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HomeMy WebLinkAboutBUSINESS PLAN IMPO/!~ANT MESSAGE , FOR /~.M. DATE TIME P.M. PHONE NO. TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALLI ~ :,, - ,~i'~ '~/~ ., ASSOCIATED L1-A2334 ..,.~ ~ ~ ,. u.~.*. ~A~FE~ ADDRESS ZIP CODE FEE. I BLOCK NO. '' · BUSINESS LICENSE NO. PERMIT REQUIRED PERMIT NO. BUILDING CLASS/TYPE OF OCCUPANCY BUSINESS NAME " BUSINESS OWNER BUSINESS MGR./RESPONSIBLE ~.//,~ ¢. f,'~ ~ ~ BUSINESS PHONE HOME PHONE NO. OF FLOORS SQUARE FOOTAGE V~OLA~tON NOTICE iSSUED? ~ Ye, C* / occu~NT LRAD DATE OF REINSPECTION (1) (2) (3) ¢' ;' iNSPECTOR '~ ~ .- ~TATION/SHIFT/STATION PHONE ~ Hazardous Materials Division .BEp. ~ 2130 "G" Street ~E. Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoicl 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 pos~ible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: ~/,~C LOCATION: MAILING ADDRESS: CITY: ~~3~ ~-~ STATE:~,~ ZIP:~ PHONE: DUN & BRADSTREET NUMBER: PRIMARY ACTIVITY: OWNE~: ~/2Z,~ ~, ~~c~ MAILING ADDRESS: SECTION 2: EMERGENCY NOTIFICATIION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1. FD1590 Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3:· TRAINING: NUMBER OF EMPLOYESS: I~ATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJUR~I"THAT MY BUSINESS'IS EXEMPT"FROM THE REPORTING RE©UIREMENIS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFEI~/ CODE" FOR THE FOLLOWING REASONS: WE'DO NOT HAN'DLEHA7ARDous MATERIALS. X WE DO HANDL-E HAZARDOuS'MA'TERIALS, BUT THE'©UANTITIES AT NO  TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON], SECTION 5: CERTIFICATION: I, /4,/~ Z¢) ~;;::~~ CERTIFYTHATTHEABOVEINFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITtJTES PERJURY.' SIGNATURE TITLE DATE FO1590 r.~. --... ~ 'V~ Cf FY off BAKER$?I£LD - ~.,~- ~?(?:i'., ...~ ...... ,, - .- - ,. ~ (ty~e or ~rin~ name) RECEIVED Do herebi cert~ ~-- _z~ that I have reviewem the attached Hazardous Materials bus~ness Dian (name of business) and that it along with the attached additions corrections consti'" ~ ~u~e a comDtete and correct Business Plan for my :facility. sl~na~ur-e ~ate CITY of BAKERSFIELD NON--TRADE SECRETS ' Pa~e .... of .... c~TY/ z~v: B~[~Ftn-, ~~ CITY, Z~P:' ~'' . ~ DUN AND BRADSTREET NUMBER PHONE ~: I~~g~ PHONE 8: ~ _ _ __ lrnnS ly~ ~x A~i~ ~l ~Su~ I ~ Cmt ~t ~t ~ L~ti~ (~e C~e ~t ~t Est Units m Site I~ ~ T~ ~ .. St~ 4n FKtllty ~ b I~t~ti~ Oh~cll ~ .filth ~z~ C.A.S. ~ ~t I1 ~ all t~t I~ly) .... -= .... - - ~-' ~-2 h~~/ - ~t g2 ~ of P~a~ ~lth .... L_-I ....... ~ .... L, ........... 1. 1 .... 1_~,1_'_} ...... L~.J..~ I ......... P~ic41 ~ ~lth HIZi~ C.l.S. ~ ~t II ~ (C~k ii1 t~t apply) , : ........................ - r - ~ r -- ~ r -- r -- ~ ~t 12 ~ '& C.A.S. With of Pmsn ~lth ....... " P~Icil ~ ~lth ~z4~ C.A.S. ~ ~t II h A ~t 13 _.Z_.LL...iL_LL ........ l .......... J. i .! .... i ...... l_lll__~ .......... ~' ' e--~ ~ ~ ~ ~ C~t 12 ~&C.A.S. ~ : .... Ftre Hazard--~ ~tivity ~_a ~10~ a~dd~ bh~e H~ith of Pt.;uti Health ~t 13 ~&C.A.S. ~r ...... , .. Ro~- "~ .............................. ~' TT~Ii ~P'~! ....... (wr~t~icati~ (Read and si~ af(er co,plet~n~ all I cmrtify.~der ~ty of 1~ t~t I ~ve ~rs~el)yexamin~ end mm f~i)ilr with t~ tnfor~ti~ su~itt~ tn this ~ to~ obt,inin{ t~ inf~ttm. I ~li~ve t~t t~ sumitt~ inlomtim is t~. accurate, and c~pl~te. ~/ ~ ~ ~) ~ . ~~ ~, ~-~: - ~ ~ ~ /Yl~ ~~~ ' ~~-ZZ~2 ............. ' BAKERSFIELD CITY FIRE DEPARTMENT O ~AKERSrIE~D, CA o~¢o~ NOV 2 5 1987 INS~UCTI ONS: ~. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions be!o~ for the business as a ~hole. ~. Be as brief and concise as possible. SECTION 1: BUSI~SS IDE~IFICATION DATA SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involvin~ the release or threatened release of a hazardous material, call 911 and 1-800-852-7560 or 1-916-42T-4341. This will notify your local fire department and the State Office of Emer5ency Services as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TI,TLE DURING BUS. HRS. AFTER BUS. HRS. B. ~--P.-h~ SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: B. ELECTRICAL: 2~'/~ /~--~_! c. WATER: b~,~A- ' D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES ./ NO FLOOR PLANS? YES / NO KEYS? YES / NO 2A - SECTION '4:' PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASS][,STANCE 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 INITI.J3d, REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS ~ ~TERIALS:...' .................................... YES NONO ~ YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES ~0 YES XO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. ' YES NO YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES YES NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES, - NO - NONE DOES YOUR BUSINESS HANDLE HAZARDOUS ~TERIAL IN Q'UANT!TIES L~ss THAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF .4 COMPRESSED GAS: ...... (~ NO I, , certify that the above information is accurate. I understand that this information will. be used to fulfill ms' 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 con'stitutes perjury. BAKERSFIELD CITY FIRE DEPART3IENT Z130 "G" STREET BAKERSFIELD, CA 93301 OFF:CT'AL USE ONLY ID~ BUSINESS NAME: BUS I INIESS PLAN SINGLE FACILITY UNIT F O RlVf 3 A INSTRUCTIONS . 1. TO avoid further action, this form must be'returned by: Z. ~PE/PR:NT YOUR ANSWERS :N ENGLISH. ~. Answs~ the questions below fo~ THE FACILITY USIT LIST:D B:LON 4. Be as BRIEF and CONCISE a~ .pos~ible. ' "- S~CTION l: ~ITIGATION~ PR~ION~ ABAT~ PROC~L~ES SECTION 2: NOTIFICATION AS'D EVACUATION' PROCEDL'RES AT THIS L%.-'I.T 0.YLY SECTION 3: HAZARDOUS MATERIALS FOR TWIS UNiT ONLY A. Does this Facility Unit contain Hazardous Materials9 ...... If YES, see B. If NO, continue with SECTiOiY 4. B. Are any of the hazardous materials a bona fide Trade Secret YES If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (~vhite form :4A-l) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (yellow form ~4A-2) in addition to the non-trade secret form. List only the trade secrets on'form 4A-2. SECTION 4: PRIVATE FIRE' PROTECTION SECTION $: 50CATI05' OF WATER Sb'PPL¥ FOR USE BY EMERGENC? RESPONDERS SECTION 6: LOCATIO~ OF ~ILITY SHL~--OFFS ~T THIS U~IT ONLY. · ~A~,',~OPAN~: A NAT. B. ELECTRICAL: C. WATER O. SPECIAL: E. LOCK ,q.O.~: YES .'~ IF YES, LOCIT!ON: rr Pr .\X¢~ 'rE% \'0 :,r~-S~ yr% 3:0 NON--I'RADE SECRETS IIAZARDOUS MATERI ALS' I NVENTOI{Y .... ] ONLY , LOCATION IN Tills ~ fly .... IIAT. ARI) I). ~ ~~ /~ , -, TE/F.~CICI TY D NORTH SCALE: BUSINESS (CHECK ONE) SITE DIAGR.~I I(Inspector's Comments): -OFFICIAL USE ONLY- - SA - SITE DIAGRAM (Required 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 Tracks Driveways, and Parking Areas adjacent to the : I2. Fence or Barrier property. Include the a. Wire  street names. b. ~asonry S. Storm Drains, Culverts, Yard Drains ¢. Wood · 4. Drainage Canals, Ditches. d. Gates Creeks, 13. Powerllnes 5. Buildings a. Frame construction 14. Guard Station b. ~asonry construction 15. Stora~ Tanks: Identify the c. Metal construction capacity In a. ~ova ground d. Access Door b. Underllm'ound 6~ ~tllity Controls a. Gao 16. Biking or Bern b. Electricity 17. Evacuation Route c. Mater 18. Evacuation Area: - Identify the 7. Fire Suppression Systems: location where a. Fire Hydrants ' ~Sloyee8 will b. Fire Sprinkler 19. Outside Hazardous Connecttonm Waste Storage Fire Standpipe 20. Outside Eazardous Connections Waterial Storage d. Water Control Valves 21. outside ~azardoua for protection systems Waterial Ose/Hand~lng e. Fire P~p 22. T~pe of Hazardous Watertal/waste Stored 8. Fire OepartaenC Access o~ Osed (See Below) TY~8 OF RAZARDOUS MATERIAL F - Flammable E - Explosive L - LiqUid R - Radiologlca! C - Corrosive 0 - Oxidizer O - Gas P - Poison Water Reactive T - Toxic S - Solid R - Cryogenic D - Waste B - Etiological Example: Flam~able Liquid - FL FACILI~ DIAGRAM (Required item~ in addition to the abo~e) 1. Risers for Sprinklers 8. Fire Escapes 2. Partitions 9. Air Conditioning Units 3. Stairways: Indicate the 10. Windows levels served from highest to lowest. 12. inside Hazardous MasSe Storage 4. Escalator: Indicate the levels served ~rom 12. Inside Hazardous highest to lowest. Materials Storage 5. Elevator 13. Inside Hazardous Materials Use/Handling 6. Attic Access 14. Sewer Drain Inlets 7. Skylights MARCH 18, 1988 Dear Mr. PIERCE NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YOUR BUSINESS PIERCE SHEET METAL LOCATED AT 3408 GETTY ST. BAKERSFIELD, CA 93308 ON MARCH 16 THE FOLLOWING HAZARDOUS MATERIALS REGULATION VIOLATIONS WERE IDENTIFIED.: 1)NO MATERIAL SAFETY DATA SHiEETS AVAILABLE ON HAZARDOUS MATERIALS: VIOLATION OF OSHA 1910.1200(G) (9)Material safety data sheets may be kept in any form, including operating procedures, and may be designed to cover groups of hazardous chemicals in a work area where it may be more appropriate to address the hazards of a process rather than individual hazardous chemicals. However, the employer shall ensure that in all cases the required information is provided for each hazardous chemical, and is readily accessible during each work shift to employees when they are in their work area(s). The above violation must be .corrected by APRIL 1ST,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. Sin~ nazardous Materials Coordinator HAZARDOUS MATEF IALS INSPECTION INSPECTION DATE: ~- ~ -- ~ INSPECTOR: ~~o. o~ ~u~~ PROP~ SECTION OF ~~ ~ ~IFI~TION OF ~ ~T ~~G ~IFI~TION OF ~S AV~~ VERIFICATION OF ABATEMENT SUPPLIES & PROCedURES I~ EMERGENCY PROCEDURES POSTED CONTAINERS PROPERLY LAB~--~.F~ COMMENTS: VERIFICATION OF FACILITY DIAG~J~ SPECIAL HAZARDS ASSOCIATED WITH THIS FACILITY: ~O~'~ON~: '"(. ~-* '~ 1~ ~,~ 'a~,-~,~}"~--5 Mm__ HAZARDOUS MATERIALS INSPECTION ' VERIFICATION OF ABA~ SUPPLiF~ & PROCEDURF~ I.~ VERIFICATION OF FACILITY DIAGR~ SPECIAL HAZARDS ASSOCIATED WIT~ THIS FACILITY: MARCH 18, 1988 Dear Mr. PIERCE NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE IN THE INSPECTION OF YOUR B'USINESS PIERCE SHEET METAL LOCATED AT 3408 GETTY ST. BAKERSFIELD, CA 93308 ON MARCH 16 THE FOLLOWING HAZARDOUS MATERIALS REGULATION VIOLATIONS WERE IDENTIFIED.:. 1)NO MATERIAL SAFETY DATA SHEETS AVAILABLE ON HAZARDOUS MATERIALS: VIOLATION OF OSHA 1910.1200(G) (9)Material safety data sheets may be keDt in any form, including operating Droeedures, and may be designed to cover grouDs of hazardous chemicals in work area where it may' be more aDDroDriate to address the hazards of a Droeess rather than individual hazardous chemicals. However, the emDloyer shall ensure that in all cases the required information is Drovided for each hazardous chemical, and is readily accessible during each work shift, to employees when they are in their work area(s). The above violation must be corrected by APRIL 1ST,1988 The deDartment 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,