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Home My WebLink AboutBUSINESS PLAN/~~ U KLEINS FIRE PROTECTION ..~; ~~ 5630 DISTRICT BLVD #121 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This ~ermit is issued for the followino_j: [] Hazardous Materials Plan E] Underground Storage of Hazardous Materials · Permit ID #:: 015-000-001514 [] RiskMana~ementProamm K L E I N S F I R E P ROT E C T IO N [] Hazardous Waste On-Site Treatment LOCATION: 5630 DISTRICT BLVD 121 ~. ', ~ ;~" ~ , :. OFFICE OF ENVIRONMENTAL SER VICES ~~~ 1715 Chester Ave., 3rd Floor Approved by: ~ p uey, D~: Issue ~te Bakersfield, CA 93301 O~ceor~vim~ic~ ~amrm~r Voice (661) 326-3979 ~~~. F~ (661) 326-0576 Expiation Date: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE · ...:;~,,~,,~,~,,~,~,~i~;~??.?.,.~,!:~,~,~=,~ This permit is issued for the following: ~,~,,"~"ii~"i~:'~i'~ ~'~ ?:ii~::~,~;:,~;:,i:':,;ii,~':,ii~:;ii:::iiii::~ i::.:.i:~¥::;::~Hazardous Materials Plan ' ~ ?~'?!,~i},!i~:C,!?'~:~'~%iii::',ii!i!:,. ~.~iiii!!!!iii~: :iiiii?:::!iiii!!i}iiD!i::U~erground Storage of Hazardous Materials PERMIT ID# 015-021~)01514 ~/i"i' ~,,~. iii !!! ~,= !!~'!i!~:i!!!i!:~'i~.~':;??:ii!%:!!~!!!!:~i!!ilii~i,,~ PJ~kManagement Program LOCATION 56~0 DISTRICT ~:r',,':.. ~' :~. "~"~"~u ....... 121 BA~R$~!~LD~ ......... ~' ~'" CA .... ~C~"..~,,~:~.~:r::::':"~,' .... ~" '~' ' .......... ~ ~'"..."..,'~ .,:... '"'~F,I:2 .~ .... ~ ~ ~ '~ , ~ ~ ~$~ · ~ ~ .......... jl~,.... '....~] ',~J~jj~ji~~' ~,::;' -.~,.~ ....... '"~.,-.,~;:...:~ ~j~i, '.,i~. ~i t "'."' ~ I..I '~,,,~,,,~ 'i.'"' '~ ~':h..:"'-.;'~4~: .. ,~ ~: :~ .~: ~ .......... ::::-~,.~: ,. r '. , 'i~.'...~:~,,., ~ · .' , · ,' · : ~ , ~ r'~,,. ~ !~ ~-. ",..~ ~,~:~i, ~ ............ , ....... ,.,.~,.,. ,.,.~ ~...., ...... . ~i~;:~....::~, '!;C""'"-'-'~!, Issu~ by: Bakersfield Fire Depa~ment Approved by: OFFICE OF EN~R O~AL S~ ~CES 171S Chewer Ay,., 3rd Floor // ~'ph Huey~ Office of ~enml S~i~ B~e~fiel~ CA ' Voice (805) ~2~3979 ~1630 DISTRICT BLVD,, SUITE BAKERSFIELD, CA. 93313 bathroom ' . halon mach. / .I mtrogen clX. / i ~ mr compressor' / ............................................ ?door , ~ ........................ ...~ hydro.tester i ~~ extra. I ' ,~ ~ '""' fire extr chemical ~ '-st-ait's' ................ refrigerator work tables -~~file ~ file cabinet office nitrogen & o co2 cyl.s or de ~bay roll up door parts shelves hoses fire extinguishes door ~ ..----~'- 0 oO stairway from 1 st to 2nd floor page two upstairs ~, S KLEINS FIRE PROTECTION & EXT Manager THOMAS D KLEIN Location: 5630 DISTRICT BLVD 121 City BAKERSFIELD SiteID: 015-021-001514 BusPhone: (661) 835-1591 Map 123 CommHaz Low Grid: 13B FacUnits: 1 AOV: CommCode: BFD STA 13 EPA Numb: SIC Code:7389 DunnBrad: Emergency Contact / Title Emergency Contact / Title THOMAS D KLEIN / OWNER / Business Phone: (661) 835-1591x Business Phone: ( ) - x 24-Hour Phone (661) 333-0265x 24-Hour Phone ( ) - x Pager Phone (661) 307-1470x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact THOMAS D KLEIN Phone: (661) 333-0265x MailAddr: PO BOX 1038 State: CA City LAKE ISABELLA Zip 93240 Owner THOMAS D KLEIN Phone: (661) 333-0265x Address PO BOX 1038 State: CA City LAKE ISABELLA Zip 93240 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT'D ~ ~ ~ 2 0 20Q7 {3a^ed on my inquiry of those individuals res~~onsihi<^-: fcr ovtaining the information, I certify under penalty of law that i have personally s~amined and am familiar with the information submitted and beiieve the information is true, ac Karate, and complete. A -~~ " gi atur~ -1- 07/12/2007 i F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROGEN COMPRESSED CARBON DIOXIDE P F P IH IH G G 1824.00 326.00 FT3 FT3 Min Min -2- 07/12/2007 -3- 07/12/2007 F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: 1 CYL N WALL BY COMPRESSOR SW CRNR DOWNSTAIRS BY ROLLUP DOOR CAS# 1 CYL E WALL MIDDLE OF WHSE ~E ~ TYPE T PRESSURE ~ TEMPERATURE ~ CONTAINER TYPE Gas Pure I Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 228.00 FT3 1824.00 FT3 800.00 FT3 tiAGAttLUU~ ~vriruiv~iv 15 %Wt. RS CAS# 100.00 Nitrogen No 7727379 riHGE1tCL Aa7t5ab1~1~1V1b TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: 3 - 20-LB CYLS ON TRUCK CAS# UPSTAIRS SE CRNR BOTTOM SHELF EXTINGUISHERS 124-38-9 STATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas 1 Pure Above Ambient Cryogenic INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Co163100rFT3 Daily 326100m FT3 I Daily A40r00e FT3 - nr-~~.Yx.LUUa ~urirviv~ivl~ %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 riEiL,1~KlJ H. 7JL" J.71~1L' 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 07/12/2007 z F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/18/2006 ~ DIAL 911 AND OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation 03/22/2000 VERBAL. Public Notif./Evacuation 03/22/2000 VERBAL. Emergency Medical Plan 10/10/1994 TRANSPORT TO NEAREST HOSPITAL. -5- 07/12/2007 r ~ F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/10/1994 ~ KEEP CYLINDERS CHAINED AND KEEP SHIPPING CAPS IN PLACE WHEN NOT IN USE. Release Containment 04/18/2006 OPEN ROLL-UP DOOR AND ALLOW GAS TO ESCAPE TO ATMOSPHERE. Clean Up NONE NECESSARY, INERT GAS. 10/16/2006 v1..11ct itc.7VUt ~:c t1lrL1VCLL1V11 -6- 07/12/2007 n ., F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~rcc:iai ncic~cxtu5 Utility Shut-Offs A) NATURAL GAS/PROPANE - NONE B) ELECTRICAL - SE CRNR OF 5630 DISTRICT BLVD C) WATER - 20FT S OF 5610 DISTRICT BLVD 104 D) SPECIAL - N/A E) LOCK BOX - NO 02/02/2007 Fire Protec./Avail. Water 04/18/2006 NEAREST FIRE HYDRANT - FRONT OF W 5630 DISTRICT BLVD 122 Building Occupancy Level 1 EMPLOYEE 03/14/2006 -7- 07/12/2007 F KLEINS FIRE PROTECTION & EXT SitelD: 015-021-001514 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/16/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: READ MSDS, WATCH VIDEO TAPE PREPARED BY NATIONAL ASSOCIATION OF FIRE EQUIPMENT DIST (NAFED), STUDY NAFED TRAINING MANUAL, ON-THE-JOB TRAINING. rayc ~ nciu ivt ru~.utc vac nc 1lA tvt r UL U.LC V5C .,y t'~"+ -~- ,~~,f ~, V ~_. 07/12/2007 ~. , G KLEINS FIRE PROTECTION & EXT Manager Location: 5630 DISTRICT BLVD 121 City BAKERSFIELD BusPhone: Map 123 Grid: 13B SiteID: 015-021-001514 CommCode: BFD STA 13 EPA Numb: (661) 835-1591 CommHaz Low FacUnits: 1 AOV: SIC Code:7389 DunnBrad: Emergency Contact / Title Emergency Contact / Title THOMAS KLEIN / OWNER / Business Phone: (661) 835-1591x Business Phone: ( ) - x 24-Hour Phone (661) 333-0265x 24-Hour Phone ( ) - x Pager Phone {661) - '~Q Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact THOMAS D KLEIN Phone: (661) 333-0265x MailAddr: PO BOX 1038 State: CA City LAKE ISABELLA Zip 93240 Owner THOMAS D KLEIN Phone: (661) 333-0265x Address PO BOX 1038 State: CA City LAKE ISABELLA Zip 93240 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT'D F E ~ 2 6 2007 Based on my inquiry of those individuals responsible far obtaining the information, I certify under penalty of lave that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ignature Date -1- 02/02/2007 14 i~ F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROGEN COMPRESSED CARBON DIOXIDE P F P IH IH G G 1824.00 326.00 FT3 FT3 Min Min -2- 02/02/2007 -3- 02/02/2007 T~ ~ F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: 1 CYL N WALL BY COMPRESSOR SW CRNR DOWNSTAIRS BY ROLLUP DOOR CAS# 1 CYL E WALL MIDDLE OF WHSE STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPureAbove Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 228.00 FT3 1824.00 FT3 800.00 FT3 - t1AGEitCLVUa 1:V1~lYV1V~1V1~ °~wt. Rs cAS# 100.00 Nitrogen No 7727379 t1HGL~ttL E~JJ~5~1~1~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: 3 - 20-LB CYLS ON TRUCK CAS# UPSTAIRS SE CRNR BOTTOM SHELF EXTINGUISHERS 124-38-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Cryogenic INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 163.00 FT3 326.00 FT3 40.00 FT3 ru,c~i-ucuvua Lvl~lrviV~lVl~ owt. Rs cAS# 100.00 Carbon Dioxide No 124389 riHL,KKL 1-x.7.7 L" .7.71~1L' 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 02/02/2007 F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/18/2006 ~ DIAL 911 AND OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation 03/22/2000 VERBAL. Public Notif./Evacuation 03/22/2000 VERBAL. Emergency Medical Plan 10/10/1994 TRANSPORT TO NEAREST HOSPITAL. -5- 02/02/2007 c F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/10/1994 ~ KEEP CYLINDERS CHAINED AND KEEP SHIPPING CAPS IN PLACE WHEN NOT IN USE. Release Containment 04/18/2006 OPEN ROLL-UP DOOR AND ALLOW GAS TO ESCAPE TO ATMOSPHERE. Clean Up NONE NECESSARY, INERT GAS. 10/16/2006 V1.11CL tCC50LLL-C:C L"~C:C.1VdL10I1 -6- 02/02/2007 ~ ;. F KLEINS FIRE PROTECTION & EXT SiteID: 015-021-001514 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~~c~tai nct~.ca.[.u~ Utility Shut-Offs 02/02/2007 A) NATURAL GAS/PROPANE - NONE B) ELECTRICAL - SE CRNR OF 5630 DISTRICT BLVD C) WATER - 20FT S OF 5610 DISTRICT BLVD 104 D) SPECIAL - N/A E) LOCK BOX - NO ---- Fire Protec./Avail. Water 04/18/2006 NEAREST FIRE HYDRANT - FRONT OF W 5630 DISTRICT BLVD 122 Building Occupancy Level 03/14/2006 1 EMPLOYEE -7- 02/02/2007 '~ ~R F KLEINS FIRE PROTECTION & EXT SiteID: 0.15-021-001514 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/16/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: READ MSDS, WATCH VIDEO TAPE PREPARED BY NATIONAL ASSOCIATION OF FIRE EQUIPMENT DIST (NAFED), STUDY NAFED TRAINING MANUAL, ON-THE-JOB TRAINING. rayc c. 17c 11A 1V1 L'LL1.. U1C 1./.7~C nclu lUi 1' UI.UIC USC -8- 02/02/2007 UNIFIED PROGRAM INSPECTION CHECKLIST ~' ,. _...,. ...~ ..t ..-. ''9 .a,. - .... .- .SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT e Prevention Services ,rl~~ 9001Yuxtun Ave., Suite 210 ~R>rr Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSP CTION AT NSPECTION IME ADDRESS I/~~ ,'L ~,1~~ I ~~~ ~ I ~ J HONE~~'~ B OOF PLOYEES FACILITY CONTACT .Y1~pww,5 ~~~,~, INESS ID NUMBER US ~s-o2~-o~isl Section 1: Business Plan and Inventory Program ~ ~~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ~ ^ COMPLAINT ^ RE-INSPECTION • C V (c=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND L~ . / - ^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES - I~ ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ~j ~I ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE f~ ^ CONTAINERS PROPERLY LABELED ,~ ^ HOUSEKEEPING N. ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES j~NO EXPLAIN: - _ - _--. l~rt-G'~ ~ ~ 3Z~ - c7 g4-gL •QUES IONS REGARDING THIS INSPECTION?2,PLEASE CALL US AT (881) 328-3879 CA./~ S ~ J ~, Inspector (PI Print) Fire Prevention / t`t In / Shift of tation # Business S0e/School Site Res i Party (Please Pritt) White - Prwention Services Yellow -Station Copy pink - Buaineas Copy FD20~8 (Rw. OZ/05- ~. ,: + KLEINS FIRE PROTECTION & EXT ________________________ SiteID: 015-021-001514 + Manager BusPhone: (661) 835-1591 Location: 5630 DISTRICT BLVD 121 Map 123 CommHaz Minimal City BAKERSFIELD Grid: 13B FacUnits: 1 AOV: CommCode: BFD STA 13 SIC Code:7389 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title THOMAS KLEIN / OWNER / Business Phone: (661) 835-1591x Business Phone: ( ) - x 24-Hour Phone (760) 379-2797x 24-Hour Phone ( ) - x Pager Phone (661) 333-0265x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact Phone: -(661) 835-1591x MailAddr: PO BOX 1038 State: CA City LAKE ISABELLA Zip 93240 Owner THOMAS D KLEIN Phone: (661) 835-1591x Address PO BOX 1038 State: CA City LAKE ISABELLA Zip 93240 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT ~~~ APR 1 ~ 2DO6 Based on my inquiry of those individuals responsible far abtaining the information, I certify under penalty of taw that I have personally examined and am fzmiliar with the information submitted and i7alirwe the information is true, accurate, and complete. " 1, i uFe Date -1- 03/14/2006 ~-N~F~ED PROGRAM INSPECTION CHECKLIST :.~ SECTION 1 Business ,Plan and Inventory PirC~gram U Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME .- -... _ ADORESS PHONE No. No. of Em yeas as ~ - q.~s = rs9 ~ /__--- -- _ - FACILITYCO T Business ID Number o ` ~ /j 15-021- po/S t Section 1: Business Plan and Inventory Program toutine ~ Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection • ANY HAZARDOUS WASTE ON SITE?: ^ YES ®-IQO /'' EXPLAIN: (~ iti/t L ~ S C G ~~ ~ Ct>~fA~ `~ f~ ~~ .. ~~ ~ ~ ~~ • QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~66'I ~ 326-3979 tns ctor ase ~ J Fire Prevention ist-In/Shift of Site White -Environmental Services Yellow • Station Copy ~~ ~ c _._ _. _ ~~~ a~--c --.. .- -- Busi ess ife Responsible Pa ( Print) Pink • 8usines8 Copy KLEINS FIRE ROTECT & EXTR SVC SiteID: 0t5~-- t,~001514 Manager : BusPhone: (661) 835-1591 Location: 5630. DISTRICT BLVD 121 ~~ Map : 123 CommHaz. : Minimal City : BAKERSFIELD Grid: 13B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 13 ~ SIC Code:7389 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title THOMAS KLEIN / OWNER / Business Phone: (661) 835-1591x Business Phone: ( ) - x 24-Hour Phone : (760) 379-2797x 24-Hour Phone : ( ) - x Pager Phone : (661) 329-0944x Pager Phone : ( ) - x Hazmat HazardS: Fire Press ImmHlth Contact : Phone: (661) 835-1591x MailAddr: PO BOX 1038 State: CA City : LAKE ISABELLA Zip : 93240 Owner THOMAS D KLEIN Phone: (661) 835-1591x Address : PO BOX 1038 State: CA City : LAKE ISABELLA Zip : 93240 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: '--/~"~'"~-- "'--~ I, "r;,~m~.~.. ~/P_ Do hereby cerfi~ thru ! have .~ . reviewed ths a~ached h~ardous materials ~ msnt plan ~or~/~/~ ~ ~ t~t it alon~ wi~h . =ny ~~ons ~nst~tuts a ~mplsts end ~rr~ man- ~ement plan for my facility. 1 08/22/2003 KLEINS FIRE PROTECTION & EXTR SVC SiteID: 215-000-001514 Manager : ~ ..... BusPhone: (805) 835-1591 Location: 5630 DISTRICT BL Map : 123 CommHaz : Minimal City : BAKERSFIELD Grid: 13B FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 13 SIC Code:7389 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title THOMAS KLEIN ~ OWNER -~~ Business Phone: ) 835-1591x Business Phone: (~%)?~-l~! x 24-Hour Phone : (~) 379-2797x 24-Hour Phone : (7~9 -~7 x Pager Phone : (~) - x Pager Phone : (~)~Z~ -Oqqq x Hazmat Hazards: Fire Press ImmHlth Contact : ~Mt ~kkS,~ Phone: (~&~)g~-' -I~'~1 x MailAddr: PO BOX 1038 State: CA City : LAKE ISABELLA Zip : 93240 Owner THOMAS D. KLEIN Phone: (805) 835-1591x Address : PO BOX 1038 State: CA City : LAKE ISABELLA Zip : 93240 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: ~C~: No Emergency Directives: E~tRON. I, T~ow,~,s 7), ~,.~;~_ .Do hereby certify that I have (Type or pdnt n~me) reviewed the attached hazardous materials manage- ment plan for K[PJ~ ~e_.~.~-. and that it along with (Name o! Business) any corrections constitute a complets and correct man- agement plan ior my facilily. Signature J Date 1 02/28/2000 F KLEINS FIRE PROTECTION & EXTR SVC SiteID: 215-000-001514 = Hazmat Inventory By Facility Unit --Alphabetical Order Fixed Containers at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax Unit MCP CARBON DIOXIDE F P IH G 326.00 FT3 Min NITROGEN COMPRESSED P IH G 1824.00 FT3 Min -2- 02/28/2000 KLEINS FIRE PROTECTION & EXTR SVC SiteID: 215-000-001514 = Inventory Item 0002 Facility Unit: Fixed Containers at Site CARBON DIOXIDE Days On Site Location within this Facility Unit Map: Grid: ,- CAS# Gas Pure Above Ambient Cryogenic, INSITL.TANK / CRYOGENIC I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average I~'~c~,,.~.. FT3 32~.00 FT3 40.00 FT3 100.00 Carbon Dioxide N 124389 HAZARD ASSESSMENTS TSecretINo N~S I Bi°HasINo Radi°active/Am°untlEPANo/ Curies F P HazardsiH NFPA/// USDOT# MinMCP = Inventory Item 0001 Facility Unit: Fixed Containers at Site ~tvUVl~ ~Vl~ / ~± ~,/--LL.~ ~Vl~ NITROGEN COMPRESSED Days On Site Location within this Facility Unit Map: Grid: F STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas /Pure I Ambient I Ambient I PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average ~_,R,~.~.~_..~L.. FT3I 1824.00 FT3I 800.00 FT3 ZARDOUS COMPONENTS I 100.00 Nitrogen N ??2?3?9 HAZARD ASSESSMENTS TSecretINO N~S I BioHazNo Radioactive/AmountNo/ Curies EPAp HazardsiH NFPA/// I USDOT# IMCpMin 3 '02/28/2000 F KLEINS FIRE PROTECTION & EXTR SVC SiteID: 215-000-001514 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 10/10/1994 DIAL 911 AND OFFICE OF EMERGENCY SERVICES 1-800-852-7550. -- Employee Notif./Evacuation 10/10/1994 VERBAL Public Notif./Evacuation 10/10/1994 VERBAL Emergency Medical Plan 10/10/1994 TRANSPORT TO NEAREST HOSPITAL. -4- 02/28/2000 F KLEINS FIRE PROTECTION & EXTR SVC SiteID: 215-000-001514 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 10/10/1994 KEEP CYLINDERS CHAINED AND KEEP SHIPPING CAPS IN PLACE WHEN NOT IN USE. --Release Containment 10/10/1994 OPEN ROLL-UP DOOR AND ALLOW TO ESCAPE TO ATMOSPHERE. -- Clean Up 10/10/1994 NONE NECESSARY - INERT GAS Other Resource Activation -5- 02/28/2000 F KLEINS FIRE PROTECTION & EXTR SVC SiteID: 215-000-001514 I Fast Format F Site Emergency Factors Overall Site Hazards --Utility Shut-Offs 10/10/1994 NATURAL GAS/PROPANE: NONE ELECTRICAL: SOUTHEAST CORNER OF 5630 DISTRICT BLVD. WATER: APPROXIMATELY 20' SOUTH OF 5610 DISTRICT BLVD., SUITE 104. LOCK BOX: NO. -- Fire Protec./Avail. Water 10/10/1994 FIRE HYDRANT IN FRONT OF WEST 5630 DISTRICT BLVD., SUITE 122. Building Occupancy Level -6- 02/28/2000 KLEINS FIRE PROTECTION & EXTR SVC SiteID: 215-000-001514 Fast Format ~ Training Overall Site -- Employee Training 10/10/1994 NUMBER OF EMPLOYEES: 1 MATERIALS SAFETY DATA SHEETS ON FILE: YES BRIEF SUMMARY OF TRAINING PROGRAM: READ MSDS, WATCH VIDEO TAPE PREPARED BY NATIONAL ASSOCIATION OF FIRE EQUIPMENT, DIST. (NAFED), STUDY NAFED TRAINING MANUAL, ON THE JOB TRAINING. Page 2 Held for Future Use I Held for Future use I 7 02/28/2000 BAKERSFIELD CITY FI-RE:' DEPARTMENT. HAZARDOUS MATERIALS DIVISION 2130 "G" STREET HI~.ARDOU$ MATERIALS MANAGEMENT PI_~N 4~) ~ ' " ". ~C~. 5 ~c~v~ 1. To avoid further,action., return this farm' within 30 days of receipt. ~'~N;2 4 ~)94J '2. TYPE/PRINT ANSWERS IN ENGLISH. ~AZ.--v.MAT"'DI- 3. Answer the questions below for the business as a whole. 4. Be Cbdet and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME: 'j~ LI~ II~S LOCATION: MAILING ADDRESS: ~ O. ~Og. 10~ CITY: ~ DUN & BRADSTRE'ET NUMBER: SIC CODE: PRIMARY ACTIVEY: Ft~ ~, ~b~ ~ ~d~- OWNER: ~o'~ MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24. HR. PHONE 2. Bakersfield Fire Dept. · '; " -. zardous 1V~terials Division HAZARDOUS MATERiALS.MANAGEMeNT PLAN SECTION 5: TRAINING: NUMBER OF EMPLOYEES: I f(:gt,,O/t.)*i~b- MATERIAL. SAFETY DATA SHEETS. ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: sECTION 4: EX£MPTION R£QUEST:_ I cERTIFY UNDER PENALTY OF PERJURY THATMY BUSINESS IS EXEMPT'FROM THE REPORTING REQUIREMENTS OF' CHAPTER 6.95 OF THE "CALtF'ORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE OD.NOT HANDLE HAZAROOUS MATERIALs. WE OD HANDLE HAZARDOUS MATERIALS, 8UT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTF[.iES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, TIA~_ I,~t,~,5 TjX. Kt..~t~ 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 SAFSTY CODE" ON HAZARDOUS MATERIALS (DIV.. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INA C CU RA-TE INFO R MATION-CONSTITUTES. PERJURY. StGNATURff TiTLe:' OAT~_ .-~. Bakersfield Fire Dept. H~RDOUS MATERIALS MANAGEME~NT !FaciJity UnitNa.me: STOCKDALE BUSINESS CENTER 'SEC?ION 6: NOTIFICAT{OrN AND 'EVACUATION PROC!EDU, R~ES: 'A. AGENCY NOTIFICATIO. N PROCEDUR, ES: DIAL '91 li ~ 6~D. ,1: -~8:.0,.0- 8.52- 7,5 50, ~(:OFFICE :OF EMERGEN,CY SERVLCES )~ .~B, :EMFLOYEE N. ,O,TI,FICA.'['.~IOCN ANo .EVA,C'UAT!O~N; VERBAL ,C, PUSi'!C EVA.C:UA~ION: . VERBAL ,D, 'EMER, G, EN~CY M!ED¢iCAL ~P!LAN: ,T,,R,ANSROR,T .T,,O. NE~-,R,E;S~T; .E, OiS. P,I ,TAL Z i. 99-Z6[: (cjog) 'sell I~Z 1. O-/..6e (cJOg) .sng ~ I..~1~6 VO 'pleusJeNetg tx L L# el!ns "P^I8 },o!J~,S!Q OC9g Buj.ujeJJ. eo!AJeS sales Bake~field Fke Dept Hazardous Materials Divi. s -HAZARDOUS MATERIALS MANAGEMENT*PLAN ~EC~I~ON 7:: 'M, ITI:GATION,~, ;PREV E:NTi~ON AND A HA?EM ENT :PLA N: A. :EEL,EASE P'~EVE:N~IO~Ni 'S~E.P,S: KE.E? .CYLINDERS CHAINED AND KEEP .SHIPPING C:A.P,S IN P, LACE WHEN NO~ IN USE B. ~EL,EASE CON~AI:NMENT A,ND/QR MIN!MIZAT[ON: .OPEN ROLL-UP DOO.R AND. ALL0~ TO ESCAPE TO ATMQSPHERE .C. CLEAN-UP PR:OCEDURES: NONE NECESSARY -INERT'-'.GAS :SECTION 8; , ~rrlLrrY $,HLIT.OFF$ (LO,CATION .OF S.,HU:T-QF:FS AT YOUR FACrlLITY),: :NATU:RAL .G.AS,/PROPANE: ,( NiONE ). :EL,ECTI~tC,AL: s_..E.,. ,CORNER ,OF 56,3~0 D,ISTRI,OT BLV, D~ ~VAT'E~: .ApP. R0,X, 20;' S,O,,. OF 56;1 0, DISTRICT BLVD. r S.UIT.E104 SREOIAL: ~L. QCK-B~OX: YES~..'~ .IF YES, 'LOCATI,ON: ,SECTION 9: PRIVATE FIRE PROTECTION/WATER ,AVAILABILITY: A, .PRIVATE FIRE P,R,O;TE.C'T, ION:' ,:AUT. OMAT!C SPRINKLER SYST,EM 5, WATE!R',AV:A..I:L,A;B;I~LI:TY ~(?IR~E H:YDRAN~)::: IN '..FR0;NT~ OF ( WE;ST ), 5,6 3 0; DISTRI~CT BLV'D.. SUIT,E .!.22 ' :' .... '"', BAKE~FIELD 'CITY FIRE DEI~RTMENT HAZARDOUS MATERIALS DIVISION . 2130 "G" STREET =::~__~ ... BAKERSFIELD, CA, 93301 "~-~'zzz/ ~%~'~ (805) 326?979 ~ H~ARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] FACtLI~ NAME SiC CODE DUN & BRADSTREET NUMBER EMERGENCY CONTACTS NAME "T~It/[A;5 '~, Kt....~.t,/~ TITLE NAME TITLE BUSINESS PHONE 24-HOUR PHONE ' BAKERSFI :D Cl'i' FIRE'DEPAI: i ENT HAZAR] DUs MATERIALS INVENTOWY CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition ( -] Revision ( ] Deletion { [ . Check if chemical is a NON TRADE SECRET 2) Common Nax'ne: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PhYSiCAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate HeaJth (A~:ute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code Eom DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY UNITS OF M~SURE 8) STORAGE CODES ' Maximum Daily Amount: lbs [ ] gal [ ] 1t3 [ ] &) Container: Average Daily Amount: curies [ ] b) Pressure: Annual Amount: c) Temperature: Largest 'Size'Container: # Days On Site Circle W'nich Months: All"ear, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT .CAS # % WT AHM the three most haz~do~s 1 ) chemical components or any AHM components 2) [ ] 3) 1 o) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New[ ] Addition [ ] Revision[ ] Deletion[ ] Check ifchemicaJis ~NON TRADE SECRET [ ] TRADE SECRET [ 2) Common Name: 3) DOT # (optional) Chemical Name: ~ AHM [ ] CAS # fi,) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Releaseof Pressure ( ] immediate Health (Acute) ( ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICAT{ON .(3-digit code from DHS Form 8022) USE COOE 6) P'HYSICALSTATE Solid ( ] Uquid ( ] Gas ( ] Pure ( ] Mixture, [ ] Waste [ ] Radioactive ( ] 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE COOES Maximum Daily Amount: f lbs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: cudes [ ] b) Pressure: Annual Amount: c) Temperature: L.~'gest Size Container: # Days On Site Circle Which Months: All Year. J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: Ust f COMPONENT CAS # % WT ' AHM the three most hazardous 1) [ ] chemicaJ components or "" ~ny AHM components 2) '" [ ] 3) [ 10) Location personally examined and am familiar wi~h ~11e intomafion suPmitted on submitted informe~on is true, accurate, and complete.. -~. PRINT Name & Title of Authorized Company Representa~ve . Signature Date BAKERSFI D CITY FIRE DEPAIF MENT HAZARDOUS MATERIALS INVENT01 Y Page_ o,f cHEMICAL DESCRI~ION IN~NTORY STA~S: New ~ Addition [ ] Revision [ ] Deletion [ ] Check if chemic~ is ~ NON ~DE SECR~ [ I '~ I Chemi~ N~e: AHM [ ] CAS 4) .PHYSICAL & H~L~ PHYSICAL. H~L~ H~RD CA~GORIES Fire [ ] Reactive [ ] Sudden Rele~e of Pressure ~ Immediate Health (Acute) {~ Delayed He~h (Chronic) 5) WAS~'~'~SSIFICA~ON (3-digit code kom DHS Fo~ 8022) USE CODE 6) PHYSICAL STA~ Solid [ ] Uquid [ ] G~ ~ Pure [ ] M~ure '~] W~te [ ]. Radioa~Ne.[ ] 7) AMOUNT AND nME AT FACIU~ ~ '~., · UN~8 OF M~SURE / 8) STOOGE CQDES M~mum Oaly Amount: t~ [] g~ [] ~3 ~ a) Contaner: Average Daly Amount: cu~es [ ] b) Pressure: ~nua Amount: ~ ~- ~ c).Temper~ure: ~gest Size'Contaner: ~ ~ ~. ~ D~ On Site ~ ' Cimle~ich Months: ~J, F, M, A, M, J, J, A, S, O, N, O 9) MITRE: . Dst COMPONENT CAS · % ~ AHM the three most h~dous 1 ) chemi~ com~nen~ or ~y AHM com~nents 2). [ ] 3). [ ] lC) Lo~tion CHEMICAL DESCRI~ION ) IN~NTQ~Y STA~S: New [~ Add,ion { ] Re.sion [ ] Deleaon [ ] Check ~ chemi~ is ~ NON ~DE SEC~ [ ] ~DE SECR~ [ ] Chemica N~e: ~ AHM [ ] CAS 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GORIES Fire [ ] Rea~ive [ ] Sudden Rele~e of Pressure [ ] Immedi~e He~h (Ac~e) [~ ~laYed He~th (Chronic) [ ] 5) WASTE C~SSIFICA~ON ,(3~igi~ code ~om OHS Fo~ 8022)' USE COON 6) PHYSICAL STA~ Solid [ ] Uquid [ ] G~ ~ Pure [ ] Mi~ure '[ ] W~te [ ] Radioa~ive [ ] 7) AMOUNT AND ~ME AT FACIU~ ~ , UNI~_ OF M~SURE~/ 8) STOOGE COONS Average D~y Amount: ' [ ] . ~ b) Pressure: Annua Amount: ~ ~~ c) Temperate: ~ O~ On Site ~ · Circte~ich Months: ~IY~, J, F, M, A, M, J,.. J, A, S, O, N, 9) MITRE: · Ust CQMPONE~ CAS · % ~ AHM the three most h~dous 1). [ ] chemi~ com~nen~ or ~y ~M com~nents 2) " [ i "" 10) Lo~ien ' ce~ u~er pen~ of Jaw, ~a~ J have pe~on~ly ex~in~ ~d ~ t~iii~ wi~ ~e mfoma~on suDm~ on ~s ~d ~l ~ch~ dOcumen~ subm~ in~a~on is ~e, accumm,~d complete. '~.'. -- PRI~ N~e & ~ffe of A~ofiz~ Com~ Represenm~ve Signa~m ' BAKERSFI i .D CITY FIRE DEPAI: MENT HAZARDOUS MATERIALS INVENTO'I~FY Page--~;'~'i__~ ~siness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ 2) Common Name: 3) DOT # (opQonal) Chemical Name: AHM [ ] cas # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release cf Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACILITY . UNITS OF MEASURE 8) STOP, AGE CODES Maximum Daily Amount: lbs [ ] gal [ ] ¢c3 [ ] a) Container:- Average Daily Amount: cudes [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size'Container: # Days On Site Circle Which Months: All Year, J, F, M, A. M, J, J, A, S, '0, N, O' 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazaxdous 1). ; [ ] chemical components or a. ny AHM components 2) [ ] [1 1 O) LocaZion CHEMICAL DESCRIPTION ~) INVENTORY'STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ 2) Common Ne. me: 3) DOT # (opQonaJ) ChemicaJ Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate He~th (Acute) [ ] Delayed Health (Chronic) [ 5) WASTE CLASSIFICATION (3-digit code from OHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas 7) AMOUNT AND TiME AT FACIUTY UNITS OF MEASURE 8) STORAGE COOES Maximum Daily Amount: lbs [ ] gaJ [ ] ft3 [ ] a) Container:, Average Daily Amount: curies [ ] b) Pressure: Annual Amobnt: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, 9) MIXTURE: Ust COMPONENT CAS # % WT AHM the three most'hazardous 1) [ ] chemical components~or ~ny AHM components 2) " [ 3) 10) Location ' ~ cer~[y un~ler penalty o/law, ~at I have per~onaily exarn[ne<f and am familiar submitted informal'on is ~e, accurate, and complete, PRINT Name & TiUe of Authorized Company i~eprasenta~ve Signature. Date UNIFIED PROGRAM INSPECTION CHECKLIST ~' ,. _...,. ...~ ..t ..-. ''9 .a,. - .... .- .SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT e Prevention Services ,rl~~ 9001Yuxtun Ave., Suite 210 ~R>rr Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSP CTION AT NSPECTION IME ADDRESS I/~~ ,'L ~,1~~ I ~~~ ~ I ~ J HONE~~'~ B OOF PLOYEES FACILITY CONTACT .Y1~pww,5 ~~~,~, INESS ID NUMBER US ~s-o2~-o~isl Section 1: Business Plan and Inventory Program ~ ~~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ~ ^ COMPLAINT ^ RE-INSPECTION • C V (c=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND L~ . / - ^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES - I~ ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ~j ~I ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE f~ ^ CONTAINERS PROPERLY LABELED ,~ ^ HOUSEKEEPING N. ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES j~NO EXPLAIN: - _ - _--. l~rt-G'~ ~ ~ 3Z~ - c7 g4-gL •QUES IONS REGARDING THIS INSPECTION?2,PLEASE CALL US AT (881) 328-3879 CA./~ S ~ J ~, Inspector (PI Print) Fire Prevention / t`t In / Shift of tation # Business S0e/School Site Res i Party (Please Pritt) White - Prwention Services Yellow -Station Copy pink - Buaineas Copy FD20~8 (Rw. OZ/05- ~-N~F~ED PROGRAM INSPECTION CHECKLIST :.~ SECTION 1 Business ,Plan and Inventory PirC~gram U Bakersfield Fire Dept. 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