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Home My WebLink AboutBUSINESS PLAN Hazardous Materials/Hazardous Waste Unified Permit ,.. CONDITIONS-OFPERMIT..ON REVERSE SIDE ~ H~ous ~als P~n .. ~ Unde~mu~ Stom~ of H.~ous Permit ID ~:: 015~00~01703 ~ Risk~~P~ LUBE EXPRESS. ~ .~o~, ~,~ o~s~,~t Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL sER VICES' ~!1~ 1715 Chester Ave., 3rd'Floor : ," : (. Appr~ved by:;:;:. ~ -- Bakersfield, CA 93301 '...': .....::)~..~i:.~:..:!.:..:_~.,.?~%:~.._.:..~:../,_...~(~o~~. · Voice (661) 326-3979 . ' ' '. "~ ~:';?~i~:?:~-~3':ii!3:~?;~3:.!3~(~ii~-~ii'~3~i:~:.:.& V~ (66~) 32~-05Z~ ....~.:: .~:~?,~?~.:~?.~?~.~?~xv~t,o~ ~t~: ' ~une 30. 2003 BUSINESS PLAN MAP [ ] SITE MAP - Form 5 [ ] AREA MAP - Form 5A Business Name:. L /-~/~_. :y/~ /'~ ~2~ If Form 5A box is checked: Area Map # of ClTY OF BAKERSFIELD IVendor No, I certify that this claim is correct and valid, and is a proper charge against the City Agency and account indicated. LUBE EXPRESS CIO KEN TEETERS ~UTHORIZED SIGNATURE OF CITY AGENCY) 1419 LINDA KAY STREET BAKERSFIELD, CA 93312 )ATE: 9/13/2002 Initials of Preparer: baw CITY DEPARTMENT: Water Resources PLEASE PROVIDE SHORT EXPLANATION OF PAYMENT: Per Ralph Huey this customer was never in the city and should not have been charges Refunding fiscal year 2001 and 2000 Fund Base Invoice # Amount COMMENTS 011 3021 523 4/lO/2OOl 011 3021 523 228.0C 6/21/2ooo VOUCHER TOT21~, $520.00 SECTION 72, PENAL CODE FINANCE DEPT. USE ONLY Section 72, Presenting False Claims. Every person who with intent to defraud, presents for allowance or for payment to any state board or officer, or any county, town, city district, ward or village board or officer, authorized to allow Examined & Approved for Payment Amount or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of afe ony. CUSTOMER TYPE & NO ~'~--~ RECEIVABLES ADJUSTMENT OATE ~- 6--~ 2_ INEWACCOUNT ~E F I NL~.~.~_C E CHARGE MAILING ~DRESS /~/ CI~- ~~~g-~ STATE ZIP CODE ~/~ SITE ADDRESS ~ 2~¢ PARCEL NUMBER (IF ~,DJUSTMENT CHARGE DATE CHARGE CODE ADJUSTMENT AMOUNT /-/~- b~ ~o~ / / 7. ~ ~us~ me~T~)e Balance ~plember 5, 2302 9:24 AM Custo ruer ID: 26583 (3706 CO FFE E) Customert~3e: iS ENV1RONIVENTAL SERVICES Payoff amount: Pending ...... : Deposit ....... ClickOK for detail infon~ation ness: e Map...:::.~. Grid D:O;:N O~:WRITE:IN~THIS: BOX Fo~s Due By: ' ~~ SECTION 1: BUSINESS IDENTIFICATION DATA B. PHYSICAL LOCATION/S~EET ADDRESS: '3 7~(~ ~ee C1~:¢¢~P.~5~,~ tg ZIP: ~~ BUSINESSPHONE:(~¢ / ) ' D, HAVE YOU FILED A BUSINESS P~ WI~ THE DEPARTmEnT UNDER A DIFFERENT. NA~E WI~IN THE ~ST ~O Y~RS? YES NO ~ IF YES, UNDER WHAT NAME DID YOU FILE? E. THIS SUBMISSION IS A N~ ~ OR REVISED BUSINESS P~N F. DOES YOUR BUSINESS HANDLE ANY "ACUTELY H~RDOUS MATERIALS" LISTED ON THE ENCLOSED HANDOUT, IN ADDITION TO OTHER ~PES OF MATERIALS? YES NO SECTION 2: EMERGENCY NOTIFICATIONS In the event of an emergency involving the release or threatened release of a hazardous material, telephone 9-1-1, and then (800) 852-7550 or (916) 262-1621. This will notify your local fire department and the State Office of Emergency Services, as required by state law. Additional federal reports may be required. PERSONS WHO SHOULD BE NOTIFIED IN CASE OF EMERGENCY AT YOUR BUSINESS THAT HAVE FULL ACCESS AND CAN PROVIDE TECHNICAL ASSISTANCE: NAME AND TITLE DURING BUSINESS HOURS AFTER BUSINESS HOURS - COnTInUED O~ REVERSE- (1) SECTION 3: LOCATION OF THE MAIN UTIEITY SHUTOFFS FOR THE ENTIRE BUSINESS D. SPECIAL/OTHER: E. LOCK BOX: YES/NO IF YES, LOCATION: - - ~F YES, DOES ~T cONTAiN-SiTE PLANS? YES / NO MSDS? YES ~ NO FLOOR PLANS? YES I NO KEYS? YES I NO SECTION 4: PRIVATE RESPONSE TEAM DESCRIPTION Do you have a group of employees trained to handle minor accidents involving hazardous materials at your business? Yes No N~/ If so, you must explain the level of-training and equipment they possess and how they are notified to respond. SECTION 5: IDENTIFICA. TION OF THE CLOSEST APPROPRIATE EMERGENCY MEDICAL ASSISTANCE AVAILABLE TO YOUR BUSINESS COMMENTS/ADDITIONAL INFO: - CONTINUED ON NEXT PAGE - (2) SECTION 6: EMPLOYEE:~AIINING EMPLOYERS ARE REQUIRED BY STATE LAW TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS: 1) Methods for safe handling of the hazardous materials used by your business, 2) The CAL OSHA Hazard Communication Standard; 3) Correct use of emergency response equipment and supplies available at yom' business; 4) The prevention, minimization, and cleanup procedures you have developed for 'our business and explained on the business plan forms; 5) The emergency evacuation plans you have developed, the notification proce utes used to alert people to evacuate, and the closest location to obtain appropriate emergency medical care; 6) Procedures to coordinate with and assist the local emergency personnel that may respond to your business; 7) Who and how to call for immediate assistance in the event of an accident involving hazardous materials, Describe the location of the written plan and the training records which are required to be developed and maintained, State law requires your training records be inspected, · ~:~ :~:.~:....: .:.~.: ~ ~: .::::.::Yo~r. name::at the:~bottOm: of:PageiS;.then fi!i:!out~~:? ~ .....:: .:. F~rm3 foreverya'rea;you~!busineSs::w~i~bdi~/id~ed :into:~ .. - CONTINUED ON REVERSE - (3) . SECTION 7: EXPLAIN WHAT PREVENTION, MINIMIZATION, AND CLEANUP PROCEDURES YOUR EMERGENCY PLAN INCLUDES. INCLUDE A DESCRIPTION OF MONITORING METHODS AND PROCEDURES. B. RELEASE CONTAINMENT: SECTION 8: EXPLAIN THE NOTIFICATION METHOD AND EVACUATION PROCEDURES YOU HAVE DEVELOPED FOR THE EMPLOYEES TO USE IN AN EMERGENCY. YOU MUST INCLUDE A MEETING POINT. A. AGENCY NOTIFICATION: B. EMPLOYEE ,NOTIFICATION/EVACUATION: - CONTINUED' ON NEXT pAGE - (4) SECTION 9: EXPLAIN WHAT PRIVATE FIRE PROTECTION SYSTEMS ARE IN PLACE THAT UAY ASSIST EMERGENCY RESPONDERS. SECTION 10: LIST THE LOCATION OF ANY WATER SUPPUES THAT MAY BE USED BY EMERGENCY RESPONDERS. business plan fo~s is accurate and complete. I undem~nd that this info~afion ~il be used to fu~ll ~ obligations under Cal~omia Heal~ and Safe~ Code Division 20 Cha~er 6.95 et seq. and ~fle 42 U~.G.C. S~fion 1100 et seq. and false info~ation may be punishable by fine, impHsonmen~ ~ bo~. Signature . ~fle Date (s) I~h.-m and Agriculture [ ] KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT HAZARDOUS MATERIALS INVENTORY DUN AND .BRADSTREEI' NUMBER Standard Business ["'~ , FORM 4 STANDARD IND..CLASSCOOE:C'~/ ~ lT/OT~ NAME OF THIS FACILITY:.~Lt hq, Map Grid RfiFfiR 10 INSTRUGIION8 FOR PROPfiR CODE8 rl 2 3 4 5 6 ' 7 8 9 I0 l I Trade ans Type L~gest M~imum Average Me.utc Coat COAt Coat ~ by NAMES OF MIXTURE/COMPONENTS Secret Code Code Container Amt ~t Units type Press Femp Wt SEE INSTRUCTIONS Y~ [.'~ Immediate Health Location ~ ~.. ~ C°mp°nent&CAS~,}e~.~ ~F*O¢ m~' O' l* ', ~J' i [~ Fire [~ Delayed llealth CAS Number Co~Fonent & CAS [ ] Reactivity [ i Sudden Release of Pressnre g Days on Site [ ~ ~ Component & CAS ~ Fire [-~ Delayed ltealth CAS Number Component & CAS [ [ ] Rcactivity [ ] Sudden Release of Pressure g Days on Site ~ ] Component & CAS [¢]lmmediateHealth Location~ ~/~ [~~ Component&CAS p~+._ ~ ~tNF~.r.¢B~S [ '~ Fire [ ~ Delayed Hcalth CAS Number Component & CAS ( ] Reactivity [ 1 Sudden Racase of Pressure ~ Days on Site {~6 ~1 Component & CAS Nme Title 24 Hr Phone N~e ~ ' Title -- 24 Hr Phone Certification (Read and sign after completing all sections} I ce~i~ under pcnal~ of law that I have personally cxmined ~d m f~ili~ wi~ ~c info.orion submiu~ in ~is ~d all auached documenB, ~d that b~ed on my inqui~ of those individuals resp~fible for ob~ng th¢info~ation, I ~licve that ~e submia~ info~ation isle~ a~umte, ~Fomplete~ ~ficml l~lle o~ owner/operafor or owner/noeratoffs aulhorized rent .sen afl e "' Sianature Date Si~ned INVENTORY CODE SH'EET Trans Code (Column I) A = Add this Item D -- Delete this Item · . R = Revised information Type Code (Column 2) P = Pure Material M = Mixture of Substances W = Waste (Must also: Add Appropriate Waste Code fi'orii "Waste Code Sheet") Measure Units (Column 6) LBS = Pounds TON ' = Tons ( 2,000 lbs) GAL = Gallons BBL = Barrels (42 gallon ,4PI, to be used by Oil Industry Only) Ft3 = Cubic Feet CUR = Curies MCI = Micro Curies Container Type (Column 7) 001. Underground Tank 002. Aboveground Tank 003. Fixed Pressure Cylinders/Vessels 004. portable Pressure Cylinders 005. Insulated Tank ** Includes Cryogenics** 006. Drums or Barrels - Metallic 007. Drums or Barrels - Non-Metallic 008. Carboy(s) 009.. Glass Container(s) 10. Plastic Container(s) 11. Box(es) 12. Bag(s) 13. Metal COntainers ( Not Drums) 14. In Machinery or Processing Equipment 15. Bin(s) 16. Unlined Sump(s) Container Pres,sure (Column 8) 1. = Ambient Pressure 2. = Greater than Ambient Pressure 3. = Less than Ambient Pressure Container TemperatUre (Column 9) 4. = Ambient Temperature 5. = Greater than Ambient Temperature 6. = Less than Ambient Temperature but NOT Cryogenic 7. = Cryogenic Conditions E~-~m and Agriculture [ ] KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT HAZARDOUS MATERIALS INVENTORY DUN AND BRADSTREET NUMBEP, Standard Business ['A' ] , FORM 4 STANDARD INB. CLASS CODE: NAME OF TBIS FACILITY: Map,~ Grid REFER TO INSTRUCTIONS FOR PROPER CODES *'1 2 3 4 5 6 7 8 910 II Trade rahs Type L~gest M~imum Average ~e~ure Cont Cont Cont % by NAMES OF MIXTURE/COMPONENTS Secret Code Code Container Amt ~t Units Type Press Femp Wt SEE INSTRUCTIONS Y~ PRODUCT NAME ~c~ [ ~ Fire [~ Delayed ilealth CAS Number Component & CAS Il ] Reactivity [ } s~a&. ea~,,~¢ ot'P~s~,,~ u Days on Site [ ~ ~] Component & CAS [ ~ Fire [ ~ Delayed He~lth CAS Number Component & CAS Sudden Release of Pressure ff Days on Site ~ ~] Component & CAS 1 Reactivity [ 1 --'[~]ImmediateHealth Location~~¢~ ~/¢ (~ Component&CAS 0o.~ flv~rgnr6~ ~ Delayed Health CAS Number Component & CAS Fire i Reactivity [ } S.aa~. Release of Pressure g Days on Site [~ ~] Component & CAS 1 N~e Title 24 Hr Phone N~e Title 24 Hr Phone Certification {Read and sign after com,letine all sectionsl '~ I ce~i~ under pcnal~ of law that I have personally ex~ined ~d ~ f~ili~ wi~ ~c info.alton submitted in this ~d all aaachcd documenU, ~d that b~ed on my inqui~ of those individuals responsible for obtaining the info~ation, I ~lieve that the submiR~ info~ation is ~e, accurate, ~d complete. Name and ~ficial lille of owner/operalor or owner/operator's anlhorized represenlalive Si~natlwe Date Siened INVENTORY CODE SHEET Trans Code (Column I) A = Add this Item D = Delete this Item · . R = Revised information Type Code (Column 2) P = Pure Material M = MixtUre of Substances W = Waste (Must also: Add Appropriate Waste Code from "Waste Code Sheet") Measure Units (Co!Umn 6) ' LBS = Pounds TON = Tons ( 2,000 lbs) GAL --"Gallons BBL = Barrels (42 gallon API, to be used by Oil Industry Only) ' Ft3 = Cubic Feet CUR = Curies MCI = Micro Curies Container Type (Column 7) 001. Underground Tank 002. Aboveground Tank 003. Fixed Pressure Cylinders/Vessels 004. Portable PressUre Cylinders 005. Insulated Tank ** Includes Cryogenics** 006. Drums or Barrels~- Metallic '~ 007. Drums or Barrels - Non-Metallic 008. Carboy(s) 009. Glass Container(s) 10. Plastic Container(s) .~ 11. Box(es) 12. Bag(s) 13. Metal Containers ( Not Drums) 14. In Machinery or Processing Equipment 15. Bin(s) 16. Unlined Sump(s) Container Pressure (Column 8) 1. = Ambient Pressure 2. = Greater than Ambient Pressure 3. = Less than Ambient Pressure Container Temperature (Column 9) 4. = Ambient Temperature 5. = Greater than Ambient Temperature 6. = Less than Ambient Temperature but NOT Cryogenic 7. = Cryogenic Conditions Farm and Agriculture [ ] KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT _. - .AZA DOUS MATERIALS VENTO V I 2 3 4 5 6 7 .8 9 10 Trans Type L~gcst M~imum Average ~e~ure Cont Cont Cont o/~y NAMES OF M~TURE/COMPONENTS Cod~ Code ~ntainer ~t Amt Units Ty~ Press T~p SEE INS~U~ION8 [ ~] lmme. iatc Hcalth Location ~ ~ ' [~] Fire [~ Delayed t-l~alth CA8 Numbc~ Component & CAS [ ] Reactivity [ ] Sudden Relc~¢ of Pressure ~ Days on Sit¢[ ] Component & CAS [~] Fire [ ~ Delayed Health CAS Number .... Component & CAS [ ] Reactivity [ ] Sudden g~le~s~ of Pressure ~ Days on Sit~ [ ] Component ~ CAS [ ] Reactivity [ ] Sudden Release of Pressure ~ Days on Site [~ ~] Component & CAS [~ R~activiW [ ] Sudden Re]esso of Prcssurc ~ Days on $itc[ 3'~ ~] Component & CAS [ ] Fire [ '~ Delayed Health CAS Number ...... ~B:ch~jb fiM126