The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN (2) Hazardous MaterialS/HazardoUS waste Unified. Permit CONDITIONS~OF .PERMIT. ON REVERSE SIDE , · .~ ' : This ~mtit is Issued for the followin~_: . . [] Hazardous Materials Plan n Underground'Storage of H.~=rdOus Materials ~ermit ID #:: 015-000..000464 Ui Riskl~r~j~tPro~mm FOOD MAXX #402 ~ Hazardous Waste On-Site Treatment LOCATION: 4128 CHESTER AVE IELD . _. · .... . . : .!' . . -.-., .. ,. OFFICE OF ENVIRONMENTAL SER VICES' '. ' 1715 Chester Ave., 3rd Floor ' Approved by: Bakersfield, CA 93301 OmecofE~i . Issue Date Voice (661) 326-3979 FAX (661)326-0576 " Expiration Date: ' Julle Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ............... ,~,,~,~,~,~,,~,,,~,~;~,,~,~,., ............... This permit is issued for the following: ~,,¢i':i':'T ;~: },?~:'~.:~:;i i i ii?;;:i iii~,il};:~::;i~e[ground Storage of Hazardous Materials PERMIT ID# 015-0214)00464 ~¢?*i '[ ,} +i ?~;~" ~?.!!!?;!!!i!!ii i! ?.:~.!![!?~[! ,iiii[[! ~ ~k::i~a0agement Program LOCATION 4128 CHESTER ~?':. '.,/¢';~;~...... '",~.::? ~SE[ELD CA 933~¥~_.~,,~,,,~.'~:'::::-.~.;~, ~,~'""".~4. ~, ~:% ~.¢ ~ . :,, ~ ......... ~,~,:~,,~ ,~- '~,,., r'.... '..~, ~ '~f~- -"""~. ~'"'. " "' "" '"" ,g'¢' .¢~ "-. ', '"~,,~;;,;;:?;.,,.'.,...'....-',,.....,. ,.,..... ,,. ,, ,* ,, B~ersfield Fke D~a~ment Approv~ by: 1715 Chewer Ave., }rd Floor B~e~fiel~ CA 93301 F~ (805) 326-0576 Expiration Date: nncn v D] FOOD MAXX #402 SiteID: 215-000-000464 Manager : BING HEWETT /'-~ BusPhone: 325-7314 Location: 4128 CHESTER AY ~.. [ Map : 103 CommHaz : Low City : BAKERSFIELD ~r~. ' ........ ~ Grid: 19A FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code:5411 EPA Numb: DunnBrad:94-124-5496 Emergency Contact / Title Emergency Contact / Title MARK TILLETT ~/ / STORE MANAGER BOB SPENGLER //_/, / DISTRICT MANAGE Business Phone: I~ 325-7315x Business Phon .a~'t(~" 835-9036x 24-Hour Phone~/(~M~) 834-7831x 24-Hour Phone~/~' 836-8996x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : SAVEMART SUPERMARKETS ~ Phone: (209) 577-1600x MailAddr: PO BOX 4278 State: CA City : MODESTO Zip : 95352 Owner SAVESIkRT SUPERMARKETS Phone: (209) 577-1600x Address : PO BOX 4278 State: CA City : MODESTO Zip : 95352 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... ISpecHazlEPA HazardsI Frm I DailyMax {UnitlMCP BLEACH L 6000 GAL Hi CHLORINE F P IH L 170 GAL Min FLOOR SEALER L 165 GAL FLOOR STRIPPER L 165 GAL MOTOR OIL -L~'~,'~ 0 homby O~ha~ O ba~ L 6O0 O~ Min PROPAATE * ~ ~ ~) F~P ~H L ' 1980 FT3 Hi any ~rr~ions ~ns~u~e a comp~s~s and ~rr~ man- FOOD MAXX #402 SiteID: 215-000-000464 = Inventory Item 0005 Facility Unit: Fixed Containers on Site ~U~ ~vl~ / ~ ± ~./--~-~ ~vl~ -- BLEACH Days On Site 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid I Pure~ I AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average GALI 6000.00 GAL 3000.00 GAL HAZARDOUS COMPONENTS 100.00 Bleach N 7681529 HAZARD ASSESSMENTS TSecretINO NoRS Bi°HazINO Radi°active/Am°unt I EPANo/ CuriesII Hazards NFPA/// USDOT# HiMCP -- Inventory Item 0007 Facility Unit: Fixed Containers on Site --' COMMON NAME / CHEMICAL NAME CH~JO~.~N.~ Days On Site KEM KLOR II 365 Location within this Facility Unit Map: Grid: SALES FLOOR/BACKROOM CAS# 7681-52-9 F STATE TYPE--PRESSURE i TEMPERATITRE CONTAINER TYPE LiquidT ~ Pure Ambient Ambient PLASTIC CONTAINER AMOI/NTS AT THIS LOCATION Largest Container Daily Maximum Daily Average =_____.=:l.00__ GAL__ __ ..... 170.00 GAL 150.00 GAL .----=----= HAZARDOUS COMPONENT~ %Wt. RS CAS~ 12.50 Sodium Hypochiorite No 7681529 0.80 Sodium Hydroxide N'o 1310732 --- --'T - HAZARD ASSESSMENTS TSe~r,~,.! RS BioHaz Radioactive/Amount i EPA Hazards NFPA USDOT# MCP Nc. ~No N'O NO/ Cuz'ies I F P IH / / / Min I -2- 08/25/1999 FOOD MAXX ~402 SiteID: 215-000-000464 = Inventory Item 0004 Facility Unit: Fixed Containers on Site --- COMMON ~E / CHEMICAL NAME FLOOR SEALER Days On Site 365 'Location within this Facility 'Unit Map: Grid: J~ITORIAL ROOM CAS# FSTATE , TYPE , PRESSURE [ TEMPERATURE i CONTAINER TYPE Liquid i Mixture i Ambient Ambient DRUM/BARREL-METALLIC ~OUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average GAL I 165.00 GAL I 100.00 GAL I I HAZARD ASSESSMENTS I [ TSecr'et RSIBioHaz Radioactive/Amount i EPA Hazards NFPA USDOT# MCP No' INo I No No/ Curies I / / / ---- Inventory Item 0003 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL N'~E FLOOR STRIPPER ~ Days On Site 365 Location within this Facility Unit Map: Grid: JAI~'I'i'OR IAL ROOM CAS ~ ~ STATE -- TYPEMi×ture Ambient PRESSURE i TEMPE~RTURE Ambient DRUM/BARREL-METALLIC CONTAINER TYPE Liquid ~¢iOUNTS AT THIS LOCATION Largest Container [ Daily Maximum Daily Average GAL [ 165.00 GAL 100.00 GAL HAZARD ASSESSMENTS ' TSecret'INo NoRS I B'i°~az IN° Radioactive/AmountNo/ Curies EPA Hazards NFPA/// USDOT# MCP -3- 08/25/1999 FOOD MAXX #402 SiteID: 215-000-000464 = Inventory Item 0002 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME INSECTICIDES Days On Site 365 Location within this Facility Unit Map: Grid: SALES AREA CAS# STATE ! TYPE PRESSURE iTEMPERATURE I CONTAINER TYPE Liquid Pure Above Ambient Ambient METAL CONTAINR-NONDRUM AFfOUNTS AT THIS LOCATION Largest Container ! Daily Maximum Daily Average GAL~ 250.00 GAL 200.00 GAL HAZARDOUS COMPONENTS 0 W~ ~ S CAS # 10,3.00 Insecticides N 0 ~ m HAZARD ASSESSMENTS ~ TSecrett RS BioHaz Radioactive/Amount ! EPA Hazards NFPA USDOT~ MCP No !No No . No/ Curies I F / / / ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NIL~E / CHEMICAL NAME MO'.?OR OZL I Days On Site 3,55 Location within this Facility UniE Map: Grid: SALES AREA I CAS# STATE =~:= TYP]E PRESSURE TEMPERATURE CONTAINER'TYPE Liquid ! Pure ,[Ambient !Ambient METAL CONTAINR-NONDRUM A~,[OUN'ZS AT THIS LOCATION Largest Container ! Daily Maximum Daily Average GAL 'L 600.00 GAL 500.00 GAL -- HAZARDOUS COMPONENTS %W'~. : RS CAS 100.00!Mozor Oil, Petroleum Based N° 8020835 HAZARD A~ L~I~I~N TSecret i RS !i~.ioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP i [ Curl..s I F DH / / / Min No No No No/ " -4-- 08/25/1999 FOOD MAXX ~402, SiteID: 215-000-000464 ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site --- COMMON NAME / CHEMICAL NA~IE PROP~.~\TE Days On Site 365 Location wiEhin this Facility Unit Map: Grid: CAS# 74-98-6 [ STATE f TYPE ,PRESSURE TEMPERATURE CONTAINER TYPE Liquid t Pure ! Ambient [." A~0ient FIXED PRESS. CYLINDER Largest C°ntainer i AJ~iOUNTS AT THIS LOCATIONI Daily Maximum Daily Average FT3 I 1980.00 FT3 1980.00 FT3 , HAZARDOUS COMPONENTS %Wt. ! RS CAS# 100. (30 I Propane NO 74986 TSecreti RS BioHaz Radioactive/Amount ! EPA Hazards NFPA i USDOT# MCP ~ ' Cuz_:es I F P IH / / / Hi Nc INo No I No/ "'~ -5- 08/25/1999 FOOD MAXX #402 SiteID: 215-000-000464 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification 01/07/1990 CALL 9!1 -- Employee Notif./Evacuation 01/07/1990 VIA Ii~'TEKCOS~Vl SYSTEM --= Public Notif./Evacuation 01/07/1990 VIA INTER COMM TO CUSTOMER AND EMPLOYEES ~ Emergency Medical Plan 04/21/1997 VALLEY iiNDUSTRiAL MEDICAL GROUP - 2501 G STREET - OR CALL 911. '-6- 08/25/1999 FOOD MAXX ~402 SiteID: 215-000-000464 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 01/07/1990 SEPERATION OF CHEMICALS -- Release Containment 01/07/1990 MOPS AND KITTY LITTER -- Clean Up 01/07f1990 DIKE AND CONTAIN SPILL Other Resource Activation 7 08/25/1999 FOOD MAXX #402 SiteID: 215-000-000464 Fast Format F Site Emergency Factors Overall Site Special Hazards -- Utility Shut-Offs 01/07/1990 A) GAS'- NORTH SIDE BUILDING GAS METER B) ELECTRICAL - SOUTHEEAST CORNER COMPRESSOR ROOM C) WATER - NORTH SIDE NEXT TO GAS METER D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - FULLY SPRINKLED BUILDING AND HAND HELD PORTABLE FIRE ~..~ .... N(~,Ji~HERS FIRE HYDRANT - NORTHEAST CORNER OF LOT Building Occupancy Level' -8- 08/25/1999 FOOD MAXX #402 ~&~&&~&&&&~&&~&~&&~&~&&~&~&~&&~ SiteID: 215-000-000464 Trainin~ &&~&&~&~&~&~&~&~&~&~~S&~&~~&~&&&~ Overall Site i~ Employee Trainin~ ~~&~~&~~&~~&~~ 01/07/1990 DO YOU HAVE MATERIALS SAFETY DATA SHEETS ON ,FILE? ( BRIEF SUMNLAi~Y OF TRAINING: HAZCOMM PROGRAM~, THROUGH PARENT COMPANY aeeeeeeeeeee~eeeeeeee~eeeeeeeee~eeeeeeeeeeeeeeeeeee~eeee~eeeeeee~~eeeeeeee~~eeef i~&&~ Held for Funure Use . CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAl. SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 HA Z~RDOUS MATERIALS INVENTORY ,,/~- ~PR, 1 CHECK IF BUSINESS IS A FARM [ ] OWNERfOPERATOR ~ao~ma~-1~ ~ ,u~tr~c~q:f~ PHONE MAILING ADDRESS '~'~- O. '~W q Z7 ~ EMERGENCY CONTACTS BUSINESS PHONE ~C~ -~2.~ --7~lq 24 HOUK PHONE BUSINESS PHONE ~ ' ~g-~' ~7~1 24 HOURPHONE ~ -~0 FOOD 4 LESS #402 SiteID: 215-000-000464 Operator: BusPhone: (805) 325-7314 Location: 4128 CHESTER AV Map : 103 OvrlHaz : Low City : BAKERSFIELD Grid: 19A FacUnits: 1AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARK TILLETT / STORE MANAGER BOB SPENGLER / DISTRICT MANAGE Business Phone: (805) 325-7315x Business Phone: (805) 835-9036x 24-Hour PHone : (805) 834-7831x 24-Hour PHone : (805) 836-8996x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: P O BOX 4278 State: CA City : MODESTO Zip : 95352 Owner : SAVE MART OF MODESTO Phone: (805) 325-7315x Address : P O BX 4278 State: CA City ............ :--.MODESTO ...... Zip : 95352 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: EHSs: No First Response Directives: ---- Hazmat Inventory One Unified List -- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax lUnitlMCP BLEACH L 6000 GAL Hi PROPANE F P IH L 1980 FT3 Hi MOTOR OIL F DH L 600 GAL Min INSECTICIDES F L 250 GAL FLOOR STRIPPER L 165 GAL FLOOR SEALER L 165 GAL -1- FOOD 4 LESS #402 SiteID: 215-000-000464 = Inventory Item 0005 Facility Unit: Fixed Containers on Site BLEACH 365 Location within this Facility Unit CAS# STATE -- TYPE PRESSURE -- TEMPERATURE CONTAINER TYPE AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax t.his Loc GAL DailyAvg this Loc GAL 6000.00 3000.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL I HAZARDOUS COMPONENTS %Wt. IEHSI CAS# 100.00 Bleach INO I 7681529 TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No- No .No ..... No/ Curies / / / Hi UFC Article 80 Control Zone: USDOT Hazards In Cabinet? Sprinklered Area? MISC. LOCAL AGENCY DATA Ag.Definedl: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag. Defined5: Ag. Defined6: Ag. Defined7: Ag. DefinedS: Ag. Defined~: Ag.definel0: Ag.Definell -2- FOOD 4 LESS #402 SiteID: 215-000-000464 = Inventory Item 0006 Facility Unit: Fixed Containers on Site uu~m~um m~ / un~luA~ NAM~ Days on s~te = PROPANE 365 Location within this Facility Unit CAS# 74-98-6 FLSTATE -- TYPE PRESSURE --[ TEMPERATURE I CONTAINER TYPE iquid PureI~ Ambient Ambient FIXED PRESS. CYLINDER AMOUNTS STORED AND IN USE Lrgst Cont.this Loc FT3 DailyMax this Loc FT3 DailyAvg this Loc FT3 1980.00 1980.00 DailyMax Stored FT3 DailyMax Open Use FT3 DailyMax Closed Use FT3 i ] HAZARDOUS COMPONENTS %Wt. }EHSI CAS# 100.00 Propane IN° I 74986 TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi UFC Article 80 Control Zone: USDOT Hazards In Cabinet? Sprinklered Area? MISC. LOCAL AGENCY DATA Ag. Defined1: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag. DefinedS: Ag. Defined6: Ag. DefinedT: Ag. DefinedS: Ag. Defined9: Ag.define10: -- Ag.Definell 3 FOOD 4 LESS #402 SiteID: 215-000-000464 = Inventory Item 0001 Facility Unit: Fixed Containers on Site uummuN m~ / U~M~UA~ NaR~ Days on s~e ~ MOTOR OIL 365 Location within this Facility Unit CAS# SALES AREA F STATE 1 TYPEPure Ambient PRESSURE I TEMPERATUREI Ambient' METAL CONTAINER TYPECONTAINR-NONDRUM Liquid AMOUNTS STORED AND IN USE Lrgst Cent.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 600.00 500.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS I .sl 100.00 Motor Oil, Petroleum Based IN° I 8020835 TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min UFC Article 80 Control Zone: USDOT Hazards In Cabinet? Sprinklered Area? MISC. LOCAL AGENCY DATA Ag.Definedl: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag. Defined5: Ag. Defined6: Ag. DefinedT: Ag.DefinedS: Ag.Definedg: Ag.definel0: -- Ag. Definell -4- FOOD 4 LESS #402 SiteID: 215-000-000464 = Inventory Item 0002 Facility Unit: Fixed Containers on Site uu~u~um Na~= / Un~MICA~ NAM~ Days On Site = INSECTICIDES 365 Location within this Facility Unit CAS# SALES AREA F STATE -q-- TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid /Pure Above Ambient I Ambient METAL CONTAINR-NONDRUM AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 250.00 200.00 .DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS I %Wt. IEHSI CAS# 100.00 Insecticides IN° I 0 TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No. No - No No/ Curies F / / / UFC Article 80 Control Zone: USDOT Hazards In Cabinet? Sprinklered Area? MISC. LOCAL AGENCY DATA Ag.Defined1: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag. Defined5: Ag. Defined6: Ag. DefinedT: Ag. DefinedS: Ag. Defined9: Ag.define10: -- Ag. Definell -5- FOOD 4 LESS #402 SiteID: 215-000-000464 = Inventory Item 0003 Facility Unit: Fixed Containers on Site uu~uN N~ / Cn~mlUA~ NME Days on Site = FLOOR STRIPPER 365 Location.within this Facility Unit CAS# JANITORIAL ROOM F STATE -- TYPE PRESSURE TEMPE~TURE CONTAINER TYPE Liquid Mixture I Ambient I Ambient I DR~/BARREL-METALLIC MOUNTS STORED MD IN USE Lrgst Cont.this Loc GAL Dail~ax this Loc GAL Dail~vg this Loc GAL 165.00 100.00 Dail~ax Stored GAL Dail~ax Open Use GAL Dail~ax Closed Use GAL TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UFC Article 80 Control Zone: USDOT Hazards In Cabinet? Sprinklered Area? MISC. LOCAL AGENCY DATA Ag. Definedl: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag. De f ined5: Ag. De f ined6: Ag. De fined7: Ag. Defined8: Ag. Defined9: Ag. definel0: -- Ag. Definell -6- FOOD 4 LESS #402 SiteID: 215-000-000464 = Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ummuN Na~ / ~MI~AL NaM~ Days On S~te = FLOOR SEALER 365 Location within this Facility Unit CAS# JANITORIAL ROOM F STATE -- TYPE PRESSURE --~ TEMPERATURE I CONTAINER TYPE I DRUM/BARREL-METALLIC Liquid Mixture Ambient Ambient AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 165.00 100.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL TSecret EHS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UFC Article 80 Control Zone: USDOT Hazards In Cabinet? Sprinklered Area? MISC. LOCAL AGENCY DATA Ag. Definedl: Ag. Defined2: Ag. Defined3: Ag. Defined4: Ag. Defined5: Ag. Defined6: Ag. Defined7: Ag. Defined8: Ag. Defined9: Ag. definel0: -- Ag. Definell -7- F FOOD 4 LESS 9402 SiteID: 215-000-000464 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 01/07/1990 CALL 911 -- Employee Notif./Evacuation 01/07/1990 VIA INTERCOMM SYSTEM -- Public Notif./Evacuation 01/07/1990 VIA INTER COMM TO CUSTOMER AND EMPLOYEES Emergency Medical Plan 01/07/1990 VALLEY INDUSTRIAL MEDICAL GROUP 2501G STREET BAKERSFIELD, CA. OR CALL 911 -8- FOOD 4 LESS #402 SiteID:~ 215-000-000464 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 01/07/1990 SEPERATION OF CHEMICALS -- Release Containment 01/07/1990 MOPS AND KITTY LITTER -- Clean Up 01/07/1990 DIKE AND CONTAIN SPILL Other Resource Activation -9- FOOD 4 LESS #402 SiteID: 215-000-000464 Fast Format = Site Emergency Factors Overall Site -- Special Hazards --Utility Shut-Offs 01/07/1990 A) GAS - NORTH SIDE BUILDING GAS METER B) ELECTRICAL - SOUTHEEAST CORNER COMPRESSOR ROOM C) WATER - NORTH SIDE NEXT TO GAS METER D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - FULLY SPRINKLED BUILDING AND HAND HELD PORTABLE FIRE EXTINGUISHERS FIRE HYDRANT - NORTHEAST CORNER OF LOT -10- FOOD 4 LESS #402 SiteID: 215-000-000464 Fast Format ~ Site Emergency Factors Overall Site Building Occupancy Level -il- FOOD 4 LESS #402 SiteID: 215-000-000464 Fast Format = Training Overall Site -- Employee Training 01/07/1990 WE HAVE ? EMPLOYEES AT THIS FACILITY? DO YOU HAVE MATERIALS SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING: HAZCOMM PROGRAM, THROUGH PARENT COMPANY SAVE MART -- Page 2 -12- HAZAI ItOUS MATERIALS INVEN'i Y Page_j__of_ CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS: New [ ] Addition ~ Revision [ ] Deletion ( ] Check if chemicat is a NON TRADE SECRET [ ] TRADE SECRET [ 2) Common Name: C~[.-C)(~-I~.~ 3) DOT# (optionaJ) 4) PHYSICAL & HEALTH PHYSICAL HE~J.r'H HAZARD CATEGORIES Fire ~ Reactive [{~ Sudden Release of Pressure [ ] Immediate HeaJth (Acute)[Y..] Delayed Healt. h (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE /"J ~ 6) PHYSICAL STATE Solid [ ] liquid ~ Gas [ ] Pure [ ] Mixture [~] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Dally Amount: 1"7(~ lbs [ ] gal [,)~ ~t3 [] a) Container. Average Dally Amount: I .~'~(~ cunes[ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site '~L~ ~ Circle Which Months: All Year, J, F, M, A. M, J. J, A, S, O, N, D 9) MIXTURE: list COMPONENT -~' ~, CAS # % WT AHM chemical components or ~nyAHM components 2) ---~:='o.OIt-x-t'~- ,ll_l~D~.o~t~l~_.' ["~[(.~-"7~>~'~'~'~'~'~'~'~'~'~'~- .~_~ [ ] 3~ [ ] lO) Location ~S ~-~OC:~--/ /~~)O/ CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Checkif chemica~ is a NON TRADE SECSET [ ] ~E SECRET [ ] 2) Common N~'ne: ~) DOT #(optionai) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release of Pressure [ ] ImmediateHeaJth (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ]. Radioactive [ ] 7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES M~ximum Daily Amount: lbs [ ] gal [ ] ft3 [ ] a) Container: Average Dally Amqunt: cunes[ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: Ail Year. J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemicaJ components or any AHM components 2) [ ] 3). [ 1 10) Location certify under penally of law, that I have personally examined and am famitiar with the infornatJon submitted on this and all attached documents. I t~eiieve me · RINT Name & Title Of Authorized Company Representa~fve Date BAKEREii IELD CITY FIRE DEP ITMENT H DOUS MATERIALS I NVEN'FORY Page__of__ 5usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chernicaJ is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] ' 5) WASTE CLASSIFICATION ,(3-digit code fi.om DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactn/e [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] gal [ ] ~3 [ ] a) Container: Average Daily Amount: cunes[ ] b) Pressure: Annual Amount: c) Temperature: Largest Size'Container: # Days On Site Circle 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) [ ] cnemicaJ cornf:x3nents or any AHM components 2) [ ] 3) ~ [ l 10) Location CHEMICAL DESCRIPTION 1) iNVENTORY STAT1JS: New [ 1 Addition [ ] Revision ~ ] Deletion [ ] Check if chemicaJ is a NON TRADE SECRET [ ] TRADE SECRET [ 1 2) Common Name: 3) DOT # (optmnal) Chemical Name: AHM [ ] CAS # fi,) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACIlITy UNITS OF MEASURE 8) STORAGE CODES Maximum Daily.Amount: lbs [ ] gaJ [ ] f~3 [ ] a) ContaJner: Average Daily Amount: cunes[ ] b) Pressure: · Annual Amount: c) Temperature: Largest Size Con[ainer: # Days On S~te Circle Which Months: All Year, J, F, M, A, M, J, J, A, $, O. N, D 9) MIXTURE: lIst COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] ci~emicaJ components or any AHM components 2) [ ] 3) [ 1 10) Location ~ cer~fy un(ier penalty of law, that I have persona#y examined and am familiar Wl~h the infoma~on submitted on this and all at, ac. ned documents. I believe the submitted information is ~ue, accurate, and complete. PRINT Name & Title of Authorized Company F~epresentafive Signature Date HAZ,~DOUS I~IA?ERT A~ BUREA~r ~ ALL ITEMS OK: [ ~ ] ~fOLATIONS NOTED: [ ] 0 - Does Not Apply 1 - In Compliance 2 - Correction Needed 3 - Verbally Warned 4 - N.O.V 5 - Citation 6 - Referred To (Specify) EMERGENCY PROCEDURES (CCR TITLE 19-2729 & 31) PREVENTION & CLEANUP PROCEDURES (CCR TITLE 19-2731) B. Employee Notification & Evac. Plan M Clean-up Materials Placement/Availability C. Emergency Responder Notification N Clean-up Equipment D. Medical Assistance 0 Fire Protection Systems E. Private Response Team Procedures P Waste Handling & Storage Q Availability of Protective Equipment TRAINING REQUIREMENTS (CCR TITLE 19-2732) INV. & DIAGRAI~ VERIFICATION (CCR TITLE 19-2729) F. Training Records R. Inventory Quantities G. MSDS Available to Employees S. Storage, Container Cond., & Labeling H. Employees Familiar with MSDS T. Location in Facility Unit I..Use of Personal Protective Equipment U. Emergency Water Supply J. Waste Material Permits & License V. Evacuation Plan & Area K. Employees Familiar with Evacuation W. Surrounding Exposures Plan. i. X' Utility Shut-offs Y. Other / Clearance Granted~[~,] Re-Inspection Required [ ] ~On. / y / B.E. Starte~ / ~ ~:lCompletedL~. / 0:~ 5 Total Tlme ~ ~ / ~ F' 580 2415 HMCU 414 (Revi~e~ 1/89) KERN COUNTY FIRE DEPARTMENT 5642 VICTOR STREET. BAKERSFIELD, CA 93308 BUSINESS NAME INSPECTOR QUESTIONNAIRE BUSINESS PLA/~ AS A WHOLE FOR USE WITH THOSE BUSINESSES COMPLETING A BUSINESS PLAN (2A). INSTRUCTIONS: 1. Complete this form only once for each occupancy. 2. Attach this form to BUSINESS PLAN (2A) and forward to Data Entry. BUSINESS PLAN VERIFIED ON: ]0 / ~ /~ SECTION 1: RESPONSE SU~Y (Limit to 4-5 lines) SECTION 2: NOTIFICATION / EVACUATION OF AFFECTED PUBLIC (Limit to 13 lines) HMCU-5~ BUSINESS NAME Food ~407_ ID Z !5--0~00-0004G4 1. OVERVIEW L8ST CHANGE ~1/8S/87 8Y ESTER JURIS CODE Zl5-~4 JURIS BAKERSFIELD ST~TION MAP PAGE l~ GRID 1BR F~CILITY UNITS .~SPONSE ~UMMARY ZA SEC 4) IN SMALL OR MINOR EMERGENCY'S OUR M~NAGEHENT'TEAM WILL;C~LL FOR · ASSISTANCE IF NEEOED, OUR THREE SECURITY OFFICERS H~VE,.SEEN CE.RT~FIED BY THE REO CROSS FOR EME~ENCY FIRST 8I~ AND CPR. E~RGENCY CON'rACTS. 2n SEC Z)32~ ~Y15 ~q ~ ~E u STORE HG.R - 3ZS-~314 ~ BOB SPENGLER - DISt ~R - 83.B-B83B OR 836-8BBfi UI'ILiTY SHUTOFFS Zfl SEC 3) fl) GAS - NORTH S10E BLDG GAS METER B) ELECTRICAL - SE CORNER CO~RESSOR RM C) WATER - NORTH SIDE NEXT TO GAS ~ETE~ D) SPECIAL - NONE E) LOCK BOX ,- NO NOTIFICATION / P-U~.IC EVACUATION LAST CHANGE / / BY I < NO INFORMATION RECO~ED FOR THIS SECTION > ~ PAGE ! 04/11/89 0?:57 MATERIAL SAFETY OR'FA SYSTEMS, INC. (805) 648-6800 / ! ~' BUSINESS N~ME FOOD ~402 ID Z lS-OOO-OOO464 " L. OCRTiON 41Z8 CHESTER flV H~GH HRZ-RRO RRT!'NG Z 3. HRZ ~RT TRAINING ~UHNRRY LAST CHANGE / / BY < NO ZNFORN~T~ON -RECORDED FOR THZS SECTION ) 4. LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE tW06/87 BY ESTER SEC S) SOtJTHWEST URGENT CARE CENTER -, OR CALL. PAGE Z 041]1/89 0?:3? M~TE,RIRL S~FETY DATA SYSTEMS~ INC~ (805) -B4B-B800 ~ BUSINESS NFIME FOOD ~40Z ID Z1S-CX~O-~O484 · LOC~TION' 41Z8 Chi R RV" HI( ZRRD RATING FACILITY UNIT ~1 A. OVERALL HSZ~tROOUS M~TERI~LS INVENTORY L~ST CHflNGE 1~/~1/88 BY VAL ID TYPE NAME MAX AMT UNIT BRZRRD LOCRTI ON ' CONTRINMENT USE t PURE MOTOR OIL ~88 GAL UNENOWN SALES RRER METRL CONTAINERS LUBRICANT ID PERCENT CO~ONENTS H~ZRRD _LIST Z8~8.~8 188,~ No,of Oil NONE Z -PURE INSECTICIDES Z24 GAL UNKNOWN S~LES "RE" METRL CONTaINErS INSECTICIDE %~I10 PERCENT COMPONENTS HAZARD LIST ,,-F,~ ~ eSG.~e l~,e INSECTICIDES UNKNOWN , 3 'MIXTURE FLOOR STRIPPER lB5 GRL UNKNOWN 3RNI'fORIRL ROOM DRUMS OR BARRELS MET.. STRIPPER ID -PERCENT CO~ONENTS HAZARD LIST 4 MIXTURE FLOOR SEAL. ER 165 G~. UNKNOUN .JRNITORI.RL ROOM mUMS OR BARRELS MET.. CLEANING ID PERCENT COMPONENTS HRZRED LIST LAST CHANGE / / BY < NO INFORM~T. ION RECORDED FOR THIS SECTIDN PAGE 3 04111189 MATE.RIAL SAFETY DATA SYSTEMS, INC. (885) 648-G800 · BUSINESS N/~ME FOOD ~-E$S .$t-40Z I0 N~ER Z I S-0~-0004~z~ " LOC~TION 41Z8 CHESTER ~V -HIGH -H~Z~RD -RIFTING % D. EMPLOYEE NOTIFICATION / EVaCUaTION L~S'T CHANGE / / BY < NO INFORMBTION RECORDEO FOR THIS SECTION E, '~ITIGflTiON ! PREVENTION / ABATEMENT LAST CHANGE / / 8Y - - < NO {INFOR.M~T]ON RECORDED FO~ THIS SECTION > PAGE 4 MATERIAL SAFETY DATA SYSTEMS, INC. · .'.~...-'"." ~,~ CITY o./' BAKERSFIELD ~,,,.~ ,,~ ,...;'.% '. ~-. ~'! '/ I'I"E CARE (t~e or prin~ name) RECEIVED J AN 3 0 1989 ~o ~e~eb7 oe~tLf7 that Z h~ve ~evLe~ed the A~s'd ............ attached Hakardous Materials business plan (name of business) and that it along with the attached additions or corrections constitute a complete and correct Business Plan for mM facility. ~/ signature date LOCATION 4128 CHESTER AY HIGH HAZARD RATING 1. OVERVIEW LAST CHANGE 11105187 BY ESTER JURIS CODE 215-004 JURIS BAKERSFIELD STATION 04 MAP PAGE 103 GRID IgA FACILITY UNITS 1 HAZARD RATING Z RESPONSE SUMMARY ZR SEC 4) IN SMALL OR MINOR EMERGENCY'S OUR MANAGEMENT TEAM WILL CALL FOR ASSISTANCE IF NEEDED. OUR THREE SECURITY OFFICERS HAVE BEEN CERTIFIED BY THE RED CROSS FOR EMER6ENCY FIRST RIDE AND CPRo EMERGENCY CONTACTS 2A SEC Z) JOHN ROUNTREE -- STORE MGR - 3Z5,-7314 OR 589-5056 BOB SPENGLER - DIST MGR - 835-9036 OR 836-8996 UTILITY SHUTOFFS ~A SEC 3) R) GAS - NORTH SIDE BLOB GAS METER 8> ELECTRICAL - SE CORNER COMPRESSOR RM C) WATER - NORTH SIDE NEXT TO GAS METER D) SPECIAL - NONE E> LOCK BOX - NO NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 lZ/Z3/88 15:53 MATERIAL SAFETY DATA SYSTEMS, INC. (80S) 648-6800 BUSINESS NAME FOOD 4 LESS ~02 ID NUMBER Z1S-O(DO-000464 LOCATION 4128 CHESTER AV HIGH HAZARO RATING 3, HAZ MAT TRAINING SUMMARY LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > 4, LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE l}/OG/8? 8Y ESTER 2~ SEC S> ~LTH~.IFST IIRGFNT CAlF ~FN'rER - 539 t TRUXTUN ~U ' 0R CALL ~ ~ PAGE Z 1~/2~/88 1S:S~ M~TERIAL SAFETY DATR SYSTEMS, INC, (805) G48-GB00 BUSINESS NAME FOOD ESS ~.40Z ID ER ZlS-000-00046~ LOCATION 4128 CHESTER AV HIGH' HAZARD RATING FACIEITY UNIT 0! OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 10/3t/88 BY UAL ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE MOTOR OIL 600 GAL UNKNOWN SALES AREA METAL CONTAINERS LUBRICANT ID PERCENT COMPONENTS HR1ARD LIST Z808.00 100.0 MOTOR OIL UNKNOWN PURE INSECTICIDES 224 GAL UNKNOWN SALES AREA METAL CONTAINERS INSECTICIDE ID PERCENT COMPONENTS HAZARO LIST -1056.00 100.0 INSECTICIDES UNKNOWN MIXTURE FLOOR STRIPPER IGS GAL UNKNOWN JANITORIAL ROOM DRUMS OR BARRELS MET., STRIPPER ID PERCENT COMPONENTS HAZARD LIST MIXTURE FLOOR SEALER 1GS GAL UNKNOWN JANITORIAL ROOM DRUMS OR BARRELS MET.. CLEANING ID PERCENT COMPONENTS HAZARD LIST B. FIRE PROTECTION / WATER SUPPLIES LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 3 1ZTZ3/88'l'S:53' MATERIAL SAFETY DATA SYSTEMS, INC. (80S) 648-6800 BUSINESS NAME FOOD 4 LESS ~¢0Z ID NUMBER Z15-0~0-000464 LOCATION 41Z8 CHESTER 8V HIGH H~ZBRD RATING D. EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > E. MITIGATION / PREVENTION / ABR"FEMENT LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 4 ~Z/Z3/88 15:53 MATERIAL SAFETY BATS-SYSTEMS, INC. (805) B48-B800 CITY of BAKERSFIELD NON--~I?RADE SECRETS CITY, ZiP: (~a~2~,&'~/,/ , Ca, CITY, ZIP: ~,~ ~, DUN AND BRADSTREET NUMBER C~e ~e it ~t Est Units m Site T~ ~1 Tm ~ .. St~ in F~tltty~ ~ I~t~tiw r-- r--a r--a r--a ~t 12 ~&C.A.S. ~ ~lth of P~ ~lth - r-~ -- r--~ r--~ ~t ~ ~EC.A.S. ~ ~lth of P~ ~lth H~lth of P~su~ ~lth H~lth of Pr~sure Health ........... ~t 13 M&C.A.S. ~r Certificetim (Read and s~ after compJet~ng all sections) BAKERSFIELD CITY FIRE DEPAR 2130 "G" STREET BAKERSFIELD, CA 03301 (805) 326-3979 OFFICIAL USE ONLY BUSINESS NAME HAZARDOUS MATER I ALS BUSINESS PLAN AS A WHOLE FORM 2A 000 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 ~h61e. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDE~IFICATION DATA A. BUSINESS NAME: F~oA~LI--L~ '~ ~ SECTION 2: E~RGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITL~ ~ DURING BUS. HRS. AFTER BUS. HRS. ECTION3: OF ~ILI~ S~-OFFS FOR BUSI~SS AS ~ ~OLE BOCATION D. SPECIAL: E. LOCK BOX: YES /~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / N0 MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - f~SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE ~SEC~ LOCAL EMEROENCYVMEDICAL 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 ~ ~ MATERIALS:..., .................................... NO NO B. PROCEDURES FOR COORDINATING ACTIVITIES ~ WITH RESPONSE AGENCIES: .......................... YE~ NO NO C. PROPER USE OF SAFETY EQUIPMENT: ..................~ES NO NO D. EMERGENCY EVACUATION PROCEDURES: ................. NO ~ E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... ~ YES SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO~ DOE._S YOUR BUSINESS HANDL~ HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUN~OF A SOLID~ 5%GA~ON~, OF A~QUID, OR 200_QI/B~C-.FEET OF A COMPRESSED GAS: ...... ~ NO ~ ~--'~~ ~~ , certify that the above information is accurate. I understand that thi~ x"lh~orm'~iion will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) 'n that inaccurate information constitutes perjury. SIGNAT TITLE DATE ....... ~. _ ~ ~--, ..... , o,/ ~,I / - 2B - BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page __of NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY ADDRESS: 4]28 Cho~ter Ave. ADDRESS: ~,f), 5~/~ 9~lr)$ FACILITY UNIT NAME: CITY, ZIP: ~[-~rc-~;~l~ ~A CITY ZIP: ~~ t ~ ~$ PHONg ,: 3~'-qfth' ........ ~,9330 ' I ON~ I 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT . WT. CHEMICAL 0R COMMON NAME CODE GUID,,~ NAME: - : ~ - : EMERGENCY CONTA TITLE: ' ~a~- ~%'.5r,~ PHO~k ~BUS .OURS': AFTER BUS BPS: PRINCIPAL, BUSINESS ACTI~IT~: ' V I~}~,~ ~5 ' ~rDC~,r~ gtaC~ ~ AFTER BUS .RS: - 4A-Ia INSECTICIDES (HOUSEHOLD TYPE) Antrol Ant Killers 1 1/3 oz Boyle-Midway Antrol Ant Traps 159 o~. " " Grants Ant Stakes 3.33 oz Grant Lab's Inc. Off 6 oz S.C. Johnson & Son, Inc. Raid Flea Killer Plus 12 oz " " Raid Pro. Strength Ant/Roach Killer 16 oz " " Raid Ant/Roach Killer 16 oz " " Raid Liquid Pun~p Ant/Roach (11 oz) 16 oz " " Combat Ant Control 0.177 oz American Cyanaid c/o Household Prod. Black Flag Ant/Roach 11 oz Boyle-Midway, Inc. Black Flag Ant/Roach 15.5 oz " " Holiday Fogger 5 oz " " Raid Flea Killer 16 oz Johnson & Son, Inc. Raid Yard ~uard Outdoor Fogger 16 oz " " Raid Strip 3.3 oz " " Raid Flying Insect Killer 12 oz " " Raid House & Garden 16 oz " " Raid House & Garden 13 oz " " Combat Roach Control 0.635 oz American Cynamid c/o Household Prod. Black Flag ~ach Motel Boyle-Midway, Inc. Raid Roach Traps JohnsOn ~&~-~Son, Inc. d-Con Rat & Mice Trays 1 lb Sterling Drug, Inc. POOL SUPPLIES Type Manufacturer Kemex Chlorinating Granules 4 LBS Chemical Lab Products, Inc. Ontario, California Shock Superchlorinating Granules 8 LBS " " Kem-2 Chlorinator Cartridge 4 LBS " " Spa-Kem Granules 2 LBS " " Kemex Chlorinating' Granules 8 LBS .... PH Minus Dry Acid 7 LBS .... A19y Cop 32 OZ " " Chlorinating Tabs (Spakem) 1 LB " " Diatomaceous Earth 5 LBS " " Chlorinating Tablets 9 LBS " " Shock Superchlorinating Tablets 4 LBS " " -, 3" Chlorinating Tablets 4 LBS " " Kem 2 Chlorinator Cartridge 5 LBS " " Kemklor II Liquid Chlorine 1 GAL " " Water Clarifer 32 OZ .... Spa Granules 2 LBS " " Soda Ash 5 LBS " " Chlorine Tab-100 ' s 8 LBS " " Chlorine Budy Cartridge 4 LBS " " MOTOR OIL Type Manufacturer Pennzoil Transmission Fluid Type F 32 OZ Pennzoil Co~oany Oil City, PA Pennzoil Dexron II Transmission Fluid 32 OZ " " Pennzoil 10-30 32 OZ " " Pennzoil 10-40 32 OZ .... Pennzoil 30 W 32 OZ " " Pennzoil GT 20/50 32 OZ " " STRIPPER (JANITORIAL SUPPLIES) Solven - Concrete Cleaner/Stripper 5 gal. Fed. International Chem. Co. San Carlos, Ca. SEALERS ( JANITORIAL SUPPLIES) 6/29/87 None in store at this time Fed. International Chem. Co. San Carlos, Ca. BAKERSFIELD, CA 93301 (805) 326-39'79 0FFIC[AL USE ONLY SUSINESS NAME HAZARDOUS i~[ATE R I ALS INS~UCTI ONS: 1. To avoid further action, return this form 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a wh6le. 4. Be as brief and concise as possible. SECTION 1: BUSI~SS IDE~IFICATION DATA A. BUSINESS NAME: SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State 0ffice of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME ~ND TITL~-, , /~ .~ DURING BUS. HRS. .AFTER BUS. HRS. SECTION 3: LOCATION OF ~ILI~ S~-OFFS FOR BUSI~SS AS A ~OLE D. SPECIAL: FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL E~ERGENCY~DICAL ASS~ST~CE FOR YO~ SUSINESS 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 .ANDLING OF .AZARDOUS MATERIALS:...- .................................... NO ~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~.YE=~ NO "~ NO C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO~ NO D EMERGENCY EVACUATION PROCEDURES: ................. NO E DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES ~ YES ~_~ SECTION 7: HAZ~d~DOUS ~ATERIAL CIRCLE YES OR NO~ DOES YOUR BUSINESS HANDL~ HAZARDOUS .MATERIAL IN QUANTITIES LESS THAN 500 POUN~k~xOF A SO~ID, '58. GALLON'S OF A~QUID, OR 200 _CI/BIC FEET OF A COMPRESSED GAS: ...... /?ESj NO ~ ,~.~'L/~,._~,*,,~__,--r/~ , certify that the above information is accurate. I understand that this ~o.rmation will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. - 2B - BAKERSFIEI,~ITY FIRE DEPARTMENT I.D. # '-FORM 4A-1 0f NON--TRADE SECRETS HAZARDOUS MATER'{' ALS INVENTORY BUSINESS NAME: Food /J. !=ess &~-0 OWNER NAME: ~ ~, C FACILITY UNIT ~:~ PHONE ~:~3~--~fl~' ........ ~' ~'' ~°°u~' PHONE ~: I-~C:,9',fqP' /~.~ [OFFICIAL usg CFIRS CODE ONLY , ] 2 3 4 5 6 7 8 9 10 TYPE ~AX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE ~ACILITY UNIT WT. CHEMICAL OR COMMON N~ME CODE GUIDE AFTER BUS HRS: INSECTICIDES (HOUSEHOLD TYPE) Antrol Ant Killers 1 1/3 oz Boyle-Midway Antrol Ant Traps 159 o~ .... Grants Ant Stakes 3.33 oz Grant Lab's Inc. Off 6 oz S.C. Johnson & Son, Inc. Raid Flea Killer Plus 12 oz " " Raid Pro. Strength Ant/Roach Killer 16 oz .... Raid Ant/Roach Killer 16 oz " " Raid Liquid Pump Ant/Roach (11 oz) 16 oz " " Combat Ant Control 0.177 oz American Cyanaid c/o Household Prod. Black Flag Ant/Roach 11 oz Boyle-Midway, Inc. '~ Black Flag Ant/Roach 15.5 oz " " Holiday Fogger 5 oz " " Raid Flea Killer 16 oz Johnson & Son, Inc. Raid Yard Guard Outdoor Fogger 16 oz " " Raid Strip 3.3 oz " " Raid Flying Insect Killer 12 oz " " Raid House & Garden 16 oz " " Raid House & Garden 13 oz " " Combat RDach Control 0.635 oz American Cynamid c/o Household Prod. Black Flag Roach Motel Boyle-Midway, Inc. Raid Roach Traps Johnson~& Son, Inc. d-Con Rat & Mice Trays 1 lb Sterling Drug, Inc. POOL SUPPLIES Type Manufacturer Kemex Chlorinating Granules 4 LBS Chemical Lab Products, Inc. Ontario, California Shock Superchlorinating Granules 8 LBS .... Kem-2 Chlorinator Cartridge 4 LBS .... Spa-Kern Granules 2 LBS .... Kemex Chlorinating Granules 8 LBS " " PH Minus Dry Acid 7 LBS " " Algy Cop 32 OZ .... Chlorinating Tabs (Spakem) 1 LB " " Diatomaceous Earth 5 LBS " " Chlorinating Tablets 9 LBS " " Shock Superchlorinating Tablets ~ 4 LBS " " -, 3" Chlorinating Tablets 4 LBS " " Kem 2 Chlorinator Cartridge 5 LBS " " Kemklor II Liquid Chlorine 1 GAL " " Water C]arifer 32 OZ " " Spa Granules 2 LBS " " Soda Ash 5 LBS " " Chlorine Tab-100 ' s 8 LBS " " Chlorine Budy Cartridge 4 LBS " " MOTOR OIL · ype Manufacturer Pennzoil Transmission Fluid Type F 32 OZ Pennzoil Company Oil City, PA Pennzoil Dexron II Transmission Fluid 32 OZ " " Pennzoil 10-30 32 OZ " " Pennzoil 10-40 32 OZ " " Pennzoil 30 W 32 OZ " " Pennzoil GT 20/50 32 OZ " " STRIPPER ( JANITORIAL SUPPLIES ) Solven - Concrete Cleaner/Stripper 5 gal. Fed. International Chem. Co. San Carlos, Ca. SEALERS ( JANITORIAL SUPPLIES ) 6/29/87 None in store at this time Fed. International Chem. Co. San Carlos, Ca.