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Home My WebLink AboutBUSINESS PLAN 8/22/2003 O. H SCALE l" : 10' BUSiNE ME: JERRY'S` FACILITY DIAGRAM /~/~ / 7 o~ __~.~,~.__e ~_~ . o~4 - EST SCAEE l" = 50' BUSINESS NAME: JERRY'S~.MOBIL ? DATE 7/11/87 SITE DIAGRAM PLOT PLAN JOBSITE LOCATION TANK SIZE PRODUCT LEGEND #1 / 0(300 S6f Pe ~ F FILL ~T} TURBINE ~ TURBINE WITH LEAK DETECTOR #3 G OVERSPILL CONTAINER ON FILL #4 ~ REMOTE FILL #5 ~E~ EXTRACTOR VALVE #6 iMJ MONITOR SYSTEM #7 l'---] MANIFOLD SYSTEM I~ '~'-~ ADDRESS '"~;~! . i ',' ZIP CODE ' FEE I BLOCK NO. iBUSlNE~ "~, _,; ~; ' . . PERMiT REQUiRED PERMITNO, ~BUSI.NESS PHONE '" HuME PHONE NO. OF FLOORS ' ~.E_FbOTAGE · ' . .' _. ',..~.~,¢..:%?,. ,/~ INSPECTOR _ '/ ' '." sTATION/SHIFT/STATION PHONE; ~ - . .- ..... ,. . ::,/.-.: -:..: . JIMS MOBIL SiteID: 015'-"02i-000512 Manager : ~% BusPhone: (661) 322-2250 Location: 3200 F ST __%%%°'. Map : 102 CommHaz : Low City : BAKERSFIELD .~\~%-- Grid: 24D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad: 77 -016 -4041 Emergency Contact / Title Emergency Contact / Title JEHAD HADDADIEN / OWNER HUDA HADDADIEN / Business Phone: (661) 322-2250x Business Phone: (661) 322-2250x 24-Hour Phone : (661) 834-8610x 24-Hour Phone : (661) 834-8610x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 322-2250x MailAddr: 3200 F ST State: CA City : BAKERSFIELD Zip : 93301 'Owner JEHAD KH HADDADIEN Phone: (661) 834-8610x Address : 7005 ALTAVILLE LN State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: reviewed [he a~ach~d h~ardous ma~srisls mere plan for ~ ~,~ .... and ~ha~ ~ any ~rre~ions ~nsfi~ute a complete and corr~ agement plan for my -1- 08/14/2003 JIMS MOBIL I'~_',L-~?,_?'?~ r~_---. SiteID: 215-000-000512 Manager : ,~1 FEB 1 2000 BusPhone: (805) 322-2250 Location: 3200 F ST I/~.~ Map : 102 Comm}{az : Low City : BAKERSFIELD~IBy.-~- Grid: 24D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad:77-016-4041 Emergency Contact / Title Emergency Contact / Title JEHAD HADDADIEN ~%~ / OWNER HUDA HADDADIEN ~J / Business Phone: (~8~) 322-2250x Business Phone: ~8~) 322-2250x 24-Hour Phone : (~0'5) 834-8610x f 24-Hour Phone : (%~0'5) 834-8610x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 3200 F ST State: CA City : BAKERSFIELD Zip : 93301 Owner JEHAD KH HADDADIEN Phone: (805) 834-8610x Address : 7005 ALTAVILLE LN State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ('rvpe or p~m name) reviewed the ~ached h~;~rdo~$ rn~ter~s manage- mere plan ~o~ ~,; ~ ~ ~; ~nd tha~ i~ a~ng ~i~h (~ of ~) - any ~rr~ions cons~ut~ ~ ~mD~e~ and ~rr~ man- -1- 01/31/2000 f JIMS MOBIL SiteID: 215-000-000512 ~ Hazmat Inventory By Facility Unit --Alphabetical Order Fixed Containers on Site Hazmat Common Name... ISpooHazlEPA Hazards{ Frm DailyMax UnitlMCP MOTOR OIL F DH L 120.00 GAL Min SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod 2 01/31/2000 JIMS MOBIL SiteID: 215-000-000512 ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~UIvUVlU~ ~Vl~ / ~ ~_.~.x_J~ ~Vl~ MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: SOUTH LUBE ROOM WALL CAS# 8020835 ~ STATE I TYPEpure AmbientPRESSURE I TEMPERATUREAmbient BOX CONTAINER TYPE Liquid AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average GALI 120.00 GAL 60.00 GAL HAZARDOUS COMPONENTS 100.00 Motor Oil, Petroleum Based N 8020835 HAZARD ASSESSMENTS TSecret RS BioHaz, Radioactive~Amount I EPA Hazards, NFPA USDOT# MCP No N° I IINo No/ Curies F DH / / / Min ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: WEST OF BUILDING CAS# 8006-61-9 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container ! Daily Maximum Daily Average 10000.00 GALL 10000.00 GAL 3500.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS No N No No/ Curies F IH DH / / / Mod -3- 01/31/2000 JIMS MOBIL SiteID: 215-000-000512 = Inventory Item 0001 Facility Unit: Fixed Containers on Site ~lvU~U~ ~vl~ / ~£ ~.~...k/J ~Vl~ UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: WEST OF BUILDING CAS# 8006-61-9 F STATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 3500.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretl ~S BioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MOP No N No No/ Curies F IH DH / / / Mod -4- 01/31/2000 F JIMS MOBIL SiteID: 215-000-000512 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 11/30/1990 CALL 911 CALIFORNIA OFFICE OF EMERGENCY SERVICES 1-800-852-7550 HAZ MAT OFFICE 326-3979 -- Employee Notif./Evacuation 11/30/1990 VERBAL -- Public Notif./Evacuation 11/30/1990 VERBAL Emergency Medical Plan 07/13/1998 SAN JOAQUIN HOSPITAL - 2615 EYE ST - 327-1711 OR HALL AMBULANCE - 327-4111. -5- 01/31/2000 JIMS MOBIL SiteID: 215-000-000512 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 11/30/1990 GAS: DEPRESSED DOUBLE CONTAINMENT - EMERGENCY SHUT OFF SWITCH - SOUTHWEST WALL OUTSIDE. OIL: DEPRESSED DOUBLE CONTAINMENT -- Release Containment 11/30/1990 SAWDUST; WEST CABINETS - MIDDLE -- Clean Up 11/30/1990 LCI GASOLINES 1-800-333-9011 COLES WASTE OIL SERVICE - 322-8258 Other Resource Activation 6 01/31/2000 f~IMS MOBIL SiteID: 215-000-000512 Fast Format ~ Site Emergency Factors Overall Site Special Hazards --Utility Shut-Offs 07/13/1998 A) GAS - NONE B) ELECTRICAL - W OF THE SINK ON THE N LUBE RM WALL C) WATER - SW CORNER OF LOT NEXT TO F ST SIDEWALK D) SPECIAL - GAS PUMP EMERGENCY SHUTOFF W OUTSIDE WALL E) LOCK BOX - NO -- Fire Protec./Avail. Water 07/13/1998 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - SW CORNER OF 30TH & F ST. Building Occupancy Level 7 01/31/2000 F,~IMS MOBIL SiteID: 215-000-000512 Fast Format ~ Training Overall Site --Employee Training 07/13/1998 WE HAVE 3 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING: VERBAL WHEN HIRED. MSDS SHEETS AVALABLE IN WORK AREA. Page 2 -- Held for Future Use Held for Future Use 1 S 01/31/2000 / / ~ / / SiteID: 215-000-000512 Manager : ~f/ BusPhone: (805) 322-2250 Location: 3200 F ST Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 24D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Numb: DunnBrad:77-016-4041 Emergency Contact ~ / ~.Title Emergency Contact. / Title Business Phone: (805) 322-2250x Business Phone: (805) 322-2250x 24-Hour Phone : (805) ~ 24-Hour Phone : Pager Phone : ( ) ~-9~l~x Pager Phone : Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 3200 F ST State: CA City : BAKERSFIELD Zip : 93301 Address : ~~oog ~%~;%%~ t~ State: CA City : BAKERSFIELD Zip : Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: = Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpecHazlEpA HazardsI Frm I DailyMax IUnitIMCP UNLEADED GASOLINE F IH DH L 10000 GAL Mod SUPER UNLEADED GASOLIN~ F IH DH L 10000 GAL Mod MOTOR OIL Uv~m~mW L 120 GAL Min re~ie~ved ~h® attached hazardous ma~oria~s manage- men~ p~an ~or "5 ~ ~, ~,,~ %,', ~,- and thru i~ alor~ ~i~h (Name~ aU.~) ' any corrections constitute a complete and correc~ man- agemem plan ~or my facility. 07/07/1998 WESTCHESTER MOBIL SiteID: 215-000-000512 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: WEST OF BUILDING CAS# 8006-61-9 Liquid ~Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 3500.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 2 07/07/1998 F WESTCHESTER MOBIL SiteID: 215-000-000512 = Inventory Item 0002 Facility Unit: Fixed Containers on Site ~lVUVlU~ ~Vl~ / ~ ~.~,_~ ~vi~ SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: WEST OF BUILDING CAS# 8006-61-9 STATE -- TYPE PRESSURE --[ TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 3500.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS %Wt. ~S CAS# 100.00 Gasoline N 8006619 -3- 07/07/1998 WESTCHESTER MOBIL SiteID: 215-000-000512 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: EAST OF BUILDING CAS# 221 STATE TYPE PRESSURE --[ TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 500.00 GAL 500.00 GAL 250.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS %Wt. ~SI CAS# 100.00 Waste Oil, Petroleum Based N 0 4 07/07/1998 WESTCHESTER MOBIL SiteID: 215-000-000512 -- Inventory Item 0004 Facility Unit: Fixed Containers on Site L.~L.,ILVLLVLL,J.L~I .L~I.~-~LVL~ / L.~L-L r~LVL.L L~Z-~J~ MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: SOUTH LUBE ROOM WALL CAS# 8020835 Ambient BOX Ambient lLiquid Pure AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 120.00 GAL 60.00 GAL Maximum Stored Maximum Open Use Maximum Closed Use GAL GAL GAL HAZARDOUS COMPONENTS 100.00 Motor Oil, Petroleum Based N 8020835 -5- 07/07/1998 fi WESTCHESTER MOBIL SiteID: 215-000-000512 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 11/30/1990 CALL 911 CALIFORNIA OFFICE OF EMERGENCY SERVICES 1-800-852-7550 HAZ MAT OFFICE 326-3979 Employee Notif./Evacuation 11/30/1990 VERBAL Public Notif./Evacuation 11/30/1990 VERBAL Emergency Medical Plan 11/30/1990 SAN JOAQUIN HOSPITAL 2615 EYE ST 327-1711 HALL AMBULANCE 327-4111 6 07/07/1998 F WESTCHESTER MOBIL SiteID: 215-000-000512 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site --Release Prevention 11/30/1990 GAS: DEPRESSED DOUBLE CONTAINMENT - EMERGENCY SHUT OFF SWITCH - SOUTHWEST WALL OUTSIDE. OIL: DEPRESSED DOUBLE CONTAINMENT -- Release Containment 11/30/1990 SAWDUST; WEST CABINETS - MIDDLE -- Clean Up 11/30/1990 LCI GASOLINES 1-800-333-9011 COLES WASTE OIL SERVICE - 322-8258 Other Resource Activation 7 07/07/1998 WESTCHESTER MOBIL SiteID: 215-000-000512 Fast Format Site Emergency Factors Overall Site Special Hazards -- Utility Shut-Offs 11/30/1990 A) GAS - NONE B) ELECTRICAL - WEST OF THE SINK ON THE NORTH LUBE ROOM WALL C) WATER - SOUTHWEST CORNER OF LOT NEXT TO F STREET SIDEWALK D) SPECIAL - GAS PUMP EMERGENCY SHUTOFF WEST OUTSIDE WALL E) LOCK BOX - NO Fire Protec./Avail. Water 11/30/1990 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT - SOUTHWEST CORNER OF 30TH & F STREETS Building Occupancy Level -8- 07/07/1998 WESTCHESTER MOBIL ~~~~~~~&~ SiteID: 215-000-000512 i~ Training ~~~~~~~~~~~ Overall Site i~ Employee Training ~~~~~~~~~ 11/30/1990 WE HAVE 3 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: VERBAL WHEN HIRED. MSDS SHEETS AVALABLE IN WORK AREA I/c~akersfield l~ire Dept' ~ OF ENVIROArMEJVT~A£ ~qER - 1715 Chester Ave. ~ B~ersfield, CA 93301 Date Completed Business Name: ~~o~~ ~,/ ~ ; / L~a~on: ~~ ~ Business Iden~fica~on No. 215-000~,~ ~ (Top of Business Plan) ~val Time: Depaflure lime: lnspec~on lime: Adequate Inadequate Adequate Inadequate Address Visable ~ [] Emergency Procedures Posted ~ [] Correct Occupancy Gl"' [] Containers Propedy Labled ~ [] Verification of Inventory Materials 1~' [] Comments: Verification of Quantities J~r Verification of Location ,Er [] Verification of Facility Diagram ~ [] Proper Segregation of Matedal ~ ri Housekeeping ,,12f'_ [] Fire Protection ~ [] Comments: Electrical ,J:3'" [] Comments: Verification of MSDS Availablity X [] Number of Employees: UST Monitoring Program ~1 Comments: Verification oi Haz Mat Training ,[:3/ [] Permits ./Er' [] Comments: Spill Control ..[] [] Hold Open Device ~ ...El" Verification of Hazardous Waste EPA No. ¢)~)c)'~ t./..'7 Abbatement Supplies and Procedures ~ [:3 Proper Waste Disposal l;~ Comments: Secondary Containment ~ [] Secudty ~ [] Special Hazards Associated with this Facility: ~, ~ / ~ ,_ CA,/ All Items O.K Business (~wner/Man.~ ,RII~-NAM~ -- S,~.[~'ATURE %-I~'~ ~ Correction Needed /,/Gl ,~_ White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy " 03/17/92 WESTCHESTER MOBIL 215-000-000512 Page Overall Site with 1 Fac. Unit General Information Location: 3200 F ST Map: 102 Hazard:'Low Community: BAKERSFIELD STATION 01 Grid: 24D F/U: 1 AOV: 0.0 [ Contact NameI Title i Business Phone 24-Hour Phone~ DOUGLAS HULSEY (805) 322-2250 x (805) 393-8791 JERRY HULSEY (805) 322-2250 x (805) 872-0243 AdministratiVe Data Mail Addrs: 3200 F ST D&B Number: 77-016-4041 City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: Owner: DOUGLAS B. HULSEY Phone: (805) 393-8791 Address: 4212 HIGHLAND HILLS State: CA City: BAKERSFIELD Zip: 93308- Summary RECEIVED ~'~PR I 7 1992 HAZ. MA~ DI~ t, ~ Do h®reb~ ce~fl/that ~ h~ve reviewed ~hs st[ached h~~rdous materials merit, plan fo n~ ~h~ ~ ~lon~ ~ny ~fm~ions ~n~[ute a cOmple~ ~d ~ ~m~n~ plan ~or my 03/17/92 WESTCHESTER MOBIL 215-000-000512 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 UNLEADED GASOLINE Liquid 7000 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 .Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL 7,000 ~ 3,500.00 168,000.00 Storage~~Press T Temp Lo~ation UNDER GROUND TANK IAmbient/AmbientlWEST OF BUILDING -- Cons Components MCP List 100.0% [Gasoline ModerateI 02-002 SUPER UNLEADED GASOLINE Liquid 7000 Moderate ~ Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily'Max GALI Daily Average GAL I Annual Amount GAL -- 7,000 ~ 3,500.00 168,000.00 Storage Press T Temp Location UNDER GROUND TANK IAmbientlAmbientlWEST OF BUILDING -- Cons Components ~ MCP .List 100.0% IGasoline IModerateI 02-003 WASTE OIL Liquid 500 Low ~ Fire, Delay Hlth GAL CAS #: 221 Trade Secret: No FOrm: Liquid Type: Waste Days: 365 Use: WASTE Daily Max GAL Daily Average GAL Annual Amount GAL 500 I 250.00 I 3,000.00 Storage IIPress T Temp Location UNDER GROUND TANK IAmbientlAmbientlEAST OF BUILDING -- Cons I Components I MCP iList 100.0% Waste Oil, Petroleum Based Low 03/17/92 WESTCHESTER MOBIL 215-000-000512 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-004 MOTOR OIL Liquid 120 Minimal ~ Fire, Delay Hlth GAL CAS #: 8020835 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GAL120I~ Daily Average60.00GAL I Annual Amount375.00GAL -- Storage~~Press T Temp Location BOX IAmbientJAmbientlSOUTH LUBE ROOM WALL -- Conc Components ~. MCP List 100.0% IMotor Oil, Petroleum Based IMinimal I 03/17/92 WESTCHESTER MOBIL 215-000-000512 Page 4 · 00 - Overall Site <D> 'Notif./Evacuation/Medical <1> Agency NotifiCation CALL 911 CALIFORNIA OFFICE OF EMERGENCY SERVICES' 1-800-852-7550 HAZ MAT OFFICE 326-3979 <2> Employee Notif./Evacuation VERBAL <3> pUblic Notif./Evacuation VERBAL <4> Emergency Medical Plan SAN JOAQUIN HOSPITAL 2615 EYE ST 327-1711 HALL AMBULANCE 327-4111 03/17/92 'WESTCHESTER MOBIL 215-000-000512 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <i> Release Prevention GAS: DEPRESSED DOUBLE CONTAINMENT - EMERGENCY SHUT OFF SWITCH - SOUTHWEST WALL OUTSIDE. OIL: DEPRESSED DOUBLE CONTAINMENT <2> Release Containment SAWDUST; WEST CABINETS - MIDDLE <3> Clean Up LCI ~ASOLINES 1-800-333-9011 COLES WASTE OIL SERVICE - 322-8258 <4> Other Resource Activation 03/17/92 WESTCHESTER MOBIL 215-000-000512 Page '6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs' A) GAS - NONE .B) ELECTRICAL - WEST OF THE SINK ON THE NORTH LUBE ROOM WALL C) WATER r SOUTHWEST CORNER OF LOT NEXT TO F STREET S~DEWALK D) SPECIAL - GAS PUMP EMERGENCY SHUTOFF WEST OUTSIDE WALL E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT - SOUTHWEST'CORNER OF 30TH & F STREETS <4> Building Occupancy Level 03/17/92 WESTCHESTER MOBIL 215-000-000512 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE 3 EMPLOYEES ~T THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: VERBAL WHEN HIRED. 'MSDS SHEETS AVALABLE IN WORK AREA <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ~ __' HAZARDOUS MATERIALS DIVISION 2130 G Street, Bakersfield, CA 93301 ~/b ' (805) 326-3970 U /.~ UNDERGROUND TANK Q~JES-~NNAIRE RECEIVED I. FAcILIW/SITE No. OF TAN H~?~ ~ DIV. O~ OR FACIM~ NAME I NA~ OPE~TOR ,x ~ r. . ~ sox ~O ~ND~cATE O cOR~ON j~NDlvlDOAL ~ PAE~EEsHIP ~ [~A[ AG~cY D~Ic~ ~ cO~N~ AGENCY O sTA~ hGENcY O FEDEx[ AGENCY ~PE ~ BUSiNE~ ~AS STA~ONQ 3 FA RM · Q 2 DISTRt~ORQ 4 P~ E~OR O 50mERjJ TOKERN COUNm P~RMffOpE~ ~. ~~1 ~' 7 ~//~ ~ ~t t O~ ~: EMERGENCY CONTACT PERSON ~PRIMAR~ EMERGENCY CONTACT PERSON (SECONDAR~ optional NiGHm: NAME (~ST. F~B PHO~. Wire AR~ CODE NIGHTS: NA~E (~. FI~BO ' PHONE ~. w~ AR~ CODE II. PROPER~ OWNER INFORMATION (MUST BE COMPLETED) NAME CARE OF ADDRE~ IN~RMATION MAIuN~ O~T~E~ ADDREss - - ' ' ~ 8Ox ~DIvlDuA[ O LOCAl AGENCY ~ sTATE AGENCY CI~E ~ ZIP CODE PHONE ~, WITH AR~ CODE III. TANKOWNER INFORMATION (MUST BE COMPLETED) MAILING OR STREET ADORESS ~ BOX ~IVIDUAL ~ LOCAL AGENCY. ~ STATE AGENCY TO INDICATE ~ PARTNERSHIP ~ COUN~ AGENCY ' ~F~DE~L AGENCY CI~ NAME STATE ZIP COD~ PHONE ~. WiTH AR~ COD~ OWNER'S DATE VOLUME PRODUCT IN TANK No. INSTATED STORED SERVICE Y/N Y/N YIN DO YOU HAVE FINANCIAL RESPONSIB'~'~?' Y~ ~PE I. ~rANK' DESCRIPTION ¢~WN A OWNER'S TANK I D # - ~ ~-~ ,~ / /~' ~l, i' MANUFAC~R . . . ~(~ ,~, /~)~ III. TAN K CONSTRUCTION ~AR~ 0~ ~a O~LY ~N ~X~S ~ ~, A~O C, ~0 A~L ~AT A~S ~ ~OX 0 A. ~PE OF ~ 1 ~UBLE WALL ~ 3 SINGLE WA~ WI~ E~ERIQR UNER ~5 UN~OWN SYSTEM ~ 2 SINGLE WALL ~ 4 SECONDARY ~NTAINMENT (VAUL~DTAN~ ~ ~ O~ER · B, TANK ~ 1 ~RESTEEL ~ 2 STNNLESS S~ · ~ 3 FlaERG~S ~ 4 STEEL C~D WI FIBERG~ REINFORCED P~C MATERIAL ~ 5 CONCRE~ ~ 6 ~LWlNYL CHLORIDE ~ 7 ~UMINUM ~ 8 1~. ME~ANOL ~MPA~B~W/FRP {PrimaryTank) ~ 9 BRON~ ~ I0 ~LVANI~D S~ ~ UN~OWN ~ .~ O~ER ~ 1 RUBBER LINED ~ 2 ~D L~G ~' 3 ~O~ LINI~ ~ 4 PHENOL~ LINING C. [NTER[0R ~NING ~ 5 ~ LINING ~. 8 UNLIN~ ~ ~ UN~WN ~ ~ O~ER IS UNING' MATERIAL ~MPATIBLE WI~ 1~ M~A~L ? YES ~ NO~ D. CORROSION ~ 1 ~LY~LENE WRAP ~ 2 ~A~NG ~ 3 ~L ~ ~ 4 FIBERG~S REINFORCED ~C PROTEC~0N, ~ 5 CA~ODIC PROT~CTiON ~ 9~ ~E ~ UN~OWN IV. PIPING INFORMATION C%RCm A iF ABOVE GROUND OR U IFUNDERG~UND, BO~IF~L~A~ A. SYSTEM ~PE A U I SUCTION ~ PR~SURE A ~ 3 G~V~ A ~ ~ O~ER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 ~UBLE WA~ A U 3 LINED TR~CH A~5 UN~OWN A ~ ~ O~ER C. MA~RIAL AND A U 1 ~RE STEEL A ~ 2 STNNLESS S~ A U 3 ~LWINYL CHLORIDE (PVC)A ~ 4 FIBERG~ PIPE CORROSION A ~ 5 ~UMINUM A ~ 6 ~NCRE~ A ~ 7 ST~LWI~A~ A ~ ~ 1~ M~OL ~MPA~W~RP PROTE~ION A U g ~LVANI~D S~ A ~. 10 CA~ODICPRO~CTION ~g5 UN~O~ A ~ ~ ~ER D. LEAK DETECTION ~ ~TOMATiCLiNELEAKDE~CTOR ~ 2 LINET~H~ESSTESTING V. TANK LEAK D~ECTION I I. TANK DESCRIPTION COUPLEmALL~T~S- SPEC~IFUNKNO~ :: C. QATE iNSTALLED (MO/DAY, EAR) ~I D. TANK C~ACI~ IN G~LONS: ~ '' Ill. TANK CONSTRUCTION MARK ONE ~ ONLY IN ~OXES ~ ~.AN0 O. ~D ALL'AT'PLIES IN ~OX D A. ~P~ 0F ~ ~DOUBLE WALL ~ 3 SINGLE WA~ WI~ E~ERIOR LINER ~ g5 UNKNOWN SYSTE~ .~ 2 SINGLE WALL ~ 4 ~ECONDARY ~NTAINMENT (VAUL~DTAN~ ~ ~ O~ER ~ BARE STEEL ~ 2 STAINLESS S~EL ~ 3 FIBERG~S ~ 4 STEEL.C~D W/FIBERG~ REINFORCED PLASTIC B. TANK ~AT~[~L ~ 5 CONCRE~ '~ 6 POL~INYL CHLORIDE ~ 7 ~UMINUM ~ 8 1~ ME~ANOL ~MPA~BLEW~RP (PrimaryTank) ~ 9 BRON~ ~ 10 ~LVANI~D STEEL C.[NTERIOR ~ 5 G~ LINING ~S UNLIN~ UNING is LINING MATERIAL COMPAT{BLE WITH 1~. ME~ANOL ? YES ~ NO~ O.CORROStON ~ I ~LYE~YLENE WRA, ~ , ~ 3 ~L W,~ ~ 4 FiaERGL~S REINFORCED P~ST~C OATING . PROTECTION ~ S CATHODIC PROTECTION~ 91 ~NE IV. PIPING INFORMATION c~Rc~ A ~FAaOVEGROUNOOR U IFUNDERG.OUNO. aO~IFAPPUCAaLE A. SYSTEM TYPE A~ 1 SUCTION A ~ 2 PRESSURE ~ GRAVI~ A U 99 O~ER B. CONSTRUCTION A~ 1 SINGLE WALL A U 2 ~UBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U ~ O~ER C. MATERIAL AN0 ' A~ BARE STEEL A ~ 2 STAINLESS STEEL A U ~ ~LWINYL CHLORIDE [~VC)A ~ 4 FIBERG~S PiPE CORROSION A U 5 ~UMINUM A U 6 CONCRE~ A U 7 STEEL W/ COATING A U 8 10~. ME~ANQL COMPATI~LEW/FRP PROTECTION A U 9 ~LVANI~D S~EL A ~ 10~ CATHOOIC PROTECT[ON A U 95 UNKNOWN A U ~ O~ER D. LEAK D~ECT~ON ~ I ~TOMAT[C LINE LEAKDE~CTOR ~ 2 LINET~HTNESS T~T~NG ~N~ORING V, TANK LEAK D~ECTION ~ ~ VISUAL CHECK ~ 2 IN~NTORY RECONCILIATION ~ 3 VAPOR MONITORING ~ 4 ~TOMATiC TANK ~UGING ~ 5 GRoUNDWA~ONITORING ~ TANK TESTING ~ 7 iN~RSTmALMONITORING ~ 91 NONE .~ 95 UN~OWN ~ ~ O~ER I. TANK DESCRIPTION COMPLETE l A. OWNER'S TANK t.D.# ~ B. MANUFACTURED BY: '' C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: II1. TANK CONSTRUCTION M^RKONE~TEMONLY~NBOXES~,mANDC.~NDALLT~^TAP~.IES~NDOXO A. '~'YPE OF ~ I ~UBLE WALL ~ 3 SINGLE WA~ Wl~ E~ERiOR LINER ~ 95 UN~OWN SYSTEM ~ 2 SINGLE WALL ~ 4 SECONDARY ~NTAINME~ (VAUL~DTAN~ ~ ~ O~ER B, TANK ~ .1 ~RE STEEL ~ 2 STAINLESS S~EL · ~ 3 FIBERG~S ~ 4 STEEL C~D Wl FIBERG~ REINFORCED P~TIC MATERIAL ~ 5 CONCRE~ ~. 6 ~LWlNYL CHLORIDE ~ 7 ~UMINUM ~ 8 1~ ME~ANOL ~MPATIBLEW/FRP (Prim=yTank) ~ 9 8,ON~ ~ 10 ~V~I~D S~ ~ ~ UN~OWN ~ ~ O~ER C. INTERIOR UNING ~ s ~ LINING ~ e UNLIN~ ~ ~ UN~WN ~ ~ 'OmER iS uNING MATER~ ~MPATIB~ WI~ 1~ ME~A~L ? YES ~ NO~ O. CORROSION ~ I ~L~LENE W~ ~ 2 ~A~ ~ 3 ~L ~ ~ 4 FIBERG~S REINFORCED ~S~C PROTEC~ON, ~ 5 CA~ODIC PROTECTION ~ 91 ~NE ~ ~ UN~WN ~ ~ O~ER IV. PIPING INFORMA~ON C~RC~ A IF ~0VE GROUND OR U IFUNOERGROUND. BO~IF~L~A~ A. SYSTEM~PE A U I SUCTION A U 2 PRESSURE A U 3 G~VI~ A ~ ~ O~ER B. CONSTRUCTION A ~ i SINGLE WA~ A U 2 ~UB~ WA~ ' A U 3 LINED TR~H A U g5 UN~OWN A ~ ~ O~ER C. MA~RIAL AND A U I ~RE STEEL A O 2 STNN~SS S~ A U 3 ~L~I~L ~LORIDE (PVC)A U 4 FIBERG~S PIPE CORROSION A U 5 ~UMINUM A ~ 6 ~NCRE~ A ~ 7 ST~LW/~A~ A U 8 1~ MEdrOL ~MPA~B~W/FRP PROTE~ION A ~ 9 ~LV~I~D S~ A U 10 ~OOlCPRO~C~ON A ~ ~ UN~O~ A U' ~ O~ER D. LEAK D~ECTION ~NffOR~NG ~ ~ O~ER V. TANK LEAK D~ECTION I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN C. OATE INSTALLED (MO/DAY/YEAR) O. TANK CAPACITY tN GALLONS: III. TANK CONSTRUCTION 'MARK ONE ITEM ONLY IN BOXES A, B. ANDC, ANOALLTHATAPPLIESINBOXD A. TYPE OF [] i OOUSLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] g5 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK3 [] 99 OTHER B. TANK [] 1 SARE STEEL [---~' 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC MATERIAL L_~ 5 CONCRETE [] 6 POLYVINYL CHLORIOE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (Primary Tank) [] 9 BRONZE [] 10 C.~ALVANIZED STEEL [] 95 UNKNOWN ~ 99 OTHER [] , RUBBER .NED [] = AL~O L,..NG [] = EPOX~ L,N,NG [] 4 PHENOL= L,.,NG C. INTERIOR LINING [] 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN [] 99 OTHER IS LINING MATERIAL COMPATIBLE WITM 100% METHANOL ? YES ~ NO~ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION C~RCLE A IFABOVEGROUNDOR U IFUNDERGROUNO. I]OTHIFAPPLICASLE A. SYSTEM TYPE A U 1 SUCTION A lJ 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U I SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARE STEEL. A lJ 2 STAINLESS STEEL A [J 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A [J 6 CONCRETE A U 7 STEELWlCOATING A U 8 100% METHANOL COMPATISLEWIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A I~ 95 UNKNOWN A U 99 OTHER D..LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTF. RSTITtAL [~ 99 OTHER ' MONn'ORING V. TANK LEAK DETECTION I ~ viSUAL CHECK [] 2 ,NVENTORY RECONCILI^TtDN [] 3 VAPO. MONITORING []. *UTOMAT~C TANK GAUGING [] S GROUND WA~.~,~DNITORING [] 6 TANK TEST,NG [] ~ ~NTERST,~,ALMON,TOR,NG [] .. 'NONE [] ~S UNKNOWN [] ~ oTHER C]'I'Y of BAKERSFIELL) . . _ · ~.HAZAR DOUS MATERIALS ~NVENTORY LOCATION; ~'~o~ ~ %:+~. ~ ADDRESS; ~'~m~N,~[~ "STANDARD IND. CLASS COD[[ CIIY. ZIP~ I%~Eec[~,'e~ ~S~-~ CITY. ZIP[ ~ds~2[q C~.~ DUN AND BRADSTREEI' NUMBER frans ~yqe Hax Average Annual Heasure I OVSeslt ~ont ~ont ~ont Us tocqtion?e(e. Code coae Act AeC Est Un,ts on ~ype Press Coue See Storeo In Pacl/ity Phvsicallcheck alland'Hellth H~ard " .... that ~ire Hazard ~ aeactivity ~Oela~ed ~ Sudden Release ~ leaediate Component Name Number ' Health of Pressure Health Coaponent t3 Na~e ~ C.A.S. Humber Physical(check allandthatHealthapp/y]Ua~ard C.A.S. Number ~]b~. o'~ F,'~ Component II Name I C.A.S. Number v ~ Component I~ Name t C.A.S. Number ~Fire Hazard ~ Reactivity ~0~layed ~ ~ Sudden Relesse ~[emediate Health . of Pressure Health Component 13 Name I C.A.S. Number Physical andHeal:h Hazard C,A.S, Number ~ON~ Fk'l~. Componen: II Name I C,A.S. Number Coeponent 12 Name I C,A,S, Nueber ~ire Hazard B Reactivity ~laye.duea/:~ B Suddenof Pressure~elease Component 13 Naee I C,A,S, Nueber Physical and Health Hazard C,A.S. Number Component II N~me '1 C,A,S. Number (Check all that apply) Component 12 Name C.A.S. Number · U Fire Haza'rd B Reactivity ~ 0elayed ~ Sudden Release ~ l~e~ Health of Pressure,,~,,,,, ComponenL 13 Name I C,A.S. Number ert& ;a~ioq .(Ref~ ~.~ign after compl~ti(tg.~ll sec~i~n~) at~;~ ~.dQcvmen~s, 8hq ~c ~seo on.my inquiry 9i.~nose.lnolvlousis responslD/e tot obtaining ~ne IntOrm~lon, [ believe th~L the Overall Site with 1 Fac. Urlit- NOV 1 6 1990 Ger~et-a 1 Ir~forrnat ic, r~ ............ '"~"~ ~. ~IY. Lc, cation: 3200 F ST Map: 102 Hazard: Low Ider~t Number: 215-000-000512 Grid: 24D Area of Vul: 0.0 ....... Cc, r~tact Name .............. Title Business Phc, r~e ~--24 Hc, ur Phor~e] DOUGLAS HULSEY (805) 322-2250 x (805) 393-8791! .JERRY HULSEY (805) .... ~o_ x (805) 872-0243 .......... Admir~istrat ire Data Mail Addrs: 3200 F ST D&B Nurnber: City: BAKERSFIELD State: CA Zip: 93301- Cornm Cc, de: 215-001 BAKERSFIELD STAT-ION 01 SIC Cc, de: Owr~er: DOUGLAS B. HULSEY Phc, r,e: Address: 4212 HIGHLAND HILLS State: City: BAKERSFIELD Zip: 93308- I, k'~b~,~-~ ~.L .~ .~ Do hereby certify that I have reviewed the ~'~.~¢.ched hazardous materials manage-.. ment plan for_l,,(3~.~- l~.b}///~,o and that it along with any corroetion$ constitute a ~omplete and correct man- agement plan for my facility. 10/24/g0 WESTCHESTER MOBIL 215-000-000512 Page 2 Haz~at Inventory List ir, MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Quantity MCP 02-001 GASOLINE ? 10,000 Moderate GAL 02-002 GASOLINE ? 10~000 Moderate GAL 02-003 WASTE OIL ~ 500 Low GAL 02-004 MOTOR OIL ? 120 Minimal GAL 21 O0 - Overall Site <D> Notif./Evacuation/Medical <2> Employee Notif. /Evacuatior, <3> Public Notif. /Evacuatic,~s <4> Emergency Medical Plan SAN JOAQUIN HOSPITAL 2615 EYE ST 327-1711 HALL AMBULANCE 327-4111 1[)/24/9[) WESTCHESTER MOBIL 215-[)[)[)-[)[)[)512 Page 4 00 - Overall Site <E> Mit igat iorJPrever~t/Abater~t <2> Release Contain~ent <4> Other Resource Activatior~ 10/E~4/~0 WES ESTER MOBIL 215-000-000 Page 5 00 - Overall Site <F) Site E~er_qer~cy Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - WES]' OF THE SINK ON THE NORTH LUBE ROOM WALL C) WATER - SOUTHWEST CORNER OF LOT NEX]' TO F STREET SIDEWALK D) SPECIAL - GAS PUMP EMERGENCY SHUTOFF WES]' OUTSIDE WALL E) LOCK BOX - NO <3> Fire Protec. /Avail. Water PRIVATE FIRE PROTECTION - ???????????? FIRE HYDRANT - ?????????????? <4> Held for Future use 10/24Z90 WESTCHESTER MOBIL 215-000-000512 Page 6 · · O0 - Overall Site <G> Trair, ir, g < 1> Page 1 WE HAVE ?? EMPLOYEES AT THIS FACILITY DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE? BRIEF SUMMARY OF TRAINING: <2> Page 2 as r, eeded Held for Future U~e -~ <4> Held for Future Use rsfield Fire Dept. ~ HAZARDOUS MATERIALS DIVISION ~,?~e Completed Business Name: ~ C 5 ~ c ~E.. ~ T-E__ ~ -~ Location: ~ 0 ,~ o.~vx ,~ . F /.._ ~ 2_~ ~ ,~ S T- ~ RECEIVED Business Identification No. 215-000 (Top of Business Plan) Station No.' I Shift .'~ Inspector '-T-'. ~ <9 ~-~5 o ~ HAZ MAT. DiV. Adequate Inadequate Verification of Inventory Materials ~ Verification of Quantities . IE~ ~)r[~ Verification of Location ~ - Proper Segregation of Material~ 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: '~[2",-.' ~ ~ ::F H, TI% Violations: Correction Needed ]~ Business/Owner/Manager j FD 1652 (Rev. 1-90) Whita-Haz Mat Div. Yellow-Station Copy · Pink-Business Copy BAKERSFIELD, CA 93301 (805) 326-39'79 OFFICIAL USE ONLY ID~ BUSINESS HAZARDOUS MATERIALS BUSINESS PLAN AS A WHOLE FORM 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: WESTCHESTER MOBIL. B. LOCATION / STREET ADDRESS: 3200 F ST CITY: BAKERSFIELD ZIP: 93301 BUS.PHONE: (805) 322-2250 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. A. KIMBERLY HULSEY - OWNER'S WIFE Ph# 393-8791 Ph# B. JON G HULSEY - OWNER'S FATHER PhS 872-0243 Ph~ SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: N/A B. ELECTRICAL: WEST OF THE SINK ON THE NORTH LUBE ROOM WALL C. WATER: SOUTHWEST CORNER OF LOT NEXT TO F ST SIDEWALK D. SPECIAL: GAS PUMP EMERGENCY SHUT-OFF -- WEST OUTSIDE WALL E. LOCK BOX: YES / NO IF YES, .LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / MO MSDSS? YES / NO FLOOR PLANS? YES ./ .Y0 KEYS? YES / NO SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE FIRE EXTINGUISHER IS EASILY ACCESSIBLE. EMERGENCY TELEPHONE NUMBERS ARE POSTED. FIRST AID KIT AVAILABLE. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE FIRST AID KIT AVAILABLE. SAN JOAQUIN HOSPITAL, 26~5'EYE ST, 327-1711 HALL AMBULANCE, 327-4111. 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 )~TERIALS:...' .................................... .~NO O N0 B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: ........................... ~ 50 ~ 50 C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ NO~ NO D. EMERGENCY EVACUATION PROCEDURES: ..... ~ ........... -~ NO NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS': .......... YES.~)~:yES NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES - NO - NONE DOES YOUR BUSINESS HANDLE HAZARDOUS ~RTERIAL IN QUANTITIES LESS THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... YES NO I, DOUGLAS B. HULSEY, 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. ~5500 Et Al.) and that inaccurate information con'stitutes perjury. NON--TRADE SECRETS llAZARDOUS MATERI ALS' I NVENTOIIY NAME: WESTCHESTER.MOBIL'~ . OWN~ NAflEI DOUGLAS B HULSEY FACll, ITY UNIT 3200 F ST AUIIflESS~ 42~2 HIGHLAND BILLS ~ACll, IT~ UNIT NAME: I~: BAKERSFIELD, CA 93301 ~IT~, ZI~I BAKERSFIELD. CA nl.t(~lltl'l'AH(iUNT UNIT (;OI)~ CgU~ FACiliTY UNIT HTr,,. CIIEHI~A~ OR COMMON NAME CODE 10,000 153,400 GA~ ] 19 west of bu~]d~n9 100 9aso]~ne FLL~ 10,000 75,400 GAL ] ]9 west of build,n9 100 9aso]~ne FLLQ 500 300 GAL ] 40 east of bu~]d~n9 100 motor o~1-- waste FLLQ 120 375 GAL 11 26 south lube room 100 motor o~1 FLLO wa]] 3 3 GAL 14 39 north lube room 100 solvent.for parts washer FLLQ wa]] ] ] GAL overhead sh'e]f 100 4 ca~ batteries (~Cl~ ~ CMLQ C(}N'[A[;T: KIMBERLEY HULSEY TITI, EI O~ER'S WIFE u/~li0NE f'~us~ 322-2250 AFTER ~U~ fiRS C(INIACT: JON G HULSEY T[TL~I OWNER'S FATHER Pfl0NE ~ 8US [[(}URS: 872-0243 III;SINESS ACTIVITY: GAS STATION AFTER ~lJS. J[RS: 393-8791 BAKERSFIEL~ CI~ FIRE DEPA~r~NT RECEIVED 3_~dSP ( BAKERSFIELD. CA 93301 JUL {$ ~987 ~ (805) 326-3979 Ans'd ............ l OFFICIAL USE ONLY ID# USINESS NAME HAZARDOUS MATERI ALS BUSINESS PLAN AS A WHOLE FORM 2A 000512 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: Oerr_v's Mobil B. LOCATION / STREET ADDRESS: 3200 F Str.e~t cITY:, Bakers,.fi~ld ZIP: 93301 BUS.PHONE: (805) ~??-7250 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 ~ND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. Douqlas Hulsey, .Manaqer Ph# 805-322-2250 Ph# ~05-393-879l B. Jerry Hulsey, Owner' Ph# 805-322-2250 Pb# 805-872-0243 SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: N/A B. ELECTRICAL: west of the sink on the north lube room wall c. WATER: south-west corner of lot next to F Street sidewalk D. SPECIAn: ,9as pump emergency shut-off -- west outside wall E. LOCK BO>[: 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 FO~ BUSINESS AS A WHOLE Fire extinguisher is easily accessible Emergency telephone numbers posted. First aid kit available. SECTION S: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE First aid kit available. San Joaquin Hospital, 2615 Eye St., 327-1711 Hall Ambulance, 327-4111 SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WIT}{ INITIAL AND REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER m. METHODS FOR SAFE HANDLING OF HAZARDOUS B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... ~ NO ~E~,S~ NO C. PROPER USE OF SAFETY EQUIPMENT:.. ................ ,,~/_ NO ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. ~ NO ~$~ NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES ~ YES NO SECTION 7: 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 NO I, 0'OD G. Hulsey~ Sr. , 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. SIGNATU TITLE Owner DATE 7- l 1 - 87 - 2B - BAKERSFIELD CITY FIRE DEPARTMENT I D ~ FORbl 4A-1 Page NON--TRADE SECRETS HAZARDOUS MATERI ALS INVENTORY BUSINESS NAME: Jerry's Mobil OWNER NAME: ion G. Hulsey~ Sr. FACILITY UNIT.,#: ADDRESS: 3200 F St. ADDRESS: 2104 Sandy Ln. FACILITY UNIT NAME:Je'rry'svMObii CITY, ZIP: Bakersfield, CA 9330l CITY,ZIP: Bakersfield, CA 93306 PHONE ~: 805-322-2250 PHONE '*: 805-872-0243 [~)FFICIA'L USE CFiRS CODE I , .ONLY I 2 3 4 ,5 6 ? '8 9 16' TYPE MAX ANNUAL CONT USE LOCATION IN THIS % BY HAZARD D.O.T CODE A.M. OUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIqAL OR .C. OMMON NAME CODE, GUIDE //iH 10',000 153,400 G_A.L_. 1 19 west of building 100 gasoline FLLQ ~M 10,000 75,400 GAL;> 1 19 west of building 100 gasoline //Z~- FLLQ M 500 300 GAL 1 40 east of building 100 motor oil-- waste /~'-~.~ FLLQ I p 120 375 GAL ll 26 south lube room 100 motor oil ~.d67~/~7 FLLQ wall P 3 3 GAL 14 39 north lube room 100 solvent.for parts washer FLLQ wall p . 1 1 GAL overhead shelf 100 4 car batteries ~c..tc~ .CMLQ .... / .,' ' I ' ',~ ~'A~/xY.f;,~/ /'/~ n,~T~. 711 181 NAMI~.. don' G. HulSev. Sr. TIFTLF_. owner ~ .~IIINATIIRIq EI~ERGENCY CONTACT: DOUg Hulsey TITI, E: manager ,..// PIIONE #~'BDS ~({UR~: g05-3~2f2250 I AFTER BUS HRS: 805-3'93-87! EMERGENCY CONTACT: Mary Huls.ey TITLE: owner's wife PIIONE # BUS HOURS: 805'-87]-5500, PR. INCIPAL BUSINESS ACTIVITY: qas station ~ AFTER BUS HRS: UOb-S/2-0243 - 4A-1 - HAZARDOUS MATERIALS INSPECTION ,,,-/ VERIFICATION OF INVENTORY MATERIALS ~ VERIFICATION OF QUANTITIes ~ VERIFICATION OF LOCATION ~ PROPER ,SEGR]~aATION OF MATERIAL ~ COMMENTS .' VERIFICATION OF HAZ MAT TRAINING ~ /~ VERIFICATION OF MSDS AVAILABLE/ ~ VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURF~ ~--~ COMMENTS: EMERGENCY PROCEDI]RES POSTED [-~ CONTAINERS PROPERLY L~R~---'~.~ ~ VERIFICATION OF FACILITY DIAGI~%M ~ SPECIAL HAZARDS ASSOCIATED WITH THIS FACILITY: /~/c)~ APRIL 11, 1988 Dear Mr. HULSEY NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YoUR BUSINESS WEST CHESTER MOBIL LOCATED AT 3200 "F" STREET BAKERSFIELD, CA 93301 ON 4-8-88 THE FOLLOWING HAZARDOUS MATERIALS REGULATION VIOLATIONS WERE IDENTIFIED.: 11 SECTION 3A OF YOUR BUSINESS PLAN NOT COMPLETED VIOLATION OF CALIFORNIA HEALTH AND SAFETY CODE CHAPTER 6.95, 25504(B) Business plans shall include all of the following: Emergency response plans and procedures in the event of a reportable of threatened release of a hazardous material, including, but not limited to, all of the following: (1) Immediate notification to the administering agency and to appropriate local emergency rescue personnel and the office. (2) Procedures for the mitigation of a release or threatened release to minimize any potential harm or damage to persons, property, or the environment. (3) Evacuation plans and procedures, including immediate notice, for the business site. 2) MATERIAL SAFETY DATA SHEETS NOT AVAILABLE VIOLATION OF OSHA 1910.1200 (g)The employer shall maintain copies of the required material safety data sheets for each hazardous chemical in the workplace, and shall ensure that they are readily accessible during each work shift to employees when they are in their work area(s) (h)(1) INFORMATION. Employees shall be informed of: (i)The requirements of this section (ii)Any operations in their work area ~here hazardous chemicals are Dresent; and, (iii)The location and availability of' the written hazard communication program, including the required list(s) of hazardous chemicals, and material safety data sheets required by this section. The above violations must be corrected by APRIL 25TH 1988 . · The deDartment will schedule a re-insDection of 7our 'facility to verify comDliance. If you have any questions regarding this notice, please contact Ralch Huey at 398-39~9.,:,'~L?~'.s. ~.,<,/'c:7'~ . RalDh E.Huey '~' Hazardous ~agerials Coordinagor ~.. APRIL 11, 1988 Dear Mr. HULSEY NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION' OF YOUR BUSINESS-WEST CHESTER MOBIL LOCATED AT 3200 "F" STREET BAKERSFIELD, CA 93301 ON 4-8-88 THE FOLLOWING HAZARDOUS MATERIALS REGULATION ~'.~?~,;.~.~?.f~:'/.~.~:4~!.?i!~: VIOLATIONS WERE IDENTIFIED.: , . ~.~. 1) SECTION 3A OF YOUR BUSINESS PLAN NOT COMPLETED .... VIOLATION OF CALIFORNIA HEALTH AND SAFETY. / Business Dlans shall include all of the following: Emergency resDonse Dlans and ~rocedures in the event of a reDortable of threatened release of a hazardous material, including, but not limited to, all of the following: (1) Immediate notification to the administering agency ~d to aDmroDriate local emergency rescue Dersonnel and the office. (2) Procedures for the mitigation of a release or threatened release to minimize any Dotential harm or damage to Dersons, DroDerty, or the environment. (3) Evacuation Dlans and Drocedures, including immediate notice, for the business site. 2) MATERIAL SAFETY DATA SHEETS NOT AVAILABLE VIOLATION OF OSHA ~§ 1-2UU ........ ................. ' ............................ (g)The emDloyer'shall maintain co~ies of the required material safety data sheets'for each hazardous chemical in the workDlac~, and shall ensure that they are readily accessible during each work shift to emDloyees when they are in their work area(s) (h)(1) INFORMATION. EmDloyees shall be informed of: (i)The requirements of this section (ii)Any oDerations in their work area ~here hazardous chemicals are Dresent; and, (iii)The location and availability of the written hazard communication Drogram, including the required list(s) of hazardous chemicals, and material safety data sheets required by this section. The above violations must be corrected by APRIL 25TH 1988 The department Will schedule a re-inspection of your facility- to verify compliance. If you have any questions regarding this notice, please contact Ralph Huey at 326-3979. Sincerely, Ralph E.Huey Hazardous Materials Coordinator