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Home My WebLink AboutBUSINESS PLAN CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME~~ INSPECTION DATE I O "3 ADDRESS ~-~?/7.3 [~."7'1~1":t;:f--103 PHONENO. ~732 FACILITY CONTACT~P.O/~Zie~C I~lx~bOl~_..4"' BUSINESS ID NO. 15-210- INSPECTION TIME ~.~ ~ t ~ NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~l Routine I~l Combined I~[ Joint Agency [~l Multi-Agency [~ Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities \~'~ Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures .~ _~ ~/~Q,~---~.~ Emergency procedures adequate ~(~ '~[~.~ ~ Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation ~4{.J~ Any hazardous waste on site?: ~Yes []No Explain: ---- CITY OF BAKERSFIELD OF ENVIRONMENTAL SF~ICES 1715 Chester Ave., Bakersfield, CA (66~26-3979 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 as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. 'SECTION I: BUSINESS IDENTIFICA~TION DATA BUSINESS NAME: (__.~eo~_~ril' <~o,oio. oq '. '.'. ~L~'G ~D~SS: -- -- __ CITY: ~~~ STA~:~ ZIP: q55'~PHONE: ~t [3zqosq MAILING ADDP,2SS' EMERGENCY NOTIFICATION · CONTACT TITLE BUS. PHONE 24 HR. PHONE HAZARDOUS MATERIALS ~,L4,NAGEME 'LAN SECTION II. 1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. ENVIRONMENTAL RESPONSE MANAGEMENT: D. EMERGENCY MEDICAL PLAN: :t:'?,~f HA DOUS MATERIALS MANAGE PLAN ~ A. HAZA~ ASSESSMENT AND P~VENTION MEAS~s: B. ~LEASE CONTENT ~/OR ~TIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) · ... NATURAL GAS/PROPANE: ELECTRICAL: tSr~la,- [~e_,,4~A i~. o;2'~· WATER:' SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY HAZA~DUS MATERIALS MANAGEM PLAN NUMBER OF EMPLOYEES: /~ -. ~ MATERIAL SAFETY DATA SHEETS' ON'FILE: '~oC~.~C[ 'tgt" ~ C:~ BRIEF SUMMARY OF TRAINING PROGRAM: " ~": ' ' ', "' .i ' ":; ~ ';' ' '" '" ~':" ". ' I, ,kat,,,. av~ d'r~ CERTIFY THAT THE ABOVE INFORMATION 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 INFORMATIQN CONSTITUTES PER.K1RY~ ..... TITLE SI~TURE DATE II.AZ MAT MNOMN'F PLAN & INSTRU(2 '~": . . : : ,, CITY OF BAKERSFIE[ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) ~6-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS SECTION I. - BUSINESS IDENTIFICATION DATA: The Business Owner / Operator Form, Chemical Description Form(s) and other Forms (e.g.: underground storage tank information, hazardous waste treatment, etc., as needed) may be submitted as the first section of the Hazardous Materials Management Plan in order to avoid duplication of information for initial submissions. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. 1 - DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Describe the procedures an{equip__ment u~s_ed to detect any__rele~e or_thr__e~at._e_ned release of a hazardous material from any storage container, tank, or vessel at your business. Please provide a written explanation that also includes the make and model number of any automated or electronic leak detection equipment in use at your facility. B. EM'PLOYEE AND AGENCY NOTIFICATION: , What agencies and or corporate officials are notified in case of a hazardous materials spill or emergency -- What procedures are used to notify these parties? At a minimum, you must call 9-1-1 and the Office 'of Emergency Services at 1-800- 852-7550 to report any spills that are a threat to life, safety or the environment, or for other non-emergency spill reporting, please call our office at (661) 326-3979. C. ENVIRONMENTAL RESPONSE MANAGEMENT: Please describe who will be responsible for what activities (notifying authorities, clean-up companies, etc.), and what the chain-of-command is at your facility for making sure these activities are carried out. D. EMERGENCY MEDICAL PLAN: Summarize your plan for handling medical emergencies occurring at your business. List the local medical facility capable of handling an accident i, ",-,lying Hazardous Materials used at your business. HAZARDO US MATERIALS PLAN SECTION II.2 - RELEASE RESPONSE PLAN ~5, A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Explain the procedures that you have developed and implemented to help prevent an incident from occurring. These steps could include, but are not limited to, storage methods, container types, segregation, safety equipment, and/or procedures used. B. RELEASE CONTAINMENT AND/OR MITIGATION: Explain the procedures that you have developed and implemented to assist in keeping a hazardous materials incident at your business as small or confined as possible. C. CLEAN-UP AND RECOVERY PROCEDURES: Explain what clean up procedures will be implemented in case of a release at your business. This should address small spills, as well as a major release of material once the material is · .. contained. Hazardous Waste: Please provide the name of the hazardous waste company that regularly removes the wastes from your business, and how often that waste is removed. Please keeP all dispoial-receipts for the-last-three years availabl.e._on site for inspection. UTILITY SHUT-OFFS List locationS of shut offs using compass points and known or obvious landmarks. If you have a lock box containing keys and maps of the facility for the Fire Department to use, please list its location also. PRIVATE FIRE PROTECTION/WATER AVAILABILITY A.: Private Fire Protection: Describe on-Site fire protection for Your business or facility unit, including sprinklers, fire extinguishers, alarm systems and private response teams. ~.'i' B. Water Availability (Fire Hydrant): Give the location of the closest water supply · ~ or fire hydrant to be used by the Fire Department in caz: of an emergency. SEC ,. T[ON [11 - T~ List the number of employees that are working in the area ,..~.'.fl'te hazardous materials, use or storage. Include all employees who have ~y occasion'to be in those ~eas. Give the location where Material Safety Data Sheets (MSDS) are kept on tile. The MSDS must be readily available on site in a place where employees can access them. Give a brief summary of your Hazardous Materials Training Program. Employees are required by State law to have a program which provides employees with initial and refresher training in the following areas: l) Methods for safe handling of the hazardous materials used by your business. 2) The Cai OSHA Hazard Communication Standard. 3) Correct use of emergency response equipment and supplies available at your business. .. 4) The prevention, minimizing and clean up procedures you have developed for your business. 5) The emergency evacuation plans you have developed, as well as, your notification procedure and medical plan. 6) Procedure to coordinate with and assist the local emergency personnel that may respond to your business 7) Who and how to call for immediate assistance in the event of an a:ccident involving hazardous materials. CERTIFICATION Please fill in your name, title, and sign and date on the signature line. IMPORTANT You must return this plan, inventory forms, and map within 30 days of receipt. If you have any questions please call us at (661) 326-3979 - 'rhank you for helping to keep our All America City cleaner and safer. 3 OFFi~E'OF ENVIR0~MENTAL S VICES ~71rChester Ave., CA.93301 (661) [-3979 BUSINESS OWNER / OPERATOR IDENTIFICATION FACILITY INFORMATION I. FACILITY IDENTIFICATION FACILITY ID # '1 I : 1 Year Beginning Ioo Year Ending BUSINg'SS NAME ~Samo as FACILITY NAMfi or DBA- Ooing Business As) 3 BUSINESS PHONE(,~(~,~,'' ~"~'- 6'~"~c'~"i ,02 SITE ADDRESS '.~ ~t~t~ ~tu~'~XO~' ,03 CITY .~~~[~ ........................................................... ......... ~ .': .... CA .................................. ZIP ~}~ ~0s DUN & ~ SIC CODE ~o7 D~DSTREET (4 Digit ~) COUNTY ~oa OPE~TOR NAME ~ OPE~TOR PHONE ~o il. OWNER INFORMATION OWNER MAILING III. ENVIRONMENTAL CONTACT - CONTACT NAME ~r CONTACT PHONE CONTACT MAILING ADDRESS CITY ~ ' STATE ~ ZIP -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- TITLL O¢ M~ - ' ~2S [ TITLE ,~ [_ ~, ' 24-HOURPHONE ~ ~q~ ~ ~[_~ .......................... PAGER ¢ ~28 ' PAGER ¢ V. CERTIFICATION ,Uertification: Based on my inquiw of ~oso Individuals responsible for obtaining tho info~atlon, I cedi~ under penal¢ of law that 1 have personally examined and am familiar ~th tho Information submitt~ in this invontow and believe the info~atlon Is tree, accurate, and complete. ............................................................................OF OWNE~OPEmTOR bX'f~ ................. ,;;- ~"~'5'¢ ~oCUMdhT" fiR'¢PX~ .................... SIGNATURE ~ , NAMES OF OWNE~OPE~TOR (pdnt) ........................... ~'~"' ~' TitLE o~'o~NE~6'PE~oR ...................... ~3~"' PCF (7/99) S:\CUPAFORMS\OE S2730.TV4.wpd :,,.::,,::,~:~,~:~~~ OF OF ENVIRONMENTAL S~VICES 17 Chester Ave., CA 93301 (661)~6-3979 ~~ ~ '~ .... ' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one IOtm Der mate~ol Der Outl~mq or ~ NEW ~ ADO ~ OELETE ~ REVISE 2~ Page -- ~ I. FACILI~ INFORMATION CHEMI~L LOCATION 201 CHEMI~L LO~TION ~ Yes ~ No 202 CONFI~EN;IAL (E~) II. CHEMICAL INFORMATION CHEMI~L NAME ~. ~ Yes If Subj~ to EPC~. ref~ to insignias 207 COnNiE . EHS' ~Y~ ~No ' 210 ~E ~ p PURE ~ m MI~URE ~w WASTE 2~1 ; ~DIOACTIVE ~ Y~ ~ No 212 CURIES 2~3 PHYSt~L STATE ~ s ~LID ~1 LIQUID ~ g ~S 214' ~GEST~NTAINER 215 FED H~D ~TE~RIES ~ I FIRE ~ 2 ~CT~E ~ 3 ~ESSURE REdE ~ 4 ACUTE H~ ~ 5 CHRONIC H~ 216 ALWASTE 217 i ~M 218 i A~GE 219 STATE WASTE C~E UN~S' ~ ga ~ ~ d CU~ ~ ~ LBS ~ ~ TONS .- ~1 OAYSONS~E ' E ~S. ~nt must ~ ~ ~s. STOOGE ~A~NER ~ a ~GROUND T~K ~ · ~STI~ONM~ALLIC DRUM ~ i FlOR DRUM ~ m G~SS BO~E ~ q ~IL ~R (Check all ~at app.) . ~ c T~K INSIOE BUI~ING ~ g ~BOY ~ k ~X ~ o TOTE BIN ~ d STEEL ORUM ~ h SILO ): ~ I C~INDER ~ p TANK WAGON STOOGE PRESSURE ~ a ~IE~ ~ ~ ~ ~BI~ ~ ba BELOW~IE~ STOOGE T~~ ' ~ a~IE~ ~ ~ ~E~ ~ ba BELOW~IE~ ~ c CRYOGENIC %~ H~RDOUS COMPONE~ ,.~ EHS CAS g 1 226 i ~7 ~ ~y~ ~No 228 ~ 2 230 ~ ~ 231 , ~y~ ~No 232 : IlL SIGNATURE JPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wp~ OFFICL OF ENVIRONMENTAL SEK C'ES '. 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 FACILITY INFORMATION Business Activities Addendum Page of I, FACILITY IDENTIFICATION Ill. CONSOLIDATED PERMIT ACTIVITIES Is your Facility Compliance Plan subject to review by... ' for satisfying the conditions of these permits? H. DEPARTMI=NT OF TOXIC SUBSTANCES CONTROL OYES ~NO ~' STANDARDIZED PERMIT All Modifications OYES ~NO ¢' Non-RCRA HAZARDOUS WASTE FACILITY OYES ~NO ¢' RCRA HAZARDOUS WASTE FACILITY I. S~,N JO^QUIN VALLEY UNIFIED AIR POLLUTtON OYES ~NO ~ AUTHORITY TO CONSTRUCT CONTROL OISTRICT OYES ~INO v' PERMIT TO OPERATE J. STATE WATER RESOURCES CONTROL BOARD OYES ~INO ¢ WASTE DISCHARGE REQUIREMENT (WDR) :NTRAL VALLEY REGIONAL WATER QUALITY CONTROL OY~S ~INO ¢' GENERAL PERMITS dOARD . -. ....... · ~ (~)YE-S (~tqO ¢ SPECIFIC PERMITS C' { ¢' NATIONAL POLLUTION DISCHARGE OYES ~INO ~ ELIMINATION SYSTEM (NPDES) K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD OYES I~NO i v' REGISTRATION PERMIT "'L. KERN COUNTY RESOURCE MANAGEMENT AGENCY ,,_ ENVIRONMENTAL HEALTH SERVICES PERMITS oY~S ~I~NO ~ Domestic Water Well Permit - OYES t~NO ¢ Haz Mat Monitoring Well Permit OYES ~NO v' Septic System Permit OYB,¢ ~INO ,/ Public Swimming Pool Permit OYE,,~ ~NO ¢ Food Facility Construction Permit OYES ~NO ¢' Solid Waste Local Enforcement Agency ~, i (LEA) Related Permits OYES t~NO J ¢' Medical Waste Related Permffs " I PERMIT NOTE: ~'~ v' It' you checked YES to any part of Sections IlI-H to III-M above, then please address all applicable permit requirements in the Facility Compliance Plan. ,~,CITY OF BAKERSFIELD " OFFIO~OF ENVIRONMENTAL SE] ICES I1_":1 r 1715 'Chester Ave.,.CA 93301 (661) 3~ ;979 ~X~..;.~/,.,z FACILITY INFORMATION Business Ac{iW{ies ~age I. FACILITY IDENTIFICATION FACILITY ID ~ IF~ ol~co use ~y · please leave Dlan~) I . EPA ID ~ ........ > ............................................................................ II. ACTIVITIES DECLAraTION Does %our Facili~... . If Yes, Please Complete... ~' '~A~'RDO~S ................................................. MATERIALS ~9~ 'i~ ..... ~ .....~-- ......... ~-E~-FoRM' 2~1 ~C~,C', O~'~'F-~I 1, Hav~ on sito {for any purposo) hazardous materials at or ~ CONSOLIDATED COMPLIANCE P~N above 55 gallons ~or liquids, ~0 ~unds ~or solids, or 200 [. ~nimum r~uir~ planninq elemems: cu ~ for compmss~ gases {includo liquids in ASTs and · Emergency Response Plan USTs)? · Maps 2, Have any amount of an explosive matedal {other than OY~S ~NO 5 · Training ammuni~on) on site? ~ Prevention ,,., e Ce~ifications "~i'-R'~u~f~6'~d~gXh'~-{ks) OYES ~O ~ g OES FOa~'2'iSi-~',g;'~~ ................ Have onsite RS at greater than the threshold planning '~- ~ RISK MANAGEMENT P~N (R~ ~mit quantities establishod by ~ California Accidental ~ CONSOLIOATED COMPLIANCE Release Prevention program {CalARP)? '~L · Incorporating CatARP Program Elements ~'~Bb'~'~-~O~GE TANKS {USTs) OYES eNO ~ ~ Ug~-~%~iDT~"~6~M ~ ~ or operate Underground Storago Tanks? .~: ~ UST TANK FORM (m~ ~ ~ank) Intend to upgrade oxis~ng or install new USTs? OYES ~NO 8 ~ MST FACILITY FORM ~ ~ UST TANK FORM ....... ~ ¢ UST INSTAL~TION FORM (~e p~ tank) '~'~AN'~LOSURE I REMOVAL . OYES ~NO 9 ¢ UST TANk"~6~'('J~ute S~i~e p., lank) 1. Need to re~ closing a UST that held hazardous materials or waste? 2. Need to repoffi ~e closur~ removal of a tank that was OYeS ~NO ~0 ~ TANK CLOSURE FORM Classified as hazardous waste and clean~ onsite? '-~~"~ROUND PETROL~ STOOGE TANKS (ASTs) OY~S ~E~ ,, ~ CO~b~D~?~C~'~PLIANCE P~N ~ or operate ASTs above ~ese ~resholds: any tank · Inco~orating Federal Spill Prevention ~paci~ is grater ~an 660 gallons or ~e total ~paci~ Control and Countermeasure (SPCC) for the facili~ is greater ~an 1,320 gallons. " Elements pumuant to 40 CFR Pad 112 ' ~R'DOUS WASTE: ~ EPA IO nu~provide on this page 1. Generate hazardous ~ste? OY~S ~NO ~2 To obtain EPA ID~, please phone (916) 324-1781 2. Recycle more than 100 k~mo of recyclable materials at OY~S ~O ~ ~ RECYCLING FORM Ihe same Io~tion it was generated? 3. Recycle more than 100 kg/mo of recyclable materiats at OY~S ~NO ~ ~ RECYCLING FORM an offsite location different from the point of generation? .... 4. Treat Hazardous Waste on site? OYES ~NO ~ ~ TP FACILITY FORM (DTSC Form 1772) : ~ TP UNIT FORM (one per unit) 5. Subject to Financial Assurance requiremenls? OYeS ~O ~s ~ CERTIFICATION OF FINANCIAL ASSU~NCE 6. Consolidate Hazardous Waste generated at a remote OYES ~NO ~z ~ ~ REMOTE WASTE / CONSOLIDATION SITE site? NOTIFICATION FORM G. PERMIT CONSOLIOATION ....................................................... ZONE: ~ '~'¢~"~" '~"~"'J ..... ~o~S~'EI~E~"COMPL¥~"~'~ ............. Intend to consolidate other Cai/EPA agency permits? ~ · Incorporating all other environmental (If yes, please complete Section fil and attach) permit r~uirements per 27 CCR 10410 ~TE: / If you checked YES to any part of Sections IIA-IIG above, the~ in addition to the forms requested above, please Submit OES Form 2730. UPCF (7199) $ ACU PAF O RMS~ACTIVITY.wpU