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Home My WebLink AboutBUSINESS PLAN SITE/FACILITY DIAGRAM FORM 5 NORTH SCALE: BUSINESS NAME: CRake% ~(~]% FLOOR: OF . UNIT ~:/Iq0F~q ¢ DATE ~./2 /~7 FACILITY NAME SToci<~bmt~ ~uS~6%s ua~¢~ - .. (CHECK ONE) SITE DIAGR~%M X- FACILITY DIAGRAM N l(Inspector's Comments): -OFFICIAL USE ONLY- - .SA - S[T£ D[AGRAH (Requl( teas) ~~,-~'- ...,~;.~ 1. Address: Identify the 9. Lock (key).Box principle buildings · ,by the Street numbers, 10. ~SDS Storage' Box 2.,Street(s). Alleys. 11. Railroad Tracks Driveways. and Parking Areas adjacent to the 12, Fence or Battler property. Include the a. Wire · street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wood 4. Drainage Canals, Ditches, d. Gates Creeks. 13. Pomerllnes 5. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c. Metal construction capacity tn gal, a. Above ground d. Access Door ~ b. Underground 6. Utility Controls a. Gas 16. Diking or Bern b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: Identify the ?. Fire Suppression Systems: location mhere a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Masts Storage c. Fire Standpipe 20. Outside Hazardous Connections Material Storage d, Water Control'Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fire Pump 32. Type oF Hazardous Material/Masts 'Stored 8. Fire Department Access or Used (See Below) TYPE OF HAZARDOUS MATERIAL F - Flammable E - Explosive L - Liquid R - Radiologlcal C - Corrosive 0 - Oxidizer G - Gas P - Poison Water Reactlve T - Toxic g - Solid H - Cryogenic D - Waste B - Etiological Example: Flauable Liquid · FL FACILITY DIAGRAM (Required Items In addition to the above) I. Risers for Sprinklers 8. Fire Escapes Partitions g. Air Conditioning Units 3. Stairways: Indicate the 10. #lndoua levels set'red from highest to lowest. 11. Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials Storage S. Elevator 13. Inside Hazardous Naterlala Usa/Handling 6. Attic Access " · 14. Se~er Drain Inlets 7. Skylights 308' No~th BAKERSFIELD District\B'vd ~ Pacheco Rd DISTRICT BOULEVARD North F O R L A Office, War~housing & Manufacturing Space. 680 SQ FT AND UP · Each unit has office area equipped with central heating and air conditioning · Tilt-Up Construction · Individual Restrooms · Loft areas are available in some units · 100-amp., 3-phase power · Extensive Landscaping · Easy freeway access via White Lane · Some units are fire sprinklered for safety · FOR LEASING INFORMATION PLEASE CALL: (80s) a98-8888 Al_SO, WE HAVE OTHER PROJECTS IN SAN DIMAS, VENTURA, Vv'ESTLAKE VILLAGE AND NEWBURY PARK BBI~SINESS (ENIEll BAKERSFIELD This information has been furnished from sources which we deem reliable, but for which we assume no liability ; '~ RECEIVED 02/04/93 GRASS ROOTS 215-000-000928 ' . " Overall Site with 1 Fac. Unit HAZ. MAT. DIV. General Information Location: 5640 DISTRICT BLVD 114 Map: 123 Hazard: Low Community: BAKERSFIELD STATION 13 Grid: 15D F/U: 1 AOV: 0.0 Contact Name Title BuSiness Phone---T 24-Hour Phone- VELMA EMERSON (805) 328-0711 x ~(805) 328-1167 BRAD EMERSON OWNER (805) 836-1188 x/(805) 664-1534 Administrative Data Mail Addrs: 5640 DISTRICT BLVD #114 D&B Number: 77-018-0230~ City: BAKERSFIELD State: CA Zip: 93313- COmm Code: 215-013 BAKERSFIELD· STATION 13 SIC Code: Owner: JERRY/VELMA/BRAD EMERSON Phone: (805) 664-1534 Address: 2813 EDMONTON State: CA City: BAKERSFIELD Zip: 93309- Summary 02/04/93 GRASS ROOTS 215-000-000928 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCP 02-003 TRIPLE 20 VEROISOL Solid 750 High · LBS 02-002 UREA Solid 1000 Moderate · LBS 02-004 GROW MORE Solid 1000 Low · Fire, Immed Hlth, Delay Hlth LBS 02-001 AMMONIUM SULFATE Solid 800 Minimal · LBS 02/04/93 GRASS ROOTS 215-000-000928 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in' MCP Order 02-003 TRIPLE 20 VEROISOL Solid 750 High · LBS CAS #: 57-13-6 Trade Secret: No Form: Solid Type: Mixture Days: 365 Use: FERTILIZER Daily Max LBS Daily Average LBS ~Annual Amount LBS -- 750 I 750.00 [ 750.00 Storage Press T TempI Location BAG - Ambient|AmbientlNORTHWEST CORNER -- Conci Components MCP ---TGuide 32.0% IPotassium Nitrate High ! 35 52.0% IUrea ModerateI 1 16.0% IMonoammonium Phosphate Minimal I 5 02-002 UREA Solid 1000 Moderate · LBS CAS #: 57-13=6 Trade Secret: No Form: Solid Type: Pure Days: 365 Use: FERTILIZER Daily Max LBSI Daily Average LBS I Annual Amount LBS 1,000 I 1,000.00 5,0.00.00 Storage Press T Temp Location BAG IAmbiontJAmbiontlNoRTHWEST CORNER -- ConcI Components MCP ---/Guide 100.0% IUrea ModerateI 1 02/04/93 GRASS ROOTS 215-000-000928 Page 4 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-004 GROW MORE Solid 1000 Low · Fire, Immed Hlth, Delay Hlth LBS CAS #: 7439987 Trade Secret: No Form: Solid Type: Mixture Days: 365 Use: FERTILIZER Daily Max LBS I Daily Average LBS I Annual Amount~LBS 1,000 ~ 1,000.00 2,000.00 Storage Press T Temp Location BAG IAmbientlAmbientlNW CORNER -- Conc 20.0% Sodium Molybdate Components I MCP ---~uide Low ! 7 12.0% Manganese IL°w ~ ~ 1 7.0% Copper Minimal I 53 5.0% Zinc Low ~ 37 02-001 AMMONIUM SULFATE Solid 800 Minimal · LBS CAS #: 7783-20-2 Trade Secret: No Form: Solid. Type: Pure Days: 365 Use: FERTILIZER Daily Max LBS I Daily Average LBS I Annual Amount LBS 800 ~. 800.00 4,000.00 Storage Press T Temp Location ~BAG IAmbientlAmbientlNORTHWEST CORNER -- Conc Components MCP Guide 100.0% [AmmOnium Sulfate IMinimal I 7 02/04/93 GRASS ROOTS 215-000-000928 Page 5 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911. <3> Public Notif./Evacuation NO EMPLOYEES <4> Emergency Medical Plan DR. FAULSTICK. 02/04/93~ GRASS ROOTS 215-000-000928 Page 6 00 - Overall Site <E>Mitigation/Prevent/Abatemt <1> Release Prevention MITIGATION- NO SMOKING SIGNS AND PESTICIDE WARNING SIGNS PREVENTION- FIRE EXT., CLEAN SHOP, MASK, GQGGLES, GLOVES, BOOTS'... <2> Release Containment ABSORBANTS.- LIQUID FOR MINOR SPILLS, PICK UP SOLIDS, coNTAINMENT OF MAJOR SPILLS AND CONTACT AG DEPT & 911 <3> Clean Up ~ ABSORBANTS <4> Other Resource Activation 02/04/93 GRASS ROOTS 215-000-000928 Page 7 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - RIGHT OUTSIDE SUITE 114 B) ELECTRICAL - INSIDE 114 ON EAST WALL C) WATER - IN FRONT OF 109 PER LEASING OFFICE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. water PRIVATE FIRE PROTECTION - OVERHEAD SPRINKLER SYSTEM IN WAREHOUSE. FIRE EXTINGUISHER IN WAREHOUSE. FIRE HYDRANT - FIRE HYDRANT LOCATED NEAR BY IN BUSINESS CENTER COMPLEX. <4> Building Occupancy Level 02/04/93 GRASS ROOTS 215-000-000928 Page 8 00 - Overall Site <G> Training <1> Page 1 WE HAVE NO EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING PROGRAM: OWNER/OPERATOR - 6 YRS EXPERIENCE INVOLVED IN BUSINESS. ON HANDS EXPERIENCE. WITH TYP~ OF BUSINESS AND NO EMPLOYEES, NO FORMAL TRAINING NECESSARY. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 08/18/92 GRASs ROoTs 215-000-000928 .Page 1 Overall Site with 1 Fac. Unit General Information Location: 5640 DISTRICT BLVD 114 Map: '123 Hazard: Low Community: BAKERSFIELD STATION 13 Grid: 15D F/U: 1 AOV: '0.0 i Contact Name Title i Business Phone i 24-Hour Phone VELMA EMERSON (805) 328'-0711 x (80.5) 328-1167~- Administrative Data Mail Addrs: 5640 DISTRICT BLVD #114 D&B Number: 77-018-0230 City: BAKERSFIELD State: CA Zip: 93313- comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code: Owner: · JERRY/VELMA/BRAD EMERSON Phone: (~O5) 66~ - ;5~/ Address: 2813 EDMONTON State: CA City: BAKERSFIELD Zip: 93309- Summary RECEIVED $£P 2 2 1 92 HAZ MAT. DIV. r~i~d .~h~ ~eCh~d h~ardous matsriels ment Can ocr ~5 ~o%3 and that it along ~ith ~y ~~on~ ~sl~me ~ complete and ~rr~ man- 08/18/92'~ GRASS ROOTS 215-000-000928 Page 2 02.- Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 AMMONIUM SULFATE Solid 800 Minimal · LBS CAS #: 7783-20-2 Trade Secret: No Form: Solid Type: Pure Days: 365 Use: FERTILIZER Daily Max LBS800I~' Daily Average800.00LBS I Annual Amount4,000.00LBS .... Storage Press T Temp Location BAG Iambient/ambientlNORTHWEST CORNER -- Conc Components MCP List 100.0% IAmmonium Sulfate IMinimal I 02-002 UREA Solid 1000 Moderate · LBS CAS #: 57-13-6 'Trade secret: No Form: Solid Type: Pure Days: 365 Use: FERTILIZER Daily MaXl, LBS000I~ Daily Averagel, 000.LBS00 I Annual Amount5,000LBS. 00 ..... Storage Press T Temp Location BAG I ambient/Ambient I NORTHWEST CORNER -- Conc Co,mponents MCP · List 100.0% lUres I Moderate I 02-003 TRIPLE 20 VEROISOL Solid 750 High · LBS CAS #: 57-13-6 Trade Secret: No Form: Solid Type: Mixture Days: 365 Use: FERTILIZER Daily Max LBS Daily Average LBS Annual Amount LBS 750 I 750.00 [ 750.00 Storage Press T Temp Location BAG IAmbient/ambient I NORTHWEST CORNER -- Conc Components MCP List 32'0% IP°tassium Nitrate IHigh I 52.0% Urea Moderate 16.0% IMonoammonium Phosphate Minimal 08/18/92 GRASS ROOTS 215-000-000928 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-004' GROW MORE .Solid 1000 Low ~ Fire, ~I~ed Hlth, Delay Hlth LBS CAS.#: 7439987 Trade Secret: No Form: Solid Type: Mixture Days: 365 Use: FERTILIZER Daily Max LBS I Daily Average LBS I Annual ~ount LBS -- 1,000 I. 1,000.00 2,000.00 Storage IIPress T Temp Location BAG IA~ient~bientlNW CORNER ~ -- Conc , Components MCP List 20'0% ISodium M°lybdate IL°w I 12.0% Manganese Low 7.0% Copper Minimal 5.0% ZinC Low 08/18/92 GRASS ROOTS 215-00'0-000928 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911. <3> pUblic Notif./Evacuation NO EMPLOYEES <4> Emergency Medical Plan DR. FAULSTICK. 08/18/92 GRASS ROOTS 215-000-000928 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention MITIGATION - NO SMOKING SIGNS AND PESTICIDE"WARNING SIGNS PREVENTION - FIRE EXT., CLEAN SHOP, MASK, GOGGLES, GLOVES, BOOTS... <2> Release Containment ABSORBANTS -.LIQUID FOR MINOR sPILLS, PICK UP SOLIDS, CONTAINMENT OF MAJOR SPILLS AND CONTACT AG DEPT & 911 <3> Clean Up ABSORBANTS <4> Other Resource Activation 08/18/92 GRASS ROOTS 215-000-000928 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - RIGHT OUTSIDE SUITE 114 B) ELECTRICAL - INSIDE 114 ON EAST WALL C) WATER - IN FRONT OF 109 PER.LEASING OFFICE D) SPECIAL - NONE. E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - NONE LISTED FIRE HYDRANT - ????? <4> Building Occupancy Level 08/18/92 GRASS ROOTS 215-000-000928 Page 7 00 -~Overall Site <G> Training <1> Page 1 WE HAVE NO ,EMPLOYEES AT THIS FACILITY· WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE · ~G ~GRA~4-- <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use NAME (~f C~e Mt ~ Est ~Its m Site I~ ~ lW ~ ,. St~ In FKlllty W b IHt~tlw . blth of P~lu~ ~lth ~ - C.~lfic.ti~ (Read and ~Jgn after co~pletJnE all ~ections) for obt 4 minQ ~ ~ ~ ..~ --.~. -~ ....... ~-. -~--~-:--. ~;. ,..).,. ..~_. - ~ .:/ . _O..ix "I,'F£ CARE ,o6; '~.:: . ~. ,,'~' .... .... "":.~"~' ~" -:' .'/ , ~~'~ ~ ~.~' I ~ ~;i:~:~,,,~i~':"~'Y:~'~ ~ , , ~e~ ~me~so~ .. F E S o I 1989 heweby cer~LSy that Z h~ve reviewed thel~s,~.~ .......... attached Hazardous Haterials business ~lan for ~ ~ ~ ~oP5 , (name of business) and that it along with the attached additions or corrections constitute a complete and correct Business P1an for my facility. =z_~na~ure date LOCRTION 564Q%l 1.4 DISTRICT BLVD HIGH Hf~Z~RD RRT;~NG 2 1. OVERVIEU LAST CHANGE 07/14/88 BY ESTER JURIS CODE 215-009 JURIS BAKERSFIELD.STATION 09 MRP PAGE 123 GRID 150 FACILITY UNITS 1 HAZARD RATING Z RESPONSE SUMMARY ZR SEC 4> NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS 2R SEC 2) VELMR EMERSON ---'~OR 831-0788 UTILITY SHUTOFFS Zfi SEC 3) fi) GRS- RIGHT OUTSIDE SUITE 114. B) ELECTRICAL - INSIDE 114 ON EAST URLL C) URTER - IN FRONT OF 109 PER LEASING OFFICE D) SPECIAL - NONE E) LOCK BOX - NO Z. NOTIFICATION / PUBLIC EVACURTION ensp~o~!$~ l_fiST CHflNGE / / BY {.NO INFORMRTION RECORDED FOR THIS SECTION MRTERIRL SRFETY DRTR SYSTEMS, INC. (805) G48-B800 BUSINESS NRME GRRSS ROOTS ID NUMBER Z15-O~)~-OOOgZB LDCRTION 5640-11¢ DISTRICT BLVD HIGH HRZRRD RRTING Z ~. HRZ MRT TRAINING SUMMRRY LRST CHI~NGE / / ElY < NO INFORMATION RECORDED FOR THIS SECTION > LOCAL EMERGENCY MEDICAL RSSISTRNCE · L~ST CHANGE 07/14/~8 BY ESTER ZA SEC S).DR. F~ULSTICK. P~GE Z lZ/15/BB 16:2G MATERI~L S~F'ETY DRT~ SYSTEMS. INC. (80S) 648-6800 BUS~NESS NI-IME GRASI ]TS tO ER 215-0~-(~BZ8 LOCATION SG40-114 DISTRICT BLVD HIGH HAZARD RATING 2 FAOILITY UNiT 0; A. OVERALL. HAZARDOUS MATERIALS INVENTORY [RST'"'C'HRNGE07/14/88 BY ESTER' ID TYPE NAME MAX RMT UNIT HRZARD LOCATION CONTAINMENT USE 1 PURE ~MMONIUM SULF~TE 16~ LBS LOW NW CORNER B~G[S]' FERTILIZER ID PERCENT COMPONENTS 'HRZRRD LIST 1911;(Z~) 1(~.0 AMMONIUM SULFATE LOW Z PURE UREA 18~ LBS UNKNOWN NW CORNER BAG[S] FERTILIZER ID PERCENT COMPONENTS HAZARD LIST -1075~0~ l(i~.~ URE~ UNKNOWN FIRE PROTECTION / WATER SUPPLIES L~ST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE ~ 12115/88 t8:ZG ...... MATERIAL S~FETY DRTR SYSTEMS, INC. (805) G48-G8(2X~ BUSINESS NRME GRBSS ROOTS ID NUMBER ZIS-OOO-~O~VZB LOCRTION SG40-114 DISTRICT BLVD HIGH HAZARD RATING D..EMPLOYEE NOTIFICATION / EVACUATION L~ST CHANGE 07/!4/BB BY ESTER SEC 2) VERBAL AND CRL. L 911. E. MITIGATION / PREVENTION t ~BATEMENT L~ST CHANGE 07/14/88 BY ESTER SEC I) MITIGATION - NO SMOKING SIGNS A'ND PESTICIDE YARNING SIONS PREVENTION - FIRE EXT., CLEAN SHOP, MASK, GOGGLES, GLOVES, BOOTS... RBATEMENT - ABSORBRNTS - LIQUID FOR MINOR SPILLS, PICK UP SOLIDS= CONTflINMENT OF MflJOR SPILLS AND CONTACT PAGE 4 12/15/GB'IB:ZG MATERIAL.. SAFETY DATA SYSTEMS, INC. (8~5) G4B-G80~ CITY of BAKERSFIELD HAZARDOUS MATERI NVENTORY N O N-- '1? RAD E S E C R E ]' S ' oq~ .[_ of _$_ LOCATION: ~G ~ ~taT~ [ ~'~t/~ ADDRESS: ~t~ ~~Off STANDARD IND. CLASS CODE CITY, ZIP: ~A~~f~A~ O~, ~aaff~ CITY, ZIP: ~fl~~/~D DUN AND BRADSTRKET NUMBER.. ~ ~ ~U~O~ ~R ~OP~ COD~ (~e C~e, ~kt Mt Est ,~*ts m Site I~ . ~ TM ~ St~ in FKtltty~ b I~t=ti~ blth of blth ~lth of ~ ~lth blth of Pm~ blth ...... ~)th of Pr~sure ~lth (irttficlctm (Reed and sign after co~pJetlng ail sections) CITY of BAKERSFIELD NO N-- '];'RAD E S E C R ETS ' oa~e~of .... $ CITY, ZIP: ~~t~&~. ~.~A~t~ C~TY, Z~P: DUN AND BRADSTR~ET NUMBgR PHONE ~: ~lv-[t~ ' PHONE e: __ - ___ ~ ~ ~U~O~ ~R ~OP~ P~icll ~ ~lth ~tl~ C.A.S. ~ It II ~ I C.A.S. i at 13 k&C.i.S. ~t. ~ & C.A.S. ~ -~- (/~ ]'d'~7~Y ~lth of ~ ~lth p~c,l~lt~,~ C.A.S.~ ~ttt ~SC.A.S.~_ ~-'0T FRo~,~e ~lth of P~su~ ~lth ~t I~ ~&C.a.S.~ t L ...................... J ........ t__J_~ 1__~ r ~ AA T~n V ~,~ ~ ,,~th ~,~ C.A.S. ~ _' 1 ~ I ~- ~ HZ ~ . ~t tt ~ ~ C.A.S. ~ C~t 12 ~ & C.A.S. fl~lth of Pr~sure ~)th " .......... ~t I1 ~&C.A.S. ~ ,~GE~CY C~IACTS I1 Certtficati~ (Read and sJ~ after co=p~etJnK a~J sections) certUy ~der ~lty of 1~ t~t I ~ve ~rsmeltye.am~n~ ~ e. fmiliir .tth t~ t~f~mtim su~itt~ tn thug ~ ill ettK~ ~ts. ~ t~t ~s~ m W i~W of t~e t~tvi~ls m~sible fo~ ob?mm9 t~ infantry. I ~lieve t~t t~ ~u~itt~ info~ti~ i~ t~. accurate, ~ c~lete. CITY oj' rat, and I~<lricultuce L._J Standard 8u, i-es, ~ ~~R~OU~ ~R~R~ ~~ ~ ~V~~OR~' RIISINESS NAME: ~t,~ ~9~5 ONNER HAME: HAME OF T~ .... FACILITY: ~lth ~lth ef ~ ~lth ................ (~ ~k all t~t flHIth of Pr~lurl Health :~faGENCY C~IACTS II (Irtlficlti~ (Reed and sign after completing ali sections) fo~ obtaining t~ tnf~Ntt~. I ~iieve t~t t~ su~ttt~ info~ti~ is t~d ~ccurite. ~d c~l~te. CIT'Y oJ' t3AKi=R~I~i NO N-- *J' R AD ~ S E C R ~T~ ' ~w* of~._ BIISlNESS NAME:~a~ ~ ~5 OWMER.NAME: NAME O~ T~ FACILITY: LOCATION: ~& ~~ ~ ~//~ ADDRESS: STANDARD IND. CLASS CODE CITY. ZIP: ~n~~ CITY, ZIP: DUN AND BRADSTR~ET NOHBER -- r--~ I~t r--n r--~ ~t Il ~IC.A.S. ~ ~lth of ~m ~lth ...... '" ~-' ~ ,-,~ ~,~ c.~.s..~._~.}_~=qX:.~___ ~, ,,-~ ~ C.A.S. ~ - ~-~ r--~ r--q -- r-- C~tl2 ~&C.A.S. ~ :Nf~G~C~ C~TACTS It for obtaining t~ tnf~tt~. I ~lilve t~t t~ gu~ttt~ info~ti~ is t~,LKcurltl, ~d C~lltl. CITY oJ' BAKI:,Ra NON--'I'RAI) E SEC REq'S .... CITY, ZIP: CITY, ZIP: DUN AND BRADSTRgET NUMBER rHoae ~: ~ $~'//~ PHONE e: __ t~ C~ ~t ~t Est ~Its m Site l~ ~ Tm ~ St~ In F~lllty ~ ~ IHt~ti~ .... 1 ..... 1 ........... i .... 1 ~- . ..... I.~ O~ysicll ~ fl~lth ~Zo~ C.A.S. ~ ~t Il ~ L C.A.S. ~ ~) ~1~0 ~0~ rire Hlzlrd L_J ~fi~ity L_J ~1S~ ~--J ~ ~1~ L--J I~(atl ~1. ~ - ~ ~lth of P~ ~lth ................... P~icml ~ Mlth NIIIH C.A.S. ~ ~t Il h & C.A~S. ~ IC~k iII t~t I~ly) ' ~ rl~bzard ~ ~ ~tlvtty L_j hl~ ~--~ ~ ~1~ ~--J I~tate ~lth of M~ ~lth P~tc$1 ~ ~lth ~t.~' C.A.S. ~ ~t 11 h i C.l.S. ~ (~k ell t~t B~ly) ;~ .... ~ - ~t12 ~&C.A.S.~ ~ Fire Hazard ~ ~ R~tivlty ~ ~ ~le~ ~--J ~ ~)me ~-~ I~tate ~lth of P~su~ ~lth ' '~" ~t 13 h &C.A.S. ~ - ............... l .... .~ .... L q I '~' ~a~l ~l___l._' ! ~1~ ~co~~ mff~ ~lth of Pr~lure He,)th .. N~'~ ................................... ~TIi ....................... ?I-RF'P~ ....... ~ Hill (Irtlli~l~i~ (Read and sJ~n after colpietJn~ all sections) for obtamin~ t~ inf~Mtl~, I ~lieve t~t t~ su~itt~ info~ti~ is t~.j:~ccurltl, ~d cMeietl.] ' ~ / . l;~' ~[a'STTiEiil-TtT1;'$T-~i;~F$T[F'~-~[;I[~F~TS; i'iGl~Fii~';i[;~lillGi 51Q[iTG;e .................................................. CITY oj' LOCATION:.~6 ~,',~ ~d ~ [1~ ADDRESS: STANDARD IND.'C~s~ODE CITY, ZIP: CITY, ZIP: DUN AND BRADSTREET NUMBER P 3o o .... ~lt of P~ blth ~-~ -- -- -- r--~ ~tlt ~ i C.A.S. .Mlth of P~su~ Mlth H~lth 0f Fr~sure Holth [erti/iclti~ (8~d ~d sign after completJnE ali sections/ loc obtaining t~ inf~tl~. I ~lieve t~t t~ eu~itt~ info~ti~ is t~.leccuritl. ~d c~lltl. '[ __~ / ,. '" '~/~" RECEIVED .. B,~ERSVIELD cra, FraE-DEPA~T~NT 2130 "G" S~EET AUS 1 2 1987 B~RSFIELD, CA 93301 OFFICIAL USE ONLY 000928 HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4, Be as brief and concise as possible, SECTION 1: BUSINESS IDENTIFICATION DATA A. ~USI~ESS nAME: ~-~ ~ s: ,~oo ~5 B. LOCATION / STREET ADDRESS: ~-~ ~f) f~/¢?~/c~ .~.X ¢/o ~// CITY: i~~'i~z~ ZIP: ~/3 BUS.PHONE: (~3~ SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7850 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE ~. DURING BUS. HRS. AFTER BUS. HRS. A. Ve~ma".E~ers0n~;i.i_- Ph# 327 0333 Ph# 83~ 07~8 . B. Ph# Ph# SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE B. ELECTRICAL: ~:~s:i~ ~/~0n~east wall / M con ro~ room on ~w corner of ffllq C. WATER: ~-~ /~,~+5~,w4 ~ Water in front of ~109 Per lea'sin~ off~ee D. SPECIAL: E. LOCK BOX: YES / N~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - ~A - ..'BAKERSFIELD CITY FIRE DEPARTMENT 2f30 "G" STREET BAKERSFIELD, CA 93301 0FFICIAL USE ONLY ID# BUSINESS NAME: BUS I NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this fol'm must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. FACILITY UNIT~ FACILITY UNIT N~ME: SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BUSINESS NAME: OWNER NAME: FACILITY UNIT #: ADDRESS: ADDRESS: FACILITY UNIT NAME: CITY, ZIP: CITY,ZIP: PHONE ~: PHONE #: OFFICIAL USE CFIRS CODE ONLY 1 2 3 4 5 6 7 8 9 10 TYPE ~AX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T ~.ODE A~OUNT A~OUNT UNIT CODE CODE FACILITY UNIT WT. C'HEMIqAL OR COMMON NAME CODE GUIDE NA~E: TITLE: : DATE: E~EROENCY CO~TACT: TITLE: PHONE ~ BUS HOURS: AFTER BUg HRS: EMERGENCY CONTACT: TITLE: PHONE ~ BUg HOUR9: PRI~CIPAL BUSINESS ACTIVITY: AFTER BUS HRS: ..... COUN?Y FIRE' DEPARTMENT I.D. # FORM 4A-I ~. : · page" ~ u'f~"J~ . NON--TR,ADE SECRETS '- " HAZARDOUS MATER'r ALS INVENTORY ..'BUSINESS NAME: ~;~-r~.~_~f~0()~S = OWNER NAME:~~ , ~/~~ + t~'~ 'FACILITY UNIT ~: -ADDRESS: ~D ~/'~/~ ~o ~ //~ ADDRESS:~/B ~O~r~/~/~ , FACILITY 'UNIT NA'~E:. CITY, ZIP: ~4(C~5~/~p ~33/~ . CITY,ZIP: i~~S'~'~ ~o~ " ': ' .PHONE ~:,83~-/Y~ -- PHONE *:-~]-dV~ ~0FFicIAL U'SE cFIRS.CODE 1 ~ 2 ,. 3 4 5. 6 7 "' 8 9 . '1'0 ....... TYPE NAX ANNUAL CONT ~5E LOCATION IN .I~IS ~ BY -. . ~AZh~D 9.O.T- CODE ~OU~T ~OU~T 'U~IT CODE CODE .~ClBIT~'H~IT ~T. C~IC~L OR CO~O~ ~E ~' .CODE ~ ' ~ ~s ,~ ~- ~,~ eo~~ . ~'7~- ~-' ' "' · NAME ~mA ~~$O~ TITLE: ~A- ~ SIGNATURE: DATE:__ EMERGENCV ,CONTACT: TITLE: PHONE $ BUS HouRs:2~O~' '- AFTER BUS HRS: ~/-~?'~ · . · 'EMERGENCY CONTACT: ~AD ~~So~ .,.TITLE: C0 0~~ .PHONE 8 BUS PRINCIPAL BUSINESS ACTIVITY: ~A~/ ~~;~'~d~- AFTER BUS HRS: ~'/-O~