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Home My WebLink AboutBUSINESS PLAN 1/14/1994 (CHECK ONE) SITE DIAGR.~ FACILI~ DIAGR.~ Inspector's Comments): -OFFICIAL USE ONLY- - 5A - SITE D[AGRAN (Requi itess) /i. Address: Identify the ~9. Lock principle buildings /~1 by the Street numbers. O. NSDS Storage Box ! , Street(s), Alleym, 11. Railroad Tracks Driveways, and Perking Areas adjacent to the J!2. Fence or Barrier property, Include the a. Nire 3 street names. b. Masonry · Store Orains., Culverts.. 4 Yard Drains c. Mood · Oralnage Canals. Ditches, d. Gates Creeks, /1~. Powerllnes '/§. Sulldln~s a. Fraee construction / 14. Guard Station b. Masonry construction . Storage Tanks: Identify the c. Metal construction capacity In gal. a. Above ground d. Access Door _ b. Underground 6. Utility Controls a. Gan /16. Diking or Bern / b. Electricity / 17. Evacuation Route c. #stet /18. Evacuation Area: . ldsntlfy the Fire Suppression Systems: location where a. Fire Hydrants employees will b. Fire Sprinkler /19. Outside Hazardous Connections Waste Storagk c. Fire Standpipe /20. Outside Hazardous Connections ~ Material Stodage / d. ~ater Control Valves /21. Outside Hazardous .~ ~or protection systems Material Use/Handling / e. Fire P~p /~;. Type o~ Hazardous ~ Stored ~lre Department Access DC Used (See ~1o~) TYPE OF HAZARDOUS NATERIAL { F - Flameable g - Ea~ploelve L - Liquid R - Radlologlcal C - Corrosive 0 - Oxidizer G.,- Gas P - Poison Water Reactive T - Toxic $ - SOlid H - Cryogenic O · Waste B - Etiological Exaaple: ~lam~able Liquid - ~L FACILITY DIAGRA~ (Required lteea lo addition to the abo~e) ~.Rlser. for Sprinklers 8.~Flr. E.cape. ~nrtltlons ~. Stairways: Indicate the . MlndM levels se,.ved fro. ~ghest to loeest. /11. Inside Hazardous ~aste / Storage 4. Escalator: Indicate the levels, served froa ~l;hest to lo,st. Materials Storage ~evator ~. Inside Hazardous ~Attic Access / ~terlala Use/~dllng //-~Ylights /14. Se~r Drain Inlets ' ITE/FACILITY D GRAM ~ /[~ NORTH SCALE: BUSINESS NAME: FLOOR: O~ DATE:9 /9'~f FACILITY N~ME: · UNIT ~: OF (CHECK ONE) SITE DIAGRAM ~ FACILITY DIAGR.~M ' ' " ' - "'., ~.~ C'" ' " ~o J~ ~specto~'s Comments): -O~C~A5 ~S~ ONLY-'"" SITE DIAGRAM Items) 1, Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSDS' Storage Box 2. Street(s), Alleys. il. Railroad Trackm 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. Wood 4. Drainage Canals, Ditches, d. Gates .. Creeks, i3. Powerllnes 5. 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 Berm b. Electricity 17. EvacuationRoute c. Water 18. Evacuation A~ea: Identify the ?. Fire Suppression Systems: location where a. Fire Hydrants employees will mast. b. Fire Sprinkler 19, Outside Hazardous Connections Waste Storage c, Fire Standpipe 30. Outside Hazardous Connections Material Storage d. Water Control Valves 21, Outside Hazardous for protection systems Material Use/Handling e, Fire Pu~p 22. Type of Hazardous Material/Waste 3toted 8. Fire Department Access or Used (See Below) TYPE OF HAZARDOUS MATERKAL F - Flammable E - ILxploslve L - Llquid R - Radlologlca! C - Corrosive O - Oxidizer O = Gas P - Poison M - Mater Reactive T - Toxic S - Solid H - Cryogenic D - Waste B - Etiological Example: Flauable Liquid - FL FACILITY OIAOP.~J~ (Required items in addition to the above) 1. Risers for Sprinklers 8. Fire Escapes 2. Partitions g. Air Conditioning Units 3, Stairways: Indicate the 10. Windo~e levels served from highest to lowest. 11. Inside Hazardous Waste Storage 4. £scaiator: Indicate the levels served from '13. Inside Hazardous highest to lowest. #aterlals Storage S. Elevator 13. Inside Hazardous Naterials Use/Handling 8. Attic Access 14. Sewer Drain Inlets " 7. Skylights OFFt&l 01-14-94 11:56 AM FROM LI] E BAKERSFIELD TO 805 326 0576 P01 BAKFFISC-.F, [) CA[ )Fo~NmA 93313 ;AX' 605, 836 JCAHO A;J:C ~L)l 01-14-94 11'56 AM FROM LI} E BAKERSFIELD TO 805 326 0576 P02 01/07/94 LINCARE ]NC 215-000-000154 Page 1 Overall Site with i Fac. Unit General Information Location: 4100 EASTON DR 17 Map: 103 Hazard: Low Community: BAKERSFIELD STATION 03 Grid: 30A F/U: 1 AOV: 0.0 Contact Name Title [ Business Phone/--T124-H°ur Phone~ LANA M... ~;3kNt4_~TER CENTER MANAGER [ (805) 322-2220 X 805) 329-4504'[ ._M~_.N?Y__LA__NF,_ ..... CUSTOMER SERVICE (805) 322-2220 x 805) 398-13811 Administrative Data 'Mail AddrS: 4100 EASTON DR 17 D&B Number: City: BAKERSFIELD State: CA Zip: 93301- comm Code: 215-003 BAKERSFIELD STATION 03 SIC Code: Owner: LINCARE INC Phone: (805) 284-2006 Address: P O BOX 6765 State: FL City: CLEARWATER Zip: 34618-6765 · Summary ...... .~OvED TO 4600 ASHE RD., SUITE 309 - FORMS SENT I, maF~J~/ ~1'/')/~2 Do hereby cerlily that ,have reviewed the a~ached h~a~ous minerals ma~age- merit plan for, / J~~3 -and tha tt along with any ~rm~ions ~nstitute a ~mplete and ~e~ man- agement plan for my fadll~. ~ ~. Bakersfield'Fire Dept.~ ~,/' HAZARDOUS MATERIALS DIVISION Date Completed ~ ' ~ 'Y ,ct Business Name: ,~ ~ (:::~__ ~c_ Location: z./! co ~c'~,~.r~ ~ I '7 il//.~ $r2,? . Il Iii Business Identification No. 215-000 ~3~)/~"/{Top of Business Plan) /L/Li '~"'- Station No. ~ Shift 1t~ InspectorJ'. ~ * ~'-r ~ ~..,,_- Adequate Inadequate ~ - Verification of Inventory Materials I~ Verification of Quantities ~ ~r-;~ ~.(~ Verification of Location ~ ~ !~O~Vu' Proper Segregation of MaterialI~ Comments: '~. Verification of MSDS Availablity ~] Number of Employees Verification of Haz Mat Training ~ Comments: Verification of Abatement Supplies & Procedures ~ ~ Comments: Emergency Procedures Posted ~ Containers Properly Labeled ~ Comments: -- Verification of Facility Diagram ~ Special Hazards Associated with this Facility: Business 0 w-"~e~~ FD 1652 (Rev. 1-90) · White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy For "Ship to" addresses loc Connecticut, Massachusetts or Island with the "Bill to" P.O. Box 22407: LINCARE INC. Accounts Payable Department P.O. Box 5479 Clearwater, FL 34618-5479 For "Ship to" addresses located in New York or New Jersey with the "Bill to" P.O. Box 21233: LINCARE INC. Accounts Payable Department P.O. Box 5690 Clearwater, FL 34618-5690 For "Ship to" addresses located in Florida or Alabama with the "Bill to" P.O. Box 42002: LINCARE INC. Accounts Payable Department PTOVBox-W5889 Clearwater, FL 34618-5889 For "Ship to" addresses located in Indiana, West Virginia or Missouri with the "Bill to" P.O. Box 20025: LINCARE .INC. Accounts Payable Department P.O. Box 6217 Clearwater, FL 34618-6217 For "Ship to" addresses located in Colorado, Oklahoma or Texas with the "Bill to" P.O. Box 20290: LINCARE INC. Accounts Payable Department P.O. Box 6227 Clearwater, FL 34618-6227 For "Ship to" addresses located in Arkansas, Louisiana, Mississippi or Tennessee with the "Bill to" P.O. Box 20290: L-INC~.2p,7~iNC. ~ , ~ Accounts Payable Department P.O. Box 6525 Clearwater, FL 34618-6525 For "Ship to" addresses located in California with the "Bill to" P.O. Box 20440: LINCARE INC. ,,~ ~ 5~.~{~1 AccountSp.o. Box 6765Payable Department ~\ ~,~ Clearwater, FL 34618-6765 For "Ship to" addresses located in Washington, Oregon or Idaho with the "Bill to" P.O. Box 20866: LINCARE INC. Accounts Payable Department P.O. Box 6815 Clearwater, FL 34618-6815 RECEIVED ciTY OF BAI<ERSFIELD H~ I ~ 1992 P 0 BOX 2057 BAKERSFIELD~ CA 9~,(.)~. _ _,. _, HAZ. MAT. DIV. ..~. .-/ ,- ..-:.. E¢¢ective March 1B~ 1~92~ the corporate ¢,¢¢ice o¢ LINCARE are moving. The accounts payable {unction {or processing payments will be handled by the LINCARE locations listed on the attached sheet. Please correct your records to reelect our new billing address. This change will provide you with prompt and accurate payment. I¢ you have any questions~ please call 1-(813)--576-4404. P.O. Box 5479, 5690, 6Z17 Ext ~61 Aimee Lir, gvay P.O. Bo>: ~889, 5227, 65~S Ext 223 Mary I. Rennie P.O. Box 6?65, 6815, Ext 234 Stacy Motrin Mary I. Rennie Divisional Accour, tir, 9 Manager CC: {i~e 1094B-000 02/27/92 L=~NDE ::C,v, ECARE ~ .215-000-000154 RECEiVE~ge 1 Overall Site with 1 Fac. Unit General Information ~A'R 0 5 1992 H.a,z. MAT. DIV, Location: 4100 EASTON DR 17 Map: 103 Hazard: Low Community: BAKERSFIELD ~TATION 03 Grid: 30A F/U: 1 AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- LANA M. '~M~A~I%~ENTER MANAGER (805) 322-2220 x (805) 329-4504 MANDY LANE CUSTOMER SERVICE (805) 322-2220 x (805) 398-1381 Administrative Data Mail Addrs: 4100 EASTON DR #17 D&B Number: City: BAKERSFIELD State: CA Zip:. 93301- Comm Code: 215-003 BAKERSFIELD STATION 03 SIC Code: Owner: ~L C-~/~IO~ ~,~i~.Phone: (~0o)a~ _~ooG Address: ~q~-~4-T44--A~--N--SU ~,~3. ~o~x ~'7~-- State: FL City: S~-J~F~U~G ~,~o3~r~ Zip: ~ ' ~ ~/4~/~' -&'/~ ~- Summary ~vi~wed ~hs a~ach~d hazardous materials manage- , ~ plan for ~; p~, ~. a~d ~hat i~ along ~vi~h (~ of Busings) ' any ~rmcfion~ ~n~i~u~e a complete ~nd corre~ man-. ~m~nt p~n. ~or my facili[y. 02/27/92 LINDE HOMECARE MEDICAL SYSTEMS 215-000-000154 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN, PRESSURIZED GAS Gas 330 Low · Fire, Pressure FT3 CAS #: Trade Secret: No Form: -Gas Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS Daily Max FT3I Daily Average FT3 I Annual Amount FT3 330 I 330.00_ 3,960.00 StorageI' Press T TempI Location PORT. PRESS. CYLINDER Iabove ~AmbientlNOaTH WEST CORNER OF WAREHOUSE -- Conc Components ~ MCP List 100.0% IOxygen, Compressed ILOw I 02-002 OXYGEN, LIQUID Liquid 970 Low · Fire, Pressure, Immed Hlth FT3 CAS #: Trade Secret: No Form: Liquid .Type: Pure Days: 365 Use: MEDICAL AID OR PROCESS -- Daily Max FT3I Daily Average FT3 I Annual Amount FT3. 970 ~ 970.00_ 11,640.00 Storage press T Temp Location INSUL.TANK / CRYOGENICIADovo /CryogonlNORTHWEST CORNER OF WAREHOUSE -- Conc Components MCP List -100.0% IOxygen, Cryogenic Liquid ILOw I 02/27/92 LINDE HOMECARE MEDICAL sySTEMS 215-000-000154 Page 3 00 - Overall Site <D> Not~f./Evacuation/Medical' <1> Agency Notification LANA M. REMSEN/VAN METER 397-6803 OR PAGER 329-4504 MANDY LANE - 398-1381 <2> Employee Notif./Evacuation ABOVE EMPLOYEES TO BE NOTIFIED - CENTER MANAGER TO CALL 911 EMPLOYEES ARE TO USE THE EMRGENCY ROUTES AS INDICATED BY THE EVACUATION PLAN ON THE FACILITY LAYOUT~ THIS IS POSTED ABOVE THE COPY MACHINE. .WE WILL EVACUATE QUICKLY AND MEET AT THE FAR END OF THE PARKING LOT. THE CENTER MANAGER OR PERSON IN CHARGE WILL CONDUCT AN ACCOUNTING OF ALL CENTER PERSONNEL AT THE GATHERING POINT. NO ONE IS TO LEAVE THE GATHERING POINT UNTIL INSTRUCTED TO DO SO BY THE MANAGER. EMPLOYEES ARE NOT TO RE- ENTER THE BUILDING UNTIL THE PROPER AUTHORITIES HAVE DETERMINED THAT IT IS SAFE. <3> Public Notif./Evacuation INSTRUCTION ALL OFFICE IN COMPLEX TO MEET IN THE FAR END OF PARKING LOT IN CASE OF FIRE OR EXPLOSION. ~ <4> Emergency Medical Plan CRYOGENIC OXYGEN - SLOW WARMING.IN WATER AT 108 DEGREES OF DAMAGED TISSUES. NOTIFY 911 FOR PARAMEDICS AND FIRE DEPARTMENT 02/27/92 LINDE HOMECARE MEDICAL SYSTEMS 215-000-000154 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention CYLINDERS STORED UP RIGHT. NO FILLED RESERVOIRS IN VAN - PRESSURE RELEASE VALVES ON ALL LIQUID OXYGEN EQUIPMENT <2> Release Containment STORE ALL IN WELL VENTILATED AREA. WHEN FILLING PATIENTS RESERVOIR FROM THE VAN RESERVOIR IS PLACED ON SCALE THAT IS IN A METAL BOX TO PREVENT ANY SPILLAGE FROM COMING IN CONTACTWITH GROUND AND ROAD OILS. <3> Clean Up EVACUATE PERSONNEL FROM IMMEDIATE AREAS. ALLOW SPILLED LIQUID TO EVAPORATE. VENTILATE AREA. <4> Other Resource Activation 02/27/92 LINDE HOMECARE MEDICAL SYSTEMS 215~000-000154 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE .B) ELECTRICAL - MAIN SWITCH FOR #17 LOCATED ON SOUTHWEST WALL C) WATER - WATER MAINON FRONT OF BUILDING AT'4100 EASTON DRIVE D) SPECIAL - NONE E) LOCK. BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - TWO FIRE .EXTINGUISHERS - ONE NEAR FRONT OFFICES THE OTHER OUTSIDE RESTOOM DOOR AT BACK OF BUILDING FIRE HYDRANT - DIRECTLY ACROSS THE STREET FROM 4100 EASTON DRIVE· <4> Building Occupancy ·Level 02/27/92 LINDE HOMECARE MEDICAL SYSTEMS 215-000-000154 Page 6 · · 00 - Overall Site · <G> Training <1> Page 1 WE HAVE 3 EMPLOYEES WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE HANDLING OF 'LIQUID AND COMPRESSED OXYGEN USING OSHA HAZARD COMMUNICATION PROGRAM. WRITTEN PROGRAM, LIST OF HAZARDOUS· CHEMICALS, MSDS, OPERATION OF EQUIPMENT, METHODS TO DETECT RELEASE, HEALTH AND PHYSICAL HAZARDS, PROTECTIVE EQUIPMENT PROCEDURES,~ LABELING OF CONTAINERS, EMERGENCY PROCEDURES, EVACUATION PLAN. <·2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use INClItIE LINCAFIE INC. $88 EXECUTIVE CENTE~ D~IVE WEST SUITE ~ ST. PETerSBUrG FLOriDA 3370~ TEL: 8~3~ 5764404 FAX: 813 5Z7-~858 04/Z9/91 EFCective immediately, the accounts payable Function For processing p~yments will b'e handled by the Following LINCARE locations: For "Ship to" addresses located in Cali¢ornia: Accounts Payable Dep~rtment P. O. Box 20440 St. Petersburg, FL 33742 FOr "Ship to" ~ddresses located in Washington, Oregon or Idaho LINCARE INC. Accounts P~yable Dep~rtment P. O. Box 20866 St. Petersburg, FL 33742 Please correct your records to re{lect out' new billing address. This change will'provide you with prompt and accurate payment,. ~ you have any questions, please call 1-(813)-576-4404. Thank you, L. Stacy Morrin Accounts P~y~ble Mar,~ger CC: .¢ile 12739 Bakersfield Fire Dept. Hazardous Materials Division RECEIVED 2130 "G" Street AUC 0 8 ]9§9 Bakersfield, CA. 93301 HA~.. MAL DiV. HAZARDOUS MATERIALS MANAGEMENT PLAN¢ INSTRUCTIONS: 1, To avoid further action, return this form within 30 days of receipt,. -~---=~---~3:-~ ----A n s w e r -tt-~e-61uestier~s--below-4or~t he-business :as-a.whole~---.~- .......~ "'~'"- ~'-~-~ ' ' 4. Be brief and concise as po~ible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~'~'~ ~Ome~e~ ~/~no ~qS~ms LOCATION: ~100 ~s~ ~q~ MAILING ADDRESS: CITY' ~~sF/~'~o STATE: ~ ziP: ~3Boq PHONE' DUN ~ BRADSTREET NUMBER' ~¢-6Ma-~¢5~ SIC CODE: PRIMARY ACTIVITY: '~_fiat~ ~~ OWNER: ~ ~¢ % ........... SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR, PHONE FD1590 Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS[ ~ ., MATE.~IAL SAFETY DATA SHEETS ON FILE: BRIEF SOMMARY OF TRAINING P~OGRAM' SEOTION 4: EXEMPTION RE~EST: 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, BUT THE QUANTITIES AT NO J TIMEEXCEED THE MINIMUM REPORTING QUANTITIES, OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, /.../~/~ J~A,, jg~nl~e~ CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFE:I'Y CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. / SIGNATURE TITLE DATE FD1590 Bakersfield Fire Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: B. RELEASE CONTAINMENT AND/OR MINIMIZATION: C. CLEAN-UP PROCEDURES' ~w~ e~~ SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANF' ~J/Pr ELECTRICAL: fll~i~ ,3~;~-E~ ~,,6 ~V"/ k~T~ ~ S~ ~ WATER: ~ ~n;~ o~ ~ ~,~br~ ~ 4~o~ ~s~o~. SPECIAL: LOCK BOX: YE~ IFYES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION' B. WATER AVAILABILITY (FIRE HYDRANT)' ' FD1590 Bakersfield Fire Dept. '~ ,' Hazardous Materials Division ,, ~ HAZARDOUS MATERIALS MANAGEMENT PLAN . Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C, PUBLIC EVACUATION: ~LINDE HOMECARE MEDICAL.SYSTEMS INC. ....... 70:* All. Bakersfield Employees DATE: December I,. 1988' FROM: Lana Re, sen SUBJECT: Evacuation .Pla/ EVACUATION PLAN .4100 Easton Drive #17 Bakersfield, CA 93309 Types of threats which could require 'evaCUaLion: FIRE BOMB Th~EA7 DISASTER. EXPLOSION Evacua~io6: Employees are ko' use the emergency ~ou~s as indicated ~y the evacuation plan on the .facility 'layout. This is posted a~ove the Copy mac~ine." 'Communication:' * . Each of the. a~ove threats to personal safety will ~ 'communicated ~y the person whom it is found' to all. employees . The senior emp£oye'e will ca~l "911" as soon as possible. Employees wil~ evacuate quickly and ,zeet at the far end~ of the par/ting lot. Accountability: ~. . ~he Center Manager or person in cha~ge will conduct an accounting .of a~ certer personnel at Lhe gathering ~oint. No one is to leave the. gathering point until instructed to do so by the-manager... EmFloyees are not to re-enter the building unti~ the proper authorities have determined that it is safe.... " please read 'and sign. Tha/d~ you. " 4i00 'EASTON DRIVE, SUITE 17', BAKERSFIELD, CALIFORNIA 93309 · (80§) 322-2220 or 1-800-322-5255 CITY of BAKERSFIELD MATERIALS INVENTORY Farm andAgticuiture I1 Standard Business ~HAZARDOUS NON--TRADE SECRETS Page of BUSINESS NAHE: /_/~u/'~ .Z,/~/,,/,~zx~//~.~ OWNER NAHE: NAHE 0F TH[S FAC[L[TY: LOCATION; ~/~ ~j .~ ~/~ ADDRESS; STANDARD IND. CLASS CODE: C[TY, ZIP: ~5~/~z3, K/~ ~ CITY. ZIP: DUN AND BRADSTREET. NgHBER~ ...... PHONE ~: ~,~ ~~ · PHONE ~: - ' - -- REFER TO JN~[~UCI~ON~ ~'0~ H~UH~N CODES I 2 ) 4 5 : 6 , 8 9 10 11 12 ,Trans [yqe Max Avgr~ge Annual Heasure I ~ya Cent Con: Cent Us Location?e[e. Names Of N1xCure/Coeoonen:s Code ~oae Aa: AeC ES: Units on 5~e Type Press Temo Co3e Stored in ~acl/Icy I°" (Chock ail ~ha~ apOly) -- ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~;~'~Im~i~c°mp°nenC C,A,S. Health of Pressure Componen[ 13 ~a~ I C.i.S, ~u~ber Physical Iod Health Uazard C.A.S. Number , ComponenC I1 Name I C,A,S, Number (Check al/ that app/yJ ComponenC 12 Name & C.A.S, Number ~ Fire Hazard ~ Reactivity ~ Oelayed :~{udden Release ~ HealCh ~ of Pressure Component 13 Name ~ C,A.S, Number (Check all that apply) ~ Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Im~i~ - HealCh of Pressure Co~ponenC 13 Name & C,A,S. Number Physical 80d Health UaTard C,A.S. Number Component II Name I C.A,S, Number (Check all that apply/ Componen: I~ Name & C.A.S. Number ~ Fire Hazard ~ Reactivity ~ Oelayed ~ Sudden Release ~ Health of Pressure Component 13 Name t C,A.S, Number. EHERGEHCY CONTACTS ~la~'~' ~~ ~~~t~e ~z~~~ Hr Phone fl2Name~9 ertifiatio . Re and f naf r com 7 Cf g.:all, sections) . .. . ~0 ~no oti.i~l ti.'e of own. cee a. . . 0 ' "~ -~'~ 'V/~~ BAKERSFIELD CITY FIRE DEPARTMENT "G" sTR .-ET R E I BAKERSFIELD, CA 93301 (805) 326-3979 JUN 1987 A Id ............ l OFFICIAL USE ONLY USINESS N~E HAZARDOUS ~ATERIALS BUSINESS PLAN AS A WHOLE FOR~ 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 A. BUSINESS NAME: 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 T0 NOTIFY IN CASE OF EMERGENCY: NA~E AND TITLE , DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: C. WATER: . ,. D. SPECIAL: BOX: YES /~ IF YES, LOCATION: E. LOCK 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 B26-6, 3 3 q 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 C. PROPER USE OF SAFETY EQUIPMENT: .................. 'NO NO D. EMERGENCY EVACUATION PROCEDURES: ...... ; .......... NO NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... NO NO 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 CUBIC FEET OF A COMPRESSED GAS: ...... YES ~ I, (~(~/~ff~ [~d~/.~2~O ,-certify that the above information is accurate. I understand that this 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. - 2B - BAKERSFIELD CITY FIRE DEPART,~NT 2130 "6" STREET BAKERSFIELD, CA 93301 0FFiCL4L USE ONLY ID# _- _.-__ BUSINESS N~ME: ~ . BUSI NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further' action, this form must be returned by: 2. TYPE/PRINT YQUR ANSWERS IN ENGLISH. 3. Answer the-questions below for THE FACILITY UNIT LISTED B, ELOW 4. Be as BRIEF and CONCISE as .possible. .............. SECTION 1: MITIGATION, PRE~ION~ ABATEME~ PROCEDb~ES - 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 alaterials inventory form marked: NON-TRADE SECRETS ONLY (~hite form If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (~ello~.form ~4A-2) in add{tion to the non-trade secret form. gist only the trade secrets on form 4A-2. SECTION 4: PRIVATE FIRE pROTECTION ,SECTION 5: LOC~TION OF W~TER SUPPLY FOR USE ~'E~R0ENCY RESeO~ERS 6: LOCAl!ON OF UTiLi~ S~T-OFFS AT THIS b~.T O~Y. A. NAT. QAS~ANE'~ .- B. ELECTRICAL: C. WATER: E. LOCK BOX-: YES ~ tF 'YES, LOCATION: iF VES, SiTE PLANSO VES / YO MSD.qs? YES FLOOR pr. ANS? YES / NO KEYS? YF_S ," :fO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT ':' I.D. # FORM 4A-1 Page of NON--TRADE SECRETS :, HAZARDOUS MATER'i' ALS 'r NVENTORY ADDRESS: 9~1 ~O~h ~5~. ' ADDRESS: 7o/ 9g~~o~.~,,~. FA~LITY UNIT NAME: PHONE ~: (~D.~] $22-2220 PHONE m: (et~).svO-2~z. I°FFICIALoNLY USE CFIRS CODE 1 2 3 4 5 '6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.0.T ,CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT. WT. CHEMIQAL OR COMMON NAME CODE GUIDE E~ER6ENCY CONTACT: ~_~ U)~ TITLE: ~/~ ~~A PHONE ~ BUS HOURS: "'E~EROE~CY CONTACT: ~IcL/A~ C~OVa//~ TITLE: J~o/o~ ~~~HONE { BUS HOURS: ~}PRI~CI, PAL BUSINESS ACTIVITY: ~/d~] ~t~'~/)r'K -- AFTER BUS HRS: ~-~ BUSINESS NAME LIND ~MEcARE MEDICAL SYSTEMS ID ZlS-000-0001S4~ LOCATION BO1 ZOTH ,,ST ,HIOH HAZARD RATING Z .. t. OVERVIEW LAST CHANGE 0.'3/Z~/88 BY ESTER JURIS CODE Z;S-001 JURIS BAKERSFIELD STATION 01 MAP PAGE i03 GRIO 30fl FACILITY UNITS i HAzn~O R~TING Z RESPONSE SUMMARY 2~.SEC 4.)'C~RLA ~EISS - CENTER MaNaGER UM CROUELLA - SENIOR SERVICE REPQESENTHTIUE EMERGENCY CONTACTS Z~ SEC Z) JUL 2'5 1989 CARLA ·WEISS - 3ZZ-Z'ZZ~ OR 3GG-S!.8B WH CROVELLA - 322-2228 OR 389-Z~41 ~A~. ~AT. DJ~. UTILITY SHU'FDFFS , ZA SEC ~). - · R) G~S - NONE: B) ELECTRICAL - OUTSIDE BATHROOM WALL C), WATER- NONE D.) SPECIAL ~ NONE E) LOCK BOX .- NO 2. NOTIEICA'FION'/'P{JBLIC EVACUATION LAST CHANGE / / By < NO INFORMATION RECORDED FOFt THIS SECTION > PAGE 1 03/~Z/8B 11:Z4 MATERIAL SAFETY DATA SYSTEMS. INC. (80S) ~48,-6800