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HomeMy WebLinkAboutBUSINESS PLAN~ALIFORNIA WATER SER CO 180 Si : - -002373 ~Manager :~ BusPhone: (661) 396-2400 Location: 4407 COUNTRYWOOD LN Map : 123 CommHaz : City : BAKERSFIELD- .~ %%~ Grid: 23C FacUnits: i'AOV: CommCode: BAKERSFIELD STATION 13 SIC Code:4941 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title ~ . ,, ----~TRE!~ / ~$S'i'~DISR~FK3R-- Business Phone: (661) 396-2400x Business Phone: (661) 396-2400x 24-Hour Phone : (661) 396-2400x 24-Hour Phone : (661) 396-2400x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: React ImmHlth Contact : M~q-~RD Phone: (661) 396-2400x MailAddr: 3725.S H ST State: CA City : BAKERSFIELD Zip : 93304 Owner CALIFORNIA WATER SERVICE COMPANY Phone: (661) 396-2400x Address : 3725 S H ST State: CA City : BAKERSFIELD Zip : 93304 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd:ParcelNo ~ ....... : ~Dis~i~ M~ag~-Tim ~elo~ . Emergency Directives: ] ~S n'~;~b~~s~n Ii (~ or pint nme) ...... " reviewed the aEached haza~ous mmerials manage- ment plan fo~,~ p. CO~Tc~ and t~ it along with (~ of Bu~ ~ ' any corrosions con~itute a complete and corre~ man-' agement plan ~r my facility. ~ionalu(~ tl:)ate , 1 10/10/2003 ~_~~;,__~ 1715 Chester. Ave., Bake~ael~ CA (661> 326-3979 ~AZ~OUS.' ~TE~S. ~AGE~NT'PL~ · .: . ~. T0 av°id ~er actio~ re~ ~'s'fo~ wi~ 30 ~ys of receipt. 3 ~ ~swer ~e. quesfi0m, be~ow for ~e bm~s ~ a whole. ~ ~ 0 I 4. · Be ~. b~ef'~d'concise ~ possible. : :.. 5. Y°u may ~0 ~ch Bm~s Omer / ~emtor F~ ~d Ch~c~Des~p~n Fo~(s)-'. to ~e.front offs pl~ ~ste~ of eomPle~g SE~O~I. below f6~ ~fi~ mbmissi~ ... sEC~oN I~ BUS.SS ~~ICA~ON DATA ( LOCX~O~: . - E~RGENCY NOT~ICA~ON CO.ACT T~E BUS. P.HO~ 24 ' "~. CTI©N [I. I: DISCOVERY AND NOTIFICATIONS .. ' A.. LEAK DE~CTIoN AND. MONYI'© ,R~4G PtEOCEDUR.ES: 2 " HAZARDOUS. ~L4.TERIALS B~IA~AGEMENT. PLAN SECTION [I.2: RELEASE RESPONSE P'~ A.' '~~ ASSESS~ ~ P~~ON ~AS~S:.~ ~ B. RELEASE CONTA]2qME1VT AND/OR'MITIGATION: C. :.'CT.~A.N-LrP A_ND RECOVERY' PROCEDURES: . ..- UTILITY' SHUT-OFFS-(LOCATION OF SHUT-OFFS AT YOUR. FACILITY) OAS P OpAm: ELECTRICAL: "' WATER:' 7'~/f /d ,4 i,",qF~,~ I~LZ." SPECIAL: "" ' LOCK, BOX: YES~ IF YES, LO ,C.A~..ON: PR_rVATE FIRE PROTECTION/WATER AVArr.ABrUTY .... A. PRIVATE FIRE PROTECTION: B. WATER AVAU~ABFt.[TY (FII~ HYDRANT): /4/'~'ZZ Z)I../z~/-/A~;~' .3 · -' 54AaN'AGEl~ENT PLAN SE~ION Ilk ~~G CERTIFICATION IS ACCURATE. I UNDERSTAND TILkT THIS LNFO~TION WILL'BE USED TO FULFU~L MY FIRM'S OBLIGATIONS UNY)ER TI-IE "CAL~FORaNIA HEAL~ AND. S2kFE'IrZ CODE" ON ~OUS MATERIALS ('DI:V] 20.CF_APTEI~ 6.95 sec. 25500. ET:AL.)AND TI-tAT INACCURATE INFORMATION ¢ONS~ $IO~ Trl'LE DATE 4 .... OFFICEOF E ONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979' - ...... ' · ,-.~,,, ~ ..... 13usiness Activities '"Page I. FACILITY IDENTIFICATION ! ~ACII.ITY ID ~ (Fox' offic~ usa only - pteas~ leave hlanl0 .' II. ACTIVITIES DECLARATION 'i ' Does. Your Facility... :If YeS, Please Complete... ( -i A. HAZARDOUS MATERIALS " S ONO 4 ¢ OE.S FORM 273.1 (C~emicaOeSmpaon.~onm 1. Have'on Site (fOr, any purpose) h~zardbus matsdals at or v*" CONSOLIDATED COMPLIANCE PLAN al3o~e 55 ga IonBfo~!iquids; 500.gounds for Solids, or 200 Minimum required' pla~aninq elements: cuft for comllrassed~gasos (include liquids in ASTs and · Eme~enb~/Response Pt~in USTs)? ' ' ' ' ' (~O · Maps 2. Have an//amount. o~.an explosi,ve material (other than OYES' s ·. Training " · Prevention ammunition)..., on site~ . ' , · Certifications 13. REGULATED SUBSTANCES (RS) . OYES (~O 8 v' O. ES FORM 2731 (ch~u~c~ ~,~;,!;.-..-, Have 0nsite RS atgreater than'the.threshold planning ' .. ~ v'. RISK MANAGEMENT PLAN (RMP Su~mit t,, uSF..PA) · quantities estaJ:itist~ed by the Califomia Accidental I ' v' CONSOL.IDATED; COMPLIANCE' Pt. AN · . Incorporating CalARP program Elements ' Release Prevention, program (CalARP)?' / ., C. UNDERGROUND STORAGE TANKS (USTS) OYES (~NO ? v' UST FACILITY FORM ~. Own or.operate Undergmt~nd'Storage Fanks? (~NO v' .US.T TANK FORM'(oeo,portal) Intend to Upgrade existing or install new USTs? OYES i a ~ US~' FACILITY FORM ' ' v~ UST TANK FORM /' v' UST INSTALLATION FORM (me per tan,) D. TA~NK CLOSURE / REMOVAL . ~ OYES (~NO . 9 v' UST TANK'FORM (c~osures,~-one~ertan~) 1. Need to 'reP0rt.ct0~s!ng, a U,.qT that. held hazardous i . "· materials or waste?" ' :' ~ ~N 2. Need to rel3ort the ~tosQre/removal ora tank that'was OYES O. ~o ~ TANt.~ CLOSURE FORM. ' ~ ~.tn.qsified as hazardous waste and cleaned onsite? ~ I . E. ABOVE'GROUND PETROLELIM STORAGE TANKS (AST.s.) OYES (~l~lO 1~ v~ CONSOI. j. UP~TED.'C.Q. MPLIANCF-- PLAN ' - ~ · IncomOrating Federal Spill Prevention ' Own or operate ASTs' above these thresholds: any. tank '1 Control and Countermeasure (SPCC) i capacity s great~ than 660 gallons or the total capacJty I Elements pursuant to 40 CFR Part 112 ~ for the fac!lib/'is g~eater than'1,320:gallons. . ' I N ~' EPA tD number---provide on this page - F. HAZARDOUS WASTE: . OYES O ~2 To obtain EPA ID#, please pt3one(916) 324-178i ':'i 1.' Generate hazardous waste? .2. Recycle more than 100 kg/mo of'feCYctable materials at OYES O ~3 v' - RECYCLING FORM the same location it was gene~ted? · ' '"OYES ~N 3. Recycle mom than 100 kg/mO of reCYctable materials at O ~ ~ RECYCLING FORM an offsite ocatton different from the 3pint of generation? i ~N0 4. Treat Hazardous Waste. on site? ' OYES 15 [.-,i~' TP FACILITY FORM (DTSC Form 1772) . ~/ TP'UNIT FORM (one per unit) 5. Subject to ~nanc~al Assurance requ'rements? ] OYI~S(~O ~s ' CERTIFICATION OF FINANCIAL ASSURANCE ~' 6. Consolidate Hazardous .Waste generated at a remote OYES ~7 v' = REMIDTE WASTE/. CONSOLiDaTION SITE "NOTIFICATION FORM site? (~' G. PERMIT CONSOLIDATION ZONE: (~Y-'~S O ~8 ~' CO'NSOIJDATED COMPL~NC~ PLAN Intend 'to conso idate other Cai/EPA agency permits? ' · Incorporating all other environmental ~ (If yes, pJease complete Section II! and attach) i permit requirements per 2T CCR 104,0 J If you checked YE3 to any part of Sections IIA-tlG above, thor{ in addition to the forms requested .above, please Submit DES Form 2730. $..'~CH pAFO RMS1ACTIVITY.wlI¢I' UPCF (7/99) ~' - 1715 :chester Ave., Bakersfield, CA 93301 (661) 326-3979 FACILITY INFORMATION Busings A~i~ Add.dura " III. CONSOLIDATED PERMIT ACTIVITIES.. Is your F~cili~ Compliance Plan subje~ to review by... '~ for sa~ing, ~e Condi~ons &~es~. pe~? H. OEPAR~ENT' OF TOXIO SUBSTANCES, CONSOL ? , i I. SAN 3OAQU.IN VAL~Y UNIEIED-AIR POLLU~ON OYES ' CONTROL O'IS~IGT : ' OYES ~O ~ PERMI~ TO OP~ "- j' J. sTA~ WA~R RESOURCES CON~OL BOARD' OYES ¢ WAS~ DISCHARGE REQUIREMENT (~R) : F-~OARD ~ Oyes ~o" ¢ SPeCiFiC ~E~TS " 'OyEs ~ ¢ ~TIO~L P¢~0TION OISCHARGE " EQMINA~QN SYs~M' (NPOES)' K. CALIFORNIA IN~G~D WA~ MA~GEMENT BOARD OYES. ~ ~ ~EGIS~T1ON PERMIT ENVIRONMEN;AL H~L~ SERVICES PERM~ ~ KERN COU~ RESOURCE MANAGEMENT AGENCY ~S ONO ¢ 'Dem'~ac'Wa{~ Well ~e~ . OYES ~0 ¢ H~ MatMonit°fing Well P~it ~YES ~0 ~ Septic System Pe~it OYES ~0 ~ Public Swimming moo~ ~YES ¢ Food Facili~ ~ns~on Pe~it ~YES ~O ~ Solid Waste ~l"En~mem~t Agen~ ' M. CI~ OF BAKERS~ELD WAS~-WA~R DIVISION ~YES ~ , NDU3TR~L WAS~ WA~R DI~CHARG~ PERMIT ~ If you ~ YES'~' any paE~ S~ans III-H t~'llI-M above,' ~en please addr~ all appli~ble p~it r~ui~ in ~e Famli~ Complianceplan. ,~ .. . ~ CITY OF BAKEI~FLEI · a.~s'a s s ~ ~ OFFICE O'F'E~IRON~NTAL SERVICES 1'715 Chester Ave., CA93301 (661) 326-3979 i" ' ' ~~~--' . BUSINESS OWNER/OPE~TORIBEN*IFICATiON FAC1LI~ INFORMATION ~:. ~ -' - . . I. FAcIL!~.IDENT1FICA~ON ~ BUSINESS ~ME (Same ~ FACI~ N~E or DBA- 0oing 8min~ ~) ---' / ~ ~ BUSINESS ~HONE i ~ ...... 2~ ' - · : ~ DUN &. ms '~. SIC CODE OWNER MAIUNG ' II!, ENVIRONMENTAL coNTA~ ' . -PBIMARY- IV. EMERGENCy CONTACTS ' 4ECoN:DARY- 2~HOURPHONE ~. a~ i 2~OUR PHONE . ~ 132 V, CERTIFICATION Se~fica~on: Bas~ on my inquiw of ~ose individuals responsible for ob~ining ~e info~a~on, I ce~ unde[, penal~ of law ~hat I have pe~onally examin~ and am ~miligr ~B Be in~a~on submi~ in ~is inven~w and b~ieve ~e i~o~a~on is ~e, a~umte, an~'comCete. · " ., BUsiness Owner/OperatOr Identification ' P1ease submit the Business Activities page, the BUSiness Owner/Operator Identification page (OES Form ~,-30), and Hazardous Materials- C,.h~micaiI, DesCr~tion pages (OES Form 2731) for all hazardous materials inventory' submissions: For the inventorY ~ be considered_ complete,' ' .. this page must be signed by the al3pmprfate individual. '.~ ~qote: the ,numl3en,ng. of ~he ~nsa-uc~ons follows the data element numl3ers ~at are on..the. UPCF, pages.. These~ data e~emertt numbem am used~: '. ar eJectmn~c submission and are ~he same as the numbenng used ~n 27 CCR, Appendix C, the Business Sectio~ of the Unified Program Date.~cffonary.) Please number all pages of your submittal.. This helps you~' CUPA or AA, identify Whether the submittal is complete and if any pages are separated. 1, FACII.JTY ID NUMBER * This number is assigned by the CLIPA or A~,. This is the,unique numDer which identffes your facliib/. 3. ,~ I~USINESS NAME - Enter the full legat name of. the 13usiness. 100. BEGINNING DATE - Enter the beginning year and date of the report. (Y~fYMMDD) ~ ,, 101. ENDING DATE * E,qter the ending year and date of the ref3ort. (Y'FYYMMDD)-' 107_,~ BUSINESS PHONE - Enter the phone number, area'code first, and any extortion. ·. . ~.- 10,3. :BUSINESS SITE ADDRESS - Enter the street address where the facility is Jocated, No past office box numbem are altowed. This informat~3n · must provide a means to geoC~aphicaily locate file facility. 104. CITY - Enter t~e dity or unincarl3orated area in wt3ich business site is located.. 105. zIP CODE ~ Enter the zip code of business site. The exffa 4 digit z~13 may also be added., 106. DUN & BRADSTREET - Enter the Dun & Bradstreat number for the facility.' The Dun.& Bradstreet number may be obtained by calling (610) 882,-7748 or by Intemet. , : 107. SIC CODE - Enter the pdmarY S~andard Indus~at Ciassificatton Code number for primary business activity. NOTE: If code is mare than 4 digits, re~ort only the first four. 108. COUNTY ~ Enter t~e county in which the bUSiness sim isi.located. .: 109. BUSINESS OPERATOR NAME -.Enter the name Of the business operator. 110. BUSINESS OPERATOR PHONE - Enter business operal~..~r .phone number, if different from business phone, ama code first, and any extension. ' 111. OWNER NAME - Enter name of business owner, if different f~3m business operator. 11:2. OWNER PHONE - Enter the business owner's phone number if different.from bUSiness phone, area code first, and any extension. 113. OWNER MA!I-JNG ADDRESS- E~ter the owner's mailing address if d~erent from business site address. ' 114. OWNER CITY - Enter the name of the (:fly for the owner's mailing address. 115. OWNER STATE ;. Enter the 2 ct~aracter state abbreviation for the owner's mailing~address. ' · 116: OWNERZJP CODE- Enter the zip code for the owne~ address. Theex, ffa4d~gitzJpmayalso beadded. 117. ENVIRONMENTAL CaNT .AC'T:. NAME ~ Enter the :name of the person, if diffe~t fram.the Business Own~ ar operator, who receives ~ environmental .correspondence and will respond to enforcement aciivity. 118. CONTACT PHONE - Enter the phone number; if different from Owner or Operator, at whi. 'ch the environmental contact can be contacted, area code lirst, and any extension.. 119. CONTACT MAILING ADDRESS - Enter the mailing adclrees .wflere ail envimnmantal contact correspondenc~ should be sent, jf different from the site address. 120. CITY - Enter the name of the dry ~3r the er~, 'mnmentai co[~tact=s mailing address. '121. STATE; Enter the 2 character State abbreviation for the environmental contact=s mailing address. 122. 7_JP CODE - Enter the zip cocl.e for the environmental contac't=s mailing address; The exlm 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME - Enter the name of a representa~ve that can be contacted in case of an emergency involving hazardous' materials at the business Site. The contact shall have FULL facility access, site familia~/~, and,authOrity to make decisions for the business regarcling incident mitigation. 124. TITLE - Enter the ~e of the primary emergency contact. ' ' 125, BUSINESS PHONE - Enter the business number for the primary emergency contact, area code ~mt, and any extensions. 126. 24-HOUR PHONE - EDt~ a 24-hour phone number for the pdmary emercjency contact, The 24-hou~ phone number must be one which is answered 24 houm a day. If it is not ff~e,contact~s hame phone nUmber, then the service answering,the phone must be able to immediately contact the individual stated above. 127, PAGER. NUMBER - Enter the pager number for the primary emergency contact, if ava~able` 128. SECONDARY EMERGENCY CONTACT NAME - Enter the name of a secondarY representative that can be contacted in the evant ~at the pdmary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and au~adty to make decisions for the bus,ess regarding incident mitigaton. 12.9. TFI'LE - Enter the title of the secondary emergency contact. 130. BUSINESS PHONE - Enter the business telephone number for the secondary emergency contact, area code first, and any extensio~ 131. 24-HOUR PHONE - Enter a 24--hour phone number for the secondary emergency contact..The 24 hour phone number must beane which is answered 24 hours a day. If it is rtot the contact's home phone number, th~. the service answering the phone must be ab(e to immediately contact the individual stated above. 132. PAGER NUMBER - Enter the pager number for the secondary emergency contact, if available` 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - This space may be used for CUP,As or ~ to collect any additional information necessary to meet the requirements of their indh/iduai programs. Contact your local agency, for'guidanca- 134. DATE - Enter the date that the document was signed. (Y'YYYMMDD) ' ~i "i' TM ' ' 135. NAME OF DOCUMENT PREPARER - Enter the full name of the person who prepared the inventory su~mit~l information. 136. NAME OF SIGNER - En~r the fuji pdnted name of the person signing the page. The signer cer~e~ to a.familiadty with the information submitted and that based on the signer~ inquiry of those individuals responsible fi3r ol3taining the informaton, all the information submitted is ~rue, accurate and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE - The Business Owner/Operator, or officially designated representalJve of the Owner/Operator, shall sign in the space provided. This signa[ure cerl~es that the signer is familiar with informalion submitted and that based on the signer~ inquiry of those individuals responsible for obtaining the information it is the signe~ belief that the submitted information is flue, acc,_rate and complete. 137. TITLE OF SIGNER - Enter the title of the person signing the page~  ' OFFICE OF EN~IRO~/IENTAL SERVICES I715 Chester .Ave., CA 93301 (661) 326-3979 ...~,-~m,~ ,~-. . HAZARDOUS, MATERiALs iNVENTORY CHEMICAL DEscRIPTION · . ~ (one form per material per building or area)  NEW' F'/ADO [] OELETE [] REVISE 200 Page I. FACILITY INFORMATION gUSINESS NAME (Same as FACILITY NAME or O~A ~ Ooing I~siness AS)~ . - ' II. CHEMICAL INFORMA~ON N~E PHYSI~L~A~ ~ s SOUD UQUID ~ g ~S' 214 ~GE~CO~AI~ ~.~ . 215 219, ' ~f ~S. ~nt m~ be in tbs. ~ a ~O~ROUND TANK ~ e ~ON~C DRUM ~ i ~ DRUM ~ m' G~S B~ ~ q ~L ~R '~) ~ b UNO.GROUND T~K ~ f ~N ~ j ~G · ' ~ P~C BO~' ~ r O~ ~ ¢ TANK iNSIDE BUI~ING ~ g ~OY ~ k BOX ~ o TQ~ BIN ~ d S~DRUM ~ h SILO ~1 C~ND~ ~ a TANK'WA~N STO~GEPRESSU~ 'AMBI~ ~ ~ A~VE~BI~ ~ ba B~O~AMBI~T %~ ' ' H~RDOUS coMpoNENT EHs J CAS 4 me J ~9. ~Y~ ~No 2~ 5 242 2~' ~Y~ ~ No 2~ IlL SIGNA~~ Hazardous Materials Inventory - Chemica! Description "~'., You ~us~ complete a' separate Hazardous Materials Inventory - Chemical Desc,'iptJcn page tar each haza~ous mstenal (hazardous sutistance~ and hazardous waste) ~al you handle at your facility in aggregate quantifies equal to or greater than 500 poun(ts, 55 gallons. 200 cubic feet of gas (calculated at s'tendard tempsra(ure ea(~ pressure) or the federal threshold ptenning quantity for Extremely HazardouS Su/3stances, whicJlever is less. AL~3 complete a page for eactl radioadave r~atsdal hand/ed quantities [or which an emergency plan is required {o be adopted pursuant to ? 0 C;:R Parts 30, 40. or 70. The comoleted inventory s~ould reflect ail re0ortaois quantifies of hazardous materials at y~3ur facility, relx)rted separately for each building or outside adiacent area. with separate pages for unique occurrences of physical state, storage' temperature and storage pressure. (Note: {he numbering ef the instructions fot/dw~ {ha data element numbem {hat are on the UPCF pages. These date element numbem are usecl for electronid submission and are the same as the numbering used in 27 OCR, Appendix C, the Business Section of the Unil3ed Program Date Dictionary.} number ail pages of your submittal. This helps your CUPA or AA idenlify whether the submittal is complete and if any pages are separate,'* 1. FACIIJTY ID NUMBER - This number !a aS~gned by the CUPA or AA. This is ~e unique number which identifies your facility. ~-~ . 3. BUSINESS NAME_- Enter,the Adl legal name of the business. 2.00. ADD/DELETE] REVISE - Indicate if the 'matsdal ia being added to the inventory, deleted/'rom the inventor, Or if the information previously submilted is being revise~ - *NOTI:=, You' may choose to leave this blank: if you resu~3mit your enfire-inventon/annually. 21~1. CHEMICAL LOCA'T3ON - Enter ~e building or outside/a~acent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature` in muiUpta/dcadons within a building, can be reported on a single page. NOTE; This information ia not subject to public dlscJcsura i~.u~usnt to HSC . §25506. **. 202. CHEMICAL LOCATION CONFIDENTIAL - EPCRA - All businesses which1 are sutiject to [he Emen:jency Planping and Oommun ty Right to Know Act (EPCRA) must checA "Yes' to keep c_JlemK=al location information confidential if the business does not wish to keep chemical location informatioh cont/dentlsl caeca. 'No'. 203. MA/3 NUMBER - If a map is inciudsd, enter the number of the map on which the location-of the hazardous materiel ia shown. . , 204. GRID NUMBER - If grid coordinates are used, enter the grid coordinates of the map that correspond to the location Of the hazardous material. If appiicabts muitipts gdd coordinates can be listed. ' ' 205. CHEMICAL NAME - Enter ~e proper chemical name asan~atad with the Chemical Absmact Sa~ice. (CAS) number of the hazardous matada .. This should be the Int.emationa Union of Pure and Applied Chemistry (iUPAC) name ~ound on the Mamrial Safely Data Sheet (MSba). NOTE; If'the chemicai is a mixture, do'nst complets this field; complete the "COMMON NAME" field instead. 206. TRADE SECRET - Chec~ "*Yes" if the information in this section is declared a trade secret' or "No' if ii: is not. State ~eqU~rem6nt: If yes. and business ia net subject to EPC,~A, disalosura of the designated {rede secret infonmation ia bound by HSC 9'25511. Feclsral req,u!rement: If yes, and business ia ~ubiect to EPCRA, dlscJosure of the designated'Trade Secret information ia beund by 40 CFR and the i3usineas must submit a "Substantiation to Accompany C~3ims of Trade Secrecy' form (40- C~R 350.Z7) ~ 207. COMMON NAME - Enter the common name or trade name of the hazardous material or mixture contething a hazan~us material. 208. EHS - Chec~ 'Yes" if the hazardous matedal is an Extremely Hazardous Substance (EH$}. as defined in 40 ~ Part 355, Appendix A. If the matadal is a mixture containing an EH,R, leave this section blank and complete the sec~on on hazardous c~3mponente below. ' 209. ~AS # - Enter the Chemical Abst~ct Se~viC~ (CA~) number for the hazardous material. For mixtures, enter the CAS number of the mi~e if it has'been assigned a number d/sfinc~ from its components. If the mixture has no CA~ ~umber, leave this column blanl( and report the CAS numbers of the individual hazardous components in the appropriate ses~on bblow. 210. FIRE CODE HAZARD CLASSES - Fire Code Haza~ Clssses' describe ID ~rat respondera the type and level of hazardous matariats which a business handles. This information shall only,be provided if the local fire chief deems it necessa~ and requests the CUPA or AA lo coilect iL A list of the hazard classes and instructions on how to qetormine whiCh ~,~a_~$ a rhatedal- falls under are ind/udsd in ~e appendices of Art~ls 80 of the Uniform F'tm Code. if a material has mom than ~ne · ' applicable hazard ~_]~_, thcJude alL' Contact CUPA arAA for guidance, 211.' H,a~'.ARDOUS MATERIAL TYPE ~ Check the one bo,~ that best describes the type o~ hazardous material: pure, mixture or waste, if waste material, check only that box; If mixture or waste, complete hazardobs componen~ sect/on. .212.RAOIOACTlVE-Chec.~- -yes" if the hazardous matsdal,~rad/oac:tiveor "No' ifittsnot. 213. CURIES * It' the hazardous material is radioactive, uSe this area to _report the activity in cudes. You may use up to nine dtgit~ with a.floating, decimal point to report activity in curies. 214. PHYSICAL STATE - Check the one box that best describes the state in wi~i~l the hazardous material is handled: solid, liquid or gas. ' '... 215. LARGEST CONTAINER - Enter the total capacity of the largest container in which the material is stored. . · 216. FEDERAL HAZARD CATEGORIEB - Check ail catec~lories that describe the f3hyalcal and health hazan:ls associated with the 'h~'~,~u~ material. Fire: Flammable Uqu/ds and Sot/ds, Combustible LJqu/ds, Pymphorica, Oxidizers Acute Health (Immediate): Highly T~3xic, Toxic, Irritants, Senaltizem, Com3alvas.. Reactive: Unstal)le Reactive, Crc. tonic Peroxides. Water Reactive, Radioactive other hazardous chemi~'~£,~ with an adverse effect .with short term e_.~_'_nsare Pressure ReleaSe: Explosives, Compressarl Gases.. Blasting Agents Chronic Health (Delayed): CaminogenS, other hazardous chemicals with an advema effect with Ion,q tarm expOSUre. ' 2.17: AVERAGE DALLY AMOUNT - C,a~cuiata the average daily amount of the hazardous material or mixture containing a hazardous material, in eaCh building er ad~acant~ ' outside area. Calculations shall be dasedon the provinua year's invanto~ of matadal reported on this page. Total ali daily amounts and div/de by the numl3er of days the,~hemiCal will be on ~Jte If ~hls is a metedal that has not prey/dusty been present at this location, the amount st3ail be the average daily amount you · project to be on i~and during the co ,u ,me of th~ year. This amount should be consistent with the units raporta~ in box 221 and shcu/d not exceed that of mox~mum daily amount. . . ~ , . , 218. MAX]MUM DALLY AMOUNT - Enter the maximum amount of eaCh hazardous'material or mixti~e containing a haza[doue ~iatertal, which is handled in a building or ' adiacant/eutside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the matsrisi reposed on this page, with the reflection of additions, deletions, or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219. ANNUAL WA..~'E AMOUNT - If tile hazardoue matoria being inventoried is a waste, provide an eal~'tata of the annual amount handled., 220. STATE WASTE CODE - If the hazardous matsdal ia a waste, eater the appropriate California 3.-digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. 221. UNITS - Chec~ the unit of measure that is most approPdate for the material being reported on this page: ge.lip, ne` pounds, cubic feet or tons. NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS), all amoqnts must he reported in pounds. If matadal is a mixture containing an E/ts, report the units that the matahal is stored in (gallons, poUnds, cubic fee(, or tons). 222. DAYS ON SITE - L Jet the total number of days during the year that the material ia on sits. 223. STORAGE CONTAINER - Check att boxes that describe the type of storage containers in wliich the hazardous material is stored. NOTE: If appropriate, you may choose more than one. 224. STOI:~AGE PRESSURE - Chec~ the one box that best describes the pressure at which the hazardous ~atedal is stored. 225. STORAGE TEMPEP, ATLIRE - Check the one box that best deSCribes the lamperetura at which the hazardous mstenal is stored. 22§° H,AZARDDUS COMPONENTS. 1-5 (% BY WF~GHT) - Enter the percentage w~ight of the hazardous componen~ in a mixture. If a range of percentages is available, report the highest peroantege in that range. (Report for components 2 through 5 in 230, 234, 2.38, a~d 242.) 227. HAZARDOUS COMPONENTS' 1-5 NAME - When reporting a hazardous material that is a mixture, list up to five chemical names of hazardous components in that · · mixture by percent weight (refer'to MSDS or, in the case of trade secrets, refer to manufacturer). All hazardous components in the mixture present at greater then 1% by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, should be reported. If mom than t'we' hazardous compqnenta are present above these pernsnteges, you may attach an additional st3eet of paper to capture the required information. When reporting was't~ mixtures, mineral and chemical.composition sbou/d ha listed. (Report for components 2 through 5 in 231,235, 239, and 243.) 228. HAZARDOUS COMPONENTS 1-5 EHS - Check "Yes' if the component of the mixture is considered an Extremely Hazardous Sudstsnce as defined in 40 CFR, Part 355, or "No" if. it ia not. (Report i'or components 2 through 5 in 232, 236, 2,40, and 244.) 22_9. HAZ-.ARDDU$ COMPONENTS' 1.5 CAS. L~.t {he Chemical Apstmct Service (CAS) numbers as related to the hazardous components in the mixture. (Repeat for 246. LOCALLY COLLECTED INFORMATION - This space'may be used by the CI. JPA or AA, to collect any additional information neceSSary to meet the requu'ements of their ind/viduat programs. Contac~ the CUPA or AA for guidance. U?CE ( [/99). 7 DE$ Form 273 ! :\PRO~EDURE MANUAL'~.~v~