Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
BUSINESS PLAN
UNIFIED PROGRAM INSPECTION CHECKLIST I SECTION 1: Business Plan and Inventory Program Prevention Services B E R SF t o 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 D ARTM r Tel.: (661) 326 -3979 Fax: (661) 872 -2171 FACILITY NAME C 9 I/AG INSPE TION DATE INSPECTION TIME o" c--r E S n c t✓\ M Xr I C V a �$ i o I. ADDRESS U10 Got v. �, b PHONE NO. 2 _2 %31 NO OF EMPLOYEES _3 FACILITY TACT BUSINESS ID NUMBER 15 -021- �,ectlon 1:' Business -_Plan and Inventory Program ROUTINE A_.] COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION C V ( C= Compliance OPERATION V= Violation COMMENTS ❑ I. APPROPRIATE PERMIT ON HANDCI ❑ Business PLAN CONTACT INFORMATION ACCURATE Y) /_% El VISIBLE ADDRESS ❑ CORRECT OCCUPANCY ❑ ❑ VERIFICATION OF INVENTORY MATERIALS ❑ ❑ VERIFICATION OF QUANTITIES ❑ ❑ VERIFICATION OF LOCATION ❑ ❑ PROPER SEGREGATION OF MATERIAL L�D ❑ VERIFICATION OF MSDS AVAILABILITY ?I ❑ VERIFICATION OF HAZ MAT TRAINING ❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES CrIA ❑ EMERGENCY PROCEDURES ADEQUATE fC �C g ❑ CONTAINERS PROPERLY LABELED ❑ HOUSEKEEPING ❑ FIRE PROTECTION ❑ \a.,, SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: Cie, - s- NO nnr -ouij QUESTIONSAgGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979 Inspector (Please Print) Fire Prevention / 1" In / Shift of Site /Station # A , A � uslness Site /Res onsible Party (Please Print) White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05 Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST FARFM I 900TruxtunAve., Suite 210 Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program Tel.: (661) 326 -3979 Fax: (661) 872 -2171 FACILITY NAME �1 r I/A6 INSPE TION DATE INSPECTION TIME o�. rre s i'n1 c LA mxr/ C 4 v s Io U. ADDRESS 01 vJ PHONE NO. 31 NO OF EMPLOYEES .3 FACILITY TACT G�Li BUSINESS ID NUMBER 15 )1D -021- Se�yction1:. Business Plan and Inventory Program ROUTINE `EI COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION C v c C= Compliance OPERATION V= Violation COMMENTS ❑ U. APPROPRIATE PERMIT ON HAND ❑ Business PLAN CONTACT INFORMATION ACCURATE )1D ❑ VISIBLE ADDRESS ❑ CORRECT OCCUPANCY ❑ ❑ VERIFICATION OF INVENTORY MATERIALS ❑ ❑ VERIFICATION OF QUANTITIES ❑ ❑ VERIFICATION OF LOCATION ❑ ❑ PROPER SEGREGATION OF MATERIAL 13) ❑ VERIFICATION OF MSDS AVAILABILITY (© ❑ VERIFICATION OF HAZ MAT TRAINING NZ]) ❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES G 1A S / Cj✓ �,..�� LJ ❑ EMERGENCY PROCEDURES ADEQUATE v ❑ CONTAINERS PROPERLY LABELED /M-) ❑ HOUSEKEEPING ❑ FIRE PROTECTION ❑ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: EXPLAIN: e ! P, —+,. — 'r- RQ Vic-N-/ 0— « QUESTIONS R GARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979 Inspector (Please Print) Fire Prevention / 1" In / Shift of Site /Station # OuEflness Site / Resl5onsible Party (Please Print) White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05 .,, ~~ COURTESY PNEUMATIC & VALVE SERV Manager HURSHEL WILLIAMS Location: 1101 W COLUMBUS ST City BAKERSFIELD SiteID: 015-021-002043 BusPhone: (661) 327-5633 Map 103 CommHaz Moderate Grid: 18C FacUnits: 1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code: DunnBrad:95-376-8800 Emergency Contact / Title Emergency Contact / Title HURSHEL WILLIAMS / PRESIDENT DONNA DIAL / SECTY/TREASURER Business Phone: (661) 327-5633x Business Phone: (661) 327-5633x 24-Hour Phone (661) 833-2640x 24-Hour Phone (661) 978-0793x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact HURSHEL WILLIAMS Phone: (661) 327-5633x MailAddr: 1101 W COLUMB US ST State: CA City BAKERSFIELD Zip 93301 Owner HURSHEL WILLIAMS Phone: (661) 833-2640x Address 3816 SALEM CT State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A _ HAZMAT T EN I ~ ~J ~,J ~ 2 Q 2P1 f'1~ VV PROG H HAZ WASTE GEN '~~~'rt on my inquiry of those individuals resp;~r;e~~~,l~ fi<)r obtaining the information, I certify un;;er p~',bity pf law that I have personally ' examines t E~nc4 familiar with the information submitted ? d b li ve the information is true, accurate, e ~ np1 t -~ ~ ~"~~9n ture ~ _._.~ Date -1- 07/10/2007 :-• ~ F'COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCII? WASTE SOLVENT NITROGEN F DH F P IH L G 30.00 912.00 GAL FT3 i Moc~i Mii1 -2- 07/10/20(,)7 -3- 07/10/2007 F"COURTESY PNEUMATIC & VALVE SERV ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME WASTE SOLVENT Location within this Facility Unit OUTSIDE SW CRNR SHOP SiteID: 015-021-002043 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 221 Liquid TWaste -~mbient~E ~ AmbientT~E DRUM/BARRELEMETALLIC AMOUNTS AT THIS LOCATION Largest Container - Daily Maximum I Daily Average 30.00 GAL 30.00 GAL 30.00 GAL I1HGti[CLVUiJ 1.V1~lYUlVIJ1Vl~7 ~Wt. RS CAS# 100.00 Cleaning Solvent No 8030306 I1tiGKttL H. 7.7L~JJ1~1J;1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE E WALL SHOP CAS# 7727-37-9 STATE T TYPE PRESSURE ~ TEMPERATURE ~~ CONTAINER TYPE ~GaS I Pure Above Ambient I Ambient I PORT _ PRF~S _ ("'YT~TNTIF.R I AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 304.00 FT3 912.00 FT3 304.00 FT3 au-auruu~vUO ~.va•irvivr~lvt~ -- aWt. RS CAS# 100.00 Nitrogen No 7727379 ruyunccL na a~a~l•l~ty t ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 07/10/2007 ~ F~COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/11/2000 ~ INSURANCE AGENT, OWNER OF THE CYLINDERS AND FIRE DEPT IF APPLICABLE. Employee Notif./Evacuation BY PHONE. 10/11/2000 Public Notif./Evacuation 10/11/2000 BY PHONE. Emergency Medical Plan 03/28/2006 MEMORIAL HOSPITAL. -5- 07/10/2007 r F'COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/11/2000 ~ KEEP CYLINDERS TURNED OFF AND CAPPED. Release Containment 04/19/2006 KEEP CYLINDERS TURNED OFF AND CAPPED. CONTACT AIRGAS, THE OWNERS OF THE CYLINDERS. Clean Up CONTACT AIRGAS, THE OWNERS OF THE CYLINDERS. 04/19/2006 Other Resource Activation -6- 07/10/2007 3' F~COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JC l:1d1 i1dGdIC.iS Utility Shut-Offs GAS - BACK YARD ELECTRICAL - BACK YARD WATER - FRONT YARD 03/28/2007 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - W COLUMBUS AND ON SIDE OF BLDG JEWETT ST. 04/19/2006 Building Occupancy Level 03/28/2006 3 EMPLOYEES -7- 07/10/2007 F~COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/24/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: TAILGATE BRIEF OF NEW POLICIES AND ALL SAFETY REQUIREMENTS AND EXPECTATIONS. rayc c nciu ivi ru~uic u5c nclu 1.c.~L r u~uiC use -8- 07/10/2007 + COURTESY PNEUMATIC & VALVE SERV _____________________ SiteID: 015-021-002043 + Manager Location: 1101 W COLUMBUS ST City BAKERSFIELD BusPhone: (661) 327-5633 Map 103 CommHaz Moderate Grid: 18C FacUnits: 1 AOV: CommCode: KCFD STA 64 SIC Code: EPA Numb: DunnBrad:95-376-8800 Emergency Contact / Title Emergency Contact / Title HURSHEL WILLIAMS / PRESIDENT DONNA DIAL / SECTY/TREASURER Business Phone: (661) 327-5633x Business Phone: (661) 327-5633x 24-Hour Phone (661) 833-2640x 24-Hour Phone :(661) 978-0793x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact Phone: (661) 327-5633x MailAddr: 1101 W COLUMBUS ST State: CA City BAKERSFIELD Zip 93301 Owner. HURSHEL WILLIAMS Phone: (661) 833-2640x Address 3816 SALEM CT State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN THIS FACILITY IS A HAZARDOUS WASTE GENERATOR AND REQUIRES A JOINT INSPECTION. PLEASE GIVE THIS OFFICE 5 DAYS NOTICE PRIOR TO SCHEDULING THE INSPECTION. Based on my inquiry oi` tlip~~ ii~~ivi~uals responsible for obtaining the )ntprm,atiat~, I gertify exam ned nanid am taml late with the nformation submitted and--~lieva the information is true, accurate. ~ ~~~,,,,ie,,, Date _ _ O ENT ~ PR ~ 9 2006 -1- 03/28/2006 ~• „ ~~~ y' Y COURTESY PNEUMATIC &~.VALVE SERV SiteID: 015-021-002043 Manager ~'Ll-fi~~re,~ ~ ~ v~ A'd~-5 Location: 1101 W COLUMBUS ST City BAKERSFIELD BusPhone: (661) 327-5633 Map 103 CommHaz Moderate Grid: 18C FacUnits: 1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code: DunnBrad:95-376-8800 Emergency Contact / Title Emergency Contact / Title HURSHEL WILLIAMS % PRESIDENT DONNA DIAL / SECTY/TREASURER Business Phone: (661) 327-5633x Business Phone: (661) 327-5633x 24-Hour Phone (661) 833-2640x 24-Hour Phone (661) 978-0793x Pager Phone ( ) - x Pager Phone ( ) - x .............. Hazmat Hazards: Fire Press ImmHlth De1Hlt~i .. ~t~ Contact ~ if~j~'1~(,~ ~ b v1,,Q1"I~.S Phone : ( 6 61) 3 2 7- 5 6 3 3 x MailAddr: 1101 W COLUMBUS ST State: CA City BAKERSFIELD Zip 93301 Owner HURSHEL WILLIAMS Phone: (661) 833-2640x Address 3816 SALEM CT State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN ~ ~ n ~'N~'~ M'A ~ z ~ ~~a~ Ba,ed on my inquiry of chose individuals responsible for obtaining the informati on, 9 cartify under penalty of law that I have person exa ll i a m y ned and am familiar with the information submitted and be 'ev t e he information is true, accu te, and com I ignat , e Date -1- 01/29/2007 5 ~ t . F COURTESY PNEUMATIC & VALVE SERV ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-002043 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit 1'~ICP ............. WASTE SOLVENT F DH L 30.00 GAL 1~Iod NITROGEN F P IH G 912.00 FT3 t~+tn -2- 01/29/2007 -3- 01/29/2007 j 1 t F COURTESY PNEUMATIC & VALVE SERV ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME WASTE SOLVENT Location within this Facility Unit OUTSIDE SW CRNR SHOP STATE TYPE PRESSURE Liquid TWaste -Ambient SiteID: 015-021-002043 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 221 TEMPERATURE CONTAINER TYPE _ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 30.00 GAL 30.00 GAL 30.00 GAS HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Cleanina Solvent No 8030306 t1AGH.1tL ASJL",JJ1~11'~1VlJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MBA No No No No/ Curies F DH / / / Mod ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME NITROGEN Location within this Facility Unit INSIDE E WALL SHOP STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7727-37-9 TEMPERATURE CONTAINER TYPE Ambient - PORT. PRESS. CYLINDER,.., AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ~ Daily 304r00e FT3 304.00 FT3 912.00 FT3 I].E1GtliCL V U .7 l.. V1~lY V1V L' 1V 1.7 %Wt. RS CAS# 100.00 Nitrogen No 7727379 t1HGKKL K.7.7L" J~1~1L" 1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F P IH % / / M11 -4- 01/29/2007 F COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/11/2000 ~ INSURANCE AGENT, OWNER OF THE CYLINDERS AND FIRE DEPT IF APPLICABLE. Employee Notif./Evacuation BY PHONE. 10/11/2000 Public Notif./Evacuation BY PHONE. 10/11/2000 Emergency Medical Plan 03/28/2006 MEMORIAL HOSPITAL. -5- 01/29/2007 F COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/11/2000 ~ KEEP CYLINDERS TURNED OFF AND CAPPED. Release Containment 04/19/2006 KEEP CYLINDERS TURNED OFF AND CAPPED. CONTACT AIRGAS, THE OWNERS OF THE CYLINDERS. Clean Up CONTACT AIRGAS, THE OWNERS OF THE CYLINDERS. 04/19/201)6 v~rr~r rc~~c~urc:~ s~c:LivaLic~n -6- 01/29/2007 F COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-002043 ~ Fast Format ~ ~ Site Emergency Factors Overall Sits ~ Special Hazards Utility Shut-Offs 04/19/2006 A) GAS - BACK YARD B) ELECTRICAL - BACK YARD C) WATER - FRONT YARD D) SPECIAL - NONE E) LOCK BOX - NO = Fire Protec./Avail. Water 04/19/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - W COLUMBUS AND ON SIDE OF BLDG JEWETT ST. Building Occupancy Level 03/28/2006 3 EMPLOYEES -7- 01/29/2607 d w F COURTESY PNEUMATIC & VALVE SERV SiteID: 015-021-00203 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/24/2046 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: TAILGATE BRIEF OF NEW POLICIES AND ALL SAFETY REQUIREMENTS AND EXPECTATIONS. rays ~ nCiu Lui ru~ure use nCiu iur ru~ure use -8- Ol/29/~007 ,~~ " srr~ DIAGRAM ~ IrA DIAGRAM ~~N~: courtesy PneUmatic & valve service Inc, ~'~ I ~~ ~~.. 11 01 w. Columbus .~. W. Columbus Fire HYd. ~ .~Water Shutoff Shop Area Office Area ~ · -~ } ............................ ~Nit Cyl Gas Shutoff ~Electric 'Shutoff Back Yard Courtesy Pneumat~ .lc & Falve Service, Inc. 1101 W. COLUMBUS BAKERSFIELD, CALIFORNIA 93301 Contractors License No. 611484 ~ Ph,# 661-2327-5633 - Fax # 66t-327-2521- Email cpvsinc~aol.¢om May 9, 2001 Mr. Ralph E. Huey, Director Bakersfield Fire Department Office of Environrka_ en_t S_~eryices 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 Dear Mr. Huey: Per your request I am resubmitting my site diagram (a straight edge ruler was used). Please except my apologue for any inconvenience this may have caused and t do hope this will suffice. Thank you very much. Sincerely,~--, \~~ Hershel Williams, President Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This m~rmit is issued for the following: [] Hazardous Materials Plan [] Underground Storage of HazardOus Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002043 COURTESY LOCATION 1111 W 933.01 Bakersfield, CA 93301 t umceofnv~Services ' Voice (661) 326~3979 FAX (661) 326-0576 Expiration Date: 'June 30; 2003 COURTESY PNEUMATIC & SVC SiteID: 015-0~1~002043 Manager : BusPhone: (661) 327-5633 Location: 1101 W COLUMBUS ST Map : 103 CommHaz : High City : BAKERSFIELD ~ULj$~, Grid: 18C FacUnits: 1 AOV: CommCode: COUNTY STATION 64 SIC Code: EPA Numb: DunnBrad:95-376-8800 Emergency Contact / Title Emergency Contact / Title HURSHEL WILLIAMS / PRESIDENT ~RENE WILLI~ / SEC/TREASURER Business Phone: (661) 327-5633x Business Phone: (661) 327-5633x 24-Hour Phone : (661) 833-2640x 24-Hour Phone : (661) ~ Pager Phone : ,( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: (661) 327-5633x MailAddr: 1101 W COLUMBUS ST State: CA City : BAKERSFIELD Zip : 93301 Owner HURSHEL WILLIAMS Phone: (661)' - 83x32640 Address : 3816 SALEM CT State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: THIS FACILITY IS A HAZARDOUS WASTE GENERATOR AND REQUIRES A JOINT INSPECTION WITH HOWARD WINES AND THE ENGINE COMPANY. PLEASE GIVE THIS OFFICE 5 DAYS NOTICE PRIOR TO SCHEDULING THE INSPECTION. -- Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailYMax IUnitlMcP NITROGEN F P IH G 912.00 FT3 Min WASTE SOLVENT F DH L 30.00 GAL Mod 1 07/18/2003 F COURTESY PNEUMATIC & SVC SiteID: 015-021-002043 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 10/11/2000 INSURANCE AGENT, OWNER OF THE CYLINDERS A_ND FIRE DEPT IF APPLICABLE. -- Employee Notif./Evacuation 10/11/2000 BY PHONE. Public Notif./Evacuation 10/11/2000 BY PHONE. Emergency Medical Plan 10/11/2000 MEMORIAL. .Do hereby certify that I have (Tyl:e ~ ~nt name) reviewed ther~ , ' ~.-,,attached hazardous' materials manage- ment plan for ~ar'~r~eufl%~and that it along with (~ of ~) ~ - any ~e~ions constitute a ~mplete.a~ corr~ man- agement plan for my facility. Signature 2 07/18/2003 Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST ~ Enizonmenta] Sea. rices .............................i 1715 Chester Ave SECTION 1 Business Plan and inventory Program Bakersfield, CA 93301 Tel: {661)326-3979 FAClL. ffY NAME ~ INSPECTION DATE INSPECTION TIME ADDRESS ~ PHONE No. No. of Employees ~ Business ID Number FACIL!TYCONTACT ~ 15-02 l- Section 1' Business Plah and Inventory Program ~ Routine ~,,,Combined I:::1 Joint Agency I:3 Multi-Agency ~3 Complaint ~ Re-inspection C V (C=Cor. p,a.oe~ OPERATION COMMENTS %. V=Violation ~/"[~ APPROPRIATE PERMIT ON HAND [~/'~ VISIBLE ADDRESS ~ VERIFICATION OF INVENTORY MATERIALS ~ VERIFICATION OF QUANTITIES [~/'~l VERIFICATION OF LOCATION [~//~:~ PROPER SEGREGATION OF MATERIAL ~'"'~ VERIFICATION OF MSDS AVAILABILITYE I:~./'~:] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~/r"l EMERGENCY PROCEDURES ADEQUATE [~' [~ HOUSEKEEPING ~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?; [~ YES ['1 NO EXPLAIN: QUESTION~REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ .. .... ............... ............ Inspector Badge No.. Business Site Responsible Party White - Environmental Services Yello~ - Station Copy Pink - Business Copy COURTESY PNEUMATIC & VALVE SVC ,.~7~../ .,."~,'~'~'.../.~ SiteID: 015-021-002043 Manager : ~,, / / ~h.~DusPhone: (661) 327-5633 Location: 1101 W COLUMBUS ST ~vv/~0~ ~ug~4ap : 103 CommHaz : High City : BAKERSFIELD 'v'~[cR~Grid: 18C FacUnits: 1 AOV: CommCode: CO~TY STATION 64 S'~iC Code: EPA Nu~: ~ ~ /,~ ~ ~ DunnBrad: 95-376-8800 Emergency Contact / Title Emergency Contact / Title HURSHEL WILLIAMS / PRESIDENT IRENE WILLIAMS / SEC/TREASURER Business Phone: (661) 327-5633x Business Phone: (661) 327-5633x 24-Hour Phone : (661) 833-2640x 24-Hour Phone : (661) 397-0628x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: (661) 327-5633x MailAddr: 1101 W COLUMBUS ST State: CA City : BAKERSFIELD Zip : 93301 Owner HURSHEL WILLIAMS Phone: (661) - 83x32640 Address : 3816 SALEM CT State: CA City : BAKERSFIELD Zip : 93309 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... ISpooHazlEPA HazardsI Frm I DailyMax Unit MCP NITROGEN F P IH G 912.00 FT3 Min WASTE SOLVENT F DH L 30.00 GAL Mod '(Type or pdnt r~me) -- reviewed tt~e attached hazardous rear, ri=Is mar~a~e- ment plan for~'n~g'/~'thm it along with any corrections constitute a complete and correct man- agemem plan ior my facili~/. ' - - Signatu~e~ COURTESY PNEUMATIC & VALVE SVC SiteID: 015-021-002043 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE E WALL OF SHOP CAS# 7727-37-9 r STATE = TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container [ Daily Maximum Daily Average 304.00 FT3I 912.00 FT3 304.00 FT3 HAZARDOUS COMPONENTS %Wt. Nitrogen ~S CAS# lOO.OO N 7727379 HAZARD ASSESSMENTS ITsecret RS BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0002 Facility Unit: Fixed Containers'at Site -- COMMON NAME / CHEMICAL NAME WASTE SOLVENT Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE SW CORNER OF SHOP CAS~ 221 rSTATE -- TYPE PRESSURE I TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 30.00 GALI 30.00 GAL 30.00 GAL HAZARDOUS COMPONENTS 100.00 Cleaning Solvent N 8030306 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F DH / / / Mod 2 07/25/2000 F COURTESY PNEUMATIC & VALVE SVC SiteID: 015-021-002043 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification 07/25/2000~ -- Employee Not~f./Evaduation 07~25~2000 HOW ARE YOU GOING TO, NOTIFY YOUR EMPLOYEES OF AN EMERGENCY??????????? -- Public 'Notif./Evacuation 07~25~2000 HOW ARE YOU GOING TO N~IFY THE/UBLIC OF AN EMERGENCY?????????? Emergency Medical .Plan 07/25/2000 WHAT MEDICAL FACILITY ARE YOU GOING TO USE IN CASE OF AN EMERGENCY ........ 3 07~25/2000 COURTESY PNEUMATIC & VALVE SVC SiteID: 015-021-002043 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 07/25/2000 HOW DO.~OU PREVENT A RELEASE FROM HAPPENING??????????? -- Release C~ntainm~n~ - // 07/25/2000 HOW WOULD YOU CONTAIN A RELEASE ONCE IT HAS HAPPENED?????????? ~ H~~/Clean Up WOUbD YOU CLEAN UP'THAT.RELEASE ONCE IT HA~ BEEN CONTAINED?????????? Other Resource Activation -4- 07/25/2000 COURTESY PNEUMATIC & VALVE SVC SiteID: 015-021-002043 Fast Format ~ Site Emergency Factors Overall Site / Special Hazards -- Utility Shut-Offs 07/25/2000 GIVE THE LOCATION OF YO~ UT~.LITY S~OFFS???????????? / B) ELECTRICAL- ~--, A o: ~THING SPECIAL ~OUT YOUR FACILITY E) DO YOU HAVE A LOCK BOX -.,~/'Z'~ -- Fire Protec./Avail. Water 07/25/2000 PRIVATE FIRE PROTECTION - (IE~EXTI'N OR SPRINKLER SYSTEM???) -5- 07/25/2000 COURTESY PNEUMATIC & VALVE SVC SiteID: 015-021-002043 Fast Format ~ Training Overall Site -- Employee Training 07/25/2000 HOW MANY EMPLOYEES DO YOU HAVE AT THIS FACILITY????????????~ DO YOU HAVE MSDS SHEETS ON FILE?????????? ~~ ~iv~ ~ BRi~ ~~~ o~ Y~ T~INI~ ~RO~: ~ ~~~ .~ ~.Z- ~ ~ Page 2 -- Held for Future Use I Held for Future Use 6 07/25/2000 September 29, 2000 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H" Street : Hurshel Williams Bakersfield, CA 93301 VOICE (661) 326-3941 Courtesy Pneumatic & Valve Svc FAX (601) 395-1349 1101 W Columbus St. SUPPRESSION SERVICES Bakersfield, CA 93301 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear Mr. Williams: FAX (661) 395-1349 PREVENTION SERVlCF..~ California Law requires that all Businesses, which at any time during the 1715 ChesterAve. year handle reportable quantities of hazardous materials, file a Hazardous Bakersfield, CA 93301 VOICE (661)326-3951 Materials Business Plan, including inventory of hazardous materials, with FAX (661)326-0576 the local administering agency. ENVIRONMENTAL SERVICES 1715 ChesterAve. Your business has filed such a plan but there was some missing Bakersfield, CA 93301 VOICE (661) 326-3979 information. The computer print out enclosed, shows the information you FAX (661) 326-0576 gave us and I've highlighted the areas that were left blank. Please answer TRAINING DIVISION those questions as best you can, sign, date and if you have any questions 5642 VictorAvo. don't hesitate to call me. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 sty Esther Duran Office of Environmental Services ~ OFFICE OF ENVIRONMENTAL SERVICES ~.~ tl~p.~ ~'},~l~t~rr 1715 Chester Ave., Bakersfield, CA (661) 326-3979' HAZARDOUS MATERIALS M3ANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the fi'ont of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA PRIMARY ACTIVITY: ,---~'~"~~' f" ~-<~- Z.~/ C'~ ~' EMERGENCY NOTIFICATION C/ONTAC/T ~, , ~TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1' DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCy NOTIFICATION: C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: 2 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: B. RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFs (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABILITY (FIRE HYDRANT): HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYE~ -- MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: CERTIFICATION I,~ ~-'~,/,f~" 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~ACCURATE INFOR, M~TION CONSTITUTES PERJURY. SIGNk~JRE / TITLE / ~T~ 4 ~~. ~ CITY OF BAKERSFIELD~ OFI~EE OF ENVIRONMENTAL S[~I~VICES ~1 Flirt w 1715 Chester Ave., CA 93301 (661) 326-3979 *'~~"~' BUSINESS OWNER I OPE~TOR IDENTIFICATION FAClLI~ INFORMATION Page Of ~ F~ ~ ~ ' ' ,:~:!,¢;h~,¢~-¢~,~ ~7>~ ~<*~',~,/.',~; ~:;~,~:~.'~:~"t~'~ ,,'~¢7~'~-¢?/;..*' U*~: ~ ~ ~;;.~'~/~ ~;' ,~ %' ~ ~' . ~ ~'~. ~Q~;~,~ '~ ~:'*~¢~'~; ~ ~ ~ ~ '*',~= :~:'=,:'~' = ' < ~'- ,7<,', :,~* q ,AC[LI*IO, ' [~ ~ .... I Year Beginning . 1oo ~ Year Ending ~SINESS~AME (S~ILI, N~E oCBA-Doi~gB3;¢,~ ~ ~ 3 BUSINESS PHONE 102 SITE ADDRE~ . ~ ~/ / - ,03 COUN~ OPE~TOR NAME ~09 OPE~TOR PHONE OWNER ABBRESS ~3 114 116 CONTACT NAME CONTACT MAILING ADDRESS ~20 STATE ~2~ ZIP CITY BUSINESS PHONE ~ BUSINESS PHONE 24-HOUR PHONE PAGER ¢ ~2e PAGER ¢ '".' '~*:'; "=',; ( ;'~', Cedifi~on: Based on my inquiW ¢ ~ose individuals responsible for ob~ining ~e info~ation, I ~di~ under penal~ of law ~at I have personally examined an~m ~miliar with the Info~afion submiffed in ~is inventow and believe SCN~¢URE UPCF (7/99) S:\CU PAFORMS\OES2730.TV4.wpd ITY B I RSFIELL OF CE oF ENVIRONMENTkL VICES H RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per matehal per building or ama) ~ NEW ~ ADD ~ DELVE ~ REVISE ~ Page ~ ~ BUSINESS ~ME (~me ~ FAClLI~ ~ME ~ D~ - O~ng Busin~ ~) 3 CHEMICAL LOCATION 201CONFIDENTIALCHEMICAL LOCATION(EPCRA) ['-] Yes r-1 No 202 FACILITY ID # [~ ~ ';'~C 1 MAP if (opt/ona/) 203 GRID if (optional) 204 CHEMI6AL ~ME . ~5 T~DE SECRET ~ Y~ If Subj~ to EPC~, refer to instm~i~s 207 COM~N ~ EHS* ~ Y~ ~s ~ ~ ~i~s~:.v~:~::~'~"~'~ FIRE CODE H~D C~SSES (~plete if ~u~t~ by I~1 fire ~i~ 210 ~PE ~ p PU~ ~ m MI~URE ~ w WASTE 21'~ ~DIOA~IVE ~ Y~ ~ No 212 CURIES 213 PHYSlC~ STA~ ~ s SOLID ~1 LIQUID ~ g ~S 214 ~GEST~AINER 2~5 FED ~RD ~TE~RIES ~ 1 FIRE ~ 2 ~ ~ 3 PRESSURE REL~SE ~ 4. AC~ H~L~ ~ 5 CHRONIC H~LTH 216 (~ all that apply) ~NU~ WASTE 217 I ~I~M 218 } A~GE 219 STATE WAS~ ~DE DAYS ON SITE UN.S* ~ ga ~L ~ d CU ~ ~ lb LBS ~ ~ TONS 221 * ff EHS, am~nl must be in lbs. STOOGE CO~AINER ~ a A~VEGROUND TANK ~ e P~STI~ONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR (Check afl ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~ j BAG ~ n P~STIC BO~LE ~ r O~ER ~ c TANK INSIDE BUILDING ~ g CAR~ ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSU~ ~ a ~BIE~ ~ aa ABOVE A~IE~ ~ ba BELOW AMBIE~ ~4 STOOGE TEMPE~RE ~ a A~IE~ ~ ~ A~VE AMBIE~ ~ ba BELOWA~IE~ ~ c CRYOGENIC 226 227 [] Yes [] No 228 229 230 231 [] Yes [] No 232 233 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 242 243 [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 UPCF (7/99) S:\CUPAFORMS\OES2731 .'rV4.wpd No. PW 008833 safelq,llleell,® America's Largest Solvent Recycler Certificate of Assurance For ~ Safety-Kleen Corp. certifies to its parts Washer, immersion cleaner and CaMS customers, that we assume responsibility for proper disposal of all solvents provided by Safety-Kleen Corp., as follows: · We agree to transport, store, recycle, and dispose of your waste in accordance with ali applicable state and federal laws. · In the event a spill occurs while we are transporting, storing, recycling or disposing of your waste, we will pay ali expenses of clean-up of that spill. · In the event ground or water pollution results from our handling or disposal of your waste, we will pay all costs and damages arising from that pollution. While nO one can offer to fully relieve your firm of its "cradle-to-grave" responsibility as a generator of hazardous waste, this certificate is your assurance that your wastes will be handled in the most economical and ecologically sound manner available. SAFETY-KLEEN CORP. NYSE Symbol: (SK) Doflald ~Brinckman D&B Rating: 5A1 Parts Cleaning Service S~felil,llleell .. · -,~ /' > < '"/' /'--' Cdsto~e~ Name ~ / ' -' Date of Agreement Cu~to~e¢~ddress ' Date Sewice Commences Ci~, State, Zip Expiration Date of Initial Term (2 years after date sewice commences) ,,.._ Customer Telephone Number Safety-Kleen Branch Telephone No. Safety-Kleen Customer Number Safety-Kleen Placement Form Number Safety-Kleen agrees to sewice and maintain the pa~s cleaning machine(s) at the service infewals and prices set fo~h below pursuant to the terms of (i) this Agreement and (ii) Safety-Kleen's Machine Placement Form referenced above, which is incorporated herein by this reference. The initial term (the "Initial Term") of this Agreement shall be for two (2) years from the date sewice commences until the expiration date of the Initial Term, both of which dates are wri~en above. Upon expiration of the Initial Term, this Agreement shall be automatically renewed for successive ~o (2) year terms ("Renewal Terms"), subject to written notice of termination by either pa~y hereto received at least thi~y (30) days prior to the expiration of the Initial Term or any Renewal Term, as the case may be. The service prices and inte~als set fo~h below shall be in effect during the first year of the Initial Term. Thereafter, the service prices shall be adjusted once at the beginning of each service year by an amount equal to the percentage increase or decrease, if any, in the Consumer Price Index during the prior year, as more fully described on the reverse side of this Agreement. During any Renewal Term, Safety-Kleen may increase theservice prices (in addition to any CPi adjustment) by giving Customer written notice thereof at least thi~y (30) days prior to the effective date of any such price increase;.provided, however, any such written notice of a non-CPI price increase shall entitle Customer to terminate this Agreement by giving Safety-Kleen written notice of Customer's election to terminate prior to the effective date of the price increase. Service Interval Price per Service during Quantity Size or Model (no. of weeks) Year 1 of the Initial Term / S_KModel:~/Pa~sCleaner /~ $ Z:: S~K Model~ Pa~s Cleaner $ S-K Model.~ Pans Cleaner $ ~ Gallon Capacity.COMS $ ~ Gallon Capacity COMS $ Safety-Kleen or Customer may only terminate this Agreement (a) at theend of its two year Initial Term or any Renewal Term, as the case may be, in accordance with the second paragraph of this Agreement, (b) at any time if the other party defaults hereunder, as described on the reverse side of this Agreement or (c) in the case of Customer, if Safety-Kleen institutes a non- CPI price increase during a Renewal Term in accordance with the fourth paragraph of this Agreement. THIS AGREEMENT CONTINUES ON THE REVERSE SIDE J The parties have read, understand and agree to be bound by the terms of this Agreement, including the terms written on the reverse hereof. SAFETY-KLE!N'C~RP /' /" '- ..... ' Customer Representative' Signature -~- Print Safety-Kleen Representative's Name Print Name and Title of Customer Representative Safety-Kleen Employee No. / Branch No. Pa~l No. 91907 (4/97) CUSTOMER'S COPY K54214-R5732 ~m~ SAFETY-KLEEN 09/14/98 PACE' I LOCATION: 701501 LAN~SPOSAL RESTRICTION NOTIC] 1~: 18:04 TO: SAFETY-KLEEN SYSTEMS, INC. EPA ID NO. CADO&6113465 3561 SOUTH MAPLE ST (DESIGNATED FACILITY) FRESNO, CA UNDER MANIFEST/SALES SERVICE NUMBER ~-~,~-7-~ THE GENERATOR NOTED BELOW IS SHIPPING TO YOU WASTE DETERMINED TO BE RESTRICTED UNDER 40 CFR PART 268. IN ACCORDANCE WITH 40 CFR PART 268.7, THE GENERATOR HEREBY PROVIDES NOTICE THAT THE WASTE IS RESTRICTED FROM LAND DISPOSAL. A COPY OF THIS FORM MUST BE KEPT BY THE GENERATOR FOR FIVE (5) YEARS FROM THE DATE OF WASTE SHIPMENT. WASTE NAME: &62 SOLVENT 105 DO01 SKDOT#: 0010083 WASTE CODE(S): DO01 DO0~ DO08 DOI8 D027 D039 DO40 TREATABILITY GROUP: NONWASTEWATERS EPA WASTE DESCRIPTION AND TREATMENT STANDARD WASTE TREATMENT/REGULATORY SUBCATEGORY OR CONCENTRATION OR CODE REQULATED HAZARDOUS CONSTITUENT TECHNOLOGY CODE DOO1 HIQH TOC IGNITABLE CHARACTERISTIC WASTE. RORGS; OR CMBST ~ DO0~ CADMIUM (CD) 1.0 MQ/L TCLP DO06 CADMIUM (CD) 0. 11MG/L D006 CADMIUM CONTAINING BATTERIES SUBCATEGORY RTHRM DO08 LEAD (PB) 5.0 MG/L EP OR TCLP DO08 LEAD (PB) 0.75 M~/L DO08 LEAD ACID BATTERIES SUBCATEQORY RLEAD DO08 RADIOACTIVE LEAD SOLIDS SUBCATEOORY MACRO DO18 BENZENE 10 M~/~ D027 P-DICHLOROBENZENE (1,4-DICHLOROBENZENE) 6.0 MQ/KO D03~ TETRACHLOROETHYLENE 6.0 M~/~Q DOdO TRICHLOROETHYLENE 6.0 M~/~ NOTES TH~ CONSTiTUENT III'~oMPOSITION IS BASED ON KNOWLEDGE OF THE WASTE (VIAI MATERIA}"' .... SAFETY DATA SHEETS FOR THE CHEMICAL(S) USED, AND THE PROCESS WHICH CREATED THE WASTE). NOTES: w THESE TREATMENT STANDARDS DO NOT PRECLUDE RECLAMATION PRIOR TO FINAL DISPOSITION. ~*~ NEW TREATMENT STANDARDS UNDER FEDERAL RULES EFFECTIVE 12-19-94. w~* TREATMENT STANDARDS APPLICABLE IN CERTAIN HSWA-AUTHORIZED STATES AND MEET UNIVERSAL TREATMENT STANDARDS. ~ NEW TREATMENT STANDARDS UNDER FEDERAL RULES EFFECTIVE ~~NEW TREATMENT STANDARDS UNDER FEDERAL RULES EFFECTIVE 8-~4-98. UHC NOTICE: GENERATOR IS NOT REGUIRED TO LIST UNDERLYIN[~ CONSTITUENTS WHEN TREATER MONITORS FOR ALL REQULATED CONSTITUENTS PRIOR TO DISPOSAL. EXP NOTICE: THIS LORN EXPIRES ON 12/31/c78. GENERATOR NAME: COURTESY PNEUMATIC EPA ID: CAL000013687 SEGa: 7768 LOC: 701501CUST: 7-015'01-7678 TERR: O1REF#: 921588 SW: 9840 TOP COPY: GENERATOR MIDDLE COPY: FACILITY BOTTOM COPY: TRANSFER · . '/! OF I. AgO OISP(}SAL RESTR£CTION OF (Oe~gn4t~ ;actUary) " -(~es~gnated Facility) ' ... O~ttQn ~: Un~r ~ntfest numar _,of s~les/serv~ce ac~-n~ledge~nt numar A co;y of th;s faro mst be kept by ~e ~enerator and factllty for ftve (S) years from ~e ~te of ~ste sMpmnt, OOt~on 8: I ~ ~ s~11 quanttty gener~tar (tOO-Z,O00 kg/~), ~ts nottce covers 411 ~astes shfpoed under the ~al?~1ng ~chtne PlaceMnC~n~/or CusCo~r ~ned Hachlne Service A co~y of ~?s nottce w111 be ~t:led wt~ ~he conCracC(s) ~e ~aste Hay (Check boxes ~aC appTy) ~PA Conta?n ~he ~alT~flg Treat~nC S~andard (~11) ~as~a N~ ~as~e Code ~es~c~ed Cons~ue~s o~ Me~od ~Vaste Petroleum . TNa~htha OOOt Ignitable 11qut~ ?nclnerat~on, fuel · , su~stltuC(ons or Halogenated organic See (ndtvtdual co~ounds (a~ove ~000 mg/1) standards may ?nclude: pe~.40 CF~ ~ethylane chlortde 0.96 -Tet~achlo~oe~hylane 0.05 -Taluene 0.33 T~t ch Io~oe~h~ lene 0 -X~ lene 0 ~ Vesta Petrole~ O00l: All of ~e above, .plus: · Naphtha [sJudgeS ~r~ 0006, <admt~ 0.~ Safety-~Jeefl Se~vtce "DOO8 .... "<. Center Operettas) -Lead ['I~ lead subcatego~) O.S~ ~' Vas~e C~d FO02, Cresyllc Actd . - 0.75 Cleafl?ng LJqutd/ FO04 1,2~Ichlorobenzene [~rst~ Cleaner ~e~nyJene cholortde 0.96 ~. Vesta PercAToro- FO02 TeC~achT~roe~hylene 0.05 aChyTene ~ vesta T~c~Tora- FO02 ~r~chTorotr~f?uoroethane 0,96 tr ~ ~ Tuoroec~ne ' Vaste Tr(chloro- F002 Trtchloroet~ane ~ ~aste Paint F005, Acetone ~elaCe4 Hater~ml F003, Hethyl Ethyl Ketone 0.75 O00t, Hethyl ;sobutyl Ketone 0.33 0006, Tq~uene 0.33 0008 Xylene O. lS .. Cadmtum 0.~ Ch~tum 0.094 Lead (l~-lead subca~ego~) 0.51 ignitable l~qutd ~nc~nera~on, ~uel : substttutfon . ~ecovery -- · ~e constituent co~os~t~ ?s based on kn~?e~ge of ~A~ ~aste (v~a ~aCer~al Sa~e~y Oa~a Sheets ~o~ ~e chemical(s)~useU, and ~e p~ocess which lliffll,lllelfl ~ TO: SAFETY-KLEEN CORP. EPA ID NO. ~:: (DESIGNATED FACILITY) (DESIGNATED FACILITY) ADDRESS: ¢ ~ s~,~a, c~ Under manifest number , the generator noted below is shipping to you a waste determined to be restricted under 40 CFR Part 268. In accordance with 40 CFR Part 268.7, the generator hereby provides notice that the waste is restricted from land disposal. A copy of this form must be kept by the generator and facility for five (5) years from the date of waste shipment. In accordance with 40 CFR 268.7, the generator hereby provides notice that the waste is restricted from land disposal. I am a small quantity generator (100-1,000 kg/mo) in accordance with 40 CFR 268.7. This notice applies to all waste shil:~n~Dt~.,..under my service contract with Safety-Kleen/'~_ / Col:p.~lt. cQ,vers today's shipment on manifest No. tf;~._~, ~:/.;2[/' , or sales/service acknowledgement No. _ L~-- '~> , and all subsequent shipments. A copy of this notice will be maintained with the service contract(s) or sales/service acknowledgment(s) for five (5) years beyond the termination of the service contract. Ignitable Liquid (High TOC Subcategory) Incineration (INCIN), fuel substitution (FSUBS) [~Waste Petroleum Halogenated Organic Compounds (HOC's) >_. 1000 mg/I or recovery (RORGS) (40 CFR 268.42) (non-waste water) Naphtha INCIN (40 CFR 268.42) (non-waste water) (105) Benzene Not Established Tetrachloroethylene Not Established [--]Waste Petroleum Naphtha Ignitable Liquid (High TOC Subcategory) INClN, FSUBS, orRORGS (140) All of the above, plus: [] Waste Petroleum _ Cadmium 1.0 (non-waste water) Naphtha (sludges from _ Chromium 5.0 (non-waste water) Safety-Kleen Service Lead 5.0.(non-waste ,Wa, ter) Center Operations) _-- Tetrachloroethylene Not Establisneo HOC's >_. 1000 mg/I INCIN (40 CFR 268.42) (non-waste water) _ Cadmium 1.0 (non-waste water) _ Chromium 5.0 (non-waste water) [] Waste Compound _ Lead 5.0 (non-waste Water Cleaning Liquid/ _ Benzene ' Not Established Immersion cleaner 699 _ Chlorobenzene Not Established _ 1, 4-Dichlorobenzene Not Established _ Tetrachloroethylene Not Established _ Trichloroethylene Not Established [] Waste Perchloroethylene Tetrachloroethylene 5.6 (non-waste water) [] Waste Perc. Filters This hazardous debris is sub Tetrachloroethylene 5.6 (non-waste water) to the alternative treatment standards of 40CFR 268.45. [] Waste Trichlorotrifluoroethane Trichlorotrifluoroethane 28.0 (non-waste water) [] Waste 1,1,1 Trichloroethane 1, 1, I Trichloroethane 5.6 (non-waste water) Waste Petroleum Naphtha Ignitable Liquid (High TOC Subcategory) INCIN, FSUBS, orRORGS(40CFR268.42)(non-wasteWater) Tetrachloroethylene Not Established Acetone 160.0 (non-waste water) Methyl Ethyl Ketone 36.0 (non-waste water) Methyl Isobutyl Ketone 33.0 (non-waste water) Toluene 28.0 (non-waste water) [] Waste Paint Xylene 28.0 (non-waste water) Related Material Methanol 0.75(non-waste water) Ignitable Liquid (High TOC Subcategory) INCIN, FSUBS, orRORGS(40CFR268.42)(non-wastewater) Cadmium 1.0 (non-waste water) Chromium 5.0 (non-waste water) Lead (TOC 5.0 {.non-waste water) [] Waste Antifreeze Lead 5.0 (non-waste water) Not Established The constituent composition is based on knowledge of the waste (via Material Safety Data Sheets for the chemical(s) used, and the process which created the waste). ,These treatment standards do not preclude reclamation prior to final disposition. ~3 (~ 7 7-- 0 ~. ~-- 0 t - 7 ~ 7 a 0 2 t O 0 COURI-ES¥ P N IF U N,,,4 ~r :[ c,, C~LOO00 t 3b ~"1 Generator Company: , EPA ID NO.: ' " I 5'/:w"/'"' 7 -/7-- 7> Generator's Signature: X ~,--,~f ./" ~ -~-';/~-'~-~'~:~,.-;~'"~.'"') Date: ,Printed Name and Title of Generator: /~ -? -~' ,~ ,.--'?.--' / STAI'~ Ol~ CALIFOIINIA.---HEAI, TH AND W~LF'ARE AG~hlCY G~G~ D~UK. MF~JIAN, DEPARTMENT OF HEALTH SERVICES 714/7~4 I~ STIIEET SACRAJ~NTO, CA 95~14 (916) 324-1'781 ACKNOWLEDGEMENT OF NOTIFICATION OF HAZARDOUS WASTE ACTIVITY The State of California, Department of Health Services, Toxic Substances Control Division, Program Monitoring and Personnel Section is now issuing California I.D. numbers for all small quantity generators in California. These numbers will begin with a CAL prefix. A permanent California I.D. number has been assigned to the address location of your company. A copy of your application form is attached. The number is SITE-SPECIFIC. If your company should move, this I.D. number does NOT move with the company and a new one must be obtained. If you should make any changes to the attached form please notify us in writing. The number must be included on all manifests for transporting of hazardous waste; all Annual/Biannual Reports that generators of hazardous waste, and owners/operators of hazardous waste treatment, storage and disposal facilities must file. Please retain this I.D. number in your files for reference when disposing of hazardous waste. Program Monitoring & Personnel Section Toxic Substances Control Division ~L Fm'm Ap~'oved. OM8 N(~ 2050.-0028. Exl~res 9-30-88. ~ea~ pnm or ~ ~th E~ ~ (~2 char~ers ~r J~h) in the unsh84~ areas only GSA No. 02~-EPA Unit~ S~tes Environmental Prot~ion Agen~ Plea~ refer to the/nst~uct/ons Washin~on, DC 2~ F/I/n~ Notificatmn ~fore com;letinQ thai form. ~e information r~uest~ EPA Notification of HazardoUs Wa e ActiviW ,,,, ,,w a~ R~ove~ For O~cial U~ Onl ~mme~ Courtesy Pne~aCic & Valve Svc. o~e~ 1101 Vest Columbus ~ fF. ~ ~W ~ T~ $t~te ZIP ~' S~t ~ fl~te Num~ ~ a~e a~ ~fle (1~ fir~ ~j~ t~le/ ~ne Numar (~ea ~e a~ num~/ 'VI. T · ~ R ula~ Wa~e A ' ' Ma~ 'X' in~~ Refer to in~~ 7 O c. Bum~ ~VII. Wa~e Fuel Burning: T~ of Comb~on 0~ fe~ 'r/n alla~o~i~e ~es ~o/~icale ~ of c~u~ion d~icgs/in IX. Fi~ or Sub~uen Ma~ 'X' in t~e a~r~iate ~ to inflate ~mh~ tbJa is ~ur inmallati~'s fi~ nmifi~tJon ~ ha~r~us ~me ~i~w ~ a su~uem notifi~tion. If this is n~ ~ur fir~ notifi~J~. ~t~ ~r in~llat~n's EPA I0 Num~ in the ~ ~ ~1~. C. In~allation's EPA ID Number EPA Fo~ 8700-12 (R~. 11-851 Pr~ious ~ition is ~lete. ~n~ ~ ~ · ID -- For OflicM Uie Only ,,, · C ~ :T/Al C W -.I I1-- X. Oe_~cHption of H~;=rdou$ Wa~e_~ (co..'u~ from [ront/ I · ' A. H~ W~ ~ Nonl~ Sou~ EntM ~e ~ur~igit nu~ ~ ~ CFR'~ 261.31 f~ ~ list~ h~r~us ~ non~ific ~urc~ ~ur in~aflati~ ha~l~ UM ~i~l ~ if I 2 3 4 6 6 7 8 S 10 II B. ~ W~ ~ $~ ~ ~ ~ ~ n~ ~ ~ ~R ~ 261.32 ~ ~ I~ h~ ~e ~ ~f~ ~ ~r in~l~ h~& ~ ~ ~ if ~. 13 14 15 lO 17 18 ,1, !1!:, I1~ Ill I1~ 19 ~ 21 ~ ~ 24 .... ~ 20 27 ~ ~ ..om.~. ~ ~ ~ ~ ~ Wi ~g ~ ~it nW ~ ~ ~ ~ 261 .~ f~ ~ chemi~l su~ce 31 ~ ~ ~ ~ 36 .... 81 ,I .... ~f~ ~ ~. ~ ~ ~ ~ ~ 41 42 '1~1 [" ~ ~' ! , ~. ~ I~ W~ Em~ ~ f~r~ n~W f~ ~ CFR ~n 261.~ fM ~ h~ ~e fr~ h~it~, veterina~ hos- -- i~~. IS. ~ C~ ~ 2~, -- 261.24, / ce~ under pena~ of few that / have pe~one/Iy exam/n~ 8~ em fem//ier w~h the information subm~ed ~is end 8//g~8~ document~ end that ~s~ on ~ /~qu/~ of ~o~ /~/dua/s /mm~/ete/y respons/b/e for obte/~/n~ the/nformg~on,/believe ~8t ~e subm~ /nformat/on is ~ue, accurate, 8~d comp/ete. / em aware ~ere are sign/f/cant penaaies f~ submit/ha fe/~ inf~u~n, including the ~S~ibi/~ of fine and /mprisonment. ~ ,,,,..~,~.~ ~/~ ~ z~/~.~,?~ ,, ~ ~? ~h,,.h/~ EPA ~ ~-12 (R~. 11-86) Rm CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersiield, CA 93301 Section 4: Hazardous Waste Generator Program EPA ID # [] Routine []~ombined [] Joint Agency [] Multi-Agency [] Complaint [~1 Re-inspection OPERATION C V COMMENTS Hazardous xvaste determination has been made t;/ ~ ( ,'~-~-.-ri~ q° (~.._. ~-, EPA 1D Number (Phone: 916-324-1781to obtain EPA1D #) Authorized for waste treatment and/or storage Reported l'eleasc, fire. or explosion xvithin 15 days of occurance Established or maintains a contingency plan and training t..o'~ Hazardous waste accumulation time fi'ames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondar5) containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper ma, nagement of lead acid batteries including labels Proper management of' used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests tbr 3 years Retains hazardous xvaste analysis for 3 years Retains copies of used oil receipts lbr 3 years Determines if waste is restricted from land disposal C=Compliance V=Violation Omce of Environmental Services (805) 326-3979 ~ l~u~--~'S yt~' Re[p~sible -Party \Vhite - Env. Svcs. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ~.~,7..9c,'~n'C-5~ io,o~on, vk, rvC.~ INSPECTION DATE ADDRESS {{O { (.~, Edc, O~fSO5 PHONENO. FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [] Routine /~Combined [] Joint Agency [] Multi-Agency [] Complaint [~ 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=C°mpliance V=Vi°lati°n 'x~/J/t.f ~~/~Y/~ Any hazardous w~ste on site?: ~.-Yes [] No Explain: ~,x.~'A~g ~ ~~ Questions reg~ding ~is inspection? Please c~l us at (661) 326-3979 fi~siness ~i~ ~sp~ns~ Party White- Env. Svcs. Yellow- Station Copy Pink- Su~i.~ Cory Inspector: ~, ~ mmm OFI~CE OF ENVIRONMENTAL SERVICES t~'~tl'Y_~l'r 1715 Chester Ave., CA 93301 (661) 326-3979 "~'~" H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per mate~al per bu~ or ama) ~ ~ D~ ~ ~ Page of ADD REVISE BUSINESS ~E (~e ~ FACIL~ ~ ~ O~ - ~ng Bu~n~ ~) 3 CHEMICAL LOCATION ; 201 CHEMICAL LOCATION [] Yes [] No 202 /~'x~-~ 0~" ~ ~J¥~-- ~ ~ ~ ~NF~OEmlAL(EPC~) FACILI~ ID = ~ ~ ~ I ~ 0 (Op~ ~3 GRID ~ (o~naO ~5 ", T~E SECR~ ~7 : ~M~N ~ ~ EHS' FIRE ~DE ~ C~ES (~ ~ ~ by I~ tim ~ ~0 ~PE ~ ~ m ~ ~wWA~ 211 ~ ~D~A~ ~Y. D. 212 ~CURIES ~3 ~ 1 FI~ ~ 2 ~ ~U~ ~E ~ 4 AC~ H~L~ ~ 5 ~RONIC H~ ~6 FED ~D ~RIES (~ all ~at ~) .NU~ WAS. 217 I ~M ~ ~A~ 219 STA~W~DE A~U~ ~ILY ~U~ / ~ 218 = , DAILY ~ UN.S* ~ ~ ~ ~ ~ ~ ~ lb ~S ~ m TONS ~1 DAYS ON S~E * ~ EHS, ~t m~ ~ In I~. STOOGE ~AINER ~a ~UNOT~K ~e ~N~C~UM ~i FIBERDRUM ~m G~BO~E ~q ~IL~R (~eck a// ~at a~) ~ b UNDER~UND TANK ~ f ~ ~ j ~G ~ n ~C BO~E D r O~ER ~ c T~K INSI~ BUI~ING ~ g ~Y ~ k BOX ~ o TO~ BIN ~ d S~EL DRUM ~ h SILO ~LINDER ~ p T~K WA~N STOOGE PRES~ ~ a ~IE~ ~ ~VE ~IE~ ~ ~ BELOW A~IE~ ~4 STOOGE ~~ ~IE~ ~ ~ A~VE ~1~ D ~ BELOW A~IE~ D c CRYOGENIC 4 ~ ~9 ~ Y~ 0 ~ 2~ 24~ 5 242 2<3 0 Y~ 0 ~ 2~ PRI~ ~ & TI~ OF AU~OR~D ~A~ ~PRESE~AT~E SI~TU~ UPCF (7199) S:\CUPAFORMS\OES2731.7¥4.wpd o ~ CITY OF BAKERSFIELI~ OFPI~E OF ENVIRONMENTAL SERVICES 17IS Chester Ave., CA 93301 (661) 326-3979 "~'~" ~' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ pe~ mate~al ~ ADO ~ DELVE ~ REVISE ~ Page ~ of BUSINESS ~E (~e ~ FACIL~ ~ME ~ O~ - ~ng Bu~n~ ~) 3 CHEMICAL LOCATION ~NFIDE~IAL (E~) ' :' ' ;' "%' '"' :m'*' :'e%~ '-'~*~e';:~,~C<x;*~ ~*~''' "~?;"'~' *"-'~ C~ IN~A~ON";.'W. ·, .... CHERYL ~E ~ ~ ~ ~C~~ FIRE ~OE H~D ~E~ (~e E ~ by ~ tim ~ ~0 ~PE ~ ~ ~ ~ m ~ ~ WA~ 2~ ~D~OA¢~ ~ Y~ D PHYSI~ STA~ ~ , ~LID ~' L"UID ~g~S 214 t ~GEST ~AINER FED~D~RIES ~FI~ ~2 ~ ~3 P~SSU~ ~ D4 A~ H~L~ (~ ~ ~at ~pN) A~U~ DAILY ~ ~ ~ DAILY ~U~ UN~* ~ ~ ~ ~ CU ~ ~ ~ ~ ~ ~ TON~ · ffE~.~tm~ ~. STOOGE ~AINER (Checka~ata~/y) ~G~UND T~K ~e ~Tt~N~IC ~UM ~i FIBERDRUM Dm ~ b UNDER~UND T~K ~ f ~ D j ~G ~ n ~C ~E D r O~ER ~ c T~K INSIDE ~I~ING ~ g ~Y ~ k ~X ~ o TO~ BIN ~ d S~EL D~M ~ h SILO ~ I CYLINDER ~ ~ T~K WA~N STO~GEPRESSU~ ~a ~IE~ ~ ~ A~VE~IE~ D ~ BELOWA~IE~ ~4 ' 5TO.GE ~~ . ~1~ ~ ~ ~VE ~1~ D ~ BELOW A~IE~ 3 2~ ~5 ~y~ 4 ~8 ~9 242 [ 243 / UPCF (7~99) S:\CUPAFORMS\OES2731.TV4.wpd