HomeMy WebLinkAboutBUSINESS PLAN 12/29/2002 ITE DIAGRAM ~ FACILrl'Y DIAGRAM
',if-
SITE DIAGRAM FACILITY DIAGRAM
Business Name:
Business Address:
ITE DIAGRAM l"~ ! FACILITY DIAGRAM
Business Name: be_ ~q~oo //lo/a,[
Business Address: qoj. ~. fffv_~'t- ~
CITY OF BAKERSFIELD ~
s Wic s
1715 Chester Ave., CA 93301 (661) 326-3979
.... BUSINESS OWNER / OPERATOR IDENTIFICATION
FACILITY INFORMATION
Page Of
,-,~,a,.,-,-w IDE I
· ' "': "L r,~,~,,,~ NTIFICATON ' ;
FACILITY ID* / :il' ~i~ ' '~i~ ~1 ~4 ":~! ' ~ ~J, ' ~ i 1 Yea~e~in~in~'------ v~ ~ ~ ~ool, Year Ending ~o~
BUSINESS NAME (Same as FACILI~ NAME or DBA- Doing Business ~) 3 ~ BU~NESS PHONE
SITE ADDRESS m3
DUN & ~o6 SIC CODE m7
B~DSTREET (4 Digit ~) 5
,,; ~ :,~{ ::':5 ",:,,~:: L, ,,.-, ~:.:' ¥~,~,,, ~: ::~:,: ,~: ,11. ~OWNER,I~ F ' ' ?' ' '
,,, (ggt.) 3-3q5
O~ER ~ILING
/ ·
CONTACTADDRESs~ILING 4 0 ~ 3 ' ~X~[~
.
PAGER g ~28 PAGER g 133
Ce~i~cation: Based on my inqui~ of those individuals responsible for obtaining the info~ation, I ~i~ under penal~ of law that I have personally examined
and am familiar with the information submiEed in this invento~ and believe the info~ation is tree, accurate, and ~mplete.
SI.GNAT~E~TOR D~ ~ 134 NAME OF DOCUMENT PREPARER 135
NAMES OF OWNE~OPE~TOR (print) ~36 TITLE OF OWNE~OPE~IOR ~37
UPCF (7/99) S:\CUPAFORMS\OES2730.TV4.wpd
CITY OF BAKERSFIELD ~
OFFI~ OF ENVIRONMENTAL SER~'ICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
HAZARDOUS MATERIALS MANAGEMENT PLAN
Section I1.1 - DISCOVERY AND NOTIFICATIONS
I. FACILITY IDENTIFICATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing B~siness As)
ADORESS (For local u~e oniy)
FACILITY ID # ~ ~ t
DISCOVERY
A. LEAK DETECTION AND MONITORING PROCEDURES:
,. . -:::,:, ~..~.,,'NOTiFicATI~aS -, ..: ,,.: ,., .; ._ ,.<~.,,..
.-.: .~'.. ,.Z ..,~, ..,~.~...?,..~ ,'~ ', . . ',.-.' ~, ,. .... -~ -~, . .
· . :,- i; b ' ,'."-",, -~ '. ,' .' '-:.'-t- · ~ ',' .,' ..' "· ~-. .~ ,'. ~ ~
B. EMERGENCY AND AGENCY NOTIFICATION PROCEDURES:
~,. ~:,. ,,- d, . .~',.., .... ::.:.",b'..'. ,;~ ;::;' ~.'i~,~ ~.'~:.-~.i~!:'~;.'-;~ ~'~ '~ ENVIRONMENTAL, ~NAGEMENT ,. ~;-~';':~,~O-.~.:ih ,' ~,;'~; :?:,: ..... : ": ~:'' ~ -: ~ "".' '
C. SPECIFIC RESPONSIBILITIES OF EMPLOYEES:
D. CLOSEST LOCAL MEDICAL FACILITY:
UPCF (7/99) S:~PROCEDURE MANUAD.New HMMP fotm.wpd
Section 11.2 - RELEASE RESPONSE PLAN
:.~':.. RESPONSE,,. . ACTIONS.,. . , *' .
RELEASE CONTAINMENT AND MITIG^TION:
..-.~o,Low ',. , ;..:, ]
.'. ;UP ACTIONS ' .. %
~. CLEAN-UP AND RECOVERY PROCEDURES:
UPCF ~7/99) $:~EDURE MANUAI. q~Iew HMMP form.wpd
HAZARDOUS MATERIALS MANAGEMENT PLAN
Section II1.1 - FACILITY AND LOCALITY INFORMATION
UTILITY SHUT-OFFS
LOCATION OF SHUT-OFFS AT YOUR FACILITY:
NATURAL GAS / PROPANE: ~, '~-~ ~tJ~'~ ~"~7_. ~J ~ b~:)t ~.~'~
ELECTRICAL:
WATER: "-'~ ~---~~
SPECIAL:
LOCK BOX: YES ~O) IF YES, LOCATION:
PRIVATE FIRE pROTEcTION I WATER AvAiLABILITY
B. WATER AVAI~BILI~ (FIRE HYD~T):
' ' I ~ .'TRAINING -
A. NUMBEROF EMPLOYEES:
B. MATERIALS DATA SHEETS ON FILE:
C. BRIEF SUMMARY OF TRAINING PROGRAM: /~/ T'~.)~ ~ 'F~ _~ Tv'~"'~d~
CERTIFICATION
Based on my inqui,~ of those individuals res~x~sible f~- o~talning the info~natlon, I certify under peflalty of law that I have persunnaly examined and am familiar with the Infomlatlon submitted and betleve the
information is true, accurate, and c~t~ete. )
NAME OF SIGNER (p~nt) 478. TITLE OF SIGNER 4?9,
UPCF (7/g9) $:~3CED~RE MANUN.~Iew HMMP f~mlWlXl
ONE STOP MOBIL SiteID: 015-021-001755
STORAGE CONTAINER DATA (UST ~ORM A)
Last Action Type:
FACILITY/SITE INFORMATION
Business Name: ONE STOP MOBIL
Cross Street :
Business Type: Org Type:
Total Tanks : IndnRes/Trust: No PA Contact:
PROPERTY OWNER INFORMATION
Name : MANOORANE PATEL Phone: (805) 835-9544x
Address:
City : State: Zip:
Type : INDIVIDUAL
TANK OWNER INFORMATION
Name : MANOORANE PATEL Phone: (805) 835-9544x
Address:
City : State: Zip:
Type : INDIVIDUAL
BOE UST Fee# : UNKNOWN
Financ'l Resp:
Legal Notif : Business Mailing Address
Date:02/21/1998 Phone: ( ) - x
Name:HEMENDER PATEL Ttl:OWNER
'State UST # : 1998 Upg Cert#:
= Hazmat Inventory One Unified List
--As Designated Order Ail Materials at Site
Hazmat Common Name... SpecHaz EPA HazardsI Frm DailyMax Unit MCP
GASOLINE F IH DH L 10000.00 GAL Mod
GASOLINE F IH DH L 8000.00 GAL Mod
· I, ~\ -;~,~,~-r..~. Do hereby certify that I ha,;e
(Typo or print name)
reviewed the attached hazardous materials ma~'~age-
for~~d that it alo~g 'with
merit
plan
any eorreofion8 aons~i~u~e a oompl~ end oorreeJ
agemem plan Jot my Jaoili~.
- -- ' '~i~-~ature- Date
2 12/11/2000
ONE STOP MOBIL SiteID: 015-021-001755
~ Inventory Item 0001 Facility Unit: Fixed Containers at Site
-- COMMON NAME / CHEMICAL NAME
GASOLINE Days On Site,
REGULAR UNLEADED 365
Location within this Facility Unit Map: Grid:
UNDERGROUND W SIDE OF BLDG CAS#
CORNER OF TERRACE WAY & S CHESTER 8006619
r STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid /Pure Ambient I Ambient UNDER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
10000.00 GALI 10000.00 GAL 6000.00 GAL
HAZARDOUS COMPONENTS
%Wt.] ~S CAS#
100.00 Gasoline N 8006619
TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT#
No N No No/ Curies F IH DH / / / Mod
= Inventory Item 0002 Facility Unit: Fixed Containers at Site
GASOLINE Days On Site
PREMIUM UNLEADED 365
Location within this Facility Unit Map: Grid:
UNDERGROUND W SIDE OF BDLG CAS#
CORNER OF TERRACE WAY & S CHESTER 8006619
Liquid Pure Ambient Ambient UNDER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum Daily Average
8000.00 GALI 8000.00 GAL 4000.00 GAL
HAZARDOUS COMPONENTS
%Wt.I ~S CAS#
100.00 Gasoline N 8006619
HAZARD ASSESSMENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No N° No No/ Curies F IH DH / / / Mod
-3- 12/11/2000
ONE STOP MOBIL SiteID: 015-021-001755
Fast Format
F Notif./Evacuation/Medical Overall Site
Agency Notification
Employee Notif./Evacuation
Public Notif./Evacuation
Emergency Medical Plan
-4- 12/11/2000
ONE STOP MOBIL SiteID: 015-021-001755
Fast Format
~ Mitigation/Prevent/Abatemt Overall Site
Release Prevention
Release Containment
-- Clean Up
Other Resource Activation
-5- 12/11/2000
F ONE STOP MOBIL SiteID: 015-021-001755
f Fast Format
F Site Emergency Factors Overall Site
Special Hazards
--Utility Shut-Offs 02/26/1998
A) GAS-
B) ELECTRICAL -
C) WATER -
D) SPECIAL -
E) LOCK BOX -
-- Fire Protec./Avail. Water 02/26/1998
PRIVATE FIRE PROTECTION - ????????
NEAREST FIRE HYDRANT - ???????
6 12/11/2000
ONE STOP MOBIL ~~fi/5~/~~/~/~¢/~ SitelD: 015-021-001755 i
i~ Training ~~~~~~~~ Overall Site i
i~ Employee Training ~~~~~~~ 02/26/1998 i
o
WE HAVE 3 EMPLOYEES AT THIS FACILITY. o
o
WE DO HAVE MSDS SHEET ON FILE.
o
B~EF SUMMARY OF T~INING PROG~M: UNDERSTAND HOW TO READ MSDS AND ARE
AWARE OF EMERGENCY PROCEEDURES. o
o
o
o
i~ Held for Fumre Use
o
o
i~ Held for Future Use
o
o
-7- 12/11/2000
CUST 'I~E & NO. ~.~'- [ ~ 10~
MISCELLANEOUS RECEIVABLES ADJUSTMENT
ADDRESS CHANGE
CLOSE ACCT j
: FINANCE CHARGEI/t
· OTHER ~J
CUSTOMER NAME ~~ ~0,¢
MAILING ADDRESS ~~ ~ ~~~ ~ ~ "
C,~ ~~~& ~. X g. STATE ?~ ZIP CODE q
SITE
PARCEL NUMBER
(IF APPUCABLE)
ADJUSTMENT
I CHG DATE r CHARGE CODE I ADJUSTMENT.AMOUNT
: I i
REMARKS: '~"-'~ ~-,~r{;c' .~0 r~ co,.P ,~O~'V~__..
t
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chestier Ave., Bakersfield, CA (805) 326-3979
INSTRUCTIONS'
1. To avoid further action, return this form within 30 days of receipt, q4-~-~ I ~'~ Q) (~
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the questions below for the business asa whole. I ~--q- C(~ ~
4. Be as brief and concise as possible. {=~- ('~{~.~
SECTION 1: BUSINESS IDENTIFICATION DATA
BUSINESS NAME: O01e_
LOCATION: qt3&
MAILING ADDRESS:
CITY: ~¢.f~ STATE:
DUN & BRADSTREET NUMBER: SIC CODE:
SECTION 2: EMERGENCY NOTIFICATION
CONTACT TITLE BUS. PHONE 24 H~. PHONE
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 TIME EXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION
I, .~ p_:rr-~.vx ~-J~c_ .~crx~CJ~ 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 PERJURY.
SIGNATURE TITLE DATE
2
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES
A. AGENCY NOTIFICATION PROCEDURES:
B. EMPLOYEE NOTIFICATION AND EVACUATION:
C. PUBLIC EVACUATION:
D. EMEKGENCY MEDICAL PLAN:
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN
A. RELEASE PREVENTION STEPS:
B. RELEASE CONTAINMENT AND/OR MINIMIZATION:
C. CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)
NATURAL GAS/PROPANE:
ELECTRICAL:
WATER:
SPECIAL:
LOCK BOX: YES/NO W YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY
A. PRIVATE FIRE PROTECTION:
B. WATER AVAItJABILITY (FIRE HYDRANT):
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (805) 326-3979
HAZARDOUS MATERIALS INVENTORY
FACILITY DESCRIPTION
CHECK IF BUSINESS IS A FARM [ ]
BUS~,~SS N~ ~ .~,~ m~h,{
FAC~ITY N~
S~TE ~D~SS
C~TY ~ STA~
NAT~ OF BUS--SS
SIC CODE D~ & B~S~ET
OWNER/OPERATOR [4xw~{er' ~Octdrc l PHONE
MAII.INGADDRESS '/~g 6. ~r ~
CItY E~t4. STATE ~ ZIP q330~
EMERGENCY CONTACTS
NAME [4e~avzfcc ~a ~ ( TITLE
BUS.SS PHO~ ~3~- 9~qq 24 HO~ PHO~
N~ ~a n o c g ~ ~[ TITLE ,.
BUS.SS PHO~ ~ 3~- ~,qqq 24 HO~
1
H~RDOUS MATERIALS INVENTORY
Page I of 9._.
Business Name {0he gal'~? ~/~b~'( Address c/0~ 5, d~.51~c~'
CHEMICAL DESCRIPTION
1 ) INVENTORY STATUS: New [~.] Addition [ ] Revision [ ] Deletion [ ] Che~k ifch~n~ical is a NON Trado Secret
2) Common Name: a¢,~. Onlca,,~dr qd~dt~_ 3) DOW # (optional)
Chemical Name: AI-IM [ ] CAS #
4) Physical & Health PHYSICAL HEALTH
Hazard Categories Fire[~]Reactive['~]SuddenReleaseofPressur~[ ] lmmediate Health (Acute) [t~c ] Delayed Health (Chronic) [ ]
5) WASTE CLASSI~CATION (3-digit code from DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ] Liquid'[~ ] Gas { ] Pure [~<] Mixture [ ] Waste [ ] Radio~tive [ ]
7) AMOUNT AND TIME AT FACILITY UlqlTS OF MF.a~UI~ 8) STORAGE CODES
Maximum Daily Amotmt t~;~ .~[ Lbs[ ]Gal[,/~]fc3[ ] a) Container:
Average Daily Amount ~ use_ Curies [ ] b) Pressure:
Annual Amount c) T~mperature
Largest Size Container
# Days on Site Circle Wlxich Months: All Year, J, F, M, A, M, J, $, A, S, O, N, D
9) MIXTURE: List COMPONENT CAS# % WT AtIM
the three most hazardous 1) [ ]
chemicad components or 2) [ ]
any AHM components 3) [ ]
10 )LOCATION
!
1) INVENTORY STATUS: Ncw ["/L] Addition [ ]Revision[ ]Deletion[ ] Ch~kffchemie, al is a NON Trade S~:ret [ ]TradeSoc'ret[ ]
2) Common Nam¢: 0tct~. t)lA{c~(c~ _Os.Co'/sc7 3)DOT # (optional)
Chemical Name: AHM [ ] CAS #
4) Physical & Health PHYSICAL HEALTH
Hazard Categories Fire['-i~]Reactive[~<]SuddenReleas~ofPressure~"t<] lmmediateHealth(Acute)[ ]DelayedH{~lth(Chroni¢)[
5) WASTE CLASSIFICATION (3-digit code fxom DHS Form 8022) USE CODE
6) PHYSICAL STATE Solid [ ~ Liquid [ ~] Gas [ ] Pure [~7.] Mixture [ ] Waste [ ] RadioaCtive [ ]
7) AMOLrNT AND TIME AT FACILITY UNITS OF IVlEASURE 8) STORAGE CODES
Maximum Daily Amount ~; 0~3 Lbs [ ] Gal [ ] fl3 [ ] a) Container:.
Average Daily Amount ~ Curies [ ] b) Pressure:
Annual Amount c) Temperature
Largest Size Container
# Days on Site Circle Which Months: Ail Year, $, F, M, A, M, $, $, A, S, O, lq, D
9) MIXTURE: List COMPO~ CAS# % WT AHM
the tl~ree most b~s~rdous 1) [ ]
chemical components or 2) [ ]
any AHM components 3) [ ]
10)LOCATION
I certify under penalty of law, that ]~ have pea'sonally examined and arn familiar with the information on this and all att~hod doonments. I
believe the submitted information ia true, ae~urat~ and complete.
PRINT Name & Title of Authorized Company Representative Signature Date