The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN Materlals/HaZhrdous Waste , Unffied.::Perm ~. * :, - .'D* Unde~mund Storage of H~ous U~als Permit LOCATION: 5640 DISTRICT BLVQ 111 .. * ' ;-~ :: ' '- Issued by: Bakersfield Fire Department:. ' '"' OFFICE OF ENVIRONMENTAL SER VICES' .~~ 1715 Chester Ave., 3rd Floor ' ' . ..' ' {~,.Raipl/Hucy, ~ i . .- Issue Date Bakersfield, CA %301 ~,~.m~r Voice (661) 326-3979 ~~'~- FAX (661) 326-0576 Expiration Date: ITE DIAGRAM Business Name: WE. VE MOVED! Our Pfione and fax number remain the same: Phone: (661) 396-0261 Fax: (661) 396-0262 Please change our mailing address to: Black's Construction 5300 Woodmere Suite 101 Bakersfield CA 93313 BLACKS CONSTRUCTION SiteID: 215-000-000216 1999 Manager : usPhone: (661) 396-0261 Location: 5640 DISTRICT BLVD ~ ~ap : 123 CommHaz : Low City : BAKERSFIELD ~rid: lSD FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 13 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title JIM BLACK / OWNER GARY KAUK / FOREMAN Business Phone: (661) 396-0261x Business Phone: (661) 396-0261x 24-Hour Phone : (661) 588-2517x 24-Hour Phone : (661) 632-4882x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire DelHlth Contact : Phone: (661) 396-0261x MailAddr: 5640 DISTRICT BLVD 111 State: CA City : BAKERSFIELD Zip : 93313 Owner JIM BLACK Phone: (661) 665-1890x Address : PO BOX 2251 State: CA City : BAKERSFIELD Zip : 93303 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Site Hazmat Common Name... ISpocHazlEPA Hazards Frm DailyMax Unit MCP LACQUER & LATEX PAINTS F DH L 55 GAL UnR -1- 03/26/1999 BLACKS CONSTRUCTION SiteID: 215-000-000216 = Inventory Item 0002 Facility Unit: Fixed Containers on Site ~UIvuvIU~ ~Vl~ / ~ ~_/...~_~ ~vl~ LACQUER & LATEX PAINTS Days On Site 365 Location within this Facility Unit Map: Grid: CAS# FSTATE i TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 5.00 GALI 55.00 GAL 35.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# HAZARD ASSESSMENTS TSecret oRS f BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No N No No/ Curies F DH / / / UnR -2- 03/26/1999 F BLACKS CONSTRUCTION 'SiteID: 215-000-000216 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 03/26/1999 ~o =~ ~o~ ~oI~ ~o o~ i~ = ~~o~ =is~s????????~lI Employee Notif./Evacuation 03/26/1999 HOW ARE YOU GOING TO NOTIFY YOUR EMPLOYEES OF ANY EMERGENCY??????? Public'Notif./Evacuation ~ 03/26/1999 HOW ARE YOU GOING TO NOTIFY THE PUBLIC OF ANY EMERGENCY??????? Emergency Medical Plan 03/26/1999 WHERE ARE YOU GOING TO GO FOR MEDICAL HELP IN CASE OF AN INJURY?????? -3- 03/26/1999 BLACKS CONSTRUCTION SiteID: 215-0'00-000216 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 03/26/1999 HOW DO YOU KEEP YOUR PAINTS FROM SPILLING??????? · -- Release Containment 03/26/1999 ONCE YOU HAVE A SPILL HOW WOULD YOU CONTAIN IT????? -- Clean Up 03/26/1999 ONCE YOU HAVE CONTAINED A SPILL, HOW ARE YOU GOING TO CLEAN IT UP???????? Other Resource Activation -4- 03/26/1999 BLACKS CONSTRUCTION SiteID: 215-000-000216 Fast Format ~ Site Emergency Factors Overall Site Special Hazards -- Utility Shut-Offs 03/26/1999 LIST THE LOCATIONS OF ALL OF YOUR UTILITY SHUT-OFFSi A) SAS -~ , , . ~, ~_ ~ D) SPECI~ - fl~ E) LOCK BOX - ~ -- Fire Protec./Avail~..Water 03/26/1999 ~T DO YOU USE FOR YO~ O~ PRIVATE FIRE PROTECTION - IE. SPRINKLER SYSTEM, FIRE EXTINGUISHERS...?????????~ . ~ ~.~1 ~ ~, --~--~~-~ ~ERE IS YOU R NEWEST FIRE HYD~T LOCATED????????? Buildin~ Occupancy Level -5- 03/26/1999 BLACKS CONSTRUCTION SiteID: 215-000-000216 Fast Format ~ Training Overall Site -- Employee Training 03/26/1999 How ~ E~PLOYEES DO YOU ~VE??????? I\ ~o~ ~ DO YOU HAVE MSDS SHEETS ON FILE???????? ~ ~ Page 2 -- -- Held for Future Use Held for Future Use -6- 03/26/1999 BLACKS CONSTRUCTION i~_~~V~V~i SiteID: 215-000-000216 / Manager / MAR 25 7999 B~sPhone-. (805) 396-0261 Location: 5640 DISTRICT BLVD 1~1 _~ M~p : 123 CommHaz : UnRated City : BAKERSFIELD ~1'~-~,~~ G~id: 15D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 13 SIC Code: EPA Numb: DunnBrad: I Emergency Contact / Title I Emergency Contact / Title JIM BLACK / OWNER I ~COTT ~UNC~~ ~/ FOREMAN Business Phone: (805) 396-0261x Business Phone: (805) 396-0261x 24-Hour Phone : (805) ~3~---7~x 24-Hour Phone : (805) ~7!-2~28x Pager Phone : ( ) ~ -~Tx Pager Phone : '( ) ~3~:~Ax Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 5640 DISTRICT BLVD 111 State: CA~_~ ~ City. : BAKERSFIELD Zip : 9~1~ Owner JIM BLACK Phone: (805) 665-1890x Address : PO BOX 2251 State: CA City : BAKERSFIELD Zip : 93303 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 lUnitlMCP ~ ~ F P IH G 251 FT3 Low LACQUER & LATEX PAINTS F DH L 55 GAL UnR ~, ~ ;,, "~ L.,,-c/'c'''' Do hereby certify that l have ' (Type o~ p~nt nam~) revie~ved ~he attached hazardous materials manage- merit plan f~r~~-~ ~ ~.-.~/~-~6~ha~ It alon~ with an7 corrsc'fions constitute a complete ~nd correcl man- a§ement plan for my ~-ili~. -1- 02/18/1999 BLACKS CONSTRUCTION SiteID: 215-000-000216 = Inventory Item 0001 Facility Unit: Fixed Containers on Site OXYGEN Days On Site 365 Location within this Facility Unit Map: /Grid: NE CORNER OF SHOP AREA~ CAS# 7781-44-7 PRESSURE TEM~RATURE CONTAINER TYPE Gas Pure Above Ambien /~mbient PORT. PRESS. CYLINDER THIS LOCATION Largest Container I~O~DTaSilA~ Maximum Daily Average F 3/ 251.00 FT3 251.00 FT3 HAZARDOUS COMPONENTS 100.00 Oxy/ge repressed .~) /_~.~.. ~,3 5/77 N 7782447 '/ HAZARD ASSESSMENTS /No No No No/ Curies F P IH / / / Low = Inventory Item 0002 Facility Unit: Fixed Containers on Site LACQUER & LATEX PAINTS Days On Site 365 Location within this Facility Unit Map: Grid: CAS# Liquid { Mixture Ambient Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container { Daily Maximum I Daily Average %Wt. { HAZARDOUS COMPONENTS IRS CAS# HAZARD ASSESSMENTS lTSecret ~SIBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# I MCP No N No No/ Curies F DH / / / UnR 2 02/18/1999 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE .................. ~,,,.=~;~,:..:~,,~, .................. This permit is issued for the following: ¢,??~, !? ..... :i ,,~i!!i:,~..,~ilE::.i!ii~= ;;~ .... .,ii?~U~derground Storage of Hazardous Materials ;%'"'~ ~ ' ';~ 2'i ~"~" "'~?']~? ' ' · ~ '" 'i I""~ " ~'-.,%~ ~"-~ ~,.. ¢" . ........ "~t ', ,"J~p~'J~/¢~,¢.~.~..'. ~11~. ~ i~'-. I:~....., ~i',. ~ .~, r: ................. ~.~,.~. ,~. u~.,~,' ~ ¢~'~"~["~'~?~i~'~'~i~'~ I..~ ,i~, "'- '~.'*'-"-- ~ ,~' ' ,%"¢["~i~L~:B~~'*.'', · ¢'~ ~ . ", B ~.., _% %?, L...,.. ? ~ .,¢-/ ?, *. '%; ...---.-:~.."~F:~i~ii! ¢~" .:?"~'~;,;:(7;%'"~ ~*,,"-'~---*"¢'~'%~'"~=E *~i~, '~l~,,~i~[~[~ ,~ ~ '~ B~ersfield Fke D~ment Approv~ by: ~ O~CE OF E~O~AL S~ ~CES ~ph Hu~~ 1715 Chewer Ave., ~rd Floor Office of ~~1 B~e~el~ CA 93301 Voice (80S)~7~ Expiration Date: dUn~~O~~000 F~ (805) ~26~s76 Hazardous Materials Division ~ Date Completed / Business Name: Business Identification No. 215-000 O~ ~J ~ (Top of Business Plan) Station No. / 3 Shift '~ ,nspe~or 3. g [~jg. ~F~ '. o g ~al Time: ~ Depa~re Time: Inspe~on Time: Adequate Inadoqu~to Vefifica~on of Invento~ Materials ~~ ~ RECEIVED Vedficaflon of Quan~es ~rop~r 8o~r~fla~on of Matorial ~ Common~: Vorifica~on of MSD8 ~ailabil~ ~ ~umbor of fimplow~: V~rifica~on of Haz Mat lraininfl ~ Common~: V~rifica~on o[ ~atom~nt 8uppli~ ~ ~roc~dures ~ Common~: fim~r~n~ ~rocoduros ~ostod ~ Containers Propo~ [abolod ~ Common~: V~rifiea~on o[ Faeil~ Diaflram ~ Spocial Hazards ~ssociatod ~ ~is Facili~: ''PRINT ~ME ' Correction Needed Busin~'~er~a~a~ 01GN~TUR~ WhicH= Mat Db Yellow-Satori ~py Pink-Busings ~py 05/16/94 BLACKS CONSTRUCTION 215-000-000216 'Page 1 Overall Site with 1 Fac. Unit General Information Location: 5640 DISTRICT BLVD 111 Map:123 Haz:0 Type: 3 Community: BAKERSFIELD STATION 11 Grid: 15D F/U: 1 AOV: 0.0 Contact Name ~ Title Business Phone 24-Hour Phone JIM BLACK IOWNER (805) 396-0261 x (805) 631-7883~ SCOTT DUNCAN FOREMAN (805) 396-0261 x (805) 871-2828 Administrative Data Mail Addrs: 5640 DISTRICT BLVD SUITE 111 D&B Number: City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-01~ BAKERSFIELD STATION 11 SIC Code: Owner: JIM BLACK Phone: (805) 665-1890 Address: P O BOX 2251 State: CA City: BAKERSFIELD Zip: 93303- Summary ~ ~--? ~O [ 05/16/94 BLACKS CONSTRUCTION 215-000-000216 Page 2 Hazmat Inventory List in MCP Order I 02 - Fixed Containers on Site : Pln-Ref Name/Hazards Form Max Qty MCP 02-001 OXYGEN Gas 251 Low· · Fire, Pressure, Immed Hlth FT3 02-002 LACQUER & LATEX PAINTS Liquid 55 Unrated · Fire, Delay Hlth GAL 05/16/94 BLACKS CONSTRUCTION 215-000-000216 Page 3 - 02 - Fixed Containers on Site Hazmat InVentory Detail in MCP Order 02-001 OXYGEN Gas 251 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7781-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 I Annual Amount FT3 -- 251 ~ 251.00 251.00 . Storage~ Press T TempI Location PORT. PRESS. CYLINDER IAbove IAmbientlNE CORNER OF SHOP AREA - Conc~ Components MCP ---/Guide 100.0% I Unrated I 0 02-002 LACQUER & LATEX PAINTS Liquid 55 Unrated · Fire,. Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: PAINTING Daily Max GALI Daily Average GAL I Annual Amount GAL 55 ~ 55.00 55.00 Storage Press T Temp Location METAL~CONTAINR-NONDRUM Ambient//~bientI -- Conc ~ Components , MCP ---~Guide 05/16/94 BLACKS CONSTRUCTION 215-000-000216 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification <2> Employee Notif./Evacuation <3> Public Notif./Evacuation <4> Emergency Medical Plan 05/16/94 BLACKS CONSTRUCTION 215-000-000216 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention <2> Release Containment <3> Clean Up <4> Other Resource Activation 05/16/94 BLACKS CONSTRUCTION 215-000-000216 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs <3> Fire Protec./Avail. Water <4> Building Occupancy Level 05/16/94 BLACKS CONSTRUCTION 215-000-000216 Page 7 00 - Overall Site <G> Training <1> page 1 <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use BAKERSFIELD CITY FIRE DEPARTMENT · -¢,~~~ HAZARDOUS MATERIALS .DIVISION' 1715 CHESTERiAVE., ~)~,N..~.__~__'~'_.~,~/,~'~' BAKERSFIELD, CA. 93301 '~' (805) 326-3979 HAZARDOUS MATERIALS INVENTORY INSTRUCTIONS FAcILITy DESCRIPTION: .~ ~._ Check if your business is a farm. Enter the full legal name and site address of your business. Do not use post office box numbers. Give a brief deScription of the nature Your business activities. Enter the Standard Industrial Classification (SIC) number for your business. Each type of business has a Standard Industrial Classification code number. Some common SIC codes are listed on page 4. Other SIC codes may be obtained from your worker's compensation insurance forms, the State of California Employment Development Department by giving them your employer number, ' from the U.S. Labor Department or from the. St;andard Industrial Classification Manual. Enter the Dun & Bradstreet or federal tax identification number for your business. Enter the name of the owner, their mailing address and phone number. EMERGENCY CONTACTS: List two persons who have full access tO the facility, including, locked areas, and that are knowledgeable about your 'materials' and process. CHEMICAL DESCRIPTION: Make as manY copies of the chemical description form as necessary to report your entire inventory of hazardous materials. Report every hazardous material handled in quantities equal to or exceeding 55 gallons of a liquid, 500 pounds of a solid or 200 cubic feet of'a gas. Enter the full legal name and site location of your business at the top. of the form. Enter the page number in the right hand corner. Each of the instructions below correspond to the entry field with the same number on the chemical description form. REGION ¥ ~ ,~TANI2AP~ FOPA4 1.. Check the-appropriate box for a new inventory or for additions, revisions or deletions t5 ar~ exisdng inVentory. Check nontrade secret unless the chemical composition meets the criteria for trade secret status per Section 6254.7 of the California Government Code a~'d Section 1060 of the California Code of Evidence. Copy trade secret pages onto yellow paper before submitting your-inventory so that they will be easily identified. 2. Enter the common name or tine manufactL]re's product'name. Enter the standard chemical name. If a pure material is an acutely hazardous material (AHM), check the box labeled AH~vl. Report the components of mixtures under item 9 below. 3. Enter the (Dept. of Transportation (DOT) identification number and the Chemical Abstract Service (CAS) number for this chemical. CAS numbers are commonly found, on Material Safe~ Data Sheets.' 4. Check the box(es) which describe the'physical and health hazards associated with the chemical. " 5. If the material is a waste, enter the appropriate three-digit California waste code. California's nonrestricted waste codes are listed on page 4 of these instructions. Questions regarding the waste classification codes and requests for hazardous waste manifest form #8022 may be addressed to the (Department of Health Services, Toxic Substances Control Program at (916) 322-3670. EnTer the appropriate use code from the following list. USE CODES 01. Additive 20. Fungicide 39. Washing 02. Adhesive 21. Grinding 40. Waste 03. Aerosoi 22. Heating 41. Wa[er Treatment 04. Anesthetic 23. ~er~ c de - ,~2. Welding/soldering 05. Bactericide 24.. Insec.',icide . 4,3. Weil injec*,ion 0(5. Blasting 25. !ns~rucuanat 44. Oil treatment 07. Ca~aiyst 25. Luorican[ 45. Resale 08, C;eaning' 27. MediCal aid/process 46. Aircraft sys;ems OD. Coolant 28. Neu~raiizer 47. 8atl:ery etec:rotyte 10. Cooling 29. P~in~ing 48. Breathing air 11. Oritling 30. Pesticide 49. Drafting ai~ 12. Drying 31. Plating 50. FinisHed product 13. ¢'muisifier/demulsifier 32. Preservative 51. Fire pro~ecticn 1'~. E',ching 33. Refining 52. Hydraulic e~ui~rnent 15. ~x:2erimental 34. Sealer 53. RoadlHwy maintenance 18. Fai~rica[ion 35. S0raying ,54. TesUng 17. Fertilization 36. Sf. eritizer 5~. Whoiesaie c~emicats 18, Formuiaf. icn 37. S~:orage ' 99. Other - s~2ecify 19, Fuel 38. S[npper ~ 6. Check the boxes which describe the ·physical state of the chemical: Pure materials are 100% of the chemical listed in item ~2. Chemicals that have been diiuted with water or combinations of two or more chemicals should be reported as mixtures and the components listed in under item #9. 7. Enter the maximum daily amount, the average' daily amount and the total annual amount of material in storage or use at your facility. Enter the largest container size and the number of days/year that the material is on site. Circle the months th'at the material is. on site. Enter the units of measure. Report solids in pounds, Ii'quids in gallons, gases in cubic feet and radioactive materials in curies.. 8. Select the appropriate storage codes from the lists below. a) CCNTAINER'COOES 01. Underground tank 09. Glass container(s) 02. Aboveground tank 10. Plastic container(s) 03. Fixed Pressurized tank 11. Box(es) 04. Portable pressurized cylinders 12. Bag(s) 05. Insulated tank 13. Metal containers (not drums) (inciudes crYogenics) 14.' In machinery or :rocessing 06. Drums or barrels - metallic equipment 07. Drums or barrels - non-metallic 15. Bin(s) 08. Caruoy(s) 99. Other- specify b) PRESSURE COOES 1 - The material is stored at ambient (normal atmospheric) pressure. 2 - The material is stored at greater than ambient pressure. 3 - The materials is stored at less than ambient pressure. c) TEMPERATt3RE COoEs 4 - The material is stored at ambient (surrounding).tem.~erature. 5 - The materiai is stored at greater than ami:ien~ temoerature. '5 - The maieriai is stored at less than amoient temoerar, ure. 7 - The. material is stared under crYogenic conditions 9. Enter the maximum % concentration by weight of the three MOST hazardous components in the 'material. Round up to the nearest whole number percentage. Enter the CAS number for each component of the mixture.' If the component is ~-n acutely hazardous material, check the box labeled AHM. 10. Briefly describe the location of the 'naterial within the building/facility using compass directions and 'obvious landmarks. COMMON STAND, INDUSTRIAL CLASSIFICATI~ 0111 Wheet ~roduction 0?24 Co~anginning 5821 Eating places 0115 Corn proaucaen 0541 G~'ocery.S[ore 5813 Onnking places 0131 Coffion proauc~ion I ~1 O~ cle~e~ (~co~ol se~ce) 0139 ~eid cro~. exce0( c~n grmns 2911 Oil refineries 5~3 Fuel o~l de~e~ 01~1 V~et~les & melons ~1 Weldin~nc~tion- s~mctur~ 5~4 ~G 017~ G~s 3~ Weldin~bnc~ion. ~iler 7~2 Pest comrol 0t73 Tree nuts 356g Machine s~o~ 7~2 A~o toO. ~, 017~ C~tms ~ts 4222 C~id s~orage u0hols(ew 0175 0ectauous tree ~ 4~5 Comotesse~ g~ supoiier ' Auto D~n~ shoos ~17g ~C~e~ ~ree ~ & n~s ~ Aut~moO~le savage 75~ Au(o ezhaus[ reo~r ~1~ Gene~ ~S. pnm~ crop . 51~9 Chem~c~ SUDpty. 7~6 A~o ~l~s replacement ~241 0~ ~s 5~11 Mo[orvehicle de,em (new & used) 7~7 Auto tr~smission ~e~r 0252 Chicxen eggs 5521 Mo~er Vehicle (use~ only 7538 Gener~ ~o ~253 Tumey eggs 5~1 Amd & home suo~{y stores 7542 C~ w~nes 2851 Pant m~utsc=ure 5541 G~oline so,ice st&lions 8071 Chem~ ~or~to~ 02~1 Gene~ ~.. Dnm~ty livestock & ~ima s~ci~ies NONRESTRICTED WASTE CODES Code 0escnotion Code 0escnD~:ion Inorcjanics 111 Acicl solution 2< pH <7 with metals &ndmony, ~u'senic. 272 POlymeric resin waste ha-qum. Peryllium. cadmiu~-n..c~lromJum, coPalt, copper, lead. 281 Adhesives mercury, moly~3C~enum, nicxel, selenium, silver, thaJIJum. 291 LAtex waste v-nac~ium and 71nc) 311 Pharmaceu{ica] waste 11 2 Acid solution without metals 113 UnsoecifieO &mc~ solution 321 Sewage siudge 322 =~ioiogical waste o[her tha~ sewage sludge 121 Alkaline solution oH > 12.5 with metals (see 111) 122 AlkeJine smution ~mhout me{als 331 Off-soec ~gecl or surplus organics 123 Unsoec~fied aikaiine soiution 341 Organic liquids (nonsoivents)w~tn halogens ' 34.3 Unsoecified organic licluid mU~ure 131 Adueous soiution (2<p~<12.5) con~ning reactive ~ions · ~10rg~ic soil. s ~h h~ogens (~e, ~toma[e, chloraCe,'cy~iae, fluori~e, hypocniome,nA~e, percnJora~e an~ su~fi~e ~ons} 132 A~ueous solutton w,t~ me~s (see 111) ~11 Alum ~d gypsum sludge 1 ~ A~ueous solution ~t~ to~ o~ic residues 10% or more ~21 ~me siuage 134 A~ueous solution wtt~ to~ or~i~ residues less t~ 10% 1~ U~oec~ea ~ueous sot~ion. ~1 Phosph~e studge ~1 Suer sludge 141 Cff-s~ec, aged, or su~lus inorg~i~ 451 De~re~ing sludge 151 ~bestos con[anmg w~¢e ~51 P~nt sludge 161 FCC W~te 471 Paper 1 52 Other soent 171 Metal sludge (see 111) ~1 Tetrae[Ayilead siudge 172 Me~ ~us~ AnO mscmning w~{e (see 111 } ~gl Unspecified sluage w~te 1 81 C:~er morgamc sou~ w~te Miscetl~eous 5~ I Empw pesticide con(anem 30 g~ o~ more 211 N~e~ena~e~ soivents 512 Other empW con~nem 30 ~ or more 513 Em~w cent~nem less ~h~ 30 (memy(ene c~lon~e, c~toco~rm, TOE, TCA) 521 0dlling mu~ 23 2 C~gen~eo solvents (acetone, ~u~ot, ME~ 531 Chem~ tode~w~e 21 3 Hyoroc~mon soiven[s (sto¢~ar~ soivent. ~tene) ~1 Photo cnem~/pno(o processinQ w~:e 214 Uns~c~fieo sotvent m~ure 551 ~r~o~w~:e cnemlc~s 221 W~te o~i ~a m~xea oil 561 Cetergent~ so~ 222 Oi(~a~er seo~ion siuo~e 223 Unspecified oil - con~mng w~e 571 F~y ~n. ~om ~n. ~ re~o~ ~n · 581 G~ scmDber W~te 231 Pesticide nnse water 591 ~&g~ouse w~te 23~ Pesticides and oc~er 5~ 1 C~m~m~easoil ~om s~e c~e~-ups 512 Housenol~ w~tes 241 T~ ~o~omw~te 252 Ct~et s~ll ~.omw~te 251 pC3's ~ ma[en~ com~nmg PC~'s ~e~ ~ l~j~ 4' REG~:3N V t..~=~ STANOA,¢~O F~RM HAZARDOUS MATERIAL'S DIVISION '. 17'15 CHESTER AVE. . · ' BAKERSFIELD, CA. 93301 ' (805) 326-3979 ' HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME· ¢'~L/3~ '~, FACILITY NAME SITE ADDRESS ~'(o Z_~ CITY .~N~, ~.~,-,o STATE ¢_.,,X'.~ ZIP ~ ~ 3 ( "~ NATURE OF BUSINESS ~,"~, SIC CODE DUN & BRADSTREET NUMBER; . owNER/OPERATOR ~ ,,.v,. '~/...~'M_..~ PHONE --..-~ -'.o~! MAILING ADDRESS f>O f"~.py~ "2-2-g'- / CITY' ~'A,4"c'--~$,F', c--..-~ r> STATE ~,,A, ZiP EMERGENCY CONTACTS NAME J-.,. ~ ESLAC~. ' TITLE ~P~.J ~ BUSINESS PHONE ~ -O'Z.L(; ( 24-HOUR PHONE ~'~1- ?'~ ~",~o,~") NAME' %(--~"FT i') o,,,u'c::/~ TITLE BUSINESS PHONE 24-HOUR PHONE · S~' ~ 1~ma~ I~--~ION¥ UDcK:: ST,a, NO,~D F- BAKERSFII D CITY FIRE DEPARI /IENT HAZARDOUS MATERIALS INVENTORY Page_of__ CHEMICAL DESCRI~ION 1 ) IN~NTORY ST~S: New ~Add~ion [ ] Revision [ ] Deletion [ ] Check if chemi~ is ~ NON ~DE SECR~ [ ] ~DE SECR~ [ ] Chemi~ Nme: AHM [ ] CAS 4) PHYSICAL & H~L~ PHYSICAL .H~L~ . H~RD CA~GORIES Fire [ ] Reactive [ ] Sudden Rele~e of Pressure~ Immedi~e He~h (Ac~e) [ ] Delayed He~h (Chronic) [ ] 5) WAS~ C~SSIFICA~ON .(3-digit code from DHS Fo~ 80~2) USE CODE ~ ~ 6) pHysICALSTA~ Solid [ ] ~quid [ ] G~ [~ Pure [ ] M~ure [ ] W~te [ ] R~io~Ne [ ] 7) AMOUNT AND ~ME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES M~mum Daly Amount: ~ I~ [ ] .g~ [ ] E3 [~ a) Contaner: Average Omly Amount: ~ cudes [ ] b) Pressure: Annu~ Amount: ~ ~ · c) Tem~r~ure: ~gest Size Contaner: ~ ~ · Da~ On S~e '~ Circle~ich Months: AllYe~, J, F, M, A, M, J, J, A, S, O, N, D 9) MITRE: Dst COMPONENT CAS · % ~ AHM the throe most h~dous 1). [ ] · ch~mi~ com~nen~ or ~y AHM com~nen~ - 2) [ ] 3) ' [ ] CHEMICAL DESCRI~ION 1) INVENTORY STA~S: New~ Addition [] Revision [ ] Deletion [ ] Check ~ chemi~l is a NON ~DE SECR~ [ ] ~DE SECR~ [ ] Chemic~ Name: AHM [ ] CAS 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GQRIES Fire [ ] Reactive [ ] Sudden Rele~eof Pressure [ ] Immedi~e He~th (Ac~e) [ ] ~layed He,th (Chronic) [ ] 5) WAS~ C~SSIFICA~ON (~digit code from DHS Form 8022) USE CODE ~ ~ 6) PHYSICALSTA~ Solid [ ] ~quid ~ G~ [ ] Pure [ ] Mi~ure ~ W~te [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACIM~ UNITS OF M~SURE 8) STOOGE CODES M~imum D~ly Amount: ~ I~ [ ] g~ ,~ ~3 [ ] a) Contaner: Average Daly Amount: ~ cu~es [ ] b) Pressure: Annu~ Amount: ~ ~ c) Temper~ure: ~gest Size Container: · Days On Site ~ Circle ~ich Months: AllYe~, J, F, M, A, M, J, J, A, S, O, N, 9) MITRE: Ust COMPONENT CAS · % ~ ~M the throe most h~dous 1) [ ] chemi~ com~nen~ or ~y ~M com~nen~ 2). [ ] 3), [ ] 10) Lo~ion ce~ under pen~ o~ law, ~at I have pe~onally ex~in~ ~d ~ f~i/i~ wi~ ~e infoma~on suDmi~ on ~is ~d all submi~ info~agon is ~e, actuate, ~d complete. PRINT Name & Title of Authorized Company Representatlve Signature Date BAKEP iELD CITY FIRE DEi RTMENT HAZARDOUS 'MATERIALS INVERTORY Page_of_ ~usiness Name Address .. CHEMICAL DESCRIPTION 1) iNVENTORY STATUS: -New [ ] Addition [ ] Revision [ ] Deletion[ ] Check if chemical is a NON TRADE'SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) ChemicaJ Name: ~ AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] ReaCtive [ ] Sudden Release of Pressure [ ] . Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CL.ASSIFiCATION (3-digit code from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND T1ME AT FAClUTY ~JNITS OF MEASURE 8) STORAGE CODES Maximum Dally Amount: lbs [ ] gal { ] ~t3 [ ] a) Conta~ner: Average OaJly Amount: cunes [ ] b) Pressure: Annual Amount: c) Temperature: largest Size'Container; ' ..._ . . # Days on site CircteW~ich Months: All Yea~. J, F, M, A, M, J, J, A,. S, O, N, D 9) MIXTURE: · List .COMPONENT CAS # % WT AHM the three most hazardous 1) · ' [ ] chemical components or ~ny AHM components 2). [ ] 3) [ ] 10) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New[ ] Addition[ ] Revision[ ] Deletion[ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: .AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire { ] Reactive [ ] Sudden Release of Pressure [ I Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 1 5) WASTE CLASSIFICATION .(3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture ['] Waste [ ] Radioactive [ ] 7) AMOUNT AND T1ME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: tbs [ ] gal [ ] tt3 [ ] a) Container: Average Oa~ly Amount: curies. [ ] b) Pressure: Annual Amount: c) Temperature: L~rgest Size Container: # Oays On Site Circte Which Months: All Ye~-, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: · List COMPONENT CAS'# % WT AHM the three most hazm'dous ' 1) · [ ] chemicaJ components or any AHM components '2) [ J 3) [ ] 1 O) Location cer~fy un(~ er penalty of law, ~hat l~ have personally examinee eno am familiar w~h the mfoma~on suDmitteo on Elis an(i ail ariacneo Oocumen~s. I betieve me submitted informa~on is ~TUe, accurate, and complete. PRINT Name & Title of Authorized Company/~epresentafive Signature Date BAKERSFi .D CITY FIRE DEPAP MENT 'HAZARDOUS MATERIALS INVENTORY Page_of__ 3usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] ' Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) ChemicaJ Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive[ ] Sudden Release of Pressure [ ] Immediate Health {Acute) [ 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] 'Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive ['] 7) AMOUNT AND TiME AT FACILITY UNITS OF MEASURE 8) STORAGE CODES Maximum Dally Amount: lbs [ ] gal [ ] It3 [ ] a) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size'Container: # Days On Site Circle Which Months: All Yea~. J, F, M, A, M. J, J, A. S, O, N. D 9) MIXTURE: Ust COMPONENT CAS # % WT AHM , the three most hazardous 1) [ ] chemicaJ components or any AHM components 2) [ ] 3) [ l 10) Location CHEMICAL DESCRIPTION 1 ) INVENTORY STATUS:. New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemiceJ is a NON TRADE SECRET [ ] TRADE SECRET [ 2) Common Name: ;3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire ( I Reactive{ ] Sudden Release of Pressure { ] Immediate Health (Acute) 5) WASTE CLASSIFICATION .(3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FAClUTY UNITS OF MEASURE 8) STORAGE CODES Maximum O~ily Amount: lbs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: cunes[ ] b) Pressure: Annual Amount: c) Temperature: LaJ'gest Size Container: # Days On Site Circle Which Months: . AllYea~. J, F, M, A. M, J, J, A. S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the lhree most hazarc~ous 1 ) chemicaJ coml3onents or any AHM components '2) [ ] 3) 10) Loca~on cer~fy unOer penal~y or /aw, ~hat i have personally examined and am familiar wlm the infome~on suDmitted on mis eno ail a~tacheO document, t believe me submitted mforma~on is ~ue, accurate, and complete. PRINT Name & Title of AuthonZect Company t~epresentatJve Signature Date