HomeMy WebLinkAboutBUSINESS PLAN ITE DIAGRAM FACTLITY DIAGRAM
BakerSfield Fire Dept.
Hazardous Materials Division RECEIVED
F~B 1 6 1990
2130
Street
Bakersfield, CA. 93301
HaZ. i~,~T, DIV.
HAZARDOUS MATERIALS MANAGEMENT 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 os o whole.
4, Be brier and concise as possible.
SECTION 1' BUSINESS IDENTIFICATION DATA
BUSINESS NAME' 'D.¢ L. F~OO~' (--1~5 S~0tOJ{ ~.~
LOCATION' ~0 0~¢[C~ ~O, ~
MAILING ADDRESS: JO[~ ~~
CITY:~~~ STATE:[~ ZIP: ~/~ PHONE:
DUN &BRADSTREETNUMBER' '~7-O~8~ J SIC CODE'
PRIMARY ACTIVITY: ~~ ~ ~~ C~c~
MAILING ADDRESS: [0~ ~A~ -~ ~~~O CA,
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS, PHONE 24 HR, PHONE
FD15~
~H Bakersfield Fire Dept.
azardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
'SECTION 3: TRAINING:
NUMBER OF EMPLOYESS: /
MATERIAL SAFETY DATA SHEETS ON FILE' ~'-~--~
BRIEF SUMMARY OF TRAINING PROGRAM'
SECTION 4: EXEMPTION REQUEST: ~'~
I'CERTIFY'UNDER PENALTY OF PERJURY T'HAT MY BUSINESS IS EXEMPT FROM THE
REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH &
SAFETY CODE" FOR THE FOLLOWING REASONS:
WE DO NOT HANDLE HAZARDOUS MATERIALS.
WE DO HANDLE I~AZARDOUS 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. 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
INACCURATE INFORMATION CONSTITUTES PERJURY.
SIGNATURE TITLE DATE
Bakersfield Fire Dept~_
Hazardous Materials Divis
HAZARDOUS MATERIALS MANAGEMENT PLAN
Facility Unit Name:
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A, AGENCY NOTIFICATION PROCEDURES:
B, EMPLOYEE NOTIFICATION AND EVACUATION'
C. PUBLIC EVACUATION:
D. EMERGENCY MEDICAL PLAN:
¢~-\\
-- Bakersfield Fire Dept
azardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
A, RELEASE PREVENTION STEPS:
B, RELEASE CONTAINMENT AND/OR MINIMIZATION:
C, CLEAN-UP PROCEDURES:
~.-'~ C~.~,,~,-., ulo Sp~lg ,~
SECTION S: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)'
NATURAL GAS/PROPANE:
ELECTRICAL:
WATER' ~J ~.r
SPECIAL:
LOCK BOX: YES~ IF YES, LOCATION'
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A. PRIVATE FIRE PROTECTION: ~V~-fl..H~e.a
B. WATER AVAILABILITY (FIRE HYDRANT)'
CITY of BAKERSFIELD COy-
HAZARDOUS MATERIALS INVENTOR
Farm and Agticul~u~re [1 Standard Business [1 ......... ,_.
LOCATION: ~G~° D~¢~ D)v~, ~ ~' ~ES~[_'o/~ ~ ~,~ ~ ~ _
'
1 2 3 4 5 6 7 8 9 t0 11
Trans [Yfle Hex Avfr~ge Annual ,easure '~y~ Cent Cent Cent ~e Loc
Code team AmC Amc - EsL Units on ~ce Type Press Temp Stored in PaCl/1cy
Physical ~ndHealthH~z~rd C.A.S. Humber Component I1 ~e ~ C,A,S, ~u~
(Check al/ that applyl .- 7/' 5~-~
Component 12 Na~e ~ C,A.S. Number
Fire Hazard ~ Reactivit~ ~Oelayed ~ Sudden Release ~ Immediate
~ Health of Pressure Health
Component J3 Name J C.A.S. Number
Physical ~0dBealth~ard C,A,S, Humber Component I1 N~a t C,A,S, Number
(Check all that apP/yl
Componen: 12 Ha~e & C.A.S. Humber
~Fi,, Hazard O Reactivity ~Delayed a Sudden Release O
Health of Pressure
Component 13 Hame ~ C.A,S, Number
Physical and HealthUalard C.A.a. Number Component II Name I C,A.S, Number
(Check all Chat Apply/
Component 12 Name I C.A.S. Number
~ Fire Hazard ~ Reactivity ~ Oelsyed ~ Sudden Release ~ Immediate
Health of Pressure Health
Component 13 Name & C.A.a. Number
Physical And Health UalArd C,A.S. Humber Component II Name t C,A,S. Number
ICheck 81/ Cha[ app/yl
Co~ponenC 12 Name & C.A.a. Number
~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~
He~lth of Pressure
Component 13 Hame & C.k,S. Humber
EMERGENCY CONTACTS ¢1'~ ~- 3~ 0~ 5e~'Z~G? f12~
Name iitie z4 Hr Phone Name
~erti[i~atioq ,(Repd and sign af~pr comp7~Cipg,a77 sectipns)
t,cerpty un0er pensl[~ o?~a~ th4( ]hav~pe[sonajlLexamln4O~qo~m ~amimlar,~it~ the ~ntormat~pn ~u~mittfd in this.~nd all
~[cacned d~c~mencs, sn~ [~ac Dssea on.my lnqutry 9r Chose lnOlVlaUa/S responsible rot obcalning cne InrormacIon,
subm~d inter.itOh IS true, accurate, aha compme~ ~ ~ .
~n0~.~ic~ai titie of o~nerlooerator UH o~ner!oo~rstor s authorized .resentat~ve ~ure