HomeMy WebLinkAboutBUSINESS PLAN 3/5/1996
~ HM*'IPP L AN MAP
D~GRAM
Si'TE , FA~ILI T Y DIAGRAM
/
· ?~': ' I TE / FAC I L I TY G R~%I~I
FORM
'
(CHECK ONE) SITE DIAGRAM ~ FACILITY DiAGR.a~
' "~ to .,
..: I " · _,C~$o O;-~t-,",'~ t' 8.t,,'~, '":"'
'::i,.': [ '[(inspector's Comments): .... £OFFIC.IAL USE ONLY- .,.
CHECK ONE) SITE DIAGRA~ FACILI~,DIAGR.~
(Inspector's Comments): -OFFICIAL USE ONLY-
' ~.- ~ TE/FACI LI T¥ DI ~ "-"-, ...... ~
~ ~ FORb'I ~5 '~
%. L
(CHECK ONE) SITE DIAGR~ FACILITY DIAGR.%~ ~/
(Inspector's Comments): -OFFICIAL USE ONLY-
,\ I'OTAL UUI:: q~a/'/. UU
STATEMENT DF 'ACCOUNT
CITY OF BAKERSFIELD
1501TRUXTUN AVE
BAKERSFIELD, CA 93301-0000
CUSTOMER NO:
· ...... ~:'~ ~,~ CUSTOMER TYPE: ES/ 32~1
'i.
FINANCE DEPARTMENT ,-< ~.,,..... ta,.~ ,.,,[ ,, ~ nn~-
CITY OF BAKERSFIELD ~ (;.;: ~,_~.~c.~ ~1 /:
P.O. BOX 205' ~ ~o~ ¢~
..... ' _~ 67977991 J~.
ADDRESS OORRECTION REQUESTED ~'
EPOC~O ~lB~O0~ lCg~
RETURN TO SENDER
:EPOCH NELL LOG~ZN~
BAKERSFIELD CA
RETURN TO SENDER
Ilh,,Ih,,,,Ih,ll,,Ih,,ll,,,Ih,,Ih,,,,,llll,,,Ih,,Ih,,I
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 1
Overall Site with 1 Fac. Unit
General Information
Location: 5880 DISTRICT BLVD 10 Map:123 Haz:3 Type: 3
City : BAKERSFIELD Grid: 15C F/U: 1 AOV: 0.0
Contact Name Title Contact Name Title
STEVE APPLETON / JOEL LINDSLE¥ /
Business Phone: (805) 397-7472x Business Phone: (805) 397-7472x
24-Hour Phone : (805) 664-1401x 24-Hour Phone : (805) 664-8159x
Pager Phone : ( ) - x Pager Phone : ( ) - x
Administrative Data
Mail Addrs: 5880 DISTRICT BLVD 10 D&B Number:
City: BAKERSFIELD Statei: CA Zip: 93313-
Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code:
Owner: STEVE APPLETON Phone: (805) 664-1401
Address: 5880 DISTRICT BLVD #10 State: CA
City: BAKERSFIELD Zip: 93313-
Summary ~EC~Iv~D
,~t~ 0 ? ~996
!, _::3"oel L;,,~.~Icy Do hereby certify that I have
(Type er l~lm tame) ,
reviewed the attached hazardous materials; manage-
ment plan for EPocH Yell/:o.~':,and that it along wilh
' (Nameof Bua~,eU) C/
any correctlons constitute a complete and correct man.~
agement plan for my facility.
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 2
Hazmat Inventory List in MCP Order
02 - Fixed Containers on Site
Pln-Ref Name/Hazards Form Max Qty MCP
02-002 HYDROGEN Gas 1500 Extreme
· Fire, Pressure FT3
02-003 SPAN GAS (CALIBRATION) Gas 4000 Extreme
· Fire, Pressure FT3
02-001 CARBIDE Solid 900 High
· Fire, Delay Hlth LBS
02-004 1,1,1-TRICHLOROETHANE Liquiid 100 Low
· Fire, Immed Hlth GAL
02-005 ETHYLENE GLYCOL Liqulid 55 Low
· Fire, Delay Hlth GAL
02-006 MOTOR OIL Liqulid 55 Minimal
· Fire, Reactive, Immed Hlth, Delay Hlth GAL
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 3
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-002 HYDROGEN Gas 1500 Extreme
· Fire, Pressure FT3
CAS #: 1333-74-0 Trade Secret: No
Form: Gas Type: Pure Days: 365 Use: EXPERIMENTAL/ANALYTICAL
Daily Max FT3 I Daily Average FT3 1 Annual Amount FT3
1,500 ~ 100.00 1,500.00
Storage I Press T TempI Location
PORT. PRESS. CYLINDER Iabove ~AmbientlNE CORNER OF SHOP
-- Conc Components MCP ---TGuide
100.0% ilHydrogen IExtreme I 22
02-003 SPAN GAS (CALIBRATION) Gas 4000 Extreme
· Fire, Pressure FT3
CAS #: 74-82-8 Trade Secret: No
Form: Gas Type: Mixture Days: 365 Use: EXPERIMENTAL/ANALYTICAL
Daily Max FT3I Daily Average FT3 1 Annual Amount FT3
4,000 ~ 2,000.00 4,000.00
Storage I Press T Temp I Location
PORT. PRESS. CYLINDER Above I Ambient NE CORNER OF SHOP
-- Conc Components MCP ---~Guide
20.0% Methane
IExtreme I 17
20.0% IEthane IHigh ! 22
20.0% ~ln-Butane Or Butane Mixture IHigh ! 22
20.0% IPropane IExtreme I 22
20.0% IIsobutane IHigh ~ 22
-- Notes
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 4
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-001 CARBIDE Solid 900 High
· Fire, Delay Hlth LBS
CAS #: 1305-62-0 Trade Secret: No
Form: Solid Type: Pure Days: 365 Use: ~EXPERIMENTAL/ANALYTICAL
Daily Max LBS I Daily Average LBS I Annual Amount LBS --
900 ~ 600.00 900.00
Storage Press T Temp Location
DRUM/BARREL-METALLIC AmbientlAmbientlNE COR~ER OF SHOP
-- Conc Components MCP ---/Guide
100.0% ICarbide IHigh / 40
- Notes
02-004 1,1,1-TRICHLOROETHANE Liqu!id 100 Low
~ Fire, Immed Hlth GAL
CAS #: 16-89-6 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: ,EXPERIMENTAL/ANALYTICAL
Daily Max GAL I Daily Average GAL ----~Annual Amount GAL --
100 ~ 100.00 100.00
Storage IIPress T Temp Location
METAL CONTAINR-NONDRUMIAmbient/AmbientlNE CORNER OF SHOP
- Conc '1 Components I . MCP --~uide
100.0%'ll,l,l-Trichloroethane ILow ! 74
- Notes
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 5
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-005 ETHYLENE GLYCOL Liquid 55 Low
· Fire, Delay Hlth GAL
CAS #: 107-21-1 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: .EXPERIMENTAL/ANALYTICAL
~ Daily Max GALI Daily Average GAL I Annual Amount GAL
55 ~ 30.00 55.00
StoragelIPress T Temp Location
PLASTIC CONTAINER IAmbient~AmbientlNE CORNER OF SHOP
- Conc:1 Components MCP -~Guide
100.0% :lEthylene Glycol Low ! 27
02-006 MOTOR OIL Liqu!id 55 Minimal
· Fire, Reactive, Immed Hlth, Delay Hlth GAL
CAS #: 68649423 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: ,LUBRICANT
Daily Max GAL I Daily Average GAL T Annual Amount GAL
55I 55.00! 55.00
Storage Press T Temp Location
DRUM/BARREL-METALLIC IAmb~ent~AmB~ontl
-- Conc~ Components MCP ---~uide
10.0% IMotor Oil, Petroleum Based Minimal I 27
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 6
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
EXITS ARE LABELED FRONT AND REAR. SAFE MEETING AREA IS DESIGNATED
(FRONT PARKING AREA). EMERGENCY PHONE NUMBERS ARE POSTED IN THE
SHOP AND OFFICE.
<3> Public Notif./Evacuation
EXITS LABELED FRONT AND REAR
SAFE MEETING AREA IS DESIGNATED (FRONT PARKING AREA)
EMERGENCY PHONE NUMBERS POSTED (SHOP AND OFFICE)
NOTIFY SURROUNDING BUSINESSES
<4> Emergency Medical Plan
START APPROPRIATE TREATMENT AND TRANSPORT TO:
MEMORIAL HOSPITAL - 420 34TH ST - 327-1792
MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371
WHITE LANE MEDICAL - 5401 WHITE LN - 832-2000
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 7
00 - Overall Site
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
ALL HAZARDOUS MATERIALS LABELED. SAFETY MEETING HELDI ONCE A MONTH.
ALL PRESSURIZED GAS BOTTLES STORED IN RACK (EMPTY ONES OUTSIDE).
NO CHEMICALS ARE USED IN SHOP (ONLY IN FIELD).
SOLID FLAMMABLES STORED IN WATER RIGHT DRUMS IN WELL VENTILATED AREA.
<2> Release Containment
LIQUID - NEUTRALIZE SPILLS WITH A SPILL MAT OR WITH ABSORBANT MATERIAL.
PRESSURIZED GAS - SHUT OFF POWER, LOCATE AND TERMINATE LEAK, OR REMOVE
LEAKING CYLINDER TO OUTSIDE. ALL CYLINDERS ARE PRESSURE CHECKED UPON
ARRIVAL AND EVERY MONTH THEREAFTER.
SOLID - CONTAIN SPILL WITHIN BOARDERS TO STOP THE SPREAD OF THE CHEMICAL.
<3> Clean Up
LIQUID - REMOVE SPILL MAT OR ABSORBANT MATERIAL TO POLY BAG, RINSE SPILL
WITH EQUAL AMOUNT OF WATER, USE TOWELING TO PICK UP RiINSE AND TO DRY AREA.
PRESSURIZED GAS - OPEN SHOP DOORS, PURGE AIR TO ATMOSPHERE, USE BLOWERS IF
NECESSARY.
SOLID - SWEEP UP AND RETURN MATERIAL TO PROPER CONTAINER.
<4> Other Resource Activation
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 8
00 - Overall Site
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - SOUTH WEST CORNER OF BUILDING IN FRENCED YARD
B) ELECTRICAL - BEHIND UNIT 919 NORTH SIDE OF BUILDING IN FENCED YARD
C) WATER - SOUTH WEST CORNER OF BUILDING IN FENCED YARD
D) SPECIAL - FIRE SPRINKLERS BEHIND UNIT #12 W SIDE OF BLDG IN FENCED YARD
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - BUILDING FIRE SPRINKLER SYSTEM W/ALARM AND
SHOP FIRE EXTINGUISHERS FOR FIRE PROTECTION
FIRE HYDRANT - TWO LOCATED IN FRONT OF BUILDING ON DISTRICT BLVD.
<4> Building Occupancy Level
03/04~96 EPOCH WELL LOGGING 215-000-001140 Page 9
00 - Overall Site
<G> Training
<1> Employee Training
WE HAVE 4 EMPLOYESS AT THIS FACILITY
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE
WE HAVE SAFETY MEETINGS EVERY MONTH, ON HEALTH HAZARDS, FIRE HAZARDS,
PROPER HANDLING, CLEAN-UP AND DISPOSAL. WE USE MSDS SHEETS
<2> Page 2
<3> Held for Future Use
<4> Held for Future Use
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 10
00 - Overall Site
<M> Inspections
WELBORN 10/12/88 FOLLOW UP OK
/ /
WELBORN 09/13/89 OK
/ /
M. DAVIES 12/08/93 FOLLOW-UP RALPH HUEY
/ /
PERRY 11/22/94 OK
/ /
PERRY 12/26/95 OK
/ /
03/04/96 EPOCH WELL LOGGING 215-000-001140 Page 11
00 - Overall Site
<M> Inspection Summary
WELBORN 10/12/88 FOLLOW UP OK
/ /
CARBIDE 1200 LBS OVER REPORTED LIMIT
WELBORN 09/13/89 OK
/ /
M. DAVIES 12/08/93 FOLLOW-UP RALPH HUEY
/ /
PERRY 11/22/94 OK
/ /
PERRY 12/26/95 OK
/ /
SECURE HIGH PRESSURE CYLINDERS.
Bakersfield, CA · Ventura, CA · Anchorage, AK
(805) 397-7472 (805) 658-7708 (907) 561-2465
Houston, TX Lafayette, LA
(713) 496-6018 · (318) 898-1610
SITE/FACILITY DIAGRAM
FORM S
DATE . NAME: -- -'i ' UNIT
(CHECK ONE) SITE DIAGP, A.~f ~< FACILITY DIAGRAM
,
. :~'~:~::;.';~,'. ~ .'.'t.~:'';' , .
(CHECK ONE) SITE DIAGRAM FACILITY DIAGRA~
Clnspector's Comments): -OFFICIAL USE ONLY-
o~sc,~r.~:~,,~v,, s,~s~N~.ss ~',,s: ~'?OC~' W,J/ /-.,:,S~,,~, ~oo~: ~o~' ,;2.
(CHECK ONE) SITE DIAGR~Sf FACILITY DIAGR.4~%f '/ ,,.
[Inspector's Comments): -OFFICIAL USE ONLY-
- SA -
....... N1 :~IP P L A
SITE DIAGRAM~ FACTLITY DIAGRAM
_~,.,-_....-..~ ~,,,.:. EP~dt ~,/I Lo.o,,"',_]
!
.HMSiPPLA~ ~IAP
,/
SITE DIAGRAM [I FAC.LITY DIAGRAM
Business Name: ~,..'Po(..,~ -'~ ~\~. '~o¢..~.;',,,.,, .
Location: $ ~ ~ ~,G,, ,'~ ~ ,, ~
Business Identification No. 215-000 ~, ~. ~ (Top of Business Plan)
Station No. ~ % Shift ~ Inspector
Adequate Inadequate
' Verification of Invento~ Maerials
~:, t~ ~'~ Verificationdeu~tities
Verification of Locaion
Proper S~regation of Material
Comments:
Verification of MSDS Availabli~
Number of Employees
~ ~ Verification of H~ Mat Training
Comments:
Vorifieation of ~B~omo~ 8upplio~ & Procoduro~
Oomments:
Containers Pro~rly Labeled
Comments:
Verification of Facility Diagram
'Special H~ards Associated with this Facility:
~~~~~ All Items O.K. ~
~ess Ow~/Manag~ Correction Needed ~
FD 16~ (~. 1-~) ~i~-H~ ~t Div. Yellow-Sat~n ~py Pink-Busin~ ~y
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page 1
Overall Site with l'Fac. Unit
General Information
Location: 5880 DISTRICT BLVD 10 Map: 123 Hazard: Moderate
Community: BAKERSFIELD STATION 13 Grid: 15C F/U: 1 AOV: 0.0,
Contact Name Title Business ~Phone1'---~124-H°ur Phone-
STEVE APPLETON (805) 397-74!72 x 805) 664-1401
JOEL LINDSLEY (805) 397-74172 x 805) 664-8159
Administrative Data
Mail Addrs: 5880 DISTRICT BLVD 10 D&B Number:
City: BAKERSFIELD State: CA Zip: 93313-
Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code:
Owner: STEVE APPLETON Phone: (805) 664-1401
Address: 5880 DISTRICT BLVD #10 State: CA
City: BAKERSFIELD Zip: 93313-
Summary
.HAZ. ~AL Si~
~, ~Yo¢l L:^~t~I~7' Do hereby certify tha~:~ have
(Type o~ print name)
reviewed ~he a~ached h~ardous mmerials manage-
(~me of BUaI~) ~
any ~rm~ions ~nsli~uis ~ ~mpl~s and ~rr~ man-
~emem plan ~r my ~acili~.
,
%
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page 2
Hazmat Inventory List in MCP Order
02 - Fixed Containers on Site
Pln-Ref Name/Hazards Form Max Qty MCP
02-002 'HYDROGEN Gas 1500 Extreme
· Fire, Pressure '~ FT3.
02-003 SPAN GAS (CALIBRATION) Gas 4000 Extreme
· Fire, Pressure FT3
02-001 CARBIDE Sol~d 900 High
· Fire, Delay Hlth LBS
02-004 1,1,1-TRICHLOROETHANE Liquid 100 Low
· Fire, Immed Hlth GAL
02-005 ETHYLENE GLYCOL Liquid 55 Low
· Fire, Delay Hlth GAL
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page 3
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-002 HYDROGEN Gas 1500 Extreme
· Fire, Pressure FT3
CAS #: 1333-74-0 Trade Secret: No
Form: Gas Type: Pure Days: 365 Use:iEXPERIMENTAL/ANALYTICAL
-- Daily Max FT3 Daily Average FT3 Annual Amount FT3
1,500 I 100.00 I 1,500.00
Storage Press T Temp Location
PORT. PRESS. CYLINDER IAbove IAmbiontlNE'CORNER OF SHOP
-- Conc Components MCP ---~uide
100.0% IHydrogen IExtreme I 22
02-003 SPAN GAS (CALIBRATION) Gas 4000 Extreme
· Fire, Pressure FT3
CAS #: 74-82-8 Trade Secret: No
Form: Gas Type: Mixture Days: 365 Use: ,EXPERIMENTAL/ANALYTICAL
Daily Max FT3 Daily Average FT3 I Annual Amount FT3
4,000 I 2,000.00 4,000.00
Storage ~ Press T Temp~ LocatiOn
PORT. PRESS. CYLINDER IAbove I AmbientlNE CORNER OF SHOP
-- Conc I Components ~ MCP ---TGuide
20.0% iMethane IExtreme I~. 17
20.0%IEthane IHigh ! 22
20.0% n-Butane Or Butane Mixture IHigh ! 22
20.0% Propane IExtreme I 22
20.0% Isobutane IHigh ! 22
-- Notes
12/15/93 EPOCH WELL LOGGING 215-000-0011.40 Page 4
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-001 CARBIDE' Solid 900' High
· Fire, Delay'Hlth LBS
CAS #: 1305-62-0 Trade Secret: No
Form: Solid Type: Pure Days: 365 Use: EXPERIMENTAL/ANALYTICAL
Daily Max LBS I Daily.~,. Average LBS I Annual Amount LBS
900 I 600.00 900.00
Storage ~~Press T Temp Location
DRUM/BARREL-METALLIC IAmbient~AmbientlNE coRNER OF SHOP
-- Conc Components. MCP ---~uide
100.0% ICarbide ' High
40
-- Notes
02-004 1,1,1-TRICHLOROETHANE Liquid 100 Low
· Fire, Immed Hlth GAL
CAS #: 16-89-6 Trade Secret: No
FOrm: Liquid Type: Pure Days: 365 Use:EXPERIMENTAL/ANALYTICAL
Dai'ly Max GALI Daily Average GAL T Annual .Am°unt GAL --
100 ~ 100.00 100.00
S~orage · I PresS T TempI ~ Location
METAL
CONTAINR-NONDRUMIAmbientlAmbientlNE coRNER OF SHOP
· -- Conc Components MCP ---/Guide
100.0% Ii,l,l-Trichloroethane ILow / 74
- Notes
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page 5
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-005 ETHYLENE GLYCOL Liquid 55 Low
· Fire, Delay Hlth GAL.
CAS #: 107-21-1 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use:~EXPERIMENTAL/ANALYTICAL
Daily Max GAL I Daily Average GAL I Annual Amount GAL
55 I 30.00 55.00
Storage Press T Temp~ Location
PLASTIC CONTAINER AmbientlAmbientlNE CORNER OF SHOP
-- ConcI Components· I MCP ---TGuide
100.0% IEthylene Glycol ILow ! 27
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page 6
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
'EXITS ARE LABELED FRONT AND REAR. SAFE MEETING AREA' IS DESIGNATED
(FRONT PARKING AREA). EMERGENCY PHONE NUMBERS ARE POSTED IN THE
SHOP AND OFFICE.
<3> Public Notif./Evacuation
EXITS LABELED FRONT AND REAR
SAFE MEETING AREA IS DESIGNATED (FRONT PARKING AREA)
EMERGENCY PHONE NUMBERS POSTED (SHOP AND OFFICE)
NOTIFY SURROUNDING BUSINESSES
<4> Emergency Medical Plan
START APPROPRIATE TREATMENT AND TRANSPORT TO:
MEMORIAL HOSPITAL - 420 34TH ST - 327-1792
MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371
WHITE LANE MEDICAL - 5401 WHITE LN - 832-2000
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page 7
00 - Overall Site
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
ALL HAZARDOUS MATERIALS LABELED. SAFETY MEETING HELD ONCE A MONTH.
ALL PRESSURIZED GAS BOTTLES STORED IN RACK (EMPTY ONES OUTSIDE).
NO CHEMICALS ARE USED IN SHOP (ONLY IN FIELD).
SOLID FLAMMABLES STORED IN WATER RIGHT DRUMS IN WELL IVENTILATED AREA.
<2> Release Containment
LIQUID - NEUTRALIZE SPILLS WITH A SPILL MAT OR WITH ~BSORBANT MATERIAL.
PRESSURIZED GAS - SHUT OFF POWER, LOCATE AND TERMINATE LEAK, OR REMOVE
LEAKING CYLINDER TO OUTSIDE. ALL CYLINDERS ARE PRESSURE CHECKED UPON
ARRIVAL AND EVERY MONTH THEREAFTER.
SOLID - CONTAIN SPILL WITHIN BOARDERS TO STOP THE SPREAD OF THE CHEMICAL.
<3> Clean Up
LIQUID - REMOVE SPILL MAT OR ABSORBANT MATERIAL TO POLY BAG, RINSE SPILL
WITH EQUAL AMOUNT OF WATER, USE TOWELING TO PICK UP RINSE AND TO DRY AREA.
PRESSURIZED GAS - OPEN SHOP DOORS, PURGE AIR TO ATMOSPHERE, USE BLOWERS IF
NECESSARY.
SOLID - SWEEP UP AND RETURN MATERIAL TO PROPER CONTAIiNER.
<4> Other Resource Activation
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page '8
00 - Overall Site
<F> Site EmergenCy Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - SOUTH WEST CORNER OF BUILDING IN FRENCED YARD
B) ELECTRICAL - BEHIND UNIT #19 NORTH SIDE OF BUILDING IN FENCED YARD
C) WATER - SOUTH WEST CORNER OF BUILDING IN. FENCED YARD
D) SPECIAL - FIRE SPRINKLERS BEHIND UNIT #12 W SIDE OF BLDG IN FENCED YARD
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - BUILDING FIRE SPRINKLER SYSTEM W/ALARM AND
SHOP FIRE EXTINGUISHERS FOR FIRE PROTECTION
FIRE HYDRANT - TWO LOCATED IN FRONT OF BUILDING ON DISTRICT BLVD.
'<4> Building Occu,pancy Level
12/15/93 EPOCH WELL LOGGING 215-000-001140 Page 9
00 - Overall Site
<G> Training
<1> Page 1
WE HAVE 4 EMPLOYESS AT THIS FACILITY
WE' HAVE MATERIAL SAFETY DATA SHEETS.~ON FILE
WE HAVE SAFETY MEETINGS EVERY MONTH, ON HEALTH HAZARDS, FIRE HAZARDS,
PROPER HANDLING, CLEAN-UP AND DISPOSAL. WE USE MSDS~SHEETS
<2> Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
12/15/93 EPOCH WELL LOGGING 215-000-0011~40 Page 10
~ 00 - Overall Site
<H> RMPP DATA
<1> Release Containment
<2> Offsite Consequences
<3> In House Capa~bilities
<4> Plant Shutdown Instruction
· . -. . ~lq,~ I-IAZARDOUS I%%TERIALS INVE~RY
~ NON - TRADE SECRET
LOCATION: $~0 D:~t.';~ ~/~ ~7o ADDRESS: q~l~ ~Id~. t¢,~ ..~' STANDARD IND. CLASS CODE:
CITY, ZIP: ~.~.; ~$3 ~3 CITY, ZIP: ~. ~o ~3~/; DUN AND BRADSTREET NUMBER/FEDERAL ID
PHONE #: ~D~ ~9~-?~;A PHONE ,#:' ~- 6~- /~! _/ ~_ - ~ 9 - O ~
~m~ -u ~.o~RUCTIONS FOR PROPER CODES
i 2 3 4' 5 6 7 8 9 10 11 12 13 14
Trans T~pe Max Average Annual Measure # Days Cont Cont Cont Use Location Where % by Names of Mixture/Components
Code Cede Amt Amt Amt Units on Site Type Press Temp Code Stored in Facility wt See Instructions
~cal and aealth Hazard C.A.S. Nun~er ' ~-~ ~/' ' ' :'
~ , -; ~ ~ Component # , Name & C.A.S. Number 10 I0 %4/+, m~lO~
~eck .11 that apply) ' ' '~ %~ .~ ~4~$ 3 Component # 2 Name & C.A.S. NUmber
·
Fire Hazard ~ Sudden Release ~ 'Reactivity ~ Immediate 'u-~ Doiayed
of Pressure Health Health ) Component # 3 Name & C.A.S. Number
Physical and Health Hazard C.A.S. Number Component # i Name & C.A.S. Number
(Check all that apply) , Component # 2 Name & C.A.S. Number
~ Fire Hazard [] Sudden Release '~ Reactivity [] I~ediat. O Delayed
of Pressure Health Health Component # 3 Name & C.A.S. N~er
Ph~mical and Health Haza~ -. C.A.S. N~er Component # i N~ & C.A.S. Nu~er
(Check all that apply) Component # 2 N~ & C.A.S. N~er
ill ~] Fire Hazard [] Sudden Release ~ Reactivity [] Immediate ~ Delayed
O - ' 6f P~ssure Health Health Component # 3 Name & C.A.S. Number
I I I I I- I ,I I I I I
! Physical and Health Hazard C.A.S. Number -. Component # i Name & C.A.S. Number
. (Check all that apply) Component # 2 Name & C.A.S. Number
~ Fire Hazard ~ Sudden Release ~ Reactivity ~ Immediate ~ Delayed
of Pressure Health Health Component # 3 Name & C.A.S. Number
Name / Title 24 Hr. Phone Name Title 24 Hr Phone
Certification (READ AND SIGN AFTER COMPLETING ALL
I certify under peanlty of law that I hayer personally examined and am familiar with the information submitted in this and all attached documents and that based on my inquiry of those
08/i8/92 EPOCH WELL LOGGING 215-000-001140 Page 1
Overall Site with 1 Fac. Unit
General Information
I
Location: 5880 DISTRICT BLVD 10 Map: 123 Hazard: Moderate
Community: BAKERSFIELD STATION 13 Grid: 15C F/U: 1 AOV:' 0.0
Contact Name Title BUsiness Phone 24-Hour Phoneq
STEVE APPLETON (805) 397-7472 x (805) 664-1401!
JOEL LINDSLEY (805) 397-7472 x (805)
Administrative Data
Mail Addrs: 5880-10 DISTRICT BLVD D&B Number:
City: BAKERSFIELD State: CA Zip: 93313-
Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code:
Owner: STEVE APPLETON. ' - Phone:
Address: 5880 DISTRICT BLVD #10 State: CA
City: BAKERSFIELD Zip: 93313-
' SEP 2 4 199~
HA7. MAT. ~IV.
~, S,eve ,pple,on DO hereby cs~ ~hat ~ h~e
r~viowod ~he a~mched h~ardous materials manage,
ment~la~ for ~POCH Well Logging and ~h~ i~ ~lO~g ~i~h
~ mrre~ions ~n~i~u~ ~ comp~s~e a~d ~rre~
08/~8/92 EPOCH WELL LOGGING 215-000-001140 Page 2
02 - Fixed Containers on Site
Hazmat Inventory Detail in Reference Number Order
02-001 CARBIDE Solid 900 High
~ Fire, Delay Hlth LBS
CAS #: 1305-62-0 Trade Secret: No
Form: Solid Type: Pure Days: 365 Use: .EXPERIMENTAL/ANALYTICAL
Daily Max LBS I Daily Average LBS ----~ Annual Amount LBS
900 I 300.00 900.00
Storage Press T Temp Location
DRUM/BARREL-METALLIC IAmbientJAmbientlNW cORNER OF SHOP
-- Conc Components MCP List
100.0% Icarbide IHigh
- Notes
02-002 HYDROGEN Gas 1000 Extreme
~ Fire, Pressure FT3
CAS #: 1333-74-0 Trade Secret: No
Form: Gas Type: Pure Days: 365 Use: EXPERIMENTAL/ANALYTICAL
Daily Max FT3I Daily Average FT3 [ Annual Amount FT3
1,000 I 1,000.00 1,000.00
StorageIIPress T Temp Location
PORT. PRESS. CYLINDER IAmbient/AmbientlNW CORNER OF SHOP
- Conc Components MCP --~List
100.0% IHydrogen JExtreme I
08/i8/~2 EPOCH WELL LOGGING 215-000-001140 Page 3
02 - FiXed Containers on Site
Hazmat Inventory Detail in Reference Number Order
02-003 SPAN GAS (CALIBRATION) Gas 1500 Extreme
· Fire, Pressure FT3
CAS #: 74-82-8 Trade Secret: No
Form: Gas Type: Mixture Days: 365 Use: ~EXPERIMENTAL/ANALYTICAL
Daily Max FT3 Daily Average FT3 Annual Amount FT3
1,500 I 1,500.00 1 1,500.00
Storage Press T Temp Location
PORT. PRESS. CYLINDER Iambient~ambientlNW CORNER. OF SHOP
-- Conc Components I MCP ~List
20 0% Methane
· I Extreme
20.0% Ethane High
20.0% In-Butyl Alcohol ~ ModerateI
20.0% IPropane Extreme
'20.0% IHexane ModerateI
-- Notes
02-004 1,1,1-TRICHLOROETHANE Liquid 30 Low
· Fire, Immed Hlth GAL
CAS #: 16-89-6 Trade Secret: No
Form: Liquid ~ Type: Pure Days: 365 Use: EXPERIMENTAL/ANALYTICAL
Daily Max GALI Daily Average GAL I Annual Amount GAL
30 ~ 30.00 30.00
Storage I Press T Temp~ Location
METAL CONTAINR-.NONDRUMIAmbient|AmbientlNE CORNER OF SHOP
- Conc Components MCP List
100,0% Ii,l,l-Trichloroethane ILow I
- Notes
08/18/92 EPOCH WELL LOGGING 215-000-001140 Page 4
02 - Fixed Containers on Site
Hazmat Inventory Detail in Reference Number Order
02-005 ETHYLENE GLYCOL Liquid 55 Low
· Fire, Delay Hlth t~ GAL
CAS #: 107-21-1 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: EXPERIMENTAL/ANALYTICAL
Daily Max GAL~ Daily Average GAL ~ Annual Amount GAL
55 I 50.00~ 55.00
Storage I Press T Temp Location
PLASTIC cONTAINER IAbove ~AmbientlSW CORNER IN SHOP
-- Conc Components
100.0% IEthylene Glycol ILo~CP IList
08/18/92 EPOCH'WELL LOGGING 215-000-001140 Page 5
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
EXITS ARE LABELED FRONT AND REAR. SAFE MEETING AREA IS DESIGNATED
(FRONT PARKING AREA). EMERGENCY PHONE NUMBERS ARE ,POSTED IN THE
SHOP AND OFFICE.
<3> Public Notif./Evacuation
EXITS LABELED FRONT AND REAR
SAFE MEETING AREA IS DESIGNATED (FRONT PARKING AREA)
EMERGENCY PHONE NUMBERS POSTED (SHOP AND OFFICE)
NOTIFY SURROUNDING BUSINESSES
<4> Emergency Medical Plan
START APPROPRIATE ~TREATMENT. AND TRANSPORT TO:
MEMORIAL HOSPITAL - 420 34TH ST - 327-1792
MERCY HOSPITAL - 2215 TRUXTUN AVE - 327-3371
WHITE LANE MEDICAL - 5401 WHITE LN - 832-2000
08/18/92 EPOCH WELL LOGGING 215-000-001140 .Page 6
00 - Overall Site
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
ALL HAZARDOUS MATERIALS LABELED. SAFETY MEETING HELD ONCE A MONTH.
ALL PRESSURIZED GAS BOTTLES STORED IN RACK (EMPTY ONES OUTSIDE).
NO CHEMICALS ARE USED IN SHOP (ONLY IN FIELD).
SOLID FLAMMABLES STORED IN WATER RIGHT DRUMS IN WELL VENTILATED AREA.
~2>--Re--lease ~n~ainment__~
Liquid: Neutralize spills with a spill mat or with absobant material.
Pressi:zed Gas: Shut Off Power,'.Locate and Terminate'Leak, or remove leaking cylinder
to oufslde. All cylinders are pressure checked upon arlval and every month thereafter.~ .
Solid: Contain spill wlthln boarders'to stop the spread of the chemlcal. /
<3~-~ 1.e a-n--Up__~
Liquid: Remove spill, mat or absorbanf material to poly bag, rinse spill with equal
amount of water, use toweling to pick up rTnse and to d~y area~ /
Pressurized Gas: Open shop doors, purge air fo atmosphere, use blowers ifn~y.
Solid: Sweep up and retern material to proper container. ' -,
<4> Other Resource Activation
08/18/92 EPOCH WELL LOGGING 215-000-001140 Page 7
00- Overall Site
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs ',
A) GAS - SOUTH WEST CORNER OF BUILDING IN FRENCED YARD
B) ELECTRICAL - BEHIND UNIT #19 NORTH SIDE OF BUILDING IN FENCED YARD
C) WATER - SOUTH WEST CORNER OF BUILDING IN FENCED YARD
D) SPECIAL - FIRE SPRINKLERS BEHIND UNIT #12 W SIDE OF BLDG IN FENCED YARD
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - BUILDING FIRE SPRINKLER SYSTEM W/ALARM AND
SHOP FIRE EXTINGUISHERS FOR FIRE PROTECTION
FIRE HYDRANT - TWO LOCATED IN FRONT OF BUILDING ON DISTRICT BLVD.
<4> Building Occupancy Level
~
.08/18/92 EPOCH WELL LOGGING 215-000-001140 Page 8
00 - Overall Site
<G> Training
<1> Page 1
WE HAVE 4 EMPLOYESS AT THIS FACILITY
WE HAVE MATERIAL SAFETY DATA SHEETS ON-FILE
WE HAVE SAFETY iMEETINGS EVERY MONTH, ON HEALTH HAZARDS, FIRE HAZARDS,
PROPER HANDLING, CLEAN-UP AND DISPOSAL. WE USE MSDS SHEETS
<2> Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
CITY OF BAKERSFI ET'D · i
HAZARDOUS MATERIALS INVENTORY J
Farm and Agriculture [] Standard Business '. Page 1 of 3'~.:. ~
NON - TRADE SECRET ~
BUSINESS NAME: EPOCH Well ~.,oaa{na OWNER NAME: Steve Appleton NAME OF THIS' FACILITY:
LOCATION: 5886 D{str,{,c% Blvd. ~10 ADDRESS: 9~1~ Meadowle~f Dr. , STANDARD IND. CLASS CODE: 1~9
CITY, ZIP: Bakfd. ~3~1~ CITY, ZIP:
.,. PHONE %: 80~/]97_7477~ PHONE ,S: ' R0~/~-~n~
~ ~ INSTRUCTIONS FOR P~)PER
I 2 3 ¢' 5 6 ? 8 9 10 11 12 13 14
Tranm T~pe Max Average annual _~_a-ure # Days Cont Cont Oont Usa I~cat~on Where % ~ Names of IOxture/C~mponentm
t~=_ ~__'~_~_ ~mt Amt ~ Units on S~te ~ Pr~ss Tem~ ~od~ Stored ~n Fa~lllt~ wt See In,ruCtions
Physical and Health Hazard C.A.B. ~ 1 ~-74-0 co~on.n~
(Check all ~ha~ apply) Com~onen~ # 2 N~ · ~.A.S. N~m~er
of Presmur~ Health Health .~ Comt~m~nt # 3 Name i ¢.A.8. Number
!0 methane 74-82-8
~t~atcaZ aa~ lteelth Ha~ c.A.s, mmber 74-82-8 . Ceatxmeat ! I ~ma ~ C.~.S. mm=be~ '.0 eChane 74-84-0
~0 pnopane 74-98-6
(c~k all ~t apply) . ~t ~ 2 ~ · C.A.S. ~ ~0 n-bu*ane 106-97=8
of Pr~ N~I~ H~I~ ~t J 3 ~ & C.A.S. ~ ~0)~ {so-butane 7440-59-7
/
(C~k all ~t ap~)
of Pr~s~ ~lth H~lth ~on~
~RGENCY ~TACTS Jl S~eve Appleton Owns.
c~&~ (~ ~ SIGN ~T~ CO~LETING ~L SECTIONS)
~'J0el { ~nH~l~v Y ShoD?ManaaeP 9/25/92
· HAZARDOUS MATERIALS Ih'VEN'K)RY
[] Farm and Agriculture [~ Standard Businese Page 2 of
NON - TRADE SECRET
BUSINESS NAME: EPOCH WELL LOGGING OWNER NAME: NAME OF THIS· FACILITY:
LOCATION: ADDRESS: STANDARD IND. CLASS CODE:
CITY, ZIP: ~ CITY, ZIP: DUN AND BRADSTREET NUMBER/FEDERAL ID
PHONE J: PHONE ,J: _ _
..... .~,., ~,,.~UCTIONS FOR PROPER
1 :2 3 4' 5 6 ? 8 9 10 11 1:2 r,i 3.4,
Tran~ ~ Max Average Annual Measure J Da~s Con~: cont cent uso Loce=J."" Whe~-e % by Hams of xhcturo/ccmponente
r.--'.= .~o Anfc Ant aw~ Units on Site T~ Prose Tem~ ~- Stored in Facilit~ w~ Bee
~ 10 .._.,_[ 15____[ GALS 36 ~ ....
Ph~tcal and Health Hazard C.A.S. Number 7647-01-0 component # 1 aamo & C.A.S. ember
(Chock all that apply) Component # 2 Nam~ S C.A.8. ~unber
of Pressur~ Health Health ; Component # 3 Name & C.A.B. Number
u [ . I 15 I ~0 I 15 I .^,..~ I ~.. I~. I, I 4 115 Is.-. corner o, .~hot~ ?O Hvdrn~hnr'r. A~'~
Phlmieal and Health Hazard C.A.a. Humber 7647-01-0 . Cce~onent ! Z ~amo '~ C.A.a. ember
(Check
· Component ! 2 Name & C.A.S. aumber
of Pressure Health Health Componea~ ] 3 Name & C.l.fl. Number
u IpI15I ,,~0 I15I ~.,~ I ~. I ,~ III ~ 115I S.W. corner 6f shop 10 Nlfrlc Ac~d 10%
Ph~ical and Health Hazard C.A.S. ~umber 7697-37-2 Component f 1 a~ a C.A.S. aumber
of Prenouro Health Health Component # 3 aamo & C-.AlS. ~umber
u I. I ~ I ~ I ~ I GA~-S I 36~ .I =o I ~ I 4 I~ i s..i corner o~,~o~- O0 A~on,~
pbymimal ~ Health Hazaz~ C.A.S. aum~ 7&6~-~ !-.7. C~ent ! 1 aamm & ¢.&.S. ~
(¢~__-ck all t~at apt~l~) Componeat # 2 lame & C.A.S. ~u~
~ Fire Hazard ~ Sudden aolenee ~ Reac~ivi~¥ ~ Immediate ~Dela~ed
\
of Prensur~ Health Health -.: Component # 3 Name & C.A.S. Number
EMERGENCY CONTACTS Jl #2
N~n~a Title 24 Hr. Phone aamo T~lo 24 Hr Phone
cer~fina~on (READ AND SIGN A~'T~k COMPLETING ALL SECTIONS) ·
'T ce~ --der ~an~ o~ ~w U~t ~ hair ~ro~ ~ nd ~ ~m~i= with tho in~oro.a, t~o.n submit~ in ~s ~d en.a.~,-~h~ d~ --d U~= has~
HAZARIK)US IqATERIALS INVENTORY
[] Farm and Agr£culture ~ Standard Bus£nee~ '. Page ~ oE ,'~'~.
NON - TRADE SECRET
~BUSINESS NAME: ~0C~ ~ J o~J~ OWNER NAME: NAME OF THIS" FACILITY~
~LOCATION: ADDRESS: STANDARD IND. CLASS CODE:
CITY, ZIP: ; CITY, ZIP: DUN AND BRADSTREET NUMBER/FEDERAL ID
PHONE %: PHONE .%: ' _ .....
1 2 3 4' 5 6 7 e 9 10 11 12 13 14
Trane Type Max Averag~ ~nnual Measure # Da~s Cont Coat Cont Use Loca~z~on Where % b~ Names of Mixtu~/C~ponents
r~-~= r~ ~t A~c ~ Umi~s on Site T~ Press ~m ~' 8~ored ~n Facilit~ w~ See Instruc~cio~
Physical and Health ~azard ,_ C.A.S. Number 1 07-21-1 Component # 1 nann · C.A.S. ~mber
-(Check all that apply) ·
Compcaent # 2 Name & C.A.S. ~mber
.of Pre°sure Health Health .~ Coml~mont # 3 Name & C.A.B. Number
u l "1 ' I 1 I 1 I ~A~s I ~ 11011 I ~ I1~1 s...cot-net of shop- 100 Al'tzarln Red S'
~h~ieal and Health ~azazd C.A.a. nunb~ 130-22-~ . ,Component ! Z nam '~ C.A.a. nunber
(Check all ~hat apply) , Con,orient ! 2 Name ~ C.A.8. ~unbe~
of P~eenuze Health Health C°n~°ne~ J 3 Nam~ · C.A.8. Nmnb~
~ I ~ I 1 I 1 I 1 I GA~$ I ~ I 101 1 I ~ I1~1 s,w~ co~er o~ shop 100 S~¥er ~,*r~e
Phl~ieal and Health ~azazd C.A.S. ~nber 7761-88-8 Component ! ~ nan~ · C.A.S. nunbe~
of PreaSuz~ Bealth Health C°mp°ne~t ~ 3 I/°me i ~.A.B. ~mber
U I P ] 1 ] I I I [' GALS I 365 'l 10 I I [ 4[151 s~w.corner of shop.: 00 Pofass|um Choma~re
p~3mi~al ami aealt~ ~ama~l C.A.S. au~be= 7789-00-6 ~eat ! i ~ame · C.A.a. ~=mber
. (Cta~.k °11 that apply) Coat.°.eat # 2 Rame & C.A.S. aumber
~RGEN~ ~TACTS %1
N~ Title 24 ~. Ph~e N~ Title 24 ~ Pho~
Bakersfield Fire Dept. .~.c~_~VEO
Hazardous Materials Division
2130 "G" Street HAY 3 1 1990
Bakersfield, CA. 93301 Ans'd ............
HAZARDOUS MATERIALS MANAGEMENT__...,,,.P~AN0_.~ ,~
i. 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
- ll °33
MAILING ADDRESS: ~e
CITY' ~~ STATE: (~- ZIP: ~ PHONE ~
DUN &BRADSTREETNUMBER' ¢~¢~/~ SIC CODE:
PRIMARY ACTIVITY: 0,'/ ¢ G~ S ~// ~,~:
SECTION 2: EMERGENCY NOTIFICATION:
CONTACT TITLE BUS, PHONE 24 HR, PHONE
~D1590
Bakersfield Fire Dept.
- Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECIION ~: IRAININO:
MATERIAL SAFETY DATA SHEETS ON FILE:
SECTION 4: EXEMPTION REQUEST:
I CERTIFY UNDER 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 HANDLE HAZARDOUS MATERIALS, BU!T THE QUANTITIES AT NO
TIMEEXCEED THE MINIMUM REPORTING QUANTITIES.
OTHER (SPECIFY REASON)
SECTION 5: CERTIFICATION:
MATIC~NtS ACCL~A/TE. , UI~STAND THAT THIS INFORMATION WILL BE USED T~,
FULFILLNV-AY 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 INFORMATION CONSTITUTES PERJURY.
TITLE ' D~TE
2.
FD1590
Bakersfield Fire Dept. ~
Hazardous Materials Divisio~l~.
HAZARDOUS MATERIALS MANAGEMENT PLAN
'Facility Unit Name:
SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES:
A, AGENCY NOTIFICATION PROCEDURES:
~SL - 8~i~ed. F,'.~ O,,~.~,,.e,..?
B. EMPLOYEE NOTIFICATION AND EVACUATION'
C, PUBLIC EVACUATION:
Ail oECi~e.~ ,'". ~o~p.l~.,~' ~,o~,1~ ~ ~/,'~',',c~/
D, EMERGENCY MEDICAL PLAN:
Bakersfield Fire Dept.
-- Hazardous Materials Division
HAZARDOUS MATERIALS MANAGEMENT PLAN
SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN:
B, RELEASE CONTAINMENT AND/OR MINIMIZATION'
C, CLEAN-UP PROCEDURES:
SECTION 8: UTILITY SHUT-~OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY):
NATURAL
GAS/PROPANE:
ELECTRICAL:
WATER' ~.e~-~
LOCK BOX: YES/~OJ IF YES, LOCATION:
SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY:
A. PRIVATE FIRE PROTECTION' £,',*,~
B. WATER AVAILABILITY (FIRE HYDRANT): ,y):)~ ~X~''~fs 0~ ~.'Z~','~/~,
C'I'TY of' BAKERSFIELD
Farm and-Agriculture I'] Standard Business HAZARDOUS MATERIALS INVENTORY
NON--TRADE SECRETS Paqe / of
BUSINESS NAME: £POCfl OWNER NAME: .~-/e~/e ,Z~/m~o~ NAME OF THIS FACILITY:
LQCATI~[tl ~'~o. O,~f,.'~ 81~ ~/~ ADDRESS; ' ' STANDARD IND. CLASS CODE~ ....
CIIY, (tP~t~. ' ' q3{la' - CITY, ZIP[ ~ ~/~ ~ DUN AND BRADSJREEI NUMBER .......
' REFER TO~NSTRUCTIONS-~R-PROPER CODES .
Trans [yqe ,ax Avgrage Annual ~easure I~y~e ConL Con~ ConC ~3e Loc~tion. Vhece.v~ ~laees of
~ixture/C:e~onents
(;ode Lpaq AeL Act EsL Un~Ls on lype Press lemp Stored ~n e~c~y See ~nstru:L~ons
~hvslcal and Health Hazard C.A,S. Humber ~2~.0:~'~-- 0 Component II Name I C.A.S, Number
(C~ec[ 811 that applyl
~ ~ Componen[ 12 Name t C.A.S. Number
i/e Hazard Reactiyity ~ Pelayed ~ Sudden Release ~ Immediate
Heal[h of Pressure Health ....
~ e~e~ Component 13 Name I C.A.S. Humber.
He~/Lb of Pressure
Physical and Health Hazard C,A,S. Humber 7~- ~--~ Component II Name I C,k.S, Humber ~0 ~&.~
(Che:k a]l that ApplH ~
~Fire Hazard ~ Reactivit~ ~ Delayed ~Sudden Re]ease ~ lmmedia[eC°mp°nent 12 Name I C,A.S. Number QC
Health ~ of Pressure Health
~ Component 13 Name I C,A,S, Humber aD
Physical end ~ealth ~a~ard C,A.S. Humber / ~ ~G Component II Name I C.k,S. Number
[Check all that apply) '
CoAponen: 12 Name I C.A.S. Number
~]'Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate
'.. Health of Pressure Health
Component 13 Name I C.A.S. Number
' ~e ~r PhOne R~e
[~ [ip~ioq ,(Re~d an~.~fgn after compl~tiog.all sectipn~)
.~er~frY under Bana~[~ or~a~ that J navepe[sona/~Lexaaln~O~qa~ ~a~i~la{,~it~ the ~nlo(aaUpn ~u~iL~fd in this,~ad all
attached documents, an~ [~at based on.my tnqutr~ QL[nose Inatvloua~s responslo~e ~or ob[atnlng the IntoraaHon, I believe Lha[ the ~ ~
~~r~~ of o~ner/operitor UH o~nerloperitoP's authorized t~resentattve
ClTY of BAKERSFIELD
F · . - ' JHAZARDOUS MATER:]:ALS ']:NVENTORY
aria andAgticulture FI Standard Business/ ~ NON--TRADE ' '
SECRETS
,B~s,s..~N~.S,S,S, NAME_.' ~/~/" ~-~¢~,'/~_.--, OWNER NAME: ~ ~o~,~' NAME OF THIS FACILITY:
L ~, ~ur~'_____~'C~ /~:t~,'~- ~ ADDRESS' ~ ~ · · ST NDA D IND. CLASS COD
r~u,~c .: ~P~ ~9'~w~'' - PHONE $: - --~ ...... ~ - q q ~-
' ' ' '~ - REFER TO~STRUCYJO~S~R~ROP~ CODES ~ ~ - ~
! 2 3 4 5 6 1 8 9 I0 It 12 14
Pixture/::eDonents
Code code Act Am: Est Un,ts on ~ype Press ~emp· Stored In facility See lnstru:t~ons
'IFire Hazard ~Reactivity ~ Delayed D Sudden Release U 'immediate Component 12 Name I C.A.S. Number
/
Hem [th of Pressure Health
%~. Component t3 Name I C.A.S. Number
~ I ? I ~ I ¢ I ~ I~,/I ~1 'ol ~ I~ I/A Is,~.~"'-*~ ,~s~ ,o b,.~,..<
Physical and ~ealth Pazard C.A.S. Number ~ ~ ~
- - Compon~t II Name I C.A.S. Number
tCheck all that app/y}
~ Fire Hazard '~aeactivity ~ Delayed ~ Sudden Release ~ ]mmedia:eC°mp°nent I~Name I C.A.S. Number
Health of Pressure Health Component 13~'Name I C.A.S. Number
~ I~1 ~- I ~ I ~ .1~/1~; I ,,I ~ .l .~ I/~ I~. c~.~o~ ,~ ~o~/o,.~ ~,'4
~ysicallche~k all~ndlh8tHe~llh~pplll6al4rd C,A,S, Number Component II Name I C,~S~: :Number
N
Component .13 Name I. C-.A.S. Number
~lPl s I ~ I ~' I.~1 ~1 ,~ l al ~.1 /~1 ~.~ ~.~..~~ ~o Hyd<~o~.'~
Physical and ~ealth ~azard C.A.S. Number Component II Name I C.A.S. Number
{Check-all that app/yl ..
~ Fire Hazard ~Reactivity ~ Delayed ~ Sudden Release ~ lm~i~c°mp°nent If Name I C.A.S. Number
Health of Pressure ~
~ Component 13 Name I C.A.S. Number
EHERGENCY. COflTACTS fllaa,e~eve ~/~*~' TITle~'~';~P Zl~'/Y~/Hr Phone t2R~de/ :,'q~l/o ~ . ' TI[1¢~°~
erLifi atio Re and f naf r c~m ~ Cf]g a~ s cCfons
[.~er[ily. un3er ponal~, o~ thqt ]~av~ pe[sona~.exaelnq~aq~,, famil,aL vitb ~e fnforeat~pn ,u~mittpO In this.end all.
a~.~acned.d0cveent~, anl tpat oaseo on.my Inquiry ~.~nose InOlVl~UllS respons~o~e tor obLa~n~ng ~ne ~nioreauon. ] believe tha~ the
sU~ltteo IniOr~a:lO~ Is :rue, Iccurate~ log complete. .
~T~e ePd oficial ttt~ of ounerloperator uK ounerloperator's authoriz~d representative
CITY, of BAKERSFIELD,
· '~[~--IAZARDOUS "i'HATERTALS., TNV NTORY .
,.,,,,,,-,,., a ,.,o,,,,,,,,,,, r- ....'£~::,~::~-,- .... ~
.. ~. ~_ ,' T--]~:.:.~:~ .'+ ~.,. ~ / o ' -'
~[Y. ~]P. · ~' .~ ........ C][f, ZIP. ~ 5m~ ~ ~ . DUN AND BflAD~IRE
" ' ' "~ :~:'~'~::~':~:' o~ t on"V~ ' ' :',~':::'~ ' I ~ Nmi of ~ixtur, Ce,pon,ars
as e Pat Ay ~ ge A n al ~ a uti I on~ on~ . on~ · s -~..;:~. ,',..[ I
~1 ~1 ~ I.~ I~o I~.II ~,~1 ~1
~. . . . ~ ', - , - ,..: .. . {.- ,~ - .... ':.. .,~'..: ~:: , ;-:~t.~ ..
,.~ 3t;...-- ~ :- , .~; ~;3-,~-: . -~. · .
~l . ',' .' . . ' HelKh O[ Ptessurl . " .Health :, · :: -x.: ...... ....:, - .~-~.,~..,:.,....;j.;.:.
:' ,' · ." · ' ...,'....,~.,,~. ,,,, ~c.u, ,,,h, ' ' :..:.,.. · "
· . . :, ; .~ . .' ',. ,' ~ · ','~.~, :.- . .
~ ' . '. ..:' '--:' . : ~ Component 13~ Ilai I C.A.I; luaber;',-.'::/'.?/'~:':.~.
~lj~tl, dtl:l'~h ~,{,,d '.' · C.A.6. Number. ' ' ' " ':" ' =~' '
pi Il .' '. . . . .~ .. COlpOneflt II JIM I C,A,I, lubber.. ""v.
..... '.~ .... Coaponenl II Ilal I C.A,i. luaber't.:.-.'
' .~ . ..._ ~ -.' flelK~ . .o~r~essu~l ' '-. . .. .' ~:,~'' .
, Co~ponen~ 13 .lime t C,A,S, Nu~ber.c~.~
llicll I~d 8.llth 8111rd ' ' . - -C.A.S. Nuaber Conponeflt II .Nile I C.l.S. lulblr '
..~ '
Fire Hlzlrd '~ Reactivity 0 OHlyed ~ Sudden Release .~ lB .
-HeaKh of Pressurg ' - - ','~-.;:':'~'~:'.~'-.'.'..' '. .... ' · -' ·
. Coaponlnt'll~alle I C.A,I; lulbe'r ' ~ . .
,~ TI&Il ~ Hr ~hone 't."keae~ ' TITle 21~t Phone -
,,, ,i,..,,~,, ,,,,~ o ~ ,, ¢,~..,.,, fi ,,,, ~ ~., fi ,,fi', it ~, ,fo,, ,- , .' -
' . ..... :..,.~--,:" . -. ~' '.','.-.. ' - L
I
~~.f ovnerloperltor UN ovnerloperuot's authorized represenLitive Signature'
HAZARDOUS MATERIALS INSPECTION
RECEIVED
,~ OCT 14 1988
~.ATXO.= ,~'~',;",'~'~ ~~ ~ ~~ ~/~ Ans'd ............
2130 "G" STREET RECEIVED
'Il BAKERSFIELD, CA 93301
(805) 326-3979 i ~),~-I~ NOV 3 0 1987
ned
OFFICIAL USE ONLY
~USINESS
INSTRUCT I ONE:
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
B. LOCATION / STREET ADDRESS: ~ ~D ~,'~,'~ B/~
CITY: /~~, ZIP: q~,~ /~ BUS.PHONE:
SECTION 2: E~RGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 o~ 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 ~ILI~ S~-OFFS FOR BUSI~SS AS A ~OLE
E. LOCK BOX: YES /~ IF YES~ L0~ATION:
IF YES, DOES IT CONTAIN SITE PLANS? YES / N0 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
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL REFRESHER
A. METHODS FOR SAFE HANDLING OF HAZARDOUS ~ ~
MATERIALS:...' .................................... NO NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: ..... ~ .................... ~E~-~S~ NO ~S~
NO
C. PROPER USE OF SAFETY EQUIPMENT:... ................ ~S ,N0 N~E.~
D. EMERGENCYEVACUATIONPROCEDURES: ................. /"Y_.E~N..~Q.O 'E~S~,~NO
E. DO YOU I~INTAIN EMPLOYEE TRAINING RECORDS: .......
"TES ~ N~
SECTION ?: HAZARDOUS MATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES. LESS THAN 500 POUNDS OF A
SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIgFEET OF A COMP'R"f~'~'GAS: ...... YES ~
.
I understand that this ~formation 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 constit,utes perjury.
BAKERSFIELD CITY FIRE DEPARTMENT'
2130 "G" STREET
BAKERSFIELD, CA 93301
OFFICIAL USE ONLY
ID#
BUSINESS N~E:
BUS I NESS pLAN
9I NGLE FACILITY UNIT
FORM
INSTRUCTIONS
1. To avoid fu~iher action, this form must be r'eturned 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.
SECTION 1: MITIGATION, PRE~NTION, ABATEMEN~ PROCED~E:S
SECTION 2: NOTZFZCATION ~ EVACUATZON PROCEDE~ES AT TH~S b%~T' ONLY'
- 3A -
/SECTION 3:.HAZARDOUS ~hTERIALS FOR THIS UNIT ONLY
.. A. Does this Facility Unit contain Hazardous Materia'~s? ...... NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YE,~OJ
If No,.comple~e a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form #4A-l)
If Yes, complete a hazardous materials inven%orY form marked:
TRADE SECRETS ONLY (yellow form #4A-2) in additioh to the non-trade
secret form. List .only ~he trade secrets on form.4A-2.
SECTION 4: PRIVATE FIRE PROTECTION
SECTION 5: LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS
SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS [iNIT ONLY,
A. NAT. 6::~S/'PROPAN~.~
B. ELECTRICAL:
C. WATER:
D. SPECIAL:
~ IF YES LO~ATION:
E. LOCK BOX: YES ,,, ,
IF YES, SITE PLANS? YES / NO MSDSs? YES / NO
FLOOR PLANS? YES / NO KEYS? YES ./ NO
- 3E -
. BAKERSFIELD CITY FIRE DEPARTMENT ....
I D. #' FORM 4A-1 .e~.-.. Page ~
NON--TRADE SECRETS
HAZARDOUS I~IATE R I ALS INVENTORY
ADDRESS: .~9~0 ~,~k~/~ ~lO ADDRESS: FACILITY UNIT NAME:
1 2 3 4 9 6 7 8 9 10
TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD ~D.O.T
CODE AMOUNT AMOUNT UNIT CODE ~ODE FACILITY UNIT. WT. CHEMIqAL OR COMMON NAME CODE ~OUIDE
~P,300 /~ /~ ~ /~ ~:~.~, ~~, ~s~,, too~~ ' ~,~' ,/&V&.~ . ". ,
m ~ ~ ~,1ZO,,. 15 /' "'/ -31'., mo,~,'~ ~~ P/nO
- .....
,
~AN~: TITL~: S I~NATBRE: DITE:
EMERGENCY CONTACT: ~o~ TITLE:, ~9~, [ HOURS:
· AFT! BUS BRS:
PRINC'IPAL BUSINESS ACTIVITY: O,'1 ~ ~S ~1[ ~,']!;~ AFTER BUS Has:
- 4A-1 -
~,~ CITY BAK_FRSFI£LD ~lCf O ~,,~
~~,' ~.'j '
JAN 2 6 1989
Do hereby certify that I have revie;;ced the
~,'~ .....
attached Hazardous F~aterials business ~lan
(name of business)
and that it along with the attached additions
or corrections constitute a comDlete and correct
Business Plan for my facility.
BUSINESS NAME EPOCH ~I- LOGGING IDNU/z s,- e-oo 4e /
LOC~T~ON S88e-le~STRZCT BLVD H~ FI~Z~RD R~T~NG
-- '-
t. OVERVIEW
LAST CHANGE ~B/!G/88 BY ESTER
JURIS COOE Z1S-OSB JURIS 8~KERSFIELD STATION
MAP PAGE' 1Z~ GRIO 1SC ...... FAC'~[~'T~UNI'TS ; HAZARD RSTING
RESPONSE SUMMARY
ZA SEC 4) FIGHT SM~LL FIRES W SHOP EXTINGUISHERS. SORK UP AND CQNTAIN
CHEMICAL SPILLS. ~RCUR%E"BLOG"~OR'~R~'SQRIZED' GB~ LEAK.
EMERGENCY CONTACTS
STEVE APPLETON-
JOEL'LINOSLEY - 397-747Z OR 834-07Z8
UTILITY SHUTOFFS
A) ~AS - SW CORNER OF ~LDG IN FENCED Y~RD B> ELECTRICAL-. ~EHIND UNIT ~1~
N SIDE OF ~LDO IN FENCED Y~RD C)-~TER - SW CORNER OF BLDG IN FENCED YARD
D) SPECIAL - FIRE SPRINKLERS BEHIND [INIT ~12 Y SIDE OF BLDG IN FENCED YARD
NOTIFICATION / PUBLIC EVAC'URT'ION
........ E~ST"CFIANGE"' /" / BY
< NO INFORMATION RECORDED FOR THIS SECTION >
PAGE 1 1Z/19/88 1S:04
MATERIAL S~FE'T¥"DRTR"SYSTEMS, "INC" ('BOS)'B~B-G800
BUSINESS NAMEEPOCEt--'I_LOGGING ID NUI z~s-~e~-e~ ~4~
LOCATION S880-10"OISTRICT BLVO H~H~Z~RD R~TING 4
~. F1AZ M~T TRAINING SUMMARY
< NO INFORMATION RECORDED FOR THIS SECTION >
At. LOCAL EMERGENCY MEDI'CAL""RSS"I'STFINCE
"I':RST' CF~i~NGE ag/18/88 BY ESTER
ZA SEC S) START APPROPRIATE TREATMENT AND TRANSPORT'TO:
MEMORIAL HOSFITAL - ~ZO 341~ST"- ~ZT~l'7BZ '
MERCY HOSPITAL' "-'"ZZ1S-"TRUXq't~ R9~ -' 327~3371'
WHITE L~NE MEOICf~L'''~' S4~'1 ~HI"TE' LN "- 8'3Z'~'ZO~O
PAGE Z ..... 12119/88 15:04
MA'fERI'RE' S'RFE-T't'"DATR'~Ys"rE~s'; INC';"¢8(~;)"-'E'48~'GF00 .....
BUSINESS NAME EPOCH ~. LOGGING ID NU~ ~15-000-001140
LOCATION seee-te"'ozs'rRzc'r BLVD H~HAZRRD RATING 4
FACILITY UNIT 0!
A. OVERALL HAZARDOUS MATERIALS INVENTORY
E'R'$T"CHRl~GE"09/l'6/88 BY ESTER
ID TYPE NAME MAX AMT UNIT HAZARD
LOCATION "COFTY~TNI~I~NT ..... USE
! PURE CARBIDE " 300 LBS EXTREME
NW CORNER OF SHOP DRUMS OR BARRELS MET.. EXPEREMENTAL
ID PERCENT COMPONENTS HAZARD LIST
1040.03 1~.~ CARBIDE ........ EXTREHE
Z P~JRE HYDROGEN 448 FT3 EXTREME
NE CORNER OF SHOP PORTABLE PRESS. CYL. 'EXPERE~ENTAL
ID PERCENT COMPONENTS HAZARD LIST
Z~SZ.~ 1~.8 HYDROGEN EXTREME
3 MIXTURE WELL LOGGING TEST GAS 176~ FT3 EXTREME
NE CORNER. OF SHOP PORTRBLE"PRESS. CYL. EXPEREHENTAL
ID PERCENT COMPONENTS '~ HAZARD LIST
~19~.88 Z8.8 METHANE EXTREME
18Zt.88 Z8,,8 ETHANE EXTREME
1818.88 ~81~ n-BUTYL ALCOHOL HIGH
llSS.BZ ZB.~ PROPANE EXTREHE
115~.81 Z818 HEXRNE ...... HIGH
B. FIRE PROTECTION / WATER SUPPLIES
.... EAST"CHANGE 09/1!8/88 BY ESTER
SEC z~) BLDG. FIRE SPRINKLER SYSTEM~'~IT~AC'f~RM"RND sHop FiRE EXTINGUISHERS FOR
FIRE PRO'rECTtON.~ ........
SEC S) TWO FIRE HYDRANTS IN "FRO~T" OF"BE06' ON"~DISTRICT BLVD.
PAGE ~ 12tt9/88 15:04
MATERIAL. SAFETY DATA STST1ZMS.'~NC. (805) G~8-6800
LOCATION 5880-10~'~)ISTRICT BLVD AZARD RRTING 4
D. EMPLOYEE NOTIFICRTION / EVACUATION
lAST'CHANGE 09/1G/88 BY ESTER
SEC Z> EXITS ARE I_RBELED"FRONTRh'D REAR. SRFE'MEET~NG"'RRER IS DESIONRTED
(FRONT PARKING 'RRE~')";' 'EMERGENC¥"PFIO'NE'"NUMBERS ARE POSTEO IN'THE
SHOP AND OFFICE. '"~'
E. MITIGATION / PREVENTION/ RB~TEMEN'F'
" :LR~'F'~C~N~E'"Og/1B/88 BY ESTER
SEC 1) ALL HAZARDOUS MATERIALS ERBELED, SAFETY MEETING HELD-ONCE R MONTH.
ALL PRESSU'F~'ZED"'"GRS""BOTT['E~"STOF~-D'~IN~"R~CK'(EMPTY ONES OUTSIDE). NO
£HEMICRLS ARE USED"IN SHOP ('0NL¥'-IN"FI'EED),~ SOLID FLAMMABLES STORED
I N WATER TIGHT DRUMS" IN"'WEE[ ' ~ENTIE'~TEB AREA.
PA~E 4 .... 1Zt19/88 i~:04
MATERIAL ~RFETY"DR'T~' S¥STEMS~ ~C~
CITY of BAKERSFIELD
Farm end Aqri~lture ~ Standard Busi.ess HJ~LZ aPk, AC~,.DO U S ~A'~q~ ]~ ]1~,'~' A~S
NON--T~D~ S~
CITY, ZIP: ~a~wVff,'e/~ ~3315 CITY. ZIP: ffa/e~, q33 Il ' DUN AND BRADSTREET NUMBER
~ ~ z~mu~zo~ ~n mo~m coo~
~ Irons T~ ~x A~e ~1 ~su~ I ~ ~t ~t ~t ~ L~ttm ~ T ~ i ~ Nl~~ts
C~e C~e ~t ~t Est Un,ts ~ Site T~ ~ T~ ~ -. St~ in F~tltty ~ ~ I~t~tiw
_~_l.8._J[~Y~.eff~.lt°oovr31j~e~_Lr31&Sl33c Ioe I ~ I ~ I/~T I d,~. ~/~,, o~ s~oF
Itek ell tbt I~ly) ............ ~ --
Fire Hazard ~--J R~ttvlty ~--J ~1~~ ~l~e u--J I~lltl '
h of P~ ~lth
._~.[~'_J~qp.~D_J.~-~.~LlWo ~3 l~l~..lf~_~~J~4~.~
16~k ~ll Iht ~lf} ..........
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H. lth of P~su~ HNIth '
.~?, ~ ,.~,h ~,,~ C.A.S. ~ Ih ~ ~ ,, ~ ~ C.A.S. ~ 10~ ' '- '- ~ ,, ~, ,~a~, '
~,~, .ir t~t rely) .......... u ~. ~, ~,~., / ~,'C.&/~rto~.r~./o~ ~ ....
-- r--~ -- C~t 82 ~ & C.A.S. ~
H~ith of Pr~sure ~4ith
~ 13 ~&C.A.S. ~r
~I'RF'P~i ........................ TI~lr-- ii:ii'~l .......
Certffic~ti~ .(Read and si~ after co~plet~ng all sect~ons)
I certify ~de. ~ity of la. t~t I ~ve ~rs~allye~amn~ ~d aa f~iliar .tth t~ tnfov~tim su~itt~tn t~ts ~ ell ett~ ~ts.
.............. , ....