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BUSINESS PLAN 7/21/2003
· SITE DIAGRAM [ · ~ ! FA~ DL~GRAM ~-~'~--! BusinessAd~ess: 5001 Commerce Drive (100% Sprinkler) Commerce Drive Fire · Exit~. ILI_I,M_i. F,3_LI/J-m ~71%- 1." . ,..., ~Exit ~ ' .~ I · '" :~LJ~I, ,i~ '1 fl ~ Utility Main· -.~' I And Riser .: ~ ~. Exit ~ EX'it 1000 gal. ' Compressed Gas ~aer ~ro~na Diesel Fuel _:;- ', .... Brandon Neal ;~egion~/ Director of P/ant operations. ' , ' .50~1 Commerce Dr~ye .. Bakersfie/d~ 9330~. . - '. Pac/~ic ~ell 9u&181ng . Fax 805 ~33-5253 * -. N B~KERSFIELD REGIONAL HOSP SiteID: 015-021-001021 Manager : / ~ BusPhone: (661) Location: 5001 COMMERCE DR ~%.~ Map : 102 CommHaz : Low City : BAKERSFIELD ~= Grid: 34B FacUnits: 1 AOV: SIC Code:8361 CommCode: BAKERSFIELD STATION 11~ ' DunnBrad:18-369-2987 EPA Numb: Emergency Contact / Title Emergency Contact / Title~ Business Phone: 661) 323-5500x Business Phone: (661) 323-5500x ~ 24-Hour Phone : 661) ~m/ -m~$lx 24-Hour Phone : (661) ~-/ I Pager Phone : (~ Pager Phone : Hazmat Hazards~ Fire Press React ImmHlth DelHlth Contact : Phone: (661) 323-5500x MailAddr: 5001 COMMERCE DR State: CA City : BAKERSFIELD Zip : 93309 Owner HEALTHSOUTH 'CORP Phone: (661) 323-5500x Address : ONE HEALTHSOUTH PARKWAY State: AL City : BIRMINGHAM .Zip : 35243 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: GET COPY OF HOSPITAL POLICY EOC 406.00 ~, ,'~.,'~ /~/ Do hereby certihj ~hat l have ~ (Type or print name) reviewed the atiached hazardous materials manage- ment plan for//~////~--.~/~'/~- and that i~ along Wi~h (Name of 8usine~) any corrosions constitute a complete and corr~ man- ~emem P~., SignOre '07/15/2003 F BAKERSFIELD REGIONAL HOSP SiteID: 015-021-001021 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention· 02/18/1999 ~o~ DO ~ou ~ ~ R~S~ ~ROM~P~NIN~--~???.~? --Release Containment 02/26/1999 DIESEL FUEL WILL BE CONTAINED IN UNDER GROUND SECONDARY CONTAINMENT. -- Clean Up 02/26/1999 OXYGEN AND GAS WILL VAPORIZE. NO CLEANUP WILL BE REQUIRED.' DIESEL FUEL WILL BE REMOVED FROM SECONDARY CONTAINER DURING TANK REPAIR AND REPLACEMENT. Other Resource Activation -12- 07/15/2003 ~-BAK~'~:~FiELD REGi'ONAL REHAB HOSP' - J~iteID: 015-021-00102'1 + Manager_: ~ BusPhone: (661) 323-5500 /-E0[ation: 5001 COMMERCE DR' Map : 102 CommHaz : Low {-~ci~y .... : BAKERSFIELD ~ Grid: 34B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 SIC Code:8361 EPA Numb: DunnBrad:18-369-2987 + --~-- + Emergency Contact / Title Emergency Contact/~~E~oTitle 'BRANDON NEAL / DIRECTOR OPERAT Business Phone: (661) 323-5500x Business Ph~e: (661) 323-5500x 24-Hour Phone : (661) - x '24-Hour Phone : (661) - x Pager Phone : (661) 632-4893x Pager Phone : (661) 321-~-3~ ............................ ~ ...... + Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact : ~. ~ ~. P~one-: (661) 323-5500x MailAddr:~ 5001 cOMMERCE DR ~ State: CA City : BAKERSFIELD , Zip : 93309 Owner HEALTHSOUTH CORP Phone: (661) 323-5500x Address : ONE HEALTHSOUTH PARKWAY State: AL City : BIRMINGHAM Zip : 35243 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No .................................................................... ~ ......... + Emergency Directives: GET COPY OF HOSPITAL POLICY EOC 406.00 += Hazmat Inventory -- One Unified List + +== Alphabetical Order .... All Materials at Site + ........................... · ..... + ....... + ........... + ..... + .......... + .... +- - -+ Hazmat Common Name... ISpecHazlEPA HazardsI Frm I DailyMax IUnitlMCPI ................... ~ ............ + ....... + ........... + ..... + .......... + .... +___+ F IH DH L 1000.00 GAL Low ~ DIESEL .......... --~- .... ~--'~ ...... ~F~ .... IH ......... G ....... 2~4-4~ 00 FT3 Min HELIUM LIQUID OXYGEN F P I.H G 1000.00 GAL Low OXYGEN F P IH G 4056.00 FT3 Low WASTE FIXER R L 720.00 GAL' Min I, /aJ~O ~lflP/)/.~ Do hereby ce~i~ th~ I have ~y~or p~nt ~a~) · reviewed ~he a~ached haza~ous m~erials manage: ment plan for ~'~,,,/',~".~ev,~'~-t and ~h~ i~ along ~i~h (~ of Bushy) any corre~ions constitute a complete and coffe~ man- agemen~ plan for my ~li~. . + BAKERSFIELD REGIONAL REHAB HOSP .... : SiteID: 015-021-001021 += Inventory Item 0004 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME DIESEL I Days On Site 1365 Location within this Facility Unit Map: Grid:. +---~ ............ SW BY GENERATOR 68476-34-6 +==_ =------= =+=== += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Liquid I Pure I Ambient ~ + ~ ~ =~ ~ + AMOUNTS AT THIS LOCATION -- Largest Container I Daily Maximum I Daily Average 1000.00 GAL I 1000.00 GAL I 800.00 GAL +== + ~ ==+= - HAZARDOUS COMPONENTS +===+== 100.00 ,Diesel Fuel No. 2 .~ ~, ~ :~ No., 68476302 +== +===+ ~ HAZARD ASSESSMENTS ===4 =+ ........ + ..... ITSecret[ RSIBi°Haz[ Radi°active/Am°unt I EPA Hazards NFPA I' USDOT# MCP INo No No . No/ Curies F IH DH / / / Low % ~===+======+ .... + ~ ......... += ....... +=====+ Inventory Item 0003 Facility Unit: Fixed Containers on Site + +== COMMON NAME / CHEMICAL NAME + ................. HELIUM I ' Days On Site 1365 Location within this Facility Unit Map: Grid: + ................ SW CORNER 02 ROOM CAS# 7440-59-7 ........ +=== += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER +-- ~ ~ ~ +== =+ ~ AMOUNTS AT THIS LOCATION '=+ Largest Container Daily Maximum I Daily Average 244.00 FT3 244.00 FT3 244.00 FT3 ~ ~ =+ =4 ~ H~ZARDOUS-'COMPONENTS~'~-=--- - --'=-+===+= =+ 100.00 Helium No 7440597 +===+==== =+===4 ~ HAZARD ASSESSMENTS ===4 ~ + ..... ITSecret] RSlBioHazI Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No No No No/ Curies F P IH / / / Min +------ ~===4 ~ + ~ ~ -2- 03/21/2002 + BAKERSFIELD REGIONAL REHAB HOSP - SiteID: 015-021-001021 += Inventory Item 0001 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME LIQUID OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: + ................ SW CORNER 02 ROOM CAS# 7782-44-7 += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Gas I Pure I Above Ambient + ~ ~ ~ ~ ~ ~ AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 40.00 GAL 1000.00 GAL 750.00 GAL += ~ ~ ~ += HAZARDOUS COMPONENTS -+===+ .......... 100.00 pxygen, Compressed-; ~ ~ ~ ~_ . ~ NO. 7782447 += +===+= .... =4 HAZARD ASSESSMENTS ===4 + +===== ITSecret N~SIBi°Hazl Radi°active/Am°untNo No No/ Curies EPA HazardsIF P IH NFPA/// IUSDOT# MCP += Inventory Item 0002 Facility Unit: Fixed Containers on Site +== COMMON NAME / CHEMICAL NAME + OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: + ................ SW CORNER 02 ROOM CAS# 7782-44-7 +-- += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER += ~ ~ ~ += ~ AMOUNTS AT THIS LOCATION I Largest Container Daily Maximum I Daily Average 2400.00 FT3 4056.00 FT3 4056.00 FT3 + + HAZARDOUS COMPONENTS .... a-+===~ I 100.00 Oxygen, Compressed No 7782447 += += += +===+= ~ HAZARD ASSESSMENTS ===~ + + ..... TSecret NoRSIBioHaz] Radioactive/Amount I EPA HazardsI NFPA I USDOT# I MCP No No No/ Curies F P IH / / / Low += +===+= ~ ~ ~ + ~=====+ -3- 03/21/2002 + BAKERSFIELD REGIONAL REHAB HOSP SiteID: 015-021-001021 + +=-Inventory Item 0005 Facility Unit: Fixed Containers on Site + +== COMMON NAME / CHEMICAL NAME .... 4 ....... + WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: + ................ INSIDE X-RAY VIEWING ROOM CAS# += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE ..... I Liquid I Waste I Ambient I Ambient 4 ~ =+=== .... =+_. + ...... ~ + AMOUNTS AT THIS LOCATION ........... Largest Container I Daily Maximum I Daily Average 180.00 GAL ~ ' 720.00 GAL , 180.00 GAL + + =4 ....... ~ ~ HAZARDOUS COMPONENTS + + ~-+ %Wt. -- ~ -- No~ 7440224 ~Silver - ~ .... ~ .... + + k===4 =+ += + + ~ HAZARD ASSESSMENTS ITSecretl RSIBi°Hazl Radi°active/Am°unt IEPA Hazards NFPA I USDOT# MCP INo No No No/ Curies R / / / Min +=======+===4 ~ ............. 4 ~ 4 ........ +=====+ -4- 03/21/2002 + BAKERSFIELD REGIONAL REHAB HOSP SiteID: 015-021-001021 +=. = Fast Format += Notif./Evacuation/Medical Overall Site +== Agency Notification 02/26/1999 CITY FIRE DEPT @ 911, CAL HAZ MAT SPILL NOTIFICATION @ 1-800-852-7550, AIR LIQUIDE @ 1-800-231-1366. +=== Employee Notif./Evacuation - 02/26/1999 EMERGENCY CALL TREE. + .... Public Notif./Evacuation --- 02/26/1999 EMERGENCY CALL TREE. Emergency Medical Plan 02/26/1999 MERCY. -5- 03/21/2002 + BAKERSFIELD REGIONAL RE}{AB HOSP -- SiteID: 015-021-001021 ~ _ Fast Format += Mitigation/Prevent/Abatemt Overall Site +== Release Prevention ....... 02/18/1999 HOW DO YOU KEEP A RELEASE FROM HAPPENING??????????? + - ' 02/26/1999 +=== Release Containment -- DIESEL FUEL WILL BE CONTAINED IN UNDER GROUND SECONDARY CONTAINMENT. .... Clean Up 02/26/1999 OXYGEN AND GAS WILL VAPORIZE. NO CLEANUP WILL BE REQUIRED. DIESEL FUEL WILL BE REMOVED FROM SECONDARY~CONTAINER DURING TANK REPAIR AND REPLACEMENT. Other Resource Activation -6- 03/21/2002 + BAKERSFIELD REGIONAL REHAB HOSP == SiteID: 015-021-001021 4 Fast Format += Site Emergency Factors Overall Site +== Special Hazards - +=== Utility Shut-Offs 02/26/1999 + A) GAS - SE CORNER/OUTSIDE B) ELECTRICAL - SE CORNER IN MAIN ELECTRICAL RM/INSIDE C) WATER - SE CORNER IN PUMP RM/INSIDE D) SPECIAL - MEDICAL GAS SE 02 RM OR @ EACH ZONE VALVE/INSIDE E) LOCK BOX - NO .... Fire Protec./Avail' Water 02/26/1999 + PRIVATE~FI~E PROTECTION ~ ~LDG~SPRI~K~--E~'-W~H BACk--AIdE C~'~R~E-~6~ ...... BLDG. ~ ..... Building Occupancy Level -7- 03/21/2002 BAKERSFIELD REGIONAL REHAB HOSP SiteID: 015-021-001021 + Fast Format + += Training = Overall Site + .... Employee Training --- 02/26/1999 + WE HAVE 150 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF YOUR TRAINING PROGRAM: NEW EMPLOYEE ORIENTATION, ANNUAL SAFETY ORIENTATION AND EMERGENCY PREPAREDNESS TRAINING FOR PLANT OPERATIONS +=== Page 2 I + .... Held for Future Use =+ ..... Held for Future Use ==+ -8- 03/21/2002 CITY OF BAKERSFIEL~-~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester AVe., CA 93301 (661) 326-3979 -.,~.,, ,~ ~~... ~ ~r,.,.~' HAZARDOUS MATERIALS INVENTORY Ch. emical Description Form (one form per material per building or ama) ~ADD [] DELETE [] REVISE 200 Page __ of __ '~ .:'::~ ;~:~i: ~:!i~i:~ :: ~.: :~:: :~ '~? ?:~i,:~:? ~: ?ii!ii!, :::i'i: ~:~ :~ i: i:~.~ ?~: :!?~!?~'i:i, :!i~ i i~:i~ :.:i~!~i ,~?~i iii~i~i~:ili,:~ :: !~ ~. ~'~ i?~ ~!/'" i~. ~c'i~i~: ::'i~::~M~,~":'~: .?.:!-~::~ ~ ::~ ~: ?: :: ~.~ ~; ~ ~?: ~?~:~ ?~ ~::~ ~ ~ ~?: :~ :~ ~;~ ~; ::~ ~?~ ~?~ ~?~ ~ ~ :~ ?~ ~;~?~ ~usINE~s NAME (Same as FACILI~ ~ME ~ D~ - ~ng Busin~ ~) ' ' 3 CHEMI~LLOCATION .. ~ ~ ~ ._ ~., ~ ~ ..... ' ~ 201 CHEMI~LLOCATION ' ~ . ~ ~, i~ ~- '~ ~ (~/~ ~ ICONFIDENTIAL(EPC~) ' ~ Y~ ~ No 202 FACILI~ ID ~ ~: ,~ ~:~ J ~ I ~P ~ (opt~na~ . 203 GRID ~ (opt~naO 2~ 205 T~DE SECRET ~ Y~ ~ No ~ ~.~. 207 COM~N NAME EHS* . ~ Y~ D No ~ FIRE CODE H~ C~SSES (~plete if r~u~t~ by I~1 fire ~i~ 210 ~PE ~ p PURE D m MI~URE ~w WASTE 211 ~ ~DIOACTNE ~ Y~ ~ No 212 CURIES 213 PHySI~L STATE ~ s ~LID ~1 LIQUID D g ~s 214~ ~RGEST~AINER ~ 215 FED H~RD CATE~RIES D 1 FIRE D 2 R~CTNE ~ 3 PRESSURE REL~SE ~ 4 ACU~ H~LTH ~HRONIC H~LTH 216 (Ch~ all that apply) + AMOU~ ~ DALLY A~U~ ~ DAILY A~UNT DAYS ON SIXE ~ UNITS* ~ ga ~L D d cu ~ D lb LBS D m TONS 221 * E EHS. am~nt must be in lbs. STOOGE ~NTAINER ~ a ABOVEGROUND T~K ~e. P~STI~NONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS ~LE ~ q ~IL CAR 223 ~ ~pply) ~ b UNDERGROUND T~K ~ f CAN D j BAG ~ n P~STIC BO~LE ~ r OTHER ' ~ c TANK INSIDE BUILDING ~ g ~BOY ~ k BOX ~ o TOTE BIN D d STEEL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ a ~BIE~ ~ aa ABOVE AMBIE~ ~ ba BELOWAMBIE~ 224 STOOGE TEMPE~TURE a ~IE~ D ~ ABOVE ~BIE~ ~ ba BELOW AMBIENT ~ c CRYOGENIC 225 226 227 [] 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 F \ Form 2731(3/99) [RECE[V ED BAKERSFIELD REGIONAL REHAB HOSPI~-,I SiteID: 215-000-001021 Manager : ~~~ Bu.:Phone: (805) 323'5500 ~ : 102 CommHaz : Low Location: 5001 COMMERCE DR~----~_~~~"--'~-~ GriMa]d: City : BAKERSFIELD 34B FacUnits: 1 AOV : CommCode: BAKERSFIELD STATION 11 SIC Code:8361 EPA Numb: DunnBrad:18-369-2987 Emergency Contact / Title Emergency Contact / Title BRAN-DON NEAL / DIRECTOR OPERAT TOM MEAGHER / CEO Business Phone: (805) 323-5500x Business Phone: (805) 323-5500x 24-Hour Phone : (805) - x 24-Hour Phone : (805) - x Pager Phone : (805) 632-4893x Pager Phone : (805) 321-2392x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: (805) 323-5500x MailAddr: 5001 COMMERCE DR State: CA City : BAKERSFIELD Zip :' 93309 Owner HEALTHSOUTH CORP Phone: (805) 323-5500x Address : ONE HEALTHSOUTH PARKWAY State: AL City : BIRMINGHAM Zip : 35243 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... ISpocHazIEPA HazardsI Frm DailyMax lunitIMCP LIQUID OXYGEN F P IH G 1000 GAL Low /~/~/~77 ~2/ 4,t~.~ IH G 4056 FT3 Low OXYGEN ~, DO bs[sby 08~i.~ t ~,,,'~'~ G 244 FT3 Min DIESEL F IH DH L 1000 G~ Low: r~i~d ~b~ a~h~d h~ardous materials (N~ o~ B~) any ~rr~ions consfiluis a ~mpleis and corre~ man- ' -1- 02/18/1999 B~ERSFIELD REGION~ REHAB HOSP SiteID: 215-000-001021 Inventory Item 0001 Facility Unit: Fixed Containers on Site ~lVUVl~ ~Vl~ / ~ ~ ~Vl~ ~IQUID OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SW COMER 02 ROOM CAS# 7782-44-7 as Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION I ' Largest Container ~ I Daily Maximum I Daily Average I' 1000.00 Gu 750.00 HAZ~DOUS COMPONENTS 100.00 Oxygen, Compressed N 7782447 HAZARD ASSESSMENTS [TSecret RS BioHaz Radioactive/~ount EPA Hazards NFPA I USDOT# I MCP No No No No/ Curies F P IH / / / Low = Inventory Item 0002 Facility Unit: Fixed Containers on Site , ~lvUVl~ ~vl~ / ~~Z-.~-~ ~Vl~ XYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SW CORNER 02 ROOM CAS# 7782-44-7 F STATE -- TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient I Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION { Largest Container .I Daily Maximum Daily Average J~-~ X~ ~n~ 4o5~. oo FT~ 4o5~. oo FT~ HAZARDOUS COMPONENTS %Wt. CAS# 100.00 Oxygen, Compressed 7782447 HAZARD ASSESSMENTS ITsecretI ~S BioHazI Radioactive/Amount EPA Hazards NFPA I USDOT# I MCP No N No No/ Curies F P IH / / / Low 2 02/18/1999 BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME· ~ELILTM Days OnSite 365 Location within this Facility Unit Map: Grid: SW CORNER 02 ROOM CAS# 7440-59-7 F STATE '~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas /Pure Above AmbientIi Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average ,~ ~ ~ FT3 244.00 FT3 244.00 FT3 HAZARDOUS COMPONENTS wt. I ms# 100.00 Helium N 7440597 HAZARD ASSESSMENTS TSecret [No N~S I Bi°HazINo Radi°active/Amount I EPANo/ Curies F P HazardsIIH NFPA/// USDOT# MinMCP Inventory Item 0004 Facility Unit: Fixed Containers on Site DCOMMON NAME / CHEMICAL NAME IESEL Days On Site 365 LocatiOn within this Facility Unit Map: Grid: SW BY GENERATOR CAS# 68476-34-6 F STATE ~ TYPE Ambient PRESSURE ITEMPERATUREAmbient CONTAINER TYPE TANK Pure UNDER Liquid GROUND AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average /~ GAL 1000.00 GAL 800.00 GAL HAZARDOUS COMPONENTS I 100.00 Diesel Fuel No. 2 N 68476302 S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Low 3 02/18/1999 F BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 9 Fast Format 9 ---- Notif./Evacuation/Medical Overall Site ~ -- Agency Not,f/cation .......... 02/18/1999 ~ WHO AR~YOU GOING TO NOTIFY?????????????I -- Employee Notif./E_vacuation . _ /~ _ 02~8/1999 HOW ARE YOU GOING TO E~CUATE YOI/R EMPLOYEES?????????? /' Public Not/f :/Evacuation .~ j _ 02/18/1999 HOW ARE YOU GOING TO E~ACUATE THE PUBLIC??????????? ./ Eme~gency.Med~ical Plan ~4~ ' /~ 02/18/1999 ARE YOU GOING TO GO FO~ MEDICAL TREATMENT??????????? / 4 02/18/1999 BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 Fast Format = Mitigation/Prevent/Abatemt Overall Site --~Release Prevention . 02/18/1999 HOW DO YOU KEEP A RELEASE FROM HAPPENING??????????? ~ Release Containment ~/~ _ 02/18/1999 HOW DO YOU CONTAIN A SPILL THAT ~AS OCCURRED???????~??.? ,'Clean Up. ,. __ _ ~' ., __ { / 02/18/~999 q HOW ~O YOU CLE~ UP THE SPSLL AFTER IT IS O~R?????????~ .. ' / .I I /<t~ ~r. . ~ ~ ~ Ot~r Resource Activation 5 02/18/1999 :~'BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 Fast Format Site Emergency Factors Overall Site -- Special Hazards -- Utility Shut-Offs 10/21/1998 C) WATER - ~/k ~;~Z- ~r~f/~ /~ /~'~ ( f'~;'~ ~ --Fire Protec /Avail. Water 10/21/1998 Building OcCupancy Level / -6- 02/18/1999 ~'BAKER~FIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 Fast Format ~ ~'Training Overall Site : --\Employee Training 10/21/1998 How ~ EMPLOYEES DO YOU HAVE???????? /~ DO YOU HAVE MSDS SHEETS ON FILE???????? ~ GIVE A BRIEF SUMMARY OF YOUR TRAINING PROGRAM: Held for Future Use Held for Future Use , 7 02/18/1999 HealthSouth Bakersfield Rehabilitation Hospital (03-089) 5001 Commerce Drive Bakersfield Ca. 93309 Brandon Neal Regional, Plant Operations Director February 24, 1999 Mr. Ralph Huey Director, Office of Environmental Services Dear Mr. Huey, Enclosed you will find the completed Hazardous Materials Business Plan you sent our facility for completion. I completed the plan to the b~st of my ability, however if you desire any changes or wiSh to offer any suggestions it would, be greatly appreciated. Please contact me if any additional information or actual policies are required and I will be glad to provide them. SBirn~/~~~55~ HF- TH OUTH Bakersfield Rehabilitat~bn Hospital. * .Brandon Neal . Regional D/rector of Plant Operations 500-1 Commerce Drive · Bakersfield, CA 93309 - 805 633-3780-,~ 805 32325500~ E,~t.-4077_-_ _ Fax 805 633-5253 BAKERSFIELD REGIONAL REHAB Hos~EC-E~VEpl SiteID: 215-000-001021 Manager : ' i 1 5 9sa B{sPhone:' . (805) 323-5500 Location: 5001 COMMERCE DR '[BY: M~p : 102 CommHaz : Low City : BAKERSFIELD ~' ~id: 34B FacUnits: 1 AOV: Commcode:~ BAKERSFIELD STATION 11 SIC code:8361 EPA Numb: DunnBrad:18-369-2987 Emergency Contact / Title Emergency-'.~ont~ct / Title BRANDON NEAL / DIRECTOR~OPERAT -g~i~f~--M~fd / CEO ~ Business Phone: (805) 323-5500x Business Phone: (805) 323-55D0x 24-Hour Phone : (805) ~x~ 24-Hour Phone : (805) ~~3~x~-~ Pager Phone : (~)~2 -~x Pager Phone : (~pg) $~ / -~x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: ( '~) ~,~' .... · x MailAddr: 5001 COMMERCE DR State:.CA City : BAKERSFIELD Zip : 93309 Owner ' ' MS//~/~F~ ~/~° Phone: (805) 323-5500x Address : 3-607 ROgEMONT 5TII ~LQOR,~V~E /~ State: PA City : ~/~,~ .~¢ /~/~/~,~ ~, ~,A"~-/ Zip 17011 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... SpeoHazlEPA HazardsI Frm DailyMax IUnitlMcP LIQUID OXYGEN F P IH· G 1000 GAL Low OXYGEN ~/ ~.. F P IH G 4056 FT3 Low HELI~'~ Do hereby c~fy ~ha~ ~hW~ iH G 244. FT.3 Min DIESEL--~ ~ F IH DH L 1000 GAL Low ~'~,i~sd ~h~ aitached hazardous materials mana§®- msn~ plan for~//~~ ,.and tha~ R ak~n~ ~h - (Name of any corrections constitute a complete and corr~c~ a~srn~n~ plan for my facilRy. '::~ -1- o 10/1s/199s BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME LIQUID OXYGEN Days on Site 365 Location within this Facility Unit Map: Grid: SW CORNER 02 ROOM CAS# 7782-44-7 F STATE ~ TYPE PRESSURE i TEMPERATURE I CONTAINER TYPE Gas ~Pure Ii Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average GAL 1000.00 GAL I 750.00 GAL HAZARDOUS COMPONENTS %Wt. I ~S CAS# 100.00 Oxygen, Compressed N 7782447 HAZARD ASSESSMENTS TSocrotl RSIBioHaz Radioactive/Amount EPA Hazards I NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~- Inventory Item 0002 Facility Unit: Fixed Containers on Site 9 -- COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SW CORNER 02 ROOM CAS# 7782-44-7 STATE [ TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average FT3I 4056.00 FT3 4056.00 FT3 HAZARDOUS COMPONENTS 100.00 Oxygen, Compressed N 7782447 HAZARD ASSESSMENTS I TSecret. RS I BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -2- 10/15/1998 BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME HELIUM Days On Site 365 Location within this Facility Unit Map: Grid: SW CORNER 02 ROOM CAS# 7440-59-7 F STATE [ TYPE I pRESSI/RE I TEMPERATURE ICONTAINER TYPEPure · · Gas J~ove Ambient Ambient PORT PRESS CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 244.00 FT3 244.00 FT3 HAZARDOUS COMPONENTS %Wt. ~S[ CAS# 100.00 Helium N 7440597 HAZARD ASSESSMENTS TSecretI RS BioHazI Radioactive/Amount I EPA HazardsI NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME DIESEL Days On Site 365 Location within this Facility Unit Map: Grid: SW BY GENERATOR CAS# 68476-34 -6 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION l Largest Container Daily Maximum Daily Average GAL 1000.00 GAL 800.00 GAL HAZARDOUS COMPONENTS I 100.00 Diesel Fuel No. 2 N 68476302 HAZARD ASSESSMENTS TSecretI RSIBioHazI Radioactive/Amount EPA Hazards NFPA [ USDOT# I MCP No No No No/ Curies F IH DH / / / Low 3 10/15/1998 BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 Fast Format ~Notif./Evacuation/Medical Overall Site Agency NotificatiOn Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan -4- 10/15/1998 F BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 Fast Format ~ Mitigation/Prevent/Abatemt )verall~Site Release Prevention --Release' Containment -- Clean Up Other Resource Activation -5- · 10/15/1998 F BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 Fast Format F Site Emergency Factors Overall Site lSpecial Hazards --Utility Shut-Offs Fire Protec./Avail. Water Building Occupancy Level 6 10/~5/x998 BAKERSFIELD REGIONAL REHAB HOSP SiteID: 215-000-001021 Fast Format Overall Site F Training Employee Training Page 2 Held for Future Use Held for Future Use -7- 10/15/1998 BAKERSFIELD REGIONAL REHAB HOSP SiteID:~ 215-000-001021 ~ Fast Format Type+Category+Sub-Category+8 CharID Order One Unified List INSPECTIONS Reference Dates Summary Description B. PERRY 04/13/1994 OK ~ATTS 11/30/1995 OK ~ATTS 11/04/1996 OK Reference Dates Summary Description DICKENSH 02/17/1992 OK Reference Dates Summary Description 'DICKENSH 11/27/1990 OK DICKENSH 03/19/1991 OK DICKENSH 06/29/1993 OK BUSINESS PLAN PROGRAM COMBINED PROGRAM INSPECTION Reference Dates Summary Description WATTS 09/14/1998 OK UNDERGROUND STORAGE TANK PROGRAM COMBINED PROGRAM INSPECTION Reference Dates Summary Description 5101 COM 03/01/1996 UST & HZ-MT inspection. -8- 10/15/1998 F BAKERSFIELD REGIONAL REHAB HOSP SiteID 215-000-001021 ~ Fast Format Type+Category+Sub-Category+8 CharID Order One Unified List INSPECTIONS UNDERGROUND STORAGE TANK PROGRAM COMBINED PROGRAM INSPECTION Reference Dates Summary Description TURK 12/28/1993 UST Inspection. OK -9- 10/15/1998 ~ 'BakerSfield Fire Dept. '~rFICE~ OF ENVIRONMENTAL SER VICES · 1715 Chester Ave. - - ' . · ' ' i 'Bakersfield, CA 93301 · Business Identification No. 215-000/~/ (Top of Business Plan) Station No. ~ ~ ¢-- Shift . Inspector· Arrival Time: Departure Time: Inspection Time: · Adequa~te Inadequate Adequate Inadequate Address Visable ~. i-I Emergency Procedures Posted ~ r'l Correct Occupancy ~"'~/i [] Containers Propedy Labled 131~'' [] Verification of Inventory Materials I~1'.,-,/ [] Comments: : Verification of Quantities I~ [] Verification of Location [] Verification of Facility Diagram prOper Segregation of Material El Housekeeping Fire Protection ~ [] Comments: Electrical ~ [] Comments: Verification of MSDS Availablity E]''/' [] · UST Monitoring Program ~ [] Number of Employees~ .~ Comment's: · Verification of Haz Mat Training ~ [] Permits ~ [] Comments: Spill Controlx ~ [] Hold Open Device//~ I:~:l~~' [] Verification of ~ Hazardous Waste EPA No. Abbatement Supplies and Procedures [~' - []. ·. Proper Waste Disposal El'¢'''' [] Comments: Secondary Containment [3-'"" [] Secudty Special Hazards Associated with this Facility: _L)_<'7~ ;~e em, ae~,o--, o~*~,e,qS/t:~ . Violations: . ! ~ All ItemsO.K- ~ ~ Business Owner/Manager PRINT ·NAME SIGNATURE Correction Needed D ~ White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy " CITY of BAKERSFIELD "WE CARE" FiRE ©EPARTMENT 2101 H STREET D. S NEEDHAM BAKERSFELD 9330~ FIRE CHIEF 326-3911 Dear Business Owner: Enclosed please find a copy of your response to the Hazardous Material Management Plan (HMMP) request. We have found it necessary to reject your plan for the f611owing reason(s) as checked below. ~--~ Illegible Management Plan (please print or type information). Section(s) ~ )~~.~ 7 &of HMMP incomplete. Invent6ry I,I Missing or Incomplete. Diagram ~ Missing or Incomplete. This is to be corrected and resubmitted within 30 days to: City of Bakersfield, Fire Department Hazardous Materials Division 2130 G Street Bakersfield, CA 93301 If additional copies of any forms arc'needed they can be picked up from the Hazardous Materials Division at 2130 G Street in person. Sincerely yours, Ralph E. Huey Hazardous Materials Coordinator ~. ~ ~~ REH/ed Bakersfield Fire Dept. RECEIVED Hazardous Materials DiviSion 2130 "G" Street AUg ~, $19911:1 BakerSfield, CA. 93301 HAZ. MAT. DIV, HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. TO avoid further action, return this form within 30 days of receipt. ~u.~ L 2. TYPE/PRINT ANSWERS IN ENGUSH. 3. Answer the questiOns below for the business as a whole. \~)"~.- 4. Be brief and concise as possible. ,~,~ ~.~ SECTION 1" BUSINESS IDENTIFICATION DATA BUSINESS NAME' J~R~..-s',q~'~b ~"4~.,v~c J~¢~,B~'ra-rl~v LOCATION' .5"~m/ L~,~,,'~,,'~'' MAILING ADDRESS: _5"",~ / ~,~c'~ce'- J~,~, .~,,~,';,~,~.r',~'~r_/~.. /~. ,,¢..r.~y CITY: .~,,~'-d~ STATE: ~, ZIP: ?..g~,d? PHONE: (,¢(.,-j).~.z...~-.~ DUN & BRADSTREET NUMBER: /2-~ ~?..z~, .,~' SiC CODE: PRIMARY ACTIVITY: /q~t'~/g,¢~ OWNER: /~'~'~,g ~'~:~z-~y " MAILING ADDRESS: ..qT~ ,~'z-,~4: .-~/,~? ~ ~,,~/~ ~ ~; ~. /~// SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE · 24 HR. pHONE ,. FD1590 Bakersfield Fire Dept Hazardous Materials, Division · ""~' :' ..... HAZARDOUS MATERIALS MANAGEMENT PLAN " $ECTIoN 3: TRAINING: .- . NUMBER oF.EMPLOYESS' '. MAT'ERIAL SAFETY DATA S'HEEIS~ON F]I:.E: " BRIEF SUMMARY OFTRAINING PROGRAM: SECTION 4: EXEMPTION'REQUEST: '?' '~. I ~E'R~I~Y uNb'ER PENALTY O'F PERJURY THAT MY BUSINESS IS EXEI~IPT'F~O'M'THE REPORTING REQ'UIREMENTS .OF CHAPTER 6.95 oF THE "CALIFORNIA HEALTH & SAFETY (~)DE"'FOR THE FOLLOWING REASONS:: 'WE DO NOT HANDE'E'~AZA'RDO'US MATERIA'L'S: '" WE DO HANDLE HAZARDOUS MATERIALS/BUT'THE QUANTITIES AT NO .-,..~ ~. , TIMEEXCEED.THE, MINIMUM,REPORTING QUANTITIES. OTHER (SPECIFY REASON)'. SECTION 5: CERTIFICATION: I, CERTIFY THAT THE ABOVE INFOR- MATION. IS ACCURATE.- It. UNDERSTAND THAT .THIS INFORMATION WILL BE USED TO · 'FUEFILL. MY FIRM'S OBL'IGATIONS' UNDER~"" TH'E "CALIFORN'IA HEALTH A'ND'SAFETY" ""COL)E" oN,HAZARDoUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 .ET AL,),AND THAT IN~,CcuR~TE-INFORM/~TI~N"CONSTITUTES PERJURY. "~"~' ' '_~i siGNATuRE ' TITLE .' DATE , - FD1590 .Hazardous. Materials Division ~HAZARDOUS MATERIALS MANAGEMENT PLAN 7: MJTIGATION, PREVENTION '~'N:D ~B'ATEM[~NT' ~LAN: " A. ,.RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION:. · C. CLEAN-UP PROCEDURES: SECTION 8:' UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' SPECIAL: YES~ IF YES, LOCATION: LOCK BOX: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: -' A. .PRIVATE FIRE PROTECTION: -.. ... B. WATER AVAILABILITY (FIRE· HYDRANT)' . "4. , ' ,~ Bakersfield'Fire Dept. Hazardous Materials Division HAZARDOUS.MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:. A. AGENCY NOTIFICATION PROCEDURES: /~,-,~E- £~--~ ~',~ .5",e,~'~-"r' ,,~.,~ B. EMPLOYEE NOTIFICATION AND EVACUATION' C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: HMblP PLaN MAP SITE- DIAGRAM FACILITY DIAGRAM .1~'~ SAFETY PROGRAM NUMBER:- SAF3.1 HAZARDOUS MATERIALS MANAGEMENT PLAN 11 of 12 Do nOt store different wastes in the same container if there is a chance that they may react together to cause fire, leaks or other reactions. H. Hazardous Material Emergency 1.~ ·Every department that contains hazardous materials should evaluate and prepare for the potential emergency appropriate for the type, quantity, and severity of the hazards faced. Step 1: Whenever an imminent or actual ·emergency exists, the Risk Manager and/or Administrator on call will be notified. a. Notify all personnel in the area of hazard and begin evacuation. Step 2: The Risk Manager and/Or administrator on call will identify the substance and assess the impact to the environment and human health. Step 3: The Risk Manager and/or Administrator on call will notify the appropriate agencies of the hazard. a.~/ Kern County Health· ~Department: 861-3621. l/~al- ~ ~- ~! ~' b.,/ National Response Center: s~-D977 ,/~ 1-800-424-8802. da- 69~ ~ c Dept of Environmental Services: i-~-~z- F~'~'O '~· 426-5468. Cali, fornia Department of Health d.,~/ services: (805) 258-6942 e.~ Hazardous Waste Hotline (800-258-6942). The notification will include: 1, Name and telephone number of reporter. 2. Name and address of facility. 3. Time and type of incident. 4.Name and quantity of material involved and to extent known. 5.The extent of injuries. 6. The possible hazards to human health and environment. Step 4: In case there is a fire or explosion: a. Put fire plan into operation. b. Determine proper personnel protection. c. Fight fire until relieved by the Fire Department. Step 5: In case of spill: SAFETY PROGRAM NUMBER: SAF3.1 HAZARDOUS MATERIALS MANAGEMENT PLAN 12 of 12 Step 5: In case of spill: a. Evacuate the area. b. Determine proper personnel protection. c. COntain spill with absorbent material. SAFETY PROGRAM NUMBER: SAF3.1 HAZARDOUS MATERIALS MANAGEMENT PLAN 7 of 12 An inventory of hazardous chemicals used in each department will be posted within the department. A notebook with the MSDS will be communicated and maintained for the employee's use at all times. 4o Department Directors shall provide their employees with information and training on hazardous chemicals in their work area at the time of their initial assignment and whenever a new hazard is introduced into their work areas. Specifically, employees shall be informed of: a. Any operations in their work area where hazardous chemicals are present. b. The location and availability of the written Hazard Waste Management Program, including theMaterial Safety Data Sheets. c. Methods and observations that may be used to detect the presence or release of a hazardous chemical in the work area, i.e., monitoring devices, visual appearance, odor, etc.. d. The physical'and health hazards of the chemicals in the work area. e. The measures employees can ~ake ~o protect themselves from these hazards, including specific procedures the employee has implemented to protect employees from exposure to hazardous chemicals, such as appropriate' work practices, emergency procedures, and personal protective equipment to be used. 5. Department Directors must assure that'all chemicals in the work place are properly labeled and that the information on the labels match the information on the Master Safety Data Sheets. E. Monitoring and Inventory 1. All hazardous chemicals and wastes need to be monitored while they are here in the Hospital. This monitoring should start when the material is received at the loading dock and should proceed 'through its safe removal and tracking of.certain wastes via waste manifests after it leaves the Hospital. Whilethe Director of Risk Management has responsibilities to insure that the tracking of these materials occur, the bulk of the actual · responsibility must be delegated to the individual departments in'which the materials exist. These departmental personnel are the only ones who can monitor the status of these materials on a real time basis. ~rvet[la~e R~ for Haza~ #ater~ais 1, %nv~tory of hazardous o~terials ~sted, 2, M~$ available for each hazards ~. Staff aware of MSDS. 5. Staff aware of Location of #SDS. 6. Cytotoxic ~aste properly stored. 7. Cytotoxic.~aste properly Labeled. 8. Documentation present of annual inserve attendance regarding Hazardous Nateria:s of ail employees. 9. Dot,narration present annual rev~e~ and update of by Department Director of NSDS. 10. Evidence through observation that emp:oyees are handling hazardous meter~a~ according to poLicy and proceclures (using appropriate equipment i.e. gtoves, etc.) 11. Hazardous material stored according to policy and procedure. 1~. A cradle to grove tracking system iS evident. ~ames of those surveyed Area Survey Conducted In Date and time of Survey CITY of BAKERSFIELD MATERIALS INVENTORY NON--TRADE SECRETS' ~a~e *1 2 2 4 5 6 1 8 9 10 11 12 ~y Ha,es of Hixture/Copponents rqns [yfle Max AvDr~ge Annual ~easure I ~e ~onL Cone Con[ Us LocaLion.Uhece. Stored Iff kacl/iCy ...... ~oe ~ooe Ant Ami Est Units on /ype Press Tamp Co~e See lflstru:tlens _ . . Component 12 Name I C.A.S. Number ~ Fire Hazard ~Reactiviky a Delayed ~ Sudden Release ~ Immpai~Le ~~ ~ _ ' /-F Component 13 Hame I C,A.S. Number · hvsical mod Health Uel~rd C,A,S, Number ~-~ ~'~ ¢~ . Component I1 Name & C,A.S, Number ~' (Check that 8PP/H Component I~ Name I C.A.S. ~umber ~ Fire Hazard ~ ~eactivtty ~ Delayed D Sudden Release U Heal[h of Pressure Component 13 Name & C,A,S, Humber hvsicai And Health Palard C.A.S. Number Component Il Name I C.A.S. Number ICheck 41l that apP/yl Component 12 Name I C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Oelayed a Sudden Release ~ Immediate Health of Pressure Health · ~ ~ -- Component 13 Name ~ C.A.S. Number 'hysicll ood Health Uallrd C.l.S. Number Component I! Name i C.A.S. Number (Check ali Thai Ipp/yt C°mponenL 12 Hame & C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release a Heal&h of Pressure Component 13 Name & C.A.S. Number ,rtifi atio Re and f n al' c CO~ I Cf g all secCfons) ~,rp~,.un~er penal~, o~w thqt l~,v~ pe(son;~.examlnq~eq~ Q, ~mii,ar.,iL~ Lhe informatlpn ,u~miLtpd in this.,~d all .~acneo.oqc~ment~, an~ t~a& oaseo on.my Inquiry 9r.~nose Lnolv~oua~s responsible rot obLa~nin9 Lhe information, i believe that Lhe :~e e~ oficisi ~i~e of" e~nertooera~or u~ o~fler;o~erator s 8ut~or~zea reoresefltatJve s~qflatur~ -'" ........ CITY of BAKERSFIELD Farm andAgticulture i-!. Standard Business /~HAZARDOUS MATERIALS INVENTORY NON--TRADE SECRETS P,ge _.__1~.. ..... of~_. r~ns [yom Nax Avtr~ge Annual Heasure ' i ~y~' ConL Cont Cont Us LocaLjon.~he[e. t~y Ha~es of ~ixturelCo~onents 3ne ~ooe A,~ Am~ Est Units on 5~Le Type Press Temp Co3eStored iff ~aClll~y See.lnstru;k~ens. ~viic81 and Henlth Hazard C.A.L Number Component tl Name A C.A.S. Number Component 13 Na~e ~ C,A,S, Number hYSical Iod Pealth Ulzard C.A.5. Number Component II Name & C.A.S. Number ~Fire Hazard ~e8ctivity D Delayed ~ Sudden Release D ]m~i~Component 12 Name & C.A.S. ~umber Health of Pressure P~ Component 13 Na~e'I C.A.S. Number hvsical and Health PeTard C.A.S. Number Component I1 Name.&'C,A.S. Humber Component 12 Name & C.A.S. Number ~Fire Hazard D Reactivit~ D Delayed D SuddeA Release ~ Immediate ~kvsic8! Aod Health UaTsrd C,A.S. Number Component 11 Nsme I C.A,S. Number' ~Fire Hazard ~Reactivity ~ Delayed ~ Sudden Release ~ la~i~ Co~ponent 12 Ha~e ~ C.A.S. Humber Health of Pressure .C~ponent 13 Nsme ~ C.A.S Humber ~.zE ~rtifiptioq . ,(Re~ ~.~fgn after compT~f~g.aT? sec:fpn~) ,cerHty uaoer pena~t~ or~a~ tnqtlnavepe[sonH~Lexaainffoaqo~e taai~ar.~it~ the intoraatt~n ~u~eitt¢~ in this and all ;~acned.docgeent~, ae~ t~at oaseo on.ay tnqutry ~.[nose tn~tv~ua~s responsio~e tot obCatning the tntoraauon, [ believe Chat the JDeltte~ information ts crum, accura[e, ann complete. ~'~e e~ oficlli [itie et eunerlooerator uN oufler!operator:s-autflor~zeo reoresencauve . ' 5iqnature · '"-:'"' .... CITY of BAKERSFIELD MATERIALS INVENTORY, Farm and Agriculture ri Standard Business I~''HAZARDOUS NON--T RAD. E SECRETS ..~ .......... ,,,- ..... ~,~ ...... rqfls. [yom Hex Avtr~ge Annual geasure I ~y~ ~onL Coot Coat Us Location?ece. flaees of Hixture/Co~ponenTs 3ae coae kaC ~ac Es~ Units on,5~ce ~ype Press Temp Co~e lnstru:t~ons See .... $Lored In Facility hYsical and Health Uazard C.A.S. Humber Component Il Hame & C.A.S. Humber Component 12 Hame & C.~.S. ~umber ~.~ ,eaiLh of Pressure Component 13 Hame s C.A.S. Number hYsical Bad Health ~zard C.A.a. Humber Component I! Name & C.A.S, Humber Component S2 Name & C.A.S. Humber ~Fire Hazard ~ Reactivity .~ DelayedHea/Th ~ Suddenof PressureRelease ~lmmpdi~tefleal~h ~o~/A - ~~/-7 Component 13 Name & C.A.S. Number ,hYSical iod Health Uallrd C.A.S. Humber Component II Hame I C.A.S.-Number ~ Fire Hazard ~ Reactivity ~' OelayedHeai~h ~ Suddenof PressureHelease ~ [ m~i~ C°mP°nentN~~12 Hame_& C.A.S.~/~Humber_ ~-~ C~oneot 13 Hame I C.A.S. Humber . EHERGEHCY CONTACTS ¢1fl i~le ~fi~ Hame z4 ,rtifjcation (Read and sign af~pr compl~Cfpg.all secC'i~n~) ~erpfy under penaEv of]a~ th{t I havepe(sonal~Y, eXamlnq~eqo~a raai~ta[.~it~ the intoraat~pn ~u~aittid in this ~nd :~a~ned.dec~aent~, an~ tbac oasea on.ay ~nqu~ry 9r.cnose tno~vtaua!s responsible rot obLatning one ~ntoraac~on. I believe ~hat the J~alLLea i~oraatlo~ IS true, accurate, aha complete, . · - * .......... ' CITY of BAKERSFIELD I~HAZARDOUS HAT ERTALS INVENTORY farea~dAgticuiture ri Standard Business NON--TRADE SECRETS 'CATION;?oo~ ~_~c~- ~. ' ' ADDRESS:~Z ~c~,~ STANDARD !ND. CLASS CODE~ '-~ TY, ZIP. ~ ~ff ~ITY. ZIP: ~_m~,~ /~// DUN AND BRADSTREET NUHBER 'REFER TO~R~S~~ CODES - ', , , , , , I 8 , 10 11 ,2 ,j~, ,ares of ,ixture/Co,ponents qns ~yRe Nax Avfr~ge Annual ~easure I ~ya Cent Cent Cent ~s Locqtjon.~he[e. eom come Ret AmC Est Un~ts on 5~[e Type Press Temp Co~e See ]flstru:tlens . Stereo In kacIIIty vsical and Health Pallrd C.A.S. Humber Component Ii Hame A C.A.S. Number Check all ~hlt 8PP/H ~p~C~CO~LC ~ - ~7-~/-d Component & C.A.S'. Number ~ Fire Hazard ~e~ctivit~ ~qelayed ~ Sudden Release 'Health of Pressure Component 13 Ham8 A C.A.S. Number hvsical ind Health ~az~rd C.A.S. Humber Componeat II Name I C.A.S. Number tCheck all Chat APP]H ~ ~ ~,~~a~a/~_ ~_~_~ / .. .... Component I~ Name & C.A.S. Nu~er ~ Fire Hazard ~eactivity D Belayed ~ Sudden Release e ~m~- ~,~ ~,~(~~?~/~_~_~ Health of Pressure COmponent ~3 Name & C.A.S. ~umoer 'hysical 80d Health UaTard C.A.S. Number Component l] Name S C.A.S. Number lCheck all that aPP/H ~ ~ - YY~:- ~-7 ~re Hazard U Reactivit~ n 0eta,ed ~udd~Release O [m~i~ Component 12 Name ~ C.A.S. Number __ Heai[~ or ~ressure Component 13 Ha~e I C.A.S. Nu~ber ~hYsicll led Health Ualard C.A.S. Number ' Component I1 Name i C.A.S. Number (Check 8/1 that aPP/H : ~m ~w~- ¢~/-~¢-/ CqmponenL 12 Na~e ~ C.A.S. Number ~ Fire Hazard ~ReactJvity ~ Delayed ~ Sudden ~elease ~ Immediate ~c~o~~ ~/~-~- ~ Health of Pressure Health Component 12 Name I C.A.S. Number ' EHERGENCY' CONTACTS ~1 ~ ~~ '~/~, .~r ~/r. 32~-~ fl2 ~/~ ~rti[i~atioq .(Re~ a.n~.~fgn aF~pr co~pl~Cf~g.e11 secCfpn~) .cerH~ unoar ~ena~[~ ol~al tn~t ~ aave ~e[sOnal~L exaain~o ~ ~aai~tsC ~it~ the i~lor~stton ~u~aitt~ i~ this.lnd all ,~¢ned,d~c~.ant~ ln~ t~a[ ~ase~ oa..y ~qu~ry ~,[nosa ~notv~ua~s responsible ~or obtatnin9 the InformatiOn. [beltaVe tha~ the iI,lttee IAtOrmatlOfl Il true, accurate, lflO cOmplete. ~ee e~Q oTIc181 title 0t euneriooerator uR o~ner!ooerato s aut~ortzea representative CITY of BAKERSFIELD .~r. and Mticulture [] Standard Business ~j, HAZARDOUS HATERTALS T NVENTORY NON--TRADE SECRETS Page __,~____ of ~]J[N~.S. NAME': ~-~,,,~ /~e-~, n°~4~'. ,//~/%-#z, O.~_N~R__NsAME: ,~/+~ _C~s~-~-7~,~- NAME OF THIS FACILITY: [;~11~1~.5'0o/ ~,o~,,w~¢~ ~4, ~V~b~_[_ _~A~ ~~ * STANDARD IND. CLASS CODE~-- ~.[X. 4tV:~. ~, ¢~oy ~.[X~ (IF: C~P t~;~[, ~m. /7~[~ DUN AND BRADSTREE7 NUMBER .......... tUNb ~:K~) ~3;5~ ~HU~ ~: '~)~ ?47- ~4~ CODES Z ~ - ~ ~ ~ ' , '' ' '.REFER TO~~~~R~ ~easure I ~D Con[ Con[ Conk Us [ocation.~he[e. :one coco Jmt Amc EsL Units on 51[e ~ype Press ..... Temp Co~e Stored la kactlt[y__ See lfi~tru;Ltons 'hvsical and Health ~lard C.A.S. Humber ~7~ - ~ - ~ Co~ponen[ 8l Name I C.A.S. Number ICheck ali that ~pp/y) Oz~ - 77 ~- ¢~- 7 Hazard n Reactivity n Delayed ~Sudden Release fl ]m,~dimcomp°nenk 12 Name C.A.S. Number ~ire Health of PressureHealth .. Component 13 Name & C.A.S. Number 'hv~ical and Health ~azard C.A.S. NuAber ~ Component II N~me A C.A,~. Number (Check all that AppIH W~/~,~ f ' ?f~o-5~- 7 . . .. ~ Component 12 Name & C.A,a. Number Hem/[h ' ' ComponenC I~ Name I C.A.S. Number )hvsical and PealLh Uazard C.A.5. Number ~~ Componen~ I! Name & C.A.L Humber. (Check ali that ~pp/y) ' ~te~re~ ~- ComponenL 12 Name & C,A.S, Number ~Fire Hazard n Reactivity ~Oglayed n Sudden Release a I'~i~ uealth of Pressure Component 83 Hame & C.A.S. Number )hvsicll amd ~e~ith Dazerd C.A.S. Humber Component tl Hame & C.A,S. Humber (Check all that apply) ; ~5~ - ~oo~-~-~ ,, ComponenL i2 flame & C.A.S. Humber · ~Fire Hazard ~ Reactivity ~ Delayed ~Sudd~n Release ~ Immediate ~F~/~ ~/~ - 2Old- Health of Pressure Health Component 13 Hame & C.LS. Number arti~i;atioa ,(Re~d an~.~fgn af~m complo~i~g,a~I sectipn~) serp~y.ufloer penalty or]a~ thqc l flave petsonalq, exsmln~oQqoQa Tamilla[~it~ the ifllormaHpn ~u~mittfd in this ~fld all CDGAeO.OQCVBeflT~ ARQ &pC based On.my inquiry 9r.cnose Individuals responsible rot obtaining The InformaTion. ] believe LhaL the ~Daltteo information Is True, 8ccurlce, Ino comp/eom. ~,e e~ bficial tttle et ev,er/ooerator u, o~ner/operator s autnorize~ representative s~qaature '~' ..... CITY of BAKERSFTELD Farm and A~ticultore I1 Standard Business I~i''HAZARDOUS. MAT ERIALS NVENTORY NON--TRADE SECRETS Page _~.... ..... of SINESS NAME: ~/~ ~e~, ~. /~P. OWNER NAME: ~ ~~ NAME OF THIS FACILITY: ~,~.~.(~ '~TIQ~; ~o~ ~~ ' A~P~ES~;_ ~o7 ~=~ STANDARD IND. CLASS CODE~"- ~/ /Y. ZtF: ~ ~ CIIY. ZiP: C~ H,~, ~, /~// . DUN AND BRADSTREE~ NUMBER .................................... ONE a: ~_ ~mm ~ PHONE ~: ?/~ - ?~/. ~o CODES ~ ~ - ~ ~ ~ - ~ ~ ~ Z · - -RE~ER TO~~NS Fu~ HHUP~ · rqns ]YOm Nax Avfr)ge Annual Measure I ~y) Cont Cont ConL Us Location.Whe[e. ' )De. code Amt Amc Est Un,ts on 5~te lype Press Temp CODe Wt See ]flstru:tlons Stored In kacIil:y , I ~ I~ ~ I~,~~ I ~ ~ I~ I ,~s I, ~/ !,/ I k, I or I~~-~,,,~ ~,, ~,~ ~, wsicml and Health Hmlard C.A.S. Number ~,~ Component II Hame ~ C.A.S. Humber ~ ~ ~c~,~,- - [Check Al/ that Apply) ~o ~yP~ - /~-~-~ __~~' _/ , . Compoflen[ 12 Name ~ C.A.S. Number Health of Pressure - ' mponent 13 NaA8 I C.A.S. Number h~sicsi a~d ~eatth ~a~ard C.A.S. ~uaber ~,~ Coauonen[ St ~aae g C.LS. ~uaber (Check ali that aPP/H p~~ b,~,~ ~?~/-~-y Coepone~ Name & C.A.S. Kumber ~ Fire Hazard ~ ReaCtivity ~ Oelmyed ~Sudd)~Release ~ Immediate Hem/th or Pressure Health · . Component 13 Name A C.A.S. Number ~ bye[cai and Health ~a~ard C.A.S. Number ~,~ Componen[ II Name & C,k.S, Number [Check ~ii that App/H .... ~ta~ W~/~¢ - /~/~-~-~ . '.. Component 12. -Name & C.A.S. Number n Fire Hazard ~Reactivit~ ~ DelayedUealCh O Suddenof PressureRelease O tm~%~i~ __ . Component ~3 Ha~e & C,A,S, Humber ~ !~ I s~ !. w I~.' !~ I,.52 l lc I , I ~ Ix? I~ -,~~ ~o~ z~¢ ~hysicll Iod Health UaTmrd C.A.S. Humber ~/x Component II Name & C.A.S. Nueber .~ ~er~?~y (Check ail that apply) ~te ~e,~ - //~- ~/ ~/?~?- Component 12 Name & C.A.S. Number D Fire Hazard ~Reactivit~ D Delayed D Sudden Release ~ Im~i~ ~'c J~a /~-~-? Hem/th of Pressure ' ' Component 13 Name i C.A.S. Number .JUc~/~,d ~/~ - //~-/5-~ Z J. ,rti[i~atioq .(Re~ an~.~Tgn after compl~og.all sec~p~.~ . ,cerH~Y unoer ~ena~t% o%~a~ t~q[ t navepe[sonH~Lexamln~aqo~m tami~ar.~it~ the ~nlormatt~n ~u~mittf~ in this and all .~agned.dgcgmen[~, an~ t~at oasea on.my tnqutry F.tnose tnatvtoua~s responsiD~e ~or obLatning [he tnrormaEton. [ believe that the Onltteo information IS True, accurate, Ina complete. ' · . _b,~,. ~_~ ~,~..~ /~ ~~ ~-/- .... '" C,ITY of BAKERSFIELD ~ar, and Agriculture n Standard Business [~-I'AZARDOUS MATERTALS 'r NVENTORY NON--TRADE SECRETS ATION: ~oo/ ~~e~ ~, ADDRESS: J&~? ~~ STANDARD INp. TY. ZIP: ~v F3~O ? CITY. ZIP: ~ ~ ~, /~// DUN AND BRADSTREE1 NUMBER ...... ~ ...... ' ....................... PHONE ~: ~ -' ' ~ · Z '12 , 4 5 6 I 8 9 10 11 12 ,;{y Names of ,,xture/Coe0onents r~ns [y~e ~ax Average Annual ,easure ~ ~e ~ont Con: Cont Us tocation Stored ~n FacHIty : __ ode CODe Amt Amt Est Units off ~ype Press Temp Co~e lflstru:tlofls hvsical and Health Hazard C,A,a, Number Component Il Name t C,A,S, Humber ~ Fire Hazard ~Reactivity ~ Delayed ~ Sudden Release · ~ Immediate Component 12 Name I C,A,S, Number Health of Pressure Health. ' ' ' Component 13 Na;8 ~ C.A.S, Number b~sicai lnd ~ealth ~a~ard C.A.S. Nueber · Component ~1 Naee a C.A.S. Number Coe~onent ~ Naee ~ C.A.S. ~ueber ~ ~ire ~azard ~aeactivtty ~ Oehyed ~ Sudden aelease ~ l~i~ ,, ~ealth of Pressure Co~onent ~3 Naee ~ C.A.S. Number 'hvsical and Health PaZard C.A.a. Number Component I! Name A C.A.a. Humber (Check ali that App/H · ~r~ ~c~ ~ ~¢-/?-~ Component 12 Name I C,A,a, Number ~Fire Hazard D Reactivity ~ OelayedHealth D Suddenof PressureRelease ~]mm~diALeuealth ~xV ~c- ///-?~-~ Component 13 Name I C,A.S, Number . ]hysic~l Iod Health ~a~ard C.A,S. Number Component II NaAe I C.A,S. Humber (Check all that app/yl ~ ~ H~P~¢~- ~1-~_ y ~ ... Component 12 Name & C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Belayed ~ Sudden Release ~ l"~i~ .... Health of Pressure Component 13 Name I C.A.S. Number EMERGENCY CONTACTS ~1 ~ ~~ ~(~e~,~ ~/~ ~Y-~ fl2 ~/~/~Y: ~rtifi atio Re and f naf r corn 7 Cf 9 aT? sectfons). .certify under penal~, o~p thqt ]~av~pe~son;~.examln,~aq~ ~, ~,iila~.~it~ the tnform,tlOn Submitted in this and all . ;~acned.dqc~meflc~l anl t~at oaseo on.my inquiry ~.tnose lnelvleua~s responslo/e rot obLalnin9 the inTormaclOn. ] believe Chat the iomltteg iflforlltlOO is ~roe~ accurate, and complete. ,m. e~ oficJal ~ttle of o~ner/ooerl~or'uH oMnerfo0erator's-autnorlzee reoresen:atlve SignatUre CITY of BAKERSFIELD HAZARDOUS MATERIALS INVENTORY I~ara and Apl;[culture I1 Standard Bu$ioe$~ [~' NON--TRADE SEORETS 'SINESS NAME:~A~,~ ~e-~ ~ ~ 'OWNER NAME: ~_ ~r~ . NAME OF THIS FACILITY: i' , , 4 5 , 1.8 , l0 Il 12 ,'~y ,aBes of ,ixture/Coeponent, ' rims !yam ~ax 'Avgr~ge Annual xeasure I ~y~ Cont Cont Cont. ~3e tocqtion.~hece. aaa cone Aa: amc Est Un,ts on ~ce Type Press leap Storea !n eaclt~tyYt See 1.9stru:t~ons ~vsical and Health Hazard C.A.S. Number Component II Hame S C.A.S. Humber [Check all that apply) ~ire Hazard ~ Reactivity~ ~ Delayed ~5udden Release ~ Im~i~ Component 12 Name ~ C.A.S. au,bmr aea/t~ of Pressure ~-T~ ~ ~/c ~ ~Z- ~6 -~ Component a3 Name I C.A.S. Number ysical and Health ffazard C.A.5. Number Component I1 Name & C.A.S. Number ~,z. ~.~ Check al/ that apPlII ~~r~~- ~-~-~ ~Fire Hazard ~ Reactivity ~played ~ Sudden Release ~ ]m~i~C°ep°nent Name ~aber ,ealth of Pressure X~:~ - /3~ - ~ - 7 ~.~' ~, ~ Component 13 Name I C.A.S. Number . Nvsical and Health Lazard C.A.S. Number . Component II Name & C.A.S. Number (Check all that app/~l /~~ ~d~- ~ ~ ..... ~ire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate Component 12 Name & C.A.S. Number ~ Health of Pressure Health Component 13 Name & C.A.S. Number 'hysical Dod Health ~aiard C.k.S. Number Component I1 Name S C.A.S. Number (Check ali that app/yl : ~~o~/~ ~e/a ~7-~/-~ 7,5 O Fire Hazard ~ReactivJty ~O~iayed ~ Sudden Release ~I~%~i~C°mp°nent 12 Name C.A.S. Number uealtn of Pressure Component 13 Name I C.A.S. Number · Na~e i i c l e ,rtification (Read and sign after compl~tipg.all secti,on~) ~er[~(y.uader penaE~ o~]a~ thqt ] have pe(sonal~LeXamln~Oaqo ~a ~ami~ia[ ~itb the in[ormation ~u~aitt~ in this ~nd ,~ac~o.oecgeenta, ami t~a~ cased on.ay Inquiry ~r.tnose ~n~v~oua~s respons~D~e tot obLa~ning :he intormauon. [ believe that the ~Daltceo iatormauon IS crum. accurate, and complete. CITY of .BAKERSFIELD Farm and Agriculture ri. Standard Business I~'HAZARDOUS NATERTALS INVENTORY NON--TRADE SECRETS Page I 2 3 4 S 8 ' 8 ' 10 11 12 ,l~y ,a,e, of ,ixture/Co,oonents rqns [y~e Hax Avfr~e Annual ~easure I ~a Cont Cont Cont Us Locqtion.~hece. ccc coca Act Aa[ Est Units on ~lte lype Press Te~p Co~e Storeo In facility~t See Instru:ttons hysicsl mod Health Hazard C.~;S, Number Component tl Name I C.A.S. Humber D Fire Hazard ~Reactivity D Delayed D Sudden Release D tm~l~5~/~ ~w ~/~ ~~- /~, Health o.f Pressure Component 13 Name ~ C,A,S, ~' ~sic~! ~od Health ~azard C,A,S, Number z~ ~ /~zo, /~o Component II Na~e & C.A.S, Number Component ~2 Hame & C.A;S, H~¢ ~ Fire Hazard ~e~ctivity ~ Delayed ~ Sudden Release ~ laaediaLe HealLh · of Pressure HeaiLh ... Component 13 Na~e I C,l,S, Number hySical ~nd Health Ua~ard C.A.S, Number Co~ponenL ~1 Name & C.A.S, Number Component 12 Name t C,A,S, Number e Fire Hazsrd ~esctivit~ D Oehyed D Sudden Release ~ Immediate~,~ e~~ ~?-/~-~ Hem(th of Pressure Health Component t3 Name ~ C.LS,,Number ~hvsical Iod Health UsTard C,A.S. Number Component II Name I C.A,S, Number D Fire H4zard ~ Reactivit~ D Delayed D Suddgn Release D [m~i~ Component 82 Name I C.A.S. Number Cqmponent 13 Name I C.A.S. Number ~rLfflatto Re and T n a~ ~ corn 7 C g ~ C ) :~acned.d~c~menth 8hQ t~a[ based on.my tnquiry 9t.cnose individuals responsto/e Tor obLainin9 the lflTormacton. [ belleve that the Jemltteo 1A~OrmAtlOfl IS ~rue~ AccurAte, AnD complete. - ~e e,~ o'ftci8i titie of eunerrooera[or u~ o~fler!ooerator's authorized r'eoresentative signature CITY of BAKERSFIELD · HAZARDO"US MATERIALS INVENTORY Fare and Ag[iculture ~ Standard Business [] ...'"T~T-R-A'D E -- S'~ c R E'-T S; BUSINESS NAME: /~//~/~ OWNER NAHE~\ " ' NAME OF THIS FACILITY: · ADDRESS: ', STANDARD IND. CLASS CODE; .................................. LOCATION;/,~/_Sr/ o,Ty_ ?]p: DUN AND BRADSTREE! NUMBER .......... CITY. ZIP~ ~.O.E .: - ~F~a__~_ -~~O--Z~S~RUC,~ZO~S--FO~C-~RO~ COa~S --- - !yfle Hex' Average Annual Heasure I¢ Cent ~ont Coot Us [oc~tion.¥he[e. code LODe Am~ Am[ ESL Units on e lype ~ress lem~co3eStored in ~aClll[¥ See ]nstructtons (Checkal/thatapply) Component 12 Name I C.A.S. Number ~ Fire Hazard ~Reactivity ~ Delayed ~ Sudden Release ~ Health of Pressure Component 13 Name I C.A.S. Number ,Physical led Health Ualard C.A.S. Number Component II Name t C.A.8. Number ~Check al/ that app/yl Component 12 Name I C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Health of Pressure Component 13 Name I C.A.S. Number Physical and Health bayard C.A.S. Humber Component II Name I C,A.S. Number ~Check a/I that app/yl Component 12 Name I C,A.5. Number ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Immediate Health of Pressure Health Component 13 Name I C.A.S. Humber Physical pod Health 6alard C.A.S, Number Component II Name I C,A,S. Number [Check al/ that apply) ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ ]m~i~C°mp°nent Name C.A.S. Number Health of Pressure Component 13 Name I C,A.S. Number ..... ~rti[i;,tioq .(Re~ o.n~.~i¢n af~e compI~Ciog.a7I secCipn~) certuy un,er ~en,~t~ o~ tn~t ~nave pe~5on~q, exa~ln~qo ~ n~i~ar, vit~ the i,lor~auon Su~itte~ in ~ ~t'~a~hed.d~c~ent}, an~ tm ~5~ o,.q ~nqu~ry ~.tnose ~no~v~oua~s responsible lot obmning the ~morut~on. ~eve that' the sUO~ltte~ i~lor~atloo 15 true, accurate, eno CO~p/ete.