HomeMy WebLinkAboutBUSINESS PLAN '. ": - S I TE-/FAC ~' L I .TY D'I'~G.R~I
NORTH . S Aq~.~: B~SIN~SS N~ .:' ...- .. : :' . .. .... 'FLOOR: 0F.
' DATE: /'' / .FAC~.LfTY N~E: : UN~T.'~: OF .' .
~. (CHECK ONE)' SITE DIAGR~ .. F~C:ILITY'DIAGR~, '': '
~ , .- .. . ". . .~:'.' · .
. :. .. ' ' :: '~'.':"-? ' ~.' .' '1. <?~J
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. . . .. ...:.',.-' . :~ ~ ........,. ...,~<.. . . . ~..., -~,.
....... ., ......... ~~~ · ,;~ ... ... ... -~ . .
I(Inspecto~'s Comments): .' ~OFFIOIAL USE ONLY~ ' . . ..
[ .. ~~/z. ~~.:~." ... ' -'-...: '" ...-..-. I,.~'~.....
. . ~. . ~-. - ..:. ....- ...: .'.. . :.. '~..: .- ~cu_~o .~..:....'...'., ~...
MISCELLANEOUS RECEIVABLES ADJUSTMENT'
DATE '~- ~/- ~/ / NEWACCOUNT
ADDRESS CHANGE
CLOSE ACCT
FINANCE CHARGE I
: OTHER ADJ
CUSTOMER NAME
MAILING ADDRESS
SITE ADDRESS
PARCEL NUMBER
(IF APPLICABLE)
ADJUSTMENT
CHG DATE ' CHARGE CODE ADJUSTMENT AMOUNT
STATEMENT OF ACCOUNT
CITY OF BAKERSFIELD
1501TRUXTUN AVE
BAKERSFIELD, CA 93301-0000
(805) 326-3979
DATE: 1/01/97
TO: JIMMYS BODY SHOP
dIMMY ENRI~UZ JRET
BAKERSFIELD, CA 93307
CUSTOMER NO' 3315 CUSTOMER TYPE: ES/ 3315
CHARQE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL. AMOUNT
12/01/96 BEGINNINQ BALANCE 662.51
HMO09 1/0i/97 FINANCE CHARGE 1.58
FCOll
HMO09 1/01/97 FINANCE CHARGE 1.58
FCOll
HMO09 1/01/97 FINANCE CHARGE 1.58
FCOil
HMO09 1/01/97 HAZ MAT HANDLING FEE I 158.00
HMO17 1/01/97 FINANCE CHARGE .50
FCOll
HMO17 1/01/97 FINANCE CHARQE .50
FCOll
CONTINUED ON NEXT PAGE...
DATE: l/Oi/~7 O
RE~t~T AND MAKE CNECK PAYABLE TO:
CZTY OF B~AERSFZELD
P.O. BOX 2057
CUSTOHER NO: 3315 CUSTOMER TYPE: ES/ 33i5
STATEMENT DF ACCOUNT
CITY OF BAKERSFIELD
1501TRUXTUN AVE
BAKERSFIELD, CA ~3301-0000
(805) 326-3~79
DATE: 1/01/97
TO: JIMMYS BODY SHOP
JIMMY ENRI~UZ JRET
BAKERSFIELD, CA 93307
CUSTOMER ND: 3315 CUSTOMER TYPE: ES/ 3315
CHARQE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT
HMO17 1/01/97 FINANCE CHARQE .50
FCOII
HMOI7 1/01/97 HAZ MAT ANNUAL INSPECTION 50.00
PBO17 1/01/97 FINANCE CHARGE 3.57
FCOll
PBO17 1/01/97 FINANCE CHAROE 3.57
FCOil
PBOI7 1/01/97 FINANCE CHARGE 3.57
FCOI1
FOR QUESTIONS DR CHANQES TO YOUR ACCOUNT PLEASE
CALL THE NUMBER AT THE TOP OF THIS STATEMENT.
CURRENT OVER 30 OVER 60 OVER 90
224.95 5.65 5.65 651.21
DUE DATE: 1/01/97 PAYMENT DUE: 887.46
TOTAL DUE: $887.46
9ATE: t/Oi/~7 DUE 9ATE: ~/O1Z~7
REMIT AND MA~E CHEC~ PAYABLE TO:
C~TY OF BAKERSFIELD
P.O. BOX 2057
CUSTOMER NO: 3315 CUSTOMER TYPE: ES/ 3315
TOTAL DUE: ~887.46
09/10/93 'J~S BOD~'SHOP 215-000-001176 ~,,.~,~% Page 1
~Ove~all Site with 1 Fac. Unit
~~./_M_~;~..~ General'Information ~~/~
Location: 628 DOLORES ST Map: -103 Hazard: Moderate
Community: BAKERSFIELD STATION 02 Grid: 29C F/U: 1 AOV: 0.0
I Contact Name I Title Business Phone i 24-Hour Phone-
JIfY ENRIQUEZ (805) 324-6966 x (805) 832-2573
JIMMY ENRIQUEZ 1(805) 324-6966 x · (805) 397-173'8
Admihistrative Data
· Mail Addrs: 628 DOLORES ST D&B'Number:
City: BAKERSFIELD State: CA Zip: 93305-
Comm Code: 215-002 BAKERSFIELD STATION 02 SIC Code:
Owner: JIMMIE ENRIQUEZ, JR. Phone: (805) 324~6966
Address: 3804 TEAL ST State: CA
City:BAKERSFIELD Zip: 93304-
i,,,~i~l~J~/~'-D~wd~_...~_~o hereby certify that I have RECEIVED
reviewed the 'a',:~.a.:'xi'~,.~d h~ardous materials manage-
ment plan forJ~q~ ~ ~,and that it along with
(~ of ~sine~) I
any corrections constitute a ~mplete and co~ect man-
agement plan for my facili~,
09/10/93 jIMMys BODY SHOP 215-000r001176 Page 2
Hazmat Inventory List in MCP Order
02 - Fixed Containers on Site ~
Pln-Ref Name/Hazards Form Max Qty MCP
02-002 ACETYLENE Gas 220 High
· Fire, Pressure', Immed Hlth FT3
02-001 OXYGEN Gas 242 Low
· Fire, Pressure, Immed Hlth FT3
09/10/93 JIMMYS BODY SHOP 215-000-001176 Page 3
02 - Fixed Containers on Site
Hazmat Inventory Detail in MC~.Order
02-002 ACETYLENE Gas 220 High
· Fire, Pressure, Immed Hlth FT3
CAS #1:74-86-2 'Trade Secret: No
Form: Gas Type: Pure Days: 365 Use: WELDING.SOLDERING
Daily Max FT3 I Daily Average FT3 I Annual Amount FT3
220 ~ 110.00 440.00
storage Press T Temp Location
PORT. PRESS. CYLINDER IAbove "lAmbientlMoBILE
-- Conc Components I Guide
1000% IAcetylene I MCP
· High . 17
02-001 OXYGEN Gas 242 Low
· Fire, Pressure, Immed Hlth .. FT3
CAS #: 778,2-44-7 Trade Secret: No
Form: Gas Type: Pure Days: '365 Use: WELDING SOLDERING
Daily Max FT3242 I Daily Average121.00FT3 I Annual Amount484.00FT3
Storage Press T Temp ' ' Location
PORT. PRESS. CYLINDER Iabove.~AmbientlMOBILE
-- Conc Components MCP -~Guide
100.0% IOxygen, Compressed ILOw I 14
09/10/93 JIMMYS'BODY SHOP 215-000.001176 Page 4
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notificat'ion
CALL 911 ·
<2> Employee Notif./Evacuation ~
WILL NOTIFY EMPLOYEES IF THEY NEED TO EVACUATE THEY CAN EXIT ANY DOOR
<3> Public Notif./Evacuation,
<4> Emergency Medical plan
MERCY HOSPITAL
2215 TRUXTUN AV
327-3371
09/10/93 JIMMYS BODY SHOP 215-000-001176 Page 5
00 - Overall Site~
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
2 UNITS OF OXYGEN AND ACETYLENE ARE ON MOBILE CARTS. WHICH ARE cHAINED TO
CARTS
<2> Release Containment
<3~.Clean Up .
<4> Other Resource Activation
09/10/93 JIMMYS BODY SHOP 215-000-001176 '~ Page 6
00 - Overall Site
<F> Site Emergency Factors
<1> speCial Hazards
<2~ Utility Shut-Offs
A) GAS - NONE
B) EL~ECTRICAL - BEHIND BUILDING
C) WATER - BAKER ST CORNER OF ALLEY~
D). SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. water
PRIVATE FIRE PROTECTION - ?????????
FIRE HYDRANT .- ON BAKER ST CORNER~OF ALLEY
<4> Building Occupancy Level
09/10/93 JIMMYS BODY SHOP 215-000-001176 Page 7
00 - Overall Site
<G> Training
<1> Page 1
WE HAVE 5 EMPLOYEES AT THIS FACILITY
WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE
BRIEF SUMMARY OF TRAINING:
<2> Page 2 as needed
~3> Held for Future Use
<4> Held for Future Use
2130 "G" STREET RECEtVEEI
· B~dr~ERSFIELD, CA 93301
(805) 326-3979DEC" 1 1 1987
............
BUSINESS PLAN AS A WHOLE
FORM 2 A .~.
1. To avoid further action, return this for~ b~
2. TYPE/PRIST ASS~ERS IS ESGLISH.
3. Answer the questions belo~ for the business as a ~hole.
4. Be as brie~ and concise as possible.
SECTIO~ 1: B~SI~SS IDE~I~IC~TIO~
LOCATION / STREET ADDRESS: ~ ~k~,~ ~'~
CITY: ~~~, ~ ZIP: ~%~ BUS.PHONE: (~0~
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 91! 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 SHUT-OFFS FOR BUSINESS AS A WHOLE
A. NAT. GAS/PROPANE: /~ dG~s)
B. ELECTRICAL: 7~~ (,-D~59 r~n g~,;go ._;~/~/c~,//~ ')
C. WATER: ~g~ ,~. ~r~- ~ /'f/zE~
D~ SPECIAL:
E. LOCK BOX: YES /~)IF-~- YES, LOCATION: ~d ~- '~
IF YES, DOES IT CONTAIN SITE PLANS? YES / NO ~ MSDSSV 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:... .......................... ' .......... E~ NO ~ N.O
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: .......................... ~ NO $ NO
C. PROPER USE OF SAFETY EQUIPMENT: .................. NO NO
D. EMERGENCY EVACUATION PROCEDURES: ...... ' ........... C4~-'SX NO NO
E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES ~ YES
SECTION ?: HAZARDOUS ~ATERIAL
CIRCLE YES OR NO
DOES YOUR BUSINESS HANDLE HAZARDOUS ~TERIAL IN QUANTITIES LESS THAN 800 POUNDS O~
SOLID~ 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED~GAS: ...... YES
I, 3 ~m~ ~fX-lx{qk) f 'Z-- ' , certify that' the. above -inf'o~mation is accurate.
I understand that th~s information will be used to fulfill my fi~z's obliaations unde~
the new CalifoFnia Health and Safety code on Hazardous Materials (Div. 20 Chapter 6.95
Sec. 25500 Et Al.) and that inaccurate information constitutes perjflry. .;
BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
0~,.Au USE ONLY
BUSINESS- PLAN
SINGLE FACILITY UNIT
FORM
INSTRUCTIONS
1. To avoid further ac{ion, this form must be returned by:
g. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as .possible.
FACILITY UNIT~ FACILITY UNIT NA~WE:
SECTION 1: MITIGATION, PRE~ION, ABATEMES~ PROCED%~ES'
SECTION. 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS U/'iT ONLY
SECTION 3: HAZARDOUS MATERIALS FOR THIS I~IT ONLY
A. Does this Facilit.y Unit contain Hazardous Mater~a!s? ...... YES NO
If YES, see B.
If NO, continue with SECTION 4.
B. Are any of the hazardous materials a bona fide Trade Secret YE~ NO
If No, complete a separate hazardous materials inventory
form marked: NON-TRADE SECRETS ONLY (white form ~4A-1)
If Yes, complete a hazardous materials inventory form ma :
CRETS ONLY (yellow form #4A-2) in addition to non-trade
secret List only the trade secrets on form 4A
SECTION 4: [VATE PROTECTION
SECTION §: LOCATION OF WATER Sb~PLY EMERGENCY RESPONI)ERS
SECTION 6: LOCATION OF UTILITY_ SHL~ AT THIS ~IT ONLY.
A. ~A'f. GAS/PROPANE'~
B. ELECTRICAL:
C. WA~ER:
D.
E, LOCK BOX: YES./ .YO IF YES, I. OC..%T!ON:
' IF YES, SITE PLANS?"ES~ . / >~0 MgDgs?, .. ?-,-:,:.~ ' v,-,,,,
FLOOR P.r..A.YS? YES ./ .'x'O .KEVS0 YES
- 3B -
'" KERN COUNTY FIRE DEPARTMENT . ·
I.D. '#'"', .:.': · ~'ORM 4A~l " '. ': - page' ~'~o.f
?...::,' .:. ..: ,-~ HAZARDOUS'- I~IAT-ERI ALS' :'I NVENTORY
'usINESs'N.~E:'~ I~ /~ ~-. ' owNER NA~E:"_~I'~.~/~ ~,~~.~' -FACILITY UNI.T ~: .
"'.'.' ADDREs.S: ~ '~Dl~r~.~ ~ . ADDRESS: '~O~ '~~ / ' FACILITY .'UNIT. NA~E: ' ' ' . "~.:
',:"..::%C'~I,TY',' ZIP: ~~~ ' ~ ~ ' ' ClTY,.ZI.P~ ~~_~'~ ' ~f~ . "
':.'.",'".PHO'N~ *:'. ~.~.~'~'~ ", : . PHON~ g: ... ~~/~ .' -.. .[OFFICIAL. ONLY USE ~FIRS CODE
1 '.: 2. 3 4~ ' 5 ' 6 7 8 " 9 , ' 10'
TYPE'. 'MAX ANNUA'L CONT USE LOCATION IN,,THIS % BY " ' HAZARD D.O'T
~ODE '" ' : ' " " . '
AMOUNT 'AMOUNT UNIT CODE CODE' FACILITY UNIT' WT CHEMICAL OR COMMON. NAME . .CODE GUI'DE
:~.- . .
'
,'- ,"; ' i ' :~ ' : ".'
',' , ,. ~ · ~ - ff~-: ~a '
NAME:~/~,'t~ ~/~_~ f'~' TITLE: SIONATURE:~}~' ~~~ DATE:__
E~ERGENCY CONTACT: .'~~ ~/~e~ " TITLE: PHONE ~B~OURS:__ ,
' ' /. g ' AFTER BUS.~RS:~
~ ' ~ ' " ' ~~' 'pHoNE ~ BUS HOURS:
.E~ERGENCV CO~T~C.T: ~/~ [~~/~ ~ TITLE: '
.PRI~Ci'PaL BUSINESS aCT'IVlT~: ' ~FTER ~US ~RS: ,~7g~'7~ .
HMC U-- 9""
CODES '.-: ·. . ~,.. TYPE CODES
01 Under¢~'0und'Tank- ' ' P-~ pure
02; Aboyeg~ound Tank -'"-. ".. 'M = Mixtures of pure'
· 03. Fixed Pressurized TFnk~ :~ substances.
04. Portable .P~essur'ized:Cyl.~ers W ='Was~es iAlso'add,
05: Insulated. Tank (~ncl:u~es,..~,yogenics) appropriate waste -.
06 Drums or Barrels.,,- Me~alli'c - code)-. ·
07 Drums Or Barrels ~ Non-Net'at'lic
08 Carboy(s) "' '" ~"':'
09 Glass Conta~.n~r("s) , . , '....
10 Plastic Container(s) .. .
II Box(es) '- ,. UNIT CODES .'~,.
~2 Bag(~) : .:-'
13 Metal Containers CNo'~ Dru~.~}- LBS = Pounds
14 in Machinery or'processing equipment TON ~ Tons (2,000 lbs)'
15 '-Bin(s) ' . GAL.= Gallons"
'99 OTHER -.specify on S~araie sheet BBL = Barrels.(42 gals)
.- '.Ft3 = Cubic Feet ..,
CUR = Curies
USE CODES
01. Additive : 23 Herbicide-
,,: 02, Adhesive -24 Insecticide
03. Aerosol 25 Instructional.
-04, Anesthetic ..',...,'~ 26 Lubricant
05. Bactericide '' ~'7-.27 Medical Aid Or Process
06, Blasting '<'" ' 28 Neutralizer
'07, Catalyst ::~ - 29 Painting- ":
08, Cleaning ..~ .... 30 Pesticide ,
09, Coolant : ,:1.- 31 Plating
10. Cooling ~2 Preservative ,.
1'1, Dr. illi. ng " 33 Refining
'1: 12. Drying. " ~34.. Sealer~
13. Emuisifier/Demul~ifier 35 "Spraying
.' 14., Etching :,..- 36 Sterilizer
..15. Exp.erimehtal .- 37 Storage
16. FabriCation~ . .... 38 Stripper .
17. Fertiiizer 39 Washing'
" 18 Formulation' : .. 40 Waste'
19 Fuel : "' · .: "41 ~ater Treatment
20 Fungicide :. :42 Welding Soldering
2.1 Grinding .' , '43 Well Injection
.22 Heating .,~ 0il Treatment
· , ~ 9~ OTHER-Specify on
IiAZARD CODES : -
· EXPL -ExPlosive ~' -..ORM~ - Anesthetic, Irritant
CMLQ - COmbustible Liquid ORME - Hazardous Waste
'CMSL - Combustible Solid' '.,.ORMS - Other regulated '
. '~ '- Material:B,C;and D -,.
' 'CRMT -'Corrosive Material' '" PSNA - Poison A (Gas)
· FLGS - Flammable ,Gas PSNB - Poison B (Liquid or Sdli'd)"
' - FLLQ - Flammable Liquid RADI - Radioactive .. . .,
".:FLSL ~' Flamm~ble So]id. ' ': WATR - ~ater. Reactive "
NFLG" Non-Flammable'Gas '' 'ETIO ~ Etiological Agent · '
'.OG?X' '.Organic PerOxide '- PYRO -'-Pyro'phoric,. Hypergolic or ". ""
::,~,~,i':~~ .... spontaneously cOmbustible'. ...~ "-," '
~OX~3,~.oxidtzer . -~. · .... .
· CRy~.2:Cryogenics .- . ..... ..- ....
HAZARDOUS MATERIALS INSPECTION
,./'
VERIFICATION OF INTBN'fORY M~TERIAL~
VERIFICATION OF QUANTITIES
VERIFICATION OF LOCATION
PROPE~ SEGP3~TION OF MATERIAL
VERIFICATION OF ~ MAT TRAINING
VERIFICATION OF MSDS AVAILABLE
VERIFICATION OF ABATEMENT SOPPLIES & PROCEDI]R.ES J~'"'- .
~S: