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HomeMy WebLinkAboutBUSINESS PLAN MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE /-~-~7 NEWACCOUNT ADDRESS CHANGE CLOSE ACCT FINANCE CHARGE i OTHER ADJ " MAILING ADDRESS ~-~ ~(~) SITE ADDRESS PARCEL NUMBER (IF APPLICABL~ ADJUSTMENT CHG DATE CHARGE CODE ADJUSTMENT AMOUNT .~slness NOm'e~ For Office Use Only ..... ~'.. · ilil!::  M E M O R A N D U M FIRE DEPARTMENT 2101 H SREET D. S. NEEDHAM BAKERSFIELD, 93301 FIRE CHIEF RECEIVEB 326-3911 NOV 2 0 1991 TO ~--~'~-//e~- su.~c~- ~ ~/~- / .... HI~MP PLAN~ MAP sITE DIAGRAM, FACILITY DIAGRAM ~ " Business Name: .%"~7~' ',-,/~¢~r'//-~ ~ ~-e;,,~. (//c: ~ For O~o~ Us~ Only : First In Station: Area Map/t of Inspection Station: NORTH /"~ 111 ~"~' ~',,~"; i~ ! ~ I North ~o~ i !~o~ I ~ i BAKERSFIELD 124 ; 126 ~105 ' ~ ,....~ .... ...~~ ~ .,.~,~.~ "' , , · ..... 128 r,~03 '__~ ~ ~.' ',,. i ¢. SAN JOAQUIN FIR~ERVICE ~//d ~'mt~c'~'~'; 5630 DISTRICT BLVD., SUITE 124 BAKERSFIELD, CA. 93313 North  ERSFIELD Districl~ DISTffiCT B~ Hi~MP PLA~ MAP SITE DIAGRAM ~*' FACILITY DIAGRAM Business Name: ~-~" -~/~,~,~'/',~.~ ,'L-"~f~C ~ ~/C For Office Use Only First In Station: Area Map # of Inspection Station: NORTH Z~ North IBAKERSFIELD IBiJsiNi:ss (E~IED managing partner 805-397-0173 5630 district boulevard fire extinguisher sales and service suite 124 license number 503857 bakersfield, california 93313 ? ~: o~Q N FIRE SE£' SALES · SERVICE · TRAINING LEE JOHNSON 0 WNER 805-397-O173 5630 DISTRICT BLVD. RES: 397-661 7 SUITE 124 FAX: 805-397-7525 BAKERSFIELD, CA 93313 MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE (¢-.,.~-\~ -C'{~-.~ NEW ACCOUNT ADDRESS CHANGE CLOSE ACCT 'FINANCE CHARGE I OTHER ADJ MAILING ADDRESS ~~)~ ~ ~,__~'t ~ ~, ~ ~J '~', SITE ADDRESS PARCEL NUMBER (IF APPUCABLE) ADJUSTMENT CHG DATE CHARGE CODE ADJUSTMENT AMOUNT 09/07/94 -. SAN JOAQUINFIRE SERVICE 215-000-000306 Pa'ge 1 Overall Site with 1 Fac. Unit General Information Location: 5630 DISTRICT BLVD 124' Map:123 Haz:l Type: 3 City : Grid: 15D F/U: 1 AOV: 0.0 Contact Name N~ft~ ,,ER Contact Name Title LEROY JOHNSON / OW / Business Phone: (805) 397-0173x RI Business Phone: ( ) - x 24-Hour Phone : (805) 397-6617x Il 24-Hour Phone : ( ) - x Pho] : ( )3~ -~x ~[ Pager Phone : ( ) - x ~/~s t rat ive Data Mail Addrs: 5630 DISTRICT BLVD 124 D&B Numk~er: City: BAKERSFIELD State: CA Zip: 93313- Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code: 7389 Owner: LEROY JOHNSON Phone: (805) 397-0173 Address: 6301 MANCHESTER LN State: CA City: BAKERSFIELD Zip: 93309- Summary :' ~'00 ?~_~ _{),~ ~ ~ Bakersfield Fire Dept~ ~' HAZARDOUS MATERIALS DIVISION .__ Date Completed' /~~'~ Business Name: ~'~'~/'/1 I~0~ 0~,4-/l'/1. ~'l'jr"~ ~ ~/"'/,"~('. Location! ~:~3'{~) .r'~--J-i-..T~+ {"~ji/~ Business Identification No. 215-000 ,4~)00,.~C) ~ (Top of BusineSs Plan) · StationNo. 13 Shift ~') Inspector .-,~,~,,,[2,~.[,,/,,-,~, .~,./V~,~£~ - /.~ ~'.~!1.¢j~'{'¥~4,, '~ ] L/~" ,. Adequate Inadequate ~%~-9~..~.~ -e.. 43c,'~0- Verification of Inventory Materials ~ 'T'O~ I '1' i ~'C~-~ ~ Verification of Quantities ~/ Verification of Location I~ · Proper Segregation of Material~ Comments: Verification of MSDS Availablity ~ Number of Employees t"~t~ Verification of Haz Mat Training ~ Comments: Verification of Abatement Supplies & Procedures· ~ Comments: Emergency Procedures Posted ~ Containers Properly Labeled ~ Comments: Verification of Facility Diagram I~] ' Special Hazards Associated with this Facility: .~~~ All ltems O.K. ~ i~,~tn~sS_. _~a~ Correction Needed ~ 1652 ('/::lev. 1-90I Whita-Haz Mat Div. Yellow-Station Copy Pi~k-Business Copy · 01/I4/94- SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 1 Overall Site with 1 Fac. Unit General Information Location: 5630 DISTRICT BLVD 124 Map: 123 Hazard: Minimal Community: BAKERSFIELD STATION 13 Grid: 15D F/U: 1AOV: 0.0 C°ntact Name i~~Title i Business Phone i 24-Hour Phonel ILEROY JOHNSON ~ o~¢~ (805) 397-0173 x (805) 397-6617! Administrative Data Mail Addrs: 5630 DISTRICT BLVD 124 D&B Number: City: BAKERSFIELD State: CA Zip: 93313- Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code: 7389 Owner: LEROY JOHNSON Phone: (805) 397~0173 Address: 6301.MANCHESTER LN State: CA City: BAKERSFIELD Zip: 93309- Summary / ('ry,~:;e ~' Iwint name) rsviewed the a~hed h~ard°us ma~edaJs ma~ag~ - ~,~ ,~ and th~ (N~e of Busl~) - ~Y ~o~s constitute a ~mple~e a~ ~rr~ men- ~e~ P~sn for.my facility. . 01/14/94 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-001 NITROGEN Gas 1500 Minimal · Fire, Pressure, Immed Hlth FT3 01/'14/94 ~ SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 3 02 - Fixed Containers on'Site Hazmat Inventory Detail in MCP Order 02-001 NITROGEN Gas 1500 Minimal ~ Fire, Pressure, Immed Hlth FT3 CAS #: 7727-59-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: AEROSOL/INFLATION Daily Max FT3 I 'Daily Average FT3 I Annual Amount FT3 1,500 ~ 1,200.00 15,000.00 Storage I Press T Temp; Location PORT. PRESS. CYLINDER IAbove ~AmbientlNORTH END, NEAR EAST DOOR -- Cons Components 'MCP ~Guide 100.0% I Iunrated -- Notes 01/14/94 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 4 O0 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 AND 1-800-852-7550 (OFFICE OF EMERGENCY SERVICES) <2> Employee Notif./Evacuation VERBAL <3> Public Notif./Evacuation VERBAL <4> Emergency Medical Plan SAN JOAQUIN COMMUNITY HOSPITAL - 2615 EYE ST - 327-1711 01/14/94 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 5 00 -~Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention COMPRESSED GAS IN CYLINDERS AND CHAINED TO WALL. KEEP CYLINDERS CHAINED AND KEEP SHIPPING CAPS IN PLACE WHEN NOT IN USE. <2> Release Containment OPEN ROLL UP DOOR AND ALLOW TO ESCAPTE TO ATMOSPHERE. .<3> Clean Up NONE NECESSARY - INERT GAS <4> Other Resource Activation 01/14/94 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 6 00 - Overall Site <F> Site Emergency Factors <l>'Special Hazards <2> Utility Shut-Offs A) GAS - N/A B) ELECTRICAL - SOUTHEAST CORNER OF 5630 DISTRICT BLVD C) WATER - FRONT OF 5610 DISTRICT BLVD, SUITE 104 D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water pRIVATE FIRE PROTECTION -AUTOMATIC SPRINKLER SYSTEM FIRE HYDRANT - IN FRONT OF 5630 DISTRICT BLVD, SUITE 122 <4> Building Occupancy Level 01/14/94 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE~C~EMPLOYEE~AT THIS FACILITY WHICH INCLUDES ~. WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: READ MsDs SHEETS, WATCH VIDE© TAPE PREPARED BY NATIONAL ASSOCIATION OF FIRE EQUIPMENT DISTRIBUTORS (NAFED), STUDY NAFED TRAINING MANUAL AND ON THE JOB TRAINING. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 08/18/92 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 1 Overall Site with 1 Fac. Unit General Information I Location: '5630 DISTRICT BLVD 124 Map: 123 Hazard: Minimal I Community: BAKERSFIELD STATION 13 Grid: 15D F/U: 1AOV: 0.0 , Contact Name ~ Title Business Phone 24-Hour Phoneq IILEROY JOHNSON PARTNER (805) 397-0173 x (805) 397-6617! THOMAS KLEIN PARTNER (805) 397-0173 x (619) 379-2797/ Administrative Data Mail Addrs: 5630 DISTRICT BLVD 124 D&B Number: City: BAKERSFIELD State: CA Zip: 93313- Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code: 7389 Owner: LERoY JOHNSON Phone: (805) 397-0173 Address: 6301 MANCHESTER LN State: CA City: BAKERSFIELD Zip: 93309- Summary RECEIVED SEP 1 6'~ 1992 HAZ. MA~ DI~ [/, "~ Do hereby certify that ~vie~ed ~hs a~tached h~.:?~:~..~:~ mmsrials m~nage- ang~ons cons~i~uls ' a complete and ~rr~ age~en~ p~an for 08/18/92 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 NITROGEN Gas 1500 Minimal · Fire, Pressure, Immed Hlth FT3 CAS #: 7727-59-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: AEROSOL/INFLATION Daily Max FT3I Daily Average FT3 [ Annual Amount FT3 -- 1,500 ~ 1,200.00 15,000.00 Storage Press T Temp~ Location PORT. PRESS. CYLINDER Above. IAmbientlNORTH END, NEAR EAST DOOR -- Conc Components MCP List 100.0% INitrogen Low I -- Notes 08/18/92 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 3 00 - Overall Site <D> N0tif./Evacuation/Medical <1> Agency Notification CALL 911 AND 1-800-852-7550 (OFFICE OF EMERGENCY SERVICES) <2> Employee Notif./Evacuation ~ VERBAL <3> Public Notif./Evacuation VERBAL <4> Emergency Medical Plan SAN JOAQUIN COMMUNITY HOSPITAL - 2615 EYE ST - 327-1711 08/18/92 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention COMPRESSED GAS IN CYLINDERS AND CHAINED TO WALL. KEEP CYLINDERS CHAINED AND KEEP SHIPPING CAPS IN PLACE WHEN NOT IN USE. <2> Release Containment OPEN ROLL UP DOOR AND ALLOW TO ESCAPTE TO ATMOSPHERE. <3> Clean Up NONE NECESSARY - INERT GAS <4> Other Resource Activation 08/18/92 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - N/A B) ELECTRICAL - SOUTHEAST CORNER OF 5630 DISTRICT BLVD C) WATER - FRONT OF 5610 DISTRICT BLVD, SUITE .104 D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - AUTOMATIC SPRINKLER SYSTEM FIRE HYDRANT - IN FRONT OF 5630 DISTRICT BLVD, SUITE 122 <4> Building Occupancy Level 08/18/92 SAN JOAQUIN FIRE SERVICE 215-000-000306 Page 6 00 - Overall Site <G> Training <1> Page 1 WE HAVE 2 EMPLOYEES AT THIS FACILITY WHICH INCLUDES PARTNERS. WE'DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: READ MSDS SHEETS, WATCH VIDEO TAPE PREPARED BY NATIONAL ASSOCIATION OF FIRE EQUIPMENT DISTRIBUTORS (NAFED), STUDY NAFED TRAINING MANUAL AND ON THE JOB TRAINING. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use · Bakersfield 'Fire. D~p . HAZARDOUS MATERIALS DIVISION, ~ .. . ' , Date Completed Business Identification No, 215-000 ~0..~'0~, :(Top of Business Plan) - ' " '.. Station No. /~> Shift ~ Ins e r ~. /~4Y/ ~9~9/9 - Adequate Inadequate .. ' ' Verification of Inventoff Maerials Verification of eu~tities ~ - ,; ~'/ ' .. Verification of Locaion Proper Segregation of Maeri~ ~"~ ~. Comments: Verification of MSDS Availabli~~'"' Number of Employees Verification of H~ ~at Training~" ~/fi 'Comments: VerifiCation of Abaeme~ Supplies & Procedures~"' Comments: ' ,. ' Emergency Procedures Posted " Containers Properly Labeled ~/ Comments: Verification of Facility Diagram ~ "~ Special H~ards Associated w~h this Facility: '~o ~'- ' . /~/~'.. ' . ' . ' ~.' .'/ .. - . . , " 'AIHtemSO.K. ' _ ' CorreCtion Needed F~,16~ (~. {-90~ ' , . ~i~-H~ ~t DN. Yalow-~t~n ~py -Pink-Busin~ Bakersfield Fire DSpt. Hazardous Materials Division RECEIVED .2130 "G" Street Og~ 0 9 1991 Bakersfield, CA. 93301 HAZ. MAT. DiV. HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. TO avoid further action, return this form within 30 days of receipt. 2. . TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME: SAN JOAOUIN FIRE SERVICE LOCATION: 5630 DISTRICT BLVD., SUITE 124 MAILING ADDRESS: 5630 DISTRICT BLVD., SUITE 124 · CITY: RAT<W..R,qPTW..T.Ih STATE: CA ZIP: 9331 3 ' PHONE' ¢ 805 ) 397-01 73 DUN & BRADSTREET NUMBER,: 36-34P,-'t0R2 SIC CODE: 7389 PRIMARY ACTIVITY: FIRE EXTINGUISHER SALES 'AND SERVICE OWNER'LEROY JOHNSON & THOFJA$ D. KLEIN: PARTNERs MAILING ADDRESS: 5630 DISTRICT BLVD., SUITE 124, BAKERSFIELD,CA. 93313 SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE ]. LEROY JOHNSON GENERAL' PARTNER 80.5/397-0173 805/397-6617 2. THOMAS KLEIN GENERAL PARTNER 805/397-0173 619/379-2797 FO1590 Bakersfield Fire Dept. Hazardous Materials Division ~:~.,..-;~ HAZARDOUS MATERIAES MANAGEMENT PLAN SECTION.3: TRAINING: NUMBER O.F EMPLOYEES: 2 (INCLUDES PARTNERS) MATERIAL SAFETY DATA SHEETs ON FILE: YES BRIEF SUMMARY OF TRAINING PROGRAM' READ MSD SHEETS, WATCH VIDEO TAPE PREPARED BY NATIONAL ASSOCIATION OF FIRE._ EQUIPMENT DISTRIBUTORS (NAFED), STUDY NAFED TRAINING MANUAL, ON THE JOB TRAINING SECTION 4: EXEMPTION REQUEST: I CERTIFY IJNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. .......... WE-DO -HANDL-E-HAZA-RDOUS- MA-TERIA[:S, .BUT THE QU-A-NTITIES AT. NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) · SECTION 5: CERTIFICATION: I, .LEROY JOHNSON ~' CERTIFY THAT THE ABOVE INFOR- ,MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WlLL 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 IN~AC~MATION CONSTITUTES PERJURY, S~RE TITLE DATE FD1590 Bakersfield Fire Dept.. Hazardous Materials Division HAZARDOUS'MATERIALS MANAGEMENT PLAN FQcilify Unit NQme: STOCKDALE BUSINESS CENTER SECTION 6: NOTIFICATION 'AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: DIAL. 911 6~D 1-800-852-7550 (OFFICE 0F EMERGENCY SERVICES) B. EMPLOYEE NOTIFICATION AND EVACUATION' VERBAL · C. PUBLIC EVACUATION: VERBAL D. EMERGENCY MEDICAL PLAN' TRANSPORT TO NEAREST HOSPITAL Bakersfield Fire Dept. HazardoUs Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: KEEP CYLINDERS CHAINED AND KEEP SHIPPING CAPS IN PLACE WHEN NOT IN USE B. RELEASE CONTAINMENT AND/OR MINIMIZATION: OPEN ROLL-iUP DOOR AND ALLOW'TO EscAP~- TO ATMOSPHERE C. CLEAN-UP PROCEDURES: NONE NE~S-SARY INERTTG~S'. SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' NATURAL GAS/PROPANE: (NONE) ELECTRICAL:S.E. CORNER OF 5630 DISTRICT BLVD. WATERi'~APP~OX[ f0'~ s0~ '-~F ~--610~DISTRI-CT BLVD. , SdI~E1 04-' SPECIAL' LOCKBOX: .YES~ IF YES, LOCATION:, SECTION' 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: AUTOMATIC SPRINKLER SYSTEM B. WATER'AVAILABILITY (FIRE HYDRANT): IN ,FRONT OF (WEST) 5630 :~ ::.' '" ~DISTRICT .BLVD., SUITE 122 ~. 4, , ' ' FD1590 Bakersfield Fire Dept. -// R~ c ~ t v ~ v Hazardous Materials Inspection . OCT 2 6 1990 Date Completed ]/~)'?~/~ (~" ........... Plan ID # 215-000000~o ¢ (Top right comer.Business Plan) Station No. 13 Shift '8 Inspector / · Adequate Inadequate Verification of Inventory Materials Verification of Quantities ~ [-~ Verification of Location Proper Segregation of Material ~ [--] Comments:. ~ ~¢~z..zo~ ~ Verificatitin (~ MSDS Availability ' Number of EmPloyees ~ '" Verification of Haz Mat Training X [~] Verification of Abatement Supplies & Procedures Emergency Procedures Posted ~ [--] Containers Properly Labeled ~ [-~ Comments: Verifcafion of Facility Diagram ~ [-~ Special Hazards Associated with this Facility: ~;::]j~ White-Haz Mat Div. Yellow-Station Copy Pink-Business Office Q Bakers_field Fire Dept. ~ e E c E~v E 0 . Hazardous Materials Inspection JUN 7 1990 · Date Completed ~/ :~7-¢(/~/&-~~ ....... Adequate Inadequate Verification of InventO~ Materials Verification of Quantities Verification of Location ~oper Se~egafion of Matefi~ Comments: Verification of MSDS Availability [~] [---] Number of Employees Verification of Haz Mat Training [--] [~] Comments: VerifiCation of Abatement Supplies & Procedures Comments: Emergency Procedures Posted :ontainers Properly Labeled Coinrrlents: of Facility I [--] [-~ Associated with this Facility: \ _ rD 1652 (~v. 3-89) White-~az ~at Div. Yellow-Statioo Copy Pink-Business Office ?" i'i~ CJT¥ of BAK£RSF[ELD _ h~ ~,,';',.~ ~ /~0x jo~ ~~,. , RECEIVED An~'d ............ ~o ke~eby ce~t~i t~t ~ h~ve ~ev~e~ed the attached Hazardous ~laterials business plan (name of business) and that it along with the attached additions or corrections constitute a complete and correct Business Plan for my facility. /~.~na~ur.e date ' 2130 "G" STREET .... : ,' , BAKERSFIELD, CA 93301 (805) 326-3979 ' OFFICIAL USE ONLY :sr: ESS XX, E HAZARDOUS ~TERI ALS BUSINESS PLAN AS A WHOLE FORM 2A INS~UCTIONS: "' 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. 8~ as b~ief and concise as possible. SECTION 1: BUSI~SS IDE~IFICATION DATA B. LOCATION / STREET ADDRESS: ~--~0 D/~'~ CITY: ~f~~~ d~. ZIP: 9~/ ~ BUS.PHONE: SECTION. 2: ENE~GENCYNOTIFICATIONS' In case of an emergency involving the release or threatened release of a hazardous material, call 911'and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as requ£red by law. EMPLOYEES TO NOTIFY IN CASE 0F EMERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: D. SPECIAL: fv/e/u'd... E. LOCK BOX: YES /~ IF YES, LOCATION: .;. IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES ./ NO FLOOR PLANS? YES / NO KEYS? YES / NO SECTION 4: PRIMATE RESPONSE TE~dW FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL' ASSISTANCE FOR YOUR BUSINESS AS A WHOLE _ 7.- SECTION 6: F_J4PLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAH WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS . .VATERIALS: ....................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES k/U WITH RESPONSE AGENCIES: .......................... YES NO YES NOI~~l~ ,~ C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO /~/~/..~-'''' D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO E. DO YOU ,~uiINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: HAZ~uRDOUS MATERIAL CIRCLE YES OR NO OR NONE DOES YOUR BUSINESS I~DLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ~_~ NO I. ~4/~F' ~-~$~'~Y , certify ~hat the above information is 'accurate. I understand that this information will be used to fulfill ~y fir~'s obligations under the new California Health and Safety code on Hazardous ~aterials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. - 2B - SITE/FACILITY D I AGR~d~I FORM 5 NORTH SCALE: BUSINESS NAME: .v~ ,/~a~z~¢ ~-~- FLOOR: ! OF ! DATE'.. ,/ / FACILITY NA~ME: UNIT ~: OF (CHECK ONE) SITE DIAGRAM FACILITY DIAGRAM Inspector's Comments): -OFFICIAL USE ONLY-- SITE D[AGRAH (Requ items) . 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. ' 10. MSDS Storage Box 2. Street(s), Alleys, 11, Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or. Barrier property. Include the a. Wire street names. b. Masonry 3. Storm Drains, Culverts, Yard Drains c. Wo~d 4. Drainage Canals. Ditches, d. Gates Creeks, 13. Powerllnes $. Buildings a. Frame construc, tion 14. Guard Station b. Masonry construction 15. Storage Tanks: " Identify the c. Metal construction capacity in gal. · a. Above ground ".' ..:""'- :.".'~ :'i,~',',;~'- /.'d..:Acces8 Door.~..."'. ',:.:" ':*: .--":;,*".-~"-'-': .:':, ;, '*: -..,',1 ....... './ b. Underground 6. Utility Controls a. Gas 16. Dtking or Berm b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: Identify the 7. Fire Suppression Systems: location where' a. Fire Hydrants employees will meet. b. Fire Sprinkler 19. Outside Hazardous Connections Waste 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 22. Type of Hazardous Material/Waste Stored 8. Fire Oepartment Access or Used (See Below) TYPE OF HAZARDOUS MATERIAL F = Flammable E - Explosive L = Liquid R ~ Radtological C - Corrosive o - Oxidizer O = Gas P = Poison M = Water Reactive T = Toxic' S = Solid H = Cryogenic O = Waste B - Etiological Example: Flammable Liquid = FL FACILITY DIAGRAM (Required items in addition'to the above) 1. Risers for Sprinklers 8. Fire Escapes 2. Partitions 9. Air Conditioning Units , 3. Stairways: Indicate the 10. Windows '"Qi, levels served from highest to lowest. 11' Inside Hazardous Waste Storage 4. Escalator: Indicate the levels served from 12. Inside Hazardous highest to lowest. Materials .Storage 5. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access .. 14; Sewer Drain Inlets " CITY of BAKERSFIELD r aL~ ~lth of P~su~ ~lth ~ h ~ Pe~sure ~alth ~;ACTS BUSINESS NAME SAN JOAQUIN FIRE SERVICE ID NUMBER 215-000-000306 LOCATION --~e-3~-I14 DISTRICT BLVD HIGH HAZARD RATING 1 -/o7 1 OVEI~V I EW LAST CHANGE 04/20/88 BY ESTER ~JURIS CODE 215-009' JURIS BAKERSFIELD STATION' 09 MAP PAGE 123 GRID 15C FACILITY UNITS 1 HAZARD RATING 1 RESPONSE SUMMARY 2A SEC 4) NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS 2A SEC 2) LEROY JOHNSON - 397-0173 OR 397-6617 THOMAS KLEIN - 397-0173 OR UTILITY SHUTOFFS 2A SEC A) GAS - N/A B) ELECTRICAL -.A~E'CORNER OF ~ DISTRICT BLVD C) WATER - FRONT OF 5610 DISTRICT BLVD D) SPECIAL - NONE E) LOCK BOX - NO 2 . NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 12/16/88 12:2t MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME SAN JOAQUIN FIRE SERVICE ID NUMBER 215-000-000306 LOCATION ---~6-~r~--1-t-~ DISTRICT BLVD HIGH HAZARD RATING 1 3 . HAZ MAT TRAINING SUMMARY LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 04/20/88 BY ESTER 2A SEC 5) SAN JOAQUIN COMMUNITY HOSPITAL - 2615 EYE ST - 327-1711 PAGE 2 12/16/88 12:2t MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BUSINESS NAME SAN JOAQUIN FIRE SERVICE ID NUMBER 215-000-000306 LOCATION --~F~3-8~t-1-4 DISTRICT BLVD HIGH' HAZARD RATING 1 FACILITY UNIT 01~'r~? A . OVERALL HAZARDOUS MATERIALS INVENTOR LAST CHANGE 06/30/88 BY ESTER ID TYPE NAME MAX AMT UNIT HAZARD LOCATION CONTAINMENT USE 1. PURE NITROGEN 1500 FT3 MODERATE CENTER WEST WALL PORTABLE PRESS. CYL. ADDITIVE ID PERCENT COMPONENTS HAZARD LIT 2324.00 100.0 NITROGEN MODERATE B . FIBRE PROTECTION / WATER SUPPLIES LAST CHANGE 04/20/88 BY ESTER 3A SEC 4) NO PRIVATE FIRE PROTECTION 3A SEC 5) AT.-Fr~ END OF ISLAND BETWEEN 5630 & 5640 DISTRICT BLVD PAGE 3 12/16/88 12:2 MATERIAL SAFETY DATA SYSTEMS, INc. (805) 648-6800 BUSINESS NAME SAN JOAQUIN FIRE SERVICE ID NUMBER 215-000-000306 LOCATION -~ DISTRICT BLVD HIGH HAZARD RATING 1 D . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 04/20/88 BY ESTER 3A SEC 2) DOES NOT APPLY (NO EMPLOYEES) E . MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 04/20/88 BY ESTER 3A SEC 1) COMPRESSED GAS IN CYLINDERS AND CHAINED TO WALL. PAGE 4 12/16/88 12:2! MATERIAL SAFETY DATA SYSTEMS, INC. (,805) 648-6800 CITY o.f BAKERSFIELD NO N-- ]: RADE SEC RE~ 4C~k ~11 t~t o~ly) (C~k .il t~t apply) ~t II ~& C.A.S. i - r- ~ - - r- ~ ~t ~ ~ & C.A.S. ~ I - r--~ r-~ - - ~t 12 ~&C.A.S. ~. ~lth ~ Pr~surt ~alth ~t 13 h i C.A.S. hr' ~ .... ~ .... ~NERGENCY ~TACTS C~tlfiC~ti~ (Reid lad sign after completing 4lJ sections) BAKERSFIELD CITY FIRE DEPARTMENT 2230 "G" STREET BAKERSFIELD, CA 93301 1~3- X~ ~-~ (805) 326-3979 D OFFICIAL ~SE OSLY HAZARDOUS NATERI ALS BUSINESS PLAN AS A WHOLE FOEN 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 SECTION 2: EMERGENCY NOTIFICATIONS In case of an'emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 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. SECTION 3: LOCATION OF UTILITY SHI~-0FFS FOR BUSINESS AS A I~IOLE A. NAT. GAS/PROPANE: /~/,~° . ' · , B. ELECTRICAL: /.2 ~. _,,_~"~--~ O~'- .-.~"~ /~Z~/,~,f~Z' ./5~'f~, D. SPECIAL: E. LOCK BOX: YES /(~ IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO. HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WiTH INITIAL AND CIRCLE YES OR NO INITIAL REFRESHER' A. METHODS FOR SAFE HANDLING OF HAZARDOUS, MATERIALS:...- .................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES NO YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO 'YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: HAZ~J~I)OUS NATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS THAN 500 POUNDS-OF A SOL.ID,'5$ GALLONS 0/ A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... Y~N9~ I, ~f-/ - certify that the above information is accurate. I unders~nd that-~his information will be used to fulfill my firm's obligations under the new California Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. :,.BAKERSFIELD CITY FIRE DEPARTMENT 2130 '"G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUS INESS ,.NAME: BUS I NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To a~oid 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 b~NIT N~.ME: SECTION 1: .MITIGATION, :PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION ;uN]] EVACUATION PROCEDLTRES AT THIS b~IT ONLY - 3A - SECTION 3: HAZARDOUS MATERIALS FOR THIS UNIT ONLY A. Does this Facility Unit contain Hazardous Materials? ...... ~ NO If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YES .~ If No, complete a separate hazardous materials inveWtory form marked: NON-TRADE SECRETS ONLY (white form #4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS. ONLY (yellow form #4A-2) in addition to the non-trade secret.form, List only the trade secrets on form 4A-2. SECTION 4:'PRI~VATE.FIRE PROTECTION SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPO5~ERS SECTION $: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. D. SPECIAL: E, LOCK BOX: YES /0 IF YES, LOCATION: IF YE§, SITE PLANS? YES / NO MSDSs? YES / NO FLOOR PLANS? 'YES / NO KEYS? YES / NO - 3B - NON--TRADE SECRETS HAZARDOUS I~[ATERI ALS INVENTORY PHONE ~: 39~'~g7~ PHONE t: ~-~/F [OFFICIAL USE CFIRS CODE ONLY 1 2 3 4 9 6 7 8 9 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T ~ODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIQAL OR COMMON ,NAME CODE OUIDE N~ME: __ TITLE: SIONATURE: DATE: EMEROENCV f : TITLE: ~~ /P~NE ~ BUS HOURS: AFTER BUS HRS: · . - 4A-1 - SITE/FACILITY D I AG R/kl~f ~o~ ~ ~f DATE:~ /'¢ /~7FACILITY N~ME: ~~ ~/~/ UNIT ~: { OF I (CHECK ONE) SITE DI.AGR.~ FACILITY DIAGR.~ Inspector's Comments): -OFFICIAL USE ONLY- SITE DIAGRAN (Required as) 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSD$ Storage Box 2. Street(s), Alleys, li. Railroad Tracks Driveways, and Parking Areas adjacent to the 12. Fence or Battler property. Include the a. Wire street ns=ea. b. Masonry 3 Storm Drains, Culverts, Yard Drains c. Wood 4 Drainage Canals, Ditches, d. Gates Creeks. 13. Powerllnea S. Buildings a. Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c. Metal construction capacity In gal. a. Above ground d. Access Door b. Underground 6. Utility Controls a. Gas : · · 16. Diking or Sera b. Electricity 17. Evacuation Route c. Water 18. Evacuation Area: ~ Identify the ?. Fire Suppression *Systems: location where a. Fire Hydrants employees mill meet. b. Fire Sprinkler 19. Outside Hazardous Connections #ante Storage c. Fire Standpipe 20. Outside Hazardous Connections Naterlal Storage d. Water Control Valves 21. Outside Hazardous for protection systems Material Use/Handling e. Fire Pu~p 22. Type of Hazardous #atertal/#aate Stored S. Fire Department Access or Used (See ~PE OF a~OUS F - Flammable ~ - 8~rploslve L - L~qutd R - Rad~ologJcal C - Corrosive 0 - ~xidlzer ~ - Gas P - Poison Water Reactlve T - Toxic S - Solid *H - Cryogenic O - Waste B - Etiological Example: Flammable Liquid - FL FACILITY OIAGRA~ (Requl~ed items in addltloo to the. abo~e) 1, R/sore for Sprlflklmre 8. Firm Escapee 2. Partitions g, Air Conditioning Units 3. Stairways: Indicate the 10, Nl~do~a levels served from highest to lo~est. 11. Inside Huardous Waste Storage 4. Escalator: Indicate the levels served from 1~. Inside Hazardous highest to lowest. ~terlals Storage 5. Elevator 13, Inside Hazardous Naterlals Use/Handling 6. Attic Access 14. Sewer Drain Inlets ?. Skylights 11~ 11~ ,~6 ~11:;' 110 109 108 107 106 105 1~ 1~ 1~ 12~ North IBAKERSFIELD Min Ave IBIJ IFYE I 116' 116' DISTRICT BOULEVARD F O R L A Office, Warehousing & 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-arnp., 3-phase power · Extensive Landscaping · Easy freeway access via White Lane · Some units are fire sprinklered for safety · FOR LEASING INFORMATION PLEASE CALL: (805) 398-8888 ALSO, WE HAVE OTHER PROJECTS IN SAN DIMAS, VENTURA, WESTLAKE VILLAGE AND NEW'BURY PARK BBIJ]IN (ENIEII BAKERSFIELD This information has been furnished from sources which we deem reliable, but for which we assume no liabili~.