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Home My WebLink AboutBUSINESS PLAN BAKERSFIELD cITY FIRE DEPARTMENT HAZARDOUS MATERIALS ' SITE/FACILITYDIAGRAMS FORM 5 '. INSTRUCTIONS GENERAL INSTRUCTIONS Use these instructions and the attached form to complete a SITE DIAGRAM of the property and immediate surrounding area, and a FAC,!LITY DIAGRAM of each facility unit or building. tf the entire business can be shown in adequate detail on the Site Plan, individual Facility Plans may not be necessary. The. Inspector can assist you in making this determin~ti6n if there is a question. Complete th~ information at the top of the diagram form, The box at the bottom of the form should be left blank. SITE DIAGRAM The SITE DIAGRAM should include the business and at least 300 feet from the property line. Identify the items listed on the SITE DIAGRAM using the symbols provided on tb~.~~ back. Include all items that apply. See the attached example. FACILITY DIAGRA~ Develop a FACILITY DIAGRAM that will show the building interior and the immediate ext¢_rior area. Complete a separate FACILITY DIAGRAM for each floor of a multi-story building. Identify on FACILITY DIAGRAM items listed under both "SITE DIAGRAM" and "FACILITY DIAGRAM" on the back of this page. Use the symb'ols provided. Include ali items that apply. See the attached example. SITE/FACILITY D I AGR~k~4 DATE~ .~/~ FACILITY NAME: UNIT ~:/ OF l (CHECK ONE) SITE DIAGRAM .~ FACILITY DIAGR.~M (Inspector's Comments): -OFFICIAL USE 0NLY- / S[TE DIAGRA~I (Required liens) 1. Address: Identify the 9. Lock (key) Box principle buildings by the Street numbers. 10. MSDS Storage Box 2. Street(s), Alleys, 11. Railroad Tracks 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, 13. Pouerllfles 5, Buddings ) Frame construction 14. Guard Station b. Masonry construction 15. Storage Tanks: Identify the c, M~tal"constructlon capacity in gal, . ' a. Above ~round · d,. Access Door · - b, Underground 6. Utility Controls a, Gas[ .... 16, Diking or Bern b. Electricity / 17. Evacuation Route c. Water / 18. Evacuation Area: Identify the 7. Fire Suppression Systems: location uhere . a, Fire Hydrants employees sill b. Fire Sprinkler 10, Outside Hazardous Connections Wests Storage c, Fire Standpipe 20. Outside Hazardous Connections Waterlal Storage d, Water Control Valves ~I, Outside Hazardous for protection system~ Material Use/Handling e, Fire Puup ~2, Type of Hazardous Material/Waste Stored S. Fire Department Access or Used (See Below) TyPI; OF HAZARDOUS MATERIAL F - Flammable g - Kxploslve L - Liquid R - Radtologlcel C - Corrosive 0 - Oxidizer G. - Gas P - Poison W - Water Reactive ? - Toxic S - Solid ~ - Cryogenic D - Waste B - Eth)loglcal Example: Flammable Liquid - FL FACILITY DIAGRAM (Required Items In addition to the abo~e) 1, Risers for Sprinklers .8, Fire Escapes 2, Partiticns O, Air Coflditloflln~ Units 3, Stairways: Indicate the 10, Windows levels served from highest to lowest, 1~, Inside Razardou8 Waste Storage 4, Escalator: Indicate the levels served from 13, Inside Hazardous highest to lowest. Hater/als Storage S. Elevator 13. Inside Hazardous Materials Use/Xandllng ~, Attic Access 14, Se~er Drain Inlets FINANCE DEPARTMENT CITY OF BAKERSFIELD BAKERSFIELD, CALIFORNIA 93303 ' , ....... ' ' R~URN SERVICE REQUESTED ~~~ ~~~~~ " '~ AUTOI3Z ~330l~0~8 &lO0 Ob 0~/0~/00 RETURN TO SENDER :AUTOHOT~VE RADIATOR BAKERSFIELD CA Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ................ ~,~,~,~,~=~,~:,~,~,,~,,~, ................ This permit is issued for the following: .:~,::~"~i~'?~i':::[:., ~,~i?~:'~''~;='~:::ii i[!!i:~,. =~iiii!!!!ii~i~. i!iii!~;i i;"';~'::i iiiiiii~::iiiU~emround Storage of Hazardous Materials LOCATION 131 GOLDEN S~A~:E~:;;;,"'"":'.:.~;~'~,;;~'~':''''' ~';~'~'~'"'::~':""-' B~'~S~j~LD CA ~ ...... ~,. ~ ~" ~;'~,,.;'",.." '~,' ,,' .,~ ........ t~,'":~ '*"~'~:":~' ,,~l~ ', *,. ,~ : . ~ ~. ~ "" ~ ~ ~'~"'F ....... "~",.~.~.~':;.~, ~i[~, iii~c~"'~P:' .~'~' i ' · , ...... :,, .~.~~ ~, ~ ~.~ .............. [ ............ ,,~ !~ *.1% ,~ ,.¢ ', 'i 1715 Chewer Ave., 3rd Floor B&ersfiel~ CA 93301 Voice (805) 32~3979 F~ (S0~),:6-0576 Expiration Date: dun~ 30.. ~000 STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501 TRUXTUN AVE BAKERSFIELD, CA 9330i-5~0i 9/01/98 CHAROE TOTAL AMOUNT 342. O0 360, 50-- REFND 8/19/98 MR~INT REFUND S:~i~ ~ VCHR ...' ,~: ..... '~ ,.. ~. '18. 50 FOR (~UESTIONS 'OR CHANQES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. CURRENT OVER 30 OVER 60 OVER 90 DUE DATE' 10/01/98 PAYMENT DUE: 18.50- TOTAL DUE: $18.50- CITY OF BAKERSFIELD CLAIM VOUCHER Vendor No. J I certify that this claim is correct and valid, and is a proper charge against the City Agency and account indicated. CLAIMANT'S NAME AND ADDRESS: Automotive Radiator Service (AUTHORIZED SIGNATURE OF CITY AGENCY) 131 Golden State Ave Bakersfield, CA 93301 Date: 08-12-98 Initials of Preparer: CITY DEPARTMENT: FINANCE PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable) This business overpaid their Hazardous Materials bill by $18.50. For that reason they now have a credit of $18.50 which we will be refunding. Dept. El / Objt Project # Ilnvoice # Amount Date of Invoice 0000 7900 $18.50 VOUCHER TOTAL $18.50 SECTION 72, PENAL CODE FINANCE DEPT. USE ONLY Section 72, Presenting False Claims. Every person who with inten,t to defraud, presents for allowance or for payment to any state board or officer, or any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, Examined & Approved for Payment Amount or writing, is guilty of a felony. BAKERSFIELD FIRE DEPARTMENT MEMORANDUM DATE: August 6, 1998 TO: Susan Chichester FROM: Esther Duran SUBJECT: Claim Voucher Please issue a Claim Voucher to refund overpayment of $18.50 made by Automotive Radiator Service. They made a payment of $18.50 on 6/12/98 and another payment of $360.50 on 7/01/98. They now have a credit of $18.50. Please send refund to: Automotive Radiator Service 131 Golden State Ave Bakersfield, CA 93301 Thank you, /ed S'TATEMEI~i'T OFMt,^- ...... L;u,J:~iT' CITY OF BAKERSFIELD 1501 TRU×TUN AVE BAKERSFIELD, CA ~'~.~,- (805) 326-3979 DATE: 8/01/98 AUTOMOTIVE RADIATOR SERVICE dAMES D BRATCHER i3i gOLDEN STATE AVE BAKERSFIELD, CA 93301 CUSTOMER NO: 2962 CUSTOMER TYPE' ES/ 2962 'CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT 6/30,/98 BEgINNINg BALANCE 342.00 7/0i/98 PAYMENT 360.50- FOR QUESTIONS OR CHAN~5 TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEidENT. CURRENT OVER 30 OVER 60 OVER 90 DUE DATE: 8/31/98 PAYMENT DUE' 18.50- TOTAL DUE' $18.50- ' ':.' ' pLEASE DETACH'AND SEND THIS COPY WITH REMITTANCE DATE' 8/01/98 DUE DATE: 8/31/98 REMIT AND MAKE CHECK PAYABLE TO' CITY OF BAKERSFIELD PO BOX 2057 BAKERSFIELD CA 93303-2057 CUSTOMER NO' 2962 CUSTOMER TYPE: ES/ 2962 TOTAL DUE: $18.50- MR4'$0~07 CITY OF BAKERSFIELD 8/05/98 Mi laneous Receivables In y 16:16:12 Customev ID . . . : 2962 Name: AUTOMOTIVE RADIATOR SERVICE Last statement : 8/01/98 Addr: JAMES D BRATCHER Last invoice : 0/.00/00 131 GOLDEN STATE AVE Current balance : 18.50- BAKERSFIELD, CA 93301 Pending ..... : .00 A ACTIVE ENVIRONMENTAL SERVICES Type options, press Enter. Combined Detail 5=Display Chg Bnk G Opt Trans Date Code Description Amount Balance Typ Cd L 8/01/98 stmrn Statements Processed 00 18.50- 7/01/98 PAYMENT 360 50- 18 50- 00 Y 6/30/98 stmrn Statements Processed 00 342 00 6/12/98 PAYMENT 18 50- 342 00 00 Y 6/11/98 stmrn Statements Processed 00 360 50 6/10/98 HM017 HAZ MAT ANNUAL INSPE 50 00 360 50 6/10/98 HM010 HAZ MAT HANDLING FEE 292 00 310 50 6/01/98 stmrn Statements Processed 00 18 50 6/01/98 SS001 CA STATE SURCHARGE 18 50 18 50 A + F3=Exit F12=Cancel * = Pending MISCELLANEOUS RECEIVABLES ADJUSTMENT DATE ._~'-(/ -~]~ NEW ACCOUNT ADDRESS CHANGE CLOSE ACCT · FINANCE CHARGE j ~ OTHE. ADJ CITY '~~-eC ~ ~---~,~ STATE -~' ZIP CODE~~( SITE ADDRESS PARCEL NUMBER (IF APPUCABLE) ADJUSTMENT CHG DATE . CHARGE CODE I ADJUSTMENT AMOUNT APPROVED BY ~ CITY OF BAKERSFIELD CLAIM VOUCHER IVendor No. I I certify that this claim is correct and valid, and isa proper charge against the City Agency and account indicated. CLAIMANT'S NAME AND ADDRESS: Automotive Radiator Service (AUTHORIZED SIGNATURE OF CITY AGENCY) 131 Golden State Ave Bakersfield, CA 93301 Date: 04-01-99 Initials of Preparer: CITY DEPARTMENT: FINANCE PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable) This customer made a duplicate payment of this years Haz Mat bill in the amount of $360.50. ]We have since made an adjustment to the California State surcharge in the amount of $8.50 leaving them with a credit of $369.00. Dept. El / Objt Project # Invoice # Amount Date of Invoice 0000 7900 $369.00 VOUCHER TOTAL $369.00 !SECTION 72, PENAL CODE FINANCE DEPT. USE ONLY I Section 72, Presenting False Claims. Every person who with intent to defraud, presents for allowance or for payment to any state board or officer, or any county, town, city district, ward or village board or officer, authod;.ed" to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, Examined & Approved for Payment Amount or writing, is guilty of a felony. STATEMENT OF ACCOUNT CITY OF BAKERSFIELD iSOi TR:UXTUN AVE BAKERSFIELD, CA 93301-5201 ~ ~ DATE: 4/01/99 TO: AUTOMOTIVE RADIATOR~SERVICE dAMES D BRATCHER 131 gOLDEN STATE AVE BAKERSFIELD, CA 93301 CUSTOMER NO: ~962 CUSTOMER~'TYPE: ES/ 2962 CHARQE DATE DESCRIPTION 'REF-NUMBER DUE~/DATE TOTAL AMOUNT 3/01/99 BE~INNINO BALAN~E .00 2/03/9~ PAYMENT 360.50~" SSO01 3/31/9~ Cha~§e adjus~men~ 4/30/~9 8.50- CA..,STATE SURCHARQE FOR ~UESTIONS OR CHANQES To YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT~ CURRENT OVER 30 OVER 60 OVER 90 8. 50- DUE DATE: 5/03/99 PAYMENT DUE: 369.00- TOTAL DUE: $369.00- General Information By. Location: 131 GOLDEN STATE Map: 103 Hazard: Moderate I Community: BAKERSFIELD STATION 01 Grid: 30B F/U: 1AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- STEVEN BRATCHER MANAGER (805) 324-6170 x 805) 872-6322 Administrative Data Mail Addrs: 131 GOLDEN STATE D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: ~7534 Owner: JAMES BRATCHER Phone: (~;~g) ~-.~ ?// Address: 131 GOLDEN STATE AV State: CA City: BAKERSFIELD 'Zip: 93301- Summary ... any ~rred;o:'~s ~nst~tu~e a ageme~ plan for my 02/20/92 AUTOMOTIVE RADIATOR SERVICE 215-000-000493 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-001 OXYGEN Gas 1300 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas ~ype: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3 Daily Average FT3 Annual Amount FT3 -- 1,300 I 1,300.00 I 5,200.00 Storage Press + Temp Location I PORT. PRESS. CYLINDER Ambient/AmbientlOUTSIDE BACK BLDG -- Conc · Components MCP --List 100.0% JOxygen, Compressed ILow ~ 02-002 HOT TANK CLEANER Solid 500 Moderate · Reactive, Immed Hlth, Delay Hlth LBS CAS #: 1310-73-2 Trade Secret: No Form: Solid Type: Pure Days: 365 Use: CLEANING Daily Max LBSj Daily Average LBS I Annual Amount LBS -- 500' ~ 500.00. 2,000.00 Storage I press T TempI ' Location DRUM/BARREL-NONMETAL I Ambient[AmbientlOUTSIDE BACK BLDG -- Conc Components MCP rList 100.0% ISodium Hydroxide, Sol. ution IModerate / 02-003 RADIATOR COOLANT Liquid 60 Low · Immed Hlth, Delay Hlth GAL CAS #: 107-21-1 Trade Sec:ret: No Form: Liquid Type: Pure _ Days: 365 Use: COOLANT/ANTIFREEZE Daily Max GALI Daily Average GAL I Annual Amount GAL 60 ~ 30.00 240.00 Storage Press T Temp Location PLASTIC CONTAINER IAmbient/Ambient NORTHWEST OF' BLDG -- Conc Components MCP List 100.0% IEthylene Glycol 02/20/92 AUTOMOTIVE RADIATOR SERVICE 215-000-000493 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-004 MURATIC ACID Liquid~ 50 High ~ Reactive, Immed Hlth, Delay Hlth GAL CAS #: 7647-01-0 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: CLEANING Daily Max GALI Daily Average GAL I Annual Amount GAL 50 I 50.00 100.00 Storage Press ·T Temp~ · Location CARBOY Ambient{AmbientlOUTSIDE BACK BLDG -- Conc Components MCP List 100.0% IHydrochloric Acid IHigh I 02-005 ACETYLENE Gas 600 High ~ Fire, Pressure, Immed Hlth FT3 CAS #: 74-86-2 Trade Secret: No Form: Gas Type: Pure -Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 I Annual Amount FT3 -- 600 ~ 600.00 1,800.00 Storage Press I Temp~ Location PORT. PRESS. CYLINDER Ambient{AmbientlOUTSIDE BACK BLDG -- Conc Components MCP ~List 100.0% IAcetylene IHigh 02/20/92 AUTOMOTIVE RADIATOR SERVICE 215-000-000493 Page 4 ~ ~ 00 - Overall Site <D> ,Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL WARNING OF ALL EMPLOYEES AND CALL 911. IF SERIOUS NOTIFY OTHER PEOPLE IN AREA. <3>~ Public Notif./Evacuation WE WOULD ADVISE ANY PERSONS TO LEAVE BY THE EXIT <4> Emergency Medical Plan CALL 911 OR GO TO DOCTOR MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD, CA. (805) ~327-1792 02/20/92 AUTOMOTIVE RADIATOR SERVICE 215-000-000493 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention INSTRUCT EMPLOYEES IN SAFETY PROCEDURES TRY TO CONTAIN MATERIAL IN LOCATION OF SPILL. <2> Release Containment <3> Clean Up <4> Other Resource Activation 2/20/92 AUTOMOTIVE RADIATOR SERVICE 215-000-000493 Page 6 00 - Overall .Site <F> Site Emergency Factors Special Hazards <2> Utility Shut-Offs A) GAS - EXTREME SOUTH END OF BUILDING - METAL SHED B) ELECTRICAL - SOUTHWEST CORNER OF SS~UCCO BUILDING C) WATER - BEHIND WEST SIDE OF METAL SHED D) SPECIAL D) SPECIAL - MAIN BOX OR VALVE ONLY E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT - ? <4> Building Occupancy Level 02/20/92 AUTOMOTIVE RADIATOR SERVICE 215-000-000493 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE 4 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE TRAIN AT BRIEF MEETING WITH EMPLOYEES <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use (tyue or orint name) Do hereby certify that I have reviewed the attached Hazardous Materials business plan (name of business) and that it along with the attached additions or corrections consti~ ~ ~.u~e a complete and correct Business Plan for my facility. ig'na%ure - ~ --' date - BUSINESS NAME AUTO VE RADIATOR SERVICE ID N ER ZI5-000-000493 · LOCATION 13! GOLDEN STATE HIGH HAZARD RATING 3 1. OVERVIEW LAST CHANGE 11/(~9/87 BY ESTER JURIS CODE 215'-00'~ JURIS BAKERSFIELD STATION 01 MAP PAGE t03 GRID 30B FAC]~LITY UNITS 1 HAZARD RATING 3 RESPONSE SUMMARY ZA SEC 4) NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS ZA SEC DAVID BRATCHER - MANAGER 3Z4-GF?O OR 393-2?04 STEVEN BRATCHER - MANAGER 324.-.6170 OR UTILITY SHUTOFFS 2A SEC A) GAS - EXTREME SO. END OF BUILDING - METAL SHED B) ELECTRICAL - SW CORNER"" OF STUCCO BUILDING C) WATER - BEHIND WEST SIDE OF METAL SHED D) SPECIAL - MAIN BOX OR VALVE ONLY E) LOCK BOX - NO NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY ( NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 lZtZ3/88 t8:30 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 848-6800 BUSINESS NRME AUTO VE RADIATOR SERVICE ID N ER ZlS--O(~-OOO493 LOCATION 131 GOLDEN STATE HIGH HAZARD RATING 3 3. HAZ MAT TRAINING SUMMARY LRST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION,> LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 09/02/87 BY ESTER SEC S) CALL 9;~ OR GO TO DOCTOR PAGE Z 1ZIZ3/88 16:30 MATERIAL SAFETY DATA ~iYSTEMS, INC. <80S) 648-'6800 BUSINESS NAME RUI'O VE RADIATOR SERVICE ID ER 215-.0~-(D~493 LOCATION 131 GOLDEN STATE HI6H HAZARD RRTINO 3 FACILITY UNIT 0~ ~. OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 06/29/8B BY ESTER ID TYPE NAME MAX ~MT UNIT HAZARD LOCATION CONTAINMENT USE 1 PURE OXYGEN 19OO FT3 HIGH OUTSIDE BLDG BACK W. SID PORTABLE PRESS. CYL. WELDING/SOLDERING ID PERCENT COMPONENTS HAZARD LIST ZDSB.~ 1OO.O OXYGEN. COMPRESSED HIGH PURE HOT TANK CLEANER/ 500 LBS HIGH OUTSIDE BLDG BACK W. BID DRUMS OR BRRRELS MET.. CLEANING ID PERCENT COMPONENTS HRZRRO LIST 1560.00 ~.0 SODIUM HYDROXIDE, SOLUTION HIGH 3 PURE RADIATOR COOLRNT 60 GAL UNKNOWN INSIDE ROOM WORK RRER PLASTIC CONTAINER[SI COOLANT ID PERCENT COMPONENTS HRZRRD LIST Z80Z.(~D ~.0 ETHYLENE GLYCOl. UNKNOWN- 4 PURE MURRTIC ACID 50 GAL HIGH OUTSIDE BLOB ~. SIDE DRUMS OR BRRR NON MET. CLEANING ID PERCENT COMPONENTS HRZRRD LIST 107B.00 100.0 HYDROCHLORIC RI]ID HIGH S PURE ACETYLENE '! BOO FT~ EXTREME OUTSIDE SHOP BLDG. PORTABLE PRESS. CYL. WELDING/SOLDERING ID PERCENT COMPONENTS HAZARD LIST IZ41.OO 1OO.O ACETYLENE EXTREME PAGE 3 12/~/88 1G:30 MATERIAL SAFETY DATA SYSTEMS, INC. (80S) G48-G800 BUSINESS NAME AUTOM VE RADIATOR SERVICE ID N R Z1S-.OOO-f~)8493 LOCATION 131 GOLDEN STATE HIGH HAZARD RATING B. FIRE PROTECTION / WATER SUPRLIES LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 11109187 BY ESTER SEC Z) VERBAL WARNING OF ALL EMPLOYEES AND CALL 911. IF SERIOUS NOTIFY OTHER PEOPLE IN AREA. PAGE 4 12/23/88 16:30 HATERIAL SAFETY DATR SYSTEMS, INC. (805> 848-8800 BUSINESS NAME RUTOM E RADIATOR SERVICE ID N R 215-000-000493 LOC~TION ~3! GOLDEN STATE HIGH HAZARD R~TING 3 E. MITIGATION / PREVENTION / ABATEMENT "~ LAST CHANGE 09/02/87 BY ESTER SEC l> INSTRUCT EMPLOYEES IN SAFETY PROCEDURES ~FRY TO CONTAIN MATERIAL IN LOCBTION OF SPILL. PAGE S ~" IZ72'7~/88 fG': 30' M_/R~E~RL SAFETY DATA SYSTEMS, INC. (805) 648-1~800 CITY of BAKERSFIELD NoN--~IfRADE SECRETS BUSINESS NAME:/~T~ ~4~MM ~/~o~e.~.~WNER NAME: ~~ //~/_ ~ ~ NAME OF T~ FACILITY: LOCATION: /29/-~,~/~ ~ ~ ADDRESS: ~ f/~L (~~ ~ $~ STANDARD IND.-~S~ ~ODE[{ CITV. ZIP: ~/~ ~z~; ~//- ~ .~7 ~/ CITY. ZIP: ~_~/,~/~ ~. ~ ~? ~ ~ DUN AND BRADSTREET NUMBER PHON~ ~: ~' ~o~ ~-~'/~ PHON~ ~: ~,>~ '~ ~// __ - --_- - _~ (~ C~e ~t~ ~t~ ~/~. EstF~; ~*ts m Site T~ ~l lW , ~_ -. St~ in F~tllty~- ~ I~t~ti~ ~lth of P~ ~lth ~-~ r--~ ' - r~ r--~ ~t ~ ~&C.A.S. ~ / ~--~ FI~ ~z4r~ ~--~ ~ctt~tty [ ] ~l~th~-~ ~ bl~ ~--~ I~t1~1 · of ~ ~l~h ........... p~c., ~ ~,~h ~..~ C.A.S. ~ ~- ~ -~ . ~t ,, ~ ~ c.~.s. ~ Fire Hazard ~--J R~ctivity [ ~ ~14~ [-- Reline [ ~ I~tite . HHith of P~su~ ~lth - ' ~t l] ~&C.A.S. ................. fl~lth of Pr~surl H~lth ............. Certtficati~ (Re~d and siKn after co~pIettnE ali sections) i c&:ttfy ~der ~lty of law t~t I ~ve ~rsmmllyexaminff ~d la fNililr vtth t~ tflforNti~ su~itt~ tn this ~ ~11 IttK~ ~ts. ~ t~t ~s~ ~ ~ i~i~ of t~e for o~ojniflg t~ inf~tim, I ~lieve t~t t~ su~itt~ info~ti~ is t~. 4ccurate, 4nd c~piete. ." iL;i ~.CITY of BAKERSFIELD Far, a,d A~ricuhure ~--~ Standard eusiness ~ HAZJq~X=~'DOT':tS MAT~m_X~.'I' ~~ ~ ~~~.O~ BUSINESS NAME: OHNER NAME: NAME OF T~ FACILITY: CITY, ZIP: OITY~ Z~D: . DUN AND BRADSTRE~T NUMBER PHONE 9: P~ON~ ~: --- - ---- - ~ ~0 Z~S~UC~ZO~S FOR ~RO~ COD~S ~ 2 ~ 4 S S 1 B ~ I0 I1 12 13 Code Code Ant Ami Est Units m Site IVN Prell i~p ~e .. Stored in Facility See Instructi~s ~_~~ ................. .~l~_L_~d~___i___~ .... L~.._k~.~~ ~J~Z=l~J ~l_~/~ ~..~e~ ........ ~.'._~~~ *"" ~., ..~ ,..,,, ,...~, ~.,.,. ,u.,. ~--'"'" ""' ~"-'-"'" k ~1] that ~pp]y). ....................................~ ~--~ Fire Hazard ~--] Reactivity~- ~lay~ ~--J ~dd~ Relees~~- I~tmte ....... Health of Pressure HNIth ..... Cm~t I] Na~ & C.A.S, Number L'_LLL ........ LI', ............ L ..... ~ ..... L,.1--~.I~2 L~:! ZL~I ........_Z. ....... ....... Physical and Health H~zard C.A,S. Numar ~ffit II Ma~ & C.A.S. Numar (Check ail t~t apply) .... . -- -- -- r--n r--n bG~t 12 NaN i C.A.S, Numar [--] Fire Hazard [ ] Reactivity [ ] ~ley~ u--J ~dd~ Rmlmase ~--J im~late ....... Hem Ith , of P~sure · HNlth ~t I~ Nam ~ C.l.$, Nue~ 'Physical ,nd Health Hazard C.A.S, ~m~r ~mt Il NaN I C.A.S. Numar (C~k all t~t apply) r -- ~ r -- n r -- n r-- n . ~mt Il NaN & C.A.S. Nul~ ~--J Fire Hazard ~--J Reactivity ~--J Oelay~ ~--J ~dd~ ~elease ~--J I~tate Health of Pr~sure Health .......... 2'i ..... ~ ........ i' '{ ............. ~_L2!_i_2_ 1 .... ....................... ~ .t__ ~ 2 ............ Ph~icml ~nd Health Hazard C.A.S. ~m~r ~mt II Na~ & C.l.S. (Ch~k ali that -- r -- ~ r -- ] r -- ~ r -- n tin,mt It Nm~ & C.A.S. HUmber r ] Fine Hazard ~--~ Reactivity ~ Oe]aye~ u d ~dd~ Release ~--J I~tate . Health of Fr~sure Health .~, ~t I1 Na~ & C.A.S, Nun~r MERGENCY CONTACTS It N)~)-[ ................................. lt)li )I'R)'P~i ....... R)~ ~ ltll) ...................... 21'a~-P~) ......... ~?ti(ication freed and s~n after comp~et~nE ali I certify under ~mlty of law that I have oersonally examined and mm famiHa~ elth t~ tnfereat(~ su~itt~ in thil m~ el1 ettme~ d~u~ts, and t~t ~s~ ~ ~ inquiry of t~se (ndivi~all res~siblm for obtaining the infertile. I believe t~t t~ submitted tnformatl~ (I t~, a~curate, ~ BAKERSFIELD CITY FIRE DEPARTMENT 213o "G" STREET BAKERSf'IELD, CA 93301 (8(;15) 326-3979 OFFICIAL USE ONLY HAZ ARDOIJS MATERI ALS BUSINESS PLAN AS A WHOLE F () RlV[ 2A 0.00493 INSTRUCTIONS: " 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for tke business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAME: .,~.//'7~:/P~,(~_7~/~'~ B. LOCATION / STREET ADDRESS: SECTION 2: E~RGENCY NOTIFICATIONS In case of an emergency' involving the release ov threatened release of a hazapdous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fi~e department and the State Office of Emergency Sevvices as required by law. EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY: NAME AND TITLE /v%~ DURING BUS. HRS. AFTER BUS. HRS. SECTION 3: LOCATION 0F UTILITY SHUT-OFFS; FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE: L~ ~'~ A4~ .f¢~,. '/~At~Z,~f/~,'~v~, ' A4~_~"/'~/~ .~/~ E. LOCK BOX: YES /~ IF YES, LOCATION: ' IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO FL00R 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~ INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS ~ MATERIALS:...' .................................... fY~ NO ~ NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES ~ YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. ~ES~ ~ YES NO D. EMER6ENCY EVACUATION PROCEDURES: ................. ~i~E'S ~ YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES YES NO SECTION ?: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUANTITIES LESS.THAN 500' POUN~OF~ SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS I, ~~f ~~/~/__m , 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. BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NAME: BUS I ]NESS PLAN SINGLE FACILITY UNIT F'(2) RM $ A INSTRUCTIONS 1. To avoid further action, this form must be retuI-ned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 8. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as .BRIEF and ~0NCISE as possible. ,SECTION 1: MITIGATION, PREVENTION, ABATEMENT PROCEDURES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS UNIT ONLY SECTION 3: ,HAZARDOUS MATERIALS FOR THIS b~IT ONLY .A. Does this Facility Unit contain Hazardous Materials? ...... YES NO ", If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous mateztJals a bona fide Trade Secret YES NO If. No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form #,iA-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 5:,'LOCATION OF WATER SUPPLY FOR USE BY EMERGENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHUT-OFFS AT THIS UNIT ONLY. A. NAT. 6AS../PROPAN~'~ B. ELECTRICAL: } C. WATER: D. SPECIAL: E. LOCK BOX: YES / NO IF YES, LOCATION: ·, E YES IF YES, St" PLANS? / NO MSDSs? YES .,/ NO FI. OOR. PLANS? YES / NO i<EYS'? YES / NO - 3B - BAKERSFIELD CITY FIRE DEPARTMENT I.D. # FORM 4A-1 Page NON--TRADE SECRETS ,l HAZARDOUS MATERI ALS INVENTORY BUSINESS NAME: OWNER NAME: FACILITY UNIT #: ADDRESS: ADDRESS: FACILITY UNIT NAME: CITY, ZIP: CITY,ZIP: PHONE ~: PHONE #~ OFFICIAL USE CFIRS CODE ONLY , 1 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS 9~ BY HAZARD D.0.T ..CODE AMO.UNT AMOUNT UNIT CODE CODE FACILITY UNIT. WT. CHEMICAL OR COMMON NAME CODE GUIDE AFTER BUS HR9: ~6- PRINCIPAL BUSINESS ACTIVITY: O.~ ~R~ ~o//< ~g/~b ~ff~g/~ AFTER BUS HRS: 7Pi--