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Home My WebLink AboutBUSINESS PLAN (2) .t-J. LV.I..tV.I..t-' t--'~N .k¥.k~~ SITE DIAGRAM I j FACILITY DIAGRAM 8usine~ Nome: L,,J~r-'o.,z~ C.~- First In Station: Area Moo .~ Inspection Station: NORTH Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT. ON REVERSE SIDE This _oermit is issued for the followin_=: [] Hazardous Materials Plan [3 Underground Storage of Hazardous Materials Permit ID #:: 015-000-001854 [3 Risk Managernent Program WA L G R E E N S # 3 2 2 2 [3 .~rdou. w.,~t,, o.-s.,, 'rr.~m.~ LOCATION: 40 CHESTER AVE 1ELD ~. OFFICE OF ENVIRONMENTAL SER VICES .... ' "" 1715 Chester Ave., 3rd Floor Approved by: (..~pU'Uu~y.~ ' ; Date Bakersfield, CA 93301 omceofE~.i~~i Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date:June 30, 2003 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ........ ,~,,~,~;,~??.?!?~=~?~,~,~,,, ........ This permit is issued for the following: ~' Materials Plan ,,?~!ii!ii,,~ ii!ii?i::iiiiii!!i?':~i::~de[gr°und Storage of Hazardous MateHals ~%.~"'-..7~ ~ ~ .. '::.::::::...-..~' f;7'':r''.'%'C¢:; ~ ~: =; · /" :'~ : ~ ~%. ~ :~ ~' ~: "-. :~ , ;~:-.[ ~' "' .........~'"~[~ .~ ' :. ~ ~' .J~F ~i; ~h,~=~ .¢ .~ ../.¢~ .~ .~ .~ .' .' ;~ f~h ' i ~... ~;;:"-'-.;:~, ' '~, :~, '"'~4~;~:~?' ....... '~ii~ii:~i;~!ili~ii!~!~i!i~!iE~]~ ......... ',~i~"::;~i;? .¢!;::!~ -:,,r; .... ¢'."'..'? '%.'"" .. -.-::~;~,.. .;:iiii~ .~iiii~ ~ii~. ';;:::'=,,.~.,=~,..;;'?.'"F':i'":: ;i:.;~.~,,'*""::;~ "~ ~ ~ ~ [~""!P' .~' ' ""~i~;~,,:-' ..." .,': "' .."' ".,'"'/' .."/ ,' ~' ,' ~' ~ :t /,:,~t~ Issu~ by: O Bakersfield Fire DePa~ment Approv~ by: ~~~u~ OFFICE OF EN~R O~AL S~ ~CES 1715 Chewer Ave., 3rd Floor f~~ B~ersfiel~ CA 93301 Voice (805) 326-3979 F~ (80S)~2~76 Expiration Date: ~n~ ~O~ ~O00 ITE DIAGRAM Business Nc~me: For Offico Use Only First In Sro?ion: Area Moo # Insoection Stction: NORTH CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 '/ADDRESS -~g~- ~vS,'i~"'P, ~tl~; ' PHONE NO. 0'3/-Z-'ff'/{.) FACILITY CONTACT_ I41gff"14'RtVl'~ BUSINESS lD NO. 15-210- l~?.5/'''-'- INSPECTION TIME__ ~/~IW. NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~]/Routinc} [~ Combined [~ Joint Agency I~ Multi-Agency ~ Complaint {~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Vt/ Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials / Verification of quantities Verification of location Proper segregation of material V Verification of MSDS availability Verification of Haz Mat training v Verification of abatement supplies and procedures v/ Emergency procedures adequate Containers properly labeled Housekeeping ./ Fire Protection I,'/ Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~ Yes Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party oor White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: WALGREENS #3222 SiteID: 015-021-001854 Manager : STEVEN SMITH BusPhone: (661) 631-2810 Location: 40 CHESTER AVE Map : 103 CommHaz : Moderate City : BAKERSFIELD Grid: 31C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:5912 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact /s--_~itle ~%kT~h~ $~T]4' / STORE MANAGER MIKE HART /~_~ ~ MANAGER Business Phone: (661) 631-2810x Business Phone: (661) 631-2810x 24-Hour Phone : (661) 5q~-~957 24-Hour Phone : (661) 589-9085x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 631-2810x MailAddr: 40 CHESTER AVE State: CA City : BAKERSFIELD Zip : 93304 Owner WALGREEN CORPORATION Phone: (847) 940-2500x Address : 200 WILMOT RD State: IL City : DEER FIELD Zip : 60015 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpocHazlEPA HazardsI Frm I DailyMax IunitlMCP ANTIFREEZE L 24.00 GAL Low DETERGENTS DH L 200.00 GAL Mod LIGHTER FLUID F DH L 20.00 GAL Mod PESTICIDES F IH L 200.00 GAL UnR I, S'/'e~'e,/ s~-r'14 Do hereby certify that I have (Type or pdnt name) reviewed the attached hazardous materials manage- ment p~an for~k/..(,~,~-.~ .~,~3~ and that it along with (Name of Business) any corrections constitute a complete and correct man- agement plan for my facility. ~~.~ ~~- 04/09/2002 Signature f WALGREENS #3222 SiteID: 015-021-001854 ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~lvl~ ~vl~ / ~ ~ ~ ~vl~ ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: NE CORNER OF SALES FLOOR CAS# r STATE ~ TYPE I PRESSURE I TEMPERATURE CONTAINER TYPE Liquid {Pure Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 1.00 GALI 24.00 GAL 24.00 GAL 100.00 Ethylene Glycol N 107211 HAZARD ASSESSMENTS TSecretI oRSIBioHaz Radioactive/Amount [ EPA Hazards NFPA I USDOT# MCP No N No No/ Curies / / / Low ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~U~i~ ~Vl~ / ~±~ ~vl~ DETERGENTS Days On Site DETERGENTS, LAUNDRY SOAP, HOUSEHOLD CLEANERS 365 Location within this Facility Unit Map: Grid: 8D CAS# 7681-52 -9 Liquid { Mixture Ambient A~ient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 5.50 GALI 200.00 GAL 200.00 GAL TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies DH / / / Mod 2 04/09/2002 WALGREENS #3222 SiteID: 015-021-001854 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ivlivl~ ~vl~ / ~ l ~ ~vi~ LIGHTER FLUID Days On Site LIGHTER FLUID, FUEL, BUTANE, DISPOSABLE LIGHTERS 365 Location within this Facility Unit Map: Grid: NE CORNER OF SALES FLOOR CAS# ~ STATE i TYPE PRESSURE i TEMPERATUREI CONTAINER TYPE Ambient Ambient METAL CONTAINR-NONDRUM Pure Liquid AMOUNTS AT THIS LOCATION Largest Container { Daily Maximum I Daily Average 1.00 GALI 20.00 GAL I 20.00 GAL HAZARDOUS COMPONENTS wt. I CAS# 100.00 Naphtha N 8030306 HAZARD ASSESSMENTS TSeoretI ~S BioHazI Radioactive/Amount EPA HazardsI NFPA USDOT# I MCP No N No No/ Curies F DH / / / Mod = Inventory Item 0002 Facility Unit: Fixed Containers at Site ~U~ ~vi~ / ~£~ ~vi~ PESTICIDES Days On Site 365 Location within this Facility Unit Map: Grid: SE CORNER OF SALES FLOOR CAS# Liquid Pure Ambient Ambient GLASS CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 5.50 GALI 200.00 GALI 200.00 GAL HAZARDOUS COMPONENTS %Wt. I ~S CAS# 100.00 Pesticides N HAZARD ASSESSMENTS TSecretINO N~S I Bi°HazINO Radioactive/AmountNo/ Curies FEPA HazardsiH NFPA/// USDOT# I MCPunR -3- 04/09/2002 F WALGREENS #3222 SiteID: 015-021-001854 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 02/23/1998 CALL 911 AND NOTIFY LOCAL FIRE DEPT OF ANY HAZARDOUS MATERIAL PROBLEMS. GET ALL PERSONS OUT OF THE BLDG BY CHECKING ALL POSSIBLE LOCATIONS TO BEING PRESENT DURING A PROBLEM. -- Employee Notif./Evacuation 02/23/1998 WE WILL USE OUR PA SYSTEM TO ALERT ALL PERSONS IN THE STORE TO LEAVE. CHECK ALL POSSIBLE LOCATIONS SO EVERYONE IS OUT. Public Notif./Evacuation 02/23/1998 WE WILL USE OUR PA SYSTEM TO ALERT ALL PERSONS IN THE STORE TO LEAVE. CHECK ALL POSSIBLE LOCATIONS SO EVERYONE IS OUT OF THE BLDG. Emergency Medical Plan 02/23/1998 WE HAVE A FIRST AID KIT THAT WE CAN USE IN CASE OF AN EMERGENCY. WE WILL CALL 911 AND GET INSTRUCTIONS BEFORE THE FIRE DEPT IS ON SCENE. 4 04/09/2002 WALGREENS #3222 SiteID: 015-021-001854 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 02/23/1998 WE TRAIN ALL EMPLOYEES ON THE PROPER WAY TO HANDLE HAZARDOUS MATERIALS. WE ALSO REINFORCE BY REPEATING THE READING OF THE BOOKLETS ONE TIME PER YEAR AND RETAKE THE WRITTEN TEST. -- Release Containment 02/23/1998 WE WILL CALL THE FIRE DEPT FIRST ON ANY HAZARDOUS MATERIAL WE MUST RELEASE. -- Clean Up 02/23/1998 FOR MOST CLEAN UP IT WILL MEAN TO MOP UP SPILL THEN RINSE WITH WATER.. Other Resource Activation -5- 04/09/2002 F WALGREENS #3222 SiteID: 015-021-001854 Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 02/23/1998 A) GAS - BACK OF STORE BY RESTROOMS B) ELECTRICAL - PANALS BY OFFICE C) WATER SHUTOOFF VALVE AT BACK OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 12/20/1999 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ARE THROUGHOUT THE FACILITY AND THIS FACILITY HAS A SPRINKLER SYSTEM. NEAREST FIRE HYDRANT SW CORNER & NW CORNERS OF BLDG, OUTSIDE. Building Occupancy Level -6- 04/09/2002 WALGREENS #3222 SiteID: 015-021-001854 Fast Format ~ Training Overall Site -- Employee Training 12/20/1999 WE HAVE 19 EMPLOYEES AT THIS FACILITY. DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE???????????? BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES READ A TRAINING MANUAL AND ARE TESTED ON STORING AND MANAGING HAZARDOUS MATERIALS. ALL MANAGEMENT STAFF MEMBERS AND RECEIVING STAFF READS A MANUAL ON TRANSPORTING HAZARDOUS MATERIALS AND ARE TESTED. ALL MANAGEMENT STAFF READS A MANAGEMENT VERSION AND AGAIN ARE TESTED ON TRANSPORTING HAZARDOUS MATERIALS. Page 2 Held for Future Use Held for Future Use I -7- 04/09/2002 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ ,,I~'1_~-'~1 ~ INSPECTION D~5 ADDRESS q0 t,,~r-~/'~,. PHONE NO. . '- FACILITY CONTACT ~' _'EL~ ~ BUSINESS ID NO. 15-210- ! INSPECTION TIME -~0 ~t(,l~ .1~ NUMBER OF EMPLOYEES ~ Section 1: Business Plan and Inventory Program j/.Routine [] Combined [] Joint Agency {~1 Multi-Agency ~ Complaint {~j Re-inspection OPERATION C V COMMENTS Appropriate permit on hand V/ Business plan contact information accurate / {4~l),~'Plgr Visible address d/ Correct occupancy / Verification of inventory materials ~ I~t~l,~' ~t"],~ ~ Verification of quantities ~ ~ ~.~c.~'~,,.~ Verification of location¢ ~ Proper segregation of material Verification of MSDS availability Verification of Haz Mat training V/ la~'l~"q'~ ~ Verification of abatement supplies and procedures Emergency procedures adequate V 14~l"~'~'~' ,,l~'i~ ~' Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand I/ C=Compliance V=Violation/ Any hazardous waste on site?: ~Yes [] No Explain: ,Sk..~ ~' Questions regarding this inspection? Please call us at (661 ) 326-3979 ustness :S~te Responst ~le ~y White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: WALGREENS ~3222 -=== SiteID: 015-021-001854 Manager : STEVEN SMITH BusPhone: (661) 631-2810 Location: 40 CHESTER AVE Map : 103 CommHaz : Moderate City : BAKERSFIELD Grid: 31C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:5912 EPA Numb: DunnBrad: += EmerHency Contact / Title EmerHency Contact-~ / Title STEVEN SMITH / STORE MANAGER MIKE HART -/ ASSIST MANAGER Business Phone: (661) 631-2810x Business Phone: (661) 631-2810x 24-Hour Phone : (661) 588-8450x 24-Hour Phone : (661) 589-9085x PaHer Phone : ( ) - x PaHer Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 631-2810x MailAddr: 40 CHESTER AVE State: CA City : BAKERSFIELD Zip : 93304 Owner WALGREEN CORPORATION Phone: (847) 940-2500x Address : 200 WILMOT RD State: IL City : DEER FIELD Zip : 60015 ......... Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No .............. Emergency Directives: += Hazmat Inventory = One Unified List + +== Alphabetical Order -- Ail Materials at Site + ................................ + ....... + ........... + ..... + + .... +---+ Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax IUnit}MCPI +- -+ ....... +- +- + + .... +- - -+ ANTIFREEZE L 24.00 GAL Low DETERGENTS DH L 200.00 GAL Mod LIGHTER FLUID F DH L 20.00 GAL Mod PESTICIDES F IH L 200.00 GAL UnR I, Do hereby certify that I have (Type or pdn[ name) reviewed the attached hazardous materials manage- ment plan for and that it along with (Name of Business) any corrections constitute a complete and correct man- agement plan for my facility. -1- 01/25/2002 , Sig~;a[uro Da~e WALGREENS CO~~ SiteID: 215-0.00-001854 Manager : -~A%~-MARC%~ S~U~ S~i~ f BusPhone: (~) 631-2810 Location: 40 CHESTER AVE Map : 103 CommHaz : Moderate City : BAKERSFIELD Grid: 31C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 06 SIC Code:5912 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title D~~5~i~ STORE MANAGER ~ICI~ R~Y~SMi~5~ / ASSIST MANAGER Business Phone:~8~) 631-2810x Business Phone~D~8~ ~-°~810x 24-Hour Phone ~.~8~ 588-8450x 24-Hour Phone Q~(.8~ ~~- pager Phone~-~) - x Pager Phone : ( ) - x ~0~ Hazmat Hazards: Fire ImmHlth DelHlth Contact : ~~ ~q~i~ Phone: (,~05) 631-2810x MailAddr: 40 CHESTER AVE State: CA City : BAKERSFIELD Zip : 93304 Owner WALGREEN CORPORATION Phone: (~~-67~0~:[500 Address : 200 WILMOT RD State: IL City : DEER FIELD Zip : 60015 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ---- Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax IUnitIMCP ANTIFREEZE L 24 GAL Low DETERGENTS DH L 200 GAL Mod LIGHTER FLUID F DH L 20 GAL Mod PESTICIDES F IH L 200 GAL UnR I, ~Vi~ ~ Do hsmby certify ~hat ' have (T~p~ or p~m ~) m~is~ ~h~ a~achsd h~a~s ma~ed~s m~nage- men~ plan ~o~Q~F~ ,a~ ~ha~ i~ a~ong wi~h a~ c0rr~fi0ns C0os~i~u~s a c0mple~e and ~rre~ man- agemen~ p~n ~or my ~cili~, ~'-~~~-'1 ~ 08/24/1999 Signature D~te WALGREENS CO SiteID: 215-000-001854 ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: WHAT ISLE??????? ~ C0~¢3~ O~ ~t~ FIOO~ CAS# rSTATE ~ TYPE I PRESSURE i TEMPERATURE CONTAINER TYPE Liquid {Pure Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 1.00 GALI 24.00 GAL I 24.00 GAL Z DOUS COmPONeNTS %Wt.I ~S CAS# 100.00 Ethylene Glycol N 107211 HAZARD ASSESSMENTS I TSecret I ~S IBiOHazNO N No Radioactive/AmountNo/ Curies EPA Hazards NFPA/// IUSDOT# MCPILOw = Inventory Item 0001 Facility Unit: Fixed Containers at Site ~JUlViiViU£'~ l'~/-~iVlr', / %Jrl~lVl J. ~J/-k.b DETERGENTS Days On Site DETERGENTS, LAUNDRY SOAP, HOUSEHOLD CLEANERS 365 Location within this Facility Unit Map: Grid: 8D CAS# 7681-52-9 F STATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION I Largest Container I Daily Maximum Daily Average 5.50 GAL 200.00 GAL 200.00 GAL %Wt. HAZARDOUS COMPONENTS RS CAS# HAZARD ASSESSMENTS TSecretNo NoRS BioHazl Radioactive/Amount I EPA HazardsINO No/ Curies DH NFPA/// USDOT# MCP -2- 08/24/1999 WALGREENS CO SiteID: 215-000-001854 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~tVUVl~ ~Vl~ / ~ ~.~J..~ ~Vl~ LIGHTER FLUID Days On Site LIGHTER FLUID, FUEL, BUTANE, DISPOSABLE LIGHTERS 365 Location within this Facility Unit Map: Grid: WHAT ISLE????????? N~ C~" 0~ ~DcLi~..% ~IOC~ CAS# ~ STATE ~ TYPE i PRESSURE i TEMPERATURE I CONTAINER TYPE Liquid ~Pure Ambient Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 1.00 GAL I 20.00 GAL I 20.00 GAL HAZARDOUS COMPONENTS 100.00 Naphtha N 8030306 HAZARD ASSESSMENTS TSecret oRStBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# I MCP No N No No/ Curies F DH / / / Mod = Inventory Item 0002 Facility Unit: Fixed Containers at Site PESTICIDES Days On Site 365 Location within this Facility Unit Map: Grid: STATE I TYPE PRESSURE --~ TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient GLASS CONTAINER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 5.50 GALI 200.00 GAL 200.00 GAL HAZARDOUS COMPONENTS %Wt. R~oRS CAS# 100.00 Pesticides HAZARD ASSESSMENTS TSocrotl ~SIBioHaz Radioactive/Amount I EPA HazardsI NFPA USDOT# MCP No N No No/ Curies F IH / / / UnR -3- 08/24/1999 i WALGREENS CO ~~&~~~~~~ SiteID: 215-000-001854 i~ Notif./Evacuation/Medical ~~~~~~~~ Overall Site i~ Agency Notification ~~~~~~~~~ 02/23/1998 O o CALL 911 AND NOTIFY LOCAL FIRE DEPT OF ANY HAZARDOUS MATERIAL PROBLEMS. GET o ALL PERSONS OUT OF THE BLDG BY CHECKING ALL POSSIBLE LOCATIONS TO BEING o PRESENT DURING A PROBLEM. O O o WE WILL USE OUR PA SYSTEM TO ALERT ALL PERSONS IN THE STORE TO LEAVE. CHECK o ALL POSSIBLE LOCATIONS SO EVERYONE IS OUT. O O o WE WILL USE OUR PA SYSTEM TO ALERT ALL PERSONS IN THE STORE TO LEAVE. CHECK o ALL POSSIBLE LOCATIONS SO EVERYONE IS OUT OF THE BLDG. O O o WE HAVE A FIRST AID KIT THAT WE CAN USE IN CASE OF AN EMERGENCY. WE WILL o CALL 911 AND GET INSTRUCTIONS BEFORE THE FIRE DEPT IS ON SCENE. O -4- 08/24/1999 i WALGREENS CO ~~~~~~~~ SiteID: 215-000-001854 i~ Mitigation/Prevent/Abatemt ~~~~~~~ Overall Site £~ Release Prevention ~~~~~~~~~ 02/23/1998 o o WE TRAIN ALL EMPLOYEES ON THE PROPER WAY TO HANDLE HAZARDOUS MATERIALS. WE o ALSO REINFORCE BY REPEATING THE READING OF THE BOOKLETS ONE TIME PER YEAR o AND RETAKE THE WRITTEN TEST. o i~ Release Containment 8888888888888~8~888888888888~88888~888~ 02/23/1998 O o WE WILL CALL THE FIRE DEPT FIRST ON ANY HAZARDOUS MATERIAL WE MUST RELEASE. O i~ Clean Up ~88888888~~~~~~~~ 02/23/1998 O o FOR MOST CLEAN UP IT WILL MEAN TO MOP UP SPILL THEN RINSE WITH WATER. o o o 5 08/24/1999 WALGREENS CO ~~~~~~~~ SiteID: 215-000-001854 Site Emergency Factors ~~~~~~~~ Overall Site i~ Special Hazards ~~~~~~~~~~~~i i~ Utility Shut-Offs ~~~~~~~~~ 02/23/1998 A) GAS - BACK OF STORE BY RESTROOMS B) ELECTRICAL - PANALS BY OFFICE C) WATER - SHUTOOFF VALVE AT BACK OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO PRIVATE FIRE PROTECTION - (IE. FIRE EXTINGUISHERS, SPRINKLER SYSTEM???????) ........~n~ ¢ci~i~ has o~~-'Fri n~¢ ~jct-em. '~ i~ Building Occupancy Level ~~~~~~~~~~i 6 08/24/1999 WALGREENS CO ~~~~~~~~ SiteID: 215-000-001854 i~ Trainin~ ~~~~~~~~~~~ Overall Site i~ Employee Trainin~ ~~~~~~~~~ 02/23/1998 WE HAVE 19 EMPLOYEES AT THIS FACILITY. DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE???????????? BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES READ A TRAINING MANUAL AND ARE TESTED ON STORING AND MANAGING HAZARDOUS MATERIALS. ALL MANAGEMENT STAFF MEMBERS AND RECEIVING STAFF READS A MANUAL ON TRANSPORTING HAZARDOUS MATERIALS AND ARE TESTED. ALL MANAGEMENT STAFF READ A MANAGEMENT VERSION AND AGAIN ARE TESTED ON TRANSPORTING HAZARDOUS MATERIALS. -7- 08/24/1999 BAKERSFIELD CITY FIRE DEPARTMENT 1715-CHESTER A.VE~ BAKERSFIELD, CA. 93301 · HAZARDOUS MATERIALS M~,,NA~G~MENT PLAN~ ~., I..]N St~ U CTIO NS: ,. .:,o =,.,o,,~ ~,,..,~-.~n~,. =o:~o~.. :--:,~],~ :,~ ,o,-~ ~,t~,n .:.,::: ~=v~ o~' ,-eo~,ot. II/I/ OCT 1 ~UN & BRACSTREET NUMSER' SiC CODE: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE ~US. PHONE 24 HR. PHONE ., ~ a.~.ez"su.e~.a..~ -- ~ardo~ ~atefia~ Di~sion HA~RDOUS MATERIALS MANAGEMENT'P~N ' SECTION3: T~AININ~: NUMBER OF ~MPLOY~S: }~ MATERIAL SAFE~ DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTfON4: EXEMPTION REQUEST: 1 CERTIFY UNDER PENALTY OF PERJURY THATMY BUSINESS IS EXEMPT FROM THE RE?ORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FCLLGWING REASONS: WE DO NOT HANDLE HAE&ROOUS MATERIALS. ~ ','Vc OD HANDLE "^'~'" ~ - ~. ,_ m,--',,.-,.,~.DCUS MATERIALS, BUT iH: QUANTITIES AT NO TiMEEXCEED THE MINIMUM REPORTING QUANTITIES. SECTION S' CERTIFICATION: i, O~t~ ~~u~ CERTIFY THAT THE A~OVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY F'RM S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON H~OOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INAQCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE ' DATE ..-.. o FccJlity Unil' Name: SECT[CN 6: NOTiFICATICN AND EVACUATION PROCEDURES: · . ' - Bakersfieicl. FL~e Dept. ~- Hazardous Materials Division ' .... ~ HAZARDOUS MATERIALS MANAGEMENT PLAN C. -LE,"-,N-UP ?RCCEC:uREs,: '"~x--- r,mo~ c..b_m ,,,,,P J"/- k/ill ~ SECTION 8: UTILITY SHUT-CFFS ""~' ^?: :. L'..-,~.,--, :,ON CF ~Ul-wF~'~ AT YOUR FACILITY) SECTION 9: PRIVATE FiRE pRCTECTION/WATER AVAILABILITY: A. PRIVATE FiRE PROTECT[ON: WATER AVAtLA~,IL[TY (FIRE HYDRANT): ,-- '* BAKEI~FIELD CITY FiRE DFi~ARTMENT HAZARDOUS MATERIALS DIVISION ~'~ ~ ~'~ ~ 1715 CHESTER AVE. '~,~ "~--'- .~ BAKERSFIELD, CA. 93301 ~~%**~i[~ (805) 326-3979 H~ARDOUS MATERIALS INVENTORY FACILI~ DESCRIPTION CHECK ;F BUSINESS 1S A FARM [ ] ~us~N~SS NAM~ ~i3~ r~,~ t r NAME SIC CCDE %9 I% CDUN & B~DSTREET NUMBER OWNER/CPERATCR ~,.,-...(..~ ..... <.c, H,,,~'Y,-.,,'- PHONE t MAIUNG ACDRESS .~.Oc~ 6,./t[r~-"l' CiTY O¢_r-~e..,I ~ STATE ~-L- ZIP EMERGENCY CONTACTS NAME .O~LI¢' KY~h~d-d...,% TITLE (J"~r~. BUSINESS FHGNE ~l-~lO 24-HOURPHONE BUSINESS FHONE ¢~I-Z~O 24-HOURPHONE BAKlgH6PIELD (.;i I:.Y I-IHI= UEPAH I NII-'N I- HAZARI US MATERIALS INVENTQ Y .siness Name Address CHEMICAL DESCRIPTION ) INVENTORY STATUS: New~ Addition ( ] Revision [ ] Deletion { ] Check if chemicat is a NON TRADE SECRET :) CommonN~e: ?~'~r~¢~'S, L~,,~,~ 3~Pr Clc~r'~'~ri~.,rs. h0~,~_k0t~ c.~,~' 3) DOT · Chemical Name: AHM [ ] CAS ~.) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire i '1 ~eac,qve ~ Sudden Release of Pressure [ ] Immediate Hee/ttl (Acute) .~ 5) WASTE CLASSIFICATION 5 ~ i' [3-cligit coci. from OHS Form 8022) USE CODE ~ 5) PHYSICAL STATE Solid .~ "c~u,d .~ Gas '[ ] Pure [] Mixture Waste [] Radioactive [] 7) AMOUNT ANO TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Average Daqy Amount: ~.~ curies [ ] b) Pressure: Annua Amount: I c~, ~ ,~ c, c) Temperature: L.~'gest Size Container: '~. ·r # ~ays On Site (oO Circie Which Months: All Ye~, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1 ) [ ] cnem,caJ ccmDonen~ or ~ny AHM ccmoonents 2) [ ] 3~ ~0) Location g O CHEMICAL DESCRIPTION iNVENTORY STATUS: New {)~ Addition { t Revision {' ] Deletion { ] Check if chemical is a NON TRADE SECRET Common Na~ne: ~_~ 3) DOT # (optional) ChemicaJ N~-ne: AHM [ ] CAS # PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] F~eactive~ Suclden Release of Pressure [ ] Immediate HeaJtll (Acute) '~ Delsyed Health (Chronic) wAsTE C~SS~CA'r~ON 2 3 ) ~:~*g,t co~,, fro~ ~H~ ~or~ .0~-~.SE CODE PHYSICAL STATE Solid [ ] Uauid ']~ Gas [ ] Pure [ ] Mixture'S] Waste [ ] Radioactive [ ] AMOUNT AND TIME AT FAC[~ I"['Y UNITS CF MEASURE 8) STORAGE CODES M~x,mum OmiyAmount: /O~3 ihs '~ gaJ { ] ~3 [ ] a) Container: Average Oa~iy Amount: J OD curies [ ] b) Pressure: Annum Amount: ~o c) Temperature: L~gest S~ze Contmner: I' ~ ,~ Days On Site ~ Circle W~ich Months: All Year. J. F. M. A. M. J. J. A. S. O. N. MIXTURE: List COMPONENT CAS # % WT AHM the three most hazareous 1 ) chem~caJ ¢omoonents or any AHM components ?) [ ] 3~ [ ] uDmirte¢l inforrnaDon is ~e, accurate, ~Jlo complete, j / / v~/~~' ~'. ' '~RINT Name &'/Ttle of Au~onzeo Company ~e~resenm~ve Signature Dam AI I:.H:::ii"II-LU CI I.Y I-IHI Ui HAH I ,. ..... HAZA IOUS MATERIALS INVEN' RY Page '--of__ ~siness Name Address CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New ( I Add.on ( ] ReViSiOn ( ] Deletion { J Check if cttemicad is & NON TRADE SECRET [ ] TRADE SECRET [ ] ChemtcaJ Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire "~ Reactfve ( ] Sudden Retease of Pressure { ] immediate HeaJth (Acute) Delayed HeaJth (Chronic) [ 5) WASTE CLASSIFICATION (3-cligit code fi.om DHS Form 80221 USE CODE 5) PHYSICAL STATE Solid [ ] liClUid ~ Gas [ ] Pure"~ Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT ANO TIME AT FAClLJTY UNITS OF MEASURE 8) STORAGE COOLS MaxJmum Dai,!Amount: ?~..O ihs [ ] gM '~ fi,3 [ i a) Contaner: Average Dmty Amount: "~_.O cunes~ [ ] b) Pressure: AnnuaJ Amount: I 0 O O c) TemDerature: ~.a. rgest Size Contmner: ;~ Days On Site CircteWhich Months: All Year. J, F, M. A, M, J. J, A, Si O, N, D 9) MIXTURE: L~st COMPONENT 'CAS # % WT AHM the three most hazaroous 1), [ ] chem~ca~ components or any AHM comrxments 2) [ 31 < [] 0) CHEMICAL DESCRIPTION ) INVENTORY STATUS: New { ] A(~dition [ ] Revision ( ] Deletion ( ] Check if Chemic. m isa NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: A'~'~F'~ '~'~'7-.-P.... 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive ~ Sudden Release of Pressure [ ] tmrnadiate Health (Acute) ['~ Delayed Health (Chronic) [ ] .5) WASTE CLASSIFICA~ON //-/~- (3-digit code fi.om OHS Form 8022) USE CQDE C) q PHYSICAL STATE Solid [ ] liquid ~ Gas [ ] Pure '~ Mixture [ ] Waste [ ] Radioactive [ ] AMOUNT AND TIME AT PAC~I ITY UNITS OF MEASURE 8) STORAGE CQDES Max,mum O;~iv Amount: "~---('~ lbs [] gm Average D~.Jy Amount: ~. ~ curies [ ] b) Pressure: AnnuaJ Amount: ~ ~(~ c) Temoera~ure: Largest Size Contamer: # D~ys On Site Circle Which Months: All Year. J. F, M, A, M, J, J, A, S, O, N. O MIXTURE: tJst COMPONENT CAS # % WT AHM the three most ha. zaroous 1) [ ] chemicaJ com~onenm or ~ny AHM coml:)onents 2) [ ] [ ] erofy unaer oena~/ or law, that t nave ~ersona.¥ exarn/neo eno am {arlliiiar wi~l ~38 ~ntoma eno ~ut a cneo aocurnenm. I oe~eve me :rnitteOD , J~mf°rrnati°n~,~ ~.J ts~ ~ue, ~accurate' an~[.~comoiete.Ti g~..~ INT Name &T/Ee o! Au;nor/ze~ Company Representative Signature Date BAKERSFIELD CITY FIRE DEPARTMENT HAZAI OUS MATERIALS INVEN'I IY 3us/ness Name Address ,~ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New-~ Addition [ ] Revision { ] Deletion { ] Check if chemical is ,, NON TRADE SECRET [ ] TRADE SECRET [ 2) Common Name: 3) DOT # (optJonaJ) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire { ] Reactive[ I Sudden Release of Pressure { ] Immediate Health (Acme) [ ] DelayemlHeeJth (Chronic) [ 5) WASTE CLJ~.SSIFICATION (3-digit code fi.om OHS Form 8022} USE CODE 6) PHYSICAL STATE Solid [ ] ~quid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND 'nME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Da~ly Amount: lbs [ ] gaJ [ ] it3 [ ] ,~) Conta~ner: Average Daily Amount: curies [ ] b) Pressure: Annuai Amount: c) Temperature: Largest Size Container: ,~ Days On Site Circle W~ich Months: All Yeas. J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the tt~ree most hazardous 1) [ ] chem~c_.~ components or any AHM components 2) [ ] [ lO) Locaaon CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision { ] Deletion I ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optJorlaJ) ChemicaJ Name: AHM 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive ( ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed HeeJth (Chronic) [ 5) WASTE CLASSIFICATION .(3-digit code from DI~S Form 8022) USE CODE 6) PHYSICAL STATE Solid [ I Ucluid [ ] Gas [ ] Pure [ ] Mixture [ ] Was:e [ ] Radioactive [ ] 7) AMOUNT AND T1ME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum DaiJy Amount: Jb$ [ ] gaJ [ ] fi3 [ ] a) Conl~a~ner: Average Oa~ly Amount: cunes [ ] b) Pressure: AnnuaJ Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Yeas, J, F, g) MIXTURE: List COMPONENT CAS # % WT AHM the I:hree most hazasdous 1 ). [ cnemlc..~ com0onents or any AHM components '2) [ ] 3) [ ] 1 O) Locaaon cer~ty unaer oen~uB/ or law, [nat t have oersonafly exammeo aha am familiar wi~h ~e infomal~on suDm~ed on ~ul~miffed information is ~'ue, accurate, an(3 comDtete. PRINT Name & T/fie of Au~horize~ Com~any /~el~resentaffve Signature Date