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Home My WebLink AboutHAZ-BUSINESS PLAN 11/6/1989 ~.~_.;....---~.~ SHOP SK ETCH PAD ~ ~--~J~-~, ~ ~ E R DATE P.O, ADDRESS BILLING INSTR. / ~,--~ ~ 0 ~ . ~ ~ , I I .,__.. .. }~.C~~ ~' F ... ~, ~ ;~ ,, . ~ ~, '~. ~ ~ t~'.b ~..d ~/~ ~~<~ - _..~ .... :' .......... ~~. / , ~ '. ~'~ SHOP SKETCH PAD EUSTOMER DATE P.O. ADDRESS BI L~-ING INSTR. CONTACT .PHONE __JOB NO 02/27/92 K~verallK ENTERPRISESsite with]:NC 215-000-0012011 Fac. Unit MAR 1 3 1992 Page 1 A,s'~I ............ General Information Location: 516 GOLDEN STATE Map: 103 Hazard: Moderate' Community: BAKERSFIELD STATION 01 Grid: 30B F/U: 1AOV: 0.0 Contact Name Title ~ Business Phone ~ 24-Hour phone] KENNETH KOOP PRESIDENT 1(805) 327-3739 x 1(805)-~ Administrative Data Mail Addrs: 516 GOLDEN STATE D&B Number: City: BAKERSFIELD State: CA Zip: 93301- Comm Code: 215-001 BAKERSFIELD STATION 01 SIC Code: Owner: KENNETH KOOP Phone: (805) 327-3739 Address: 516 GOLDEN STATE State: CA City: BAKERSFIELD Zip: 93301- Summary 02/27/92 KCK ENTERPRISES INC 215-000-001201 Page 2 02 - Fixed Containers on Site Hazmat Inventory ~etail in Reference Number Order 02-001 DIESEL · Liquid 1500 Low · Fire, Immed Hlth, Delay Hlth GAL CAS #: 68476-34-6 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL Daily Average GAL Annual Amount GAL 1,500 I 1,000.00 [ 20,000.00 StorageIIPress T Temp Location UNDER GROUND TANK IambientlAmbientlBEHIND #1 -- Conc Components MCP . List 100.0% IFuel Oil No. 1 .ILow I 02-002 GASOLINE Liquid 1500 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL Dai. ly Average GAL ~ Annual Amount GALm 1,500 I 1,000.00 I 20,000.00 Storage I Press T TempI Location UNDER GROUNDTANK IAmbient[AmbientlBEHIND #1 -- Conc Components MCP List 100.0% IGasoline IModeratel 02-003 WASTE OILS Liquid 500 Low · Fire, Delay Hlth GAL CAS #: 221 Trade Secret: No Form: Liquid TyPe: Waste Days: 365 Use: WASTE Daily Max GALI Daily Average GAL I Annual Amount GAL. 500 ~ 100.00 1,000.00 StorageIIPress T Temp Location UNDER GROUND TANK IAmbient~AmbientlBEHIND #1 -- Conc ComponentS MCP List 100.0% }Waste Oil, Petroleum Based 02/27/92 KCK ENTERPRISES INC 215-000-001201 Page 3 02 - Y±xed Containers on Site Hazmat Inventory D~tail in Reference Number Order 02-004 OILS Liquid 275 Minimal · Fire, Delay Hlth GAL CAS #: Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: LUBRICANT Daily Max GALI Daily Average GAL I Annual Amount GAL 275 ~ 100.00 2,750.00 Storage Press T Temp. Location UNDER GROUND TANK IAmbient~AmbientlIN UNIT #2 -- Conc ~Components MCP ---/List 100.0% IMotor Oil, Petroleum Based IMinimal I 02-005 ACETYLENE Gas 1000 High · Fire, Pressure, Immed Hlth FT3 CAS #: 74-86-2 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: FABRICATION Daily Max FT3I Daily Average FT3 I Annual Amount FT3 -- 1,000 ~ 500.00 10,000.00 Storage~lPress I Temp ' Location DRUM/BARREL-METALLIC IAmbientlAmbientlIN UNIT #2 -- Conc Components MCP --~List 100.0% IAcetylene IHigh 02-006 OXYGEN Gas 1500 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: FABRICATION Daily Max FT3I Daily Average FT3 1 ,Annual Amount FT3 1,500 ~ 1,000.00. 15,000.00 LOcation Storage, Press T Temp PORT. PRESS. CYLINDER IAbove ~AmbientllN UNIT #2 -- Conc Components MCP List 100.0% IOxygen, Compressed ILow 02/27/92 KCK ENTERPRISES'lINC 215-000-001201 Page 4 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order 02-007 STARGON Gas 1000 Minimal · Fire, Pressure, Immed Hlth FT3 CAS #: Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 I Annual Amount FT3 -- 1,000 ~ .500.00 10,000.00 Storage Press T Temp Location PORT. PRESS. CYLINDER Iabove IAmbientlxN UNIT #2 -- Conc Components MCP iList 25.0% IArgon IMinimal I 75.0% Carbon Dioxide Minimal 02-008 PROPANE Liquid 500 High · Fire, Immed Hlth, Delay Hlth GAL CAS #: 74-98-6 Trade Sec:ret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL -- 500 I 250.00 2,000.00 StorageI PreSs T TempI Location ABOVE GROUND TANK IAbove lAmbientlIN YARD BEHIND #1 -- Conc Components MCP -~List 100.0% IPropane ' IExtreme I ~ 02/27/92 KC'K ENTERPRISES liNC 215-000-001201 Page 5 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification 911 FIRE NOTIFICATION PUBLIC EVACUATION HIGH UNLIKELY FOR SUCH SMALL QUANTITIES, MEDICAL EMERGENCY MEMORIAL HOSPITAL. <2> Employee Notif./Evacuation EMPLOYEE NOTIFICATION OVER INTERCOM SYSTEM. ALL COULD BE IMMEDIATELY NOTIFIED. WE HAVE FULL YARD AND SHOP INTERCOM. EVERYONE COULD BE NOTIFIED TO EVACUATE AT ONCE CALL 911. <3> Public Notif./Evacuation PUBLIC INTERCOM SYSTEM <4> Emergency Medical Plan MEMORIAL HOSPITAL 420 34TH ST 327-1792 02/27/92 KCK ENTERPRISES ~[NC 215-000-001201 Page 6 00 - Overall Site <E> Mitigation/Prevent/Abatemt '<1> Release Prevention THE LARGEST SPILL POSSIBLE WOULD BE 55 GALLONS OF OIL WHICH COULD BE CONTAINED WITH,FLOOR SWEEP AND DUMPED INTO OUR WASTE OIL TANK. QUARTERLY.EMPLOYEE SAFETY MEETINGS ARE HELD TO DISCUSS RELATIVE SAFETY PROCEDURES. NO SMOKING SIGNS ARE POSTED AND SAFETY IS DETAILED IN EMPLOYEE MANUAL. <2> Release Containment ANY SPILLS WOULD BE CONTAINED THROUGH FLOOR SWEEP AND DISPOSED IN OUR WASTE OIL TANK IMMEDIATELY. <3> Clean Up FLOOR SWEEP, ETC. <4> Other Resource Activation 02/27/92 KCK ENTERPRISES ][NC 215-000-001201 , Page 7 00 - Overall Site <F> Site Emergency Factors Special Hazards <2> Utility Shut-Offs A)'GAS - SOUTHWEST CORNER MAIN BUILDING B) ELECTRICAL - INSIDE PARTS DEPARTMENT C) WATER - SOUTHWEST CORNER IN SIDEWALK D) SPECIAL - FUEL ISLAND ADJACENT TO PUMPS ON OFFICE WALL E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - PLENTY OF LARGE DRY CHEMICAL EXTINGUISHERS PLUS EVERY VEHICLE WATER HYDRANT THROUGHOUT UNIT WITH HOSES FIRE HYDRANT-- CORNER' OF' 24TH- ST 'A~ND' GOLDEN STATE AV (ACROSS STREET) <4> Building OCcupancy Level 02/27/92 KCK ENTERPRISES ~[NC 215-000-001201 Page 8 00 - Ow~rall Site <G> ~raining <1> Page 1 WE HAVE 18 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BRIEF SUMMARY OF TRAINING: MONTHLY SAFETY MEETINGS COVERING NEW MATERIAL SAFETY DATA SHEETS AND FIRE SAFETY, HANDLING HAZARDOUS MATERIALS, SPILL CLEAN UP, EVACUATION AND NOTIFICATION. <2> Page 2 as needed. <3> Held for Future Use <4> Held for Future Use O~R N~ CIT~, ZiP= ~~[~ ' 1 2 3 i 5 6 I ~ 9 10 11 12 13 14 ~s ~e ~ Average ~nual ~as~e ~ Da~ Cont ' · Cont '. Cont Use bcation ~e~: . ; .., % ~ N~a of M~u~/C~nenta Code C~e ~t ~ ~t Units on Site ~ P~ss ~ Code S~red tn Facility . :?:~' ~ See Inat~iona OI ~1 ~oo I ~o0 I/~o0 '1 ~.~'13~mlo~l'~ I o~ I~l 5fio~ ~,, ' : C;A.S. cai and R~lth ~'za~ C.l.8. N~er : : .... . ~C~e~ all t~t appll} : : · FA~ Baz Sudden ~le~e , 5;.4 -': ' ' :;~ '' "":':~?= .... ' of Preaau~ .:*... H~lth. H~lth : .i~,~5; '. .~:'.. . Co~onent ~ 3 ~ & C.A'.S.'~ .... ,:~{ 'i;~. .... fi' '.', . . . I i. ~ ~ . . (Chec~ all t~t apply} ' , Ft~ Haz~ Sudden ~lease ~ of Pgeasu~ Ph~tcal and H~lth ~u~ C.l.8. (C~eck all t~t~apply) ' . . . · .'i~,~ Co~on~t ~ 2 N~ i C.l.8. N~'. FI~ Raz Sudden ~leaae of Pressure H~lth H~lth Co~onent ~ 3 Na~ & C.A.S~ N~ .. Ph~iual"and H~lth ~za~ C.A.S. N~ . (Check all t~t apply) ' 'Delay~ ~ Fi~ H,z~d' ~ Sudden ~leaae of Pr~su~ ' . ,.~..: , ~ ~itl~ ~4 ~. Phone H~e / · : ~ttla 24 ~ Phona [.. "', , , -: ......?'.:.. c~igicati~ {~ ~ SIGN AF~RR CO~TING ~ SECTIONS) . . ., .... c~i~ ~ez p~n1~ o~ 1~ t~t ~ ~v~r ~onally ~tn~ ~d ~ f~lt~ ~ith the 'tn~o~atton au~tttad tn '~ts "~; all a~tach~ d~ta ~d ~at ~aad ~ ~ in~t~ o~ ~oaa t~ivtd~la r~ible f~ ob~i~ng the tn~o~ti~. I believe that Bakersfield Fire Dept. Hazardous Materials Division 2130 "G" Street Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return tills form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as o whole. 4. Be brief anct concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA LOCATION: MAILING ADDRESS: CITY: ~.t(-- STA'rE.C~ ZIP' O/ PHONE:~-~.'~..::,-~,,,~? DUN & BRADSTREET NUMBER' OWNER: I'~-,-V~ //.~ MAILING ADDRESS: L_~/{"_,,--, ~c..r)~~c':- Ad (= ~_'-~.~/ SECTION 2:. EMERGENCY NOTIFICA'rlON: CONTACT TITLE BUS. PHONE 24 HR. PHONE I 2, Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: /2 MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: 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 TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I. IL'~ /~-o,-)D CERTIFY THAT THE ABOVE INFOR- MATIOr~ISAC~UR/ATE. 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 CONSTITUTES PERJURY. / SIG NA~R~ ' TIT~E -~ATE FD1590 Bakersfield Fire Dept. ~.., Hazardous Materials Division' HAZARDOUS MATE!RIALS MANAGEMENT PLAN Facility Unit Name: SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: D, EMERGENCY MEDICAL PLAN: R~15-X: Bakersfield Fire Dept. HazardOus Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: B. ~ELEASE CONTAINMENT AND/O~ MINIMIZATION: C. CLEAN-UP PROCEDURES: SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: ELECTRICAL: ~G~ WATER: ~ ~ ~o'~,~ LOCK BOX: YES~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRIVATE FIRE PROTECTION: ' B, WATER AVAILABILIT IRE HYDRANt): , FO1 ~ CITY of BAKERSFIELD F . . , HAZARDOUS HAT ER-I'ALS I'NVENTORY arm and Agriculture U Standard Business I~ "'"-""' TRADE SEC[~ETS P~l~Je 0t LOCATION: __~_t./.~ ~'O,z..Z..)z-'~u ,..3T'_y, gZ, g_ A.D~D.R..ESS_; _ ' '~0.,9 / .~3 ~L(~,~.u(~,L~u_!.,.~,u..~.~C~.~,oo,,,t;H~u~c~ ........................... C.[IY. ZIP.~ ,g::~X-'/~L~. ~ ~'/.~..~_); CI/Y. Z:JF~ ~c~ ~'-b, UUN AriU U,t(AUb/t(~:~-~ PHONE 1~: '~ '- A~'~'-:e:) ~ ' - PHONE I~: - . - -' ' '5'-' - - g'~ ..... ~' ~' ~' REFER TO-T~C~-~/~2N?3-FOR--PROPER CODES - - 14 lr~ns .Iyqe I~ax Av.eracje Annual Yeasure ! .0y.s Cent Cent Cent Us tocqtion Whe[~ Of ~xtu~/C?~onents Code cooe Am~ Am~ Es~ Un,tS on b~ce l~pe Press lemp Code n Stored ~ See Instructions Physical ~nd ~e~l~h Y~z~rd C.A,S, Number Component I1 I~heck ~/I ~h~ Component 12 Namel C,A,S, Number Fire Hazard ~ Reactivity ~ Delayed ~ Sudden Release ~ Immediate , Health of Pressure Health Component ~ Name & C,A,S, Number Physical 8nd Health Yazard C.A,S. Number Componenb 11 ~ame I C,A,S, Number (Check al1 thai apply n .;.. ,,....~ ~ .....:..;.,, n .., .... ~ n .,,~....~ .... n ,...~;.~. Component 12 Name & C.A.S, Number U r~,¢ noLalu U ncau~l~mul U Hea o ressure HealLh ComponenL 13 Name & C.A.S, Number I I I I I I I I [ I Physical tnd Health Hazard C.A,S, Number ComponenL II Name I C,A.S, Number (Check sll [hal ComponenL 12 Name & C.A,S, Number ~ Fire Hazard ~ ReacLiviLy ~ Delayed ~ Sudden Release ~ ImmediaLe HealLh of Pressure HealLh ComponenL 13 Name & C.A,S. Number Phvsical~ tnd Health Hazard C.A,S. Number Component II Name & C.A,S, Number {Check al1 that apply) Component 12 Name & C.A.S, Number ~ Fire H)zard ~ Reactivity ~ Deleyed ~ Sudden ~elease ~ Immediate Health of Pressure Health Component ~3 Na~e ~ C.A.S. ~umber ferLiiatioq,(Re~ And.~ign aF~pc complcCi(~g,all sec~ipns) cer~,y under pena)[X o/)a~ (hq( t navepe~sonaj~y, examlnqo~qoQm lamJllar,viLh the JnlormaL)on ~u~miLted in this ~nd all at~Qcned,docvmen[~tHc oaseo on.my ~nqu~ry ~r. cnose ~na~v~ouams responsiHe rot obtaining the Tnrormatton, I believe thaL the su~',[tteo Tn~op.~p true, ~ace, aha compmece. ~ CITY of BAKERSFIELD FIqE CEP!R-MEN7 FIPE C~E; 326-39: EnoLosed ~e&se ¢&~d & copy of your eesponse ~0 the ~laterial Management Plan ( E[~IMP ) request. We have found it necessary to re.)ect !our plan for the following reason(s) as checked below. ~ Illegible Management Plan (please ~rint or ty~e information) . Section(s) of HMMP incomplete. Inventory ~ Missing or ~Incomplet~~ /~~ ~ Diagram E~ ~issing or ~ Incomplete. This is to be corrected and resubmitted within 3~ays to: City of B~kersfield, Fi~e Department ]~ Hazardous ~aterials Division 2130 G Street Bakersfield, CA ~3301 If additiona~ co¢ies of any forms are needed they can be p~cked from the Hazardous ~agerials Division ag 2130 G Stree% in cerson. Sincerely yours, R~'iph E. Huey Hazardous Materials Coordinator REH/ed II^I(I~IISI;Ii~I,IJ Gl 1¥ i' Illl~ IIi~l'Allli, lhlll NON--q'RAI) E 8 E~RE'I'S IJq I NI:~5 N · ;?~P/! C~ c-~,, OWNEll NAME l~ (~-~~ (~ FAC i I, I TY I1~,1T f f~' ziP: ~( ~o / ClTY,ZlPJ-~ .... I'1 I flAX ANNUAl, I I:oN'rlllSE I, OCATION IN 11118 · IIY IIAZAIIII Il.l)I' :"':'1~'''''''"~' ~"""""'-I' ~.,T,:,,,,,~'~ c,,u~ ~'~c,,,,T~ UN, T ~..~ c,,~.,~, o,, c,,~,,,o. N~,,~ ,;,,,,~ ,;,,,,,~' ........ ~-~'~:":~ .............. ; ~ I+ ~~,~ ~ ~ / ~ 'P, ~,~.~_ ,//. ?. x :~J/,~,, ~I,' ', " ~ '~ HI".: T ! TI,~: ONATURE ~ I)AT£: lktll;l~il~-~' L:IiiI'FACT TITI, E I'IIONE I llllS IiOIIR$: AFTER llll$ IIIIS: ~ll(i%.lll:',' (:III'ITACT: TITI, EI PIIONE I BUS IIOURS: IHf'll'^l, IlliS[I'I[::SS ~,C'rl¥lT¥: AFT[R BUS. CITY of BAKERSFIELD HAZARDOUS MATERIALS INVENTORY Farm and ~,gticulture ['] Standard Business, ~/ NON--TRADE SECRETS lr~ns Code ~ooe Aat Ami Est Un,ts on 5ire iype Press ]emp Code Stored in ~act~)cy.~ See rhysical and ~ealth ~azard C,A,S, Hu=ber Component II ~a~e ~ C,A,S, ~u~ber (Check all that apply) Component t2 Name & C,A,S, Number HealLh of Pressure ttealLh ComponenL 13 Na~e ~ C.A,S, Number I Physical and Health Hazard C,k.S. Xumber Component i1 Xa~e t C,~.S. Number Co~ponen~ 12 Ha~e & C,A,S. Number Health Health ' ' Component 13 Na~e I C,A.a. Number Physical )nd Health Hazard C,A.S, Number Component Il Name S C,A.S. Number (Check ali that appl~) Component 12 Na~e ~ C,A,S, Number D Fire Hazard ~ Reactivity D Delayed ~ Sudden Release ~ Im~i~ Health of Pressure ~ Co~ponen~ 13 Name ~ C,A,S, Nu=ber Physic]l ~nd Health Hazard C.l.S, number Component II N~me ~ C,A,S. Number (Check all that apply) ., ~o~ Component 12 Name & C,A.S, Number ~ Fire H~zard ~ Re]ctivity ~ Oel~yed ~ Sudden Release ~ Health of Pressure ' ' Component 13 Name S C.A~r 2 erti[jatioq ,(Re,a~ ~/td,~ign after colnpl~i(lg,all, se.c~i,ons) , attached,do~, ~tOat oaseo on.~y ~qu~ry gr.tnose ~no~yt(,ua~s respons~Ole for obtaining the information. I believe that the C'I"I'Y of' BAKERSFIELD HAZARDOUS MATERTALS T NVENI'ORY Farm aad A~jticulture I1 Standard ~usiness [] NON--TRADE SECRETS Pa~J~ _~__.__ ot' _~_ BUSINESS NAME: OWNER NAME: NAME OF THirS FACILITY: LOCATION: ADDRESS; STANDARD IND, CLASS CODE: CiIY, ZIP: . ' CITY, ZIP~ DUN AND BRADSTREE! NUMBER ................................. .REliER 7'O--INSTRUCTIONS-FOR-PROPER CODES -- Tr~ns .lille Vax Ay.erase Annual I~easure I gYSeSit Cont Cont Cont Use Location Whel:e. ,/,-bYj/t Hames ~1 xtur ~,1..~ one nts Code ~ooe A~t. ^mt. Est Un,ts on l~pe Press lamp CodeStored in Fac]~]h' See Instructions Physical and I~ea]th Malard C.A,S, Numbe.~' Component ~1 Name ~ C,A,$, Component 12 Name ~ C.A.S. Number Fire Hazard ~ Reactivity ~ Delayed ~ Sudden fielease ~ Immediate Health oi Pressure Health Component t3 Name ~ C.A,S, Number Physical and Health Yazard C,A.5. Number Component II Name & C.A,S. Number [Check ali :hal apply) Component t2 Name I C.A.S, Number ~ Fire Hazard ~ Reactivity ~ Delayed D buoo~n .e,ea~e u ~,,,,,,.u,.~= Health of Pressure Health Component 13 ~a~e I C.A.~. ~umber Physical ]nd Health Hazsrd C,A,S. Humber Component I1 Name t C,A.S. Number ICheck ~ Fir~ Hszlrd D RescLivi[y D Delayed ~ Sudden. Release ~ immediate Componen[ J2 Name & C,A,S, Number Health DJ Fressure Heal[h .... ~ Component 13 Name I C,A.S. Number PhYsical ~ndH~alth H~zard C.A.S. Number Componen[ I1 ~ t C.~.S. Number [Check al1 [hit U Fire Hazard D Reactivity D Delayed D Sudden Release D Im~i~ Hea [:h of Pressure ..- Component 13 ~me ~ C.A.S. Number EMERGENCY COUTACTS fll :erti~j~tio~ .(Re~ ~.nd.~ign after compT¢ti(~g.all sections) J cer~lty under penBl[X ol]a~ [nqc l navepe[sonaj~LexmmlnqqOqd{m lamJllar.~it~ the )nformat]on Submitted in this ~nd all ~ttached documents, an~ t~at DOSED on.my inquiry g~.cnose ~noiv]aua/s responsio/e for obtaining the ]ntormatlon. i believe that the ~bm~tted information Is true, accurate, and complete. FIRE OEPA?TMEiu7 £'2'~ - STREET O S NEEDHAM $.~KEFSF;ELC. 93301 FIRE C~iEF i ,'~ 226-39~ ~ Dear Businest Enclosed Dlea ~nse to the Hazardous Material Man~ _~uest. We have found it necessary to ~.Lan for the f611owing reason(s) as checked below. ~ Illegible Management Plan (Dlease print or t¥~e information). ~ Section(s) of HMMP incomplete. Inventory Missing or [~'X~Incompleteo /~'~ ~'~ Diagram [/ Missing or Incomplete. This is to be corrected and resubmitted within 30 da~s to: Cit~ of Bakersfield, Fire Department Hazardous Materials Division 2130 G Street Bakersfield, CA 9~301 If additional coDies of any forms are needed they can be ~icked uD from the Hazardous Materials Division at 2130 G Street in person. Since~el~ yours, R~Tph E. Huey Hazardous Materials Coordinator REH/ed Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed F~ - ~-~ Bus~e~ N~e: ~ ~ ~ ~~/~ /~C. Location: ~/~ ~o~ ~~ ~ '' Plan ID # 215-000/2. O ! (Top right comer Business Plan) Station No. ~ Shift ~ Inspector ,,..WCo Adequate Inadequate Verification of Inventory Materials RECEIVED Verification of Quantities [--] 5 19§9 H/iT'.. MAT. DIV. Verification of Location Proper Segregation of Material Comm~n~: ~l-o~eo ~o0 (~ P~~ ~T~-~ ~, ' Verification of MSDS Availability Number of Employees / '7 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: Violations: FD 1652 (Rev. 3-89) ~Vhite-Haz Mat Div. Yellow-Station Copy Pink-Business Office -~' BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERS~E?,D, CA 9330~ EEC£1VEI3 - (8(15)326-3979 DEC 2 ,~ 1987 A,8'd ....... . ..... Io-- 001201 HAZ ARDOLIS MATERI BUSINESS PLAN CAs A AwL2oLE m O RM 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 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 8US. HRS. AFTER 8'I.;S. HRS. SECTION 3: LOCATION OF UTILITY SHUT-OFFS FOR BUSINESS AS A WI{OnE B. ELECTRICAL: j,~a~'t~ ?/~/,'r~% ~"7':o E. LOCK BOX: YES ~~F YES, LOCATION: ~F YES, DOES IT CONTAIN S~TE PLANS? YES / NO MSDSS? YES / NO FLOOR PLANS? YES / N0 KEYS? YES / NO 2A - SECTION 4: PRIVATE RESPONSE TEAM FOR BUSINESS AS A WHOLE SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOP~R BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH INITIAL AND REFRESHER TRAI~ING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS .MATERIALS:.... .................................... ~ NO ~ NO W TH RESPONSE AGENCIES: ..........................YES C. PROPER USE OF SAFETY EQUIPMENT: .................. ~NO ~ NO D. EMERGENCY EVACUATION PROCEDURES: ................. '~N0 E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... ~)NO (~ N0 SECTION ?: HAZARDOUS MATERIAL CIRCLe. NO - NONE DOES YOUR BUSINESS HANDLE HAZARDOUS ~TERIAL IN QUANTITIES LESS THAN 500 POUNDS SOLID, $$ GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED GAS: ...... Y~S' .g I, ~--~¢fw-b~-ibc>7-~/ ,//¢)0~_. , certify that the above information is accurate. I understand that this info~mation 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>IENT 2130 "G" STREET BAKERS]?IELD, CA 93301 OFTiCTAL USE ONLY ID~ BUSINESS NAME: BUS I NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be' returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW 4. Be as BRIEF and CONCISE as possible. " SECTION 1: MITIGATION, PREVENTION~ ABATEME~'F PROCEDL~ES SECTION 2: NOTIFICATION AND EVACUATION PROCEDURES AT THIS L~.'.TT SECTION 3: IIAZARDOUS MATERIALS FOR Ti!IS Ii:tiT ONlY A. Does this Facility Unit contain Hazardous If YES, see B. If NO, continue with SECTION 4. B. Are any of the hazardous materials a bona fide Trade Secret YE~ If No, complete a separate hazardous materials inventory form marked: NON-TRADE SECRETS ONLY (white form ~4A-1) If Yes, complete a hazardous materials inventory form marked: TRADE SECRETS ONLY (~'ello~ form ~4A-2) in addition to the non-trade secret form. List only the trade secrets on' form 4A-2. SECTION 4: PRIVAI"E FIRE PROTECT!O.~ SECTION 8: r~OCATION OF WATER SUPPLY FOR USE BY Ei~GENCY RESPONDERS SECTION 6: LOCATION OF UTILITY SHb~?-OFFS AT THIS U~IT ONLY. A.'~'AT. GAS/PROPANE~ B. ELECTRICAL: ! C. WATER: E, LOCK Br.)X: YES .'~ IF YES, LOC.kT!03.': ~ ' ' ~ :E.~ , "'q .~ISD~ ~9 '?~ ~'~ fF YES, $~TE P~AX~: "'~ / ~..:~ -", , .,OOR .... · ..... YES ,' I) ~ FORH 4A-I Page IIAZARDOUS MATERI ALS' I NVENTORY -- ' IONLY ....... ~ '-{ 2 3 7 8 g ')I)E/ A[:IOUNT AFIO.U. NI' FAClhlTY UHIT ClIE~IG~h OR COMFION HAHE CODE (~UII~E ',XHE: TITLE: 80HATURE~ PATE: AFTER BUS IIRS: :.I~..f~{;Er4CV CfINTACT: TITLEg PIIOHE t BUS IIOURS: t~l~{~;l{'~l, IIIJS{HEgS ACTIVITY: AFTER BUS. I{RS: