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HomeMy WebLinkAboutBUSINESS PLAN ~ Hazardous Materials/Hazardous Waste Unified Permit ~ CONDITIONS OF Pi=ItMIT O~ I::IgYEFI$1= ~ ~~ ~1~ P~n Pe~it ID ~:: 015~00~00663 ~ ~ .: ~ Risk~n~P~mm ~ '-'~'.WEBSTER SAND INC a H~sWa~O~T~ LOCATION: CHINA G~DE LOOP Issued by: Bakersfield Fire Department '  -OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor' Appr°vedby: Bakersfield, CA 93301 . , Office of E'~~i¢cs'"'; issue Date Voice (661) 326-3979 . FAX (661) 326-0576 :Expimtionnate: 'June 30.. 2003 -. . . '. . '.':" Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE .......... ~,,,,,,;.~.~,~,~;;~,~,:;~...;,:;~ ................... This permit is issued for the following: ~,,~??'?~i:i?i ! ::'~?~i~i~::ii'?~;ii':~::::ii iii': i !!!ii~i?i~;~:~.i~Hazardous Materials Plan ,~?~!?~"!' ':~,i ~"?~:'::ii !iiiii:~. ~;ii!!!!iiii~,. ;ii~;iil;iiii?'::iiii:iil;eii~emround Storage of Hazardous Materials PERMIT ID# 015-0214)00663 =?i;~?!i ~!~.~[~i!:'~;~i;: ii ~]~ ~;' ~? ~ ~,~;:: ]~=~?~;~k~aoagement Program j~j~ ',~' ~ ~ '=~7=.~F'~P:'' ~¥'-. '~ ' ~ ~ ........ "~'~'"%~':....,~::'~?~:'~ ?' ':~i'..;~~ ' ' [ ~ .... ~h~ ..... '-.~ ~ ..... ~ ~.'".-.?~! ~ ~...... ~. ~;: ....... ,, ~./ ~ ...... ~-... ~ r. ~.a .... .:... j~,~ ;,...~ ~ ,. ~,, ~,~........-....,[~ .~ r ~' :~ ~Z7'~,'=~=.; LLEJ..Z., .~,~'~'.-,~E4 'ij~l~. ~j~F~'~'' ~ [ ~ i '~ '-" '"_ :~.~ '" ..~'~' ~( ':'~J~ ........~ "~ ~ ~'~L ~ j ~k . ~= ls~ O~CE OF E~R O~AL S~ 1715 Chewer Ave., 3rd Floor B~e~fiel~ CA 93301 Voice (805) ~2~979 F~ (80S)~6-0S76 Expiration Date: ~Un~ ~O~ ~OOO SITE/FACILITY DIAGRAM FORM 5 NORTH SCALE: BUSINESS NAME: FLOOR: OF .DATE:X./// FACISITY N~E: UNIT ~: OF (CHECK ONE) SrTE DIAGRA~ FACILI~ ~.)0 /~lrJ~14_~ //~K/-CV7~I l(Inspector's Comments): -OFFICIAL USE ONLY-.. _ NORTH _scar.;':. [3~J[¢ [ >;E.X:.< :,,'.',:.ii .------ :r... -J(}R: i 07. (CKECK ONE) S~TE D[AGRA)~ ~ FACILITY DIAGRAM . , . ., .............. 4, ~,.,, /. "' - '= ' '. "', ", '%,-.;" " ' ...... ' ', , "-.,,. ' .......~.L'~ :',.". %.'~. c,,~, ~',, .. --,~.'-~-"-"--- .,, b, ,<=....,.:.,::,::.,,./:,/,:?.,,~y:,.::,~,~,;-;~C;?~,"<e,L, " '"""""' ""'"'"' "' " .... ' ......~;"'~ x.,. '"' '": /,.-~,C;-~"- ,t4,,~':j, · · /- ,Y' '~'17, '-+' '"+,:'~'~'t~ '"' ,~ .... .. ;;'.:;. "' +. __'+' "'+, ".+,./.,, .,+/.~' ':C/~,-,,%. "+. -,- '/.: +,, +, /,~ /., /,,, f... '- ~. ',, '"',,, '"'-~ +,:'""'..-,.. :;., .-,,~.1, "'"' .......... ~. .. ~..,'., .,+C; .... - ' . · · '"' '" ~]./ =..¥~",_: ~ . ¢#t,,,,~# "- '" ', ' ",' ',,.. ,C,-"l'" " '~' ...... '"' ..... '"' , kl : . ' .,;. ' .. t ~ "~'~ ; ' ~ IO .. "2 F- -! , i ........ '~'-~ "'= .-~=-....:,. ",:.; /!... ,' I . , ........ ':':"::! .... '?:":';': u ~/i';::~ ............ --1 %-:-:-7- ......... >~.". / ~ ; t I ................ · .................. -: :-- " : ..,.,,~ .... ... =_.:.:: ..--, , ~, , .: .?;.?. ci',~';.'f--:;;-.:;;:: :T" ;~ I I ',. )'?' _.I"'~ ,.:::.-.. ,..:~-.,.~::-r~.~..-,.,?~.~. -I.~ ,, /~, r-I ,~ ,.,,..,..,/,~ .':~.-,.e :-.~ ~..,..;,..:~-:,::,:..¥.. ,--,,..,: '"~ ....... .::. ~,..; ,-.,..:.~]i,',<~':;:~:.-..-::4 t y/., .', I . ,..'~ ~:"1 '-':'.' · '..-" ':..I .... // · .. ,.~,..~......:...;.~ ..... ,~,;-.,...?,..~.. ,. -- , !' '."." ' ., ,- "'~,~." .~?~;.,"rJ'2~ .~ :,' ='." ' :' · .-_.. ~.: ~-,,.~,,~-,-.:,~::~, ....... ?.,.::~. --- ,.,- :,~' PiT U ~:~ l~,O .... ' .................. "" '"'""-""-"-' ...... "' ..... =": .... ........ "' ·.. -~¢c*o-.*e .- ~:.'.. ,.,. '" .' .,,'.. ~; ':-x'~"" '7-~'-' '4... ' .... ' ' · :" ' ' ";: ';" ~:-~'"" .... : ' "~ v ': .,..,.*x'-.~s, :.. ~.. ~j: ~ ,....'.;?.,'L';' ;Ir ~.~, ?-:,'.." ,= '. ' ·. ..':<, . · ..... .,,;,.,,,e.~,~'.~,r + ..... ..: ~,~.;..:;:,.:..~.,~, ~B.~;.:.~,,~.,..:,~.,~,~.~i~f!::~c.?~x ?~ :. ~f.:.,,;...::.. .... :'::" ~"::"~¥"?,': ,~.'>~,~'~.~m-'-~;:".:~.!?~: · ~'.r'~,~.-,,:':;;r.~,.: ..... :. ~' ,:~ .,~itti~~~'~;~;,.~:~.<~.~:i:~...,...i.j., :'. :-.:'.. ..... '-,, .' ~ :'?:-'.. '..?-'?~.~?~,..::,'~;~,~::~-;~'~-,i.~,'.:'-~-...~:~¥,=..~,:.?x,:-~.' ..- . '~... SITE/FACILITY DIAGRAM .... FORM 5 NORTH SCALE: BUSINESS NAME: FLOOR: OF .DATE:/./ ,/ FACILITY ~N~E: UNIT ~: .OF (CHECK QNE) SITE DIAGR,~ FACILI~ DIAGR.~ .~ i(Inspector's Comments): -OFFICIAL USE ONLY- SITE DIAGRAM items) 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers 10. WeDS'Storage Box 2. Street(s). Altsys, ti. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Barrier property. Include the a. Hire street names. b. Masonry 3. Storm Brains. Culverts, Yard Drains c. Hood 4. Drainage Canals, Ditches, d. Gates Creeks, 13. Powerllnes 5. Buildings a. Frame construction 14. Guard Station b. Hasonry construction 15. Storage Tanks: Identify the c. Metal construction capacity tn gal. a. Above ground d. Access Door b. Underground 6. Utility Controls a. Gas 16. Diking or Berm b. Electricity 17. Evacuation Route c. Hater 18. Evacuation Area: Identify the ?. Fire Suppression Systems: location mhere a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d. Hater Control Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fire Pu~p 22. Type ~f Hazardous NatertaA/Waete ~ Stored 8. Fire Oepartaent Access or Used (See Below) :, TyPE oF HAZARDOUS HATERIAL F - Flammable g - Explosive ' L - Liquid R - Radlological C - Corrosive 0 - Oxidizer O - Gas P · Poison W - Water Reactive T - Toxic S - Solid H - Cryogenic O · Waste B - Etiological Example: Flammable Liquid - FL FACILITY DIAGRAM (Required items tn addition to the above) ' 1. Risers for Sprinklers 8. Fire Escapes Partition, 9. Air Conditioning Unit, 3. Stairways: Indicate the 10. Windows levels served from highest to lo~eat. 11. Inside Hazardous Haste Storage 4. Escalator: Indicate the · levels served from 12. Inside Hazardous highest to lowest. Materials Storage S. Elevator 13. Inside Hazardous Nateriale Uae/Handling 6..Attic Access 14. Se~er Drain Inlets ?. Skylights Manager : BusPhone: (661) 399-3131 Location: CHINA GRADE LOOP Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 10C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 08 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title JOHN B GILLETT / GENERAL MANAGER FRED LUTZ / Business Phone: (661) 399-3131x Business Phone: (661) 399-3131x 24-Hour Phone : (661) 872-3286x 24-Hour Phone : (661) 399-0151x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 399-3131x MailAddr: PO BOX 271 State: CA City : BAKERSFIELD Zip : 93302 Owner JOHN GILLETT CORP Phone: (661) 872-3286x Address : 6116 DE PARSIA AVE State: CA City : BAKERSFIELD Zip : 93302 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpooHaz[EPA HazardsI Frm I DailyMax Unit MCP DIESEL FUEL F IH DH L 7000.00 GAL Low MOTOR OIL F DH L 330.00 GAL Mit USED OIL F DH L 250.00 GAL Low reviewed the a~ached h~ardous mmefials manage- ment plan for J nd that it along with (Na~ of Busine~) '~ any corrections constitute a complete and correct man- agement plan for my facili~. WEBSTER SAND INC SiteID: 015-021-000663 = Inventory Item 0001 Facility Unit: Fixed Containers on Site ~lV~Vl~ ~Vl~ / ~± ~1.~ ~Vl~ DIESEL FUEL Days On Site 365 Location within this Facility Unit Map: Grid: NW PART OF YARD CAS# 68476-34-6 r STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid 'Pure Ambient I.Ambient I ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 7000.00 GAL 7000.00 GAL 3500.00 GAL HAZARDOUS COMPONENTS ~ %Wt. S CAS# 100.00 Diesel Fuel No. 2 N 68476302 TSoorot RS BioHaz i HAZARD ASSESSMENTS I Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ---- Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ ~UIvUVlUJN J.~{.&U.Vl~ / ~l-J-~lVl±~'X-L, £Y_,~U. vI~ MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: MAINT SHACK CAS# 8020835 F STATE -- TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Ambient Ambient DRUM/BARREL -METALLIC Pure Liquid AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 55.00 GALI 330.00 GAL 165.00 GAL HAZARDOUS COMPONENTS 100.00 Motor Oil, Petroleum Based N 8020835 -- HAZARD ASSESSMENTS .TSecret oRS BioHazl Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No N No No/ Curies F DH / / / Min 2 12/20/2000 W~BSTER SAND INC SiteID: 015-021-000663 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site I ~lVUVlU~ ~Vl~ / ~ 1 ~k/~ ~Vl~ USED OIL Days On Site' 365 Location within this Facility Unit Map: Grid: MAINT SHACK CAS# 221 TATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE I Ambient I Ambient I ABOVE GROUND TANK Waste ILliquid AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 250.00 GALI 250.00 GAL 125.00 GAL HAZARDOUS COMPONENTS 1100.00 Waste Oil, Petroleum Based N 0 I HAZARD ASSESSMENTS TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP N No No/ Curies F DH / / / Low 3 12/20/2000 F WEBSTER SAND INC SiteID: 015-021-000663 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 01/18/2000 CALL 911 - FIRE DEPt. -- Employee Notif./Evacuation 01/18/2000 IN THE EVENT OF A TANK/BARREL RUPTURE OR OTHER EVENT THAT COULD CAUSE A SPILL OR FIRE, ALL PLANT EMPLOYEES HAVE STANDING INSTRUCTIONS TO EVACUATE BLDGS, ALERT OTHER EMPLOYEES, CONTAIN THE SPILL OR FIRE IF POSSIBLE AND TO NOTIFY THE FIRE DEPT. -- Public Notif./Evacuation 12/04/1990 DUE TO THE REMOTE LOCATION OF THE SITE THERE IS NO NEED FOR PUBLIC NOTIFICATION AND ATTENDANT EVACUATION. Emergency Medical Plan 01/18/2000 MEMORIAL HOSPITAL EMERGENCY - 420 34TH ST - 327-1792 OR KERN GENERAL EMERGENCY - 1830 FLOWER ST - 326-2000. -4- 12/20/2000 WEBSTER SAND INC SiteID: 015-021-000663 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 12/04/1990 DAILY INSPECTION OF ALL FUEL TANKS AND OIL BARRELS. Release Containment 12/04/1990 ANY RELEASE WILL BE CONTAINED BY SAND BERMS. BERMS WILL BE AUGMENTED IF NECESSARY SHOULD A RELEASE OCCUR. -- Clean Up · 01/18/2000 ANY MATERIAL WHICH MIGHT BECOME CONTAMINATED WILL BE CONSIGNED TO AN APPROPRIATE WASTE HAULER AND TAKEN TO AN APPROPRIATE DISPOSAL FACILITY. Other Resource Activation 5 12/20/2000 F WEBSTER SAND INC SiteID: 015-021-000663 Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 10/24/1990 A) GAS - NONE B) ELECTRICAL - NEXT TO MAINTENANCE SHACK C) WATER - NONE D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 01/18/2000 PRIVATE FIRE PROTECTION - 2 5LB FIRE EXTINGUISHERS AND LOW PRESSURE, LOW VOLUME WATER WHICH IS DEPENDENT ON ELECTRICAL POWER TO RUN PUMPS. FIRE HYDRANT - NO HYDRANTS BUT WATER CAN BE PUMPED FROM THE KERN RIVER OR BEARDSLEY CANAL IF SUBMERSIBLE PUMPS ARE BROUGHT IN. Building Occupancy Level 6 12/20/2000 WEBSTER SAND INC/~/~/~5~/~5~/~/~5~5~/~¢~ SiteID: 015-021-000663 i i~ Training ~~~~~~~~ Overall Site i~ Employee Trai~ng ~~~~66~~~ 01/18/2000 i O WE HAVE 9 EMPLOYEES AT THIS FACILITY. o WE HAVE MATE~AL SAFETY DATA SHEETS ON FILE. o o B~EF SUMMARY OF T~INING: VENAL B~EFING TO ALL EMPLOYEES REGARDING THESE PROCEDURES. o o o o i~ Held for Fumre Use o o i~8~ Held for Future Use o o SU PACIFIC REGENCY 6212 TUDOR WAY BAKERSFIELD 805 325-9421 0 0 N 805 PAUL & BOB MONSON 871-3133 Property Owner Name: Phone: ( ) - CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME (./)e.{151-~ ~ttl~ .F_I~_. INSPECTION DATE i o2 la I[ 0r0 ADDRESS ~/~t~0. ~rt~e. PHONE NO. 3 ?q- RI '3 ~ FACILITY CONTACT BUSINESS ID NO. I5-210- INSPECTION TIME NUMBEROF EMPLOYEES "~ Section 1: Business Plan and Inventory Program ~} Routine I~ Combined I~ Joint Agency I~ Multi-Agency ~ Complaint [~1 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 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 o~n site?: [~es [~ No Explain: Al Jh~C-z._~_ t _ ~_ ~ [ Questions regarding this inspection? Please call us at (661) 326-3979 Business Site,l~esponsible Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: _~_, WEBSTER SAND INC SiteID: 215-000-000663 Manager : BusPhone: (805) 399-3131 Location: CHINA GR3tDE LOOP Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 10C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 08 SIC Code: EPA Numb: DunnBrad: Emergency Contact '/ Title Emergency Contact / Title JOHN B. GILLETT / GENERAL MANAGER FRED LUTZ / Business Phone: ('805) 399-3131x Business Phone: (805) 399-3131x 24-Hour Phone : (805) 872-3286x 24-Hour Phone : (805) 399-0151x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : ? ~ Phone: ( ) - x MailAddr: PO BOX 271' , State: CA / City : BAKERSFIELD / Zip : 93302 ~ / Owner JOHN GILLETT CORP -~!,%"~, Phone: (805) 872-3286x Address : 6116 DE PARSIA AVEr-'.;'~'~ State: CA City : BAKERSFIELD , % Zip : 93302 Period : to -. TotalASTs: = Gal Preparer: ' TotalUSTs: = Gal Certif 'd: RSs: No Emergency Directives: = Hazmat Invrentory One Unified List -- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax UnitlMCP DIESEL FUEL F IH DH L 7000.00 GAL Low USED OIL F DH L 250.00 GAL Low __ Do hereby ce~i~ ~ha~ ~ hay® revieWed ~he a~ached h~a~ous made,als ~anags- any corrs~ions consl~lul~ ~ composts ~nd ~ ~n- agems~t plan ~or ~ ~c~. WEBSTER SAND INC SiteID: 215-000-000663 = Inventory Item 0001 Facility Unit: Fixed Containers on Site DIESEL FUEL Days On Site 365 Location within this Facility Unit Map: Grid: NW PART OF YARD CAS# 68476-34-6 Liquid /Pure Ambient Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average HAZARDOUS COMPONENTS 100.00 Diesel Fuel No. 2 N 68476302 HAZARD ASSESSMENTS I TSecret I NRoS I BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# I MCP No No No/ Curies F IH DH / / / Low = Inventory Item 0003 Facility Unit: Fixed Containers on Site ~LV~VZ~ ~vL~ / ~t~ ~ ~vt~ USED OIL Days On Site 365 Location within this Facility Unit Map: Grid: MAINT SHACK CAS# 221 Liquid Waste Ambient Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average [ 2so.oo 125.oo HAZARDOUS COMPONENTS 100.00 Waste Oil, Petroleum Based N HAZARD ASSESSMENTS TSecret I NRoS I Bi°HasINo No Radi°active/Am°unt I EPANo/ Curies F HazardsIDH NFPA/// USDOT# MCP -2- ,, 12/21/1999 WEBSTER SAND INC SiteID: 215-000-000663 = Inventory Item 0002~ Facility Unit: Fixed Containers on Site ~lvUVl~ ~vl~ / ~I~Z-'%.J_~ ~vl~ MOTOR OIL Days On Site i 365 Location within this Facility Unit Map: Grid: MAINT SHACK CAS# 8020835 F STATE T TYPE i PRESSURE i TEMPERATURE CONTAINER TYPE DRUM/BARREL- METALL I C Ambient Ambient Liquid Pure AMOUNTS AT THIS LOCATION ~ Largest Container I Daily Maximum Daily Average ,'9",5' GMI 330. oo GM 165.00 HAZARDOUS COMPONENTS 100.00 Motor Oil, Petroleum Based N 8020835 HAZARD ASSESSMENTS :TSecretI ~SIBioHazI Radioactive/Amount I EPA Hazards NFPA I USDOT# MCP No N No No/ Curies F DH / / / Min -3- 12/21/1999 F WEBSTER SAND INC SiteID: 215-000-000663 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 12/04/1990 CALL 911 - FIRE DEPARTMENT -- Employee Notif./Evacuation 12/04/1990 IN THE EVENT OF A TANK/BARREL RUPTURE OR OTHER EVENT THAT COULD CAUSE A SPILL OR FIRE, ALL pLANT EMPLOYEES HAVE STANDING INSTRUCTIONS TO EVACUATE BUILDINGS, ALERT OTHER EMPLOYEES, CONTAIN THE SPILL OR FIRE IF POSSIBLE AND TO NOTIFY THE FIRE DEPT. -- Public Notif./Evacuation 12/04/1990 DUE TO THE REMOTE LOCATION OF THE SITE THERE iS NO ~EED FOR PUBLIC NOTIFICATION AND ATTENDANT EVACUATION. Emergency Medical Plan 12/04/1990 MEMORIAL HOSPITAL EMERGENCY - 420 34TH ST. - 327-1792 KERN GENERAL EMERGENCY - 1830 FLOWER ST. - 326-2000 -4- 12/21/1999 F WEBSTER SAND INC SiteID: 215-000-000663 Fast.Format =Mitigation/Prevent/Abatemt Overall Site --Release Prevention 12/04/1990 DAILY INSPECTION OF ALL FUEL TANKS AND OIL BARRELS. --Release Containment 12/04/1990 ANY RELEASE WILL BE CONTAINED BY SAND BERMS. BERMS WILL BE AUGMENTED-IF NECESSARY SHOULD A RELEASE OCCUR. -- Clean Up 12/04/1990 ANY MATERIAL WHICH MIGHT BECOME CONTAMINATED WILL BE CONSIGNED TO AN APPROPRIATE WASTE HAULER AND TANKEN TO AN APPROPRIATE DISPOSAL FACILITY. Act ivat ion IOther Res'°urce I -5- 12/21/1999 F WEBSTER SAND INC SiteID: 215-000-000663 Fast Format ~ Site Emergency Factors Overall Site ISpecial Hazards --Utility Shut-Offs 10/24/1990 A) GAS - NONE B) ELECTRICAL - NEXT TO MAINTENANCE SHACK C) WATER - NONE D) SPECIAL - NONE E) LOCK BOX - NO -- Fire ~rotec./Avail. Water 10/24/1990 PRIVATE FIRE. PROTECTION - 2 5LB FIRE Ex~INGu~E--R-S-AN~--~O~ ~EsSI~RE,-L~W VOLUME WATER WHICH IS DEPENDENT ON ELECTRICAL POWER TO RUN PUMPS. FIRE HYDRANT - NO HYDRANTS BUT WATER CAN BE PUMPED FROM THE KERN RIVER OR BEARDSLEY CANAL IF SUBMERSIBLE PUMPS ARE BROUGHT IN Building Occupancy Level 6 12/21/1999 WEBSTER SAND INC ~~~~~~ SiteID: 215-000-000663 i~ Trai~ng ~~~~~~~~ Overall Site i i~ Employee Trai~ng ~~~~~~~ 12/04/1990 i o WE HAVE 9 EMPLOYEES AT THIS FACILITY o O WE ~VE MATE~AL SAFETY DATA SHEETS ON FILE o O B~EF SUM~RY OF T~INING: VENAL B~EFING TO ALL EMPLOYEES ~GARDING THESE o PROCEDURES. o o O o i~ Held for Fumre Use ~~~~~{~~~i O o ieee~e Held for Fumre Use o o 03/18/92 WEBSTER SAND INC 215-000-000663 MAR £3 1992 ]ge Overall Site with 1 Fac. Unit G~neral Information By_ Location: CHINA GRADE LOOP Map: 103 Razard: Low Community: BAKERSFIELD STATION 08 Grid: 04 F/U: 1AOV: 0.0 Contact Name Title Business Phone i 24-Hour Phone- JOHN B. GILLETT GENERAL MANAGER (805) 399-3131 x (805) 872-3286 FRED LUTZ (805) 399-3131 x 1(805) 399-0151 I Administrative Data Mail Addrs: P O BX 271 D&B Number: City: BAKERSFIELD State: CA Zip: 93302- ~ Comm Code: 215-008 BAKERSFIELD STATION 08 SIC Code: I I ' , Owner: JOHN GILLETT CORP. Phone: (805) 872-3286 Address: 6116 DE PARSIA AV State: CA City: BAKERSFIELD Zip: 93302- Summary 03/18/92 WEBSTER SAND INC 215-000-000663 Page '2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 DIESEL FUEL Liquid 7000 Low ~ Fire, Immed Hlth, Delay Hlth GAL CAS #: 68476-34-6 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL' Daily Average GAL I Annual Amount GAL -- 7,000 I 3,500.00 35,000.00 Storage Press T Temp ABOVE GROUND TANK IAmbient/AmbientlNW.PART OF YA~cati°n -- Conc Components ~ MCP. List 100.0% IDiesel Fuel No.2 ILow I 02-002 MOTOR OIL Liquid 330 Minimal ~ Fire, Delay Hlth GAL ' CAS #: .8020835 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GALI Daily Average GAL I Annual Amount GAL -- 330 ~ 165.00 990.00 'Storage Press T Temp Location DRUM/BARREL-METALLIC IAmbient/AmbientlMAINT SHACK -- Conc Components MCP List 100.0% IMotor Oil, PetroleUm Based }Minimal I 02-003 USED OIL Liquid 250 Low ~ Fire, Delay Hlth GAL CAS #: 221 Trade Secret: No Form: Liquid Type: Waste Days: 365 Use: WASTE Daily Max GALI Daily Average GAL 1 Annual Amount GAL 250 ~ '125.00 550.00 StorageIIPress T Temp Location ABOVE GROUND TANK IAmbient~ambientlMAINT SHACK -- Conc Components MCP List 100.0% IWaste Oil, PetrOleum Based I.Low [ 03/18/92 WEBSTER SAND INC 215-000-000663 Page 3 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 - FIRE DEPARTMENT <2> Employee Notif./Evacuation IN THE EVENT OF A TANK/BARREL RUPTURE OR OTHER EVENT THAT COULD CAUSE A SPILL OR FIRE, ALL PLANT EMPLOYEES HAVE STANDING INSTRUCTIONS TO EVACUATE BUILDINGS, ALERT OTHER EMPLOYEES, CONTAIN THE SPILL OR FIRE IF POSSIBLE AND TO NOTIFY THE FIRE DEPT. <3> Public Notif./Evacuation DUE TO THE REMOTE LOCATION OF THE SITE THERE IS NO NEED FOR PUBLIC NOTIFICATION AND ATTENDANT EVACUATION. <4> Emergency Medical Plan MEMORIAL HOSPITAL EMERGENCY - 420 34TH ST. - 327-1792 KERN GENERAL EMERGENCY - 1830 FLOWER ST. - 326-2000 03/18/92 WEBSTER SAND INC 215-000-000663 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention DAILY INSPECTION OF ALL FUEL TANKS AND OIL BARRELS. <2> Release Containment ANY RELEASE WILL BE CONTAINED BY SAND BERMS. BERMS WILL BE AUGMENTED IF NECESSARY SHOULD A RELEASE OCCUR. <3> Clean Up ANY MATERIAL WHICH MIGHT BECOME CONTAMINATED WILL BE CONSIGNED TO AN APPROPRIATE WASTE HAULER AND TANKEN TO AN APPROPRIATE DISPOSAL FACILITY. <4> Other Resource Activation 03/18/92 WEBSTER SAND INC 215-000-000663 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE 'B) ELECTRICAL - NEXT TO MAINTENANCE SHACK C) WATER - NONE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 2 5LB FIRE EXTINGUISHERS 'AND LOW PRESSURE, LOW VOLUME WATER WHICH IS DEPENDENT ON ELECTRICAL POWER TO RUN PUMPS. FIRE HYDRANT - NO HYDRANTS BUT WATER CAN BE PUMPED FROM THE KERN RIVER OR BEARDSLEY CANAL IF SUBMERSIBLE PUMPS ARE BROUGHT IN <4> Building Occupancy Level 03/18/92 WEBSTER SAND INC 215-000-000663 Page 6 00 - Overall Site <G> Training <1> Page 1· WE HAVE 9 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: VERBAL BRIEFING TO ALL EMPLOYEES REGARDING THESE PROCEDURES. / <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ~. ----~. RECEIVED 10/24/~0 WEBSTER SAND INC 215-000-000663 N~V 1 ~ l~ Page 1 Overal 1 Site with 1 Fac. Unit H~Z. MAT. DiV. Ger~eral Ir~formatic, r~ ILocatic, r,: CHINA GRADE LOOP' Map: 103 Hazard: Low I lderlt Number: 215-000-000663 Grid: 04 Area c,f Vul: 0.0 Contact Name ~ Title j Busir, ess Phor, e i 24 Hour Phone] [JOHNB. GILLETT E?~r~i~~ (8C)5) 399-3131 x ~(8C)5) 8'72-3286/ FRED LUTZ ~ ~ ~ (805) 399-3131 x I(~ I I I I I Administrative Data , Mail Addrs: P 0 BX 2'71 D&B Number: City: BAKERSFIELD State: CA Zip: 93302-~%]~ Come Code: 215-008 BAKERSFIELD STATION 08 ........ SIC Code: ' 6116 DE PARSIA AV State: CA~ City: BAKERSFIELD Zip: 93d02- reviewed the attached hazardous materials manage- ment plan for and that it along with -- any corrections'constitute a complete and correct man- agement plan for my facility. ...... RECEIVED 10/24/~0 WEBSTER SAND INC 215-000-000663 ~OV 1 9 l~ page 1 OYerall Site with 1 Fac. Ur, it GerJeral Irs format i Locatior~: CHINA GRADE LOOP 'Map: 103 Hazard: Low Ildent Number: 215-000-000663 Grid: 04 Area of Vul: 0.0, Contact Name } Title ~ Busir~ess Phc, r~e i 24 Hour Phor~e- JOHN B. GILLETT ~eo~Fw[~E~ (805) 399-3131 x ~ (Sqo) .87~ o~86 FRED LUTZ ~& (805) 399-3131 x [(ff~ Administrative Data Mail Addrs: P 0 BX 2'7i D&B Number: City: BAKERSFIELD Stat~: CA Zip: Comrn Cc, de: 215-008 BAKERSFIELD STATIOI~ 08 SIC Code:  g~,~q~: JOHN GZLLETT CORP. Phc, ne: (~05)gTZ-~Z~ ~ddress: 6116 DE PARSIA AV State: CA City: B~E~SF IELD Zip: Sumrnary reviewed the attached h~zardou$ materl~l$ manage- ment plan for ~5~ ~ and that it alo~ with any corr~ions'~nstitute a ~mplete ~nd ~e~ man- agement plan for my facili~. 1(')/24/90 WEBSTER SAND INC 215-0[)0-[)00663 Page 2 Haz~at Ir~ventory List in MCP Order [)2 - Fixed Cor~tair~ers or~ Site Pln-Ref Na~e/Hazards For~ Quant ity MCP (i)2-001 DIESEL FUEL ? 7~ ()00 Low GAL (.)~-(.)~)~ HYDRAULIC OIL ~ 110 Low GAL [)~-~)[)4 USED OIL ? 275 Low GAL 02-002 MOTOR OIL ? 220 Mir~i~a 1 GAL 10/24/90 WEBSTER SAND INC 215-000-000663 Page 3 O0 - Overall Site <D> Not if. /Evacuat iota/Medical <1> Agency Notificatior~ <2> Employee Notif./Evacuation IN THE EVENT OF A TANK/BARREL RUPTURE OR OTHER EVENT THAT COULD CAUSE A SPILL OR FIRE, ALL PLANT EMPLOYEES HAVE STANDING INSTRUCTIONS TO EVACUATE BUILDINGS, ALERT OTHER EMPLOYEES, CONTAIN-THE SPILL OR FIRE IF POSSIBLE AND TO NOTIFY THE FIRE DEPT. <4> Er~lergency Medical Plar~ MEMORIAL HOSPITAL EMERGENCY - 420 34TH ST. - 327-1'792 KERN GENERAL EMERGENCY - 1830 FLOWER ST. - 326-2000 10/24/90 WEBSTER SAND INC 215-000-000663 Page 4 00 - Overall Site <E> Mi t i gat ion/Prevent/Abat emt <1> Release Preventior~ DAILY INSPECTION OF ALL FUEL TANKS AND OIL BARRELS. ~--~CCURS S--AND W I,L ' TO OAK ' T. " L D ' ' ' · · RDANCE-~-TH <2> Release Containment <3> Clean Up <4> Other Resource Activation WEBSTER SAND INC 215-000-000663 Page 5 00 - Overall Site <F> Site Er~ergerscy Factors <1> SPecial Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - NEXT TO MAINTENANCE SHACK C) WATER - NONE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - 2 5LB FIRE EXTINGUISHERS AND LOW PRESSURE, LOW VOLUME WATER WHICH IS DEPENDENT ON ELECTRICAL POWER TO RUN PUMPS. FIRE HYDRANT - NO HYDRANTS BUT WATER CAN BE PUMPED FROM THE KERN RIVER OR BEARDSLEY CANAL IF SUBMERSIBLE PUMPS ARE BROUGHT IN <4> Held for Future use 10./24/90 W TER SAND INC :='15-000-00£ Page 6 00 - Overal'l Site <G> Trainir, g < 1> Page 1 WE HAVE ~. EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use C1'TY of BAKi:RSFIELD I:]rm end Agriculture I1 Standerdl]usiness ~,~-IAZARDOUS HATERTALS TNVENTORY NON--TRADE. SECRET'S Page __t__._ Of._L_ BUSINESS HAHE.~'[~I~. "Sl~.~-, ~c~'-[~d" OWNER NAHE'~""/')L~k ~'3;[t~ ,~T~- NAHE OF THIS FACILITY: LOCATION;_~'~e~+~o~-- ~~ ADDRESS; '(o~1~ a~P~ (~ STANDARD IND CLASS CODE~ CJ]Y. ZIP;~~-~''' · " C]]Y. ZIP= ~~ ,~"~ ~%~ DUN AND BRAD~TREEI NUHBER ............................... PtlONE ~: ' ~_~['~'~ ; PlO E ~' '-' ~- - '~ - - Codelrans Loee[Y~e AaL~ax AverageAmL AnnUalEsL ~ea~Ureun~Ls onl ~e~ype~°nL Press~°nL. ConLlemp USco3e SLo[~ Fact ~ ][y Locq~ i o~ ~he[e. ~la~es S~e°f ~i xt ur e/Co~onent s ]nstruc[ anna ' _ Physical and Health Hazard C.A,S, Number Co~ponenL II Na~e I C,A,S. Number .. (Che. c~ all LhaL apply)  Component 12 Name I C,A,S. Number re Hazard ~ Reactivity ~ ~elayed ~ Sudden Release ~ Immediate · Health o[ Pressure Health Component 13 Name I C.A.S. Number Physical and Health Hazard C,A.S. Number Compq'nenL II Name I C.A,S. Number (Cflec~ all that apply} ' Component 12 Name I C,A.S. Number Component 13 Name I C.A.S. Number Physical and Health,Hard C,A,S. Number CompOnent II Name A C,A,S. Number (Che:k ali that apply) e Hazard ~ Reactivity ~ OelayedHea/Lh ~ Suddenof Pressure Release ~ Im~i~ Component 12 Name I C,A.S. Number ~ Component 13 Hame I C.A,S, Number Physidal end HealthPal~rd C,A,S. Number Component II Name I C.A,S. Number (Check.ail that applH ~e Hazard ~ Reactivity ~ Oelayed ~'Sudden Release ~ ],~i~ Co~ponenL 12 Name C.A.S. Number Health of Pressure Component 13 Name I C.A,S. Number er[iii atio Re and i n af r corn 1 t il]g ~ 1 I sections) J cert,~y un'er eenal~, o~w thqt ]~av~pe~sona~.examlnq~aqtQm familla[vit~ the Informat~pn au~mitted in this.lnd a11/' aL~ached.doc~rent~, an~ tpac Daseo on.my inquiry qr. tnose InolvIOUalS respons~o/e rot obtaining the Information. I be~eve th~e~ ~ ~ // RECEIVED BAKERSFIELD CITY FIRE' DEPARTHENT mO "G" S~EET ~ JUL BAKERSFIELD, CA~,~93301~~~ .,sd (805) 326-397~ OFFICIAL USE ONLY ~ v HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this form by 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: ~[~-~ %~,.)0 ~t~ B. 'LOCATION / STREET ADDRESS: ~q m[C~ SECTION 2: E~RGENCY NOTIFICATIONS In case of an emergency involving the release oe 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 Emeegency Services as required law. EMPLOYEES T0 NOTIFY IN CASE 0F EMERGENCY: SgCTIO~ 3: ~OCATIO~ OP ~ILI~ S~-O~S ~OR BUSI~SS AS C. WATER: 1)l~ ' . SPECIAL: ~[ ~ E.D' LOCK BOX: YES ~O~F YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A ~HOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER' A. METHODS FOR SAFE HANDLING OF HAZARDOUS MATERIALS:...- .................................... ~__~_~ ~0~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES ................. WITH RESPONSE AGENCIES: .......................... NO NO C. PROPER USE OF SAFETY EQUIPMENT: .................. NO N© D. EMERGENCY EVACUATION PROCEDURES: t,~NO NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... ~NO YE~NO SECTION 7: HAZARDOUS F~ATERIAL CIRCLE YES ~ DOES YOUR ~HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALI~)NS OE A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I,~_~/~ Z~ ~//~k~. , certify that the above information is accurate. I understand that this i~formation 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 - BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: · BUSINESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3, Answer the questions below for ~HE FACII, ITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. -. SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY - 3A - BUSINESS NAME WEBSTER SAND INC ID NUMBER 215-000-000663 LOCATION- CHINA GRADE LOOP RD HIGH HAZARD RATING 2 1. OVE2VI~W LAST CHANGE 11/30/88 BY VAL JURIS CODE 215-008 JURIS BAKERSFIELD STATION 08 MAP PAGE 103 GRID 04 FACILITY UNITS 1 HAZARD RATING 2 RESPONSE SUMMARY 2A SEC 4) ONLY 8 EMPLOYEES, ALL ARE QUALIFIED TO INITALE EMERGENCY PROCDURES IN CASE OF A SPILL OR FIRE. EMERGENCY CONTACTS 2A SEC 2) JOHN B. GILLETT, JR., 399-3131 OR 872-3286 FEED LUTZ - 399-3131 UTILITY SHUTOFFS 2A SEC 3) A) GAS - NONE B) ELECTRICAL - NEXT TO MAINT SHACK C) WATER - NONE D) SPECIAL - NONE E) LOCK BOX - NO 4 o LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 11/30/88 BY VAL 2A SEC 5) MEMORIAL HOSPITAL EMERGENCY - 420 34TH ST. - 327-1792 KERN GENERAL EMERGENCY - 1830 FLOWER ST. - 326-2000 PAGE 1 11/30/88 15:39 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME WEBSTER SAND INC ID NUMBER 215-000-000663 LocATION CHINA GRADE LOOP RD HIGH HAZARD RATING 2 FACILITY UNIT 01 A . OVERALL HAZARDOUS MATERIALS INVENTORt~ LAST CHANGE 11/30/88 BY VAL ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE DIESEL FUEL ?000 GAL MODERATE NW PART OF YARD ABOVE GROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LISTS 1178.03 100.0 DIESEL FUEL NO.1 MODERATE 2 PURE MOTOR OIL 220 GAL UNKNOWN MAINT SHACK DRUMS OR BARRELS MET..'LUBRICANT ID PERCENT COMPONENTS HAZARD LISTS 2808.00 100.0 MOTOR OIL UNKNOWN 3 PURE HYDRAULIC OIL 110 GAL UNKNOWN MAINT SHACK DRUMS OR BARRELS MET.. LUBRICANT ID PERCENT COMPONENTS HAZARD LISTS 1224.02 100.0 HYDRAULIC BRAKE OIL UNKNOWN 4 WASTE USED OIL 275 GAL UNKNOWN MAINT SHACK DRUMS OR BARRELS MET.. STORAGE ID PERCENT COMPONENTS HAZARD LISTS 1598.00 100.0 WASTE OIL UNKNOWN B o FIRE PROTECTION / WATER SUPPLIES LAST CHANGE 11/30/88 BY VAL 3A SEC 4) 2 5LB FIRE EXTINGUISHERS AND LOW PRESSURE, LOW VOLUME WATER WHICH IS DEPENDENT ON ELECTRICAL POWER TO RUN PUMPS° 3A SEC 5) FIRE HYDRANT - NO HYDRANTS BUT WATER CAN BE PUMPED FROM THE KERN RIVER OR BEARDSLEY CANAL IF SUBMERSIBLE PUMPS ARE BROUGHT IN PAGE 2 11/30/88 15:39 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME WEBSTER SAND INC ID NUMBER 215-000-000663 LOCATION CHINA GRADE LOOP RD HIGH HAZARD RATING 2 D o E l~4P L OYE E NOTIFICATION / EVACUATION LAST CHANGE 11/30/88 BY VAL 3A SEC 2) IN THE EVENT OF A TANK/BARREL RUPTURE OR OTHER EVENT THAT COULD CAUSE A SPILL OR FIRE, ALL PLANT EMPLOYEES HAVE STANDING INSTRUCTIONS TO EVACUATE BUILDINGS, ALERT OTHER EMPLOYEES, CONTAIN THE SPILL OR FIRE IF POSSIBLE AND TO NOTIFY THE FIRE DEPT. E . MITIOATION / PREVENTION / ABATEMENT LAST CHANGE 11/30/88 BY VAL 3A SEC 1) DAILY INSPECTION OF ALL FUEL TANKS AND OIL BARRELS. IF A SPILL OCCURS SAND WILL BE APPLIED TO SOAK UP THE SPILL AND DISPOSE OF IN ACCORDANCE WITH APPROVED PROCEDURES. PAGE 3 11/30/88 15:39 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page ~f NON--TRADE SECRETS HAZARDOUS MATERI ALS I NVENTOI~'~_,~,~ BUSINESS N~HE: ~~~ ~ ~~ OWNER NAME: F FACILITY UNIT ADDRESS: ~,~, ~-~{ ~ ADDRESS: /~ FAC TY~NIT NAME: PHONE ~ {OFFICIAL USE CFIRS CODE ~ 4 7 8 9 10 TYPE ~AX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T .CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT . WT. CHEMIqAL 0R COMMON NA~E CODE GUIDE S I~ATURE: ~.INCIPAL BUSINESS ACTIVITYL)'~d~tr -~rr~ ~F AFTER BUS HRS: - 4A-1 -