO 2~ ........ ........... .... . ..... .,.. :,;. ....... :=~- :~..11. CHEM C~INFORMATI N ..... ", ':' : , . ' - ~ .... ''.' : . ' ~l; . ['~' ~'t.['::: ~: :,[[', ".1 ::~:' 7:':~t[[~ ?~ z~'~.~.~'"~:~? ]t':~ : .... ,:t ;:.,t;/. ::',. ~,~: ... ;,.:-:U:~:t:~'~2; :~;~:%:~::~::~.:'.:~:~ ,::'5'', ..:~;;: ':~ .:. ',~:,..~: .~* .~:~- ~:.:, :.: CHEMICAL ~ME ~ If Subi~ tO EPC~ ref~ to COM~N ~ME ~ y~ FIRE CODE H~RD C~SSES (~plete if ~u~t~ by I~1 fire ~ie0 210 FED ~RD ~TE~RIES D 1 FIRE ~CTIVE D 3 PRESSURE RELEASE ~C~ HDL~ D 5 CHRONIC HEALTH 216 (Ch~ ali that apply) A~GE 219 STATE WAS~ CODE 220 A~U~ [ DAILY A~U~ UNITS' D ga GAL ~ d CU ~ ~LBS ~ tn TONS 221 DAYS ON SITE 222 STOOGE CONTAINER ~ a ~OVEGROUND T~K ~ e P~STI~NMETALLIC DRUM DJ~ER DRUM D m G~SS BO~LE ~ q ~IL ~R ~3 (Check afl ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~ BAG ~ n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TO~ BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANKWA~N STOOGE P~SSURE ~ A~IE~ ~ aa ABOVE AMBIE~ ~ ba BELOWA~IE~ ~4 STOOGE TEMPE~TURE ~MBIE~ ~ aa ABOVE A~IE~ ~ ba BELOW A~IENT ~ c CRYOGENIC I 229 2 ~ ~0 ~1 ~Y~ ~No~2 2~ ~ ~ ~5 ~Y~No 236 3 237 ~8 239 ~ Y~ ~ No 240 241 242 243 ~ Y~ ~ No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731,TV4.wpd ICE OF ENVIRONMENTAL-nJERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 "'"~'~~~"~ ~-'""' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fearn per material per building ~£.area) ONEW OADO ODELETE 200. BUSINESS ~ME (Same as FACILI~ ~E ~ DBA - ~ng Busin~ ~) 3 201 CHEMI~L LO~TION CHEMICAL EDITION , CONFIDE~L(EPC~) '~ Y~ FACILI~ ID ~ ~ ~] I ] ' ' 1 ~ g (op~naO 203 ~ GRID ~ (op~naO CHEMICAL ~ME ~ If Subj~ to EPC~ refer to instm~i~s CAS~ ~ J~:~;,:~:~:~: ~ '~::.':' Z' · ~ : ~ ' ': .'~ FIRE CODE H~D C~SSES (~plete if ~u~ by I~1 fire ~ie0 210 ~PE OpPU~ ~ MI~URE ~ w WASTE 2111 ~DIOACTIVE ~y~ ~ 212 ~ CURIES 213 ~RGESTCONTAINER l G P.YSlC~STA~ Os SOLID ~IQUID O g ~S 214 j -- FED ~RD ~TE~RIES ~ 1 FIRE ~ 2 ~CTmVE ~ 3 PRESSURE RELEASE ~CU~ H~LTH ~HRONIC H~LTH 216 (Ch~ ~1 that apply) A~u~ANNUAL WAST. 21' l DAILYA~U~,~ ~ !DAILY A~UNT U UN~TS' ~ ~L ~ ~ CU ~ ~ lb LBS ~ tn TONS 221 DAYS ON SITE 222 ' If EHS, amounl must be in lbs. STO~E CONTAINER ~ ~ ABOVe,ROUND T~K ~ e P~TI~NONMETALLIG DRUM ~ i FIB6R DRUM ~SS BO~L~ ~ b UNDERGROUND TANK ~ f CAN ~ j BAG ~ n P~ST~C BO~L~ ~ r OTH~R ~ c TANK INSIDE BUILDING ~ g ~RBOY ~ k BOX ~ o TOTE BIN ~ d STEEL DRUM ~ h SILO ~ I CYLINDER ~ ~ TANK WA~N STO~GE PRESSURE ~E~ ~ aa ABOV6 AMB~E~ ~ ba BELOW A~I~ 224 STO~GE TEMPE~TURE ~IE~ ~ aa ,ABOVE A~IE~ ~ ba BELOW A~IENT ~ c CRYOGENIC ~5 ~ ~Y~ ~No 228 229 2 ~ 230 231 ~Y~ ~No~2 233 ~ ~ ~5 ~Y~No 236 3 237 ~ 239 ~ Y~ ~ No 240 241 242 243 ~ Y~ ~ ~ 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4-wpd ~F CITY OF BAKERSFIF~ /'[' r ~ ICE OF ENVIRONMENTAL"~JERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fo~ per m~al per buSding o~a) D NEW ~ ADD ~ DELETE ~ISE 200 Page ~ of BUSINESS ~ME (Same as FACILI~ ~E ~ DBA - D~ng Busin~ ~)-"3, CHEMICAL LOCTION ~1 CHEMICAL LOCTION ~ FAOILI~ ID ~ ~J ~ I j 1 ~ ~ (~naO 203 [ GRID ~ (op~naO 205 f T~DESECRET ~ If Subj~ to EPC~ refer to instm~i~s COM~N roME ~ D Y~ FIRE CODE H~RD C~SSES (~plete if r~u*t~ by I~1 fire ~i~ 210 PHYSICAL STATE O S SOLID ~UID OgO'S 214 ~~RGEsT ~NTAINER I-- q~L 215 I FED ~RD ~TE~RIES D1 FIRE ~¢IVE ~3 PRESSURE ~L~SE ~C~ H~L~ ~HRONIC HE~TH 216 (Ch~ all that apply) ' ~GA UNITS* L ~ ~ CU ~ ~ lb LBS ~ m TONS 22a D~YS ON SlIE 222 * tf EHS, am~nt must be in lbs. STOOGE CONTAINER O a ABOVEGROUNO T~K O e P~TI~ONM~LIC DRUM O i FIBER DRUM O~SS BOWLE O q miL ~R (Check all ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~ j BAG ~n~P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CAR~Y ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE P~SSURE ~a A~IE~ ~ aa A~VE AMSlE~ ~ ba SELOWA~IE~ STOOGE T~EgTURE ~AMBIE~ ~ aa A~VE A~IE~ ~ ba BELOW A~IE~ ~ c CRYOGENIC 225 2 i 230 23a ~ Y~ ~ No 232 233 3 ~ ~ ~5 OY~O"O 236 ~7 I 4 ~ 239 ~ Y~ ~ No 2~ 24~ 5 242 243 ~ Y~ ~ ~ 244 245 PRI~ ~ & TITLE OF A~ORIZED ~MPA~ REP~SE~AT~E SIG~TURE DA~ UPCF (7/99) S:\CUPAFORMS\OES2731.TV4-wpd FICE CITY OF BAKERSFIF OF ENVIRONMENTAL'SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per ~jatedal per building Dj_area) BUSINESS ~ME {Same ~ FACIU~ ~E ~ DBA - ~n9 ~n~ ~) 3 201 CHEMI~L LO~TION CHEMI~L LO~TION , CONFIDE~IAL (EPC~) FACILI~ ID ~ 1~' ~ I J ' t ~ ~ (~naO 203 ~ GR O ~ (op~naO ,. ~ ~ ........ s~ ~. ~ ~ :i. CHEMICALINEORMA~ION . ~ CHEMI~L ~E ~ If Subj~ to EPC~ ref~ to instm~ions 207 ~ FIRE CODE H~EO C~SSES (~plete if ~u~t~ by I~1 fire ~ie0 210 PHYSICAL STAR DUO ~ I ~ GAS ~ ~ROEST ~AINER 215 (Ch~ ~1 that apply) IRE ~ 2 R~CTIVE ESSURE REL~E ~ 4 ACU~ H~LTH 0 5 CHRONIC H~LTH 216 ~IMUM 2~8 A~GE ' ' 219 STATE WASTE CODE ~0 ANNUAL WASTE 217 A~U~ , DAILY A~U~ I DAILY A~U~ UNITS* ~ ga GAL ~ d CU ~ LBS ~ tn TONS 221 DAYS ON SITE 222 STOOGE CONTAINER ~ a ABOVEGROUND T~K ~ e P~STI~ONMET~LIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~ 2~ (Check ag ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~j~G ~ n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g ~OY ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N : SIO~GE PRESSURE ~IE~ ~ aa ABOVE AMBIE~ ~ ba BELOW AMSlE~ 224 STOOGE TEMPE~TURE BIE~ ~ aa ABOVE A~IE~ ~ be BELOW A~IE~ ~ c CRYOGENIC 225 i'..,, 2 ~ ~0 ~1 ~Y~ ~232 233 3 ~ 237 ~8 239 ~ Y~ ~ No 240 24~ 242 243 ~ Y~ ~ No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd D ~F CITY OF BAKERSFIF~ ICE OF ENVIRONMENTAL"~ERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 "~~'~-~' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fo~ per matedal per building or ama) ~ NEW ~ ADD ~ DELETE VISE 2~ Page BUSINESS ~ME (Same as FACILI~ NAME ~ D~ - ~ng Bu~n~ ~) 3 CHEMICAL LO~TION ~ - - ~ ~ ~ ~ FACI[IW ID n $~ * ~ ! ~ [ 1 ~P ~ (op~naO 203 GRID ~ (Opt~naO 205 I T~DE SECRET _ CHE~CAL ~E ~ If Subj~ to EPC~, refer ~7 } FIRE ~DE ~RD C~SSES (~mplete ~ ~u~t~ by I~1 fire ~i~ 210 ~M I ~ CURIES 213 ~PE ~ p PURE I~RE ~ w WASTE 211 ~ ~DIOACTIVE ~Y~ 212 ~ 1 FI~ ~ 2 R~II~ ~ 3 P~SSURE REL~SE ~AC~E H~LTH ~ 5 CHRONIC H~TH 216 FED H~RD ~TE~RIES (Ch~ all ~at apply) · ~ EHS~ am~nt must be in lbs[ STOOGE CONTAINER O a A~VEGROUND TANK O e P~TIONON~TALUC DRUMED i ORUM ~ m G~SS BO~LE ~ q (Check afl ~at apply) ~ b UNDERGROUND TANK ~ f ~N ~j BAG O n P~STIC BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g ~RBOY ~ k BOX ~ o TOTE BIN ~ d STEEL DRUM ~ h SILO ~ I CYLINDER ~ p T~K WAGON STOOGE PRESSURE ~A~IE~ ~ aa ABOVE A~IE~ ~ ba BELOW A~IE~ ~4 STOOGE TEMPE~TURE ~A~IE~ ~ aa A~VEA~IE~ ~ be BELOWAMBIE~ ~ c CRYOGENIC ~5 1 226 227 ~ Y~ ~ No 228 2 230 231 ~ Y~ ~ No 232 4 238 239 ~ Y~ ~ ~ 240 241 [ ~ 245 5 ' 242 243 ~Y~ ~ NO 2~ UPCF (7/99) S:\CUPAFORMS\OE$2731.TV4.wpd CITY OF BAKERSFIE~i~ I~ICE OF ENVIRONMENTAL"~ERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER I OPE~TOR IDENTIFICATION FACILI~ INFORMATION Page Of BUSINESS ~ME (Same ~ FACILI~ N~E or DBA- Doing Busin~ ~) 3 ~ BUS.SS PHONE DUN & ~__ z ~tm~. ~o6 SIC CODE OWNER NAME ~~* ~ ~~ ] ~ 111 ~ OWNER PHONE 112 OWNER ~ILING CONTACT ~ILING PAGER g a28 PAGER g 133 Ceaifica~oa: Based on m7 inqui~ oi gose individuals responsible ~r ob~ining t~e ialomation, I ~ under penal~ of law ~at I have personally examined and am familiar ~th Se infomatioa submiR~ in this invento~ and believe the infomation i5 tree, a~uate, and SIGNATURE OF OWNE~OPE~TOR DATE 1~ NAME OF DOCUMENT PREPARER 135 NAMES OF OWNER/OPERATOR (pdnt) 13s TITLE OF OWNEPJOPERATOR 137 UPCF (7/99) S:\CU PAFORMS\OES2730.TV4.wpd I ' WN02 143 ~5 ~10 Bll B12 ~05 EO~ ~1~7 ~ E03 E09; ~ S19 ~0 ~ EO2 ElOi ~o~ ~1~- I~, I~- II Jl~ J17J19 F~ F57 F~ [ ~w ~IF~4 F13 F12. . F11 NN18 FLOYDS STORES INC SiteID: 015-021-001830 Manager : TERRY TIDWELL BusPhone: (805) 327-5105 Location: 3940 CHESTER AVE Map : 103 CommHaz : Moderate City : BAKERSFIELD Grid: 19A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title T~R.~Y TIDWELL / MANAGER ~h~R~--f~B~fL~/%B~ / Business Phone: (805) 327-5105x Business Phone: (805) 327-5105x 24-Hour Phone : (805) 3DD 6656x 24-Hour Phone : (805) ~8-3~-~x Pager Phone : ( ) ~-q~tx Pager Phone : ( ) ~ a $7~ %x Hazmat Hazards: RSs Fire React ImmHlth DelHlth Contact : Phone: {805) 327-5105x MailAddr: 3940 CHESTER AVE State: CA City : BAKERSFIELD Zip : 93301 Owner FLOYDS STORES INC Phone: (805) 327-5105x Address': 3940 CHESTER AVE State: CA City : BAKERSFIELD Zip : 93301 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: Yes Emergency Directives: = Hazmat Inventory One Unified List --As Designated Order Ail Materials at Site Hazmat Common Name ISpooHazlEPA HazardsI Frm DailyMax Unit MCP FERTILIZER R IH DH S 4000 00 LBS Min SULFURIC ACID IH L 7 00 GAL Hi ENAMEL PAINTS F L 400 00 GAL Mod PORTLAND CEMENT DH S 3150 00 LBS Min PESTICIDES F IH S 55 00 GAL. UnR AMMI/NITIO~ S 600 00 LBS UnR ~, 70~1 J~N~ Do hereby co~i~'~h~ ~ h~e 9 ~y~ or p~nt ~) reviewed ~he a~ached haza~ous m~e~als rear, age- any corrs~ions constitute a complete and corre~ man- agement plan ~or ~¥ ~acili~. FLOYDS STORES INC SiteID: 015-021-001830 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~tv~vl~ ~vl~ / ~~_/.-1_1~ ~vl~ FERTILIZER Days On Site 365 Location within this Facility Unit Map: Grid: GARDEN SHOP CAS# STATE i TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Solid Pure Ambient Ambient BOX I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 4000.00 LBS 4000.00 LBS 4000.00 LBS HAZARDOUS COMPONENTS 100.00 Ammonium Sulfate No 7783202 HAZARD ASSESSMENTS TSecret' oRS IBi°Haz Radioactive/AmountNo N No No/ Curies EPA HazardsR IH DH NFPA/// ] UBDOT# MCPIMin = Inventory Item 0002 Facility Unit: Fixed Containers at Site SULFURIC ACID Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE STORE CAS# 7664-93-9 F STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid /Pure I Ambient I Ambient I GLASS CONTAINER AMOUNTS AT THIS LOCATION Largest Container ! Daily Maximum . Daily Average 70.00 GALL 7.00 GAL 70.00 GAL HAZARDOUS COMPONENTS %Wt.I ~S CAS# 100.00 Sulfuric Acid (EPA) N 7664939 HAZARD ASSESSMENTS TSecretlRsIBioHazRadioactive/AmountEPAHazardsNFPAIUSDOT#MCPNo Yes No No/ Curies IH / / / Hi -2- 12/19/2000 FLOYDS STORES INC SiteID: 015-021-001830 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~UvIU~ ~Vl~ / ~lVl~ ~.,~..~J_~ ~Vl~ ENAMEL PAINTS Days On Site 365 Location within this Facility Unit Map: Grid: PAINT DEPT CAS# 67-64-1 F STATE ~ TYPE PRESSURE 'TEMPERATURE CONTAINER TYPE Liquid I Mixture I Ambient I Ambient I METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 400.00 GAL 400.00 GALI 400.00 GAL HAZARDOUS COMPONENTS %Wt. ~SI CAS# 40.00 Acetone N 67641 15.00 Naphtha No I 8030306 5.00 Magnesium Silicate NoI 14807966 3.00 Iron Oxide, Magnetic No ' 1309371 n-Butyl Alcohol No 71363 Mineral Spirits No 8030306 HAZARD ASSESSMENTS I TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No N° No No/ Curies F / / /I Mod -3- 12/19/2000 FLOYDS STORES INC SiteID: 015-021-001830 ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site .... ~UivHvluN N~vl~ / ~1 ~Z-~ N~Vl5 PORTLAND CEMENT Days On Site 365 Location within this Facility Unit Map: Grid: S SIDE OF YARD CAS# Solid /Pure Ambient Ambient IN MACHINE/EQUIP AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum' { Daily Average 3150.00 LBsI 3150.00 ,BsI3150.00 ,Bs Z DOUS COMPONENTS %Wt. oRSI CAS# 100.00 Cement N 65997151 HAZARD ASSESSMENTS ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site -- COMMON NAME / CHEMICAL NAME PESTICIDES Days On Site 365 Location within this Facility Unit Map: Grid: GARDEN SHOP CAS# 0 ~ STATE[PureTYPE PRESSURE iAm.bientTEMPERATURE CONTAINER TYPE {Solid I Ambient { GLASS CONTAINER AMOUNTS AT THIS LOCATION , Largest Container { Daily Maximum I Daily Average ' 55.00 GAL{ 55.00 GAL { 55.00 GAL COMPONENTS I100.00 Pesticides 0. HAZARD ASSESSMENTS TSecretl ~SIBioHaz Radioactive/Amount EPA Hazards NFPA USDOT# I MCP No N No No/ Curies F IH / / / UnR 4 12/19/2000 FLOYDS STORES INC SiteID: 015-021-001830 ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~UlVUVl~ ~Vl~ / ~1 ~,/,--~,_L, ~vi~ AMMUNITION Days On Site FIRE'ARM AMMO 365 Location within this Facility Unit Map: Grid: INSIDE STORE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE I Ambient I Ambient I BOX Pure Solid AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 9600.00 LBSI 9600.00 LBS 9600.00 LBS HAZARDOUS COMPONENTS %Wt. I RS CAS# HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT#' MCP No N° No No/ Curies F R / / / UnR -5- 12/19/2000 FLOYDS STORES INC SiteID: 015-021-001830 Fast Format ~Notif,/Evacuation/Medical Overall Site Agency Notification -- Employee Notif,/Evacuation -- Public Notif,/Evacuation. Emergency Medical Plan -6- 12/19/2000 FLOYDS STORES INC SiteID: 015-021-001830 Fast Format Mitigation/Prevent/Abatemt Overall Site Release Prevention -- Release Containment -- Clean Up Other Resource Activation -7- 12/19/2000 F FLOYDS STORES INC siteID: 015-021-001830 f Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs -- Fire Protec./Avail. Water Building Occupancy Level · 8 12/19/2000 f FLOYDS STORES INC SiteID: 015-021-001830 Fast Format ~ Training Overall Site Employee Training -- Page 2 --Held for Future Use Held for Future Use -9- 12/19/2000 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~/Ox[c( 5'~OO...q ~.,t~c INSPECTION DATE .... ADDRESS woqqo .~. O/,cs4 r PHONE NO. °oc~"l -5'10.., FACILITY CONTACT BUSINESS IDNO. I5-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~ Routine [21 Combined 1~ Joint Agency [~1 Multi-Agency [...-1 Complaint [21 Re-inspection OPERATION C V COMMENTS / Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities st/ Verification of location / Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled / Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~ Yes [~ No . /'~ Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Busines Respon.5,ible Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector:. L~ ~, MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE c~-~' ?? NEW ACCOUNT ADDRESSOHANGE CLOSE ACCT ~FINANCECHARGEI 'OTHER ADJ CUSTOMER NAME '~{ O VCJ % -,..~'"~(5 (-C % .=~ ~C_,. ( MAILING ADDRESS ~. ~, ~ ~ ~q ~ ~ SITE ADDRESS PARCEL NUMBER (IF .APPLICABLE) ADJUSTMENT i CHG DATE CHARGE CODE ADJUSTMENT AMOUNT REMARKS: ~o%,-~-r~+ ,~"'5 ~:::)~-~c~o, ~'YO,.~ ~ / APPROVED BY ~~~ jp3/28/96 FLOY[~STORES ZNC 015-010--:071~~~''~~__.~ Page ========== ......===,=======~==== ........ == ................ ==========~ ¢' '-'~ AV '" L. ocatSon; 3940 CHEoT=¢, l~ap;103 r-I~z;0 Type; i AkTv CSt:y : BAKERSFIELD .... ,~, 'rd; 19A ; 1 .... 0 --- Contact Name T~t~e ............ ~ ............... ~ui~au~ Name TERRY TZDWELL / ~uR iDAN OoTL. Un~D / 8us~iqess Phone; (805) 327-5105x I Business P~,(.i~e; (805) 327-5105x 24-t-.tour Phone ; (805) 399-6698x I ~ ~,--HouP Phone ; (805) o36-2142x Pager Phone ; ( ) - x I Pager Phone ; ( ) - x Summa py ...................................................................................................... RE'TAZL *~EPIERAL NER~nANDZSE SALES. TWO 10 uALk. OiJ PRwPANE ~*' STORED BY oW CRNR OF TENT k,¢O,~. [..Ar, ui: QUANTITIES OF RETAI~. PAINTo LOCATED SLI¢' TLY S OF TH~: CNTR OF klA,,,~' ' ~' BLDG }..lazm~t: Invent:or'y I..~st: 5n MCP OF. der' f~atePial Name ---l..lazaPds .... ~X Qty Ui'~t FERTILIZER F R i}--} 4000 LBS ExtPeme GARDEN "~ SULFURIC ACID F IH 70 GAL n Igh INSIDE ~,wRE ENAI~EL PAINT DH 400 GAL Low PAINT DEPT PORTLAND ,.t:J~4~ Dn 3150 I BS S SIDE OF YARD PEST~C!DE F' IH DH 55 GAl_ Unrated GARDEN SHOP irc. ARI~ ¢~,~, ,~, F' R ll"~ 9600 L' '"¢'b ~ Ui'~I' ' ' ~ed-' INSIDE ¢~ i'03/28/96 FLOYI STORES Ii,lC 015-010-~00146 Page 2 · 00 - Ovena]] Si're <M> Inspe(~tion Dates & Status 64 64 0~,0q-8 04/28/93 / / 23--2 / / 09/30/~o8 ANNUA~/¢ZOLAT~ON' ' ' / /